Evaluating the Carotid Plaque: Going beyond Stenosis

Chalela, Julio A.

doi:10.1159/000200438

Cited by 48 publications

(38 citation statements)

References 35 publications

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“…Collateral status in intracranial atherosclerosis app ears to differentiate cases beyond currently employed variables, providing an opportunity as a novel biomarker for this disorder (Chalela, 2009). Clinical correlates of collaterals were not evident in our study, suggesting the inherently complex nature of collateral flow.…”

Section: Collaterals As Biomarkermentioning

confidence: 55%

Collateral Circulation in Symptomatic Intracranial Atherosclerosis

Liebeskind

Cotsonis

Saver

et al. 2010

J Cereb Blood Flow Metab

109

107

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Collateral circulation in intracranial atherosclerosis has never been systematically characterized. We investigated collaterals in a multicenter trial of symptomatic intracranial atherosclerotic disease. Baseline angiography was reviewed for information on collaterals in stenoses of the internal carotid, middle cerebral, vertebral, and basilar arteries. A battery of angiographic scales was utilized to evaluate lesion site, arterial patency, antegrade flow, downstream territorial perfusion, and collateral circulation, blinded to all other data. Collateral circulation was adequately available for analysis in 287/569 (50%) subjects with proximal arterial stenoses ranging from 50% to 99%. Extent of collaterals was absent or none in 69%, slow or minimal in 10%, more rapid, yet incomplete perfusion of territory in 7%, complete but delayed perfusion in 11%, and rapid, complete collateral perfusion in 4%. Extent of collateral flow correlated with percentage of stenosis (P < 0.0001), with more severe stenoses exhibiting greater compensation via collaterals. Overall, collateral grade increased with diminished antegrade flow across the lesion (thrombolysis in myocardial ischemia) and resultant downstream perfusion (thrombolysis in cerebral infarction) (both P < 0.001). Our findings provide the initial detailed description of collaterals across a variety of stenoses, suggesting that collateral perfusion is a pivotal component in pathophysiology of intracranial atherosclerosis and implicating the need for further evaluation in ongoing studies.

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Section: Collaterals As Biomarkermentioning

confidence: 55%

Collateral Circulation in Symptomatic Intracranial Atherosclerosis

Liebeskind

Cotsonis

Saver

et al. 2010

J Cereb Blood Flow Metab

109

107

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“…Several imaging techniques, including sonography, MRI and MDCT, can be used to analyze the constitutions of carotid plaques [23,24]. For instance, echolucent carotid plaques on B-mode ultrasound are associated with procedural embolization [25] and neurological complications during CAS [26].…”

Section: Discussionmentioning

confidence: 99%

Fibro-Fatty Volume of Culprit Lesions in Virtual Histology™ Intravascular Ultrasound Is Associated with the Amount of Debris during Carotid Artery Stenting

et al. 2010

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Objectives: This study aimed to evaluate the relationship between the amount of aspirated debris during distal balloon-protected carotid artery stenting (CAS) and the pre-intervention plaque composition, as assessed by Virtual Histology™ (VH) intravascular ultrasound (IVUS). Methods: The study subjects were 25 consecutive patients (mean age, 73.0 ± 5.2 years; 20 males and 5 females) who underwent CAS under distal balloon protection. The average rate of carotid stenosis was 74.6 ± 12.9% by North American Symptomatic Carotid Endarterectomy Trial criteria. We assessed culprit plaque components by VH-IVUS before CAS. Aspirated debris was filtered, stained with HE and mounted onto glass slides. The quantity of debris was evaluated by measuring its surface area. We evaluated the relationship between the quantity of aspirated debris and VH-IVUS measurements before CAS. Results: The amount of debris during CAS was positively correlated with the total plaque volume in grayscale IVUS (Rs = 0.480, p = 0.015) and fibro-fatty volumes over the entire lesion length in VH-IVUS (Rs = 0.561, p = 0.001). Conclusions: Culprit lesions with large plaque volumes, especially larger fibro-fatty volumes, as imaged by VH-IVUS, are associated with large amounts of debris during balloon-protected CAS.

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“…Advanced atherosclerotic lesions of carotid arteries are highly vulnerable and often lead to ischemic events [1,2,3,4]. Degradation of extracellular matrix components particularly by matrix metalloproteinases (MMPs), together with an increased inflammatory reaction is the main reason for plaque progression to rupture and consequent neurological symptoms [3,5,6].…”

Section: Introductionmentioning

confidence: 99%

Multiple Biological Predictors for Vulnerable Carotid Lesions

Pelisek¹,

Rudelius²,

Zepper

et al. 2009

Cerebrovasc Dis

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Background: In this study a multiscore analysis of various biomarkers including matrix metalloproteinases (MMPs), inflammatory factors and other clinical parameters was performed to establish a set of reliable biomarkers for improved detection of plaque instability in patients with advanced carotid stenosis. Methods: Study patients (n = 101) were classified as histologically stable (n = 37) or unstable (n = 64). Serum levels of MMP-1, -2, -3, -7, -8, -9, MMP inhibitors TIMP-1, -2, and inflammatory factors such as tumor necrosis factor (TNF-α), interleukin (IL)-1β, -6, -8, -10, and -12 were measured by ELISA assays. Multiscore analysis was performed using multiple receiver operating characteristics analysis and determination of appropriate cutoff values. Results: Circulating levels of MMP-1, -7, TIMP-1, TNF-α, and IL-8 were significantly enhanced in patients with unstable plaques compared to individuals with stable lesions, mean differences being 1.2 (p = 0.032), 2.5 (p = 0.004), 30.0 (p = 0.014), 1.3 (p = 0.047), and 2.2 (p = 0.033), respectively. The combination of MMP-1, -7, TIMP-1 and IL-8 demonstrated the highest positive predictive value of 89.4% and negative predictive value of 60.1% for patients correctly classified as individuals with unstable and stable carotid lesions by means of blood sample analysis. Conclusions: Multiple relevant biomarkers that play a decisive role in plaque instability can improve the correct determination of vulnerable carotid plaques in patients with advanced carotid artery stenosis.

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Evaluating the Carotid Plaque: Going beyond Stenosis

Cited by 48 publications

References 35 publications

Collateral Circulation in Symptomatic Intracranial Atherosclerosis

Collateral Circulation in Symptomatic Intracranial Atherosclerosis

Fibro-Fatty Volume of Culprit Lesions in Virtual Histology™ Intravascular Ultrasound Is Associated with the Amount of Debris during Carotid Artery Stenting

Multiple Biological Predictors for Vulnerable Carotid Lesions

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