Exclusion of echo-lucent plaque using superb micro-vascular imaging: A case report

Area of Science:

• Vascular imaging techniques
• Carotid artery hemodynamics
• Cerebrovascular disease diagnostics

Background:

• Carotid bulb (CB) morphology can reduce blood flow velocity near the wall, promoting plaque formation.
• Echo-lucent plaques (ELPs) in the CB are a risk factor for cerebral embolism.
• Distinguishing ELPs from slow blood flow using B-mode and color Doppler imaging (CDI) in carotid ultrasonography (CU) can be challenging.

Observation:

• A case presented with a suspected ELP or thrombus in the CB due to a flow void detected by CU with CDI.
• The patient had risk factors for atherosclerosis but no neurological symptoms or signs of cerebral embolization.
• Superb micro-vascular imaging (SMI) was employed for further assessment of the carotid bulb.

Findings:

• SMI successfully visualized extremely low-velocity blood flow near the carotid bulb wall.
• This finding allowed for the exclusion of an ELP that was indistinguishable by CDI.
• The case highlights SMI's capability in detecting subtle blood flow dynamics.

Implications:

• SMI can be a valuable tool when CDI is insufficient to differentiate ELPs from slow flow in the carotid bulb.
• This imaging modality may help avoid more invasive diagnostic procedures.
• Improved characterization of carotid bulb lesions can enhance patient management and reduce risks of cerebral embolism.