Aggressive lipid-lowering is more effective than moderate lipid-lowering treatment in carotid plaque stabilization

Kadoglou, Nikolaos P.E.; Sailer, Nikolaos; Moumtzouoglou, Anestis; Kapelouzou, Alkistis; Gerasimidis, Thomas; Liapis, Christos D.

doi:10.1016/j.jvs.2009.07.119

Cited by 75 publications

(54 citation statements)

References 43 publications

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“…There are several potential reasons why our meta-analysis showed a significant reduction in aortic AIx following statin therapy which was not so clearly proven in some other studies. Some of these include a higher number of subjects included, and restriction to only controlled trials having the highest level of evidence [44]. Results of this meta-analysis suggest one more pleiotropic effect of statin therapy apart from those which were described previously suggesting also that the indication for statin therapy might be potentially extended.…”

Section: Discussionmentioning

confidence: 84%

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Effects of statin therapy on augmentation index as a measure of arterial stiffness: A systematic review and meta-analysis

Sahebkar

Pećin

Tedeschi-Reiner

et al. 2016

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 84%

“…Moreover, it has been recently reported about potential role of galectin-3 intra-plaque concentration on plaque stability: low concentrations seem to correlate with clinically and ultrasonically defined unstable human carotid plaques. Given that statins increase intra-plaque galectin-3 concentration, they could contribute to reduce plaque instability[43,44].…”

mentioning

confidence: 99%

Effects of statin therapy on augmentation index as a measure of arterial stiffness: A systematic review and meta-analysis

Sahebkar

Pećin

Tedeschi-Reiner

et al. 2016

International Journal of Cardiology

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“…21 Others have found that patients with moderate carotid stenosis on an aggressive atorvastatin regimen demonstrate increased plaque echogenicity after 12 months of treatment. 47 Plaque neovascularization on CEUS is also known to decrease following statin therapy. These findings highlight the role that detailed carotid ultrasonography can play in monitoring response to therapy.…”

Section: Ultrasound Plaque Imaging In Medical and Surgical Managementmentioning

confidence: 99%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

290

172

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abbreviatioNs AHA = American Heart Association; CAS = carotid artery stenting; CEA = carotid endarterectomy; CEUS = contrast-enhanced ultrasonography; CTA = CT angiography; DCE = dynamic contrast-enhanced; DSCT = dual-source CT; FDG = fluorodeoxyglucose; FSE = fast spin echo; Gd = gadolinium; HU = Hounsfield units; IPH = intraplaque hemorrhage; LRNC = lipid-rich necrotic core; MDCT = multidetector-row CT; MDCTA = MDCT angiography; MES = microembolic signal; MMP-9 = matrix metalloproteinase-9; MRA = MR angiography; PDW = proton density-weighted; SUV = standardized uptake value; SUVmax = maximal SUV; TBR = target-to-background ratio; TCD = transcranial Doppler ultrasonography; TIA = transient ischemic attack; TOF = time of flight; USPIO = ultrasmall superparamagnetic iron oxide. Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis....

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“…A previous study has detected change in carotid plaques by ultrasound following administration of 40 or 80 mg/day atorvastatin in Western populations, and the administration of 20 mg/day atorvastatin as a homeopathic dose appeared to induce no strong response in the plaques in Western populations (25). However, some studies have indicated that small doses of atorvastatin are safe and effective to administer to ethnic Chinese patients (21,26).…”

Section: Discussionmentioning

confidence: 99%

Improved plaque neovascularization following 2-year atorvastatin therapy based on contrast-enhanced ultrasonography: A pilot study

Jin

et al. 2018

Exp Ther Med

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Abstract. The present study assessed changes in carotid plaque neovascularization following long-term atorvastatin therapy (20 mg/day) using contrast-enhanced ultrasonography (CEUS). In this prospective case series, seven males (mean age, 68±9 years) and three females (mean age, 67±10 years) with a total of 13 carotid plaques underwent standard ultrasonography and CEUS at baseline, as well as after 1 and 2 years of atorvastatin treatment. The same plaques were then examined using real-time CEUS. The results of the enhanced intensity of plaque neovascularization at baseline were compared with results obtained during follow-up to examine the effects of long-term atorvastatin therapy. Standard ultrasonography revealed that 7 of the 13 carotid plaques were uniformly echolucent, whereas 6 carotid plaques were predominantly echolucent. CEUS revealed an enhanced intensity of 10.5±2.1 decibels (dB) prior to treatment, which decreased significantly to 7.3±2.6 dB following 2 years atorvastatin therapy (P<0.001). The ratio of enhanced intensity in the carotid artery lumen to that in the plaque was 3.10±1.10 at baseline and this value significantly increased to 4.96±2.98 following treatment for 2 years (P<0.001). The current pilot study therefore indicates that two-year atorvastatin therapy (20 mg/day) may reduce plaque neovascularization in the Chinese population.

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Aggressive lipid-lowering is more effective than moderate lipid-lowering treatment in carotid plaque stabilization

Cited by 75 publications

References 43 publications

Effects of statin therapy on augmentation index as a measure of arterial stiffness: A systematic review and meta-analysis

Effects of statin therapy on augmentation index as a measure of arterial stiffness: A systematic review and meta-analysis

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Improved plaque neovascularization following 2-year atorvastatin therapy based on contrast-enhanced ultrasonography: A pilot study

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