Lesión carotídea arteriosclerótica en pacientes con cirugía coronaria / Carotid atherosclerotic lesion in patients with coronary surgery

Introducción: Las enfermedades cardiovasculares isquémicas constituyen la primera causa de muerte en el mundo desarrollado o en vías de serlo, por encima de las oncológicas, de los accidentes del tránsito y de las enfermedades vásculo-cerebrales. El diagnóstico temprano de una lesión coronaria permite lograr la prevención del ataque isquémico agudo, y realizar el tratamiento revascularizador oportuno con evaluación de riesgo quirúrgico, que permita obtener cifras de morbimortalidad aceptables. Objetivo: Describir las características ultrasonográficas de las arterias carotídeas como riesgo de accidente cerebro-vascular en pacientes con revascularización miocárdica. Métodos: Se realizó un estudio observacional, descriptivo y longitudinal en 208 pacientes revascularizados del sector coronario, con estudio ultrasonográfico prequirúrgico de las arterias carotídeas como método predictivo de enfermedad vásculo-cerebral isquémica. Resultados: En 20 pacientes se presentaron síntomas cerebrales que se clasificaron en menores y mayores. Existió preponderancia de los menores y, entre ellos, de la agitación. Se evaluaron los factores de riesgo primarios y en las características de las placas ateroescleróticas se destacó el grado de irregularidad. Conclusiones: El estudio ultrasonográfico del árbol arterial carotídeo debe formar parte esencial del estudio predictivo del paciente que va a ser sometido a una revascularización coronaria(AU)

Introduction: Ischemic cardiovascular diseases are the leading cause of death in the developed world or in the process of becoming so, above oncological ones, traffic accidents and vascular-cerebral diseases. The early diagnosis of a coronary lesion allows to achieve the prevention of acute ischemic attack, and to perform the appropriate revascularization treatment with surgical risk assessment, which allows to obtain acceptable morbidity and mortality figures. Objective: To describe the ultrasonographic characteristics of carotid arteries as a risk of stroke in patients with myocardial revascularization. Methods: An observational, descriptive and longitudinal study was conducted in 208 coronary sector´s revascularized patients, with pre-surgical ultrasonographic study of the carotid arteries as a predictive method of ischemic cerebral vascular disease. Results: In 20 patients there were brain symptoms that were classified into minor and major. There was a predominance of minors and, among them, of agitation. The primary risk factors were evaluated and the degree of irregularity was highlighted in the characteristics of the atherosclerotic plaques. Conclusions: The ultrasonographic study of the carotid arterial tree should be an essential part of the predictive study of the patient who is undergoing coronary revascularization(AU)

Microscopic analysis of the myocardial bridges and their relationship with atheromatous plaque / Análisis microscópico de los puentes miocárdicos y su relación con la placa ateromatosa

SUMMARY: Most histopathological studies have reported that the segment of the coronary artery below the myocardial bridge does not present atheromatous plaque, while the segment proximal to the myocardial bridge may have it. The aim of this study was to evaluate the microscopic environment of myocardial bridges. This descriptive study was carried out with 60 hearts of individuals who underwent autopsy at the National Institute of Legal Medicine and Forensic Sciences in Bucaramanga-Colombia. For each specimen, the coronary arteries and their branches were dissected, removing the subepicardial adipose tissue to identify the myocardial bridges and obtain histological sections of the compromised arterial branches. The presence of myocardial bridges was observed in 22 hearts (36.7%) with a length of 17.31 + 4.41 mm and a thickness of 904.57 + 312.27 mm. The coronary vessel caliber at the prepontine level was 246.57 + 49.33 mm and was significantly higher than in the pontine (188.92 + 60.55 mm) and postpontin (190.40 + 47 mm) segments (p=0.001 for both values). Atheromatous plaque was observed in the prepontine segment in 12 cases (46.15 %) and in 8 samples (30.76%) at the pontine level, but in this segment, there was slight damage to the vascular endothelium, or phase I level. The thickness of the tunica intima in the cases with atheromatous plaque was 15.68 + 13.39 mm and that of the plaque-free segments was 5.10 + 4.40 mm (p=0.005), and in the pontine segment the overlying periarterial adipose tissue had a thickness of 72.01 + 69.44 mm, which was higher than the other three locations (p=0.005). The morphometry of the perivascular fat pad and the presence of phase I atheromatous plaque are the main contributions of this study to the histology of myocardial bridges.

RESUMEN: La mayoría de los estudios histopatológicos han reportado que el segmento de la arteria coronaria debajo del puente miocárdico no presenta placa ateromatosa, mientras que el segmento proximal al puente miocárdico puede tenerla. El objetivo de este estudio fue evaluar el entorno microscópico de los puentes miocárdico. Este estudio descriptivo se realizó con 60 corazones de individuos a quienes se les práctico autopsia en el Instituto Nacional de Medicina Legal y Ciencias Forenses de Bucaramanga-Colombia. Para cada espécimen se realizó disección de las arterias coronarias y sus ramas, eliminando el tejido adiposo subepicárdico para identificar los puentes miocárdicos y obtener secciones histológicas de las ramas arteriales comprometidas. Se observó presencia de puentes miocárdicos en 22 corazones (36,7 %) con una longitud de 17.31 + 4.41 mm y un espesor de 904.57 + 312.27 mm. El calibre del vaso coronario a nivel prepontino fue 246.57 + 49.33 mm y fue significativamente mayor que en el segmento pontino (188.92 + 60.55 mm) y pospontino (190.40 + 47 mm) (p=0.001 para ambos valores). Se observó placa ateromatosa en el segmento prepontino en 12 casos (46.15 %) y en 8 muestras (30.76%) al nivel pontino, pero en este segmento, correspondieron a fase I, con ligero daño en el endotelio vascular. El espesor de la túnica íntima en los casos con placa ateromatosa fue de 15.68 + 13.39 mm y de los segmentos libres de placa fue 5.10 + 4.40 mm (p=0.005) y en el segmento pontino el tejido adiposo periarterial suprayacente presento un espesor de 72.01 + 69.44 mm, el cual fue mayor a las otras tres ubicaciones (p=0.005). La morfometría de la almohadilla adiposa perivascular y la presencia de placa ateromatosa en fase I son los principales aportes de este estudio a la histología de los puentes miocárdicos.

Factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide / Risk factors for the development of atherosclerosis in patients with rheumatoid arthritis

Introducción: la artritis reumatoide es una enfermedad sistémica, de etiología desconocida, caracterizada por provocar inflamación crónica, cursa con manifestaciones articulares, extrarticulares y comportamiento clínico variable. Objetivo: caracterizar los factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide e identificar su relación con el tiempo de diagnóstico, actividad inflamatoria y tratamiento. Método: se realizó estudio descriptivo transversal, en pacientes con artritis reumatoide atendidos en el Centro de Reumatología del Hospital Docente Clínico Quirúrgico 10 de Octubre entre febrero 2016 y junio 2017. Resultados: la mayor frecuencia fue para el sexo femenino, el rango etario 45-54 años. Se observó placa ateromatosa en 37.2 por ciento y engrosamiento complejo íntima media en el 15.4 por ciento. Los factores de riesgo que mostraron asociación con la presencia de placa fueron: hipertrigliceridemia (p= 0.000), hipercolesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) y los niveles elevados de proteína C Reactiva (p= 0.003). Conclusiones: los factores de riesgo tradicionales que presentaron significación estadística fueron la hipercolesterolemia, hipertrigliceridemia y la Diabetes Mellitus. La presencia de más de un factor elevó la frecuencia de alteraciones en el eco doppler; existió asociación entre la elevación de los niveles de PCR y la presencia de alteraciones del eco doppler. Se constató en aquellos pacientes con alteraciones eco doppler carotídeo relación con el tiempo de evolución, actividad de la enfermedad y dosis acumulada de esteroides(AU)

Introduction: rheumatoid arthritis is a systemic disease, of unknown etiology, characterized by chronic inflammation; It presents with joint, extra-articular manifestations and variable clinical behavior. Objective: to characterize the risk factors for the appearance of atherosclerosis in patients with rheumatoid arthritis and to identify their relationship with the time of diagnosis, inflammatory activity and treatment. Method: a cross-sectional, descriptive study was conducted in patients with rheumatoid arthritis treated at the Rheumatology Center of the Surgical Clinical Teaching Hospital 10 de Octubre in the period between February 2016 and June 2017. Results: the highest frequency was for the female sex, the age range 45-54 years. Atheromatous plaque was observed in 37.2 percent and intimal complex thickening in 15.4 percent. The risk factors that showed association with the presence of plaque were: hypertriglyceridemia (p= 0.000), hypercholesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) and high levels of C-reactive protein (p= 0.003) Conclusions: the traditional risk factors that presented statistical significance were hypercholesterolemia, hypertriglyceridemia and Diabetes Mellitus. The presence of more than one traditional risk factor increased the frequency of alterations in Doppler echo; There was an association between the elevation of C-Reactive Protein levels and the presence of Doppler echo alterations. It was found in those patients with carotid echo Doppler alterations, relationship with the time of evolution, activity of the disease and cumulative dose of steroids(AU)

Relationship between homocysteine in plasma and carotid atherosclerosis in the elderly patients / 上海交通大学学报（医学版）

Objective • To study the relationship between homocysteine (HCY) in plasma and carotid atherosclerosis in the elderly patients and its clinical significance. Methods • The intima-media thickness (IMT) of the common carotid arteries and the sclerotic lesions at the carotid arteries bulbs were evaluated by color Doppler ultrasonography in 99 elderly in-patients (65 years old or above). Fasting venous blood was drew from the patients for the determination of plasma HCY and other indexes. According to the plasma HCY concentration, the patients were divided into two groups, i.e., control group (HCY<15 μmol/L) and high HCY group (HCY ≥ 15 μmol/L). General clinical data, carotid plaque number, plaque thickness, plaque stability and carotid IMT were investigated in the two group of patients. Results • The numbers (P=0.015), stability (P=0.013) and thickness (P=0.001) of carotid plaques between the two groups were significantly different. After balancing the effects of age by the partial correlation analysis, plasma HCY concentration was positively correlated with the number (partial correlation coefficient=0.133, P=0.049), instability (partial correlation coefficient=0.046, P=0.023) and thickness (partial correlation coefficient=0.119, P=0.024) of carotid plaques. Nevertheless, the difference in the IMT of carotid arteries between the two groups was not significant (P=0.057). Conclusion • Plasma HCY concentration is correlated with the number, stability and thickness of carotid plaques.

Establishment and ultrasonic evaluation of rabbit abdominal aorta atheromatous plaque / 重庆医学

Objective To prepare the rabbit abdominal aorta atheromatous plaque model ,and to monitor its forming process by ultrasound .Methods Totally 60 Japanese male white rabbits(mdel group ,dead 6 rabbits) fed by high fat diet and the abdominal a‐orta atheromatous plaque formation process was monitored by ultrasound ,20 normal rabbits were taken as control .The abdominal aorta atheromatous plaque was finally confirmed by pathology .Results 52 rabbits in the model group were successful in preparing the abdominal aortic plaque model .The thickness of intima‐media complex was obviously higher than that of the control group .Con‐clusion High fat diet is an effective method for preparing the rabbit atherosclerosis model .The arterial atheromatous plaque forma‐tion is the typical characteristic of atherosclerosis .The high frequency ultrasound can better evaluate the formation process and con‐dition of rabbit abdominal aorta atheromatous plaque .

Influence of pharmaceutical care on medication compliance and treatment effect and carotid atheromatous plaque in patients with hyperhpidemia / 中国药学杂志

OBJECTIVE: To explore the influence of pharmaceutical care on medication compliance and treatment effect and carotid atheromatous plaque in patients with hyperlipidemia.

Captured Macro-embolus of Fractured Atheromatous Plaque by the Embolic Protection Device during Carotid Stent Assisted Angioplasty / 신경중재치료의학

The authors present a case in which macro-embolus from the ruptured atheromatous plaque developed during carotid artery stenting (CAS). A 63-year-old man who had suffered a left middle cerebral artery territory infarction had significant proximal left internal carotid artery stenosis required CAS procedure. Immediate after stent deployment, the patient showed abrupt neurological deterioration with 12 x 3 mm sized macro-embolus which was caught by the embolus protection device (EPD). Retrieval of the macro-embolus was performed safely and the patient recovered to pre-procedure status. Macro-embolus can be resulted during the CAS. The EPD can capture the macro-embolus and safe removal is technically feasible.

Espesor de íntima media carotídea y placa de ateroma en sujetos con hígado graso no alcohólico / Carotid intima-media thickness and plaque in subjects with NAFLD

Existe evidencia que en pacientes con enfermedad de hígado graso no alcohólica (EHGNA) hay aumento del estrés oxidativo hepático y que esta entidad puede también ser un marcador temprano de ateroesclerosis en personas sanas. Establecer la relación entre el espesor de íntima media carotídea (EIMC) y la placa de ateroma, con la EHGNA, como un marcador precoz de ateroesclerosis subclínica independiente de los factores de riesgo cardiometabólicos clásicos. Estudio clínico no experimental, transversal, analítico. 40 sujetos distribuidos en 2 grupos: sin EHGNA y con EHGNA, diagnosticados por ultrasonido hepático, a quienes se les determinó el EIMC. Para el análisis de los resultados se calculó la media y la desviación estándar, U de Mann-Whitney y la prueba chi-cuadrado (p <0,05). Prevalencia de EHGNA 64, %. En el grupo con EHGNA 80% grado I, 20% grado II, y ninguno grado III. La media del EIMC fue mayor en el grupo con EHGNA. Se encontraron 14 individuos (35%) con EIMC > 0,8 mm; 17 individuos (40%) con placa ateromatosa carotídea, y 20 individuos (50%) con una o ambas características, en su mayoría, se encontraron en el grupo con EHGNA (p=0,004). Los pacientes con EHGNA tienen un incremento en el EIMC, y por consiguiente, del riesgo de enfermedad cardiovascular. Así, la detección de EHGNA por ultrasonido podría ser un marcador temprano de ateroesclerosis

There is evidence that in patients who have Nonalcoholic Fatty Liver Disease (NFLD), there is an increase of hepatic oxidative stress, and this entity could be an early marker of atherosclerosis in healthy people. To establish the relationship between carotid intimamedia thickness (CMT), atheroma plaque and NFLD as a possible early marker of subclinic atherosclerosis independently of the classical cardiometabolic factors. Our sample consisted of 40 subjects, divided in two groups: with and without NFLD diagnosed by hepatic ultrasound. CIMT was done in all. For statistical analysis we applied median, standard deviation, U de Mann-Whitney and chi-square. Prevalence of NFLD was 64%. In the group with NFLD 80% had stage I. 20% stage II. Median of CMT was higher in the group with NFLD. 14 subjects (40 %) had a CMT > 0,8 mm; 17 (40%) had atheromatous plaque and 20 (50%) both. (p=0,004). Patients with NFLD have a higher CMT, and, thereforea higher risk of CVD. Hepatic Ultrasound could help as an early marker of atherosclerosis

Effect of atorvastatin on the arteria carotis atheromatous plaque and blood lipid in old people / 中国综合临床

Objective To observe the influence of atorvastatin on the arteria carotis atheromatous plaque and blood lipid in old people. Methods 57 hospitalized patients who had cerebral infarction or transient ischemic attack(TIA) were examined for atheromatous plaque by the color Doppler. They were administered atorvastatin 20 mg/d for three months. The changes of diameter of arteria carotis, rate of flow and size of plaque were measured be-fore and after treatment. Results The diameter of arteria carotis was expanded [left ( 0.99 ± 0. 11 ) era, right (0.98 ± 0.08 ) cm vs left (0.94 ± 0.09 ) cm, right ( 0.95 ± 0.07 ) cm, P < 0.05], the hemorrheology was improved, the size of plaque was diminished[left(0.57±0.20)cm2, right (0.54± 0.18 )cm2 vs left (0.86±0. 17 ) cm2 and right (0.82 ±0. 16 )cm2, P < 0. 05], TC, TG, LDL-C were lowered and HDL-C was elevated with statistical signifi-cance ( P < 0. 05). Conclusions The atorvastatin has positive therapeutical effect in diminishing the size of plaque, adjusting blood lipid and improving hemorrheology.

Analysis on Relationship between Leukoaraiosis and Carotid Atheromatous / 中国康复理论与实践

@#Objective To investigate the relationship between the leukoaraiosis(LA) and atheromatous.Methods 86 LA patients(as the observation group) and 84 non-leukoaraiosis patients(as the control group) were given examinations of carotid color doppler ultrasonography and magnetic resonance angiography(MRA).The imaging data of two groups were analyzed contrastively.Results In the observation group,the detectable rate of carotid atheromatous plaques was 86.05%,the rates of medium and serious stenosis were 52.70% and 24.32%;the detectable rate of intracalvarium artery atheromatous plaques were 75.58%,the rates of medium and serious stenosis were 46.15% and 29.23%.By analysis of statistics,there was a significant difference between the two groups(P<0.01).Conclusion Carotid and intracalvarium artery atheromatous plaques are closely correlation with LA,and may signify the genesis,development and severity of LA.

Changes of oxidized low density lipoprotein levels before and after percutaneous coronary intervention / 临床检验杂志

Objective To study the changes of the oxidized low density lipoprotein(ox-LDL) levels before and after percutaneous coronary intervention(PCI),and clarify the clinical significance of ox-LDL.Methods One hundred and thirty three patients with coronary heart disease(CHD) were divided into PCI(80) and non-PCI(53) groups.Fasting plasmas of before coronary angiography(CAG),plasmas immediate after CAG or PCI,and two days after PCI were collected,and the levels of ox-LDL and other lipids were detected.Results The level of ox-LDL in PCI group immediate after PCI was significantly higher than that before PCI [(86.9 ? 32.9) mg/L vs(75.4 ? 27.4) mg/L,P

Relation of IL-18 and collagen fibre with plaque stability in aorta atherosclerotic lesion / 基础医学与临床

Objective To investigate relation of IL-18 and collagen fibre(CF) with plaque stability in aorta atherosclerotic lesion.Methods Morphology and content of CF in rupture of aorta atherosclerotic group(A group),non-rupture of aorta atherosclerotic group(B group) and normal aorta group(C group) were examined by Massion's staining.Expression of IL-18 by was measured immunohistochemical staining among three groups.Results Increasing and arranging turbulence of the CF was found in tunica intima,middle layer and tunica adventitia in A and B groups.Around necrosis of atheromatous plaque,CF significantly increased and arranged turbulence,but the CF decreased or disappeared in necrosis area of atheromatous plaque in A group.The CF significantly increased,arranged turbulence and extended to SMCs in necrosis of atheromatous plaque in B group.Arranging orderliness and absence of disruption of the CF was recorded in C group.Percent age of CF content was significantly different among three groups(P

Application of dual-source CT in carotid arterial angiography / 医学研究生学报

Objective: To evaluate the application value and potential faults of Dual-source CT in carotid arterial angiography.Methods: We retrospectively analyzed the images of 477 patients with symptomatic carotid atherosclerosis detected by dual-source CT angiography(CTA) from February 2007 to January 2008,and evaluated the quality of the images,which were classified into 3 quality grades: excellent(with clear display of the lesion and no noticeable motion artifacts,good(with a few motion artifacts but still diagnostically applicable),and poor(with heavy motion artifacts,unclear display and no diagnostic value).Results: Of the 477 images,420(88.1%) were of excellent quality,44(9.2%) of good quality and 13(2.7%) of poor quality.Among the total number of cases,134(28.1%) were shown to be normal and 34(7.1%) abnormal in anatomic structure.Atheromatous plaques were detected in 295 cases(61.8%),carotid artery stenting in 11(2.3%),internal carotid artery occlusion in 1,common carotid artery occlusion in 1,and cervical tumor in 3.Conclusion: Dual-source CT,faster,effective and minimally invasive,is particularly valuable in the diagnosis of carotid arterial lesion and stenosis.

Morphologic Differences of Vessel Wall at Sites of Focal and Diffuse Coronary Vasospasm by Intravascular Ultrasound(IVUS)

BACKGROUND AND OBJECTIVES: The coronary vasospasm has been shown to play an important role in the pathogenesis of not only variant angina but also ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarct, and sudden death. The angiographic features of coronary vasospasm are focal and diffuse patterns in clinical setting. We attempted to clarify the differences in vessel wall morphologic appearance between the sites of focal and diffuse vasospasm by intravascular ultrasound(IVUS). MATERIAL AND METHODS: We studied 23 patients(32 segments) with variant angina in whom coronary angiograms were normal and coronary spasm was documented by intracoronary injection of acetylcholine. Coronary spasm was defined as luminal diameter reduction > or = 90% compared with baseline coronary artery diameter. Focal spasm was defined if the length of spastic narrowing was less than 10mm. By IVUS, we observed atheromatous plaques in 32 spasm segments with either focal or diffuse vasospasm. We measured maximal intimal thickness, luminal cross-sectional area(CSA), and external elastic membrane-CSA in spasm sites. RESULT: When comparing maximal intimal thickness between focal (n=15) and diffuse vasospasm segments(n=17), there was significantly greater thickness at focal spasm segments(1.21+/-0.36mm vs. 0.70+/-0.23mm, P<0.001). The maximal plaque area was similar between two groups but tended to be greater in focal spasm segments(6.03+/-2.06mm2 vs. 4.92+/-2.59mm2, P=NS). When circular shaped factor(CSF : standardized index of eccentricity) was compared, focal spasm segments were greater than diffuse spasm segments(0.89+/-0.06 vs. 0.97+/-0.02, P<0.001). At the segments of focal spasm, remodeling index was greater compared to the segments of diffuse spasm(1.02+/-0.16 vs. 0.86+/-0.13, P<0.001). CONCLUSION: Focal spasm segments were more eccentric and had greater atheromatous plaque than diffuse spasm segments. Positive remodeling pattern was observed at the segments of focal spasm and negative remodeling pattern at the segments of diffuse spasm. There were morphologic differences of vessel wall appearance between focal and diffuse spasm sites.

Relationship between matrix metalloproteinase-9 and tissue metalloproteinase inhibitor-1 and carotid atheromatous plaque stability / 中国病理生理杂志

AIM:To investigate the correlation between matrix metalloproteinase-9(MMP-9),tissue metalloproteinase inhibitor-1(TIMP-1),MMP-9/TIMP-1 and carotid atheromatous plaque stability in cerebral infarction patients.METHODS:80 patients with cerebral infarction were categorized as microemboli-negative group(n=70)and microemboli-positive group(n=10),20 normal human were served as control group.The MMP-9 and TIMP-1 levels in plasma were determined by mean of ELISA in 3 groups.RESULTS:The levels of MMP-9 and TIMP-1 in plasma were significantly higher in cerebral infarction patients than those in control group(P

Relationship between carotid atheromatous plaque and its related biochemical indexes and cerebral infarction / 临床神经病学杂志

Objective To investigate the relationship between carotid atheromatous plaque and its related biochemical indexes and cerebral infarction.Methods 65 cases with cerebral infarction served as cerebral infarction(CI) group and 35 cases of non-cerebral infarction as control group. In both groups,the location,number and nature of carotid atheromatous plaque and diamete of carotid artery were assessed by Doppler ultrasonography,and the related biochemical indexes such as blood lipid,blood glucose and fibrinogen were evaluated.Results Significant differences of the detectable rate of carotid atheromatous plaque and the diameter of common carotid artery were found between CI group[81.54%,( 7.43? 0.07)mm of left side,(7.52?0.60)mm of right side] and control group[28.57%,(7.75?0.10)mm of left side,( 7.97? 0.75)mm of right side]( P