Circulating miRNA levels differ with respect to carotid plaque characteristics and symptom occurrence in patients with carotid artery stenosis and provide information on future cardiovascular events

Serum c-reactive protein (CRP) was suggested for the assessment of intermediate cardiovascular (CV) risk. Here, systemic or intraplaque CRP levels were investigated as predictors of major adverse cardiovascular events (MACEs) in patients with severe carotid stenosis. CRP levels were assessed in the serum and within different portions (upstream and downstream) of carotid plaques of 217 patients undergoing endarterectomy. The association between CRP and intraplaque lipids, collagen, neutrophils, smooth muscle cells (SMC), and macrophage subsets was determined. No correlation between serum CRP and intraplaque biomarkers was observed. In upstream portions, CRP content was directly correlated with intraplaque neutrophils, total macrophages, and M1 macrophages and inversely correlated with SMC content. In downstream portions, intraplaque CRP correlated with M1 and M2 macrophages. According to the cut-off point (CRP > 2.9%) identified by ROC analysis in upstream portions, Kaplan-Meier analysis showed that patients with high CRP levels had a greater rate of MACEs. This risk of MACEs increased independently of age, male gender, serum CRP, and statin use. In conclusion, in patients with severe carotid artery stenosis, high CRP levels within upstream portions of carotid plaques directly and positively correlate with intraplaque inflammatory cells and predict MACEs at an 18-month follow-up period.

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Soluble ST2 levels are not associated with secondary cardiovascular events and vulnerable plaque phenotype in patients with carotid artery stenosis

Atherosclerosis ◽

10.1016/j.atherosclerosis.2013.08.024 ◽

2013 ◽

Vol 231 (1) ◽

pp. 48-53 ◽

Cited By ~ 10

Author(s):

Sanne Willems ◽

Paul H.A. Quax ◽

Gert Jan de Borst ◽

Jean-Paul P.M. de Vries ◽

Frans L. Moll ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Vulnerable Plaque ◽

Cardiovascular Events ◽

Artery Stenosis ◽

Soluble St2 ◽

Plaque Phenotype

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Association between the −514 c→t polymorphism of the hepatic lipase gene promoter and unstable carotid plaque in patients with severe carotid artery stenosis

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)02116-2 ◽

2002 ◽

Vol 40 (6) ◽

pp. 1059-1066 ◽

Cited By ~ 19

Author(s):

Elisabetta Faggin ◽

Alberto Zambon ◽

Massimo Puato ◽

Samir S Deeb ◽

Sandra Bertocco ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Plaque ◽

Hepatic Lipase ◽

Gene Promoter ◽

Artery Stenosis ◽

Lipase Gene ◽

Hepatic Lipase Gene

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Serum levels of osteopontin predict major adverse cardiovascular events in patients with severe carotid artery stenosis

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.01.008 ◽

2018 ◽

Vol 255 ◽

pp. 195-199 ◽

Cited By ~ 24

Author(s):

Federico Carbone ◽

Fabio Rigamonti ◽

Fabienne Burger ◽

Aline Roth ◽

Maria Bertolotto ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Cardiovascular Events ◽

Serum Levels ◽

Artery Stenosis ◽

Major Adverse Cardiovascular Events

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Abstract 125: Intravascular Ultrasound: A Clinically Useful Tool for Carotid Plaque Characterization

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.32.suppl_1.a125 ◽

2012 ◽

Vol 32 (suppl_1) ◽

Author(s):

Elizabeth Hitchner ◽

Mohamed A Zayed ◽

George Lee ◽

Weesam Al-Khatib ◽

Barton Lane ◽

...

Keyword(s):

Carotid Artery ◽

Intravascular Ultrasound ◽

Carotid Artery Stenosis ◽

Carotid Plaque ◽

Patient Characteristics ◽

Carotid Stenting ◽

Artery Stenosis ◽

Plaque Morphology ◽

Plaque Characterization ◽

Plaque Area

OBJECTIVE: Virtual Histology Intravascular Ultrasound (VH™ IVUS) is valuable for estimating minimal lumen diameter (MLD) and plaque characterization. The clinical use of IVUS in the carotid arteries is not well characterized. To evaluate carotid plaque morphology, we performed VH™ IVUS in patients with known carotid artery stenosis. METHODS: From July 2010, patients were prospectively enrolled in an IRB approved study to undergo IVUS prior to an elective carotid stenting procedure. Hospital records were reviewed for co-morbidities, carotid/arch anatomy, preoperative carotid duplex velocity measurements, and incidence of postoperative microemboli. Comparison of pre- and postoperative diffusion-weighted MR images was used to identify microemboli. IVUS-derived MLD and vessel wall plaque characteristics were collected. Spearman correlation was performed between MLD and duplex estimated stenosis, and between plaque characteristics and frequency of postoperative microemboli. RESULTS: 14 patients were enrolled during the study period with carotid artery stenosis (average ICA/CCA ratio 5.5, 64.3% asymptomatic). Major co-morbidities included hyperlipidemia (79%), diabetes (71%), and angina (43%). 57% of patients had type 1 arches, and 50% of patients had heavily calcified irregular carotid plaques. MLD correlated with preoperative duplex ICA/CCA ratio (R2=-0.56,p=0.05), and carotid plaque area correlated with peak systolic and diastolic velocities (R2=-0.55,p=0.05). Although microembolic frequency did not correlate with preoperative patient characteristics, it correlated with IVUS-derived plaque necrotic core area (R2=0.53,p=0.05). CONCLUSION: We demonstrate that periprocedural carotid IVUS is clinically feasible and useful. Preoperative duplex measurements correlated with IVUS MLD confirming the fidelity of the technique. Moreover carotid IVUS demonstrates that patients with necrotic plaque cores have a higher frequency of postoperative microemboli. These findings suggest that carotid IVUS may be helpful to identify patients who are at higher risk of microemboli during carotid artery stenting.

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Abstract TP137: The Association Between MRI-detected Carotid Vulnerable Plaque and Coronary Artery Stenosis

Stroke ◽

10.1161/str.47.suppl_1.tp137 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Manabu Nagata ◽

Kazumichi Yoshida ◽

Ryu Fukumitsu ◽

Yohei Takenobu ◽

...

Keyword(s):

Coronary Artery ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Plaque ◽

Coronary Artery Stenosis ◽

Coronary Intervention ◽

Artery Stenosis ◽

Vulnerable Plaques ◽

Carotid Mri ◽

History Of

It is now accepted that carotid artery stenosis should be treated as a part of systemic atherothrombosis. However, little is known about the association in atherosclerosis between the carotid and coronary arteries. We retrospectively investigated the association between carotid plaque vulnerability diagnosed on carotid magnetic resonance imaging (MRI) and coexisting coronary artery stenosis in patients scheduled for carotid endarterectomy (CEA) or carotid artery stenting (CAS). Eighty-nine consecutive cases that underwent carotid reconstruction for carotid artery stenosis at Kyoto University Hospital between 2010 and 2015 were enrolled in this study. Ten cases that received neither coronary angiography (CAG) nor coronary computed tomography angiography (CCTA) as preoperative examinations, 6 cases with restenosis after CEA or CAS, and 2 cases that did not undergo carotid MRI were excluded. We evaluated relative overall signal intensity (roSI) of the carotid plaque on T1-weighted imaging and coronary artery stenosis detected on CAG or CCTA in the remaining 71 cases. Carotid plaques with roSI >1.5 were defined as MRI-detected vulnerable plaques. Thirty-one cases had a history of previous coronary intervention (stenting or bypass surgery), of which 26 (84%) showed carotid vulnerable plaques. In the cases with no history of coronary intervention, coronary artery stenosis was newly detected in 21 cases, and was not demonstrated in the other 19 cases. Fifteen of the 21 cases with coronary artery stenosis (71%) also showed carotid vulnerable plaques. On the other hand, only 4 of the 19 cases without coronary artery stenosis (21%) had carotid vulnerable plaques, representing a significant difference (P<0.05). Among the cases with no history of coronary intervention, prevalence of coronary artery stenosis in cases with carotid vulnerable plaques was 79%, significantly higher than that in cases without carotid vulnerable plaques (29%). In conclusion, this study demonstrated that patients with carotid vulnerable plaques are more likely to have advanced coronary artery stenosis. Plaque characterization by carotid MRI is useful not only for treatment of carotid artery stenosis, but also for predicting coronary artery stenosis.

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Antithrombotic Therapy in Carotid Artery Disease

Current Pharmaceutical Design ◽

10.2174/1381612826666200518111359 ◽

2020 ◽

Vol 26 (23) ◽

pp. 2725-2734 ◽

Cited By ~ 1

Author(s):

Paraskevi Papanikolaou ◽

Alexios S. Antonopoulos ◽

Irene Mastorakou ◽

Andreas Angelopoulos ◽

Efthalia Kostoula ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Antithrombotic Therapy ◽

Carotid Plaque ◽

Carotid Artery Disease ◽

Artery Stenosis ◽

Non Invasive ◽

Risk Of Rupture ◽

Artery Disease

: The management of asymptomatic atherosclerotic carotid artery disease and the role of antithrombotic therapy is of increasing importance for stroke prevention. Non-invasive imaging of carotid plaques can identify high-risk plaque features that are associated with the risk of plaque rupture. Carotid plaque necrosis, hemorrhage, fibrous cap thinning, and the presence of foam cells have all been correlated with the risk of rupture and onset of neurological symptoms in patients with carotid stenosis. Antiplatelets are currently recommended for patients with a history of ischemic stroke and/or significant carotid artery stenosis, with aspirin and clopidogrel being the most widely used and studied agents. The role of dual antiplatelet therapy remains controversial. Moreover, there is scarce evidence on the role of newer anticoagulant agents in stable patients with carotid artery stenosis. In this review article, we discuss the pathophysiology of carotid atherosclerosis, the use of non-invasive imaging for detecting the vulnerable carotid plaque and summarize the existing clinical evidence on the use of antiplatelet and antithrombotic agents in carotid artery disease.

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