Atheromatous Lesions Research Articles

429 KOUNIS-ZAVRAS SYNDROME: UNDERREPRESENTED OR UNDERDIAGNOSED?

Abstract A 64-year-old man was admitted to the emergency department for a major allergic reaction to an insect bite. On physical examination, he presented with tachycardia, hypotension and diffuse pomphoid erythema requiring treatment with intravenous cortisone and antihistamines, with partial benefit. From his past medical history hypertension and previous percutaneous coronary intervention (PCI) with drug eluting stents (DES) on left anterior descendant (LAD) and circumflex coronary artery (Cx) for stable angina emerged. Almost 15 minutes after his admission he developed oppressive chest pain and dyspnea, so an electrocardiogram (EKG) was performed showing an ST segment elevation in inferior-posterior-lateral leads. Therefore, the patient was transferred to the Cath Lab to perform a coronary angiography study with finding of intrastent thrombosis (IST) of Cx and LAD and sub-occlusion of the posterior interventricular branch of the right coronary artery (RCA), not responsive to nitrates. PCI was performed with manual thrombus aspiration and high pressure non-compliant balloons of the IST and PCI with a single DES of the RCA lesion. The patient was then transferred to coronary intensive care unit. Echocardiography revealed a normal left ventricle ejection fraction without any wall motion abnormalities and the EKG showed a complete ST resolution. Laboratory exams showed increased troponin, typical of myocardial infarction, and an increase in IgE and serum tryptase, typical for an allergic reaction. Based on clinical, angiographic and biochemical data, diagnosis of type III Kounis-Zavras (KS) syndrome was made. KS is an acute coronary event in the setting of a hypersensitivity reaction which trigger the release of inflammatory mediators by activated mast cell leading to coronary artery spasm, atheromatous plaque rupture or stent thrombosis. Optimal medical therapy for both ischemic heart disease and allergic reaction was set, with ace inhibitor, high dose statin, non-dihydropyridine calcium channel blocker, dual antiplatelet therapy, antihistamines and cortisone with a decalage scheme. There is no consensus for KS management and the difficulty lies in the fact that treating one of the two concomitant conditions could worsen the other. Three variants of this syndrome have been described in the literature. Type I KS is characterized by coronary spasm in patients typically lacking cardiovascular risk factors and coronary arteries free from atheromatous lesions. Type II KS is characterized by instability of an already present coronary plaque. Type III KS is characterized by intrastent thrombosis in patients with previous coronary angioplasty. Several factors incriminated in KS syndrome have been described, including medications (such as antibiotics, analgesics and anti-inflammatories) and environmental factors (such as, bee sting, viper venom, wasp sting). The underlying pathophysiological process involves a series of mediators, such as histamine and tryptase, released by activated mast cells locally during an immunological reaction. KS syndrome is a real challenge since there is no definitive guidelines for diagnosis, management and treatment and the plethora of clinical presentation range from angina pectoris with mild atopic dermatitis to acute coronary syndrome with cardiogenic shock and anaphylaxis. This broad spectrum of clinical manifestations associated with the increasing new triggers (drugs, contrast dye, insects) often leads to a misdiagnosis with a delay of the proper administration of the effective therapy, sometimes resulting fatal.

Correlation between chronic inflammation of rheumatoid arthritis and coronary lesions: “About a monocentric series of 202 cases”

Introduction: Cardiovascular diseases are the leading cause of death in the world, headed by coronary artery disease, which is secondary to atherosclerosis. The latter recognizes classic risk factors such as diabetes, high blood pressure, tobacco, and dyslipidemia and other less classic factors such as chronic inflammation of rheumatoid arthritis. Many studies have highlighted the correlation between this chronic inflammation and clinical coronary disease but very few have focused on the anatomical correlation. Objective: To describe the correlation between the chronic biological inflammation of rheumatoid arthritis and anatomical coronary lesions on angiography. Method: This observational, retrospective, single-center study, including over 10 years, of patients with rheumatoid arthritis, confirmed the EULAR 2010 criteria and presented with coronary artery disease requiring coronary angiography. Patients with missing data or in whom coronary angiography was not done were excluded (n = 14). We divided then the patients according to the existence or not of chronic inflammation to study the impact of the latter on the existence (Stenosis < 50% vs. stenosis ≥ 50%), the extent (single vs. multivessel disease), and the severity of the coronary lesions (syntax score < 32 vs. ≥ 32). Results: 202 patients (49♂/153♀) aged between 30-75 years with a history of rheumatoid arthritis have had a coronary event requiring coronary angiography, were included; The mean ejection fraction at baseline was 57.3% +/- 5.8 (37 vs.-65%). 75% of them were ≥ 65 years old. 55% were diabetics, 61% with hypertension, 38% with dyslipidemia, and 19% were smokers. Chronic inflammation was diagnosed in 70% of them on non-specific parameters (ESR, CRP, fibrinogen, anemia, and rheumatoid factor). All patients had coronary angiography, which made it possible to identify the coronary lesions according to their existence (Stenosis < 50%: 51 patients vs. stenosis ≥ 50%: 151 patients), the extent (single: 86 patients vs. multivessel disease: 116 patients) and the severity of the coronary lesions (syntax score < 32: 142 patients vs. ≥ 32: 60 patients). Chronic inflammation of rheumatoid arthritis was correlated in bivariate and multivariate analysis (after excluding the impact of other risk factors) with the existence and extent of coronary lesions (p < 0.05) but not with their severity (p > 0.05). Discussion: The two limitations of this work are the monocentric nature of the study and the absence of specific inflammatory parameters such as anti-CCP antibodies. Strengths are anatomical correlations and multivariate analysis. Chronic inflammation apart from any influence of the various risk factors predisposes to the existence and extent of coronary lesions (p < 0.05). The severity of coronary lesions assessed by Syntax Score was not correlated with chronic inflammation, although other studies suggest that this inflammation is the cause of complex lesions. Interpretation: Rheumatoid arthritis is associated with an increase in cardiac morbidity and mortality. Atheromatous lesions are more frequent in those patients than the existence of classic cardiovascular risk factors would suggest. Several explanations could account for this risk: the inflammatory syndrome and its impact on the cardiovascular risk factors and the vessel and the deleterious effect of the treatments. This requires stricter screening and management of risk factors in rheumatoid arthritis.

Rapid Rise in Cardio-Ankle Vascular Index as a Predictor of Impending Cardiovascular Events -Smooth Muscle Cell Contraction Hypothesis for Plaque Rupture.

Predictive factors for vascular events have not been established. The vasculature of the atheroma is supplied by penetration of the vasa vasorum through the smooth muscle cell layer from the adventitia. Smooth muscle cell contraction induces compression of the vasa vasorum, resulting in ischemia in intimal atheromatous lesions. Cardio-ankle vascular index (CAVI) has become known as an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle. CAVI reflects the progress of arteriosclerosis, and a rapid rise in CAVI indicates arterial smooth muscle cell contraction. We hypothesized that rapidly increased arterial stiffness evaluated by CAVI may be a predictor of impending cardiovascular events.

Spatial metabolomics identifies lipid profiles of human carotid atherosclerosis

Background and aimsCarotid atherosclerosis is an important cause of ischemic stroke. Lipids play a key role in the progression of atherosclerosis. To date, the spatial lipid profile of carotid atherosclerotic plaques related to histology has not been systematically investigated. MethodsCarotid atherosclerosis samples from 12 patients were obtained and classified into four classical pathological stages (preatheroma, atheroma, fibroatheroma and complicated lesion) by histological staining. Desorption electrospray ionization-mass spectrometry imaging (DESI-MSI) was used to investigate the lipid profile of carotid atherosclerosis, and correlated it with histological information. Bioinformatics technology was used to process MSI data among different pathological stages of atherosclerosis lesions. ResultsA total of 55 lipids (26 throughout cross-section regions [TCSRs], 13 in lipid-rich regions [LRRs], and 16 in collagen-rich regions [CRRs]) were initially identified in carotid plaque from one patient. Subsequently, 32 of 55 lipids (12 in TCSRs, eight in LRRs, and 12 in CRRs) were further screened in 11 patients. Pathway enrichment analysis showed that multiple metabolic pathways, such as fat digestion and absorption, cholesterol metabolism, lipid and atherosclerosis, were enriched in TCSRs; sphingolipid signaling pathway, necroptosis pathway were enriched in LRRs; and glycerophospholipid metabolism, ether lipid metabolism pathway were mainly enriched in CRRs. ConclusionsThis study comprehensively showed the spatial lipid metabolism footprint in human carotid atherosclerotic plaques. The lipid profiles and related metabolism pathways in three regions of plaque with disease progression were different markedly, suggesting that the different metabolic mechanisms in these regions of carotid plaque may be critical in atherosclerosis progression.

Myocardial Bridge Syndrome: A Case Report and Literature Review

Introduction: Myocardial bridging (MB) is a congenital coronary artery malformation. Various clinical symptoms related to MB have been reported; however, subxiphoid pain has rarely been reported. Moreover, it is rarer for electrocardiography (ECG) to show such obvious ischaemia in patients with MB. Objectve: To report the case of a 65- year-old patient in whom the diagnosis was made during coronary angiography, and whose management was pharmacological with good progress. Case Report: The patient was 65 years old, with no cardiovascular risk factors other than age and male gender, a former smoker with 20 BPs, admitted to our clinic for management of stress angina that had been present for 3 years prior to his admission, associated with NYHA stage II dyspnea. On admission, the patient was conscious, hemodynamically and respiratory stable, with no signs of right or left heart failure. The ECG was in regular sinus rhythm, with negative T waves in septo-apical, extended to the right leads. Troponin was positive at 110ng/l. TTE was performed showing a non-dilated, non-hypertrophied LV with preserved systolic function LVEF at 72%, preserved segmental and global kinetics, non-dilated atria free of echoes, absence of significant mitro-aortic valve disease, LV size and longitudinal systolic function preserved. A coronary angiography was performed showing a Milking aspect of the anterior interventricular artery, associated with coronary-ventricular fistulas, without significant atheromatous lesions. Discussion and Conclusion: The myocardial bridge corresponds to a coronary anomaly, most often congenital, in its anatomical relationship to the myocardial muscle, which more frequently affects the anterior interventricular artery. Despite technical advances, angiography remains the reference diagnostic method with a typical image of milking systolic compression. In most cases benign and asymptomatic, it can nevertheless be responsible for serious and even fatal complications. Several therapeutic alternatives are available, ranging from pharmacological treatment to interventional treatment

Results of the endovascular treatment of long femoropopliteal lesions: A meta-analysis

Open surgery remains the first line treatment for the longest femoropopliteal lesions. However, for about twenty years, the indications of the endovascular treatment of atheromatous femoropopliteal lesions have continually increased. Additional studies are thus necessary before retaining endovascular treatment as an alternative to the conventional surgical treatment and to define the type of implantable device indicated to treat long femoropopliteal lesions.

Cholesterol Crystals in the Retrieved Thrombus by Mechanical Thrombectomy for Cerebral Embolism: A Case Report and Literature Review

There are only a few case reports in which cholesterol crystals were found in the thrombus retrieved by mechanical thrombectomy for cryptogenic stroke, leading to a definitive diagnosis. We herein report a case of aortogenic embolic stroke diagnosed by the presence of rich cholesterol crystals in the retrieved thrombus and review the previously reported cases. A woman in her 80s was transferred as an emergency due to consciousness disturbance, right conjugate deviation, and severe left hemiparesis. Magnetic resonance imaging showed occlusion of the right middle cerebral artery (MCA) and acute infarction in the territory. The MCA was recanalized by thrombectomy using an aspiration catheter and stent retriever, and the symptoms improved. Although the physiological examination did not detect the embolic source during hospitalization, pathological examination of the thrombus revealed atheroma with numerous cholesterol crystal clefts and intermixing of fibrin. Contrast-enhanced computed tomography performed based on the pathological results showed atheromatous lesions in the aortic arch as the embolic source. As a subsequent treatment, medications of a strong statin and an antiplatelet agent were continued, and the patient had no recurrence. The finding that the retrieved thrombus is a simple atheroma containing cholesterol crystals with poor hemocytes suggests embolism due to plaque rupture. Pathological examination of the thrombus obtained by thrombectomy is one of the useful diagnostic approaches for stroke etiology and the determination of its treatment.

P413 ISCHEMIC ECG CHANGES, NOT ALWAYS CORONARY ISSUES

Abstract Background Many abdominal deseases can mimic cardiac symthoms at their presentation and they can lead to electrocardiographic (ECG) changes, acting as a confounding factor for the physichan during the diagnostic process. Case presentation A 77–year–old man, former smoker, with high blood pressure not being treated, came to the emergency room with mesogastric pain and vomiting, since three hours before. The ECG showed a sinus rhythm, at 55 beats per minute and a slight elevation of the ST segment in the leads DII, DIII and aVF, evolving as T waves negativization in the same leads and flattening in V5– V6. Laboratory tests showed increasing Troponin I values from 23 to 277 ng / L. Because of this pathological context, the patient was taken to our Unit to perform a coronary angiography study in the hypothesis of acute myocardial infarction. The examination showed diffuse atheromatous lesions in the coronaries without haemodynamically significant stenosis. The patient developed fever during the hospitalization, abdominal CT study with contrast was performed, with a definitive diagnosis of acute cholecystitis and the patient was finally moved to the Internal Medicine ward. Conclusions ECG alterations in acute cholecystitis are not specific, but some of them are recurrent: among these there are ischemic modifications affecting the ST segment or the T waves, widely described in the scientific literature. All these ECG modifications solve with the treatment of cholecystitis, whether conservative or surgical, without acting on the cardiological side in any way; on the other hand, they can lead to unnecessary diagnostic–therapeutic investigations, to a diagnosis’delay and to complications’ onset. It is important for the clinician being able to consider abdominal pathology in case of diagnostic investigations’ inconsistency. However, ST segment’s changes during cholecystitis may deserve a cardiological study, as they are specific for acute myocardial infarction, especially in patients with high cardiovascular risk. This reminds to us, once again, the importance of anamnesis, physical examination and appropriate tests, to reach the correct diagnosis.

Role of myeloperoxidase in inflammation and atherosclerosis (Review)

Myeloperoxidase (MPO) belongs to the heme peroxidase family, which includes a set of enzymes with potent oxidoreductase activity. MPO is considered an important part of the innate immune system's microbicidal arm and is secreted by neutrophils and macrophages. Interestingly, this enzyme has been implicated in the pathogenesis of several diseases including atherosclerosis. MPO is ubiquitous in atherosclerotic lesions and contributes to the initiation and progression of the disease primarily by oxidizing low-density lipoprotein (LDL) particles. MPO is the only human enzyme with the ability to produce hypochlorous acid (HOCl) at physiological chloride concentrations and HOCl-LDL epitopes were shown to be present inside atheromatous lesions making it a physiologically relevant model for the oxidation of LDL. It has been shown that MPO modified LDL is not able to bind to the native LDL receptor and is recognized instead by scavenger receptors on both endothelial cells and macrophages, which can lead to endothelial dysfunction and foam cell formation, respectively; both of which are instrumental in the progression of the disease. Meanwhile, several studies have proposed MPO as a biomarker for cardiovascular diseases where high levels of this enzyme were linked to an increased risk of developing coronary artery disease. Overall, there is sufficient evidence supporting the value of MPO as a crucial player in health and disease. Thus, future research should be directed towards investigating the still unknown processes associated with this enzyme. This may assist in better understanding the pathophysiological role of MPO, as well in the development of therapeutic strategies for protecting against the deleterious effects of MPO in numerous pathologies such as atherosclerosis.

Failing to palpate femoral pulses in adult hypertensive patients may lead to diagnostic wandering and major cerebrovascular events in cases of undetected aortic coarctation

In developed countries, aortic coarctation (AC) is generally diagnosed by fetal echocardiography during the third trimester of pregnancy, or during the neonatal period based on the absence of femoral pulses or the presence of a left supraclavicular systolic murmur. However, AC may be diagnosed late, such as in adult migrants arriving from developing countries without documented medical history although they may require healthcare support during their stay. We report three cases of the incidental diagnosis of thoracic aortic malformations in adults (27, 38 and 43 years) referred for the management of uncontrolled high blood pressure, with major cerebrovascular events for the two oldest. Doppler ultrasound imaging indicated for suspected renal artery stenosis and atheroma lesions revealed abnormal lower-body and normal upper-body arterial blood flow velocity waveforms constitutive of a pathognomonic hemodynamic pattern of AC, a diagnostic which was in all three cases confirmed by multidetector computed tomography-angiography. None of these patients had undergone complete cardiovascular examination, particularly with effective peripheral pulse palpation, during the period preceding the occurrence of major cardiovascular events or at any other time after birth. Our observation suggests that a simple medical examination could have prevented diagnostic wandering and, possibly, the occurrence of severe cerebrovascular complications in two of these three patients.

Retrospective Study of Outpatient Treatment of Acute Mesenteric Circulatory Disorders

Introduction. Acute violation of mesenteric blood circulation is one of the most severe urgent diseases of the abdominal cavity. The number of patients, and the mortality rate resulted from this pathology, is steadily increasing every year. The number of patients has only increased during the pandemic of new coronavirus infection COVID-19.The aim of study was to develop options to prevent severe outcomes of this pathology at the pre-hospital stage identifying patients with high risk of developing mesenteric thrombosis.Materials and methods. The study was a retrospective analytical study that included 279 (100%) patients and their outpatient records. All patients were diagnosed with acute mesenteric circulation disorder and treated at the hospital surgery clinic in Smolensk in 2013-2020. When conducting a thorough analysis of patients findings, special attention was paid to: past medical history, in particular, the presence of abdominal pain syndrome, features, localization and intensity of pain; the nature of labour activity during life; existing comorbidity; surgical interventions of the abdominal organs, objective examination findings, and laboratory and instrumental test findings. The data obtained were processed using methods of statistical analysis described in the book "Statistics in biology and medicine" by Medik V.A., Tokmachev M.S., Fishman B.B. (2001), and MS Excel 2019.Results. A retrospective analysis revealed that 63 (22.5%) patients had a burdened anamnesis of acute mesenteric circulatory disorders in close relatives. An increased number of "bad" lipoproteins of low and very low density was noted, this being an unfavorable factor in the development of atheromatous lesion of the mesenteric vascular bed followed by the manifestation of acute mesenteric circulatory disorders. The analysis revealed a group of patients with ischemic colitis that included 139 patients (49.1 %). The diagnosis was supported by fibrocolonoscopy. In addition, it was found that 4 0.7 years (from 3 to 4.5 years) passed from the onset of symptoms to hospitalization for acute mesenteric circulatory disorders in patients with abdominal symptoms.Conclusions. All patients with acute mesenteric circulatory disorders had manifested clinical signs of the disorder 3-4.5 years before it was diagnosed; this allowed suspecting violations along the mesenteric bed. Patients with a burdened anamnesis of the cardiovascular system (coronary heart disease-93.7%, arterial hypertension 86.1%, various forms of atrial fibrillation 83.4%) were mostly at risk. Identification of a risk group at the outpatient stage for potential occurrence of acute mesenteric circulatory disorders can help reduce incidence of this pathology.

Carotid Plaque Characterization Using Quantitative Shear Wave Elastography: A Pilot Study

Objective: To assess the feasibility and reliability of incorporating quantitative shear wave elastography (SWE) data as an additional means of characterizing focal atheromata during routine carotid sonographic examinations when compared with conventional gray-scale Gray-Weale (GW) methods. Methods: Inpatients and outpatients undergoing routine carotid examinations at a medical center were included in the pilot study. Patients with prior history of endarterectomy, interventional therapeutic procedures, or absence of plaque formation were excluded. All examinations were performed by registered vascular technologist using a Mindray Resona 7 ultrasound equipment system with an L9-3U transducer in a carotid examination mode. The images were later reviewed by two independent, blinded observers and correlated to GW characterization. Results: There were 41 atheromatous lesions evaluated during the pilot study. The range of absolute (low to high) average and median Young’s modulus (YM) kPa values vary widely across each plaque type; they nonetheless still exhibit evidence of increasing stiffness as the gray-scale sonographic appearance becomes denser. The same observation is true of the average kPa and median kPa values as increasing YM values indicate increasing stiffness of interrogated tissues. Conclusion: This pilot study affirms the feasibility and reliability of incorporating quantitative SWE data as an additional means of characterizing focal atheromata during routine carotid sonographic examinations; further large-scale studies are needed to determine the sensitivity and specificity of individual kPa values associated with specific plaque types.

Nanoprobes for Computed Tomography and Magnetic Resonance Imaging in Atherosclerosis Research.

Atheromatous lesions are characterized by intrusion into the vascular lumen, resulting in morphological changes to the blood compartment and into the vessel wall, resulting in characteristic molecular and cellular signatures in the solid tissue of the intima, tunica media, adventitia and surrounding tissue. Nanoprobes can be easily formulated to provide long blood-pool residence and molecular targeting, facilitating the imaging of atheromatous changes. Detection of nanoprobes can be accomplished by a variety of methods. We focus in this chapter on the use of cross-sectional imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI), that facilitate in vivo, noninvasive imaging of the vascular morphology and molecular/cellular signatures of the atheroma. The methods described are suitable for use in animal models, although versions of the probes are being readied for clinical trials, potentially facilitating clinical use in the future.

Principais achados incidentais em tomografia computadorizada de feixe cônico na região de cabeça e pescoço e o impacto na vida dos pacientes: uma revisão integrativa de literatura

ABSTRACT To identify the main incidental findings (IFs) in the head and neck region using Cone-Beam Computed Tomography (CBCT) and the impact on patient’s live. The study was carried out using an integrative review method, starting with a guiding question followed by searches in the databases Pubmed, Scopus, Virtual Health Library and Dentistry & Oral Sciences Source for articles from 2009 until 2019. Forty-one articles became the object of this work. The incidental findings most reported by the articles are present in the bone and TMJ regions, with 35 different AIs being found. However, they are also common in the airways, such as mucosal thickening and retention mucosal cysts. Among the dental, the most pointed are impacted and supernumerary teeth. In the group of soft tissue calcifications, tonsillolite and calcification of the hyoid-style process are the most frequent. Atheroma and malignant lesions are less prevalent, but important due to the impact on patient’s life. The main incident findings are bone / TMJ, followed by dental, soft tissue calcifications, airways and other findings. Most of them do not affect patient’s life. However, some IFs require immediate interventions and are generally associated with elderly patients. Finally, more than half of the studies pointed out that the incidental findings are located in an extragnatic region.

MORPHOLOGICAL JUSTIFICATION OF THE SIGNIFICANCE OF LUMBAR ARTERIES IN THE PREVENTION OF SPINAL CORD ISCHEMIA IN ATHEROSCLEROTIC LESIONS OF ABDOMINAL AORTA.

The aim: To investigate atherosclerosis of the abdominal part of the aorta and atherosclerosis of the lumbar arteries, aimed at improving surgical tactics during reconstructive interventions on the abdominal part of the aorta in patients with multifocal atherosclerosis. Materials and methods: 20 autopsies were performed. The macro preparation consisted of the part of the abdominal aorta 1х1 sm taken along with a separated lumbar artery for 1-1,5 sm. Histological cuts were coloured with hematoxylin and eosin. The histochemical research was conducted in order to establish changes in all layers of blood vessels. The immunohistochemical research was carried out along with generally accepted histological methods in 10 cases to determine the morphological vessel wall functional state, connective tissue and smooth muscle components. Results: In all cases there were morphological signs of aortic atherosclerosis with different degrees of damage to the lumen. In none of the analyzed cases did we establish pathomorphological signs of atherosclerosis of the lumbar artery distal to the mouth. In the walls of the lumbar arteries, we noted the preservation of the layered structure, the integrity of the endothelial cells, the normal arrangement of smooth muscle cells. Conclusions: It was established that there cannot be the atherosclerotic occlusion of the lumbar artery, since there are no signs of atheromatous lesions in its walls, the structure of all layers is preserved, the endothelial damage is absent, the location and structure of the lining cells is normal.

Protective Action of Simvastatin in the Development of Aortic and Hepatic Lesions in Hypercholesterolemic Rabbits

As simvastatin is the most prescribed and distributed drug for high cholesterol by the National Health Service the authors carry out an experimental work to study special detailed effects of this drug. The authors studied the effect of simvastatin on the development of atherosclerotic lesions in aortas of rabbits submitted to a high-cholesterol diet, at 1.5%. The authors studied 30 New Zealand rabbits, males, adults, distributed in three groups according to diet: (A) cholesterol, (B) cholesterol + simvastatin (100 mg/day) and (C) normal. We took blood samples to evaluate cholesterol and plasma triglycerides at times zero, five and nine weeks and found lower serum cholesterol levels in the treated group. After nine weeks, we sacrificed the animals and examined the aortas for the extent of the atheromatous lesion area evaluated by computerized planimetry and the height of the lesion analyzed by morphometry, in histological sections of thoracic and abdominal aorta. There was no statistically significant difference between groups A and B in relation to the percentage of the injured area. However, in rabbits treated with simvastatin, smoother and less relief lesions were observed macroscopically by us and confirmed by morphometric analyses of atheroma plaque thickness. We observed intense morphological changes in the liver of the two groups of animals with a hypercholesterolemic diet, although to a slightly lower degree in those treated with simvastatin. We concluded that simvastatin had a protective effect on the volume of atherosclerotic lesions in aortas of hypercholesterolemic rabbits.

The influence of high-density lipoprotein cholesterol on maximal lipid core burden indexing thin cap fibrous atheroma lesions as assessed by near infrared spectroscopy

BackgroundPrevious studies suggest that higher plasma concentrations of several lipid molecules are associated with higher lipid core burden index (LCBI) near infrared spectroscopy (NIRS) imaging. The aim of this study was to investigate whether an association between plasma lipids depends on plaque morphology (thin cap fibrous atheroma [TCFA] vs. non-TFCA) as measured by near-infrared spectroscopy–intravascular ultrasound (NIRS-IVUS).MethodsSixty-four patients retrospectively enrolled were diagnosed with stable coronary artery disease or acute coronary syndrome who underwent NIRS-IVUS imaging. Before percutaneous coronary intervention, blood samples were collected for measurement of serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (HDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Patients were divided into two groups based on maxLCBI4mm and IVUS imaging. Those with maxLCBI4mm ≥ 323 were included into TCFA group (n = 35) while others were assigned to the non-TCFA group (n = 29).ResultsThin cap fibrous atheroma lesions were significantly longer than the non-TCFA lesions (25.66 ± 9.56 vs. 17.03 ± 9.22, p = 0.001). TCFA characterizes greater plaque burden (78.4 [70.9, 82.2] vs. 72.70 [64.77, 76,05]; p = 0.021) and plaque volume (176.1 [110.75, 247.5] vs. 68.1 [55.58, 143.35]; p = 0.000) as compared to non-TCFA. In TCFA suspected lesions, there was no correlation between max-LCBI4mm and LDL levels (r = 0.105, p = 0.549) nor TC levels (r = –0.035, p = 0.844) but a negative correlation was found between HDL-C and maxLCBI4mm (r = −0.453, p = 0.007).ConclusionsThe present study showed that there was no correlation between plasma LDL-C, TC and TG level and the amount of lipids in coronary plaque assessed by NIRS in both TCFA and non-TCFA groups. Only HDL-C correlated with maxLCBI4mm in TCFA lesions.

Lipoprotein(a) is associated with coronary atheroma progression: analysis from a serial coronary computed tomography angiography study.

BACKGROUNDLipoprotein(a) [Lp(a)] has been closely related to coronary atherosclerosis and might affect perivascular inflammation due to its proinflammatory properties. However, there are limited data about Lp(a) and related perivascular inflammation on coronary atheroma progression. Therefore, this study aimed to investigate the associations between Lp(a) and the perivascular fat attenuation index (FAI) with coronary atheroma progression detected by coronary computed tomography angiography (CCTA).METHODSPatients who underwent serial CCTA examinations without a history of revascularization and with available data for Lp(a) within one month before or after baseline and follow-up CCTA imaging scans were considered to be included. CCTA quantitative analyses were performed to obtain the total plaque volume (TPV) and the perivascular FAI. Coronary plaque progression (PP) was defined as a ≥ 10% increase in the change of the TPV at the patient level or the presence of new-onset coronary atheroma lesions. The associations between Lp(a) or the perivascular FAI with PP were examined by multivariate logistic regression.RESULTSA total of 116 patients were ultimately enrolled in the present study with a mean CCTA interscan interval of 30.80 ± 13.50 months. Among the 116 patients (mean age: 53.49 ± 10.21 years, males: 83.6%), 32 patients presented PP during the follow-up interval. Lp(a) levels were significantly higher among PP patients than those among non-PP patients at both baseline [15.80 (9.09−33.60) mg/dLvs. 10.50 (4.75−19.71) mg/dL,P = 0.029] and follow-up [20.60 (10.45−34.55) mg/dLvs. 8.77 (5.00−18.78) mg/dL,P = 0.004]. However, there were no differences in the perivascular FAI between PP group and non-PP group at either baseline or follow-up. Multivariate logistic regression analysis showed that elevated baseline Lp(a) level (OR = 1.031, 95% CI: 1.005−1.058,P = 0.019) was an independent risk factor for PP after adjustment for other conventional variables. CONCLUSIONSLp(a) was independently associated with coronary atheroma progression beyond low-density lipoprotein cholesterol and other conventional risk factors. Further studies are warranted to identify the inflammation effect exhibited as the perivascular FAI on coronary atheroma progression.

Isolated acute renal infarction in an obese patient

Background: Uncontrolled cardiovascular (CV) risk factors is been related to a higher incidence of atherosclerosis. Obesity itself could predispose to significant cardiac disease including arterial atheromatous leading to acute events. Case: A 46 years old obese patient who presented with left abdominal pain radiating to the left quadrant and left testicle. No significant abnormality was observed in the laboratories, but imaging showed left renal lower pole may be due to renal infarct (Figure 1), and CT-Angiography (CTA) of the abdomen showed infarction of the anterior two-thirds of the lower pole of the left kidney (Figure 2) secondary to occlusion of the supplying small inferior segmental artery and minimal atherosclerosis. Transthoracic Echocardiogram (TTE) showed a density in the LVOT may be artifact vs. calcification (Figure 3). A transesophageal echocardiogram (TEE) showed Grade III atherosclerotic changes of descending aorta (Figure 4), aortic arch, and a mobile plaque seen in the thoracic aorta. Conclusion: Cardiovascular risk factors have been associated with multiple vascular complications. Obesity as a single cardiovascular risk factor is associated with advanced arterial disease; our case is an example of an unstable atheromatous lesion causing thrombosis and ischemia in the kidney in a patient without another risk factor for thrombosis.

Abstract 12565: Rotational Atherectomy in the Left Coronary System

It′s known that the Left Coronary Artery stenosis has greater mobility and mortality compared to the rest of the coronary tree, due to its size since the formation of plaques has a disseminated distribution, greater volume and severity of calcification. The use of rotational atherectomy (RA) has proven to be an effective tool to facilitate the sub-expansion of stents in atheromatous calcified lesions. We present a case study where plaque modification is performed by atherectomy and angioplasty in the Left Coronary system.A 62 years old female patient diagnosed with diabetes mellitus 2, systemic arterial hypertension and dyslipidemia. Antecedent of coronary angiography 10 days prior to admission due to chest pain and dyspnea, where found trivascular disease of left dominance with diffuse calcified lesion. She was programmed for RA with ROTABLATOR and ROTAWire system. It started by advancing the microcatheter on the angioplasty guide and exchanging for ROTAWIRE 0.009”. Subsequently, the 1.5 mm abrasive bur was advanced, rotating up to 6 times in the proximal and middle segment of the Anterior Descending Artery, proceeding to predilate with balloon noting a non-dilatable distal lesion, a 1.25 mm abrasive bur was passed, rotating up to 3 times, and it was decided to perform balloon predilatation and placement of spliced stents.Continuing with Circumflex Artery, an intermediate 0.014” Zinguer guide was advanced to the distal segment, spliced stents were placed in the proximal segment and it was dilated with a balloon to optimize results. It was decided to exchange guides and predilated the artery ostium, then it was decided to advance the stent using the Culotte bifurcation technique and a proximal optimization of the stent with a balloon was performed.Finally, a post-dilation was performed in the Anterior Descending Artery and the Left Coronary Trunk with a balloon to optimize a successful result (Figure 1), with no dissection image or thrombus. Final flow TIMI 3, TMP 3.