title: Concurrent Carotid Inflammation in Acute Coronary Syndrome as Assessed by (18)F-FDG PET/CT: A Possible Mechanistic Link for Ischemic Stroke.
abstract: BACKGROUND
  Patients with acute coronary syndrome (ACS) are prone to ischemic stroke (IS) especially during the early phase. ACS patients are more likely to have concurrent complex carotid plaques which, when destabilized, may serve as a source of distal embolism. This study investigated whether inflammatory activity in carotid artery was increased in ACS survivors compared to chronic stable angina (CSA) patients.
  
  
  METHODS
  We prospectively enrolled 74 patients with ACS or CSA (39 ACS patients versus 35 CSA patients), and fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) was performed within 1 week after diagnosis. Carotid PET signal was quantified as standardized uptake value (SUV) and target-to-background ratio (TBR, carotid SUV/jugular venous SUV).
  
  
  RESULTS
  Baseline characteristics were similar between groups. TBRs and SUVs were significantly higher in the carotid arteries of ACS patients than those of CSA patients (P < .001). Systemic inflammatory biomarker correlated significantly with carotid FDG uptake (high-sensitivity C-reactive protein versus average SUV: r = .361, P = .002), and the presence of cardiovascular risk factors was also related to inflammation activity. During follow-up, 3 cerebrovascular events occurred in ACS patients (including 1 early IS in a patient with severe baseline carotid inflammation), whereas none in CSA patients (P = .057).
  
  
  CONCLUSIONS
  This study provided in vivo evidence that ACS survivors might experience concurrent carotid arterial inflammation. Our findings supported the role of systemic immune activation contributing to multiarterial instability in symptomatic atherosclerosis as a possible mechanistic link between ACS and IS.
authors: Multimodal Imaging and Theranostic Lab, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea; Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
authors: Sunwon
authors: S
authors: Kim
authors: Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Korea.
authors: Sinae
authors: S
authors: Lee
authors: Multimodal Imaging and Theranostic Lab, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea; Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
authors: Ji Bak
authors: JB
authors: Kim
authors: Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
authors: Jin Oh
authors: JO
authors: Na
authors: Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
authors: Cheol Ung
authors: CU
authors: Choi
authors: Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
authors: Hong-Eui
authors: HE
authors: Lim
authors: Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
authors: Seung-Woon
authors: SW
authors: Rha
authors: Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
authors: Chang Gyu
authors: CG
authors: Park
authors: Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
authors: Dong Joo
authors: DJ
authors: Oh
authors: Department of Biomedical Engineering, Hanyang University, Seoul, Korea.
authors: Hongki
authors: H
authors: Yoo
authors: Multimodal Imaging and Theranostic Lab, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea; Cardiovascular Center, Department of Cardiology, Korea University Guro Hospital, Seoul, Korea. Electronic address: kjwmm@korea.ac.kr.
authors: Jin Won
authors: JW
authors: Kim
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000473:pathology; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D056910:Republic of Korea; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D002097:C-Reactive Protein
keywords: Atherosclerosis; PET/CT; acute coronary syndrome; arterial inflammation; unstable plaque