# Contrast-enhanced carotid ultrasound improves vulnerable plaque detection in acute central retinal artery occlusion: a propensity score–matched study

## TL;DR

Contrast-enhanced ultrasound improves detection of dangerous carotid plaques in patients with acute eye artery blockage, helping assess stroke risk.

## Contribution

Demonstrates that combining contrast-enhanced ultrasound with conventional methods improves diagnostic accuracy for vulnerable carotid plaques in CRAO patients.

## Key findings

- CRAO patients had significantly more vulnerable carotid plaques than controls (85.5% vs. 21.8%).
- CEUS enhancement score was a key predictor of CRAO when combined with conventional ultrasound parameters.
- The combined model achieved high diagnostic accuracy (AUC = 0.916) for detecting vulnerable plaques.

## Abstract

Central retinal artery occlusion (CRAO) is an ophthalmic emergency that signals a markedly increased risk of ischemic stroke and systemic vascular events. Contrast-enhanced ultrasound (CEUS) offers advanced imaging of carotid plaque vulnerability, but its diagnostic utility in CRAO remains inadequately explored.

To evaluate the diagnostic value of CEUS in identifying vulnerable carotid plaques in patients with acute CRAO.

In this retrospective, propensity score–matched study, 110 patients with acute CRAO and 110 matched healthy controls were enrolled. Matching was performed for age, sex, and key cardiovascular risk factors. All participants underwent standardized carotid duplex ultrasound and CEUS, with plaque vulnerability assessed by intraplaque neovascularization grading. Logistic regression was used to identify independent predictors of CRAO. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.

Compared to controls, CRAO patients had a significantly higher prevalence of vulnerable carotid plaques (CEUS enhancement scores ≥2: 85.5% vs. 21.8%, p < 0.001). Key ultrasound predictors of CRAO included increased intima-media thickness, plaque length, higher peak systolic velocity, resistance index, pulsatility index, and CEUS enhancement score. The combined diagnostic model, integrating both conventional and CEUS parameters, demonstrated superior accuracy (AUC = 0.916) compared to conventional ultrasound (AUC = 0.738) or CEUS alone (AUC = 0.754).

CEUS significantly improves the detection of vulnerable carotid plaques in patients with acute CRAO and, when combined with conventional ultrasound, markedly enhances diagnostic performance. Incorporating CEUS into routine vascular assessment may facilitate better risk stratification and inform personalized secondary prevention strategies for CRAO patients.