Early diagnostic value of carotid artery ultrasound parameters combined with epicardial adipose layer thickness in coronary heart disease

BACKGROUND Coronary heart disease is associated with coronary atherosclerosis indicated by carotid intima-media thickness(CIMT)thickening and altered vascular elasticity.The epicardial adipose layer can secrete proinflammatory factors that promote the formation of coronary atherosclerosis.Thus,the epicardial fat layer thickness(EAT)may also predict coronary heart disease.AIM To determine the role of common carotid artery ultrasound parameters and EAT in the early diagnosis of coronary artery disease.METHODS Based on coronary angiography,patients with newly suspected coronary heart disease were divided into case(n=107)and control(n=41)groups.The carotid ultrasound parameters,including vascular stiffness(β),elastic coefficient(EP),pulse wave conduction velocity(PWV-β),CIMT,and EAT were compared between the case and control groups and among patients with different lesion numbers in the case group.Pearson correlation was used to evaluate the early diagnostic value of EAT,common carotid artery elasticity,and CIMT for coronary heart disease.RESULTS EP,β,PWV-β,CIMT,and EAT were significantly higher in the case group compared with the levels in the control group(all P<0.001).In the case group,lesions were detected in one vessel in 34 patients,two vessels in 38 patients,and three vessels in 35 patients.Within the case group,β,EP,PWV-β,CIMT,and EAT levels significantly increased with an increased number of lesions(all P<0.001).EAT positively correlated withβ,EP,PWV-β,and CIMT(all P<0.01).The area under the curve for diagnosing coronary heart disease using EAT combined with CIMT and carotid elasticity was 0.893,and the sensitivity and specificity were 0.890 and 0.837.CONCLUSION EAT correlated well with changes in carotid artery elasticity and CIMT in patients with coronary heart disease.The combination of EAT,carotid artery elasticity,and CIMT facilitates the early diagnosis of coronary heart disease.

Ultrafast pulse wave velocity technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis patients with euthyroidism

Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.

Idiopathic steno-occlusive disease with bilateral internal carotid artery occlusion:A Case Report

BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We report a 4-year-old girl with left hemiparesis after an acute ischemic stroke.Her history was also significant for repeated left or right focal motor seizures,generalized tonic-clonic convulsions and transient ischemic attacks.Her magnetic resonance imaging and computed tomography(CT)of the brain and magnetic resonance angiography,CT angiography and venography on the cerebral vessels revealed evidence of bilateral fronto-parietal ischemic infarctions,occlusion of the right and left internal carotid arteries started at its bifurcation and non-visualization of right and left anterior and middle cerebral arteries.There was evidence of progression in angiography manifested as development of collaterals from the basal perforating vessels,increase in the extent of large intracranial arterial stenosis/occlusion and extensive collateral circulation with predominance from the posterior circulation.Physical and neurological evaluation and comprehensive laboratory investigations excluded an obvious comorbid disease or risk factor for the child’s condition.The diagnosis of MMD was highly suggested as a cause of the child’s steno-occlusive condition.She was treated symptomatically with levetiracetam,an antiepileptic medication.Aspirin was prescribed for secondary prevention.Her clinical manifestations were improved during the three years of follow-up.Revascularization surgery was postponed.CONCLUSION Up to our knowledge,this is the first report for MMD in a child in our country.The clinical improvement and the stabilization of the child’s condition over the 3 years of follow-up could be attributed to the rapid and extensive recruitment of collaterals and absence of risk factors or comorbidities.Revascularization surgery is highly recommended.

Relationship between peripheral arterial disease, carotid intima-media thickness and C-reactive protein in elderly diabetic patients

Purpose: To study the association between carotid intima media thickness (CIMT) and high sensitivity CRP (hs-CRP) level as markers for PAD in elderly patients with DM. Subjects: A case-control study on 90 participants aged 60 years and older divided into 60 cases (30 patients with DM alone and 30 patients with DM and comorbidities) and 30 healthy controls. All were assessed by measuring CIMT, ankle brachial index (AB), and markers for cardiovascular disease such as high-sensitivity CRP (hs-CRP), total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), and low density lipoprotein (LDL). Results: hs-CRP levels showed statistically significant difference being highest among patients with DM and comorbidities and lowest among controls (P < 0.001). Also, symptoms of PAD were significantly higher among cases than controls. ABI was able to detect PAD in many asymptomatic patients. Color changes were present in only 43.30% (n = 26) of positive PAD cases while delayed wound healing, claudication pain, rest pain, cold extremities, and trophic changes were present in 23.30% (n = 14), 16.71% (n = 10), 16.71% (n = 10), 45.00% (n = 27), and 21.7% (n = 13). Using logistic regression analysis revealed that DM, CIMT, and hs-CRP were independent predictors for PAD (OR = 4.194, 7.236, 1.003;P value = 0.044, 0.25, 0.031) after adjustment of other coronary risk factors such as sex, smoking, hypertension, TC, and TG. Conclusion: Diabetic elderly have higher prevalence of asymptomatic PAD thannon-diabetics using solely ABI. DM, CIMT, and hs-CRP are independent predictors for the occurrence of PAD. Hs-CRP levels are highest among diabetics with comorbidities.

Incidence &Risk Factors Associated with Carotid Disease in Patients Undergoing Coronary Artery Bypass Grafting Surgery

Objective: The purpose of this study was to evaluate the true incidence and the risk factors associated with carotid disease in the sitting of high risk patients undergoing coronary artery bypass graft (CABG) using carotid duplex scan and to find out if routine preoperative carotid duplex scan is needed among all these patients. Methods: This retrospective study included 402 consecutive patients who underwent bilateral carotid duplex scan admitted for CABG during the period from January 2006 to December 2008. We excluded patients in cardiogenic shock who were taken to operating room emergently. Results: The prevalence of associated risk factors showed diabetes mellitus recorded the highest (93.3%) whereas peripheral vascular disease the lowest (1.7%), hypertension (89.3%), dyslipidemia (72.6%), smoker (21.1%), left main disease (4.7%), and previous stroke (3%). Patients undergoing CABG has high incidence of carotid disease (68.7%) and severe stenosis is more in patients aged 60 and above (13.5%) versus (2.3%) in age 60, previous stroke and left main disease). Conclusion: This study showed that carotid screening is recommended for all patients who are undergoing CABG due to high incidence of carotid disease.

Correlation of carotid plaque vulnerability with lipid metabolism, inflammatory response and protease activity in patients with coronary artery disease

Objective: To study the correlation of carotid plaque vulnerability with lipid metabolism, inflammatory response and protease activity in patients with coronary artery disease. Methods: Patients who were diagnosed with coronary heart disease combined with carotid atherosclerosis in People's Hospital of Dongxihu District Wuhan City between April 2015 and October 2017 were selected and divided into vulnerable group and stable group according to ultrasonic judgment of carotid plaque vulnerability;the healthy volunteers who underwent physical examination during the same period were selected as the control group. The serum was collected to determine the contents of lipid metabolism, inflammatory response and protease activity indexes, and the peripheral blood was collected to determine the expression of inflammatory response indexes. Results: LDL-C, Lp(a), CXCL5, E-selectin, CatK and Meprin- levels in serum as well as ERK1/2, NF-κB and TNF-α expression in peripheral blood of stable group and vulnerable group were significantly higher than those of control group whereas ATGL, Omentin-1, Vaspin, PAI-1, TIMP1 and TIMP2 levels were significantly lower than those of control group;LDL-C, Lp(a), CXCL5, E-selectin, CatK and Meprin-levels in serum as well as ERK1/2, NF-κB and TNF-α expression in peripheral blood of vulnerable group were significantly higher than those of stable group whereas ATGL, Omentin-1, Vaspin, PAI-1, TIMP1 and TIMP2 levels were significantly lower than those of stable group. Conclusion: The changes of carotid plaque vulnerability in patients with coronary artery disease are closely related to the changes in lipid metabolism, inflammatory response and protease activity in the course of disease.

Significance of ultrasound evaluation of carotid atherosclerotic plaque for diagnosing ischemic cerebrovascular disease

BACKGROUND： Carotid artery is the main source for craniocerebral blood supply. Its intimal plaque formation and arterial stenosis degree both are the risk factors for ischemic cerebrovascular disease.Therefore, the close relationship of carotid atherosclerotic plaque and ischemic cerebrovascular disease, and ultrasound evaluation of carotid atherosclerotic plaque have become the hot spot in studying ischemic cerebrovascular disease.OBJECTIVE： This study was to detect the degree of carotid atherosclerosis of ischemic cerebrovascular disease patients by ultrasonography, and to analyze the situation of carotid atherosclerosis and its relationship with clinic.DESIGN： Clinical randomized concurrent control experiment.SETTING： Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS： Totally 60 outpatients and inpatients with ischemic cerebrovascular disease, 42 males and 18 females, admitted to Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA between January 2006 and December 2006 were involved in the patient group. They met the diagnosis criteria of ischemic cerebrovascular disease constituted by the 4th Cerebrovascular Disease Conference in 1996, and were confirmed to suffer from ischemic cerebrovascular disease by skull CT and MRI. Another 20 subjects who received healthy examination concurrently in the same hospital, 12 males and 8 females, were involved in the control group. Informed consents of detected items were obtained from involved subjects.METHODS： The plaque thickness of mid portion, distal end and crotch of common carotid artery （CCA）,internal carotid artery （ICA）, external carotid artery （ECA） and vertebral artery （VA） of involved subjects,who received health examination was separately detected with color Doppler ultrasonograph （HDI-5000）.Then, total integral of plaque was calculated. The intima-media thickness （IMT） was measured with two-dimensional ultrasonography. The inner diameter stenosis degree of subjects who had plaque was measured. Blood flow parameters were recorded, and stenosis degree and plaque area were calculated. Blood flow volume of bilateral carotid artery and VA was separately measured with ultrasound equipment software,and brain blood flow volume was calculated.MAIN OUTCOME MEASURES： Atherosclerotic degree and blood flow volume of patients of two groups.RESULTS： Sixty patients with ischemic cerebrovascular disease and twenty subjects who received health examination participated in the final analysis. ①The IMT thickness, total plaque score, and total plaque area of patient group was significantly superior to that of control group, respectively（ t=5.216 - 10.158, P 〈 0.05 ）.② There were significant differences in the stenosis degree of CCA, ICA and VA between patient group and control group （t=6.720 - 12.816, P 〈 0.05 ） . ③ The blood flow volume of CCA, ICA, VA and brain of patient group was significantly lower than that of control group, respectively （t=2.872 - 10.860, P 〈 0.05）.CONCLUSION： Ischemic cerebrovascular disease patients have different degrees of changes in atherosclerosis and arterial blood flow.

Coronary atherosclerosis burden is not advanced in patients with β-thalassemia despite premature extracardiac atherosclerosis： a coronary artery calcium score and carotid intima-media thickness study

Background Thalassemic patients demonstrate an increased rate of extracardiae vascular complications and increased carotid wall intima-media thickness （cIMT）, but very low prevalence of coronary artery disease （CAD）. We investigated the atheroma burden by assessing the coronary artery calcium （CAC） and elMT in these patients. Methods We examined 37 patients with β-thalassemia and 150 healthy control volunteers with multi-detector computer tomography （CT） and ultrasonography to determine CAC score and cIMT, respectively. Results Propensity score matching （C-statistic： 0.88; 95% CI： 0.83-0.93） resulted in 27 pairs of patients; severe CAC was observed in 2 （7.4%） and 0 of β-thalassemia patients and healthy volunteers respectively （P = 0.5）. Median calcium score was 0 （0-0） in β-thalassemia patients and 0 （0-4） in healthy volunteers （P = 0.8）. Median intima-media thickness was higher in β-thalassemia patients compared to control group [0.45 （0.06-0.65） vs. 0.062 （0.054-0.086）; P = 0.04]. Conclusions Patients with β-thalassemia in comparison with healthy control subjects exhibit similar CAC score and increased cIMT. Our findings indicate a disparate rate of progression of atherosclerosis between coronary and extracardiac arteries in these patients lending support to the epidemiological evidence.

Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports

BACKGROUND One of the major perioperative complications for coronary artery bypass graft(CABG)is stroke.The risk of perioperative stroke after CABG is approximately 2%.Carotid stenosis(CS)is considered an independent predictor of perioperative stroke risk in CABG patients.The optimal management of such patients has been a source of controversy.One of the possible surgical options is synchronous carotid endarterectomy(CEA)and CABG.Here,we have presented 4 cases of successful synchronous CEA and CABG.Our center’s experience with 4 cases of significant carotid artery stenosis,which were successfully managed with combined CEA and CABG,are detailed.The first case was a female who presented for CABG after a ST-elevation myocardial infarction.She had right internal carotid artery(ICA)occlusion and 90%left ICA stenosis.The second case was a male who was electively admitted for CABG.It was discovered that he had left ICA occlusion and 90%right ICA stenosis.The third case was a male with a history of stroke,two months prior to admission.He presented with non-ST-elevation myocardial infarction.Preoperatively,it was discovered that he had>90%right ICA stenosis.The final case was a male who was electively admitted for CABG.It was discovered that he had bilateral>90%ICA stenosis.We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG.CONCLUSION Our case series demonstrated that synchronous CEA and CABG was safe.A multicenter study with additional patients is needed.It is necessary for clinicians to screen for CS in high-risk patients with features.

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.

Fifty-eight cases of ocular ischemic diseases caused by carotid artery stenosis

Background The blood supply to the eye comes from the retinal central vascular system of the ophthalmic artery and the ciliary vascular system. The ophthalmic artery stems from the ipsilateral internal carotid artery. If occlusion or stenosis occurs in the carotid artery, the blood perfusion to the ophthalmic artery becomes insufficient, leading to signs and symptoms of anterior and posterior ocular ischemia. The objective of this study was to evaluate the clinical characteristics and risk factors of ocular ischemic diseases caused by carotid artery stenosis. Methods This study was a retrospective review of 145 patients with carotid artery stenosis. Fifty-eight patients who had symptoms of ocular ischemic disease caused by carotid artery stenosis formed group A and the other 87 patients who only had carotid artery stenosis formed group B. We analyzed the causes and course of disease, and relative risk factors, by comparing the two groups. Results The degree of carotid artery stenosis in group A was higher than that in group B. And group A had a greater decrease of ophthalmic artery flow. Male, hypertension, hyperlipidemia, and smoking were significantly related to carotid artery stenosis. Amaurosis fugax was the most common ocular symptom in group A. The ocular ischemic diseases mainly included ischemic optic neuropathy, central/branch retinal artery occlusion, ophthalmoplegia externa, and ocular ischemic syndrome. Conclusions Carotid artery stenosis correlates with ocular ischemic diseases. Ophthalmologists must observe for ocular symptoms, which were the onset symptoms in some patients.

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.

Ultrasound screening of multifocal atherosclerosis: markers for coronary heart disease

Background and Objective The frequency of multifocal atherosclerosis (MFA) in patients with coronary heart disease (CHD) has not been thoroughly studied. The purpose of our study was to perform ultrasound screening for MFA in patients with coronary atherosclerosis and make evaluation of the sensitivity and significance of different atherosclerosis markers. Methods Using Color Dupplex Ultrasound (CDU), we studied 32 clinically healthy persons and 87 patients of the city of B with clinical data for CHD where we also performed coronarography. Results In patients with coronary atherosclerosis we found high frequency of carotid atherosclerosis (93%) and peripheral artery disease (PAD) (81%). We established verifiable thickening of the intima-media (IMT) of the common carotid artery (CCA) and common femoral artery (CFA) in patients with CHD. There is a correlation between the frequency of carotid and femoral stenoses and CHD proven by coronarography. Patients with CHD had a high relative risk to develop carotid (RR = 5) and peripheral atherosclerosis (RR=3.5) and high frequency of asymptomatic stenoses and thromboses of the internal carotid artery (86.9%) and femoral artery (78.3%), as well as aneurisms of the abdominal aorta (8.1%). Markers for CAD with high sensitivity were the atherosclerotic plaques of ICA (0.93) and CFA (0.81) as well as IMT of the CFA (0.84). Conclusions MFA are common among patients with CHD. Ultrasound diagnosis is the method of choice for simultaneous non-invasive screening of carotid, peripheral and MFA and provides sensitive markers for coronary atherosclerosis. The most sensitive and specific markers for CHD are the combination of the IMT and atherosclerotic plaques of CCA, ICA and CFA (100% sensitivity and 0.92 specificity).

Community-Based Cardiovascular Screening: Detection of Disease in Individuals with No Self-Reported Risk Factors

Introduction: Community-based cardiovascular screening presents an opportunity to detect the presence of cardiovascular disease in individuals who report having no traditional risk factors, and also to identify the presence of those risk factors in those who are unaware of their health status. Identification of both disease and risk factors (e.g. high cholesterol, high blood pressure, diabetes, etc.) creates an opportunity for treatment and management to reduce and prevent cardiovascular events from occurring. Methods: Over 230,000 screening records for individuals who had undergone carotid artery stenosis (CAD), abdominal aortic aneurysm (AAA), or peripheral artery disease (PAD) screening were reviewed. Participants were stratified based on self-reported risk factors as having no risk factors, one risk factor, or two or more risk factors. Self-reported risk factors were also compared with results of screening for blood pressure, blood glucose, and lipid level status. Results: Abnormal findings of CAS, AAA, and PAD were all uncovered in individuals who self-reported as having no traditional risk factors. These abnormal findings included those defined as severe. The review of self-reported risk factors for accuracy demonstrated varying levels of inaccuracies in both under and over-reporting of risk factors. Conclusions: Community-based cardiovascular screening may result in the identification of cardiovascular disease in individuals with no established risk factors. While the underreporting of risk factors has also be demonstrated, it is clear that further research is warranted to better understand the presence of disease in the absence of risk factors.

TyG和TyG-BMI与冠心病患者颈动脉粥样硬化的相关性

目的分析冠心病患者颈动脉粥样硬化与TyG及TyG-BMI的关系。方法选取2021年1月~2022年12月天津市人民医院心内科收治并进行冠脉造影和颈动脉超声检查患者592例为研究对象。依据冠脉造影结果分为正常对照组(n=103)及CAD组(n=489)。收集患者临床资料,计算TyG指数和TyG-BMI水平。分析TyG和TyG-BMI与冠心病患者颈动脉病变程度的相关性。结果与正常对照组比较,CAD组TyG指数和TyGBMI水平明显升高(均P<0.01)。按照Gensini评分三分位数将患者分为三组,中分组(均P<0.05)和高分组(均P<0.01)TyG指数和TyG-BMI水平显著高于低分组。高分组TyG指数和TyG-BMI水平显著高于中分组(均P<0.01)。Spearman相关性分析显示TyG与TyG-BMI和Gensini评分呈现正相关,且TyG指数关联性更强(均P<0.01)。与颈动脉正常组相比,颈动脉粥样硬化组TyG指数更高(P<0.01),TyG-BMI更高(P<0.05)。二元Logistic回归分析发现年龄(OR=1.114,95%CI:1.05~1.18,P<0.01)与高血压(OR=2.913,95%CI:1.27~6.70,P<0.05)是颈动脉粥样硬化的独立危险因素),HDL-C(OR=0.108,95%CI:0.03~0.43,P<0.01)是保护因素。多元Logistic回归分析结果提示高水平TyG和TyG-BMI是颈动脉斑块形成的危险因素。以颈动脉正常为参照,排除混杂因素(如性别、年龄、BMI、收缩压、吸烟史、高血压病史、糖尿病史、药物服用情况)后,高TyG指数组CAD患者发生颈动脉斑块形成的风险是低TyG组的2.56倍,高TyG-BMI组发生颈动脉斑块的风险是低水平TyG-BMI组的4.35倍。Spearman相关性分析发现,TyG指数和颈动脉斑块厚度呈显著正相关(P<0.05),而TyGBMI和斑块厚度无相关。ROC曲线分析结果显示,TyG指数对冠心病患者合并颈动脉斑块形成具有较好的预测价值。结论TyG指数和TyG-BMI是冠心病患者颈动脉斑块形成的危险因素,且TyG指数对颈动脉斑块的预测价值优于TyG-BMI。

颈动脉狭窄合并冠心病同期外科治疗的疗效分析:单中心经验

目的总结同期颈动脉血运重建手术及冠状动脉血运重建手术治疗颈动脉狭窄合并冠心病患者的单中心临床经验。方法回顾性分析2008年1月至2020年1月中日友好医院心脏血管外科收治的54例颈动脉狭窄合并冠心病患者资料,其中同期行颈动脉内膜剥脱术(carotid endarterectomy,CEA)+冠状动脉搭桥术(coronary artery bypass grafting,CABG)38例,同期行颈动脉支架植入术(carotid artery stenting,CAS)+CABG 16例。结果手术成功率100%。围手术期内出现小卒中3例,短暂性脑缺血发作4例,术后短暂低血压8例,术后高灌注综合征3例,二次开胸3例,心肌梗死4例;无围手术期死亡病例。同期CEA+CABG组与同期CAS+CABG组的手术时间、术中出血量、围手术期输血量、神经系统并发症和循环系统并发症发生率差异均无统计学意义(P>0.05)。48例患者获得随访,随访时间29~140个月,平均(89.8±35.6)个月,因心肌梗死和心功能不全死亡患者各1例。结论同期CEA+CABG与同期CAS+CABG治疗颈动脉狭窄合并冠心病患者均安全有效。

缺血性脑血管病患者血清β淀粉样蛋白和壳多糖酶3样蛋白1水平与颈动脉病变的关系

目的探讨缺血性脑血管病(ICD)患者血清β淀粉样蛋白(Aβ)和壳多糖酶3样蛋白1(CHI3L1)水平与颈动脉病变的关系。方法选取2019年1月—2023年5月沧州市中心医院ICD患者298例(ICD组)、健康体检者300名(对照组)。根据颈动脉内膜中层厚度(ITM)、斑块积分和颈动脉狭窄程度分别分组。收集所有研究对象一般资料,并检测血清Aβ、CHI3L1、糖化血红蛋白(Hb A1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。采用偏相关分析评估血清Aβ、CHI3L1水平与颈动脉病变的相关性。结果ICD组血清TG、TC、LDL-C、Aβ和CHI3L1水平均高于对照组(P<0.01),其他指标2个组之间差异均无统计学意义(P>0.05)。内膜正常组、内膜增厚组、斑块形成组血清Aβ和CHI3L1水平依次升高(P<0.001)。轻度硬化组、中度硬化组和重度硬化组血清Aβ和CHI3L1水平依次升高(P<0.001)。轻度狭窄组、中度狭窄组和重度狭窄组血清Aβ、CHI3L1水平依次升高(P<0.001)。血清Aβ和CHI3L1水平与ITM、斑块积分和颈动脉狭窄程度均呈正相关(P<0.001)。结论ICD患者血清Aβ和CHI3L1水平升高,且与颈动脉病变密切相关,或可作为反映ICD患者颈动脉病变程度的指标。

经颅多普勒超声微栓子监测评估PAS治疗颈动脉颈段易损斑块疗效的观察

目的探讨经颅多普勒超声(TCD)微栓子监测评估PAS(抗氧化、抗血小板、调脂治疗)治疗颈动脉颈段易损斑块的疗效。方法收集中国人民解放军联勤保障部队第九一〇医院2019年7月至2021年7月收治的采用PAS疗法进行治疗的颈动脉颈段易损斑块患者作为研究组(46例)。选取2015年6月至2019年6月该院收治的仅采用AS疗法(抗血小板、调脂治疗)治疗的颈动脉颈段易损斑块患者作为对照组(38例)。对2组患者治疗前后进行TCD微栓子监测,并评估斑块稳定性。结果治疗后研究组共检测出微栓子信号(MES)阳性患者1例,对照组共检测出MES阳性患者6例(P<0.05)。治疗后颈动脉内膜中层厚度(IMT)研究组低于对照组(P<0.05)。研究组治疗后IMT明显低于治疗前(P<0.05),对照组治疗前后IMT无明显变化(P>0.05)。随访1年,研究组缺血事件发生率显著低于对照组(P<0.05),且发生急性脑梗死患者的卒中严重程度轻于对照组(P<0.05)。研究组出现3例消化系统不良反应,不影响治疗及预后。结论PAS治疗颈动脉颈段易损斑块,有助于提高斑块稳定性,可以降低卒中发生风险,减轻卒中严重程度。

缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系

目的 探讨缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系。方法 选择60例缺血性脑血管病患者,其中,短暂性脑缺血发作30例(短暂性脑缺血发作组);脑梗死30例(脑梗死组),测定两组患者的血清尿酸水平,分析缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块的关系。结果 短暂性脑缺血发作组的血清尿酸水平显著低于脑梗死组(P<0.05)。Logtisic回归分析显示,血清尿酸水平升高是缺血性脑血管病患者斑块发生的危险因素(P<0.05)。随着斑块面积增大,血清尿酸水平升高(P<0.05)。结论 缺血性脑血管病血清尿酸水平与颈动脉不稳定斑块关系密切,血清尿酸水平是患者斑块发生的独立危险因素,通过早期监测血清尿酸水平,可更好地评估颈动脉斑块的不稳定性,为疾病早期诊治提供基础。

血管内支架植入术治疗缺血性脑血管病颈动脉狭窄患者的临床效果分析

目的观察血管内支架植入术治疗缺血性脑血管病(ICVD)颈动脉狭窄患者的临床效果。方法选取行ICVD治疗的患者83例分为观察组43例和对照组40例,比较2组患者的血流动力学指标和颈内动脉血管狭窄程度、神经标志物与血管内皮功能、神经功能缺损程度、临床疗效和不良反应。结果2组患者经治疗后的血管收缩期峰流速(PSV)、舒张末期流速(EDV)和血管狭窄程度均呈下降趋势,且对照组的PSV、EDV和血管狭窄程度下降幅度均小于观察组,差异有统计学意义(P<0.05);2组患者治疗后的正五聚蛋白-3(PTX-3)、神经元特异性烯醇化酶(NSE)均有降低,血管扩张功能(FMD)和血管内皮生长因子(VEGF)均有提升,且观察组的PTX-3、NSE低于对照组,VEGF、FMD高于对照组,差异有统计学意义(P<0.05);治疗后2组患者的美国国立卫生研究院脑卒中量表(NIHSS)和改良爱丁堡-斯堪的纳维亚评分(MESSS)均降低,且对照组NIHSS评分和MESSS降低幅度小于观察组;对照组的临床总有效率为80.00%,低于观察组的97.67%,差异有统计学意义(P<0.05);观察组和对照组的不良反应发生率分别为2.33%和22.50%,差异有统计学意义(P<0.05)。结论血管内支架植入术能够有效提高ICVD患者的临床疗效,减轻血管狭窄程度,改善患者的认知功能,且具有较高安全性。