The presenter does not have any potential conflicts of interest to disclose

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Emory Phelps
5 years ago
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1 Carotid intima-media thickness as a predictor of multi territory atherosclerotic occlusive disease in patients with symptomatic subclavian artery obstruction Leszek Wrotniak 1, Anna Kabłak Ziembicka 1, Tadeusz Przewłocki 1, Piotr Pieniążek 1, Jacek Gacoń 2, Agnieszka Rosławiecka 1, Łukasz Tekieli 1, Piotr Podolec 1 The presenter does not have any potential conflicts of interest to disclose 1 Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, John Paul II Hospital, Kraków, Poland 2 E. Szczeklik Hospital, Department of Invasive Cardiology, Tarnow, Poland

OBJECTIVE The study aimed to assess the prevalence of concomitant to subclavian artery stenosis (SAS), significant stenoses in other major vascular

2 OBJECTIVE The study aimed to assess the prevalence of concomitant to subclavian artery stenosis (SAS), significant stenoses in other major vascular locations, as well as possible associations between carotid intima-media thickness (CIMT) and internal carotid artery stenosis (ICAS) with cardiovascular (CV) risk.

3 STUDY ALGORYTHM 218 patients, in the mean age of 62.1±8.4 y with symptomatic SAS referred for PTA CVD - cardio-vascular death Baseline ultrasound evaluation of CIMT/ICAS degree MI - myocardial infarction IS - ischemic stroke Repeated CIMT/ICAS measurement in 108 randomly chosen patients The incidences of CV events were recorded mean follow-up time: 36.5±26 months during the follow-up period of 56.5±35 months Δ CIMT was calculated (the difference between CIMT final and CIMT initial ) Δ CIMT value was compared between patients with CV-event and those without CV-event in follow-up

4 Prevalence of classic risk factors for atherosclerosis in studied population (218 patients, 116 men) (79%) 176 (81%) 60 (28%) 111 (51%) 0 smoking history diabetes arterial hypertension hypercholesterolemia

METHODS The prevalence of classic risk factors for atherosclerosis (diabetes, hyperlipidemia, arterial

verified for presence of atherosclerotic lumen reductions of 50% by means of ultrasonography, CT or

mean CIMT value Interpretation of mean CIMT change (Δ CIMT): Mean CIMT regression: any decrease in mean CIMT

5 METHODS The prevalence of classic risk factors for atherosclerosis (diabetes, hyperlipidemia, arterial hypertension, smoking status) were recorded Coronary, renal and lower limb arteries (CAD/RAS/PAOD) were verified for presence of atherosclerotic lumen reductions of 50% by means of ultrasonography, CT or angiography Maximum CIMT of common, the bulb and internal carotid arteries were measured and expressed as a mean CIMT value Interpretation of mean CIMT change (Δ CIMT): Mean CIMT regression: any decrease in mean CIMT value at F-U No significant change: mean CIMT increase between mm/year Progression mean CIMT value increase > 0.016mm/year

5%) 2 territories 55 ; (25%) 3 or 4 territories 34 ; (16%) isolated SAS 46 ; (21%) 1 territory 83

6 Number of arterial territories with a significant stenosis in 218 subjects Involved territory N of patients CAD >50% 123 (53.4%) PAOD >50% 65 (29.8%) ICAS >50% 89 (40.1%) RAS >50% 25 (11.5%) 2 territories 55 ; (25%) 3 or 4 territories 34 ; (16%) isolated SAS 46 ; (21%) 1 territory 83 ; (38%) * Significant stenosis the presence of an artery lumen reduction of at least 50% in a given territory

CIMT quartiles and baseline subjects allocation depending on initial CIMT value and grade of ICA stenosis Median CIMT 1.38 mm 1st Q CIMT < 1.10 mm 2nd Q CIMT 1.

7 CIMT quartiles and baseline subjects allocation depending on initial CIMT value and grade of ICA stenosis Median CIMT 1.38 mm 1st Q CIMT < 1.10 mm 2nd Q CIMT rd Q CIMT th Q CIMT > 1.71 CIMT <1mm 28 ; (12,8%) ICAS 50% 89 ; (40,8%) CIMT mm 50 ; (22,9%) CIMT >1.3 mm but ICAS <50% 51 ; (23,4%)

8 Initial CIMT value, incl. ICA atherosclerotic plaques, were significantly related to the presence of at least 50% lumen reduction in other arterial territories (Spearman co-efficient test) CAD presence CAD severity p=0.004 P=0.005 R = R = PAOD p=0.003 R = RAS p=0.014 R = The number of involved territories p<0.001 R = Initial CIMT value, incl. ICA atherosclerotic plaques, occurred an independent marker of multi-territory arterial stenoses Relative risk Confidence interval p-value Initial CIMT value ICA stenosis >50% <0.001

9 LATE RESULTS CV events mean follow-up period of 56.5±35 months 218 patients after successful SAS PTA CV events 27 (12.4%) CV deaths 4 (1.8%) non-fatal MI 11 (5.0%) Non-fatal IS 12 (5.5%) 108 patients with repeated CIMT CV events 13 (12.0%) CV deaths 0 (0%) non-fatal MI 7 (6.5%) Non-fatal IS 6 (5.6% )

10 LATE RESULTS CV events mean follow-up period of 56.5±35 months 108 patients with CIMT follow-up Higher CIMT progression was noted in patient with CV-event, as compared to those with CV-event free follow-up (ΔCIMT: ± 0.57mm vs ± 0.26mm, p=0.039) with CVevent without CVevent P-value Progression vs. no progression CIMT: progression n=53 10 (19%) 43 (81%) CIMT: no change n=10 1 (10%) 9 (90%) CIMT: regression n=45 2 (7%) 43 (93%)

11 LATE RESULTS CV events mean follow-up period of 56.5±35 months 108 patients with CIMT follow-up CV-events were more prevalent in patients with initially more widespread atherosclerosis despite revascularization they underwent afterwards (mean number of involved territories: 1.8±1.1 vs. 1.3±1.1, p=0.042) Multivariate regression analysis identified 2 independent risk factors of CV events Relative risk CI 95% p-value Significant CAD CIMT progression

CONCLUSIONS CIMT and ICAS stenosis are independently associated with multi-territory arterial stenoses Subjects with CIMT progression during mean 3-year F-U, suffered from CV events more

12 CONCLUSIONS CIMT and ICAS stenosis are independently associated with multi-territory arterial stenoses Subjects with CIMT progression during mean 3-year F-U, suffered from CV events more often than whose with CIMT regression or stabilization Both significant CAD and CIMT progression were independently associated with a risk of future CV events in patients with symptomatic SAS

Predictors of restenosis and cardiovascular events in patients undergoing percutaneous angioplasty for subclavian/innominate artery stenosis

Predictors of restenosis and cardiovascular events in patients undergoing percutaneous angioplasty for subclavian/innominate artery stenosis Tadeusz Przewlocki, Anna Kablak Ziembicka, Piotr Pieniazek,