Risk Of Ischemic Cerebrovascular Events Research Articles

Elevated plasma protein carbonylation increases the risk of ischemic cerebrovascular events in patients with atrial fibrillation: association with a prothrombotic state.

Plasma protein carbonylation that reflects oxidative stress has been demonstrated to be associated with the prothrombotic fibrin clot phenotype. However, the role of protein carbonyls (PC) in predicting ischemic stroke in atrial fibrillation (AF) is largely unknown. This study aimed to investigate whether PC increase the risk of stroke in anticoagulated AF patients during follow-up. In 243 AF patients on anticoagulation (median age 69years; median CHA2DS2-VASc of 4), we measured plasma PC using the assay by Becatti, along with plasma clot permeability (Ks), clot lysis time (CLT), thrombin generation, and fibrinolytic proteins, including plasminogen activator inhibitor type 1 (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI). Ischemic stroke, major bleeding, and mortality were recorded during a median follow-up of 53months. Plasma PC levels (median, 3.16 [2.54-3.99] nM/mg protein) at baseline showed positive associations with age (P < 0.001), CHA2DS2-VASc (P = 0.003), and N-terminal B-type natriuretic peptide (P = 0.001), but not with type of AF or comorbidities except for heart failure (P = 0.007). PC levels were correlated with CLT (r = 0.342, P < 0.001), endogenous thrombin potential (r = 0.217, P = 0.001) and weakly with Ks (r = -0.145, P = 0.024), but not with fibrinogen, PAI-1, or TAFI levels. Stroke was recorded in 20 patients (1.9%/year), who had at baseline 36% higher PC levels (P < 0.001). Elevated PC (P = 0.003) at baseline were independently associated with stroke risk. Our findings suggest that in patients with AF enhanced protein carbonylation is associated with increased "residual" risk of stroke despite anticoagulation, which is at least in part due to unfavorably altered fibrin clot phenotype.

The Impact of Changing Antithrombotic Management in Patients With Atrial Fibrillation and Ischemic Cerebrovascular Events Despite Anticoagulation.

Patients with atrial fibrillation (AF) are at increased risk of ischemic cerebrovascular events despite anticoagulants (AC). We aim to evaluate whether changing AC or adding antiplatelet therapy to anticoagulants (AP + AC) in patients with AF presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) despite AC, decreases the risk of recurrent AIS/TIA compared to patients continued on same AC regimen. Patients with AF on AC presenting with AIS or TIA at our center between 2011- 2021 were included. Data on Demographics, index event, antithrombotic therapy before and after index event, recurrent AIS/TIA, or major bleeding events (MBE) were extracted. Cox proportional hazards models were used to compare outcomes between AC unchange vs AC change, and AP + AC vs AC only groups. One hundred eighty-five patients were included (mean age 78.3years; 62% males, median follow-up 9months (IQR 1-34)). Seventeen patients (9%) had AC change, 100 (54%) received AP + AC, 39 (21%) had recurrent AIS/TIA, and 27 (15%) had MBE following index event. No difference was observed between AC unchange vs AC change and AP + AC vs AC only groups regarding recurrent AIS/TIA (HR 1.72 [.65-4.57], P = .27 and HR 1.02 [.53- 1.98], P = .95, respectively) or MBE (HR .85 [.19-3.67], P = .83 and HR 1.49 [.67-3.33)], P = .33, respectively). Fourteen vascular neurologists treated this cohort and 9(64%) implemented AC changes. In this single center retrospective study of 185 patients with AF and AIS/TIA despite AC, changing AC or adding AP agents did not decrease the risk of ischemic cerebrovascular events.

Abstract 16215: Reduced Left Atrial Strain and Risk of Ischemic Stroke in Patients With Normal Sinus Rhythm: A Systematic Review and Meta-Analysis

Introduction: Abnormalities in the left atrium have been linked to a higher risk of ischemic cerebrovascular events. Left atrial (LA) strain analysis can identify LA dysfunction, even in patients with normal LA volumes. However, the precise association between LA strain and the occurrence of ischemic stroke in individuals who are in normal sinus rhythm (NSR) is not well established. Hypothesis: This systematic review and meta-analysis aimed to assess the relationship between reduced LA strain and the risk of ischemic stroke in patients with NSR. Methods: We searched PubMed, Embase, and Cochrane Central for studies that examined our clinical question. Two reviewers independently performed study selection, data extraction, and assessment of bias. Statistical analysis was performed using Review Manager 5.4.1. Heterogeneity was assessed with I2 statistics. We calculated pooled multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CI) under a random effects model. Results: We included 8,632 patients from 4 cohort studies, of which 3 were prospective. The mean follow-up ranged from 2.5 years to 10.9 years. The mean age ranged from 68.8 to 75.2 years. All results were obtained through multivariable-adjusted analysis, which includes adjusting for LA size and occurrence of new-onset atrial fibrillation during follow-up. The incidence of ischemic stroke was significantly increased in patients with reduced reservoir strain (HR 1.53; 95% CI 1.09-2.15; p=0.01; Figure 1) and conduit strain (HR 1.39; 95% CI 1.16-1.59; p &lt; 0.001). Reduced contractile strain was not predictive of stroke incidence (HR 1.94; 95% CI 0.96-3.93; p=0.07). Conclusions: Our findings indicate an independent association of reduced LA strain with an increased incidence of ischemic stroke in patients without a previous history of atrial fibrillation. Future studies are warranted to evaluate the role of LA strain as part of a comprehensive risk stratification for stroke.

Analysis of Risk Factors for Ischemic Cerebrovascular Events by Carotid Artery Ultrasound

<i>Objective</i>: Analysis of risk factors for ischemic cerebrovascular events using carotid artery ultrasound. <i>Method</i>: A total of 3500 patients who underwent carotid ultrasound examination at the encephalopathy department of our hospital from March 2022 to March 2023 were selected as the study subjects. 1731 males and 1846 females; the age ranged from 20 to 95 years, with an average of 61.48 ± 12.55 years. All patients were divided into age groups under 40 years of age, 41-60 years of age, and over 60 years of age. According to carotid ultrasound results, the study subjects were divided into normal carotid ultrasound, stenosis rate<50%, and stenosis rate ≥ 50%. To observe the incidence of carotid stenosis, compare the differences in the degree of carotid stenosis among patients of different ages and diseases, and use logistic regression analysis to analyze the influencing factors of carotid artery stenosis and predict the risk of ischemic cerebrovascular events. <i>Result</i>: Of the 3500 patients, 2609 had carotid stenosis, with a detection rate of 74.54%. Among them, the carotid stenosis rate was less than 50% in 2472 cases, and the stenosis rate was ≥ 50% in 137 cases; the positive rate was 74.54%. Multivariate logistic regression analysis showed that age, diabetes, hypertension, dyslipidemia, smoking history and cerebral infarction were independent risk factors for carotid artery stenosis (<I>P</I><0.05). <i>Conclusion</i>: Early carotid ultrasound screening and regular reexamination in high-risk stroke populations are necessary. Constructing a logistic regression model based on high-risk factors can predict the risk of cerebrovascular events as early as possible, providing a reliable basis for timely formulation of prevention and treatment measures in clinical practice. There are many factors influencing cerebrovascular events. Regular monitoring of blood pressure, blood sugar, and blood lipids, and determination of arterial stenosis by carotid ultrasound to predict cerebrovascular events are of great significance for the prevention and treatment of stroke high-risk populations. At the same time, attention should be paid to young people, and correctable risk factors should be identified in a timely manner for early intervention to minimize the risk of stroke in asymptomatic populations.

Thoracoscopic epicardial ablation of atrial fibrillation: Safety, efficacy, single center experience.

Atrial fibrillation (AF) is associated with reduced quality of life and increased risk of ischaemic cerebrovascular events. The left atrial epicardial ablation procedures have evolved towards a successful and safe rhythm control strategy for patients with symptomatic drug-refractory paroxysmal, persistent or post-ablation AF or with a high risk of catheter ablation failure. The aim was to evaluate the efficacy and safety of thoracoscopic ablation at our instituiton. We observed 81 patients undergoing thoracoscopic ablation from January 2015 to December 2019. The mean age was 61.3±8.5 years and the average duration of AF was 3.1±2.6 years. The cohort consisted of 16.5% of paroxysmal AF, 36.7% persistent, and 46.8% of long-standing AF. The procedure was completed in 79 patients; during follow-up, 15 patients (19%) received radiofrequency ablation. Freedom from atrial arrhythmia recurrence was 55.7% after a follow-up (FUP) period of 3.1 ± 1.4 years. At the follow-up visit, sinus rhythm was present in 81% of patients. No relationships between arrhythmia recurrence and BMI, LVEF, left atrial dimension, gender, and AF duration were found. Major complications were noticed in 4 patients (5.0%); 2 had peripheral embolisation, 2 patients were converted to a sternotomy. At the time of the FUP visit, 25.3% of patients were using antiarrhythmic and 74.7% were still using anticoagulants. In the majority of patients, sinus rhythm remained despite a considerable atrial tachycardia recurrence rate, with a relatively low percentage of patients on antiarrythmic drugs.

A Novel Factor in Determining the Risk of Ischemic Cerebrovascular Events in Patients with Atrial Fibrillation: Pulmonary Hypertension

ObjectivesPulmonary hypertension (PH) is closely related to clinical decompensation and poor clinical outcomes in atrial fibrillation (AF) patients. However, the association between PH and ischemic cerebrovascular events (ICE) in AF patients has not been investigated. The authors purposed to examine this relationship. Materials and methodsThe researchers conducted an observational study on 371 AF patients between January and November 2021. In line with the European Society of Cardiology guideline recommendations, echocardiographic parameters suggestive of PH were performed. The study population was stratified into two groups based on the presence (n = 98, 31%) or non-presence (n = 219, 69%) of PH. Also, we did logistic regression analyses for the independent predictors of the ICEs in AF patients. ResultsIschemic cerebrovascular events were significantly more frequent in the PH group than the non-PH group (n = 30, 13% vs. n = 18, 18%, p = 0.03). At univariable analysis, hypertension, diabetes mellitus, PH (OR = 0.23 [95% CI, 0.13-0.41], p = 0.005) and diastolic dysfunction were significantly related to ICE in AF patients. Moreover, at multivariable analysis, age, diabetes mellitus, PH (OR = 0.19 [95% CI, 0.10-0.36], p = 0.01), and diastolic dysfunction were predictive of ICE. ConclusionsPulmonary hypertension is likely associated with ischemic cerebrovascular events in patients with AF, requiring further investigation to determine its association.

Prediction of Atrial Fibrillation Using Machine Learning: A Review.

There has been recent immense interest in the use of machine learning techniques in the prediction and screening of atrial fibrillation, a common rhythm disorder present with significant clinical implications primarily related to the risk of ischemic cerebrovascular events and heart failure. Prior to the advent of the application of artificial intelligence in clinical medicine, previous studies have enumerated multiple clinical risk factors that can predict the development of atrial fibrillation. These clinical parameters include previous diagnoses, laboratory data (e.g., cardiac and inflammatory biomarkers, etc.), imaging data (e.g., cardiac computed tomography, cardiac magnetic resonance imaging, echocardiography, etc.), and electrophysiological data. These data are readily available in the electronic health record and can be automatically queried by artificial intelligence algorithms. With the modern computational capabilities afforded by technological advancements in computing and artificial intelligence, we present the current state of machine learning methodologies in the prediction and screening of atrial fibrillation as well as the implications and future direction of this rapidly evolving field.

Residual Recurrence Risk of Ischemic Cerebrovascular Events: Elements and Implications.

Residual Recurrence Risk of Ischemic Cerebrovascular Events: Elements and Implications.

Risk of ischaemic cerebrovascular events in head and neck cancer patients is associated with carotid artery radiation dose

Background and purposeRadiotherapy in the head and neck area may cause vascular damage to the carotid arteries, increasing the risk of anterior circulation ischaemic cerebrovascular events (ICVEs). However, limited data exists on the relationship between radiation dose to the carotid arteries and risk of ICVE. The purpose of this study was therefore to determine the relationship between radiation dose to the carotid arteries and anterior circulation ICVE risk. Materials and methodsA retrospective analysis of a prospective study cohort of 750 head and neck cancer patients treated with definitive (chemo)radiotherapy was performed. Carotid arteries were delineated, and dose–volume parameters of the treatment plans were calculated. ICVEs were scored prospectively and checked retrospectively by analysing all patient records. Cox proportional hazards analysis was performed to analyse the dose–effect relationships. ResultsThe median follow-up period was 3.4 years, 27 patients experienced an ICVE and the 5-year cumulative risk was 4.6%. ICVE risk was significantly associated with dose to the carotid arteries. Multivariable analysis showed that the absolute volume (cm3) of the carotid arteries that received at least a radiation dose of 10 Gy was the most important prognostic factor for ICVE (HR = 1.11, AUC = 0.68, p < 0.001). ConclusionThis is the first large prospective cohort study that demonstrates an independent dose–effect relationship between radiation dose to the carotid arteries and the risk of ICVE. These findings may be used to identify patients at risk for ICVE after radiotherapy who may benefit from primary or secondary preventive measures.

Changes in Vessel Wall Enhancement Related to the Recent Neurological Symptoms in Patients with Moyamoya Disease.

Moyamoya disease (MMD) causes intracranial arterial stenosis progression. The progression of intracranial arterial stenosis will increase the risk of ischemic cerebrovascular events. This study aims to investigate the relationship between intracranial arterial stenosis progression, vessel wall enhancement (VWE), and the recent neurological symptoms. A total of 39 MMD patients (12 male; 37.6 ± 18.0 years old) were registered in this study analysis between April 2016 and July 2018. All patients received MRI at registration and 6, 12, and 24 months post-registration. The incidence of ischemic cerebrovascular events (transit ischemic attacks or cerebral infarction) was checked until December 2018. We evaluated the relationship between the intensity of VWE, intracranial arterial stenosis, and the recent neurological symptoms. During the mean follow-up period of 13.8 ± 5.5 months, the changes in VWE were observed in 33 hemispheres (42.3%), stenosis progression was observed in 21 hemispheres (26.9%), and recent neurological symptoms occurred in 10 hemispheres (12.8%). Stenosis progression was observed in 11 hemispheres (33.3%) in the VWE(+) group and ten hemispheres (22.2%) in the VWE(−) group (p = 0.310). The recent neurological symptoms were observed in eight hemispheres (21.2%) in the VWE(+) group and two hemispheres (4.44%) in the VWE(−) group (odds ratio 6.88, 95% confidence interval 1.35–34.98, p = 0.015). The intensity of VWE sometimes changes. The changes in VWE were significantly associated with the recent neurological symptoms but not with stenosis progression.

Red and White Thrombus Characteristics in Patients Undergoing Carotid Endarterectomy

ObjectiveThe study aimed to compare the characteristics of red and white thrombi in patients undergoing carotid endarterectomy. Material and MethodsThe study was conducted in 81 patients with ischemic stroke who underwent carotid endarterectomy for carotid artery stenosis. Carotid plaques were graded by two pathologists. Thrombus materials were divided into two groups: white and red. The parameters of assessment were plaque rupture, lipid core, fibrous cap thickness, inflammation, intraplaque hemorrhage, calcification, necrotic core, and neovascularization. Normally distributed data were evaluated using Mann–Whitney U and Chi-squared tests. ResultsThe ratio of white and red thrombus was 19.8% and 80.2%, respectively. Lipid core, plaque rupture, necrotic core, neovascularization, intraplaque hemorrhage, obstruction, and inflammation were observed more in red thrombus, which were statistically significant. Calcification and fibrous cap thickness were not statistically significant in the two groups. Moreover, intimal smooth muscle cells were present in all thrombus types. ConclusionIn our study, we found that red thrombi had more unstable characteristics than white thrombi. Thus, the risk for ischemic cerebrovascular events is more in red thrombi. However, this finding cannot be generalized due to the small number of patients in this study. Therefore, studies involving more patients are needed.

Long-term follow-up outcomes in a real-world study cohort after percutaneous patent foramen ovale closure.

In recent years, percutaneous closure of a patent foramen ovale (PFO) has gained widespread use. This study is an evaluation of the safety and efficacy of the Figulla and Amplatzer devices for PFO closure, including long-term follow-up results. A total of 305 patients (43.6% male; mean age: 43.25±10.98 years) who underwent percutaneous PFO closure between 2003 and 2019 were enrolled. The Risk of Paradoxical Embolism (RoPE) score was calculated to predict the recurrence risk of cerebrovascular events due to PFO. Transthoracic echocardiography was used during the procedure. The devices were successfully implanted in all patients. The in-hospital periprocedural complications recorded were atrial fibrillation in 1 patient (0.3%), supraventricular tachycardia in 1 patient (0.3%), and femoral hematoma in 3 patients (1%). The procedure time and fluoroscopy time was 21.92±2.93 minutes and 2.19±0.24 minutes, respectively. Recurrent ischemic stroke or transient ischemic attack (TIA) was observed in 7 (2.2%) patients during the median 85.77 months (25th-75th percentile: 10.21-108.00 months) follow-up. The RoPE score was significantly lower in patients with recurrent ischemic cerebral event (stroke or TIA) compared with asymptomatic patients (p<0.001). Kaplan-Meier curve analysis revealed that there was no significant difference between PFO device types (Amplatzer: 2.4% vs. Figulla: 3.3%) in terms of recurrent ischemic cerebral events during follow-up (log-rank; p=0.642). Percutaneous PFO closure was safe, feasible, and effective. Our study confirmed the efficacy and safety of transthoracic echocardiogram guidance during percutaneous closure of PFO, which shortens the procedure time. A lower RoPE score was related to the recurrence risk of ischemic cerebrovascular events.

NBP in Patients With Moyamoya Disease of High Risk for Ischemic Cerebrovascular Events

NBP in Patients With Moyamoya Disease of High Risk for Ischemic Cerebrovascular Events

Early and late risk of ischemic stroke after TAVR as compared to a nationwide background population.

Ischemic stroke is a feared complication associated with transcatheter aortic valve replacement (TAVR). Data on the late risk of ischemic stroke following TAVR are scarce. This study aimed to investigate the early (0-90days) and late (90days-5years) risk of ischemic cerebrovascular events (CVE) in a large, unselected cohort of patients undergoing TAVR and to compare this risk with a matched background population. Therefore, all patients undergoing first-time TAVR in Denmark were matched to a background population (controls) in a 1:4 ratio based on age, sex, atrial fibrillation (AF), and the major stroke risk factors. A total of 2455 TAVR patients were matched with 9820 controls. TAVR was associated with a significantly higher ischemic CVE risk as compared with their controls in the early phase [hazard ratio (HR) 5.35 [95% CI 3.50-8.17]; p < 0.001) but not in the late phase (HR 1.17 [95% CI 0.94-1.46]; p = 0.15). In a predefined stratified analysis, no patient-related factors were associated with this higher CVE risk in the early phase. The cumulative 90-day ischemic CVE risk was the lowest in TAVR-patients with known AF receiving oral anticoagulant (OAC) therapy (1.3% [95% CI 0.6-2.5%] and was two-fold higher in OAC-naïve TAVR-patients (2.4% [95% CI 1.8-3.3%] in patients without AF and 2.5% [95% CI 0.9-5.3%] in patients with AF). In conclusion, TAVR was associated with an increased risk of ischemic CVE in the early phase, but not in the late phase, as compared to their matched controls-OAC therapy reduced this early risk of ischemic CVE by half.

Risk of Ischemic Cerebrovascular Events Is Associated with Carotid Artery Radiation Dose

Risk of Ischemic Cerebrovascular Events Is Associated with Carotid Artery Radiation Dose

OC-0392 Risk of ischemic cerebrovascular events is associated with carotid artery radiation dose

OC-0392 Risk of ischemic cerebrovascular events is associated with carotid artery radiation dose

Intracranial artery stenosis magnetic resonance imaging aetiology and progression study: Rationale and design.

BackgroundIt has been shown that intracranial artery stenosis (ICAS) plays a key role in Chinese ischemic stroke or transient ischemic attack (TIA) patients. Many vascular diseases can lead to ICAS, such as atherosclerosis, dissection, vasculitis, moyamoya disease, and reversible cerebral vasoconstriction syndrome (RCVS). In addition, progression of intracranial atherosclerotic disease (ICAD) will increase the risk of ischemic cerebrovascular events. The ICASMAP study primarily aims to determine the etiology and disease distribution of ICAS using noninvasive magnetic resonance (MR) imaging and evaluate the rate for progression of ICAD in symptomatic population.MethodsThe ICASMAP study is a prospective, observational, and multicenter study by recruiting 300 subjects (18–80 years old) with recent stroke or TIA (within 2 weeks after onset of symptoms) in China. All the subjects will undergo MR imaging examination including brain and intracranial artery MR imaging at baseline. In addition, the clinical risk factors will be collected and blood biomarkers will be tested. A subgroup of more than 200 subjects who were diagnosed with ICAD according to baseline MR imaging will be followed up for 2 years. During the follow‐up study, MR imaging examination will be performed at 12 and 24 months. The primary end point is presence of progression of intracranial artery atherosclerotic plaques.ConclusionsThe ICASMAP study investigates the etiology of ICAS and progression of ICAD in Chinese stroke patients and may help to improve the precise diagnosis and intervention of ICAS and stroke prevention.

Platelet Reactivity and Risk of Ischemic Stroke After Coronary Drug-Eluting Stent Implantation: From the ADAPT-DES Study

ObjectivesThe authors sought to investigate the association between P2Y12 reaction units (PRU) and the risk of ischemic stroke (IS) after successful coronary drug-eluting stents (DES) implantation. BackgroundThe association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear. MethodsIncidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation. ResultsAmong 8,582 patients enrolled, 68 (0.8%) had an IS during 2-year follow-up. Across the spectrum of PRU, rates of IS were progressively greater as patients transitioned from the lowest quintile of PRU (more P2Y12 receptor inhibition; 2-year rate of 0.51%) to the highest quintile of PRU (less P2Y12 receptor inhibition; 2-year rate of 1.34%; adjusted p = 0.04). PRU >208 was independently associated with higher risk of IS at 2 years (adjusted hazard ratio 1.81; 95% confidence interval 1.08 to 3.04; p = 0.03). The association between higher PRU and risk for IS was also consistent in patients with versus without high CHA2DS2-VASc score (pinteraction = 0.30) and in those on or off oral anticoagulation at discharge (pinteraction = 0.99). Occurrence of IS was strongly associated with increased risk of all-cause mortality at 2 years (adjusted HR: 4.16; 95% CI: 1.95 to 8.87; p < 0.0001). ConclusionsHigher PRU was associated with increased risk of IS after coronary DES implantation. Ensuring adequate platelet P2Y12 receptor inhibition may reduce the risk of IS in this patient population. (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents [ADAPT-DES]; NCT00638794)

Spotty Carotid Plaques Are Associated with Inflammation and the Occurrence of Cerebrovascular Symptoms

Background: Echolucent carotid plaques have been related to an increased risk of ischemic cerebrovascular events. The aim of the present study was to evaluate whether a new objective ultrasonographic parameter, the statistical geometric feature (SGF), reflecting spottiness of carotid plaques, can be associated with cerebrovascular symptoms and with a rupture-prone plaque phenotype. Methods: The plaques of 144 patients who underwent carotid endarterectomy were included in this study. SGF and plaque area were estimated by outlining the plaque on ultrasound (US) images. The correlation coefficient for inter- and intraobserver variability was 0.69 and 0.93, respectively. The SGF values were normalized to the degree of stenosis (SGF/DS). The plaques collected at surgery 1 day after the US were analyzed histologically, and inflammatory markers and matrix metalloproteinases (MMPs) were measured. Results: Patients with ipsilateral hemispheric symptoms had higher SGF/DS compared to patients without symptoms (0.82 [0.59–1.16] vs. 0.70 [0.56–0.89], p = 0.01). Analysis of plaque components revealed a positive correlation between SGF/DS and the percentage of the plaque area stained for lipids, macrophages, and hemorrhage. A correlation was also found between SGF/DS and plaque expression of interleukin-6, monocyte chemoattractant protein-1, macrophage inflammatory protein-1β, vascular endothelial growth factor A, C-C motif chemokine 3 and 20, and MMP-9. An inverse correlation was found with plaque levels of osteoprotegerin. Conclusions: The present study supports the concept that spottiness is a feature of the carotid plaques rich in inflammation and can be associated with the typical phenotype of high-risk plaques.

An evaluation of dual source computed tomography used with the de Weert classification to detect vulnerable plaque, using IVUS virtual histology as a standard of reference.

One of the main risk factors for cerebral ischemic events is atherosclerotic disease of the internal carotid artery (ICA). Nowadays, increasing attention is being paid to the relationship between the morphological features of atherosclerotic plaque and the occurrence of stroke. Several studies have demonstrated that the presence of specific vulnerable plaque types, with a large lipid core and thin fibrous cap, can be used as an independent risk predictor of cerebral ischemic events. The present study is an attempt to develop the method of plaque surface morphology assessment presented by de Weert et al. by correlating the results of Dual Source Computed Tomography (DSCT) with those from intravascular ultrasound virtual histology (IVUS-VH). A group of 30 symptomatic patients (13 men and 17 women; 72 ± 9 years) with ICA stenosis suspected on the basis of ultrasound imaging (US) and confirmed to be above 70% in DSCT underwent intravascular ultrasound (IVUS) imaging. The results of DSCT were categorized according to the de Weert classification. There were 13 cases (43%) with smooth wall surfaces, 10 cases (33%) with discreet wall irregularities, and seven cases (23%) with incursions of contrast, indicating the presence of ulceration. In the IVUS-VH examinations, 4 out of 30 cases (13%) were identified as having adaptive intimal thickening (AIT), 4 (13%) as showing pathological intimal thickening (PIT), 6 (20%) with fibroatheromas (FA), six (20%) with fibrocalcific plaque (FCa), and 10 (33%) as having thin-cap fibroatheroma (TCFA), which is high-risk plaque. Comparing the above results showed that all the patients with confirmed wall ulceration in DSCT were characterized as having high-risk plaque in IVUS-VH. Using DSCT with the de Weert classification of plaque surface morphology makes reliable detection of ulcerations possible; therefore, this could become a significant new technique to improve current imaging protocols for patients with a high risk of ischemic cerebrovascular events.