Early ultrasound imaging of carotid arteries in the acute ischemic cerebrovascular patients

Summary Background and purpose The early identification of ischemic stroke pathophysiology may lead to different diagnostic and therapeutical strategies. In 1/3 of patients, stroke is related to carotid disease, when a vulnerable plaque evolves with surface rupture and local apposition of highly embolic/thrombotic material. This being a rapidly evolving dynamic process, the value of its early identification may be underestimated. With the diffusion of high-resolution ultrasound equipments, the possibility of identifying these features of plaque vulnerability has become easily available. These plaque characteristics have to be always considered in the patient management, in order to avoid further worsening of neurological conditions or to prevent recurrent events, and to choose the appropriate strategies. Methods Early ultrasonography was performed with high frequency probes (9, 15, 18 MHz) in patients admitted to emergency area for acute ischemic symptomatology from carotid stenosis. Results In 8 patients admitted to the emergency area few hours after the onset of neurological symptoms, we detected peculiar plaque characteristics closely related to the neurological events and at high risk of further embolic events with local thrombosis, surface plaque rupture and carotid floating thrombi. All these cases were successfully submitted to emergency carotid endarterectomy repair. Conclusions Timing of carotid endarterectomy has always been debated in stroke patients’ clinical management, depending on several factors. All imaging techniques contribute to the identification of plaque morphology features, but early admission of stroke patients to the emergency areas and early US have a crucial leading role in detecting plaque rupture and dynamic changes in real-time. Peculiar characteristics of high unstable plaques allow the identification of those lesions at particularly high risk of further embolic events according to their fragile characteristics that may benefit from early surgery.