Clinical Investigations
Carotid Plaque Imaging and Coronary Artery Disease
Association between Carotid Intraplaque Neovascularization Detected by Contrast-Enhanced Ultrasound and the Progression of Coronary Lesions in Patients Undergoing Percutaneous Coronary Intervention

https://doi.org/10.1016/j.echo.2022.10.012Get rights and content
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Highlights

  • IPN and MPH were correlated with the progression of coronary lesions.

  • IPN of 1.5 was helpful to diagnose the progression of coronary lesions.

  • IPN is a useful tool for restratifying high-risk patients undergoing PCI.

Background

It is thought that the progression of vulnerable plaque is due in part to neovascularization, and plaque vulnerability is a useful approach for classifying cardiovascular risk. The aim of this retrospective study was to evaluate the correlation between carotid intraplaque neovascularization (IPN) detected on contrast-enhanced ultrasound and the progression of coronary lesions in patients undergoing percutaneous coronary intervention (PCI).

Methods

Contrast-enhanced ultrasound and angiography were performed in 131 patients undergoing PCI. All patients had angiograms obtained ≥12 months after PCI, and progression was defined using those angiograms. On the basis of angiographic images, patients were divided into progression and nonprogression groups. IPN was graded from 0 to 3 according to each plaque's microbubble appearance and extent, detected using contrast-enhanced ultrasound. The plaque with the highest IPN was used for analysis. Logistic regression and receiver operating characteristic analyses were applied to evaluate risk factors for predicting the progression of coronary lesions in patients undergoing PCI.

Results

In the progression group, the numbers of patients with IPN values of 0, 1, 2, and 3 were one (3.3%), nine (30.0%), 16 (53.3%), and four (13.3%), respectively. Significant differences were found in maximum plaque height and IPN between groups. IPN and maximum plaque height were independent risk contributors to coronary lesion progression in patients undergoing PCI. The sensitivity, specificity, positive predictive value, and negative predictive value of IPN of 1.5 and to predict the progression of coronary lesions were 67%, 91%, 68%, and 89%, respectively. The area under the curve was 0.822.

Conclusions

Carotid plaque neovascularization was correlated with the progression of coronary lesions in patients undergoing PCI. IPN is a clinically useful tool for detecting the progression of coronary lesions and for risk stratification, especially in patients >60 years old.

Keywords

Carotid plaque
Contrast-enhanced ultrasound
Coronary artery disease
Intraplaque neovascularization
Progression of coronary lesions

Abbreviations

AUC
Area under the curve
CAD
Coronary artery disease
CAG
Coronary angiography
CEUS
Contrast-enhanced ultrasound
IPN
Intraplaque neovascularization
ISR
In-stent restenosis
MPH
Maximum plaque height
N-PRO
Nonprogression
PCI
Percutaneous coronary intervention
PRO
Progression

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Conflicts of interest: None.

Drs. Han and Ren contributed equally to this work.