Atherosclerotic Disease In Patients Research Articles

Prognostic value of mitral annular calcification in coronary atherosclerotic disease assessed by coronary computed tomographic angiography

Abstract Background: There is a lack of evidence on the link between mitral annular calcification (MAC) and coronary atherosclerotic diseases. The present investigation was undertaken to detect the clinical and prognostic value of MAC in coronary atherosclerotic diseases in patients who underwent coronary computed tomographic (CT) angiography. Materials and Methods: Two hundred and five individuals with MAC and without it (n = 85 and 120, respectively) were included in the present cross-sectional study. Coronary artery disease-reporting and data system (CAD-RADS) at coronary CT angiography was used to define the severity of coronary atherosclerotic diseases. Patients were classified into no or non-significant CAD (CAD-RADS 0–2) and significant CAD (CAD-RADS 3–5) according to the severity of coronary atherosclerotic diseases. The association of MAC with two mentioned groups (no or non-significant CAD and significant CAD) was assessed using the Chi-squared test and logistic regression in crude and adjusted models. Results: Patients with MAC were significantly older (69.34 ± 8.20 vs. 60.64 ± 11.42, P < 0.001), had lower glomerular infiltration rate (69.67 ± 20.92 vs. 78.00 ± 20.23, P = 0.005), and higher coronary artery calcification score (352.87 ± 495.85 vs. 200.55 ± 426.13, P = 0.05) in comparison to those without MAC. However, the significant difference between the two groups regarding coronary artery calcification score disappeared after adjustment for confounders (P = 0.14). In addition, a statistically significant positive link between MAC and significant CAD was observed (odds ratio [OR] [95% confidence interval (CI)]: 1.96 [1.04–3.71], P = 0.04). Nevertheless, the association became statistically insignificant after adjustment for confounders (OR [95% CI]: 1.60 [0.78–3.28], P = 0.2). Conclusion: The findings of the study revealed that MAC has no independent prognostic value in coronary atherosclerotic diseases evaluated by coronary CT angiography.

Prevalence of intracranial atherosclerotic disease in patients with ischemic cerebrovascular event(s) in various geographical regions: A systematic review and meta-analysis

Prevalence of intracranial atherosclerotic disease in patients with ischemic cerebrovascular event(s) in various geographical regions: A systematic review and meta-analysis

First-in-human trial of a self-expandable, temporary dilation system for intracranial atherosclerotic disease in patients presenting with acute ischemic stroke

BackgroundIntracranial atherosclerotic disease (ICAD) significantly contributes to ischemic stroke, especially among Asian populations. Large vessel occlusion (LVO) due to underlying ICAD accounts for 15–35% of acute ischemic stroke cases requiring...

S1363 A 5-Year National Inpatient Sample Analysis of Atherosclerotic Disease in Patients With Primary Biliary Cholangitis

S1363 A 5-Year National Inpatient Sample Analysis of Atherosclerotic Disease in Patients With Primary Biliary Cholangitis

Uric acid plasma levels are associated with C-reactive protein concentrations and the extent of coronary artery lesions in patients with acute coronary syndromes.

Many studies have pointed out that inflammation plays a pivotal role in pathophysiology of acute coronary syndromes (ACS) because several inflammatory molecules impair the endothelial functions in the coronary circulation and promote atherothrombotic events. Recently, many clinical/experimental evidences indicate that elevated plasma levels of uric acid (UA) might be considered a risk factor for developing ACS. It has been reported that elevated UA doses impair physiologic functions of endothelial cells, shifting them toward a pro atherothrombotic phenotype. In the present manuscript, we investigated the relationship between UA plasma levels, inflammatory burden, and extension of coronary atherosclerotic disease in patients with ACS. Patients with a clinical presentation of ACS (ST-elevated and non-ST-elevated myocardial infarction) admitted to the Vanvitelli Catheterization Laboratory at Monaldi Hospital in 2019, before the COVID-19 pandemia, were retrospectively analyzed. Biochemical profile, type of ACS presentation, as well as extension of coronary atherosclerosis were assessed. A total of 132 ACS patients were included in the analysis, and grouped into 3 tertiles according to the UA values (UA < 4.72mg/dl, UA between 4.72 and 6.15mg/dl, and UA > 6.15mg/dl). Patients with UA plasma levels ≥ 6.15mg/dL showed higher levels of C-reactive protein (mean of 5.1mg/dL) as compared to patients with lower UA plasma levels. Moreover, the former group of patients showed higher levels of cardiac troponin and CPK, and presented more often with multivessel disease and complex coronary stenosis (type C of Ellis classification). Even though monocentric and with limited sample size, the present study shows that plasma levels of UA and hs-CRP are elevated in ACS patients and are associated with a more severe coronary disease, suggesting a potential role of UA in the pathophysiology of acute coronary events.

Role of galectin-3 in diagnosis and severity assessment of epicardial artery lesions in patients with suspected coronary artery disease

BackgroundThis study aimed to investigate the possible role of serum galectin-3 (Gal-3) levels in the diagnosis and assessment of significant epicardial artery lesions in patients with suspected coronary artery disease (CAD).MethodsThis was a single-center cross sectional cohort study including 168 subjects with suspected CAD and indications for coronary angiography divided into three groups: percutaneous coronary intervention (PCI) group (N 64), coronary artery bypass graft surgery (CABG) group (N 57), and group with no coronary stenosis (N 47). Gal-3 levels were measured and the syntax score (Ss) was calculated.ResultsThe mean value of Gal-3 in the PCI and CABG group was 19.98 ng/ml, while in the control group, it was 9.51 ng/ml (p < 0.001). The highest value of Gal-3 was found in the group of subjects with three-vessel disease (p < 0.001). When subgroups were analyzed by Gal-3 levels (< 17.8 ng/ml low, 18.8–25.9 ng/ml intermediate, > 25 ng/ml high risk) there was a significant difference between at least two Gal-3 groups for the arithmetic mean of Syntax score (p < 0.001). The syntax I’s arithmetic mean at low and intermediate-risk Gal-3 levels was significantly lower than at high-risk Gal-3 levels (p < 0.001).ConclusionGal-3 could be used as an additional tool for diagnosis and severity assessment of atherosclerotic disease in patients with suspected CAD. Furthermore, it could help identify high-risk subjects in patients with stable CAD.

High-risk carotid plaques and incident ischemic stroke in patients with atrial fibrillation in the Cardiovascular Health Study.

Whether carotid artery disease could improve stroke risk stratification tools in patients with atrial fibrillation (AF) remains uncertain. This study was undertaken to investigate the risk of ischemic stroke associated with occlusive and nonocclusive carotid atheroscleroticdisease in patients with AF in the prospective population-based Cardiovascular Health Study. We included participants aged ≥65 years with AF. We used multivariable Cox regression analysis to explore the risk of ischemic stroke associated with the percentage of carotid stenosis, plaque irregularity, echogenicity, and vulnerability (markedly irregular, ulcerated, or hypoechoic plaques). A total of 1398 participants were included (55.2% female, 61.7% aged 65-74 years). The maximum carotid stenosis was <50%, 50%-99%, and 100% in 94.5%, 5%, and 0.5% of participants, respectively. High-risk plaques based on echogenicity and plaque irregularity were found in 25.6% and 8.9% of participants, respectively. After a median follow-up of 10.9 years (interquartile range = 7.5-15.6), 298 ischemic strokes were recorded. There was no difference in the incidence of ischemic stroke according to the degree of carotid artery stenosis (p = 0.44), plaque echogenicity (low vs. high risk, p = 0.68), plaque irregularity (low vs. high risk, p = 0.55), and plaque vulnerability (p = 0.86). The CHA₂DS₂-VASc score was associated with an increased risk of ischemic stroke (adjusted hazard ratio = 1.28, 95% confidence interval = 1.18-1.40, p < 0.001). Both maximum grade of stenosis and plaque vulnerability were not associated with incident ischemic stroke (all p > 0.05). Neither the degree of carotid stenosis nor the presence of vulnerable plaques was associated with incident ischemic stroke in this cohortof individuals with AF. This suggests that carotid disease was probably not a significant contributor to ischemic stroke in this population.

From MIA to FIFA: The vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis.

Cardiovascular disease (CVD) is a major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Two decades ago, the common co-existence of malnutrition and systemic inflammation PD patients with atherosclerosis and CVD led to the proposed terminology of 'malnutrition-inflammation-atherosclerosis (MIA) syndrome'. Although the importance of malnutrition is well accepted, frailty represents a more comprehensive assessment of the physical and functional capability of the patient and encompasses the contributions of sarcopenia (a key component of malnutrition), obesity, cardiopulmonary as well as neuropsychiatric impairment. In recent years, it is also increasingly recognized that fluid overload is not only the consequence but also play an important role in the pathogenesis of CVD. Moreover, fluid overload is closely linked with the systemic inflammatory status, presumably by gut oedema, gastrointestinal epithelial barrier dysfunction and leakage of bacterial fragments to the systemic circulation. There are now a wealth of published evidence to show intricate relations between frailty, inflammation, fluid overload and atherosclerotic disease in patients with chronic kidney disease (CKD) and those on PD, a phenomenon that we propose the term 'FIFA complex'. In this system, frailty and atherosclerotic disease may be regarded as two patient-oriented outcomes, while inflammation and fluid overload are two inter-connected pathogenic processes. However, there remain limited data on how the treatment of one component affect the others. It is also important to define how treatment of fluid overload affect the systemic inflammatory status and to develop effective anti-inflammatory strategies that could alleviate atherosclerotic disease and frailty.

Development and validation of a nomogram for evaluating the incident risk of carotid atherosclerosis in patients with type 2 diabetes.

The purpose of this study was to evaluate the clinical characteristics of carotid atherosclerotic disease in patients with type 2 diabetes mellitus, investigate its risk factors, and develop and validate an easy-to-use nomogram. 1049 patients diagnosed with type 2 diabetes were enrolled and randomly assigned to the training and validation cohorts. Multivariate logistic regression analysis identified independent risk factors. A method combining least absolute shrinkage and selection operator with 10-fold cross-validation was used to screen for characteristic variables associated with carotid atherosclerosis. A nomogram was used to visually display the risk prediction model. Nomogram performance was evaluated using the C index, the area under the receiver operating characteristic curve, and calibration curves. Clinical utility was assessed by decision curve analysis. Age, nonalcoholic fatty liver disease, and OGTT3H were independent risk factors associated with carotid atherosclerosis in patients with diabetes. Age, nonalcoholic fatty liver disease, smoke, HDL-C, and LDL-C were characteristic variables used to develop the nomogram. The area under the curve for the discriminative power of the nomogram was 0.763 for the training cohort and 0.717 for the validation cohort. The calibration curves showed that the predicted probability matched the actual likelihood. The results of the decision curve analysis indicated that the nomograms were clinically useful. A new nomogram was developed and validated for assessing the incident risk of carotid atherosclerotic in patients with diabetes; this nomogram may act as a clinical tool to assist clinicians in making treatment recommendations.

Synthesis of Pd nanoparticle and study the effect on Adenosine amino hydrolase (ADA) enzyme activity in blood serum

Chemical reduction with trisodium citrate as the reducing agent resulted in the successful formation of palladium nanoparticles (Pd NPs), and all of the material's components were synthesised in double-distilled water. UV-vis spectroscopy, X-ray diffraction, with Transmission Electron Microscopy were all utilised to investigate the Pd nanoparticles. According to TEM investigations, the average size of the Pd nanoparticles formed was 13.5 - 45 nm. Serum adenosine deaminase (ADA) activity in atherosclerosis patients was tested to see if Pd NPs had any effect. Serum ADA activity was considerably higher in individuals with atherosclerotic disease, both in those treated with Pd nanoparticles and in those who were not (P&lt;0.01). Pd nanoparticles significantly lowered blood levels of ADA activity in atherosclerotic disease patients compared to those who did not receive Pd nanoparticles.

Dissecting genetics in hypothyroidism as an independent risk factor in atherosclerotic disease

Abstract Background Thyroid disease comprises a joint group of diseases estimated to affect 10% of the general adult population [1]. Hypothyroidism is characterized by high Thyroid-Stimulating Hormone (TSH) production and low concentrations of Thyroxine (T4). This is known to increase overall mortality and risk of cardiovascular disease (CVD), including heart failure (HF), dyslipidemia, stroke, and coronary artery disease (CAD) [2,3]. Still, the association between CVD and hypothyroidism seems independent of conventional CVD risk factors. This highlights that possible genetic underlying mechanisms remain uncovered and could support CVD monitoring and treatment in patients with hypothyroidism [3]. This study aimed to dichotomize independent genetic mechanisms involved in the increased risk of atherosclerotic disease in patients with hypothyroidism. Methods We conducted the largest ever genome-wide association study (GWAS) meta-analysis of hypothyroidism from three European cohorts, which amounted to 71,590 cases and 848,581 controls. Using Linkage Disequilibrium Regression Score, we highlight novel cardiovascular disease correlations in hypothyroidism. With Mendelian Randomization, we dissected which hypothyroidism-associated Single Nucleotide Polymorphisms (SNPs) infer atherosclerotic disease risk. Results We identified 79 novel disease loci in hypothyroidism, and tested 12 correlations which identified novel genetic overlap to CVD (Figure 1). We found five significant correlations to cardiovascular disease and two to cardiometabolic disease. Interestingly, we found overlap to atherosclerotic diseases; CAD (rg=0.16, P=2.12x10–9), HF (rg=0.16, P=1.6x10–5), stroke (rg=0.17, P=1.75x10–3) and aorta aneurysm (rg=0.12, P=3.65x10–3). We also found overlap to triglycerides (rg=0.10, P=1.4x10–5) and a negative correlation to HDL (rg=−0.16, P=8.8x10–11). Mendelian Randomization suggested hypothyroidism as an independent genetic risk factor with 3% increased risk of CAD (OR=1.03, 95% CI: 1.02–1.04, P=8.1x10–7) and 4% increased risk of myocardial infarction (MI) (OR=1.04, 95% CI: 1.02–1.05, P=3.3x10–6). We identified novel causal SNPs involved in CAD and MI in genes suggesting accelerated atherogenesis, namely; TRIM14 (rs141471464, OR_MI = 1.16 and OR_CAD = 1.10), CTLA4 (rs76749018, OR_MI = 1.10 and OR_CAD = 1.11) (Figure 2). Conclusions This analysis highlights novel significant findings between atherosclerotic disease and hypothyroidism. These findings could suggest improving consideration in clinical care for hypothyroid patients at risk of atherosclerotic disease. The genetic findings point towards solid indications, that atherogenesis is frequent and accelerated in this disease. Thus, the usual treatment, monitoring, and prevention strategies, could be reviewed with respect to considering other causal pathways than dyslipidemia for atherosclerotic disease in hypothyroid patients. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The John and Birthe Meyer FoundationVilladsen Family Foundation

MRA-detected intracranial atherosclerotic disease in patients with TIA and minor stroke

ObjectivesPatients with TIA and minor stroke commonly undergo CT and CTA in the emergency department with subsequent MRI with MRA for further workup. The purpose of this study was to review outpatient MRIs for TIA/stroke patients to assess the additional benefit, if any, of the MRA sequence in the detection of intracranial atherosclerotic disease in patients for whom CTA had already been performed.MethodsThe radiology reports of outpatient MRIs of the brain for TIA/minor stroke patients were retrospectively reviewed via the hospital PACS system. Following this, the imaging report from the patient’s initial presentation to the emergency department was reviewed. This index imaging and subsequent MRI were compared to assess the incidence of new vascular findings detected on the MRA sequence in patients for whom CTA had already been performed. Where new lesions had been identified at follow-up, the imaging was retroactively reviewed to assess if they were present on the index imaging.ResultsTwo hundred seven consecutive patients were reviewed. Significant (> 50%) intracranial atherosclerotic disease was present on MRA in 18 patients (8.7%). This was a new finding in 11 patients. Five had initial CTA where the atherosclerosis was not detected. All 5 of these cases were located in the posterior cerebral arteries. Incidental aneurysms were seen in 14 (6.7%); 12 were a new finding at time of MRI.ConclusionThe MRA sequence provides additional value by increasing the detection of clinically important intracranial atherosclerotic disease which may inform management in patients with minor stroke and TIA.

Prevalence of Intracranial Atherosclerotic Disease in Patients with Low-Risk Transient or Persistent Neurologic Events.

There are limited data on the prevalence and outcome of intracranial atherosclerotic disease in patients with low-risk transient or persistent minor neurologic events. We sought to determine the prevalence and risk factors associated with intracranial atherosclerotic disease in patients with low-risk transient or persistent neurologic events. Participants with available intracranial vascular imaging from the Diagnosis of Uncertain-Origin Benign Transient Neurologic Symptoms (DOUBT) study, a large prospective multicenter cohort study, were included in this post hoc analysis. The prevalence of intracranial atherosclerotic disease of ≥50% was determined, and the association with baseline characteristics and DWI lesions was evaluated using logistic regression. We included 661 patients with a median age of 62 years (interquartile range, 53-70 years), of whom 53% were women. Intracranial atherosclerotic disease was found in 81 (12.3%) patients; asymptomatic intracranial atherosclerotic disease alone, in 65 (9.8%); and symptomatic intracranial atherosclerotic disease, in 16 (2.4%). The most frequent location was in the posterior cerebral artery (29%). Age was the only factor associated with any intracranial atherosclerotic disease (adjusted OR, 1.9 for 10 years increase; 95% CI, 1.6-2.5). Multivariable logistic regression showed a strong association between intracranial atherosclerotic disease and the presence of acute infarct on MR imaging (adjusted OR, 3.47; 95% CI, 1.91-6.25). Intracranial atherosclerotic disease is not rare in patients with transient or persistent minor neurologic events and is independently associated with the presence of MR imaging-proved ischemia in this context. Evaluation of the intracranial arteries could be valuable in establishing the etiology of such low-risk events.

Statin Intolerance and Noncompliance: An Empiric Approach

Statin Intolerance and Noncompliance: An Empiric Approach

Assessing the applicability and outcomes of the COMPASS trial a large cohort of atherosclerotic disease patients

Abstract Background Atherosclerotic Cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide with substantial impact on health care resources. Rivaroxaban 2.5 mg twice daily with low dose ASA reduced death, myocardial infarction and stroke compared to ASA alone in stable ASCVD patients studied in the COMPASS trial. Purpose To assess the applicability and potential outcomes of applying the COMPASS antithrombotic strategy in a population-based cohort of patients with ASCVD. Methods All patients with a new diagnosis of ASCVD identified during hospital admission or outpatient medical encounters using validated case definitions from 2008–2019 were included. We determined the proportion who met COMPASS eligibility criteria (Eligible), the proportion who met inclusion criteria but had exclusion criteria (Excluded), and the proportion who did not meet inclusion criteria (Ineligible). Primary outcomes of interest were CV death, myocardial infarction, and stroke (MACE), with secondary outcomes all cause death, CV hospitalization, PAD intervention, amputation, and all bleeding which were followed to end of study. Results Of 226,446 new ASCVD patients in the 11 years studied, 73% had coronary artery disease, 17% had peripheral artery disease including cerebral and peripheral vascular disease (PAD), and 10% had both. Of the 364,442 prevalent cases, 27% met COMPASS eligibility criteria, another 42% met inclusion criteria but would have been excluded and 31% were Ineligible. The main reasons for exclusion were high bleeding risk characteristics in 69% and concomitant medical therapy (CYP3A4 inducers 30%, oral anticoagulants 28%, and dual antiplatelet therapy 7%). The MACE event rates were approximately twice as high in the excluded group as those deemed COMPASS eligible (figures 1). COMPASS eligible patients in our cohort exhibited event rates similar to the ASA arm of COMPASS (figure 2). The other event rates per 100 person-years for Eligible, Excluded, and Ineligible patients respectively were: all-cause death 4.6, 10.6, 1.2,; CV hospitalization 4.8, 8.8, 3.0; PAD intervention 0.6, 0.6, 0.1; and all bleeding 1.9, 4.3, 1.1. If the COMPASS antithrombotic strategy of Rivaroxaban 2.5 twice daily with low dose ASA was given to patients deemed eligible in this population, there would have been a potential reduction of 87 MACE events, 34 CV death, 25 MI, 24 stroke, and 12 amputations per 10,000 patient years of treatment. Conclusion In a population of 4.4 million persons, there are approximately 20,000 incident ASCVD patients diagnosed yearly. Approximately 70% of patients with ASCVD in the real-world met COMPASS inclusion criteria, although more than half would be excluded due to high-bleed risk characteristics or concomitant medical therapy. Implementing the COMPASS antithrombotic strategy would result in substantial reduction in CV death and MACE events. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bayer MACE by COMPASS eligibilityEvent rates compared to COMPASS ASA

The effect of preventative cardiovascular therapies on coronary artery disease in people with and without type 2 diabetes: a propensity-matched score study

BackgroundAlthough it is known that patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of coronary artery disease (CAD), the actual coronary artery burden of atherosclerotic disease in patients with and without T2DM in a real-world setting and its possible modification by preventative therapies has not been extensively documented.MethodsMerged coronary angiography and hospital discharge data between 2013 and 2019 were obtained for analysis and a random sub-sample of patient charts were reviewed for medication use. Propensity scores were estimated using logistic regression models and used to match patients, looking at the effect of severity of CAD over time in years in an ordinal logistic regression model. A separate propensity score was estimated and used to inverse probability weight the ordinal logistic regression looking at the effect of medication use on CAD severity in patients with and without T2DM.ResultsFrom 3,016 patients in the coronary angiography database, 1421 with T2DM and 1421 without T2DM were matched on propensity score. T2DM patients had more extensive CAD in 2018 compared to 2013 ((adjusted odds ratio) adjOR: 2.06 95% C.I. 1.38, 2.07), but this risk appeared to be attenuated in 2019. In contrast, there was no effect of time on CAD burden in patients without diabetes. In the sub-sample of 760 patients who underwent a chart review of their medication use, there were 367 (48%) with T2DM. For patients with T2DM 69.8% reported taking statins, 64.0% RAS inhibitors and 64.0% anti-platelet drugs. This was significantly higher than patients without diabetes of whom 46.6% reported taking statins, 49.0% RAS inhibitors and 49.9% anti-platelet drugs. As in the full matched sample, patients with diabetes had more extensive CAD (adjOR: 1.32 95% CI: 1.01, 1.74). However, after adjustment for the use of RAS inhibitors, statins and anticoagulants there was no difference in extent of CAD between patients with and without diabetes (adjOR: 1.14 95% CI: 0.85, 1.53).ConclusionsAlthough patients with diabetes have a greater extent of CAD in comparison to those without T2DM, preventative medication use decreases this CAD burden significantly.

English

BACKGROUND Central retinal artery occlusion (CRAO) was first described by Van Graefe in 1859 as an embolic event to the central retinal artery in a patient with endocarditis. CRAO has various causes, but patients typically present with sudden, severe, and painless loss of vision. Retinal arterial occlusions are a cause for profound visual loss in the population. Carotid atherosclerosis is common in elderly people. Dyslipidaemia, hypertension, and diabetes mellitus are factors which accelerate the development of carotid atheromatous plaques. Embolism from the carotid bifurcation is the most common cause of retinal artery occlusions. In retinal arterial occlusion carotid arterial occlusion is usually assessed using radiological techniques. The purpose of this study was to evaluate carotid atherosclerotic disease in patients with arterial occlusions in the eye and determine the relation between arterial occlusions in the eye &amp; carotid artery occlusive disease. METHODS This retrospective study included patients aged thirty and above, who had come with symptoms suggestive of arterial occlusions in the eye and carotid doppler was done. The inclusion criteria included patients diagnosed with the following conditions CRAO, branch retinal artery occlusion (BRAO), ophthalmic artery occlusion, anterior ischaemic optic neuropathy (AION) and cilioretinal artery occlusion. Patients usually present with sudden loss of vision in one eye. After taking a detailed history, all patients were subjected to a thorough ocular examination. Patient’s vision is assessed using Snellen’s visual acuity chart, pupillary assessment done, and fundus examination to look for retinal arterial occlusion is also done. Fundus imaging is also done. Carotid doppler was done to rule out carotid artery occlusive disease. RESULTS Patients presenting with retinal arterial occlusion should be investigated thoroughly for both systemic and local causes of CRAO. The risk of developing arterial occlusions were 1.7 - 9.15 times more in patients with carotid artery occlusion than in patients with normal carotids. Arterial occlusion was more found in patients with 70 % occlusion of the carotid artery. CONCLUSIONS There was a strong association between retinal arterial occlusions and carotid artery occlusion. KEYWORDS Central Retinal Artery Occlusion (CRAO), Carotid Artery Occlusive Disease, Carotid Doppler

Effect of the Brazilian Cardioprotective Nutritional Program on the Quality of Life of Atherosclerotic Disease Patients

Abstract Background Cardiovascular diseases (CVD) accounted for 27% of deaths in Brazil in 2017. Most of the recorded deaths caused by CVD would be preventable if patients controlled risk factors including inadequate diet. The Brazilian Cardioprotective Nutritional Program (Dica Br) adapted the Mediterranean diet pattern to Brazilian typical foods and evaluated the effectiveness of a nutritional program based on cardioprotective foods on cardiovascular events and death of patients with cardiovascular diseases. Objectives To evaluate the effect of Dica Br on [...]

Does stroke etiology influence outcome in the posterior circulation? An analysis of 107 consecutive acute basilar occlusion thrombectomies

Acute basilar artery occlusion (BAO) harbors a more guarded prognosis after thrombectomy compared with anterior circulation large-vessel occlusion. Whether this is a function of a greater proportion of atherosclerotic/intrinsic lesions is not well studied. The authors aimed to elucidate the prevalence and predictors of intracranial intrinsic atherosclerotic disease in patients with acute BAO and to compare angiographic and clinical outcomes between patients with BAO secondary to embolic versus intrinsic disease. A prospectively maintained stroke database was reviewed for all patients presenting between January 2013 and December 2019 to a tertiary care academic comprehensive stroke center with acute, nontandem BAO. Patient data were extracted, subdivided by stroke mechanism and treatment modality (embolic [thrombectomy only] and intrinsic [thrombectomy + stenting]), and angiographic and clinical results were compared. Of 107 patients, 83 (78%) had embolic occlusions (thrombectomy only) and 24 (22%) had intrinsic disease (thrombectomy + stenting). There was no significant difference in patient age, presenting National Institutes of Health Stroke Scale score, time to presentation, selected medical comorbidities (hypertension, hyperlipidemia, diabetes, and atrial fibrillation), prior stroke, and posterior circulation Alberta Stroke Program Early CT Score. Patients with intrinsic disease were more likely to be active smokers (50% vs 26%, p = 0.04) and more likely to be male (88% vs 48%, p = 0.001). Successful recanalization, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2b or 3, was achieved in 90% of patients and did not differ significantly between the embolic versus intrinsic groups (89% vs 92%, p > 0.99). A 90-day good outcome (modified Rankin Scale [mRS] score 0-2) was found in 37% of patients overall and did not differ significantly between the two groups (36% vs 41%, p = 0.41). Mortality was 40% overall and did not significantly differ between groups (41% vs 36%, p = 0.45). In the current study, demographic and clinical results for acute BAO showed that compared with intrinsic disease, thromboembolic disease is a more common mechanism of acute BAO, with 78% of patients undergoing thrombectomy alone. However, there was no significant difference in revascularization and outcome results between patients with embolic disease and those with intrinsic disease.

Disparate trends of atherosclerotic plaque evolution in stroke patients under 18-month follow-up: a 3D whole-brain magnetic resonance vessel wall imaging study.

The trend of atherosclerotic plaque feature evolution is unclear in stroke patients with and without recurrence. We aimed to use three-dimensional whole-brain magnetic resonance vessel wall imaging to quantify the morphological changes of causative lesions during medical therapy in patients with symptomatic intracranial atherosclerotic disease. Patients with acute ischemic stroke attributed to intracranial atherosclerotic disease were retrospectively enrolled if they underwent both baseline and follow-up magnetic resonance vessel wall imaging. The morphological features of the causative plaque, including plaque volume, peak normalized wall index, maximum wall thickness, degree of stenosis, pre-contrast plaque-wall contrast ratio, and post-contrast plaque enhancement ratio, were quantified and compared between the non-recurrent and recurrent groups (defined as the recurrence of a vascular event within 18 months of stroke). Twenty-nine patients were included in the final analysis. No significant differences were found in plaque features in the baseline scan between the non-recurrent (n = 22) and recurrent groups (n = 7). The changes in maximum wall thickness (-13.32% vs. 8.93%, P = 0.026), plaque-wall contrast ratio (-0.82% vs. 3.42%, P = 0.005) and plaque enhancement ratio (-11.03% vs. 9.75%, P = 0.019) were significantly different between the non-recurrent and recurrent groups. Univariable logistic regression showed that the increase in plaque-wall contrast ratio (odds ratio 3.22, 95% confidence interval 1.55-9.98, P = 0.003) was related to stroke recurrence. Morphological changes of plaque features on magnetic resonance vessel wall imaging demonstrated distinct trends in symptomatic intracranial atherosclerotic disease patients with and without stroke recurrence.