European Journal of Vascular & Endovascular Surgery
Volume 39, Issue 2 , Pages 125-133, February 2010

Advanced Carotid Plaque Imaging☆

  • L. Hermus

      Affiliations

    • Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    • ,
  • G.M. van Dam

      Affiliations

    • Department of Surgery, Division of Abdominal Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    • ,
  • C.J. Zeebregts

      Affiliations

    • Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    • Corresponding Author InformationCorresponding author. Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. Tel.: +31 503613382; fax: +31 503611745.

Received 18 September 2009; accepted 17 November 2009. published online 23 December 2009.

Abstract 

Treatment of carotid artery stenosis by endarterectomy or stenting can significantly reduce stroke risk. In clinical practice, indication for surgery or stenting is primarily based on the degree of stenosis, but there is growing awareness that pathophysiological features within a vulnerable plaque play a key role in predicting stroke risk. Important molecular processes associated with plaque vulnerability are inflammation, lipid accumulation, proteolysis, apoptosis, angiogenesis and thrombosis. The rapidly emerging field of molecular and functional imaging strategies allows identification of pathophysiological processes in carotid artery stenosis.

We aimed to review the literature regarding the current most promising advanced imaging techniques in carotid artery disease.

Various advanced imaging methods are available, such as high-resolution magnetic resonance imaging (HR-MRI), single photon emission computed tomography (SPECT), positron emission tomography (PET) and near-infrared fluorescence (NIRF). Radionuclide and fluorescent tracers that identify inflammation, apoptosis and proteolysis, such as FDG, MMP probes and Annexin A5, are promising. A combination of activity of molecular processes and detailed anatomic information can be obtained, providing a powerful tool in the identification of the vulnerable plaque. With these developments, we are entering a new era of imaging techniques in the selection of patients for carotid surgery.

Keywords: Atherosclerosis, Carotid artery, Vulnerable plaque, Molecular imaging, Near-infrared fluorescence

Abbreviations: AMA-MoAB, amino malonic acid monoclonal antibody, CCP, cathepsin cysteine protease, CTA, computed tomography angiography, FDG, 18fluorodeoxyglucose, GSM, grey scale median, HR-MRI, high-resolution magnetic resonance imaging, 125I-MCP-1, 125I-monocyte chemotactic protein-1, MNP, magnetic nanoparticle, MMP, matrix metalloproteinases, MRI, magnetic resonance imaging, NIRF, near-infrared fluorescence, PET, positron emission tomography, PS, phosphatidyl serine, PDA, pixel distribution analysis, SPECT, single photon emission computed tomography, 99mTc-IL-2, 99mtechnetium-interleukin-2, TIA, transient ischaemic attack

 

☆ This paper was presented at the XXIII Annual Meeting 3–6 September, 2009, European Society for Vascular Surgery, Oslo, Norway.

PII: S1078-5884(09)00589-9

doi:10.1016/j.ejvs.2009.11.020

European Journal of Vascular & Endovascular Surgery
Volume 39, Issue 2 , Pages 125-133, February 2010

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