Carotid Artery Atherosclerotic Profile as a Progression Marker for Cardiovascular Disease

Keywords
Cardiovascular Diseases; Atherosclerosis; Mortality; Coronary Artery Disease; Stroke; Plaque, Atherosclerosis

Conditions directly linked to atherosclerosis are among the main causes of mortality worldwide, notably ischemic stroke and coronary artery disease (CAD).¹ Diagnosing cardiovascular disease or its progression in the early stages, aiming to apply measures that can prevent or delay its progression and subsequent complications is currently a major challenge.² The identification and characterization of atherosclerotic plaques allows the identification of a significant number of patients with low or intermediate risk scores.² Many of these patients would not be identified by the available algorithms for cardiovascular diseases, which could result in the lack of correct management.

The quantification of the carotid artery plaque may be a measure of atherosclerosis, which should be associated with future risk of atherosclerotic cardiovascular disease, encompassing coronary, cerebrovascular, and peripheral arterial diseases.³ It is already known that impaired endothelial function and increased carotid intima-media thickness are substantial events in the atherosclerotic process,^4,5 with imaging of carotid features being used to predict the risk of cardiovascular events.³

Atherosclerosis is a diffuse inflammatory process that affects the arterial intima with extensive lipid deposition, foam cell formation, and vascular smooth muscle cell migration.⁶ The resulting plaque can cause symptoms due to progressive vessel narrowing or small fragment migration.

The diagnosis of carotid atherosclerotic plaque has shifted from pure stenosis quantification to plaque characterization, which allows an improved pathophysiological understanding, and for more precise patient risk stratification and management.³ Measurement of the intima-media thickness (IMT) and the plaque score (PS) – both using carotid ultrasonography - provide information on the extent of structural vascular damage⁵ reflecting a possible coronary heart involvement.

Thus, using ultrasound for the detection and evaluation of atherosclerosis, particularly through carotid plaque assessment, and more recently, femoral plaque assessment, is becoming increasingly utilized in clinical decision-making for both at-risk and prevalent CAD patients.⁷ Nevertheless, limited outcome-based research has confirmed the association between ultrasound-assessed carotid plaque burden and cardiovascular events.⁷

Representing a systemic impairment, the study of carotid plaques provides indirect information about the atherosclerotic profile and also about the greater or lesser risk associated with CAD.⁶

In the article “Carotid artery atherosclerotic profile as risk predictor for restenosis after coronary stenting” the authors go beyond the usual use of carotid images for cardiovascular risk tracking.⁸ By evaluating more than 100 patients undergoing percutaneous coronary intervention, they correlate the presence of echolucent atherosclerotic plaques in the carotid artery with an increased risk of coronary in-stent restenosis. This finding may introduce a new tool in the follow-up of CAD patients and, maybe, influence the decision regarding the type of stent to be implanted in coronary angioplasty.

• Short editorial related to the article: Carotid Artery Atherosclerotic Profile as Risk Predictor for Restenosis After Coronary Stenting

Referências

• ¹
  Corrado E, Camarda P, Coppola G, Muratori I, Ciaramitaro G, Farinella M, et al. Prognostic role of endothelial dysfunction and carotid intima-media thickness in patients undergoing coronary stent implantation. Int Angiol 2009; 28(1):12-9.
• ²
  Zhu G, Hom J, Li Y, Jiang B, Rodriguez F, Fleischmann D, et al. Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2020; 10(4):1048-67.
• ³
  Ojima S, Kubozono T, Kawasoe S, Kawabata T, Miyata M, Miyahara H, et al. Association of risk factors for atherosclerosis, including high-sensitivity C-reactive protein, with carotid intima-media thickness, plaque score, and pulse wave velocity in a male population. Hypertens Res 2020; 43(5):422-30.
• ⁴
  Grubic N, Colledanchise KN, Liblik K, Johri AM. The Role of Carotid and Femoral Plaque Burden in the Diagnosis of Coronary Artery Disease. Curr Cardiol Rep 2020; 22(10):121.
• ⁵
  Moreyra E Jr, Moreyra C, Tibaldi MA, Crespo F, Arias V, Lepori AJ, et al Concordance and prevalence of subclinical atherosclerosis in different vascular territories. Vascular 2020; 28(3):285-94.
• ⁶
  Negrão EM, Freitas MCDNB, Marinho PBC, Hora TF, Montanaro VVA, Martins BJAF, et al. Coronary Calcium Score and Stratification of Coronary Artery Disease Risk in Patients with Atherosclerotic and Non-Atherosclerotic Ischemic Stroke. Arq Bras Cardiol 2020; 115(6):1144-51.
• ⁷
  Daghem M, Bing R, Fayad ZA, Dweck MR. Noninvasive Imaging to Assess Atherosclerotic Plaque Composition and Disease Activity: Coronary and Carotid Applications. JACC Cardiovasc Imaging 2020; 13(4):1055-68.
• ⁸
  Rodrigues CSA, Bazan R, Reis FM, Silveira CFSMP, Hueb LMS, Carvalho FC, et al. Perfil Aterosclerótico da Artéria Carótida como Preditor de Risco para Reestenose após Implante de Stent Coronário. Arq Bras Cardiol. 2021; 116(4):727-733.

Publication Dates

• Publication in this collection
  16 Apr 2021
• Date of issue
  Apr 2021