Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2019; 7(7): 839-848
Published online Apr 6, 2019. doi: 10.12998/wjcc.v7.i7.839
Value of superb micro-vascular imaging in predicting ischemic stroke in patients with carotid atherosclerotic plaques
De-Bin Yang, Jie Zhou, Lan Feng, Rong Xu, Ying-Chun Wang
De-Bin Yang, Jie Zhou, Lan Feng, Rong Xu, Ying-Chun Wang, Department of Ultrasonic Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201800, China
Author contributions: Yang DB, Zhou J, Feng L, Xu R and Wang YC contributed to the manuscript design and manuscript writing; All authors approved the final version of the manuscript.
Supported by Shanghai Jiading District Health and Family Planning Commission Health Planning Commission Scientific Research Project, No. KYXM, 2015-KY-02.
Institutional review board statement: The study was approved by the ethics committee of Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ying-Chun Wang, MD, Chief Doctor, Department of Ultrasonic Imaging, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No. 1 Chengbei Road, Shanghai 201800, China. wangyingchun4478@163.com
Telephone: +86-21-67073318
Received: January 16, 2019
Peer-review started: January 16, 2019
First decision: March 10, 2019
Revised: March 14, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: April 6, 2019
Abstract
BACKGROUND

Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke. Contrast-enhanced ultrasound (CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging (SMI) offers the possibility of clinically screening for unstable plaque

AIM

To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.

METHODS

Patients with carotid atherosclerotic plaques (luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication. The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not. Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.

RESULTS

In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level (P = 0.013) and enhancement intensity (P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity (r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level II, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and 89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually (X2 = 108.931, P = 0.000).

CONCLUSION

SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.

Keywords: Superb micro-vascular imaging, Contrast-enhanced ultrasound, Carotid atherosclerotic plaques, Ischemic stroke

Core tip: Unstable carotid plaques are easily ruptured leading to the occurrence of ischemic stroke. Contrast-enhanced ultrasound is currently the primary means of assessing plaque stability, but it cannot be used for screening for unstable plaques. Superb micro-vascular imaging is able to check for low-speed blood flow in the plaque and is expected to be a screening tool for unstable plaques. This study found that superb micro-vascular imaging shows promise in predicting ischemic stroke.