Carotid Artery Calcification Research Articles

Prevalence of soft tissue calcifications in panoramic radiographs of the maxillofacial region of older adults.

To investigate the presence of soft tissue calcifications in the head and neck region on panoramic radiographs of older adults. We analysed 1176 panoramic radiographs obtained between January 2013 and December 2018 from individuals of both sexes aged 60years or older, who were referred by dental specialities to the Dental Imaginology Service of the Federal University of Rio Grande do Norte, Brazil. The types of soft tissue calcification evaluated were as follows: carotid artery calcification (CAC), thyroid cartilage calcifications, triticeous cartilage calcifications, sialoliths, tonsilloliths and lymph node calcifications. The presence of soft tissue calcifications was correlated with age and sex. The chi-square test with continuity correction was used for the calculation of p values and the evaluation of the proposed associations. Prevalence ratios and 95% confidence intervals were also calculated. At least one type of soft tissue calcification was found in 43% of the sample. The main calcifications detected were CAC, thyroid and triticeous cartilage calcifications, tonsilloliths,sialoliths, calcified lymph nodes, and phleboliths. Mean patient age was 67.47years and there was a predominance of females (62.8%) in the sample. Bivariate analysis showed a statistically significant association between female sex and the presence of thyroid and triticeous cartilage calcifications and between male sex and the presence of tonsilloliths. Routine panoramic radiography permits the identification of soft tissue calcifications that may be indicators of future cardiovascular disorders, the referral to a medical service and the establishment of therapies for stroke prevention.

Association of high cardiovascular risk and diabetes with calcified carotid artery atheromas depicted on panoramic radiographs

To evaluate whether estimates of risk of future cardiovascular events and death and established or unknown diabetes are significantly associated with calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs). The main focus was on men and women without previous myocardial infarction (MI). The PAROKRANK (Periodontitis and its Relation to Coronary Artery Disease) study included patients with a first MI and matched control subjects. In this substudy, 738 patients (138 women) and 744 control subjects (144 women) with available PRs were assessed for CCAA. Cardiovascular risk estimates were determined according to the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE). Established and previously unknown diabetes was also determined. CCAA was detected on PRs in 206 control subjects (28%) and 251 patients (34%). FRS was significantly associated with CCAA among control subjects (P=.04) and patients (P=.001). SCORE was associated with CCAA among control subjects (P < .01) but not patients (P=.07). Among men, FRS and SCORE were associated with CCAA in both control subjects and patients. Diabetes was not significantly associated with CCAA after adjustments. Elevated cardiovascular risk scores were associated with CCAA on PRs among control subjects. Diabetes was not independently associated with CCAA, possibly owing to selection bias.

Panoramic imaged carotid atheromas are associated with increased neutrophil count: both validated, independent predictors of near-term myocardial infarction

Panoramic images (PXs) demonstrating calcified carotid artery atheromas (CCAAs) are associated with heightened risk of near-term myocardial infarction (MI). Elevated neutrophil counts (NC) within normal range 2,500-6,000 per mm3 are likewise associated with future MI signaling the role neutrophils play in the chronic inflammation process underlying coronary artery atherogenesis. We determined if CCAAs on PXs are associated with increased NC. Investigators implemented a retrospective study of PXs and accompanying medical records of white males ≥ 65 years treated by a VA dental service. Two groups (N = 60 each) were constituted, one with atheromas (CCAA+) and one without (CCAA-). Predictor variable was CCAA + and outcome variable was NC. Bootstrapping analysis determined the difference in mean NCs between two groups, significance set at ≤0.05. The study group of (CCAA+) (mean age 75.9; range 69-91 years) demonstrated a mean NC of 4,843 per mm3 and control group (CCAA-) (mean age 75.3; range; 66-94) a mean NC of 4,108 per mm3. The difference between the groups was significant (p = 0.0008) (95% CI of difference of mean: -432, 431; observed effect size 736). CCAAs on PXs of elderly white males are associated with elevated NC; amplifying need for medical consultation prior to invasive dental procedures.

Prevalence of suggestive images of atheroma in panoramic radiographs: clinical profile and risk factors for cardiovascular disease / Prevalência de imagens sugestivas de ateroma em radiografias panorâmicas: perfil clínico e fatores de risco para a doença cardiovascular

Background: In recent years, the use of panoramic radiography (PR) has been proposed as a reliable method for early diagnosis of calcified carotid artery atheroma (CCAA). The aim of this study was to determine the prevalence of images suggestive of CCAA, observed in digital PRs from users of a Brazilian military organization, and investigate the presence of cardiovascular risk factors. Material and methods: The study analyzed a total of 2.015 digital PRs, taken for dental diagnostic purposes between January and September 2019 from patients of both genders and older than 18 years. Data were analyzed regarding prevalence of CCAA and cardiovascular risk factors using the Chi-square test at the significance level of 5%. Patients with a suggestive diagnosis of CCAA were contacted by telephone and invited to further evaluation. Results: Of 2.015 patients, 105 (6.06%; 46 women, 25 men) had CCAA detected on digital images. Of the 71 patients who agreed to further evaluation, 64.8% were women, 54.9% were 60 years or older, 38% military service, 45.1% overweight, 64.3% blood pressure alterations, 23.9% diabetics, 11.3% cardiovascular and respiratory disorders, 5.6% history of COVID-19, 12% cholesterol ≥ 240mg/dL, 26.5 % triglycerides ≥ 200mg/dL and 51% glycaemia ≥ 100mg/dL. For all variables analyzed there was statistically significant differences (p0.05), except for glycaemia (p=889). Conclusion: The presence of risk factors for stroke was meaningful in the population with CCAA, indicating the relevant role of the dentist in the early diagnosis.

NTCP Modeling of Late Effects for Head and Neck Cancer: A Systematic Review.

NTCP Modeling of Late Effects for Head and Neck Cancer: A Systematic Review.

Abstract P154: Leisure-Time Physical Activity, Sedentary Behavior, And Carotid Atherosclerosis Morphology: The ARIC Carotid-MRI Study

Introduction: Studies suggest that greater physical activity (PA) may be associated with favorable carotid artery characteristics, while greater time spent in sedentary behavior (SB) may be a potential risk factor for atherosclerosis development and progression. We evaluated the association between leisure-time PA and SB in midlife and their temporal patterns with carotid atherosclerotic morphology measured by MRI. Methods: ARIC Carotid-MRI participants (n=1582, mean age: 53 years, 43% male, 18% Black) with self-reported assessments of PA and SB at visits 1 (1987-1989) and 3 (1993-1995), who participated in the Carotid MRI substudy in 2004-2006 were included. Self-reported leisure-time PA was categorized based on the American Heart Association’s Life Simple 7 categorization of ideal, intermediate, or poor PA. SB was ascertained based on participant report of how often they watched television during leisure-time, and categorized as low [“never”/ “seldom”], medium [“sometimes”], or high [“often”/“very often”]. To measure persistent PA and SB, we examined participants who reported the same level of PA (n=849) or SB (n=954) at both visits 1 and 3. Carotid MRI using a 1.5T scanner quantified internal carotid artery wall thickness, lipid core, and calcification measures. Weighted analyses accounted for the sampling design allowing for generalizability to the visit 1 ARIC population. Multivariable linear and logistic regression were used for continuous and categorical outcomes, respectively. All models were adjusted for demographic, behavioral, and lifestyle factors. Results: Though no clear trends were observed for PA, higher levels of SB were associated with a greater odds of lipid core presence and lower odds of calcification (Table). Similar trends were observed for the persistence analyses, though none were statistically significant. Conclusions: PA and SB may influence atherosclerotic plaque characteristics. SB and lack of PA may have different measurable effects on plaque morphology.

Intracranial arteriosclerosis is related to cerebral small vessel disease: a prospective cohort study

Intracranial arteriosclerosis has been increasingly recognized as a risk factor for cognitive impairment and even dementia. A possible mechanism linking intracranial arteriosclerosis to cognitive impairment and dementia involves structural brain changes including cerebral small vessel disease (CSVD). To assess whether intracranial carotid artery calcification (ICAC) and vertebrobasilar artery calcification (VBAC), as proxies for intracranial arteriosclerosis, are related to CSVD.Within the population-based Rotterdam Study, between 2003 and 2006 a computed tomography (CT)-based measurement of ICAC and VBAC and at least one magnetic resonance imaging (MRI) measurement of structural brain changes were performed from 2005 onwards in 1,489 participants. To estimate the burden of calcification independent of age, we computed age-adjusted percentile curves for ICAC and VBAC separately, based on the calcification volumes. Using the longitudinal MRI data, we assessed whether a larger calcification burden accelerates structural brain changes using appropriate statistical models for repeated outcome measures. A larger burden of ICAC and VBAC was associated with an increase of CSVD markers accelerating over time. A larger burden of ICAC and VBAC was not significantly (p > 0.05) associated with accelerated brain atrophy. Arteriosclerosis is related to accelerating structural brain changes over time.

Calcified carotid artery atheroma and stroke risk assessment. Use of Doppler ultrasonography as a secondary marker: a meta-analysis.

Objective: Calcified carotid artery atheroma (CCAA) detected by panoramic radiographs has been suggested as an accurate biomarker for cerebrovascular accidents (CVAs). However, there has not been agreement on the relationship between CCAA and risk for stroke or other CVA. Method and materials: The question asked was, "Are patients with CCAA detected on panoramic radiographs more likely to get a stroke or CVA in the future compared to those who do not have CCAA and, further, would Doppler ultrasonography of the neck obtained secondary to panoramic radiography in suspected individuals add value to this association with stroke or CVA?" This meta-analysis was conducted by searching PubMed, Ovid Medline, Dentistry & Oral Sciences Source, CINAHL, Web of Science, Google Scholar, and ClinicalTrials.gov. Six studies that met the inclusion criteria were included in the final analysis; three used panoramic radiography and the rest used panoramic radiography and ultrasonography. Multiple random effect meta-analyses were conducted using RevMan 5.2 software. Conclusion: Evidence from this meta-analysis shows that although detection of CCAA via panoramic radiography to predict risk for stroke may be comparable to Doppler ultrasonography, risk prediction is somewhat more significant when diagnostic confirmation is made using Doppler ultrasonography than panoramic radiography alone. Clinical implications: Because stroke risk assessment is complicated and comprises many additional systemic factors beyond calcification of the carotid artery, CVA prediction is more reliable when Doppler ultrasonography is used after panoramic radiography. Managing hypertension, diabetes, and smoking habit are far more important in risk management of patients with CCAA detection on panoramic radiography.

The Prevalence of Soft Tissue Calcifications in the Head and Neck Region Using CBCT among Egyptian Population

Background: calcifications may be physiological or pathological. Understanding about soft tissuecalcifications help to reach appropriate diagnosis and take the right decision whether treatment, referral,further investigations or do nothing.Aim: To detect the prevalence of soft tissue calcifications using (CBCT) scans in the Egyptian population.Method: Retrospective Data Analysis was performed on (417) CBCT patients’ scans collected from thedatabase available at the Oral &amp; Maxillofacial Radiology department,Faculty of Dentistry, Cairo University.Data collection of patient sex and age was made. Data was assessed for presence or absence of calcification,type of calcification, sidedness and single or multiple occurring.Results: There were (94) scans detected with calcifications within the whole sample size (417 scans).The prevalence was (22.54%). There were (141) calcifications detected in the (94) scans. The soft tissuecalcifications detected were calcified stylohyoid ligament, tonsilloliths, sialoliths, laryngeal cartilagecalcification, carotid artery calcification and only one case of ethmoidal sinolith. There were 3 cases withoutcertain final diagnosis.Conclusions: The prevalence of calcifications seen on CBCT images is not uncommon, dental practitionersshould be aware of their presence. Their detection during routine dental examination should be made toensure the broad evaluation of the patients.

Abstract P573: The Interplay Between Mineral and Skeletal Metabolism Biomarkers and Intracranial Internal Carotid Artery Calcifications in Stroke Patients

Background: Intracranial internal carotid artery calcifications (IICAC), considered a phenomenon within the spectrum of atherosclerosis and vascular aging, are frequently encountered in ischemic stroke patients. While intimal IICAC directly contributes to ischemic stroke pathophysiology, the medial counterpart is generally deemed as a risk factor for vascular end-points. Apart from aging and cardiovascular risk factors, the underlying pathophysiology that contributes to development of IICAC is not well understood; herein we studied the interplay between mineral and skeletal metabolism biomarkers, and IICAC presence and pattern. Methods: In a prospective series of 194 ischemic stroke patients (mean±SD age: 69±14 yr), blood samples were collected to determine calcium, phosphorus, magnesium, osteocalcin, parathyroid hormone, and vitamin D levels within 72 hours of symptom onset. IICAC presence and type was determined on admission CT-angiography source images; a medial or intimal type of IICAC category was assigned according to Kockelkoren criteria. Results: A total of 45 (23%) patients had no calcifications, while 95 (49%) had an intimal pattern and 54 (28%) had non-intimal (or medial) pattern. Apart from the well-known factors related with IICAC, such as age, lower glomerular filtration rate (GFR), history of hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation, we identified admission magnesium levels to be associated with IICAC presence and pattern (no calcification: 1.96±0.18 mEq/L, intimal calcification 1.93±0.19 mEq/L, medial calcification: 1.81±0.28 mEq/L; p=0.006). None of the other biomarkers had any significant relationship to IICAC. In multivariate models, a lower magnesium level was significantly associated with medial calcification (each 0.1 mEq/L drop increased the odds by 1.2 (95% CI 1.0-1.4; p=0.046)), in addition to older age, history of diabetes mellitus and lower GFR. Conclusion: Hypomagnesemia is one of the factors well-known to be associated with vascular calcifications in the body. Our findings, extend this relationship to the intracranial vascular bed. No similar association was observed for other biomarkers related to mineral and skeletal metabolism. (Funding: TUBITAK grant 218S753)

Can Styloid Process and Internal Carotid Artery Anatomy be Used to Predict Carotid Artery Dissection?

Carotid artery dissection is a common cause of stroke in the young. It has been related to the association of the carotid artery with fixed neighboring anatomical structures. This study assesses the association between styloid process length, internal carotid artery position and cervical carotid artery dissection (CCAD). This information would provide potential predicative radiological measurements, which could prevent delays in CCAD diagnosis. Retrospective data was collected from 2 central London hospitals over 5 years. CCAD cases were identified from individuals who underwent computer topography angiography of the neck for suspected CCAD. The following data was collected: evidence of CCAD; bilateral styloid process length and presence of styloid-hyoid ligament calcification; bilateral styloid process-internal carotid distance; calcification of carotid arteries and whether their position was aberrant. Cases were dissection-side, age and gender matched with two non-dissection controls. Three hundred and fifty-five individuals were identified. Fifty individuals had CCAD, of which 4 had bilateral dissection. In individuals with CCAD, average styloid process length was 27.5 mm and styloid process-internal carotid distance was 5.14 mm. There was no significant association between styloid process length or styloid process-internal carotid distance, and CCAD when compared with matched controls. Internal carotid artery aberrancy was significant for nondissection. In this study, there was no association between styloid process length and styloid process-internal carotid distance with CCAD. These measurements can not be used to predict the possibility of a CCAD following trauma.

Red Cell Distribution Width, Unlike Neutrophil Lymphocyte Ratio Is Unable to Accurately Gauge Enhanced Systemic Inflammation Associated With Panoramic Imaged Carotid Plaque.

We have previously shown that panoramic X-rays (PXs) demonstrating calcified carotid artery atheromas (CCAA) are associated with increased systemic inflammation demonstrating increased neutrophil lymphocyte ratios (NLRs), a validated risk indicator of fatal myocardial infarctions arising from coronary artery atherosclerosis. Using this same cohort of patients (with minor adjustments because of missing data), we sought to determine if a like association existed between PXs evidencing CCAA and elevated red blood cell distribution width (RDW) given conflicting data as its reliability relative to NLR as a biologic marker of system inflammation. We hypothesized that CCAAs on PXs would simultaneously be associated with both increased NLR and RDW. Investigators implemented a cross-sectional study design. Study sample consisted of patient medical records and PXs of white men ≥ 55 years. Two groups (N = 50 each) were constituted, one with atheromas (CCAA+) and without atheromas (CCAA-). The predictor variable was CCAA+and outcome variables were NLR and RDW. Bootstrapping analysis was employed to analyze the differences in mean NLRs and RDWs between groups since the data was not normally distributed. Statistical significance determined to be ≤ 0.05 for all tests. The Medical Center's Institutional Review Board approved the research protocol. A study group of 50 CCAA+men (mean age 71; range 58-89 years) demonstrated a mean NLR of 2.98 ± 1.38 and an RDW of 13.21 ± 0.85. A control group of 50 CCAA- males (mean age 70 range; 55-91 years) evidenced a mean NLR of 2.38 ± 0.77 and an RDW of 13.16 ± 0.77. Bootstrapping comparison of NLR values evidenced significant (P = 0.008) difference (95% confidence interval of difference of mean: - 0.4272, 0.4384; observed effect size: 0.579) between groups; however, there was no significant difference in RDW values between the groups. Furthermore, logistic regression modeling demonstrated that for a one unit increase in NLR the odds of being CCAA+ (vs. CCAA-) increases by a factor of 1.659. The existence of CCAA seen on PXs of elderly white men is associated with significantly (P = 0.008) elevated NLR values but is not associated with increases in RDW.

Assessment of Carotid Artery Calcifications on Digital Panoramic Radiographs and Their Relationship With Periodontal Condition and Cardiovascular Risk Factors

ObjectiveThe main purpose of this study is to determine the presence of carotid artery calcification (CAC) detected on digital panoramic radiographs (DPRs) retrospectively and correlate the findings with cardiovascular risk factors including gender, age, smoking status, hypertension, diabetes, and hyperlipidemia, along with atherosclerotic cardiovascular disease and periodontal status. MethodsThis clinical study is registered at ClinicalTrials.gov as NCT04017078. DPRs, periodontal status and cardiovascular risk factors of 1,101 patients (576 males, 525 females) were evaluated. The patients were grouped based on whether CAC was detected in dental DPRs [CAC (+)] or not [CAC (–)]. Periodontal status was categorised as gingivitis, periodontitis, and gingivitis with reduced periodontium (periodontally stable patient). ResultsOut of 1,101 patients, whose mean age was 42.1 ± 15.5 years and 525 (47.7%) were female, 34 (3.1%) were diagnosed with CAC on DPRs. No significant difference was observed between groups considering gender, hypertension, diabetes, hyperlipidemia, smoking, and periodontal status. Patients aged 40–55 years (n = 398, 36.15%) and patients older than 55 years (n = 222, 20.16%) were associated with CAC (odds ratio = 4.49, 95% confidence interval = 1.65–12.17, P = 0.003; odds ratio = 4.41, 95% confidence interval = 1.33–14.61, P = 0.015, respectively). ConclusionAmong all parameters, only age exhibited significant correlation with an increased risk of carotid calcification. Further studies with prospective designs and larger study populations are needed.

Association between intracranial carotid artery calcifications and periodontitis: A cone-beam computed tomography study.

Intracranial carotid artery calcifications (ICACs) are one type of calcification that may be detected as incidental findings in cone-beam computed tomography (CBCT). This retrospective study aimed to examine the prevalence of ICACs on CBCT images and their associations among age, gender, chronic periodontitis, and patient-reported cardiovascular diseases (CVDs). A total of 303 CBCT scans were reviewed and a total of 208 patients met the inclusion criteria. The presence or absence of ICACs was evaluated in the ophthalmic and cavernous segments of each scan. Patient demographic data, including age, gender, and medical history, specifically focused on CVDs were recorded. The presence or absence of periodontitis was recorded from each subject with full mouth radiographs and clinical measurements. Odds ratios (ORs) were calculated as part of the logistic regression analysis. Overall, ICACs were found in 93 subjects (45%). The bilateral ICACs were found in 43 subjects (21% of the total subjects, 46% of the subjects with ICACs). There were statistically significant associations between presence of ICACs and periodontitis (OR=4.55), hypertension (OR=3.02), hyperlipidemia (OR=2.87), increasing age (OR=2.24), and the male gender (OR=1.85). Smoking status was not significantly correlated with ICACs. This study revealed that nearly half (45%) of the subjects displayed ICACs on the CBCT images. ICACs are significantly related to the status of chronic periodontitis, age, gender, and CVDs. A more careful review of CBCT scans is highly recommended to detect these calcifications and refer patients for further medical evaluation.

Clinical features of ischemic complications after unruptured middle cerebral artery aneurysm clipping: patients and radiologically related factors.

Postoperative ischemic complication results in neurological sequelae and longer hospitalization after unruptured middle cerebral artery (MCA) aneurysm clipping surgery. We evaluated the radiological and patient-related factors associated with ischemic complications after unruptured MCA aneurysm clipping surgery. Patient demographics, radiological findings, and intraoperative factors were compared between patients with and without postoperative ischemic complications. The clinical courses and outcomes of postoperative ischemic complications were compared according to the types of ischemic complication. Forty-two out of 2227 patients (1.9%) developed postoperative ischemic complications after MCA aneurysm clipping. Multivariate analysis revealed that diabetes mellitus (DM) was a patient-related factor. Intraarterial (IA) calcification of the distal internal carotid artery (ICA), preoperative M1 stenosis, and M1 aneurysm were radiological factors that increased the risk of postoperative ischemic complications. DM was significantly associated with divisional branch territory infarction (P = 0.04). The time to first presentation of ischemic complication was significantly longer in divisional branch territory infarction than perforator territory infarction (67.8 ± 75.9 h vs. 22 ± 20.7, P = 0.023). Twelve out of 42 patients with ischemic complications (28.6%) had unfavorable outcome (mRS > 3). Perforator territory infarction was significantly associated with an unfavorable outcome (mRS > 3, P = 0.019). IA calcification of the distal ICA, M1 stenosis and aneurysms, and DM were significantly associated with postoperative ischemic complications after unruptured MCA aneurysm clipping. Patients with DM should be closely monitored postoperatively to detect delayed occurrence of divisional branch infarction. Trial registration number: 2019-1002, Date of registration: January 1, 2005, "retrospectively registered".

Prevalence of carotid artery calcifications in Riyadh from digital panoramic radiographs and its relationship with cardiovascular disorders: A retrospective cross-sectional study

Introduction: Atherosclerosis of the external division of the carotid artery contributes to approximately 20% among all the reasons leading to stroke. The strategies for the prevention of stroke remain underutilized despite the advancements in healthcare. Dentists can contribute in the prevention of stroke by identifying patients at risk from the details revealed in radiographic imaging. Aim: The aim of this study is to determine the prevalence of carotid artery calcifications (CACs) detected on digital panoramic radiographs in Riyadh and its relationship with cardiovascular disorders. Methodology: A retrospective cross-sectional study was conducted in Riyadh Elm University using digital panoramic radiographs. A total of 158 panoramic radiographs were analyzed with patients aged ≥18 years. The presence of CAC was determined and confirmed by an oral radiologist. Medical records were retrieved and collected from the digital data base after ethical approval. Chi-square test of independence was performed to examine the relationship between variables (age, gender, and medical problems) and the presence of calcification. Results and Discussion: From the data scrutinized, 158 panoramic radiographs were included for the study. 111 radiographs did not have any calcifications. 47 radiographs depicted the presence of soft tissue calcification, out of which 20 radiographs were of CAC and the remaining contributed to other soft tissue calcifications seen in the neck region. There was significant correlation between age and calcification, P = 0.003 with the highest prevalence in 40–69 years. Correlation between gender, CAC, and medically compromised conditions associated with cardiovascular systems was not significant. Conclusion: The prevalence of CAC in the Riyadh population was 1.12%. CAC comprised of 12.66% among all the soft tissue calcifications of the neck in this study. Patients are not aware of the underlying cardiovascular risk that CAC can pose. Dentists' diagnostic efficiency in analyzing CAC, which is a risk factor for cardiovascular events, can reduce further morbidities or mortality rates enhancing the quality of life and life span.

Ateroma arteri karotis pada radiograf panoramik sebagai diagnosis awal aterosklerosis

Objectives: This review aimed to understand the radiographic features of carotid artery atheroma on panoramic radiographs as an early diagnosis of atherosclerosis. &#x0D; Literature Review: Carotid artery calcification is caused by a plaque known as an atheroma. Atheroma is a plaque composed of lipids and rich in calcium. If atheroma formation in the carotid arteries increases, it would cause stenosis of the blood vessels and increase the risk of stroke. On panoramic radiographs, carotid artery atheroma appears as a heterogeneous radiopaque image with an irregular shape and well-defined borders. Radiopaque image located inferior to the angle of the mandible, close to the cervical spine (C3-C5) and above the hyoid bone.&#x0D; Conclusion: Incidental findings on panoramic radiograph could be an initial reference for further examination and evaluation of atherosclerosis.

CROT (Carnitine O-Octanoyltransferase) Is a Novel Contributing Factor in Vascular Calcification via Promoting Fatty Acid Metabolism and Mitochondrial Dysfunction.

Vascular calcification is a critical pathology associated with increased cardiovascular event risk, but there are no Food and Drug Administration-approved anticalcific therapies. We hypothesized and validated that an unbiased screening approach would identify novel mediators of human vascular calcification. Approach and Results: We performed an unbiased quantitative proteomics and pathway network analysis that identified increased CROT (carnitine O-octanoyltransferase) in calcifying primary human coronary artery smooth muscle cells (SMCs). Additionally, human carotid artery atherosclerotic plaques contained increased immunoreactive CROT near calcified regions. CROT siRNA reduced fibrocalcific response in calcifying SMCs. In agreement, histidine 327 to alanine point mutation inactivated human CROT fatty acid metabolism enzymatic activity and suppressed SMC calcification. CROT siRNA suppressed type 1 collagen secretion, and restored mitochondrial proteome alterations, and suppressed mitochondrial fragmentation in calcifying SMCs. Lipidomics analysis of SMCs incubated with CROT siRNA revealed increased eicosapentaenoic acid, a vascular calcification inhibitor. CRISPR/Cas9-mediated Crot deficiency in LDL (low-density lipoprotein) receptor-deficient mice reduced aortic and carotid artery calcification without altering bone density or liver and plasma cholesterol and triglyceride concentrations. CROT is a novel contributing factor in vascular calcification via promoting fatty acid metabolism and mitochondrial dysfunction, as such CROT inhibition has strong potential as an antifibrocalcific therapy.

Impact of Carotid Lesion Calcification on Outcomes After Transfemoral Versus Transcarotid Artery Stenting

The impact of carotid artery lesion calcification on adverse events following carotid artery stenting is not well studied. There are few reports that associate heavily calcified lesions with high risk of perioperative stroke following transfemoral carotid artery stenting (TFCAS). With the advent of transcarotid artery revascularization (TCAR), we thought to compare the outcomes of these two procedures stratified by the degree of lesion calcification. Our cohort was derived from the Vascular Quality Initiative (VQI) daTabase for carotid artery stenting. Patients with missing information on the degree of carotid artery calcification were excluded. Patients were stratified into two groups: >50% circumferential calcium (severe), and ≤50% calcification. The Student t test and the χ2 test were used to compare patients’ baseline characteristics and crude outcomes, as appropriate. Clinically relevant and statistically significantly variables on univariable analysis were added to a logistic regression model clustered by center identifier. The final models were tested for goodness of fit using the Hosmer-Lemeshow test. A total of 11,342 patients were included (TFCAS, 4,416; TCAR, 6,926). Patients with more severe calcification were older, had more comorbidities (coronary artery disease, chronic obstructive pulmonary disease, and congestive heart failure) and more contralateral occlusion. There were more patients with prior ipsilateral carotid endarterectomy in the less severe calcification group. In patients who underwent TCAR, there were no significant differences between those who had >50% versus ≤50% carotid calcification in the odds of in-hospital stroke (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.8-1.8; P = .41), death (OR, 0.87; 95% CI, 0.36-2.1; P = .75), stroke or death (OR, 1.2; 95% CI, 0.8-1.7; P = .45), MI (OR, 1.1; 95% CI, 0.6-2.0; P =.78), or stroke, death or MI (OR, 1.2; 95% CI, 0.81.6; P = .31). However, in patients with heavy calcification who underwent TFCAS, there was 50-60% increase in the odds of stroke (OR, 1.6; 95% CI, 1.04-2.5; P = .03), stroke or TIA (OR, 1.6; 95% CI, 1.1-2.3; P = .013) and stroke or death (OR, 1.5; 95% CI, 1.02-2.08; P = .039). There was no significant difference in the odds of in-hospital death and stroke, death or myocardial infarction (MI) (Table). In patients with severe calcification and compared with TFCAS, TCAR was associated with 40-70% reduction in the odds of stroke or TIA (OR, 0.6; 95% CI, 0.38-0.91; P = .018), death (OR, 0.3; 95% CI, 0.13-0.72; P = .006), stroke or death (OR, 0.5; 95% CI, 0.32-0.8; P = .004) (Fig), stroke, death or MI (OR, 0.58; 95% CI, 0.39-0.87; P = .008). There were no significant differences between TCAR and TFCAS in the odds of in-hospital stroke and MI (Table). The degree of carotid artery calcification has a negative impact on the outcomes of patients undergoing TFCAS. However, it does not seem to impact the outcomes of patients undergoing TCAR. In patients with heavily calcified lesions, TCAR seems to have favorable outcomes compared with TFCAS. These results confirm the superiority of the flow reversal compared with distal embolic protection devices. Further research is needed to assess long-term outcomes and confirm the safety of TCAR in heavily calcified lesions.TableMultivariable logistic regression analysis of adverse outcomesIn-hospital outcomesTCARP valueTFCASP valueTCAR vs TFCASP value(>50% calcification vs ≤50% calcification)(>50% calcification vs ≤50% calcification)Patients with severe (>50%) calcificationStroke/death1.2 (0.8-1.7).451.5 (1.02-2.08).0390.51 (0.32-0.8).004Stroke1.2 (0.8-1.8).411.6 (1.04-2.5).030.69 (0.4-1.1).140Death0.87 (0.36-2.1).751.05 (0.6-1.9).8710.3 (0.13-0.72).006Stroke/transient ischemic attack1.12 (0.8-1.6).531.6 (1.1-2.3).0130.6 (0.38-0.91).018Stroke/death/MI1.2 (0.8-1.6).371.4 (0.99-2.06).0600.58 (0.39-0.87).008MI1.1 (0.6-2.0).781.04 (0.5-2.3).9240.79 (0.37-1.7).536MI, Myocardial infarction; TCAR, transcarotid artery revascularization; TFCAS, transfemoral carotid artery stenting.Values are odds ratio (95% confidence interval). Open table in a new tab

Concealed deciduous root fragment-cause of recurrent gingival pain: A case report

Radiographs are the most useful imaging technique from a clinical perspective when broad coverage of the jaws is needed for diagnosis. Several incidental finding can be seen such as impacted teeth, carotid artery calcification, variants in anatomical landmarks, foreign bodies and retained root fragments. Even though, embedded roots have come across as incidental radiographic findings without any symptoms these roots can cause difficulties in some dental treatments. So here, we report a case of pain and tenderness in lower molar tooth region which was a consequence of retained root fragment. Keywords: Deciduous dentition, Embedded portion, Gingivitis, Retained root fragment, Root resorption, Periodontitis.