Communication of inwardly projecting neovessels with the lumen contributes to symptomatic intraplaque hemorrhage in carotid artery stenosis

OBJECT Recent studies have demonstrated that plaque morphology can contribute to identification of patients at high risk of carotid artery atherosclerosis as well as the degree of stenosis in those with carotid atherosclerosis. Neovascularization of carotid plaques is associated with plaque vulnerability. However, the mechanism of neovascularization in intraplaque hemorrhage (IPH) and its clinical contribution remain undetermined. In this study, the authors aimed to clarify the characteristics of neovessel appearance with a focus on inwardly projecting neovessels, which are reportedly important in plaque advancement. METHODS Consecutive patients with moderate to severe carotid atherosclerosis who underwent carotid endarterectomy were prospectively analyzed from 2010 to 2014. The neovessel appearance was categorized into 3 groups based on intraoperative indocyanine green (ICG) videoangiography: early appearance of neovessels from the endothelium (NVe), late appearance of neovessels from the vasa vasorum (NVv), and no appearance of vessels. Each neovessel pattern was evaluated with respect to clinical, radiological, and pathological findings including IPH, neovascularization, hemosiderin spots, and inflammation. RESULTS Of 57 patients, 13 exhibited NVe, 33 exhibited NVv, and 11 exhibited no neovessels. Overall, the interobserver and intraobserver reproducibilities of neovessel appearance were substantial for ICG videoangiography (κ = 0.76) and at 7 days postoperatively (κ = 0.76). There were no significant differences in baseline characteristics among the 3 groups, with the exception of a higher percentage of symptomatic presentations in patients with NVe (artery-to-artery embolic infarction in 61.5% and transient ischemic attack in 23.1%). Moreover, patients with NVe exhibited larger infarctions than did those with NVv (9675.0 ± 5601.9 mm3 vs 2306.6 ± 856.9 mm3, respectively; p = 0.04). Pathologically, patients with NVe had more severe IPH (47.2 ± 8.3 mm2 vs 19.8 ± 5.2 mm2, respectively; p < 0.01), hemosiderin spots (0.5 ± 0.2 mm2 vs 0.2 ± 0.1 mm2, respectively; p = 0.04), neovessels (0.4 ± 0.7 mm2 vs 0.1 ± 0.4 mm2, respectively; p = 0.11), and inflammation (1.0 ± 1.1 mm2 vs 0.6 ± 0.9 mm2, respectively; p = 0.26) around the endothelium than did patients with NVv, and all of these parameters were correlated with hyperintensity on time-of-flight MRI. However, the neovessel and inflammation differences were nonsignificant. Interestingly, inflammation was significantly correlated with neovessel formation (r = 0.43, p = 0.0008), hemosiderin spots (r = 0.62, p < 0.0001), and IPH (r = 0.349, p = 0.0097), suggesting that inflammation may be a key factor in plaque vulnerability. CONCLUSIONS Communication of inwardly projecting neovessels with the lumen and inflammation synergistically contribute to IPH and symptomatic presentations in patients with carotid stenosis and are more specific than the vasa vasorum. This condition could be a new therapeutic target, and regression of luminal neovessel sprouting and inflammation may help to prevent IPH development and a symptomatic presentation.

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Abstract 170: Luminal Neovascular Sprouting with Inflammation Contributes to Symptomatic Intraplaque Hemorrhage in Carotid Stenosis

Stroke ◽

10.1161/str.46.suppl_1.170 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Nobutaka Horie ◽

Yoichi Morofuji ◽

Minoru Morikawa ◽

Susumu Yamaguchi ◽

Yohei Tateishi ◽

...

Keyword(s):

Carotid Stenosis ◽

Carotid Atherosclerosis ◽

Vasa Vasorum ◽

Intraplaque Hemorrhage ◽

Resonance Imaging ◽

Plaque Vulnerability ◽

Indocyanine Green Videoangiography ◽

Key Factor ◽

Baseline Characteristics

Background and Purpose: Neovascularization of carotid plaques is associated with plaque vulnerability. However, the role of neovascularization in the development of intraplaque hemorrhage (IPH) and the clinical contribution of neovascularization to IPH and symptomatic presentation remain undetermined. Methods: Consecutive patients with moderate to severe carotid atherosclerosis who underwent carotid endarterectomy were prospectively analyzed from 2010 to 2014. The neovessel appearance was categorized into three groups based on dynamic intraoperative indocyanine green videoangiography: neovessels derived from the endothelium (NVe), neovessels derived from the vasa vasorum (NVv), and no neovessels. Each neovessel pattern was evaluated with respect to clinical, radiological, and pathological findings. Results: Of 57 patients, 13 exhibited NVe, 33 exhibited NVv, and 11 exhibited no neovessels. There were no significant differences in baseline characteristics among the three groups with the exception of a higher percentage of symptomatic presentations among patients with NVe. Moreover, patients with NVe exhibited larger infarctions than did those with NVv (P=0.04). Pathologically, patients with NVe had more severe IPH (P=0.002), hemosiderin spots (P=0.04), neovessels (P=0.11) and inflammation (P=0.26), all of which were correlated with hyperintensity on time-of-flight magnetic resonance imaging. Interestingly, inflammation was significantly correlated with neovessel formation (R=0.43, P=0.008), hemosiderin spots (R=0.62, P<0.0001), and IPH (R=0.349, P=0.0097), suggesting that inflammation may be a key factor in plaque vulnerability. Conclusions: Luminal neovascular sprouting with inflammation and lumen communication could clinically contribute to IPH and symptomatic presentation in patients with carotid stenosis. This condition may thus be a key therapeutic target against neovessel formation and inflammation.

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The Course of Carotid Plaque Vulnerability Assessed by Advanced Neurosonology

Frontiers in Neurology ◽

10.3389/fneur.2021.702657 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sander Johan Aarli ◽

Lars Thomassen ◽

Ulrike Waje-Andreassen ◽

Nicola Logallo ◽

Christopher Elnan Kvistad ◽

...

Keyword(s):

Cerebral Ischemia ◽

Carotid Artery ◽

Time Course ◽

Plaque Morphology ◽

Plaque Vulnerability ◽

Clinical Trial Registration ◽

Carotid Artery Atherosclerosis ◽

Acute Cerebral Ischemia ◽

Ischemic Attack

Background: Carotid artery atherosclerosis is a major risk factor for ischemic stroke. This risk is related to plaque vulnerability and is characterized by plaque morphology, intraplaque neovascularization, and cerebral microembolization. Advanced neurosonology can identify vulnerable plaques and aid in preventing subsequent stroke. We aimed to assess the time course of cerebral microembolization and intraplaque neovascularization during 6 months of follow-up and to explore the utility of advanced neurosonology in patients with acute cerebral ischemia.Methods: Fifteen patients with acute cerebral ischemia and carotid artery plaques underwent comprehensive extra- and intracranial ultrasound examinations, including microemboli detection and contrast-enhanced ultrasound. The examinations were repeated after 3 and 6 months.Results: We examined 28 plaques in 15 patients. The ultrasonographic features of plaque vulnerability were frequent in symptomatic and asymptomatic plaques. There were no significant differences in stenosis degree, plaque composition, plaque surface, neovascularization, or cerebral microembolization between symptomatic and asymptomatic plaques, but symptomatic plaques had a higher number of vulnerable features. None of the patients had recurrent clinical stroke or transient ischemic attack during the follow-up period. We observed a decrease in cerebral microembolization at 6 months, but no significant change in intraplaque neovascularization.Conclusions: In patients with acute cerebral ischemia and carotid artery plaques, cerebral microembolization decreased during 6 months of follow-up, indicating plaque stabilization.Clinical Trial Registration:ClinicalTrial.gov, identifier NCT02759653.

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3039Vulnerability of carotid atherosclerosis: relationship with plaque location, plaque eccentricity and vessel remodeling patterns. Insight from the the MAGNETIC observational study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0006 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O Catalano ◽

C Cerabolini ◽

E Eshja ◽

G Bendotti ◽

M De Salvo ◽

...

Keyword(s):

Carotid Artery ◽

Wall Thickness ◽

Carotid Atherosclerosis ◽

Internal Carotid ◽

Intraplaque Hemorrhage ◽

Plaque Vulnerability ◽

Cross Sectional ◽

Fibrous Cap ◽

Vessel Remodeling ◽

Maximum Wall Thickness

Abstract Carotid atherosclerosis is a cause of brain ischemic events. Cardiovascular magnetic resonance (CMR) can assess plaque vulnerability. We investigated atherosclerosis vulnerability in relation to plaque location, eccentricity and vessel remodeling. Methods-Baseline CMR evaluations of the MAGNETIC observational study, were analyzed. We quantitated with MRI-Plaque View™, vessel lumen/wall and vulnerable plaque components of a 32-mm segment of common carotid artery (12 mm), bulb (8 mm) and internal carotid artery (12 mm). Lipid-rich necrotic core [LRNC], fibrous cap [CAP] and intraplaque hemorrhage [IPH] were expressed as percent of wall area. Results-A data-set of 8080 sections of adequate quality in 260 patients (198 male [76%], median age 71 years [65–76]), were analyzed. Patients were on therapy with antiplatelet, ACE-inhibitors/ARB and statins (196–229 out of 260 [75–88%]). We found significant differences in plaque composition according to longitudinal and circumferential location, eccentricity and vessel remodeling (table). At multivariate regression analysis, including classical RF and atherosclerotic burden, we found an independent association of: LRNC and IPH with longitudinal location, eccentricity and positive remodeling, and of CAP with eccentricity (p<0.001 for all). Lipid-rich necrotic core Fibrous cap Intraplaque hemorrhage Longitudinal distribution Common carotid artery 4% [1–10] p<0.001 6% [4–11] p<0.001 0% [0–3] p<0.001 Carotid bulb 7% [3–13] 9% [5–13] 1% [0–4] Internal carotid artery 3% [0–10] 7% [4–11] 0% [0–1] Circunferenzial location Antero-medial 4% [0–11] p<0.001 7% [4–12] p=0.07 0% [0–2] p<0.001 Antero-lateral 6% [1–12] 8% [5–12] 1% [0–4] Postero-lateral 5% [0–11] 7% [4–12] 0% [0–3] Postero-medial 5% [0–11] 7% [4–12] 0% [0–1] Plaque eccentricity Concentric 3% [0–9] p<0.001 7% [4–11] p<0.001 0% [0–2] p<0.001 Eccentric 9% [4–15] 9% [5–13] 1% [0–4] Remodelling pattern Negative 4% [0–10] p<0.001 7% [4–11] p<0.001 0% [0–2] p<0.001 Positive 7% [3–13] 8% [5–13] 1% [0–4] Plaque eccentricity was defined as eccentricity index (EI = [maximum wall thickness − minimum wall thickness]/maximum wall thickness) in the highest quartile. Positive remodeling was defined as remodeling index (= [vessel cross-sectional area − reference area]/cross-sectional area) in the highest quartile. Conclusions Carotid atherosclerotic plaque vulnerability seems to be independently associated with longitudinal location, plaque eccentricity and vessel positive remodeling. Acknowledgement/Funding Bayer AG, Leverkusen, Germany

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Abstract 3482: Increased Matrix Metalloproteinase-9 Expression is Correlated with Carotid Intraplaque hemorrhage in a Swine Model

Stroke ◽

10.1161/str.43.suppl_1.a3482 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Zhong-Song Shi ◽

Xiao-Bing Jiang ◽

Jin-Shan Wang ◽

Wei-Si Yuan ◽

Dong-Hong Liu

Keyword(s):

Carotid Artery ◽

Matrix Metalloproteinase ◽

Vulnerable Plaque ◽

Carotid Plaque ◽

Carotid Atherosclerosis ◽

Intraplaque Hemorrhage ◽

Swine Model ◽

Carotid Plaques ◽

Rete Mirabile ◽

Atherosclerotic Changes

Purpose: The limited number of large animal carotid atherosclerotic models restricts the preclinical evaluation of endovascular therapies. Carotid intraplaque hemorrhage may be associated with a higher risk of ischemic stroke in patients with carotid disease. In this study, we assess the association of the lesional expression of matrix metalloproteinase (MMP)-9 with vulnerable atherosclerotic carotid plaque and intraplaque hemorrhage in a Swine model. Materials and Methods: Carotid atherosclerosis was induced in miniswines using the combination of partial ligation and high cholesterol diet, and a minimum 70% stenosis was confirmed by Doppler ultrasonography immediately post-ligation. Carotid artery sections were obtained for histopathological examination and immunohistochemical study for MMP-9 at three months. Distal embolism was determined by the presence of atheroemboli in the ipsilateral rete mirabile. Atherosclerotic changes were classified by AHA/Stary stage (type I to VI). The association of distal embolism in the rete mirabile with vulnerable carotid plaque was analyzed. The association of MMP-9 expression in the plaque with the vulnerable plaque and intraplaque hemorrhage was further analyzed. Results: One hundred ninety-one carotid segments from ten carotid artery models were assessed. Among 139 segments with atherosclerotic changes, 102 segments had vulnerable plaque (Stary IV to VI). Vulnerable atherosclerotic plaques were found more frequently in the vessel wall proximal to the partial ligation than distal ( P <0.0001). Distal embolism was found in all 10 rete mirabilis, and deemed to be from the ipsilateral vulnerable carotid plaques. Areas positive for MMP-9 tended to be greater in the vulnerable plaque than in the stable plaque (8.69 ± 0.73% vs. 7.04 ± 0.94%, p=0.35). Areas positive for MMP-9 were significantly greater in the plaque with intraplaque hemorrhage than in the plaque without intraplaque hemorrhage (11.84 ± 1.22% vs. 6.63 ± 0.59%, p<0.001). On multivariate analysis, positive expression of MMP-9 was an independent predictor of intraplaque hemorrhage (p=0.007). Conclusion: Vulnerable carotid plaques with distal embolism were created in a Swine model of carotid atherosclerosis. Increased expression of MMP-9 may be associated with vulnerable carotid plaques, especially having the feature of intraplaque hemorrhage.

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Abstract WP162: Impact of Carotid Artery Remodeling by T1 weighted MR Imaging for the Assessment of Plaque Vulnerability in High-grade Carotid Stenosis

Stroke ◽

10.1161/str.44.suppl_1.awp162 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Kenji Fukuda ◽

Koji Iihara ◽

Naoaki Yamada ◽

Hatsue Ueda

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Average Rate ◽

Intraplaque Hemorrhage ◽

High Grade ◽

Plaque Vulnerability ◽

Rapid Acquisition ◽

Asymptomatic Patients ◽

Artery Remodeling ◽

The Relationship

Background- The relationship between coronary artery remodeling and plaque vulnerability has been described on the basis of symptomatology and histology. However, the association with carotid artery remodeling has not been explored in detail. The aim of this study was to validate the relationship between carotid artery remodeling and plaque vulnerability by comparing the degree of outward remodeling calculated using 3D inversion-recovery-based T1-weighted imaging (magnetization-prepared rapid acquisition gradient-echo [MPRAGE]) with the symptomatology and histology of plaques extracted during carotid endarterectomy (CEA). Methods and Results- Sixty-one patients with high-grade carotid stenosis who underwent CEA and whose plaque could be examined were included. The average rate of stenosis as per the NASCET criteria was 79.8%. The carotid remodeling index (CRI) was determined by measuring the external cross-sectional vessel area (CSVA) of the maximum stenosis of the internal carotid artery (ICA) and dividing it by the external CSVA of the distal ICA unaffected by atherosclerosis using MPRAGE imaging. The relationship between the CRI and plaque vulnerability was evaluated on the basis of symptomatology and histology. The CRI was significantly higher in symptomatic patients than in asymptomatic patients (1.98 ± 0.26 vs. 1.68 ± 0.24, p < 0.0001). A higher CRI was positively correlated with the necrotic core area (r = 0.568, p < 0.0001) as well as significantly associated with severe intraplaque hemorrhage (p < 0.0001) and the prevalence of cap inflammation with macrophage (p = 0.03) and lymphocyte (p = 0.01) infiltration. Conclusion- These results validate the relationship between carotid artery remodeling and plaque vulnerability in high-grade carotid stenosis. MPRAGE imaging is effective to assess plaque vulnerability in terms of the CRI in addition to the signal intensity of carotid plaques.

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Correlation between computed tomography angiography and histology of carotid artery atherosclerosis: Can semi-automated imaging software predict a plaque's composition?

Interventional Neuroradiology ◽

10.1177/15910199211031093 ◽

2021 ◽

pp. 159101992110310

Author(s):

John C Benson ◽

Valentina Nardi ◽

Melanie C Bois ◽

Luca Saba ◽

Waleed Brinjikji ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Computed Tomography Angiography ◽

Necrotic Core ◽

Intraplaque Hemorrhage ◽

Histological Evaluation ◽

Plaque Volume ◽

Volumetric Imaging ◽

Carotid Artery Atherosclerosis

Background Using computed tomography angiography to differentiate between components of carotid atherosclerotic lesions remains largely elusive. This study sought to validate a semi-automated software for computed tomography angiography plaque analysis using histologic comparisons. Materials and Methods A retrospective review was performed of consecutive patients that underwent a carotid endarterectomy, with pre-procedural computed tomography angiography imaging of the cervical arterial vasculature available for review. Images were evaluated using a commercially-available software package, which produced segmented analyses of intraplaque components (e.g. intraplaque hemorrhage, lipid-rich necrotic core, and calcifications). On imaging, each component was assessed in terms of its (1) presence or absence, and (2) both volume and proportion of the total plaque volume (if present). On histological evaluation of carotid endarterectomy specimens, each component was evaluated as an estimated proportion of total plaque volume. Results Of 80 included patients, 30 (37.5%) were female. The average age was 69.7 years (SD = 9.1). Based on imaging, intraplaque hemorrhage was the smallest contributor to plaque composition (1.2% of volumes on average). Statistically significant linear associations were noted between the proportion of intraplaque hemorrhage, lipid-rich necrotic core, and calcifications on histology and the volume of each component on imaging ( p values ranged from 0.0008 to 0.01). Area under curve were poor for intraplaque hemorrhage and lipid-rich necrotic core (0.59 and 0.61, respectively) and acceptable for calcifications (0.73). Conclusion Semi-automated analyses of computed tomography angiography have limited diagnostic accuracy in the detection of intraplaque hemorrhage and lipid-rich necrotic core in carotid artery plaques. However, volumetric imaging measurements of different components corresponded with histologic analysis.

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170 Vasa Vasorum Activities in Human Carotid Atherosclerosis is Associated with Plaque Development and Vulnerability

Neurosurgery ◽

10.1093/neuros/nyx417.170 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 243-244

Author(s):

Sungpil Joo

Keyword(s):

T Cell ◽

Mast Cells ◽

Carotid Artery ◽

Carotid Plaque ◽

Vasa Vasorum ◽

Plaque Vulnerability ◽

Unstable Plaque ◽

Symptomatic Carotid ◽

Before And After ◽

Stable Plaque

Abstract INTRODUCTION Carotid endarterectomy (CEA) has been shown to be beneficial in patients with high-grade symptomatic carotid artery stenosis. Subintimal and intraplaque hemorrhages are frequently seen during CEA in the absence of any visible breach in the intima, as these changes are derived from the vasa vasorum system rather than from blood in the vessel lumen. Imaging modalities to characterize unstable, vulnerable plaques are strongly needed for better risk stratification in these patients. The aim of this study was to investigate the correlation between the activities of the carotid vasa vasorum and carotid plaque vulnerability using indocyanine green-video angiography (ICG-VA) during CEA, focusing on how the carotid artery vasa vasorum is depicted. METHODS Sixty-nine patients (mean age, 68.5 ± 2.5 years; mean degree of stenosis, 78.9 ± 3.8) who underwent CEA were enrolled prospectively from September 2013 to December 2014. ICG was injected intravenously as a bolus before and after resecting the atheroma during CEA. We also performed immunohistochemistry using CD68 (macrophage), CD117 (mast cell), CD4 (T-cell), and CD8 (T-cell) antibodies for resected plaque specimens. RESULTS >Active vasa vasorum density was observed in all patients on ICG-VA (n = 69). The vasa vasorum externa (VVE) and interna (VVI) were seen in 11 (16%) and 57 patients (82.6%), respectively. The types of VVE were strongly associated with preoperative angiographic instability (90.0%, P = 0.005) and carotid plaque vulnerability (100%, P = 0.007) macroscopically. In contrast, the types of VVI were less associated with angiographic instability (36.1%) and plaque vulnerability (49.1%, P = 0.003). CD86- and CD117-stained macrophages and mast cells were observed more frequently in unstable plaque, compared to those in stable plaque (P < 0.0001, P = 0.002, respectively). CONCLUSION The early appearance of VVE on ICG-VA was strongly associated with unstable carotid plaque and many microvessel channels that provided nutrients to the developing and expanding intima and potentially created an unstable hemorrhagic environment prone to rupture. Macrophages and mast cells were involved in the formation of microvessels in the atherogenic plaque and accelerated plaque progression into an unstable plaque phenotype.

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Carotid Plaque Morphology is Similar in Patients with Reduced and Normal Renal Function

Clinical Medicine Insights Cardiology ◽

10.1177/1179546820951793 ◽

2020 ◽

Vol 14 ◽

pp. 117954682095179

Author(s):

Caroline Heijl ◽

Fredrik Kahn ◽

Andreas Edsfeldt ◽

Christoffer Tengryd ◽

Jan Nilsson ◽

...

Keyword(s):

Renal Function ◽

Carotid Plaque ◽

Continuous Variable ◽

Intraplaque Hemorrhage ◽

Plaque Morphology ◽

Plaque Vulnerability ◽

Vulnerable Atherosclerotic Plaque ◽

Increased Risk ◽

Plaque Phenotype ◽

Tissue Calcium

Background: Chronic Kidney Disease (CKD) is associated with an increased risk for cardiovascular events such as stroke. However, it is still unclear if decreased kidney function is associated with a vulnerable atherosclerotic plaque phenotype. To explore if renal function was associated with carotid plaque vulnerability we analyzed carotid plaques obtained at surgery from the Carotid Plaque Imaging Project (CPIP). Methods: Patients were enrolled through the CPIP cohort. The indication for surgery was plaques with stenosis >70%, associated with ipsilateral symptoms or plaques with stenosis >80% not associated with symptoms. Transversal sections from the most stenotic plaque region were analyzed for connective tissue, calcium, lipids, macrophages, intraplaque hemorrhage, and smooth muscle cells. Homogenates were analyzed for collagen and elastin. Results: Carotid endarterectomy specimens from 379 patients were obtained. The median GFR was 73 ml/min/1.73 m2. Plaque characteristics showed no significant association with eGFR, neither when eGFR was divided in CKD groups nor when eGFR was handled as a continuous variable and adjusting for other known risk factors (ie, age, diabetes, hypertension, and smoking). Conclusions: The higher risk of cardiovascular disease such as stroke in CKD is not associated with increased plaque vulnerability and other factors have to be sought.

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Association Between Carotid Atherosclerosis Plaque With High Signal Intensity on T1-Weighted Imaging and Subsequent Ipsilateral Ischemic Events

Neurosurgery ◽

10.1227/neu.0b013e3181fc60a8 ◽

2011 ◽

Vol 68 (1) ◽

pp. 62-67 ◽

Cited By ~ 41

Author(s):

Yoshitaka. Kurosaki ◽

Kazumichi. Yoshida ◽

Hideki. Endo ◽

Masaki. Chin ◽

Sen. Yamagata

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Carotid Artery ◽

Intraplaque Hemorrhage ◽

High Signal ◽

Resonance Imaging ◽

Severe Stenosis ◽

Positive Group ◽

Ischemic Attack ◽

Ischemic Events

Abstract BACKGROUND: An association between magnetic resonance imaging detection of intraplaque hemorrhage and the risk of cerebral ischemic events has been described. However, few studies have followed patients with intraplaque hemorrhage. OBJECTIVE: We used 3-dimensional gradient-echo black-blood T1-weighted imaging (screening BB [S-BB]) as a magnetic resonance imaging sequence to evaluate acute cerebrovascular stroke. The association between S-BB high signal plaques and the risk of subsequent ipsilateral ischemic events was investigated. METHODS: A total of 928 consecutive patients hospitalized for a stroke or transient ischemic attack according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification were evaluated. Recurrence was retrospectively evaluated in S-BB–positive patients and patients with severe stenosis (SS) (≥70%) by magnetic resonance angiography. Based on clinical and imaging findings, recurrence was defined as a carotid artery stroke or transient ischemic attack that developed after hospital discharge as an initial event. RESULTS: Sixty-six patients were S-BB positive and 62 patients had severe stenosis (S-BB positive with SS, 32 patients; S-BB negative with SS, 30 patients; S-BB positive without SS, 34 patients). During a mean follow-up period of 9.1 months, 7 S-BB–positive patients with SS (18.7%) and 1 S-BB-negative patient with SS (3%) had a recurrent event (P = .051). In the S-BB–positive group, in 34 patients without SS, the recurrence rate was 14.7% (5/34); the difference in the recurrence rate between S-BB–positive group with and without SS was not significant (P = .34). CONCLUSION: Patients with carotid artery lesions and intraplaque hemorrhage tend to be at higher risk of a subsequent ipsilateral ischemic event. Risk evaluation of carotid artery disease should include plaque characteristics.

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The relationship between sclerostin and carotid artery atherosclerosis in patients with stages 3-5 chronic kidney disease

10.21203/rs.2.13024/v1 ◽

2019 ◽

Author(s):

Ban Zhao ◽

Aiqun Chen ◽

Haitao Wang ◽

Ju Cui ◽

Ying Sun ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Logistic Regression ◽

Renal Function ◽

Kidney Disease ◽

Carotid Artery ◽

Carotid Atherosclerosis ◽

Interquartile Range ◽

Atherosclerotic Plaques ◽

Unconditional Logistic Regression ◽

Carotid Artery Atherosclerosis

Abstract Background: Sclerotin is an antagonist of the Wnt-β-catenin pathway, may play an important role in the pathophysiology of artery atherosclerosis. Previously, we reported that sclerostin was closely related to carotid atherosclerosis and the long-term outcomes of hemodialysis patients. Here, we aimed to investigate the associations of sclerostin with renal function and carotid artery atherosclerosis in non-dialysis patients with chronic kidney disease in stages 3–5 (CKD 3–5ND). Methods: A total of 140 patients with CKD 3–5ND were enrolled in this cross-sectional study. The Chronic Kidney Disease Epidemiology Collaboration Equation (CKD-EPI) was used to estimate glomerular filtration rate (eGFR). Carotid artery atherosclerotic plaques were identified by B-mode Doppler ultrasound. Blood samples were collected to assess serum sclerostin. Unconditional logistic regression analysis was used to assess risk factors for carotid atherosclerotic plaques. Results: The median eGFR and serum sclerostin were 24.9 mL/min/1.73m 2 (interquartile range: 10.0 to 40.3 mL/min/1.73m 2 ) and 46.76 pmol/L (interquartile range: 30.18 to 67.56 pmol/L) , respectively. Carotid atherosclerotic plaques were detected in 104 subjects (74.3%). There was a negative association between sclerostin and eGFR (r = -0.214, p = 0.011). Unconditional logistic regression revealed that sclerostin was an independent factor that was significantly related to the presence of carotid plaques, with odds ratio (OR) of 1.026 (1.003, 1.051). Conclusions: Patients with CKD 3–5ND showed a gradual increase in serum sclerostin with declining renal function, and sclerostin is an independent correlate for carotid atherosclerosis.

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