Contrast-Enhanced Ultrasound: Identification of Neovascularization Permits Characterization of Vulnerable Carotid Plaques

Objective: Carotid atherosclerotic vascular disease (ASVD) represents an ongoing health problem and is responsible for a significant proportion of all cerebral ischemic events (CIEs). Method: A review of the literature was performed on the application of contrast-enhanced ultrasound (CEUS) to enhance the diagnosis of ASVD and further avoid CIEs. Results: Cerebral ischemic events are those resulting from reduction or cessation of perfusion to localized regions of the brain made manifest by neurological, typically stroke-like, symptoms. Traditional triplex ultrasound evaluation is a reliable and widely established method of identifying carotid ASVD lesions and grading the accompanying degree of focal stenoses and their hemodynamic impact. While this information plays an integral role in determining management of patients with significant carotid ASVD, it is less useful in classifying individual lesions as "vulnerable" or not. Vulnerable lesions are those that, based on their histological and morphological features, predispose a patient to an increased risk of a CIE due to plaque or thrombus embolization. Conclusions: The addition of CEUS to carotid artery diagnostic studies offers new potential in identifying vulnerable plaques and predicting which patients will progress to sequelae associated with a cerebral ischemic event.