REVIEW  CAROTID DISEASE Editor’s choice • Free access

International Angiology 2019 December;38(6):451-65

DOI: 10.23736/S0392-9590.19.04267-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Global perspective on carotid intima-media thickness and plaque: should the current measurement guidelines be revisited?

Luca SABA ¹, Ankush JAMTHIKAR ², Deep GUPTA ², Narendra N. KHANNA ³, Klaudija VISKOVIC ⁴, Harman S. SURI ⁵, Ajay GUPTA ⁶, Sophie MAVROGENI ⁷, Monika TURK ⁸, John R. LAIRD ⁹, Gyan PAREEK ¹⁰, Martin MINER ¹¹, Petros P. SFIKAKIS ¹², Athanasios PROTOGEROU ¹³, George D. KITAS ¹⁴, Vijay VISWANATHAN ¹⁵, Andrew NICOLAIDES ¹⁶, Deepak L. BHATT ¹⁷, Jasjit S. SURI ¹⁸ ✉

¹ Department of Radiology, University of Cagliari, Cagliari, Italy; ² Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India; ³ Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India; ⁴ Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, Zagreb, Croatia; ⁵ Brown University, Providence, RI, USA; ⁶ Department of Radiology, Weill Cornell Medicine, New York, NY, USA; ⁷ Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece; ⁸ Department of Neurology, University Medical Center Maribor, Maribor, Slovenia; ⁹ Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA; ¹⁰ Minimally Invasive Urology Institute, Brown University, Providence, RI, USA; ¹¹ Men’s Health Center, Miriam Hospital, Providence, RI, USA; ¹² Unit of Rheumatology, National Kapodistrian University of Athens, Athens, Greece; ¹³ Department of Cardiovascular Prevention and Research, Clinic and Laboratory of Pathophysiology, National and Kapodistrian, University of Athens, Athens, Greece; ¹⁴ R and D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK; ¹⁵ MV Hospital for Diabete, Professor M Viswanathan Diabetes Research Center, Chennai, India; ¹⁶ Vascular Screening and Diagnostic Center, University of Nicosia Medical School, Nicosia, Cyprus; ¹⁷ Brigham and Women’s Hospital Heart, Vascular Center, Harvard Medical School, Boston, MA, USA; ¹⁸ Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA

Carotid intima-media thickness (cIMT) and carotid plaque (CP) currently act as risk predictors for CVD/Stroke risk assessment. Over 2000 articles have been published that cover either use cIMT/CP or alterations of cIMT/CP and additional image-based phenotypes to associate cIMT related markers with CVD/Stroke risk. These articles have shown variable results, which likely reflect a lack of standardization in the tools for measurement, risk stratification, and risk assessment. Guidelines for cIMT/CP measurement are influenced by major factors like the atherosclerosis disease itself, conventional risk factors, 10-year measurement tools, types of CVD/Stroke risk calculators, incomplete validation of measurement tools, and the fast pace of computer technology advancements. This review discusses the following major points: 1) the American Society of Echocardiography and Mannheim guidelines for cIMT/CP measurements; 2) forces that influence the guidelines; and 3) calculators for risk stratification and assessment under the influence of advanced intelligence methods. The review also presents the knowledge-based learning strategies such as machine and deep learning which may play a future role in CVD/stroke risk assessment. We conclude that both machine learning and non-machine learning strategies will flourish for current and 10-year CVD/Stroke risk prediction as long as they integrate image-based phenotypes with conventional risk factors.

KEY WORDS: Ultrasonography; Carotid arteries; Cardiovascular diseases; Stroke