Intravascular Frequency-Domain Optical Coherence Tomography Assessment of Carotid Artery Disease in Symptomatic and Asymptomatic Patients

Purpose To assess whether an asymmetry exists in the prevalence of carotid artery intraplaque hemorrhage (IPH) between right- and left-sided arteries. Materials and methods The records of all patients with atherosclerotic carotid artery disease that underwent neck magnetic resonance angiography imaging with high-resolution plaque sequences between 2017 and 2020 at our institution were retrospectively reviewed. The prevalence of stenosis and IPH was determined for all patients and compared between the left and right carotid arteries of those with unilateral anterior circulation ischemic strokes. Multiple regression analysis was performed to determine potential independent associations of IPH laterality with ischemic strokes. Results A total of 368 patients were included overall and 241 were male (65.4%). There were a total of 125 asymptomatic patients and 211 patients with unilateral anterior circulation ischemic strokes. Of patients with ischemic strokes, 55.5% had left-sided strokes compared with 44.5% who had right-sided strokes ( p = 0.03). Patients with left-sided strokes had a higher prevalence of ipsilateral IPH than those with right-sided strokes (64.1% versus 36.2%, p < 0.0001), despite similar degrees of stenosis. Both age (odds ratio (OR): 1.0; 95% confidence interval (CI): 1.0–1.1; p = 0.007) and the presence of left-sided IPH (OR: 3.2; 95% CI: 1.5–6.8; p = 0.003) were independently associated with unilateral ischemic strokes. Conclusions Left-sided plaques more frequently have IPH and may be more likely to result in ipsilateral ischemic strokes compared with right-sided plaques. The underlying mechanism of asymmetric distribution of IPH between right and left carotids remains unclear.

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Coronary Artery Disease and Carotid Artery Disease Progress Despite Normal Lipid Levels by Standard Statin Therapy in Asymptomatic Patients without Known Coronary Artery Disease: Implications for Statin Therapy

Enliven Clinical Cardiology and Research ◽

10.18650/2375-7310.12003 ◽

2014 ◽

Vol 01 (02) ◽

Author(s):

Iwasaki Kohichiro ◽

Matsumoto Takeshi

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Statin Therapy ◽

Carotid Artery Disease ◽

Lipid Levels ◽

Disease Progress ◽

Asymptomatic Patients ◽

Artery Disease

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SHA 20. Carotid artery disease in asymptomatic patients. What to do?

Journal of the Saudi Heart Association ◽

10.1016/j.jsha.2010.02.293 ◽

2010 ◽

Vol 22 (2) ◽

pp. 90

Author(s):

Mohamed Abd Alwahab

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Asymptomatic Patients ◽

Artery Disease

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C-reactive Protein is Elevated in Symptomatic Compared with Asymptomatic Patients with Carotid Artery Disease

European Journal of Vascular and Endovascular Surgery ◽

10.1053/ejvs.2002.1632 ◽

2002 ◽

Vol 23 (6) ◽

pp. 505-509 ◽

Cited By ~ 16

Author(s):

K. Rerkasem ◽

C.P. Shearman ◽

J.A. Williams ◽

G.E. Morris ◽

M.J. Phillips ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

C Reactive Protein ◽

Reactive Protein ◽

Asymptomatic Patients ◽

Artery Disease

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Selection of Treatment for Patients with Carotid Artery Disease: Medication, Carotid Endarterectomy, or Carotid Artery Stenting

Vascular ◽

10.1258/rsmvasc.13.2.92 ◽

2005 ◽

Vol 13 (2) ◽

pp. 92-97 ◽

Cited By ~ 3

Author(s):

Marc Bosiers ◽

Patrick Peeters ◽

Koen Deloose ◽

Jürgen Verbist ◽

L. Richard Sprouse

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Medical Therapy ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Limiting Factors ◽

Treatment Modalities ◽

Asymptomatic Patients ◽

Artery Disease ◽

Selection Of

Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case. This algorithm was then employed to determine therapy in 308 consecutive patients presenting to a single institution during one calendar year. Ninety-five (30.8%) patients presented with an asymptomatic carotid stenosis of more than 80% and 213 (69.2%) with a symptomatic stenosis of more than 50%. According to our algorithm, 59 (62.1%) of the 95 asymptomatic patients received CAS, 20 (21.1%) received CEA, and 16 (16.8%) received medical therapy. All symptomatic patients underwent intervention; 153 (71.8%) were treated with CAS and 60 (28.2%) with CEA. Combined 30-day stroke and death rates after CAS were 1.7% in asymptomatic patients and 2.6% in symptomatic patients. After CEA, these rates were 0% and 3.3%, respectively. Careful selection of treatment modality according to predetermined criteria can result in improved outcomes.

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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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Frequency-domain optical coherence tomography plaque morphology in stable coronary artery disease

Coronary Artery Disease ◽

10.1097/mca.0000000000000522 ◽

2017 ◽

Vol 28 (6) ◽

pp. 472-477 ◽

Cited By ~ 2

Author(s):

Luca Mariani ◽

Francesco Burzotta ◽

Cristina Aurigemma ◽

Andrea Romano ◽

Giampaolo Niccoli ◽

...

Keyword(s):

Coronary Artery Disease ◽

Optical Coherence Tomography ◽

Coronary Artery ◽

Frequency Domain ◽

Stable Coronary Artery Disease ◽

Plaque Morphology ◽

Optical Coherence ◽

Artery Disease

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Incomplete circle of Willis and cerebrovascular reactivity in asymptomatic patients before and after carotid endarterectomy

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh200203068m ◽

2020 ◽

pp. 68-68

Author(s):

Vladimir Manojlovic ◽

Djordje Milosevic ◽

Nebojsa Budakov ◽

Dragan Nikolic

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Disease ◽

Circle Of Willis ◽

Cerebrovascular Reactivity ◽

Collateral Flow ◽

Apnea Test ◽

Asymptomatic Patients ◽

Before And After ◽

Artery Disease

Introduction/Objective. Circle of Willis (CoW) provides the most significant collateral flow in the presence of significant stenosis or occlusion of internal carotid artery. In terms of collateral flow ?incomplete? type and ?complete? type of CoW can be recognized. Patients with carotid artery disease with incomplete CoW have lower cerebrovascular reactivity and higher risk for stroke. Cerebrovascular reactivity refers to the residual capacity of dilatation of cerebral blood vessels in the condition of insufficient blood flow. In this study we analyzed changes in cerebrovascular reactivity after carotid endarterectomy in asymptomatic patients with respect to complete and incomplete CoW morphology. Methods. In this study in 97 patients with asymptomatic carotid artery disease we measured cerebrovascular reactivity before and after carotid endarterectomy by using method of ?apnea test? and ? Breath Hold Index? (BHI). Patients were divided into two following groups: patients with ?complete? CoW and ?incomplete? CoW based on non-contrast magnetic resonance angio performed previously to the operation. Descriptive statistics, univariate analysis, and ANOVA for comparison of BHI values between groups were used. Results. Results showed significant increase in cerebrovascular reactivity at the side of stenosis in both groups of patients with complete CoW (BHI value increased from 0,897 to 1.090; F(1.65) = 30.788, p < 0.0005, parc. ?2 = 0.321) and incomplete CoW (BHI value increased from 0.690 to 1.010; F ( 1.27 ) = 62.318 , p < 0.0005, parc. ?2 = 0.698) and the more significant increase in the group of incomplete CoW compared to the group with complete CoW (F (1.92 ) = 4.557 , p =0.035 , parc. ?2 =0.047) Conclusion. In most asymptomatic patients, cerebrovascular reactivity restores to normal following carotid endarterectomy. Parameters of cerebrovascular reactivity are lower in patients with incomplete CoW and the increase after carotid endarterectomy is more significant in such patients.

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