Carotid artery plaque composition : Relationship to clinical presentation and ultrasound B-mode imaging

Objective: To correlate B-mode ultrasound findings to carotid plaque histology. Design: European multicentre study (nine centres). Material and Methods: Clinical presentation and risk factors were recorded and preoperative ultrasound Duplex scanning with special emphasis on B-mode imaging studies was performed in 270 patients undergoing carotid endarterectomy. Perioperatively macroscopic plaque features were evaluated and the removed specimens were analysed histologically for fibrous tissue, calcification and 'soft tissue' (primarily haemorrhage and lipid). Results: Males had more soft tissue than females (p = 0.0006), hypertensive patients less soft tissue than normotensive (p = 0.01) and patients with recent symptoms more soft tissue than patients with earlier symptoms (p = 0.004). There was no correlation between surface description on ultrasound images compared to the surface judged intraoperatively by the surgeon. Echogenicity on B-mode images was inversely related to soft tissue (p=0.005) and calcification ions directly related to echogenicity (p < 0.0001). Heterogeneous plaques contained more calcification than homogeneous (p = 0.003), however there was no difference in content of soft tissue. Conclusion: Ultrasound B-mode characteristics are related to the histological composition of carotid artery plaques and to patient's history. These results may imply that patients with distant symptoms may be regarded and treated as asymptomatic patients whereas asymptomatic patients with echolucent plaques should be considered for carotid endarterectomy

Renal denervation: An &apos;upstream therapy&apos; for metabolic disease?

Renal sympathetic denervation (RSD) was introduced as a promising technique for the treatment of patients with true drug-resistant hypertension. Increased sympathetic firing has been considered a pivotal pathophysiological mechanism underlying adverse cardiovascular adaptations and metabolic derangements. The cause-effect relationship between metabolic disease and sympathetic overactivity has not been fully understood. It has been hypothesized that reduction of efferent sympathetic drive might be associated with beneficial effects on metabolic surrogates and especially on insulin resistance beyond blood pressure lowering. The limited evidence so far qualifies RSD as a potential &apos;upstream&apos; therapy to ameliorate insulin resistance. However, the impact of RSD on metabolic syndrome components, especially of obesity, is less clear and biologically questioned. In addition, sleep apnea strongly associated with resistant hypertension and glucose metabolism impairment might constitute an additional target of RSD, as sympathetic activation is highly pronounced in this setting. At present, RSD should not be considered a clinical option to treat metabolic disease, but only as an innovative technique requiring strong evidence in the field. © 2013 Wolters Kluwer Health | Lippincott Williams &amp; Wilkins

Right subclavian double steal syndrome: A case report

Introduction: Double-steal syndrome represents a causative factor for blood flow compromise of the cerebral vascular bed with transient neurologic symptoms. We present the case of a patient with innominate artery atherosclerotic occlusion, manifested as blood flow reversal in the vertebral and common carotid arteries. Symptomatic atherosclerotic occlusive disease of the innominate artery is relatively rare and represents less than 2% of all extracranial causes of cerebrovascular insufficiency. Case presentation: We report on a 73-year-old male patient who presented at our hospital for the evaluation of dizziness and episodes of syncope. Angiography and color Doppler examinations documented the double syndrome as retrograde flow in the right vertebral artery and the right carotid artery. Conclusion: Constituting an indication for surgical correction, his condition was managed with the performance of carotid-carotid extra-anatomic bypass for the permanent reestablishment of antegrade blood flow in the vascular network supplying the brain. Carotid-carotid extra-anatomic bypass was a good option for our patient, since he remains symptom free after one year of follow up. © 2008 Filis et al; licensee BioMed Central Ltd

C Reactive protein, moderate alcohol consumption, and long term prognosis after successful coronary stenting: four year results from the GENERATION study

Objectives: To determine the impact of moderate alcohol consumption on long term prognosis after successful coronary stenting, and whether it could be related to preprocedural plasma C reactive protein (CRP). Design: Part of the prospectively designed GENERATION study which investigated the impact of several biochemical factors, including plasma CRP, on long term prognosis after coronary stenting. Setting: Tertiary referral centre. Patients: 483 consecutive patients with stable or unstable coronary artery disease who underwent successful coronary stenting and were followed for up to four years. Information about alcohol consumption was collected prospectively. Interventions: Successful coronary stenting. Main outcome measures: The incidence of the composite end point of readmission to hospital for unstable angina, non-fatal myocardial infarction, or cardiac death, whichever occurred first. Results: By the end of follow up the incidence of the composite end point was 22.8%. Patients with a baseline plasma CRP concentration of < 0.68 mg/dl (defined by ROC analysis) did not show any difference in the composite end point (p  =  0.9) or its components, regardless of the amount of alcohol consumed during follow up. However, among patients with plasma CRP concentration of ⩾ 0.68 mg/dl, those who drank moderately had a lower incidence of the composite end point (p < 0.001) or its components. Conclusions: Moderate alcohol consumption may have a beneficial impact on the long term prognosis following successful coronary stenting. The extent of this effect is positively related to preprocedural inflammatory status. An anti-inflammatory action of moderate alcohol consumption cannot be excluded

Reprinted Article &quot;carotid artery plaque composition - Relationship to clinical presentation and ultrasound b-mode imaging&quot;

Objective: To correlate B-mode ultrasound findings to carotid plaque histology. Design: European multicentre study (nine centres). Material and Methods: Clinical presentation and risk factors were recorded and preoperative ultrasound Duplex scanning with special emphasis on B-mode imaging studies was performed in 270 patients undergoing carotid endarterectomy. Perioperatively, macroscopic plaque features were evaluated and the removed specimens were analysed histologically for fibrous tissue, calcification and 'soft tissue' (primarily haemorrhage and lipid). Results: Males had more soft tissue than females (p = 0.0006), hypertensive patients less soft tissue than normotensive (p = 0.01) and patients with recent symptoms more soft tissue than patients with earlier symptoms (p = 0.004). There was no correlation between surface description on ultrasound images compared to the surface judged intraoperatively by the surgeon. Echogenicity on B-mode images was inversely related to soft tissue (p = 0.005) and calcification was directly related to echogenicity (p &lt; 0.0001). Heterogeneous plaques contained more calcification than homogeneous (p = 0.003), however, there was no difference in content of soft tissue. Conclusion: Ultrasound B-mode characteristics are related to the histological composition of carotid artery plaques and to patient's history. These results may imply that patients with distant symptoms may be regarded and treated as asymptomatic patients whereas asymptomatic patients with echolucent plaques should be considered for carotid endarterectomy

Carotid Artery Plaque Composition Relationship to Clinical Presentation and Ultrasound B-mode Imaging (Reprinted from Eur J Vasc Endovasc Surg, vol 10, pg 23-30, 1995)

Objective: To correlate B-mode ultrasound findings to carotid plaque histology. Design: European multicentre study (nine centres). Material and Methods: Clinical presentation and risk factors were recorded and preoperative ultrasound Duplex scanning with special emphasis on B-mode imaging studies was performed in 270 patients undergoing carotid endarterectomy. Perioperatively, macroscopic plaque features were evaluated and the removed specimens were analysed histologically for fibrous tissue, calcification and ‘soft tissue’ (primarily haemorrhage and lipid). Results: Males had more soft tissue than females (p = 0.0006), hypertensive patients less soft tissue than normotensive (p = 0.01) and patients with recent symptoms more soft tissue than patients with earlier symptoms (p = 0.004). There was no correlation between surface description on ultrasound images compared to the surface judged intraoperatively by the surgeon. Echogenicity on B-mode images was inversely related to soft tissue (p = 0.005) and calcification was directly related to echogenicity (p &lt; 0.0001). Heterogeneous plaques contained more calcification than homogeneous (p = 0.003), however, there was no difference in content of soft tissue. Conclusion: Ultrasound B-mode characteristics are related to the histological composition of carotid artery plaques and to patient’s history. These results may imply that patients with distant symptoms may be regarded and treated as asymptomatic patients whereas asymptomatic patients with echoluceht plaques should be considered for carotid endarterectomy. (C) 2011 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery