Intraplaque calcium and its relation with the progression of carotid atheromatous disease
Manuel Miralles1,2,3, Manel Arrébola4, Aida Lago5
1Department of Angiology and Vascular Surgery, La Fe University and Polytechnic Hospital, Valencia, Spain - Mirallesmanher@gva.es.
Insights
Higher calcium content in carotid plaques may indicate greater stability, potentially reducing the risk of stroke progression. This study investigated calcium
Area of Science:
- Cardiovascular Imaging
- Vascular Biology
- Biomedical Engineering
Background:
- Atheromatous disease (AD) progression and calcification are linked to stroke risk.
- The precise relationship between plaque calcification and AD progression remains unclear.
- Understanding this link is crucial for predicting stroke risk and managing carotid artery disease.
Purpose of the Study:
- To analyze the temporal changes in calcium (Ca) content within carotid atheromatous plaques.
- To investigate the relationship between Ca content evolution and the progression of carotid AD.
- To utilize quantitative CT angiography (CTA) for assessing these changes.
Main Methods:
- Quantitative CTA was used to measure contrast mold volume and Ca content in 43 asymptomatic patients with >50% internal carotid artery stenosis.
- Measurements were taken at baseline and after a 12±2 month follow-up period.
- Biochemical markers of calcium/phosphorus metabolism were also analyzed.
Main Results:
- A significant increase in volumetric stenosis and intraplaque Ca content was observed over the follow-up period.
- An inverse correlation was found between baseline Ca content and volumetric stenosis progression.
- Higher baseline intraplaque Ca, adjusted for BMI, was the most significant predictor of carotid AD progression.
Conclusions:
- Increased calcium content in carotid plaques appears to confer greater stability.
- Higher calcification may reduce the progression of atheromatous disease.
- This suggests a potential protective role of plaque calcification against disease advancement and symptomatology.
Background:
Calcification and progression of atheromatous disease (AD) both have been independently related with the risk of stroke. However, the link between the two phenomena is still unclear. The main objective of this study was to analyze the temporal evolution of Ca content of carotid atheromatous plaques and its relation with the progression of carotid AD using quantitative CT Angiography (CTA).
Methods:
Forty-three asymptomatic patients with stenosis of the internal carotid artery (ICA)>50% completed the study. Contrast mold volume and calcium (Ca) content by quantitative CTA and Modified Agatston Score (Ca volume × radiological density) were assessed at baseline and after 12±2 months. Biochemical parameters, including main markers of Ca/Phosphorus (P) metabolism, were determined.
Results:
CTA measurement showed an increase of volumetric stenosis (volume decrease of the contrast mold), compared to baseline (475.45 [155.6] mm3 × U.H vs. 501.3 [171.9] mm3 × U.H; P=0.04) as well as an increase of intraplaque Ca (64.58 [57.8] mm3 × U.H. vs. 56.8 [52.3] P=0.002). An inverse correlation between baseline Ca content and volumetric stenosis progression (r=-0.481; P<0.001), as well as between the increase of carotid Ca and plasma levels of vitamin D (r=0.4; P=0.025) were also found. Multiple regression analysis found a model with baseline intraplaque Ca, adjusted by Body Mass Index (BMI) as most predictive of carotid AD progression.
Conclusions:
These results suggest that a higher content of Ca confers greater stability against the progression of carotid AD and, eventually, its ability to generate symptomatology.
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