Multicenter validation study of real-time (B-mode) ultrasound, arteriography, and pathologic examination

Ricotta, John J.; Bryan, Fred A.; Bond, M. Gene; Kurtz, Alfred B.; O’Leary, Daniel H.; Raines, Jeffrey K.; Berson, Alan S.; Clouse, Melvin E.; Calderon-Ortiz, Mauricio; Toole, James F.; DeWeese, James A.; Smullens, Stanton N.; Gustafson, Nancy

doi:10.1016/0741-5214(87)90312-0

Cited by 138 publications

(35 citation statements)

References 21 publications

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“…As previously described, 20,21 a 7.0-to 7.5-MHz duplex transducer was used to scan the common, internal, and external carotid arteries for discrete atherosclerotic plaques, 28 defined as the presence of a focal protrusion into the lumen at least 50% greater than the surrounding wall. Two-dimensionally guided M-mode recordings of the distal common carotid artery were recorded on videotape and subsequently digitized with a frame grabber and customized software (ARTSS©, Cornell Research Foundation, New York, NY).…”

Section: Echocardiography and Carotid Ultrasonographymentioning

confidence: 99%

Relation of Blood Pressure Variability to Carotid Atherosclerosis and Carotid Artery and Left Ventricular Hypertrophy

Roman

Pickering

Schwartz

et al. 2001

ATVB

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Abstract-The relationship of blood pressure (BP) variability to cardiovascular target-organ damage is controversial.Studies examining BP variability and left ventricular (LV) hypertrophy have been contradictory, and only limited data on the relation of BP variability to carotid atherosclerosis and carotid artery hypertrophy exist. BP variability was assessed as the standard deviation and coefficient of variation of awake and asleep pressures in 511 normotensive or untreated hypertensive subjects who underwent ambulatory BP monitoring and cardiac and carotid ultrasonography. Although the presence of focal carotid plaque was associated with an increase in ambulatory pressures and pressure variability, the differences in variability were eliminated by adjustment for age and absolute pressures. Similarly, LV mass was significantly related to BP variability, but the significance of this finding was eliminated after adjustment for important covariates. In multivariate analyses, age was the primary determinant of carotid artery cross-sectional area, with a weak but independent contribution from awake systolic and diastolic BP variability in addition to absolute pressure. BP variability was not independently related to either carotid or LV relative wall thickness, both measures of concentric remodeling. In the present study, awake BP variability was weakly but independently associated with carotid artery cross-sectional area, a measure of arterial hypertrophy. However, neither systolic nor diastolic BP variability was independently associated with carotid atherosclerotic plaque or LV mass. Key Words: blood pressure Ⅲ hypertension Ⅲ hypertrophy Ⅲ carotid arteries Ⅲ atherosclerosis B lood pressure (BP) variability is modulated by both intrinsic cyclic vasomotion and the impact of physical and mental activity 1 and is inversely related to baroreceptor reflex sensitivity, its primary determinant. 2 An increase in BP variability is additionally seen with aging and hypertension. 2,3 Whereas early studies of BP variability were based on intra-arterial recordings in selected subjects, the development of reliable, noninvasive, ambulatory BP monitoring has permitted more widespread study of its determinants and consequences. BP variability is most commonly quantified as the standard deviation (SD) of BP readings assessed during a particular activity or time period or as the coefficient of variation (CV; SD of blood pressure/mean pressure), which adjusts for the tendency of those with a higher average BP to also have a higher SD. 3,4 Two recent studies, one population based 4 and the other hospital based, 5 have suggested that an increase in BP variability (primarily manifested as an increase in daytime systolic BP variability) is associated with an increase in subsequent cardiovascular events 5 and cardiovascular mortality. 4 The mechanism of this relationship remains speculative but may involve an excess of underlying cardiovascular target-organ damage, including carotid atherosclerosis, as either a cause or a result of increase...

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Section: Echocardiography and Carotid Ultrasonographymentioning

confidence: 99%

Relation of Blood Pressure Variability to Carotid Atherosclerosis and Carotid Artery and Left Ventricular Hypertrophy

Roman

Pickering

Schwartz

et al. 2001

ATVB

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“…They have greatest validity if end points in the target vessel have been calibrated with specimens of known degrees of atherosclerosis. Angiograms of femoral 2 and carotid 15 arteries as well as ultrasound images of the carotid artery 1517 have been calibrated with autopsy and operative specimens. Individual lesions or vessel segments can be used as the experimental unit to reduce the number of subjects and cut study costs.…”

Section: Selection Of End-point Measuresmentioning

confidence: 99%

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

Blankenhorn

Hodis

1994

Arterioscler Thromb

202

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This review explores evidence for the reversibility of atherosclerosis and augmentation of angiography with noninvasive arterial wall imaging. Meta-analysis from coronary angiographic trials demonstrates that regression and stabilization are 1.5 to 2 times more common in treated than placebo subjects, and progression is reduced by half in treated subjects. Odds ratios for clinical coronary events are significantly reduced with treatment. Lesion improvement occurs more readily in women than men and more so in women receiving concomitant estrogen replacement therapy. Lesions with >50% diameter stenosis (%S) at baseline respond more readily to lipid lowering than those <50%S, whereas reduction in coronary events is related to stabilization of lesions <50%S. Lipoproteins have a differential effect on lesion progression according to lesion size, and triglyceride-rich lipoproteins play an important role in the progression of coronary artery lesions <50%S. Improved therapeutic regimens to alter progression of atherosclerosis may require adjunctive therapy, such as with antioxidants or hormone replacement therapy, in concert with low-density lipoprotein cholesterol reduction to prevent new lesion formation or early lesion progression. Sequential coronary angiographic determination of progression evaluated by both quantitative coronary angiography and global change score, a visual assessment of overall lesion change, predicts clinical coronary events. Only inferences about the state of the arterial wall can be made from angiography, because it delineates only the lumen. Therapy testing and study of atherosclerosis progression can be improved with noninvasive B-mode ultrasonographic imaging of the distal common carotid artery far-wall intima-media thickness (IMT), a reliable measure of early preintrusive atherosclerosis. Measurement of common carotid IMT is useful for the study of coronary artery risk factors and can augment studies of coronary artery intrusive lesions, because it is associated with coronary artery disease. B-mode measurement of common carotid IMT has the potential of serving as a noninvasive surrogate end point for clinical coronary events. Screening for peripheral vessel changes indicative of high risk for coronary artery disease is possible and cost-effective with the noninvasive procedures now available. (Arterioscler Thromb. 1994;14:177-192.) Key Words • atherosclerosis • angiography • ultrasound • regression • clinical trials • intima-media thickness • quantitative computerized angiography • common carotid artery • coronary arteries • meta-analysis E vidence that progression of atherosclerosis can be retarded and atherosclerotic lesions can regress derives from several sources. These sources include studies of arterial lesions obtained at autopsy from starved human populations, animal experimentation, and clinical trials using serial angiography. In the first half of this article, we review serial angiographic evidence for atherosclerotic lesion improvement induced by diverse modes of int...

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“…This observation may also to some extent explain why conventional catheter angiography and use of standard imaging planes is associated with a tendency to underestimate the degree of carotid stenosis. [5][6][7][8] The implications of the present study for carotid imaging are as follows: First, it is arguable that conventional catheter angiography should routinely include a reverse oblique projection, particularly in cases of moderate carotid stenosis. Second, it confirms the importance of obtaining angiographic projections in multiple planes in 3D imaging modalities and supports the routine use of 3D imaging, whether MR angiography, CT angiography, or rotational catheter angiography is used for the imaging of extracranial atherosclerotic disease.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that carotid atheroma is frequently eccentric 4 and that the accuracy of stenosis measurement may be limited by the use of 2D imaging techniques. [5][6][7][8] For this reason, 3D imaging techniques, including magnetic resonance (MR) angiography and CT angiography, have been suggested as the optimal form for the imaging of extracranial carotid disease. 9 -14 The purpose of the present study was to use CT angiography to determine the frequency of eccentric lumens in patients with significant carotid atheroma and to evaluate the effect that noncircular lumens have on stenosis measurement determined from angiographic reconstructions.…”

mentioning

confidence: 99%

Evaluation of Cross-Sectional Luminal Morphology in Carotid Atherosclerotic Disease by Use of Spiral CT Angiography

Porsche¹,

Walker²,

Mendelow³

et al. 2001

Stroke

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Background and Purpose-This study sought to determine the frequency of noncircular lumens in patients with significant carotid atherosclerotic disease and to evaluate the effect of noncircular lumens on stenosis measurement derived from angiographic projections. Methods-One hundred consecutive patients presenting with an internal carotid artery stenosis of at least 50% were imaged with spiral CT angiography. The transverse morphology of the diseased lumen was assessed on axial images, and the frequency of noncircular lumens was determined. In these cases, maximum intensity projection angiograms were reconstructed in standardized angiographic planes and in a plane selected according to the luminal obliquity, which was chosen to optimize the angiographic representation of the maximal stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) measurements were calculated from the maximum intensity projection images, and differences between values obtained from standard and optimized projections were recorded. Results-Noncircular lumens were observed in 18 of 100 patients and consisted of elliptical and linear transverse profiles.The transverse orientation of the lumen in these cases ranged from ϩ90°to Ϫ87°relative to the anteroposterior plane. An increase in the calculated NASCET stenosis was demonstrated when measurements were obtained from angiographic reconstructions obtained in the exact plane of the luminal obliquity compared with standard angiographic projections. As a result, the stenosis severity was upgraded from moderate to severe in 2 patients. Conclusions-Noncircular

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Multicenter validation study of real-time (B-mode) ultrasound, arteriography, and pathologic examination

Cited by 138 publications

References 21 publications

Relation of Blood Pressure Variability to Carotid Atherosclerosis and Carotid Artery and Left Ventricular Hypertrophy

Relation of Blood Pressure Variability to Carotid Atherosclerosis and Carotid Artery and Left Ventricular Hypertrophy

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

Evaluation of Cross-Sectional Luminal Morphology in Carotid Atherosclerotic Disease by Use of Spiral CT Angiography

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