tailieunhanh - Contrast enhanced ultrasonography and carotid plaque imaging: From the hemodynamic evaluation to the detection of neoangiogenesis

In recent years, even all information about degree of stenosis and plaque morphology is not yet considered enough to recognize lesions at risk. New further concepts regarding functional activities of carotid plaques represent the future target to be investigated, in order to indentify the so called “vulnerable plaques” and, consequently, to avoid the disabling ischemic event. | 10 Contrast Enhanced Ultrasonography and Carotid Plaque Imaging from the Hemodynamic Evaluation to the Detection of Neoangiogenesis - The New Approach to the Identification of the Unstable Plaque from Morphology to Patophysiology Maria Fabrizia Giannoni1 Edoardo Vicenzini2 Claudia Monaco3 and Piergiorgio Cao4 1Vascular Ultrasound Investigation Unit Vascular Surgery Department P. Stefanini Sapienza University of Rome Department of Neurology and Psychiatry Sapienza University of Rome 3Kennedy Institute of Rheumatology Imperial College London 4Vascular Surgery Department of Cardioscience S. Camillo-Forlanini Hospital Rome 1 2 4Italy 3UK 1. Introduction Ischemic Stroke IS represents the third leading cause of death in the Western World and it is particularly relevant because disability is a major frightening issue both for patients quality of life as well as for social and therapeutical implications Engel 1998 . One of the most frequent causes of Ischemic Strokes and Transient Ischemic Attacks TIAs is cerebral embolism that originates from atherosclerotic plaques in the carotid vessels. This Large artery LA pathogenesis accounts for 25-30 of all IS . more than 1 4 million per year worldwide Diener 2004 . In patients with a previous manifested TIA or IS LA atherosclerosis is indeed observed in nearly 70 of the cases. Nonetheless IS is proceeded by a TIA only in half of the patients with carotid atherosclerosis while in the other half Stroke may occur without the former manifestation of symptoms Barnett 1998 . In regards to preventive surgical strategies for carotid artery diseases two major fundamental trials represent a cornerstone in treatment strategy of the carotid Strokes these trials clearly and definitively confirmed the relationship between the risk of neurological events and the degree of the internal carotid artery stenosis. According to data collected from European Carotid Surgery Trial Rothwell 2004 ECST 1991 ECST 1998 and to the North American .