Larger studies are though needed to clarify the prognostic value

Larger studies are though needed to clarify the prognostic value of plaque vascularization detection in asymptomatic patients with non-severe carotid stenosis that are not candidated for surgery. Moreover, the identification Rucaparib research buy and evaluation of plaque angiogenesis may be in the future useful to evaluate the possible effects of therapies aimed to plaque remodeling. “
“The possibility that inflammation may represent an index of plaque vulnerability has brought the

scientific interest to concentrate on the “in vivo” imaging the pathophysiological status of the atheroma, with the goal to identify the more vulnerable ones, to adopt the more adequate preventive strategies as early as possible. Contrast Enhanced Carotid Ultrasonography (CCU) is nowadays a well-established tool for angiogenesis detection in several fields of application, with the principal advantage of ultrasound being a minimally invasive technique that allows “real-time” imaging. Since the first data of 2006, several papers have now described the possibility to identify adventitial vasa-vasorum and neovascularization in carotid plaques,

with a specific pattern of vascularization in acute symptomatic lesions, and Selleckchem MK 2206 thus identifying “plaque activity”. Aim of this work is to describe the state of art of the methodology, to propose practical guidelines for CCU exam to obtain comparable data and to discuss the related clinical implications of plaque vascularization detection. In moderate-to-severe internal carotid artery stenosis, both neurologically

symptomatic and asymptomatic. (a) Advantages in clinical routine: – better Intima–Media-Thickness visualization; CCU first requires the standard, basal exam of carotid plaques, to obtain the “best view” images, mandatory to be documented for further analysis. Ultrasound carotid duplex scanning should be performed with up-to-date OSBPL9 ultrasound equipment, contrast enhanced ultrasound with machine-specific low-Mechanical-Index-software. The same, user defined “machine presets” have to be maintained constant in different examinations, to allow comparisons. (a) Plaque basal assessment After the bolus injection, few seconds are required for the contrast to be carried through the venous system to the pulmonary filter, heart and to the carotid arterial lumen. This time may differ from patient to patient, according to heart rate and ventricular ejection fraction. After the contrast is detected in the carotid axis, few seconds later, mainly during the diastolic cardiac phase, contrast agent may be shown inside the plaques allowing plaque vascularization detection. Microbubbles appear as little echogenic spots rapidly moving within the texture of the atheromatic lesion, easily identifiable in the real-time-motion, and depicting the small microvessels.

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