Abstract
Purpose: The presence of intraplaque neovascularization has been identified as a factor in unstable plaque. Contrast-enhanced carotid artery ultrasonography has been used for evaluating such neovascularizations. However, it is difficult to define the inflow routes of a contrast agent into carotid artery plaque with conventional 2-dimensional (2D) ultrasonography. We aimed to evaluate the distribution of intraplaque neovascularization with 4-dimensional (4D) contrast-enhanced carotid arterial ultrasonography. Subjects: The study included 29 patients with internal carotid artery stenosis (M:F =26:3, mean age:70.4 years) who were inpatients or outpatients of the Department of Neurology and Gerontology or the Department of Neurosurgery, and who were candidates for carotid endarterectomy. Methods: Four-dimensional contrast-enhanced ultrasonography was performed using the contrast agent Perflubutane prior to the undertaking of a carotid endarterectomy. The presence or absence of inflow of the contrast agent from the intimal side and adventitial side was observed using 2D and 4D modes and compared with the number of neovessels on the luminal side and outer wall side in a 2.5 mm 2 window of a pathological specimen obtained by surgery. Results: The number of neovessels on the intimal side in the pathological specimens was significantly higher in patients with inflow of the contrast agent from the intimal side (14.83±10.06/2.5 mm 2 ) than in those without such inflow (6.60±5.296/2.5 mm 2 ) (p=0.025, Mann-Whitney U test). In addition, the number of neovessels on the medial side in the pathological specimens was significantly higher in patients with inflow from the adventitial side (11.93±8.147/2.5 mm 2 ) than in those without such inflow (5.57±5.585/2.5 mm 2 ) (p=0.036, Mann-Whitney U test). Conclusions: Four-dimensional contrast-enhanced ultrasonography can be used to evaluate the distribution of neovessels in carotid artery plaque.
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