Extracranial Carotid Atherosclerosis Research Articles

Intracranial Atherosclerosis and Postoperative Stroke Following Coronary Artery Bypass Surgery: A Literature Review

Stroke is a devastating complication of cardiac surgery. Extracranial carotid atherosclerosis (ECAS) is a risk factor for postoperative stroke, but there is limited insight into the effect of intracranial atherosclerosis (ICAS). It is believed that this is the first literature review investigating ICAS and postoperative stroke in a cardiac surgery patient cohort. This review aimed to explore the prevalence and predictors of intracranial ICAS, association with postoperative stroke, and treatment options in patients with ICAS undergoing cardiac surgery.

Rational clinical approach to transient ischaemic attack, stroke and associated mimics: A retrospective cohort study.

The present study was performed to identify the individual clinical features and risk factors most strongly associated with the diagnosis of transient neurological symptoms with a cerebrovascular cause (transient ischaemic attack (TIA) or stroke), as compared to common TIA mimics (including retinal ischaemia, migraine and seizure). In a retrospective cohort study, consecutive patients presenting with transient neurological symptoms to TIA clinic in Royal Adelaide Hospital were included. Clinical features and risk factors were recorded in a standardised form, categorised into subgroups, and analysed using descriptive statistics and diagnostic performance indicators, such as sensitivity, specificity and likelihood ratios. For 218/1273 individuals diagnosed with stroke, the three features with the highest positive likelihood ratio were the presence of diffusion weighted imaging positive lesion on magnetic resonance imaging (23.66, 95% confidence interval (CI) 14.35-51.08), extracranial carotid atherosclerosis (3.98, 95% CI 1.19-6.87) and a history of peripheral vascular disease (3.33, 95% CI 1.64-6.27). For TIA, the three features with the highest positive likelihood ratio were extracranial carotid atherosclerosis (3.98, 95% CI 1.19-8.27), presence of atrial fibrillation (2.43, 95% CI 1.54-3.46) and pre-existing anticoagulant therapy (2.39, 95% CI 1.61-3.29). For stroke and TIA, the respective features with the lowest negative likelihood ratios were limb weakness (0.71, 95% CI 0.65-0.77) and hypertension (0.66, 95% CI 0.49-0.84). The present study demonstrated that specific clinical features and risk factors were associated with the final diagnosis at TIA clinic. These clinical features may assist with diagnosis of TIA in centres without access to a vascular neurologist.

Co-existing intracranial and extracranial carotid atherosclerosis predicts large-artery atherosclerosis stroke recurrence: a single-center prospective study utilizing combined head-and-neck vessel wall imaging.

Intracranial and extracranial plaque features on high-resolution vessel wall imaging (HR-VWI) are associated with large-artery atherosclerosis (LAA) stroke recurrence. However, most studies have focused on a single vascular bed, and the prognostic value of combined intracranial and extracranial plaque features has yet to be studied. This study aimed to investigate the roles of plaque features, plaque number, and co-existing atherosclerosis in predicting stroke recurrence, utilizing combined head-and-neck HR-VWI. From September 2016 to March 2020, participants with acute LAA ischemic strokes were prospectively enrolled and underwent combined head-and-neck HR-VWI. The participants were followed for stroke recurrence for at least 12months or until a subsequent event occurred. The imaging features at baseline, including conventional and histogram plaque features, plaque number, and co-existing atherosclerosis, were evaluated. Univariable Cox regression analysis and the least absolute shrinkage and selection operator (lasso) method were used for variable screening. Multivariable Cox regression analyses were used to determine the independent risk factors of stroke recurrence. A total of 97 participants (59 ± 12years, 63 men) were followed for a median of 30.9months, and 21 participants experienced recurrent strokes. Multivariable Cox analysis identified co-existing intracranial high signal on T1-weighted fat-suppressed images (HST1) and extracranial carotid atherosclerosis (HR, 6.12; 95% CI, 2.52-14.82; p = 0.001) as an independent imaging predictor of stroke recurrence. Co-existing intracranial HST1 and extracranial carotid atherosclerosis independently predicted LAA stroke recurrence. Combined head-and-neck HR-VWI is a promising technique for atherosclerosis imaging. This prospective study using combined head-and-neck HR-VWI highlighted the necessity of both intracranial culprit plaque evaluation and multi-vascular bed assessment, adding value to the prediction of stroke recurrence. • This study highlighted the necessity of both intracranial culprit plaque evaluation and multi-vascular bed assessment, adding value to the prediction of stroke recurrence. • This prospective study using combined head-and-neck HR-VWI found co-existing intracranial HST1 and extracranial carotid atherosclerosis to be independent predictors of stroke recurrence.

Antiplatelet Agents and Oral Anticoagulant Use in Patients with Atrial Fibrillation and Carotid Artery Disease After First-Time Ischaemic Stroke

IntroductionPeople with atrial fibrillation (AF) frequently have competing mechanisms for ischaemic stroke, including extracranial carotid atherosclerosis. The objective of this study was to determine associations between use of oral anticoagulants (OACs) plus antiplatelet agents (APA) after ischaemic stroke and outcomes for patients with AF and carotid artery disease.Patients and MethodsA retrospective cohort study was conducted. Participants receiving OACs with or without APA were propensity score–matched for age, sex, ethnicity, co-morbidities and presence of cardiac and vascular implants and grafts. Outcomes were 1-year mortality, recurrent stroke and major bleeding.ResultsOf 5708 patients, 24.1% (n=1628) received non-vitamin K antagonist OACs (NOACs) with no APA, 26.0% (n=1401) received NOACs plus APA, 20.7% (n=1243) received warfarin without APA and 29.2% (n=1436) received warfarin plus APA. There was no significant difference in risk of recurrent stroke between the groups. Compared to receiving NOACs without APA, receiving warfarin plus APA was associated with a higher risk of mortality (hazard ratio (HR) 1.51 (95% confidence interval (CI) 1.20, 1.89)) and major bleeding (HR 1.66 (95% CI 1.40, 1.96)). Receiving NOACs plus APA was also associated with a higher risk of major bleeding compared to NOACs without APA (HR 1.27 (95% CI 1.07, 1.51), respectively).ConclusionsThe results suggest for patients with AF and carotid artery disease after ischaemic stroke, receiving NOACs without APA is associated with a lower risk of major bleeding with no negative impact on recurrent stroke or mortality. Evidence from randomised trials is needed to confirm this finding.

Association between Extracranial Carotid Artery Plaque and Cognitive Dysfunction: A Systematic Review and Meta-Analysis

Background: Extracranial carotid atherosclerosis has been variably associated with dementia. Prior studies have focused on the association of carotid intima media thickness or carotid stenosis; however, there is evidence that carotid plaque may contribute to dementia, perhaps via microembolic phenomena. Objectives: We sought to evaluate the role of carotid plaque in contributing to cognitive impairment by performing a systematic review and meta-analysis to summarize the association between extracranial carotid plaque and cognitive dysfunction and dementia. Methods: We performed a comprehensive literature search evaluating the association of extracranial carotid plaque with cognition. We included studies measuring carotid plaque on ultrasound, computed tomography, or MR and also evaluated cognition through neuropsychological testing. Meta-analyses with assessment of study heterogeneity and publication bias were performed. Results were presented in a forest plot and summarized using a random-effects model. Results: After screening 1,674 studies, we included 40 for systematic review and 16 and 7 studies for two meta-analyses with a total of 19,029 and 27,325 patients, respectively. We found a positive relationship between the presence of extracranial carotid plaque and cognitive dysfunction with a pooled random-effects odds ratio (OR) of 1.83 (95% CI, 1.50, 2.24) and a pooled random-effects hazard ratio (HR) of 1.47 (95% CI, 1.15, 1.89), respectively. A sensitivity analysis of only longitudinal studies found a persistent positive association. Measures of heterogeneity showed moderate heterogeneity in each meta-analysis, respectively (I-squared statistic = 57% and 70%). Conclusion: The presence of extracranial carotid plaque is significantly associated with cognitive dysfunction and dementia in both cross-sectional and longitudinal analyses. After further confirmation, our results support carotid plaque being a potentially modifiable risk factor in the development of dementia.

Extracranial carotid atherosclerosis is associated with increased neurofibrillary tangle accumulation.

We sought to determine whether extracranial carotid atherosclerotic disease (ECAD) is associated with increased key neurodegenerative pathology such as neurofibrillary tangle (NFT), beta-amyloid plaque, or cerebral amyloid angiopathy (CAA) accumulation, findings associated with Alzheimer's disease (AD) and other dementias. Our prospective, longitudinal, clinicopathologic study, the AZSAND (Arizona study of aging and neurodegenerative disorders) and Brain and Body Donation Program, recorded the presence or absence of clinically diagnosed ECAD and performed semiquantitative density estimates of NFT, beta-amyloid plaque, and CAA at death. After adjusting for potential confounding factors determined by logistic regression analysis, histopathology density scores were evaluated in individuals with ECAD (n= 66) and those without ECAD (n= 125). We found that the presence of ECAD was associated with a 21% greater NFT burden at death compared with no ECAD (P= .02). Anatomically, an increased NFT burden was seen throughout the brain regions evaluated but was significant in the temporal lobe (P< .05) and entorhinal cortex (P= .02). In addition, we found that subjects who had undergone carotid endarterectomy (CEA), the surgical treatment of ECAD (n= 32), had decreased NFT densities compared with those with ECAD who had not undergone CEA (n= 66; P= .04). In contrast to NFT, ECAD was not associated with beta-amyloid plaques or CAA density. These findings indicate that ECAD is associated with the NFT burden in the temporal lobe and entorhinal cortex, which has clinical significance for AD and non-AD dementias and cognitive dysfunction. Further understanding of whether ECAD increases the risk of neurodegenerative brain changes is highly relevant because ECAD is a treatable disease that has not, otherwise, been evaluated for nor specifically treated as a dementia risk factor.

Co-existence and interrelationship between intracranial artery stenosis and extracranial carotid atherosclerosis in an asymptomatic rural population of 13 villages in northern China

ObjectiveWe investigated the characteristics and relationship of co-existing intracranial artery stenosis (ICAS) and extracranial carotid atherosclerosis in an asymptomatic rural population in northern China. MethodsAsymptomatic residents ≥ 30 years old in 13 villages underwent simultaneous cervical vascular and transcranial Doppler ultrasound. ICAS was defined as ≥ 50% stenosis. Extracranial carotid atherosclerosis severity was classified as increased intimal medial thickness (IMT), plaques, and a plaque with ≥ 50% extracranial artery stenosis (ECAS). Demographic details, medical history, and blood biochemistry results were collected. The relationship between ICAS and extracranial carotid atherosclerosis severity was determined using the chi-square trend test and binary logistic regression analysis. ResultsA total of 2598 asymptomatic participants were included; 122 (4.7%) had ICAS, 1071 (41.2%) had extracranial carotid atherosclerosis, and 84 (3.2%) had co-existing extracranial carotid atherosclerosis and ICAS. Those with co-existing ICAS and extracranial carotid atherosclerosis were older (P = 0.006) and had a higher hypertension (HTN) and diabetes mellitus (DM) prevalence (P < 0.001). HTN (95% confidence interval [CI]=1.31–3.55, odds ratio [OR]=2.15) and DM (95% CI=1.17–4.30, OR=2.24) were found to be independent risk factors for asymptomatic ICAS with extracranial carotid atherosclerosis. Among those with ICAS, 38/122 had no extracranial carotid atherosclerosis, 8/122 had increased IMT, 64/122 had a plaque, and 12/122 had ECAS. As extracranial carotid atherosclerosis severity increases, ICAS prevalence increases. ConclusionCo-existing ICAS and extracranial carotid atherosclerosis occurred in 3.2% of asymptomatic populations in rural areas of northern China. As extracranial carotid atherosclerosis severity increased, ICAS prevalence also increased. HTN and DM might be independent indicators of co-existing ICAS and extracranial carotid atherosclerosis.

Correlation of orthostatic hypotension with extracranial carotid and intracranial cerebral arteries atherosclerosis in patients with acute ischemic stroke under cerebral angiography.

The clinical management of patients with acute ischemic stroke (AIS) is complicated by orthostatic hypotension, which might have close relationship with the atherosclerosis of cerebral arteries. The primary objectives were to evaluate the relationship of orthostatic hypotension with extracranial carotid arteries atherosclerosis (ECAS) and intracranial atherosclerosis (ICAS) in AIS patients. This study was a prospective cohort analysis of consecutive AIS patients under cerebrovascular angiography. A total of 289 patients were included. orthostatic hypotension was defined as a systolic BP decline ≥20 mmHg or a diastolic BP decline ≥10 mmHg within 3 min of standing. Univariate and multivariate analysis were performed to investigate the association of the clinical variables with orthostatic hypotension. Orthostatic hypotension was identified in 80 (27.7%) of all patients. ECAS (≥70%) and ICAS (≥50%) was found in 39 (13.5%) and 71 (24.6%) respectively. In multivariate analysis, only diabetes mellitus (odds ratio = 2.00, 95% confidence interval, 1.12-3.58, P = 0.019) and ECAS (odds ratio = 1.97, 95% confidence interval, 1.54-2.51, P < 0.001) were independent risk factors for orthostatic hypotension. Orthostatic hypotension is a relatively common finding among patients with AIS. AIS patients should be screened for orthostatic hypotension, especially combined with severe ECAS and diabetes mellitus.

The relationship between intracranial arterial dolichoectasia and intracranial atherosclerosis

ObjectiveWe aimed to investigate the relationship between intracranial arterial dolichoectasia (IADE) and intracranial atherosclerosis (ICAS). MethodsPatients with acute ischemic stroke were screened via the Nanjing Stroke Registry Program. Patients were diagnosed with IADE (diameter, height of bifurcation, and laterality of basilar artery) based on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) results. Intracranial atherosclerosis was defined as a ≥50 % diameter reduction in internal carotid artery, middle cerebral artery, posterior cerebral artery, or anterior cerebral artery on MRA, computed tomography angiography, or digital subtraction angiography. We also evaluated the presence and degree of white matter changes and lacuna infarctions on MRI. ResultsOf the 469 enrolled patients, 61 (13 %) had IADE. Patients with IADE were older (64.1 ± 9.9 vs. 59.6 ± 11.4 years, P = 0.004) and had a higher prevalence of hypertension (78.7 % vs. 61.0 %, P = 0.008) than patients without IADE. Patients with ICAS were older (62.6±10.5 vs 58.1±11.6 years, P < 0.001), had higher prevalence of hypertension (72.9 % vs. 55.0 %, P < 0.001) and a previous history of stroke (21.6 % vs. 9.2 %, P < 0.001), had higher levels of serum low-density lipoprotein cholesterol (2.57±0.82 vs. 2.31±0.86mmol/l P = 0.002), and had high counts of white blood cells (7.90±3.29 vs 7.10±2.44, P = 0.004). No association was detected between IADE and extracranial carotid atherosclerosis [odds ratio (OR)=0.618; 95 % confidence interval (CI), 0.280–1.367; P = 0.235]. After adjusting for age, sex, hypertension, and ischemic heart disease, patients with IADE had a lower ICAS rate than that in those without IADE (OR 0.417, 95 % CI, 0.213–0.816, P = 0.011). Unlike patients with ICAS, patients with IADE were more likely to have infratentorial stroke lesions (OR=2.952, 95 % CI, 1.207–7.223, P = 0.018), multi-lacuna (OR=2.142, 95 % CI, 1.158–3.964, P = 0.015), and white matter changes (OR = 2.782; 95 % CI, 1.522–5.085, P = 0.001). ConclusionsIADE was associated with advanced age, hypertension, multi-lacuna, and white matter changes but was not associated with ICAS.

Apolipoproteins A1 and B and their ratio in acute ischemic stroke patients with intracranial and extracranial arterial stenosis: an Egyptian study

BackgroundApolipoprotein A1 and B and their ratio are considered a better biomarker for cardiovascular diseases than a lipid profile, but this previous finding is not proved to cerebrovascular ischemic diseases. The aim of this study is to assess the relation between apolipoprotien A1 and B and their ratio to intra- and extracranial carotid atherosclerosis in patients with ischemic acute stroke.Methods90 Egyptian patients with acute ischemic stroke are included in the study, and they have been classified into 3 groups: group 1 includes 30 patients with intracranial stenosis, group 2 includes 30 patients with extracranial arterial stenosis, and group 3 includes 30 patients with non-arterial stenosis. Patients were subjected to clinical assessment, routine laboratory measures, and Color-Coded Duplex Sonography for extracranial and intracranial arteries. The measurement of serum levels of apolipoproteins A1 and B was done using enzyme-linked immuno-sorbent assay (ELISA).ResultsA statistically significant difference was found between patient groups as regards the frequency of abnormal serum LDL-cholesterol (p = 0.04), being elevated in patients with extracranial stenosis (p = 0.01). There was a significant difference between patients groups as regards the frequency of abnormal serum HDL-cholesterol (p = 0.02), being lower in patients with extracranial stenosis. High Apo B/A1 ratio was an independent risk factor for intracranial arterial stenosis (p = 0.045). An abnormal elevation of serum LDL cholesterol was an independent risk factor of extracranial arterial stenosis (p = 0.021).ConclusionApo B/A1 ratio is an independent risk factor for intracranial arterial stenosis, while serum LDL cholesterol is an independent risk factor for extracranial arterial stenosis. Apo B/A1 ratio and serum LDL cholesterol are reliable serum biomarkers for cranial arterial stenosis in acute ischemic stroke patients.

Bilaterally Asymmetric Associations Between Extracranial Carotid Artery Atherosclerosis and Ipsilateral Middle Cerebral Artery Stenosis in Symptomatic Patients: A CARE-II Study.

To determine the bilaterally asymmetrical associations between extracranial carotid artery atherosclerosis and ipsilateral middle cerebral artery (MCA) stenosis in symptomatic patients using magnetic resonance vessel wall imaging. Approach and Results: Patients with symptomatic carotid artery atherosclerosis were recruited from the Chinese Atherosclerosis Risk Evaluation, a multicenter study. All subjects underwent intracranial magnetic resonance angiography and extracranial carotid artery magnetic resonance imaging. Severe stenosis (stenosis ≥50%) of MCA, carotid moderate-to-severe stenosis (stenosis ≥50%), plaque compositions, and high-risk plaque on symptomatic side were evaluated in all subjects. Associations between ipsilateral MCA stenosis and extracranial carotid plaque features were evaluated. A total of 363 patients (mean age: 61.2±10.4 years old; 254 males) were included. In the left symptomatic cerebrovascular group (n=186), carotid moderate-to-severe stenosis (odds ratio [OR], 3.00 [95% CI, 1.03-8.79]; P=0.045), intraplaque hemorrhage (OR, 3.68 [95% CI, 1.21-11.19]; P=0.021), fibrous cap rupture (OR, 5.70 [95% CI, 1.60-20.31]; P=0.007), and high-risk plaque (OR, 2.95 [95% CI, 1.19-7.35]; P=0.020) were significantly associated with ipsilateral severe MCA stenosis, after adjusting for confounding factors. In the right symptomatic cerebrovascular group (n=177), severe MCA stenosis was significantly associated with ipsilateral carotid moderate-to-severe stenosis (OR, 3.98 [95% CI, 1.54-10.32]; P=0.004) but not with other extracranial carotid plaque features (all P>0.05), after adjusting for confounding factors. In the symptomatic arteries, vulnerable plaque features are independently associated with ipsilateral severe MCA stenosis on the left side, but this association is not found on the right side, indicating the associations of atherosclerotic disease between intracranial and extracranial carotid arteries are asymmetrical.

Abstract WP241: Prevalence of Subclinical Extracranial Carotid Atherosclerosis Detected by Ultrasound Among Amerindians: A Population Study in Rural Ecuador

Background: Epidemiological information on extracranial carotid atherosclerosis (ECA) among Amerindians is limited. We aim to determine the prevalence of subclinical ECA and its correlation with cardiovascular risk factors in community-dwelling adults of Amerindian ancestry living in a rural Ecuadorian village. Methods: Utilizing a population-based design, stroke-free individuals aged ≥40 years were invited to undergo carotid ultrasound. Subclinical ECA was defined as an intima-media thickness (cIMT) &gt;1mm and/or the presence of carotid plaques (focal intima thickening &gt;1.5mm that protrudes into the lumen). Degree of luminal stenosis was calculated and considered significant if &gt;50%. We investigated the association between these biomarkers and cardiovascular risk factors. Results: Of 728 candidates, 559 (77%) stroke-free individuals underwent carotid sonographic evaluation and were included. The mean age was 62.3 ±12.5 and 238 (43%) were men. The mean value of the cIMT was 0.85 ± 0.17mm (median cIMT: 0.83mm; IQ range: 0.74-0.92 mm). The prevalence of increased cIMT, carotid plaques, and increased cIMT and/or carotid plaques were 14%, 23.8%, and 26.1%, respectively. Table depicts the association of these biomarkers with cardiovascular risk factors. A multinomial logistic regression model, using individuals with normal carotids as the referent category, showed significant associations of ECA with increasing age, male gender, smoking and high blood pressure. Significant carotid stenosis was found in 19 subjects (3.4%). Conclusions: About one-fourth of Amerindians living in a rural setting have subclinical ECA. Increasing age, male gender, smoking and high blood pressure were independent determinants of the burden of ECA, while elevated glucose and total cholesterol showed no significant association. Obesity was inversely associated with ECA in univariate analysis, but such association disappeared in the multivariate model.

Comparison of risk factors that play a role in extra-cranial carotid artery atherosclerosis

Objective: W hich risk factors are important in preventing or stabilizing possible extra-cranial carotid artery stenosis is unclear. We aimed to investigate risk factors that are associated with extra-cranial carotid artery stenosis in patients with ischemic stroke . Method: The records of 215 patients with ischemic stroke who were admitted to Taksim Research Hospital were screened. Patients who had been monitored with color Doppler ultrasonography were then categorized on the basis of the degree of stenosis in the carotid artery (group A: 0%–49%, group B: 50%–69%, group C: >70%). Hypertension, diabetes mellitus, hyperlipidemia, cigarette smoking, ischemic heart disease, age, and sex were evaluated as risk factors. These risk factors were compared among the three groups by using SPSS version 17. Results: We found a significant relationship between high mean low-density lipoprotein and the severity of carotid stenosis (p<0.05). A similar relationship was found between sex and the severity of carotid stenosis (p<0.05). Conclusions: A high low-density lipoprotein level and male sex are important risk factors for having extra-cranial carotid artery stenosis. Therefore, use of more aggressive lipid-lowering treatments, recommending an appropriate diet, and encouraging physical activity in hyperlipidemic men are important in preventive medical practice.

Carotid Intima-media Thickness, Cognitive Performance and Cognitive Decline in Stroke-free Middle-aged and Older Adults. The Atahualpa Project

Background: Little is known on factors influencing cognitive function in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the carotid intima-media thickness (cIMT) – used as a surrogate of extracranial carotid atherosclerosis – is associated with cognitive performance and further decline in community-dwelling adults living in a rural setting. Methods: The study included Atahualpa residents aged greater than or equal to 40 years who had ultrasound examination of the extracranial carotid arteries and a baseline Montreal Cognitive Assessment (MoCA), as well as the subset of individuals who also had a follow-up MoCA at least 1 year after baseline. Relationship between cIMT and cognitive function was assessed by means of generalized linear and longitudinal models, adjusted for relevant covariates. Mediation analysis was utilized to establish the proportion of the effect between increased cIMT and cognitive performance, which is mediated by age. Results: A total of 561 individuals were included for the cross-sectional study, and 510 of them were assessed for the prospective cohort. Univariate analysis showed a significant association between increased cIMT and worse cognitive performance (P < .001), which vanishes after considering the effect of age and low scholarity. Causal mediation analysis confirms that age captures 82.6% (95% C.I.: 63.9% to 100%) of the effect of this association. There was no relationship between increased cIMT and cognitive decline in the follow-up. Conclusions: In this rural population, the association between increased cIMT and cognitive dysfunction is mostly mediated by increasing age.

Atherosclerotic calcification in major vessel beds in chronic obstructive pulmonary disease: The Rotterdam Study

Background and aimsCOPD is associated with an increased risk of cardiovascular morbidity and mortality, potentially by mechanisms of atherosclerosis. Insight into location-specific vulnerability to atherosclerosis in COPD, including intracranial arteries, is lacking. We aimed to investigate the relation between COPD and atherosclerosis in multiple vessel beds within a large population-based cohort study. MethodsFrom 2003 to 2006, a random sample of 2187 elderly participants (mean age, 69.6 ± 6.8 years; 50.9% female; 11.7% COPD) from the population-based Rotterdam Study underwent computed tomography to quantify atherosclerotic coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial carotid artery calcification (ECAC), and intracranial carotid artery calcification (ICAC). We investigated the association of COPD [ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) < 70%] with the presence of calcification and with calcification volumes in each vessel bed using logistic and linear regression, with adjustments for cardiovascular risk factors including smoking. ResultsThe prevalence of CAC, AAC and ECAC was significantly higher in subjects with COPD compared to those without. After adjusting for age and smoking, COPD remained associated with the presence of ECAC (odds ratio 1.46 [95% confidence interval, 1.02–2.07, p = 0.037]). COPD was significantly associated with larger calcification volumes in all four vessel beds in people in whom calcification was present. ConclusionsThe results of this study suggest that COPD plays a role in extracranial carotid artery atherosclerosis initiation and systemic atherosclerosis aggravation.

Prevalence of extracranial carotid atherosclerosis in the patients with coronary artery disease in a tertiary hospital in Malaysia.

There is limited information regarding the prevalence of extracranial carotid atherosclerosis in the patients with coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG) surgery in South East Asia. The primary objective was to assess the prevalence of extracranial carotid stenosis, raised carotid intima media thickness (CIMT), and plaques in the patients with CAD undergoing elective CABG. The secondary objective was to evaluate the risk factors for extracranial carotid atherosclerosis.A total of 119 consecutive patients with CAD undergoing elective CABG in a tertiary hospital in Malaysia were recruited. Data on the demographic characteristics and risk factors were collected. The ultrasound carotid Doppler findings comprising of raised CIMT, plaques, and stenosis in the extracranial carotid vessels were recorded.The mean age of the patients was 64.26 ± 10.12 (range 42–89). Most of the patients were men (73.1%). The patients consisted of 44 (37%) Malays, 26 (21.8%) Chinese, and 49 (41.2%) Indians.A total of 67 (56.3%) patients had raised CIMT, 89 (74.8%) patients had plaques, and 10 (8.4%) patients had stenosis in the internal and common carotid arteries. The mean age of patients with plaques was higher compared to those without plaques (66.00 ± 9.63 vs 59.10 ± 9.92, P = .001). The body mass index (BMI) of patients with stenosis was higher compared to those without stenosis (28.35 ± 4.92 vs 25.75 ± 3.16, P = .02).The patients with plaques were more likely to be older, whereas the patients with carotid stenosis were more likely to have higher BMI.

Role of carotid artery stenting in stroke prevention

Carotid revascularization is an effective method of primary and secondary prevention of ischemic cerebral stroke in patients presenting with extracranial carotid atherosclerosis leading to significant stenosis of the internal carotid artery. Currently, the European guidelines recommend surgical revascularization in all symptomatic patients with >50% stenosis with a documented periprocedural death/stroke risk of <6%. Endovascular revascularization should be considered in symptomatic patients with anatomical and clinical features that contribute to making such patients at high surgical risk. According to the guidelines, revascularization should be considered in patients with >60% stenosis, in the presence of clinical and/or imaging features associated with an increased risk of ipsilateral stroke (in the presence of documented risk of perioperative stroke/death <3% and patient's life expectancy >5 years). In patients with low and/or average surgical risk should be considered carotid endarterectomy, while in patients who are deemed at high surgical risk carotid stenting should be considered.Nowadays, thanks to technological advances and improved operators' experience, carotid stenting can be considered a valuable therapeutic strategy.

Extracranial Carotid Atherosclerosis and Acute Ischemic Stroke in a Tertiary Hospital in Burkina Faso

Objective: To determine the prevalence and risk factors of carotid atherosclerosis among ischemic stroke patients in a tertiary hospital in Burkina Faso. Methodology: This was a descriptive and analytical retrospective study of patients admitted at neurology department of Yalgado Ouedraogo University Teaching Hospital with ischemic stroke and cerebral large vessel atherosclerosis in the period from January 1, 2012 to December 31, 2016. Results: The prevalence of extracranial carotid atherosclerosis was 23.9%. The mean age of patients was 63.5 years (Range 31 - 90 years). The study population included 65% of men and 35% of women. Hypertension was the most common vascular risk factor (75.6%). Stroke was mostly located in the anterior circulation in 23.9%. Low HDL-C was present in 52% of patients. The majority of plaque was homogeneous (85.2%). Plaque were located in carotid bulbar artery (38.5%) followed by common carotid artery (28.2%) and extracranial internal carotid artery (18.6%). According to cerebral lesion, plaque was bilateral in 45.5%, ipsilateral in 42.3% and contralateral in 12.1% of cases. Tight stenosis was found in 30.1% of patients. There was a significant link between male gender and tight stenosis (p = 0.004). Aspirin was the most antiplatelet therapy used (95.5%). Statin therapy was used in 91% of patients. The mean duration of hospitalization was 12.5 days with a mortality rate of 7.1%. Conclusions: Our study showed that extra carotid atherosclerosis was the most common cause of ischemic stroke in Burkina Faso. Man gender was most represented than women.

Association between non-alcoholic fatty liver disease evaluated by transient elastography with extracranial carotid atherosclerosis in a multiethnic Asian community.

Background and AimThere is not much data on the association between non‐alcoholic fatty liver disease (NAFLD) and advanced fibrosis assessed using Fibroscan with carotid intima‐media thickness (CIMT) in the general population. The objective of this study was to evaluate the association between NAFLD and advanced fibrosis, as diagnosed by Fibroscan, with an increased CIMT in the Malaysian population.MethodsA cross‐sectional study of government officers and their family members attending a health screening at a public healthcare facility was conducted. All subjects underwent clinical evaluation, biochemical testing, anthropometry, ultrasound carotid Doppler, and Fibroscan examination.ResultsData for 251 subjects were analyzed (mean age 47.1 ± 12.4 years, 74.1% male). Prevalence of NAFLD and advanced fibrosis were 57.4 and 17.5%, respectively. Independent factors associated with NAFLD were waist circumference (odds ratio [OR] = 1.077, 95% confidence interval [CI] 1.038–1.118, P < 0.001) and serum alanine aminotransferase (ALT) (OR = 1.039, 95% CI 1.005–1.074, P = 0.024). Independent factors associated with advanced fibrosis were male gender (OR = 4.847, 95% CI 1.369–17.155, P = 0.014) and serum aspartate aminotransferase (AST) (OR = 1.057, 95% CI 1.003–1.113, P = 0.036). Prevalence of increased CIMT was 29.0%. Independent factor associated with increased CIMT was older age (OR = 1.146, 95% CI 1.067–1.231, P < 0.001). Of the subjects, 34.5% with NAFLD had increased CIMT compared to 19.1% of the subjects without NAFLD (P = 0.063). Advanced fibrosis was not associated with increased CIMT.ConclusionsPrevalence of NAFLD, advanced liver fibrosis, and increased CIMT were high. NAFLD and advanced liver fibrosis appeared not to be associated with increased CIMT. However, a larger sample size is needed to demonstrate whether there is any association.

Long term efficacy of endovascular stent in treatment of extracranial carotid artery atherosclerosis stenosis

Long term efficacy of endovascular stent in treatment of extracranial carotid artery atherosclerosis stenosis