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Gürsoy Çoruh A, Peker E, Gülpınar B, Sorgun MH, Elhan AH, Fitoz ÖS. Prediction of degree of carotid stenosis with the transluminal attenuation difference ratio. ACTA ACUST UNITED AC 2021; 26:249-254. [PMID: 32071030 DOI: 10.5152/dir.2019.19259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the diagnostic performance of transluminal attenuation difference (TAD) in predicting the severity of internal carotid artery (ICA) stenosis. METHODS The study cohort consisted of 48 patients with <50% stenosis, 50%-69% stenosis, 70%-99% stenosis, and 51 controls without plaque development in ICA. A total of 143 measurements were performed through right and left internal and common carotid arteries. The TAD ratio was calculated as the difference between the mean attenuation values of the common carotid artery (CCA) and ICA, divided by the MAV of the CCA, multiplied by 100. RESULTS TAD ratio was significantly higher in severe (>70%) stenosis compared with control arteries and low-moderate stenosis. A TAD ratio cutoff of 4.5 predicted 70%-99% stenosis with a sensitivity of 100% and specificity of 93%. The inter- and intraobserver agreements in TAD measurements were almost perfect (ICC, 0.89-0.86). CONCLUSION Assessment of TAD ratio predicts the degree of stenosis in concordance with NASCET system.
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Affiliation(s)
| | - Elif Peker
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Başak Gülpınar
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Mine Hayriye Sorgun
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Ömer Suat Fitoz
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
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Ignatyev IM, Gafurov MR, Krivosheeva NV. Criteria for Carotid Atherosclerotic Plaque Instability. Ann Vasc Surg 2020; 72:340-349. [PMID: 32927044 DOI: 10.1016/j.avsg.2020.08.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The study aim is to determine the criteria for carotid atherosclerotic plaque instability with the use of an advanced ultrasound technology, immunohistochemical analysis, and electron paramagnetic resonance (EPR) and assess their correlations with histologic results. METHODS A total of 92 patients were included in the study and were examined by ultrasound duplex scanning and ultrasound elastography. Plaques harvested during carotid endarterectomy were obtained for histologic analysis, immunofluorescent assay, and EPR spectroscopic measurements. RESULTS Multivariate logistic regression analysis showed that plaques with an area >90 mm2 (odds ratio [OR], 4.05; 95% confidence interval [CI], 1.32-13.2; P = 0.006), plaque volume index > 0.6 cm3 (OR, 2.72; 95% CI, 1.05-9.58; P = 0.04), and juxtaluminal black area ≥8 mm2 (OR, 2.82; 95% CI, 1.22-6. 23; P = 0.02) were statistically significant independent predictors of histologically verified unstable plaques. Unstable plaques occurred in 94% of the patients with these indicators. Significant increases in the number of CD68+ and CD36+ cells (inflammatory markers) and CD31+ cells (neovasculogenesis markers) were revealed in unstable plaques by the immunohistochemical assay. EPR data analysis showed that divalent manganese could serve as a marker of plaque instability. CONCLUSIONS Additional ultrasound criteria, verified by histologic studies, significantly increased the information content for identifying patients with unstable plaques, which can be of great importance in stratifying the risk of ischemic stroke, especially in asymptomatic patients. The degree of calcification is not a mandatory criterion for plaque stabilization.
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Affiliation(s)
- Igor M Ignatyev
- Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia.
| | - Marat R Gafurov
- Institute of Physics of the Kazan (Volga Region) Federal University, Kazan, Russia
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Liu S, Luo Y, Wang C, Tang R, Sheng Z, Xie W, Chai S, Guo Y, Chai C, Yang Q, Fan Z, Chang B, Xia S. Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis. J Magn Reson Imaging 2019; 51:195-204. [PMID: 31069889 DOI: 10.1002/jmri.26778] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Song Liu
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Yu Luo
- Radiology DepartmentTranslational Research Institute of Brain and Brain‐Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine Shanghai China
| | - Chen Wang
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Ruowei Tang
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Zhiguo Sheng
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Weiwei Xie
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Shengting Chai
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Yu Guo
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Chao Chai
- Radiology DepartmentTianjin First Central Hospital Tianjin China
| | - Qi Yang
- Radiology DepartmentXuanwu Hospital, Capital Medical University Beijing China
| | - Zhaoyang Fan
- Biomedical Imaging Research InstituteCedars‐Sinai Medical Center California Los Angeles USA
| | - Binge Chang
- Neurosurgery DepartmentTianjin First Central Hospital Tianjin China
| | - Shuang Xia
- Radiology Department, First Central Clinical CollegeTianjin Medical University Tianjin China
- Radiology DepartmentTianjin First Central Hospital Tianjin China
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Selwaness M, Hameeteman R, Van 't Klooster R, Van den Bouwhuijsen Q, Hofman A, Franco OH, Niessen WJ, Klein S, Vernooij MW, Van der Lugt A, Wentzel JJ. Determinants of carotid atherosclerotic plaque burden in a stroke-free population. Atherosclerosis 2016; 255:186-192. [PMID: 27806835 DOI: 10.1016/j.atherosclerosis.2016.10.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS In a large stroke-free population, we sought to identify cardiovascular risk factors and carotid plaque components associated with carotid plaque burden, lumen volume and stenosis. METHODS The carotid arteries of 1562 stroke-free participants from The Rotterdam Study were imaged on a 1.5-Tesla MRI scanner. Inner and outer wall of the carotid arteries were automatically segmented and lumen volume (mm3), wall volume (outer wall-inner wall) and plaque burden (wall volume/outer wall volume) (%) were quantified. Plaque components were visually determined and luminal stenosis was assessed. We analyzed associations of cardiovascular risk factors and carotid plaque components with plaque burden and lumen volumes using regression analysis. RESULTS We investigated 2821 carotid plaques and found that women had larger plaque burden (50.7 ± 7.8% vs. 49.2 ± 7.7%, p < 0.0001) and smaller lumen volumes (933 ± 286 mm3vs. 1078 ± 334 mm3, p < 0.0001) than men. In women, age, HDL-cholesterol and systolic blood pressure, and in men, total cholesterol, non-HDL cholesterol and statin use were independently associated with higher plaque burden and lumen volume. Furthermore, smoking and diabetes were associated with lumen volume in men (respectively p = 0.04 and p = 0.002). Intraplaque hemorrhage (IPH) and lipid were related to a larger plaque burden (OR 1.30 [1.05-1.60] and OR 1.28[1.06-1.55]). Finally, within the highest quartile of plaque burden, IPH was strongly associated with luminal stenosis independent of age, sex, plaque burden and composition (Beta = 15.2; [11.8-18.6]). CONCLUSIONS Several cardiovascular risk factors and plaque components, in particular IPH, are associated with higher plaque burden. Carotid IPH is strongly associated with an increased luminal stenosis.
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Affiliation(s)
| | - Reinhard Hameeteman
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ronald Van 't Klooster
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Albert Hofman
- Department of Epidemiology, MC, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, MC, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands; Faculty of Applied Sciences, Delft University of Technology, The Netherlands
| | - Stefan Klein
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
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Lu J, Duan W, Qiao A. Finite element analysis of mechanics of neovessels with intraplaque hemorrhage in carotid atherosclerosis. Biomed Eng Online 2015; 14 Suppl 1:S3. [PMID: 25603398 PMCID: PMC4306113 DOI: 10.1186/1475-925x-14-s1-s3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Intraplaque hemorrhage is a widely known factor facilitating plaque instability. Neovascularization of plaque can be regarded as a compensatory response to the blood supply in the deep intimal and medial areas of the artery. Due to the physiological function, the deformation of carotid atherosclerotic plaque would happen under the action of blood pressure and blood flow. Neovessels are subject to mechanical loading and likely undergo deformation. The rupture of neovessels may deteriorate the instability of plaque. This study focuses on the local mechanical environments around neovessels and investigates the relationship between the biomechanics and the morphological specificity of neovessels. Methods Stress and stretch were used to evaluate the rupture risk of the neovessels in plaque. Computational structural analysis was performed based on two human carotid plaque slice samples. Two-dimensional models containing neovessels and other components were built according to the plaque slice samples. Each component was assumed to be non-linear isotropic, piecewise homogeneous and incompressible. Different mechanical boundary conditions, i.e. static pressures, were imposed in the carotid lumen and neovessels lumen respectively. Finite element method was used to simulate the mechanical conditions in the atherosclerotic plaque. Results Those neovessels closer to the carotid lumen undergo larger stress and stretch. With the same distance to the carotid lumen, the longer the perimeter of neovessels is, the larger stress and the deformation of the neovessels will be. Under the same conditions, the neovessels with larger curvature suffer greater stress and stretch. Neovessels surrounded by red blood cells undergo a much larger stretch. Conclusions Local mechanical conditions may result in the hemorrhage of neovessels and accelerate the rupture of plaque. The mechanical environments of the neovessel are related to its shape, curvature, distance to the carotid lumen and the material properties of plaque.
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Adaptation of the main peripheral artery and vein to long term confinement (Mars 500). PLoS One 2014; 9:e83063. [PMID: 24475025 PMCID: PMC3903485 DOI: 10.1371/journal.pone.0083063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 11/07/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose The objective was to check if 520 days in confinement (MARS 500), may affect the main peripheral arterial diameter and wall thickness and the main vein size. Method Common carotid (CC) femoral artery (FA) portal vein (PV), jugular (JG), femoral vein (FV) and tibial vein were assessed during MARS 500 by echography, performed by the subjects. A hand free volumic echographic capture method and a delayed 3D reconstruction software developed by our lab were used for collecting and measuring the vascular parameters. Results During the MARS 500 experiment the subjects performed 6 sessions among which 80% of the echographic data were of sufficient quality to be processed. No significant change was found for the Common carotid, Jugular vein, femoral artery, femoral vein, portal vein, and tibial vein diameter. CC and FA IMT (intima media thickness) were found significantly increased (14% to 28% P<0.05) in all the 6 subjects, during the confinement period and also at +2 days after the confinement period, but there was no significant difference 6 month later compare to pre MARS 500. Conclusion The experiment confirmed that even untrained to performing echography the subjects were able to capture enough echographic data to reconstruct the vessel image from which the parameters were measured. The increase in both CC and FA IMT should be in relation with the stress generated by the confined environment or absence of solar radiation, as there was no change in gravity, temperature and air in the MARS 500 module, and minor changes in physical exercise and nutrition.
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Rodriguez G, Arnaldi D, Campus C, Mazzei D, Ferrara M, Picco A, Famà F, Colombo BM, Nobili F. Correlation between Doppler velocities and duplex ultrasound carotid cross-sectional percent stenosis. Acad Radiol 2011; 18:1485-91. [PMID: 21889897 DOI: 10.1016/j.acra.2011.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 07/25/2011] [Accepted: 07/31/2011] [Indexed: 10/17/2022]
Abstract
RATIONALE AND OBJECTIVES Cross-sectional imaging is being increasingly proposed as a suitable tool to characterize carotid plaques. The aim of this work was to correlate the Doppler velocity parameters with the cross-sectional percent stenosis (CPoS) of internal carotid artery (ICA) and to identify the cutoff values of these parameters in five progressive classes of stenosis area severity (ie, 40%-49%, 50%-59%, 60%-69%, 70%-79%, 80%-90%). MATERIALS AND METHODS High-quality scans from 90 patients (mean age, 74 ± 9 years) with 43%-90% ICA stenosis were analyzed. ICA peak-systolic (PSV) and end-diastolic (EDV) velocities were measured at maximum stenosis level. Total ICA area and residual lumen (RL) were measured to derive the CPoS. A simple physical model described by the equation Velocity = Flow rate/Area was considered. Effectively, the CPoS is expected to negatively correlate with the inverse of velocity parameters, assuming flow rate to be constant. Multiple stepwise regression analyses were used to investigate the relationships between velocity and echographic measures. RESULTS With CPoS as the dependent variable, the first significant regressor was the inverse ICA-EDV (r(2) = 0.64; P < .0001) followed by inverse ICA-PSV (r(2) = 0.43; P < .0001). ICA-EDV mean values throughout five progressive classes of stenosis were: 28 cm/second for 40%-49% stenosis, 35 cm/second for 50%-59%, 43 cm/second for 60%-69%, 69 cm/second for 70%-79%. and 103 cm/second for 80%-90%. ICA-PSV mean values were: 97 cm/second for 40%-49%, 110 cm/second for 50%-59%, 136 cm/second for 60%-69%, 224 cm/second for 70%-79%, and 286 cm/second for 80%-90%. CONCLUSION ICA-EDV is the parameter that better correlates with CPoS. Nevertheless, ICA-PSV maintained a highly significant correlation with CPoS. Moreover, the categorization of Doppler parameters in five progressive classes of severity of stenosis could provide physicians with an easily accessible tool in clinical practice, complementary to the morphological evaluation of cross-sectional stenosis.
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Douglas AF, Christopher S, Amankulor N, Din R, Poullis M, Amin-Hanjani S, Ghogawala Z. Extracranial Carotid Plaque Length and Parent Vessel Diameter Significantly Affect Baseline Ipsilateral Intracranial Blood Flow. Neurosurgery 2011; 69:767-73; discussion 773. [DOI: 10.1227/neu.0b013e31821ff8f4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Chien A, Sayre J, Dong B, Ye J, Viñuela F. 3D quantitative evaluation of atherosclerotic plaque based on rotational angiography. AJNR Am J Neuroradiol 2011; 32:1249-54. [PMID: 21596803 DOI: 10.3174/ajnr.a2483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Atherosclerosis is a systemic disease that has been shown to cause various cardiovascular diseases and stroke. However, technologies to evaluate the volume of atherosclerotic plaque are limited. We present a method for determination of 3D plaque volume based on RA. MATERIALS AND METHODS 3DRA images obtained from patients were used to evaluate the plaque. Six patients who were diagnosed with atherosclerotic lesions were included. The PR model developed for 3DRA was applied to analyze the geometry of the vessel and calculate the plaque volume. To validate the present method, we tested computer-generated phantoms with different degrees of stenosis. RESULTS Application of PR to clinical cases allowed the estimation of plaque morphology and quantification of plaque volume. Technique validation showed that on average, PR can rebuild 92% of the plaque and provide satisfactory determination of plaque volume. CONCLUSIONS A new approach to obtain plaque volume based on 3DRA is presented. The initial tests in 6 clinical cases and validation with different phantoms showed that this method is feasible. Further validation in a larger clinical series is required to assess the ultimate value of the present technique.
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Affiliation(s)
- A Chien
- Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Mohr J, Mast H. Carotid Artery Disease. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lanktree MB, Hegele RA, Schork NJ, Spence JD. Extremes of unexplained variation as a phenotype: an efficient approach for genome-wide association studies of cardiovascular disease. ACTA ACUST UNITED AC 2010; 3:215-21. [PMID: 20407100 DOI: 10.1161/circgenetics.109.934505] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Matthew B Lanktree
- Department of Medicine, Robarts Research Institute, University of Western Ontario, London, Canada
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