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

2010 ◽  
Vol 103 (06) ◽  
pp. 1193-1202 ◽  
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.

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

2018 ◽  
Vol 42 (3) ◽  
pp. 109-115 ◽  
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.

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

2017 ◽  
Vol 51 (2) ◽  
pp. 103-107 ◽  
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.

scholarly journals Preventing stroke in symptomatic carotid artery disease during the COVID-19 pandemic

2020 ◽  
Vol 72 (2) ◽  
pp. 755-756
Author(s):  
Joyce Hellegering ◽  
Maarten J. van der Laan ◽  
Erik-Jan de Heide ◽  
Maarten Uyttenboogaart ◽  
Clark J. Zeebregts ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Symptomatic Carotid ◽  
Artery Disease

scholarly journals Exploration of a zero-tolerance regime on cerebral embolism in symptomatic carotid artery disease

2012 ◽  
Vol 1 (1-12) ◽  
pp. 218-223 ◽  
Author(s):  
Ruud W.M. Keunen ◽  
Agnes van Sonderen ◽  
Maayke Hunfeld ◽  
Michael Remmers ◽  
D.L. Tavy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Zero Tolerance ◽  
Cerebral Embolism ◽  
Symptomatic Carotid ◽  
Artery Disease

scholarly journals Circulating Microparticles in Patients with Symptomatic Carotid Disease Are Related to Embolic Plaque Activity and Recent Cerebral Ischaemia

2019 ◽  
Vol 9 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Neghal Kandiyil ◽  
Shane T. MacSweeney ◽  
Stan Heptinstall ◽  
Jane May ◽  
Susan C. Fox ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Ischaemia ◽  
Carotid Artery Disease ◽  
Transcranial Doppler Ultrasound ◽  
Risk Markers ◽  
Stroke Patients ◽  
Symptomatic Carotid ◽  
Circulating Microparticles ◽  
Artery Disease ◽  
Embolic Signals

Background and Purpose: In order to assess the association of microparticles derived from activated platelets (PMP) or endothelial cells (EMP) with risk markers for recurrent embolic events in patients with symptomatic carotid artery disease, we studied the associations between PMP/EMP and three risk markers: plaque haemorrhage (PH), micro-embolic signals and cerebral diffusion abnormalities. Methods: Patients with recently symptomatic high-grade carotid artery stenosis (60–99%, 42 patients, 31 men; mean age 75 ± 8 years) and 30 healthy volunteers (HV, 11 men; mean age 56 ± 12 years) were prospectively recruited. Patients were characterised by carotid magnetic resonance imaging (presence of PH [MRI PH]), brain diffusion MRI (cerebral ischaemia [DWI+]) and transcranial Doppler ultrasound (micro-embolic signals [MES+]). PMP and EMP were classified by flow cytometry and expressed as log-transformed counts per microlitre. Results: MES+ patients (n = 18) had elevated PMP (MES+ 9.61 ± 0.57) compared to HV (8.80 ± 0.73; p < 0.0001) and to MES– patients (8.55 ± 0.85; p < 0.0001). Stroke patients had elevated PMP (9.49 ± 0.64) and EMP (6.13 ± 1.0) compared to non-stroke patients (PMP 8.81 ± 0.73, p = 0.026, EMP 5.52 ± 0.65, p = 0.011) and HV (PMP 8.80 ± 0.73, p = 0.007, and EMP 5.44 ± 0.47, p = 0.006). DWI+ patients (n = 16) showed elevated PMP (DWI+ 9.53 ± 0.64; vs. HV, p = 0.002) and EMP (DWI+ 5.91 ± 0.99 vs. HV 5.44 ± 0.47; p = 0.037). Only PMP but not EMP were higher in DWI+ versus DWI– patients (8.67 ± 0.90; p = 0.002). No association was found between PMP and EMP with MRI PH. Conclusions: PMP and EMP were associated with stroke and recent cerebrovascular events (DWI+) but only PMP were also associated with ongoing (MES+) thrombo-embolic activity suggesting a differential biomarker potential for EMP to index cerebral ischaemia while PMP may predict on-going thrombo-embolic activity.

scholarly journals Left-sided carotid arteries have a higher prevalence of intraplaque hemorrhage than right-sided: An asymmetric conundrum

2020 ◽  
Vol 33 (6) ◽  
pp. 494-500
Author(s):  
Anthony S Larson ◽  
Waleed Brinjikji ◽  
Luis Savastano ◽  
Eugene Scharf ◽  
John Huston ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Carotid Artery Disease ◽  
Underlying Mechanism ◽  
Intraplaque Hemorrhage ◽  
Asymmetric Distribution ◽  
Anterior Circulation ◽  
Asymptomatic Patients ◽  
Left And Right ◽  
Artery Disease

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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