Assessment of carotid plaque morphology in symptomatic carotid artery disease on ultrasound for predicting the increased ischaemic stroke risk – A systematic review

Background and Purpose: The red blood cell fatty acid composition objectively reflects the long-term dietary intake of several fatty acids. In patients undergoing carotid endarterectomy, we explored whether red blood cell status of selected fatty acids related to symptomatic carotid artery disease. Methods: We included patients with symptomatic (n=22) and asymptomatic (n=23) carotid artery disease. We determined all-C18:1 trans, linoleic acid (LA, C18:2n6), alpha-linolenic acid (C18:3n3), and the omega-3 index (sum of eicosapentaenoic [C20:5n3] and docosahexaenoic [C22:6n3] acids) in both red blood cells and carotid plaque phospholipids by gas-chromatography. Results: In a multivariate logistic regression analysis, we only observed a significant association for LA, whose red blood cell status was inversely related to symptomatic carotid artery disease (odds ratio, 0.116 [95% CI, 0.022–0.607], P =0.011, for each 1-SD increase). A similar result was observed for LA in carotid plaque phospholipids. Conclusions: Cell membrane enrichment in LA, which reflects its intake, was inversely related to symptomatic carotid disease. This increases evidence supporting a favorable role of dietary LA in vascular health.

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Activated monocytes capture platelets for heterotypic association in patients with severe carotid artery stenosis

Thrombosis and Haemostasis ◽

10.1160/th09-09-0620 ◽

2010 ◽

Vol 103 (06) ◽

pp. 1193-1202 ◽

Cited By ~ 24

Author(s):

Carsten Schriek ◽

Hugo Van Aken ◽

Dirk Droste ◽

E. Bernd Ringelstein ◽

Kerstin Jurk ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Surface Expression ◽

Plaque Morphology ◽

Monocyte Activation ◽

Close Link ◽

Symptomatic Carotid ◽

Asymptomatic Patients ◽

Artery Disease ◽

Activated Monocytes

SummaryInflammation and thrombosis, two processes influencing each other, are involved in the pathogenesis of cerebrovascular disease. We showed that in patients with acute ischaemic stroke circulating platelets are activated and exhausted. To identify whether activated haemostasis might be cause or effect, we investigated the role of leukocyte and platelet activation in patients with severe asymptomatic and symptomatic carotid artery disease. Flow cytometry analysis demonstrated that monocytes from symptomatic (acute stroke aetiology) and asymptomatic patients were highly activated, shown by significantly enhanced presentation of inflammatory markers CD11b and thrombospondin-1 (TSP-1) on the surface. Both correlated positively with monocyte-platelet association rate. However, increased monocyte activation and elevated levels of monocyte-platelet associates in asymptomatic patients were restricted to patients with echo-lucent plaques, providing a close link between monocyte activation and plaque morphology. Circulating single as well as monocyte-bound platelets from symptomatic patients showed significantly enhanced surface expression of P-selectin and TSP-1, whereas platelets from asymptomatic patients were not significantly activated. These results indicate that monocytes activated by inflammation rather than platelets might be the candidates to initiate platelet-monocyte rosetting during the pathogenesis of atherothrombotic cerebral ischaemia and that haemostasis might be activated secondarily by the first occurring inflammation.

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Utility of high resolution MR imaging to assess carotid plaque morphology: A comparison of acute symptomatic, recently symptomatic and asymptomatic patients with carotid artery disease

Atherosclerosis ◽

10.1016/j.atherosclerosis.2009.05.002 ◽

2009 ◽

Vol 207 (2) ◽

pp. 434-439 ◽

Cited By ~ 60

Author(s):

Umar Sadat ◽

Ruwan A. Weerakkody ◽

David J. Bowden ◽

Victoria E. Young ◽

Martin J. Graves ◽

...

Keyword(s):

High Resolution ◽

Carotid Artery ◽

Mr Imaging ◽

Carotid Plaque ◽

Carotid Artery Disease ◽

Plaque Morphology ◽

Asymptomatic Patients ◽

Artery Disease

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Evaluation of haemodynamic impairment and collateral flow in symptomatic carotid artery disease using arterial spin labelling MRI

Aktuelle Neurologie ◽

10.1055/s-2005-919686 ◽

2005 ◽

Vol 32 (S 4) ◽

Author(s):

R Kern ◽

M Günther ◽

F Sallustio ◽

K Szabo ◽

M Griebe ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Arterial Spin Labelling ◽

Collateral Flow ◽

Symptomatic Carotid ◽

Artery Disease ◽

Spin Labelling

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Statins in adult patients with carotid artery disease: A protocol for a systematic review and network meta-analysis

General Medicine Open ◽

10.15761/gmo.1000152 ◽

2018 ◽

Vol 2 (6) ◽

Author(s):

Leonardo R ◽

Elmiro SR ◽

Angelica LDD ◽

Nilson PS ◽

João Lucas OC ◽

...

Keyword(s):

Systematic Review ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Meta Analysis ◽

Adult Patients ◽

Artery Disease

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Contrast Enhanced Ultrasound: Visualization of Far Field and Classification of Plaque in the Extracranial Carotid Arteries

Journal for Vascular Ultrasound ◽

10.1177/1544316718783739 ◽

2018 ◽

Vol 42 (3) ◽

pp. 109-115 ◽

Cited By ~ 1

Author(s):

Paige L. Rowland ◽

Michelle Colpitts ◽

Angela Malone ◽

Munis Raza ◽

Lenora L. Eberhart ◽

...

Keyword(s):

Image Quality ◽

Carotid Artery ◽

Carotid Arteries ◽

Carotid Artery Disease ◽

Plaque Morphology ◽

Far Field ◽

Contrast Enhanced Ultrasound ◽

Contrast Imaging ◽

Contrast Enhanced ◽

Artery Disease

Ultrasound stratification for the degree of carotid artery disease based solely on lumen reduction has poorly predicted patient outcomes. This pilot study focused on patients with moderate carotid artery stenosis. Our purpose was to use contrast imaging with ultrasound to improve carotid field. A total of 10 patients diagnosed with moderate carotid artery stenosis were rescanned with an administration of a contrast imaging agent. Two-dimensional (2D) imaging, color, and Doppler were utilized to scan the patients. The 20 carotid arteries were blindly read by 2 experienced physicians. Visualization of far field, quality of Doppler envelope, plaque morphology, and overall image quality were semi-quantifiably assessed. With the use of a contrast imaging agent, there was a reduction in interphysician interpretation variability. The Kappa coefficient yielded an increase in agreement for postcontrast imaging in the majority of variables. The Doppler envelope showed improvement from precontrast (0.06) to postcontrast (0.63). The visualization of the far fields demonstrated a significant increase in agreement (0.77, 0.71, and 0.67) postcontrast. Plaque morphology demonstrated enhancement in characterization with contrast (–0.09 to 0.66). In this study, contrast-enhanced ultrasound (CEUS) was found to increase overall image quality. Improved interpretation can enhance risk stratification and with further exploration could be used to guide treatment plans for patients with asymptomatic moderate carotid artery disease.

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Concomitant Surgical Treatment of Symptomatic Carotid Artery Disease With a Coexisting Shamblin I Carotid Body Tumor

Vascular and Endovascular Surgery ◽

10.1177/1538574416689430 ◽

2017 ◽

Vol 51 (2) ◽

pp. 103-107 ◽

Cited By ~ 2

Author(s):

Carlos A. Hinojosa ◽

Javier E. Anaya-Ayala ◽

Hugo Laparra-Escareno ◽

Adriana Torres-Machorro ◽

Rene Lizola ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Body ◽

Carotid Artery Disease ◽

Duplex Ultrasound ◽

Neurological Deficits ◽

Symptomatic Carotid ◽

Carotid Body Tumors ◽

Carotid Artery Endarterectomy ◽

Artery Disease ◽

Dissection Technique

Symptomatic carotid artery atherosclerotic disease is an indication for carotid artery endarterectomy. The coexistence of carotid body tumors (CBTs) with symptomatic carotid disease is rarely encountered and adds significant challenges to vascular surgeons, with a reported overall mortality for patients who undergo endarterectomy and tumor excision of 8.8%, as opposed to the 2% for those who had CBT excision only. We describe the case of a 79-year-old female who experienced an acute cerebrovascular accident in the left hemisphere; duplex ultrasound revealed high-grade carotid stenosis in the left side and the presence of a Shamblin I CBT. The risks and benefits of the planned operation were reviewed, and the decision was made to proceed with early carotid endarterectomy and concomitant surgical resection of the tumor using the retrocarotid dissection technique. The patient recovered well, and at 11 months from the combined procedure, her neurological deficits improved significantly.

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