Impact of chronic kidney disease on carotid plaque vulnerability

Pelisek, Jaroslav; Hahntow, Ines N.; Eckstein, H.‐H.; Ockert, S.; Reeps, Christian; Heider, P.; Luppa, Peter B.; Frank, Helga

doi:10.1016/j.jvs.2011.05.049

Cited by 41 publications

(25 citation statements)

References 38 publications

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“…Although Davaine et al 34 showed that vascular calcification is associated with plaque stability, other studies revealed ambiguous results. 26,33,35 Howard et al 33 did not find any relationships between calcification, intraplaque hemorrhage, or lymphocyte infiltration and stroke occurrence. In accordance with the latter findings, our study confirmed the assumption that increased calcification or higher amounts of inflammatory infiltration were also not associated with a history of neurological symptoms.…”

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confidence: 95%

Carotid Plaque Morphology Is Significantly Associated With Sex, Age, and History of Neurological Symptoms

Wendorff

Pelisek

et al. 2015

Stroke

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T he short-term risk of stroke or death of surgically treated patients having a symptomatic carotid stenosis has been shown to be similar in younger and older patients (<70 years [5.7%] versus ≥70 years [5.9%]).1 In contrast, a meta-analysis of 3 large randomized controlled trials (EVA-3S, SPACE, ICSS) revealed that the risk of stroke or death after carotid artery stenting increases significantly with age (<70 years [5.8%] versus ≥70 years [12.0%]).1 A similar trend (although not significant) has also been found in asymptomatic patients, particularly when sex was taken into account. 2 These observations might be explained by embolism derived from ruptured plaques or sheared-off arterial calcifications caused by guidewire manipulations during carotid artery stenting procedures. 3,4 In addition, multivariable analyses of pooled randomized controlled trial data on symptomatic patients showed that men have had a higher risk of stroke or death when treated with carotid artery stenting compared with carotid endarterectomy (9.0% versus 5.5%, respectively).1 In contrast, no significant differences were found in women. 1 This discrepancy in the available data raises the question of whether age and sex are associated with differences in plaque morphology or plaque composition.The pathophysiological development of an atherosclerotic plaque is a long-lasting and dynamic process. 5 The development of atherosclerosis begins already at an early age. However, the incidence of clinically apparent atherosclerosisrelated cardiovascular events increases only at an advanced age. [6][7][8][9][10] In Germany, the prevalence of extracranial carotid artery stenosis (>50%) is ≈6.9% in patients aged >65 years but increases further with age. 4,11 Among all ischemic stroke events, ≈15% were caused by arterioarterial embolization from extracranial atherosclerotic carotid artery stenosis. 4 InBackground and Purpose-The purpose of this study was to analyze the association between morphological characteristics of human carotid plaques and patient's sex, age, and history of neurological symptoms. Methods-The study included 763 atherosclerotic plaques from patients treated surgically for carotid stenosis between 2004 and 2013. Histological analyses of carotid plaques were performed to assess the type of plaque (American Heart Association classification), the stability of the plaque, the extent of calcification, inflammation, and neovascularization, as well as the deposition of collagen and elastin. According to the scale of outcome measurement, logistic regression, ordinal regression, and multinomial regression analyses were applied. All results were adjusted for common risk factors of atherosclerosis. contrast, in coronary arteries, acute angina underlies the consequences of rupture or erosion of the plaque surface and subsequent luminal thrombus formation. 12,13 It is also known from coronary artery disease that fibrous plaques are mainly associated with stable syndromes, whereas atheromatous plaques are more often related to unstable ...

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confidence: 95%

Carotid Plaque Morphology Is Significantly Associated With Sex, Age, and History of Neurological Symptoms

Wendorff

Pelisek

et al. 2015

Stroke

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“…Furthermore serum matrix metalloproteinases were found raised in cases of moderate to severe renal dysfunction patients and these result in progression of plaque and degradation of overlying fibrous cap. 23 Experimental data support the view that renal dysfunction increases foam cell generation by stimulating macrophage entry into vascular endothelium. 24 Further studies have revealed an accelerated infarct expansion, active inflammation and oxidative stress in patients having ACS with renal dysfunction.…”

Section: Discussionmentioning

confidence: 75%

Renal Dysfunction in Patients With Acute Coronary Syndrome (Acs) at a Tertiary Care Hospital

Ijaz

Saad

et al. 2017

TPMJ

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ABSTRACT… Objectives:To determine the frequency of renal dysfunction in patients with acute coronary syndrome at a tertiary care hospital. Study design: Descriptive Cross-sectional study. Setting: Department of Cardiology, Nishtar Hospital Multan. Duration of study: Six months from November 2016 to May 2017. Subjects and Methods: Consecutive 285 patients who met inclusion criteria of our study were enrolled from department of Cardiology, Nishtar Hospital Multan. History was taken and relevant investigations were done. Computer based formula for MDRD eGFR was used to calculate eGFR in our patients. All these findings were entered in pre-designed, pre -tested study questionnaire. Data was entered and analyzed using computer based software SPSS version 20. All the quantitative variables of the study (such as age, serum creatinine level, GFR value) were calculated for mean and standard deviation. Frequencies and percentages were calculated for categorical variables like gender, residential area, socioeconomic status, level of education, H/O diabetes, H/O hypertension, H/O smoking and family history of IHD etc. Results: We studied 285 patients of acute coronary syndrome admitted in Cardiology department of Nishtar Hospital Multan, 210 (73.7%) were male and 75 (26.3%) female. One hundred eighty (63.2%) were from rural area and 105 (36.8%) were urban. One hundred thirty two (46.3%) were from low income group, 144 (50.5%) from middle income and 9 (3.2%) were from high income group. Two hundred four (71.6%) patients presented with chest pain and 72 (25.3%) presented with chest pain and shortness of breath. One hundred eight (37.9%) were hypertensive, 63 (32.6%) were diabetic, 135 (47.4%) were smokers and family history of IHD was present in 102 (35.8%) of the cases. eGFR was calculated by MDRD eGFR formula. eGFR was less than 30 ml/min/1.73 m 2 in 30 (10.5%) of the cases, 31-60 ml/ min/1.73 m 2 in 66 (23.2%) cases and eGFR was more than 60 ml/min/1.73 m 2 in 189 (66.3%) of the cases. Conclusion: The present study reveals that the substantial proportion of our study patients have underlying renal dysfunction. So eGFR estimation in ACS patients should be given due consideration. This will help in the management of these patients and may improve short and long term disease outcome. Further follow up studies especially in terms of morbidity and mortality in this sub-group of patients are suggested.

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“…CKD patients display advanced carotid atherosclerosis with more frequently unstable or ruptured plaques due to composition changes (less collagen, more calcified) and this explains the 3-fold higher prevalence of remote cerebrovascular events in these patients compared to non-CKD [21]. …”

Section: Ischaemic Strokementioning

confidence: 99%

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update

Bîlha¹,

Burlacu²,

Siriopol³

et al. 2018

Cerebrovasc Dis

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Background: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking. Summary: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population. The use of oral anticoagulation in AF appears safe in non-end stage CKD, but it should be individualized and preferably based on thromboembolic and bleeding stratification algorithms. Non-vitamin K antagonist oral anticoagulants with definite dose adjustment are generally preferred over vitamin K antagonists in mild and moderate CKD and their indications have started being extended to severe CKD and dialysis also. Aspirin, but not clopidogrel, has limited indications for reducing the risk for atherothrombotic events in CKD due to its increased bleeding risk. Carotid endarterectomy has shown promising results for stroke risk reduction in CKD patients with high-grade symptomatic carotid stenosis. The medical treatment of arterial hypertension in CKD often fails to efficiently lower blood pressure values, but recent data regarding the use of interventional procedures such as renal denervation, baroreflex activation therapy or renal artery stenting are encouraging. Key Messages: In the absence of clear guidelines and protocols, primary prevention of stroke in CKD patients remains a subtle art in the hands of the clinicians. Nevertheless, refraining CKD patients from standard therapies often worsens their prognosis.

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Impact of chronic kidney disease on carotid plaque vulnerability

Cited by 41 publications

References 38 publications

Carotid Plaque Morphology Is Significantly Associated With Sex, Age, and History of Neurological Symptoms

Carotid Plaque Morphology Is Significantly Associated With Sex, Age, and History of Neurological Symptoms

Renal Dysfunction in Patients With Acute Coronary Syndrome (Acs) at a Tertiary Care Hospital

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update

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