Assessment of neovascularization within carotid plaques in patients with ischemic stroke

AIM:To assess neovascularization within human ca-rotid atherosclerotic soft plaques in patients with isch-emic stroke.METHODS:Eighty-one patients with ischemic stroke and 95 patients without stroke who had soft athero-sclerotic plaques in the internal carotid artery were studied.The thickest soft plaque in each patient was examined using contrast-enhanced ultrasound.Time-intensity curves were collected from 5 s to 3 min after contrast injection.The neovascularization within the plaques in the internal carotid artery was evaluated using the ACQ software built into the scanner by 2 of the experienced investigators who were blinded to the clinical history of the patients.RESULTS:Ischemic stroke was present in 7 of 33 patients(21%) with grade Ⅰ plaque,in 14 of 51 pa-tients(28%) with grade Ⅱ plaque,in 26 of 43 patients(61%) with grade Ⅲ plaque,and in 34 of 49 patients(69%) with grade Ⅳ plaque(P < 0.001 comparing grade Ⅳ plaque with grade I plaque and with grade Ⅱ plaque and P = 0.001 comparing grade Ⅲ plaque with grade Ⅰ plaque and with grade Ⅱ plaque).Analysis of the time intensity curves revealed that patients with ischemic stroke had a significantly higher intensity of enhancement(IE) than those without ischemic stroke(P < 0.01).The wash-in time(WT) of plaque was signifi-cantly shorter in stroke patients(P < 0.05).The sensi-tivity and specificity for IE in the plaque were 82% and 80%,respectively,and for WT were 68% and 74%,respectively.There was no significant difference in the peak intensity or time to peak between the 2 groups.CONCLUSION:This study shows that the higher the grade of plaque enhancement,the higher the risk of ischemic stroke.The data suggest that the presence of neovascularization is a marker for unstable plaque.

Value of superb micro-vascular imaging in predicting ischemic stroke in patients with carotid atherosclerotic plaques

BACKGROUND Unstable carotid atherosclerotic plaques are prone to cause ischemic stroke.Contrast-enhanced ultrasound(CEUS) is the primary method of assessing plaque stability, but CEUS cannot be a method for screening for unstable plaque. The emergence of superb micro-vascular imaging(SMI) offers the possibility of clinically screening for unstable plaque AIM To investigate the value of SMI in predicting ischemic stroke in patients with carotid atherosclerotic plaques.METHODS Patients with carotid atherosclerotic plaques(luminal stenosis of 50%-70%) were enrolled into the present study. All patients received conservative medication.The patient's clinical baseline data, serological data, CEUS and SMI data were analyzed. All patients underwent a 3-year follow-up. The follow-up endpoint was the occurrence of ischemic stroke and patients were divided into stroke group and non-stroke group according to whether the prognosis occurred or not.Subsequently, the difference in clinical data was compared, the correlation of SMI and CEUS was analyzed, and multiple Cox regression and receiver operating characteristic curve were applied to investigate the value of SMI and CEUS in predicting cerebral arterial thrombosis in three years.RESULTS In this study, 43 patients were enrolled in the stroke group and 82 patients were enrolled in the non-stroke group. Cox regression revealed that SMI level(P =0.013) and enhancement intensity(P = 0.032) were the independent factors influencing ischemic stroke. There was a positive correlation between SMI level and enhancement intensity(r = 0.737, P = 0.000). The area under curve of SMI level predicting ischemic stroke was 0.878. The best diagnostic point was ≥ level Ⅱ, and its sensitivity and specificity was 86.05% and 79.27%. The area under curve of enhancement intensity predicting ischemic stroke was 0.890. The best diagnostic point was 9.92 db, and its sensitivity and specificity was 88.37% and89.02%. As the SMI level gradually increased, the incidence of ischemic stroke increased gradually(X^2 = 108.931, P = 0.000).CONCLUSION SMI can be used as a non-invasive method of screening for unstable plaques and may help prevent ischemic stroke.

Contrast-enhanced ultrasound imaging of the vasa vasorum of carotid artery plaque

The vasa vasorum of carotid artery plaque is a novel marker of accurately evaluating the vulnerability of carotid artery plaque, which was associated with symptomatic cerebrovascular and cardiovascular disease. The presence of ultrasound contrast agents in carotid artery plaque represents the presence of the vasa vasorum in carotid artery plaque because the ultrasoundcontrast agents are strict intravascular tracers. Therefore, contrast-enhanced ultrasound(CEUS) is a novel and safe imaging modality for evaluating the vasa vasorum in carotid artery plaque. However, there are some issues that needs to be assessed to embody fully the clinical utility of the vasa vasorum in carotid artery plaque with CEUS.

Relationship between Levels of Serum C-Reactive Protein,Leucocyte Count and Carotid Plaque in Patients with Ischemic Stroke

In order to study the relationship between serum C-reactive protein (CRP) levels, leukocyte count and carotid plaque in patients with ischemic stroke, carotid duplex examination was performed by high-definition imaging (HDI) 5000 triplex system. Serum CRP was measured by nephelometry within 72 h after index ischemic stroke. A lesion was considered a plaque in the presence of a maximum intimal-medial wall thickness (IMT) 1.2 mm. Results of carotid ultrasonography were divided into two groups: M1, normal (IMT <1.2 mm) and M2, abnormal (IMT ≥1.2 mm). The results showed that the mean age of M2 was significantly older than that of M1 (69.7±10.4 versus 62.5±9.6, P =0.001). The patients with hypertension and diabetes mellitus (78 %, 35 % respectively)in M2 were significantly more than those (52 %, 18 % respectively) in M1 ( P <0.01, P <0.05). There were 32 (65 % ) patients with elevated CRP levels in M2, but 33 (46 %) patients with elevated CRP levels in M1, with the difference being significant between the two groups ( P <0.05). The levels of serum glucose and leukocyte count (8.1±5.5, 10.3±4.0, respectively) in abnormal CRP group were significantly higher than that of normal CRP group (6.4±2.8, 8.7±3.4) ( P <0.05, P <0.05); elevated CRP levels was found in 42 (62 %) patients with territory infarction and 23 (43 %) patients with lacunar infarction respectively, with the difference being significant between these two groups ( P <0.05). It was concluded that the elevation of CRP levels was an significant clinical index for carotid plaque in patients with acute cerebral infarction.

Correlation of Enhancement Degree on Contrast-enhanced Ultrasound with Histopathology of Carotid Plaques and Serum High Sensitive C-Reactive Protein Levels in Patients Undergoing Carotid Endarterectomy

This study was undertaken to investigate the correlation of the enhancement degree on contrast-enhanced ultrasound(CEUS) with the histopathology of carotid plaques and the serum high sensitive C-reactive protein(hs-CRP) levels in patients undergoing carotid endarterectomy(CEA). Carotid CEUS was performed preoperatively in 115 patients who would undergo CEA, and the enhancement degree of the carotid plaques was evaluated by both the visual semiquantitative analysis and the quantitative time-intensity curve analysis. Serum hs-CRP levels were detected using the particle-enhanced immunoturbidimetric assay also before the operation. Additionally, the carotid plaque samples were subjected to histopathological examination postoperatively. The density of neovessels and the number of macrophages in the plaques were assessed by immunohistochemistry. The results showed that among the 115 patients, grade 0 plaque contrast enhancement was noted in 35 patients, grade 1 in 48 patients and grade 2 in 32 patients. The degree of plaque enhancement, the density of neovessels, the number of macrophages, and the hs-CRP levels were highest in the grade 2 patients. Correlation analysis showed that the enhancement degree of the carotid plaques was closely related to the immunohistochemical parameters of the plaques and the serum hs-CRP levels. It was suggested that the carotid plaque enhancement on CEUS can be used to evaluate the vulnerability of carotid plaques.

Evaluation of Carotid Atherosclerotic Plaque Stability with Contrast-enhanced Ultrasonography

This study was aimed to evaluate the relationship between carotid atherosclerotic plaque stability and the clinical symptoms in patients with carotid atherosclerotic plaques by using contrast-enhanced ultrasonography. Fifty patients with carotid atherosclerotic plaques were enrolled and examined with contrast-enhanced ultrasonography. The correlation of contrast agent enhancement of the carotid atherosclerotic plaques and the clinical symptoms was analyzed. The results showed that among the 50 patients, plaques were enhanced in the 23 patients with obvious clinical symptoms. In 27 patients without apparent clinical symptoms, plaques were enhanced sparsely in 15 patients and not enhanced in 12 patients. It was suggested that contrast-enhanced ultrasonography could be used for the examination of the microcirculation in carotid atherosclerotic plaques on real-time basis and serve as a new noninvasive approach for the assessment of stability of carotid atherosclerotic plaques.

Beneficial clinical effects of grape seed proanthocyanidin extract on the progression of carotid atherosclerotic plaques

Background Atherosclerotic plaques indicate the occurrence of ischemia events and it is a difficult task for clinical physicians. Grape seed proanthocyanidin extract （GSPE） has been reported to exert an antiatherogenic effect by inducing regression of atherosclerotic plaques in animal experimental studies. In this study, the antiatherogenic effect of GSPE has been investigated in clinical use. Methods Consecu- tive 287 patients diagnosed with asymptomatic carotid plaques or abnormal plaque free carotid intima-media thickness （CIMT） were ran- domly assigned to the GSPE group （n = 146） or control group （n = 141）. The patients in the GSPE group received GSPE 200 mg per day orally, while patients in the control group were only enrolled in a lifestyle intervention program. Carotid ultrasound examination was per- formed at baseline and 6, 12, 24 months during follow-up. Mean maximum CIMT （MMCIMT）, plaque score, echogenicity of plaques and ischemic vascular events were recorded. Results As anticipated, after treatment, GSPE resulted in significant reduction in MMCIMT pro- gression （4.2% decrease after six months, 4.9% decrease after 12 months and 5.8% decrease after 24 months） and plaque score （10.9% de- crease after six months, 24.1% decrease after 12 months and 33.1% decrease after 24 months） for the primary outcome, while MMCIMT and plaque score were stable and even increased with the time going on in control group. The number of plaques and unstable plaques also de- creased after treatment of GSPE. Furthermore, the carotid plaque can disappear after treatment with GSPE. The incidence rate for transitory ischemic attack （TIA）, arterial revascularization procedure, and hospital readmission for unstable angina in GSPE group were statistically significant lower （P = 0.02, 0.08, 0.002, respectively） compared with the control group. Conclusions GSPE inhibited the progression of MMCIMT and reduced carotid plaque size in GSPE treated patients, and with extended treatment, the superior efficacy on MMCIMT and carotid plaque occurred. Furthermore, the GSPE group showed lower rates of clinical vascular events.

Effect of Plaque Composition on Biomechanical Performance of a Carotid Stent: Computational Study

Clinical application of bare metal stents is constrained by the occurrence of instent restenosis,mainly due to the complex biomechanical environment in the body.Numerical simulation method was used to evaluate the effect of plaque composition on stent performance in a carotid artery.CT angiography(CTA)data were used as a reference,and zero-load state of the carotid artery was used to establish a 3D stenotic artery model.Different plaque compositions,calcified and hypo-cellular were defined in Model 1 and Model 2,respectively.Interactions between the stents and arterial tissues within the stent crimping-expansion process were analyzed to explore the effects of plaque composition on the mechanical parameters of carotid stents.Goodman diagram and fatigue safety factor(FSF)were analyzed to explore the effects of plaque composition on fatigue performance of a carotid stent in the stent service process.In the stent crimping-expansion process,the von Mises stress in the stent and the dog-boning ratio in Model 1 were higher than that in Model 2.The calcified plaque prevented the stent from expanding the stenotic vessel to a pre-set diameter.Thus,the risk of rupture in the calcified plaque was higher than that in the hypo-cellular plaque.Plaque also affected the stress/strain in the vessel wall,which was observed to be lower in Model 1 than in Model 2.This indicated that calcified plaque could decrease the stress-induced injury of arterial tissues.Within the stent service process,the stents used in these two models were predicted to not fail under fatigue rupture as calculated by the Goodman diagram.Additionally,the points closer to the fatigue limit were generally observed at the inner bend of the stent crowns.The FSF of the stent in Model 1 was lower than that in Model 2.The stent operating in the presence of calcified plaques suffered high risk of fractures.Reliability and fatigue performance of the stent were found to be associated with plaque composition.Hence,this study may provide stent designers an approach toward enhancing the mechanical reliability of a stent.

The Relationship of Carotid Plaque, Intima Media Thickness (IMT), Resistivity Index (RI) and Pulsatility Index(PI) in Asian-Indian Patients with Acute Ischemic Stroke with and without Type2 DM

Aim: To determine the relationship of carotid plaque, intima media thickness (IMT), resistivity index (RI) and pulsatility index (PI) and prevalence of different risk factors with acute ischemic stroke and stroke subtypes in both diabetic and non-diabetic subjects. Materials and methods: 80 cases of acute ischemic strokes and 40 healthy controls were included in the study. The plaque, IMT, RI and PI were measured by carotid duplex ultrasound. Results: 31 subjects were Type 2 diabetic, 54 hypertensive while 25 were both diabetic and hypertensive. 23 cases (28.75%) had lacunar stroke (LACI), 32 (40%) stroke involving partial anterior circulation(PACI), 10(12.5%) stroke in posterior circulation (PACI) and 15(18.75%) stroke involving total anterior circulation(TACI) respectively. The mean IMT (0.88 ± 0.19mm), RI(0.76 ± 0.05) and PI(1.71 ± 0.19) of patients and mean IMT (0.6±0.09mm), RI (0.61 ± 0.06) and PI (1.53 ± 0.11) of controls were statistically significant (p-0.000). The mean values of IMT, PI and RI were significantly higher in diabetics (IMT-0.90 ± 0.16 VS 0.64 ± 0.11, p-0.013;PI-1.76 ± 0.20 VS 1.49 ± 0.09, P-0.000 and RI-0.76 ± 0.04 VS 0.59 ± 0.06, P-0.000) and similarly the mean values for IMT, PI and RI in hypertensives as compared to controls (IMT-0.88 ± 0.16 vs 0.65 ± 0.10, P-0.006;PI1.69 ± 0.18 vs 1.49 ± 0.09, P-0.000 and RI 0.76 ± 0.04 vs 0.59 ± 0.06, P-0.000). The mean IMT, PI and RI were increased significantly in smokers compared to controls (IMT-0.93 ± 0.20 vs 0.63 ± 0.06, P-0.000;PI-1.82 ± 0.22 vs 1.49 ± 0.09, P-0.000 and RI-0.77 ± 0.04 vs 0.59 ± 0.06, P-0.000). Type 3 plaque accounted for 27 (56.2%) cases and Type 2 plaque 12 (25%) cases. The total number of plaques in patients as compared to controls were significantly more (P-0.0034) and the mean plaque area was 46 mm2 for cases and 20 mm2 for control (P-0.0001). TACI was the most common type of ischemic stroke seen in DM (60%), HTN (66.6%) and smokers (66.7%). Plaques (73.3%), IMT (0.90 ± 0.12), PI(1.72 ± 0.14) and RI (0.76 ± 0.13) were more commonly associated with TACI subtype. On multivariate analysis using ANOVA, the mean PI was highly significant (0.000) in relation to types of plaque. Summary and Conclusions: IMT, RI, PI and plaque type are useful diagnostic parameters for acute ischemic stroke and its subtypes. They can be used as noninvasive tools for predicting and preventing ischemic stroke in smokers as well as subjects with DM and hypertension.

Significance of Increased CIMT with Coexisting Carotid Plaques in Cerebral White Matter Lesions in Elders

It is very common that increased carotid intima media thickness （CIMT） and carotid plaque coexist in a single subject in elderly patients with white matter lesions （WMLs）. In this study we inves- tigated whether the coexistence of increased CIMT and carotid plaque is more strongly associated with the presence and extent of WMLs than either alone. All patients were classified into 1 of the following 4 groups： without either increased CIMT （I） or carotid plaque （P）： I（-）P（-）; with only increased CIMT： I（＋）P（-）; with only carotid plaque： I（-）P（＋）; and with both increased CIMT and carotid plaque： I（＋）P（＋） The presence and severity of periventricular WMLs （PWMLs） and deep WMLs （DWMLs） were as- sessed and the prevalence of MRI findings by the Cochran-Armitage trend test was calculated. The characteristics of subjects showed that the percentages of patients with increased CIMT and carotid plaque in the DWMLs group and the PWMLs group were significantly higher than those without WMLs group. Both DWMLs and PWMLs were strongly associated with age, carotid plaque and CIMT. Furthermore, the Cochran-Armitage trend test indicated that the prevalence of MRI findings of PWMLs and DWMLs increased in the order of I（-）P（-）〈 I（＋）P（-）〈 I（-）P（＋）〈 I（＋）P（＋） （P〈0.0001）. For the pa- tients with DWMLs, the grades of both I（＋）P（-） and I（＋）P（＋） were increased significantly compared to I（-）P（-） （P〈0.0025, P〈0.05, respectively） without such a difference found in patients with PWMLs. Our results suggested that the coexistence of increased CIMT and carotid plaque is most closely associated with WMLs, and that increased CIMT is associated with the severity of DWMLs, whereas carotid plaque is related to the presence of WMLs.

Plaque components affect wall stress in stented human carotid artery: A numerical study

Carotid artery stenting presents challenges of in-stent restenosis and late thrombosis, which are caused primarily by alterations in the mechanical environment of the artery after stent implantation. The present study constructed patient-specific carotid arterial bifurcation models with lipid pools and calcified components based on magnetic resonance imaging. We numerically analyzed the effects of multicomponent plaques on the distributions of von Mises stresses (VMSs) in the patient-specific models after stenting. The results showed that when a stent was deployed, the large soft lipid pool in atherosclerotic plaques cushioned the host artery and reduced the stress within the arterial wall; however, this resulted in a sharp increase of VMS in the fibrous cap. When compared with the lipid pool, the presence of the calcified components led to slightly increased stresses on the luminal surface. However, when a calcification was located close to the luminal surface of the host artery and the stenosis, the local VMS was elevated. Overall, compared with calcified components, large lipid pools severely damaged the host artery after stenting. Furthermore, damage due to the calcified component may depend on location.

Numerical study of biomechanical characteristics of plaque rupture at stenosed carotid bifurcation:a stenosis mechanical property-specific guide for blood pressure control in daily activities

Acute stress concentration plays an important role in plaque rupture and may cause stroke or myocardial infarction.Quantitative evaluation of the relation between in vivo plaque stress and variations in blood pressure and flow rates is valuable to optimize daily monitoring of the cardiovascular system for high-risk patients as well as to set a safe physical exercise intensity for better quality of life.In this study,we constructed an in vivo stress model for a human carotid bifurcation with atherosclerotic plaque,and analyzed the effects of blood pressure,flow rates,plaque stiffness,and stenosis on the elastic stress and fluid viscous stress around the plaque.According to the maximum values of the mechanical stress,we define a risk index to predict the risk level of plaque rupture under different exercise intensities.For a carotid bifurcation where the blood flow divides,the results suggest that the stenosis ratio determines the ratio of the contributions of elastic shear stress and viscous shear stress to plaque rupture.A n increase of the plaque stiffness enhances the maximum elastic shear stress in the plaque,indicating that a high-stiffness plaque is more prone to rupture for given stenosis ratio.High stress co-localization at the shoulder of plaques agrees with the region of plaque injury in clinical observations.It is demonstrated that,due to the stress-shield effect,the rupture risk of a high-stiffness plaque tends to decrease under high-stenosis conditions,suggesting the existence of a specific stenosis corresponding to the maximum risk.This study may help to complement risk stratification of vulnerable plaques in clinical practice and provides a stenosis mechanical property-specific guide for blood pressure control in cardiovascular health management.

Relation between Carotid Artery Plaques Characteristics as a Predictor of Haemodynamics Changes after Carotid Artery Stenting

Objectives: To study relationship between carotid artery plaques characteristics and haemodynamic changes after carotid stenting. Patients and Methods: This observational prospective (pilot) study included 20 patients—who underwent CAS. The study was carried out in Ain shams university hospitals—Railway hospital (ERMED) and Suez insurance hospital from December 2018 to February 2020. Inclusion criteria, Symptomatic (defined as amaurosis fugax, TIA, Minor stroke or Major stroke) stenosis > 70%. Asymptomatic stenosis > 80% (accidentally discovered during pre-operative assessment for CABG and during full assessment for irrelevant stroke). Results: Regarding to plaque character for degree of stenosis, calcification and ulceration revealed significantly higher degree of stenosis in hemodynamic events group (P = 0.024). On the other hand, that there was no statistically significant difference between the two groups as regard calcification, ulceration and lesion location. Conclusion: The study revealed that HI is a common occurrence following CAS procedures and significantly higher degree of stenosis in hemodynamic events group. Plaque shape, ulcerations hardly affect haeodynamic instability after carotid stenting.

Prevalence of Carotid Atheromatous Plaques in Pre-Dialysis Chronic Kidney Disease Patients in South East, Nigeria

Background: Chronic kidney disease (CKD) patients have considerably high atherosclerotic changes which predict cardiovascular events;hence, this study evaluated the prevalence of carotid atherosclerotic plaques in pre-dialysis CKD patients at a tertiary institution in south-east, Nigeria. Materials and Method: 107 pre-dialysis CKD patients were consecutively recruited for the study. 81 subjects who were screened and had no kidney disease served as control. The control group was sex and age matched with the CKD patients. A pre-tested questionnaire was administered to all participants and physical examination was done. Presence of atheromatous plaques was assessed using doppler ultrasound at 3 sites—distal common carotid artery (CCA), the internal carotid artery (ICA) and the carotid bulb by a single skilled radiologist specialized in doppler ultrasound. Results: Atheromatous plaques were significantly increased in CKD patients. 14.2% of CKD patients had atheromatous plaques versus 2.5% in the control group (p value < 0.05). Commonest site of occurrence was at the common carotid artery (CCA-7.5% versus ICA-4.7% versus bulb 1.8%). Conclusions: Atheromatous plaques are prevalent in CKD patients. It is recommended that carotid doppler ultrasound should be done in CKD patients to identify patients for possible intervention.

Correlation of serum NGAL and OPG contents with the change of carotid plaques in diabetic patients

Objective:To investigate the correlation of serum NGAL and OPG contents with the change of carotid plaques in diabetic patients.Methods: A total of 99 patients with type 2 diabetes mellitus combined with carotid plaque who were treated in our hospitals between February 2016 and March 2018 were selected as group A and 86 patients with carotid plaque alone were selected as group B. The serum contents of NGAL OPG, inflammatory markers and lipid metabolism indexes were compared between the two groups, and Pearson test was used to evaluate the inner link of serum NGAL and OPG contents with carotid plaque properties in diabetic patients with carotid plaques.Results: Serum NGAL content of group A was higher than that of group B whereas OPG content was lower than that of group B;serum inflammatory markers MMP-9, IL-1β, IL-17 and CRP contents were higher than those of group B;serum lipid metabolism indexes ApoB and Lp-PLA2 contents were higher than those of group B whereas ApoAⅠcontent was lower than that of group B. Correlation analysis showed that serum NGAL and OPG contents of patients with diabetes mellitus combined with carotid plaque were directly correlated with the content of inflammatory markers and lipid metabolism indexes.Conclusion: Serum NGAL content abnormally increases whereas OPG content abnormally decreases in patients with diabetes mellitus combined with carotid plaque, and they are directly correlated with the stability of carotid plaque.

Effect of paraoxonase1 gene polymorphism on carotid plaque and cerebral infarction in Hainan population

Objective:To investigate the effect of paraoxonase 1 gene polymorphism on carotid plaque stability with cerebral infarction in Hainan population.Methods:277 patients of caroticl plaque With cerebral infarction who underwent physical examination in a hospital in Hainan from 2015 to another awarding 2018 were selected as the experimental group and the 363 people who no cerebral infarction as the Analytical methods:control group.The clinical data analyzed.DNA was collected from peripheral blood of two groups of patients and genotyped by flight mass analytical methods.''AG and GG could be detected by rs3917538.The distribution frequencies of The three genotypes in The control group accorded with Hardy-Weinberg equilibrium.Results:The distribution frequencies of AA,AG and GG in the control group were 97(26.7%),175(48.2%)and 91(25.1%)respectively.In the experimental group,the distribution frequencies were 76(27.4%),136(49.1%)and 65(23.5%).There were no statistical differences among the three detection methods of co-dominant model,Dominant model and recessive model.There was no difference in the frequency of allele A and G between groups.Conclusion:Polymorphism of paraoxonase 1 gene rs3917538 has No significant effect on carotid plaque formation and cerebral infarction in Hainan population.The Supplementary sample size to add more SNP research sites for further study,It is expected to further Revral the relationship between PON1and carotial piaque complicatecl with cerebral infarction in Hainan.

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.

Value of contrast-enhanced ultrasonography for evaluating the angiogenesis of carotid plaque in patients with cerebral infarction and its correlation with the changes of plaque properties

Objective: To study the value of contrast-enhanced ultrasonography for evaluating the angiogenesis of carotid plaque in patients with cerebral infarction and its correlation with the changes of plaque properties. Methods: The patients with carotid low-echo plaque detected by carotid artery ultrasound in Xinjiang Uygur Autonomous Region People's Hospital between January 2014 and January 2016 were selected as the research subjects, received at least 2 years of follow-up and divided into the cerebral infarction group who were with acute cerebral infarction during follow-up and the control group who were without cerebral infarction. CEUS was conducted on inclusion to measure the peak intensity (Peak) and time to peak (TP), and the serum was collected to determine the contents of angiogenesis molecules, inflammatory cytokines and collagen metabolism indexes. Results: The Peak level as well as serum VEGF, HGF, Ang-1, PDGF-BB, VE-cadherin, FKN, IL-17, ICTP, MMP10 and Caspase-3 contents of cerebral infarction group was higher than those of control group whereas TP level as well as serum IL-4, IL-10, TIMP1 and Vaspin contents was lower than those of control group;serum VEGF, HGF, Ang-1, PDGF-BB, VE-cadherin, FKN, IL-17, ICTP, MMP10 and Caspase-3 contents of cerebral infarction group were positively correlated with Peak level, and negatively correlated with TP level;serum IL-4, IL-10, TIMP1 and Vaspin contents were negatively correlated with Peak level, and positively correlated with TP level. Conclusion: CEUS parameters can be used to evaluate the angiogenesis in carotid plaque and the changes of plaque properties in patients with cerebral infarction.

SMI technique for the diagnosis of neovascularization in carotid plaques and its association with plaque acoustic characteristics

Objective:Application of microvascular imaging technique to evaluate the difference of blood flow imaging with different sonographic characteristics.Method:Selection in our hospital with carotid plaques in 120 patients,record 120 plaques on the patient's body, the thickness of endometrium by two-dimensional bounce and SMI technology to the patient, plaque morphology, acoustic characteristics, and the formation of new blood flow inside the plaque were analyzed.Result:The rate of neovascularization in the mixed echo plaques and hypoechoic plaques was significantly higher than that in the other two plaques, there was a difference in blood flow in all types of plaques. The internal echo between different patches of blood flow rate of appearance comparison, we can get a conclusion, no significant hypoechoic plaques and mixed plaques echo difference, compared with mixed echo plaque and medium echo, hyperechoic plaque had significant difference. Conclusion The SMI technique evaluated plaque blood flow imaging to obtain the followingConclusions: the rate of neovascularization in hypoechoic plaques and mixed echo plaques was significantly higher than that in moderate echo plaques and hyperechoic plaques,and SMI provides a new possibility for the diagnosis of neovascularization in atherosclerotic plaques and its manifestation in different echo plaques.

Correlation of carotid contrast-enhanced ultrasonography parameters with nerve damage and plaque properties in patients with atherosclerosis cerebral infarction

Objective: To explore the correlation of carotid contrast-enhanced ultrasonography parameters with nerve damage and plaque properties in patients with atherosclerosis cerebral infarction. Methods: A total of 176 patients with atherosclerosis cerebral infarction who were sent to this hospital for medical treatment between August 2014 and February 2018 were enrolled in cerebral infarction group, and 100 healthy elderly subjects who received physical examination in this hospital during the same period were enrolled in normal control group. Carotid CEUS parameter levels as well as serum contents of indexes related to nerve injury and plaque property were compared between the two groups, and Pearson test was used to evaluate the correlation of CEUS parameters levels with nerve damage and plaque properties in patients with cerebral infarction. Results: CEUS parameter Tp level in cerebral infarction group was lower than that in normal control group whereas P and AUC levels were higher than those in normal control group;serum nerve damage-related indexes SAA, NT-proBNP, Hcy, NSE and copeptin contents were higher than those of normal control group;serum plaque property-related indexes Lp-PLA2, MMP-9, Cat S and CD62P contents were higher than those of normal control group while APN and Cys C contents were lower than those of normal control group. Correlation analysis confirmed that carotid CEUS parameter levels in patients with cerebral infarction were correlated with the contents of indexes related to nerve damage and plaque property. Conclusion: Carotid CEUS parameters are obviously abnormal in patients with atherosclerosis cerebral infarction, they are directly correlated with the specific nerve damage and plaque properties, and they can be used as the reliable indexes to forecast the risk of cerebral infarction and evaluate its severity.