الفهرس 
Anatomy of coronary arteries
B.Pathological intimal thickening (PIT):Only 14 pages are availabe for public view
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Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in both industrialized and low income to middle-income countries. Atherosclerosis is the underlying pathological state responsible for the majority of the cardiovascular disease burden worldwide. Atherosclerosis remains asymptomatic until it progresses to flow limiting disease (plaque stenosis of 70 -80%) or when a thrombus forms on an existing plaque as a result of rupture or erosion. However, a substantial proportion of patients progress abruptly from in apparent disease to a myocardial infarction or possible death. This is often due to rupture of plaques with less than 50% stenosis. Because atherosclerosis is a systemic process, it is intuitive that assessing disease at multiple, rather than single, vascular sites may provide greater insight on the overall burden and risk associated with subclinical atherosclerosis. The process of early detection of heart disease begins with risk assessment. Risk assessment classification is then used as a means to guide treatment recommendations for prevention of severe cardiac events. For example, those classified as high risk are typically started on statin therapy. So in order to prevent or delay the progression of CHD, early detection of CHD status for asymptomatic individuals is required. Multiple studies have many combined direct (i.e., coronary artery calcium [CAC]) and indirect markers of atherosclerosis (i.e., carotid intima-media thickness (cIMT) & carotid plaque score). Therefore it can be hypothesized that carotid artery disease and coronary calcium score may associate with subclinical atherosclerosis. Our study aimed to evaluate the ability of carotid artery Doppler ultrasound and coronary artery calcium score to assess atherosclerosis as a predictor of coronary disease in patients without known cardiovascular disease. This study included 30 patients referred to diagnostic radiology and medical imaging department at Tanta University Educational Hospital from cardiology department and private clinics with symptoms of atypical chest pain for evaluation by multislice CT angiography of coronary arteries to rule out coronary artery disease, during the period between February 2018 and February 2019. All the patients were subjected to detailed history taking, clinical examination, laboratory investigations and radiological examination including: 1-Carotid ultrasound Doppler: measuring CIMT & carotid plaque to obtain carotid plaque score. 2- Multislice CT angiography for evaluation of the coronary arteries through calculation of coronary artery calcium score & Gensini score. 43.3 % of the cases were female and 56.7% were male. The age of the patients ranged between 40 and 72 years with significance of increased age in comparison between the patients with and without carotid artery disease and CAD. There is positive association between CIMT, CPS &CACS and different cardiovascular risk factors as BMI, diabetes mellitus, smoking and hypertension but there is no significance for sex. In this study, we focused on the role of carotid artery Doppler and CT coronary calcium score to detect the atherosclerosis as a major cause of coronary artery disease as follow: 1- There was high prevalence of carotid arteries disease in patients with documented CAD (91.7%). 2- There was a significant association between carotid artery disease that was estimated by CIMT, CPS and severity of coronary artery disease as estimated by gensini score & number of coronary arteries affected. 3- There was high prevalence of high coronary artery calcium score in patients with documented CAD (95.8%). 4- There was a significant association between CACS and severity of coronary artery disease as estimated by gensini score & number of coronary arteries affected.