Mechanisms of Medial Wall Thinning in Chronic Total Occlusion.

BACKGROUND: The success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is lower and the risk for complications higher compared with other non-CTO PCI. Although interventionalists focus on intimal plaque characteristics, the coronary media is an important (especially for techniques involving antegrade dissection and re-entry) but poorly understood structure in CTO PCI. OBJECTIVES: The aim of the present study was to investigate coronary medial wall thinning in CTO lesions and determine how this thinning might affect CTO PCI. METHODS: A total of 2,586 sections were investigated, from arteries with evidence of CTO from 54 subjects (1,383 sections) and arteries without evidence of CTO from 54 subjects with non-coronary-related deaths (1,203 sections) after matching for age, gender, body weight, and body height. RESULTS: The medial thickness in subjects with CTO was lower than that in those with non-coronary-related death (P < 0.001). In subjects with CTO, CTO lesions had thinner medial walls compared with those with lower luminal narrowing (P < 0.001). At the CTO distal segments, the 6- to 12-mm distal segment from the distal end of the CTO had significantly less luminal narrowing (P < 0.001), and similar medial thickness, compared with the distal end of the CTO. Immunohistochemical analysis revealed that short-duration CTO had more cleaved caspase-3-positive cells in media and had significantly more CD3+, CD4+, CD8+, and CD4+CD28null T cells compared with long-duration CTO. CONCLUSIONS: CTO lesions demonstrated coronary medial thinning compared with non-CTO lesions. Further investigation of the cause-and-effect relationship among inflammation, apoptosis, and coronary medial wall thinning is warranted in future mechanistic studies.

Ultrasound detection of non-atherosclerotic intima-medial abnormalities of lower limbs arteries in amateur endurance runners.

BACKGROUND: Structural changes in the lower limb's arterial wall in amateur endurance runners are a rare incidental finding, represented just by several case reports. AIM: Study the incidence of non-atherosclerotic lower limb artery wall changes in defined group of amateur endurance runners and identify relationship with the training parameters and the relevant biochemical markers. METHODS: Amateur male athletes engaged in endurance running for more than 5 years were enrolled. Tibial and anterior popliteal arteries on each side were examined by ultrasound with focus on non-atherosclerotic structural wall changes: intima-medial border blurring, presence and character of non-atherosclerotic noduli. Subsequently the descriptive and correlation analysis were performed. RESULTS: The study enrolled 20 amateur male endurance runners from Black Swan Triathlon Club Slovakia. The low atherosclerotic risk was represented by normal lipid levels, BMI under 30 kg/m2 and non-smokers in all participants. At least one type of structural artery wall abnormality (noduli or intima-medial border blurring) was present in 19 of 20 participants (95%). The most present was the intima-medial blurring. (80% of participants). The noduli were present in 65% of study group, in almost 40% of these, they were considered as hyperechogenic. All these affections were predominantly in popliteal artery area (65%). The vast majority has bilateral affection. We find a mild correlation between these ultrasound findings and training load represented by annual kilometers and run hours. There was no association between these changes and lipid spectrum or CRP level. CONCLUSION: The subclinical lower limb artery changes, represented by intima-medial border blurring and non-atherosclerotic noduli were present in almost every amateur endurance runner. Despite the underlying mechanism is not understood, the increased training load seems to be one of the responsible factors.

Stasis and Inflammation in Varicose Vein Development: An Interleukin-Mediated Process from Intima to Media.

INTRODUCTION: This study investigated the combination of venous stasis and inflammation in varicose vein development. METHODS: The study included patients with primary varicose veins operated using high ligation and stripping of greater saphenous vein. All of them showed reflux at sapheno-femoral junction on preoperative Doppler ultrasound. Mesenteric veins from early or advanced gastric cancer specimens were used as control group. Inflammatory mediators expressed in the venous wall were measured via immunohistochemistry and compared between the two groups. RESULTS: Thirty-five (59.3%) men and 24 women with a mean age of 52.8 years (range, 23-77 years) were included and 29 (49.2%) patients had edema or skin changes according to Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification and reporting standards for chronic venous disorders. The expression of interleukin 6 (IL-6) and transforming growth factor ß1 (TGF-ß1) in intima and those of IL-6 in media of greater saphenous veins increased, with statistically significant differences between the two groups (p < 0.001). IL-6 in media and TGF-ß1 levels in intima were independent predictors of varicose veins (adjusted odds ratios 74.62 and 66.69, respectively). CONCLUSION: Elevated venous pressure represented by reflux on Doppler ultrasound and increased expression of inflammatory cytokines including IL-6 in media and TGF-ß1 in intima are associated with the development of varicose veins.

Influence of age and sex on the thickness of the radial artery wall.

OBJECTIVE: The aim of this study is to investigate whether there is a relationship between age or sex and the thickness of the radial artery wall. MATERIALS AND METHODS: We harvested human radial arteries from 48 cadavers (30 men and 18 women) in the anatomy laboratory. Histological sections of 3 µm thickness were prepared at the Laboratory of Anatomy and Pathological Cytology, mounted on slides, and stained with hematoxylin-phloxine-safran, Masson's trichrome, and orcein. The thickness of each radial artery wall (intima-media thickness) was measured using optical microscopy, and an average measurement was established among the three thicknesses (upper third, middle third, and lower third). STATISTICAL METHODS: Statistical analyses were performed using the R software. Means and standard deviations were utilized. A correlation analysis was also conducted to assess the relationship between radial artery wall thickness and subjects' age. RESULTS: On average, the thickness of the left radial artery wall and that of the right radial artery measured 282 (34) micrometers (µm). We found a correlation between radial artery wall thickness and age in both men (p < 0.001) and women (p < 0.001). CONCLUSIONS: In conclusion, this study elucidates that radial artery wall thickness is related to age and sex in its assessment.

Arterial evaluation of systemic sclerosis patients with Doppler ultrasound: What did we find?

AIM: The aim of this study was to detect macrovascular findings in systemic sclerosis (SSc) by means of color Doppler ultrasonography (CDUS) and to evaluate the relationship between the laboratory and clinical findings in the setting of the disease. METHODS: This was a cross-sectional study. Eighty-eight patients were included in the study. CDUS examinations of the bilateral carotid, vertebral, and peripheral arteries were performed. The presence of macrovascular involvement was investigated and recorded, and its relationships with the clinical, laboratory, and cardiovascular risk factors were evaluated. RESULTS: An atheromatous plaque was found in 67.7% of the 1936 arteries examined by CDUS. Of these 1936 arteries, 37.4% demonstrated a narrowing of the intraluminal diameter. On the other hand, the carotid intima-media thickness (CIMT) was found to have increased in 55.7% of the patients. This increase was found to be statistically correlated with disease duration, the modified Rodnan Skin Thickness Score, and the Medsger Disease Activity Score. But no relation existed with the disease subtype, age, or cardiovascular risk factors. Arterial occlusion was detected in 10 patients. An association was found between the CIMT values and arterial occlusion. CONCLUSIONS: In this study, we examined the arteries by means of CDUS, and we detected structural alterations in the peripheral and carotid arteries. We witnessed that these macrovascular changes had a close association with certain features of SSc. We think there is a need for broader prospective studies in order to evaluate the contribution of these factors to the macrovascular changes stated in the article.

Intimal thickening and disruption of the media occur in the arterial walls of coronary arteries not associated with coronary arterial aneurysms in patients with Kawasaki disease.

BACKGROUND: Coronary artery aneurysm (CAA) is an important complication of Kawasaki disease (KD) that is associated with arterial structure damage. However, few studies have examined structural changes in coronary arteries that are not associated with CAA. METHODS: We examined coronary arteries in KD patients with CAAs who underwent follow-up coronary angiography (CAG) and optical coherence tomography (OCT). Coronary arterial branches with no abnormal findings during the most recent CAG were classified into two groups. Arteries with an acute-phase CAA that later regressed were classified as group R; arteries with no abnormal findings on either acute or convalescent phase CAG were classified as group N. Coronary arterial wall structural changes were compared between groups using OCT. RESULTS: Fifty-seven coronary arterial branches in 23 patients were evaluated by OCT. Thirty-six branches showed no abnormality during the most recent CAG. Both groups R and N comprised 18 branches. Maximum intimal thicknesses in groups R and N were 475 and 355 µm, respectively (p = 0.007). The incidences of media disruption were 100% and 67%, respectively (p = 0.02). Calcification, macrophage accumulation, and thrombus were not found in either group. CONCLUSIONS: Intimal thickening and disruption of the media occur in coronary arteries with acute phase CAAs that later regress in the convalescent phase, as well as in arteries with normal CAG findings in the acute and convalescent phases.

Abdominal Aortic Intima-Media Thickness Predicts Coronary Artery Disease Severity in Patients With Stable Angina Pectoris: A Prospective Study.

Accurately identifying coronary artery disease (CAD) is the key element in guiding the work-up of patients with suspected angina. Thickening of the arterial wall is a hallmark of atherosclerosis. Therefore, the main purpose of this study was to determine whether abdominal aortic intima-media thickness (AAIMT), which is the earliest zone of atherosclerotic manifestations, has a predictive value in CAD severity. A total of 255 consecutive patients who were referred for invasive coronary angiography due to suspected stable angina pectoris were prospectively included in the study. B-mode ultrasonography was used to determine AAIMT before coronary angiography. Coronary artery disease severity was assessed with the SYNTAX score (SS). A history of hypertension, age, dyslipidemia, and higher AAIMT (odds ratio: 2.570; 95%CI 1.831-3.608; P < .001) were independent predictors of intermediate or high SS. An AAIMT <1.3 mm had a negative predictive value of 98% for the presence of intermediate or high SS and 83% for obstructive CAD. In conclusion, AAIMT showed a significant and independent predictive value for intermediate or high SS. Therefore, AAIMT may be a noninvasive and useful tool for decision-making by cardiologists (eg, to use a more invasive approach).

Structural Thickening of Medial Layer in Coronary Artery With Spasm in Patients With Myocardial Infarction.

Background The underlying pathophysiology of coronary artery spasm (CAS) remains unclear. We aim to determine whether coronary artery medial layer thickness is associated with CAS using optical coherence tomography. Methods and Results A total of 50 patients with previous myocardial infarction underwent optical coherence tomography of the left anterior descending artery: 20 with CAS and 30 without CAS. Intimal and medial layer areas were measured by planimetric analysis of optical coherence tomography images. The medial area/external elastic membrane (EEM) area was significantly greater in patients with than without CAS (0.13±0.01 versus 0.09±0.01, respectively, P<0.01), whereas the intimal area/EEM area was similar in the 2 groups. In patients without CAS, the relationship of intimal area/EEM area with medial area/EEM area and coronary diameter response to intracoronary injection of acetylcholine was characterized by an inverted U-shaped curve (y=-1.85x2+0.81x+0.01, R2=0.43, P<0.001) and a U-shaped curve (y=2993.2x2-1359.6x+117.1, R2=0.53, P<0.001), respectively. Thus, the medial layer became thin and the contractile response became weak in coronary arteries with greater intimal area in the non-CAS patients. In contrast, in patients with CAS, the intimal area/EEM area had no significant relationship with the medial area/EEM area in either linear correlation analysis or quadratic regression analysis. Thus, even when the intimal layer thickened, the medial layer did not thin in patients with CAS. Conclusions The structural thickness of the coronary medial layer was increased in patients with CAS, which may provide mechanistic insight into the pathogenesis of CAS. Registration URL: https://www.upload.umin.ac.jp; Unique identifier: UMIN000018432.

Ultra-High Frequency Ultrasound, A Promising Diagnostic Technique: Review of the Literature and Single-Center Experience.

OBJECTIVES: Ultra-high frequency ultrasonography (UHFUS) is a recently introduced diagnostic technique which finds several applications in diverse clinical fields. The range of frequencies between 30 and 100 MHz allows for high spatial resolution imaging of superficial structures, making this technique suitable for the imaging of skin, blood vessels, musculoskeletal anatomy, oral mucosa, and small parts. However, the current clinical applications of UHFUS have never been analyzed in a consistent multidisciplinary manner. The aim of this study is to revise and discuss the current applications of UHFUS in different aspects of research and clinical practice, as well as to provide some examples of the current work-in-progress carried out in our center. MATERIALS AND METHODS: A literature search was performed in order to retrieve articles reporting the applications of UHFUS both in research and in clinical settings. Inclusion criteria were the use of frequencies above 30 MHz and study design conducted in vivo on human subjects. RESULTS: In total 66 articles were retrieved. The majority of the articles focused on dermatological and vascular applications, although musculoskeletal and intraoral applications are emerging fields of use. We also describe our experience in the use of UHFUS as a valuable diagnostic support in the fields of dermatology, rheumatology, oral medicine, and musculoskeletal anatomy. CONCLUSION: Ultra-high frequency ultrasonography application involves an increasing number of medical fields. The high spatial resolution and the superb image quality achievable allow to foresee a wider use of this novel technique, which has the potential to bring innovation in diagnostic imaging.

Tunica intima compensation for reduced stiffness of the tunica media in aging renal arteries as measured with scanning acoustic microscopy.

OBJECTIVES: Aging causes stiffness and decreased function of the renal artery (RA). Histological study with light microscopy can reveal microscopic structural remodeling but no functional changes. The present study aimed to clarify the association between structural and functional aging of the RA through the use of scanning acoustic microscopy. METHODS: Formalin-fixed, paraffin-embedded cross-sections of renal arteries from 64 autopsy cases were examined. Speed-of-sound (SOS) values of three layers, which correspond to the stiffness, were compared among different age groups. SOS of the tunica media was examined in terms of blood pressure (BP) and SOS of the ascending aorta. Vulnerability to proteases was assessed by SOS reduction after collagenase treatment. RESULTS: The tunica intima presented inward hypertrophy with luminal narrowing, and the tunica media showed outward hypertrophic remodeling with aging. SOS of the tunica media and internal and external elastic laminae showed a reverse correlation with age. SOS of the tunica media was negatively correlated with BP and strongly associated with that of the aorta. The tunica media of young RAs were more sensitive to collagenase compared with the old ones. CONCLUSIONS: Scanning acoustic microscopy is useful for observing the aging process of the RA. This technique simultaneously shows structural and mechanical information from each portion of the RA. In the process of aging, the RA loses contractile function and elasticity as a result of protease digestion. The tunica media and the internal and external elastic laminae exhibit reduced stiffness, but the tunica intima stiffens with atherosclerosis. As a consequence, the RA's outer shape changes from round to oval with inward and outward hypertrophy. This indicates that the inner resistant intima supports the mechanical weakness of the tunica media to compensate for an increase in BP with aging.

The association between carotid atherosclerosis and treatment with lithium and antipsychotics in patients with bipolar disorder.

OBJECTIVES: Patients with bipolar disorder are at high risk of cardiovascular diseases. Among cardiovascular diseases, coronary heart disease and stroke are the leading causes of premature death and both share the pathogenesis of arterial atherosclerosis. Increased carotid intima-media thickness is sensitive for detecting early atherosclerosis and a practical index for predicting cardiovascular diseases. However, few studies investigated carotid intima-media thickness in adults with bipolar disorder. We attempted to determine the factors associated with carotid intima-media thickness in adults with bipolar disorder. METHODS: The euthymic out-patients with bipolar I disorder aged over 20 years were recruited to measure the carotid intima-media thickness value through B-mode carotid ultrasound. Those with any psychiatric disorder, acute or life-threatening medical condition were excluded. All clinical information was obtained by reviewing medical records and directly interviewing patients with reliable others. RESULTS: Of the 106 participants with a mean age of 44.5 years, 40.6% (N = 43) had concurrent cardiovascular/endocrine/metabolic diseases. A multivariate regression indicated that higher assumed daily lithium dosage was significantly associated with a decreased carotid intima-media thickness in the whole sample. In the young subgroup (⩽45 years old, N = 63), higher current daily lithium dosage and lower body mass index were associated with lower carotid intima-media thickness. In those without concurrent cardiovascular/endocrine/metabolic diseases, higher ratio of first-generation antipsychotics exposure in relation to illness chronicity was associated with higher carotid intima-media thickness, after controlling for body mass index or age. CONCLUSION: Lithium treatment may be associated with less progression in carotid intima-media thickness and the reduced risk for atherosclerosis in adults with bipolar disorder, including those with high cardiovascular disease risk. In addition to age and body mass index, antipsychotics may increase carotid intima-media thickness even in the low cardiovascular disease-risk patients.

Full-field optical coherence tomography for the diagnosis of giant cell arteritis.

Histopathological examination of temporal artery biopsy (TAB) remains the gold standard for the diagnosis of giant cell arteritis (GCA) but is associated with essential limitations that emphasize the need for an upgraded pathological process. This study pioneered the use of full-field optical coherence tomography (FF-OCT) for rapid and automated on-site pathological diagnosis of GCA. Sixteen TABs (12 negative and 4 positive for GCA) were selected according to major histopathological criteria of GCA following hematoxylin-eosin-saffron-staining for subsequent acquisition with FF-OCT to compare structural modifications of the artery cell wall and thickness of each tunica. Gabor filtering of FF-OCT images was then used to compute TAB orientation maps and validate a potential automated analysis of TAB sections. FF-OCT allowed both qualitative and quantitative visualization of the main structures of the temporal artery wall, from the internal elastic lamina to the vasa vasorum and red blood cells, unveiling a significant correlation with conventional histology. FF-OCT imaging of GCA TABs revealed destruction of the media with distinct remodeling of the whole arterial wall into a denser reticular fibrous neo-intima, which is distinctive of GCA pathogenesis and accessible through automated Gabor filtering. Rapid on-site FF-OCT TAB acquisition makes it possible to identify some characteristic pathological lesions of GCA within a few minutes, paving the way for potential machine intelligence-based or even non-invasive diagnosis of GCA.

Aortic intima-media thickness in neonates exposed to early-onset preeclampsia.

Aortic intima-media thickness (aIMT) and its ratio to aortic diameter (aIMT/AoD) were measured on the second and fifth postnatal day in 39 neonates exposed to early-onset preeclampsia and 39 controls. Both aIMT and aIMT/AoD were higher in neonates exposed to preeclampsia (P < 0.001 for all comparisons).

Intimal and medial calcification in relation to cardiovascular risk factors.

PURPOSE: To assess specific risk factors and biomarkers associated with intimal arterial calcification (IAC) and medial arterial calcification (MAC). METHODS: We conducted a cross-sectional study in patients with or at risk of vascular disease from the SMART study(n = 520) and the DCS cohort(n = 198). Non-contrast computed tomography scanning of the lower extremities was performed and calcification in the femoral and crural arteries was scored as absent, predominant IAC, predominant MAC or indistinguishable. Multinomial regression models were used to assess the associations between cardiovascular risk factors and calcification patterns. Biomarkers for inflammation, calcification and vitamin K status were measured in a subset of patients with IAC(n = 151) and MAC(n = 151). RESULTS: Femoral calcification was found in 77% of the participants, of whom 38% had IAC, 28% had MAC and 11% were scored as indistinguishable. The absolute agreement between the femoral and crural arteries was high(69%). Higher age, male sex, statin use and history of coronary artery disease were associated with higher prevalences of femoral IAC and MAC compared to absence of calcification. Smoking and low ankle-brachial-index (ABI) were associated with higher prevalence of IAC and high ABI was associated with less IAC. Compared to patients with IAC, patients with MAC more often had diabetes, have a high ABI and were less often smokers. Inactive Matrix-Gla Protein was associated with increased MAC prevalence, while osteonectin was associated with decreased risk of MAC, compared to IAC. CONCLUSIONS: When femoral calcification is present, the majority of the patients have IAC or MAC throughout the lower extremity, which have different associated risk factor profiles.

Age-dependent effect of metabolic phenotypes on carotid atherosclerotic disease in coronary heart disease patients (CORDIOPREV study).

BACKGROUND: Aging is associated with a high risk for cardiovascular disease. The relation of obesity and risk of cardiovascular events appears to be more closely linked to certain clinical or metabolic phenotypes than to obesity itself. Our aim was to establish whether aging influenced the metabolic phenotypes regarding to cardiovascular risk, evaluated by changes in the intima media thickness-common carotid (IMT-CC), in coronary heart disease (CHD) patients. METHODS: In this cross-sectional study, 1002 CHD patients were studied at entry from the CORDIOPREV study. We performed carotid ultrasound assessment to obtain their IMT-CC values. Carotid atherosclerosis was considered to exist if IMT-CC > 0.7 mm. RESULTS: Age determined a higher IMT-CC, regardless metabolic phenotype (all p < 0.05). Metabolically healthy non-obese (MHNO) aged< 60 showed a lesser prevalence for carotid atherosclerotic disease than metabolically sick non-obese (MSNO) and obese (MSO), while MHNO aged≥60 only showed less prevalence for the disease than the MSO. Carotid atherosclerosis associated with age, sex, impaired fasting glucose (IFG), hypertension and high sensitivity C-reactive protein (hsCRP). However, in patients aged< 60, it associated with sex and IFG and in the age ≥ 60 group, with hypertension and hsCRP. CONCLUSIONS: Our results suggest that CHD patients aged≥60 are less metabolic flexible compared to patients aged< 60. Thus, MHO patients aged≥60 show the same risk of suffering carotid atherosclerosis as those with metabolic disease, while MHO patients aged< 60 show lower risk than MSO. This fact indicates the need to focus on therapeutic strategies in order to modify those parameters related to obesity and metabolic inflexibility in patients with CHD before entering old age.

Relationship of a thinned medial layer to the attenuated contractile response in atherosclerotic coronary arteries.

Coronary arteries with advanced atherosclerosis do not necessarily have greater contractile responses than those with early atherosclerosis. This study aimed to clarify the relationship between thickness of the medial layer and the contractile response to acetylcholine (ACh) in coronary artery using optical coherence tomography (OCT). The OCT and the vasomotor response to ACh in the left anterior descending coronary artery were assessed in 32 patients with previous myocardial infarction. The intimal and medial layer areas were measured by planimetric analysis of the OCT images. The coronary contractile response to ACh had a positive linear relationship with medial area (r = 0.61, P < 0.001). In contrast, the relationship between the coronary contractile response to ACh and intimal area was described by an inverted U-shaped curve that was fitted to a quadratic regression model (R2 = 0.35, P = 0.002, y-axis, contraction; x-axis, intimal area). The contractile response increased as the intimal layer thickened up to the inflection point; thereafter, the contractile response declined. The relationship between medial area and intimal area was also described by an inverted U-shaped curve that was fitted to a quadratic regression model (R2 = 0.41, P < 0.01, y-axis, medial area; x-axis, intimal area). The medial area increased as the intimal area thickened up to the inflection point; thereafter, the medial area thinned. In conclusion, the thinned medial layer was associated with the attenuated contractile response in a coronary artery with greater atherosclerosis.NEW & NOTEWORTHY This is the first clinical study to show the relationship between the contractile response and the thickness of medial smooth muscle layer in coronary artery of patients with previous myocardial infarction using OCT. The contractile response to acetylcholine was attenuated, and medial layer area was thinned in coronary artery with greater atherosclerosis compared with those in coronary artery with mild or moderate atherosclerosis. The coronary contractile response was positively correlated with thickness of the medial layer in coronary arteries with either mild or greater atherosclerosis. Thus, coronary arteries with advanced atherosclerosis do not necessarily have greater contractile responses than those with early atherosclerosis, which could be related to the thinned medial layer.

Venous intima-media thickness increases both in deep and superficial systems in patients with great saphenous vein reflux.

OBJECTIVE: To evaluate by Doppler ultrasound (DUS) the venous intima-media thickness (vIMT) in patients with or without great saphenous vein (GSV) incompetence. METHODS: A prospective vIMT measurement was performed by DUS in an outpatient cohort. Patients were divided in two groups: group A, patients without GSV reflux; and group B, patients with at least one refluxing GSV. Group B was further divided in group B1, patients with monolateral refluxing GSV; and group B2, patients with bilateral GSV reflux. The vIMT was measured in the femoral vein (FV), 3 to 5 cm distal to the saphenofemoral junction (vIMT[FV]), and in the GSV, 3 to 5 cm from saphenofemoral junction (vIMT[R-] or vIMT[R+]) in the case of a nonrefluxing or a refluxing GSV, respectively. Only one limb per patient was considered for vIMT analysis: in group A, the limb with the greater vIMT(R-), in subgroup B1 the limb with a refluxing GSV, and in subgroup B2 the limb with the lower vIMT(R+). The primary outcome was the difference of vIMT of GSV between groups A and B. Secondary outcomes were differences in vIMT(FV) among groups and the correlation between vIMT of GSV and demographic or clinical parameters. A subgroup analysis of vIMT in GSV was conducted in B1 patients, describing vIMT variations in both limbs. RESULTS: Forty-four patients were enrolled. In the group A (26 patients), vIMT of the GSV was lower than in the group B (18 patients; 0.31 ± 0.01 mm vs 0.49 ± 0.02 mm; P < .001). The difference was significant also for vIMT(FV) (group A, 0.67 ± 0.02 mm vs group B, 0.77 ± 0.03 mm; P < .014). No statistical correlation between age, body mass index, family history, or use of elastic stockings and vIMT(FV) or vIMT(R+ or R-) was detected. Considering the whole population, vIMT of GSV was higher in patients with Clinical, Etiology, Anatomy and Pathophysiology (CEAP) class C of 2 or greater than in classes C 0 and 1 (0.43 ± 0.02 mm vs 0.32 ± 0.02 mm; P < .0002). The difference was significant also for vIMT(FV) in patients with class a class C of 2 or greater and C of 0 to 1 (0.77 ± 0.02 mm vs 0.64 ± 0.03 mm; P < .0008, respectively). In group B1, vIMT(R+) was higher than vIMT(R-) (0.50 ± 0.02 mm vs 0.32 ± 0.02 mm, respectively; P < .0001). The difference was not significant for vIMT(FV). CONCLUSIONS: vIMT seems to be an indirect marker of saphenous insufficiency. In GSV incompetence, an augmented wall thickening is visible in the FV as well. Further studies are needed to assess the accuracy of DUS measurements of vIMT. Longitudinal studies are also needed to evaluate possible GSV and FV vIMT variations related to disease progression or treatment.

High-resolution magnetic resonance imaging of intracranial vessel walls: Comparison of 3D T1-weighted turbo spin echo with or without DANTE or iMSDE.

BACKGROUND: The black-blood (BB) technique was developed to suppress the signal from blood and cerebrospinal fluid (CSF) to provide improved depiction of vessel walls. PURPOSE: The aim was to compare three-dimensional turbo spin echo T1-weighted imaging (3D TSE T1WI) with or without two BB techniques (delay alternating with nutation for tailored excitation [DANTE], and improved motion-sensitized driven equilibrium [iMSDE]) for high-resolution magnetic resonance imaging (HR-MRI) of the vessel walls of intracranial arteries. STUDY TYPE: Prospective. POPULATION: Fourteen healthy volunteers who underwent 3D T1WI for examination of intracranial vessel walls. FIELD STRENGTH/SEQUENCE: 3 Tesla, 3D TSE T1WI (SPACE and BrainVIEW) and BB (DANTE and iMSDE). ASSESSMENT: SPACE with or without DANTE, and BrainVIEW with or without iMSDE, were acquired in each subject. Two neuroradiologists independently assessed image quality, vessel wall delineation, BB effect, CSF, and acceptability using visual scoring systems, and measured signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in vessel walls, lumen, and CSF, while blinded to the presence and type of BB technique used. STATISTICAL TESTS: Repeated measures ANOVA or Friedman tests were performed for the comparisons, followed by Bonferroni correction. RESULTS: The 3T T1WI sequences without BB are significantly superior in vessel wall delineation (P = 0.001). Black CSF scores were lower in SPACE with DANTE than SPACE without DANTE, and in BrainVIEW without iMSDE than SPACE without DANTE (P < 0.001). However, there were no significant differences in BB effect, image quality, and acceptability between the four 3D T1WI sequences (p > .05). The SNRVessel wall, CNRWall-Lumen, and CNRWall-CSF were higher (all p < .001) on SPACE with and without DANTE than on BrainVIEW with and without iMSDE. SNRLumen were higher (all p < .001) on BrainVIEW with and without iMSDE than on SPACE with and without DANTE. SNRCSF was higher (all p < .001) on BrainVIEW with iMSDE than on SPACE with DANTE. DATA CONCLUSION: Both 3D TSE T1WI sequences were acceptable for intracranial vessel wall evaluation, with or without BB techniques. Therefore, BB techniques may not necessarily be required with 3D TSE T1WI with a long ETL and TR (below 1160 ms).

Intima-media thickness of femoral arteries and carotids among an adult hypertensive Nigerian population: A case-control study to assess their use as surrogate markers of atherosclerosis.

Background: Increased intima-media thickness (IMT) is an established and important surrogate marker for atherosclerosis. Intima-media thickening in the femoral arteries occur earlier and reflect the true extent of generalized atherosclerosis better than in the carotids. Aims: To study the ultrasound-detected morphological changes in the common femoral versus carotid artery wall. Patients and Methods: A case-control study design was used, with 61 adult hypertensive as cases and 61 age-, sex- and BMI-matched normotensive as controls. Variables were participants' characteristics, cardiovascular risk factors, and ultrasonographically evaluated IMT of the carotid and femoral arteries. Results: A total of 122 participants were studied. The mean femoral IMT in hypertensives and controls on the right and left was 0.63 ± 0.07mm vs. 0.52 ± 0.06mm [P < 0.0001] and 0.69 ± 0.0 mm vs. 0.55 ± 0.05mm [P < 0.0001]. Also, the mean carotid IMT among hypertensives and controls on the right =0.80 ±0.15mm vs. 0.64 ± 0.06mm [P < 0.0001], and 0.91 ± 0.22mm vs. 0.65 ± 0.06mm [P < 0.0001] on the left. Significant correlation was observed between IMT and age (B = 0.006, P < 0.001 and B = 0.003, P < 0.001), hypertension (B = 0.205, P < 0.001 and B = 0.122, p< 0.001), and duration of hypertension (B = 0.02, P < 0.001 and B = 0.006, P = 0.02) the femoral and carotid arteries respectively. Conclusion: The femoral and the carotid artery show similar significantly increased IMT in hypertensive adults. The femoral IMT appears to be a good surrogate marker of atherosclerosis among hypertensive Nigerians.

RésuméContexte: L'épaisseur accrue de l'intima-média (IMT) est un marqueur de substitution établi et important de l'athérosclérose. L'épaississement intima-média dans les artères fémorales survient plus tôt et reflète mieux l'étendue réelle de l'athérosclérose généralisée que dans les carotides. Objectifs: étudier les modifications morphologiques détectées par échographie dans la paroi de l'artère fémorale commune par rapport à la carotide. Patients et méthodes: Un schéma d'étude cas-témoins a été utilisé, avec 61 adultes hypertensifs en tant qu'études des cas et 61 normo-tensifs appariés pour l'âge, le sexe et l'IMC en tant que contrôles. Les variables étaient les caractéristiques des participants, les facteurs de risque cardiovasculaires et les TMI évaluées par échographie des artères carotides et fémorales. Résultats: Un total de 122 participants ont été étudiés. Le TMI fémoral moyen chez les hypertensifs et chez les témoins de droite et de gauche était de 0,63 ± 0,07 mm contre 0,52 ± 0,06 mm [P <0,0001] et de 0,69 ± 0,0 mm contre 0,55 ± 0,05 mm [P <0,0001]. En outre, la moyenne IMT carotidienne chez les hypertendus et les contrôles à droite = 0,80 ± 0,15 mm vs 0,64 ± 0,06 mm [P <0,0001] et 0,91 ± 0,22 mm contre 0,65 ± 0,06 mm [p < 0,0001] à gauche. Une corrélation significative a été observée entre les TMI et l'âge (B = 0,006, p < 0,001 et B = 0,003, p < 0,001), l'hypertension (B = 0,205, p <0,001 et B = 0,122, p <0,001) et la durée de l'hypertension (B = 0,02, p < 0,001 et B = 0,006, p = 0,02) respectivement des artères fémorale et carotide. Conclusion: Les artères fémorales et carotide montrent une augmentation similaire du TMI chez les adultes hypertensifs. L'IMT fémoral semble être un bon marqueur de substitution de l'athérosclérose chez les Nigérians hypertensifs.