Anti-oxLDL antibodies are clinically insignificant for stroke patients.

OBJECTIVES: The question about anti-oxidized low-density lipoprotein antibodies (anti-oxLDL Abs) involvement in the pathogenesis of atherosclerosis-related ischemic stroke is still open. The aim of this study was to determine how anti-oxLDL Abs are involved in the pathogenesis of atherosclerosis-related ischemic stroke and identify the main risk factors for stroke, such as arterial hypertension, diabetes mellitus type 2, dyslipidemia, and atherosclerotic changes in the common and internal carotid arteries. MATERIAL AND METHODS: A total of 40 stroke patients and 25 age- and sex-matched healthy individuals were included in the study. For each subject, IgG anti-oxLDL Abs expression in peripheral blood was assessed and analyzed in relation to clinical data, carotid Doppler ultrasonography results, and results of peripheral blood laboratory tests, including inflammatory parameters and lipid profile. RESULTS: The blood level of assessed antibodies was significantly higher in stroke patients than in control group. It did not relate to stroke severity and stroke outcome. The relationship between anti-oxLDL Abs and carotid plaques hyperechogenicity was observed. The antibodies concentration was significantly higher in patients with diabetes mellitus type 2 and also positively correlated with C-reactive protein blood level. However, multiple regression method did not confirm their independent influence. DISCUSSION: Patients with atherogenic ischemic stroke may have significantly higher anti-oxLDL Abs concentrations. This should be interpreted as an attempt to limit the consequences of oxLDL production; however, this phenomenon does not seem to protect patients against cerebrovascular events.

CD4⁺CD28⁻ lymphocytes and cerebral ischaemic stroke. Part II: CD4⁺CD28⁻ lymphocytes and carotid artery atherosclerotic plaque characteristics.

BACKGROUND AND PURPOSE: CD4⁺CD28⁻ lymphocytes can directly contribute to the instability of atherosclerotic plaque. This paper attempts to answer the question of the potential influence of the CD4⁺CD28⁻ lymphocyte population on the ultrasound image of atherosclerotic plaque in the common carotid artery (CCA) wall. MATERIAL AND METHODS: The study involved a group of 109 patients, aged 45 to 65 years, including 42 patients with first ever ischaemic stroke, experiencing symptoms resulting from disturbances of the anterior area of cerebral circulation, arterial hypertension and/or type 2 diabetes mellitus (group 1). Group 2 consisted of 34 patients with mentioned risk factors, without ischaemic stroke. The control group comprised 33 heal-thy individuals. The percentage of CD4⁺CD28⁻ lymphocytes was assessed with flow cytometry. RESULTS: A significant difference in the incidence of heterogeneous plaques was noted between groups 1 and 3 (p = 0.0023) as well as between group 2 and 3 (p = 0.0005), whereas groups 1 and 2 did not differ from each other. The proportion of CD4⁺CD28⁻ lymphocytes was similar in groups 1 and 2 (p = 0.97), but it differed between groups 1 and 3 (p < 0.0001) and between groups 2 and 3 (p < 0.001). A correlation was found between the proportion of CD4⁺CD28⁻ lymphocytes in the blood and the number of CCA atherosclerotic plaques (Rs = 0.191, p = 0.046). The proportion of CD4⁺CD28⁻ lymphocytes in peripheral blood did not correlate with the ultrasound types of atherosclerotic plaques. No correlation between the proportion of CD4⁺CD28 ⁻lymphocytes and the area of atherosclerotic plaques was found. CONCLUSIONS: The correlation between the proportion of CD4⁺CD28⁻ lymphocytes and the number of atherosclerotic plaques within the CCA suggests that the cells are involved in the mechanism of carotid plaque formation. There is no proof of the involvement of the above-mentioned cells in the mechanism of plaque destabilization in those arteries.

CD4⁺CD28⁻ lymphocytes and ischaemic stroke. Part I: CD4⁺CD28⁻ lymphocytes and common carotid artery intima-media thickness.

BACKGROUND AND PURPOSE: More and more data point to the involvement of the CD4⁺CD28⁻ lymphocyte subpopulation in the pathogenesis of ischaemic stroke. This paper attempts to answer the question of whether an increase in the percentage of CD4⁺CD28⁻ lymphocytes in the blood may be associated with carotid artery intima-media thickness (IMT). MATERIAL AND METHODS: The study involved a group of 109 patients, aged 45 to 65 years, including 42 patients with first-ever ischaemic stroke, experiencing symptoms resulting from disturbances of the anterior area of cerebral circulation, arterial hypertension and/or type 2 diabetes mellitus (group 1). Group 2 consisted of 34 patients with above-mentioned risk factors but without ischaemic stroke. The control group comprised 33 healthy individuals. Distribution of sex and mean age was comparable. The IMT of carotid arteries was measured by ultrasonography. Flow cytometry was applied to determine the percentage of CD4⁺CD28⁻ lymphocytes in the peripheral blood. RESULTS: The IMT was significantly greater in patients with stroke than in patients without stroke. No significant correlation was found between the proportion of CD4⁺CD28⁻ lymphocytes in the blood and the IMT of carotid arteries. CONCLUSIONS: The significant proportion of CD4⁺CD28⁻ lymphocytes in patients with ischaemic stroke points to the involvement of the cells in the pathogenesis of stroke. The CD4⁺CD28⁻ lymphocytes are not involved in the pathomechanism of common carotid arteries IMT thickening in this group of patients.

Middle cerebral artery flow after angioplasty and stenting of symptomatic internal carotid artery stenosis.

BACKGROUND AND PURPOSE: Improved haemodynamics in the middle cerebral arteries (MCAs) after carotid artery endaterectomy (CEA) has been demonstrated in a number of studies, whereas similar analyses on carotid angioplasty and stenting (CAS) remain insignificant. The purpose of the study was to test whether CAS affects haemodynamic parameters of MCA ipsilaterally and contralaterally to the side of the procedure in patients with symptomatic internal carotid artery (ICA) stenosis, assessed by transcranial Doppler (TCD) examination. MATERIAL AND METHODS: Carotid angioplasty and stenting was performed in 51 patients (39 men and 12 women) aged 45-86 (mean age: men 65.5 years, women 69 years) after first ever ischaemic stroke. Patients were divided into three groups: with CAS of the left stenotic ICA - group I, with CAS of the right stenotic ICA - group II and group III with CAS of the left stenotic ICA and right ICA occlusion. RESULTS: Increase of MCAs flow after CAS was recorded both in ipsilateral MCAs and contralateral MCAs. Although an increase of MCAs flow was observed, it was not significant in either MCAs of group I and II patients, or in ipsilateral MCAs of individuals in group III. An evident increase of blood flow after CAS occurred in cMCAs of group III individuals. Similar results were received with reference to Gosling's pulsatility index. CONCLUSIONS: Carotid angioplasty and stenting improves blood flow in both the ipsilateral and contralateral middle cerebral artery in patients with symptomatic carotid artery stenosis. Carotid angioplasty and stenting seems to be more effective in patients with symptomatic carotid artery stenosis combined with contralateral carotid artery occlusion than in individuals with symptomatic carotid artery stenosis alone.

Patients' and bystanders' awareness of stroke and pre-hospital delay after stroke onset: perspectives for thrombolysis in West Pomerania Province, Poland.

OBJECTIVE: Thrombolysis is a time-dependent therapy. It is therefore very important how fast stroke patients can reach hospital. The present study was designed to assess which proportion of patients with stroke (from the population of Szczecin, the capital of West Pomerania Province, Poland) reaches hospital within the recommended time from the thrombolytic therapy point of view. The purpose of our study was also to elucidate which factors can influence the time before the ambulance service is called. PATIENTS AND METHODS: The study involved 1,015 patients with stroke admitted to the Emergency Department of the University Hospital, Szczecin. RESULTS: 235 patients (23.1%) were admitted to the hospital within the appropriate period for thrombolytic therapy. Hospital arrival time was significantly earlier in older patients and in patients with severer neurological deficits. We also observed a tendency for faster hospitalization of women, the highly educated, and patients regularly using antiplatelet drugs for cardiovascular disease prevention. CONCLUSIONS: The percentage of stroke patients hospitalized within 2 h after stroke onset should be increased. The most susceptible subpopulations in our country seem to be older patients, the highly educated and patients regularly using antiplatelet drugs for cardiovascular disease prevention.

Nonembolic, hemodynamic blood flow disturbances in the middle cerebral arteries in patients with paroxysmal atrial fibrillation without significant carotid stenosis.

OBJECTIVES: The aim of the present study was to evaluate whether patients with paroxysmal atrial fibrillation (AF) without symptoms of cerebral ischemia or significant carotid stenosis have reduced blood flow through the middle cerebral arteries (MCAs), as well as to assess differences between blood flow through the MCAs during AF and after cardioversion. PATIENTS AND METHODS: A total of 65 subjects were included in the study: 30 patients consecutively admitted to the University Hospital in Szczecin, Poland, with an episode of AF and 35 healthy volunteers with normal sinus rhythm. All individuals underwent transcranial Doppler ultrasonography (TCD) with assessment of mean blood flow velocity (MV) in the MCAs. RESULTS: There were no significant differences in MCA MV values between patients with AF and controls. In patients in whom pharmacological cardioversion was successful within 24h of hospital admission, MV values before and after cardioversion differed significantly in both MCAs. CONCLUSION: In conclusion, AF adversely affects cerebral circulation leading to hemodynamic blood flow disturbances that might result in changes in MV values of the MCAs but which are usually insufficient to develop clinical symptoms of brain ischemia.