Carotid Sclerosis Research Articles

Relationship between carotid intima-media thickness (cIMT) and dual-system imbalance in tobacco dependence: An rs-fMRI research.

According to the classic cognitive behavioral theory proposes, dysfunctional goal-directed and habit control systems are considered central to the pathogenesis of dependent behavior and impair recovery from addictions. The functional connectivity (FC) of the brain circuits for goal-directed or habitual behavior has not been clearly reported in tobacco-dependent groups. Smoking is one of the factors in the formation of atherosclerosis. Studies have shown that the thickness of carotid intima-media (cIMT) is associated with attention-executive-psychomotor functioning. Therefore, we hypothesized whether cIMT in tobacco-dependent individuals is associated with changes in the FC of the dual-system network. A total of 29 male tobacco-dependent subjects (tobacco-dependent group) (mean age: 64.20 years, standard deviation [SD]: 4.81 years) underwent resting-state functional magnetic resonance imaging (rs-fMRI). Exactly 28 male nonsmokers (control group) (mean age: 61.95 years, SD: 5.52 years) were also recruited to undergo rs-fMRI. We used the dorsolateral striatum (putamen) and dorsomedial striatum (caudate) as regions of interest for whole-brain resting-state connectivity to construct habitual and goal-directed brain networks, respectively. In addition, all participants were evaluated by carotid artery ultrasound to obtain the cIMT values. Then, we compared the dual-system brain networks between the tobacco dependence and control groups and the relationship between cIMT and imbalance of dual-system brain networks in tobacco dependence. The results showed a reduction in the connection between the caudate and precuneus and an increased connection between the putamen and prefrontal cortex; and supplementary motor area. The bilateral connectivity between the caudate and inferior frontal gyrus showed a significant negative correlation with the cIMT, and no positive correlation was observed with cIMT in the brain region that connects to the caudate. However, for the putamen, increased connectivity with the inferior temporal and medial frontal gyri was strongly associated with a high cIMT. The results indicate that the formation of tobacco dependence behavior is related to changes in the dual-system brain network. Carotid sclerosis is associated with the weakening of the goal-directed network and enhancement of the habit network in tobacco dependence. This finding suggests that tobacco dependence behavior and clinical vascular diseases are related to changes in brain functional networks.

Analysis of risk factors of cerebral infarction in young adults and its correlation with TOAST types

Objective To explore the risk factors of youth cerebral infarction and its correlation with clinical TOAST types. Methods 82 young patients with acute cerebral infarction(aged from 18 to 45 years old) were selected.The risk factors for youth cerebral infarction patients, and the proportion of TOAST subtype and related risk factors were analyzed. Results Risk factors for youth cerebral infarction were as follows: hyperlipidemia (χ2=48.703, P<0.05), hypertension (χ2=40.829, P<0.05), carotid sclerosis (χ2=46.217, P<0.05), hyperhomocysteinemia (χ2=40.255, P<0.05), smoking history (χ2=7.853, P<0.05), diabetes (χ2=18.256, P<0.05) and family history (χ2=5.944, P<0.05), heart disease (χ2=5.754, P<0.05). The proportion of their TOAST subtypes were as following: small artery occlusion lacunar(SAD)(39.0%), large artery atherosclerosis(LAA)(24.4%), stroke of other undetemined etiology(SUE)(17.0%), and acute stroke of other detemined etiology(SOE)(12.2%), cardioembolism(CE) type(7.3%). Major risk factors for LAA subtype included hyperlipidemia, hypertension and carotid atherosclerosis; Major risk factor for SUE subtype was hyperhomocysteinemia; Major risk factors for SOE included hypertension, diabetes.Major risk factor for CE subtype was heart disease. Conclusion The highest proportion of TOAST types in youth cerebral infarction group is small artery occlusion lacunar.Major risk factors for this group of youth cerebral infarction are as follows: hypertension, carotid atherosclerosis, heart disease, diabetes, hyperhomocysteinemia, obesity, smoking and family history, and these risk factors should be actively intervened. Key words: Cerebral infarction; Youth; TOAST types; Risk factors

Abstract 16784: Incidence of Cerebral Infarction is Relatively Low in Japanses Patients With Severe Carotid Sclerosis

There have been few reports on prognosis of severe carotid sclerosis(SCS) in association with other cardiovascular disease(CVD).Then we evaluated new development or recurrence of cerebral infarction(CI) (Methods) Severe carotid sclerosis was diagnosed by carotid ultrasonography, and plaque score(PS) was calculated by summation of max thickness of each plaque. The 468 patients with severe carotid sclerosis(SCS: PS &gt;10)were studied and compared those with 262 patients with mild carotid sclerosis(MCS: PS 5). Patients with significant carotid stenosis (’50% in diameter)were excluded. We evaluated hypertension, diabetes mellitus, dyslipidemia and smoking history as risk factors for arteriosclerosis. (Results) In patients with SCS, mean age was 74.7±9.2(mean±SD), and mean PS was13.8. Cerebral infarction(CI) was observed in 114 patients(24.3%). Cardiovascular disease including peripheral artery disease was observed in 158(33.8 %), and coronary artery disease(CAD) only was observed in 124 (26.4 %). In patients with MCS, mean age was 69.5±8.6, and mean PS was 3.82. CI was observed in 28 patients(10.69%)(P 0.0001 vs SCS)Cardiovascular disease was observed in 26 patients(9.92%),and coronary artery disease(CAD) only was observed in 20(7.63%)(P 0001 vs SCS) . In 3 year follow up, CI developed in 13 (2.78%) out of 468 with SCS, and in 4(1.53%) out of 262 patients with MCS. Antiplatelet therapy had been done in 48% of patients with SCS and in 12% of MCS. There was no difference in percentage of antiplatelet therapy between patients with new CI and those without. All patients who developed CI had other cardiovascular disease. Mean number of RF was 2.7±1.0 in patients who developed CI and 2.5±0.9 in those who did not. Conclusions. Incidence of CAD or CI was greater in patients with SCS than in those with MCS. At 3 year follow up of patients with CS, CI did develop more commonly in patients with SCS than in those with MCS, but the difference was not significant. When patient has not severe carotid stenosis, risk of new development or recurrence of CI is very low in Japanese patients with SCS. Presence of poly vascular lesions may be major risk for CI.

Three-Year Longitudinal Clinical Trial of Arterial Function Assessed by a Oscillometric Non-Invasive Method in Comparison With Carotid Sclerosis and Transferrin Kidney-Transplanted Patients

Chronic kidney disease remains one of the main risk factors of cardiovascular disease. However, patients with kidney transplantation have better life expectancy and better quality of life compared with patients on dialysis. In patients with a well-functioning graft, the main cause of death is cardiovascular in origin. Metabolic pathways have complex effects on arterial function that can be monitored by conventional ultrasonography and with the assessment of arterial stiffness by oscillometric non-invasive technique. Forty-one primer cadaver kidney–transplanted patient were involved in a 3-year longitudinal clinical trial (21 female, 20 male; average age, 40.16 ± 12.56 years). Arterial stiffness parameters referring to rigidity of the arterial wall (pulse wave velocity [PWV], augmentation index, and pulse pressure) were investigated. Correlation between stiffness, and laboratory parameters (serum creatinine, urea, hemoglobin, albumin, cholesterine, triglycerides, transferrin, uric acid, glomerular filtration rate, and C-reactive protein) were analyzed. A non-invasive oscillometric method—Tensiomed Arteriograph—was applied to assess the arterial stiffness parameters. Statistical analysis was performed with the use of Statistica for Windows, version 8.0. A value of P < .05 was considered statistically significant for all statistical tests. We found a positive correlation between PWV and left ventricular wall thickness and a negative correlation between PWV and ejection fraction. We also found a positive significant correlation between serum level of transferrin and PWV. There was simultaneous significant progression concerning PWV and carotid artery sclerosis in a 3-year follow-up. There was no fatal cardiovascular event during the study period among our patients. All of our patients involved in this study are still alive. Our findings suggest that arterial stiffness monitoring is a reliable method to assess global cardiovascular risk among kidney-transplanted patients. The oscillometric method is convenient, fast, painless technique to monitor arterial function, which, in the case of pathological findings, proposes more frequent cardiovascular control.

Effects of Carotid Endarterectomy on the Dynamics of Cognitive Impairments in Patients with Atherosclerotic Stenosis of the Carotid Arteries

The clinical and neurochemical characteristics of non-dementia cognitive disorders were studied in 102 patients with atherosclerotic carotid sclerosis, with assessment of their dynamics after carotid endarterectomy (CEAE). Mild cognitive disorders were seen in 37 patients (36.3 %) and moderate cognitive disorders in 36 patients (35.3 %). Moderate cognitive impairments were significantly more common in patients with symptoms of carotid stenosis, dominated by structural changes in the brain on neuroimaging (leukoaraiosis and infarcts); unstable atherosclerotic plaques, with a predominance of the hypodense component, were also more frequent. This suggests that cognitive dysfunction in patients with atherosclerotic carotid stenosis results not only from decreased perfusion, but also from arterio-arterial microembolism. CEAE was found to have favorable effects on cognitive functions. Positive changes were marked in patients with asymptomatic carotid stenosis. However, CEAE could also have adverse influences on cognitive functions in patients with moderate cognitive disorders of dysmnestic type and symptoms of carotid stenosis.

Hypertension in patients with peripheral arterial disease

Objective To analyse the frequency and the features of hypertension in high cardiovascular risk patients with peripheral arterial disease (PAD) in Algeria. Methods A multicenter and retrospective study in 2 Algerian areas (Algiers and Ghardaia) from June 2004 to May 2005 collecting 317 patients. Results Hypertension was observed in 209 patients (66%), and in 6% of them it was a revealing circumstance. Hypertension was associated to carotid sclerosis in 69 patients (35%), to coronary atherosclerosis in 35 patients (16.7%) and to kidney arteriosclerosis in 7 patients (3%). Hypertension treatment was prescribed to 137 patients (43%) but appears inadequate in 18 cases (6%) so the control of blood pressure was obtained in only 56 patients (26%). Discussion If we compare our results to the URCAM study (294 patients) we observed the same frequency of hypertension prevalence (URCAM: 60%) in peripheral PAD patients but we noted a significant difference of the frequency of carotid atherosclerosis (46% for URCAM), coronary atherosclerosis (39%) and kidney arthrosclerosis (31%) which appeared to be well detected. Conclusion Hypertension is narrowly linked with PAD in our study. The screening of other sides of atherosclerosis suffers from insufficient appropriate exploration. Our study showed an insufficiency to evaluate correctly and completely the polyvascular patients. So patients with hypertension must have an early exploration of atherosclerosis according to ESH/ESC recommendations including evaluation of the ankle brachial index. Objective To analyse the frequency and the features of hypertension in high cardiovascular risk patients with peripheral arterial disease (PAD) in Algeria. Methods A multicenter and retrospective study in 2 Algerian areas (Algiers and Ghardaia) from June 2004 to May 2005 collecting 317 patients. Results Hypertension was observed in 209 patients (66%), and in 6% of them it was a revealing circumstance. Hypertension was associated to carotid sclerosis in 69 patients (35%), to coronary atherosclerosis in 35 patients (16.7%) and to kidney arteriosclerosis in 7 patients (3%). Hypertension treatment was prescribed to 137 patients (43%) but appears inadequate in 18 cases (6%) so the control of blood pressure was obtained in only 56 patients (26%). Discussion If we compare our results to the URCAM study (294 patients) we observed the same frequency of hypertension prevalence (URCAM: 60%) in peripheral PAD patients but we noted a significant difference of the frequency of carotid atherosclerosis (46% for URCAM), coronary atherosclerosis (39%) and kidney arthrosclerosis (31%) which appeared to be well detected. Conclusion Hypertension is narrowly linked with PAD in our study. The screening of other sides of atherosclerosis suffers from insufficient appropriate exploration. Our study showed an insufficiency to evaluate correctly and completely the polyvascular patients. So patients with hypertension must have an early exploration of atherosclerosis according to ESH/ESC recommendations including evaluation of the ankle brachial index.

Integrated backscatter analysis of carotid intima–media complex in patients with systemic lupus erythematosus

A number of studies based on conventional ultrasound scanning (CUS) gave contrasting results about the occurrence of early atherosclerosis in patients with systemic lupus erythematosus (SLE), while no study on early arterial sclerosis in the same patients are available. Recently, information on early arterial sclerosis can be provided by the integrated backscatter (IBS) analysis which reflects the collagen and calcium content within the vascular wall. In order to evaluate if atherosis and/or sclerosis of carotid arteries are early features of SLE, we performed carotid CUS and IBS analysis in 16 SLE patients (15 females; aged 37 +/- 10 years), free from clinically evident cardiovascular diseases and cardiovascular risk factors, with the only exception of five patients who had arterial hypertension. The same investigations were performed in 16 sex- and age-matched healthy control subjects. No statistically significant difference was observed either in carotid corrected IBS values or in carotid intima-media thickness (IMT) values between SLE patients and control subjects (-17.9 +/- 2.5 dB vs -19.0 +/- 1.7 dB, p = 0.14; 0.66 +/- 0.08 mm vs 0.62 +/- 0.13 mm, p = 0.35, respectively). The little sub-group of hypertensive SLE patients exhibited a significantly higher carotid corrected IBS mean value compared to control subjects (-16.4 +/- 3.1 dB vs -19.0 +/- 1.7 dB, p = 0.026), while it did not significantly differ in carotid IMT value from control group (0.67 +/- 0.09 mm vs 0.62 +/- 0.13 mm, respectively; p = 0.86). These findings show that neither atherosis nor sclerosis of carotid arteries are early features of SLE patients free from cardiovascular risk factors. Further studies are needed to clearly demonstrate that early carotid sclerosis affects hypertensive SLE patients.