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The histopathology of “symptomatic” plaques has demonstrated some well-documented characteristics linked to plaque rupture and thrombus formation: higher rates of intraplaque hemorrhage, the presence of a lipid-rich necrotic core, thin fibrotic cap with fissuring and ulceration, inflammation and neovascularization. Notably, higher CCA-IMT values together with significant carotid stenosis have been linked to an increased risk of recurrence and poor prognosis after a first non-cardioembolic AIS. It is a priori considered to be an independent predictor of future vascular events and consequently its value predominantly relates to primary prevention of cardiovascular diseases. IMT reflects either an early stage of atherosclerosis or a vascular remodeling in certain conditions that lead to smooth vessel hyperplasia or fibrocellular hypertrophy. Two parallel lines, which consist of the leading edges of two anatomical boundaries, form it: the lumen-intima and media-adventitia interfaces”. Key questions that can be timely answered by ultrasonography, include:Īccording to a recent update of the Manheim consensus criteria, “IMT is a double-line pattern visualized by echography on both walls of the CCA in a longitudinal image. On the other hand, poor reproducibility is the main limitation it is an operator-dependent examination, thus, adequate education and experience of the performer is a prerequisite. Ultrasound of carotid and vertebral arteries (cervical duplex ultrasonography CDU) coupled with transcranial doppler sonography are essential parts of the diagnostic workflow in every acute stroke unit, and has some key advantages: high temporal and spatial resolution, real-time evaluation, low cost, bed side application of an exam that can be repeated multiple times throughout hospitalization without exposing the patient to any serious complications. Ultrasound has evolved for many years into an excellent screening tool for the evaluation of extracranial and intracranial vasculature that can also sufficiently complement other acute imaging modalities like Magnetic Resonance Imaging/Magnetic Resonance Angiography (MRI/MRA) or computed tomography angiography (CT/CTA). According to a recent systematic review and metanalysis of the worldwide distribution and temporal trends of AIS etiologic subtypes, large artery atherosclerosis is the most common subtype in Asian patients and the second most common (responsible for almost 20% of AIS) in white populations.Īssessing etiology and mechanism during the acute phase of an ischemic stroke is crucial in order to tailor and monitor appropriate treatment and determine prognosis. One third of ischemic strokes remain of undetermined cause and a subgroup among them is defined as having embolic strokes of undetermined source (ESUS) following a more granular diagnostic work-up. Major etiologic subtypes of AIS include cardiac embolism, large artery atherosclerosis, small vessel disease and other less common etiologies (i.e., dissection, angiitis, hematological disorders, etc.). The present narrative review outlines all potential applications of CDU in acute stroke management and also highlights its potential therapeutic implications.Īcute ischemic stroke (AIS) remains one of the leading causes of mortality and morbidity worldwide. CDU may also aid the diagnosis of non-atherosclerotic lesions of vessel walls including dissections, arteritis, carotid-jugular fistulas and fibromuscular dysplasias. CDU provides well validated estimates of the type of the atherosclerotic plaque, the degree of stenosis, as well as structural and hemodynamic information directly about extracranial vessels (e.g., subclavian steal syndrome) and indirectly about intracranial circulation. It represents an easily repeatable test that can be performed in the emergency room as a first-line examination of cervical artery pathology. CDU has the advantages of a low cost, easily applicable, bed side examination with high temporal and spatial resolution and without exposing the patients to any significant complications. Cervical Duplex Ultrasound (CDU) has evolved since many years as an excellent screening tool for the evaluation of extracranial vasculature. Assessing ischemic etiology and mechanism during the acute phase of an ischemic stroke is crucial in order to tailor and monitor appropriate treatment and determine prognosis.
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