[Atherosclerosis and coronary artery disease in Senegal: an autopsy series of 116 african patients at Aristide Le Dantec Hospital (Dakar-Senegal)]. / Athérosclérose aortique et coronarienne au Sénégal : à propos d'une série autopsique de 116 patients d'origine africaine au CHNU Aristide Le Dantec (Dakar-Sénégal).

OBJECTIVE: To study the prevalence of atherosclerosis (aortic and coronary lesions) in Senegalese people, to determine main risks factors and morphological patterns. METHODS: A prospective autopsy study was conducted in the pathology department of Aristide Le Dantec Hospital (Dakar-Senegal) where 116 specimens aged over 5 years old were studied. RESULTS: Autopsy study of 116 Senegalese specimens for atherosclerotic lesions revealed aortic lesions in 100 cases (86%), aortic and coronary lesions both in 48 cases. There were 88 men versus 12 women. The median age was 37.1 years comprised 5 to 77 years old. Hypertensive, smoking and abdominal obesity were detected respectively in 5 cases, 37 cases and 33 cases. In aortic vessel, the main lesions detected were severe fibrous plaques detected in 40 cases. In coronary arteries, fibrous plaques were detected in 18 cases, severe fibrous plaques in 17 cases. CONCLUSION: Our study in Senegalese population showed existence of atherosclerotic lesions. These lesions were more responsible for complications as myocardial infarction.

[An atypical presentation of atherosclerosis in psoriasis: "Porcelain aorta"]. / Présentation particulière de l'athérome au cours du psoriasis : un cas d'« aorte porcelaine ¼.

BACKGROUND: Several recent epidemiological studies have shown an increase in cardiovascular morbidity and mortality in patients with psoriasis; such increase is greater in the event of severe and early psoriasis. PATIENTS AND METHODS: We report the case of a 42-year-old patient with severe skin psoriasis ongoing since childhood and presenting with porcelain aorta, a little-known sign of atherosclerosis. This is the first publication reporting this association. DISCUSSION: Porcelain aorta results from atherosclerotic calcification of the aortic arch. For long asymptomatic, it can manifest itself in various complications. This observation highlights the importance of cardiovascular risk assessment and of screening for complications thereof in patients presenting psoriasis.

[Acute finger ischemia: A retrospective study of 13 patients]. / Ischémie digitale aiguë : étude rétrospective de 13 cas.

BACKGROUND: Acute ischemia of the upper limbs is rare in comparison with ischemia of the lower limbs. The origins of this condition are varied. GOALS: We retrospectively analyzed cases of acute finger ischemia (Raynaud's phenomena was excluded) in a dermatology department between 2008 and 2013 in order to evaluate the etiology and management of this phenomenon. RESULTS: Thirteen cases of finger ischemia were reported. The mean age was 54 years. Active smoking was noted in 11 cases. Ischemia was acute in 9 cases and subacute in 4 cases. The location was unilateral in 10 cases and bilateral in 2. Etiologies were: dysplasia of the palmar arch, antiphospholipid antibody syndrome, frostbite, distal arteritis linked to smoking, paraneoplastic arteritis, Buerger's disease, polyarteritis nodosa, stenosis of the subclavian artery, and 3 cases of embolic origin (ulnar, cardiac, and paraneoplastic aneurysm). In the acute phase, antiplatelets were given in 6 cases, anticoagulants in 10 cases and ilomedin in 6 cases. Sympathectomy was performed in 1 case and amputation in 2 cases. DISCUSSION: This study illustrates the diversity of etiologies of finger ischemia. The etiological test battery should be broad and include immunological and thrombophilia tests, arterial and cardiac investigations, cervical radiography and CT scan (screening for cancer). Close collaboration between dermatologists, hematologists, vascular surgeons and radiologists is essential for the management of these patients.

[Assessment of peripheral artery disease in proven coronary patients in Abidjan Heart Institute of Côte d'Ivoire]. / Évaluation des lésions artérielles périphériques chez le coronarien avéré à l'Institut de cardiologie d'Abidjan en Côte d'Ivoire.

BACKGROUND: Coronary artery disease is mainly due to atherosclerosis. The aim of this study was to evaluate the frequency of peripheral arterial disease in proven coronary artery disease and to determine the associated factors in our context. MATERIAL AND METHODS: We included in a cross-sectional descriptive and analytical study 224 patients with proven coronary artery disease confirmed on coronary angiography from March 1 to October 30, 2019. It took place in the external exploration department of the Abidjan Heart Institute. An ultrasonographic exploration of the supra-aortic trunks and arteries of the lower extremity with measurement of the ankle brachial index (ABI) was carried out. RESULTS: The mean age was 57.4±10.9 years (27-81years). There was a clear male predominance with a sex-ratio of 5. The prevalence of carotid artery disease was 56.4% of patients. The main factors associated with elevated Intima Media Thickness (IMT) and the presence of carotid plaques were male sex (OR=8.8; P=0.038), smoking (OR=2.5; P=0.049) and multi-truncular involvement (OR=3.2; P=0.014). In the lower extremities, there was a prevalence of peripheral arterial disease of 48.5%. The main factors associated with the decrease of ABI were age ≥50 years (OR=2.6; P=0.043), diabetes (OR=2.8; P=0.02), dyslipidemia (OR=3.8; P=0.001) and pluri-truncular involvement (OR=4.5; P<0.0001). CONCLUSION: The presence of significant coronary artery disease in our context is associated with a high prevalence of peripheral carotid artery and lower extremity artery disease. This is all the more so as we are male, over 50 years old, pluri-truncular with many cardiovascular risk factors.

Fundus autofluorescence in retinal artery occlusion: A more precise diagnosis.

IMPORTANCE: Retinal artery occlusion (RAO) is a medical emergency associated with a high risk of cerebral vascular accident and other cardiovascular events. Among patients with non-arteritic RAO, a retinal embolus is observed in approximately 40% of cases. Fundus examination and retinography are not reliable to predict the nature of the emboli. OBSERVATIONS: We report three consecutive cases of central and branch RAO that were investigated with fundus autofluorescence, fluorescein angiography and color retinal photographs. All patients underwent complete neurological and cardiovascular workups, with brain imaging, cardiac Doppler ultrasound, carotid Dopplers and Holter ECG's, to determine the underlying mechanism of retinal embolism. In the three cases, aged 77.7±4 years (2 women and 1 man), fundus autofluorescence demonstrated hyperautofluorescent emboli. In two cases, it allowed visualization of emboli that were not detected with fundus examination or retinography. The cardiovascular work-up demonstrated atheromatous carotid or aortic plaques in all patients. In one case, it permitted the diagnosis of RAO. Two of the three cases were considered to be of atherosclerotic origin and one of undefined origin. CONCLUSION AND RELEVANCE: Fundus autofluorescence may help to detect and characterize retinal emboli. Since lipofuscin, which is present in large quantity in atherosclerotic plaques, is the main fluorophore detected with fundus autofluorescence, this non-invasive and simple examination may give information about the underlying mechanism of retinal embolism, and thus impact the etiologic assessment of RAO. Additional studies are necessary to confirm this potential role of autofluorescence.

[Prevalence of macrovascular arterial involvement of the 4 limbs in systemic sclerosis: About a case series of 14 patients]. / Prévalence de l'atteinte artérielle macrovasculaire des 4 membres dans la sclérodermie systémique : à propos de 14 patients.

INTRODUCTION: Trophic disorders of the extremities are a common complication of systemic sclerosis (SSc), mainly related to microvascular damage. However, SSc seems to be a risk factor for premature athero-thrombotic disease that can affect the peripheral arteries, participate in the occurrence of trophic disorders and promote the occurrence of infectious complications. The objective of this study was to assess the prevalence of arterial disease of the limbs in SSc patients. METHODS: Consecutive inclusions in the context of a multidisciplinary consultation centered on disability of the hand with collection of clinical data [cardiovascular risk factors (CVRF), history of trophic disorders of ischemic origin, peripheral pulse palpation, Allen maneuver the upper (UL) and lower limbs (LL)], and hemodynamic data (flow recorded by Doppler in radial, ulnar, anterior and posterior tibial arteries, and measurement of systolic indices ankles). RESULTS: Fourteen patients were included (11 right-handers, 2 left-handers, 1 ambidextrous). The sex-ratio male/female was 0.27 and the average age of 58.1±10.4 years. The main CVRF were age and smoking. In the UL, 42.8% of patients had a history of trophic disorders, Allen maneuver was abnormal for 35.7% of the superficial palmar arch, 42.9% of ulnar pulse were not perceived and there was no recordable flow in 25% of ulnar artery. In the LL, 14.3% of patients had already presented trophic disorders toes, Allen maneuver was abnormal for 15.4% of the posterior tibial artery, 25.6% of posterior tibial pulse were not perceived and flow of 15.4% of posterior tibial arteries was pathological. CONCLUSION: The distal macrovascular disease preferentially affecting the ulnar and posterior tibial arteries with a high frequency to the UL and two times less at LL. The pathophysiology is unclear but it could be a proper manifestation of SSc. It seems necessary that SSc patients have a strict balance of their CVRF and a screening of macrovascular arterial lesions. There is also the question of the place of an anti-atherosclerotic therapy in these patients.

Usefulness of a systematic screening of carotid atherosclerosis in asymptomatic people with type 2 diabetes for cardiovascular risk reclassification.

AIMS: Routine screening of carotid atherosclerosis lesions is frequently suggested for people with type 2 diabetes, the presence of a carotid lesion being associated with a significant increase risk for vascular events. However, the impact of this strategy on medical management is not validated. We herein question the usefulness of such screening. METHODS: We assessed the prevalence and severity of carotid lesions in 337 consecutive people with type 2 diabetes without known cardiovascular disease who underwent a systematic carotid duplex ultrasonography. We analyzed whether the results of duplex ultrasonography allowed reclassification of cardiovascular risk level relative to the most recent international recommendations on diabetes and modified therapy. RESULTS: We found that 35.9% of people had no atherosclerotic lesion. Prevalence of carotid stenosis<20%, between 20 and 50% and ≥50% were 32.9%, 28.4% and 2.7% respectively. Regarding the use of statins and LDL-C target, the result of carotid duplex ultrasonography allowed to reclassify respectively 11.8% to 55.2% of the cohort in a higher cardiovascular risk level. For the indication of antiplatelet agent, reclassification in a higher risk level concerned 6.8% of the patients. No subject had an indication of carotid revascularization. CONCLUSIONS: Carotid atherosclerosis is frequent in asymptomatic people with type 2 diabetes in primary cardiovascular prevention. Screening for carotid atherosclerosis by duplex ultrasonography seems useful to redefine the level of cardiovascular risk.

[TIMMA: Ultrasonographic scale of carotid atherosclerosis by vascular neurologists]. / TIMMA : échelle échographique de la surcharge athéromateuse en carotide pratiquée par des neurologues vasculaires.

BACKGROUND: Carotid atherosclerosis is a powerful predictive factor of vascular risk at the individual patient level. Ultrasonography is a reference technique for the evaluation of this condition. However, its use in common practice remains difficult due to a lack of standardization and inter-operator variability. We present a new and simple technique for the assessment of carotid atherosclerosis; and evaluate the ability of vascular neurologists to obtain results consistent with those of an expert in vascular ultrasound. MATERIAL AND METHODS: The TIMMA scale is an acronym for the five classes of carotid atherosclerosis in French, VIMMA in English: very important, important, moderate, minimal and absent. Combined, the first two classes make up the group "significant atheroma" and the last three classes make up the group "no significant atheroma". This scale was evaluated in 38 patients (76 carotid arteries) suffering from ischemic stroke or transient ischemic attack by five operators who are competent in carotid echocardiography: one TIMMA-trained (40 hours of training) vascular neurologist physician (VNP), three VNPs informed on the measurement method (1 hour of information) and one specialized vascular physician (SVP) who was considered to be the reference examiner. We evaluated the concordance between the VNPs and the SVP in classifying patients, firstly into the significant or not atheroma group and, secondly, into the five TIMMA classes. RESULTS: The evaluation of the two-group clustering scale found a concordance between the informed VNPs and the SVP on 76 carotid arteries of 86% (kappa=0.7) and between the trained VNP and the SVP on 58 carotid arteries of 90% (kappa=0.8). The positive and negative predictive values for significant atheroma diagnosis were 100% and 81%, respectively, for the informed VNPs, and 100% and 80% for the trained VNP. The evaluation of the Five-Class Scale showed a concordance between the informed VNPs and the SVP of 46% (kappa=0.3), and between the trained VNP and the SVP of 74% (kappa=0.7). CONCLUSION: TIMMA allows VNPs who are competent in carotid ultrasonography to reproducibly identify subjects with significant carotid atheroma. The contribution of this scale to the determination of cardiovascular risk should be evaluated.

[Prevalence of atherosclerotic carotid plaques in semi-rural Gueoul, Senegal: Survey of 1411 subjects]. / Prévalence des porteurs de plaques d'athérome carotidiennes dans la population semi-rurale de Guéoul au Sénégal : enquête sur 1411 sujets.

AIMS: The purpose of this study was to investigate the prevalence of atherosclerotic carotid plaques and association with cardiovascular risk factors and vascular diseases in a semi-rural area of Gueoul in Senegal. PATIENTS AND METHOD: This was a cross-sectional, descriptive study over a period of one month in 2012 in Senegalese people who were older than 35 years, and resided in semi-rural Gueoul for at least six months. Carotid plaques were measured with a portable Doppler Diadop 50(®) and defined by an intima-media thickness greater than 1.5mm. P-values less than 0.05 were considered statistically significant. RESULTS: The survey involved 1411 individuals with a sex ratio of 2.93 and an average age of 48.5 years. Prevalence of risk factors was high: dyslipidemia (61.1 %), physical inactivity (56.2 %), abdominal obesity (53.9 %), hypertension (46.4 %), obesity (12 %), diabetes (7.2 %) and smoking (2.5 %). Prevalence of atherosclerotic carotid plaques was 6.8 %, including 42.7 % with bilateral plaques. Prevalence increased with age (P=0.001), hypertension (P=0.0001), diabetes (P=0.004) and metabolic syndrome (P=0.008). There were no significant associations with the other risk factors. The presence of carotid plaques was associated with medical history of stroke (P=0.01), myocardial infarction (P=0.02) and peripheral artery obstructive disease (P=0.5). CONCLUSION: Prevalence of atherosclerotic carotid plaques seems weak but it is associated with many cardiovascular risk factors. It requires measures for early diagnosis and prevention of cardiovascular diseases in Senegal.

[Contribution of vascular ultrasonography in patients with ischemic strokes in Brazzaville (Congo)]. / Apport de l'écho-Doppler vasculaire dans les infarctus cérébraux à Brazzaville (Congo).

OBJECTIVE: To determine the prevalence of the carotid lesions during ischemic strokes. METHODS: This was a descriptive cross-sectional study, conducted in Brazzaville from January 2011 to June 2012 in a consecutive series of 73 patients, victims of a transient ischemic attack or ischemic stroke, documented by a brain computed tomography. All patients underwent vascular ultrasonography of the supra-aortic trunks, carried out within the framework of etiological assessment. The examination searched for plaques, parietal infiltration (measurement of intima-media thickness), and carotid stenosis or occlusion. RESULTS: There were 49 men (67%) and 24 women (33%), mean age 58.7 ± 11.8 years. Eleven patients (15%) had a transient ischemic attack and 62 (85%) an ischemic stroke. The identified independent vascular risk factors were known and treated hypertension (n=66, 90.4%), dyslipidemia (n=16, 22%), diabetes mellitus (n=9, 12.3%), and smoking (n=5, 6.8%), with on average 2.5 factors per individual. Vascular ultrasonography of the supra-aortic trunks, normal in 44 patients (60.3%) was pathological in the other 29 (39.7%). The main anomalies were atheromatous plaque (n=10, 13.7%), parietal infiltration (n=19, 26%). On average intima-media thickness was 0.86 ± 0.11 mm on the left and 0.83 ± 0.11 mm on the right. Two cases of moderate stenosis were noted on the right and left internal carotids, respectively. CONCLUSION: This preliminary study confirms the existence of carotid atherosclerosis anomalies during ischemic strokes. These lesions, though non-significant, must nevertheless be taken into consideration when searching for the cause of stroke in high-risk vascular patients.