An update of the Italian Stroke Organization–Stroke Prevention Awareness Diffusion Group guidelines on carotid endarterectomy and stenting: A personalized medicine approach

Lanza, Gaetano Antonio; Setacci, Carlo; Ricci, Stefano; Castelli, Patrizio; Cremonesi, Alberto; Lanza, Jessica; Novali, Claudio; Pratesi, Carlo; Santalucia, Paola; Speziale, Francesco; Zaninelli, Augusto; Gensini, Gian Franco

doi:10.1177/1747493017694395

Cited by 10 publications

(3 citation statements)

References 36 publications

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“…As a starting point, we characterized lymphocyte populations in human atherosclerotic plaques obtained by endarterectomy, a surgical procedure to remove the atheromatous plaque from carotids (31). Donor's characteristics are presented in Table 1 (section Materials and Methods).…”

Section: Characterization Of Human Atherosclerotic Plaques: Tregs Accmentioning

confidence: 99%

Altered Tregs Differentiation and Impaired Autophagy Correlate to Atherosclerotic Disease

et al. 2020

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Atherosclerosis is a progressive vascular disease representing the primary cause of morbidity and mortality in developed countries. Formerly, atherosclerosis was considered as a mere passive accumulation of lipids in blood vessels. However, it is now clear that atherosclerosis is a complex and multifactorial disease, in which the involvement of immune cells and inflammation play a key role. A variety of studies have shown that autophagy-a cellular catalytic mechanism able to remove injured cytoplasmic components in response to cellular stress-may be proatherogenic. So far, in this context, its role has been investigated in smooth muscle cells, macrophages, and endothelial cells, while the function of this catabolic protective process in lymphocyte functionality has been overlooked. The few studies carried out so far, however, suggested that autophagy modulation in lymphocyte subsets may be functionally related to plaque formation and development. Therefore, in this research, we aimed at better clarifying the role of lymphocyte subsets, mainly regulatory T cells (Tregs), in human atherosclerotic plaques and in animal models of atherosclerosis investigating the contribution of autophagy on immune cell homeostasis. Here, we investigate basal autophagy in a mouse model of atherosclerosis, apolipoprotein E (ApoE)-knockout (KO) mice, and we analyze the role of autophagy in driving Tregs polarization. We observed defective maturation of Tregs from ApoE-KO mice in response to tumor growth factor-β (TGFβ). TGFβ is a well-known autophagy inducer, and Tregs maturation defects in ApoE-KO mice seem to be related to autophagy impairment. In this work, we propose that autophagy underlies Tregs maturation, advocating that the study of this process in atherosclerosis may open new therapeutic strategies.

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Section: Characterization Of Human Atherosclerotic Plaques: Tregs Accmentioning

confidence: 99%

Altered Tregs Differentiation and Impaired Autophagy Correlate to Atherosclerotic Disease

et al. 2020

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“…52 It was suggested that the stroke risk of individual ACS patients should be stratified and the treatment should be tailored to each patient's needs. [53][54][55] Risk prediction tools/improvements in CEA outcomes for ACS patients Improvements in MRI/CT imaging techniques and technology nowadays make it possible to identify plaque features associated with increased stroke risk. 56,57 Irregular plaque morphology and/or ulcerated plaque surface are associated with an increased risk for future stroke.…”

Section: Patient Adherence With Bmtmentioning

confidence: 99%

Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action

Paraskevas¹,

Mikhailidis

Baradaran

et al. 2021

J Stroke

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The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient’s life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.

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“…All measurements were repeated thrice, and the mean values were calculated. Acute organ damage was diagnosed in accordance with international guidelines (16)(17)(18)(19).…”

Section: Selection Of Participantsmentioning

confidence: 99%

Low serum corin levels predict end-organ damage in patients with hypertensive crisis

Yavuz

Söğüt

Çolak

et al. 2021

The Anatolian Journal of Cardiology

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Objective: The study aimed to investigate the predictive power of serum corin levels for distinguishing between hypertensive urgency (HU) and hypertensive emergency (HE) in patients with hypertensive crisis (HC) admitted to the emergency department. Methods: A total of 120 consecutive consenting adult patients diagnosed with HC and 55 age-and sex-matched healthy controls were enrolled. Blood pressure measurements [(systolic, diastolic, and mean arterial pressure (MAP)] and the evidence of end-organ damage at the first admission were recorded. Patients with HC were classified as patients with HE or HU according to the presence or absence of acute end-organ damage. Serum corin levels were compared between the 2 groups. Results: The mean serum corin level was significantly lower in the HC group than in the control group; it was also lower in the HE group than in the HU group (p<0.001 for all). In the HE group, clinical features associated with end-organ damage included ST-elevation myocardial infarction (n=28, 46.7%), hemorrhagic stroke (n=11, 18.3%), ischemic stroke (n=11, 18.3%), and non-ST-elevation myocardial infarction (n=10, 16.7%). The receiving operator characteristic (ROC) analysis identified a serum corin cutoff value of 45 pg/mL for distinguishing patients with HE from patients with HU with 98.3% sensitivity and 95% specificity. Conclusion: Our findings suggest that serum corin levels play an important role in regulating blood pressure and are involved in the pathogenesis of HC. Low serum corin levels may predict end-organ damage and serve as a guide for diagnostic decision making in patients with HC.

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An update of the Italian Stroke Organization–Stroke Prevention Awareness Diffusion Group guidelines on carotid endarterectomy and stenting: A personalized medicine approach

Cited by 10 publications

References 36 publications

Altered Tregs Differentiation and Impaired Autophagy Correlate to Atherosclerotic Disease

Altered Tregs Differentiation and Impaired Autophagy Correlate to Atherosclerotic Disease

Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action

Low serum corin levels predict end-organ damage in patients with hypertensive crisis

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