Modulation of carotid strain by statin therapy in atherosclerosis                     patients

Abstract. Background: The beneficial effect of statin therapy on the progress of atherosclerotic disease has been demonstrated by numerous studies. Vascular strain imaging is an arising method to evaluate arterial stiffness. Our study examined whether an influence of statin therapy on the vessel wall could be detected by vascular strain imaging. Patients and methods: 88 patients with recently detected atherosclerosis underwent an angiological examination including ankle-brachial index (ABI), pulse wave index (PWI), central puls ewave velocity and duplex ultrasound. Captures for vascular strain analysis were taken in B-mode during ultrasound examination of the common carotid artery and evaluated using a workstation equipped with a speckle tracking based software. A statin therapy was recommended and after six months a follow-up examination took place. Meanwhile, the non-adherence of a group of patients (N = 18) lead to a possibility to observe statin effects on the vascular strain. Results: In the statin non-adherent group the ABI decreased significantly to a still non-pathological level (1.2 ± 0.2 vs. 1.0 ± 0.2; p = 0.016) whereas it stagnated in the adherent group (1.0 ± 0.2 vs. 1.0 ± 0.2; p = 0.383). The PWI did not differ in the non-adherent group (180.5 ± 71.9 vs. 164.4 ± 75.8; p = 0.436) but under statin therapy it decreased significantly (261.8 ± 238.6 vs. 196.4 ± 137.4; p = 0.016). In comparison to the adherent group (4.2 ± 2.0 vs. 4.0 ± 1.8; p = 0.548) under statin therapy the radial strain decreased significantly in the non-adherent group (4.7 ± 2.0 vs. 3.3 ± 1.1; p = 0.014). Conclusions: Our findings reveal a beneficial influence of statin therapy on the arterial wall detected by vascular strain analysis.

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Duplex Ultrasound—Guided Femoropopliteal Angioplasty: Initial and 12-Month Results from a Case Controlled Study

Journal of Endovascular Therapy ◽

10.1177/152660280200900622 ◽

2002 ◽

Vol 9 (6) ◽

pp. 873-881 ◽

Cited By ~ 4

Author(s):

Ramazanali Ahmadi ◽

Ara Ugurluoglu ◽

Martin Schillinger ◽

Reinhold Katzenschlager ◽

Schila Sabeti ◽

...

Keyword(s):

High Risk ◽

Ankle Brachial Index ◽

Duplex Ultrasound ◽

Duplex Sonography ◽

Controlled Study ◽

Technical Success ◽

Ultrasound Guided ◽

Procedural Complications ◽

Feasible Alternative

Purpose: To evaluate initial technical success, procedural complications, and 12-month patency of duplex-guided angioplasty compared to conventional fluoroscopically-guided procedures. Methods: One hundred four patients (65 men; mean age 69 years) who underwent duplex-guided femoropopliteal angioplasty were compared to 104 patients undergoing fluoroscopically-guide procedures who were matched for age, sex, baseline ankle-brachial index (ABI), and length and grade of lesion. Patients were followed for 12 months, and restenosis was assessed by ABI and duplex sonography. Results: Technical success was achieved in 88 (84.6%) patients from the duplex-guided group and in 102 (98.1%) control patients (p=0.001). Periprocedural complications occurred in 12.5% (n=13) and 18.3% (n=19), respectively (p=0.4). Contrast-induced transient renal impairment was observed in 7 (6.7%) patients in the fluoroscopic group. One hundred (96.1%) patients in the duplex and 102 (98.1%) patients in the fluoroscopic group completed the 12-month follow-up. Restenosis was found in 35 (39.8%) patients of the duplex group and in 38 (37.2%) patients of the fluoroscopic group (p=0.8). Conclusions: Technical success of duplex-guided procedures was significantly lower compared to fluoroscopic angioplasty; complications and 12-month patency were similar with both techniques. Duplex-guided angioplasty may be a feasible alternative, particularly for patients at high risk for contrast-induced complications.

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Combination of Rotational Atherothrombectomy and Paclitaxel-Coated Angioplasty for Femoropopliteal Occlusion

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s15231 ◽

2014 ◽

Vol 8s2 ◽

pp. CMC.S15231 ◽

Cited By ~ 1

Author(s):

F Scheer ◽

CW Lüdtke ◽

P Kamusella ◽

P Wiggermann ◽

H Vieweg ◽

...

Keyword(s):

Femoral Artery ◽

Ultrasound Examination ◽

Ankle Brachial Index ◽

Efficient Treatment ◽

Safe Method ◽

Vascular Occlusions ◽

Technical Failures ◽

Low Rate ◽

Observation Period

Objective The rotational atherothrombectomy with Straub Rotarex® is a safe and efficient treatment of acute/subactute vascular occlusions. The purpose of this study was to evaluate the benefit of paclitaxel-coated angioplasty after rotational atherothrombectomy over an observation period of six months. Materials and Methods Overall, 29 patients were treated with the Rotarex catheter in combination with paclitaxel-coated angioplasty. All patients had acute/subacute and chronic occlusions of the superficial femoral artery (SFA) and/or popliteal arteries. The ankle-brachial index (ABI) was detected before the intervention, after the procedure, and after six months. Also clinical examination and ultrasound scans were done in the observation period. Results There were no technical failures. The ABI shows a significant increase from 0.52 ± 0.17 to 0.91 ± 0.25 in the follow-up. By ultrasound examination, there were found two (6.9%) restenoses during the follow-up. There was one dissection during the intervention (3.5%). Conclusion The rotational atherothrombectomy in combination with paclitaxel-coated angioplasty might be an effective and safe method with a promising low rate of restenosis at six months.

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Comprehensive strain analysis in oncological patients undergoing thoracic radiotherapy: 1-year follow-up of a prospective study comparing proton vs. photon beam therapy

European Heart Journal ◽

10.1093/eurheartj/ehab724.024 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S N Cordova-Madera ◽

L Garcia-Bello ◽

G Bruno ◽

C Di Stefano ◽

J A Quintero-Martinez ◽

...

Keyword(s):

Strain Rate ◽

Heart Function ◽

Statistical Significance ◽

Radial Strain ◽

Strain Analysis ◽

Photon Beam ◽

Wilcoxon Test ◽

Thoracic Radiotherapy ◽

One Year

Abstract Background Proton beam therapy (PBT) is a promising radiotherapeutic method by which the proton Bragg peak may be exploited to reduce the dose to non-target normal tissues, when compared with the conventional photon treatment (PhT). Purpose To evaluate the mechanical function of the left ventricle by endocardial longitudinal (GLS-basic strain), circumferential (GCS) and radial strain (GRS) and systolic (SRs) and early diastolic (SRe) strain rate following thoracic radiotherapy. Methods Between March 2016 and March 2017, 58 patients with breast or thoracic cancer scheduled to receive radiotherapy were enrolled prospectively and, underwent 2D-STE echocardiography with basic (GLS) and comprehensive (GCS, GRS,GLSRs, GCSRs, GRSRs, GLSRe, GCSRe, GRSRe parameters) analysis at pre-treatment, mid-treatment, end of treatment, 3 month and 1 year follow-up. LVEF was calculated by the biplane Simpson technique. Shapiro-Wilk's test was performed to evaluate the normal distribution of the data. Comparison between groups was performed with Student's t-test or Wilcoxon test for quantitative variables and with Chi-Square test or Fisher's exact test for qualitative variables. Tukey-Kramer method was used to compare means during follow up. A p-value <0.05 was assumed as the level of statistical significance. Results Mean age was 53.3±10.9 years and 91.3% were women. PBT was used to treat 38 patients; PhT in 20. The median of the mean heart dose was lower with PBT than PhT (79±92 vs 829±1121 cGy, respectively [P<.001]). No significant changes in LVEF or GLS for PBT or PhT were seen. Comprehensive strain analysis showed changes in endocardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing photon beam (PhT) up to one year of follow up (Table 1). No changes were detected in the PBT group. All other variables were non-significant (Not shown). Conclusion This is the first longitudinal study, with a one-year follow-up, that shows the relaxation properties of LV are compromised during PhT but not PBT. These findings should be followed in time to evaluate their influence on overall heart function. FUNDunding Acknowledgement Type of funding sources: None. Table 1

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Open repair with resection and reimplantation for popliteal artery aneurysm

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0127 ◽

2020 ◽

Vol 102 (9) ◽

pp. e1-e2

Author(s):

G Zenunaj ◽

M Mucignat ◽

V Gasbarro

Keyword(s):

Popliteal Artery ◽

Ultrasound Examination ◽

Clinical Signs ◽

Artery Aneurysm ◽

Duplex Ultrasound ◽

Transverse Diameter ◽

Limb Ischaemia ◽

Arterial Aneurysm ◽

Popliteal Aneurysm

Popliteal artery aneurysms are the most frequent type of peripheral arterial aneurysm and can be repaired by either open or endovascular techniques. An 81-year-old man presented with leg swelling and during duplex ultrasound examination was diagnosed a popliteal aneurysm. The transverse diameter was 3.6 × 4.5cm, length 2.8cm, one run-off vessel patent. The popliteal aneurysm was asymptomatic for clinical signs of limb ischaemia. We opted for an open surgical repair through a posterior approach. During dissection of the popliteal artery above and below the aneurysm, the two non-diseased popliteal extremities appeared to be very close, leading to the decision to perform an end-to-end anastomosis between the two arterial extremities. The patient was discharged after three days with no adverse events. Follow-up consisted of duplex ultrasound examination at one, three and six months, and then annually. At the six-month follow-up there was no restenosis at the anastomosis.

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Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome

Thrombosis and Haemostasis ◽

10.1055/s-0039-1697955 ◽

2019 ◽

Vol 119 (12) ◽

pp. 2064-2073 ◽

Cited By ~ 5

Author(s):

Tim Sebastian ◽

David Spirk ◽

Rolf P. Engelberger ◽

Jörn F. Dopheide ◽

Frederic A. Baumann ◽

...

Keyword(s):

Stent Thrombosis ◽

Femoral Vein ◽

Anticoagulation Therapy ◽

Duplex Ultrasound ◽

Incidence Rates ◽

Postthrombotic Syndrome ◽

Clinical Trial Registration ◽

Common Femoral Vein ◽

The Common

Abstract Background Patients with postthrombotic syndrome (PTS) treated with stents are at risk of stent thrombosis (ST). The incidence of ST in the presence and absence of anticoagulation therapy (AT) is unknown. Risk factors are not well understood. Patients and Methods From the prospective Swiss Venous Stent registry, we conducted a subgroup analysis of 136 consecutive patients with PTS. Incidence of ST was estimated from duplex ultrasound or venography, and reported for the time on and off AT. Baseline, procedural, and follow-up data were evaluated to identify factors associated with ST. Results Median follow-up was 20 (interquartile range [IQR] 9–40) months. AT was stopped in 43 (32%) patients after 12 (IQR 6–14) months. Cumulative incidence of ST was 13.7% (95% confidence interval [CI] 7.8–19.6%) and 21.2% (95% CI 13.2–29.2%) during the first 6 and 36 months, respectively. The time-adjusted incidence rate was 11.2 (95% CI 7.7–16.2) events per 100 patient-years, 11.3 (95% CI 7.3–17.3) for the period on, and 11.2 (95% CI 5.3–23.6) for the period off AT. May–Thurner syndrome (MTS) was associated with decreased incidence of ST (hazard ratio [HR] 0.37, 95% CI 0.15–0.91), whereas age < 40 years (HR 2.26, 95% CI 1.03–4.94), stents below the common femoral vein (HR 3.03, 95% CI 1.28–7.19), and postthrombotic inflow veins (HR 2.92, 95% CI 1.36–6.25) were associated with increased incidence. Conclusion The 6-month incidence of ST was considerably high. Beyond 6 months, consecutive annual incidence rates persisted at 4.1 and 3.4% per year thereafter. Patients with higher incidence of ST were younger, had stents below the common femoral vein, postthrombotic leg inflow veins, and less often MTS. Incidence rates for the period on and off AT must be interpreted with caution. Clinical Trial Registration The study is registered on the National Institutes of Health Web site (ClinicalTrials.gov; identifier NCT02433054).

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Progression of asymptomatic peripheral artery disease over 1 year

Vascular Medicine ◽

10.1177/1358863x11431106 ◽

2012 ◽

Vol 17 (1) ◽

pp. 10-16 ◽

Cited By ~ 13

Author(s):

Emile R Mohler ◽

Warner Bundens ◽

Julie Denenberg ◽

Elizabeth Medenilla ◽

William R Hiatt ◽

...

Keyword(s):

Lower Extremity ◽

Peripheral Artery Disease ◽

Time Course ◽

Ankle Brachial Index ◽

Duplex Ultrasound ◽

Leg Pain ◽

Peripheral Artery ◽

Community Screening ◽

Artery Disease

The pathophysiology and time course of an individual converting from asymptomatic peripheral artery disease (PAD) to symptomatic claudication is unclear. The objectives of this study were: (1) to characterize the extent of atherosclerotic disease in individuals with an abnormal ankle–brachial index (ABI), but without claudication; and over 1 year of follow-up to (2) evaluate the progression of PAD using ultrasound imaging, (3) determine changes in the ABI and leg pain symptoms, and (4) correlate PAD progression with changes in the ABI and leg symptoms. We hypothesized that PAD progression would be associated with the development of claudication and changes in the ABI, 6-minute walk distance (6-MWD), and walking quality of life. Individuals with a reduced ABI but without typical intermittent claudication noted on community screening were invited to undergo baseline and 1-year follow-up assessment, including duplex ultrasound. The initial and repeat evaluations included measurement of the ABI, lower extremity duplex arterial mapping, and assessment of leg pain and functional status. Of the 50 people studied, 44 (88%) had significant atherosclerotic lesions in the lower extremity arteries, affecting 80 legs. A total of 33 of 50 individuals (66%) returned for the 1-year follow-up visit. On ultrasound examination, two of 18 normal legs developed PAD, and in 48 legs with PAD at baseline, 17 legs (35%) developed new or progressive lesions. Thirteen legs developed new claudication. Overall, there was no significant worsening in the ABI, 6-MWD, or the Walking Impairment Questionnaire (WIQ). However, legs with new lesions or lesion progression were significantly more likely to develop claudication, and the 13 legs (seven subjects) developing claudication showed a significant decline in the 6-MWD. In conclusion, these data indicate that a significant number of people with asymptomatic PAD show progression over 1 year, that such individuals are more likely to develop claudication, and that those developing claudication have a significant decrease in their 6-MWD.

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Venous Reflux at the Sapheno-Femoral Junction

Phlebology The Journal of Venous Disease ◽

10.1177/026835559501000402 ◽

1995 ◽

Vol 10 (4) ◽

pp. 132-135 ◽

Cited By ~ 14

Author(s):

G. M. Somjen ◽

J. Donlan ◽

J. Hurse ◽

J. Bartholomew ◽

A. H. Johnston ◽

...

Keyword(s):

Saphenous Vein ◽

Ultrasound Examination ◽

Varicose Veins ◽

Femoral Vein ◽

Duplex Ultrasound ◽

Venous Reflux ◽

Duplex Scan ◽

Common Femoral Vein ◽

Long Saphenous Vein ◽

The Common

Objectives: To clarify reflux patterns in the sapheno-femoral junction in legs with varicose veins that display incompetence in the proximal long saphenous vein on duplex scan examination. Patients and method: One hundred consecutive extremities were selected for ultrasound studies. Venous reflux was examined in the common femoral vein and long saphenous vein at five selected levels in the vicinity of the sapheno-femoral junction. Results: Duplex ultrasound examination confirmed that in 44 extremities reflux was detectable both in the long saphenous vein and common femoral vein indicating ‘true’ sapheno-femoral incompetence. In 56 legs reflux was limited to the long saphenous vein, whilst the first saphenous valve remained competent. The ultrasound examination suggested that in these cases the reflux originated from the numerous tributaries of the proximal long saphenous vein. Conclusion: Our findings emphasize the transfascial escape (reflux from the deep veins) is not a necessary precondition of long saphenous vein incompetence and related varicose veins.

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Common Carotid Artery Imbrication as an Adjunct to Carotid Endarterectomy to Prevent Postoperative Carotid Kinking

The American Surgeon ◽

10.1177/000313480707300316 ◽

2007 ◽

Vol 73 (3) ◽

pp. 276-278

Author(s):

Juergen Falkensammer ◽

Albert G. Hakaim ◽

W. Andrew Oldenburg ◽

Todd B. Berland

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Endarterectomy ◽

Common Carotid Artery ◽

Internal Carotid ◽

Duplex Ultrasound ◽

Retrospective Chart Review ◽

Patch Angioplasty ◽

The Common

Mobilization of a tortuous carotid artery during endarterectomy may produce redundancy of the carotid artery, and kinking. We reviewed our experience with common carotid artery (CCA) imbrication as a technique to shorten the common and internal carotid artery postendarterectomy and to avoid carotid kinking. A retrospective chart review of 163 patients who underwent carotid endarterectomy by the same surgeon between August 1998 and February 2006 was performed. All patients underwent conventional endarterectomy via a longitudinal arteriotomy with an indwelling shunt and patch angioplasty. Patients undergoing concomitant carotid artery imbrication were identified. Twelve patients who underwent carotid imbrication were identified. The mean age was 74.9 ± 8.8 years. Nine patients underwent imbrication of the CCA, and in three cases, the internal carotid artery was plicated. Follow-up duplex ultrasound examinations were available for 10 individuals and mean follow-up time was 10.7 months (range, 1–58 months). There were no cases of peri- or postoperative cerebral accidents and there was no case of restenosis. CCA imbrication as an adjunct to carotid endarterectomy is a feasible technique in preventing postoperative carotid kinking.

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Early period results of radiofrequency ablation and cyanoacrylate embolization for great saphenous vein insufficiency

Vascular ◽

10.1177/17085381211026154 ◽

2021 ◽

pp. 170853812110261

Author(s):

Abdullah B Balcı ◽

Umut S Sanrı ◽

Kadir K Özsin ◽

Ahmet B Tatlı ◽

Ahmet F Özyazıcıoğlu ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Ultrasound Examination ◽

Great Saphenous Vein ◽

Early Period ◽

Duplex Ultrasound ◽

Efficacy And Safety ◽

Work Activity ◽

Saphenous Veins ◽

Vein Insufficiency

Objective To evaluate the 6 months efficacy and safety of cyanoacrylate closure for the treatment of incompetent great saphenous veins (GSVs) in comparison with radiofrequency ablation (RFA). Methods In this multicenter, retrospective, clinical trial, 398 symptomatic subjects with incompetent GSVs were assigned to either cyanoacrylate closure or RFA. The primary endpoint, complete closure of the target GSV, was determined using duplex ultrasound examination starting from one-, three-, and six-month visits. Results All patients were followed for 6 months and there was no difference between the groups in terms of mean follow-up time. Hospital stay and return to work/activity were shorter in the cyanoacrylate ablation (CAA) group, and these differences between the groups were statistically significant. Ecchymosis was observed higher in the RFA group and was statistically significant. Conclusions In this study, in which we examined the CAA and RFA methods, we found that both methods were effective and reliable; however, we found that patients in the CAA group had a more comfortable postoperative period and returned to work earlier.

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Mid-term effects of implanting stents for relief of aortic recoarctation on systemic hypertension, carotid mechanical properties, intimal medial thickness and reflection of the pulse wave

Cardiology in the Young ◽

10.1017/s1047951105000521 ◽

2005 ◽

Vol 15 (3) ◽

pp. 245-250 ◽

Cited By ~ 15

Author(s):

Gabriella Agnoletti ◽

Caroline Bonnet ◽

Damien Bonnet ◽

Daniel Sidi ◽

Yacine Aggoun

Keyword(s):

Mechanical Properties ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Pulse Wave ◽

Augmentation Index ◽

Systemic Hypertension ◽

Intimal Medial Thickness ◽

The Common ◽

Primary Implantation

Objective:Primary implantation of stents is an accepted technique for treating aortic recoarctation, albeit that the effects of stenting on pressure profiles, carotid mechanical properties, intimal medial thickness, and reflection of the pulse wave have not been systematically investigated.Methods:Over the period from 1 January, 1999, to 31 December, 2002, we implanted stents to relieve aortic recoarctation in 15 patients, with a median age of 17 years, and a range from 7 to 29 years, with a median weight of 56 kilograms, ranging from 20 to 96 kilograms. Indications were a gradient of 20 millimetres of mercury or more measured in all, systemic hypertension at rest in 8, and systemic hypertension at exercise in all. Of the patients, 5 were receiving anti-hypertensive treatment. Before implantation of the stents, and after a mean follow-up of 22 months, all patients underwent an exercise test, vascular echography, and examination of the common carotid artery so as to determine its cross sectional compliance and distensibility, and the augmentation index.Results:The stents were implanted successfully in all patients. The mean gradient was reduced from 27 to 4 millimetres of mercury (p < 0.001). Systolic blood pressure at rest diminished from 140 to 131 millimetres of mercury (p = 0.04), while hypertension at rest regressed in 4 patients. Systolic blood pressure at exercise diminished from 245 to 222 millimetres of mercury (p = 0.018), and hypertension at exercise regressed in 1 patient. Anti-hypertensive treatment is still required for 4 patients. A correlation was found between systolic blood pressure at rest and initial peak-to-peak gradient (r = 0.8), and between initial gradient and percentage reduction of systolic blood pressure at rest at follow-up (r = −0.73). Compliance and distensibility of the common carotid artery were not significantly modified, albeit that the intimal medial thickness diminished from 0.64 to 0.57 millimetres (p = 0.04), and the augmentation index decreased from 5 to −1 (p = 0.012).Conclusions:Primary implantation of stents is effective in mid-term repair of aortic recoarctation. Although there is an improvement in systemic hypertension, the tensional profile and vascular sonography are not normalized. At long term follow-up, the suppression of an early reflection site of the pulse wave could decrease the wall stress of the great elastic vessels, reducing the thickness of the arterial walls.

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