Plaque Vulnerability On Contrast-enhanced Carotid Ultrasound And The Association With Stroke Mechanisms In Acute Cerebral Infarction

Objective: To investigate the diagnostic value of contrast-enhanced carotid ultrasound(CEUS)for vulnerable plaques in acute cerebral infarction patients and to analyze its association with stroke mechanisms and relapse,thus providing more evidence for secondary prevention strategy.Method: Patients from Beijing Tiantan hospital,affiliated to Capital Medical University,who suffered from acute cerebral infarction in anterior circulation attributing to intra/extracranial large artery atherosclerosis,were enrolled.Imaging characteristics were evaluated with brain MR and vulnerable plaques were assessed with CEUS within 14 days since the onset of the symptoms.Participants also attended a follow-up after 90±7 days.Logistic regression was used to analyze the relationship between plaque vulnerability and imaging characteristics.ROC curve was used to calculate the diagnostic value.Survival analysis was performed to evaluate the predictive effects of vulnerable plaques on ischemic stroke relapse.Results: Vulnerable plaque was found in 35(37.6%)participants on CEUS and was an independent risk factor of embolization(OR=3.63,95%CI 1.19-11.12,P=0.02),especially in patients without intracranial large artery atherosclerosis(OR=5.67,95%CI 1.36-23.67,P=0.02).Compared to traditional carotid ultrasound,vulnerable plaques on CEUS had medium diagnostic value for embolization infarction(AUC 0.73,P=0.01),indicating artery to artery embolization as the stroke mechanism.When analyzing with single-factor Kaplan-Meier curve,vulnerable plaque on CEUS was also an indicator of stroke relapse within 3 months(P=0.04).Conclusion: For patients with acute cerebral infarction attributing to atherosclerosis,compared to traditional carotid ultrasound,CEUS is more precise when assessing the vulnerability of the plaque.Vulnerable plaque on CEUS is associated with stroke mechanisms and prognosis and may provide more evidence for making appropriate secondary prevention plans.