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- Asciutto, Giuseppe
(författare)
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Carotid stenosis: aspects on progression, stabilization and follow-up
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cardiovascular (CV) atherosclerotic diseases are the leading cause of death in Western nations. The presence of a carotid plaque, the degree of carotid stenosis as well as the rate of progression of carotid disease has been shown to be independent predictive factors for future ischemic events. The aim of this thesis was to detect clinical, sonographic and serologic patterns that could aid in identifying patients at risk of progression of atherosclerosis and the development of symptoms; the thesis also focuses on the role of current medical treatments in atherogenesis and plaque composition. In this thesis we demonstrate a high incidence of symptoms and disease progression contralateral to the carotid artery treated by endarterectomy, particularly in the presence of a moderate (i.e. >60%) stenosis degree at baseline. As evidence of possible protective effects on atherogenesis by beta-blockers grows, we decided to analyse plaque content of two factors involved in regulating the inflammatory process leading to the atherogenesis. Focusing on the soluble urokinase plasminogen activator receptor and the lipoprotein associated phospholipase A2 we detected a lower level of inflammation in patients on long-term treatment with beta-blockers. These findings were in line with a higher echogenicity of carotid plaques as evaluated using grey-scale median (GSM) analysis in patients on long-term treatment with beta-blockers. Finally, assessing possible preoperative plaque and serological markers we observed higher risk for postoperative stroke in patients with lower elastin plaque content and a higher risk of CV death in patients with lower circulating titers of antibodies of type IgG against the epitope p210 of the apolipoprotein B100 of LDL In conclusion, this thesis underlines that progression of contralateral disease after unilateral CEA occurs frequently. Moreover, it reinforces the possible atheroprotective effects of beta-blockers beyond the purely hemodynamic and the need to monitor the effects with non-invasive diagnostic tools. It also supports the concept that ECM proteins are important for plaque stability and suggest the potential of the assessment of Ab against oxLDL as a supplemental marker of generalised atherosclerosis. Further studies are needed to better identify high risk populations that are in need of more intensive secondary prevention
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| 2. |
- Asciutto, Giuseppe, et al.
(författare)
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Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence.
- 2012
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Ingår i: Vasa: European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 41:2, s. 120-124
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.
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| 3. |
- Asciutto, Giuseppe, et al.
(författare)
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Long-term progression of contralateral carotid artery disease after endarterectomy: is there a need for Duplex surveillance?
- 2012
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Ingår i: International Angiology. - 1827-1839. ; 31:4, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this paper was to define the incidence of disease progression of the contralateral internal carotid artery (CICA) in patients undergoing carotid endarterectomy (CEA) and to identify factors influencing disease progression. METHODS: Patients from our primary catchment area that had undergone CEA between 2002 and 2005 were included. The study cohort was divided in four groups based on the preoperative stenosis grade (normal ICA <40%, N.=56; mild 40-60%, N.=41; moderate 61-80%, N.=12; severe 81-99%, N.=7). Patients initially planned or already submitted to contralateral CEA or with contralateral occlusion were excluded. RESULTS: One hundred and seventeen patients were analysed. Disease progression occurred in 13 (11%) patients after a mean of 47.6 months (SD 1.6 months). A moderate preoperative CICA stenosis was associated with disease progression (P=0.017). Late neurologic events referable to the CICA independently of progression occurred in 13 (11%) patients. There were 4 (30.7%) events in the 13 carotids with progression and only 9 (7%) in the 117 without progression (P=0.060). .Moderate and severe preoperative CICA stenosis and renal insufficiency were associated with postoperative ipsilateral neurological symptoms (P=0.001 and 0.009, respectively). CONCLUSION: Disease progression of the CICA after CEA is not uncommon. The preoperative degree of CICA stenosis is related to subsequent disease progression and to the occurrence of symptoms. More studies are needed to identify risk factors influencing the progression of ICA disease.
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| 5. |
- Asciutto, Giuseppe, et al.
(författare)
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Treatment with beta-blockers is associated with lower levels of Lp-PLA2 and suPAR in carotid plaques.
- 2013
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Ingår i: Cardiovascular Pathology. - : Elsevier BV. - 1879-1336 .- 1054-8807. ; 22:6, s. 438-443
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To determine whether a long-term treatment with beta-blockers influences the inflammatory activity in carotid artery disease by reducing the carotid plaque levels of lipoprotein-associated phospholipase A2 (Lp-PLA2), its enzymatic products lysophosphatidylcholine (lysoPCs), and of soluble urokinase plasminogen activator receptor (suPAR). MATERIALS AND METHODS: One hundred and thirty-four patients with significant symptomatic or asymptomatic carotid stenosis undergoing surgery were prospectively included and divided into two groups (Group A or B) based on the absence or presence of an on-going long-term oral treatment with beta-blockers. The harvested carotid plaques were analyzed for the levels of lysoPCs using mass spectrometry and Lp-PLA2 and suPAR by Enzyme-linked immunosorbent assay (ELISA). RESULTS: Plaques of patients on long-term treatment with beta-blockers revealed lower levels of Lp-PLA2 (Group A 0.752±0.393 ug/g vs. Group B 0.644±0.445 ug/g, P=.049) as well as suPAR (Group A 0.044±0.024 μg/g vs. Group B 0.036±0.025 μg/g, P=.028). Levels of Lp-PLA2 and suPAR were positively correlated (r=.637, P<.0001). Lp-PLA2 and suPAR levels were also correlated (P<.0001) with the three lysoPC species tested (lysoPC 16:0, lysoPC 18:0. lysoPC 18:1). All the above-mentioned findings were confirmed after correction for age, gender, hypertension, coronary artery disease, and statin usage. CONCLUSIONS: The reduced levels of Lp-PLA2 and suPAR in human carotid plaques of subjects on long-term treatment with beta-blockers suggest their possible protective role in plaque inflammation. Our findings support an even more selective Lp-PLA2 and suPAR inhibition as a possible strategy for the prevention of cardiovascular disease.
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| 6. |
- Asciutto, Giuseppe, et al.
(författare)
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Treatment with betablockers is associated with higher grey-scale median in carotid plaques
- 2014
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: The presence of echolucent carotid plaques as defined by low ultrasound grey-scale median (GSM) is associated with a higher risk of stroke and myocardial infarction. Betablockers have shown possible anti-atherosclerotic effects. The aim of the present study was to determine if there is an association between carotid plaque GSM and treatment with betablockers. Methods: The GSM of the carotid plaques of 350 patients who underwent carotid endarterectomy (CEA) for asymptomatic (n = 113) or symptomatic (n = 237) carotid disease was measured. Patients were divided in two groups based on the absence/presence of an on-going long-term (i.e. at least 6 months) oral treatment with betablockers at the time of CEA. Results: The prevalence and type of preoperative neurological symptoms were similar in the two groups. Patients with betablockers had more frequently arterial hypertension (P < .0001), diabetes (P = .035) and a higher BMI (P = .0004), while patients without betablockers were most frequently smokers (P = .017). Patients with betablockers revealed to have higher GSM (37.79 +/- 25 vs 32.61 +/- 23.50 P = .036). Echogenic plaques (i.e. with GSM > 30) showed to be more frequent in patients with betablockers also after correction for age, gender, the occurrence of preoperative symptoms, diabetes, hypertension, smoking and statins use (P = .024). Conclusions: These results suggest the use of standardized ultrasound techniques as an important tool in evaluating the effect of anti-atherosclerotic medications and underline the need of. further prospective randomized studies on larger patient cohorts in order to confirm these results.
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