Current Strategies and Possible Perspectives of Ultrasonic Risk Stratification of Ischemic Stroke in Internal Carotid Artery Disease

Zusammenfassung

Häufige Ursache eines akuten ischämischen Schlaganfalls ist eine atherosklerotische Veränderung der Halsschlagader. Es ist bisher nicht eindeutig geklärt, welche Veränderungen das Risiko eines Schlaganfalls definieren. Mit der stetig verbesserten Qualität von Ultraschalluntersuchungen gelingt es zunehmend, unterschiedliche Veränderungen in atherosklerotischen Plaques darstellen zu können. Sollte auf diesem Wege eine bessere diagnostische Identifizierung von „Risikoplaques” gelingen, so könnte die therapeutische Entscheidung, ob und insbesondere wie eine Karotisstenose behandelt werden muss, in erheblich rationalerer Art erfolgen. In dieser Übersicht werden aktuelle Entwicklungen in der Ultraschalldiagnostik atherosklerotischer Gefäßwandveränderungen insbesondere der Arteria carotis interna beschrieben. Stattgehabte technische Entwicklungen sowie die Rationale der kontrastmittelgestützten Darstellung der Plaque-Neovaskularisation werden vor dem Hintergrund methodischer Limitationen und möglicher weiterer Entwicklungen erläutert.

Abstract

Atherosclerotic alterations of the internal carotid artery frequently result in ischemic stroke. However, it remains unclear which specific factor mainly causes an increased risk of stroke. Constant improvements of the diagnostic possibilities of ultrasonic examinations provide increasingly profound insight into plaque alterations. If ”risk plaque” could be reliably identified, the therapeutic decision for either medical or surgical treatment could be made more rationally. In this review, we summarize current developments in the ultrasound imaging of atherosclerotic changes in carotid artery disease with special emphasis on technical aspects and the rationale of contrast imaging of plaque vascularization. Methodological limitations and possible future applications are discussed.

Key words

carotid arteries - ultrasound color Doppler - microbubbles

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