Carotid Artery Stenosis Group Research Articles

Stroke risk after transcatheter aortic valve replacement in patients with carotid stenosis: A systematic review and meta-analysis

BackgroundStroke is a feared complication of transcatheter aortic valve replacement (TAVR). Patients undergoing TAVR typically have multiple comorbidities, such as carotid artery stenosis (CAS). We conducted the present meta-analysis to determine the risk of stroke and mortality following TAVR in patients with CAS. MethodsWe searched PubMed/Medline, Scopus, ScienceDirect, and Cochrane Clinical Trials databases for clinical studies that compared CAS ≥50% and CAS ≥70% versus non-CAS TAVR population. The endpoints included the 30-day incidence of stroke or transient ischemic attack (TIA) and 30-day all-cause of mortality. ResultsWe identified seven studies that included 12,418 patients in the CAS group and 102,316 in the control group. CAS ≥50% was not associated with an increased risk of 30-day stroke or TIA after TAVR [risk ratio (RR): 1.38; 95% confidence interval (95% CI): 0.95–2.02; p = 0.09]. However, patients with CAS ≥70% had an increased risk of stroke or TIA (RR: 1.43; 95% CI: 1.02–2.01; p = 0.04). No difference in 30-day all-cause mortality was observed between CAS ≥50% or CAS ≥70% and control groups (RR: 1.09; 95% CI: 0.79–1.52; p = 0.59 and RR: 1.11; 95% CI: 0.85–1.45; p = 0.43, respectively). ConclusionsCAS ≥70% was associated with an increased risk of stroke or TIA following TAVR compared with patients without CAS.

Quantitative assessment of retinochoroidal microvasculature in patients with carotid artery stenosis using OCT angiography

PurposeTo investigate the alterations in retinochoroidal parameters measured by optical coherence tomography (OCT) and OCT angiography (OCTA) in patients with carotid artery stenosis (CAS) and assess their associations with digital subtraction angiography (DSA) data. MethodThis study enrolled patients diagnosed with CAS and age-matched healthy controls. Both groups underwent OCT and OCTA examinations. DSA and assessment of carotid artery stenosis were performed only in the CAS group. The study evaluated various retinochoroidal parameters from OCT and OCTA, including linear vessel density (LVD), foveal avascular zone (FAZ), choroidal thickness (ChT), and retinal nerve fiber layer (RNFL) thickness. DSA-derived measures included cervical segment (C1) diameter, cavernous segment (C4) diameter, stenosis percentage, ophthalmic artery (OA) filling time, C1-OA filling time, and residual stenosis. ResultsA total of 42 eyes from 30 CAS patients and 60 eyes from 30 healthy controls were included. Patients with CAS displayed significantly decreased LVD compared to controls (p < 0.001). Additionally, the CAS group had thinner choroid and RNFL (p = 0.047 and p < 0.001, respectively). Macular LVD negatively correlated with both stenosis percentage and C1-OA filling time (p = 0.010 and p = 0.014, respectively). In patients who underwent carotid artery stenting, preoperative ChT significantly correlated with residual stenosis (Pearson r = -0.480, p = 0.020). ConclusionOCT and OCTA provide a quantitative assessment of retinochoroidal microstructural changes associated with CAS, suggesting potential for noninvasive evaluation of the disease. This might contribute to the prevention of irreversible ocular complications and early detection of CAS. Furthermore, ChT may not only aid in diagnosing CAS more reliably but also offer prognostic information.

Correlation analysis of serum miR-145 and miR-210 with carotid artery stenosis and their predictive value for cerebral ischemic events

Objective To analyze the significance of serum miR-145 and miR-210 expression levels in the diagnosis of carotid artery stenosis. Methods During the same period, 55 healthy individuals who received physical examination in the same hospital were recruited as controls and assigned to a non-stenosis group. Among the included patients, there were 45 cases of mild stenosis, 14 cases of moderate stenosis, and 6 cases of severe stenosis after carotid color Doppler ultrasonography. The expression levels of miR-145 and miR-210 in serum were measured using real-time fluorescence quantitative polymerase chain reaction (qPCR) technology. Results The expression levels of serum miR-145 and miR-210 in carotid artery stenosis group were significantly lower than those in non-stenosis group (p < 0.001). Multivariate Logistic regression analysis showed that smoking history, diabetes, hypertension and total cholesterol were positively correlated with the occurrence of carotid artery stenosis (p < 0.05). The expression levels of miR-145 and miR-210 were significantly negatively correlated with carotid artery stenosis (p < 0.001). In addition, patients with carotid artery stenosis and low expression levels of miR-145 and miR-210 had a greater risk of cerebral ischemia (p < 0.05). Cox regression analysis showed that the low expression of miR-145 and miR-210 were independent predictors of cerebral ischemic events. ROC analysis confirmed that miR-145 and miR-210 had good diagnostic efficacy in cerebral ischemia (p < 0.001). Conclusion The decreased expression of miR-145 and miR-210 in serum is closely related to the diagnostic significance of carotid artery stenosis, and may be used to predict the occurrence of cerebral ischemic events.

The role of carotid artery stenosis in predicting stroke after coronary artery bypass grafting in a Chinese cohort study

Current guidelines give priority to surgical treatment of carotid artery stenosis (CAS) before coronary artery bypass grafting (CABG), especially in symptomatic patients. Carotid artery stenting is an alternative treatment for narrowing of the carotid arteries. This study sought to demonstrate the role of severe CAS in predicting stroke after CABG and assess the efficacy of carotid artery stenting in preventing postoperative stroke in a Chinese cohort. From 2015 to 2021, 1799 consecutive patients undergoing isolated CABG surgery were retrospectively recruited in a Chinese cohort. The predictive value of severe CAS in postoperative stroke and carotid stenting in preventing postoperative stroke was statistically analyzed. The incidence of postoperative stroke was 1.67%. The incidence of CAS with stenosis ≥ 50% and ≥ 70% was 19.2% and 6.9%. After propensity matching, the incidence of stroke was 8.0% in the severe CAS group and 0% in the non-severe CAS group. We successfully established an optimal predictive nomogram for predicting severe CAS in patients undergoing CABG. Carotid artery stenting was found ineffective in preventing postoperative stroke. The present study provides the incidence of CAS and postoperative stroke in a Chinese cohort, identifies severe CAS as an independent risk factor for postoperative stroke after CABG, constructs a nomogram predicting the incidence of severe CAS, and evaluates the effectiveness of carotid artery stenting in preventing postoperative stroke after CABG.

Carotid Artery Stenosis on Panoramic Radiographs and CT Scans in Patients With Malignancies After Radiotherapy.

This study aimed to identify the progression of carotid artery stenosis (CAS) in patients with head and neck cancer following radiation therapy (RT) by characterizing associated risk factors. Panoramic radiographs (OPG), computed tomography (CT) scans, cone-beam CT (CBCT) scans, and ultrasonography (US) of 69 patients with head and neck tumors were selected and analyzed to identify the presence of CAS. Data on tumor location, smoking status, hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), and treatment were collected from the patients' medical records. Patients who received chemotherapy or no treatment were excluded from the study. The differential diagnosis of other radiopacities and anatomical landmarks were excluded. Patients were divided into two groups: those with CAS (group1) and those without CAS (group 2) and their clinical information was compared. The overall prevalence of CAS on the panoramic radiographs was 16%. Of the 69 patients, 44 underwent radiography before and after radiotherapy, only seven had mild CAS on radiographs after radiotherapy, and no significant difference in CAS was identified before and after radiotherapy. There were also no differences between the groups regarding age, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, tumor location, and RT dose before and after radiation (p>0.05). Radiotherapy does not seem to affect the prevalence of CAS, although it has been identified in some patients after radiotherapy completion.

High-density lipoprotein dysfunction in carotid artery stenosis.

Background: High density lipoprotein (HDL) is well established to have an athero-protective role under normal conditions; however, pro-inflammatory alteration of HDL proteins may transform the HDL particle into a dysfunctional molecule. Our aim was to investigate HDL dysfunction by measuring enzyme-based markers in carotid artery stenosis (CAS). Patients and methods: All participants underwent duplex ultrasound and 52 subjects diagnosed with CAS and 51 subjects who had no significant stenosis (as controls) were enrolled in this study. Serum lipid profiles and serum parameters associated with dysfunctional HDL including myeloperoxidase (MPO), paraoxonase 1 (PON1), arylesterase (ARE) activity, and lipid hydroperoxide (LOOH) levels were measured. Results: It was found that the patients with CAS had increased levels of MPO and LOOH while PON1 activity was decreased. There was no significant difference between the CAS and non-CAS groups in terms of HDL levels. MPO/PON1, MPO/ARE, and LOOH/PON1 ratios were significantly increased in the CAS group. MPO/PON1 and MPO/ARE ratios both demonstrated significant correlations with degree of stenosis (%). Conclusions: The MPO/PON1 and MPO/ARE ratios may be potential serum markers that can enable the monitoring of HDL functionality and the assessment of atherosclerotic disease risks. Additionally, monitoring the oxidative balance of lipids on HDL molecules by LOOH/PON1 ratio may have value in the early detection of pro-atherosclerotic transformation of the HDL particle.

Meta-Analysis of the Prognostic Significance of Carotid Artery Stenosis in Patients Who Underwent Transcatheter Aortic Valve Implantation

Stroke is a known complication of both transcatheter aortic valve implantation (TAVI) and carotid artery stenosis (CAS). Whether CAS is a predictor of worse prognosis after TAVI is unclear. We performed a meta-analysis to assess the impact of CAS on the incidence of neurovascular complications and mortality after TAVI. We searched PubMed/MEDLINE and EMBASE databases from inception to January 2023. CAS was defined by ≥50% stenosis of at least 1 carotid artery. Studies comparing CAS versus non-CAS TAVI populations were included. Patients' baseline characteristics and 30-day clinical outcomes were extracted. End points included the 30-day incidence of neurovascular complications (stroke or transient ischemic attack) and 30-day all-cause mortality. We identified six studies, totaling 6,763 patients in the CAS group and 23,861 patients in the non-CAS group. Patients with CAS had a higher prevalence of hypertension, diabetes mellitus, dyslipidemia, previous myocardial infarction, coronary artery bypass graft, peripheral artery disease, previous neurovascular disease, and chronic kidney disease. There was no significant difference in the rates of 30-day neurovascular complications between CAS and non-CAS groups (relative risk 1.23, 95% confidence interval 0.63 to 2.40, p=0.54). CAS was associated with a higher risk of 30-day all-cause mortality (relative risk 1.28, 95% confidence interval 1.12 to 1.47, p<0.001), not found in a sensitivity analysis. In conclusion, patients with CAS presented with a significantly higher co-morbidity burden. CAS was not associated with an increased risk of 30-day neurovascular complications. 30-day mortality was higher in the CAS group but that may be a surrogate of the heavy co-morbidity burden of patients with CAS.

Increased Serum Systemic Immune-Inflammation Index is Independently Associated With Severity of Carotid Artery Stenosis.

Stroke is a significant contributor to morbidity and mortality. The present study investigated how the systemic immune inflammation index (SII) could be used to predict the likelihood of developing carotid artery stenosis (CAS), which can be seen using carotid artery angiography (CAAG). This study comprised 418 individuals who underwent CAAG for CAS. SII was calculated by multiplying the platelet count by the neutrophil/lymphocyte ratio (NLR). The patients were divided into two groups: non-critical and critical CAS (stenosis below %70 and above ≥70%, respectively). Compared with the non-critical CAS, the critical CAS group had greater high sensitivity C-reactive protein levels (4.5 [3.1-5.7] vs 3.9 [2-5] [mg/L], P < .001), NLR (4.1 [2.9-7.5] vs 2.9 [1.8-3.7], P < .001), platelet/lymphocyte ratio (233 [110-297] vs 119 [96-197], P < .001), and SII (860 [608-2455] vs 604 [458-740], P < .001). Receiver Operating Characteristic Curve analysis demonstrated the best cutoff value of 672.3 for SII to predict the critical CAS with 71.2% sensitivity and 60.1% specificity. According to our study, an increase in SII is an independent predictor of the severity of CAS in patients undergoing CAAG.

Quantification of the Tissue Oxygenation Delay Induced by Breath-Holding in Patients with Carotid Atherosclerosis.

Carotid artery stenosis (CAS) is a common vascular disease with long-term consequences for the brain. Although CAS is strongly associated with impaired cerebral hemodynamics and neurodegeneration, the mechanisms underlying hemodynamic impairment in the microvasculature remain unknown. In this work, we employed functional near-infrared spectroscopy (fNIRS) to introduce a methodological approach for quantifying the temporal delay of the evoked hemodynamic response. The method was validated during a vasodilatory task (breath-holding) in 50 CAS patients and 20 controls. Our results suggest that the hemodynamic response to breath-holding can be delayed by up to 6 s in the most severe patients, a significant increase from the median 4 s measured for the control group (p = 0.01). In addition, the fraction of brain regions that responded to the task decreased as the CAS severity increased, from a median of 90% in controls to 73% in the most severe CAS group (p = 0.04). The presence of collateral circulation increases the response to breath-holding and decreases the average time delays across the brain, although the number of communicating arteries alone cannot predict these fNIRS-based hemodynamic variables (p > 0.09). Overall, this work proposes a method to quantitatively assess impaired cerebral hemodynamics in CAS patients.

IgG Glycosylation Profiling of Peripheral Artery Diseases with Lectin Microarray.

Background: Inflammation plays a key role in the progression of atherosclerotic plaque for peripheral artery disease (PAD). Immunoglobulin G (IgG) glycosylation could modulate immunological effector functions and has been explored as biomarkers for various diseases. Methods: Lectin microarray was applied to analyze the expression profile of serum IgG glycosylation in patients with lower-extremity peripheral artery disease (LEPAD), carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), and healthy controls. Lectin blot was performed to validate the differences. Results: SNA (Sambucus nigra agglutinin) binding (preferred sialic acid) was significantly higher in the LEPAD (3.21 ± 2.06) and AAA (3.34 ± 2.42) groups compared to the CAS (2.47 ± 1.45) group. Significantly higher binding levels of ConA (Concanavalin A) (preferred mannose) and PSA (Pisum sativum agglutinin) (preferred fucose) were also observed in LEPAD compared to CAS patients. Among LEPAD patients, a significant lower binding level of Black bean crude (preferred GalNAc) was present for dyslipidemia patients. A higher binding level of MNA-M (Morniga M agglutinin) (preferred Mannose) and Jacalin-AIA (Artocarpus integrifolia agglutinin) (preferred Galβ3GalNAc) was observed for Fontaine severe patients. Higher binding levels of PHA-E (Phaseolus vulgaris Erythroagglutinin) and PHA-L (Phaseolus vulgaris Leucoagglutinin) (preferred Galβ4GlcNAc) were observed for diabetic patients, and higher binding of ASA (Allium sativum agglutinin) (preferred Mannose) was present in patients with hypertension. The level of high-sensitivity C-reactive protein (hsCRP) was positively associated with LTL (Lotus tetragonolobus lectin) (r = 0.44), PSA (r = 0.44), LCA (Lens Culinaris agglutinin) (r = 0.39), SNA (r = 0.57), and CSA (Cytisus sscoparius agglutinin) (r = 0.56). For CAS, symptomatic patients had lower binding levels of AAL (Aleuria aurantia lectin) (preferred fucose) and IAA (Iberis amara agglutinin) (preferred GalNAc). Blood total cholesterol level was positively associated with SNA-I (r = 0.36) and SBA (Soybean agglutinin) (r = r = 0.35). Creatinine levels were positively associated with lectins including, but not limited to, MNA-M (r = 0.42), CSA (r = 0.45), GHA (Glechoma hederacea agglutinin) (r = 0.42), and MNA-G (Morniga G agglutinin) (r = 0.45). Conclusion: LEPAD patients had increased IgG binding levels of SNA and ConA compared to CAS, which could provide potential diagnostic value. Fontaine severity was associated with Mannose-rich IgG N-glycan, while diabetic LEPAD correlated with bisecting GlcNAc. The levels of hsCRP and creatinine were positively associated with IgG fucosylation and galactosylation. Changes in IgG glycosylation may play important roles in PAD pathogenesis and progression.

Detection of Asymptomatic Carotid Artery Stenosis through Machine Learning.

Carotid artery disease, the pathological condition of carotid arteries, is considered as the most significant cause of cerebral events and stroke. Carotid artery disease is considered as an inflammatory process, which involves the deposition and accumulation of atherosclerotic plaque inside the carotid intima, resulting in the narrowing of the arteries. Carotid artery stenosis (CAS) is either symptomatic or asymptomatic and its presence and location is determined by different imaging modalities, such as the carotid duplex ultrasound, the computed tomography angiography, the magnetic resonance angiography (MRA) and the cerebral angiography. The aim of this study is to present a machine learning model for the diagnosis and identification of individuals of asymptomatic carotid artery stenosis, using as input typical health data. More specifically, the overall model is trained with typical demographics, clinical data, risk factors and medical treatment data and is able to classify the individuals into high risk (Class 1-CAS group) and low risk (Class 0-non CAS group) individuals. In the presented study, we implemented a statistical analysis to check the data quality and the distribution into the two classes. Different feature selection techniques, in combination with classification schemes were applied for the development of our machine learning model. The overall methodology has been trained and tested using 881 cases (443 subjects in low risk class and 438 in high risk class). The highest accuracy 0.82 and an area under curve 0.9 were achieved using the relief feature selection technique and the random forest classification scheme.

Cerebrospinal Fluid CSF Flow Artifacts are Associated with Brain Pulsation in Patients with Severe Carotid Artery Stenoses.

We investigated the factors associated with cerebrospinal fluid (CSF) flow artifacts on fluid-attenuated inversion recovery imaging in patients with carotid artery (CA) stenosis. Each CSF artifact grade was defined by comparing the highest intensity in a given region of interest (ROI) to those in reference ROIs, as follows: higher than the intensity of normal white matter in the centrum semiovale = 2 points; equal to or less than the white matter, and higher than CSF = 1 point; and equal to CSF = 0. CSF flow scores in eight sites were measured and added to the total score (0 -16). The prevalences of each finding, specifically white matter lesions, CA stenoses and brain atrophy, were compared using multivariate logistic regression models. We evaluated the findings in 54 patients with CA stenosis treated by CA stenting (CAS) and 200 adults with no history of neurological disorders (control group). Adjusted by stroke risk factors, a CSF flow score ≤ 11 was positively associated with CA stenosis, heart rate > 70 / min, and brain atrophy, and negatively with the female gender. The score was 12.8 ± 1.8 in the control group and 12.0 ± 2.0 in CA stenosis group after CAS, which was significantly higher than before CAS (10.4 ± 2.8, p<0.001). The CSF flow score was associated with female gender, brain atrophy, heart rate, and severe CA stenosis, and was found to be elevated after revascularization.

Asymptomatic cerebral findings on 3-Tesla MRI in patients with severe carotid artery stenoses

Background and purposeSmall vessel diseases (SVDs) are often asymptomatic. However, SVDs significantly influence the prognosis in patients with large vessel diseases (LVDs). We investigated asymptomatic cerebral findings on 3-Tesla MRI in patients with severe carotid artery (CA) stenoses, compared to peoples without a past history of neurological disorders, including strokes. MethodsWe retrospectively analyzed the prevalences of various asymptomatic cerebral findings which were intracerebral hemorrhages (ICHs), cortical superficial siderosis, ventricular dilatation (Evans’ index) and SVDs including cerebral microbleeds (CMBs), lacunar infarctions (LIs), deep white matter hyperintensities (WMHs), periventricular hyperintensities (PVHs). The prevalence of each finding was compared using multivariate logistic regression models with adjustment for stroke risk factors. ResultsWe evaluated the findings in 54 patients with severe CA stenosis treated by stenting (CA stenosis group) and 200 adults with health screening tests of the brain and no past history of neurological disorders (control group). Multivariate analyses adjusted for age ≥ 65 years old, female gender, hypertension, hyperlipidemia, diabetes mellitus, alcohol consumption, and smoking index revealed that the prevalences of severe PVHs, severe deep WMHs, asymptomatic deep ICHs, and asymptomatic LIs were significantly higher in the CA stenosis group than the control group. However, there were no significant differences in the prevalences of CMBs, or the remaining asymptomatic findings described above. ConclusionsWith pathological differences between SVD and LVD, asymptomatic SVDs except CMBs and deep ICHs often co-exists severe CA stenosis as a presentative LVD.

Correlation between serum sortilin levels and severity of extracranial carotid artery stenosis.

Atherosclerosis is a chronic inflammatory vascular condition characterised by intimal thickening with cholesterol accumulation and macrophage foam cell infiltration causing plaque formation at the site of the injured vessel wall. This condition is a major contributor to carotid artery stenosis (CAS). Sortilin, a member of the mammalian vacuolar protein sorting 10 protein family, promotes uptake of low-density lipoprotein particles into macrophages with consequent foam cell formation independent of the low-density lipoprotein receptor, and thereby, accelerates atherosclerotic plaque formation and progression. We investigated the correlation between serum sortilin levels and the severity of extracranial CAS. The study included 149 patients who underwent carotid angiography for suspected carotid artery disease. The North American Symptomatic Carotid Endarterectomy Trial 2011 criteria were used to determine the degree of CAS. Serum sortilin concentrations were measured using the enzyme-linked immunosorbent assay. Serum sortilin levels were significantly higher in the severe CAS than in the non-severe CAS group (2.71±0.71ng/mL vs 1.63±0.57ng/mL, P<.001). Receiver operating characteristic curve analysis showed that serum sortilin levels >1.66ng/mL predicted severe CAS with sensitivity of 83.49% and specificity of 56.76%. Current data suggest that prediction of severe CAS may serve as an atherosclerosis biomarker and significantly contribute to research on disease progression in atherosclerosis, as well as in other arterial diseases. Sortilin may be a potential therapeutic target owing to its role in the pathogenesis of atherosclerotic carotid artery disease.

Lp-PLA2 evaluates the severity of carotid artery stenosis and predicts the occurrence of cerebrovascular events in high stroke-risk populations.

BackgroundLipoprotein‐associated phospholipase A2 (Lp‐PLA2) is an independent risk factor for cardiovascular disease. However, relationship between carotid artery stenosis and cerebrovascular events in high stroke‐risk populations is still unclear.MethodsA total of 835 people at a high risk of stroke were screened from 15,933 people aged >40 years in April 2013 and followed at 3, 6, 12, and 24 months. Finally, 823 participants met the screening criteria, and the clinical data and biochemical parameters were investigated.ResultsAmong the 823 participants, 286 had varying degrees of carotid artery stenosis and 18 had cerebrovascular events. The level of Lp‐PLA2 in the carotid artery stenosis group was higher than that in the no stenosis group, and the level in the event group was higher than that in the no event group (p < 0.05). Spearman correlation analysis showed that Lp‐PLA2 was positively correlated with the degree of carotid artery stenosis (r = 0.093, p = 0.07) and stenosis involvement (r = 0.094, p = 0.07). The correlation coefficient between Lp‐PLA2 and lipoprotein was the highest on the levels of sdLDL (r = 0.555, p < 0.001), followed by non‐HDL, LDL, TC, and TG. Cox multivariate regression analysis revealed that, compared with the first quantile of Lp‐PLA2 level (Q1, low level), the risk of cerebrovascular events in the fourth quantile of Lp‐PLA2 was 10.170 times that of the first quantile (OR = 10.170, 95% CI 1.302–79.448, p = 0.027).ConclusionsLp‐PLA2 levels can evaluate carotid artery stenosis and predict the occurrence of cerebrovascular events in high stroke‐risk populations and provide scientific guidance for risk stratification management.

In-hospital clinical outcomes of transcatheter aortic valve replacement in patients with concomitant carotid artery stenosis: Insights from the national inpatient sample.

BackgroundCarotid artery stenosis (CAS) is a common occurrence in elderly patients undergoing transcatheter aortic valve replacement (TAVR). We conducted a retrospective study to identify the impact of CAS on in-hospital outcomes following TAVR.MethodsWe queried the National Inpatient Sample (NIS) for 2016–2017 and identified patients who underwent TAVR with concomitant CAS using the ICD-10 codes. The primary endpoint of our study was in-hospital mortality and acute ischemic stroke.ResultsWe identified 80,740 TAVR-related hospitalizations. Of these, 6.9% (N = 5555) patients had concomitant CAS. The mean age for CAS patients was 80 ± 7.4 years. Females were represented equally in both groups. Traditional comorbidities like dyslipidemia [78.3% (N = 4350) vs. 68.2% (N = 51261); P < 0.001] and peripheral arterial disease [27.4% (N = 1525) vs. 12.7% (N = 9526); P < 0.001] were more frequently observed among CAS patients. Patients with CAS had higher rates of previous stroke [17.5% (N = 970) vs. 11.8% (N = 8902); P < 0.001] and CABG 23.8% (N = 1320) vs. 18.6% (N = 14022); P < 0.001]. Other cardiovascular risk factors were similar between the two groups. Moreover, no differences in in-hospital outcomes including mortality [odds ratio (OR): 1.35, CI: 0.48–3.83; P = 0.57] were observed in the propensity matched cohort.ConclusionsOur study did not find any major differences in outcomes in the CAS group following TAVR; however, a more detailed randomized controlled study with long-term follow-up of these patients is needed.

Pentraxin 3, TNF-α, and LDL-C Are Associated With Carotid Artery Stenosis in Patients With Ischemic Stroke.

Background: Carotid artery stenosis (CAS), typically resulting from atherosclerotic progression, is more common than intracranial atherosclerotic disease in patients with cerebrovascular disease. Prior literature has incompletely established the relationship of Pentraxin 3 (PTX3) and CAS complexity and severity. This study aims to more thoroughly evaluate the association of plasma PTX3 levels and the prevalence and severity of CAS in patients with cerebrovascular disease.Methods: Two hundred and six patients with ischemic stroke underwent multiphase computerized tomography angiography (CTA) of the head and neck to assess the presence and severity of carotid artery stenosis. Patients were divided into groups with either no carotid artery stenosis (CAS-free) or carotid artery stenosis (CAS). The CAS group was further divided into groups based on the degree of stenosis and the number of involved vessels. The PTX3 and Tumor Necrosis Factor-alpha (TNF-α) concentration were measured by ELISA.Results: Plasma levels of PTX3, TNF-α, and low-density lipoprotein cholesterol (LDL-C) were increased significantly in the CAS group patients vs. the CAS-free group (p = 0.000, 0.002, 0.002, respectively). Within the CAS group, PTX3, TNF-α, and LDL-C were significantly elevated in stenosis of ≥50% group compared to <50% group (p = 0.001, 0.002, 0.049, respectively). The multivariate logistic binary regression analysis revealed that increased age, elevated levels of PTX3, LDL-C, and TNF-α were all independent risk factors for occurrence of carotid stenosis. PTX3 level correlated with the severity of carotid stenosis.Conclusions: High plasma PTX3 levels, TNF-α, and LDL-C are significantly correlated with the prevalence and severity of carotid artery stenosis. PTX3 may be a more powerful predictor for the severity of carotid artery stenosis.

Monocyte Subsets, Stanford-A Acute Aortic Dissection, and Carotid Artery Stenosis: New Evidences.

Monocytes are a heterogeneous cell population distinguished into three subsets with distinctive phenotypic and functional properties: “classical” (CD14++CD16-), “intermediate” (CD14++CD16+), and “nonclassical” (CD14+CD16++). Monocyte subsets play a pivotal role in many inflammatory systemic diseases including atherosclerosis (ATS). Only a low number of studies evaluated monocyte behavior in patients affected by cardiovascular diseases, and data about their role in acute aortic dissection (AAD) are lacking. Thus, the aim of this study was to investigate CD14++CD16-, CD14++CD16+, and CD14+CD16++ cells in patients with Stanford-A AAD and in patients with carotid artery stenosis (CAS). Methods. 20 patients with carotid artery stenosis (CAS group), 17 patients with Stanford-A AAD (AAD group), and 17 subjects with traditional cardiovascular risk factors (RF group) were enrolled. Monocyte subset frequency was determined by flow cytometry. Results. Classical monocytes were significantly increased in the AAD group versus CAS and RF groups, whereas intermediate monocytes were significantly decreased in the AAD group versus CAS and RF groups. Conclusions. Results of this study identify in AAD patients a peculiar monocyte array that can partly explain depletion of T CD4+ lymphocyte subpopulations observed in patients affected by AAD.

Metabolomics study in severe extracranial carotid artery stenosis

BackgroundSignificant genetic association has been found in patients with severe carotid artery stenosis (CAS). The present study wished to investigate if metabolites may also act as biomarkers for CAS.MethodsConsecutive patients with at least one carotid artery stenosis > = 60% on cerebral angiography were prospectively recruited from May 2007 to January 2016. Normal controls were recruited from outpatient clinic who had no stroke and coronary artery disease (CAD) history, and the brain magnetic resonance or computed tomographic angiography showed bilateral CAS < 30%. Risk factor profile, clinical characteristics, age, and clinical features were recorded. All subjects were male, and none had diabetes. 1H-NMR spectroscopy-based metabolomics analysis was carried out for plasma samples.ResultsTotally, 130 male subjects were recruited. Age had no significant difference between the controls and CAS group (60.2 ± 5.9 vs. 63.3 ± 6.0, p = 0.050). The CAS group had significantly higher frequency of CAD, hypertension, smoking and alcohol but lower body mass index than the controls (p < 0.05). The laboratory tests showed CAS group had significantly higher level of homocysteine but lower levels of cholesterol, high-density lipoprotein and hemoglobin than the controls (p < 0.05). The 1H-NMR based plasma metabolomics analysis indicated that choline was significantly lower in CAS patients. The VIP values of lipids were greater than 1.0, which were considered significantly different.ConclusionsOur results suggest homocysteine, choline and lipids in association with traditional risk factors may be involved in the pathogenesis of CAS. Diet adjustment to control homocysteine, choline and lipids may be helpful for the prevention of CAS.

The association between metabolic syndrome and asymptomatic carotid artery stenosis in menopausal women: a cross-sectional study in a Chinese population.

BackgroundTo examine the association of metabolic syndrome (MetS) with carotid artery stenosis (CAS), especially in menopausal women in China.Materials and methodsA cross-sectional study of menopause women aged ≥40 years were enrolled from the Jidong community of Tangshan City between 2013 and 2014 to examine the association between MetS and CAS. Logistic regression analyses were performed to analyze the association between MetS and the presence of CAS.ResultsA total of 762 menopause women with mean age 59.3±5.6 years were enrolled in our analysis. Of all the people, 111 participants in CAS group (n=159) and 297 participants in no CAS group (n=603) were diagnosed with MetS meantime. Menopausal women with MetS had increased risk of CAS (OR, 2.383; 95% CI, 1.639–3.464), and the association was further verified by adjusting for confounding factors (OR, 1.949; 95% CI, 1.269–2.994). In addition, age, physical activity (never or moderate), body mass index (>24 kg/m2), and family income (<3,000 RMB) were independent important factors to CAS development in those with MetS.ConclusionMetS is associated with CAS especially in women after menopause.