Aortic Arch Atherosclerosis Research Articles

Transthoracic Echocardiographic Diagnosis of Mobile Aortic Arch Atherothrombosis Associated with Stroke

Aortic arch atherosclerosis is associated with an increased risk of stroke or TIA. Up to now, transesophageal echocardiography has been the standard method for diagnosing protruding and/or mobile aortic arch atherosclerosis. We report a case where a mobile aortic arch atheroma was diagnosed using transthoracic echo in a patient with a recent stroke.

The cis-9,trans-11 isomer of conjugated linoleic acid (CLA) lowers plasma triglyceride and raises HDL cholesterol concentrations but does not suppress aortic atherosclerosis in diabetic apoE-deficient mice

Objective Reduction in atherosclerosis has been reported in experimental animals fed mixtures of conjugated linoleic acid (CLA). In this study, the major naturally occurring CLA isomer (cis-9,trans-11) was tested in an atherosclerosis-prone mouse model. Methods In a model of insulin deficient apoE deficient mice, 16 animals were fed for 20 weeks with supplemental CLA (09.%, w/w) and compared with a similar number of mice of this phenotype. A control comparison was made of metabolic changes in non-diabetic apoE deficient mice that develop little atherosclerosis over 20 weeks. At 20 weeks, plasma lipids were measured and aortic atherosclerosis quantified by Sudan staining in the arch, thoracic and abdominal segments. Results The diabetic apoE deficient mice developed marked dyslipidemia, primarily as cholesterol-enriched chylomicron and VLDL-sized lipoproteins and atherosclerosis in the aortic arch. However, there were no significant differences between CLA fed and non-CLA fed mice in either phenotype in plasma cholesterol concentration (in diabetic: 29.4 ± 7.7 and 29.5 ± 5.9 mmol/L, respectively) or in the area of aortic arch atherosclerosis (in diabetic: 24.8 ± 10.3 and 27.6 ± 7.7%, respectively). However, among diabetic mice the triglyceride concentration in triglyceride-rich lipoproteins was significantly lower in those fed CLA (for plasma 2.2 ± 0.8 to 1.1 ± 0.3 mmol/L; P < 0.001), a significant difference that was seen also in the non-diabetic mice in which HDL cholesterol increased significantly with CLA (0.35 ± 0.12–0.56 ± 0.15 mmol/L). Conclusion In this atherosclerosis-prone model, the diabetic apoE deficient mouse, supplemental 0.9% CLA (cis-9,trans-11) failed to reduce the severity of aortic atherosclerosis, although plasma triglyceride concentration was substantially lowered and HDL cholesterol raised.

Are Patent Foramen Ovale and Aortic Arch Atherosclerosis Commonly Associated with Stroke

Cryptogenic strokes are those that cannot be attributed to large-vessel stenotic, small-vessel lacunar, or cardioembolic etiologies. Several studies have suggested that paradoxical embolism through a patent foramen ovale (PFO) and embolism of atherosclerotic aortic arch debris are important causes of cryptogenic stroke. Now, in a pair of population-based …

Catheter‐Based Aortography Fails to Identify Aortic Atherosclerotic Lesions Detected on Transesophageal Echocardiography

ABSTRACT Background and Purpose. Transesophageal echocardiography is used to detect the aortic arch pathology during diagnostic workup of ischemic stroke events. Conventional angiography is increasingly used in diagnosing and treating atherosclerotic vas cular lesions in patients with ischemic stroke. Although catheter‐based aortography can be performed with cerebral angiography, there is limited information about the utility of aortography in identifying atherosclerotic abnormalities of the aortic arch. Methods. A retrospective chart review was performed to identify patients who underwent aortography as part of their angio‐graphic study and transesophageal echocardiography. Both studies were reviewed independently in the absence of knowl edge of the results of the other study. The findings of these aortograms were correlated with the findings of transesophageal echocardiography. Results. A total of 34 patients underwent both aortography and echocardiography. Of a total of 34 trans esophageal echocardiograms, 29 showed abnormal findings in the aorta (85%) and 5 appeared normal (15%). These aortic abnormalities included mild to moderate atherosclerosis in 18 cases (52%), moderate to severe atherosclerosis in 4 cases (12%), and severe atherosclerosis in 7 cases (21%). None of these abnormalities were detected by aortography. No disease was visualized in the origin of the supraaortic arteries. Conclusions. Aortic arch atherosclerosis is common in patients with ischemic stroke; however, aortograms acquired during conventional angiography fail to identify abnormalities detected on transesophageal echocardiogram.

Carotid atherosclerosis as a risk factor for complex aortic lesions in patients with ischemic cerebrovascular disease.

Aortic arch atherosclerotic lesions can cause ischemic cerebrovascular disease (ICVD). The association between carotid and aortic atherosclerosis was examined, and it was investigated whether noninvasive carotid evaluation aids in the identification of aortic lesions as potential ICVD risk. The subjects comprised 147 patients with ICVD who had undergone carotid ultrasonography and transesophageal echocardiography. Carotid and aortic arch atherosclerosis was evaluated by measuring the maximum intima - media thickness (IMT), with aortic IMT of at least 4 mm, mobile plaques and/or ulcers defined as complex aortic lesions with potential ICVD risk. Carotid IMT was linearly associated with aortic IMT (r=0.53, p<0.001), and the association was independent of traditional cardiovascular risk factors (beta =0.36, p<0.001). Also, each 1 SD greater carotid IMT was associated with 4.2-fold (95% confidence interval: 2.5-7.0) higher likelihood of complex aortic lesions, with the likelihood little modified when controlling for cardiovascular risk factors. In particular, complex aortic lesions were found in 78% of patients with the highest carotid IMT tertile, compared with 14% of those with the lowest tertile (p<0.05). Based on these findings, carotid atherosclerosis is associated with aortic atherosclerosis, representing a risk factor for aortic lesions that are a potential ICVD risk.

Asymptomatic cerebral embolic signals in patients with acute cerebral ischaemia and severe aortic arch atherosclerosis.

Severe aortic arch atheroma (AAA) is a strong risk factor for ischaemic stroke, but it is unclear whether AAA is a source of cerebral emboli or simply a marker of cerebral atherosclerosis. The purpose of this study was to find out the prevalence of asymptomatic cerebral embolic signals (ES) in patients with acute cerebral ischaemia, AAA and no other potential source of cerebral embolism. Forty patients with anterior circulation ischaemic stroke or transient ischaemic attack (TIA) were prospectively studied using transesophageal echocardiography (TEE) and transcranial Doppler (TCD) scanning within seven days of symptom onset. Patients with a cardiac source of embolism or carotid stenosis > 50% were excluded. ES were detected in 14.3% (2/14) of patients with AAA > or = 4 mm and in no patients with AAA < 4 mm or no AAA (p=0.14). The findings suggest that ES may be associated with severe AAA but their prevalence is low in this setting.

Prediction of future embolic events in patients with aortic arch atherosclerosis determined by endoscopic ultrasound

Prediction of future embolic events in patients with aortic arch atherosclerosis determined by endoscopic ultrasound

Hemispheric Stroke following Cardiac Surgery: A Case-Control Estimate of the Risk Resulting from Ipsilateral Asymptomatic Carotid Artery Stenosis

A case-control study was undertaken to determine if asymptomatic carotid artery stenosis (ACS) is independently associated with ipsilateral hemispheric stroke following cardiac surgery (CS). All CS patients (3069) who were at two hospitals between 1989 and 1994 were reviewed. Cases (31) selected for this study were those with hemispheric stroke within 30 days following CS. Controls (69) were taken from those without hemispheric stroke. Case-control analysis demonstrated that ACS of 50-90% and of 80-90% increased the risk of ipsilateral stroke 5.2-fold (95% confidence interval [CI] = 1.5-16.3, p = 0.01) and 24.3-fold (CI = 2.6-114.9, p = 0.002), respectively. Other variables with significant odds ratios (OR) were age > or =65 years (OR = 4.0, CI = 1.3-10.5, p = 0.01), peripheral vascular disease (OR = 3.4, CI = 1.3-8.8, p = 0.02), hypertension (OR = 3.0, CI = 1.2-7.0, p = 0.02), and female gender (OR = 3.0, CI = 1.2-7.1, p = 0.04). A second conservative analysis for missing data demonstrated a significant association for ACS of 80-90% alone (OR = 13.1, CI = 1.5-60.9, p = 0.01). This association remained significant after multivariate adjustment with propensity score stratification. ACS (80-90%) appears to be independently associated with ipsilateral hemispheric stroke following CS when evaluated against the present study variables. This finding supports the need for a properly conducted prospective natural history study, including an evaluation of aortic arch atherosclerosis, to determine the clinical relevance of this observation.

Protruding aortic arch atheromas: Risk of stroke during heart surgery with and without aortic arch endarterectomy

Background Stroke occurs in 1% to 7% of heart surgery. Aortic arch atherosclerosis is a risk factor for intraoperative stroke, and endarterectomy has been proposed to prevent stroke during heart surgery in patients with arch atheromas. Methods and Results Intraoperative transesophageal echocardiography was performed in 3404 patients undergoing heart surgery between 1990 and 1996. Use of transesophageal echocardiography was unselected and based on equipment availability. Aortic arch atheromas (≥5 mm, or mobile) were seen in 268 (8%) patients. They were evaluated for intraoperative stroke (confirmed by a neurologist and cerebral infarction on computed tomography or magnetic resonance imaging). Arch endarterectomy was performed in 43 patients as an adjunct to their cardiac procedure in an attempt to prevent intraoperative stroke. The intraoperative stroke rate in all 268 patients with atheromas was high (15.3%). On univariate analysis, age, previous stroke, and arch endarterectomy were significantly associated with intraoperative stroke. On multivariate analysis, age (odds ratio 3.9, P = .01) and arch endarterectomy (odds ratio 3.6, P = .001) were independently predictive of intraoperative stroke. Mortality rate in all 268 patients was high (14.9%). These patients with atheromas also had a long recovery room, intensive care unit, and total hospital length of stay (48 days). Conclusions Patients with protruding aortic arch atheromas are at high risk for intraoperative stroke, significant and multiple morbidity, prolonged hospital stay, and death resulting from heart surgery. Aortic arch endarterectomy is strongly associated with intraoperative stroke; its use should be carefully considered in light of these results. (Am Heart J 1999;138:746-52.)

Replacing the atherosclerotic ascending aorta is a high-risk procedure

Background. Improved techniques in cerebral and myocardial protection have made replacement of the chronically aneurysmal ascending thoracic aorta a safe and effective procedure. We hypothesized that patients with severe ascending or aortic arch atherosclerosis were at greater risk for operative complications during ascending aortic replacement because of the diffuse nature of their atherosclerotic process. Methods. We retrospectively analyzed the records of 17 patients who received ascending aortic replacement during elective coronary artery bypass grafting (CABG) because of the intraoperative finding of severe atherosclerosis. All 17 patients underwent tube graft replacement of the ascending aorta under hypothermic circulatory arrest and retrograde cerebral perfusion before coronary artery bypass grafting. The outcomes for these patients were compared with those of a control group of 89 consecutive patients who underwent replacement for ascending thoracic aortic aneurysm. Results. The hospital mortality rate for replacement of the ascending thoracic aorta for severe atherosclerosis was 23.5% (4/17) versus 2.25% (2 of 89) for the control group ( p = 0.006). The incidence of cerebrovascular accident in the atherosclerotic group was 17.6% (3/17) and 3.37% (3/89) for the control group ( p = 0.051). Nine of 17 atherosclerotic patients (52.9%) had operative morbidity. Only 20.2% (18 of 89) of the control patients had nonfatal postoperative complications. Conclusions. The severely atherosclerotic ascending aorta is a marker of diffuse atherosclerosis. Despite improved techniques of myocardial and cerebral protection, we have been unable to duplicate our success with ascending thoracic aneurysm repair. Preoperative screening of the ascending aorta by chest computed tomography may be appropriate in select high-risk patients to determine operability.

EMBOLISM FROM THE AORTIC ARCH IN PATIENTS WITH CEREBRAL ISCHEMIA

The pathogenic role of aortic arch atherosclerosis (AAA) in embolic stroke is not well understood. We investigated, prospectively, the prevalence and severity of AAA in patients with embolic stroke to ascertain its role as a risk factor for cerebral ischemia. We examined 100 consecutive patients who had experienced acute symptoms due to cerebral ischemia. Clinical examination, electrocardiogram, x-ray, ultrasound examination of craniocervical arteries, transesophageal echocardiography (TEE), cranial computerized tomography, and magnetic resonance imaging were undertaken. Seventy-five patients showed evidence of AAA; 34 patients had moderate to severe (>5 mm thickening) AAA. Age was positively related to the severity of AAA, as were smoking, coronary heart disease, diabetes mellitus, internal carotid artery (ICA) occlusive disease, and embologenic heart disease. Hypertension, which was evident in 52 patients, did not distinguish those cases showing AAA. Twelve patients showed evidence of high-degree ICA stenosis on the symptomatic side, although the extent of ICA stenosis and AAA were unrelated. A cardiac source of emboli was found in 28 patients. AAA was found to be the probable source for embolic stroke in 14 patients. These data indicate that aortic arch atherosclerosis is an important source of cerebral emboli which may increase the risk for ischemic stroke. Furthermore, we suggest that TEE examination of the aortic arch may be important for the diagnosis of AAA and ultimately for the prophylactic treatment of severe cerebral ischemia. Copyright © 1996 Elsevier Science Ltd

Predictors of stroke after cardiac surgery.

From January 1, 1988 to September 30, 1993, 44 of 2,455 patients undergoing cardiac surgery for acquired heart disease at our institution sustained an intraoperative or postoperative cerebrovascular accident (CVA). Demographic data, atherosclerosis risk factors, past medical history, cardiac catheterization reports, and intraoperative findings were retrospectively reviewed. The highest rate of CVA was in the sub-group of patients undergoing simultaneous myocardial revascularization and carotid endarterectomy (18.2%). The lowest rate was in a group of patients who underwent aortic valve replacement (0.9%). Severe aortic arch atherosclerosis with the presence of atheromatous material or calcinosis at the cannulation site was identified intraoperatively in 43.2% of patients with neurological complications and in 5% of the group without CVA (x2 = 18.1, p = 0.0001). Of 44 patients with CVA, 13.6% had a history of preoperative completed stroke. CPB time was 90.1 +/- 4.9 min vs. 71.6 +/- 3.7 min (p = 0.004), and aortic cross-clamping time was 54.5 +/- 3.2 min compared to 39.8 +/- 2.7 min (p = 0.001) in groups with and without postoperative stroke, respectively. Hypertension was an independent risk factor of postoperative CVA (x2 = 9.5, p = 0.02), but age was not. Neurological complications correlated with high operative mortality (38.6%) and prolonged postoperative hospital stays (35.1 +/- 5.3). These data describe predictors for the development of post-cardiopulmonary bypass CVA and identify a high-risk subgroup for neurological events. The preoperative recognition of risk factors is an essential step toward the reduction of morbidity and mortality.

Stroke during coronary artery bypass grafting using hypothermic versus normothermic perfusion

Does the abandonment of hypothermic perfusion during cardiopulmonary bypass compromise cerebral protection and thus lead to a higher incidence of stroke? From 1987 to June 1993, 2,585 consecutive patients underwent myocardial revascularization using warm-body (perfusion at 37 degrees C), cold-heart (cold cardioplegic arrest) surgical technique and were followed for new overt neurologic deficits. Perfusion pressure was maintained between 50 and 70 mm Hg, and hematocrit was kept around 20%. There were 25 operative deaths (1%) in this normothermic group, and new neurologic deficits developed after operation in 25 patients (1%). These results were compared retrospectively with those in 1,605 patients who underwent myocardial revascularization between 1980 and 1986 with moderate hypothermic (25 degrees to 30 degrees C) perfusion, the same surgical team, and similar operative techniques. The normothermic group included more elderly patients, more patients with left ventricular dysfunction and unstable angina, and more frequent use of an internal mammary artery conduit. Neurologic complication rates were 1% and 1.3% for the normothermic and hypothermic perfusion groups, respectively. Risk factors for stroke that were identified included age greater than 70 years, severity of aortic arch atherosclerosis, and severe hypotension in the perioperative period. Thus, in a large clinical series, the incidence of overt neurologic injuries was found to be no higher with normothermic perfusion than with hypothermic perfusion.

Detection of experimental atherosclerosis with indium-111 radiolabelled hematoporphyrin derivative

It has been observed that atherosclerotic lesions (AL) concentrate certain porphyrins. We evaluated the usefulness of 111In-labelled Photofrin II (PFII), a porphyrin derived from haematoporphyrin derivative, for detection of experimental AL in cholesterol fed rabbits. Three groups of rabbits were studied: non-atherosclerotic (n = 3), 6 and 12 week cholesterol fed (n = 4, 3). 111In-PFII was injected intravenously and gamma camera images were obtained at 24 and 48 h. At 48 h, explanted aortas were also imaged. Aortic arch (AA) to background (BKG) count ratios were calculated from images of the whole body and explanted aortas. AA/BKG ratios were significantly higher in the 12 week cholesterol fed rabbits (3.9 +/- 0.72 at 24 h) and (4.0 +/- 0.67 at 48 h) than in the non-atherosclerotic rabbits (2.2 +/- 0.07 at 24 h) and (2.3 +/- 0.18 at 48 h) (p less than 0.05). The AA/BKG ratio for the explanted aortas showed similar results. Additionally, in two of three 12 week cholesterol fed rabbits, focal count deposition was visible on the whole animal images at the site of aortic arch atherosclerosis. We conclude that 111In-PFII concentrates in AL as early as 24 h after injection and has the potential to be used as an imaging agent for experimental atherosclerosis.

Effect of cold shock on respiration and glycolysis in swine arterial tissue.

ARTICLESEffect of cold shock on respiration and glycolysis in swine arterial tissueRF Scott, ES Morrison, and M KromsRF Scott, ES Morrison, and M KromsPublished Online:01 Nov 1970https://doi.org/10.1152/ajplegacy.1970.219.5.1363MoreSectionsPDF (784 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByRole of Digital Artery Adrenoceptors in Raynaud's Disease24 June 2016 | Vascular Medicine, Vol. 2, No. 1Metabolism of Fibromuscular and Atheromatous Plaques in an Experimental Model: Causal Mechanisms for the Development of Intimal NecrosisMeasurements of adipose tissue respiration in a closed chamber using an oxygen sensor: methodological considerations.Journal of Lipid Research, Vol. 27, No. 9Aortic wall metabolism in relation to susceptibility and resistance to experimental atherosclerosisJournal of Vascular Surgery, Vol. 7, No. 5Existence of fatty acyl-CoA oxidizing system in (micro)peroxisomes of rabbit aortaBiochemical Medicine and Metabolic Biology, Vol. 38, No. 2Metabolism of the arterial wall—influence of atherosclerosis and drugsPharmacology & Therapeutics, Vol. 32, No. 3Histochromatographical determination of cholesteryl ester composition in the human atherosclerotic aortaActa Histochemica, Vol. 76, No. 1Focal alterations in metabolic capabilities associated with development of cholesterol-induced atheromatous lesions: A quantitative cytochemical studyExperimental and Molecular Pathology, Vol. 36, No. 2Pasteur effect in human arterial tissueActa Physiologica Scandinavica, Vol. 114, No. 4Glycolytic activity of rat aorta after exerciseEuropean Journal of Applied Physiology and Occupational Physiology, Vol. 48, No. 2Metabolism of the Arterial WallMetabolic changes in modified smooth muscle cells of rabbit carotid arteriesBasic Research in Cardiology, Vol. 77, No. 1Chemical Energetics of Vascular Smooth Muscle1 January 2011Physical Factors of Regulation1 January 2011Significance of glucose for mechanical activity, flavin and pyridine nucleotide oxidation-reduction changes in isolated rat portal veins under ACh-stimulationBasic Research in Cardiology, Vol. 75, No. 6Enhanced oxygen uptake and lactate production of smooth muscle cell proliferates of rabbit carotid arteriesPfl�gers Archiv European Journal of Physiology, Vol. 387, No. 1Vascular Smooth Muscle: Aerobic Glycolysis Linked to Sodium and Potassium Transport ProcessesScience, Vol. 206, No. 4425Carnitine palmitoyltransferase activity in mitochondrial fractions isolated from aortas of rabbits fed cholesterol-supplemented dietsAtherosclerosis, Vol. 34, No. 1Metabolic Activities in the Arterial WallHemodynamic Contribution to AtherosclerosisThe effects of O2 concentration and albumin on respiration and aerobic glycolysis in rabbit aortic intima-mediaBiochemical Medicine, Vol. 20, No. 2Changes in chemical and metabolic properties of rabbit aorta by dietary cholesterol, and saturated and polyunsaturated fatsAtherosclerosis, Vol. 29, No. 4In vitro tissue oxygen tensions in the rabbit aortic archAtherosclerosis, Vol. 28, No. 3Effect of Lipid Accumulation on Arterial Wall BioenergeticsThe aerobic metabolism of porcine carotid artery and its relationship to isometric forcePfl�gers Archiv European Journal of Physiology, Vol. 370, No. 1Influence of oxygen tension on the metabolism of vascular smooth muscle Demonstration of a Pasteur effectAtherosclerosis, Vol. 25, No. 2-3Abnormalities of the arterial wall and its metabolism in atherogenesisProgress in Cardiovascular Diseases, Vol. 18, No. 5Inherited depression of arterial lipoamide dehydrogenase activity associated with susceptibility to atherosclerosis in pigeons.Circulation Research, Vol. 36, No. 5Vascular Metabolism, Vascular Enzymes, and the Effect of DrugsUptake, oxidation, and esterification of free fatty acids in normal and atherosclerotic rabbit aortaBiochemical Medicine, Vol. 11, No. 2Vascular Enzymes and the Relevance of Their Study to Problems of AtherogenesisMedical Clinics of North America, Vol. 58, No. 2Aortic mitochondrial function in experimentally induced atherosclerosis in swine and rabbitsBiochemical Medicine, Vol. 7, No. 2Glucose degradation in normal and atherosclerotic aortic intima-mediaAtherosclerosis, Vol. 16, No. 2Effect of Hypoxia on Reactivity of Cutaneous and Mesenteric Veins of the Dog More from this issue > Volume 219Issue 5November 1970Pages 1363-1365 Copyright & PermissionsCopyright © 1970 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1970.219.5.1363PubMed5473119History Published online 1 November 1970 Published in print 1 November 1970 Metrics

A microelectrode for measuring intracellular PO2.

A simple and reliable method of constructing an intracellular pH microelectrode is described. Antimony is used as the pH sensor. Antimony electrodes have been used in biological systems as early as 1927 (1). Since then several investigators have used different kinds of Sb electrodes. Roos and Boton (3) describe the latest methods of construction and application of pH sensitive micro-electrodes. In most cases the pH electrodes were fabricated by pulling glass capillaries filled with molten antimony and in a few cases by coating glass with antimony. The electrodes were of the open type.