scholarly journals Predictive Value of Neutrophil-to-Lymphocyte, Aspartate-to-Alanine Aminotransferase, Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratios in Severity and Side of Carotid Artery Stenosis: Are Those Significant?

2021 ◽  
Vol 24 (1) ◽  
pp. E072-E078
Author(s):  
ÖZGÜR ALTINBAŞ ◽  
Şeniz Demiryürek ◽  
Mehmet Işık ◽  
Ömer Tanyeli ◽  
Yüksel Dereli ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Patient Group ◽  
Carotid Artery Stenosis ◽  
Alanine Aminotransferase ◽  
Healthy Subjects ◽  
Artery Occlusion ◽  
Artery Stenosis ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
The Relationship

Background: Atherosclerosis is a chronic disease that leads to mortality and morbidity by affecting arterial vascular structures. Carotid artery is one of these arterial structures and occlusive disease of carotid artery may cause stroke or cranial ischemic infarction. Inflammation plays a role in the atherosclerotic process. In this study, we aimed to discuss the relationship between the severity and side of carotid artery occlusion and novel inflammatory parameters include platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios. Methods: One-hundred-fifteen patients who had carotid artery stenosis between 50%-99% and 115 healthy subjects with no carotid artery stenosis or additional disease were included in the study. The relationship between the side and degree of the lesion and platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios were studied in the patient group. The patients with carotid artery stenosis and the healthy subjects were compared, in the terms of same parameters. Data were evaluated statistically. Results: There were no statistically significant differences between the groups, in the terms of platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios and the degree of stenosis. There was no statistically significant difference between the sides of the lesions and the parameters above except lymphocyte-to-monocyte ratio. It was statistically significantly higher in left-sided lesions. Aspartate-to-alanine aminotransferase and neutrophil-to-lymphocyte ratios were markedly higher in the patient group, when compared to controls. Conclusion: Platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios are inexpensive, easy, fast, and reproducible parameters that can be used in determining the prediction of carotid artery stenosis.

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.

Abstract 113: Platelet and Monocyte Activity in Carotid Artery Stenosis Treated with Carotid Endarterectomy

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Arvind Reddy Devanabanda ◽  
Caron Rockman ◽  
Nicole Allen ◽  
Maya Rubin ◽  
Binita Shah ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Healthy Subjects ◽  
Artery Stenosis ◽  
Monocyte Subsets ◽  
Platelet Activity ◽  
Platelet Surface ◽  
Inflammatory Monocytes ◽  
Anti Inflammatory

Background: Carotid artery stenosis (CAS) is a marker of atherosclerosis, a disease mediated by abnormalities in platelet and monocyte function, and a significant cause of stroke. Moreover, the effect of carotid artery revascularization via carotid endarterectomy (CEA) on platelet and monocyte markers is unknown. Objective: This study aims to investigate platelet activity, monocyte subsets and monocyte platelet aggregates (MPA) in CAS and changes with CEA. Methods: This prospective cohort study evaluated 48 patients who underwent non emergent CEA. Peripheral venous blood samples were obtained before, immediately postoperative and at 24 hours postoperative. Twenty healthy subjects served as controls. Platelet surface expression of P-selectin and PAC-1, monocyte subsets, and MPA were assessed using flow cytometry. Three distinct monocyte subsets were measured: anti-inflammatory (i.e. classical CD14 ++ CD16 - ) and pro-inflammatory (i.e. intermediate CD14 ++ CD16 + and nonclassical CD14 + CD16 ++ ) monocytes. Differences between two matched samples and between the study and control groups were statistically analyzed. Results: Compared to healthy subjects, CAS subjects had significantly greater markers of platelet activity (P-selectin [p=0.003] and PAC-1 [p=0.01]), pro-inflammatory monocytes (intermediate [p<0.0001] and nonclassical [p=0.009]) and MPA (p=0.0002). Following CEA, anti-inflammatory monocytes increased and pro-inflammatory monocytes decreased (Figure 1A). Platelet expression of P-selectin and MPA did not change, while PAC-1 transiently increased but then returned to baseline by 24 hours postoperative (Figure 1B &C). Conclusions: Subjects with CAS have elevated markers of thrombosis, inflammation, and their interface. However, only the pro-inflammatory monocytes are significantly reduced following CEA. Future studies investigating the clinical consequences of this reduction are warranted.

Effect of Ultrasonography in the Assessment of Carotid Artery Stenosis

Vascular ◽  
2005 ◽  
Vol 13 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Sergio X. Salles-Cunha ◽  
Enrico Ascher ◽  
Anil P. Hingorani ◽  
Natalia Markevich ◽  
Richard W. Schutzer ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Artery Stenosis ◽  
Regression Equations ◽  
Velocity Data ◽  
Data Set ◽  
Natural Logarithm ◽  
The Relationship

Although ultrasonography (US) advantageously portrays lumen and wall thickness, velocity criteria have been used primarily to interpret carotid artery stenosis. The relationship of US and velocity measurements was investigated. Peak-systolic and end-diastolic velocities (PSV, EDV) increase exponentially as the lumen of the internal carotid artery narrows and the percent stenosis (%S) increases. We tested the consistency of the relationship between carotid velocities and US %S in two distinct data sets. One data set was used to obtain regression equations relating velocity parameters and %S based on US. Validation of these equations was conducted using a separate, independent data set. US measurements were classified in 12 %S intervals. PSV, EDV, the ratio of the internal carotid artery to the common carotid artery PSV, and %S were entered consecutively until 10 records for each %S interval were obtained. Regression equations obtained in the first data set were used to predict %S in the second data set. Predicted %S was then compared with actual US %S. The highest correlation in the first data set ( r = .89) was between %S and the natural logarithm (ln) of PSV. This ln PSV -%S equation was then applied to a second data set of an additional 120 carotid duplex images. In the second data set, actual %S and PSV–predicted %S differed by > 10% in 38 cases (32%). When all velocity-%S regression equations were used for comparison, differences between actual and at least one velocity-predicted %S were > 10% in 19% of the arteries. Conversely, actual %S matched at least one prediction of %S based on velocity data in 81% of the cases. US %S differed significantly from single velocity-based estimates of %S in at least one-third of the cases. On the other hand, four of five US measurements were confirmed by at least one velocity parameter. Emphasis on US, in addition to velocity data, is recommended for the interpretation of duplex US carotid examinations.

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.

Carotid Artery Stenosis Is Associated with Better Intracranial Collateral Circulation in Stroke Patients

2020 ◽  
Vol 49 (2) ◽  
pp. 200-205
Author(s):  
Juha-Pekka Pienimäki ◽  
Niko Sillanpää ◽  
Pasi Jolma ◽  
Sara Protto
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Acute Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Collateral Circulation ◽  
Artery Stenosis ◽  
Stroke Patients ◽  
Significant Difference

Background: Adequate collateral circulation improves the clinical outcome of ischemic stroke patients. We evaluated the influence of ipsilateral carotid stenosis on intracranial collateral circulation in acute stroke patients. Methods: We collected the data of 385 consecutive acute stroke patients who underwent mechanical thrombectomy after multimodal computed tomography (CT) imaging in a single high-volume stroke center. Patients with occlusion of the first segment (M1) segment of the middle cerebral artery were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of carotid stenosis on intracranial collateral circulation was studied with appropriate statistical tests and ordinal regression analysis. Results: Fifty out of the 247 patients eligible for analysis had severe ipsilateral carotid stenosis (≥75%). These patients were 4-times more likely to have very good intracranial collaterals (Collateral Score 3–4, p = 0.001) than the nonstenotic and slightly stenotic (<75%) patients. The severely stenotic patients had a longer mean operation time (41 vs. 29 min to reperfusion, respectively, p = 0.001). Nevertheless, 54% of severely stenotic patients had good 3-month clinical outcome (modified Rankin Scale ≤2) with no significant difference between the 2 groups. Conclusions: Carotid artery stenosis of over 75% of vessel diameter was associated with better intracranial collateral circulation of patients with acute ischemic stroke. This did not significantly change the 3-month clinical outcome.

scholarly journals ABCD2 risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis

2017 ◽  
Vol 2 (2) ◽  
pp. 41-46 ◽  
Author(s):  
Mahmud Saedon ◽  
Charles E Hutchinson ◽  
Christopher H E Imray ◽  
Donald R J Singer
Keyword(s):  
Carotid Artery ◽  
Risk Score ◽  
Carotid Artery Stenosis ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Artery Stenosis ◽  
Minor Stroke ◽  
Early Assessment ◽  
Symptomatic Carotid ◽  
Significant Difference

IntroductionABCD2 risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methodsWe studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis (≥50%). 86 patients (age 70±1 (SEM: years), 58 men, 83 Caucasian) had evidence of microemboli; 72 (84%) of these underwent carotid endarterectomy (CEA). 120 patients (age 72±1 years, 91 men, 113 Caucasian) did not have microemboli detected; 102 (85%) of these underwent CEA. Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic (ROC) curves.Results140/206 (68%: 95% CI 61.63 to 74.37) patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score ≥4. There was no significant difference in the NICE red flag criterion for early assessment (ABCD2 risk score ≥4) for patients with cerebral microemboli versus those without microemboli (59/86 vs 81/120 patients: OR 1.05 ABCD2 risk score ≥4 (95% CI 0.58 to 1.90, p=0.867)). The ABCD2 risk score was <4 in 27 of 86 (31%: 95% CI 21 to 41) embolising patients and in 39 of 120 (31%: 95% CI 23 to 39) without cerebral microemboli. After adjusting for pre-neurological event antiplatelet treatment (APT), area under the curve (AUC) of ROC for ABCD2 risk score showed no prediction of cerebral microemboli (no pre-event APT, n=57: AUC 0.45 (95% CI 0.29 to 0.60, p=0.531); pre-event APT, n=147: AUC 0.51 (95% CI 0.42 to 0.60, p=0.804)).ConclusionsThe ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis. On the basis of NICE guidelines (refer early if ABCD2 ≥4), assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients.

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