The expanding indications for virtual histology intravascular ultrasound for plaque analysis prior to carotid
1Department of Radiology, University of Pittsburgh Medical Center Pittsburgh, PA 15213, USA. schirobj@upmc.edu
Insights
Carotid artery stenting (CAS) complications are high. Virtual Histology intravascular ultrasound (VH IVUS) assesses plaque morphology, potentially improving CAS patient selection and outcomes for carotid artery disease.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Interventional Cardiology
Background:
- Carotid artery stenting (CAS) complications, including stroke, are higher than carotid endarterectomy (CEA).
- Current CAS patient selection relies heavily on comorbidities, overlooking plaque morphology.
- Atherosclerotic plaque morphology varies significantly, influencing vulnerability and procedural risk.
Purpose of the Study:
- To review atherosclerotic plaque morphology concepts.
- To discuss Virtual Histology intravascular ultrasound (VH IVUS) for plaque assessment.
- To illustrate VH IVUS application in carotid stenting.
Main Methods:
- Review of existing literature on plaque morphology and VH IVUS.
- Discussion of VH IVUS technology and its interpretation.
- Illustrative examples of VH IVUS in carotid artery stenting.
Main Results:
- Plaque morphology assessment provides crucial information beyond traditional risk factors.
- VH IVUS enables detailed characterization of plaque composition and vulnerability.
- Tailoring CAS based on plaque morphology can potentially mitigate risks.
Conclusions:
- VH IVUS is a valuable tool for assessing carotid plaque morphology.
- Improved patient and plaque selection using VH IVUS may enhance CAS outcomes.
- This approach could establish CAS as a primary treatment for carotid artery disease.
Abstract:
Complications of carotid artery stenting (CAS), including stroke, remain relatively high when compared with carotid endarterectomy (CEA). Current selection criteria for patients undergoing CAS are based predominately on surgical risk related to other comorbidities. Little attention is given to the morphology of the atherosclerotic plaque, although studies have shown that extensive variability exists which confers certain risks for plaque vulnerability. Virtual Histology intravascular ultrasound (VH IVUS) offers a unique method of assessing plaque morphology prior to CAS. Herein, the authors review the concepts of atherosclerotic plaque morphology and discuss the background of VH IVUS and illustrate its use in the carotid system. With selection of the appropriate patient and the appropriate plaque, more favorable outcomes of CAS may be achieved which will solidify its place as a frontline treatment of carotid vascular disease.
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