Moderate ICA stenosis altered physiological
WSS distribution whereas recanalization of previously high-grade ICA stenosis led to a similar distribution of WSS compared to healthy volunteers [3]. Flow-sensitive 4D MRI demonstrated the distribution of absolute ZD1839 and oscillatory WSS in vivo. Moreover, physiological and pathological blood flow parameter could be identified that were associated with atherosclerotic disease and recanalization procedures. This in vivo MRI technique seems very promising to study the influence of individual bifurcation geometry on local hemodynamics and the development and progression of carotid artery atherosclerosis. “
“Atherosclerosis is a complex inflammatory process underlying the occurrence of heart attacks and most ischemic strokes. Sirolimus in vivo Traditional vascular risk
factors are important for development of atherosclerosis but interestingly, explain only about 50% of the risk of cardiovascular disease (CVD) and stroke. Current screening strategies are based on these risk factors. However the complexity of stroke and CVD has led to the increasing use of intermediate phenotypes in risk prediction of vascular disease and surrogate outcomes in clinical trials. Carotid intima–media thickness (cIMT) and carotid plaque are widely used as intermediate, preclinical phenotypes of vascular disease ( Fig. 1). Although individuals with subclinical atherosclerosis have not yet experienced overt vascular disease, they have a greater risk for incident stroke and MI in comparison to individuals without evidence of increased subclinical atherosclerotic disease. Carotid ultrasound imaging measures of carotid plaque and cIMT are proposed as surrogate markers of CVD and stroke as objective indicators of the biological and pathobiological processes of atherosclerosis. They can also serve as surrogate endpoints for clinical vascular outcomes based on epidemiologic, therapeutic, pathophysiologic and other scientific evidence. This review article 4��8C will provide an overview on the relevant literature regarding the use of cIMT and carotid plaque as surrogate markers in various research investigations and clinical
practice. Carotid IMT is a widely accepted imaging surrogate marker of generalized atherosclerosis [1] and [2]. On ultrasound, cIMT is represented by a double-line pattern on the near and the far wall of the carotid artery (Fig. 2). The two anatomical landmarks which can be measured as the double-line pattern are the lumen–intima and the media–adventitia interfaces [3]. Even without presence of atherosclerosis the intima and the media layer increase with advancing age as a result of adaptive changes to biomechanical parameters, like blood flow and tension on the wall [4]. Since these changes give rise to molecular and cellular pathways, which are also involved in the formation of atherosclerotic plaque, cIMT is related to subclinical atherosclerosis, but should not be used synonymously [5].