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Takeshita S, Inoue K, Ogata T, Ishii A, Uesugi N, Hamasaki M, Abe H, Tsugawa J. Impact of distribution of carotid intraplaque neovessels on plaque vulnerability. J Stroke Cerebrovasc Dis 2024; 33:107859. [PMID: 38997050 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND AND PURPOSE Intraplaque neovessels (INVs) are considered important contributors to carotid plaque vulnerability. The purpose of this study was to examine whether differences in INV distribution affect plaque vulnerability. METHODS The study cohort comprised 110 patients with significant stenosis of the carotid artery who had undergone carotid endarterectomy. The distribution of INVs within carotid plaques was assessed by immunohistochemical studies using anti-CD-34 antibody as a marker for endothelial cells. First, we divided the patients into M group and S group depending on the numbers of INVs in middle and shoulder region. Next, we categorized carotid plaques into four categories according to the distributions of INVs: Shoulder, Middle, Mixed, and Scarce. We then compared total area of intraplaque hemorrhage, cholesterol, and calcification, width of thinnest fibrous cap, and number of INVs between the four categories of plaque. RESULTS The area of intraplaque hemorrhage was significantly larger in the M group than in the S group (P = 0.011). Meanwhile, symptomatic carotid stenosis was significantly more frequently associated with the Middle and Mixed than the Shoulder and Scarce categories (P < 0.01). The area of intraplaque hemorrhage was significantly different between the four groups (P = 0.022). Rupture of the fibrous cap was more frequently detected in the Middle and Mixed than the other categories (P = 0.002). CONCLUSIONS INVs in the middle region of carotid plaques are strongly associated with symptomatic carotid stenosis, intraplaque hemorrhage, and rupture of the fibrous cap. Our findings indicate that the distribution of INVs may affect plaque vulnerability.
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Affiliation(s)
- Sho Takeshita
- Department of Neurology, Fukuoka University, Fukuoka, Japan.
| | - Kenichi Inoue
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Toshiyasu Ogata
- Department of Neurology, Fukuoka University, Fukuoka, Japan; Department of Neurology, Japan Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Ayako Ishii
- Department of Neurology, Fukuoka University, Fukuoka, Japan
| | - Noriko Uesugi
- Department of Pathology, Fukuoka University, Fukuoka, Japan
| | | | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
| | - Jun Tsugawa
- Department of Neurology, Fukuoka University, Fukuoka, Japan
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Ma T, Shi X, Yuan C, Yang Y, Guan L, Li Y, Zhang W, Mu Y, Cheng X. Contrast-Enhanced Ultrasound Combined With 2D Strain Imaging and Histopathological Multimodal Assessment of Carotid Plaque Vulnerability. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1595-1601. [PMID: 37088605 DOI: 10.1016/j.ultrasmedbio.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/25/2023] [Accepted: 03/06/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The aim of this study was to explore the value of contrast-enhanced ultrasound (CEUS) combined with 2-D strain imaging in evaluating carotid plaque vulnerability and the correlations among CEUS perfusion parameters, strain parameters and histopathological findings in different plaque segments. METHODS Patients with carotid artery stenosis who underwent carotid endarterectomy (CEA) at the First Affiliated Hospital of Xinjiang Medical University from September 2020 to June 2021 underwent preoperative carotid artery 2-D ultrasonography and CEUS. The plaques were divided into three segments: the proximal end of the shoulder, central cap and distal end of the shoulder. The peak intensity (PI) value and strain rate parameters of the regions of interest were analyzed. Plaques were divided into a stable group (8 cases) and an unstable group (19 cases). The microvascular density (MVD) and vascular endothelial growth factor (VEGF) expression of each patch in the unstable group were analyzed. RESULTS The peak strain during the systolic period in each plaque segment in both groups showed the following pattern: proximal end shoulder > distal end shoulder > top (p < 0.05). The PI value for CEUS is also represented. In the unstable group, the PI values of each segment of the plaque were positively correlated with the MVD, near-center PI value and VEGF average optical density value. The average optical density of each segment was positively correlated with the MVD (p < 0.05). There were positive correlations between the PI values of the proximal and distal shoulder and the strain values (p < 0.05), and the MVD value of each segment, VEGF value and strain value were positively correlated (p < 0.05). CONCLUSION PI and the pathological tissue components represented by CEUS were positively correlated with the mechanical parameters of the plaque along the long axis. There may be overlap between the high shear stress area of the plaque and the neovascular aggregation area, and the combination of the two has certain significance for assessing the vulnerability of the plaque.
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Affiliation(s)
- Ting Ma
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China
| | - Xuan Shi
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China
| | - Chen Yuan
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China
| | - Yuanyuan Yang
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China
| | - Lina Guan
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China; State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yanhong Li
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China
| | - Wei Zhang
- Department of Pathology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yuming Mu
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Key Laboratory of Ultrasound Medicine of Xinjiang, Urumqi, China; State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Xiaojiang Cheng
- Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Metformin: Expanding the Scope of Application-Starting Earlier than Yesterday, Canceling Later. Int J Mol Sci 2022; 23:ijms23042363. [PMID: 35216477 PMCID: PMC8875586 DOI: 10.3390/ijms23042363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/29/2022] [Accepted: 02/18/2022] [Indexed: 12/15/2022] Open
Abstract
Today the area of application of metformin is expanding, and a wealth of data point to its benefits in people without carbohydrate metabolism disorders. Already in the population of people leading an unhealthy lifestyle, before the formation of obesity and prediabetes metformin smooths out the adverse effects of a high-fat diet. Being prescribed at this stage, metformin will probably be able to, if not prevent, then significantly reduce the progression of all subsequent metabolic changes. To a large extent, this review will discuss the proofs of the evidence for this. Another recent important change is a removal of a number of restrictions on its use in patients with heart failure, acute coronary syndrome and chronic kidney disease. We will discuss the reasons for these changes and present a new perspective on the role of increasing lactate in metformin therapy.
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Pigarevsky PV, Vorozhbit RA, Snegova VA, Guseva VA, Maltseva SV, Davydova NG, Yakovleva OG. [The role of neovascularization in the formation of an unstable human atherosclerotic plaque]. Arkh Patol 2021; 83:5-10. [PMID: 34041890 DOI: 10.17116/patol2021830315] [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]
Abstract
MATERIAL AND METHODS The study material was 20 autopsy samples obtained from males aged 65 to 72 years who died from acute atherosclerotic cardiovascular insufficiency. Aortic segments (from the arch, thoracic and abdominal regions), coronary arteries and the arteries of the base of the brain (a. basilaris) were investigated; these totaled 45 tissue segments. Neovessels and cellular responses in the arterial wall were examined by hematoxylin and eosin staining. VEGF was immunohistochemically detected using a highly sensitive two-stage streptavidin-biotin method. RESULTS In unstable atherosclerotic lesions, there were active neovascularization processes in both the fibrous cap and the underlying parts of the adventitia. These changes are usually combined with a pronounced cellular inflammatory response that can contribute to their development. Endothelial growth factor may be one of the causes of neovascularization in unstable atherosclerotic lesions. CONCLUSION A comparative immunomorphological study in the human aorta, coronary arteries, and a. basilaris revealed active neovascularization processes in the cap and the underlying parts of the adventitia in unstable atherosclerotic lesions. The cause of this neovascularization is probably endothelial growth factor and cellular inflammatory responses.
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Affiliation(s)
- P V Pigarevsky
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - R A Vorozhbit
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - V A Snegova
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - V A Guseva
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - S V Maltseva
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - N G Davydova
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - O G Yakovleva
- Institute of Experimental Medicine, St. Petersburg, Russia
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Yuan C, Ni L, Zhang C, Hu X, Wu X. Vascular calcification: New insights into endothelial cells. Microvasc Res 2020; 134:104105. [PMID: 33189731 DOI: 10.1016/j.mvr.2020.104105] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023]
Abstract
Vascular calcification, a common pathological basis of vascular disease, is caused by various diseases and is an independent risk factor for cardiovascular events. Therefore, elucidating the pathogenesis of vascular calcification has significant clinical benefits. It is generally believed that vascular calcification is similar to the processes of bone development and cartilage formation. The transformation of vascular smooth muscle cells into osteoblast- and chondrocyte-like cells is a key event. However, recent studies have found that under certain conditions, endothelial cells participate in vascular calcification via endothelial-mesenchymal transition, cytokine secretion, extracellular vesicle synthesis, angiogenesis regulation and hemodynamics. This review aims to explore the relationship between endothelial cells and vascular calcification and to provide a theoretical basis and new ideas for the active prevention and treatment of vascular calcification in the clinic.
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Affiliation(s)
- Cheng Yuan
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China
| | - Lihua Ni
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China
| | - Changjiang Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China.
| | - Xiaorong Hu
- Department of Cardiology, Zhongnan Hospital, Wuhan University, Wuhan 430071, PR China.
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR China.
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Evdokimenko A, Chechetkin A, Druina L, Tanashyan M. Contrast-enhanced ultrasonography for assessing neovascularization of carotid atherosclerotic plaque. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2019. [DOI: 10.24075/brsmu.2019.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Neovascularization of a carotid atherosclerotic plaque (AP) is associated with an increased risk of stroke. Contrast-enhanced ultrasonography (CEUS) is a widely used method for imaging intraplaque neovascularization in vivo. Unfortunately, there are no standardized guidelines for CEUS interpretation. The aim of this study was to identify the most reliable method for CEUS-based assessment of AP neovascularization. Seventy-eight AP were removed during carotid endarterectomy in 73 patients, of whom 5 had AP on both sides, and examined morphologically. All patients underwent preoperative duplex scanning and CEUS; Sonovue was used as a contrast agent. AP neovascularization was assessed on a 4-grade visual scale and with 3 different quantitative methods using QLAB software. On the visual scale (method 1), poorly (37%) and moderately (51%) vascularized plaques were the most common. Quantitative analysis (data were presented as Me (Q1; Q3)) revealed that the number of blood vessels per 1 cm2 of the plaque (method 2) was 16 (10; 26), the ratio of the total vessel area to the plaque area (method 3) was 6% (3; 9), and AP ROI (method 4) was 2.6 dB (1.8; 4.1). Significant correlations were demonstrated between the results produced by method 2 and method 3 (р < 0.0001), method 3 and method 2 (p = 0.0006), and between pathomorphological findings and the results produced by methods 1–3, especially method 2 (p < 0.004). AP ROI brightness did not correlate with other results. The presence of hyperechoic components (calcifications) in AP dramatically reduced the reliability of US-based intraplaque neovascularization assessment. The most accurate CEUS-based quantitative method for assessing intraplaque neovascularization is estimation of blood vessel number per 1 cm2 of the plaque.
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Affiliation(s)
| | | | - L.D. Druina
- Research Center of Neurology, Moscow, Russia
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