Distal Common Carotid Research Articles

Abstract P298: Progression Of Subclinical Atherosclerosis And Its Determinants In Early Postmenopausal Chinese Women - A Five-year Followup Study Of A Population-based Cohort

Introduction: Subclinical atherosclerosis (SA) progresses silently over a period of time before the clinical manifestations of cardiovascular disease. Hypothesis: We hypothesize that early postmenopausal women with adverse cardiovascular risk factors or their progression to abnormal values have a higher risk of SA. This study aimed to investigate the progression of SA and its determinants in early postmenopausal Chinese women. Methods: This is a community-based 5-year followup study on a cohort of 518 women aged 50–64, within 10 years menopause, and recruited through random telephone dialing. Clinical assessments, fasting blood samples, lifestyle and dietary variables based on validated and structured questionnaires, as well as intima-media thickness (IMT) were obtained at baseline and at followup. IMT was measured using a 12.5-MHz linear probe of the HDI 5000 ultrasound scanner at the near and far walls of three 10-mm segments: distal common carotid, bifurcation, proximal internal carotid of both the left and right carotid arteries. Plaque was defined as a focal wall thickening of at least 1.5mm and graded as: grade 0, 1 and 2. Plaque progression was the difference of the plaque index at baseline and followup, and classified into 3 categories. Results: This study of Chinese early postmenopausal women (followup mean age 61.5 years at followup) has revealed a progression of IMT of 2.1% per year (standard deviation = 1.7). 17% were found to have a moderate and 8% severe plaque progression. Stepwise multiple regression analyses showed that baseline IMT, age, low density lipoprotein cholesterol (LDL-C), systolic and diastolic blood pressure were significant predictors of higher followup IMT, while vegetable and fruit intake were inversely related. Women with values belonging to the “normal” ranges of blood pressure, waist circumference, lipid and fasting blood glucose levels had lower IMT at followup compared to those with abnormal baseline values and those with progression from “normal” to the “abnormal” ranges. Women with high soy-vegetable-fruit intake at both baseline and followup had lower IMT than those with low intakes at both time points. Increasing age, waist circumference ≥80 cm, cholesterol ≥200 mg/L, having diabetes, regular drinking were significant predictors of plaque progression (adjusted odds ratios from 1.10 to 2.81), while higher vegetable and fruit intake lowered the risk. Conclusion: Age, central obesity, diabetes, dislipidaemia, high blood pressure, regular drinking were significant predictors for an increased risk of SA. Maintenance of these CVD factors within normal ranges through early menopausal years with adequate fruit and vegetable intake is important to reduce the progression of SA.

G-016 REVERSAL OF CAROTID INTIMA-MEDIA THICKNESS AND ARTERIAL STIFFNESS IN PATIENTS WITH ALDOSTERONE PRODUCING ADENOMA RECEIVING ADRENALECTOMY

Background Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, and is associated with more prominent vascular stiffness and atherosclerosis. Current studies have implied that access aldosterone induced by PA could lead to increase vascular stiffness and carotid intima media thickness (CIMT). Though aldosterone producing adenoma (APA) is the most common subtype that can be cured by adrenalectomy, the post-surgical vascular changes remains unclear. Method We prospectively analyzed 20 patients with APA that received adrenalectomy from October 2006 to Dec 2008and 21 patients with essential hypertension (EH) were enrolled as the control group. CIMT measurement by B-mode ultrasound of the distal right common carotid arteries and pulse wave velocity (PWV) measurement including brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV) were performed in both groups. The follow-up measurements were performed one year after adrenalectomy in APA group. Results APA patients had significantly higher diastolic blood pressure, plasma aldosterone concentration (PAC) and aldosterone-renin ratio (ARR), but lower serum potassium level and plasma renin activity (PRA) than EH patients.APA patients had significantly higher CIMT, greater baPWV and haPWVthan EH patients (both p < 0.05). One year afteradrenalectomy, CIMT and PWV level decreased significantly (0.64 ± 0.13 to 0.59 ± 0.14 mm for CIMT, 1589 ± 296 to 1463 ± 188 cm/s for baPWV, 1095 ± 150 to 1017 ± 109 cm/s for haPWV, all p < 0.05). Conclusion The results of this study showed that APA patients have higher degree of early atherosclerosis and vascular stiffness. More importantly, this study is the first human trial demonstrating that adrenalectomy not only corrects the high blood pressure and biochemical data but also reverse adverse vascular change in APA patients.

Segmental Analysis of Carotid Arterial Strain Using Speckle-Tracking

Increased arterial stiffness has been shown to be associated with aging and cardiovascular risk factors. Speckle-tracking algorithms are being used to measure myocardial strain. The aims of this study were to evaluate whether speckle-tracking could be used to measure carotid arterial strain (CAS) reproducibly in healthy volunteers and to determine if CAS was lesser in individuals with diabetes. Bilateral electrocardiographically gated ultrasound scans of the distal common carotid arteries (three cardiac cycles; 14-MHz linear probe; mean frame rate, 78.7 ± 8.9 frames/sec) were performed twice (2-4 days apart) on 10 healthy volunteers to test repeatability. Differences in CAS between healthy subjects (n= 20) and patients with diabetes (n= 21) were examined. Peak CAS was measured in each of six equal segments, and averages of all segments (i.e., the global average), of the three segments nearest the probe, and of the three segments farthest from the probe (i.e., the far wall average) were obtained. Global CAS (intraclass correlation coefficient= 0.40) and far wall average (intraclass correlation coefficient= 0.63) had the greatest test-retest reliability. Global and far wall averaged CAS values were lower in patients with diabetes (4.29% [SE, 0.27%] and 4.30% [SE, 0.44%], respectively) than in controls (5.48% [SE, 0.29%], P= .001, and 5.58% [SE, 0.44%], P= .003, respectively). This difference persisted after adjustment for age, gender, race, and hemodynamic parameters. Speckle-tracking to measure CAS is feasible and modestly reliable. Patients with diabetes had lower CAS obtained with speckle-tracking compared with healthy controls.

Sarcoidosis Masquerading as Carotid Body Tumor

Sarcoidosis, which is a heterogeneous disease process of unknown etiology with varying presentations, may affect multisystem organs and have an unpredictable course. We report a rare case of sarcoidosis with 360° encasement of the distal left common carotid and proximal internal carotid arteries. Findings of a transcervical biopsy confirmed a diagnosis of sarcoidosis. In the absence of hemodynamic compromise of the patient's carotid artery, medical rather than surgical treatment was initiated. To our knowledge, this is the first report of a circumferential sarcoid lesion involving the common carotid artery. Vascular sarcoid lesions are rare, and treatment should depend on which vessel is involved and its function at the time of presentation. Masses involving the carotid artery should be approached with thoughtful presurgical planning.

Tandem High-grade Stenoses in the Innominate and Right Internal Carotid Arteries Diagnosed with Carotid Duplex Ultrasound

Peak systolic velocity criteria for assessing the severity of internal carotid artery (ICA) stenosis may be inadequate in the setting of a critical proximal lesion. A 54-year-old man with a history of panvascular atherosclerosis presented for re-evaluation of known carotid stenosis. Carotid duplex ultrasound was performed by using B-mode ultrasound (Philips) with color and pulsed Doppler. Velocities within the innominate artery were markedly increased (PSV 553 cm/sec; EDV 211 cm/sec), consistent with high-grade stenosis. Waveforms in the right subclavian and common carotid (CCA) arteries were poststenotic in appearance, and velocity in the distal right CCA was very low (PSV 39 cm/sec). There was an additional step-up in velocity in the proximal right ICA with extensive homogeneous plaque visualized (right ICA PSV 210 cm/sec; EDV 115 cm/sec). Although the ICA lesion did not meet peak systolic velocity or end diastolic velocity criteria for &gt;80% stenosis in our laboratory, the lesion was interpreted as an 80–99% lesion on the basis of the markedly increased ICA/CCA ratio (ICA/CCA ratio 5.38). The left subclavian artery had low, monophasic flow and was likely occluded near its origin with filling from a retrograde vertebral artery. The patient was referred for percutaneous intervention. Angiography confirmed a 99% stenosis of the innominate artery and a 90% stenosis of the right ICA in its proximal portion. The left subclavian artery was occluded. The left CCA arose from a bovine aortic arch. The innominate and right ICA lesions were treated successfully with balloon angioplasty and stenting. Duplex ultrasound is an outstanding diagnostic tool for the evaluation of extracranial carotid and innominate lesions. In the setting of tandem lesions, critical stenosis of the ICA may be missed with reliance on traditional PSV criteria alone. In such cases, interpretation of secondary criteria, particularly the ICA/CCA ratio, is crucial to establish an accurate diagnosis.

Consumption of omega-3 fatty acids is not associated with a reduction in carotid atherosclerosis: The Genetics of Coronary Artery Disease in Alaska Natives study

Objective This study was designed to evaluate the relation between omega-3 fatty acid (FA) consumption and atherosclerosis. Background The hypothesis that omega-3 FAs protect against atherosclerosis has not been tested with objective measures of atherosclerosis. Methods A population-based sample of 1131 Alaskan Eskimos of age ≥18 underwent ultrasound assessment of carotid atherosclerosis. Those of age >35 ( N = 686) were included in the analysis. Diet was assessed by a food frequency questionnaire. Intimal–medial thickness (IMT) of the far wall of the distal common carotid arteries and plaque score (number of segments containing plaque) were assessed. Results Mean consumption of total omega-3 FAs was 4.76 g/day in those without and 5.07 g/day in those with plaque. In models adjusting for relevant risk factors, presence and extent of plaque were unrelated to intake of C20–22 omega-3 FAs or total omega-3 FAs. In contrast, the odds of plaque rose significantly with quartiles of palmitic ( p = 0.02) and stearic acid intake ( p = 0.04). The extent of plaque (or plaque score) was also associated with a higher percentage intake of palmitic acid ( p = 0.01). IMT was negatively associated with grams of C20–22 omega-3 FAs ( p = 0.05), total omega-3 ( p = 0.05), palmitate ( p = 0.03), and stearate ( p = 0.03) consumed. Conclusions Dietary intake of omega-3 FAs in a moderate-to-high range does not appear to be associated with reduced plaque, but is negatively associated with IMT. The presence and extent of carotid atherosclerosis among Eskimos is higher with increasing consumption of saturated FAs.

Duplex Evaluation of a Carotid Artery Aneurysm

Introduction A carotid artery aneurysm is a rare yet significant finding. The purpose of this report is to describe the clinical presentation and sonographic findings of a post-endarterectomy aneurysm. Case Report A 65-year-old woman presented to our laboratory with an enlarging mass on the left side of her neck. Her medical history was significant for a left carotid endarterectomy approximately 1o years earlier. Methods A standard carotid Duplex evaluation was performed. Gray scale imaging on the left side of the neck revealed multiple irregular dilatations along the distal common carotid (CCA) and internal carotid arteries (ICA). Results The maximum diameter of the distal CCA measured 2.3cm compared with 0.8cm proximally. Areas of mixed echogenicity suggesting thrombus formation were observed in the CCA where the diameter of the artery was at its greatest. Color and spectral Doppler demonstrated highly turbulent flow in the aneurysmal area, along with an unremarkable velocity profile proximal and distal to this segment. The unusual irregularity of these dilatations along with no obvious neck characteristic of a pseudoaneurysm made it difficult to distinguish whether this lesion represented a false or true aneurysm. A computed tomography angiogram (CTA) demonstrated aneurysmal dilatation of the carotid artery with possible pseudoaneurysm formation at the level of the bifurcation. Angiography and subsequent surgical exploration revealed that the lesion was a true aneurysm. Repair was accomplished by insertion of a 6mm polytetrafluoroethylene interposition graft. Conclusion Color Duplex ultrasound was an accurate technique for identification of an uncommon carotid artery aneurysm.

Increased carotid intima media thickness and cardiac biomarkers in HIV infected children

To assess carotid intima media thickness (IMT) and cardiac biomarkers in HIV infected children on antiretroviral therapy (ART). This was a single site, cross sectional, controlled observational study. We assessed carotid IMT, homocysteine, high-sensitivity C-reactive protein and myeloperoxidase levels in HIV infected children on stable ART for >or= 6 months. Carotid IMT was reported as internal carotid artery (ICA) and common carotid artery (CCA) thickness; left and right sides were measured separately. Groups were compared using appropriate two-sample tests. Of the 62 subjects enrolled, 31 were HIV positive (50%), 66% were female, and 69% were African-American. Median CD4% was 32% and 26 patients (84%) had HIV-1 RNA< 400 copies/ml. Sixteen patients had been taking protease inhibitors for a median duration of 27 months. None had hypertension or smoked. HIV infected children had higher HOMA-IR, waist-to-hip ratio, cholesterol, triglycerides, myeloperoxidase and lower homocysteine levels. Left and right CCA IMT, and left and right ICA IMT were significantly higher in the HIV infected group. Significant predictors of carotid IMT measurements in uninfected controls were body mass index and homocysteine, but only the duration of ARV therapy was predictive of IMT in the HIV infected group. Higher levels of carotid IMT and some cardiac markers were found in ART treated HIV infected children when compared to matched uninfected controls. These results suggest that HIV infected children receiving ART may be at increased risk of cardiovascular disease.

Aortic Arch Vessel Stenting

Endovascular interventions have revolutionized the contemporary treatment of peripheral vascular occlusive disease. Traditional management of supra-aortic trunk disease has employed surgical extra-anatomic bypass via a cervical approach or median sternotomy. Endoluminal therapy may be a less morbid alternative. A retrospective review of procedures performed by vascular surgeons in an operating room angiosuite at a single university-based, tertiary referral center. Eighteen consecutive patients with 20 brachiocephalic-origin stenoses. From December 2001 through September 2005, 20 brachiocephalic-origin stenoses were treated endoluminally with balloon-expandable stents. Treated vessels were innominate (n = 8), common carotid (n = 9), and subclavian (n = 3). The target lesion was accessed by one of the following methods: antegrade via the femoral artery (n = 5), retrograde through the brachial artery (n = 1), or via a retrograde cut-down on the common carotid artery (n = 14). Cerebral protection was achieved with either a distal embolic filter device or with open surgical occlusion of the distal common carotid artery. We report immediate and midterm outcomes of all aortic arch vessel stenting procedures with mean follow-up of 12 months. Mean age was 68 years (6 men and 12 women) and overall mean stenosis was 85%. Preprocedural symptoms including stroke, transient ischemic attack, arm fatigue, digital ischemia, and angina were present in 16 of 20 cases (80%). The 4 asymptomatic patients all had more than 90% stenosis on angiography. At 30-day follow-up, there were no deaths, myocardial infarctions, or strokes. During follow-up, there were no cases of restenosis. Endoluminal arterial stenting of brachiocephalic arch vessels may be a viable alternative to traditional open bypass in cases of focal stenotic disease.

Hepatic and Cardiovascular Consequences of Familial Hypobetalipoproteinemia

Individuals with familial hypobetalipoproteinemia (FHBL) have been reported to be prone to fatty liver disease (FLD). Conversely, the profound reduction of low-density lipoprotein (LDL) cholesterol in this disorder might decrease cardiovascular risk. In the present study, we assessed hepatic steatosis as well as noninvasive surrogate markers for cardiovascular disease (CVD) in subjects with FHBL and in matched controls. Hepatic steatosis was assessed by abdominal ultrasonography. Carotid intima-media thickness (IMT) and distal common carotid arterial wall stiffness as surrogate markers for CVD risk were measured using high-resolution B-mode ultrasonography. Whereas transaminase levels were only modestly elevated, both prevalence (54% versus 29%; P=0.01) and severity of steatosis were significantly higher in FHBL individuals compared with controls. Despite similar IMT measurements, arterial stiffness was significantly lower in FHBL (P=0.04) compared with controls. Additionally, the increase in arterial stiffness as seen in the presence of traditional risk factors was attenuated, suggesting that very low levels of apoB-containing lipoproteins can negate the adverse effects of other risk factors on the vasculature. FHBL is characterized by an increased prevalence and severity of fatty liver disease. The observed decreased level of arterial wall stiffness, most pronounced in the presence of nonlipid risk factors, is indicative of cardiovascular protection in these subjects.

Ｃａｒｏｔｉｄｙｎｉａの超音波およびＣＴ画像評価

We report 2 cases of clinical signs and symptoms consistent with idiopathic carotidynia, evaluating and following up the appearance of carotidynia on CT and ultrasonography. Subjects were a 22-year-old woman and an 82-year-old man reporting pain and mass on the left side of the neck. They had abnormal soft-tissue infiltration surrounding the symptomatic carotid artery centered at the distal common carotid and carotid bifurcation in CT and ultrasonography. Their symptoms were resolved within 2 weeks. Repeat CT and ultrasonography after resolution of symptoms showed an absence of the previous abnormality. Few reports have described radiological findings in carotidynia, and CT and ultrasonography enable the evaluation of patients with suspected carotidynia and of most common entities in the differential diagnosis of carotidynia, including aneurysm, aneurysmal dissection, thrombosis, lymphadenitis, submandibular gland disease, and head and neck tumors.

Low concentrations of folate, not hyperhomocysteinemia, are associated with carotid intima-media thickness

Aim: We examined whether total homocysteine, B vitamins and the 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C → T polymorphism are related to common carotid intima-media thickness, a marker of atherosclerosis, and carotid distension, a marker of arterial stiffness. Methods: We used cross-sectional data from 819 individuals aged 50–70 years. B-mode ultrasound of the distal common carotid arteries was performed to determine maximum carotid intima-media thickness, mean carotid intima-media thickness and distension. Results: Carotid intima-media thickness and distension did not differ across homocysteine, serum folate, vitamin B 6 and vitamin B 12 quartiles or between MTHFR C677T genotype. Erythrocyte folate was independently associated with maximum carotid intima-media thickness (mean difference first versus third quartile, 0.03 mm, 95% CI 0.004–0.06 mm; first versus fourth quartile, 0.03 mm, 95% CI −0.002 to 0.06 mm). Further adjustment for homocysteine did not affect this association. Folate deficient subjects had greater maximum carotid intima-media thickness than those with high-normal folate concentrations (serum folate: mean difference 0.05 mm, 95% CI 0.01–0.08 mm; erythrocyte folate: mean difference 0.04 mm, 95% CI −0.03 to 0.11 mm). Conclusion: Low folate concentrations, independent of hyperhomocysteinemia, may promote atherogenesis. Our findings confirm the null association of homocysteine with carotid intima-media thickness observed in other population-based studies, suggesting that hyperhomocysteinemia does not perpetuate atherosclerosis or arterial stiffness.

Acute Simultaneous Occlusion of the Distal Common Carotid Artery and Middle Cerebral Artery

Occlusion of the proximal segment of the internal carotid artery (ICA) or distal part of the common carotid artery (CCA) together with a thromboembolic occlusion of the middle cerebral artery (MCA) is one of the most critical conditions for acute ischemia. The low rate of recanalization and the high mortality rate for this clinical category of patients with major stroke are discouraging. The author reports on his experience in the management of one single patient, discussing different strategies of treatment with a review of the literature. A 70-year-old patient presented with acute major stroke indicating left hemisphere at risk (NIHSS-Score [National Institute of Health Stroke Scale] 20). Magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and perfusion imaging (PI) revealed an extended DWI/PI mismatch. Magnetic resonance angiography (MRA) showed occlusion of the ICA, collateral flow was poor. The patient underwent intraarterial diagnostic three-vessel angiography. The thrombotic occlusion of the left distal CCA was revascularized by urgent stenting using an oversized carotid stent followed by a gentle balloon expansion with an undersized balloon. Additionally, local intraarterial fibrinolysis (LIF) of the MCA occlusion was performed. The endovascular procedure was uneventful and led to a marked improvement in perfusion of the hemisphere with regression of the neurologic deficit (NIHSS score 4). In acute major stroke patients with an entire hemisphere at risk, urgent stenting of the occluded cervical CCA may improve the outcome.

The Osteoporosis Prevention and Arterial effects of tiboLone (OPAL) study: design and baseline characteristics

The Osteoporosis Prevention and Arterial effects of tiboLone (OPAL) trial is a three-arm, randomized, placebo-controlled, double-blind study to determine the effect of tibolone 2.5 mg (Org OD 14) and continuous combined conjugated equine estrogens plus medroxyprogesterone acetate (0.625 mg/2.5 mg respectively) on progression of intima-media thickness of the carotid arteries and bone mineral density of the lumbar vertebrae and proximal femur in postmenopausal women. A total of 866 healthy postmenopausal women were recruited in six U.S. centers and five European centers. Duplicate carotid ultrasound examinations of the common carotid artery, the carotid bifurcation, and the internal carotid artery were performed at baseline. Single measurements of bone mineral density of the lumbar vertebrae and proximal femur were obtained at baseline. After randomization, ultrasound examinations were repeated every 6 months for 36 months following baseline, with a duplicate examination at the end of the study. Bone mineral density was measured every 12 months throughout the trial. The primary outcome is change in mean common carotid intima-media thickness (CIMT), defined as the average of the intima-media thickness measurements performed circumferentially at predefined angles for the near and far wall of 10-mm segments of the right and left distal common carotid arteries. Unique new features of the OPAL study are the specifically developed OPAL ultrasound protocol, yielding highly reproducible CIMT measurements, and the use of two experienced core laboratories for CIMT readings (one in the United States and one in Europe) with one common quality assurance and control program. The OPAL study is a large, placebo-controlled trial evaluating the effects of tibolone, as well as one of the first large randomized studies to determine the effects of continuous combined estrogen-progestin therapy on carotid atherosclerosis in healthy postmenopausal women. The OPAL study results are expected to complement other studies on atherosclerosis progression in healthy postmenopausal women.

Insulin resistant young subjects at risk of accelerated atherosclerosis exhibit a marked reduction in peripheral endothelial function early in life but not differences in intima-media thickness

Reduced bio-availability of nitric oxide leading to disturbed flow mediated (endothelial dependent) vasodilation (FMD) has been shown to be an early functional abnormality of the vascular system in insulin resistant individuals and other subjects at high risk for accelerated atherosclerosis. In addition, an increase of the intima-media thickness (IMT) is regarded as an early marker of morphological alterations of the vessel wall. Whether endothelial dysfunction (ED) is evident already at an early stage when morphological changes of the vessel wall are not apparent is still an open question. We, therefore, examined IMT and peripheral endothelial function in a group of young insulin resistant subjects in a cross-sectional study and compared these results with a metabolically healthy (insulin sensitive) control group. We measured IMT (distal common carotid arteries), endothelium-dependent and endothelium-independent vasodilation (flow mediated and glyceroltrinitrate induced vasodilation of the brachial artery) non-invasively with high resolution ultrasound (13 MHz) in 91 young normoglycemic subjects (40/51 M/F, median: 31 years, range 18–50 years). Insulin sensitivity was measured with a euglycemic, hyperinsulinemic glucose clamp. Despite a marked reduction in flow-mediated vasodilation in insulin resistant (IR) subjects (FMD: median 3.4%, range −4.0 to 12.5 in IR versus 6.6%, range −1.2 to 20.1% in insulin sensitive subjects; P=0.017), there was no difference in endothelial independent vasodilation (16.3%, range 5.7–41.0% versus 16.1%, range 0.5–39.2%) and in IMT (0.50 mm, range 0.39–0.66 and 0.51, 0.40–0.70 mm, respectively). These data suggest that ED can be detected very early in the life of insulin resistant subjects whereas no significant structural changes, indicated by a thickening of the intima-media layer, could be found. We therefore conclude that for identification of subjects with a high risk for accelerated atherosclerosis at an early stage, measurement of flow mediated vasodilation of the brachial artery may be more helpful than measuring thickness of the vascular wall.

C-Reactive Protein Levels and Arterial Abnormalities in the Offspring of Patients with Premature Myocardial Infarction

Aims: To determine whether high C-reactive protein (CRP) levels and increased intima-media thickness of the common carotid arteries are coexistent in adolescents and young adults with a family history (FH) of premature myocardial infarction (MI). Methods: 50 healthy young subjects whose parents had had premature MI and 50 control matched subjects were enrolled in the study. CRP levels and the intima-media thickness of the distal common carotid arteries were evaluated in all subjects. Results: As compared with the control subjects, the offspring of patients with premature MI had a higher CRP concentration (mean ± SD 8.8 ± 2.6 versus 3.9 ± 0.6 mg/l, p < 0.02) and greater intima-media thickness of the common carotid arteries (values for combined sides, mean ± SD 0.48 ± 0.02 versus 0.43 ± 0.02 mm, p < 0.03). Conclusion: High serum levels of CRP and arterial structural changes are coexistent at an early age in subjects with an FH of premature MI.

Assessment of Vessel Wall Thickness in Carotid Atherosclerosis using Spiral CT Angiography

Objectives: the purpose of this study was to evaluate the amount of vessel wall thickening in the internal and common carotid arteries in patients undergoing spiral CT angiography for the investigation of significant atherosclerotic disease.Materials and Methods: forty-five carotid systems in patients with a 70% or greater stenosis (according to carotid duplex) were imaged with CT spiral angiography using a standardised protocol. The vessel wall thickness of the distal common and mid internal carotid artery was measured using axial CT sections.Results: vessel wall thickness was greater and more variable within the common carotid artery than within the internal carotid artery. The mean proportion of total vessel diameter constituted by vessel wall thickness was significantly greater in the common carotid artery as compared to the internal carotid artery: 28±12% (SD) vs 15±6%, respectively (p < 0.001).Conclusions: significant and extended wall thickening is commonly present in the internal and common carotid arteries of patients with atherosclerotic disease, but the internal carotid artery is significantly less affected than the common carotid artery. These observations question the validity of using the common carotid artery as a reference vessel for angiographic stenosis measurements

Arterial Abnormalities in the Offspring of Patients with Premature Myocardial Infarction

A BSTRACT Background The offspring of patients with premature coronary disease may be at increased risk for atherosclerosis. We undertook a study to determine whether changes in brachial-artery reactivity and the thickness of the carotid intima and media, two markers of early atherosclerosis, are present in adolescents and young adults with a parental history of premature myocardial infarction. Methods We enrolled 40 healthy young people whose parents had had premature myocardial infarction (48 percent male; mean [±SD] age, 19.0±5.2 years) and 40 control subjects who were matched with the first group according to age and sex. All the subjects underwent high-resolution B-mode ultrasound examinations for the measurement of the brachialartery vasodilatory response after arterial occlusion (i.e., reactive hyperemia) and the intima–media thickness of the distal common carotid arteries. Results As compared with the control subjects, the offspring of patients with premature myocardial infarction had lower flow-mediated reactivity of the brachial arteries (5.7±5.0 percent, vs. 10.2±6.6 percent in the control subjects; P=0.001) and greater mean intima–media thickness of the common carotid artery (0.49±0.08 mm, vs. 0.44±0.07 mm in the control subjects; P=0.004). In the subjects with a parental history of premature myocardial infarction, an inverse association was found between brachial-artery reactivity and carotid intima–media thickness (r=–0.46, P=0.003). In a conditional logistic-regression analysis, both brachial-artery reactivity and carotid intima–media thickness were significantly and independently correlated with a parental history of premature myocardial infarction. Conclusions Structural and functional changes are present at an early age in the arteries of persons with a parental history of premature myocardial infarction. (N Engl J Med 2000;343:840-6.)

Arterial abnormalities in the offspring of patients with premature myocardial infarction.

Findings from epidemiologic and autopsy studies suggest that the offspring of patients with premature coronary disease may be at increased risk for atherosclerosis. We undertook a study to determine whether changes in brachial-artery reactivity and thickness of the carotid intima and media, two markers of early atherosclerosis, are present in adolescents and young adults with a parental history of premature myocardial infarction. We enrolled 40 healthy young people whose parents had had premature myocardial infarction (48 percent male; mean [+/-SD] age, 19.0+/-5.2 years) and 40 control subjects who were matched with the first group according to age and sex. All the subjects underwent high-resolution B-mode ultrasound examinations for the measurement of the brachial-artery vasodilatory response after arterial occlusion (i.e., reactive hyperemia) and the intima-media thickness of the distal common carotid arteries. Lipid profiles, blood pressure while at rest, body-mass index, and smoking status were also determined. As compared with the control subjects, the offspring of patients with premature myocardial infarction had lower flow-mediated reactivity of the brachial arteries (5.7+/-5.0 percent, vs. 10.2+/-6.6 percent in the control subjects; P=0.001) and greater mean intima-media thickness of the common carotid artery (0.49+/-0.08 mm, vs. 0.44+/-0.07 mm in the control subjects, P=0.004). In the subjects with a parental history of premature myocardial infarction, an inverse association was found between brachial-artery reactivity and carotid intima-media thickness (r=-0.46, P=0.003). In a conditional logistic-regression analysis, both brachial-artery reactivity and carotid intima-media thickness were significantly and independently correlated with a parental history of premature myocardial infarction. Structural and functional changes are present at an early age in the arteries of persons with a parental history of premature myocardial infarction.

Axillary-to-carotid artery bypass grafting for symptomatic severe common carotid artery occlusive disease

Purpose: Revascularization of the internal or external carotid arteries is occasionally indicated for symptomatic atherosclerotic common carotid artery occlusion or long-segment high-grade stenosis beginning at its origin. I report the outcome of axillary artery-based bypass grafts to the distal common, internal, or external carotid arteries. Methods: Between 1981 and 1997, 29 axillary-to-carotid bypass grafting procedures were performed on 28 patients, 15 men and 13 women, with a mean age of 68 years. Indications were transient ischemia in nine patients, amaurosis fugax in four patients, completed stroke in six patients, and nonlateralizing global ischemia in nine patients. Twenty-three common carotid arteries were totally occluded, and six had long-segment stenosis of 90% or greater beginning at the origin. Saphenous vein grafts were used in 25 procedures, and synthetic grafts were used in four. Grafts were placed to 13 internal, eight distal common, and eight external carotid arteries. Results: There were no perioperative deaths; one stroke occurred (3.4%). No lymphatic or peripheral nerve complications occurred. In a 1- to 11-year follow-up period (mean, 4.5 years), there were no graft occlusions, one restenosis of 50% or greater, and two restenoses of 70% or greater. The 1-year stenosis-free rate for 50% or greater stenosis was 93%, and the 5- and 10-year rates were 87%. No late ipsilateral strokes occurred. The 5- and 10-year survival rates were 64% and 28%, respectively. Coronary artery disease was the major cause of late mortality. Conclusion: Axillary-to-carotid bypass grafting for severe symptomatic common carotid occlusive disease is safe, well tolerated, durable, and effective in stroke prevention. There is a high late mortality rate because of coronary artery disease in patients with severe proximal common carotid occlusive disease. (J Vasc Surg 1999;30:1106-12.)