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Vulnerable carotid plaque

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https://www.readbyqxmd.com/read/29111018/embolic-stroke-of-undetermined-source-the-role-of-the-nonstenotic-carotid-plaque
#1
Zachary Bulwa, Ajay Gupta
Cryptogenic stroke, or stroke of undetermined cause, presents a remarkably challenging dilemma for the treating physician as there are limited therapeutic options to prevent recurrence. Roughly one third of transient ischemic attacks (TIAs) and ischemic strokes are classified as cryptogenic, with an even greater proportion in young patients. While classification systems have been successfully used in trials to refine therapeutic approaches specific to subtype, there has been little progress made in secondary prevention of cryptogenic stroke...
November 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29097799/dual-targeting-improves-capture-of-ultrasound-microbubbles-towards-activated-platelets-but-yields-no-additional-benefit-for-imaging-of-arterial-thrombosis
#2
F Günther, T Heidt, M Kramer, E Khanicheh, A L Klibanov, A Geibel-Zehender, E A Ferrante, I Hilgendorf, D Wolf, A Zirlik, J Reinöhl, C Bode, K Peter, B A Kaufmann, C von Zur Mühlen
Platelets can be found on the surface of inflamed and ruptured atherosclerotic plaques. Thus, targeting of activated platelets may allow for molecular imaging of vulnerable atherosclerotic lesions. We here investigated microbubbles (MB) functionalized with the selectin ligand sialyl Lewis(a) individually (MBsLea) or dually with sLe(a) and an antibody targeting ligand-induced binding sites of the activated GPIIb/IIIa receptor (MBDual). Assessed by in vitro flow chamber, targeted MB exhibited increased adhesion to platelets as compared to MBControl...
November 2, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29097437/associations-of-endogenous-estradiol-and-testosterone-levels-with-plaque-composition-and-risk-of-stroke-in-subjects-with-carotid-atherosclerosis
#3
Marija Glisic, Blerim Mujaj, Oscar L Rueda-Ochoa, Eralda Asllanaj, Joop S Laven, Maryam Kavousi, M Kamran Ikram, Meike W Vernooij, M Arfan Ikram, Oscar H Franco, Daniel Bos, Taulant Muka
Rationale: Sex steroids may play a role in plaque composition and in stroke incidence. Objective: To study the associations of endogenous estradiol and testosterone with carotid plaque composition in elderly men and postmenopausal women with carotid atherosclerosis, as well as with risk of stroke in this population. Methods and Results: Data of 1023 postmenopausal women and 1124 men (≥45 years) with carotid atherosclerosis, from prospective population-based Rotterdam Study, were available. At baseline, total estradiol (TE) and total testosterone (TT) were measured...
November 2, 2017: Circulation Research
https://www.readbyqxmd.com/read/29076745/cost-effectiveness-of-magnetic-resonance-carotid-plaque-imaging-for-primary-stroke-prevention-in-canada
#4
Lechtman E, Balki I, Thomas K, Chen K, Moody Ar, Tyrrell Pn
OBJECTIVES: Magnetic resonance (MR) imaging of the carotid arteries provides important insight into plaque composition and vulnerability in addition to the traditional measure of stenosis. The purpose of this study was to evaluate the cost-effectiveness of MR imaging as a first-line modality to assess carotid disease and guide management for high-risk patients with < 50% stenosis. METHODS: Using TreeAge Pro, a cost effectiveness simulation was conducted comparing two strategies: a) standard of care first-line carotid duplex ultrasound (DUS) with regular follow-up, versus b) first-line MR assessment of stenosis and intraplaque hemorrhage (MRIPH) in which patients with IPH received annual DUS surveillance and immediate carotid endarterectomy in case of plaque progression...
October 27, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29064776/carotid-stenosis-basing-treatment-on-individual-patients-needs-optimal-medical-therapy-alone-or-accompanied-by-stenting-or-endarterectomy
#5
Ralf Langhoff
Though carotid artery stenosis is a known origin of stroke, risk assessment and treatment modality are not yet satisfactorily established. Guideline updates according to latest evidence are expected shortly. Current clinical weakness concerns in particular the identification of "at-risk" patients. Beside the symptomatic status and the degree of stenosis, further signs of unstable plaque on carotid and cerebral imaging should be considered. Moreover, medical and endovascular therapy are continuously improving...
October 24, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/29030047/evaluation-of-the-time-dependent-changes-and-the-vulnerability-of-carotid-plaques-using-contrast-enhanced-carotid-ultrasonography
#6
Hirofumi Shimada, Toshiyasu Ogata, Koichi Takano, Hiroshi Abe, Toshio Higashi, Takaaki Yamashita, Akira Matsunaga, Tooru Inoue
BACKGROUND: The association of carotid plaque enhancement on contrast-enhanced carotid ultrasound (CEUS) and plaque vulnerability evaluated by magnetic resonance imaging (MRI) was to be determined. MATERIALS AND METHODS: The 103 patients underwent CEUS from May 2013 until June 2016. CEUS images of the carotid plaque were obtained offline. Plaque images obtained at 1, 3, 5, and 10 minutes were compared with the reference image, defined as the image obtained at 0 minute...
October 10, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29027678/evaluation-of-carotid-plaque-neovascularization-in-patients-with-coronary-heart-disease-on-contrast-enhanced-ultrasonography
#7
Chuan Qin, Li Zhang, Xinfang Wang, Yilian Duan, Zhou Ye, Mingxing Xie
OBJECTIVES: To examine the repeatability of quantitative time-intensity curve analysis of neovascularization within carotid plaques with contrast-enhanced ultrasonography (US) and to investigate carotid plaque neovascularization in patients with coronary heart disease using contrast-enhanced US and the correlation between risk factors and acute coronary syndrome (ACS). METHODS: Sixty patients with ACS and 60 with stable coronary artery disease (CAD) underwent conventional carotid and contrast-enhanced US, and plaque enhancement was observed and analyzed quantitatively...
October 13, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29024865/impaired-kidney-function-is-associated-with-intraplaque-hemorrhage-in-patients-undergoing-carotid-endarterectomy
#8
Marian Wesseling, Ian D van Koeverden, Guus W van Lammeren, Sander W van der Laan, Saskia Haitjema, Jean-Paul P M de Vries, Hester M den Ruijter, Saskia C A de Jager, Imo Hoefer, Peter Blankestijn, Marianne Verhaar, Dominique P V de Kleijn, Gert J de Borst, Gerard Pasterkamp
BACKGROUND AND AIMS: Previously, we showed that patients undergoing carotid endarterectomy have an increased risk for major atherosclerotic events in the presence of moderate or poor kidney function. Acceleration of vascular inflammatory responses is considered to be causally involved in progression of atherogenesis and poor outcome in chronic kidney disease patients. The association between kidney function and plaque composition has not been thoroughly investigated yet. The aim of this study was to investigate the association between kidney function and atherosclerotic plaque composition in patients undergoing carotid endarterectomy...
November 2017: Atherosclerosis
https://www.readbyqxmd.com/read/29021922/texture-feature-variability-in-ultrasound-video-of-the-atherosclerotic-carotid-plaque
#9
Christos P Loizou, Constantinos S Pattichis, Marios Pantziaris, Efthyvoulos Kyriacou, Andrew Nicolaides
The objective of this paper was to investigate texture feature variability in ultrasound video of the carotid artery during the cardiac cycle in an attempt to define new discriminatory biomarkers of the vulnerable plaque. More specifically, in this paper, 120 longitudinal ultrasound videos, acquired from 40 normal (N) subjects from the common carotid artery and 40 asymptomatic (A) and 40 symptomatic (S) subjects from the proximal internal carotid artery were investigated. The videos were intensity normalized and despeckled, and the intima-media complex (IMC) (from the N subjects) and the atherosclerotic carotid plaques (from the A and S subjects) were segmented from each video, in order to extract the M-mode image, and the texture features associated with cardiac states of systole and diastole...
2017: IEEE Journal of Translational Engineering in Health and Medicine
https://www.readbyqxmd.com/read/28990089/kinin-b1-receptor-as-a-novel-prognostic-progression-biomarker-for-carotid-atherosclerotic-plaques
#10
Tiantian Liu, Hengfang Liu, Li Feng, Bo Xiao
Stroke caused by atherosclerosis remains a leading cause of morbidity and mortality worldwide, associated with carotid plaque rupture and inflammation progression. However, the inflammatory biomarkers which aid in predicting the future course of plaques are less detailed. The present study investigated the association between plaque vulnerable and inflammatory biomarkers using blood and plaque specimens. Carotid plaque specimens were obtained from 80 patients following stroke, 14 patients suffering from transient ischaemic attack and 17 asymptomatic patients that underwent carotid endarterectomy...
December 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/28975971/the-relationship-between-serum-cxcl16-level-and-carotid-vulnerable-plaque-in-patients-with-ischemic-stroke
#11
G Jin
OBJECTIVE: We investigated the relationship between the serum macrophage chemokine ligand 16 (CXCL16) levels and the vulnerable carotid plaque in patients with ischemic stroke. PATIENTS AND METHODS: We successively selected 118 cases of patients with an initial diagnosis of acute ischemic stroke (time of onset < 72 h), recorded risk factors, including gender, age, family history, smoking, body mass index, blood glucose levels, blood lipid levels, average systolic pressure and diastolic blood pressure (DBP) and homocysteine levels...
October 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28964389/-contribution-of-contrast-enhanced-ultrasonography-in-the-characterization-of-carotid-lesions
#12
J M Baud, S Luong, O Rouyer, A Maurizot, C Gautier
Harmonic mode ultrasound with injection of a contrast enhancement agent allows visualization of mobile microbubbles in the carotid plaque corresponding to neovessels secondary to an inflammation or hypoxia. These neovessels could be considered "precursor" markers of the vulnerable plaque. The aim of this work was to give an update on ultrasound contrast imaging acquisition in the exploration of carotid artery both for atheromatous lesions and for large vessel vasculitis. A precise description of the material to be used, the image acquisition methodology and the environmental conditions is discussed, emphasizing the pitfalls to be avoided as well as proper image interpretation...
October 2017: J Med Vasc
https://www.readbyqxmd.com/read/28946147/ischemic-stroke-patients-demonstrate-increased-carotid-plaque-microvasculature-compared-to-ocular-transient-ischemic-attack-patients
#13
Raf H M van Hoof, Floris H B M Schreuder, Patty Nelemans, Martine T B Truijman, Narender P van Orshoven, Tobien H Schreuder, Werner H Mess, Sylvia Heeneman, Robert J van Oostenbrugge, Joachim E Wildberger, M Eline Kooi
BACKGROUND: Patients with a recent ischemic stroke have a higher risk of recurrent stroke compared to (ocular) transient ischemic attack (TIA) patients. Plaque microvasculature is considered as a feature of plaque vulnerability and can be quantified with carotid dynamic contrast-enhanced MRI (DCE-MRI). The purpose of this cross-sectional study was to explore the association between plaque microvasculature and the type of recent cerebrovascular events in symptomatic patients with mild-to-moderate carotid stenosis...
September 26, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28931265/diagnostic-and-interventional-optical-angioscopy-in-ex-vivo-carotid-arteries
#14
Luis E Savastano, Neeraj Chaudhary, Carlos Murga-Zamalloa, Michael Wang, Thomas Wang, B Gregory Thompson
BACKGROUND: Angioscopy - or endovascular endoscopy - is a catheter-based technique employing a flexible fiberoptic angioscope to directly visualize arterial lumen. Poor resolution and excessive stiffness of pre-existent angioscopes limited their use clinically. Recent advances resulted in novel fused optical fiber bundle angioscopes with improved flexibility and imaging resolution. Use of these devices in endovascular neurosurgery is still largely unexplored. OBJECTIVE: To evaluate image quality and feasibility of optical angioscopes for diagnostic and interventional neuro-angioscopy in carotid arteries of human cadavers...
February 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28893252/association-between-carotid-plaque-characteristics-and-acute-cerebral-infarction-determined-by-mri-in-patients-with-type-2-diabetes-mellitus
#15
Beibei Sun, Xiao Li, Xiaosheng Liu, Xiaoqian Ge, Qing Lu, Xihai Zhao, Jun Pu, Jianrong Xu, Huilin Zhao
BACKGROUND: Type 2 diabetes mellitus (T2DM) might aggravate the carotid plaque vulnerability, and increase the risk for ischemic stroke. Few studies reported the acute stroke subtype with carotid plaque characteristics in T2DM patients. This study aimed to investigate the association between carotid plaque characteristics and acute cerebral infarct (ACI) lesion features determined by MRI in T2DM patients. METHODS: Patients with acute cerebrovascular syndrome in internal carotid artery territory were recruited...
September 11, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/28856989/from-vulnerable-plaque-to-blood-healthy-therapy
#16
Sun Yuhua, Wang Baoping
Cardiovascular atherosclerotic disease is the leading cause of death in China and in Western nations. People with plaque or stenosis in the coronary artery or the carotid artery are the most susceptible population to suffer from acute events. Current investigations showed that plaque with the characteristics of intra-plaque hemorrhage or a thin cap with a large lipid core was causally associated with vulnerable plaque and plaque rupture. Of the many plaque ruptures occurring in patients with atherosclerotic disease, very few will trigger symptomatic events, rendering it exceedingly difficult to predict adverse outcomes...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28818260/transcranial-doppler-monitoring-for-microemboli-a-marker-of-a-high-risk-carotid-plaque
#17
REVIEW
J David Spence
In the United States, 90% of carotid intervention is being performed for asymptomatic carotid stenosis, even though 90% of patients would be better treated with intensive medical therapy. This is being justified by comparing risks of stroke or death with medical therapy during clinical trials completed decades ago (approximately 2% per year) with risks of intervention with carotid artery stenting (CAS) versus carotid endarterectomy in recent trials that did not have a medical arm. Such extrapolations are, simply put, invalid...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818258/imaging-of-high-risk-carotid-plaques-ultrasound
#18
REVIEW
Rafael S Cires-Drouet, Mahvash Mozafarian, Amir Ali, Siddhartha Sikdar, Brajesh K Lal
Duplex ultrasonography has a well-established role in the assessment of the degree of stenosis caused by carotid atherosclerosis. This assessment is derived from Doppler velocity changes induced by the narrowing lumen of the artery. New research into the mechanisms for plaque rupture and atheroembolic stroke indicates that the degree of narrowing is an imperfect predictor of stroke risk, and that other factors, such as plaque composition and remodeling and biomechanical forces acting on the plaque, can play a role...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818257/high-risk-carotid-plaque-lessons-learned-from-histopathology
#19
REVIEW
Frank D Kolodgie, Kazuyuki Yahagi, Hiroyoshi Mori, Maria E Romero, Hugh H Trout, Aloke V Finn, Renu Virmani
The pathophysiology and natural history of atherosclerotic carotid disease is predicated on a more extensive knowledge of lesion progression gained in the studies conducted in the coronary arteries, and these will be reviewed. While the precise sequence of lesion progression leading to carotid plaque vulnerability and cerebrovascular events remain less well understood, specific early and more advanced progressive lesion morphologies associated with stroke risk have been characterized. Of late, there has been a conscious effort for stroke prevention in symptomatic and asymptomatic patients to move beyond luminal stenosis as the only guidance to predict future cerebrovascular events...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28798867/effect-of-intraplaque-angiogenesis-to-atherosclerotic-rupture-prone-plaque-induced-by-high-shear-stress-in-rabbit-model
#20
Juhui Qiu, Daoxi Lei, Jianjun Hu, Tieying Yin, Kang Zhang, Donghong Yu, Guixue Wang
Atherosclerotic prone-rupture plaque is mainly localized in the region of the entrance to the stenosis with high shear stress and the reasons are largely unknown. Our hypothesis is that such a distribution of cells in atherosclerotic plaque may depend on the angiogenesis. Silastic collars induced regions of high shear stress (20.68 ± 5.27 dynes/cm(2)) in the upstream flow and low shear stress (12.25 ± 1.28 dynes/cm(2)) in the downstream flow in carotid arteries. Compared with the low shear stress region, plaques in the high shear stress region showed more intraplaque haemorrhaging, less collagen and higher apoptotic rates of vascular smooth muscle cells; endothelial cells (ECs) in the high shear stress region were characterized with integrity and high endothelial nitric oxide synthase (eNOS) expression (1570...
August 2017: Regenerative Biomaterials
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