Abstract WP187: Subclinical Macro and Microvascular Disease in Stroke-free Subjects With Nonsustained Atrial Fibrillation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ezgi Yetim ◽  
Ethem Murat Arsava ◽  
Ugur Canpolat ◽  
Rahsan Gocmen ◽  
Kader K Oguz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
White Matter ◽  
Carotid Artery ◽  
Carotid Plaque ◽  
Microvascular Disease ◽  
Plaque Burden ◽  
White Matter Disease ◽  
Atherosclerotic Burden ◽  
Carotid Distensibility

Introduction: Prevalence of nonsustained atrial fibrillation (NSAF), described as irregular atrial runs lasting shorter than 30-seconds, is higher in patients with ischemic stroke compared to stroke-free controls. Nonetheless, its role in causality of stroke and future cerebrovascular risk is still not established. Subclinical atherosclerotic burden and vascular stiffness are more prevalent, and have been shown to modify future risk of vascular events in patients with atrial fibrillation (AF). We aimed to determine the relationship between NSAF and subclinical atherosclerosis, vascular dysfunction and cerebral microvascular disease. Methods: Sonographic carotid distensibility metrics, carotid intima-media thickness (IMT), carotid plaque burden score (Ten Cate’s), middle cerebral artery (MCA) pulsatility index (PI) and cerebral white matter disease burden (Fazekas’ periventricular and subclinical scores) were studied in 263 stroke-free control subjects. 24-hour Holter monitoring documented NSAF in 27% of study population. Abnormality limits were set as mean±standard deviation. Results: Compared to those without NSAF (age 62±8 yr, 43% male), subjects with NSAF (age 67±9 yr, 31% male) had significantly higher total carotid plaque burden score (p=0.009) and significantly lower common carotid artery carotid distensibility (p=0.019). Maximum and averaged IMT, carotid stiffness and elastic modulus, and asymptomatic significant (≥50%) carotid artery stenosis were numerically higher. Patients with NSAF had significantly higher MCA PI (p=0.007) and numerically higher white matter disease scores. Regression analysis models showed that NSAF is one independent predictors of abnormal carotid distensibility (p=0.026) and presence of carotid plaque (p=0.023); but not for carotid plaque burden score (>4), MCA PI (>1.1) and IMT max (>0.966). Conclusions: The presence of a significant relationship between NSAF and presence of carotid artery plaque and decreased cervical artery distensibility raises the possibility that NSAF might be a reflection of subclinical atherosclerotic burden. This crosstalk between surrogate markers might explain the higher prevalence of NSAF in ischemic stroke patients.

Abstract WP188: Impact of Carotid Plaque Burden on Long-Term Outcomes in Ischemic Stroke Patients With Atrial Fibrillation

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Hyungjong Park ◽  
Young Dae Kim ◽  
Ji Joe Heo ◽  
Hyo Suk Nam
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Carotid Plaque ◽  
Plaque Burden ◽  
Stroke Patients ◽  
Long Term Outcomes

Abstract TP178: Pre-existing Volume of White Matter Disease Predicts Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Ariana J Andere ◽  
Shadi Yaghi ◽  
Andrew D Chang ◽  
Scott Collins ◽  
Derek Merck ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
White Matter Disease

Elevated serum sortilin is related to carotid plaque concomitant with calcification

2020 ◽  
Vol 14 (5) ◽  
pp. 381-389
Author(s):  
Shanshan Huang ◽  
Xingxing Yu ◽  
Haiqing Wang ◽  
Jianlei Zheng
Keyword(s):  
Ischemic Stroke ◽  
Carotid Plaque ◽  
Elevated Serum ◽  
Area Under The Curve ◽  
Plaque Burden ◽  
Multivariable Logistic Regression Analysis ◽  
Characteristic Analysis ◽  
Plaque Score ◽  
Carotid Calcification

Aim: To explore whether elevated serum sortilin was associated with calcified carotid plaque and ischemic stroke. Methods: A total of 171 patients with cardiovascular risk factors were enrolled. Ultrasonography was performed to evaluate calcified plaques and noncalcified plaques. Serum sortilin concentration was measured by ELISA. Results: Serum sortilin level was higher in patients with calcified carotid plaque and positively related to carotid plaque burden, but not with ischemic stroke during the follow-up. Multivariable logistic regression analysis revealed serum sortilin level was an independent determinant for calcified carotid plaque (p = 0.001). Receiving operating characteristic analysis showed an area under the curve of sortilin for carotid calcification was 0.759. Conclusion: Higher serum sortilin level was associated with carotid calcification and severe carotid plaque score.

scholarly journals Association of Atrial Fibrillation With White Matter Disease

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 989-991 ◽  
Author(s):  
Iris Yuefan Shao ◽  
Melinda C. Power ◽  
Thomas Mosley ◽  
Clifford Jack ◽  
Rebecca F. Gottesman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
White Matter ◽  
Mean Diffusivity ◽  
Brain Magnetic Resonance Imaging ◽  
White Matter Disease ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Microstructural Integrity

Background and Purpose— Evidence suggests that atrial fibrillation (AF) is associated with increased risk of cognitive decline and dementia, even in the absence of stroke. White matter disease (WMD) is a potential mechanism linking AF to cognitive impairment. In this study, we explored the association between prevalent AF and WMD. Methods— We performed a cross-sectional analysis of participants attending the ARIC-NCS (Atherosclerosis Risk in Communities–Neurocognitive Study) in 2011 to 2013 who underwent brain magnetic resonance imaging. AF was ascertained from study visit electrocardiograms or prior hospitalization codes. Extent of WMD was defined by measures of white matter (WM) microstructural integrity and WM hyperintensity volume. Multivariable linear regression models were used to assess the association between AF and WMD. Results— Among 1899 participants (mean age, 76 years; 28% black; 60% women), 133 (7%) had prevalent AF. After multivariable adjustment, differences between participants with and without AF were −0.001 (95% CI, −0.006 to 0.004) for global WM fractional anisotropy, 0.031×10 −4 mm 2 /s (95% CI, −0.075 to 0.137) for global WM mean diffusivity, and 0.08 mm 3 (95% CI, −0.14 to 0.30) for WM hyperintensity volume. Conclusions— The results suggest that there is no association between prevalent AF and WMD.

scholarly journals Carotid artery stiffness, digital endothelial function, and coronary calcium in patients with essential thrombocytosis, free of overt atherosclerotic disease

2017 ◽  
Vol 51 (2) ◽  
pp. 203-210 ◽  
Author(s):  
Matjaz Vrtovec ◽  
Ajda Anzic ◽  
Irena Preloznik Zupan ◽  
Katja Zaletel ◽  
Ales Blinc
Keyword(s):  
Carotid Artery ◽  
Endothelial Function ◽  
Carotid Plaque ◽  
Calcium Score ◽  
Coronary Calcium ◽  
Coronary Calcium Score ◽  
Plaque Burden ◽  
Essential Thrombocytosis ◽  
Control Subjects ◽  
Artery Stiffness

Abstract Background Patients with myeloproliferative neoplasms (MPNs) are at increased risk for atherothrombotic events. Our aim was to determine if patients with essential thrombocytosis (ET), a subtype of MPNs, free of symptomatic atherosclerosis, have greater carotid artery stiffness, worse endothelial function, greater coronary calcium and carotid plaque burden than control subjects. Patients and methods 40 ET patients without overt vascular disease, and 42 apparently healthy, age and sex-matched control subjects with comparable classical risk factors for atherosclerosis and Framingham risk of coronary disease were enrolled. All subjects were examined by physical and laboratory testing, carotid echo-tracking ultrasound, digital EndoPat pletysmography and CT coronary calcium scoring. Results No significant differences were found between ET patients and controls in carotid plaque score [1 (0-1.25) vs. 0 (0-2), p=0.30], β- index of carotid stiffness [7.75 (2.33) vs. 8.44 (2,81), p=0.23], pulse wave velocity [6,21 (1,00) vs. 6.45 (1.04) m/s; p=0.46], digital reactive hyperemia index [2.10 (0.57) vs. 2.35 (0.62), p=0.07], or augmentation index [19 (3-30) vs. 13 (5-22) %, p=0.38]. Overall coronary calcium burden did not differ between groups [Agatston score 0.1 (0-16.85) vs. 0 (0-8.55), p=0.26]. However, significantly more ET patients had an elevated coronary calcium score of >160 [6/40 vs. 0/42, p < 0.01]. Conclusions No significant differences between groups were found in carotid artery morphology and function, digital endothelial function or overall coronary calcium score. Significantly more ET patients had an elevated coronary calcium score of >160, indicating high cardiovascular risk, not predicted by the Framingham equation.

scholarly journals Extent of white matter lesion is associated with early hemorrhagic transformation in acute ischemic stroke related to atrial fibrillation

2021 ◽  
Author(s):  
Lucio D'Anna ◽  
Filippos T. Filippidis ◽  
Kirsten Harvey ◽  
Marilena Marinescu ◽  
Paul Bentley ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
White Matter Lesion ◽  
Hemorrhagic Transformation

Abstract 2572: Dual Imaging with MRI and 18 F-FDG PET Can Highly Predict Lipid and Hematoma in Carotid Plaque

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
hisayasu saito ◽  
Satoshi Kuroda ◽  
Kenji Hirata ◽  
Keiichi Magota ◽  
Tohru Shiga ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Mr Imaging ◽  
Predictive Value ◽  
Fdg Pet ◽  
Vulnerable Plaque ◽  
Carotid Plaque ◽  
The Other ◽  
Soft Plaque ◽  
Sensitivity Specificity

Background and Purpose - Recent studies have disclosed that inflamed and vulnerable plaques in the carotid artery are at high risk for subsequent ischemic stroke, suggesting the importance of non-invasive diagnostic modalities with high sensitivity and specificity to detect them in patients with carotid artery stenosis. Although many investigators have reported that MR imaging is a useful tool to predict the components of carotid plaque, its validity is not established. On the other hand, 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) may be an alternative modality to directly identify the inflamed plaque in carotid artery stenosis. Therefore, this study was aimed to evaluate the validity of MR imaging and 18 F-FDG PET to predict the components of carotid plaques. Methods - Totally 19 patients were included in this study. Prior to carotid endarterectomy (CEA), 18 F-FDG PET, black-blood fat-suppressed T1-weighted (FS-T1) imaging, and 3-dimensional time-of-flight (TOF) imaging were performed in all of them. During CEA, macroscopic observation of carotid plaque was performed under surgical microscope. The specimens were stained with primary antibodies against CD68 and MMP9. Results - 18 F-FDG PET revealed that 11 of 19 patients had the carotid plaque with significantly high 18 F-FDG uptake (SUVmax >2.0). All of them had lipid-rich soft plaque with strong immunoreactivity against CD68 and MMP9. Its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to identify lipid-rich soft plaque were all 100%. On the other hands, 6 out of 19 patients had the carotid plaque with high signal intensity on both FS-T1 and TOF imaging. Carotid plaque had a large intraplaque hematoma in these 6 patients. Their sensitivity, specificity, PPV, and NPV to identify intraplaque hematoma were 86%, 100%, 100%, and 92%, respectively. Conclusions - These findings strongly suggest that MRI and 18 F-FDG PET are complementary to predict the components of carotid plaque. The former would be useful to detect vulnerable plaque with subintimal hemorrhage, and the latter would be sensitive to identify vulnerable plaque with lipid-rich component. Therefore, combination of these two modalities may be quite valuable to non-invasively predict the carotid plaque at higher risk for subsequent ischemic stroke.

Abstract TMP44: Contrast Enhanced Ultrasound Can Detect Small Disruption of Carotid Plaques Related to Symptomatic Internal Carotid Artery Stenosis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Soichiro Abe ◽  
Kozue Saito ◽  
Hatsue Ishibashi-Ueda ◽  
Shuichi Tonomura ◽  
Kota Mori ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Internal Carotid ◽  
Color Doppler ◽  
Internal Carotid Artery Stenosis ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced

Background: The ulcerated atheroma of the carotid artery is a risk factor of ipsilateral ischemic stroke. Contrast-enhanced ultrasound (CEUS) is a novel noninvasive technique useful for evaluating the morphology of carotid plaques, and can detect small disruptions on plaque surface. However, it remains unclear whether the disrupted carotid plaque detected by CEUS is related to the symptomatic internal carotid artery stenosis (ICS). Methods: A total of 79 ICS patients who underwent carotid endarterectomy (CEA) were enrolled from July 2010 to July 2015. Before operation, ICA lesions were examined by color Doppler ultrasound (CDUS) and CEUS using perflubutane. The ulceration was diagnosed when both of the color Doppler signal on CDUS and the pooling of microbubbles on CEUS were observed within the plaque. The disruption was diagnosed only by CEUS when microbubbles pooled through the fissured surface, unlike the linear delineation of neovessels. We validated findings on ultrasound compared with the histopathological findings of ulceration and present/recent plaque rupture. The associations between ulceration/disruption on ultrasound and symptomatic ICS (with a history of ipsilateral transient ischemic attack and/or ischemic stroke) were investigated. Results: Of 79 subjects (mean age 71.2±6.8 years old, 78 men), 55 had symptomatic ICS. The ulceration by CEUS and CDUS was recognized in 20 patients (25%), and the disruption on plaque surface was seen by CEUS solitary in 26 patients (33%). The sensitivity and specificity of detecting plaque ulceration or disruption using CEUS compared with histopathological findings were 0.57 (45/66) and 1.00 (13/13), respectively. The detection rate of ulceration or disruption using CEUS was higher in symptomatic ICS than in asymptomatic ICS (66% vs 42%, P=0.049). Compared to plaques without ulceration/disruption on ultrasound, prevalence of symptomatic ICS was higher in plaques with the disruption (88% vs 58%, P=0.01), whereas it was similar in plaques with the ulceration (65% vs 58%, P=0.77) Conclusion: Small disruptions on carotid plaque surface detected by CEUS were significantly related to symptomatic ICS and this results may help the detailed assessment of plaque vulnerability.

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