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Imaging of the vasa vasorum

Nature Clinical Practice Cardiovascular Medicine volume 5, pages S18–S25 (2008)Cite this article

Abstract

Neovascularization of the arterial walls by adventitial vasa vasorum appears to participate in the process of atherosclerosis progression and destabilization. Although the biological mechanisms associated with plaque instability are still unclear, the uncontrolled formation of intraplaque neovessels appears to contribute to the development of complex atheromatous lesions. Recent reports have described the use of several ultrasound-based techniques for the real-time detection of intraplaque neovascularization. Preliminary studies in animal models have shown that the detection and characterization of adventitial neovascularization are technically feasible. The further development of these imaging techniques relies on the successful implementation of contrast microspheres capable of enhancing microvascular structures. These contrast agents serve as surrogate red blood cells and perform acoustically as true intravascular tracers providing, in real-time, the amount and distribution of neovessels within atherosclerotic lesions. Several ultrasound-based techniques are under development for the detection of adventitial vasa vasorum in the carotid and coronary vascular territories. Although still in early validation phases, these techniques might permit the early diagnosis and stratification of subclinical atherosclerosis, thus permitting aggressive preventive therapy. In the near future, innovative contrast agents using specific ligands are likely to expand the diagnostic and therapeutic possibilities of these emerging imaging techniques.

Key Points

  • Atherosclerotic plaque neovascularization is thought to be key in the process of atherosclerosis progression and destabilization

  • Several ultrasound-based techniques are under development for the detection of atherosclerosis neovascularization in the carotid and coronary territories

  • Preliminary studies in animal models have shown that the detection and characterization of atherosclerotic plaque neovascularization are technically feasible

  • The development of these imaging techniques relies on the further development of contrast microsphere technologies capable of enhancing microvascular structures

  • In the future, ultrasound-based imaging techniques may permit the early diagnosis and stratification of subclinical atherosclerosis, thus permitting aggressive preventive therapy

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Figure 1: The presence of angiogenic neovascular vessels surrounding an atherosclerotic lesion (plaque) in a human coronary artery, as revealed by postmortem cinemicrographic technique.
Figure 2: Contrast-enhanced carotid artery imaging demonstrating the use of automated software for detection and quantitation of the carotid intima-media thickness.
Figure 3: Contrast-enhanced carotid artery imaging showing the contrast-enhanced lumen of the common carotid artery (small white arrow).
Figure 4: Intravascular ultrasound contrast study showing atherosclerotic plaque neovascularization.
Figure 5: Harmonic imaging in a porcine model of atherosclerosis.

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Acknowledgements

The authors wish to acknowledge W Li, T Thomas, TJ Teo (Boston Scientific Corporation, MA) and I Kakadiaris (University of Houston, TX) for editorial comments included in this manuscript.

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Authors and Affiliations

  1. JF Granada is the Medical Director of the Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, New York, NY, USA.,

    Juan F Granada

  2. SB Feinstein is Professor of Medicine and Director of the Echocardiography Laboratory at Rush University Medical Center in Chicago, IL, USA.,

    Steven B Feinstein

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  1. Juan F Granada
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Corresponding author

Correspondence to Steven B Feinstein.

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Competing interests

SB Feinstein has received speakers' honoraria and grant/research support from Takeda Pharmaceutical Company. JF Granada declared no competing interests.

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Granada, J., Feinstein, S. Imaging of the vasa vasorum. Nat Rev Cardiol 5 (Suppl 2), S18–S25 (2008). https://doi.org/10.1038/ncpcardio1157

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