Introduction:
Stroke remains a leading cause of death and disability. The reliance on the occurrence of symptoms and degree of stenosis for selecting patients with carotid stenosis for intervention is not ideal because it is often seen that patients with severe stenosis remain asymptomatic while many patients with moderate stenosis experience stroke. Furthermore, the majority of patients are asymptomatic until they experience stroke. It is known that intimal neovascularization flourishes as atherosclerotic disease progresses; however no technique in current use adequately correlates neovascularization to stroke risk.
Objective:
With seed grant support from the Society for Vascular Surgery Foundation we are executing a study based on our hypothesis that Vasovasorum Volume (VVV) measured using CE-3DCDU as a valid tool for mapping stroke risk.
Method:
We are recruiting symptomatic and asymptomatic patients adjudged to have >50% and >70% stenosis respectively on routine duplex ultrasound. Vasovasorum volume is measured using CE-3DCDU in patients who are eligible for carotid endarterectomy. Plaque removed during surgery is marked, decalcified and immunostained with CD34. Thereafter, VVV is measured in the excised plaque using 3D reconstruction histometry. We then evaluate the reliability and accuracy of CE-3DCDU in relation to the histopathology and compare VVV in symptomatic and asymptomatic patients.
Results:
The preliminary study included six patients and the results show that VVV measurement in carotid ultrasound and histopathology is feasible and reproducible (Figures 1 and 2).
Conclusion:
Vasovasorum volume is a promising predictor of stroke risk. By identifying patients who are truly at high risk for stroke, VVV measured by CE-3DCDU will aid precise patient selection for intervention, thus prevent stroke, save lives, limit disability and expend health care resources in an informed manner. The next phase of this project involves the establishment of efficacy and a population based multi-center clinical trial to generate evidence required to incorporate VVV measured using CE-3DCDU into clinical practice.
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