Carotid Artery Disease Clinical Trial
Official title:
Plaque Neovascularization Assessment by Contrast Ultrasounds and Plaque Magnetic Resonance: "in Vivo" Comparison in Human Carotid Atherosclerosis
Atherosclerosis may initiate early in life and takes years to progress. This contrasts to the
abrupt coronary or cerebrovascular events occurring following the transition from a stable to
an unstable atherosclerotic plaque. The causes of this discontinuity of the disease are
complex and probably multiple. There is increasing evidence that, besides inflammation,
neovascularisation of atherosclerotic plaques and intra-plaque hemorrhages play an important
role in plaque instability ending-up frequently in acute thrombotic occlusion or distal
embolisation of athero-thrombotic material associated with heart attack or stroke.
Contrast-enhanced Ultrasound, is a bed-side non-invasive technique, which allows to enhance
microvascular structures and to visualize the adventitia and intraplaque vascularization.
Dynamic contrast-enhanced plaque MRI (DCE-MRI) which has also been evaluated for in vivo
detection and quantification of plaque neovascularity. Together with the presence of a large
lipid-rich core, thin fibrous cap, positive remodeling and active inflammatory infiltrate,
plaque neovascularisation is considered a valid marker of high-risk (or vulnerable) plaque as
demonstrated in histopathological studies using microvessel density.
Aim of the study is to assess and validate the value of contrast enhanced ultrasound (CEUS),
a bed-side technique, in detecting plaque neovascularisation and compare it with the
quantitative assessment by DCE-MRI in carotis atherosclerosis.
A group of 30 patients with asymptomatic carotid atherosclerosis (> 50% stenosis on Doppler
ultrasound) will undergo Carotid Duplex ultrasounds and CEUS. High-resolution plaque MRI and
DCE-MRI will be performed in the same patients and will be analyzed by two separate operators
blinded to the results of the CEUS in order to detect the efficacy of CEUS when compared with
in vivo DCE-MRI, as the standard of reference.
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