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Background: Both airflow limitation and smoking are established cardiovascular risk factors. However, their interaction as risk factors for the development of atherosclerosis in coronary artery disease patients remains unclear. Objectives: To evaluate the effect of the interaction between airflow limitation and smoking status on the severity of carotid atherosclerosis. Methods: We categorized the 234 enrolled patients with coronary artery disease into four groups: never-smokers with normal pulmonary function (group A), never-smokers with airflow limitation (group B), ever-smokers with normal pulmonary function (group C), and ever-smokers with airflow limitation (group D). Results: The prevalence of airflow limitation in the enrolled patients was 23.1% (ever-smokers: 15.8%, never-smokers: 7.3%). The prevalence of severe carotid atherosclerosis was 28.2, 29.4, 41.3, and 45.9%, respectively, in the four groups (group D vs. group A, p = 0.035). Even after multivariate adjusting for confounding factors, ever-smokers with airflow limitation were independently associated with severe carotid atherosclerosis (odds ratio 2.89, 95% confidence interval, 1.19-7.00, p = 0.019). Conclusions: Ever-smokers with airflow limitation were significantly associated with severe carotid atherosclerosis among patients with coronary artery disease. These findings also provide additional insight into the correlation between airflow limitation and poor cardiovascular clinical outcomes. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: It is well known that the presence of atheroma of the thoracic aorta is a risk factor for cerebrovascular events.We sought to evaluate whether the presence and the morphology of atherosclerotic plaque in the carotid artery detected by duplex ultrasonography is associated with disease in the proximal aorta visualized by transesophageal echocardiogram in patients with a cerebrovascular event. Methods: We carried out a cross-sectional prospective study including 147 consecutive patients with prior stroke or transient ischemic attack (TIA). Neurological evaluations were performed by an expert neurologist using clinical and tomographic diagnostic criteria including the definition of etiology and whether the patient suffered from stroke or TIA. Transthoracic and transesophageal echocardiograms and carotid artery duplex ultrasonography were performed by the same examiner. Patients with and without plaque in the carotid artery were compared using Student's t test or the χ2 test. Regression analysis was used to determine whether the presence of plaque in the carotid artery was predictive of the presence of plaque in the proximal aorta and to analyze the relationship between the echogenicity of carotid and aortic plaques. The significance level was set at p < 0.05. Results: All 147 patients (95 men) were included in the analysis. Patients' ages ranged from 23 to 85 years (65 ± 12.4 years). Most of the patients (58.5%) were Caucasian, while 41.5% were African-Brazilian. Arterial hypertension, diabetes and tobacco use were more frequent among patients with atherosclerotic plaque in the aorta. A normal carotid intima-media thickness halved the risk of atherosclerotic plaque in the aorta [odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23-0.91; p = 0.026]. The presence of carotid plaque increased the risk of aortic plaque by 70-fold (OR 73.2, 95% CI 25.6-2,018.6; p < 0.001) in univariate analysis. The absence of atherosclerotic plaque in the carotid artery reduced the risk of plaque in the aorta to almost 0 (OR 0.014, 95% CI 0.004-0.041; p < 0.001). Considering the 86 patients with both aortic and carotid plaques, the presence of hypoechoic plaque in the carotid artery was a predictor of hypoechoic plaque in the aorta (OR 10.1, 95% CI 3.3-31.2; p < 0.001). Conclusions: The carotid artery atherosclerotic profile defined by ultrasonography is a strong predictor of the atherosclerotic profile of the proximal aorta. This should be taken into consideration before referring patients with acute cerebrovascular events for transesophageal echocardiogram. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: Several specialists use three-dimensional (3D) ultrasound as adjuvant imaging technique in their clinical practice. It has been applied to study carotid plaque morphology, surface and volume during atherosclerosis progression. Nonetheless, no papers have so far described the use of this technique in conditions different than carotid stenosis, such as bifurcation anatomy changes of the caliber and vessel course modifications. Methods: Patients admitted to our ultrasound laboratory for vascular screening were submitted to standard carotid duplex and to 3D ultrasound reconstruction of the carotid bifurcation. Results: Forty normal subjects, 7 patients with caliber alterations (4 carotid bulb ectasia and 3 internal carotid lumen narrowing), 45 patients with course variations (tortuosities and kinking) and 35 patients with internal carotid artery stenosis of various degrees have been investigated. Conclusions: 3D ultrasound is a feasible technique. It can improve carotid axis imaging through a better presentation of caliber variations and vessel course 'at a glance'. 3D ultrasound from the inward flow can provide imaging of the stenosis, but stenosis quantification should always take into account the assessment of plaque morphology and vessel wall. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Although black-blood MRI (BB-MRI) can identify plaques in the cervical carotid arteries, this modality has not been applied in intracranial arteries. We imaged the lumina and walls of stenotic middle cerebral arteries (MCAs) in symptomatic and asymptomatic patients using high-resolution BB-MRI, in order to characterize vulnerable plaques and to determine the diagnostic accuracy of BB-MRI in MCA stenosis. Methods: Multicontrast (T1, T2 and proton density)-weighted BB-MRIs were acquired in 15 patients with MCA stenosis and in 2 volunteers. Each MCA was classified into one of three groups based on MR angiographic findings and symptoms: normal, symptomatic stenosis, or asymptomatic stenosis. The plaque signal intensity was interpreted and the total wall thickness was measured at the most stenotic segment. These values were then compared between asymptomatic and symptomatic MCAs using t test. For assessment of lumen imaging, the MCA stenosis graded on BB-MR images was compared with that graded on conventional angiography (digital subtraction angiography). Results: Twenty-eight MCAs were evaluated (normal MCAs: 12, symptomatic stenoses: 7, and asymptomatic stenoses: 9). T1- and/or T2-hyperintense foci were demonstrated more frequently within the plaques of symptomatic stenoses than within the plaques of asymptomatic stenoses (57.1 vs. 22%). The total wall thickness in the symptomatic stenoses was significantly higher than that seen in the asymptomatic stenoses. The stenosis grade for the BB-MRI was significantly correlated with the digital subtraction angiography grade. Conclusion: High-resolution, multicontrast-weighted BB-MRI has the potential to characterize atherosclerotic plaques in the MCA and may be a useful modality for evaluating the degree of stenosis. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Carotid intima-media thickness (IMT) measurements are increasingly used as an intermediate outcome for vascular risk. The study aim was to evaluate segment-specific IMT progression rates and their relationship to vascular risk factors compared with baseline measurements in a healthy population. Methods: In a population of healthy male military pilots (n = 1,258) IMT of the common carotid artery and of the bifurcation and vascular risk factors were evaluated at baseline and serially with an annual follow-up for a period of 5 years. Results: Complete baseline and follow-up data were available for 1,258 subjects. Progression of the carotid IMT at the common carotid artery was significantly associated with age, body mass index, smoking status and erythrocyte sedimentation rate, whereas progression of IMT at the carotid bifurcation was significantly associated with age, body mass index, diastolic blood pressure and negatively associated with physical working capacity. Conclusion: IMT progression is segment-specific and governed by a different risk factor composition. Physical exercise can slow IMT progression at the carotid bifurcation. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Factors involved in atherosclerotic plaque progression are still a topic of hot debate. With the advance of new ultrasound techniques it has been possible to identify atherosclerotic plaque characteristics that may reflect a higher risk of vulnerability. Among the various proposed mechanisms, one of the least investigated is plaque motion, i.e. plaque stability in respect to the arterial wall. We report here two asymptomatic patients with internal carotid stenosis that showed differences in plaque motion, a finding that could determine a change in their future treatment. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: We examined the hypothesis that endothelial denudation in advanced carotid plaques (CPs) occurs by increased apoptosis of endothelial cells (ECs) using scanning electron microscopy (SEM) as well as markers of cellular proliferation and apoptosis in advanced symptomatic CPs (SCPs) and asymptomatic CPs (ACPs). Methods: 93 consecutive patients underwent carotid endarterectomy. Five additional specimens were studied by SEM. We performed TUNEL assays, and immunostaining against Fas receptor (FasR), Fas ligand (FasL), activated caspase 3 (ACA3) and Ki-67. Results: SEM revealed morphological changes consistent with EC detachment. Surprisingly, ACA3 positivity was more pronounced on the endothelium of ACPs (4.6 ± 0.7% of total EC count) than on SCPs (3.3 ± 0.7%, p = 0.049), and was found to correlate positively with nuclear Ki-67 expression (rs = 0.275, p = 0.040). FasL expression was significantly increased on the endothelium of SCPs compared with ACPs (66.4 ± 4.4 vs. 53.9 ± 4.5%, p = 0.047). Conclusions: Absence of increased positivity of apoptotic markers dismisses apoptosis as a dominant mechanism underlying endothelial detachment of SCPs. Rather, increased ACA3 with co-expression of Ki-67 in ACPs might suggest that renewal of endothelium by active cell turnover may contribute to clinically silent evolution of plaques with preserved EC integrity. These observations may assist in designing novel therapies to prevent endothelial decay and symptom generation in advanced carotid artery disease. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Intima-media thickness (IMT) is increasingly used as a surrogate end point of vascular outcomes in clinical trials aimed at determining the success of interventions that lower risk factors for atherosclerosis and associated diseases (stroke, myocardial infarction and peripheral artery diseases). The necessity to promote further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT and to standardize IMT measurements is expressed through this updated consensus. Plaque is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding IMT value or demonstrates a thickness >1.5 mm as measured from the media-adventitia interface to the intima-lumen interface. Standard use of IMT measurements is based on physics, technical and disease-related principles as well as agreements on how to perform, interpret and document study results. Harmonization of carotid image acquisition and analysis is needed for the comparison of the IMT results obtained from epidemiological and interventional studies around the world. The consensus concludes that there is no need to ‘treat IMT values’ nor to monitor IMT values in individual patients apart from exceptions named, which emphasize that inside randomized clinical trials should be performed. Although IMT has been suggested to represent an important risk marker, according to the current evidence it does not fulfill the characteristics of an accepted risk factor. Standardized methods recommended in this consensus statement will foster homogenous data collection and analysis. This will help to improve the power of randomized clinical trials incorporating IMT measurements and to facilitate the merging of large databases for meta-analyses. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

No abstract available Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction/Background: Carotid cavernous fistula (CCF) is an abnormal communication, traumatic or spontaneous in origin, between the carotid arterial system and the cavernous sinus, resulting in short-circuiting of arterial blood into this intracranial venous system. Patients will often present with ocular signs and symptoms such as conjunctival chemosis, proptosis, pulsating exophthalmos, diplopia, ophthalmoplegia, orbital pain, audible bruits and decreased visual acuity, which can be attributed to secondary glaucoma, ischemic optic neuropathy or chorioretinal dysfunction. Treatment is usually accomplished through trans-arterial or trans-venous embolization. Methods: Case report of a single patient presenting with ocular manifestations from a chronic carotid cavernous fistula. Results: We report the case of a 92 year old female patient presenting with gradually decreasing visual acuity on her left eye (LE). She had a chronic history of red eye interpreted as allergic conjuntivitis. On examination, best corrected visual acuity LE was 3/10 (Snellen); biomicroscopy revealed exuberant conjunctival vascular tortuosity on a 'medusa head' pattern and conjunctival chemosis. On gonioscopy, grade IV Schaffer open angle was observed on all quadrants but blood was present on Schlemm's cannal. On fundus exam, papillary and macular edema were present, as well as exuberant retinal arterial and venous tortuosity and engorgement. Suspecting a low debit arterial-venous fistula, the patient underwent orbital and cranial MRI scan which showed increased extraocular muscle thickness, superior ophthalmic vein dilation and left side cavernous sinus dilation, confirming the diagnosis. She was referred to a neuroradiology consult but her advanced age was deemed contraindicate to invasive intervention. Conclusions: CCV is a rare clinical entity often presenting with ocular manifestations. A high index of suspicion for its characteristic signs and symptoms is of indisputable importance in both establishing an early diagnosis and designing a suitable treatment plan. Acknowledgements: No financial interests to declare. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 62-year-old man who experienced left paresis of the face, leg, and arm with hypoesthesia and hemineglect. It notes that the patient was diagnosed with a right internal carotid artery occlusion within the territory of right middle cerebral artery (MCA) and definitive infarct within the internal capsule's posterior limb. It cites that a fiber discontinuation within the right internal capsule was revealed by diffusion tensor imaging at 34th day after its onset.