# Prevent Unnecessary Carotid Intervention and Stroke using Noninvasive Transcutaneous Ultrasound Thermal Strain Imaging (US-TSI)

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2020 · $644,425

## Abstract

PROJECT SUMMARY
In this application, we seek to develop a transcutaneous ultrasound-induced thermal strain imaging (US-TSI)
probe and protocol for human use and evaluate the ability to quantify the lipid burden in carotid atherosclerotic
plaques (AP) in patients undergoing carotid endarterectomy (CEA). Stroke affects millions in the U.S. each
year. Although progress in the treatment has been made, the mortality rate remains high at ~8-12% within 30
days of a stroke. Surgical interventions such as CEA or stenting help to prevent stroke in a subset of patients
who have significant carotid stenosis. However, only a small fraction of the patients with carotid stenosis
develop symptoms of transient ischemic attack or stroke. Current screening tools are effective at estimating
degree of stenosis and offer some general morphometric information but cannot accurately predict which
lesions are at higher risk of causing symptoms. This leads to questions of which patients with significant carotid
disease need to be treated and the uncertainty results in significant over-treatment of CEA or stenting, which
often results in surgical complications like stroke and myocardial infarction. Post-mortem and ex vivo
studies in the past as well as recent clinical trials strongly suggest that vulnerable carotid AP possess a lipid
rich core (LRC). Noninvasive characterization of AP composition and morphology to identify rupture prone
lesions would be an extremely powerful clinical tool. It offers the potential to reduce morbidity, mortality, and
healthcare costs through early detection of AP with high-risk features. In the carotid alone, noninvasive AP
characterization could help address 650,000+ ischemic strokes attributed to carotid AP in the U.S. annually
while reducing the $30 billion for the treatment and long-term care following stroke as well as reducing the
number of unnecessary carotid interventions. Transcutaneous US-TSI is a promising, noninvasive means of
evaluating the lipids of carotid AP. Our previous cholesterol-fed rabbit study and pilot human subject study
demonstrated that US-TSI identified and quantified percent lipid contents of AP. The current application for
optimizing US-TSI for human use builds logically on this work, which supports a strong scientific premise. The
central hypothesis in this project is that US-TSI can effectively quantify lipid contents of carotid AP in human
subjects. Our long-term goal is to use US-TSI to create carotid triplex sonography (CTS) which will enhance
the current gold standard, carotid duplex sonography (CDS), by allowing for detection of AP composition along
with morphometric measures of stenosis. If successful, US-TSI will change clinical paradigm by improving
patient selection for carotid interventions and the longitudinal follow up of patients with carotid disease.
Furthermore, CTS will also provide a means of evaluating the treatment efficacy of newly developed drugs.
Within the scope of this proposal the centr...

## Key facts

- **NIH application ID:** 9945131
- **Project number:** 1R01HL152023-01
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** KANG KIM
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $644,425
- **Award type:** 1
- **Project period:** 2020-06-15 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9945131

## Citation

> US National Institutes of Health, RePORTER application 9945131, Prevent Unnecessary Carotid Intervention and Stroke using Noninvasive Transcutaneous Ultrasound Thermal Strain Imaging (US-TSI) (1R01HL152023-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9945131. Licensed CC0.

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