scholarly journals Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study

2015 ◽  
Vol 39 (5-6) ◽  
pp. 319-324 ◽  
Author(s):  
Quirijn J.A. van den Bouwhuijsen ◽  
Daniel Bos ◽  
M. Arfan Ikram ◽  
Albert Hofman ◽  
Gabriel P. Krestin ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Plaque ◽  
Population Based ◽  
Intraplaque Hemorrhage ◽  
Wall Thickening ◽  
Lower Prevalence ◽  
Rotterdam Study ◽  
Lipid Core ◽  
Logistic Regression Models ◽  
The Relationship

Background: There is a growing amount of evidence suggesting that the composition of carotid atherosclerotic plaques may be of clinical relevance. Yet, little is known on the coexistence of potentially vulnerable and stabilizing components within asymptomatic plaques. Therefore, in this study we set out to investigate the coexistence of intraplaque calcification, hemorrhage and lipid core within the carotid artery using a multi-modality imaging approach. Methods: In 329 subjects from the population-based Rotterdam Study, all with ultrasound-confirmed carotid wall thickening, we performed a multi-detector CT and a high-resolution MRI of the carotid artery bifurcation at both sides. On the CT examinations, we quantified the volume of intraplaque calcification, and using the MRI examinations we rated the presence of intraplaque hemorrhage and of lipid core. In total, we investigated 611 carotid arteries with plaques. With logistic regression models we investigated the relationship of calcification volume - as a potential stabilizing component - with the presence of potential vulnerable components (intraplaque hemorrhage and lipid core) within each carotid plaque. We adjusted all analyses for age, sex and maximal plaque thickness. Next, we stratified on degree of stenosis (≤ or >30%) to evaluate effect modification by atherosclerotic burden. Results: We found that a larger calcification volume was associated with a higher prevalence of intraplaque hemorrhage, and a lower prevalence of lipid core (fully-adjusted odds ratio (OR) per standard deviation (SD) increase in calcification volume: 2.04 (95% confidence intervals (CI): 1.49; 2.78) and 0.72 (95% CI: 0.58; 0.90), respectively). Stratification on the degree of stenosis showed no difference in the association between calcification volume and hemorrhage over strata, while the relationship between a larger calcification volume and a lower prevalence of lipid seemed more pronounced in persons with a high degree of stenosis. Conclusions: In this population-based setting, we found that there is a complex relationship between calcification, intraplaque hemorrhage and lipid core within the carotid atherosclerotic plaque. Plaques with a higher load of calcification contain more often hemorrhagic components, but less often lipid core. Our results suggest that both in small and large plaques, intraplaque calcification may not be a stabilizing factor per se. These findings create an urge for conducting prospective studies investigating the interrelation of these different plaque components with regard to future cerebrovascular events.

scholarly journals Serum insulin levels are associated with vulnerable plaque components in the carotid artery: the Rotterdam Study

2020 ◽  
Vol 182 (3) ◽  
pp. 343-350
Author(s):  
Blerim Mujaj ◽  
Daniel Bos ◽  
Maryam Kavousi ◽  
Aad van der Lugt ◽  
Jan A Staessen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Carotid Artery ◽  
Atherosclerotic Plaque ◽  
Carotid Atherosclerosis ◽  
Serum Insulin ◽  
Intraplaque Hemorrhage ◽  
Rotterdam Study ◽  
Lipid Core ◽  
Insulin Levels ◽  
Glucose Levels

Background To investigate the association between fasting serum insulin and glucose levels with atherosclerotic plaque composition in the carotid artery. Impaired insulin and glucose levels are implicated in the etiology of cardiovascular disease; however, their influence on the formation and composition of atherosclerotic plaque remains unclear. Methods In 1740 participants (mean age 72.9 years, 46% women, 14.4% diabetes mellitus) from the population-based Rotterdam Study, we performed carotid MRI to evaluate the presence of calcification, lipid core, and intraplaque hemorrhage in carotid atherosclerosis. All participants also underwent blood sampling to obtain information on serum insulin and glucose levels. Using logistic regression models, we assessed the association of serum insulin and glucose levels (per s.d. and in tertiles) with the different plaque components, while adjusting for sex, age, intima-media thickness, and cardiovascular risk factors. Results Serum insulin levels were associated with the presence of intraplaque hemorrhage (adjusted odds ratio (OR): 1.42 (95% CI: 1.12–1.7)) We found no association with the presence of calcification or lipid core. Sensitivity analyses restricted to individuals without diabetes mellitus yielded similar results. No associations were found between serum glucose levels and any of the plaque components. Conclusions Serum insulin levels are associated with the presence of vulnerable components of carotid plaque, specifically with intraplaque hemorrhage. These findings suggest a complex role for serum insulin in the pathophysiology of carotid atherosclerosis and in plaque vulnerability.

Abstract 3482: Increased Matrix Metalloproteinase-9 Expression is Correlated with Carotid Intraplaque hemorrhage in a Swine Model

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Zhong-Song Shi ◽  
Xiao-Bing Jiang ◽  
Jin-Shan Wang ◽  
Wei-Si Yuan ◽  
Dong-Hong Liu
Keyword(s):  
Carotid Artery ◽  
Matrix Metalloproteinase ◽  
Vulnerable Plaque ◽  
Carotid Plaque ◽  
Carotid Atherosclerosis ◽  
Intraplaque Hemorrhage ◽  
Swine Model ◽  
Carotid Plaques ◽  
Rete Mirabile ◽  
Atherosclerotic Changes

Purpose: The limited number of large animal carotid atherosclerotic models restricts the preclinical evaluation of endovascular therapies. Carotid intraplaque hemorrhage may be associated with a higher risk of ischemic stroke in patients with carotid disease. In this study, we assess the association of the lesional expression of matrix metalloproteinase (MMP)-9 with vulnerable atherosclerotic carotid plaque and intraplaque hemorrhage in a Swine model. Materials and Methods: Carotid atherosclerosis was induced in miniswines using the combination of partial ligation and high cholesterol diet, and a minimum 70% stenosis was confirmed by Doppler ultrasonography immediately post-ligation. Carotid artery sections were obtained for histopathological examination and immunohistochemical study for MMP-9 at three months. Distal embolism was determined by the presence of atheroemboli in the ipsilateral rete mirabile. Atherosclerotic changes were classified by AHA/Stary stage (type I to VI). The association of distal embolism in the rete mirabile with vulnerable carotid plaque was analyzed. The association of MMP-9 expression in the plaque with the vulnerable plaque and intraplaque hemorrhage was further analyzed. Results: One hundred ninety-one carotid segments from ten carotid artery models were assessed. Among 139 segments with atherosclerotic changes, 102 segments had vulnerable plaque (Stary IV to VI). Vulnerable atherosclerotic plaques were found more frequently in the vessel wall proximal to the partial ligation than distal ( P <0.0001). Distal embolism was found in all 10 rete mirabilis, and deemed to be from the ipsilateral vulnerable carotid plaques. Areas positive for MMP-9 tended to be greater in the vulnerable plaque than in the stable plaque (8.69 ± 0.73% vs. 7.04 ± 0.94%, p=0.35). Areas positive for MMP-9 were significantly greater in the plaque with intraplaque hemorrhage than in the plaque without intraplaque hemorrhage (11.84 ± 1.22% vs. 6.63 ± 0.59%, p<0.001). On multivariate analysis, positive expression of MMP-9 was an independent predictor of intraplaque hemorrhage (p=0.007). Conclusion: Vulnerable carotid plaques with distal embolism were created in a Swine model of carotid atherosclerosis. Increased expression of MMP-9 may be associated with vulnerable carotid plaques, especially having the feature of intraplaque hemorrhage.

Abstract WP162: Impact of Carotid Artery Remodeling by T1 weighted MR Imaging for the Assessment of Plaque Vulnerability in High-grade Carotid Stenosis

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kenji Fukuda ◽  
Koji Iihara ◽  
Naoaki Yamada ◽  
Hatsue Ueda
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Average Rate ◽  
Intraplaque Hemorrhage ◽  
High Grade ◽  
Plaque Vulnerability ◽  
Rapid Acquisition ◽  
Asymptomatic Patients ◽  
Artery Remodeling ◽  
The Relationship

Background- The relationship between coronary artery remodeling and plaque vulnerability has been described on the basis of symptomatology and histology. However, the association with carotid artery remodeling has not been explored in detail. The aim of this study was to validate the relationship between carotid artery remodeling and plaque vulnerability by comparing the degree of outward remodeling calculated using 3D inversion-recovery-based T1-weighted imaging (magnetization-prepared rapid acquisition gradient-echo [MPRAGE]) with the symptomatology and histology of plaques extracted during carotid endarterectomy (CEA). Methods and Results- Sixty-one patients with high-grade carotid stenosis who underwent CEA and whose plaque could be examined were included. The average rate of stenosis as per the NASCET criteria was 79.8%. The carotid remodeling index (CRI) was determined by measuring the external cross-sectional vessel area (CSVA) of the maximum stenosis of the internal carotid artery (ICA) and dividing it by the external CSVA of the distal ICA unaffected by atherosclerosis using MPRAGE imaging. The relationship between the CRI and plaque vulnerability was evaluated on the basis of symptomatology and histology. The CRI was significantly higher in symptomatic patients than in asymptomatic patients (1.98 ± 0.26 vs. 1.68 ± 0.24, p < 0.0001). A higher CRI was positively correlated with the necrotic core area (r = 0.568, p < 0.0001) as well as significantly associated with severe intraplaque hemorrhage (p < 0.0001) and the prevalence of cap inflammation with macrophage (p = 0.03) and lymphocyte (p = 0.01) infiltration. Conclusion- These results validate the relationship between carotid artery remodeling and plaque vulnerability in high-grade carotid stenosis. MPRAGE imaging is effective to assess plaque vulnerability in terms of the CRI in addition to the signal intensity of carotid plaques.

scholarly journals Possible involvement of pericytes in intraplaque hemorrhage of carotid artery stenosis

2019 ◽  
Vol 130 (6) ◽  
pp. 1971-1977 ◽  
Author(s):  
Tatsuya Tanaka ◽  
Atsushi Ogata ◽  
Jun Masuoka ◽  
Taichiro Mizokami ◽  
Tomihiro Wakamiya ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Medical Records ◽  
Intraplaque Hemorrhage ◽  
Positive Staining ◽  
Glycophorin A ◽  
Endothelial Cell Marker ◽  
Carotid Stenoses ◽  
Novel Therapeutic Strategies ◽  
The Relationship ◽  
Study Inclusion

OBJECTIVEIntraplaque hemorrhage (IPH) is most often caused by the rupture of neovessels; however, the factors of intraplaque neovessel vulnerability remain unclear. In this study, the authors focused on pericytes and aimed to investigate the relationship between IPH and pericytes.METHODSThe authors retrospectively analyzed the medical records of all patients with carotid artery stenoses who had undergone carotid endarterectomy at their hospitals between August 2008 and March 2016. Patients with carotid plaques that could be evaluated histopathologically were eligible for study inclusion. Intraplaque hemorrhage was analyzed using glycophorin A staining, and patients were divided into the following 2 groups based on the extent of granular staining: high IPH (positive staining area > 10%) and low IPH (positive staining area ≤ 10%). In addition, intraplaque neovessels were immunohistochemically evaluated using antibodies to CD34 as an endothelial cell marker or antibodies to NG2 and CD146 as pericyte markers. The relationship between IPH and pathology for intraplaque neovessels was investigated.RESULTSSeventy of 126 consecutive carotid stenoses were excluded due to the lack of a specimen for histopathological evaluation; therefore, 53 patients with 56 carotid artery stenoses were eligible for study inclusion. Among the 56 stenoses, 37 lesions had high IPH and 19 had low IPH. The number of CD34-positive neovessels was equivalent between the two groups. However, the densities of NG2- and CD146-positive neovessels were significantly lower in the high IPH group than in the low IPH group (5.7 ± 0.5 vs. 17.1 ± 2.4, p < 0.0001; 6.6 ± 0.8 vs. 18.4 ± 2.5, p < 0.0001, respectively).CONCLUSIONSPlaques with high IPH are associated with fewer pericytes in the intraplaque neovessels. This finding may help in the development of novel therapeutic strategies targeting pericytes.

scholarly journals Hemoglobin A1c as A Potential Indicator for Intraplaque Hemorrhage of Carotid Artery Atherosclerosis in Asymptomatic Adults

2021 ◽  
Author(s):  
Yu Wang ◽  
Runhua Zhang ◽  
Yong Jiang ◽  
Miaoxin Yu ◽  
Huiyu Qiao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Plaque ◽  
Hemoglobin A1c ◽  
Univariate Analysis ◽  
Intraplaque Hemorrhage ◽  
Stepwise Logistic Regression ◽  
Community Based ◽  
Stepwise Logistic Regression Analysis ◽  
Cross Sectional ◽  
High Hba1c

Abstract BackgroundTo investigate the association between hemoglobin A1c (HbA1c) and intraplaque hemorrhage (IPH) in carotid atherosclerotic plaque detected by high-resolution magnetic resonance imaging (HR-MRI) in a community-based population. MethodsIn this cross-sectional, community-based study, a total of 598 participants were recruited from May 2015 to September 2019. All participants underwent carotid artery HR-MRI. Data on demographics, medical history, and physical examinations were obtained through face-to-face interview, and fasting blood sample were collected. HbA1c was determined using high-performance liquid chromatographic analysis. Presence or absence of carotid plaque IPH was determined by HR-MRI. Multiple stepwise logistic regression analysis was performed to investigate the association between HbA1c levels and carotid plaque IPH. ResultsOf the 598 participants, 317 (53.0%) had atherosclerotic plaques, and 25 (4.2%) had IPH in carotid arteries. HbA1c was associated with the presence of IPH (OR, 1.94; 95% CI, 1.38-2.73) in the univariate analysis, and the association remained significant after adjustment for age, sex, traditional vascular factors, high-sensitivity C-reactive protein, and other potential confounders (OR, 1.70; 95% CI, 1.14-2.52).ConclusionsThis study showed that high HbA1c was associated with carotid plaque IPH detected by HR-MRI, which suggests that individuals with high HbA1c may have a higher risk of developing vulnerable carotid plaques.

Abstract MP16: Prevalence of Dyslipidemia Patterns among US Hispanics: Results from the Hispanic Community Health Study / Study of Latinos

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Carlos J Rodriguez ◽  
Katrina Swett ◽  
Sylvia Wassertheil-Smoller ◽  
Martha Daviglus ◽  
Robert Kaplan ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Population Based ◽  
Health Study ◽  
Diabetes Diagnosis ◽  
Continuous Variables ◽  
Lower Prevalence ◽  
Chi Square ◽  
Logistic Regression Models ◽  
Low Hdl

Background: Prevalence and determinants of dyslipidemia among Hispanics/Latinos are not well known. Methods: Lipid and lipoprotein data from the HCHS/SOL -- a population-based cohort study of 16,415 US Hispanic/Latino participants, ages 18-74, from Cuban, Dominican, Mexican, Puerto Rican, and Central and South American backgrounds -- were used. Criteria for dyslipidemia are based on National Cholesterol Education Program Adult Treatment Panel III guidelines as low density lipoprotein-cholesterol (LDL-C) >130 mg/dl, triglycerides (TG) >200 mg/dl, non-high density lipoprotein (non-HDL-C) >160 mg/dl, or low HDL-C (<40 mg/dl for men and <50 mg/dl for women). Differences across Hispanic/Latino groups were tested using Mantel- Haenszel Chi-square and analysis of variance for categorical and continuous variables, respectively. Demographics, anthropometric measurements, lifestyle factors, dietary and metabolic profiles in those with abnormal vs. normal lipid components were compared using multivariable logistic regression models. Results: Mean age was 40.7 years (SE 0.23) and 48.3% are male. The overall prevalence of any dyslipidemia was 65.1%; prevalence of elevated LDL-C was 35.5%, and highest among Cubans (44.5%; p<0.001). Low HDL-C was present in 41.9% overall, Central Americans had the highest prevalence (44.1%) but not significantly different from other groups (p=0.09). High TGs were seen in 14.9% overall, most commonly among Cubans (17.5%; p<0.001). Elevated non-HDL-C was seen in 34.3% of the sample, and highest among Cubans (43.2%). Dominicans had the lowest prevalence of all four types of dyslipidemia. Multivariate analyses, across all Hispanics, show that prevalence of any dyslipidemia was significantly associated with increasing body mass index and diabetes diagnosis. Higher age was associated with a significantly lower prevalence of low HDL but a higher prevalence of all other dyslipidemia types. Female sex was associated with higher prevalence of low HDL-C but a lower prevalence of elevated TGs, non-HDL-C or LDL-C. Low physical activity was significantly associated with elevated TGs and low HDL-C. Alcohol use was associated with a lower prevalence of low HDL-C only. Conclusion: Dyslipidemia is very common among Hispanics/Latinos; Cubans seem particularly at risk. Low HDL-C and elevated LDL-C are most commonly seen. Across all Hispanics, determinants of dyslipidemia varied depending on the type of dyslipidemia. To prevent dyslipidemias, effective public health measures among the Hispanic/Latino population are needed.

scholarly journals Irritable Bowel Syndrome and Gastrointestinal Parasite Infection in a Developing Nation Environment

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Douglas R. Morgan ◽  
Matthew Benshoff ◽  
Mercedes Cáceres ◽  
Sylvia Becker-Dreps ◽  
Loreto Cortes ◽  
...  
Keyword(s):  
Developing World ◽  
Population Based ◽  
Parasite Infection ◽  
Gastrointestinal Infections ◽  
Logistic Regression Models ◽  
Industrialized Nations ◽  
Stool Samples ◽  
Irritable Bowel ◽  
The Relationship ◽  
Post Infectious

Postinfectious IBS is defined in the industrialized world as IBS onset following a sentinel gastrointestinal infection. In developing nations, where repeated bacterial and parasitic gastrointestinal infections are common, the IBS pathophysiology may be altered. Our aim was to investigate the relationship between intestinal parasite infection and IBS in the “nonsterile” developing world environment. IBS subjects were identified from a population-based sample of 1624 participants using the Rome II Modular Questionnaire. Stool samples from cases and randomly selected controls were examined for ova and parasites. Logistic regression models explored the relationship between IBS and parasite infection. The overall IBS prevalence among participants was 13.2% (9.3% males, 15.9% females). There was no difference in parasite carriage between IBS cases and controls, 16.6% versus 15.4% (P=0.78), nor among IBS subtypes. The pathophysiology of post-infectious IBS may be altered in the developing world as compared to industrialized nations and warrants investigation.

The relation of SYNTAX score with Carotid Plaque Morphology in Patients who Undergoing Coronary By-pass Surgery

2021 ◽  
Author(s):  
Suleyman Hilmi Aksoy ◽  
Oğuzhan Birdal ◽  
Işıl Yurdaışık
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Odds Ratio ◽  
Carotid Plaque ◽  
Bypass Graft ◽  
Plaque Morphology ◽  
Syntax Score ◽  
Left Internal Carotid Artery ◽  
Left Carotid Artery ◽  
The Relationship

Objectives: Although there are many studies assessing the relationship between carotid artery ultrasound findings and coronary artery disease, the relationship between carotid plaque types and the complexity of coronary lesions is not assessed. We aimed to examine the relationship between the SYNTAX score and carotid plaque morphology. Patients and Methods: We retrospectively screened patients who underwent carotid Ultrasound before the coronary artery bypass graft operation between 2015 and 2020. Syntax score was calculated by two independent interventional cardiologists with online SYNTAX score calculator (www.syntaxscore.com). The lesions of carotid arteries by ultrasound were classified as fibrous, calcific and mixed plaques. Results: A total of 407 patients were enrolled. Median age was 65 (58-71) years and 81.6% of patients were male. We used multinomial logistic regression to test the association between plaque types and syntax score. The syntax score was associated with calcified plaque both in right (odds ratio 1.04, 95% CI 1.01-1.07, p=0.006) and left internal carotid artery (odds ratio 1.04, 95% CI 1.02-1.06, p=0.004). However, the syntax score was not associated with fibrous (odds ratio 0.97, 95% CI 0.94-1.01, p=0.155 for right and odds ratio 0.99, 95% CI 0.96-1.02, p=0.759 for left carotid artery) and mixed plaque types (odds ratio 1.02, 95% CI 0.98-1.06, p=0.168 for right and odds ratio 1.00, 95% CI 0.96-1.04, p=0.791 for left carotid artery). Conclusion: Syntax score may provide an idea for carotid plaque morphology prediction. Especially higher SYNTAX score may be a predictor of calcific carotid plaque.

Abstract WP122: Asymptomatic Moderate Carotid Artery Stenosis With Intraplaque Hemorrhage ∼ Progression of Degree of Stenosis and New Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kiyofumi Yamada ◽  
Masanori Kawasaki ◽  
Shinichi Yoshimura ◽  
Shigehiro Nakahara ◽  
Yoshikazu Sato
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Plaque ◽  
Intraplaque Hemorrhage ◽  
Progression Rate ◽  
Negative Group ◽  
Positive Group ◽  
Carotid Plaques

Background: Carotid artery stenosis is one of the major causes of ischemic stroke. Carotid intraplaque hemorrhage (IPH) plays a critical role in the progression of carotid atherosclerotic disease. Previous studies showed that IPH was associated with high intensity signal (HIS) on maximum intensity projection (MIP) images from routine three dimensional magnetic resonance imaging (3D-TOF MRA). The aim of this study was to evaluate the relationships among HIS, new ipsilateral ischemic stroke and a progression rate in carotid plaques with moderate stenosis. Materials and Methods: We included 45 carotid plaques with moderate stenosis (50% to 69%) in 45 patients who could be followed more than 12 months. Carotid IPH was defined as the presence of HIS in carotid plaque on MIP image from routine 3DTOF MRA using the criteria previously we published. We analyzed the relation between the presence of HIS in the plaques and new ischemic strokes and annual progression rate of carotid stenosis. Results: HIS in carotid plaque was present in 21 (47%) carotid arteries. Over a follow-up period of 24 ± 9 months, six ischemic strokes occurred ipsilateral to the index carotid artery. New ipsilateral ischemic stroke occurred more frequently in HIS positive group (6 of 21, 29%) than HIS negative group (0 of 24, 0%) (p=0.017). Annual progression rate of carotid stenosis is significantly higher in HIS positive group (+3.35%/year) than HIS negative group (-0.02%/year) (p= 0.0026). In multivariate regression analysis, HIS positive was an independent predictor for annual progression rate of carotid stenosis (p=0.003). Conclusions: HIS in carotid plaques on 3DTOF-MRA MIP images are associated with new ischemic stroke and higher annual progression rate of stenosis. Evaluation of HIS in asymptomatic moderate carotid stenosis can potentially provide risk stratification of new ipsilateral ischemic strokes.

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