Contrast Ultrasound Imaging of the Carotid Artery Vasa Vasorum and Atherosclerotic Plaque Neovascularization
Steven B. Feinstein, MD, FACC*
Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois
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Figure 1 (A) This image is an example of an unenhanced carotid artery ultrasound image. (B) After an intravenous injection of an ultrasound contrast agent, the carotid artery lumen appears echodense (white) revealing an ulcerative plaque along the far wall. The presence of the ulcer was not clearly defined in the previous unenhanced ultrasound examination.
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Figure 2 (A) The carotid intima-media thickness of the near wall of the carotid artery is not well visualized, limiting measurement. (B) After an intravenous injection of an ultrasound contrast agent, the near-wall carotid intima-media thickness is identified, permitting measurement of the carotid intima-media thickness.
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Figure 3 Ultrasound contrast agents enhance the vessel lumen and reveal the presence of intraplaque angiogenesis, emanating from the adventitial vasa vasorum.
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Figure 4 The presence of intraplaque angiogenesis is highlighted by the use of ultrasound contrast agents. The image was obtained during an ultrasound examination of a patient who had a history of a transient ischemic attack.
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Figure 5 This photomicrograph highlights the abundance of vascular endothelial cells identified within the carotid artery plaque (Fig. 4). This specimen was obtained at the time of carotid artery endarterectomy surgery and was prepared with a CD-31 stain.
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Figure 6 A prominent blood vessel (adventitial vasa vasorum) is readily identified along the near wall of the carotid artery in this 53-year-old man with diabetes. Of note, at the time of these studies, the patient was not on statin therapy.
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Figure 7 After 8 months of statin therapy, the patient (Fig. 6) returned for a follow-up contrast-enhanced carotid ultrasound examination. Note that the adventitial vasa vasorum vessel prominently seen in Figure 6 has been significantly reduced. This may represent regression of the adventitial vasa vasorum after antiangiogenesis therapy with statins.
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