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Backgroud: The presence of adventitial vasa vasorum and the occurrence of plaque vascularization have been considered as predictors of unstable lesions in cerebrovascular and cardiovascular patients. Contrast-enhanced ultrasound imaging of the carotid arteries (CECU) permits direct, real-time visualization of neovascularization of the presence of atherosclerotic plaques as well as associated adventitial vasa vasorum.The aim of the study was the assessment of a new, automatically measured index of density ROI in quantitative estimation of the contrast flow through the carotid plaque (till now assessed only visually).Materials and methods: we studied 34 patients (mean age 70.4±11.4) with ultrasound diagnosed significant stenosis of internal carotid artery (ICA), after cerebrovascular or cardiovascular events, qualified for carotid artery stenting (CAS). The carotid ultrasound examinations were performed using Philips iE33 ultrasound system with QLAB software to measure ROI. The ultrasound contrast agent Sonovue was used.Results: Visually in 16 patients (47.1%) contrast flow through the atherosclerotic plaque was found. In 17 patients (50%) massive, calcified atherosclerotic plaques were present. Patients with preserved contrast flow through the plaque more frequently had a history of cerebral stroke (p=0.04). There was no relation between the history of ischemic heart disease, previous myocardial infarction, the presence and the progression of atherosclerotic changes in coronary angiography and the degree of calcification of atherosclerotic plaques. Massive calcifications of atherosclerotic plaques correlated with a previous MI (p=0.03), but not with a previous cerebral stroke. Contrast flow through the atherosclerotic plaque significantly positively correlated with ROI values, as an index of density (p<0.00001, r=0.69). In patients with preserved contrast flow the mean value of ROI was 22.24±3.55 dB as compared with 12.37±7.67 dB a value present in patients without preserved contrast flow. No significant relation was found for the degree of cacifications and the value of ROI index.Conclusions: The assessment of ROI index is a simple and automatic method to estimate the degree of contrast flow through the carotid plaque. The values of ROI correlate with the contrast flow through the atherosclerotic plaque, but not with its calcification.