OBJECTIVETo investigate the difference in the vulnerability of carotid atherosclerotic plaques in patients with unilateral and bilateral intraplaque hemorrhage (IPH).

METHODSA retrospective analysis was conducted among 44 patients with unilateral IPH (30 cases) or bilateral IPH (14 cases) in the carotid plaques detected by magnetic resonance imaging (MRI) in our hospital between December, 2009 and December, 2012. The age, maximum wall thickness and incidence of fibrous cap rupture were compared between the two groups.

RESULTSCompared with those with unilateral IPH, the patients with bilateral IPHs had a significantly younger age (66.6∓9.4 years vs 73.7∓9.0 years, P=0.027), a significantly greater maximum plaque thickness (6.3∓1.9 mm vs 5.0∓1.3 mm, P=0.035) and a higher incidence of ulcers (50% vs 13.3%, P=0.025). Logistic regression analysis revealed a significant association between bilateral IPHs and the occurrence of ulcer with an odd ratio (OR) of 6.5 (95% confidence interval [CI]: 1.5-28.7, P=0.014). After adjustment for gender in Model 1, bilateral IPHs were still significantly associated with presence of ulcer (OR=5.7, 95%CI: 1.1-29.2, P=0.036). But after adjustment for age (P=0.131) or maximum plaque thickness (P=0.139) in model 2, no significant correlation was found between bilateral IPHs and the presence of ulcer.

CONCLUSIONCompared with patients with unilateral IPH, those with bilateral IPHs are at a younger age and have a greater plaque burden and a higher incidence of fibrous cap rupture, suggesting a greater vulnerability of the carotid plaques in patients with bilateral IPHs.

Aged ; Carotid Arteries ; diagnostic imaging ; Carotid Stenosis ; diagnostic imaging ; physiopathology ; Fibrosis ; Hemorrhage ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Odds Ratio ; Plaque, Atherosclerotic ; diagnostic imaging ; Retrospective Studies

OBJECTIVE: To evaluate the differences of plaquecomposition and volume between symptomatic and asymptomatic patients with carotid artery stenosis by multi-detector computed tomography angiography (MDCTA). METHODS: The consecutive patients with internal carotid artery stenosis≥70% diagnosed by digital subtraction angiography (DSA) were retrospectively analyzed from July 2011 to December 2015 in Peking University China-Japan Friendship School of Clinical Medicine. The symptomatic patients were defined as those who experienced nondisabling ischemic stroke or transient cerebralis chemic symptoms, including hemispheric events oramaurosis fugaxin the last 6 months. Otherwise, the patients were considered as a symptomatic. A total of 78 patients were enrolled in the study. Of these patients, there were 35 asymptomatic patients (44.9%) and 43 symptomatic patients (55.1%). All the patients received MDCTA before DSA. According to the plaque analysis of post processing work station, carotid plaques were divided into lipid-rich necrotic coreplaques (HU≤60), fibrous plaques (60 to 130 HU) and calcified plaques (HU≥130) through the different value sthreshold of HU. The plaque volume and proportion were all calculated. The differences between the two groups were compared by statistical methods. RESULTS: The proportion of calcified plaques in asymptomatic patients was significantly higher than in symptomatic patients (t=2.760, P=0.007).And the proportion of LRNC plaqueswas lower than that in symptomatic patients (Z=2.009, P=0.044). There was statistical significance between the asymptomatic and symptomatic patients. Multivariate analysis showed that there was a positive correlation between the proportion of calcified plaques and asymptomatic carotid artery stenosis (OR=0.949; 95%CI: 0.915 to 0.985; P=0.005). The proportion of LRNC plaques showed a negative correlation with asymptomatic carotid artery stenosis (OR=1.068; 95%CI: 1.021 to 1.117; P=0.004). For the symptomatic patients, when the LRNC plaque proportion was greater than 30.3%, the specificity was 94.3%, and the sensitivity was 37.2%. There was no significant difference in plaque volume and fibrous plaque proportion in both groups. CONCLUSION Compared with symptomatic carotid plaques, the proportion of asymptomatic calcified plaques increased but the proportion of LRNC plaques decreased. Plaque LRNC 30.3% of the total volume may represent a clinically useful cutoff. For the patients with carotid artery stenosis, MDCTA may help noninvasively risk-stratify patients.
Carotid Arteries ; Carotid Stenosis/diagnostic imaging* ; China ; Computed Tomography Angiography ; Humans ; Plaque, Atherosclerotic/diagnostic imaging* ; Retrospective Studies

OBJECTIVETo demonstrate the abnormal intima rotation pattern of the carotid atherosclerosis plaque using velocity vector imaging, and to develop a new method for the clinical mechanical state assessment of the plaque intima.

METHODSThe rotation movement and rotation angle on the serial dynamic ultrasonic short-axis gray scale views of 48 isolated atherosclerosis plaques (i. e., upstream, midstream, and downstream) and nearby reference segments of carotid artery in 46 patients were derived and analyzed using a dedicated velocity vector imaging workstation. The incidence of intima rotation movement and the rotation angle at different sections of the plaque and nearby reference segments before and after the standard grip stress test during systole and diastole respectively were counted and measured.

RESULTSBefore and after the stress test, the intima rotation movement occurred at the majority of the short-axis sections of the plaque and the nearby reference segments during cardiac cycle. Before the stress test, the incidence of intima rotation movement at the upstream section of the plaque during systole was significantly higher than that of reference segment (P = 0.036) The reversal direction of the intima rotation at those sections and reference segment during systole and diastole was demonstrated. After the stress test, the incidence of intima rotation movement at the midstream section of the plaque during diastole was significantly lower than that of reference segment (P = 0.031). The incidence of the intima rotation movement changed at the sections of upstream, midstream, and downstream of the plaque before and after the stress test also were explored (i. e., increased in systole and decreased in diastole) except the reference segment intima.

CONCLUSIONSThe intima rotation movement occurs at the majority of the isolated plaque and nearby reference segment, and the incidences of the intima rotation movement at the plaque is different from that of the reference segment during systole and diastole respectively. The abnormal pattern of intima rotation movement may be used to indicate the unstable mechanical state of the isolated plaque intima.

Carotid Arteries ; diagnostic imaging ; physiopathology ; Carotid Stenosis ; diagnostic imaging ; physiopathology ; Echocardiography, Stress ; Exercise Test ; Humans ; Rotation ; Tunica Intima ; diagnostic imaging ; physiopathology

OBJECTIVETo evaluate the relationship between coronary artery stenosis and internal carotid artery, vertebral and basilar artery stenosis using computed tomographic angiography.

METHODSThe imaging and clinical data of 84 patients who underwent coronary, head and cervical computed tomographic angiography in our hospital between September 2008 and June 2010 were retrospectively analyzed. Segment stenosis scoring was performed to quantify the degree of stenosis of coronary arteries. The relationship between the segment stenosis scoring and the degree of stenosis for internal carotid artery, vertebral and basilar artery was analyzed.

RESULTThe coronary segment stenosis scores were significantly correlated with the degree of stenosis for internal carotid artery, vertebral and basilar artery (r=0.450 and 0.475,P<0.05) .

CONCLUSIONThe degree of the stenosis of coronary artery is associated with the stenosis of internal carotid artery, vertebral and basilar artery, which can be confirmed by computed tomographic angiography."

Aged ; Angiography ; methods ; Carotid Artery, Internal ; diagnostic imaging ; Carotid Stenosis ; diagnostic imaging ; Coronary Stenosis ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods ; Vertebrobasilar Insufficiency ; diagnostic imaging

OBJECTIVETo assess the accuracy of computed tomography angiography (CTA) in quantifying atherosclerotic area in the vascular wall of the carotid artery in comparison with high-resolution magnetic resonance imaging (MRI).

METHODSEighteen subjects (15 males and 3 females aged 63-/+8 years) with >or=50% stenosis in at least one carotid artery were enrolled in this study. CTA and high-resolution MRI scans (in-plane pixel size of 0.25 mmx0.25 mm for both) were conducted within 1 week on a multi-slice spiral CT scanner and a 1.5T MR scanner (Signa, GE Medical Systems), respectively. CTA images were matched with MR images with the carotid bifurcation as the mark. For each patient, multiple matched slices with carotid atherosclerotic plaques in the bilateral carotid arteries were selected to measure the outer wall boundary (OWB) area, lumen area and wall area. Bland-Altman analysis and Pearson correlation coefficients were used to analyze the correlations of the area measurements between CTA and high-resolution MRI.

RESULTSA wide range of lesion size (vascular wall area) was found in these patients. Strong correlations were noted between CTA and high-resolution MRI with the correlation coefficients for OWB area, lumen area and wall area of 0.98, 0.98 and 0.96, respectively. The mean differences between CTA and high-resolution MRI were 0.16-/+5.71 mm(2), 4.47-/+1.44 mm(2) and -4.31-/+5.73 mm(2) for OWB area, lumen area and wall area, respectively.

CONCLUSIONCompared to high-resolution MRI, CTA is also a reliable method to measure carotid vascular wall area. CTA might become an alternative modality to high-resolution MRI for follow-up examination of patients with carotid artery atherosclerosis, especially in uncooperative patients or patients with contra-indications for MRI.

Aged ; Angiography ; methods ; Carotid Artery Diseases ; diagnostic imaging ; pathology ; Carotid Stenosis ; diagnostic imaging ; pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, Spiral Computed ; methods

OBJECTIVETo explore the relationship between clinical ischemic events and carotid calcification detected by 64 slices CT angiography.

METHODSWe retrospectively analyzed the carotid calcified plaques in 116 patients underwent the 64 slices CT angiography. The relationship between the carotid calcification and the clinical ischemic events was analyzed.

RESULTSA total of 377 plaques were detected and the incidence of carotid plaque calcification was 63.40%. Incidence of plaque calcification was significantly lower in patients with ages < 50 years than that in patients with ages 51 - 59 years, 60 - 69 years and higher than 70 years (P = 0.003, P = 0.002, P = 0.000, respectively). The incidence of plaque calcification in the common carotid artery was significantly lower than the carotid bifurcation (P = 0.000) and the internal carotid artery (P = 0.000). The incidences of calcification in the mild, moderate and severe degree of stenosis and occlusion were 46.54%, 33.33%, 26.67% and 0% respectively. The distribution of intraplaque calcium was similar between patients with ischemic event and non-ischemic event group. However, the incidence of calcification was significantly lower patients with ischemic event than that in patients without ischemic event (30.34% vs. 43.10%, P = 0.013). Calcified plaque was negatively associated with ischemic event (beta = -0.688, P = 0.006).

CONCLUSION64 slices CT angiography can analyze the characterization of carotid plaque calcium.

Age Factors ; Aged ; Calcinosis ; complications ; diagnostic imaging ; epidemiology ; Carotid Stenosis ; complications ; diagnostic imaging ; Humans ; Incidence ; Middle Aged ; Myocardial Ischemia ; complications ; diagnostic imaging ; Retrospective Studies ; Tomography, Spiral Computed ; methods

OBJECTIVETo investigate the effect of Purified Xuefu Capsule (PXC) on ultrasonographic figures in patients with carotid atherosclerosis (CAS).

METHODSNinety-two patients with CAS were randomly divided into two groups, the 45 patients in the treated group were treated by conventional western medicine with additional PXC, the 47 patients in the control group were given conventional western medicine alone. One month's treatment was regarded as one course, and three courses of treatment were given successively to both groups. Carotid ultrasonography was performed before and after treatment, and the figures were compared.

RESULTSThe thickness of endangium, average number of plaques, plaque scores, plaque volume index and length of the biggest soft plaque or mixed plaques, stenosis rate of vascular area, and the resistant index of blood vessels were decreased after treated with PXC for 3 months in the treated group. The differences of these indexes in the treated group before and after treatment, and that between the treated group and the control group after treatment were significant (P < 0.01).

CONCLUSIONPXC can improve hemodynamics and eliminate atherosclerotic plaque to a certain degree, so it has definite effect for prevention and treatment of CAS.

Aged ; Capsules ; Carotid Arteries ; diagnostic imaging ; Carotid Artery Diseases ; diagnostic imaging ; drug therapy ; Carotid Stenosis ; diagnostic imaging ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Ultrasonography, Doppler, Color

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

OBJECTIVETo study the effect of Xiaoyu Tablet (XYT) on blood flow parameters and morphology of carotid artery in atherosclerotic patients.

METHODSUsing color Doppler ultrasonographic technique to examine the blood flow parameters and intimal thickness of carotid artery in 20 patients of carotid atherosclerosis after 24 weeks treatment of XYT, and compared with those in 10 patients treated with gastrodine lipid-lowering tablet.

RESULTSAfter 24 weeks treatment, blood flow parameters of carotid artery were obviously improved and intimal thickness of common carotid arteries in both side was markedly decreased. XYT showed an effect better than that of gastrodine lipid-lowering tablet.

CONCLUSIONXYT is effective in increasing blood flow of cervical and cerebral arteries.

Arteriosclerosis ; diagnostic imaging ; drug therapy ; physiopathology ; Blood Flow Velocity ; Carotid Arteries ; diagnostic imaging ; pathology ; Carotid Stenosis ; diagnostic imaging ; pathology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Tablets ; Tunica Intima ; pathology ; Ultrasonography, Doppler, Color

OBJECTIVETo illustrate the morphological characteristics of atherosclerotic lesions of the internal carotid artery.

METHODSThe morphological characteristics of cervicocerebral atherosclerotic lesions in digital subtracted angiography were retrospectively reviewed in 120 cases.

RESULTSTotally 217 atherosclerotic lesions were detected. Of all the lesions, moderately and severely stenosed lesions accounted for 62.21% and mild stenosed lesions for 37.79%; long lesions were found in 18.89% and short ones in 81.11%; 37.33% of the lesions were ulcerated while 62.67% were non-ulcerated; 13.36% were angulated lesions and 86.64% non-angulated; 50.23% were eccentric lesions and 49.77% were concentric; lesions with adjacent artery dilation were found in 9.22%, and lesions without with adjacent artery dilation in 90.78%.

CONCLUSIONThe atherosclerotic lesions are characterized by moderate to severe stenosis and non-ulcerated, non-angulated, eccentric lesions without adjacent artery dilation.

Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; methods ; Atherosclerosis ; diagnostic imaging ; pathology ; Carotid Artery, Internal ; diagnostic imaging ; pathology ; Carotid Stenosis ; diagnostic imaging ; pathology ; China ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies