High shear stress relates to intraplaque haemorrhage in asymptomatic carotid plaques

DEFF Research Database (Denmark)

Tuenter, A.; Selwaness, M.; Arias Lorza, A.

2016-01-01

estimating equations analysis, adjusting for age, sex and carotid wall thickness. RESULTS: The study group consisted of 93 atherosclerotic carotid arteries of 74 participants. In plaques with higher maximum shear stresses, IPH was more often present (OR per unit increase in maximum shear stress (log......BACKGROUND AND AIMS: Carotid artery plaques with vulnerable plaque components are related to a higher risk of cerebrovascular accidents. It is unknown which factors drive vulnerable plaque development. Shear stress, the frictional force of blood at the vessel wall, is known to influence plaque...... formation. We evaluated the association between shear stress and plaque components (intraplaque haemorrhage (IPH), lipid rich necrotic core (LRNC) and/or calcifications) in relatively small carotid artery plaques in asymptomatic persons. METHODS: Participants (n = 74) from the population-based Rotterdam...

Assessment of 'on-treatment platelet reactivity' and relationship with cerebral micro-embolic signals in asymptomatic and symptomatic carotid stenosis.

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Kinsella, Justin A; Oliver Tobin, W; Tierney, Sean; Feeley, Timothy M; Egan, Bridget; Coughlan, Tara; Ronan Collins, D; O'Neill, Desmond; Harbison, Joseph A; Doherty, Colin P; Madhavan, Prakash; Moore, Dermot J; O'Neill, Sean M; Colgan, Mary-Paula; Saqqur, Maher; Murphy, Raymond P; Moran, Niamh; Hamilton, George; McCabe, Dominick J H

2017-05-15

The relationship between on-treatment platelet reactivity and cerebral micro-embolic signals (MES) is unknown, and has not been previously simultaneously assessed in asymptomatic and symptomatic carotid stenosis patients. Consecutive eligible patients with ≥50% asymptomatic or recently symptomatic carotid stenosis (≤4weeks following TIA/ischaemic stroke) were recruited to this pilot study. Symptomatic patients were followed up to the 'late' phase (≥3months) following symptom onset or carotid intervention; longitudinal data were analysed from symptomatic patients with data available at both time-points. Platelet function/reactivity was assessed with the PFA-100® to measure collagen-ADP (C-ADP) and collagen-epinephrine (C-EPI) closure times in citrate-anticoagulated whole blood. Bilateral simultaneous 1-hour transcranial Doppler ultrasound (TCD) monitoring of the middle cerebral arteries was performed to classify patients as MES +ve or MES -ve. 31 patients with ≥50% asymptomatic and 46 with early symptomatic carotid stenosis or occlusion were included. 35 symptomatic patients were followed up to the late phase (23 following carotid intervention). Prevalence of 'high on-treatment platelet reactivity' (HTPR) on the C-EPI cartridge did not differ between asymptomatic and symptomatic patients overall, but was lower in 'symptomatic post-intervention' than asymptomatic patients on aspirin monotherapy (10% vs. 50%; p=0.03). The prevalence of HTPR on the C-EPI cartridge decreased between the early and late phases in symptomatic patients (63% vs. 34%; p=0.017), including those on aspirin monotherapy (p=0.016). There were no significant differences in HTPR status between asymptomatic vs. early or late symptomatic MES +ve or MES -ve patients. Carotid interventional treatment, presumably in combination with resolution of the acute phase response, may decrease the prevalence of HTPR in patients with recently symptomatic carotid stenosis over time. Preliminary subgroup

Impact of Provider Characteristics on Outcomes of Carotid Endarterectomy for Asymptomatic Carotid Stenosis in New York State.

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Meltzer, Andrew J; Agrusa, Christopher; Connolly, Peter H; Schneider, Darren B; Sedrakyan, Art

2017-11-01

The purpose of this study is to explore the impact of surgeon characteristics (including annual volume, specialty, and years in practice) on outcomes of carotid endarterectomy (CEA) for asymptomatic carotid atherosclerosis in New York State. The New York Statewide Planning and Cooperation System database was utilized to identify patients undergoing CEA from 2004 to 2011. Provider characteristics were determined by linkage to the New York Office of Professions and National Provider Identification databases. Provider-level factors were characterized by defining 5 quintiles of equal size for each factor. Hierarchical logistic regression models were created to evaluate the impact of provider characteristics on outcome. In total, 36,495 patients underwent CEA for asymptomatic disease performed by vascular (75.7%), general (16.1%), cardiac (6%), and neuro (2.1%) surgeons. Outcomes of interest included in-hospital mortality (0.26%), stroke (0.45%), and the composite end point of mortality, stroke, or cardiac complication (2.2%). Unadjusted outcomes improved with increasing surgeon annual CEA volume. Mid-career surgeons had lower mortality and stroke rates than early or late-career surgeons. Odds of mortality were increased when surgery was performed by the lowest volume providers (quintile 1; 0-11 CEA/year) (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.3-5.28) or a nonspecialty trained (general) surgeon (OR 1.64, 95% 1.01-2.67). After adjustment for all patient-level factors, provider volume remained an independent predictor of outcome, with significantly increased odds of mortality for volume quintile 1 (OR 2.57, 95% CI 1.27-5.23) and quintile 2 (12-22 CEA/year) (0.30%; OR 2.07, 95% CI 1-4.27) surgeons. Adverse events after CEA for asymptomatic disease are comparatively rare. However, surgeon characteristics impact outcome, with the best results offered by high-volume, mid-career, specialty-trained surgeons. Efforts to define the optimal treatment of asymptomatic

Congenital Absence of the Internal Carotid Artery

International Nuclear Information System (INIS)

Florio, Francesco; Balzano, Silverio; Nardella, Michele; Strizzi, Vincenzo; Cammisa, Mario; Bozzini, Vincenzo; Catapano, Giuseppe; D'Angelo, Vincenzo

1999-01-01

We report three cases of congenital absence of an internal carotid artery (ICA), diagnosed incidentally by digital subtraction angiography. The analysis of the cases is based on the classification of segmental ICA agenesis proposed by Lasjaunias and Berenstein. Usually the patients with this rare vascular anomaly are asymptomatic; some may have symptoms related to cerebrovascular insufficiency, compression by enlarged intracranial collateral vessels, or complications associated with cerebral aneurysms. Diagnosis of congenital absence of ICA is made by skull base computed tomography (CT) scan, CT and magnetic resonance angiography, and conventional or digital subtraction angiography

Internal Carotid Artery Hypoplasia: Role of Color-Coded Carotid Duplex Sonography.

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Chen, Pei-Ya; Liu, Hung-Yu; Lim, Kun-Eng; Lin, Shinn-Kuang

2015-10-01

The purpose of this study was to determine the role of color-coded carotid duplex sonography for diagnosis of internal carotid artery hypoplasia. We retrospectively reviewed 25,000 color-coded carotid duplex sonograms in our neurosonographic database to establish more diagnostic criteria for internal carotid artery hypoplasia. A definitive diagnosis of internal carotid artery hypoplasia was made in 9 patients. Diagnostic findings on color-coded carotid duplex imaging include a long segmental small-caliber lumen (52% diameter) with markedly decreased flow (13% flow volume) in the affected internal carotid artery relative to the contralateral side but without intraluminal lesions. Indirect findings included markedly increased total flow volume (an increase of 133%) in both vertebral arteries, antegrade ipsilateral ophthalmic arterial flow, and a reduced vessel diameter with increased flow resistance in the ipsilateral common carotid artery. Ten patients with distal internal carotid artery dissection showed a similar color-coded duplex pattern, but the reductions in the internal and common carotid artery diameters and increase in collateral flow from the vertebral artery were less prominent than those in hypoplasia. The ipsilateral ophthalmic arterial flow was retrograde in 40% of patients with distal internal carotid artery dissection. In addition, thin-section axial and sagittal computed tomograms of the skull base could show the small diameter of the carotid canal in internal carotid artery hypoplasia and help distinguish hypoplasia from distal internal carotid artery dissection. Color-coded carotid duplex sonography provides important clues for establishing a diagnosis of internal carotid artery hypoplasia. A hypoplastic carotid canal can be shown by thin-section axial and sagittal skull base computed tomography to confirm the final diagnosis. © 2015 by the American Institute of Ultrasound in Medicine.

Stent-induced flow disturbances in the ipsilateral external carotid artery following internal carotid artery stenting: a temporary cause of jaw claudication.

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Giurgea, Georgiana-Aura; Haumer, Markus; Mlekusch, Irene; Sabeti-Sandor, Schila; Dick, Petra; Schillinger, Martin; Minar, Erich; Mlekusch, Wolfgang

2017-07-01

We hypothesize that stenting of the internal carotid artery can immediately impede blood flow to the external carotid artery by either plaque shift or stent coverage of the ostium, and thereby cause ischemic symptoms like ipsilateral jaw claudication. Thirty-three patients with high-grade asymptomatic stenosis of the internal carotid artery who underwent endovascular treatment were examined by ultrasound of the external carotid artery and performed an exercise test by chewing chewing gum synchronously to an electronic metronome for 3 min. Tests were performed before, the day after, and 1 week after the stenting procedure. Claudication time was defined as the timespan until occurrence of pain of the masseter muscle and/or chewing dyssynchrony to the metronome for more than 15 s. Ten patients with an isolated, atherosclerotic stenosis of the external carotid artery served as controls. A significantly reduced claudication time (in seconds) was recorded in patients who underwent carotid artery stenting compared to baseline values; median 89 (interquartile range, IQR, 57 to 124) vs. median 180 (IQR 153 to 180; p external carotid artery into faster or slower as 200 cm/sec, the effect was even accentuated. Stenting values showed improvement 1 week after but did not return to baseline levels. No respective changes were found in controls. Stenting of the internal carotid artery lead to ipsilateral flow deterioration at the external carotid artery resulting in temporary jaw claudication. This impairment attenuated over the time and was significantly reduced after 1 week.

Sex-associated differences in the modulation of vascular risk in patients with asymptomatic carotid stenosis.

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Buratti, Laura; Balestrini, Simona; Avitabile, Emma; Altamura, Claudia; Vernieri, Fabrizio; Viticchi, Giovanna; Falsetti, Lorenzo; Provinciali, Leandro; Silvestrini, Mauro

2015-03-31

In this study, we aimed to identify determinants of the different sex-related stroke risk in subjects with asymptomatic internal carotid artery (ICA) stenosis. In all, 492 women (44.4%) and 617 men (55.6%), with unilateral ⩾ 60% asymptomatic ICA stenosis, were prospectively evaluated with a median follow-up of 37 months (interquartile range, 26 to 43). Vascular risk profile, plaque characteristics, stenosis progression, and common carotid artery intima-media thickness were investigated. Outcome measure was the occurrence of ischemic stroke ipsilateral to ICA stenosis. Myocardial infarction, contralateral stroke and transient ischemic attack were considered as competing events. The incidence rate of ipsilateral stroke over the entire follow-up period was 0.16%: 0.09% (95% confidence interval (CI) 0.05 to 0.15) in women and 0.22% (95% CI 0.17 to 0.29) in men (log-rank test, P<0.001). Stenosis progression significantly influenced the risk of ipsilateral stroke in both men (subhazard ratio, SHR, 8.99) and women (SHR 4.89). Stenosis degree (71% to 90%, SHR 2.35; 91% to 99%, SHR 3.38) and irregular plaque surface (SHR 2.32) were relevant risk factors for ipsilateral stroke only in men. Our findings suggest that characteristics of the stenosis and plaque exert a different effect in modulating vascular risk in the two sexes. Understanding sex differences in cardiovascular disease could help to target sex-specific future therapies.

Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.

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Derdeyn, C P; Powers, W J

1996-11-01

The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.

Internal carotid artery occlusion or subocclusion: Contemporary diagnostic challenges: Case report

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Popov Petar

2009-01-01

Full Text Available Introduction. Measurement of vessel stenosis using ultrasonography or magnetic resonance is still the principal method for determining the severity of carotid atherosclerosis and need for endarterectomy. Case Outline. A 56-year-old male was admitted to the Cardiovascular Institute 'Dedinje' due to a clinically asymptomatic restenosis of the operated left internal carotid artery (ICA. Angiography and magnetic resonance angiography (MRA in previous hospitalization had revealed occluded right ICA. However, routine duplex ultrasonography revealed a highgrade restenosis (85% of the left ICA and subocclusion of the right ICA by an ulcerated plaque (confirmed on repeated MRA. Conclusion. Selective arteriography examination could misrepresent the degree of stenosis especially in patents with the ICA that seems to be occluded. MRA is considered the method of choice for identifying pseudo-occlusions of ICA.

Intracranial carotid anastomosis and partial aplasia of an internal carotid artery

Energy Technology Data Exchange (ETDEWEB)

Huber, G.

1980-12-01

A rare arterial anastomosis between the right and left internal carotid arteries at the base at the skull, with aplasia of the cervical part of the left internal carotid artery is reported. The case is unusual because, in addition to the vascular anomaly of the carotid artery, there is an aneurysm of the anterior communicating artery and bilateral renal cysts. The condition is a complex malformation syndrome caused by defective regression of the third branchial artery. Because of the characteristic angiographic aspects such a case should be called transverse carotid anastomosis.

Increased platelet count and leucocyte-platelet complex formation in acute symptomatic compared with asymptomatic severe carotid stenosis.

LENUS (Irish Health Repository)

McCabe, D J H

2005-09-01

The risk of stroke in patients with recently symptomatic carotid stenosis is considerably higher than in patients with asymptomatic stenosis. In the present study it was hypothesised that excessive platelet activation might partly contribute to this difference.

Predictors of subclinical atherosclerosis evaluated by carotid intima-media thickness in asymptomatic young women with type 1 diabetes mellitus.

Science.gov (United States)

Kupfer, Rosane; Larrúbia, Manuella Rangel; Bussade, Isabela; Pereira, Joana Rodrigues Dantas; Lima, Giovanna A Balarini; Epifanio, Marcio Antonio; Schettino, Claudio Domenico Sahione; Momesso, Denise Prado

2017-01-01

This study aimed to evaluate the occurrence and clinical predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM. The study included 45 women with type 1 diabetes mellitus (DM) (aged 36 ± 9 years) who underwent carotid Doppler ultrasound evaluation to determine the carotid artery intima-media thickness (CIMT) and to assess the occurrence of carotid artery plaques. Insulin sensitivity was assessed by estimated glucose disposal rate (eGDR), and metabolic syndrome (MS) was defined by the World Health Organization criteria. The cohort had a mean age of 36 ± 9 years, diabetes duration of 18.1 ± 9.5 years, and body mass index (BMI) of 24.6 ± 2.4 kg/m2. MS was present in 44.4% of the participants. The CIMT was 0.25 ± 0.28 mm, and the prevalence of carotid artery plaques was 13%. CIMT correlated positively with hypertension (p = 0.04) and waist-to-hip ratio (r = 0.37, p = 0.012). The presence of carotid artery plaques correlated positively with age (p = 0.018) and hypertension (p = 0.017). eGDR correlated negatively with CIMT (r = -0.39, p = 0.009) and carotid plaques (p = 0.04). Albuminuria showed a correlation trend with CIMT (p = 0.06). Patients with carotid artery plaques were older, had a higher prevalence of hypertension, and lower eGDR. No correlation was found between CIMT and carotid plaques with diabetes duration, MS, BMI, cholesterol profile, glycated hemoglobin, high-sensitivity C-reactive protein, or fibrinogen. Insulin resistance, central obesity, hypertension, and older age were predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM.

Association between Asymptomatic Unilateral Internal Carotid Artery Stenosis and Electrophysiological Function of the Retina and Optic Nerve

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Anna Machalińska

2017-01-01

Full Text Available Purpose. This study was designed to assess retinal and optic nerve bioelectrical function in patients with unilateral asymptomatic but hemodynamically significant internal carotid artery stenosis (ICAS. Methods. Forty-two subjects with a diagnosis of unilateral ICAS and 34 controls were analyzed. Full-field electroretinogram (ERG, pattern electroretinogram (PERG, and pattern visual-evoked potentials, as well as optical coherence tomography and ophthalmological examination, were performed. Data analysis included eyes ipsilateral to ICAS (EIS and eyes contralateral to ICAS (ECS. Results. Intraocular pressure was significantly decreased in EIS and ECS compared to that in the controls. In the macula, both the cube average thickness and cube volume values were significantly reduced both in EIS and ECS compared to those in the controls. Similarly, PERG P50 and N95 wave amplitudes were significantly smaller in EIS and ECS compared to those in the controls. The ERG rod b-wave and rod-cone a-wave amplitudes were decreased, and implicit times were significantly prolonged, whereas the OP wave index was reduced in EIS compared to that in the controls. No differences in IOP, OCT, or ERG and PERG parameters were identified between EIS and ECS. Conclusions. Our study demonstrated that retinal bioelectrical function is negatively affected by ICAS despite the absence of objective clinical signs and symptoms of ocular ischemia.

Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting.

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Illuminati, Giulio; Ricco, Jean-Baptiste; Caliò, Francesco; Pacilè, Maria Antonietta; Miraldi, Fabio; Frati, Giacomo; Macrina, Francesco; Toscano, Michele

2011-10-01

This study evaluated the timing of carotid endarterectomy (CEA) in the prevention of stroke in patients with asymptomatic carotid stenosis >70% receiving a coronary artery bypass graft (CABG). From January 2004 to December 2009, 185 patients with unilateral asymptomatic carotid artery stenosis >70%, candidates for CABG, were randomized into two groups. In group A, 94 patients received a CABG with previous or simultaneous CEA. In group B, 91 patients underwent CABG, followed by CEA. All patients underwent preoperative helical computed tomography scans, excluding significant atheroma of the ascending aorta or aortic arch. Baseline characteristics of the patients, type of coronary artery lesion, and preoperative myocardial function were comparable in the two groups. In group A, all patients underwent CEA under general anesthesia with the systematic use of a carotid shunt, and 79 patients had a combined procedure and 15 underwent CEA a few days before CABG. In group B, all patients underwent CEA, 1 to 3 months after CABG, also under general anesthesia and with systematic carotid shunting. Two patients (one in each group) died of cardiac failure in the postoperative period. Operative mortality was 1.0% in group A and 1.1% in group B (P = .98). No strokes occurred in group A vs seven ipsilateral ischemic strokes in group B, including three immediate postoperative strokes and four late strokes, at 39, 50, 58, and 66 days, after CABG. These late strokes occurred in patients for whom CEA was further delayed due to an incomplete sternal wound healing or because of completion of a cardiac rehabilitation program. The 90-day stroke and death rate was 1.0% (one of 94) in group A and 8.8% (eight of 91) in group B (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.01-0.91; P = .02). Logistic regression analysis showed that only delayed CEA (OR, 14.2; 95% CI, 1.32-152.0; P = .03) and duration of cardiopulmonary bypass (OR, 1.06; 95% CI, 1.02-1.11; P = .004) reliably predicted

Increased platelet count and reticulated platelets in recently symptomatic versus asymptomatic carotid artery stenosis and in cerebral microembolic signal-negative patient subgroups: results from the HaEmostasis In carotid STenosis (HEIST) study.

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Murphy, S J X; Lim, S T; Kinsella, J A; Murphy, D; Enright, H M; McCabe, Dominick J H

2018-02-23

The pathophysiological mechanisms responsible for the disparity in stroke risk between asymptomatic and symptomatic carotid stenosis patients are not fully understood. The functionally important reticulated platelet fraction and reticulocytes could play a role. We performed a prospective, multi-centre, observational analytical study comparing full blood count parameters and platelet production/turnover/activation markers in patients with asymptomatic versus recently symptomatic moderate (≥ 50-69%) or severe (≥ 70-99%) carotid stenosis. Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the 'early phase' (≤ 4 weeks) and 37 of these patients in the 'late phase' (≥ 3 months) after TIA/ischaemic stroke. Reticulated platelets were quantified by whole blood flow cytometry and reticulated platelets and red cell reticulocytes by 'automated assays' (Sysmex XE-2100™). Bilateral simultaneous transcranial Doppler ultrasound monitoring classified patients as micro-embolic signal (MES)+ve or MES-ve. Mean platelet count was higher in early (216 × 10 9 /L; P = 0.04) and late symptomatic (219 × 10 9 /L; P = 0.044) than asymptomatic patients (194 × 10 9 /L). Mean platelet volume was higher in early symptomatic than asymptomatic patients (10.8 vs. 10.45 fl; P = 0.045). Automated assays revealed higher % reticulated platelet fractions in early (5.78%; P < 0.001) and late symptomatic (5.11%; P = 0.01) than asymptomatic patients (3.48%). Red cell reticulocyte counts were lower in early (0.92%; P = 0.035) and late symptomatic (0.93%; P = 0.036) than asymptomatic patients (1.07%). The automated % reticulated platelet fraction was also higher in early symptomatic than asymptomatic MES-ve patients (5.7 vs. 3.55%; P = 0.001). The combination of increased platelet counts and a shift towards production of an increased population of larger, young, reticulated platelets could contribute to a higher risk of first or recurrent

Neovascularization in Vertebral Artery Atheroma-A Dynamic Contrast-Enhanced Magnetic Resonance Imaging-Based Comparative Study in Patients with Symptomatic and Asymptomatic Carotid Artery Disease.

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Usman, Ammara; Yuan, Jianmin; Patterson, Andrew J; Graves, Martin J; Varty, Kevin; Sadat, Umar; Gillard, Jonathan H

2018-05-24

Atherosclerosis is a systemic inflammatory disease intertwined with neovascularization. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables the assessment of plaque neovascularization. This study aimed to explore the systemic nature of atherosclerosis by assessing difference in severity of neovascularization as quantified by DCE-MRI of vertebral arteries (VAs) between patients with symptomatic and asymptomatic carotid artery disease. Ten consecutive patients with asymptomatic VA stenosis and concomitant symptomatic carotid artery disease (group 1) and 10 consecutive patients with asymptomatic VA stenosis and concomitant asymptomatic carotid artery disease (group 2) underwent 3-dimensional DCE-MRI of their cervical segment of VAs. A previously validated pharmacokinetic modeling approach was used for DCE-MRI analysis. K trans was calculated in the adventitia and plaque as a measure of neovessel permeability. Both patient groups were comparable for demographics and comorbidities. Mean luminal stenosis was comparable for both groups (54.4% versus 52.27%, P = .32). Group 1 had higher adventitial K trans and plaque K trans (.08 ± .01 min -1 , .07 ± .01 min -1 ) compared with Group 2 (.06 ± .01 min -1 , .06 ± .01 min -1 ) (P = .004 and .03, respectively). Good correlation was present among the two image analysts (intraclass correlation coefficient = .78). Vertebral Artery atheroma of patients with symptomatic carotid artery disease had increased neovessel permeability compared with the patients with asymptomatic carotid artery disease. These findings are consistent with the hypothesis that atherosclerosis is a systemic inflammatory disease. The VA atherosclerosis is likely to have increased severity of neovascularization if another arterial territory is symptomatic in the same patient cohort. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Anomalous external carotid artery-internal carotid artery anastomosis in two patients with proximal internal carotid arterial remnants

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Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Cho, Young Dae; Kang, Hyun Seung; Kim, Jeong Eun; Han, Moon Hee [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyong [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)

2015-08-15

Two angiographic instances of anomalous external carotid artery (ECA) and internal carotid artery (ICA) anastomosis are described, each occurring at the C2-3 level and bearing remnants of proximal ICA. The ICA remnant of one patient (identifiable immediately upon bifurcation of the common carotid artery) was hypoplastic, and that of the other patient was an occluded arterial stump. These features are not typical of non-bifurcating ICA. The occipital artery originated from an anomalous connection in one instance and from the main trunk of the ECA (just past the ECA-ICA connection) in the other.

Establishing experimental model of human internal carotid artery siphon segment in canine common carotid artery

International Nuclear Information System (INIS)

Cui Xuee; Li Minghua; Wang Yongli; Cheng Yingsheng; Li Wenbin

2005-01-01

Objective: To study the feasibility of establishing experimental model of human internal carotid artery siphon segment in canine common carotid artery (CCA) by end-to-end anastomoses of one side common carotid artery segment with the other side common carotid artery. Methods: Surgical techniques were used to make siphon model in 8 canines. One side CCA was taken as the parent artery and anastomosing with the cut off contra-lateral CCA segment which has passed through within the S-shaped glass tube. Two weeks after the creation of models angiography showed the model siphons were patent. Results: Experimental models of human internal carotid artery siphon segment were successfully made in all 8 dogs. Conclusions: It is practically feasible to establish experimental canine common carotid artery models of siphon segment simulating human internal carotid artery. (authors)

Cerebral vasomotor reactivity and apnea test in symptomatic and asymptomatic high-grade carotid stenosis

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Lučić-Prokin Aleksandra

2015-01-01

Full Text Available Introduction. Cerebral vasomotor reactivity (VMR represents an autoregulatory response of the arterial trunks on the specific vasoactive stimuli, most commonly CO2. Objective. The aim of this retrospective study was to compare VMR in high-grade symptomatic (SCAS and asymptomatic carotid stenosis (ACAS, using the apnea test to evaluate the hemodynamic status. Methods. The study included 50 patients who were hospitalized at the neurology and vascular surgery departments as part of preparation for carotid endarterectomy. We evaluated VMR by calculating the breath holding index (BHI in 34 patients with SCAS and 16 patients with ACAS, with isolated high-grade carotid stenosis. We evaluated the impact of risk factors and collateral circulation on BHI, as well as the correlation between the degree of carotid stenosis and BHI. Results. A pathological BHI was more frequent in the SCAS group (p<0.01. There was no difference in the range of BHI values between the groups, both ipsilaterally and contralaterally. Only male gender was associated with pathological BHI in both groups (p<0.05. Collateral circulation did not exist in over 60% of all subjects. We confirmed a negative correlation between the degree of carotid stenosis and BHI. Conclusion. SCAS and ACAS patients present with different hemodynamics. While ACAS patients have stable hemodynamics, combination of hemodynamic and thromboembolic effects is characteristic of SCAS patients.

Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

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Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito [Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Department of Neurosurgery, Aichi (Japan); Miyachi, Shigeru; Hattori, Kenichi [Nagoya University Graduate School of Medicine, Department of Neurosurgery, Nagoya (Japan)

2006-11-15

Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

International Nuclear Information System (INIS)

Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito; Miyachi, Shigeru; Hattori, Kenichi

2006-01-01

Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

Carotid Artery End-Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients.

Science.gov (United States)

Chung, Hyemoon; Jung, Young Hak; Kim, Ki-Hyun; Kim, Jong-Youn; Min, Pil-Ki; Yoon, Young Won; Lee, Byoung Kwon; Hong, Bum-Kee; Rim, Se-Joong; Kwon, Hyuck Moon; Choi, Eui-Young

2016-01-01

Prognostic value of additional carotid Doppler evaluations to carotid intima-media thickness (IMT) and plaque has not been completely evaluated. A total of 1119 patients with risk factors for, but without, overt coronary artery disease (CAD), who underwent both carotid ultrasound and Doppler examination were included in the present study. Parameters of interest included peak systolic and end-diastolic velocities, resistive indices of the carotid arteries, IMT, and plaque measurements. The primary end-point was all-cause cerebro-cardiovascular events (CVEs) including acute myocardial infarction, coronary revascularization therapy, heart failure admission, stroke, and cardiovascular death. Model 1 covariates comprised age and sex; Model 2 also included hypertension, diabetes and smoking; Model 3 also had use of aspirin and statin; and Model 4 also included IMT and plaque. The mean follow-up duration was 1386±461 days and the mean age of the study population was 60±12 years. Amongst 1119 participants, 43% were women, 57% had a history of hypertension, and 23% had diabetes. During follow-up, 6.6% of patients experienced CVEs. Among carotid Doppler parameters, average common carotid artery end-diastolic velocity was the independent predictor for future CVEs after adjustments for all models variables (HR 0.95 per cm/s, 95% confident interval 0.91-0.99, p=0.034 in Model 4) and significantly increased the predictive value of Model 4 (global χ(2)=59.0 vs. 62.8, p=0.029). Carotid Doppler measurements in addition to IMT and plaque evaluation are independently associated with future CVEs in asymptomatic patients at risk for CAD.

Intracranial carotid anastomosis and partial aplasia of an internal carotid artery

International Nuclear Information System (INIS)

Huber, G.

1980-01-01

A rare arterial anastomosis between the right and left interal carotid arteries at the base at the skull, with aplasia of the cervical part of the left internal carotid artery is reported. The case is unusual because, in addition to the vascular anomaly of the carotid artery, there is an aneurysm of the anterior communicating artery and bilateral renal cysts. The condition is a complex malformation syndrome caused by defective regression of the third branchial artery. Because of the characteristic angiographic aspects such a case should be called transverse carotid anastomosis. (orig.)

High-grade symptomatic and asymptomatic carotid stenosis in the very elderly. A challenge for proponents of carotid angioplasty and stenting

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De Rossi Aldo

2006-03-01

Full Text Available Abstract Background Carotid angioplasty and stenting (CAS is often considered as the preferred treatment for severe carotid occlusive disease in patients labelled as "high risk", including those aged 80 or more. We analyzed 30-day stroke risk and death rates after carotid endarterectomy (CEA for severe symptomatic or asymptomatic carotid disease in patients aged 80 or more, by comparison with the outcome of CAS reported in the recently- published literature. Methods A retrospective review was conducted on a prospectively compiled computerized database of all primary CEAs performed by a single surgeon at our institution from 1990 to 2003. Descriptive demographic data, risk factors, surgical details, perioperative strokes and deaths, and other complications were recorded. Results In all, 1260 CEAs were performed in 1099 patients; 1145 were performed in 987 patients less than 80 years old, and 115 were performed in 112 patients aged 80 or more. There were 11 perioperative strokes in the 1145 procedures in the younger group, for a stroke rate of 0.8%, and no strokes in the 115 procedures in the older group. The death rates were 0% for the octogenarians and 0.3% for the younger group. Conclusion The conviction that older age means higher risk needs to be revised. Patients aged 80 or more can undergo CEA with no more perioperative risks than younger patients. Proponents of CAS should bear this in mind before recommending CAS as the best therapeutic option for such patients.

Carotid stiffness indicates risk of ischemic stroke and TIA in patients with internal carotid artery stenosis: the SMART study

NARCIS (Netherlands)

Dijk, Joke M.; van der Graaf, Yolanda; Grobbee, Diederick E.; Bots, Michiel L.

2004-01-01

Patients with a carotid artery stenosis, including those with an asymptomatic or moderate stenosis, have a considerable risk of ischemic stroke. Identification of risk factors for cerebrovascular disease in these patients may improve risk profiling and guide new treatment strategies. We

Carotid Velocities Determine Cerebral Blood Flow Deficits in Elderly Men with Carotid Stenosis <50%

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Arkadiusz Siennicki-Lantz

2012-01-01

Full Text Available To examine if mild carotid stenosis correlates with silent vascular brain changes, we studied a prospective population-based cohort “Men born in 1914.” Data from followups at ages 68 and 81, have been used. Carotid ultrasound was performed at age 81, and cerebral blood flow (CBF was measured with SPECT at age 82. Out of 123 stroke-free patients, carotid stenosis <50% was observed in 94% in the right and 89% in the left internal carotid arteries (ICAs. In these subjects, Peak Systolic Velocities in ICA correlated negatively with CBF in a majority of several brain areas, especially in mesial temporal area. Results were limited to normotensive until their seventies, who developed late-onset hypertension with a subsequent blood pressure, pulse pressure, and ankle-brachial index growth. Elderly with asymptomatic carotid stenosis <50% and peak systolic velocities in ICA 0.7–1.3 m/s, should be offered an intensified pharmacotherapy to prevent stroke or silent cerebrovascular events.

[Risk factors of rupture of internal carotid artery during surgical resection of carotid body tumor].

Science.gov (United States)

Li, Y H; Wang, J S; Yao, C; Chang, G Q; Yin, H H; Li, S Q; Lü, W M; Hu, Z J; Wang, S M

2017-06-13

Objective: To investigate risk factors of rupture of internal carotid artery resection during carotid body tumor resection and to summarize our treatment experience. Methods: During the period from 1991 to 2016, rupture of internal carotid artery occurred in 27 patients (28 tumors) during surgical resection of carotid body tumor in the First Affiliated Hospital of Sun Yat-sen University. Their clinical and follow-up data were retrospectively collected and analyzed. For all patients underwent surgical resection during this period, Logistic regression analysis was used to investigate the risk factors of intraoperative rupture of internal carotid artery. Results: Of these 28 tumors, there were 15 (53.6%) tumors with diameter≥5 cm and 20 (71.4%) Shamblin Ⅲ tumors. Intraoperatively, shunt was applied for 8 (28.6%) cases. Thirteen (46.4%) patients underwent ligation of external carotid artery, while 2 (7.1%) patients accepted resection of cranial nerves. Direct closure/patchplasty, autologous vessels or graft reconstruction was used in 16, 10 and 2 cases, respectively. Postoperatively, stroke occurred in 4(14.3%) cases and cranial nerve deficit in 15 (53.6%) cases. During a median length of 36 (14-125) months, cranial nerve deficit persisted in 5 cases. Follow-up radiologic examination indicated 3 (10.7%) cases of targeted vessel occlusion. However, no new-onset stroke was identified. Among all patients underwent surgical resection of carotid body tumor, female ( OR =3.650, P =0.012), age≤25 years old ( OR =3.710, P =0.013) and Shamblin Ⅲ tumor ( OR =4.631, P =0.008) increase the risks of intraoperative carotid artery rupture. Conclusions: Shamblin Ⅲ tumor is the predictor of rupture of internal carotid artery. Intraoperative, properly increased blood pressure, intraoperative heparinization and use of shunt for those cases without well-compensated cranial collateral arteries are likely to decreasing the incidence of stroke.

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study) : an interim analysis of a randomised controlled trial

NARCIS (Netherlands)

Ederle, Joerg; Dobson, Joanna; Featherstone, Roland L.; Bonati, Leo H.; van der Worp, H. Bart; de Borst, Gert J.; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumaira; Lyrer, Philippe A.; Hendriks, Johanna M.; McCollum, Charles; Nederkoorn, Paul J.; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Bradbury, A.; Brown, M. M.; Clifton, A.; Gaines, P.; Collins, R.; Molynewc, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Hendriks, J. M. H.; Hendriks, J. M.

2010-01-01

Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid

The evidence for medicine versus surgery for carotid stenosis

International Nuclear Information System (INIS)

Ederle, Joerg; Brown, Martin M.

2006-01-01

Atherosclerotic stenosis of the internal carotid artery is an important cause of stroke. Several large randomised trials have compared best medical management with carotid endarterectomy and provide a strong evidence base for advising and selecting patients for carotid surgery. Best medical management of carotid stenosis includes lowering of blood pressure, treatment with statins and antiplatelet therapy in symptomatic patients. Combined analysis of the symptomatic carotid surgery trials, together with observational data, has shown that patients with recently symptomatic severe carotid stenosis have a very high risk of recurrent stroke in the first few days and weeks after symptoms. Carotid endarterectomy has a risk of causing stroke or death at the time of surgery in symptomatic patients of around 5-7%, but in patients with recently symptomatic stenosis of more than 70%, the benefits of endarterectomy outweigh the risks. In patients with moderate stenosis of between 50 and 69%, the benefits may justify surgery in patients with very recent symptoms, and in patients older than 75 years within a few months of symptoms. Patients with less than 50% stenosis do not benefit from surgery. In asymptomatic patients, or those whose symptoms occurred more than 6 months ago, the benefits of surgery are considerably less. Patients with asymptomatic stenosis treated medically only have a small risk of future stroke when treated medically of about 2% per annum. If carotid endarterectomy can be performed safely with a perioperative stroke and death rate of no more than 3%, then the randomised trials showed a significant benefit of surgery over 5 years follow-up, with an overall reduction in the risk of stroke from about 11% over 5 years down to 6%. However, of 100 patients operated, only 5 will benefit from avoiding a stroke over 5 years. The majority of neurologists have concluded that this does not justify a policy of routine screening and endarterectomy for asymptomatic

Preoperative White Matter Lesions Are Independent Predictors of Long-Term Survival after Internal Carotid Endarterectomy

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Niku Oksala

2014-06-01

Full Text Available Background: Cerebral white matter lesions (WMLs predict long-term survival of conservatively treated acute stroke patients with etiology other than carotid stenosis. In carotid endarterectomy patients, WMLs are associated with severe carotid stenosis and unstable plaques, with the risk of perioperative complications and with increased 30-day perioperative risk of death. However, no data exist on their effect on postoperative long-term survival, a factor important when considering the net benefit from carotid endarterectomy. Whether this effect is independent of classical risk factors and indications for surgery is not known either. We hypothesized that WMLs could be evaluated from preoperative routine computed tomography (CT scans and are predictors of postoperative survival, independent of classical cardiovascular risk factors, indication category and degree of carotid stenosis. Methods: A total of 353 of 481 (73.4% consecutive patients subjected to carotid endarterectomy due to different indications, i.e. asymptomatic stenosis (n = 28, 7.9%, amaurosis fugax (n = 52, 14.7%, transient ischemic attack (n = 135, 38.2% or ischemic stroke (n = 138, 39.1%, from prospective vascular registries during the years 2001-2010 with digital preoperative CT scans, were included in the study. WMLs were rated by a radiologist (Wahlund criteria in a blinded fashion. Internal carotid artery (ICA stenoses were angiographically graded (Results: WML severity could be assessed with a substantial intraobserver agreement (Spearman's rho 0.843, p Conclusions: WMLs in a preoperative CT scan provide a substantially reliable estimate of postoperative long-term survival of carotid endarterectomy patients independent of currently used criteria, i.e. cardiovascular risk factors, indication category and degree of ipsilateral ICA stenosis.

Early control of distal internal carotid artery during carotid endarterectomy: does it reduce cerebral microemboli?

Science.gov (United States)

Mommertz, G; Das, M; Langer, S; Koeppel, T A; Krings, T; Mess, W H; Schiefer, J; Jacobs, M J

2010-06-01

According to the results of the large trials on carotid endarterectomy (CEA), this type of surgery is only warranted if perioperative mortality and morbidity are kept considerably low. Less attention has been paid to methods of cerebral protection during CEA, although intraoperative transcranial Doppler (TCD) can visualise intracerebral microemboli (MES) during routine carotid dissection, although MES occur throughout the CEA, only those during dissection are related to neurological outcome. Prevention of MES by means of early control of the distal internal carotid artery dislodging from the carotid artery plaque during dissection is very likely the mechanism behind an eventual benefit from this approach. Hence, the amount of MES might serve as a surrogate parameter for the risk of periprocedural neurological events. So, the aim of the present study was to evaluate whether early control of the distal carotid artery during CEA is capable of reducing the number of MES by means of a prospective randomised trial. Twenty-eight patients (29 procedures) could be prospectively included in our study. Before surgery we randomly assigned the patients to two groups: group A (N.=12): CEA by means of early control of the distal internal carotid artery; group B (N.=17): CEA with dissection of the total carotid bifurcation before clamping the arteries. Periprocedurally, we continuously monitored the cerebral blood flow in the ipsilateral middle cerebral artery by means of TCD. Pre- and postoperative morbidity were independently verified by a neurologist control of the distal internal carotid artery did not reduce the occurrence of MES during dissection of the carotid bifurcation. Also, the total number of MES throughout the procedure and postoperatively was comparable between both groups. The procedure related times as well as the clinical outcome did not differ significantly. Thus, early control of the distal internal carotid artery has got no advantage but also no disadvantage

Agenesis of internal carotid artery associated with congenital anterior hypopituitarism

International Nuclear Information System (INIS)

Moon, W.-J.; Porto, L.; Lanfermann, H.; Zanella, F.E.; Weis, R.

2002-01-01

We report a rare case of unilateral agenesis of the internal carotid artery in association with congenital anterior hypopituitarism. The collateral circulation is supplied by a transsellar intercavernous anastomotic vessel connecting the internal carotid arteries. These abnormalities are well depicted on MRI and MRA. The agenesis of the internal carotid artery may explain the pathogenesis of some of congenital anterior hypopituitarism. (orig.)

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

NARCIS (Netherlands)

Ederle, J.; Dobson, J.; Featherstone, R.L.; Bonati, L.H.; Worp, H.B. van der; Borst, G.J. de; Lo, T.H.; Gaines, P.; Dorman, P.J.; Macdonald, S.; Lyrer, P.A.; Hendriks, J.M.; McCollum, C.; Nederkoorn, P.J.; Brown, M.M.; Blankensteijn, J.D.; Leeuw, F.E. de; Schultze Kool, L.J.; Vliet, J.A. van der; et al.,

2010-01-01

BACKGROUND: Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. METHODS: The International

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial

NARCIS (Netherlands)

Ederle, Jörg; Dobson, Joanna; Featherstone, Roland L.; Bonati, Leo H.; van der Worp, H. Bart; de Borst, Gert J.; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumaira; Lyrer, Philippe A.; Hendriks, Johanna M.; McCollum, Charles; Nederkoorn, Paul J.; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Collins, R.; Molyneux, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Chu, P.; Clark, D.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Saunder, A.; Than, P. G.; Gett, S.; Leggett, D.; McGahan, T.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Stanley, B.; Allard, B.; Atkinson, N.; Cambell, W.; Davies, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; d'Archambeau, O.; Hendriks, J. M. H.; van Schil, P.; St Blasius, A. Z.; Bosiers, M.; Deloose, K.; van Buggenhout, E.; de Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verbist, J.; Blair, J.-F.; Caron, J. L.; Daneault, N.; Giroux, M.-F.; Guilbert, F.; Lanthier, S.; Lebrun, L.-H.; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Weill, A.; Hill, M.; Hu, W.; Hudion, M.; Morrish, W.; Sutherland, G.; Wong, J.; Albäck, A.; Harno, H.; Ijäs, P.; Kaste, M.; Lepäntalo, M.; Mustanoja, S.; Paananen, T.; Porras, M.; Putaala, J.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; Skalej, M.; Brennan, P.; Kelly, C.; Leahy, A.; Moroney, J.; Thornton, J.; Koelemay, M. J. W.; Reekers, J. A. A.; Roos, Y. B. W. E. M.; Hendriks, J. M.; Koudstaal, P. J.; Pattynama, P. M. T.; van der Lugt, A.; van Dijk, L. C.; van Sambeek, M. R. H. M.; van Urk, H.; Verhagen, H. J. M.; Bruijninckx, C. M. A.; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H.; Wever, J.; de Beer, F. C.; van den Berg, J. S. P.; van Hasselt, B. A. A. M.; Zeilstra, D. J.; Boiten, J.; van Otterloo, J. C. A. de Mol; de Vries, A. C.; Lycklama a Nijeholt, G. J.; van der Kallen, B. F. W.; Blankensteijn, J. D.; de Leeuw, F. E.; Kool, L. J. Schultze; van der Vliet, J. A.; de Borst, G. J.; de Kort, G. A. P.; Kapelle, L. J.; Lo, T. H.; Mali, W. P. Th M.; Moll, F.; van der Worp, H. B.; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sørensen, K.; Skjelland, M.; Tennøe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Jedrzejewska, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; Obach, V.; Riambau, V.; San Roman, L.; Branera, J.; Canovas, D.; Estela, Jordi; Gaibar, A. Gimenez; Perendreu, J.; Björses, K.; Gottsater, A.; Ivancev, K.; Maetzsch, T.; Sonesson, B.; Berg, B.; Delle, M.; Formgren, J.; Gillgren, P.; Kall, T.-B.; Konrad, P.; Nyman, N.; Takolander, R.; Andersson, T.; Malmstedt, J.; Soderman, M.; Wahlgren, C.; Wahlgren, N.; Binaghi, S.; Hirt, L.; Michel, P.; Ruchat, P.; Engelter, S. T.; Fluri, F.; Guerke, L.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E.-W.; Stierli, P.; Wasner, M.; Wetzel, S.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Murith, M.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Varty, K.; Adam, D.; Bell, J.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; D'Souza, S.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, J. A.; Enevoldson, T. P.; Gilling-Smith, G.; Gould, D. A.; Harris, P. L.; McWilliams, R. G.; Nasser, H.-C.; White, R.; Prakash, K. G.; Serracino-Inglott, F.; Subramanian, G.; Symth, J. V.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dorman, P.; Dyker, A.; Ford, G.; Golkar, A.; Jackson, R.; Jayakrishnan, V.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Rose, J.; Stansby, G.; Wyatt, M.; Baker, T.; Baldwin, N.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Cleveland, T.; Dodd, D.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Venables, G.; Belli, A.; Cloud, G.; Halliday, A.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Thompson, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Malik, I.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Brookes, J.; Jäger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.

2010-01-01

BACKGROUND: Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. METHODS: The International

Hemodynamic significance of internal carotid artery disease

DEFF Research Database (Denmark)

Schroeder, T

1988-01-01

Neurologic symptoms in the region of an internal carotid artery stenosis are considered to be embolic in most instances. Only in a subgroup has carotid occlusive disease with impairment of the collateral supply, caused a state of hemodynamic failure with marked reduction of perfusion pressure. Th...

Thrombosis of internal carotid artery following blunt neck injuries

International Nuclear Information System (INIS)

Houdek, M.; Klaus, E.

1986-01-01

Complicated problems of nonpenetrating injuries of the internal carotid artery, their pathophysiological mechanisms, clinical picture, diagnosis and therapy are analyzed. The possible surgical management is considered. Attention was paid to angiographic diagnosis of traumatic and spontaneous lesions of internal carotid arteries. (author). 87 refs

Bilateral Internal Carotid Artery Occlusion Associated with the Antiphospholipid Antibody Syndrome

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Pria Anand

2014-03-01

Full Text Available A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies.

Evidence for shear stress-mediated dilation of the internal carotid artery in humans

DEFF Research Database (Denmark)

Carter, Howard Henry; Atkinson, Ceri L; Heinonen, Ilkka H A

2016-01-01

-mediated dilation of larger conduit arteries in humans. There was a strong association between change in shear and diameter of the internal carotid (r=0.68; Ptime in humans, that shear stress is an important stimulus for hypercapnic vasodilation of the internal carotid...... increases carotid shear stress, a known stimulus to vasodilation in other conduit arteries. To explore the hypothesis that shear stress contributes to hypercapnic internal carotid dilation in humans, temporal changes in internal and common carotid shear rate and diameter, along with changes in middle.......01) carotids. Diameter also increased (Ptime course is associated with shear...

Effect of Cervical Siphon of External and Internal Carotid Arteries.

Science.gov (United States)

Singh, Rajani; Tubbs, Richard Shane

2017-10-01

Variant courses, configuration, and branching pattern of the external and internal carotid arteries, especially when curved in S-shape, are important for hemodynamic changes and clinical implications. Therefore, the aim of the study is to report abnormal cervical siphons observed in external and internal carotid arteries to explore clinical significance by review of literature and hemodynamic changes theoretically.The right common carotid artery bifurcated into external and internal carotid arteries at the level of the upper border of thyroid cartilage in a 70-year-old female cadaver. After bifurcation, the external carotid artery underwent severe tortuosity coursing through 5 bends at points A, B, C, D, and E from its origin to termination and 2 bends at A' and B' in internal carotid artery in the cervical region. The angles between inflow and out flow of the blood at the bends were measured and the change in velocity at each bend was computed for both arteries. Hemodynamic changes were calculated, compared and relevant clinical complications were theoretically correlated.The angles of 20°, 30°, 51°, 52°, 60°, and 28°, 48° were formed by 5 bends of external and 2 bends of internal carotid arteries, respectively. The curved courses of these arteries caused reduction in velocity/stasis, turbulence, and low shear stress. Such kinks might cause stroke, ischemia and mistaken for tumors and abscess in imagery leading to or otherwise producing iatrogenic repercussions. This study will be useful for anatomists, clinicians, and radiologists.

The changes of individual carotid artery wall layer by aging and carotid intima-media thickness value for high risk.

Science.gov (United States)

Bae, Jang-Ho; Kim, Wuon-Shik; Lee, Moo-Sik; Kim, Kee-Sik; Park, Jeong Bae; Youn, Ho-Joong; Park, Chang-Gyu; Hong, Kyung-Soon; Kim, Jang-Young; Jeong, Jin-Won; Park, Jong Chun; Lim, Do-Sun; Kim, Moo Hyun; Woo, Jeong Taek

2016-12-01

It is still unclear which layer (intima or media) is mainly involved in increased carotid intima-media thickness (CIMT) by aging and also unclear regarding CIMT value suggesting high cardiovascular risk, although 75th percentile value of CIMT is known as a high risk in asymptomatic adults. We sought to find the changes of carotid intima thickness (CIT) and carotid media thickness (CMT) by aging and the 75th percentile value of CIMT in asymptomatic Korean adults. This is an observational cohort study. Carotid ultrasound findings (n=2204 from 12 hospitals) were prospectively collected. The carotid images were sent to Korea Research Institute of Standards and Science for analysis using specialized software which can measure intima and media wall also. Mean age was 58.1±13.5 years old (52% of men). Pearson's correlation coefficient between age and right CIMT (r=.489, Pvalue was 0.778 and 0.771 mm, respectively. Mean right CIT was 0.311±0.069 and 0.303±0.064 mm (P=.009), and mean right CMT was 0.391±0.124 and 0.388±0.131 mm (P=.694) in male and female, respectively. Left carotid ultrasound findings showed similar to the right one. An increased CIMT by aging was mainly due to increased CMT rather than CIT in asymptomatic adults. The 75th percentile values of right CIMT were 0.778 and 0.771 mm in asymptomatic Korean male and female adults, respectively. © 2016 John Wiley & Sons Ltd.

Discrepancy analysis between crystallized and fluid intelligence tests: a novel method to detect mild cognitive impairment in patients with asymptomatic carotid artery stenosis.

Science.gov (United States)

Takaiwa, A; Kuwayama, N; Akioka, N; Kashiwazaki, D; Kuroda, S

2018-02-01

The present study was conducted to accurately determine the presence of mild cognitive impairment, which is often difficult to evaluate using only simple tests. Our approach focused on discrepancy analysis of fluid intelligence relative to crystallized intelligence using internationally recognized neuropsychological tests. One-hundred and five patients diagnosed with asymptomatic carotid artery stenosis were assessed. The neuropsychological tests included the two subtests (information and picture completion) of Wechsler Adult Intelligence Scale-Revised (WAIS-R-two-subtests): crystallized intelligence tests and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (immediate memory, visuospatial/constructional, language, attention, delayed memory and total score) as fluid intelligence tests. Discrepancy analysis was used to assess cognitive impairment. The score for RBANS was subtracted from the score for WAIS-R-two-subtests, and if the score difference was greater than the 5% confidence limit for statistical significance, it was defined as a decline in cognitive function. The WAIS-R-two-subsets was within normal limits when compared with the standardized values. However, all RBANS domains showed significant declines. Frequencies of decline in each RBANS domain were as follows: 69 patients (66%) in immediate memory, 26 (25%) in visuospatial/constructional, 54 (51%) in language, 63 (60%) in attention, 54 (51%) in delayed memory and 78 (74%) in the total score. Moreover, 99 patients (94%) showed decline in at least one RBANS domain. Cognitive function is only preserved in a few patients with asymptomatic carotid artery stenosis. Mild cognitive impairment can be precisely detected by performing the discrepancy analysis between crystallized and fluid intelligence tests. © 2017 EAN.

Anatomical characteristics of the styloid process in internal carotid artery dissection: Case-control study.

Science.gov (United States)

Amorim, José M; Pereira, Daniela; Rodrigues, Marta G; Beato-Coelho, José; Lopes, Margarida; Cunha, André; Figueiredo, Sofia; Mendes-Pinto, Mafalda; Ferreira, Carla; Sargento-Freitas, João; Castro, Sérgio; Pinho, João

2018-06-01

Introduction Pathophysiology of cervical artery dissection is complex and poorly understood. In addition to well-known causative and predisposing factors, including major trauma and monogenic connective tissue disorders, morphological characteristics of the styloid process have been recently recognized as a possible risk factor for cervical internal carotid artery dissection. Aims To study the association of the anatomical characteristics of styloid process with internal carotid artery dissection. Methods Retrospective, multicenter, case-control study of patients with internal carotid artery dissection and age- and sex-matched controls. Consecutive patients with internal carotid artery dissection and controls with ischemic stroke or transient ischemic attack of any etiology excluding internal carotid artery dissection, who had performed computed tomography angiography, diagnosed between January 2010 and September 2016. Two independent observers measured styloid process length and styloid process distance to internal carotid artery. Results Sixty-two patients with internal carotid artery dissection and 70 controls were included. Interobserver agreement was good for styloid process length and styloid process-internal carotid artery distance (interclass correlation coefficient = 0.89 and 0.76, respectively). Styloid process ipsilateral to dissection was longer than left and right styloid process in controls (35.8 ± 14.4 mm versus 30.4 ± 8.9 mm and 30.3 ± 8.2 mm, p = 0.011 and p = 0.008, respectively). Styloid process-internal carotid artery distance ipsilateral to dissection was shorter than left and right distance in controls (6.3 ± 1.9 mm versus 7.2 ± 2.1 mm and 7.0 ± 2.3 mm, p = 0.003 and p = 0.026, respectively). Internal carotid artery dissection was associated with styloid process length (odds ratio = 1.04 mm -1 , 95% confidence interval = 1.01-1.08, p = 0.015) and styloid process-internal

The prevalence of carotid artery stenosis in patients undergoing aortic reconstruction.

Science.gov (United States)

Cahan, M A; Killewich, L A; Kolodner, L; Powell, C C; Metz, M; Sawyer, R; Lilly, M P; Benjamin, M E; Flinn, W R

1999-09-01

Coronary artery disease occurs frequently in patients undergoing aortic reconstruction, and it has been presumed that internal carotid artery occlusive disease is also common. This has led to the practice of screening for and repairing significant carotid lesions in asymptomatic patients prior to aortic reconstruction. The purpose of this study was to determine the true prevalence of internal carotid artery disease in these patients. The records of 240 patients who underwent duplex ultrasound screening for carotid artery disease prior to aortic reconstruction were reviewed. Surgery was performed for aortic aneurysm (AA) or aorto-iliac occlusive disease (AO). The prevalence of hyperlipidemia and coronary artery disease was similar between the two groups, but tobacco use, hypertension, and diabetes mellitus differed. Internal carotid artery stenosis > or = 50% occurred in 26.7% of the total group (64 of 240 cases). Stenosis > or = 50% was more common in the AO group (40 of 101 cases, 39.6%) than the AA group (24 of 139 cases, 17.3%, P = 0.0001). Severe disease (70% to 99%) was also more common in the AO group than the AA group (9.9% versus 3.6%, P = 0.0464). Internal carotid artery disease occurs commonly in patients undergoing aortic reconstruction, and screening is worthwhile. Significant disease is more common in patients with aorto-iliac occlusive disease than in those with aortic aneurysm, although atherosclerotic risk factors occur with varying frequency in the two groups. These findings suggest that additional factors may contribute to the higher prevalence of internal carotid artery stenosis in aorto-iliac occlusive disease.

Quantitative analysis and predictors of embolic filter debris load during carotid artery stenting in asymptomatic patients.

Science.gov (United States)

Piazza, Michele; Squizzato, Francesco; Chincarini, Chiara; Fedrigo, Marny; Castellani, Chiara; Angelini, Annalisa; Grego, Franco; Antonello, Michele

2018-03-01

The objective of this study was to perform a quantitative analysis and to identify predictors of embolic filter debris (EFD) load during carotid artery stenting (CAS) in asymptomatic patients. All patients with asymptomatic carotid stenosis >70% undergoing CAS between 2008 and 2016 were included in a prospective database. A distal filter protection device was used in all patients. At the end of the procedure, the filter was fixed in formalin and then analyzed with a stereomicroscope. Morphometric analysis was performed with Image-Pro Plus software (Media Cybernetics, Rockville, Md). The total area of the filter membrane and the area covered by particulate material were quantified. The quantity of membrane occupied by debris was expressed as percentage of covered surface area. Anatomic and clinical variables were evaluated for their association with EFD load using multiple logistic regression. Among the 278 patients undergoing CAS, an open-cell stent was implanted in 211 patients (76%); 67 patients (24%) received a closed-cell stent. Overall technical success and clinical success were both 99%; no perioperative death was reported. Stroke rate was 1.8% (major, n = 1 [0.4%]; minor, n = 4 [1.4%]); transient ischemic attacks occurred in 5% of cases (n = 14). The quantitative analysis of the filter revealed that EFD was present in 74% of cases (n = 207). The mean EFD load was 10% of the filter surface (median, 1; range, 0-80); it was 31% in 22 (8%). Patients with any type of ischemic neurologic event after CAS (stroke and transient ischemic attack) had a significantly higher mean EFD load compared with uneventful cases (26.7% ± 19.0% vs 8.5% ± 13.5%; P 12.5% EFD load as the optimal cutoff for the association with clinically relevant perioperative ischemic events (sensitivity, 78%; specificity, 77%; area under the curve, 0.81). The multivariate analysis demonstrated that age >75 years (odds ratio [OR], 2.56; P = .003), pre-existing ipsilateral ischemic

Hemodynamic significance of internal carotid artery disease

DEFF Research Database (Denmark)

Schroeder, T

1988-01-01

Neurologic symptoms in the region of an internal carotid artery stenosis are considered to be embolic in most instances. Only in a subgroup has carotid occlusive disease with impairment of the collateral supply, caused a state of hemodynamic failure with marked reduction of perfusion pressure...... stenosis. This is considered a result of chronic low perfusion pressure with subsequent loss of autoregulation, and autoregulatory control is first regained after some days.(ABSTRACT TRUNCATED AT 400 WORDS)...

Recommendations for Management of Patients with Carotid Stenosis

Directory of Open Access Journals (Sweden)

Arijana Lovrencic-Huzjan

2012-01-01

Full Text Available Stroke is a one of the leading causes of morbidity and mortality in the world. Carotid atherosclerosis is recognized as an important factor in stroke pathophysiology and represents a key target in stroke prevention; multiple treatment modalities have been developed to battle this disease. Multiple randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting, a newer treatment option, presents a less invasive alternative to the surgical intervention on carotid arteries. Advances in medical therapy have also enabled further risk reduction in the overall incidence of stroke. Despite numerous trials and decades of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. We will attempt to highlight some of the pivotal trials already completed, discuss the current controversies and complexities in the treatment decision-making, and postulate on what likely lies ahead. This paper will highlight the complexities of decision-making optimal treatment recommendations for patients with symptomatic and asymptomatic carotid stenosis.

Normalized wall index specific and MRI-based stress analysis of atherosclerotic carotid plaques. A study comparing acutely symptomatic and asymptomatic patients

International Nuclear Information System (INIS)

Zhu, C.; Teng, Z.; Sadat, U.; Young, V.E.; Graves, M.J.; Gillard, J.H.; Li Zhiyong

2010-01-01

Biomechanical stresses play an important role in determining plaque stability. Quantification of these simulated stresses can be potentially used to assess plaque vulnerability and differentiate different patient groups. 54 asymptomatic and 45 acutely symptomatic patients underwent in vivo multicontrast magnetic resonance imaging (MRI) of the carotid arteries. Plaque geometry used for finite element analysis was derived from in vivo MRI at the sites of maximum and minimum plaque burden. In total, 198 slices were used for the computational simulations. A pre-shrink technique was used to refine the simulation. Maximum principle stress at the vulnerable plaque sites (id est (ie), critical stress) was extracted for the selected slices and a comparison was performed between the 2 groups. Critical stress in the slice with maximum plaque burden is significantly higher in acutely symptomatic patients as compared to asymptomatic patients (median, inter quartile range: 198.0 kPa (119.8-359.0 kPa) vs 138.4 kPa (83.8-242.6 kPa), P=0.04). No significant difference was found in the slice with minimum plaque burden between the 2 groups (196.7 kPa (133.3-282.7 kPa) vs 182.4 kPa (117.2-310.6 kPa), P=0.82). Acutely symptomatic carotid plaques have significantly high biomechanical stresses than asymptomatic plaques. This might be potentially useful for establishing a biomechanical risk stratification criteria based on plaque burden in future studies. (author)

Treatment of a symptomatic intrathoracic internal carotid artery

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Christopher R. Brown

2017-09-01

Full Text Available Intrathoracic common carotid artery bifurcations are an anatomic anomaly with such rarity that only six cases have been reported to date. The true incidence of and preferred treatment options for a diseased intrathoracic common carotid artery bifurcation or internal carotid artery (ICA have not been clearly described. This case report describes a 72-year-old man who experienced a postoperative right hemispheric stoke after an aortic valve replacement, radiofrequency maze procedure, and left atrial appendage clip. Postoperative cerebrovascular evaluation revealed a severely diseased intrathoracic ICA that was treated by ligation of the diseased proximal ICA and transposition of the distal ICA to the disease-free external carotid artery. The patient provided written consent to present the history, data, and images in this manuscript.

Cerebellar arteries originating from the internal carotid artery: angiographic evaluation and embryologic explanations

International Nuclear Information System (INIS)

Lee, Jae Young; Han, Moon Hee; Yu, In Gyu; Chang, Ki Hyun; Kim, Eui Jong; Kim, Dae Ho

1997-01-01

To find and describe the cerebellar arteries arising from the internal carotid artery, explain them embryologically, and evaluate their clinical implication. To determine the point in the internal carotid artery from which the cereballar artery arose anomalously, consecutive angiographic studies performed in the last three years were reviewed. The distribution of such anomalous cerebellar arteries, the point in the internal carotid artery from which the anomalous vessels originated, and associated findings were analyzed. Five anomalous origins of cerebellar arteries arising arising directly from the internal carotid artery were found in five patients. Three anterior inferior cerebellar arteries (AICA) and one common trunk of an AICA and a posterior inferior cerebellar artery (PICA) were found to originate from the internal carotid artery at a point close to the origin of the primitive trigeminal artery. A PICA arose from an artery presenting a course similar to the proatlantal intersegmental artery. Intracranial aneurysms in two patients, Moyamoya disease in one, and facial arteriovenous malformation in one. In our series, AICAs supplied from the arteries considered to be persistent trigeminal artery variants were the most common type. A correlation between type of anomalous cerebellar artery and type of carotid-vertebrobasilar anastomosis may exist. Cerebellar arteries originating anomalously from the internal carotid artery seem to occur as a result of the persistence of carotid-vertebrobasilar anastomoses associated with incomplete fusion of the longitudinal neural arteries. An understanding of these anomalous cerebellar arteries may help prevent accidents during therapeutic embolization and surgical treatment, as well as misinterpretation

Predictors of antegrade flow at internal carotid artery during carotid artery stenting with proximal protection.

Science.gov (United States)

Harada, Kei; Kakumoto, Kosuke; Oshikata, Shogo; Fukuyama, Kozo

2018-06-01

Carotid artery stenting (CAS) with proximal occlusion effectively prevent distal cerebral embolism by flow arrest at internal carotid artery (ICA); however, the method can expose antegrade flow at ICA due to incomplete flow arrest. The aim of this study was to identify predictors of antegrade flow during CAS with proximal protection. We retrospectively analyzed clinical and angiographic data among 143 lesions treated with CAS with proximal protection by occluding the common carotid artery (CCA) and external carotid artery (ECA). Flow arrest or antegrade flow at ICA was confirmed by contrast injection during proximal protection. Antegrade flow at ICA was observed in 12 lesions (8.4%). Compared with lesions in which flow arrest of ICA was achieved, the diameter of the superior thyroid artery (STA) was significantly larger (2.4 ± 0.34 vs. 1.4 ± 0.68 mm, p protection should be combined with proximal protection for the lesions with antegrade flow to prevent distal migration of the carotid debris.

Extracranial Carotid Artery Stenting in Surgically High-Risk Patients Using the Carotid Wallstent Endoprosthesis:Midterm Clinical and Ultrasound Follow-Up Results

International Nuclear Information System (INIS)

Maleux, Geert; Bernaerts, Pauwel; Thijs, Vincent; Daenens, Kim; Vaninbroukx, Johan; Fourneau, Inge; Nevelsteen, Andre

2003-01-01

The purpose of this study was to evaluate the feasibility, safety and midterm outcome of elective implantation of the Carotid Wallstent (registered) in patients considered to be at high surgical risk. In a prospective study, 54 carotid artery stenoses in 51 patients were stented over a 24-month period. Three patients underwent bilateral carotid artery stenting. Institutional inclusion criteria for invasive treatment of carotid occlusive disease (carotid endarterectomy or carotid artery stenting) are patients presenting with a 70% or more symptomatic stenosis and those with an 80% or more asymptomatic stenosis having a life-expectancy of more than 1 year. All patients treated by carotid artery stenting were considered at high risk for carotid endarterectomy because of a hostile neck (17 patients-31.5%) or because of severe comorbidities (37 patients-68.5%). No cerebral protection device was used. Of the 54 lesions, 33 (61.1%) were symptomatic and 21 (38.8%) were asymptomatic. Follow-up was performed by physical examination and by duplex ultrasonography at 1 month, 6 months, 1 year and 2 years after the procedure. All 54 lesions could be stented successfully without periprocedural stroke. Advert events during follow-up (mean 13.9 ± 5.7 months) were non-stroke-related death in 6 patients (11.1%), minor stroke in 4 stented hemispheres(7.4%), transient ipsilateral facial pain in 1 patient (1.8%),infection of the stented surgical patch in 1 patient (1.8%) and asymptomatic in stent restenosis in 4 patients (7.4%). The percutaneous implantation of the Carotid Wallstent (registered) , even without cerebral protection device, appears to be a safe procedure with acceptable clinical and ultrasonographic follow-up results in patients at high surgical risk. But some late adverse events such as ipsilateral recurrence of non-disabling (minor) stroke or in stent restenosis still remain real challenging problems

Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial

NARCIS (Netherlands)

Bonati, Leo H.; Dobson, Joanna; Featherstone, Roland L.; Ederle, Jörg; van der Worp, H. Bart; de Borst, Gert J.; Mali, Willem P. Th M.; Beard, Jonathan D.; Cleveland, Trevor; Engelter, Stefan T.; Lyrer, Philippe A.; Ford, Gary A.; Dorman, Paul J.; Brown, Martin M.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Clifton, A.; Gaines, P.; Collins, R.; Molyneux, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Coward, L.; Dobson, J.; Doig, D.; Ederle, J.; Featherstone, R. F.; Kennedy, F.; Tindall, H.; Turner, E.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Koelemay, M. J. W.; Nederkoorn, P. J.; Reekers, J. A. A.; Roos, Y. B. W. E. M.

2015-01-01

Background Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. Methods Patients with symptomatic carotid stenosis

Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial

NARCIS (Netherlands)

Bonati, L.H.; Dobson, J.; Featherstone, R.L.; Ederle, J.; Worp, H.B. van der; Borst, G.J. de; Mali, W.P.; Beard, J.D.; Cleveland, T.; Engelter, S.T.; Lyrer, P.A.; Ford, G.A.; Dorman, P.J.; Brown, M.M.; Leeuw, F.E. de; et al.,

2015-01-01

BACKGROUND: Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. METHODS: Patients with symptomatic carotid

Intraoperative Hypoglossal Nerve Mapping During Carotid Endarterectomy: Technical Note.

Science.gov (United States)

Kojima, Atsuhiro; Saga, Isako; Ishikawa, Mami

2018-05-01

Hypoglossal nerve deficit is a possible complication caused by carotid endarterectomy (CEA). The accidental injury of the hypoglossal nerve during surgery is one of the major reasons for permanent hypoglossal nerve palsy. In this study, we investigated the usefulness of intraoperative mapping of the hypoglossal nerve to identify this nerve during CEA. Five consecutive patients who underwent CEA for the treatment of symptomatic or asymptomatic carotid artery stenosis were studied. A hand-held probe was used to detect the hypoglossal nerve in the operative field, and the tongue motor evoked potentials (MEPs) were recorded. The tongue MEPs were obtained in all the patients. The invisible hypoglossal nerve was successfully identified without any difficulty when the internal carotid artery was exposed. Intraoperative mapping was particularly useful for identifying the hypoglossal nerve when the hypoglossal nerve passed beneath the posterior belly of the digastric muscle. In 1 of 2 cases, MEP was also elicited when the ansa cervicalis was stimulated, although the resulting amplitude was much smaller than that obtained by direct stimulation of the hypoglossal nerve. Postoperatively, none of the patients presented with hypoglossal nerve palsy. Intraoperative hypoglossal nerve mapping enabled us to locate the invisible hypoglossal nerve during the exposure of the internal carotid artery accurately without retracting the posterior belly of the digastric muscle and other tissues in the vicinity of the internal carotid artery. Copyright © 2018 Elsevier Inc. All rights reserved.

Circulating MicroRNAs as Novel Biomarkers of Stenosis Progression in Asymptomatic Carotid Stenosis.

Science.gov (United States)

Dolz, Sandra; Górriz, David; Tembl, José Ignacio; Sánchez, Dolors; Fortea, Gerardo; Parkhutik, Vera; Lago, Aida

2017-01-01

Progression of asymptomatic carotid artery stenosis (ACAS) in patients with >50% luminal narrowing is considered a potential risk factor for ischemic stroke; however, subclinical molecular biomarkers of ACAS progression are lacking. Recent studies suggest a regulatory function for several microRNAs (miRNAs) on the evolution of carotid plaque, but its role in ACAS progression is mostly unknown. The aim of our study was to investigate a wide miRNA panel in peripheral blood exosomes from patients with ACAS to associate circulating miRNA expression profiles with stenosis progression. The study included 60 patients with ACAS carrying >50% luminal narrowing. First, miRNA expression profiles of circulating exosomes were determined by Affymetrix microarrays from plasma samples of 16 patients from the cohort. Second, those miRNAs among the most differentially expressed in patients with ACAS progression were quantified by real-time polymerase chain reaction in a separate replication cohort of 39 subjects within the patient sample. Our results showed that ACAS progression was associated with development of stroke. MiR-199b-3p, miR-27b-3p, miR-130a-3p, miR-221-3p, and miR-24-3p presented significant higher expression in those patients with ACAS progression. In conclusion, our study supports that specific circulating miRNA expression profiles could provide a new tool that complements the monitoring of ACAS progression, improving therapeutic approaches to prevent ischemic stroke. © 2016 American Heart Association, Inc.

Severe carotid stenosis and impaired cerebral hemodynamics can influence cognitive deterioration.

Science.gov (United States)

Balestrini, Simona; Perozzi, Cecilia; Altamura, Claudia; Vernieri, Fabrizio; Luzzi, Simona; Bartolini, Marco; Provinciali, Leandro; Silvestrini, Mauro

2013-06-04

To evaluate whether severe carotid stenosis and related hemodynamics impairment may increase the risk of cognitive deterioration in asymptomatic subjects. A total of 210 subjects with unilateral asymptomatic severe carotid stenosis and 109 healthy controls were included and prospectively evaluated for a 36-month period. At entry, demographics, vascular risk profile, and pharmacologic treatments were defined. Cerebral hemodynamics was assessed by transcranial Doppler-based breath-holding index (BHI) test. Cognitive status was evaluated with the Mini-Mental State Examination (MMSE) at entry and at the end of the follow-up period. Cognitive deterioration was defined as a decrease in the MMSE score of 3 points or more during the overall follow-up period. Subjects with carotid stenosis showed an increased probability of developing cognitive deterioration compared with the group without stenosis (odds ratio [OR] 4.16 [95% confidence interval (CI) 1.89-9.11]; p < 0.001). The presence of an impaired BHI ipsilateral to the stenosis was associated with an increased incidence of reduction in cognitive performance (OR 14.66 [95% CI 7.51-28.59]; p < 0.001). Our findings show that the presence of a severe carotid stenosis influences cognitive deterioration over a 36-month period in asymptomatic subjects. An associated hemodynamic impairment significantly increases the risk. Evaluation of functional consequences of carotid stenosis may offer the opportunity to select a group with an increased risk of developing cognitive impairment from subjects with asymptomatic severe carotid stenosis.

Clinical features of 10 patients with spontaneous cervical internal carotid artery dissection

International Nuclear Information System (INIS)

Nagoya, Harumitsu; Takeda, Hidetaka; Dembo, Tomohisa; Kato, Yuzi; Deguchi, Ichiro; Fukuoka, Takuya; Maruyama, Hazime; Horiuchi, Yohsuke; Tanahashi, Norio

2011-01-01

We clinically investigated 10 patients with spontaneous cervical internal carotid artery dissections (age range 36-70, mean 52±12 years; 8 male and 2 female) who were admitted to our university hospital between August 2002 and 2009. Cervical internal carotid artery dissection was diagnosed using findings from MRI, MR angiography (MRA), 3D-CTA, cerebral angiography, and carotid artery ultrasonography according to the diagnostic criteria of brain artery dissociation defined by the brain artery dissociation working group of the Strategies Against Stroke Study for Young Adults in Japan. The initial symptoms were stroke in eight patients, only neck pain in another, and no symptoms in the last. Four patients (40%) had neck pain or headache at onset. Five of the 10 patients had radiological improvements within three months after onset. The outcomes at three months were relatively good, with seven and three patients scoring 1 and 2, respectively, on the modified Rankin Scale. Disease did not recur in any patients during an average of 17.2 months of follow up. Spontaneous cervical internal carotid artery dissection is not rare in Japan. This condition should be considered when patients present with internal carotid artery occlusion or stenosis. (author)

Dissecting aneurysm of the cervical internal carotid artery

International Nuclear Information System (INIS)

Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi.

1987-01-01

On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm. (author)

Usefulness of CT angiography after metallic stent implantation of the internal carotid artery

International Nuclear Information System (INIS)

Yoon, Man Won; Kim, Hyeon Chul; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun

1999-01-01

To evaluate the usefulness of CT angiography in patients with implantation of metallic stent for stenosed internal carotid artery. Seven patients with atherosclerotic stenosis of the internal carotid artery underwent metallic stent implantation. All were male and their ages ranged from 36 to 69 years. A total of seven stents were placed in the internal carotid artery in five patients and in the carotid bifurcation in two. Spiral CT scans were obtained and CT angiographic images were reconstructed using MPR or curved MPR techniques at a workstation. The interval between CT and conventional angiography did not exceed six days except in one patient, in whom it was 61days. CT and conventional angiography were compared for stent position with respect to the carotid bifurcation, stent deformation, intraluminal filling defect, and luminal caliber and outflow. Luminal patency of the implanted stent was measured according to NASCET(North American Symptomatic Carotid Endarterectomy Trial) criteria, and statistically processed (p>.05). The presence or absence of intrastent thrombus and vascular wall calcification was determined using axial source images. In all patients, CT angiographic findings matched those obtained by conventional angiography. Complications such as migration or deformation of an implanted stent, intraluminal filling defect, change of luminal caliber or outflow of implanted stent were not observed in any patient. In two studies in which Wilcoxon signed rank test was used, degree of stent expansion correlated closely(p=0.237). Axial source images showed that in no patient was an intrastent thrombus present, though in five, vascular wall calcification of internal carotid arteries outside the stent was noted. CT angiography is useful for the assessment of positional change, occlusion, and luminal patency of a stent-implanted internal carotid artery

Classical surgical approach and treatment with clips of extracranial internal carotid artery berry aneurysm

Directory of Open Access Journals (Sweden)

Haris Vukas

2016-06-01

Full Text Available Introduction: We can define extracranial carotid artery aneurysm (ECAA as bulb dilatation greater than 200% of the diameter of the internal carotid artery (ICA or in a case of common carotid artery (CCA greater than 150% of the diameter. Surgical intervention is required for the treatment of this disease.Case report: This study presents an open vascular surgical procedure to resolve ECAA. We report a case of 61 years old woman with an extracranial internal carotid artery berry aneurysm, presented with a headache and dizziness when turning the head aside. Classic open surgery was performed and the lumen of berry aneurysm was separated with three clips from the lumen of ICA.Conclusions: The open surgical approach is the method of choice for the treatment of extracranial internal carotid artery pathological conditions.

Carotid Artery Stenting in a Patient with Spontaneous Recanalization of a Proximal Internal Carotid Artery Occlusion: a Case Report

International Nuclear Information System (INIS)

Kim, Eui Jong; Koh, Jun Seok; Choi, Woo Suk

2006-01-01

We report here on a rare case of carotid artery angioplasty and stenting in a patient with spontaneous recanalization after complete occlusion of the proximal internal carotid artery (ICA). The patient initially showed severe stenosis at the left proximal ICA on MR angiography (MRA). Digital subtraction angiography (DSA) performed three days after MRA showed complete occlusion of the proximal ICA. The follow-up DSA after four weeks showed recanalization of the ICA, and then carotid artery stenting was successfully performed. There has been no neurologic complication during more than one year follow-up. cute internal carotid artery (ICA) occlusions may result in profound disability and death (1). An occluded ICA can spontaneously recanalize, but this doesn't happen frequently, and the natural course of a proximal ICA occlusion and its possibility of recanalization, including the exact time of recanalization after occlusion, are not well known (2, 3). A few studies have reported the incidence of spontaneous recanalization of the proximal internal carotid artery, which has mostly occurred in patients with ICA dissections (4 6). A few limited studies have reported a considerable incidence of spontaneous recanalization in patients with underlying atherosclerotic lesion or atherothombotic diseases (2). The possibility of repeated occlusion and repeated cerebral ischemic infarction may exist for the patients exhibiting spontaneous recanalization of the ICA and underlying atherosclerosis. We report here on a case of carotid artery stenting (CAS) in a patient who exhibited underlying atherosclerosis with spontaneous recanalization after complete occlusion of the proximal ICA

Stent impact on the geometry of the carotid bifurcation and the course of the internal carotid artery

International Nuclear Information System (INIS)

Berkefeld, J.; Zanella, F.E.; Rosendahl, H.; Theron, J.G.; Guimaraens, L.; Treggiari-Venzi, M.M.

2002-01-01

A measurement system is proposed to evaluate reconstructive effects of carotid stents on the geometry of the carotid bifurcation and the course of the internal carotid artery. To describe deviations of the stenotic internal carotid artery (ICA) from the extended axis of the common carotid artery (CCA) the CCA-ICA angle is measured between the CCA midaxis and the midaxis of the stenotic ICA segment. Maximal extensions of ICA tortuosities perpendicular to the course of the CCA axis are defined as ICA offset. The measurements were applied to DSA images of 224 carotid stenoses to evaluate variation and correlation between the two parameters. Comparative pre- and post-stent evaluation was performed in two series of 55 and 31 carotid stenoses treated with Wallstents and in a historic control group of 35 stenoses treated with Strecker stents. Straight course of the ICA was associated with low angle and low offset values, whereas tortuous course of the ICA showed larger angle and offset. A moderate linear correlation between the two parameters was found. Corresponding to a straightening of the stented segment, Wallstents reduced mean angle and offset values significantly. In five cases of the second series of Wallstents, transferrals of curves above the distal stent end associated with kinks were observed, and offset remained constant or increased. Strecker stent implantation caused no significant changes of bifurcational geometry. The proposed parameters corresponded to visual aspects of ICA tortuosity and detected reconstructive effects of self-expanding Wallstents on the ICA course. The measurement system may provide a basis for geometric evaluation of different stent types or implantation concepts with the aim: to optimize anatomic recanalization results in tortuous high angle-high offset bifurcations. (orig.)

Contemporary Management of Patients with Concomitant Coronary and Carotid Artery Disease.

Science.gov (United States)

Poi, Mun J; Echeverria, Angela; Lin, Peter H

2018-01-01

The ideal management of concomitant carotid and coronary artery occlusive disease remains elusive. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines among national or international clinical societies. Clinical studies show that coronary artery bypass grafting (CABG) with either staged or synchronous carotid endarterectomy (CEA) is associated with a high procedural stroke or death rate. Recent clinical studies have found carotid artery stenting (CAS) prior to CABG can lead to superior treatment outcomes in asymptomatic patients who are deemed high risk of CEA. With emerging data suggesting favorable outcome of CAS compared to CEA in patients with critical coronary artery disease, physicians must consider these diverging therapeutic options when treating patients with concurrent carotid and coronary disease. This review examines the available clinical data on therapeutic strategies in patients with concomitant carotid and coronary artery disease. A treatment paradigm for considering CAS or CEA as well as CABG and percutaneous coronary intervention is discussed.

A case of unusual collateral circulation from internal carotid occlusion

International Nuclear Information System (INIS)

Jang, Il Jung; Choi, Byung So

1972-01-01

A 23 year old Korean boy was admitted to Dept. of Neurosurgery. Capital Army Hospital on Feb. 2, 1971 because of recurrent transient focal seizure and more weakness in the left extremities. During hospitalization, he recovered from focal seizure and motor weakness in the left extremities without specific therapy. Right carotid angiograms were performed. Right carotid angiograms show right internal carotic occlusion at the level of distal siphon of extradural level with good filling of ophthalmic artery of right. Extensive small vascular network developed intracranial region of right hemisphere. There are appearance to be two major anastomotic communication. 1. Via at the base of the brain. 2. Via the rete mirabile with external carotid artery. These angiographic finding were similar to that of the so-called 'cerebral rete mirabile' which was described in many literature. Etiology of cerebral rete mirabile is divided as to whether these represent true congenital vascular malformations or whether the 'rete mirabile' develops as a collateral because of a primary stenosis in the internal carotid arteries. Evidence for either theory is still inconclusive

Optimal Treatment of the ‘High-Risk’ Patient with Carotid Artery Stenosis

NARCIS (Netherlands)

Fokkema, T.M.

2013-01-01

Four landmark randomized trials have clearly validated the use of carotid endarterectomy (CEA) for the management of asymptomatic and symptomatic significant carotid artery stenosis. However, its risk-to-benefit ratio is variable for different patients. With the advent of carotid artery stenting

Common carotid artery thrombosis; Clinical and radiological evaluation

Energy Technology Data Exchange (ETDEWEB)

Ito, Yasuhiro; Yasuda, Takeshi; Hakusui, Shigetaka; Yanagi, Tsutomu (Nagoya Daini Red Cross Hospital (Japan)); Ito, Eiichi

1994-02-01

Common carotid artery thrombosis (CCAT) is not common. We studied 4 patients with CCAT to clarify the clinical and radiological features of this disorder. Case 1 had only episodes of TIA. Case 2 was diagnosed by chance as having CCAT at the time of admission due to cerebellar infarction. On the contrary, Cases 3 and 4 were admitted because of disturbance of consciousness and hemiparesis. Case 4 died soon after his stroke because of complications. We evaluated cases 1, 2 and 3 using head CT, head MRI, neck MRI, MR angiography, SPECT and cerebral angiography. Case 4, who was evaluated with head CT and cerebral angiography, was autopsied to confirm the occlusion of the common carotid artery. The clinical severity of CCAT varies from asymptomatic to severe, because each case differs in the time taken for complete occlusion of the common carotid artery; the development of collateral circulation; and hemodynamics of the brain. As for the collaterals their contribution is variable; for example, the thyrocervical and other arteries function as the bypass. We can diagnose CCAT easily and noninvasively using MR angiography and neck MRI based on disappearance of the flow void in the common carotid artery or internal carotid artery. On physical examination, it is important to detect faded pulsation of the superficial temporal artery that is ipsilateral to the occluded common carotid artery. (author).

Asymptomatic Extracranial Artery Stenosis and the Risk of Cardiovascular and Cerebrovascular Diseases

OpenAIRE

Wang, Dandan; Wang, Jing; Jin, Cheng; Ji, Ruijun; Wang, Anxin; Li, Xin; Gao, Xiang; Wu, Shouling; Zhou, Yong; Zhao, Xingquan

2016-01-01

Asymptomatic extracranial artery stenosis (ECAS) is a well-known risk factor for stroke events, but it remains unclear whether it has the same role in predicting cardiovascular and cerebrovascular diseases, especially in China. We investigated the potential associations between ECAS, carotid plaque and carotid intima-media thickness and the new occurrence of cardiovascular and cerebrovascular diseases in the study. Out of 5440 study participants, 364 showed an asymptomatic ECAS at baseline, a...

Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

OpenAIRE

Michael Kelly; Marcus Bradley; Ankur Srivastava

2008-01-01

A 58 year old man was involved in a high impact road traffic incident and was admitted for observation. Asymptomatic for the first 24 hours, he collapsed with symptoms and signs consistent with a cerebrovascular accident. Computed tomography angiogram (CTA) and Magnetic resonance angiogram (MRA) demonstrated bilateral internal carotid artery dissections and a left middle cerebral artery infarct. It was not considered appropriate to attempt stenting or other revascularistation. The patient was...

Pain as the only manifestation of internal carotid artery dissection.

Science.gov (United States)

Biousse, V; Woimant, F; Amarenco, P; Touboul, P J; Bousser, M G

1992-10-01

Internal carotid artery dissection is a major cause of ischemic stroke in the young. Pain is the leading symptom and is associated with other focal signs such as Horner's syndrome and painful tinnitus or with signs of cerebral or retinal ischemia. We report two patients with angiographically confirmed extracranial internal carotid artery dissection presenting with cephalic pain as the only manifestation. The first patient had a diffuse headache and a latero-cervical pain lasting for 12 days, reminiscent of carotidynia. The second patient experienced an exploding headache suggestive of subarachnoid hemorrhage, which was ruled out by computed tomography of the head and cerebrospinal fluid study. These patients demonstrate that recognition of carotid artery dissection as a cause of carotidynia and headache suggestive of subarachnoid hemorrhage may permit an earlier diagnosis and possibly the prevention of a stroke through the use of anticoagulation.

Interventional therapy of traumatic pseudoaneurysms in internal carotid artery siphon

International Nuclear Information System (INIS)

Tang Jun; Shang Jianqiang; Chen Jie; Li Fengxin; Liu Yanjun

2007-01-01

Objective: To determine the methods and results of treating traumatic pseudoaneurysms in siphon segment of internal carotid artery (ICA)by interventional therapy. Methods: Twelve cases of traumatic pseudoaneurysms in siphon segment of internal carotid artery were treated. The collateral circulation of Willis circle was observed after DSA. Different methods of treatment were applied according to the collateral circulation of Willis circle. Ten cases were treated by occlusion of ICA completely, 1 case was embolized by guglielmi detachable coil (GDC) only. Results: Nine of 12 treated by occlusion of ICA were cured. In the 3 cases who had poor collateral of Willis circle, one was cured by GDC embolization alone; one died 48 hours later after ICA occlusion though his consciousness and the activity of extremities were normal during the temporary balloon test occlusion (BTO) of ICA. One died during the training to improve the collateral of the Willis circle. Conclusion: ICA embolization is feasible for treatment of traumatic pseudoaneurysms in siphon segment of internal carotid artery after evaluating the collateral circulation of Willis circle. (authors)

The relationship between oxidized lipoprotein(a and carotid atherosclerosis in asymptomatic subjects: A comparison with native lipoprotein(a

Directory of Open Access Journals (Sweden)

Taniguchi Nobuyuki

2011-10-01

Full Text Available Abstract Background Oxidized lipoprotein(a (oxLp(a can be a more potent marker of atherogenesis than native Lp(a, although Lp(a is considered to be a risk factor for atherosclerotic diseases. Limited clinical data are available regarding the significance of oxLp(a in atherosclerotic manifestations. This study aimed to investigate the association between the serum oxLp(a and carotid artery intima-media thickness (CIMT, in comparison to the serum Lp(a levels, among asymptomatic subjects. Methods The atheroscrerosis-related variables including Lp(a and oxLp(a were measured in 136 cardiovascular disease-free subjects (61 males and 75 females, mean age of 64 years. The serum oxLp(a level was quantified using a sandwich ELISA system. The CIMT level was ultrasonographically measured on bilateral carotid arteries. Results The median level of Lp(a was 120 μmol/L, oxLp(a was 0.06 nmol/L, and CIMT was 0.7 mm, respectively. A simple correlation test showed that the CIMT was significantly and positively correlated with age, systolic blood pressure and oxLp(a (r = 0.208, P Conclusions These results suggest that oxLp(a may be more closely associated with accelerated carotid atherosclerosis, in comparison to Lp(a, in this population. This finding can be important for obtaining a better understanding of the different atherogenic roles played by oxLp(a in comparison to Lp(a.

Revascularization of the internal carotid artery for isolated, stenotic, and symptomatic kinking.

Science.gov (United States)

Illuminati, Giulio; Calió, Francesco G; Papaspyropoulos, Vassilios; Montesano, Giuseppe; D'Urso, Antonio

2003-02-01

The operation for isolated, stenotic, and symptomatic kinking of the internal carotid artery is safe and effective in preventing stroke and relieving the symptoms of cerebral ischemia. A consecutive sample clinical study with a mean follow-up of 44 months. The surgical department of an academic tertiary care center and an affiliated secondary care center. Fifty-four patients with a mean age of 67 years underwent 55 revascularizations of the internal carotid artery. The surgical procedures consisted of the following: shortening and reimplantation in the common carotid artery in 36 cases, bypass grafting in 15 cases, and transposition into the external carotid artery in 4 cases. Cumulative survival, primary patency, and stroke-free and neurologic symptom-free rates expressed by standard life-table analysis. No patients died in the postoperative period. The postoperative stroke rate was 1.8%. The cumulative rates (SEs) at 5 years were as follows: survival, 70% (10.2%); primary patency, 89% (7.8%); overall stroke free, 92% (6.8%); ipsilateral stroke free, 96% (5.3%); neurologic symptom free, 90% (7.5%); and ipsilateral symptom free, 93% (6.5%). Revascularization of the internal carotid artery for the treatment of isolated, stenotic, and symptomatic kinking is safe and effective in preventing stroke and relieving symptoms of cerebrovascular insufficiency.

Blood flows in the maxillocarotid anastomoses and internal carotid artery of conscious dogs.

Science.gov (United States)

Lee, M C; Reid, I A; Ramsay, D J

1986-06-01

Although the external carotid artery is known to contribute to the cerebral blood flow in anesthetized dogs, quantitative information on the anastomoses and their role in conscious dogs is lacking. This study was carried out to determine blood flows in these anastomoses and the internal carotid artery, and also to examine the functional significance of the anastomoses in conscious dogs. Fifteen-micron radioactive microspheres were injected into common and external carotid arteries of four conscious dogs through chronically implanted catheters. Blood flows were determined by the reference sample method and by comparing microsphere distributions in the brain and the masseter muscle. Blood flows were estimated to be 140 +/- 32, 7.7 +/- 1.4, and 3.3 +/- 1.1 ml/minute (mean +/- SD) in the common carotid artery, internal carotid artery, and anastomoses on each side, respectively. Additional evidence indicated that the anastomotic flow so determined was primarily the flow in the anastomotic artery. Humoral responses to angiotensin II infusions were also studied in conscious dogs. External carotid angiotensin increased plasma 11-hydroxycorticosteroid concentration (used as an index of ACTH secretion) but did not increase plasma vasopressin concentration to the same extent as common carotid infusion. Therefore, the external carotid artery is functionally important in perfusing the brain in conscious dogs.

Endovascular Treatment for Fusiform Dilation of Internal Carotid Artery Following Craniopharyngioma Resection: A Case Illustration.

Science.gov (United States)

Li, Qiang; Wang, Chaohua; Xu, Jianguo; You, Chao

2015-09-01

Fusiform dilation of the internal carotid artery complicates aggressive craniopharyngioma resection and occurs mainly in children. We report a case to describe the availability of endovascular treatment for this rare entity. A 13-year-old boy presented with headache for 2 years after resection of craniopharyngioma. A fusiform dilation of the right carotid artery was found and was coiled using stent-assisted technique. Follow-up showed satisfactory outcome and disappearance of headache. To our knowledge, this is the first report regarding endovascular treatment for fusiform dilation of the internal carotid artery after craniopharyngioma resection. Stent-assisted coiling is a useful approach for fusiform dilation of the internal carotid artery following craniopharyngioma surgery. © The Author(s) 2014.

Pseudoaneurysm of the Internal Carotid Artery: Treatment with a Covered Stent

International Nuclear Information System (INIS)

Scavee, Vincent; Wispelaere, Jean-Francois de; Mormont, Eric; Coulier, Bruno; Trigaux, Jean-Paul; Schoevaerdts, Jean-Claude

2001-01-01

Dissection of the cervical segment of the internal carotid artery may occur spontaneously or after trauma. We report the management of a 53-year-old right-handed man with progressive dizziness and neck pain 6 weeks after a motor vehicle collision. The clinical and neurologic examinations were normal. The CT scan led to the diagnosis of a pseudoaneurysm of the right internal carotid artery near the skull base. We successfully treated this post-traumatic lesion with a covered stent. The patient underwent the endovascular procedure under general anesthesia and transcranial Doppler monitoring. No neurologic event was observed. Obliteration of the pseudoaneurysm with preservation of the carotid artery was achieved. The patient was discharged from the hospital 72 hr later with no complications. Clinical and imaging follow-up at 6 months was unremarkable

Carotid artery stenting: Rationale, technique, and current concepts

International Nuclear Information System (INIS)

Yilmaz, Hasan; Pereira, Vitor Mendes; Narata, Ana-Paula; Sztajzel, Roman; Lovblad, Karl-Olof

2010-01-01

Carotid stenosis is a major risk factor for stroke. With the aging of the general population and the availability of non-invasive vascular imaging studies, the diagnosis of a carotid plaque is commonly made in medical practice. Asymptomatic and symptomatic carotid stenoses need to be considered separately because their natural history is different. Two large randomized controlled trials (RCTs) showed the effectiveness of carotid endarterectomy (CEA) in preventing ipsilateral ischemic events in patients with symptomatic severe stenosis. The benefit of surgery is much less for moderate stenosis and harmful in patients with stenosis less than 50%. Surgery has a marginal benefit in patients with asymptomatic stenosis. Improvements in medical treatment must be taken into consideration when interpreting the results of these previous trials which compared surgery against medical treatment available at the time the trials were conducted. Carotid artery stenting (CAS) might avoid the risks associated with surgery, including cranial nerve palsy, myocardial infarction, or pulmonary embolism. Therefore and additionally to well-established indications of CAS, this endovascular approach might be a valid alternative particularly in patients at high surgical risk. However, trials of endovascular treatment of carotid stenosis have failed to provide enough evidence to justify routine CAS as an alternative to CEA in patients suitable for surgery. More data from ongoing randomized trials of CEA versus CAS will be soon available. These results will help determining the role of CAS in the management of patients with carotid artery stenosis.

Dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection.

Science.gov (United States)

Heldner, Mirjam R; Nedelcheva, Mila; Yan, Xin; Slotboom, Johannes; Mathier, Etienne; Hulliger, Justine; Verma, Rajeev K; Sturzenegger, Matthias; Jung, Simon; Bernasconi, Corrado; Arnold, Marcel; Wiest, Roland; Fischer, Urs

2015-08-01

We prospectively investigated temporal and spatial evolution of intramural hematomas in patients with acute spontaneous internal carotid artery dissection using repeated magnetic resonance imaging over six-months. The aim of the present study was to assess dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection at multiple follow-up time-points with T1w, PD/T2w, and magnetic resonance angiography. We performed serial multiparametric magnetic resonance imaging in 10 patients with spontaneous internal carotid artery dissection on admission, at days 1, 3, 7-14 and at months 1·5, 3, and 6. We calculated the volume and extension of the hyperintense intramural hematoma using T1w and PD/T2w fat suppressed sequences and assessed the degree of stenosis due to the hematoma using magnetic resonance angiography. Mean interval from symptom onset to first magnetic resonance imaging was two-days (SD 2·7). Two patients presented with ischemic stroke, three with transient ischemic attacks, and five with pain and local symptoms only. Nine patients had a transient increase of the intramural hematoma volume, mainly up to day 10 after symptom onset. Fifty percent had a transient increase in the degree of the internal carotid artery stenosis on MRA, one resulting in a temporary occlusion. Lesions older than one-week were predominantly characterized by a shift from iso- to hyperintese signal on T2w images. At three-month follow-up, intramural hematoma was no longer detectable in 80% of patients and had completely resolved in all patients after six-months. Spatial and temporal dynamics of intramural hematomas after spontaneous internal carotid artery dissection showed an early volume increase with concomitant progression of the internal carotid artery stenosis in 5 of 10 patients. Although spontaneous internal carotid artery dissection overall carries a good prognosis with spontaneous hematoma resorption in all our patients, early

Balloon test occlusion of the internal carotid artery with stable xenon/CT cerebral blood flow imaging

International Nuclear Information System (INIS)

Erba, S.M.; Horton, J.A.; Latchaw, R.E.; Yonas, H.; Sekhar, L.; Schramm, V.; Pentheny, S.

1988-01-01

We describe a technique to predict preoperatively the safety of permanently occluding an internal carotid artery. The method was performed by imaging stable xenon cerebral blood flow (CBF) with the internal carotid artery both open and temporarily occluded with a nondetachable balloon on a double lumen Swan-Ganz catheter. Patients were those in whom we planned to sacrifice the internal carotid artery (those with giant or inaccessible aneurysms) or those in whom such a sacrifice was at least likely (those with skull base tumors). Patients were divided into three groups on the basis of a comparison of occluded and nonoccluded CBF values. Group-I patients had no significant change in CBF with internal carotid artery occlusion; group-II patients showed a symmetric decrease in CBF; and group-III patients had an asymmetric decrease in CBF, always greater on the occluded side. A fourth group clinically failed to tolerate even brief carotid occlusion. The internal carotid artery in one patients from group III was sacrificed at surgery: the size and shape of his postoperative infarct corresponded almost exactly to the area of asymmetrically decreased CBF on his occluded study. The data suggest that if surgery is likely to result in permanent occlusion of the internal carotid artery, then patients who are at risk for delayed neurologic injury due to a compromised cerebral blood flow should have arterial bypass grafts before such surgery is performed

Assessment of carotid plaque vulnerability using structural and geometrical determinants

International Nuclear Information System (INIS)

Li, Z.Y.; Tang, T.; U-King-Im, J.; Graves, M.; Gillard, J.H.; Sutcliffe, M.

2008-01-01

Because many acute cerebral ischemic events are caused by rupture of vulnerable carotid atheroma and subsequent thrombosis, the present study used both idealized and patient-specific carotid atheromatous plaque models to evaluate the effect of structural determinants on stress distributions within plaque. Using a finite element method, structural analysis was performed using models derived from in vivo high-resolution magnetic resonance imaging (MRI) of carotid atheroma in 40 non-consecutive patients (20 symptomatic, 20 asymptomatic). Plaque components were modeled as hyper-elastic materials. The effects of varying fibrous cap thickness, lipid core size and lumen curvature on plaque stress distributions were examined. Lumen curvature and fibrous cap thickness were found to be major determinants of plaque stress. The size of the lipid core did not alter plaque stress significantly when the fibrous cap was relatively thick. The correlation between plaque stress and lumen curvature was significant for both symptomatic (p=0.01; correlation coefficient: 0.689) and asymptomatic patients (p=0.01; correlation coefficient: 0.862). Lumen curvature in plaques of symptomatic patients was significantly larger than those of asymptomatic patients (1.50±1.0 mm -1 vs 1.25±0.75 mm -1 ; p=0.01). Specific plaque morphology (large lumen curvature and thin fibrous cap) is closely related to plaque vulnerability. Structural analysis using high-resolution MRI of carotid atheroma may help in detecting vulnerable atheromatous plaque and aid the risk stratification of patients with carotid disease. (author)

Association between internal carotid artery dissection and arterial tortuosity

International Nuclear Information System (INIS)

Saba, Luca; Piga, Mario; Argiolas, Giovanni Maria; Siotto, Paolo; Sumer, Suna; Wintermark, Max; Raz, Eytan; Sanfilippo, Roberto; Montisci, Roberto

2015-01-01

Carotid artery dissection is an important cause of ischemic stroke in all age groups, particularly in young patients. The purpose of this work was to assess whether there is an association between the presence of an internal carotid artery dissection (ICAD) and the arterial tortuosity. This study considered 124 patients (72 males and 52 females; median age 57 years) with CT/MR diagnosis of ICAD of the internal carotid artery were considered in this multi-centric retrospective study. The arterial tortuosity was evaluated and, when present, was categorized as elongation, kinking, or coiling. For each patient, both the right and left sides were considered for a total number of 248 arteries in order to have the same number of cases and controls. Fisher's exact test was applied to test the association between elongation, kinking, coiling, dissection, and the side affected by CAD. Fisher's exact test showed a statistically significant association between the ICAD and kinking (p = 0.0089) and coiling (p = 0.0251) whereas no statistically significant difference was found with arterial vessel elongation (p = 0.444). ICAD was more often seen on the left side compared to the right (p = 0.0001). These results were confirmed using both carotid arteries of the same patient as dependent parameter with p = 0.0012, 0.0129, and 0.3323 for kinking, coiling, and elongation, respectively. The presence of kinking and coiling is associated with ICAD. (orig.)

Association between internal carotid artery dissection and arterial tortuosity

Energy Technology Data Exchange (ETDEWEB)

Saba, Luca; Piga, Mario [Azienda Ospedaliero Universitaria (A.O.U.), Department of Radiology, Monserrato, Cagliari (Italy); Argiolas, Giovanni Maria; Siotto, Paolo [Azienda Ospedaliero Brotzu (A.O.B.), Department of Radiology, di Cagliari (Italy); Sumer, Suna; Wintermark, Max [Neuroradiology Division, Neuroradiology, UVA Department of Radiology, Charlottesville, VA (United States); Raz, Eytan [New York University School of Medicine, Department of Radiology, New York, NY (United States); Sapienza University of Rome, Department of Neurology and Psychiatry, Rome (Italy); Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria (A.O.U.), Department of Vascular Surgery, di Cagliari (Italy)

2014-10-18

Carotid artery dissection is an important cause of ischemic stroke in all age groups, particularly in young patients. The purpose of this work was to assess whether there is an association between the presence of an internal carotid artery dissection (ICAD) and the arterial tortuosity. This study considered 124 patients (72 males and 52 females; median age 57 years) with CT/MR diagnosis of ICAD of the internal carotid artery were considered in this multi-centric retrospective study. The arterial tortuosity was evaluated and, when present, was categorized as elongation, kinking, or coiling. For each patient, both the right and left sides were considered for a total number of 248 arteries in order to have the same number of cases and controls. Fisher's exact test was applied to test the association between elongation, kinking, coiling, dissection, and the side affected by CAD. Fisher's exact test showed a statistically significant association between the ICAD and kinking (p = 0.0089) and coiling (p = 0.0251) whereas no statistically significant difference was found with arterial vessel elongation (p = 0.444). ICAD was more often seen on the left side compared to the right (p = 0.0001). These results were confirmed using both carotid arteries of the same patient as dependent parameter with p = 0.0012, 0.0129, and 0.3323 for kinking, coiling, and elongation, respectively. The presence of kinking and coiling is associated with ICAD. (orig.)

Staged bilateral carotid endarterectomy

DEFF Research Database (Denmark)

Schroeder, T; Sillesen, H; Engell, Hans Christian

1986-01-01

In a series of 56 staged bilateral carotid endarterectomies, new neurologic symptoms developed in 5% and 20% following the first and second procedure, respectively. All complications were transient or minor. The incidence of postendarterectomy hypertension was significantly higher following...... the second procedure, when operations were staged less than 3 weeks apart. A correlation between these hypertensive episodes and the occurrence of new neurologic symptoms could not be shown. However, as this correlation has been proved in several other reports, bilateral carotid endarterectomy is advised...... to be staged at least 3 weeks apart. In addition, a conservative attitude towards contralateral asymptomatic lesions is proposed....

Experiences with carotid endarterectomy at Sree Chitra Tirunal Institute

Directory of Open Access Journals (Sweden)

Unnikrishnan Madathipat

2008-01-01

Full Text Available Background: Atherosclerotic carotid artery disease poses a grave threat to cerebral circulation, leading to a stroke with its devastating sequelae, if left untreated. Carotid endarterectomy has a proven track record with compelling evidence in stroke prevention. Objectives: aTo confirm that carotid endarterectomy (CEA is safe and effective in preventing stroke at both short and long term. b to demonstrate long term patency of internal carotid artery when arteriotomy repair is performed using autologous saphenous vein patch. Materials and Methods: During ten years, from September 1997 to February 2008, thirty nine patients who underwent consecutive carotid endarterectomy at our institute, form the basis of this report. Their age ranged from thirty to seventy eight years, with a mean age of 56. There were four women in this cohort. Thirty seven patients were symptomatic with> 70% stenosis and two were asymptomatic with> 80% stenosis, incidentally detected. Imaging included Duplex scan and MRA for carotid territory and brain, and non-invasive cardiac assessment. Co-morbidities included smoking, hypertension, diabetes, and coronary artery disease. Carotid Endarterectomy was performed under general anaesthesia, using carotid shunt and vein patch arteriotomy repair. Results: All the patients made satisfactory recovery, without major adverse cerebral events in this series. Morbidities included Transient Ischemic Attack (TIA in two, needing only medications in one, and carotid stenting in the other. Minor morbidities included neck hematoma in two and transient hypoglossal paresis in three patients. Yearly follow-up included duplex scan assessment for all the patients. Two patients died of contralateral stroke, two of myocardial events and two were lost to follow up. Thirty three patients are well and free of the disease during the follow up of three to 120 months. Conclusion: Carotid endarterectomy provided near total freedom from adverse cerebral

Comparison of I-123 IMP cerebral uptake and MR spectroscopy following experimental carotid occlusion

International Nuclear Information System (INIS)

Holman, B.L.; Jolesz, F.A.; Polak, J.F.; Kronauge, J.F.; Adams, D.F.

1985-01-01

Both I-123 IMP scintigraphy and MRI have been suggested as sensitive detectors of changes shortly after acute cerebral infarction. We compared the uptake of N-isopropyl I-123 p-iodoamphetamine (IMP) and MR spectroscopy of the brain after internal carotid artery ligation. Thirteen gerbils were lightly anesthetized with ether. After neck dissection, an internal carotid artery was occluded. After 2.8 hours, 100 muCi I-123 IMP was injected intravenously into the 13 experimental animals plus three controls. Seven gerbils remained asymptomatic while six developed hemiparesis. At 3 hours after ligation, the animals were killed. The brains were bisected and T1 and T2 relaxation times were determined for the right and left hemispheres by MR spectroscopy immediately after dissection. I-123 IMP uptake was then determined in the samples. Interhemispheric differences in uptake for I-123 IMP were 0.1 +/- 1.7% (SEM) in the control, 33.5 +/- 10% in the asymptomatic and 54.6 +/- 9.7% in the symptomatic animals. Significant differences were seen with I-123 IMP in 6/7 asymptomatic and 6/6 symptomatic animals. In conclusion, I-123 is more sensitive than T1 or T2 relaxation times for the detection of cerebral perfusion abnormalities. Prolongation in T1 and T2 relaxation times correlates closely with increased brain tissue water content and the development of symptoms, indicators of structural brain damage and probable infarction

The subpetrous carotid wall hematoma. A sign of spontaneous dissection of the internal carotid artery on non-enhanced computed tomography. A retrospective study

International Nuclear Information System (INIS)

Jensen-Kondering, U.; Univ. Hospital Schleswig-Holstein, Kiel; Huhndorf, M.; Madjidyar, J.; Jansen, O.

2015-01-01

Spontaneous dissection of the internal carotid artery (CAD) is an increasingly recognized cause for stroke especially in young and middle-aged patients. We hypothesized that non-enhanced cranial computed tomography (NECCT) can visualize the subpetrous carotid wall hematoma and thus enable identification of patients with CAD. We retrospectively reviewed patients with confirmed CAD (n=21) and a control group with ischemic symptoms but without CAD (n=42) who received NECCT at admission. Two independent neuroradiologists rated the presence and shape of SPH, density and diameter of the subpetrous internal carotid artery. Additionally, we correlated the shape of the subpetrous carotid wall hematoma with the grade of stenosis on subsequent angiographic imaging. The subpetrous carotid wall hematoma was present in 14 of 21 patients (Cohen's k = 0.67). Mean diameter was 6.95 ± 1.05 mm in dissected vessels and 5.71 ± 1.52 mm in the contralateral vessel (p<0.05). Mean difference in vessel density was 15.05 ± 8.01 HU (p<0.01). Median grade of stenosis was significantly higher in patients with a full moon- shaped (n=11) than crescent-shaped (n=3) subpetrous carotid wall hematoma (21% vs. 80%, p<0.05). Two-thirds of patients with CAD were correctly identified on NECCT. The extracranial carotid artery should be evaluated in patients with symptoms of cerebral ischemia.

The subpetrous carotid wall hematoma. A sign of spontaneous dissection of the internal carotid artery on non-enhanced computed tomography. A retrospective study

Energy Technology Data Exchange (ETDEWEB)

Jensen-Kondering, U. [Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Radiology and Neuroradiology; Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Neurology; Huhndorf, M.; Madjidyar, J.; Jansen, O. [Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Radiology and Neuroradiology

2015-03-15

Spontaneous dissection of the internal carotid artery (CAD) is an increasingly recognized cause for stroke especially in young and middle-aged patients. We hypothesized that non-enhanced cranial computed tomography (NECCT) can visualize the subpetrous carotid wall hematoma and thus enable identification of patients with CAD. We retrospectively reviewed patients with confirmed CAD (n=21) and a control group with ischemic symptoms but without CAD (n=42) who received NECCT at admission. Two independent neuroradiologists rated the presence and shape of SPH, density and diameter of the subpetrous internal carotid artery. Additionally, we correlated the shape of the subpetrous carotid wall hematoma with the grade of stenosis on subsequent angiographic imaging. The subpetrous carotid wall hematoma was present in 14 of 21 patients (Cohen's k = 0.67). Mean diameter was 6.95 ± 1.05 mm in dissected vessels and 5.71 ± 1.52 mm in the contralateral vessel (p<0.05). Mean difference in vessel density was 15.05 ± 8.01 HU (p<0.01). Median grade of stenosis was significantly higher in patients with a full moon- shaped (n=11) than crescent-shaped (n=3) subpetrous carotid wall hematoma (21% vs. 80%, p<0.05). Two-thirds of patients with CAD were correctly identified on NECCT. The extracranial carotid artery should be evaluated in patients with symptoms of cerebral ischemia.

The significance of CBF measurements for precise management of carotid stenosis

Energy Technology Data Exchange (ETDEWEB)

Nakagawara, Jyoji; Kamiyama, Kenji; Usui, Reiko; Takeda, Rihei; Nakamura, Hirohiko [Nakamura Memorial Hospital, Sapporo (Japan)

2002-12-01

Severe hemodynamic cerebral ischemia associated with carotid stenosis could be one of the difining characteristics of the high-risk group for carotid endarterectomy (CEA). Measurements of cerebral blood flow (CBF) and vascular reactivity in patients treated with CEA were analyzed to clarify the significance of preoperative evaluation of hemodynamic cerebral ischemia using CBF-SPECT. Both the resting and acetazolamide-activated rCBF, and the severity of the hemodynamic cerebral ischemia (Stage 0-II) were quantified using the {sup 123}I-IMP autoradiography (ARG) method and preoperative cerebral hemodynamics were compared in both symptomatic patients (n=30) and asymptomatic patients (n=24). Postoperative improvement of resting rCBF was estimated in both groups. Stage II ischemia was quantitatively defined as both a resting rCBF of less than 80% of normal mean CBF and a vascular reserve (VR: (acetazolamide-activated rCBF/Resting rCBF-1) x 100%) of less than 10%. In the other 31 patients treated with CEA, postoperative hyperperfusion was investigated using CBF-SPECT within 24 hours after CEA. Preoperatively, Stage II ischemia (hemodynamically compromised state) was observed in 20% of symptomatic patients and 8% of asymptomatic patients. A significant difference in resting rCBF was indicated between symptomatic patients (31.8{+-}6.1 ml/100 g/min) and asymptomatic patients (37.6{+-}6.6 ml/100 g/min)(p<0.002, t-test). Severity of hemodynamic cerebral ischemia was generally moderate in symptomatic patients. Postoperatively, a significant increase of resting CBF was observed in symptomatic patients but not in asymptomatic patients. In the other 31 patients treated by CEA, symptomatic hyperperfusion was observed in 3 of 4 patients with Stage II ischemia and asymptomatic hyperperfusion was indicated in 3 of 4 patients with Stage I ischemia with a VR of less than 10%. Preoperative CBF measurements in patients treated with CEA were significant to define severe hemodynamic

New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS)

NARCIS (Netherlands)

Bonati, Leo H.; Jongen, Lisa M.; Haller, Sven; Flach, H. Zwenneke; Dobson, Joanna; Nederkoorn, Paul J.; Macdonald, Sumaira; Gaines, Peter A.; Waaijer, Annet; Waajier, Annet; Stierli, Peter; Jäger, H. Rolf; Lyrer, Philippe A.; Kappelle, L. Jaap; Wetzel, Stephan G.; van der Lugt, Aad; Mali, Willem P.; Brown, Martin M.; van der Worp, H. Bart; Engelter, Stefan T.; Koelemaij, M. J. W.; Majoie, C. B. L. M.; Reekers, J. A. A.; Roos, Y. B. W. E. M.; Flach, H. Z.; Hendriks, J. M.; Koudstaal, P. J.; Pattynama, P. M. T.; van Dijk, L. C.; van Sambeek, M. R. H. M.; van der Lugt, A.; van Urk, H.; Verhagen, H. J. M.; de Borst, G. J.; de Kort, G. A. P.; Jongen, L. M.; Kappelle, L. J.; Lo, T. H.; Mali, W. P. Th M.; Moll, F. L.; van der Worp, H. B.; Bonati, L. H.; Engelter, S. T.; Fluri, F.; Haller, S.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E.-W.; Stierli, P.

2010-01-01

BACKGROUND: The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI between the

In vivo measurements of cerebral metabolic abnormalities by proton spectroscopy after a transient ischemic attack revealing an internal carotid stenosis > 70%; Anomalies metaboliques cerebrales mesurees in vivo par la spectroscopie du proton dans les accidents ischemiques transitoires revelant une stenose de la carotide interne superieure a 70%

Energy Technology Data Exchange (ETDEWEB)

Giroud, M.; Becker, F.; Lemesle, M.; Walker, P.; Guy, F.; Martin, D.; Baudouin, N.; Brunotte, F.; Dumas, R. [Centre Hospitalier Universitaire, 21 -Dijon (France)

1996-06-01

Aims: The aim of this work is to look for cerebral metabolic abnormalities within the first 3 days after a transient ischemic attack revealing an internal carotid stenosis > 70 %. Methods: Five patients with a transient ischemic attack lasting between 30 and 180 minutes, affecting sensory and motor brachio-facial territory, with or without aphasia. Were studied. A CT-scan, an EEG, a cervical Doppler ultrasound, a standard arteriography, a magnetic resonance imaging and a proton spectroscopy were performed within the cerebral area affected by the transient ischemic attack. We measured 2 markers: N-acetyl-aspartate, the marker of the neuronal mass, and lactate, the marker of anaerobe metabolism. In each case, a contralateral internal stenosis was diagnosed by cervical Doppler ultrasound and standard arteriography. No cerebral infarction was observed. Results: With the affected cerebral area defined according to clinical and EEG features, proton spectroscopy showed a significant rise of lactate, without any change in N-acetyl-aspartate levels. Conclusions: Within the first 3 days after a transient ischemic attack, there is a significant risk of lactate inside the affected cerebral area. This change may reflect a localized and transient hypoperfusion, but long enough to induce a rise of lactate but not sufficient to produce a cerebral infarct. This area is probably at risk to induce cerebral infarct. This data lead us to study the metabolic change induced by the asymptomatic internal carotid stenosis. (authors). 18 refs.

Platelet activation, function, and reactivity in atherosclerotic carotid artery stenosis: a systematic review of the literature.

LENUS (Irish Health Repository)

Kinsella, J A

2012-09-27

An important proportion of transient ischemic attack or ischemic stroke is attributable to moderate or severe (50-99%) atherosclerotic carotid stenosis or occlusion. Platelet biomarkers have the potential to improve our understanding of the pathogenesis of vascular events in this patient population. A detailed systematic review was performed to collate all available data on ex vivo platelet activation and platelet function\\/reactivity in patients with carotid stenosis. Two hundred thirteen potentially relevant articles were initially identified; 26 manuscripts met criteria for inclusion in this systematic review. There was no consistent evidence of clinically informative data from urinary or soluble blood markers of platelet activation in patients with symptomatic moderate or severe carotid stenosis who might be considered suitable for carotid intervention. Data from flow cytometry studies revealed evidence of excessive platelet activation in patients in the early, sub-acute, or late phases after transient ischemic attack or stroke in association with moderate or severe carotid stenosis and in asymptomatic moderate or severe carotid stenosis compared with controls. Furthermore, pilot data suggest that platelet activation may be increased in recently symptomatic than in asymptomatic severe carotid stenosis. Excessive platelet activation and platelet hyperreactivity may play a role in the pathogenesis of first or subsequent transient ischemic attack or stroke in patients with moderate or severe carotid stenosis. Larger longitudinal studies assessing platelet activation status with flow cytometry and platelet function\\/reactivity in symptomatic vs. asymptomatic carotid stenosis are warranted to improve our understanding of the mechanisms responsible for transient ischemic attack or stroke.

In-stent restenosis of innominate artery with critical stenosis of right internal carotid artery

International Nuclear Information System (INIS)

Hussain, S.; Raza, A.; Ahmed, W.

2011-01-01

A lady with aortitis syndrome developed in-stent restenosis (ISR) of the innominate artery stent and critical stenosis of right internal carotid artery. The therapeutic challenge was gaining access to the carotid vessel, after treating the innominate artery ISR and all the while using distal protection to circumvent potential cerebral embolism. Percutaneous transluminal angioplasty (PTA) with or without stenting is a safe therapeutic option for re-vascularization of the supra aortic vessels. In the event of re-stenosis, re-treatment with PTA and stenting is safe. Ample evidence-base exists now for carotid artery stenting (CAS) in preference to carotid endarterectomy in patients with stenotic lesions of the carotid vessels. (author)

In vivo measurements of cerebral metabolic abnormalities by proton spectroscopy after a transient ischemic attack revealing an internal carotid stenosis > 70%

International Nuclear Information System (INIS)

Giroud, M.; Becker, F.; Lemesle, M.; Walker, P.; Guy, F.; Martin, D.; Baudouin, N.; Brunotte, F.; Dumas, R.

1996-01-01

Aims: The aim of this work is to look for cerebral metabolic abnormalities within the first 3 days after a transient ischemic attack revealing an internal carotid stenosis > 70 %. Methods: Five patients with a transient ischemic attack lasting between 30 and 180 minutes, affecting sensory and motor brachio-facial territory, with or without aphasia. Were studied. A CT-scan, an EEG, a cervical Doppler ultrasound, a standard arteriography, a magnetic resonance imaging and a proton spectroscopy were performed within the cerebral area affected by the transient ischemic attack. We measured 2 markers: N-acetyl-aspartate, the marker of the neuronal mass, and lactate, the marker of anaerobe metabolism. In each case, a contralateral internal stenosis was diagnosed by cervical Doppler ultrasound and standard arteriography. No cerebral infarction was observed. Results: With the affected cerebral area defined according to clinical and EEG features, proton spectroscopy showed a significant rise of lactate, without any change in N-acetyl-aspartate levels. Conclusions: Within the first 3 days after a transient ischemic attack, there is a significant risk of lactate inside the affected cerebral area. This change may reflect a localized and transient hypoperfusion, but long enough to induce a rise of lactate but not sufficient to produce a cerebral infarct. This area is probably at risk to induce cerebral infarct. This data lead us to study the metabolic change induced by the asymptomatic internal carotid stenosis. (authors). 18 refs

Timing of menarche related to carotid artery intima-media thickness in black and white young adult women: the Bogalusa Heart Study.

Science.gov (United States)

Bhuiyan, Azad R; Srinivasan, Sathanur R; Chen, Wei; Fernandez, Camilo; Xu, Ji-Hua; Berenson, Gerald S

2015-06-01

The early onset of menarche is related to the adulthood risk of cardiovascular (CV) disease. This study examines the relation of early onset of menarche to carotid artery intima-media thickness (IMT), which is a surrogate marker of CV disease, among asymptomatic young adult women in a black-white community. A cohort of 461 women (31% black, 69% white) aged 24 to 43 years (mean of 35.6 years) were participants in the Bogalusa Heart Study. The age at menarche was retrospectively collected. In addition to CV risk factor variable measurements B-mode ultrasound images of the far walls of carotid artery segments were obtained. The multivariate linear regression model along with mediating effect by Sobel test was applied to analyze menarcheal age effect on carotid artery IMT, adjusting for covariates. Waist to height ratio was significantly greater (P = .01) in early menarcheal age (women. Homeostasis model assessment of insulin resistance (HOMA-IR) was significantly greater (P = .01) in early menarcheal age (women and also similar direction in black women. Internal carotid artery IMT was the same in early menarcheal age (women but higher (P = .02) in black women. Given as previously mentioned these different associations, the mediation analysis by race was performed. The effect of early menarcheal age (women after adjusting for parental education and age. The mediating effect of waist to height ratio (Sobel test = -2.26 and P = .02) and HOMA-IR (Sobel test = -1.85 and P = .06) on internal carotid artery IMT was noted in white women. The direct effect of early menarcheal age (women. The observed deleterious effect of early onset of menarche on carotid artery IMT in asymptomatic black and white younger adult women has biological, social, and public health implications. Copyright © 2015 Elsevier Inc. All rights reserved.

Diagnóstico y tratamiento de la enfermedad carotídea aterosclerótica extracraneal asintomática Diagnosis and treatment of asymptomatic extracranial atherosclerotic carotid artery disease

Directory of Open Access Journals (Sweden)

Luciano A. Sposato

2011-12-01

Full Text Available La enfermedad aterosclerótica asintomática de la arteria carótida interna extracraneal alcanza una prevalencia de hasta el 12.5%. La angioplastia carotídea todavía no ha demostrado ser lo suficientemente segura y eficaz para prevenir el ACV isquémico en estos pacientes. Estudios aleatorizados demostraron que la endarterectomía carotídea es superior al tratamiento médico en cuanto a reducción del riesgo de ACV isquémico si es realizada por equipos con tasas de complicaciones (ACV o muerte menores que 3%. Sin embargo, los pacientes evaluados en estos estudios comenzaron a reclutarse hace más de 25 años, cuando la utilización de antiagregantes plaquetarios era menor que la actual, el tratamiento de la hipertensión arterial era menos efectivo y todavía no se usaban estatinas como componentes fundamentales de los esquemas de prevención vascular. La optimización de la calidad del tratamiento médico en las últimas décadas ha llevado a una significativa reducción del riesgo de ACV en pacientes no intervenidos quirúrgicamente. En base a estas observaciones y con la excepción de casos específicos, el tratamiento médico es la opción terapéutica de elección en pacientes con enfermedad aterosclerótica carotídea extracraneal asintomática.The reported prevalence of asymptomatic atherosclerotic disease of the extracranial internal carotid artery is up to 12.5%. Carotid angioplasty has not yet proven safe and effective enough to prevent ischemic stroke in these patients. Randomized studies showed that carotid endarterectomy is superior to medical therapy in reducing the risk of ischemic stroke when performed by surgical teams with complication rates (stroke or death of less than 3%. However, recruitment of these patients began more than 25 years ago, when the use of antiplatelet agents was lower than today, the treatment of hypertension was less effective than currently, and statins were not considered as key components of

Angioplasty of symptomatic high-grade internal carotid artery stenosis with intraluminal thrombus: therapeutic approach

Energy Technology Data Exchange (ETDEWEB)

Gonzalez, A.; Mayol, A. [Seccion de Neurorradiologia Intervencionista, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Gil-Peralta, A.; Gonzalez-Marcos, J.R. [Servicio de Neurologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Boza, F. [Servicio de Neurofisiologia, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain); Ruano, J. [Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013, Sevilla (Spain)

2004-04-01

Intraluminal thrombus in the internal carotid artery (ICA) is usually found in patients with severe atheromatous stenosis. Having reviewed 300 carotid angioplasties for symptomatic >70% ICA stenosis, we found three patients (1%) with intraluminal thrombus. Conservative treatment with anticoagulants and double antiplatelet coverage can result in lysis of the thrombus without severe risks. Percutaneous transluminal angioplasty and stenting, preferably with distal protection, can be an excellent alternative to carotid endarterectomy. (orig.)

Traumatic intracranial internal carotid artery pseudoaneurysm presenting as epistaxis treated by endovascular coiling

Science.gov (United States)

Al-Jehani, Hosam M.; Alwadaani, Hassan A.; Almolani, Fadhel M.

2016-01-01

Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization. We discuss endovascular treatment options and review the literature. PMID:26818170

Results in a consecutive series of 83 surgical corrections of symptomatic stenotic kinking of the internal carotid artery.

Science.gov (United States)

Illuminati, Giulio; Ricco, Jean-Baptiste; Caliò, Francesco G; D'Urso, Antonio; Ceccanei, Gianluca; Vietri, Francesco

2008-01-01

Although there is a growing body of evidence to document the safety and efficacy of operative treatment of carotid stenosis, surgical indications for elongation and kinking of the internal carotid artery remain controversial. The goal of this study was to evaluate the efficacy of surgical correction of internal carotid artery kinking in patients with persistent hemispheric symptoms despite antiplatelet therapy. A consecutive series of 81 patients (mean age, 64 years) underwent 83 surgical procedures to correct kinking of the internal carotid artery either by shortening and reimplanting the vessel on the common carotid artery, inserting a bypass graft, or transposing the vessel onto the external carotid artery. Mean follow-up was 56 months (range, 15-135 months). Study endpoints were 30-day mortality and any stroke occurring during follow-up. No postoperative death was observed. The postoperative stroke rate was 1%. Primary patency, freedom from neurologic symptoms, and late survival at 5 years (x +/- standard deviation) were 89 +/- 4.1%, 92 +/- 4%, and 71 +/- 6%, respectively. The findings of this study indicate that surgical correction for symptomatic stenotic kinking of the internal carotid artery is safe and effective in relieving symptoms and preventing stroke. Operative correction should be considered as the standard treatment for patients with symptomatic carotid kinking that does not respond to antiplatelet therapy.

Carotid endarterectomy in cervical block anesthesia in patients with occluded contralateral internal carotid artery

Directory of Open Access Journals (Sweden)

Ilijevski Nenad

2006-01-01

Full Text Available Introduction: The goal of modern carotid surgery is relief of symptoms, stroke prevention, improvement in quality of life, prevention of vascular dementia, and prolongation of lifetime. OBJECTIVE: The objective of this paper was to compare the outcome of carotid endarterectomy in cervical block vs. general anesthesia in patients with occluded contralateral internal carotid artery (ICA. METHOD: One hundred patients (76 male, 24 female, mean age 60.81 years with occluded contralateral ICA were operated from 1997-2000. Neurological symptomatology, deficiency and stroke incidence were preoperatively analyzed in two groups. Duplex-scanning, angiograms and CT-scan confirmed the diagnosis. Risk factors analysis included hypertension, diabetes, lipid metabolism disorders, smoking and history of CAD, CABG and PAOD. Morbidity and mortality were used to compare the outcome of surgery in two groups. RESULTS There was no difference of age, gender and symptomatology between the groups. Paresis, TIA and dysphasia were most frequent. 70%-90% of ICA stenosis was seen in the majority of patients. Hypertension and smoking were dominant risk factors in these two groups. Eversion carotid end arterectomy was the most frequent technique used. In three cases out of nine that were operated under cervical block, the neurological symptoms developed just after clamping, so the intra-luminal shunt was placed. Postoperative morbidity was 12% and mortality was 8%. Conclusion: There was no difference of preoperative parameters, surgical technique and outcome in these two groups. Without other intraoperative monitoring, cervical block anesthesia might be an option in patients with the occlusion of the contralateral ICA. However, prospective studies involving more patients are needed.

Shear-mediated dilation of the internal carotid artery occurs independent of hypercapnia

DEFF Research Database (Denmark)

Hoiland, Ryan L; Smith, Kurt J; Carter, Howard Henry

2017-01-01

preceded increases in diameter in both transient (time: 16.8 ± 13.2 vs. 59.4 ± 60.3 s, P time: 18.2 ± 14.2 vs. 110.3 ± 79.6 s, P dilation was positively correlated with shear rate area under the curve in the transient (r2 = 0.44, P ...Evidence for shear stress as a regulator of carotid artery dilation in response to increased arterial CO2 was recently demonstrated in humans during sustained elevations in CO2 (hypercapnia); however, the relative contributions of CO2 and shear stress to this response remains unclear. We examined...... the hypothesis that, after a 30-s transient increase in arterial CO2 tension and consequent increase in internal carotid artery shear stress, internal carotid artery diameter would increase, indicating shear-mediated dilation, in the absence of concurrent hypercapnia. In 27 healthy participants, partial...

Multidisciplinary approach to carotid stenting.

Science.gov (United States)

Mak, C S; Chambers, B R; Clark, D J; Molan, M; Brooks, M; Roberts, N; Fell, G; Roberts, A K; New, G; Donnan, G A

2011-11-01

Stroke neurologists, vascular surgeons, interventional neuroradiologists and interventional cardiologists have embraced carotid angioplasty and stenting (CAS) because of potential advantages over carotid endarterectomy (CEA). At Austin Health, a multidisciplinary neuro-interventional group was formed to standardise indications and facilitate training. The aims of this study were to describe our organisational model and to determine whether 30-day complications and early outcomes were similar to those of major trials. A clinical protocol was developed to ensure optimal management. CAS was performed on patients with high medical risk for CEA, with technically difficult anatomy for CEA, or who were randomised to CAS in a trial. From October 2003 to May 2008, 47 patients (34 male, mean age 71.5) underwent CAS of 50 carotid arteries. Forty-three cases had ipsilateral carotid territory symptoms within the previous 12 months. The main indications for CAS were high risk for CEA (n= 17) and randomised to CAS (n= 21). Interventionists were proctored in 27 cases. The procedural success rate was 94% with two cases abandoned because of anatomical problems and one because of on-table angina. Hypotension requiring vasopressor therapy occurred in 12 cases (24%). The duration of follow up was one to 44 months (mean 6.8 months). The 30-day rate of peri-procedural stroke or death was 6% and the one-year rate of peri-procedural stroke or death or subsequent ipsilateral stroke was 10.6%. Restenosis occurred in 13% (all asymptomatic). A multidisciplinary approach is a useful strategy for initiating and sustaining a CAS programme. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

Development of a Microsimulation Model to Predict Stroke and Long-Term Mortality in Adherent and Nonadherent Medically Managed and Surgically Treated Octogenarians with Asymptomatic Significant Carotid Artery Stenosis.

Science.gov (United States)

Luebke, Thomas; Brunkwall, Jan

2016-08-01

The primary study objective was to develop a microsimulation model to predict preventable first-ever and recurrent strokes and mortality for a population of medically or surgically managed octogenarians with substantial (>60%) asymptomatic carotid artery stenosis and comparing an adherent with a real-world nonadherent best medical treatment (BMT) regimen subjected to sex. A Monte Carlo microsimulation model was constructed with a 14-year time horizon and with 10,000 patients. Probabilities and values for clinical outcomes were obtained from the current literature. The stratification of the microsimulation estimates by treatment strategy within the female group of octogenarians showed a statistically significant lower stroke rate during follow-up for carotid endarterectomy (CEA) compared with nonadherent BMT (P < 0.0001) as well as compared with adherent BMT (P < 0.0001). In male octogenarians, the CEA strategy was also associated with statistically significant lower stroke rates compared with adherent and nonadherent BMT (P < 0.0001 and P < 0.0001, respectively). For each treatment strategy, female octogenarians had a statistically significant longer overall long-term survival compared with male octogenarians (P < 0.0001, respectively). In terms of stratification by sex, in octogenarian men and women, long-term survival was significantly better for adherent BMT compared with nonadherent BMT, and CEA was associated with a significant better long-term survival compared with nonadherent BMT. In the present microsimulation, in real-world drug adherence, it was likely that a strategy of early endarterectomy was beneficial in octogenarians with significant asymptomatic carotid artery disease compared with BMT alone. Copyright © 2016 Elsevier Inc. All rights reserved.

Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries especially the internal carotid artery

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Kachel, R.; Basche, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Radiologische Klinik); Heerklotz, I.; Grossmann, K. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Innere Medizin); Endler, S. (Medizinische Akademie, Erfurt (Germany, F.R.). Klinik fuer Neurologie und Psychiatrie)

1991-06-01

We present our experience with 105 patients in whom percutaneous transluminal angioplasty was performed in 112 stenosed or occluded supra-aortic arteries. Symtoms of cerebrovascular and/or vertebrobasilar insufficiency were present in 104 of the 105 patients. The angioplasty was successful in 35 stenoses of the internal carotid artery, 2 stenoses of the common carotid artery, 1 stenosis of the external carotid artery, 15 stenoses of the vertebral artery, 3 stenoses of the innominate artery and 44 stenoses of the subclavian artery. There were only 4 minor-complications (2 haematomas, 1 transient ischemic attack, 1 small thrombus of the internal carotid artery which was detected by 111-indium platelet scintigraphy and treated by thrombendarterectomy before the appearance of neurological symptoms). All patients were symptom free after angioplasty. During the observations period of 3 to 109 months (average 58 months) there were only two cases with re-stenosis after subclavian angioplasty. The results of more than 700 personal and international published percutaneous transluminal angioplasties of supra-aortic arteries are presented. The results suggest that angioplasty of supra-aortic arteries is an effective method. On strict definition of the indications, the complication rate for angioplasty of the supra-aortic arteries is not likely to be higher than that for operative treatment. (orig.).

Applying the payoff time framework to carotid artery disease management.

Science.gov (United States)

Yuo, Theodore H; Roberts, Mark S; Braithwaite, R Scott; Chang, Chung-Chou H; Kraemer, Kevin L

2013-11-01

and Asymptomatic stenosis of the carotid arteries is associated with stroke. Carotid revascularization can reduce the future risk of stroke but can also trigger an immediate stroke. The objective was to model the generic relationship between immediate risk, long-term benefit, and life expectancy for any one-time prophylactic treatment and then apply the model to the use of revascularization in the management of asymptomatic carotid disease. In the "payoff time" framework, the possibility of losing quality-adjusted life-years (QALYs) because of revascularization failure is conceptualized as an "investment" that is eventually recouped over time, on average. Using this framework, we developed simple mathematical forms that define relationships between the following: perioperative probability of stroke (P); annual stroke rate without revascularization (r0); annual stroke rate after revascularization, conditional on not having suffered perioperative stroke (r1); utility levels assigned to the asymptomatic state (ua) and stroke state (us); and mortality rates (λ). In patients whose life expectancy is below a critical life expectancy (CLE = P/(1-P)r0-r1, the "investment" will never pay off, and revascularization will lead to loss of QALYs, on average. CLE is independent of utilities assigned to the health states if a rank ordering exists in which ua > us. For clinically relevant values (P = 3%, r0 = 1%, r1 = 0.5%), the CLE is approximately 6.4 years, which is longer than published guidelines regarding patient selection for revascularization. In managing asymptomatic carotid disease, the payoff time framework specifies a CLE beneath which patients, on average, will not benefit from revascularization. This formula is suitable for clinical use at the patient's bedside and can account for patient variability, the ability of clinicians who perform revascularization, and the particular revascularization technology that is chosen.

Enterprise stent in recanalizing non-acute atherosclerotic intracranial internal carotid artery occlusion.

Science.gov (United States)

Wang, Xiaofei; Wang, Zhigang; Ji, Yong; Ding, Xuan; Zang, Yizheng; Wang, Chengwei

2017-11-01

To investigate the safety and effectiveness of recanalization in non-acute occlusion of intracranial internal carotid arteries using the flexible Enterprise self-expanding stent. From June 2014 to June 2016, 12 consecutive patients with non-acute occlusion of intracranial internal carotid arteries received endovascular recanalization with Enterprise stenting. All patients received medication for anti-platelet aggregation therapy before and after the operation. The perioperative complications and recanalization efficacy were evaluated with the modified Rankin scoring system and digital subtraction angiography (DSA) follow-up, respectively. Endovascular recanalization was successfully performed in 10 out of 12 patients with Enterprise stenting. Stent implantation following balloon dilatation failed in one patient because the lumen diameter was too small. Another recanalization failed because the guide wire could not pass through the occlusion. No perioperative mortality was observed. One case of acute thrombosis and one case of intraoperative carotid spasm occurred, but these were resolved with thrombolytic therapy by microcatheter exposure treatment and antispasmodic medications, respectively. DSA follow-up in seven patients revealed no re-occlusion. One stroke event occurred in the 10 patients who completed the follow-up. A meaningful improvement in the modified Rankin score during follow-up was suggested by Wilcoxon signed-rank test results. The Enterprise stent was shown to be safe and efficient in recanalizing non-acute atherosclerotic intracranial internal carotid artery occlusion. However, the long-term outcomes need to be further investigated. Copyright © 2017 Elsevier B.V. All rights reserved.

External Carotid-Internal Jugular Fistula as a Late Complication After Carotid Endarterectomy: A Rare Case

International Nuclear Information System (INIS)

Bakar, Bulent; Cekirge, Saruhan; Tekkok, Ismail Hakki

2011-01-01

A 66-year-old man presented with mild amnesia, progressive fatigue, ataxia, visual hallucinations, and debility. His past medical history included right-sided carotid endarterectomy performed elsewhere 6 years previously. Cranial magnetic resonance imaging showed left parieto-occipital arteriovenous malformation-like tortous vessels, venous congestion, and ischemic areas. Cerebral angiography showed right-sided compound external carotid artery-internal jugular vein (IJV) fistula, and distal occlusion of the right IJV. Transvenous embolization via contralateral IJV was performed, and the fistula, together with fistulous portion of the distal IJV, was sealed using coils. Two years later, patient is well with normal neurologic examination findings. The presence of an arteriovenous communication after vascular surgery is a serious complication with potential long-term effects and therefore should be diagnosed and treated as promptly as possible.

Long-term outcomes of internal carotid artery disease treated using radial artery graft

International Nuclear Information System (INIS)

Murai, Yasuo; Teramoto, Akira; Mizunari, Takayuki; Kobayashi, Shiro; Umeoka, Katsuya; Tateyama, Kojiro

2009-01-01

Complex internal carotid artery disease presents a surgical challenge because limitations and difficulty are encountered with either clipping or endovascular treatment. Our review of previous reports suggests that no current vascular assessment can accurately predict occurrence of ischemic complications after internal carotid artery ligation. The present study concerns long-term clinical outcome of radial artery grafting followed by parent artery trapping or proximal occlusion for management of these difficult lesions. Between September 1997 and October 2007, we performed radial artery grafting followed immediately by parent artery occlusion in 20 sides of 19 patients with complex internal carotid arteries disease with follow-up for more than 36 months (5 men, 14 women; mean follow-up duration, 62 months). All patients underwent postoperative MRI and MR angiography (MRA) every year to assess graft patency, ischemic complications, and de novo aneurysm. Another 20 carotid aneurysms with visual disturbance were assessed concerning outcome. Among 13 patients with cranial nerve (III and VI) disturbances, all dysfunctions were improved in cases treated within 8 months of onset to operation. On the other hand, patients with second cranial nerve disturbances were not improved in cases treated after 4 months of onset. No long-term complications were discovered with MRI and MRA. With appropriate attention to surgical technique, radial artery grafting followed by acute parent artery occlusion is a safe treatment for complex internal carotid artery aneurysms. Long-term safety is satisfactory, with no delayed complications such as graft stenosis, ischemic complications or de novo aneurysm formations in follow-up periods of more than 3 years. Good clinical outcome of cranial nerve palsy was achieved in patients treated within 8 months of onset for cranial nerve (CN) III and VI, and 4 of CN II palsy. (author)

Hypoplasia of the internal carotid artery with intercavernous anastomosis

International Nuclear Information System (INIS)

Chen, C.J.; Wang, L.J.; Wong, Y.C.; Chen, S.T.; Hsieh, F.Y.

1998-01-01

We report a symptomatic case of unilateral hypoplasia of the internal carotid artery with an intercavernous anastomosis, a very rare developmental anomaly. The symptoms were caused by occlusion of the proximal middle cerebral artery which possibly related to the haemodynamic stress caused by the anomalous intercavernous anastomosis. (orig.)

Aberrant internal carotid artery presenting as a retrotympanic vascular mass

International Nuclear Information System (INIS)

Nicolay, Simon; De Foer, Bert; Bernaerts, Anja; Van Dinther, Joost; Parizel, Paul M

2014-01-01

We report a case of a young woman with an aberrant right internal carotid artery (ICA) presenting as a retrotympanic reddish mass. This variant of the ICA represents the collateral pathway that is formed as a result of an embryological agenesis of the cervical segment of the ICA. The embryonic inferior tympanic artery is recruited to bypass the absent carotid segment. This hypertrophied vessel may be seen otoscopically and wrongfully considered to be a vascular middle ear tumor. Informing the otorhinolaryngologist of this important vascular variant not only obviates biopsy but also helps in careful preoperative planning of eventual middle ear procedures

Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

Directory of Open Access Journals (Sweden)

Michael Kelly

2008-11-01

Full Text Available A 58 year old man was involved in a high impact road traffic incident and was admitted for observation. Asymptomatic for the first 24 hours, he collapsed with symptoms and signs consistent with a cerebrovascular accident. Computed tomography angiogram (CTA and Magnetic resonance angiogram (MRA demonstrated bilateral internal carotid artery dissections and a left middle cerebral artery infarct. It was not considered appropriate to attempt stenting or other revascularistation. The patient was treated with heparin prior to starting warfarin. He made a partial recovery and was discharged to a rehabilitation facility. This case is a reminder of carotid dissection as an uncommon but serious complication of high speed motor vehicle accident, which may be silent initially. Literature Review suggests risk stratification before relevant radiological screening at risk patients. Significant advances in CTA have made it the diagnostic tool of choice, but ultrasound is an important screening tool.

Aberrant internal carotid artery in the middle ear

Energy Technology Data Exchange (ETDEWEB)

Roh, Keun Tak; Kang, Hyun Koo [Dept. of Radiology, Seoul Veterans Hospital, Seoul (Korea, Republic of)

2014-10-15

The knowledge about the aberrant internal carotid artery (ICA) in the middle ear is essential for clinicians, because a misdiagnosis of the aberrant ICA could have serious consequences such as excessive aural bleeding during a middle ear surgery. A 38-year-old woman presented with tinnitus and hearing difficulties of the left ear that had started 5 years ago. During otoscopy, an anteroinferior bluish mass was seen in the tympanic space. Computed tomography and magnetic resonance imaging demonstrated a left-side aberrant ICA with bony dehiscence of the carotid canal in the middle ear and a reduced diameter of the tympanic ICA. Herein we report a case of an aberrant ICA in the middle ear. We also review the literature regarding this important vascular anomaly of the temporal bone which may lead to disastrous surgical complications.

Aberrant internal carotid artery in the middle ear

International Nuclear Information System (INIS)

Roh, Keun Tak; Kang, Hyun Koo

2014-01-01

The knowledge about the aberrant internal carotid artery (ICA) in the middle ear is essential for clinicians, because a misdiagnosis of the aberrant ICA could have serious consequences such as excessive aural bleeding during a middle ear surgery. A 38-year-old woman presented with tinnitus and hearing difficulties of the left ear that had started 5 years ago. During otoscopy, an anteroinferior bluish mass was seen in the tympanic space. Computed tomography and magnetic resonance imaging demonstrated a left-side aberrant ICA with bony dehiscence of the carotid canal in the middle ear and a reduced diameter of the tympanic ICA. Herein we report a case of an aberrant ICA in the middle ear. We also review the literature regarding this important vascular anomaly of the temporal bone which may lead to disastrous surgical complications.

Missed Total Occlusion Due to the Occipital Artery Arising from the Internal Carotid Artery

International Nuclear Information System (INIS)

Ustunsoz, Bahri; Gumus, Burcak; Koksal, Ali; Koroglu, Mert; Akhan, Okan

2007-01-01

A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound

p.Q192R SNP of PON1 seems not to be Associated with Carotid Atherosclerosis Risk Factors in an Asymptomatic and Normolipidemic Brazilian Population Sample

Directory of Open Access Journals (Sweden)

Daniel Zanetti Scherrer

2015-07-01

Full Text Available Background:Evidences suggest that paraoxonase 1 (PON1 confers important antioxidant and anti-inflammatory properties when associated with high-density lipoprotein (HDL.Objective:To investigate the relationships between p.Q192R SNP of PON1, biochemical parameters and carotid atherosclerosis in an asymptomatic, normolipidemic Brazilian population sample.Methods:We studied 584 volunteers (females n = 326, males n = 258; 19-75 years of age. Total genomic DNA was extracted and SNP was detected in the TaqMan® SNP OpenArray® genotyping platform (Applied Biosystems, Foster City, CA. Plasma lipoproteins and apolipoproteins were determined and PON1 activity was measured using paraoxon as a substrate. High-resolution β-mode ultrasonography was used to measure cIMT and the presence of carotid atherosclerotic plaques in a subgroup of individuals (n = 317.Results:The presence of p.192Q was associated with a significant increase in PON1 activity (RR = 12.30 (11.38; RQ = 46.96 (22.35; QQ = 85.35 (24.83 μmol/min; p Conclusion:In low-risk individuals, the presence of the p.192Q variant of PON1 is associated with a beneficial plasma lipid profile but not with carotid atherosclerosis.

Unilateral dysgenesis of the internal carotid artery: spectrum of imaging findings

International Nuclear Information System (INIS)

De Mendonca, J.L.F.; Viana, S.L.; Freitas, F.M.O.; Matos, V.L.; Viana, M.A.C.B.; Silva, R.F.; Quaglia, L.A.N.; Guerra, J.G.

2008-01-01

Dysgenesis of the internal carotid artery (ICA) is a broad term comprising hypoplasia, aplasia and agenesis of the vessel. It is a rare anomaly, often clinically silent, that can be confidently diagnosed by means of noninvasive imaging methods. After a review of teaching files, 7 patients with unilateral carotid dysgenesis were found, 2 with agenesis of the ICA, 3 with carotid aplasia, and 2 with hypoplasia of the vessel. Computed tomography (CT) and magnetic resonance angiography (MRA) of the brain were performed in all patients, with a complete magnetic resonance of the brain in 3 of them, a CT angiography of the brain in one, and MRA of the cervical arteries in 3. The fetal pattern of arterial circulation was found in 3 patients with agenesis/aplasia of the ICA and the adult pattern was found in 2 patients, being the brain circulation of normal pattern in the patients with hypoplasia of the ICA. Two patients presented signs of reduced flow to the brain hemisphere ipsilateral to the carotid dysgenesis; one of them with an old homolateral brain infarction. Far from being just an anatomic curiosity, the dysgenesis of the ICA may have serious consequences if not recognized prior to endarterectomies, carotid ligation or transsphenoidal surgery. As much as one-third of these patients will have intracranial aneurysms as well. The imaging methods, instead being mutually exclusive, are complementary in the evaluation of carotid dysgenesis. (author)

Morning Glory Syndrome with Carotid and Middle Cerebral Artery Vasculopathy.

Science.gov (United States)

Nezzar, Hachemi; Mbekeani, Joyce N; Dalens, Helen

2015-12-01

To report a case of incidental asymptomatic atypical morning glory syndrome (MGS) with concomitant ipsilateral carotid and middle cerebral dysgenesis. A 6-year-old child was discovered to have incidental findings of MGS, with atypia. All visual functions were normal including vision and stereopsis. Neuroimaging revealed ipsilateral carotid and middle cerebral vascular narrowing without associated collateral vessels or cerebral ischemia commonly seen in Moyamoya disease. Subsequent annual examinations have been stable, without signs of progression. This case demonstrates disparity between structural aberrations and final visual and neurological function and reinforces the association between MGS and intracranial vascular disruption. Full ancillary ophthalmic and neuroimaging studies should be performed in all patients with MGS with interval reassessments, even when the patient is asymptomatic and functionally intact.

CrossFit-related cervical internal carotid artery dissection.

Science.gov (United States)

Lu, Albert; Shen, Peter; Lee, Paul; Dahlin, Brian; Waldau, Ben; Nidecker, Anna E; Nundkumar, Anoop; Bobinski, Matthew

2015-08-01

CrossFit is a high-intensity strength and conditioning program that has gained popularity over the past decade. Potential injuries associated with CrossFit training have been suggested in past reports. We report three cases of cervical carotid dissection that are associated with CrossFit workouts. Patient 1 suffered a distal cervical internal carotid artery (ICA) dissection near the skull base and a small infarct in Wernicke's area. He was placed on anticoagulation and on follow-up has near complete recovery. Patient 2 suffered a proximal cervical ICA dissection that led to arterial occlusion and recurrent middle cerebral artery territory infarcts and significant neurological sequelae. Patient 3 had a skull base ICA dissection that led to a partial Horner's syndrome but no cerebral infarct. While direct causality cannot be proven, intense CrossFit workouts may have led to the ICA dissections in these patients.

Carotid bifurcation calcium and correlation with percent stenosis of the internal carotid artery on CT angiography

International Nuclear Information System (INIS)

McKinney, Alexander M.; Casey, Sean O.; Teksam, Mehmet; Truwit, Charles L.; Kieffer, Stephen; Lucato, Leandro T.; Smith, Maurice

2005-01-01

The aim of this paper was to determine the correlation between calcium burden (expressed as a volume) and extent of stenosis of the origin of the internal carotid artery (ICA) by CT angiography (CTA). Previous studies have shown that calcification in the coronary arteries correlates with significant vessel stenosis, and severe calcification (measured by CT) in the carotid siphon correlates with significant (greater than 50% stenosis) as determined angiographically. Sixty-one patients (age range 50-85 years) underwent CT of the neck with intravenous administration of iodinated contrast for a variety of conditions. Images were obtained with a helical multidetector array CT scanner and reviewed on a three-dimensional workstation. A single observer manipulated window and level to segment calcified plaque from vascular enhancement in order to quantify vascular calcium volume (cc) in the region of the bifurcation of the common carotid artery/ICA origin, and to measure the extent of ICA stenosis near the origin. A total of 117 common carotid artery bifurcations were reviewed. A ''significant'' stenosis was defined arbitrarily as >40% (to detect lesions before they become hemodynamically significant) of luminal diameter on CTA using NASCET-like criteria. All ''significant'' stenoses (21 out of 117 carotid bifurcations) had measurable calcium. We found a relatively strong correlation between percent stenosis and the calcium volume (Pearson's r= 0.65, P<0.0001). We also found that there was an even stronger correlation between the square root of the calcium volume and the percent stenosis as measured by CTA (r= 0.77, P<0.0001). Calcium volumes of 0.01, 0.03, 0.06, 0.09 and 0.12 cc were used as thresholds to evaluate for a ''significant'' stenosis. A receiver operating characteristic (ROC) curve demonstrated that thresholds of 0.06 cc (sensitivity 88%, specificity 87%) and 0.03 cc (sensitivity 94%, specificity 76%) generated the best combinations of sensitivity and

Carotid Ultrasound for Assessment of Nonobstructive Carotid Atherosclerosis in Young Adults with Cryptogenic Stroke.

Science.gov (United States)

Buon, Raphael; Guidolin, Brigitte; Jaffre, Aude; Lafuma, Marie; Barbieux, Marianne; Nasr, Nathalie; Larrue, Vincent

2018-05-01

The role of nonobstructive (young adults with ischemic stroke is not well understood. In the present study, we investigated the prevalence and the ultrasonic characteristics of NOCA in a consecutive series of young adults with cryptogenic stroke (CS). Patients aged 18-54, consecutively treated in a tertiary hospital for first-ever CS (defined as an ischemic stroke without ASCOD (A: atherosclerosis; S: small-vessel disease; C: cardiac pathology; O: other causes) grade 1 potential cause) in the carotid artery territory, were prospectively enrolled. NOCA was assessed using carotid duplex ultrasonography. Of 148 patients with first-ever ischemic stroke, 70 had CS, including 44 patients with carotid CS. NOCA was found in 22 of 44 (50%) patients. All but 1 plaque were echolucent. NOCA was bilateral in 15 patients and unilateral in 7 patients. All unilateral plaques were on the symptomatic side (P = .02). Plaque thickness, plaque length, and plaque volume were greater on the symptomatic side than on the asymptomatic side (P = .001, P young adults with CS. Measurement of the plaque burden with carotid duplex may help to identify symptomatic NOCA. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Hybrid endovascular and surgical approach for mycotic pseudoaneurysms of the extracranial internal carotid artery

Directory of Open Access Journals (Sweden)

Daniela Mazzaccaro

2014-11-01

Full Text Available Objectives: Mycotic pseudoaneurysms of the extracranial internal carotid artery are rare, and their management often represents a challenge, but treatment is necessary due to the high risk of rupture and distal brain embolization. Systemic antibiotics associated with open surgical excision of the infected tissues and carotid reconstruction using autologous grafts are the treatment of choice. The use of endovascular techniques still remains controversial in infective fields; however, it can be an attractive alternative in high-risk patients or more often as a “temporary” solution to achieve immediate bleeding control for a safe surgical reconstruction. Methods: We discuss the unusual case of an extracranial right internal carotid artery mycotic pseudoaneurysm following methicillin-resistant Staphylococcus aureus infection, in a patient with poor general conditions. Results and Conclusion: The lesion was successfully treated using a hybrid endovascular and surgical procedure.

Utility of USPIO-enhanced MR imaging to identify inflammation and the fibrous cap: A comparison of symptomatic and asymptomatic individuals

International Nuclear Information System (INIS)

Howarth, S.P.S.; Tang, T.Y.; Trivedi, R.; Weerakkody, R.; U-King-Im, J.; Gaunt, M.E.; Boyle, J.R.; Li, Z.Y.; Miller, S.R.; Graves, M.J.; Gillard, J.H.

2009-01-01

Background and purpose: Inflammation is a risk factor the vulnerable atheromatous plaque. This can be detected in vivo on high-resolution magnetic resonance (MR) imaging using a contrast agent, Sinerem TM , an ultra-small super-paramagnetic iron oxide (USPIO). The aim of this study was to explore whether there is a difference in the degree of MR defined inflammation using USPIO particles, between symptomatic and asymptomatic carotid plaques. We report further on its T 1 effect of enhancing the fibrous cap, which may allow dual contrast resolution of carotid atheroma. Methods: Twenty patients with carotid stenosis (10 symptomatic and 10 asymptomatic) underwent multi-sequence MR imaging before and 36 h post-USPIO infusion. Images were manually segmented into quadrants and signal change in each quadrant was calculated following USPIO administration. Mean signal change across all quadrants were compared between the two groups. Results: Symptomatic patients had significantly more quadrants with a signal drop than asymptomatic individuals (75% vs. 32%, p < 0.01). Asymptomatic plaques had more quadrants with signal enhancement than symptomatic ones (68% vs. 25%, p < 0.05); their mean signal change was also higher (46% vs. 15%, p < 0.01) and this appeared to correlate with a thicker fibrous cap on histology. Conclusions: Symptomatic patients had more quadrants with signal drop suggesting larger inflammatory infiltrates. Asymptomatic individuals showed significantly more enhancement possibly suggesting greater stability as a result of thicker fibrous caps. However, some asymptomatic plaques also had focal areas of signal drop, suggesting an occult macrophage burden. If validated by larger studies, USPIO may be a useful dual contrast agent able to improve risk stratification of patients with carotid stenosis and inform selection for intervention.

Mandibular subluxation for distal internal carotid artery exposure in edentulous patients

NARCIS (Netherlands)

Jaspers, Gijs W.; Witjes, Max J.; van den Dungen, Jan J.; Reintsema, Harry; Zeebregts, Clark J.

2009-01-01

Four patients with high internal carotid artery (ICA) occlusive disease were indicated for surgical endarterectomy and needed additional exposure be-sides regular head rotation and extension. When indicated, in our clinic this is usually achieved by mandibular subluxation with interdental wiring.

The usefulness of carotid sinus massage in different patient groups.

Science.gov (United States)

Kumar, Narasimhan Pradeep; Thomas, Alan; Mudd, Paul; Morris, Robert O; Masud, Tahir

2003-11-01

to determine the positive yield of carotid sinus massage in different patient groups: unexplained syncope, falls, dizziness and controls. observational study. teaching hospital. we studied consecutive patients over the age of 60 years referred to the 'falls clinic' with a history of unexplained syncope, unexplained falls and unexplained dizziness. We also studied asymptomatic control subjects recruited from a general practice register aged 60 years and over. All patients and control subjects underwent a full clinical assessment (comprehensive history and detailed clinical examination including supine and erect blood pressure measurements) and 12-lead electrocardiography. We performed carotid sinus massage in the supine position for 5 seconds separately on both sides followed by repeating the procedure in the upright positions using a motorised tilt table. Heart rate and blood pressure were recorded using a cardiac monitor and digital plethysmography respectively. The test was considered positive if carotid sinus massage produced asystole with more than a 3 second pause (cardioinhibitory type of carotid sinus syndrome), or a fall in systolic blood pressure of more than 50 mmHg in the absence of significant cardioinhibition (vasodepressor type of carotid sinus syndrome) or where there was evidence of both vasodepressor and cardio-inhibition as above (mixed type). we studied 44 asymptomatic control subjects and 221 symptomatic patients (130 with unexplained syncope, 41 with unexplained falls and 50 with unexplained dizziness). In the overall symptomatic patient group, the positive yield (any type of carotid sinus syndrome) was 17.6% (95% CI = 12.7-22.5). The positive yield in men (26.3% (95% CI = 16.4-36.2)) was twice that in women (13.1% (95% CI = 7.6-18.6)) (P = 0.014). Overall any type of carotid sinus syndrome was present in 22.3% (n = 29) of the syncope group, 17.1% (n = 7) in the unexplained fallers group and 6% (n = 3) in the dizziness group. We also found that

Evaluation of Contrast MR Angiography in the Study of Internal Carotid Artery Stenosis. Systematic Review of the Literature

International Nuclear Information System (INIS)

Rodriguez Perez, P.; Martinez Cantarero, J.; Ruiz Diaz, M.; Blazquez Morera, J. A.; Llano Senaris, J. E. de

2004-01-01

To evaluate the diagnostic benefit of using contrast MR Angiography (MRA) in the study of extracranial internal carotid artery stenosis as opposed to intraarterial digital subtraction arteriography (LADSA). A search for relevant articles from 1990 to 2000 using MDLINE and EMBASE databases. Initial selection criteria: 1. articles which compare MRA and IADSA in the study of extracranial internal carotid artery stenosis; and 2, sample size of 10 or more subjects. Studies employing contrast MRA were subsequently selected. Contrast MRA diagnostic results were studied, as were those of non-contrast MRA (TOF) if included. Roc curves and 95% confidence intervals were calculated. In the studies, 324 patients and 648 extracranial internal carotid arteries were evaluated (12 articles). The diagnostic results in carotid artery stenosis discrimination using contrast MRA as opposed to IADSA were sensitivity and specificity=97.28% and 96.08%. With regard to contrast MRA vs. non-contrast MRA (TOF), significant differences favoring contrast MRA in both sensitivity and specificity were observed. (p=0.08 and p<0.001, respectively). MRA techniques demonstrate very high diagnostic capabilities in the detection of carotid stenosis, with contrast MRA being more effective than non-contrast. MRA. In spite of not being superior to IADSA, given the morbimortality risk which the latter is associated (0.7-1.2%). many authors defend contrast MRA (in association with Doppler echography) having become the method of choice for presurgical study of extracranial internal carotid artery stenosis. (Author) 53 refs

SONOlysis in prevention of Brain InfaRctions During Internal carotid Endarterectomy (SONOBIRDIE) trial - study protocol for a randomized controlled trial.

Science.gov (United States)

Hrbáč, Tomáš; Netuka, David; Beneš, Vladimír; Nosáľ, Vladimír; Kešnerová, Petra; Tomek, Aleš; Fadrná, Táňa; Beneš, Vladimír; Fiedler, Jiří; Přibáň, Vladimír; Brozman, Miroslav; Langová, Kateřina; Herzig, Roman; Školoudík, David

2017-01-17

Carotid endarterectomy (CEA) is a beneficial procedure for selected patients with an internal carotid artery (ICA) stenosis. Surgical risk of CEA varies from between 2 and 15%. The aim of the study is to demonstrate the safety and effectiveness of sonolysis (continual transcranial Doppler monitoring, TCD) using a 2-MHz diagnostic probe with maximal diagnostic energy on the reduction of the incidence of stroke, transient ischemic attack (TIA) and brain infarction detected using magnetic resonance imaging (MRI) by the activation of the endogenous fibrinolytic system during CEA. Design: a multicenter, randomized, double-blind, sham-controlled trial. international, multicenter trial for patients with at least 70% symptomatic or asymptomatic ICA stenosis undergoing CEA. patients with symptomatic or asymptomatic ICA stenosis of at least 70% are candidates for CEA; a sufficient temporal bone window for TCD; aged 40-85 years, functionally independent; provision of signed informed consent. Randomization: consecutive patients will be assigned to the sonolysis or control (sham procedure) group by computer-generated 1:1 randomization. Prestudy calculations showed that a minimum of 704 patients in each group is needed to reach a significant difference with an alpha value of 0.05 (two-tailed) and a beta value of 0.8 assuming that 10% would be lost to follow-up or refuse to participate in the study (estimated 39 endpoints). the primary endpoint is the incidence of stroke or TIA during 30 days after CEA and the incidence of new ischemic lesions on brain MRI performed 24 h after CEA in the sonolysis and control groups. Secondary endpoints are occurrence of death, any stroke, or myocardial infarction within 30 days, changes in cognitive functions 1 year post procedure related to pretreatment scores, and number of new lesions and occurrence of new lesions ≥0.5 mL on post-procedural brain MRI. descriptive statistics and linear/logistic multiple regression models will be

Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound.

Science.gov (United States)

Ali, Abid; Ashrafi, Mohammed; Zeynali, Iraj

2015-01-01

Spontaneous resolution of carotid stenosis is a phenomenon that has been described in literature in the past. At present it is not routine practise to scan patients prior to carotid endarterectomy surgery within the UK. A 58 year old female presented to hospital with a history of sudden onset headache and left sided weakness. CT head showed findings in keeping with an acute right MCA territory infarct. A duplex ultrasound scan showed echolucent material in the right internal carotid artery forming a greater than 95% stenosis. The scan was unable to visualise the patency of the vessel distally due to the position of the mandible. The patient was provisionally listed for carotid endarterectomy. An MRA was requested prior to surgery to assess the patency of the distal internal carotid artery. The MRA of the carotids showed normal appearance of the common carotid, internal and vertebral arteries with no definite stenosis. A repeat duplex ultrasound confirmed there was no significant stenosis. The finding of complete resolution of stenosis on MRA was an unexpected event. Had the initial duplex imaging allowed visualisation of the distal vessel patency, our patient would have undergone unnecessary carotid surgery with the associated morbidity and mortality. This case report draws attention to the benefits of selective preoperative scanning, in sparing patients from unnecessary surgery as a result of finding occlusion or resolution of a previously diagnosed carotid stenosis. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Quantitative study of the opticocarotid and carotid-oculomotor windows for the interpeduncular fossa, before and after internal carotid artery mobilization and posterior communicating division.

Science.gov (United States)

Kim, Young-Don; Elhadi, Ali M; Mendes, George A C; Maramreddy, Naveen; Agrawal, Abhishek; Kalb, Samuel; Nakaji, Peter; Spetzler, Robert F; Preul, Mark C

2015-03-01

The management of basilar apex (BX) aneurysms remains problematic. We quantified the surgical exposure of the BX through the opticocarotid window (OCW) and the carotid-oculomotor window (COW), before and after mobilization of the internal carotid artery and division of the posterior communicating artery (PCoA). Eleven silicone-injected cadaveric heads were dissected bilaterally. The surgical dissection was divided into 4 major steps: (1) supraorbital modified orbitozygomatic craniotomy, (2) mobilization of the internal carotid artery after drilling out the anterior clinoid process intradurally and cutting the distal dural ring, (3) drilling out the posterior clinoid process and dorsum sellae, and (4) dividing the PCoA from the posterior third portion of the vessel. A frameless navigation system was used to quantify the surgical exposure area of the BX through the OCW and COW. The total surgical area increased significantly from steps 1 to 4 (P PCoA significantly increased the overall surgical area for permanent clip application (P PCoA and height of the BX.

Internal carotid artery aneurysms, cranial nerve dysfunction and headache: the role of deformation and pulsation

Energy Technology Data Exchange (ETDEWEB)

Rodriguez-Catarino, M.; Wikholm, G.; Svendsen, P. [Interventional Neuroradiology, Sahlgrenska Hospital, Goeteborg (Sweden); Frisen, L. [Ophthalmology Dept., Sahlgrenska Hospital, Goeteborg (Sweden); Elfverson, J. [Neurosurgery Dept., Sahlgrenska Hospital, Goeteborg (Sweden); Quiding, L. [Medical Physics and Biomedical Engineering Dept., Sahlgrenska Hospital, Goeteborg (Sweden)

2003-04-01

Cranial nerve dysfunction and headache may occur with unruptured aneurysms of the cavernous and supraclinoid portions of the internal carotid artery. Nerve deformation (mass effect) and transmitted pulsations have been suggested as pathogenetic mechanisms. Differentiation may be possible by studying effects of endovascular treatment with Guglielmi detachable coils. Symptoms and signs of cranial neuropathy were retrospectively contrasted with angiographic aneurysm volumes before and after treatment in 10 patients. Mean follow-up was 36 months. Symptoms improved in three of four patients with cranial nerve dysfunction and in all patients with headache: None of the other patients, one with cranial nerve dysfunction, and three who were asymptomatic, developed any new symptoms after treatment. Aneurysm volume ranged from 0.1 to 2.7 cm{sup 3} before and 0.2 to 5.7 cm{sup 3} after treatment; the size thus increased by 15 to 110%, a change which was statistically significant (P = 0.004). The consistent increase in aneurysm volume with treatment is not associated with clinical deterioration, suggesting that deformation and displacement play a minor role in cranial neuropathy and that transmitted pulsations may be more important. (orig.)

Internal carotid artery aneurysms, cranial nerve dysfunction and headache: the role of deformation and pulsation

International Nuclear Information System (INIS)

Rodriguez-Catarino, M.; Wikholm, G.; Svendsen, P.; Frisen, L.; Elfverson, J.; Quiding, L.

2003-01-01

Cranial nerve dysfunction and headache may occur with unruptured aneurysms of the cavernous and supraclinoid portions of the internal carotid artery. Nerve deformation (mass effect) and transmitted pulsations have been suggested as pathogenetic mechanisms. Differentiation may be possible by studying effects of endovascular treatment with Guglielmi detachable coils. Symptoms and signs of cranial neuropathy were retrospectively contrasted with angiographic aneurysm volumes before and after treatment in 10 patients. Mean follow-up was 36 months. Symptoms improved in three of four patients with cranial nerve dysfunction and in all patients with headache: None of the other patients, one with cranial nerve dysfunction, and three who were asymptomatic, developed any new symptoms after treatment. Aneurysm volume ranged from 0.1 to 2.7 cm 3 before and 0.2 to 5.7 cm 3 after treatment; the size thus increased by 15 to 110%, a change which was statistically significant (P = 0.004). The consistent increase in aneurysm volume with treatment is not associated with clinical deterioration, suggesting that deformation and displacement play a minor role in cranial neuropathy and that transmitted pulsations may be more important. (orig.)

Separate origins of the left internal and external carotid arteries from the aortic arch and cervical internal carotid artery aneurysm in a patient with Noonan syndrome.

Science.gov (United States)

Tahir, Rizwan Ahmad; Asmaro, Karam; Pabaney, Aqueel; Kole, Max; Nypaver, Timothy; Marin, Horia

2017-04-01

Distinct origins of the external carotid artery and the internal carotid artery (ICA) from the aortic arch have been rarely described, and represent an aberrant development of the aortic arches during fetal life. This anatomical variation is usually discovered incidentally; infrequently, an aneurysm of the cervical ICA might accompany this rare configuration. We describe one such case in a patient with Noonan syndrome who presented with pulsatile neck mass. The diagnostic features and management of the aneurysm and a review of the literature are presented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Surgical dissection of the internal carotid artery under flow control by proximal vessel clamping reduces embolic infarcts during carotid endarterectomy.

Science.gov (United States)

Yoshida, Kazumichi; Kurosaki, Yoshitaka; Funaki, Takeshi; Kikuchi, Takayuki; Ishii, Akira; Takahashi, Jun C; Takagi, Yasushi; Yamagata, Sen; Miyamoto, Susumu

2014-01-01

To evaluate the efficacy of flow control of the internal carotid artery (ICA) by the clamping of the common carotid artery, external carotid artery, and superior thyroid artery during surgical ICA dissection to reduce ischemic complications after carotid endarterectomy (CEA). Sixty-seven patients (59 men; age, 70.5 ± 6.2 years) who underwent CEA by the same surgeon were retrospectively studied. Both conventional CEA (n = 29) and flow-control CEA (n = 38) were performed with the patient under general anesthesia and with the use of somatosensory-evoked potential and near-infrared spectroscopy monitoring as a guide for selective shunting. The number of new postoperative infarcts was assessed with preoperative and postoperative diffusion-weighted images (DWIs) obtained within 3 days of surgery. In addition to surgical technique, the effects of the following factors on new infarcts also were examined: age, side of ICA stenosis, high-grade stenosis, symptoms, and application of shunting. New postoperative DWI lesions were observed in 7 of 67 patients (10.4%), and none of them was symptomatic. With respect to operative technique, the incidence rate of DWI spots was significantly lower in the flow-control group (2.6%) than in the conventional group (20.7%), odds ratio: 0.069; 95% confidence interval: 0.006-0.779; P = 0.031). On multiple logistic regression analysis, age, side of ICA stenosis, high-grade stenosis, symptoms, and the use of internal shunting did not have significant effects on new postoperative DWI lesions, whereas technique did have an effect. The proximal flow-control technique for CEA helps avoid embolic complications during surgical ICA dissection. Copyright © 2014 Elsevier Inc. All rights reserved.

Utility of USPIO-enhanced MR imaging to identify inflammation and the fibrous cap: A comparison of symptomatic and asymptomatic individuals

Energy Technology Data Exchange (ETDEWEB)

Howarth, S.P.S. [University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ (United Kingdom); Tang, T.Y. [University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ (United Kingdom); Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge (United Kingdom); Trivedi, R.; Weerakkody, R.; U-King-Im, J. [University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ (United Kingdom); Gaunt, M.E.; Boyle, J.R. [Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge (United Kingdom); Li, Z.Y. [University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ (United Kingdom); Miller, S.R. [Biostatistics and Data Sciences, GlaxoSmithKline, Harlow (United Kingdom); Graves, M.J. [University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ (United Kingdom); Gillard, J.H. [University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ (United Kingdom)], E-mail: jhg21@cam.ac.uk

2009-06-15

Background and purpose: Inflammation is a risk factor the vulnerable atheromatous plaque. This can be detected in vivo on high-resolution magnetic resonance (MR) imaging using a contrast agent, Sinerem{sup TM}, an ultra-small super-paramagnetic iron oxide (USPIO). The aim of this study was to explore whether there is a difference in the degree of MR defined inflammation using USPIO particles, between symptomatic and asymptomatic carotid plaques. We report further on its T{sub 1} effect of enhancing the fibrous cap, which may allow dual contrast resolution of carotid atheroma. Methods: Twenty patients with carotid stenosis (10 symptomatic and 10 asymptomatic) underwent multi-sequence MR imaging before and 36 h post-USPIO infusion. Images were manually segmented into quadrants and signal change in each quadrant was calculated following USPIO administration. Mean signal change across all quadrants were compared between the two groups. Results: Symptomatic patients had significantly more quadrants with a signal drop than asymptomatic individuals (75% vs. 32%, p < 0.01). Asymptomatic plaques had more quadrants with signal enhancement than symptomatic ones (68% vs. 25%, p < 0.05); their mean signal change was also higher (46% vs. 15%, p < 0.01) and this appeared to correlate with a thicker fibrous cap on histology. Conclusions: Symptomatic patients had more quadrants with signal drop suggesting larger inflammatory infiltrates. Asymptomatic individuals showed significantly more enhancement possibly suggesting greater stability as a result of thicker fibrous caps. However, some asymptomatic plaques also had focal areas of signal drop, suggesting an occult macrophage burden. If validated by larger studies, USPIO may be a useful dual contrast agent able to improve risk stratification of patients with carotid stenosis and inform selection for intervention.

Giant cervical internal carotid artery pseudoaneurysm in a child: endovascular treatment

Energy Technology Data Exchange (ETDEWEB)

Koeroglu, M.; Arat, A.; Cekirge, S.; Akpinar, E. [Hacettepe University, Department of Radiology, 06100 Ankara (Turkey); Eryilmaz, A.; Akmansu, H. [Ankara Numune Research and Education Hospital, ENT Department, Ankara (Turkey); Koeroglu, Kale B. [Ankara Numune Research and Education Hospital, Internal Medicine Department, Ankara (Turkey)

2002-10-01

We report a child with a giant upper cervical internal carotid artery pseudoaneurysm presenting with dysphagia, respiratory distress and a sentinel mild epistaxis, then massive epistaxis. Rupture of the pseudoaneurysm during treatment occurred, as in one reported case. Prompt endovascular treatment yielded a good outcome. (orig.)

Giant cervical internal carotid artery pseudoaneurysm in a child: endovascular treatment

International Nuclear Information System (INIS)

Koeroglu, M.; Arat, A.; Cekirge, S.; Akpinar, E.; Eryilmaz, A.; Akmansu, H.; Koeroglu, Kale B.

2002-01-01

We report a child with a giant upper cervical internal carotid artery pseudoaneurysm presenting with dysphagia, respiratory distress and a sentinel mild epistaxis, then massive epistaxis. Rupture of the pseudoaneurysm during treatment occurred, as in one reported case. Prompt endovascular treatment yielded a good outcome. (orig.)

Treatment of complex internal carotid artery aneurysms using radial artery grafts. Surgical technique, perioperative complications, and results in 17 patients

International Nuclear Information System (INIS)

Murai, Yasuo; Teramoto, Akira; Mizunari, Takayuki; Kobayashi, Shiro; Kamiyama, Hiroyasu

2007-01-01

Complex giant or large internal carotid artery aneurysms present a surgical challenge because limitations and difficulty are encountered with either clipping or endovascular treatment. Our review of previous reports suggests that no current vascular assessment can accurately predict the occurrence of ischemic complications after internal carotid artery ligation. The present study concerns surgical technique, complications, and clinical outcome of radial artery grafting followed by parent artery trapping or proximal occlusion for management of these difficult lesions. Between September 1997 and October 2005, we performed radial artery grafting followed immediately by parent artery occlusion in 17 patients with giant or large complex intracranial carotid aneurysms (3 men, 14 women; mean follow-up duration, 62 months). All patients underwent postoperative digital subtraction angiography to assess graft patency and aneurysm obliteration. All 17 aneurysms were excluded from the cerebral circulation, with all radial artery grafts patent. Among 4 patients with cranial nerve disturbances, dysfunction was temporary in 5; in the others, oculomotor nerve paresis persisted. No perioperative cerebral infarction occurred. Sensory aphasia reflecting cerebral contusions caused by temporal lobe retraction resolved within 2 months, as did hemiparesis from a postoperative epidural hematoma. With appropriate attention to surgical technique, radial artery grafting followed by acute parent artery occlusion is a safe treatment for complex internal carotid artery aneurysms. Graft patency and aneurysm thrombosis were achieved in all patients. Cranial nerve dysfunction (III, VI) caused by altered blood flow from the internal carotid artery after occlusion was the most common complication and typically was temporary. In our experience with these difficult aneurysms, not only clipping but also reconstruction of the internal carotid artery was required, especially for wide-necked symptomatic

[Damage to cranial and peripheral nerves following patency restoration of the internal carotid artery].

Science.gov (United States)

Myrcha, P; Ciostek, P; Szopiński, P; Noszczyk, W

2001-01-01

The aim of the study was an assessment of the incidence of injury to cranial and peripheral nerves as complication of patency restoration of the internal carotid artery, and analysis of the effect of peripheral nerve injury on the results of carotid patency restoration. From Oct 1987 to Sept 1999 543 procedures were carried out for restoration of patency of the internal carotid artery. After the operation hypoglossus nerve injury was found in 7 cases (1.4%), vagus injury in 9 (1.8%). Signs of exclusively recurrent laryngeal nerve damage were found in 6 cases (1.2%). Glossopharyngeus nerve was damaged in 2 cases (0.4%), transient phrenic nerve palsy as a result of conduction anaesthesia was noted in 2 cases (0.4%). Damage to the transverse cervical nerve was found in 96 cases (60%). In 2 patients (1.2%) lower position of mouth angle was due to section of the mandibular ramus of the facial nerve. In another 2 cases skin sensation disturbances were a consequence of lesion of the auricularis magnus nerve and always they coexisted with signs of transverse cervical nerve damage. damage to the cranial nerves during operation for carotid patency restoration are frequent but mostly they are not connected with any health risks and often they regress spontaneously.

Installation of carotid stent in a group of patient of high surgical risk for carotid endarterectomy - Preliminary experience

International Nuclear Information System (INIS)

Gomez Hoyos, Juan Fernando; Celis Mejia, Jorge Ignacio; Yepes Sanchez, Carlos Jaime; Duque Botero, Julieta

1998-01-01

Carotid endarterectomy success in symptomatic or asymptomatic patients has been demonstrated in NASCET and ACAS studies. Although, some patients with carotid stenosis have frequently other pathologies which increase risk in endarterectomy or other surgeries like coronary bypass and aortic-iliac reconstruction. Other patients have lesions such as post surgical restenosis, fibromuscular dysplasia, radiation stenosis or tumoral disease, or stenotic lesions above jaw angle. The main objectives of this work are: to demonstrate, upon the results, that multidisciplinary management of 1 patient with symptomatic or not carotid critical stenosis. Let to select, with strict clinical criteria, those doing well with endovascular therapy. To evaluate implantation technique, peryoperatory morbidity and mortality and permeability time with implanted dispositive. In this study, the preliminary experience of the neurovascular group at the Clinica Cardiovascular Santa Maria in Medellin is presented, during an 18 months period of multidisciplinary management in 15 patients, 7 men and 8 women with critical carotid stenosis. 18 procedures were performed and 21 stents were implanted. The mean age was 66 years. All patients had 70% or greater stenotic lesions, and 93.3% were symptomatic. Twelve (80%) had contraindications to perform surgery. one asymptomatic patient (6.6%) was referred with procedure indications and two (13.3%) requested the stent implantation as their own election. the patient with fibromuscular dysplasia was treated with Wallstent (number 4) and the remaining patients were treated with Palmaz stent. technical success was 100%, 3 patients had pacemaker rhythm, one patient (6.6%) presented extra-pyramidal syndrome which responded to medical treatment in 24 hours. one patient developed right side hemiparesis with total recovery in 4 hours. One patient with a critical left carotid artery stenosis presented right side hemiparesis (3/5) and aphasia, nine months later paresis

Stenosis of calcified carotid artery detected on Panoramic Radiography

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Cho, So Yang; Oh, Won Mann; Yoon, Suk Ja; Yoon, Woong; Lee, Jae Seo; Kang, Byung Cheol [School of Dentistry, Chonnam National University, Seoul (Korea, Republic of); Palomo, Juan M. [Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland (United States)

2009-09-15

This study aimed to investigate the luminal stenosis of the internal carotid artery with calcification detected on panoramic radiographs. This study used fifty carotid arteries of 36 dental patients whose panoramic radiograph and computed tomography angiography (CTA) revealed the presence of carotid artery calcification. A neuroradiologist interpreted CTA to determine the degree of stenosis of the internal carotid arteries. The degree of stenosis was stratified in four stages; normal (no stenosis), mild stenosis (1-49%), moderate stenosis (50-69%) and severe stenosis (70-99%). Among the fifty carotid arteries with calcification detected on both panoramic radiography and CTA, 20 carotid arteries (40%) were normal, 29 carotid arteries (18%) had mild stenosis, 1 carotid artery (2%) had moderate stenosis, and there was none with severe stenosis. Sixty percent of the carotid arteries with calcification detected on both panoramic radiography and CTA had internal luminal stenosis, and two percent had moderate stenosis. When carotid atheroma is detected on panoramic radiograph, it is possible that the dental patient has luminal stenosis of the internal carotid artery.

Separate origins of the internal and external carotid arteries depicted on CT angiography: A case report

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Choi, Kwang Ho [Dept. of horacic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of); Beak, Hye Jin; Jung, Hyun Kyung [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

2015-08-15

Agenesis of the common carotid artery (CCA) is a rare congenital anomaly. We presented a rare case of unilateral congenital absence of the right CCA with separate origins of the ipsilateral internal and external carotid arteries from the brachiocephalic artery. Further, we reviewed the embryological mechanism and clinical importance of this anomaly.

Distal Marginal Stenosis: A Contributing Factor in Delayed Carotid Occlusion of a Patient With Carotid Blowout Syndrome Treated With Stent Grafts

Directory of Open Access Journals (Sweden)

Feng-Chi Chang

2010-05-01

Full Text Available Distal marginal stenosis is rarely reported to be a factor associated with poor long-term patency of patients of head and neck cancers with carotid blowout syndrome treated with stent grafts. We report a case of laryngeal cancer with rupture of the right common carotid artery. A self-expandable stent graft was deployed, but bleeding recurred. Another stent graft was deployed for the pseudoaneurysm located distal to the first stent graft. Rebleeding occurred because of pseudoaneurysm formation from reconstituted branches of the right superior thyroid artery. We performed direct percutaneous puncture of the proximal superior thyroid artery for successful embolization. Distal marginal stenosis and asymptomatic thrombosis of the carotid artery were noted at 3.5- and 5-month follow-ups, respectively. We suggest aggressive early follow-up and reintervention for distal marginal stenosis by combined antibiotic therapy and angioplasty and stenting to improve the long-term patency of stent-graft deployment for management of carotid blowout syndrome.

Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

LENUS (Irish Health Repository)

Ederle, Jörg

2010-03-20

Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.

Treatment of internal carotid artery dissections with endovascular stent placement: report of two cases

Energy Technology Data Exchange (ETDEWEB)

Lee, Deok Hee; Hur, Seung Ho; Kim, Hyeon Gak; Jung, Seung Mun; Ryu, Dae Sik; Park, Man Soo [Kangnung Hospital, Kangnung (Korea, Republic of)

2000-03-01

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of trauma-related extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpetrosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.

Clinical study of internal carotid artery occlusion

International Nuclear Information System (INIS)

Okada, Kyoko

1989-01-01

Fourteen patients with internal carotid artery (ICA) occlusion identified by cerebral angiography were studied for clinical features, computed tomographic findings, collateral circulation and risk factors. Eleven patients were males, and at age distribution it occurred more frequently in patients over 50 years to 60 years of age rather than other ages. As for the risk factors of cerebral infarction, smoking was more frequent in patients with thrombosis, and heart disease was more common in those with embolism. Stroke occurred progressively in patients with thrombosis whereas it occurred suddenly in those with embolism. The consciousness was more severely disturbed in patients with embolism than in those with thrombosis. On neuro-radiological findings, in the patients with thrombosis, the infarcted area on CT were small and emerged as deep or watershed types, and on the angiograms, occlusion at carotid bifurcation were found more frequently and the collateral circulation were well developed. In those with embolism, the infarcted areas were large and emerged as cortical types, and on the angiograms, occlusions were observed more frequently in the intracranial portion and collateral circulation were poorly developed. In many patients with thrombosis, platelet aggregation, hematocrit and blood viscosity increased, but in those with embolism did not. (author)

Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery

NARCIS (Netherlands)

Kockelkoren, Remko; Vos, Annelotte; Van Hecke, Wim; Vink, Aryan; Bleys, Ronald L A W; Verdoorn, Daphne; Mali, Willem P Th M; Hendrikse, Jeroen; Koek, Huiberdina L; de Jong, Pim A; De Vis, Jill B

2017-01-01

BACKGROUND: Intracranial internal carotid artery (iICA) calcification is associated with stroke and is often seen as a proxy of atherosclerosis of the intima. However, it was recently shown that these calcifications are predominantly located in the tunica media and internal elastic lamina (medial

En bloc resection of skull base tumor including internal carotid artery. Preoperative evaluation of cerebral blood flow

International Nuclear Information System (INIS)

Okamoto, Yoshitaka; Matsuzaki, Zensei; Kamijo, Atsushi; Ogino, Jun; Nagaseki, Yoshishige; Nukui, Hideaki; Yokomizo, Michinori; Togawa, Kiyoshi

1998-01-01

Carotid artery resection yields a possibility of cure in patients with advanced head and neck carcinoma involving the carotid artery. However, the criteria for the identification of those who are vulnerable to neurologic injury after resection have not been established. Interposition graft covered with a well-vascularized flap could minimize the rate of perioperative morbidity. Particularly, when an extensive resection of the skull base including carotid artery and sigmoid vein, is planned, extracranial-intracranial bypass should be considered to minimize the risks of neurologic morbidity, even if preresection positron emission tomography during balloon test occlusion of internal carotid artery suggested the adequacy of hemispheric collateral blood flow. In these cases, the temporary occlusion of the carotid artery is not an accurate prediction of the morbidity after permanent occlusion. (author)

Cerebro-retinal ischemia after bilateral occlusion of internal carotid artery

International Nuclear Information System (INIS)

Bogousslavsky, J.; Regli, F.

1985-01-01

Six patients with occlusion of internal carotid arteries (ICAs) were prospectively followed during a mean period of 14 months. Prior to demonstration of occlusions, four patients suffered a mild stroke, and three isolated transient ischemic attacks (TIAs) or amaurosis fugax. All patients remained alive and with an unchanged functional ability. During follow-up, one patient suffered amaurosis fugax and TIAs followed by a mild stroke, three suffered isolated TIAs or amaurosis fugax, two suffered reversible cerebro-retinal ischemia of more than 24 hours, and one remained symptomfree. In three cases, delayed cerebro-retinal ischemia distal to one of the occluded ICAs was systematically triggered by orthostatic, cardiogenic or iatrogenic hypotension, and resolved after adequate medical treatment or restoration of a functional collateral circulation by endarterectomy of a tightly stenosed ipsilateral external carotid artery (ECA), suggesting hemodynamic phenomena. In three cases, micro-emboli originating from a stump or an ulcerated ipsilateral common carotid artery and migrating through well-developed ECA collateral channels explained delayed episodes of ipsilateral TIAs or amaurosis fugax, which disappeared in two cases after adequate anticoagulant therepy was introduced. Bilateral occlusion of ICA may be a relatively benign condition, if the patients are carefully controlled and treated. (orig.)

Noninvasive characterization of carotid plaque strain.

Science.gov (United States)

Khan, Amir A; Sikdar, Siddhartha; Hatsukami, Thomas; Cebral, Juan; Jones, Michael; Huston, John; Howard, George; Lal, Brajesh K

2017-06-01

Current risk stratification of internal carotid artery plaques based on diameter-reducing percentage stenosis may be unreliable because ischemic stroke results from plaque disruption with atheroembolization. Biomechanical forces acting on the plaque may render it vulnerable to rupture. The feasibility of ultrasound-based quantification of plaque displacement and strain induced by hemodynamic forces and their relationship to high-risk plaques have not been determined. We studied the feasibility and reliability of carotid plaque strain measurement from clinical B-mode ultrasound images and the relationship of strain to high-risk plaque morphology. We analyzed carotid ultrasound B-mode cine loops obtained in patients with asymptomatic ≥50% stenosis during routine clinical scanning. Optical flow methods were used to quantify plaque motion and shear strain during the cardiac cycle. The magnitude (maximum absolute shear strain rate [MASSR]) and variability (entropy of shear strain rate [ESSR] and variance of shear strain rate [VSSR]) of strain were combined into a composite shear strain index (SSI), which was assessed for interscan repeatability and correlated with plaque echolucency. Nineteen patients (mean age, 70 years) constituting 36 plaques underwent imaging; 37% of patients (n = 7) showed high strain (SSI ≥0.5; MASSR, 2.2; ESSR, 39.7; VSSR, 0.03) in their plaques; the remaining clustered into a low-strain group (SSI routine B-mode imaging using clinical ultrasound machines. High plaque strain correlates with known high-risk echolucent morphology. Strain measurement can complement identification of patients at high risk for plaque disruption and stroke. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Nursing assistance for spring coil occlusion for the treatment of intracranial giant internal carotid artery aneurysms

International Nuclear Information System (INIS)

Ma Yugang; Mao Yanjun; Yuan Yili; Hu Yaqin; Liu Jing; Xi Juan

2010-01-01

Objective: To discuss the importance of balloon occlusion test before interventional treatment of the intracranial giant internal carotid artery aneurysms and to sum up the nursing experience in assisting the procedure. Methods: Proper perioperative nursing measures were carried out for 12 patients, who suffered from intracranial giant internal carotid artery aneurysm and underwent spring coil occlusion treatment. Nursing measures included mental care, observation of the vital signs, prevention of the complications, etc. Results: Neither death nor exacerbation of the condition occurred in all the 12 patients. The patients were discharged from the hospital with a mean hospitalization of nine days. During a follow-up period ranged from 4 months to one year, seven patients had no disagreeable feeling, one patient complained of discomfort but no abnormality was found on follow-up DSA, and disappearance of the aneurysm was observed in 4 patients. Conclusion: The monitoring of the vital signs, the prevention of the complications and the standard nursing care are the key points for ensuring a successful operation in treating intracranial giant internal carotid artery aneurysms with spring coil occlusion. (authors)

Endovascular Treatment of Unusual Multiple Aneurysms of the Internal Carotid Artery-Posterior Communicating Artery Complex

OpenAIRE

Kubo, Michiya; Kuwayama, Naoya; Hirashima, Yutaka; Ohi, Masayoshi; Takami, Masaaki; Endo, Shunro

2000-01-01

A 79-year-old female presented with subarachnoid hemorrhage due to rupture of a rare true posterior communicating artery(PCoA)aneurysm and with poor general condition. Endovascular therapy was performed in the chronic stage. Right carotid angiography just before embolization demonstrated unusual multiple aneurysms of the internal carotid artery(ICA)-PCoA complex. Superselective an-giography and aneurysmography using microcatheter revealed two separate aneurysms arising from the PCoA and the I...

Dynamics of clinical semiotics in children with pathological tortuosity of internal carotid arteries in remote period after surgical management.

Science.gov (United States)

Shoĭkhet, Ya N; Khorev, N G; Kulikova, N I; Beller, A V; Kulikov, V P; Miller, V E

2010-01-01

The present study enrolling a total of eighty-eight 4-to-16-year-old children and adolescents was aimed at detailed elaboration and formalization of clinical signs of the internal carotid artery pathological kinking syndrome. To achieve these objectives, the authors carried out a comparative analysis of clinical manifestations of the disease in the surgically treated subjects (constituting the Surgery Group comprising 43 children and adolescents) and non-operated patients (making up the Comparison Group consisting of 45 age- and gender-matched subjects). There were no baseline differences in the incidence rate of clinical syndromes and symptoms between the groups of the would-be operated and conservatively treated patients. Also studied were the remote outcomes (1-to-12-year follow up) of surgical correction for pathological tortuosity of the internal carotid artery. The incidence rate of regression of neurological symptomatology along different clinical signs after surgery was shown to vary within a wide range from 11.6% to 96.3%. Resection of the proximal portion of the internal carotid artery with re-implantation into the old ostium turned out to be clinically effective in 90.0% of cases, with the haemodynamic efficacy amounting to 83.3%. Arteriolysis of the internal carotid artery rendered a clinical effect in 75% of cases, with a haemodynamical effect thereof equalling 25.0%. The decision as to the type of a surgical intervention to perform was primarily made based on the findings of angiography of the internal carotid artery. The operation of arteriolysis did not lead to deterioration of the child's condition.

Carotid artery disease progression and related neurologic events after carotid endarterectomy.

Science.gov (United States)

Avgerinos, Efthymios D; Go, Catherine; Ling, Jennifer; Naddaf, Abdallah; Steinmetz, Amy; Abou Ali, Adham N; Makaroun, Michel S; Chaer, Rabih A

2016-08-01

During the last decade, there has been a dramatic improvement in best medical treatment for patients with vascular disease. Yet, there is a paucity of contemporary long-term data for restenosis and contralateral internal carotid artery (ICA) progression. This study assessed ipsilateral and contralateral disease progression and cerebrovascular events after carotid endarterectomy (CEA). A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed. End points were restenosis ≥50% and ≥70%, contralateral carotid disease progression (50%-69%, 70%-99%, or occlusion) and stroke. Survival analysis and Cox regression models were used to assess the effect of baseline predictors. During the 11-year study period, 1639 patients underwent 1782 CEAs (50.0% patch closure, 23.9% primary closure, 26.1% eversion, and 2.5% combined with coronary artery bypass grafting). The combined stroke/death rate was 2.6% overall and 1.8% in the asymptomatic cohort. The rate of restenosis ≥50% at 2, 5, and 10 years was 8.5%, 15.6%, 27.2%, and the rate for restenosis ≥70% was 3.4%, 6.5%, 10.2%, respectively. Restenosis ≥50% was predicted by hypertension (hazard ratio [HR], 2.09; P = .027), female gender (HR, 1.43; P = .042), and younger age (≤65 years; HR, 1.56; P = .016), but not by statins, surgical technique, symptoms, or other baseline risk factors. Restenoses remained asymptomatic in 125 of 148 (84.5%). Progression of contralateral ICA disease at 2, 5, and 10 years was estimated at 5.4%, 15.5%, and 46.8%, respectively. Contralateral progression was only predicted by smoking (HR, 1.74; P = .008). The stroke rate in patients with disease progression of the contralateral ICA was not different compared with those without progression (7.0% vs 3.3%; P = .063). Any-stroke rates at 2, 5, and 10 years were 4.6%, 7.3%, and 15.7%, respectively. Predictors were symptomatic lesion (HR, 1.48; P = .039), renal insufficiency, defined as a

Asymptomatic cervicocerebral atherosclerosis, intracranial vascular resistance and cognition: the AsIA-neuropsychology study.

Science.gov (United States)

López-Olóriz, Jorge; López-Cancio, Elena; Arenillas, Juan F; Hernández, María; Jiménez, Marta; Dorado, Laura; Barrios, Maite; Soriano-Raya, Juan José; Miralbell, Júlia; Cáceres, Cynthia; Forés, Rosa; Pera, Guillem; Dávalos, Antoni; Mataró, Maria

2013-10-01

Carotid atherosclerosis has emerged as a relevant contributor to cognitive impairment and dementia whereas the role of intracranial stenosis and vascular resistance in cognition remains unknown. This study aims to assess the association of asymptomatic cervicocerebral atherosclerosis and intracranial vascular resistance with cognitive performance in a large dementia-free population. The Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) Neuropsychology Study included 747 Caucasian subjects older than 50 with a moderate-high vascular risk (assessed by REGICOR score) and without history of neither symptomatic vascular disease nor dementia. Extracranial and transcranial color-coded duplex ultrasound examination was performed to assess carotid intima-media thickness (IMT), presence of carotid plaques (ECAD group), intracranial stenosis (ICAD group), and middle cerebral artery pulsatility index (MCA-PI) as a measure of intracranial vascular resistance. Neuropsychological assessment included tests in three cognitive domains: visuospatial skills and speed, verbal memory and verbal fluency. In univariate analyses, carotid IMT, ECAD and MCA-PI were associated with lower performance in almost all cognitive domains, and ICAD was associated with poor performance in some visuospatial and verbal cognitive tests. After adjustment for age, sex, vascular risk score, years of education and depressive symptoms, ECAD remained associated with poor performance in the three cognitive domains and elevated MCA-PI with worse performance in visuospatial skills and speed. Carotid plaques and increased intracranial vascular resistance are independently associated with low cognitive functioning in Caucasian stroke and dementia-free subjects. We failed to find an independent association of intracranial large vessel stenosis with cognitive performance. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Clinical value of MSCTA in the interventional treatment of the initial origin stenotic segment of the internal carotid artery

International Nuclear Information System (INIS)

Qi Yueyong; Zou Liguang; Chen Lin; Sun Qingrong; Shuai Jie; Zhou Zheng; Huang Lan

2007-01-01

Objective: To assess the clinical value of MSCTA in the interventional treatment of the initial origin stenotic segment of internal carotid artery. Methods: Forty two patients with stenosis of initial origin stenotic segment of internal carotid artery underwent interventional treatment and MSCTA were analyzed retrospectively. Results: Forty two patients were diagnosed correctly through MSCTA. The percentages of stenotic area were measured from the multiplanar reconstruction (MPR)images of MSCTA, including mild stenosis( 70%)in 30, obstruction in 4 (>100%)and normal in 18. Plaques and endoscopic views of stenosis were delineated on MSCTA and CTVE. Conclusion: MSCTA is an accurate method for the assessment of the stenosis and plaques of the stenotic origin segment of internal carotid artery. MSCTA can be used as a convenient follow-up modality for instent restenosis. (authors)

Extracranial internal carotid artery aneurysm: case illustration

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Zenteno Marco

2017-12-01

Full Text Available Extracranial internal carotid artery aneurysms (EICAA are uncommon lesion. These aneurysms can be classified as true or false aneurysms, atherosclerotic, dysplastic, infectious, posttraumatic and iatrogenic aneurysms. The most common presentation is central neurologic dysfunction, either a stroke or a transient ischemic attack. The rupture of these aneurysms can lead to severely impairment and can affect the quality of life of the patients or even may lead to death. Management of these lesions is required in most cases to prevent complications, however there is no treatment guideline or expert consensus for the management. We present a case of an unusual EICAA, associated with kinking of the affected vessel and review the literature.

Incidental internal carotid artery calcifications on temporal bone CT in children

International Nuclear Information System (INIS)

Koch, Bernadette; Jones, Blaise; Blackham, Aaron

2007-01-01

Incidental internal carotid artery (ICA) calcifications are occasionally noted on CT images of the brain and temporal bone. In adults, incidental calcifications have been correlated with increased incidence of hypercholesterolemia, cardiac disease, diabetes and carotid stenosis. To determine the incidence of incidental calcifications of the carotid siphon on temporal bone CT in children. We retrospectively reviewed 24 months of consecutive temporal bone CT examinations in children aged 18 years and younger. CT examinations on 663 patients were reviewed and the presence or absence of ICA calcifications was ranked as absent, questionable or definitive. In patients in whom definitive calcifications were identified, hospital charts were reviewed for evidence of diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hyperlipidemia and chronic renal disease as potential causes of early atherosclerosis. Of the 663 patients, 25% had definitive calcifications within the wall of the ICA: 6% of children younger than 2 years and 28% of children 12-19 years of age. Incidentally noted ICA calcifications are a common finding on temporal bone CT in children, most likely a physiologic response to turbulent flow at natural bends in the artery rather than secondary to underlying disease predisposing to early atherosclerotic calcification. (orig.)

Incidental internal carotid artery calcifications on temporal bone CT in children

Energy Technology Data Exchange (ETDEWEB)

Koch, Bernadette; Jones, Blaise [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Blackham, Aaron [University of Cincinnati College of Medicine, Cincinnati, OH (United States)

2007-02-15

Incidental internal carotid artery (ICA) calcifications are occasionally noted on CT images of the brain and temporal bone. In adults, incidental calcifications have been correlated with increased incidence of hypercholesterolemia, cardiac disease, diabetes and carotid stenosis. To determine the incidence of incidental calcifications of the carotid siphon on temporal bone CT in children. We retrospectively reviewed 24 months of consecutive temporal bone CT examinations in children aged 18 years and younger. CT examinations on 663 patients were reviewed and the presence or absence of ICA calcifications was ranked as absent, questionable or definitive. In patients in whom definitive calcifications were identified, hospital charts were reviewed for evidence of diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, hyperlipidemia and chronic renal disease as potential causes of early atherosclerosis. Of the 663 patients, 25% had definitive calcifications within the wall of the ICA: 6% of children younger than 2 years and 28% of children 12-19 years of age. Incidentally noted ICA calcifications are a common finding on temporal bone CT in children, most likely a physiologic response to turbulent flow at natural bends in the artery rather than secondary to underlying disease predisposing to early atherosclerotic calcification. (orig.)

[Bilateral hypoplasia of the internal carotid arteries associated with aneurysm of the right posterior communicating artery. Apropos of a case].

Science.gov (United States)

el Khamlichi, A; Amrani, F; el Azzusi, M; el Oufir, M; Khamlichi, A M

1989-01-01

The authors report a case of bilateral hypoplasia of the internal carotid arteries associated with aneurysm of the right posterior communicating artery in a 17 year old female patient. This anomaly was discovered following a meningeal haemorrhage, which recurred 18 months later, causing the patient's death. Surgical operation was refused by the patient and her family. Bilateral hypoplasia of the internal carotid arteries is a rare congenital malformation (16 cases have been reported in the literature, our case constitutes the 17th). It is distinguished from aplasia by the presence of a patent but very reduced vascular lumen, while aplasia is associated with vestiges of non-patent vessels. The mechanism of development of such a malformation is unclear: some authors have suggested secondary regression of the internal carotid artery following a phase of normal development, while others consider it to represent arrest of the development of the internal carotid artery, at a given moment in time. The frequency of associated aneurysm would be due to the haemodynamic disruption induced by the malformation, especially as parietal defects are more frequent in a malformed vasculature. Bilateral hypoplasia of the internal carotid arteries may be compatible with normal life for an indefinite period of time due to the development of a large number of collateral vessels. However, the new vasculature is threatened by rupture with meningeal haemorrhage and by acute ischaemia, which would probably involve another aetiological factor.

Stent implantation for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation

International Nuclear Information System (INIS)

Xing Ming; Yang Pengfei; Huang Qinghai; Zhao Wenyuan; Hong Bo; Xu Yi; Liu Jianmin

2012-01-01

Objective: To preliminarily evaluate the feasibility, safety and efficacy of stent placement for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation. Methods: Eleven patients with wide-necked aneurysms located at internal carotid artery bifurcation, who were encountered during the period from Jan. 2004 to Dec. 2010 in hospital, were collected. A total of 16 intracranial aneurysms were detected, of which 11 were wide-necked and were located at internal carotid artery bifurcation. The diameters of the aneurysms ranged from 2.5 mm to 18 mm. Individual stent type and stenting technique was employed for each patient. Follow-up at 1, 3, 6 and 12 months after the procedure was conducted. Results: A total of 11 different stents were successfully deployed in the eleven patients. The stents included balloon expandable stent (n=1) and self-expanding stent (n=10). According to Raymond grading for the immediate occlusion of the aneurysm, grade Ⅰ (complete obliteration) was obtained in 4, grade Ⅱ (residual neck) in 2 and grade Ⅲ (residual aneurysm) in 5 cases. No procedure-related complications occurred. At the time of discharge, the modified Rankin score was 0-1 in the eleven patients. During the follow-up period lasting for 1-108 months, all the patients were in stable condition and no newly-developed neurological dysfunction or bleeding observed. Follow-up examination with angiography (1-48 months) showed that the aneurysms were cured (no visualization) in 4 cases, improved in 2 cases and in stable condition in one case. Conclusion: For the treatment of wide-necked aneurysms located at internal carotid artery bifurcation, stent implantation is clinically feasible, safe and effective. Further studies are required to evaluate its long-term efficacy. (authors)

Colour Doppler evaluation of extracranial carotid artery in patients presenting with features of cerebrovascular disease: A clinical and radiological correlation

Directory of Open Access Journals (Sweden)

Sanjeev Sehrawat

2012-01-01

Full Text Available Aim: To evaluate the morphological and hemodynamic changes that take place in carotid arteries by colour Doppler in patients presenting with features of stroke. Background and Objectives: Cerebrovascular accidents constitute a major cause of adult mortality. The principal indication for cerebrovascular Doppler examination is stroke prevention. Colour Doppler sonography is a sensitive method for detection of atherosclerotic plaque and provides considerable information about the extent and severity of plaque as well as the resulting diminution of arterial lumen. The main strengths of sonography of carotid arteries are patient comfort, lack of risk and accuracy in detecting carotid stenosis. Material and Methods: A prospective study of Colour Doppler in carotid arteries was carried out for 12 months from 1 st July 2009 to 1 st July 2010. The study was carried out on 40 individuals, suspected of cerebrovascular insufficiency and having one or the other risk factors for cerebrovascular disease. A detailed clinical history, CNS examination findings and evidence of hypertension, diabetes mellitus, hyperlipidemia and ischemic heart disease were noted. Carotid Doppler evaluation was done by using Siemens Antares Ultrasound system. The data gathered were grey scale and Doppler findings of common carotid artery, internal carotid artery and external carotid arteries. Doppler findings were correlated with clinical features and risk factors. Results: In our study of 40 patients, the commonest lesion found was the atherosclerotic plaque. Highest incidence of plaque was seen in males 41% in the age group of 60-70 years and in females 37% in age group of 70-80 years. Cigarette smoking was the most common risk factor (60% associated with stroke/ Transient Ischaemic Attacks (TIA. Hemiparesis was the most common presenting symptom (35% among the symptomatic cases. Atheromatous plaque was most commonly found in the right carotid system (60%. Most common site for

NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis

DEFF Research Database (Denmark)

Reinhard, Henrik; Wiinberg, Niels; Hansen, Peter R

2011-01-01

for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. METHODS...... AND RESULTS: P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score=400, carotid intima...

Rupture of an internal carotid artery pseudoaneurysm after irradiation for a nasopharyngeal carcinoma. Case report

International Nuclear Information System (INIS)

Hanada, Yukiko; Nakamura, Megumi; Sasai, Hisanori; Kamakura, Aya; Sakata, Yoshiharu; Miyahara, Hiroshi

2013-01-01

The primary treatment of nasopharyngeal carcinoma (NPC) has been external radiotherapy. Rupture of an internal carotid artery (ICA) pseudoaneurysm is a rare complication of irradiation therapy for a nasopharyngeal carcinoma. A 78 years old man had a history of NPC treated with radiotherapy in 1993. He was admitted to the hospital because of epistaxis. Angiography showed an ICA pseudoaneurysm pointing medially to the nasopharynx. Coil embolization of the ICA was performed, but cerebral infarction occurred. Internal carotid artery (ICA) pseudoaneurysms are an uncommon but potentially lethal condition. Angiography is the mainstay of diagnosis of the aneurysm and planning the embolization of the ICA. We should be more aware of this complication in NPC patients. (author)

Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

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Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

1987-06-01

On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

Mycotic aneurysm of the extracranial internal carotid artery - report of a case and review of the literature

International Nuclear Information System (INIS)

Nascimento, Edilene Cristina do; Silva, Ivone Martins da

1998-01-01

The authors report a case of mycotic aneurysm of the extracranial internal carotid artery in a 4-year-old- male child, resulting from tonsillar infection. The authors relate the difficulties to initially suggest the diagnosis, stress the importance of the differential diagnosis particularly in children and describe the findings on conventional films, US colour-Doppler, CT and carotid digital subtraction angiography. (author)

Trickle Arteriography: Demonstration of Thrombi in the Origin of the Internal Carotid Artery

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Hugh, A. E.

1970-01-01

Thrombi developing within the origin of the internal carotid artery may be demonstrated by a slow trickle injection of highly concentrated contrast medium, which lingers in pools around the thrombus on the dependent wall of the vessel. With this technique thrombi have been detected which could not be visualized on conventional arteriography because they were obscured by the density of the vascular shadow produced by the forceful injection usually employed in carotid angiography. In addition, trickle arteriography is useful for assessing the position and extent of atheromatous plaques and the contrast stasis associated with them. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6 PMID:5526613

The infarction patterns and the compensatory effect of collateral circulation in patients with internal carotid artery occlusion: a correlative study

International Nuclear Information System (INIS)

Gao Honghua; Wen Jiamei; Gao Lianbo

2012-01-01

Objective: To investigate the infarction patterns and the collateral circulation in patients with internal carotid artery occlusion with diffusion-weighted imaging and DSA, to analyze the mechanism of stroke caused by internal carotid artery occlusion and to discuss the correlation between the infarction patterns and the compensatory effect of collateral circulation. Methods: A total of 45 patients with acute cerebral infarction due to DSA-confirmed unilateral internal carotid artery occlusion, who were admitted to the hospital during the period from Jan. 2009 to Sep. 2010, were enrolled in this study. Diffusion-weighted imaging and DSA were performed in all patients. The infarction regions and the findings of PCoA/ACoA were recorded, and the ipsilateral infarction patterns were evaluated. The relationship between the infarction patterns and the compensatory effect of collateral circulation was statistically analyzed. Results: The ipsilateral infarction patterns caused by internal carotid artery occlusion were classified as small cortical infarcts (84.4%), internal watershed infarcts (48.9%), territory infarcts (46.7%), posterior watershed infarcts (22.2%), anterior watershed infarcts (13.3%), perforating artery infarcts (22.2%). Among them, 23 patients had small cortical infarcts together with cerebral watershed infarcts (60.5%). No territory infarcts were found in the patients with patent ACoA (0%, P=0.013), while 91.7% of the patients showing no patent PCoA and/or ACoA had territory infarcts (11/12, p=0.003). Conclusion: Both artery-to-artery embolism and hypoperfusion with impaired emboli clearance are involved in the mechanism of ipsilateral infarctions caused by internal carotid artery occlusion. Patent ACoA can reduce the incidence of territory infarcts, and it maybe protect patients from territory infarcts. (authors)

Systematization and description of the internal carotid arteries and their main ramifications at the brain base in turtles (Trachemys scripta elegans).

Science.gov (United States)

Voll, Juliana; Campos, Rui

2016-08-01

Thirty turtle brains (Trachemys scripta elegans) were injected with latex to systematize and describe the internal carotid arteries and their main ramifications at the brain base. The internal carotid arteries had one intercarotid anastomosis. At the level of the tuber cinereum, the internal carotid artery bifurcated into its terminal branches, the rostral and the caudal branches. The rostral branch emitted the rostral choroid artery, the orbital artery, and a series of middle cerebral arteries. After giving off the last middle cerebral artery, the rostral branch continued as the rostral cerebral artery in the cerebral longitudinal fissure, and had one anastomosis with its contralateral homologous artery, the rostral communicating artery, making the first rostral closure of the cerebral arterial circle. Next, the rostral cerebral arteries anastomosed forming a rostral interhemispheric artery, making the second rostral closure of the cerebral arterial circle. The internal carotid artery, after emitting its rostral branch, continued caudally as the caudal branch. The caudal branch ran caudally along the ventral surface of the mesencephalic tegmentum, emitted the caudal cerebral artery and the mesencephalic artery, and continued caudomedially while progressively narrowing, and anastomosed with its contralateral homologous artery, forming the basilar artery. The narrower portion also emitted the trigeminal artery. The anastomosis of the caudal branches closed the cerebral arterial circle caudally. The internal carotid arteries exclusively supplied the cerebral arterial circle of the turtle. Anat Rec, 299:1090-1098, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

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Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

1987-06-01

On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

Extracranial Internal Carotid Artery Aneurysms: Report of a Ruptured Case and Review of the Literature

International Nuclear Information System (INIS)

Siablis, Dimitrios; Karnabatidis, Dimitrios; Katsanos, Konstantinos; Mastronikolis, Nikos; Zabakis, Peter; Kraniotis, Pantelis

2004-01-01

Aneurysms of the extracranial carotid arteries (ECAA) are extremely rare. Schechter et al. documented 835 cases in the literature up to 1977. One hundred and sixteen cases of ECAA have been documented in the Chinese literature since 1981, suggesting a higher prevalence of carotid aneurysmal disease in China than in the West. Four percent of all peripheral artery aneurysms are reported to be ECAA. Those arising from the internal carotid artery (EICAA) are even more rare. Two recent reviews reported 24 and 25 cases of EICAA during 21 and 17 years, respectively, the majority of them is treated surgically. Our literature review revealed only a few true EICAA managed endovascularly, but none of them with a covered stent. We describe a rare such case of ruptured atherosclerotic EICAA which was treated percutaneously

Complications and Follow-up after Unprotected Carotid Artery Stenting

International Nuclear Information System (INIS)

Hauth, Elke A.M.; Drescher, Robert; Jansen, Christian; Gissler, H. Martin; Schwarz, Michael; Forsting, Michael; Jaeger, Horst J.; Mathias, Klaus D.

2006-01-01

Purpose. This prospective study was undertaken to determine the success rate, complications, and outcome of carotid artery stenting (CAS) without the use of cerebral protection devices. Methods. During 12 months, 94 high-grade stenoses of the carotid artery in 91 consecutive patients were treated. Sixty-six (70%) of the stenoses were symptomatic and 28 (30%) were asymptomatic. Results. In all 94 carotid stenoses CAS was successfully performed. During the procedure and within the 30 days afterwards, there were 2 deaths and 3 major strokes in the 66 symptomatic patients, resulting in a combined death and stroke rate of 5 of 66 (7%). Only one of these complications, a major stroke, occurred during the procedure. In the 6-month follow-up, one additional major stroke occurred in a originally symptomatic patient resulting in a combined death and stroke rate of 6 of 66 (10%) for symptomatic patients at 6 months. No major complications occurred in asymptomatic patients during the procedure or in the 6-month follow-up period. At 6 months angiographic follow-up the restenosis rate with a degree of >50% was 3 of 49 (6%) and the rate with a degree of ≥70% was 1 of 49 (2%). Conclusions. Cerebral embolization during CAS is not the only cause of the stroke and death rate associated with the procedure. The use of cerebral protection devices during the procedure may therefore not prevent all major complications following CAS

Carotid Surgery in a District General Hospital

Science.gov (United States)

Fairgrieve, John

1981-01-01

The carotid surgical experience of Cheltenham General Hospital over a 13 year period (1968-81) is presented. This includes 42 operations for stenosis, and 12 further operations for carotid body tumour, carotid aneurysm, subclavian steal syndrome and trauma to the internal carotid artery. The operative techniques and complications are briefly discussed and reasons advanced for a more agressive approach to the problems of extra-cerebral carotid disease in this country. PMID:7185417

Flow diversion in the treatment of carotid injury and carotid-cavernous fistula after transsphenoidal surgery

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Lum, Cheemum; Ahmed, Muhammad E; Glikstein, Rafael; dos Santos, Marlise P; Lesiuk, Howard; Labib, Mohamed; Kassam, Amin B

2015-01-01

We describe a case of iatrogenic carotid injury with secondary carotid-cavernous fistula (CCF) treated with a silk flow diverter stent placed within the injured internal carotid artery and coils placed within the cavernous sinus. Flow diverters may offer a simple and potentially safe vessel-sparing option in this rare complication of transsphenoidal surgery. The management options are discussed and the relevant literature is reviewed. PMID:26015526

Approach To Unstable Plaque In Carotid Disease

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Mojdeh Ghabaee

2017-02-01

Full Text Available Risk of cerebral infarction due to thrombo emboli originating  from carotid artery disease estimated to be near 15%, and this risk  is closely associated with the severity of luminal stenosis. But at the same time characteristics  of the plaque should be taken into account for therapeutic planning when the patient is asymptomatic and the diameter of the stenosis does not reach the threshold of 70%. Search for markers of plaque vulnerability, instability, or thromboembolic potential as complementary to the degree of the luminal stenosis in stroke risk prediction should be considered .These morphologic features of carotid plaques are increasingly believed to be one of those markers that could carry further prognostic information, and early recognition of these plaques features may identify a high-risk subgroup of patients who might particularly benefit from aggressive interventions with aggressive medical treatment. Color and duplex Doppler sonography  evaluates both  morphologic and hemodynamic   abnormalitie of carotid. Echogensity, degree of stenosis and plaque surface features are essential parameters of morphological abnormality.

Clinical observations on the effect of carotid artery occlusion on cerebral blood flow mapped by xenon computed tomography and its correlation with carotid artery back pressure

International Nuclear Information System (INIS)

Steed, D.L.; Webster, M.W.; DeVries, E.J.; Jungreis, C.A.; Horton, J.A.; Sehkar, L.; Yonas, H.

1990-01-01

Xenon computed tomographic cerebral blood flow mapping was correlated with internal carotid artery stump pressures and clinical neurologic assessment during temporary internal carotid artery occlusion. One hundred fourteen patients with skull base tumors or intracranial aneurysms potentially requiring carotid resection or ligation underwent angiography, xenon CT cerebral blood flow mapping, and internal carotid artery blood pressure monitoring. The internal carotid artery was then temporarily occluded with a balloon catheter, stump pressure was measured through the catheter, and the xenon CT cerebral blood flow mapping was repeated. Adequate xenon CT cerebral blood flow was defined as greater than 30 cc/100 gm/min. All patients had normal xenon CT cerebral blood flow before internal carotid artery occlusion. During internal carotid artery occlusion, xenon CT cerebral blood flow was found to be normal (group I, 40 patients), globally reduced but still within the normal range (group II, 50 patients), or low in the distribution of the ipsilateral middle cerebral artery (group III, 13 patients). With balloon occlusion, an immediate neurologic deficit developed in 11 patients (9%) requiring deflation of the balloon preceding xenon CT cerebral blood flow measurement (group IV). In group I internal carotid artery blood pressure was 128 mm Hg. (range 85 to 171 mm Hg) with stump pressure 86 mm Hg (range 46 to 125 mm Hg). In group II internal carotid artery blood pressure was 130 mm Hg. (range 78 to 199 mm Hg), with stump pressure 86 mm Hg (range 31 to 150 mm Hg)

Multi-scale AM-FM motion analysis of ultrasound videos of carotid artery plaques

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Murillo, Sergio; Murray, Victor; Loizou, C. P.; Pattichis, C. S.; Pattichis, Marios; Barriga, E. Simon

2012-03-01

An estimated 82 million American adults have one or more type of cardiovascular diseases (CVD). CVD is the leading cause of death (1 of every 3 deaths) in the United States. When considered separately from other CVDs, stroke ranks third among all causes of death behind diseases of the heart and cancer. Stroke accounts for 1 out of every 18 deaths and is the leading cause of serious long-term disability in the United States. Motion estimation of ultrasound videos (US) of carotid artery (CA) plaques provides important information regarding plaque deformation that should be considered for distinguishing between symptomatic and asymptomatic plaques. In this paper, we present the development of verifiable methods for the estimation of plaque motion. Our methodology is tested on a set of 34 (5 symptomatic and 29 asymptomatic) ultrasound videos of carotid artery plaques. Plaque and wall motion analysis provides information about plaque instability and is used in an attempt to differentiate between symptomatic and asymptomatic cases. The final goal for motion estimation and analysis is to identify pathological conditions that can be detected from motion changes due to changes in tissue stiffness.

Endoscopic repair of an injured internal carotid artery utilizing femoral endovascular closure devices.

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Van Rompaey, Jason; Bowers, Greg; Radhakrishnan, Jay; Panizza, Benedict; Solares, C Arturo

2014-06-01

Injury to the internal carotid artery is a feared complication of endoscopic endonasal surgery of the skull base. Such an event, although rare, is associated with high morbidity and mortality. Even if bleeding is controlled, permanent neurological defects frequently persist. Many techniques have been developed to manage internal carotid artery rupture with varying degrees of success. The purpose of this study was to explore endoscopic management of arterial damage with endovascular closure devices used for a femoral arteriotomy. The ability to remotely suture a damaged artery permits the possible adaptation of this technology in managing endoscopic arterial complications. Technical note. After the creation of an endoscopic endonasal corridor in a cadaveric specimen, an arteriotomy was created at the cavernous portion of the internal carotid artery. The Angio-Seal, StarClose, and MynxGrip vascular closure devices were utilized under endoscopic guidance to repair the arteriotomy. Angiography was then done on a cadaver sutured with the StarClose. Both the Angio-Seal and StarClose were deployed quickly and appeared to provide sufficient closure of the arteriotomy. The Angio-Seal required the use of a guidewire and was longer to deploy when compared with the StarClose. The StarClose deployment was quick and facile. The MynxGrip also deployed without difficulty. The Angio-Seal and StarClose systems were both successfully deployed utilizing an endoscopic endonasal approach. The MynxGrip was the easiest to deploy and has the greatest potential to be of benefit in this application. Further studies with hemodynamic models are required to properly assess the appropriateness in this setting. NA. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

The role of contrast-enhanced ultrasound (CEUS) in visualizing atherosclerotic carotid plaque vulnerability: Which injection protocol? Which scanning technique?

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Iezzi, Roberto, E-mail: roberto.iezzi@rm.unicatt.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Petrone, Gianluigi [Institute of Pathology, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168, Rome (Italy); Ferrante, Angela [Department of Vascular Surgery, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Lauriola, Libero [Institute of Pathology, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168, Rome (Italy); Vincenzoni, Claudio [Department of Vascular Surgery, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Torre, Michele Fabio la [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Snider, Francesco [Department of Vascular Surgery, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Rindi, Guido [Institute of Pathology, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168, Rome (Italy); Bonomo, Lorenzo [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital—Catholic University, L.go A Gemelli 8, 00168 Rome (Italy)

2015-05-15

Highlights: • CEUS is a safe and efficacious technique for the identification and characterization of carotid plaque. • CEUS represents a diagnostic tool for the management of patients with carotid plaque, particularly in asymptomatic patients. • Improved diagnostic performance is achieved with the injection of 4 mL bolus of contrast-medium. • Improved diagnostic performance is achieved with the use of Dynamic Imaging rather than late-phase imaging. - Abstract: Purpose: To correlate the degree of plaque vulnerability as determined by contrast-enhanced ultrasound (CEUS) with histological findings. Secondary objectives were to optimize the CEUS acquisition technique and image evaluation methods. Materials and methods: Fifty consecutive patients, either symptomatic and asymptomatic referring to our department in order to perform carotid endarterectomy (TEA), were enrolled. Each patient provided informed consent before undergoing CEUS. Ultrasound examination was performed using high-frequency (8–14 MHz) linear probe and a non-linear pulse inversion technique (mechanical index: 0.09–1.3). A double contrast media injection (Sonovue, 2 mL and 4 mL; Bracco, Italy) was performed. Two videotapes were recorded for every injection: early “dynamic” phase and late “flash” phase, performed with 6 high mechanical index impulses. Movies were quantitatively and qualitatively evaluated. Qualitative and quantitative evaluation were statistically compared to immunohistological diagnosis of vulnerable plaque, considered as gold standard. Results: Qualitative CEUS evaluation obtained high statistical results when compared to immunohistological results, with values of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 94%, 68%, 87%, 85% and 86%, respectively, which became higher if considering only asymptomatic patient, with a NPV of 91%. Nevertheless, quantitative software evaluation proved less

Hydrocortisone supresses inflammatory activity of metalloproteinase - 8 in carotid plaque

Science.gov (United States)

Gabriel, Sthefano Atique; Antonangelo, Leila; Capelozzi, Vera Luiza; Beteli, Camila Baumann; de Camargo Júnior, Otacílio; de Aquino, José Luis Braga; Caffaro, Roberto Augusto

2015-01-01

Objective Matrix metalloproteinases are inflammatory biomarkers involved in carotid plaque instability. Our objective was to analyze the inflammatory activity of plasma and carotid plaque MMP-8 and MMP-9 after intravenous administration of hydrocortisone. Methods The study included 22 patients with stenosis ≥ 70% in the carotid artery (11 symptomatic and 11 asymptomatic) who underwent carotid endarterectomy. The patients were divided into two groups: Control Group - hydrocortisone was not administered, and Group 1 - 500 mg intravenous hydrocortisone was administered during anesthetic induction. Plasma levels of MMP-8 and MMP-9 were measured preoperatively (24 hours before carotid endarterectomy) and at 1 hour, 6 hours and 24 hours after carotid endarterectomy. In carotid plaque, tissue levels of MMP-8 and MMP-9 were measured. Results Group 1 showed increased serum levels of MMP- 8 (994.28 pg/ml and 408.54 pg/ml, respectively; P=0.045) and MMP-9 (106,656.34 and 42,807.69 respectively; P=0.014) at 1 hour after carotid endarterectomy compared to the control group. Symptomatic patients in Group 1 exhibited lower tissue concentration of MMP-8 in comparison to the control group (143.89 pg/ml and 1317.36 respectively; P=0.003). There was a correlation between preoperative MMP-9 levels and tissue concentrations of MMP-8 (P=0.042) and MMP-9 (P=0.019) between symptomatic patients in the control group. Conclusion Hydrocortisone reduces the concentration of MMP- 8 in carotid plaque, especially in symptomatic patients. There was an association between systemic and tissue inflammation. PMID:26313719

Traumatic aneurysms of the internal carotid artery at the base of the skull. Two cases treated surgically.

Science.gov (United States)

Magnan, P E; Branchereau, A; Cannoni, M

1992-01-01

Internal carotid aneurysms at the base of the skull after blunt trauma are infrequent but their management is difficult, leading many surgeons to only attempt ligation. We report 2 cases presenting with high traumatic aneurysms, following motorcycle accidents. The 2 aneurysms underwent repair by a venous graft. The petrous portion of the carotid artery was approached and controlled by an ENT surgeon. This "infratemporal" approach was used exposing the facial nerve, combined with temporary anterior sub-luxation of the temporomaxillary joint to expose the lower part of the carotid canal which was opened up with a drill in order to control the carotid artery in the petrous canal. Both patients developed facial nerve palsies which improved within 3 months. Postoperative angiography showed patent vein grafts and the patients were doing well, without any symptoms 18 and 24 months later.

Acute hemifacial ischemia as a late complication of carotid stenting

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Maurizio Domanin, MD

2017-06-01

Full Text Available Concerns about carotid artery stenting (CAS center primarily on procedural complications like acute occlusion, stroke, and long-term intrastent restenosis. External carotid artery (ECA thrombosis is observed during CAS follow-up, but it often remains asymptomatic or, at worst, results in jaw claudication. We report here a case of late occlusion of the ECA after CAS with symptoms of acute homolateral facial ischemia as well as pain, cyanosis, tongue numbness, and skin coldness. The patient was submitted to local thrombolysis and balloon angioplasty with regression of symptoms after recanalization. With this report, we add a caveat about blockage of the ECA ostium during CAS.

Shape and texture analysis of the carotid plaque, and its correlation with cerebral infarctions on CT, and cerebrovascular symptoms

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Kalomiris, Konstantinos; Tegos, Thomas J; Sabetai, Michael; Nicolaides, Andrew N [Irvine Laboratory for Cardiovascular Investigations and Research, Imperial College School of Medicine at St Mary` , Praed Street, London W2 1NY (United Kingdom)

1999-12-31

This work has studied the relationship between ultrasonic texture characteristics, ultrasonic shape characteristics, cerebral infarctions on CT, and cerebrovascular symptoms, in an attempt to identify the unstable carotid plaque, i.e. the plaque associated with high prevalence of ipsilateral cerebral infarctions on CT, and cerebrovascular symptoms. The morphological features used were : the grey scale median (GSM) for the texture, and the bending energy (BE) for the shape. It has been shown that echoluscent plaques (plaques with low GSM) with irregular shape (high BE) are associated with high prevalence of ipsilateral cerebral infarctions on CT and cerebrovascular symptoms, whereas echogenic plaques (high GSM) with smooth shape (low BE) are associated with low prevalence of ipsilateral cerebral infarctions on CT and cerebrovascular symptoms. Previous work has demonstrated the significance of the GSM in identifying the unstable carotid plaques, but no attempt, to our knowledge, has been made to establish the clinical significance of the ultrasonic shape characteristics of the carotid plaque. The importance of the ultrasonic texture and shape characteristics will be established in prospective studies of patients with asymptomatic carotid plaques, aiming at the identification of patients with a high risk for stroke, and therefore for a better selection of asymptomatic patients who might benefit from a carotid endarterectomy. (authors) 5 refs., 3 figs.

Osteoprotegerin, pericytes and bone-like vascular calcification are associated with carotid plaque stability.

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Jean-Michel Davaine

Full Text Available BACKGROUND AND PURPOSE: Vascular calcification, recapitulating bone formation, has a profound impact on plaque stability. The aim of the present study was to determine the influence of bone-like vascular calcification (named osteoid metaplasia = OM and of osteoprotegerin on plaque stability. METHODS: Tissue from carotid endarterectomies were analysed for the presence of calcification and signs of vulnerability according to AHA grading system. Osteoprotegerin (OPG, pericytes and endothelial cells were sought using immuno-histochemistry. Symptoms and preoperative imaging findings (CT-scan, MRI and Doppler-scan were analyzed. Human pericytes were cultured to evaluate their ability to secrete OPG and to influence mineralization in the plaque. RESULTS: Seventy-three carotid plaques (49 asymptomatic and 24 symptomatic were harvested. A significantly higher presence of OM (18.4% vs 0%, p<0.01, OPG (10.2% of ROI vs 3.4% of ROI, p<0.05 and pericytes (19% of ROI vs 3.8% of ROI, p<0.05 were noted in asymptomatic compared to symptomatic plaques. Consistently, circulating OPG levels were higher in the plasma of asymptomatic patients (3.2 ng/mL vs 2.5 ng/mL, p = 0.05. In vitro, human vascular pericytes secreted considerable amounts of OPG and underwent osteoblastic differentiation. Pericytes also inhibited the osteoclastic differentiation of CD14+ cells through their secretion of OPG. CONCLUSIONS: OPG (intraplaque an plasmatic and OM are associated with carotid plaque stability. Pericytes may be involved in the secretion of intraplaque OPG and in the formation of OM.

Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

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Huakun Liu

2016-01-01

Full Text Available The aim of this study was to compare the clinical outcomes of early versus delayed carotid artery stenting (CAS for symptomatic cerebral watershed infarction (sCWI patients due to stenosis of the proximal internal carotid artery. We retrospectively collected clinical data of those who underwent early or delayed CAS from March 2011 to April 2014. The time of early CAS and delayed CAS was within a week of symptom onset and after four weeks from symptom onset. Clinical data such as second stroke, the National Institutes of Health Stroke Scale (NHISS score, and modified Rankin Scale (mRS score and periprocedural complications were collected. The rate of second stroke in early CAS group is lower when compared to that of delayed CAS group. There was no significant difference regarding periprocedural complications in both groups. There was a significant difference regarding mean NHISS score 90 days after CAS in two groups. Early CAS group had a significant better good outcome (mRS score ≤ 2 than delayed CAS group. We suggest early CAS for sCWI due to severe proximal internal carotid artery stenosis as it provides lower rate of second stroke, comparable periprocedural complications, and better functional outcomes compared to that of delayed CAS.

TREATMENT OF INTERNAL CAROTID ARTERY OCCLUSION USING PROXIMAL CEREBRAL PROTECTION DEVICE AND ITS EFFECT ON THE BLOOD PRESSURE DYNAMICS. CLINICAL CASE

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F. В. Shukurov

2018-01-01

Full Text Available In 2016, according to the Ministry of Health of the Russian Federation, about 200 thousand people died from stroke. Strokes are considered as the main cause of disability of the population, causing huge economic damage to the country. One of the most common causes of ischemic stroke is atherosclerosis of the branches of the aortic arch. The most common localization of atherosclerotic plaques is the extracranial section of the carotid arteries – bifurcation and ostium of the common carotid artery and the internal carotid artery. Recanalization of occlusion of the internal carotid artery until recently was an insoluble task for interventional surgery due to the high risk of distal embolization. The invention and use of the proximal cerebral protection device, which ensure the complete cessation of blood flow, has changed the situation. Effect of carotid revascularization on arterial hypertension, due to the effect on the baroreceptors of the carotid plexus by balloon angioplasty, which leads to a reflex decrease in arterial pressure, is an additional advantage of the endovascular technique in some cases. This effect requires further study. One also needs to pay careful attention to the diagnosis and imaging of carotid artery lesions before procedure. This clinical case is the illustration that an adequate assessment of the risk factors for intraoperative complications allows to achieve maximum results of endovascular treatment.

Angiographic patterns of carotid-cavernous fistulas

International Nuclear Information System (INIS)

Georgieva, G.; Jekova, M.; Genov, P.; Hadjidekov, V.

2006-01-01

Full text: The aim of the study is to present our experience in angiographic evaluation of carotid-cavernous fistulas. 8 patients with carotid-cavernous fistula (6 men and 2 women, range of age from 15 to 62) are included in the study out of all undergone cerebral angiography for a four year period (1996 - 2000). All patients underwent CT brain examination, two out of 8 - MRI. Visualization of ipsi- and contra lateral cavernous sinus and ophthalmic vein dilatation are assessed. In all cases the communication between the internal carotid artery and the cavernous sinus has been assessed as direct. Near simultaneous visualization of the home internal carotid artery, the dilated ipsilateral cavernous sinus and dilated superior ophthalmic vein is found in 2 patients, simultaneous visualization of both cavernous sinuses - in two. In 1 patient the early visualization of the cavernous sinus through the fistula enabled visualization of ipsilateral main internal carotid artery from the contra lateral circulation through the communicating arteries.In 1 excessive contralateral cavernous sinus and contralateral superior ophthalmic vein dilatation is detected. In other 1 excessive flow to dilated ipsilateral cavernous sinus lead insufficient circulation in distal vessels. Digital subtraction Angiography remains the most suitable imaging method in carotid-cavernous fistula assessment regarding type of communication and level of following vessels morphology changes

Multi-parametric ultrasound criteria for internal carotid artery disease - comparison with CT angiography

International Nuclear Information System (INIS)

Barlinn, Kristian; Kepplinger, Jessica; Siepmann, Timo; Pallesen, Lars-Peder; Bodechtel, Ulf; Reichmann, Heinz; Puetz, Volker; Floegel, Thomas; Kitzler, Hagen H.; Alexandrov, Andrei V.

2016-01-01

The German Society of Ultrasound in Medicine (known by its acronym DEGUM) recently proposed a novel multi-parametric ultrasound approach for comprehensive and accurate assessment of extracranial internal carotid artery (ICA) steno-occlusive disease. We determined the agreement between duplex ultrasonography (DUS) interpreted by the DEGUM criteria and CT angiography (CTA) for grading of extracranial ICA steno-occlusive disease. Consecutive patients with acute cerebral ischemia underwent DUS and CTA. Internal carotid artery stenosis was graded according to the DEGUM-recommended criteria for DUS. Independent readers manually performed North American Symptomatic Carotid Endarterectomy Trial-type measurements on axial CTA source images. Both modalities were compared using Spearman's correlation and Bland-Altman analyses. A total of 303 acute cerebral ischemia patients (mean age, 72 ± 12 years; 58 % men; median baseline National Institutes of Health Stroke Scale score, 4 [interquartile range 7]) provided 593 DUS and CTA vessel pairs for comparison. There was a positive correlation between DUS and CTA (r s = 0.783, p < 0.001) with mean difference in degree of stenosis measurement of 3.57 %. Bland-Altman analysis further revealed widely varying differences (95 % limits of agreement -29.26 to 22.84) between the two modalities. Although the novel DEGUM criteria showed overall good agreement between DUS and CTA across all stenosis ranges, potential for wide incongruence with CTA underscores the need for local laboratory validation to avoid false screening results. (orig.)

Multi-parametric ultrasound criteria for internal carotid artery disease - comparison with CT angiography

Energy Technology Data Exchange (ETDEWEB)

Barlinn, Kristian; Kepplinger, Jessica; Siepmann, Timo; Pallesen, Lars-Peder; Bodechtel, Ulf; Reichmann, Heinz; Puetz, Volker [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neurology, Dresden (Germany); Floegel, Thomas [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neurology, Dresden (Germany); Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neuroradiology, Dresden (Germany); Kitzler, Hagen H. [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neuroradiology, Dresden (Germany); Alexandrov, Andrei V. [The University of Tennessee Health Science Center, Department of Neurology, Memphis, TN (United States)

2016-09-15

The German Society of Ultrasound in Medicine (known by its acronym DEGUM) recently proposed a novel multi-parametric ultrasound approach for comprehensive and accurate assessment of extracranial internal carotid artery (ICA) steno-occlusive disease. We determined the agreement between duplex ultrasonography (DUS) interpreted by the DEGUM criteria and CT angiography (CTA) for grading of extracranial ICA steno-occlusive disease. Consecutive patients with acute cerebral ischemia underwent DUS and CTA. Internal carotid artery stenosis was graded according to the DEGUM-recommended criteria for DUS. Independent readers manually performed North American Symptomatic Carotid Endarterectomy Trial-type measurements on axial CTA source images. Both modalities were compared using Spearman's correlation and Bland-Altman analyses. A total of 303 acute cerebral ischemia patients (mean age, 72 ± 12 years; 58 % men; median baseline National Institutes of Health Stroke Scale score, 4 [interquartile range 7]) provided 593 DUS and CTA vessel pairs for comparison. There was a positive correlation between DUS and CTA (r{sub s} = 0.783, p < 0.001) with mean difference in degree of stenosis measurement of 3.57 %. Bland-Altman analysis further revealed widely varying differences (95 % limits of agreement -29.26 to 22.84) between the two modalities. Although the novel DEGUM criteria showed overall good agreement between DUS and CTA across all stenosis ranges, potential for wide incongruence with CTA underscores the need for local laboratory validation to avoid false screening results. (orig.)

p.Q192R SNP of PON1 seems not to be Associated with Carotid Atherosclerosis Risk Factors in an Asymptomatic and Normolipidemic Brazilian Population Sample

Science.gov (United States)

Scherrer, Daniel Zanetti; Zago, Vanessa Helena de Souza; Vieira, Isabela Calanca; Parra, Eliane Soler; Panzoldo, Natália Baratella; Alexandre, Fernanda; Secolin, Rodrigo; Baracat, Jamal; Quintão, Eder Carlos Rocha; de Faria, Eliana Cotta

2015-01-01

Background Evidences suggest that paraoxonase 1 (PON1) confers important antioxidant and anti-inflammatory properties when associated with high-density lipoprotein (HDL). Objective To investigate the relationships between p.Q192R SNP of PON1, biochemical parameters and carotid atherosclerosis in an asymptomatic, normolipidemic Brazilian population sample. Methods We studied 584 volunteers (females n = 326, males n = 258; 19-75 years of age). Total genomic DNA was extracted and SNP was detected in the TaqMan® SNP OpenArray® genotyping platform (Applied Biosystems, Foster City, CA). Plasma lipoproteins and apolipoproteins were determined and PON1 activity was measured using paraoxon as a substrate. High-resolution β-mode ultrasonography was used to measure cIMT and the presence of carotid atherosclerotic plaques in a subgroup of individuals (n = 317). Results The presence of p.192Q was associated with a significant increase in PON1 activity (RR = 12.30 (11.38); RQ = 46.96 (22.35); QQ = 85.35 (24.83) μmol/min; p < 0.0001), HDL-C (RR= 45 (37); RQ = 62 (39); QQ = 69 (29) mg/dL; p < 0.001) and apo A-I (RR = 140.76 ± 36.39; RQ = 147.62 ± 36.92; QQ = 147.49 ± 36.65 mg/dL; p = 0.019). Stepwise regression analysis revealed that heterozygous and p.192Q carriers influenced by 58% PON1 activity towards paraoxon. The univariate linear regression analysis demonstrated that p.Q192R SNP was not associated with mean cIMT; as a result, in the multiple regression analysis, no variables were selected with 5% significance. In logistic regression analysis, the studied parameters were not associated with the presence of carotid plaques. Conclusion In low-risk individuals, the presence of the p.192Q variant of PON1 is associated with a beneficial plasma lipid profile but not with carotid atherosclerosis. PMID:26039660

Open Heart Surgery Does Not Increase the Incidence of Ipsilateral Ischemic Stroke in Patients with Asymptomatic Severe Carotid Stenosis.

Science.gov (United States)

Castaldo, John E; Yacoub, Hussam A; Li, Yuebing; Kincaid, Hope; Jenny, Donna

2017-10-01

We evaluated the incidence of perioperative stroke following the institution's 2007 practice change of discontinuing combined carotid endarterectomy and open heart surgery (OHS) for patients with severe carotid stenosis. In this retrospective cohort study, we compared 113 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both from 2007 to 2011 with data collected from 2001 to 2006 from a similar group of patients. Our aim was to assess whether the practice change led to a greater incidence of stroke. A total of 7350 consecutive patients undergoing OHS during the specified time period were screened. Of these, 3030 had OHS between 2007 and 2011 but none were combined with carotid artery surgery (new cohort). The remaining 4320 had OHS before 2007 and 44 had combined procedures (old cohort). Of patients undergoing OHS during the 10-year period of observation, 230 had severe (>80%) carotid stenosis. In the old cohort (before 2007), carotid stenosis was associated with perioperative stroke in 2.5% of cases. None of the 113 patients having cardiac procedures after 2007 received combined carotid artery surgery; only 1 of these patients harboring severe carotid stenosis had an ischemic stroke (.9%) during the perioperative period. The difference in stroke incidence between the 2 cohorts was statistically significant (P = .002). The incidence of stroke in patients with severe carotid artery stenosis undergoing OHS was lower after combined surgery was discontinued. Combined carotid and OHS itself seems to be an important risk factor for stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery

OpenAIRE

Kockelkoren, Remko; Vos, Annelotte; Van Hecke, Wim; Vink, Aryan; Bleys, Ronald L. A. W.; Verdoorn, Daphne; Mali, Willem P. Th. M.; Hendrikse, Jeroen; Koek, Huiberdina L.; de Jong, Pim A.; De Vis, Jill B.

2017-01-01

BACKGROUND: Intracranial internal carotid artery (iICA) calcification is associated with stroke and is often seen as a proxy of atherosclerosis of the intima. However, it was recently shown that these calcifications are predominantly located in the tunica media and internal elastic lamina (medial calcification). Intimal and medial calcifications are thought to have a different pathogenesis and clinical consequences and can only be distinguished through ex vivo histological analysis. Therefore...

Evaluation of the carotid artery stenosis based on minimization of mechanical energy loss of the blood flow.

Science.gov (United States)

Sia, Sheau Fung; Zhao, Xihai; Li, Rui; Zhang, Yu; Chong, Winston; He, Le; Chen, Yu

2016-11-01

Internal carotid artery stenosis requires an accurate risk assessment for the prevention of stroke. Although the internal carotid artery area stenosis ratio at the common carotid artery bifurcation can be used as one of the diagnostic methods of internal carotid artery stenosis, the accuracy of results would still depend on the measurement techniques. The purpose of this study is to propose a novel method to estimate the effect of internal carotid artery stenosis on the blood flow based on the concept of minimization of energy loss. Eight internal carotid arteries from different medical centers were diagnosed as stenosed internal carotid arteries, as plaques were found at different locations on the vessel. A computational fluid dynamics solver was developed based on an open-source code (OpenFOAM) to test the flow ratio and energy loss of those stenosed internal carotid arteries. For comparison, a healthy internal carotid artery and an idealized internal carotid artery model have also been tested and compared with stenosed internal carotid artery in terms of flow ratio and energy loss. We found that at a given common carotid artery bifurcation, there must be a certain flow distribution in the internal carotid artery and external carotid artery, for which the total energy loss at the bifurcation is at a minimum; for a given common carotid artery flow rate, an irregular shaped plaque at the bifurcation constantly resulted in a large value of minimization of energy loss. Thus, minimization of energy loss can be used as an indicator for the estimation of internal carotid artery stenosis.

Connectivity features for identifying cognitive impairment in presymptomatic carotid stenosis.

Directory of Open Access Journals (Sweden)

Chun-Jen Lin

Full Text Available Severe asymptomatic stenosis of the internal carotid artery (ICA leads to increased incidence of mild cognitive impairment (MCI likely through silent embolic infarcts and/or chronic hypoperfusion, but the brain dysfunction is poorly understood and difficult to diagnose. Thirty cognitively intact subjects with asymptomatic, severe (≥ 70%, unilateral stenosis of the ICA were compared with 30 healthy controls, matched for age, sex, cardiovascular risk factors and education level, on a battery of neuropsychiatric tests, voxel-based morphometry of magnetic resonance imaging (MRI, diffusion tensor imaging and brain-wise, seed-based analysis of resting-state functional MRI. Multivariate regression models and multivariate pattern classification (support vector machines were computed to assess the relationship between connectivity measures and neurocognitive performance. The patients had worse dizziness scores and poorer verbal memory, executive function and complex visuo-spatial performance than controls. Twelve out of the 30 patients (40% were considered to have MCI. Nonetheless, the leukoaraiosis Sheltens scores, hippocampal and brain volumes were not different between groups. Their whole-brain mean fractional anisotropy (FA was significantly reduced and regional functional connectivity (Fc was significantly impaired in the dorsal attention network (DAN, frontoparietal network, sensorimotor network and default mode network. In particular, the Fc strength at the insula of the DAN and the mean FA were linearly related with attention performance and dizziness severity, respectively. The multivariate pattern classification gave over 90% predictive accuracy of individuals with MCI or severe dizziness. Cognitive decline in stroke-free individuals with severe carotid stenosis may arise from nonselective widespread disconnections of long-range, predominantly interhemispheric non-hippocampal pathways. Connectivity measures may serve as both predictors for

Investigation into drivers of cost of stenting for carotid stenosis.

Science.gov (United States)

Rinaldo, Lorenzo; Brinjikji, Waleed; Cloft, Harry; DeMartino, Randall R; Lanzino, Giuseppe

2017-09-01

We aimed to identify factors associated with cost of carotid artery stenting (CAS). Patient and hospital characteristics affecting cost of admission for CAS were identified using the Vizient national database of hospital-reported outcomes. Patients who underwent CAS for either asymptomatic or symptomatic carotid stenosis were identified using surgical Medicare Severity-Diagnosis Related Groups and appropriate International Classification of Diseases, Ninth Revision and Tenth Revision codes. There were 166 hospitals that reported outcomes from 7369 inpatient admissions for CAS. Each institution reported a mean value for cost related to patient care per admission for CAS; the average cost across all reporting institutions was $12,834.14 (standard error of the mean [SEM], 492.88). Institutions in the lowest 25th percentile with respect to frequency of intensive care unit admission after CAS had lower cost of admission than institutions above the 75th percentile ($10,971.30 [SEM, 460.67] vs $14,992.90 [964.29]; P = .002), without any differences in incidence of stroke during admission (2.2% [SEM, 0.3] vs 2.0% [0.4]; P = .877) or 30-day readmission (1.9% [SEM, 0.4] vs 2.5 [0.6]; P = .329). Admissions for patients with symptomatic stenosis were more expensive than those with asymptomatic stenosis ($20,462.10 [SEM, 819.93] vs $11,285.20 [347.11]; P costs of admission ($14,176.20 [SEM, 597.13] vs $12,287.10 [395.73]; P care unit, symptomatic stenosis, and obesity were associated with increased costs in patients undergoing CAS. These data may aid in identifying opportunities to improve the cost-effectiveness of this procedure. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: Technical aspects, cerebral monitoring, and results

International Nuclear Information System (INIS)

Vazquez Anon, V.; Aymard, A.; Gobin, Y.P.; Casasco, A.; Rueffenacht, D.; Khayata, M.H.; Merland, J.J.; Abizanda, E.; Redondo, A.

1992-01-01

We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia; a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria included xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their aneurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permament and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated. (orig.)

Retinal artery occlusion during carotid artery stenting with distal embolic protection device.

Science.gov (United States)

Kohara, Kotaro; Ishikawa, Tatsuya; Kobayashi, Tomonori; Kawamata, Takakazu

2018-01-01

Retinal artery occlusion associated with carotid artery stenosis is well known. Although it can also occur at the time of carotid artery stenting, retinal artery occlusion via the collateral circulation of the external carotid artery is rare. We encountered two cases of retinal artery occlusion that were thought to be caused by an embolus from the external carotid artery during carotid artery stenting with a distal embolic protection device for the internal carotid artery. A 71-year-old man presented with central retinal artery occlusion after carotid artery stenting using the Carotid Guardwire PS and a 77-year-old man presented with branch retinal artery occlusion after carotid artery stenting using the FilterWire EZ. Because additional new cerebral ischaemic lesions were not detected in either case by postoperative diffusion-weighted magnetic resonance imaging, it was highly likely that the debris that caused retinal artery occlusion passed through not the internal carotid artery but collaterals to retinal arteries from the external carotid artery, which was not protected by a distal embolic protection device. It is suggested that a distal protection device for the internal carotid artery alone cannot prevent retinal artery embolisation during carotid artery stenting and protection of the external carotid artery is important to avoid retinal artery occlusion.

Efficacy of Surgical Therapy for Carotid Body Tumors

Institute of Scientific and Technical Information of China (English)

Li-shan Lian; Chang-wei Liu; Heng Guan; Yue-hong Zheng; Xing-ming Chen; Yong-jun Li

2011-01-01

Objective To evaluate the efficacy of surgical therapy for carotid body tumors.Methods A retrospective analysis was conducted,covering the diagnosis,surgical procedure,post-operative complications,and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May,2011.Results Surgical excision was successfully performed in 111 cases with 117 tumors.In all those cases,50 underwent simple tumor resection,42 underwent resection of tumors and ligation of the external carotid arteries,7 underwent co-resection of tumors and common carotid arteries,internal carotid arteries,as well as external arteries without vascular reconstruction,and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved.After operation,3 cases developed cerebral infarction,30 cases showed cranial nerve palsy,including 15 cases of hypoglossal nerve damage,10 cases of vagus paralysis,and 5 cases of Horner's syndrome.Conclusion It is essential to make a proper surgical strategy,which can reduce postoperative complications.

The Influence of Various Morphologic and Hemodynamic Carotid Plaque Characteristics on Neurological Events Onset and Deaths

Directory of Open Access Journals (Sweden)

Milan D. Brajovic

2009-01-01

Full Text Available A group of 72 patients with 111 asymptomatic carotid stenoses (ACS, mean age 65.42 ± 9.21, and a group of 36 patients with 58 symptomatic carotid stenoses (SCS, mean age 67.63 ± 8.79, were analyzed prospectively during a 3-year follow-up period. All patients underwent color duplex scan sonography (CDS, carotid arteriography, computed tomography (CT scan, and neurological examination. The aim of the study was to analyze the correlation between echo plaque morphology (degree and plaque quality, local hemodynamic plaque characteristics, ischemic CT findings, and onset of new neurological events and deaths. The results analysis showed significantly more ACS in the group of 30–49% stenosis (p < 0.001, but significantly more SCS in the group of 70–89% (p < 0.0001 and ≥90% stenosis (p < 0.05. Fibrous plaque was more frequent in the ACS group (p < 0.001, while ulcerated and mixed plaques were more frequent in the SCS group (both p < 0.0001. In the SCS group, a significantly higher frequency of increased peak systolic and end diastolic velocities was noted at the beginning and end of the study (both p < 0.01, as well as for contralateral common (CCA or internal carotid artery (ICA occlusion (p < 0.05 and p < 0.01, respectively, but reduced carotid blood flow volume (p < 0.05 only at the end of the study. In the ACS group, the best correlation with new neurological events and deaths was shown with positive CT findings, peak systolic flow velocity over 210 cm/sec, end diastolic flow velocity over 110 cm/sec, plaque stenosis ≥70%, plaque ulceration, mixed plaque (all p < 0.0001; stenosis ≥50% (p < 0.001; and reduced carotid blood flow volume (p < 0.05.

Emergency embolization in the treatment of intractable epistaxis resulted from carotid arterial disease

International Nuclear Information System (INIS)

Sun Zengtao; Liu Yanjun; Chao Baoting; Tang Jun; Liu Zuoqin; Chen Jie; Shang Jianqiang; Zhang Lei; Li Jijun

2012-01-01

Objective: To evaluate the clinical value of internal carotid artery occlusion in treatment of intractable epistaxis caused by carotid artery siphon traumatic lesions. Methods: A total of 37 patients with intractable epistaxis caused by traumatic carotid artery siphon pseudoaneurysm or carotid cavernous fistula were retrospectively analyzed. All the patients underwent embolization from October 1998 to June 2010, including 34 men and 3 women with the age ranged from 25 to 65 years and a average of 40 years. Only lesions were occluded in 12 cases without involving the internal carotid artery, while occlusions of internal carotid artery were performed in the rest 25 cases. Results: Thirty-six patients were cured without recurrent hemorrhage after embolization. Only 1 patient with carotid artery occlusion died 48 hours after operation. Conclusion: For patients with carotid arterial intractable epistaxis, if the elimination of the lesions is not applicable and the collateral circulation of Willis ring has a good compensation, the use of detachable balloon or coil occlusion of ipsilateral internal carotid artery is a quick and easy method to save patients' lives. (authors)

MRA of the intracranial circulation in asymptomatic patients with sickle cell disease

International Nuclear Information System (INIS)

Gillams, A.R.; McMahon, L.; Weinberg, G.; Carter, A.P.

1998-01-01

Background. MR angiography (MRA) provides a mechanism for non-invasively studying blood flow, thus providing a new opportunity to study the intracranial circulation in asymptomatic sickle cell disease (SCD) patients. Although conventional angiography is the gold standard for the depiction of vascular anatomy, this is too invasive for an asymptomatic population. Objective. To establish the range of appearances in asymptomatic SCD patients and to correlate brain MRI results (either sub-clinical abnormalities or normal brain parenchyma) with the MRA findings. Materials and methods. Brain MRI and MRA of the intracranial circulation was performed on 22 patients (13 male and 9 female, median age 7.5 years, range 1.3-20 years). Fourteen were homozygous SS and eight were SC. The median haematocrit at the time of MRI was 25.9 (range 13.8-33.3). Results. On MR imaging, four patients had infarcts in eight vascular territories (six anterior and two posterior). In 3/4 of anterior vascular territories with infarction, long (≥ 6 mm) segments of abnormal signal were seen at the internal carotid artery bifurcation with associated reduced distal flow. Short focal areas of abnormal signal were commonly seen where vessels branched, bifurcated or curved and were not associated with infarcts. These areas probably represent turbulence-related dephasing secondary to high velocity flow found in SCD. Conclusion. Long segments (≥ 6 mm) of abnormal signal with reduced distal flow correlated with sub-clinical infarction. (orig.)

Supraorbital cutaneous blood flow rate during carotid endarterectomy

DEFF Research Database (Denmark)

Hove, Jens D; Rosenberg, Iben; Sejrsen, Per

2006-01-01

: The supraorbital cutaneous blood flow rate was measured by the application of heat to the skin and following the subsequent dissipation of the heat in seven patients undergoing carotid endarterectomy. At the same time, the oxygenation in the right and left frontal region was monitored by near-infrared spectroscopy......BACKGROUND: The supraorbital skin region is supplied by the supraorbital artery, which is a branch of the internal carotid artery. The supraorbital cutaneous blood flow rate may therefore be influenced by changes in the internal carotid artery flow during carotid endarterectomy. METHODS...... (NIRS). RESULTS: During cross-clamping of the carotid artery, the ipsilateral NIRS-determined frontal oxygenation tended to decrease [67 +/- 13% to 61 +/- 11% (P = 0.06); contralateral 68 +/- 11% to 66 +/- 8%] as did the supraorbital cutaneous blood flow rate from 56 +/- 23 to 44 +/- 7 ml 100 g(-1) min...

Guidelines for patient selection and performance of carotid artery stenting.

Science.gov (United States)

Bladin, Christopher; Chambers, Brian; New, Gishel; Denton, Michael; Lawrence-Brown, Michael

2010-06-01

The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS. We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC). Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and

Internal Carotid Artery Aneurysms Presenting with Epistaxis - Our Experience and Review of Literature.

Science.gov (United States)

Garg, Kanwaljeet; Gurjar, Hitesh Kumar; Singh, Pankaj Kumar; Singh, Manmohan; Chandra, P Sarat; Sharma, Bhawani Shankar

Intracranial internal carotid artery aneurysms are an extremely rare cause of spontaneous epistaxis, with a few documented cases. The management of such cases is challenging due to the relative anatomical inaccessibility of the bleeding point. The aim of the present study was to acquaint the readers with this rare type of aneurysm presenting with epistaxis and to report our experience of treating cases of severe epistaxis due to internal carotid artery (ICA) aneurysms. Data of 4 patients with İCA aneurysms presenting with epistaxis from June 2011 to July 2013 was retrospectively reviewed. The age of patients ranged from 16 to 62 years. Duration of epistaxis ranged from 3 months to 3 years. Two patients had severe epistaxis following transnasal biopsy. Two patients had a history of trauma. Two patients developed hemodynamically instability. All the patients were managed with trapping of the aneurysm. Complete exclusion of aneurysm from circulation was achieved in all the patients. ICA aneurysms can rarely present as life-endangering epistaxis. In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Trapping of the aneurysm is a good option if there is good cross circulation.

Angiographic diagnosis of the carotid artery pseudoaneurysm

International Nuclear Information System (INIS)

Qi Yueyong; Zou Liguang; Dai Shuhua; Tan Yinghui; Li Zhongyu; Zhou Zheng

2004-01-01

Objective: To create a further understanding of the angiographic features of the carotid artery pseudoaneurysm (CAPA) and to explore the clinical diagnostic value of angiography. Methods: Sixteen cases of CAPA with clinical and angiographic data were analyzed retrospectively. The angiographic appearances in all of the patients were observed dynamically and precisely with a double blind method by two experienced radiologists together and formed a consensus interpretation. Results: Angiography provided a definite diagnosis for all cases. The parent arteries included the common carotid artery (1 case), common carotid artery bifurcation (9 cases), internal carotid artery (5 cases) and external carotid artery (1 case). The angiographic features of the CAPA were: All cases showed the contrast media retension in the aneurysms; turbulent flow within aneurysm in 9 cases; the 'jetting sign' at the leak of the parent artery in 7 cases; increase angulation of the bifurcation of internal and external carotid arteries in 12 cases. Conclusions: Angiography is the most valuable examination method in diagnosis of CAPA, and it can not only provide definite diagnosis, but also play an important role in selection of therapeutic plan. (authors)

Acetazolamide stimulation test in patients with unilateral internal carotid artery stenosis using Tc-99m HMPAO SPECT and transcranial doppler sonography

Energy Technology Data Exchange (ETDEWEB)

Hyun, I. Y.; Na, J. H. [Inha University Hospital, Incheon (Korea, Republic of)

2007-07-01

We compared perfusion reserve by acetazolamide (ACZ) challenged brain perfusion SPECT and cerebral vasoreactivity (CVR) by transcranial Doppler sonography (TCD) in patients with unilateral internal carotid artery stenosis. This study was conducted prospectively in 37 consecutive patients with angiographically proven unilateral internal carotid artery stenosis (stenosis> 50%). We estimated % CVR (100? {l_brace}post-ACZ mean velocity (cm/sec) - Pre-ACZ mean velocity (cm/sec){r_brace} / pre-ACZ mean velocity) by TCD. The % CVR was compared with perfusion reserve of SPECT. The % CVR of MCA and ICA was significantly decreased in the ipsilateral side to the carotid stenosis (p<0.05). The CVR impairment was more severe when cerebral infarct is already developed (p<0.01). There was a significant correlation between the degree of carotid stenosis and the CVR (p<0.01). In the area of impaired perfusion reserve on the SPECT, the estimated CVR by TCD was significantly lower (p<0.05), even to the negative value, implying that there is actually steal phenomenon in that area. ACZ challenge can actually decrease cerebral blood flow in the area of impaired perfusion reserve on brain SPECT. So we should be very cautiously performing in ACZ challenge especially when there is a severe carotid stenosis because there is a possibility of developing hemodynamic stroke.

Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial.

Science.gov (United States)

Lal, Brajesh K; Beach, Kirk W; Roubin, Gary S; Lutsep, Helmi L; Moore, Wesley S; Malas, Mahmoud B; Chiu, David; Gonzales, Nicole R; Burke, J Lee; Rinaldi, Michael; Elmore, James R; Weaver, Fred A; Narins, Craig R; Foster, Malcolm; Hodgson, Kim J; Shepard, Alexander D; Meschia, James F; Bergelin, Robert O; Voeks, Jenifer H; Howard, George; Brott, Thomas G

2012-09-01

In the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), the composite primary endpoint of stroke, myocardial infarction, or death during the periprocedural period or ipsilateral stroke thereafter did not differ between carotid artery stenting and carotid endarterectomy for symptomatic or asymptomatic carotid stenosis. A secondary aim of this randomised trial was to compare the composite endpoint of restenosis or occlusion. Patients with stenosis of the carotid artery who were asymptomatic or had had a transient ischaemic attack, amaurosis fugax, or a minor stroke were eligible for CREST and were enrolled at 117 clinical centres in the USA and Canada between Dec 21, 2000, and July 18, 2008. In this secondary analysis, the main endpoint was a composite of restenosis or occlusion at 2 years. Restenosis and occlusion were assessed by duplex ultrasonography at 1, 6, 12, 24, and 48 months and were defined as a reduction in diameter of the target artery of at least 70%, diagnosed by a peak systolic velocity of at least 3·0 m/s. Studies were done in CREST-certified laboratories and interpreted at the Ultrasound Core Laboratory (University of Washington). The frequency of restenosis was calculated by Kaplan-Meier survival estimates and was compared during a 2-year follow-up period. We used proportional hazards models to assess the association between baseline characteristics and risk of restenosis. Analyses were per protocol. CREST is registered with ClinicalTrials.gov, number NCT00004732. 2191 patients received their assigned treatment within 30 days of randomisation and had eligible ultrasonography (1086 who had carotid artery stenting, 1105 who had carotid endarterectomy). In 2 years, 58 patients who underwent carotid artery stenting (Kaplan-Meier rate 6·0%) and 62 who had carotid endarterectomy (6·3%) had restenosis or occlusion (hazard ratio [HR] 0·90, 95% CI 0·63-1·29; p=0·58). Female sex (1·79, 1·25-2·56), diabetes (2·31, 1·61-3·31

Visual Hallucinations in a Patient with Horner's Syndrome Secondary to Internal Carotid Dissection

OpenAIRE

Amardeep Singh; Panteleimon Mortzos; Torben Lykke Sørensen

2014-01-01

A 67-year-old female presented with post-ganglionic Horner's syndrome. In addition to the classical symptoms of Horner's syndrome, the patient reported experiencing frightening complex visual and auditory hallucinations on two different occasions. Magnetic resonance angiography of the cerebrum, neck and upper thorax revealed internal carotid dissection. The symptoms and hallucinatory experiences resolved soon after antiplatelet therapy was commenced. We propose peduncular hallucinosis as the ...

Severe ipsilateral carotid stenosis and middle cerebral artery disease in lacunar ischaemic stroke: innocent bystanders?

Science.gov (United States)

Mead, G E; Lewis, S C; Wardlaw, J M; Dennis, M S; Warlow, C P

2002-03-01

Lacunar infarcts are thought to be mostly due to intracranial small vessel disease. Therefore, when a stroke patient with a relevant lacunar infarct does have severe ipsilateral internal carotid artery (ICA) or middle cerebral artery (MCA) disease, it is unclear whether the arterial disease is causative or coincidental. If causative, we would expect ICA/MCA disease to be more severe on the symptomatic side than on the asymptomatic side. Therefore, our aim was to compare the severity of ipsilateral with contralateral ICA and MCA disease in patients with lacunar ischaemic stroke. We studied 259 inpatients and outpatients with a recent lacunar ischaemic stroke and no other prior stroke. We used carotid Duplex ultrasound and transcranial Doppler (TCD) ultrasound to identify ICA and MCA disease, and compared our results with previously published data. In our study, there was no difference between the severity of ipsilateral and contralateral ICA stenosis within individuals (median difference 0%, Wilcoxon paired data p=0.24, comparing severity of ipsilateral and contralateral stenosis). The overall prevalence of severe ipsilateral stenosis was 5%, and the prevalence of severe contralateral stenosis was 4% (OR 1.6, 95% CI 0.6, 4.8). There was no difference in the prevalence of ipsilateral and contralateral MCA disease. A systematic review of the other available studies strengthened this conclusion. Carotid stenosis in patients with a lacunar ischaemic stroke may be coincidental. Further studies are required to elucidate the causes of lacunar stroke, and to evaluate the role of carotid endarterectomy.

Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience.

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Mpotsaris, Anastasios; Kabbasch, Christoph; Borggrefe, Jan; Gontu, Vamsi; Soderman, Michael

2017-04-01

Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre. Methods This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015. Results A total of 63 patients with a median age of 67 years (range 33-84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1-29). Median time from stroke onset to recanalization was 408 minutes (range 165-1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15-202 minutes] vs. 130 minutes [range 60-280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of ≥2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0-2) after three months. Conclusions Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high

Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease

DEFF Research Database (Denmark)

Anand, Sonia S; Bosch, Jackie; Eikelboom, John W

2018-01-01

BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. METHODS: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were...... recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective...... evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1...

Carotid Stenting with Distal Protection in High-Surgical-Risk Patients: One-Year Results of the ASTI Trial

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Bosiers, Marc, E-mail: marc.bosiers@telenet.be [A.Z. Sint-Blasius, Department of Vascular Surgery (Belgium); Scheinert, Dierk, E-mail: dierk.scheinert@gmx.de [Park Hospital, Center for Vascular Medicine-Angiology and Vascular Surgery (Germany); Mathias, Klaus, E-mail: k.mathias@asklepios.com [Klinikum Dortmund GmbH (Germany); Langhoff, Ralf, E-mail: ralf.langhoff@sankt-gertrauden.de [Sankt Gertrauden-Krankenhaus (Germany); Mudra, Harald, E-mail: haraldmudra@aol.com [Klinikum Neuperlach (Germany); Diaz-Cartelle, Juan, E-mail: juan.diazcartelle@bostonscientific.com [One Boston Scientific Place, Boston Scientific Corporation (United States)

2015-04-15

PurposeThis prospective, multicenter, nonrandomized study evaluated the periprocedural and 1-year outcomes in high-surgical-risk patients with carotid artery stenosis treated with the Adapt Carotid Stent plus FilterWire EZ distal protection catheter (Boston Scientific Corporation, Natick, MA).Materials and MethodsThe study enrolled 100 patients (32 symptomatic, 63 asymptomatic, 5 unknown) at high risk for carotid endarterectomy due to prespecified anatomical criteria and/or medical comorbidities. Thirty-day and 1-year follow-up included clinical evaluation, carotid duplex ultrasound, and independent neurologic and NIH stroke scale assessments. One-year endpoints included the composite rate of major adverse events (MAE), defined as death, stroke, and myocardial infarction (MI) and the rates of late ipsilateral stroke (31–365 days), target lesion revascularization, and in-stent restenosis.ResultsOf the 100 enrolled patients, technical success was achieved in 90.9 % (90/99). The 30-day MAE rate (5.1 %) consisted of major stroke (2.0 %) and minor stroke (3.1 %); no deaths or MIs occurred. The 1-year MAE rate (12.2 %) consisted of death, MI, and stroke rates of 4.4, 3.3, and 8.9 %, respectively. Late ipsilateral stroke (31–365 days) rate was 1.1 %. Symptomatic patients had higher rates of death (11.1 vs. 1.7 %) and MI (7.4 vs. 1.7 %), but lower rates of major (7.4 vs. 10.0 %) and minor stroke (0.0 vs. 6.7 %), compared with asymptomatic patients.ConclusionResults through 1 year postprocedure demonstrated that carotid artery stenting with Adapt Carotid Stent and FilterWire EZ is safe and effective in high-risk-surgical patients.

Carotid Stenting with Distal Protection in High-Surgical-Risk Patients: One-Year Results of the ASTI Trial

International Nuclear Information System (INIS)

Bosiers, Marc; Scheinert, Dierk; Mathias, Klaus; Langhoff, Ralf; Mudra, Harald; Diaz-Cartelle, Juan

2015-01-01

PurposeThis prospective, multicenter, nonrandomized study evaluated the periprocedural and 1-year outcomes in high-surgical-risk patients with carotid artery stenosis treated with the Adapt Carotid Stent plus FilterWire EZ distal protection catheter (Boston Scientific Corporation, Natick, MA).Materials and MethodsThe study enrolled 100 patients (32 symptomatic, 63 asymptomatic, 5 unknown) at high risk for carotid endarterectomy due to prespecified anatomical criteria and/or medical comorbidities. Thirty-day and 1-year follow-up included clinical evaluation, carotid duplex ultrasound, and independent neurologic and NIH stroke scale assessments. One-year endpoints included the composite rate of major adverse events (MAE), defined as death, stroke, and myocardial infarction (MI) and the rates of late ipsilateral stroke (31–365 days), target lesion revascularization, and in-stent restenosis.ResultsOf the 100 enrolled patients, technical success was achieved in 90.9 % (90/99). The 30-day MAE rate (5.1 %) consisted of major stroke (2.0 %) and minor stroke (3.1 %); no deaths or MIs occurred. The 1-year MAE rate (12.2 %) consisted of death, MI, and stroke rates of 4.4, 3.3, and 8.9 %, respectively. Late ipsilateral stroke (31–365 days) rate was 1.1 %. Symptomatic patients had higher rates of death (11.1 vs. 1.7 %) and MI (7.4 vs. 1.7 %), but lower rates of major (7.4 vs. 10.0 %) and minor stroke (0.0 vs. 6.7 %), compared with asymptomatic patients.ConclusionResults through 1 year postprocedure demonstrated that carotid artery stenting with Adapt Carotid Stent and FilterWire EZ is safe and effective in high-risk-surgical patients

Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature.

Science.gov (United States)

Tveita, Ingrid Aune; Madsen, Martin Ragnar Skjerve; Nielsen, Erik Waage

2017-06-02

We present a report of a patient with blunt trauma and mandibular fractures who developed a significant cerebral infarction due to an initially unrecognized injury of her left internal carotid artery. We believe that increased knowledge of this association will facilitate early recognition and hence prevention of a devastating outcome. A 41-year-old ethnic Norwegian woman presented to our Emergency Room after a bicycle accident that had caused a direct blow to her chin. At admittance, her Glasgow Coma Scale was 15. Initial trauma computed tomography showed triple fractures of her mandible, but no further pathology. She was placed in our Intensive Care Unit awaiting open reduction of her mandibular fractures. During the following 9 hours, she showed recurrent episodes of confusion and a progressive right-sided hemiparesis. Repeated cerebral computed tomography revealed no further pathology compared to the initial scan. She had magnetic resonance angiography 17 hours after admittance, which showed dissection and thrombus formation in her left internal carotid artery, total occlusion of her left medial cerebral artery, and left middle cerebral artery infarction was detected. Carotid artery dissection is a rare but life-threatening condition that can develop after trauma to the head and neck. There should be a high index of suspicion in patients with a mechanism of injury that places the internal carotid artery at risk because blunt vascular injury may show delayed onset with no initial symptoms of vascular damage. By implementing an algorithm for early detection and treatment of these injuries, serious brain damage may be avoided.

Carotid endarterectomy in patients with occlusion of the contralateral carotid artery. Perioperative risk and late results

DEFF Research Database (Denmark)

Sillesen, H; Schroeder, T; Rasmussen, L

1987-01-01

severe strokes when compared to patients with only minor reduction in CPP. In addition, the internal carotid artery blood flow following endarterectomy was significantly higher in the low pressure group (P less than 0.02). No patients were lost during follow-up, for a mean of 34 months. The cumulative....... Compared with a complication rate of about 5% previously reported from this institution, this clearly indicates contralateral carotid occlusion as a major risk factor in carotid surgery. Though not statistically significant, patients with severely reduced cerebral perfusion pressure (CPP) had suffered more...

Quantitative evaluation of the structure and function of the common carotid artery in hypertriglyceridemic subjects using ultrasound radiofrequency-data technology

International Nuclear Information System (INIS)

Dan, Hai-Jun; Wang, Yan; Sha, Hai-Jing; Wen, Shu-Bin

2012-01-01

Assessment of the properties of blood-vessel walls by ultrasound radiofrequency (RF)-data technology is an innovative technique. We quantitatively evaluated the intima-media thickness (IMT) and arterial elasticity of the common carotid artery (CCA) in asymptomatic subjects with hypertriglyceridemia (HTG) using RF-data technology. Thirty HTG subjects and 30 matched controls were enrolled in the study. The common carotid arterial systolic diameter, diastolic diameter, IMT, carotid distensibility (CD), local pulse wave velocity (PWVβ), and stiffness (β) were compared between the two groups, as was the correlation between triglyceride level and the parameters mentioned above. The HTG group had significantly higher values of CCA-IMT compared with the control group (p 0.05). The level of triglycerides had significant positive correlations with CCA-IMT (r = 0.493, p < 0.001), whereas significant correlations with CD, PWVβ, and β were not observed in the HTG group. Ultrasound RF-data technology can be used to non-invasively and quantitatively detect the change in the structure and function of the CCA in asymptomatic HTG subjects for evaluating preclinical atherosclerosis.

Comparative analysis of conventional and eversion carotid endarterectomy: Prospective randomized study

Directory of Open Access Journals (Sweden)

Marković Dragan M.

2008-01-01

Full Text Available INTRODUCTION Studies completed in the last decade of the 20th century showed benefits of carotid endarterectomy in the prevention of stroke in patients with a high-grade stenosis of the internal carotid artery. OBJECTIVE The aim of this prospective, randomized study was the comparison of early and long-term results between the conventional and eversion carotid endarterectomy, and literature review. METHOD By the method of random choice, 103 patients were operated on using the eversion carotid endarterectomy and 98 patients using the conventional technique. Operative treatment was carried out under general anaesthesia. Following the clammping of the carotid artery, retrograde blood pressure was determined by a direct puncture of the internal carotid artery above the stenotic lesions. In patients with retrograde pressure below 20 mm Hg intraluminal shunting was routinely performed. Early results were estimated (during the first seven postoperative days based on mortality, central neurological complications (stroke, TIA and cranial or cervical nerve lesions. Long-term results were estimated (after at least two years based on long-term survival rate, central neurological complications (stroke, TIA and the incidence of haemodynamically significant restenosis of the carotid artery treated by endarterectomy. RESULTS The average time of clamming of the internal carotid artery in the eversion carotid anderectomy group was 5.36 minutes shorter than in the group treated by the conventional technique. Student's t-test showed a statistically highly significant difference in the time needed for clamming of the internal carotid artery between the two groups. The average duration of eversion endarterectomy (82 minutes was most often 19 minutes shorter than the duration of the conventional endarterectomy (101 minutes. Student's t-test showed a statistically highly significant difference in the average length of surgeries. The distal intimal fixation was more

Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease.

Science.gov (United States)

Hartkamp, Nolan S; Petersen, Esben T; Chappell, Michael A; Okell, Thomas W; Uyttenboogaart, Maarten; Zeebregts, Clark J; Bokkers, Reinoud Ph

2017-01-01

Collateral blood flow plays a pivotal role in steno-occlusive internal carotid artery (ICA) disease to prevent irreversible ischaemic damage. Our aim was to investigate the effect of carotid artery disease upon cerebral perfusion and cerebrovascular reactivity and whether haemodynamic impairment is influenced at brain tissue level by the existence of primary and/or secondary collateral. Eighty-eight patients with steno-occlusive ICA disease and 29 healthy controls underwent MR examination. The presence of collaterals was determined with time-of-flight, two-dimensional phase contrast MRA and territorial arterial spin labeling (ASL) imaging. Cerebral blood flow and cerebrovascular reactivity were assessed with ASL before and after acetazolamide. Cerebral haemodynamics were normal in asymptomatic ICA stenosis patients, as opposed to patients with ICA occlusion, in whom the haemodynamics in both hemispheres were compromised. Haemodynamic impairment in the affected brain region was always present in symptomatic patients. The degree of collateral blood flow was inversely correlated with haemodynamic impairment. Recruitment of secondary collaterals only occurred in symptomatic ICA occlusion patients. In conclusion, both CBF and cerebrovascular reactivity were found to be reduced in symptomatic patients with steno-occlusive ICA disease. The presence of collateral flow is associated with further haemodynamic impairment. Recruitment of secondary collaterals is associated with severe haemodynamic impairment.

Biological signatures of asymptomatic extra- and intracranial atherosclerosis: the Barcelona-AsIA (Asymptomatic Intracranial Atherosclerosis) study.

Science.gov (United States)

López-Cancio, Elena; Galán, Amparo; Dorado, Laura; Jiménez, Marta; Hernández, María; Millán, Mónica; Reverté, Silvia; Suñol, Anna; Barallat, Jaume; Massuet, Anna; Alzamora, Maria Teresa; Dávalos, Antonio; Arenillas, Juan Francisco

2012-10-01

Intracranial atherosclerotic disease (ICAD) remains a challenge for stroke primary and secondary prevention. Molecular pathways involved in the development of ICAD from its asymptomatic stages are largely unknown. In our population-based study, we aimed to compare the risk factor and biomarker profiles associated with intracranial and extracranial asymptomatic cerebral atherosclerosis. The Asymptomatic Intracranial Atherosclerosis (AsIA) study cohort includes a random sample population of 933 white subjects >50 years with a moderate to high vascular risk (based on REGICOR score) and without a history of stroke (64% males; mean age, 66 years). Carotid and intracranial atherosclerosis were screened by cervical and transcranial color-coded Duplex ultrasound, being moderate to severe stenoses confirmed by MR angiography. We registered clinical and anthropometric data and created a biobank with blood samples at baseline. A panel of biomarkers involved in atherothrombogenesis was determined: C-reactive protein, asymmetric-dimethylarginine, resistin, and plasminogen activator inhibitor-1. Insulin resistance was quantified by Homeostasis Model Assessment index. After multinomial regression analyses, male sex, hypertension, smoking, and alcoholic habits were independent risk factors of isolated extracranial atherosclerotic disease. Diabetes and metabolic syndrome conferred a higher risk for ICAD than for extracranial atherosclerotic disease. Moreover, metabolic syndrome and insulin resistance were independent risk factors of moderate to severe ICAD but were not risk factors of moderate to severe extracranial atherosclerotic disease. Regarding biomarkers, asymmetric-dimethylarginine was independently associated with isolated ICAD and resistin with combined ICAD-extracranial atherosclerotic disease. Our findings show distinct clinical and biological profiles in subclinical ICAD and extracranial atherosclerotic disease. Insulin resistance emerged as an important molecular

Radiographically occult perforation and dissection of the common carotid artery following stab injury to the neck

Directory of Open Access Journals (Sweden)

Sebastian Gamba

2017-06-01

Full Text Available In recent years, many diagnostic algorithms have been devised to reduce the rate of negative explorations associated with indiscriminate surgical management of penetrating neck injuries. In hemodynamically stable patients, the need for surgical intervention is usually determined by integrating both clinical signs and radiological findings; if such investigations remain unremarkable, recommended treatment consists in close observation and sequential physical examinations. We report on a 29-year-old male who was admitted to a Swiss tertiary care hospital after sustaining a penetrating injury to his left neck following a knife attack. Disregarding a pre-hospital account of hemorrhage from the wound and slight dysphagia, no manifest symptoms or signs of internal organ damage were present on primary survey. Moreover, there was no evidence of vascular or aerodigestive tract injury on initial CT angiography. We nonetheless proceeded with immediate surgical exploration, exposing a significant perforation of the left common carotid artery with concomitant dissection of the said vessel. Surgical repair was successfully performed and the patient suffered no long-term sequelae. We thus recommend that a high level of suspicion be upheld in both asymptomatic and oligosymptomatic patients with PNI and that clinical practitioners remain cautious in the face of deceptively reassuring radiologic findings. Keywords: Penetrating neck injury, Carotid artery perforation, Carotid artery dissection, CT angiography

Significance of postoperative crossed cerebellar hypoperfusion in patients with cerebral hyperperfusion following carotid endarterectomy: SPECT study

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Ogasawara, Kuniaki; Kobayashi, Masakazu; Suga, Yasunori; Chida, Kohei; Saito, Hideo; Komoribayashi, Nobukazu; Otawara, Yasunari; Ogawa, Akira [Iwate Medical University, Department of Neurosurgery, Morioka (Japan); Iwate Medical University, Cyclotron Research Center, Morioka (Japan)

2008-01-15

Cerebral hyperperfusion after carotid endarterectomy (CEA) results in cerebral hyperperfusion syndrome and cognitive impairment. The goal of the present study was to clarify the clinical significance of postoperative crossed cerebellar hypoperfusion (CCH) in patients with cerebral hyperperfusion after CEA by assessing brain perfusion with single-photon emission computed tomography (SPECT). Brain perfusion was quantitatively measured using SPECT and the [{sup 123}I]N-isopropyl-p-iodoamphetamine-autoradiography method before and immediately after CEA and on the third postoperative day in 80 patients with ipsilateral internal carotid artery stenosis ({>=}70%). Postoperative CCH was determined by differences between asymmetry of perfusion in bilateral cerebellar hemispheres before and after CEA. Neuropsychological testing was also performed preoperatively and at the first postoperative month. Eleven patients developed cerebral hyperperfusion (cerebral blood flow increase of {>=}100% compared with preoperative values) on SPECT imaging performed immediately after CEA. In seven of these patients, CCH was observed on the third postoperative day. All three patients with hyperperfusion syndrome exhibited cerebral hyperperfusion and CCH on the third postoperative day and developed postoperative cognitive impairment. Of the eight patients with asymptomatic hyperperfusion, four exhibited CCH despite resolution of cerebral hyperperfusion on the third postoperative day, and three of these patients experienced postoperative cognitive impairment. In contrast, four patients without postoperative CCH did not experience postoperative cognitive impairment. The presence of postoperative CCH with concomitant cerebral hyperperfusion reflects the development of hyperperfusion syndrome. Further, the presence of postoperative CCH in patients with cerebral hyperperfusion following CEA suggests development of postoperative cognitive impairment, even when asymptomatic. (orig.)

Significance of postoperative crossed cerebellar hypoperfusion in patients with cerebral hyperperfusion following carotid endarterectomy: SPECT study

International Nuclear Information System (INIS)

Ogasawara, Kuniaki; Kobayashi, Masakazu; Suga, Yasunori; Chida, Kohei; Saito, Hideo; Komoribayashi, Nobukazu; Otawara, Yasunari; Ogawa, Akira

2008-01-01

Cerebral hyperperfusion after carotid endarterectomy (CEA) results in cerebral hyperperfusion syndrome and cognitive impairment. The goal of the present study was to clarify the clinical significance of postoperative crossed cerebellar hypoperfusion (CCH) in patients with cerebral hyperperfusion after CEA by assessing brain perfusion with single-photon emission computed tomography (SPECT). Brain perfusion was quantitatively measured using SPECT and the [ 123 I]N-isopropyl-p-iodoamphetamine-autoradiography method before and immediately after CEA and on the third postoperative day in 80 patients with ipsilateral internal carotid artery stenosis (≥70%). Postoperative CCH was determined by differences between asymmetry of perfusion in bilateral cerebellar hemispheres before and after CEA. Neuropsychological testing was also performed preoperatively and at the first postoperative month. Eleven patients developed cerebral hyperperfusion (cerebral blood flow increase of ≥100% compared with preoperative values) on SPECT imaging performed immediately after CEA. In seven of these patients, CCH was observed on the third postoperative day. All three patients with hyperperfusion syndrome exhibited cerebral hyperperfusion and CCH on the third postoperative day and developed postoperative cognitive impairment. Of the eight patients with asymptomatic hyperperfusion, four exhibited CCH despite resolution of cerebral hyperperfusion on the third postoperative day, and three of these patients experienced postoperative cognitive impairment. In contrast, four patients without postoperative CCH did not experience postoperative cognitive impairment. The presence of postoperative CCH with concomitant cerebral hyperperfusion reflects the development of hyperperfusion syndrome. Further, the presence of postoperative CCH in patients with cerebral hyperperfusion following CEA suggests development of postoperative cognitive impairment, even when asymptomatic. (orig.)

Dissection of internal carotid artery presenting as isolated ischaemic optic neuropathy

Directory of Open Access Journals (Sweden)

Serdar Oruc

2016-08-01

Full Text Available Carotid artery dissections are one of the important reasons of cerebrovascular events that are observed before the age of 45. Besides the local findings such as head, neck and face pains, Horner syndrome findings, pulsatile tinnitus and cranial nerve involvements, some other symptoms such as ischemic stroke, transient ischemic attacks and amaurosis fugax can also be observed in the approximately three quarters of patients. Ischemic optic neuropathy may be seen as %4 in the carotid artery dissections and it mostly accompanies other ischemic local symptoms. It is rare to observe the ischemic optic neuropathy as the first and unique finding in the carotid artery dissections. In this study, a 55 year old male patient with carotid artery dissection was represented. He did not have any other complaint, except the sudden unilateral visual loss and he was sent to our clinics from the opthalmology clinics in order to search for the etiology of ischemic optic neuropathy. It should be kept in mind that there can be a possibility to have carotid artery dissections in patients with unilateral visual loss.

18FDG PET and ultrasound echolucency in carotid artery plaques

DEFF Research Database (Denmark)

Graebe, Martin; Pedersen, Sune F; Højgaard, Liselotte

2010-01-01

OBJECTIVES: The objective was to evaluate inflammation in echolucent carotid artery plaques. BACKGROUND: Ultrasound echolucency of carotid artery plaques has been proven to differentiate patients at high risk of stroke. On the other hand, positron emission tomography (PET) of plaques with the use...... for ultrasound and PET imaging. Plaque standardized gray scale medians (GSM) were measured in longitudinal ultrasound images to quantitate echolucency, and GSM values were compared with FDG PET uptake quantified by maximum standardized uptake values (SUV). Symptomatic plaques were compared with contralateral...... plaques ranged from high to low inflammatory activity, as depicted with PET. Quantitative FDG SUV differentiated asymptomatic from symptomatic plaques, whereas GSM values did not. There was a positive correlation between CD68 expression and FDG uptake (r = 0.50, p = 0.04). CONCLUSIONS: Our results...

Vertebrocarotid collateral in extracranial carotid artery occlusions: digital subtraction angiography findings

International Nuclear Information System (INIS)

Oguzkurt, Levent; Kizilkilic, Osman; Tercan, Fahri; Tuerkoez, Riza; Yildirim, Tuelin

2005-01-01

The internal and external carotid arteries are usually considered occluded distal to a common carotid artery occlusion but some collateral vessels may provide blood keeping the internal and external carotid arteries patent distal to the occlusion. Most common communication in such a case is diversion of blood from muscular branches of the vertebral artery to occipital branch of the external carotid artery which in turn could maintain blood flow into the internal carotid artery, a condition called carotid steal. We encountered vertebrocarotid anastomoses maintaining the patency of carotid circulation in six patients. Patients were four females and two males, ages ranging from 40 to 67 (mean age: 56) years. Five of the patients had ischemic cerebral symptoms. The origin of the external carotid artery was occluded in two and the whole common carotid artery in the remaining four patients. Two patients had double steal, carotid and subclavian at the same time. There was also severe stenosis or occlusion of at least one other major extracranial cerebral artery in all the cases. This concomitant involvement of the second extracranial cerebral artery was thought to be the main reason for the development of vertebrocarotid collateral. In contrast to most of the previously published reports claiming the inadequacy of angiography when compared with colour Doppler ultrasonography, angiography finely depicted the distal patency of the carotid circulation and all the collaterals in detail in every case. Selective injection of the vertebral artery ipsilateral to the occlusion, is the key to demonstrate distal patency of the carotid circulation in cases of proximal carotid occlusion. Demonstration of patency of the distal circulation is very important because some of the patients might get benefit from a reconstructive surgery

Vertebrocarotid collateral in extracranial carotid artery occlusions: digital subtraction angiography findings

Energy Technology Data Exchange (ETDEWEB)

Oguzkurt, Levent; Kizilkilic, Osman; Tercan, Fahri; Tuerkoez, Riza; Yildirim, Tuelin

2005-02-01

The internal and external carotid arteries are usually considered occluded distal to a common carotid artery occlusion but some collateral vessels may provide blood keeping the internal and external carotid arteries patent distal to the occlusion. Most common communication in such a case is diversion of blood from muscular branches of the vertebral artery to occipital branch of the external carotid artery which in turn could maintain blood flow into the internal carotid artery, a condition called carotid steal. We encountered vertebrocarotid anastomoses maintaining the patency of carotid circulation in six patients. Patients were four females and two males, ages ranging from 40 to 67 (mean age: 56) years. Five of the patients had ischemic cerebral symptoms. The origin of the external carotid artery was occluded in two and the whole common carotid artery in the remaining four patients. Two patients had double steal, carotid and subclavian at the same time. There was also severe stenosis or occlusion of at least one other major extracranial cerebral artery in all the cases. This concomitant involvement of the second extracranial cerebral artery was thought to be the main reason for the development of vertebrocarotid collateral. In contrast to most of the previously published reports claiming the inadequacy of angiography when compared with colour Doppler ultrasonography, angiography finely depicted the distal patency of the carotid circulation and all the collaterals in detail in every case. Selective injection of the vertebral artery ipsilateral to the occlusion, is the key to demonstrate distal patency of the carotid circulation in cases of proximal carotid occlusion. Demonstration of patency of the distal circulation is very important because some of the patients might get benefit from a reconstructive surgery.

Interobserver variability in the evaluation of internal carotid artery stenosis by CT angiography

International Nuclear Information System (INIS)

Carrascosa, Patricia; Meli, Francisco; Sampere, Tulio; Capunay, Carlos; Sanchez, Flavio; Carrascosa, Jorge

2001-01-01

Ischemic cerebral vascular events are primarily due to atherosclerotic narrowing of carotid bifurcation. Catheter Angiography (CA) is the best test for determining carotid artery stenosis, but it is invasive and has some risks. The purpose of this study was to evaluate CT Angiography (CTA) as a non-invasive method compared with CA. Different estimate procedures (NASCET, ESCT and area quantification) were done to compare the Sensitivity (S) and Specificity (E) of each one with CA. Afterwards, interobserver variability of the three procedures was evaluated. Thirty-eight internal carotid arteries were studied in 19 patients with transient ischemic attacks. CTA studies were done in a helical CT scanner. The images were evaluated in a workstation by two radiologists, who were blinded to the percentage of stenosis determined by CA. For statistical analysis, the measurement of stenosis percentage was divided in two groups: a) Negative (0-69%) and b) Positive:(70-100%). Kappa analysis (K) was used to determine the agreement of stenosis. Results: Observer 1: Sensitivity (S) NASCET: 94%, ESCT: 77% and area 94% and Specificity (E): 91%, 87,5% and 87,5%. Observer 2: 77%, 77% and 74%. The interobserver K was 0.83, 0792 and 0.78 for NASCET, ESCT and area quantification methods respectively. In conclusion, CTA has high S and E especially in NASCET and area quantification. (author)

Multi-slice spiral CT diagnosis of carotid body tumor

International Nuclear Information System (INIS)

Li Peiling; Leng Renli; Li Shu; Xie Xiuli; Xu Ke

2006-01-01

Objective: to explore the Multi-slice spiral CT (MSCT) findings of carotid body tumor (CBT). Methods: Twelve cases of CBT proved by surgery were collected in this study and all patients accepted contrast-enhanced MSCT examination. Two-dimensional and three-dimensional post-processing were performed at diagnostic workstation using Aquilion 1.42. The CT features of CBT were analyzed. Results Each of 12 patients had one lesion. All lesions demonstrated well-marginated masses of homogeneous soft- tissue density with CT value within 29-48 HU on pre-enhanced images. All lesions were markedly enhanced with CT value over 200 HU on arterial-phase images, and the density of lesions decreased rapidly on delay- phase images. Twelve lesions were all located at the level of carotid artery bifurcation, 3 of them enveloping common carotid artery and internal/external carotid artery, and other 9 of them riding right on the carotid bifurcation. Internal carotid artery usually were shifted toward posterior-lateral, and external carotid artery toward anterior or anterior-medial. Conclusion: Contrast-enhanced MSCT examination not only can make a qualitative diagnosis of CBT, but determine its accurate location. It plays an importantly instructional role in clinical diagnosis and treatment. (authors)

Identification of internal carotid dissection in patients with migraine--case report and literature review

International Nuclear Information System (INIS)

Sharif, M.; Trinick, T.; Khan, H.Y.

2010-01-01

Although patho-physiology of spontaneous internal carotid artery dissection (sICAD) is largely unknown, an association with migraine has been suggested but not proven. Migraine is a condition which is worth considering while one is hunting a possible cause for internal carotid artery dissection (ICAD) and it may be found more often than expected.2 To date it remains a diagnosis of exclusion in patients with migraine. As opposed to migraine with aura, migraine without aura is significantly more frequent among patients with SICAD. It has been suggested that ICAD produces stroke in 36-68% of patients as a result of occlusion of the artery at or near the site of the dissection, or embolization occurring distally from a dislodged fragment of thrombus. We report a 31-year old woman with headache and ptosis as initial symptoms. Magnetic resonance imaging (MRI) confirmed the diagnosis. Prompt treatment was instituted with anti-platelet agents and the patient had complete resolution of symptoms. Our case report highlights the importance of identifying the patients with ICD with history of migraine, in the absence of other risk factors and adds to the sparse literature currently available on the subject. (author)

Pulsating Tonsil Due to Medial Displacement of the Internal Carotid Artery.

Science.gov (United States)

Alsini, Albaraa Y; Ibrahim, Alsheikhi

2017-05-06

BACKGROUND The internal carotid artery (ICA) is about 2.5 cm away from the tonsils. It has no branches in the cervical portion. ICA anomalies of the neck zone may result in a massive arterial bleeding during pharynx and neck surgery. Due to these anomalies, the surgeon must be aware of this risk during tonsillectomy, adenoidectomy, and pharyngeal operations.  CASE REPORT A 23-year-old woman who was discovered to have an acute S curling-type anomaly of the ICA in contact with the lateral border of the right tonsil during a work-up for a tonsillectomy. This anomaly was incidentally discovered via computed tomography (CT) with contrast. In re-evaluating the course of treatment, we found a severe S-shape kink on the right side, bringing it close to the right tonsil by approximately 2 mm, and putting it at severe risk of injury during a simple tonsillectomy, possibly exposing the patient to serious bleeding. Partial tonsillectomy was performed for this patient with the aim to preserve and not expose the internal carotid artery. Pulsation of right tonsil was recorded. The patient made an uneventful postoperative recovery. CONCLUSIONS Undetected ICA anomaly variation can lead to fatal bleeding during a simple procedure, like tonsillectomy. We recommend vigilance during tonsillectomy if one is using a hot dissection method versus a cold dissection method, which may allow for detection of a perioperative ICA anomaly. Tonsillectomy performed by a junior resident should be under direct supervision, particularly if the hot dissection method is used.

Percutaneous transluminal angioplasty of the carotid artery

International Nuclear Information System (INIS)

Numaguchi, Y.; Tulane Univ., New Orleans, LA; Puyau, F.A.; Provenza, L.J.; Richardson, D.E.

1984-01-01

The successful dilatation of postsurgical concentric stenosis of an internal carotid artery using percutaneous transluminal angioplasty (PTA) is reported here. Only one such case has been previously documented. Review of the literature disclosed 16 patients who received transluminal angioplasty for stenosis of carotid arteries by percutaneous or open arteriotomy techniques. The authors feel that PTA may be the treatment of choice for postoperative concentric stenosis of a short segment of the carotid artery as opposed to surgical repair. (orig.)

Angiographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid artery

International Nuclear Information System (INIS)

Na, Dong Gyu; Han, Moon Hee; Chang, Kee Hyun; Han, Gi Seok; Yeon, Kung Mo

1995-01-01

The purpose of this study is to describe the angiographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid arteries and to evaluate the extent of angiographic assessment needed before embolization. We retrospectively reviewed 10 cervicofacial vascular lesions with previously ligated carotid artery, which were 6 cases of arteriovenous malformation, 2 cases of carotid cavernous fistula, 1 case of hemangioma and 1 case of arteriovenous malformation with carotid cavernous fistula. The previously ligated arteries are proximal external carotid artery (n = 5), branches of external carotid artery (n = 2) and common carotid artery (n = 3). Common carotid artery or internal carotid artery (n = 9), vertebral artery (n = 5), ipsilateral external carotid artery (n = 4), contralateral external carotid artery (n = 5), costocervical trunk (n = 2), thyrocervical trunk (n = 2) were assessed by conventional angiography. Angiography of both carotid and vertebral arteries was performed in 5 cases. The collateral vascular channels were inferolateral trunk of internal carotid artery (n = 8), vertebral artery (n = 5), contralateral external carotid artery (n = 5), ipsilateral external carotid artery (n = 4), deep cervical artery (n = 2) and ascending cervical artery (n = 1). Embolization were performed in 9 cases with operative cannulation (n = 4), embolization via collateral branches of ipsilateral external carotid artery (n = 1), embolization via collateral branches of contralateral external carotid artery (n = 3) and balloon occlusion via direct puncture (n = 1). The collateral channels in cervicofacial vascular lesions with previously ligated carotid artery were inferolateral trunk of internal carotid artery, contralateral or ipsilateral external carotid artery, vertebral artery, deep cervical artery and ascending cervical artery on angiography. Complete angiographic assessment of possible collateral channels is mandatory for the

Pre-operative Carotid Plaque Echolucency Assessment has no Predictive Value for Long-Term Risk of Stroke or Cardiovascular Death in Patients Undergoing Carotid Endarterectomy.

Science.gov (United States)

de Waard, D; de Borst, G J; Bulbulia, R; Pan, H; Halliday, A

2017-08-01

In patients with carotid stenosis receiving medical treatment, carotid plaque echolucency has been thought to predict risk of future stroke and of other cardiovascular events. This study evaluated the prognostic value of pre-operative plaque echolucency for future stroke and cardiovascular death in patients undergoing carotid endarterectomy in the first Asymptomatic Carotid Surgery Trial (ACST-1). In ACST-1, 1832/3120 patients underwent carotid endarterectomy (CEA), of whom 894 had visual echolucency assessment according to the Gray-Weale classification. During follow-up patients were monitored both for peri-procedural (i.e. within 30 days) death, stroke, or MI, and for long-term risk of stroke or cardiovascular death. Unconditional maximum likelihood estimation was used to calculate odds ratios of peri-procedural risk and Kaplan-Meier statistics with log-rank test were used to compare cumulative long-term risks. Of 894 operated patients in whom echolucency was assessed, 458 plaques (51%) were rated as echolucent and peri-procedural risk of death/stroke/MI in these patients was non-significantly higher when compared with patients with non-echolucent plaques (OR 1.48 [95% CI 0.76-2.88], p = .241). No differences were found in the 10 year risk of any stroke (30/447 [11.6%] vs. 29/433 [11.0%], p = .900) or cardiovascular (non-stroke) death (85/447 [27.9%] vs. 93/433 [32.1%], p = .301). In ACST-1, carotid plaque echolucency assessment in patients undergoing CEA offered no predictive value with regard to peri-operative or long-term stroke risk or of cardiovascular (non-stroke) death. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Measurement of blood flow in the carotid arteries using color doppler in healthy Korean adults

International Nuclear Information System (INIS)

Moon, Ki Ho; Jeon, Do Ig; Choi, Chang Ho; Ro, Young Jin; Kim, Hak Jin; Lee, Suck Hong; Kim, Byung Soo

1994-01-01

To evaluate the blood flow patterns and velocities of the carotid arteries in healthy Korean adults. We evaluated the blood flow patterns and measured the peak systolic and end-diastolic velocities of the common, internal and external carotid arteries in 48 healthy adults who did not have cardiovascular disorders and neck lesions. The velocity difference was analyzed according to different age groups. In addition, peak systolic and end-diastolic velocity ratio of the internal to common carotid artery was estimated, and our data were compared with values reported by other authors. Generally, the velocity in the younger age group tends be to higher than in older group. The peak systolic and end diastolic velocities of the internal carotid artery were 84.5 cm/sec and 30.5 cm/sec. The peak systolic and end diastolic velocity ratio of the internal to common carotid artery were 0.715 and 0.966. The internal carotid artery was less resistant in blood flow than the external carotid artery. Our data were lower than the values which were reported by Bluth et al. The blood flow velocities of the internal carotid artery in healthy adults were lower than those of previous reported foreign values, but the patterns were similar

Heparin surface stent-graft for the treatment of a carotid pseudoaneurysm.

Science.gov (United States)

Tsolaki, Elpiniki; Elpiniki, Tsolaki; Salviato, Elisabetta; Rocca, Tiberio; Braccini, Lucia; Galeotti, Roberto; Mascoli, Francesco

2010-10-01

Carotid pseudoaneurysms are a rare consequence of carotid surgery, trauma, and infection. Historically, carotid aneurysms and pseudoaneurysms were treated surgically. However, endovascular techniques have recently become a valid alternative for the treatment of carotid pseudoaneurysms. The case of a 57-year-old male patient with a pseudoaneurysm of the right internal carotid artery is described. The patient came to our unit with a painless and pulsatile mass in the neck, which was growing slowly. Five years earlier, he had undergone surgery on a saccular aneurysm located on the distal extracranial segment of the right internal carotid artery. The pseudoaneurysm was successfully treated with a heparin surface Viabahn stent-graft system (Gore AL, Flagstaff, AZ). Heparin surface stent-grafts can be used for the treatment of carotid lesions and may offer protection against intimal hyperplasia and thrombosis. Further studies are needed to evaluate the long-term results. Copyright © 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Measurement of carotid bifurcation pressure gradients using the Bernoulli principle.

Science.gov (United States)

Illig, K A; Ouriel, K; DeWeese, J A; Holen, J; Green, R M

1996-04-01

Current randomized prospective studies suggest that the degree of carotid stenosis is a critical element in deciding whether surgical or medical treatment is appropriate. Of potential interest is the actual pressure drop caused by the blockage, but no direct non-invasive means of quantifying the hemodynamic consequences of carotid artery stenoses currently exists. The present prospective study examined whether preoperative pulsed-Doppler duplex ultrasonographic velocity (v) measurements could be used to predict pressure gradients (delta P) caused by carotid artery stenoses, and whether such measurements could be used to predict angiographic percent diameter reduction. Preoperative Doppler velocity and intraoperative direct pressure measurements were obtained, and per cent diameter angiographic stenosis measured in 76 consecutive patients who underwent 77 elective carotid endarterectomies. Using the Bernoulli principle (delta P = 4v(2), pressure gradients across the stenoses were calculated. The predicted delta P, as well as absolute velocities and internal carotid artery/common carotid velocity ratios were compared with the actual delta P measured intraoperatively and with preoperative angiography and oculopneumoplethysmography (OPG) results. An end-diastolic velocity of > or = 1 m/s and an end-diastolic internal carotid artery/common carotid artery velocity ratio of > or = 10 predicted a 50% diameter angiographic stenosis with 100% specificity. Although statistical significance was reached, preoperative pressure gradients derived from the Bernoulli equation could not predict actual individual intraoperative pressure gradients with enough accuracy to allow decision making on an individual basis. Velocity measurements were as specific and more sensitive than OPG results. Delta P as predicted by the Bernoulli equation is not sufficiently accurate at the carotid bifurcation to be useful for clinical decision making on an individual basis. However, end

Management of radiation-induced accelerated carotid atherosclerosis

International Nuclear Information System (INIS)

Loftus, C.M.; Biller, J.; Hart, M.N.; Cornell, S.H.; Hiratzka, L.F.

1987-01-01

Patients with long survival following cervical irradiation are at risk for accelerated carotid atherosclerosis. The neurologic presentation in these patients mimics naturally occurring atheromatous disease, but patients often present at younger ages and with less concurrent coronary or systemic vascular disease. Hypercholesterolemia also contributes to this accelerated arteriosclerosis. Angiographic findings in this disorder include disproportionate involvement of the distal common carotid artery and unusually long carotid lesions. Pathologic findings include destruction of the internal elastic lamina and replacement of the normal intima and media with fibrous tissue. This article describes two surgical patients with radiation-induced accelerated carotid atherosclerosis who typify the presentation and characteristics of this disease

Carotid artery disease and low cerebral perfusion pressure

DEFF Research Database (Denmark)

Schroeder, T; Utzon, N P; Aabech, J

1990-01-01

Direct internal carotid artery blood pressure measurements in patients undergoing carotid endarterectomy identified 49 patients, among 239 consecutive cases (21%), who had a reduction in perfusion pressure of 20% or more. The clinical history, objective findings and angiographic data were compared...

Carotid stenosis and cognitive impairment amongst older Chinese adults living in a rural area: a population-based study.

Science.gov (United States)

Yan, Z; Liang, Y; Shi, J; Cai, C; Jiang, H; Song, A; Qiu, C

2016-01-01

The possible association between carotid stenosis and cognitive impairment in the Chinese population has been rarely investigated. The association between the severity of carotid stenosis and cognitive impairment amongst older Chinese people living in a rural area was assessed. This cross-sectional study included 1375 participants (age ≥60 years) from the Confucius Hometown Aging Project in Shandong. In 2010-2011, data were collected through interviews and clinical examinations. Carotid stenosis was assessed using ultrasonography. Cognitive impairment was defined according to the education-specific cutoff scores of the Mini-Mental State Examination. Data were analyzed using multinomial logistic models. The overall prevalence was 7.0% for moderate carotid stenosis, 2.0% for severe stenosis and 6.0% for cognitive impairment. The multi-adjusted odds ratio of cognitive impairment was 1.43 (95% confidence interval 0.63-3.22) for moderate carotid stenosis and 3.75 (1.24-11.40) for severe carotid stenosis (P(trend) = 0.023). Similar results were obtained in people without a history of cerebrovascular disease. Severe carotid stenosis, even asymptomatic, is associated with cognitive impairment independent of atherosclerotic risk factors and disorders amongst older Chinese people. © 2015 EAN.

Diffusion-weighted magnetic resonance imaging in carotid angioplasty and stenting with balloon embolic protection devices

International Nuclear Information System (INIS)

Asakura, Fumio; Kawaguchi, Kenji; Sakaida, Hiroshi; Toma, Naoki; Matsushima, Satoshi; Kuraishi, Keita; Tanemura, Hiroshi; Miura, Yoichi; Taki, Waro; Maeda, Masayuki

2006-01-01

We compared the results of two procedures to protect against distal embolism caused by embolic debris from carotid angioplasty with stent deployment (CAS) using diffusion-weighted magnetic resonance imaging (MRI). The study group comprised 39 men and 3 women (42 and 3 CAS procedures, respectively) with severe carotid stenosis (average age 70.0±6.6 years). During 20 CAS procedures the internal carotid artery was protected with a single balloon. A PercuSurge GuardWire was used for temporary occlusion. During 25 CAS procedures the internal and external carotid arteries were simultaneously temporarily occluded with a PercuSurge GuardWire and a Sentry balloon catheter, respectively. Diffusion-weighted MRI was performed 1 to 3 days after CAS. Data from 26 patients undergoing conventional angiography for diagnosis of cerebral ischemic disease, cerebral aneurysm or brain tumors were included as controls. Diffusion-weighted MRI after conventional diagnostic angiography showed ischemic spots in 3 of the 26 controls (11.5%). Ischemic spots were observed during 11 of 20 CAS procedures with the internal carotid artery protected with a single balloon (55.0%), and were observed during 9 of 25 CAS procedures with both the internal and external carotid arteries protected (36.0%). This difference was significant (P=0.0068). Ischemic lesions appeared not only ipsilateral to the carotid stenosis but also in the contralateral carotid artery (31.9%) and vertebrobasilar territory (25.3%). Better protection was obtained with simultaneous double occlusion of both the internal and external carotid artery than with single protection of the internal carotid artery during CAS. (orig.)

Thrombin Injection Failure with Subsequent Successful Stent-Graft Placement for the Treatment of an Extracranial Internal Carotid Pseudoaneurysm in a 5-Year-Old Child

International Nuclear Information System (INIS)

Garcia-Monaco, R. D.; Kohan, A. A.; Martinez-Corvalan, M. P.; Cacchiarelli, N.; Peralta, O.; Wahren, C. G.

2012-01-01

Internal carotid artery pseudoaneurysm is a rare life-threatening condition that may develop in different clinical situations. We report the case of an extracranial internal carotid artery pseudoaneurysm secondary to a throat infection in a pediatric patient that was initially treated with percutaneous thrombin injection under ultrasound guidance. However, recanalization occurred at 48 h, and definitive treatment was then performed by endovascular stent-graft placement. We briefly review the clinical characteristics of this uncommon clinical condition as well as the treatment options.

Stent-Graft Repair of a Large Cervical Internal Carotid Artery Pseudoaneurysm Causing Dysphagia

International Nuclear Information System (INIS)

Gupta, Vivek; Niranjan, Khandelwal; Rawat, Lokesh; Gupta, A. K.

2009-01-01

Pseudoaneurysms of the cervical internal carotid artery (ICA) are rare and most frequently result from trauma, infection, or sometimes spontaneously. They have the potential to cause life-threatening hemorrhage; thus, their immediate management is necessary. Endovascular treatment by stent graft placement in the affected artery appears to be a safe and effective treatment option. We present a case of a child who presented with neck swelling and dysphagia caused by a ruptured cervical ICA pseudoaneurysm which was managed by stent graft placement.

Characterization of plaque in the internal carotid artery. Comparison neuroradiological findings with pathological findings

International Nuclear Information System (INIS)

Nishikawa, Misao; Nishio, Akimasa; Takami, Toshihiro; Goto, Takeo; Ueda, Makiko; Hara, Mitsuhiro

2006-01-01

We evaluate the morphology of the carotid plaque using echogram, CT scan and MRI and compare those neuroradiological findings with histological findings of the plaque. We evaluated 14 cases operated with carotid endoarterectomy for carotid stenosis. We estimated the findings of the echogram, enhanced CT scan and black blood MRI (BB MRI), in comparison with the histological findings of the carotid plaque. Echogram, enhanced CT scan and MRI clearly demonstrated the plaque in cervical carotid stenosis. In most cases, echograms could show the plaque, but in some cases could not due to the back shadow caused by plaque calcification. Enhanced CT scan clearly demonstrated the calcification and the neovasculization in plaque. BB MRI clearly showed the carotid plaque. Low-intensity lesions in T1 and T2 weighted images showed hard and fibrous plaque. High-intensity lesions in T1 and T2 weighted images showed soft plaque with lipoprotein and/or hemorrhage. This study demonstrates the potential of a systemic approach to atherosclerotic plaque with enhanced CT scan and BB MRI compared with histological findings of the carotid plaque. These estimations elucidate the growth mechanism of carotid plaque. (author)

Petrous internal carotid aneurysm causing epistaxis: Balloon embolization with preservation of the parent vessel

Energy Technology Data Exchange (ETDEWEB)

Willinsky, R.; Lasjaunias, P.; Pruvost, P.; Boucherat, M.

1987-11-01

A patient with severe, recurrent posterior epistaxis was shown at angiography to have an aneurysm of the petrous portion of the internal carotid artery (ICA). Since childhood, she had had pain related to eustachian tube blockage by the aneurysm. An endovascular balloon embolization of the aneurysm was successful with preservation of the parent artery. The treatment resulted in resolution of the symptoms. The report confirms the usefulness of an angiographic protocol in evaluating vascular problems.

Development and pilot feasibility study of a health information technology tool to calculate mortality risk for patients with asymptomatic carotid stenosis: the Carotid Risk Assessment Tool (CARAT)

OpenAIRE

Faerber, Adrienne E; Horvath, Rebecca; Stillman, Carey; O?Connell, Melissa L; Hamilton, Amy L; Newhall, Karina A; Likosky, Donald S; Goodney, Philip P

2015-01-01

Background Patients with no history of stroke but with stenosis of the carotid arteries can reduce the risk of future stroke with surgery or stenting. At present, a physicians? ability to recommend optimal treatments based on an individual?s risk profile requires estimating the likelihood that a patient will have a poor peri-operative outcomes and the likelihood that the patient will survive long enough to gain benefit from the procedure. We describe the development of the CArotid Risk Assess...

Relationship between intracranial internal carotid artery calcification and enlarged cerebral perivascular space

Energy Technology Data Exchange (ETDEWEB)

Tao, Xiao-Xiao [Shanghai Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Neurology, Shanghai (China); The First People' s Hospital of Wenling, Department of Neurology, Wenling (China); Li, Ge-Fei; Wu, Yi-Lan; Liu, Yi-Sheng; Zhao, Ying; Shi, Yan-Hui; Zhuang, Mei-Ting; Hou, Tian-Yu; Zhao, Rong; Liu, Feng-Di; Wang, Xue-Mei; Shen, Ying; Cui, Guo-Hong; Su, Jing-Jing; Chen, Wei [Shanghai Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Neurology, Shanghai (China); Tang, Xue-Mei; Sun, Ji; Liu, Jian-Ren [Shanghai Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Neurology, Shanghai (China); Shanghai Jiao Tong University School of Medicine, Clinical Research Center, Shanghai (China)

2017-06-15

The association between intracranial internal carotid artery (IICA) calcification and lacunes, white matter hyperintensity (WMH), and cerebral microbleeds (CMBs) has been well researched. However, enlarged cerebral perivascular space (PVS) has not yet been reported to correlate with intracranial internal carotid artery calcification. Therefore, the primary aim of this study was to investigate the relationship between IICA calcification and enlarged PVS. A total of 189 patients with ischemic stroke in the middle cerebral artery territory who presented within 7 days of ictus from 2012 to 2015 were enrolled respectively. All patients were required to have undergone head computed tomography, magnetic resonance imaging, susceptibility-weighted magnetic resonance imaging, magnetic resonance angiography, or computed tomography angiography. Clinical characteristics were recorded. IICA calcification and enlarged PVS were semi-quantitatively evaluated, and the presence of lacunes, WMH, and CMBs was recorded. Of the 189 patients, 63.5% were male. Mean age of the patients was 68.6 ± 12.2 years. There were 104 patients with IICA calcification. Age, diabetes mellitus, lacunes, and white matter hyperintensity were significantly associated with IICA calcification (P < 0.05). Multivariate logistic regression analysis showed that age, diabetes mellitus, and lacunes were independent predictors of IICA calcification (P < 0.05). A lower risk of IICA calcification was found in patients with a higher enlarged PVS score (P = 0.004). Higher enlarged PVS scores were associated with a lesser degree of IICA calcification. There appears to be a relationship between reduced risk of IICA calcification and enlarged PVS. (orig.)

Significance of preoperative cerebral blood flow measurements in endovascular occlusion of the internal carotid and middle cerebral arteries

International Nuclear Information System (INIS)

Laurent, A.; Weitzner, I.; Luft, A.; Merland, J.J.

1988-01-01

Cerebral blood flow (CBF) measurements during 12 endovascular balloon occlusions (ten internal carotid and two middle cerebral arteries) with good clinical and angiographic tolerance were done with repeated boluses of Xe-133 injected directly into the ipsi- and contralateral carotid systems, during the occlusion and repeated measurements with detectors on both sides (before occlusion and 5-30 minutes after occlusion). In two cases of unchanged and four of increased CBF, one reversible deficit was probably due to an embolus. In six cases of decreased CBF, two deficits occurred, characterized by a greater than 25% decrease. It seems to represent a good predictive value for intolerance to occlusion

Brainstem ischemic stroke without permanent sequelae during the course of spontaneous internal carotid artery dissection – case report

International Nuclear Information System (INIS)

Nesteruk, Tomasz; Nesteruk, Marta; Bulik-Pasińska, Marta; Boroszko, Dariusz; Ostrowska, Monika

2012-01-01

Internal carotid artery dissection (ICAD) is a frequent cause of a stroke in young patients. Risk factors which can lead to dissection include neck injury and diseases of the inner wall of the artery. Common symptoms in ICAD are cervical pain and headache, Horner’s syndrome, paralysis of the cranial nerves and subsequently cerebral and retinal ischemia. MR angiography in TOF technique and brain MRI in T1- and T2-weighted images, FLAIR and DWI sequences are the method of choice in patients with ICAD but contrast-enhanced multislice computed tomography remains the fastest and the most available diagnostic method. A 39-year old woman, previously healthy, presented to the Hospital Emergency Department because of increasing neck pain on the right side and difficulty in swallowing. The neurological examination revealed: drooping of the right eyelid with narrow palpebral fissure, dysarthria, anisocoria (narrower pupil on the right side), unilateral hypoesthesia on the left side, weak palatal and pharyngeal reflexes on both sides, paresthesia within the left half of the body. Seven days before, the patient felt a sudden, severe neck pain radiating to the temporal apophysis. CT angiography revealed a defect in contrast filling within the left internal carotid artery and right vertebral artery. MRI of the head with MR angiography showed internal carotid artery dissection on the left side and dissection of the right vertebral artery and no ischemic changes within the brain. CT and MR angiography are methods characterized by high sensitivity in detecting dissection of the cervical arteries

Bilateral non-superselective embolization with particles under transient occlusion of the internal carotid artery in the management of juvenile nasopharyngeal angiofibroma: technical note.

Science.gov (United States)

Santos-Franco, J A; Lee, A; Campos-Navarro, L A; Tenorio-Sánchez, J; Zenteno, M; Osorio-Alvarado, A R

2012-10-01

Juvenile nasopharyngeal angiofibroma (JNA) is a rare histologically benign tumor, highly vascularized, with usually aggressive behavior, and can extend from the nasal cavity to neighboring structures. We present the case of a 14-year-old male harboring a JNA, presenting with an active severe and persistent epistaxis. Two previous surgical attempts of removal were unsuccessful, because of profuse intraoperative bleeding. Angiography showed a highly vascularized neoplasm with multiple branches arising from both internal carotid arteries, with absence of branches from the external carotid due to previous surgical ligation. Direct puncture tumor embolization was not possible because removal of nasal packing triggered major hemorrhage. The only option for embolization was a technique of non-superselective embolization with particles under transient occlusion of the internal carotid artery. The procedure was performed uneventfully from either side, the tumor was subsequently removed, and the patient had no recurrence 2 years after the initial treatment.

A Case of Complete Recovery of Fluctuating Monocular Blindness Following Endovascular Treatment in Internal Carotid Artery Dissection.

Science.gov (United States)

Kim, Ki-Tae; Baik, Seung Guk; Park, Kyung-Pil; Park, Min-Gyu

2015-09-01

Monocular blindness may appear as the first symptom of internal carotid artery dissection (ICAD). However, there have been no reports that monocular visual loss repeatedly occurs and disappears in response to postural change in ICAD. A 33-year-old woman presented with transient monocular blindness (TMB) following acute-onset headache. TMB repeatedly occurred in response to postural change. Two days later, she experienced transient dysarthria and right hemiparesis in upright position. Pupil size and light reflex were normal, but a relative afferent pupillary defect was positive in the left eye. Diffusion-weighted imaging showed no acute lesion, but perfusion-weighted imaging showed perfusion delay in the left ICA territory. Digital subtraction angiography demonstrated a false lumen and an intraluminal filling defect in proximal segment of the left ICA. Carotid stenting was performed urgently. After carotid stenting, left relative afferent pupillary defect disappeared and TMB was not provoked anymore by upright posture. At discharge, left visual acuity was completely normalized. Because fluctuating visual symptoms in the ICAD may be associated with hemodynamically unstable status, assessment of the perfusion status should be done quickly. Carotid stenting may be helpful to improve the fluctuating visual symptoms and hemodynamically unstable status in selected patient with the ICAD. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Petrous internal carotid aneurysm causing epistaxis: Balloon embolization with preservation of the parent vessel

International Nuclear Information System (INIS)

Willinsky, R.; Lasjaunias, P.; Pruvost, P.

1987-01-01

A patient with severe, recurrent posterior epistaxis was shown at angiography to have an aneurysm of the petrous portion of the internal carotid artery (ICA). Since childhood, she had had pain related to eustachian tube blockage by the aneurysm. An endovascular balloon embolization of the aneurysm was successful with preservation of the parent artery. The treatment resulted in resolution of the symptoms. The report confirms the usefulness of an angiographic protocol in evaluating vascular problems. (orig.)

Clinical implications of internal carotid artery tortuosity, kinking and coiling: a systematic review

Directory of Open Access Journals (Sweden)

Zenteno M.

2014-03-01

Full Text Available Anatomical variations of the internal carotid artery are diverse. Abnormalities in their geometry and paths are commonly identified by ultrasonography and angiography. The surgical correction of symptomatic CAs is better in preventing stroke compared with best medical therapy, as well as it completely eliminates the symptoms in patients with nonhemispheric symptoms. The ICA anomalies may be dangerous and represent a risk factor for massive bleeding. Suture ligatures can penetrate and occlude torn vessels, scalpels or biting instruments can lacerate vessels, and indirectly conducted electric cauterization can burn the soft of bony tissues

Carotid angiography in the diagnosis and treatment planning of juvenile angiofibroma

International Nuclear Information System (INIS)

Szymanska, A.; Pietura, R.; Krzyzanowski, W.; Szczerbo-Trojanowska, M.

2005-01-01

Juvenile nasopharyngeal angiofibroma is a benign, hyper vascular neoplasm, which affects almost exclusively young males. Although histologically benign it shows malignant clinical course with episodes of severe epistaxis due to marked tendency to spontaneous bleeding. It also leads to serious surgical complications like massive intraoperative bleeding resulting in incomplete resection and high rate of recurrence. The aim of the study was to discuss angiographical findings of the juvenile angiofibroma, evaluate its vascular composition and main feeding vessels, and assess the usefulness of carotid angiography in treatment planning. Typical angiographical findings: rich vascularity and the internal maxillary artery as the main feeding vessel confirm the clinical diagnosis of the juvenile nasopharyngeal angiofibroma. In patients with abundant blood supply from the internal carotid artery a nonsurgical treatment modality may be recommended. Visualisation of the course of the internal maxillary artery facilitates its identification and ligation during surgery. There were 40 patients with angiofibroma juvenile. All patients underwent carotid angiography. We assessed vascularity of the tumour, main feeding vessels and displacement of the internal maxillary artery due to the lateral tumour spread to the infra temporal and pterygopalatine fossa. The relationship between tumour extension and the presence of the internal carotid artery blood supply was also evaluated. In all patients angiography revealed the presence of pathological vessels and defined tumour blood supply. The internal maxillary artery was the main feeding vessel in 97,5% of tumours. In a group of 27 patients 33% showed dislocation of the internal maxillary artery due to the involvement of the infratemporal and pterygopalatine fossa. The relationship between tumour extension and the presence of the internal carotid artery blood supply was statistically significant. (author)

Influence of carotid artery stenting on cognitive function

Energy Technology Data Exchange (ETDEWEB)

Quasar Grunwald, Iris [Saarland University Clinic, Department for Diagnostic and Interventional Neuroradiology, Homburg (Germany); Department of Neuroradiology, Homburg (Germany); Papanagiotou, Panagiotis; Backens, Martin; Politi, Maria; Vedder, Verena; Zercher, K. [Saarland University Clinic, Department for Diagnostic and Interventional Neuroradiology, Homburg (Germany); Reith, Wolfgang; Supprian, Tilman; Muscalla, B.; Haass, Anton; Krick, Christoph M. [Saarland University Clinic, Clinic for Neurology, Homburg (Germany); Saarland University Clinic, Clinic for Psychiatry and Psychotherapy, Homburg (Germany)

2010-01-15

There have only been a few studies on cognitive changes in patients with carotid occlusive disease, and the results of these show major discrepancies in the extent to which treatment affects neuropsychological function. We sought to clarify these discrepancies by evaluating the effects of carotid artery stenting (CAS) on the cognitive function. Forty-one asymptomatic CAS patients were administered a test battery of neuropsychological tests measuring cognitive speed and memory function before and 3 months after the procedure. A control group was also evaluated. To test for thromboembolic lesions, diffusion-weighted imaging was used. CAS led to a significant increase in cognitive speed (p < 0.001) but did not afford any change in memory function. This was regardless of the degree or side of stenosis or patient age or gender. CAS significantly improved functions that involve cognitive speed. Earlier studies did not differentiate between speed and memory tests and thus might have missed these changes. Further studies correlating changes in brain perfusion with increase in cognitive speed are needed. (orig.)

Influence of carotid artery stenting on cognitive function

International Nuclear Information System (INIS)

Quasar Grunwald, Iris; Papanagiotou, Panagiotis; Backens, Martin; Politi, Maria; Vedder, Verena; Zercher, K.; Reith, Wolfgang; Supprian, Tilman; Muscalla, B.; Haass, Anton; Krick, Christoph M.

2010-01-01

There have only been a few studies on cognitive changes in patients with carotid occlusive disease, and the results of these show major discrepancies in the extent to which treatment affects neuropsychological function. We sought to clarify these discrepancies by evaluating the effects of carotid artery stenting (CAS) on the cognitive function. Forty-one asymptomatic CAS patients were administered a test battery of neuropsychological tests measuring cognitive speed and memory function before and 3 months after the procedure. A control group was also evaluated. To test for thromboembolic lesions, diffusion-weighted imaging was used. CAS led to a significant increase in cognitive speed (p < 0.001) but did not afford any change in memory function. This was regardless of the degree or side of stenosis or patient age or gender. CAS significantly improved functions that involve cognitive speed. Earlier studies did not differentiate between speed and memory tests and thus might have missed these changes. Further studies correlating changes in brain perfusion with increase in cognitive speed are needed. (orig.)

Delayed Cerebral Ischemia following to Repair of Penetrating Trauma to External Carotid artery Introduction

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M. Eskandarlou

2016-01-01

Full Text Available Introduction: Penetrating trauma to anterior neck can induce cerebral ischemia due to carotid artery injury. Brain ischemia also can present after surgical carotid repairs. Early diagnosis and suitable treatment modality prevent from permanent neurologic deficit post operatively. Case Report: A 30 years old man with stab wound to zone two left side of neck underwent exploration and penrose insertion. Due to excessive bleeding through drain tube, patient was transferred to Besat Hospital of Hamadan. Surgical repair of external carotid artery successfully was done. Four days later patient developed right hemiparesis suddenly. According to MRI and color Doppler sonography finding of thrombosis of left common and internal carotid artery, reoperation was done. After thrombectomy cerebral ischemia and hemi-paralysis improved. Conclusions: Surgical approach to symptomatic penetrating neck trauma is oblique cervical incision, control of bleeding, repair of internal carotid, repair or ligature of external carotid artery base on some factors and preferential repair of internal jugular vein. Meticulous and fine surgical technique for both vascular repair and protection of adjacent normal vessels for avoiding to blunt trauma or compression with retractors is noticeable. Exact postoperative care as repeated clinical examination with goal of early diagnosis of internal carotid artery thrombosis and rapid diagnostic and treatment planning of this complication are important factors for taking of good result in treatment of penetrating trauma to carotid. Sci J Hamadan Univ Med Sci . 2016; 22 (4 :353-357

Fusiform dilatation of the internal carotid artery in childhood-onset craniopharyngioma : multicenter study on incidence and long-term outcome

NARCIS (Netherlands)

Hoffmann, Anika; Warmuth-Metz, Monika; Lohle, Kristin; Reichel, Julia; Daubenbuchel, Anna M. M.; Sterkenburg, Anthe S.; Mueller, Hermann L.

Fusiform dilatations of the internal carotid artery (FDCA) represent a vascular complication following surgery for suprasellar tumors in children. Incidence rate and long-term prognosis of FDCA in terms of survival rates, vascular complications, and quality of survival are unknown for patients with

Internal carotid artery dissection in a patient with Ehlers-Danlos syndrome type IV: diagnosis and management

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Michel Nasser

2013-06-01

Full Text Available Ehlers-Danlos syndrome (EDS type IV, also known as vascular EDS, is an inherited connective tissue disorder with an estimated prevalence of 1/100,000 to 1/250,000. In EDS type IV, vascular complications may affect all anatomical areas, with a preference for large- and medium-sized arteries. Dissections of the vertebral and carotid arteries in their extra- and intra-cranial segments are typical. The authors report the case of a patient with EDS type IV for whom the diagnosis was established based on clinical signs and who developed internal carotid artery dissection at the age of 44 years. In the absence of a specific treatment for EDS type IV, medical interventions should focus on symptomatic relief, prophylactic measures, and genetic counseling. Invasive imaging techniques are contraindicated, and a conservative approach to vascular complications is usually recommended.

Does carotid intima-media thickness have relationship with polycystic ovary syndrome?

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Zahra Allameh

2013-01-01

Full Text Available Background: Polycystic ovary syndrome (PCOS is a common reproductive endocrine disorder associated with cardiovascular disease (CVD risk factors and metabolic disturbances and a genetically heterogeneous disease. Intima-media thickness (IMT is an indicator of atherosclerosis. This study aimed to determine the relation between IMT and PCOS in women. Methods: This cross-sectional study was performed on 44 PCOS patients and 44 healthy women. Data collection included lipid profiles, blood pressure, waist circumference, body mass index (BMI, and common and internal IMT of carotid artery which were measured in studied subjects. IMT was measured by a radiologist using a linear 12 MHz ultrasound probe (LOGIC S6, GE in carotid setting. Results: IMT of common carotid artery (56.8 ΁ 7.6 in cases versus 49.8 ΁ 7.3 in controls, internal carotid artery (56.9 ΁ 6.03 in cases versus 49.6 ΁ 6.9 in controls, and both common and internal carotid artery (56.6 ΁ 6.7 in cases versus 49.7 ΁ 6.9 in controls were significantly higher in PCOS patients than healthy women (P < 0.001. Conclusions: In summary, results demonstrated that carotid artery thickness as a risk for premature atherosclerosis in patients with PCOS is higher than healthy subjects. And hence care and monitoring of PCOS women with these risk factors sounds to be important and necessary.

Cigarette smoking in military pilots and intima-media thickness of the carotid arteries

Directory of Open Access Journals (Sweden)

Jovelić Stojan

2005-01-01

Full Text Available Background. It is well known that smoking is associated with an increase in arterial wall thickness. However, most studies of this problem have been undertaken in age and sex heterogeneous groups, as well as in patients with already present other conventional risk factors. The aim of this study was to assess the effect of cigarette smoking on arterial wall thickness of the common carotid artery in asymptomatic pilots. Methods. The imaging of intima−media thickness of the posterior wall of the distal 1 cm of both common carotid arteries was performed using a B mode ultrasound device, in 39 pilots (37.05 ± 6.66 years, for whom smoking was the single cardiovascular risk factor. Comparisons were made with 49 non-smokers (35.12 ± 7.39 years. Results. The posterior walls of both common carotid arteries were thicker in smokers (left, p < 0.05; right, p > 0,05. Intima-media thickness was significantly lower on the right side than on the left side in both smokers and nonsmokers (p < 0.01. Conclusion. Cigarette smoking as the single cardiovascular risk factor was associated with the wall thickness of the carotid arteries in our study. This finding indicated that early atherosclerosis was already present in pilots - smokers entering middle age.

Current Issues in the Presentation of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Fourth International Workshop

Science.gov (United States)

Clarke, Bart L.; Peacock, Munro; Bandeira, Francisco; Boutroy, Stephanie; Cusano, Natalie E.; Dempster, David; Lewiecki, E. Michael; Liu, Jian-Min; Minisola, Salvatore; Rejnmark, Lars; Silva, Barbara C.; Walker, Marcella D.; Bilezikian, John P.

2014-01-01

Objective: This report summarizes data on traditional and nontraditional manifestations of primary hyperparathyroidism (PHPT) that have been published since the last International Workshop on PHPT. Participants: This subgroup was constituted by the Steering Committee to address key questions related to the presentation of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed. Evidence: Data from the 5-year period between 2008 and 2013 were presented and discussed to determine whether they support changes in recommendations for surgery or nonsurgical follow-up. Consensus Process: Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was undertaken. After extensive review and discussion, the subgroup came to agreement on what changes in the recommendations for surgery or nonsurgical follow-up of asymptomatic PHPT should be made to the Expert Panel. Conclusions: 1) There are limited new data available on the natural history of asymptomatic PHPT. Although recognition of normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism) is increasing, data on the clinical presentation and natural history of this phenotype are limited. 2) Although there are geographic differences in the predominant phenotypes of PHPT (symptomatic, asymptomatic, normocalcemic), they do not justify geography-specific management guidelines. 3) Recent data using newer, higher resolution imaging and analytic methods have revealed that in asymptomatic PHPT, both trabecular bone and cortical bone are affected. 4) Clinically silent nephrolithiasis and nephrocalcinosis can be detected by renal imaging and should be listed as a new criterion for surgery. 5) Current data do not support a cardiovascular evaluation or surgery for the purpose of improving cardiovascular markers, anatomical or functional abnormalities. 6) Some patients with mild PHPT

Intracerebral haemorrhage after carotid endarterectomy

DEFF Research Database (Denmark)

Schroeder, T; Sillesen, H; Boesen, J

1987-01-01

Among 662 consecutive carotid endarterectomies eight cases of postoperative ipsilateral intracerebral haemorrhage were identified, occurring into brain areas which, preoperatively were without infarction. As blood pressures across the stenosis were routinely measured during surgery, the internal...

Spontaneous Recanalization of Complete Internal Carotid Artery: A ...

African Journals Online (AJOL)

examination revealed global aphasia and right hemiplegia. No carotid bruits or heart murmurs were. ABSTRACT. Spontaneous recanalization of atherothrombotic extracranial cerebral arteries is rare vis-à-vis recanalization of intracranial vessels. The time course is unknown. The question is the advisability and timing of ...

Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

International Nuclear Information System (INIS)

Cil, Barbaros E.; Ucar, Ibrahim; Ozsoy, Fatma; Arat, Anil; Yorgancioglu, Cem; Boeke, Erkmen

2005-01-01

Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions

Congenital absence of the bilateral internal carotid artery: a review of the associated (ab)normalities from a newborn status to the eighth decade of life.

Science.gov (United States)

Vasović, Ljiljana; Trandafilović, Milena; Vlajković, Slobodan; Radenković, Goran

2018-01-01

Due to the fact that the internal carotid artery (ICA) is responsible for nourishing two thirds of the brain volume, our aim was to inspect the morphofunctional consequences of the bilateral lack of this artery. In order to examine this condition, we referred to both the library archive of our Faculty of Medicine and electronic databases of anatomical and clinical reports that included the following keywords: "absence," "aplasia," or "agenesis" in combination with "internal carotid artery," "common carotid artery," or only "carotid artery." We found 60 recorded cases of the bilateral ICA absence in the subjects of newborn status to the eighth decade of life, which had been discovered in 20 countries. The following ten parameters were described: the embryological base, terminology, history, incidence, general data, differential diagnosis, collateral circulation, the associated vascular aplasia and/or other variants, pathophysiology, and the importance in praxis. This review noted all the cases of the bilateral ICA aplasia published for the past 104 years. Although there were 11.6% of cases of the associated cerebral aneurysms and 1-4 cases of 16 other diseases, approximately one quarter of the cases was without any pathology.

Ideal Internal Carotid Artery Trapping Technique without Bypass in a Patient with Insufficient Collateral Flow

OpenAIRE

Chung, Joon Ho; Shin, Yong Sam; Lim, Yong Cheol; Park, Minjung

2009-01-01

Internal carotid artery (ICA) trapping can be used for treating intracranial giant aneurysm, blood blister-like aneurysms and ICA rupture during the surgery. We present a novel ICA trapping technique which can be used with insufficient collaterals flow via anterior communicating artery (AcoA) and posterior communicating artery (PcoA). A patient was admitted with severe headache and the cerebral angiography demonstrated a typical blood blister-like aneurysm at the contralateral side of PcoA. F...

Carotid artery surgery

Science.gov (United States)

Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

Persistent dorsal ophthalmic artery arising from the internal carotid artery: Report of three cases

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Shin, Jae Hwan; Lee, Ghi Jai; Shim, Jae Chan; Lee, Kyoung Eun; Kim, Ho Kyun; Suh, Jung Ho [Dept. of Radiology, Seoul Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

2016-12-15

Normally, the ophthalmic artery (OA) arises from the supraclinoid segment of the internal carotid artery (ICA) and enters the orbit via the optic canal. A persistent dorsal OA is a rare variation that originates from the cavernous segment of the ICA and enters the orbit via the superior orbital fissure. To the best of our knowledge, persistent dorsal OA has not been described in the Korean literature. In this paper, we report three cases of persistent dorsal OA with review of the literature on embryogenesis and other origins of the OA.

Emergency treatment by intravascular embolization in traumatic carotid cavernous fistula

International Nuclear Information System (INIS)

Tang Jun; Sun Zengtao; Liu Zuoqin; Liu Yanjun; Li Fengxin

2006-01-01

Objective: To discuss the method of intervenfional intravascular treatment in traumatic carotid cavernous fistula (TCCF) and the significance of clinical application in emergency. Methods: In 297 eases of TCCF, 36 cases were treated by interventional intravascular embolization by detachable balloon, embolization orificium or occlusion in one side of carotid artery. In the 36 cases, serious epistaxis occurred in 22 eases, cortical vein inflow in 9 cases, intracranial hemorrhage in 3 cases, aggravation of eyesight in 3 cases, and limb dysfunction in 2 cases. Results: Fistula was successfully embolized and internal carotid artery remained patent in 19 cases. Complete embolization of orificium or internal carotid artery was achieved in 17 eases. The serious epistaxias in 22 cases and intracranial hemorrhage in 3 cases stopped. Eyesight recovered in 2 eases and improved in 1 case. Limb dysfunction improved evidently in 2 cases. Conclusion: Intravascular embolization treatment is the first therapeutic choice for TCCF, especially in emergency. It is necessary, safe and effective. (authors)

Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis.

LENUS (Irish Health Repository)

Edmundson, S P

2012-01-31

We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently. An awareness of this injury is needed to diagnose blunt trauma to the internal carotid artery. Even in the absence of obvious neck trauma, carotid artery dissection should be suspected in patients with a neurological deficit in the peri-operative period.

There is no benefit to universal carotid artery duplex screening before a major cardiac surgical procedure.

Science.gov (United States)

Adams, Brian C; Clark, Ross M; Paap, Christina; Goff, James M

2014-01-01

Perioperative stroke is a devastating complication after cardiac surgery. In an attempt to minimize this complication, many cardiac surgeons routinely preoperatively order carotid artery duplex scans to assess for significant carotid stenosis. We hypothesize that the routine screening of preoperative cardiac surgery patients with carotid artery duplex scans detects few patients who would benefit from carotid intervention or that a significant carotid stenosis reliably predicts stroke risk after cardiac surgery. A retrospective review identified 1,499 patients who underwent cardiac surgical procedures between July 1999 and September 2010. Data collected included patient demographics, comorbidities, history of previous stroke, preoperative carotid artery duplex scan results, location of postoperative stroke, and details of carotid endarterectomy (CEA) procedures before, in conjunction with, or after cardiac surgery. Statistical methods included univariate analysis and Fisher's exact test. Twenty-six perioperative strokes were identified (1.7%). In the 21 postoperative stroke patients for whom there is complete carotid artery duplex scan data, 3 patients had a hemodynamically significant lesion (>70%) and 1 patient underwent unilateral carotid CEA for bilateral disease. Postoperative strokes occurred in the anterior cerebral circulation (69.2%), posterior cerebral circulation (15.4%), or both (15.4%). Patient comorbidities, preoperative carotid artery duplex scan screening velocities, or types of cardiac surgical procedure were not predictive for stroke. Thirteen patients (0.86%) underwent CEA before, in conjunction with, or after cardiac surgery. Two of these patients had symptomatic disease, 1 of whom underwent CEA before and the other after his cardiac surgery. Of the 11 asymptomatic patients, 2 underwent CEA before, 3 concurrently, and 6 after cardiac surgery. Left main disease (≥50% stenosis), previous stroke, and peripheral vascular disease were found to be

Exclusion of Atherosclerotic Plaque from the Circulation Using Stent-Grafts: Alternative to Carotid Stenting with a Protection Device?

International Nuclear Information System (INIS)

Peynircioglu, Bora; Geyik, Serdar; Yavuz, Kivilcim; Cil, Barbaros E.; Saatci, Isil; Cekirge, Saruhan

2007-01-01

Purpose. To retrospectively assess the feasibility, safety, and clinical mid-term outcome of patients undergoing carotid artery stenting with stent-grafts. Methods. Over a 4 year period stent-grafts were used in the endovascular treatment of symptomatic internal carotid artery stenosis in 12 patients (2 women, 10 men, aged 47-83 (mean 64) years). Protection devices were not used. Possible microembolic complications were evaluated by magnetic resonance imaging (MRI) examinations of the brain before and the day after the procedure in all patients. Mean follow-up was 22 months (range 1-42 months), by Doppler ultrasonography and conventional angiography as well as clinical examination .Results. The technical success rate was 100%. A total of 13 coronary stent-grafts were used. The mean stenosis rate (in terms of diameter) was 85% and the mean length of stent-grafts used was 20.9 mm. The mean diameter to which the stent-grafts were dilated was 4.66 mm. In-hospital complications occurred in 1 patient who suffered a minor femoral access hematoma that did not require transfusion or surgical decompression. Post-stenting diffusion-weighted MRI revealed several ipsilateral silent microemboli in only 1 case, which was completely asymptomatic. Two patients had a major stroke after 2 years of follow-up. Restenosis was found in 2 patients who underwent successful balloon dilatation followed by placement of a self-expandable bare stent within the stent-grafts. Conclusions. Stent-grafts may prevent microembolic complications during stenting of atherosclerotic carotid lesions in selected cases, offering immediate exclusion of the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Comparative, randomized studies in larger series of patients are needed with carotid-dedicated stent-graft designs

Does the new International Diabetes Federation definition of metabolic syndrome improve prediction of coronary artery disease and carotid intima-media thickening?

Science.gov (United States)

Timóteo, Ana; Santos, Rui; Lima, Sandra; Mamede, Andreia; Fernandes, Rita; Ferreira, Rui

2009-02-01

Metabolic syndrome (MS) is associated with increased incidence of diabetes and atherosclerotic complications. The new definition of the International Diabetes Federation (IDF) increases the population with this entity, compared to the NCEP ATP III definition. To study the prevalence of coronary artery disease (CAD) and carotid intima-media thickness (IMT) in patients with and without MS, according to the NCEP ATP III and IDF definitions, and the predictive ability of carotid IMT for CAD. We studied 270 consecutive patients admitted for elective coronary angiography due to suspicion of CAD. All patients underwent ultrasound study of the carotid arteries to measure IMT (the highest value between the right and left common carotid arteries was used in the analysis). Coronary stenosis of > or =70% (or 50% for the left main coronary artery) was considered significant. By the ATP III definition, 14% of the patients had MS, and these patients had a higher prevalence of CAD (87% vs. 63%, p = 0.004), but no significant difference was found for carotid IMT (1.03 +/- 0.36 mm vs. 0.95 +/- 0.35 mm, p=NS). With the IDF definition, 61% of the patients had MS; this group was slightly older and included more women. There were no differences in terms of CAD (68% vs. 63%) or carotid IMT (0.97 +/- 0.34 vs. 0.96 +/- 0.39 mm). On multivariate analysis, the ATP III definition of MS predicts CAD (OR 4.76, 95% CI 1.71-13.25, p = 0.003), but the IDF definition does not (OR 1.29, 95% CI 0.74-2.27, p = 0.37). On ROC curve analysis, an IMT of > or = 0.95 mm predicts CAD (AUC 0.66, p definition increases the population with MS, decreasing the capacity to predict the presence of CAD. In our population, neither the ATP III nor the IDF definition showed differences in terms of carotid IMT. Carotid IMT can predict CAD, but with only modest sensitivity.

Haemodynamic evaluation of carotid artery disease

DEFF Research Database (Denmark)

Sillesen, H; Schroeder, T

1989-01-01

Cerebral ischaemia in the region of an internal carotid artery (ICA) stenosis may be caused by embolism or cerebral hypoperfusion. A severe ICA stenosis may be well compensated by collateral blood supply, however, in some patients the capacity of the collateral blood supply is insufficient. Studies...... evaluating therapeutic modalities or natural history of carotid artery disease should therefore include a test capable of assessing cerebral haemodynamics. However, most studies, invasive as well as non-invasive, have focused on the ability of the test to diagnose the ICA lesions itself, rather than...

Intraplaque stretch in carotid atherosclerotic plaque--an effective biomechanical predictor for subsequent cerebrovascular ischemic events.

Directory of Open Access Journals (Sweden)

Zhongzhao Teng

Full Text Available BACKGROUND: Stretch is a mechanical parameter, which has been proposed previously to affect the biological activities in different tissues. This study explored its utility in determining plaque vulnerability. METHODS: One hundred and six patients with mild to moderate carotid stenosis were recruited in this study (53 symptomatic and 53 asymptomatic. High resolution, multi-sequence magnetic resonance (MR imaging was performed to delineate various plaque components. Finite element method was used to predict high stretch concentration within the plaque. RESULTS: During a two-year follow-up, 11 patients in symptomatic group and 3 in asymptomatic group experienced recurrent cerebrovascular events. Plaque stretch at systole and stretch variation during one cardiac cycle was greater in symptomatic group than those in the asymptomatic. Within the symptomatic group, a similar trend was observed in patients with recurrent events compared to those without. CONCLUSION: Plaques with high stretch concentration and large stretch variation are associated with increased risk of future cerebrovascular events.

Preliminary clinical application in the cranial internal carotid artery of covered stents specially designed for intracranial vasculature

International Nuclear Information System (INIS)

Li Minghua; Luo Qiyi; Fang Chun; Xie Zhiyong; Cheng Yingsheng; Gao Bulang; Li Yu; Zhang Beilei; Xie Jian; Wang Yongli

2007-01-01

Objective: To investigate the flexibility of both the covered stents specially designed for use in intracranial vasculature and the delivering system in passing through the bone tube and the physiological curves of the cranial internal carotid artery (CICA) to reach the targeted area, the performance (adherence) of the covered stents in occluding vascular wall diseases and the impact on the vascular branches of the covered segment. Methods: The covered stents specially designed for use in intracranial vasculature were used to treat 13 patients with CICA diseases using endovascular techniques. There were 4 huge pseudoaneurysms, 4 giant aneurysms, 3 small wide-necked aneurysms, 1 giant pseudoaneurysm with concurrent internal carotid cavernous fistula (CCF), and 1 CCF. Prior to the detachment of the covered stents, balloon occlusion test (BOT) of the internal carotid artery on the diseased side and whole-brain digital subtraction angiography (DSA) were performed in all the patients. Three to 16 months following procedure, DSA and clinical follow-ups were performed. Results: Thirteen patients all tolerated the BOT well with the DSA demonstrating well-opened anterior and posterior communicating arteries. The covered stents and the delivering systems all successfully passed CICA to reach the targeted diseased area, with the diseased segments of the internal carotid artery including C3-C4 in 4 cases, C4-C5 in 4 and C6-C7 in 5. Immediately following the detachment of the covered stents, DSA demonstrated that 7 aneurysms were completely occluded, 4 aneurysms had slight endoleak, and 1 CCF had markedly-decreased blood flow through the fistula. In the patient with concurrent pseudoaneurysm and CCF, the pseudoaneurysm disappeared and the blood flow through the fistula was markedly-reduced immediately following the stenting procedure. Apart from one patient with aneurysmal subarachnoid hemorrhage who died due to extensive vascular spasm on the 9th day following the stenting

Cerebral metabolism of patients with stenosis or occlusion of the internal carotid artery. A 1H-MR spectroscopic imaging study

NARCIS (Netherlands)

van der Grond, J.; Balm, R.; Kappelle, L. J.; Eikelboom, B. C.; Mali, W. P.

1995-01-01

BACKGROUND AND PURPOSE: Occlusion or severe stenosis of extracranial vessels may lead to hypoperfusion without overt infarction of brain tissue. The aim of this study was to investigate whether occlusion of the internal carotid artery or stenosis with reduction in diameter of more than 70% leads to

Thirty-day outcomes of direct carotid artery stenting with cerebral protection in high-risk patients

International Nuclear Information System (INIS)

Veselka, J.; Cerna, D.; Zimolova, P.; Blasko, P.; Fiedler, J.; Hajek, P.; Maly, M.; Zemanek, D.; Duchonova, R.

2007-01-01

Implantation of a carotid artery stent after predilation is a standard approach in the endovascular treatment of carotid artery stenoses. Stenting without predilation may be an alternative approach in a certain subset of patients. The present prospective, single-center registry was designed to evaluate the feasibility and safety of direct carotid artery stenting (DCAS) in high-risk patients. Symptomatic patients with stenosis >50% and asymptomatic patients with stenosis >70% were eligible for enrolment. Criteria for high-risk patients included: need or history of open heart surgery, history of myocardial infarction, multivessel coronary artery disease, left ventricular dysfunction (ejection fraction ≤40%), severe pulmonary or renal disease, significant contralateral carotid disease, previous endarterectomy, and age ≥80 years. All procedures were performed using a filter protection device. Patients underwent complete clinical examination before and after DCAS and at 30-day follow-up. A total of 83 consecutive patients (45 males, 68±9 years, 33% symptomatic) underwent 100 procedures and 103 stents were deployed successfully. The technical success rate of stenting was 100%. Predilation of carotid stenosis was necessary in 1 (1%) procedure. Carotid-artery stenoses before and after DCAS were 80±9% and 7±9%, respectively. The median fluoroscopic time for DCAS was 7 min. The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, myocardial infarction) was 5% (2 minor strokes, 3 transient attacks). There was 1 (1%) minor stroke within the 30-day follow-up. DCAS is feasible and can be performed with an acceptable risk in high-risk patients. (author)

Incidence of New Ischaemic Brain Lesions After Carotid Artery Stenting with the Micromesh Roadsaver Carotid Artery Stent: A Prospective Single-Centre Study

Energy Technology Data Exchange (ETDEWEB)

Ruffino, Maria Antonella, E-mail: mruffino@cittadellasalute.to.it [Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Vascular Radiology Unit, Department of Diagnostic Imaging and Radiotherapy (Italy); Faletti, Riccardo [University of Torino, Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Radiology Unit, Department of Surgical Sciences (Italy); Bergamasco, Laura [University of Torino, Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Department of Surgical Sciences (Italy); Fonio, Paolo [University of Torino, Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Radiology Unit, Department of Surgical Sciences (Italy); Righi, Dorico [Azienda Ospedaliera Universitaria- Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, Vascular Radiology Unit, Department of Diagnostic Imaging and Radiotherapy (Italy)

2016-11-15

AimsSeveral randomized trials of patients with carotid stenosis show increased adverse neurological events with stenting versus endarterectomy in the 30-day post-procedure. This study examines the incidence of new ischaemic lesions in patients treated in our centre using the new Roadsaver stent.Methods and resultsBetween September 2015 and January 2016, 23 consecutive patients (age 74.3 ± 7.3 years, 17.4 % female) underwent carotid artery stenting with the Roadsaver stent, a nitinol double-layer micromesh device. A distal protection device was used in all cases. Diffusion-weighted magnetic resonance imaging was performed 24 h before, and 24 h and 30 days after the procedure. The 24-h post-procedure imaging showed 15 new ipsilateral ischaemic lesions in 7 (30.4 %) patients: median volume 0.076 cm{sup 3} (interquartile range 0.065–0.146 cm{sup 3}). All lesions were asymptomatic. The 30-day imaging showed complete resolution of all lesions and no new ischaemic lesions. Follow-up clinical and ultrasound examinations at 30 days and 6 months recorded no adverse cardiac or cerebrovascular events.ConclusionsProtected stenting with micromesh Roadsaver stent showed good safety and efficacy in the treatment of carotid stenosis, with a low incidence of delayed embolic events and new ipsilateral ischaemic brain lesions. These preliminary results are encouraging, but need to be confirmed with larger populations.

Incidence of New Ischaemic Brain Lesions After Carotid Artery Stenting with the Micromesh Roadsaver Carotid Artery Stent: A Prospective Single-Centre Study

International Nuclear Information System (INIS)

Ruffino, Maria Antonella; Faletti, Riccardo; Bergamasco, Laura; Fonio, Paolo; Righi, Dorico

2016-01-01

AimsSeveral randomized trials of patients with carotid stenosis show increased adverse neurological events with stenting versus endarterectomy in the 30-day post-procedure. This study examines the incidence of new ischaemic lesions in patients treated in our centre using the new Roadsaver stent.Methods and resultsBetween September 2015 and January 2016, 23 consecutive patients (age 74.3 ± 7.3 years, 17.4 % female) underwent carotid artery stenting with the Roadsaver stent, a nitinol double-layer micromesh device. A distal protection device was used in all cases. Diffusion-weighted magnetic resonance imaging was performed 24 h before, and 24 h and 30 days after the procedure. The 24-h post-procedure imaging showed 15 new ipsilateral ischaemic lesions in 7 (30.4 %) patients: median volume 0.076 cm"3 (interquartile range 0.065–0.146 cm"3). All lesions were asymptomatic. The 30-day imaging showed complete resolution of all lesions and no new ischaemic lesions. Follow-up clinical and ultrasound examinations at 30 days and 6 months recorded no adverse cardiac or cerebrovascular events.ConclusionsProtected stenting with micromesh Roadsaver stent showed good safety and efficacy in the treatment of carotid stenosis, with a low incidence of delayed embolic events and new ipsilateral ischaemic brain lesions. These preliminary results are encouraging, but need to be confirmed with larger populations.

Spontaneous carotid artery dissection causing a juvenile cerebral infarction

Energy Technology Data Exchange (ETDEWEB)

Trattnig, S.; Huebsch, P.; Schindler, E.

1988-11-01

The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred.

Detection of subclinical atherosclerosis in asymptomatic subjects using ultrasound radiofrequency-tracking technology.

Directory of Open Access Journals (Sweden)

Lili Niu

Full Text Available Atherosclerosis is a chronic and systemic disease and its developmental process involves the synergism of multiple risk factors such as hypertension, dyslipidemia, diabetes, obesity and smoking. The diagnosis of subclinical atherosclerosis is essential for strategic guidance towards suitable treatments and efficient prevention against acute cardiovascular events. This study employed ultrasound radiofrequency (RF tracking technology to characterize human carotid arteries in vivo in terms of intima-media thickness (IMT and artery stiffness, and evaluated the statistical correlation between carotid IMT and stiffness, and the number of risk factors for atherosclerosis.A total of 160 asymptomatic subjects were enrolled. Ultrasound RF-tracking technology was employed to acquire carotid IMT and stiffness parameters: maximum IMT ((MAXIMT, RF Quality IMT ((RFQIMT, distensibility coefficient (DC, compliance coefficient (CC, αindex, β index and local pulse wave velocity (PWVβ. The subjects were categorized in four groups in terms of the number of risk factors: 'zero', 'single', 'double', and 'multiple', and statistical analyses of carotid IMT and stiffness parameters were performed between these different groups.The subjects (n = 145 with (MAXIMT smaller than 1.0 mm matched the IMT criteria for non-atherosclerosis and were named as NA-subjects. Spearman's rho correlation analysis of the whole group and the NA-subjects both showed that (MAXIMT correlated positively with (RFQIMT, α, β, and PWVβ, and negatively with DC and CC (p<0.01. The analysis of covariance of NA-subjects showed significant differences between subjects with and without risk factors, and also showed significant differences between the 'zero', 'single', 'double', and 'multiple' groups.The carotid IMT and stiffness parameters obtained by the ultrasound RF-tracking technology were demonstrated to possess significant statistical correlation with the number of risk factors from 160

Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report

OpenAIRE

Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

2016-01-01

A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on ...

Intraplaque hemorrhage, a potential consequence of periodontal bacteria gathering in human carotid atherothrombosis.

Science.gov (United States)

Brun, Adrian; Rangé, Hélène; Prouvost, Bastien; Meilhac, Olivier; Mazighi, Mikael; Amarenco, Pierre; Lesèche, Guy; Bouchard, Philippe; Michel, Jean-Baptiste

2016-06-28

Periodontal diseases are multifactorial inflammatory diseases, caused by a bacterial biofilm involving both innate and adaptative immunity, characterized by the destruction of tooth-supporting tissues. In the context of periodontitis, the spread of weak pathogenic bacteria into the bloodstream has been described. These bacteria will preferentially localize to existing clot within the circulation. Atherothrombosis of the carotid arteries is a local pathology and a common cause of cerebral infarction. Intraplaque hemorrhages render the lesion more prone to clinical complications such as stroke. The main objective of this study is to explore the biological relationship between carotid intraplaque hemorrhage and periodontal diseases. This study included consecutive patients with symptomatic or asymptomatic carotid stenosis, admitted for endarterectomy surgical procedure (n=41). In conditioned media of the carotid samples collected, markers of neutrophil activation (myeloperoxidase or MPO, DNA-MPO complexes) and hemoglobin were quantified. To investigate the presence of DNA from periodontal bacteria in atherosclerotic plaque, PCR analysis using specific primers was performed. Our preliminary results indicate an association between neutrophil activation and intraplaque hemorrhages, reflected by the release of MPO (p<0,01) and MPO-DNA complexes (p<0,05). Presence of DNA from periodontitis-associated bacteria was found in 32/41 (78%) atheromatous plaque samples. More specifically, DNA from Pg, Tf, Pi, Aa was found in 46%, 24%, 34% and 68% of the samples, respectively. Hemoglobin levels were higher in conditioned media in carotid samples where the bacteria were found, but this was not statistically significant. Our data confirm the relationship between intraplaque hemorrhage and neutrophil activation. In addition, the presence of periodontal bacteria DNA in carotid atheromatous plaque, may contribute to this activation. Further analysis is needed to fully explore the raw

A road map to the internal carotid artery in expanded endoscopic endonasal approaches to the ventral cranial base.

Science.gov (United States)

Labib, Mohamed A; Prevedello, Daniel M; Carrau, Ricardo; Kerr, Edward E; Naudy, Cristian; Abou Al-Shaar, Hussam; Corsten, Martin; Kassam, Amin

2014-09-01

Injuring the internal carotid artery (ICA) is a feared complication of endoscopic endonasal approaches. To introduce a comprehensive ICA classification scheme pertinent to safe endoscopic endonasal cranial base surgery. Anatomic dissections were performed in 33 cadaveric specimens (bilateral). Anatomic correlations were analyzed. Based on anatomic correlations, the ICA may be described as 6 distinct segments: (1) parapharyngeal (common carotid bifurcation to ICA foramen); (2) petrous (carotid canal to posterolateral aspect of foramen lacerum); (3) paraclival (posterolateral foramen lacerum to the superomedial aspect of the petrous apex); (4) parasellar (superomedial petrous apex to the proximal dural ring); (5) paraclinoid (from the proximal to the distal dural rings); and (6) intradural (distal ring to ICA bifurcation). Corresponding surgical landmarks included the Eustachian tube, the fossa of Rosenmüller, and levator veli palatini for the parapharyngeal segment; the vidian canal and V3 for the petrous segment; the fibrocartilage of foramen lacerum, foramen rotundum, maxillary strut, lingular process of the sphenoid bone, and paraclival protuberance for the paraclival segment; the sellar floor and petrous apex for the parasellar segment; and the medial and lateral opticocarotid and lateral tubercular recesses, as well as the distal osseous arch of the carotid sulcus for the paraclinoid segment. The proposed endoscopic classification outlines key anatomic reference points independent of the vessel's geometry or the sinonasal pneumatization, thus serving as (1) a practical guide to navigate the ventral cranial base while avoiding injury to the ICA and (2) further foundation for a modular access system.

Characteristics of carotid atherosclerotic plaques of chronic lipid apheresis patients as assessed by In Vivo High-Resolution CMR - a comparative analysis

Directory of Open Access Journals (Sweden)

Grimm Jochen M

2012-11-01

Full Text Available Abstract Background Components of carotid atherosclerotic plaques can reliably be identified and quantified using high resolution in vivo 3-Tesla CMR. It is suspected that lipid apheresis therapy in addition to lowering serum lipid levels also has an influence on development and progression of atherosclerotic plaques. The purpose of this study was to evaluate the influence of chronic lipid apheresis (LA on the composition of atherosclerotic carotid plaques. Methods 32 arteries of 16 patients during chronic LA-therapy with carotid plaques and stenosis of 1–80% were matched according to degree of stenosis with 32 patients, who had recently suffered an ischemic stroke. Of these patients only the asymptomatic carotid artery was analyzed. All patients underwent black-blood 3 T CMR of the carotids using parallel imaging and dedicated surface coils. Cardiovascular risk factors were recorded. Morphology and composition of carotid plaques were evaluated. For statistical evaluation Fisher’s Exact and unpaired t-test were used. A p-value Results Patients in the LA-group were younger (63.5 vs. 73.9. years, p2, p Conclusion Results of this study suggest that, despite a severer risk profile for cardiovascular complications in LA-patients, chronic LA is associated with significantly lower lipid content in carotid plaques compared to plaques of patients without LA with similar degrees of stenosis, which is characteristic of clinically stable plaques.

Evaluation of results and radiologic follow-up in detachable balloon occlusion therapy of the internal carotid artery aneurysms

International Nuclear Information System (INIS)

Chung, Sun Yang; Kim, Dong Ik; Lee, Kyu Chang; Huh, Seung Kon; Yoon, Pyeong Ho; Choi, Jin Young; Kim, Dong Jun

1999-01-01

The author has studied the clinical results of CT and MR findings of proximal carotid artery occlusion using detachable balloons in the treatement of unclippable internal carotid (IC) aneurysms. From 1987 to 1995, twenty-eight patients with IC aneurysms were treated by proximal artery occlusion with detachable balloons. Of these patients, 4 had aneurysms arising from the supraclinoid portion of the IC artery, 23 had aneuryms arising from cavernous portion of the IC artery, and one had aneurysm arising from cervical portion of the IC artery. Of the 28 patients, 7 patients without CT or MR examinations were excluded in this study. The mean follow-up period was 18.6 months. The causes of aneurysm formation were spontaneous in 17 cases and traumatic in 4 cases. Of 20 patients with aneurysms arising from supraclinoid and cavernous portion of the IC artery, 16 patients (80%) had cranial nerve symptoms by mass effect. Five patients had epistaxis (3 patient), carotid cavernous fistula (1 patient) or subarachnoid hemorrhage (1 patient) due to aneurysm rupture. Two patients, each with aneuryms arising from supraclinoid and cervical portion of carotid artery had 9th and 12th cranial nerve symptom. There were three instances of complication after permanent occlusion; two patients had subarachnoid and intracerebral hemorrhage by aneurysm rupture and expired. One patient had ischemia of posterior cerebral artery teritorry after one day. Delayed ischemic event did not occur during the follow-up period. All aneurysms of the carotid artery below the level of ophthalmic artery presented radiographic proof of complete thrombosis within two months. However, complete thrombosis of aneurysm was considerably delayed in two aneurysms arising from the supraclinoid portion of the carotid artery. In long-term follow-up study, completely thrombosed aneurysms decreased in size slowly. But incompletely thrombosed aneurysms did not decrease in size for a long time and began to contract after

Evaluation of results and radiologic follow-up in detachable balloon occlusion therapy of the internal carotid artery aneurysms

Energy Technology Data Exchange (ETDEWEB)

Chung, Sun Yang; Kim, Dong Ik; Lee, Kyu Chang; Huh, Seung Kon; Yoon, Pyeong Ho; Choi, Jin Young; Kim, Dong Jun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

1999-06-01

The author has studied the clinical results of CT and MR findings of proximal carotid artery occlusion using detachable balloons in the treatement of unclippable internal carotid (IC) aneurysms. From 1987 to 1995, twenty-eight patients with IC aneurysms were treated by proximal artery occlusion with detachable balloons. Of these patients, 4 had aneurysms arising from the supraclinoid portion of the IC artery, 23 had aneuryms arising from cavernous portion of the IC artery, and one had aneurysm arising from cervical portion of the IC artery. Of the 28 patients, 7 patients without CT or MR examinations were excluded in this study. The mean follow-up period was 18.6 months. The causes of aneurysm formation were spontaneous in 17 cases and traumatic in 4 cases. Of 20 patients with aneurysms arising from supraclinoid and cavernous portion of the IC artery, 16 patients (80%) had cranial nerve symptoms by mass effect. Five patients had epistaxis (3 patient), carotid cavernous fistula (1 patient) or subarachnoid hemorrhage (1 patient) due to aneurysm rupture. Two patients, each with aneuryms arising from supraclinoid and cervical portion of carotid artery had 9th and 12th cranial nerve symptom. There were three instances of complication after permanent occlusion; two patients had subarachnoid and intracerebral hemorrhage by aneurysm rupture and expired. One patient had ischemia of posterior cerebral artery teritorry after one day. Delayed ischemic event did not occur during the follow-up period. All aneurysms of the carotid artery below the level of ophthalmic artery presented radiographic proof of complete thrombosis within two months. However, complete thrombosis of aneurysm was considerably delayed in two aneurysms arising from the supraclinoid portion of the carotid artery. In long-term follow-up study, completely thrombosed aneurysms decreased in size slowly. But incompletely thrombosed aneurysms did not decrease in size for a long time and began to contract after

Relation between wall shear stress and carotid artery wall thickening MRI versus CFD

DEFF Research Database (Denmark)

Cibis, Merih; Potters, Wouter V.; Selwaness, Mariana

2016-01-01

Wall shear stress (WSS), a parameter associated with endothelial function, is calculated by computational fluid dynamics (CFD) or phase-contrast (PC) MRI measurements. Although CFD is common in WSS (WSSCFD) calculations, PC-MRI-based WSS (WSSMRI) is more favorable in population studies; since...... it is straightforward and less time consuming. However, it is not clear if WSSMRI and WSSCFD show similar associations with vascular pathology. Our aim was to test the associations between wall thickness (WT) of the carotid arteries and WSSMRI and WSSCFD. The subjects (n=14) with an asymptomatic carotid plaque who...... underwent MRI scans two times within 4 years of time were selected from the Rotterdam Study. We compared WSSCFD and WSSMRI at baseline and follow-up. Baseline WSSMRI and WSSCFD values were divided into 3 categories representing low, medium and high WSS tertiles. WT of each tertile was compared by a one...

Resting and hypercapnic rCBF in patients with unilateral occlusive disease of the internal carotid artery

International Nuclear Information System (INIS)

Keyeux, A.; Laterre, C.; Beckers, C.

1988-01-01

Regional cerebral blood flow was measured by the 133 Xe inhalation technique in 15 patients with severe unilateral internal carotid artery stenosis (75%) or occlusion, and in the absence of evidence of any sign of occlusive disease in other main afferent cerebral arteries. A comparison with normal subjects showed that lowered resting flow in both hemispheres was a common finding in all patients. Interhemispheric asymmetry was present only in patients with occlusion and the precentral, posterior temporal, and occipital regions were the most seriously affected. The CO 2 reactivity was substantially reduced in both hemispheres of all stenotic and occluded patients, but occluded patients showed an increased reduction of CO 2 reactivity only in the ipsilateral hemisphere. In addition to an hypothetical age effect, the atherosclerotic involvement of the cerebral vascular system leads to a reduction of flow and loss of CO 2 reactivity in both hemispheres. In this context, the collateral supply capacity is not overloaded in case of a unilateral severe stenosis but fails in case of a unilateral occlusion of the internal carotid artery. A suitable estimate of the blood flow reduction as a result of occlusion is made by the hemispheric and regional laterality indices applied in resting and hypercapnia conditions. These indices could be used as indicators for endarterectomy or bypass surgery as well as a sensitive means for appreciating cerebral blood flow response to treatment

Spontaneous carotid artery dissection causing a juvenile cerebral infarction

International Nuclear Information System (INIS)

Trattnig, S.; Huebsch, P.; Schindler, E.

1988-01-01

The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred. (orig.) [de

Insulin resistance is associated with lower arterial blood flow and reduced cortical perfusion in cognitively asymptomatic middle-aged adults

Science.gov (United States)

Hoscheidt, Siobhan M; Kellawan, J Mikhail; Berman, Sara E; Rivera-Rivera, Leonardo A; Krause, Rachel A; Oh, Jennifer M; Beeri, Michal S; Rowley, Howard A; Wieben, Oliver; Carlsson, Cynthia M; Asthana, Sanjay; Johnson, Sterling C; Schrage, William G

2016-01-01

Insulin resistance (IR) is associated with poor cerebrovascular health and increased risk for dementia. Little is known about the unique effect of IR on both micro- and macrovascular flow particularly in midlife when interventions against dementia may be most effective. We examined the effect of IR as indexed by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) on cerebral blood flow in macro- and microvessels utilizing magnetic resonance imaging (MRI) among cognitively asymptomatic middle-aged individuals. We hypothesized that higher HOMA-IR would be associated with reduced flow in macrovessels and lower cortical perfusion. One hundred and twenty cognitively asymptomatic middle-aged adults (57 ± 5 yrs) underwent fasting blood draw, phase contrast-vastly undersampled isotropic projection reconstruction (PC VIPR) MRI, and arterial spin labeling (ASL) perfusion. Higher HOMA-IR was associated with lower arterial blood flow, particularly within the internal carotid arteries (ICAs), and lower cerebral perfusion in several brain regions including frontal and temporal lobe regions. Higher blood flow in bilateral ICAs predicted greater cortical perfusion in individuals with lower HOMA-IR, a relationship not observed among those with higher HOMA-IR. Findings provide novel evidence for an uncoupling of macrovascular blood flow and microvascular perfusion among individuals with higher IR in midlife. PMID:27488909

Association between Champagne Bottle Neck Sign of Internal Carotid Artery and Ipsilateral Hemorrhagic Stroke in Patients with Moyamoya Disease.

Science.gov (United States)

Wang, Jian; Chen, Gong; Yang, Yongbo; Zhang, Bing; Jia, Zhongzhi; Gu, Peiyuan; Wei, Dong; Ji, Jing; Hu, Weixing; Zhao, Xihai

2018-06-15

To assess the association between champagne bottle neck sign (CBNS) in carotid artery and intracranial hemorrhage in patients with moyamoya disease (MMD). From January 2016 to December 2017, a total of 76 consecutive patients with MMD without definite risk factors associated intracranial hemorrhage who underwent preoperative angiography were included in this retrospective study. CBNS was defined as luminal diameter of internal carotid artery (ICA)/common carotid artery (CCA) ≤ 0.5 on angiographic imaging. The right and left cerebral hemisphere in each patient was separately identified as hemorrhagic and none-hemorrhagic. The association between CBNS and intracranial hemorrhage was analyzed. Of 76 MMD patients, intracranial hemorrhage was found in 44 (28.9%) hemispheres of 152 and 6.8% (3/44) had multiple events. Compared carotid arteries without intracranial hemorrhage in the ipsilateral hemispheres, those with intracranial hemorrhage in the ipsilateral hemispheres had significantly smaller luminal diameter ratio of ICA/CCA (0.49 ± 0.11 vs. 0.55 ± 0.12, p < 0.01) and higher prevalence of CBNS (63.7% vs. 41.7%, p = 0.01). For hemispheres with intracranial hemorrhage, those with ipsilateral carotid artery CBNS had significantly higher prevalence of hemorrhage at posterior territories than those without (57.1% vs. 23.1%, p=0.05). Logistic regression revealed that CBNS was significantly associated with ipsilateral intracranial hemorrhage before (OR, 2.45; 95% CI, 1.19-5.05; p=0.02) and after (OR, 3.43; 95% CI, 1.50-7.87; p<0.01) adjusted for female, lenticulostriate anastomosis, and choroidal anastomosis. CBNS is significantly associated with intracranial hemorrhage at ipsilateral hemisphere in MMD patients, particularly for intracranial hemorrhage at posterior territories. Copyright © 2018. Published by Elsevier Inc.

Carotid intima-media thickness in patients with head and neck irradiation for the treatment of nasopharyngeal carcinoma

Energy Technology Data Exchange (ETDEWEB)

So, N.M.C.; Lam, W.W.M.; Chook, P.; Woo, K.S.; Liu, K.H.; Leung, S.F.; Wong, K.S.; Metreweli, C

2002-07-01

AIM: Intima-media thickness (IMT) has been shown to be useful in the evaluation and monitoring of carotid artery atherosclerosis in patients at risk of cardiovascular events. In this study, we aimed to examine the IMT in patients with nasopharyngeal carcinoma (NPC) who received irradiation to the carotid arteries during radiotherapy, and compared them with a control group. MATERIALS AND METHODS: Fifty-one NPC patients (aged between 39 and 69 years) and a group of 51 age-and sex-matched controls were studied by ultrasound. The IMT at the far wall of the common carotid artery was measured three times and the average value taken in each subject. The IMT of both groups were compared. Risk factors for IMT thickness, including hypertension, smoking, hyperglycaemia, hypercholesterolaemia, history of cerebrovascular accidents and cardiovascular disease, were also studied. RESULTS: The mean carotid IMT of patients in the NPC group (2.2+/-1.5 mm) was statistically greater than that in normal controls (0.7+/-0.15 mm) (P < 0.05). There was no statistically significant difference between the IMT in the right and left common carotid arteries within each group of patients. CONCLUSION: The findings suggest that patients with irradiation have increased arterial IMT. As they are asymptomatic the clinical relevance is not clear. So, N.M.C. et al. (2002)

Carotid intima-media thickness in patients with head and neck irradiation for the treatment of nasopharyngeal carcinoma

International Nuclear Information System (INIS)

So, N.M.C.; Lam, W.W.M.; Chook, P.; Woo, K.S.; Liu, K.H.; Leung, S.F.; Wong, K.S.; Metreweli, C.

2002-01-01

AIM: Intima-media thickness (IMT) has been shown to be useful in the evaluation and monitoring of carotid artery atherosclerosis in patients at risk of cardiovascular events. In this study, we aimed to examine the IMT in patients with nasopharyngeal carcinoma (NPC) who received irradiation to the carotid arteries during radiotherapy, and compared them with a control group. MATERIALS AND METHODS: Fifty-one NPC patients (aged between 39 and 69 years) and a group of 51 age-and sex-matched controls were studied by ultrasound. The IMT at the far wall of the common carotid artery was measured three times and the average value taken in each subject. The IMT of both groups were compared. Risk factors for IMT thickness, including hypertension, smoking, hyperglycaemia, hypercholesterolaemia, history of cerebrovascular accidents and cardiovascular disease, were also studied. RESULTS: The mean carotid IMT of patients in the NPC group (2.2+/-1.5 mm) was statistically greater than that in normal controls (0.7+/-0.15 mm) (P < 0.05). There was no statistically significant difference between the IMT in the right and left common carotid arteries within each group of patients. CONCLUSION: The findings suggest that patients with irradiation have increased arterial IMT. As they are asymptomatic the clinical relevance is not clear. So, N.M.C. et al. (2002)

PLACD-7T Study: Atherosclerotic Carotid Plaque Components Correlated with Cerebral Damage at 7 Tesla Magnetic Resonance Imaging.

Science.gov (United States)

den Hartog, A G; Bovens, S M; Koning, W; Hendrikse, J; Pasterkamp, G; Moll, F L; de Borst, G J

2011-02-01

In patients with carotid artery stenosis histological plaque composition is associated with plaque stability and with presenting symptomatology. Preferentially, plaque vulnerability should be taken into account in pre-operative work-up of patients with severe carotid artery stenosis. However, currently no appropriate and conclusive (non-) invasive technique to differentiate between the high and low risk carotid artery plaque in vivo is available. We propose that 7 Tesla human high resolution MRI scanning will visualize carotid plaque characteristics more precisely and will enable correlation of these specific components with cerebral damage. The aim of the PlaCD-7T study is 1: to correlate 7T imaging with carotid plaque histology (gold standard); and 2: to correlate plaque characteristics with cerebral damage ((clinically silent) cerebral (micro) infarcts or bleeds) on 7 Tesla high resolution (HR) MRI. We propose a single center prospective study for either symptomatic or asymptomatic patients with haemodynamic significant (70%) stenosis of at least one of the carotid arteries. The Athero-Express (AE) biobank histological analysis will be derived according to standard protocol. Patients included in the AE and our prospective study will undergo a pre-operative 7 Tesla HR-MRI scan of both the head and neck area. We hypothesize that the 7 Tesla MRI scanner will allow early identification of high risk carotid plaques being associated with micro infarcted cerebral areas, and will thus be able to identify patients with a high risk of periprocedural stroke, by identification of surrogate measures of increased cardiovascular risk.

PLACD-7T Study: Atherosclerotic Carotid Plaque Components Correlated with Cerebral Damage at 7 Tesla Magnetic Resonance Imaging

Science.gov (United States)

den Hartog, A.G; Bovens, S.M; Koning, W; Hendrikse, J; Pasterkamp, G; Moll, F.L; de Borst, G.J

2011-01-01

Introduction: In patients with carotid artery stenosis histological plaque composition is associated with plaque stability and with presenting symptomatology. Preferentially, plaque vulnerability should be taken into account in pre-operative work-up of patients with severe carotid artery stenosis. However, currently no appropriate and conclusive (non-) invasive technique to differentiate between the high and low risk carotid artery plaque in vivo is available. We propose that 7 Tesla human high resolution MRI scanning will visualize carotid plaque characteristics more precisely and will enable correlation of these specific components with cerebral damage. Study objective: The aim of the PlaCD-7T study is 1: to correlate 7T imaging with carotid plaque histology (gold standard); and 2: to correlate plaque characteristics with cerebral damage ((clinically silent) cerebral (micro) infarcts or bleeds) on 7 Tesla high resolution (HR) MRI. Design: We propose a single center prospective study for either symptomatic or asymptomatic patients with haemodynamic significant (70%) stenosis of at least one of the carotid arteries. The Athero-Express (AE) biobank histological analysis will be derived according to standard protocol. Patients included in the AE and our prospective study will undergo a pre-operative 7 Tesla HR-MRI scan of both the head and neck area. Discussion: We hypothesize that the 7 Tesla MRI scanner will allow early identification of high risk carotid plaques being associated with micro infarcted cerebral areas, and will thus be able to identify patients with a high risk of periprocedural stroke, by identification of surrogate measures of increased cardiovascular risk. PMID:22294972

Hybrid treatment of tandem, common carotid/innominate artery and ipsilateral carotid bifurcation stenoses by simultaneous, retrograde proximal stenting and eversion carotid endarterectomy: Preliminary results of a case series.

Science.gov (United States)

Illuminati, Giulio; Pizzardi, Giulia; Pasqua, Rocco; Frezzotti, Francesca; Palumbo, Piergaspare; Macrina, Francesco; Calio', Francesco

2018-04-01

Tandem stenoses of the internal carotid artery (ICA) and proximal, ipsilateral common carotid artery (CCA) or innominate artery can be treated with a hybrid approach, combining conventional carotid endarterectomy (CEA) and retrograde stenting of the proximal stenosis, through surgical exposure of the carotid bifurcation. The purpose of this study was to evaluate the results of combining eversion CEA with retrograde CCA/innominate artery stenting. From January 2015 to July 2017, 7 patients, 6 men of a mean age of 72 years (range 59-83 years) underwent simultaneous, retrograde stenting of the proximal CCA/innominate artery and an eversion CEA of the ipsilateral ICA, through surgical exposure of the carotid bifurcation, for severe tandem stenoses. The proximal stenosis involved the left proximal CCA in 4 patients, the proximal innominate artery in 2 patients and the right CCA in one patient. The procedure was performed under general anesthesia in a conventional operating room equipped with a mobile C-arm. A covered, balloon expandable stent was deployed over the proximal stenosis via a 6-F sheath directly introduced into the proximal CCA through the obliquely transected carotid bulb. After removing the sheath, debris were flushed through the carotid bulb and eversion CEA completed the procedure. Study endpoints were: postoperative stroke/mortality rate, cardiac mortality and morbidity, peripheral nerve injury, cervical hematoma, overall late survival, freedom from ipsilateral stroke and patency of arterial reconstruction. No postoperative mortality or neurologic morbidity was observed in any patient. Cervical hematomas and peripheral nerve injuries were likewise absent. At a mean follow-up of 18 months, all the patients were alive, free from neurologic events of new onset and free from restenosis. Combined proximal stenting and eversion CEA for tandem lesions seems a valid treatment, with the advantages of eversion CEA over other techniques of carotid bifurcation

Case of radiation induced aneurysm of extracranial carotid artery

Energy Technology Data Exchange (ETDEWEB)

Tashiro, Takashi; Ikota, Toshio; Yamashita, Kousuke; Kodama, Takao

1988-08-01

An unusual case of post-irradiation aneurysm of extracranial internal carotid artery is presented. A 70-year-old man, complaining of left cervical throbbing mass with focal pain, was admitted on February 8, 1985. It was noted, from his past history, that he had had surgery of the removal of cervical lymphnodes and that unknown dosage of irradiation had been added to the cervical region 30 years before. Left carotid angiography (on admission) demonstrated a giant aneurysm in the cervical portion of internal carotid artery. Right carotid angiography with compression of left carotid artery revealed good cross filling through anterior communicating artery. Computed tomography with contrast media showed a ring like enhanced mass, which was thought to suggest that a large part of the aneurysm was filled with intraluminal thrombosis. During 30 days of evaluation, the aneurysm grew larger and his cervical pain became untolerable. Operation, the resection of the aneurysm and the reconstruction (of circulation) with vein graft, was challenged on March 12. It was so difficult with meticulous work that the ligation of left common carotid artery was performed after all. Seven days after the operation, he suffered from the gastrointestinal bleeding, which was enough to lead him to hypovolemic shock. Thereafter, right hemiparesis and aphasia were brought about. Two months later, he died of pneumonia. On histological examination, it was demonstrated that the aneurysm communicated with the necrotic tissue and that the normal structure of the blood vessel was not observed in the aneurysmal wall and consisted of the collagenous fiber and granulated tissue. The aneurysm was interpreted as a false one.

Internal carotid artery rupture caused by carotid shunt insertion.

Science.gov (United States)

Illuminati, Giulio; Caliò, Francesco G; Pizzardi, Giulia; Vietri, Francesco

2015-01-01

Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Radioimmunoscintigraphy of experimental internal carotid arterial thrombi in dogs with 99mTc-labelled monoclonal anti-activated platelet antibody SZ-51

International Nuclear Information System (INIS)

Bao Shiyao; Li Wen; He Guangren; Shao Guofu; Zhang Zhilin; Wu Jinchang

1995-05-01

The capacity of McAbSZ-51, which is specific for an α-granule membrane protein (GMP-140) expressed on the surface of activated platelets, to bind to the grafted human thrombus in rabbits was studied. The feasibility of imaging thrombus with 99m Tc-labelled McAbSZ-51 in the internal carotid artery of dog was also explored. The results showed that McAbSZ-51 could bind to the grafted human thrombus in rabbits. The thrombus in internal carotid artery was clearly discerned at 2 to 6 h after injection of 99m Tc-SZ-51, with the optimal imaging time at 2 to 4 h after injection. The radioactivity ratio of thrombus to blood was 6.03 +- 1.09 at 6 to 8 h after injection. It is thus concluded that by using the 99m Tc-labelled McAbSZ-51, the early and specific detection of thrombi formed in vivo was fairly possible and feasible. (3 figs., 1 tab.)

[CHANGES OF CAROTID AND VERTEBRAL ARTERIES IN PATENTS WITH ARTERIAL HYPERTENSION AND HEPATOBILIARY PATHOLOGY].

Science.gov (United States)

Polyakov, V Ya; Nikolaev, Yu A; Pegova, S V; Matsievskaya, T R; Obukhov, I V

2016-01-01

The study included 1172 patients (410 men and 762 women) at the mean age of 60.3 ± 10.4 years with grade I-II (stage I-II) arterial hypertension (AH) admitted to the clinic of Institute of Experimental Medicine. The patients were divided into 2 groups based on the results of clinical and laboratory diagnostics. Group 1 (n = 525) included patients with AH and hepatobiliary system (HBS) diseases, group 2 (n = 647) patients with AH without HBS diseases. The patients group 1 had a thicker intima-media complex of carotid arteries, higher peak systolic bloodflow rate in the internal and vertebral carotid arteries, more pronounced coiling of internal carotid arteries than patients of group 2. Patients with AH and HBS diseases exhibited correlation between bloodflow rate in external carotid arteries and atherogenicity coefficient. Duplex scanning of neck vessels of in patients with AH without HBS diseases revealed peculiar changes of the intima-media thickness and hemodynamically significant changes of the blood flow in the internal carotid arteries that may be of prognostic value in this nosological syntropy and require the personified approach to diagnostics, treatment, and prevention of these conditions.

Carotid near-occlusion frequently has high peak systolic velocity on Doppler ultrasound

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Khangure, Simon R.; Machnowska, Matylda; Fox, Allan J.; Hojjat, Seyed-Parsa; Aviv, Richard I. [Sunnybrook Health Sciences Centre, Department of Medical Imaging, Neuroradiology Division, Toronto, ON (Canada); University of Toronto, Department of Medical Imaging, Division of Neuroimaging, Toronto (Canada); Benhabib, Hadas [Sunnybrook Health Sciences Centre, Department of Medical Imaging, Neuroradiology Division, Toronto, ON (Canada); Groenlund, Christer [Umeaa University, Department of Radiation Sciences, Biomedical Engineering, Umeaa (Sweden); Herod, Wendy [Department of Surgery, Sunnybrook Health Sciences Centre, Toronto (Canada); Maggisano, Robert [Department of Surgery, Sunnybrook Health Sciences Centre, Toronto (Canada); University of Toronto, Division of Vascular Surgery, Department of Surgery, Toronto (Canada); Sjoeberg, Anders [Umeaa University, Department of Radiation Sciences, Biomedical Engineering, Umeaa (Sweden); Umeaa University, Department of Pharmacology and Clinical Neuroscience, Umeaa (Sweden); Wester, Per [Umeaa University, Department of Public Health and Clinical Medicine, Umeaa (Sweden); Karolinska Institutet Danderyds Hospital, Department of Clinical Sciences, Stockholm (Sweden); Hopyan, Julia [University of Toronto, Division of Neurology, Department of Medicine, Toronto (Canada); Johansson, Elias [Umeaa University, Department of Pharmacology and Clinical Neuroscience, Umeaa (Sweden); Umeaa University, Department of Public Health and Clinical Medicine, Umeaa (Sweden)

2018-01-15

Carotid near-occlusion is a tight atherosclerotic stenosis of the internal carotid artery (ICA) resulting in decrease in diameter of the vessel lumen distal to the stenosis. Near-occlusions can be classified as with or without full collapse, and may have high peak systolic velocity (PSV) across the stenosis, mimicking conventional > 50% carotid artery stenosis. We aimed to determine how frequently near-occlusions have high PSV in the stenosis and determine how accurately carotid Doppler ultrasound can distinguish high-velocity near-occlusion from conventional stenosis. Included patients had near-occlusion or conventional stenosis with carotid ultrasound and CT angiogram (CTA) performed within 30 days of each other. CTA examinations were analyzed by two blinded expert readers. Velocities in the internal and common carotid arteries were recorded. Mean velocity, pulsatility index, and ratios were calculated, giving 12 Doppler parameters for analysis. Of 136 patients, 82 had conventional stenosis and 54 had near-occlusion on CTA. Of near-occlusions, 40 (74%) had high PSV (≥ 125 cm/s) across the stenosis. Ten Doppler parameters significantly differed between conventional stenosis and high-velocity near-occlusion groups. However, no parameter was highly sensitive and specific to separate the groups. Near-occlusions frequently have high PSV across the stenosis, particularly those without full collapse. Carotid Doppler ultrasound does not seem able to distinguish conventional stenosis from high-velocity near-occlusion. These findings question the use of ultrasound alone for preoperative imaging evaluation. (orig.)

Results of subclavian to carotid artery bypass for occlusive disease of the common carotid artery: A retrospective cohort study.

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Illuminati, Giulio; Pizzardi, Giulia; Calio, Francesco G; Masci, Federica; Pasqua, Rocco; Frezzotti, Francesca; Peschillo, Simone

2018-05-01

Optimal treatment of significant atherosclerosis of the common carotid artery (CCA) is not well-defined. The purpose of this study was to evaluate the long-term results of prosthetic subclavian to carotid bypass for occlusive disease of the CCA. From January 1994 to December 2015, 45 patients, mean age 67 years, underwent an ipsilateral subclavian to carotid bypass for occlusive disease of the CCA. Thirty-eight patients (84%) presented with neurologic symptoms, including transitory ischemic attacks in 29 cases and minor strokes in 9 cases. The graft material consisted of a 7 mm polytetrafluoroethylene conduit, and the distal anastomosis was done on the carotid bulb in 21 patients, on the internal carotid artery in 19 cases, and on the distal CCA in 5 cases. Median length of follow-up was 58 months. Study endpoints were the combined postoperative stroke/mortality rate, graft infection, overall late survival, freedom from ipsilateral stroke, and graft patency. Postoperative stroke/mortality rate was 2%. No graft infection was observed throughout follow-up. At 60 months, overall survival, freedom from stroke, and graft patency were 71% (standard error [SE] = 0.07), 98% (SE = 0.02), and 95.5% (SE = 0.06), respectively. Subclavian to carotid bypass allows very good patency rates and excellent protection from postoperative and late stroke, remaining a benchmark for any other treatment method. Copyright © 2018. Published by Elsevier Ltd.

Accuracy of Carotid Duplex Criteria in Diagnosis of Significant Carotid Stenosis in Asian Patients.

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Dharmasaroja, Pornpatr A; Uransilp, Nattaphol; Watcharakorn, Arvemas; Piyabhan, Pritsana

2018-03-01

Extracranial carotid stenosis can be diagnosed by velocity criteria of carotid duplex. Whether they are accurately applied to define severity of internal carotid artery (ICA) stenosis in Asian patients needs to be proved. The purpose of this study was to evaluate the accuracy of 2 carotid duplex velocity criteria in defining significant carotid stenosis. Carotid duplex studies and magnetic resonance angiography were reviewed. Criteria 1 was recommended by the Society of Radiologists in Ultrasound; moderate stenosis (50%-69%): peak systolic velocity (PSV) 125-230 cm/s, diastolic velocity (DV) 40-100 cm/s; severe stenosis (>70%): PSV greater than 230 cm/s, DV greater than 100 cm/s. Criteria 2 used PSV greater than 140 cm/s, DV less than 110 cm/s to define moderate stenosis (50%-75%) and PSV greater than 140 cm/s, DV greater than 110 cm/s for severe stenosis (76%-95%). A total of 854 ICA segments were reviewed. There was moderate stenosis in 72 ICAs, severe stenosis in 50 ICAs, and occlusion in 78 ICAs. Criteria 2 had slightly lower sensitivity, whereas higher specificity and accuracy than criteria 1 were observed in detecting moderate stenosis (criteria 1: sensitivity 95%, specificity 83%, accuracy 84%; criteria 2: sensitivity 92%, specificity 92%, and accuracy 92%). However, in detection of severe ICA stenosis, no significant difference in sensitivity, specificity, and accuracy was found (criteria 1: sensitivity 82%, specificity 99.57%, accuracy 98%; criteria 2: sensitivity 86%, specificity 99.68%, and accuracy 99%). In the subgroup of moderate stenosis, the criteria using ICA PSV greater than 140 cm/s had higher specificity and accuracy than the criteria using ICA PSV 125-230 cm/s. However, there was no significant difference in detection of severe stenosis or occlusion of ICA. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Central retinal and posterior ciliary artery occlusion after particle embolization of the external carotid artery system.

Science.gov (United States)

Mames, R N; Snady-McCoy, L; Guy, J

1991-04-01

A 15-year-old boy underwent neuroradiologic embolization of the left internal maxillary artery with polyvinyl alcohol to stop traumatic epistaxis after failure of surgical clipping and nasal packing. Selective catheterization of the external carotid artery before embolization showed a faint choroidal blush. Although the procedure provided hemostasis, embolization to the central retinal artery and ciliary arteries resulted in loss of vision. The route of the emboli to the eye was via the anastomotic network of the lacrimal artery supplied by the external carotid artery system. Neuroradiologic embolization of the external carotid artery is an effective mode of therapy for dural-cavernous fistulas when fed by the external carotid artery system. Because the blood flow to the brain and eye is predominantly supplied by the internal carotid artery, embolization of the external carotid artery is considered relatively safe. The authors document the importance of recognition of the choroidal blush during selective external carotid artery angiography as a sign of collateral blood flow to the eye. Physicians and patients need to be aware of the risk of blindness as a complication of external carotid artery embolization when this sign is present.

Endovascular treatment with a stent-graft for internal carotid artery laceration during trans sphenoidal surgery: a case report

International Nuclear Information System (INIS)

Choe, Eun Hwa; Ko, Ji Ho; Lee, Tae Hong; Rho, Myung Ho

2008-01-01

An internal carotid artery (ICA) tear during or after trans-sphenoidal surgery (TSS) is rare but may cause potentially lethal complications. A 23-year-old female patient visited our hospital for treatment of a Rathke's cleft cyst. The patient had massive hemorrhage during surgery and angiography performed after surgery showed laceration of the cavernous ICA. We successfully controlled the hemorrhage with emergency placement of an endovascular stent-graft

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability.

Science.gov (United States)

Brinjikji, Waleed; Huston, John; Rabinstein, Alejandro A; Kim, Gyeong-Moon; Lerman, Amir; Lanzino, Giuseppe

2016-01-01

Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is

Evaluation of Contrast MR Angiography in the Study of Internal Carotid Artery Stenosis. Systematic Review of the Literature; Evaluacion de la estenosis de la arteria carotida interna por angiografia REM con contraste: revision sistematica de la bibliografia

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Rodriguez Perez, P.; Martinez Cantarero, J. [Hospital Universitario 12 de Octubre. Madrid (Spain); Ruiz Diaz, M.; Blazquez Morera, J. A. [Universidad Autonoma de Madrid (Spain); Llano Senaris, J. E. de [Fundacion Gaspar Casal. Madrid (Spain)

2004-07-01

To evaluate the diagnostic benefit of using contrast MR Angiography (MRA) in the study of extracranial internal carotid artery stenosis as opposed to intraarterial digital subtraction arteriography (LADSA). A search for relevant articles from 1990 to 2000 using MDLINE and EMBASE databases. Initial selection criteria: 1. articles which compare MRA and IADSA in the study of extracranial internal carotid artery stenosis; and 2, sample size of 10 or more subjects. Studies employing contrast MRA were subsequently selected. Contrast MRA diagnostic results were studied, as were those of non-contrast MRA (TOF) if included. Roc curves and 95% confidence intervals were calculated. In the studies, 324 patients and 648 extracranial internal carotid arteries were evaluated (12 articles). The diagnostic results in carotid artery stenosis discrimination using contrast MRA as opposed to IADSA were sensitivity and specificity=97.28% and 96.08%. With regard to contrast MRA vs. non-contrast MRA (TOF), significant differences favoring contrast MRA in both sensitivity and specificity were observed. (p=0.08 and p<0.001, respectively). MRA techniques demonstrate very high diagnostic capabilities in the detection of carotid stenosis, with contrast MRA being more effective than non-contrast. MRA. In spite of not being superior to IADSA, given the morbimortality risk which the latter is associated (0.7-1.2%). many authors defend contrast MRA (in association with Doppler echography) having become the method of choice for presurgical study of extracranial internal carotid artery stenosis. (Author) 53 refs.

Delayed pan-hypopituitarism as a complication following endovascular treatment of bilateral internal carotid artery aneurysms. A case report and review.

Science.gov (United States)

Hall, Jonathan; Caputo, Carmela; Chung, Carlos; Holt, Michael; Wang, Yi Yuen

2015-04-01

Pan-hypopituitarism has been reported in patients who are subsequently found to have a cerebral aneurysm and there have been reports of pituitary dysfunction immediately following both surgical and endovascular treatment. The authors report a rare case of delayed pan-hypopituitarism following endovascular treatment of bilateral internal carotid artery aneurysms with coil embolisation and flow-diverting stents.

Modified Eversion Carotid Endarterectomy (mECEA): Analysis of Clinical and Financial Outcomes.

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Musicant, Scott E; Guzzetta, Vincent J; Terramani, Thomas T; Greenwood, Kristina L; Chiodo, Wendy C; Heaney, Karen M; Berthiaume, Shelley J

2017-07-01

Several carotid endarterectomy techniques have been described, including conventional carotid endarterectomy (CCEA) performed with patch repair and eversion carotid endarterectomy (ECEA) performed with transection of the internal carotid artery. We describe our simplified technique of modified eversion carotid endarterectomy (mECEA) with longitudinal arteriotomy limited to the carotid bulb, without transection of the internal carotid artery and present our analysis of its safety, efficacy, and cost effectiveness. A retrospective review of all carotid endarterectomies performed by 3 vascular surgeons over a 3-year period was completed. About 197 mECEA were performed during the study period. Follow-up data were obtained on 77.7% of patients. A comparison was made with the contemporary literature with respect to outcomes for both CCEA and ECEA. Between January 2012 and December 2014, a total of 197 mECEA were performed. The perioperative stroke and death rates for those undergoing mECEA was 0.5% and 0.5%, respectively. Late stroke and death rates were 3.0% and 5.1%, respectively. Perioperative rate of myocardial infarction was 1.0%. Early restenosis rates of >70% occurred in 1.4%, whereas late restenosis of >70% occurred in 2.7%. Mean operating time for those undergoing mECEA was 57.9 min. Average costs savings for mECEA compared to CCEA were $5,835. This simplified technique has comparable outcomes to those described in the contemporary literature for both CCEA and ECEA with respect to postoperative neurologic events as well as restenosis rates. In our institution, the short mean operative times with mECEA has led to reduced resource utilization. Copyright © 2017 Elsevier Inc. All rights reserved.

Endovascular Extraction of a Needle from the Internal Carotid Artery: A Novel Approach to a Controversial Dental Misadventure

Science.gov (United States)

Giurintano, Jonathan P.; Somerville, Jessica; Sebelik, Merry; Hoit, Daniel; Michael, L. Madison; Shires, Courtney B.

2017-01-01

Objective  To review the literature concerning the management of dental needles broken off into the deep spaces of the neck, to report what we believe is the first case of a fractured dental needle migrating into the jugular foramen, and the unconventional use of endovascular intervention to retrieve the needle fragment. Design  Case report with review of literature. Setting  Academic tertiary care center. Participants  Intervention was performed by the otolaryngology–head and neck surgery, vascular surgery, and neurovascular interventional radiology teams. Results  Transoral exploration, including palatal split and exposure of the poststyloid parapharyngeal space with C-arm image guidance, was unable to retrieve the broken needle, which traversed the internal carotid lumen with the distal end entering the jugular foramen. Through endovascular intervention, the neurovascular interventional radiology team captured the proximal end of the needle and retrieved it through the femoral artery. The patient recovered uneventfully. Conclusion  Fracture and loss of oral injection needles remain a persistent and preventable problem. This case demonstrates a novel, minimally invasive, well-tolerated, and successful method to extract a fractured needle that migrated into the lumen of the internal carotid artery at the level of the skull base. PMID:28845380

The internal carotid artery stenosis or occlusion. The evaluation for the posterior communicating artery on DSA and MRA

International Nuclear Information System (INIS)

Zhao Yunhui; Gao Xinjiang; Ma Zhubin; Xu Yikai

2003-01-01

Objective: To study the changes of the posterior communicating artery in patients with internal carotid artery (ICA) severe stenosis or occlusion on digital subtract angiography (DSA) and magnetic resonance angiography (MRA). Methods: DSA or MRA findings were analyzed in 74 patients with ICA stenosis or occlusion and in 120 persons selected in the control group, who were unremarkable on cerebral DSA or MRA. Results: On DSA, the presence rate of ipsilateral posterior communicating artery (PCoA) between the study group and the control group had no significant difference; on MRA the rate in the study group was significantly higher than the control group (P 0.05). In the study group, the presence rate of PCoA on DSA was significantly higher than that on MRA (P 0.05). The presence rate of PCoA shown no significant difference between the cases with unilateral ICA involved and cases with bilateral ICA involved. Conclusion: The posterior communicating artery is very important to the patients with the internal carotid artery stenosis or occlusion. Its dilatation on DSA and MRA or appearance on MRA shows its compensation. DSA is valuable in the evaluation of the posterior communicating artery. MRA is a noninvasive and functional imaging method for evaluation the posterior communicating artery

Internal Carotid Artery Ectasia: The Value of Imaging Studies Prior to Biopsy of a Retropharyngeal Mass

Directory of Open Access Journals (Sweden)

Kenneth Chan

2010-11-01

Full Text Available The presence of retropharyngeal tissue mass often raises the suspicion of malignancy, especially in elderly patients. This prompts urgent biopsy to investigate tissue histology. We discuss a case where this is contraindicated as the retropharyngeal mass was illustrated by CT scanning and confirmed with MRI to be a tortuous coursing internal carotid artery. An awareness of this unusual anatomical variation and a careful interpretation of imaging studies both at the stage of differential diagnosis and pre-operative screening are essential to avoid damage to important structures, causing unnecessary complications.

A case of radiation induced aneurysm of extracranial carotid artery

International Nuclear Information System (INIS)

Tashiro, Takashi; Ikota, Toshio; Yamashita, Kousuke; Kodama, Takao

1988-01-01

An unusual case of post-irradiation aneurysm of extracranial internal carotid artery is presented. A 70-year-old man, complaining of left cervical throbbing mass with focal pain, was admitted on February 8, 1985. It was noted, from his past history, that he had had surgery of the removal of cervical lymphnodes and that unknown dosage of irradiation had been added to the cervical region 30 years before. Left carotid angiography (on admission) demonstrated a giant aneurysm in the cervical portion of internal carotid artery. Right carotid angiography with compression of left carotid artery revealed good cross filling through anterior communicating artery. Computed tomography with contrast media showed a ring like enhanced mass, which was thought to suggest that a large part of the aneurysm was filled with intraluminal thrombosis. During 30 days of evaluation, the aneurysm grew larger and his cervical pain became untolerable. Operation, the resection of the aneurysm and the reconstruction (of circulation) with vein graft, was challenged on March 12. It was so difficult with meticulous work that the ligation of left common carotid artery was performed after all. Seven days after the operation, he suffered from the gastrointestinal bleeding, which was enough to lead him to hypovolemic shock. Thereafter, right hemiparesis and aphasia were brought about. Two months later, he died of pneumonia. On histological examination, it was demonstrated that the aneurysm communicated with the necrotic tissue and that the normal structure of the blood vessel was not observed in the aneurysmal wall and consisted of the collagenous fiber and granulated tissue. The aneurysm was interpreted as a false one. (author)

Fatty Acid binding protein 4 is associated with carotid atherosclerosis and outcome in patients with acute ischemic stroke.

Directory of Open Access Journals (Sweden)

Sverre Holm

Full Text Available BACKGROUND AND PURPOSE: Fatty acid binding protein 4 (FABP4 has been shown to play an important role in macrophage cholesterol trafficking and associated inflammation. To further elucidate the role of FABP4 in atherogenesis in humans, we examined the regulation of FABP4 in carotid atherosclerosis and ischemic stroke. METHODS: We examined plasma FABP4 levels in asymptomatic (n = 28 and symptomatic (n = 31 patients with carotid atherosclerosis, as well as in 202 subjects with acute ischemic stroke. In a subgroup of patients we also analysed the expression of FABP4 within the atherosclerotic lesion. In addition, we investigated the ability of different stimuli with relevance to atherosclerosis to regulate FABP4 expression in monocytes/macrophages. RESULTS: FABP4 levels were higher in patients with carotid atherosclerosis, both systemically and within the atherosclerotic lesion, with particular high mRNA levels in carotid plaques from patients with the most recent symptoms. Immunostaining of carotid plaques localized FABP4 to macrophages, while activated platelets and oxidized LDL were potent stimuli for FABP4 expression in monocytes/macrophages in vitro. When measured at the time of acute ischemic stroke, high plasma levels of FABP4 were significantly associated with total and cardiovascular mortality during follow-up, although we did not find that addition of FABP4 to the fully adjusted multivariate model had an effect on the prognostic discrimination for all-cause mortality as assessed by c-statistics. CONCLUSIONS: FABP4 is linked to atherogenesis, plaque instability and adverse outcome in patients with carotid atherosclerosis and acute ischemic stroke.

Urgent carotid stenting before cardiac surgery in a young male patient with acute ischemic stroke caused by aortic and carotid dissection

Directory of Open Access Journals (Sweden)

Popović Rade

2016-01-01

Full Text Available Introduction. Acute aortic dissection (AD is the most common life-threatening disorder affecting the aorta. Neurological symptoms are present in 17-40% of cases. The management of these patients is controversial. Case report. We presented a 37-year-old man admitted for complaining of left-sided weak-ness. Symptoms appeared two hours before admission. The patient had no headache, neither thoracic pain. Neurological examination showed mild confusion, left-sided hemiplegia, National Institutes of Health Stroke Scale (NIHSS score was 10. Ischemic stroke was suspected, brain multislice computed tomography (MSCT and angiography were performed and right intrapetrous internal carotid artery dissection noted. Subsequent color Doppler ultrasound of the carotid arteries showed dissection of the right common carotid artery (CCA. The patient underwent thoracic and abdominal MSCT aortography which showed ascending aortic dissection from the aortic root, propagating in the brachiocephalic artery and the right CCA. Digital subtraction angiography was performed subsequently and two stents were successfully implanted in the brachiocephalic artery and the right CCA prior to cardiac surgery, only 6 hours after admission. The ascending aorta was reconstructed with graft interposition and the aortic valve re-suspended. The patient was hemodynamically stable and with no neurologic deficit after surgery. Unfortinately, at the operative day 6, mediastinitis developed and after intensive treatment the patients died 35 days after admission. Conclusion. In young patients with suspected stroke and oscillatory neurological impairment urgent MSCT angiography of the brain and neck and/or Doppler sonography of the carotid and vertebral artery are mandatory to exclude carotid and aortic dissection. The prompt diagnosis permits urgent carotid stenting and cardiosurgery. To the best of our knowledge, this is the first published case of immediate carotid stenting in acute ischemic

A Novel Carotid Device for Embolic Diversion: Lessons Learned from a “First in Man” Trial in Patients with Atrial Fibrillation

International Nuclear Information System (INIS)

Sievert, Horst; Franke, Jennifer; Grad, Ygael; Nishri, Boaz; Assaf, Yaron; Yodfat, Ofer; Römer, Albrecht; Robertson, Greg C.; Stone, Gregg W.

2012-01-01

Purpose: This study was designed to investigate a novel device that was developed to direct emboli away from the internal carotid artery to the external carotid artery to prevent embolic stroke while avoiding the necessity for anticoagulation with warfarin. Methods: A stent-like, self-expandable filter was developed consisting of fine cobalt alloy mesh. After promising preclinical animal testing, the device was implanted into the common carotid artery extending into the external carotid artery in three patients with atrial fibrillation, each of whom were at high-risk for cerebral emboli and were suboptimal candidates for anticoagulation. Follow-up was performed clinically and with carotid duplex ultrasound. Results: The implantation was successful in all three patients. Unrestricted flow through the filter was demonstrated in each patient at 6 months by duplex sonography. However, at 7 months ultrasound demonstrated occlusion of the internal carotid artery filter in one patient, which was subsequently confirmed by angiography. Subtotal filter occlusion occurred in a second patient at 14 months. Neither patient had clinical symptoms. Both internal carotid arteries were successfully recanalized using standard angioplasty techniques without complication. The third patient had completely normal carotid blood flow at 29 months follow-up. Conclusions: Implantation of a novel device intended to divert emboli away from the internal carotid artery was feasible, but resulted in occlusive neointimal proliferation in two of three patients. These results demonstrate a discrepancy from the findings of preclinical animal studies and human investigation.

Effect of white-matter lesions on the risk of periprocedural stroke after carotid artery stenting versus endarterectomy in the International Carotid Stenting Study (ICSS): a prespecified analysis of data from a randomised trial

NARCIS (Netherlands)

Ederle, J.; Davagnanam, I.; Worp, H.B. van der; Venables, G.S.; Lyrer, P.A.; Featherstone, R.L.; Brown, M.M.; Jager, H.R.; Leeuw, F.E. de; Schultze Kool, L.J.; Vliet, J.A. van der; et al.,

2013-01-01

BACKGROUND: Findings from randomised trials have shown a higher early risk of stroke after carotid artery stenting than after carotid endarterectomy. We assessed whether white-matter lesions affect the perioperative risk of stroke in patients treated with carotid artery stenting versus carotid

Asymptomatic bacteriuria.

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Nicolle, Lindsay E

2014-02-01

Asymptomatic bacteriuria is a common finding. Inappropriate antimicrobial treatment of asymptomatic bacteriuria has been identified as a major issue for antimicrobial stewardship programs. This review summarizes and evaluates recent studies which extend our knowledge of the occurrence, management, and outcomes of bacteriuria. The reported prevalence of bacteriuria is higher in some developing countries than generally reported for developed countries, but reasons for this remain unclear. Clinical studies of young women, renal transplant patients, and patients undergoing minor nontraumatic urologic procedures confirm that treatment of asymptomatic bacteriuria for these populations is not beneficial, and may be harmful. There is also no benefit for treatment of asymptomatic bacteriuria prior to orthopedic surgery to decrease postoperative surgical site infection. Studies continue to report substantial inappropriate antimicrobial use for treatment of asymptomatic bacteriuria. Recent publications confirm that asymptomatic bacteriuria is benign in most patients. Management strategies for pregnant women with recurrent bacteriuria require further clarification. There is a continuing problem with inappropriate treatment of asymptomatic bacteriuria, and sustainable strategies to optimize antimicrobial use for this problem are needed.

Physical and computational fluid dynamics models for the hemodynamics of the artiodactyl carotid rete.

Science.gov (United States)

O'Brien, Haley D; Bourke, Jason

2015-12-07

In the mammalian order Artiodactyla, the majority of arterial blood entering the intracranial cavity is supplied by a large arterial meshwork called the carotid rete. This vascular structure functionally replaces the internal carotid artery. Extensive experimentation has demonstrated that the artiodactyl carotid rete drives one of the most effective selective brain cooling mechanisms among terrestrial vertebrates. Less well understood is the impact that the unique morphology of the carotid rete may have on the hemodynamics of blood flow to the cerebrum. It has been hypothesized that, relative to the tubular internal carotid arteries of most other vertebrates, the highly convoluted morphology of the carotid rete may increase resistance to flow during extreme changes in cerebral blood pressure, essentially protecting the brain by acting as a resistor. We test this hypothesis by employing simple and complex physical models to a 3D surface rendering of the carotid rete of the domestic goat, Capra hircus. First, we modeled the potential for increased resistance across the carotid rete using an electrical circuit analog. The extensive branching of the rete equates to a parallel circuit that is bound in series by single tubular arteries, both upstream and downstream. This method calculated a near-zero increase in resistance across the rete. Because basic equations do not incorporate drag, shear-stress, and turbulence, we used computational fluid dynamics to simulate the impact of these computationally intensive factors on resistance. Ultimately, both simple and complex models demonstrated negligible changes in resistance and blood pressure across the arterial meshwork. We further tested the resistive potential of the carotid rete by simulating blood pressures known to occur in giraffes. Based on these models, we found resistance (and blood pressure mitigation as a whole) to be an unlikely function for the artiodactyl carotid rete. Copyright © 2015 Elsevier Ltd. All

Radiation-Induced Carotid Artery Stenosis in a Patient with Carcinoma of the Oral Floor

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Kahori Seto

2013-01-01

Full Text Available Radiation-induced carotid artery stenosis (RI-CS, a life-threatening condition, can occur after external radiation for head and neck cancer. We here describe a case of asymptomatic RI-CS in a 73-year-old patient treated with chemoradiotherapy and radical neck dissection for a basaloid squamous cell carcinoma of the oral floor. Stenosis of the left carotid artery, diagnosed as RI-CS, showed on an MRI performed 1.5 years after radiotherapy. Blood from the left side of the anterior cerebral artery and the middle anterior artery was flowing to the brain through the anterior and posterior communicating arteries, so no stent surgery or other treatment was necessary. The cancer has not recurred during approximately 5 years of followup after radiotherapy, and the patient has had no adverse effects from the RI-CS since it was diagnosed 3.5 years ago. This case emphasizes the necessity of early scrutiny for RI-CS in patients given radiotherapy for oral cancer.

Carotid stenosis: a comparison between MR and spiral CT angiography

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Magarelli, N.; Carriero, A.; Bonomo, L. [Institute of Radiology, University ``G. D`Annunzio``, Chieti (Italy); Scarabino, T.; Simeone, A.L.; Florio, F. [IRCCS, Foggia (Italy); Salvolini, U. [Department of Neuroradiology, University of Ancona (Italy)

1998-06-01

We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0 % vs 80.8 %, 98.2 % vs 96.4 %, 96.3 % vs 91.3 % and 96.0 % vs 88.0 %, respectively). MRA gave rise to a 5.0 % overestimation rate, whereas SCTA occasioned a 7.5 % underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70 % stenosis. (orig.) With 6 figs., 4 tabs., 17 refs.

Carotid stenosis: a comparison between MR and spiral CT angiography

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Magarelli, N.; Carriero, A.; Bonomo, L.; Scarabino, T.; Simeone, A.L.; Florio, F.; Salvolini, U.

1998-01-01

We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0 % vs 80.8 %, 98.2 % vs 96.4 %, 96.3 % vs 91.3 % and 96.0 % vs 88.0 %, respectively). MRA gave rise to a 5.0 % overestimation rate, whereas SCTA occasioned a 7.5 % underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70 % stenosis. (orig.)

Fusiform dilatation of the internal carotid artery following childhood craniopharyngioma resection treated by endovascular flow diversion-A case report and literature review.

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Reynolds, Matthew R; Heiferman, Daniel M; Boucher, Andrew B; Serrone, Joseph C; Barrow, Daniel L; Dion, Jacques E

2018-05-24

Fusiform dilatation of the internal carotid artery (FDICA) is a well-described radiographic finding following resection of childhood craniopharyngioma (CP). A 39-year-old woman with right-sided FDICA was successfully treated for lesion enlargement with endovascular flow diversion, which has not been described in the literature. Published by Elsevier Ltd.

Clinical experience of cerebral protection with balloon occlusion during carotid artery stenting

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Jaeger, H.J.; Mathias, K.D.; Drescher, R.; Bockisch, G.; Hauth, E.; Demirel, E.; Gissler, H.M.; Witten/Herdecke Univ.

2001-01-01

Purpose: To asses the technical feasibility and the results of cerebral protection with the GuardWire Plus Temporary Occlusion and Aspiration System during carotid artery stenting for high-grade stenosis. Patients and Methods: In 20 patients 20 carotid artery stenoses were treated with stent placement under cerebral protection. A contralateral carotid occlusion was an exclusion criteria for the use of the protection device. In all cases only aspiration, but no flushing was used before deflation of the occlusion balloon. In 17 of 20 patients diffusion-weighted (DW-)MRT imaging of the brain was performed before and 24 hours after the procedure. Results: The stent implantation was successfully performed in all patients. In 3 patients neurologic symptoms occurred during the occlusion time. In these 3 patients the symptoms immediately disappeared after deflation of the balloon. In one case there was dilatation of the internal carotid artery at the site of the balloon inflation. In 3 of the 17 DW-MR images new ipsilateral cerebral lesions, in one case a new contralateral lesion occurred after the procedure. Conclusions: The cerebral protection procedure is technically feasible. The occlusion of the internal carotid artery was not tolerated by all patients. The DW-MR imaging demonstrated cerebral lesions indicating the occurrence of cerebral microemboli during the procedure. Further investigations are necessary to determine if the use of the cerebral protection device will improve the results of the carotid artery stenting for high-grade stenoses. (orig.) [de

Laser Doppler anemometer measurements of pulsatile flow in a model carotid bifurcation.

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Ku, D N; Giddens, D P

1987-01-01

Hemodynamics at the human carotid bifurcation is important to the understanding of atherosclerotic plaque initiation and progression as well as to the diagnosis of clinically important disease. Laser Doppler anemometry was performed in a large scale model of an average human carotid. Pulsatile waveforms and physiologic flow divisions were incorporated. Disturbance levels and shear stresses were computed from ensemble averages of the velocity waveform measurements. Flow in the common carotid was laminar and symmetric. Flow patterns in the sinus, however, were complex and varied considerably during the cycle. Strong helical patterns and outer wall flow separation waxed and waned during each systole. The changing flow patterns resulted in an oscillatory shear stress at the outer wall ranging from -13 to 9 dyn cm-2 during systole with a time-averaged mean of only -0.5 dyn cm-2. This contrasts markedly with an inner wall shear stress range of 17-50, (mean 26) dyn cm-2. The region of transient separation was confined to the carotid sinus outer wall with no reverse velocities detected in the distal internal carotid. Notable disturbance velocities were also time-dependent, occurring only during the deceleration phase of systole and the beginning of diastole. The present pulsatile flow studies have aided in identifying hemodynamic conditions which correlate with early intimal thickening and predict the physiologic level of flow disturbances in the bulb of undiseased internal carotid arteries.

[3H]Haloperidol labels brain dopamine receptors after its injection into the internal carotid artery of the rat

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D'Ambrosio, A.; Zivkovic, B.; Bartholini, G.

1982-01-01

Pulse injection of [ 3 H]haloperidol (0.1 μCi; 0.003 μg) into the internal carotid artery of the rat specifically labelled dopamine receptors in striatum and olfactory tubercle, as indicated by the kinetics of, and the effects of neuroleptic drugs on, the ligand disposition. The described method may prove useful for labelling brain receptors with ligands which readily cross the blood-brain barrier but which do not selectively mark their receptors if injected systemically. (Auth.)

A case of Behcet's disease with aneurysms of common carotid arteries and abdominal aorta

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Choo, Yeon Myung; Chang, Kee Hyun; Choi, Sung Jae

1984-01-01

One case of Behcet's disease with multiple aneurysms in both common carotid arteries and abdominal aorta is presented with brief review of the literatures. A 26-year-old woman had slowly enlarging pulsatile masses in both sides of neck and recurrent ulcerations in oral cavity and genitalia. One day prior to admission, aphasia, right facial nerve palsy and right hemiplegia suddenly developed. Brain CT showed acute infarction in left basal ganglia. Both Carotid Angiography and abdominal Aortography demonstrated multiple aneurysms in both common carotid arteries and abdominal aorta with organizing thrombi and thromboembolism of internal carotid artery

Predictive Value of Dynamic Cerebral Autoregulation Assessment in Surgical Management of Patients with High-Grade Carotid Artery Stenosis

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Vladimir B. Semenyutin

2017-11-01

Full Text Available Dynamic cerebral autoregulation (DCA capacity along with the degree of internal carotid artery (ICA stenosis and characteristics of the plaque can also play an important role in selection of appropriate treatment strategy. This study aims to classify the patients with severe ICA stenosis according to preoperative state of DCA and to assess its dynamics after surgery. Thirty-five patients with severe ICA stenosis having different clinical type of disease underwent reconstructive surgery. DCA was assessed with transfer function analysis (TFA by calculating phase shift (PS between Mayer waves of blood flow velocity (BFV and blood pressure (BP before and after operation. In 18 cases, regardless of clinical type, preoperative PS on ipsilateral side was within the normal range and did not change considerably after surgery. In other 17 cases preoperative PS was reliably lower both in patients with symptomatic and asymptomatic stenosis. Surgical reconstruction led to restoration of impaired DCA evidenced by significant increase of PS in postoperative period. Our data suggest that regardless clinical type of disease various state of DCA may be present in patients with severe ICA stenosis. This finding can contribute to establishing the optimal treatment strategy, and first of all for asymptomatic patients. Patients with compromised DCA should be considered as ones with higher risk of stroke and first candidates for reconstructive surgery.

DURAL CAROTID-CAVERNOUS FISTULAS

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Barbara Cvenkel

2002-12-01

Full Text Available Background. Dural carotid-cavernous sinus fistulas (CCF are communications fed by meningeal branches of the intracavernous internal carotid artery (ACI or/and external carotid artery (ACE. In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause.Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical presentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present (»redeyed shunt syndrome«. Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion (»white-eyed shunt syndrome«. Also different therapeutic approaches as well as possible complications are described.Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.

Visualization and analysis of flow patterns of human carotid bifurcation by computational fluid dynamics

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Xue Yunjing; Gao Peiyi; Lin Yan

2007-01-01

Objective: To investigate flow patterns at carotid bifurcation in vivo by combining computational fluid dynamics (CFD)and MR angiography imaging. Methods: Seven subjects underwent contrast-enhanced MR angiography of carotid artery in Siemens 3.0 T MR. Flow patterns of the carotid artery bifurcation were calculated and visualized by combining MR vascular imaging post-processing and CFD. Results: The flow patterns of the carotid bifurcations in 7 subjects were varied with different phases of a cardiac cycle. The turbulent flow and back flow occurred at bifurcation and proximal of internal carotid artery (ICA) and external carotid artery (ECA), their occurrence and conformation were varied with different phase of a cardiac cycle. The turbulent flow and back flow faded out quickly when the blood flow to the distal of ICA and ECA. Conclusion: CFD combined with MR angiography can be utilized to visualize the cyclical change of flow patterns of carotid bifurcation with different phases of a cardiac cycle. (authors)

Delayed Presentation of an Extracranial Internal Carotid Artery Pseudoaneurysm and Massive Epistaxis Secondary to a Nasal Foreign Body: Case Report and Review of the Literature.

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Katsevman, Gennadiy A; Braca, John A; Welch, Kevin C; Ashley, William W

2016-08-01

Epistaxis is a very common medical condition and can often be controlled with conservative measures. Rarely, uncontrolled and life-threatening epistaxis can occur. We present the case of a 58-year-old man who developed delayed, massive epistaxis caused by an extracranial left internal carotid artery pseudoaneurysm caused by an intranasal foreign object without apparent recent trauma. The patient was successfully treated with endovascular stenting of the affected vessel segment. Massive epistaxis is a potentially lethal condition. Although the source uncommonly originates from the internal carotid artery, pseudoaneurysm rupture needs to be considered on the differential diagnosis in selected patients. This case illustrates the need for vigilance for the presence of foreign objects and/or vessel injuries in the setting of acute, massive epistaxis. Additionally, we describe treatment options and review the literature. Copyright © 2016 Elsevier Inc. All rights reserved.

Atheromatous extracranial carotid arteries: CT evaluation correlated with arteriography and pathologic examination

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Leeson, M.D.; Cacayorin, E.D.; Iliya, A.R.; Hodge, C.J.; Culebras, A.; Collins, G.H.; Kieffer, S.A.

1985-01-01

Dynamic, rapid sequence, axial computed tomography (CT) was employed to evaluate the extracranial common and internal carotid arteries in 17 patients with clinical histories suggesting recent or remote ischemia in the territory supplied by the internal carotid artery. The CT findings were correlated with arteriographic observations and with gross and histologic evaluations of endarterectomy specimens. Areas of arterial wall thickening were evaluated on CT scans with regard to both degree of thickening and radiographic density (attenuation). The degree of vessel wall thickening secondary to atheromatous plaque demonstrated on CT scans corresponded closely to the severity of luminal compromise seen on arteriograms. While arteriography provides information regarding the status of the arterial lumen, CT offers the potential of accurate characterization of pathologic changes in the wall of the extracranial carotid arteries in patients with symptoms of cerebral ischemia

The CLEAR-ROAD study: evaluation of a new dual layer micromesh stent system for the carotid artery.

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Bosiers, Marc; Deloose, Koen; Torsello, Giovanni; Scheinert, Dierk; Maene, Lieven; Peeters, Patrick; Müller-Hülsbeck, Stefan; Sievert, Horst; Langhoff, Ralf; Bosiers, Michel; Setacci, Carlo

2016-08-05

The aim of this study was to evaluate the 30-day clinical outcome of treatment using the Roadsaver carotid stent in non-consecutive subjects at high risk for carotid endarterectomy requiring revascularisation. The CLEAR-ROAD study is a prospective, multinational, single-arm, physician-initiated study planned to include 100 patients in nine centres in Belgium, Italy and Germany. The primary endpoint was the 30-day rate of major adverse events (MAE), defined as the cumulative incidence of any death, stroke or myocardial infarction (MI). The use of embolic protection devices (EPDs) was not mandatory; 31.0% of the patients were symptomatic and in 58.0% of the patients EPDs were used. Technical success was achieved in all cases. The 30-day MAE rate was 2.1% (one patient experienced MI followed by death; another patient experienced a stroke within the first 30 days after procedure). While no statistical analysis could be performed, subgroup data suggested that there were no notable differences in the 30-day MAE rate between symptomatic and asymptomatic patients, or between EPD use. The 30-day clinical outcome of 100 patients treated with a dual layer micromesh carotid stent (Roadsaver) shows promising results. The Roadsaver stent is a safe and effective device for endovascular treatment of subjects at high risk for carotid endarterectomy.

[Ehlers Danlos type IV syndrome presenting with simultaneous dissection of both internal carotid and both vertebral arteries].

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Mondon, K; de Toffol, B; Georgesco, G; Cassarini, J-F; Machet, M-C; Cottier, J-P; Arbeille, B; Autret, A

2004-04-01

Dissection of cervical arteries is a frequent cause of stroke in young subjects. We report the case of a 34-year-old patient who experienced simultaneous dissection of both internal carotid arteries and both vertebral arteries leading to repeated motor deficit of the right half-body associated with persistent otalgia. Search for an etiology led to the diagnosis of Ehlers-Danlos syndrome type IV. Search for the cause of cervical artery dissection must consider connective tIssue disease, particularly vascular forms of Ehler-Danlos syndrome. Diagnostic, therapeutic as well as prognostic aspects are discussed.

Role of carotid duplex imaging in carotid screening programmes – an overview

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Gillard Jonathan H

2008-07-01

Full Text Available Abstract Background Stroke is the third most common cause of death in the UK and the largest single cause of severe disability. Each year more than 110,000 people in England suffer from a stroke which costs the National Health Service (NHS over GBP2.8 billion. Thus, it is imperative that patients at risk be screened for underlying carotid artery atherosclerosis. Aim To assess the role of carotid ultrasound in different carotid screening programmes. Methods A literature overview was carried out by using PubMed search engine, to identify different carotid screening programmes that had used ultrasound scan as a screening tool. Results It appears that the carotid ultrasound is an effective method for screening carotid artery disease in community as it effectively predicts the presence of stenosis with high accuracy. There is a need for primary care to recommend high risk patients for regular screening, to reduce stroke and transient ischemic attack (TIA related morbidity and mortality. Conclusion Screening programmes using carotid ultrasonography contribute to public health awareness and promotion which in long term could potentially benefit in disease prevention and essentially promote better standards of healthcare.

Treatment and experience of traumatic carotid artery injury with massive epistaxis

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RAO Hai-cheng

2013-09-01

Full Text Available A retrospective analysis was made on 5 cases who had the traumatic carotid artery injury with massive epistaxis (from September 2007 to June 2011. All of them were finally diagnosed by digital substraction angiography (DSA. Among them, 2 cases of traumatic pesudoaneurysm from internal maxillary artery were embolized with polyvinyl alcohol particles and gelatin sponge. One case was carotid-cavernous fistula (CCF with traumatic pesudoaneurysm located in the sphenoid sinus. This patient's internal carotid artery (ICA and fistula was blocked with balloon, and then ICA was clipped proximal to the posterior communicating artery. One case with injuried ICA was treated with blocking by balloon. The pesudoaneurysm located in ICA cavernous segment of one case was embolized with coil and liquid glue. No recurrence was found after successful surgeries. Patients with massive epistaxis or recurrent epistaxis after craniofacial trauma should undergo CT angiography (CTA or DSA examination so as to get proper diagnosis and treatment as early as possible.

The prognostic value of cerebral oxygenation and retrograde pressure during carotid endarterectomy

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А. А. Карпенко

2016-08-01

Full Text Available Aim: The study aimed to determine the predictive value of retrograde pressure (RP indicators and cerebral oxygenation in the evaluation of ischemic brain damage during carotid endarterectomy (CEA.Methods: This nonrandomized, prospective pilot study included 87 patients with asymptomatic stenosis greater than 70% who underwent carotid endarterectomy under general anesthesia. Brain tolerance to ischemia was determined by measuring and evaluating RP (∆rSO2 and cerebral oxygenation (rSO2 during a trial clamping of the carotid artery. Depending on the degree of reduction of cerebral oxygenation from the baseline (∆rSO2 during a trial clamping of the carotid artery, patients were divided into 3 groups: the first group (n = 35 - ∆rSO2 <9.9%, the second group (n = 35 - ∆rSO2 from 10 to 19.9%, the third group (n = 14 - ∆rSO2 ≥ 20%. The primary end-point of the study was to obtain the AUC value exceeding 0.70, which could mean a high predictive quality of research methods. Results: There were no perioperative strokes or myocardial infarctions during the study. Average time of carotid artery clamping was 28 (26-30 minutes. 3 patients who received temporary shunts were excluded from the study because of a simultaneous decrease in the rSO2 and ∆rSO2 indicators. It was found out that S-100 and NSE protein concentration in all groups did not significantly differ at different stages (p> 0.05. A temporary shutdown of blood flow in the carotid artery during CEA is accompanied by significant elevation of cerebral damage markers (S100, NSE concentration with their subsequent restoration at 3 days after surgery. ROC - analysis revealed that none of the methods for assessing cerebral ischemic tolerance (RP, ∆rSO2 and rSO2 is precise enough (AUC > 0.7 to predict brain injury during carotid endarterectomy. Satisfactory, but a poor quality (AUC< 0.7 of predicting an increase in the reference values of S-100 protein neuromarkers was demonstrated by

Dural carotid cavernous sinus fistula presenting as isolated oculomotor nerve palsy: Case report

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Şehnaz Arıcı

2015-04-01

Full Text Available Indirect (dural carotid cavernous fistula is formed by the connection between meningeal branches of the internal carotid artery and the cavernous sinüs, and low flow circulation with low pressure is occured. Proptosis, ophtalmoplegia, headache, scleral and conjuctival hyperemia expanding around the eyeball can be observed. A forty-eight year old female patient with a background of diabetes mellitus and hypertension was admitted with complaints of double vision. Isolated oculomotor nerve palsy was found in neurological examination and an indirect carotid cavernous fistula was revealed by digital subtraction angiography. Our case with carotid cavernous fistula as a rare cause of isolated oculomotor nerve palsy is worth to be reported.

Mycotic aneurysm of the extracranial internal carotid artery - report of a case and review of the literature; Aneurisma micotico da arteria carotida interna extracraniana - relato de um caso e revisao da literatura

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Nascimento, Edilene Cristina do; Silva, Ivone Martins da [Pernambuco Univ., Recife, PE (Brazil). Hospital das Clinicas. Servico de Radiologia; Albuquerque, Silvio Cavalcanti de [Instituto Materno Infantil de Pernambuco, Recife, PE (Brazil). Servico de Radiologia; Abath, Carlos [Angiorad, Recife, PE (Brazil)

1998-08-01

The authors report a case of mycotic aneurysm of the extracranial internal carotid artery in a 4-year-old- male child, resulting from tonsillar infection. The authors relate the difficulties to initially suggest the diagnosis, stress the importance of the differential diagnosis particularly in children and describe the findings on conventional films, US colour-Doppler, CT and carotid digital subtraction angiography. (author)

Analysis of flow and LDL concentration polarization in siphon of internal carotid artery: Non-Newtonian effects.

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Sharifi, Alireza; Niazmand, Hamid

2015-10-01

Carotid siphon is known as one of the risky sites among the human intracranial arteries, which is prone to formation of atherosclerotic lesions. Indeed, scientists believe that accumulation of low density lipoprotein (LDL) inside the lumen is the major cause of atherosclerosis. To this aim, three types of internal carotid artery (ICA) siphon have been constructed to examine variations of hemodynamic parameters in different regions of the arteries. Providing real physiological conditions, blood considered as non-Newtonian fluid and real velocity and pressure waveforms have been employed as flow boundary conditions. Moreover, to have a better estimation of risky sites, the accumulation of LDL particles has been considered, which has been usually ignored in previous relevant studies. Governing equations have been discretized and solved via open source OpenFOAM software. A new solver has been built to meet essential parameters related to the flow and mass transfer phenomena. In contrast to the common belief regarding negligible effect of blood non-Newtonian behavior inside large arteries, current study suggests that the non-Newtonian blood behavior is notable, especially on the velocity field of the U-type model. In addition, it is concluded that neglecting non-Newtonian effects underestimates the LDL accumulation up to 3% in the U-type model at the inner side of both its bends. However, in the V and C type models, non-Newtonian effects become relatively small. Results also emphasize that the outer part of the second bend at the downstream is also at risk similar to the inner part of the carotid bends. Furthermore, from findings it can be implied that the risky sites strongly depend on the ICA shape since the extension of the risky sites are relatively larger for the V-type model, while the LDL concentrations are higher for the C-type model. Copyright © 2015 Elsevier Ltd. All rights reserved.

Current Approaches for Carotid Endarterectomy

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Cengiz Köksal

2010-12-01

Full Text Available Permanent neurologic injuries and death following stroke, necessitates more vigorous treatment of carotid disease. Carotid stenting and carotid endarterectomy are treatment options in many centers besides medical treatment. Whether the patient is symptomatic or asymtomatic, indications and management strategies for treatment remain controversial. Despite the debate, carotid endarterectomy is still accepted to be the most efficientintervention to decrease risk of stroke due to carotid artery stenosis.

Agenesis of the internal carotid artery with a trans-sellar anastomosis: CT and MRI findings in late-onset congenital hypopituitarism

International Nuclear Information System (INIS)

Mellado, J.M.; Merino, X.; Ramos, A.; Salvado, E.; Sauri, A.

2001-01-01

A 29-year-old woman with a history of hypothyroidism since early childhood developed hypopituitarism. CT and MRI revealed anterior pituitary hypoplasia, an ectopic posterior lobe, a Chiari I malformation and agenesis of the right internal carotid artery with a trans-sellar anastomosis. This constellation of findings constitutes a previously unreported association in congenital hypopituitarism of late onset. The usefulness of imaging modalities and the pathogenic implications are also discussed. (orig.)

Zotarolimus-eluting stent for the treatment of recurrent, severe carotid artery in-stent stenosis in the TARGET-CAS population.

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Tekieli, Lukasz; Pieniazek, Piotr; Musialek, Piotr; Kablak-Ziembicka, Anna; Przewlocki, Tadeusz; Trystula, Mariusz; Moczulski, Zbigniew; Dzierwa, Karolina; Paluszek, Piotr; Podolec, Piotr

2012-06-01

To evaluate the safety and efficacy of a balloon-mounted drug-eluting stent (DES) for recurrent carotid in-stent stenosis (ISS). As part of our targeted carotid artery stenting (TARGET-CAS) protocol, neurological and ultrasound evaluations have been performed at 3, 6, and 12 months and then annually since 2001 in all carotid stent patients. For angiographically-confirmed >70% ISS, balloon angioplasty was performed as a first-line treatment. Recurrent ISS was treated with a 4.0-mm zotarolimus-eluting coronary stent (ZES) that was postdilated according to intravascular ultrasound imaging. Among the 1350 neuroprotected CAS procedures performed between January 2001 and March 2011, there were 7 (0.52%) patients (5 men; ages 51-72 years), all neurologically asymptomatic, with >70% recurrent ISS that occurred at 5 to 11 months after the initial balloon angioplasty treatment for ISS. ZES implantation under distal embolic protection was technically successful and uncomplicated. Angiographic stenosis was reduced from 84.6%±7.5% to 10.7%±3.6% (p<0.01). In 5 patients with ZES implanted fully within the self-expanding carotid stent, duplex ultrasound follow-up (mean 17 months, range 6-36) revealed no evidence of restenosis or stent fracture/deformation. In the 2 other patients, the ZES had been implanted for distal edge ISS such that the ZES protruded beyond the original carotid stent. This protruding segment of the ZES demonstrated deformation/kinking in both; in one, this led to symptomatic stent occlusion. The use of coronary ZES in the treatment of recurrent carotid ISS is feasible and appears effective provided the ZES is placed entirely within the original stent. Placement of a coronary ZES outside the carotid stent scaffold should be avoided.

Clinical efficiency of the Auditory Verbal Learning Test for patients with internal carotid artery stenosis

International Nuclear Information System (INIS)

Seki, Yasuko; Maeshima, Shinichiro; Osawa, Aiko; Imura, Junko; Kohyama, Shinya; Yamane, Fumitaka; Ishihara, Shoichiro; Tanahashi, Norio

2010-01-01

Most patients who have an internal carotid artery (ICA) stenosis with cerebral lesion have some cognitive dysfunction. To clarify the clinical efficiency of the Auditory Verbal Learning Test (AVLT) and to assess the relationship between AVLT and cerebral damage, we examined AVLT in patients with ICA stenosis. 44 patients (35 males and 9 females) with ICA stenosis aged 56 to 83 (69.6±6.5) years old were evaluated. The educational periods were from 9 to 16 (12.3±2.8) years. Their activities of daily living (ADL) were independent. We assessed cognitive function with neuropsychological tests including AVLT, Mini-mental State Examination (MMSE), Raven's coloured progressive matrices (RCPM) and Frontal Assessment Battery (FAB), etc. We assessed cerebral damage (periventricular high intensity; PVH and white matter hyperintensity; WMH) with MRI. Then, we investigated the relationship between AVLT and other neuropsychological tests, and the relationship between AVLT and carotid/cerebral lesion. There was no association with lesion side of ICA stenosis and the scores of AVLT. In patients with ICA stenosis and cerebral damage (PVH and/or WMH), there was a significant relationship between the severity of cerebral damage and the scores in AVLT. AVLT had a significant relationship to other neuropsychological tests. AVLT might be a good cognitive assessment for patients who have cerebral damage due to ICA stenosis. (author)

Immediate Catheter Directed Thrombolysis for Thromboembolic Stroke During Carotid Endarterectomy

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E. Fletcher

Full Text Available : Background: Carotid artery endarterectomy (CEA is a common procedure undertaken by vascular surgeons with over 5,000 procedures performed annually worldwide. Published rates of perioperative stroke range from 1.3% to 6.3%. Case report: A case is presented in which on-table intra-cranial angiography and catheter directed thrombolysis were used for a thromboembolic occlusion of the distal internal carotid artery (ICA and proximal middle cerebral artery (MCA. An 83-year-old lady developed a dense right hemiparesis while undergoing a CEA under local anaesthetic (LA. Immediate re-exploration of the endarterectomy did not reveal technical error. Intraoperative duplex scanning of the internal carotid artery revealed no detectable diastolic flow. On-table angiogram showed complete occlusion of the distal ICA and proximal MCA. Catheter directed administration of TPA was undertaken. The entire ICA and MCA were completely clear on a completion angiogram. The patient made a full neurological recovery. Discussion and conclusion: Prompt diagnosis and treatment with intraoperative catheter directed thrombolysis can resolve thromboembolic occlusion of the ICA/MCA. It is argued that performing CEA under LA is useful for immediate recognition of perioperative stroke. Furthermore, the advantage is highlighted of vascular surgeons having both the resources and skillset to perform on-table angiography and thrombolysis. Keywords: Carotid endarterectomy, Stroke, Thrombolysis, Thromboembolus, Local anaesthetic

Carotid angioplasty and stenting for symptomatic carotid kinking combined with stenosis

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JIANG Xue-li

2013-03-01

Full Text Available Background Carotid endarterectomy (CEA is currently the preferred treatment for severe carotid kinking and stenosis. Kinking is generally believed to be a relative contraindication for endovascular stent placement. This article aims to study the necessity, feasibility and security of carotid angioplasty and stenting (CAS for symptomatic carotid kinking combined with stenosis, and summarize clinical experience of this disease according to therapeutic results. Methods Twenty-two cases with symptomatic carotid kinking and high-grade stenosis demonstrated by digital subtraction angiography (DSA were performed CAS. Their clinical manifestations, imaging features, procedure safety and follow-up data were collected and retrospectively analyzed. All patients understood CEA and voluntarily received CAS. Results Twenty-two cases with carotid kinking and stenosis were all successfully performed CAS (the success rate was 100% without stent-related disability or mortality. Twenty-four self-expandable stents were implanted. The mean degree of stenosis was reduced from 85.63%before stenting to 11.25% after stenting and the angles of kinking were improved from 120° (Metz' category. During the period of hospitalization, no transient ischemic attack (TIA or cerebral infarction occurred, and the clinical symptoms and signs of ischemia, such as dizziness and headache, were improved or disappeared. Besides, no permenant complications or deaths happened. All cases were followed up from 6 to 72 months, among whom 1 patient experienced contralateral carotid TIA, and 2 patients experienced ipsilateral carotid TIA (one indicated aspirin resistance in platelet aggregation test and the other showed restenosis in DSA. Computed tomography angiography (CTA of 10 patients and Duplex scan of 7 patients during the follow-up demonstrated carotid in good morphology and fluent blood flow, without kinking or restenosis. Conclusion CAS is a feasible and safe therapeutic method and

Carotid duplex ultrasound and transcranial Doppler findings in commercial divers and pilots.

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Dormanesh, Banafshe; Vosoughi, Kia; Akhoundi, Fahimeh H; Mehrpour, Masoud; Fereshtehnejad, Seyed-Mohammad; Esmaeili, Setareh; Sabet, Azin Shafiee

2016-12-01

The risky working environments of divers and pilots, and the possible role of extreme ambient pressure in carotid stenosis, make ischemic stroke an important occupational concern among these professionals. In this study, we aimed to evaluate the association of being exposed to hyperbaric or hypobaric conditions with carotid artery stenosis by comparing common carotid intima-media thickness (CCIMT) and blood flow velocities of cerebral arteries in divers and pilots using carotid duplex ultrasound (CDUS) and transcranial Doppler (TCD). CDUS and transtemporal TCD were performed in 29 divers, 36 pilots and 30 control participants. Medical history, blood pressure, lipid profile and blood sugar were recorded to control the previously well-known risk factors of atherosclerosis. Findings of the CDUS and TCD [including: CCIMT and blood flow velocities of internal carotid artery (ICA), common carotid artery (CCA), and middle cerebral artery (MCA)] of divers and pilots were compared with those of the control group using regression analysis models. Both right and left side CCIMT were significantly higher in divers (P < 0.05) and pilots (P < 0.05) in comparison with the control group. Carotid index [peak systolic velocity (PSV) of ICA/PSV of CCA) of divers and pilots were also higher than the control group. TCD findings were not significantly different between divers, pilots, and the control group. Increased CCIMT and carotid index in diver and pilot groups appear to be suggestive of accelerated atherosclerosis of carotid artery in these occupational groups.

Post-traumatic pseudoaneurysm of internal carotid artery: a cause of intractable epistaxis.

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Adeel, Mohammad; Ikram, Mubasher

2012-05-23

In this case report, the authors are presenting a case of a 35-year-old lady who presented to our clinic with recurrent episodes of massive epistaxis and loss of right eye vision for last 6 months following road traffic accident. There was no other significant medical and surgical history. Bleeding episodes were sometimes very severe with loss up to 400-500 cc and would stop spontaneously. She was given multiple blood transfusions after these episodes. A complete otorhinolaryngological examination including rigid endoscopy and coagulation investigation did not reveal any abnormality. CT with contrast of paranasal region showed blood within the right sphenoid sinus with linear fracture of the lateral wall with post-traumatic cavernous pseudoaneurysm of internal carotid artery localised to right sphenoid sinus. That was managed successfully by embolisation using a detachable balloon and a coil. She was followed up in the clinic at 6 weeks and 6 months interval with no symptoms.

Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report.

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Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

2017-01-01

A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on computed tomography. The trapping and bypass was planned. However, sudden epistaxis occurred, we performed trapping to stop the bleeding and save his life. After the operation, no right ICA or aneurysm was detected. However, severe epistaxis recurred two months after the operation. In the second operation, a ligation of the common -/- external carotid artery and a severance of an ICA portion between the ophthalmic artery and the aneurysm were insufficient to stop the bleeding. This case indicates ICA trapping, even if a trapping portion is below an ophthalmic artery, is insufficient to treat an ICA aneurysm. ICA aneurysms should be suspected when a patient present with recurrent -/- massive epistaxis, who has a head injury history, even if it is far past.

(/sup 3/H)Haloperidol labels brain dopamine receptors after its injection into the internal carotid artery of the rat

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D' Ambrosio, A; Zivkovic, B; Bartholini, G [Research Department, Synthelabo-L.E.R.S., Paris (France)

1982-04-29

Pulse injection of (/sup 3/H)haloperidol (0.1 ..mu..Ci; 0.003 ..mu..g) into the internal carotid artery of the rat specifically labelled dopamine receptors in striatum and olfactory tubercle, as indicated by the kinetics of, and the effects of neuroleptic drugs on, the ligand disposition. The described method may prove useful for labelling brain receptors with ligands which readily cross the blood-brain barrier but which do not selectively mark their receptors if injected systemically.

Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature

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Tveita, Ingrid Aune; Madsen, Martin Ragnar Skjerve; Nielsen, Erik Waage

2017-01-01

Source at https://doi.org/10.1186/s13256-017-1316-1 Background: We present a report of a patient with blunt trauma and mandibular fractures who developed a significant cerebral infarction due to an initially unrecognized injury of her left internal carotid artery. We believe that increased knowledge of this association will facilitate early recognition and hence prevention of a devastating outcome. Case presentation: A 41-year-old ethnic Norwegian woman presented to our Emerg...

Recovery of Third Nerve Palsy after Endovascular Packing of Internal Carotid-Posterior Communicating Artery Aneurysms

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Mavilio, N.; Pisani, R.; Rivano, C.; Testa, V.; Spaziante, R.; Rosa, M.

2000-01-01

Summary Endovascular packing of intracranial aneurysm with preservation of the parent vessel has become in many cases a valid alternative to surgical clipping. Regression of oculomotor disorders after clipping of internal carotid-posterior communicating artery (ICA-PCoA) aneurysms has been well assessed. This report focuses on the reversal of third nerve palsy after endovascular packing of ICA-PCoA aneurysms. To this end, clinical appearances, neuroradiological features, and endovascular interventional procedures of six treated patient are reported and discussed in the light of the very few previous case observations found in the literature. Results indicate that endovascular packing of ICA-PCoA aneurysms may produce effective recovery of correlated third nerve dysfunction. PMID:20667199

Gene expression and 18FDG uptake in atherosclerotic carotid plaques

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Pedersen, Sune Folke; Graebe, Martin; Fisker Hag, Anne Mette

2010-01-01

) and an additional ipsilateral internal carotid artery stenosis of greater than 60% were recruited. FDG uptake in the carotids was determined by PET/computed tomography and expressed as mean and maximal standardized uptake values (SUVmean and SUVmax). The atherosclerotic plaques were subsequently recovered...... by carotid endarterectomy. The gene expression of markers of vulnerability - CD68, IL-18, matrix metalloproteinase 9, cathepsin K, GLUT-1, and hexokinase type II (HK2) - were measured in plaques by quantitative PCR. RESULTS: In a multivariate linear regression model, GLUT-1, CD68, cathepsin K, and HK2 gene...... expression remained in the final model as predictive variables of FDG accumulation calculated as SUVmean (R=0.26, PK, and HK2 gene expression as independent predictive variables of FDG accumulation calculated...

Pituitary Dysfunction from an Unruptured Ophthalmic Internal Carotid Artery Aneurysm with Improved 2-year Follow-up Results: A Case Report.

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Qi, Meng; Ye, Ming; Li, Meng; Zhang, Peng

2018-01-01

Internal carotid artery (ICA) supraclinoid segment aneurysms extending into the sellar region and leading to pituitary dysfunction are a rare occurrence. To date, long-term follow up of pituitary function 2 years post-treatment has never been reported. Herein, we present a case of pituitary dysfunction due to an unruptured ophthalmic segment internal carotid artery aneurysm and report improved 2-year follow-up results. A 76-year-old male presented with disturbed consciousness due to hyponatremia, which was caused by hypoadrenocorticism resulting from pituitary dysfunction complicated by hypogonadism and hypothyroidism. Computed tomography angiography revealed an intracranial aneurysm of the ophthalmic segment of the right ICA with an intrasellar extension. Thus, digital subtraction angiography and coil embolization were performed, followed by hormone replacement therapy. A 2-year follow-up revealed a partial improvement in the pituitary function, including complete restoration of thyroid-stimulating hormone level and other thyroid hormones levels, and partial restoration of testosterone levels, followed by discontinuation of thyroid hormone replacement therapy. However, the mechanisms of such pituitary dysfunction and the effects of various treatments, including clipping and coiling, on different hormones of pituitary function recovery remain unclear. A long-term follow-up of >2 years may elucidate the pituitary function recovery post-treatment and provide a medication adjustment for hormone replacement therapy.

The relationship of flow velocities to vessel diameters differs between extracranial carotid and vertebral arteries of stroke patients.

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Owolabi, Mayowa O; Agunloye, Atinuke M; Ogunniyi, Adesola

2014-01-01

Chronic changes in flow rate through arteries produce adjustment of arterial diameters. We compared the relationship between flow velocity and diameter in the carotid and in the vertebral arteries of stroke patients. Using triplex ultrasonography, the internal diameter and flow velocities of the common carotid, internal carotid, and vertebral arteries of 176 consecutive stroke patients were measured. Correlations were examined with Pearson's statistics at an alpha level of 0.05. Mean age of the patients was 59.3 ± 12 years, and 66% had cerebral infarcts. Diameter and blood flow velocities showed significant negative correlations (-0.115 ≥ r ≥ -0.382) in the carotid arteries on both sides, but positive correlations (0.211 ≤ r ≤ 0.320) in the vertebral arteries, even after controlling for age, gender, and blood pressure. Our study demonstrated different diameter/flow relationships in the carotid and the vertebral arteries of stroke patients, which may suggest pathologic changes in the adaptive processes governing vessel diameter and growth, especially in the carotid arteries. Copyright © 2013 Wiley Periodicals, Inc.

Endarterectomía carotídea en pacientes sintomáticos y asintomáticos: resultados de morbi-mortalidad desde 1998 hasta 2005 Carotid endarterectomy in symptomatic and asymptomatic patients: morbid-mortality results from 1998 to 2005

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Juan G Barrera

2007-12-01

carotid endarterectomy for carotid artery disease treatment by demonstrating high safety profiles. Objective: to determine the surgical morbidity and mortality results at 3, 6 and 12 months of follow-up in patients submitted to carotid endarterectomy from 1998 to 2005. Design-Method: clinical histories of patients submitted to carotid endarterectomy from 1998 to September 2005 were evaluated. Results: 42 procedures were realized since 1998 until September 2005. 57% of the patients were men with mean age 68.8 ± 9.9 years. Important antecedents were arterial hypertension (82%, cigarette smoking (61 and dyslipidemia (50%. 82% showed symptoms of carotid disease. 11 patients had right carotid lesion and in 15 the lesion was bilateral, with mean obstruction of 85 ± 11.4%. Mortality was 4.7% and was not related to the surgical procedure. At September 2005, 57% of the discharged patients were asymptomatic. Conclusions: mortality for this group of patients is comparable to the worldwide published results. Procedure safety guarantees this surgical technique as the first option in this carotid pathology management.

Extracranial-intracranial bypass in medial sphenoid ridge meningioma associated with severe stenosis of the intracranial segments of the internal carotid artery: A case report.

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Huang, Yabo; Wang, Zhong; Han, Qingdong

2018-06-01

Tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery (ICA) of intracranial segments has been rarely presented. Effective treatment as to the complex lesions may be complicated. Tumor resection and cerebrovascular protection should be both taken into consideration. We presented one case of medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments. The patient suffered hyperthyroidism, mirror-image dextrocardia and congenital heart disease atrial septal defect simultaneously. Before the neurosurgical treatment , the colleagues of department of cardiac surgery, anesthesiology and respiratory medicine agreed on our plan of resecting the tumor following the comprehensive evaluation of basal clinical conditions in the patient. For reducing the bleeding intraoperatively, the interventional branch performed digital subtraction angiography(DSA) and found collateral anastomosis between the supplying vessels of left middle meningeal arteries and anterior choroid arteries. No preoperative interventional embolization was determined considering the risk of cerebral ischemia. The following subtotal resection of medial sphenoid ridge meningioma and left extracranial-intracranial bypass were carried out. Additionally, ipsilateral decompressive craniectomy was done. Post-operative imaging Computed tomography (CT), Computed tomography angiography (CTA) and Transcranial Doppler (TCD) indicated subtotal resection of tumor and bypass patency. The patient was discharged with the right limbs of muscle strength of grade IV. The muscle strength of the patient returned to grade V after 6 months of follow-up. Comprehensive treatment of tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments is

Effect of fosinopril on progression of the asymptomatic carotid atherosclerosis and left ventricular hypertrophy in hypertensive patients

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Tasić Ivan

2006-01-01

Full Text Available INTRODUCTION The cardiovascular changes (vascular structure changes, hypertrophy of the left ventricle contribute to both the increased cardiovascular morbidity and the mortality of essential hypertension. Therefore, modern treatment strategies should not only target blood pressure (BP reduction but also normalize cardiovascular structure and function. OBJECTIVE Aim of the study was to determine the effect of the ACE inhibitor Fosinopril on the Intima-media thickness of the common carotid artery and on the left ventricle mass after 9-month treatment of hypertensive patients. METHOD The study included 40 patients with the arterial hypertension and the left ventricle hypertrophy verified by echocardiography. The patients were randomized on A ACE-inhibitor - Fosinopril and 6 without ACE inhibitor - atenolol, and they were followed up 9 months. The groups were not different by age, sex, and metabolic status. Color Duplex ultrasonography of the carotid arteries was performed by Acuson Sequia C236 with high-frequency linear probe of 8 MHz. The Intima-media thickness of the common carotids on the left and the right was measured in diastole at 1.5. cm from the highest point of bifurcation under maximal magnification. Using the same device, the left ventricle mass and other parameters of the left ventricle were determined in M-mode and by means of 2D image. RESULTS After 9 months, BP In both groups Was reduced In similar range (group A: systolic BP from 158 to 137 mmHg, and diastolic BP from 94 to 85 mmHg, and group B; systolic BP from 164 to 137 mmHg, and diastolic BP from 87 to 84 mmHg. The thickness of the intimomedial complex in patients using Fosinopril was decreased by 0.0278 ± 0.03 mm, while in the group of patients that did not use the ACE-inhibitor, it was increased by 0.078 ±0.13 mm. The left ventricle mass in patients using Fosinopril was decreased by 5 grams (312 ± 72 g vs. 307 ± 77 g, while in group B patients, it was increased by 15

Standard duplex criteria overestimate the degree of stenosis after eversion carotid endarterectomy.

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Benzing, Travis; Wilhoit, Cameron; Wright, Sharee; McCann, P Aaron; Lessner, Susan; Brothers, Thomas E

2015-06-01

The eversion technique for carotid endarterectomy (eCEA) offers an alternative to longitudinal arteriotomy and patch closure (pCEA) for open carotid revascularization. In some reports, eCEA has been associated with a higher rate of >50% restenosis of the internal carotid when it is defined as peak systolic velocity (PSV) >125 cm/s by duplex imaging. Because the conformation of the carotid bifurcation may differ after eCEA compared with native carotid arteries, it was hypothesized that standard duplex criteria might not accurately reflect the presence of restenosis after eCEA. In a case-control study, the outcomes of all patients undergoing carotid endarterectomy by one surgeon during the last 10 years were analyzed retrospectively, with a primary end point of PSV >125 cm/s. Duplex flow velocities were compared with luminal diameter measurements for any carotid computed tomography arteriography or magnetic resonance angiography study obtained within 2 months of duplex imaging, with the degree of stenosis calculated by the methodology used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) as well as cross-sectional area (CSA) reduction. Simulations were generated and analyzed by computational model simulations of the eCEA and pCEA arteries. Eversion and longitudinal arteriotomy with patch techniques were used in 118 and 177 carotid arteries, respectively. Duplex follow-up was available in 90 eCEA arteries at a median of 16 (range, 2-136) months and in 150 pCEA arteries at a median of 41 (range, 3-115) months postoperatively. PSV >125 cm/s was present at some time during follow-up in 31% of eCEA and pCEA carotid arteries, each, and in the most recent duplex examination in 7% after eCEA and 21% after pCEA (P = .003), with no eCEA and two pCEA arteries occluding completely during follow-up (P = .29). In 19 carotid arteries with PSV >125 cm/s after angle correction (median, 160 cm/s; interquartile range

Doppler examination of the periorbital arteries adds valuable hemodynamic information in carotid artery disease

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Sillesen, H; Schroeder, T; Steenberg, H J

1987-01-01

The periorbital flow direction and internal carotid artery (ICA) angiogram were compared to the ICA pressure gradient across the stenosis and the distal ICA pressure in 51 patients subjected to carotid endarterectomy. All 17 patients with inverted periorbital flow had stenoses exceeding 50%. The ...... collaterals and, Patients with 50% stenosis or more and insufficient collaterals....

Plasma creatinine levels, estimated glomerular filtration rate and carotid intima media thickness in middle-aged women: a population based cohort study.

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Gentile, M; Panico, S; Mattiello, A; de Michele, M; Iannuzzi, A; Jossa, F; Marotta, G; Rubba, P

2014-06-01

The relationships between high Creatinine (Cr) levels or low estimated Glomerular Filtration Rate (eGFR) and common carotid Intima Media thickness (IMT) have been evaluated in a population-based cohort study in women, aged 30-69 (Progetto ATENA). Serum Cr and eGFR were measured in 310 women, as a part of 5.062. In this group carotid ultrasound examination (B-Mode imaging) was performed and mean max IMT was calculated. Women were classified by Cr levels >1 mg/dL or eGFR Women with Cr > 1 mg/dL (90th percentile of creatinine distribution) or eGFR less than 56 ml/min (5th percentile of eGFR distribution) had relatively more carotid plaques as compared to the rest of the cohort. Multivariate logistic analysis, after adjustment for age, demonstrated a significant association between Cr (>1 mg/dL) and IMT (≥1.2 mm): OR 4.12 (C.I 1.22-13.86), p = 0.022; or eGFR (women, independently of age, suggest the value of screening for early carotid disease in asymptomatic middle aged-women with mild renal insufficiency, in order to predict those at relatively higher risk for future cardiovascular events. Copyright © 2013 Elsevier B.V. All rights reserved.

A clear map of the lower cranial nerves at the superior carotid triangle.

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Cavalcanti, Daniel D; Garcia-Gonzalez, Ulises; Agrawal, Abhishek; Tavares, Paulo L M S; Spetzler, Robert F; Preul, Mark C

2010-07-01

The lower cranial nerves must be identified to avoid iatrogenic injury during skull base and high cervical approaches. Prompt recognition of these structures using basic landmarks could reduce surgical time and morbidity. The anterior triangle of the neck was dissected in 30 cadaveric head sides. The most superficial segments of the glossopharyngeal, vagus and its superior laryngeal nerves, accessory, and hypoglossal nerves were exposed and designated into smaller anatomic triangles. The midpoint of each nerve segment inside the triangles was correlated to the angle of the mandible (AM), mastoid tip (MT), and bifurcation of the common carotid artery. A triangle bounded by the styloglossus muscle, external carotid artery, and facial artery housed the glossopharyngeal nerve. This nerve segment was 0.06 ± 0.71 cm posterior to the AM and 2.50 ± 0.59 cm inferior to the MT. The vagus nerve ran inside the carotid sheath posterior to internal carotid artery and common carotid artery bifurcation in 48.3% of specimens. A triangle formed by the posterior belly of digastric muscle, sternocleidomastoid muscle, and internal jugular vein housed the accessory nerve, 1.90 ± 0.60 cm posterior to the AM and 2.30 ± 0.57 cm inferior to the MT. A triangle outlined by the posterior belly of digastric muscle, internal jugular vein, and common facial vein housed the hypoglossal nerve, which was 0.82 ± 0.84 cm posterior to the AM and 3.64 ± 0.70 cm inferior to the MT. Comprehensible landmarks can be defined to help expose the lower cranial nerves to avoid injury to this complex region. Copyright © 2010 Elsevier Inc. All rights reserved.

Neuroradiological diagnosis and interventional therapy of carotid cavernous fistulas

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Struffert, T.; Engelhorn, T.; Doelken, M.; Doerfler, A.; Holbach, L.

2008-01-01

Carotid cavernous fistulas are pathologic connections between the internal and/or external carotid artery and the cavernous sinus. According to Barrow one can distinguish between direct (high flow) and indirect (low flow) fistulas, whereby direct fistulas are often traumatic while indirect fistulas more frequently occur spontaneously in postmenopausal women. Diagnosis can easily be established using MRI and angiography, which allow exact visualization of the anatomy of fistulas to plan the interventional neurological therapy that in recent years has replaced surgical therapy. This article provides an overview on imaging findings, diagnosis using MRI and angiography as well as interventional treatment strategies. (orig.) [de

Functional magnetic resonance imaging to determine hemispheric language dominance prior to carotid endarterectomy.

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Smits, M; Wieberdink, R G; Bakker, S L M; Dippel, D W J

2011-04-01

We describe a left-handed patient with transient aphasia and bilateral carotid stenosis. Computed tomography (CT) arteriography showed a 90% stenosis of the right and 30% stenosis of the left internal carotid artery. Head CT and magnetic resonance imaging (MRI) of the brain showed no recent ischemic changes. As only the symptomatic side would require surgical intervention, and because hemispheric dominance for language in left-handed patients may be either left or right sided, a preoperative assessment of hemispheric dominance was required. We used functional MRI to determine hemispheric dominance for language and hence to establish the indication for carotid endarterectomy surgery. Functional MRI demonstrated right hemispheric dominance for language and right-sided carotid endarterectomy was performed. We propose that the clinical use of functional MRI as a noninvasive imaging technique for the assessment of hemispheric language dominance may be extended to the assessment of hemispheric language dominance prior to carotid endarterectomy. Copyright © 2010 by the American Society of Neuroimaging.

Various endovascular approaches to the management of free floating carotid thrombi: a technical report.

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Park, Jee Won; Lee, Deok Hee; Choi, Choong Gon; Kim, Sang Joon; Suh, Dae Chul

2012-09-01

Ischemic strokes are seldom caused by free floating thrombi (FFTs) in the carotid artery. Because FFTs are fairly uncommon and their pathophysiology has not yet been clarified, no definite management guidelines have been established. Four consecutive patients with FFTs in the internal and/or common carotid artery are described. These patients were successfully treated by various endovascular treatment methods.

Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

International Nuclear Information System (INIS)

Köklü, Erkan; Arslan, Şakir; Yüksel, İsa Öner; Bayar, Nermin; Koç, Pınar

2015-01-01

Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication

Semi-automatic quantitative measurements of intracranial internal carotid artery stenosis and calcification using CT angiography

International Nuclear Information System (INIS)

Bleeker, Leslie; Berg, Rene van den; Majoie, Charles B.; Marquering, Henk A.; Nederkoorn, Paul J.

2012-01-01

Intracranial carotid artery atherosclerotic disease is an independent predictor for recurrent stroke. However, its quantitative assessment is not routinely performed in clinical practice. In this diagnostic study, we present and evaluate a novel semi-automatic application to quantitatively measure intracranial internal carotid artery (ICA) degree of stenosis and calcium volume in CT angiography (CTA) images. In this retrospective study involving CTA images of 88 consecutive patients, intracranial ICA stenosis was quantitatively measured by two independent observers. Stenoses were categorized with cutoff values of 30% and 50%. The calcification in the intracranial ICA was qualitatively categorized as absent, mild, moderate, or severe and quantitatively measured using the semi-automatic application. Linear weighted kappa values were calculated to assess the interobserver agreement of the stenosis and calcium categorization. The average and the standard deviation of the quantitative calcium volume were calculated for the calcium categories. For the stenosis measurements, the CTA images of 162 arteries yielded an interobserver correlation of 0.78 (P < 0.001). Kappa values of the categorized stenosis measurements were moderate: 0.45 and 0.58 for cutoff values of 30% and 50%, respectively. The kappa value for the calcium categorization was 0.62, with a good agreement between the qualitative and quantitative calcium assessment. Quantitative degree of stenosis measurement of the intracranial ICA on CTA is feasible with a good interobserver agreement ICA. Qualitative calcium categorization agrees well with quantitative measurements. (orig.)

Autopsy findings in carotid arterial rupture following radiotherapy of head and neck advanced carcinoma

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Satake, Bunsuke; Matsuura, Shizumu; Sakaino, Kouji; Maehara, Yasunobu

1989-01-01

The influence of radiotherapy in advanced head and neck cancer was investigated by autopsy of head and neck patients who had had carotid artery rupture. Twenty-five cases of head and neck cancer revealed carotid artery rupture among the 255 head and neck cases autopsied from 1972 to 1985. The rate of carotid artery rupture in hypopharyngeal cancer was 8/32 (25%); in oral cancer 8/55 (14.5%), and in other cancers 9/165 (5.4%). In localization of ruptured arteries there were 9 cases of common carotid artery, 14 cases of external carotid artery, one case of internal carotid artery, and one unknown. These cases were irradiated using more than 70 Gy. The following reasons for carotid artery rupture were suspected: 1. There was a tumor with deep ulceration and necrosis near the vessel. 2. The wall of the artery had radiation angitis. 3. The artery wall was necrotic because of invasion by the tumor. 4. Thrombosis developed with ensuant rupture of the artery. Radiotherapy for advanced cancer of the head and neck is necessary to control pain and as palliative treatment, but to avoid rupture of the carotid artery, pain clinic techniques and chemotherapy as palliative treatment for this kinds of terminal condition should also be considered. (author)

Mixing in the human carotid artery during carotid drug infusion studied with PET

International Nuclear Information System (INIS)

Junck, L.; Koeppe, R.A.; Greenberg, H.S.

1989-01-01

The safety and efficacy of drug infusion into the carotid artery require adequate mixing of the infused solution with carotid blood. Using positron emission tomography (PET), we studied the mixing of solutions infused into the human carotid artery in seven patients by analyzing the distribution of [15O]H2O infused into the carotid artery and by vein. At four infusion rates ranging from 0.5 to 10 ml/min, the variability in distribution averaged 16.5-17.8% among the pixels in a large volume of interest, without dependence on the infusion rate. The overall correlation between [15O]H2O influx with arterial infusion and [15O]H2O influx with venous injection was 0.78-0.82 at the four infusion rates, with no trend toward higher correlations at the faster infusion rates. The distribution into the anterior, middle, and posterior cerebral artery territories differed from distribution throughout the entire carotid territory by an average of 6.2-9.6% at the four infusion rates, with no trend toward smaller differences at the faster infusion rates. Infusions performed into a vinyl tube simulating the carotid artery indicated that at 0.5 ml/min, the velocity of fluid exiting the catheter makes no apparent contribution to mixing. We conclude that with infusions at the carotid bifurcation, mixing in the human carotid artery is complete or nearly complete over a wide range of infusion rates. The mixing appears to result from the patterns of blood flow within the artery, and not from jet effects at the catheter tip

Association Between Macrominerals Intake and Changes in Internal Carotid Artery-Intima Media Thickness in POST Ischemic Stroke Patients

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Pudjonarko, Dwi; Tugasworo, Dodik; Silaen, Rumintang

2017-02-01

Carotid Intima Media Thickness (C-IMT) has been widely used as marker for atherosclerosis. Previous studies on minerals intake and its association with C-IMT revealed various. Most of the studies showed inconsistent results. The aim of this study is to determine wether macro minerals intake is related to internal carotid-intima media thickness (IC-IMT). This is a longitudinal study, pre test post test design conducted in Neurology clinic, Kariadi hospital, Semarang from June to December 2014. Subjects were 22 post ischemic stroke patients. Minerals intake and IC-IMT was measured using Food Frequency Questionnaire and Duplex Carotid Ultrasonography. Statistical analysis was performed using Chi-Square, Fisher Exact and Logistic Regression test. Subjects included in this study were 17 male subjects (77.3%) and 5 female subjects (22.7%). Mean of IC-IMT in female subjects was found to be higher than in male. Mean of total IC-IMT was increased after a period of six months (0.96±0.80 to 0.97±0.21 mm). There were significant association between calcium as well as sodium intakes and IC-IMT. In contrast, there were no association between magnesium as well as potassium intake and IC-IMT. Multivariate analysis suggest that sodium intake (OR=26.828) was the most influencing factor for IC-IMT, followed by calcium intake (OR=0.042). Calcium as well as potassium intake were independently associated with IC-IMT. Magnecium as well as sodium intake were not independently associated with IC-IMT changes. Sodium intake was the most influencing variable to IC-IMT changes, followed by calcium intake.

Outcomes of early carotid stenting and angioplasty in large-vessel anterior circulation strokes treated with mechanical thrombectomy and intravenous thrombolytics.

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Mehta, T; Desai, N; Mehta, K; Parikh, R; Male, S; Hussain, M; Ollenschleger, M; Spiegel, G; Grande, A; Ezzeddine, M; Jagadeesan, B; Tummala, R; McCullough, L

2018-01-01

Introduction Proximal cervical internal carotid artery stenosis greater than 50% merits revascularization to mitigate the risk of stroke recurrence among large-vessel anterior circulation strokes undergoing mechanical thrombectomy. Carotid artery stenting necessitates the use of antiplatelets, and there is a theoretical increased risk of hemorrhagic transformation given that such patients may already have received intravenous thrombolytics and have a significant infarct burden. We investigate the outcomes of large-vessel anterior circulation stroke patients treated with intravenous thrombolytics receiving same-day carotid stenting or selective angioplasty compared to no carotid intervention. Materials and methods The study cohort was obtained from the National (Nationwide) Inpatient Sample database between 2006 and 2014, using International Statistical Classification of Diseases, ninth revision discharge diagnosis and procedure codes. A total of 11,825 patients with large-vessel anterior circulation stroke treated with intravenous thrombolytic and mechanical thrombectomy on the same day were identified. The study population was subdivided into three subgroups: no carotid intervention, same-day carotid angioplasty without carotid stenting, and same-day carotid stenting. Outcomes were assessed with respect to mortality, significant disability at discharge, hemorrhagic transformation, and requirement of percutaneous endoscopic gastronomy tube placement, prolonged mechanical ventilation, or craniotomy. Results This study found no statistically significant difference in patient outcomes in those treated with concurrent carotid stenting compared to no carotid intervention in terms of morbidity or mortality. Conclusions If indicated, it is reasonable to consider concurrent carotid stenting and/or angioplasty for large-vessel anterior circulation stroke patients treated with mechanical thrombectomy who also receive intravenous thrombolytics.

MR imaging of carotid webs

International Nuclear Information System (INIS)

Boesen, Mari E.; Eswaradass, Prasanna Venkatesan; Singh, Dilip; Mitha, Alim P.; Menon, Bijoy K.; Goyal, Mayank; Frayne, Richard

2017-01-01

We propose a magnetic resonance (MR) imaging protocol for the characterization of carotid web morphology, composition, and vessel wall dynamics. The purpose of this case series was to determine the feasibility of imaging carotid webs with MR imaging. Five patients diagnosed with carotid web on CT angiography were recruited to undergo a 30-min MR imaging session. MR angiography (MRA) images of the carotid artery bifurcation were acquired. Multi-contrast fast spin echo (FSE) images were acquired axially about the level of the carotid web. Two types of cardiac phase resolved sequences (cineFSE and cine phase contrast) were acquired to visualize the elasticity of the vessel wall affected by the web. Carotid webs were identified on MRA in 5/5 (100%) patients. Multi-contrast FSE revealed vessel wall thickening and cineFSE demonstrated regional changes in distensibility surrounding the webs in these patients. Our MR imaging protocol enables an in-depth evaluation of patients with carotid webs: morphology (by MRA), composition (by multi-contrast FSE), and wall dynamics (by cineFSE). (orig.)

MR imaging of carotid webs

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Boesen, Mari E. [University of Calgary, Department of Biomedical Engineering, Calgary (Canada); Foothills Medical Centre, Seaman Family MR Research Centre, Calgary (Canada); Eswaradass, Prasanna Venkatesan; Singh, Dilip; Mitha, Alim P.; Menon, Bijoy K. [University of Calgary, Department of Clinical Neurosciences, Calgary (Canada); Foothills Medical Centre, Calgary Stroke Program, Calgary (Canada); Goyal, Mayank [Foothills Medical Centre, Calgary Stroke Program, Calgary (Canada); University of Calgary, Department of Radiology, Calgary (Canada); Frayne, Richard [Foothills Medical Centre, Seaman Family MR Research Centre, Calgary (Canada); University of Calgary, Hotchkiss Brain Institute, Calgary (Canada)

2017-04-15

We propose a magnetic resonance (MR) imaging protocol for the characterization of carotid web morphology, composition, and vessel wall dynamics. The purpose of this case series was to determine the feasibility of imaging carotid webs with MR imaging. Five patients diagnosed with carotid web on CT angiography were recruited to undergo a 30-min MR imaging session. MR angiography (MRA) images of the carotid artery bifurcation were acquired. Multi-contrast fast spin echo (FSE) images were acquired axially about the level of the carotid web. Two types of cardiac phase resolved sequences (cineFSE and cine phase contrast) were acquired to visualize the elasticity of the vessel wall affected by the web. Carotid webs were identified on MRA in 5/5 (100%) patients. Multi-contrast FSE revealed vessel wall thickening and cineFSE demonstrated regional changes in distensibility surrounding the webs in these patients. Our MR imaging protocol enables an in-depth evaluation of patients with carotid webs: morphology (by MRA), composition (by multi-contrast FSE), and wall dynamics (by cineFSE). (orig.)

Pituitary dysfunction from an unruptured ophthalmic internal carotid artery aneurysm with improved 2-year follow-up results: A case report

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Qi Meng

2018-04-01

Full Text Available Internal carotid artery (ICA supraclinoid segment aneurysms extending into the sellar region and leading to pituitary dysfunction are a rare occurrence. To date, long-term follow up of pituitary function 2 years post-treatment has never been reported. Herein, we present a case of pituitary dysfunction due to an unruptured ophthalmic segment internal carotid artery aneurysm and report improved 2-year follow-up results. A 76-year-old male presented with disturbed consciousness due to hyponatremia, which was caused by hypoadrenocorticism resulting from pituitary dysfunction complicated by hypogonadism and hypothyroidism. Computed tomography angiography revealed an intracranial aneurysm of the ophthalmic segment of the right ICA with an intrasellar extension. Thus, digital subtraction angiography and coil embolization were performed, followed by hormone replacement therapy. A 2-year follow-up revealed a partial improvement in the pituitary function, including complete restoration of thyroid-stimulating hormone level and other thyroid hormones levels, and partial restoration of testosterone levels, followed by discontinuation of thyroid hormone replacement therapy. However, the mechanisms of such pituitary dysfunction and the effects of various treatments, including clipping and coiling, on different hormones of pituitary function recovery remain unclear. A long-term follow-up of >2 years may elucidate the pituitary function recovery post-treatment and provide a medication adjustment for hormone replacement therapy.

Long-term results after carotid artery stenting. Restenosis after carotid artery stenting using self-expandable stent

International Nuclear Information System (INIS)

Matsumoto, Yasushi; Furui, Eisuke; Tsuboi, Ken; Takahashi, Akira; Ezura, Masayuki

2008-01-01

Carotid artery stenting has emerged as an acceptable treatment alternative in patients with carotid artery stenosis. Although early clinical results of carotid artery stenting have shown promise, long, term clinical results remain less certain. We report the frequency, management, and clinical results of in-stent restenosis after carotid artery stenting using a self-expandable stent. Between August 1998 and September 2004, 80 carotid artery stenting procedures in 78 patients were performed. We evaluated 76 of the 80 procedures in 75 of the 78 patients treated during this period who had a minimum 6-month clinical and imaging (ultrasound and/or magnetic resonance angiography) follow-up. Recurrent stenosis (≥50%) after carotid artery stenting occurred in 3 (3.9%) patients. The recurrent stenosis occurred within one year after the procedure in all cases. The low rate of in-stent restenosis using self-expandable stent suggested that carotid artery stenting may be an effective alternative treatment for carotid artery stenosis, but more data of long-term follow-up are required. (author)

[Analysis of brain hemometabolism behavior during carotid endarterectomy with temporary clamping.].

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Duval Neto, Gastão Fernandes; Niencheski, Augusto H

2004-04-01

Carotid endarterectomy with temporary clamping changes cerebral blood flow and cerebral metabolic oxygen demand ratio with consequent oligemic hypoxia or hemometabolic uncoupling. This study aimed at identifying changes in brain hemometabolism, evaluated through changes in oxyhemoglobin saturation in internal jugular vein bulb (SvjO2) during carotid endarterectomy with clamping, and at correlating these changes with potentially interfering factors, mainly end tidal CO2 pressure (P ET CO2) and cerebral perfusion pressure (CPP). Sixteen patients with unilateral carotid stenotic disease scheduled to carotid endarterectomy with carotid arterial clamping were enrolled in this study. Parameters including internal jugular bulb oxyhemoglobin saturation, stump pressure and end tidal CO2 pressure were measured at the following moments: M1 - pre-clamping; M2 - 3 minutes after clamping; M3 - pre-unclamping; M4 - post-unclamping). The comparison among SvjO2 (%, mean +/- SD) in all studied periods has shown differences between those recorded in moments M1 (52.25 +/- 7.87) and M2 (47.43 +/- 9.19). This initial decrease stabilized during temporary clamping, showing decrease in the comparison between M2 and M3 (46.56 +/- 9.25), without statistical significance (p = ns). At post-unclamping, M4 (47.68 +/- 9.12), SvjO2 was increased as compared to M2 and M3 clamping stages, however it was still lower than that of pre-clamping stage M1.(M4 x M1 - p brain hemometabolic uncoupling trend were correlated to P ET CO2. The comparison between CPP and SvjO2 showed weak correlation devoid of statistical significance. In the conditions of our study, SvjO2 measurement is a fast and effective way of clinically monitoring changes in CBF/CMRO2 ratio. Temporary carotid clamping implies in a trend towards brain hemometabolic uncoupling and, as a consequence, to oligemic ischemia; cerebral perfusion pressure does not assesses brain hemometabolic status (CBF and CMRO2 ratio); hypocapnia, may lead to

Internal carotid arterial occlusion in computed tomography. Correlation of CT and angiographic findings

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Harada, K.; Miura, T.; Nishikubo, Y.; Kawai, R.; Mitomo, M. (Osaka Univ. (Japan). Faculty of Medicine)

1981-09-01

The computed tomographic appearance of internal carotid arterial occlusion was reviewed in 33 patients. In 23 of them, who underwent 4-vessel study, the angiographic and CT findings were compared. Ten patients were disclosed to have watershed infarction by CT. Seven of them had watershed processes in the centrum semiovale which were considered to be terminal infarction. Patients who showed watershed infarction under CT revealed inadequate circle of Willis and well-developed cortical anastomosis under angiography. Unilaterally accentuated cerebral atrophy, which we have called asymmetrical atrophy in this paper, was noted in 10 patients. The findings of asymmetrical cerebral atrophy sometimes resemble the changes secondary to old infarction. However, the changes in the lateral ventricle caused by asymmetrical cerebral atrophy are somewhat different from those resulting from old infarction. The angiographic findings suggested that asymmetrical cerebral atrophy is, in addition to being associated with incomplete circle of Willis, also associated with local circulatory disturbances which further decrease the regional cerebral blood flow in the affected hemisphere.

Right retrograde brachial cerebral angiography with simultaneous compression of the left carotid artery

International Nuclear Information System (INIS)

Ericson, K.; Mosskin, M.

1981-01-01

Right retrograde brachial angiography with simultaneous compression of the left common carotid artery was performed in 12 patients, invariably resulting in filling of the right vertebral and the basilar artery. In all but one patient, the right carotid artery and its branches were also filled. Retrograde filling of the left internal carotid artery occurred in 8 patients. Furthermore, retrograde filling of the intracranial part of the left vertebral artery was obtained in 5 of 12 patients. A complete four-vessel cranial angiography was thus obtained in one third of the patients. The method may be considered as a safe and valuable adjunct to other angiographic techniques. (Auth.)

A 22-year Northern Irish experience of carotid body tumours.

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O'Neill, Stephen; O'Donnell, Mark; Harkin, Denis; Loughrey, Maurice; Lee, Bernard; Blair, Paul

2011-09-01

Carotid body tumours (CBTs) are rare vascular neoplasms originating in paraganglionic cells of the carotid bifurcation. The aim of this study was to review all patients diagnosed with CBTs in Northern Ireland. A retrospective review was performed of all patients who had CBTs treated at our institutions between 1987 and 2009. Patient demographics, clinical symptomatology, investigative modality, therapeutic intervention, pathological analysis and long-term outcomes were assessed. Twenty-nine patients were identified with 33 CBTs and three glomus intravagale tumours (GITs). Six patients had bilateral CBTs (21%), one of whom had a synchronous GIT. Twenty-six patients underwent a total of 30 operative procedures for the resection of 28 CBTs and 3 GITs. Conventional operative treatment included subadventitial tumour excision. A vascular shunt facilitated arterial reconstruction following the removal of seven (23%) tumours and on six of these occasions (19%) continuity was restored with an interposition vein graft. For access the external carotid artery was ligated during the removal of four tumours (13%). Two tumours were considered malignant. No peri-operative mortalities were recorded. Immediate complications included peri-operative stroke secondary to an occluded vein graft (n=1), requirement of tracheostomy (n=2), emergency haematoma drainage (n=2) and transient cranial nerve damage (n=8). Late complications included pseudoaneurysm of vein graft with subsequent stoke (n=1), permanent cranial nerve damage (n=9), Horner's syndrome (n=1) and an asymptomatic vein graft occlusion (n=1). One patient had tumour recurrence two years post-operatively and died due to pulmonary metastases. Two other patients died of unrelated causes. All other patients remain well with no evidence of tumour recurrence at mean followup of 1801 days (range 159-9208 days). Our long-term experience is comparable with other reported case series where surgical intervention conferred a long

Impact of Hypertriglyceridemia on Carotid Stenosis Progression under Normal Low-Density Lipoprotein Cholesterol Levels.

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Kitagami, Masayuki; Yasuda, Ryuta; Toma, Naoki; Shiba, Masato; Nampei, Mai; Yamamoto, Yoko; Nakatsuka, Yoshinari; Sakaida, Hiroshi; Suzuki, Hidenori

2017-08-01

Dyslipidemia is a well-known risk factor for carotid stenosis progression, but triglycerides have attracted little attention. The aim of this study was to assess if serum triglycerides affect progression of carotid stenosis in patients with well-controlled low-density lipoprotein cholesterol (LDL-C) levels. This is a retrospective study in a single hospital consisting of 71 Japanese patients with internal carotid artery stenosis greater than or equal to 50% and normal serum LDL-C levels who underwent angiographic examination with or without the resultant carotid artery stenting or endarterectomy from 2007 to 2011, and were subsequently followed up for 4 years. Clinical factors including fasting serum triglyceride values were compared between the progression (≥10% increase in degree of carotid stenosis on ultrasonography) and the nonprogression groups. During 4 years, 15 patients (21.1%) had carotid stenosis progression on either side. Cox regression analysis demonstrated that symptomatic cases (hazard ratio [HR], 4.327; P = .019), coexisting intracranial arteriosclerotic stenosis (HR, 5.341; P = .005), and hypertriglyceridemia (HR, 6.228; P = .011) were associated with subsequent progression of carotid stenosis. Kaplan-Meier plots demonstrated that the progression-free survival rate was significantly higher in patients without hypertriglyceridemia and intracranial arteriosclerotic stenosis at baseline. Among patients with moderate to severe carotid stenosis and well-controlled LDL-C, hypertriglyceridemia was an important risk factor for progression of carotid stenosis irrespective of surgical treatments. It would be worthwhile to test if triglyceride-lowering medications suppress carotid stenosis progression. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Asymptomatic Primary Hyperparathyroidism

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Silverberg, Shonni J.; Walker, Marcella D.; Bilezikian, John P.

2014-01-01

The clinical profile of primary hyperparathyroidism (PHPT) as it is seen in the United States and most Western countries has evolved significantly over the past half century. The introduction of the multichannel serum autoanalyzer in the 1970s led to the recognition of a cohort of individuals with asymptomatic hypercalcemia, in whom evaluation led to the diagnosis of PHPT. The term “asymptomatic primary hyperparathyroidism” was introduced to describe patients who lack obvious signs and symptoms referable to either excess calcium or parathyroid hormone. Although it was expected that asymptomatic patients would eventually develop classical symptoms of PHPT, observational data suggest that most patients do not evolve over time to become overtly symptomatic. In most parts of the world, the asymptomatic phenotype of PHPT has replaced classical PHPT. This report is a selective review of data on asymptomatic PHPT: its demographic features, presentation and natural history, as well as biochemical, skeletal, neuromuscular, psychological, and cardiovascular manifestations. In addition, we will summarize available information on treatment indications and options for those with asymptomatic disease. PMID:23374736

A SPECT study in internal carotid artery occlusion: Discrepancies between flow image and neurologic deficits

International Nuclear Information System (INIS)

Moriwaki, H.; Hougaku, H.; Matsuda, I.; Kusunoki, M.; Shirai, J.

1989-01-01

A SPECT (single photon emission computed tomography) study in internal carotid artery (ICA) occlusion was performed in 6 patients. The validity of iodoamphetamine (IMP) SPECT study in the evaluation of cerebral blood flow (CBF) or neurologic function is still controversial. In this study, the authors showed several cases in whom SPECT images of brain were not compatible with their neurologic deficits. In 2 typical cases, a large low-density area was observed in the non-dominant hemisphere in computed tomography (CT) scan, but no apparent motor-sensory deficits in left limbs were present. In these patients, SPECT study also revealed flow reduction in the affected side of the brain. So there was a possibility that an IMP brain image could not always reflect CBF, which maintains neurologic function of the brain

Surgical techniques and curative effect of carotid endarterectomy for carotid artery stenosis

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Min HAN

2014-02-01

Full Text Available Objective To investigate the surgical techniques of carotid endarterectomy (CEA for treating carotid artery stenosis, in order to improve the surgical efficacy and reduce intraoperative adverse events and complications after operation. Methods Retrospective analysis was carried out on surgical data of 53 cases who were performed CEA from October 2010 to October 2013 in Department of Neurosurgery in Tianjin Huanhu Hospital. There were 39 males and 14 females, aged from 40 to 78 years old and mean age (60.34 ± 8.92 years old; the course of disease was from 2 d to 4 years. Twenty-six cases were diagnosed as right carotid stenosis, 15 cases left carotid stenosis and 12 cases double-sided carotid stenosis. Among all of those cases, 35 cases were diagnosed as moderate stenosis (30%-69%, 16 cases severe stenosis (70%-99% , and 2 cases complete occlusion. Results Among 53 patients, 50 patients underwent CEA; 2 cases underwent CEA and aneurysm clipping; one case underwent stent removal surgery and CEA because restenosis was found after carotid artery stenting (CAS. Postoperative neck CTA and fMRI showed good morphology of carotid artery, fluent blood flow and improved cerebral perfusion after operation. All of those patients were followed up for 3 to 24 months. One case died of myocardial infarction; 2 cases appeared skin numbness on the operating side of the neck, and the symptom disappeared 3 months later; one case appeared hoarseness after operation; 3 cases experienced mild transient ischemic attack (TIA and the symptom disappeared 2 months later. No case of stroke was found. Conclusions CEA is a safe and effective surgical approach to treat carotid stenosis. Correct and reasonable choices of the surgical indications and skilled surgical technique are the key to ensure the success of operation and to improve efficacy of the therapy. doi：10.3969/j.issn.1672-6731.2014.02.006Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v14n2a6

Usefulness of Doppler echography for the diagnosis of traumatic carotid thrombosis

International Nuclear Information System (INIS)

Joaquín Castillo Duany.Santiago de Cuba (Cuba))" data-affiliation=" (Hospital Militar Joaquín Castillo Duany.Santiago de Cuba (Cuba))" >Rodríguez Montero, Enri; Joaquín Castillo Duany.Santiago de Cuba (Cuba))" data-affiliation=" (Hospital Militar Joaquín Castillo Duany.Santiago de Cuba (Cuba))" >González Méndez, Melvis; Joaquín Castillo Duany.Santiago de Cuba (Cuba))" data-affiliation=" (Hospital Militar Joaquín Castillo Duany.Santiago de Cuba (Cuba))" >González López, Ariel; Joaquín Castillo Duany.Santiago de Cuba (Cuba))" data-affiliation=" (Hospital Militar Joaquín Castillo Duany.Santiago de Cuba (Cuba))" >Campa, Belkis Ortega de la; Joaquín Castillo Duany.Santiago de Cuba (Cuba))" data-affiliation=" (Hospital Militar Joaquín Castillo Duany.Santiago de Cuba (Cuba))" >Germán Meliz, Jorge L.

2015-01-01

Carotid artery system traumas are rare and show high mortality rates. The case of right internal carotid artery thrombosis caused by a gunshot injury in the neck was presented in this report to show evidence of the usefulness of Doppler echography in the medical practice for the early diagnosis of these lesions in spite of the fact that literature highlights angiography, nuclear magnetic resonance and angioresonance as the imaging studies of choice. This case confirmed that carotid thrombosis due to trauma has low incidence but it can not be ignored in the cervical región traumas. For these reasons, the neurological complications stemming from artery occlusion are frequent and Doppler echography turned to be very useful for the early diagnosis of this illness in a patient. (author)

Three-dimensional power Doppler sonography in screening for carotid artery disease.

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Keberle, M; Jenett, M; Beissert, M; Jahns, R; Haerten, R; Hahn, D

2000-01-01

Color Doppler sonography has gained considerable recognition as a noninvasive method to detect carotid artery disease and to assess the degree of carotid artery stenosis. However, results are highly operator-dependent and cannot be presented as survey images. The purpose of this study was to evaluate real-time 3-dimensional (3D) power Doppler sonography as a method for screening for atherosclerosis in the carotid arteries. We prospectively screened 75 patients for carotid artery disease using both conventional color Doppler sonography and 3D power Doppler sonography, and the results from the 2 modalities were compared. A total of 150 common carotid arteries, 150 internal carotid arteries, and 150 external carotid arteries were examined utilizing a 7.5-MHz linear-array transducer combined with tissue harmonic imaging. Color Doppler sonography detected 297 normal or atherosclerotic arteries without stenosis, 57 arteries with mild (1-49%) stenosis, 41 with moderate (50-69%) stenosis, 32 with severe (70-99%) stenosis, and 9 with occlusions. The degree of stenosis determined by color Doppler sonography correlated with that determined by 3D power Doppler sonography (r = 0.982-0.998). Moreover, there was a good correlation between the measurements for both the length of the lesion and its distance from the bulb as determined by the 3D volume surveys and by color Doppler sonography (r = 0.986). The interobserver variability rate was 3.7% +/- 0.5%. Generally, the acquisition and reconstruction of the 3D data took less than 5 minutes. 3D power Doppler sonography is easy to perform and is an accurate method in screening for atherosclerotic lesions of the carotid arteries. Moreover, it provides excellent 3D volume surveys that may be helpful in the planning of surgical treatment. Copyright 2000 John Wiley & Sons, Inc.

Embolization of carotid-cavernous fistula using a silicone balloon and a tracker-catheter system

International Nuclear Information System (INIS)

Kim, Sun Yong; Cho, Kil Ho; Park, Bok Hwan

1992-01-01

With the recent introduction and development of the detachable balloon system, it has become the treatment of choice in the management of carotid cavernous fistulas(CCFs). But, since most delivery systems for embolization of CCF mainly depend on flow guidance for balloon delivery, in case of small fistula, pseudo aneurysm and arterialized venous collaterals, failure of balloon embolization can occur. To overcome these limitation, the authors designed and used a new versatile, steerable, and flow-guided detachable balloon system by using a Tracker catheter system with silicone or latex balloons. Using this maneuver, we could get successful fistula occlusion in 7 out of 8 patients (silicone balloon). But in one case, we had to occlude the internal carotid artery at the fistula site, proximal and distal cervical portions of the internal carotid artery. This balloon delivery system proved to provide high selectivity for fistula and relatively ease of handing

Carotid endarterectomy: the change in practice over 11 years in a stroke centre.

Science.gov (United States)

Tse, Gabrielle T W; Kilkenny, Monique F; Bladin, Chris; Grigg, Michael; Dewey, Helen M

2017-11-13

Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome. There were 510 CEAs performed during 2004-2014 and 95 CASs during 2003-2008. The proportion of patients undergoing CEA compared to CAS increased from 60% to 90% from 2004 to 2008 (P < 0.001). CAS patients were more likely to have cardiac co-morbidities. From 2004 to 2014, the proportion of CEA patients aged ≥80 years increased (P = 0.001) and the proportion of asymptomatic patients decreased (P = 0.003) over time. Median time from symptom onset to surgery decreased from 52 days (Q1: 25, Q3: 74) in 2004 to 8 days (Q1: 5, Q3: 37) in 2014 (P < 0.001). Use of preoperative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (P < 0.001). Overall, 5.9% of CEAs were complicated by death, stroke or acute myocardial infarction with no significant change over time. The trends in CEA practice at our centre align with international trends and guidelines. This study provides a representative indicator of Australian hospital practice, and illustrates how evidence from research is translated into clinical care. © 2017 Royal Australasian College of Surgeons.

Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

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Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

2012-01-15

Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

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Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

2015-12-01

Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to

Asymptomatic bacteriuria in pregnancy.

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Smaill, Fiona

2007-06-01

Screening for asymptomatic bacteriuria is a standard of obstetrical care and is included in most antenatal guidelines. There is good evidence that treatment of asymptomatic bacteriuria will decrease the incidence of pyelonephritis. All pregnant women should be screened for asymptomatic bacteriuria, and there are no new data that would indicate otherwise. Antibiotic treatment of asymptomatic bacteriuria is associated with a decrease in the incidence of preterm delivery or low birth weight, but the methodological quality of the studies means any conclusion about the strength of this association needs to be drawn cautiously. A better understanding of the mechanism by which treatment of asymptomatic bacteriuria could prevent preterm delivery is needed. While several rapid screening tests have been evaluated, none perform adequately to replace urine culture for detecting asymptomatic bacteriuria. Until there are data from well-designed trials that establish the optimal duration of therapy for asymptomatic bacteriuria, standard treatment courses are recommended.

Alterations of carotid arterial mechanics preceding the wall thickening in patients with hypertension.

Science.gov (United States)

Kim, Sung-Ai; Park, Sun-Hee; Jo, Sang-Ho; Park, Kyoung-Ha; Kim, Hyun-Sook; Han, Sang-Jin; Park, Woo-Jung; Ha, Jong-Won

2016-05-01

Carotid intima-media thickness (cIMT) is an established surrogate marker of atherosclerosis. However, cIMT may not reflect the whole arterial changes occurring in various pathologic conditions, such as hypertension. The aim of this study was to evaluate whether vascular properties of carotid artery (CA) in patients with hypertension differ from those of patients with diabetes and controls before the progression of cIMT. Vascular properties of CA were assessed in 402 consecutive asymptomatic subjects who have normal cIMT (131 with hypertension, 151 with diabetes mellitus, and 120 controls). Conventional carotid stiffness indices calculated from vessel diameter and blood pressure, and parameters from velocity-vector imaging (VVI), including vessel area, fractional area change (FAC), radial velocity, circumferential strain, and strain rate were measured to assess the differences between the groups. In univariate analysis, both patients with hypertension and diabetes showed higher elastic modulus, lower distensibility coefficients and FAC of VVI than those of controls. However, when adjusting for baseline covariates, only FAC (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.70-0.97, p = 0.025) and vessel area (OR = 2.84, 95% CI = 1.64-4.91, p hypertension from those of controls. Also, patients with hypertension showed larger vessel area than diabetes (OR = 2.58, 95% CI = 1.75-3.80, p hypertensive patients was stiffer than those of controls and positive remodeling preceded the wall thickening independent of baseline covariates. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.

Science.gov (United States)

Dellaretti, Marcos; de Vasconcelos, Laura T; Dourado, Jules; de Souza, Renata F; Fontoura, Renato R; de Sousa, Atos A

2016-03-01

During carotid endarterectomy (CEA), carotid cross-clamping is performed to allow for artery incision and plaque removal. A small subgroup of patients can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurologic deficit. These patients are described as having ''cross-clamp intolerance.'' The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition. From August 2008 to May 2010, 115 consecutive patients were submitted to CEA under locoregional anesthesia at the Santa Casa de Belo Horizonte; the procedure was performed by the main author. Patients who showed intolerance to internal carotid artery (ICA) occlusion for intolerance. Among the 115 participating patients, 9.6% (11 patients) showed intolerance to ICA occlusion and developed deficits in intolerance). The factor that was associated with cross-clamp intolerance was the mean degree of contralateral carotid stenosis, which was 57.5% for those who presented intolerance and 27.8% for those who tolerated ICA occlusion. Locoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion. Copyright © 2016 Elsevier Inc. All rights reserved.

Endoscopic endonasal approach for the treatment of a large clival giant cell tumor complicated by an intraoperative internal carotid artery rupture

Directory of Open Access Journals (Sweden)

Iacoangeli M

2013-01-01

Full Text Available Maurizio Iacoangeli,1 Alessandro Di Rienzo,1 Massimo Re,2 Lorenzo Alvaro,1 Niccolò Nocchi,1 Maurizio Gladi,1 Maurizio De Nicola,3 Massimo Scerrati11Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy; 2Department of Ear, Nose, and Throat Surgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy; 3Department of Radiology, Interventional Radiology Section, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, ItalyAbstract: Giant cell tumors (GCTs are primary bone neoplasms that rarely involve the skull base. These lesions are usually locally aggressive and require complete removal, including the surrounding apparently healthy bone, to provide the best chance of cure. GCTs, as well as other lesions located in the clivus, can nowadays be treated by a minimally invasive fully endoscopic extended endonasal approach. This approach ensures a more direct route to the craniovertebral junction than other possible approaches (transfacial, extended lateral, and posterolateral approaches. The case reported is a clival GCT operated on by an extended endonasal approach that provides another contribution on how to address one of the most feared complications attributed to this approach: a massive bleed due to an internal carotid artery injury.Keywords: clival giant cell tumor, endoscopic endonasal approach, internal carotid artery injury, minimally invasive surgery

Patient characteristics and outcomes of carotid endarterectomy and carotid artery stenting: analysis of the German mandatory national quality assurance registry - 2003 to 2014.

Science.gov (United States)

Kallmayer, M A; Tsantilas, P; Knappich, C; Haller, B; Storck, M; Stadlbauer, T; Kühnl, A; Zimmermann, A; Eckstein, H H

2015-12-01

In Germany, every surgical or endovascular procedure on the extracranial carotid artery is documented in a mandatory quality assurance registry. The purpose of this study is to describe the patient characteristics, the indications for treatment, and the short-term outcomes as well as to analyse the corresponding trends from 2003 to 2014. Data on demographics, peri-procedural measures, and outcomes were extracted from the annual quality reports published by the Federal Agency for Quality Assurance and the Institute for Applied Quality Improvement and Research in Health Care. Data were available from 2003 to 2014 for carotid endarterectomy (CEA) and from 2012 to 2014 for carotid artery stenting (CAS). The primary outcome event of this study is any stroke or death until discharge from hospital. Temporal trends of categorical variables were statistically analysed using the Cochran-Armitage test for trend. Between 2003 and 2014, 309,405 CEAs and 18,047 CAS procedures were documented in the database; 68.1% of all patients were male. The mean age of patients treated with CEA increased from 68.9 years in 2003 to 70.9 years in 2014. The proportion of patients with ASA stages III to V increased from 65% to 71% in CEA, whereas it decreased from 44% to 41% in CAS patients. 53.1% of all CEAs were performed for asymptomatic patients (group A), 34.4% for symptomatic patients treated electively (group B), and 11.2% a in a collective group including other indications for CEA or CAS (such as recurrent stenosis, carotid aneurysms, emergency treatment due to stroke-in-evolution). The corresponding data for CAS are 49.3%, 26.1% and 26.3% respectively. In group B, the interval between the neurological index event and CEA decreased from 28 to 8 days (P<0.001). In patients treated with CAS, this interval was 9 days in 2012 (no further data available). On average, 67.1% and 48.2% of surgically treated patients as well as 77.8% and 69.8% of CAS patients were neurologically assessed before

A remodelling metric for angular fibre distributions and its application to diseased carotid bifurcations.

LENUS (Irish Health Repository)

Creane, Arthur

2012-07-01

Many soft biological tissues contain collagen fibres, which act as major load bearing constituents. The orientation and the dispersion of these fibres influence the macroscopic mechanical properties of the tissue and are therefore of importance in several areas of research including constitutive model development, tissue engineering and mechanobiology. Qualitative comparisons between these fibre architectures can be made using vector plots of mean orientations and contour plots of fibre dispersion but quantitative comparison cannot be achieved using these methods. We propose a \\'remodelling metric\\' between two angular fibre distributions, which represents the mean rotational effort required to transform one into the other. It is an adaptation of the earth mover\\'s distance, a similarity measure between two histograms\\/signatures used in image analysis, which represents the minimal cost of transforming one distribution into the other by moving distribution mass around. In this paper, its utility is demonstrated by considering the change in fibre architecture during a period of plaque growth in finite element models of the carotid bifurcation. The fibre architecture is predicted using a strain-based remodelling algorithm. We investigate the remodelling metric\\'s potential as a clinical indicator of plaque vulnerability by comparing results between symptomatic and asymptomatic carotid bifurcations. Fibre remodelling was found to occur at regions of plaque burden. As plaque thickness increased, so did the remodelling metric. A measure of the total predicted fibre remodelling during plaque growth, TRM, was found to be higher in the symptomatic group than in the asymptomatic group. Furthermore, a measure of the total fibre remodelling per plaque size, TRM\\/TPB, was found to be significantly higher in the symptomatic vessels. The remodelling metric may prove to be a useful tool in other soft tissues and engineered scaffolds where fibre adaptation is also present.

Plasma thrombin-cleaved osteopontin elevation after carotid artery stenting in symptomatic ischemic stroke patients

International Nuclear Information System (INIS)

Kurata, Mie; Okura, Takafumi; Kumon, Yoshiaki; Tagawa, Masahiko; Watanabe, Hideaki; Miyazaki, Tatsuhiko; Higaki, Jitsuo; Nose, Masato; Nakahara, Toshinori

2012-01-01

Atherothrombosis is the primary pathophysiology that underlies ischemic cerebral infarction. Osteopontin (OPN) is produced in atherosclerotic lesions and is cleaved by activated thrombin. We hypothesized that the rupture or damage of an unstable atherosclerotic plaque increases plasma levels of thrombin-cleaved OPN (trOPN). This study included 90 patients who received carotid angioplasty with stenting (CAS), 23 patients with essential hypertension (EHT) and 10 patients who were treated with carotid endarterectomy (CEA). The CAS patient group included 36 patients that had pre- and post-operative blood tests, diffusion-weighted imaging (DWI) using cerebral MRIs and estimated thrombus debris within the protection device. Immunohistochemistry of CEA specimens revealed that trOPN was detected around intra-plaque vessels. The highest tertile of plasma trOPN levels in CAS patients was higher than trOPN levels in EHT patients. Post-operative trOPN levels were significantly higher in symptomatic compared with asymptomatic patients (P=0.003). New ipsilateral DWI-positive patients revealed higher post-operative trOPN levels (P=0.003) and a higher grade of thrombi (P<0.001) than DWI-negative patients. TrOPN may be a novel biomarker that reflects the atherothrombotic status in ischemic stroke. (author)

Self-Expandable Stenting over a Stent Graft for the Exclusion of a Carotid Stump: Troubleshooting for Device Incompatibility

International Nuclear Information System (INIS)

Youn, Sung Won; Kim, Ho Kyun; Do, Jin Kook; Kim, Young Whan

2011-01-01

Carotid stump, the blind remnant of an occluded internal carotid artery, can be a potential source of microemboli, and warrants its exclusion from the vascular lumen to prevent the recurrence of a microembolism. In a 69-year-old male with a symptomatic carotid stump and acute angle between left common carotid artery and aortic arch, a 7-Fr. shuttle sheath was scarcely placed into the left carotid artery but the 7-mm-diameter stent-graft-loading balloon could not be inserted into the 7-Fr. shuttle sheath. With the mounting a stent graft over a 5-mm balloon, the balloon-expandable stent graft was unfolded. The self-expandable stent was placed over the stent graft, and an 8-mm balloon was subsequently expanded. Self-expanding stenting can be useful for troubleshooting in a case of device incompatibility coming from the different calibers of the external and common carotid arteries for the successful exclusion of a symptomatic carotid stump.

Self-Expandable Stenting over a Stent Graft for the Exclusion of a Carotid Stump: Troubleshooting for Device Incompatibility

Energy Technology Data Exchange (ETDEWEB)

Youn, Sung Won; Kim, Ho Kyun [Dept. of Radiology, Catholic University of Daegu School of Medicine, Daegu (Korea, Republic of); Do, Jin Kook [Dept. of Neurology, Catholic University of Daegu School of Medicine, Daegu (Korea, Republic of); Kim, Young Whan [Dept. of Radiology, University College of Medicine, Daegu (Korea, Republic of)

2011-12-15

Carotid stump, the blind remnant of an occluded internal carotid artery, can be a potential source of microemboli, and warrants its exclusion from the vascular lumen to prevent the recurrence of a microembolism. In a 69-year-old male with a symptomatic carotid stump and acute angle between left common carotid artery and aortic arch, a 7-Fr. shuttle sheath was scarcely placed into the left carotid artery but the 7-mm-diameter stent-graft-loading balloon could not be inserted into the 7-Fr. shuttle sheath. With the mounting a stent graft over a 5-mm balloon, the balloon-expandable stent graft was unfolded. The self-expandable stent was placed over the stent graft, and an 8-mm balloon was subsequently expanded. Self-expanding stenting can be useful for troubleshooting in a case of device incompatibility coming from the different calibers of the external and common carotid arteries for the successful exclusion of a symptomatic carotid stump.

Presentation of a glomus carotid tumor as carotid sinus syndrome with syncopal episodes