Clinical Review: Ultrasound Evaluation of Atherosclerotic Plaques

Background

Atherosclerosis is the main cause of cardiovascular disease, including coronary heart disease, cerebrovascular disease, and peripheral artery disease. Assessing plaque vulnerability may complement stenosis measurement and improve cardiovascular risk stratification.

Data Highlights

• The presence of carotid plaques is associated with significant 10-year cardiovascular event risk.

• Risk is higher with bilateral carotid plaques or a carotid plaque accompanied by a plaque at the femoral bifurcation.

• A grayscale median of 25 or lower was associated with a significantly greater risk of stroke during carotid stenting.

• Echolucent plaques were associated with a 2.5-fold higher 5-year risk of ipsilateral ischemic stroke in patients with severe asymptomatic carotid stenosis.

Key Findings

• Duplex ultrasound can measure morphological markers associated with plaque vulnerability, including intraplaque hemorrhage, lipid-rich necrotic core, calcification, and neovascularization.

• Plaque ulceration and surface irregularity are associated with structural vulnerability and adverse clinical outcomes.

• Maximum carotid plaque thickness predicts stroke risk independently of stenosis severity.

• Three-dimensional ultrasound detects carotid plaque ulcerations more effectively than two-dimensional ultrasound.

• European vascular guidelines emphasize incorporating plaque morphology into decision-making for asymptomatic patients.

Clinical Implications

Plaque morphology and composition may complement stenosis severity and established clinical variables when stratifying cardiovascular risk. Emerging techniques require further study and standardization, while multiparametric scores require prospective validation and correlation with clinical outcomes before routine clinical use.

Conclusion

Noninvasive ultrasound enables increasingly detailed assessment of atherosclerotic plaque morphology, composition, vulnerability, and progression. Standardized protocols and harmonized Doppler criteria are needed to support reproducibility and consistency across centers.

Related Resources & Content

1. European Society for Vascular Surgery clinical practice guidelines on carotid and vertebral artery disease

2. American Society of Echocardiography recommendations for ultrasound assessment of carotid plaque

3. European Carotid Surgery Trial

4. North American Symptomatic Carotid Endarterectomy Trial

5. American College of Cardiology/American Heart Association primary prevention guideline