Clinical Value Of Contrast-enhanced Ultrasonography In Monitoring The Stability Of Carotid Plaque Before And After Treatment With Monotherapeutic Or Dual Drug Therapy

Objective: Contrast-Enhanced Ultrasonography(CEUS)is used to compare the effects of atorvastatin monotherapeutic and dual drug therapy which combined atorvastatin with aspirin on the stability of carotid plaques,and to investigate the meaning of CEUS in evaluating Arterial plaque stability and the clinical value of monitoring drug efficacy.Methods: The clinical data of patients with arteriosclerosis plaque from December 2018 to December 2020 in the cerebrovascular disease center of our hospital were analyzed,They received medical treatment and came back to our hospital 6 months after the treatment.Inclusion criteria: At least one low echo or mixed echo plaque has a thickness of ≥1.5mm;Exclusion criteria: patients with severe coronary arteriosclerosis,Arrhythmia and cardiac insufficiency;patients with active liver disease;patients with Hemophilia or Thrombocytopenia;patients with active gastrointestinal ulcers;patients who are taking statins or aspirin regularly;Patients who are allergic to Atorvastatin or aspirin and those with contraindications to ultrasound contrast agents.By inclusion and exclusion,88 patients were enrolled with a total of 95 plaques(14patients were lost to follow-up for various reasons).Among the 88 patients,62 were male and 26 were female.The age range ranged from 52 to 77 years,with a mean of(65.00±8.6)years.All patients signed informed consent before examination,all patients were required to undergo contrast-enhanced ultrasound(CEUS)examination.The plaques were divided into two groups:group A(34 cases,grade I and II)and group B(54 cases,grade III and IV)according to semi-quantitative visual grading,and then randomly divided into two groups,the patients were divided into group A1(17 cases),group A2(17cases)and group B1(27 cases),group B2(27 cases).The patients in group A1 and group B1 were treated with Atorvastatin monotherapy.meanwhile the patients of group A2 and group B2 were treated with Atorvastatin and aspirin.The blood biochemical parameters of the four groups were monitored dynamically at admission and 6 months after treatment.The changes of TG,TC and hs-CRP levels were compared among the four groups;Siemens Acuson S3000 ultrasonic diagnostic instrument is equipped with line array probe with ultrasonic enhancement technology,The contrast agent is Sulfur hexafluoride microbubbles(Sonovue),The video recording of the entire procedure is stored on the machine’s hard drive.Before treatment and after 6 months of treatment,the same plaques were routinely re-examined by conventional ultrasound and contrast-enhanced ultrasound,the changes of conventional ultrasound data(including IMT,plaque size and plaque Area),contrast-enhanced ultrasound data(including Peak(p),Time To Peak(TTP),Area Under Curve(AUC),Average Transit Time(MTT)and the visual grading of contrast-enhanced ultrasound were compared before and after treatment.The therapeutic efficacy was evaluated by the improvement of ultrasonic visual grading score.Results:1.Comparison of biochemical indexes among four groupsComparison of triglyceride(TG),total cholesterol(TC)and high-sensitivity C-reactive protein(hs-CRP)in four subgroups before and after treatment:triglyceride level,total cholesterol level and hs-CRP level in 4 groups after treatment were better than that before treatment(P<0.05);after treatment,there was no significant difference in triglyceride levels and TG levels among the four groups(P>0.05),but the hs-CRP levels in the dual drug therapy group after treatment were the same Significantly lower than the monoclonal antibody group,the difference between the groups was obvious(P<0.05).2.Comparison of conventional ultrasound indicators among the four groupsThere was no significant difference in carotid IMT thickness,plaque thickness and plaque area among the four groups before treatment(P>0.05);After treatment,the plaque thickness and area of the four groups decreased to varying degrees compared with that before treatment(P<0.05).The plaque area reduction rate of A2 and B2 groups was significantly higher than that of A1 and B1 groups(P < 0.05),and the plaque thickness and area reduction rate of B2 group was greater than that of A2 group(P<0.05).There was no significant difference in the changes of carotid IMT among the four groups(P>0.05).3.Comparison of improvement rate of plaque grading in four groupsAfter treatment,30 cases and the rate of 73.2% improved in group A and 40 cases and the rate of 74.1% improved in group B.According to the statistical results: there was no significant difference in the improvement of plaque stability between the group A and group B,and the difference was not statistically significant(P>0.05).The comparison between subgroups showed that after 6 months of treatment,the improvement rate of dual drug therapy group(group A2 and group B2)(87.2%)was significantly higher than that of monotherapeutic group(group A1 and group B1)(60.4)(P<0.05).4.Comparison of different plaque angiography parameters among the four groups.Contrast parameter indexes P(%),TTP(s),AUC(%s)and MTT(s)of different plaque types in the four groups were compared.The values of P(%),TTP(s),AUC(%s)and MTT(s)in the two subgroups of group A after treatment were all improved than those before treatment(P<0.05).But the P(%),AUC(%s)values of group A2 after treatment were better than A1(P<0.05).After treatment the p(%),TTP(s),AUC(%s)and MTT(s)values of the two subgroups in group B were absolutely improved than those before treatment(P<0.05).And,the P(%),AUC(%s)values of group B2 were better than those of group B1 after treatment(P<0.05).After treatment,the absolute changes of P(%),AUC(%s)and MTT(s)in group A2 and group B2 were higher than those in group A1 and group B1(P<0.05).Conclusion:1.The dual drug therapy has been shown to be more effective than Atorvastatin alone in treating carotid plaque at any stage,it can effectively reduce the area and range of carotid plaque,reduce the number of neovascularization and increase the stability of carotid plaque,and to be more effective in treating Class III and IV plaques.2.Contrast-enhanced ultrasound has excellent performance in plaque stability assessment,discovery of lateral wall plaques and display of neovascularization within plaques,and is convenient and feasible,which can be used as the preferred imaging method for carotid plaque stability assessment and the efficacy of drug therapy.