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Ha SH, Kim BJ. Dyslipidemia Treatment and Cerebrovascular Disease: Evidence Regarding the Mechanism of Stroke. J Lipid Atheroscler 2024; 13:139-154. [PMID: 38826180 PMCID: PMC11140251 DOI: 10.12997/jla.2024.13.2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 06/04/2024] Open
Abstract
Dyslipidemia stands as a significant risk factor for stroke, on par with the impact of hypertension, diabetes, and smoking. While the role of dyslipidemia is firmly established in the context of coronary artery disease, its influence on strokes remains somewhat enigmatic. This complexity likely arises from the diverse mechanisms underpinning strokes, which encompass a heterogeneous spectrum (hemorrhagic and ischemic; large artery atherosclerosis, small vessel occlusion, cardioembolism, and etc.). The extent to which lipid-lowering treatments affect stroke outcomes may vary depending on the specific stroke subtype. For instance, in cases of large artery atherosclerosis (LAA), the optimal target level of low-density lipoprotein cholesterol (LDL-C) is relatively clear. However, when dealing with other stroke subtypes like small vessel occlusion or cardioembolism, the appropriate LDL-C target remains uncertain. Furthermore, reperfusion therapy has emerged as the foremost treatment for acute ischemic stroke. Nevertheless, the precise relationship between LDL-C levels and outcomes in patients undergoing reperfusion therapy remains shrouded in uncertainty. Consequently, we have undertaken an in-depth exploration of the existing evidence supporting the utilization of lipid-lowering medications such as statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Our objective is to elucidate their role in secondary stroke prevention and the management of dyslipidemia across the various stroke subtypes.
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Affiliation(s)
- Sang Hee Ha
- Department of Neurology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea
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Associations between medications and carotid artery plaque morphology using semi-automated CTA analyses. Clin Neurol Neurosurg 2023; 227:107676. [PMID: 36933405 DOI: 10.1016/j.clineuro.2023.107676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023]
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Della-Morte D, Dong C, Crisby M, Gardener H, Cabral D, Elkind MSV, Gutierrez J, Sacco RL, Rundek T. Association of Carotid Plaque Morphology and Glycemic and Lipid Parameters in the Northern Manhattan Study. Front Cardiovasc Med 2022; 9:793755. [PMID: 35141303 PMCID: PMC8818735 DOI: 10.3389/fcvm.2022.793755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Low Gray-Scale Median (GSM) index is an ultrasonographic parameter of soft, lipid rich plaque morphology that has been associated with stroke and cardiovascular disease (CVD). We sought to explore the contribution of the modifiable and not-modifiable cardiovascular risk factors (RFs) to vulnerable plaque morphology measured by the low GSM index. A total of 1,030 stroke-free community dwelling individuals with carotid plaques present (mean age, 71.8 ± 9.1; 58% women; 56% Hispanic, 20% Non-Hispanic Black, 22% Non-Hispanic White) were assessed for minimum GSM (min GSM) using high-resolution B-mode carotid ultrasound. Multiple linear regression models were used to evaluate the association between RFs and minGSM after adjusting for sociodemographic characteristics. Within an individual, median plaque number was 2 (IQR: 1–3) and mean plaque number 2.3 (SD: 1.4). Mean minGSM was 78.4 ± 28.7 (IQR: 56–96), 76.3 ± 28.8 in men and 80 ± 28.5 in women; 78.7 ± 29.3 in Hispanics participants, 78.5 ± 27.2 in Non-Hispanic Black participants, and 78.2 ± 29 in Non-Hispanic white participants. In multivariable adjusted model, male sex (β = −5.78, p = 0.007), obesity BMI (β = −6.92, p = 0.01), and greater levels of fasting glucose (β = −8.02, p = 0.02) and LDL dyslipidemia (β = −6.64, p = 0.005) were positively associated with lower minGSM, while presence of glucose lowering medication resulted in a significant inverse association (β = 7.68, p = 0.04). Interaction (with p for interaction <0.1) and stratification analyses showed that effect of age on minGSM was stronger in men (β = −0.44, p = 0.03) than in women (β = −0.20, p = 0.18), and in individuals not taking glucose lowering medication (β = −0.33, p = 0.009). Our study has demonstrated an important contribution of glycemic and lipid metabolism to vulnerable, low density or echolucent plaque morphology, especially among men and suggested that use of glucose lowering medication was associated with more fibrose-stable plaque phenotype (greater GSM). Further research is needed to evaluate effects of medical therapies in individuals with vulnerable, low density, non-stenotic carotid plaques and how these effects translate to prevention of cerebrovascular disease.
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Affiliation(s)
- David Della-Morte
- Department of Neurology, The Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
- Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy
- *Correspondence: David Della-Morte
| | - Chuanhui Dong
- Department of Neurology, The Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Milita Crisby
- Department of Neurobiology, Karolinska Institute, Care Sciences and Society, Stockholm, Sweden
| | - Hannah Gardener
- Department of Neurology, The Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Digna Cabral
- Department of Neurology, The Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ralph L. Sacco
- Department of Neurology, The Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Tatjana Rundek
- Department of Neurology, The Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
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Benson JC, Nardi V, Hunt CH, Lerman A, Lanzino G, Brinjikji W. Cardiovascular risk factors and cervical carotid plaque features on CT angiography. Neuroradiol J 2021; 35:346-351. [PMID: 34569868 DOI: 10.1177/19714009211047450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about the impact that cardiovascular (CV) risk factors have on the formation of various carotid atherosclerotic plaque features. This study set out to assess the association between CV risk factors and plaque characteristics on computed tomography (CT) angiography (CTA). MATERIALS AND METHODS A retrospective review was completed of consecutive patients that underwent a carotid endarterectomy and had CTA imaging of the head and neck vasculature. Atherosclerotic plaques of both carotid arteries were evaluated for calcification(s), low-density plaque (LDP) components, ulceration(s), and degree of stenosis. Various clinical CV risk factors were assessed using medical records. Last recorded laboratory levels were dichotomized into categories: total cholesterol <200 or ≥200 mg/dL, low-density lipoprotein (LDL) <130 or ≥130 mg/dL, high-density lipoprotein <35 or ≥35 mg/dL, and triglyceride <200 or ≥200 mg/dL. RESULTS Of 97 included patients, 62 were male (63.9%); the average age was 72.7 (standard deviation = 9.5). Calcifications were in 95/97 (97.9%) of patients (one or both carotid plaques); LDP components were in 73/97 (75.3%), and ulcerations were in 21/97 (21.6%). Elevated total cholesterol and elevated LDL levels were both associated with a higher likelihood of LDP components (p = 0.004 and p = 0.02, respectively). There were no other statistically significant associations between individual plaque features or severity of arterial stenosis and CV risk factors. CONCLUSION In carotid atherosclerotic plaques, LDP components are more frequently present in one or both carotid arteries in patients with elevated total cholesterol and/or LDL levels. Such findings raise the possibility that cholesterol levels may be directly related to the formation of specific high-risk plaque features.
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Affiliation(s)
| | - Valentina Nardi
- Department of Cardiovascular Medicine, 6915Mayo Clinic, Mayo Clinic, USA
| | - Christopher H Hunt
- Department of Cardiovascular Medicine, 6915Mayo Clinic, Mayo Clinic, USA
| | | | | | - Waleed Brinjikji
- Department of Cardiovascular Medicine, 6915Mayo Clinic, Mayo Clinic, USA
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Tshomba Y, Baccellieri D, Carta N, Cilli G, Ardita V, Apruzzi L, Loschi D, Kahlberg A, Bertoglio L, Castellano R, Simonini E, Andreotti F, Chiesa R. Doppler Ultrasound Monitoring of Echogenicity in Asymptomatic Subcritical Carotid Stenosis and Assessment of Response to Oral Supplementation of Vitamin K2 (PLAK2 Randomized Controlled Trial). Diagnostics (Basel) 2021; 11:229. [PMID: 33546354 PMCID: PMC7913481 DOI: 10.3390/diagnostics11020229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Plaque composition may predict the evolution of carotid artery stenosis rather than its sole extent. The grey scale median (GSM) value is a reproducible and standardized value to report plaque echogenicity as an indirect measure of its composition. We monitored plaque composition in asymptomatic subcritical carotid stenosis and evaluated the effect of an oral modulating calcification factor (vitamin K2). METHODS Carotid plaque composition was assessed by GSM value. Monitoring the effects of standard therapy (acetylsalicylic acid and low-medium dosage statin) (acetylsalicylic acid (ASA) arm) or standard therapy plus vitamins K2 oral supplementation (ASA + K2 arm) over a 12 months period was conducted using an ultrasound scan in a prospective, open-label, randomized controlled trial (PLAK2). RESULTS Sixty patients on low-medium dosage statin therapy were enrolled and randomized (30 per arm) to either ASA + K2 or ASA alone. Thirty-seven patients (61.6%) showed at 12 months a stable plaque with a mean increase in the GSM value in respect to the baseline of 2.6% with no differences between the two study arms (p = 0.66). Fifteen patients (25%) showed an 8% GSM value reduction respect the baseline with no differences between the two study arms (p = 0.99). At multivariable analysis, the adjusted mean (95% confidence interval) GSM change per month from baseline was greater in the ASA + K2 arm (-0.55 points, p = 0.048) compared to ASA alone (-0.18 points, p = 0.529). CONCLUSIONS Carotid plaque composition monitoring through GSM value represents a laborious procedure. Although its use may not be applied to everyday practice, a specific application consists in evaluating the effect of pharmacological therapy on plaque composition. This 12 months randomized trial showed that the majority of subcritical asymptomatic carotid plaque on treatment with low-medium dosage statin presented a stable or increased echogenicity. Although vitamin K2 beyond standard therapy did not determine a significant change in plaque composition, for those who presented with GSM reduction it did enhance a GSM monthly decline.
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Affiliation(s)
- Yamume Tshomba
- Department of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Domenico Baccellieri
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Niccolò Carta
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Giuseppe Cilli
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Vincenzo Ardita
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Luca Apruzzi
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Diletta Loschi
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Andrea Kahlberg
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Luca Bertoglio
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Renata Castellano
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Elisa Simonini
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
| | - Felicita Andreotti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Roberto Chiesa
- Department of Vascular Surgery, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132 Milan, Italy; (N.C.); (G.C.); (V.A.); (L.A.); (D.L.); (A.K.); (L.B.); (R.C.); (E.S.); (R.C.)
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Ganjali S, Bianconi V, Penson PE, Pirro M, Banach M, Watts GF, Sahebkar A. Commentary: Statins, COVID-19, and coronary artery disease: killing two birds with one stone. Metabolism 2020; 113:154375. [PMID: 32976855 PMCID: PMC7511211 DOI: 10.1016/j.metabol.2020.154375] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Key Words
- ace2, angiotensin-converting enzyme 2
- ards, acute respiratory distress syndrome
- covid-19, coronavirus disease 2019
- cvd, cardiovascular disease
- ldl, low-density lipoprotein
- mers-cov, middle east respiratory syndrome coronavirus
- myd88, myeloid differentiation primary response 88
- nf-kb, nuclear factor kappa-light-chain-enhancer of activated b cells
- sars-cov, severe acute respiratory syndrome coronavirus
- tlr, toll-like receptor
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Affiliation(s)
- Shiva Ganjali
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vanessa Bianconi
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Gerald F Watts
- Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Stein JH, Yeh E, Weber JM, Korcarz C, Ridker PM, Tawakol A, Hsue PY, Currier JS, Ribaudo H, Mitchell CKC. Brachial Artery Echogenicity and Grayscale Texture Changes in HIV-Infected Individuals Receiving Low-Dose Methotrexate. Arterioscler Thromb Vasc Biol 2019; 38:2870-2878. [PMID: 30571173 DOI: 10.1161/atvbaha.118.311807] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective- We evaluated the biological effects of low-dose methotrexate on 3 novel brachial artery grayscale ultrasound measures that may indicate subclinical arterial injury. Approach and Results- Exploratory analysis from a clinical trial of people with HIV infection at increased cardiovascular disease risk who were randomly assigned to low-dose methotrexate (target dose 15 mg/wk) or placebo. Brachial artery ultrasound grayscale median, gray level difference statistic texture-contrast (GLDS-CON), and gray level texture entropy were measured at baseline and after 24 weeks of intervention. Findings from the intention-to-treat (N=148) and adequately-dosed (N=118) populations were consistent, so the adequately-dosed population results are presented. Participants were a median (Q1, Q3) age of 54 (50, 60) years. After 24 weeks, the low-dose methotrexate intervention was associated with a 25.4% (-18.1, 58.6; P=0.007) increase in GLDS-CON compared with 1.3% (-29.1, 44.7; P=0.97) with placebo ( P=0.05) and a 0.10 u (-0.06, 0.23; P=0.026) increase in entropy compared with 0.02 u (-0.11, 0.14; P=0.54) with placebo ( P=0.14). At week 24, changes in CD4+ T cells correlated inversely with changes in GLDS-CON (ρ=-0.20; P=0.031), and entropy (ρ=-0.21; P=0.023). Changes in D-dimer levels, but no other inflammatory biomarkers, also correlated inversely with changes in GLDS-CON (ρ=-0.23; P=0.014) and entropy (ρ=-0.26; P=0.005). Conclusions- Brachial artery GLDS-CON and entropy increased after 24 weeks of low-dose methotrexate, though the latter was not significantly different from placebo. Grayscale changes were associated with decreases in CD4+ T-cell and D-dimer concentrations and may indicate favorable arterial structure changes.
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Affiliation(s)
- James H Stein
- From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S., J.M.W., C.K., C.K.C.M.)
| | - Eunice Yeh
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA (E.Y., H.R.)
| | - Joanne M Weber
- From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S., J.M.W., C.K., C.K.C.M.)
| | - Claudia Korcarz
- From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S., J.M.W., C.K., C.K.C.M.)
| | - Paul M Ridker
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston (P.M.R., A.T.)
| | - Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston (P.M.R., A.T.)
| | - Priscilla Y Hsue
- Department of Medicine, University of California-San Francisco School of Medicine (P.Y.H.)
| | - Judith S Currier
- Division of Infectious Diseases, David Geffen School of Medicine at University of California-Los Angeles (J.S.C.)
| | - Heather Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA (E.Y., H.R.)
| | - Carol K C Mitchell
- From the Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S., J.M.W., C.K., C.K.C.M.)
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Berroug J, Korcarz CE, Mitchell CK, Weber JM, Tian L, McDermott MM, Stein JH. Brachial artery intima-media thickness and grayscale texture changes in patients with peripheral artery disease receiving supervised exercise training in the PROPEL randomized clinical trial. Vasc Med 2018; 24:12-22. [PMID: 30418100 DOI: 10.1177/1358863x18804050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We performed an exploratory analysis to evaluate the effects of a treadmill exercise program on brachial artery (BA) intima-media thickness (IMT) and three BA grayscale ultrasound measures that may indicate subclinical arterial injury. Data were from a clinical trial in individuals with peripheral artery disease who were randomly assigned to treadmill exercise training or attention control. B-mode ultrasonography was performed at baseline and after 26 weeks. BA IMT, grayscale median (GSM), entropy, and gray-level difference statistic-contrast (GLDS-CON) were measured by a single reader. The 184 participants were (mean (SD)) 66.7 (8.2) years old and had an ankle-brachial index of 0.70 (0.18). Exercise training was associated with a 0.01 (0.06) mm ( p = 0.025) reduction in BA IMT compared to 0.00 (0.05) mm ( p = 0.807) in the control group (between-group p = 0.061). BA GSM, entropy, and GLDS-CON did not change significantly with exercise. Improvements in the 6-minute walk distance correlated with increases in resting BA blood flow ( r = 0.23, p = 0.032), flow-mediated dilation ( r = 0.24, p = 0.022), diameter ( r = 0.29, p = 0.005), entropy ( r = 0.21, p = 0.047), and GLDS-CON ( r = 0.22, p = 0.041). In a post hoc analysis, BA IMT improved significantly with treadmill exercise training but did not change with attention control; however, the between-group difference did not reach statistical significance. With exercise, improvements in the 6-minute walk distance were associated with improved endothelial function, increased resting blood flow, and BA dilation, as well as higher grayscale entropy and GLDS-CON, indicating that lower extremity exercise is associated with salutary changes in upper-extremity arterial wall structure and function. ClinicalTrials.gov Identifier: NCT01408901.
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Affiliation(s)
- Jack Berroug
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Claudia E Korcarz
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carol Kc Mitchell
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - JoAnne M Weber
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lu Tian
- 2 Stanford University School of Medicine, Stanford, CA, USA
| | - Mary M McDermott
- 3 Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James H Stein
- 1 Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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9
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Texakalidis P, Giannopoulos S, Jonnalagadda AK, Chitale RV, Jabbour P, Armstrong EJ, Schwartz GG, Kokkinidis DG. Preoperative Use of Statins in Carotid Artery Stenting: A Systematic Review and Meta-analysis. J Endovasc Ther 2018; 25:624-631. [PMID: 30101624 DOI: 10.1177/1526602818794030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine through meta-analysis whether administration of statins before carotid artery stenting (CAS) is associated with fewer periprocedural adverse events. METHODS All randomized and observational English-language studies of periprocedural statin administration prior to CAS that reported the outcomes of interest (stroke, transient ischemic attack, myocardial infarction, and death at 30 days) were included in a random-effects meta-analysis. The I2 statistic was used to assess heterogeneity. Meta-regression analysis was performed to determine whether an association of statin treatment with risk of outcome events was influenced by other trial-level baseline characteristics of statin-treated and untreated patients. RESULTS Eleven studies comprising 4088 patients were included. Patients who received statins prior to CAS had a significantly lower risk of stroke (OR 0.39, 95% CI 0.27 to 0.58, p<0.01; I2=0%) and death (OR 0.30, 95% CI 0.10 to 0.96, p=0.042; I2=0%). Statin use was not associated with a reduced risk of transient ischemic attack or myocardial infarction. In meta-regression analysis, other trial-level baseline characteristics had no significant influence on the association of statin treatment with death or stroke. CONCLUSION Statin therapy prior to CAS is associated with decreased risk of perioperative stroke and death without any effect on the rates of transient ischemic attack or myocardial infarction.
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Affiliation(s)
| | | | - Anil K Jonnalagadda
- 3 Division of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Rohan V Chitale
- 4 Department of Neurosurgery, Vanderbilt University Hospital, Nashville, TN, USA
| | - Pascal Jabbour
- 5 Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ehrin J Armstrong
- 6 Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO, USA
| | - Gregory G Schwartz
- 6 Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO, USA
| | - Damianos G Kokkinidis
- 7 Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Hae Kim C, Wang S, Park JB, Jung KH, E Yoon Y, Lee SP, Kim HK, Kim YJ, Cho GY, Sohn DW. Assessing Impact of High-Dose Pitavastatin on Carotid Artery Elasticity with Speckle-Tracking Strain Imaging. J Atheroscler Thromb 2018. [PMID: 29515050 PMCID: PMC6224202 DOI: 10.5551/jat.42861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
AIM Speckle-tracking imaging has been introduced for the precise assessment of vessel mechanics. However, there are no data on the role of this imaging tool in assessing the changes in vasculature with statin therapy, which is known to enhance vascular elasticity. METHODS This study was a prospective study including 48 statin-naïve patients (age, 58.2±8.4 years; 29.2% male) with hypercholesterolemia. Circumferential carotid artery strain (CAS) and stiffness index (β2) were measured using speckle-tracking imaging before and after 3 months of high-dose pitavastatin treatment (4 mg daily). For the comparison, we measured conventional carotid elasticity parameters and intima-media thickness using B-mode ultrasound at the same time points. RESULTS Compared with baseline, there was significant improvement in circumferential CAS (2.98%±1.18% to 3.40%±1.43%, p=0.008) and β2 (0.19±0.07 to 0.17±0.08, p=0.047) after statin therapy. Contrariwise, there were no significant changes in all conventional carotid elasticity metrics and intima-media thickness. When stratifying patients into two subgroups by 10 year atherosclerotic cardiovascular disease (ASCVD) risk, speckle-tracking-derived circumferential CAS and β2 improved significantly only in patients with ASCVD risk ≥ 7.5%. CONCLUSIONS Short-term treatment with high-dose pitavastatin improved carotid artery elasticity measured by speckle-tracking method, but not conventional parameters by B-mode ultrasound. Speckle-tracking-based measurements may allow the early noninvasive assessment of statin effects on vascular function in hypercholesterolemic patients.
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Affiliation(s)
- Chee Hae Kim
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Shuang Wang
- Department of Cardiology, Xiangtan Central Hospital
| | - Jun-Bean Park
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital
| | - Yeonyee E Yoon
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Bundang Hospital
| | - Seung-Pyo Lee
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Hyung-Kwan Kim
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Goo-Yeong Cho
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Bundang Hospital
| | - Dae-Won Sohn
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
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11
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Xu B, Xing J, Wu W, Zhang WJ, Zhu QQ, Zhang D, Sun NN, Wu C, Kang GJ, Zhai L, Li WD, Meng Y, Du TY. Improved plaque neovascularization following 2-year atorvastatin therapy based on contrast-enhanced ultrasonography: A pilot study. Exp Ther Med 2018; 15:4491-4497. [PMID: 29725384 DOI: 10.3892/etm.2018.5926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 04/07/2017] [Indexed: 01/23/2023] Open
Abstract
The present study assessed changes in carotid plaque neovascularization following long-term atorvastatin therapy (20 mg/day) using contrast-enhanced ultrasonography (CEUS). In this prospective case series, seven males (mean age, 68±9 years) and three females (mean age, 67±10 years) with a total of 13 carotid plaques underwent standard ultrasonography and CEUS at baseline, as well as after 1 and 2 years of atorvastatin treatment. The same plaques were then examined using real-time CEUS. The results of the enhanced intensity of plaque neovascularization at baseline were compared with results obtained during follow-up to examine the effects of long-term atorvastatin therapy. Standard ultrasonography revealed that 7 of the 13 carotid plaques were uniformly echolucent, whereas 6 carotid plaques were predominantly echolucent. CEUS revealed an enhanced intensity of 10.5±2.1 decibels (dB) prior to treatment, which decreased significantly to 7.3±2.6 dB following 2 years atorvastatin therapy (P<0.001). The ratio of enhanced intensity in the carotid artery lumen to that in the plaque was 3.10±1.10 at baseline and this value significantly increased to 4.96±2.98 following treatment for 2 years (P<0.001). The current pilot study therefore indicates that two-year atorvastatin therapy (20 mg/day) may reduce plaque neovascularization in the Chinese population.
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Affiliation(s)
- Bin Xu
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Jin Xing
- Department of Ultrasound, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Wenqing Wu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, P.R. China
| | - Wen-Jing Zhang
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Qian-Qian Zhu
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Dan Zhang
- Department of Ultrasound, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Nan-Nan Sun
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Chan Wu
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Geng-Jie Kang
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Lin Zhai
- Department of Ultrasound, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Wei-Dong Li
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Yan Meng
- Department of Ultrasound, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Tie-Ying Du
- Department of Neurology, Fuxing Hospital, Capital Medical University, Beijing 100038, P.R. China
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12
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Paraskevas KI, Veith FJ, Mikhailidis DP, Liapis CD. Appropriate Patient Selection for Carotid Revascularization Procedures is Urgently Needed. Angiology 2017; 69:12-16. [PMID: 28078914 DOI: 10.1177/0003319716687870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The identification/selection of appropriate patient subgroups with asymptomatic carotid artery stenosis and the performance of prophylactic carotid endarterectomy (CEA)/carotid artery stenting (CAS) exclusively on these asymptomatic patient subgroups is currently one of the "hottest" topics in vascular surgery. It is now clear that offering CEA/CAS to asymptomatic carotid patients based only on the degree of carotid stenosis is unjustified and scientifically flawed. On the other hand, offering only best medical therapy to every asymptomatic patient, irrespective of certain high-risk criteria (such as the detection of microemboli by transcranial Doppler, intraplaque hemorrhage, silent embolic infarcts on brain computed tomography/magnetic resonance imaging, elevated biomarkers, family history), is equally wrong. The validation of specific measures to identify those asymptomatic patients at high risk for developing symptoms is crucial to achieve optimal use of carotid interventions and avoid wasting stroke prevention resources.
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Affiliation(s)
- Kosmas I Paraskevas
- 1 Northern Vascular Centre, Freeman Hospital, Newcastle Upon Tyne, NHS Foundation Trust, UK
| | - Frank J Veith
- 2 Divisions of Vascular Surgery, New York University Langone Medical Center and Cleveland Clinic, New York, NY and Cleveland, OH, USA
| | - Dimitri P Mikhailidis
- 3 Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - Christos D Liapis
- 4 Vascular and Endovascular Clinic, Athens Medical Center, Athens, Greece
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13
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Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg 2016. [DOI: 10.3171/2015.1.jns142452.test] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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Dong C, Della-Morte D, Cabral D, Wang L, Blanton SH, Seemant C, Sacco RL, Rundek T. Sirtuin/uncoupling protein gene variants and carotid plaque area and morphology. Int J Stroke 2015; 10:1247-52. [PMID: 26332421 PMCID: PMC6561468 DOI: 10.1111/ijs.12623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sirtuins and uncoupling proteins have been implicated in cardiovascular diseases by controlling oxidative stress. AIMS We sought to investigate the association of sirtuins and uncoupling proteins single nucleotide polymorphisms with total carotid plaque area and morphology measured by ultrasonographic gray scale median. METHODS We analyzed 1356 stroke-free subjects (60% women, mean age = 68 ± 9 years) from the Northern Manhattan Study. Multiple linear regression models were used to evaluate the association of 85 single nucleotide polymorphisms in 11 sirtuins/uncoupling protein genes with total plaque area and gray scale median after controlling for demographics, vascular risk factors (RFs), and population stratification. We investigated effect modifications of these relationship by gender and RFs and performed stratified analysis if the interaction effect had P < 0·005. RESULTS Among individuals with present plaque (55%), the mean total plaque area was 20·3 ± 20·8 mm(2) and gray scale median 90 ± 29. After adjustment, SIRT6 rs107251 was significantly associated with total plaque area (β = 0·30 per copy of T allele increase, Bonferroni-corrected P = 0·005). T allele carriers of rs1430583 in UCP1 showed a decreased gray scale median in women but not in men. The minor allele carriers of rs4980329 and rs12363280 in SIRT3 had higher gray scale median in men but not in women. Variants in UCP3 gene were significantly associated with higher mean gray scale median in individuals with dyslipidemia. CONCLUSION Our findings suggest that polymorphisms in SIRT6/UCP1 genes may be important for increased carotid plaque burden and echodensity, but translation of these findings to an individual risk of cerebrovascular events needs further investigation. Significant associations of rs1430583 in women, rs12363280 in men, and rs1685354 in those with dyslipidemia also deserve further investigations.
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Affiliation(s)
- Chuanhui Dong
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David Della-Morte
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS San Raffaele Pisana, Rome, Italy
| | - Digna Cabral
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Liyong Wang
- John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Susan H. Blanton
- John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Chaturvedi Seemant
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ralph L. Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
- John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA
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15
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Haussen DC, Rose DZ, Drazin D, Newsome SD, Gardener H, Edgell RC, Boulos A, Bernardini G, Rundek T, Yavagal DR. Ipsilateral Infarct in Newly Diagnosed Cervical Internal Carotid Artery Atherosclerotic Occlusion. INTERVENTIONAL NEUROLOGY 2015; 3:142-8. [PMID: 26279661 DOI: 10.1159/000382133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to determine factors associated with recent infarct (RI) in patients with newly identified atherosclerotic cervical internal carotid artery occlusion (CICAO). METHODS This was a retrospective review of consecutive patients who underwent cervical CT angiography from 2002 to 2006 at a single tertiary center. RI was defined by positive diffusion-weighted imaging/apparent diffusion coefficient magnetic resonance imaging (MRI) in the correspondent CICAO territory. Subjects were dichotomized into those with a RI versus patients with no RI (No-RI). RESULTS Of 2,459 patients with cervical CT angiograms in the study period, 108 (4.4%) had complete medical records and brain MRI and were included. The mean age was 64 ± 13 years, 58% were men, and 62 (57%) had a RI. The demographics of the RI and No-RI patients were comparable, with the exception that those with RI had a lower frequency of coronary artery disease (CAD, 13 vs. 54%; p < 0.01) and dyslipidemia (38 vs. 69%; p < 0.01). The use of antiplatelets was not statistically different between the groups (56 vs. 71%; p = 0.1). Subjects with RI were less likely on statins (21 vs. 56%; p < 0.01) and antihypertensives (9 vs. 71%; p < 0.01). Multivariate regression revealed that CAD, the use of statins, and the use of antihypertensives were associated with No-RI CICAO presentation. CONCLUSION The use of statins and antihypertensives is associated with a decreased risk of RI atherosclerotic CICAO.
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Affiliation(s)
- Diogo C Haussen
- Department of Neurology, Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Ga., USA
| | - David Z Rose
- Department of Neurology, University of South Florida, Tampa, Fla., USA
| | - Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, Calif., USA
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Md., USA
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Randall C Edgell
- Department of Neurology and Psychiatry, St. Louis University, St. Louis, Mo., USA
| | - Alan Boulos
- Department of Neurosurgery, Albany Medical Center, Albany, N.Y., USA
| | - Gary Bernardini
- Department of Neurology, Albany Medical Center, Albany, N.Y., USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Dileep R Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA
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16
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Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg 2015; 124:27-42. [PMID: 26230478 DOI: 10.3171/2015.1.jns142452] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis. For example, identification of IPH on MRI in patients with low-grade carotid artery stenosis is a risk factor for failure of medical therapy, and studies have shown that such patients may fair better with carotid endarterectomy (CEA). MR plaque imaging has also been found to be useful in identifying revascularization candidates who would be better candidates for CEA than carotid artery stenting (CAS), as high intraplaque signal on time of flight imaging is associated with vulnerable plaque and increased rates of adverse events in patients undergoing CAS but not CEA.
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Affiliation(s)
| | | | | | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Yang D, Iyer S, Gardener H, Della-Morte D, Crisby M, Dong C, Cheung K, Mora-McLaughlin C, Wright CB, Elkind MS, Sacco RL, Rundek T. Cigarette Smoking and Carotid Plaque Echodensity in the Northern Manhattan Study. Cerebrovasc Dis 2015; 40:136-43. [PMID: 26227885 DOI: 10.1159/000434761] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We sought to determine the association between cigarette smoking and carotid plaque ultrasound morphology in a multiethnic cohort. METHODS We analyzed 1,743 stroke-free participants (mean age 65.5 ± 8.9 years; 60% women; 18% white, 63% Hispanic, 19% black; 14% current and 38% former smokers, 48% never smoked) from the Northern Manhattan Study using an ultrasound index of plaque echodensity, the Gray-Scale Median (GSM). Echolucent plaque (low GSM) represents soft plaque and echodense (high GSM) more calcified plaque. The mean GSM weighted by plaque area for each plaque was calculated for those with multiple plaques. Quintiles of GSM were compared to no plaque. Multinomial logistic regression models were used to assess associations of cigarette smoking with GSM, adjusting for demographics and vascular risk factors. RESULTS Among subjects with carotid plaque (58%), the mean GSM scores for quintiles 1-5 were 48, 72, 90, 105, and 128, respectively. Current smokers had over a two fold increased risk of having GSM in quintile 1 (odds ratio (OR) = 2.17; 95% confidence interval (CI), 1.34-3.52), quintile 2 (OR = 2.33; 95% CI, 1.42-3.83), quintile 4 (OR = 2.05; 95% CI, 1.19-3.51), and quintile 5 (OR = 2.13; 95% CI, 1.27-3.56) but not in quintile 3 (OR = 1.18; 95% CI, 0.67-2.10) as compared to never smokers in fully adjusted models. Former smokers had increased risk in quintile 2 (OR = 1.46; 95% CI, 1.00-2.12), quintile 3 (OR = 1.56; 95% CI, 1.09-2.24), quintile 4 (OR = 1.66; 95% CI, 1.13-2.42), and quintile 5 (OR = 1.73; 95% CI, 1.19-2.51), but not in quintile 1 (OR = 1.05; 95% CI, 0.72-1.55). CONCLUSIONS A nonlinear, V-shaped-like relationship between current cigarette smoking and plaque echodensity was observed. Former smokers were at the highest risk for plaques in high GSM quintiles. Thus, current smokers were more likely to have either soft or calcified plaques and former smokers were at greater risk of having only echodense plaques when compared to those who have never smoked. Further research is needed to determine if plaque morphology mediates an association between smoking and clinical vascular events.
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Affiliation(s)
- Dixon Yang
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fla., USA
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18
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Li J, Mi D, Pu Y, Zou X, Pan Y, Soo Y, Leung T, Wang Y, Wong KS, Liu L. Comparison of carotid atherosclerotic plaque characteristics between patients with first-time and recurrent acute ischaemic stroke using B-mode ultrasound. Neurol Res 2015; 37:1-5. [PMID: 26100248 DOI: 10.1179/1743132815y.0000000064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The differences between initial and recurrent stroke plaques are not defined. Hence, a nested case-control study was conducted to evaluate the association of stroke recurrence with the echogenic characteristics of carotid plaques in patients with ischaemic stroke. METHODS One hundred and four patients with 1-year recurrent acute ischaemic stroke were enrolled and compared with 104 control patients (first-time ischaemic stroke) matched for age, gender, stroke severity and treatment allocation. Based on the Mannheim Carotid Intima-Media Thickness Consensus (2004-2006), the number of carotid plaques and echogenicity between the two groups of patients were compared. RESULTS As compared to patients with first-time stroke, those with recurrent stroke showed significantly higher prevalence of heart disease (13.46 vs 28.85%, P = 0.0066) and presence of intracranial stenosis (55.77 vs 89.90%, P < 0.0001). During the 1-year follow-up, patients with recurrent stroke had a significantly higher rate of unstable plaques (80.41%) than patients with first-time stroke (64.21%, P = 0.036). Also, patients with recurrent stroke had a significantly larger number of plaques than patients with first-time stroke (P = 0.0152). Multivariate conditional logistic regression analysis (after adjustment for heart disease and intracranial stenosis) identified an association between 1-year stroke recurrence and the presence of unstable plaques (hazard ratio 3.077; 95% CI: 1.133-8.355). CONCLUSION Stroke recurrence is related to advanced atherosclerosis defined by carotid plaque and its characteristics.
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Affiliation(s)
- Jin Li
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China
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19
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Ibrahimi P, Jashari F, Bajraktari G, Wester P, Henein MY. Ultrasound assessment of carotid plaque echogenicity response to statin therapy: a systematic review and meta-analysis. Int J Mol Sci 2015; 16:10734-47. [PMID: 25984600 PMCID: PMC4463673 DOI: 10.3390/ijms160510734] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate in a systematic review and meta-analysis model the effect of statin therapy on carotid plaque echogenicity assessed by ultrasound. METHODS We have systematically searched electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to April, 2015, for studies evaluating the effect of statins on plaque echogenicity. Two researchers independently determined the eligibility of studies evaluating the effect of statin therapy on carotid plaque echogenicity that used ultrasound and grey scale median (GSM) or integrated back scatter (IBS). RESULTS Nine out of 580 identified studies including 566 patients' carotid artery data were meta-analyzed for a mean follow up of 7.2 months. A consistent increase in the echogenicity of carotid artery plaques, after statin therapy, was reported. Pooled weighted mean difference % (WMD) on plaque echogenicity after statin therapy was 29% (95% CI 22%-36%), p<0.001, I2=92.1%. In a meta-regression analysis using % mean changes of LDL, HDL and hsCRP as moderators, it was shown that the effects of statins on plaque echogenicity were related to changes in hsCRP, but not to LDL and HDL changes from the baseline. The effect of statins on the plaque was progressive; it showed significance after the first month of treatment, and the echogenicity continued to increase in the following six and 12 months. CONCLUSIONS Statin therapy is associated with a favorable increase of carotid plaque echogenicity. This effect seems to be dependent on the period of treatment and hsCRP change from the baseline, independent of changes in LDL and HDL.
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Affiliation(s)
- Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå 901 87, Sweden.
| | - Fisnik Jashari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå 901 87, Sweden.
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå 901 87, Sweden.
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå 901 87, Sweden.
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå 901 87, Sweden.
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20
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Picano E, Paterni M. Ultrasound tissue characterization of vulnerable atherosclerotic plaque. Int J Mol Sci 2015; 16:10121-33. [PMID: 25950760 PMCID: PMC4463636 DOI: 10.3390/ijms160510121] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/16/2022] Open
Abstract
A thrombotic occlusion of the vessel fed by ruptured coronary atherosclerotic plaque may result in unstable angina, myocardial infarction or death, whereas embolization from a plaque in carotid arteries may result in transient ischemic attack or stroke. The atherosclerotic plaque prone to such clinical events is termed high-risk or vulnerable plaque, and its identification in humans before it becomes symptomatic has been elusive to date. Ultrasonic tissue characterization of the atherosclerotic plaque is possible with different techniques--such as vascular, transesophageal, and intravascular ultrasound--on a variety of arterial segments, including carotid, aorta, and coronary districts. The image analysis can be based on visual, video-densitometric or radiofrequency methods and identifies three distinct textural patterns: hypo-echoic (corresponding to lipid- and hemorrhage-rich plaque), iso- or moderately hyper-echoic (fibrotic or fibro-fatty plaque), and markedly hyperechoic with shadowing (calcific plaque). Hypoechoic or dishomogeneous plaques, with spotty microcalcification and large plaque burden, with plaque neovascularization and surface irregularities by contrast-enhanced ultrasound, are more prone to clinical complications than hyperechoic, extensively calcified, homogeneous plaques with limited plaque burden, smooth luminal plaque surface and absence of neovascularization. Plaque ultrasound morphology is important, along with plaque geometry, in determining the atherosclerotic prognostic burden in the individual patient. New quantitative methods beyond backscatter (to include speed of sound, attenuation, strain, temperature, and high order statistics) are under development to evaluate vascular tissues. Although not yet ready for widespread clinical use, tissue characterization is listed by the American Society of Echocardiography roadmap to 2020 as one of the most promising fields of application in cardiovascular ultrasound imaging, offering unique opportunities for the early detection and treatment of atherosclerotic disease.
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Affiliation(s)
- Eugenio Picano
- Biomedicine Department, NU School of Medicine, Astana 010000, Kazakistan.
| | - Marco Paterni
- CNR (Consiglio Nazionale Ricerche), Institute of Clinical Physiology, 56124 Pisa, Italy.
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21
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Abstract
BACKGROUND This represents the first update of this review, which was published in 2012. Atorvastatin is one of the most widely prescribed drugs and the most widely prescribed statin in the world. It is therefore important to know the dose-related magnitude of effect of atorvastatin on blood lipids. OBJECTIVES Primary objective To quantify the effects of various doses of atorvastatin on serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and triglycerides in individuals with and without evidence of cardiovascular disease. The primary focus of this review was determination of the mean per cent change from baseline of LDL-cholesterol. Secondary objectives • To quantify the variability of effects of various doses of atorvastatin.• To quantify withdrawals due to adverse effects (WDAEs) in placebo-controlled randomised controlled trials (RCTs). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2013), MEDLINE (1966 to December Week 2 2013), EMBASE (1980 to December Week 2 2013), Web of Science (1899 to December Week 2 2013) and BIOSIS Previews (1969 to December Week 2 2013). We applied no language restrictions. SELECTION CRITERIA Randomised controlled and uncontrolled before-and-after trials evaluating the dose response of different fixed doses of atorvastatin on blood lipids over a duration of three to 12 weeks. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility criteria for studies to be included and extracted data. We collected information on withdrawals due to adverse effects from placebo-controlled trials. MAIN RESULTS In this update, we found an additional 42 trials and added them to the original 254 studies. The update consists of 296 trials that evaluated dose-related efficacy of atorvastatin in 38,817 participants. Included are 242 before-and-after trials and 54 placebo-controlled RCTs. Log dose-response data from both trial designs revealed linear dose-related effects on blood total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. The Summary of findings table 1 documents the effect of atorvastatin on LDL-cholesterol over the dose range of 10 to 80 mg/d, which is the range for which this systematic review acquired the greatest quantity of data. Over this range, blood LDL-cholesterol is decreased by 37.1% to 51.7% (Summary of findings table 1). The slope of dose-related effects on cholesterol and LDL-cholesterol was similar for atorvastatin and rosuvastatin, but rosuvastatin is about three-fold more potent. Subgroup analyses suggested that the atorvastatin effect was greater in females than in males and was greater in non-familial than in familial hypercholesterolaemia. Risk of bias for the outcome of withdrawals due to adverse effects (WDAEs) was high, but the mostly unclear risk of bias was judged unlikely to affect lipid measurements. Withdrawals due to adverse effects were not statistically significantly different between atorvastatin and placebo groups in these short-term trials (risk ratio 0.98, 95% confidence interval 0.68 to 1.40). AUTHORS' CONCLUSIONS This update resulted in no change to the main conclusions of the review but significantly increases the strength of the evidence. Studies show that atorvastatin decreases blood total cholesterol and LDL-cholesterol in a linear dose-related manner over the commonly prescribed dose range. New findings include that atorvastatin is more than three-fold less potent than rosuvastatin, and that the cholesterol-lowering effects of atorvastatin are greater in females than in males and greater in non-familial than in familial hypercholesterolaemia. This review update does not provide a good estimate of the incidence of harms associated with atorvastatin because included trials were of short duration and adverse effects were not reported in 37% of placebo-controlled trials.
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Affiliation(s)
- Stephen P Adams
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Sciences Mall, Medical Block CVancouverBCCanadaV6T 1Z3
| | - Michael Tsang
- McMaster UniversityDepartment of Internal Medicine, Internal Medicine Residency Office, Faculty of Medicine1200 Main Street WestHSC 3W10HamiltonONCanadaL8N 3N5
| | - James M Wright
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics2176 Health Sciences Mall, Medical Block CVancouverBCCanadaV6T 1Z3
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Marchione P, Vento C, Morreale M, Izzo C, Maugeri A, Manuppella F, Romeo T, Giacomini P. Atorvastatin treatment and carotid plaque morphology in first-ever atherosclerotic transient ischemic attack/stroke: a case-control study. J Stroke Cerebrovasc Dis 2014; 24:138-43. [PMID: 25440329 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/17/2014] [Accepted: 08/01/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A relationship between echolucency of carotid plaques and the consequent risk of ipsilateral ischemic stroke has been observed. An aggressive lipid-lowering therapy may increase the echogenicity of carotid plaque in patients with elevated low-density lipoprotein cholesterol levels. The aim of this study is to prospectively evaluate the long-term effect of high-dose atorvastatin on carotid plaque morphology in patients with first-ever transient ischemic attack or stroke. METHODS All patients with symptomatic first ischemic atherosclerotic cerebrovascular event occurred within the previous 10 days were enrolled. Carotid Doppler ultrasound of the neck vessels with 7-11 MHz probe for the definition of the atherosclerotic carotid framework was performed. The analysis of the gray-scale median (GSM) of each plate was carried out with image processing software. RESULTS A total of 240 symptomatic plaques were included and divided into 3 groups: 80 in group A (atorvastatin 80 mg), 80 in group B (atorvastatin 40 mg), and 80 to group C (no atorvastatin). GSM score increases significantly more extensive in group A than in group B (+48.65 vs. +39.46, P < .02) and group C (+48.65 vs. 19.3, P = .0002). An inverse association between reduction of low-density lipoprotein and the increase in the GSM score (r = -.456, P = .007) has been observed. Moreover, the reduction of high-sensitive C-reactive protein correlates inversely with the increase of the GSM (r = -.398, P = .021). CONCLUSIONS Dose-dependent effect of atorvastatin on symptomatic carotid plaque morphology may suggest a specific role of this drug in the atherosclerotic stroke prevention.
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Affiliation(s)
- Pasquale Marchione
- Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy; Operative Unit of Neurology, Department of Clinical Neurosciences, Neurological Center of Latium, Rome, Italy.
| | - Claudio Vento
- Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy
| | - Manuela Morreale
- Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy
| | - Chiara Izzo
- Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy; Operative Unit of Neurology, Department of Clinical Neurosciences, Neurological Center of Latium, Rome, Italy
| | - Andrea Maugeri
- Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy
| | - Federica Manuppella
- Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy
| | - Tommaso Romeo
- Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy
| | - Patrizia Giacomini
- Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy
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Cortese B, De Carlo M, De Matteis S, Rizza A, Giannini D, Palmieri C, Petronio AS, Berti S, Balbarini A, Ramee S. Distal embolisation during carotid stenting is predicted by circulating levels of LDL cholesterol and C-reactive protein. EUROINTERVENTION 2014; 10:513-517. [DOI: 10.4244/eijv10i4a88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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López-Cancio E, Matheus MG, Romano JG, Liebeskind DS, Prabhakaran S, Turan TN, Cotsonis GA, Lynn MJ, Rumboldt Z, Chimowitz MI. Infarct patterns, collaterals and likely causative mechanisms of stroke in symptomatic intracranial atherosclerosis. Cerebrovasc Dis 2014; 37:417-22. [PMID: 25011483 DOI: 10.1159/000362922] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are limited data on the specific mechanisms of stroke in patients with intracranial atherosclerotic stenosis (ICAS). We undertook this study to describe infarct patterns and likely mechanisms of stroke in a large cohort of patients with ICAS, and to evaluate the relationship of these infarct patterns to angiographic features (collaterals, stenosis location and stenosis severity). METHODS We evaluated infarct patterns in the territory of a stenotic intracranial artery on neuroimaging performed at baseline and during follow-up if a recurrent stroke occurred in patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We defined the likely mechanism of stroke (artery-to-artery embolism, perforator occlusion, hypoperfusion or mixed) according to the site of ICAS and based on the infarct patterns on neuroimaging. Collaterals were assessed using American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grades, and stenosis severity using the WASID trial's measurement technique. We evaluated the association of infarct patterns with angiographic features using χ(2) tests. RESULTS The likely mechanisms of stroke based on the infarct patterns at baseline in the 136 patients included in the study were artery-to-artery embolism (n = 69; 50.7%), perforator occlusion (n = 34; 25%), hypoperfusion (n = 12; 8.8%) and mixed (n = 21; 15.5%). Perforator-occlusive infarcts were more frequent in the posterior circulation, and mixed patterns were more prevalent in the anterior circulation (both p < 0.01). Most of the mixed patterns in the anterior circulation combined small pial or scattered multiple cortical infarcts with infarcts in border-zone regions, especially the cortical ones. Isolated border-zone infarcts were not significantly associated with a poor grading for collaterals or the severity of stenosis. Among 47 patients with a recurrent infarct during follow-up, the infarct patterns suggested an artery-to-artery embolic mechanism in 29 (61.7%). CONCLUSIONS Artery-to-artery embolism is probably the most common mechanism of stroke in both the anterior and the posterior circulations in patients with ICAS. An extension of intracranial atherosclerosis at the site of stenosis into adjacent perforators also appears to be a common mechanism of stroke, particularly in the posterior circulation, whereas hypoperfusion as the sole mechanism is relatively uncommon. Further research is important to accurately establish the specific mechanisms of stroke in patients with ICAS, since preliminary data suggest that the underlying mechanism of stroke is an important determinant of prognosis.
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Affiliation(s)
- Elena López-Cancio
- Department of Neurosciences, Germans Trias i Pujol University Hospital, Badalona, Spain
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25
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De Carlo M, Cortese B, Pennesi M, Misuraca L, Conte L, Pitì A, Petronio AS, Balbarini A. Design of the rosuvastatin pretreatment to reduce embolization during Carotid Artery Stenting trial. J Cardiovasc Med (Hagerstown) 2014; 15:595-600. [PMID: 24922046 DOI: 10.2459/01.jcm.0000446384.42103.a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Carotid artery stenting (CAS) is a worldwide diffuse intervention, but may be associated with distal plaque component embolization, and sometimes major and minor stroke. Statin use has been demonstrated to reduce atherosclerotic plaque burden, but its effect in reducing distal embolization during carotid stenting has not yet been well validated. AIMS With the Rosuvastatin Pretreatment to Reduce Embolization during Carotid Artery Stenting trial, we aim to discover if a pretreatement with high doses of rosuvastatin in dyslipidemic patients is able to reduce periprocedural cerebral ischemic complications following carotid stenting. METHODS This is a phase III prospective, randomized controlled trial. All consecutive patients with asymptomatic carotid stenosis at least 80% will be randomized to a 6-week rosuvastatin treatment followed by carotid stenting, and to direct carotid stenting. Carotid stenting will be performed following common practice with distal or proximal embolic protection. The primary efficacy end point of the trial will be the prevalence of 'relevant' embolization during CAS, as a surrogate end point for cerebral ischemic complications. Other laboratory and clinical data will be registered and patients will be followed up to 1 year. In order to obtain the expected superiority of statin pretreatment on primary end point, a population of 130 patients will be enrolled into the study. CONCLUSION In conclusion, with the Rosuvastatin Pretreatment to Reduce Embolization during Carotid Artery Stenting trial, we want to evaluate whether a high dose of rosuvastatin for 6 weeks before CAS in asymptomatic patients with severe carotid stenosis is able to reduce the rate of plaque embolization during the procedure, thus suggesting a possible reduction in cerebral ischemic complications.
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Affiliation(s)
- Marco De Carlo
- aCardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria, Pisana bInterventional Cardiology, A.O. Fatebenefratelli, Milan cCliniche Humanitas Gavazzeni, Bergamo dCardioangiology Unit, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria, Pisana, Italy
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26
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Sannino A, Brevetti L, Giugliano G, Scudiero F, Toscano E, Mainolfi C, Cuocolo A, Perrino C, Stabile E, Trimarco B, Esposito G. Non-invasive vulnerable plaque imaging: how do we know that treatment works? Eur Heart J Cardiovasc Imaging 2014; 15:1194-202. [PMID: 24876097 DOI: 10.1093/ehjci/jeu097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Atherosclerosis is an inflammatory disorder that can evolve into an acute clinical event by plaque development, rupture, and thrombosis. Plaque vulnerability represents the susceptibility of a plaque to rupture and to result in an acute cardiovascular event. Nevertheless, plaque vulnerability is not an established medical diagnosis, but rather an evolving concept that has gained attention to improve risk prediction. The availability of high-resolution imaging modalities has significantly facilitated the possibility of performing in vivo regression studies and documenting serial changes in plaque stability. This review summarizes the currently available non-invasive methods to identify vulnerable plaques and to evaluate the effects of the current cardiovascular treatments on plaque evolution.
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Affiliation(s)
- Anna Sannino
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Linda Brevetti
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Giuseppe Giugliano
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Fernando Scudiero
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Evelina Toscano
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Ciro Mainolfi
- Nuclear Medicine, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Alberto Cuocolo
- Nuclear Medicine, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Cinzia Perrino
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Eugenio Stabile
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Bruno Trimarco
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
| | - Giovanni Esposito
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Via Pansini, 5, 80131 Naples, Italy
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Ibrahimi P, Jashari F, Nicoll R, Bajraktari G, Wester P, Henein MY. Coronary and carotid atherosclerosis: how useful is the imaging? Atherosclerosis 2013; 231:323-33. [PMID: 24267246 DOI: 10.1016/j.atherosclerosis.2013.09.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/13/2013] [Accepted: 09/30/2013] [Indexed: 02/08/2023]
Abstract
The recent advancement of imaging modalities has made possible visualization of atherosclerosis disease in all phases of its development. Markers of subclinical atherosclerosis or even the most advanced plaque features are acquired by invasive (IVUS, OCT) and non-invasive imaging modalities (US, MRI, CTA). Determining plaques prone to rupture (vulnerable plaques) might help to identify patients at risk for myocardial infarction or stroke. The most accepted features of plaque vulnerability include: thin cap fibroatheroma, large lipid core, intimal spotty calcification, positive remodeling and intraplaque neovascularizations. Today, research is focusing on finding imaging techniques that are less invasive, less radiation and can detect most of the vulnerable plaque features. While, carotid atherosclerosis can be visualized using noninvasive imaging, such as US, MRI and CT, imaging plaque feature in coronary arteries needs invasive imaging modalities. However, atherosclerosis is a systemic disease with plaque development simultaneously in different arteries and data acquisition in carotid arteries can add useful information for prediction of coronary events.
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Affiliation(s)
- Pranvera Ibrahimi
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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28
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Diet induced mild hypercholesterolemia in pigs: local and systemic inflammation, effects on vascular injury - rescue by high-dose statin treatment. PLoS One 2013; 8:e80588. [PMID: 24260430 PMCID: PMC3829827 DOI: 10.1371/journal.pone.0080588] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/07/2013] [Indexed: 11/19/2022] Open
Abstract
Objective The aim of the present study was to comprehensively evaluate systemic and local inflammation as well as progression of vascular inflammation in normal and mechanically injured vessels in a large animal model of mild hypercholesterolemia. Our aim was also to test the effect of high-dose statin treatment on these processes. Methods Pigs were kept for 120 days on a standard diet (SD, n=7), high-cholesterol diet (HCD, n=7) or high-cholesterol diet with Atorvastatin starting after 50 days (STATIN, n=7). Left carotid artery balloon injury was conducted in all groups after 60 days of diet treatment. Biochemical analysis together with evaluation of blood and tissue markers of vascular injury and inflammation were performed in all groups at the end of experiment. Results HCD compared to SD induced systemic inflammation demonstrated by increased number of circulating monocytes and lymphocytes. HCD compared to SD induced also local inflammation demonstrated by adipocyte hypertrophy and infiltration of T-lymphocytes in abdominal white adipose tissue, activation of hepatic stellate cells with infiltration of T- and B-lymphocytes and macrophages in the liver and increased macrophage content in lung parenchyma. These changes were accompanied by increased Intima/Media thickness, stenosis, matrix deposition and activated T-cell infiltrates in injured but not in uninjured contralateral carotid artery as we previously reported. The treatment with high-dose statin attenuated all aspects of systemic and local inflammation as well as pathological changes in injured carotid artery. Conclusions Diet related mild hypercholesterolemia induce systemic and local inflammation in the liver, lung and adipose tissue that coincide with enhanced inflammation of injured vessel but is without deleterious effect on uninjured vessels. High dose statin attenuated systemic and local inflammation and protected injured vessels. However, finding exact role of reduced systemic and remote inflammation in vascular protection requires further studies.
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Martinez-Sanchez P, Alexandrov AV. Ultrasonography of carotid plaque for the prevention of stroke. Expert Rev Cardiovasc Ther 2013; 11:1425-40. [PMID: 23980574 DOI: 10.1586/14779072.2013.816475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A carotid ultrasonography is a non-invasive technique that provides an accurate and reliable characterization of the broad spectrum of carotid arteriosclerosis, from the intima-media thickness to the atherosclerotic plaque. Carotid ultrasonography has become a useful tool for identifying patients at high risk of stroke and selecting those who can benefit most from revascularization therapies such as carotid endarterectomy and stenting. In addition to the degree of stenosis, plaque echomorphology has emerged in recent years as an important contributory factor to stroke risk. Changes in plaque echogenicity, as measured by the quantitative computer-assisted ultrasonography index, could be a marker of plaque instability as well as an indicator of plaque remodeling, thereby providing the means for monitoring anti-atherosclerosis drugs such as statins.
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Affiliation(s)
- Patricia Martinez-Sanchez
- Department of Neurology and Stroke Center, IdiPAZ Health Research Institute, La Paz University Hospital, Autonomous University of Madrid, Spain
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30
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Alsulaimani S, Gardener H, Elkin MS, Cheung K, Sacco RL, Rundek T. Elevated homocysteine and carotid plaque area and densitometry in the Northern Manhattan Study. Stroke 2013; 44:457-61. [PMID: 23287787 PMCID: PMC3567916 DOI: 10.1161/strokeaha.112.676155] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Studies have linked elevated total homocysteine (tHcy) levels to atherosclerotic carotid plaque development, but data are limited to predominantly white populations. We examined the association between tHcy and carotid plaque burden and morphology in a multiethnic cohort. METHODS In the Northern Manhattan Study, we conducted a cross-sectional analysis among 1327 stroke-free subjects (mean age, 66 ± 9; 41% men; 19% black; 62% Hispanic; 17% white) with serum tHcy and ultrasonographic assessment of plaque morphology measured by gray-scale median (GSM) and total plaque area (TPA). GSM and TPA were examined in 4 categories. High and low GSM categories were considered echodense and echolucent plaque, respectively, and compared with no plaque. Logistic regression models were used to assess the associations of tHcy with GSM and TPA adjusting for demographics, vascular risk factors, renal insufficiency, and B(12) deficiency. RESULTS The mean tHcy was 9.4 ± 4.8 µmol/L (median=8.6). The prevalence of carotid plaque was 57% (52% among Hispanics, 58% black, and 70% white). Among those with plaque, the mean TPA was 20.3 ± 20.6 mm(2) (median=13.6) and mean GSM 90.9 ± 28.5 (median=93.0). The top 2 tHcy quartiles (versus quartile 1) had an elevated risk of having either echolucent plaque (tHcy Q3, odds ratio [OR]=1.8; [95% confidence interval {CI} 1.2-2.8]; tHcy Q4, OR=1.9 [95% CI 1.2-3.1]) or echodense plaque (tHcy Q3, OR=1.7 [95% CI, 1.1-2.7]; tHcy Q4, OR=1.9 [95% CI, 1.2-3.2]). The top 2 tHcy quartiles were also more likely to be in the highest TPA category (tHcy Q3, OR=1.8 [95% CI, 1.1-3.0]; tHcy Q4, OR=2.2 [95% CI, 1.3-3.7]). CONCLUSIONS In this population-based multiethnic cohort, elevated tHcy was independently associated with plaque morphology and increased plaque area, subclinical markers of stroke risk.
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Affiliation(s)
- Sara Alsulaimani
- Department of Neurosurgery, Collage of Medicine, King Saud University, Riyadh, KSA
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL
| | - Hannah Gardener
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Mitchell S.V. Elkin
- Departments of Neurology and Epidemiology, Columbia University, New York, NY
| | - Ken Cheung
- Departments of Neurology and Epidemiology, Columbia University, New York, NY
| | - Ralph L. Sacco
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Tatjana Rundek
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
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Tadros RO, Vouyouka AG, Chung C, Malik RK, Krishnan P, Ellozy SH, Marin ML, Faries PL. The Effect of Statin Use on Embolic Potential During Carotid Angioplasty and Stenting. Ann Vasc Surg 2013; 27:96-103. [DOI: 10.1016/j.avsg.2012.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 06/04/2012] [Accepted: 06/27/2012] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Atorvastatin is one of the most widely prescribed drugs and the most widely prescribed statin in the world. It is therefore important to know the dose-related magnitude of effect of atorvastatin on blood lipids. OBJECTIVES To quantify the dose-related effects of atorvastatin on blood lipids and withdrawals due to adverse effects (WDAE). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 4, 2011, MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), ISI Web of Science (1899 to November 2011) and BIOSIS Previews (1969 to November 2011). No language restrictions were applied. SELECTION CRITERIA Randomised controlled and uncontrolled before-and-after trials evaluating the dose response of different fixed doses of atorvastatin on blood lipids over a duration of 3 to 12 weeks. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. WDAE information was collected from the placebo-controlled trials. MAIN RESULTS Two hundred fifty-four trials evaluated the dose-related efficacy of atorvastatin in 33,505 participants. Log dose-response data revealed linear dose-related effects on blood total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides. Combining all the trials using the generic inverse variance fixed-effect model for doses of 10 to 80 mg/day resulted in decreases of 36% to 53% for LDL-cholesterol. There was no significant dose-related effects of atorvastatin on blood high-density lipoprotein (HDL)-cholesterol. WDAE were not statistically different between atorvastatin and placebo for these short-term trials (risk ratio 0.99; 95% confidence interval 0.68 to 1.45). AUTHORS' CONCLUSIONS Blood total cholesterol, LDL-cholesterol and triglyceride lowering effect of atorvastatin was dependent on dose. Log dose-response data was linear over the commonly prescribed dose range. Manufacturer-recommended atorvastatin doses of 10 to 80 mg/day resulted in 36% to 53% decreases of LDL-cholesterol. The review did not provide a good estimate of the incidence of harms associated with atorvastatin because of the short duration of the trials and the lack of reporting of adverse effects in 37% of the placebo-controlled trials.
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Affiliation(s)
- Stephen P Adams
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver,
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