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Special Issue "Atherosclerosis and Vascular Imaging"

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A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology".

Deadline for manuscript submissions: closed (31 May 2015)

Special Issue Editor

Guest Editor
Prof. Michael Henein

Department of Public Health and Clinical Medical and Heart Center, Umea University, Umea, Sweden
Website | E-Mail
Phone: +46 90 785 00 00
Fax: +46 90 13 76 33
Interests: non-invasive cardiology; echocardiography; coronary artery disease imaging; carotid atherosclerosis

Special Issue Information

Dear Colleagues,

Cardiovascular disease is the main cause of death in the West, and vascular disease is the most common cardiovascular clinical problem. The disease results in serious morbidity and mortality, and carries economic cost implications. While conventional risk factors are well established, and their biomarkers regularly monitored, patients may continue to suffer subclinical active disease, even in the absence of risk factors, until they present with sudden cardiac death or stroke. Early disease detection using direct imaging has shown to be more accurate in identifying vulnerable patients and unstable plaques than conventional risk factors. This IJMS issue deals with the current opinion concerning the state-of-the-art imaging technologies available for clinical applications and their unique value over  the sole use of conventional risk factor analysis, in identifying vulnerable patients, recommending aggressive treatments, prognosticating, and in assessing related nutritional and environmental issues.

Prof. Michael Henein
Guest Editor

Submission

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Keywords

  • intima media thickness (imt) accuracy in identifying high risk individuals
  • IMT vs conventional risk factors in improving risk stratification
  • carotid plaque characterization
  • coronary calcification for daily risk assessment
  • coronary calcification: a risk or benefit?
  • nutritional influences on cardiovascular calcification
  • environmental influences on cardiovascular calcification
  • MRA for plaque characterization
  • PET/CT use in assessing lipid cores and their clinical relevance
  • vascular imaging for direct treatment delivery
  • vascular calcification challenges in intervention

Published Papers (12 papers)

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Research

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Open AccessArticle Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT
Int. J. Mol. Sci. 2015, 16(8), 19978-19988; doi:10.3390/ijms160819978
Received: 30 June 2015 / Revised: 7 August 2015 / Accepted: 13 August 2015 / Published: 21 August 2015
Cited by 2 | PDF Full-text (899 KB) | HTML Full-text | XML Full-text
Abstract
Background and Aim: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam
[...] Read more.
Background and Aim: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT). Methods: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3) was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations. Results: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: <8; 8–35; 36–70 and >70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients. Conclusion: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
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Open AccessArticle Meta-Analysis of miR-146a Polymorphisms Association with Coronary Artery Diseases and Ischemic Stroke
Int. J. Mol. Sci. 2015, 16(7), 14305-14317; doi:10.3390/ijms160714305
Received: 21 April 2015 / Revised: 1 June 2015 / Accepted: 9 June 2015 / Published: 24 June 2015
Cited by 6 | PDF Full-text (2858 KB) | HTML Full-text | XML Full-text
Abstract
Coronary artery disease (CAD) and ischemic stroke (IS) are manifestations of atherosclerosis, with a high death rate. miR-146a is a microRNA that participates in the progress of CAD and IS. A single nucleotide polymorphism (SNP) in the precursor of miR-146a, rs2910164, was found
[...] Read more.
Coronary artery disease (CAD) and ischemic stroke (IS) are manifestations of atherosclerosis, with a high death rate. miR-146a is a microRNA that participates in the progress of CAD and IS. A single nucleotide polymorphism (SNP) in the precursor of miR-146a, rs2910164, was found to be associated with the risks of CAD and IS. However, the results were inconsistent and inconclusive. A meta-analysis was performed to assess the relationship of rs2910164 and CAD as well as IS susceptibility. The database Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM) were searched for related studies. Crude odds ratios with 95% confidence intervals were used to investigate the strength of the association by random- or fixed-effect model. A total of eight studies, with 3138 cases and 3097 controls were identified for the meta-analysis. The results shows that rs2910164 is associated with the risk of CAD significantly in allelic model (OR = 0.86), homozygous model (OR = 0.70), heterozygous model (OR = 0.80) and dominant model (OR = 0.76). The subjects carrying the GG genotype, GG + GC genotype or G allele are at lower risks of CAD. For the susceptibility of IS, there are no significant associations between rs2910164 and total studies. However, in subgroup analysis by sample size and ethnicity, the GG, GG + GC and G allele of rs2910164 are found to be associated with higher risks of IS in large sample size group and in Koreans, under homozygous and dominant models. In conclusion, the current meta-analysis suggests lower risks of CAD for GG, GG + GC genotype and G allele of rs2910164, while rs2910164 is not associated with the risk of IS. Thus rs2910164 might be recommended as a predictor for susceptibility of CAD, but not IS. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
Open AccessArticle The Arginine/ADMA Ratio Is Related to the Prevention of Atherosclerotic Plaques in Hypercholesterolemic Rabbits When Giving a Combined Therapy with Atorvastatine and Arginine
Int. J. Mol. Sci. 2015, 16(6), 12230-12242; doi:10.3390/ijms160612230
Received: 8 April 2015 / Revised: 17 May 2015 / Accepted: 26 May 2015 / Published: 29 May 2015
Cited by 1 | PDF Full-text (1053 KB) | HTML Full-text | XML Full-text
Abstract
Supplementation with arginine in combination with atorvastatin is more efficient in reducing the size of an atherosclerotic plaque than treatment with a statin or arginine alone in homozygous Watanabe heritable hyperlipidemic (WHHL) rabbits. We evaluated the mechanism behind this feature by exploring the
[...] Read more.
Supplementation with arginine in combination with atorvastatin is more efficient in reducing the size of an atherosclerotic plaque than treatment with a statin or arginine alone in homozygous Watanabe heritable hyperlipidemic (WHHL) rabbits. We evaluated the mechanism behind this feature by exploring the role of the arginine/asymmetric dimethylarginine (ADMA) ratio, which is the substrate and inhibitor of nitric oxide synthase (NOS) and thereby nitric oxide (NO), respectively. Methods: Rabbits were fed either an arginine diet (group A, n = 9), standard rabbit chow plus atorvastatin (group S, n = 8), standard rabbit chow plus an arginine diet with atorvastatin (group SA, n = 8) or standard rabbit chow (group C, n = 9) as control. Blood was sampled and the aorta was harvested for topographic and histological analysis. Plasma levels of arginine, ADMA, cholesterol and nitric oxide were determined and the arginine/ADMA ratio was calculated. Results: The decrease in ADMA levels over time was significantly correlated to fewer aortic lesions in the distal aorta and total aorta. The arginine/ADMA ratio was correlated to cholesterol levels and decrease in cholesterol levels over time in the SA group. A lower arginine/ADMA ratio was significantly correlated to lower NO levels in the S and C group. Discussion: A balance between arginine and ADMA is an important indicator in the prevention of the development of atherosclerotic plaques. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
Open AccessArticle Ultrasound Assessment of Carotid Plaque Echogenicity Response to Statin Therapy: A Systematic Review and Meta-Analysis
Int. J. Mol. Sci. 2015, 16(5), 10734-10747; doi:10.3390/ijms160510734
Received: 16 February 2015 / Revised: 1 May 2015 / Accepted: 5 May 2015 / Published: 12 May 2015
Cited by 5 | PDF Full-text (809 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Objective: To evaluate in a systematic review and meta-analysis model the effect of statin therapy on carotid plaque echogenicity assessed by ultrasound. Methods: We have systematically searched electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to April, 2015, for studies evaluating
[...] Read more.
Objective: To evaluate in a systematic review and meta-analysis model the effect of statin therapy on carotid plaque echogenicity assessed by ultrasound. Methods: We have systematically searched electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to April, 2015, for studies evaluating the effect of statins on plaque echogenicity. Two researchers independently determined the eligibility of studies evaluating the effect of statin therapy on carotid plaque echogenicity that used ultrasound and grey scale median (GSM) or integrated back scatter (IBS). Results: Nine out of 580 identified studies including 566 patients’ carotid artery data were meta-analyzed for a mean follow up of 7.2 months. A consistent increase in the echogenicity of carotid artery plaques, after statin therapy, was reported. Pooled weighted mean difference % (WMD) on plaque echogenicity after statin therapy was 29% (95% CI 22%–36%), p < 0.001, I2 = 92.1%. In a meta-regression analysis using % mean changes of LDL, HDL and hsCRP as moderators, it was shown that the effects of statins on plaque echogenicity were related to changes in hsCRP, but not to LDL and HDL changes from the baseline. The effect of statins on the plaque was progressive; it showed significance after the first month of treatment, and the echogenicity continued to increase in the following six and 12 months. Conclusions: Statin therapy is associated with a favorable increase of carotid plaque echogenicity. This effect seems to be dependent on the period of treatment and hsCRP change from the baseline, independent of changes in LDL and HDL. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
Open AccessArticle A Variant in the Osteoprotegerin Gene Is Associated with Coronary Atherosclerosis in Patients with Rheumatoid Arthritis: Results from a Candidate Gene Study
Int. J. Mol. Sci. 2015, 16(2), 3885-3894; doi:10.3390/ijms16023885
Received: 14 December 2014 / Accepted: 6 February 2015 / Published: 11 February 2015
Cited by 2 | PDF Full-text (708 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Objective: Patients with rheumatoid arthritis (RA) have accelerated atherosclerosis, but there is limited information about the genetic contribution to atherosclerosis in this population. Therefore, we examined the association between selected genetic polymorphisms and coronary atherosclerosis in patients with RA. Methods: Genotypes for single-nucleotide
[...] Read more.
Objective: Patients with rheumatoid arthritis (RA) have accelerated atherosclerosis, but there is limited information about the genetic contribution to atherosclerosis in this population. Therefore, we examined the association between selected genetic polymorphisms and coronary atherosclerosis in patients with RA. Methods: Genotypes for single-nucleotide polymorphisms (SNPs) in 152 candidate genes linked with autoimmune or cardiovascular risk were measured in 140 patients with RA. The association between the presence of coronary artery calcium (CAC) and SNP allele frequency was assessed by logistic regression with adjustment for age, sex, and race. To adjust for multiple comparisons, a false discovery rate (FDR) threshold was set at 20%. Results: Patients with RA were 54 ± 11 years old and predominantly Caucasian (89%) and female (69%). CAC was present in 70 patients (50%). A variant in rs2073618 that encodes an Asn3Lys missense substitution in the osteoprotegerin gene (OPG, TNFRSF11B) was significantly associated with the presence of CAC (OR = 4.09, p < 0.00026) and withstands FDR correction. Conclusion: Our results suggest that a polymorphism of the TNFRSF11B gene, which encodes osteoprotegerin, is associated with the presence of coronary atherosclerosis in patients with RA. Replication of this finding in independent validation cohorts will be of interest. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
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Review

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Open AccessReview Advances in the Study of the Antiatherogenic Function and Novel Therapies for HDL
Int. J. Mol. Sci. 2015, 16(8), 17245-17272; doi:10.3390/ijms160817245
Received: 23 April 2015 / Revised: 26 June 2015 / Accepted: 16 July 2015 / Published: 28 July 2015
PDF Full-text (953 KB) | HTML Full-text | XML Full-text
Abstract
The hypothesis that raising high-density lipoprotein cholesterol (HDL-C) levels could improve the risk for cardiovascular disease (CVD) is facing challenges. There is multitudinous clear clinical evidence that the latest failures of HDL-C-raising drugs show no clear association with risks for CVD. At the
[...] Read more.
The hypothesis that raising high-density lipoprotein cholesterol (HDL-C) levels could improve the risk for cardiovascular disease (CVD) is facing challenges. There is multitudinous clear clinical evidence that the latest failures of HDL-C-raising drugs show no clear association with risks for CVD. At the genetic level, recent research indicates that steady-state HDL-C concentrations may provide limited information regarding the potential antiatherogenic functions of HDL. It is evident that the newer strategies may replace therapeutic approaches to simply raise plasma HDL-C levels. There is an urgent need to identify an efficient biomarker that accurately predicts the increased risk of atherosclerosis (AS) in patients and that may be used for exploring newer therapeutic targets. Studies from recent decades show that the composition, structure and function of circulating HDL are closely associated with high cardiovascular risk. A vast amount of data demonstrates that the most important mechanism through which HDL antagonizes AS involves the reverse cholesterol transport (RCT) process. Clinical trials of drugs that specifically target HDL have so far proven disappointing, so it is necessary to carry out review on the HDL therapeutics. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
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Open AccessReview Vasa Vasorum in Atherosclerosis and Clinical Significance
Int. J. Mol. Sci. 2015, 16(5), 11574-11608; doi:10.3390/ijms160511574
Received: 9 April 2015 / Accepted: 11 May 2015 / Published: 20 May 2015
Cited by 3 | PDF Full-text (1321 KB) | HTML Full-text | XML Full-text
Abstract
Atherosclerosis is a chronic inflammatory disease that leads to several acute cardiovascular complications with poor prognosis. For decades, the role of the adventitial vasa vasorum (VV) in the initiation and progression of atherosclerosis has received broad attention. The presence of VV neovascularization precedes
[...] Read more.
Atherosclerosis is a chronic inflammatory disease that leads to several acute cardiovascular complications with poor prognosis. For decades, the role of the adventitial vasa vasorum (VV) in the initiation and progression of atherosclerosis has received broad attention. The presence of VV neovascularization precedes the apparent symptoms of clinical atherosclerosis. VV also mediates inflammatory cell infiltration, intimal thickening, intraplaque hemorrhage, and subsequent atherothrombosis that results in stroke or myocardial infarction. Intraplaque neovessels originating from VV can be immature and hence susceptible to leakage, and are thus regarded as the leading cause of intraplaque hemorrhage. Evidence supports VV as a new surrogate target of atherosclerosis evaluation and treatment. This review provides an overview into the relationship between VV and atherosclerosis, including the anatomy and function of VV, the stimuli of VV neovascularization, and the available underlying mechanisms that lead to poor prognosis. We also summarize translational researches on VV imaging modalities and potential therapies that target VV neovascularization or its stimuli. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
Open AccessReview Ultrasound Tissue Characterization of Vulnerable Atherosclerotic Plaque
Int. J. Mol. Sci. 2015, 16(5), 10121-10133; doi:10.3390/ijms160510121
Received: 30 January 2015 / Revised: 23 April 2015 / Accepted: 24 April 2015 / Published: 5 May 2015
Cited by 5 | PDF Full-text (939 KB) | HTML Full-text | XML Full-text
Abstract
A thrombotic occlusion of the vessel fed by ruptured coronary atherosclerotic plaque may result in unstable angina, myocardial infarction or death, whereas embolization from a plaque in carotid arteries may result in transient ischemic attack or stroke. The atherosclerotic plaque prone to such
[...] Read more.
A thrombotic occlusion of the vessel fed by ruptured coronary atherosclerotic plaque may result in unstable angina, myocardial infarction or death, whereas embolization from a plaque in carotid arteries may result in transient ischemic attack or stroke. The atherosclerotic plaque prone to such clinical events is termed high-risk or vulnerable plaque, and its identification in humans before it becomes symptomatic has been elusive to date. Ultrasonic tissue characterization of the atherosclerotic plaque is possible with different techniques—such as vascular, transesophageal, and intravascular ultrasound—on a variety of arterial segments, including carotid, aorta, and coronary districts. The image analysis can be based on visual, video-densitometric or radiofrequency methods and identifies three distinct textural patterns: hypo-echoic (corresponding to lipid- and hemorrhage-rich plaque), iso- or moderately hyper-echoic (fibrotic or fibro-fatty plaque), and markedly hyperechoic with shadowing (calcific plaque). Hypoechoic or dishomogeneous plaques, with spotty microcalcification and large plaque burden, with plaque neovascularization and surface irregularities by contrast-enhanced ultrasound, are more prone to clinical complications than hyperechoic, extensively calcified, homogeneous plaques with limited plaque burden, smooth luminal plaque surface and absence of neovascularization. Plaque ultrasound morphology is important, along with plaque geometry, in determining the atherosclerotic prognostic burden in the individual patient. New quantitative methods beyond backscatter (to include speed of sound, attenuation, strain, temperature, and high order statistics) are under development to evaluate vascular tissues. Although not yet ready for widespread clinical use, tissue characterization is listed by the American Society of Echocardiography roadmap to 2020 as one of the most promising fields of application in cardiovascular ultrasound imaging, offering unique opportunities for the early detection and treatment of atherosclerotic disease. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
Open AccessReview Ultrasound Imaging for Risk Assessment in Atherosclerosis
Int. J. Mol. Sci. 2015, 16(5), 9749-9769; doi:10.3390/ijms16059749
Received: 6 February 2015 / Revised: 9 April 2015 / Accepted: 9 April 2015 / Published: 29 April 2015
Cited by 3 | PDF Full-text (3351 KB) | HTML Full-text | XML Full-text
Abstract
Atherosclerosis and its consequences like acute myocardial infarction or stroke are highly prevalent in western countries, and the incidence of atherosclerosis is rapidly rising in developing countries. Atherosclerosis is a disease that progresses silently over several decades before it results in the aforementioned
[...] Read more.
Atherosclerosis and its consequences like acute myocardial infarction or stroke are highly prevalent in western countries, and the incidence of atherosclerosis is rapidly rising in developing countries. Atherosclerosis is a disease that progresses silently over several decades before it results in the aforementioned clinical consequences. Therefore, there is a clinical need for imaging methods to detect the early stages of atherosclerosis and to better risk stratify patients. In this review, we will discuss how ultrasound imaging can contribute to the detection and risk stratification of atherosclerosis by (a) detecting advanced and early plaques; (b) evaluating the biomechanical consequences of atherosclerosis in the vessel wall; (c) assessing plaque neovascularization and (d) imaging the expression of disease-relevant molecules using molecular imaging. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
Open AccessReview Coronary Artery Calcium Screening: Does it Perform Better than Other Cardiovascular Risk Stratification Tools?
Int. J. Mol. Sci. 2015, 16(3), 6606-6620; doi:10.3390/ijms16036606
Received: 26 January 2015 / Revised: 17 February 2015 / Accepted: 5 March 2015 / Published: 23 March 2015
Cited by 11 | PDF Full-text (798 KB) | HTML Full-text | XML Full-text
Abstract
Coronary artery calcium (CAC) has been advocated as one of the strongest cardiovascular risk prediction markers. It performs better across a wide range of Framingham risk categories (6%–10% and 10%–20% 10-year risk categories) and also helps in reclassifying the risk of these subjects
[...] Read more.
Coronary artery calcium (CAC) has been advocated as one of the strongest cardiovascular risk prediction markers. It performs better across a wide range of Framingham risk categories (6%–10% and 10%–20% 10-year risk categories) and also helps in reclassifying the risk of these subjects into either higher or lower risk categories based on CAC scores. It also performs better among population subgroups where Framingham risk score does not perform well, especially young subjects, women, family history of premature coronary artery disease and ethnic differences in coronary risk. The absence of CAC is also associated with excellent prognosis, with 10-year event rate of 1%. Studies have also compared with other commonly used markers of cardiovascular disease risk such as Carotid intima-media thickness and highly sensitive C-reactive protein. CAC also performs better compared with carotid intima-media thickness and highly sensitive C-reactive protein in prediction of coronary heart disease and cardiovascular disease events. CAC scans are associated with relatively low radiation exposure (0.9–1.1 mSv) and provide information that can be used not only for risk stratification but also can be used to track the progression of atherosclerosis and the effects of statins. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)
Open AccessReview Coronary CT Angiography in Managing Atherosclerosis
Int. J. Mol. Sci. 2015, 16(2), 3740-3756; doi:10.3390/ijms16023740
Received: 4 January 2015 / Accepted: 4 February 2015 / Published: 9 February 2015
Cited by 9 | PDF Full-text (1130 KB) | HTML Full-text | XML Full-text
Abstract
Invasive coronary angiography (ICA) was the only method to image coronary arteries for a long time and is still the gold-standard. Technology of noninvasive imaging by coronary computed-tomography angiography (CCTA) has experienced remarkable progress during the last two decades. It is possible to
[...] Read more.
Invasive coronary angiography (ICA) was the only method to image coronary arteries for a long time and is still the gold-standard. Technology of noninvasive imaging by coronary computed-tomography angiography (CCTA) has experienced remarkable progress during the last two decades. It is possible to visualize atherosclerotic lesions in the vessel wall in contrast to “lumenography” performed by ICA. Coronary artery disease can be ruled out by CCTA with excellent accuracy. The degree of stenoses is, however, often overestimated which impairs specificity. Atherosclerotic lesions can be characterized as calcified, non-calcified and partially calcified. Calcified plaques are usually quantified using the Agatston-Score. Higher scores are correlated with worse cardiovascular outcome and increased risk of cardiac events. For non-calcified or partially calcified plaques different angiographic findings like positive remodelling, a large necrotic core or spotty calcification more frequently lead to myocardial infarctions. CCTA is an important tool with increasing clinical value for ruling out coronary artery disease or relevant stenoses as well as for advanced risk stratification. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)

Other

Jump to: Research, Review

Open AccessCase Report Imaging of a Cilioretinal Artery Embolisation
Int. J. Mol. Sci. 2014, 15(9), 15734-15740; doi:10.3390/ijms150915734
Received: 31 July 2014 / Revised: 29 August 2014 / Accepted: 1 September 2014 / Published: 4 September 2014
PDF Full-text (3984 KB) | HTML Full-text | XML Full-text
Abstract
Retinal artery occlusion can be the first indicator of a significant cardiovascular disorder and the need for treatment. We present the case of a 69-year-old man with a cilioretinal artery occlusion and retinal ischemia. Retinal imaging, in particular fundus autofluorescence, highlighted an intraluminal
[...] Read more.
Retinal artery occlusion can be the first indicator of a significant cardiovascular disorder and the need for treatment. We present the case of a 69-year-old man with a cilioretinal artery occlusion and retinal ischemia. Retinal imaging, in particular fundus autofluorescence, highlighted an intraluminal hyperautofluorescent lesion which led to the diagnosis of retinal emboli. Subsequently a severe, previously undiagnosed carotid occlusive disease was discovered. The patient underwent prompt endarterectomy. Full article
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging)

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