RESUMO
AIM: Early-stage phenotypes of carotid atherosclerosis (CAS), such as increased carotid intima-media thickness (cIMT), and advanced-stage phenotypes, such as carotid plaque (CP), are at risk for adverse ischemic stroke events. There is limited evidence regarding the causal association between dietary patterns and the risk of CAS in Chinese adults. We therefore examined multiple dietary patterns associated with the risk of CAS and identified the optimal dietary pattern for preventing CAS. METHODS: We analyzed data collected from the prospective MJ Health Check-up Study (2004-2020), including 13,989 participants 18-80 years of age without CAS. The dietary intake was measured using validated food frequency questionnaires, and dietary pattern scores were calculated for four a priori and four a posteriori dietary patterns. The Cox model was used to estimate the adjusted hazard ratios (HRs) relating various dietary pattern scores to the risk of CAS. RESULTS: During 43,903.4 person-years of follow-up, 3732 incidents of increased cIMT and 2861 incident CP events were documented. Overall, the seven dietary patterns, except for the high-protein diet, exhibited significant associations with the risk of increased cIMT and CP. Comparing the highest and lowest quartiles, the a posteriori high-fiber dietary pattern (HFIDP) score demonstrated the strongest inverse associations with the risk of increased cIMT (HR 0.65 [95% confidence interval (CI) 0.59-0.71]) and CP (HR 0.65 [95% CI 0.59-0.73]); conversely, another a posteriori high-fat dietary pattern (HFADP; i.e., incorporating high-fat and processed foods) demonstrated the strongest positive associations with the risk of increased cIMT (HR 1.96 [95% CI 1.75-2.20]) and CP (HR 1.83 [95% CI 1.61-2.08]) (all p for trend < 0.01). CONCLUSIONS: Multiple dietary patterns are significantly associated with the risk of early- and advanced-stage phenotypes of CAS. Notably, a high adherence to an HFIDP and low adherence to an HFADP may confer the greatest risk reduction for CAS.
Assuntos
Doenças das Artérias Carótidas , Espessura Intima-Media Carotídea , Dieta Saudável , Humanos , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Pessoa de Meia-Idade , Masculino , Feminino , China/epidemiologia , Adulto , Idoso , Dieta Saudável/estatística & dados numéricos , Fatores de Risco , Estudos Prospectivos , Adulto Jovem , Idoso de 80 Anos ou mais , Adolescente , Estudos de Coortes , Modelos de Riscos Proporcionais , Cooperação do Paciente/estatística & dados numéricosRESUMO
AIMS: Evaluate the association between cumulative tobacco consumption (CTC; packs-year) and atherosclerosis in type 1 diabetes (T1D), and study whether the inclusion of CTC in the Steno T1 Risk Engine (ST1RE) equation improves the identification of plaques. METHODS: Cross-sectional study in T1D patients without cardiovascular disease (CVD), with ≥ 1 of the following: ≥40 years-old, diabetic kidney disease, and/or T1D duration ≥ 10 years + cardiovascular risk factors.Preclinical atherosclerosis was evaluated by carotid ultrasonography. RESULTS: N = 584 patients were included (46.1 % women, age 48.7 ± 10.5 years, T1D duration 27.3 ± 10.8 years, 26.2 % active smokers). The overall plaque prevalence was 40.9 %. In models adjusted for age, sex, lipids, blood pressure, kidney function, statin use, microvascular complications and HbA1c, CTC was dose-dependently associated with the number of plaques (none, 1-2, ≥3) overall and in both active and former smokers (p < 0.001). This association remained after adjusting for ST1RE (OR 1.11 [1.02-1.19]). Although the inclusion of CTC in the ST1RE did not improve plaque identification overall (p = 0.180), it did so when analyzing active smokers separately (AUC 0.738 vs. 0.768; p < 0.01). CONCLUSIONS: In T1D patients, CTC is dose-dependently associated with atherosclerosis. Further prospective studies are needed to determine if CTC could identify T1D individuals more prone to accelerated atherosclerosis.
Assuntos
Doenças das Artérias Carótidas , Diabetes Mellitus Tipo 1 , Humanos , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/etiologia , Estudos Transversais , Adulto , Uso de Tabaco/efeitos adversos , Uso de Tabaco/epidemiologia , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/diagnóstico por imagem , Fatores de Risco , PrevalênciaAssuntos
Doenças das Artérias Carótidas , Microplásticos , Placa Aterosclerótica , Humanos , Microplásticos/efeitos adversos , Microplásticos/análise , Nanopartículas/efeitos adversos , Nanopartículas/análise , Placa Aterosclerótica/química , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/ultraestrutura , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/patologia , Cromatografia Gasosa-Espectrometria de Massas , Microscopia Eletrônica de VarreduraRESUMO
BACKGROUND: Compelling evidence suggests that calcium/phosphorus homeostasis-related parameters may be linked to diabetes mellitus and cardiovascular events. However, few studies have investigated the association of fibroblast growth factor 23 (FGF23), α-klotho and FGF23/α-klotho ratio with atherosclerosis in patients with type 2 diabetes mellitus (T2DM). OBJECTIVE: This study was designed to evaluate whether FGF23, α-klotho and FGF23/α-klotho ratio are associated with T2DM and further to explore the relationships between these three factors and atherosclerosis in Chinese patients with T2DM. METHODS: Serum FGF23 and α-klotho levels were measured via an enzyme-linked immunosorbent assay (ELISA) kit, and the carotid intima-media thickness (CIMT) was assessed via high-resolution color Doppler ultrasonography. The associations of serum FGF23, α-klotho and FGF23/α-klotho ratio with atherosclerosis in T2DM patients were evaluated using multivariable logistic regression models. RESULTS: This cross-sectional study involved 403 subjects (207 with T2DM and 196 without T2DM), 41.7% of the patients had atherosclerosis, and 67.2% of the carotid intima were thickened to a thickness greater than 0.9 mm. Compared with those in the lowest tertile, higher tertiles of FGF23 levels and FGF23/α-klotho ratio were positively associated with T2DM after adjusting for covariates, and serum α-klotho concentration was inversely correlated with T2DM (all P values < 0.01). Moreover, elevated serum FGF23 levels and FGF23/α-klotho ratio were positively associated with CIMT and carotid atherosclerosis in T2DM patients (all P values < 0.01). Further spline analysis similarly revealed linear doseâresponse relationship (all P values < 0.01). And there was still significant differences in CIMT and carotid atherosclerosis between the highest group of α-klotho and the reference group in T2DM patients (P values = 0.05). CONCLUSIONS: T2DM was positively linearly related to serum FGF23 concentration and FGF23/α-klotho ratio, and negatively correlated with serum α-klotho concentration. Furthermore, both FGF23 and FGF23/α-klotho ratio were positively correlated with CIMT and atherosclerosis in T2DM patients, while α-klotho was inversely correlated with both CIMT and atherosclerosis, although the associations were not completely significant. Prospective exploration and potential mechanisms underlying these associations remain to be further elucidated.
Assuntos
Aterosclerose , Doenças das Artérias Carótidas , Diabetes Mellitus Tipo 2 , Humanos , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Espessura Intima-Media Carotídea , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Estudos Prospectivos , Fatores de RiscoRESUMO
Carotid artery puncture is a common complication of internal jugular vein (IJV) catheterization. However, there are few reports about an aneurysm from the carotid artery that can develop into an occult mediastinal hematoma, leading to airway compression. In this case study, we present the case of a 71-year-old male who experienced an aneurysm and delayed mediastinal hematoma, ultimately resulting in airway compression after right jugular line insertion. Our findings highlight the importance of not only addressing local hematoma formation at the puncture site promptly, but also recognizing the potential for aneurysm extension into the mediastinum and the formation of an occult hematoma, which can lead to airway compression. Additionally, we provide a summary of landmark technique precautions that can help reduce the occurrence of such severe complications.
Assuntos
Obstrução das Vias Respiratórias , Aneurisma , Lesões das Artérias Carótidas , Hematoma , Veias Jugulares , Punções , Idoso , Humanos , Masculino , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/terapia , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/cirurgia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/terapia , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/diagnóstico por imagem , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Hematoma/etiologia , Hematoma/diagnóstico por imagem , Hematoma/terapia , Veias Jugulares/lesões , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapiaRESUMO
BACKGROUND: Microplastics and nanoplastics (MNPs) are emerging as a potential risk factor for cardiovascular disease in preclinical studies. Direct evidence that this risk extends to humans is lacking. METHODS: We conducted a prospective, multicenter, observational study involving patients who were undergoing carotid endarterectomy for asymptomatic carotid artery disease. The excised carotid plaque specimens were analyzed for the presence of MNPs with the use of pyrolysis-gas chromatography-mass spectrometry, stable isotope analysis, and electron microscopy. Inflammatory biomarkers were assessed with enzyme-linked immunosorbent assay and immunohistochemical assay. The primary end point was a composite of myocardial infarction, stroke, or death from any cause among patients who had evidence of MNPs in plaque as compared with patients with plaque that showed no evidence of MNPs. RESULTS: A total of 304 patients were enrolled in the study, and 257 completed a mean (±SD) follow-up of 33.7±6.9 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4%), with a mean level of 21.7±24.5 µg per milligram of plaque; 31 patients (12.1%) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2±2.4 µg per milligram of plaque. Electron microscopy revealed visible, jagged-edged foreign particles among plaque macrophages and scattered in the external debris. Radiographic examination showed that some of these particles included chlorine. Patients in whom MNPs were detected within the atheroma were at higher risk for a primary end-point event than those in whom these substances were not detected (hazard ratio, 4.53; 95% confidence interval, 2.00 to 10.27; P<0.001). CONCLUSIONS: In this study, patients with carotid artery plaque in which MNPs were detected had a higher risk of a composite of myocardial infarction, stroke, or death from any cause at 34 months of follow-up than those in whom MNPs were not detected. (Funded by Programmi di Ricerca Scientifica di Rilevante Interesse Nazionale and others; ClinicalTrials.gov number, NCT05900947.).
Assuntos
Doenças das Artérias Carótidas , Microplásticos , Placa Aterosclerótica , Humanos , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/etiologia , Estenose das Carótidas/patologia , Microplásticos/efeitos adversos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Placa Aterosclerótica/química , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/mortalidade , Placa Aterosclerótica/patologia , Plásticos/efeitos adversos , Estudos Prospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de Risco de Doenças Cardíacas , Endarterectomia das Carótidas , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/cirurgia , SeguimentosRESUMO
BACKGROUND: Evidence of the effects of metabolically healthy obesity (MHO) on atherosclerosis is limited; the transition effects of metabolic health and obesity phenotypes have been ignored. We examined the association between metabolic health and the transition to atherosclerosis risk across body mass index (BMI) categories in a community population. METHODS: This cross-sectional study was based on a national representative survey that included 50,885 community participants aged ≥40 years. It was conducted from 01 December 2017 to 31 December 2020, in 13 urban and 13 rural regions across Hunan China. Metabolic health was defined as meeting less than three abnormalities in blood pressure, glucose, high-density lipoprotein cholesterol, triglycerides, or waist circumference. The participants were cross-classified at baseline based on their metabolic health and obesity. In addition, the relationship between atherosclerosis and transitions in metabolic health status based on 4733 participants from baseline to the second survey after 2 years was considered. The relationship between metabolic health status and the risk of transition to Carotid atherosclerosis (CA) was assessed using logistic regression and Cox proportional hazards regression analyses. RESULTS: In this study, the mean age of the participants was 60.7 years (standard deviation [SD], 10.91), 53.0% were female, and 51.2% had CA. As compared with metabolically healthy normal weight (MHN), those with MHO phenotype (odd ratio [OR] 1.10, 95% confidence interval [CI] 1.02-1.21), metabolically unhealthy normal weight (OR 1.27, 95% CI 1.19-1.35), metabolically unhealthy overweight (OR 1.41, 95% CI 1.33-1.48), and metabolically unhealthy obese (OR 1.54, 95% CI 1.44-1.64) had higher risk for CA. However, during the follow-up of 2 years, almost 33% of the participants transitioned to a metabolically unhealthy status. As compared with stable healthy normal weight, transition from metabolically healthy to unhealthy status (hazard ratios [HR] 1.21, 95% [CI] 1.02-1.43) and stable metabolically unhealthy overweight or obesity (MUOO) (HR 1.32, 95% CI 1.17-1.48) were associated with higher risk of CA. CONCLUSIONS: In the community population, obesity remains a risk factor for CA despite metabolic health. However, the risks were highest for metabolically unhealthy status across all BMI categories. A large proportion of metabolically healthy overweight or participants with obesity converts to an unhealthy phenotype over time, which is associated with an increased risk of CA.
Assuntos
Aterosclerose , Doenças das Artérias Carótidas , Obesidade Metabolicamente Benigna , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Obesidade Metabolicamente Benigna/epidemiologia , Sobrepeso/complicações , Estudos Transversais , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/metabolismo , Fatores de Risco , Índice de Massa Corporal , Nível de Saúde , Fenótipo , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/etiologia , Aterosclerose/epidemiologia , Aterosclerose/etiologiaRESUMO
AIMS: People with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD). The Mediterranean diet is associated with reduced CVD; however, the evidence in T1D is scarce. We aimed to analyse the relationships between adherence to the energy-restricted Mediterranean diet (erMEDd) and carotid atherosclerosis. MATERIALS AND METHODS: We included children with T1D without CVD, with ≥1 of the following: age ≥40 years, diabetic kidney disease, or ≥10 years of disease duration with another risk factor. Plaque presence (intima-media thickness ≥1.5 mm) was determined by ultrasonography. The PREDIMED-Plus 17-item questionnaire (PP-17) was used to assess adherence to the erMEDd. RESULTS: Four hundred one individuals were included (48% males, age 48.3 ± 11 years, diabetes duration 26.8 ± 11.4 years). Those harbouring plaques (42%) showed lower adherence to the erMEDd (PP-17: 8.9 ± 2.3 of a maximum of 17 vs. 9.8 ± 2.5, p < 0.001). Greater adherence to the erMEDd was correlated with an overall better metabolic profile. After adjusting for multiple confounders, adherence to the erMEDd was independently associated with carotid atherosclerosis (OR 0.86 [0.77-0.95] for plaque presence and OR 0.85 [0.75-0.97] for ≥2 plaques). The consumption of fruit and nuts and preference of white over red meat was higher in individuals without atherosclerosis (p < 0.05). Fruit and nut consumption was associated with lower plaque prevalence in the fully adjusted models (OR 0.38 [0.19-0.73] and 0.51 [0.29-0.93]). CONCLUSIONS: Greater adherence to the erMEDd is associated with less carotid atherosclerosis in children with T1D at high risk of CVD. Strategies to improve and implement healthy dietary patterns in this population should be encouraged.
Assuntos
Doenças das Artérias Carótidas , Diabetes Mellitus Tipo 1 , Dieta Mediterrânea , Placa Aterosclerótica , Masculino , Criança , Humanos , Adulto , Pessoa de Meia-Idade , Feminino , Diabetes Mellitus Tipo 1/complicações , Espessura Intima-Media Carotídea , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/etiologia , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/etiologia , Fatores de RiscoRESUMO
BACKGROUND AND AIM: Gout and cardiovascular disease are closely related, but the mechanism linking them is still unknown. Gout may affect the insulin signaling pathway inducing insulin resistance (IR). The study aims to evaluate the association between tophi and carotid atherosclerosis, considering the potential role of IR. METHODS AND RESULTS: A total of 595 patients with gout aged 18 to 80 were enrolled in this study. Carotid intima-media thickness, plaques and tophi were evaluated by B-mode ultrasonography. IR was assessed by the HOMA index (hepatic IR) and Gutt index (peripheral IR). Multivariable logistic regression and interaction analysis were used to examine the association between tophi and IR and its impact on carotid atherosclerosis. Among these participants, the average age was 55.4 (±12.54) years, and 94.6 % were male. Tophi were associated with increased odds of carotid atherosclerosis and burden after adjustment for confounders (P < 0.05). Tophi and IR synergically interacted for inducing carotid atherosclerosis. The interaction between peripheral IR with tophi was more pronounced than hepatic IR with tophi. CONCLUSIONS: Tophi were independently associated with carotid atherosclerosis risk. IR mediated a significant amount of the effect of tophi on the development of carotid atherosclerosis. Peripheral IR probably plays a more important role than hepatic IR does.
Assuntos
Doenças das Artérias Carótidas , Gota , Resistência à Insulina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Espessura Intima-Media Carotídea , Gota/complicações , Gota/diagnóstico , Fatores de Risco , Adulto , IdosoRESUMO
OBJECTIVE: Lower neck cancers (LNCs) include specific tumour types and have some different vascular supply or collaterals from other head and neck cancers. This prospective study evaluated the outcome of endovascular management of post-irradiated carotid blowout syndrome (PCBS) in patients with LNC by comparing reconstructive management (RE) and deconstructive management (DE). METHODS: This was a single centre, prospective cohort study. Patients with LNC complicated by PCBS between 2015 and 2021 were enrolled for RE or DE. RE was performed by stent graft placement covering the pathological lesion and preventive external carotid artery (ECA) embolisation without balloon test occlusion (BTO). DE was performed after successful BTO by permanent coil or adhesive agent embolisation of the internal carotid artery (ICA) and ECA to common carotid artery, or ICA occlusion alone if the pathological lesion was ICA only. Cross occlusion included the proximal and distal ends of the pathological lesion in all patients. Re-bleeding events, haemostatic period, and neurological complications were evaluated. RESULTS: Fifty-nine patients (mean age 58.5 years; 56 male) were enrolled, including 28 patients undergoing RE and 31 patients undergoing DE. Three patients originally grouped to DE were transferred to RE owing to failed BTO. The results of RE vs. DE were as follows: rebleeding events, 13/28 (46%) vs. 10/31 (32%) (p = .27); haemostatic period, 9.4 ± 14.0 months vs. 14.2 ± 27.8 months (p = .59); neurological complication, 4/28 (14%) vs. 5/31 (16%) (p = .84); and survival time, 11.8 ± 14.6 months vs. 15.1 ± 27.5 months (p = .61). CONCLUSION: No difference in rebleeding risk or neurological complications was observed between the DE and RE groups. RE could be used as a potential routine treatment for PCBS in patients with LNC.
Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Neoplasias de Cabeça e Pescoço , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Estudos Prospectivos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Idoso , Resultado do Tratamento , Stents , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Lesões por Radiação/etiologia , Lesões por Radiação/diagnóstico , Lesões por Radiação/cirurgia , Doenças das Artérias Carótidas/terapia , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , AdultoRESUMO
Carotid blowout syndrome (CBS) is an uncommon but potentially life-threatening condition characterized by the spontaneous or traumatic rupture of the carotid artery in the neck. Oftentimes, CBS is due a loss of structural arterial integrity from local radiotherapy or surgical procedures. A vast majority of patients who develop CBS also have a previous diagnosis of head and neck cancer. Due to the specific patient population who develop CBS and its life-threatening nature, CBS should be a part of emergency physicians differential for those who present with a chronic neck wound or neurological symptoms in those with a previous head and neck cancer diagnosis. In this case report, a patient with a history of squamous cell carcinoma of the oropharynx who was treated with chemoradiation therapy, presented to the emergency department with spontaneous bleeding from an existing chronic wound on the left lateral neck. Conservative measures were taken including wound dressing, and the patient was discharged to see dermatology for biopsy of a suspected cancerous lesion. Once the chronic lesion was biopsied, the patient had to be immediately rushed to the operating room due to a brisk pulsatile bleeding from puncturing the carotid artery. Proper wound packing and an ultrasound of the neck for a proper diagnosis may have prevented the need for surgical intervention in this case. Although CBS is not common, complications can lead to death as seen in this case. Timely recognition and proper interventions are critical for preventing potentially fatal outcomes in those with CBS.
Assuntos
Carcinoma de Células Escamosas , Doenças das Artérias Carótidas , Neoplasias de Cabeça e Pescoço , Humanos , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Artérias Carótidas , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/terapia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Hemorragia/complicações , Stents/efeitos adversosRESUMO
To explore the treatments for and manifestations of carotid blowout syndrome (CBS) and to further explore the critical role of high-flow bypass combined with parent artery isolation. The clinical data of nine patients with radiotherapy-related CBS who were admitted to our hospital from March 2020 to March 2023 were retrospectively analyzed. Relevant literature was reviewed. From March 2020 to March 2023, nine CBS patients were admitted to Tianjin Huanhu Hospital, including eight males and one female. Digital subtraction angiography was performed for all the patients; all the pseudoaneurysms were located at the petrous segment of the internal carotid artery. A balloon occlusion test was performed on four patients, which was tolerated by all patients. CT and MRI scans showed seven cases of osteonecrosis combined with infection and two cases of tumor recurrence. Emergency permanent parent artery occlusion was performed on six patients, aneurysm embolization was completed in one case, covered stent implantation was performed in one patient, and three cases were treated by cerebral bypass surgery (including two patients with failed interventional treatment). Rebleeding was found in two patients, and no rebleeding was found in the bypass group. Paralysis was found in three patients, and asymptomatic cerebral infarction without permanent neurologic impairment was found in three patients. Two patients died due to tumor progression. Emergency occlusion surgery is lifesaving in the acute phase of CBS. Endovascular therapy cannot prevent the progression of pseudoaneurysms or lower the recurrence rate of bleeding events. High-flow bypass combined with parent artery isolation is a safe and effective method that may facilitate further surgical treatment. Further research is warranted.
Assuntos
Falso Aneurisma , Doenças das Artérias Carótidas , Embolização Terapêutica , Neoplasias de Cabeça e Pescoço , Masculino , Humanos , Feminino , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/cirurgia , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Estudos Retrospectivos , Recidiva Local de Neoplasia/cirurgia , Artérias Carótidas , Embolização Terapêutica/efeitos adversos , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Stents , Resultado do TratamentoRESUMO
BACKGROUND: The relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and atherosclerosis has been controversial, which has become a hit of recent research. The study aimed to explore the association between MASLD, cardiovascular and cerebrovascular diseases (CCVD), and the thickness of carotid plaque which was assessed by ultrasound. METHODS: From September 2018 to June 2019, 3543 patients were enrolled. We asked participants to complete questionnaires to obtain information. All patients underwent liver ultrasound and bilateral carotid ultrasound to obtain carotid intima-media thickness (IMT) and maximum carotid plaque thickness (CPT). Hepatic steatosis was quantified during examination according to Hamaguchi's ultrasonographic score, from 0 to 6 points. A score < 2 was defined as without fatty liver, and a score ≥ 2 was defined as fatty liver. Information about blood lipids was collected based on the medical records. RESULTS: We found common risk factors for CCVD events, MASLD, and atherosclerosis. There was a significant correlation between MASLD and carotid plaque, but not with CPT. No association was found between MASLD and CCVD events. CPT and IMT were thicker in CCVD patients than in non-CCVD patients. No significant difference was found between IMT and CPT in MASLD patients and non-MASLD patients. CCVD was independently and consistently associated with higher IMT, and free fatty acid (FFA). CONCLUSIONS: According to our results, we recommend carotid ultrasound examination of the patients when FFA is increased, regardless of the presence of risk factors and MASLD. Due to the distribution of CPT of both CCVD and MASLD patients in the CPT 2-4 mm group, contrast-enhanced ultrasound is necessary to assess the vulnerability of the plaque when CPT ≥ 2 mm. Timely treatment of vulnerable plaques may reduce the incidence of future CCVD events.
Assuntos
Aterosclerose , Doenças Cardiovasculares , Doenças das Artérias Carótidas , Transtornos Cerebrovasculares , Fígado Gorduroso , Placa Aterosclerótica , Humanos , Espessura Intima-Media Carotídea , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etiologia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/etiologia , Doenças Cardiovasculares/epidemiologia , Fatores de Risco , Fígado Gorduroso/complicações , Placa Aterosclerótica/complicaçõesRESUMO
Objective: Emerging evidence highlighted that perirenal adipose tissue might regulate the cardiovascular and metabolism system through several pathways. This study aimed to assess the association between perirenal fat thickness (PrFT) and subclinical carotid atherosclerosis (SCCA) in type 2 diabetes mellitus (T2DM). Method: A total of 670 participants with complete data were included in this study. The trained reviewer collected demographic and anthropometric information. Laboratory assessments were determined by standard methods. PrFT and SCCA were evaluated by computed tomography and ultrasound. Binomial logistic regression analysis was conducted to assess the association between PrFT and SCCA. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the identifying value of PrFT for SCCA. Results: Overall, the prevalence of SCCA was 61.8% in T2DM. PrFT was significantly increased in the SCCA group. Growing trends were observed in the prevalence of hypertension, carotid intima-media thickness (cIMT) > 1, plaque, and SCCA across the PrFT quartiles. Spearman correlation analysis revealed that PrFT was positively associated with cIMT (r = 0.401, p < 0.001). This correlation remained significant after adjustment for visceral fat area (VFA), subcutaneous fat area (SFA), and traditional metabolic risk factors (ß = 0.184, p < 0.001). Meanwhile, PrFT was independently correlated with plaque, cIMT > 1 mm, and SCCA. The ORs (95% CI) were 1.072 (1.014-1.135), 1.319 (1.195-1.455), and 1.216 (1.119-1.322). Furthermore, PrFT remained correlated considerably with SCCA in subgroup analysis after stratification for age, sex, smoking, hypertension, and body mass index. From the ROC curve analysis, the AUCs (95% CI) of PrFT, VFA, and SFA identifying SCCA were 0.794 (0.760-0.828), 0.760 (0.724-0.796), and 0.697 (0.656-0.737), respectively. The AUC of PrFT was significantly higher than VFA (p = 0.028) and SFA (p < 0.001). The optimal cutoff values of PrFT were 14.0 mm, with a sensitivity of 66.7% and a specificity of 76.2%. Conclusion: PrFT was independently associated with cIMT, plaque, cIMT > 1 mm, and SCCA as a superior obesity-related marker of SCCA in T2DM. Clinical trial registration: Clinical Trials.Gov, identifier ChiCTR2100052032.
Assuntos
Doenças das Artérias Carótidas , Diabetes Mellitus Tipo 2 , Hipertensão , Placa Aterosclerótica , Humanos , Diabetes Mellitus Tipo 2/metabolismo , Espessura Intima-Media Carotídea , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/metabolismo , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/etiologia , Obesidade/complicações , Obesidade/metabolismo , Hipertensão/metabolismoRESUMO
BACKGROUND: Carotid Blowout (CBO), a neuro-oncological emergency characterized by the rupture of the carotid artery, has been predominantly reported in patients with head and neck cancer who have undergone radiation therapy. In this study, our objective is to share our experience with deconstructive and reconstructive endovascular treatments for CBO. METHODS: This study includes 17 patients who experienced intractable acute CBO, presenting with ear, oral, or nasal bleeding, between 2003 and 2022. We employed deconstructive embolization using vascular plugs, expanding hydrogel coils, glue, and balloons. If vascular anatomy and pathology permitted, we opted for reconstructive treatment using a covered stent. All patients underwent clini-cal follow-up visits, and we used the modified Rankin Scale to evaluate the clinical success of the procedures. We compared outcomes in terms of complications between the deconstructive and reconstructive treatment methods using the Chi-square test. RESULTS: The patient cohort had an age range of 20-64 years (mean 50.9), including three females (18%) and 14 males (82%). We conducted 15 endovascular procedures on 14 patients during 19 angiography sessions. All 15 treatments achieved immediate hemo-stasis, resulting in complete technical success (p=1.0). Six patients (35%) underwent reconstructive treatments with covered stents in the internal carotid artery, while nine patients (65%) underwent deconstructive embolization in either the external or internal carotid artery. We found no significant association between the treatment paradigms (deconstructive vs. reconstructive) and the development of complications using a Chi-square test of independence X² (2, n=15)=0.07, p=0.79. CONCLUSION: Recent advancements in endovascular treatments have shown promising results in managing life-threatening acute CBO cases. Our study found no significant difference in outcomes between deconstructive and reconstructive endovascular paradigms in such patients. However, it is important to note that the available data, including ours, is heterogeneous and scarce, necessitating higher levels of evidence to draw more definitive conclusions.
Assuntos
Doenças das Artérias Carótidas , Embolização Terapêutica , Procedimentos Endovasculares , Neoplasias de Cabeça e Pescoço , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/cirurgia , Embolização Terapêutica/efeitos adversos , Artéria Carótida Interna/cirurgia , Stents/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Resultado do Tratamento , Estudos RetrospectivosRESUMO
BACKGROUND AND AIMS: Carotid intima-media thickness (cIMT) is inconsistent in predicting cardiovascular risk. This may stem from the variability of the media thickness (cM) outweighing the intimal thickness (cIT) as the sign of atherosclerosis. Thus, we evaluated in type 2 diabetes (T2D) individuals, the association between carotid measures and coronary artery calcification (CAC). METHODS AND RESULTS: Association between the presence of CAC and cIT, cM, and cIMT were examined on 224 individuals. Logistic binary regression was used to assess CAC predictors. The Akaike information criterion (AIC) and log-likelihood test (LLT) were used to assess differences among univariate models. The cIT (0.335 mm vs 0.363 mm; p = 0.001) and cIMT (0.715 vs 0.730; p = 0.019), but not cM (0.386 mm vs 0,393 mm; p = 0.089) were higher among individuals with CAC. In unadjusted analysis, cIT (273;-134; p = 0.001) showed greater relationship with CAC, when compared to cIMT (279;-137; p = 0.022) and cM (281;-139; p = 0.112) based on the AIC and LLT, respectively. In multivariate logistic regression, CAC was related to carotid plaque (OR): 1.91, 95% confidence interval (CI):1.08, 3.38; p = 0.027), and high-cIT (OR: 2.70, 95%CI:1.51, 4.84; p = 0.001), but not to high-cIMT (OR:1.70, 95%CI:0.96, 3.00; p = 0.067) nor high-cM (OR:1.33, 95%CI:0.76, 2.34; p = 0.322). CONCLUSION: In T2D individuals, cIT is a better predictor of CAC than cIMT; cM is not associated with CAC.
Assuntos
Doenças das Artérias Carótidas , Doença da Artéria Coronariana , Diabetes Mellitus Tipo 2 , Humanos , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Brasil/epidemiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Fatores de Risco , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/etiologiaRESUMO
AIM: Our study aims to determine the prevalence and factors associated with carotid atherosclerosis in Malagasy Type 2 diabetes mellitus (T2DM). METHODS: This was a cross-sectional retrospective study, carried out over a period of 30 months. The diagnosis of carotid atherosclerosis is established by the presence of a carotid plaque increased carotid intima-media thickness ≥1.1 mm on Doppler ultrasound. RESULTS: We included 132 T2DM. The prevalence of carotid atherosclerosis was 63.6% (38.6% carotid plaque and 25% intima-media thickening). After univariate analysis, the factors associated with carotid atherosclerosis were age ≥70 years (3.28 [1.18-10, 62]), previous intake of oral antidiabetics (0.33 [0.14-0.73]), insulin (0.28 [0.11-0.66]) and angiotensin receptor blocker (0.45 [0.20-0.98]), and current smoking (5.93 [1.64-32.6]). After adjustment for age and gender, previous intake of oral antidiabetics (0.29 [0.13-0.64]), insulin (0.27 [0.12-0.61]) and angiotensin receptor blocker (0.40 [0.19-0.86]), and current smoking (5.98 [1.61-22.1]) were associated with carotid atherosclerosis. CONCLUSION: Smoking cessation, education on therapeutic compliance and comprehensive management of all cardiovascular risk factors and T2DM are therefore essential in order to reduce the occurrence of carotid atherosclerosis.
Assuntos
Doenças das Artérias Carótidas , Diabetes Mellitus Tipo 2 , Insulinas , Humanos , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Espessura Intima-Media Carotídea , Estudos Transversais , Prevalência , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/etiologia , Hipoglicemiantes/uso terapêutico , Antagonistas de Receptores de AngiotensinaRESUMO
BACKGROUND AND AIMS: We investigated the causal relevance of alcohol intake with measures of carotid artery thickness and atherosclerosis in Chinese adults. METHODS: The study included 22,384 adults from the China Kadoorie Biobank, with self-reported alcohol use at baseline and resurvey, carotid artery ultrasound measurements, and genotyping data for ALDH2-rs671 and ADH1B-rs1229984. Associations of carotid intima media thickness (cIMT), any carotid plaque, and total plaque burden (derived from plaque number and size) with self-reported (conventional analyses) and genotype-predicted mean alcohol intake (Mendelian randomization) were assessed using linear and logistic regression models. RESULTS: Overall 34.2% men and 2.1% women drank alcohol regularly at baseline. Mean cIMT was 0.70 mm in men and 0.64 mm in women, with 39.1% and 26.5% having carotid plaque, respectively. Among men, cIMT was not associated with self-reported or genotype-predicted mean alcohol intake. The risk of plaque increased significantly with self-reported intake among current drinkers (odds ratio 1.42 [95% CI 1.14-1.76] per 280 g/week), with directionally consistent findings with genotype-predicted mean intake (1.21 [0.99-1.49]). Higher alcohol intake was significantly associated with higher carotid plaque burden in both conventional (0.19 [0.10-0.28] mm higher per 280 g/week) and genetic analyses (0.09 [0.02-0.17]). Genetic findings in women suggested the association of genotype-predicted alcohol with carotid plaque burden in men was likely to due to alcohol itself, rather than pleiotropic genotypic effects. CONCLUSIONS: Higher alcohol intake was associated with a higher carotid plaque burden, but not with cIMT, providing support for a potential causal association of alcohol intake with carotid atherosclerosis.
Assuntos
Consumo de Bebidas Alcoólicas , Doenças das Artérias Carótidas , Espessura Intima-Media Carotídea , Placa Aterosclerótica , Adulto , Feminino , Humanos , Masculino , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/genética , Aldeído-Desidrogenase Mitocondrial/genética , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/genética , População do Leste Asiático , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/genética , Fatores de RiscoRESUMO
Background: The arterial pathology and mechanisms of increased cardiovascular disease (CVD) risk in HCV-infected individuals are not yet clear. The aim of this study was to identify types of arterial pathology in treatment-naive chronic HCV patients and to test their reversibility after successful treatment. Methods: Consecutive, never-treated, HCV-infected patients were compared with age and CVD-related risk factors, matched controls, healthy individuals (HI), patients with rheumatoid arthritis (RA) and people living with HIV (PLWH), in terms of arterial stiffening by pulse wave velocity, arterial atheromatosis/hypertrophy by carotid plaques/intima-media thickness and impaired pressure wave reflections by augmentation index. After three months of sustained virological response (SVR) administered using direct-acting antivirals, vascular examination was repeated in HCV-infected patients to test drug and viral-elimination effect in subclinical CVD. Results: Thirty HCV patients were examined at baseline; fourteen of them were re-examined post-SVR. Compared with HI, HCV patients had significantly more plaques, which is similar to that of RA patients and the PLWH group. No other differences were found in all other vascular biomarkers, and regression among HCV patients also revealed no differences 3 months post-SVR. Conclusions: Accelerated atheromatosis, rather than arterial stiffening, arterial remodeling and peripheral impaired hemodynamics is the underlying pathology leading to increased CVD risk in HCV patients.
Assuntos
Artrite Reumatoide , Aterosclerose , Doenças das Artérias Carótidas , Hepatite C Crônica , Placa Aterosclerótica , Humanos , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/tratamento farmacológico , Doenças das Artérias Carótidas/etiologia , Espessura Intima-Media Carotídea , Antivirais/uso terapêutico , Análise de Onda de Pulso/efeitos adversos , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Aterosclerose/diagnóstico , Aterosclerose/tratamento farmacológico , Aterosclerose/etiologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/tratamento farmacológico , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológicoRESUMO
Flow diverter (FD) stenting is expected to improve cranial nerve symptoms caused by aneurysms via the theoretical reduction of the mass effect by promoting spontaneous thrombosis through the flow diversion effect. However, the factors involved in symptom improvement after treatment remain unclear. This study was performed to identify factors for symptom improvement after FD stenting and the symptom improvement rate of each impaired cranial nerve. We retrospectively evaluated 33 patients who underwent FD stenting for symptomatic internal carotid artery aneurysms at our institution from January 2016 to June 2021. Twenty-three (69.7%) patients had resolved or improved symptoms after 1 year of treatment. The optic nerve was affected in 12 patients; the oculomotor nerve, in 16; the trigeminal nerve, in 2; and the abducens nerve, in 13. There was no statistically significant difference in the symptom improvement rate of each impaired cranial nerve. The patients were classified into the improved and nonimproved groups based on their symptoms after 1 year of treatment, and the factors related to the symptoms were analyzed. The time from onset to treatment was significantly shorter in the improved group than in the nonimproved group (197.1 and 800 days, respectively; p = 0.023). There were no significant differences in age, aneurysm diameter, adjunctive coil embolization, partial thrombosis, change in mass diameter on magnetic resonance imaging, or aneurysm occlusion rate on angiography between the two groups. These results suggest that early treatment after the onset of aneurysm-induced cranial neuropathies increases the likelihood of symptom improvement.