Internal carotid artery agenesis disclosed by carotid ultrasonography.

(Upper panels) Ultrasonography showed caliber difference of common carotid arteries (right side: 0.39 cm; left side: 0.70 cm) for right internal carotid artery agenesis. (Lower panels) Bilateral ophthalmic arteries showed anterograde flow with 50% flow reduction over right side (right: peak systolic velocity, PSV [23.3 cm/s]; end diastolic velocity, EDV [7.0 cm/s]; left: PSV [47.0/s] EDV [14.2 cm/s]).

The relationships among serum glucose, albumin concentrations and carotid atherosclerosis in men with spinal cord injury.

Limited information is available that examines the interrelationships between glucose tolerance, serum albumin, subclinical inflammation, and carotid atherosclerosis (CA) in patients with spinal cord injury (SCI). We prospectively recruited 110 male patients with traumatic SCI, 57 with SCI at thoracic level 6 or above (SCI-T6) and 53 with SCI at T7 or below (SCI-T7), and 62 age-matched able-bodied controls from the National Taiwan University Hospital. The associations among glucose levels after oral glucose tolerance tests (OGTT), serum albumin, high-sensitivity C-reactive protein (hs-CRP), and CA in terms of the extracranial carotid artery (ECCA) plaque score and common carotid artery (CCA) intima-media thickness (IMT) were examined. Results showed significantly higher post-challenge glucose levels and carotid plaque scores and lower serum albumin in the SCI-T6 patients. In addition, serum albumin was negatively associated with CA and post-challenge glucose levels. The higher post-challenge glucose levels at 120min (Glu120) were associated with higher serum hs-CRP levels and lower serum albumin levels. In addition, lower serum albumin levels were associated with a thicker CCA IMT and a higher prevalence of ECCA plaque. Mixed models revealed that body mass index, age, LDL-cholesterol, Glu120, homeostasis model assessment for insulin resistance (HOMA-IR), lower serum albumin and smoking habits were positively associated with CCA IMT. Age, HOMA-IR, LDL-cholesterol, and lower serum albumin were identified as the important factors for the presence of carotid plaque by multiple linear regression analyses. In conclusion, post-challenge hyperglycemia and serum albumin levels are important indicators of CV health in men with SCI.

Primary hypercholesterolemia, carotid atherosclerosis and insulin resistance among Chinese.

We investigated the genetic contributions to carotid atherosclerosis and insulin resistance in Chinese patients with primary hypercholesterolemia. A family study of probands from the outpatient clinics in patients with high low-density-lipoprotein cholesterol levels was conducted. A total of 62 families (360 subjects) underwent carotid ultrasonography and insulin resistance measurement. The correlation coefficients of carotid intima-media thickness (IMT) were high among spouse, parent-offspring, and sibling pairs (0.39, 0.38 and 0.35, respectively). All insulin indices and IMT had significant estimates of heritability, of which fasting insulin had the highest heritability (0.410 +/- 0.104, P = 0.0001), followed by homeostasis model assessment (HOMA) (0.395 +/- 0.108, P = 0.0001). The estimated heritability of IMT was significant (0.185 +/- 0.103, P = 0.025) but not of plaque score. Bivariate genetic coefficient between IMT and HOMA was 0.569 +/- 0.292, while the environmental coefficient was 0.028 +/- 0.103. The study confirms a relationship between insulin resistance and atherosclerosis and, in particular, between insulin resistance and the thickening of the arterial wall. Moreover, it shows that genetics influence both insulin resistance and atherosclerosis, implying that the management of insulin resistance may benefit the prevention of atherosclerotic disease in familial hypercholesterolemia.

Transcranial color-coded sonography for the detection of middle cerebral artery stenosis.

OBJECTIVE: The purpose of this study was to validate the accuracy and criteria of transcranial color-coded sonography (TCCS) in detecting severe middle cerebral artery (MCA) stenosis. METHODS: One hundred ninety-three patients with acute ischemic cerebrovascular disease who received both TCCS and magnetic resonance angiography (MRA) examinations were evaluated. Middle cerebral artery stenosis assessed by MRA was graded as follows: grade 0, normal to mild (< 50%); grade 1, focal severe stenosis (> or = 50% and stenotic length within the M1 prebifurcation segment); and grade 2, diffuse severe stenosis (> or = 50% and stenotic length greater than the M1 prebifurcation segment). The peak systolic velocity (Vs) and mean velocity (Vm) of bilateral MCAs were obtained by TCCS. Estimates of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for TCCS relative to MRA. RESULTS: After 46 patients were excluded, 309 MCAs (grade 0, 77.3%; grade 1, 15.5%; and grade 2, 7.1%) were evaluated. The optimal diagnostic accuracy of TCCS for the detection of grade 1 MCA stenosis can be reached if Vs is 140 cm/s or higher or Vm is 90 cm/s or higher (sensitivity, 83.3%; specificity, 91.2%). The optimal diagnostic accuracy of grade 2 MCA stenosis can be obtained if V(s) is lower than 50 cm/s or V(s) is 140 cm/s or higher (sensitivity, 81.8%; specificity, 92.1%). In our study, none of the grade 1 but around half of the grade 2 stenosis showed a low flow velocity pattern. CONCLUSIONS: Transcranial color-coded sonography is reliable in detecting severe MCA stenosis. Except for high flow velocity, the addition of a low cutoff of normal flow velocity in our criteria not only increases the study sensitivity but also enables the identification of around half of diffuse severe MCA stenosis.