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Traditionally, stroke risk stratification has centred on the degree of internal carotid artery stenosis, and the presence of focal neurological symptoms. However, degree of stenosis alone is a relatively poor predictor of future stroke in asymptomatic patients; the Asymptomatic Carotid Surgery Trial highlighting the need to identify a subgroup of asymptomatics that may benefit from intervention. Attempting to define this subgroup has inspired imaging research to identify, in vivo, high-risk plaques. In addition to pre-operative risk stratification of carotid stenosis, contrast enhanced ultrasound (CEUS) may be employed in monitoring response to plaque-stabilising therapies. Unlike most contrast agents used for computed tomography and magnetic resonance imaging, microbubbles used in CEUS remain within the vascular space and can hence be used to study the vasculature. In addition to improving current carotid structural scans, CEUS has potential to add extra information on plaque characteristics. Furthermore, by targeting microbubbles to specific ligands expressed on vascular endothelium, CEUS may have the ability to probe plaque biology. This review describes the current carotid ultrasound examination and the need to improve it, rationale for imaging neovascularisation, use of CEUS to image neovascularisation, microbubbles in improving the structural imaging of plaque, potential problems with CEUS, and future directions.

Original publication

DOI

10.1016/j.ejvs.2009.12.011

Type

Journal article

Journal

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

Publication Date

04/2010

Volume

39

Pages

381 - 387

Addresses

Imperial Vascular Unit, Department of Vascular Surgery, Imperial College London, 4th Floor, Charing Cross Hospital, Fulham Palace Road, London, UK. j.shalhoub@imperial.ac.uk

Keywords

Humans, Carotid Stenosis, Rupture, Neovascularization, Pathologic, Contrast Media, Ultrasonography, Interventional, Risk Assessment, Predictive Value of Tests, Microbubbles, Stroke