Evaluation of Intima-Media Thickness and Arterial Stiffness as Early Ultrasound Biomarkers of Carotid Artery Atherosclerosis

Carotid atherosclerosis is a major and potentially preventable cause of ischemic stroke. It begins early in life and progresses silently over the years. Identification of individuals with subclinical atherosclerosis is needed to initiate early aggressive vascular prevention. Although carotid plaque appears to be a powerful predictor of cardiovascular risk, carotid intima-media thickness (CIMT) and arterial stiffness can be detected at the initial phases and, therefore, they are considered important new biomarkers of carotid atherosclerosis. There is a well-documented association between CIMT and cerebrovascular events. CIMT provides a reliable marker in young people, in whom plaque formation or calcification is not established. However, the usefulness of CIMT measurement in the improvement of risk cardiovascular models is still controversial. Carotid stiffness is also significantly associated with ischemic stroke. Carotid stiffness adds value to the existing risk prediction based on Framingham risk factors, particularly individuals at intermediate cardiovascular risk. Carotid ultrasound is used to assess carotid atherosclerosis. During the last decade, automated techniques for sophisticated analysis of vascular mechanics have evolved, such as speckle tracking, and new methods based on deep learning have been proposed with promising outcomes. Additional research is needed to investigate the imaging-based cardiovascular risk prediction of CIMT and stiffness.

Automated summary

Carotid atherosclerosis is a major and potentially preventable cause of ischemic stroke, with early detection of subclinical atherosclerosis being crucial for initiating vascular prevention strategies. Carotid intima-media thickness (CIMT) and arterial stiffness are important new biomarkers in the early stages of carotid atherosclerosis, providing reliable markers for cardiovascular risk prediction, particularly in young individuals. Despite the controversy surrounding the usefulness of CIMT measurement in improving cardiovascular risk models, carotid stiffness has been shown to add value to risk prediction based on traditional factors like Framingham risk assessment, especially for those at intermediate cardiovascular risk.