Current status of carotid ultrasound in atherosclerosis

Area of Science:

• Cardiovascular imaging and atherosclerosis research.

Background:

• Cardiovascular disease (CVD) is a leading cause of mortality, often driven by atherosclerosis.
• Sonographic carotid intima-media thickness (CIMT) is a common marker for subclinical atherosclerosis, but lacks standardized measurement, limiting its clinical utility.
• CIMT alone has limited predictive value for CVD; incorporating plaque presence significantly enhances prediction.

Purpose of the Study:

• To highlight the limitations of CIMT in CVD risk prediction.
• To emphasize the enhanced predictive power of carotid plaque assessment.
• To explore the role of advanced ultrasound in identifying high-risk plaques for stroke risk stratification.

Main Methods:

• Review of existing evidence on CIMT and carotid plaque characteristics in CVD risk prediction.
• Discussion of advances in ultrasound technology for plaque assessment.
• Analysis of the impact of plaque quantification and characterization on predictive power.

Main Results:

• Standardized CIMT measurement is lacking, leading to inconsistent findings.
• Carotid plaque presence improves CVD prediction over CIMT alone.
• Quantification of plaque burden and sonographic plaque characteristics further enhance predictive accuracy.
• Advanced ultrasound enables detection of high-risk/vulnerable plaques.

Conclusions:

• Carotid plaque assessment, including burden and characteristics, offers superior CVD and ischemic stroke risk prediction compared to CIMT alone.
• Advanced ultrasound technology facilitates comprehensive carotid plaque evaluation for improved patient risk stratification.
• Standardization of measurement methodologies remains crucial for maximizing the clinical value of carotid ultrasound in atherosclerosis management.