Volume 437, 15 October 2025, 133495Author links open overlay panelYingying Liu 1, Xin Fu 1, Xin Ai, Guangyin Li, Chun Wang, Piao Wu, Haizhuo Yu, Shuangquan JiangShow moreHighlights•

Higher carotid IPN grade in CEUS was linked to coronary plaque vulnerability in CAD patients.

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PI, EI, and P/L ratio were higher in vulnerable vs. non-vulnerable coronary plaque groups.

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EI and P/L ratio could be used as a diagnosis marker to assess the coronary artery plaque vulnerability in patients with CAD.

AbstractObjective

The aim of the present study was to evaluate the relationships between carotid intraplaque neovascularization (IPN) measured by contrast-enhanced ultrasound (CEUS) and culprit coronary artery plaque vulnerability evaluated by optical coherence tomography (OCT) in patients with coronary artery disease (CAD).

Methods

A total of 131 participants were divided into the vulnerable coronary plaque (VP) and non-vulnerable coronary plaque (non-VP) group. The plaque vulnerability was determined by OCT. In CEUS, carotid IPN was assessed by semi-quantitative and quantitative evaluation, the carotid plaque with the maximum plaque height (MPH) was used for analysis. Logistic regression was used to assess risk factors of coronary plaque vulnerability.

Results

Patients were classified into VP group (N = 92) and non-VP group (N = 39) according to the features of plaque vulnerability in OCT. In CEUS, the IPN score between the two groups was significant different(P = 0.003). Quantitative analysis of CEUS showed that carotid plaque peak intensity (PI) (28.65 ± 4.21 dB vs. 22.51 ± 3.13 dB, P < 0.001), enhancement intensity (EI) (24.91 ± 4.05 dB vs. 19.20 ± 3.17 dB, P < 0.001), and enhanced intensity ratio of plaque/lumen (P/L ratio) (0.32 ± 0.08 vs. 0.24 ± 0.09, P < 0.001) were higher in VP group than non-VP group. Multivariate logistic regression analyses demonstrated that EI (OR = 1.473, 95 %CI: (1.039–2.086)) and P/L ratio (OR = 1.109, 95 %CI: (1.024–1.2)) were strongly associated with coronary plaque vulnerability.

Conclusion

The CEUS parameters of carotid plaques is correlated with coronary plaque vulnerability. As a non-invasive examination, CEUS may provide valuable information to advance risk stratification and clinical treatment in patients with CAD.

Graphical abstractDownload: Download high-res image (321KB)Download: Download full-size imagePrevious article in issueNext article in issueKeywords

Carotid plaque

Contrast-enhanced ultrasound

Coronary plaque

Optical coherence tomography

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1

These authors contributed equally to this work.

© 2025 The Authors. Published by Elsevier B.V.