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JACC. Cardiovascular Imaging Oct 2022Patients with symptomatic carotid stenosis are at high risk for recurrent stroke. The decision for carotid endarterectomy currently mainly relies on degree of stenosis...
BACKGROUND
Patients with symptomatic carotid stenosis are at high risk for recurrent stroke. The decision for carotid endarterectomy currently mainly relies on degree of stenosis (cutoff value >50% or 70%). Nevertheless, also, patients with mild-to-moderate stenosis still have a considerable recurrent stroke risk. Increasing evidence suggests that carotid plaque composition rather than degree of stenosis determines plaque vulnerability; however, it remains unclear whether this also provides additional information to improve clinical decision making.
OBJECTIVES
The PARISK (Plaque At RISK) study aimed to improve the identification of patients at increased risk of recurrent ischemic stroke using multimodality carotid imaging.
METHODS
The authors included 244 patients (71% men; mean age, 68 years) with a recent symptomatic mild-to-moderate carotid stenosis in a prospective multicenter cohort study. Magnetic resonance imaging (carotid and brain) and computed tomography angiography (carotid) were performed at baseline and after 2 years. The clinical endpoint was a recurrent ipsilateral ischemic stroke or transient ischemic attack (TIA). Cox proportional hazards models were used to assess whether intraplaque hemorrhage (IPH), ulceration, proportion of calcifications, and total plaque volume in ipsilateral carotid plaques were associated with the endpoint. Next, the authors investigated the predictive performance of these imaging biomarkers by adding these markers (separately and simultaneously) to the ECST (European Carotid Surgery Trial) risk score.
RESULTS
During 5.1 years follow-up, 37 patients reached the clinical endpoint. IPH presence and total plaque volume were associated with recurrent ipsilateral ischemic stroke or TIA (HR: 2.12 [95% CI: 1.02-4.44] for IPH; HR: 1.07 [95% CI: 1.00-1.15] for total plaque volume per 100 µL increase). Ulcerations and proportion of calcifications were not statistically significant determinants. Addition of IPH and total plaque volume to the ECST risk score improved the model performance (C-statistics increased from 0.67 to 0.75-0.78).
CONCLUSIONS
IPH and total plaque volume are independent risk factors for recurrent ipsilateral ischemic stroke or TIA in patients with mild-to-moderate carotid stenosis. These plaque characteristics improve current decision making. Validation studies to implement plaque characteristics in clinical scoring tools are needed. (PARISK: Validation of Imaging Techniques [PARISK]; NCT01208025).
Topics: Aged; Calcinosis; Carotid Arteries; Carotid Stenosis; Cohort Studies; Constriction, Pathologic; Female; Hemorrhage; Humans; Ischemic Attack, Transient; Ischemic Stroke; Magnetic Resonance Imaging; Male; Plaque, Atherosclerotic; Predictive Value of Tests; Prospective Studies; Risk Factors; Stroke
PubMed: 36202450
DOI: 10.1016/j.jcmg.2022.04.003 -
American Journal of Physiology. Cell... May 2022Elastin is a long-lived extracellular matrix protein that is organized into elastic fibers that provide elasticity to the arterial wall, allowing stretch and recoil with... (Review)
Review
Elastin is a long-lived extracellular matrix protein that is organized into elastic fibers that provide elasticity to the arterial wall, allowing stretch and recoil with each cardiac cycle. By forming lamellar units with smooth muscle cells, elastic fibers transduce tissue-level mechanics to cell-level changes through mechanobiological signaling. Altered amounts or assembly of elastic fibers leads to changes in arterial structure and mechanical behavior that compromise cardiovascular function. In particular, genetic mutations in the elastin gene () that reduce elastin protein levels are associated with focal arterial stenosis, or narrowing of the arterial lumen, such as that seen in supravalvular aortic stenosis and Williams-Beuren syndrome. Global reduction of levels in mice allows investigation of the tissue- and cell-level arterial mechanical changes and associated alterations in smooth muscle cell phenotype that may contribute to stenosis formation. A loxP-floxed allele in mice highlights cell type- and developmental origin-specific mechanobiological effects of reduced elastin amounts. production is required in distinct cell types for elastic layer formation in different parts of the mouse vasculature. deletion in smooth muscle cells from different developmental origins in the ascending aorta leads to characteristic patterns of vascular stenosis and neointima. Dissecting the mechanobiological signaling associated with local depletion and subsequent smooth muscle cell response may help develop new therapeutic interventions for elastin-related diseases.
Topics: Animals; Aorta; Arteries; Constriction, Pathologic; Elastin; Mice; Myocytes, Smooth Muscle
PubMed: 35196168
DOI: 10.1152/ajpcell.00448.2021 -
Biomedical Journal Jun 2017A form of systemic vasculitis that affects mostly small and medium-sized vessels, Kawasaki disease (KD) is most commonly found in children under the age of 5 years old.... (Review)
Review
A form of systemic vasculitis that affects mostly small and medium-sized vessels, Kawasaki disease (KD) is most commonly found in children under the age of 5 years old. Though its etiology is unknown, KD has been the most frequent acquired heart disease in developing countries. Its incidence has increased over recent decades in many centuries, including Japan, Korea, and China. The most severe complications of KD are coronary artery lesions (CAL), including dilation, fistula, aneurysm, arterial remodeling, stenosis, and occlusion. Aneurysm formation has been observed in 20-25% of KD patients that do not receive intravenous immunoglobulin (IVIG) treatment, and in 3-5% that do receive it. Coronary artery dilation has been found in about 30% of KD patients in the acute stage, although mostly in the transient form. Diminishing the occurrence and regression of CAL is a vital part of treating KD. In this review article, I demonstrate the clinical method to prevent CAL formation used at the Kawasaki Disease Center in Taiwan.
Topics: Constriction, Pathologic; Coronary Artery Disease; Coronary Vessels; Humans; Immunoglobulins, Intravenous; Mucocutaneous Lymph Node Syndrome
PubMed: 28651735
DOI: 10.1016/j.bj.2017.04.002 -
The European Respiratory Journal Dec 2023Peripheral pulmonary artery stenosis (PPS) refers to stenosis of the pulmonary artery from the trunk to the peripheral arteries. Although paediatric PPS is well...
BACKGROUND
Peripheral pulmonary artery stenosis (PPS) refers to stenosis of the pulmonary artery from the trunk to the peripheral arteries. Although paediatric PPS is well described, the clinical characteristics of adult-onset idiopathic PPS have not been established. Our objectives in this study were to characterise the disease profile of adult-onset PPS.
METHODS
We collected data in Japanese centres. This cohort included patients who underwent pulmonary angiography (PAG) and excluded patients with chronic thromboembolic pulmonary hypertension or Takayasu arteritis. Patient backgrounds, right heart catheterisation (RHC) findings, imaging findings and treatment profiles were collected.
RESULTS
44 patients (median (interquartile range) age 39 (29-57) years; 29 females (65.9%)) with PPS were enrolled from 20 centres. In PAG, stenosis of segmental and peripheral pulmonary arteries was observed in 41 (93.2%) and 36 patients (81.8%), respectively. 35 patients (79.5%) received medications approved for pulmonary arterial hypertension (PAH) and 22 patients (50.0%) received combination therapy. 25 patients (56.8%) underwent transcatheter pulmonary angioplasty. RHC data showed improvements in both mean pulmonary arterial pressure (44 40 mmHg; p<0.001) and pulmonary vascular resistance (760 514 dyn·s·cm; p<0.001) from baseline to final follow-up. The 3-, 5- and 10-year survival rates of patients with PPS were 97.5% (95% CI 83.5-99.6%), 89.0% (95% CI 68.9-96.4%) and 67.0% (95% CI 41.4-83.3%), respectively.
CONCLUSIONS
In this study, patients with adult-onset idiopathic PPS presented with segmental and peripheral pulmonary artery stenosis. Although patients had severe pulmonary hypertension at baseline, they showed a favourable treatment response to PAH drugs combined with transcatheter pulmonary angioplasty.
Topics: Adult; Female; Humans; Child; Stenosis, Pulmonary Artery; Hypertension, Pulmonary; Constriction, Pathologic; Pulmonary Artery; Familial Primary Pulmonary Hypertension; Pulmonary Arterial Hypertension
PubMed: 38061784
DOI: 10.1183/13993003.00763-2023 -
The Cochrane Database of Systematic... Feb 2022The subclavian arteries are two major arteries of the upper chest, below the collar bone, which come from the arch of the aorta. Endovascular treatment for stenosis of... (Review)
Review
BACKGROUND
The subclavian arteries are two major arteries of the upper chest, below the collar bone, which come from the arch of the aorta. Endovascular treatment for stenosis of the subclavian arteries includes angioplasty alone, and with stenting. There is insufficient evidence to guide the use of stents following angioplasty for subclavian artery stenosis. This is the second update of a review first published in 2011.
OBJECTIVES
The aim of this review was to determine whether stenting was more effective than angioplasty alone for stenosis of the subclavian artery.
SEARCH METHODS
For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and LILACS databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 2 February 2021.
SELECTION CRITERIA
We searched for randomised controlled trials of endovascular treatment of subclavian artery lesions that compared angioplasty alone and stent implantation.
DATA COLLECTION AND ANALYSIS
Two review authors independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, we asked a third review author to assess the study for inclusion. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions, and assess the certainty of the evidence using a GRADE approach.
MAIN RESULTS
To date, we have not identified any completed or ongoing randomised controlled trials that compare percutaneous transluminal angioplasty and stenting for subclavian artery stenosis.
AUTHORS' CONCLUSIONS
There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.
Topics: Angioplasty; Constriction, Pathologic; Humans; Stents; Subclavian Steal Syndrome; Systematic Reviews as Topic
PubMed: 35187653
DOI: 10.1002/14651858.CD008461.pub4 -
BMJ Case Reports Aug 2016
Topics: Aorta, Thoracic; Aortic Diseases; Aortography; Constriction, Pathologic; Female; Humans; Middle Aged; Syndrome
PubMed: 27530885
DOI: 10.1136/bcr-2016-217139 -
Indian Heart Journal 2015
Topics: Angioplasty, Balloon; Constriction, Pathologic; Humans; Iliac Artery; Peripheral Vascular Diseases; Stents; Treatment Outcome
PubMed: 26702677
DOI: 10.1016/j.ihj.2015.09.034 -
European Review For Medical and... Nov 2014Data regarding the cerebral atherosclerotic stenosis (CAS) and incidence of stroke are conflicting. The number of stroke patients is more than three times that from... (Review)
Review
OBJECTIVE
Data regarding the cerebral atherosclerotic stenosis (CAS) and incidence of stroke are conflicting. The number of stroke patients is more than three times that from coronary heart disease in China. The main aim of this report is to review the current status of intracranial and extracranial atherosclerotic stenosis including epidemiology, diagnosis, treatment and risk factors in China.
METHODS
Data was identified by searches of MEDLINE (January 1966 to December 2008), China Biological Medicine Database (CBM-disc 1979 to 2008), China National Knowledge Infrastructure (CNKI 1994 to December 2008).
RESULTS
The occurrence of intracranial artery stenosis was more frequent than that of extracranial artery in the Chinese population. TCD, Doppler ultrasound, CTA, MRA and DSA techniques are established to examine intracranial and extracranial atherosclerotic stenosis in China. Evidence-based treatments and CAS are more commonly applied in patients with cerebrovascular stenosis in China. However, the development of carotid endoarterectomy (CEA) is limited in Chinese communities. The risks of cerebral atherosclerotic stenosis include age, hypertension, diabetes mellitus, dyslipidemia, smoking and metabolic syndrome.
CONCLUSIONS
Further studies are needed to focus on the intracranial atherosclerotic stenosis.
Topics: China; Constriction, Pathologic; Endarterectomy, Carotid; Humans; Hypertension; Intracranial Arteriosclerosis; Risk Factors; Stroke; Treatment Outcome; Vascular Surgical Procedures
PubMed: 25491610
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Mar 2021
Topics: Celiac Artery; Constriction, Pathologic; Humans; Incidental Findings; Median Arcuate Ligament Syndrome
PubMed: 33648963
DOI: 10.3949/ccjm.88a.21001 -
Ugeskrift For Laeger Apr 2015Iliac endofibrosis or iliac kinking and popliteal artery entrapment syndrome are uncommon causes of arterial insufficiency and intermittent claudication in young... (Review)
Review
Iliac endofibrosis or iliac kinking and popliteal artery entrapment syndrome are uncommon causes of arterial insufficiency and intermittent claudication in young physically active adults. Diagnostics can be difficult, as the symptoms often are confused with sport injuries and musculoskeletal disorders. Investigation of these patients relies on accurate clinical history and examination as well as both static and dynamic imaging. Early diagnosis and vascular intervention is essential for continued exercise and to prevent thromboembolic complications and, in worst case, limb loss.
Topics: Angiography, Digital Subtraction; Arterial Occlusive Diseases; Athletes; Bicycling; Constriction, Pathologic; Humans; Iliac Artery; Intermittent Claudication; Lower Extremity; Popliteal Artery; Posture; Regional Blood Flow; Syndrome
PubMed: 25922163
DOI: No ID Found