Background

Neovascularization is a marker of plaque vulnerability that can be assessed noninvasively using contrast-enhanced ultrasound (CEUS). The presence and extent of plaque neovascularization and their relation to cardiovascular risk factors and treatments were assessed in asymptomatic patients with carotid stenosis of intermediate severity and no indication for revascularization.

Methods

Sixty-six patients aged 69 ± 8 years (59% men) were prospectively enrolled. Plaque neovascularization was assessed using CEUS with sulfur hexafluoride contrast in each of the four carotid segments bilaterally (a total of 528 segments). In each plaque, the presence or absence of contrast enhancement was assessed semiquantitatively as CEUS grade 1 (no signal or signal confined to the adventitia and/or shoulder of the plaque) or CEUS grade 2 (signal within the plaque).

Results

Plaques were detectable in 289 of 528 carotid segments (54.7%). CEUS grade 2 was present in at least one plaque in 48 of 66 patients (72.7%) and was not influenced by stenosis severity or morphology. The highest CEUS grade 2 prevalence was observed in patients with diabetes and the lowest in those treated with angiotensin-converting enzyme inhibitors and statins, especially when low-density lipoprotein cholesterol was <100 mg/dL. Patients with multiple CEUS grade 2 plaques (20 of 66 [30%]) had both higher low-density lipoprotein and higher C-reactive protein.

Conclusion

Intraplaque neovascularization is frequent in asymptomatic patients with intermediate carotid stenosis and is more prevalent in those with diabetes. Low-density lipoprotein cholesterol < 100 mg/dL and treatment with angiotensin-converting enzyme inhibitors seem to confer protection from neovascularization, although larger interventional studies are necessary to confirm these data.

中文翻译：

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造影剂检测到的心血管危险因素和药物治疗对颈动脉斑块内新血管形成的影响

背景

新血管形成是斑块易损性的标志，可以使用造影剂增强超声（CEUS）进行无创评估。在无症状的中度颈动脉狭窄无症状且无血运重建迹象的无症状患者中，评估了斑块新血管形成的存在和程度及其与心血管危险因素和治疗的关系。

方法

前瞻性纳入了66名年龄为69±8岁的患者（男性占59％）。使用CEUS评估斑块新血管形成情况，同时在两侧的四个颈动脉节段（共528个节段）中使用六氟化硫造影剂。在每个斑块中，对比增强的存在或不存在以半定量评估为CEUS 1级（无信号或仅限于斑块的外膜和/或肩部）或CEUS 2级（斑块内的信号）。

结果

在528个颈动脉节段中的289个中可检测到斑块（54.7％）。CEUS 2级存在于66例患者中的48例中至少有一块斑块中（72.7％），并且不受狭窄严重程度或形态的影响。在糖尿病患者中观察到CEUS 2级患病率最高，而在使用血管紧张素转换酶抑制剂和他汀类药物治疗的患者中观察到最低，尤其是在低密度脂蛋白胆固醇<100 mg / dL时。具有多个CEUS 2级斑块的患者（66个中的20个[30％]）同时具有较高的低密度脂蛋白和较高的C反应蛋白。

结论

斑块内新血管形成在中度颈动脉狭窄的无症状患者中很常见，在糖尿病患者中更普遍。<100 mg / dL的低密度脂蛋白胆固醇和使用血管紧张素转换酶抑制剂的治疗似乎可以预防新血管形成，尽管需要更大的干预研究来证实这些数据。