Ultrasound and Carotid Bifurcation Atherosclerosis PDF
Preview Ultrasound and Carotid Bifurcation Atherosclerosis
Ultrasound and Carotid Bifurcation Atherosclerosis Andrew Nicolaides (cid:129) Kirk W. Beach Efthyvoulos Kyriacou Constantinos S. Pattichis Editors Ultrasound and Carotid Bifurcation Atherosclerosis Editors AndrewNicolaides,MS,FRCS, KirkW.Beach,MD,PhD FRCSE,PhD(Hon) DepartmentofSurgeryandBioengineering ImperialCollegeandVascularScreening UniversityofWashington andDiagnosticCentre Seattle,WA,USA London,UK ConstantinosS.Pattichis,PhD EfthyvoulosKyriacou,PhD DepartmentofComputerScience DepartmentofComputerScience UniversityofCyprus andEngineering Nicosia,Cyprus FrederickUniversityCyprus Lemesos,Cyprus ISBN978-1-84882-687-8 e-ISBN978-1-84882-688-5 DOI10.1007/978-1-84882-688-5 SpringerLondonDordrechtHeidelbergNewYork BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressControlNumber:2011942267 #Springer-VerlagLondonLimited2012 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permittedundertheCopyright,DesignsandPatentsAct1988,thispublicationmayonlybereproduced, storedortransmitted,inanyformorbyanymeans,withthepriorpermissioninwritingofthepublishers,or inthecaseofreprographicreproductioninaccordancewiththetermsoflicencesissuedbytheCopyright LicensingAgency.Enquiriesconcerningreproductionoutsidethosetermsshouldbesenttothepublishers. Theuseofregisterednames,trademarks,etc.inthispublicationdoesnotimply,evenintheabsenceofa specificstatement,thatsuchnamesareexemptfromtherelevantlawsandregulationsandthereforefreefor generaluse. Productliability:Thepublishercangivenoguaranteeforinformationaboutdrugdosageandapplication thereofcontainedinthisbook.Ineveryindividualcasetherespectiveusermustcheckitsaccuracyby consultingotherpharmaceuticalliterature. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Foreword Atherosclerotic plaques at the carotid bifurcation are a common problem in individuals over 50 years of age in developed countries. Although most of these plaques produce no ill effects, a small minority produce embolic strokes. Because the carotid bifurcation is easily approached by open surgery and endovascular techniques, invasive treatment of carotid plaques has been widely advocated as a stroke prevention measure. However, whether or not such treatment is justified in asymptomatic patients and how this plaque neutralization should be performed (by carotid endarterectomy or stenting) remain topics of much controversy and debate. Because of the frequency of carotid plaques, these controversies carry enormous financial implications for society and for the physicians performing theseprocedures. This gem of a book addresses all the issues surrounding the natural history and managementofthesecarotidplaques.Itprovidesanup-to-datesummaryofaccurate scientific information about the pathophysiology of carotid plaques, their signifi- cance, and why they remain quiescent or become active. Most importantly, it providesacurrentsummaryofinformationforimagingtechniquesusingultrasound, includingmethods formeasuringcarotidarterialwallchangessuch asIMT, plaque thickness,areaandvolumeusedaspredictorsoffuturecardiovascularevents,mainly myocardialinfarction,andameansofbetterselectionofindividualsforprevention. In addition, it provides cutting edge information on carotid plaque characterization sothatthoseathighriskofproducingstrokescanbeselectedforinvasivetreatment. Inthatway,informationinthisvaluabletextformsthebasisforselectingoutthose patients with high risk plaques so they can be treated invasively while the vast majority of patients with low risk plaques can be treated medically and conserva- tively. This will avoid the absurd and enormously expensive current practice of invasively treating most asymptomatic plaques, a practice which may benefit the physician specialists performing the procedures but certainly does not benefit most patients. Inthisrapidlyadvancingandcontroversialfield which impacts somanyasymp- tomatic individuals and patients, methods for selecting those at increased risk are sorely needed. Although there are glimmers that some methods have prospects for doingso,nonearegenerallyacceptedasbeingdependablyeffective.Sotheexpen- sive and risky practice of treating many patients who do not need treatment continues. This volume provides starting points for those interested in seeing this unmetneedresolved. This book also reviews important current information on the most recent developments in monitoring plaque growth and destabilization or stabilization and regression during medical treatment. Enormous advances have been made in this v vi Foreword arearecently,chieflybecauseofimprovementsinultrasoundimagingtechniquesand the widespread availability of statins. Advances in medical therapy have greatly diminished cardiovascular risk including stroke risk of asymptomatic carotid plaques, raising the real possibility that few if any asymptomatic plaques have to betreatedinvasively.Ofcourse,thislikeotherfutureadvancesinthemanagementof carotidplaquediseasewillhavetobeprovenbyappropriaterandomizedcontrolled trials. This volume will be an essential primer, a must read, for those who are designingandinterpretingsuchtrials,andforallothersinterestedintheprevention of cardiovascular atherosclerotic disease in general as well as the management of carotidbifurcationplaques. FrankJ.Veith Preface Atherosclerosis is a multifactorial and dynamic disease that makes the process of prevention and management highly complex. New methods of ultrasonic imaging have made the noninvasive visualization and assessment of arterial wall changes possible with precise measurements. The latter include the thickness of the intima mediacomplex,estimationoftheseverityofstenosisduetoatheroscleroticplaque, plaque thickness, area and volume, plaque characterization, and evaluation of the hemodynamiceffectsofthestenosisandforcesontheplaque.Theabilitytoassess plaquemorphologyandhenceidentifyhighriskindividualsofferstheadvantageof monitoring plaque stabilization by drug therapies and the development of new therapeuticandprophylacticstrategies,contributingtowardthereductionofcardio- vascular events. During the last two decades, the rapid advancements in imaging technologies,linkedwiththeadvancementsininformationtechnology,havesignifi- cantly improved the objective assessment of carotid plaque morphology. This vol- umeisintendedtoprovideacomprehensiveoverviewofthemostrecentadvancesin ultrasoundimageprocessingandapplicationsonimagesofcarotidplaques,andhow thesemayaffectclinicalmanagement. The book consists of 37 chapters, grouped into 5 parts. Part I discusses the pathophysiology of carotid bifurcation atherosclerosis, related symptomatology, and the controversy over the management of patients with asymptomatic stenosis. Part II covers ultrasound image instrumentation and imaging techniques, including despeckling and ultrasound contrast agents. Part III deals with measurements and imageanalysis.Itincludesintima-mediathickness(IMT),plaquethickness,areaand volume measurements, automated classification of plaques, texture feature extrac- tion, elastography, and plaque motion analysis. Part IV discusses the validated and emergingultrasonic and other biomarkers associated with early atherosclerosis and their value in epidemiological studies and population screening with emphasis on adviceforindividualpersonsintermsofprevention.PartVcoverslateatherosclero- sis,gradingofinternalcarotidstenosis,thesignificanceofhypoechoicplaques,and markers associated with the latter. It includes intravascular ultrasound (IVUS), transcranial Doppler (TCD), and carotid plaque characterization with emphasis on clinicalapplicationssuchastheeffectofstatintherapyandstrokeriskstratification. Itindicateshowmethodsdescribedinprevioussectionscanbeappliedforthebenefit ofthepatient. The book is intended for all those working in the field of atherosclerosis, ultra- soundimaging,andcardiovascularrisk,includingtheclinician,thevascularultraso- nographer,theepidemiologist,themolecularbiologist,thebiomedicalengineer,and the informatics scientist. Furthermore, the book aims to bridge the gap between vii viii Preface researchersandclinicianswhoarekeentoincorporatethelatestresultsofresearchto theirdailypractice. Itishopedthatthisvolumewillprovideaforumforthedisseminationofthemost recent medical and technological advances in the area of ultrasound and carotid bifurcation atherosclerosis, thus facilitating the development of emerging imaging andinformaticstechnologicalsystems,andmedicalstrategiesfortheinvestigationof bothasymptomaticindividualsandpatients. Contents PartI PathophysiologyofAtheroscleroticPlaques 1 StableandVulnerableAtheroscleroticPlaques ................ 3 AlkystisPhinikaridou,YeQiao,andJamesA.Hamilton 2 PathophysiologyofCarotidAtherosclerosis ................... 27 HeatherA.HallandHishamS.Bassiouny 3 VascularHemodynamicsoftheCarotidBifurcation andItsRelationtoArterialDisease.......................... 41 AndreasAnayiotosandYannisPapaharilaou 4 TheProblemwithAsymptomaticCarotidStenosis.............. 53 A.RossNaylor PartII ImagingTechniques 5 PrinciplesofUltrasonicImagingandInstrumentation ........... 67 KirkW.Beach 6 Despeckling............................................. 97 ChristosP.LoizouandConstantinosS.Pattichis 7 VascularUltrasoundImagingwithContrastAgents: CarotidPlaqueNeovascularizationandtheHyperplastic VasaVasorumNetwork ................................... 121 MichalakisA.Averkiou,ChristophorosMannaris, andAndrewNicolaides 8 NonlinearContrastIntravascularUltrasound ................. 137 DavidE.Goertz,MartijnE.Frijlink,NicodeJong, andAntoniusF.W.vanderSteen ix
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