PubMed · 14263087
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F W ROBINSON. 1965. TECHNIC FOR ARTERIAL CANNULIZATION.. https://pubmed.ncbi.nlm.nih.gov/14263087/
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Increased carotid artery intima-media thickness (IMT), but not necessarily peripheral vessel IMT, accompanies atherosclerosis. We hypothesized that IMT in a peripheral, muscular artery known to be resistant to atherosclerotic changes would increase with hypertension, thereby limiting increases in wall stress and potentially preserving endothelial cell function reflected by flow-mediated dilation (FMD). Plasminogen activator inhibitor type-1 (PAI-1) can inhibit vascular smooth muscle cell migration contributing to increased IMT. Thus, increased PAI-1 may attenuate the mural adaptive response. A high-resolution scanner designed to delineate brachial artery FMD and IMT was used in studies of previously untreated patients with essential hypertension (n = 18) and age- and gender-matched normotensive subjects (n = 15). Brachial IMT was increased with hypertension (0.36 +/- 0.07 vs 0.27 +/- 0.03 mm in controls, p <0.01), and FMD was lower (3.6 +/- 1.5% vs 7.8 +/- 3.6, p <0.01). PAI-1 antigen in blood was increased (40.5 +/- 31.8 vs 26.3 +/- 11.6 ng/ml, p <0.05). IMT and FMD correlated positively (r = 0.63, p <0.05) in hypertensive patients. FMD correlated inversely with wall stress (r = -0.57, p <0.05). IMT correlated inversely with PAI-1 (r = -0.61, p <0.05). These observations support the hypothesis that increased PAI-1 attenuated increases in neointimal vascular smooth muscle cell cellularity. Thus, increased PAI-1 may attenuate a mural, adaptive response to hypertension associated with preservation of endothelial cell function.
The prognosis after TIA may be more serious than previously thought. Recent studies suggest that the risk of subsequent stroke after a TIA may be 5% within the first two days after a TIA, which emphasizes the need for urgent management and institution of therapy. A correct diagnosis is essential, but sometimes difficult because many conditions mimic TIA symptoms. Routine diagnostic procedures include a careful patient history, neurological examination, EKG, CT scan of the brain, and in selected cases carotid and cardiac ultrasound examinations. A recent survey of clinical management after TIA indicates that these investigations are sometimes delayed, particularly in non-hospitalized patients. Patients with a new TIA should immediately be referred to hospital, and ultrasound examination of the carotid arteries (when indicated) should be performed within one week (preferably even earlier) after the TIA onset.
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