Unstable atherosclerotic plaque in the common carotid artery: Diagnosis and treatment strategy

Insulin resistance, vulnerable plaque and stroke risk in patients with carotid artery stenosis

Insulin resistance (IR) is linked to both the vulnerable plaque and the stroke risk. However, the precise extent of this correlation and its impact on stroke risk in carotid artery stenosis patients remain unclear. Therefore, this study aims to investigate the relationship between vulnerable plaque and IR and stroke risk and the mediating role of vulnerable plaque in patients with carotid artery stenosis. This study included 505 patients with carotid artery stenosis. IR was assessed using the triglyceride-glucose (TyG) index. The association of the TyG index and vulnerable plaque with stroke risk was investigated using the restricted cubic splines (RCS)and adjusted Logistic regression. Additionally, the mediation analysis was used to explore the mediating impact of the vulnerable plaque on the association between the TyG index and stroke risk. A total of 184 (36.4%) stroke events were recorded. The RCS curves revealed a positive linear association between TyG index and risk events among patients with carotid artery stenosis (P-value < 0.001 and P for nonlinear = 0.860). After fully adjusting for covariates, both the TyG index and vulnerable plaque emerged as significant predictors of stroke events. Mediation analysis indicated that the vulnerable plaque mediated 18.3%, 15.8%, 13.9%, and 11.6% of the correlation between the TyG index and stroke risk in different adjusted models, respectively. TyG index and vulnerable plaque are associated with a higher risk of stroke in patients with carotid artery stenosis. In addition, vulnerable plaques partially mediated the relationship between TyG index and stroke risk.

The correlation between the cardiovascular instability and the size of the developed ischaemic lesions in patients who underwent carotid stenting

AIMS

In this study we investigated the relationship between cardiovascular instability and the size of the developed ischaemic lesions during carotid stent implantation by diffusion-weighted (DWI) magnetic resonance (MR) examination.

MATERIAL AND METHODS

We retrospectively analyzed anaesthesia reports and follow-up MR examinations after stent implantation of 192 patients in a 3-year period. Nineteen aspects of cardiovascular status were analyzed. We registered the duration of the intervention, low and high blood pressure (BP) values during anaesthesia and heart rates. The fluctuations of BP and heart rate and the time of their compensations after the stent expansion were also recorded. Values were compared with the number and the size of ischaemic lesions on DWI scans. We used Spearman and Kendall rank correlations and Welch's tests for statistical analysis. Values of p ≤ 0.05 were considered as statistically significant.

RESULTS

Decreased heart rate significantly correlated with the number (p = 0.0123) and size (p = 0.00323) of ischaemic lesions during stent expansion. Other cardiovascular parameters did not show any significant correlations.

CONCLUSIONS

Our results indicate that only heart rate attenuation affects the size of ischaemic lesions; thus the prevention of bradycardia is highly important.