Duplex sonographic criteria for measuring carotid stenoses

Staikov, Ivan; Nedeltchev, Krassen; Arnold, Marcel; Remonda, Luca; Schroth, Gerhard; Sturzenegger, Matthias; Herrmann, Cornelia; Rivoir, Anita; Mattle, Heinrich

doi:10.1002/jcu.10078

Cited by 41 publications

(28 citation statements)

References 29 publications

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“…A carotid plaque was defined as a focal thickening ≥1.5 mm [23]; none of the study participants had clinically relevant carotid stenosis (i.e. ≥ 70%) [24,25]. A cIMT value of more than 0.9 mm [26] or over the 75th percentile for the patient's age, sex, and race/ethnicity [27] was considered abnormal being associated with an increased risk of cardiovascular events [28,29].…”

Section: Body Fat Measurementsmentioning

confidence: 99%

Age, abdominal obesity, and glycated hemoglobin are associated with carotid atherosclerosis in type 2 diabetes patients with nonalcoholic fatty liver disease

Silaghi

Crăciun

et al. 2015

Med Ultrason

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Aim: The aim of this study was to evaluate the impact of clinical parameters and indices of body composition on the relation between non-alcoholic fatty liver disease (NAFLD) and carotid intima-media thickness (cIMT), in a type 2 diabetes mellitus population (T2DM). Material and methods: We retrospectively enrolled 336 T2DM outpatients who regularly attended Regina Maria Clinic in Cluj. Clinical, anthropometric and biochemical parameters were measured. Ultrasonography (US) was used to assess hepatic steatosis (HS) in all patients and cIMT in 146 subjects. Body composition was assessed by bioelectric impedance (BIA, InBody 720) in all patients. Results: cIMT was correlated with age (r=0.25; p=0.004), systolic blood pressure (r=0.18; p=0.041), glycated haemoglobin A1C (HbA1C, r=0.20; p=0.04), and with coronary artery disease (r=0.20; p=0.007). HS did not correlate with cIMT (r=0.04; p=0.64). cIMT was correlated with visceral fatty area (VFA, r=0.18; p=0.014) but not with other indices of body composition. Homeostasis model assessment for insulin resistance (HOMA-IR) was not correlated with cIMT (r=0.17; p=0.086). After multivariate analysis, age, HbA1c, and VFA were good independent predictors of cIMT (r=0.45; p˂0.001). Conclusions: These results are suggestive that in T2DM patients, fatty liver is not a direct mediator of early carotid atherosclerosis. Our data indicate that visceral fat accumulation and HbA1C are determinant factors of cIMT sugesting that controlling abdominal obesity and hyperglicemia might reduce atherosclerotic disease risk in NAFLD-T2DM subjects.

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Section: Body Fat Measurementsmentioning

confidence: 99%

Age, abdominal obesity, and glycated hemoglobin are associated with carotid atherosclerosis in type 2 diabetes patients with nonalcoholic fatty liver disease

Silaghi

Crăciun

et al. 2015

Med Ultrason

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“…From December 2007 to August 2009, 68 patients with 71 ACS ≥50% as determined by carotid duplex ultrasound [18,19,20] gave their informed consent to undergo 3-T MRI of the carotid bifurcation and the brain. Carotid stenosis was considered asymptomatic if there were no clinically apparent ischemic events within the previous 6 months in the corresponding carotid territory.…”

Section: Methodsmentioning

confidence: 99%

Plaque Characteristics of Asymptomatic Carotid Stenosis and Risk of Stroke

et al. 2012

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Background: The optimal treatment of asymptomatic carotid stenosis (ACS) is controversial. To optimize the risk-benefit ratio of carotid artery revascularization, it is crucial to identify ACS patients who are at increased stroke risk. Recent data suggest that plaque vulnerability depends on its composition. Therefore, we assessed plaque composition in ACS to determine predictors for ipsilateral cerebrovascular events. Methods: 62 patients with 65 ACS ≥50% underwent 3-T MRI of the carotid bifurcation (TOF, special dark-blood weighted noncontrast and contrast-enhanced T₁ and T₂ images) and of the brain. The different plaque components (lipid core, intraplaque hemorrhage, calcification and the status of the fibrous cap) were assessed. Furthermore, the plaque volume and the volume of clinically silent cortical and subcortical infarcts in the territory of the stenosed carotid artery as seen on FLAIR images were determined by using a semi-automated software. Carotid stenosis was considered asymptomatic if there had not been any clinically apparent ischemic events in the corresponding vascular territory within the previous 6 months. During follow-up, information on the occurrence of cerebrovascular events, medical treatment and sonographic changes of the stenosis was collected. Results: At baseline, 24 ACS (37%) were classified as high grade. A lipid-rich necrotic core was the dominant plaque component in 16 ACS (25%). The plaque volume was higher in ACS with a lipid-rich necrotic core as dominant plaque component (p = 0.002) and in patients with prior stroke/TIA (p = 0.010). After a median follow-up of 18.9 months (interquartile range 3.5–30.1) there were 2 ipsilateral strokes and 3 ipsilateral TIAs. The average annual event rate was 7.7%. A lipid-rich necrotic core (HR 7.21; 95% CI 1.12–46.28; p = 0.037), sonographic progression of the stenosis (HR 7.00; 95% CI 1.13–41.34; p = 0.036), history of stroke (HR 11.03; 95% CI 1.23–99.36; p = 0.032), and the volume of clinically asymptomatic ischemic brain lesions (HR 1.14/cm³; 95% CI 1.03–1.25; p = 0.008) predicted cerebrovascular events. Patients on statin therapy at follow-up were at lower risk of events (HR 0.17; 95% CI 0.03–1.00; p = 0.05). Conclusions: In addition to medical history and sonographic findings, a lipid-rich necrotic core within the plaque turned out as a predictor of cerebrovascular events. Therefore, MR imaging of carotid plaques deserves further attention and might be helpful to improve risk stratification of asymptomatic carotid disease. The identified predictors could be combined in a risk model and tested in larger prospective studies.

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“…13 Several classifications of carotid stenosis degree have been proposed, according to PSV and end-diastolic velocity (EDV) in the ICA and PSV ICA/CCA ratios. [26][27][28][29][30][31][32][33][34][35][36][37][38] It is clear that choosing a velocity threshold affects sensitivity and specificity of the test; with lowered thresholds, sensitivity increases whereas specificity decreases, and vice versa. Achieving high sensitivity comes at the price of lowered specificity.…”

Section: Color Doppler Imagingmentioning

confidence: 99%

Diagnosing Carotid Stenosis by Doppler Sonography

Gaitini

Soudack

2005

Journal of Ultrasound in Medicine

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Objective. The goal of this review article is to present the state of the art in the clinical applications and technical performance and interpretation of carotid sonographic examinations. Methods. Relevant publications regarding color and duplex Doppler sonography (CDDS) of the carotid arteries extracted from a computerized database (MEDLINE) and from references cited in these articles not appearing on the Internet were reviewed. Results. The ability to quickly and efficiently identify stenosis in the carotid artery is an important goal for clinicians and vascular surgeons. Identification of potentially treatable carotid stenosis enables selection of appropriate candidates for endarterectomy or stent implantation. Advances in performance and interpretation of carotid sonographic studies over the last 20 years have been driven by technological improvements in gray scale and CDDS examinations and have made carotid sonography an important means to reach this goal. On the basis of CDDS, intimamedia thickness measurements and plaque location and characterization on gray scale imaging, flow disturbance and areas of stenosis on color Doppler sonography, and flow velocities on spectral Doppler sonography are obtained. The degree of the diameter of a stenosis of the internal carotid artery is the main parameter used for therapeutic approaches. Advantages and limitations of the method are included. Conclusions. Carotid sonography is a unique imaging method for the investigation of carotid abnormalities. Noninvasive, accurate, and cost-effective, it provides morphologic and functional information. It is increasingly becoming the first and often the sole imaging study before endarterectomy, whereas costly and invasive procedures are reserved for special cases.

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Duplex sonographic criteria for measuring carotid stenoses

Cited by 41 publications

References 29 publications

Age, abdominal obesity, and glycated hemoglobin are associated with carotid atherosclerosis in type 2 diabetes patients with nonalcoholic fatty liver disease

Age, abdominal obesity, and glycated hemoglobin are associated with carotid atherosclerosis in type 2 diabetes patients with nonalcoholic fatty liver disease

Plaque Characteristics of Asymptomatic Carotid Stenosis and Risk of Stroke

Diagnosing Carotid Stenosis by Doppler Sonography

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