Abstract
Background: Improved stroke risk stratification may improve stroke prevention. We aimed to study the value of a novel Doppler method, superb microvascular imaging (SMI), in correlating plaque thickness and evidence of intra-plaque neovascularization with a history stroke and TIA involving any cerebrovascular territory among community residents considered at high stroke risk.Methods: We selected residents aged at least 40 years from the Donghuashi community in China who had at least three stroke risk factors (including a history of stroke or TIA) and carotid plaque thickness of at least 1.5 mm (but without heavy calcification) and no history of carotid endarterectomy or stenting. In this cross-sectional study, each subject underwent carotid plaque examination with standard ultrasound and SMI. SMI evidence of plaque neovascularization was categorized as none or mild (Grade 1) or moderate or marked (Grade 2) and correlated with past history of stroke or TIA.Results: A total of 131 individuals (mean age 69 ± 8 years, 63% male) met the study inclusion criteria. SMI revealed no or mild neovascularization in 74 subjects (56.5%) and moderate or marked neovascularization in 57 subjects (43.5%). Subjects with moderate or marked neovascularization were more likely to have a history of any territory stroke or TIA, 43.9 vs. 17.6% (P = 0.001). Multivariate logistic regression analyses showed a thicker plaque (odds ratio: 2.272, 95% CI: 1.351–3.822, P = 0.002) and a history of stroke or TIA (odds ratio: 4.017, 95% CI: 1.719–9.387, P = 0.001) significantly correlated with evidence of moderate to marked intra-plaque neovascularization.Conclusions: Moderate to marked intraplaque neovascularization detected by SMI was more likely in subjects with a history of any territory stroke or TIA or thicker plaque. This indicates a potential new role of SMI in stratifying future risk of stroke or other arterial disease complications.
Highlights
The prevalence of stroke in China has increased over the past decades, leading to high mortality and severe disability among survivors and indicating a heavy disease burden [1, 2]
Recent studies confirmed a pronounced association between intraplaque neovascularization and plaque vulnerability in terms of increased risk for neovessel rupture, hemorrhage, and inflammation, which is an evident marker of cerebrovascular disease [3, 4]
Several studies have demonstrated that Superb microvascular imaging (SMI) and Contrast-enhanced ultrasound (CEUS) are consistent for the detection of neovascularization in carotid plaques that were verified by histology [10,11,12]
Summary
The prevalence of stroke in China has increased over the past decades, leading to high mortality and severe disability among survivors and indicating a heavy disease burden [1, 2]. Recent studies confirmed a pronounced association between intraplaque neovascularization and plaque vulnerability in terms of increased risk for neovessel rupture, hemorrhage, and inflammation, which is an evident marker of cerebrovascular disease [3, 4]. In some other studies, there was an association between neovascularization and plaque thickness [15, 16] The aim of this communitybased population study was to correlate the clinical history of stroke or TIA with the plaque thickness and degree of intraplaque neovascularization under the detection of SMI in patients considered at high stroke risk. We aimed to study the value of a novel Doppler method, superb microvascular imaging (SMI), in correlating plaque thickness and evidence of intra-plaque neovascularization with a history stroke and TIA involving any cerebrovascular territory among community residents considered at high stroke risk
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