Presence Of Carotid Artery Disease Research Articles

Risk factors in central retinal vein occlusion: A multi-center case-control study conducted on the Italian population : Demographic, environmental, systemic, and ocular factors that increase the risk for major thrombotic events in the retinal venous system.

To explore the risk factors for central retinal vein occlusion (CRVO) by comparing a large sample of patients with healthy controls. Multi-center case-control study. The study group includes patients affected by central retinal vein occlusion, confirmed angiographically, aged 50 years old or above (Group A). The control group includes healthy subjects without an history of retinal vein occlusion (Group B). Outcome measures: age, gender, active smoking, presence of uncontrolled arterial hypertension (uHTN), presence of the following comorbidities: diabetes mellitus type II (DMII), chronic liver disease (CLD), chronic kidney disease (CKD), thyroid disease (TD), systemic lupus erythematosus (SLE), hyperhomocystenemia (HHcy), dyslipidemia (DLip), carotid artery disease (CAD), glaucoma, atrial fibrillation (AF), migraine headache (MH), chronic obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome (OSAS), history of myocardial infarction (MI). Odds-ratios were calculated with logistic regression analysis. A total of 203 patients (Group A) and 339 controls (Group B). Statistically-significant differences were found for the following variables: age (OR: 1.109 [1.081-1.138], p < .001), active smoking (OR: 2.048 [1.210- 3.466], p < .008), DMII (OR: 4.533 [2.097-9.803], p < .001), HHcy (OR: 4.507 [2.477-10.001 ], p < .001), DLip (OR: 2.255 [1.352-3.762], p = .002), CAD (OR: 6.632 [2.944- 14.942], p < .001), glaucoma (OR: 4.656 [2.031-10.673], < .001), OSAS (OR: 1.744 [1.023-2.975], < .041), uHTN (OR: 3.656 [2.247-5.949], < .001). No statistically-significant differences were found for the other variables. Older age, active smoking, as well as presence of DMII, HHcy, DLip, CAD, glaucoma, OSAS, and uHTN, all increase the risk for CRVO. A comprehensive assessment of patients with CRVO is paramount. Adequate control of all the aforementioned risk factors is likely of great significance in reducing the incidence of CRVO among the general population, and it likely plays an important role in improving the prognosis following the occlusive event.

Monocyte to high-density lipoprotein cholesterol ratio is associated with the presence of carotid artery disease in acute ischemic stroke.

Aim: Monocyte to high-density lipoprotein cholesterol ratio (MHR) has recently emerged as a predictor of cardio-cerebrovascular diseases. Since around one-fifth of strokes are linked to atherosclerosis carotid artery, we aimed to present the relationship between carotid artery disease (CAD) and MHR value in acute ischemic stroke (AIS). Materials & methods: A total of 209 adult AIS patients analyzed. Patients divided into two groups in respect tothe existence of CAD. MHR was compared between the two groups. Results: MHR with a cutoff of 17.23 predicted the presence of disease in the carotid artery, with a sensitivity of 91.9% and specificity of 66.7. MHR was the independent predictor for the presence of disease in the carotid artery. Conclusion: MHR was found to be an independent predictor for the CAD in AIS. Therefore, in AIS patients with high MHR value, CAD should be examined more carefully.

Timing of coronary artery bypass grafting after acute myocardial infarction: does it influence outcomes?

IntroductionThe optimal timing of coronary artery bypass grafting (CABG) operations in patients with recent acute myocardial infarction (AMI) remains unclear.AimTo assess the influence of timing on post-operative outcomes in patients undergoing CABG following AMI.Material and methodsIn this retrospective analysis 12,224 consecutive patients undergoing CABG were included. 2477 (20.5%) patients had a history of AMI. Based on timing, patients were divided into 3 groups: those operated within 7 days of AMI; those operated after 7 days but within 1 month; and a third group operated after 1 month but within 3 months. The 3 groups were compared in terms of baseline, intra-operative, and post-operative morbidity and mortality. Multivariate analysis was carried out to assess the independent influence of timing of CABG on outcomes.ResultsThere was no difference in terms of previous neurological events (p = 0.554), presence of carotid artery disease (p = 0.555), prevalence of hypertension (p = 0.119), diabetes (p = 0.144), hypothyroidism (p = 0.53), chronic obstructive pulmonary disease (p = 0.079), peripheral vascular disease (p = 0.771), and impaired left ventricular function (p = 0.072). On univariate analysis, mortality risk was highest between 1 week and 1 month (p = 0.003). Multivariate analysis showed that the closer the MI and CABG duration, the higher the mortality (co-efficient –0.517; p = 0.019; odds ratio = 0.596; 95% CI: 0.388–0.917).ConclusionsThe duration between MI and CABG has a direct influence on outcomes after CABG. While it is clear that the longer the duration between MI and CABG, the lower the mortality risk, it is however difficult to decide on an exact cut-off time frame.

Midterm Results After Simultaneous Carotid Artery Stenting and Cardiac Surgery

The presence of carotid artery disease is known risk factor for perioperative stroke in cardiac surgery. The optimal management of patients with concomitant heart and carotid artery disease is not known. Simultaneous or staged carotid endarterectomy has been proposed to prevent stroke. In an attempt to reduce perioperative morbidity and death, simultaneous carotid stenting and cardiac surgery were implemented (hybrid procedure). This study evaluated early and midterm results after the hybrid procedure. From November 2012 through November 2018, 54 patients (36 men; an average age, 65.8 ± 7.3 years) underwent the hybrid procedure. The primary end points were the occurrence of perioperative cerebral stroke, transient ischemic attack (TIA), acute myocardial infarction, bleeding, or death. The mean follow-up period was 30 months. The 30-day mortality was 0%. Periprocedural incidence of stroke and transient ischemic attack were 1.9% and 7.6%, respectively, and acute myocardial infarction occurred in 1 patient (1.9%). No patients required repeat thoracotomy for bleeding. Four patients (7.6%) died during follow-up. The cause of death was stroke in 2 patients (3.8%), heart failure in 1 (1.9%), and multiorgan failure in 1 (1.9%). In-stent restenosis of the carotid artery occurred in 1 patient (1.9%). In this small group of patients, the hybrid procedure proved to be a safe and efficient treatment for patients with concomitant carotid and cardiac diseases. The low rate of perioperative complications and good midterm results are encouraging.

Is peripheral arterial disease associated with carotid artery disease in Egyptians? A pilot study

Background Atherosclerosis involves various vascular segments. The association of carotid artery disease (CAD) to peripheral arterial disease (PAD) is not well investigated in Egyptian patients. Objective In this pilot study, our aim was to examine the relationship between PAD and CAD in an Egyptian population. Patients and methods We examined 37 consecutive patients with PAD for the presence of CAD. Vascular and neurologic examination and duplex assessment of extracranial and intracranial carotid system and ankle-brachial index measurement were carried out to determine whether CAD is symptomatic or not. Results CAD was found in 20 (54.1%) patients. Eight (21.6%) patients had significant extracranial internal carotid stenosis and 13(37%) had intracranial stenosis and were more significantly above the age of 60 years. All patients with intracranial stenosis were men. PAD with RC6 was significantly associated with cerebrovascular events ( P = 0.001) and significant extracranial stenosis ( P = 0.013) and intracranial internal carotid stenosis ( P = 0.001). Conclusion Intracranial and extracranial carotid stenoses are commonly present in patients with critical PAD. Duplex ultrasound screening for CAD presence and severity may be of great benefit, especially in the elderly and patients with critical limb ischemia. These findings need to be further confirmed in a study on larger population of Egyptians.

9. Prevalence and impact of carotid disease in adult Saudi patients undergoing isolated coronary artery bypass surgery on early post-operative outcome

Assess the prevalence of carotid disease in our Saudi population undergoing coronary artery bypass surgery and determine its impact on stroke and early post-operative outcome. 3197 consecutive adult patients underwent major cardiac surgery in our center between January 2002 and December 2012. 3150 of these had preoperative duplex scanning, and out of these, 210 patients (6.6%) had significant carotid artery disease defined as ⩾75% stenosis (Group A), while 2940 (94.4%) were free from carotid artery disease (Group B). Both groups were compared for presence of pre-operative risk factors and for occurrence of adverse events in the immediate post-operative period. In uni-variant analysis, pre-operative risk factors for the presence of carotid artery stenosis were diabetes mellitus (p < 0.0001); hypertension (p < 0.0001); past cerebrovascular accident (p < 0.0001) and peripheral vascular disease (p < 0.0001). All-cause in hospital mortality was high in group A in comparison to group B (3.8% vs 1.56%; p = 0.004). The Morbidity was also high in group A compared to group B in terms of stroke (4.3% vs 1.6%; p = 0.0014), nosocomial pneumonia (16.4% vs 8.9%; p = 0.0015), leg wound infection (14.2% vs 6%; p = 0.0001), septicemia (9.3% vs 4.8%; p = 0.013), acute limb ischemia (1.1% vs 0.4%; p = 0.034), new-onset atrial fibrillation (26.8% vs 16.3%; p = 0.0005), ventricular fibrillation (4.9% vs 1.5%; p = 0.0035) and renal dysfunction (11% vs 4.9%; p = 0.0017). The Presence of carotid artery disease in Saudi patients undergoing cardiac surgery is associated with increased prevalence of diabetes, hypertension, cerebro-vascular accidents and peripheral vascular disease. It is also a major determinant of adverse outcome after coronary surgery.

Aortic and Mitral Calcification Is Marker of Significant Carotid and Limb Atherosclerosis in Patients with First Acute Coronary Syndrome.

Atherosclerosis is a systemic disease and coronary artery disease is frequently associated with peripheral artery disease. As aortic and mitral valvular calcification (VC) share some etiopathogenetic mechanisms with atherosclerosis, we analyzed the risk profile and the echocardiographic characteristics of patients admitted for first acute coronary syndrome (ACS) to investigate whether the presence of VC could be a marker of asymptomatic hemodynamically significant peripheral atherosclerosis. A total of 151 patients admitted for ACS without previous history of cardiovascular disease were consecutively enrolled. The presence of VC was identified by echocardiography; a carotid stenosis ≥50% by ultrasound identified carotid artery disease (CarAD); an ankle-brachial index ≤0.9 or ≥1.4 identified lower extremity artery disease (LEAD). Significant peripheral atherosclerosis was defined by the presence of CarAD and/or LEAD. Peripheral atherosclerosis was diagnosed in 82 (54.3%) patients; isolated CarAD in 24, isolated LEAD in 20, both diseases in 38 patients. VC was present in 103 (68.2%) patients. By multivariate analysis, age (OR = 1.059, 95% CI 1.007-1.113, P = 0.025), diabetes mellitus (OR = 5.068, 95% CI 1.480-17.351, P = 0.010), VC (OR = 7.422, 95% CI 2.421-22.880, P < 0.001), and multivessel CAD (OR = 3.317, 95% CI 1.281-8.586, P = 0.013) were the only independent predictors of having peripheral atherosclerosis. C-statistic for VC was not inferior to that obtained by age (0.728, 95% CI 0.649-0.797 vs. 0.800, 95% CI 0.727-0.861, P = 0.101) and to that obtained by the combination of multivessel CAD with diabetes (0.750; 95% CI 0.673-0.817, P = 0.635), and, furthermore, it was higher than that obtained by diabetes alone (0.620, 95% CI 0.538-0.698, P = 0.036). Ruling out the presence of significant peripheral atherosclerosis should be routinely considered in patients with ACS showing VC at echocardiography.

Prevalence and impact of carotid disease in adult Saudi patients undergoing isolated coronary artery bypass surgery on early postoperative outcome

The aim of the study is to assess the prevalence of carotid disease in our Saudi population undergoing coronary artery bypass surgery and to determine its impact on stroke and early postoperative outcome. A total of 3197 consecutive adult patients underwent major cardiac surgery in our center between January 2002 and December 2012. Of these, 3150 had preoperative duplex scanning, and out of these, 210 patients (6.6%) had significant carotid artery disease defined as ≥75% stenosis (Group A), whereas 2940 (94.4%) were free from carotid artery disease (Group B). Both groups were compared for the presence of preoperative risk factors and for occurrence of adverse events within 30 days, postoperative period. In univariate analysis, preoperative risk factors for the presence of carotid artery stenosis were diabetes mellitus ( P < 0.0001); hypertension ( P < 0.0001); past cerebrovascular accident (CVA) ( P < 0.0001), and peripheral vascular disease (PVD; P < 0.0001). All-cause in-hospital mortality was high in Group A in comparison with Group B (3.8 vs. 1.56%; P = 0.004). The morbidity was also high in Group A compared with Group B in terms of stroke (4.3 vs. 1.6%; P = 0.0014), nosocomial pneumonia (16.4 vs. 8.9%; P = 0.0015), leg wound infection (14.2 vs. 6%; P = 0.0001), septicaemia (9.3 vs. 4.8%; P = 0.013), acute limb ischaemia (1.1 vs. 0.4%; P = 0.034), new onset atrial fibrillation (AFIB) (26.8 vs. 16.3%; P = 0.0005), ventricular fibrillation (4.9 vs. 1.5%; P = 0.0035), and renal dysfunction (11 vs. 4.9%; P = 0.0017). The presence of carotid artery disease in Saudi patients undergoing cardiac surgery is associated with increased prevalence of diabetes, hypertension, CVA, and PVD. It is also a major determinant of adverse outcome after coronary surgery.

Carotid artery disease in Sudanese diabetic patients asymptomatic for cerebrovascular disease

Introduction: Diabetes is a risk factor in the development of atherosclerosis and likewise carotid artery disease which can be detected usingcarotid ultrasound examinations. Methodology: The study undertaken in a group of asymptomatic type 2 Sudanese diabetic patients to assess the prevalence of carotid artery disease. Intima-media thickness (IMT), the presence and degree of carotid artery stenosis were assessed by ultrasonography in 63 diabetic subjects. The findings of ultrasound examinations were correlated to the patients' clinical information. Results: Abnormal IMT found in 65% of the studied subjects a degree of carotid artery stenosis in 31.7%. More than 50% carotid artery stenosis in 14.3%. The results also showed association between the abnormal findings increasing age, female gender, prolonged duration of the disease. Presence of carotid artery disease in diabetic patients asymptomatic for cerebrovascular disease, the increasing frequency of these abnormalities with increasing subject's age, and duration of illness was also investigated and it was found to decrease when the concentration is increased.

Carotid artery disease in patients undergoing elective coronary artery bypass surgery.

To determine frequency of carotid artery disease in patients undergoing elective coronary artery bypass grafting (CABG) using Doppler sonography. Observational study. Radiology Department, The Aga Khan University Hospital, Karachi, from January 2005 to September 2008. Patients with known cardiovascular disease waiting for CABG surgery were enrolled for carotid artery Doppler sonography. A predefined data entry form was used for data collection. Coronary angiography findings, carotid artery findings and other associated factors were noted from medical and radiological records. Frequency and pattern of carotid artery disease along with associated risk factors were evaluated. Data was entered and analyzed in SPSS version 15. Pearson chi-square for categorical and independent "t" test was applied for continuous variables at 95% confidence level. P-value of less than 0.05 were considered significant. A total of 176 patients (85% male, mean age=65 years) undergoing elective coronary artery bypass grafting were evaluated preoperatively for carotid artery disease by neck color Doppler sonography. Twenty percent of patients were found to have advanced carotid artery disease (> 50% stenosis), 6% had critical stenosis (> 75% stenosis) and 3% had complete stenosis. Frequency of atherosclerotic plaques was 50%, more common on right side and more prevalent in common carotid artery. Family background of carotid or coronary artery disease and history of smoking were significantly associated with presence of carotid artery disease (p < 0.05). A sizeable proportion of patients undergoing elective coronary artery bypass grafting surgery for coronary artery disease were found to have coexistant carotid artery disease.

All Asymptomatic Patients with Carotid Stenosis of 70-80% Should Undergo Surgery or Stenting before Myocardial Revascularization Surgery

Managing patients scheduled for cardiac surgery with significant carotid artery disease is a controversial issue that usually produces very polarized opinions, even in the literature. Discussion focuses on determining if carotid disease, concomitant with the need for coronary artery bypass, is an important etiologic factor for post-surgical stroke, or simply a marker of increased risk of vascular disease. There are different clinical situations and therapeutic alternatives for patients with carotidcoronary artery disease. Carotid artery stenosis can be symptomatic or asymptomatic, unilateral or bilateral, stenotic or occlusive. Furthermore, the treatment can be both conservative and endovascular or open, sequential or simultaneous, and the order can also be changed. In some cases, the evidence is fully established, but unfortunately, in other cases it has to be drawn up according to the patient and the experience of the treating group. Whether or not a consequence of carotid atherosclerosis, coronary artery bypass surgery in the presence of carotid artery disease faces a greater risk of stroke, even when most of the cerebrovascular events are not mechanically associated with carotid artery stenosis. The published reports indicate that cardiac surgery without carotid artery bypass surgery in patients with symptomatic carotid artery stenosis is associated with high rate of stroke (OR 3.6), and even higher if stenosis is > 50% (OR 4.3, CI 95%, 3.2-5.7). Internationally, morbidity and mortality of combined surgery is close to 10%. By contrast, separately, cardiac surgery in the presence of severe symptomatic carotid disease shows a 2-22% rate of stroke, while carotid surgery in the presence of severe or unstable coronary artery disease has a rate of acute myocardial infarction (AMI) that may reach 40%. For that reason, the AHA/ASA consensus recommends (Class IIa recommendation) carotid artery bypass (carotid endarterectomy [CE] or carotid angioplasty and stenting [CAS] and brain protection system) for those patients with stenosis > 80%, provided they

Association between Carotid and Coronary Artery Disease in Patients with Aortic Valve Stenosis: An Angiographic Study

Patients with aortic stenosis have a high prevalence of coronary artery disease, but there is little information about the association of coronary artery disease and carotid artery disease. The study includes 317 consecutive patients with aortic stenosis, who underwent carotid and coronary angiography during the same catheterization before aortic valve replacement. At univariate analysis, the prevalence of coronary artery disease was associated with (1) presence of carotid artery disease (P < .001); (2) angina pectoris as presentation symptom (P < .001); (3) age more than 65 years (P < .05); and (4) hypertension (P < .05). At multivariate analysis, only carotid artery disease, angina, and age emerged as independent predictors of coronary artery disease. The combination of 2 variables (carotid artery disease, angina) allowed the identification of 4 groups, with decreasing prevalence of coronary artery disease: (1) angina+/carotid artery disease+: 85%; (2) angina-/ carotid artery disease+: 50%; (3) angina+/carotid artery disease-: 41%; (4) angina-/carotid artery disease-: 21% (P < .001). In patients with symptomatic aortic stenosis, the presence of significant carotid artery disease is a strong marker of significant coronary artery disease.

Interplay of Vascular Phenotype and Metabolic Phenotype in Populations With or Without Type 2 Diabetes

HomeStrokeVol. 39, No. 11Interplay of Vascular Phenotype and Metabolic Phenotype in Populations With or Without Type 2 Diabetes Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBInterplay of Vascular Phenotype and Metabolic Phenotype in Populations With or Without Type 2 Diabetes Marijan Bosevski, MD Marijan BosevskiMarijan Bosevski University Heart Institute, Skopje, Macedonia Search for more papers by this author Originally published18 Sep 2008https://doi.org/10.1161/STROKEAHA.108.528372Stroke. 2008;39:e175Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: September 18, 2008: Previous Version 1 To the Editor:Recently, Dr Sourij and colleagues1 concluded that insulin resistance is one of the main factors for carotid atherosclerosis measured as intima-media thickness (IMT). There was evidence given in this article that HOMA index rather than Short Insulin Tolerance Test is associated with carotid IMT. HDL has been inversely related to carotid atherosclerosis by the Insulin Resistance Atheroscterosis Study (IRAS).2 Metabolic syndrome amplifies LDL-related increase of carotid IMT in the general population.3 Arterial hypertension and increased waist have been also related to carotid IMT.4,5Dehnavi in his study hypothesized that metabolic syndrome as clinical expression of insulin resistance, as well as low-grade systemic inflammation modify the extent of atherosclerosis in type 2 diabetes (T2DM).6 The study proved this thesis using sonographic measurements for carotid IMT for vascular phenotype determination. Ethiopathogenesis of carotid artery disease is a result of several factors: hiperinsulinemia, low HDL, high LDL, obesity and arterial hypertension.7–9 Individual constellation of metabolic syndrome predicts presence of carotid artery disease in a type 2 diabetes population.10Today there is no doubt that by targeting metabolic risk factors we reduce a global risk of patients with or without type 2 diabetes.11 Do we still need to estimate HOMA index, or is it necessary to estimate its clinical entity (metabolic syndrome)? What does Dr Sourij’s team mean by this?DisclosuresNone.1 Sourij H, Schmoelzer I, Dittrich P, Paulweber B, Iglseder B, Wascher TC. Insulin resistance as a risk factor for carotid atherosclerosis: a comparison of the homeostasis model assessment and the short insulin tolerance test. Stroke. 2008; 39: 1349–1351.LinkGoogle Scholar2 Wagenknecht LE, D'Agostino R Jr, Savage PJ, O'Leary DH, Saad MF, Haffner SM. Duration of diabetes and carotid wall thickness: The Insulin Resistance Atherosclerosis Study (IRAS). Stroke. 1997; 28: 999–1005.CrossrefMedlineGoogle Scholar3 Kawamoto R, Tomita H, Oka Y, Kodama A, Kamitami A. Metabolic syndrome amplifies the LDL-cholesterol associated increases in carotid atherosclerosis. Intern Med. 2005; 44: 1232–1238.CrossrefMedlineGoogle Scholar4 Rajala U, Laakso M, Paivansalo M. Low insulin sensitivity measured by both quantitative insulin sensitive check index and homeostasis model assessment method as a risk factor of increased intima-media thickness of the carotid artery. J Clin Endocrinol Metab. 2002; 87: 5092–5097.CrossrefMedlineGoogle Scholar5 Szernichow S, Bertrais S, Oppert JM, Galan P, Blacher J, Ducimetiere P, Hercberg S, Satar M, Zureik M. Body composition and after repartition in relation to structure and function of a large arteries in middle-aged adults (the SU.VI.MAX study). Int J Obes. 2005; 29: 826–832.CrossrefMedlineGoogle Scholar6 Dehnavi RA, Beishuizen ED, van de Ree MA, Le Cessie S, Huisman MV, Kluft C, Princen HM, Tamsma JT. The impact of metabolic syndrome and CRP on vascular phenotype in type 2 diabetes mellitus. Eur J Intern Med. 2008; 19: 115–121.CrossrefMedlineGoogle Scholar7 Williams R, Aiery M. Epidemiology and pathogenesis of diabetic angiopathy. In: Tooke J. Diabetic Angiopathy. London: Arnold; 1999.Google Scholar8 Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults. JAMA. 2002; 287: 356–359.CrossrefMedlineGoogle Scholar9 Pollex R, Al-Shalli KZ, House AA, Spence JD, Fenster A, Mamakeesick M, Zinman B, Harris SB, Hanley AJ, Hegele RA. Relationship of metabolic syndrome to carotid ultrasound traits. Cardiovascular Ultrasound. 2006; 4: 28–35.CrossrefMedlineGoogle Scholar10 Bosevski M, Borozanov V, Georgievska-Ismail L. Influence of metabolic risk factors on the presence of carotid artery disease in patients with type 2 diabetes and coronary artery disease. Diab Vasc Dis Res. 2007; 4: 49–52.CrossrefMedlineGoogle Scholar11 Grant PJ. Diabetes mellitus and vascular disease: targeting cardiometabolic risk. Diab Vasc Dis Res. 2008; 5: 7–8.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails November 2008Vol 39, Issue 11 Advertisement Article InformationMetrics https://doi.org/10.1161/STROKEAHA.108.528372PMID: 18802203 Originally publishedSeptember 18, 2008 PDF download Advertisement

Influence of metabolic risk factors on the presence of carotid artery disease in patients with type 2 diabetes and coronary artery disease

The aim of the study was to evaluate the prevalence of carotid artery disease in type 2 diabetes patients with coronary artery disease, and to establish the influence of metabolic factors on its occurrence. In all, 145 patients (aged 59.85+/-8.43 years, diabetes duration 8.89+/-6.29 years) were randomly selected in a cross-sectional study. Carotid ultrasound was used for evaluation of the presence of carotid plaque (CP) and stenosis (CS). A logistic regression model was constructed to define the influence of risk factors-- arterial hypertension, systolic blood pressure, weight, waist to hip ratio, high blood glucose and plasma lipid levels. Carotid artery disease was present in these patients with a prevalence of 81.9% for CP, 25.2% for unilateral CS and 13.5% for bilateral CS. The low-density lipoprotein (LDL) cholesterol level was an independent predictor for CS (OR 1.936; 95% CI 1.2413.026). Non-high density lipoprotein (HDL) cholesterol (OR 1.374; 95% CI 1.0351.825) and glycaemia (OR 1.214; 95% CI 1.0221.442) were predictors for carotid plaque.

Is the ABCD Score Truly Useful?

The understanding of transient ischemic attack (TIA) has changed. The high early risk of stroke demands rapid assessment and treatment. Some patients, such as those with TIA attributable to an active carotid artery plaque, appear to be at higher risk than others.1 The direct result of this paradigm shift is the need to develop tools for stratifying patients according to risk. Although some have adopted a strategy of admitting all TIA patients, this approach may not be the most efficient. Clinical prediction rules may be the most helpful in triaging patients. Factors that are risks for early stroke include clinical ones such as age, diabetes mellitus, longer duration TIA, motor or speech symptoms of TIA, and imaging factors such as the presence of carotid artery disease or a diffusion-weighted imaging lesion …

Microbubble Administration Accelerates Clot Lysis During Continuous 2-MHz Ultrasound Monitoring in Stroke Patients Treated With Intravenous Tissue Plasminogen Activator

We sought to evaluate the effects of administration of microbubbles (MBs) on the beginning, speed, and degree of middle cerebral artery (MCA) recanalization during systemic thrombolysis and continuous 2-MHz pulsed-wave transcranial Doppler (TCD) monitoring. We evaluated 111 patients with acute stroke attributable to MCA occlusion treated with intravenous tissue plasminogen activator (tPA). Thirty-eight patients were treated with tPA plus continuous 2-hour TCD monitoring plus 3 doses of 2.5 g (400 mg/mL) of galactose-based MBs given at 2, 20, and 40 minutes after tPA bolus (MB group). These patients were compared with 73 patients who were allocated to receive tPA plus continuous 2-hour TCD ultrasound (US) monitoring (tPA/US group) or tPA plus placebo monitoring (tPA group), most of whom were enrolled in a previous study of US-enhanced thrombolysis. The beginning, degree, and time to maximum completeness of recanalization during the first 2 hours of tPA bolus were recorded. Median prebolus National Institutes of Health Stroke Scale (NIHSS) score was 18. Eighty patients (72%) had a proximal and 31 (28%) a distal MCA occlusion on TCD. Thirty-seven patients (33%) received tPA/US, 38 (34%) received tPA/US/MB, and 36 (32%) were treated with tPA alone. Stroke severity, time to treatment, location of MCA occlusion, and presence of carotid artery disease were similar among groups. Two-hour recanalization was seen in 14 (39%), 25 (68%), and 27 patients (71%) in the tPA, tPA/US, and tPA/US/MB groups, respectively (P=0.004). Two-hour complete recanalization rate was significantly (P=0.038) higher in the tPA/US/MB group (54.5%) compared with tPA/US (40.8%) and tPA (23.9%) groups. The time to beginning of recanalization after tPA bolus was 26+/-18 minutes in the tPA/US group and 19+/-12 minutes in the tPA/US/MB group (P=0.12). Four patients (3.6%) experienced symptomatic intracranial hemorrhage: 2 (5.5%), 1 (2.7%), and 1 patient (2.6%) who received tPA only, tPA/US, and tPA/US/MB, respectively, experienced symptomatic intracranial hemorrhage. At 24 hours, 31%, 41%, and 55% of tPA, tPA/US, and tPA/US/MB improved >4 points in the NIHSS score. Administration of MBs induces further acceleration of US-enhanced thrombolysis in acute stroke, leading to a more complete recanalization and to a trend toward better short- and long-term outcome.

The Extracranial Carotid Artery in Familial Hypercholesterolemia: Relationship of Intimal-Medial Thickness and Plaque Morphology with Plasma Lipids and Coronary Heart Disease

Increased frequency of coronary heart disease in familial hypercholesterolaemia is well documented but the association with carotid atherosclerosis is less well established. The ultrasound appearances of the carotid arteries in familial hypercholesterolaemia patients without symptomatic cerebrovascular disease were therefore investigated. 59 patients (34 men, 25 women; mean age 46.6 (+/-12.1 years) were prospectively studied using ultrasound examination of the extracranial carotid vessels. Intimal-medial thickness was measured 1 cm proximal to the carotid bulb and morphology of plaque was classified as heterogeneous or homogeneous according to echogenicity. 44 (75.0%) of the patients had carotid artery disease. On stepwise logistic regression, significant predictors of the presence of carotid artery disease were age (P = 0.014), serum triglycerides at time of examination (P = 0.013), coexistent coronary heart disease (P = 0.03) and the cholesterol-years score (CYS) (P = 0.015). Heterogeneous carotid plaque was associated with a higher plasma level of Lp(a) (P = 0.035), TG (P = 0.024), CYS (P = 0.0003) and the presence of CHD (P = 0.001). Matched pairs (n = 22) of patients, where the only variable was Lp(a), showed a marked increase in heterogeneous plaque frequency in those with high Lp(a) levels (P < 0.03). Asymptomatic carotid artery disease occurs in a high proportion of familial hypercholesterolaemia patients. The presence of heterogeneous carotid plaque is significantly associated with the presence of coronary heart disease, the calculated cholesterol-years score, hypertriglyceridaemia and raised levels of Lp(a).

Computed tomography scanning findings associated with rapid expansion of abdominal aortic aneurysms

Purpose: Early repair of abdominal aortic aneurysms (AAA) is particularly appropriate for those that are most likely to expand. Our aim was to define features on computed tomography (CT) scanning associated with subsequent rapid aneurysm expansion.Methods: We reviewed CT scans of 80 patients with AAA (> 3.0 cm) who underwent CT scanning of the abdomen and pelvis two times, at least 6 months apart, between 1986 and 1992. The aneurysms initially measured 4.4 ± 0.6 cm, and the mean interval between obtaining scans was 22 ± 12 months. Clinical variables assessed included age, sex, medical risk factors, underlying cardiovascular and pulmonary diseases, and administration of beta blockers and lipid-lowering agents. Computer-aided measurements on each CT scan section included the maximal and minimal diameters and area of the aneurysm. Dimensions of the luminal thrombus and the arc of aneurysm wall covered by thrombus (TARC). Maximal aneurysm dimensions were related to juxtarenal aortic and second lumbar vertebral body dimensions.Results: Mean aneurysm expansion was 0.26 ± 0.25 cm/yr. CT scanning variables that correlated significantly with rate of expansion included the mean TARC (r = 0.43, p < 0.001), thrombus volume fraction (r = 0.37, p < 0.001), TARC on the largest aneurysm cross section (r = 0.34, p < 0.01), and thrombus area fraction (r = 0.30, p < 0.01). Rapid expansion (> 0.5 cm/yr) occurred in 15 (19%) aneurysms. The two predictors for rapid expansion on logistic regression analysis were mean TARC (p < 0.005) and the presence of carotid artery disease (p < 0.05).Conclusion: An increased AAA thrombus load is associated with a higher likelihood of rapid expansion and should weigh in favor of early surgical repair.

Results of Coronary Bypass Surgery in Elderly Women

One hundred two female and 102 male patients all older than 70 years who underwent coronary artery bypass grafting (CABG) between 1978 and 1983 were matched according to age, anginal status, ejection fraction (EF), number of bypass grafts, and year of operation. These 204 patients were characterized by a mean age of 73 years, a mean EF of 64%, a mean of 3.2 bypass grafts per patient, and unstable angina in 82%. Statistical analyses were performed on the following variables in conjunction with patient sex to determine whether the two samples (women and men) can be considered representative of a single patient population: preoperative resting ECG, stress test result, number of diseased vessels, left ventricular end-diastolic pressure, presence of carotid artery disease, use of an internal mammary artery graft, incidence of operative death, perioperative myocardial infarction (MI), hospital complications, late MI, recurrent angina, late death, and cumulative survival. All differences were small and failed to reach statistical significance except that women had a higher incidence of recurrent angina-like chest pain and a higher incidence of ischemic changes in the preoperative ECG and men had a higher incidence of conduction abnormalities. We conclude that in this age group, CABG is equally beneficial to women and men in terms of survival, but may result in less subjective symptomatic benefit in women.