"In Vivo" Comparison in Human Carotid Atherosclerosis: Plaque Neovascularization

Summary

Atherosclerosis may initiate early in life and takes years to progress. This contrasts to the abrupt coronary or cerebrovascular events occurring following the transition from a stable to an unstable atherosclerotic plaque. The causes of this discontinuity of the disease are complex and probably multiple. There is increasing evidence that, besides inflammation, neovascularisation of atherosclerotic plaques and intra-plaque hemorrhages play an important role in plaque instability ending-up frequently in acute thrombotic occlusion or distal embolisation of athero-thrombotic material associated with heart attack or stroke. Contrast-enhanced Ultrasound, is a bed-side non-invasive technique, which allows to enhance microvascular structures and to visualize the adventitia and intraplaque vascularization. Dynamic contrast-enhanced plaque MRI (DCE-MRI) which has also been evaluated for in vivo detection and quantification of plaque neovascularity. Together with the presence of a large lipid-rich core, thin fibrous cap, positive remodeling and active inflammatory infiltrate, plaque neovascularisation is considered a valid marker of high-risk (or vulnerable) plaque as demonstrated in histopathological studies using microvessel density.

Aim of the study is to assess and validate the value of contrast enhanced ultrasound (CEUS), a bed-side technique, in detecting plaque neovascularisation and compare it with the quantitative assessment by DCE-MRI in carotis atherosclerosis.

A group of 30 patients with asymptomatic carotid atherosclerosis (\> 50% stenosis on Doppler ultrasound) will undergo Carotid Duplex ultrasounds and CEUS. High-resolution plaque MRI and DCE-MRI will be performed in the same patients and will be analyzed by two separate operators blinded to the results of the CEUS in order to detect the efficacy of CEUS when compared with in vivo DCE-MRI, as the standard of reference.

Conditions

• Carotid Artery Disease
• Plaque Neovascularization

Interventions

OTHER

Contrast enhanced ultrasound of the carotid plaque

visual grading of neovessel

OTHER

Dynamic contrast-enhanced carotid plaque MRI

quantitative analysis of gadolinium enchantment in a region of interest

Sponsors & Collaborators

• Ospedale San Giovanni Bellinzona

  lead OTHER

Principal Investigators

• Augusto Gallino, Prof. MD · Ospedale Regionale di Bellinzona e Valli - Ospedale San Giovanni Bellinzona

• Mattia Cattaneo, MD · Ospedale Regionale di Bellinzona e Valli - Ospedale San Giovanni Bellinzona

Study Design

Allocation

NA

Purpose

DIAGNOSTIC

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Max Age

90 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2014-02-28

Primary Completion

2016-04-30

Completion

2016-04-30

Countries

• Switzerland

Study Locations