Clinical carotid atherosclerosis

Atherogenesis is an inflammatory process that begins in childhood. Early detection of atherosclerosis might allow for selection of subjects at risk for future cerebrovascular events at a time when dietary and lifestyle modification may have its greatest impact, and medical intervention may be useful for those who are refractory to such treatment or who are at greater risk for an event. Early detection relies on a knowledge of the distribution of atheroma formation, which can be predicted by understanding the hemodynamic patterns of blood flow. Early formation is accompanied by a vascular remodeling that normalizes the area of the vessel lumen, making early detection impossible by angiography. Elevated serologic markers of inflammation may be used as evidence of formation of atherosclerosis, but inflammatory markers lack sensitivity and specificity. Preliminary evidence supports the ability of MRI to detect early atheroma formation, possibly even before substantial wall thickening occurs. Once atheroma has formed with measurable stenosis, the goal of imaging studies is to predict stroke risk and determine the need for surgical intervention. Subjects with symptomatic high-grade carotid stenosis have been shown to benefit from surgery with a reduced stroke risk when compared with medical management alone, although controversy exists regarding the management of moderate symptomatic carotid stenosis or asymptomatic carotid disease. In these individuals, understanding atheroma morphology may prove to be of greater utility for assessing stroke risk and determining the appropriate management. Morphologic characterization may also be helpful in monitoring the effect of medical intervention. MRI has proven capable of characterizing the morphologic composition of carotid atheroma, although the clinical implications continue to be investigated.     

血管内支架术治疗颈动脉粥样硬化性高度狭窄症三例报告

目的利用颈动脉支架成形术治疗高度狭窄的颈动脉粥样硬化病人。方法选择３例缺血性脑血管病病人,其中２例表现为短暂性脑缺血发作,１例表现为脑梗死,相应颈动脉狭窄均大于７０％。选用Ｐａｌｍａｚ１５４和Ｗａｌｓｔｅｎｔ支架进行颈动脉成形术。结果植入支架后,病人临床症状消失或减轻,影像学显示血管形态恢复正常,没有发生严重的并发症。随访１年,支架形态正常,血管无再狭窄。结论在因颈动脉粥样硬化导致的颈动脉高度狭窄病人的治疗中,颈动脉支架成形术是一种安全有效的方法。     

Management of radiation-induced accelerated carotid atherosclerosis

Patients with long survival following cervical irradiation are at risk for accelerated carotid atherosclerosis. The neurologic presentation in these patients mimics naturally occurring atheromatous disease, but patients often present at younger ages and with less concurrent coronary or systemic vascular disease. Hypercholesterolemia also contributes to this accelerated arteriosclerosis. Angiographic findings in this disorder include disproportionate involvement of the distal common carotid artery and unusually long carotid lesions. Pathologic findings include destruction of the internal elastic lamina and replacement of the normal intima and media with fibrous tissue. This article describes two surgical patients with radiation-induced accelerated carotid atherosclerosis who typify the presentation and characteristics of this disease.     

辛伐他汀对颈动脉粥样硬化的影响

目的 探讨辛伐他汀对颈动脉内膜-中膜厚度及颈动脉粥样硬化斑块的影响.方法 用彩色多普勒超声技术,检测出具有不同程度的颈动脉粥样硬化患者48例,给予辛伐他汀20mg每晚口服,共3个月.观察患者治疗前后颈动脉内膜-中膜厚度、颈动脉粥样硬化斑块面积的变化以及血脂水平、丙氨酸转换酶、肌酸激酶的变化和药物不良反应. 结果 全部患者治疗前共有79个斑块,治疗后54个斑块,斑块消失率32%,其余未消失的斑块面积均有明显缩小(P＜0.01);颈动脉内膜-中膜厚度明显缩小(P＜0.01),TC、TG、LDL-C明显下降(P＜0.01),HDL-C升高(P＜0.05),ALT、CK无变化(P＞0.05),无明显不良反应. 结论 彩色多普勒超声能检测出早期颈动脉粥样硬化.辛伐他汀能稳定和消退粥样斑块,调脂疗效确切,从而减少心脑血管事件的发生.     

Ultrasonic evaluation of early carotid atherosclerosis

We investigated the prevalence of carotid atherosclerosis, including mild early lesions, and its association with cervical bruits and various risk factors (age, male sex, hypertension, hyperlipidemia, diabetes mellitus, obesity, and cigarette smoking) in 232 consecutive Japanese patients. High-resolution real-time B-mode ultrasonography was performed to determine the extent of atherosclerosis, and it was quantified by using a scoring system. The prevalence of carotid atherosclerosis was 49%, 59%, and 41% in all 232 patients, the 100 symptomatic patients, and the 132 asymptomatic patients, respectively. Although carotid lesions were detected frequently (87%) in the 30 patients with cervical bruits, bruits were noted in only 30% of the 88 examined patients with carotid atherosclerosis. Independent risk factors for carotid atherosclerosis in these patients were found to be age, male sex, and hyperlipidemia; diabetes mellitus was a possible risk factor for carotid atherosclerosis. Our study did not show a close association between hypertension and carotid atherosclerosis, and this might be caused by the high prevalence of hypertension in our patients. Our findings suggest an increasing prevalence of carotid atherosclerosis in the Japanese, though this should be confirmed in a population-based study. Our study demonstrates the clinical usefulness of high-resolution B-mode ultrasonography for the evaluation of early carotid atherosclerosis.     

Anti-inflammatory cytokines in subclinical carotid atherosclerosis

Some studies have shown correlations between selected proinflammatory factors and carotid atherosclerosis. It has not been established whether anti-inflammatory cytokines are associated with carotid intima-media thickness (IMT), an ultrasound surrogate marker of atherosclerosis. Therefore, the authors studied the relationship between the carotid IMT and serum levels of interleukin (IL)-10 and transforming growth factor-beta1 in 76 subjects. They discovered that lower IL-10 levels were associated with increased mean IMT in common carotid arteries.     

Subclinical carotid atherosclerosis and cognitive function

Carotid artery atherosclerosis is a major risk factor for stroke and subsequent cognitive impairment. Recent studies indicate that carotid atherosclerosis without clinical stroke may also be an independent risk factor for cognitive decline and dementia. Ultrasonography is an easily assessable and non-invasive method to measure different stages of the carotid artery atherosclerotic process and is widely used in clinical assessment as well as in epidemiological and clinical research. We give a brief review of studies that have investigated degrees of the subclinical atherosclerosis in the carotid arteries in relation to cognitive function and dementia, and we discuss several possible mechanisms that could explain the association between atherosclerosis and cognitive impairment.     

普伐他汀对颈动脉粥样硬化患者血浆同型半胱氨酸水平及颈动脉粥样硬化程度的影响

目的:探讨普伐他汀对颈动脉粥样硬化(CAS)患者血浆同型半胱氨酸(Hey)水平及颈动脉粥样硬化程度的影响.方法:给100例CAS患者(≥ 60岁50例,老年CAS组;<60岁50例,中年CAS组)普伐他汀20mg/d,连续服用2个月;检测治疗前后血浆Hey水平并与50例健康体检者(正常对照组)比较;采用颈动脉超声多普勒仪检查治疗前后CAS程度.结果:两CAS组患者血浆Hey水平均明显高于正常对照组(均P<0.01).两CAS组患者治疗后血浆Hey水平及CAS程度均较治疗前明显降低(均P<0.01).结论:普伐他汀能明显降低CAS患者血浆Hey水平,并能减轻其CAS程度.     

Correlation of carotid bruits and carotid atherosclerosis detected by B-mode real-time ultrasonography

The extent of carotid atherosclerosis evaluated by B-mode real-time ultrasound and the presence of bruits established by carotid phonoangiography were determined in 1,107 patients. Unilateral bruit was associated with increased atherosclerosis compared with no bruit (p less than or equal to 0.0001). However, there was no association between laterality of the bruit and the degree of atherosclerosis (p = 0.66). There was marginal evidence that patients with bilateral bruits had more severe atherosclerosis than patients with unilateral bruit (p = 0.046). The relation between bruit and atherosclerosis categorized by B-mode ultrasound was not sufficient to reliably predict the presence or absence of disease in an individual patient, though the presence of a bruit should be viewed as a risk factor for, or an indicator of, increased risk of systemic atherosclerosis.     

Chlamydia pneumoniae and atherosclerosis following carotid endarterectomy

BACKGROUND: Seroepidemiological studies have shown an association between raised antibody titres against Chlamydia pneumoniae, and carotid atherosclerosis or stroke. However, direct evidence for a causal link between arterial infection with C. pneumoniae and carotid disease remains weak. We hypothesized that long-term follow-up of patients with pathologically-proven arterial C. pneumoniae infection might provide further insight into the role of C. pneumoniae in carotid atherosclerosis. METHODS: We followed a cohort of 70 carotid endarterectomy patients for ipsilateral restenosis, contralateral progression, and all-cause mortality (four year median follow-up period). All patients had presence or absence of C. pneumoniae in their carotid plaques documented by immunohistochemistry after endarterectomy. A survival function was generated and the log-rank test was used to assess the difference in survival between subjects with and without documented chlamydial infection in their plaque. RESULTS: Baseline demographic and cardiovascular risk factors were similar between the two groups, and survival analysis demonstrated no difference (p>0.05) in all-cause mortality, or all-cause mortality combined with restenosis and progression. CONCLUSIONS: Our data finds no causal role for C. pneumoniae in restenosis or progression of carotid disease or mortality in this patient population with advanced carotid atherosclerosis.     

Risk factors for extracranial carotid artery atherosclerosis

We related risk factors, cardiovascular symptoms, and coronary status to the extent of extracranial carotid atherosclerosis as measured by B-mode ultrasonography in 376 volunteers hospitalized for elective coronary angiography. In a first analysis, we correlated risk factors and cardiovascular symptoms with carotid atherosclerosis. Univariate analysis showed that relations between many continuous risk factors and carotid atherosclerosis were graded and consistent for men and women. Multivariate analysis identified 6 significant variables (age, hypertension, pack-years smoked, and inversely, plasma concentrations of high density lipoprotein cholesterol and uric acid, and Framingham Type A score) that together accounted for 35% of the variability in extent of carotid atherosclerosis. In a second multivariate analysis, addition of coronary status (presence or absence of coronary stenosis as evaluated by coronary angiography) to the roster of candidate independent variables produced a new equation that accounted for an additional 5% of the variability in carotid atherosclerosis extent. Although much of the variability in extent of carotid atherosclerosis remains unexplained, these data define an association between coronary and carotid atherosclerosis that depends partly on shared exposure of both arteries to the same risk factors. They are also consistent with the concept that as yet undiscovered risk factors and/or genetic (e.g., arterial wall) factors common to both arterial beds also contribute to the relation between coronary and carotid atherosclerosis in human beings.     

脑梗死患者颈动脉粥样硬化斑块的相关危险因素分析

目的探讨脑梗死患者的颈动脉粥样硬化发生情况及其主要危险因素。方法对170例脑梗死患者应用彩超进行颈动脉检查,观察动脉粥样硬化的发生情况和记录相关危险因素的资料,同时实验室检测血脂、血糖、纤维蛋白原水平。结果脑梗死患者有颈动脉粥样硬化斑块者131例(77.1%),颈动脉狭窄11例(6.5%)。经Logistic回归分析发现,年龄(OR 1.352,95%CI:1.087~1.569)、吸烟(OR 1.854,95%CI:1.362~2.258)及糖尿病(OR 2.774,95%CI:1.612~5.956)可能是导致斑块发生的独立危险因素。颈动脉有斑块组其总胆固醇、低密度脂蛋白、血糖及纤维蛋白原水平较无斑块组显著增高(P<0.01)。结论年龄、吸烟和糖尿病是发生脑梗死颈动脉粥样硬化斑块的独立危险因素,应对存在多种危险因素的患者进行积极干预。     

阿托伐他汀钙治疗颈动脉粥样硬化疗效观察

目的观察阿托伐他汀钙在颈动脉粥样硬化中的治疗效果。方法92例合并颈动脉粥样硬化以及血脂异常的缺血性脑血管病患者随机分为常规治疗组46例,阿托伐他汀钙治疗组46例(常规治疗基础上加阿托伐他汀钙治疗)分别给予相应的药物治疗12个月;比较2组治疗前后血清C-反应蛋白(CRP)、血脂水平以及颈动脉内-中膜厚度(IMT)、颈动脉斑块面积的变化以及脑血管事件的复发率。结果2组治疗前后血清CRP水平较治疗前显著降低(均P0.05);阿托伐他汀钙组治疗后颈动脉IMT、斑块面积以及血脂水平显著降低(均P0.05);常规治疗组治疗前后颈动脉IMT、斑块面积以及血脂水平差异无统计学意义;2组患者脑血管病复发率差异无统计学意义。结论阿托伐他汀钙干预对于降低CRP水平,延缓和逆转劲动脉粥样硬化优于常规治疗组,并可能预防脑血管病复发。     

Noninvasive study of arterial hypertension and carotid atherosclerosis

We noninvasively evaluated the prevalence and severity of atherosclerotic lesions of the internal carotid artery in 146 nonobese, nondiabetic hypertensive patients who were free of cardiovascular symptoms. We found internal carotid artery disease in 63 patients (43%), 26 (18%) with unilateral disease and the other 37 (25%) with bilateral disease. Disease severity was correlated with age but not duration of hypertension, cholesterol level, or current smoking habit. We also followed disease progression and clinical outcome with respect to cardiovascular events for 3 years in a subgroup of 95 unselected patients. In 20 of the 93 survivors (21.5%) we noted progression of the atherosclerotic lesions that was predicted by neither risk factors nor initial status of the internal carotid artery. New neurologic symptoms developed in four survivors (4%) and symptoms of cardiac ischemia in six (6%). No survivor who developed new cerebrovascular symptoms showed progression of carotid disease. These data provide useful elements for a rational approach to prevention of the atherosclerotic complications of hypertension.     

颈动脉粥样硬化对轻度认知功能损害的影响

目的 探讨颈动脉粥样硬化对轻度认知功能损害(mild cognitive impairment,MCI)的影响.方法 2006年11月至2007年9月单纯随机抽选1886名广州市50岁或以上,自报未患有脑卒中、心肌梗死、肺心病及恶性肿瘤等重大慢性疾病的相对健康的中老年人进行MCI测试和颈动脉彩色超声多普勒检查,以简易精神状态检查(Mini Mental State Examination,MMSE)及10个单词延迟记忆测试(10-word list learning task,CWL)得分和颈总动脉内膜-中膜厚度(IMT)作为评价指标.结果 (1)本研究共检出MCI 300例,患病率为15.9%.男女之间患病率差异无统计学意义.(2)CWL得分随年龄、吸烟率、收缩压、腹围和低密度脂蛋白的升高而降低,随教育程度、体力活动和高密度脂蛋白上升而增加;而MMSE则与吸烟、体力活动、腹围和脂蛋白水平无明显相关.(3)在校正了多种潜在混杂因素后,IMT的增加均与CWL(β=-l.05,95%CI:-1.73～-0.36)和MMSE分数(β=-0.95,95%CI:-1.67～-0.23)的下降呈线性相关(P＜0.01).(4)在校正了年龄、性别、教育、运动、吸烟、腹围、收缩压和高密度及低密度脂蛋白后,MCI患者相对非MCI者的平均IMT显著增加(0.76 mm与0.74 mm,F=6.9,P＜0.01).结论 颈动脉IMT增加与MCI的严重程度呈线性相关,与MCI的发生、发展关系密切.