The relationship between the carotid and coronary artery stenosis: a study based on angiography

Assessment of Risk Factors for Coronary Artery Disease and Severity by Coronary Computed Tomography Angiography Imaging

Objective

To investigate the correlation between risk factors for coronary stenosis and the degree of coronary artery stenosis based on coronary computed tomography angiography (CCTA).

Methods

Two hundred seventy-eight patients with coronary artery disease who received treatment in our hospital between January 2020 and January 2021 were selected as the experimental group, and 100 healthy people who received physical examination in our hospital during the same period were selected as the control group (age and gender matched with the study group). The clinical data and CCTA data of the two groups of patients were collected and compared. Computed tomography fractional flow reserve (FFRCT) values were calculated based on the CCTA data of the patients in the study group, risk factors for coronary artery stenosis were analysed and the correlation between the risk factors and CT flow reserve fraction was explored.

Results

The serum total bilirubin (BIL), apolipoprotein A (apoA), low-density lipoprotein cholesterol (LDL-C), uric acid, total cholesterol (TC) and mean platelet volume levels were higher in the experimental group than in the control group (P < 0.05). Unconditional logistic regression analysis showed that LDL-C, uric acid, TC, triglyceride, serum total BIL and apoA were independent risk factors for coronary heart disease (P < 0.05). Serum total BIL (r = 0.27), apoA (r = -0.30), uric acid (r = -0.48), TC (r = -0.35), triglyceride (r = -0.73) and LDL-C (r = -0.65) showed a negative correlation with FFRCT values (P < 0.05). A positive correlation was detected between high-density lipoprotein cholesterol and FFRCT values (r = 0.37, P < 0.05).

Conclusion

Triglycerides, LDL-C, uric acid, TC, serum total BIL and apoA are risk factors for coronary artery stenosis that should be closely monitored and receive active intervention in clinical practice.

Stop Ischemic Event to the Brain: Screening Risk Factors of Cerebrovascular Stenosis in Coronary Artery Disease Patients

OBJECTIVES

In this study, we investigated the difference in risk factors between the 2 diseases, aiming to further clarify who needs to do ischemic cerebrovascular disease (ICVD)-related screening among coronary artery disease (CAD) patients.

METHODS

Clinical data of 326 patients with first-episode CAD from June 1, 2017, to July 31, 2020, in the Chinese PLA General Hospital were retrospectively reviewed. Outcomes, including clinical features and laboratory examination, were taken. Features related to ICVD including the extension of intracranial arterial (internal carotid artery intracranial segment, middle cerebral artery M1 segment, anterior cerebral A1 segment, vertebrobasilar artery intracranial segment, posterior cerebral artery P1 segment) and carotid arterial (internal carotid artery extracranial segment, common carotid artery, subclavian artery) stenosis were detected. Risk factors for the occurrence of ICVD in patients with CAD were analyzed.

RESULTS

Among patients with the onset of CAD, in comparison of the nonstenosis and stenosis of intracranial artery subgroups, there were statistical differences in the onset age, hypertension, and duration of hypertension as well as the biochemical indicators, including high-density lipoprotein and glycosylated hemoglobin. In addition, statistical differences were detected in the onset age as well as the biochemical indicators, including glycosylated hemoglobin and blood glucose serum protein, along with the difference in the degree of cardiovascular stenosis.

CONCLUSIONS

The onset age of CAD was shown to serve as a vital risk factor for ICVD. The primary prevention of ICVD in patients with CAD should lay more emphasis on the management of hypertension and diabetes.

Carotid Artery Doppler: A Possible Non-invasive Diagnostic Approach to Assessing the Severity of Coronary Artery Disease

BACKGROUND AND OBJECTIVES

Carotid artery Doppler ultrasound is being explored for its potential as a non-invasive tool for evaluating coronary artery disease (CAD) severity and cardiovascular risk. This study aimed to investigate the association between carotid Doppler parameters and CAD severity, as determined by the Gensini score (GS) and multi-vessel disease presence.

METHODS

Ninety patients undergoing coronary angiography (CAG) and carotid ultrasound were retrospectively analysed. Carotid Doppler parameters and CAD severity were assessed through bivariate and multivariable analyses.

RESULTS

Among the patients studied, 80% were male, with a mean age of 65.24 years (±9.91). Triple vessel disease (68.9%) and dominant vessel disease (73.3%) were prevalent coronary findings, with a mean GS of 139.2 (±76.6). Increased intima-media thickness (IMT) in the common carotid artery (CCA) and internal carotid artery (ICA) showed significant associations (CCA IMT: OR = 0.312, p = 0.037; ICA IMT: OR = 0.354, p = 0.017) with high GS (>125) and multi-vessel disease. Significant carotid stenosis (>50% diameter stenosis) emerged as an independent predictor of CAD severity. Fibrocalcific plaques, detected in 62.2% of cases, correlated significantly with elevated GS. Plaque burden, especially plaques in >3 locations, indicated a higher likelihood of triple vessel disease and a higher GS.

CONCLUSION

Carotid Doppler parameters, particularly IMT and significant stenosis, are robust predictors of CAD severity, including high GS and multi-vessel disease. Integrating carotid artery assessment into clinical protocols can aid in timely interventions and preventive strategies for CAD management.

The value of coordinated analysis of multimodal atherosclerotic plaque imaging in the assessment of cardiovascular and cerebrovascular events

Background

Although atherosclerosis (AS) can affect multiple vascular beds, previous studies have focused on the analysis of single-site AS plaques.

Objective

The aim of this study is to explore the differences or similarities in the characteristics of atherosclerotic plaque found in the internal carotid artery, cerebral artery, and coronary artery between patients with atherosclerotic cardiovascular disease (ASCVD) and those without events.

Methods

Patients aged ≥ 18 years who underwent both high-resolution vessel wall imaging (HR-VWI) and coronary computed tomography angiography (CCTA) were retrospectively collected and categorized into the ASCVD group and the non-event group. The plaques were then categorized into culprit plaques, non-culprit plaques, and non-event plaques. Plaque morphological data such as stenosis, stenosis grades, plaque length (PL), plaque volume (PV), minimal lumen area (MLA), enhancement grade, and plaque composition data such as calcified plaque volume (CPV), fibrotic plaque volume (FPV), fibro-lipid plaque volume (FLPV), lipid plaque volume (LPV), calcified plaque volume ratio (CPR), fibrotic plaque volume ratio (FPR), fibro-lipid plaque ratio (FLPR), lipid plaque volume ratio (LPR), intraplaque hemorrhage volume (IPHV), and intraplaque hemorrhage volume ratio (IPHR)were recorded and analyzed.

Results

A total of 44 patients (mean age 66 years, SD 9 years, 28 men) were included. In cervicocephalic plaques, the ASCVD group had more severe stenosis grades (p = 0.030) and demonstrated significant differences in LPV, LPR, and CPV (p = 0.044, 0.030, 0.020) compared with the non-event group. In coronary plaques, the ASCVD group had plaques with greater stenosis (p < 0.001), more severe stenosis grades (p < 0.001), larger volumes (p = 0.001), longer length (p = 0.008), larger FLPV (p = 0.012), larger FPV (p = 0.002), and higher FPR (p = 0.043) compared with the non-event group. There were significant differences observed in stenosis (HR-VWI, CCTA: p < 0.001, p < 0.001), stenosis grades (HR-VWI, CCTA: p < 0.001, p < 0.001), plaque length (HR-VWI, CCTA: p = 0.028, p < 0.001), and plaque volume (HR-VWI, CCTA: p = 0.013, p = 0.018) between the non-event plaque, non-culprit plaque, and culprit plaque. In the image analysis of HR-VWI, there were differences observed between IPHR (p < 0.001), LPR (p = 0.001), FPV (p = 0.011), and CPV (p = 0.015) among the three groups of plaques. FLPV and FPV were significantly different among the three different plaque types from the coronary artery (p = 0.043, p = 0.022).

Conclusion

There is a consistent pattern of change in plaque characteristics between the cervicocephalic and coronary arteries in the same patient.

Prevalence and Risk Factors of Carotid Artery Stenosis (CAS) Among Cardiac Surgery Patients

INTRODUCTION

Cardiac disease and carotid atherosclerosis rates have increased in recent years. Carotid artery stenosis (CAS) has been recognized as a high-risk factor of perioperative stroke among cardiac surgery patients.  Aims: The aims of the study are to identify the prevalence and common risk factors of CAS among patients undergoing cardiac surgery that include coronary artery bypass surgery or valvular cardiac surgery.

MATERIALS AND METHODS

This retrospective cross-sectional study was conducted in the radiology department at Medina Cardiac Center, Al Madinah Al-Munawara. The inclusion criteria for the study were patients aged ≥ 20 years who were scheduled for coronary artery bypass surgery or valvular cardiac surgery and had carotid duplex examination before surgery. A Philips X matrix IU22 linear-array ultrasound probe (Philips, Bothell, WA) was used to scan the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery.  Results: Of the 261 patients in this study, 78.5% (n = 205) were male. The mean age of patients was 61.6 ± 11.3 years (median: 62.0; range: 55.5-68.0). The overall prevalence of CAS was 71% (n = 187): 52% (n = 136) with bilateral CAS and 19.5% (n = 51) with unilateral CAS. Age group was significantly associated with bilateral CAS and the severity of CAS (p = 0.001). Diabetes mellitus, hypertension and both diabetes mellitus and hypertension together were significantly associated with CAS status (p < 0.05, for all). A significantly higher proportion of smokers had a mild level of CAS on the left side compared to non-smokers (55.8% vs. 46.5%, p = 0.033). Gender and weight status were not linked to severity of CAS.

CONCLUSION

This study shows a high prevalence of CAS among cardiac surgery patients. In addition, older age, diabetes mellitus, and hypertension were found to be major risk factors for CAS. Gender and weight status were not associated with CAS. Preoperative carotid duplex scan is a useful exam to identify CAS among cardiac surgery patients and, therefore, to predict and reduce postoperative neurological complications.

Perioperative Bilateral Medial Medullary Infarction With "Snake Eyes Appearance": A Case Report

Perioperative bilateral medial medullary infarction (BMMI) cases mimicking acute motor axonal neuropathy (AMAN) under general anesthesia have not been reported. We describe a patient who suffered flaccid quadriplegia and could not wean from mechanical ventilation after emergence from general anesthesia in cardiac surgery. A diagnosis of AMAN was considered, but intravenous immunoglobulin showed little efficacy. Magnetic resonance imaging of the patient later revealed BMMI with "snake eyes appearance," and he was found to have severe vertebral artery stenosis. Considering the association between severe coronary heart disease and cerebrovascular stenosis, we highlight the significance of preoperative evaluation and comprehensive management of the cerebrovascular system for certain patients.

Factors influencing the outcome of cardiogenic cerebral embolism: a literature review

OBJECTIVE

The onset of cardiogenic cerebral embolism is sudden, dangerous, and often has high morbidity and mortality. Improving understanding of factors contributing to outcomes of cardiogenic cerebral embolism will improve prognostic and therapeutic capabilities.

METHODS

Through PubMed and Google Scholar, this paper examined and analyzed the factors implicated in the outcome of patients with cardiogenic cerebral embolism using the key terms 'cardiogenic cerebral embolism', 'atrial fibrillation', 'stroke related diseases', 'collateral circulation', 'emboli profile', 'epigenetic' up to 28 February 2021. Full texts of the retrieved articles were accessed. In general, in these literatures, National Institute Health of Stroke Scale (NIHSS) score ≥ 17, modified Rankin Scale (mRS) score ≥ 2, stroke recurrence, death caused by stroke are regarded as the criteria of poor prognosis. As long as one of these conditions occurs, it is judged as poor prognosis.

RESULTS

Factors influencing patient outcomes including patient outcome include severity of neurological impairment, types and severity of combined heart diseases, establishment of cerebral collateral circulation, treatments, components of emboli causing cardiogenic cerebral embolism, existence and control of other system complications, distribution and expression of inflammatory immune cells and molecules in the course of cardiogenic cerebral embolism, and epigenetic changes related to disease prognosis.

CONCLUSION

Regarding to prevention and treatment of cardiogenic cerebral embolism, the related factors, such as clinical setting, emboli pathological profile, and epigenetic changes should be emphasized so that outcomes and recurrence of cardiogenic cerebral embolism can be improvised.

Predictive Value of Limb Artery Indices and Endothelial Functional Tests for the Degree of Coronary Artery Stenosis in a Diabetic Population

Objective

To investigate the correlation between limb artery indices (brachial-ankle pulse wave velocity and ankle-brachial index), endothelial function index (FMD value), and the degree of coronary artery stenosis in diabetic patients and analyze their values in predicting the degree of coronary artery stenosis.

Methods

The study included 151 patients with type 2 diabetes mellitus and suspected coronary atherosclerotic heart disease. The patients were divided into “coronary atherosclerotic heart disease” (N=94) and “non-coronary atherosclerotic heart disease” (N=57) groups based on the coronary angiographic findings. Within the coronary atherosclerotic heart disease group, the patients were further divided into “low stenosis” (N=47) and “high stenosis” (N=47) subgroups according to their Gensini score. Indicators such as brachial-ankle pulse wave velocity, ankle-brachial index, and FMD value were measured and correlated with the degree of coronary artery stenosis. Logistic regression models were constructed and receiver operating characteristic curves plotted to assess the predictive ability of limb artery and endothelial functional indices for the degree of coronary artery stenosis.

Results

In a diabetic population, FMD value (P=0.003), ankle-brachial index (P=0.004), and brachial-ankle pulse wave velocity (P=0.003) were different in patients with and without coronary atherosclerotic heart disease. In the population with both diabetes mellitus and coronary atherosclerotic heart disease, the ankle-brachial index and FMD value were both independently associated with the degree of coronary artery stenosis (P=0.003). The area under the receiver operating characteristic curve plotted from the combined coefficients of ankle-brachial index and FMD value was 0.773, which is predictive of coronary artery stenosis in diabetic patients.

Conclusion

Ankle-brachial index and FMD value are indicative of the degree of coronary artery stenosis in diabetic patients, and predictive efficacy can be improved by combining the two tests.