Value of Carotid Intima Thickness in Assessing Advanced Carotid Plaque Vulnerability: a Study Based on Carotid Artery Ultrasonography and Carotid Plaque Histology

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2024 Feb 28

PMID 38415155

Authors

Ya-Chao Zhao

Jia Zhang

Fei Wang

Yi-Ming He

Ming-Jun Xu

Dong-Hai Wang

Mei Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Research has shown that carotid intima-media thickness (CIMT) could help to predict carotid plaque (CP) progression in patients with mild carotid stenosis. However, the debate continues as to the value of carotid intima thickness (CIT) in monitoring the development of CP in patients with severe carotid stenosis. This study sought to evaluate the relationships between CIT and the ultrasonic characteristics of CP and to analyze the value of CIT and the ultrasonic parameters of CP in assessing plaque vulnerability in advanced human carotid atherosclerosis.

Methods: A total of 55 individuals who underwent carotid endarterectomy (CEA) were included in the study (mean age: 65±7 years; female: 9.1%). CIMT and CIT were examined at the common carotid artery (CCA). Plaque textural features, such as the gray-scale median (GSM), superb microvascular imaging (SMI) level, and total plaque area (TPA), were also identified. A Spearman correlation coefficient analysis was performed to examine the relationship between CIT and the ultrasonic parameters of CP. The CIT of various plaque types was compared. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic values of the ultrasound characteristics to evaluate CP vulnerability.

Results: The mean CIT of all the participants was 0.382±0.095 mm, the mean CIT of the participants with stable plaques was 0.328±0.031 mm, and the mean CIT of participants with vulnerable plaques was 0.424±0.106 mm (P<0.001). CIT was associated with the SMI level (Spearman's correlation coefficient: r=0.392, P=0.005), TPA (Spearman's correlation coefficient: r=0.337, P=0.012). Patients with thicker CIT had larger lipid cores, higher levels of plaque vulnerability, and more intraplaque hemorrhages (IPHs). The areas under the ROCs (AUCs) with 95% confidence interval (CI) for CIMT, CIT, the SMI level, the GSM, the TPA, and the combined model for identifying vulnerable plaques were 0.673 (0.533-0.793), 0.849 (0.727-0.932), 0.771 (0.629-0.879), 0.669 (0.529-0.790), 0.858 (0.738-0.938), and 0.949 (0.854-0.990), respectively.

Conclusions: CIT was associated with both the histology and ultrasonic features of CP. CIT may be helpful in the detection of severe CP development.

Citing Articles

Associations of the triglyceride-glucose index and remnant cholesterol levels with the prevalence of Carotid Plaque in patients with type 2 diabetes: a retrospective study.

Xu X, Pan T, Zhong X, Du Y, Zhang D Lipids Health Dis. 2025; 24(1):26.

PMID: 39871275 PMC: 11771029. DOI: 10.1186/s12944-025-02449-1.

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review: Part I-Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients.

Piechocki M, Przewlocki T, Pieniazek P, Trystula M, Podolec J, Kablak-Ziembicka A J Clin Med. 2024; 13(5).

PMID: 38592280 PMC: 10935176. DOI: 10.3390/jcm13051471.

References

Goncalves I, den Ruijter H, Nahrendorf M, Pasterkamp G . Detecting the vulnerable plaque in patients. J Intern Med. 2015; 278(5):520-30. DOI: 10.1111/joim.12414. View

Zhang H, Du J, Wang H, Wang H, Jiang J, Zhao J . Comparison of diagnostic values of ultrasound micro-flow imaging and contrast-enhanced ultrasound for neovascularization in carotid plaques. Exp Ther Med. 2017; 14(1):680-688. PMC: 5488622. DOI: 10.3892/etm.2017.4525. View

Rundek T, Gardener H, Della-Morte D, Dong C, Cabral D, Tiozzo E . The relationship between carotid intima-media thickness and carotid plaque in the Northern Manhattan Study. Atherosclerosis. 2015; 241(2):364-70. PMC: 4509793. DOI: 10.1016/j.atherosclerosis.2015.05.027. View

Semb A, Rollefstad S, Provan S, Kvien T, Stranden E, Olsen I . Carotid plaque characteristics and disease activity in rheumatoid arthritis. J Rheumatol. 2013; 40(4):359-68. DOI: 10.3899/jrheum.120621. View

Sabetai M, Tegos T, Nicolaides A, Dhanjil S, Pare G, Stevens J . Reproducibility of computer-quantified carotid plaque echogenicity: can we overcome the subjectivity?. Stroke. 2000; 31(9):2189-96. DOI: 10.1161/01.str.31.9.2189. View

Du H, Yang W, Chen X . Histology-Verified Intracranial Artery Calcification and Its Clinical Relevance With Cerebrovascular Disease. Front Neurol. 2022; 12:789035. PMC: 8818681. DOI: 10.3389/fneur.2021.789035. View

Hellings W, Peeters W, Moll F, Piers S, van Setten J, van der Spek P . Composition of carotid atherosclerotic plaque is associated with cardiovascular outcome: a prognostic study. Circulation. 2010; 121(17):1941-50. DOI: 10.1161/CIRCULATIONAHA.109.887497. View

Inaba Y, Chen J, Bergmann S . Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis. 2011; 220(1):128-33. DOI: 10.1016/j.atherosclerosis.2011.06.044. View

Xu M, Zhang M, Xu J, Zhu M, Zhang C, Zhang P . The independent and add-on values of radial intima thickness measured by ultrasound biomicroscopy for diagnosis of coronary artery disease. Eur Heart J Cardiovasc Imaging. 2019; 20(8):889-896. DOI: 10.1093/ehjci/jez026. View

10.

Salem M, Bown M, Sayers R, West K, Moore D, Nicolaides A . Identification of patients with a histologically unstable carotid plaque using ultrasonic plaque image analysis. Eur J Vasc Endovasc Surg. 2014; 48(2):118-25. DOI: 10.1016/j.ejvs.2014.05.015. View

11.

Perez H, Garcia N, Spence J, Armando L . Adding carotid total plaque area to the Framingham risk score improves cardiovascular risk classification. Arch Med Sci. 2016; 12(3):513-20. PMC: 4889685. DOI: 10.5114/aoms.2016.59924. View

12.

Kablak-Ziembicka A, Przewlocki T . Clinical Significance of Carotid Intima-Media Complex and Carotid Plaque Assessment by Ultrasound for the Prediction of Adverse Cardiovascular Events in Primary and Secondary Care Patients. J Clin Med. 2021; 10(20). PMC: 8538659. DOI: 10.3390/jcm10204628. View

13.

Virmani R, Kolodgie F, Burke A, Finn A, Gold H, Tulenko T . Atherosclerotic plaque progression and vulnerability to rupture: angiogenesis as a source of intraplaque hemorrhage. Arterioscler Thromb Vasc Biol. 2005; 25(10):2054-61. DOI: 10.1161/01.ATV.0000178991.71605.18. View

14.

Mushenkova N, Summerhill V, Zhang D, Romanenko E, Grechko A, Orekhov A . Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque. Int J Mol Sci. 2020; 21(8). PMC: 7216001. DOI: 10.3390/ijms21082992. View

15.

Finn A, Kolodgie F, Virmani R . Correlation between carotid intimal/medial thickness and atherosclerosis: a point of view from pathology. Arterioscler Thromb Vasc Biol. 2009; 30(2):177-81. DOI: 10.1161/ATVBAHA.108.173609. View

16.

Willeit P, Tschiderer L, Allara E, Reuber K, Seekircher L, Gao L . Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk: Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients. Circulation. 2020; 142(7):621-642. PMC: 7115957. DOI: 10.1161/CIRCULATIONAHA.120.046361. View

17.

Al-Shali K, House A, Hanley A, Khan H, Harris S, Mamakeesick M . Differences between carotid wall morphological phenotypes measured by ultrasound in one, two and three dimensions. Atherosclerosis. 2005; 178(2):319-25. DOI: 10.1016/j.atherosclerosis.2004.08.016. View

18.

Nikic P, Savic M, Jakovljevic V, Djuric D . Carotid atherosclerosis, coronary atherosclerosis and carotid intima-media thickness in patients with ischemic cerebral disease: Is there any link?. Exp Clin Cardiol. 2008; 11(2):102-6. PMC: 2274859. View

19.

Formanowicz D, Krawczyk J, Perek B, Lipski D, Tykarski A . Management of High-Risk Atherosclerotic Patients by Statins May Be Supported by Logistic Model of Intima-Media Thickening. J Clin Med. 2021; 10(13). PMC: 8267973. DOI: 10.3390/jcm10132876. View

20.

Spence J . Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disease. Am J Cardiol. 2002; 89(4A):10B-15B; discussion 15B-16B. DOI: 10.1016/s0002-9149(01)02327-x. View