INTRODUCTION :
Decades of silent arterial wall alterations precede vascular clinical
events, which then reflect advanced atherosclerotic disease. The first
morphological abnormalities of arterial walls can be visualized by Bmode
ultrasonography. This high-resolution, noninvasive technique is
one of the best methods for the detection of early stages of atherosclerotic
disease, because it is rapidly applicable, readily available and
demonstrates the wall structure with better resolution than any other
similar technique .Accordingly, ultrasound has been used in a number of
studies to monitor the intima-media thickness (IMT) of the carotid
arteries, a measurement which has consequently been shown to be
associated with cardiovascular risk factors and the incidence of
cardiovascular disease. Furthermore, there are diverse approaches for
measuring IMT, and some of these may lead to divergent results.
Moreover, there are no unified criteria for distinguishing atherosclerosis
as seen in early plaque formation from thickening of the intimal-medial
complex. This is because IMT reflects not only early atherosclerosis, but
also non atherosclerotic compensatory enlargement with largely medial
hypertrophy as a result of smooth muscle cell hyperplasia and fibro
cellular hypertrophy. This differentiation is important because
epidemiological studies have shown that wall thickening as depicted by
ultrasonographic measurements of IMT is different from atherosclerotic
plaque regarding localization, natural history, risk factors and predictive
value for vascular events. As IMT is being increasingly used in clinical
trials to serve as a surrogate end point for determining the success of
interventions that lower risk factors for atherosclerosis, it is imperative
that standardized methods be used to allow homogenous data collection
and analysis. This would help to improve the power of such studies and to
facilitate the merging of large databases for meta-analyses. In our study
correlation of intima medial thickness with carotid artery remodeling and
coronary artery disease status is assessed.
AIM OF STUDY :
To study the carotid arterial remodeling in patients with coronary
artery disease.
To study the relationship between carotid arterial inter adventitial
and lumen diameters to the intima medial thickness.
To evaluate carotid arterial diameters of individuals with coronary
artery disease and how it differed from those of CAD-free controls and
To study the relationship between carotid artery remodeling and
severity of cornary artery disease.
CONCLUSIONS :
1. Common carotid atherosclerosis is associated with larger IA
diameter and no reduction in lumen diameter POSITIVE
REMODELING. Conversely, in the internal carotid, greater IMT is
associated with smaller lumina in the absence of IA diameter
enlargement. NEGATIVE REMODELING.
2. Case-control comparisons suggest differences in arterial
dimensions: common carotid IA diameter was greater in cases than
controls, whereas internal carotid lumen and IA diameter were both
reduced in CAD cases compared with controls. However,
interactive effects of case status on the associations between IMT
and arterial dimensions did not reach significance. Patients with
triple vessel disease had significant remodeling of carotids when
comparing patients with single vessel disease.
3. The data is consistent with the concept that lack of arterial
enlargement of the internal carotid during atherosclerosis
progression partly explains the well-documented association of this
carotid segment with symptomatic cardiovascular disease and the
difference in the arterial biologic, physiologic and atherogenic
prones properties of the different segments of carotid arteries