Aterosclerose Carotídea e Hipodensidades da Substância Branca: uma Relação Controversa

Introduction: White matter hypodensities of presumed vascular origin, are recognized as an important cause of morbidity with established clinical and cognitive consequences. Nonetheless, many doubts remain on its physiopathology. Our goal is to clarify the potential role of carotid atherosclerosis and other vascular risk factors in the development of white matter hypodensities of presumed vascular origin. Material and Methods: We included patients that underwent CT brain scan and neurosonologic evaluation within a one-month period. Full assessment of vascular risks factors was performed. We seek to find independent associations between white matter hypodensities of presumed vascular origin, carotid intima-media thickness and vascular risk factors. Results: 472 patients were included, mean age was 67.32 (SD: 14.75), 274 (58.1%) were male. The independent predictors of white matter hypodensities of presumed vascular origin were age (OR: 1.067, 95% IC: 1.049 – 1.086, p < 0.001) and hypertension (OR: 1.726, 95% IC: 1.097 – 2.715, p = 0.018). No association was found between IMT (OR: 2.613, 95% IC: 0.886 – 7.708, p = 0.082) or carotid artery stenosis (OR: 1.021, 95% IC: 0.785 – 1.328, p = 0.877) and white matter hypodensities of presumed vascular origin. Discussion: Only age and hypertension proved to have an independent association with white matter hypodensities of presumed vascular origin. Carotid atherosclerosis, evaluated by IMT and the degree of carotid artery stenosis, showed no association with white matter hypodensities of presumed vascular origin. Since atherosclerosis is a systemic pathology, these results suggest that alternative mechanisms are responsible for the development of white matter hypodensities of presumed vascular origin. Conclusion: Age and hypertension seem to be the main factors in the development of white matter hypodensities of presumed vascular origin. No association was found between carotid atherosclerosis and white matter hypodensities of presumed vascular origin. Keywords: Brain; Carotid Artery Disease.

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Inner Ear Disorders in the Elderly with Carotid Artery Disease Requiring Revascularization: Prevalence, Characteristics, and Association

Journal of Geriatric Medicine ◽

10.30564/jgm.v2i3.2385 ◽

2020 ◽

Vol 2 (3) ◽

Author(s):

RAZAN AL FAKIR

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Inner Ear ◽

Carotid Artery Disease ◽

Vascular Risk Factors ◽

Control Group ◽

Study Group ◽

Vascular Risk ◽

Age Related ◽

Artery Disease

Background: Aging is almost assocaited with inner ear disorders (InEarDs) by means of age-related hearing impairment (ARHI) or vertigo-and-dizziness as well as the carotid artery disease requiring revascularization (CAD-R).Objective: The present study aimed to study the prevalence and characteristics of InEarDs in older adults diagnosed with CAD-R. The other aim was to determine if InEarDs in CAD-R patients is age-related or might be explained by a concomitant CAD-R.Method: A retrospective, case-control study was conducted at the Mayo Clinic, Florida. The study cohort includes 919 patients who had CAD-R. The control group consisted of 244 age- and gender-matched patients presenting with cardiac or peripheral artery disease. The InEarDs were assessed based on the diagnosis upon presentation to the Audiology Clinic and follow-up.Results: Of the 919, 348 had ARHI that includes significant peripheral signs and central symptoms (24.9%), vertigo-and-dizziness events that are recurrent and persistent with normal objective vestibular testing (12.9%), or a combination of both (11.0%). These percentages were significantly higher in the study group relative to the control group. After adjustment for the vascular risk factors, the study group had significantly higher odds of ARHI (OR= 1.94; 95% CI: 1.09-3.44; P<0.05),Conclusion: CAD-R patients had significantly higher InEarDs than the control group. CAD-R is more likely to be associated with ARHI rather than the vertigo-and-dizziness even after adjusting for the vascular risk factors.

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Transcarotid Artery Revascularization and Advances in Vascular Surgery for Carotid Artery Disease

Surgical Technology Online ◽

10.52198/21.sti.39.cv1484 ◽

2021 ◽

Author(s):

James Hu ◽

◽

Andy Sohn ◽

Justin George ◽

Rajesh Malik ◽

...

Keyword(s):

Carotid Artery ◽

Vascular Surgery ◽

Carotid Endarterectomy ◽

Surgical Management ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Artery Stenosis ◽

Cerebrovascular Accidents ◽

Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

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Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis

Acta Biochimica Polonica ◽

10.18388/abp.2017_2581 ◽

2018 ◽

Vol 65 (1) ◽

pp. 151-162

Author(s):

Arkadiusz Szarmach ◽

Mariusz Kaszubowski ◽

Agnieszka Sabisz ◽

Andrzej F Frydrychowski ◽

Grzegorz Halena ◽

...

Keyword(s):

White Matter ◽

Carotid Artery ◽

Temporal Lobe ◽

Resting State ◽

Carotid Artery Stenosis ◽

Parietal Lobe ◽

Contralateral Side ◽

Artery Stenosis ◽

Ipsilateral Side ◽

Acetazolamide Challenge

The aim of this study was to assess regional perfusion at baseline and regional cerebrovascular resistance (CVR) to delayed acetazolamide challenge in subjects with chronic carotid artery stenosis.Sixteen patients (ten males) aged 70.94±7.71 with carotid artery stenosis ≥90% on the ipsilateral side and ≤50% on the contralateral side were enrolled into the study. In all patients, two computed tomography perfusion examinations were carried out; the first was performed before acetazolamide administration and the second 60 minutes after injection.The differences between mean values were examined by paired two-sample t-test and alternative nonparametric Wilcoxon’s test. Normality assumption was examined using W Shapiro-Wilk test.The lowest resting-state cerebral blood flow (CBF) was observed in white matter (ipsilateral side: 18.4±6.2; contralateral side: 19.3±6.6) and brainstem (ipsilateral side: 27.8±8.5; contralateral side: 29.1±10.8). Grey matter (cerebral cortex) resting state CBF was below the normal value for subjects of this age: frontal lobe – ipsilateral side: 30.4±7.0, contralateral side: 33.7±7.1; parietal lobe – ipsilateral side: 36.4±11.3, contralateral side: 42.7±9.9; temporal lobe – ipsilateral side: 32.5±8.6, contralateral side: 39.4±10.8; occipital lobe – ipsilateral side: 24.0±6.0, contralateral side: 26.4±6.6). The highest resting state CBF was observed in the insula (ipsilateral side: 49.2±17.4; contralateral side: 55.3±18.4). A relatively high resting state CBF was also recorded in the thalamus (ipsilateral side: 39.7±16.9; contralateral side: 41.7±14.1) and cerebellum (ipsilateral side: 41.4±12.2; contralateral side: 38.1±11.3). The highest CVR was observed in temporal lobe cortex (ipsilateral side: +27.1%; contralateral side: +26.1%) and cerebellum (ipsilateral side: +27.0%; contralateral side: +34.6%). The lowest CVR was recorded in brain stem (ipsilateral side: +20.2%; contralateral side: +22.2%) and white matter (ipsilateral side: +18.1%; contralateral side: +18.3%). All CBF values were provided in milliliters of blood per minute per 100 g of brain tissue [ml/100g/min]. Resting state circulation in subjects with carotid artery stenosis is low in all analysed structures with the exception of insula and cerebellum. Acetazolamide challenge yields relatively uniform response in both hemispheres in the investigated population.Grey matter is more reactive to acetazolamide challenge than white matter or brainstem.

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Angioplasty and stenting for carotid artery stenosis: indications, techniques, results, and complications

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.6.6 ◽

1998 ◽

Vol 5 (6) ◽

pp. E5 ◽

Cited By ~ 1

Author(s):

Giuseppe Lanzino ◽

Richard D. Fessler ◽

Robert A. Mericle ◽

Ajay K. Wakhloo ◽

Lee R. Guterman ◽

...

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Disease ◽

Artery Stenosis ◽

High Risk Patients ◽

Clinical Series ◽

Risk Patients ◽

Artery Disease ◽

Angioplasty And Stenting

Following the favorable results obtained in the treatment of coronary artery disease, combined angioplasty and stenting has been advocated for the treatment of carotid artery stenosis as well. Although widespread application of angioplasty and stenting for carotid artery disease is neither indicated nor recommended, it may be a viable alternative therapy for select patients who are high-risk patients for surgery. The results of early series have suggested that endoluminal revascularization in these high-risk patients can be performed with an acceptable degree of safety. Although the incidence of death and major stroke rates following angioplasty and stenting procedures compares favorably with surgery, results of more recent clinical series have suggested that the incidence of perioperative transient neurological events and minor strokes may be higher than suggested by earlier reports, especially in patients with recent neurological symptoms and “unstable” plaques. In this article, the authors review the current potential indications for and preliminary results of angioplasty and stenting and describe their procedural technique. In addition, potential applications of stenting to intracranial thromboocclusive carotid artery disease are reviewed.

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Abstract TMP58: Determinants of White Matter Hyperintensity in Acute Ischemic Stroke Patients: The MRI-GENIE Study

Stroke ◽

10.1161/str.48.suppl_1.tmp58 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Anne-Katrin Giese ◽

Markus D Schirmer ◽

Adrian V Dalca ◽

Ramesh Sridharan ◽

Lisa Cloonan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Ischemic Stroke ◽

White Matter ◽

Stroke Risk ◽

Smoking Status ◽

Vascular Risk Factors ◽

White Matter Hyperintensity ◽

Vascular Risk ◽

Prior Stroke

Introduction: White matter hyperintensity (WMH) is a highly heritable trait and a significant contributor to stroke risk and severity. Vascular risk factors contribute to WMH severity; however, knowledge of the determinants of WMH in acute ischemic stroke (AIS) is still limited. Hypothesis: WMH volume (WMHv) varies across AIS subtypes and is modified by vascular risk factors. Methods: We extracted WMHv from the clinical MRI scans of 2683 AIS subjects from the MRI-Genetics Interface Exploration (MRI-GENIE) study using a novel fully-automated, volumetric analysis pipeline. Demographic data, stroke risk factors and stroke subtyping for the Causative Classification of Stroke (CCS) were performed at each of the 12 international study sites. WMHv was natural log-transformed for linear regression analyses. Results: Median WMHv was 5.7cm 3 (interquartile range (IQR): 2.2-12.8cm 3 ). In univariable analysis, age (63.1 ± 14.7 years, β=0.04, SE=0.002), prior stroke (10.2%, β=0.66, SE=0.08), hypertension (65.4%, β=0.75, SE=0.05), diabetes mellitus (23.1%, β=0.35, SE=0.06), coronary artery disease (17.6%, β=0.04, SE=0.002), and atrial fibrillation (14.6%, β=0.48, SE=0.07) were significant predictors of WMHv (all p<0.0001), as well as smoking status (52.2%, β=0.15, SE=0.05, p=0.005), race (16.5% Non-Caucasian, β=0.25, SE=0.07) and ethnicity (8.2% Hispanic, β=0.30, SE=0.11) (all p<0.01). In multivariable analysis, age (β=0.04, SE=0.002), prior stroke (β=0.56, SE=0.08), hypertension (β=0.33, SE=0.05), smoking status (β=0.16, SE=0.05), race (β=0.42, SE=0.06), and ethnicity (β=0.34, SE=0.09) were independent predictors of WMHv (all p<0.0001), as well as diabetes mellitus (β=0.13, SE=0.06, p=0.02). WMHv differed significantly (p<0.0001, unadjusted) across CCS stroke subtypes: cardioembolic stroke (8.0cm 3 , IQR: 4.2-15.4cm 3 ), large-artery stroke (6.9cm 3 , IQR: 3.1-14.7cm 3 ), small-vessel stroke (5.8cm 3 , IQR: 2.5-13.5cm 3 ), stroke of undetermined (4.7cm 3 , IQR: 1.6-11.0cm 3 ) or other (2.55cm 3 , IQR: 0.9-8.8cm 3 ) causes. Conclusion: In this largest-to-date, multicenter hospital-based cohort of AIS patients with automated WMHv analysis, common vascular risk factors contribute significantly to WMH burden and WMHv varies by CCS subtype.

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Abstract WP141: Genetic Polymorphisms Influence Carotid Atherosclerosis

Stroke ◽

10.1161/str.48.suppl_1.wp141 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Eugenia Arias ◽

Horacio Martinetto ◽

Naomi Arakaki ◽

Gustavo E Sevlever ◽

Sebastian F Ameriso

Keyword(s):

Risk Factors ◽

General Population ◽

Carotid Atherosclerosis ◽

Vascular Risk Factors ◽

Genetic Profile ◽

Vascular Risk ◽

Chi Square ◽

Symptomatic Disease ◽

Endothelial Proliferation ◽

Pcr Rflp

Introduction: Genetic susceptibility affects atherosclerosis in humans. Polymorphisms of genes of angiotensin-converting enzyme (ACE), lipoprotein APOE (APOE), IL1 receptor antagonist (IL1Ra) and myeloperoxidase (MPO) are associated with several components of atherosclerotic disease. We evaluated allelic and genotypic frequencies and their association with age at presentation, vascular risk factors, and presence of symptoms in subjects with carotid atherosclerosis. Methods: We studied Argentine patients with severe carotid atherosclerosis and controls from the general population. Age, vascular risk factors and presence of neurological symptoms were recorded. DNA was obtained from peripheral blood and PCR or PCR-RFLP were used to typify ACE, APOE, IL1Ra, and MPO genes. Allelic and genotypic frequencies were compared and genotypic susceptibility variants were established. Chi-square and good fit test were applied for differences between expected and observed frequencies. Results: There were 137 patients, 36 women and 101 men, aged 67±8 years. Symptomatic subjects younger than 60 years had higher frequency of the alleles ACE-DD, associated to vasoconstriction, endothelial proliferation, oxidation, and apoptosis (p<0.01); IL1RN-12/22, associated to inflammation and apoptosis (p<0.01); and MPO*GA/AA, associated to less oxidative response and proatherogenic (p<0.05). Subjects older than 60 years had a genetic profile similar to the general population without atherosclerosis, with similar prevalence of ACE-ID/II, IL1RN-11, and MPO-GG and a higher frequency of APOE23, 24 and 34m. Independent associations of ACE*D and IL1RN*2 with dyslipidemia and of MPO-GA and APOE-34 with hypertension were observed. Conclusions: Subjects with carotid atherosclerosis are genetically different from the general population. Carriers of certain gene variants were predominant among atherosclerotic subjects, suggesting susceptibility, and others were more prevalent in controls, suggesting protection. Some polymorphisms and their combinations are associated with occurrence of symptomatic disease at an earlier age. The genetic profile of older patients does not substantially differ from the general population.

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