Criteria for Carotid Atherosclerotic Plaque Instability.

BACKGROUND: The study aim is to determine the criteria for carotid atherosclerotic plaque instability with the use of an advanced ultrasound technology, immunohistochemical analysis, and electron paramagnetic resonance (EPR) and assess their correlations with histologic results. METHODS: A total of 92 patients were included in the study and were examined by ultrasound duplex scanning and ultrasound elastography. Plaques harvested during carotid endarterectomy were obtained for histologic analysis, immunofluorescent assay, and EPR spectroscopic measurements. RESULTS: Multivariate logistic regression analysis showed that plaques with an area >90 mm2 (odds ratio [OR], 4.05; 95% confidence interval [CI], 1.32-13.2; P = 0.006), plaque volume index > 0.6 cm3 (OR, 2.72; 95% CI, 1.05-9.58; P = 0.04), and juxtaluminal black area ≥8 mm2 (OR, 2.82; 95% CI, 1.22-6. 23; P = 0.02) were statistically significant independent predictors of histologically verified unstable plaques. Unstable plaques occurred in 94% of the patients with these indicators. Significant increases in the number of CD68+ and CD36+ cells (inflammatory markers) and CD31+ cells (neovasculogenesis markers) were revealed in unstable plaques by the immunohistochemical assay. EPR data analysis showed that divalent manganese could serve as a marker of plaque instability. CONCLUSIONS: Additional ultrasound criteria, verified by histologic studies, significantly increased the information content for identifying patients with unstable plaques, which can be of great importance in stratifying the risk of ischemic stroke, especially in asymptomatic patients. The degree of calcification is not a mandatory criterion for plaque stabilization.

Long-Term Results of Endovascular Treatment of Chronic Iliofemoral Venous Obstructive Lesions.

OBJECTIVE: To evaluate the long-term results in endovascular treatment of iliofemoral venous obstructive lesions. METHODS: From January 2009 to March 2017, 75 patients were admitted for endovascular treatment of chronic obstructive lesions of the iliofemoral veins. Of these, 60 patients underwent stenting of postthrombotic obstructions and 15 patients stenting of nonthrombotic obstructive lesions of the iliac veins (May-Thurner syndrome in 11, for tumor-induced compression and cicatricial stenosis in 4). Dynamic control of stent patency was carried out by means of duplex ultrasound. Efficacy of endovascular intervention was evaluated by measuring the venous pressure gradient and malleolar circumference. The clinical result was determined by the Venous Clinical Severity Score (VCSS). RESULTS: Technical success of endovascular intervention in postthrombotic occlusions of iliac vein was 92% and in nonthrombotic iliac vein lesions was 100%. Cumulative primary and secondary patency in postthrombotic lesions at 60 months amounted to 72% and 81%, respectively, in nonthrombotic lesions to 85% (primary patency). Reinterventions were successfully performed in 6 patients including catheter-directed thrombolysis (3 patients) and stenting (3 patients). The mean VCSS score fell from 14.2 (4.2) to 7.5 (2.6; P < .001). The quality of life was improved; its mean score decreased from 62.6 (18.7) to 48.7 (12.8; P < .01). CONCLUSION: Endovascular angioplasty and stenting for obstructive lesions of the iliofemoral veins is a minimally invasive, safe, and highly effective method of treatment, which is confirmed by a significant improvement of the limb's condition and good long-term results of patency of the restored venous segments.

Long-term results of the monocusp valve formation in the common femoral vein in patients with avalvular deep veins of the lower extremities.

BACKGROUND: Aim of the study was to evaluate the long-term results of the monocusp valve formation in the common femoral vein (CFV) in patients with avalvular deep veins (ADV) of the lower extremities. METHODS: A total of 36 patients (24 women and 12 men) at the age varying from 37 to 58 years old were given surgical treatment during the period from 2008 to 2014. Six patients presented with congenital ADV, while the remaining 30 ADV had a consequence of the post-thrombotic lesion in the valves with the complete recanalization and manifested deep venous axial reflux. In terms of CEAP clinical classification, the patients were categorized into the following groups: С4b (N.=11), C5 (N.=18), C6 (N.=7). All the patients underwent Duplex ultrasound (DUS) examination. Twelve patients were additionally examined by venography. Kistner grade IV reflux was diagnosed in all the patients. Twenty-eight patients had undergone surgical interventions on superficial and perforating veins before. The severe (C4b-C6) forms of chronic venous disease with manifested axial reflux in deep veins were regarded as an indication for surgery in the patients refractory to traditional treatment. The method described by Opie et al. was employed to construct the monocusp venous valve in the CFV. RESULTS: The long-term results of the treatment were evaluated in 26 patients followed up during the period from 18 to 48 (mean 29.5±8.2) months. Cumulative clinical success rate at four years was 76.5%. Freedom from ulcer recurrence at four years was 83.4% (C6 patients). Cumulative competence rate of the neovalve was accomplished in 70.6%. The evaluation in two years based on the VCSS revealed the reduction in the severity of the manifestations of chronic venous insufficiency (P<0.01). The quality of life was improved, its index decreased from 60.6±18.7 to 40.7±12.8 (P<0.05). The circumference of the narrowest segment of the tibia decreased from 271.1±4.7 to 256.8±5.7 mm (P<0.05). CONCLUSIONS: Formation of the monocusp valve in CFV makes it possible to eliminate pathological blood reflux from the inferior vena cava to deep veins of the lower extremities that is known to be one of the main factors in the appearance and progression of chronic venous insufficiency (CVI). The high effectiveness of this operation is confirmed by the well apparent clinical improvement in the state of the affected lower extremity and the quality of life of the patients.

Bacterial Communities Associated with Atherosclerotic Plaques from Russian Individuals with Atherosclerosis.

Atherosclerosis is considered a chronic disease of the arterial wall and is the major cause of severe disease and death among individuals all over the world. Some recent studies have established the presence of bacteria in atherosclerotic plaque samples and suggested their possible contribution to the development of cardiovascular disease. The main objective of this preliminary pilot study was to better understand the bacterial diversity and abundance in human atherosclerotic plaques derived from common carotid arteries of individuals with atherosclerosis (Russian nationwide group) and contribute towards the further identification of a main group of atherosclerotic plaque bacteria by 454 pyrosequencing their 16S ribosomal RNA (16S rRNA) genes. The applied approach enabled the detection of bacterial DNA in all atherosclerotic plaques. We found that distinct members of the order Burkholderiales were present at high levels in all atherosclerotic plaques obtained from patients with atherosclerosis with the genus Curvibacter being predominant in all plaque samples. Moreover, unclassified Burkholderiales as well as members of the genera Propionibacterium and Ralstonia were typically the most significant taxa for all atherosclerotic plaques. Other genera such as Burkholderia, Corynebacterium and Sediminibacterium as well as unclassified Comamonadaceae, Oxalobacteraceae, Rhodospirillaceae, Bradyrhizobiaceae and Burkholderiaceae were always found but at low relative abundances of the total 16S rRNA gene population derived from all samples. Also, we found that some bacteria found in plaque samples correlated with some clinical parameters, including total cholesterol, alanine aminotransferase and fibrinogen levels. Finally, our study indicates that some bacterial agents at least partially may be involved in affecting the development of cardiovascular disease through different mechanisms.