Stability Of Carotid Atherosclerotic Plaque Research Articles

The value of Lp(a) and TG/HDLC in peripheral blood to assess the stability of carotid plaque in patients with ischemic stroke.

The objective of this study was to investigate the relationship between lipoprotein (a) (Lp(a)), triglyceride/high-density lipoprotein cholesterol (TG/HDL-C), and the stability of carotid atherosclerotic plaque in patients with acute ischemic stroke. A total of 142 patients with acute ischemic stroke were selected and divided into group A (59 cases of stable plaque formation) and group B (83 cases of unstable plaque formation) according to the characteristics of carotid artery plaque formation detected by carotid color Doppler ultrasound. The serum Lp(a), lipid metabolism indexes, peripheral blood routine indexes, and related serum inflammatory factors indexes were compared between the two groups. Receiver operating characteristic curve and multivariate logistic regression model were used to analyze the relationship between each index and the formation of carotid unstable plaque. There were no significant differences in serum total cholesterol (TC), HDL-C, and low-density lipoprotein cholesterol (LDL-C) between groups A and B (p > .05). The values of Lp(a), TG, and TG/HDL-C in group B were higher than those in group A, and the differences were statistically significant (p < .05). There were no significant differences in serum TC, HDL-C, and LDL-C between groups A and B (p > .05). The values of Lp(a), TG, and TG/HDL-C in group B were higher than those in group A, and the differences were statistically significant (p < .05). The values of HBA1C, Lp-PLA2, CRP, CysC, Hcy, TNF-α, neutrophils, and NLR in group B were higher than those in group A, and the differences were statistically significant (p < .05). There was no significant difference in FPG, systolic blood pressure, diastolic blood pressure, Hb, white blood cells, platelets, and lymphocytes between groups A and B (p > .05). The results of logistic regression model showed that the increase of Lp(a), TG/HDL-C, HBA1C, Lp-PLA2, CRP, CysC, Hcy, and NLR could increase the risk of carotid artery unstable plaque in patients with ischemic stroke (p < .05). Lp(a) and TG/HDL-C have certain value in evaluating the stability of carotid atherosclerotic plaque in patients with acute ischemic stroke, and the increased levels of LP (a) and TG/HDL-C will significantly increase the risk of carotid unstable plaque in patients.

Influence of ferroptosis indicators on the stability of atherosclerotic plaque.

Ferroptosis is a new form of cell death that is unique and closely related to iron concentration, and reactive oxygen species (ROS) production. We investigated the indicators of ferroptosis between vulnerable plaque and stable plaque in atherosclerotic. Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting were used to detect the expression of the ferroptosis-related genes and proteins and extracellular matrix stability-related genes and proteins (FN, CoL-1). Superoxide dismutase (SOD) activities, glutathione peroxidase (GSH) and malondialdehyde (MDA) were detected by ELISA. The commercially available kit was used to detect Fe2+ concentration in tissue. DCFH-DA fluorescent probe was used to detect the ROS levels. H&E stain, Masson trichrome stain, and Oil Red O stain were used to detect pathological states in vulnerable plaque and stable plaque. Tissue localization and positive rate of GPX4, SLC7A11, COX-2, FN, and COL-1 were evaluated by immunohistochemistry. The results showed a significant increase in the expression of COX2 and a significant decrease in the expression of GPX4 and SLC7A11 in genes related to ferroptosis in vulnerable plaque compared with stable plaque. Pathologic results showed vulnerable plaque with higher levels of inflammatory cell infiltration, more diffuse collagen fibers, and larger particles of lipid droplets. Concentrations of the antioxidant metabolites SOD and GSH were significantly reduced and concentrations of the oxidative metabolites MDA and Fe2+ were significantly increased in vulnerable plaque compared with stable plaque. The expression of FN and CoL-1 was significantly reduced in genes related to extracellular matrix stability in vulnerable plaque. Taken together, these findings indicate that the degree of ferroptosis in vulnerable plaque is higher than that in stable plaque, suggesting that changes in indicators of ferroptosis may affect carotid atherosclerotic plaque stability, target spot in the ferroptosis signaling pathway may provide further theoretical basis for the clinical treatment of carotid atherosclerosis.

Serum ANGPTL4 and SIRT1 factor levels and the Carotid Atherosclerotic plaque stability relationship analysis.

This study was to investigate the relationship between the levels of Angiopoietin-Like Protein 4 (ANGPTL4) and Silent Mating-type Information Regulation 2 Homolog 1 (SIRT1) and the stability of carotid atherosclerotic plaque. For this purpose, 108 patients with coronary heart disease in our hospital from Jan 2021 to May 2022 were selected as the coronary heart disease (CHD) group and 80 patients with the healthy examination as the control group. Patients' serum levels of ANGPTL4 and SIRT1 were collected, and their stability of carotid atherosclerotic plaque was determined by carotid ultrasound. According to their stability results, patients were divided into three subgroups: No plaque, Stable plaque, and Unstable plaque. The serum ANGPTL4 and SIRT1 levels were analyzed in different groups, and the correlation between their serum levels and the stability of carotid atherosclerotic plaque was analyzed by rank correlation. Results showed that the CHD group's serum ANGPTL4 and SIRT1 levels were lower, with statistical significance (P<0.05); A statistically significant difference in serum ANGPTL4 and SIRT1 levels were observed among patients with No plaques, Stable plaques, and Unstable plaques (P<0.05); A negative correlation was observed between serum levels of ANGPTL4 and SIRT1 and the stability of carotid atherosclerotic plaque (r=-0.438, -0.717, P<0.001); Serum ANGPTL4 and SIRT1 can be used as the evaluation method of carotid atherosclerotic plaque stability. When ANGPTL4 ≤ 30.17mg/L and SIRT1 ≤ 6.91μg/L, patients were more likely to develop unstable plaques; When ANGPTL4 ≤ 30.40mg/L and SIRT1 ≤ 6.87μg/L, patients were more likely to develop plaques (instability and/or stability). In conclusion, the serum levels of ANGPTL4 and SIRT1 in patients with CHD decreased. ANGPTL4 and SIRT1 will participate in the formation and development of carotid plaque, which can be used as a serological evaluation index to evaluate the occurrence and carotid atherosclerotic plaque's stability.

CCL3 and CCL5 as potential markers of carotid atherosclerotic plaque stability – preliminary research

Introduction: Carotid atherosclerosis is one of the main causes of ischaemic stroke. The study verified the hypothesis on the relationship between the expression of selected inflammatory markers and the stability of atherosclerotic plaque in stroke patients. Aim: The aim of the study was to determine CCL3 and CCL5 levels in both plasma and carotid atherosclerotic plaques in relation to the history of ischaemic stroke, as well as to assess plaque morphology and stability. Materials and methods: The levels of CCL3 and CCL5 chemokines were determined by ELISA for both plasma and supernatants of atherosclerotic plaque homogenates from patients undergoing endarterectomy due to at least 70% carotid artery stenosis. Results: Both chemokines were found in atherosclerotic plaques, with elevated CCL3 in unstable plaques. Furthermore, patients with atherosclerosis showed significantly higher plasma CCL5 compared to healthy individuals. Conclusions: The chemokines CCL3 and CCL5 are likely to be involved in the inflammatory processes contributing to the development of atherosclerotic plaque, but this needs to be confirmed in further studies.

Contribution of FBLN5 to Unstable Plaques in Carotid Atherosclerosis via mir128 and mir532–3p Based on Bioinformatics Prediction and Validation

FBLN5, a member of the short fibulins in the fibulin family of extracellular matrix/matricellular proteins, is involved in interactions with components of the basement membrane and extracellular matrix proteins. It plays key roles in endothelial tissues in many vascular diseases. In this study, the relationship between FBLN5 and carotid atherosclerotic plaque stability as well as the regulatory roles of miRNAs were evaluated. Differential gene expression analyses and weighted gene co-expression network analysis (WGCNA) based on the GSE163154 dataset (including 16 samples without intraplaque hemorrhage and 27 samples with intraplaque hemorrhage) in GEO revealed that FBLN5 is related to plaque stability and is the most significantly differentially expressed gene. LASSO regression was used to evaluate genes obtained from the intersection of differentially expressed genes and clinically significant modules identified by WGCNA. A prediction model based on eight genes, including FBLN5, was constructed and showed an accuracy of 0.951 based on an ROC analysis. Low FBLN5 expression in plaque tissues was confirmed by immunohistochemistry and western blotting. GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) enrichment analyses showed that FBLN5 acted mainly by the maintenance of the cellular matrix and reactive oxygen species production. miRNAs upstream of these eight predictive genes, including FBLN5, were identified and used to construct a network diagram. These results revealed that hsa-mir-128 and hsa-mir-532–3p were upstream regulatory factors of FBLN5, as verified by PCR assays of human plaque tissues demonstrating that both miRNAs were significantly up-regulated. Therefore, FBLN5 may play an important role in carotid atherosclerosis via hsa-mir-128 and hsa-mir-532–3p as well as become an essential target for treatment.

Correlation between neutrophil-to-lymphocyte ratio and stability of carotid plaques

ObjectiveThe neutrophil-to-lymphocyte ratio (NLR) has been proved to be a strong predictor of carotid atherosclerotic plaque, but the correlation between NLR and the stability of carotid plaque is not clear. Thus we conducted a study to evaluate the correlation between NLR and the stability of carotid atherosclerotic plaque, and to develop a new evaluation scale for rapid clinical evaluation of carotid plaque stability. MethodsWe recruited 528 patients with acute anterior circulation ischemic stroke who were in accordance with extracranial and intracranial large artery atherosclerosis of Chinese ischemic stroke subtype. Blood routine examination and carotid ultrasound examination were performed on admission. According to the ultrasonic characteristics, the patients were divided into plaque stabilization group and plaque instability group. ResultsThere was significant difference in NLR between plaque stability and instability groups (P < 0.001). The risk of plaque instability increased with the increase of NLR (odds ratio (OR), 4.737; 95% confidence interval (CI), 3.404–6.592; P < 0.001). Receiver operating characteristic (ROC) curve showed that the critical point of NLR is 2.55 and the area under the curve (AUC) was 0.782 (95%CI, 0.740–0.823; P < 0.001). The best cut-off value of the evaluation scale was ≥ 4 points (sensitivity, 0.77; specificity, 0.75; accuracy, 0.76). ConclusionThere is a correlation between NLR and carotid plaque instability. NLR may be useful as a potential inflammation biomarker indicating the risk of unstable carotid plaques. The new scoring scale is a reliable index to predict the stability of carotid plaque.

Reduction of TMAO level enhances the stability of carotid atherosclerotic plaque through promoting macrophage M2 polarization and efferocytosis.

It has been demonstrated that trimethylamine N-oxide (TMAO) serves as a driver of atherosclerosis, suggesting that reduction of TMAO level might be a potent method to prevent the progression of atherosclerosis. Herein, we explored the role of TMAO in the stability of carotid atherosclerotic plaques and disclosed the underlying mechanisms. The unstable carotid artery plaque models were established in C57/BL6 mice. L-carnitine (LCA) and methimazole (MMI) administration were applied to increase and reduce TMAO levels. Hematoxylin and eosin (H&E) staining, Sirius red, Perl’s staining, Masson trichrome staining and immunohistochemical staining with CD68 staining were used for histopathology analysis of the carotid artery plaque. M1 and M2 macrophagocyte markers were assessed by RT-PCR to determine the polarization of RAW264.7 cells. MMI administration for 2 weeks significantly decreased the plaque area, increased the thickness of the fibrous cap and reduced the size of the necrotic lipid cores, whereas 5-week of administration of MMI induced intraplate hemorrhage. LCA treatment further deteriorated the carotid atherosclerotic plaque but with no significant difference. In mechanism, we found that TMAO treatment impaired the M2 polarization and efferocytosis of RAW264.7 cells with no obvious effect on the M1 polarization. In conclusion, the present study demonstrated that TMAO reduction enhanced the stability of carotid atherosclerotic plaque through promoting macrophage M2 polarization and efferocytosis.

One Year on: Test Your Knowledge From November 2019

1. The current gold-standard method to investigate carotid atherosclerotic plaque stability is performed through histological assessment of plaque features using semi-quantitative classifications. What is the advantage of quantitative image analysis methods over traditional semi-quantitative methods for histological/pathological assessment?1A.More rapid processB.Based solely on visual estimationC.Increased inter-individual variabilityD.Improvement of pathologic interpretation biasE.Does not need manual evaluation

Characteristics of the carotid plaque in hypertensive patients with hyperhomocysteinemia using multimode ultrasound

BackgroundIschemic stroke is related to the level of total homocysteine and the stability of carotid atherosclerotic plaque. In this study, the characteristics of carotid plaque in hypertensive patients with hyperhomocysteinemia were preliminarily studied by conventional ultrasound, contrast-enhanced ultrasound and virtual touch image quantification. MethodsHypertensive patients (n=196) hospitalised in the Department of Neurology and Cardiology of our hospital from April 2016 to February 2019 were studied to compare and analyse differences in general clinical data, conventional ultrasound, contrast-enhanced ultrasound and virtual touch image quantification between hypertension with hyperhomocysteinemia and hypertension with normal tHcy. Results1. There was no statistical difference in other clinical data, except fasting blood sugar (P=0.021) and the history of cerebral infarction (P=0.0001). 2. There were significant differences in plaque thickness, stenosis degree, contrast-enhanced ultrasound level, The maximum shear wave velocity (SWVmax) , the minimum shear wave velocity (SWVmin) and the mean shear wave velocity (SWVmean) (P<0.05), except intima-media thickness between the two groups (t=0.160, P=0.873). 3. Blood tHcy level in hypertensive patients with hyperhomocysteinemia was positively correlated with carotid plaque thickness, stenosis degree and contrast-enhanced ultrasound level (r=0.349, 0.647, 0.421), but negatively correlated with SWVmax, SWVmin and SWVmean (r=−0.348, −0.409, −0.393). ConclusionsUltrasonography can reflect the vulnerability of hypertensive patients with hyperhomocysteinemia, providing reliable and comprehensive information for the prevention and treatment of stroke in hypertensive patients with hyperhomocysteinemia.

Study on the Correlation between apolipoprotein and homocysteine levels with carotid atherosclerotic plaque stability and degree of stenosis

Objective To investigate the correlation between apolipoprotein and homocysteine levels with the stability of carotid plaque and the degree of stenosis. Methods One hundred elderly patients with acute cerebral infarction from January 2017 to December 2017 were collected continuously in Harbin Fourth Hospital, All patients underwent color Doppler ultrasound examination of carotid artery.They were divided into stable plaque group and unstable plaque group according to the results of color Doppler ultrasound, then according to the degree of stenosis they were divided into intimal thickening group with 23 cases, mild stenosis (stenosis degree<50%) with 26 cases, moderate stenosis group (50%≤stenosis degree<70%) with 28 cases, severe stenosis group (70%≤stenosis degree) with 23 cases.All the patients were selected to collect the blood of the elbow in the early morning to detect the level of apolipoprotein B and Hcy. Results Compared with unstable plaque group, smoking, drinking, hemoglobin A1c (HbA1c), ApoB and Hcy had significant differences (all P 0.05). Multivariate logistic regression was performed after correcting the related risk factors excluding blood lipids.The results showed that alcohol (OR=1.247(95%CI: 0.626-1.958), P=0.043), Hcy (OR=3.163(95%CI: 1.824-4.772), P=0.045), bloodpressure (OR=1.286(95%CI: 0.688-2.005), P=0.027), HbA1c (OR=3.671(95%CI: 1.904-6.630), P=0.011), ApoB (OR=1.717(95%CI: 1.005-2.634), P=0.036), LDL-C(OR=1.516(95%CI: 0.968-2.489), P=0.024), TC(OR=1.403(95%CI: 0.801-2.343), P=0.030) and TG (OR=1.342(95%CI: 0.712-2.198), P=0.019) are independent risk factors for unstablecarotid plaque and severe carotid stenosis. Conclusion Apolipoprotein and homocysteine may be independent predictors of unstable carotid plaque and severity of carotid stenosis. Key words: Apolipoprotein; Homocysteine; Carotid atherosclerotic plaque

Correlation between of small dense low-density lipoprotein cholesterol with acute cerebral infarction and carotid atherosclerotic plaque stability.

BackgroundAcute cerebral infarction (ACI) is seriously harmful to human health worldwide. However, at present, the risk of disease onset is still not accurately predicted for some people.MethodsFive hundred and nineteen patients with ACI and 300 healthy controls were included in this study. We divided the patients into three groups according to the results of cervical artery contrast‐enhanced ultrasound. Ninety‐five patients were in the CAS without plaque group, 108 patients were in the stable plaque group, and 316 patients were in the unstable plaque group. TC, TG, HDL‐C, LDL‐C, and sdLDL‐C were measured in all subjects.ResultsThe level of small dense low‐density lipoprotein cholesterol (sdLDL‐C) in the ACI group was significantly higher than that in the control group (P < 0.001). Logistic regression analysis showed that sdLDL‐C was an independent risk factor for ACI (OR = 1.067, 95% CI: 1.041‐1.093, P < 0.001); serum sdLDL‐C was significantly higher in the unstable plaque group than in the stable plaque group and plaque‐free group (P < 0.05, P < 0.001); serum sdLDL‐C was also higher in the stable plaque group than the plaque‐free group (P < 0.001). Logistic regression analysis showed that sdLDL‐C was an independent risk factor for unstable carotid plaques (OR = 1.053, 95% CI: 1.038‐1.068, P < 0.001); Spearman correlation analysis showed that sdLDL‐C test results were positively correlated with carotid plaque stability (r = 0.363, P < 0.001).ConclusionSmall dense low‐density lipoprotein cholesterol is an independent risk factor for the onset of ACI and may be an early serum marker for this disease.

Relevance research on carotid atherosclerosis and levels of serum cathepsin K and cystatin C on patients with ischemic cerebral vascular disease

The relationship between carotid atherosclerosis (AS) and levels of serum cathepsin K (CatK) and cystatin C (CysC) on patients with ischemic cerebral vascular disease (ICVD) was explored. In total, 266 patients with ICVD who were admitted in our hospital were enrolled. According to the results of carotid ultrasound, they were randomly divided into plaque group (n = 133) and control group (n = 133). According to atherosclerotic plaque type distribution, the plaque group was divided into stable plaque group and unstable group. The relationship between levels of serum CatK and CysC of two groups and carotid AS indicator (such as intima-media thickness (IMT)) were analyzed with Spearman’s correlation. Spearman’s correlation analysis showed that IMT level was positively correlated with stability of carotid atherosclerotic plaque ( P &lt; 0.05). The level of serum CatK in plaque group was significantly higher than control group, and the level of serum CysC in plaque group was significantly lower than control group ( P &lt; 0.05); the level of serum CatK in unstable plaque group was significantly higher than stable plaque group, and the level of serum CysC in unstable plaque group was significantly lower than stable plaque group ( P &lt; 0.05). Serum CatK and IMT levels were positively correlated, and serum CysC and CatK levels were negatively correlated ( P &lt; 0.05). CatK and CysC levels may be used as serum markers for predicting carotid AS plaque instability, providing a new observational index for prevention and treatment of ICVD caused by carotid AS plaque.

Association of blood glucose control with carotid plaque and pulse wave velocity in elderly patients with type 2 diabetes mellitus

Objective To investigate the correlation of glycosylated hemoglobin(HbA1C)levels with carotid atherosclerotic plaque and pulse wave velocity (PWV) in elderly patients with type 2 diabetes mellitus (T2DM). Methods There were 130 cases of elderly patients with T2DM, aged from 60 to 92 years, of whom there were 59 males.All subjects were divided into 3 groups based on the HbA1C levels: the low level group (HbA1C<7%, n=49), the middle level group (7%≤HbA1C<8.5%, n=58)and the high level group (HbA1C≥8.5%, n=23). Height, body weight, blood pressure, blood glucose, blood lipids, HbA1C and other indexes were collected and compared among groups.In addition, carotid ultrasound and PWV examinations were performed. Results There were significant difference in levels of systolic blood pressure (SBP), fasting blood glucose (FBG), high density lipoprotein cholesterol (HDL-C), carotid intima-media thickness (IMT), plaque score, plaque stability and PWV among groups (all P<0.05). Correlation analysis showed that IMT levels were correlated with gender (r=0.389), age (r=0.296), FBG (r=0.203), HbA1C (r=0.405) and HDL-C (r=-0.208), all P<0.05.Carotid artery plaque score correlated with gender (r=0.321), age (r=0.355), HbA1C (r=0.340) and HDL-C (r=-0.249) (all P<0.01)and there is a correlation between the stability of carotid plaques with body mass index (BMI) (r=-0.286), SBP (r=-0.188), HbA1C (r=-0.368) and HDL-C (r=0.405) (all P<0.05); PWV was correlated with age (r=0.516), SBP (r=0.521), diastolic blood pressure (r=0.225), FBG (r=0.181), HbA1C (r=0.229), triglyceride (r=-0.253), total cholesterol (r=-0.311) and LDL-C (r=-0.244), all P<0.05.Moreover, there was a correlation between IMT and PWV (r=0.234, P<0.01). Logistic regression analysis showed that gender, age and HbA1C were independently associated with IMT; gender, age, BMI and HbA1C were independently associated with carotid atherosclerosis plaque score; age, HbA1C and HDL-C were independently associated with the stability of carotid atherosclerotic plaque; age and SBP were independently associated with PWV. Conclusions HbA1C, SBP, HDL-C and BMI are independent risk factors for arteriosclerosis in elderly diabetics. Key words: diabetes mellitus, type 2; Carotid stenosis; Tunica media

Clinical values of serum visfatin and thrombus precursor protein in the diagnosis of lacunar infarction

Objective To explore the changes of serum visfatin and thrombus precursor protein(TpP) levels in patients with lacunar infarction, and the relationship with carotid atherosclerotic plaque, and to determine the values of the two factors to predict lacunar infarction. Methods Carotid atherosclerosis plaques were detected in 95 cases with lacunar infarction, including 56 cases in unstable plaque group, 39 cases in stable plaque group, and another 70 healthy persons were selected as control group.Serum visfatin, high-sensitivity C reactive protein(hs-CRP), interleukin-6(IL-6) and TpP levels were measured.The carotid atherosclerotic plaque was examined by color Doppler ultrasonography. Results The levels of visfatin, hs-CRP and IL-6 in the unstable plaque group and stable plaque group were higher than those in the control group(t=10.886, 9.180, 11.889, 4.990, 5.084, 9.703, all P<0.05). The levels of visfatin, hs-CRP and IL-6 in the unstable plaque group were (29.10±8.85)μg/L, (6.15±2.78)mg/L and (5.98±2.66)pg/mL, respectively, which were higher than those in the stable plaque group [(21.47±8.39)μg/L, (4.37±2.09)mg/L and (4.64±2.03)pg/mL, t=4.222, 3.385, 2.652, all P<0.05]. Pearson linear correlation analysis and multiple linear stepwise regression analysis showed that serum visfatin levels were positively correlated with hs-CRP and IL-6.The TpP levels of 3h, 6h and 12h after cerebral infarction in the unstable plaque group and stable plaque group were higher than those in the control group(t=17.342, 21.770, 18.138, 11.228, 15.245, 14.306, all P<0.05). The TpP levels of 3h, 6h and 12h after cerebral infarction in the unstable plaque group were (18.52±6.43)mg/L, (25.95±7.98)mg/L, (18.43±6.10)mg/L, respectively, which were higher than those in the stable plaque group[(12.40±5.37)mg/L, (20.81±8.60)mg/L, (13.86±5.04)mg/L, t=3.282, 2.991, 3.850, all P<0.05]. Conclusion The serum levels of visfatin and TpP are highly specific, can be used as important indicators for prediction and diagnosis of lacunar infarction, and they are related to the stability of carotid atherosclerotic plaque. Key words: Lacunar infarction; Serum visfatin; Thrombus precursor protein; Carotid atherosclerotic plaque

Serum lipoprotein-associated phospholipase A2 predicts the formation of carotid artery plaque and its vulnerability in anterior circulation cerebral infarction

ObjectiveCirculation inflammation markers such as high-sensitive C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) are considered as predictors of cerebral and cardiac vascular diseases. However, the role of hsCRP and Lp-PLA2 in the anterior circulation cerebral infarction (ACI) is to be elaborated. Patients and methodsWe included 100 patients with acute anterior circulation cerebral infarction (AaCI group) and 50 non-infarction subjects (control group). Carotid artery was detected by color Doppler ultrasound. Subjects were grouped based on carotid intima-media thickness (IMT) and degree of stability of carotid atherosclerotic plaque. The levels of hsCRP and Lp-PLA2 were measured in corresponding groups and the association was analyzed. ResultshsCRP and Lp-PLA2 levels were the risk factors for AaCI. With the increment of carotid IMT and degree of plaque instability, the level of hsCRP and Lp-PLA2 showed an elevating tendency. hsCRP and Lp-PLA2 levels were significantly higher in plaque formation group than in IMT normal group (P=0.002 and P=0.001, respectively). hsCRP and Lp-PLA2 levels were significantly higher in vulnerable plaque group than in mixed plaque group and stable plaque group (P=0.003, P<0.001 for hsCRP and P<0.001, P<0.001 for Lp-PLA2). Lp-PLA2 was finally included in the atherosclerotic plaque model (OR=1.019, 95% confidence interval (CI): 1.003–1.035, P=0.020) and vulnerable plaque model (OR=1.041, 95%CI: 1.017–1.065, P=0.001) by performing multivariate logistic regression analysis. The area under the ROC curve (AUC) of Lp-PLA2 levels for atherosclerotic plaque was 0.746 (95% CI: 0.628–0.865, P<0.001). The optimal cut-off value for Lp-PLA2 level was 267.5ng/ml, and its sensitivity and specificity for diagnosis of atherosclerotic plaque were 70.8% and 67.1%, respectively. ConclusionsThe current study demonstrates that hsCRP and Lp-PLA2 are among the risk factors for AaCI. Elevated hsCRP and Lp-PLA2 are associated with carotid plaque formation. Univariate and multivariate logistic regression analysis suggests that elevated Lp-PLA2 is the independent risk factor for carotid plaque and its vulnerability.

Association between serum γ-glutamyltransferase and the stability of carotid atherosclerotic plaque

Objective To investigate the relation between the level of serum γ-glutamyltransferase (GGT) and the stability of carotid atherosclerotic plaque. Methods A total of 1032 patients with carotid atherosclerotic plaques were divided into stable plaque group (N = 511) and unstable plaque group (N = 521) according to the results of carotid artery Doppler ultrasound examination. Risk factors for unstable carotid plaques were screened by univariate and multivariate forward Logistic regression analysis. Results Compared with patients with stable plaques, percentage of males ( P = 0.000), proportion of smoking history ( P = 0.000), the serum levels of triglyceride (TG, P = 0.002), low-density lipoprotein cholesterol (LDL-C, P = 0.008) and GGT ( P = 0.000) increased significantly, while age ( P = 0.000) and serum high-density lipoprotein cholesterol level (HDL-C, P = 0.032) decreased significantly in patients with unstable plaques. Univariate and multivariate forward Logistic regression analysis showed that sex ( OR = 1.516, 95%CI: 1.170-1.964; P = 0.002), smoking history ( OR = 1.447, 95% CI: 1.085-1.930; P = 0.012), serum TG ( OR = 1.127, 95% CI: 1.032-1.231; P = 0.008), serum LDL-C ( OR = 1.235, 95%CI: 1.069-1.426; P = 0.004) and serum GGT ( OR = 1.012, 95%CI: 1.006-1.019; P = 0.000) were independent risk factors for the occurrence of unstable carotid plaques. Conclusions Elevation of serum GGT level is a risk factor for unstable carotid plaques. DOI: 10.3969/j.issn.1672-6731.2016.03.011

Evaluation of the stability of carotid atherosclerotic plaque with contrast-enhanced ultrasound.

The aim of this study is to determine the stability of carotid atherosclerotic plaque (CAP) using contrast-enhanced ultrasound (CEUS). CEUS images of 93 patients were evaluated to observe new vessels within CAPs. Microembolic signals (MES) were detected using transcranial Doppler (TCD). Thirty-four patients with hyperechoic plaques were evaluated as the control group. Eighty percent (75/93) of plaques showed contrast enhancement on CEUS, including 50.7% (38/75) of hypoechoic plaques and 49.3% (37/75) of mixed echoic plaques. No plaques in the control group showed enhancement on CEUS. With TCD, 35.5% (33/93) of patients were positive for MES. Plaques with grade 2 or 3 enhancement on CEUS had a higher positive rate for MES. Forty-one patients with grade 2 or 3 enhancement on CEUS presented with fresh infarctions confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). In conclusion, grade 2 or 3 contrast enhancement observed on CEUS indicated vulnerable plaques.

A numerical study of the effect of varied blood pressure on the stability of carotid atherosclerotic plaque.

BackgroundBlood pressure (BP) is associated with early atherosclerosis and plaque rupture because the BP variability can significantly affect the blood flow velocity and shear stress over the plaque. However, the mechanical response of BP variability to the plaque remains unclear. Therefore, we investigated the correlation between different maximum systolic blood pressure (SBP) and the stress distribution on plaque, as well as the stress over the plaque and blood velocity around the plaque using different BP variations, which are the BP variability in different phases during one cardiac cycle and beat-to-beat BP variability.MethodWe established a two-dimensional artery model with stenosis at the degree of 62.5%. Eight combinations of pulsatile pressure gradients between the inflow and outflow were implemented at the model. Three levels of fibrous cap thickness were taken into consideration to investigate the additional effect on the BP variability. Wall shear stress and stress/strain distribution over the plaque were derived as well as the oscillation shear index (OSI) to analyze the impact of the changing rate of BP.ResultThe stresses at diastole were 2.5% ± 1.8% lower than that at systole under the same pressure drop during one cycle. It was also found that elevated SBP might cause the immediate increment of stress in the present cycle (292% ± 72.3%), but slight reduction in the successive cycle (0.48% ± 0.4%).ConclusionThe stress/strain distribution over the plaque is sensitive to the BP variability during one cardiac cycle, and the beat-to-beat BP variability could cause considerable impact on the progression of atherosclerosis in long-term.

The observation on the effect of the joint treatment containing single sialic acid four hexose gangliosides, clopidogrel, atorvastatin in the treatment of cerebral infarction

Objective To observe the effect of the joint treatment containing single sialic acid four hexose gangliosides,clopidogrel,atorvastatin in the treatment of cerebral infarction.Methods 88 acute cerebral infarction patients met the inclusion criteria were randomly divided into the observation group of 44 cases and the control group of 44 cases.The control group were given clopidogrel and atorvastatin,and the observation group were give single sialic acid four hexose gangliosides on the base of the control group,100mg/time,qd,4 week for a course.The symptoms before and after treatment were observed.The NIHSS and ADL score were calculated.Blood lipids,CRP,IMT was inspected.Results The total effective rate of the observation group was 90.91％,the control group was 77.27％,the observation group was significantly higher than the control group (x2 =11.967,P ＜ 0.05) ; the TC,TG,LDL-C,HDL-C,CRP,IMT,ADL,NIHSS of both group after treatment were significantly improved than before treatment,there were a statistically significant differences (all P ＜ 0.05).After treatment,the TC,TG,LDL-C,HDL-C,CRP,IMT,ADL NIHSS of observation group and the group were (4.06/ ± 0.98) mmol/L vs (4.18 t 1.02) mmol/L,(1.35 ±0.73)mmol/L vs (1.42 ±0.81)mmol/L,(1.68 ±0.82) mmol/L vs (1.74 ±0.85)mmol/L,(1.44 ±0.58) mmol/L vs (1.41 ±0.52)mmol/L,(40.55 ±3.12)mg/L vs (47.27 ±3.57)mg/L,(0.78 ±0.08)mm vs (0.87 ±0.09)mm,(28.9 ± 11.3) scores vs (22.3 ± 10.0) scores,(8.2 ± 5.3) scores vs (15.5 ± 6.2) scores.the CRP,IMT,ADL,NIHSS of observation group were improved more significantly than the control group,the differences were statistically significant(all P ＜ 0.05).Conclusion Jointing treatment containing single sialic acid four hexose gangliosides,clopidogrel,atorvastatin can improve significantly lipid levels,inhibit platelet aggregation,make a stability of carotid atherosclerotic plaque,improve activities of daily living and neurological deficit,but also can prevent secondary brain damage after traumatic brain injury,which is the ideal solution for the treatment of cerebral infarction. Key words: Single sialic acid four hexose ganglioside ; Clopidogrel; Atorvastatin; Cerebral infarction

High-resolution MR study of the relationship between superficial calcification and the stability of carotid atherosclerotic plaque

In this study, we have aimed to evaluate the relationship between the shape and location of superficial calcification and the presence of fibrous cap rupture and intraplaque hemorrhage in atherosclerotic carotid plaque. Sixty-three patients with carotid stenosis underwent contrast-enhanced high resolution MR examinations with a 3-T MR scanner and 226 slices with superficial calcification were evaluated in the study. The shape of superficial calcification was categorized as the irregular type (dotted/arcuated) and patchy type and the location of superficial calcification was categorized as the marginal type and central type. Intraplaque hemorrhage and fibrous cap rupture depicted on the same slice as superficial calcification were identified. The chi-squared test was used for statistical analysis. A total of 149 slices (65.9%) with intraplaque hemorrhage and 107 slices(47.3%)with fibrous cap rupture were detected. There were 191 slices with irregular type (dotted/arcuated) calcification and 166 slices with marginal type calcification. Irregular superficial calcification was found more frequently accompanied with intraplaque hemorrhage as compared to the patchy type (73.8 vs. 22.9%, P < 0.0001); there was a significant difference between the marginal type and the central type for the accompaniment of intraplaque hemorrhage (72.9 vs. 46.7%, P < 0.05). However, there was no significant difference between different shapes and locations of superficial calcification that accompanied with fibrous cap rupture (P > 0.05). This study showed that superficial calcification is an important factor for determination of instability of atherosclerotic carotid plaque. The shape and location of superficial calcification are important features associated with the occurrence of intraplaque hemorrhage.