Structural Stability of Carotid Plaque and Symptomatology

描述（由申请人提供）：本研究探讨了动脉粥样硬化颈动脉斑块结构稳定性与非运动性脑血管病（包括脑萎缩和认知能力下降）发展之间关系中的“无症状”卒中问题。它解决了颈动脉栓塞在“无症状”中风及其认知后遗症中的作用问题。该研究使用人类颈动脉内膜切除术患者来研究三个特定目标。第一种使用超声将斑块弹性及其机械应变特征的发展与脉动和斑块的组织生理学相关，用于溃疡、出血和在这些机械应变特征点处稳定纤维帽的变薄。第二组检查超声检测斑块内弹性、应变特征及经颅多普勒TCD检测微栓子的存在。第三个着眼于超声应变缺陷，微栓子，认知能力下降和脑MRI证据的局灶性和全身性萎缩。了解结构性斑块异常，使颈动脉斑块机械不稳定和栓塞的风险，将证明一个病理生理机制，在个人谁可能遭受不仅是经典的发作性大中风，但功能进行性下降的贡献，微栓子脑“沉默”中风和认知能力下降。 公共卫生相关性：脑血管疾病仍然是一个主要的健康问题，对老龄化人口的影响越来越大。研究表明，临床和“沉默”中风每年影响1100万美国人。动脉粥样硬化引起的血管老化是这个问题的主要原因。出于这个原因，我们提出了一项颈动脉粥样硬化的研究，开发颈动脉斑块不稳定性的新标志物，这可能导致存在多种微栓子，这反过来可能有助于增加动脉粥样硬化，包括经典的中风，以及认知能力下降。如果成功，这项研究将大大增加我们对动脉粥样硬化症状的病理生理学的理解，并导致开发潜在的新措施来无创地检测这种疾病。

DESCRIPTION (provided by applicant): This study examines the issue of "silent" strokes in the relationship between the structural stability of atherosclerotic carotid plaque and the development of nonmotor symptomatology, including brain atrophy and cognitive decline. It addresses the question of the role of carotid emboli in "silent" stroke and their cognitive sequelae. The study uses human carotid endarterectomy patients to study three specific aims. The first uses ultrasound to relate plaque elasticity and its development of mechanical strain features with pulsation and the histopathophysiology of the plaque for ulcer, hemorrhage and thinning of stabilizing fibrous cap at the point of these mechanical strain features. The second examines ultrasound detected elasticity strain features in the plaques and the presence of transcranial Doppler TCD detectable microemboli. The third looks at ultrasound strain deficits, microemboli, cognitive decline and brain MRI evidence of focal and generalized atrophy. Understanding the structural plaque abnormalities, which render a carotid plaque mechanically unstable and at risk of embolization will demonstrate a pathophysiologic mechanism in individuals who are likely to suffer not only classic episodic major strokes, but also functional progressive decline from the contribution of microemboli to cerebral "silent" stroke and cognitive decline. PUBLIC HEALTH RELEVANCE: Cerebrovascular disease remains a major health problem with increasing impact on an aging population. Studies suggest that clinical and "silent" stroke affects 11 million Americans per year. Vascular aging from atherosclerosis is a major contributor to this problem. For this reason, we propose a study of carotid atherosclerosis developing novel markers for carotid plaque instability which may result in the presence of multiple microemboli, which in turn may contribute to increased symptomatology, both classic strokes, as well as, cognitive decline. If successful, this study will greatly increase our understanding of the pathophysiology of symptoms from atherosclerosis, as well as, lead to the development of potential new measures to detect this disorder noninvasively.