Carotid Plaque Echomorphology and Serum Vascular Endothelial Growth Factor Levels (original) (raw)
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Vascular endothelial growth factor is associated with histological instability of carotid plaques
British Journal of Surgery, 2008
Background Vascular endothelial growth factor (VEGF) promotes events favouring carotid plaque instability: inflammatory chemoattraction, thrombogenesis, and upregulation of matrix metalloproteinases and cell adhesion molecules. The aim of this study was to assess neovascularization, VEGF and its receptors in high-grade stable and unstable carotid plaques. Methods Immunohistochemical staining for CD34, VEGF, VEGF receptor (VEGFR) 1 and VEGFR2 was performed in 34 intact carotid endarterectomy specimens, and compared in sections demonstrating maximal histological instability (cap rupture/thinning) or, if stable, maximal stenosis. Results VEGF staining was increased in 12 unstable compared with 22 stable plaques (median (interquartile range, i.q.r.) plaque score 4·0 (4·0–4·0) versus 3·0 (2·0–3·0); P = 0·002) with upregulation of VEGFR1 (plaque score 4·0 (2·0–4·0) versus 2·0 (1·0–3·0); P = 0·016). In unstable plaques this was associated with increased microvessel density in the cap (medi...
VASA, 2009
Symptomatische Erkrankung der Arteria carotis interna: Zusammenhang zwischen Echostruktur der Plaque und Herz-Kreislaufrisikofaktoren Hintergrund: Bei Patienten mit Veränderungen der Arteria carotis interna (ACI) ist der Schweregrad der Stenose der wichtigste Faktor für die Beurteilung des Risikos, einen Schlaganfall zu erleiden. Diese Studie wurde durchgeführt, um bei Patienten mit ACI Stenosen die Echogenität der Plaques zu erfassen, und diese mit etablierten und "neuen" Herz-Kreislauf-Risikofaktoren und anderen klinischen Merkmalen zu korrelieren. Design: Cross-sectional Studie von aufeinander folgenden Patienten mit signifi kanter (> 50 %) ACI Stenose. Patienten und Methoden: Echostruktur der Karotis-Plaque, Rauchen, Bluthochdruck, Diabetes mellitus, Serum-Lipoprotein (a), Homozystein, Vitamin B12, Folsäure, Gesamtcholesterin, Gesamtcholesterin zu High-Density-Lipoprotein Verhältnis, Triglyceride, C-reaktives Protein, und der Framingham-Risiko-Score wurden bei 124 aufeinander folgenden Patienten (70 asymptomatisch; 54 symptomatisch) mit signifi kanter (> 50 %) ACI-Stenose gemessen. Ergebnisse: Die asymptomatische und die symptomatische Gruppe unterschieden sich nicht in Bezug auf die Geschlechtsverteilung (p = 0,76) und den Schweregrad der Stenose (p = 0,62). Ultraschalldurchlässige Plaques (Typ 1 und 2) waren häufi ger in Patienten mit symptomatischer Erkrankung (p = 0,004, OR = 2,13, 95 % CI = 1,26-3,6). Patienten mit Typ-1-Plaques waren relativ jünger als diejenigen mit Typ-4 (p = 0,02). Keiner der anderen bewerteten Faktoren hatte eine signifi kante Beziehung zu symptomatischer Krankheit oder Art der Karotis-Plaque. Schlussfolgerungen: Neben der Schwere der Karotis-Stenose scheint die Existenz einer ultraschalldurchlässigen Plaque ein wichtiger Faktor bei symptomatischer ACI-Stenose zu sein. Junge Patienten haben die größere Wahrscheinlichkeit, eine ultraschalldurchlässige Plaque zu haben, was auf einen Zusammenhang zwischen Alter und Plaque-Reifung hindeutet. Mean: 39.43 (SD: 43.8) Mean: 45.35 (SD: 41.8) Cholesterol (mg/dL) Mean: 233 (SD: 55.2) Mean: 232 (SD: 48.69) LDL (mg/dL) Mean: 153.5 (SD: 45.5) Mean: 153.27 (SD: 40.53) Triglycerides (mg/dL) Mean: 188.58 (SD: 96.19) Mean: 189.94 (SD: 90.68) HDL (mg/dL) Mean: 41.7 (SD: 11.63) Mean: 41.66 (SD: 10.93) Cholesterol/HDL Mean: 5.86 (SD: 1.67) Mean: 5.88 (SD: 1.82) CRP (μmol/L) Mean: 1.82 (SD: 3.88) Mean: 1.36 (SD: 2.24) Framingham (FHS) score
Plaque Echodensity and Textural Features Are Associated With Carotid Plaque Instability
Journal of Vascular Surgery, 2015
Background: Carotid plaque echodensity and texture features predict cerebrovascular symptomatology. Our purpose was to determine the association of echodensity and textural features obtained from a digital image analysis (DIA) program with histologic features of plaque instability as well as to identify the specific morphologic characteristics of unstable plaques. Methods: Patients scheduled to undergo carotid endarterectomy were recruited and underwent carotid ultrasound imaging. DIA was performed to extract echodensity and textural features using Plaque Texture Analysis software (LifeQ Medical Ltd, Nicosia, Cyprus). Carotid plaque surgical specimens were obtained and analyzed histologically. Principal component analysis (PCA) was performed to reduce imaging variables. Logistic regression models were used to determine if PCA variables and individual imaging variables predicted histologic features of plaque instability. Results: Image analysis data from 160 patients were analyzed. Individual imaging features of plaque echolucency and homogeneity were associated with a more unstable plaque phenotype on histology. These results were independent of age, sex, and degree of carotid stenosis. PCA reduced 39 individual imaging variables to five PCA variables. PCA1 and PCA2 were significantly associated with overall plaque instability on histology (both P [ .02), whereas PCA3 did not achieve statistical significance (P [ .07). Conclusions: DIA features of carotid plaques are associated with histologic plaque instability as assessed by multiple histologic features. Importantly, unstable plaques on histology appear more echolucent and homogeneous on ultrasound imaging. These results are independent of stenosis, suggesting that image analysis may have a role in refining the selection of patients who undergo carotid endarterectomy.
A new method for characterizing carotid plaque: Multiple cross-sectional view echomorphology
Journal of Vascular Surgery, 2003
Purpose: This study compares the ability of computer-derived B-mode ultrasound gray-scale measurements from a single longitudinal view (SLV) versus multiple cross-sectional views (MCSV) to differentiate symptomatic from asymptomatic carotid plaque causing more than 70% stenosis. Method: Seventy-four internal carotid artery (ICA) stenoses (70%-99%; 33 asymptomatic, 41 symptomatic within 3 months) were imaged to obtain the "best" SLV and five to eight MCSV images at 5 mm intervals from the carotid bifurcation. Digitized sonograms were computerized and normalized to the gray scale median (GSM) of blood (0) and vessel adventitia 200). Plaque GSM was determined for each frame (image analysis, MATLAB 5.3). General risk factors for stroke and plaque echogenicity (SLV GSM; minimum MCSV GSM; cross-sectional axial heterogeneity (highest minus lowest MCSV GSM) were determined for each group. Results: Risk factors for stroke were similar in both groups, as was mean SLV GSM: symptomatic, 34 (95% confidence interval [CI], 24.8-43.0), asymptomatic, 43 (CI, 32.6-53.2); P ؍ .1. Minimum MCSV GSM was lower for symptomatic plaque: 7 (CI, 4.2-9.8] vs 18.3 (CI, 12.2-24.5); P ؍ .002. Greater axial GSM heterogeneity was present in symptomatic plaque: 34.5 (CI, 27.2-41.9) vs 16 (CI, 11.0-20.8); P ؍ .0001. Conclusions: MCSV cross-sectional imaging that enables objective assessment of regional plaque echolucency and heterogeneity is more sensitive than SLV sonography for differentiating symptomatic from asymptomatic plaque. (J Vasc Surg 2003;37:778-84.) From the General Infirmary at Leeds. Competition of interest: none.
Plaque echodensity and textural features are associated with histologic carotid plaque instability
Journal of Vascular Surgery, 2016
Background: Carotid plaque echodensity and texture features predict cerebrovascular symptomatology. Our purpose was to determine the association of echodensity and textural features obtained from a digital image analysis (DIA) program with histologic features of plaque instability as well as to identify the specific morphologic characteristics of unstable plaques. Methods: Patients scheduled to undergo carotid endarterectomy were recruited and underwent carotid ultrasound imaging. DIA was performed to extract echodensity and textural features using Plaque Texture Analysis software (LifeQ Medical Ltd, Nicosia, Cyprus). Carotid plaque surgical specimens were obtained and analyzed histologically. Principal component analysis (PCA) was performed to reduce imaging variables. Logistic regression models were used to determine if PCA variables and individual imaging variables predicted histologic features of plaque instability. Results: Image analysis data from 160 patients were analyzed. Individual imaging features of plaque echolucency and homogeneity were associated with a more unstable plaque phenotype on histology. These results were independent of age, sex, and degree of carotid stenosis. PCA reduced 39 individual imaging variables to five PCA variables. PCA1 and PCA2 were significantly associated with overall plaque instability on histology (both P [ .02), whereas PCA3 did not achieve statistical significance (P [ .07). Conclusions: DIA features of carotid plaques are associated with histologic plaque instability as assessed by multiple histologic features. Importantly, unstable plaques on histology appear more echolucent and homogeneous on ultrasound imaging. These results are independent of stenosis, suggesting that image analysis may have a role in refining the selection of patients who undergo carotid endarterectomy.
Journal of Neuroimaging
Background and Purpose: To determine the prognostic value for ischemic stroke or transitory ischemic attack (TIA) of plaque surface echogenicity alone or combined to degree of stenosis in a Swiss multicenter cohort Methods: Patients with ≥60% asymptomatic or ≥50% symptomatic carotid stenosis were included. Grey-scale based colour mapping was obtained of the whole plaque and of its surface defined as the regions between the lumen and respectively 0-0.5, 0-1, 0-1.5, and 0-2 mm of the outer border of the plaque. Red, yellow and green colour represented low, intermediate or high echogenicity. Proportion of red color on surface (PRCS) reflecting low echogenictiy was considered alone or combined to degree of stenosis (Risk index, RI). Results: We included 205 asymptomatic and 54 symptomatic patients. During follow-up (median/mean 24/27.7 months) 27 patients experienced stroke or TIA. In the asymptomatic group, RI ≥0.25 and PRCS ≥79% predicted stroke or TIA with a hazard ratio (HR) of respectively 8.7 p = 0.0001 and 10.2 p < 0.0001. In the symptomatic group RI ≥0.25 and PRCS ≥81% predicted stroke or TIA occurrence with a HR of respectively 6.1 p = 0.006 and 8.9 p = 0.001. The best surface parameter was located at 0-0.5mm. Among variables including age, sex, degree of stenosis, stenosis progression, RI, PRCS, grey median scale values and clinical baseline status, only PRCS independently prognosticated stroke (p = 0.005). Conclusion: In this pilot study including patients with at least moderate degree of carotid stenosis, PRCS (0-0.5mm) alone or combined to degree of stenosis strongly predicted occurrence of subsequent cerebrovascular events. K E Y W O R D S carotid plaque echogenicity, carotid plaque surface, degree of stenosis, duplex ultrasound, stroke This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
European Journal of Vascular and Endovascular Surgery, 2005
Objective. To determine the concentration of tissue factor (TF), tissue factor pathway inhibitor (TFPI) and vascular endothelial growth factor A (VEGF-A) in carotid plaques. Materials and methods. Thirty-eight consecutive patients (20 symptomatic, 18 asymptomatic) undergoing carotid endarterectomy were enrolled into the current study. The concentration of TF, TFPI and VEGF-A in carotid plaque homogenates and blood plasma was measured using enzyme immunoassay. Results. The concentration of TF in carotid plaque homogenates was 60 fold higher than in blood plasma. There were no statistically significant differences between the concentration of TF, TFPI and VEGF-A in symptomatic and asymptomatic plaques. Carotid plaques of diabetic patients contained an increased level of TF and VEGF-A (pZ0.002, pZ0.005). The plaque concentration of VEGF-A was elevated among older patients (pZ0.02). Carotid plaques of non-smokers contained an increased level of TFPI (pZ0.03). The concentration of TF, TFPI and VEGF-A in carotid plaques correlated positively with plasma level of these factors (RZ0.86; p!0.0001; RZ0.91; p!0.0001; RZ0.80; pZ0.001, respectively). A highly positive correlation between concentration of VEGF-A and TF, TFPI in carotid plaques was also observed (RZ0.75; p!0.001; RZ 0.62; p!0.001, respectively). Conclusions. TF, TFPI and VEGF-A concentrations do not differ in atheroma removed from symptomatic and asymptomatic patients but are higher in diabetic patients. There is a highly positive correlation between the level of VEGF-A and TF, TFPI in carotid plaques.
Data in Brief, 2016
Here we provide the correlation among different carotid ultrasound (US) variables to assess echogenicity n standard carotid US and to assess intraplaque neovascularization on contrast enhanced US. We recruited 45 consecutive subjects with an asymptomatic Z50% carotid artery stenosis. Carotid plaque echogenicity at standard US was visually graded according to Gray-Weale classification (GW) and measured by the greyscale median (GSM), a semi-automated computerized measurement performed by Adobe Photoshop s. On CEUS imaging IPNV was graded according to the visual appearance of contrast within the plaque according to three different methods: CEUS_A (1 ¼ absent; 2 ¼present); CEUS_B a three-point scale (increasing IPNV from 1 to 3); CEUS_C a fourpoint scale (increasing IPNV from 0 to 3). We have also implemented a new simple quantification method derived from region Contents lists available at ScienceDirect