{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:04:14Z","timestamp":1779361454366,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["GR-2018-1236686"],"award-info":[{"award-number":["GR-2018-1236686"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Carotid artery stenosis (CAS) is one of the main causes of stroke, and the vulnerability of plaque has been proved to be a determinant. A joint analysis of shear wave elastography, a radiofrequency echo-based wall tracking technique for arterial stiffness evaluation, and of autonomic and baroreflex function is proposed to noninvasively, preoperatively assess plaque vulnerability in asymptomatic CAS patients scheduled for carotid endarterectomy. Methods: Elastographic markers of arterial stiffness were derived preoperatively in 78 CAS patients (age: 74.2 + 7.7 years, 27 females). Autonomic and baroreflex markers were also assessed by means of an analysis of the beat-to-beat fluctuations in heart period and systolic arterial pressure, derived at rest in supine position (REST) and during active standing. Postoperative analysis identified 36 patients with vulnerable plaque (VULN) and 42 with stable plaque (STABLE). Results: Baroreflex sensitivity (BRS) at a respiratory rate decreased during STAND only in VULN patients, being much higher at REST compared to STABLE levels. Autonomic indexes were not helpful in separating experimental conditions and\/or populations. The Young\u2019s modulus (YM) of the plaque was lower in the VULN group than in the STABLE one. Cardiovascular control and elastographic markers were significantly correlated only in VULN patients. A multivariate logistic regression model built combining YM and BRS at the respiratory rate improved the prediction of plaque vulnerability, reporting an area under the ROC curve of 0.694. Conclusions: Noninvasive techniques assessing shear wave elastography and baroreflex control could contribute to the early detection of plaque vulnerability in patients with asymptomatic CAS.<\/jats:p>","DOI":"10.3390\/jcm14020648","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T12:32:52Z","timestamp":1737376372000},"page":"648","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Joint Analysis of Cardiovascular Control and Shear Wave Elastography to Determine Carotid Plaque Vulnerability"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5346-2677","authenticated-orcid":false,"given":"Vlasta","family":"Bari","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"},{"name":"Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3396-6883","authenticated-orcid":false,"given":"Beatrice","family":"Cairo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Gelpi","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabiana","family":"Fancoli","sequence":"additional","affiliation":[{"name":"Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicoletta","family":"Curcio","sequence":"additional","affiliation":[{"name":"3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3171-3348","authenticated-orcid":false,"given":"Giulia","family":"Matrone","sequence":"additional","affiliation":[{"name":"Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4038-5406","authenticated-orcid":false,"given":"Paolo","family":"Righini","sequence":"additional","affiliation":[{"name":"Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Nano","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"},{"name":"Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6720-9824","authenticated-orcid":false,"given":"Alberto","family":"Porta","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"},{"name":"Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7414-642X","authenticated-orcid":false,"given":"Daniela","family":"Mazzaccaro","sequence":"additional","affiliation":[{"name":"Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1001\/jama.2022.4835","article-title":"Incidence of Ischemic Stroke in Patients with Asymptomatic Severe Carotid Stenosis Without Surgical Intervention","volume":"327","author":"Chang","year":"2022","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S1474-4422(21)00359-8","article-title":"Management of atherosclerotic extracranial carotid artery stenosis","volume":"21","author":"Bonati","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1177\/1747493016643552","article-title":"Endarterectomy vs. stenting vs. medical therapy","volume":"11","author":"Spence","year":"2016","journal-title":"Int. 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