Internal Carotid Artery Atherosclerosis Research Articles

#1554 The association between gut-derived metabolites and biomarkers of renal and cerebro-vascular damage in type 2 diabetes mellitus patients

Abstract Background and Aims Due to its numerous complications, type 2 diabetes mellitus (T2DM) has a major impact on the global economic burden and overall mortality. This condition modifies the metabolic microenvironment in targeted organs, such as the kidney and the brain, by its hyperglycemic nature. Gut microbiota seems to have significant interference with the renal-cerebral axis, especially in a dysbiosis state. The aim of the study was to quantify gut derived metabolites by metabolomic techniques and to evaluate their association with markers of endothelial, podocyte and proximal tubule damage and with cerebro-vascular hemodynamic indices. Method The metabolomic profiling was realized on serum and urine samples originated from 90 T2DM patients, divided into three subgroups, such as the following: 30 normal to mildly-, 30 moderately-, and 30 severely increased albuminuria, respectively, and 20 healthy subjects. The samples were examined by using untargeted and targeted ultra-high performance liquid chromatography coupled with electrospray-ionization quadroupole time-of-flight mass spectrometry (UHPLC-QTOF-ESI+-MS), in order to obtain the metabolic profile. The markers of renal damage such as synaptopodin (SP), podocalyxin (PD), N-acetyl-β-D-glucosaminidase (NAG), kidney injury molecule 1 (KIM-1), monocyte chemotactic protein 1 (MCP-1), and intercellular adhesion molecule 1 (ICAM-1) were assessed by ELISA technique. The hemodynamic cerebro-vascular indices were obtained by high resolution Doppler ultrasound of common carotid arteries (CCAs), internal carotid arteries (ICAs), and middle cerebral arteries (MCAs), bilaterally. The correlations between the metabolites, the markers of renal damage, and neurosonological indices were realized by univariable and multivariable linear regression analyses. Results UHPLC-QTOF-ESI+-MS targeted analysis and subsequent statistical assessments revealed a subset of metabolites with a specific pattern for the normal to mildly increased albuminuria subgroup. The metabolites identified as significant were, in serum: arginine (sArg), hippuric acid (sHA), indoxyl sulfate (sIS), butenoylcarnitine (sBCA), sorbitol (sSorb); and in urine, arginine (uArg), butenoylcarnitine (uBCA), indoxyl sulfate (uIS) and p-cresyl sulfate (uPCS). The univariable linear regression analysis revealed that sArg correlated positively with the breath-holding index (BHI) and negatively with intima media thickness (IMT) in ACI, MCP-1 and ICAM-1; sIS, sSorb, and sBCA correlated inversely with these parametes. The multivariable linear regression analysis displayed the specific correlations between metabolites, markers of endothelial dysfunction, and neurosonological indices, such as follows: sArg correlated with IMT and ICAM-1; sIS followed a predictive pattern along with resistance index (RI) in ACIs and ICAM-1; sBCA correlated with IMT and MCP-1 and sSorb correlated with ICAM-1 and BHI. The urine metabolites were correlated with markers of podocyte and proximal tubule dysfunction: uIS and uBCA were correlated with PD and urinary albumin to-creatinin ratio (uACR), and uPCR correlated with KIM-1 and uACR. Conclusion This study revealed a set of metabolites potentially derived from the intestinal microflora which may act as biomarkers for the early detection of both CMA and DKD in T2DM patients. SArg, sIS and, sBCA are indicators of renal endothelial dysfunction. Moreover, sArg and sIS reflect incipient common and internal carotid artery atherosclerosis, suggesting vascular remodeling at these levels. SSorb correlated with BHI, indicating blood-brain barrier dysfunction and CMA development. In urine, uBCA and uIS are indicators of podocytopathy, whereas uPCS is associated with proximal tubule damage in incipient DKD.

Carotid Artery Tortuosity and Internal Carotid Artery Plaque Composition.

Little is known about the association between carotid artery tortuosity and internal carotid artery atherosclerosis. This study sought to evaluate the associations between various types of arterial tortuosity and vulnerable plaque components on magnetic resonance angiography (MRA). Aretrospective review was completed of 102patients who had undergone MRA neck imaging, with intraplaque hemorrhage (IPH) present in one or both cervical internal carotid arteries (ICA). Each ICA was assessed for two categories of tortuosity: variant arterial pathway(s) (retrojugular and/or retropharyngeal) and abnormal curvature (kinks, loops, and/or coils). All ICA plaques were assessed for the presence or absence of intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), ulceration, and enhancement, as well as the volume of IPH and degree of luminal stenosis. The mean age of included patients was 73.5years (SD = 9.0 years) and 88 (86.3%) subjects were male. The left carotid plaque was significantly more likely to have IPH (68.6% vs. 47.1%; p = 0.02). The left ICA was more likely to have aretrojugular course (22% vs. 9.9%; p = 0.002) and any variant arterial course (26.5% versus 14.67%, p = 0.01). On the right there was an association between the presence of aLRNC and retropharyngeal and/or retrojugular arterial pathway (p = 0.03). On the left there was an association between the presence of any abnormal arterial curvature and IPH volume (p = 0.03). Neither association met the adjusted statistical threshold after Bonferroni correction, with alpha set at 0.0028. ICA tortuosity is not associated with carotid artery plaque composition, and likely does not play arole in the development of high-risk plaques.

An Atypical Manifestation of Lateral Medullary Syndrome (P12-5.011)

<h3>Objective:</h3> To describe a case of lateral medullary syndrome (LMS) presenting with ipsilateral hemiparesis and upper motor neuron (UMN)-type facial palsy. <h3>Background:</h3> LMS is a classical vascular syndrome involving the posterior inferior cerebellar artery, which presents typically with ipsilateral Horner syndrome, ipsilateral ataxia, and contralateral hemianesthesia. Motor weakness and facial palsy are not traditionally presented in LMS. <h3>Design/Methods:</h3> Case report. <h3>Results:</h3> A 62-year-old male with poorly controlled hypertension presented with sudden onset left hemiparesis. On presentation, initial blood pressure was 178/95 mmHg. The neurological exam showed dysarthria, left facial palsy sparing the forehead, left facial hypoesthesia, and left hemiparesis (NIHSS 8). Diffusion-weighted MR Brain showed acute infarct in the left lateral medulla. FLAIR sequence showed chronic infarct in the right thalamus. CT arteriogram revealed non-opacification of the left vertebral artery at the level of C2–C3 with opacification of the distal left V4 via retrograde flow, severe stenosis of the right M1 segment, and multifocal atherosclerosis of the bilateral internal carotid arteries. Initial labs showed elevated LDL (213 mg/dl) and normal hemoglobin A1c. Right hemianesthesia was reported during his hospitalization; dysphagia, frequent hiccups, and left dysmetria out of proportion to weakness were noted during the recovery. After acute interventions, he was started on dual antiplatelet treatments for 90 days and a single antiplatelet afterward given concerns of large vessel disease as stroke etiology. <h3>Conclusions:</h3> Atypical clinical presentation in this LMS case included the combination of ipsilateral hemiparesis and ipsilateral UMN-type facial palsy. LMS with ipsilateral hemiparesis is known as Opalski’s syndrome, which is explained by involving the post-decussating pyramidal tract at the lower medulla and upper cervical spine. The explanation of ipsilateral UMN-type facial palsy in our case remains unclear. One possible explanation is the aberrant caudal looping of facial corticobulbar fibers into medulla oblongata prior to synapsing with the pontine facial nucleus. <b>Disclosure:</b> Dr. Yu has nothing to disclose. Mr. Bluntson has nothing to disclose. Dr. Sharma has nothing to disclose.

Disturbed Ratios between Essential and Toxic Trace Elements as Potential Biomarkers of Acute Ischemic Stroke.

Cadmium (Cd) and lead (Pb) are known to be two of the metal contaminants that pose the greatest potential threat to human health. The purpose of this research study was to compare the levels of toxic metals (Cd, Pb) in patients with acute ischemic stroke (AIS), with a control group in Podlaskie Voivodeship, Poland. The study also aimed to assess the correlations between toxic metals and clinical data in AIS patients, and to assess the potential effect of smoking. The levels of mineral components in the collected blood samples were assessed by means of atomic absorption spectrometry (AAS). The Cd blood concentration was significantly higher in AIS patients as compared to the control group. We found that the molar ratios of Cd/Zn and Cd/Pb were significantly higher (p < 0.001; p < 0.001, respectively), when the molar ratios of Se/Pb, Se/Cd, and Cu/Cd were significantly lower (p = 0.01; p < 0.001; p < 0.001, respectively), in AIS patients as compared to control subjects. However, there were no considerable fluctuations in relation to the blood Pb concentration or molar ratios of Zn/Pb and Cu/Pb between our AIS patients and the control group. We also found that patients with internal carotid artery (ICA) atherosclerosis, particularly those with 20-50% ICA stenosis, had higher concentrations of Cd and Cd/Zn, but lower Cu/Cd and Se/Cd molar ratios. In the course of our analysis, we observed that current smokers among AIS patients had significantly higher blood-Cd concentrations, Cd/Zn and Cd/Pb molar ratios, and hemoglobin levels, but significantly lower HDL-C concentrations, Se/Cd, and Cu/Cd molar ratios. Our research has shown that the disruption of the metal balance plays a crucial role in the pathogenesis of AIS. Furthermore, our results broaden those of previous studies on the exposure to Cd and Pb as risk factors for AIS. Further investigations are necessary to examine the probable mechanisms of Cd and Pb in the onset of ischemic stroke. The Cd/Zn molar ratio may be a useful biomarker of atherosclerosis in AIS patients. An accurate assessment of changes in the molar ratios of essential and toxic trace elements could serve as a valuable indicator of the nutritional status and levels of oxidative stress in AIS patients. It is critical to investigate the potential role of exposure to metal mixtures in AIS, due to its public health implications.

Role of CT Angiography in Detection of Extracranial Carotid and Vertebral Artery Disease in Patients With Acutely Ruptured Intracranial Aneurysms

Introduction: Computed tomography (CT) and CT angiography are standard imaging modalities for suspected acute intracerebral hemorrhage due to ruptured intracranial aneurysms. In this clinical setting, several protocols of computed tomography and CT angiography may be implemented. The standard CT angiography protocol is limited to intracranial vessels. The extended protocol may also include carotid and vertebral arteries and the aortic arch.Objective: To define the CT angiography role in detection of extracranial carotid and vertebral artery disease and clinical significance of this method for patients with suspected acute intracerebral hemorrhages due to ruptured intracranial aneurysms.Materials and methods: The study included 275 neurosurgical patients with acute nontraumatic intracranial hemorrhages due to ruptured intracranial aneurysms who were treated in Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) from September 2017 to August 2020. Computed tomography and CT angiography were performed in all patients. The scanned area included both intracranial and extracranial arteries (an arch-to-vertex angiogram) to detect extracranial carotid and vertebral artery diseases such as stenoses, occlusions, tortuosity, and hypoplasia.Results: Atherosclerosis of internal carotid and vertebral arteries was diagnosed in 95 patients (34.5% of the total number of patients included in the study). In 13 (4.7%) patients these stenoses were hemodynamically significant. We identified a high frequency of tortuous carotid and vertebral arteries (122 cases, 44.3%) and vertebral artery hypoplasia (59 cases, 21.5%). The carotid and vertebral artery stenoses and congenital anomalies of vertebral arteries (however, not of carotid arteries) were associated with a higher incidence of unfavorable outcomes after endovascular treatment of intracranial aneurysms.Conclusions: The optimal CT angiography protocol for acute nontraumatic intracranial hemorrhage should focus on the arteries of the head and neck (up to the aortic arch). This protocol shows higher detection rate of concomitant anomalies of carotid and vertebral arteries. These findings are important for planning and successful performance of endovascular treatment for intracranial aneurysms.

Abstract Number ‐ 255: Laser Speckle Flowgraphy As A Surrogate Marker For Symptomatic Carotid Stenosis

Introduction The severity of internal carotid artery (ICA) atherosclerosis is assessed through measurements of degree of stenosis. This approach does not factor in mechanisms compensating for reduced distal perfusion, such as collateral circulation. An alternative approach is evaluating severity of carotid stenosis based on downstream changes in ocular perfusion. Laser speckle flowgraphy (LSFG) is a non‐invasive tool that quantifies intraocular blood flow. This pilot study investigated whether LSFG metrics could be surrogates for degree of stenosis. Additionally, we quantified changes in flow through the stenosed vessel before and after stenting usingsyngoiFlow (iFlow). Methods Fourteen patients had stents placed to treat symptomatic carotid stenosis. LSFG metrics were obtained before and after stenting. Mean blur rate (MBR), an index of ocular blood velocity, and associated waveform parameters were extracted from the optic nerve head (ONH) region of the eye. iFlow quantified time to peak (TTP), an index of peak cerebral contrast flow, by transforming digital subtraction angiography (DSA) images into perfusion heat maps.TTPswere extracted for seven regions of interest (ROIs) by two raters. Results Two LSFG waveform parameters were significantly negatively correlated with degree of stenosis. These parameters, flow acceleration index (FAI) and rising rate (RR), also increased significantly after stenting. Intraclass correlation coefficients calculated for TTPs showed substantial agreement across all ROIs. Significant decreases in TTP after stenting were observed in ROIs placed in the high cervical ICA, cavernous segment of the ICA, and brain parenchyma. Conclusions LSFG provides biometrics that can accurately measure the impact of ICA stenosis by quantifying distal perfusion. Indices of ocular blood flow acceleration may serve as surrogate metrics for degree of stenosis. iFlow is a sensitive tool to quantify changes in flow after stenting. Non‐invasive flow‐dependent methods are promising in the assessment of patients with ICA stenosis.

Association between the rs2279238 of the Liver X receptor alpha gene polymorphism and advanced carotid atherosclerosis in the Slovenian cohort

BackgroundLiver X receptor alpha (LXRA) plays important role in cholesterol and lipid homeostasis and lipid metabolism; moreover, it has been investigated as a candidate gene in a number of conditions, including onset and progression of atherosclerosis. We hypothesized that the LXRA gene rs2279238 polymorphism may be associated with the onset and progression of carotid atherosclerosis in the Slovenian cohort. Methods783 unrelated Slovenian patients were included in this cross-sectional case-control study: 308 patients in the group of cases with severe internal carotid artery (ICA) stenosis (>75 %) and 475 patients with hemodynamically insignificant ICA stenosis (<50 %) in the control group. Medical records were used to acquire patient laboratory and clinical data. The TaqMan SNP Genotyping assay was used to genotype the rs2279238 polymorphism. ResultsBetween the case and control groups, we identified a statistically significant variation in genotype distribution (p = 0.04), but not in allele frequency (p = 0.13) of the LXRA gene polymorphism rs2279238. The results, also show that there is a statistically significant association (p = 0.04) between the two genetic models (codominant and recessive) of the LXRA gene rs2279238 polymorphism and carotid atherosclerosis. ConclusionIn the Slovenian cohort, we found a significant association between the TT genotype of rs2279238 and advanced carotid artery disease, suggesting that this polymorphism might be a genetic risk factor for ICA atherosclerosis.

THE EFFECT OF RENAL DENERVATION ON CEREBRAL BLOOD FLOW IN DIABETIC PATIENTS WITH RESISTANT HYPERTENSION

Objective: Long-term and persistent increase in blood pressure (BP) leads to vascular remodeling, which deteriorates cerebral blood flow. The combination of hypertension (HTN) with diabetes mellitus (DM) accelerates the vascular damage and impairs the cerebral blood flow autoregulation, which may be accompanied by an uncompensated decrease in cerebral perfusion in response to a decrease in BP. Renal denervation (RDN) leads to a rapid and sustained decrease in BP, therefore the aim of this study was to assess of changes in cerebral blood flow in patients with resistant HTN (RHTN) and type 2 DM at 6 month after the intervention. Design and method: Evaluation of cerebral blood flow was performed in 21 patients with RHTN and type 2 DM, who were included in single-arm prospective interventional studies (protocol numbers NCT01499810 and NCT02667912 on ClinicalTrials.gov) (mean age 61.4 ± 7.6 years, mean office (systolic/diastolic) BP (SBP/DBP) 167.1 ± 19.4/85.6 ± 15.9 mmHg, HbA1c 7.1 ± 1.3%, 8 men (32%), 19 pts (91%) had atherosclerosis of internal carotid arteries (ICA) with mean values of stenosis 22.2 ± 9.7%). All patients were undergone to ambulatory 24-hour BP, Doppler high-resolution ultrasound of ICA and middle cerebral arteries (MCA) at baseline and 6 month follow-up. The patients were instructed not to change their medication regimen during the study. Results: There was a significant decrease in mean 24-hour BP (systolic/diastolic) (-12.6/-7.3 mmHg, p &lt; 0.05). At the same time, there was no deterioration in blood flow of ICA and MCA at 6 months after RDN. Conclusions: Our data indicate that the significant decrease in BP after RDN does not lead to deterioration of cerebral blood flow and therefore indicates the safety of this procedure for the brain in patients with RHTN with type 2 DM.

Differences Between Anticoagulated Patients With Ischemic Stroke Versus Intracerebral Hemorrhage.

BackgroundData on the relative contribution of clinical and neuroimaging risk factors to acute ischemic stroke (AIS) versus intracerebral hemorrhage (ICH) occurring on oral anticoagulant treatment are scarce.Methods and ResultsCross‐sectional study was done on consecutive oral anticoagulant–treated patients presenting with AIS, transient ischemic attack (TIA), or ICH from the prospective observational NOACISP (Novel‐Oral‐Anticoagulants‐In‐Stroke‐Patients)‐Acute registry. We compared clinical and neuroimaging characteristics (small vessel disease markers and atherosclerosis) in ICH versus AIS/TIA (reference) using logistic regression. Among 734 patients presenting with stroke on oral anticoagulant treatment (404 [55%] direct oral anticoagulants, 330 [45%] vitamin K antagonists), 605 patients (82%) had AIS/TIA and 129 (18%) had ICH. Prior AIS/TIA, coronary artery disease, dyslipidemia, and worse renal function were associated with AIS/TIA (adjusted odds ratio [aOR] [95% CI] 0.51 [0.32–0.82], 0.48 [0.26–0.86], 0.55 [0.34–0.89], and 0.82 [0.75–0.90] per 10 mL/min). Prior ICH, older age, higher admission blood pressure, and statin treatment were associated with ICH (aOR [95% CI] 6.33 [2.87–14.04], 1.37 [1.04–1.81] per 10 years, 1.19 [1.10–1.29] per 10 mm Hg, and 1.81 [1.09–3.03]). Cerebral microbleeds and moderate‐to‐severe white matter hyperintensities contributed more to ICH (aOR [95% CI] 2.77 [1.34–6.18], and 2.62 [1.28–5.63]). Aortic arch, common and internal carotid artery atherosclerosis, and internal carotid artery stenosis ≥50% contributed more to AIS/TIA (aOR [95% CI] 0.54 [0.31–0.90], 0.29 [0.05–0.97], 0.48 [0.30–0.76], and 0.32 [0.13–0.67]).ConclusionsIn patients presenting with stroke on oral anticoagulant, AIS/TIA was 5 times more common than ICH. A high atherosclerotic burden (indicated by cardiovascular comorbidities and extracranial atherosclerosis) and prior AIS/TIA contributed more to AIS/TIA, while small vessel disease markers and prior ICH were stronger determinants for ICH.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02353585.

Systemic Arterial Correlates of Cervical Carotid Artery Tortuosity : The Northern Manhattan Study.

The association between cervical internal carotid artery (cICA) tortuosity and atherosclerosis is amatter of debate. Additionally, some genetic syndromes characterized by connective tissue remodeling are associated with arterial tortuosity, raising the possibility that cICA tortuosity may not only be atherosclerotic. In this study, we hypothesized that cICA tortuosity is not associated with imaging biomarkers of atherosclerosis. The Northern Manhattan Study (NOMAS) was aprospective, multiethnic cohort of stroke-free individuals who underwent brain MRA, carotid ultrasound and transthoracic echocardiogram from 2003-2008. The cICA tortuosity was scored in each carotid as 0 = no tortuosity, 1 = tortuosity <90°, 2 = tortuosity ≥90°. Asummary cICA tortuosity score (possible range 0-4) was created by adding up the tortuosity score from each carotid. Participants were assessed for atherosclerotic markers by using B‑mode carotid sonography and transthoracic echocardiography. Of 558 participants 178 (31.9%) had any cervical ICA tortuosity (tortuosity score >0). The cICA tortuosity score was higher in women and was associated with diastolic and systolic blood pressures and height (all P < 0.05). In models adjusted for demographics and risk factors, only the association with diastolic blood pressure remained significant (β = 0.002, P = 0.02). Similarly, cICA tortuosity was associated with larger aortic root diameter (B = 1.03 ± 0.36, P = 0.004) but not with other markers of carotid or aortic atherosclerosis. Cervical ICA tortuosity is associated with ahigher diastolic blood pressure and larger aortic root diameter but not with other measures of atherosclerosis. Determining the risks of vascular events associated with this non-atherosclerotic phenotype may help for abetter risk stratification for individuals with cICA tortuosity.

Association between rs2107595 HDAC9 gene polymorphism and advanced carotid atherosclerosis in the Slovenian cohort

BackgroundHistone deacetylase 9 (HDAC9) plays an important role in transcriptional regulation, cell cycle progression and developmental events; moreover, it has been investigated as a candidate gene in a number of conditions, including the onset and progression of atherosclerosis. We hypothesized that the rs2107595 HDAC9 gene polymorphism may be associated with advanced carotid artery disease in a Slovenian cohort. We also investigated the effect of this polymorphism on HDAC9 receptor expression in the internal carotid artery (ICA) specimens obtained by endarterectomy.MethodsThis case-control study enrolled 619 unrelated Slovenian patients: 311 patients with ICA stenosis > 75% as the study group and 308 patients with ICA stenosis < 50% as the control group. Patient laboratory and clinical data were obtained from the medical records. The rs2107595 polymorphisms were genotyped using TaqMan SNP Genotyping assay. HDAC9 expression was assessed by immunohistochemistry in 30 ICA specimens from patients with ICA atherosclerosis > 75%, and the numerical areal density of HDAC9 positive cells was calculated.ResultsThe occurrence of advanced ICA atherosclerosis in the Slovenian cohort was 3.81 times higher in the codominant genetic model (OR = 3.81, 95%CI = 1.06–13.77, p = 0.04), and 3.10 times higher in the recessive genetic model (OR = 3.10, 95%CI = 1.16–8.27, p = 0.02). In addition, the A allele of rs2107595 was associated with increased HDAC9 expression in the ICA specimens obtained by endarterectomy.ConclusionsWe observed a significant association between the AA genotype of rs2107595 with the advanced carotid artery disease in our Slovenian cohort, indicating that this polymorphism may be a genetic risk factor for ICA atherosclerosis.

ASSOCIATION OF CHIROPRACTIC THERAPY, ATHEROSCLEROSIS AND AMAUROSIS FUGAX

Chiropractic therapy (CPT) is a popular physical therapy. Cerebrovascular accidents were reported with neck manipulation (NM), mainly due to vertebral artery dissection. However, it is unclear whether NM could be associated with internal carotid artery atherosclerosis (ICAAS). We present a case of

Abstract TP194: Relation Between Lipoprotein (a) and Cerebral Arteriosclerosis

Background: Lipoprotein(a) is known to be associated with increased atherosclerotic burden and vascular event. We investigated the relationship between lipoprotein(a) level and cerebral arteriosclerosis burden, including both atherosclerosis and small vessel disease. Methods: Consecutive patients with acute cerebral infarction or transient ischemic attack who had been through both brain imaging and serum lipoprotein a level analysis were included in the study. For cerebral atherosclerosis, intracranial arterial calcification status at cavernous portion of internal carotid artery and cerebral atherosclerosis score as the sum of major cerebral arterial stenosis were measured from brain CT angiography. Assessed cerebral small vessel disease phenotype included white matter hyperintensities, old lacune, cerebral microbleeds and extensive perivascular space. The patients were categorized into four groups according to the predefined cut-off values of lipoprotein(a) (15, 30, 50mg/dL). Results: A total of 990 patients were included with 457 female patients (mean age = 68.2 ± 12.8 years). Overall cerebral atherosclerosis score or total small vessel disease burden was not increased according to increased lipoprotein(a) group, although the proportion of the patients with severe calcification showed increasing tendency. Multivariable logistic regression analysis revealed that increased lipoprotein(a) was independently associated with severe calcification (group 4, odds ratio = 1.68, confidence interval = 1.01 – 2.80). Increased lipoprotein(a) was associated with the presence of white matter hyperintensities and extensive perivascular space, but not associated with old lacune or cerebral microbleed. Conclusion: Lipoprotein(a) is independently associated with severe calcification of intracranial artery. The impact of elevated lipoprotein(a) toward small vessel disease burden seems to be different according to its phenotype.

The Correlation between Hypertensive Intracerebral Hemorrhage and Internal Carotid Atherosclerosis Investigated by Carniocervial CTA

Objective: To investigate the relationship between hypertensive intracerebral hemorrhage and internal carotid atherosclerosis and its risk factors by CTA (Computed tomography angiography). Methods: The clinical materials of hypertensive intracerebral hemorrhage patients with carniocervial CTA from January 2018 to August 2019 in Puren Hospital of Wuhan were analyzed retrospectively. The correlation and risk factors between hypertensive intracerebral hemorrhage and internal carotid atherosclerosis were studied by logistic regression and descriptive analysis, at the same time, the application value of carniocervial CTA in patients with cerebral hemorrhage was evaluated. Results: There was a correlation between hypertensive intracerebral hemorrhage and internal carotid atherosclerosis (χ2 = 5.319, P = 0.021 1), which indicated that internal carotid atherosclerosis was the risk factor of hypertensive intracerebral hemorrhage, and there was no significant correlation between the location of internal carotid atherosclerosis, multiple atherosclerosis of internal carotid artery and hypertensive intracerebral hemorrhage. Monofactor analysis showed that the risk factors of hypertensive intracerebral hemorrhage with internal carotid atherosclerosis were sex, age, diabetes and hyperlipidemia. According to the logistic regression analysis, hyperlipidemia and diabetes were independent risk factors for hypertensive. Conclusion: The occurrence of hypertensive intracerebral hemorrhage is related to internal carotid atherosclerosis and is affected by many factors. Carniocervial CTA is helpful to the diagnosis of cerebral hemorrhage.

Abstract TP255: Assessment of Hemodynamic Changes in Persistent Carotid-Vertebrobasilar Anastomoses by Ultrasonography

Objectives: Persistent carotid-vertebrobasilar anastomoses (PCVBA) is a rare cerebral arterial variant between anterior and posterior circulation. This study aimed to evaluate the hemodynamic characteristics of PCVBA by the combination of color Doppler flow imaging (CDFI) and transcranial color-coded sonography (TCCS). Methods: Patients diagnosed with PCVBA were imaged by combination of CDFI and TCCS, then confirmed by digital subtraction angiography (DSA) or computed tomography angiography (CTA) from July 2015 to July 2017. The parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI), were acquired in extracranial vertebral artery (VA), intracranial VA, basilar artery and posterior cerebral artery. The vessel diameter of the extracranial VA was measured as well. Results: A total of 14 patients were analyzed in this study. Posterior ischemic stroke associated with ipsilateral internal carotid artery (ICA) atherosclerosis were found in 3 patients (3/14, 21.4%), and posterior transient ischemic attack occurred in 8 patients (8/14, 57.1%). Persistent trigeminal artery (PTA) was confirmed in 6 cases, which the PSV decreased but RI increased in bilateral VA, meanwhile normal velocity was acquired in BA. After compressing the ipsilateral CCA, velocities of BA and bilateral PCA decreased significantly. There were 5 persistent hypoglossal artery (PHA) and 3 proatlantal intersegmental artery (PIA). Among these patients, CDFI displayed a tiny-lumen with reduced PSV and increased RI in bilateral VA. TCCS showed normal velocity in ipsilateral intracranial VA and BA, which were significantly reduced after compressing the ipsilateral CCA. Conclusions: PCVBA may cause the posterior circulation ischemia, especially in patients associated with ipsilateral ICA atherosclerotic lesions. The abnormal hemodynamic changes in different types of PCVBA could be evaluated by combination of CDFI and TCCS.

Reversible cerebral vasoconstriction syndrome (RCVS) in the context of aseptic meningitis in a twenty eight year-old postpartum female

Reversible cerebral vasoconstriction syndrome (RCVS) is an uncommon pathology that typically presents with a severe thunderclap headache in middle-aged postpartum females. Our patient was a twenty eight year-old Caucasian female seven months postpartum who presented with a ten day history of severe frontal headaches, myalgia, nausea, and anorexia without fevers. She then developed severe left hemiplegia, dysarthria, and paresthesias. Initial cerebrospinal fluid was significant for lymphocytepredominant pleocytosis, and acyclovir, vancomycin, and doxycycline were started for empiric meningitis. Cultures and marker were pan-negative for viral, bacterial, fungal, and autoimmune etiology. A computed tomography head scan was suggestive of distal right internal carotid artery atherosclerosis and ectasia, highly unusual for a woman of this age with no cardiovascular risk factors. Her hospital course was characterized by insomnia, delirium, worsening overnight headaches, and unusual bradycardic episodes. A computed tomography angiogram confirmed right internal carotid artery and middle cerebral artery M1 and M2 segment narrowing, suggestive of RCVS. A follow-up cerebral arteriogram highlighted right middle cerebral artery M1 segment tapering, confirming this diagnosis. We suspect an additional diagnosis of aseptic meningitis, due to her cerebrospinal fluid findings, which likely exacerbated her clinical presentation. Her refractory headaches eventually improved spontaneously. This presentation of reversible cerebral vasoconstriction syndrome in the context of a late post-partum onset and aseptic meningitis is the first such case to be documented, and we hope to shed some light on this unusual and uncommon disease, as well as some avenues for future research.

ВЛИЯНИЕ МЕТОДА АНЕСТЕЗИИ НА АКТИВНОСТЬ ПЕРЕКИСНОГО ОКИСЛЕНИЯ ЛИПИДОВ ПРИ КАРОТИДНОЙ ЭНДАРТЕРЭКТОМИИ

The objective of the study: to assess the effect of two types of general anesthesia on lipid peroxidation and to establish a correlation between the degree of its activation and the number of pos t-o perative neurological disorders. Subjects and methods. 130 patients (84 men and 46 women) at the age from 48 to 68 years were examined, they all were admitted to hospital for carotid endarterectomy due to atherosclerosis of internal carotid artery. The blind envelopes method was used for randomization. The patients were divided into 2 groups. The control group included 20 practically healthy persons (the median age made 50 ± 2 years). Propofol was used for anesthesia in 60 patients (Group 1), while sevoflurane was used in 70 patients (Group 2). Student test was used for statistical processing of data. The critical significance level corresponded to p < 0.05. The groups were considered representative based on 12 attributes. During the surgery, the following parameters were monitored: oxidant and ant i-o xidant statuses, markers of neuronal damage; pos t-o perative neurological complications were assessed. Results. When comparing and assessing the rates of the general pr o-o xidant activity and general ant i-o xidant activity in the patients from both groups, the initial rates of oxidant and ant i-o xidant statuses did not confidently differ, which can be explained by the homogeneity of the patients' examinations. The activation of general pr o-o xidant activity and general ant i-o xidant activity was higher in Group 1 at the moment of carotid clamping. The same tendency was observed during the restoration of cerebral blood flow. The intensity of lipid peroxidation activation correlated with the frequency of pos t-o perative neurological disorders and it was lower in Group 2.

Comparison of the risk factors between patients with ischemic stroke due to atherosclerosis of intracranial and extracranial internal carotid artery and vertebrobasillary artery

Comparison of the risk factors between patients with ischemic stroke due to atherosclerosis of intracranial and extracranial internal carotid artery and vertebrobasillary artery

DYNAMICS OF HIGHGER MENTAL FUNCTION IN PATIENTS WITH OBLITERATING LESIONS OF INTERNAL CAROTID ARTERIES IN SURGICAL BRAIN REVASCUL

Obliterating atherosclerosis of internal carotid arteries is one of the main causes of ischemic stroke and discirculatory encephalopathy. It causes up to 40% of ischemic disorders of cerebral circulation. Currently, the strategy for stroke prevention is determined by the intensive development of surgical methods of treatment, primarily methods for managing lesions of brachiocephalic arteries. Based on the results of a number of international multicenter randomized studies, indications for reconstructive operations for BCA, tactics for managing patients in the postoperative period were formulated. A number of patients with atherosclerotic lesions of brachiocephalic arteries have reduced cognitive functions. The aim of the study is to compare cognitive functions (CF) in patients who underwent different surgical approaches in the treatment of obliterating atherosclerotic lesion of internal carotid arteries (ICA). MATERIAL AND METHODS. We studied higher mental functions (HMFs) in 116 patients with obliterating unilateral or bilateral lesion of ICA. The study of cognitive functions (MF) was performed prior to carotid endarterectomy (CE, group 1, n=73) and transluminal balloon angioplasty of ICAs (TBA of ICA, group 2, n=43), and on days 5–7 and 30–31 after cerebral revascularization (CR). To assess the overall severity of cognitive impairment, the summary indicators of main screening neuropsychological tests were used: MMSE; MoCA; Frontal Assessment Battery (FAB); Beck Depression Inventory and Hamilton Depression Rating Scale. RESULTS. Results Neuropsychologic disorders were reavealed in 98% of patients prior to surgery. An initially comparable condition of HMF in groups with CE and TBA of ICA was revealed. MMSE2 revealed a significant improvement in the results in group 1 both in comparison with the initial data (p 0.05). MMSE3 showed a significant improvement in the test results in each group compared to MMSE1 and MMSE2. MMSE3 results were significantly better (p 0.05)). During the second test, the depressive mood of patients was reduced (on the Hamilton scale 8.4 and 13.8 points. CONCLUSION When comparing HMFs in patients who underwent a different surgical approach (CE vs TBA of ICAs) in the treatment of obliterating atherosclerotic lesions of ICAs, we found that: 1) the maximum improvement in HMFs appears by the 30th day of the postoperative period in comparison with preoperative parameters; 2) the most significant improvement HMFs test parameters by the 30th day of the postoperative period is noted in the group where CE was used as the method of surgical revascularization of the brain.

Ocular Ischemic Syndrome Associated with Primary Hyperparathyroidism

Aim: To present a case of bilateral ocular ischemic syndrome associated with severe carotid artery occlusive disease and to discuss any possible etiological factors, including parathyroid adenoma. Case Presentation: We report a rare and unusual case of bilateral ocular ischemic syndrome, secondary to internal carotid artery atherosclerosis, occurring as a result of primary hyperparathyroidism. Discussion: A significant decrease in the visual acuity may be an early sign of PH. Considering calcium homeostasis in the eye is useful in establishing the right diagnosis of PH. Conclusion: To our knowledge, this is the first report of bilateral ocular ischemic syndrome associated with primary hyperparathyroidism.