Manifestações oftalmológicas em paciente com aneurisma gigante de carótida interna / Ophthalmological manifestation in patient with gigantic aneurysm of the internal carotid

RESUMO Os aneurismas intracranianos são dilatações em segmentos arteriais que irrigam o sistema nervoso central. Acometem 2% da população e as alterações oftalmológicas podem ser as primeiras manifestações do quadro. O objetivo deste relato foi descrever um caso de aneurisma de artéria carótida interna que cursou com restrição da movimentação ocular, alteração do reflexo fotomotor, ptose palpebral, dor facial e cervical. O diagnóstico foi confirmado pela identificação do aneurisma por meio do exame de angiografia cerebral. Foi realizado teste de oclusão por balão, cujo resultado positivo possibilitou a oclusão total da artéria carótida interna por meio de ligadura cirúrgica, procedimento este realizado com sucesso.

ABSTRACT Intracranial aneurysms are dilations in segments of the arteries that irrigate the central nervous system. They affect 2% of the population and the ophthalmologic disorders may be the first evidence in the clinical examination. The aim of the report is to describe a case of an internal carotid artery aneurysm that showed restrictions of ocular movements, change of pupillary light reflex, palpebral ptosis, facial, and cervical pain. This diagnosis was confirmed by the identification of the aneurysm through angiography. A balloon occlusion test was performed, and its positive result made a complete occlusion of the Internal Carotid Artery possible through surgery ligation, procedure that was successful.

Increased serum chemerin levels associated with carotid intima-media thickness / Aumento dos níveis séricos de chemerin associados à espessura das camadas intima-media carotídea

ABSTRACT Background: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. Objectives: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. Methods: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. Results: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). Conclusion: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

RESUMO Introdução: Níveis elevados de chemerin podem prever doenças cerebrovasculares isquêmicas futuras. Embora se acredite que a chemerin desempenhe um papel na inflamação aterosclerótica, ainda não foi determinado se os níveis circulantes de chemerin estão associados à gravidade da aterosclerose Objetivos: Por meio do uso da ultrassonografia Doppler da carótida, nosso objetivo neste estudo foi investigar as relações dos níveis séricos de chemerin com a espessura da íntima-média da carótida (EIMC) como um indicador de aterosclerose generalizada. Métodos: Este estudo comparou 40 pacientes com AVC isquêmico e 40 indivíduos saudáveis. As medidas foram feitas no final da diástole usando ultrassonografia Doppler em cores (USDC), após um intervalo de descanso de 5 minutos em um quarto silencioso e escuro. A EIMC foi definida como a distância entre a borda mais interna do eco luminal e a borda mais interna do eco da mídia/adventícia. EIMC foi medido na parede posterior de ambas as artérias carótidas comuns dentro de 1 cm proximalmente ao bulbo. Três medições foram feitas em ambos os lados e a medição média foi tomada como o EIMC. Os níveis séricos de chemerin foram determinados em todos os pacientes e indivíduos saudáveis. Resultados: Os níveis séricos de chemerin foram significativamente maiores no grupo de pacientes do que no grupo controle (p=0,004). Os níveis séricos de chemerin foram positivamente correlacionados com EIMC (p<0,05). Houve diferença significativa entre os grupos em relação à EIMC (p<0,001). Conclusão: Níveis séricos elevados de chemerin parecem estar associados com a EIMC, sugerindo que existe uma ligação entre chemerin e doença cerebrovascular isquêmica aterosclerótica.

Fresh vegetable and fruit consumption and carotid atherosclerosis in high-cardiovascular-risk population: a cross-sectional study in Jiangsu, China / Consumo de frutas e verduras frescas e aterosclerose carotídea em uma população de alto risco cardiovascular: um estudo transversal em Jiangsu, China / Consumo de verduras frescas y fruta y la aterosclerosis carotídea en una población con alto riesgo cardiovascular: un estudio trasversal en Jiangsu, China

This study aimed to investigate the association of vegetable and fruit consumption with carotid plaque (CP) and carotid intima-media thickness (CIMT), two predictors of carotid atherosclerosis, within urban and rural adults at high risk of developing cardiovascular diseases (CVDs) in regional China. A total of 11,392 adults at high CVD risk were identified from general population of 71,511 in this cross-sectional study, conducted between November of 2015 and May of 2016 in the Jiangsu Province. Among these 11,392 high risk participants, CP prevalence was 36.7%. The independent variables, vegetable and fruit intake frequency, were assessed by a food frequency questionnaire. The outcome variables, CIMT and CP, were measured by ultrasound examination. The ANCOVA analysis showed no association between CIMT values and vegetable and fruit intake frequencies. Multivariate logistic regression models were introduced to examine the association between vegetable and fruit intake and CP. After adjustment for potential confounders, the odds ratios (ORs) for participants who occasionally and daily consumed vegetable to experience any CP were 0.67 (95%CI: 0.58-0.78) and 0.70 (95%CI: 0.62-0.79), respectively, compared with those rarely consumed vegetable. While the adjusted ORs were 0.77 (95%CI: 0.64-0.92) and 0.80 (95%CI: 0.68-0.94), separately, for occasional and daily vegetable consumers to develop single CP relative to their counterparts who rarely consumed any vegetables. However, no significant association between fruit consumption and CP was observed. Among the Chinese population at high CVD risk, consumption of fresh vegetables was negatively associated with the risk of developing carotid plaque.

O estudo buscou investigar a associação entre consumo de frutas e verduras e placa carotídea (PC) e espessura íntima-média carotídea (EIMC), dois preditores de aterosclerose entre adultos das áreas urbana e rural com alto risco de desenvolver doenças cardiovasculares (DCVs) em uma região da China. Foram identificados 11.392 adultos com alto risco de DCV, entre 71.511 indivíduos da população geral, em um estudo transversal entre novembro de 2015 e maio de 2016 na Província de Jiangsu. Entre esses 11.392 participantes de alto risco, a prevalência de PC foi de 36,7%. As variáveis independentes, ou seja, frequências de consumo de frutas e verduras, foram avaliadas através de um questionário de frequência alimentar. As variáveis de desfecho, EIMC e PC, foram medidas por ultrassom. A análise ANCOVA não mostrou associação entre valores de EIMC e frequências de consumo de frutas e verduras. Foram introduzidos modelos de regressão logística multivariada para examinar a associação entre consumo de frutas e verduras e PC. Depois de ajustar para potenciais fatores de confusão, as ORs para participantes com consumo eventual e diário de verduras para qualquer PC foram 0,67 (IC95%: 0,58-0,78) e 0,70 (IC95%: 0,62-0,79), respectivamente, comparado com aqueles com consumo raro de verduras. Enquanto isso, as ORs ajustados foram 0,77 (IC95%: 0,64-0,92) e 0,80 (IC95%: 0,68-0,94), separadamente, para adultos com consumo eventual e diário de verduras para desenvolver uma PC única, comparado aos que relatavam consumo raro de verduras. Entretanto, não foi observada uma associação significativa entre consumo de frutas e PC. Entre a população chinesa com alto risco de DCV, o consumo de verduras frescas mostrou associação negativa com o risco de desenvolvimento de placa carotídea.

El objetivo de este estudio fue investigar la asociación del consumo de frutas y verduras con la placa carotídea (PC) y el grosor íntima-media carotídeo (GIMC), dos predictores de la aterosclerosis carotídea en adultos urbanos y rurales, con alto riesgo de desarrollar enfermedades cardiovasculares (ECV) en una región de China. Se identificaron, en este estudio transversal, a 11.392 adultos con alto riesgo de ECV dentro de una población general de 71.511, realizado entre noviembre de 2015 y mayo de 2016 en la provincia de Jiangsu. De estos 11.392 participantes en alto riesgo, la prevalencia de PC fue de un 36,7%. Las variables independientes, así como la frecuencia de consumo de verduras y fruta, se evaluaron mediante un cuestionario de frecuencia de comidas. Las variables de resultado, GIMC y PC, se midieron por un examen de ultrasonido. El análisis ANCOVA mostró que no existía asociación entre los valores GIMC y la frecuencia en el consumo de verduras y frutas. Los modelos de regresión logística multivariantes se introdujeron para examinar la asociación entre el consumo de verduras y frutas y la PC. Tras el ajuste para los factores potenciales de confusión, las ORs de haber tenido alguna PC para los participantes que ocasionalmente y diariamente consumían verduras fueron 0,67 (IC95%: 0,58-0,78) y 0,70 (IC95%: 0,62-0,79), respectivamente, comparadas con quienes raramente consumían verduras. Mientras que las ORs ajustadas fueron 0,77 (IC95%: 0,64-0,92) y 0,80 (IC95%: 0,68-0,94), separadamente, para los consumidores ocasionales y los consumidores diarios de verduras de desarrollar una única PC, en relación con sus contrapartes que raramente consumían verduras. No obstante, no se observó una asociación significativa entre el consumo de frutas y la PC. Entre la población con alto riesgo de ECV, el consumo de verdura fresca estuvo negativamente asociado con el riesgo de desarrollar PC.

Prevalencia de lesiones ateroscleróticas carotídeas en radiografía panorámica y su relación con factores de riesgo cardiovascular en brasileños / Prevalence of atherosclerotic carotid lesions on panoramic radiography and relationship with cardiovascular risk factors in Brazilians

RESUMEN: Aunque la radiografía panorámica no es una prueba de diagnóstico inicial para detectar la aterosclerosis carotídea, no podemos ignorar su valor al ver estas lesiones como hallazgos incidentales que pueden ser grandes aliados en el diagnóstico temprano y la prevención de eventos vasculares graves. El objetivo de este estudio fue evaluar la prevalencia de calcificaciones en la bifurcación de la arteria carótida en las radiografías panorámicas de rutina como principio diagnóstico, así como su relación con los factores de riesgo cardiovascular en individuos brasileños. Se analizaron 449 exámenes de radiografía panorámica de la base de datos del Departamento de Radiología de la Facultad de Odontología de Piracicaba, UNICAMP, São Paulo, Brasil. Después de obtener mediciones de la presión arterial e información sobre el tabaquismo y las enfermedades sistémicas, fue buscado en la radiografía panorámica la presencia o ausencia de la masa radiopaca en las regiones de las vértebras cervicales C3-C4. En el caso de una imagen sugestiva de ateroma, se realizó una radiografía anteroposterior para confirmar el diagnóstico. Aplicamos la prueba estadística de Chi-cuadrado con distribución normal y muestras independientes y aleatorias con un intervalo de confianza del 95 %. La confirmación de calcificaciones carotideas se produjo en el 8,5 % de la población de estudio (38 casos). No encontramos ninguna relación entre la presencia de calcificaciones con el tabaquismo, con el sexo o con datos previos de antecedentes familiares. Sin embargo 49,1 % de los casos estaban por encima de sesenta años y tenía asociación significativa con la hipertensión (P = 0,006). El mayor riesgo se presenta en pacientes ancianos hipertensos y, por lo tanto, hacemos hincapié en la importancia de una observación minuciosa de las radiografías panorámicas en la búsqueda de cualquier alteración de la anatomía normal y si es así, proceder con la derivación lo antes posible para un diagnóstico concluyente por parte de un especialista, pudiendo así ayudar en la prevención de episodios vasculares graves.

SUMMARY: Although panoramic radiography is not an initial diagnostic test for detecting carotid atherosclerosis, we cannot ignore its value in viewing these lesions as incidental findings that can be great allies in early diagnosis and prevention of serious vascular events. The aim was to evaluate the prevalence of calcifications in the bifurcation of the carotid artery on routine panoramic radiographs as a diagnostic principle, as well as its relationship with cardiovascular risk factors in Brazilians. We analyzed 449 panoramic radiography exams from the database of the Department of Radiology of the Faculty of Dentistry of Piracicaba, UNICAMP, São Paulo, Brazil. After obtaining blood pressure measurements and information on smoking and systemic diseases, the researcher observed on the panoramic radiograph, the presence or absence of the radiopaque mass in the regions of the cervical vertebrae C3-C4. In the case of a suggestive image of atheroma, an anteroposterior radiography was performed to confirm the diagnosis. The Chi-square test of normal distribution for independent and random samples with a 95 % confidence interval was applied to the data. Confirmation of carotid calcifications occurred in 8.5 % of the study population (38 cases). We did not find any relationship between the presence of calcifications with smoking, sex or previous family history. However, 49.1 % of cases occurred above sixty years old and there was a significant relationship with hypertension (P = 0.006). The greatest risk was presented in elderly and hypertensive patients, so we highlight the importance of a thorough observation by the dentist of panoramic radiographs to detect any alteration of the normal anatomy and in the positive case, proceed with the referral as soon as possible for a conclusive diagnosis by a specialist, being able to thus assist in the prevention of severe vascular episodes.

Panoramic radiography for detection of bilateral carotid calcified atheroma: an unusual case report / Radiografía panorámica para la detección de ateroma calcificado carotídeo bilateral: reporte de un caso inusual

Introduction: Atherosclerosis is a progressive inflammatory disease that can trigger serious medical consequences like acute myocardial infarction or stroke. Case Report: The purpose of this study is to report an unusual case of finding calcified atheromatous plaques in the carotid arteries bilaterally using a panoramic radiography (PR). A 75-year-old female with a morbid history, attends the Teaching Dental Clinic of the Pontifical Catholic University with complementary exams. PR showed well-defined radiopaque structures adjacent to C4. Using a Doppler ultrasound, the presence of calcified atheromas in the right and left carotid arteries were confirmed. The patient was informed of these findings and is currently under medical follow-up. Conclusion: PR is a useful complementary resource in the detection of atherosclerotic plaques of the upper carotid region.

Introducción: La aterosclerosis es una enfermedad inflamatoria progresiva que puede desencadenar graves consecuencias médicas como infarto agudo de miocardio o accidente cerebrovascular. Case Report: El propósito de este estudio es reportar un caso inusual de hallazgo de placas ateromatosas calcificadas en las arterias carótidas de forma bilateral mediante una radiografía panorámica. Mujer de 75 años con antecedentes mórbidos, acude a la Clínica Odontológica Docente de la Pontificia Universidad Católica con exámenes complementarios. La radiografía panorámica mostró estructuras radiopacas bien definidas adyacentes a C4. Mediante ecografía Doppler se confirmó la presencia de ateromas calcificados en las arterias carótidas derecha e izquierda. El paciente fue informado de estos hallazgos y actualmente se encuentra en seguimiento médico. Conclusión: La radiografía panorámica es un recurso complementario útil en la detección de placas ateroscleróticas de la región carotídea superior.

Doença Arterial Coronariana Anatômica Associada à Quimioterapia em Pacientes com Câncer de Pulmão Avaliada pelo Escore Angiográfico SYNTAX / Chemotherapy-Related Anatomical Coronary-Artery Disease in Lung Cancer Patients Evaluated by Coronary-Angiography SYNTAX Score

Resumo Fundamento A doença arterial coronariana (DAC) associada à quimioterapia está se tornando um tema emergente na prática clínica. Contudo, o mecanismo subjacente da quimioterapia associada à DAC permanence incerto. Objetivos O estudo investigou a associação entre a quimioterapia e as anomalias anatômicas ateroscleróticas das artérias coronárias dentre pacientes com cancer de pulmão. Métodos Foram incluídos pacientes submetidos à angiografia coronária (AGC), entre 2010 e 2017, com câncer de pulmão prévio. Os fatores de risco associados à DAC e os dados sobre o câncer de pulmão foram avaliados. Avaliamos as anomalias das artérias coronárias de acordo com o escore SYNTAX (SXescore) calculado à AGC. Na análise de regressão logística, o escore SYNTAX foi classificado como alto (SXescoreALTO) se ≥22. Os dados foram analisados através de estatística descritiva e análise de regressão. Resultados Ao todo, 94 pacientes foram incluídos no estudo. O SXescore foi mais alto no grupo com quimioterapia quando comparado com o grupo sem quimioterapia (25,25, IIQ [4,50-30,00] versus 16,50, IIQ [5,00-22,00]; p = 0,0195). A taxa do SXescoreALTO foi maior no grupo com quimioterapia do que no no grupo sem quimioterapia (58,33% versus 25,86; p = 0,0016). Tanto a análise de regressão logística univariada (OR: 4,013; 95% IC:1,655-9,731) quanto a multivariada (OR: 5,868; 95% IC:1,778-19,367) revelaram que a quimioterapia aumentou o risco de uma maior taxa do SXescoreALTO. A análise multivariada de regressão logística Stepwise mostrou que o risco para DAC anatômica mais grave aumenta com a quimioterapia como um todo em 5.323 vezes (95% IC: 2,002-14,152), e com o regime à base de platina em 5,850 vezes (95% IC: 2,027-16,879). Conclusões A quimioterapia está associada com a complexidade e gravidade anatômica da DAC, o que pode explicar, em parte, o maior risco de DAC associada à quimioterapia dentre pacientes com câncer de pulmão. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Chemotherapy-related coronary artery disease (CAD) is becoming an emerging issue in clinic. However, the underlying mechanism of chemotherapy-related CAD remains unclear. Objective The study investigated the association between chemotherapy and atherosclerotic anatomical abnormalities of coronary arteries among lung cancer patients. Methods Patients undergoing coronary angiography (CAG) between 2010 and 2017, who previously had lung cancer, were examined. Risk factors associated with CAD and information about lung cancer were evaluated. We assessed coronary-artery abnormalities by SYNTAX score (SXscore) based on CAG. In logistic-regression analysis, we defined high SXscore (SXhigh) grade as positive if ≥22. Data were analyzed through descriptive statistics and regression analysis. Results A total of 94 patients were included in the study. The SXscore was higher in the chemotherapy group than in the non-chemotherapy group (25.25, IQR [4.50-30.00] vs. 16.50, IQR [ 5.00-22.00], p = 0.0195). The SXhigh rate was greater in the chemotherapy group than in the non-chemotherapy group (58.33% vs. 25.86; p = 0.0016). Both univariate (OR:4.013; 95% CI:1.655-9.731) and multivariate (OR:5.868; 95% CI:1.778-19.367) logistic-regression analysis revealed that chemotherapy increased the risk of greater SXhigh rates. Multivariate stepwise logistic-regression analysis showed the risk of more severe anatomical CAD is increased by chemotherapy as a whole by 5.323 times (95% CI: 2.002-14.152), and by platinum-based regimens by 5.850 times (95% CI: 2.027-16.879). Conclusions Chemotherapy is associated with anatomical complexity and severity of CAD, which might partly account for the higher risk of chemotherapy-related CAD among lung cancer patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Enfermedad carotídea aterosclerosa y enfermedad de sustancia blanca en sujetos sin historia de infarto cerebral o isquemia cerebral transitoria / Atherosclerotic Carotid Disease and White Matter Disease in Subjects Without a History of Cerebral Infarction or Transient Cerebral Ischemia

Resumen Introducción: La enfermedad carotídea aterosclerosa (ECA) es un factor de riesgo importante para enfermedad vascular cerebral. Objetivo: Analizar la asociación entre factores de riesgo vascular mayores con ECA y leucopatía cerebral en pacientes sin historia de ictus isquémico. Método: Se evaluaron factores de riesgo en sujetos con exploración de carótidas mediante ultrasonografía Doppler dúplex. No se incluyeron casos con historia de infarto cerebral o ataque isquémico transitorio. Los sujetos contaron con resonancia magnética cerebral y se excluyeron aquellos con lesiones isquémicas de grandes vasos. Se construyeron modelos multivariable para la predicción de ECA, estenosis carotídea significativa, carga de ateromas y leucopatía cerebral. Resultados: Se estudiaron 145 sujetos (60.7 % mujeres, edad de 73 años). Se documentó ECA en 54.5 %, estenosis carotídea ≥ 50 % en 9 %, carga de placas de ateroma > 6 en 7.6 % y leucopatía periventricular o subcortical en 28.3 % (20.6 % tenían concurrentemente ECA y leucopatía). Los factores asociados independientemente con ECA fueron edad e hipertensión; con estenosis ≥ 50 %, hipertensión; con cargas de ateromas > 6 placas, edad; con leucopatía, edad, diabetes e hipertensión. La obesidad no se asoció con las variables independientes analizadas. Conclusiones: En los sujetos asintomáticos sin historia de ictus isquémico, la edad y la hipertensión fueron los factores de riesgo más importantes para enfermedad macrovascular. La diabetes mellitus se asoció con enfermedad microvascular. La obesidad por sí sola no fue un determinante mayor de ECA o leucopatía cerebral.

Abstract Introduction: Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. Objective: To analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients without a history of ischemic stroke. Method: Risk factors were assessed with carotid examination using Doppler duplex ultrasound. Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD. Results: One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, > 6 atheroma plaques in 7.6%, and periventricular or subcortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated with > 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated with any of the analyzed independent variables. Conclusions: In asymptomatic subjects without a history of ischemic stroke, age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with microvascular disease. Obesity alone was not a major determinant of CAD or WMD.

Carotid intima-media thickness and plaques in internal carotid artery as surrogate markers of lower limb arterial lesions in Chinese patients with diabetic foot

Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056-1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450-40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092-7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.

Internal carotid artery aneurysm mimicking normal-tension glaucoma / Aneurisma de carótida interna simulando glaucoma de pressão normal

ABSTRACT Differentiating glaucomatous from nonglaucomatous optic disc cupping remains challenging. We present a case of a 48-year-old woman with an internal carotid aneurysm of approximately 3.5 mm × 6.5 mm that mimicked normal-tension glaucoma. The patient had a 2-year history of low vision acuity in her left eye and frontal oppressive headache. Owing to the carotid aneurysm, she developed an asymmetric vertical cup-to-disc ratio above 0.2, and marked inferotemporal neuronal rim loss and pallor of the residual rim were noted in the left disc. She also developed a visual field defect with an arcuate scotoma in the left eye. The patient was referred to a neurosurgeon and underwent endovascular aneurysm occlusion. This case highlights the diagnostic importance of recognizing that many neurological defects remain underdiagnosed.

RESUMO diferenciação de escavações glaucomatosas e não glaucomatosas ainda permanece um desafio ainda nos dias de hoje. Nos descrevemos um caso de aneurisma de carótida interna medindo 3.5mm x 6.5mm que simulava um glaucoma de pressão normal. O caso é sobre uma paciente feminino de 48 anos com história de 2 anos de baixa acuidade visual no olho esquerdo e cefaléia frontal. Devido ao aneurisma de carótida a paciente desenvolveu uma assimetria de escavação vertical maior que 0.2 no olho esquerdo em relação ao direito com defeito localizado da camada de fibras nervosas temporal inferior. Ela também apresentava um defeito arqueado temporal superior a esquerda, cruzando a linha média vertical consistente. Após o diagnostico confirmado pela ressonância magnética funcional, a paciente foi enviada para o neurocirurgião para realização de uma oclusão endovascular do aneurisma. Esse caso nos alerta da importância de se lembrar que não apenas o glaucoma gera escavações suspeitas no disco óptico e que ainda muitos defeitos por causas neurológicas são subdiagnosticados.

The association of the circle of Willis anomaly and risk of stroke in patients with carotid artery disease / A associação de anomalia de Círculo de Willis e o risco de AVC em pacientes com doença carotídea

ABSTRACT The circle of Willis is an important collateral system that maintains perfusion to the stenotic area from the contralateral carotid and basilar artery to the region of reduced brain perfusion. The aim of the present study was to compare the circle of Willis anomaly in patients with unilateral symptomatic and asymptomatic carotid artery disease. Results In this retrospective study, we analyzed 175 patients who presented at our outpatient stroke clinic between January, 2013 and June, 2015 with either unilateral symptomatic or asymptomatic carotid artery disease, and who had had CT angiography imaging performed. Demographic properties, carotid artery stenosis and the anomaly of the circle of Willis was recorded. Conclusion There was no statistically significant difference in patients with symptomatic and asymptomatic carotid artery disease in terms of the anomaly of the circle of Willis.

RESUMO O Círculo de Willis é um importante sistema colateral que mantém a perfusão à área estenótica da carótida contralateral e da artéria basilar para a região de perfusão cerebral reduzida. O objetivo do presente estudo foi comparar a anomalia do Círculo de Willis em pacientes com doença carotídea assintomática e sintomática unilateral. Resultados Neste estudo retrospectivo, foram analisados 175 pacientes que foram à nossa clínica ambulatorial de AVC, entre janeiro de 2013 e junho de 2015, com doença carotídea assintomática ou sintomática unilateral, e que fizeram angiografia por tomografia computadorizada. Propriedades demográficas, estenose da artéria carótida e anomalia do Círculo de Willis foram registradas. Conclusão Não houve diferença estatisticamente significativa em pacientes com doença carotídea sintomática e assintomática em termos de anomalia do Círculo de Willis.

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals / Espessamento Mediointimal nas Carótidas e Femorais para Detectar Aterosclerose em Pessoas que Vivem com o Vírus da Imunodeficiência Humana

Abstract Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Resumo Fundamento: Pessoas que vivem com o HIV (HIV +) têm maior prevalência de aterosclerose e a desenvolvem mais precocemente do que a população geral. Objetivos: Foi avaliar e comparar as prevalências de aterosclerose avaliada pela medida da espessura mediointimal (EMI) das carótidas comuns e femorais, e do índice tornozelo-braquial (ITB) nos grupos controle e HIV com e sem inibidores de protease (IPs). Métodos: Foram incluídas 80 pessoas com HIV + [40 usavam IPs e 40 não] e 65 controles. O diagnóstico de aterosclerose foi determinado pela medição da EMI (carótidas e femorais) e do ITB. Fatores de risco clássicos para aterosclerose e específicos para o HIV foram comparados entre os grupos, usando testes estatístcos. O valor de p ≤ 0,05 foi cosiderado significativo. Resultados: A EMI > P75 ou presença de placa foi mais elevada no grupo de HIV sem IP que no controle (37,5% vs 19%, p = 0,04). A análise comparativa mostrou diferença significativa (p=0,014) na EMI nas artérias carótidas entre HIV + com IPs (0,71 ± 0,28 mm), sem IPs (0,63 ± 0,11 mm) e controles (0,59 ± 0,11 mm), A EMI na femoral não teve diferença significante entre os grupos. Não houve diferença significante entre os grupos controle e de HIV + quanto ao ITB. No entanto, observou-se uma diferença significativa (p=0,015) no ITB entre os grupos HIV + sem IPs (1,17 [1,08 - 1,23]), e controles [1,08 (1,07 - 1,17)]. Conclusão: Em pacientes com HIV, a aterosclerose é mais prevalente e parece ocorrer mais precocemente, com características distintas, em comparação a indivíduos HIV-negativos.

Early diagnosis of atherosclerosis with panoramic radiographs: a review / O diagnóstico precoce de aterosclerose através de radiografias panorâmicas: uma revisão

Abstract Carotid artery disease has been linked with cerebral vascular accident, also known as stroke, cerebral hemorrhage, or cerebral ischemia. It is caused by narrowing or obstruction of arteries in the neck (the carotid arteries) that are responsible for transporting blood from the aorta to the brain. Panoramic radiographs are used in dentistry to show both dental arches as a supplement to the clinical dental examination. The objective of this study is to highlight the importance of panoramic radiographs for diagnosis of arterial disease, by means of a bibliographic review. The PubMed database was searched using the keywords “atherosclerosis” and “panoramic”, with the filters “last 5 years” and “humans”. Twenty articles were identified, six of which were chosen for this study because they were open access. The review concluded that panoramic radiographs enable early diagnosis of carotid artery calcification, resulting in earlier interventions, and offer an accessible cost.

Resumo Doenças das artérias carótidas estão associadas a casos de acidente vascular cerebral, também chamados de derrame ou isquemia cerebral. Ocorrem devido ao estreitamento ou obstrução das artérias do pescoço, ou artérias carótidas, responsáveis por levar o sangue da aorta para o cérebro. A radiografia panorâmica é um exame de ambos os arcos dentários que ajuda no exame clínico odontológico. Destacar a importância da radiografia panorâmica no diagnóstico de doença arterial é o objetivo deste trabalho, que foi realizado através de pesquisa bibliográfica na PubMed, com as palavras-chave “atherosclerosis” e “panoramic”, e os filtros: últimos 5 anos e humanos. Vinte artigos foram elencados, dos quais seis formaram a base para este estudo, graças ao acesso livre ao seu conteúdo. Conclui-se que a radiografia panorâmica permite o diagnóstico precoce de calcificação da artéria carótida, levando a uma intervenção precoce a um custo acessível.

Prevalence of suggestive images of carotid artery calcifications on panoramic radiographs and its relationship with predisposing factors / Prevalência de imagens sugestivas de calcificações da artéria carótida em radiografias panorâmicas e sua relação com fatores predisponentes

Abstract Panoramic radiographs (PR) can display radiopaque images suggestive of calcified atheroma in the carotid artery in asymptomatic patients. The aim of this study was to evaluate the prevalence of these images on PR and their linkage with hypertension, obesity, age, gender and smoking habits. PR of 505 patients were evaluated. They were older than 30 years old and their PR had been taken for different clinical reasons. Their body mass index was calculated; their waist circumference was also taken into consideration. Information about smoking habits and hypertension was obtained. The observers analyzed the presence of radiopaque mass in the region of the cervical vertebrae C3-C4 through the PR, confirmed by an antero-posterior (AP) radiograph. The results showed a 7.92% prevalence of suggestive images of calcifications on PR and on AP radiograph. The adjusted Odds Ratio showed association with age and smoking habits. The calcification process is almost nine times higher for the elderly when compared to the young. As far as smokers are concerned, this process is twice worse when compared to no smokers. In conclusion, 7.92% of the group studied presented suggestive images of carotid atherosclerosis on PR, which is directly associated with the age and smoking habits.

Resumo As radiografias panorâmicas (RP) podem exibir imagens radiopacas sugestivas de ateromas calcificados na artéria carótida em pacientes assintomáticos. O objetivo deste estudo foi avaliar a prevalência destas imagens na RP e sua relação com hipertensão, obesidade, idade, sexo e tabagismo. Foram avaliadas RP de 505 pacientes acima de trinta anos, que realizaram esse exame por diversos motivos clínicos. Seu índice de massa corpórea foi calculado; sua circunferência abdominal também foi considerada. Informações sobre hipertensão e tabagismo foram obtidas. Os observadores avaliaram as RP para a presença de massas radiopacas na região das vértebras cervicais C3-C4, confirmadas por meio de uma radiografia ântero-posterior (AP). Os resultados mostraram prevalência de 7,92% de imagens sugestivas de calcificações em RP e na radiografia AP. A razão de probabilidade (OR) ajustada mostrou associação com idade e tabagismo. O risco para as pessoas mais velhas aumenta até cerca de nove vezes quando comparado com aqueles mais jovens, enquanto para os fumantes, o risco é o dobro, quando comparado com não fumantes. Na população estudada, 7,92% de todos os sujeitos apresentaram imagens sugestivas de aterosclerose carotídea em RP e houve associação com idade e tabagismo.

Ateroesclerosis subclínica en población de riesgo cardiovascular bajo y moderado por Framingham chileno / Subclinical atherosclerosis among Chilean subjects classified as having a low cardiovascular Framingham risk

Background: Framingham risk score (FRS) has limitations and can underestimate risk. Carotid ultrasound to measure intima media thickness or plaques is recommended for cardiovascular risk assessment. Aim: To determine the prevalence of subclinical atherosclerosis in asymptomatic subjects classified as low and intermediate risk. Material and Methods: Cross-sectional study performed in subjects without cardiovascular disease. Cardiovascular risk was estimated using the Chilean FRS and the General Cardiovascular Disease FRS. Carotid ultrasound was performed in all subjects. We defined subclinical atherosclerosis as the presence of carotid plaque or intima media thickness greater than 75th percentile by gender and age. Results: We studied 203 subjects aged 47.2 ± 9.6 years (54% males). Mean intima media thickness was 0.62 ± 0.1 mm. An abnormal value was detected in 68 subjects (33%) and carotid plaques in 32 subjects (15.7%). Based on Chilean FRS, 96% were considered at low risk, 4% at intermediate, and none at high risk. In the low risk group the prevalence of abnormal intima media thickness and plaques was 40 and 14% respectively. Presence of plaques was more common in women than men (23 and 7% respectively, p < 0.01). According to the General Cardiovascular Disease FRS, 23% were at low, 39% at low intermediate and 28% at high intermediate risk. In the low risk group the prevalence of an abnormal intima media thickness was 34% and no subject had plaques. Conclusions: Carotid plaques were detected in Chilean subjects classified as having a low FRS risk. The underestimation of risk was higher in Chilean women.

Reliability of digital panoramic radiographs in detecting calcified carotid artery atheromatous plaques: A clinical study.

Objectives: The objective of this study was to determine whether digital panoramic radiography is a reliable method to detect calcified carotid artery atheromatous plaques (CCAAP) as compared with ultrasonography. Study Design: Digital panoramic radiographs were obtained from 50 patients who also underwent carotid ultrasound examination. The images were interpreted by trained maxillofacial radiologist for the presence or absence of calcified atheromatous plaques. The extent of carotid calcification on carotid ultrasonography was determined by a trained Sonologist, which was considered as the gold standard assessment. Results: Digital panoramic radiographs had a sensitivity of 76% and specificity of 98.66% in determining CCAAP. There was a high level of agreement between diagnoses, with a kappa value of 0.8. Conclusion: To conclude, digital panoramic radiographs had good sensitivity and high specificity in detecting CCAAP. If properly trained, dentists can detect such plaques and can refer patients to physician for timely medical treatment.

Progressão atípica de perda visual em paciente com glaucoma primário de ângulo aberto / Atypical progression of visual loss in a patient with primary open-angle glaucoma

A dolicoectasia da artéria carótida interna (ACI) é uma condição rara que pode ser acompanhada de manifestações neuro-oftalmológicas, como perda da acuidade e alteração do campo visual decorrente da compressão do nervo óptico (NO). O objetivo é relatar um caso de paciente do sexo masculino, 67 anos, portador de glaucoma primário de ângulo aberto (GPAA) com evolução atípica, assimetria de escavação, palidez da rima do NO à esquerda, devido à neuropatia óptica compressiva à esquerda, por segmento dolicoectásico da ACI. O diagnóstico foi baseado na história clínica, aspecto do NO e exames de neuroimagem.

Dolichoectasia of the internal carotid artery (ICA) is a rare condition that may be associated with neuro-ophthalmic manifestations, such as loss of visual acuity and visual field resulting from compression of the optic nerve (ON). The aim is to report a 67-year-old male patient with primary open-angle glaucoma (POAG) with atypical evolution, asymmetry of cupping and increased pallor of the rim of the left ON, due to compressive optic neuropathy by the dolichoectatic segment. The diagnosis was based on clinical history, appearance of the ON and neuroimaging.

Spontaneous extracranial internal carotid artery aneurysm: a case report / Aneurisma espontáneo de la arteria carótida interna extracraneal: reporte de caso

Extracranial internal carotid artery aneurysms are rare. They may result in thromboembolic phenomena but spontaneous rupture is rare. The clinical presentation may be an asymptomatic neck mass or there may be symptoms of upper aerodigestive tract compression. The diagnosis may be suspected on clinical examination but radiologic investigations play an important role in diagnosis as well as in assessing the risk of complications of surgical intervention. We present a case of a patient with an extracranial internal carotid artery aneurysm, along with a short review of the treatment options.

Los aneurismas de la arteria carótida interna extracraneal son raros. Pueden ocasionar fenómenos tromboembólicos pero la ruptura espontánea no es común. La manifestación clínica puede ser una masa asintomático en el cuello, o pueden presentarse síntomas de compresión de las vías aerodigestivas superiores. Pueden producirse indicios para el diagnóstico a partir de sospechas durante el examen clínico, pero las investigaciones radiológicas desempeñan un papel importante a la hora de diagnosticar, y evaluar el riesgo de complicaciones de la intervención quirúrgica. Presentamos un caso de un paciente con un aneurisma de la arteria carótida interna extracraneal, junto con una breve reseña de las opciones de tratamiento.