Abstract
Carotid ultrasound allows rapid and reliable quantification of atherosclerosis in humans. Although the definition of carotid plaque is not uniform, intimal thickening of at least 1.5 mm is currently defined as plaque. Plaque can be easily quantified by tracing the plaque area, a software-independent low-cost technique. More sophisticated quantifications involve 3D volume acquisitions, which is software-dependent and not widely available. Carotid plaque has a higher prognostic impact than intimal thickening, and carotid plaque volume showed comparable prognostic power to coronary calcifications. According to the latest European Joint ESC guidelines, carotid artery scanning should be considered for adjusting the level of risk especially in intermediate-risk subjects. There are various methods to incorporate results from imaging into clinical decision making, such as using arterial age instead of chronological age in risk equations or post-test risk calculations using the sensitivity and the specificity of the results from a given carotid plaque burden. In subjects with low or intermediate cardiovascular risk, the search for atherosclerosis may be appropriate and ultrasound of the carotid or the femoral arteries could be the primary method applied (depending on local expertise). Assessment of carotid total plaque presence, progression, stability and regression over time may be a valuable clinical tool for optimising the intensity of preventive therapies.
Highlights
Whenever illness or injury occurs, the question arises: could it have been prevented?The identification of factors that predict future risk in order to manage and eventually reduce this risk are the subject of extensive ongoing research
We have shown for two populations from the Olten (Switzerland) and Koblenz (Germany) areas that the sensitivity of global risk calculators such as PROCAM and SCORE is low for the detection of advanced carotid atherosclerosis assessed as the total carotid plaque area [9] and the agreement between PROCAM and SCORE with respect to risk category appears to be limited [10]
In 2010, Lorenz reported on the atherosclerosis progression study including 4904 low-risk patients with a follow-up of 10 years and found carotid IMT derived from the common carotid artery, the bulb and the internal carotid artery to be less predictive than the Framingham and SCORE risk models, but only 5% of subjects had carotid plaques [62]
Summary
Carotid ultrasound allows rapid and reliable quantification of atherosclerosis in humans. The definition of carotid plaque is not uniform, intimal thickening of at least 1.5 mm is currently defined as plaque. According to the latest European Joint ESC guidelines, carotid artery scanning should be considered for adjusting the level of risk especially in intermediate-risk subjects. There are various methods to incorporate results from imaging into clinical decision making, such as using arterial age instead of chronological age in risk equations or post-test risk calculations using the sensitivity and the specificity of the results from a given carotid plaque burden. In subjects with low or intermediate cardiovascular risk, the search for atherosclerosis may be appropriate and ultrasound of the carotid or the femoral arteries could be the primary method applied (depending on local expertise).
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