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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:169-177 • 0278-4297

Prevalence and Clinical Importance of Spontaneous Echo Contrast Within the Carotid Artery in Patients With Ischemic Cerebrovascular Disease

Hisao Onozuka, MD, Mutsuko Muraki, BS, Taisei Mikami, MD, Tetsuyuki Yoshimoto, MD, Takeshi Yoshizumi, MD, Mayumi Kitaguchi, AA, Tomoko Sugawara, MD, Kohichi Tokuda, MD, Sadao Kaneko, MD, Takeshi Kashiwaba, MD, Satoshi Yamada, MD, Hiroyuki Tsutsui, MD and Akira Kitabatake, MD

Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (H.O., S.Y., H.T.); Kashiwaba Neurosurgery Hospital, Sapporo, Japan (M.M., Te.Y., Ta.Y., M.K., T.S., K.T., S.K., T.K.); Department of Health Sciences, Hokkaido, University School of Medicine, Sapporo, Japan (T.M.); and Caress Sapporo, Sapporo, Japan (A.K.).

Address correspondence to Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan. E-mail: honozuka{at}med.hokudai.ac.jp

Objective. Spontaneous echo contrast (SEC) is composed of numerous microechoes swirling in the cardiovascular lumen, usually appearing during blood stasis. This study aimed to clarify the clinical importance of SEC in the carotid artery (CA) in patients with ischemic cerebrovascular disease (ICVD). Methods. In 264 CAs of 132 consecutive patients with ICVD and in 40 CAs of 20 healthy control subjects, SEC was classified as none, faint, or dense, and CA abnormalities, including plaque, plaque ulcer, mural thrombus, and internal CA stenosis, were assessed with 10-MHz sonography. Results. The overall prevalence of SEC was greater in CAs of patients with ICVD (164/264 [62%]) than in CAs of control subjects (6/40 [15%]; P < .0001). Dense SEC was more specifically detected in CAs of ICVD with the prevalence of 81 (31%) of 264, which was greater than that of controls (1/40 [3%]; P = .0002). Dense SEC was more frequently detected in CAs with plaque (38/98 [39%]) than in those without (43/166 [26%]; P = .0285), in CA plaque with ulcerative lesions (7/10 [70%]) than in those without (31/88 [35%]; P = .0325), in CA plaque with a thrombus (11/12 [92%]) than in those without (27/86 [31%]; P < .0001), and in CAs with severe stenosis (11/13 [85%]) than in those with mild stenosis (25/75 [33%]; P = .0005) and in those without stenosis (45/176 [26%]; P < .0001). Conclusions. Dense SEC was frequently observed in CAs of patients with ICVD, especially in those with local atheromatous lesions, although the influence of systemic factors could not be excluded. Dense SEC within a CA may be a marker of ICVD.

Key Words: carotid artery • ischemic cerebrovascular disease • sonography • spontaneous echo contrast

Abbreviations: CA, carotid artery • HDL, high-density lipoprotein • ICVD, ischemic cerebrovascular disease • LDL, low-density lipoprotein • SEC, spontaneous echo contrast

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.