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Ristow AVB, Massière B, Meirelles GV, Casella IB, Morales MM, Moreira RCR, Procópio RJ, Oliveira TF, de Araujo WJB, Joviliano EE, de Oliveira JCP. Brazilian Angiology and Vascular Surgery Society Guidelines for the treatment of extracranial cerebrovascular disease. J Vasc Bras 2024; 23:e20230094. [PMID: 39099701 PMCID: PMC11296686 DOI: 10.1590/1677-5449.202300942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 08/06/2024] Open
Abstract
Extracranial cerebrovascular disease has been the subject of intense research throughout the world, and is of paramount importance for vascular surgeons. This guideline, written by the Brazilian Society of Angiology and Vascular Surgery (SBACV), supersedes the 2015 guideline. Non-atherosclerotic carotid artery diseases were not included in this document. The purpose of this guideline is to bring together the most robust evidence in this area in order to help specialists in the treatment decision-making process. The AGREE II methodology and the European Society of Cardiology system were used for recommendations and levels of evidence. The recommendations were graded from I to III, and levels of evidence were classified as A, B, or C. This guideline is divided into 11 chapters dealing with the various aspects of extracranial cerebrovascular disease: diagnosis, treatments and complications, based on up-to-date knowledge and the recommendations proposed by SBACV.
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Affiliation(s)
- Arno von Buettner Ristow
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-RIO, Disciplina de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-RJ, Rio de Janeiro, RJ, Brasil.
| | - Bernardo Massière
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-RIO, Disciplina de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-RJ, Rio de Janeiro, RJ, Brasil.
| | - Guilherme Vieira Meirelles
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade Estadual de Campinas – UNICAMP, Hospital das Clínicas, Disciplina de Cirurgia do Trauma, Campinas, SP, Brasil.
| | - Ivan Benaduce Casella
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina, São Paulo, SP, Brasil.
| | - Marcia Maria Morales
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Associação Portuguesa de Beneficência de São José do Rio Preto, Serviço de Cirurgia Vascular, São José do Rio Preto, SP, Brasil.
| | - Ricardo Cesar Rocha Moreira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-PR, Curitiba, PR, Brasil.
- Pontifícia Universidade Católica do Paraná – PUC-PR, Hospital Cajurú, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.
| | - Ricardo Jayme Procópio
- Universidade Federal de Minas Gerais – UFMG, Hospital das Clínicas, Setor de Cirurgia Endovascular, Belo Horizonte, MG, Brasil.
- Universidade Federal de Minas Gerais – UFMG, Faculdade de Medicina, Belo Horizonte, MG, Brasil.
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-MG, Belo Horizonte, MG, Brasil.
| | - Tércio Ferreira Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SE, Aracajú, SE, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.
| | - Walter Jr. Boim de Araujo
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-PR, Curitiba, PR, Brasil.
- Universidade Federal do Paraná – UFPR, Hospital das Clínicas – HC, Curitiba, PR, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.
| | - Júlio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e de Cirurgia Vascular – SBACV-SP, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
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Sun T, Wang F, He Y, Mao B, Han M, Liu H, Zhao P, Li X, Wang D. Enlarged Pericarotid Lymph Nodes Suggest Recent Ischemic Symptoms in Patients with Carotid Atherosclerosis. Front Immunol 2022; 13:900642. [PMID: 35903093 PMCID: PMC9315152 DOI: 10.3389/fimmu.2022.900642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease closely associated with immunological activity. Lymph nodes (LNs) are essential secondary lymphoid organs, in which complex immune responses occur. Enlarged LNs are commonly observed around inflamed tissues or tumors; however, their role in atherosclerosis is not well understood. We hypothesized that enlarged pericarotid LNs would be present in symptomatic patients with carotid atherosclerosis. Therefore, we recorded the size of LNs around the carotid artery during surgery in patients undergoing carotid endarterectomy (CEA) for carotid atherosclerotic stenosis. Patients were stratified by enlarged LNs, defined as a diameter ≥ 10mm in the transverse diameters. Demographic and clinical data of participants were measured and analyzed. Hematoxylin and eosin (H&E), Sirius red, DAB-enhanced Perls’ Prussian blue, alizarin red, and immunohistochemistry (IHC) staining were performed for composition identification of plaques or LNs. Symptomatic patients were defined as those presenting with an ipsilateral cerebral ischemic event. Compared with patients with non-enlarged LNs, patients with enlarged LNs were more likely to be symptomatic (22/32, 68.8% versus 9/40, 22.5%, P < 0.001) and use calcium channel blocker drugs (17/32, 53.1% versus 10/40, 25%, P=0.014). In addition, they showed lower body mass index (mean ± SD: 24.00 ± 2.66 versus 25.34 ± 2.56 kg/m2, P=0.034), lower weight (median [interquartile range]: 64 [60.00-76.00] versus 72.5 [65.00-77.50] Kg, P = 0.046) and higher diastolic blood pressure (mean ± SD: 78.94 ± 9.30 versus 73.93 ± 8.84 mmHg, P = 0.022). The plague from patients with enlarged LNs exhibited a lower relative percentage of fibrous tissue (29.49 ± 10.73% versus 34.62 ± 10.33%, P = 0.041). The enlarged LNs remained oval-shaped by visual inspection. Compared to non-enlarged LNs, the predominant changes in enlarged LNs were atrophic lymphatic sinuses and dilated LNs parenchyma. Enlarged LNs contained more germinal centers and lymphocytes. In conclusion, symptomatic patients with carotid atherosclerosis have enlarged pericarotid LNs. The current study supports the conclusion that enlarged LNs with an activated and enhanced adaptive immune response may indicate plaque instability. Pericarotid LNs will be a promising marker of plaque stability and may be a potential therapeutic target in patients with carotid atherosclerosis.
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Affiliation(s)
- Tao Sun
- Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fei Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yiming He
- Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bo Mao
- Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mengtao Han
- Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Han Liu
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peng Zhao
- Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Xingang Li, ; Donghai Wang,
| | - Donghai Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
- Institute of Brain and Brain-Inspired Science, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Xingang Li, ; Donghai Wang,
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Rykaczewska U, Zhao Q, Saliba-Gustafsson P, Lengquist M, Kronqvist M, Bergman O, Huang Z, Lund K, Waden K, Pons Vila Z, Caidahl K, Skogsberg J, Vukojevic V, Lindeman JHN, Roy J, Hansson GK, Treuter E, Leeper NJ, Eriksson P, Ehrenborg E, Razuvaev A, Hedin U, Matic L. Plaque Evaluation by Ultrasound and Transcriptomics Reveals BCLAF1 as a Regulator of Smooth Muscle Cell Lipid Transdifferentiation in Atherosclerosis. Arterioscler Thromb Vasc Biol 2022; 42:659-676. [PMID: 35321563 DOI: 10.1161/atvbaha.121.317018] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Understanding the processes behind carotid plaque instability is necessary to develop methods for identification of patients and lesions with stroke risk. Here, we investigated molecular signatures in human plaques stratified by echogenicity as assessed by duplex ultrasound. METHODS Lesion echogenicity was correlated to microarray gene expression profiles from carotid endarterectomies (n=96). The findings were extended into studies of human and mouse atherosclerotic lesions in situ, followed by functional investigations in vitro in human carotid smooth muscle cells (SMCs). RESULTS Pathway analyses highlighted muscle differentiation, iron homeostasis, calcification, matrix organization, cell survival balance, and BCLAF1 (BCL2 [B-cell lymphoma 2]-associated transcription factor 1) as the most significant signatures. BCLAF1 was downregulated in echolucent plaques, positively correlated to proliferation and negatively to apoptosis. By immunohistochemistry, BCLAF1 was found in normal medial SMCs. It was repressed early during atherogenesis but reappeared in CD68+ cells in advanced plaques and interacted with BCL2 by proximity ligation assay. In cultured SMCs, BCLAF1 was induced by differentiation factors and mitogens and suppressed by macrophage-conditioned medium. BCLAF1 silencing led to downregulation of BCL2 and SMC markers, reduced proliferation, and increased apoptosis. Transdifferentiation of SMCs by oxLDL (oxidized low-denisty lipoprotein) was accompanied by upregulation of BCLAF1, CD36, and CD68, while oxLDL exposure with BCLAF1 silencing preserved MYH (myosin heavy chain) 11 expression and prevented transdifferentiation. BCLAF1 was associated with expression of cell differentiation, contractility, viability, and inflammatory genes, as well as the scavenger receptors CD36 and CD68. BCLAF1 expression in CD68+/BCL2+ cells of SMC origin was verified in plaques from MYH11 lineage-tracing atherosclerotic mice. Moreover, BCLAF1 downregulation associated with vulnerability parameters and cardiovascular risk in patients with carotid atherosclerosis. CONCLUSIONS Plaque echogenicity correlated with enrichment of distinct molecular pathways and identified BCLAF1, previously not described in atherosclerosis, as the most significant gene. Functionally, BCLAF1 seems necessary for survival and transdifferentiation of SMCs into a macrophage-like phenotype. The role of BCLAF1 in plaque vulnerability should be further evaluated.
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Affiliation(s)
- Urszula Rykaczewska
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Quanyi Zhao
- Division of Cardiovascular Medicine, Cardiovascular Institute (Q.Z., P.S.-G.), Stanford University School of Medicine, CA
| | - Peter Saliba-Gustafsson
- Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine (P.S.-G., O.B., G.K.H., P.E., E.E.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Division of Cardiovascular Medicine, Cardiovascular Institute (Q.Z., P.S.-G.), Stanford University School of Medicine, CA
| | - Mariette Lengquist
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Malin Kronqvist
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Otto Bergman
- Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine (P.S.-G., O.B., G.K.H., P.E., E.E.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Zhiqiang Huang
- Department of Biosciences and Nutrition (Z.H., E.T.), Karolinska Institutet, Stockholm, Sweden
| | - Kent Lund
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Waden
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Zara Pons Vila
- Clinical Chemistry and Blood Coagulation, Department of Molecular Medicine and Surgery (Z.P.V.), Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital and Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.C.)
| | - Josefin Skogsberg
- Department of Medical Biochemistry and Biophysics (J.S.), Karolinska Institutet, Stockholm, Sweden
| | - Vladana Vukojevic
- Department of Clinical Neuroscience, Center for Molecular Medicine (V.V.), Karolinska Institutet, Stockholm, Sweden
| | - Jan H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, the Netherlands (J.H.N.L.)
| | - Joy Roy
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Göran K Hansson
- Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine (P.S.-G., O.B., G.K.H., P.E., E.E.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Eckardt Treuter
- Department of Biosciences and Nutrition (Z.H., E.T.), Karolinska Institutet, Stockholm, Sweden
| | - Nicholas J Leeper
- Department of Surgery (N.J.L.), Stanford University School of Medicine, CA.,Department of Medicine (N.J.L.), Stanford University School of Medicine, CA
| | - Per Eriksson
- Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine (P.S.-G., O.B., G.K.H., P.E., E.E.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Ehrenborg
- Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine (P.S.-G., O.B., G.K.H., P.E., E.E.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anton Razuvaev
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Hedin
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ljubica Matic
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery (U.R., M.L., M.K., K.L., K.W., K.C., J.R., A.R., U.H., L.M.), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Karlöf E, Buckler A, Liljeqvist ML, Lengquist M, Kronqvist M, Toonsi MA, Maegdefessel L, Matic LP, Hedin U. Carotid Plaque Phenotyping by Correlating Plaque Morphology from Computed Tomography Angiography with Transcriptional Profiling. Eur J Vasc Endovasc Surg 2021; 62:716-726. [PMID: 34511314 DOI: 10.1016/j.ejvs.2021.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/03/2021] [Accepted: 07/11/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Ischaemic strokes can be caused by unstable carotid atherosclerosis, but methods for identification of high risk lesions are lacking. Carotid plaque morphology imaging using software for visualisation of plaque components in computed tomography angiography (CTA) may improve assessment of plaque phenotype and stroke risk, but it is unknown if such analyses also reflect the biological processes related to lesion stability. Here, we investigated how carotid plaque morphology by image analysis of CTA is associated with biological processes assessed by transcriptomic analyses of corresponding carotid endarterectomies (CEAs). METHODS Carotid plaque morphology was assessed in patients undergoing CEA for symptomatic or asymptomatic carotid stenosis consecutively enrolled between 2006 and 2015. Computer based analyses of pre-operative CTA was performed to define calcification, lipid rich necrotic core (LRNC), intraplaque haemorrhage (IPH), matrix (MATX), and plaque burden. Plaque morphology was correlated with molecular profiles obtained from microarrays of corresponding CEAs and models were built to assess the ability of plaque morphology to predict symptomatology. RESULTS Carotid plaques (n = 93) from symptomatic patients (n = 61) had significantly higher plaque burden and LRNC compared with plaques from asymptomatic patients (n = 32). Lesions selected from the transcriptomic cohort (n = 40) with high LRNC, IPH, MATX, or plaque burden were characterised by molecular signatures coupled with inflammation and extracellular matrix degradation, typically linked with instability. In contrast, highly calcified plaques had a molecular signature signifying stability with enrichment of profibrotic pathways and repressed inflammation. In a cross validated prediction model for symptoms, plaque morphology by CTA alone was superior to the degree of stenosis. CONCLUSION The study demonstrates that CTA image analysis for evaluation of carotid plaque morphology, also reflects prevalent biological processes relevant for assessment of plaque phenotype. The results support the use of CTA image analysis of plaque morphology for risk stratification and management of patients with carotid stenosis.
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Affiliation(s)
- Eva Karlöf
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Buckler
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Elucid Bioimaging, Boston, MA, USA
| | - Moritz L Liljeqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mariette Lengquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Malin Kronqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mawaddah A Toonsi
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lars Maegdefessel
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ljubica P Matic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Hedin
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Iskander-Rizk S, Visscher M, Moerman AM, Korteland SA, Van der Heiden K, Van der Steen AF, Van Soest G. Micro Spectroscopic Photoacoustic (μsPA) imaging of advanced carotid atherosclerosis. PHOTOACOUSTICS 2021; 22:100261. [PMID: 33854946 PMCID: PMC8027769 DOI: 10.1016/j.pacs.2021.100261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 05/11/2023]
Abstract
Atherosclerosis is a lipid-driven and an inflammatory disease of the artery walls. The composition of atherosclerotic plaque stratifies the risk of a specific plaque to cause a cardiovascular event. In an optical resolution photoacoustic microscopy setup, of 45 μm resolution, we extracted plaque lipid photoacoustic (PA) spectral signatures of human endarterectomy samples in the range of 1150-1240 nm, using matrix assisted laser desorption ionization mass spectrometry imaging as a reference. We found plaque PA signals to correlate best with sphingomyelins and cholesteryl esters. PA signal spectral variations within the plaque area were compared to reference molecular patterns and absorption spectra of lipid laboratory standards. Variability in the lipid spectroscopic features extracted by principal component analysis of all samples revealed three distinct components with peaks at: 1164, 1188, 1196 and 1210 nm. This result will guide the development of PA-based atherosclerosis disease staging capitalizing on lipidomics of atherosclerotic tissue.
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Key Words
- Atherosclerosis
- CE, cholesteryl ester
- CEA, carotid endarterectomy
- DG, diacylglycerol
- DHB, 2,5-dihydroxybenzoic acid
- ESI, electrospray ionization
- FTICR, fourier-transform ion cyclotron resonance
- HPLC, high-performance liquid chromatography
- Lipids
- MALDI-MSI, matrix-assisted laser desorption ionization mass spectrometry imaging
- Mass spectrometry imaging
- Microscopy
- NIRS, near-infrared spectroscopy
- PC, phosphatidylcholine
- PCA
- PCA, principal component analysis
- PFA, paraformaldehyde
- SM, sphingomyelin
- Spectroscopy
- TG, triacylglycerol
- WREnS, Waters Research Enabled Software suite
- m/z, mass to charge ratio
- μsPA, Micro Spectroscopic Photoacoustic
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Affiliation(s)
| | | | | | | | | | | | - Gijs Van Soest
- Corresponding author at: Erasmus Medical Center, Ee-2302, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Ogata T, Shimada H, Inoue T, Takeshita S, Tsuboi Y, Uesugi N, Fujiwara M, Sata M, Yamada H. Quantification of Carotid Plaque Histology Using iPlaque Software. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:928-931. [PMID: 33408050 DOI: 10.1016/j.ultrasmedbio.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
The iPlaque software package can use integrated backscatter (IB) values of carotid plaque to extract information on tissue composition. The aim of this study was to evaluate the association between the plaque histologic classification and IB values evaluated by iPlaque. In 49 patients undergoing carotid endarterectomy, IB values of whole carotid plaque were measured using iPlaque from the long-axis ultrasonographic image. Histologic findings of resected plaques were defined using the classification of the American Heart Association. The average IB values were statistically compared with the classification. Plaque samples from 49 patients were categorized into V, VI and VII, (13, 32 and 4 cases, respectively). Both the average and standard deviation of the IB values in each plaque sample significantly differed among the three classifications (p = 0.001). The IB of carotid plaque obtained by iPlaque analysis was associated with its histologic characteristics.
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Affiliation(s)
- Toshiyasu Ogata
- Department of Neurology, Fukuoka University, Fukuoka, Japan.
| | - Hirofumi Shimada
- Department of Laboratory Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
| | - Sho Takeshita
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Noriko Uesugi
- Department of Pathology, Fukuoka University, Fukuoka, Japan
| | - Mika Fujiwara
- Department of Cardiovascular Medicine, Takamatsu Municipal Hospital, Takamatsu, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan; Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Karlöf E, Seime T, Dias N, Lengquist M, Witasp A, Almqvist H, Kronqvist M, Gådin JR, Odeberg J, Maegdefessel L, Stenvinkel P, Matic LP, Hedin U. Correlation of computed tomography with carotid plaque transcriptomes associates calcification with lesion-stabilization. Atherosclerosis 2019; 288:175-185. [PMID: 31109707 DOI: 10.1016/j.atherosclerosis.2019.05.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/29/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Unstable carotid atherosclerosis causes stroke, but methods to identify patients and lesions at risk are lacking. We recently found enrichment of genes associated with calcification in carotid plaques from asymptomatic patients. Here, we hypothesized that calcification represents a stabilising feature of plaques and investigated how macro-calcification, as estimated by computed tomography (CT), correlates with gene expression profiles in lesions. METHODS Plaque calcification was measured in pre-operative CT angiographies. Plaques were sorted into high- and low-calcified, profiled with microarrays, followed by bioinformatic analyses. Immunohistochemistry and qPCR were performed to evaluate the findings in plaques and arteries with medial calcification from chronic kidney disease patients. RESULTS Smooth muscle cell (SMC) markers were upregulated in high-calcified plaques and calcified plaques from symptomatic patients, whereas macrophage markers were downregulated. The most enriched processes in high-calcified plaques were related to SMCs and extracellular matrix (ECM) organization, while inflammation, lipid transport and chemokine signaling were repressed. These findings were confirmed in arteries with high medial calcification. Proteoglycan 4 (PRG4) was identified as the most upregulated gene in association with plaque calcification and found in the ECM, SMA+ and CD68+/TRAP + cells. CONCLUSIONS Macro-calcification in carotid lesions correlated with a transcriptional profile typical for stable plaques, with altered SMC phenotype and ECM composition and repressed inflammation. PRG4, previously not described in atherosclerosis, was enriched in the calcified ECM and localized to activated macrophages and smooth muscle-like cells. This study strengthens the notion that assessment of calcification may aid evaluation of plaque phenotype and stroke risk.
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Affiliation(s)
- Eva Karlöf
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Till Seime
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Nuno Dias
- Vascular Center, Department of Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Mariette Lengquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anna Witasp
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Almqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Malin Kronqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper R Gådin
- Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Odeberg
- Science for Life Laboratory, Department of Proteomics, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden
| | - Lars Maegdefessel
- Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Vascular and Endovascular Surgery, Klinikum Klinikum rechts der Isar Isar, Technical University Munich, Munich, Germany
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ljubica Perisic Matic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Ulf Hedin
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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8
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Yamada K, Yoshimura S, Shirakawa M, Uchida K, Nakahara S, Nishida S, Iwamoto Y, Sato Y, Kawasaki M. Asymptomatic moderate carotid artery stenosis with intraplaque hemorrhage: Progression of degree of stenosis and new ischemic stroke. J Clin Neurosci 2019; 63:95-99. [PMID: 30732983 DOI: 10.1016/j.jocn.2019.01.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/06/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
Carotid intraplaque hemorrhage (IPH) plays a critical role in the progression of carotid atherosclerotic disease. IPH was associated with high intensity signal (HIS) in the plaque on Maximum intensity projection (MIP) images from routine three dimensional magnetic resonance imaging (3D-TOF MRA). The aim of this study was to evaluate the relationships among HIS, new ipsilateral ischemic stroke and a progression rate in carotid plaques with moderate stenosis. We included 45 carotid plaques with moderate stenosis (50%-69%) in 45 patients who could be followed more than 12 months. Carotid IPH was defined as the presence of HIS on 3DTOF MRA using the criteria previously we published. We analyzed the relation between the presence of HIS and new ischemic strokes and annual progression rate of carotid stenosis. HIS was present in 21 (47%) carotid arteries. Over a follow-up period of 24 ± 9 months, six ischemic strokes occurred in ipsilateral side. New ipsilateral ischemic stroke occurred more frequently in HIS positive group (P group: 6 of 21, 29%) than negative group (N group: 0 of 24, 0%) (p = 0.017). Annual progression rate of carotid stenosis is significantly higher in P group (+3.35%/year) than N group (-0.02%/year) (p = 0.0026). In multivariate regression analysis, HIS positive was an independent predictor for annual progression rate of carotid stenosis (p = 0.003). Evaluation of HIS in asymptomatic moderate carotid stenosis can potentially provide risk stratification of new ipsilateral ischemic strokes.
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Affiliation(s)
- Kiyofumi Yamada
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Shuji Nishida
- Department of Radiology, Sato Daiichi Hospital, Usa, Japan
| | | | - Yoshikazu Sato
- Department of Radiology, Sato Daiichi Hospital, Usa, Japan
| | - Masanori Kawasaki
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
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9
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Matic LP, Jesus Iglesias M, Vesterlund M, Lengquist M, Hong MG, Saieed S, Sanchez-Rivera L, Berg M, Razuvaev A, Kronqvist M, Lund K, Caidahl K, Gillgren P, Pontén F, Uhlén M, Schwenk JM, Hansson GK, Paulsson-Berne G, Fagman E, Roy J, Hultgren R, Bergström G, Lehtiö J, Odeberg J, Hedin U. Novel Multiomics Profiling of Human Carotid Atherosclerotic Plaques and Plasma Reveals Biliverdin Reductase B as a Marker of Intraplaque Hemorrhage. JACC Basic Transl Sci 2018; 3:464-480. [PMID: 30175270 PMCID: PMC6115646 DOI: 10.1016/j.jacbts.2018.04.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022]
Abstract
Clinical tools to identify individuals with unstable atherosclerotic lesions are required to improve prevention of myocardial infarction and ischemic stroke. Here, a systems-based analysis of atherosclerotic plaques and plasma from patients undergoing carotid endarterectomy for stroke prevention was used to identify molecular signatures with a causal relationship to disease. Local plasma collected in the lesion proximity following clamping prior to arteriotomy was profiled together with matched peripheral plasma. This translational workflow identified biliverdin reductase B as a novel marker of intraplaque hemorrhage and unstable carotid atherosclerosis, which should be investigated as a potential predictive biomarker for cardiovascular events in larger cohorts.
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Key Words
- BLVR, biliverdin reductase
- BiKE, Biobank of Karolinska Endarterectomies
- CAC, coronary artery calcium
- CEA, carotid endarterectomy
- HMOX, heme oxygenase
- Hb, hemoglobin
- Hp, haptoglobin
- IPH, intraplaque hemorrhage
- LC-MS/MS, liquid chromatography mass spectrometry/mass spectrometry
- TMT, tandem mass tags
- atherosclerosis
- biomarkers
- intraplaque hemorrhage
- mRNA, messenger ribonucleic acid
- omics analyses
- translational studies
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Affiliation(s)
- Ljubica Perisic Matic
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Maria Jesus Iglesias
- Science for Life Laboratory, Department of Proteomics, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden
| | - Mattias Vesterlund
- Department of Oncology-Pathology, Cancer Proteomics, Science for Life Laboratory, Karolinska Institute, Stockholm, Sweden
| | - Mariette Lengquist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Mun-Gwan Hong
- Science for Life Laboratory, Department of Proteomics, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden
| | - Shanga Saieed
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Laura Sanchez-Rivera
- Science for Life Laboratory, Department of Proteomics, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden
| | - Martin Berg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anton Razuvaev
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Malin Kronqvist
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Kent Lund
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Peter Gillgren
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Mathias Uhlén
- Science for Life Laboratory, Department of Proteomics, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden
| | - Jochen M Schwenk
- Science for Life Laboratory, Department of Proteomics, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden
| | - Göran K Hansson
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Erika Fagman
- Department of Radiology, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Janne Lehtiö
- Department of Oncology-Pathology, Cancer Proteomics, Science for Life Laboratory, Karolinska Institute, Stockholm, Sweden
| | - Jacob Odeberg
- Science for Life Laboratory, Department of Proteomics, School of Biotechnology, Royal Institute of Technology, Stockholm, Sweden.,Department of Medicine, Karolinska Institute, Stockholm, Sweden.,Coagulation Unit, Centre for Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Hedin
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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10
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Yamada K, Yoshimura S, Shirakawa M, Uchida K, Maruyama F, Nakahara S, Nishida S, Iwamoto Y, Sato Y, Kawasaki M. High intensity signal in the plaque on routine 3D-TOF MRA is associated with ischemic stroke in the patients with low-grade carotid stenosis. J Neurol Sci 2018; 385:164-167. [DOI: 10.1016/j.jns.2017.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 12/02/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
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11
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Kargiotis O, Safouris A, Magoufis G, Georgala M, Roussopoulou A, Stamboulis E, Moulakakis KG, Lazaris A, Geroulakos G, Vasdekis S, Tsivgoulis G. The Role of Neurosonology in the Diagnosis and Management of Patients with Carotid Artery Disease: A Review. J Neuroimaging 2018; 28:239-251. [DOI: 10.1111/jon.12495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 01/11/2023] Open
Affiliation(s)
| | | | | | - Maria Georgala
- Department of Clinical NeurophysiologyMetropolitan Hospital Piraeus Greece
| | - Andromachi Roussopoulou
- Second Department of NeurologyMedical SchoolNational and Kapodistrian University of Athens“Attikon” University Hospital Athens Greece
| | | | - Konstantinos G. Moulakakis
- Department of Vascular SurgeryMedical SchoolNational and Kapodistrian University of Athens“Attikon” University Hospital Athens Greece
| | - Andreas Lazaris
- Department of Vascular SurgeryMedical SchoolNational and Kapodistrian University of Athens“Attikon” University Hospital Athens Greece
| | - George Geroulakos
- Department of Vascular SurgeryMedical SchoolNational and Kapodistrian University of Athens“Attikon” University Hospital Athens Greece
| | - Spyros Vasdekis
- Department of Vascular SurgeryMedical SchoolNational and Kapodistrian University of Athens“Attikon” University Hospital Athens Greece
| | - Georgios Tsivgoulis
- Second Department of NeurologyMedical SchoolNational and Kapodistrian University of Athens“Attikon” University Hospital Athens Greece
- Department of NeurologyThe University of Tennessee Health Science Center Memphis TN
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12
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Loizou CP, Pattichis CS, Pantziaris M, Kyriacou E, Nicolaides A. Texture Feature Variability in Ultrasound Video of the Atherosclerotic Carotid Plaque. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2017; 5:1800509. [PMID: 29021922 PMCID: PMC5633332 DOI: 10.1109/jtehm.2017.2728662] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 01/23/2023]
Abstract
The objective of this paper was to investigate texture feature variability in ultrasound video of the carotid artery during the cardiac cycle in an attempt to define new discriminatory biomarkers of the vulnerable plaque. More specifically, in this paper, 120 longitudinal ultrasound videos, acquired from 40 normal (N) subjects from the common carotid artery and 40 asymptomatic (A) and 40 symptomatic (S) subjects from the proximal internal carotid artery were investigated. The videos were intensity normalized and despeckled, and the intima-media complex (IMC) (from the N subjects) and the atherosclerotic carotid plaques (from the A and S subjects) were segmented from each video, in order to extract the M-mode image, and the texture features associated with cardiac states of systole and diastole. The main results of this paper can be summarized as follows: 1) texture features varied significantly throughout the cardiac cycle with significant differences identified between the cardiac systolic and cardiac diastolic states; 2) gray scale median was significantly higher at cardiac systole versus diastole for the N, A, and S groups investigated; 3) plaque texture features extracted during the cardiac cycle at the systolic and diastolic states were statistically significantly different between A and S subjects (and can thus be used to discriminate between A and S subjects successfully). The combination of systolic and diastolic features yields better performance than those alone. It is anticipated that the proposed system may aid the physician in clinical practice in classifying between N, A, and S subjects using texture features extracted from ultrasound videos of IMC and carotid artery plaque. However, further evaluation has to be carried out with more videos and additional features.
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Affiliation(s)
- Christos P Loizou
- Department of Electrical, Computer Engineering and InformaticsCyprus University of Technology
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13
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Wehrum T, Guenther F, Vach W, Gladstone BP, Wendel S, Fuchs A, Wu K, Maurer CJ, Harloff A. Aortic Atherosclerosis Determines Increased Retrograde Blood Flow as a Potential Mechanism of Retrograde Embolic Stroke. Cerebrovasc Dis 2017; 43:132-138. [PMID: 28049202 DOI: 10.1159/000455053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Retrograde brain embolization from complex plaques of the proximal descending aorta (DAo) has been identified as a new potential mechanism of stroke. Our purpose was to identify predictors of increased retrograde aortic blood flow indicating an elevated risk of brain embolization from the DAo. METHODS A total of 485 patients with acute ischemic stroke were prospectively included and underwent transesophageal echocardiography. Blood flow velocities in the proximal DAo were studied using 2D pulse-wave Doppler ultrasound. Velocity-time integrals (VTI) were calculated for antegrade and retrograde velocity directions. The ratio (VTIretrograde/VTIantegrade) was used to estimate retrograde flow extent. Associations between patient demographics, cardiovascular risk factors, echocardiographic parameters, and VTIratio were analyzed using multivariate linear regression. RESULTS Retrograde blood flow in the DAo occurred in all patients. Velocity profiles in the proximal DAo were as follows (mean ± SD): VTIantegrade = 21.1 ± 6.5, VTIretrograde = 11.0 ± 3.6, and VTIratio = 0.54 ± 0.16. Diameter (r = 0.25, p < 0.001), presence of complex plaques (r = 0.12, p = 0.007), and reduced strain of the DAo (r = -0.23, p < 0.001) had significant partial effects in a predictor model based on predefined variables, which predicted 26% (adjusted R2 = 0.26) of the variance in VTIratio. A unit increase in the DAo diameter was associated with a 2% increase in VTIratio (95% CI 1-2.8%, p < 0.001). Presence of complex plaques increased VTIratio by 7% (95% CI 2-13%, p = 0.007) and an increase in strain by 0.1 indicated a decrease in VTIratio by about 11% (95% CI 6.2-15.5%, p < 0.001). Complex atheroma was found in the proximal DAo of 79 subjects, of which 40 (50.6%) had a VTIratio above average (VTIratio ≥0.54) compared to 87 of 261 (33.3%) patients without any complex plaques (p < 0.001). Twenty-five of 79 (31.7%) patients with complex DAo plaques had a VTIratio ≥0.60, which indicates a high likelihood of retrograde pathline length of ≥3 cm and thus increased risk of retrograde cerebral embolization. Stroke etiology of those 25 patients was determined in 13 and cryptogenic in 12 cases. CONCLUSIONS Retrograde blood flow in the DAo was found in all stroke patients. However, it increased further in patients with concomitant complex plaques, low strain, and/or large aortic diameter, that is, in those with atherosclerosis of the DAo. Accordingly, such patients may be predisposed to retrograde embolization in case of occurrence of a complex plaque in proximity to a brain-supplying artery.
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Affiliation(s)
- Thomas Wehrum
- Department of Neurology, University Medical Center Freiburg, Freiburg, Germany
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14
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Hage ZA, Alaraj A, Arnone GD, Charbel FT. Novel imaging approaches to cerebrovascular disease. Transl Res 2016; 175:54-75. [PMID: 27094991 DOI: 10.1016/j.trsl.2016.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/19/2022]
Abstract
Imaging techniques available to the physician treating neurovascular disease have substantially grown over the past several decades. New techniques as well as advances in imaging modalities continuously develop and provide an extensive array of modalities to diagnose, characterize, and understand neurovascular pathology. Modern noninvasive neurovascular imaging is generally based on computed tomography (CT), magnetic resonance (MR) imaging, or nuclear imaging and includes CT angiography, CT perfusion, xenon-enhanced CT, single-photon emission CT, positron emission tomography, magnetic resonance angiography, MR perfusion, functional magnetic resonance imaging with global and regional blood oxygen level dependent imaging, and magnetic resonance angiography with the use of the noninvasive optional vessel analysis software (River Forest, Ill). In addition to a brief overview of the technique, this review article discusses the clinical indications, advantages, and disadvantages of each of those modalities.
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Affiliation(s)
- Ziad A Hage
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA.
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15
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Lan L, Leng X, Abrigo J, Fang H, Ip VHL, Soo YOY, Leung TWH, Yu SCH, Wong LKS. Diminished Signal Intensities Distal to Intracranial Arterial Stenosis on Time-of-Flight MR Angiography Might Indicate Delayed Cerebral Perfusion. Cerebrovasc Dis 2016; 42:232-9. [PMID: 27173386 DOI: 10.1159/000445842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracranial arterial stenosis (ICAS) is a predominant cause of ischemic stroke in Asia. Changes in the signal intensities (SIs) across ICAS lesions on time-of-flight magnetic resonance angiography (TOF-MRA) have been indicated to partially reflect the hemodynamic significance of the lesions, which we aimed to verify by correlating it with cerebral perfusion features provided by CT perfusion (CTP) imaging. METHODS Ischemic stroke or transient ischemic attack patients with unilateral symptomatic stenosis (≥50%) of intracranial internal carotid artery or middle cerebral artery (MCA) were included in this study. Change of SIs across an ICAS lesion on TOF-MRA was calculated by the distal and proximal SI ratio (SIR). Cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) within the MCA territory of ipsilateral and contralateral hemispheres were evaluated on the CTP images at the basal ganglia level. Relative CBV, CBF and MTT were defined as ratios of the values obtained from ipsilateral and contralateral hemispheres. The relationships between SIR and CTP parameters were analyzed. RESULTS Fifty subjects (74% male, mean age 62) were recruited. Overall, the mean SIR was 0.77 ± 0.17. SIR of ICAS was significantly, linearly and negatively correlated with ipsilateral CBV (r = -0.335, p = 0.017), ipsilateral MTT (r = -0.301, p = 0.034), and ipsilateral/contralateral MTT ratio (r = -0.443, p = 0.001). CONCLUSIONS Diminished SIs distal to ICAS on TOF-MRA might be associated with delayed ipsilateral cerebral perfusion. Changes of the SIs across ICAS lesions on TOF-MRA may be a simple marker to reflect cerebral perfusion changes in patients with symptomatic ICAS.
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Affiliation(s)
- Linfang Lan
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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16
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Affiliation(s)
- Marco Roffi
- Division of Cardiology, University Hospital, Geneva, Switzerland
| | - Zsolt Kulcsár
- Division of Neuroradiology, University Hospital, Geneva, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, University Hospital, Geneva, Switzerland
| | - Alberto Cremonesi
- Cardiovascular Department, Maria Cecilia Hospital-GVM Care & Research, Cotignola, Italy
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17
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Lopez Gonzalez M, Foo S, Holmes W, Stewart W, Muir K, Condon B, Welch G, Forbes K. Atherosclerotic Carotid Plaque Composition: A 3T and 7T MRI-Histology Correlation Study. J Neuroimaging 2016; 26:406-13. [PMID: 26919134 DOI: 10.1111/jon.12332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/18/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- M.R. Lopez Gonzalez
- Department of Clinical Physics and Bioengineering; Glasgow Royal Infirmary; Glasgow UK
| | - S.Y. Foo
- ST1, West of Scotland Radiology Training Scheme, NHS; Glasgow UK
| | - W.M. Holmes
- Glasgow Experimental MRI Centre; Institute of Neuroscience and Psychology, University of Glasgow; UK
| | - W. Stewart
- Department of Neuropathology, Laboratory Medicine Building; Queen Elizabeth University Hospital; Glasgow UK
| | - K.W. Muir
- Centre for Stroke and Brain Imaging Research, Institute of Neuroscience and Psychology; University of Glasgow; UK
| | - B. Condon
- Institute of Neurological Sciences; Queen Elizabeth University Hospital; UK
| | - G. Welch
- Vascular Surgery; Queen Elizabeth University Hospital; Glasgow UK
| | - K.P. Forbes
- Institute of Neurological Sciences; Queen Elizabeth University Hospital; UK
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18
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Searching the perfect ultrasonic classification in assessing carotid artery stenosis: comparison and remarks upon the existing ultrasound criteria. J Ultrasound 2016; 19:83-90. [PMID: 27298648 DOI: 10.1007/s40477-016-0193-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/11/2016] [Indexed: 12/12/2022] Open
Abstract
Doppler ultrasound scanning is the first line investigation for quantifying the internal carotid artery stenosis. Nevertheless, the lack of internationally accepted ultrasound criteria for describing the degree of stenosis has contributed to the different and confusing measurements ranges. The use of two different angiographic methods, the North American Symptomatic Carotid Endoarterectomy Study and the European Carotid Surgery Trial was probably the major initial source of confusion in deriving valid and reliable duplex ultrasound criteria worldwide. The consensus proposed in 2003 by the Society of Radiologists in Ultrasound has been a great attempt to create a conformity document, establishing grey scale and Doppler criteria in considering the different degrees of stenosis. According to this attempt, in 2010, the multi-parametric Deutsche Gesellschaft für Ultraschall in der Medizin ultrasound criteria have been proposed with a precise differentiation between main and additional criteria and depicted a different peak systolic velocity (PSV) threshold. In 2012, these criteria have been implemented, focusing on the multi-parametric approach, re-defining the PSV values and clearly introducing the concept of PSV average. Despite these attempts, a wide range of practice patterns still exists, with consistent disparities in patients' care. This paper collects these previous experiences and summarizes their strengths and weaknesses, to give a contribution in the carotid artery stenosis grading standardization using ultrasonic methods. Carotid ultrasound as the only diagnostic tool for the selection of patients for carotid surgery or stenting will be possible only with internationally accepted criteria.
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19
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Hennerici MG, Fatar M. Editorial. Cerebrovasc Dis 2016; 42:512-513. [DOI: 10.1159/000452636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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20
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Moody AR, Singh N. Incorporating Carotid Plaque Imaging into Routine Clinical Carotid Magnetic Resonance Angiography. Neuroimaging Clin N Am 2015; 26:29-44. [PMID: 26610658 DOI: 10.1016/j.nic.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The incorporation of a short, easy-to-acquire and simple to read sequence to visualize the vessel wall and detect intraplaque hemorrhage (IPH) is achievable now. Demonstration of IPH may be helpful in primary or secondary prevention of neuroischemic events, assessment prior to carotid intervention and the general definition of an individual's vascular phenotype. The addition of an IPH-detecting vessel wall sequence only adds 5 to 6 minutes to a standard carotid MRI examination making clinical translation feasible and achievable.
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Affiliation(s)
- Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Navneet Singh
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Eyding J, Kitzrow M, Krogias C, Reimann G, Weber R, Weimar C, Bartig D. [Treatment reality of internal carotid artery stenosis in Germany : requirement and reality in international comparison and in light of the current S3 guidelines]. DER NERVENARZT 2015; 86:1261-7. [PMID: 26341691 DOI: 10.1007/s00115-015-4419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Severe atherosclerotic extracranial carotid artery stenosis accounts for 5-10 % of all ischemic strokes. Currently, therapeutic recommendations are undergoing changes, particularly regarding the treatment of asymptomatic stenosis. Consolidated knowledge on the indications, nationwide distribution and numbers of cases are not available. Moreover, the impact and grade of implementation of the recently published national S3 guidelines on the reality of medical treatment remain unclear. METHODS Analysis of administrative hospital data involving the diagnosis-related groups (DRG) statistics and structured quality reports for 2010 and 2013 to evaluate the procedural therapy trends concerning operative and interventional approaches for symptomatic and asymptomatic carotid artery stenoses. RESULTS In Germany approximately 37,000 carotid endarterectomies (CEA) and approximately 5,000 carotid angioplasties with stenting (CAS) are carried out per year. Approximately 94 % of CEA and 62 % of CAS are performed in centers with more than 25 procedures per year. Only 33 % of CEA and 39 % of CAS are related to symptomatic stenosis. CONCLUSION Mathematically, an undertreatment of symptomatic and an overtreatment of asymptomatic carotid artery stenoses become apparent. Efforts should be made to achieve inpatient medical treatment conforming to the national S3 guidelines, in particular to adequately reduce the risk of stroke recurrence in patients with atherosclerotic symptomatic carotid artery stenosis.
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Affiliation(s)
- J Eyding
- Neurologische Klinik, Universitätsklinikum Knappschaftskrankenhaus, Ruhr Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland. .,Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
| | - M Kitzrow
- Neurologische Klinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr Universität Bochum, Bochum, Deutschland.,Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland
| | - C Krogias
- Neurologische Klinik, Universitätsklinikum St. Josef-Hospital, Ruhr Universität Bochum, Bochum, Deutschland.,Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland
| | - G Reimann
- Neurologische Klinik, Klinikum Dortmund GmbH, Dortmund, Deutschland.,Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland
| | - R Weber
- Neurologische Klinik, Alfried Krupp Krankenhaus Essen, Essen, Deutschland.,Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland
| | - C Weimar
- Neurologische Klinik, Universitätsklinikum Essen, Essen, Deutschland.,Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland
| | - D Bartig
- drg market Osnabrück, Osnabrück, Deutschland.,Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland
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Singh N, Moody AR, Roifman I, Bluemke DA, Zavodni AEH. Advanced MRI for carotid plaque imaging. Int J Cardiovasc Imaging 2015; 32:83-9. [PMID: 26293362 PMCID: PMC4706840 DOI: 10.1007/s10554-015-0743-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/13/2015] [Indexed: 10/28/2022]
Abstract
Atherosclerosis is the ubiquitous underling pathological process that manifests in heart attack and stroke, cumulating in the death of one in three North American adults. High-resolution magnetic resonance imaging (MRI) is able to delineate atherosclerotic plaque components and total plaque burden within the carotid arteries. Using dedicated hardware, high resolution images can be obtained. Combining pre- and post-contrast T1, T2, proton-density, and magnetization-prepared rapid acquisition gradient echo weighted fat-saturation imaging, plaque components can be defined. Post-processing software allows for semi- and fully automated quantitative analysis. Imaging correlation with surgical specimens suggests that this technique accurately differentiates plaque features. Total plaque burden and specific plaque components such as a thin fibrous cap, large fatty or necrotic core and intraplaque hemorrhage are accepted markers of neuroischemic events. Given the systemic nature of atherosclerosis, emerging science suggests that the presence of carotid plaque is also an indicator of coronary artery plaque burden, although the preliminary data primarily involves patients with stable coronary disease. While the availability and cost-effectiveness of MRI will ultimately be important determinants of whether carotid MRI is adopted clinically in cardiovascular risk assessment, the high accuracy and reliability of this technique suggests that it has potential as an imaging biomarker of future risk.
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Affiliation(s)
- Navneet Singh
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada
| | - Idan Roifman
- Division of Cardiology, Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - David A Bluemke
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Anna E H Zavodni
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room AG56b, Toronto, ON, M4N 3M5, Canada.
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