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Zhao YC, Zhang J, Wang F, He YM, Xu MJ, Wang DH, Zhang M. Value of carotid intima thickness in assessing advanced carotid plaque vulnerability: a study based on carotid artery ultrasonography and carotid plaque histology. Quant Imaging Med Surg 2024; 14:1994-2007. [PMID: 38415155 PMCID: PMC10895139 DOI: 10.21037/qims-23-1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/20/2023] [Indexed: 02/29/2024]
Abstract
Background Research has shown that carotid intima-media thickness (CIMT) could help to predict carotid plaque (CP) progression in patients with mild carotid stenosis. However, the debate continues as to the value of carotid intima thickness (CIT) in monitoring the development of CP in patients with severe carotid stenosis. This study sought to evaluate the relationships between CIT and the ultrasonic characteristics of CP and to analyze the value of CIT and the ultrasonic parameters of CP in assessing plaque vulnerability in advanced human carotid atherosclerosis. Methods A total of 55 individuals who underwent carotid endarterectomy (CEA) were included in the study (mean age: 65±7 years; female: 9.1%). CIMT and CIT were examined at the common carotid artery (CCA). Plaque textural features, such as the gray-scale median (GSM), superb microvascular imaging (SMI) level, and total plaque area (TPA), were also identified. A Spearman correlation coefficient analysis was performed to examine the relationship between CIT and the ultrasonic parameters of CP. The CIT of various plaque types was compared. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic values of the ultrasound characteristics to evaluate CP vulnerability. Results The mean CIT of all the participants was 0.382±0.095 mm, the mean CIT of the participants with stable plaques was 0.328±0.031 mm, and the mean CIT of participants with vulnerable plaques was 0.424±0.106 mm (P<0.001). CIT was associated with the SMI level (Spearman's correlation coefficient: r=0.392, P=0.005), TPA (Spearman's correlation coefficient: r=0.337, P=0.012). Patients with thicker CIT had larger lipid cores, higher levels of plaque vulnerability, and more intraplaque hemorrhages (IPHs). The areas under the ROCs (AUCs) with 95% confidence interval (CI) for CIMT, CIT, the SMI level, the GSM, the TPA, and the combined model for identifying vulnerable plaques were 0.673 (0.533-0.793), 0.849 (0.727-0.932), 0.771 (0.629-0.879), 0.669 (0.529-0.790), 0.858 (0.738-0.938), and 0.949 (0.854-0.990), respectively. Conclusions CIT was associated with both the histology and ultrasonic features of CP. CIT may be helpful in the detection of severe CP development.
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Affiliation(s)
- Ya-Chao Zhao
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Jia Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fei Wang
- Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China
| | - Yi-Ming He
- Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China
| | - Ming-Jun Xu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Dong-Hai Wang
- Neurosurgery Department, Qilu Hospital of Shandong University, Jinan, China
| | - Mei Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
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Li DQ, Lv FF, Li ZC, Dai ZY, Wang HX, Han Y. Anti-atherosclerotic effects between a combined treatment with simvastatin plus hirudin and single simvastatin therapy in patients with early type 2 diabetes mellitus. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:302. [PMID: 31475172 DOI: 10.21037/atm.2019.05.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background This study aimed to investigate the efficacy and safety of simvastatin plus hirudin in preventing atherosclerosis in the patients with early type 2 diabetes mellitus (T2DM). Methods This was a 24-week, randomized, open-label and controlled study in which 150 outpatients initially diagnosed with T2DM were randomly assigned into either simvastatin (40 mg daily at night) plus hirudin (3 g thrice daily) group [combined group (CG) n=75] or simvastatin (40 mg once daily) group [monotherapy group (MG) n=75]. The therapeutic efficacy was evaluated by the score of carotid artery atherosclerosis, plaque size, peak systolic velocity (PSV) and end-diastolic velocity (EDV) on carotid ultrasonography at three and six months after treatment. Logistic regression analysis was used to investigate the correlation between treatment and carotid atherosclerosis. Results One hundred and thirty-one patients completed this study, and there were no significant differences in the dropout rate in the CG (14.67%) and the MG (10.67%). Significant difference was found in the incidence of adverse events in the CG compared with the MG (37.50% vs. 17.91%, P<0.05) due to the higher risk of hemorrhage (12.50% vs. 1.49%, P<0.05), which did not affect the treatment compliance. The efficacy of combined treatment was better than monotherapy in the enhancement of carotid artery atherosclerosis scores (P<0.01), the plaque thickness (P<0.05) and the change of PSV (P<0.05) and EDV (P<0.05) since three months after treatment, which maintained to the end of observation. In addition, hirudin treatment was able to independently predict the carotid artery atherosclerosis scores (β=2.37, P<0.05), the plaque thickening (β=3.51, P<0.01) and the change of PSV (β=1.69, P<0.05) and EDV (β=1.79, P<0.05). Conclusions Combined use of simvastatin and hirudin is well tolerated and possesses better anti-atherosclerotic effects than simvastatin alone in patients with early T2DM.
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Affiliation(s)
- De-Qiang Li
- Department of Integrated Internal Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China
| | - Fei-Fei Lv
- Department of Integrated Internal Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China
| | - Zhong-Chun Li
- Department of Neurology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Zhi-Yuan Dai
- Department of Preventive Medicine, Xiaoying Street Community Health Center, Hangzhou 310002, China
| | - Hong-Xia Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China
| | - Yang Han
- Department of Integrated Internal Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China
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Steinbuch J, Schreuder FHBM, Reesink KD, Hoeks APG, Mess WH. Orthogonal B-Mode Evaluation of Common Carotid Artery Plaques Reveals the Absence of Outward Remodeling. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:986-994. [PMID: 29477746 DOI: 10.1016/j.ultrasmedbio.2017.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 06/08/2023]
Abstract
To properly assess morphologic and dynamic parameters of arteries and plaques, we propose the concept of orthogonal distance measurements, that is, measurements made perpendicular to the local lumen axis rather than along the ultrasound beam (vertical direction for a linear array). The aim of this study was to compare orthogonal and vertical artery and lumen diameters at the site of a plaque in the common carotid artery (CCA). Moreover, we investigated the interrelationship of orthogonal diameters and plaque size and the association of artery parameters with plaque echogenicity. In 29 patients, we acquired a longitudinal B-mode ultrasound recording of plaques at the posterior CCA wall. After semi-automatic segmentation of end-diastolic frames, diameters were extracted orthogonally along the lumen axis. To establish inter-observer variability of diameters obtained at the location of maximal plaque thickness, a second observer repeated the analysis (subset N = 21). Orthogonal adventitia-adventitia and lumen diameters could be determined with good precision (coefficient of variation: 1%-5%. However, the precision of the change in lumen diameter from diastole to systole (distension) at the site of the plaque was poor (21%-50%). The orthogonal lumen diameter was significantly smaller than the vertical lumen diameter (p <0.001). Surprisingly, the plaques did not cause outward remodeling, that is, a local increase in adventitia-adventitia distance at the site of the plaque. The intra- and inter-observer precision of diastolic-systolic plaque compression was poor and of the same order as the standard deviation of plaque compression. The orthogonal relative lumen distension was significantly lower for echogenic plaques, indicating a higher stiffness, than for echolucent plaques (p <0.01). In conclusion, we illustrated the feasibility of extracting orthogonal CCA and plaque dimensions, albeit that the proposed approach is inadequate to quantify plaque compression.
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Affiliation(s)
- J Steinbuch
- Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - F H B M Schreuder
- Radiology, Maastricht University Medical Center, Maastricht, The Netherlands; Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands; Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - K D Reesink
- Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - A P G Hoeks
- Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - W H Mess
- Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Della-Morte D, Gardener H, Dong C, Markert M, Cabral D, Elkind MSV, Sacco RL, Rundek T. Association Between Carotid Artery Function and Structure in the Northern Manhattan Study. Front Neurol 2018; 9:246. [PMID: 29713306 PMCID: PMC5911635 DOI: 10.3389/fneur.2018.00246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Carotid plaque (CP), carotid intima media thickness (cIMT), and stiffness (STIFF) are pre-clinical markers of atherosclerosis and predictors of cerebrovascular disease (CVD). We sought to investigate whether STIFF is a significant determinant of cIMT and CP, which may provide an insight into the mechanism by which STIFF adds to the risk of CVD. Methods We analyzed 876 stroke-free subjects from the Northern Manhattan Study with available ultrasound measures. To obtain the associations with STIFF, we performed multivariable-adjusted regression, negative binomial regression (for CP number), and multinomial logistic regression (for plaque area). Results The mean age was 64 ± 9 years; 63% women and 65% Caribbean Hispanics. The mean cIMT was 0.93 ± 0.9 mm, the mean diastolic diameter 6.24 ± 0.94 mm, and STIFF 8.6 ± 6.2 ln mmHg. Prevalence of CP was 57%, and the mean total plaque area was 22.6 ± 23.0 mm2. STIFF was positively associated with cIMT but not with CP. There was an association between diastolic diameter and thick plaque. For each millimeter increase in diastolic diameter, there was about a 20% increased risk of having thick plaque (vs. no plaque). In longitudinal analyses, each millimeter increase in diastolic diameter was associated with a 37% increased risk of incident plaque. Conclusion Increased STIFF was associated with increased cIMT and carotid artery dilatation with greater plaque burden. Increased cIMT and plaque burden represent vascular remodeling likely resulting from the two different age-related mechanisms, one that includes diffuse wall thickening (cIMT) with STIFF and another that incorporates focal atherosclerosis (plaque) with luminal dilatation.
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Affiliation(s)
- David Della-Morte
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy
| | - Hannah Gardener
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Chuanhui Dong
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Matthew Markert
- Department of Neurology, Kansas University Medical Center, Kansas City, MO, United States
| | - Digna Cabral
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Mitchell S V Elkind
- Division of Stroke, Department of Neurology, Columbia University, New York, NY, United States
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
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