Purpose: Intraplaque neovascularization is reportedly associated with plaque progression and instability. We aimed to determine whether intraplaque blood flow (IPBF) could be visualized without contrast medium using B-flow ultrasound imaging, and to evaluate the relationship between IPBF and ultrasound findings or clinical significance. Methods: We investigated IPBF in 66 carotid arteries with
≥ 30% area stenosis using B-mode ultrasound imaging with a Logiq s8 ultrasound system (GE) and a linear probe (9L). We assessed characteristics such as signal intensity and plaque uniformity, as well as their relationships with IPBF. Results: We visualized IPBF in 20 funicular and linear lesions with either a straight or a tortuous course. Among them, IPBF was connected with the outside of the vessel in 4 lesions, with the vascular lumen in 4 lesions, and with both sides in 9 lesions. Twenty lesions with IPBF had hypoechoic and heterogeneous plaques more frequently than 46 lesions without IPBF. Lesions with IPBF were symptomatic relatively compared with those without IPBF. Conclusion: B-flow ultrasound imaging could detect IPBF without contrast medium. IPBF was observed more frequently in hypoechoic and heterogeneous plaques, and lesions with IPBF were symptomatic relatively, therefore seemed to indicate plaque instability.
A 82-year-old male presented with trembling of upper right limb. The MRI showed carotid artery stenosis on his left side. He underwent percutaneous carotid artery stenting (CAS) via left transfemoral artery approach. The Angio-Seal
®, which is an arterial closure device was placed after the procedure. A few days after he was discharged, he had started complaining the cold feeling, the numbness and the pain in the rest of his left lower limb. The mobile lesion was observed by ultrasonography at this point. However, one month later, complete occlusion of left common femoral artery was detected by the follow up ultrasonography. Large collagen sponge was successfully removed using endoscopic forceps via retrograde popliteal artery approach and the blood flow was improved of left lower limb. The ultrasonography was found to be useful for distinguishing thromboembolism from collagen sponge.
Background and Purpose: Cerebral artery stenting is an effective treatment of cerebral artery stenosis. However, methods for assessing efficacy and techniques for follow-up imaging still need to be developed. We report the case of a patient with intracranial stenting in the right middle cerebral artery (MCA), and we evaluated the application of transcranial color flow imaging (TC-CFI). Case: A 43-year-old man was admitted to our hospital for left hemiparesis that corresponded to a National Institutes of Health Stroke Scale score of 6. Diffusion magnetic resonance imaging revealed an acute symptomatic brain infarct in the right hemicerebrum. Magnetic resonance angiography (MRA) revealed an occlusion at the right horizontal segment (M1), which caused the infarction. Thrombectomy was performed for the M1 occlusion. Recanalization was achieved, although stenosis of the M1 segment accompanying cerebral artery dissection remained. Balloon percutaneous transluminal angioplasty was performed in the stenosed segment, and a 3.0mm × 21mm NeuroForm Atlas stent was then deployed there. The angiogram indicated complete coverage of the stenotic segment by the stent. The stent appeared as hyperechoic images on two-dimensional images. TC-CFI demonstrated blood flow through the hyperechoic stent. Conclusions: TC-CFI can be considered a quick and effective clinical detection method to evaluate intracranial arterial stenting.