PMID- 17622211
OWN - NLM
STAT- MEDLINE
DCOM- 20071211
LR  - 20161124
IS  - 0392-9590 (Print)
IS  - 0392-9590 (Linking)
VI  - 26
IP  - 3
DP  - 2007 Sep
TI  - Hyperhomocysteinemia and hypercoagulable state in carotid plaque evolution. Novel 
      risk factors or coincidental risk predictors?
PG  - 270-8
AB  - AIM: The majority of patients with carotid occlusive disease (COD) have one or 
      more of the conventional risk factors of atherosclerosis. In addition, 
      hyperhomocysteinemia (HHCY) and hypercoagulable state (HCGS) are increasingly 
      recognized as potentially ''novel'' risk factors. The aim of this study was to 
      determine the role of these factors in carotid plaque evolution and clinical 
      manifestation of COD. METHODS: Between September 2003 and 2005, 153 patients were 
      admitted in our Department with clinical and duplex ultrasound evidence of severe 
      (>70%) COD as operative candidates and 33 patients with evidence of moderate 
      (50-69%) stenosis included in the protocol of conservative treatment and lifelong 
      observation. Conventional risk factors of atherosclerotic disease and plasma 
      levels of homocysteine (HCY), fibrinogen (FBG), protein C (PC), protein S, 
      antithrombin III and activated protein C resistance were recorded in all 
      patients. The degree of carotid stenosis was measured in a carotid angiogram 
      following North American Symptomatic Carotid Endarterectomy Trial (NASCET) 
      criteria for all operative candidates. Angiographic workup revealed 147 carotid 
      stenoses >70% and 16 internal carotid occlusions in 82 symptomatic and 52 
      asymptomatic patients, while in 19 patients the carotid stenosis was moderate 
      (50-69%) and these patients included in the conservative treatment group. The 
      study of the ''novel'' and conventional risk factors was performed with 
      univariate and multivariate statistical analysis as well as with correlational 
      analysis of HCY and the other risk factors between patients with severe or 
      moderate COD and between symptomatic and asymptomatic patients with carotid 
      stenosis >70%. RESULTS: Our data showed that HHCY was a strong independent risk 
      factor of symptomatic carotid disease >70%. In addition, the coexistence of high 
      FBG levels and thrombophilia factor deficiency with HHCY was significantly 
      related with the clinical manifestation of COD. CONCLUSION: HHCY and HCGS are 
      often detected among patients with severe and symptomatic carotid stenosis. The 
      early diagnosis and treatment of these deficiencies might be helpful for the 
      management of COD, but their role in future clinical practice is yet to be 
      determined.
FAU - Pitoulias, G A
AU  - Pitoulias GA
AD  - Division of Vascular Surgery, 2nd Department of Surgery, G Gennimatas Hospital, 
      Aristotle University of Thessaloniki, Thessaloniki, Greece. pitoulias@yahoo.com
FAU - Tachtsi, M D
AU  - Tachtsi MD
FAU - Tsiaousis, P Z
AU  - Tsiaousis PZ
FAU - Papadimitriou, D K
AU  - Papadimitriou DK
LA  - eng
PT  - Journal Article
PL  - Italy
TA  - Int Angiol
JT  - International angiology : a journal of the International Union of Angiology
JID - 8402693
RN  - 0 (Blood Coagulation Factors)
RN  - 0 (Protein C)
RN  - 0 (Protein S)
RN  - 0 (Receptors, Cell Surface)
RN  - 0 (activated protein C receptor)
RN  - 0LVT1QZ0BA (Homocysteine)
RN  - 9000-94-6 (Antithrombin III)
RN  - 9001-32-5 (Fibrinogen)
SB  - IM
MH  - Aged
MH  - Antithrombin III/metabolism
MH  - Blood Coagulation Factors
MH  - Carotid Artery Diseases/blood/*complications/diagnostic imaging
MH  - Female
MH  - Fibrinogen/metabolism
MH  - Follow-Up Studies
MH  - Greece/epidemiology
MH  - Homocysteine/blood
MH  - Humans
MH  - Hyperhomocysteinemia/blood/*complications/epidemiology
MH  - Immunoassay
MH  - Incidence
MH  - Male
MH  - Prognosis
MH  - Protein C/metabolism
MH  - Protein S/metabolism
MH  - Receptors, Cell Surface/blood
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Thrombophilia/blood/*complications/epidemiology
MH  - Ultrasonography, Doppler, Duplex
EDAT- 2007/07/12 09:00
MHDA- 2007/12/12 09:00
CRDT- 2007/07/12 09:00
PHST- 2007/07/12 09:00 [pubmed]
PHST- 2007/12/12 09:00 [medline]
PHST- 2007/07/12 09:00 [entrez]
PST - ppublish
SO  - Int Angiol. 2007 Sep;26(3):270-8.