MORPHOLOGIC AND FUNCTIONAL MODIFICATIONS OF COMMON

CAROTID ARTERIES IN HYPERTENSION ASSOCIATED WITH

THE AGING PROCESS AN ECHO-DOPPLER STUDY

A. Andritoiu MILITARY HOSPITAL - CRAIOVA

INTRODUCTIONINTRODUCTION

Hypertensives pts are particularly prone to the Hypertensives pts are particularly prone to the develop-ment of atheromatous disease in larger develop-ment of atheromatous disease in larger vessels. vessels.

Large arteries are not passive conduits ; they have an Large arteries are not passive conduits ; they have an important place in the mechanisms of hypertensive important place in the mechanisms of hypertensive vascu-lar disease.vascu-lar disease.

The elevation of blood flow per se may be responsible The elevation of blood flow per se may be responsible for mechanical and geometrical factors in for mechanical and geometrical factors in development of compliance reduction.development of compliance reduction.

There is a significant expected relation between age There is a significant expected relation between age and CCA dimensional and functional data. In HBP and and CCA dimensional and functional data. In HBP and aging process, structural and functional changes of aging process, structural and functional changes of arterial wall (remodeling) involve the totality of arterial wall (remodeling) involve the totality of arterial system, princi-pally the aorta and its major arterial system, princi-pally the aorta and its major branches.branches.

Both aging and HBP have a great impact on global Both aging and HBP have a great impact on global level of arterial stiffness.level of arterial stiffness.

OBJECTIVESOBJECTIVES

to evaluate a few morphologic and to evaluate a few morphologic and functional parameters in a group of functional parameters in a group of hypertensives pts divided into three hypertensives pts divided into three subgroups according to the age subgroups according to the age

to demonstrate the relation between to demonstrate the relation between HBP and aging process and the both HBP and aging process and the both contribution in developing of contribution in developing of atheromatosis process and arterial wall atheromatosis process and arterial wall stiffning of CCAstiffning of CCA

METHODSMETHODS

assessment of changes in R&L- CCA wall by an assessment of changes in R&L- CCA wall by an ultrasonographic equipment ultrasonographic equipment

( SIEMENS SONOLINE Versa Plus- 7.5 MHz linear array ( SIEMENS SONOLINE Versa Plus- 7.5 MHz linear array probe)probe)

anterior and lateral views (middle segment and anterior and lateral views (middle segment and bifurcation) bifurcation)

morphologic parameters ( B-mode)morphologic parameters ( B-mode) - Dd(mm), IMTh(mm), plaques evaluation- Dd(mm), IMTh(mm), plaques evaluation functional parameters (Doppler - PW)functional parameters (Doppler - PW) - PI, RI, S(m/s),D(m/s), S/D ratio,TAMx (m/s) - PI, RI, S(m/s),D(m/s), S/D ratio,TAMx (m/s) intra-observer reproducibility <5% intra-observer reproducibility <5%

PATIENTS CHARACTERISTICSPATIENTS CHARACTERISTICS

Study group = 100 ptsStudy group = 100 pts ; BP> 160/90 mmHg ; BP> 160/90 mmHg non diabetes; smokers/non-smokers rate 1/3non diabetes; smokers/non-smokers rate 1/3 Cholesterol > 250 mg% - 22% Cholesterol > 250 mg% - 22%

GROUP I GROUP II GROUP IIIGROUP I GROUP II GROUP III

N (pts) 35 30 35N (pts) 35 30 35

age ranged 20 - 29 30 - 59 60 - 75 age ranged 20 - 29 30 - 59 60 - 75

mean age(yr.) 22.4 47.5 67.8mean age(yr.) 22.4 47.5 67.8

M/F rate 30 : 5 24 : 11 21 : 9M/F rate 30 : 5 24 : 11 21 : 9

SBP(mmHg) 170+/-13 190+/-26 185+/-16SBP(mmHg) 170+/-13 190+/-26 185+/-16

DBP(mmHg) 92+/-11 114+/-14 105+/-18DBP(mmHg) 92+/-11 114+/-14 105+/-18

ES/SEC rate 31 : 4 27 : 3 22 : 13 ES/SEC rate 31 : 4 27 : 3 22 : 13

RESULTS RESULTS I.I. MORPHOLOGIC MORPHOLOGIC PARAMETERSPARAMETERS

GROUP I GROUP II GROUP III R-CCA L-CCA R-CCA L-CCA R-CCA L-CCAR-CCA L-CCA R-CCA L-CCA R-CCA L-CCA

Dd 5,8+/-0.8 5,6+/-0.7 6,5+/-0.7 6.7+/-0,9 8,3+/-0.3 7.7+/-0,2

(mm)

IMTh 0,45+/-0,2 0,44+/-0,2 0,67+/-0,2 0,65+/-0,3 0,89+/-0,3 0,93+/-0.2

(mm)

% Plaques 28,5% 80%

% Segnif.stenosis 22 % 14%

Mean stenosis(%) 45+/-10,7 % 38+/-9,7%

II . FUNCTIONAL PARAMETERSII . FUNCTIONAL PARAMETERS

GROUP I GROUP II GROUP IIIGROUP I GROUP II GROUP III

R-CCA L-CCA R-CCA L-CCA R-CCA L-CCAR-CCA L-CCA R-CCA L-CCA R-CCA L-CCA

PI PI 3.16+/-1.42 2.85+/-1.38 2.04+/-0.7 1.97+/-0.6 1.08+/-0.67 1.83+/-0.623.16+/-1.42 2.85+/-1.38 2.04+/-0.7 1.97+/-0.6 1.08+/-0.67 1.83+/-0.62 RI RI 0.82+/-0.07 0.81+/-0.06 0.78+/-0.11 0.79+/-0.11 0.83+/-0.10 0.80+/-0.090.82+/-0.07 0.81+/-0.06 0.78+/-0.11 0.79+/-0.11 0.83+/-0.10 0.80+/-0.09

S S 1.02+/-0.3 1.03+/-0.3 1.05+/-0.4 0.73+/-0.2 0.86+/-0.4 0.69+/-0.21.02+/-0.3 1.03+/-0.3 1.05+/-0.4 0.73+/-0.2 0.86+/-0.4 0.69+/-0.2

D D 0.17+/-0.07 0.18+/-0.08 0.18+/-0.07 0.16+/-0.03 0.17+/-0.01 0.12+/-0.07 0.17+/-0.07 0.18+/-0.08 0.18+/-0.07 0.16+/-0.03 0.17+/-0.01 0.12+/-0.07

S/DS/D 6.1+/-1.6 5.7+/-1.6 4.7+/-1.7 5.2+/-1.3 3.95+/-2.7 4.79+/-2.37 6.1+/-1.6 5.7+/-1.6 4.7+/-1.7 5.2+/-1.3 3.95+/-2.7 4.79+/-2.37

TAM TAM 0.26+/-0.11 0.27+/-0.09 0.27+/-0.09 0.31+/-0.11 0.33+/-0.09 0.29+/-0.10 0.26+/-0.11 0.27+/-0.09 0.27+/-0.09 0.31+/-0.11 0.33+/-0.09 0.29+/-0.10

LOCALIZATIONLOCALIZATION OF ATHEROSCLEROTICOF ATHEROSCLEROTIC LESIONSLESIONS OF CAROTIDOF CAROTID ARTERIESARTERIES

GROUP II GROUP IIIno of lesions >2 mm

CCA-middle 3 5 CCA-bulb 4 10ICA 5 11 ECA 2 6TOTAL 12 32

Case 1.Case 1. Large atherosclerotic calcified plaque placed on the bulbar segment of CCA -inferior wall

Case 2.Case 2.Thickening of intima-media complex in CCA. The use of color Doppler effect revealed well the intimal contour

Case 3.Case 3.Mean eccentric CCA stenosisMean eccentric CCA stenosis due to a large fibrous due to a large fibrous plaque plaque

A) Axial view

B) Cross-sectional view

CONCLUSIONSCONCLUSIONS

There was a significant expected There was a significant expected relationship between age and CCA relationship between age and CCA dimensional and functional data dimensional and functional data indicating a widening of the lumen and indicating a widening of the lumen and wall thickness with advancing age and wall thickness with advancing age and a decrease in its buffering functiona decrease in its buffering function

Atherosclerosis of the CCA and carotid Atherosclerosis of the CCA and carotid bifurcation appears like a classical bifurcation appears like a classical feature in subjects with E.H. feature in subjects with E.H. particularly in those over 60 yr. of particularly in those over 60 yr. of age.age.

Large atherosclerotique plaques at the Large atherosclerotique plaques at the

middle portion of CCA are most probably in middle portion of CCA are most probably in

relation with the atherosclerosis process relation with the atherosclerosis process

and not properly with the parietal stretch.and not properly with the parietal stretch.

The decrease in CCA distensibility is The decrease in CCA distensibility is

observed in hypertension and observed in hypertension and

atherosclerosis and, when the two process atherosclerosis and, when the two process

are combined, both of them contribute to are combined, both of them contribute to

this functional disturbance. this functional disturbance.