Abstract TP482: Carotid Calcification Predicts Systemic Vascular Events

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Noritaka Sano ◽  
Tamaki Kobayashi ◽  
Hiroharu Kataoka ◽  
Naomi Morita ◽  
Jun Takahashi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Calcium Score ◽  
Whole Body ◽  
Cerebral Stroke ◽  
Vascular Events ◽  
Significant Difference ◽  
The Future ◽  
Coronary Events ◽  
Carotid Calcification

Background and Objective: It is well known that systemic arterial calcifications progress simultaneously. And coronary calcifications are a well-known predictor of coronary event in the future. Impact of carotid artery calcifications for cerebral stroke is still controversial among various articles, and the relationship between carotid artery calcifications and systemic vascular events are not known either. In this study, we aim to examine if the carotid calcification can be used as a predictor of systemic vascular events. Methods: This is a prospective study, which enrolled 199 subjects who have already suffered from vascular events, including carotid stenosis, coronary syndromes or stroke. We collected data at entry on risk factors, blood examination, and whole-body computed tomography analysis to assess the calcifications of carotid, coronary, aorta (three distinct part; arch, abdominal, and bifurcation) and renal artery using modified Agatston calcium score (ACS) for each vessel. According to the median carotid ACS, subjects were divided into two groups. And during 5 years of follow up period, cerebrovascular events, coronary events and other systemic vascular events were counted. Results: Carotid ACS has a stronger correlation with aortic ACS than coronary ACS. Hypertension and low renal function have significant impact on increasing carotid ACS, while a diabetes mellitus increase coronary calcification. On Kaplan-Meier estimates, subjects with higher carotid ACS (higher group) suffered more systemic vascular events than lower group (p=0.03, log rank correlation coefficient), and hazard ratio was 1.88 (95%CI; 1.02-3.46). There was no significant difference in the risk of cerebral or coronary events, however, higher group have tendency to be treated for aortic or peripheral arterial disease in the follow up period (HR6.86, 0.9-54.7). Conclusion: Carotid ACS have strong correlation with systemic large vascular bed including aorta, and can be a useful tool to extract a subject who will be suffered from systemic vascular event in the future.

Abstract 16464: Coronary Artery Calcium Score and Incidence of Clinically Significant Carotid Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aditya Singh ◽  
Tom Stys ◽  
Valerie Bares ◽  
Jeffrey Wilson ◽  
Adam Stys
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Coronary Artery Calcium ◽  
Carotid Artery Stenosis ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Artery Stenosis ◽  
Plaque Burden ◽  
Significant Difference

Introduction: Coronary artery calcium (CAC) has been found to be associated with coronary artery plaque burden and is a major predictor of coronary heart disease (CHD) events. The data on its role in predicting carotid artery stenosis (CAS) is limited. Methods: Participants age ≥ 18 years with heart screen done from Nov 2008- Feb 2019 were selected and were assessed for documented diagnosis of carotid artery stenosis after their heart screen. Only the most recent heart screen per person and earliest documented CAS was considered. The chi-squared test and Welch’s 2-sample t-test was used to test for significant association between CAS and the nominal variables and mean calcium score respectively. Results: A total of 35,084 patient were screened for CAC score and 1439 (4.1%), were recorded to have a diagnosis of carotid artery stenosis. 53.5% being females and mean age of 63.69±9.31 years. The mean time between heart screen and documented diagnosis of CAS was 1529.4 ± 1211.0 days. The presence of CAS was significantly higher in patients ≥ 60 years (8.5%) as compared to those age <60 years (2%). There was a significant difference in mean CAC score between those with CAS as compared to non- carotid stenosis group (324.2, vs 107.27, p<.0001). In patient with elevated CAC ≥ 100, 9.98% had diagnosis of CAS, as compared to 2.82% in patients with CAC <100, however among patients with diagnosis of CAS 46.6% had elevated CAC ≥ 100. Conclusions: The presence of carotid artery stenosis (CAS) was significantly associated with elevated coronary artery calcium score (≥100) and was significantly higher in patients with age ≥ 60 years, which in correct clinical context is helpful in suspecting CAS.

scholarly journals Whole-Body SPECT/CT versus Planar Bone Scan with Targeted SPECT/CT for Metastatic Workup

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Olivier Rager ◽  
René Nkoulou ◽  
Nadia Exquis ◽  
Valentina Garibotto ◽  
Claire Tabouret-Viaud ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Whole Body ◽  
Significant Difference ◽  
Planar Images ◽  
History Of ◽  
Bone Scans ◽  
Base Of The Skull ◽  
History Of Cancer ◽  
Higher Sensitivity

Purpose. The use of SPECT/CT in bone scans has been widespread in recent years, but there are no specific guidelines concerning the optimal acquisition protocol. Two strategies have been proposed: targeted SPECT/CT for equivocal lesions detected on planar images or systematic whole-body SPECT/CT. Our aim was to compare the diagnostic accuracy of the two approaches. Methods. 212 consecutive patients with a history of cancer were referred for bone scans to detect bone metastases. Two experienced readers randomly evaluated for each patient either planar images with one-field SPECT/CT targeted on equivocal focal uptakes (targeted SPECT/CT) or a whole-body (two-field) SPECT/CT acquisition from the base of the skull to the proximal femurs (whole-body SPECT/CT). The exams were categorized as “nonmetastatic,” “equivocal,” or “metastatic” on both protocols. The presence or absence of any extra-axial skeletal lesions was also assessed. The sensitivity and specificity of both strategies were measured using the results of subsequent imaging follow-up as the reference standard. Results. Whole-body SPECT/CT had a significantly higher sensitivity than targeted SPECT/CT to detect bone metastases (p=0.0297) and to detect extra-axial metastases (p=0.0266). There was no significant difference in specificity among the two approaches. Conclusion. Whole-body SPECT/CT is the optimal modality of choice for metastatic workup, including detection of extra-axial lesions, with improved sensitivity and similar specificity compared to targeted SPECT/CT.

scholarly journals Atherosclerotic Plaque Fissuration and Clinical Outcomes in Pre-Diabetics vs. Normoglycemics Patients Affected by Asymptomatic Significant Carotid Artery Stenosis at 2 Years of Follow-Up: Role of MIcRoRNAs Modulation. The ATIMIR Study

2021 ◽  
Author(s):  
Celestino Sardu ◽  
Piero Modugno ◽  
Gaetano Castellano ◽  
Lucia Scisciola ◽  
Michelangela Barbieri ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Atherosclerotic Plaque ◽  
Carotid Artery Stenosis ◽  
Expression Profiles ◽  
Artery Stenosis ◽  
Atheromatous Plaque ◽  
Study Cohort ◽  
Altered Glucose ◽  
Significant Difference

BACKGROUND AND PURPOSE&mdash;Atherosclerotic plaque instability and rupture in patients with asymptomatic carotid artery stenosis (ACAS) is a leading cause of major adverse cardiac events (MACE). This could be mainly evidenced in patients with pre-diabetes. Indeed, the altered glucose homeostasis and insulin resistance could cause over-inflammation of atherosclerotic plaque, favoring its conversion to unstable phenotype with rupture and MACE. Notably, the metformin therapy reducing the metabolic distress and the inflammatory burden, could lead to reduction of MACE in ACAS patients with pre-diabetes. In this setting, microRNAs (miRs) could be used as molecular biomarkers of atherosclerosis progression, plaque rupture and worse prognosis in normoglycemics (NG) vs. pre-diabetics metformin users (PDMU) vs. pre-diabetics non metformin users (PDNMU). However, the aim of our study was to investigate a wide miRNA panel in peripheral blood exosomes from patients with ACAS divided in NG vs. PDMU vs. PDNMU, and to associate the circulating miRNA expression profiles with MACE at 2 years of follow-up after endarterectomy. METHODS&mdash;The study included 234 patients with ACAS divided in NG (n 125), PDNMU (n 73) and PDMU (n 36). The miRs&rsquo; expression profiles of circulating exosomes were determined at baseline and at 2 years of follow-up by Affymetrix microarrays from plasma samples of the patients from any study cohort. Then we collected and analyzed MACE at 2 years of follow-up in NG vs. PDMU vs. PDNMU. RESULTS&mdash;prediabetics vs. NG had over-inflammation (p&lt;0.05) and over expressed miR 24 and miR 27 at baseline. At 2 years of follow-up PDNMU vs. NG, PDMU vs. NG and PDNMU vs. PDMU over-expressed inflammatory markers and miR 24, miR 27, miR 100, miR 126 and miR 133 (p&lt;0.05). Finally, at follow-up end we observed a significant difference about MACE comparing PDNMU vs. NG (n 27 (36.9%) vs. n 8 (6.4%); p&lt;0.05), PDNMU vs. PDMU (n 27 (36.9%) vs. n 6 (16.6%); p &lt;0.05), and PDMU vs. NG (n 6 (16.6%) vs. n 8 (6.4%); p&lt;0.05). Admission glucose values (HR 1.020, CI 95% [1.001-1.038], p 0.029), atheromatous carotid plaque (HR 5.373, CI 95% [1.251-11.079], p 0.024), and miR 24 (HR 3.842, CI 95% [1.768-19.222], p 0.011) predicted MACE at 2 years of follow-up. CONCLUSIONS&mdash;Specific circulating miRs could be over-expressed in pre-diabetics and specifically in PDNMU vs. PDMU after endarterectomy. MiR24, hyperglycemia and atheromatous plaque could predict MACE at 2 years of follow-up.

scholarly journals Mid-and Long-term Clinical Efficacy Analysis of Carotid Artery Stenosis Treated With Carotid Endarterectomy

2020 ◽  
Author(s):  
Yanhua Wan ◽  
Yiran Li ◽  
Jiasheng Xu ◽  
Shasha Wan ◽  
Riwei Wang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Clinical Efficacy ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Cerebral Stroke ◽  
Improvement Rate ◽  
Efficacy Analysis ◽  
Significant Difference

Abstract Objective: To explore the mid-and long-term clinical efficacy analysis of carotid artery stenosis treated with carotid endarterectomy.Methods: Retrospective analysis of 89 cases of patients with carotid artery stenosisundergoing carotid endarterectomy from our center from Jan,2013 to June,2017. To gather the hospitalization data of patients including the general information, the past medical history, preoperative conditions, the situation during surgery, postoperative situations. All the patients were followed up from 16 months to 63 months, and to make survival analysis on the follow-up status.Results：Among the 89 cases, 22cases of mild stenosis ,67cases of severe stenosis. 5 cases had postoperation wound hemorrhage or hematoma, 2 cases of cranial nerve injury, 2cases of cerebral stroke. Among the 62 cases of symptomatic carotid artery stenosis,48cases have been improved in term of their clinical symptoms with improvement rate of 77.4%. The Nonparametric test of mRS scores before and after surgery showed that there was significant difference in the preoperative and postoperative scores（P<0.05）.Conclusion: The mid-and long-term clinical efficacy of carotid artery stenosis treated with carotid endarterectomy is good. The previous history of coronary heart disease and peripheral vascular diseases are the influence factors for the mid- and long-term adverse outcomes after carotid endarterectomy.

Expression of P-selectin, von Willebrand and endothelin-1 after carotid artery stenting

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 199-204 ◽  
Author(s):  
Xia ◽  
Yang ◽  
Qu ◽  
Cheng ◽  
Wang
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Endothelin 1 ◽  
Significant Difference ◽  
Group 2 ◽  
One Year ◽  
Von Willebrand ◽  
The Impact ◽  
Group 1

Background: This study was designed to investigate the impact of carotid artery stenting (CAS) on plasma levels of P-selectin, von Willebrand (vWF) and endothelin-1. Patients and methods: Sixty-seven patients who received CAS were divided into group 1 (one stent for a simple lesion, n = 38) and group 2 (two stents for complex lesions, n = 29). The levels of P-selectin, vWF and endothelin-1 were measured before CAS, 1 h, 6h, 24 h and 2 weeks after the stenting. Results: Sixty-one patients completed one-year follow up. Restenosis was noted in 14 (23 %) patients, among these three (4.8 %) had a restenosis of > 50 % of the vascular lumen. In all patients, the levels of P-selectin, vWF and endothelin-1 increased immediately after CAS (P < 0.05 or < 0.01). The levels of vWF and endothelin-1 in group 2 were higher than in group 1 (P < 0.05 or 0.01). There was no significant difference in P-selectin and endothelin-1 between the restenosis and non-restenosis group (P > 0.05). The 24 h vWF in patients with restenosis were higher than in non-restenosis group (P < 0.05). Conclusions: CAS results in a significant increase in plasma P-selectin, vWF and endothelin-1. The post-CAS levels of P-selectin, vWF and endothelin-1 are related to the extent of endothelial injury. Whether they are associated with restenosis 12 months after the treatment requires further investigation.

Abstract 115: Is Routine Patching Necessary Following Carotid Endarterectomy (CEA)?

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Nicholas J Gargiulo
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Retrospective Review ◽  
Primary Closure ◽  
Perioperative Stroke ◽  
Symptomatic Carotid ◽  
Significant Difference ◽  
Patch Closure ◽  
Closure Group

Objectives: Large medicare databases and meta-analyses recommend routine patching following carotid endarterectomy (CEA). Routine patching reduces perioperative stroke, carotid thrombosis, and restenosis. This 30 year experience evaluates the long term outcome of CEA with selective patching and without routine postoperative duplex examination. Methods: An IRB-approved retrospective review of all CEAs peformed by two surgeons over a 30 year period (1984-2014). Pre-operative imaging studies, operative reports, physical findings, co-morbid conditions, and pre- and postoperative medications were evaluated. Results: Over a 30-year period, 439 CEAs were performed for symptomatic carotid disease using a selective patch technique depending on gender, internal carotid artery diameter, cardiovascular risk factors, and preoperative arteriogram. In this group of 439 patients, 17 (3.9%) had patch closure of the carotid artery and the other 422 (96.1%) had primary closure. There were 2 (0.47%) perioperative strokes in the primary closure group and 4 (0.95%) patients in this group developed symptomatic carotid restenosis at a mean follow-up of 49.5 months (range 1 to 237 months). There was 1 (5.8%) carotid thrombosis in the patch closure group who also had a perioperative stroke and was serologically positive for a hypercoagulable disorder. The 4 patients who developed symptomatic restenosis had arteriographically proven > 90% stenosis and required repeat CEA. The remaining 418 (99.0%) patients having primary closure remained neurologically asymptomatic (mean follow-up 10.3 years, range 2.5 to 17 years). There was 1 (0.23%) operative death that occurred following the induction of general anesthesia. Conclusions: In this experience, there is no statistically significant difference in restenosis in the primary closure group and selective patch group following CEA. Although this data set is a small, single center, two surgeon, retrospective review, it does not support the generally well accepted view of routine patching following CEA

Mortality in adult patients with fluid overload evaluated by BIVA upon admission to the emergency department

2018 ◽  
Vol 94 (1113) ◽  
pp. 386-391 ◽  
Author(s):  
Ashuin Kammar-García ◽  
Ziv Pérez-Morales ◽  
Lilia Castillo-Martinez ◽  
José Luis Villanueva-Juárez ◽  
Fernanda Bernal-Ceballos ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fluid Balance ◽  
Fluid Overload ◽  
Bioelectrical Impedance ◽  
Whole Body ◽  
Assessment Scores ◽  
Significant Difference ◽  
Failure Assessment ◽  
Impedance Vector

Purpose of the studyThe aim of this study was to investigate the association of fluid overload, measured by bioelectrical impedance vector analysis (BIVA) and also by accumulated fluid balance, with 30-day mortality rates in patients admitted to the emergency department (ED).DesignWe conducted a prospective observational study of fluid overload using BIVA, taking measures using a multiple-frequency whole-body tetrapolar equipment. Accumulated fluid balances were obtained at 24, 48 and 72 hours from ED admission and its association with 30-day mortality.Patients109 patients admitted to the ED classified as fluid overloaded by both methods.ResultsAccording to BIVA, 71.6% (n=78) of patients had fluid overload on ED admission. These patients were older and had higher Sequential Organ Failure Assessment scores. During a median follow-up period of 30 days, 32.1% (n=25) of patients with fluid overload evaluated by BIVA died versus none with normovolaemia (p=0.001). There was no statistically significant difference in mortality between patients with and without fluid overload as assessed by accumulated fluid balance (p=0.81).ConclusionsFluid overload on admission evaluated by BIVA was significantly related to mortality in patients admitted to the ED.

scholarly journals Intracranial Internal Carotid Artery Calcification Is Not Predictive of Future Cognitive Decline

2021 ◽  
Author(s):  
Farzaneh Rahmani ◽  
Marina Nguyen ◽  
Charles D. Chen ◽  
Nicole McKay ◽  
Aylin Dincer ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Small Vessel Disease ◽  
Calcium Score ◽  
Hippocampal Volume ◽  
Imaging Biomarkers ◽  
Amyloid Burden ◽  
Vessel Disease ◽  
Future Risk

Abstract BackgroundIntracranial internal carotid artery (ICA) calcification is a common incidental finding in non-contrast head CT. We evaluated the predictive value of ICA calcification for future risk of dementia and compared the results with conventional imaging biomarkers of dementia.MethodsIn a retrospective observational cohort, we included 230 participants with a PET-CT scan within 18 months of a baseline clinical assessment and longitudinal imaging assessments. Intracranial ICA calcification was quantified on baseline CT scans using the Agatson calcium score. The ability of baseline ICA calcification to discriminate between a control group (participants who maintained a Clinical Dementia Rating (CDR™) score of zero over all follow-up visits) and a converter group (participants who had a baseline CDR of zero but received a persistent CDR>0 at any follow-up visit) was evaluated along with the predictive value of baseline ICA calcification for longitudinal clinical and imaging biomarkers. ResultsBaseline ICA calcium score could not distinguish participants who converted to CDR>0. ICA calcium score was also unable to predict longitudinal changes in cognitive scores, imaging biomarkers of small vessel disease such as white matter hyperintensities (WMH) volume, or AD such as hippocampal volume, AD cortical signature thickness, and amyloid burden. Severity of intracranial ICA calcification increased with age, male sex, and higher WMH volumes at baseline visit. Higher WMH volume and amyloid burden as well as lower hippocampal volume and AD cortical signature thickness at baseline predicted lower Mini-Mental State Exam scores at longitudinal follow-up. Baseline ICA calcification was indirectly associated with longitudinal cognitive decline, fully mediated through WMH volume.ConclusionsIn elderly and preclinical AD populations, atherosclerosis of large intracranial vessels as demonstrated through ICA calcification is not directly associated with a future risk of dementia, cognitive impairment, or progression of imaging biomarkers of AD or small vessel disease.

scholarly journals The Role of Prolotherapy in Fibromyalgia Patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N Elsheshtawy ◽  
N Fouda ◽  
M Nassif ◽  
N Ahmed
Keyword(s):  
Functional Disability ◽  
Whole Body ◽  
P Value ◽  
Tender Points ◽  
Daily Life Activities ◽  
Significant Difference ◽  
Scale Total Score ◽  
Average Pain

Abstract Objectives To assess the potential role of prolotherapy in treating the most tender points of FM patients as a trial to improve symptoms. Patients and Methods 20 primary FM Patients were injected with 3 cc of 25 % dextrose with 2 cc of 1 % lidocaine and then filled to 6 cc total volume with saline, making dextrose concentration of 12.5%, with 0.5 ml of the solution prepared per point,with a maximum of 6 points/ session. - Follow up visit were required every two weeks for other injections over a course of six weeks (duration of healing cascade). After 6 weeks, patients were assessed using NRS, FIQ VAS , MFI - 20 , SQS and PHQ-9 scales. Results As regard number of tender points, there was a highly Statistically significant P- value (&lt;0.001) between number of tenderpoints (6-16) before injection, which decreased to (5-9) after injection, with a change of 34.17%. As regard whole body average pain, there was a highly Statistically significant difference (&lt;0.001) between NRS before injection(5-10), which decreased to a range of (2-6) after injection, with a change of 39.57%. PHQ-9 scale total score showed a highly Statistically significant difference (P – value&lt;0.001), ranging from (15-22) pre injectionand dropped to (10-18) post injection, with an improvement of 25.37%. Conclusion Prolotherapy may offer great therapeutic advantages for FM patients, as it is well tolerated with minimal or no side effects. Moreover, prolotherapy injection reduces pain intensity and functional disability in daily life activities.

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