Carotid Artery Disease In Patients Research Articles

Individualized MRI-based stroke PRediction scOre using plaque Vulnerability for symptomatic carotid artEry disease patients (IMPROVE).

In TIA and stroke patients with carotid stenosis, estimations of future ipsilateral ischemic stroke risk and treatment decisions are currently primarily based on the degree of stenosis. Intraplaque hemorrhage (IPH), which can be readily visualized on carotid MRI, is increasingly established as an easy to assess and a very strong and independent predictor for ipsilateral stroke risk, stronger than any clinical risk factor. We developed a clinical prediction model (IMPROVE) incorporating IPH, degree of stenosis, and clinical risk factors to select patients with symptomatic carotid stenosis at high risk for stroke. IMPROVE was developed on pooled clinical and MRI data from five cohort studies of 760 recent TIA or minor stroke patients with carotid plaque who received optimal medical treatment. We used Cox proportional hazards models to determine the coefficients of IMPROVE. IMPROVE was internally validated using bootstrapping and converted to one- and three-year ipsilateral ischemic stroke risk. The development dataset contained 65 ipsilateral incident ischemic strokes that occurred during a median follow-up of 1.2 years (IQR: 0.5-4.1). The IMPROVE model includes five predictors, which are in order of importance: degree of stenosis, presence of IPH on MRI, classification of last event (cerebral vs ocular), sex, and age. Internal validation revealed a good accuracy (C-statistic: 0.82; 95% CI: 0.77-0.87) and no evidence for miscalibration (calibration slope: 0.93). Using presence of IPH on MRI and only four conventional parameters, the IMPROVE model provides accurate individual stroke risk estimates, which may facilitate stratification for revascularization.

A SINGLE-CENTER COMPARATIVE STUDY OF ENDARTERECTOMY AND STENTING FOR SYMPTOMATIC CAROTID ARTERY DISEASE: DECISION-MAKING PROCESSES AND EARLY TO MID-TERM OUTCOMES

Introduction: Ischemic stroke constitutes a significant burden on global health. Carotid artery atherosclerosis is a significant contributor to the occurrence of ischemic strokes. Both carotid endarterectomy and stenting are viable treatment options for symptomatic carotid artery disease, yet the optimal choice between them remains debated, particularly in elderly patients with multiple comorbidities. This study aims to compare decision-making processes and early to mid-term outcomes between carotid endarterectomy and carotid artery stenting in elderly symptomatic carotid artery disease patients. Materials and Method: A total of 88 symptomatic carotid artery disease patients (carotid endarterectomy: n=35, mean age: 71.72±7.87 years; carotid artery stenting: n=53, mean age: 70.64±7.46 years) were retrospectively analyzed. Results: No significant differences were observed in demographic characteristics between carotid endarterectomy and stenting groups. Chronic renal disease was more prevalent in the carotid endarterectomy group. Carotid artery stenting patients had a higher prevalence of 50–69% stenosis and less plaque ulceration. Complication rates were comparable between groups, with longer intensive care and hospitalization durations in the carotid endarterectomy group. Mid-term mortality rates and major complications did not significantly differ between groups. Conclusion: Both carotid endarterectomy and carotid artery stenting are effective treatments for symptomatic carotid artery disease. Despite differences in lesion characteristics, complication rates were similar between carotid endarterectomy and carotid artery stenting. This study emphasized the efficacy of a full cooperation between the cardiovascular surgery and neurology teams through an in-depth evaluation of each of the patients and the creation of individualized treatment strategies that optimized overall outcomes. Keywords: Aged; Endarterectomy; Carotid; Carotid Stenosis; Stents.

Abstract 13378: Identifiable Differences in Comorbidities and Surgical History Among Asian, Native Hawaiian, and Pacific Islander Stroke Patients With Carotid Artery Disease

Introduction: A detailed characterization of comorbidity prevalence among carotid artery disease patients has not been thoroughly explored in Asian, as well as Native Hawaiian and Pacific Islander (NHPI) populations. Research Question: This study investigated the types of comorbidities and surgical procedures associated with carotid artery disease in Asian and NHPI populations. Methods: This retrospective study utilized data from a stroke treatment center in Hawaii between the years 2020-21. Patients were identified with ICD-10 codes for stroke and only those ≥18 years old with either a completed carotid artery Doppler ultrasound or carotid angiography were included in the study. Collected data included demographics, location of stroke, degree and location of carotid stenosis, comorbidities, and previous surgical history. Wilcoxon rank sum test and Fisher's exact test were used as appropriate. Results: Overall, 117 patients were included with 74 of identifiable race (45% NHPI, 32% Asian, and 23% White). The average age at the time of stroke was 69 years and 40.0% (47/117) of patients were female. Amongst all races, there were no differences in the greatest degree of carotid stenosis (p=.15) or location of stenosis along the right carotid artery (p=.16), but there was a difference in the location of left carotid stenosis (p=.04). Endocrine conditions were the only comorbidity identified at significantly different rates between all racial groups (p=.02). Prior cardiac (p=.03), otolaryngological (0=.007), and orthopedic (p=.01) procedures differed significantly by race among the cohort. The majority of these differences were present when comparing NHPI or Asian patients against White patients, with no significant differences found between Asian and NHPI patients. Conclusions: Asian and NHPI stroke patients were found to have significantly different rates of left carotid stenosis, endocrine conditions, and prior cardiac, otolaryngological, or orthopedic surgeries when compared to White patients. Due to these race-specific differences in patient demographics and history, the implementation and investigation of carotid artery disease risk assessments should be pursued to best improve stroke outcomes among all patients.

Optimal management of carotid artery disease in patients undergoing coronary artery bypass

Optimal management of carotid artery disease in patients undergoing coronary artery bypass

10-channel phased-array coil for carotid wall MRI at 3T.

Accurate assessment of plaque accumulation near the carotid bifurcation is important for the effective prevention and treatment of stroke. However, vessel and plaque delineation using MRI can be limited by low contrast-to-noise ratio (CNR) and long acquisition times. In this work, a 10-channel phased-array receive coil design for bilateral imaging of the carotid bifurcation using 3T MRI is proposed. The proposed 10-channel receive coil was compared to a commercial 4-channel receive coil configuration using data acquired from phantoms and healthy volunteers (N = 9). The relative performance of the coils was assessed, by comparing signal-to-noise ratio (SNR), noise correlation, g-factor noise amplification, and the CNR between vessel wall and lumen using black-blood sequences. Patient data were acquired from 12 atherosclerotic carotid artery disease patients. The 10-channel coil consistently provided substantially increased SNR in phantoms (+77 ± 27%) and improved CNR in healthy carotid arteries (+62 ± 11%), or reduced g-factor noise amplification. Patient data showed excellent delineation of atherosclerotic plaque along the length of the carotid bifurcation using the 10-channel coil. The proposed 10-channel coil design allows for improved visualization of the carotid arteries and the carotid bifurcation and increased parallel imaging acceleration factors relative to a commercial 4-channel coil design.

Dual Antiplatelet Therapy: A Concise Review for Clinicians.

Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for patients taking DAPT for established cardiovascular diseases. Short-term dual DAPT of 3-6 months, or even 1 month in high-bleeding risk patients, is equivalent in terms of efficacy and effectiveness compared to long-term DAPT for patients who experienced percutaneous coronary intervention in an acute coronary syndrome setting. Prolonged DAPT beyond 12 months reduces stent thrombosis, major adverse cardiovascular events, and myocardial infarction rates but increases bleeding risk. Extended DAPT does not significantly benefit stable coronary artery disease patients in reducing stroke, myocardial infarction, or cardiovascular death. Ticagrelor and aspirin reduce cardiovascular events in stable coronary artery disease with diabetes but carry a higher bleeding risk. Antiplatelet therapy duration in atrial fibrillation patients after percutaneous coronary intervention depends on individual characteristics and bleeding risk. Antiplatelet therapy is crucial for post-coronary artery bypass graft and transcatheter aortic valve implantation; Aspirin (ASA) monotherapy is preferred. Antiplatelet therapy duration in peripheral artery disease depends on the scenario. Adding vorapaxar and cilostazol may benefit secondary prevention and claudication, respectively. Carotid artery disease patients with transient ischemic attack or stroke benefit from antiplatelet therapy and combining ASA and clopidogrel is more effective than ASA alone. The optimal duration of DAPT after carotid artery stenting is uncertain. Resistance to ASA and clopidogrel poses an incremental risk of deleterious cardiovascular events and stroke. The selection and duration of antiplatelet therapy in patients with cardiovascular disease requires careful consideration of both efficacy and safety outcomes. The use of combination therapies may provide added benefits but should be weighed against the risk of bleeding. Further research and clinical trials are needed to optimize antiplatelet treatment in different patient populations and clinical scenarios.

Early postoperative outcome after carotid artery endarterectomy with bifurcation advancement.

Background: The aim of this study is to review the single center experience in surgical treatment of carotid artery disease (CAD) using bifurcation advancement carotid endarterectomy (BA-CEA) and compare the in-hospital outcome with one of the largest nationwide carotid endarterectomy (CEA) databases worldwide, the German statutory quality assurance database (GD). Patients and methods: Data of BA-CEA procedures in the period of 2006-2015 were analyzed retrospectively. The primary endpoint was defined as combined stroke and death rate. Secondarily, isolated stroke, TIA, patient death, myocardial infarction, major neck hematoma and cranial nerve injuries were analyzed. Symptomatic and asymptomatic CAD patients were divided into two subgroups. The results were compared to extracted published data from the German database (GD). Results: Of 239 included BA-CEA procedures188 (78.7%) procedures were carried out in patients with symptomatic carotid artery stenosis. The overall perioperative combined stroke and death rate after BA-CEA was 2.5%.Five (2.1%) patients suffered from a stroke (one minor and four major strokes), of which two hemorrhagic strokes ended fatally. Overall, four (1.7%) patients died perioperatively. The combined stroke and death rate was higher in the symptomatic subgroup (3.2%; 0% in the asymptomatic group). No significant differences were found between the results of BA-CEA and the German database (n=142'074) for combined stroke and death rates and isolated stroke. Significant differences were found among the overall mortality rate (BA-CEA: 1.7% vs. GD: 0.6, p=0.04). The risk of postoperative cranial nerve injuries was also significantly higher after BA-CEA overall (BA-CEA: 5.0% vs. GD: 1.2%, p=<0.0001), in symptomatic CAD patients (BA-CEA: 4.8% vs. GD: 1.2%, p=<0.0001) and in asymptomatic CAD patients (BA-CEA: 5.9% vs. GD: 1.3%, p=0.01). Conclusions: CEA with bifurcation advancement provides comparable perioperative results, focusing on combined stroke and mortality, but seems to have some technical drawbacks, which may lead to more frequent local neurological complications.

Epidemiological Aspects of the Carotid Artery Disease in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Background and aims: Concomitant carotid artery disease (CaAD) in patients referred to coronary surgical revascularization is a strong hazard to perioperative stroke. The current study addressed the epidemiology features of concomitant CaAD in patients referred to a coronary surgical revascularization center. Methods: This descriptive-analytical cross-sectional study was conducted on all incoming patients to coronary surgical revascularization for two years at a single center who underwent a color duplex-sonography (CDS) interrogation. The demographic, clinical, echocardiographic, coronary angiographic, and color duplex-sonographic data were collected from patients’ medical records. Quantitative and qualitative data were expressed as means and standard deviations, as well as numbers and percentages, respectively. The relationships between quantitative and qualitative variables were investigated using Pearson’s correlation and chi-square test, respectively. Results: In total, 430 patients with a mean age of 66.3±9.9 years were included (35% females) in the study. Preoperative CDS was performed on 82% of patients; in addition, 29% of them presented with an increased intima-media ratio, and CtAD was observed in 51%. Based on the results, 77 and 143 patients were detected with unilateral and bilateral involvement, respectively. Severe carotid stenosis accounted for 4% of patients. Age older than 65 years (P=0.02), unstable angina (P=0.045), and the presence of an occluded coronary artery (P=0.002) were associated with the presence of CtAD. Finally, the severity of the left and right carotid stenosis was associated with diabetes mellitus (P&lt;0.05). Conclusion: The prevalence of concomitant CtAD in patients referred to coronary surgical revascularization remains high. The current data warn of the necessity of performing preoperative CDS routinely.

High prevalence of peripheral and carotid artery disease in patients with interstitial lung diseases

Background: Interstitial lung diseases (ILD) are a heterogenous group of diseases, which have pulmonary fibrosis, restrictive lung disease, and decreased diffusion capacity as a common final path. Premature death frequently results not from ILD itself but from comorbidities. Peripheral artery disease (PAD) is a common comorbid disease in different chronic lung diseases. The focus of the present study is to clarify the prevalence of PAD in ILD. Patients and methods: A total of 97 patients with ILD and 30 controls were included in the study. Patients with ILD were subdivided into two groups according to the progression of pulmonary fibrosis: progressive fibrosing and non-progressive fibrosing ILD (PF-ILD and nPF-ILD, respectively). All participants underwent standard angiological and pneumological diagnostic procedures including six-minute walking test, measurement of ankle-brachial-index, and colour-coded duplex sonography. Results: We observed no relevant differences in the baseline characteristics except age. Both, PF-ILD and nPF-ILD patients, presented with a highly increased incidence of atherosclerotic lesions compared to the control group (p<0.001). PAD was present in all patients with PF-ILD and in 73% of patients with nPF-ILD. These results were confirmed by age-adjusted regression analyses. Conclusions: The present results indicate that ILD is an independent risk factor for atherosclerosis. Patients with PF-ILD are more severely affected than nPF-ILD patients with age as a confounding variable. Atherogenesis in ILD may be mediated by increased cardiovascular risk, systemic inflammation and chronic hypoxemia.

The Predictive Value of C-Reactive ProteinAlbumin Ratio in Long-Term Mortality Among Patients Undergoing Carotid Artery Stenting

Introduction: Several inflammatory biomarkers reported in previous research have been associated with the severity of carotid artery stenosis, symptomatic carotid lesions, and carotid stent restenosis. The C-reactive protein (CRP)-to-serum albumin ratio (CAR) has been shown to predict peripheral artery disease severity in patients with carotid artery disease (CAD). However, the relationship between CAR and long-term mortality in CAD patients following carotid artery stenting (CAS) remains uncertain. The goal of this study was to investigate the ability of CAR to predict long-term mortality in patients with CAS. Patients and Methods: A total of 998 CAD patients who had percutaneous carotid artery intervention were reviewed retrospectively, and 482 of them without follow-up data were excluded from this study. The study included patients who had percutaneous carotid artery intervention between 2012 and 2018. Before the procedure, serum CRP, complete blood counts, and albumin levels were measured. The relationships between patients’ characteristics, procedural details, and CAR with all-cause mortality were evaluated in the long-term follow-up after CAS. Results: Older age (HR= 1.044; 95% CI= 1.001-1.089; p= 0.046), smoking (HR= 2.636; 95% CI= 1.213- 5.728; p= 0.014), blood urea (HR= 1.017; 95% CI= 1.002-1.033; p= 0.025), albumin (HR= 0.252; 95% CI= 0.132-0.480; p&lt; 0.001), CRP levels (HR= 1.336; 95% CI= 1.055-1.691; p= 0.016) and CAR (HR= 1.012; 95% CI= 1.003-1.022; p= 0.008) were statistically associated with all-cause mortality at 55.2 ± 12.4 months follow-up after CAS in multivariate COX regression analysis. Conclusion: In patients undergoing CAS, CAR was independently related to long-term mortality. CAR could be used in this population for risk stratification to achieve closer follow-up and optimize treatment.

Prevalence and Prognostic Impact of Carotid Artery Disease in Patients Undergoing TAVI

Prevalence and Prognostic Impact of Carotid Artery Disease in Patients Undergoing TAVI

Examining endothelial function and carotid artery disease in patients with inflammatory bowel disease: a systematic review protocol

IntroductionPatients with inflammatory bowel disease (IBD) might be at an increased risk for the development of cardiovascular disease (CVD). The present protocol is developed to review and analyse published data...

Prevalence and Prognostic Impact of Carotid Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation

To assess the prevalence of atherosclerotic carotid artery disease (ACAD) in patients undergoing transcatheter aortic valve implantation (TAVI) and postoperative cerebrovascular accidents (CVAs) and evaluate its prognostic impact on postoperative CVAs. A retrospective review of all consecutive patients with severe symptomatic aortic valve stenosis (AVS) who underwent TAVI was conducted at a single tertiary university hospital (January 2008-December 2018). Patients with AVS scheduled for TAVI and concomitant carotid stenosis were evaluated for prophylactic carotid revascularization (carotid endarterectomy [CEA] or carotid artery stenting [CAS]). Seven hundred and seventy one consecutive patients (mean age: 80 years, 52% males) were treated by TAVI procedures. Carotid stenosis > 70% was detected in 69 patients (9%); it was unilateral in 47 (68%) and bilateral in 22 (32%) patients. Prophylactic carotid revascularization was performed before TAVI in 45 patients (31%): in 63.1% of patients (30/47) with unilateral carotid stenosis > 70% and in 68.1% (15/22) with bilateral carotid stenosis > 70%. Postoperative CVA following TAVI procedures were recorded in 25 patients (3.2%): 22 cases of stroke (2.8%) and 3 cases of transient ischemic attack (0.4%). At a multiple logistic regression, only bilateral carotid stenosis > 70% (odds ratio [OR] 1.16, confidence interval [CI] 95% 1.03-1.31; P = 0.0009) was found as independent predictors of periprocedural CVA. In patients with severe symptomatic AVS undergoing TAVI, carotid stenosis was frequently observed. Unilateral carotid stenosis > 70% did not show a significant association with early CVA following TAVI. However, in the cohort of patients with bilateral carotid stenosis > 70%, a significant association with postoperative CVA was observed.

Single-Cell RNA-Seq Reveals a Crosstalk between Hyaluronan Receptor LYVE-1-Expressing Macrophages and Vascular Smooth Muscle Cells.

Background: Atherosclerosis is a chronic inflammatory disease where macrophages participate in the progression of the disease. However, the role of resident-like macrophages (res-like) in the atherosclerotic aorta is not completely understood. Methods: A single-cell RNA sequencing analysis of CD45+ leukocytes in the atherosclerotic aorta of apolipoprotein E–deficient (Apoe−/−) mice on a normal cholesterol diet (NCD) or a high cholesterol diet (HCD), respecting the side-to-specific predisposition to atherosclerosis, was performed. A population of res-like macrophages expressing hyaluronan receptor LYVE-1 was investigated via flow cytometry, co-culture experiments, and immunofluorescence in human atherosclerotic plaques from carotid artery disease patients (CAD). Results: We identified 12 principal leukocyte clusters with distinct atherosclerosis disease-relevant gene expression signatures. LYVE-1+ res-like macrophages, expressing a high level of CC motif chemokine ligand 24 (CCL24, eotaxin-2), expanded under hypercholesteremia in Apoe−/− mice and promoted VSMC phenotypic modulation to osteoblast/chondrocyte-like cells, ex vivo, in a CCL24-dependent manner. Moreover, the abundance of LYVE-1+CCL24+ macrophages and elevated systemic levels of CCL24 were associated with vascular calcification and CAD events. Conclusions: LYVE-1 res-like macrophages, via the secretion of CCL24, promote the transdifferentiation of VSMC to osteogenic-like cells with a possible role in vascular calcification and likely a detrimental role in atherosclerotic plaque destabilization.

Evaluation of Asymptomatic Carotid Artery Stenosis Prior to Coronary Artery Bypass Grafting - A Prospective Observational Study in North Indian Population.

Background:Carotid artery stenosis (CAS) is an established risk factor for peri-operative neurological complications in patients following coronary artery bypass grafting (CABG). However, routine pre-surgical screening for CAS is still a matter of debate. This study was conducted to study the prevalence of asymptomatic carotid artery disease in patients undergoing CABG and to determine the predictors of significant carotid stenosis in them.Methods:In this prospective observational study, 112 patients, who were planned for CABG, were enrolled, and their demographic details, risk factor profile, and coronary angiogram parameters were analyzed.Results:Carotid stenosis was observed in 75.0% of the study population with 11.6% having unilateral and 63.4% having bilateral carotid stenosis. A total of 56.2% of the patients had mild, 14.3% had moderate, and 4.5% had severe carotid stenosis. The presence of significant carotid stenosis showed a correlation with chronic stable angina (P = 0.009), significant left main (LM) disease (P = 0.001), chronic total occlusion (P = 0.043), and coronary vessel calcification (P = 0.004). Multivariate analysis of all the predictor variables in a regression model showed that significant LM disease (Odds ratio (OR):6.5, P = 0.002) and coronary artery calcification (OR: 4.3, P = 0.024) were the only independent predictors of significant CAS in the study population.Conclusion:The presence of significant carotid vessel stenosis in patients undergoing CABG in the Indian population has a stronger association with the chronicity of the coronary artery disease rather than the coronary atheroma load (as determined by the modified Gensini score). The presence of significant LM disease and coronary artery calcification may be useful in detecting high-risk patients for significant CAS during the pre-surgical workup.

NLRP3 Inflammasome Activation Controls Vascular Smooth Muscle Cells Phenotypic Switch in Atherosclerosis.

(1) Background: Monocytes and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome orchestrate lipid-driven amplification of vascular inflammation promoting the disruption of the fibrous cap. The components of the NLRP3 inflammasome are expressed in macrophages and foam cells within human carotid atherosclerotic plaques and VSMCs in hypertension. Whether monocytes and NLRP3 inflammasome activation are direct triggers of VSMC phenotypic switch and plaque disruption need to be investigated. (2) Methods: The direct effect of oxLDL-activated monocytes in VSMCs co-cultured system was demonstrated via flow cytometry, qPCR, ELISA, caspase 1, and pyroptosis assay. Aortic roots of VSMCs lineage tracing mice fed normal or high cholesterol diet and human atherosclerotic plaques were used for immunofluorescence quantification of NLRP3 inflammasome activation/VSMCs phenotypic switch. (3) Results: OxLDL-activated monocytes reduced α-SMA, SM22α, Oct-4, and upregulation of KLF-4 and macrophage markers MAC2, F4/80 and CD68 expression as well as caspase 1 activation, IL-1β secretion, and pyroptosis in VSMCs. Increased caspase 1 and IL-1β in phenotypically modified VSMCs was detected in the aortic roots of VSMCs lineage tracing mice fed high cholesterol diet and in human atherosclerotic plaques from carotid artery disease patients who experienced a stroke. (4) Conclusions: Taken together, these results provide evidence that monocyte promote VSMC phenotypic switch through VSMC NLRP3 inflammasome activation with a likely detrimental role in atherosclerotic plaque stability in human atherosclerosis.

Computational modeling of atherosclerotic plaque progression in carotid lesions with moderate degree of stenosis.

Carotid atherosclerotic plaque growth leads to the progressive luminal stenosis of the vessel, which may erode or rupture causing thromboembolism and cerebral infarction, manifested as stroke. Carotid atherosclerosis is considered the major cause of ischemic stroke in Europe and thus new imaging-based computational tools that can improve risk stratification and management of carotid artery disease patients are needed. In this work, we present a new computational approach for modeling atherosclerotic plaque progression in real patient-carotid lesions, with moderate to severe degree of stenosis (>50%). The model incorporates for the first time, the baseline 3D geometry of the plaque tissue components (e.g. Lipid Core) identified by MR imaging, in which the major biological processes of atherosclerosis are simulated in time. The simulated plaque tissue production results in the inward remodeling of the vessel wall promoting luminal stenosis which in turn predicts the region of the actual stenosis progression observed at the follow-up visit. The model aims to support clinical decision making, by identifying regions prone to plaque formation, predict carotid stenosis and plaque burden progression, and provide advice on the optimal time for patient follow-up screening.

Serum Biomarkers and Classification and Regression Trees Can Discriminate Symptomatic from Asymptomatic Carotid Artery Disease Patients

ObjectiveTo assess biomarkers between symptomatic and asymptomatic patients, and to construct a classification and regression tree (CART) algorithm for their discrimination.Patients and Methods136 patients were enrolled. They were symptomatic (high risk) (N = 82, stenosis degree ≥ 50%, proven to be responsible for ischemic stroke the last six months) and asymptomatic (low risk) (N = 54, stenosis degree ≤ 50%). Levels of fibrinogen, matrix metalloproteinase-1 (MMP-1), tissue inhibitor of metalloproteinase-1 (TIMP-1), soluble intercellular adhesion molecule (SiCAM), soluble vascular cell adhesion molecule (SvCAM), adiponectin and insulin were measured on a Luminex 3D platform and their differences were evaluated; subsequently, a CART model was created and evaluated.ResultsAll measured biomarkers, except adiponectin, had significantly higher levels in symptomatic patients. The constructed CART prognostic model had 97.6% discrimination accuracy on symptomatic patients and 79.6% on asymptomatic, while the overall accuracy was 90.4%. Moreover, the population was split into training and test sets for CART validation.ConclusionSignificant differences were found in the biomarkers between symptomatic and asymptomatic patients. The CART model proved to be a simple decision-making algorithm linked with risk probabilities and provided evidence to identify and, therefore, treat patients being at high risk for cardiovascular disease.

Frequency of significant carotid artery disease on carotid angiography in patients with left main stem coronary artery disease.

Objectives: To determine the frequency of significant carotid artery disease on carotid angiography in patients presenting with left main stem coronary artery disease. Study Design: Cross Sectional study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: October 2016 to April 2017. Material &amp; Methods: 140 patients were included in this study. To diagnose carotid artery disease, carotid angiography was performed. Imaging was performed while subjects were lying in a supine position. Arterial access gained through femoral artery and using Headhunter carotid angiography catheter (6F). Lateral, AP and ipsilateral oblique views was obtained. Results: Age ranges between 40-75 years with mean age of 53.91±7.05 years. There were 94 (67.2%) male patients while remaining 46 patients (32.8%) were female. Carotid artery disease was found in 54 patients (38.6%). Stratification with regard to gender and age was carried out. Conclusion: In conclusion, frequency of carotid artery disease in patients with left main stem coronary artery disease is high in our population. Therefore, screening of carotid artery disease should be recommended in patients with CAD, especially in older patients with multivessel CAD.

Long-term survival of carotid stenting patients with regard to single- or double-vessel carotid artery disease: a propensity score matching analysis.

IntroductionThere is lack of long-term data outside of controlled clinical trials in carotid artery stenting (CAS). In this study, we compared the short-term outcome, long-term survival, and rate of re-interventions for restenosis in patients after CAS, related to the extent of carotid atherosclerosis classified as single-vessel (unilateral) or double-vessel (bilateral) carotid artery disease.Material and methodsWe retrospectively evaluated 599 patients with significant carotid artery stenosis, who underwent 763 CAS procedures, and used the propensity score to match 226 pairs (452 patients) in the single- or double-vessel carotid disease.ResultsThere was no significant difference in the occurrence of in-hospital major adverse events (3.5% vs. 3.1% of patients in the double-vessel carotid group vs. the single-vessel carotid group; p = 1) The mean follow-up was 6.1 ±4.0 years, and a total of 181 (40%) deaths occurred during 2759 patient-years, which translates into 7.8 and 5.3 deaths per 100 patient-years in the double-vessel carotid group and the single-vessel carotid group, respectively (p < 0.01). The survival in the double-vessel carotid group vs. the single-vessel carotid group at 10 years was 46% (95% CI: 38–54%) vs. 55% (95% CI: 47–63%) (p < 0.01). Twenty-four (11%) patients and 6 (3%) patients underwent re-interventions for restenosis in the double-vessel and the single-vessel carotid disease group, respectively (p < 0.01).ConclusionsPatients with CAS and significant double-vessel carotid artery disease had similar peri-procedural risk, but had a worse long-term survival, and a higher rate of re-interventions for restenosis compared to the single-vessel carotid artery disease patients.