Search Results (1,087)

Vascular smooth muscle cells (VSMCs) in the tunica media are essential for maintaining the structure and function of the arterial wall. These cells regulate vascular tone and contribute to vasculogenesis and angiogenesis, particularly during development. Proper control of VSMC differentiation ensures the correct size and patterning of vessels. Dysregulation of VSMC behaviour in adulthood, however, is linked to serious cardiovascular diseases, including aortic aneurysm, coronary artery disease, atherosclerosis and pulmonary hypertension. VSMCs are characterised by their phenotypic plasticity, which is the capacity to transition from a contractile to a synthetic, dedifferentiated state in response to environmental cues. This phenotypic switch plays a central role in vascular remodelling, a process that drives the progression of many vascular pathologies. Epigenetic mechanisms, which are defined as heritable but reversible changes in gene expression that do not involve alterations to the DNA sequence, have emerged as key regulators of VSMC identity and behaviour. These mechanisms include DNA methylation, histone modifications, chromatin remodelling, non-coding RNA and RNA modifications. Understanding how these epigenetic processes influence VSMC plasticity is crucial to uncovering the molecular basis of vascular development and disease. This review explores the current understanding of VSMC biology, focusing on epigenetic regulation in health and pathology. Full article

This article presents a systematic review on methods for quantifying three-dimensional, time-resolved (3D+t) deformation and motion of human arteries from Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched Scopus, Web of Science, IEEE Xplore, Google Scholar, and PubMed on 19 December 2025 for in vivo, patient-specific CT or MRI studies reporting motion or deformation of large human arteries. We included studies that quantified arterial deformation or motion tracking and excluded non-vascular tissues, in vitro or purely computational work. Thirty-five studies were included in the qualitative synthesis; most were small, single-centre observational cohorts. Articles were analysed qualitatively, and results were synthesised narratively. Across the 35 studies, the most common segmentation approaches are active contours and threshold, while temporal motion is tracked using either voxel registration or surface methods. These kinematic data are used to compute metrics such as circumferential and longitudinal strain, distensibility, and curvature. Several studies also employ inverse methods to estimate wall stiffness. The findings consistently show that arterial strain decreases with age (on the order of 20% per decade in some cases) and in the presence of disease, that stiffness correlates with geometric remodelling, and that deformation is spatially heterogeneous. However, insufficient data prevents meaningful comparison across methods. Full article

Background: There exists some inconsistent evidence on the relationship between altered cardiac morphology, its function, and frailty. Therefore, this study aimed to assess the associations among frailty, lean body mass, central arterial stiffness, and cardiac structure and geometry in older people with a normal ejection fraction. Methods: A total of 205 patients >65 years were enrolled into this ancillary analysis of the FRAPICA study and were assessed for frailty with the Fried phenotype scale. Left ventricular dimensions and geometry were assessed with two-dimensional echocardiography. Fat-free mass was measured using three-site skinfold method. Parametric and non-parametric statistics and analysis of covariance were used for statistical calculations. Results: Frail patients were older and women comprised the majority of the frail group. Frail men and women had comparable weight, height, fat-free mass, blood pressure, central blood pressure, and carotid–femoral pulse wave velocity to their non-frail counterparts. There was a linear correlation between the sum of frailty criteria and left ventricular end-diastolic diameter (Spearman R = −0.17; p < 0.05) and relative wall thickness (Spearman R = 0.23; p < 0.05). In the analysis of covariance, frailty and gender were independently associated with left ventricular mass (gender: β of −0.37 and 95% CI of −0.50–−0.24 at p < 0.001), the left ventricular mass index (gender: β of −0.23 and 95% CI of −0.37–−0.09 at p < 0.001), and relative wall thickness (frailty: β of −0.15 and 95% CI of −0.29–−0.01 at p < 0.05; gender: β of 0.23 and 95% CI of 0.09–0.36 at p < 0.01). Frailty was associated with a shift in heart remodeling toward concentric remodeling/hypertrophy. Conclusions: Frailty is independently associated with thickening of the left ventricular walls and a diminished left ventricular end-diastolic diameter, which are features of concentric remodeling or hypertrophy. This association appears to be more pronounced in women. Such adverse cardiac remodeling may represent another phenotypic feature linked to frailty according to the phenotype frailty criteria. Full article

Background/Objectives: Epicardial fat thickness (EFT) is an echocardiographic marker of epicardial adipose tissue that has been linked to coronary atherosclerosis, but its relationship with both coronary artery disease (CAD) severity and myocardial ischemia remains incompletely assessed. This study evaluated the association between EFT, angiographic CAD severity, and stress-induced myocardial ischemia. Methods: In a prospective study, 125 consecutive patients with suspected stable angina underwent transthoracic echocardiography with EFT measurement, dobutamine stress echocardiography, and coronary angiography. EFT was measured at end-systole in the parasternal long-axis view. Significant CAD was defined as ≥50% stenosis in at least one major epicardial coronary artery. Myocardial ischemia was assessed using peak-stress wall motion score index (WMSI). Results: Significant CAD was present in 56% of patients. Mean EFT was significantly higher in patients with significant CAD compared with those without (7.8 ± 2.0 mm vs. 5.5 ± 1.5 mm; p < 0.001). EFT increased progressively with angiographic CAD severity (non-significant CAD: 5.5 ± 1.5 mm; one-vessel disease: 6.5 ± 1.8 mm; two-vessel disease: 7.5 ± 2.0 mm; three-vessel disease: 8.5 ± 1.9 mm; p < 0.001). Patients with EFT > 5 mm had a significantly higher prevalence of significant CAD (68.8% vs. 33.3%; p < 0.001) and were older, with higher body mass index and a greater prevalence of hypertension and obesity. Additionally, peak-stress WMSI was significantly higher in patients with elevated EFT (1.08 ± 0.07 vs. 1.04 ± 0.05; p = 0.005), indicating a greater ischemic burden. Conclusions: EFT is associated with both the anatomical severity of CAD and the extent of stress-induced myocardial ischemia, supporting its potential role in non-invasive risk stratification of patients with suspected CAD. Full article

Objectives: This study aimed to define the learning curve required for cardiac surgery residents to acquire basic technical and interpretive skills in transit-time flow measurement (TTFM) and high-resolution epicardial ultrasonography (HRUS) during coronary artery bypass grafting (CABG). Methods: Prospective, observational, single-center study evaluating performance using a novel scoring system combining functional (TTFM) and anatomical (HRUS) assessment criteria. This study was registered on ClinicalTrials.gov (Identifier: NCT06589323). Nine cardiac surgery residents without prior hands-on experience in TTFM or HRUS were enrolled. Twenty-seven elective CABG patients (67 grafts) were analyzed. Each measurement was compared with those obtained by an expert benchmark surgeon (N.T.) under standardized hemodynamic conditions. Results: Residents achieved the predefined primary endpoint (combined TTFM + HRUS score/number of grafts ≥ 11) after a median of 3 cases (IQR 2–4) and 7 anastomoses (IQR 7–10). Kaplan–Meier analysis showed a progressive increase in the probability of success, with a sharp rise after the seventh anastomosis. A shorter interval between attempts (<30 days) was significantly associated with earlier achievement of the endpoint (p < 0.05). Median acquisition time for TTFM was 25 s, with <10% inter-observer variability across all flow parameters. HRUS images of adequate quality were obtained within 60 s in >90% of cases, though slightly lower success rates were observed for lateral and inferior wall targets. No resident- or procedure-related variable was independently associated with performance improvement. Conclusions: Mastery of basic TTFM and HRUS skills requires only a few cases and anastomoses, demonstrating a short and attainable learning curve. These findings challenge the perception of a steep learning process and support the routine use of intraoperative graft verification techniques in all CABG procedures. Full article

This work focuses on the development of a patient-specific transient CFD–FSI numerical model combined with the Time-Averaged Entropy Generation Rate (TAEGR) to predict hemodynamic parameters in the thoracic aorta, including the Oscillatory Shear Index (OSI) and the Time-Averaged Wall Shear Stress (TAWSS). While arterial blood flow can be modeled assuming either rigid or elastic arterial walls, the effect of wall compliance on these parameters, particularly on TAEGR, remains insufficiently characterized. Moreover, the interpretation of established indicators is not unique, as regions of vascular relevance may correspond to either high or low values of OSI and TAWSS. The proposed approach aims to identify symmetry and asymmetry in shear stress and entropy generation within the arterial wall, which are closely associated with the development of atherosclerotic plaque. Four aortas from clinical patients were analyzed using the proposed numerical framework to investigate blood flow behavior. The results revealed regions with high values of the hemodynamic parameters (OSI > 0.15, TAWSS ≥ 2 Pa, and TAEGR ≥ 20 $\mathrm{W}/{\mathrm{m}}^3\mathrm{K}$) predominantly located in the vicinity of the upper arterial branches. These regions, referred to as critical zones, are considered prone to the development of cardiovascular diseases, particularly atherosclerosis. The proposed numerical model provides a reliable qualitative framework for assessing symmetry and asymmetry in aortic blood flow patterns under different surgical conditions. Full article

Background: Atherosclerosis and its associated chronic inflammation of the arterial wall disrupt fatty acid metabolism, leading to changes in plasma fatty acid composition. These alterations can be used to improve disease diagnosis and risk stratification by the development and application of specific lipidomic indices. Objectives: The objectives of this study are to evaluate the performance of conventional fatty acid indices and enhance diagnostic efficiency in atherosclerosis by introducing novel index based on plasma PUFA n-6 and n-3 content (Omega-6/3 Balance Index, O6/3-BI), as well as the perspective SFA/MUFA ratio (stearic/oleic acid ratio, C18:0/C18:1n-9) and a logit function combining PUFA and SFA/MUFA biomarkers. Methods: Plasma fatty acids were quantified by LC-MS/MS in healthy controls (n = 50) and patients with carotid atherosclerosis (n = 52), stratified by atorvastatin, rosuvastatin, or no statin therapy. The conventional indices (the Omega-3 Status (EPA + DHA), AA/EPA, and the omega-6/omega-3 ratio), and pathway ratios (C18:0/C18:1n-9; and C20:4n-6/C22:4n-6), as well as the newly introduced PUFA index and combined PUFA-SFA/MUFA logit function, were calculated. Their diagnostic performance for distinguishing atherosclerosis was assessed by a receiver operating characteristic (ROC) analysis with the cross-validation and calculation of Cliff’s Δ effect size. Results: The conventional parameters demonstrated a poor to low discrimination ability of the atherosclerosis patients’ groups from healthy controls (area under the ROC curve, AUC 0.548–0.711). In statin-treated patients, these conventional markers lost significance. The newly introduced PUFA index and SFA/MUFA ratio demonstrated improved patients’ discrimination with AUC 0.734–0.780 for the former and strong predictive power with AUC 0.831–0.858 for the latter marker and maintained their diagnostic value under statin therapy. The most significant positive effect size was observed for the SFA/MUFA ratio with Cliff’s Δ = 0.67–0.71. The combined PUFA-SFA/MUFA logit function also demonstrated a strong predictive power with AUC = 0.880 (Cliff’s Δ = −0.76), outperforming any single index. Conclusions: The newly introduced lipidomic index based on the PUFA content, SFA/MUFA ratio, and a logit function combining PUFA-SFA/MUFA biomarkers demonstrated a substantially better discrimination of atherosclerosis-related fatty acid metabolic disturbances than conventional fatty acid biomarkers. Full article

Biventricular Takotsubo cardiomyopathy (TCM) is a rare variant characterized by involvement of both the left and right ventricles. This variant is associated with greater hemodynamic instability and longer hospital stays compared to the isolated left ventricular-only variant. We report the case of a 67-year-old female patient who underwent elective resection of a left adrenal adenoma. While her preoperative and intraoperative courses were uneventful, she developed cardiogenic shock postoperatively, necessitating prolonged intensive care unit (ICU) management and vasopressor support. Further evaluation revealed elevated high-sensitivity troponin levels and reduced ejection fraction on echocardiography (30–35%). Hypokinesis was noted in the apical and mid-ventricular segments of both ventricles. A coronary angiogram performed two months prior to admission showed no significant coronary artery disease. Based on these findings, a diagnosis of biventricular TCM was established. The patient was managed supportively and discharged in stable condition with ongoing therapy, including beta-blockers, renin–angiotensin–aldosterone system inhibitors (RAASis), and statins. Follow-up echocardiography showed resolution of regional wall motion abnormalities. Although rare, biventricular TCM is associated with increased severity and a higher risk of complications. Early recognition and timely management are essential to improve outcomes in affected patients. Full article

Intravascular imaging (IVI) was introduced 35 years ago to assess coronary artery pathology and plaque vulnerability. However, from its first applications it became apparent that it can also be useful in percutaneous coronary intervention (PCI) planning and optimizing PCI results. In the early days of PCI, IVI was used to examine the efficacy of emerging endovascular devices and the vessel wall response to therapy, while in the drug-eluting stent (DES) era, IVI was used to guide DES implantation and assess final results post-intervention. The first studies assessing the role of IVI in guiding PCI with DES have failed to demonstrate a prognostic benefit for the use of IVI; however, more recent large-scale randomized trials have underscored its value in this setting. IVI, with its high resolution, allows optimal stent sizing, prompt identification and correction of common causes of stent failure, and it has been shown that it improves outcomes in complex procedures. This review summarizes the evidence supporting the role of IVI in PCI planning in DES era, synopsizes the studies that have highlighted the value of IVI in predicting stent failure, discusses the limitations of the first randomized trials that failed to demonstrate a prognostic benefit from its use, and presents the results of the more recent large-scale outcome studies that underscored its role in complex PCI planning. Full article

Objective: Evaluate the efficacy and safety following intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with diabetic macular oedema (DME). Methods: To evaluate retinal microvascular remodelling and photoreceptor metrics using adaptive optics (AO) alongside systemic vascular status assessed by brachial/aortic hemodynamic and carotid ultrasound. We conducted a single-centre longitudinal study including twenty-one patients with DME. The following four diagnostic visits were performed: baseline (V1, no anti-VEGF treatment), 2–3 months (V2), 6–8 months (V3), and 12–14 months (V4). Adaptive optics (rtx1) measured foveal cone number (N) and regularity (Reg) within a standardised 80 × 80 µm window, and superior temporal retinal arteriole morphology after the first bifurcation (vessel diameter [VD], lumen diameter [LD], wall thickness [WT], wall-to-lumen ratio [WLR], and wall cross-sectional area [WCSA]). SphygmoCor provided peripheral (brachial) and central (aortic) pressures, augmentation pressure (AP), augmentation index (AIx), and carotid–femoral pulse wave velocity (PWV and PWVHR heart rate adjusted). Carotid ultrasound assessed intima–media thickness (IMT), carotid lumen diameter (CLD), and IMT/CLD ratio (IMTLR) 2 mm proximal to the bifurcation in diastole. Visual acuity (Visus), intraocular pressure (IOP), and central retinal thickness (CRT) were obtained at each visit. Results: In the treated eye (TE), WLR showed a significant overall change (Friedman p = 0.007), with a modest V4 vs. V1 increase (Wilcoxon p = 0.045); LD also varied across visits (Friedman p = 0.034). Cone metrics improved as follows: Reg increased over time (Friedman p = 0.019), with a significant rise at V4 vs. V1 (p = 0.018), and cone number increased at V3 vs. V1 (p = 0.012). Functional/structural outcomes improved as follows: visual acuity increased at V3 (p = 0.009) and V4 (p = 0.028), while CRT decreased at V3 (p = 0.002) and V4 (p = 0.030); IOP remained stable compared to V1. Systemic hemodynamics was largely unchanged; small fluctuations in DBP and cDBP across V1–V4 were observed (Friedman p = 0.034 and p = 0.022, respectively), whereas AIx, AP, PWV, and PWVHR showed no significant trends. Carotid IMT, CLD, and IMTLR did not change significantly across visits, supporting systemic vascular safety. Conclusions: Intravitreal anti-VEGF therapy in DME was associated with improvements in photoreceptor organisation and macular structure/function, with AO-derived arteriolar remodelling detectable over time, and no adverse changes in large-artery structure. These findings support ocular efficacy and systemic vascular safety; confirmation in larger cohorts is warranted. Full article

Background: Tuberculous meningitis (TBM) is a severe central nervous system infection that can lead to cerebral vasculitis and infarction. This study aimed to evaluate changes in cerebral perfusion and vasculitis on magnetic resonance imaging (MRI) before and after anti-tuberculosis treatment, focusing on both infarcted and non-infarcted brain regions and comparing them with age-matched controls. Methods: Quantitative arterial spin labeling (ASL) perfusion and black-blood vessel wall MRI were performed at diagnosis and after 3–6 months of treatment in TBM patients and healthy controls. Regions of interest included infarcted areas, the contralateral normal brain, and TBM-affected regions without infarction. Cerebral blood flow (CBF), perfusion grading, and vasculitis were assessed and correlated with clinical stage and disease severity. Results: In total, 73 TBM patients and 26 controls were included. Among the patients, 26 (35.6%) had acute infarctions, mainly in the basal ganglia and corona radiata, and 65 (89.0%) exhibited vasculitis predominantly involving anterior circulation. Pretreatment MRI showed significantly reduced CBF in infarcted regions compared with contralateral brain and controls (p < 0.05), and both contralateral and non-infarcted TBM regions also showed lower CBF than controls (p < 0.05). After treatment, CBF increased significantly in non-infarcted regions (p < 0.05), and post-treatment perfusion grade correlated with TBM stage and vasculitis severity. Conclusions: TBM-related infarcts demonstrated marked hypoperfusion, while non-infarcted regions exhibited reversible ischemic changes. ASL and vessel wall imaging can quantitatively monitor treatment response and vascular inflammation, as well as predict late infarction in TBM patients. Full article

We describe a patient with recurrent, brief episodes of chest discomfort caused by a highly mobile papillary fibroelastoma originating from the aortic wall and intermittently encroaching on the right coronary artery ostium. Initial 2D and 3D transthoracic and 2D transesophageal echocardiography identified a highly mobile mass in the ascending aorta above the aortic valve; the exact site of attachment and its relationship to the coronary ostia could not be clearly defined. Three-dimensional transesophageal echocardiography enabled precise anatomical reconstruction of the lesion and surrounding structures, clearly demonstrating its pedicle and proximity to the right coronary ostium. This imaging modality clarified the pathophysiological mechanism of symptoms and facilitated optimal surgical planning without the need for additional complex imaging techniques. Full article

Background: Posteriorly directed aneurysms at the internal carotid–posterior communicating artery (ICA–PCoA) junction concentrate technical risk at the posteromedial neck where the PCoA origin and perforators exist beneath the optic apparatus. Our aim was to describe, in a reproducible fashion, an anatomy-driven sequence in the management of a ruptured ICA–PCoA aneurysm that visualized the posterior wall and a closing line parallel to the PCoA axis and which is placed within contemporary practice. Case Presentation: This is a single case study employing predetermined surgical techniques demonstrating a reproducible method of anatomical microsurgery applied to a posterior projecting ICA-PCoA aneurysm. The authors describe a 62-year-old female who was stabilized by nimodipine and aggressive blood pressure control in the systolic range 140–160 mmHg after an aneurysmal subarachnoid hemorrhage. Diagnostic contrast catheter angiography showed a left ICA-PCoA aneurysm of 13.1 × 10.0 mm at the base with a neck of 4.3 mm projecting posteriorly into the carotid–optic cistern. Complete adherence to a protocol of staged techniques was employed for the operation, as detailed below. Step 1: Early cisternal decompression requiring total and immediate relaxation of the temporal lobe, rapidly opening up the carotid–optic anatomical window. Step 2: Circumferential dissection about the neck of the aneurysm permitting definition of the true posteromedial wall and definition of the perforator territories and anterior choroidal territories. Step 3: Brief but effective ICA proximal quiescence (58 s) permitting clipping under direct vision. Step 4: Staged closure of two clips with the closing line of the clips orientated parallel to the axis of the PCoA with maintenance of the diameter of all parent vessels, the origin of the PCoA and the integrity of the perforators. Urgent postoperative digital subtraction angiography (DSA) study showed complete exclusion of the aneurysm with no alteration in flow characteristics, and 3 months later DSA studies again showed permanent obliteration and patency of those branches. The immediate DSA demonstrated complete exclusion of the aneurysm with patent supraclinoid ICA caliber and PCoA ostium, the anterior choroidal artery was preserved; no angiographic vasospasm was identified. The postoperative course was uncomplicated; there was no hydrocephalus, seizure disorder or delayed ischemia. At discharge and three months postprocedure the patient was neurologically intact (Modified Rankin Scale 0). Non-contrast cranial CT (three months) demonstrated stable clip position and no hemorrhagic or ischemic sequelae. Conclusions: In posteriorly projecting ICA–PCoA aneurysms that are disturbed beneath the optic apparatus, an anatomy-guided strategy—early cisternal decompression, true posteromedial neck exposure, brief purposeful quieting of the proximal ICA and two-clip closure parallel to the PCoA in selected cases—may provide the opportunity for durable occlusion whilst the physiology of branching is preserved. We intend for this transparent description to be adopted, refined or discarded based on local anatomy and practice. Full article

Drug-coated balloons (DCBs) have emerged as an alternative to drug-eluting stents (DESs) in percutaneous coronary intervention, delivering antiproliferative drugs without leaving a permanent implant. This review provides a comparative analysis of sirolimus-coated DCBs (DCB-S), paclitaxel-coated DCBs (DCB-P), and DESs across key scenarios: de novo coronary lesions in chronic coronary syndrome (CCS), acute coronary syndromes (ACS), and in-stent restenosis (ISR). We discuss late lumen loss (LLL), target lesion/vessel revascularization (TLR/TVR), vessel patency, and major adverse cardiac events (MACE) outcomes, along with current guidelines and emerging indications for DCB-S. We also examine pharmacological differences between sirolimus and paclitaxel (mechanisms of action, tissue uptake, and healing profiles), trial methodologies, and recent innovations in DCB technology. Across stable de novo lesions (especially small vessels and high bleeding-risk patients), multiple trials show DCB-P can achieve non-inferior clinical outcomes to DES. Early data suggest newer DCB-S may likewise match DES outcomes in broader populations. In ACS, DCB-only strategies have demonstrated feasibility and safety in carefully selected lesions without heavy thrombus, with randomized studies like REVELATION (STEMI) showing non-inferior fractional flow reserve and low revascularization rates compared to DES. For ISR, DCB-P is an established Class I treatment in both BMS-ISR and DES-ISR, yielding similar or lower TLR rates than repeat stenting. DCB-S are now being evaluated as an alternative in ISR, aiming to avoid additional stent layers. Contemporary guidelines endorse DCB use in ISR and small vessels, and experts anticipate expanding indications as evidence grows. Sirolimus and paclitaxel differ in antiproliferative mechanisms and pharmacokinetics—sirolimus (cytostatic, mTOR inhibition) may offer faster endothelial recovery, whereas paclitaxel’s high lipophilicity ensures sustained arterial wall retention. Technological advances (e.g., phospholipid micro-reservoirs for sirolimus) are enhancing drug transfer and addressing prior limitations. In summary, DCB-P and DCB-S now represent viable alternatives to DES in specific scenarios, especially where “leaving nothing behind” could reduce long-term complications. Ongoing large randomized trials, such as SELUTION DeNovo, currently available as conference-presented data, together with longer-term follow-up will further clarify the optimal niches for DCB-S versus DCB-P and DES. Full article

Background/Objectives: Clinical observations linking primary snoring (PS) to early markers of vascular dysfunction suggest a possible contribution to subclinical atherosclerosis. This study aimed to evaluate carotid and femoral intima–media thickness (cIMT and fIMT) in patients with atherosclerosis with or without PS, and to identify potential determinants of increased cIMT. Methods: In this cross-sectional study, 140 patients with atherosclerosis enrolled. Participants were divided into two groups based on polysomnography results: patients with PS (n = 95) and patients without snoring (n = 45). Demographic data and anthropometric measurements were recorded for all patients. High-resolution B-mode ultrasound was used to measure cIMT and fIMT. Group comparisons, correlation analyses, and multiple linear regressions were performed to evaluate the relationship between IMT and anthropometric parameters. Results: Patients with PS had significantly higher cIMT than patients without PS (0.90 ± 0.15 mm vs. 0.65 ± 0.10 mm, p < 0.001, Cohen’s d = −1.83), whereas fIMT did not differ between groups (p = 0.185). Carotid IMT was positively correlated with age, body mass index (BMI), waist circumference, and neck circumference (all p < 0.001). Multivariate analysis identified age, waist circumference, and neck circumference as independent predictors of increased cIMT (adjusted R² = 0.31, p < 0.001). Within the PS group, no significant difference was observed between cIMT and fIMT (p = 0.33). Conclusions: PS is strongly associated with increased carotid intima–media thickness in patients with atherosclerosis, independent of obstructive sleep apnea. The absence of a similar effect in the femoral artery supports the hypothesis that mechanical vibrations caused by snoring may cause local vascular damage in the carotid wall. These findings suggest that PS may represent an independent risk factor and an early marker of carotid atherosclerosis. Full article