Implication of ultrasound contrast-enhancement of carotid plaques in prevalence of acute coronary syn drome and occurrence of cardiovascular outcomes

Abstract

Purpose: Ultrasonographic contrast enhancement of carotid plaque (CECP) has been used todetect neovascularization of vasa vasorum and plaque. However, it is uncertain whether CECPcan provide risk stratification of coronary artery disease (CAD). This study aimed to evaluate therelationship between CECP and manifestations of acute coronary syndrome (ACS) in establishedCAD patients and to explore the prognostic implication of CECP for cardiovascular (CV) linicaloutcomes.

Methods: A medical record review revealed that contrast-enhanced ultrasonography was per-formed to evaluate carotid atherosclerosis in 209 coronary artery-stented and 105 non-stentedpatients. The rate of ACS manifestations was compared depending on contrast uptake

patterns: grade 0, absent; grade 1, dot; and grade 2, diffuse pattern. CV primary outcomes were assessedduring a mean 7.6 months of follow-up.Results: Male sex, smoking, history of old myocardial infarction, intensive medications, and afavorable lipid profile were common in the stented versus non-stented group. Patients withgrade 2 CECP had a higher rate of ACS, greater plaque thickness, and class I-II of Gray-Wealeplaque echogenicity. During follow-up, 10 coronary revascularizations (nine ACSs), six strokes,and four heart failures occurred. Grade 2 CECP was more closely related with CV primary out-comes and showed a tendency toward more acute CV outcomes.

Conclusion: ACS manifestations were proportionate to CECP grade. Diffuse CECP uptake couldbe a risk factor for acute CV outcomes