Efficacy of Different Types of Self-expandable Stents in Carotid Artery Stenting for Carotid Bifurcation Stenosis

Both open and closed loop self-expandable stents were used in carotid artery stenting（CAS） for carotid bifurcation stenosis. We sought to compare the efficacy of two types of stents in CAS. The data of 212 patients treated with CAS（42 and 170 cases implanted with closed and open loop stents, respectively） for carotid bifurcation stenosis and distal filtration protection devices were retrospectively analyzed. Between closed and open loop stents, there were no significant differences in hospitalization duration, NIHSS score before and after the treatment, stenosis at 12 th month, and cumulative incidence of primary endpoint events within 30 days or from the 31 st day to the 12 th month; while there were significant differences in hemodynamic changes and rate of difficulty in recycling distal filtration protection devices. Use of open vs. closed loop stents for carotid bifurcation stenosis seems to be associated with similar incidence of complications, except for greater rate of hemodynamic changes and lower rate of difficulty in recycling the distal filtration protection devices.

Retinal emboli

Retinal emboli are opacities identified in retinal arterioles and are often incidental findings on ophthalmic examination. They are generally composed of cholesterol, platelet-fibrin, or calcium and are thought to arise from carotid arteries, coronary arteries, or cardiac valves. In the general population, the estimated prevalence is 0.2% to 1.3%, and the estimated incidence is 0.9% to 2.9%. The transient nature of retinal emboli likely explains the variations between and within these reported figures. The strongest risk factor for retinal emboli is smoking, which has been reported consistently across many studies. Other likely risk factors include older age, hypertension, male sex, total cholesterol, coronary artery disease, and history of coronary artery bypass grafting. The presence of multiple risk factors, as is common in many patients, confers a higher risk for retinal emboli. Several studies suggest that retinal emboli predict an increase in stroke-related, all-cause, and possibly cardiovascular mortality. Due to these sequelae, patients often undergo further workup, most commonly carotid ultrasonography. However, given the low prevalence of significant carotid disease in patients with retinal emboli, further workup, such as carotid ultrasound, should be reserved for those with risk factors for carotid disease. All patients would benefit from medical optimization and coordinated care with the primary care physician.

Association between Nonalcoholic Fatty Liver Disease and Carotid Artery Disease in a Community-Based Chinese Population： A Cross-Sectional Study

Background： Nonalcoholic fatty liver disease （NAFLD） is one of the most common chronic liver diseases with a high prevalence in the general population. The association between NAFLD and cardiovascular disease has been well addressed in previous studies. However, whether NAFLD is associated with carotid artery disease in a community-based Chinese population remained unclear. The aim of this study was to investigate the association between NAFLD and carotid artery disease. Methods： A total of 2612 participants （1091 men and 1521 women） aged 40 years and older from Jidong of Tangshan city （China） were selected for this study. NAFLD was diagnosed by abdominal ultrasonography. The presence of carotid stenosis or plaque was evaluated by carotid artery ultrasonography. Logistic regression was used to analyze the association between NAFLD and carotid artery disease. Results： Participants with NAFLD have a higher prevalence of carotid stenosis （12.9% vs. 4.6%） and carotid plaque （21.9% vs. 15.0%） than those without NAFLD. After adjusting for age, gender, smoking status, income, physical activity, diabetes, hypertension, triglyceride, waist-hip ratio, and high-density lipoprotein, NAFLD is significantly associated with carotid stenosis （odds ratio [OR]： 2.06, 95% confidence interval [CI]： 1.45-2.91）, but the association between NAFLD and carotid plaque is not statistically significant （OR： 1. 10, 95% CI： 0.86-1.40）. Conclusion： A significant association between NAFLD and carotid stenosis is found in a Chinese population.

Preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with coexistent carotid and coronary artery diseases

Background Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy （CEA） and off-pump coronary artery bypass grafting （CABG） in patients with coexistent carotid and coronary artery diseases. Methods Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out. Results A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was （25.5_±7.0） minutes. The mean number of distal grafts per patient was 3.30±0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was （11.3±5.4） hours, （2.1±0.9） days, and （12.5±6.1） days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients （92.16%） with a mean follow-up of （39.5±12.5） months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred. Conclusion Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.

Carotid artery stenting in patients with coexistent carotid and coronary artery disease

Atherosclerotic disease, as a systemic process, affects all arteries to varying degrees. In particular,coexistent carotlid aria coronary artery diseases are common; Management of such patients has been a point of continuing controversy. Current American Heart Association （AHA） guidelines recommend carotid endarterectomy （CEA） in symptomatic patients with carotid artery stenosis of 50%-99% and in asymptomatic patients with stenosis of 60%-99%. Carotid artery stenting （CAS） has become a reasonable alternative to CEA, particularly in patients at high risk for CEA. We sought to assess feasibility, safety and midterm outcome of carotid artery stenting in patients with coexisting symptomatic coronary disease and carotid artery stenosis.

Relevant research of autophagy and carotid plaque of ischemic cerebrovascular disease

Objective To analyze the correlation of autophagylevel and carotid plaque of ischemic cerebrovascular disease,so as to provide data evidence to its pathomechanism.Methods 127 patients with ischemic cerebrovascular disease were divided into 3 groups according to carotid plague scores.The count and degree of cranial artery stenosis were observed with digital subtraction angiogra-

Percutaneous transluminal stenting in patients with carotid artery stenosis

Objective To assess the efficacy and safety of percutaneous transluminal stenting for patients with carotid artery stenosis.Methods Selective percutaneous transluminal stenting was performed for patients with symptomatic carotid artery stenosis(luminal narrowing ≥ 70%).Success rates and complications associated with the procedures were observed.During six months of follow-up,both recurrent symptom and restenosis rates were recorded.Results There were 17 bifurcating lesions among 27 stenoses in 26 patients,of whom 18 had concomitant coronary artery diseases.The acute procedural success rate was 96.3%(26/27),and the degree of stenosis was reduced from 88.6% ± 8.9%(range 70 - 100)to 0.4% ± 2.0%(range 0 - 10).Six patients developed severe bradycardia and hypotension,and 3 experienced transient loss of consciousness during balloon dilatation.During hospitalization,2 patients experienced loss of consciousness and convulsion,respectively,due to hyperperfusion,and both recovered 12 hours later.There were 2 minor stroke cases (7.4%)but no cases of major stroke or death.At the 6-month follow-up,there were no cases of TIA or new onset of stroke.There was no restenosis detected in 16 cases using angiography and in 10 cases using MRI in 6 to 16 months of follow-up.Conclusions Percutaneous transluminal stenting for patients with carotid artery stenosis has a high procedural success rate with few and acceptable complications.Few patients suffered from recurrent symptoms or showed restenosis in long-term follow-up.

Effect of Shoushen granule on arterial elasticity in patients with carotid atherosclerosis:a clinical randomized controlled trial

OBJECTIVE: To investigate the effectiveness of Shoushen granule,Chinese herbal preparation,on carotid artery elasticity in patients with carotid atherosclerosis.METHODS: The total of 156 carotid atherosclerosis patients were randomly divided into the intervention group(83 cases,treated with Shoushen granule) and the control group(73 cases,treated with pravastatin). Brachial-ankle pulse wave velocity(ba PWV) and Ankle-Brachial Pressure Index(ABI)were measured by automated arteriosclerosis detector. The changes of common carotid artery intima-media thickness(IMT) and parameters of the carotid artery elasticity in patients,including stiffness parameter(β),pressure-strain elastic modulus(Ep),arterial compliance(Ac),augmentation index(AI),and pulse wave velocity β(PWVβ) were detected by Echo-Tracking(ET) technique before and after 24 week treatment. In the meantime,levels of blood lipid,and liver and renal function were measured respectively.RESULTS: After 24 weeks,ba PWV,IMT and parameters of the carotid artery elasticity(β,Ep,AI and PWVβ) were markedly decreased in intervention group compared with those of before treatment(P < 0.01),but the level of Ac was increased significantly(P < 0.01). And there were no significant differences compared with control group on the same period(P > 0.05).CONCLUSION: In this pilot study,it was demonstrated ET technology and automated arteriosclerosis detector could be used to evaluate carotid artery elasticity effectively,and the action of Shoushen granule on carotid atherosclerosis might be related to the regulation of carotid artery elasticity.

Endovascular embolization of traumatic carotid cavernous fistulas

Objective To analyze the effectiveness of endovascular embolization on treatment of traumatic carotid cavernous fistula (TCCF).Methods From 1986 to 1997, 482 cases of traumatic carotid cavernous fi stula were treated by endovascular embolization in the Beijing Neurosurgical Institute. Se veral kinds of balloon catheter were used for embolization. External carotid c avernous fistulas and rare carotid cavernous fistulas (CCF) with minute leakage were treated by cyanoacrylate or coils. Although artery approach was applied in most cases (477 cases), vein approach showed its own advantages in some special cases.Results We found a special “bileakage sign” indicating multileakage o f TCCF, which was never mentioned before. All 482 cases were embolized successfu lly, and 405 cases maintained the patency of internal carotid artery (ICA). No t reatment related deaths occurred and the symptoms and signs of 462 cases were r elieved after embolization. Emergency embolization was needed in some conditions such as serious epistaxis, delayed or repeated subdural hematoma, and rapid vis ual impairment.Conclusion Endovascular embolization of TCCF is a safe and efficient me thod. Carefully selected operation time, operative approach, and materials are t he essential factors to reach a best result.

Effects of linagliptin on inflammatory factors and arteriosclerosis in patients with newly diagnosed type 2 diabetes mellitus

In the present study,we aimed to investigate the effects of linagliptin on inflammatory factors and carotid intima-media thickness(CIMT)in newly diagnosed type 2 diabetes mellitus(T2 DM)patients with carotid atherosclerotic disease(CAD).A total of 326 patients with newly diagnosed T2 DM complicated with CAD were randomly divided into two groups.There were 163 patients in the control group,who were treated with metformin monotherapy.There were 163 patients in the experimental group,who were treated with metformin in combination with linagliptin.The CIMT before and after treatment was measured by color Doppler ultrasound,and the contents of IL-6 and IL-1βbefore and after treatment were detected by ELISA.The levels of inflammatory factors and CIMT before and after treatment were compared between the two groups,and the correlation between IL-6,IL-1βand CIMT was studied.After 24 weeks of treatment,the levels of inflammatory factors and CIMT in the experimental group were significantly lower compared with the control group(P<0.01),and the serum levels of IL-6 and IL-1βwere positively correlated with CIMT.In the present study,we concluded that linagliptin could improve the levels of inflammatory factors and CIMT in newly diagnosed T2 DM patients with CAD,and IL-6 and IL-1βmight participate in the occurrence and development of CAD by influencing CIMT.