La osteopontina como biomarcador de riesgo neurológico en la enfermedad carotídea / Osteopontin as a neurological risk marker in carotid diseases

INTRODUCCIÓN: La osteopontina (OPN) incrementa el reclutamiento, migración y adhesión de los macrófagos y modula la expresión de citocinas proinflamatorias e interleucinas. Actualmente, no está definida su asociación con la inestabilidad de la placa de ateroma carotídea y la sintomatología clínica de los pacientes. OBJETIVOS: Estudiar los niveles en plasma de OPN de pacientes intervenidos quirúrgicamente de endarterectomía carotídea (ECA) y correlacionarlos con la sintomatología clínica preoperatoria, con el fin de valorar el riesgo neurológico y la inestabilidad de placa. MATERIAL Y MÉTODOS: Se diseñó un estudio prospectivo con una muestra de pacientes consecutivos intervenidos quirúrgicamente de ECA, previamente evaluados por el neurólogo o con la realización de una TAC o RMN cerebral. Los pacientes se dividieron en 2 grupos (sintomáticos y asintomáticos) y se compararon con un grupo control. Se excluyeron aquellos con enfermedades intercurrentes. La OPN se determinó mediante enzimoinmunoanálisis. Se utilizó para el análisis estadístico el programa SPSS V. 18.0. Las variables categóricas se describen como frecuencias y las cuantitativas como media y desviación estándar en el caso de utilizar pruebas paramétricas, y como mediana y rango intercuartil en el caso de utilizar pruebas no paramétricas. Se estableció que la relación fue estadísticamente significativa si p era inferior a 0,05. RESULTADOS: Durante el periodo de estudio, 44 pacientes (39 hombres, 5 mujeres), de edad media 75±6,62 años, fueron intervenidos de ECA por presentar una placa de ateroma que producía una estenosis significativa (>70% con ecodoppler). De acuerdo con sus antecedentes cerebrovasculares, 24 fueron sintomáticos y 20 asintomáticos. El grupo control fue de 25 sujetos sanos. La OPN en el grupo control fue de 60±6,62 ng/mL, de 74,3±60,8 ng/mL en asintomáticos y de 90,3±45,4 ng/mL en sintomáticos (p = 0,003). CONCLUSIONES: La (OPN) se comporta como un buen indicador de riesgo cerebrovascular en pacientes con placa carotídea, a pesar de que sus niveles y los mecanismos moleculares de expresión no están del todo aclarados

INTRODUCTION: Osteopontin (OPN) increases recruitment, migration and adhesion of macrophages and modulates the expression of proinflammatory cytokines and interleukins. Its association with the instability of carotid atheromatous plaque and the clinical symptoms of patients is currently not defined. AIMS: To study plasma levels of OPN in patients operated on by carotid endarterectomy (ECA) and correlate them with preoperative clinical symptoms, in order to assess the neurological risk and instability of plaque. MATERIAL AND METHODS: A prospective study was designed with a sample of consecutive patients who underwent surgery by ECA, and previously evaluated by a neurologist and/or by performing a CT or MRI brain scan. Patients were divided into 2 groups (symptomatic and asymptomatic) and compared with a control group. Those with intercurrent diseases were exclude. OPN was determined by enzyme immunoassay. Windows SPSS V. 18.0 program was used for statistical analysis. Categorical variables are described as frequencies, and quantitative variables as mean and standard deviation, in the case of using parametric tests, and median and interquartile range when using non-parametric tests. A P<.05 was established as a statistically significant relationship. RESULTS: During the study period, 44 patients (39 males, 5 females), mean age 75±6.62 years old, were operated on by ECA due to having a plaque that produced a significant stenosis (> 70% with echodoppler). According to their stroke history, 24 were symptomatic and 20 asymptomatic. The control group was 25 healthy subjects. The OPN in the control group was 60±6.62 ng/mL, 74.3±60.8 ng/mL in asymptomatic, and 45.4±90.3 ng/mL in symptomatic patients (P=.003). CONCLUSIONS: OPN behaves as a good indicator of stroke risk in patients with carotid plaque, even though its levels and molecular mechanisms of expression are not entirely clear

Incidental sonographic diagnosis of neonatal carotid occlusion.

UNLABELLED: Cranial ultrasonography including colour Doppler can detect neonatal carotid flow problems at an early stage, even before symptoms occur. Different pathogeneses can be identified. The condition is more frequent than previously reported. If the circle of Willis is fully developed, this can prevent brain injury even in case of total carotid flow obstruction CONCLUSION: Screening of the carotid artery in critically ill neonates may detect complications of treatment at an early stage.

Bony carotid canal hypoplasia in patients with moyamoya disease.

OBJECT: The natural history of moyamoya disease is not well known. We have observed that the bony carotid canal is hypoplastic in patients with adult onset moyamoya disease. Bony carotid canal development should represent internal carotid artery (ICA) development, and may stop with the beginning of ICA stenosis. The purpose of this study was to determine the onset of moyamoya disease by measuring the bony carotid canal. METHODS: The normal diameter of the bony carotid canal was evaluated on 4-mm thick bone window CT scans of the skull base in 60 Japanese patients aged 20-80 years, who had minor head trauma or headache considered to be unrelated to the skull base or arterial systems. The relationship between age and bony carotid canal development was assessed in a second group of 50 patients aged 0-19 years, including 10 under 2 years, using CT scans with the same parameters. The diameter of the bony carotid canal in 17 Japanese patients with moyamoya disease was measured. RESULTS: The normal diameter in adults was 5.27 +/- 0.62 mm (mean +/- SD). The bony carotid canal developed rapidly before approximately 2 years of age. After fusion of the bony suture, the bony carotid canal developed slowly. The mean diameter of the bony carotid canal was 3.31 +/- 0.44 mm in 11 adult patients with adult-onset moyamoya disease. According to the apparent curve of bony carotid canal development, ICA stenosis was assumed to start in early childhood. CONCLUSIONS: Our findings suggest that most cases of Asian moyamoya disease may arise in childhood and that many Asian adult patients with moyamoya disease may develop occlusive vasculopathy in childhood.