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Said S, Dardik A, Ochoa Chaar CI. What are the benefits and drawbacks of statins in carotid artery disease? A perspective review. Expert Rev Cardiovasc Ther 2023; 21:763-777. [PMID: 37994875 DOI: 10.1080/14779072.2023.2286011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION The prevalence of carotid artery stenosis in the general population is approximately 3%, but approximately 20% among people with acute ischemic stroke. Statins are recommended by multiple international guidelines as the drug of choice for lipid control in people with asymptomatic or symptomatic carotid artery stenosis due to their lipid-lowering and other pleiotropic effects. AREAS COVERED This review discusses the guidelines for statin usage as a cornerstone in the prevention and management of atherosclerotic carotid artery disease and the impact of statins on stroke incidence and mortality. Statin side effects, alternative therapy, and genetic polymorphisms are reviewed. EXPERT OPINION Statin therapy is associated with a decreased incidence of stroke and mortality as well as improved outcomes for patients treated with carotid revascularization. Statins are a safe and effective class of medications, but the initiation of therapy warrants close monitoring to avoid rare and potentially serious side effects. Lack of clinical efficacy or the presence of side effects suggests a need for treatment with an alternative therapy such as PCSK9 inhibitors. Understanding the interplay between the mechanisms of statins and PCSK9 inhibition therapies will allow optimal benefits while minimizing risks. Future research into genetic polymorphisms may improve patient selection for personalized therapy.
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Affiliation(s)
- Shreef Said
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, VA Connecticut Healthcare Systems, West Haven, CT, USA
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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The role of wall shear stress in the parent artery as an independent variable in the formation status of anterior communicating artery aneurysms. Eur Radiol 2018; 29:689-698. [PMID: 30019140 DOI: 10.1007/s00330-018-5624-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The study aimed to determine which hemodynamic parameters independently characterize anterior communicating artery (AcomA) aneurysm formation and explore the threshold of wall shear stress (WSS) of the parent artery to better illustrate the correlation between the magnitude of WSS and AcomA aneurysm formation. METHODS Eighty-one patients with AcomA aneurysms and 118 patients without intracranial aneurysms (control population), as confirmed by digital subtraction angiography (DSA) from January 2014 to May 2017, were included in this cross-sectional study. Three-dimensional-DSA was performed to evaluate the morphologic characteristics of AcomA aneurysms. Local hemodynamic parameters were obtained using transcranial color-coded duplex (TCCD). Multivariate logistic regression and a two-piecewise linear regression model were used to determine which hemodynamic parameters are independent predictors of AcomA aneurysm formation and identify the threshold effect of WSS of the parent artery with respect to AcomA aneurysm formation. RESULTS Univariate analyses showed that the WSS (p < 0.0001), angle between the A1 and A2 segments of the anterior cerebral artery (ACA) (p < 0.001), hypertension (grade II) (p = 0.007), fasting blood glucose (FBG; > 6.0 mmol/L) (p = 0.005), and dominant A1 (p < 0.001) were the significant parameters. Multivariate analyses showed a significant association between WSS of the parent artery and AcomA aneurysm formation (p = 0.0001). WSS of the parent artery (7.8-12.3 dyne/cm2) had a significant association between WSS and aneurysm formation (HR 2.0, 95% CI 1.3-2.8, p < 0.001). CONCLUSIONS WSS ranging between 7.8 and 12.3 dyne/cm2 independently characterizes AcomA aneurysm formation. With each additional unit of WSS, there was a one-fold increase in the risk of AcomA aneurysm formation. KEY POINTS • Multivariate analyses and a two-piecewise linear regression model were used to evaluate the risk factors for AcomA aneurysm formation and the threshold effect of WSS on AcomA aneurysm formation. • WSS ranging between 7.8 and 12.3 dyne/cm 2 was shown to be a reliable hemodynamic parameter in the formation of AcomA aneurysms. The probability of AcomA aneurysm formation increased one-fold for each additional unit of WSS. • An ultrasound-based TCCD technique is a simple and accessible noninvasive method for detecting WSS in vivo; thus, it can be applied as a screening tool for evaluating the probability of aneurysm formation in primary care facilities and community hospitals because of the relatively low resource intensity.
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de Eulate RG, Goñi I, Galiano A, Vidorreta M, Recio M, Riverol M, Zubieta JL, Fernández-Seara MA. Reduced Cerebral Blood Flow in Mild Cognitive Impairment Assessed Using Phase-Contrast MRI. J Alzheimers Dis 2018; 58:585-595. [PMID: 28453476 DOI: 10.3233/jad-161222] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is increasing evidence of a vascular contribution to Alzheimer's disease (AD). In some cases, prior work suggests that chronic brain hypoperfusion could play a prime pathogenic role contributing to the accumulation of amyloid-β,while other studies favor the hypothesis that vascular dysfunction and amyloid pathology are independent, although synergistic, mechanisms contributing to cognitive impairment. Vascular dysfunction can be evaluated by assessing cerebral blood flow impairment. Phase contrast velocity mapping by MRI offers a non-invasive means of quantifying the total inflow of blood to the brain. This quantitative parameter could be a sensitive indicator of vascular disease at early stages of AD. In this work, phase contrast MRI was used to evaluate cerebral hemodynamics in patients with subjective memory complaints, amnestic mild cognitive impairment, and mild to moderate AD, and compare them with control subjects. Results showed that blood flow and velocity were decreased in the patients with cognitive dysfunction and the decrease correlated with the degree of cognitive impairment as assessed by means of neuropsychological tests. Total cerebral blood flow measurements were clearly reduced in AD patients, but more importantly appeared to be sensitive enough to distinguish between healthy subjects and those with mild cognitive impairment. A quantitative measurement of total brain blood flow could potentially predict vascular dysfunction and compromised brain perfusion in early stages of AD.
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Affiliation(s)
| | - Irene Goñi
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Department of Biomedical Engineering, TECNUN Engineering School, University of Navarra, San Sebastián, Spain
| | - Alvaro Galiano
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marta Vidorreta
- Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Miriam Recio
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Mario Riverol
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José L Zubieta
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María A Fernández-Seara
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Department of Biomedical Engineering, TECNUN Engineering School, University of Navarra, San Sebastián, Spain
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Carallo C, Tripolino C, De Franceschi MS, Irace C, Xu XY, Gnasso A. Carotid endothelial shear stress reduction with aging is associated with plaque development in twelve years. Atherosclerosis 2016; 251:63-69. [DOI: 10.1016/j.atherosclerosis.2016.05.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 05/15/2016] [Accepted: 05/27/2016] [Indexed: 01/09/2023]
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Liu B, Li Q, Wang J, Xiang H, Ge H, Wang H, Xie P. A Highly Similar Mathematical Model for Cerebral Blood Flow Velocity in Geriatric Patients with Suspected Cerebrovascular Disease. Sci Rep 2015; 5:15771. [PMID: 26497612 PMCID: PMC4620558 DOI: 10.1038/srep15771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/01/2015] [Indexed: 11/21/2022] Open
Abstract
Cerebral blood flow velocity(CBFV) is an important parameter for study of cerebral hemodynamics. However, a simple and highly similar mathematical model has not yet been established for analyzing CBFV. To alleviate this issue, through TCD examination in 100 geriatric patients with suspected cerebrovascular disease (46 males and 54 females), we established a representative eighth-order Fourier function Vx(t) that simulates the CBFV. The measured TCD waveforms were compared to those derived from Vx(t), an illustrative Kolmogorov-Smirnov test was employed to determine the validity. The results showed that the TCD waves could been reconstructed for patients with different CBFVs by implementing their variable heart rates and the formulated maximum/minimum of Vx(t). Comparisons between derived and measured TCD waveforms suggest that the two waveforms are very similar. The results confirm that CBFV can be well-modeled through an eighth-order Fourier function. This function Vx(t) can be used extensively for a prospective study of cerebral hemodynamics in geriatric patients with suspected cerebrovascular disease.
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Affiliation(s)
- Bo Liu
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China.,Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China.,Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.,Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing 400016, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.,Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.,Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing 400016, China
| | - Jisheng Wang
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China
| | - Hu Xiang
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China
| | - Hong Ge
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China
| | - Hui Wang
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China
| | - Peng Xie
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China.,Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China.,Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.,Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.,Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing 400016, China
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Endothelial shear stress estimation in the human carotid artery based on Womersley versus Poiseuille flow. Int J Cardiovasc Imaging 2014; 31:585-93. [DOI: 10.1007/s10554-014-0571-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
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Intraoperative monitoring of carotid endarterectomy by transcranial motor evoked potential: A multicenter study of 600 patients. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2012.10.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jeong SK, Rosenson RS. Shear rate specific blood viscosity and shear stress of carotid artery duplex ultrasonography in patients with lacunar infarction. BMC Neurol 2013; 13:36. [PMID: 23597083 PMCID: PMC3643866 DOI: 10.1186/1471-2377-13-36] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 03/09/2013] [Indexed: 11/10/2022] Open
Abstract
Background This study describes a new method for determining site-specific vascular shear stress using dynamic measures of shear rate and blood viscosity (BV) in the carotid arteries, and examines characteristics of carotid arterial shear stress among patients with lacunar infarction. Methods Vascular shear stress measurements were conducted in 37 patients (17 lacunar infarction patients and 20 control subjects) using duplex ultrasonography. Vessel wall diameters and velocities were measured in each arterial segment at peak-systolic (PS) and end-diastolic (ED) phases, for calculation of PS/ED shear rates. PS/ED shear stresses [dyne/cm2] were determined with PS/ED shear rates and shear-rate dependent BV values. For comparison, both values of hematocrit-derived BV and BV measurements at 300 s-1 were used for calculation of shear stress. Results All cardiovascular disease (CVD) risk factors including BV values were similar between the two groups. In both common carotid arteries, PS and ED shear stresses were significantly lower in the patients with lacunar infarction than in controls in multivariate models that included age, sex, and other major CVD risk factors. PS and ED shear stresses using the shear rate specific BV were 4.5% lower and 7.3% higher than those using the two other BVs, respectively. Conclusion Lacunar infarction was associated with reduced carotid arterial shear stress. The use of estimated BV for calculating carotid arterial shear stress provides more accurate assessment of the hemodynamic contribution of shear stress than previous models that have arbitrarily assigned a constant value to this dynamic flow property.
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Irace C, Carallo C, De Franceschi MS, Scicchitano F, Milano M, Tripolino C, Scavelli F, Gnasso A. Human common carotid wall shear stress as a function of age and gender: a 12-year follow-up study. AGE (DORDRECHT, NETHERLANDS) 2012; 34:1553-62. [PMID: 21989971 PMCID: PMC3528365 DOI: 10.1007/s11357-011-9318-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 09/19/2011] [Indexed: 05/16/2023]
Abstract
Hemodynamic forces play a role in the development of atherosclerosis. Their variations with age have been assessed in cross-sectional, but not longitudinal, studies. The aim of the present study was to investigate in both sexes the age-dependent change in wall shear stress and arterial stiffness in subjects studied twice 12 years apart. Forty-eight subjects (15 women and 33 men) were studied twice 12 years apart. Subjects underwent blood viscosity measurement and echo-Doppler of carotid arteries, from which the intima-media thickness (IMT) was measured and the wall shear stress and Peterson's elastic modulus were calculated. Blood viscosity increased in both sexes, more markedly in women (+13.2%) than men (+7.2%). Common carotid diameter increased in both sexes, but in men (+7.4%) more than in women (+5.5%). Peak and mean velocity decreased at follow-up by 10.7% and 18.9% in women and by 14.2% and 18.1% in men. Peak and mean shear stress significantly decreased in men by 13.0% and 17.5%, respectively, while in women only the mean shear stress was reduced (-11.8%). The IMT of the common carotid artery increased by 29% in women and 20% in men. Arterial stiffness significantly increased (+74.5% in women and +28.0% in men). The percent change in mean shear stress was significantly and inversely associated with the percent change in IMT. The data of this study show that, in a middle-aged population observed for almost 12 years, the mean shear stress decreases significantly in both sexes, while peak shear stress decreases significantly only in men. The change in mean shear stress is inversely associated with changes in IMT. Arterial stiffness, on the other hand, increases with aging.
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Affiliation(s)
- Concetta Irace
- Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore”, “Magna Græcia” University, University Campus “S. Venuta”, Germaneto, 88100 Catanzaro, Italy
| | - Claudio Carallo
- Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore”, “Magna Græcia” University, University Campus “S. Venuta”, Germaneto, 88100 Catanzaro, Italy
| | - Maria Serena De Franceschi
- Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore”, “Magna Græcia” University, University Campus “S. Venuta”, Germaneto, 88100 Catanzaro, Italy
| | - Federico Scicchitano
- Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore”, “Magna Græcia” University, University Campus “S. Venuta”, Germaneto, 88100 Catanzaro, Italy
| | - Marianna Milano
- Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore”, “Magna Græcia” University, University Campus “S. Venuta”, Germaneto, 88100 Catanzaro, Italy
| | - Cesare Tripolino
- Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore”, “Magna Græcia” University, University Campus “S. Venuta”, Germaneto, 88100 Catanzaro, Italy
| | - Faustina Scavelli
- Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore”, “Magna Græcia” University, University Campus “S. Venuta”, Germaneto, 88100 Catanzaro, Italy
| | - Agostino Gnasso
- Dipartimento di Medicina Sperimentale e Clinica “G. Salvatore”, “Magna Græcia” University, University Campus “S. Venuta”, Germaneto, 88100 Catanzaro, Italy
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Takahashi S, Papafaklis MI, Sakamoto S, Antoniadis AP, Coskun AU, Feldman CL, Stone PH. The effect of statins on high-risk atherosclerotic plaque associated with low endothelial shear stress. Curr Opin Lipidol 2011; 22:358-64. [PMID: 21841484 DOI: 10.1097/mol.0b013e32834ab106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Low endothelial shear stress (ESS) plays an important role in the progression and severity of atherosclerotic lesions. As 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) appear to stabilize plaque, it would be valuable to understand how statins affect the nature of lesions in the proatherogenic and proinflammatory environment of low ESS and the effect of statins on that atherosclerotic process. The purpose of this review is to summarize the relationship among low ESS, high-risk plaque and statins. RECENT FINDINGS Low ESS is a critically important determinant of plaque development and progression to high-risk plaques with large necrotic lipid core, intensive inflammation and thin fibrous cap. In addition to the proatherogenic phenotypic switching in areas of low ESS, local LDL cholesterol concentrations are also increased in areas of low ESS, which exacerbates the local atherogenic process. In experimental models, statins appear to reduce the inflammation in lesions associated with low ESS and reduce the atherosclerotic phenotype even in these high-risk prone vascular areas. SUMMARY The relationship between low ESS and statins has not been fully investigated, but the available data underscore the vasculoprotective effect of statins. Understanding the mechanisms whereby statins reduce the atherogenic and inflammatory phenotype resulting from a low ESS environment would provide new insights to design strategies to prevent regional formation of high-risk, inflamed plaques likely to rupture and cause an adverse clinical event.
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Affiliation(s)
- Saeko Takahashi
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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11
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Takumi T, Yang EH, Mathew V, Rihal CS, Gulati R, Lerman LO, Lerman A. Coronary endothelial dysfunction is associated with a reduction in coronary artery compliance and an increase in wall shear stress. Heart 2011; 96:773-8. [PMID: 20448128 DOI: 10.1136/hrt.2009.187898] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Endothelial dysfunction is associated with arterial stiffness in large arteries. The purpose of this study was to investigate the association between coronary endothelial dysfunction, coronary artery compliance and wall shear stress in patients with early atherosclerosis. METHODS Coronary endothelial function was assessed according to responses to intracoronary acetylcholine in 120 patients without significant coronary stenosis. Acceleration of peak velocity (ACC), which is inversely related to coronary artery compliance, was derived from coronary flow velocity spectra, and wall shear rate (WSR) was calculated. Measurements were performed at baseline and after intracoronary nitroglycerin in order to eliminate the contribution of vascular smooth muscle tone to coronary artery compliance. RESULTS In all patients, heart rate significantly increased (72+/-1 to 77+/-1 bpm, p<0.01) and mean arterial pressure decreased (97+/-2 to 93+/-1 mm Hg, p<0.01) after nitroglycerin. Coronary blood flow (CBF) and resistance were not significantly changed, but the diastolic to systolic velocity ratio increased significantly (2.15+/-0.08 to 5.36+/-0.61, p<0.01). Patients with abnormal endothelial function (n=70) had a higher WSR at baseline (559+/-41 vs 440+/-26 s(-1), p<0.05) and after nitroglycerin (457+/-41 vs 339+/-29 s(-1), p<0.05), and a higher ACC after nitroglycerin (3.9+/-0.4 vs 2.8+/-0.4 m/s(2), p<0.05) than patients with normal function (n=50). CONCLUSIONS The current study demonstrates that intracoronary nitroglycerin does not contribute to an increase of CBF but alters the phasic coronary flow pattern. Furthermore, early coronary atherosclerosis characterised by endothelial dysfunction is associated with a decrease in coronary artery compliance and an increase in wall shear stress. Therefore, coronary wall properties are affected early in the atherosclerosis process.
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Affiliation(s)
- Takuro Takumi
- Division of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
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Makris GC, Lavida A, Nicolaides AN, Geroulakos G. The effect of statins on carotid plaque morphology: A LDL-associated action or one more pleiotropic effect of statins? Atherosclerosis 2010; 213:8-20. [DOI: 10.1016/j.atherosclerosis.2010.04.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 04/26/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
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Marchidann A, Marshall RS. Treatment of carotid artery disease: endarterectomy or angioplasty? Curr Neurol Neurosci Rep 2010; 11:61-6. [PMID: 20960240 DOI: 10.1007/s11910-010-0153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The management of carotid stenosis has enjoyed renewed interest in the neurological community in recent years due to the advent of endovascular approaches. In concert, progress in medical treatment of these patients has rekindled the debate regarding the best management of carotid stenosis overall, both for symptomatic and asymptomatic disease. For symptomatic carotid stenosis, the major decision required is choosing the type of intervention best suited for individual patients: carotid endarterectomy versus carotid artery stenting. For patients with asymptomatic carotid stenosis, intensive medical management has evolved significantly over the past decade to decrease the risk of ischemic stroke to match surgical intervention under most circumstances. This review will examine the supporting evidence for each intervention, and discuss the recent advances in medical and endovascular therapy that provide the data for a new era in clinical decision making.
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Affiliation(s)
- Adrian Marchidann
- Neurology Department, North Shore - LIJ Health System, 300 Community Drive, 9 Tower, Manhasset, NY 11030, USA.
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Duivenvoorden R, Vanbavel E, de Groot E, Stroes ESG, Disselhorst JA, Hutten BA, Laméris JS, Kastelein JJP, Nederveen AJ. Endothelial shear stress: a critical determinant of arterial remodeling and arterial stiffness in humans--a carotid 3.0-T MRI study. Circ Cardiovasc Imaging 2010; 3:578-85. [PMID: 20576811 DOI: 10.1161/circimaging.109.916304] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low endothelial shear stress (ESS) elicits endothelial dysfunction. However, the relationship between ESS and arterial remodeling and arterial stiffness is unknown in humans. We developed a 3.0-T MRI protocol to evaluate the contribution of ESS to arterial remodeling and stiffness. METHODS AND RESULTS Fifteen young (aged 26 ± 3 years) and 15 older (aged 57 ± 3 years) healthy volunteers as well as 15 patients with cardiovascular disease (aged 63 ± 10 years) were enrolled. Phase-contrast MRI of the common carotid arteries was used to derive ESS data from the spatial velocity gradients close to the arterial wall. ESS measurements were performed on 3 occasions and showed excellent reproducibility (intraclass correlation coefficient, 0.79). Multiple linear regression analysis accounting for age and blood pressure revealed that ESS was an independent predictor of the following response variables: carotid wall thickness (regression coefficient [b], -0.19 mm(2) per N/m(2); P=0.02), lumen area (b, -15.5 mm(2) per N/m(2); P<0.001), and vessel size (b, -24.0 mm(2) per N/m(2); P<0.001). Segments of the artery wall exposed to lower ESS were significantly thicker than segments exposed to higher ESS within the same artery (P=0.009). Furthermore, ESS was associated with arterial compliance, accounting for age, blood pressure, and wall thickness (b, -0.003 mm(2)/mm Hg per N/m(2); P=0.04). CONCLUSIONS Our carotid MRI data show that ESS is an important determinant of arterial remodeling and arterial stiffness in humans. The data warrant further studies to evaluate use of carotid ESS as a noninvasive tool to improve the understanding of individual cardiovascular disease risk and to assess novel drug therapies in cardiovascular disease prevention.
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Affiliation(s)
- Raphaël Duivenvoorden
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Evolution of shear stress, protein expression, and vessel area in an animal model of arterial dilatation in hemodialysis grafts. J Vasc Interv Radiol 2010; 21:108-15. [PMID: 20123196 DOI: 10.1016/j.jvir.2009.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 09/15/2009] [Accepted: 09/21/2009] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the wall shear stress, protein expression of matrix metalloproteinase (MMP)-2 and MMP-9 and tissue inhibitor of matrix metalloproteinase (TIMP)-1 and TIMP-2, and vessel area over time in a porcine model for polytetrafluoroethylene (PTFE) hemodialysis grafts. MATERIALS AND METHODS In 21 pigs, subtotal renal infarction was created, and 28 days later, a PTFE graft was placed to connect the carotid artery to the ipsilateral jugular vein. Phase-contrast magnetic resonance imaging was used to measure blood flow and vessel area at 1, 3, 7, and 14 days after graft placement. Wall shear stress was estimated from the law of Poiseuille. Animals were killed at day 3 (n = 7), day 7 (n = 7), and day 14 (n = 7) and expression of MMP-2, MMP-9, TIMP-1, and TIMP-2 were determined at the grafted and control arteries. RESULTS The mean wall shear stress of the grafted artery was higher than in the control artery at all time points (P < .05). It peaked by day 3 and decreased by days 7-14 as the vessel area nearly doubled. By days 7-14, there was a significant increase in active MMP-2 followed by a significant increase in pro-MMP-9 and active MMP-9 by day 14 (P < .05, grafted artery vs control). TIMP-1 expression peaked by day 7 and then decreased, whereas TIMP-2 expression was decreased at days 7-14. CONCLUSIONS The wall shear stress of the grafted artery peaks by day 3, with increased MMP-2 activity by days 7-14, followed by increase pro-MMP-9 and active MMP-9 by day 14. In addition, the vessel area nearly doubled.
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Cebral JR, Castro MA, Putman CM, Alperin N. Flow-area relationship in internal carotid and vertebral arteries. Physiol Meas 2008; 29:585-94. [PMID: 18460763 DOI: 10.1088/0967-3334/29/5/005] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Subject-specific computational and experimental models of hemodynamics in cerebral aneurysms require the specification of physiologic flow conditions. Because patient-specific flow data are not always available, researchers have used 'typical' or population average flow rates and waveforms. However, in order to be able to compare the magnitude of hemodynamic variables between different aneurysms or groups of aneurysms (e.g. ruptured versus unruptured) it is necessary to scale the flow rates to the area of the inflow artery. In this work, a relationship between flow rates and vessel areas is derived from phase-contrast magnetic resonance measurements in the internal carotid arteries and vertebral arteries of normal subjects.
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Affiliation(s)
- J R Cebral
- Center for Computational Fluid Dynamics, George Mason University, Fairfax, VA 22030, USA.
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Misra S, Fu AA, Puggioni A, Karimi KM, Mandrekar JN, Glockner JF, Juncos LA, Anwer B, McGuire AM, Mukhopadhyay D. Increased shear stress with upregulation of VEGF-A and its receptors and MMP-2, MMP-9, and TIMP-1 in venous stenosis of hemodialysis grafts. Am J Physiol Heart Circ Physiol 2008; 294:H2219-30. [PMID: 18326810 DOI: 10.1152/ajpheart.00650.2007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Venous injury and subsequent venous stenosis formation are responsible for hemodialysis graft failure. Our hypothesis is that these pathological changes are in part related to changes in wall shear stress (WSS) that results in the activation of matrix regulatory proteins causing subsequent venous stenosis formation. In the present study, we examined the serial changes in WSS, blood flow, and luminal vessel area that occur subsequent to the placement of a hemodialysis graft in a porcine model of chronic renal insufficiency. We then determined the corresponding histological, morphometric, and kinetic changes of several matrix regulatory proteins including VEGF-A, its receptors, matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitor of matrix metalloproteinase (TIMP)-1, and TIMP-2. WSS was estimated by obtaining blood flow and luminal vessel area by performing phase-contrast MRI with magnetic resonance angiography in 21 animals at 1 day after graft placement and prior to death on day 3 (n = 7), day 7 (n = 7), and day 14 (n = 7). At all time points, the mean WSS at the vein-to-graft anastomosis was significantly higher than that at the control vein (P < 0.05). WSS had a bimodal distribution with peaks on days 1 and 7 followed by a significant reduction in WSS by day 14 (P < 0.05 compared with day 7) and a decrease in luminal vessel area compared with control vessels. By day 3, there was a significant increase in VEGF-A and pro-MMP-9 followed by, on day 7, increased pro-MMP-2, active MMP-2, and VEGF receptor (VEGFR)-2 (P < 0.05) and, by day 14, increased VEGFR-1 and TIMP-1 (P < 0.05) at the vein-to-graft anastomosis compared with control vessels. Over time, the neointima thickened and was composed primarily of alpha-smooth muscle actin-positive cells with increased cellular proliferation. Our data suggest that hemodialysis graft placement leads to early increases in WSS, VEGF-A, and pro-MMP-9 followed by subsequent increases in pro-MMP-2, active MMP-2, VEGFR-1, VEGFR-2, and TIMP-1, which may contribute to the development of venous stenosis.
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Affiliation(s)
- Sanjay Misra
- Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Murakami M, Fujioka S, Hirata Y, Kuratsu JI. Low-dose of Statin Treatment Improves Cerebrovascular Reactivity in Patients With Ischemic Stroke: Single Photon Emission Computed Tomography Analysis. J Stroke Cerebrovasc Dis 2008; 17:16-22. [DOI: 10.1016/j.jstrokecerebrovasdis.2007.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 08/03/2007] [Accepted: 09/03/2007] [Indexed: 11/27/2022] Open
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