Contrast-enhanced Ultrasound In Evaluation Of Adventitial Vasa Vasorum Of Atherosclerotic Plaque Response To Resolving Phlegm And Turbidity

ObjectiveIt had found that adventitial vasa vasorum(VV)might be the key factor in the formation of vulnerable plaque.The related results from past topic s showed that the neovascularization affected the stability of the plaque,which resulted in the development of clinical acute events.To serially investigate the relationship between adventitial vasa vasorum proliferati on and plaque progression in carotid plaque,and the effects of resolvin phlegm and turbidity of traditional Chinese medicine on adventitial VV and atherosclerotic plaque as assessed by contrast-enhanced ultrasound(C EUS)imaging.Observing intraplaque neovascularizat-ion especially the adventitial VV in order to explore the possible mecha-nism of stabilizing the atherosclerotic vulnerable plaque.Methods1.The carotid ultrasound examinations of 86 subjects with artery atherosclerotic plaque were analyzed.Following the imaging of carotid arteries by Contrast-enhanced ultrasound(CEUS).The enhanced intensity(EI)of the neovascularization were measured with ACQ software.To correlate echogenicitu of atherosclerotic plaques at stand ultrasound with the degree of the adventitial vasa vasorum enhanced on CEUS.Meanwile the enhanced intensity of the plaque and adventitial vasa vasorum were categorized as grade 1 to grade 3 by visual interpretation and were evaluated by quantitation anyalysis.2.These observations were correlated with history of transient ischemic attack(TIA)/stroke.To determine the different of the plaque thickness,plaque area and plaque echogenicity.TO find out the relations hips between the history of TIA/strok and the plaque thickness,plaque area and plaque echogenicity.Correlated with history of transient ischemic attack(TIA)and stroke event,Including 54 patients with history of TIA/stroke,32 patients without history of TIA/stroke following the imaging of carotid arteries by CEUS.TO find out the relationships between the history of TIA/strok and the EI of adventitial vasa vasorum and intraplaque neovascularization.3.48 carotid atherosclerosis Patients was induced.Following the imaging of carotid arteries by CEUS,48 patients were randomized into Wen dan Capsule group(3g/day)or atorvastatin group(40mg/day)for 12 weeks.At week 12,CEUS were repeated.Each individual was measured the carotid intima-media thickness(IMT),Plaque thickness,plaque area,the density of the adventitial VV network,TG,TC,LDL,and HDL.Results1.The enhanced intensity(EI)of the adventitial vasa vasorum was significantly different between plaques of different echogenicity(soft plaques10.7±3.63dB,mixed plaques8.99±3.61dB,p=0.041).EI of the intrap-laque neovascularization was not significantly different between plaques of different echogenicity(soft plaques8.81 ±3.62dB,mixed plaques7.19±3.71dB,p=0.055).Overall,the EI of the adventitial vasa vasorum was higter than the intraplaque neovascularization,The correlation coefficient was 0.959,P=0.000.Semiquantitative and quantitative analysis of adventitial vasa vasorum:EI was significantly different between grade 1-grade 2,5.18±0.86dB<10.7±1.05dB,p=0.000;grade 2-grade 3,10.7+1±05dB<13.0±3.98d B,p=0.012;grade 1-grade 3,5.18±0.86dB<13.0±3.98dB,p=0.000?Semiquant-itative and quantitative analysis of intraplaque neovascularization:EI was signi-ficantly different between grade 1-grade 2,3.81±0.99dB<8.99±1.41dB,p=0.000;grade 2-grade 3,8.99±1.41dB<11.0±4.21dB,p=0.000;grade 1-grade 3,3.81±0.99dB<11.0±4.21dB,p=0.000.2.Correlation and multivariate analysis for patients with TIA and stroke event on carotid ultrasound data:Correlated analysis of TIA and stroke event risk factors carotid ultrasound data showed that male as well as the presence of plaque area,were all significantly correlated to TIA and stroke event(R=-O.234,p=0.007;R=0.209,p=0.017).Logistic regress-ion analysis showed that male and plaque area were significantly associa-ted with TIA and stroke event(OR=0.422 95%CI 0.198-0.9014,p=0.026;OR=1.015,95%CI 1.002-1.029,p=0.030).Under the Curve of ROC was 0.676(95%CI 0.580-0.772,p=0.001).Correlation and multivariate analysis for patients wi-th TIA and stroke event on CEUS data:EI of adventitial vasa vasorum was correlated to TIA and stroke event(R=0.601,p=0.000).The degree of vasa vasorum on CEUS imaging was more pronounced than in those individuals without syndomes.Logistic regression analysis showed that EI of adventi-tial vasa vasorum was significantly associated with TIA and stroke event(OR=1.762,95%CI 1.383-2.244,p=0.000).Under the Curve of ROC was 0.867(95%CI 0.776-0.958,p=0.000).3.CEUS demonstrated a significantly decreased plaque thickness,plaque area,EI,TG,TC and increased HDL,was significantly greater in the Wendan Capsule group than before(P<0.05).Group atorvastatin had signify-cantly decreased IMT,plaque thickness,plaque area,EI,TG,TC and LDL(P<0.05),while the difference of this two groups has no significance.Conclusion1.Proliferation of the adventitial vasa vasorum(VV)is inherently linked with early atherosclerotic plaque.By providing the direct visuali-zation of adventitial VV,CEUS is capable of depicting the new surrogate markers of atherosclerotic plaque in the adventitial layer as well as intraplaque neovascularization.2.El of adventitial vasa vasorum and intraplaque neovascularization with quantitative analysis significantly associate with Semiquantitative.The two methods provide us to choose meeting clinical purpose.3.Pronounced enhancement of adventitial vasa vasorum and the presence of vasa vasorum derived intraplaque neovascularization on CECU was asso-ciated with established TIA and stroke.Therefore,the use of CECU imaging may provide a noninvasive screen tool to identify patients at high risk of stroke.4.The meathod of resolving phlegm and turbidity can significantly inhibits the development of adventitial VV and progression of atheroscle-rotic plaque.