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Ultrasound in Medicine & Biology Sep 2020Ischemic stroke is a leading cause of death and disability worldwide, so adequate prevention strategies are crucial. However, current stroke risk stratification is based...
Ischemic stroke is a leading cause of death and disability worldwide, so adequate prevention strategies are crucial. However, current stroke risk stratification is based on epidemiologic studies and is still suboptimal for individual patients. The aim of this systematic review was to provide a literature overview on the feasibility and diagnostic value of vascular shear wave elastography (SWE) using ultrasound (US) in (mimicked) human and non-human arteries affected by different stages of atherosclerotic diseases or diseases related to atherosclerosis. An online search was conducted on Pubmed, Embase, Web of Science and IEEE databases to identify studies using US SWE for the assessment of vascular elasticity. A quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) checklist, and relevant data were extracted. A total of 19 studies were included: 10 with human patients and 9 with non-human subjects (i.e., [excised] animal arteries and polyvinyl alcohol phantoms). All studies revealed the feasibility of using US SWE to assess individually stiffness of the arterial wall and plaques. Quantitative elasticity values were highly variable between studies. However, within studies, SWE could detect statistically significant elasticity differences in patient/subject characteristics and could distinguish different plaque types with good reproducibility. US SWE, with its unique ability to assess the elasticity of the vessel wall and plaque throughout the cardiac cycle, might be a good candidate to improve stroke risk stratification. However, more clinical studies have to be performed to assess this technique's exact clinical value.
Topics: Atherosclerosis; Elasticity Imaging Techniques; Humans; Plaque, Atherosclerotic
PubMed: 32620385
DOI: 10.1016/j.ultrasmedbio.2020.05.013 -
The Cochrane Database of Systematic... May 2020An increasing body of evidence suggests that inflammation plays a key role in stroke, in particular stroke of atherosclerotic origin. Anti-inflammatory medications are a...
BACKGROUND
An increasing body of evidence suggests that inflammation plays a key role in stroke, in particular stroke of atherosclerotic origin. Anti-inflammatory medications are a widely heterogeneous group of drugs that are used to suppress the innate inflammatory pathway and thus prevent persistent or recurrent inflammation. Anti-inflammatory agents have the potential to stabilise atherosclerotic plaques by impeding the inflammatory pathway. By targeting specific cytokines, the inflammatory pathway may be interrupted at various stages.
OBJECTIVES
To assess the benefits and harms of anti-inflammatory medications plus standard care versus standard care with or without placebo for prevention of vascular events (stroke, myocardial infarction (MI), non-fatal cardiac arrest, unstable angina requiring revascularisation, vascular death) and all-cause mortality in people with a prior history of ischaemic stroke or transient ischaemic attack (TIA).
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; last searched 29 May 2019); MEDLINE (1948 to 29 May 2019); Embase (1980 to 29 May 2019); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 29 May 2019); and Scopus (1995 to 29 May 2019). In an effort to identify additional published, unpublished, and ongoing trials, we searched several grey literature sources (last searched 30 May 2019). We incorporated all identified studies into the results section. We applied no restrictions with respect to language, date of publication, or study setting.
SELECTION CRITERIA
We considered randomised controlled trials (RCTs) and cluster-randomised controlled trials that evaluated anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed for inclusion titles and abstracts of studies identified by the search. Two review authors independently reviewed full-text articles for inclusion in this review. We planned to assess risk of bias and to apply the GRADE method.
MAIN RESULTS
We identified no studies that met the inclusion criteria.
AUTHORS' CONCLUSIONS
There is currently a paucity of evidence on the use of anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA. RCTs are needed to assess whether use of anti-inflammatory medications in this setting is beneficial.
Topics: Angina, Unstable; Anti-Inflammatory Agents; Heart Arrest; Humans; Ischemic Attack, Transient; Myocardial Infarction; Plaque, Atherosclerotic; Secondary Prevention; Stroke
PubMed: 32392374
DOI: 10.1002/14651858.CD012825.pub2 -
Biomedicine & Pharmacotherapy =... Jul 2020The vascular endothelium plays a vital role in regulating normal vascular function. Endothelial lining maintains the balance of thrombolytic and fibrinolytic...
The vascular endothelium plays a vital role in regulating normal vascular function. Endothelial lining maintains the balance of thrombolytic and fibrinolytic microenvironment in the vasculature. Alterations of vascular endothelium referred to as endothelial dysfunction, caused the pathological changes in vessel wall such activation of proinflammatory and procoagulatory that initiate atherosclerosis. The concept that endothelial dysfunction plays a critical role in the initiation of atherosclerosis due to vascular inflammation gained tremendous attention. Diabetes mellitus is a metabolic-related disease that caused high mortality and morbidity, leading to its cardiovascular complication over the past decade. Atherosclerosis is the leading cardiovascular complication in diabetes mellitus. Despite metabolic and glycemic control, atherosclerotic plaque progression remains an enormous problem in diabetes mellitus complications. Thus, new inroads therapeutic approach in preventing complications that induced inflammation in endothelial cells could help prevent the disease progression. Signal peptide-CUB-EGF like domain-containing protein 2 (SCUBE2) expressed in vascular endothelium and reported to involve in inflammation. A recent study reported an increased SCUBE2 expression in diabetes mellitus and correlated with high expression of endothelin-1 (ET-1), a proinflammatory endothelial cell-derived peptide. Moreover, this gene showed to increase during atherosclerosis development. The present systematic review will summarize the involvement of SCUBE2 in vascular endothelium function changes and vascular complication, particularly in diabetes mellitus and atherosclerosis.
Topics: Adaptor Proteins, Signal Transducing; Atherosclerosis; Blood-Brain Barrier; Calcium-Binding Proteins; Diabetic Angiopathies; Endothelium, Vascular; Hedgehog Proteins; Humans
PubMed: 32278240
DOI: 10.1016/j.biopha.2020.110129 -
Diagnostics (Basel, Switzerland) Feb 2020Arterial wall shear strain (WSS) has been proposed to impact the features of atherosclerotic plaques. The aim of this meta-analysis was to assess the impact of different...
BACKGROUND AND AIM
Arterial wall shear strain (WSS) has been proposed to impact the features of atherosclerotic plaques. The aim of this meta-analysis was to assess the impact of different types of WSS on plaque features in coronary artery disease (CAD).
METHODS
We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar, and the Cochrane Central Registry, from 1989 up to January 2020 and selected clinical trials and observational studies which assessed the relationship between WSS, measured by intravascular ultrasound (IVUS), and plaque morphology in patients with CAD.
RESULTS
In four studies, a total of 72 patients with 13,098 coronary artery segments were recruited, with mean age 57.5 ± 9.5 years. The pooled analysis showed that low WSS was associated with larger baseline lumen area (WMD 2.55 [1.34 to 3.76, < 0.001]), smaller plaque area (WMD -1.16 [-1.84 to -0.49, = 0.0007]), lower plaque burden (WMD -12.7 [-21.4 to -4.01, = 0.04]), and lower necrotic core area (WMD -0.32 [-0.78 to 0.14, = 0.04]). Low WSS also had smaller fibrous area (WMD -0.79 [-1.88 to 0.30, = 0.02]) and smaller fibro-fatty area (WMD -0.22 [-0.57 to 0.13, = 0.02]), compared with high WSS, but the dense calcium score was similar between the two groups (WMD -0.17 [-0.47 to 0.13, = 0.26]). No differences were found between intermediate and high WSS.
CONCLUSIONS
High WSS is associated with signs of plaque instability such as higher necrotic core, higher calcium score, and higher plaque burden compared with low WSS. These findings highlight the role of IVUS in assessing plaque vulnerability.
PubMed: 32046306
DOI: 10.3390/diagnostics10020091 -
Stroke Jan 2020Background and Purpose- An ipsilateral mild carotid stenosis, defined as plaque with <50% luminal narrowing, is identified in nearly 40% of patients with embolic stroke... (Meta-Analysis)
Meta-Analysis
Background and Purpose- An ipsilateral mild carotid stenosis, defined as plaque with <50% luminal narrowing, is identified in nearly 40% of patients with embolic stroke of undetermined source and could represent an unrecognized source of atheroembolism. We aimed to summarize data about the frequency of mild carotid stenosis with high-risk features in embolic stroke of undetermined source. Methods- We searched Pubmed and Ovid-Embase for studies reporting carotid plaque imaging features in embolic stroke of undetermined source. The prevalence of ipsilateral and contralateral mild carotid stenosis with high-risk features was pooled using random-effect meta-analysis. Results- Eight studies enrolling 323 participants were included. The prevalence of mild carotid stenosis with high-risk features in the ipsilateral carotid was 32.5% (95% CI, 25.3-40.2) compared with 4.6% (95% CI, 0.1-13.1) in the contralateral carotid. The odds ratio of finding a plaque with high-risk features in the ipsilateral versus the contralateral carotid was 5.5 (95% CI, 2.5-12.0). Conclusions- Plaques with high-risk features are 5 times more prevalent in the ipsilateral compared with the contralateral carotid in embolic stroke of undetermined source, suggesting a relationship to stroke risk.
Topics: Aged; Carotid Stenosis; Female; Humans; Intracranial Embolism; Male; Plaque, Atherosclerotic; Risk Factors; Ultrasonography
PubMed: 31752616
DOI: 10.1161/STROKEAHA.119.027272 -
Frontiers in Pharmacology 2019Ischemic stroke (IS) is a leading cause of death and long-term disability worldwide. The NaoShuanTong capsule (NSTC), a traditional Chinese patent medicine, has been...
Ischemic stroke (IS) is a leading cause of death and long-term disability worldwide. The NaoShuanTong capsule (NSTC), a traditional Chinese patent medicine, has been extensively used in the treatment of stroke in China. However, the clinical efficacy and safety of this treatment has not been statistically and systematically verified by any comprehensive pooled analysis. We therefore performed a meta-analysis to evaluate the efficacy and safety of NSTC in the treatment of IS. Randomized controlled trials (RCTs) of NSTC in the treatment of IS conducted before September 2018 were retrieved from five databases, according to specific inclusion and exclusion criteria. Two investigators independently reviewed the included studies and extracted relevant data. The methodological quality of the included studies was assessed using criteria from the Cochrane Handbook, and analyzed using Review Manager 5.3 software. Thirteen RCTs comprising a total of 1,360 participants were included in this study. NSTC was shown to significantly improve the overall response rate ( = 3.04, 95% CI [1.76, 5.26], < 0.00001), and neurological function (NSTC increased Modified Barthel Index ( = 8.15, 95% CI [3.79, 12.52], = 0.0005), Functional Independence Measure ( = 29.61, 95% CI [10.11, 49.10], = 0.003) and European Stroke Scale scores ( = 8.51, 95% CI [7.00, 10.01], = 0.03). In addition, NSTC significantly increased serum adiponectin level ( = 0.66, 95% CI [0.23, 1.08], = 0.002). Moreover, NSTC reduced atherosclerotic plaque area ( = -2.24, 95% CI [-4.02, -0.46], = 0.01) and intima-media thickness ( = -0.09, 95% CI [-0.13, -0.05], < 0.0001). However, there was no significant difference between NSTC treatment and conventional therapy with respect to Fugl-Meyer Assessment score ( = 10.59, 95% CI [-1.78, 22.96], = 0.09) or Crouse score ( = -0.78, 95% CI [-1.79, -0.22], = 0.13). The results of this meta-analysis showed that NSTC exhibits efficacy in the treatment of cerebral infarction. NSTC can improve the overall response rate and neurological function, increase blood adiponectin, reduce neurological deficits, and decrease atherosclerotic plaque area.
PubMed: 31680944
DOI: 10.3389/fphar.2019.01133 -
Frontiers in Bioscience (Elite Edition) Jan 2020We investigated coronary heart disease (CHD) and cardiovascular disease (CVD) event rates in a diverse population with a coronary artery calcium score (CACS) of 0 and... (Meta-Analysis)
Meta-Analysis
We investigated coronary heart disease (CHD) and cardiovascular disease (CVD) event rates in a diverse population with a coronary artery calcium score (CACS) of 0 and the role of CACS in the detection of subclinical noncalcified atherosclerotic plaque. A total of 15,884 participants in five studies were included in this meta-analysis. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated. The results showed that CHD incidence significantly increased with increased CACS (HR=0.05, 95% CI 0.03-0.06, Z=5.82, P=0.002). The CHD rate was low and further increased with CACS of 101-300. With CACS >300, the CHD rate was highest. Similarly, CVD rate was low with CACS of 0, increased with CACS of 1-100 (HR=0.03, 95% CI 0.01-0.06, Z=1.66, P=0.096), and further increased with CACS of 101-300. With CACS >300, the CVD rate was highest. Clinical evidence indicated that the higher the CACS, the higher the CHD and CVD rates, while the CVD rate does not always decreased compared with CHD rate with the same CACS, especially with CACS of 0.
Topics: Coronary Artery Disease; Humans; Predictive Value of Tests; Severity of Illness Index; Vascular Calcification
PubMed: 31585873
DOI: 10.2741/E861 -
Stroke Aug 2019Background and Purpose- The clinical utility of positron emission tomography (PET) imaging in evaluating carotid artery plaque vulnerability remains unclear. Two tracers... (Meta-Analysis)
Meta-Analysis
Background and Purpose- The clinical utility of positron emission tomography (PET) imaging in evaluating carotid artery plaque vulnerability remains unclear. Two tracers of recent interest for carotid plaque imaging are F-fluorodeoxyglucose (F-FDG) and F-sodium fluoride (F-NaF). We performed a systematic review and meta-analysis evaluating the association between carotid artery F-FDG or F-NaF uptake and recent or future cerebral ischemic events. Methods- A systematic review of Ovid MEDLINE, Ovid EMBASE, and the Cochrane library was conducted from inception to December 2017 for articles evaluating PET tracer uptake in recently symptomatic versus asymptomatic carotid arteries, and articles evaluating carotid uptake in relation to future ischemic events. Cerebral ischemic events were defined as ipsilateral strokes, transient ischemic attacks, or amaurosis fugax. We quantitatively pooled studies by a random-effects model when 3 or more studies were amenable for analysis. We assessed the standardized mean difference between tracer uptake in the symptomatic versus asymptomatic carotid artery using Cohen's d metric. Results- After screening 4144 unique articles, 13 prospective cohort studies assessing carotid artery F-FDG uptake in patients with recent cerebral ischemia were eligible for review. Eleven cohorts of 290 subjects scanned with F-FDG were eligible for meta-analysis. We found that carotid arteries ipsilateral to recent ischemic events had significantly higher F-FDG uptake than asymptomatic arteries (Cohen's d =0.492; CI=0.130-0.855; P=0.008) as well as significant heterogeneity (Cochran's Q =31.5; P=0.0005; I=68.3%). Meta-regression was not performed due to the limited number of studies in the analysis. Only 2 studies investigating F-NaF PET imaging, and another 2 articles investigating ischemic event recurrence were found. Conclusions- Recent ipsilateral cerebral ischemia may be associated with increased carotid F-FDG uptake on PET imaging regardless of degree of carotid stenosis, although significant heterogeneity was found, and these results should be interpreted with caution. Emerging evidence suggests a similar association may be present with F-NaF plaque uptake. More studies are warranted to provide definitive conclusions on the utility of F-FDG or F-NaF in carotid plaque evaluation before investigating carotid PET as a diagnostic tool for cerebral ischemic events.
Topics: Brain Ischemia; Carotid Stenosis; Humans; Neuroimaging; Plaque, Atherosclerotic; Positron-Emission Tomography
PubMed: 31272325
DOI: 10.1161/STROKEAHA.118.023987 -
European Journal of Vascular and... Aug 2019Peri-procedural ischaemic brain lesions on diffusion weighted imaging (DWI) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) have been related to a...
OBJECTIVES
Peri-procedural ischaemic brain lesions on diffusion weighted imaging (DWI) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) have been related to a higher chance of recurrent cerebrovascular events. This systematic review provides an overview of patient characteristics associated with increased risk of new DWI lesions.
METHODS
MEDLINE, EMBASE, and Cochrane library databases were systematically searched (update November 2018) for studies reporting post-procedural DWI lesions after CEA or CAS. Data derived from both procedures were analysed separately. Studies reporting predictive features that were present prior to intervention were assigned to 10 categories: age, gender, cardiovascular risk factors, symptomatology, plaque vulnerability, atherosclerotic burden, cerebrovascular haemodynamics, carotid/arch anatomy, inflammatory markers, and markers of coagulation. A semi-quantitative analysis was performed by plotting studies that found an association between the investigated features and DWI lesions against those that did not find an association.
RESULTS
Forty-six studies (5018 patients) were included: 10 reported only CEA, 33 CAS, and three both interventions. 68.0% of 1873 CEA patients and 55.9% of 3145 CAS patients were symptomatic. The weighted prevalence of DWI lesions was 18.1% (95% CI 14.0-22.7%) in CEA patients compared with 40.5% (95% CI 35.4-45.7%) in CAS patients. Studies reporting on CEA patients predominantly found an increased risk in symptomatic patients (two of seven studies, including 848/1661 patients), those with impaired haemodynamics (five of five studies), and increased inflammatory markers (two of three studies). Studies reporting on CAS patients often found a positive association with age (10/26 studies), high plaque vulnerability (25/34 studies), or complex carotid/arch anatomy (three out of five studies).
CONCLUSIONS
For patients undergoing CEA, symptomatic status, impeded cerebral haemodynamics, and increased inflammatory markers are associated with increased susceptibility to peri-operative DWI lesions. In CAS patients, higher age, plaque vulnerability and complex carotid/aortic arch anatomy were identified as risk factors. These clinical predictors may assist with decision making on patient selection for medical treatment, CEA or CAS.
Topics: Brain Ischemia; Carotid Artery Diseases; Clinical Decision-Making; Diffusion Magnetic Resonance Imaging; Endarterectomy, Carotid; Endovascular Procedures; Female; Humans; Male; Patient Selection; Predictive Value of Tests; Prevalence; Risk Assessment; Risk Factors; Stents; Treatment Outcome
PubMed: 31266681
DOI: 10.1016/j.ejvs.2019.04.016 -
Atherosclerosis Aug 2019Intracranial atherosclerotic plaque is associated with ischemic strokes without substantial stenosis, and needs better characterization. We aim to investigate the...
BACKGROUND AND AIMS
Intracranial atherosclerotic plaque is associated with ischemic strokes without substantial stenosis, and needs better characterization. We aim to investigate the clinical significance of intracranial plaque without substantial stenosis by high resolution vessel wall MRI (vwMRI) through a systematic review of existing studies.
METHODS
Studies investigating intracranial arterial atherosclerotic plaques without substantial stenosis in acute ischemic stroke patients using vwMRI were systematically identified by searching the PubMed and Medline database and article reference lists. Study characteristics were recorded, the methodological quality of eligible studies was assessed, relevant clinical data were extracted, and collective data was analyzed.
RESULTS
Twenty-one studies were identified as eligible. 463 patients were included without stenosis of the intracranial arteries, and 651 patients were included with stenosis <50%. The prevalence of intracranial plaque revealed by vwMRI among acute/subacute ischemic stroke patients with non-stenotic Magnetic Resonance Angiography (MRA) was 50.6% (95% confidence interval (CI), 46.1%-55.1%). The prevalence of <50% MRA stenotic culprit plaque among acute/subacute ischemic stroke patients with a clinical diagnosis of intracranial atherosclerosis was 51.2% (95% CI, 38.4%-64.0%). Plaques features, including wall enhancement, positive remodeling, intraplaque hemorrhage, plaque location and eccentricity, were associated with acute stroke, progressive motor deficits and unfavorable overall functional outcomes.
CONCLUSIONS
Intracranial high-risk plaque with zero or mild degree of stenosis is more prevalent than previously acknowledged, and is associated with ischemic stroke and unfavorable outcome. VwMRI can identify the high-risk plaque features, which may act as a promising tool to better risk stratify these patients.
Topics: Brain Ischemia; Cerebral Arteries; Humans; Imaging, Three-Dimensional; Intracranial Arteriosclerosis; Magnetic Resonance Angiography; Plaque, Atherosclerotic
PubMed: 31254918
DOI: 10.1016/j.atherosclerosis.2019.06.907