[Duplex ultrasound in cerebrovascular disease - asymptomatic carotid stenosis]

Area of Science:

• Neurology
• Vascular Surgery
• Medical Imaging

Background:

• Distal embolization from asymptomatic carotid stenosis (ACS) causes many first ischemic strokes.
• Duplex ultrasound is the primary imaging tool for detecting and assessing extracranial carotid stenoses.
• Optimal medical therapy, including lifestyle changes and medications, has reduced stroke rates in ACS patients.

Purpose of the Study:

• To review ultrasound-based and other features of ACS associated with increased ipsilateral stroke risk.
• To explore how morphological characteristics of carotid plaques may identify high-risk ACS patients.
• To discuss the evolving role of interventions in managing ACS in light of improved medical therapies.

Main Methods:

• Review of current literature on duplex ultrasound, B-mode ultrasound, and contrast-enhanced ultrasound in cerebrovascular disease.
• Analysis of studies correlating stenosis severity and plaque morphology with stroke risk in ACS.
• Evaluation of the impact of medical therapy advancements on stroke rates and intervention indications.

Main Results:

• Stroke risk in ACS is influenced by both stenosis severity and plaque morphology.
• B-mode and contrast-enhanced ultrasound features like hypoechogenicity, plaque area, surface irregularities, ulceration, and intraplaque vascularization indicate vulnerable ACS.
• High progression rates of stenosis may also predict increased stroke risk.

Conclusions:

• While medical therapy has improved outcomes, specific ultrasound-identified plaque characteristics can help select ACS patients who may benefit from interventions.
• Morphological assessment via ultrasound provides crucial information beyond hemodynamic criteria for risk stratification in ACS.
• Further research into vulnerable plaque imaging may refine treatment strategies for preventing stroke in ACS patients.