OBJECTIVETo study the relationship between serum testosterone levels and the plaque formation of the carotid artery in a population-based cohort of independently living healthy women above 60 years of age.

METHODSAnalysis of the healthy elders from a population-based cohort study in 9 communities of Beijing. Carotid intima-media thickness and atherosclerotic plaques were determined ultrasonographically. Serum testosterone levels were measured by immunoassay. The data were analyzed with ANOVA and logistic regression analysis.

RESULTSThere was an inverse correlation between testosterone and plaque formation in old females (P < 0.01), while no association was found in males. Female with testosterone levels in the lowest quartile (< 0.49 nmol/L) had more risk of plaque formation (OR = 3.805, P < 0.01) after adjusted with age and other traditional factors of atherosclerosis.

CONCLUSIONTestosterone concentrations are negatively associated with carotid artery atherosclerosis in old women in Beijing, experimental and prospective studies are needed to determine the possible therapeutic role of testosterone in atherosclerosis.

Aged ; Atherosclerosis ; blood ; Carotid Arteries ; pathology ; Carotid Intima-Media Thickness ; Carotid Stenosis ; blood ; Female ; Humans ; Male ; Prospective Studies ; Testosterone ; blood

PURPOSE: To test hypothesis that pre-stenting measurement of reactivity index by using acetazolamide-challenged CT perfusion could identify patients at risk for hyperperfusion after carotid stenting. MATERIALS AND METHODS: For 24 regions of interest in 12 patients with symptomatic unilateral high-grade carotid stenosis, asymmetric indexes for cerebral blood volume, cerebral blood flow, and mean transit time and reactivity index were calculated from resting and acetazolamide-challenged CT perfusion before and 1 day after carotid stenting. We subsequently compared pre-stenting asymmetric indexes and reactivity index with percent increase of cerebral blood flow 1 day after carotid stenting. RESULTS: Percent increase of cerebral blood flow on the first post-stenting day was not significantly different between visually decreased and normal cerebrovascular reserve groups. There was no significant correlation between pre-stenting asymmetric indexs of resting CT perfusion parameters and percent increase of cerebral blood flow 1 day after carotid stenting. On the other hand, pre-stenting reduction of reactivity index showed fair correlation with 1 day cerebral blood flow increase. However, hyperperfusion or hyperperfusion syndrome was not observed in any patient with reduced reactivity index. CONCLUSION: Pre-stenting measurements of resting CT perfusion parameters and reactivity index could not predict hyperperfusion after carotid stenting. However, pre-stenting reduction of reactivity index seems to fairly correlate with immediate post-stenting cerebral blood flow increase. Further studies with larger population should be performed to validate this preliminary result.
Blood Volume ; Brain* ; Carotid Stenosis ; Hand ; Humans ; Perfusion* ; Stents*

OBJECTIVE: This study aimed to investigate the relationship between alkaline phosphatase (ALP) and common carotid intima media thickness (IMT), carotid plaque, and extracranial carotid artery stenosis (ECAS). METHODS: A total of 3,237 participants aged ⪖ 40 years were recruited from Jidong community in 2013-2014. Participants were divided into five quintile groups based on their serum ALP levels. Carotid atherosclerosis was assessed using ultrasound. Abnormal IMT, carotid plaque, and ECAS were defined as IMT > 0.9 mm, IMT > 1.5 mm, and ⪖ 50% stenosis in at least one extracranial carotid artery, respectively. RESULTS: Common carotid IMT values and the prevalence of carotid plaque increased across serum ALP quintiles. Higher ALP quintiles were correlated with an increased risk of abnormal IMT [fourth quintile: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.13-2.82, P = 0.0135; fifth quintile: OR = 1.82, 95% CI: 1.15-2.87, P = 0.0110] and ECAS compared to the lowest quintile (fifth quintile: OR = 1.47, 95% CI: 1.09-1.97, P = 0.0106). The association between ALP and prevalence of carotid plaque became insignificant after adjustment for confounders. CONCLUSION Serum ALP levels were independently associated with abnormal common carotid IMT and ECAS. These conclusions need to be further corroborated in future prospective cohort studies.
Adult ; Aged ; Alkaline Phosphatase ; blood ; Carotid Artery Diseases ; blood ; diagnostic imaging ; Carotid Intima-Media Thickness ; Carotid Stenosis ; blood ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged

Carotid ultrasound is an imaging modality that allows non-invasive assessment of vascular anatomy and function. Carotid intima-media thickness (IMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. However, in 2013, American College of Cardiology/American Heart Association guidelines designated that the carotid IMT as class III evidence level was not recommended for use in clinical practice as a routine measurement of risk assessment for a first atherosclerotic CV event. Following the announcement of this guideline, combined common carotid IMT and plaque, including plaque tissue characterization and plaque burden, using 3D ultrasound was reported to be better than either measurement alone in a variety of studies. Moreover, changes in the intima thickness were related to aging and early atherosclerosis, and remodeling of the media thickness was associated with hypertension. Separate measurement is useful for evaluating the effects of different atherosclerotic risk factors on the arterial wall; however, a more detailed and elaborate technique needs to be developed. If so, separate measurement will play an important role in the assessment of atherosclerosis and arterial wall change according to a variety of risk factors, such as metabolic syndrome. In addition, although carotid blood flow velocity is a useful tool for risk classification and prediction in clinical practice, further clinical research is needed. The value of carotid IMT by ultrasound examination for risk stratification remains controversial, and groups developing future guidelines should consider the roles of plaque presence and burden and hemodynamic parameters in additional risk stratification beyond carotid IMT in clinical practice.
Aging ; Atherosclerosis* ; Blood Flow Velocity ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Carotid Stenosis ; Classification ; Heart ; Hemodynamics ; Hypertension ; Methods* ; Risk Assessment ; Risk Factors ; Ultrasonography*

Interleukin (IL)-8 and vascular endothelial growth factor (VEGF) are important factors that induce the migration and proliferation of endothelial cells, increase the vascular permeability, and the modulate chemotaxis of monocytes. These molecules have been found in human atherosclerotic plaques. However, it is not clear whether the circulating levels of IL-8 and VEGF correlate with the extents of carotid stenosis. In this study, we investigated the relationship between circulating levels of IL-8 as well as VEGF and the extents of carotid stenosis. Sera from 41 patients with carotid stenosis were assessed for concentrations of IL-8 and VEGF by enzyme-linked immunosorbent assay. The degree of stenosis of extracranial carotid artery was calibrated by carotid B- mode ultrasonography. The serum concentration of IL-8 (r=-0.04733, p>0.05) was not correlated with the degree of stenosis. However, the serum concentration of VEGF (r=0.4974, p<0.01) was significantly correlated with the degree of carotid stenosis. These findings suggest that increased serum level of VEGF might be a marker for higher degree of stenosis of extracranial carotid artery.
Adult ; Aged ; Carotid Artery Diseases/blood ; Carotid Stenosis/*blood ; Disease Progression ; Endothelial Growth Factors/*blood ; Female ; Human ; Interleukin-8/*blood ; Lymphokines/*blood ; Male ; Middle Age

The aim of this article is to review the results of recent researches with regard to risk factors or primary prevention of stroke. We have discussed the contribution of various risk factors to the burden of stroke, variability in blood pressure, intensive glycemic control, lipid management, management of asymptomatic carotid stenosis, vitamin B supplements lowing homocysteine, lifestyle factors, and aspirin efficacy for primary prevention of stroke.
Aspirin ; Blood Pressure ; Carotid Stenosis ; Homocysteine ; Life Style ; Primary Prevention ; Risk Factors ; Stroke ; Vitamins

BACKGROUND: Platelet activation has an important role in the progression of atheroclerosis and acute ischemic events. In this study, in order to know the significance of platelet functions in a large artery atherosclerotic infarction, we evaluated the serial changes of platelet aggregability in patients with a large artery atherosclerotic infarction. METHODS: We serially (within 24 hrs, at 72 hrs, and 7 days) measured the extents of platelet aggregation to ADP and collagen in 43 patients with acute ischemic stroke (LAA-22, SVD-21) and compared them with those in patients with asymptomatic carotid stenosis (n=20) and in normal controls (n=24). RESULTS: The extents of platelet aggregation to ADP and collagen were significantly increased in large artery atherosclerotic infarctions compared to small vessel disease. These differences of platelet aggregability between the two groups were maintained for seven days after an ischemic event. However, the platelet aggregability was not different between large artery atherosclerotic infarctions and asymptomatic carotid stenosis. CONCLUSIONS: This data suggests that increased platelet aggregability is important in large artery atherosclerotic infarction and is caused by pre-existing atherosclerotic changes rather than acute ischemic events.
Adenosine Diphosphate ; Arteries ; Atherosclerosis ; Blood Platelets* ; Carotid Stenosis ; Collagen ; Humans ; Infarction ; Platelet Activation ; Platelet Aggregation* ; Stroke*

OBJECTIVETo investigate the relationship between a blood pressure variability (BPV)-based scoring system (BPVSS) and the target organ damage in patients with hypertension.

METHODSWe selected 95 consecutive inpatients with essential hypertension admitted between January and June, 2015 in the Department of Cardiology of Guangzhou General Hospital of Guangzhou Military Command. The BPV indices were analyzed for their correlation with the parameters of target organ damage (IVSd, LVPWd, baPWV_L/R, and IMT_L/R). The patients with a BPVSS of 3.9 or higher (control, 43 cases) and those with a lower BPVSS (observation group, 52 cases) were compared for differences in IVSd, LVPWd, baPWV_L/R, IMT_L/R and the proportion of carotid plaques.

RESULTSSimilar with the traditional BPV indices, BPVSS was negatively correlated with IMT_L/R (r=-0.278/-0.324, P<0.05). BPVSS was also negatively correlated with IVSd (r=-0.241), LVPWd (r=-0.223), and baPWV_L/R (r=-0.468/-0.373) (P<0.05). IVSd, LVPWd, baPWV_L/R and IMT_L/R were all significantly higher in the observation group than in the control group (t=2.307, 2.516, 3.250/2.790, and 2.372/3.425, respectively; P<0.05). The proportion of carotid plaques in the observation group was significantly higher than that in the control group (Χ(2)=27.833, P<0.001).

CONCLUSIONBPVSS indicates the severity of target organ damage in patients with hypertension. A greater BPV is correlated with a lower BPVSS score and more severe damages of the heart and blood vessels.

Blood Pressure ; Carotid Stenosis ; diagnosis ; pathology ; Essential Hypertension ; Humans ; Hypertension ; pathology

To investigate cerebral autoregulation(CA)in patients with severe unilateral carotid artery stenosis by near infrared spectroscopy. Thirty patients who underwent general anesthesia in our hospital from January 2015 to February 2017 were enrolled in this study.The stenosis group included 15 patients with severe unilateral internal carotid artery stenosis,and the control group included 15 patients without carotid artery stenosis.Both groups were matched in sex and age.Cerebral tissue oxygenation index(TOI)and mean arterial pressure were recorded continuously under stable general anesthesia.The Pearson correlation coefficient()was calculated to judge the CA status. TOI was not significantly different between the stenosis side and the non-stenosis side in the stenosis group(66.52±6.50 65.23±4.50;=0.93, =0.368)or between the stenosis side in the stenosis group and the stenosis side in the control group(66.52±6.50 64.22±3.87;=1.18, =0.248).The values of stenosis side and non-stenosis side in the stenosis group were 0.36±0.12 and 0.17±0.11,respectively,and the values of the stenosis side in the stenosis group and the stenosis side of the control group were 0.36±0.12 and 0.13±0.08,respectively.In the stenosis group,5 patients had transient ischemic attack and 2 patients had a history of stroke within 3 months before operation.When an value of 0.342 was used as the judgment point of CA abnormality,the sensitivity and specificity were 0.625 and 0.909,respectively. Within the range of normal blood pressure fluctuation,cerebral blood flow is linked to blood pressure at the stenosis side in patients with severe unilateral carotid artery stenosis.
Blood Pressure ; Carotid Stenosis ; Cerebrovascular Circulation ; Homeostasis ; Humans ; Ischemic Attack, Transient

OBJECTIVE: To correlate quantitative cerebrovascular reserve calculated by acetazolamide - challenged CT perfusion with clinical symptoms in hemodynamically compromised patients with high-grade (>70%) carotid stenosis, who did not have evidence of embolic stroke. MATERIALS AND METHODS: 37 patients diagnosed as unilateral severe carotid stenosis and 10 age-matched normal controls underwent acetazolamide - challenged CT perfusion. For quantitative measurement, asymmetric index of cerebral blood flow, cerebral blood volume, and mean transit time were determined before and after acetazolamide challenge. Reactivity index was also calculated from asymmetric index of cerebral blood flow before and after acetazolamide challenge. RESULTS: On visual analysis, all of 14 asymptomatic patients and 4 of 23 symptomatic patients showed bilateral symmetric cerebrovascular reserve on CT perfusion, and 19 symptomatic patients showed decreased cerebrovascular reserve ipsilateral to carotid stenosis. On quantitative analysis, the reactivity index was significantly different between the symptomatic and the asymptomatic groups (-24% vs -8% in external border zone) but the resting parameters were not. 11 patients with decreased cerebrovascular reserve who underwent carotid stenting showed improved clinical symptoms and quantitative cerebrovascular reserve on follow up CT perfusion. CONCLUSION: Compared with resting hemodynamic parameters, quantitative cerebrovascular reserve calculated by CT perfusion is most significantly correlated with clinical symptoms in hemodynamically compromised patients with high-grade carotid stenosis.
Acetazolamide ; Blood Volume ; Carotid Stenosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Perfusion ; Stents