Objective To evaluate the relationship between COPD and atherosclerosis, and analyze the risk factors of atherosclerosis among COPD patients. Methods A total of 40 COPD patients and 43 normal subjects were enrolled in the study. Carotid intima-media thickness (IMT) and plaques were detected in both groups. Blood samples were collected to measure the concentration of high sensitive C-reactive protein (hs-CRP) , fibrinogen (Fbg) , total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) , while smoking index was recorded. Multiple regression analysis was performed to evaluate the correlative factors of IMT among COPD patients. According to whether luminal stenosis appeared, the COPD patients were allocated into group A ( without luminal stenosis) and group B ( with luminal stenosis) . Age, gender, hs-CRP, Fbg, TC, TG, HDL-C, LDL-C, and smoking index of the two groups were compared respectively. Results Hs-CRP, Fbg, thickness of IMT, plaques detection rate, and smoking index in the COPD group were significantly higher than those in the control group ( Plt;0.05) . TC, HDL-C, LDL-C in the COPD group were significantly lower than those in the control group ( Plt;0. 05) .Multiple regression analysis of IMT correlative factors among COPD patients showed that age, hs-CRP, Fbg, TC, TG, LDL-C, HDL-C, and smoking index were in linear relationship with IMT thickening. Age, hs-CRP, TC, and smoking index were positively correlated with IMT ( Plt;0.05) . Hs-CRP and smoking index in the group A were lower than those in the group B ( Plt;0. 05) .While TC, TG, LDL-C, and HDL-C in the group A were higher than those in the group B ( Plt;0.05) . Conclusions Age, smoking index, hs-CRP, and TC are risk factors for thickening of carotid artery IMT in COPD patients. Furthermore, smoking index, hs-CRP, TC, TG, LDL-C, and HDL-C are related to the severity of IMT thickening. The ultrasound detection of carotid artery IMT can be a valuble tool to screen atherosclerosis in patients with COPD.
Twenty six cases with carotid body tumours (27 tumors) were operaterated on from November,1988 to October, 1997. Eleven of the 26 cases were misdiagnosed in other hospital. Twenty six cases experienced B-mode ultrasonic scanning and 18 carotid arteriography. Seventeen cases underwent general hypothermic anesthesia (30℃-32℃) and 9 general carotid-internal carotid shunt. Eight cases (9 tumors) experienced simple excision of tumor, 3 resection of the tumor with external carotid, 11 excision of the tumor with internal, external and general carotid and carotid-reconstructing. Two cases underwent anestomosis of general carotid with internal carotid and 2 ligation of the internal carotid. All patients showed good results but one complicated with hemiplegia. The authors consider that misdiagnosis can be avoided with careful physical examination, Bmode ultrasonic scanning and arteriography, and hypothermic general anesthesia and intraoperative general carotid internal carotid shunt were important measures for the protection of brain.
ObjectiveTo summarize our experience in treating highrisk carotid stenosis. MethodsWe retrospectively analyzed the clinical characteristics, treatment, and outcomes of 24 patients with highrisk carotid stenosis in our department from January 2001 with emphasis on the application of carotid stents and shunting tubes. ResultsAll patients were successfully treated, with 11 patients undergoing carotid angioplasty and stenting (CAS) and 13 patients receiving carotid endarterectomy (CEA) and shunting. No death, stroke, and ischemic neurological deficit occurred in 30 days postoperatively. ConclusionSelective application of CAS and shunting in CEA can effectively reduce complications and improve therapeutic effects in patients with highrisk carotid stenosis.
ObjectiveTo evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. MethodsThe clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September 2021 were retrospectively analyzed. All patients underwent staged carotid artery stenting and coronary artery bypass grafting. The incidence and risk factors of severe complications such as myocardial infarction, cerebral infarction and death during the perioperative period and follow-up were analyzed. ResultsA total of 58 patients were enrolled, including 47 males and 11 females with an average age of 52-77 (64.2±5.6) years. No complications occurred before coronary artery bypass grafting. There was 1 myocardial infarction, 1 cerebral infarction and 1 death after the coronary artery bypass grafting. The early complication rate was 5.2%. During the follow-up of 18.3 months, 1 cerebral infarction and 2 deaths occurred, and the overall complication rate was 10.3%. According to Kaplan-Meier survival curve analysis, patients with symptomatic carotid stenosis (log-rank, P=0.037) and placement of close-cell (log-rank, P=0.030) had a higher risk of postoperative ischemic cerebrovascular event, and patients with previous cerebral infarction had a higher risk of postoperative severe complications (log-rank, P=0.044). ConclusionStaged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.
Objective To observe the effect of combination of antihypertensive and lipid lowering therapy on arterial stiffness in elderly patients with mild to moderate essential hypertension. Methods A total of 216 elderly patients with mild to moderate essential hypertension were enrolled and treated by hydrochlorothiazide as the basic therapy for two weeks. Then the patients were randomly divided into four groups. Namely, the intensified antihypertensive and lipid lowering therapy group (hydrochlorothiazide 25 mg/d, Candesartan 8 mg/d, Rosuvastatin 10 mg/d, n=54), the intensified antihypertensive treatment group (hydrochlorothiazide 25 mg/d, Candesartan 8 mg/d, n=54), the antihypertensive and lipid lowering therapy group (hydrochlorothiazide 25 mg/d, Rosuvastatin 10 mg/d, n=54), and the control group (hydrochlorothiazide 25 mg/d, n=54). After 12-month treatment, the blood pressure, blood lipid and carotid-radial pulse wave velocity (crPWV) of each group were recorded. Results Twelve months later, the SBP, DBP, PP and crPWV of each group were significantly lower than before (Plt;0.05). There was interactive effect of antihypertensive and lipid lowering therapy in lowering SBP, DBP, PP and crPWV (F=40.765, 4.869, 24.829, and 53.149, respectively, all Рlt;0.05). Conclusion The combination of antihypertensive and lipid lowering therapy can significantly lower the crPWV of elderly patients with hypertension and improve the arterial stiffness; it is superior to single treatment of either antihypertensive or lipid lowering.
ObjectiveTo analysis the risk factors for carotid stenosis in patients with ischemic cerebrovascular disease based on digital subtraction angiography. MethodsA total of 312 patients diagnosed with ischemic cerebrovascular disease who underwent digital subtraction angiography from June 2011 to September 2013 were selected.The risk factors of carotid stenosis were analysised by multivariate logistic regression analysis. ResultsIn 312 patients,271 were with cerebral infarction and 41 were transient ischemic attack patients.There were 149 patients in carotid stenosis group (stenosis degree ≥50%) and 163 patients in control group (stenosis degree<50%).The age (OR=1.037,P=0.000) and coronary heart disease (OR=4.121,P=0.001) were independent risk factors of carotid stenosis with ischemic cerebrovascular disease. ConclusionCarotid stenosis is common in ischemic cerebrovascular disease.Age and coronary heart disease were the independent risk factors.The recognition and control of these risk factors are in favor of secondary prevention of ischemic cerebrovascular disease.
Objective To compare the long-term efficacy of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in the treatment of carotid artery stenosis by meta-analysis. Methods PubMed, Embase, Medline, Cochrane Library, China National Knowledge Infrastructure, Wanfang database, Chongqing VIP database, and SinoMed were searched, for randomized controlled trials comparing the efficacy of CAS and CEA in the treatment of carotid artery stenosis published before September 2nd, 2021. Stata 15.1 software was used to analyze the long-term outcome data, including any stroke, ipsilateral stroke, fatal or disabling stroke, any death, combined endpoint of stroke or death, and carotid artery restenosis. Results A total of 20 English articles from 9 studies were included, involving 8551 patients (4658 in the CAS group and 3893 in the CEA group). The medians of the follow-up time of these studies were 2-10 years. The meta-analysis showed that the risks of any stroke [hazard ratio (HR)=1.33, 95% confidence interval (CI) (1.16, 1.52), P<0.0001], ipsilateral stroke [HR=1.26, 95%CI (1.02, 1.55), P=0.034], and the combined endpoint of stroke or death [HR=1.17, 95%CI (1.02, 1.33), P=0.021] in the CAS group were significantly higher than those in the CEA group, while the risks of fatal or disabling stroke [HR=1.19, 95%CI (0.94, 1.51), P=0.152], any death [HR=1.06, 95%CI (0.95, 1.18), P=0.302], and restenosis [HR=1.20, 95%CI (0.96, 1.49), P=0.111] were not significantly different between the CAS group and the CEA group. Conclusions CAS and CEA have similar risks in terms of long-term fatal or disabling stroke, death, and carotid artery restenosis, but the long-term risks of any stroke, ipsilateral stroke and combined endpoint of death or stroke of CAS are higher than those of CEA. CEA is still the preferred non-drug method for carotid artery stenosis.
There was no enough evidence to support the view that endovascular treatment could alternate the endarterectomy to be a standard treatment of carotid stenosis. A recent Cochrane systematic review found no difference in major outcomes between endovascular treatment and surgery. The randomised trials provided data to show that the main advantage of endovascular treatment for carotid artery stenosis was the avoidance of minor complications such as cranial nerve palsy and wound haematoma of surgery. Longer term follow also showed no difference in the rate of stroke during follow-up, but the confidence intervals were very wide allowing the possibility of a substantial difference in risk and benefits of the two treatments. There was no difference in avoidance of stroke between carotid stenting using protection devices and surgery, and the protection devices could cause additional complications.
Hypertensive retinopathy (HR) often coexist with carotid lesions in hypertensive patients. Carotid lesions are closely associated with cardiovascular and cerebrovascular diseases, as well as end events, offering early important evidence to screening high risk patients. HR has significant value to predict target organ damage (TOD) of hypertension including carotid lesion. In addition, hypertensive retinopathy and carotid lesions-related ischemic ocular diseases will cause serious vision function damage. This article is going to summarize the value and correlation between hypertensive retinopathy and carotid lesions in terms of clinical manifestations, pathological physiological mechanism and target organ damage.
ObjectiveTo observe the effects of carotid artery stenting (CAS) on ophthalmic artery blood flow in patients with ischemic ophthalmopathy (IOP).MethodsA prospective case-control study. Sixty IOP patients (60 eyes) who met inclusive criteria for CAS were enrolled in this study. There was 50% stenosis of internal carotid artery on one side at least confirmed by color doppler flow imaging (CDFI). Among 60 eyes, there were 3 eyes with central retinal artery occlusion, 15 eyes with retinal vein occlusion, 37 eyes with ischemic optic neuropathy, 5 eyes with ocular ischemia syndrome. The patients were randomly divided into CAS group (32 eyes of 32 patients) and medicine therapy group (28 eyes of 28 patients). The difference of age (t=1.804) and sex (χ2=1.975) between two groups was not significant (P＞0.05). The examinations of fundus fluorescein angiography (FFA), CDFI and digital substraction angiography (DSA) were performed before, 1 week and 6 months after treatment. The following parameters were recorded: arm-retinal circulation time (A-Rct), peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) in the ophthalmic artery (OA) and central retinal artery (CRA), and the best corrected visual acuity (BCVA).ResultsThere was no significant differences in A-Rct (t=1.354) and BCVA (t=0.376) between the two groups before treatment (P＞0.05). Also, there was no significant differences in PSV (t=?0.294, ?2.446), EDV (t=0.141, ?0.305), and RI (t=?0.222, ?0.694) of OA and CRA between the two groups before treatment before treatment (P＞0.05). Compared with the medicine therapy group, the lower A-Rct was found in the CAS group at different time points after the treatment. The difference was significant on 1 week after treatment (t=?3.205, P＜0.05), but not on 6 months after treatment (t=1.345, P＞0.05). The BCVA of eyes in the two groups were increasing with the extending of time of therapy. Compared with the medicine therapy group, the better BCVA was found in the CAS group at different time points after the treatment (t=0.800, 1.527; P＜0.05). Compared with the medicine therapy group, the higher PSV, EDV and lower RI of OA and CRA were found in the CAS group at different time points after the treatment. (P＜0.05).ConclusionCompared with conventional medicine therapy, CAS shows earlier effects in improving ocular hemodynamics for IOP patients with carotid artery stenosis, which benefits visual function improvement of the patients.