1
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Zhao Y, Gu Y, Liu Y, Guo Z. Evaluation of the Correlation Between Distribution Location and Vulnerability of Carotid Plaque in Patients with Transient Ischemic Attack. Vasc Health Risk Manag 2024; 20:77-87. [PMID: 38464675 PMCID: PMC10922953 DOI: 10.2147/vhrm.s447418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/25/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose To analyze the relationship among distribution location, characteristics, and vulnerability of carotid plaque using CTA and provide more information on the risk factors of carotid atherosclerotic plaque. Patients and Methods We retrospectively analyzed the CTA images of the head and neck of 93 patients with carotid atherosclerosis. Atherosclerosis was developed in 148 carotid arteries. The plaques were divided into a high-risk plaque group and a low-risk plaque group according to whether the plaques had high-risk characteristics. The maximum cross-sectional area of carotid artery bifurcation plaque on the axial image was selected, and the cross-sectional lumen was equally divided into four 90-degree sectors, ventral side wall, dorsal side wall, inner side wall, and outer side wall. The differences in the characteristics and distribution locations of the plaques in the two groups were analyzed. The characteristic parameters of the cross-sectional plaques at the bifurcation of the carotid artery. The logistic regression analysis was used to further analyze the risk factors associated with plaque vulnerability. Results Among 148 carotid arteries,80 were classified as high-risk and 68 as low-risk groups. There were significant differences between the two groups concerning the thickness, length, maximum cross-sectional area, burden, and cross-sectional distribution of the plaques (P < 0.05). The plaque distribution on the dorsal side wall of the carotid bifurcation was higher in the high-risk group than that in the low-risk group (P < 0.05), dorsal side wall plaque-independent risk factors for the development of vulnerability of plaques in transient ischemic attack (TIA) patients (95% CI:1.522~6.991, P<0.05). Conclusion High-risk plaques tend to occur on the dorsal side wall of the carotid bifurcation, whereas low-risk plaques tend to occur on the outer side wall of the carotid bifurcation.
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Affiliation(s)
- Yinan Zhao
- Department of Radiology, The Affiliated Jinzhou Medical University, Jinzhou, People’s Republic of China
| | - Yan Gu
- Department of Radiology, The Affiliated First People’s Hospital of Lianyungang, Lianyungang, People’s Republic of China
| | - Ying Liu
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, People’s Republic of China
| | - Zhongping Guo
- Department of Radiology, The Affiliated Lianyungang Clinical College of Nanjing Medical University, Lianyungang, People’s Republic of China
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2
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Associations between medications and carotid artery plaque morphology using semi-automated CTA analyses. Clin Neurol Neurosurg 2023; 227:107676. [PMID: 36933405 DOI: 10.1016/j.clineuro.2023.107676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023]
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3
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Nardi V, Benson J, Bois MC, Saba L, Larson AS, Özcan I, Ahmad A, Morse DW, Meyer FB, Brinjikji W, Lanzino G, Lerman LO, Savastano LE, Lerman A. Carotid Plaques From Symptomatic Patients With Mild Stenosis Is Associated With Intraplaque Hemorrhage. Hypertension 2022; 79:271-282. [PMID: 34878895 DOI: 10.1161/hypertensionaha.121.18128] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Carotid plaque vulnerability features beyond the degree of stenosis may play a key role in the pathogenesis and recurrence of ischemic cerebrovascular events. This study sought to compare intraplaque hemorrhage (IPH) as a marker of plaque vulnerability in symptomatic patients with mild (<50%), moderate (50%-69%), and severe (≥70%) carotid artery stenosis. We included patients who experienced ischemic cerebrovascular events with no other identifiable sources and underwent carotid endarterectomy for mild (n=32), moderate (n=47), and severe (n=58) carotid artery stenosis. The degree of stenosis and imaging hallmarks were assessed by computed tomography angiography or magnetic resonance angiography. Plaque specimens were stained with hematoxylin and eosin and Movat pentachrome staining. Carotid plaques of patients with mild stenosis had a higher extent of IPH (%) on tissue analysis compared with patients with moderate (mild, 15.7% [interquartile range, 7.8%-26.7%]; moderate, 3.9% [0.0%-9.2%]; P<0.001) and severe carotid artery stenosis (mild, 15.7% [interquartile range, 7.8%-26.7%]; severe, 2.5% [interquartile range, 0.0%-11.2%]; P<0.001). When considering the degree of carotid artery stenosis as a continuous variable, a lower lumen narrowing was associated with higher extent of IPH (P<0.001; R, -0.329). Our major finding is the association of IPH with mild carotid artery stenosis based on histological analysis. The current study may suggest that IPH potentially plays a role in the mechanism of stroke in patients with nonobstructive carotid stenosis.
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Affiliation(s)
- Valentina Nardi
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
| | - John Benson
- Department of Radiology (J.C.B., A.S.L., W.B.), Mayo Clinic, Rochester, MN
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology (M.C.B.), Mayo Clinic, Rochester, MN
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy (L.S.)
| | - Anthony S Larson
- Department of Radiology (J.C.B., A.S.L., W.B.), Mayo Clinic, Rochester, MN
| | - Ilke Özcan
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
| | - Ali Ahmad
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
| | - David W Morse
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
| | - Fredric B Meyer
- Department of Neurologic Surgery (F.B.M., G.L., L.E.S.), Mayo Clinic, Rochester, MN
| | - Waleed Brinjikji
- Department of Radiology (J.C.B., A.S.L., W.B.), Mayo Clinic, Rochester, MN
| | - Giuseppe Lanzino
- Department of Neurologic Surgery (F.B.M., G.L., L.E.S.), Mayo Clinic, Rochester, MN
| | - Lilach O Lerman
- Department of Nephrology and Hypertension (L.O.L.), Mayo Clinic, Rochester, MN
| | - Luis E Savastano
- Department of Neurologic Surgery (F.B.M., G.L., L.E.S.), Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine (V.N., I.Ö., A.A., D.W.M., A.L.), Mayo Clinic, Rochester, MN
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4
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Timmerman N, Waissi F, Dekker M, van de Pol QY, van Bennekom J, Schoneveld A, Klein Avink MJM, de Winter RJ, Pasterkamp G, de Borst GJ, de Kleijn DPV. Pre-Operative Plasma Extracellular Vesicle Proteins are Associated with a High Risk of Long Term Secondary Major Cardiovascular Events in Patients Undergoing Carotid Endarterectomy. Eur J Vasc Endovasc Surg 2021; 62:705-715. [PMID: 34511318 DOI: 10.1016/j.ejvs.2021.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients undergoing carotid endarterectomy (CEA) maintain a substantial residual risk of major cardiovascular events (MACE). Improved risk stratification is warranted to select high risk patients qualifying for secondary add on therapy. Plasma extracellular vesicles (EVs) are involved in atherothrombotic processes and their content has been related to the presence and recurrence of cardiovascular events. The association between pre-operative levels of five cardiovascular disease related proteins in plasma EVs and the post-operative risk of MACE was assessed. METHODS In 864 patients undergoing CEA from 2002 to 2016 included in the Athero-Express biobank, three plasma EV subfractions (low density lipoprotein [LDL], high density lipoprotein [HDL], and tiny extracellular vesicles [TEX]) were isolated from pre-operative blood samples. Using an electrochemiluminescence immunoassay, five proteins were quantified in each EV subfraction: cystatin C, serpin C1, serpin G1, serpin F2, and CD14. The association between EV protein levels and the three year post-operative risk of MACE (any stroke, myocardial infarction, or cardiovascular death) was evaluated using multivariable Cox proportional hazard regression analyses. RESULTS During a median follow up of three years (interquartile range 2.2 - 3.0), 137 (16%) patients developed MACE. In the HDL-EV subfraction, increased levels of CD14, cystatin C, serpin F2, and serpin C1 were associated with an increased risk of MACE (adjusted hazard ratios per one standard deviation increase of 1.30, 95% confidence interval [CI] 1.15-1.48; 1.22, 95% CI 1.06-1.42; 1.36, 95% CI 1.16-1.61; and 1.29, 95% CI 1.10-1.51; respectively), independently of cardiovascular risk factors. No significant associations were found for serpin G1. CD14 improved the predictive value of the clinical model encompassing cardiovascular risk factors (net re-classification index = 0.16, 95% CI 0.08-0.21). CONCLUSION EV derived pre-operative plasma levels of cystatin C, serpin C1, CD14, and serpin F2 were independently associated with an increased long term risk of MACE after CEA and are thus markers for residual cardiovascular risk. EV derived CD14 levels could improve the identification of high risk patients who may benefit from secondary preventive add on therapy in order to reduce future risk of MACE.
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Affiliation(s)
- Nathalie Timmerman
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Farahnaz Waissi
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Academic Medical Centre, Amsterdam UMC, Amsterdam, the Netherlands
| | - Mirthe Dekker
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Academic Medical Centre, Amsterdam UMC, Amsterdam, the Netherlands
| | - Qiu Ying van de Pol
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joelle van Bennekom
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjan Schoneveld
- Central Diagnostic Laboratory, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marjet J M Klein Avink
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Academic Medical Centre, Amsterdam UMC, Amsterdam, the Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Haematology, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
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5
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Bos D, Vernooij MW, Kavousi M, van der Lugt A. Reply: Carotid Intraplaque Hemorrhage and Cardiovascular Events: Are Antithrombotic Therapies the Missing Piece of the Puzzle? J Am Coll Cardiol 2021; 78:198-200. [PMID: 34238443 DOI: 10.1016/j.jacc.2021.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022]
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6
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Mura M, Della Schiava N, Long A, Chirico EN, Pialoux V, Millon A. Carotid intraplaque haemorrhage: pathogenesis, histological classification, imaging methods and clinical value. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1273. [PMID: 33178805 PMCID: PMC7607119 DOI: 10.21037/atm-20-1974] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Vulnerable carotid atherosclerotic plaques are characterised by several risk factors, such as inflammation, neovascularization and intraplaque haemorrhage (IPH). Vulnerable plaques can lead to ischemic events such as stroke. Many studies reported a relationship between IPH, plaque rupture, and ischemic stroke. Histology is the gold standard to evaluate IPH, but it required carotid endarterectomy (CEA) surgery to collect the tissue sample. In this context, several imaging methods can be used as a non-invasive way to evaluate plaque vulnerability and detect IPH. Most imaging studies showed that IPH is associated with plaque vulnerability and stroke, with magnetic resonance imaging (MRI) being the most sensitive and specific to detect IPH as a predictor of ischemic events. These conclusions are however still debated because of the limited number of patients included in these studies; further studies are required to better assess risks associated with different IPH stages. Moreover, IPH is implicated in plaque vulnerability with other risk factors which need to be considered to predict ischemic risk. In addition, MRI sequences standardization is required to compare results from different studies and agree on biomarkers that need to be considered to predict plaque rupture. In these circumstances, IPH detection by MRI could be an efficient clinical method to predict stroke. The goal of this review article is to first describe the pathophysiological process responsible for IPH, its histological detection in carotid plaques and its correlation with plaque rupture. The second part will discuss the benefits and limitations of imaging the carotid plaque, and finally the clinical interest of imaging IPH to predict plaque rupture, focusing on MRI-IPH.
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Affiliation(s)
- Mathilde Mura
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France
| | - Nellie Della Schiava
- Department of Vascular and Endovascular Surgery, Groupement Hospitalier Est, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,Institut National des Sciences Appliquées Lyon, Laboratoire de Génie Electrique et Ferroélectricité EA 682, Villeurbanne, France
| | - Anne Long
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France.,Departement of Internal Medicine and Vascular Medicine, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Erica N Chirico
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Vincent Pialoux
- Univ Lyon, University Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, Lyon, France.,Institut Universitaire de France, Paris, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Groupement Hospitalier Est, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,Univ Lyon, University Claude Bernard Lyon 1, CarMeN Laboratory, INSERM U1060, Bron, France
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7
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Cao X, Zhang J, Geng D. Use of oral anticoagulant drugs is associated with carotid intraplaque hemorrhage in atherosclerosis patients: a meta-analysis. J Thromb Thrombolysis 2019; 48:68-76. [PMID: 30997600 DOI: 10.1007/s11239-019-01865-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with carotid atherosclerosis, especially the elderly population, take antithrombotic medicine regularly. However, no previous meta-analysis has focused on one of the possible side effects of such drugs, namely intraplaque hemorrhage (IPH). To determine whether antiplatelet drugs or anticoagulants are associated with an increased risk of carotid IPH. We searched Pubmed, Embase, Ovid MEDLINE, Cochrane Library for relevant studies that were published in English, from January 1st, 1989 to January 1st, 2019. We pooled the odds ratio (OR) with 95% confidence interval (CI) from individual studies and conducted quality assessment, heterogeneity, publication bias analysis and sensitivity analysis. A total of four cross-sectional studies, involving 2714 participants with carotid atherosclerotic plaques was included into this meta-analysis. We found a significant association between the use of anticoagulants and higher risk of carotid IPH (OR 1.95; 95% CI 1.16-3.30, P = 0.92; I2 = 0). No significant association was found between the use of antiplatelet drugs and increased risk of carotid IPH (OR 1.34; 95% CI 0.68-2.61, P = 0.03; I2 = 65%). Our meta-analysis reveals that it is the use of oral anticoagulants rather than antiplatelet drugs that may be associated with an increased risk of carotid IPH in atherosclerosis patients.
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Affiliation(s)
- Xin Cao
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road (Middle), Shanghai, 200040, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road (Middle), Shanghai, 200040, China. .,Institute of Functional and Molecular Medical Imaging, Fudan University, No. 12 Wulumuqi Road (Middle), Shanghai, 200040, China.
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Road (Middle), Shanghai, 200040, China. .,Institute of Functional and Molecular Medical Imaging, Fudan University, No. 12 Wulumuqi Road (Middle), Shanghai, 200040, China.
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8
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Mury P, Mura M, Della-Schiava N, Chanon S, Vieille-Marchiset A, Nicaise V, Chirico EN, Collet-Benzaquen D, Lermusiaux P, Connes P, Millon A, Pialoux V. Association between physical activity and sedentary behaviour on carotid atherosclerotic plaques: an epidemiological and histological study in 90 asymptomatic patients. Br J Sports Med 2019; 54:469-474. [PMID: 30842104 DOI: 10.1136/bjsports-2018-099677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/19/2019] [Accepted: 02/13/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Carotid atherosclerotic plaques are a source of emboli for stroke. 'Unstable' carotid atherosclerotic plaques may have intraplaque haemorrhages, neovessels, prevalent macrophages, excessive calcium deposits, a large lipid core and a thin fibrous cap. Regular physical activity (PA) may lower the risk of plaques becoming unstable. We evaluated the association of both PA and sedentary behaviour (SB) with carotid plaque histopathology. METHODS 90 asymptomatic patients who were undergoing carotid endarterectomy for carotid artery narrowing identified on ultrasound reported their PA and SB by questionnaires. We calculated PA intensity in MET (metabolic equivalent of task)-min/week. For analysis, the population was divided into tertiles according to PA (T1PA: the less PA patients; T2PA: the intermediate PA patients; T3PA: the most physically active patients) (T1PA<T2PA<T3PA) and SB (T1SB: the less sedentary behaviour patients; T2SB: the intermediate sedentary behaviour patients; T3SB: the most sedentary behaviour patients) (T1SB<T2SB<T3SB). PA was categorised as one of four PA intensities (600, 900, 1600 and 3000 MET-min/week). We obtained the carotid artery plaque at surgery and performed histological analysis of intraplaque haemorrhages (present/absent), neovessels, macrophages, lipid core, calcium deposits and the fibrous cap. RESULTS Intraplaque haemorrhage was less frequent in the most physically active tertile (T3PA, 48%) versus T1PA (74%) and in the least sedentary tertile T1SB (50%) versus T3SB (71%). The intraplaque haemorrhage was less frequent in those who exercised more than 900 MET-min/week (59% vs 47% for >900 and <900 MET-min/week, respectively). All the other features that associate with plaque instability (eg, neovessels, macrophages, etc) did not differ by level of PA or SB. CONCLUSION In this cross-sectional study of asymptomatic patients who underwent endarterectomy (i) higher reported PA, (ii) intensity of PA and (iii) lower reported SB were associated with lower prevalence of intraplaque haemorrhage. This could be a mechanism whereby PA protects against cerebrovascular disease (stroke) and death.
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Affiliation(s)
- Pauline Mury
- Interuniversity Laboratory of Human Movement Biology EA7424, University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Mathilde Mura
- Interuniversity Laboratory of Human Movement Biology EA7424, University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-Ex, Paris, France
| | | | - Stéphanie Chanon
- CarMeN Laboratory, INSERM U1060, INRA 1397, University Claude Bernard Lyon 1, Pierre Bénite, France
| | | | - Virginie Nicaise
- Laboratory of Vulnerabilities and Innovation in Sport EA7428, University Claude Bernard Lyon 1, Villeurbanne, France
| | - Erica N Chirico
- Department of Biomedical Sciences, CooperMedical School, Rowan University, Camden, NJ, USA
| | | | | | - Philippe Connes
- Interuniversity Laboratory of Human Movement Biology EA7424, University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-Ex, Paris, France.,Institut Universitaire de France, Paris, France
| | - Antoine Millon
- Department ofVascular Surgery, Edouard Herriot Hospital, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Claude Bernard Lyon 1, Bron, France
| | - Vincent Pialoux
- Interuniversity Laboratory of Human Movement Biology EA7424, University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence GR-Ex, Paris, France.,Institut Universitaire de France, Paris, France
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9
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Lu M, Cui Y, Peng P, Qiao H, Cai J, Zhao X. Shape and Location of Carotid Atherosclerotic Plaque and Intraplaque Hemorrhage: A High-resolution Magnetic Resonance Imaging Study. J Atheroscler Thromb 2019; 26:720-727. [PMID: 30626781 PMCID: PMC6711842 DOI: 10.5551/jat.47449] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: The present study aimed to investigate the association between shape and location of atherosclerotic plaques and intraplaque hemorrhage (IPH) in carotid arteries using magnetic resonance (MR) imaging. Methods: Overall, 114 symptomatic patients (mean age: 64.9±10.9 years; 81 males) who underwent MR imaging and had advanced carotid plaques were included in analysis. IPH presence and carotid plaque shape and location (below and above bifurcation) were evaluated. The plaque shape was defined as follows: type-I: the arc-length of plaque is greater in the upstream; type-II: the arc-length of plaque in downstream and upstream is equal; and type-III: the arc-length of plaque is greater in downstream. The plaque shape and location were compared between plaques with and without IPH and their associations with IPH were determined. Results: Of 181detectedplaques, 57 (31.5%) had IPH. Compared with plaques without IPH, those with IPH had higher incidence of the plaque shape of type-I (66.7% vs. 32.2%, P<0.001), lower incidence of plaque shape of type-III (24.6% vs. 50.0%, P=0.001), and were more likely located above carotid bifurcation (71.9% vs. 48.4%, P=0.003). The plaque shape of type-I (OR, 4.01; 95%CI, 1.36–11.83; P=0.012) and location above bifurcation (OR, 3.21; 95%CI, 1.07–9.61; P=0.037) of carotid plaques were significantly associated with IPH after adjusting for confounder factors. Conclusions: Carotid plaque shape and location are significantly associated with the occurrence of IPH. Our findings could provide new insights for the pathogenesis of IPH and vulnerably plaques.
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Affiliation(s)
- Mingming Lu
- Department of Radiology, PLA General Hospital.,Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces
| | | | - Peng Peng
- Department of Radiology, Pingjin Hospital, Logistics University of Chinese People's Armed Police Forces
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
| | | | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine
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10
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Ma S, Wang S, Li M, Zhang Y, Zhu P. The effects of pigment epithelium-derived factor on atherosclerosis: putative mechanisms of the process. Lipids Health Dis 2018; 17:240. [PMID: 30326915 PMCID: PMC6192115 DOI: 10.1186/s12944-018-0889-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death worldwide. Atherosclerosis is believed to be the major cause of CVD, characterized by atherosclerotic lesion formation and plaque disruption. Although remarkable advances in understanding the mechanisms of atherosclerosis have been made, the application of these theories is still limited in the prevention and treatment of atherosclerosis. Therefore, novel and effective strategies to treat high-risk patients with atherosclerosis require further development. Pigment epithelium-derived factor (PEDF), a glycoprotein with anti-inflammatory, anti-oxidant, anti-angiogenic, anti-thrombotic and anti-tumorigenic properties, is of considerable interest in the prevention of atherosclerosis. Accumulating research has suggested that PEDF exerts beneficial effects on atherosclerotic lesions and CVD patients. Our group, along with colleagues, has demonstrated that PEDF may be associated with acute coronary syndrome (ACS), and that the polymorphisms of rs8075977 of PEDF are correlated with coronary artery disease (CAD). Moreover, we have explored the anti-atherosclerosis mechanisms of PEDF, showing that oxidized-low density lipoprotein (ox-LDL) reduced PEDF concentrations through the upregulation of reactive oxygen species (ROS), and that D-4F can protect endothelial cells against ox-LDL-induced injury by preventing the downregulation of PEDF. Additionally, PEDF might alleviate endothelial injury by inhibiting the Wnt/β-catenin pathway. These data suggest that PEDF may be a novel therapeutic target for the treatment of atherosclerosis. In this review, we will summarize the role of PEDF in the development of atherosclerosis, focusing on endothelial dysfunction, inflammation, oxidative stress, angiogenesis and cell proliferation. We will also discuss its promising therapeutic implications for atherosclerosis.
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Affiliation(s)
- Shouyuan Ma
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shuxia Wang
- Department of Cadre Clinic, Chinese PLA General Hospital, Beijing, 100853, China
| | - Man Li
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yan Zhang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ping Zhu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, 100853, China.
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11
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Mujaj B, Bos D, Muka T, van der Lugt A, Ikram MA, Vernooij MW, Stricker BH, Franco OH. Antithrombotic treatment is associated with intraplaque haemorrhage in the atherosclerotic carotid artery: a cross-sectional analysis of The Rotterdam Study. Eur Heart J 2018; 39:3369-3376. [PMID: 30060115 PMCID: PMC6148524 DOI: 10.1093/eurheartj/ehy433] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/13/2018] [Accepted: 07/11/2018] [Indexed: 12/24/2022] Open
Abstract
Aims Antithrombotic treatment plays a key role in stroke prevention, but their direct effects on the composition of carotid artery atherosclerotic plaques are unknown. To investigate the association of antithrombotic treatment with carotid artery plaque composition, with a specific focus on an intraplaque haemorrhage (IPH). Methods and results From the population-based Rotterdam Study, 1740 participants with carotid atherosclerosis on ultrasound (mean age 72.9 years, 46.0 women) underwent magnetic resonance imaging of the carotid arteries to assess plaque composition. Information on the use of oral anticoagulants [vitamin K antagonists (VKA)] and antiplatelet agents (salicylates), including duration of use and dosage, was obtained from pharmacy records for all participants. We used logistic regression models to assess the association between the use of anticoagulants and antiplatelet agents, and the different plaque components adjusting for confounders. Current and past use of VKA [adjusted odds ratio (OR): 1.88, 95% confidence interval (CI): 0.74-4.75 and OR 1.89, 95% CI: 0.91-3.93] and antiplatelet agents (OR: 1.22, 95% CI: 0.91-1.62), and (OR: 1.23, 95% CI: 0.86-1.75) showed positive trend with a higher presence of IPH. Also, a longer duration of use was associated with a higher frequency of IPH (OR: 3.15, 95% CI: 1.23-8.05) for the use of VKA, and longer duration of the use for antiplatelet agents showed a positive trend (OR: 1.21, 95% CI: 0.88-1.67). We also found that higher levels of international normalized ratio above 2.97 for VKA (OR: 1.48, 95% CI: 1.03-2.15) and higher daily defined dosage than 1.0 for antiplatelet agents (OR: 1.50, 95% CI: 1.21-1.87) were related to a higher frequency of IPH. We found no association with lipid core or calcification. Conclusions The use of antithrombotic treatment relates to a higher frequency of IPH in carotid atherosclerotic plaques.
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Affiliation(s)
- Blerim Mujaj
- Department of Epidemiology, Erasmus MC, Rm Na-2717, CA Rotterdam, the Netherlands
- Department of Cardiovascular Sciences, Research Unit Hypertension and Cardiovascular Epidemiology, Studies Coordinating Centre, KU Leuven, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Leuven, Belgium
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC, Rm Na-2717, CA Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, CA Rotterdam, the Netherlands
- Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
| | - Taulant Muka
- Department of Epidemiology, Erasmus MC, Rm Na-2717, CA Rotterdam, the Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, CA Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rm Na-2717, CA Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, CA Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC, PO Box 2040, CA Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, Rm Na-2717, CA Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, CA Rotterdam, the Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC, Rm Na-2717, CA Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, Rm Na-2717, CA Rotterdam, the Netherlands
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Bildirici AE, Arslan S, Özbilüm Şahin N, Berkan Ö, Beton O, Yilmaz MB. MicroRNA-221/222 expression in atherosclerotic coronary artery plaque versus internal mammarian artery and in peripheral blood samples. Biomarkers 2018; 23:670-675. [PMID: 29737876 DOI: 10.1080/1354750x.2018.1474260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Atherosclerosis is a disease of the arterial wall with predilection to some sites on others. MicroRNAs (miRNAs) are a class of the non-coding RNAs regulating the target gene expression at post-transcriptional level. Different miRNAs were found at distinct stages of plaque development and expression of miRNAs' might play an important role in the local behaviour of atherosclerotic plaques. OBJECTIVE We aimed to investigate and compare mirR-221/222 expression levels in tissues and in circulation in patients with and without overt atherosclerosis. METHODS RNA was isolated from 40 tissues as 20 tissue samples from coronary artery atherosclerotic plaques (CAAP) and internal mammary arteries (IMA), obtained from same individual) and 80 blood (44 patients with atherosclerosis and 36 healthy subjects) samples. MiR-221/222 expression levels were measured using real time PCR. RESULTS Expression levels of miR-221 was significantly increased in CAAP compared with completely atherosclerosis-free IMA tissues with a 8.94 times fold-change (p = 0.015). The miR-221 expression in tissue samples was significantly different in patients with hypercholesterolemia (p = 0.010), hypertension (p = 0.018) and family history of CAD (p = 0.033) versus not. Expression of miR-222 was not statistically significant between the two tissue samples overall. CONCLUSIONS MiR-221 may be a potential biomarker for local atherosclerotic behavior.
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Affiliation(s)
- Aslıhan Esra Bildirici
- a Department of Medical Biology, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
| | - Serdal Arslan
- a Department of Medical Biology, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
| | - Nil Özbilüm Şahin
- b Department of Molecular Biology and Genetics, Faculty of Science , Cumhuriyet University , Sivas , Turkey
| | - Öcal Berkan
- c Department of Cardiovascular Surgery, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
| | - Osman Beton
- d Department of Cardiology, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
| | - Mehmet Birhan Yilmaz
- d Department of Cardiology, Faculty of Medicine , Cumhuriyet University , Sivas , Turkey
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13
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Superficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque. Eur Radiol 2018; 28:4968-4977. [PMID: 29876705 PMCID: PMC6223859 DOI: 10.1007/s00330-018-5535-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/18/2018] [Accepted: 05/11/2018] [Indexed: 01/09/2023]
Abstract
Objective Intraplaque hemorrhage (IPH) and ulceration of carotid atherosclerotic plaques have been associated with vulnerability while calcification has been conventionally thought protective. However, studies suggested calcification size and location may increase plaque vulnerability. This study explored the association between calcium configurations and ulceration with IPH. Methods One hundred thirty-seven consecutive symptomatic patients scheduled for carotid endarterectomy were recruited. CTA and CTP were performed prior to surgery. Plaque samples were collected for histology. According to the location, calcifications were categorized into superficial, deep and mixed types; according to the size and number, calcifications were classified as thick and thin, multiple and single. Results Seventy-one plaques had IPH (51.8%) and 83 had ulceration (60.6%). The appearance of IPH and ulceration was correlated (r = 0.49; p < 0.001). The incidence of multiple, superficial and thin calcifications was significantly higher in lesions with IPH and ulceration compared with those without. After adjusting factors including age, stenosis and ulceration, the presence of calcification [OR (95% CI), 3.0 (1.1-8.2), p = 0.035], multiple calcification [3.9 (1.4-10.9), p = 0.009] and superficial calcification [3.4 (1.1-10.8), p = 0.001] were all associated with IPH. ROC analysis showed that the AUC of superficial and multiple calcifications in detecting IPH was 0.63 and 0.66, respectively (p < 0.05). When the ulceration was combined, AUC increased significantly to 0.82 and 0.83, respectively. Results also showed that patients with lesions of both ulceration and IPH have significantly reduced brain perfusion in the area ipsilateral to the infarction. Conclusions Superficial and multiple calcifications and ulceration were associated with carotid IPH, and they may be a surrogate for higher risk lesions. Key Points • CTA-defined superficial and multiple calcifications in carotid atherosclerotic plaques are independently associated with the presence of intraplaque hemorrhage. • The combination of superficial and multiple calcifications and ulceration is highly predictive of carotid intraplaque hemorrhage. • Patients with lesions of both ulceration and intraplaque hemorrhage have significantly reduced brain perfusion in the area ipsilateral to the infarction.
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14
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Olie RH, van der Meijden PE, ten Cate H. The coagulation system in atherothrombosis: Implications for new therapeutic strategies. Res Pract Thromb Haemost 2018; 2:188-198. [PMID: 30046721 PMCID: PMC6055505 DOI: 10.1002/rth2.12080] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/05/2018] [Indexed: 12/13/2022] Open
Abstract
Clinical manifestations of atherosclerotic disease include coronary artery disease (CAD), peripheral artery disease (PAD), and stroke. Although the role of platelets is well established, evidence is now accumulating on the contribution of coagulation proteins to the processes of atherosclerosis and atherothrombosis. Coagulation proteins not only play a role in fibrin formation and platelet activation, but also mediate various biological and pathophysiologic processes through activation of protease-activated-receptors (PARs). Thus far, secondary prevention in patients with CAD/PAD has been the domain of antiplatelet therapy, however, residual atherothrombotic risks remain substantial. Therefore, combining antiplatelet and anticoagulant therapy has gained more attention. Recently, net clinical benefit of combining aspirin with low-dose rivaroxaban in patients with stable atherosclerotic disease has been demonstrated. In this review, based on the State of the Art lecture "Clotting factors and atherothrombosis" presented at the ISTH Congress 2017, we highlight the role of coagulation proteins in the pathophysiology of atherothrombosis, and specifically focus on therapeutic strategies to decrease atherothrombotic events by optimization of vascular protection.
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Affiliation(s)
- Renske H. Olie
- Department of Internal MedicineMaastricht University Medical Center+ (MUMC+)MaastrichtThe Netherlands
- Thrombosis Expertise CenterMUMC+MaastrichtThe Netherlands
- Laboratory for Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
| | - Paola E.J. van der Meijden
- Thrombosis Expertise CenterMUMC+MaastrichtThe Netherlands
- Laboratory for Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
| | - Hugo ten Cate
- Department of Internal MedicineMaastricht University Medical Center+ (MUMC+)MaastrichtThe Netherlands
- Thrombosis Expertise CenterMUMC+MaastrichtThe Netherlands
- Laboratory for Clinical Thrombosis and HemostasisMaastricht UniversityMaastrichtThe Netherlands
- Center for Thrombosis and HaemostasisGutenberg UniversityMainzGermany
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15
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Haitjema S, van Haelst ST, de Vries JPP, Moll FL, den Ruijter HM, de Borst GJ, Pasterkamp G. Time-dependent differences in femoral artery plaque characteristics of peripheral arterial disease patients. Atherosclerosis 2016; 255:66-72. [DOI: 10.1016/j.atherosclerosis.2016.10.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/20/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022]
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16
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Gulpen AJW, Ten Cate-Hoek AJ, Ten Cate H. Upstream versus downstream thrombin inhibition. Expert Rev Cardiovasc Ther 2016; 14:1273-1282. [DOI: 10.1080/14779072.2016.1224179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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17
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Selwaness M, Bos D, van den Bouwhuijsen Q, Portegies ML, Ikram MA, Hofman A, Franco OH, van der Lugt A, Wentzel JJ, Vernooij MW. Carotid Atherosclerotic Plaque Characteristics on Magnetic Resonance Imaging Relate With History of Stroke and Coronary Heart Disease. Stroke 2016; 47:1542-7. [DOI: 10.1161/strokeaha.116.012923] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mariana Selwaness
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Daniel Bos
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Quirijn van den Bouwhuijsen
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Marileen L.P. Portegies
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - M. Arfan Ikram
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Albert Hofman
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Oscar H. Franco
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Aad van der Lugt
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Jolanda J. Wentzel
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
| | - Meike W. Vernooij
- From the Departments of Epidemiology (M.S., D.B., Q.v.d.B., M.L.P.P., M.A.I., A.H., O.H.F., M.W.V.), Radiology (D.B., Q.v.d.B., M.A.I., A.v.d.L., M.W.V.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands; and Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands (J.J.W.)
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Sun J, Canton G, Balu N, Hippe DS, Xu D, Liu J, Hatsukami TS, Yuan C. Blood Pressure Is a Major Modifiable Risk Factor Implicated in Pathogenesis of Intraplaque Hemorrhage: An In Vivo Magnetic Resonance Imaging Study. Arterioscler Thromb Vasc Biol 2016; 36:743-9. [PMID: 26848155 DOI: 10.1161/atvbaha.115.307043] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/20/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Effective prevention and management strategies of intraplaque hemorrhage (IPH) remain elusive because of our limited knowledge regarding its contributing factors. This hypothesis-generating study aimed to investigate associations between cardiovascular risk factors and IPH for improved understanding of the pathogenesis of IPH. APPROACH AND RESULTS Asymptomatic subjects with 16% to 79% stenosis on ultrasound underwent carotid magnetic resonance imaging using a large-coverage, 3-dimensional magnetic resonance imaging protocol. Individual plaques (maximum thickness >1.5 mm) in bilateral carotid arteries were identified, and presence of IPH was determined. From 80 subjects, 176 de novo plaques were measured, of which 38 (21.6%) contained IPH. Blood pressure (BP), primarily low diastolic BP, was associated with IPH in multivariate analysis adjusted for age, sex, and plaque size (odds ratio with 95% confidence interval per 10-mm Hg increase: 0.51 [0.30-0.88]), which was little changed after adjusting for antihypertensive use and systemic atherosclerosis. Antiplatelet use was associated with IPH in age and sex-adjusted models (P=0.018), for which a trend remained after considering plaque size and past medical history (odds ratio for aspirin alone versus none: 3.1 [0.66-14.8]; odds ratio for clopidogrel or dual therapy versus none: 5.3 [0.80-35.0]; P=0.083). CONCLUSIONS Low diastolic BP was independently associated with IPH, which was not attributed to treatment difference or BP changes from systemic atherosclerosis. Hemodynamic changes from lowering diastolic BP may be the pathophysiological link. Prospective serial studies are needed to assess whether BP and antiplatelet use are associated with the development of new or repeated IPH.
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Affiliation(s)
- Jie Sun
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Gador Canton
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Niranjan Balu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Daniel S Hippe
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Dongxiang Xu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Jin Liu
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Thomas S Hatsukami
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle
| | - Chun Yuan
- From the Departments of Radiology (J.S., N.B., D.S.H., D.X., C.Y.), Mechanical Engineering (G.C.), Bioengineering (J.L., C.Y.), and Surgery (T.S.H.), University of Washington, Seattle.
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19
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Liem MI, Schreuder FH, van Dijk AC, de Rotte AA, Truijman MT, Daemen MJ, van der Steen AF, Hendrikse J, Nederveen AJ, van der Lugt A, Kooi ME, Nederkoorn PJ, Schreuder A, Koudstaal P, Limburg M, Weisfelt M, Korten A, Saxena R, van Oostenbrugge R, Mess W, van Orshoven N, Tromp S, Bakker S, Kruyt N, de Kruijk J, de Borst G, Meems B, Verhey J, Wijnhoud A. Use of Antiplatelet Agents Is Associated With Intraplaque Hemorrhage on Carotid Magnetic Resonance Imaging. Stroke 2015; 46:3411-5. [DOI: 10.1161/strokeaha.115.008906] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 10/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Madieke I. Liem
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Floris H.B.M. Schreuder
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Anouk C. van Dijk
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Alexandra A.J. de Rotte
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Martine T.B. Truijman
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Mat J.A.P. Daemen
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Anton F.W. van der Steen
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Jeroen Hendrikse
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Aart J. Nederveen
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Aad van der Lugt
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - M. Eline Kooi
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Paul J. Nederkoorn
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | | | | | | | | | | | | | | | - W.H. Mess
- Maastricht University Medical Center
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Mechtouff L, Ritzenthaler T, Cho TH, Derex L, Feugier P, Berthezene Y, Collet-Benzaquen D, Douek PC, Nighoghossian N. High-resolution MRI: detection of a culprit plaque after recurrent thrombolysis. J Neurol 2015; 262:2773-5. [PMID: 26530507 DOI: 10.1007/s00415-015-7915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Laura Mechtouff
- Stroke Department, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France.
| | - Thomas Ritzenthaler
- Stroke Department, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France
| | - Tae-Hee Cho
- Stroke Department, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France
- CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Laurent Derex
- Stroke Department, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France
| | - Patrick Feugier
- Vascular Surgery Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, University Lyon 1, 5 Place d'Arsonval, 69003, Lyon, France
| | - Yves Berthezene
- CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
- Neuroradiology Department, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France
| | - Diane Collet-Benzaquen
- Department of Pathology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69003, Lyon, France
| | - Philippe Charles Douek
- CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
- Radiology Department, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Jean Lépine, 69677, Bron, France
| | - Norbert Nighoghossian
- Stroke Department, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Bron, France
- CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
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21
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Effect of Intensive Statin Therapy on Coronary High-Intensity Plaques Detected by Noncontrast T1-Weighted Imaging: The AQUAMARINE Pilot Study. J Am Coll Cardiol 2015; 66:245-256. [PMID: 26184618 DOI: 10.1016/j.jacc.2015.05.056] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/21/2015] [Accepted: 05/12/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Coronary high-intensity plaques detected by noncontrast T1-weighted imaging may represent plaque instability. High-intensity plaques can be quantitatively assessed by a plaque-to-myocardium signal-intensity ratio (PMR). OBJECTIVES This pilot, hypothesis-generating study sought to investigate whether intensive statin therapy would lower PMR. METHODS Prospective serial noncontrast T1-weighted magnetic resonance imaging and computed tomography angiography were performed in 48 patients with coronary artery disease at baseline and after 12 months of intensive pitavastatin treatment with a target low-density lipoprotein cholesterol level <80 mg/dl. The control group consisted of coronary artery disease patients not treated with statins that were matched by propensity scoring (n = 48). The primary endpoint was the 12-month change in PMR. Changes in computed tomography angiography parameters and high-sensitivity C-reactive protein levels were analyzed. RESULTS In the statin group, 12 months of statin therapy significantly improved low-density lipoprotein cholesterol levels (125 to 70 mg/dl; p < 0.001), PMR (1.38 to 1.11, an 18.9% reduction; p < 0.001), low-attenuation plaque volume, and the percentage of total atheroma volume on computed tomography. In the control group, the PMR increased significantly (from 1.22 to 1.49, a 19.2% increase; p < 0.001). Changes in PMR were correlated with changes in low-density lipoprotein cholesterol (r = 0.533; p < 0.001), high-sensitivity C-reactive protein (r = 0.347; p < 0.001), percentage of atheroma volume (r = 0.477; p < 0.001), and percentage of low-attenuation plaque volume (r = 0.416; p < 0.001). CONCLUSIONS Statin treatment significantly reduced the PMR of high-intensity plaques. Noncontrast T1-weighted magnetic resonance imaging could become a useful technique for repeated quantitative assessment of plaque composition. (Attempts at Plaque Vulnerability Quantification with Magnetic Resonance Imaging Using Noncontrast T1-weighted Technique [AQUAMARINE]; UMIN000003567).
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Li X, Vink A, Niessen HWM, Kers J, de Boer OJ, Ploegmakers HJP, Tijssen JGP, de Winter RJ, van der Wal AC. Total burden of intraplaque hemorrhage in coronary arteries relates to the use of coumarin-type anticoagulants but not platelet aggregation inhibitors. Virchows Arch 2014; 465:723-9. [PMID: 25246372 DOI: 10.1007/s00428-014-1654-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/01/2014] [Accepted: 09/11/2014] [Indexed: 01/01/2023]
Abstract
Intraplaque hemorrhage (IPH) is a crucial factor in progression and destabilization of an atherosclerotic plaque. Anti-thromboembolic drugs are widely used as prophylactic treatment against arterial and venous thrombotic diseases, but a major complication is bleeding. We investigated the association between exposure to anti-thromboembolic therapy and IPH in postmortem coronary arteries. Coronary arteries with postmortem angiographically confirmed extensive atherosclerosis were obtained at autopsy from patients who had received oral anticoagulants (n = 10), platelet aggregation inhibitors (n = 10), or no anti-thrombotic drugs (n = 10) before death. Coronary arteries were cut at 3-mm interval, and all plaque-containing segments were immunohistochemically screened for IPH and microvessels. These data were related to overall plaque composition and the use of anti-thromboembolic therapies. IPH was found in 483 out of 904 (53 %) coronary segments with advanced atherosclerotic plaques and more frequently in patients on oral anticoagulants (174/284, 61 %) than in patients on anti-platelets (198/376, 53 %) or without therapy (111/244, 46 %) (P = 0.02 and P = 0.001, respectively). Also, intraplaque microvascular leakage was more frequently observed in patients on anticoagulants than in non-treated patients (P = 0.03). Finally, the IPH appeared to be larger in plaques of patients on anticoagulant treatment (P < 0.001). Density of intraplaque microvessels was highest in plaques of patients on platelet inhibitors (P < 0.05), but this was not associated with increased hemorrhagic burden. Prophylactic therapy with oral coumarin-type anticoagulants appears to be associated with a higher hemorrhagic burden in atherosclerotic coronary arteries, which may lead to increase in plaque volume over time, in this selected subgroup of patients.
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Affiliation(s)
- Xiaofei Li
- Department of Pathology, Academic Medical Center, University of Amsterdam, Room M2-129, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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23
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Polonsky TS, Liu K, Tian L, Carr J, Carroll TJ, Berry J, Criqui MH, Ferrucci L, Guralnik JM, Kibbe MR, Kramer CM, Li F, Xu D, Zhao X, Yuan C, McDermott MM. High-risk plaque in the superficial femoral artery of people with peripheral artery disease: prevalence and associated clinical characteristics. Atherosclerosis 2014; 237:169-76. [PMID: 25240112 DOI: 10.1016/j.atherosclerosis.2014.08.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 07/23/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We used magnetic resonance imaging (MRI) to study the prevalence and associated clinical characteristics of high-risk plaque (defined as presence of lipid-rich necrotic core [LRNC] and intraplaque hemorrhage) in the superficial femoral arteries (SFA) among people with peripheral artery disease (PAD). BACKGROUND The prevalence and clinical characteristics associated with high-risk plaque in the SFA are unknown. METHODS Three-hundred-three participants with PAD underwent MRI of the proximal SFA using a 1.5 T S platform. Twelve contiguous 2.5 mm cross-sectional images were obtained. RESULTS LRNC was present in 68 (22.4%) participants. Only one had intra-plaque hemorrhage. After adjusting for age and sex, smoking prevalence was higher among adults with LRNC than among those without LRNC (35.9% vs. 21.4%, p = 0.02). Among participants with vs. without LRNC there were no differences in mean percent lumen area (31% vs. 33%, p = 0.42), normalized mean wall area (0.71 vs. 0.70, p = 0.67) or maximum wall area (0.96 vs. 0.92, p = 0.54) in the SFA. Among participants with LRNC, cross-sectional images containing LRNC had a smaller percent lumen area (33% ± 1% vs. 39% ± 1%, p < 0.001), greater normalized mean wall thickness (0.25 ± 0.01 vs. 0.22 ± 0.01, p < 0.001), and greater normalized maximum wall thickness (0.41 ± 0.01 vs. 0.31 ± 0.01, p < 0.001), compared to cross-sectional images without LRNC. CONCLUSIONS Fewer than 25% of adults with PAD had high-risk plaque in the proximal SFA using MRI. Smoking was the only clinical characteristic associated with presence of LRNC. Further study is needed to determine the prognostic significance of LRNC in the SFA. CLINICAL TRIAL REGISTRATION-URL http://www.clinicaltrials.gov. Unique identifier: NCT00520312.
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Affiliation(s)
- Tamar S Polonsky
- Department of Medicine, University of Chicago, Chicago, IL, USA.
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Lu Tian
- Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - James Carr
- Department of Biomedical Engineering and Radiology, Northwestern University, Chicago, IL, USA.
| | - Timothy J Carroll
- Department of Biomedical Engineering and Radiology, Northwestern University, Chicago, IL, USA.
| | - Jarett Berry
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California at San Diego, San Diego, CA, USA.
| | - Luigi Ferrucci
- Laboratory of Clinical Epidemiology, National Institute on Aging, Bethesda, MD, USA.
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Melina R Kibbe
- Division of Vascular Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Christopher M Kramer
- Department of Radiology and Medicine, University of Virginia Health System, Charlottesville, VA, USA.
| | - Feiyu Li
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Xihao Zhao
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Mary M McDermott
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
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Teng Z, Sadat U, Brown AJ, Gillard JH. Plaque hemorrhage in carotid artery disease: pathogenesis, clinical and biomechanical considerations. J Biomech 2014; 47:847-58. [PMID: 24485514 PMCID: PMC3994507 DOI: 10.1016/j.jbiomech.2014.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 12/21/2022]
Abstract
Stroke remains the most prevalent disabling illness today, with internal carotid artery luminal stenosis due to atheroma formation responsible for the majority of ischemic cerebrovascular events. Severity of luminal stenosis continues to dictate both patient risk stratification and the likelihood of surgical intervention. But there is growing evidence to suggest that plaque morphology may help improve pre-existing risk stratification criteria. Plaque components such a fibrous tissue, lipid rich necrotic core and calcium have been well investigated but plaque hemorrhage (PH) has been somewhat overlooked. In this review we discuss the pathogenesis of PH, its role in dictating plaque vulnerability, PH imaging techniques, marterial properties of atherosclerotic tissues, in particular, those obtained based on in vivo measurements and effect of PH in modulating local biomechanics.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Umar Sadat
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Adam J Brown
- Department of Cardiovascular Medicine, University of Cambridge, UK
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Hellings WE, Moll FL, de Kleijn DPV, Pasterkamp G. 10-years experience with the Athero-Express study. Cardiovasc Diagn Ther 2013; 2:63-73. [PMID: 24282698 DOI: 10.3978/j.issn.2223-3652.2012.02.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 02/01/2012] [Indexed: 12/25/2022]
Abstract
From cross-sectional studies we have learned that composition of atherosclerotic plaques differs, and that thrombosis on top of an inflammatory lipid rich plaque is a frequently observed pathological substrate of a cerebral or coronary event. Atherosclerosis develops over decades which hampers human studies on the natural history of the diseases. Therefore, the predictive value of atherosclerotic plaque composition for development of an adverse cardiovascular event is not clear. The elucidation of markers for atherosclerotic disease progression is essential to identify patients at high risk for vascular events, to refine treatment allocation and to serve as surrogate endpoints in pharmaceutical studies. The Athero-Express study is a large scale vascular biobank that collects vascular specimens including a clinical follow-up. This study design allows the prospective study of the local atherosclerotic plaque in relation to future local and systemic vascular outcome. The readout of the study can be assessed in terms of histology as well as RNA or protein level. This paper aims to give an overview of the results of the Athero-Express biobank since its initiation in 2002. We will also discuss the clinical implications and future directions in biobanking research.
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Affiliation(s)
- Willem E Hellings
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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26
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Ijäs P, Saksi J, Soinne L, Tuimala J, Jauhiainen M, Jula A, Kähönen M, Kesäniemi YA, Kovanen PT, Kaste M, Lindsberg PJ. Haptoglobin 2 allele associates with unstable carotid plaque and major cardiovascular events. Atherosclerosis 2013; 230:228-34. [PMID: 24075749 DOI: 10.1016/j.atherosclerosis.2013.07.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Intraplaque hemorrhages (IPH) may predispose to unstable atherosclerotic disease and its atherothrombotic complications, ischemic stroke and coronary syndromes. However, the discriminative value of IPH has been limited in histological and imaging studies suggesting that confounding factors modulate the response to IPH. We studied whether common variants of haptoglobin (Hp), which facilitates the removal of free hemoglobin and protects tissues from heme-iron induced oxidative damage, would modify the inflammatory response to IPH and the risk of unstable carotid stenosis (CS) and major cardiovascular diseases. METHODS We genotyped Hp polymorphism in 91 patients with a high-grade CS from Helsinki Carotid Endarterectomy Study (HeCES) and in 1417 individuals from Health 2000, a Finnish epidemiological cross-sectional health survey, and determined heme oxygenase-1 (HO1) expression in relation to Hp genotypes in carotid plaques. RESULTS In the Health 2000 cohort, Hp genotype frequencies were 0.143 (hp1-1), 0.486 (hp1-2) and 0.371 (hp2-2) consistent with Hardy-Weinberg equilibrium and those reported from other Caucasian populations. Among patients with unstable CS, the frequency of hp2-2 genotype was higher than in the control population (0.516 vs. 0.371, P = 0.025). Hp genotypes correlated with HO1 expression in the plaque (r = 0.47, P = 0.027). In the Health 2000 cohort, hp2 allele was associated with an increased risk of major cardiovascular diseases (ischemic stroke, TIA, myocardial infarction, coronary heart disease) with an adjusted OR of 1.46 (95% CI 1.03-2.06). CONCLUSION Common haptoglobin variants modulate the inflammatory response to IPH and associate with the risk of unstable carotid stenosis and major ischemic cardiovascular events.
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Affiliation(s)
- Petra Ijäs
- Department of Neurology, Helsinki University Central Hospital, Finland; Research Programs Unit, Molecular Neurology, Biomedicum-Helsinki and Department of Clinical Neurosciences, University of Helsinki, Finland.
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27
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Biological mechanisms of microvessel formation in advanced atherosclerosis: The big Five. Trends Cardiovasc Med 2013; 23:153-64. [DOI: 10.1016/j.tcm.2012.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 12/19/2022]
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28
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Kandiyil N, Altaf N, Hosseini AA, MacSweeney ST, Auer DP. Lower prevalence of carotid plaque hemorrhage in women, and its mediator effect on sex differences in recurrent cerebrovascular events. PLoS One 2012; 7:e47319. [PMID: 23110067 PMCID: PMC3482217 DOI: 10.1371/journal.pone.0047319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 09/14/2012] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Women are at lower risk of stroke, and appear to benefit less from carotid endarterectomy (CEA) than men. We hypothesised that this is due to more benign carotid disease in women mediating a lower risk of recurrent cerebrovascular events. To test this, we investigated sex differences in the prevalence of MRI detectable plaque hemorrhage (MRI PH) as an index of plaque instability, and secondly whether MRI PH mediates sex differences in the rate of cerebrovascular recurrence. Methods Prevalence of PH between sexes was analysed in a single centre pooled cohort of 176 patients with recently symptomatic, significant carotid stenosis (106 severe [≥70%], 70 moderate [50–69%]) who underwent prospective carotid MRI scanning for identification of MRI PH. Further, a meta-analysis of published evidence was undertaken. Recurrent events were noted during clinical follow up for survival analysis. Results Women with symptomatic carotid stenosis (50%≥) were less likely to have plaque hemorrhage (PH) than men (46% vs. 70%) with an adjusted OR of 0.23 [95% CI 0.10–0.50, P<0.0001] controlling for other known vascular risk factors. This negative association was only significant for the severe stenosis subgroup (adjusted OR 0.18, 95% CI 0.067–0.50) not the moderate degree stenosis. Female sex in this subgroup also predicted a longer time to recurrent cerebral ischemic events (HR 0.38 95% CI 0.15–0.98, P = 0.045). Further addition of MRI PH or smoking abolished the sex effects with only MRI PH exerting a direct effect. Meta-analysis confirmed a protective effect of female sex on development of PH: unadjusted OR for presence of PH = 0.54 (95% CI 0.45–0.67, p<0.00001). Conclusions MRI PH is significantly less prevalent in women. Women with MRI PH and severe stenosis have a similar risk as men for recurrent cerebrovascular events. MRI PH thus allows overcoming the sex bias in selection for CEA.
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Affiliation(s)
- Neghal Kandiyil
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom
- Vascular Surgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Nishath Altaf
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom
- Vascular Surgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Akram A. Hosseini
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Shane T. MacSweeney
- Vascular Surgery, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Dorothee P. Auer
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
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Kodama T, Narula N, Agozzino M, Arbustini E. Pathology of plaque haemorrhage and neovascularization of coronary artery. J Cardiovasc Med (Hagerstown) 2012; 13:620-7. [DOI: 10.2459/jcm.0b013e328356a5f2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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30
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Koole D, Heyligers J, Moll FL, Pasterkamp G. Intraplaque neovascularization and hemorrhage. J Cardiovasc Med (Hagerstown) 2012; 13:635-9. [DOI: 10.2459/jcm.0b013e3283590cd2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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31
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Turc G, Oppenheim C, Naggara O, Eker OF, Calvet D, Lacour JC, Crozier S, Guegan-Massardier E, Hénon H, Neau JP, Toussaint JF, Mas JL, Méder JF, Touzé E. Relationships Between Recent Intraplaque Hemorrhage and Stroke Risk Factors in Patients With Carotid Stenosis. Arterioscler Thromb Vasc Biol 2012; 32:492-9. [DOI: 10.1161/atvbaha.111.239335] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Intraplaque hemorrhage (IPH) is an emerging marker of plaque instability. However, little is known about the relationships between IPH and traditional risk factors and whether these relationships differ between symptomatic and asymptomatic disease.
Methods and Results—
Two hundred thirty-four patients with symptomatic (n=114) or asymptomatic (n=120) carotid stenosis underwent high-resolution plaque magnetic resonance imaging. Seventy-five patients had recent IPH (symptomatic, 33%; asymptomatic, 31%). In symptomatic stenosis, recent IPH was independently associated with degree of stenosis (odds ratio [OR]=4.21, 1.61–10.98 for North American Symptomatic Carotid Endarterectomy Trial >35%; OR=2.92, 1.18–7.24 for European Carotid Surgery Trial >60%), qualifying event (OR=4.13; 1.11–15.32 for stroke or hemispheric transient ischemic attack ≥1 hour versus transient ischemic attack <1 hour or ocular symptoms), time from ischemic event (OR=6.65, 1.56–28.35 for ≤2 weeks; OR=2.24, 0.87–5.81 for 2–12 weeks versus >12 weeks;
P
for trend=0.03). In asymptomatic stenosis, IPH was only associated with stenosis severity >70% by ECST (OR=6.65; 1.95–22.73) but not by the NASCET method.
Conclusion—
Our findings support the potential link between recent IPH and risk of ipsilateral stroke in symptomatic disease but also imply that prognostic studies should adjust for known stroke risk factors in multivariate analyses. In asymptomatic stenosis, the potential predictive value of recent IPH is less likely to be confounded by stroke risk factors.
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Affiliation(s)
- Guillaume Turc
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Catherine Oppenheim
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Olivier Naggara
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Omer F. Eker
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - David Calvet
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Christophe Lacour
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Sophie Crozier
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Evelyne Guegan-Massardier
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Hilde Hénon
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Philippe Neau
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-François Toussaint
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-Louis Mas
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Jean-François Méder
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
| | - Emmanuel Touzé
- From the Department of Neurology, Hôpital Sainte Anne, Paris, France, and Université Paris Descartes, Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale UMR S894 (G.T., D.C., J.-L.M., E.T.), Department of Radiology, Hôpital Sainte-Anne, Paris, France (C.O., O.N., O.F.E., J.-F.M.); Centre Hospitalier Universitaire (CHU), Nancy (J.-C.L.); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre Marie Curie Paris (S.C.); CHU Rouen (E.G.-M.); CHRU Lille (H.H.); Centre
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Derksen WJM, Peeters W, van Lammeren GW, Tersteeg C, de Vries JPPM, de Kleijn DPV, Moll FL, van der Wal AC, Pasterkamp G, Vink A. Different stages of intraplaque hemorrhage are associated with different plaque phenotypes: A large histopathological study in 794 carotid and 276 femoral endarterectomy specimens. Atherosclerosis 2011; 218:369-77. [PMID: 21868015 DOI: 10.1016/j.atherosclerosis.2011.07.104] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 07/12/2011] [Accepted: 07/23/2011] [Indexed: 11/15/2022]
Affiliation(s)
- Wouter J M Derksen
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
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33
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Michel JB, Virmani R, Arbustini E, Pasterkamp G. Intraplaque haemorrhages as the trigger of plaque vulnerability. Eur Heart J 2011; 32:1977-85, 1985a, 1985b, 1985c. [PMID: 21398643 PMCID: PMC3155759 DOI: 10.1093/eurheartj/ehr054] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Atherothrombosis remains one of the main causes of morbidity and mortality in the western countries. Human atherothrombotic disease begins early in life in relation to circulating lipid retention in the inner vascular wall. Risk factors enhance the progression towards clinical expression: dyslipidaemia, diabetes, smoking, hypertension, ageing, etc. The evolution from the initial lipid retention in the arterial wall to clinical events is a continuum of increasingly complex biological processes. Current strategies to fight the consequences of atherothrombosis are orientated either towards the promotion of a healthy life style and preventive treatment of risk factors, or towards late interventional strategies. Despite this therapeutic arsenal, the incidence of clinical events remains dramatically high, dependent, at least in part, on the increasing frequency of type 2 diabetes and ageing. But some medical treatments, focusing only on prevention of the metabolic risk, have failed to reduce cardiovascular mortality, thus illustrating that our understanding of the pathophysiology of human atherothrombosis leading to clinical events remain incomplete. New paradigms are now emerging which may give rise to novel experimental strategies to improve therapeutic efficacy and prediction of disease progression. Recent studies strengthen the concept that the intraplaque neovascularization and bleeding (Figure 1, upper panel) are events that could play a major role in plaque progression and leucocyte infiltration, and may also serve as a measure of risk for the development of future events. The recent advances in our understanding of IntraPlaque Hemorrhage as a critical event in triggering acute clinical events have important implications for clinical research and possibly future clinical practice.
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Affiliation(s)
- Jean-Baptiste Michel
- UMR 698 Inserm, Paris 7-Denis Diderot University, Xavier Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France.
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