Tissue Doppler imaging of carotid plaque wall motion: a pilot study

224 normal and diseased carotid arteries (0–100% stenoses) were imaged in 126 patients (age 25–88 years, mean 68 ± 11). Longitudinal sections of the carotid bifurcation were imaged using a Philips HDI5000 scanner and L12-5 probe under optimized TDI settings. Temporal and spatial AWMs were analyzed to evaluate the vessel wall displacements and spatial gradients at peak systole averaged over 5 cardiac cycles.AWM data were successfully extracted in 91% of cases. Within the carotid bifurcation/plaque region, the maximum wall dilation at peak systole ranged from -100 to 750 microns, mean 335 ± 138 microns. Maximum wall dilation spatial gradients ranged 0–0.49, mean 0.14 ± 0.08. The AWM parameters showed a wide variation and had poor correlation with stenoses severity. Case studies illustrated a variety of pertinent qualitative and quantitative wall motion features related to the biophysics of arterial disease.Our clinical experience, using a challenging but realistic imaging protocol, suggests the use of simple quantitative AWM measures may have limitations due to high variability. Despite this, pertinent features of AWM in normal and diseased arteries demonstrate the potential clinical benefit of the biomechanical information provided by TDI.Cardiovascular disease accounts for around half the deaths in the Western world, with stroke being the third leading cause of death and disability worldwide [1]. The predictive ability to identify which patients will have a stroke is poor. Current clinical practice for selecting which patients will have a carotid endarterectomy, to reduce the risk of stroke, relies on assessment of the degree of arterial lumen narrowing. Large European [2] and North American [3] clinical trials have demonstrated the benefit of carotid endarterectomy on groups of patients with severe stenosis. However the degree of stenosis is a poor predictor of individual stroke risk, and treatment of asymptomatic patients remains controversial [4]. Recent studies