Carotid Artery Lesions Research Articles

Assessment of carotid arteries in stroke patients by ultrasonography and color Doppler

Background: Prevalence and associated mortality and morbidity rates apprehend stroke as a major health concern worldwide. Atherosclerotic disease of carotid arteries is the most common source of stroke. Quick and effective diagnosis, management and treatment of stroke is essential. Conventional diagnostic imaging techniques lacks the efficacy to rapidly and accurately dragonize stroke. Current investigation is focused towards assessing carotid arteries in stroke patients by ultrasonography and color Doppler to study the locate and study the morphology of lesion in carotid artery and to grade severity and extent of stenosis.Methods: A prospective observational study was performed on stroke patients of more than 40 years of age. The study was conducted at the department of radio diagnosis in a tertiary care center for a period of 18 months. Varied color Doppler parameters were studied and optimized to assess the morphology and surface of plaques and to determine stenosisResults: Mean age of the patients with carotid lesion was observed to be 59.7±9.8 years and male patients outnumbered postmenopausal female patients. Hemiparesis was the most common clinical presentation. Majority of patients exhibited raised intimomedial thickness and single or multiple plaques commonly in carotid bulb. Plaques of type II with irregular surface were most commonly observed which exhibited mostly 50-69% stenosis.Conclusions: The carotid artery embolic occlusion stenosis is the primary cause of stroke. Doppler sonography provides a rapid, noninvasive, relatively inexpensive and accurate means of diagnosing carotid stenosis, to determine the degree of cervical carotid stenosis and plaque morphology.

Successful throb endarterectomy in a patient with occlusion of the internal carotid artery

Strokes account for 15–25 % of confirmed cases internal carotid artery (ICA) occlusion. The frequency of ICA occlusion in asymptomatic patients is unknown. The strategy of treatment patients with symptomatic ICA occlusion has not been determined. A clinical observation is presented with the stage of surgical treatment of a 67‑year-old patient with a developed stroke in the basin of the left middle cerebral artery. The examination according to MSCT angiography revealed occlusion of the left ICA. To assess the brain perfusion, a single-photon emission computed tomography (SPECT) with 99mTc was performed. Throb endarterectomy of the left internal carotid artery was performed, with a control ultrasound examination on the 6th day after the operation and after 6 months the blood flow through the internal carotid artery was preserved. Control SPECT with 99mTc was performed, in comparison with the previous study, a significant improvement perfusion on both hemispheres is determined. Improvements in the neurological status were noted in the form of a complete regression of neurological symptoms. On the sixth day after surgical treatment, the patient was discharged in a satisfactory condition. During the hospital stay, the patient was “examined” using a questionnaire for assessing the quality of life – The Short Form‑36 (SF‑36) and MoCA (Montreal Cognitive Impairment Assessment Scale). The survey was conducted on the 15th day of inpatient treatment, before surgery, and on the 6th day after surgery. After 6 months, the patient was re-interviewed. The results obtained indicate a correlation between the improvement of brain perfusion and cognitive impairment, as well as a positive effect of revascularization of the internal carotid artery on the patient’s quality of life. The presented results indicate not only the possibility, but also the high efficiency of surgical treatment of occlusive lesions of the internal carotid artery. Surgical treatment in the early stages after occlusion against the background of the collapse of atherosclerotic plaque and thrombosis of the lumen is a determining factor in the successful restoration of blood flow, improvement of brain perfusion.

Preprocedural Prediction of Underlying Atherosclerotic Lesions in Cerebral Large-Vessel Occlusions: Clinical Backgrounds, Radiological Findings, and Treatment Outcomes.

Mechanical thrombectomy using a standard device has been effective for acute cerebral large-vessel occlusions, particularly those due to cardiogenic embolism. However, evidence for those with underlying atherosclerotic lesions is lacking. In this study, we evaluated the predictive factors, treatment details, and outcomes of acute cerebral large-vessel occlusions with underlying atherosclerotic lesions in patients who underwent mechanical thrombectomy. We retrospectively analyzed consecutive patients with acute large-vessel occlusions who underwent mechanical thrombectomy at our institution between August 2014 and May 2021. Predictive factors of underlying atherosclerotic lesions were evaluated using univariate and multivariate analyses. In addition, treatment details and outcomes were evaluated and compared with those of other etiologies. Among 322 included patients, 202 (62.7%) were males and 65 (20.2%) had underlying atherosclerotic lesions. Multivariate analysis identified dyslipidemia, lack of arterial fibrillation documented on admission, smoking, internal carotid artery lesions, and stenosis ≥ 25% in non-occluded large vessels as predictive factors of underlying atherosclerotic lesions. Regarding treatment for underlying atherosclerotic lesions, the need for percutaneous transluminal angioplasty, stent placement, medical therapy, and longer procedure time were observed, while successful reperfusion rates, favorable outcomes, and mortality rates showed no significant differences with those of other etiologies. Coexisting diseases and radiological findings were useful for predicting underlying atherosclerotic lesions. Further understanding these characteristics may lead to the early detection of underlying atherosclerotic lesions, optimal treatment strategies, and better outcomes.

Can near infrared spectroscopy predict stroke in coronary artery by-pass graft?

Aim: Central nervous system may be affected after coronary artery by-pass graft (CABG) and carotid artery stenosis is an important risk factor. Near infrared spectroscopy (NIRS) is used to measure the regional cerebral oxygen concentration (rScO2). The aim of this study is to determine the relationship of rScO2 in patients with carotid artery lesion and to determine the relation of stroke with rScO2 changes.
 Material and Method: The patients who had cardiac bypass surgery were involved in the study. Demographic characteristics and presence of carotid artery stenosis, were collected from the files. Bilateral rSO2 measurements performed by 2 sensors. RScO2 values are detected in 5 minutes of cross-clamp (XCL5), XCL30, XCL60, XCL90, XCL120 and after the by-pass.
 Results: 57 patients were involved in the study (40 male and mean age 62.54±13.08). 17 (29%) patients had carotid stenosis. rScO2 levels are statistically significantly decreased in the patients with stenosis after post-clamp 30 minutes. Three patients had stroke after surgery (5.2%). Two of the patients had carotid stenosis while one patient did not have. 
 Conclusion: RScO2 decreased in carotid artery stenosis irrespective of the degree of the stenosis after 30 minutes of cross-clamp. Cerebral perfusion follow-up is important during the CPB and NIRS is a method that can be used for this purpose.

Clinical course, laboratory and instrumental markers of vascular inflammation in the Kyrgyz cohort of patients with Takayasu's arteritis

Lack of highly sensitive and specific methods of laboratory and instrumental diagnostics leads to difficulties in timely verification of Takayasu's arteritis (AT).Objective: to analyze the clinical course, laboratory and instrumental markers of vascular inflammation in the Kyrgyz cohort of patients with AT.Patients and methods. The study included 75 patients with a reliable diagnosis of AT, who were hospitalized and observed on an outpatient basis at the clinic of the National Center for Cardiology and Therapy named after acad. Mirsaida Mirrakhimova from January 2011 to April 2022. Patients were examined using clinical, laboratory and instrumental methods once every 2 years. The follow-up period was 1–5 years in 45 (60%) patients and 6–15 years in the remaining 30 (40%) patients. All patients underwent a clinical and standard laboratory work-up with CRP and interleukin 6 levels assessment, as well as ultrasound Dopplerography of peripheral arteries in the color Doppler mapping mode and multislice computed tomography-panaortography.Results and discussion. Lesions of the common carotid (85.33%) and subclavian (84%) arteries were detected more often. Involvement of the abdominal aorta was noted in 60% of patients and was accompanied by stenosis of the renal arteries in 100% of cases. The clinical picture of the disease was mainly represented by cardiac pathology in the form of arterial hypertension (84%) and aortic regurgitation (68%) with the development of decompensated chronic heart failure in 15% of patients. During the dynamic observation, significant improvement in the course of the disease, clinical symptoms, decrease in the severity of vascular changes were not revealed, with the exception of a decrease in the clinical activity of AT (p<0.05) in one third of patients (37.4%). Conclusion. The severity of clinical manifestations and the course of AT in the Kyrgyz cohort was due to cardiovascular pathology. As dynamic observation showed, the lack of significant improvement in the course of the disease was largely due to the long duration of chronic inflammation, late diagnosis, development of irreversible stenotic, occlusive and aneurysmal changes, as well as the fact that patients did not receive adequate pathogenetic therapy at the onset of the disease. Keywords: <0.05) in one third of patients (37.4%).Conclusion. The severity of clinical manifestations and the course of AT in the Kyrgyz cohort was due to cardiovascular pathology. As dynamic observation showed, the lack of significant improvement in the course of the disease was largely due to the long duration of chronic inflammation, late diagnosis, development of irreversible stenotic, occlusive and aneurysmal changes, as well as the fact that patients did not receive adequate pathogenetic therapy at the onset of the disease.

Features of global longitudinal deformation of the left ventricle in relation to coronary and carotid atherosclerosis in patients with coronary artery disease

Background and Aims : Identify the relationship of the LV deformation properties with the presence of coronary and carotid atherosclerosis in patients with CAD.Methods: 94 patients with CAD of class II-IV aged 40 to 70 years were studied by the general clinical and laboratory blood tests, Holter -ECG monitoring, TTE, 2D-Echo with speckle tracking (STE), ultrasound of carotid artery lesions and coronary angiography (CAG). The SYNTAX score was calculated retrospectively in accordance with the SYNTAX evaluation algorithm. All patients were divided into 2 groups: group 1 included patients with a low syntax index (0-22); group 2 included patients with an average syntax index (23-32). A more objective quantitative assessment of the contractile function of the LV myocardium was obtained by assessing the global longitudinal deformation (GLS) and the strain rate (SR).Results: A comparative analysis showed that in group 2, GLS and SR indicators were significantly lower than in group 1 (P=0.0001 and P=0.0133, respectively). GLS was significantly correlated with LVL (r=-0.309; P<0.005), with the degree of atherosclerotic damage to the coronary arteries (r=0.925; P<0.005) and the number of atherosclerotic plaques in the carotid arteries (r=0.245; P<0.05). SR was also correlated with LVL (r=-0.281; P<0.005), coronary artery disease (r=0.767; P<0.0005) and the number of atherosclerotic plaques of the carotid arteries (r=0.233; P<0.05).Conclusions: The results obtained indicate the diagnostic value of STE with the determination of GLS and SR in a comprehensive assessment of severity of coronary and carotid atherosclerosis within group of patients with CAD. Background and Aims : Identify the relationship of the LV deformation properties with the presence of coronary and carotid atherosclerosis in patients with CAD. Methods: 94 patients with CAD of class II-IV aged 40 to 70 years were studied by the general clinical and laboratory blood tests, Holter -ECG monitoring, TTE, 2D-Echo with speckle tracking (STE), ultrasound of carotid artery lesions and coronary angiography (CAG). The SYNTAX score was calculated retrospectively in accordance with the SYNTAX evaluation algorithm. All patients were divided into 2 groups: group 1 included patients with a low syntax index (0-22); group 2 included patients with an average syntax index (23-32). A more objective quantitative assessment of the contractile function of the LV myocardium was obtained by assessing the global longitudinal deformation (GLS) and the strain rate (SR). Results: A comparative analysis showed that in group 2, GLS and SR indicators were significantly lower than in group 1 (P=0.0001 and P=0.0133, respectively). GLS was significantly correlated with LVL (r=-0.309; P<0.005), with the degree of atherosclerotic damage to the coronary arteries (r=0.925; P<0.005) and the number of atherosclerotic plaques in the carotid arteries (r=0.245; P<0.05). SR was also correlated with LVL (r=-0.281; P<0.005), coronary artery disease (r=0.767; P<0.0005) and the number of atherosclerotic plaques of the carotid arteries (r=0.233; P<0.05). Conclusions: The results obtained indicate the diagnostic value of STE with the determination of GLS and SR in a comprehensive assessment of severity of coronary and carotid atherosclerosis within group of patients with CAD.

The Role of Early Superficial Temporal to Middle Cerebral Artery Bypass Revascularization Surgery in Middle Cerebral Artery‐Territory Strokes: A Systematic Review Study

Background To systematically summarize and critically review the available literature regarding the functional outcome of the urgent superficial temporal artery to the middle cerebral artery (MCA) bypass surgery in stroke patients associated with MCA lesions. Methods The current systematic review was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis statement. Medline (PubMed), ISI Web of Science, Scopus, and google scholar (manually searches) were systematically searched up to August 2021. The eligibility criteria were defined as all the patients who had MCA‐territory strokes due to MCA/intradural internal carotid artery lesions that underwent same‐admission superficial temporal artery‐MCA bypass surgery. The strokes with cervical internal carotid artery and anterior cerebral artery lesions/strokes were excluded. The checklists produced by the US National Heart Lung and Blood Institute were used for quality assessment. Demographic variables, clinical findings, National Institutes of Health Stroke Scale scores, the time interval between symptoms to surgery, imaging results, endovascular treatments, surgical notes, mortality rate, follow‐up findings, modified Rankin scale scores, and all reported medical records were extracted and analyzed with SPSS software (ver. 23). P values ≤0.05 were considered meaningful. Results The initial search yielded 3050 records, and 13 articles met the inclusion criteria and entered this systematic review. A total of 165 patients were pooled for data analysis. Nine studies had data regarding neurological deficits before and after surgery. Except for 5 patients, the National Institutes of Health Stroke Scale score after the operation was the same or better than the preoperative score. Eleven out of 17 patients in 3 studies showed early neurological improvement (a decrease in National Institutes of Health Stroke Scale score of ≥4 points at 3 days) after bypass surgery. Functional outcome was stated in 10 studies. Overall, a good functional outcome (modified Rankin scale=0–2) was achieved in 9 out of 21 (42.1%) patients at discharge and in 44 out of 59 (74.5%) patients at 3 months follow‐up. Lower age was associated with favorable outcomes. Long‐term graft patency was excellent in 99.5% of patients. Postoperative hematoma and mortality (all noncranial) rates were 3% and 3.6%, respectively. Conclusion The current study suggests that early superficial temporal artery‐MCA revascularization should be considered an available option in younger patients (&lt;60‐year‐old) with MCA territory strokes who fail medical treatment.

Decreased low-density lipoprotein receptor-related protein 1 expression in pro-inflammatory monocytes is associated with subclinical atherosclerosis.

Subclinical atherosclerosis (SCA) occurs in asymptomatic individuals. Blood peripheral monocytes are involved in the development of atherosclerosis. Circulating monocytes acquire pro-inflammatory profiles, and they are involved in the early stages of atherosclerosis development. Low-density lipoprotein Receptor-related Protein 1 (LRP1) is expressed in monocytes, mainly in classical and intermediate subsets. Although LRP1 is highly expressed in macrophages and vascular smooth muscle cells (VSMCs) in atherosclerotic plaque formation, its expression in circulating monocytes has not been studied in SCA. The aim of this study was to characterize the LRP1 expression level in circulating monocytes of individuals with SCA and compared with individuals with low (LR) and intermediate (IR) risk of cardiovascular diseases, both without evidence of atherosclerotic lesions in carotid and coronary arteries. LRP1 and additional markers (CD11b, CD11c, and CD36) at cell surface of monocytes were analyzed by flow cytometry assays, whereas LRP1 and pro-inflammatory factors gene expressions were measured in isolated monocytes by quantitative RT-PCRs. Both LRP1 protein and LRP1 mRNA were significantly reduced in monocytes in SCA and IR respect to LR. Conversely, CD36, CD11b, and CD11c monocytic markers showed no significant changes between the different study groups. Finally, increased gene expressions of TNF-α and IL-1β were detected in monocytes of SCA, which were associated with decreased LRP1 expression at the cell surface in total monocytes. In summary, we propose that the decreased LRP1 expression at cell surface in total monocytes with pro-inflammatory profile is associated with the development of atherosclerosis in asymptomatic individuals.

Evidence of Efficacy of Superficial Temporal Artery-Middle Cerebral Artery Bypass in Japan

The Japanese EC-IC Bypass Trial(JET)Study demonstrated that a superficial temporal artery-middle cerebral artery(STA-MCA)bypass is effective in preventing the recurrence of ischemic stroke in cases of atherosclerotic internal carotid artery or MCA steno-occlusive lesions with symptoms. The JET-2 Study revealed that the hemodynamic criteria for STA-MCA bypass in the JET Study(rest cerebral blood flow < 80% and cerebrovascular reactivity < 10%)were adequate. An STA-MCA bypass was ranked as recommendation B; the level of evidence was moderate under the conditions of quantitative evaluation of cerebral hemodynamics and low frequency of perioperative complications, as described in the Japanese Guidelines for the Management of Stroke 2021. An education system for the accurate assessment of cerebral hemodynamics, meticulous surgical procedures, and perioperative management for STA-MCA bypass is necessary to hand over evidence of STA-MCA bypass efficacy in Japan to future generations. Simultaneously, new evidence of STA-MCA bypass efficacy should be explored with the advancement of medicine and should be disseminated worldwide.

Glomus-Saving Autografting of the Internal Carotid Artery in the Peracute Period of Ischemic Stroke with Underlying COVID-19

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 is associated with the development of arterial thromboses of different locations. This pathology is common in patients with multifocal atherosclerosis. The overwhelming majority of published reports are devoted to the surgical treatment of patients with thrombosis of lower limb arteries. Thus far, no studies of revascularization in the case of extended atherosclerotic lesion and thrombosis of the internal carotid artery (ICA) in patients with COVID-19, have been published.&#x0D; AIM: To analyze the immediate results of glomus-saving autografting of the ICA with its extended atherosclerotic lesion and thrombosis in the peracute period of ischemic stroke in patients with COVID-19.&#x0D; MATERIALS AND METHODS: The retrospective study (inclusion period 01.01.201701.03.2020) involved 49 patients with hemodynamically significant extended atherosclerotic lesion of the ICA in the peracute period of acute cerebrovascular accident (ACVA). From April 1, 2020, to May 15, 2021, 26 patients with hemodynamically significant extended atherosclerotic lesion and floating thrombus in the ICA and a positive result of polymerase chain reaction to SARS-CoV-2 were included. In all cases, brain revascularization was performed in the peracute period of ACVA in the volume of glomus-saving autografting of the ICA.&#x0D; RESULTS: No adverse cardiovascular events were noted throughout the postoperative follow-up period in both groups. In the examination of the reconstruction zone using color duplex ultrasonography, no data for restenosis/thrombosis were recorded. On day 7 after surgery, in both cohorts of patients, significant regression of neurological deficit on the National Institute of Health Stroke Scale was noted: in the first group, the values during admission and day 7 after revascularization were10.5 3.5 and 6.5 1.5, respectively (р = 0.001); in the second group, the values were 12.5 2.5 and 5.5 1.5, respectively (р = 0.001). In both groups, no cases of unstable difficult-to-control arterial hypertension were noted, and no changes were introduced to the antihypertensive therapy.&#x0D; CONCLUSIONS: Emergency autografting of the ICA with its extended atherosclerotic lesion and thrombosis in the peracute period of ACVA is an effective and safe method of brain revascularization in patients with COVID-19.

Comparison of the clinical value of transcranial Doppler ultrasound and computed tomography angiography for diagnosing ischemic cerebrovascular disease.

ObjectiveTo compare the clinical value of transcranial Doppler (TCD) ultrasound and computed tomography angiography (CTA) for diagnosing ischemic cerebrovascular disease.MethodsA retrospective clinical study was conducted in 142 patients with ischemic cerebrovascular disease who were initially diagnosed by digital subtraction angiography. Under the single-blind condition, the patients were diagnosed by using TCD ultrasound and CTA independently. The accuracy of these two methods was compared.ResultsThe accuracy of diagnosing bilateral middle cerebral artery, bilateral vertebral artery and bilateral internal carotid artery lesions with a TCD examination was significantly higher than that with a CTA examination. There were no significant differences in the accuracy of diagnosing bilateral anterior cerebral artery, bilateral posterior cerebral artery or basilar artery lesions between TCD ultrasound and CTA. The accuracy of diagnosing all cerebral arterial ischemic lesions was significantly higher with a TCD examination (87.39%) than with a CTA examination (69.75%). The accuracy of diagnosing all cerebral arteries that cause ischemic encephalopathy (cerebrovascular + cervical blood vessels) was significantly higher with a TCD examination (88.03%) than with a CTA examination (69.01%).ConclusionsTCD ultrasound has several advantages over CTA. Therefore, TCD ultrasound is better for diagnosing ischemic encephalopathy than CTA.

Atherosclerotic artery damage in miners with metabolic syndrome

Introduction. Metabolic disorders can lead to dysfunction of various systems of the human body, including cardiovascular. There is a lesion of the artery endothelium in the form of stenosing atherosclerotic plaques, which can become a substrate for the occurrence of life-threatening and fatal events. The study of the health of miners in this direction is particularly relevant due to the difficult working conditions and the danger of the profession. The study aims to evaluate the relationship of metabolic syndrome and its components with atherosclerotic artery damage in miners. Materials and methods. We examined 199 underground workers of mines in the South of the Kemerovo Region - Kuzbass in the order of passing preventive medical examinations. The researchers divided them into two groups based on the presence of a diagnosed metabolic syndrome. The first of them consisted of persons with metabolic disorders - 75 (37.7%) people, the second - without it - 124 (62.3%); the average age of the examined two cohorts did not differ from each other and amounted to 46.94±5.66 and 46.17±5.14 years, respectively, p=0.321. We conducted the condition of the arterial walls, the function of external respiration, as well as biochemical blood parameters on modern equipment in all the subjects Results. In miners with metabolic syndrome, vascular lesions in the form of atherosclerotic plaques were most common - 54.9% versus 35.8% in people without metabolic syndrome, p=0.011. When analyzing the occurrence of atheromas in different vascular basins, we found that miners with metabolic syndrome had carotid artery lesions more often than those without metabolic disorders: 36.5% and 20.2%, p=0.012. Experts also found a similar pattern with duplex scanning of the main arteries of the lower extremities: 46.7% vs. 25.8%, p=0.0025. There was the greatest association of atherosclerosis in people with hypertension, so stenotic plaques were more often among people with high blood pressure: 64.1% vs. 27.7%. Hyperbetacholesterolemia increased the relative risk of atherosclerosis by 2.2 times. Compared with abdominal obesity, the waist-hip index was a more significant indicator of body anthropometry, increased values of which were in 85.5% of cases against 70.3% in the comparison group. Impaired respiratory function increased the relative risk of atherosclerosis by 2.5 times. Conclusion. The presence of metabolic syndrome in miners we are strongly associating with the development of vascular stenosis. In the prevention of atherosclerosis in miners with metabolic syndrome, it is necessary to take into account elevated values of low-density lipoprotein cholesterol, the level of glycated hemoglobin, impaired respiratory function and the waist-hip index. Ethics. We have conducted the study in compliance with the standards of the Bioethical Committee of the Research Institute of Complex Problems of Hygiene and Occupational Diseases, established in accordance with the Helsinki Declaration of the World Association "Ethical Principles of Scientific Medical Research with Human Participation" as amended in 2013 and the "Rules of Clinical Practice in the Russian Federation", approved by Order of the Ministry of Health of the Russian Federation No. 266 dated 06/19/2003. All the subjects signed an informed consent to participate in the study.

Long-Term Outcomes of Carotid Endarterectomy in Contralateral Lesions of Internal Carotid Artery

Long-Term Outcomes of Carotid Endarterectomy in Contralateral Lesions of Internal Carotid Artery

Impact of Single Versus Multiple Stent Selection for Treatment of Solitary Lesions During Carotid Artery Stenting

Carotid artery stenting (CAS) via either transfemoral or transcarotid (transcarotid artery revascularization) approaches has emerged as a safe and feasible option for patients with high anatomic and/or physiologic risks for conventional carotid endarterectomy. We studied the differences in outcomes for patients receiving single vs multiple stents for the treatment of isolated internal carotid artery lesions.

Abstract 216: Single-cell And Spatially Resolved Transcriptome Analysis Reveals Cellular Heterogeneities And Novel Regulators Of Atherosclerotic Plaque Destabilization

Background: Cardiovascular diseases, including atherosclerosis, are the major cause of death in western societies, still molecular mechanisms of plaque destabilization remain unclear. Long non-coding RNAs (lncRNAs) are one example of novel molecular modulators, as their expression is highly cell-type specific. Methods: We utilized combined total (bulk) RNA and single cell (sc) RNA to study the transcriptome of advanced carotid artery lesions from patients undergoing carotid endarterectomy in our vascular surgery clinic. Additionally, we performed hybridization-based RNA in situ sequencing (HybRISS) to indicate where cluster-defining genes are located within the plaques. Results: In this current study, four sequencing datasets were investigated (total RNA from early vs. late lesions from the same individual patient and unstable vs. stable lesions from individual patients; two separate scRNA-seq datasets).16 lncRNAs were cross-referenced between all four datasets. All of these lncRNAs presented a cell-type specific expression pattern, with 11 lncRNAs being significantly enriched in different smooth muscle cell (SMC) clusters. We found all newly identified lncRNAs conserved in our scRNA-seq datasets of genetically mutated ( LDLR-/- ) Yucatan mini-pigs and the inducible carotid artery plaque rupture mice ( ApoE-/- ). The cluster-defining genes from the human scRNA-seq data were then located in human carotid artery tissue sections using the HybRISS method to unravel their distinct location within these plaques. Discussion: Taken together, our datasets, methods and different animal-models demonstrate that combining bulk with scRNA-seq data and spatially resolved sequencing methods are powerful tools to identify and characterize novel lncRNAs being expressed by a certain cell-type in the disease progression.

Sonographic Intima-Media Thickness Evaluation of Common Carotid and Internal Carotid Arteries in Type-2 Diabetes Mellitus

Background: Intima-media thickness (IMT) is a useful marker in early detection of atherosclerotic lesions in carotid arteries in Type-2 Diabetes Mellitus (T2DM) patients. The study was conducted to determine the association of IMT with various physical and biochemical parameters in the Indian population. Objective: To compare IMT of common and internal carotid arteries in T2DM patients and healthy individuals and study the correlation of IMT with physical and biochemical parameters. Methods: Case group with T2DM (n=27) were matched with Control group consisting of healthy individuals (n=27) of similar age and sex were included. Physical parameters and routine biochemical data were collected and compared. Ultrasonographical imaging of the common and internal carotid arteries of both sides were performed presence of plaque was observed. Data was analyzed by software IBM® SPSS Statistics V20.0. For all analyses, P&lt;0.05 was considered as statistically significant. Results: Mean IMT value obtained in case and control group are 0.711±0.14 mm and 0.601±0.16 mm respectively (P=0.005). Presence of plaque was noticed in 37.03% subjects in case group and in 14.81% subjects in control group. Mean IMT was significantly higher for smoker than non-smokers (P=0.004). Fasting blood sugar, postprandial blood sugar, Postprandial triglycerides and total cholesterol were significantly higher in case group (P&lt;0.05). There was a strong family history of T2DM in case group (51.85%) compared to control group (14.81%) with a statistical significance between them (P=0.009). Conclusion: IMT of common and internal carotid arteries have a significant association in T2DM patients compared to healthy subjects and IMT is significantly associated with physical and biochemical parameters.

Scope of endovascular surgery in correction of stenotic lesions of the internal carotid artery in complex anatomic conditions

In most cases, patients with multifocal atherosclerotic lesions, including brachiocephalic arteries, are denied surgical treatment due to the high risks of intra- and postoperative complications. Despite the severe stenotic lesion of the carotid arteries, which can lead to such a major complication as ischemic stroke, in most cases surgeons refuse to perform the operation. Endovascular surgery is often the only option for these patients. After analyzing the world experience in the treatment of hemodynamically significant lesions of the arteries of the brachiocephalic basin and applying in practice various methods of endovascular interventions in patients with complex stenotic lesions of the internal carotid arteries, we were convinced that endovascular correction of such lesions is often the main method of treatment for patients with multifocal atherosclerosis, and can also be used as a primary method of treatment, as it demonstrates high effectiveness, low risk of complications and good long-term results.

Significance of D-Dimer in Acute Ischemic Stroke Patients With Large Vessel Occlusion Accompanied by Active Cancer

BackgroundThis study aimed to investigate clinical outcome predictors of acute stroke patients with large vessel occlusion and active cancer and validate the significance of D-dimer levels for endovascular thrombectomy decisions.MethodsWe analyzed a prospectively collected hospital-based stroke registry to determine clinical EVT outcomes of acute stroke patients within 24 h with following criteria: age ≥18 years, NIHSS ≥6, and internal carotid artery or middle cerebral artery lesion. All patients were classified into EVT and non-EVT groups. Patients were divided into two groups by initial D-dimer level. We explored variables potentially associated with successful recanalization as well as 3-month functional outcomes and mortality rates.ResultsAmong 68 patients, 36 were treated with EVT, with successful recanalization in 55.6%. The low D-dimer group showed a higher rate of successful recanalization and favorable outcome than the high D-dimer group. The mortality rate was higher in the high D-dimer group. No EVT and high D-dimer level were independent predictors of mortality, whereas lesion volume and low D-dimer level were independently associated with favorable outcomes.ConclusionsD-dimer level is a prognostic factor in acute LVO stroke patients with active cancer, and its high value for EVT decisions provisionally supports its testing in this patient population.

Important recommendations of the German-Austrian S3 guidelines on management of extracranial carotid artery stenosis

Lesions of the extracranial carotid artery are the cause of 10-15 % of all cases of cerebral ischemia. The aims of the updated S3 guidelines are evidence-based and consensus-based recommendations for action on comprehensive care of patients with extracranial carotid stenosis in Germany and Austria. A systematic literature search (1990-2019) and methodical assessment of existing guidelines and systematic reviews were carried out. Consensus answers to 37 key questions with evidence-based recommendations. The prevalence of extracranial carotid stenosis is approximately 4% and increases after the age of 65 years. The most important examination method is duplex sonography. Randomized controlled studies (RCT) have shown that carotid endarterectomy (CEA) of an asymptomatic 60-99% carotid artery stenosis reduces the absolute risk of stroke (absolute risk reduction, ARR) within 5 years in comparison to drug treatment alone by 4.1%. Due to an improved pharmaceutical prevention of arteriosclerosis, the S3 guidelines recommend a prophylactic CEA of a 60-99% stenosis only for patients without an increased surgical risk. Additionally, one or more clinical or imaging results should be present, which indicate an increased risk of carotid-related stroke in the follow-up. For medium-grade (50-69 %) and high-grade (70-99 %) symptomatic stenoses the ARRs after 5 years are 4.6% and 15.6%, respectively. Systematic reviews of RCTs have shown that CEA is associated with a ca. 50% lower periprocedural risk of stroke compared to carotid artery stenting (CAS). There are no differences in the long-term course. The CEA is recommended for high-grade asymptomatic, medium-grade and high-grade symptomatic carotid stenosis as a standard procedure, alternatively CAS can be considered. For both procedures the periprocedural stroke rate/mortality during hospitalization should be a maximum of 2% (asymptomatic stenosis) or 4% (symptomatic stenosis). Both CEA and CAS necessitate a critical evaluation of the indications and strict quality criteria. Future studies should evaluate even better selection criteria for an individual, optimal, conservative, operative or endovascular treatment.

The Impact of Dietary Diversity, Lifestyle, and Blood Lipids on Carotid Atherosclerosis: A Cross-Sectional Study.

Carotid atherosclerosis is a common arterial wall lesion that causes narrowing and occlusion of the arteries and is the basis of cardiovascular events. Dietary habits, lifestyle, and lipid metabolism should be considered integrally in the context of carotid atherosclerosis (CAS). However, this area has been investigated less often in China. To understand the prevalence of CAS in China and the impact of dietary diversity and habits, lifestyle, and lipid metabolism on CAS as well as its predictive factors, a cross-sectional study was performed in two northern and southern Chinese tertiary hospitals from 2017 to 2019. Included participants underwent carotid artery color Doppler ultrasonography, blood lipid examination and dietary evaluation. In total, 11,601 CAS patients and 27,041 individuals without carotid artery lesions were included. The prevalence of CAS was 30.0% in this group. High BMI (OR: 1.685, 95% CI [1.315–2.160]), current (1.148 [1.077–1.224]) or ex-smoking (1.349 [1.190–1.529]), abstinence from alcohol ((1.223 [1.026–1.459]), social engagement (1.122 [1.050–1.198]), hypertension (1.828 [1.718–1.945]), and total cholesterol (1.438 [1.298–1.594]) were risk factors for CAS, while higher dietary diversity according to DDS-2 (0.891 [0.805–0.989]), HDL-C (0.558 [0.487–0.639]), sugar-sweetened beverages (0.734 [0.696–0.774]), and no midnight snack consumption (0.846 [0.792–0.903]) were protective factors. This current study demonstrated that higher dietary diversity was a protective factor against CAS in a healthy population. In addition, current recommendations of healthy lifestyle and dietary habits for preventing CAS should be strengthened. In addition, dietary diversity should concentrate on food attributes and dietary balance, rather than increased quantities.