Impact of Plaque Composition on Risk of Coronary Artery Diseases in Patients with Carotid Artery Stenosis

Hamada, Saori; Kashiwazaki, Daina; Yamamoto, Shusuke; Akioka, Naoki; Kuwayama, Naoya; Kuroda, Satoshi

doi:10.1016/j.jstrokecerebrovasdis.2018.08.031

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…While there is, in the general population, a low prevalence of asymptomatic carotid stenosis, with 4.2% of the population with moderate stenosis (>50%) and 1.7% with severe stenosis (>70%) [22]. Because our PAD group had all the different possible stages of the disease, and most studies of both cardiology and vascular surgery had studied critically ill patients, whether severe coronary artery disease or already revascularized lower limb ischemia, we believe this strengthens Hamada et al's hypothesis [5], in which an unstable plaque can induce systemic inflammation and Based on the obtained results, and the few studies that show the prevalence of asymptomatic carotid stenosis (with risk of complication: stenosis > 50%) in patients with PAD, and considering that cardiology has already well established the study of the extension of atherosclerosis to carotid territory in coronary artery disease patients, with a close prevalence rate of asymptomatic carotid stenosis, with stenosis > 50% for CAD, in relation to PAD, our data corroborates the consideration of the extension study for PAD for prophylaxis, once these patients were critically ill with several associated chronic comorbidities, and the PAD alone had a significant effect on the degree of stenosis, accounting for 10.4% dependence on carotid injury.…”

Section: Discussionsupporting

confidence: 76%

“…This study focused on observing the prevalences that are close in the three arterial sectors when we researched their prevalences. At the intersection of these arterial sectors, our findings for the PAD group were 22.1% for prevalence of CAD, even though not statistically significant, the prevalence was similar when comparing PAD x CAD and CAD x carotid stenosis [5,11,[23][24][25]. The group that held patients with Table 4: Linear regression analysis for the effect of independent variables on the degree of obstruction for the total sample (general model) and for patients with PAD (PAD model).…”

Section: Discussionmentioning

confidence: 41%

“…The inflammation of an unstable carotid plaque may be the link between CAD and carotid stenosis, as unstable carotid plaque is closely associated with the occurrence of CAD before or after surgical treatment of atherosclerotic disease. Therefore, an unstable carotid plaque may be the phenotype of the representation of the presence of systemic inflammation and often accompanies the presence of CAD [5].…”

Section: Introductionmentioning

confidence: 99%

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Atherosclerotic Extension of Carotid Arteries: An Insertion in Clinical Practice

Furlanetto

Chagas

Slm

2020

International Journal of Vascular Medicine

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Introduction. Atherosclerotic disease is a diffuse disease that is strongly associated with age, risk factors, and variable progression. The anatomical prevalence of atheromas does not always follow, a sequence by sectors, and in many cases are concomitant. Objectives. This study is aimed at studying atherosclerosis in the arterial territories of the carotid and lower limbs, in order to correlate their extension as a form of primary prevention. Methods. Participating patients with the main risk factors for atherosclerotic disease were composed of two groups: one with chronic peripheral obstructive arterial disease (PAD) and another without PAD. After performing carotid ultrasound Doppler (USD) of all patients, the occasional prevalence of the disease was evaluated. We performed by statistical tests the correlation between the findings in these patients and the risk factors. Obtaining n from 226 patients, in which 116 patients are from the PAD group and 110 patients are from the group without PAD. Results. Our findings add up to 8.8% for lesions over 50% in patients with PAD, with 6.2% over 70% meeting the few published scientific findings. In this study, the correlation was evaluated between carotid stenosis and PAD, in which we observed a positive association. We observed in the studies that the prevalence of moderate and severe carotid stenosis was similar to patients with coronary artery disease (CAD). There are a number of nonclassical risk factors that we do not evaluate, but even studying the traditional ones, we find that they are less than 27% dependent. Conclusion. Therefore, our study proposes an improvement in the clinical approach of patients with PAD for both the carotid and coronary territory, not using only 2 factors traditional risk factors, for the extension study and to consider the PAD that has 10% dependence alone, as effect and projection of the carotid atherosclerotic plaque.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 41%

Section: Introductionmentioning

confidence: 99%

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Atherosclerotic Extension of Carotid Arteries: An Insertion in Clinical Practice

Furlanetto

Chagas

Slm

2020

International Journal of Vascular Medicine

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“…The high rate of cardiovascular events we found can be explained by the extremely high prevalence of risk factors in our cohort and the systemic involvement of atherosclerosis. The presence of severe carotid stenosis has been proposed as a risk factor for the development of stroke, white matter disease [33], coronary artery disease [34], peripheral artery disease and all-cause mortality [35]. Atherosclerosis is a systemic vascular disorder potentially involving multiple vascular territories.…”

Section: Discussionmentioning

confidence: 99%

Elevated circulating metalloproteinase 7 predicts recurrent cardiovascular events in patients with carotid stenosis: a prospective cohort study

Pérez‐Fernández

Irimia

Rodríguez

et al. 2020

BMC Cardiovasc Disord

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Background: Major adverse cardiovascular events are the main cause of morbidity and mortality over the long term in patients undergoing carotid endarterectomy. There are few reports assessing the prognostic value of markers of inflammation in relation to the risk of cardiovascular disease after carotid endarterectomy. Here, we aimed to determine whether matrix metalloproteinases (MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10), tissue inhibitor of MMPs (TIMP-1) and in vivo inflammation studied by 18 F-FDG-PET/CT predict recurrent cardiovascular events in patients with carotid stenosis who underwent endarterectomy. Methods: This prospective cohort study was carried out on 31 consecutive patients with symptomatic (23/31) or asymptomatic (8/31) severe (> 70%) carotid stenosis who were scheduled for carotid endarterectomy between July 2013 and March 2016. In addition, 26 healthy controls were included in the study. Plasma and serum samples were collected 2 days prior to surgery and tested for MMP-1, MMP-2, MMP-7, MMP-9, MMP-10, TIMP-1, high-density lipoprotein, low-density lipoprotein, high-sensitivity C-reactive protein and erythrocyte sedimentation rate. 18 F-FDG-PET/CT focusing on several territories' vascular wall metabolism was performed on 29 of the patients because of no presurgical availability in 2 symptomatic patients. Histological and immunohistochemical studies were performed with antibodies targeting MMP-10, MMP-9, TIMP-1 and CD68. Results: The patients with carotid stenosis had significantly more circulating MMP-1, MMP-7 and MMP-10 than the healthy controls. Intraplaque TIMP-1 was correlated with its plasma level (r = 0.42 P = .02) and with 18 F-FDG uptake (r = 0.38 P = .05). We did not find any correlation between circulating MMPs and in vivo carotid plaque metabolism assessed by 18 F-FDG-PET. After a median follow-up of 1077 days, 4 cerebrovascular, 7 cardiovascular and 11 peripheral vascular events requiring hospitalization were registered. Circulating MMP-7 was capable of predicting events over and above the traditional risk factors (HR = 1.15 P = .006). When the model was associated with the variables of interest, the risk predicted by 18 F-FDG-PET was not significant. Conclusions: Circulating MMP-7 may represent a novel marker for recurrent cardiovascular events in patients with moderate to severe carotid stenosis. MMP-7 may reflect the atherosclerotic burden but not plaque inflammation in this specific vascular territory.

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“…Previous studies have reported that unstable plaques are prone to rupture and cause distal vascular obstruction to cause ischemic stroke. The abundant neovascularization in the plaque is associated with rupture of the plaque[25,26]. Therefore, SMI and CEUS are good tools for dynamic observation of blood flow distribution in the plaque, which can be used to assess the occurrence of ischemic stroke .…”

Section: Discussionmentioning

confidence: 99%

Value of superb micro-vascular imaging in predicting ischemic stroke in patients with carotid atherosclerotic plaques

Yang

Zhou

Feng

et al. 2019

WJCC

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BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke. Contrast-enhanced ultrasound (CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging (SMI) offers the possibility of clinically screening for unstable plaque AIM To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques. METHODS Patients with carotid atherosclerotic plaques (luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication. The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not. Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years. RESULTS In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level ( P = 0.013) and enhancement intensity ( P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity ( r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level II, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and 89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually ( X 2 = 108.931, P = 0.000). CONCLUSION SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.

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Impact of Plaque Composition on Risk of Coronary Artery Diseases in Patients with Carotid Artery Stenosis

Cited by 15 publications

References 17 publications

Atherosclerotic Extension of Carotid Arteries: An Insertion in Clinical Practice

Atherosclerotic Extension of Carotid Arteries: An Insertion in Clinical Practice

Elevated circulating metalloproteinase 7 predicts recurrent cardiovascular events in patients with carotid stenosis: a prospective cohort study

Value of superb micro-vascular imaging in predicting ischemic stroke in patients with carotid atherosclerotic plaques

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