Biphasic hemodynamic effects of LDL-apheresis in common carotid artery.
OBJECTIVE
Heparin-induced Extracorporeal Low Density Lipoprotein Precipitation (HELP) Apheresis gives beneficial reductions in Low Density Lipoprotein (LDL) cholesterol levels; otherwise, extracorporeal circulation settings might elicit inflammation and platelet aggregation. The net effect of these variations on carotid hemodynamic has not been established. Aim of the present study was to investigate periprocedural variations of common carotid artery wall shear stress, circumferential wall tension, and Peterson's elastic modulus.


METHODS
Measurements were sequentially performed on 22 procedures: immediately before apheresis (T1), within one hour after (T2), after 24 (T3) and 48 hours (T4). In order to confirm acute effects, in additional 30 procedures measurements were performed at T1 and T2.


RESULTS
Mean shear stress was decreased at T2, with an improvement at T4. Mean circumferential wall tension showed an improvement at T4; arterial stiffness showed the same trend, but only close to statistical significance. The following 30 procedures, where measurements were performed at T1 and T2 only, confirmed previous results, showing a deep wall shear stress decrease at T2 (-21%).


CONCLUSIONS
LDL apheresis seems to have a biphasic effect on common carotid hemodynamics: the acute worsening of shear stress, probably mediated by extracorporeal circulation, was followed by its improvement, possibly driven by LDL cholesterol reduction.
Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Claudio
C
Carallo
Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Antonio
A
Loprete
Nephrology, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Giuseppe
G
Mazza
Nephrology, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Giovanni
G
Bellotti
Hepatology, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Massimo
M
de Siena
Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Pietro
P
Serrao
Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Elisa Stella
ES
Vuoto
Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Maria Serena
MS
de Franceschi
Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Concetta
C
Irace
Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, "Mater Domini" Hospital, "Magna Græcia" University, Viale Europa, Catanzaro, Italy.
Agostino
A
Gnasso
D001781:Blood Component Removal / Q000379:methods*; D002318:Cardiovascular Diseases / Q000209:etiology*; D017536:Carotid Artery, Common / Q000378:metabolism*; D005112:Extracorporeal Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications*; D008297:Male; D008875:Middle Aged
Familial hypercholesterolemia; HELP apheresis; LDL-cholesterol; carotid artery; extracorporeal circulation; shear stress