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The use of high-resolution MRI to detect thrombosis and lipid-rich carotid artery plaques in a patient with homozygous familial hypercholesterolemia
Wang, Zhenjia; Liu, Wen; Jiang, Long; Wang, Luya; Yu, Wei.
  • Wang, Zhenjia; Capital Medical University. Beijing Anzhen Hospital. Department of Radiology. Chaoyang District,. CN
  • Liu, Wen; Capital Medical University. Beijing Anzhen Hospital. Department of Radiology. Chaoyang District,. CN
  • Jiang, Long; Capital Medical University. Beijing Anzhen Hospital. Beijing Institute of Heart, Lung, and Blood Vessel Diseases. Chaoyang District. CN
  • Wang, Luya; Capital Medical University. Beijing Anzhen Hospital. Beijing Institute of Heart, Lung, and Blood Vessel Diseases. Chaoyang District. CN
  • Yu, Wei; Capital Medical University. Beijing Anzhen Hospital. Department of Radiology. Chaoyang District,. CN
Rev. Assoc. Med. Bras. (1992) ; 66(1): 31-35, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1091903
ABSTRACT
SUMMARY Homozygous familial hypercholesterolemia is a rarely agentic disorder of the lipoprotein metabolism intimately related to premature atherosclerotic cardiovascular disease that can lead to high disability and mortality. Homozygous familial hypercholesterolemia typically affects not only the aortic root, compromising the coronary ostia, but also affects other territories such as the carotid, descending aorta, and renal arteries. Multi-contrast high-resolution magnetic resonance imaging (MRI) provides a validated and useful method to characterize carotid artery atherosclerotic plaques quantitatively. However, very few studies have been done on assessing plaque composition in patients with Homozygous familial hypercholesterolemia using high-resolution MRI. This report is to evaluate the value of MRI in accessing carotid artery disease in patients with Homozygous familial hypercholesterolemia. We describe a 28-year-old patient from Beijing, China, who presented to the Neurology Clinic with intermittent blurred vision of the right eye, headache, nausea, and vomiting for eight years without obvious causes. Familial hypercholesterolemia was suspected based on medical history and laboratory examination. Carotid Doppler ultrasound showed bilateral common carotid artery, internal carotid artery, and external carotid artery wall thickening with hyperechoic signals. Subsequently, high-resolution multi-contrast MRI of the carotid showed calcification with hypo-intense areas located at the middle layer of the plaque, with moderate stenosis. The plaque located at the right bifurcation of the common carotid artery extended to the internal carotid artery, causing lumen stenosis close to occlusion. The patient was treated with right carotid artery endarterectomy. At a 6-month follow-up, there had been no recurrence of the patient's symptoms.
RESUMO
RESUMO A hipercolesterolemia familiar homozigótica, uma doença patogênica rara do metabolismo da lipoproteína intimamente relacionada com a doença cardiovascular aterosclerótica prematura, pode conduzir a uma elevada deficiência e mortalidade. A hipercolesterolemia familiar homozigótica afeta tipicamente não só a raiz aórtica, comprometendo os óstios coronários, mas também outros territórios, como a carótida, a aorta descendente e as artérias renais. Imagens de ressonância magnética multicontraste de alta resolução (RM) fornecem um método validado e útil para caracterizar quantitativamente as placas de aterosclerose da artéria carótida. No entanto, muito poucos estudos foram feitos sobre a avaliação da composição da placa em doentes com hipercolesterolemia familiar homozigótica utilizando ressonância magnética de alta resolução. Este trabalho deve avaliar o valor da ressonância magnética no acesso à doença da artéria carótida em doentes com hipercolesterolemia familiar homozigótica. Descrevemos um paciente de 28 anos de Pequim, China, que se apresentou à clínica neurológica com visão turva intermitente do olho direito, dor de cabeça, náuseas e vômitos por oito anos sem causas aparentes. Suspeitava-se de hipercolesterolemia familiar com base no histórico médico e no exame laboratorial. O ultrassom Doppler carotídeo mostrou uma artéria carótida bilateral comum, artéria carótida interna e parede da carótida externa espessando-se com sinais hiperecoicos. Posteriormente, a ressonância multicontraste de alta resolução da carótida mostrou calcificação com áreas hipointensas localizadas na camada média da placa, com estenose moderada. A placa localizada na bifurcação direita da artéria carótida comum estendia-se até a artéria carótida interna, causando estenose do lúmen próxima à oclusão. O paciente foi tratado com endarterectomia da artéria carótida direita. Em seis meses de acompanhamento, não houve recorrência dos sintomas do paciente.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Thrombosis / Coronary Artery Disease / Magnetic Resonance Imaging / Carotid Stenosis / Plaque, Atherosclerotic / Hyperlipoproteinemia Type II Limits: Adult / Female / Humans Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2020 Type: Article Affiliation country: China Institution/Affiliation country: Capital Medical University/CN

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Full text: Available Index: LILACS (Americas) Main subject: Thrombosis / Coronary Artery Disease / Magnetic Resonance Imaging / Carotid Stenosis / Plaque, Atherosclerotic / Hyperlipoproteinemia Type II Limits: Adult / Female / Humans Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2020 Type: Article Affiliation country: China Institution/Affiliation country: Capital Medical University/CN