In their recent article, Yuan et al1 stated that they “highlight the merits and limitations of various imaging techniques for identifying carotid plaque ulceration.” It is curious, therefore, that they made no mention of 3D sonography (3DUS). Although ulceration seen on angiography predicted risk in the North American Symptomatic Carotid Endarterectomy Trial,2 it was clear that imaging of the lumen by angiography was not a reliable way to assess ulceration.3
Schminke et al4 reported that 3DUS was a better way to image ulceration than 2D sonography. In 2011, we reported that the number of carotid ulcers (Fig 1) was as strong a predictor of risk among patients with asymptomatic carotid stenosis; patients with ≥3 ulcers in either carotid artery had a risk equivalent to that of patients with microemboli on transcranial Doppler sonography.5
In 2104, we reported that ulcer volume predicted cardiovascular risk among patients attending cardiovascular prevention clinics (Fig 2).6 It is likely that the best way to image and quantify carotid ulceration is with 3DUS.
Footnotes
Disclosures: J. David Spence—UNRELATED: Other: Dr Spence is an officer of Vascularis Inc.
REFERENCES
- © 2017 by American Journal of Neuroradiology