medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-1666medvis-1666Research ArticleСЕРДЦЕ И СОСУДЫHEART AND VESSELSСостояние фиброзной покрышки атеросклеротической бляшки сонных артерий: возможности ультразвуковой диагностики и значение для стратификации риска ишемического инсультаFibrous cap state in carotid atherosclerotic plaque: Ultrasound diagnostic capabilities and implication for ischemic stroke risk stratificationhttps://orcid.org/0000-0001-7026-9417ТиминаИ. Е.TiminaI. E.

Тимина Ирина Евгеньевна – доктор мед. наук, ведущий научный сотрудник отделения ультразвуковой диагностики ФГБУ “НМИЦ хирургии им. А.В. Вишневского” Минздрава России, Москваhttps://orcid.org/0000-0001-7026-9417E-mail: timina68@mail.ru

Irina E. Timina – Doct. of Sci. (Med.), Leading Researcher, Ultrasound Diagnostics Department, A.V. Vishnevsky National Medical Research Center of Surgery, Moscowhttps://orcid.org/0000-0001-7026-9417E-mail: timina68@mail.ru

timina68@mail.ruhttps://orcid.org/0000-0002-7273-6979БалахоноваТ. В.BalakhonovaT. V.

Балахонова Татьяна Валентиновна – доктор мед. наук, профессор, главный научный сотрудник, руководитель лаборатории ультразвуковых методов исследования сосудов Института клинической кардиологии им. А.Л. Мясникова ФГБУ “НМИЦ кардиологии имени академика Е.И. Чазова” Минздрава России, Москваhttps://orcid.org/0000-0002-7273-6979

Tatyana V. Balakhonova – Doct. of Sci. (Med.), Professor, Chief Researcher, Head of the Laboratory of Ultrasound Methods for Vascular Research, A.L. Myasnikov Institute of Clinical Cardiology, National medical research centre of cardiology named after academician E.I. Chazov, Moscowhttps://orcid.org/0000-0002-7273-6979

https://orcid.org/0000-0002-8726-8928ЧечеткинА. О.ChechetkinA. O.

Чечеткин Андрей Олегович – доктор мед. наук, главный научный сотрудник, заведующий лабораторией ультразвуковых исследований института клинической и профилактической неврологии ФГБНУ “Российский центр неврологии и нейронаук”, Москваhttps://orcid.org/0000-0002-8726-8928

Andrey O. Chechetkin – Doct. of Sci. (Med.), Chief Researcher, Head of the Ultrasound Laboratory at the Institute of Clinical and Preventive Neurology, Russian Сenter of Neurology and Neurosciences, Moscowhttps://orcid.org/0000-0002-8726-8928

https://orcid.org/0009-0009-6325-8766ШульгинаЛ. Э.ShulginaL. E.

Шульгина Людмила Эдуардовна – доктор мед. наук, заведующая отделением функциональной и ультразвуковой диагностики ФГБУ “Поликлиника №1” Управления делами Президента Российской Федерации, Москваhttps://orcid.org/0009-0009-6325-8766

Liudmila E. Shulgina – Doct. of Sci. (Med.), Head of the Department of Functional and Ultrasound Diagnostics, Polyclinic №1 of the office of the President of the Russian Federation Moscowhttps://orcid.org/0009-0009-6325-8766

ФГБУ “Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского” Минздрава РоссииРоссияA.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of the Russian FederationRussian FederationФГБУ “ Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова” Минздрава РоссииRussian FederationNational medical research centre of cardiology named after academician E.I. Chazov of the Ministry of Healthcare of the Russian FederationRussian FederationФГБНУ “ Российский центр неврологии и нейронаук”Russian FederationRussian Сenter of Neurology and NeurosciencesRussian FederationФГБУ “Поликлиника №1” Управления делами Президента Российской ФедерацииRussian FederationPolyclinic №1 of the office of the President of the Russian FederationRussian Federation2026011020263033849Copyright © Тимина И.Е., Балахонова Т.В., Чечеткин А.О., Шульгина Л.Э., 20262026Тимина И.Е., Балахонова Т.В., Чечеткин А.О., Шульгина Л.Э.Timina I.E., Balakhonova T.V., Chechetkin A.O., Shulgina L.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/1666Цель

Цель. Систематизировать ультразвуковые признаки различных состояний фиброзной покрышки (ФП) атеросклеротической бляшки сонных артерий, определяющих риск развития ишемического инсульта, на основании анализа морфологических изменений ее поверхности, происходящих при трансформации бляшки в нестабильную.

Содержание

Содержание. В статье обобщены литературные данные и собственный опыт авторов. ФП отделяет липидно-некротическое ядро бляшки от просвета сосуда и наиболее уязвима к повреждению. Ее истончение, разрыв и изъязвление отражают разные состояния дестабилизации бляшки и положены в основу новой классификации риска инсульта Carotid Plaque-RADS. Описаны морфологические особенности каждого состояния, обсуждены пороговые значения толщины ФП и приведены ультразвуковые критерии толстой и тонкой покрышки, ее разрыва и зажившего изъязвления.

Заключение

Заключение. В рутинной практике при ультразвуковом исследовании толщину ФП оценивают качественно по принципу “видно/не видно” без количественного измерения. Ультразвуковое исследование выявляет с высокой точностью разрыв покрышки, а изъязвление с умеренной. Точность диагностики повышают контрастное усиление, трехмерная реконструкция и картирование низких скоростей кровотока. Оценка состояния ФП бляшки в комплексе с определением ее структуры и степени стеноза целесообразна для улучшения стратификации риска и персонализации лечения пациентов.

Objective

Objective. To systematize the ultrasound features of various fibrous cap (FC) states of carotid atherosclerotic plaques that determine the risk of ischemic stroke, based on an analysis of the morphological changes in its surface that occur during plaque destabilization.

Content

Content. This manuscript summarizes data both from literature and the authors' own experience. The FC separates the lipid-necrotic plaque core from the vessel lumen and is the most vulnerable to damage structure. Its thinning, rupture, and ulceration reflect different states of plaque destabilization and underlie the new Carotid Plaque-RADS stroke risk classification. The morphological features of each state are described, the threshold values for FC thickness are discussed. Ultrasound criteria for thick and thin plaque caps, plaque rupture, and healed ulceration are presented.

Conclusion

Conclusion. In routine practice, FC thickness on ultrasound is assessed qualitatively using the “seen/not seen” basis without quantitative measurement. Ultrasound detects cap ruptures with high accuracy and ulcerations with moderate accuracy. Contrast enhancement, three-dimensional reconstruction, and low-velocity blood flow mapping could improve diagnostic accuracy. Assessing the plaque’s FC status together with plaque structure and degree of stenosis is advisable for improving risk stratification and personalizing patient treatment.

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The authors declare that there are no conflicts of interest present.