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1.
Vasc Health Risk Manag ; 16: 29-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32021226

RESUMO

Objective: We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods: A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results: The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P<0.001 for all) shorter 6MWT distance and higher Borg dyspnea score than the patients with arterial hypertension (systolic/diastolic BP = 146.1±10.7/94.2±9.8 mmHg) and the control group = 330.2±14.6 vs 523.8±35.3 and 560.9±30.2 m respectively and 6.2±1.8 vs 1.2±2.1 and 0.9±2.8 points. The PWVm and PWVe were the highest in hypertensive patients (10.3±1.5 and 11.42±1.70 m/s). The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P<0.003/0.008) higher in IPAH patients than in the control group (8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s). The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group (7.40±1.32/7.22±1.32 vs 7.19±0.78/7.2±1.1 PWVe) did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P<0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (ß=1.104, P=0.008, CI 1.026-1.189) and TAPSE (ß=0.66, P=0.016, CI 0.474-0.925). Conclusion: In spite of equal and at normal range BP level, the age-adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients. Based on our results it is impossible to conclude the pathogenesis of arterial stiffening in IPAH patients, but the discovered changes and correlations suggest new directions for further studies, including pathogenesis and prognosis researches.


Assuntos
Pressão Arterial , Artérias Carótidas/fisiopatologia , Hipertensão Pulmonar Primária Familiar/fisiopatologia , Artéria Femoral/fisiopatologia , Artéria Pulmonar/fisiopatologia , Rigidez Vascular , Adulto , Estudos de Casos e Controles , Estudos Transversais , Hipertensão Pulmonar Primária Familiar/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Onda de Pulso
2.
Mymensingh Med J ; 29(1): 209-214, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915360

RESUMO

Most of the mortalities among Diabetic Nephropathy patients are cardiovascular, if we identify the risk factor, measures can be taken to prevent it. Hence an objective was set to evaluate the association between carotid artery intima media thickness (CIMT) with eGFR in patients of CKD stage III, IV and V among patients with type 2 diabetes mellitus; also, correlation with age, BMI, lipid profile. This cross-sectional, observational study was performed in 70 patients in different stages of CKD in Diabetic Patients selected by Inclusion Criteria (Diabetic nephropathy patients with stages III, IV, V and exclusion Criteria (Acute kidney injury, History of carotid surgery, Patients of MI and stroke). This study was performed in Department of Nephrology, Dhaka Medical College in collaboration with the Department of Radiology and Imaging, laboratory of Department of Biochemistry and Department of Microbiology at Dhaka Medical College Hospital (By standard method in laboratory) from 1st January 2016 to 31st December 2016. eGFR was measured by MDRD formula and the CIMT was measured using an ultrasonographic examination. The mean CIMT was 0.9±0.21mm, and 62.9% of the subjects showed IMT thickening (≥1mm). The carotid IMT elevated significantly with the stage progression of CKD (Overall eGFR mean 28.8±14.5mL/min/1.73m² in CIMT<1mm with range from 6 to 54 and 9.1±9.0mL/min/1.73m² in CIMT ≥1mm with range from 3 to 32 (p=0.001). The eGFR was significantly lower in the patients with CIMT thickening than those without CIMT thickening. eGFR was also significantly associated with CKD stages (p=0.001), serum creatinine (p=0.001), BMI (r = -0.330, p=0.005), and negatively associated with age group, duration of hypertension, smoking. However, the CIMT was not significantly different among the patients at different stages of diabetic nephropathy (r = -0.172, p=156) and age group. It has been concluded that the mean CIMT was markedly high in patients with CKD compared to normal expected value. This study showed a relationship between the CIMT and the renal parameters as eGFR and the stages of diabetic nephropathy with a confirm association between the CIMT and diabetic macroangiopathy.


Assuntos
Artérias Carótidas/patologia , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus/patologia , Rim/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Bangladesh/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Taxa de Filtração Glomerular , Humanos , Insuficiência Renal Crônica/epidemiologia
3.
Int J Sports Med ; 41(2): 82-88, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31902128

RESUMO

Sex differences exist in vascular responses to blood pressure perturbations, such as resistance exercise. Increases in aortic stiffness following acute resistance exercise appear different between sexes, with attenuated increases in females vs. males. Whether sex differences exist in carotid stiffness, following resistance exercise is unknown. This study sought to examine sex differences in carotid stiffness, aortic stiffness, and hemodynamics following acute resistance exercise. Thirty-five participants (18 male) completed 3 sets of 10 repetitions of maximal isokinetic knee extension/flexion. Aortic stiffness and hemodynamics were estimated using an automated oscillometric blood pressure monitor at baseline, 5- and 30-min post-exercise. Carotid stiffness was assessed by ß-stiffness index, pressure-strain elastic modulus and arterial compliance using ultrasonography. Resistance exercise increased aortic stiffness, mean and systolic pressure at 5-min (p<0.01), and pressure-strain elastic modulus at 5-min in both sexes (p<0.05). Arterial compliance decreased at 5- and 30-min post exercise in both sexes (p<0.01). No interaction effects were detected in carotid stiffness, aortic stiffness, and hemodynamics, indicating similar vascular responses between sexes. Our findings indicate that the large arteries appear to stiffen similarly following resistance exercise in males and females when presented with similar blood pressure responses.


Assuntos
Artérias Carótidas/fisiologia , Treinamento de Resistência , Rigidez Vascular/fisiologia , Adulto , Pressão Sanguínea/fisiologia , Composição Corporal , Módulo de Elasticidade/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Joelho/fisiologia , Masculino , Força Muscular/fisiologia , Fatores Sexuais , Adulto Jovem
4.
J Surg Res ; 246: 550-559, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668608

RESUMO

BACKGROUND: Intimal hyperplasia (IH) is the initial lesion of vein graft failure after coronary artery bypass grafting. The weak venous wall is likely one of the primary reasons for IH after exposure to the arterial environment. We investigate whether adventitial collagen cross-link by glutaraldehyde (GA) reinforces the venous wall and then reduces IH. MATERIALS AND METHODS: Adventitial collagen cross-link by 0.3% GA was performed on the rabbit jugular veins. The degree of cross-link was accessed by tensile test. The jugular vein with or without cross-link was implanted into the carotid artery of rabbit. Vein dilatation at the immediate anastomosis and pathological remodeling of vein graft after 4 wk was assessed. RESULTS: Tensile test indicated that the mechanical property of 3-min cross-linked veins more closely resembled that of the carotid artery. In rabbit arteriovenous graft models, 3-min adventitial collagen cross-link limited overdistension (diameter: 3.24 mm versus 4.65 mm, P < 0.01) at the immediate anastomosis and reduced IH (intima thickness: 78.83 µm versus 140.19 µm, P < 0.01) of vein grafts 4 wk after implantation in the cross-link group as compared with the graft group (without cross-link). Compared with the cross-link group, the expression of proliferating cell nuclear antigen and vascular cell adhesion molecule-1 increased significantly at both the mRNA and protein levels within the graft group (P < 0.01), but the expression of smooth muscle-22α decreased significantly (P < 0.01). CONCLUSIONS: Adventitial collagen cross-link by GA increased the vessel stiffness and remarkably reduced IH in a rabbit arteriovenous graft model.


Assuntos
Túnica Adventícia/efeitos dos fármacos , Colágeno/metabolismo , Reagentes para Ligações Cruzadas/administração & dosagem , Glutaral/administração & dosagem , Túnica Íntima/patologia , Túnica Adventícia/metabolismo , Animais , Artérias Carótidas/transplante , Ponte de Artéria Coronária/efeitos adversos , Modelos Animais de Doenças , Humanos , Hiperplasia/etiologia , Hiperplasia/prevenção & controle , Veias Jugulares/efeitos dos fármacos , Veias Jugulares/transplante , Masculino , Coelhos , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/metabolismo , Rigidez Vascular/efeitos dos fármacos
5.
Br J Radiol ; 93(1107): 20190516, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31647306

RESUMO

Re-irradiation can offer a potentially curative solution in case of progression after initial therapy; however, a second course of radiotherapy can be associated with an increased risk of severe side-effects. Particle therapy with protons and especially carbon ions spares surrounding tissue better than most photon techniques, thus it is of high potential for re-irradiation. Irradiation of tumors of the brain, head and neck and skull base involves several delicate risk organs, e.g. optic system, brainstem, salivary gland or swallowing muscles. Adequate local control rates with tolerable side-effects have been described for several tumors of these locations as meningioma, adenoid cystic carcinoma, chordoma or chondrosarcoma and head and neck tumors. High life time doses nonetheless lead to a different scope of side-effects, e.g. an enhanced rate of carotid blow outs has been reported. This review summarizes the current data on particle irradiation of the aforementioned locations and malignancies.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia com Íons Pesados/métodos , Terapia com Prótons/métodos , Reirradiação/métodos , Neoplasias da Base do Crânio/radioterapia , Carcinoma Adenoide Cístico/radioterapia , Artérias Carótidas/efeitos da radiação , Lesões das Artérias Carótidas/etiologia , Sistema Nervoso Central/patologia , Sistema Nervoso Central/efeitos da radiação , Condrossarcoma/radioterapia , Cordoma/radioterapia , Ependimoma/radioterapia , Glioma/radioterapia , Humanos , Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Necrose , Órgãos em Risco , Sarcoma/radioterapia
6.
World Neurosurg ; 133: e739-e744, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606499

RESUMO

OBJECTIVE: To carry out surgery safely in vessels with stents, it is essential to have knowledge of what would happen if the stents were clamped or cut. Using all stents that are permitted in Japan, we recorded with a surgical microscope the behavior of stents when they were clamped or cut and discussed the morphologic changes along with image findings. METHODS: We classified carotid artery and intracranial stents as group 1A and 1B or group 2A and 2B according to the structure of stent eye: laser cut or blade. Each stent was clamped using a Yasargil aneurysm clip, bulldog forceps, and vascular forceps. Degree of closure and presence or absence of stent deformation after declamping were recorded using a surgical microscope. Furthermore, we performed morphologic evaluations using high-resolution cone-beam computed tomography. Lastly, each stent was cut; the behavior of the cut stent was recorded, and differences between stents were examined. RESULTS: Complete clamping was confirmed both visually and based on image evaluations with bulldog forceps and vascular forceps in the groups of carotid artery stents, with the Yasargil aneurysm clip in the intracranial stents. In the blade-type stents, we found that the stents elongated during clamping, and the component wire scattered at the time of stent cutting. Furthermore, the stents could be easily separated by holding with forceps. CONCLUSIONS: Knowing the properties of each stent is essential to conduct safe surgery in response to complications. Special care must be taken when clamping and cutting blade-type stents.


Assuntos
Procedimentos Endovasculares/instrumentação , Teste de Materiais , Stents , Artérias Carótidas/cirurgia , Humanos , Técnicas In Vitro , Aneurisma Intracraniano/cirurgia
7.
J Stroke Cerebrovasc Dis ; 29(2): 104539, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31810722

RESUMO

BACKGROUND AND PURPOSE: Previous studies suggested that turbulent flow is closely related to plaque vulnerability. Two-dimensional (2D) flow analysis is a novel modality that enables real-time blood flow analysis by picturing particle movement in the contrast medium. We evaluated flow patterns in the carotid plaque to investigate the correlation between blood flow and plaque vulnerability. MATERIAL AND METHODS: A total of 36 consecutive patients with cervical carotid artery stenosis were evaluated. The flow pattern of carotid artery stenosis was evaluated using 2D real-time flow analysis in the digital subtraction angiography (DSA). The flow pattern was classified into either turbulent or laminar flow as vectors. Plaque vulnerability was evaluated on MR plaque imaging. Univariate analysis was performed to assess the correlation between the flow pattern and plaque features. RESULTS: The turbulent pattern was identified in 28 of 36 plaques (77.8%). Turbulence around plaques was significantly associated with Gadolinium enhancement (P = .0004). The maximum degree of stenosis (P = .0005) and concomitant ulceration (P = .02) were significantly associated with the turbulent pattern. There was no relationship between the turbulent pattern and clinical neurological symptoms. CONCLUSIONS: In the present study, the majority of carotid plaques exhibited a turbulent flow pattern, which was significantly associated with Gadolinium enhancement on MR plaque imaging and morphologic factors. Thus, real-time flow analysis may clarify the pathophysiology of plaque instability and the formation of ulceration.


Assuntos
Angiografia Digital , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Placa Aterosclerótica , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Artérias Carótidas/fisiopatologia , Estenose das Carótidas/fisiopatologia , Meios de Contraste/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Valor Preditivo dos Testes , Estudos Prospectivos , Fluxo Sanguíneo Regional , Ruptura Espontânea , Estresse Mecânico
8.
J Vasc Access ; 21(1): 92-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31081445

RESUMO

BACKGROUND: The commonly preferred right internal jugular vein was investigated in terms of its dimensions, the relationship between its dimensions and anthropometric measures, and the outcomes of its cannulation in infants. Data regarding its position with respect to the carotid artery indicated anatomical variation. AIM: The aim of this study was to share our observations pertaining to the anatomy and position of the right internal jugular vein with respect to carotid artery using ultrasound and our experience with ultrasound-guided right internal jugular vein access in neonates and small infants. MATERIALS AND METHODS: A total of 25 neonates and small infants (<4000 g) undergoing ultrasound-guided central venous cannulation via right internal jugular vein within a 6-month period were included. Ultrasound-guided anatomical evaluation of the vein was used to obtain the transverse and anteroposterior diameters, the depth from skin and the position with respect to the carotid artery. Real-time ultrasound-guided central cannulation success rates and complication rates were also obtained. The patients were divided into two groups with respect to their weight in order to compare both the position and the dimensions of right internal jugular vein and cannulation performance in infants weighing <2500 g and ⩾2500 g. RESULTS: The position was lateral to the carotid artery in 84% of all infants and similar in both groups. The first-attempt success rates of cannulation were similar (70% vs 73.3%) in both groups, with an overall success rate of 88%. CONCLUSION: Right internal jugular vein revealed a varying position with respect to carotid artery with a higher rate of lateral position. The presence of such anatomical variation requires ultrasonographic evaluation prior to interventions and real-time guidance during interventions involving right internal jugular vein.


Assuntos
Peso ao Nascer , Cateterismo Venoso Central/métodos , Recém-Nascido de Baixo Peso , Veias Jugulares/diagnóstico por imagem , Ultrassonografia de Intervenção , Fatores Etários , Pontos de Referência Anatômicos , Artérias Carótidas/diagnóstico por imagem , Cateterismo Venoso Central/efeitos adversos , Desenvolvimento Infantil , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Punções , Estudos Retrospectivos , Ganho de Peso
9.
J Stroke Cerebrovasc Dis ; 29(1): 104493, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31734123

RESUMO

OBJECTIVE: The aim of this study was to investigate the value of extracranial carotid artery calcium score in predicting severity of carotid arterial stenosis. MATERIAL AND METHODS: 200 patients who had indication of contrast neck multi detector computed tomography were included. Calcium volume score of each calcified plaque (density more than 130 HU) was determined by multiplying area of calcified plaque in slice increment and presented as cubic centimeter (cc). Calcium score of each side (right or left) and each patient were determined. Severity of carotid stenosis in axial images was estimated and categorized. Statistical analysis was performed. RESULTS: 87 cases were female with mean age of 58.90 ± 10.67 and 113 cases were male with mean age of 59.61 ± 11.89 years old. The mean of volume score for all evaluated 800 vessels was .079 ± .046 cc. There was no significant difference between calcium score of right and left side (P value = .16). The mean "patient score" was .080 ± .049 cc (range: 0-.15 cc).Nine patients had volume score of 0 and all of them had no evidence of luminal stenosis. Significant increase in severity of stenosis was seen with increase in "patient score".(P value < .001, r = .875).According to receiver operating characteristic analysis, "patient score" of .09 cc with sensitivity of 97% and "patient score" of .12 cc with sensitivity of 95% can predict 50% and 70% stenosis, respectively. CONCLUSIONS: Promising role of calcium score for predicting severity of carotid stenosis could be considered.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Tomografia Computadorizada Multidetectores , Calcificação Vascular/diagnóstico por imagem , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
10.
J Stroke Cerebrovasc Dis ; 29(2): 104512, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31786044

RESUMO

BACKGROUND: Extracranial carotid artery (ECA) tortuosity may influences successful recanalization rates of mechanical thrombectomy in acute ischemic stroke (AIS), yet the relationship between ECA tortuosity and the prognosis of patients with anterior circulation AIS who cannot undergo endovascular treatment remains uncertain. We hypothesized that increased tortuosity of the ECA leads to unfavorable outcomes in such patients. METHODS: Patients with anterior circulation AIS who underwent computed tomography angiography of the head and neck in our hospital between March 2018 and November 2018 were retrospectively analyzed. The tortuosity of the bilateral ECA was measured, and functional outcomes were evaluated by a modified Rankin Scale (mRS) at 90 days. Multivariate logistic regression models were used to determine the association between ECA tortuosity and outcomes of patients. RESULTS: A total of 203 patients were enrolled in our study, including 140 patients (68.97%) with favorable outcomes (mRS, 0-2) and 63 patients (31.03%) with unfavorable outcomes (mRS, 3-6). After adjusting for age, atrial fibrillation, stroke territory, and posthospital antithrombotics/statins therapy in multivariate logistic regression model I, ECA tortuosity (odds ratio, 1.052; 95% confidence interval, 1.010-1.096; P = .015) was an independent risk of unfavorable outcomes in enrolled patients. In the other 2 models (II and III) which adjusted for age, sex, baseline National Institutes of Health Stroke Scale score, and with or without posthospital medication, ECA tortuosity was also showed independent relationship to unfavorable outcomes. The optimal cutoff was 12.5 to predict the unfavorable outcomes in a receiver operating characteristic curve. CONCLUSIONS: Our study demonstrated that the ECA tortuosity is an independent predictor of unfavorable outcomes for anterior circulation AIS patients who without undergoing endovascular treatment after hospital admission. ECA tortuosity values greater than 12.5 may indicate an unfavorable outcome.


Assuntos
Isquemia Encefálica/terapia , Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Artérias Carótidas/fisiopatologia , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 29(2): 104448, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31852597

RESUMO

OBJECTIVES: To investigate the differences in characteristics of carotid plaques between patients Xining at high altitude and Jinan at sea level using magnetic resonance (MR) imaging. METHODS: Subjects were recruited from a cross-sectional, observational, multicenter imaging study of CARE-II study. Forty-nine (mean age 63.3 ± 12.0 years, 33 males) and 51 (mean age 64.5 ± 12.0 years, 34 males) patients were recruited from a site located in a high altitude region and a site located near sea level, respectively. All patients underwent multicontrast MR vessel wall imaging for carotid arteries on 3.0 T MR scanner. The carotid plaques features were compared between 2 patient groups. RESULTS: Compared with patients at sea level, those at high altitude had significantly greater lumen area (58.5 ± 17.8 mm2 versus 50.0 ± 19.6 mm2, P = .008), smaller maximum normalized wall index (48.6% ± 14.2% versus 57.8% ± 16.3%, P = .002), and smaller percentage volume of calcium (0.9% versus 5.6%, P < .001) in the symptomatic carotid artery. After adjustment for clinical risk factors including age, sex, systolic blood pressure, LDL-C, and statin use, these differences in plaque morphology and composition remained statistically significant. After further adjustment for normalized wall index as a measure of plaque burden, percentage volume of calcification was still significantly smaller in patients at high altitude area than that in patients at sea level area (P = .047). CONCLUSION: Symptomatic subjects from a high altitude area have lower plaque burden and less calcification in the carotid artery compared to those from an area near sea level.


Assuntos
Altitude , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Placa Aterosclerótica , Calcificação Vascular/diagnóstico por imagem , Idoso , Doenças das Artérias Carótidas/epidemiologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Calcificação Vascular/epidemiologia
13.
Maturitas ; 131: 40-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31787146

RESUMO

OBJECTIVES: To investigate whether low bone mineral density (BMD) and history of fracture at baseline are associated with the development of echogenic carotid plaques over a 10-year follow-up period. STUDY DESIGN: A prospective cohort study. MAIN OUTCOME MEASURES: Development of echogenic plaques identified by ultrasonography of the carotid arteries. METHODS: Among 1048 women aged 40 or more who completed the baseline survey of the Japanese Population-based Osteoporosis (JPOS) cohort study, 500 women who completed the first decade of follow-up and 267 women who completed the second decade of follow-up were included. We identified history and incidence of clinical osteoporotic fracture during the follow-up through medical interviews, and determined vertebral fractures by morphometry of absorptiometric images. RESULTS: We identified 67 (13.4%) and 31 (11.6%) women with echogenic plaques at the end of first and second decade of follow-up, respectively. Participants with echogenic plaques were significantly older, exhibited lower spine BMD, and had a higher prevalence of osteoporotic fracture, diabetes, and hypertension. A generalized estimating equation analysis was used to combine the participants from the two follow-up periods into a single cohort, and showed that osteoporotic BMD and osteoporotic fractures were significantly associated with the development of echogenic plaques, after adjusting for atherosclerosis risk factors (odds ratio (OR): 2.15, 95% confidence interval (95% CI): 1.04, 4.44; OR: 1.84, 95% CI: 1.03, 3.28, respectively). CONCLUSION: Osteoporotic BMD and osteoporotic fracture history were significantly, and independently, associated with an increased occurrence of echogenic plaques. Ultrasonographic screening of the carotid artery may benefit patients with osteoporosis.


Assuntos
Densidade Óssea , Doenças Cardiovasculares/complicações , Artérias Carótidas/diagnóstico por imagem , Osteoporose/complicações , Fraturas por Osteoporose/complicações , Placa Aterosclerótica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Artérias Carótidas/patologia , Feminino , Seguimentos , Humanos , Hipertensão/complicações , Incidência , Japão/epidemiologia , Estudos Longitudinais , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Estudos Prospectivos , Fatores de Risco , Coluna Vertebral/patologia
14.
Clin Ter ; 170(1): e30-e35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31850481

RESUMO

OBJECTIVE: To introduce a rapid and simple technique to engage and localize through left common carotid (LCCA) artery during selective carotid angiography using the same type of catheter (6F Medtronic™/launcher Judkins Right Guide Catheter, 4.0 Tip,2 Side holes, U.S.A.). METHODS: Patients were divided into two groups as new method and conventional method group including 295 and 292 prior to carotid angiography, respectively. The primary endpoints of this study included an analysis of total procedure time, time required for cannulation of left common carotid artery, fluoroscopy time and selective imaging success for left common carotid artery, feasibility, safety, amount of radio opaque agent and radiation exposure. RESULTS: Our novel method applied using a single catheter shortened total procedure time (5.41 ± 1.56 min. vs. 7.52 ± 2.48 min., respectively, p<0.001), fluoroscopy time (98 ± 9 sec. vs. 210 ± 19 sec., respectively, p<0.001), duration of left carotid artery cannulation (15 ± 1.2 sec vs. 42 ± 1.9 sec, respectively, p< 0.001). Use of our method reduced radiation exposure (120 ± 17 mGy vs. 217 ± 11 mGy, respectively, p<0.001), amount of contrast agent (44.99 ± 12.84 ml vs. 59.89 ± 18.93 ml, respectively, p<0.001). Aortic arch angiography was not needed in the first group compared with the conventional method group (0% vs. 29%, respectively, p<0.001). Also a higher success was achieved in cannulation of left common carotid artery using an identical catheter compared with application of conventional methods requiring use of different types of catheter (100% vs. 60%, respectively, p<0.001). No major complication and mortality was found due to use of both methods. However, a statistically insignificant elevation in minor complication was encountered in the patient group who underwent coronary angiography by the conventional method (3% vs. 7%, respectively, p<0.064). CONCLUSIONS: This new method is more easily applicable with a shorter duration for cannulation and localization of LCCA, safer for the patients with use of a limited amount of radio-opaque agent and finally cost-effective by requiring only one type of catheter and a limited.


Assuntos
Cateterismo Cardíaco/métodos , Artérias Carótidas/diagnóstico por imagem , Cateteres/normas , Meios de Contraste/normas , Angiografia Coronária/métodos , Fluoroscopia/métodos , Artéria Radial/diagnóstico por imagem , Idoso , Cateterismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Eur Radiol ; 30(1): 119-127, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31372787

RESUMO

OBJECTIVES: To compare visualization of joint intracranial and carotid vessel walls between 5× compressed sensing accelerated three-dimensional DANTE-SPACE sequence (CS VWI) acquired in 5 min and the same sequence accelerated by 2.7× parallel imaging (PI VWI) which takes 9-10 min currently. METHODS: Following institutional review board approval and informed consent, 28 subjects including 20 stroke patients underwent PI and CS VWI examinations with an acquired spatial resolution of isotropic 0.55 mm and joint coverage of intracranial and carotid arteries. Quantitative wall thickness measurements of CS VWI and PI VWI were compared on healthy volunteers and patients with wall thickening respectively. Subjective wall visualizations of the two VWI methods on patients were scored by two radiologists blindly and independently using a 4-point scale followed by inter-rater reproducibility analysis. RESULTS: Linear regression analysis of wall thickness measurements showed excellent agreement between CS VWI and PI VWI in both healthy volunteers (r = 0.99) and stroke patients with wall thickening (r = 0.99). Subjective wall visualization score of CS VWI was slightly lower than PI VWI (3.13 ± 0.41 vs. 3.31 ± 0.79) but still had good diagnostic quality (> 3 based on a 4-point scale). The two radiologists' scores agreed excellently, evidenced by the intraclass correlation coefficient (ICC) values being higher than 0.75 (p < 0.001). CONCLUSIONS: Compressed sensing expedients joint intracranial and carotid VWI acquired at an isotropic resolution of 0.55 mm in 5 min without compromising quantitative vessel wall thickness measurement or diagnostic wall visualization. KEY POINTS: • CS VWI facilitates comprehensive visualization of intracranial and carotid vessel walls at an acquired isotropic resolution of 0.55 mm in a single 5-min scan. • CS VWI affords comparable vessel wall visualization and morphology measurement as PI VWI with a shortened acquisition time by 45%. • CS VWI alleviates the intensive trade-off between imaging resolution and scan time, and benefits the scan efficiency, motion robustness, and patient tolerance of high-resolution joint intracranial and carotid VWI.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Imagem Tridimensional/métodos , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Reprodutibilidade dos Testes
16.
Pol Merkur Lekarski ; 47(281): 167-169, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31812969

RESUMO

Red Cell Distribution Width (RDW) is associated with increased morbidity and mortality in subjects with clinically manifested vascular diseases as well as predicts cardiovascular incidents and different types of cancer in a healthy population. AIM: The aim of the study was to evaluate relationship between clinical outcomes in patients after carotid thromboendarterectomy and initial RDW values. MATERIALS AND METHODS: Data from 115 subsequent patients who underwent carotid thromboendartherectomy (TEA) were retrospectively analyzed. All patients had complete blood count measured including RDW and were observed for 18 months post-operatively. On each visit doppler ultrasound of carotid arteries was performed to evaluate the development of restenosis and progression of atherosclerosis. RESULTS: Primary endpoint defined as cardiovascular death, new cerebrovascular incidents (stroke or TIA), any new revascularization procedure (carotid, coronary or peripheral) and restenosis of the operated artery occurred in 28 patients. They differed from subjects with uneventful course with increased prevalence of previous cerebrovascular incidents (75.0% and 42.5%, respectively; p=0.0028) and higher RDW values (14,37±1.55% and 13.77±0.96%, p=0.0155). CONCLUSIONS: In patients with high risk for cerebrovascular incidents, RDW identifies population at increasingly high probability of vascular complications which should be subjected to intensive therapeutic regimen.


Assuntos
Doenças das Artérias Carótidas , Índices de Eritrócitos , Artérias Carótidas , Humanos , Estudos Retrospectivos , Fatores de Risco
17.
Zhonghua Yi Xue Za Zhi ; 99(45): 3568-3573, 2019 Dec 03.
Artigo em Chinês | MEDLINE | ID: mdl-31826573

RESUMO

Objective: To investigate the feasibility, efficacy and safety of endovascular reconstruction of the carotid artery with severe stenosis and extracranial distortion under proximal protection. Methods: A retrospective analysis of 21 patients with severe carotid stenosis and extracranial distortion who were admitted to the Second Affiliated Hospital of Soochow University between January 2011 and August 2017, of which 16 patients were symptomatic stenosis with acute ischemic stroke. All the patients were treated with carotid artery stenting under (CAS) proximal protection technique, and assessed with the National Institutes of Health Stroke Scale (NIHSS) before the treatment and hospital discharge. The clinical outcome and vascular morphology were followed-up regularly after the treatment. Results: Twenty-one patients were successfully completed the CAS procedure under the proximal protection technique, the average blocking time was 241.0 (232.5-261.0) seconds. Nine patients received 1block attempt, 6 patients received 2 block attempts, and the other 6 patients received 3 block attempts. Three patients experienced transient ischemic attack (TIA) during the procedure, the maximum duration of TIA was 10 minutes. In 16 patients with symptomatic stenosis, there were no significant differences in NIHSS score before CAS procedure and hospital discharge (P>0.05). The residual stenosis rate of the carotid artery after stenting was(13±6)%, compared with preoperative (87±16)%, which appeared a significant difference (t=19.948, P<0.05). All the patients had no adverse events such as myocardial infarction, recurrent ischemic stroke and death in the follow-up period. Restenosis was assessed in 6 patients by DSA or CTA and no restenosis was found. Conclusion: Endovascular reconstruction of the carotid artery with severe stenosis and extracranial distortion under proximal protection technique has been proven as a safe and effective therapy.


Assuntos
Isquemia Encefálica , Estenose das Carótidas , Endarterectomia das Carótidas , Acidente Vascular Cerebral , Artérias Carótidas , Estenose das Carótidas/cirurgia , Constrição Patológica , Humanos , Estudos Retrospectivos , Stents , Resultado do Tratamento
18.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1432-1438, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838817

RESUMO

Objective: To understand the prevalence of carotid plaque (CP) in population at high-risk for cardiovascular disease (CVD) in Jiangsu province and identify related influencing factors. Methods: Based on the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project from 2015 to 2016, a total of 11 392 persons at high-risk for CVD were selected from six project areas in Jiangsu province for the questionnaire survey, physical measurement, laboratory test and bilateral ultrasound examination of carotid arteries. The prevalence of CP and influencing factors of abnormal carotid arteries, CP and plaque burden (CP≥2) were analyzed. Results: Among the persons surveyed, 4 821 (42.3%) were males. The age of the persons surveyed was (59.4±8.9) years. There were 5 971 abnormal carotid arteries cases (52.4%), including 1 782 carotid intima-media thickness thickening cases (15.6%), 3 811 CP cases (33.5%) and 378 carotid stenosis cases (3.3%). Older age (OR=2.253, 95%CI: 2.127-2.386), urban residence (OR=2.622, 95%CI: 2.375-2.895), hypertension (OR=1.439, 95%CI: 1.195-1.732), smoking (OR=1.441, 95%CI: 1.259- 1.650), pulse pressure difference (OR=1.270, 95%CI: 1.198-1.347), fasting plasma glucose (FPG) (OR=1.109, 95%CI: 1.059-1.161) and LDL-C/HDL-C (OR=1.225, 95%CI: 1.164-1.288) were possible risk factors of CP in population at high risk for CVD. Being women (OR=0.558, 95%CI: 0.494-0.630), high BMI (OR=0.948, 95%CI: 0.904-0.994), higher levels of education (OR=0.708, 95%CI: 0.531-0.945), and higher annual household income (OR=0.773, 95%CI: 0.669-0.894) were the possible protective factors. Conclusions: Over half of the population at high-risk for CVD in Jiangsu showed abnormal carotid arteries. High blood pressure, high blood glucose, high blood lipids and smoking were the main factors that could be changed.


Assuntos
Artérias Carótidas/patologia , Doenças das Artérias Carótidas/etnologia , Espessura Intima-Media Carotídea , Placa Aterosclerótica/epidemiologia , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/patologia , Doenças das Artérias Carótidas/patologia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
19.
Medicine (Baltimore) ; 98(52): e18526, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876747

RESUMO

A contrast agent can be pushed by a saline solution more effectively through a spiral flow tube than through a conventional T-shaped tube in contrast-enhanced magnetic resonance angiography (CEMRA). To compare the degree of contrast enhancement and signal stability in the carotid artery by using CEMRA between a spiral flow tube and a T-shaped tube.A total of 100 patients were analyzed in this retrospective study. The first 50 patients underwent CEMRA of the carotid artery with the T-shaped tube, while the last 50 patients used the spiral flow tube. Gadoterate meglumine was diluted with saline to make a total volume of 20 mL. Injection was performed with a bolus rate of 2.5 mL/s for 8 seconds. Five regions of interest (ROIs) were placed on the contrast-enhanced area in each carotid artery and the signal intensity (SI) in the ROI was used for the analysis. The ROIs on the brain stem were also placed and the average SI in this ROI was used as a reference signal. The enhancement of the artery (Eartery) was calculated as a normalized signal using the following equation: Eartery = SI in the ROI of the carotid bifurcation/SI in the ROI of the brain stem. Signal homogeneity in the contrast-enhanced area (SHenhance) was assessed by calculating the coefficient of variation from the SI in the 5 ROIs. The value of SHenhance and Eartery between the data obtained from the spiral flow tube and the T-shaped tube were compared. P-values <.05 were considered significant.We found a significant difference in SHenhance between the data obtained from the spiral flow tube (0.20 ±â€Š0.060) and the T-shaped tube (0.24 ±â€Š0.056) (P = .001). The Eartery values significantly increased by 15% (spiral flow tube, median 14.1 with interquartile range [IQR] 11.8-15.4 vs T-shaped tube, median 12.3 IQR 11.3-14.0, P = .02) using the spiral flow tube.These findings suggest that, by using the Spiral flow tube, the homogeneity of the contrast-enhanced signal intensity in the carotid artery was significantly improved without decreasing the signal intensity in CEMRA.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Angiografia por Ressonância Magnética/instrumentação , Pescoço/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Estudos Retrospectivos
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