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Preemptive Stenting of the Vulnerable Plaque: Fixing a Dogma? J Am Coll Cardiol 2021; 76:2302-2304. [PMID: 33183503 DOI: 10.1016/j.jacc.2020.09.600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 01/24/2023]
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Carotid circumferential wall stress is not associated with cognitive performance among individuals in late middle age: The Maastricht Study. Atherosclerosis 2018; 276:15-22. [PMID: 30006323 DOI: 10.1016/j.atherosclerosis.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/06/2018] [Accepted: 07/03/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Arterial remodelling aims at normalising circumferential wall stress (CWS). Greater CWS in the carotid artery has previously been associated with the prevalence and severity of cerebral small vessel disease, a major cause of ageing-related cognitive decline. Here we test the hypothesis that greater carotid CWS is associated with poorer cognitive performance. METHODS We studied 722 individuals (60 ± 8 years, 55% men, 42.5% highly educated, blood pressure 137 ± 19/77 ± 11 mmHg, n = 197 with type 2 diabetes) who completed a neuropsychological assessment and underwent vascular ultrasound to measure the intima-media thickness (IMT) and interadventitial diameter (IAD) of the left common carotid artery at a plaque-free site. From IMT and IAD, lumen diameter (LD) was calculated. These structural measures were then combined with local carotid pulse pressure and brachial mean arterial pressure to obtain a measure of pulsatile (CWSpulsatile) and average (CWSmean) mechanical load on the vessel wall. Cognitive domains assessed were memory, executive function and attention, and processing speed. RESULTS After adjustment for age, sex, and education, regression analyses showed that neither CWSpulsatile nor CWSmean were associated with measures of cognitive performance (p-values ≥0.31). This null association did not differ by age or educational level, and was observed in both individuals with and without carotid plaque, diabetes and/or hypertension. In addition, none of the individual measures of carotid structure (i.e. IMT, IAD, and LD) was related to cognitive performance. CONCLUSIONS The present cross-sectional study shows that carotid CWS is not associated with cognitive performance, at least not among relatively highly educated individuals in late middle age with adequately controlled cardiovascular risk factors.
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Deficiency of scavenger receptor class B type 1 leads to increased atherogenesis with features of advanced fibroatheroma and expansive arterial remodeling. Cardiovasc Pathol 2016; 27:26-30. [PMID: 28063350 DOI: 10.1016/j.carpath.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/07/2016] [Accepted: 12/12/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Scavenger receptor class B type 1 (SR-BI) is the main high-density lipoprotein (HDL) receptor in mammalians. Loss of SR-BI has been proven to disturb HDL metabolism and accelerate atherosclerosis. However, little is known about the plaque features and arterial remodeling in the increased atherogenesis caused by SR-BI deficiency. Here, we explored this issue in atherosclerosis-prone low-density lipoprotein receptor (LDL-R) knockout (KO) mice deficient of SR-BI. METHODS AND RESULTS SR-BI/LDL-R double KO (dKO) and control LDL-R KO mice were fed an atherogenic diet for 12 weeks. Compared with the plaques in the LDL-R KO controls, which were lipid-dominant and collagen-poor, the plaques in the dKO mice were significantly enlarged, with a massive accumulation of collagen but no significantly increased infiltration of lipids, macrophages, or smooth muscle cells. In addition, the plaques in the brachiocephalic sinus of the dKO mice typically contained a necrotic core topped with a thin fibrotic cap. The increased atherogenesis in the dKO mice led to a following expansion of the vessel walls; therefore, the lumen area in the dKO mice was even slightly enlarged. CONCLUSION We showed here that SR-BI deficiency led to increased atherogenesis with features of advanced fibroatheroma and expansive arterial remodeling in LDL-R KO mice fed an atherogenic diet.
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Szabo K, Kern R, Hennerici MG. Recent Advances in Imaging in Management of Symptomatic Internal Carotid Artery Disease. Int J Stroke 2016; 2:97-103. [DOI: 10.1111/j.1747-4949.2007.00103.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The management of patients with internal carotid artery stenosis needs to focus on the occurrence and identification of neurological symptoms, the degree and morphology of the stenosis and the determination of the mechanism of cerebral ischemia. Thus neuroimaging studies are an integral part of the neurologist's assessment of these patient and individual therapeutic decisions. Since a differentiated approach is not always taken and patients by far too often undergo surgical or interventional treatment without a proper neurological evaluation, the material presented in this review demonstrates the possibilities of such a critical assessment concerning brain and vascular imaging findings and new techniques as well as modern concepts of plaque vulnerability improving the understanding of the pathophysiology and mechanisms of ischemic symptoms in internal carotid artery disease. Furthermore, the results of recent clinical trails that need to be integrated in the optimal treatment plan of these patients are discussed.
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Chi J, Chiu B, Cao Y, Liu X, Wang J, Balu N, Yuan C, Xu J. Assessment of femoral artery atherosclerosis at the adductor canal using 3D black-blood MRI. Clin Radiol 2013; 68:e213-21. [DOI: 10.1016/j.crad.2012.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
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Molecular imaging to identify the vulnerable plaque--from basic research to clinical practice. Mol Imaging Biol 2013; 14:523-33. [PMID: 22983911 DOI: 10.1007/s11307-012-0586-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cardiovascular disease (CVD) is still the leading cause of death in the Western World. Adverse outcomes of CVD include stroke, myocardial infarction, and heart failure. Atherosclerosis is considered to be the major cause of CVD and is estimated to cause half of all deaths in developed countries. Atherosclerotic lesions of the vessel wall may obstruct blood flow mechanically through stenosis, but rupture of atherosclerotic plaques causing formation of occlusive thrombi is far more prevalent. Unfortunately, conventional diagnostic tools fail to assess whether a plaque is vulnerable to rupture. Research over the past decade identified the biological processes that are implicated in the course towards plaque rupture, like cell death and inflammation. Knowledge about plaque biology propelled the development of imaging techniques that target biologic processes in order to predict the vulnerable plaque. This paper discusses novel and existing molecular imaging targets and addresses advantages and disadvantages of these targets and respective imaging techniques in respect of clinical application and socio-economic impact.
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Harrison SC, Zabaneh D, Asselbergs FW, Drenos F, Jones GT, Shah S, Gertow K, Sennblad B, Strawbridge RJ, Gigante B, Holewijn S, De Graaf J, Vermeulen S, Folkersen L, van Rij AM, Baldassarre D, Veglia F, Talmud PJ, Deanfield JE, Agu O, Kivimaki M, Kumari M, Bown MJ, Nyyssönen K, Rauramaa R, Smit AJ, Franco-Cereceda A, Giral P, Mannarino E, Silveira A, Syvänen AC, de Borst GJ, van der Graaf Y, de Faire U, Baas AF, Blankensteijn JD, Wareham NJ, Fowkes G, Tzoulaki I, Price JF, Tremoli E, Hingorani AD, Eriksson P, Hamsten A, Humphries SE. A gene-centric study of common carotid artery remodelling. Atherosclerosis 2012; 226:440-6. [PMID: 23246012 PMCID: PMC3573227 DOI: 10.1016/j.atherosclerosis.2012.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/12/2012] [Accepted: 11/02/2012] [Indexed: 11/30/2022]
Abstract
Background Expansive remodelling is the process of compensatory arterial enlargement in response to atherosclerotic stimuli. The genetic determinants of this process are poorly characterized. Methods Genetic association analyses of inter-adventitial common carotid artery diameter (ICCAD) in the IMPROVE study (n = 3427) using the Illumina 200k Metabochip was performed. Single nucleotide polymorphisms (SNPs) that met array-wide significance were taken forward for analysis in three further studies (n = 5704), and tested for association with Abdominal Aortic Aneurysm (AAA). Results rs3768445 on Chromosome 1q24.3, in a cluster of protein coding genes (DNM3, PIGC, C1orf105) was associated with larger ICCAD in the IMPROVE study. For each copy of the rare allele carried, ICCAD was on average 0.13 mm greater (95% CI 0.08–0.18 mm, P = 8.2 × 10−8). A proxy SNP (rs4916251, R2 = 0.99) did not, however, show association with ICCAD in three follow-up studies (P for replication = 0.29). There was evidence of interaction between carotid intima-media thickness (CIMT) and rs4916251 on ICCAD in two of the cohorts studies suggesting that it plays a role in the remodelling response to atherosclerosis. In meta-analysis of 5 case–control studies pooling data from 5007 cases and 43,630 controls, rs4916251 was associated with presence of AAA 1.10, 95% CI 1.03–1.17, p = 2.8 × 10−3, I2 = 18.8, Q = 0.30). A proxy SNP, rs4916251 was also associated with increased expression of PIGC in aortic tissue, suggesting that this may the mechanism by which this locus affects vascular remodelling. Conclusions Common variation at 1q24.3 is associated with expansive vascular remodelling and risk of AAA. These findings support a hypothesis that pathways involved in systemic vascular remodelling play a role in AAA development.
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Ferreira I, Beijers HJ, Schouten F, Smulders YM, Twisk JW, Stehouwer CD. Clustering of metabolic syndrome traits is associated with maladaptive carotid remodeling and stiffening: a 6-year longitudinal study. Hypertension 2012; 60:542-9. [PMID: 22733470 DOI: 10.1161/hypertensionaha.112.194738] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Maladaptive arterial remodeling may constitute a mechanism underlying the risk of stroke in individuals with the metabolic syndrome (MetS), but evidence supporting this contention derives from cross-sectional studies only. We, therefore, investigated, in apparently healthy adults, whether changes in MetS status between the ages of 36 and 42 years (never [n=207, reference group], incident [n=31], recovery [n=23], and persistent [n=32]) were associated with changes in carotid interadventitial diameter, lumen diameter, intima-media thickness, circumferential wall tension and stress, and Young's elastic modulus. All data analyses were adjusted for sex, height, and (changes in) age, lifestyle variables, low-density lipoprotein cholesterol, and use of antihypertensive medication. At baseline and as compared with the reference group, individuals with persistent MetS had significantly higher interadventitial diameter, circumferential wall tension, circumferential wall stress, and Young's elastic modulus but not intima-media thickness. In the course of follow-up, these individuals (versus reference group) displayed significantly steeper increases in intima-media thickness (0.011 versus 0.005 mm/y), which were accompanied by significantly steeper increases in interadventitial diameter (0.077 versus 0.032 mm/y) and lumen diameter (0.055 versus 0.023 mm/y) but not circumferential wall stress, which decreased (-0.34 versus 0.12 kPa/y). These findings suggest that increases in intima-media thickness in young adults with the MetS may primarily reflect an adaptive mechanism that attempts to restore local hemodynamic conditions to an equilibrium rather than atherosclerosis, per se. However, carotid adaptations did not restore circumferential wall stress to levels comparable with those of the reference group, and, therefore, outward remodeling was maladaptive. Importantly, individuals who recovered from the MetS restored carotid properties to levels comparable to the reference group, emphasizing the potential for reversibility.
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Affiliation(s)
- Isabel Ferreira
- Department of Internal Medicine, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands.
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Ichikawa H, Mukai M, Katoh H, Hieda S, Murakami H, Kawamura M. Cerebral Microbleeds and Dilative Remodeling of the Basilar Artery: A Magnetic Resonance Imaging Study. J Stroke Cerebrovasc Dis 2011; 20:429-35. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 02/17/2010] [Accepted: 02/19/2010] [Indexed: 11/16/2022] Open
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Beijers HJBH, Henry RMA, Bravenboer B, Ferreira I, Dekker JM, Nijpels G, Stehouwer CDA. Metabolic syndrome in nondiabetic individuals associated with maladaptive carotid remodeling: the Hoorn Study. Am J Hypertens 2011; 24:429-36. [PMID: 21212746 DOI: 10.1038/ajh.2010.256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MetS) is associated with an increased risk of stroke. Arterial remodeling could play an important role herein as maladaptive remodeling is a risk factor for stroke. The purpose of this study was to investigate whether MetS was associated with maladaptive remodeling of the carotid artery and if any such association was independent of hemodynamic variables. METHODS We studied 385 (n = 195 women) nondiabetic, elderly subjects. A MetS z-score (average of sex-specific z-scores of the five MetS traits) was constructed. Intima-media thickness (IMT) and interadventitial diameter (IAD) were assessed by ultrasonography, and lumen diameter (LD), and circumferential wall stress (CWS) were calculated. Multiple linear regression analysis was used to investigate the association between MetS and carotid remodeling. RESULTS After adjustment for age, sex, height, prior cardiovascular disease (CVD), dyslipidemia, and smoking, MetS was independently associated with a greater IAD (regression coefficient (β) per s.d. increase in MetS z-score (95% confidence interval), 0.45 mm (0.28; 0.63)), LD (0.41 mm (0.25; 0.58)) and CWS (5.56 kPa (3.71; 7.42)). These associations were attenuated after additional adjustment for inflammatory, metabolic and particularly hemodynamic variables, but remained statistically significant. No significant association was found between MetS and IMT (0.020 mm (-0.006; 0.046)). CONCLUSIONS MetS is associated with maladaptive remodeling of the carotid artery, which is the result of changes in LD, IAD, and, to a lesser extent, IMT. This process is independent of hemodynamic variables. Whether this association and process will be observed in a broader population and explains the increased risk of stroke in MetS deserves further study.
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Cavalcanti Filho JLG, de Souza Leão Lima R, de Souza Machado Neto L, Kayat Bittencourt L, Domingues RC, da Fonseca LMB. PET/CT and vascular disease: current concepts. Eur J Radiol 2011; 80:60-7. [PMID: 21371842 DOI: 10.1016/j.ejrad.2010.12.102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
Abstract
Since its introduction in 2001, positron emission tomography associated to computed tomography (PET/CT) has been established as a standard tool in cancer evaluation. Being a multimodality imaging method, it combines in a single session the sensitivity granted by PET for detection of molecular targets within the picomolar range, with an underlying submilimetric resolution inherent to CT, that can precisely localize the PET findings. In this last decade, there have been new insights regarding the pathophysiology of atherosclerosis, particularly about plaque rupture and vascular remodeling. This has increased the interest for research on PET/CT in vascular diseases as a potential new diagnostic tool, since some PET molecular targets could identify diseases before the manifestation of gross anatomic features. In this review, we will describe the current applications of PET/CT in vascular diseases, emphasizing its usefulness in the settings of vasculitis, aneurysms, vascular graft infection, aortic dissection, and atherosclerosis/plaque vulnerability. Although not being properly peripheral vascular conditions, ischemic cardiovascular disease and cerebrovascular disease will be briefly addressed as well, due to their widespread prevalence and importance.
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Sadeghi MM, Glover DK, Lanza GM, Fayad ZA, Johnson LL. Imaging atherosclerosis and vulnerable plaque. J Nucl Med 2010; 51 Suppl 1:51S-65S. [PMID: 20395341 PMCID: PMC2911776 DOI: 10.2967/jnumed.109.068163] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Identifying patients at high risk for an acute cardiovascular event such as myocardial infarction or stroke and assessing the total atherosclerotic burden are clinically important. Currently available imaging modalities can delineate vascular wall anatomy and, with novel probes, target biologic processes important in plaque evolution and plaque stability. Expansion of the vessel wall involving remodeling of the extracellular matrix can be imaged, as can angiogenesis of the vasa vasorum, plaque inflammation, and fibrin deposits on early nonocclusive vascular thrombosis. Several imaging platforms are available for targeted vascular imaging to acquire information on both anatomy and pathobiology in the same imaging session using either hybrid technology (nuclear combined with CT) or MRI combined with novel probes targeting processes identified by molecular biology to be of importance. This article will discuss the current state of the art of these modalities and challenges to clinical translation.
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Affiliation(s)
- Mehran M. Sadeghi
- Yale University School of Medicine, New Haven, Connecticut, and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
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Ichikawa H, Takahashi N, Mukai M, Katoh H, Akizawa T, Kawamura M. Intracranial dilative arteriopathy is associated with chronic kidney disease and small vessel diseases in the elderly. J Stroke Cerebrovasc Dis 2010; 18:435-42. [PMID: 19900645 DOI: 10.1016/j.jstrokecerebrovasdis.2009.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 01/21/2009] [Accepted: 01/30/2009] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We sought to determine the responsible factors and clinical significance of dilatation of the internal carotid artery (ICA) and basilar artery (BA). METHODS ICA and BA diameters were measured using magnetic resonance imaging (MRI) and their association with age, sex, conventional atherosclerotic factors, and estimated glomerular filtration rate (eGFR) were evaluated in 175 outpatients aged 40 to 89 years. The arterial diameters were measured as the maximal width of the flow void on T2-weighted MRI around the brainstem. The relationship between the arterial diameters and deep white matter hyperintensities (DWMHs) on MRI graded from 0 to 3 was also examined. Comparisons were performed between groups with diameters smaller and larger than the mean value for younger (40-69 years) and older (70-89 years) patients, and multiple regression analysis was conducted. RESULTS Age differed significantly between the larger- and smaller-diameter groups in younger patients, but not in older patients. The larger-diameter group of older patients had a significantly lower eGFR (P = .0002 for ICA, P = .0035 for BA) and a higher DWMH grade (P = .0021 for ICA, P < .0001 for BA) compared to the smaller-diameter group. In multiple regression analysis adjusted for age and sex, a lower eGFR was an independent factor associated with larger arterial diameters (P = .0002 for ICA, P = .0021 for BA). CONCLUSION Kidney dysfunction is an independent factor that is related to ICA and BA dilatation, which is also associated with DWMHs that reflect small vessel diseases in older patients.
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Affiliation(s)
- Hiroo Ichikawa
- Department of Neurology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan.
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Tavakoli S, Sadeghi MM. Imaging of vascular biology in the heart. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yoshida K, Endo H, Sadamasa N, Narumi O, Chin M, Inoue K, Mitsudo K, Yamagata S. Evaluation of carotid artery atherosclerotic plaque distribution by using long-axis high-resolution black-blood magnetic resonance imaging. J Neurosurg 2008; 109:1042-8. [DOI: 10.3171/jns.2008.109.12.1042] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal of this study was to evaluate the usefulness of long-axis black-blood MR (BB–MR) imaging for assessing plaque morphology and distribution in patients with atherosclerotic carotid artery (CA) stenosis.
Methods
Sixty-eight carotid arteries in 67 patients who were scheduled to undergo CA endarterectomy or CA stent placement due to atherosclerotic stenosis were included in this study. The patients had undergone CA BB–MR imaging and digital subtraction (DS) angiography within 3 weeks of revascularization. The DS angiography studies were performed using the transfemoral artery approach with selective common CA catheterization. The BB–MR images were acquired using a 1.5-T whole-body MR imaging unit, and T1-weighted images parallel to the long axis of the artery at 1-mm intervals were obtained. Plaque distribution was evaluated by measuring the distance between the CA bifurcation and the point that appeared to be the distal extent of the plaque on BB–MR imaging (D–MR imaging) and DS angiography images (D–DS angiography).
Results
Plaque distribution was clearly shown in 88.2% of the cases using long-axis BB–MR images, except for 8 arteries with poor image quality. In 4 arteries, D–DS angiography could not be obtained because the distal plaque end could not be confirmed. In 56 vessels, both the D–DS angiography and D–MR imaging could be measured; the mean D–MR imaging (19.75 ± 6.85 mm [standard deviation]) was significantly longer than the average D–DS angiography (16.32 ± 7.07 mm).
Conclusions
Long-axis BB–MR imaging can provide a noninvasive and accurate way to show CA plaque distribution; it is of great use not only for stroke risk assessment in patients with CA atherosclerosis but also for preoperative evaluation in patients requiring CA endarterectomy or CA stent placement.
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Affiliation(s)
| | | | | | | | | | - Katsumi Inoue
- 2Cardiology, Kurashiki Central Hospital, Kurashiki City, Okayama, Japan
| | - Kazuaki Mitsudo
- 2Cardiology, Kurashiki Central Hospital, Kurashiki City, Okayama, Japan
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Palen DI, Matrougui K. Role of elevated EGFR phosphorylation in the induction of structural remodelling and altered mechanical properties of resistance artery from type 2 diabetic mice. Diabetes Metab Res Rev 2008; 24:651-6. [PMID: 18973206 PMCID: PMC2720308 DOI: 10.1002/dmrr.905] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Type 2 diabetes is associated with microvascular complications. We hypothesized that the sustained elevated EGFR phosphorylation produces structural wall remodelling and altered mechanical properties of mesenteric resistance artery (MRA) in type 2 diabetes. METHODS Freshly isolated MRA (80-100 microm diameter) from type 2 diabetic (db(-)/db(-), diabetic) and non-diabetic (db(-)/db(+), control) mice were subjected to pressure-passive diameter and wall thickness relationships; western blot analysis and immunohistology. RESULTS Data indicated that MRA from diabetic mice have a smaller passive diameter than MRA from control mice under intra-luminal pressure range from 25 to 125 mmHg. Measurements of wall thickness : lumen diameter ratios (21 +/- 1.8 vs 14 +/- 1.2 at 75 mmHg diabetic vs control, respectively), wall thickness and remodelling index (38 +/- 5% vs control) revealed eutrophic structural remodelling of MRA from diabetic mice, which was strengthened with histology. Mechanical properties revealed a great strain-stress relationship in MRA from control versus diabetic mice indicating increased stiffness in MRA from diabetic mice. Western blot analysis showed increased collagen type 1 content in a freshly isolated MRA from the type 2 diabetic mice when compared to control mice. Diabetic mice treated with EGFR inhibitor (AG1478, 10 mg/kg/day) for 2 weeks showed reduced EGFR phosphorylation, wall thickness, collagen type 1 content, and improved the altered mechanical properties of MRA. CONCLUSION These data provide evidence regarding the role of EGFR in morphological wall remodelling and altered mechanical properties of MRA from type 2 diabetic mice. This may identify new therapeutic targets for the control of vascular structure and therefore have important implications in type 2 diabetes.
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Affiliation(s)
- Desiree I Palen
- Department of Physiology, Hypertension and Renal Center of Excellence, Tulane University, 1430 Tulane Ave, New Orleans LA 70112, USA
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Raffel OC, Merchant FM, Tearney GJ, Chia S, Gauthier DD, Pomerantsev E, Mizuno K, Bouma BE, Jang IK. In vivo association between positive coronary artery remodelling and coronary plaque characteristics assessed by intravascular optical coherence tomography. Eur Heart J 2008; 29:1721-8. [PMID: 18577556 DOI: 10.1093/eurheartj/ehn286] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Positive coronary arterial remodelling has been shown to be associated with unstable coronary syndromes and ex vivo histological characteristics of plaque vulnerability such as a large lipid core and high macrophage content. The aim of this study is to evaluate the in vivo association between coronary artery remodelling and underlying plaque characteristics identified by optical coherence tomography (OCT). OCT is a unique imaging modality capable of characterizing these important morphological features of vulnerable plaque. METHODS AND RESULTS OCT and intravascular ultrasound imaging was performed at corresponding sites in patients undergoing catheterization. OCT plaque characteristics for lipid content, fibrous cap thickness, and macrophage density were derived using previously validated criteria. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque (two or more quadrants) with fibrous cap thickness <65 microm. Remodelling index (RI) was calculated as the ratio of the lesion to the reference external elastic membrane area. A total of 54 lesions from 48 patients were imaged. Positive remodelling compared with absent or negative remodelling was more commonly associated with lipid-rich plaque (100 vs. 60 vs. 47.4%, P = 0.01), a thin fibrous cap (median 40.2 vs. 51.6 vs. 87 microm, P = 0.003) and the presence of TCFA (80 vs. 38.5 vs. 5.6%, P < 0.001). Fibrous cap macrophage density was also higher in plaques with positive remodelling showing a positive linear correlation with the RI (r = 0.60, P < 0.001). CONCLUSION Coronary plaques with positive remodelling exhibit characteristic features of vulnerable plaque. This may explain the link between positive remodelling and unstable clinical presentations.
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Affiliation(s)
- Owen Christopher Raffel
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRB 800, Boston, MA 02114, USA
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Zweigerdt R. The art of cobbling a running pump--will human embryonic stem cells mend broken hearts? Semin Cell Dev Biol 2007; 18:794-804. [PMID: 18006339 DOI: 10.1016/j.semcdb.2007.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 09/25/2007] [Indexed: 12/20/2022]
Abstract
The heart is one of the least regenerative organs in the body, and highly vulnerable to the increasing incidence of cardiovascular diseases in an aging world population. Cell-based approaches aimed at cardiac repair have recently caused great public excitement. But clinical trials of patients' own skeletal myoblasts or bone marrow cells for transplantation have been disappointing. Human embryonic stem cells (hESCs) form bona fide cardiomyocytes in vitro which are readily generated in mass culture and are being tested in animal models of heart damage. The early results, while encouraging, underscore that much remains to be done. This review focuses on the many challenges that remain before hESCs-mediated repair of the human heart becomes a reality.
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Affiliation(s)
- Robert Zweigerdt
- Institute of Medical Biology, 11 Biopolis Way, # 5-6 Helios, 138667 Singapore, Singapore.
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Johansson ME, Wickman A, Fitzgerald SM, Gan LM, Bergström G. Angiotensin II, type 2 receptor is not involved in the angiotensin II-mediated pro-atherogenic process in ApoE-/- mice. J Hypertens 2005; 23:1541-9. [PMID: 16003181 DOI: 10.1097/01.hjh.0000174078.95745.77] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Angiotensin II (Ang II) accelerates atherogenesis in ApoE mice via the angiotensin II, type 1 receptor (AT1) while the type 2 receptor (AT2) is suggested to counteract atherogenesis. To confirm and further explore this possibility, we studied the effect of AT2 receptor antagonism on Ang II-accelerated atherosclerosis. METHODS ApoE mice were fed a standard or high cholesterol diet (1.25%) for 4 weeks. Mice on each diet were treated with either Ang II (0.5 microg/kg per min) or Ang II in combination with PD123319 (3 mg/kg per day). Plaque distribution was assessed by en face quantification of the thoracic aorta and in cross-sections of the aortic root. Mean arterial pressure (MAP) was measured. AT1 and AT2 receptor expression were analysed using real-time polymerase chain reaction (PCR) and the localization of the AT2 receptor protein confirmed with immunohistochemistry. RESULTS Ang II infusion increased MAP only in mice on a standard diet (P < 0.001). Regardless of diet, Ang II-infused mice had 22-30 times increased plaque area in the thoracic aorta (P < 0.001 for both). Ang II had no effect on plaque in the aortic root. Plaque area was not affected by PD123319. AT2 receptor was heavily expressed in the plaques and increased six- to ninefold by a high cholesterol diet and Ang II infusion (P < 0.01). CONCLUSION Ang II increases the extent of atherosclerosis in ApoE mice. Despite up-regulation of the AT2 receptor, we found no support for an effect of the AT2 receptor on atherogenesis in this model.
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Affiliation(s)
- Maria E Johansson
- Department of Physiology, Institute of Physiology and Pharmacology, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden
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21
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Verhoeven BAN, Pasterkamp G, de Vries JPPM, Ackerstaff RGA, de Kleijn D, Eikelboom BC, Moll FL. Closure of the arteriotomy after carotid endarterectomy: Patch type is related to intraoperative microemboli and restenosis rate. J Vasc Surg 2005; 42:1082-8. [PMID: 16376195 DOI: 10.1016/j.jvs.2005.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 08/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Patch closure after carotid endarterectomy (CEA) improves clinical outcome compared with primary closure. Whether there are differences in outcome between various patch materials is still not clear. The objective of this retrospective study was to investigate whether a relationship exists between the patch type and the number of microemboli as registered during CEA by transcranial Doppler imaging, the clinical outcome (transient ischemic attack and cerebrovascular accident), and the occurrence of restenosis. METHODS We included 319 patients who underwent CEA. Intraoperative microembolus registration was performed in 205 procedures. Microembolization was recorded during four different periods: dissection, shunting, clamp release, and wound closure. The decision to perform primary closure or to use a patch for the closure of the arteriotomy was made by the surgeon, and Dacron patches were used when venous material was insufficient. Cerebral events were recorded within the first month after CEA, and duplex scanning was performed at 3 months (n = 319) and 1 year (n = 166) after CEA. A diameter reduction of more than 70% was defined as restenosis. RESULTS Primary, venous, and Dacron patch closures were performed in 83 (26.0%), 171 (53.6%), and 65 (20.4%) patients, respectively. Primary closure was significantly related to sex (Dacron patch, 35 men and 30 women; venous patch, 108 men and 63 women; primary closure, 72 men and 11 women; P < .001). The occurrence of microemboli during wound closure was also related to sex (women, 2.5 +/- 0.6; men, 1.0 +/- 0.2; P = .01). Additionally, during clamp release, Dacron patches were associated with significantly more microemboli than venous patches (11.1 +/- 3.4 vs 4.0 +/- 0.9; P < .01), and this difference was also noted during wound closure (3.1 +/- 0.9 vs 1.4 +/- 0.4; P < .05). Transient ischemic attacks and minor strokes after CEA occurred in 5 (2.4%) of 205 and 6 (2.9%) of 205 procedures, respectively, and the degree of microembolization during dissection was related to adverse cerebral events (P = .003). In contrast, the type of closure was not related to immediate clinical adverse events. However, primary closure and Dacron patches were associated with an increase in the restenosis rate compared with venous patches: after 400 days, the restenosis rate for Primary closure was 11%, Dacron patch 16%, and venous patch 7% (P = .05; Kaplan-Meier estimates). CONCLUSIONS Microemboli are more prevalent during clamp releases and wound closure when Dacron patches are used. Additionally, the observed differences in embolization noted by patch type were mainly evident in women. However, the use of Dacron patches was not related to immediate ischemic cerebral events but was associated with a higher restenosis rate compared with venous patch closure. This suggests that venous patch closure may be preferred for CEA.
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Affiliation(s)
- Bart A N Verhoeven
- Department of Vascular Surgery, University Medical Centre Utrecht, The Netherlands
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22
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Abstract
Ischaemic strokes and transient ischaemic attacks are commonly caused by cerebral embolism originating from formation of a platelet-rich thrombus superimposed on an atherosclerotic plaque or by atherothrombotic plaque rupture in a carotid or intracranial artery. Despite advances made through ultrasound imaging in our understanding of atherosclerotic plaque progression and regression, the issue of whether differences in plaque structure alone can distinguish between lesions that become symptomatic and others that remain clinically silent continues to be debated. Recent biochemical and imaging studies have identified characteristics that may reflect a high risk of vulnerability, such as outward, abluminal plaque remodelling, the presence of intra-plaque haemorrhage, inflammation, severe flow disturbances around the encroaching lesion, plaque cap thinning and ulceration, and abnormal plaque motion. Plaque stability may be improved through management of traditional cardiovascular risk factors or with biological or pharmacological agents that target pathways involved in plaque pathophysiology. Unstable plaques place patients at risk of unpredictable ischaemic events and in patients with such lesions, specific preventive treatment beyond long-term antiplatelet therapy can be used to prevent new or recurrent events.
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Affiliation(s)
- Michael G Hennerici
- Department of Neurology, University of Heidelberg, Klinikum Mannheim, Germany.
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23
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Henry RMA, Kostense PJ, Dekker JM, Nijpels G, Heine RJ, Kamp O, Bouter LM, Stehouwer CDA. Carotid Arterial Remodeling. Stroke 2004; 35:671-6. [PMID: 14963290 DOI: 10.1161/01.str.0000115752.58601.0b] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Deteriorating glucose tolerance is associated with an increased cardiovascular disease (CVD) risk. The underlying mechanisms remain unclear. Arterial remodeling is the change in structural properties through time in response to atherogenic and/or hemodynamic alterations and aims to maintain circumferential wall stress constant (σ
C
). Arterial remodeling has not been studied in relation to glucose tolerance.
Methods—
The study population consisted of 278 people with normal glucose metabolism, 168 with impaired glucose metabolism, and 301 with type 2 diabetes (DM-2); their mean age was 67.8 years. We assessed carotid intima-media thickness (IMT), interadventitial diameter (IAD), lumen diameter (LD), and σ
C
.
Results—
After adjustment for age, sex, height, body mass index, and prior CVD, DM-2 was associated with increased IAD, IMT, and σ
C
but not LD (regression coefficients: 0.24 mm; 95% confidence interval [CI], 0.07 to 0.41; 0.050 mm; 95% CI, 0.024 to 0.077; 5.00 kPa; 95% CI, 0.92 to 9.08; and 0.13 mm; 95% CI, −0.03 to 0.29, respectively). After additional adjustment for pulse pressure, the association between DM-2 and IAD disappeared, whereas the association with IMT remained. After adjustment, impaired glucose metabolism was not significantly associated with LD (0.12 mm; 95% CI, −0.06 to 0.33), σ
C
(0.25 kPa; 95% CI, −4.49 to 4.98), IAD (0.08 mm; 95% CI, −0.11 to 0.27), or IMT (0.029 mm; 95% CI, −0.002 to 0.060). However, the IMT regression coefficient was half that of DM-2.
Conclusions—
DM-2 is associated with preserved LD at increased IMT, which, however, does not normalize the increased σ
C
. In contrast, impaired glucose metabolism is not associated with changes in LD or IAD, whereas IMT is moderately increased but σ
C
remains constant. Carotid remodeling in DM-2 thus appears maladaptive, which may explain the increased CVD risk, especially stroke, in DM-2.
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Affiliation(s)
- Ronald M A Henry
- Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
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24
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Pasterkamp G, Galis ZS, de Kleijn DPV. Expansive arterial remodeling: location, location, location. Arterioscler Thromb Vasc Biol 2004; 24:650-7. [PMID: 14764423 PMCID: PMC6662935 DOI: 10.1161/01.atv.0000120376.09047.fe] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The artery is a dynamic organ capable of changing its geometry in response to atherosclerotic plaque formation. Expansion of the vessel diameter retards luminal narrowing and is considered a compensatory response. However, the expansive remodeling response is a "wolf in sheep's clothes," because expansion is associated with the presence of inflammatory cells, proteolysis, and a thrombotic plaque phenotype. The prevalence and clinical presentation of expansively remodeled lesions may differ among vascular beds. However, it is evident that all types of atherosclerotic arterial expansive lesions share the presence of inflammatory cells and subsequent protease activities. The potential role of inflammation and protease activity in the development of the different remodeling modes is discussed.
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Affiliation(s)
- Gerard Pasterkamp
- Heart Lung Institute, Laboratory of Experimental Cardiology, Utrecht University Hospital, Utrecht, The Netherlands.
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