Korean Circ J.  2017 Jan;47(1):1-8. 10.4070/kcj.2016.0232.

Is Carotid Artery Ultrasound Still Useful Method for Evaluation of Atherosclerosis?

• Kim GH
• Youn HJ

• KMID: 2365273
• DOI: http://doi.org/10.4070/kcj.2016.0232

Abstract

Carotid ultrasound is an imaging modality that allows non-invasive assessment of vascular anatomy and function. Carotid intima-media thickness (IMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. However, in 2013, American College of Cardiology/American Heart Association guidelines designated that the carotid IMT as class III evidence level was not recommended for use in clinical practice as a routine measurement of risk assessment for a first atherosclerotic CV event. Following the announcement of this guideline, combined common carotid IMT and plaque, including plaque tissue characterization and plaque burden, using 3D ultrasound was reported to be better than either measurement alone in a variety of studies. Moreover, changes in the intima thickness were related to aging and early atherosclerosis, and remodeling of the media thickness was associated with hypertension. Separate measurement is useful for evaluating the effects of different atherosclerotic risk factors on the arterial wall; however, a more detailed and elaborate technique needs to be developed. If so, separate measurement will play an important role in the assessment of atherosclerosis and arterial wall change according to a variety of risk factors, such as metabolic syndrome. In addition, although carotid blood flow velocity is a useful tool for risk classification and prediction in clinical practice, further clinical research is needed. The value of carotid IMT by ultrasound examination for risk stratification remains controversial, and groups developing future guidelines should consider the roles of plaque presence and burden and hemodynamic parameters in additional risk stratification beyond carotid IMT in clinical practice.

Keyword

Carotid artery; Carotid atherosclerosis; Carotid artery plaque

MeSH Terms

Aging
Atherosclerosis*
Blood Flow Velocity
Carotid Arteries*
Carotid Artery Diseases
Carotid Intima-Media Thickness
Carotid Stenosis
Classification
Heart
Hemodynamics
Hypertension
Methods*
Risk Assessment
Risk Factors
Ultrasonography*

Figure

• 

  Fig. 1 The double line pattern and separate measurement of carotid intima-media thickness. Carotid IMT is defined as the distance between the luminal border of the intima and the outer border of media of carotid artery far wall on a B-mode ultrasound image. (A) True longitudinal plane simultaneously demonstrating double lines on the near and far walls of the common carotid artery. (B) Separately IMT, MT, and IT measured on far walls of the common carotid artery. IMT: intima-media thickness, MT: media thickness, IT: intima thickness. Modified with permission from Kim et al.21)

• 

  Fig. 2 Comparison of HEIT and IT. (A-C) Normotensive rats. (D-F) Spontaneously hypertensive rats SHR. (A) Measurement of HEIT and IMT on UBM images in normotensive rats. Red arrow indicates HEIT, and blue arrow indicates IMT. (B) The thin layer of endothelial cells is shown at the intimal area of the carotid artery. (C) Example of the thin layer of intima stained with MT staining. (D) Measurement of HEIT and IMT on UBM images in SHR. (E) The thick layer of endothelial cells is shown at the intimal area of the carotid artery. (F) Example of a thickened intimal layer with endothelial cells is shown with MT staining. HEIT: high-echogenic intimal thickening, IT: intimal thickness, IMT: intima-media thickness, MT: Masson's trichrome, UBM: ultrasound biomicroscope, SHR: spontaneously hypertensive rat.

• 

  Fig. 3 Variable tissue characterization of carotid plaque. (A) Single or focal plaque on normal common carotid intima-media thickness. (B) Irregular surface plaque on carotid bulb. (C) Diffuse longitudinal and echolucent plaque on common carotid artery. (D) Calcified and heterogeneous plaque on common carotid artery.

• 

  Fig. 4 Example of the image from integrated PET/CT device at transverse image and carotid ultrasonography. (A) Highly 18FDG uptake at left carotid artery. (B) Echolucent plaque was noted at left carotid artery. PET/CT: positron emission tomography-computed tomography.

• 

  Fig. 5 Doppler findings of common carotid artery. PSV: peak systolic velocity, EDV: end-diastolic velocity.

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