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Hu X, Hu Y, Sun X, Li Y, Zhu Y. Effect of aspirin in patients with established asymptomatic carotid atherosclerosis: A systematic review and meta-analysis. Front Pharmacol 2022; 13:1041400. [PMID: 36569309 PMCID: PMC9768439 DOI: 10.3389/fphar.2022.1041400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Aspirin is widely used as an antiplatelet agent for secondary prevention in patients with atherosclerotic cardiovascular disease. However, it remains unclear whether aspirin can prevent the progression of carotid atherosclerosis or reduce vascular events and all-cause death. Methods: We performed a meta-analysis of the effect of aspirin in asymptomatic carotid atherosclerotic patients. Electronic databases including Pubmed, EMBase, ISI Web, Medline, Cochrane, and clinicaltrial.gov were searched for relevant randomized controlled trials. A total of five studies (841 individuals, 2,145 person-years) were included in this study. Two reviewers independently performed the study assessment and data extraction. Forest plots were used to assess the efficacy of aspirin. Egger's test was used to evaluate publication bias. Results: Aspirin did not alleviate the progression of carotid intima-media thickness (cIMT) compared with control patients (WMD: -0.05 mm, 95% confidence interval 95%CI: -0.12, 0.03). In subset analysis, aspirin was only associated with regression of cIMT when compared with the empty/placebo group (WMD: -0.10 mm, 95%CI: -0.18, -0.02). In type 2 diabetes mellitus, there were no statistical significance between groups (WMD: 0.10 mm, 95%CI: -0.31, 0.50). For the main vascular events and all-cause death, there were no differences between the aspirin group (RR: 0.73, 95%CI: 0.41, 1.31) and the control group (RR: 0.88, 95%CI: 0.41, 1.90). For outcome events, similar results were observed when patients were classified by different cIMT value (p > 0.05). The risk of gastrointestinal bleeding was similar between participants receiving and not receiving aspirin therapy (RR: 1.04, 95%CI: 0.07, 16.46). Conclusion: In patients with asymptomatic carotid atherosclerosis, low-dose aspirin may slightly alleviate the progression of cIMT, but does not reduce vascular events and all-cause death. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier PROSPERO.
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Affiliation(s)
- Xianjin Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Hu
- Department of Traditional Chinese Medicine, Xiang He Community Healthcare Center, Chengdu, Sichuan, China
| | - Xiankun Sun
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Li
- Department of Cardiology, West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Ye Zhu,
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Fresilli D, Di Leo N, Martinelli O, Di Marzo L, Pacini P, Dolcetti V, Del Gaudio G, Canni F, Ricci LI, De Vito C, Caiazzo C, Carletti R, Di Gioia C, Carbone I, Feinstein SB, Catalano C, Cantisani V. 3D-Arterial analysis software and CEUS in the assessment of severity and vulnerability of carotid atherosclerotic plaque: a comparison with CTA and histopathology. Radiol Med 2022; 127:1254-1269. [PMID: 36114929 PMCID: PMC9587943 DOI: 10.1007/s11547-022-01551-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
Purpose Our purpose is to assess Multiparametric Ultrasound (MPUS) efficacy for evaluation of carotid plaque vulnerability and carotid stenosis degree in comparison with Computed Tomography angiography (CTA) and histology. Material and methods 3D-Arterial Analysis is a 3D ultrasound software that automatically provides the degree of carotid stenosis and a colorimetric map of carotid plaque vulnerability. We enrolled 106 patients who were candidates for carotid endarterectomy. Prior to undergoing surgery, all carotid artery plaques were evaluated with Color-Doppler-US (CDUS), Contrast-Enhanced Ultrasound (CEUS), and 3D Arterial analysis (3DAA) US along with Computerized Tomographic Angiography (CTA) to assess the carotid artery stenosis degree. Post-surgery, the carotid specimens were fixed with 10% neutral buffered formalin solution, embedded in paraffin and used for light microscopic examination to assess plaque vulnerability morphological features.
Results The results of the CTA examinations revealed 91 patients with severe carotid stenoses with a resultant diagnostic accuracy of 82.3% for CDUS, 94.5% for CEUS, 98.4% for 3DAA, respectively. The histopathological examination showed 71 vulnerable plaques with diagnostic accuracy values of 85.8% for CDUS, 93.4% for CEUS, 90.3% for 3DAA, 92% for CTA, respectively.
Conclusions The combination of CEUS and 3D Arterial Analysis may provide a powerful new clinical tool to identify and stratify “at-risk” patients with atherosclerotic carotid artery disease, identifying vulnerable plaques. These applications may also help in the postoperative assessment of treatment options to manage cardiovascular risks.
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Affiliation(s)
- Daniele Fresilli
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Nicola Di Leo
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Ombretta Martinelli
- Department of Surgery "Paride Stefanini'', Vascular and Endovascular Surgery Division, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Luca Di Marzo
- Department of Surgery "Paride Stefanini'', Vascular and Endovascular Surgery Division, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Vincenzo Dolcetti
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabrizio Canni
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Ludovica Isabella Ricci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Corrado Caiazzo
- Breast Service, Local Health Agency of Naples ASL NA1, Naples, Italy
| | - Raffaella Carletti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Cira Di Gioia
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Diagnostic Imaging Unit, ICOT Hospital, Sapienza University of Rome, Via Franco Faggiana1668, 04100, Latina, Italy
| | - Steven B Feinstein
- Department of Internal Medicine, Section of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Carlo Catalano
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Vito Cantisani
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Wang S, Chen Y, Wang R, Ma B, Wang Z, Tang G, Wang S, He Y, Qu L. Effectiveness of red yeast rice on carotid atherosclerosis: A systematic review and meta-analysis. Front Pharmacol 2022; 13:937809. [PMID: 36120360 PMCID: PMC9478999 DOI: 10.3389/fphar.2022.937809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
While several studies have demonstrated the preventive and therapeutic effects of red yeast rice (RYR), a traditional Chinese medicine, on carotid atherosclerosis through the reduction of low-density lipoprotein cholesterol (LDL-C) level and other risk factors, the evidence remains inconsistent. This study aimed to further evaluate the effects of RYR in carotid atherosclerosis. Several databases were searched for original trials of RYR for the treatment of carotid atherosclerosis that reported plaque indicators. Carotid plaque area (AREA), carotid plaque score (SCORE), and intima-media thickness (IMT) were set as the primary outcomes, while lipid profile and safety indicators were set as the secondary outcomes. Meta-analyses were performed on the randomized controlled trials (RCTs) using Comprehensive Meta-analysis software. Heterogeneity was evaluated using the I2 index and Q statistic. Subgroup, sensitivity, and dose-effect analyses were conducted. Twenty RCTs with 2217 patients were included. Compared to the control group, AREA (SMD = −0.855, 95%CI: −1.259 to −0.451, p < 0.001), IMT (SMD = −0.588, 95%CI: −0.792 to −0.384, p < 0.001), SCORE (SMD = −0.708, 95%CI: −1.135 to −0.282, p = 0.001), LDL-C (SMD = −0.938, 95%CI: −1.375 to −0.502, p < 0.001), triglyceride (SMD = −0.766, 95%CI: −0.980 to −0.551, p < 0.001), and total cholesterol (SMD = −0.858, 95%CI: −1.254 to −0.462, p < 0.001) were significantly decreased and HDL-C (SMD = 0.389, 95%CI: 0.044–0.733, p = 0.027) was significantly increased following RYR therapy. The indicators for safety were not significant and did not differ between the two groups (p > 0.050). Heterogeneities mainly existed for the treatment time or control group setting. Most results showed no changes in the sensitivity analysis. Dose-effect relationships were observed for all indicators except for TC and HDL-C. We concluded that RYR therapy showed considerable efficacy and an acceptable safety profile for the treatment of carotid atherosclerosis in the Chinese population.
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Affiliation(s)
- Shuai Wang
- Department of Psychology, Chengdu Medical College, Chengdu, China
- *Correspondence: Shuai Wang, ; Liping Qu,
| | - Yue Chen
- National Engineering and Research Center for Natural Medicines, Department of Medicine, Chengdu, China
| | - Rui Wang
- Department of Neurology, Xinxiang First People’s Hospital, Affiliated People’s Hospital of Xinxiang Medical University, Xinxiang, China
| | - Bailing Ma
- National Engineering and Research Center for Natural Medicines, Department of Medicine, Chengdu, China
| | - Zhenzhen Wang
- National Engineering and Research Center for Natural Medicines, Department of Medicine, Chengdu, China
| | - Guanguang Tang
- National Engineering and Research Center for Natural Medicines, Department of Medicine, Chengdu, China
| | - Siyu Wang
- Department of Psychology, Chengdu Medical College, Chengdu, China
| | - Yi He
- National Engineering and Research Center for Natural Medicines, Department of Medicine, Chengdu, China
| | - Liping Qu
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Shuai Wang, ; Liping Qu,
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Školoudík D, Kešnerová P, Hrbáč T, Netuka D, Vomáčka J, Langová K, Herzig R, Belšan T. Risk factors for carotid plaque progression after optimising the risk factor treatment: substudy results of the Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the carotid Bifurcation Plaque Study (ANTIQUE). Stroke Vasc Neurol 2022; 7:132-139. [PMID: 34853082 PMCID: PMC9067273 DOI: 10.1136/svn-2021-001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Carotid plaque progression contributes to increasing stroke risk. The study aims to identify factors influencing carotid plaque thickness progression after changing the preventive treatment to the 'treating arteries instead of risk factors' strategy, that is, change in treatment depending on the progression of atherosclerosis. METHODS The study participants who completed sonographic controls over the course of 3 years were enrolled to the analysis. Duplex sonography of cervical arteries was performed in 6-month intervals with measurement of carotid plaque thickness. Plaque thickness measurement error (σ) was set as 3 SD. Only evidently stable and progressive plaques (defined as plaque thickness difference between initial and final measurements of ˂σ and >2σ, respectively) were included to analysis. Univariate and multivariate logistic regression analysis was performed to identify factors influencing plaque progression. RESULTS A total of 1391 patients (466 males, age 67.2±9.2 years) were enrolled in the study. Progressive plaque in at least one carotid artery was detected in 255 (18.3%) patients. Older age, male sex, greater plaque thickness, coronary heart disease, vascular surgery/stenting history and smoking were more frequently present in patients with progressive plaque (p˂0.05 in all cases). Multivariate logistic regression analysis identified only the plaque thickness (OR 1.850 for left side, 95% CI 1.398 to 2.449; and OR 1.376 for right side, 95% CI 1.070 to 1.770) as an independent factor influencing plaque progression. CONCLUSION Carotid plaque thickness corresponding to stenosis severity is the only independent risk factor for plaque thickness progression after optimising the prevention treatment. TRIAL REGISTRATION NUMBER NCT02360137.
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Affiliation(s)
- David Školoudík
- Center for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Petra Kešnerová
- Department of Neurology, Second Faculty of Medicine, Charles University, Praha, Czech Republic
- Department of Neurology, Motol University Hospital, Praha, Czech Republic
| | - Tomáš Hrbáč
- Department of Neurosurgery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Military University Hospital Prague, Praha, Czech Republic
| | - Jaroslav Vomáčka
- Department of Radiological Assistance, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
- Deaprtment of Radiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Kateřina Langová
- Department of Biophysics, Faculty of Medicine, Palacký University Olomouc, Olomouc, Czech Republic
| | - Roman Herzig
- Department of Neurology, University Hospital Hradec Králové, Hradec Kralove, Czech Republic
- Department of Neurology, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Tomáš Belšan
- Department of Radiology, Military University Hospital Prague, Praha, Czech Republic
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Migdalski A, Jawien A. New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1207. [PMID: 34430648 PMCID: PMC8350668 DOI: 10.21037/atm-20-7197] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
Indications for intervention in hemodynamically relevant carotid artery stenosis (carotid endarterectomy or stenting) are primarily based on a degree of stenosis and symptomatology. To date the plaque vulnerability is rarely taken into account in clinical decision making although development of molecular imaging allows a better understanding of plaque biology and provides new techniques detecting potentially vulnerable plaque at risk. A significant number of reports describing the mechanisms of unstable plaque formation suggest that it is a multifactorial process. Inflammation, lipid accumulation, apoptosis, proteolysis, the thrombotic process and angiogenesis are among the main factors of carotid plaque destabilization. Although inflammation is a key process in development of plaque vulnerability, the hemostasis and neoangiogenesis should be regarded as equally important. Only a small group of asymptomatic patients may benefit from the invasive treatment and it remains a challenge to determine whether initially asymptomatic carotid plaque become unstable or vulnerable. Currently, the main task of research on atherosclerotic lesion imaging is focused on functional state of the plaque. The presence of one or more features such as stenosis progression, large plaque area, large juxta-luminal black area, plaque echolucency, intra-plaque hemorrhage, impaired cerebral vascular reserve and spontaneous embolization may indicate patients at higher risk for stroke suitable for revascularization. Treatment of carotid stenosis as one of the manifestations of generalized atherosclerosis requires a broad approach. Nowadays pharmacological treatment options for the atherosclerotic process are largely aimed at stimulating the plaque stabilization, but in symptomatic patients and selected asymptomatic patients, carotid plaque should be removed as a potential source of embolism.
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Affiliation(s)
- Arkadiusz Migdalski
- Department of Vascular Surgery and Angiology, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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Paraskevas KI. Carotid artery stenosis and stroke: controversies in prevention and treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1200. [PMID: 34430641 PMCID: PMC8350638 DOI: 10.21037/atm-21-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
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Reiff T, Ringleb PA. [Asymptomatic carotid artery stenosis - treatment recommendations]. Dtsch Med Wochenschr 2021; 146:793-800. [PMID: 34130321 DOI: 10.1055/a-1221-7065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
For the asymptomatic carotid stenosis, defined as an atherosclerotic carotid stenosis without neurological symptoms for more than 6 months, there are in contrast to a symptomatic carotid stenosis still no reliable treatment recommendations. Possible therapy recommendations based on current data are presented below.
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