Sex Differences of High-Risk Carotid Atherosclerotic Plaque with Less Than 50% Stenosis in Asymptomatic Patients: An In Vivo 3T MRI Study
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Abstract:
BACKGROUND AND PURPOSE:
Men have a greater prevalence of high-risk carotid plaque features associated with stroke compared with women who have ≥50% stenosis, but little is known about these features in less significantly stenotic carotid arteries. This study aims to evaluate sex differences in complicated carotid plaque features in asymptomatic patients with <50% stenosis.MATERIALS AND METHODS:
Ninety-six patients (50 men, 46 women) with <50% carotid stenosis on MRA who had been referred for analysis of contralateral >50% carotid stenosis were included. The associations between sex and plaque features as identified by 3T MR carotid plaque imaging were examined by using logistic and linear regression models controlling for demographic characteristics, MRA stenosis, and the presence of contralateral plaque features.RESULTS:
The presence of a thin/ruptured fibrous cap (16% versus 2%, adjusted odds ratio = 8.57, P = .047), IPH (24% versus 6%, adjusted odds ratio = 4.53, P = .027), and American Heart Association type VI plaque (26% versus 6%, adjusted odds ratio = 5.04, P = .017) was significantly higher in men than in women. These associations remained significant following adjustment for contralateral plaque features. Men demonstrated a larger percentage volume of LR/NC (median, 1.66% versus −0.21%; P < .01). Calcification was not significantly associated with sex.CONCLUSIONS:
There is a sex difference of higher risk carotid plaque features during the early stage of disease seen in patients recruited for MR imaging evaluation of contralateral moderate-to-severe stenosis. Given the potential of using LR/NC without or with IPH to monitor therapy, these results indicate the possible importance of sex-based management in patients with asymptomatic carotid atherosclerosis across all stages of carotid stenosis.Keywords:
Stroke
KEY FINDINGSAsymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur.• Manifestations of COVID-19 are highly varied and may include asymptomatic cases, who do not manifest with anysigns and symptoms despite testing positive for COVID-19 by viral nucleic acid tests. Pre-symptomatic cases areinfected individuals who are still in their incubation period, hence do not exhibit any symptoms yet but eventuallydevelop symptoms.• As of June 2020, only 586 (2.8%) of the 20,990 active cases in the Philippines were classified as asymptomatic,but it is unclear whether cases are pre-symptomatic or carriers (true asymptomatic).• Based on 36 observational studies (case reports, case series, cross-sectional and cohort studies) and 9 statisticalmodeling analysis, asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. However, 3studies reported no transmission from pre-symptomatic and asymptomatic cases.• Studies on viral load comparing symptomatic cases with pre-symptomatic and asymptomatic cases reportedcontradicting results. The duration of viral shedding was significantly longer for symptomatic patients comparedto asymptomatic patients but similar for asymptomatic and pre-symptomatic patients.• Therewas no difference in the transmission rates of symptomatic and asymptomatic cases. However,the estimatedinfectivity and probability of transmission was higherfor symptomatic cases compared to asymptomatic cases, butresults were imprecise due to a wide confidence interval.• The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recognize thepossibility of pre-symptomatic and asymptomatic transmission. According to WHO, current evidence suggestsasymptomatic cases are less likely to transmit the virus than symptomatic cases.
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Viral Shedding
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One hundred and sixty-eight asymptomatic patients with a carotid artery stenosis of more than 50% were observed over a period of up to 12 years. During this time, 136 patients remained asymptomatic, two patients developed atypical neurologic symptoms that spontaneously disappeared, 26 patients developed transient ischemic attacks and successfully underwent carotid endarterectomy, three patients developed transient ischemic attacks that were ignored and they subsequently suffered a completed stroke, and one patient suffered a completed stroke without a warning transient attack. These data suggest that surgery is not required in the patient with an asymptomatic carotid stenosis until a transient ischemic attack occurs.
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Introduction: Intravascular calcification is thought to be a marker of atherosclerosis in patients with stenosis and vascular risk factors. Little is known about the utility of quantifying intracranial calcification to help determine mechanism of stenosis. The objective of our study was to compare presence and patterns of intracranial calcification in patients with intracranial stenosis due to atherosclerosis and other etiologies. Methods: Retrospective cohort study of 89 patients < 50 years with diagnosis of intracranial stenosis who had undergone CT angiogram from 2008-2013; 44 had presumed atherosclerosis as etiology ( > 3 vascular risk factors with no other identified cause). CTAs were reviewed for presence and location of intracranial calcification. Results: Of patients with atherosclerotic stenosis, 28 (64%) had intravascular calcification compared to 16 (36%) of those with stenosis of other etiologies (P=0.0039). There was no significant difference in pattern or location of stenosis between groups. One-third had calcification outside the region of stenosis in both groups. Distal internal carotid artery and distal vertebral artery were the most common sites of intracranial calcification (Table). Conclusion: Intracranial calcification is more commonly seen in patients < 50 years old with stenosis secondary to atherosclerosis, but the pattern and location was similar between groups. More research is needed to determine the utility of using the presence of vascular calcification to help determine mechanism of intracranial stenosis in the young.
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Introduction. Our objective was to review articles that report the prevalence of cervical disc herniations in asymptomatic subjects using MRIs and conduct a qualitative systematic review.Methods. A MEDLINE search for articles published between 1974 and 2004 was performed, and five articles were retained in this review.Results. Teresi et al. (1987) studied 35 asymptomatic subjects retrospectively and 65 asymptomatic subjects prospectively, and found 20% of subjects aged 45–54 years, 35% of subjects aged 55–64 years, and 57% of subjects older than 64 years had cervical disc herniations/bulges. Boden et al. (1990) studied 63 asymptomatic subjects and found 10% of subjects of less than 40 years and 5% of subjects older than 40 years had disc herniations. Lehto et al. (1994) studied 89 asymptomatic subjects and found that each of 2 subjects (one 29 and the other 56 years) had a disc prolapse; the prevalence was 2.2%. Matsumoto et al. (1998) studied 497 asymptomatic subjects. They found that 70 of 2480 discs scanned were prolapsed posteriorly (2.8%), and reported that the frequency of these lesions increased after 40 years. Siivola et al. (2002) compared 15 asymptomatic and 16 symptomatic subjects after 7 years and found no disc herniations (0%) in the asymptomatic group and 4 disc herniations (25%) in the symptomatic group.Conclusions. The prevalence of cervical disc herniations in asymptomatic subjects of less than 40 years of age is 3% to 10% and increases to 20% in subjects up to 54 years of age. The prevalence increases with age—from 5% to 35% in subjects between 40 and 64 years of age.
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Introduction: There is no specific recommendation for the management of asymptomatic vaginal mesh erosions post antiincontinence or prolapse surgery, but revision or excision may represent overtreatment. We hypothesize that asymptomatic vaginal exposures remain asymptomatic during follow-up and do not require any intervention. Methods: We evaluated a “no treatment” approach by prospectively following-up women with asymptomatic vaginal exposures after antiincontinence and pelvic organ prolapse surgery. After a 1-month course of vaginal oestrogen, they underwent the “wait and see” protocol. It consisted of no treatment. Women were followed-up every 3 months, for the first year and then every 6 months with history, clinical examination with measurement of size of the exposure, and the evaluation of possible infection signs or vaginal discharge. Results: Forty women were followed-up for a median of 33.52 months (range 8–48 months). All exposures were ≤1 cm (mean 6.5 ± 1.5 mm, range 4–10 mm), patients were asymptomatic and without pain. During the observation period, the size of the exposure did not change and all women remained asymptomatic. Discussion/Conclusion: No treatment seems to be required for asymptomatic and small vaginal mesh exposures after prolapse or incontinence surgery.
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Introduction: The prevalence of peripheral arterial disease (PAD) ranges between 4.5% and 57% and is independently associated with cardiovascular disease burden irrespective of symptoms. Two thirds of cases are thought to be asymptomatic and may go unrecognised. Local prevalence and natural progression of asymptomatic PAD is unknown.Methods: This one year, non-interventional longitudinal study, aimed to determine prevalence and progression of asymptomatic PAD in patients with cardiovascular risk factors. Results: Of 217 patients screened, 36% had asymptomatic disease in 113 legs. Of sixty two who returned for follow-up, eight normal legs developed asymptomatic PAD, and 46%, asymptomatic at baseline showed disease progression. Initial baseline ABI showed significant change over 1 year of follow-up (p=0.001) and 21% (13) of patients eventually developed intermittent claudication. Also, 52% of baseline asymptomatic participants having at least one associated cardiovascular risk factor showed disease progression over 1 year. Those developing claudication demonstrated significant ABI deterioration. Having two or more cardiovascular risk factors significantly affected progression of asymptomatic disease, (p = 0.031). Conclusion: Study confirms high prevalence of asymptomatic PAD in our population and significant disease progression in one year.Key words: Peripheral Artery Disease, Risk Factors, Asymptomatic, Disease Progression
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Endarterectomy
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Results of treatment of 148 patients with asymptomatic carotid stenosis were analyzed in terms from 5 to 180 months. 75 (51%) patients were operated, 73 (49%)--were not operated. Non-operated asymptomatic patients with more than 90% stenosis and patients with prolonged (more than 18 mm) stenosis have the highest risk of cerebral events (4% annually and more). In long-term period (from the 70th month of follow-up) patients with the 70-90% stenosis are the group of high risk of cerebro-vascular symptoms.
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To define characteristics of pediatric asymptomatic idiopathic intracranial hypertension (IIH).We retrospectively reviewed our Neuro-Ophthalmology database (2000-2006) for all cases of symptomatic and asymptomatic pediatric IIH.Out of 45 IIH cases, 14 (31.1%) were asymptomatic (incidental examination). When compared with children with symptomatic IIH, asymptomatic cases were younger [5.6 (1.8-15) vs 11.0 (5-17) years, P = 0.007], had lower percentage of obesity (14.3% vs 48.4%, P = 0.046), and had male predominance (71.4% vs 38.7%, P = 0.06). Asymptomatic cases required shorter duration of acetazolamide treatment [3 (0-8), vs 6 (0-20) months, P = 0.021], and resulted in complete resolution of swollen discs.We speculate that asymptomatic IIH may be more common in young children and could represent a milder form or a presymptomatic phase before evolving into classic symptomatic IIH. Further studies to assess the clinical significance of asymptomatic IIH are warranted.
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