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Hikima MS, Lawal Y, Isyaku K, Kazaure IS, Suwaid MA, Ismail A. Spectrum of carotid arterial Doppler abnormalities among stroke patients at a tertiary care centre in North West Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:262-269. [PMID: 38988420 PMCID: PMC11232792 DOI: 10.4103/jwas.jwas_34_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/06/2023] [Indexed: 07/12/2024]
Abstract
Background Stroke is the second most common cause of death worldwide. It also represents one of the most common causes of disability, affecting both children and adults. The identification of risk factors for stroke is critical in preventing its occurrence. Carotid atherosclerosis is one of the most significant risk factors of stroke, yet it is not routinely evaluated in these patients. Materials and Methods We prospectively recruited 119 patients aged ≥18 years with stroke confirmed by computed tomography scan. The risk factors for stroke in these patients were identified, and carotid artery Doppler was performed to identify those with atherosclerosis. Results Eighty-one (68%) of the 119 subjects showed abnormalities in the carotid arteries in the form of increased IMT or atheromatous plaque. The mean ± SD IMT of the right common carotid artery (CCA) was 1.07 ± 0.25 mm and 1.08 ± 0.26 mm for the left CCA. The IMT mean ± SD of the right and left ICA were 0.99 ± 0.18 mm and 0.99 ± 0.17 mm, respectively. There were 36 patients (30.2%) with atheromatous plaques, of which 57.8% were unstable and liable to rupture. The carotid bulbs were the most common sites for plaques, accounting for 47.2% of cases. No abnormalities in velocimetric indices were recorded. Conclusion Carotid atherosclerosis is common in stroke patients and is a major risk factor. The evaluation of stroke patients for carotid atherosclerosis is rarely done, as most of the subjects examined only had it for the first time in this study after development of stroke.
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Affiliation(s)
| | - Yusuf Lawal
- Department of Radiology, Faculty of Clinical Sciences, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Kabir Isyaku
- Department of Radiology, Faculty of Clinical Sciences, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Idris Sule Kazaure
- Department of Radiology, Faculty of Clinical Sciences, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muhammad Abba Suwaid
- Department of Radiology, Faculty of Clinical Sciences, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Anas Ismail
- Department of Radiology, Faculty of Clinical Sciences, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
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Sebastian SA, Co EL, Tidd-Johnson A, Chowdhury S, Jain E, Davidson M, Johal G. Usefulness of Carotid Ultrasound Screening in Primary Cardiovascular Prevention: A Systematic Review. Curr Probl Cardiol 2024; 49:102147. [PMID: 37863454 DOI: 10.1016/j.cpcardiol.2023.102147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and its prevention is more cost-effective than the treatment of its complications. Although cardiovascular (CV) risk assessment based on conventional risk factors is the general recommendation, a significant percentage of the population, irrespective of these risk factors, present with subclinical atherosclerosis during carotid Doppler ultrasound (US) imaging. Subclinical atherosclerotic lesions at the carotid bifurcations may be related to the incidence of future CV events and occult atherosclerotic coronary disease. Such patients might benefit from preventive measures if the carotid Doppler US is allowed as a screening tool to detect the extent of carotid stenosis. We aimed to conduct a comprehensive and systematic evaluation of the impact of carotid US screening on CV risk stratification. METHODS We searched PubMed, Scopus, and ScienceDirect from inception until July 2023. We included literature that examined the impact of carotid US screening on cardiovascular risk factor (CVRF) prevention, CV events, and mortality in adults of all age groups free of symptomatic carotid artery disease. RESULTS We identified 2 randomized controlled trials (RCTs) and 9 observational studies, including 21,046 participants. The mean age of the participants was 49, and 53% were female. Two RCTs, with 7,064 participants, examined the impact of pictorial knowledge about subclinical carotid atherosclerosis using carotid US versus traditional CVD risk evaluation without any US evidence in primary cardiovascular prevention. Both studies reported remarkable improvement in medication adherence at 1 to 3-year follow-up after carotid US screening with a decrease in Framingham risk score (FRS). Nine observational studies with 13, 982 participants analyzed the evidence of atherosclerosis on carotid US screening and demonstrated that it is a beneficial tool in the early identification of subclinical atherosclerosis and effective therapeutic intervention. CONCLUSION This systematic review found that pictorial presentation of silent atherosclerosis using carotid US screening has a contributory role in CV risk stratification and prevention of CVD.
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Affiliation(s)
| | - Edzel Lorraine Co
- Department of Internal Medicine, University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | | | - Selia Chowdhury
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Esha Jain
- Department of Family Medicine, Cooper University Hospital, Camden, NJ, USA
| | | | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, USA
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Shahbaz R, Charpentier E, Ponnaiah M, Deshours F, Kokabi H, Brochériou I, Le Naour G, Redheuil A, Koskas F, Davaine JM. In vitro analysis of carotid lesions using a preliminary microwave sensor to detect vulnerable plaques: Correlation with histology, Duplex ultrasound examination, and computed tomography scanner: The Imaging and Microwave Phenotyping Assessment of Carotid stenosis Threat (IMPACT) study. JVS Vasc Sci 2023; 5:100182. [PMID: 38384784 PMCID: PMC10879004 DOI: 10.1016/j.jvssci.2023.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/03/2023] [Indexed: 02/23/2024] Open
Abstract
Objective Progress in best medical treatment have made identification of best candidates for carotid surgery more difficult. New diagnostic modalities could be helpful in this perspective. Microwaves (MWs) can quantify dielectric properties (complex relative permittivity) of biological tissues and MW technology has emerged as a promising field of research for distinguishing abnormal tissues from healthy ones. We here evaluated the ability of a dedicated MW sensor developed in our laboratory to identify vulnerable carotid lesions. Methods We included 50 carotid lesions in this study. The plaques were analyzed and classified preoperatively by ultrasound (US) examination, computed tomography angiography and tested postoperatively using a MW sensor. Histopathological analysis was used as a gold standard to separate vulnerable plaques (VPs) from nonvulnerable plaques (NVPs). Results VPs were more frequently types 2 or 3 plaques (on US examination), had a greater proportion of low (<60 Hounsfield unit) and moderate (60-130 Hounsfield unit) attenuation components (computed tomography angiography) and displayed higher dielectric constant values (MW) than NVPs, which had an opposite profile. NVPs were more frequently asymptomatic plaques compared with VPs (P = .035). Multivariate analysis showed that US examination and MW identified VPs with a sensitivity of 77% and a specificity of 76% (cutoff value, -0.045; area under the curve, 0.848; P < .0001). Conclusions We found that the presence of types 2 to 3 (on US examination) and high dielectric constant plaques in vitro was highly indicative of a VP based on histological analysis. Further studies are needed to determine the potential of MW to identify the most dangerous asymptomatic carotid lesions.
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Affiliation(s)
- Rania Shahbaz
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Etienne Charpentier
- Sorbonne Université, Unité d'imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Maharajah Ponnaiah
- IHU ICAN, Foundation for Innovation in Cardiometabolism and Nutrition, Pitié Salpêtrière Hospital, Paris, France
| | - Frédérique Deshours
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Hamid Kokabi
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | | | - Gilles Le Naour
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Alban Redheuil
- Sorbonne Université, Unité d'imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Fabien Koskas
- Department of Vascular and Endovascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jean-Michel Davaine
- Medicine Faculty, Sorbonne Université, Paris, France
- Department of Vascular and Endovascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
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Iluţ S, Vesa ŞC, Văcăraş V, Şipoş-Lascu D, Bârsan C, Pop RM, Crişan S, Macarie AE, Coadă CA, Perju-Dumbravă L, Muresanu DF, Buzoianu AD. Association among VKORC1 rs9923231, CYP4F2 rs2108622, GGCX rs11676382 polymorphisms and acute ischemic stroke. Medicine (Baltimore) 2023; 102:e34836. [PMID: 37653796 PMCID: PMC10470791 DOI: 10.1097/md.0000000000034836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Acute ischemic stroke is a major cause of morbidity and mortality worldwide, and genetic factors play a role in the risk of stroke. Single nucleotide polymorphisms (SNPs) in the VKORC1, CYP4F2, and GGCX genes have been linked to clinical outcomes, such as bleeding and cardiovascular diseases. This study aimed to investigate the association between specific polymorphisms in these genes and the risk of developing the first episode of acute ischemic stroke in patients without a known embolic source. This retrospective, cross-sectional, observational, analytical, case-control study included adult patients diagnosed with acute ischemic stroke. The SNPs in VKORC1 rs9923231, CYP4F2 rs2108622, GGCX rs11676382 genes were genotyped and analyzed together with the demographic and clinical factors of the 2 groups of patients. The presence of SNPs in VKORC1 or CYP4F2 genes significantly increased the risk of ischemic stroke in the context of smoking, arterial hypertension, and carotid plaque burden. The multivariate logistic model revealed that smoking (odds ratio [OR] = 3.920; P < .001), the presence of carotid plaques (OR = 2.661; P < .001) and low-density lipoprotein cholesterol values >77 mg/dL (OR = 2.574; P < .001) were independently associated with stroke. Polymorphisms in the VKORC1 and CYP4F2 genes may increase the risk of ischemic stroke in patients without a determined embolic source. Smoking, the presence of carotid plaques, and high low-density lipoprotein cholesterol levels were reconfirmed as important factors associated with ischemic stroke.
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Affiliation(s)
- Silvina Iluţ
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ştefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vitalie Văcăraş
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Şipoş-Lascu
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Bârsan
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorin Crişan
- Department of Internal Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Antonia Eugenia Macarie
- Department of Geriatrics-Gerontology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Lăcrămioara Perju-Dumbravă
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dafin Fior Muresanu
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Muhammed H, Misra DP, Jain N, Ganguly S, Pattanaik SS, Rai MK, Anuja AK, Mohindra N, Kumar S, Agarwal V. The comparison of cardiovascular disease risk prediction scores and evaluation of subclinical atherosclerosis in rheumatoid arthritis: a cross-sectional study. Clin Rheumatol 2022; 41:3675-3686. [PMID: 36006556 DOI: 10.1007/s10067-022-06349-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/28/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Primary objectives estimated prevalence of traditional cardiovascular disease (CVD) risk factors and compared different CVD risk prediction algorithms in an Indian rheumatoid arthritis (RA) population. Secondary objectives evaluated associations between carotid intima-media thickness (CIMT) and subclinical atherosclerosis (SCA) with CVD risk factors and CVD risk scores. METHODS The presence of CVD risk factors were recorded, and 10-year CVD risk was predicted using Framingham risk scoring (FRS) using lipids (FRS-Lipids), FRS using body mass index (FRS-BMI), QRISK-2, SCORE, and the algorithm recommended by ACC/AHA (ASCVD). CIMT was measured on the far-wall of the common carotid artery. Subclinical atherosclerosis was defined as CIMT > 0.9 mm or the presence of carotid plaque. RESULTS A total of 332 patents were enrolled, 12% had diabetes mellitus, 21.4% hypertension, and 6.9% were current/past smokers. Proportions of RA with predicted 10-year CVD risk > 10% varied from 16.2 to 41.9% between scores. Highest magnitude of risk was predicted by FRS-BMI. Agreement between scores in predicting risk was moderate in general. Mean CIMT was 0.70 ± 0.15 mm. Age, male sex, and extra-articular manifestations associated with greater CIMT. All risk scores except SCORE moderately correlated with CIMT. About one-seventh had SCA defined as CIMT > 0.9 mm or the presence of carotid plaques, associated with increasing age, male gender, or higher ratio of total cholesterol to high-density lipoprotein cholesterol. ASCVD and QRISK-2 scores had maximum area under curve for distinguishing SCA. CONCLUSION Individual CVD risk scores predict 10-year CVD risk differently in Indian patients with RA, and require validation for predicting hard end points (CVD events, mortality). Key Points • Diabetes mellitus and hypertension are the most prevalent cardiovascular disease risk factors in Indian patients with RA. • Individual cardiovascular risk prediction scores predict risk differently in Indian patients with RA, highest risk being predicted by the FRS-BMI. • Carotid intima-media thickness in RA associated with increasing age, male sex and extra-articular manifestations. • 14% RA had subclinical atherosclerosis, associated with increasing age, male sex, and higher total cholesterol to HDL-C ratio, best distinguished by ASCVD and QRISK-2 scores.
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Affiliation(s)
- Hafis Muhammed
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Neeraj Jain
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sujata Ganguly
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sarit Sekhar Pattanaik
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohit K Rai
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anamika Kumari Anuja
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Namita Mohindra
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Fatty Liver as Potential Biomarker of Atherosclerotic Damage in Familial Combined Hyperlipidemia. Biomedicines 2022; 10:biomedicines10081770. [PMID: 35892670 PMCID: PMC9332610 DOI: 10.3390/biomedicines10081770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022] Open
Abstract
Familial combined hyperlipidemia (FCH) is a very common inherited lipid disorder, characterized by a high risk of developing cardiovascular (CV) disease and metabolic complications, including insulin resistance (IR) and type 2 diabetes mellitus (T2DM). The prevalence of non-alcoholic fatty liver disease (NAFLD) is increased in FCH patients, especially in those with IR or T2DM. However, it is unknown how precociously metabolic and cardiovascular complications appear in FCH patients. We aimed to evaluate the prevalence of NAFLD and to assess CV risk in newly diagnosed insulin-sensitive FCH patients. From a database including 16,504 patients, 110 insulin-sensitive FCH patients were selected by general practitioners and referred to the Lipid Center. Lipid profile, fasting plasma glucose and insulin were determined by standard methods. Based on the results of the hospital screening, 96 patients were finally included (mean age 52.2 ± 9.8 years; 44 males, 52 females). All participants underwent carotid ultrasound to assess carotid intima media thickness (cIMT), presence or absence of plaque, and pulse wave velocity (PWV). Liver steatosis was assessed by both hepatic steatosis index (HSI) and abdomen ultrasound (US). Liver fibrosis was non-invasively assessed by transient elastography (TE) and by fibrosis 4 score (FIB-4) index. Carotid plaque was found in 44 out of 96 (45.8%) patients, liver steatosis was found in 68 out of 96 (70.8%) and in 41 out of 96 (42.7%) patients by US examination and HSI, respectively. Overall, 72 subjects (75%) were diagnosed with steatosis by either ultrasound or HSI, while 24 (25%) had steatosis excluded (steatosis excluded by both US and HSI). Patients with liver steatosis had a significantly higher body mass index (BMI) compared to those without (p < 0.05). Steatosis correlated with fasting insulin (p < 0.05), liver stiffness (p < 0.05), BMI (p < 0.001), and inversely with high-density lipoprotein cholesterol (p < 0.05). Fibrosis assessed by TE was significantly associated with BMI (p < 0.001) and cIMT (p < 0.05); fibrosis assessed by FIB-4 was significantly associated with sex (p < 0.05), cIMT (p < 0.05), and atherosclerotic plaque (p < 0.05). The presence of any grade of liver fibrosis was significantly associated with atherosclerotic plaque in the multivariable model, independent of alcohol habit, sex, HSI score, and liver stiffness by TE (OR 6.863, p < 0.001). In our cohort of newly diagnosed, untreated, insulin-sensitive FCH patients we found a high prevalence of liver steatosis. Indeed, the risk of atherosclerotic plaque was significantly increased in patients with liver fibrosis, suggesting a possible connection between liver disease and CV damage in dyslipidemic patients beyond the insulin resistance hypothesis.
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Tjan A, Widiana IGR, Martadiani ED, Ayusta IMD, Asih MW, Sitanggang FP. Carotid artery stiffness measured by strain elastography ultrasound is a stroke risk factor. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ismail A, Aliyu AM, Ramalan MA. Audit of carotid doppler sonography: Spectrum of findings at a tertiary hospital in Northwestern Nigeria. Ann Afr Med 2020; 19:170-175. [PMID: 32820728 PMCID: PMC7694706 DOI: 10.4103/aam.aam_52_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Doppler sonography of the cervical segment of the carotid arteries is becoming a popular tool for evaluating atherosclerosis of the carotid artery. We present the audit of findings on carotid ultrasound examination among patients with clinical suspicion and risks for cerebrovascular disease and possible correlates in Northern Nigeria. Materials and Methods We performed carotid ultrasound examination on all patients referred for screening and clinical suspicion of cerebrovascular disease within the year 2017. The patients' characteristics, risk factors, presence of atheroma and characteristic of the atheroma, degree of stenotic disease as well as the presence of incidental ultrasound findings were reviewed and documented. Results Out of the 62 patients, 55 (88.7%) of them had various degrees and types of atheromatous plaques in different segments of the cervical carotid arteries, whereas 7 (11.3%) were normal. The predominant risk factor was smoking followed by diabetes mellitus, whereas the highest indication for the scan was transient ischemic attack. Incidental thyroid lesions such as nodules and cysts were encountered in 14 (22.6%) of the patients. There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. Conclusion There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. About one-fifth of our patients had incidental thyroid lesions. Therefore, routine screening of population at risk is highly recommended.
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Affiliation(s)
- Anas Ismail
- Department of Radiology, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
| | - Abdulmalik M Aliyu
- Department of Radiology, Rasheed Shekoni Teaching Hospital, Dutse, Jigawa State, Nigeria
| | - Mansur A Ramalan
- Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
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CYP4F2 and VKORC1 Polymorphisms Amplify the Risk of Carotid Plaque Formation. Genes (Basel) 2020; 11:genes11070822. [PMID: 32698322 PMCID: PMC7396977 DOI: 10.3390/genes11070822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Atherosclerosis represents the process by which fibrous plaques are formed in the arterial wall, increasing its rigidity with a subsequent decrease in blood flow which can lead to several cardiovascular events. Seeing as vitamin K antagonists are involved in the pathogenesis of atherosclerosis, we decided to investigate whether polymorphisms in genes that influence vitamin K metabolism might have an impact in modulating the risk of plaque formation. Patients and Methods: In the current study we included adult patients admitted in the Clinical Municipal Hospital of Cluj-Napoca without any carotid or femoral plaques clinically visible at the initial investigation, and a five year follow-up was subsequently performed. We recorded the following patient characteristics: age at inclusion, gender, area of living, smoking, presence of carotid and/or femoral plaques at five years, ischemic heart disease, arterial hypertension, atrial fibrillation, heart failure, diabetes mellitus, obesity, dyslipidemia, drug (oral anticoagulants, antihypertensives, hypolipidemic, anti-diabetic) use and status for the following gene polymorphisms: VKORC1 1639 G>A, CYP4F2 1347 G>T and GGCX 12970 C>G. Results: We observed that the major predictor of both carotid and femoral plaque formation is represented by ischemic cardiac disease. VKORC1 and CYP4F2 polymorphisms did not predict plaque formation, except for VKORC1 homozygous mutants. Nonetheless, both VKORC1 and CYP4F2 interacted with ischemic cardiac disease, increasing the risk of developing a carotid plaque, while only CYP4F2, but not VKORC1, interacted with ischemic cardiac disease to increase the risk of femoral plaque formation. Conclusions: We documented that CYP4F2 and VKORC1 polymorphisms boost the proinflammatory plaque environment (observed indirectly through the presence of ischemic heart disease), increasing the risk of plaque development.
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Gameraddin M, Abdalmalik B, Ibrahim M, Mahmoud M, Alshoabi SA. Impact of Khat (<i>Catha edulis</i>) Chewing on Carotid Intima-media Thickness. Pak J Biol Sci 2020; 22:226-230. [PMID: 31930866 DOI: 10.3923/pjbs.2019.226.230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Khat has severe adverse socio-economic consequences. It causes serious cardiovascular, neurological and psychiatric problems. The study aimed to evaluate the effect of chewing khat on intima-media thickness (IMT) of the common carotid arteries. MATERIALS AND METHODS This was a descriptive case-control cross-sectional study. A total of 50 participants of chronic regular khat chewers were investigated. B-mode ultrasound 7-10 MHz linear transducers used for assessment of common carotid arteries according to the standard carotid sonography protocol. The IMT was measured and the presence of plaques was assessed. RESULTS The carotid IMT was significantly increased in regular khat chewers more than the controls (p-value = 0.016). The common carotid IMT increased in smokers more than non-smokers among khat chewers (0.6710±0.20687 vs. 0.5789±0.16859 mm). Significant correlations existed between the duration of chewing khat and age with the presence of plaque (p-values = 0.013 and 0.002, respectively). CONCLUSION There is a significant correlation between carotid plaque and longtime khat chewing. Khat is a contributory factor for increasing carotid intima-media thickness and formation of carotid plaques. A combination of khat and smoking produce more thickening of carotid intima-media.
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Yoon MK, Kang JG, Lee SJ, Ihm SH, Huh KB, Kim CS. Relationships between Thigh and Waist Circumference, Hemoglobin Glycation Index, and Carotid Plaque in Patients with Type 2 Diabetes. Endocrinol Metab (Seoul) 2020; 35:319-328. [PMID: 32615716 PMCID: PMC7386106 DOI: 10.3803/enm.2020.35.2.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/07/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study investigated the relationships of thigh and waist circumference with the hemoglobin glycation index (HGI) and carotid atherosclerosis in patients with type 2 diabetes. METHODS This observational study included 3,075 Korean patients with type 2 diabetes, in whom anthropometric measurements and carotid ultrasonography were conducted. HGI was defined as the measured hemoglobin A1c (HbA1c) level minus the predicted HbA1c level, which was calculated using the linear relationship between HbA1c and fasting plasma glucose levels. Carotid atherosclerosis was defined as a clearly isolated focal plaque or focal wall thickening >50% of the surrounding intima-media thickness. RESULTS The frequency of a positive HGI decreased with increasing thigh circumference in men and increased with increasing waist circumference in women after adjusting for potential confounding variables. Thigh and waist circumference had a combined augmentative effect on the likelihood of positive HGI, which was dramatically higher in patients in higher waist-to-thigh ratio quartiles (adjusted odds ratios for the highest compared to the lowest quartile: 1.595 in men and 1.570 in women). Additionally, the larger the thigh circumference, the lower the risk of carotid atherosclerosis, although in women, this relationship lacked significance after adjustment for potential confounders. CONCLUSION HGI was associated with thigh circumference in men and waist circumference in women. In addition, the combination of low thigh circumference and high waist circumference was strongly associated with a higher HGI in Korean patients with type 2 diabetes. In particular, thigh circumference was associated with carotid atherosclerosis in men. However, further longitudinal studies are warranted.
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Affiliation(s)
- Myung Ki Yoon
- Hallym University College of Medicine, Chuncheon,
Korea
| | - Jun Goo Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon,
Korea
| | - Seong Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon,
Korea
| | - Sung-Hee Ihm
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon,
Korea
| | - Kap Bum Huh
- Huh’s Diabetes Center and the 21st Century Diabetes and Vascular Research Institute, Seoul,
Korea
| | - Chul Sik Kim
- Department of Endocrinology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin,
Korea
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12
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Papanikolaou P, Antonopoulos AS, Mastorakou I, Angelopoulos A, Kostoula E, Mystakidi XV, Simantiris S, Galiatsatos N, Oikonomou E, Tousoulis D. Antithrombotic Therapy in Carotid Artery Disease. Curr Pharm Des 2020; 26:2725-2734. [PMID: 32418521 DOI: 10.2174/1381612826666200518111359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022]
Abstract
The management of asymptomatic atherosclerotic carotid artery disease and the role of antithrombotic therapy is of increasing importance for stroke prevention. Non-invasive imaging of carotid plaques can identify high-risk plaque features that are associated with the risk of plaque rupture. Carotid plaque necrosis, hemorrhage, fibrous cap thinning, and the presence of foam cells have all been correlated with the risk of rupture and onset of neurological symptoms in patients with carotid stenosis. Antiplatelets are currently recommended for patients with a history of ischemic stroke and/or significant carotid artery stenosis, with aspirin and clopidogrel being the most widely used and studied agents. The role of dual antiplatelet therapy remains controversial. Moreover, there is scarce evidence on the role of newer anticoagulant agents in stable patients with carotid artery stenosis. In this review article, we discuss the pathophysiology of carotid atherosclerosis, the use of non-invasive imaging for detecting the vulnerable carotid plaque and summarize the existing clinical evidence on the use of antiplatelet and antithrombotic agents in carotid artery disease.
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Affiliation(s)
- Paraskevi Papanikolaou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Irene Mastorakou
- Imaging Department - Onassis Cardiac Surgery Centre, Athens, Greece
| | - Andreas Angelopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Xara-Vasiliki Mystakidi
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Spyros Simantiris
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Nikolaos Galiatsatos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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13
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Sitthisombat P, Soontrapa S, Kaewrudee S, Sothornwit J, Eamudomkarn N, Promsorn J, Takong W, Somboonporn W. Carotid plaque and lumbar bone mineral density status in post-menopausal women: An age-matched, analytical cross-sectional study. Post Reprod Health 2020; 26:9-18. [PMID: 31795810 DOI: 10.1177/2053369119890746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ObjectiveTo explore the association between carotid plaque and lumbar spine osteoporosis in post-menopausal women.Study designAge-matched, cross-sectional study.Main outcome measuresCarotid plaque and carotid intima media thickness were measured with B-mode ultrasound. Lumbar spine bone mineral density was measured with dual-energy X-ray absorptiometry. Prevalence odds ratios and the respective 95% confidence intervals (95%CI) were calculated to determine the association.ResultsSeventy-two post-menopausal women with lumbar spine osteoporosis and 72 post-menopausal women with normal lumbar spine bone mineral density were enrolled. The adjusted prevalence odds ratio of carotid plaque presence in post-menopausal women with lumbar spine osteoporosis was 1.73 (95%CI; 0.60 to 4.94) when compared to post-menopausal women with normal lumbar spine bone mineral density. The presence of vulnerable plaque was greater in post-menopausal women with lumbar spine osteoporosis; however, the difference was not statistically significant after adjusting for other risk factors of cardiovascular disease (odds ratio 1.31; 95%CI; 0.39 to 4.43). There was no significant difference in carotid intima media thickness between the two groups. Multiple logistic regression analysis with backward elimination in assessment of potential risk factors for the presence of carotid plaque showed that the year since menopause, family history of cardiovascular disease and systolic blood pressure were nominally significant associated factors with a respective adjusted odds ratio of 1.06 (95%CI; 1.01 to 1.12), 6.23 (95%CI; 1.65 to 23.46) and 1.03 (95%CI; 1.01 to 1.06).ConclusionsThe current study indicates that lumbar spine osteoporosis is not associated with the presence of carotid plaque, whereas year since menopause, family history of cardiovascular disease and systolic blood pressure are associated factors.
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Affiliation(s)
- Patraporn Sitthisombat
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sukree Soontrapa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Srinaree Kaewrudee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jen Sothornwit
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nuntasiri Eamudomkarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Julaluck Promsorn
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wittawat Takong
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Woraluk Somboonporn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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14
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Bornachea O, Benitez-Amaro A, Vea A, Nasarre L, de Gonzalo-Calvo D, Escola-Gil JC, Cedo L, Iborra A, Martínez-Martínez L, Juarez C, Camara JA, Espinet C, Borrell-Pages M, Badimon L, Castell J, Llorente-Cortés V. Immunization with the Gly 1127-Cys 1140 amino acid sequence of the LRP1 receptor reduces atherosclerosis in rabbits. Molecular, immunohistochemical and nuclear imaging studies. Am J Cancer Res 2020; 10:3263-3280. [PMID: 32194867 PMCID: PMC7053206 DOI: 10.7150/thno.37305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/31/2019] [Indexed: 02/02/2023] Open
Abstract
Background: The LRP1 (CR9) domain and, in particular, the sequence Gly1127-Cys1140 (P3) plays a critical role in the binding and internalization of aggregated LDL (agLDL). We aimed to evaluate whether immunization with P3 reduces high-fat diet (HFD)-induced atherosclerosis. Methods: Female New Zealand White (NZW) rabbits were immunized with a primary injection and four reminder doses (R1-R4) of IrP (irrelevant peptide) or P3 conjugated to the carrier. IrP and P3-immunized rabbits were randomly divided into a normal diet group and a HFD-fed group. Anti-P3 antibody levels were determined by ELISA. Lipoprotein profile, circulating and tissue lipids, and vascular pro-inflammatory mediators were determined using standardized methods while atherosclerosis was determined by confocal microscopy studies and non-invasive imaging (PET/CT and Doppler ultrasonography). Studies treating human macrophages (hMΦ) and coronary vascular smooth muscle cells (hcVSMC) with rabbit serums were performed to ascertain the potential impact of anti-P3 Abs on the functionality of these crucial cells. Results: P3 immunization specifically induced the production of anti-P3 antibodies (Abs) and did not alter the lipoprotein profile. HFD strongly induced cholesteryl ester (CE) accumulation in the aorta of both the control and IrP groups, and their serum dose-dependently raised the intracellular CE of hMΦ and hcVSMC, promoting TNFR1 and phospho-NF-kB (p65) overexpression. These HFD pro-inflammatory effects were dramatically decreased in the aorta of P3-immunized rabbits and in hMΦ and hcVSMC exposed to the P3 rabbit serums. Microscopy studies revealed that P3 immunization reduced the percentage of lipids, macrophages, and SMCs in the arterial intima, as well as the atherosclerotic extent and lesion area in the aorta. PET/CT and Doppler ultrasonography studies showed that the average standardized uptake value (SUVmean) of the aorta and the arterial resistance index (ARI) of the carotids were more upregulated by HFD in the control and IrP groups than the P3 group. Conclusions: P3 immunization counteracts HFD-induced fatty streak formation in rabbits. The specific blockade of the LRP1 (CR9) domain with Anti-P3 Abs dramatically reduces HFD-induced intracellular CE loading and harmful coupling to pro-inflammatory signaling in the vasculature.
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15
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Seyman EE, Bornstein N, Auriel E, Cohen O, Nissel T, Hallevi H. Assessment of carotid artery ultrasonography in the presence of an acoustic shadow artifact. BMC Neurol 2019; 19:178. [PMID: 31357950 PMCID: PMC6664737 DOI: 10.1186/s12883-019-1405-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background B-mode and Color Doppler ultrasonography (CDUS) are the methods of choice for screening and determining the degree of Carotid artery stenosis. The evaluation of stenosis with calcification may be hampered by a common CDUS artifact known as acoustic shadow (AS). Our objective was to assess the change in reliability of CDUS readings in the presence of an AS artifact. Methods Single center retrospective observational study. Included were patients with either an AS artifact or high-grade stenosis (defined by peak systolic velocity (PSV) > 240 cm/s) demonstrated in CDUS, and had a CT angiography (CTA) done within 6 months of the sonographic exam. All subjects were identified through the Tel-Aviv Sorasky medical center (TASMC) CDUS unit registry from which clinical information was extracted. CDUS images were manually reviewed grading AS magnitude. All CTAs were reviewed and reconstructed for accurate assessment of percent stenosis and were used as gold standard. Results The study cohort included 227 consecutive patients (corresponding with 454 internal carotid arteries) meeting inclusion criteria. 43.2% of the arteries (n = 195) had an AS artifact present on CDUS, regardless of percent stenosis, with a large artifact present in 6.7% arteries (n = 30). Older age was significantly related to the presence of AS artifact (p < 0.001). In the study cohort as a whole there was a strong correlation between percent stenosis on CTA and PSV values (Pearson’s r 0.672, p < 0.001) regardless of AS existence. The CDUS sensitivity and specificity for predicting severe stenosis were 82 and 73% respectively. The presence of a small AS slightly diminished the correlation between CDUS and CTA results without compromising CDUS reliability. A large AS severely affected the correlation between CDUS and CTA exams (Pearson’s r = 0.24, p = 0.27) and reduced CDUS reliability with a sensitivity and specificity of 62%. Conclusion The presence of a large AS severely degrades the accuracy of the routine CDUS measurements. In these cases, the patient should be referred to a CDUS exam including doppler-measurement of periorbital arteries and intracranial arteries in addition to other imaging modalities such as CTA or MRA in order to assess future stroke risk.
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Affiliation(s)
- Estelle E Seyman
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel.
| | - Natan Bornstein
- Department of Neurology Shaarey-Tzedek Medical Center, 12 Shmuel Bait Street, Jerusalem, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
| | - Oren Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
| | - Tania Nissel
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel
| | - Hen Hallevi
- Division of Neurology, Stroke Department, Tel-Aviv Sorasky Medical Center, 6 Weizmann St., Tel Aviv-Jaffa, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv-Jaffa, Israel
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16
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Chait J, Nicoara M, Kibrik P, Ostrozhynskyy Y, Marks N, Rajaee S, Hingorani A, Ascher E. Early hemodynamic characteristics of eversion and patch carotid endarterectomies. J Ultrasound 2019; 22:433-436. [PMID: 31069757 DOI: 10.1007/s40477-019-00384-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Carotid endarterectomy (CEA) is currently the gold standard in the operative management of carotid artery stenosis. While eversion and patch CEAs vary greatly in technique, various studies have determined equivalence with regard to clinical outcomes. However, the hemodynamic differences following each procedure are not known. This study aimed to investigate any early hemodynamic differences between eversion and patch CEAs. METHODS All CEAs performed at our institution from March 2012 to June 2018 were aggregated in a retrospective database by querying the 35301 CPT code from the electronic medical record system. Variables collected included gender, age, laterality of CEA, type of procedure, and pre- and post-operative duplex ultrasound (DUS) date and quantitative findings. Exclusion criteria included any procedure with incomplete data, a post-operative DUS > 90 days following the procedure, CEAs with concomitant bypass(es), isolated external carotid artery (ECA) endarterectomies, and re-do CEAs. RESULTS One hundred and seventy-one CEAs were performed in 161 unique patients. There were 101 males and 60 females, with an average age of 69.7 (38-96; ± 9.36). 63 CEAs were excluded from analysis: 51 due to incomplete data, eight with a > 90 day post-operative DUS, 2 isolated ECA endarterectomies, 1 CEA with a carotid-subclavian bypass, and 1 re-do CEA secondary to an infected patch. Twenty-seven eversion and 81 patch CEAs were included in analysis. There was no difference in procedure laterality or gender between the two cohorts (p > 0.05); however, patients who received an eversion CEA were older on average (73.3 vs 67.5; p = 0.002). Pre-operative peak systolic velocities (PSV) of the proximal internal carotid artery (ICA), distal ICA, and distal common artery (CCA) were all similar (p > 0.05). Post-operative DUS was performed at 17.0 and 12.9 days in the eversion and patch CEA cohorts, respectively (p = 0.12). Post-operative PSV and change in PSV were similar for all three aforementioned segments (p > 0.05). CONCLUSION Although eversion and patch CEAs vary greatly in technique and post-procedure anatomy, there was no significant difference in post-operative PSV or change in PSV at or around the carotid bifurcation.
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Affiliation(s)
- Jesse Chait
- Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA.
| | - Michael Nicoara
- Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Pavel Kibrik
- Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Yuriy Ostrozhynskyy
- Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Natalie Marks
- Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Sareh Rajaee
- Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Anil Hingorani
- Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Enrico Ascher
- Division of Vascular Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
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17
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Omarjee L, Fortrat JO, Larralde A, Pabic EL, Kauffenstein G, Laot M, Navasiolava N, Mention PJ, Carrillo Linares JL, Valdivielso P, Vanakker OM, Mahé G, Martin L, Lefthériotis G. Internal Carotid Artery Hypoplasia: A New Clinical Feature in Pseudoxanthoma Elasticum. J Stroke 2019; 21:108-111. [PMID: 30732446 PMCID: PMC6372903 DOI: 10.5853/jos.2018.02705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/01/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Loukman Omarjee
- Vascular Medicine Department, INSERM CIC1414, Rennes, France.,PXE Reference Center, University Hospital of Angers, Angers, France.,MitoVasc Institute, UMR CNRS 6015-UMR INSERM 1083, Angers University, Angers, France
| | | | - Antoine Larralde
- Radiology and Medical Imaging Department, Rennes University Hospital, Rennes, France
| | - Estelle Le Pabic
- Department of Biostatistics and Methodology, Rennes University Hospital, Rennes, France
| | - Gilles Kauffenstein
- PXE Reference Center, University Hospital of Angers, Angers, France.,MitoVasc Institute, UMR CNRS 6015-UMR INSERM 1083, Angers University, Angers, France
| | - Maxence Laot
- Radiology and Medical Imaging Department, Rennes University Hospital, Rennes, France
| | - Nastassia Navasiolava
- PXE Reference Center, University Hospital of Angers, Angers, France.,MitoVasc Institute, UMR CNRS 6015-UMR INSERM 1083, Angers University, Angers, France
| | | | - Juan Luis Carrillo Linares
- Internal Medicine Unit, Hospital Virgen de la Victoria and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain
| | - Pedro Valdivielso
- Internal Medicine Unit, Hospital Virgen de la Victoria and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain
| | | | - Guillaume Mahé
- Vascular Medicine Department, INSERM CIC1414, Rennes, France
| | - Ludovic Martin
- PXE Reference Center, University Hospital of Angers, Angers, France.,MitoVasc Institute, UMR CNRS 6015-UMR INSERM 1083, Angers University, Angers, France
| | - Georges Lefthériotis
- PXE Reference Center, University Hospital of Angers, Angers, France.,Department of Physiology and Vascular Investigations, University Hospital, Nice, France
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18
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Alserr AH, Elwan H, Antonopoulos CN, Abdelreheem A, Elmahdy H, Sayed A, Taha A, Maratou E, Brountzos E, Khairy H, Liapis CD. Using serum s100-β protein as a biomarker for comparing silent brain injury in carotid endarterectomy and carotid artery stenting. INT ANGIOL 2019; 38:136-142. [PMID: 30650951 DOI: 10.23736/s0392-9590.19.04079-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND S100-β protein has been introduced as a sensitive biomarker of silent cerebral injury. This study compares its serum levels before, during, and 24 hours after carotid artery stenting (CAS) and carotid endarterectomy (CEA). METHODS We measured serum level of S100-β in arterial blood before (S100Ba), during (S100Bb), and 24 hours after (S100Bc) CAS and CEA. We assessed differences in S100-β levels using non-parametric tests. We analyzed the relationship between carotid plaque type (echolucency) and S100-β protein level. We also examined its relation to the oximetry results in the CEA group (ipsilateral and contralateral). RESULTS Thirty patients were enrolled, including 15 CAS and 15 CEA patients, with no significant differences in baseline atherosclerotic characteristics. There was no significant difference in S100Ba or S100Bb levels between CAS and CEA patients. However, a significant difference was found in S100Bc: 331.3 pg/mL (IQ range 56.4-583.5) for CAS vs. 76.3 pg/mL (IQ range 29.7-117.4) for CEA (P=0.01). Type I and II plaques were associated with the higher S100Bc levels in CAS (P=0.048). S100Bc was higher in CEA patients when the contralateral cerebral hemisphere had oximetry values less than 60% (P=0.043). CONCLUSIONS Our study suggests that CAS might produce silent brain injury. Moreover, vulnerable plaques might be associated with higher levels of S100-β protein, especially in CAS. This pilot study demonstrates that S100-β is a useful biomarker for silent brain injury in carotid revascularization. Large scale studies are still needed to confirm these findings.
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Affiliation(s)
- Ayman H Alserr
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece - .,Division of Vascular Surgery, Department of General Surgery, Cairo University Hospital, Cairo, Egypt -
| | - Hussein Elwan
- Division of Vascular Surgery, Department of General Surgery, Cairo University Hospital, Cairo, Egypt
| | | | - Amr Abdelreheem
- Division of Vascular Surgery, Department of General Surgery, Cairo University Hospital, Cairo, Egypt
| | - Hossam Elmahdy
- Division of Vascular Surgery, Department of General Surgery, Cairo University Hospital, Cairo, Egypt
| | - Ahmed Sayed
- Division of Vascular Surgery, Department of General Surgery, Cairo University Hospital, Cairo, Egypt
| | - Ahmed Taha
- Division of Vascular Surgery, Department of General Surgery, Cairo University Hospital, Cairo, Egypt
| | - Eirini Maratou
- Hellenic National Center for Research, Prevention and Treatment of Diabetes Mellitus and its Complications (HNCDC), Athens, Greece
| | - Elias Brountzos
- Department of Interventional Radiology, Attikon University Hospital, Athens, Greece
| | - Hussein Khairy
- Division of Vascular Surgery, Department of General Surgery, Cairo University Hospital, Cairo, Egypt
| | - Christos D Liapis
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
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19
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Rafailidis V, Charitanti A, Tegos T, Destanis E, Chryssogonidis I. Contrast-enhanced ultrasound of the carotid system: a review of the current literature. J Ultrasound 2017; 20:97-109. [PMID: 28592999 DOI: 10.1007/s40477-017-0239-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/01/2016] [Indexed: 12/11/2022] Open
Abstract
Carotid disease is a major current health problem accounting for a significant part of stroke patients. Ultrasound with colour Doppler and spectral analysis is the primary imaging technique used for screening and diagnostic evaluation of the extracranial part of carotid arteries offering identification and grading of carotid disease. However, inherent limitations of this technique include flow-related artefacts like Doppler angle dependence and aliasing artefact which may sometimes hinder complete assessment of a stenotic part of the vessel, potentially failing to address clinically significant differential diagnosis issues. The intravenous use of microbubbles as an US contrast agent has been introduced for the supplementation of conventional technique. The value of contrast-enhanced ultrasound (CEUS) has been investigated in the evaluation of carotid disease leading to promising results. CEUS provides improved flow visualization free of artefacts and detailed plaque surface delineation, thus being able to accurately grade stenosis, identify carotid plaque ulcerations, differentiate occlusion from highly stenotic plaques and identify carotid dissection. Furthermore, microbubbles can be used to identify and grade intraplaque neovascularization, carotid wall inflammation in patients with arteritis, follow-up patients after carotid intervention and assist interventional procedures reducing the need for nephrotoxic contrast agents. The purpose of this review is to present and discuss the current literature regarding the various uses of CEUS in carotid arteries.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloníki, Greece
| | - Afroditi Charitanti
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloníki, Greece
| | - Thomas Tegos
- 1st Neurological Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Evangelos Destanis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloníki, Greece
| | - Ioannis Chryssogonidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636 Thessaloníki, Greece
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