Analysis of risk factors and diseases associated with atherosclerosis in the progression of carotid artery stenosis.

OBJECTIVE: The objective of this study was to analyze the roles of demographic, clinical, and laboratory factors on the progression of atherosclerotic stenosis in carotid bifurcation. It was based on prospective information from records entered on a specific application form for follow-up outpatients at a tertiary university service. METHODS: Consecutive symptomatic and asymptomatic patients (n = 210) who had undergone more than one carotid duplex scan but no surgical intervention were selected for the analysis. The patients were divided into two groups: patients whose duplex scans did not show bilateral progression of carotid stenosis and patients with carotid stenosis progression of <50%, 50%-69%, or >70%. Clinical and demographic parameters were compared between groups. RESULTS: Group II levels of plasma urea (51.6 ± 27.8 mg/dl) and fibrinogen (493.2 ± 113.3 mg/dl) were higher than the Group I levels (43.0 ± 14.9 mg/dl and 441.3 ± 106.7 mg/dl, respectively) with statistical significance (p urea = 0.013 and p fibrinogen = 0.018). Paradoxically, the mean body mass index was higher in Group I (26.4 ± 4.6 kg/m(2)) than in Group II (24.6 ± 3.9 kg/m(2); p = 0.02). CONCLUSIONS: Traditional risk factors for the development of atherosclerosis in a carotid bifurcation are important but not unique. Metabolic and inflammatory factors can contribute to disease progression.

Intraplaque hemorrhage assessed by high-resolution magnetic resonance imaging and C-reactive protein in carotid atherosclerosis.

BACKGROUND: Carotid intraplaque hemorrhage is a marker of atheroma instability. Noninvasive assessment of bleeding can be performed by high-resolution magnetic resonance imaging (MRI), but its association with inflammatory markers has not been clearly demonstrated. METHODS: We evaluated consecutive carotid endarterectomy patients that underwent high-resolution MRI, independent evaluation of neurologic symptoms, C-reactive protein measurement, and histologic analysis. Intraplaque hemorrhage was determined by the presence of a hyperintense MRI signal (T1-weighted sequence). RESULTS: The study included 70 predominantly male (66%) and hypertensive (89%) patients (89%) aged 66 +/- 9 years old. MR angiography identified 15 patients (21.5%) with stenosis between 50% and 69%, 15 (21.5%) with stenosis between 70% and 90%, and 40 (57%) with stenosis >90%. High-resolution MRI depicted a hyperintense signal suggestive of intraplaque bleeding in 45 subjects (64%). All patients who had had transient ischemic attacks >90 days before the surgery showed a hyperintense signal on MRI (P = .007). Age, gender, traditional cardiovascular risk factors, and history of myocardial infarction or peripheral arterial disease were similar in patients with or without signs of intraplaque bleeding on MRI. There was excellent agreement between acute or recent hemorrhage on histologic and MRI findings (kappa coefficient, 0.91; 95% confidence interval, 0.81 to 1.00). Only one of 45 patients (2%) with a hyperintense signal on MRI did not have acute or recent hemorrhage in the histologic analysis (P < .001). High-sensitivity C-reactive protein levels were similar for different degrees of carotid stenosis as assessed by MR angiography, but they were significantly higher in clinically unstable patients (P = .006) and in those with a positive hyperintense MRI signal (P = .01). In an aggregated analysis of neurologic symptoms and MRI findings, we found a progressive increase of high-sensitivity C-reactive protein levels (P = .02). CONCLUSIONS: Intraplaque hemorrhage evaluated by MRI identified neurologically unstable patients with increased levels of high-sensitivity C-reactive protein regardless of the degree of carotid stenosis.

Vulnerable plaque detection by temperature heterogeneity measured with a guidewire system: clinical, intravascular ultrasound and histopathologic correlates.

Diagnosing plaque vulnerability may have therapeutic and prognostic implications. We used a heat sensor-tipped thermography guidewire to identify temperature variations in atherosclerotic coronary arteries in patients undergoing stent placement. This study is the first human experience with the ThermoCoil Guidewire (TG). TG consists of a 0.014 inch wire which rotates as it is retracted so as to interrogate the arterial lumen in a helical path. The wire has a temperature sensor in the distal tip with a sensitivity of 0.03 degrees Celcius. In 13 patients presenting with either acute or chronic coronary syndromes as indications for percutaneous coronary intervention, the following parameters were assessed: thermography, intravascular ultrasound (IVUS), angiography and serum markers for inflammation (C-reactive protein) and ischemia (troponin). Directional atherectomy was performed in 2 patients and tissue was analyzed histopathologically. Two patients had unstable angina, 2 had myocardial infarction, and 9 had stable angina as indications for coronary intervention. There were no device-related adverse events or system failures. Thermography was performed on all patients prior to any other intervention. Intra-arterial temperature rises between 0.1 degrees Celcius and 0.3 degrees Celcius were noted in 4 subjects. Intravascular ultrasound findings and atherectomy tissue histology showed correlates of plaque vulnerability in plaques with elevated temperature. In conclusion, thermography using a guidewire-based system can be performed safely, and detected lesions whose IVUS and/or atherectomy findings suggested plaques at high risk for rupture. Further studies will determine the predictive value of thermography or other techniques for assessing plaque composition and risk through noninvasive or invasive means.

[The influence of ethanol in alcoholic beverages in extracranial carotid arteries atherosclerosis]. / Influência do etanol das bebidas alcoólicas na aterosclerose em artérias carótidas extracranianas.

UNLABELLED: There is less incidence of occlusive cerebrovascular disease, of coronarian atherosclerosis and of other arteries with a light to moderate consumption of alcohol, suggesting that the same may occur with respect with the extracranial carotid arteries. Using color Doppler ultrasonography, we studied 328 extracranial carotid arteries of white male and females over 35 year old, with normal blood pressure, non-smokers and free of the main diseases make up the risk factors for cardiovascular diseases. They were stratified, according to the level of weekly alcohol consumption in milliliters (ml), in abstainers, light drinkers (1 to 100), moderate drinkers (101 to 300) and heavy drinkers (over 301). There was a lower incidence of atherosclerotic plaque and stenosis in the moderate drinkers. CONCLUSION: The study suggests that ethyl alcohol when drunk with moderation exerts a protective action from carotid atherosclerosis.

Comparaçäo das fraçöes HDL e LDL colesterol como fatores de risco para a aterosclerose carotídea / Comparison between HDL and LDL cholesterol fractions as risk factors for carotid atherosclerosis

Estudo prospectivo com o objetivo de verificar qual das fraçoes do colesterol sanguíneo, HDL ou LDL, é mais significativa para o desenvolvimento da aterosclerose das artérias carótidas (AC). Constou de 125 indivíduos de ambos os sexos, com idade enttre 45 a 75 anos, incluídos aleatoriamente. Em todos foi procedida a dosagem sanguínea do colesterol total e das fraçoes HDL e LDL e estudo ultrassonográfico (através de ultrasonografia modo B) das AC. Os resultados mostraram que a presença de placa de ateroma, com ou sem estenose nas AC, é inversamente proporcional aos níveis de HDL. Estes achados forma estatísticamente significantes (x2=6,57 e x2=9,24), respectivamente para placa sem estenose e com estenose; x2 crítico = 5,99 para alfa=5 por cento). Foi também constatada associaçao entre a presença de placa aterosclerótica na AC e níveis sanguíneos elevados de LDL: quanto maiores os níveis de LDL, maior a proporçao de indivíduos com placas, porém este achado nao foi estatisticamente significante (x2=0,97, x2 crítico 5,99 para alfa=5 por cento) Nao foi encontrada nesta casuística relaçao entre níveis elevados de LDL a presença de estenose nas AC. Estes resultados, ainda que iniciais, sugerem níveis baixos de HDL sao mais aterogênicos para as AC comparativamente a níveis elevados de LDL.