Predicting vulnerable carotid plaques by detecting wall shear stress based on ultrasonic vector flow imaging

Area of Science:

• Cardiovascular imaging and diagnostics
• Biomedical engineering
• Vascular biology

Background:

• Carotid plaque vulnerability is a key risk factor for cardiocerebrovascular events.
• Intraplaque neovascularization (IPN) is a critical indicator of carotid plaque vulnerability.
• Accurate assessment of IPN is crucial for risk stratification.

Purpose of the Study:

• To evaluate the utility of ultrasound vector flow imaging (V-flow) in measuring carotid plaque wall shear stress (WSS).
• To determine the correlation between V-flow-derived WSS parameters and the extent of IPN.
• To assess the potential of WSS in predicting plaque vulnerability.

Main Methods:

• 140 patients were categorized into plaque, stenosis, and control groups.
• V-flow was employed to measure average WSS (WSS mean) and maximum WSS (WSS max) at three specific plaque locations.
• Contrast-enhanced ultrasound was performed on 76 patients to quantify IPN and its relationship with WSS.

Main Results:

• WSS max was significantly higher in the stenosis group compared to control and plaque groups at maximum thickness.
• WSS mean was lower in the stenosis group compared to the control group at upstream and downstream segments.
• Plaques with IPN enhancement showed significantly higher WSS values, with WSS max at the thickest part positively correlating with IPN grade (r=0.508).
• WSS max demonstrated superior efficacy over WSS mean in evaluating IPN, with an AUC of 0.7762.

Conclusions:

• V-flow is an effective tool for measuring WSS in carotid plaques.
• WSS max is a promising metric for assessing IPN and holds potential for predicting carotid plaque vulnerability.