Atherosclerotic Plaque in the Left Carotid Artery Is More Vulnerable Than in the Right

Correlation between Morphological and Hemodynamic Parameters of Carotid Arteries and Cerebral Vasomotor Reactivity

The function of cerebral small vessels can be assessed using cerebral vasomotor reactivity (VMR). Our aim in this retrospective cross-sectional study was to investigate a correlation between carotid artery stenosis measured through ultrasonographic morphological and hemodynamic parameters and cerebral VMR. A total of 285 patients (125 males; mean age 54) were included. The breath-holding index (BHI) was used to evaluate cerebral VMR. Ultrasonographic carotid artery parameters were collected: the presence and characteristics of carotid plaques, the degree of carotid diameter stenosis, intima-media thickness (IMT), peak systolic velocity (PSV), and end diastolic velocity (EDV). Additionally, hemodynamic parameters of the middle cerebral artery (MCA) were evaluated, including the mean flow velocity (MFV) and pulsatility index (PI). The following was collected from patients' medical histories: age, gender, and vascular risk factors. A negative correlation between the BHI and age (r = -0.242, p < 0.01), BHI and the presence of carotid plaques, BHI and IMT (r = -0.203, p < 0.01), and BHI and the PI of MCA on both sides (r = -0.268, p < 0.01) was found. We found a positive correlation between the BHI in the left MCA and EDV in the left internal carotid artery (r = 0.121, p < 0.05). This study shows the correlation between cerebral VMR and carotid stenosis but indicates a higher influence of morphological parameters on VMR values.

Carotid Artery Tortuosity and Internal Carotid Artery Plaque Composition

BACKGROUND

Little is known about the association between carotid artery tortuosity and internal carotid artery atherosclerosis. This study sought to evaluate the associations between various types of arterial tortuosity and vulnerable plaque components on magnetic resonance angiography (MRA).

MATERIAL AND METHODS

A retrospective review was completed of 102 patients who had undergone MRA neck imaging, with intraplaque hemorrhage (IPH) present in one or both cervical internal carotid arteries (ICA). Each ICA was assessed for two categories of tortuosity: variant arterial pathway(s) (retrojugular and/or retropharyngeal) and abnormal curvature (kinks, loops, and/or coils). All ICA plaques were assessed for the presence or absence of intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), ulceration, and enhancement, as well as the volume of IPH and degree of luminal stenosis.

RESULTS

The mean age of included patients was 73.5 years (SD = 9.0 years) and 88 (86.3%) subjects were male. The left carotid plaque was significantly more likely to have IPH (68.6% vs. 47.1%; p = 0.02). The left ICA was more likely to have a retrojugular course (22% vs. 9.9%; p = 0.002) and any variant arterial course (26.5% versus 14.67%, p = 0.01). On the right there was an association between the presence of a LRNC and retropharyngeal and/or retrojugular arterial pathway (p = 0.03). On the left there was an association between the presence of any abnormal arterial curvature and IPH volume (p = 0.03). Neither association met the adjusted statistical threshold after Bonferroni correction, with alpha set at 0.0028.

CONCLUSION

ICA tortuosity is not associated with carotid artery plaque composition, and likely does not play a role in the development of high-risk plaques.

Traditional Cardiovascular Risk Factors Are Stronger Related to Carotid Intima-Media Thickness Than to Presence of Carotid Plaques in People Living With HIV

Background Cardiovascular disease is a major cause of morbidity and mortality in people living with HIV, who are at higher risk than the general population. We assessed, in a large cohort of people living with HIV, which cardiovascular, HIV-specific, and lipoproteomic markers were associated with carotid intima-media thickness (cIMT) and carotid plaque presence. We also studied guideline adherence on lipid-lowering medication in individuals with high and very high risk for cardiovascular disease. Methods and Results In 1814 individuals with a median (interquartile range) age of 53 (44-60) years, we found a carotid plaque in 909 (50.1%) and a median (interquartile range) intima-media thickness of 0.66 (0.57-0.76) mm. Ultrasonography was used for the assessment of cIMT and plaque presence. Univariable and multivariable regression models were used for associations with cIMT and presence of plaques. Age, Black race, body mass index, type 2 diabetes, and smoking (pack years) were all positively associated with higher cIMT. Levels of high-density lipoprotein cholesterol, specifically medium and large high-density lipoprotein subclasses, were negatively associated with higher cIMT. Only age and prior myocardial infarction were positively related to the presence of a carotid plaque. Lipid-lowering treatment was prescribed in one-third of people living with HIV, who are at high and very high risk for cardiovascular disease. Conclusions Traditional cardiovascular risk factors were significantly associated with higher cIMT but not with carotid plaques, except for age. HIV-specific factors were not associated with both ultrasound measurements. Future studies are needed to elucidate which factors contribute to plaque formation. Improvement of guideline adherence on prescription of lipid-lowering treatment in high- and very high-risk patients for cardiovascular disease is recommended. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03994835.

Factors Affecting Carotid Artery Stenosis in the Elderly Living at High Altitudes

BACKGROUND

Factors affecting carotid artery stenosis have been generally investigated. However, considering the protective effect of altitude, studies on elderly individuals at high altitudes are few. Our aim is to investigate the systematic adaptive changes caused by high-altitude exposure through the causes of carotid artery stenosis.

MATERIALS AND METHODS

Carotid Doppler ultrasound was performed on 250 patients over the age of 50 years. The patients' age, gender, height, weight, smoking history, place of residence, and presence of comorbidities were questioned. Those with diabetes, hypertension, hyperlipidemia, and coronary disease were excluded from the study. Those who did not reside at high altitudes were excluded from the study. One hundred and thirty-five patients were included in the study. Carotid artery Doppler findings and biochemical parameters were recorded. Factors affecting stenosis in the carotid arteries were compared.

RESULTS

In our study, the factors affecting carotid stenosis were determined to be age, gender, presence of plaque, plaque type, and mean carotid intima-media thickness (CIMT). The mean CIMT of the patients was calculated as 0.71±0.14 mm. The mean CIMT measurement level was significantly higher in patients with plaque in the carotid artery (p<0.05). According to receiver operating characteristic curves, CIMT values higher than 0.72 mm increase plaque and stenosis formation in the common carotid artery (CCA) and internal carotid artery (ICA) in elderly people living at high altitudes (p<0.05, area under the curve [AUC]: 0.71-0.83).

CONCLUSIONS

The most important factors affecting carotid stenosis in individuals living at high altitudes are age, gender, CIMT, plaque, and plaque type. When soft plaques were detected, the risk of stenosis was found to be higher than in calcific plaques. Additionally, the number of factors affecting stenosis was greater on the left (ICA). This suggests that the left carotid system is more vulnerable. It can be said that in elderly individuals living at high altitudes, a CIMT higher than 0.72 mm is a cutoff value in the presence of plaque and stenosis in the carotid arteries.

Long-term exposure to ambient fine particulate matter and carotid intima media thickness at bilateral, left and right in adults from Mexico City: Results from GEA study

BACKGROUND

PM2.5 exposure has been associated with intima-media thickness (cIMT) increase. However, very few studies distinguished between left and right cIMT in relation to PM2.5 exposure.

AIM

To evaluate associations between chronic exposure to PM2.5 and cIMT at bilateral, left, and right in adults from Mexico City.

METHODS

This study comprised 913 participants from the control group, participants without personal or family history of cardiovascular disease, of the Genetics of Atherosclerosis Disease Mexican study (GEA acronym in Spanish), recruited at the Instituto Nacional de Cardiología Ignacio Chávez from June 2008 to January 2013. To assess the associations between chronic exposure to PM2.5 (per 5 μg/m3 increase) at different lag years (1-4 years) and cIMT (bilateral, left, and right) we applied distributed lag non-linear models (DLNMs).

RESULTS

The median and interquartile range for cIMT at bilateral, left, and right, were 630 (555, 735), 640 (550, 750), and 620 (530, 720) μm, respectively. Annual average PM2.5 exposure was 26.64 μg/m3, with median and IQR, of 24.46 (23.5-25.46) μg/m3. Results from DLNMs adjusted for age, sex, body mass index, low-density lipoproteins, and glucose, showed that PM2.5 exposure for year 1 and 2, were positively and significantly associated with right-cIMT [6.99% (95% CI: 3.67; 10.42) and 2.98% (0.03; 6.01), respectively]. Negative associations were observed for PM2.5 at year 3 and 4 and right-cIMT; however only year 3 was statistically significant [-2.83% (95% CI: 5.12; -0.50)]. Left-cIMT was not associated with PM2.5 exposure at any lag year. The increase in bilateral cIMT followed a similar pattern as that observed for right-cIMT, but with lower estimates.

CONCLUSIONS

Our results suggest different susceptibility between left and right cIMT associated with PM2.5 exposure highlighting the need of measuring both, left and right cIMT, regarding ambient air pollution in epidemiological studies.

The association of stroke risk factors with the future thickness of carotid atherosclerotic plaques

OBJECTIVES

An advancing atherosclerotic plaque is a risk factor for stroke. We conducted this study to assess the relationship between risk factors of stroke with changing in the thickness of carotid plaques thickness evident on sonography.

METHODS

We carried out a secondary analysis of data from a study on carotid bifurcation plaques. Data were collected in the sonography laboratories of two university hospitals. In total, 564 (240; 42.6% men) patients with atherosclerotic plaques in the carotid bifurcation and internal carotid artery with stenosis ≥ 30% evident on duplex sonography were included. We developed machine learning models using an extreme gradient boosting algorithm with Shapley additive explanation method to find important risk factors and their interactions. The outcome was a change in the carotid plaque thickness after 36 months, and the predictors were initial plaque thickness and the risk factors of stroke.

RESULTS

Two regression models were developed for left and right carotid arteries. The R-squared values were 0.964 for the left, and 0.993 for the right model. Overall, the three top features were BMI, age, and initial plaque thickness for both left and right plaques. However, the risk factors of stroke showed stronger interaction in predicting plaque thickening of the left carotid more than the right carotid artery.

DISCUSSION

The effect of each predictor on plaque thickness is complicated by interactions with other risk factors, particularly for the left carotid artery. The side of carotid artery involvement should be considered for stroke prevention.

Current Biomarkers for Carotid Artery Stenosis: A Comprehensive Review of the Literature

Carotid artery stenosis (CAS), an atherosclerotic disease of the carotid artery, is one of the leading causes of transient ischemic attacks (TIA) and cerebrovascular attacks (CVA). The atherogenic process of CAS affects a wide range of physiological processes, such as inflammation, endothelial cell function, smooth muscle cell migration and many more. The current gold-standard test for CAS is Doppler ultrasound; however, there is yet to be determined a strong, clinically validated biomarker in the blood that can diagnose patients with CAS and/or predict adverse outcomes in such patients. In this comprehensive literature review, we evaluated all of the current research on plasma and serum proteins that are current contenders for biomarkers for CAS. In this literature review, 36 proteins found as potential biomarkers for CAS were categorized in to the following nine categories based on protein function: (1) Inflammation and Immunity, (2) Lipid Metabolism, (3) Haemostasis, (4) Cardiovascular Markers, (5) Markers of Kidney Function, (6) Bone Health, (7) Cellular Structure, (8) Growth Factors, and (9) Hormones. This literature review is the most up-to-date and current comprehensive review of research on biomarkers of CAS, and the only review that demonstrated the several pathways that contribute to the initiation and progression of the disease. With this review, future studies can determine if any new markers, or a panel of the proteins explored in this study, may be contenders as diagnostic or prognostic markers for CAS.

Differences in left and right carotid plaque vulnerability in patients with bilateral carotid plaques: a CARE-II study

BACKGROUND AND PURPOSE

Atherosclerosis is a very complex process influenced by various systemic and local factors. Therefore, in patients with bilateral carotid plaques (BCPs), there may be differences in carotid plaque vulnerability between the sides. We aimed to investigate the differences in BCP characteristics in patients with BCPs using magnetic resonance vessel wall imaging (MR-VWI).

METHODS

Participants with BCPs were selected for subanalysis from a multicentre study of Chinese Atherosclerosis Risk Evaluation II. We measured carotid plaque burden, identified each plaque component and measured their volume or area bilaterally on MR-VWI. Paired comparisons of the burden and components of BCPs were performed.

RESULTS

In all, 540 patients with BCPs were eligible for analysis. Compared with the right carotid artery (CA), larger mean lumen area (p<0.001), larger mean wall area (p=0.025), larger mean total vessel area (p<0.001) and smaller normalised wall index (p=0.006) were found in the left CA. Regarding plaque components, only the prevalence of lipid-rich necrotic core (LRNC) in the left CA was higher (p=0.026). For patients with a vulnerable plaque component coexisting on both sides, only the intraplaque haemorrhage (IPH) volume (p=0.011) was significantly greater in the left CA than in the right CA.

CONCLUSIONS

There were asymmetries in plaque growth and evolution between BCPs. The left carotid plaques were more likely to have larger plaque burden, higher prevalence of LRNC and greater IPH volume, which may contribute to the lateralisation of ischaemic stroke in the cerebral hemispheres.

The Association of Carotid Plaque Size, Carotid Intima-Media Thickness, Resistive Index, and Pulsatility Index With Acute Ischemic Stroke

BACKGROUND

Carotid atherosclerosis is an important etiological factor for ischemic stroke. Early carotid lesion detection may prevent further strokes. Doppler ultrasound measures carotid artery blood flow, intima-media thickness, stenosis, plaques, and lumen and wall changes.

OBJECTIVE

The objective of this study is to determine the association of carotid plaque size (CPS), carotid intima-media thickness (CIMT), resistive index (RI), and pulsatility index (PI) with acute ischemic stroke.

METHODOLOGY

A total of 60 participants were taken, including 30 cases and 30 age- and sex-matched controls. Patients with acute ischemic stroke were included as cases and age- and sex-matched healthy volunteers were included as controls. A carotid duplex study was done in both groups, and the findings were compared.

RESULTS

The mean age of the ischemic stroke cases was 63.33±10.79 years; more than half were aged >60 years. Male patients were 73.3% and female patients were 26.7% of the cases. Age and gender were statistically similar (p>0.05) in groups (cases and controls). The plaques were homogenous in 30% of patients, calcified in 26.7%, and mixed in 6.7%. About 36.6% of patients did not have any plaque. CPS was greater among cases than controls in the right and left internal and left common carotid arteries; however, it was not statistically significant (p>0.05). The mean CIMT was 0.79±0.10 mm on the right side and 0.90±0.17 mm on the left side among cases. CIMT was significantly higher in the cases group than in the controls (p<0.05). The mean RI was significantly greater in the left common carotid artery (CCA) among the cases than in the controls (p<0.05). Patients aged over 60 years had significantly higher RI and PI values in the left internal carotid artery (ICA) compared to the younger cases (p<0.05). Smoking history had a significant association with left CCA RI and PI values (p<0.05). However, RI, PI, CPS, and CIMT among cases were similar in different groups like diabetic, non-diabetic, hypertensive, and non-hypertensive patients (p>0.05).

CONCLUSION

CIMT was significantly thicker among the patients with ischemic stroke compared to the control group. RI in the left CCA was significantly greater among the stroke patients than in the control group. The age of the patient and smoking habit had an association with RI and PI values. Most of the parameters were found to be significant on the left side, suggesting carotid atherosclerosis may not be symmetrical. A large-scale further study is needed to see the association of these variables with ischemic stroke patients.

Differences in Carotid Artery Geometry and Flow Caused by Body Postural Changes and Physical Exercise

Different body postures and physical exercises may lead to changes in arterial geometry and hemodynamics, which may be associated with the distribution of atherosclerosis lesions. This study was aimed at investigating potential geometric and hemodynamic changes of the carotid bifurcation in different body postures and after high-intensity interval training (HIIT) workouts. Three-dimensional vascular ultrasound (3DVUS) and Doppler ultrasound images were acquired for 21 healthy participants (aged 29 ± 6 y, 14 men and 7 women) in different body postures (sitting and three sleeping postures [supine, left lateral and right lateral]) and after physical exercises. The common carotid artery (CCA) and internal carotid artery (ICA) diameters of the left carotid artery were found to increase significantly from supine to left lateral (both p <0.05). CCA diameters (p < 0.05) and ICA/CCA diameter ratio (p < 0.01) of the left carotid artery changed significantly from supine to sitting. Significant differences in CCA peak systolic velocity (CCA PSV, p < 0.001), CCA end-diastolic velocity (CCA EDV, p < 0.001), CCA pulsatility index (CCA PI, p < 0.001) and maximum velocity-based wall shear stress at the CCA (WSS_(max) at the CCA, p < 0.001) were identified in different postures. After physical exercises, significant increases were observed in the CCA diameter (p < 0.001), CCA PSV (p < 0.001), ICA PSV (p < 0.05), WSS_(max) at the CCA (p < 0.001) and WSS_(max) at the ICA (p < 0.05), as were significantly lower values of the CCA EDV (p < 0.01) and ICA/CCA PSV ratio (p < 0.05). Side-to-side differences were also detected in different postural change scenarios and after physical exercise; more significant differences were found to occur only in the left-sided carotid artery. Significant differences were identified under postural change and after physical exercise among healthy adults, suggesting that daily activity has an effect on the carotid bifurcation. These changes may be associated with formation and development of carotid atherosclerosis. Moreover, these side differences might be severe for patients and worth further attention in clinical practice.

Sex Differences in Carotid Atherosclerosis: A Systematic Review and Meta-Analysis

BACKGROUND

Over the last decades, several individual studies on sex differences in carotid atherosclerosis have been performed covering a wide range of plaque characteristics and including different populations. This systematic review and meta-analysis aims to summarize previously reported results on sex differences in carotid atherosclerosis and present a roadmap explaining next steps needed for implementing this knowledge in clinical practice.

METHODS

We systematically searched PubMed, Embase, Web of Science, Cochrane Central, and Google Scholar for eligible studies including both male and female participants reporting prevalence of imaging characteristics of carotid atherosclerosis and meta-analyzed these studies. Studies had to report at least the following: (1) calcifications; (2) lipid-rich necrotic core; (3) intraplaque hemorrhage; (4) thin-or-ruptured fibrous cap; (5) plaque ulceration; (6) degree of stenosis; (7) plaque size; or (8) plaque inflammation. We prespecified which imaging modalities had to be used per plaque characteristic and excluded ultrasonography.

RESULTS

We included 42 articles in our meta-analyses (ranging from 2 through 23 articles per plaque characteristic). Men had more frequently a larger plaque compared to women and, moreover, had more often plaques with calcifications (odds ratio=1.57 [95% CI, 1.23-2.02]), lipid-rich necrotic core (odds ratio=1.87 [95% CI, 1.36-2.57]), and intraplaque hemorrhage (odds ratio=2.52 [95% CI, 1.74-3.66]), or an ulcerated plaque (1.81 [95% CI, 1.30-2.51]). Furthermore, we found more pronounced sex differences for lipid-rich necrotic core in symptomatic opposed to asymptomatic participants.

CONCLUSIONS

In this systematic review and meta-analysis, we demonstrate convincing evidence for sex differences in carotid atherosclerosis. All kinds of plaque features-plaque size, composition, and morphology-were more common or larger in men compared to women. Our results highlight that sex is an important variable to include in both study design and clinical-decision making. Further investigation of sex-specific stroke risks with regard to plaque composition is warranted.

Early Amnestic Mild Cognitive Impairment Is Associated with Reduced Total Cerebral Blood Flow with no Brain Tissue Loss

BACKGROUND

Lower cerebral blood flow (CBF) and excessive brain atrophy are linked to Alzheimer's disease (AD). It is still undetermined whether reduced CBF precedes or follows brain tissue loss.

OBJECTIVE

We compared total CBF (tCBF), global cerebral perfusion (GCP), and volumes of AD-prone regions between cognitively normal (CN) and early amnestic mild cognitive impairment (aMCI) and tested their associations with cognitive performance to assess their predictive value for differentiation between CN and early aMCI.

METHODS

A total of 74 participants (mean age 69.9±6.2 years, 47 females) were classified into two groups: 50 CN and 24 aMCI, of whom 88% were early aMCI. tCBF, GCP, and global and regional brain volumetry were measured using phase-contrast and T1-weighted MRI. Neuropsychological tests tapping global cognition and four cognitive domains (memory, executive function, language, and visuospatial) were administered. Comparisons and associations were investigated using analyses of covariance (ANCOVA) and linear regression analyses, respectively.

RESULTS

Women had significantly higher GCP than men. Both, tCBF and GCP were significantly reduced in aMCI compared with CN, while differences in volumes of cerebral gray matter, white matter, and AD-prone regions were not significant. tCBF and GCP were significantly associated with global cognition (standardized beta (stβ) = 0.324 and stβ= 0.326) and with memory scores (stβ≥0.297 and stβ≥0.264) across all participants. Associations of tCBF and GCP with memory scores were also significant in CN (stβ= 0.327 and stβ= 0.284) and in aMCI (stβ= 0.627 and stβ= 0.485).

CONCLUSION

Reduced tCBF and GCP are sensitive biomarkers of early aMCI that likely precede brain tissue loss.

Sleep apnea-COPD overlap syndrome is associated with larger left carotid atherosclerotic plaques

Background

Little is known about whether the overlap syndrome (OS) combining features of chronic obstructive pulmonary disease (COPD) and sleep apnea-hypopnea syndrome increases the risk of stroke associated with COPD itself.

Methods

We prospectively studied 74 COPD patients and 32 subjects without lung disease. Spirometry and cardiorespiratory polygraphy were used to assess the pulmonary function of the study population and ultrasound measurements of intima media thickness (IMT) as well as the volume of plaques in both carotid arteries were also evaluated.

Results

Polygraphic criteria of OS were met in 51% of COPD patients. We found that 79% of patients with OS and 50% of COPD patients without OS had atherosclerotic plaques in the left carotid artery (p = 0.0509). Interestingly, the mean volume of atherosclerotic plaques was significantly higher in the left carotid artery of COPD patients with OS (0.07 ± 0.02 ml) than in those without OS (0.04 ± 0.02 ml, p = 0.0305). However, regardless of the presence of OS, no significant differences were observed in both presence and volume of atherosclerotic plaques in the right carotid artery of COPD patients. Adjusted-multivariate linear regression revealed age, current smoking and the apnea/hypopnea index (OR = 4.54, p = 0.012) as independent predictors of left carotid atherosclerotic plaques in COPD patients.

Conclusions

This study suggests that the presence of OS in COPD patients is associated with larger left carotid atherosclerotic plaques, indicating that OS might be screened in all COPD patients to identify those with higher risk of stroke.

Glymphatic system impairment in nonathlete older male adults who played contact sports in their youth associated with cognitive decline: A diffusion tensor image analysis along the perivascular space study

Background and purpose

Exposure to contact sports in youth causes brain health problems later in life. For instance, the repetitive head impacts in contact sports might contribute to glymphatic clearance impairment and cognitive decline. This study aimed to assess the effect of contact sports participation in youth on glymphatic function in old age and the relationship between glymphatic function and cognitive status using the analysis along the perivascular space (ALPS) index.

Materials and methods

A total of 52 Japanese older male subjects were included in the study, including 12 who played heavy-contact sports (mean age, 71.2 years), 15 who played semicontact sports (mean age, 73.1 years), and 25 who played noncontact sports (mean age, 71.3 years) in their youth. All brain diffusion-weighted images (DWIs) of the subjects were acquired using a 3T MRI scanner. The ALPS indices were calculated using a validated semiautomated pipeline. The ALPS indices from the left and right hemispheres were compared between groups using a general linear model, including age and years of education. Furthermore, partial Spearman's rank correlation tests were performed to assess the correlation between the ALPS indices and cognitive scores (Mini-Mental State Examination and the Japanese version of the Montreal Cognitive Assessment [MoCA-J]) after adjusting for age years of education and HbA1c.

Results

The left ALPS index was significantly lower in the heavy-contact and semicontact groups than that in the noncontact group. Although no significant differences were observed in the left ALPS index between the heavy-contact and semicontact groups and in the right ALPS index among groups, a trend toward lower was found in the right ALPS index in individuals with semicontact and heavy-contact compared to the noncontact group. Both sides' ALPS indices were significantly positively correlated with the MoCA-J scores.

Conclusion

The findings indicated the potential adverse effect of contact sports experience in youth on the glymphatic system function in old age associated with cognitive decline.

Internal Carotid Artery Angle Variations are Poorly Explained by Vascular Risk Factors: The Northern Manhattan Study

OBJECTIVES

The internal carotid artery (ICA) angle of origin may contribute to atherogenesis by altered hemodynamics. We aim to determine the contribution of vascular risk factors and arterial wall changes to ICA angle variations.

METHODS

We analyzed 1,065 stroke-free participants from the population-based Northern Manhattan Study who underwent B-mode ultrasound (mean age 68.7±8.9 years; 59% women). ICA angle was estimated at the intersection between the common carotid artery and the ICA center line projections. Narrower external angles translating into greater carotid bifurcation bending were considered unfavorable. Linear regression models were fitted to assess the relationship between ICA angle and demographics, vascular risk factors, and arterial wall changes including carotid intima-media thickness (cIMT) and plaque presence.

RESULTS

ICA angles were narrower on the left compared to the right side (153±15.4 degrees versus 161.4±12.7 degrees, p<0.01). Mean cIMT was 0.9±0.1 mm and 54.3% had at least one plaque. ICA angle was not associated with cIMT or plaque presence. Unfavorable left and right ICA angles were associated with advanced age (per 10-year increase β=-1.6; p=0.01, and -1.3; p=0.03, respectively) and being Black participant (β=-4.6; p<0.01 and -2.9; p=0.04, respectively), while unfavorable left ICA angle was associated with being female (β=-2.8; p=0.03) and increased diastolic blood pressure (per 10 mmHg increase β=-2.1; p<0.01). Overall, studied factors explained less than 10% of the variance in ICA angle (left R2=0.07; right R2=0.05).

CONCLUSION

Only a small portion of ICA angle variation were explained by demographics, vascular risk factors and arterial wall changes. Whether ICA angle is determined by other environmental or genetic factors, and is an independent risk factor for atherogenesis, requires further investigation.

White matter fiber-specific degeneration in older adults with metabolic syndrome

OBJECTIVE

Metabolic syndrome (MetS) is defined as a complex of interrelated risk factors for type 2 diabetes and cardiovascular disease, including glucose intolerance, abdominal obesity, hypertension, and dyslipidemia. Studies using diffusion tensor imaging (DTI) have reported white matter (WM) microstructural abnormalities in MetS. However, interpretation of DTI metrics is limited primarily due to the challenges of modeling complex WM structures. The present study used fixel-based analysis (FBA) to assess the effect of MetS on the fiber tract-specific WM microstructure in older adults and its relationship with MetS-related measurements and cognitive and locomotor functions to better understand the pathophysiology of MetS.

METHODS

Fixel-based metrics, including microstructural fiber density (FD), macrostructural fiber-bundle cross-section (FC), and a combination of FD and FC (FDC), were evaluated in 16 healthy controls (no components of MetS; four men; mean age, 71.31 ± 5.06 years), 57 individuals with premetabolic syndrome (preMetS; one or two components of MetS; 29 men; mean age, 72.44 ± 5.82 years), and 46 individuals with MetS (three to five components of MetS; 27 men; mean age, 72.15 ± 4.97 years) using whole-brain exploratory FBA. Tract of interest (TOI) analysis was then performed using TractSeg across 14 selected WM tracts previously associated with MetS. The associations between fixel-based metrics and MetS-related measurements, neuropsychological, and locomotor function tests were also analyzed in individuals with preMetS and MetS combined. In addition, tensor-based metrics (i.e., fractional anisotropy [FA] and mean diffusivity [MD]) were compared among the groups using tract-based spatial statistics (TBSS) analysis.

RESULTS

In whole-brain FBA, individuals with MetS showed significantly lower FD, FC, and FDC compared with healthy controls in WM areas, such as the splenium of the corpus callosum (CC), corticospinal tract (CST), middle cerebellar peduncle (MCP), and superior cerebellar peduncle (SCP). Meanwhile, in fixel-based TOI, significantly reduced FD was observed in individuals with preMetS and MetS in the anterior thalamic radiation, CST, SCP, and splenium of the CC compared with healthy controls, with relatively greater effect sizes observed in individuals with MetS. Compared with healthy controls, significantly reduced FC and FDC were only demonstrated in individuals with MetS, including regions with loss of FD, inferior cerebellar peduncle, inferior fronto-occipital fasciculus, MCP, and superior longitudinal fasciculus part I. Furthermore, negative correlations were observed between FD and Brinkman index of cigarette consumption cumulative amount and between FC or FDC and the Trail Making Test (parts B-A), which is a measure of executive function, waist circumference, or low-density lipoprotein cholesterol. Finally, TBSS analysis revealed that FA and MD were not significantly different among all groups.

CONCLUSIONS

The FBA results demonstrate that substantial axonal loss and atrophy in individuals with MetS and early axonal loss without fiber-bundle morphological changes in those with preMetS within the WM tracts are crucial to cognitive and motor function. FBA also clarified the association between executive dysfunction, abdominal obesity, hyper-low-density lipoprotein cholesterolemia, smoking habit, and compromised WM neural tissue microstructure in MetS.

Bilateral carotid artery geometry using magnetic resonance angiography: a 10-year longitudinal single center study

Aging and atherosclerotic progression can lead to geometric changes in the carotid arteries. We conducted a longitudinal study to investigate geometric changes in the bilateral carotid arteries. We conducted a retrospective study of 177 subjects who underwent carotid contrast-enhanced magnetic resonance angiography (MRA) at our clinic at baseline and 10 years after the procedure. Semi-automated methods were used to segment the bilateral carotid arteries to obtain carotid artery geometric measurements. The mean age for the total population after 10 years was 70.7 ± 10.6 years (male, 40.1%). The mean time interval between baseline and after 10 years for all subjects was 130.2 ± 8.1 months. The bilateral bifurcation angle, the diameters for both common carotid arteries (CCAs), and areas of both CCAs significantly increased (p < 0.001) over a 10-year period. The maximum diameter and internal carotid artery area did not significantly change. The bifurcation angle of the right carotid artery was significantly increased compared to the left carotid artery. However, the diameter and area of the CCA of the left carotid artery was significantly increased compared to the right carotid artery. The bifurcation angle, diameter and area of both CCAs significantly increased over a decade. The change in the bifurcation angle over a 10-year period was predominant in the right carotid artery and the change of the area and diameter of the CCA was dominant in the left carotid artery.

Cerebral Arterial Asymmetries in the Neonate: Insight into the Pathogenesis of Stroke

Neonatal and adult strokes are more common in the left than in the right cerebral hemisphere in the middle cerebral arterial territory, and adult extracranial and intracranial vessels are systematically left-dominant. The aim of the research reported here was to determine whether the asymmetric vascular ground plan found in adults was present in healthy term neonates (n = 97). A new transcranial Doppler ultrasonography dual-view scanning protocol, with concurrent B-flow and pulsed wave imaging, acquired multivariate data on the neonatal middle cerebral arterial structure and function. This study documents for the first-time systematic asymmetries in the middle cerebral artery origin and distal trunk of healthy term neonates and identifies commensurately asymmetric hemodynamic vulnerabilities. A systematic leftward arterial dominance was found in the arterial caliber and cortically directed blood flow. The endothelial wall shear stress was also asymmetric across the midline and varied according to vessels’ geometry. We conclude that the arterial structure and blood supply in the brain are laterally asymmetric in newborns. Unfavorable shearing forces, which are a by-product of the arterial asymmetries described here, might contribute to a greater risk of cerebrovascular pathology in the left hemisphere.

Helicobacter pylori Infection Is Associated With Carotid Intima and Media Thickening: A Systematic Review and Meta-Analysis

Background

Helicobacter pylori (H. pylori) infection affects ≈4.4 billion people worldwide. Several studies suggest that this pathogen impacts the digestive system, causing diverse and severe conditions, and results in extragastrointestinal disorders like vascular diseases. Our study aims to examine the association between H. pylori infection and carotid intima‐media thickness.

Methods and Results

Electronic databases (MEDLINE, Embase, CENTRAL, Web of Science, and Scopus) were searched for studies, comparing the thickness of the carotid intima‐media in H. pylori–infected and noninfected individuals listed until October 20, 2020. Statistical analyses were performed using the random effects meta‐analysis of model of weighted mean differences with the corresponding 95% CI using the DerSimonian and Laird method. The protocol was registered in advance in PROSPERO (International Prospective Register of Systematic Reviews; CRD42021224485). Thirteen studies were found meeting inclusion criteria for our systematic review and meta‐analysis, presenting data on the thickness of the carotid intima‐media considering the presence of H. pylori infection. Altogether, 2298 individuals’ data were included (1360 H. pylori positive, 938 negative). The overall carotid intima‐media thickness was significantly larger among infected patients compared with uninfected participants (weighted mean difference: 0.07 mm; 95% CI, 0.02–0.12; P=0.004; I²=91.1%; P<0.001). In case of the right common carotid artery, the intima‐media thickening was found to be significant as well (weighted mean difference, 0.08 mm; 95% CI, 0.02–0.13, P=0.007; I²=85.1%; P<0.001), while it showed no significance in the left common carotid artery (weighted mean difference, 0.12 mm; 95% CI, −0.05 to 0.28, P=0.176; I²=97.4%; P<0.001).

Conclusions

H. pylori infection is associated with increased carotid intima‐media thickness. Therefore, the infection may indirectly contribute to the development of major vascular events.

An Investigation of Water Diffusivity Changes along the Perivascular Space in Elderly Subjects with Hypertension

BACKGROUND AND PURPOSE

Hypertension may be related to alterations of the glymphatic system, a waste metabolite drainage system in the brain. We aimed to investigate analysis along the perivascular space index changes in elderly subjects with hypertension.

MATERIALS AND METHODS

Diffusion-weighted images were acquired from 126 subjects, including 63 subjects with hypertension (25 men and 38 women; mean age, 72.45 years) and 63 age- and sex-matched controls (25 men and 38 women; mean age, 72.16 years). We calculated the analysis along the perivascular space index as a ratio of the mean of x-axis diffusivities in the projection and association areas to the mean of y-axis diffusivity in the projection area and z-axis diffusivity in the association area. The left, right, and mean analysis along the perivascular space indices of both hemispheres were compared between the hypertension and control groups using a Mann-Whitney U test. The Spearman correlation coefficient was used to assess the correlation between the left, right, and mean ALPS indices and blood pressure and pulse pressure.

RESULTS

The left (P = .011) and mean (P = .024) analysis along the perivascular space indices of the hypertension group were significantly lower than that of the control group. The left, right, and mean analysis along the perivascular space indices of all subjects were significantly negatively correlated with blood pressure values (r = -0.200 to -0.278, P = .002-0.046) and pulse pressure values (r = -0.221 to -0.245, P = .006-0.013).

CONCLUSIONS

Our results are consistent with a model in which hypertension causes glymphatic dysfunction.

Vascular Auscultation of Carotid Artery: Towards Biometric Identification and Verification of Individuals

BACKGROUND

Biometric sensing is a security method for protecting information and property. State-of-the-art biometric traits are behavioral and physiological in nature. However, they are vulnerable to tampering and forgery.

METHODS

The proposed approach uses blood flow sounds in the carotid artery as a source of biometric information. A handheld sensing device and an associated desktop application were built. Between 80 and 160 carotid recordings of 11 s in length were acquired from seven individuals each. Wavelet-based signal analysis was performed to assess the potential for biometric applications.

RESULTS

The acquired signals per individual proved to be consistent within one carotid sound recording and between multiple recordings spaced by several weeks. The averaged continuous wavelet transform spectra for all cardiac cycles of one recording showed specific spectral characteristics in the time-frequency domain, allowing for the discrimination of individuals, which could potentially serve as an individual fingerprint of the carotid sound. This is also supported by the quantitative analysis consisting of a small convolutional neural network, which was able to differentiate between different users with over 95% accuracy.

CONCLUSION

The proposed approach and processing pipeline appeared promising for the discrimination of individuals. The biometrical recognition could clinically be used to obtain and highlight differences from a previously established personalized audio profile and subsequently could provide information on the source of the deviation as well as on its effects on the individual's health. The limited number of individuals and recordings require a study in a larger population along with an investigation of the long-term spectral stability of carotid sounds to assess its potential as a biometric marker. Nevertheless, the approach opens the perspective for automatic feature extraction and classification.

Left-sided carotid arteries have a higher prevalence of intraplaque hemorrhage than right-sided: An asymmetric conundrum

PURPOSE

To assess whether an asymmetry exists in the prevalence of carotid artery intraplaque hemorrhage (IPH) between right- and left-sided arteries.

MATERIALS AND METHODS

The records of all patients with atherosclerotic carotid artery disease that underwent neck magnetic resonance angiography imaging with high-resolution plaque sequences between 2017 and 2020 at our institution were retrospectively reviewed. The prevalence of stenosis and IPH was determined for all patients and compared between the left and right carotid arteries of those with unilateral anterior circulation ischemic strokes. Multiple regression analysis was performed to determine potential independent associations of IPH laterality with ischemic strokes.

RESULTS

A total of 368 patients were included overall and 241 were male (65.4%). There were a total of 125 asymptomatic patients and 211 patients with unilateral anterior circulation ischemic strokes. Of patients with ischemic strokes, 55.5% had left-sided strokes compared with 44.5% who had right-sided strokes (p = 0.03). Patients with left-sided strokes had a higher prevalence of ipsilateral IPH than those with right-sided strokes (64.1% versus 36.2%, p < 0.0001), despite similar degrees of stenosis. Both age (odds ratio (OR): 1.0; 95% confidence interval (CI): 1.0-1.1; p = 0.007) and the presence of left-sided IPH (OR: 3.2; 95% CI: 1.5-6.8; p = 0.003) were independently associated with unilateral ischemic strokes.

CONCLUSIONS

Left-sided plaques more frequently have IPH and may be more likely to result in ipsilateral ischemic strokes compared with right-sided plaques. The underlying mechanism of asymmetric distribution of IPH between right and left carotids remains unclear.

Three-dimensional ultrasound assessment of effects of therapies on carotid atherosclerosis using vessel wall thickness maps

We present a new method for assessing the effects of therapies on atherosclerosis, by measuring the weighted average of carotid vessel-wall-plus-plaque thickness change (ΔVWT¯_Weighted) in 120 patients randomized to pomegranate juice/extract versus placebo. Three-dimensional ultrasound images were acquired at baseline and one year after. Three-dimensional VWT maps were reconstructed and then projected onto a carotid template to obtain two-dimensional VWT maps. Anatomic correspondence on the two-dimensional VWT maps was optimized to reduce misalignment for the same subject and across subjects. A weight was computed at each point on the two-dimensional VWT map to highlight anatomic locations likely to exhibit plaque progression/regression, resulting in ΔVWT¯_Weighted for each subject. The weighted average of VWT-Change measured from the two-dimensional VWT maps with correspondence alignment (ΔVWT¯_Weighted,MDL) detected a significant difference between the pomegranate and placebo groups (P = 0.008). This method improves the cost-effectiveness of proof-of-concept studies involving new therapies for atherosclerosis.

Evaluation of Plaque Vulnerability via Combination of Hemodynamic Analysis and Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage (SNAP) Sequence for Carotid Intraplaque Hemorrhage

The purpose of this study was to assess the vulnerability of plaque using a combination of simultaneous non-contrast angiography, intraplaque hemorrhage (SNAP) sequence, and local hemodynamic analysis in an intraplaque hemorrhage (IPH), and to evaluate the association between morphological and hemodynamic factors and IPH by comparing the IPH (presence of IPH) and non-IPH (plaque with absence of IPH) groups. In total, 27 IPH patients and 27 non-IPH patients were involved in this study, and baseline characteristics were collected. For morphological factors, diameters, and areas of the internal carotid artery (ICA), external carotid artery, and common carotid artery were measured, and bifurcation angle (α) and ICA angle (β) were also measured for comparison between the IPH group and non-IPH group. For hemodynamic factors, time-averaged wall shear stress (WSS), minimum WSS, maximum WSS, and oscillatory shear index were calculated using computational fluid dynamics (CFD) simulations. For the qualitative analysis, cross-sectional images with analyzed WSS and SNAP sequences were combined to precisely assess local hemodynamics. Bifurcation angle (α) was significantly different between the IPH and non-IPH groups (39.47 degrees vs. 47.60 degrees, p = 0.041). Significantly higher time-averaged WSS, minimum WSS, and maximum WSS were observed in the IPH group compared to the non-IPH group. In the IPH group, when using the combined analysis with SNAP sequences and WSS, the WSS of the region with IPH was significantly higher than the region without IPH (2.32 vs. 1.21 Pa, p = 0.005). A smaller bifurcation angle (α) and higher time-averaged WSS, minimum WSS, and maximum WSS were associated with IPH. The combined analysis of SNAP sequences and WSS might help to evaluate the risk of carotid IPH.

Associations between respiratory and vascular function in early childhood

BACKGROUND AND OBJECTIVE

The link between respiratory and vascular health is well documented in adult populations. Impaired lung function is consistently associated with thicker arteries and higher incidence of cardiovascular disease. However, there are limited data on this relationship in young children and the studies that exist have focussed on populations at high risk of cardiorespiratory morbidity. We determined if an association exists between respiratory and cardiovascular function in young children and, if so, whether it is confounded by known cardiorespiratory risk factors.

METHODS

Respiratory and vascular data from a prospective cohort study established to evaluate the health implications 3 years after coal mine fire smoke exposure in children aged 3-5 years were used. Respiratory function was measured using the forced oscillation technique and included resistance at 5 Hz (R₅ ), reactance at 5 Hz (X₅ ) and area under the reactance curve (AX). Vascular health was measured by carotid intima-media thickness (ultrasound) and pulse wave velocity (arterial tonometry). Regression analyses were used to examine the relationship between the respiratory Z-scores and cardiovascular measures. Subsequent analyses were adjusted for potential confounding by maternal smoking during pregnancy, maternal education and exposure to fine particulate matter <2.5 μm in aerodynamic diameter (PM_2.5 ).

RESULTS

Peripheral lung function (X₅ and AX), but not respiratory system resistance (R₅ ), was associated with vascular function. Adjustment for maternal smoking, maternal education and early life exposure to PM_2.5 had minimal effect on these associations.

CONCLUSION

These observations suggest that peripheral lung stiffness is associated with vascular stiffness and that this relationship is established early in life.

Prevalence and characteristics of atherosclerotic plaque: Left compared with right arteries and anterior compared with posterior circulation stroke

PURPOSE

To evaluate atherosclerotic plaque prevalence and characteristics between left and right cervicocephalic arteries and between anterior and posterior circulation stroke (ACS and PCS).

METHODS

This retrospective study included 284 patients with acute ischemic stroke (199 ACS and 85 PCS) involving large-artery atherosclerosis or small-artery occlusion. We assessed atherosclerotic plaque prevalence and characteristics (plaque type, plaque surface morphology, plaque distribution, location of calcified nodules and plaque thickness) in each segment and their comparisons between left and right arteries and between ACS and PCS.

RESULTS

The left subclavian artery (L-SA), common carotid artery (L-CCA) and intracranial vertebral artery (L-IVA) had significantly higher prevalence of atherosclerotic plaque than the right (R) corresponding arteries (70.1% versus 59.5%, P = 0.008), (48.1% versus 28.9%, P < 0.001), (23.9% versus 16%, P = 0.018), respectively. L-SA had a higher prevalence of mixed plaque (non-calcified > calcified) (19.6% versus 16.4%) and noncalcified plaque (51.9% versus 31.7%), and a lower prevalence of calcified plaque (8.9% versus 23.3%) and mixed plaque (calcified > non-calcified) (19.6% versus 28.6%) than R-SA, P < 0.001. The distribution of plaque type in the SA and extracranial vertebral artery (EVA) were significantly different between ACS and PCS. The soft plaque thickness of SA in PCS was significantly greater than that in ACS (3.85 ± 1.27 versus 3.51 ± 1.04, P = 0.032).

CONCLUSIONS

Atherosclerotic plaque prevalence and characteristics vary in different segments, sides and between ACS and PCS. These differences should be noted during plaque diagnosis.

Comparison of the multi-phasic longitudinal displacement of the left and right common carotid artery in healthy humans

BACKGROUND

During the cardiac cycle, there is a multi-phasic bidirectional longitudinal movement (LMov) of the intima-media complex of large arteries, i.e. along the arteries. On the left side the common carotid artery (CCA) arises directly from the aortic arc, whereas on the right side the CCA originate from the innominate artery.

AIM

The aim of this study was to compare LMov of the left and right CCA of healthy subjects to investigate whether the difference in anatomy is of importance for LMov.

MATERIAL AND METHODS

The CCA's of 93 healthy subjects were investigated using in-house developed ultrasound methods.

RESULTS

Although the basic pattern were the same in the majority of subjects, several phases of LMov were significantly larger on the left side (the first retrograde phase, p = 0.0006; the second antegrade, "returning" phase, p < 0.00001; and the rapid retrograde phase of movement at the end of the cardiac cycle, p < 0.000001). In contrast, no significant side-difference in the amplitude of the first antegrade movement was seen. The maximal (peak-to-peak) LMov was significantly larger on the left side (p = 0.002).

DISCUSSION AND CONCLUSION

The side-differences found in LMov may be related to the difference in anatomy, including possible difference in distance to the heart and especially the presence of an extra bifurcation on the right side. Our data provide an important base for the further study of the relation between LMov and cardiovascular risk factors and atherosclerosis.

Study of Symptomatic vs. Silent Brain Infarctions on MRI in Elderly Subjects

Brain infarctions are closely associated with future risk of stroke and dementia. Our goal was to report (i) frequency and characteristics that differentiate symptomatic vs. silent brain infarctions (SBI) on MRI and (ii) frequency and location by vascular distribution (location of stroke by major vascular territories) in a population based sample. From Mayo Clinic Study of Aging, 347 participants (≥50 years) with infarcts detected on their first MRI were included. Infarct information was identified visually on a FLAIR MRI image and a vascular territory atlas was registered to the FLAIR image data in order to identify the arterial territory of infarction. We identified the subset with a clinical history of stroke based on medical chart review and used a logistic regression to evaluate the risk factors associated with greater probability of a symptomatic stroke vs. SBI. We found that 14% of all individuals with infarctions had a history of symptomatic stroke (Silent: n = 300, symptomatic: n = 47). Factors associated with a symptomatic vs. SBI were size which had an odds ratio of 3.07 (p < 0.001), greater frequency of hypertension (odds ratio of 4.12, p = 0.025) and alcohol history (odds ratio of 4.58, p = 0.012). The frequency of infarcts was greater in right hemisphere compared to the left for SBI. This was primarily driven by middle cerebral artery (MCA) infarcts (right = 60%, left = 40%, p = 0.005). While left hemisphere strokes are more common for symptomatic carotid disease and in clinical trials, right hemispheric infarcts may be more frequent in the SBI group.

Reference Values of Carotid Ultrafast Pulse-Wave Velocity: A Prospective, Multicenter, Population-Based Study

BACKGROUND

Ultrafast ultrasound imaging has been demonstrated to be an effective method to evaluate carotid stiffness through carotid pulse-wave velocity (PWV) with high reproducibility, but a lack of reference values has precluded its widespread use in clinical practice. The aims of this study were to establish reference values of PWV for ultrafast ultrasound imaging in a prospective, multicenter, population-based cohort study and to investigate the main determinants of carotid PWV.

METHODS

A total of 1,544 healthy Han Chinese volunteers (581 men [38%]; age range, 18-95 years) were enrolled from 32 collaborating laboratories in China. The participants were categorized by age, blood pressure (BP), and body mass index (BMI). Basic clinical parameters and carotid PWV at the beginning of systole (BS) and at end-systole (ES) were measured using ultrafast ultrasound imaging techniques.

RESULTS

PWV at both BS and ES was significantly higher in the left carotid artery than in the right carotid artery. PWV at BS was significantly higher in men than in women; however, no significant difference was noted in PWV at ES between men and women. Multiple linear regression analyses revealed that age, BP, and BMI were independently correlated with PWV at both BS and ES. PWV at BS and ES progressively increased with increases in age, BP, and BMI. Furthermore, age- and sex-specific reference values of carotid PWV for ultrafast ultrasound imaging were established.

CONCLUSIONS

Reference values of carotid PWV for ultrafast ultrasound imaging, stratified by sex and age, were determined for the first time. Age, BP, and BMI were the dominant determinants of carotid PWV for ultrafast ultrasound imaging, which should be considered in clinical practice for assessing arterial stiffness.

Long-term effects of adjuvant treatment for breast cancer on carotid plaques and brain perfusion

Purpose

Breast cancer treatment has been associated with vascular pathology. It is unclear if such treatment is also associated with long-term cerebrovascular changes. We studied the association between radiotherapy and chemotherapy with carotid pathology and brain perfusion in breast cancer survivors.

Methods

We included 173 breast cancer survivors exposed to radiotherapy and chemotherapy, assessed ± 21.2 years after cancer diagnosis, and 346 age-matched cancer-free women (1:2) selected from the population-based Rotterdam Study. Outcome measures were carotid plaque score, intima-media thickness (IMT), total cerebral blood flow (tCBF), and brain perfusion. Additionally, we investigated the association between inclusion of the carotid artery in the radiation field (no/small/large part), tumor location, and these outcome measures within cancer survivors.

Results

Cancer survivors had lower tCBF (− 19.6 ml/min, 95%CI − 37.3;− 1.9) and brain perfusion (− 2.5 ml/min per 100 ml, 95%CI − 4.3;− 0.7) than cancer-free women. No statistically significant group differences were observed regarding plaque score or IMT. Among cancer survivors, a large versus a small part of the carotid artery in the radiation field was associated with a higher IMT (0.05, 95%CI0.01;0.09). Also, survivors with a right-sided tumor had lower left carotid plaque score (− 0.31, 95%CI − 0.60;− 0.02) and higher brain perfusion (3.5 ml/min per 100 ml, 95%CI 0.7;6.2) than those with a left-sided tumor.

Conclusions

On average two decades post-diagnosis, breast cancer survivors had lower tCBF and brain perfusion than cancer-free women. Also, survivors with a larger area of the carotid artery within the radiation field had a larger IMT. Future studies should confirm if these cerebrovascular changes underlie the frequently observed cognitive problems in cancer survivors.

Carotid angle in young stroke

PURPOSE

To investigate whether the carotid bifurcation angle as assessed by computed tomographic angiography (CTA) is associated with anterior circulation ischemic stroke (ACIS) in young patients.

MATERIAL AND METHODS

Thirty patients (mean age 41.5 ± 6 years) with known acute ACIS (group 1) were compared to 30 control patients (mean age/ 41.2 ± 6 years) (group 2) with similar demographic variables in this retrospective study. Geometrical characteristics of bilateral carotid bifurcation were obtained by CTA. The ICA bifurcation (ICAB) angle, the carotid central bifurcation (CCB), and the carotid bifurcation wall (CBW) angle among the ICA, CCA, and ECA were measured. Carotid artery angle measurements were compared between group 1 and group 2. The comparison of pathological (ACIS) and non-pathological (non-ACIS) carotid sides in group 1 was performed as well.

RESULTS

All the measured angles (AMA) of group 1 were higher than group 2 (p˂0.05). In patients with left-sided ACIS, AMA on the left side were higher than the right side (p˂0.05), this was more prominent in males (p˂0.05). All angles measured were found to be higher in ipsilateral ACIS (p˂0.05). The left CCB angle values had a significant effect on ischemic stroke (p˂0.05). Male patients had more left-sided ACIS (p˂0.05). Plaque development in ICA was found statistically significant in group 1 compared to group 2 (p˂0.05).

CONCLUSION

Carotid artery geometry may play an important role in the development of ischemic events in young patients, especially in men and, also in patients with left-sided stroke. The left CCB angle had a significant effect on ACIS.

Bilaterally Asymmetric Associations Between Extracranial Carotid Artery Atherosclerosis and Ipsilateral Middle Cerebral Artery Stenosis in Symptomatic Patients: A CARE-II Study

OBJECTIVE

To determine the bilaterally asymmetrical associations between extracranial carotid artery atherosclerosis and ipsilateral middle cerebral artery (MCA) stenosis in symptomatic patients using magnetic resonance vessel wall imaging. Approach and Results: Patients with symptomatic carotid artery atherosclerosis were recruited from the Chinese Atherosclerosis Risk Evaluation, a multicenter study. All subjects underwent intracranial magnetic resonance angiography and extracranial carotid artery magnetic resonance imaging. Severe stenosis (stenosis ≥50%) of MCA, carotid moderate-to-severe stenosis (stenosis ≥50%), plaque compositions, and high-risk plaque on symptomatic side were evaluated in all subjects. Associations between ipsilateral MCA stenosis and extracranial carotid plaque features were evaluated. A total of 363 patients (mean age: 61.2±10.4 years old; 254 males) were included. In the left symptomatic cerebrovascular group (n=186), carotid moderate-to-severe stenosis (odds ratio [OR], 3.00 [95% CI, 1.03-8.79]; P=0.045), intraplaque hemorrhage (OR, 3.68 [95% CI, 1.21-11.19]; P=0.021), fibrous cap rupture (OR, 5.70 [95% CI, 1.60-20.31]; P=0.007), and high-risk plaque (OR, 2.95 [95% CI, 1.19-7.35]; P=0.020) were significantly associated with ipsilateral severe MCA stenosis, after adjusting for confounding factors. In the right symptomatic cerebrovascular group (n=177), severe MCA stenosis was significantly associated with ipsilateral carotid moderate-to-severe stenosis (OR, 3.98 [95% CI, 1.54-10.32]; P=0.004) but not with other extracranial carotid plaque features (all P>0.05), after adjusting for confounding factors.

CONCLUSIONS

In the symptomatic arteries, vulnerable plaque features are independently associated with ipsilateral severe MCA stenosis on the left side, but this association is not found on the right side, indicating the associations of atherosclerotic disease between intracranial and extracranial carotid arteries are asymmetrical.

Carotid geometry is an independent predictor of wall thickness - a 3D cardiovascular magnetic resonance study in patients with high cardiovascular risk

BACKGROUND

The posterior wall of the proximal internal carotid artery (ICA) is the predilection site for the development of stenosis. To optimally prevent stroke, identification of new risk factors for plaque progression is of high interest. Therefore, we studied the impact of carotid geometry and wall shear stress on cardiovascular magnetic resonance (CMR)-depicted wall thickness in the ICA of patients with high cardiovascular disease risk.

METHODS

One hundred twenty-one consecutive patients ≥50 years with hypertension, ≥1 additional cardiovascular risk factor and ICA plaque ≥1.5 mm thickness and < 50% stenosis were prospectively included. High-resolution 3D-multi-contrast (time of flight, T1, T2, proton density) and 4D flow CMR were performed for the assessment of morphological (bifurcation angle, ICA/common carotid artery (CCA) diameter ratio, tortuosity, and wall thickness) and hemodynamic parameters (absolute/systolic wall shear stress (WSS), oscillatory shear index (OSI)) in 242 carotid bifurcations.

RESULTS

We found lower absolute/systolic WSS, higher OSI and increased wall thickness in the posterior compared to the anterior wall of the ICA bulb (p < 0.001), whereas this correlation disappeared in ≥10% stenosis. Higher carotid tortuosity (regression coefficient = 0.764; p < 0.001) and lower ICA/CCA diameter ratio (regression coefficient = - 0.302; p < 0.001) were independent predictors of increased wall thickness even after adjustment for cardiovascular risk factors. This association was not found for bifurcation angle, WSS or OSI in multivariate regression analysis.

CONCLUSIONS

High carotid tortuosity and low ICA diameter were independent predictors for wall thickness of the ICA bulb in this cross-sectional study, whereas this association was not present for WSS or OSI. Thus, consideration of geometric parameters of the carotid bifurcation could be helpful to identify patients at increased risk of carotid plaque generation. However, this association and the potential benefit of WSS measurement need to be further explored in a longitudinal study.

Association between Proinflammatory Markers, Leukocyte-Endothelium Interactions, and Carotid Intima-Media Thickness in Type 2 Diabetes: Role of Glycemic Control

Glycated hemoglobin monitorization could be a tool for maintaining type 2 diabetes (T2D) under control and delaying the appearance of cardiovascular events. This cross-sectional study was designed to assess the role of glycemic control in modulating early-stage markers of cardiovascular complications. One hundred and eight healthy controls and 161 type 2 diabetic patients were recruited and distributed according to their glycemic control, setting the threshold at 6.5% (good control). Biochemical and anthropometrical parameters were registered during the initial visit, and peripheral blood was extracted to obtain polymorphonuclear cells and analyze inflammatory markers, adhesion molecules, leukocyte-endothelium interactions, and carotid intima-media thickness. Correlations between these parameters were explored. We found that inflammatory markers and adhesion molecules were augmented in type 2 diabetic subjects with poor glycemic control. Polymorphonuclear leukocytes interacted more with the endothelium in the diabetic population, and even more significantly in the poorly controlled subjects. In parallel, carotid intima-media thickness was also increased in the diabetic population, and the difference was greater among poorly controlled subjects. Finally, correlation measurement revealed that carotid intima-media thickness was related to glycemic control and lipid metabolism in diabetic patients. Our results suggest that glycemic control delays the onset of cardiovascular comorbidities in diabetic subjects.

Cooking fuels use and carotid intima-media thickness during early pregnancy of women in Myanmar

BACKGROUND

Fuels burned in households for cooking cause indoor air pollution, exposing those who are cooking. Despite the mounting evidence of the effects of fuels use on health, few studies focus on the effect of cooking fuels have on carotid intima-media thickness (CIMT), a surrogate atherosclerosis biomarker in the early stages of pregnancy. This study aimed to examine the association between the use of cooking fuels and CIMT during early trimester of pregnancy among cooking women in Myanmar.

METHODOLOGY

In this cross-sectional study, a part of an ongoing birth cohort analysis, a total of 192 cooking pregnant women over 18 years with gestational weeks less than 18 were recruited from 15 rural health centers in Nay Pyi Taw from September to November 2019. Sociodemographic data, residential data, and fuels use data were collected with semi-structured questionnaires in face-to-face interviews. Anthropometric, hemodynamic, blood lipids, and ultrasound CIMT measurements were performed under standard protocols. Multiple linear regression was modeled to explore associations.

RESULTS

The study included 70 firewood fuel users, 26 charcoal fuel users, and 96 electricity fuel users. Following adjustments for potential confounding factors, firewood use was significantly associated with the increase of all CIMT analyzed. Importantly, a greater increase of mean CIMT of the right common carotid artery (RCCA; β = 0.033 mm; 95%CI: 0.006, 0.058; P<0.05) had significant association with charcoal use compared to firewood use (β = 0.029 mm; 95%CI: 0.010, 0.049; P<0.05).

CONCLUSIONS

Our findings demonstrate that the indoor use of cooking fuels that cause indoor air pollution, such as firewood and charcoal, is a considerable risk factor for human health and is associated with increased CIMT, wherein charcoal use contributes to more increase of mean CIMT of the RCCA. Measures to prevent health risks related to the use of such fuels should be instituted early on during pregnancy.

A Preliminary 18F-FDG-PET/MRI Study Shows Increased Vascular Inflammation in Moderate-to-Severe Atopic Dermatitis

BACKGROUND

Recent data suggest that patients with atopic dermatitis (AD) have increased systemic immune activation and cardiovascular risk. However, unlike psoriasis, evaluation of active vascular inflammation using state-of-the-art imaging is lacking in AD.

OBJECTIVE

To assess aortic and carotid vascular inflammation using ¹⁸F-fluorodeoxyglucose-positron emission tomography/magnetic resonance imaging (¹⁸F-FDG-PET/MRI) imaging in moderate-to-severe AD versus healthy individuals.

METHODS

A total of 27 patients with moderate-to-severe AD and 12 healthy controls were imaged using ¹⁸F-FDG-PET/MRI. Target-to-background ratio (TBR) values were calculated in multiple segments of the aorta and carotid vessels.

RESULTS

Patients with AD had elevated aortic max TBR (fold change [FCH] = 1.45, P = .057) versus healthy controls and significantly elevated mean TBR (FCH = 1.20; P < .05) in the right carotid (RC) arteries versus controls. When examining greatest focal inflammation (most diseased segment [MDS] TBR), patients with AD had higher aortic inflammation (FCH = 1.28; P = .052). AD clinical severity significantly correlated with C-reactive protein (ρ = 0.60, P < .01) and with RC mean TBR levels (ρ = 0.60, P = .04). Stratifying patients into moderate-to-severe and very severe AD showed greater RC mean TBR in patients with very severe AD versus controls (FCH = 1.31; P = .02) and versus patients with moderate/severe AD (FCH = 1.23, P = .05). Aortic inflammation was also significantly greater in patients with very severe AD versus controls (max TBR: FCH = 1.6, P = .04; MDS TBR: FCH = 1.73, P = .03).

CONCLUSIONS

This preliminary study is the first that establishes greater vascular (aorta and carotid) inflammation in moderate-to-severe AD versus healthy controls. Furthermore, very severe AD showed higher inflammation than both moderate/severe patients and healthy controls. Future studies with larger patient cohorts and evaluation before and after treatment are needed to determine the extent to which vascular inflammation in AD is modifiable.

Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study

OBJECTIVES

The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS).

BACKGROUND

CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain.

METHODS

The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs).

RESULTS

A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001).

CONCLUSIONS

The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.

Analysis of twisted internal carotid arteries in carotid endarterectomy

Background:

The twisted carotid artery is a variant, in which the internal carotid artery (ICA) courses medially to the external carotid artery. Due to the sparse descriptions in the literature, we, here, report our experience with cases of carotid endarterectomy (CEA) for twisted carotid artery and its clinical features.

Methods:

Fifty-seven consecutive CEA-treated patients were evaluated, and the twist angle was measured on the source images of axial slices of computed tomography angiography (CTA).

Results:

Eight male patients (14.2%) demonstrated a twisted right ICA (mean age, 77.0 ± 2.6 years; and mean stenosis, 66.9% ± 19.9%). The mean twist angle was 30.1° ± 17.9°, while the normal ICA is angled at −23.0° ± 12.3°. No statistical differences in the distribution of coexisting diseases were found between the normal and twisted ICA cases. CEA was successfully performed with the correction of the carotid position in all cases; however, significant position correction was not observed in the postoperative evaluation. Right-side dominancy (P = 0.045) and prolonged clamping time (P = 0.053) were observed in the twisted cases.

Conclusion:

Twisted ICA was preferentially found in the right ICA and men. CEA of the twisted ICA was safely performed with appropriate head rotation and wider longitudinal skin incision than usual without a significant increase in the operative time. CTA is useful for preoperative evaluation. This specific variation should be considered by the neurosurgeon involved in the evaluation and treatment of carotid stenoses.

Left Common Carotid Artery Biomechanical Properties in Individuals over 80 years: Women Have Stiffer Vessels

BACKGROUND

Considering the longevity of the worldwide population, the cardiovascular diseases deserve particular attention, especially the carotid artery disease in the ≥80-year-old population. The stiffness of the common carotid artery, for example, has been showed in numerous clinical studies as a marker of increased risk of stroke, dementia, and depression. Besides, with the emergence of new surgical techniques such as the transcarotid artery revascularization that uses the common carotid artery as a workstation, the biomechanical and histological features of this vessel, more than ever, must be detailed.

METHODS

Left common carotid artery fragments from 9 cadaver donors (≥80 years old) were evaluated. Biomechanical (failure stress, tension, and strain) and histological (percentage of collagen and elastic fibers) features of these samples were analyzed with special focus on gender differences.

RESULTS

Statistically significant differences in biomechanical and histological features between the genders were observed. The percentage of collagen fiber in intima (P = 0.008) and media (P = 0.041) layers was significantly lower in men than in women. A higher elasticity (failure strain) of the specimens in male gender was also observed (P = 0.025). No significant difference was observed in the layers thickness between the genders regardless which part of the arterial wall was considered.

CONCLUSIONS

These biomechanical and histological findings could be the responsible for the higher left common carotid artery stiffness observed among ≥80-year-old women when compared with men in numerous clinical studies in literature.

The APOA1bp-SREBF-NOTCH axis is associated with reduced atherosclerosis risk in morbidly obese patients

BACKGROUND & AIMS

Atherosclerosis is characterized by an inflammatory disease linked to excessive lipid accumulation in the artery wall. The Notch signalling pathway has been shown to play a key regulatory role in the regulation of inflammation. Recently, in vitro and pre-clinical studies have shown that apolipoprotein A-I binding protein (AIBP) regulates cholesterol metabolism (SREBP) and NOTCH signalling (haematopoiesis) and may be protective against atherosclerosis, but the evidence in humans is scarce.

METHODS

We evaluated the APOA1bp-SREBF-NOTCH axis in association with atherosclerosis in two well-characterized cohorts of morbidly obese patients (n = 78) within the FLORINASH study, including liver transcriptomics, ¹H NMR plasma metabolomics, high-resolution ultrasonography evaluating carotid intima-media thickness (cIMT), and haematological parameters.

RESULTS

The liver expression levels of APOA1bp were associated with lower cIMT and leukocyte counts, a better plasma lipid profile and higher circulating levels of metabolites associated with lower risk of atherosclerosis (glycine, histidine and asparagine). Conversely, liver SREBF and NOTCH mRNAs were positively associated with atherosclerosis, liver steatosis, an unfavourable lipid profile, higher leukocytes and increased levels of metabolites linked to inflammation and CVD such as branched-chain amino acids and glycoproteins. APOA1bp and NOTCH signalling also had a strong association, as revealed by the negative correlations among APOA1bp expression levels and those of all NOTCH receptors and jagged ligands.

CONCLUSIONS

We here provide the first evidence in human liver of the putative APOA1bp-SREBF-NOTCH axis signalling pathway and its association with atherosclerosis and inflammation.

PCSK6 Is a Key Protease in the Control of Smooth Muscle Cell Function in Vascular Remodeling

RATIONALE

PCSKs (Proprotein convertase subtilisins/kexins) are a protease family with unknown functions in vasculature. Previously, we demonstrated PCSK6 upregulation in human atherosclerotic plaques associated with smooth muscle cells (SMCs), inflammation, extracellular matrix remodeling, and mitogens.

OBJECTIVE

Here, we applied a systems biology approach to gain deeper insights into the PCSK6 role in normal and diseased vessel wall.

METHODS AND RESULTS

Genetic analyses revealed association of intronic PCSK6 variant rs1531817 with maximum internal carotid intima-media thickness progression in high-cardiovascular risk subjects. This variant was linked with PCSK6 mRNA expression in healthy aortas and plaques but also with overall plaque SMA+ cell content and pericyte fraction. Increased PCSK6 expression was found in several independent human cohorts comparing atherosclerotic lesions versus healthy arteries, using transcriptomic and proteomic datasets. By immunohistochemistry, PCSK6 was localized to fibrous cap SMA+ cells and neovessels in plaques. In human, rat, and mouse intimal hyperplasia, PCSK6 was expressed by proliferating SMA+ cells and upregulated after 5 days in rat carotid balloon injury model, with positive correlation to PDGFB (platelet-derived growth factor subunit B) and MMP (matrix metalloprotease) 2/MMP14. Here, PCSK6 was shown to colocalize and cointeract with MMP2/MMP14 by in situ proximity ligation assay. Microarrays of carotid arteries from Pcsk6^-/- versus control mice revealed suppression of contractile SMC markers, extracellular matrix remodeling enzymes, and cytokines/receptors. Pcsk6^-/- mice showed reduced intimal hyperplasia response upon carotid ligation in vivo, accompanied by decreased MMP14 activation and impaired SMC outgrowth from aortic rings ex vivo. PCSK6 silencing in human SMCs in vitro leads to downregulation of contractile markers and increase in MMP2 expression. Conversely, PCSK6 overexpression increased PDGFBB (platelet-derived growth factor BB)-induced cell proliferation and particularly migration.

CONCLUSIONS

PCSK6 is a novel protease that induces SMC migration in response to PDGFB, mechanistically via modulation of contractile markers and MMP14 activation. This study establishes PCSK6 as a key regulator of SMC function in vascular remodeling. Visual Overview: An online visual overview is available for this article.

A1 asynchrony, a potential risk factor for the rupture of anterior communicating artery aneurysms: A computational fluid dynamics study

INTRODUCTION AND OBJECTIVES

The anterior communicating complex is one the most common locations for aneurysm development. It receives blood from both carotid circulations and the effect of synchrony on the arrival of blood flow has not been previously studied. The objective of this study was to compare the asynchrony conditions of the A1 pulse and its effects on the haemodynamic conditions of anterior communicating artery (ACoA) aneurysms.

MATERIALS AND METHODS

From 2008 to 2017, 54 anterior communicating artery aneurysms treated at our centre were included in the study. Computational fluid dynamics (CFD) techniques were employed and simulations consisted of complete conditions of synchrony and introducing a delay of 0.2s in the non-dominant A1 artery. Time-averaged wall shear stress (TAWSS), low shear area (LSA), A1 diameter and ACoA angles were measured.

RESULTS

The difference in the LSA in conditions of synchrony and asynchrony resulted in a broad range of positive and negative values. The symmetry index (p=0.04) and A1/A2 angle on the dominant artery (p=0.04) were associated with changes in LSA.

CONCLUSIONS

In asynchrony, LSA increased in the absence of A1 asymmetry and low A1/A2 angles, potentially increasing the risk of aneurysm rupture in this location.

Factors Affecting the Health of Retinal Vessels in Human Immunodeficiency Virus Patients Beginning Anti-Retroviral Therapy

HIV patients responding to antiretroviral therapy (ART) have a high burden of cytomegalovirus (CMV) and display accelerated cardiovascular change assessed systemically. We assessed the effects of HIV, ART and CMV on retinal artery calibers (RAC), as a non-invasive measure of vasculopathy in HIV patients beginning ART. We analysed 79 HIV patients beginning ART in Jakarta, Indonesia, with a median (range) age of 31 (19-48) years. RAC was assessed using Image J software from fundus photos of both eyes, before ART (V0) and after 3-12 months (V3-V12). CMV DNA and antibodies were assessed. Systemic vascular pathology was assessed by carotid intima media thickness (cIMT). Multivariable models assessed which variables best predicted RAC values at V12. HIV patients had narrower retinal arteries and higher levels of CMV antibodies than healthy controls. RAC decreased over 12 months of ART (p < .0001). Right RAC correlated with CMV IE-1 antibody, while the left RAC at V3 correlated with cIMT. Multivariable models linked RAC at V12 with detectable HIV RNA at V12 and declared use of alcoholic drinks, while a smoking habit was protective. Decreases in RAC in HIV patients responding to ART suggest progressive microvascular change distinct from changes assessed in large vessels. Correlations with CMV IE-1 antibodies suggest the decline in RAC may be accelerated by frequent reactivations of CMV. This may be a feature of severe HIV disease before ART, confirmed by associations with high baseline HIV RNA in multivariable models. Links with alcohol consumption and smoking testify to a complex pattern of modifiable risk factors.

Peritoneal Dialysis Is an Independent Factor Associated to Lower Intima Media Thickness in Dialysis Patients Free From Previous Cardiovascular Disease

Carotid intima media thickness (cIMT) displays prognostic value as a marker of cardiovascular risk in dialysis patients. However, few data are available regarding the impact of dialysis modality on cIMT. The aim of this study is to determine whether the modality of dialysis influences cIMT values. We compared 237 peritoneal dialysis (PD) and 451 hemodialysis (HD) patients without previous cardiovascular disease included in NEFRONA, a prospective, observational and multicenter study. This cross sectional study included the determination of cIMT in 6 carotid territories by arterial ultrasound. cIMT was determined in territories without atheroma plaque and averaged. A second analysis was performed using all territories, giving a truncated cIMT value of 1,5 mm to territories presenting with atheroma plaque. Age and plaque presence at baseline were the clinical variables more closely associated to cIMT in dialysis patients. The evaluation of the impact of the modality of dialysis on cIMT showed that PD patients had lower cIMT than HD patients, both in territories with no plaques and when using truncated cIMT values. No differences were found between right and left sides, neither in cIMT or truncated cIMT values. Lineal multivariate analysis adjusted by several clinical variables showed a statistically significant association of PD with a lower cIMT (slope -0.036; SD 0.010). These results were also confirmed when truncated cIMT values were used. We conclude that the modality of dialysis has an impact on cITM. HD patients have greater global cIMT than PD patients, and PD is and independent factor associated with a lower cIMT.

Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007-2008

BACKGROUND

Unrecognized myocardial infarction (MI) is a frequent condition with unknown underlying reason. We hypothesized the lack of recognition of MI is related to pathophysiology, specifically differences in underlying small and large vessel disease.

METHODS

6128 participants were examined with retinal photography, ultrasound of the carotid artery and a 12‑lead electrocardiography (ECG). Small vessel disease was defined as narrower retinal arterioles and/or wider retinal venules measured on retinal photographs. Large vessel disease was defined as carotid artery pathology. We defined unrecognized MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional relationship between MI recognition and markers of small and large vessel disease, adjusted for age and sex.

RESULTS

Unrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128 participants. Compared to recognized MI, unrecognized MI was associated with small vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05-2.62, highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal venules (OR 0.55, 95% CI 0.35-0.87, lowest vs. highest quartile). Compared to recognized MI, unrecognized MI was less associated with large vessel disease indicated by presence of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized MI 0.51, 95% CI 0.37-0.69). No significant sex interaction was present.

CONCLUSIONS

Unrecognized MI was more associated with small vessel disease and less associated with large vessel disease compared to recognized MI. These findings suggest that the pathophysiology behind unrecognized and recognized MI may differ.

Volumetric Distribution of the White Matter Hyper-Intensities in Subject with Mild to Severe Carotid Artery Stenosis: Does the Side Play a Role?

PURPOSE

The purpose of this paper was to assess the difference in the distribution of white matter hyperintensities (WMHs) on left and right sides of the brain hemispheres of subjects with mild to severe carotid artery stenosis.

MATERIAL AND METHODS

Eighty consecutive patients (mean age 71 ± 6 years, males 66) with carotid artery stenosis were prospectively recruited. FLAIR-WMH lesion volume was performed using a semiautomated segmentation technique (Jim, Xinapse System, Leicester, UK). The Wilcoxon test was applied to verify the differences in the volume of WMHs between the right and left hemispheres.

RESULTS

A statistically significant difference was found in the middle cerebral artery (MCA) territory for the volume of the lesions (median volume of WMHs of the left side = 889.5 mm³; median volume of WMHs on the right side = 580.5 mm³; P = .0416); no statistically significant difference was found on the other territories by taking into considerations the lesions. By analyzing the degree of stenosis, we found a higher degree of stenosis of the left side (67.9%; 95% confidence interval [CI], 64.8%-70.9%) compared with the right side (65.7%; 95% CI, 62.4%-68.9%), but the Mann-Whitney test did not show a statistically significant difference (P = .3235).

CONCLUSIONS

Results of our study suggest that there is a difference in the distribution of WMHs in the brain hemispheres according to the left/right side on the MCA territories and for the periventricular white matter in subjects with mild to severe carotid artery stenosis.

Long-term sertraline treatment and depression effects on carotid artery atherosclerosis in premenopausal female primates

OBJECTIVE

Atherosclerosis developed during premenopausal years predicts postmenopausal atherosclerosis burden. Selective serotonin reuptake inhibitor (SSRI) antidepressants, recently approved for hot flushes, have been associated with increased ischemic stroke risk in several observational studies; however, effects on carotid artery atherosclerosis, a strong predictor of future vascular events, are unknown.

METHODS

The effects of chronic administration of a commonly prescribed SSRI, sertraline HCl, on atherosclerosis in the carotid artery was assessed in a placebo-controlled, longitudinal, randomized study of premeonopausal depressed and nondepressed cynomolgus monkeys (Macaca fascicularis; n = 42). Physiologic and behavioral phenotypes were evaluated at baseline and after 18 months of oral sertraline (20 mg/kg, n = 21) or placebo (n = 21). Carotid artery atherosclerosis was measured post mortem via histomorphometry.

RESULTS

Atherosclerosis extent in the right common carotid artery, on average, was 60% greater in sertraline-treated depressed monkeys compared with all other groups (P = 0.028). The results of linear regression analyses suggested that sertraline and depression effects on atherosclerosis were not mediated by their effects on behavioral and physiological risk factors.

CONCLUSIONS

These findings suggest that chronic SSRI treatment is associated with the progression of carotid artery atherosclerosis, which may increase the risk for future vascular events, particularly in depressed women. The underlying mechanism remains to be determined, but does not appear to be related to SSRI effects on traditional cardiovascular risk factors.

Recommendations for Low-Grade Carotid Stenosis Follow-up Based on a Single-Institution Database

OBJECTIVES

The purpose of this study was to determine the incidences and rates of progression of varying degrees of carotid stenosis that do not require intervention according to the Asymptomatic Carotid Atherosclerosis Study, the European Carotid Surgery Trial, and the North American Symptomatic Carotid Endarterectomy Trial, and from this information, to provide evidence-based recommendations for follow-up imaging.

METHODS

A retrospective review was performed of all carotid ultrasound examinations performed at a single institution from January 1995 through April 2015. Examinations following endarterectomy or stenting were excluded. Stenoses were classified by a modification of the criteria of Bluth et al (Radiographics 1988; 8:487-506). A Kaplan-Meier survival analysis was performed for stenosis progression and to provide information for follow-up recommendations.

RESULTS

Most of the carotid arteries (91.6%) reviewed for this study showed 1% to 39% stenosis. However, only 6.8% of carotid arteries with 1% to 39% stenosis progressed compared to 38.9% of carotid arteries with 40% to 59% stenosis. A table of evidence-based follow-up recommendations is provided for patients with varying levels of stenosis.

CONCLUSIONS

We provide evidence-based follow-up recommendations for patients who have low degrees of carotid stenosis. Different degrees of carotid stenosis progress at different rates and therefore should be followed at different intervals. Additionally, the most patients in our database showed 1% to 39% stenosis and did not have any follow-up imaging, suggesting that carotid ultrasound may not be overused for low degrees of stenosis.