Evaluate the role of carotid ultrasound before and after carotid endarterectomy / 中国脑血管病杂志

Carotid atherosclerosis is one of the important causes of cerebral stroke. Carotid endarterectomy ( CEA) is a classic operation for the treatment of carotid atherosclerotic stenosis. Evaluation by means of ultrasonography pre - and post - operative is of great clinical significance for the success of CEA.

Carotid plaque is a predictor of major adverse cardiac and cerebrovascular events in patients undergoing coronary angiography / La presencia de placa carotídea es predictor de eventos adversos cardiacos y cerebrovasculares en sujetos sometidos a coronariografía

Abstract Introduction: Carotid disease, measured as carotid intima-media thickness (CIMT) and carotid plaque (CP), is associated with major adverse cardiac and cerebrovascular events (MACCE) in people without the previous atherosclerotic disease; however, there are few published data in patients undergoing coronary angiography. The aim of the study is to determinate if the carotid disease is associated with MACCE after coronary angiography. Methods: A total of 390 consecutive patients underwent coronary angiography after exercise echocardiography and carotid ultrasonography between 2002 and 2013. MACCE was defined as stroke, myocardial infarction due to atherosclerosis progression or death due to a stroke or cardiac event. Results: Two patients were lost (0.5%). During a mean follow-up of 6.0 years (standard deviation of 2.9), 52 patients (13.4%) suffered MACCE. 1, 5, and 10 years, event-free survival was 96.4% (1.0), 88.7% (1.7), and 81.4% (2.8), respectively. Event rates at 10 years were higher in the CP group (23.2% vs. 10.2%, p = 0.013) and in the CIMT > 0.9 mm group (25.9% vs. 13.3%, p = 0.023). Multivariate analysis showed smoking habit (hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.36-4.62, p = 0.003), glomerular filtration rate (HR 0.98, 95% CI 0.98-0.99), aortic stenosis (HR 2.99, 95% CI 1.24-7.21, p = 0.014), incomplete/no coronary revascularization (HR 1.97, 95% CI 1.06-3.67, p = 0.033), insulin treatment (HR 2.63, 95% CI 1.30-5.31, p = 0.006), and CP (HR 2.36, 95% CI 1.02-5.44, p = 0.044) as predictors of MACCE. Conclusions: CP is an independent predictor of MACCE in patients undergoing coronary angiography.

Resumen La enfermedad carotídea, definida como grosor de íntima media (GIMC) y placa (PC), se asocia con eventos adversos cardiacos y cerebrovasculares (EACC) en sujetos sin aterosclerosis previa; sin embargo hay pocos datos en pacientes sometidos a coronariografía. El objetivo del estudio es determinar si la enfermedad carotídea se asocia a EACC en pacientes remitidos a coronariografía Métodos: Entre 2002 y 2013 390 pacientes fueron sometidos a coronariografía tras ecocardiograma de esfuerzo y ecografía carotídea. Se definió EACC como accidente cerebrovascular, infarto de miocardio por progresión aterosclerótica o muerte por accidente cerebrovascular o causa cardiaca. Resultados: Durante un seguimiento medio de 6 años (desviación estándar 2, 9) se registraron 2 pérdidas y 52 eventos (13,4%). La supervivencia media libre de eventos a uno, cinco y diez años fue 96.4% (1.0), 88.7% (1.7) y 81.4% (2.8). Hubo mayor número de eventos a 10 años en el grupo de PC (23.2% frente 10.2%, p = 0.013) y GIMC > 0.9 mm (25,9% frente 13.3%, p = 0.023). En el análisis multivariado los predictores de EACC fueron tabaquismo (hazard ratio [HR] 2.51, intervalo de confianza [IC] al 95% 1.36-4.62, p = 0.003), filtrado glomerular renal (HR 0.98 IC95% 0.98-0.99), estenosis aórtica (HR 2.99, IC 95% 1.24-7.21, p = 0.014), revascularización incompleta/no revascularización (HR 1.97, IC 95% 1.06-3.67, p = 0.033), tratamiento con insulina (HR 2.63, IC 95% 1.30-5.31, p = 0.006) y PC (HR 2.36, 95%CI 1.02-5.44, p = 0.044). Conclusiones: La PC es un predictor independiente de EACC en pacientes sometidos a coronariografía.

Evaluación de la adiponectina y su correlación con la íntima media carotidea en mujeres peri y post menopáusicas hospital de engativá, bogotá

El riesgo cardiovascular (RCV), se incrementa en las mujeres después de la menopausia. La adiponectina, se postula como un biomarcador de riesgo cardiovascular. La presente investigación buscó conocer si los niveles de adiponectina y la evaluación de a Intima Media Carotidea (IMT) se modifican durante el climaterio. Se evaluó el riesgo cardiovascular a diez años, en la escala de Framingham (FRS). Se tomaron 80 pacientes, entre 45 y 65 años, de la consulta de Climaterio en el Hospital de Engativá, Bogotá, entre el 15 de enero y 15 de diciembre de 2015. Las pacientes, se dividieron en dos grupos: 46 perimenopáusicas y 34 posmenopáusicas, todas las participantes firmaron el consentimiento informado. En formulario precodificado, se consignaron las variables sociodemográficas, examen físico, valores química sanguínea y resultados de ecografía doppler de carótida. La edad media entre los dos grupos fue: 50,95 años y 60,59 años. Se evidenció diferencia significativa en la presión arterial media. No hubo diferencia estadística en el perímetro abdominal ni en el Índice de Masa Corporal (IMC). La adiponectina presentó diferencia significativa intra grupos. No hubo diferencia en el perfil lipídico, el riesgo cardiovascular aumentó significativamente entre las mujeres pre y postmenopáusicas. La evaluación de la Íntima Media Carotidea (IMT) evidenció diferencias significativas en la placa anterior y posterior, tanto de carótida derecha como de carótida izquierda. El índice de pulsatilidad (IP) fue significativo en la carótida derecha y no en la izquierda. Se postula que la adiponectina es un marcador de riesgo cardiovascular y la IMT útil en la evaluación de arterioesclerosis.

The cardiovascular risk (CVR) increases in women after menopause. Adiponectin is postulated as a biomarker of cardiovascular risk. This study sought to determine whether adiponectin levels and assessment of Carotid Intima Media (IMT) are modified during the climacteric. cardiovascular risk ten years in the Framingham (FRS) was evaluated. 80 patients between 45 and 65 years of consulting Climaterio at the Hospital of Engativá, Bogota, between January 15 and December 15, 2015. The patients were divided into two groups, 46 perimenopausal and 34 postmenopausal, all participants signed informed consent. In pre-encoded form sociodemographic variables, physical examination, blood chemistry values and results of carotid doppler ultrasound were recorded. The average age between the two groups was: 50.95 years and 60.59 years. Significant difference was evidenced in mean arterial pressure. There was no statistical difference in waist circumference or the Body Mass Index (BMI). Adiponectin showed a significant difference intra groups. There was no difference in lipid profile, cardiovascular risk increased significantly between preand postmenopausal women. Evaluation of Carotid Intima Media showed significant differences in the anterior and posterior plates both right and left carotid carotid. The pulsatility index (PI) was significant in the right carotid artery and not in the left. We hypothesize that adiponectin is a marker of cardiovascular risk and IMT useful in assessing atherosclerosis.

Clinical distribution characteristics and analysis on risk factors of carotid vulnerable plaque in patients with acute ischemic stroke / 解放军医学杂志

Objective To analyze the distribution characteristics of carotid plaque, and explore the risk factors for carotid vulnerable plaque in patients with acute ischemic stroke (AIS). Methods The clinical data were collected from 588 patients with AIS and 630 patients without AIS matched in gender and age admitted to the Department of Neurology, Second Hospital of Lanzhou University from Mar. 2014 to Feb. 2015. The distribution characteristics of carotid plaque between the two groups were analyzed. All AIS patients were classified as non-plaque group (n=247), stable plaque group (n=93) and vulnerable plaque group (n=248) according to the carotid ultrasonography results. The clinical data were compared among the different three groups, and multivariate logistic regression analysis was performed to identify the independent risk factors for carotid vulnerable plaque in AIS patients. Results The detection rates of carotid plaque in AIS group and control group were 57.99% and 50.95%, and the detection rates of vulnerable plaque in the two groups were 42.18% and 33.81%, respectively; the detection rates of both carotid plaque and vulnerable plaque were statistically higher in AIS group than in control group (P<0.05). The age, gender, history of hypertension, diabetes and the level of systolic blood pressure among the three groups showed statistically significant differences (P<0.05); the multivariate logistic regression analysis revealed that age (OR=1.043, 95%CI 1.027-1.061, P=0.000), male gender (OR=1.973, 95%CI 1.377-2.828, P=0.000), diabetes (OR=1.454, 95%CI 1.004-2.106, P=0.047) and systolic blood pressure (OR=1.011, 95%CI 1.002-1.020, P=0.016) were the independent risk factors for carotid vulnerable plaque in patients with AIS. Conclusions The embolism accompanied by carotid vulnerable plaque rupture or abscission may lead to the occurrence of AIS; the age, gender, diabetes and systolic blood pressure are the independent risk factors for carotid vulnerable plaque in patients with AIS.

Clinical observation of the carotid of patients with anterior ischemic optic neuropathy using doppler ultrasound / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigate the relationship between the anterior ischemic optic neuropathy ( AlON ) and the carotid artery change using doppler ultrasound.METHODS:Fifty-four cases of AlON patients and 54 cases of healthy control were observed, atherosclerotic spots were detected by the application of color ultrasound.RESULTS:ln AlON group of 54 patients, 38 cases appeared carotid atherosclerosis, accounting for 70%. The number of cases with hard plaque, soft plaque and mixed plaques were 18, 13, and 7 respectively, accounting for 33%, 24% and 13%. ln the control group, 20 cases were detected atherosclerotic change, accounting for 37%. And the number of cases with hard plaque, soft plaque and mixed plaques were 12, 5 and 3 respectively, accounting for 22%, 9%, 6%. Significant stenosis and velocity change were showed in neither AlON group nor control group. Compared with the control group, AlON group had more cases of atherosclerotic plaque, the difference was statistically significant (χ2=12. 836, P=0. 005)CONCLUSlON: The incidence of AlON is correlated with carotid atherosclerosis, and carotid ultrasonography is significantly valuable for AlON etiology and diagnosis.

Multicenter ultrasound screening for the results of carotid atherosclerotic lesions in a Chinese population with high-risk of stroke:a preliminary analysis / 中国脑血管病杂志

Objectives To screen the high-risk population of stroke in China using color Doppler flow imaging (CDFI)and to establish a stroke risk prediction model in Chinese population in order to prevent and treat stroke early. Methods Forty-one base hospitals and 715 286 people in the project areas of the first 6 provinces of China conducted routine physical examinations and investigated the related risk factors for cardiocerebrovascular diseases from July 2011 to April 2012 using a cross-sectional study,among them 61 860 patients underwent carotid CDFI screening,and 49 386 of them were high-risk population (exposed to≥3 risk factors). The bilateral common carotid interma-media thickness (IMT),the number of plaques and the degree of carotid stenosis were screened and documented. And whether carotid IMT thickening or not,with or without carotid plaques,and degree of carotid artery stenotic rate 0-49% and≥50% were performed by multivariate logistic regression analysis with the risk factors for stroke,respectively. Results (1)Logistic regression analysis showed that hypertension,atrial fibrillation,smoking,and lack of physical exercise were the independent risk factors for carotid IMT thickening (hypertension:OR,1. 17;95%CI 1. 12-1. 22;atrial fibrillation:OR,1. 15;95%CI 1. 09-1. 21;smoking:OR,1. 13;95%CI 1. 08-1. 17;and lack of physical exercise:OR,1. 12;95%CI 1.08-1. 16). (2)Hypertension,atrial fibrillation, smoking,and diabetes were the independent risk factors for carotid plaque and carotid artery stenosis rate≥50%(carotid plaque,hypertension:OR,1. 55;95%CI 1. 47-1. 62;atrial fibrillation:OR,1. 13;95%CI 1.06-1. 21;smoking:OR,1. 16;95%CI 1. 11-1. 22;and diabetes:OR,1. 30;95%CI 1. 24-1. 37). Carotid stenosis rate≥50%,hypertension:OR,1. 78;95%CI 1.55-2. 03;atrial fibrillation:OR,1. 59;95%CI 1. 39-1. 81;smoking:OR,1. 33;95%CI 1. 20-1. 48;and diabetes:OR,1. 30;95%CI 1. 17-1. 45. Simple obesity did not increase the incidences of carotid atherosclerotic plaque and carotid artery stenosis ≥50%(OR,0. 78, 0.83;95%CI 0. 75-0. 82 ,0. 75-0. 92,respectively). Conclusions Neck vascular ultrasound can be used as a valuable means for screening high-risk population and detecting risk factors of stroke. It has an important clinical significance for the early diagnosis and treatment of carotid atherosclerosis disease.

The Intima Media Thickness (IMT) as Measured by Carotid Ultrasonography in Patients with Retinal Vascular Diseases

PURPOSE: To evaluate the findings of carotid ultrasonography performed on patients with retinal vascular disease and to determine the risk of cardiovascular disease and association of retinal vascular disease and cardiovascular disease. METHODS: From December 2009 to May 2012, patients diagnosed with central retinal artery occlusion (CRAO, n = 18), central retinal vein occlusion (CRVO, n = 23), and branch retinal vein occlusion (BRVO, n = 68) underwent carotid ultrasonography. We evaluated the intima-media thickness (IMT) of the common carotid artery (CCA) and the internal carotid artery (ICA), stenosis and the number of plaques, and then compared these results with those of a healthy control group (n = 221). RESULTS: The mean CCA-IMT and ICA-IMT were significantly higher in the CRAO and BRVO groups compared with the control group. On the contralateral side, CCA-IMT was increased in the CRAO, BRVO, and CRVO groups and ICA-IMT was increased in the CRAO and BRVO groups compared with the control group. Contralateral CCA stenosis was higher in the CRVO group (9.1%) and ipsilateral ICA stenosis in CRAO group (21.7%) was significantly higher than that of the control group. Plaque was observed better in all groups compared with the control group. The proportion of patients risk for cardiovascular disease, i.e. those who had IMT thickenesses more than 1.0 mm, was higher in the CRAO and BRVO groups compared with the control group. CONCLUSIONS: The carotid ultrasound findings of patients with retinal vascular diseases showed increased IMT and plaque. The group of patient at risk for cardiovascular disease, which was defined with carotid artery IMT, was higher in patients with retinal vascular disease. Therefore, in patients with retinal vascular disease, carotid artery ultrasonography and the overall management and treatment of cardiovascular disease are necessary.

The Association Between the 10-Year Risk of the Korean Stroke Risk Prediction Model and the Carotid Intima-Media Thickness

BACKGROUND: Both carotid intima-media thickness (IMT) and global risk score of cardiovascular disease were independent risk factors of stroke and heart disease. We assessed the correlation between the 10-year risk of Korean Stroke Risk Prediction model (KSRP) and carotid intima-media thickness. Additionally, from a perspective of carotid IMT measurement following KSRP risk stratification, we analyzed the difference of carotid IMT and plaque according to the KSRP risk strata. METHODS: Subjects were 282 persons who visited one hospital for the screening of stroke. The 10-year risk was calculated automatically based on the equation of KSRP model. The maximal carotid IMT and the plaque were adopted as the study variables. The sensitivity and the positive predictive value of the KSRP risk categories were calculated. RESULTS: The correlation coefficient between the KSRP risk and the maximal carotid IMT was 0.29 (p<0.01). The mean (+/-standard deviation) of KSRP risk of the group with carotid plaque was statistically significantly higher, 5.3 (+/-4.1), than that of the group without plaque, 3.3 (+/-3.1) (p< or =0.01). The sensitivity of the risk stratum with more than 6% of KSRP risk for the plaque was 28.2%. The positive predictive value of the above cut-point was 48.8%. CONCLUSIONS: The 6% of KSRP risk may be considered as the beginning point of intermediate risk stratum to recommend the carotid ultrasonography. However, generalization needs further studies for various populations.

A Unique Ultrasonographic Finding of Carotid Thrombus in a Patient with Acute Cardiogenic Cerebral Infarction / 대한뇌졸중학회지

In patients with acute ischemic stroke, carotid duplex ultrasonography has been used to assess atherosclerotic lesions at the extracranial carotid artery. We reported a unique sonographic finding of carotid artery thrombus in a patient with acute cardioembolic stroke and atrial fibrillation. An 81-year-old woman with atrial fibrillation was presented with dysarthria and left side hemiparesis. She had undergone surgical thrombectomy and angioplasty for her right brachial artery occlusion four days before the stroke onset. Diffusion-weighted MRI revealed multiple territorial infarctions suggestive of acute cardio-embolic stroke. CT angiography showed an occlusion of the right common carotid artery. On B-mode ultrasonography, longitudinal intraluminal tortuous cylinderic oscillating thrombus was observed on the right distal common carotid artery to the proximal internal carotid artery. This case illustrates a unique ultrasonographic finding of acute cardiogenic thrombus in the extracranial carotid artery.

Relationship of Carotid Atherosclerosis and Coronary Artery Disease and Cerebral Infarction / 上海第二医科大学学报

Objective To study the relationship of carotid atherosclerosis and coronary artery disease and cerebral infarction. Methods One hundred and forty patients were divided into three groups: coronary artery disease(CAD) group,cerebral infarction(CI) group and control(C) group.All the patients accepted carotid ultrasonograph. Results The incidence of multiple plaques in carotid artery was much higher in CI group than in C group and CAD group(P