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Sample records for carotid endarterectomy case

  1. 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...

  2. Current Approaches for Carotid Endarterectomy

    Directory of Open Access Journals (Sweden)

    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.

  3. Carotid stenting and endarterectomy.

    Science.gov (United States)

    Yip, Hon-Kan; Sung, Pei-Hsun; Wu, Chiung-Jen; Yu, Cheuk-Man

    2016-07-01

    Stroke, either ischemic or hemorrhagic, remains the second commonest cause of death worldwide in the last decade. Etiologies for ischemic stroke (IS) vary widely. Atherothrombotic occlusion is an essential cause to which carotid artery stenosis (CAS) is a major contributor. Administration of anti-platelet agent to patients with CAS has been shown to reduce incidence of long-term IS. In additional, in patients with symptomatic CAS, clinical trials have demonstrated that carotid endarterectomy (CEA) is superior to medical therapy for prevention of future CAS-related IS. However, CEA is not suitable for CAS post-radiotherapy or those located at higher level of the internal carotid artery; and major complications of this procedure including cranial nerve injuries have stimulated the interest of using percutaneous transfemoral carotid stenting as an alternative approach. Although transfemoral arterial approach of carotid stenting is not inferior to CEA in improving clinical outcomes, it has been reported to be associated with vascular complication and has its limitations in patients with athero-occlusive disease of abdominal aorta or bilateral iliac arteries, level II or III aortic arch, or bovine type carotid arterial anatomy. Therefore, transradial/transbrachial arterial approach has emerged as a novel method for carotid stenting. This article provides a critical review on interventional approaches for the treatment of CAS. PMID:27061654

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

    International Nuclear Information System (INIS)

    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.

  5. Cerebral hyperperfusion following carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Sørensen, O;

    1987-01-01

    Serial measurements of cerebral blood flow (CBF) were performed in 56 patients before and one to four times after uncomplicated carotid endarterectomy. The findings were related to the ratio between internal carotid artery (ICA) and common carotid artery (CCA) mean pressures. Within the 1st...... ratio suggests a temporary impairment of autoregulation. Special care should be taken to avoid postoperative hypertension in such patients, who typically have preoperative hypoperfusion, to avoid the occurrence of cerebral edema or hemorrhage....

  6. Fluoroscopy Guided Cervical Plexus Block for Carotid Endarterectomy - A Case Report

    Directory of Open Access Journals (Sweden)

    Aparna A Nerurkar

    2009-01-01

    Full Text Available Carotid endarterectomy(CEA is being increasingly performed under regional anaesthesia supplemented with sedation, the world over. Deep or superficial cervical plexus blocks or a combination of both have been found to be equally effective. Various imaging modalities like fluoroscopy, computed tomography (CT, CT-fluoroscopy, ultra-sound etc have been used to increase the success rates of the technique and to reduce the rate of complications associated with the block. These are especially useful given the varying landmarks quoted by various authors as also inter-individual differences in anatomy. We present a case report of how fluoroscopy aided us in administering cervical plexus block.

  7. Advantages of carotid endarterectomy under local anaesthesia with minimal cerebral monitoring: an experience of 45 cases

    International Nuclear Information System (INIS)

    Objective: To evaluate the benefits, efficacy and safety of local cervical plexus block in the performance of carotid endarterectomy, in the absence of sophisticated cerebral perfusion monitoring. Place and Duration of Study: This study was carried out at Combined Military Hospital (CMH) Lahore, Pakistan from January 2012 to May 2013. Study Design: Quasi-experimental study. Patients and Methods: A total of 45 cases of ASA II and ASA III physical status were operated for carotid endarterectomy under local block of cervical plexus. After thorough preanaesthetic assessment, the patients physical conditions were optimized before surgery. Premedication was given with midazolam and sedated during operation with small doses of propofol. Local anaesthesia (LA) was completed by injecting bupivacaine in cervical plexuses 2, C3 and C4 areas. During operation vital signs and adequacy of cerebral perfusion were monitored by keeping the patient awake and making clinical neurological observations. Verbal contact was maintained with the patient. Breathing patterns and motor power were assessed in contralateral upper and lower limbs. Postoperatively patients were interviewed and analgesia during operation was assessed with visual analogue scale. Surgeon's satisfaction regarding intraoperative analgesia was also noted. Patients who required added sedation or local anesthetic agent were also noted. Average duration of surgery time was two hours and average stay of the patients in hospital was five days. Results: Out of 45 patients, 37 patients (82%) had smooth and comfortable anaesthesia and analgesia. In only 1 patient (2.2%) LA had to be converted into general anaesthesia (GA). In 3 cases (7%) LA was supplemented. One patient (2.2%) developed hoarseness and difficulty in breathing and 1 patient (2.2%) developed hemiparesis intra-operatively; while 1 patient (2.2%) developed hypotension in the immediate postoperative period. One patient (2.2%) developed haematoma at infiltration

  8. An audit tool for assessing the appropriateness of carotid endarterectomy

    Directory of Open Access Journals (Sweden)

    Feasby Thomas E

    2004-07-01

    Full Text Available Abstract Background To update appropriateness ratings for carotid endarterectomy using the best clinical evidence and to develop a tool to audit the procedure's use. Methods A nine-member expert panel drawn from all the Canadian Specialist societies that are involved in the care of patients with carotid artery disease, used the RAND Appropriateness Methodology to rate scenarios where carotid endarterectomy may be performed. A 9-point rating scale was used that permits the categorization of the use of carotid endarterectomy as appropriate, uncertain, or inappropriate. A descriptive analysis was undertaken of the final results of the panel meeting. A database and code were then developed to rate all carotid endarterectomies performed in a Western Canadian Health region from 1997 to 2001. Results All scenarios for severe symptomatic stenosis (70–99% were determined to be appropriate. The ratings for moderate symptomatic stenosis (50–69% ranged from appropriate to inappropriate. It was never considered appropriate to perform endarterectomy for mild stenosis (0–49% or for chronic occlusions. Endarterectomy for asymptomatic carotid disease was thought to be of uncertain benefit at best. The majority of indications for the combination of endarterectomy either prior to, or at time of coronary artery bypass grafting were inappropriate. The audit tool classified 98.0% of all cases. Conclusions These expert panel ratings, based on the best evidence currently available, provide a comprehensive and updated guide to appropriate use of carotid endarterectomy. The resulting audit tool can be downloaded by readers from the Internet and immediately used for hospital audits of carotid endarterectomy appropriateness.

  9. Carotid endarterectomy for atherosclerotic carotid artery stenosis

    International Nuclear Information System (INIS)

    Several randomized controlled trials (RCTs) have demonstrated carotid endarterectomy (CEA) to be more beneficial for the prevention of recurrent or first-ever ischemic stroke than treatment with antiplatelet agents in patients with moderate-severe stenosis of the cervical internal carotid artery. CEA is the standard treatment for such lesions; however, other RCTs have demonstrated carotid artery stenting (CAS) with a protective device to be comparable to CEA in patients with or without radiological or medical high-risks for CEA, although the selection criteria among these treatments have not yet been established in clinical practice. This review compares the results of RCTs valuating the superiority of CEA over medical treatment or CAS, preoperative examination, procedures of CEA, perioperative management and complications, long-term results, and indications for CEA based on the currently available evidence-based publications. A preoperative evaluation of the patients' medical condition, including atherosclerosis, is therefore important to minimize the perioperative complications of CEA, because myocardial infarction during the perioperative period is frequently observed in patients undergoing CEA. A through radiological examination such as plaque imaging is essential for selecting appropriate treatment strategies involving revascularization or medical treatment for atherosclerotic carotid artery stenosis. In addition, the surgical indications, particularly for asymptomatic lesions, should be carefully considered in light of the recent improvements in medical treatments including antihypertensive agents and statins. (author)

  10. Routine ultrasound surveillance after carotid endarterectomy.

    Science.gov (United States)

    Pratesi, C; Pulli, R; Ferlaino, E; Michelagnoli, S; Bernacchi, R; Borgioloi, F; Nuzzaci, G

    1996-02-01

    Ultrasounds (US) are employed in preoperative carotid disease diagnosis and in carotid endarterectomy (CEA) follow-up. The authors present their experience about postoperative modifications in CEA site with US evaluation with particular interest in restenosis. Clinical and instrumental examinations were performed at intervals 1, 3, 6, 12, and 24 months following surgery. Follow-up data were available on 189 CEAs. In 58 cases a primary closure was performed, whereas in the other 131 cases, a patch was applied. 15 restenosis (7.9%) were seen during the follow-up control period with 2 cases of haemodynamic restenosis (1%). Good results were recorded with PTFE patch angioplasty (restenosis 4.4%), instead of vein (restenosis 14.2%) and a biosynthetic material called Omniflow (restenosis 9.5%). A vein patch dilatation was encountered in 13 applications (30.9%). In conclusion the routine application of US after carotid endarterectomy allowed us to monitor the evolution of the repair processes and of the stenotic lesions from the very beginning. PMID:8606212

  11. Carotid stenting versus carotid endarterectomy : Evidence basis and cost implications

    NARCIS (Netherlands)

    Janssen, M. P.; de Borst, G. J.; Mali, W. P. Th. M.; Kappelle, L. J.; Moll, F. L.; Ackerstaff, R. G. A.; Rothwell, P. M.; Brown, M. M.; van Sambeek, M. R.; Buskens, E.

    2008-01-01

    Objective: Carotid Angioplasty combined with Stenting (CAS) is increasingly performed because of its presumed benefits. A study was performed to identify key factors that determine the cost-effectiveness as compared to conventional carotid endarterectomy (CEA). Methods: The incremental cost-effectiv

  12. Carotid endarterectomy in awake patients: safety, tolerability and results

    Directory of Open Access Journals (Sweden)

    Célio Teixeira Mendonça

    2014-12-01

    Full Text Available Objective: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. Methods: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%. Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2% and asymptomatic stenosis in 56 arteries (44.8%. Results: A carotid shunt was used in 3 cases (2.4% due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%. Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6% had minor ipsilateral strokes with good recovery, and 2 patients (1.6% had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%. Conclusion: Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates.

  13. Percutaneous endoluminal angioplasty of post endarterectomy carotid stenoses

    International Nuclear Information System (INIS)

    Percutaneous transluminal angioplasty of the carotid artery was performed in four patients with recurrent stenosis following endarterectomy. Balloon catheter dilatation was successful in 3 of the 4 lesions. Post dilatation angiography demonstrated an increase in luminal diameter: there were no neurological complications with the procedure. PTA appears to be an effective method of treating recurrent stenosis following carotid endarterectomy. (orig.)

  14. 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.; 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.; Fell, G.; 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.; Bosiers, M.; Deloose, K.; van Buggenhout, E.; De Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verhelst, R.; DeJaegher, L.; 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.; Alback, A.; Harno, H.; Ijas, P.; Kaste, M.; Lepantalo, 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.; Nederkoorn, P. J.; 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.; Bruininckx, 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.; Nieholt, G. J. Lycklama A.; 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. Bart; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sorensen, K.; Skjelland, M.; Tennoe, 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; Gimenez Gaibar, A.; Perendreu, J.; Bjorses, 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.; Bonati, L. H.; 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, N.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Adam, D.; Bell, J.; Bradbury, A. W.; 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, 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.; Dolman, 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.; Beard, J.; Cleveland, T.; Dodd, D.; Gaines, P.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Venables, G.; Belli, A.; Clifton, 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.; Brown, M. M.; Jaeger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Wong, J.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.; Rogers, P.

    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

  15. 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.

  16. Carotid artery stenting versus endarterectomy: a systematic review.

    Science.gov (United States)

    Gahremanpour, Amir; Perin, Emerson C; Silva, Guilherme

    2012-01-01

    For about 2 decades, investigators have been comparing carotid endarterectomy with carotid artery stenting in regard to their effectiveness and safety in treating carotid artery stenosis. We conducted a systematic review to summarize and appraise the available evidence provided by randomized trials, meta-analyses, and registries comparing the clinical outcomes of the 2 procedures. We searched the MEDLINE, SciVerse Scopus, and Cochrane databases and the bibliographies of pertinent textbooks and articles to identify these studies. The results of clinical trials and, consequently, the meta-analyses of those trials produced conflicting results regarding the comparative effectiveness and safety of carotid endarterectomy and carotid stenting. These conflicting results arose because of differences in patient population, trial design, outcome measures, and variability among centers in the endovascular devices used and in operator skills. Careful appraisal of the trials and meta-analyses, particularly the most recent and largest National Institutes of Health-sponsored trial (the Carotid Revascularization Endarterectomy vs Stenting Trial [CREST]), showed that carotid stenting and endarterectomy were associated with similar rates of death and disabling stroke. Within the 30-day periprocedural period, carotid stenting was associated with higher risks of stroke, especially for patients aged >70 years, whereas carotid endarterectomy was associated with a higher risk of myocardial infarction. The slightly higher cost of stenting compared with endarterectomy was within an acceptable range by cost-effectiveness standards. We conclude that carotid artery stenting is an equivalent alternative to carotid endarterectomy when patient age and anatomy, surgical risk, and operator experience are considered in the choice of treatment approach. PMID:22949763

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

    Directory of Open Access Journals (Sweden)

    Marković Dragan M.

    2008-01-01

    often needed during the conventional carotid endarterectomy (34.7% compared to eversion endarterectomy (3.9%. χ2-test showed a statistically highly significant difference. CONCLUSION Eversion carotid endarectomy represents a statistically significantly shorter procedure. Distal intimal fixation demanded by this procedure is very rare, clammping of the internal carotid artery is significantly shorter, and it also has a lower rate of the early neurological complications. Based on the results of this study, as well as the opinions of other authors, it can be concluded that the eversion carotid endarterectomy has an advantage over the conventional procedure. We recommend conventional procedure only in cases when retrograde pressure indicates the use of the intraluminal shunting.

  18. Ultrasound-guided locoregional anaesthesia for carotid endarterectomy

    DEFF Research Database (Denmark)

    Martusevicius, Robertas; Swiatek, F; Joergensen, L G;

    2012-01-01

    Ultrasound guidance is increasingly used for invasive anaesthetic procedures to improve efficacy, facilitate performance and reduce risk of complications. Herein, we present a simple approach to ultrasound-guided locoregional anaesthesia for patients undergoing eversion carotid endarterectomy....

  19. Carotid Endarterectomy in the Face of a Persistent Hypoglossal Artery.

    Science.gov (United States)

    Koleilat, Issam; Hanover, Tod

    2015-11-01

    A 68-year-old woman presented with signs and symptoms suggestive of a cerebrovascular accident. Her work-up revealed left internal carotid artery stenosis consistent with her presentation of a left middle cerebral artery distribution stroke. Imaging also incidentally revealed a persistent hypoglossal artery. She underwent carotid endarterectomy. Our intraoperative strategy for management of this persistent fetal anomaly is reviewed. PMID:26303270

  20. 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

  1. Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

    Directory of Open Access Journals (Sweden)

    Radak Đorđe

    2012-01-01

    Full Text Available Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. Methods. The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA, stroke, local surgical complications and lethal outcome after one month, six months, one year and after two years. Results. In the early postoperative period (up to 30 days there were no lethal outcomes. TIA was diagnosed in four patients (8.8%, minor stroke in one patient (2.2% and one patient (2.2% also had cranial nerve injury. After two years two patients died (4.4% due to fatal myocardial infarction, three patients (6.5% had ipsilateral stroke and one patient developed graft occlusion (2%. Conclusion. In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

  2. Quality of life after carotid endarterectomy

    Directory of Open Access Journals (Sweden)

    Barros Henrique

    2008-11-01

    Full Text Available Abstract Background Most studies documenting beneficial outcomes after carotid endarterectomy (CE are limited to mortality and morbidity rates, costs, and length of hospital stay (LOS. Few have examined the dependency of patients and how they perceive their own health changes after surgery. The aim of the present study was to evaluate quality of life and independence in activities of daily living (ADL and to study its determinants. Methods Sixty-three patients admitted in the Post Anaesthesia Care Unit (PACU after CE were eligible for this 14-month follow-up study. Patients were contacted 6 months after discharge to complete a Short Form-36 questionnaire (SF-36 and to have their dependency in ADL evaluated. Results Among 59 hospital survivors at 6 months follow-up, 43 completed the questionnaires. Sixty-three percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients had worse SF-36 scores for all domains except bodily pain than a general urban population, and comparison with a group of patients 6 months after surgical ICU discharge showed no differences. Six months after PACU discharge, the Lawton Instrumental Activities of ADL Scale and the Katz Index of ADL demonstrated higher dependency scores (5.9 ± 2.2 versus 4.3 ± 2.4 and 0.3 ± 0.8 versus 0.6 ± 0.9, p Conclusion Patients undergoing CE have improved self-perception of quality of life despite being more dependent. Almost all their scores are worse than those in an urban population. We could identify no predictors of greater dependency in ADL tasks six months after PACU discharge.

  3. A meta-analysis of carotid endarterectomy versus stenting in the treatment of symptomatic carotid stenosis

    Institute of Scientific and Technical Information of China (English)

    WANG Liang; LIU Xiao-zhi; LIU Zhen-lin; LAN Feng-ming; SHI Wan-chao; LIU Jun; ZHANG Jian-ning

    2013-01-01

    Background Carotid stenosis is one of the common reasons for patients with ischemic stroke,and the two invasive options carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most popular treatments.But the relative efficacy and safety of the methods are not clear.Methods About 521 articles related to CAS and CEA for carotid stenosis published in 1995-2011 were retrieved from MEDLINE,Cochrane Library (CL),and China National Knowledge Infrastructure (CNKI) China Journal Full-Test database.Of them,eight articles were chosen.Meta-analysis was used to assess the relative risks.Results The eight studies included 3873 patients with symptomatic carotid artery stenosis,including 1941 cases in the carotid stent angioplasty group,and 1932 cases in the carotid endarterectomy group.Fixed effect model analysis showed that within 30 days of incidence of all types of strokes,surgery was significantly highly preferred in CAS patients (CAS group) than the CEA patients (CEA group),and the difference was statistically significant (relative ratio (RR)=1.80,95% confidence interval (CI):1.380-2.401,P <0.0001).But the incidence of death in the two groups is not showed and is not statistically significant after 30 days (RR=1.52,95% CI:0.82-2.82,P=0.18).The rate of cranial nerve injury in the CAS group is lower than the CEA group (RR=0.14,95% CI:0.05-0.43,P=0.0005).The incidence of CAS patients with myocardial infarction is lower than the CEA group after 30 days,but statistically meaningless (RR=0.22,95% CI:0.05-1.02,P=0.05).The stroke or death in CAS patients were higher than the CEA group after 1 year of treatment (RR=2.58,95% CI:1.03-6.48,P=0.04).Conclusions Compared to CAS,carotid endarterectomy is still the preferred treatment methodology of symptomatic carotid artery stenosis.Future meta-analyses should then be performed in long-term follow-up to support this treatment recommendation.

  4. Eight to ten years follow-up after carotid endarterectomy

    DEFF Research Database (Denmark)

    Knudsen Rathenborg, Lisbet; Sillesen, H; Schroeder, T;

    1990-01-01

    Follow-up information was obtained on 185 patients who consecutively underwent carotid endarterectomy eight to ten years previously. Doppler ultrasound examination was performed in 59 patients who were still alive and living within 100 miles of the hospital. Using lifetable analysis, the annual...

  5. Editor's choice - Safety of carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke

    DEFF Research Database (Denmark)

    Rathenborg, L K; Venermo, M; Troëng, T;

    2014-01-01

    OBJECTIVE: Few studies have been published on the safety of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT). Registry reports have been recommended in order to gather large study groups. DESIGN: A retrospective, registry based, case controlled study on prospectively gathered data...

  6. What to Expect After Carotid Endarterectomy

    Science.gov (United States)

    ... getting larger. As part of your long-term treatment, you can take steps to keep your carotid arteries healthy. One important step is to not smoke. Smoking increases the risk of carotid artery disease and stroke. If you smoke, ask your doctor about programs and products that can help you ...

  7. Benefits of using dexmedetomidine during carotid endarterectomy: A review

    Directory of Open Access Journals (Sweden)

    Abhijit S Nair

    2014-01-01

    Full Text Available As per current recommendation, patients with acute ischemic stroke should be offered carotid endarterectomy (CEA within 24-72 hours. The same applies to patients with recurrent transient ischemic attacks (TIA. This time is usually less for hemodynamic optimization of patients who′ve suffered acute ischemic stroke. Hence′ they are hemodynamically labile and can have accelerated hypertension on induction/extubation. This can have disastrous outcomes. It is a common practice among anesthesiologists to avoid angiotensin converting enzyme(ACE inhibitors or angiotensin receptor blockers on the day of surgery. This also adds to hypertensive issues perioperatively. Dexmedetomidine is a wonderful drug which can be used during CEA. Due to its centrally mediated sympatholytic effect, it confers good hemodynamic control during induction, intraoperatively, and during extubation. We did a search on PubMed and Google for carotid endarterectomies done under general and locoregional anesthesia during which dexmedetomidine was used. The keywords used by us during the search were as follows: anesthesia, carotid endarterectomy, anesthesia. We also searched for use of dexmedetomidine infusion to attenuate hypertensive response to intubation and for providing stability in major surgeries like CABG, craniotomies, bariatric surgeries, and valve replacements.

  8. The role of completion imaging following carotid artery endarterectomy.

    Science.gov (United States)

    Ricco, Jean-Baptiste; Schneider, Fabrice; Illuminati, Giulio; Samson, Russell H

    2013-05-01

    A variety of completion imaging methods can be used during carotid endarterectomy to recognize technical errors or intrinsic abnormalities such as mural thrombus or platelet aggregation, but none of these methods has achieved wide acceptance, and their ability to improve the outcome of the operation remains a matter of controversy. It is unclear if completion imaging is routinely necessary and which abnormalities require re-exploration. Proponents of routine completion imaging argue that identification of these abnormalities will allow their immediate correction and avoid a perioperative stroke. However, much of the evidence in favor of this argument is incidental, and many experienced vascular surgeons who perform carotid endarterectomy do not use any completion imaging technique and report equally good outcomes using a careful surgical protocol. Furthermore, certain postoperative strokes, including intracerebral hemorrhage and hyperperfusion syndrome, are unrelated to the surgical technique and cannot be prevented by completion imaging. This controversial subject is now open to discussion, and our debaters have been given the task to clarify the evidence to justify their preferred option for completion imaging during carotid endarterectomy. PMID:23601598

  9. Surgical techniques and curative effect of carotid endarterectomy for carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    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

  10. Recent concepts in the management of extracranial carotid stenosis: Carotid endarterectomy versus carotid artery stenting

    Directory of Open Access Journals (Sweden)

    Jeyaraj D Pandian

    2011-01-01

    Full Text Available Carotid stenosis is seen in 10% of patients with ischemic stroke, and carotid endarterectomy (CEA and carotid artery stenting (CAS are the two invasive treatments options available. Pooled analysis of the three largest randomized trials of CEA involving more than 3000 symptomatic patients estimated 30-day stroke and death rate at 7.1% after CEA. Some subgroups among the symptomatic patients appeared to have more benefit from CEA. These include patients aged 75 years or more, patients with ulcerated plaques, and patients with recent transient ischemic attacks within 2 weeks of randomization. Selection of asymptomatic patients for carotid revascularization should be guided by an assessment of comorbid conditions, life expectancy, and other individual factors, and should include a thorough discussion of the risks and benefits of the procedure with an understanding of patient preferences. The recent trials comparing CEA with CAS has not established its superiority over CEA. The carotid revascularization endarterectomy versus stenting (CREST study showed that CAS is still associated with a higher periprocedural risk of stroke or death than CEA. In patients over 70 years of age, CEA is clearly superior to CAS. The increased risk of nonfatal myocardial infarction in the CREST group subjected to CEA clearly suggests that patients being considered for CEA or CAS require a careful preliminary cardiac evaluation. CAS can be justified for patients whose medical comorbidities or cervical anatomy make them questionable candidates for CEA. The benefit of revascularization by either method versus modern aggressive medical therapy has not been established for patients with asymptomatic carotid stenosis.

  11. Carotid angioplasty and stent placement for restenosis after endarterectomy

    International Nuclear Information System (INIS)

    Recurrent carotid stenosis following endarterectomy is a common complication, and reoperation may be associated with increased morbidity. The goal of this study was to determine the procedural safety and long-term complication rates of carotid angioplasty and stenting for recurrent stenosis. Of 248 consecutive carotid angioplasty and/or stenting procedures performed at our institution between March 1996 and November 2005, 83 procedures for recurrent stenosis following endarterectomy were performed in 75 patients (mean age 68 years; 43 men, 32 women) without cerebral protection devices. The patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and long-term complication rates were calculated. Recurrent stenosis was reduced from a mean of 80.6% to no significant stenosis in 82 of 83 procedures. The procedural stroke rate was 3 out of 83 procedures (3.6%). The procedural transient ischemic attack (TIA) rate was 2 out of 83 procedures (2.4%). Mean follow-up was 22.4 months (range 0.1 to 86.7 months) with at least 6 months follow-up for 54 of 83 procedures (65%). There were five TIAs and no strokes on follow-up (new TIAs at 25.5 and 43.4 months; recurrent TIAs at 1, 11.1, and 12 months, all with normal angiograms). The composite 30-day stroke, myocardial infarction, or death rate was 5 of 83 procedures (6.0%). In this series, angioplasty and stenting were effective in relieving stenosis secondary to recurrent carotid disease after endarterectomy, and have low rates of ischemic complications. (orig.)

  12. Management of Vascular Risk Factors in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

    OpenAIRE

    Meschia, James F; Voeks, Jenifer H.; Leimgruber, Pierre P.; Mantese, Vito A.; Timaran, Carlos H; Chiu, David; Bart M. Demaerschalk; Howard, Virginia J; Hughes, Susan E.; Longbottom, Mary; Howard, Annie Green; Brott, Thomas G

    2014-01-01

    Background The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) is a multicenter randomized trial of stenting versus endarterectomy in patients with symptomatic and asymptomatic carotid disease. This study assesses management of vascular risk factors. Methods and Results Management was provided by the patient's physician, with biannual monitoring results collected by the local site. Therapeutic targets were low‐density lipoprotein, cholesterol

  13. Correlation of restenosis after rabbit carotid endarterectomy and inflammatory cytokines

    Institute of Scientific and Technical Information of China (English)

    Jun-Jun Liang; Wei Xue; Li-Zhi Lou; Cheng Liu; Zhao-Fen Wang; Qing-Guo Li; Shao-Hua Huang

    2014-01-01

    Objective:To establish rabbit model of restenosis after carotid endarterectomy surgery, and to study tissue inflammatory cytokines(TNF-α,IL-6) involved in restenosis.Methods:A total of32 rabbits were randomly divided into two groups: model group and control group.The right common carotid artery in rabbits was damaged by carotid endar terectomy in model group.The tissues were harvested at different time points respectively, the pathological changes of the vascular wall after operation were observed at different time points.The changes of expression of tissue vascular wall inflammatory cytokines(TNF-α,IL-6) at different time points after the surgery was observed byRT-PCR, and the changes of serum inflammatory cytokines(TNF-α, IL -6) were detected byELISA.Results:The new intima appeared after7 daysof the injury and reached the peak on28 d which is uneven and significantly thicker than the control group (P<0.01).The tissue inflammatory cytokines(TNF-α,IL-6) were significantly increased after the rabbit common carotid artery injury, which was significant difference compared with normal control group(P<0.05).Conclusions:The tissue inflammatory factors significantly increase after the rabbit carotid artery injury, which suggests the mutual concurrent effects of inflammatory cytokines can result in the proliferation of vascular restenosis.

  14. Transcranial Doppler for detection of cerebral ischaemia during carotid endarterectomy

    DEFF Research Database (Denmark)

    Jørgensen, L G; Schroeder, T V

    1992-01-01

    We evaluated transcranial Doppler sonography (TCD) for the detection of cerebral ischaemia during carotid endarterectomy in 30 male and 14 female patients with ipsilateral focal cerebro-vascular symptoms. Surgery was performed during halothane-nitrous oxide anaesthesia with moderate hypocapnia....... Eight patients had a temporary shunt owing to contralateral occlusion or a stump pressure below 40 mmHg, and/or EEG flattening. Transcranial Doppler sonography was followed intra-operatively together with electro-encephalography (EEG), internal carotid artery (ICA) pressures and cerebral blood flow (CBF...... Vmean clamp: Vmean pre-clamp ratio of less than 0.6 showed an accuracy with respect to CBF below 20 ml 100 g-1 min-1 of 89%. AVmeanclamp:Vmean pre-clamp ratio below 0.4 detected all all patients with EEG flattening (n = 3) (accuracy 97%). The corresponding level of accuracy obtained with stump pressure...

  15. 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

    . 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...... 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...

  16. Early carotid endarterectomy after a nondisabling stroke: a prospective study.

    Science.gov (United States)

    Ricco, J B; Illuminati, G; Bouin-Pineau, M H; Demarque, C; Camiade, C; Blecha, L; Neau, J P

    2000-01-01

    On the recommendation of several studies, carotid endarterectomy (CEA) should be delayed for at least 6 weeks in patients suffering an acute nondisabling stroke. Our objective was to determine if these patients could be safely operated on earlier, thus decreasing the risk of a recurrent stroke prior to surgery. This prospective study, carried out from January 1990 to December 1997, included 72 consecutive patients having a nondisabling hemispheric stroke with severe ipsilateral carotid stenosis (NASCET 70-99%). All patients underwent CEA within 15 days of stroke onset. Patients were considered to have a nondisabling hemispheric stroke if (1) symptoms of hemispheric ischemia persisted longer than 24 hr and (2) the resulting deficit caused no major impairment in their everyday activities. All patients were examined by a neurologist prior to carotid angiography and contrast CT scan. Hemorrhage seen on the initial CT scan eliminated the patient from the study. If the CT scan with contrast injection was negative, patients underwent magnetic resonance imaging. CEA was performed under general anesthesia with intraluminal shunting. All patients had a postoperative duplex scan and yearly follow-up by a neurologist and a surgeon, with a duplex scan of the carotid arteries. Mean follow-up was 53 months. Our study shows that CEA can be performed relatively safely within 15 days following an acute nondisabling stroke. The arbitrary 6-week delay for CEA may unnecessarily expose patients with high-grade stenosis to a recurrent stroke, which could be prevented by earlier surgery. PMID:10629271

  17. Surgical technique of carotid endarterectomy for patients with high cervical internal carotid artery stenosis

    International Nuclear Information System (INIS)

    We retrospectively examined both the incidence of newly detected hyperintense areas using diffusion-weighted MR images (DWI-HIA) and postoperative complications after carotid endarterectomy (CEA) for patients with high cervical internal carotid artery (ICA) stenosis. Among 39 patients who underwent CEA between January 2001 and October 2006, 10 showed high cervical ICA stenosis on the preoperative carotid angiogram. CEA was successfully performed on 9 patients with oral intubation and 1 patient with nasal intubation under general anesthesia. Transient hypoglossal nerve palsy was seen in 1 patient and wound hematoma in 1 patient. Mortality and morbidity were zero at 1 month after CEA. In 3 of 10 patients (30%), asymptomatic small DWI-HIAs were detected postoperatively. Gentle manipulation of the internal carotid artery is essential for high cervical carotid artery stenosis to prevent embolic complication after CEA. (author)

  18. Cerebral hemodynamic changes and electroencephalography during carotid endarterectomy

    International Nuclear Information System (INIS)

    Some patients undergoing endarterectomy for occlusive carotid artery disease run a risk of brain ischemia during cross-clamping of the artery. The present study of 15 patients was undertaken to evaluate changes in cerebral blood flow (CBF), as measured with an intravenous (IV) tracer (133Xenon) technique, and to relate CBF changes to changes in the electroencephalogram (EEG). CBF was measured before and after induction of anesthesia, during cross-clamping of the carotid artery, after release of the clamps, and at 24 hours after the operation. All the patients were anesthetized with methohexitone, fentanyl, and nitrous oxide and oxygen. EEG was continuously recorded during the operation. Carotid artery shunts were not used. In 8 patients, cross-clamping of the carotid artery did not influence the EEG. In this group of patients, induction of anesthesia caused a 38% decrease in CBF, which presumably reflects the normal reaction to the anesthetic agent given. There were no further changes in CBF during cross-clamping. In 7 patients, the EEG showed signs of deterioration during the intraoperative vascular occlusion. In these patients, anesthesia did not cause any CBF change, whereas cross-clamping the artery induced a 33% decrease in CBF. In individual patients, the severity of EEG changes correlated with the decrease in CBF. The absence of a change in CBF by anesthesia and a decrease due to cross-clamping of the carotid artery may be explained by the presence of a more advanced cerebrovascular disease and an insufficiency to maintain CBF during cross-clamping

  19. Cerebral hemodynamic changes and electroencephalography during carotid endarterectomy

    Energy Technology Data Exchange (ETDEWEB)

    Algotsson, L.; Messeter, K.; Rehncrona, S.; Skeidsvoll, H.; Ryding, E. (University Hospital, Lund (Sweden))

    1990-05-01

    Some patients undergoing endarterectomy for occlusive carotid artery disease run a risk of brain ischemia during cross-clamping of the artery. The present study of 15 patients was undertaken to evaluate changes in cerebral blood flow (CBF), as measured with an intravenous (IV) tracer (133Xenon) technique, and to relate CBF changes to changes in the electroencephalogram (EEG). CBF was measured before and after induction of anesthesia, during cross-clamping of the carotid artery, after release of the clamps, and at 24 hours after the operation. All the patients were anesthetized with methohexitone, fentanyl, and nitrous oxide and oxygen. EEG was continuously recorded during the operation. Carotid artery shunts were not used. In 8 patients, cross-clamping of the carotid artery did not influence the EEG. In this group of patients, induction of anesthesia caused a 38% decrease in CBF, which presumably reflects the normal reaction to the anesthetic agent given. There were no further changes in CBF during cross-clamping. In 7 patients, the EEG showed signs of deterioration during the intraoperative vascular occlusion. In these patients, anesthesia did not cause any CBF change, whereas cross-clamping the artery induced a 33% decrease in CBF. In individual patients, the severity of EEG changes correlated with the decrease in CBF. The absence of a change in CBF by anesthesia and a decrease due to cross-clamping of the carotid artery may be explained by the presence of a more advanced cerebrovascular disease and an insufficiency to maintain CBF during cross-clamping.

  20. Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy.

    Science.gov (United States)

    Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2016-03-01

    A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. PMID:25653229

  1. Endarterectomy and saphenous vein ‘Y’ patchplasty technique for severe carotid artery bifurcation lesion

    Directory of Open Access Journals (Sweden)

    Cüneyt Eriş

    2013-09-01

    Full Text Available Arteriosclerosis, is mostly affect coronary and carotid arteriesespecially the ostium and bifurcation due to the natureof the flow. Arterial bifurcation lesions cause dilemmafor the treating physician during both surgical and invasiveprocedures because they require a higher clinical experienceand longer processing time. In carotid artery surgery,it is accepted that patchplasty prevents perioperativeand postoperative restenosis, and as a result of this, itreduces the incidence of ipsilateral stroke. In the presenttime synthetic patch materials (PTFE, Dacron and autologouspatch materials (saphenous and jugular veins areused. We report a case of carotid endarterectomy and ‘Y’shaped saphenous patchplasty to the carotid bifurcation.According to our research in the literature, we didn’t findany case with ‘Y’ shaped saphenous vein patch. Therewas only one Y shaped carotid patchplasty case by usingPTFE material. Our original technic is advantageous interms of easy preparation and application as well as itssuccessful outcome.Key words: Carotid artery diseases, saphenous vein,patchplasty

  2. Systemic Glucocorticoids Are Associated With Mortality After Carotid Endarterectomy.

    Science.gov (United States)

    Siemelink, Marten; den Ruijter, Hester; van der Valk, Fleur; de Vries, Jean-Paul; de Borst, Gert Jan; Moll, Frans; Stroes, Erik; Pasterkamp, Gerard

    2015-10-01

    Glucocorticoids (GCs) are widely used anti-inflammatory drugs well known to cause many adverse effects. Still, there is a dearth of data on the long-term cardiovascular effects of GCs in patients with established cardiovascular disease and the effect on atherosclerotic plaque composition. A total of 1894 patients who underwent carotid endarterectomy (CEA), of whom 40 patients received systemic GCs, were included in the Athero-Express Biobank. Atherosclerotic plaque samples and peripheral blood samples were obtained during CEA. Cardiovascular events during 3 years of follow-up were investigated using Cox regression modeling to adjust for possible confounding. Atherosclerotic plaque composition was examined using immunohistochemical staining. Use of GCs at inclusion was associated with markedly increased incidences of ischemic stroke (15.2% vs. 5.9%), composite events (48.5% vs. 26.9%), and cardiovascular death (21.2% vs. 5.7%), as well as an increased risk of cardiovascular death (hazards ratio 2.7, 95% confidence interval, 1.1-6.7) and all-cause death (hazards ratio 2.3, 95% confidence interval, 1.1-4.8) after 2.6 years of follow-up. None of the histological features of atherosclerotic plaques were significantly different in patients using GCs. After CEA, the use of systemic GCs is independently associated with an increased incidence of cardiovascular events and an increased risk of cardiovascular and all-cause death, but not atherosclerotic plaque composition. PMID:26191970

  3. Is carotid duplex scanning sufficient as the sole investigation prior to carotid endarterectomy?

    Science.gov (United States)

    Collins, P; McKay, I; Rajagoplan, S; Bachoo, P; Robb, O; Brittenden, J

    2005-11-01

    Carotid endarterectomy (CEA) is the accepted treatment for certain patients who have had, or who are at risk of having, a stroke if they have a significant narrowing of the internal carotid artery. Rapid and accurate classification of the degree of stenosis is important as the benefit of surgery is highly dependent on this. The aim of this study was to assess whether the addition of angiography to duplex scanning resulted in a change in patient management in a unit where duplex scanning was used as the sole imaging investigation prior to CEA. The study population consisted of 64 patients with significant internal carotid artery stenosis on duplex scanning who were suitable for, and wished to be considered for, CEA. All patients underwent an angiogram. In this study 9 (14%) patients did not proceed to surgery on the basis of angiography and in a further 11 (17%) patients insufficient views of the distal vessel were obtained on duplex scanning. Three of these patients had extensive disease which excluded surgery. One patient experienced a transient ischaemic attack (TIA) at the time of angiography. In conclusion, this audit has highlighted the limitations in performing duplex scanning alone, and the costs that this can incur on the patient who may undergo an unnecessary operation. We cannot recommend duplex scanning as the sole investigation prior to CEA. There is need to evaluate the role of additional non-invasive carotid imaging such as magnetic resonance angiography or CT angiography in the assessment of these patients. PMID:16249605

  4. The application of MR and CT angiography in the evaluation of carotid artery stenosis and follow-up of carotid endarterectomy

    International Nuclear Information System (INIS)

    Objective: To estimate the accuracy of MR angiography (MRA) and CT angiography (CTA) in the evaluation of the carotid artery stenosis. Methods: Eleven patients were studied with MRA and CTA. The results were compared with DSA, CT virtual endoscopy (CTVE), and Doppler ultrasound (DUS). MRA was performed with 2D and 3D TOF sequences. CTA was post processed using MIP and SSD. CTVE was performed using navigator function. Three patients with severe stenosis received carotid endarterectomy. Results: There was a total of 22 carotid arteries studied, with 8 mild, 3 moderate, 5 severe stenosis, 1 occlusion, and 5 normal. Agreement on stenosis between CTA and DSA was found in 11 of 12 carotid arteries. Agreement on stenosis between MRA and DSA was found in 9. Plaques were delineated in CTA, CTVE, and confirmed by pathology in 3 cases. Postoperative MRA and CTA proved the release of stenosis. Conclusion: MRA and DUS can be used as a screening technique to evaluate carotid artery stenosis and as a convenient follow-up modality for post-endarterectomy. CTA has a high degree of accuracy for the assessment of carotid artery stenosis compared with DSA, and it could provide information on calcified plaque

  5. Age-dependent effects of carotid endarterectomy or stenting on cognitive performance

    OpenAIRE

    Wasser, Katrin; Hildebrandt, Helmut; Gröschel, Sonja; Stojanovic, Tomislav; Schmidt, Holger; Gröschel, Klaus; Pilgram-Pastor, Sara M.; Knauth, Michael; Kastrup, Andreas

    2012-01-01

    Although evidence is accumulating that age modifies the risk of carotid angioplasty and stenting (CAS) versus endarterectomy (CEA) for patients with significant carotid stenosis, the impact of age on cognition after either CEA or CAS remains unclear. In this study, we analyzed the effects of age on cognitive performance after either CEA or CAS using a comprehensive neuropsychological test battery with parallel test forms and a control group to exclude a learning effect. The neuropsychological...

  6. Effect of carotid endarterectomy on patient evaluations of cognitive functioning and mental and physical health

    NARCIS (Netherlands)

    Bossema, ER; Brand, AN; Geenen, R; Moll, FL; Ackerstaff, RGA; van Doornen, LJP

    2005-01-01

    The prophylactic effect of carotid endarterectomy (CEA) against stroke has been well established. As a consequence of the restoration of cerebral blood supply and reduced risk of stroke, cognitive functioning and perceived health may improve. Fifty-one patients with severe atherosclerotic disease of

  7. Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

    OpenAIRE

    Radak Đorđe; Tanasković Slobodan; Vukotić Miloje; Babić Srđan; Aleksić Nikola; Kolar Jovo; Popov Petar; Nenezić Dragoslav; Vučurević Goran; Gajin Predrag; Ilijevski Nenad

    2012-01-01

    Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal c...

  8. Early complement activation follows eversion carotid endarterectomy and correlates with the time of clamping of the carotid artery

    DEFF Research Database (Denmark)

    Széplaki, Gábor; Hirschberg, Kristóf; Gombos, Tímea;

    2008-01-01

    intense increase in C3a levels were observed immediately after surgery (p<0.001), accompanied by a slight elevation in SC5b-9 levels (p<0.05). C3a levels remained elevated until 4h post-surgery, compared with the baseline values and with CAS patients. Peak C3a levels correlated with the time of carotid......BACKGROUND: Complement activation plays an important role in ischemia/reperfusion (I/R) injury. The objective of the present study was to detect the presence and mechanism of complement activation in patients who underwent carotid endarterectomy (CEA). METHODS: Complement activation products C1rsC1...

  9. [Comparative assessment of inhalation anesthesia with sevofluran and intravenous anesthesia with propofol for carotid endarterectomy].

    Science.gov (United States)

    Neĭmark, M I; Shmelev, V V; Simagin, V Iu

    2009-01-01

    Total intravenous anesthesia with propofol and inhalation sevofluran was assessed in 130 patients with carotid endarterectomy. The parameters of brain blood circulation, brain damage markers were studied. It was shown that sevofluran anesthesia caused less depression of the hemodynamic parameters, supported more optimum level of brain blood flow that limited ischemic and reperfusion damage of the brain and was accompanied by a fewer number of postoperative complications. PMID:20209996

  10. Endarterectomia de carótida em paciente acordado Carotid endarterectomy in conscious patient

    Directory of Open Access Journals (Sweden)

    Paulo César Santos

    2006-03-01

    hospital, and patients' evolution over one year. METHODS: From June 1998 to January 2004, 67 operations were performed in 61 patients, with 70% or greater internal carotid stenosis, diagnosed by Doppler and confirmed by carotid angiography. Neurologic monitoring consisted of continuous assessment of alertness and motor activity of patients during the operation. The mean age was 69.7 years old. Regarding concomitant pathologies, 45 (47% had hipertension; 21 (22%, coronary artery disease; 17 (18%, diabetes; 12 (13%, pneumopathy. RESULTS: There were three (4.48% cases of bilateral carotid disease, for which surgery was performed at different times. The mean duration of surgery was 120 minutes. The use of a shunt was necessary in six (8.95% cases and to convert to general anesthesia in two (2.98%. Two (2.98% patients evolved with mental confusion after surgery and one (1.49% presented infection of surgical site. Restenosis occurred in three (4.48% cases. The mean times of stay in the ICU and hospital were 1.34 and 4.20 days, respectively. There were no deaths, strokes or acute myocardial infarctions. CONCLUSION: Carotid endarterectomy with conscious patient is a good alternative for selected patients at high surgical risk for general anesthesia.

  11. Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

    Directory of Open Access Journals (Sweden)

    Marcia Maria Morales

    2010-01-01

    Full Text Available OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty-nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end-diastolic velocity, cm/s were measured 24 hours after the procedures and also at 12 months post-procedure. Residual stenoses (immediately postprocedure and restenoses (within 12 months of procedure were defined as narrowings of >50% on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24-hour and 12-month post-procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34% and the patch closure group (1 case, 1.53%, P = 0.08. At 12 months, 2 stenting patients (6.88% and 2 patch closure patients (3.07% had $50% restenosis (P = 0.58. One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or patched carotids.

  12. Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

    Science.gov (United States)

    Morales, Marcia Maria; Anacleto, Alexandre; Buchdid, Marcello Azem; Simeoni, Paulo Ricardo Baggio; Ledesma, Sérgio; Cêntola, Crescêncio; Anacleto, João Carlos; Aldrovani, Marcela; Piccinato, Carlos Eli

    2010-01-01

    OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty‐nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end‐diastolic velocity, cm/s) were measured 24 hours after the procedures and also at 12 months post‐procedure. Residual stenoses (immediately post‐procedure) and restenoses (within 12 months of procedure) were defined as narrowings of ≥50% on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24‐hour and 12‐month post‐procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis) were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34%) and the patch closure group (1 case, 1.53%, P  =  0.08). At 12 months, 2 stenting patients (6.88%) and 2 patch closure patients (3.07%) had ≥50% restenosis (P  =  0.58). One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or

  13. Physiological response to lipid peroxidation in ischemia and reperfusion during carotid endarterectomy

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    Cordeddu Lina

    2010-04-01

    Full Text Available Abstract Background In this study we aimed to assess lipid peroxidation during carotid endarterectomy by the formation of PUFA hydroperoxides (PUFAHP and isoprostanes (IP and concomitant peroxisomal beta-oxidation as a physiological mechanism to limit their concentration. Two markers of peroxisomal beta oxidation have been evaluated, formation of 2,3 dinor from IP and conjugated esadecadienoic acid (CD 16:2 from peroxisomal beta-oxidation of conjugated linoleic acid (CLA, an unusual fatty acid present in small concentration in our diet and preferentially beta-oxidised in peroxisomes. The study was conducted on 30 patients undergoing carotid endarterectomy. Blood samplings were performed before, during endarterectomy in the "ischemic phase", and 30 seconds, 30 minutes and 2 hours after reperfusion. Results The results showed that PUFAHP increased significantly after 30 min of reperfusion in patients with controlateral stenosis > 50%, and steeply decreased after 2 hour of reperfusion. Interestingly, IP increased in a similar fashion of PUFAHP but never significantly. Both ratios CD16:2/CLA and DIN/IP also increased significantly after 30 min of reperfusion to decrease thereafter. Conclusions Our data show that lipid peroxidation takes place only in patients with high controlateral stenosis and within 2 hours occurs a physiological response aimed to decrease IP and PUFAHP by increasing their catabolism in peroxisomes.

  14. Recognition and Surgical Techniques for Management of Nonrecurrent Laryngeal Nerve during Carotid Endarterectomy.

    Science.gov (United States)

    Jimenez, Juan Carlos; Jabori, Sinan; Gelabert, Hugh A; Moore, Wesley S; Quinones-Baldrich, William J; O'Connell, Jessica

    2016-05-01

    The presence of a nonrecurrent laryngeal nerve (NRLN) during carotid endarterectomy (CEA) may significantly limit the exposure of the surgical field during this operation. Although its reported incidence is rare, NRLN typically overlies the carotid bifurcation and failure to recognize this anatomic variation increases the risk of NRLN injury. A retrospective chart review of all patients who underwent CEA for hemodynamically significant extracranial carotid stenosis between January 2005 and December 2014 was performed. All patients with NRLN encountered intraoperatively were identified. Clinical outcomes, surgical techniques, and complications were reviewed and reported. Four left-sided NRLN were identified and 4 were right sided. No cranial nerve deficits or injuries occurred after CEA in patients where NRLN was encountered. Two distinct surgical techniques were used to manage patients with NRLN and they are discussed in detail. PMID:26965812

  15. Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.

    LENUS (Irish Health Repository)

    Killeen, Shane D

    2012-02-03

    BACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.

  16. Cognitive Performance following Carotid Endarterectomy or Stenting in Asymptomatic Patients with Severe ICA Stenosis

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    Livio Picchetto

    2013-01-01

    Full Text Available Background. Endarterectomy (CEA or stenting (CAS of a stenotic carotid artery is currently undertaken to reduce stroke risk. In addition removal of the arterial narrowing has been hypothesized to improve cerebral hemodynamics and provide benefits in cognitive functions, by supposedly resolving a “hypoperfusion” condition. Methods. In this study we sought to test whether resolution of a carotid stenosis is followed by measurable changes in cognitive functions in 22 subjects with “asymptomatic” stenosis. Results. A main finding of the study was the statistically significant pre-post difference observed in the performance of phonological verbal fluency and Rey’s 15-word immediate recall. Remarkably, there was a significant interaction between phonological verbal fluency performance and side of the carotid intervention, as the improvement in the verbal performance, a typical “lateralized” skill, was associated with resolution of the left carotid stenosis. Conclusion. The results reflect a substantial equivalence of the overall performance at the before- and after- CEA or CAS tests. In two domains, however, the postintervention performance resulted improved. The findings support the hypothesis that recanalization of a stenotic carotid could improve brain functions by resolving hypothetical “hypoperfusion” states, associated with the narrowing of the vessels.

  17. Preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with coexistent carotid and coronary artery diseases

    Institute of Scientific and Technical Information of China (English)

    CHEN Xu-jun; CHEN Xin; XIE Dong-hua; SHI Kai-hu; XU Ming

    2009-01-01

    Background Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery.The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) in patients with coexistent carotid and coronary artery diseases.Methods Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out. Results A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was (25.5±7.0) minutes. The mean number of distal grafts per patient was 3.30±0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was (11.3±5.4) hours, (2.1 ±0.9) days, and (12.5±6.1) days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients (92.16%) with a mean follow-up of (39.5±12.5) months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred.Conclusion Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.

  18. Carotid endarterectomy: Results and long-term follow-up of a single institution

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    Basant K Misra

    2011-01-01

    Full Text Available Objectives : To document our experiences, technical procedure and outcomes of carotid endarterectomy (CEA in patients with symptomatic carotid stenosis. Material and Methods : A total of 49 consecutive patients underwent 53 CEAs (three bilateral, one redo for severe carotid artery stenosis. There were 39 males and 10 females, with mean age of 63 years. All patients underwent neck Doppler, computed tomography/magnetic resonance angiography/digital substraction angiography and a detailed cardiological evaluation. Antiplatelet drugs were continued perioperatively. Surgery was performed under general anesthesia with propofol cerebral protection, mild hypothermia and continuous electroencephalogram monitoring. The procedure was done under microscope and closure was done using 6-0 prolene. Clinical and radiological follow-up was done. Results : Our mean follow-up was 4.69 years. All patients underwent primary suturing except one redo CEA done with venous patch graft. Three patients required intraoperative shunting. One patient died secondary to myocardial infarction peroperatively prior to carotid manipulation. One patient had stroke within 6 h, secondary to operative site intraluminal thrombus and was re-explored. Two patients had transient postoperative hemiparesis and aphasia while two patients had altered sensorium, all self-limiting, with normal imaging. One patient developed temporary twelfth-nerve paresis. One patient had persistent transient ischemic attack on the follow-up. Thus, the perioperative mortality rate was 1.89% and stroke rate was 1.89%. Conclusions : CEA for severe carotid stenosis is a safe procedure with good protection from ischemic events. Detailed preoperative cardiac evaluation and appropriate patient selection is essential.

  19. High-resolution multicontrast-weighted MR imaging from human carotid endarterectomy specimens to assess carotid plaque components

    International Nuclear Information System (INIS)

    The American Heart Association modified classification for atherosclerotic plaque lesions has defined vulnerable plaques as those prone to rupture. The aim of our study was to assess the sensitivity and specificity of 1.5-T magnetic resonance imaging (MRI) in the evaluation of the characteristics of plaque components. Twelve carotid endarterectomy specimens were imaged by ex-vivo high-resolution 1.5-T MRI. Thirty-four cross-section axial images were selected for pixel-by-pixel basis analysis to demonstrate the most significant tissue features. Data were then submitted for histopathological examination and each specimen analysed in the light of the histological components (lipid core, fibrous tissue, fibrous/loose connective tissue, calcifications). The overall sensitivity and specificity rates for each tissue type were, respectively, 92% and 74% for the lipid core, 82% and 94% for the fibrous tissue, 72% and 87% for the fibrous/loose connective tissue, and 98% and 99% for calcification. The use of 1.5-T MRI appears to be a reliable tool to characterise plaque components and could help in the screening of patients with high risk of plaque rupture. The possibility of applying MRI in clinical daily practice may change the non-invasive approach to carotid artery diagnostic imaging, thus allowing an early identification of patients with vulnerable plaques. (orig.)

  20. High-resolution multicontrast-weighted MR imaging from human carotid endarterectomy specimens to assess carotid plaque components

    Energy Technology Data Exchange (ETDEWEB)

    Fabiano, Sebastiano; Mancino, Stefano; Stefanini, Matteo; Chiocchi, Marcello; Simonetti, Giovanni [University ' ' Tor Vergata' ' , Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology, Nuclear Medicine and Radiotherapy, Rome (Italy); Mauriello, Alessandro; Spagnoli, Luigi Giusto [University ' ' Tor Vergata' ' , Department of Biopathology and Image Diagnostics, Institute of Anatomic Pathology, Rome (Italy)

    2008-12-15

    The American Heart Association modified classification for atherosclerotic plaque lesions has defined vulnerable plaques as those prone to rupture. The aim of our study was to assess the sensitivity and specificity of 1.5-T magnetic resonance imaging (MRI) in the evaluation of the characteristics of plaque components. Twelve carotid endarterectomy specimens were imaged by ex-vivo high-resolution 1.5-T MRI. Thirty-four cross-section axial images were selected for pixel-by-pixel basis analysis to demonstrate the most significant tissue features. Data were then submitted for histopathological examination and each specimen analysed in the light of the histological components (lipid core, fibrous tissue, fibrous/loose connective tissue, calcifications). The overall sensitivity and specificity rates for each tissue type were, respectively, 92% and 74% for the lipid core, 82% and 94% for the fibrous tissue, 72% and 87% for the fibrous/loose connective tissue, and 98% and 99% for calcification. The use of 1.5-T MRI appears to be a reliable tool to characterise plaque components and could help in the screening of patients with high risk of plaque rupture. The possibility of applying MRI in clinical daily practice may change the non-invasive approach to carotid artery diagnostic imaging, thus allowing an early identification of patients with vulnerable plaques. (orig.)

  1. Endarterectomia carotídea sob bloqueio loco-regional Carotid endarterectomy under locoregional anesthesia

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    Ana Terezinha Guillaumon

    2005-09-01

    trazem um diferencial no tratamento da doença carotídea.OBJECTIVE: The purpose of this study is to evaluate the results of carotid endarterectomy performed under locoregional anesthesia with invraoperative cerebral protection and selective shunting. METHOD: We reviewed 107 patients who underwent carotid endarterectomy under locoregional anesthesia, at Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP, between March 1996 and May 2004. This study is composed of 119 endarterectomies (108 patients, being 69 male (63.8% and 39 female (36.2%. Mean age was 63 years, ranging from 43 to 83 years. Surgery was performed to treat symptomatic stenosis in 60 patients (55.5% and asymptomatic stenosis in 48 patients (44.5%. All patients were assessed by color-flow duplex scanning and arteriography. RESULTS: Five patients were excluded from the study, since they required conversion to general anesthesia due to intolerance to carotid clamping. Of the 103 patients submitted to 114 endarterectomies, a shunt was inserted in four patients (3.5%, due to the patient's intolerance to carotid clamping during the surgery. A patch was applied in 19 patients (16.6%. Mortality rate in the immediate postoperative period was 2.6% (three patients, all due to vascular cerebral accident. One patient (0.87% presented a lower ischemic cerebral vascular accident, and one patient (0.87% presented hyperfusion syndrome, which progressed to a hemorrhagic cerebral vascular accident. This patient was submitted to aspiration of the cerebral hematoma, with full recovery of the neurological deficit. In the late postoperative period, there was restenosis or occlusion in four patients (5.3%. CONCLUSION: Carotid endarterectomy can be safely performed in the awake patient, by selective shunting and cerebral protection. Good outcome and low morbidity and mortality rate bring a differential in the treatment of the carotid disease.

  2. Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-10-01

    Endovascular treatment (angioplasty with or without stenting) is an alternative to carotid endarterectomy for carotid artery stenosis but there are scarce long-term efficacy data showing that it prevents stroke. We therefore report the long-term results of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS).

  3. Inhibition of re-stenosis in form of neointimal hyperplasia by external beam irradiation after carotid endarterectomy in rabbits

    International Nuclear Information System (INIS)

    Objective: To investigate the effect of external beam irradiation re-stenosis in form of neointimal hyperplasia following carotid endarterectomy in rabbits. Methods: 144 Japanese white rabbits were divided into 24 groups, with 6 rabbits in each. All animals underwent carotid endarterectomy and were fed on hypercholesterol diet. The vessels which underwent surgery were irradiated with 6 MV photon, to a dose of 0, 6, 12, 18, 24 and 30 Gy. The animals were sacrificed on D15, 30 , 60 and 90 after irradiation. The irradiated vessels were examined with histopathology and immunohistochemical methods. Results: The differences in the values of neointimal area/media area, proliferating cell nuclear antigen (PCNA) stain, α-Actin stain and platelet-derived growth factor (PDGF) stain were all significant (P<0.01) between each dose group and each time group. Conclusions: External beam irradiation is effective in reducing the re-stenosis in form of neointimal proliferation after carotid endarterectomy in the rabbit. The mechanism is possibly through two ways: 1) Inhibition of proliferation, migration and phenotypic conversion of the activated vessel smooth muscle cell (VSMC). 2) Inhibition of the secreting activity factors by the monocytes and macrophages

  4. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

    LENUS (Irish Health Repository)

    Bonati, Leo H

    2009-10-01

    In the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), early recurrent carotid stenosis was more common in patients assigned to endovascular treatment than it was in patients assigned to endarterectomy (CEA), raising concerns about the long-term effectiveness of endovascular treatment. We aimed to investigate the long-term risks of restenosis in patients included in CAVATAS.

  5. A literature review on anesthetic practice for carotid endarterectomy surgery based on cost, hemodynamic stability, and neurologic status.

    Science.gov (United States)

    Meitzner, Mark C; Skurnowicz, Julie A; Mitchell, Anne

    2007-06-01

    An extensive literature review was undertaken to evaluate the best anesthetic practice for carotid endarterectomy surgery. Two anesthetic techniques were evaluated: general anesthetic with an endotracheal tube and regional anesthetic block. Three variables were reviewed with respect to significant clinical outcomes based on anesthetic technique. Relevant literature was obtained through multiple sources that included professional journals, a professional website, and textbooks. According to the literature, there is an advantage to performing regional anesthesia with respect to cost and neurologic status. Information analyzed was inconclusive with respect to hemodynamic stability and anesthetic technique. We conclude that regional anesthesia may have some slight advantages; however, more investigation is warranted. PMID:17591300

  6. Early and late outcomes in Hong Kong Chinese patients undergoing carotid endarterectomy

    Institute of Scientific and Technical Information of China (English)

    丁志伟; 郑永强; 钟培言; 何蓓; 邬丽霞; 张颂恩

    2002-01-01

    Objective To determine the benefit of carotid endarterectomy (CEA) for stroke prevention by reviewing the early and late outcomes of Hong Kong Chinese patients undergoing CEA who have a high reported incidence of intracranial atherosclerotic disease (IAD).Methods Fifty-nine Chinese patients underwent 62 CEA. There were 48 males and 11 females, with a mean age of 70±7 years (range: 52-86 years). Twenty-one CEA (34%) were performed for asymptomatic disease. Duplex scan was the primary tool of evaluation prior to surgery. Preoperative angiography was done in 36 instances (58%). All CEA were performed under general anaesthesia with routine intraoperative shunting. The arteriotomy was closed primarily in all patients except three. Patients were followed up regularly with six-monthly Duplex scan surveillance.Results There were 2 perioperative neurological events consisting of one transient ischemic attack and one minor stroke. There was no operative mortality or major morbidity such as bleeding or cranial nerve injury. Mean hospital stay was 6.5±4 days (range: 3-26 days). The patients were followed up for a mean interval of 24±17 months (range: 1-57 months). Seven patients died during follow-up and subsequent neurological events occurred in 5 patients, including 2 fatal strokes. The 3-year survival, freedom from stroke and stroke free survival were 86%, 87% and 83%, respectively. One recurrent stenosis of 80% was detected on follow-up Duplex scan.Conclusions Despite a high incidence of IAD, CEA in Hong Kong Chinese patients is associated with acceptable perioperative morbidity and mortality with satisfactory long-term efficacy in stroke prevention.

  7. The role of regional nerve block anesthesia for carotid endarterectomy: an experimental comparison with previous series with the use of general anesthesia and barbiturates for cerebral protection.

    Science.gov (United States)

    Agrifoglio, G; Agus, G B; Bonalumi, F; Costantini, A; Carlesi, R

    1987-01-01

    A retrospective analysis was performed on a consecutive series of 60 cases divided into two groups given carotid endarterectomy (C.E.) for atherosclerotic disease. In the first group general anesthesia and barbiturate cerebral protection were employed; in group two, loco-regional anesthesia. Indications and risk factors were similar in the two groups; the surgical procedure was identical. The differences in the results are reported and factors contributing to cerebral protection or reduction in the risk of stroke are analyzed. The analysis indicates that loco-regional anesthesia for C.E. is a reliable method for detecting cerebral ischemia and guaranteeing cerebral protection by means of a temporary shunt when strictly necessary. PMID:3450753

  8. Facial Palsy after Carotid Endarterectomy & Difficult Intubation during Subsequent CABG Surgery: An Impact of the Cranial Nerve Injury on Airway Management

    OpenAIRE

    Won K. Chee

    2015-01-01

    Cranial nerve injuries can occur during carotid endarterectomy from extensive dissection and prolonged retraction. The nerve injuries can impact both the airway reflex and the anatomical contour to cause a difficulty with subsequent airway management for the anesthesiologists. A careful examination of the airway after the carotid procedure is critical for recognizing the subtle signs of cranial nerve injuries.

  9. Non-invasive in vivo characterization of human carotid plaques with acoustic radiation force impulse ultrasound: comparison with histology after endarterectomy.

    Science.gov (United States)

    Czernuszewicz, Tomasz J; Homeister, Jonathon W; Caughey, Melissa C; Farber, Mark A; Fulton, Joseph J; Ford, Peter F; Marston, William A; Vallabhaneni, Raghuveer; Nichols, Timothy C; Gallippi, Caterina M

    2015-03-01

    Ischemic stroke from thromboembolic sources is linked to carotid artery atherosclerotic disease with a trend toward medical management in asymptomatic patients. Extent of disease is currently diagnosed by non-invasive imaging techniques that measure luminal stenosis, but it has been suggested that a better biomarker for determining risk of future thromboembolic events is plaque morphology and composition. Specifically, plaques that are composed of mechanically soft lipid/necrotic regions covered by thin fibrous caps are the most vulnerable to rupture. An ultrasound technique that non-invasively interrogates the mechanical properties of soft tissue, called acoustic radiation force impulse (ARFI) imaging, has been developed as a new modality for atherosclerotic plaque characterization using phantoms and atherosclerotic pigs, but the technique has yet to be validated in vivo in humans. In this preliminary study, in vivo ARFI imaging is presented in a case study format for four patients undergoing clinically indicated carotid endarterectomy and compared with histology. In two type Va plaques, characterized by lipid/necrotic cores covered by fibrous caps, mean ARFI displacements in focal regions were high relative to the surrounding plaque material, suggesting soft features were covered by stiffer layers within the plaques. In two type Vb plaques, characterized by heavy calcification, mean ARFI peak displacements were low relative to the surrounding plaque and arterial wall, suggesting stiff tissue. This pilot study illustrates the feasibility and challenges of transcutaneous ARFI for characterizing the material and structural composition of carotid atherosclerotic plaques via mechanical properties, in humans, in vivo. PMID:25619778

  10. Low level termination of external carotid artery and its clinical significance: A case report

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    Surekha Devadasa Shetty

    2015-09-01

    Full Text Available The external carotid arterial system is a complex vascular system providing nourishment to the territorial areas of the head and neck. The branches of the external carotid artery are the key landmarks for adequate exposure and appropriate placement of cross-clamps on the carotid arteries during carotid endarterectomy. Knowledge of anatomical variation of the external carotid artery is important in head and neck surgeries. Variations in the branching pattern of the external carotid artery are well known and documented. We report a rare case of low-level termination of the external carotid artery. It terminated by dividing into maxillary and superficial temporal arteries deep into the posterior belly of the digastric muscle, one inch below the angle of the mandible. The occipital and posterior auricular arteries arose from a common trunk given off by the external carotid artery. [Arch Clin Exp Surg 2015; 4(3.000: 160-163

  11. Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal

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    Mercês Lobo

    2015-08-01

    Full Text Available BACKGROUND: Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results.OBJECTIVES: Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality in a tertiary center in Portugal and review the literature.METHODS: Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation.RESULTS: A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference.CONCLUSIONS: We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.

  12. Management of carotid Dacron patch infection: a case report using median sternotomy for proximal common carotid artery control and in situ polytetrafluoroethylene grafting.

    Science.gov (United States)

    Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Ceccanei, Gianluca; Pacilè, Maria Antonietta

    2009-01-01

    We report on a 58-year-old male who presented with an enlarging cervical hematoma 3 months following carotid endarterectomy with Dacron patch repair, due to septic disruption of the Dacron patch secondary to presumed infection. The essential features of this case are the control of the proximal common carotid artery gained through a median sternotomy, because the patient was markedly obese with minimal thyromental distance, and the treatment consisting of in situ polytetrafluoroethylene bypass grafting, due to the absence of a suitable autogenous saphenous vein. Median sternotomy is rarely required in case of reintervention for septic false aneurysms and hematomas following carotid endarterectomy but should be considered whenever difficult control of the common carotid artery, when entering the previous cervicotomy, is anticipated. In situ polytetrafluoroethylene grafting can be considered if autogenous vein material is lacking. PMID:19875014

  13. Risk reduction of brain infarction during carotid endarterectomy or stenting using sonolysis - Prospective randomized study pilot data

    Science.gov (United States)

    Kuliha, Martin; Školoudík, David; Martin Roubec, Martin; Herzig, Roman; Procházka, Václav; Jonszta, Tomáš; Krajča, Jan; Czerný, Dan; Hrbáč, Tomáš; Otáhal, David; Langová, Kateřina

    2012-11-01

    Sonolysis is a new therapeutic option for the acceleration of arterial recanalization. The aim of this study was to confirm risk reduction of brain infarction during endarterectomy (CEA) and stenting (CAS) of the internal carotid artery (ICA) using sonolysis with continuous transcranial Doppler (TCD) monitoring by diagnostic 2 MHz probe, additional interest was to assess impact of new brain ischemic lesions on cognitive functions. Methods: All consecutive patients 1/ with ICA stenosis >70%, 2/ indicated to CEA or CAS, 3/ with signed informed consent, were enrolled to the prospective study during 17 months. Patients were randomized into 2 groups: Group 1 with sonolysis during intervention and Group 2 without sonolysis. Neurological examination, assessment of cognitive functions and brain magnetic resonance imaging (MRI) were performed before and 24 hours after intervention in all patients. Occurrence of new brain infarctions (including infarctions >0.5 cm3), and the results of Mini-Mental State Examination, Clock Drawing and Verbal Fluency tests were statistically evaluated using T-test. Results: 97 patients were included into the study. Out of the 47 patients randomized to sonolysis group (Group 1) 25 underwent CEA (Group 1a) and 22 CAS (Group 1b). Out of the 50 patients randomized to control group (Group 2), 22 underwent CEA (Group 2a) and 28 CAS (Group 2b). New ischemic brain infarctions on follow up MRI were found in 14 (29.8%) patients in Group 1-4 (16.0%) in Group 1a and 10 (45.5%) in Group 1b. In Group 2, new ischemic brain infarctions were found in 18 (36.0%) patients-6 (27.3%) in Group 2a and 12 (42.9%) in Group 2b (p>0.05 in all cases). New ischemic brain infarctions >0.5 cm3 were found in 4 (8.5 %) patients in Group 1 and in 11 (22.0 %) patients in Group 2 (p= 0.017). No significant differences were found in cognitive tests results between subgroups (p>0.05 in all tests). Conclusion: Sonolysis seems to be effective in the prevention of large ischemic

  14. Ultrasonografic monitoring of hemodynamic parameters in symptomatic and asymptomatic patients with high-grade carotid stenosis prior and following carotid endarterectomy

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    Mitrašinović Anka

    2012-01-01

    Full Text Available Background/Aim. Doppler ultrasonography is now a reliable diagnostic tool for noninvasive examination of the morphology and hemodynamic parameters of extracranial segments of blood vessels that participate in the brain vascularisation. This diagnostic modality in recent years become the only diagnostic tool prior to surgery. The aim of the study was to determine hemodynamic status in symptomatic and asymtomatic patients with severe carotid stenosis prior to and after carotid endarterectomy (CEA. Methods. A total of 124 symptomatic and 94 asymptomatic patients who had underwent CEA at the Clinic for Cardiovasculare Disease “Dedinje” in Belgrade were included in this study. Doppler ultrasonography examinations were performed one day before CEA and seven days after it. The peak systolic velocity (PSV, end-dyastolic velocity (EDV, time-averaged maximum blood flow velocity (MV, resistance index (RI and the blood flow volume (BFV of the ipsilateral and the contralateral internal carotid artery (ICA were measured. Results. Diabetes was the only risk factor found significantly more frequent in symptomatic patients. There were significantly more occluded contralateral ICAs in the group of symptomatic patients. There was a significant increase in PSV, EDV, MV and BFV of the ipsilateral ICA after CEA and a significant decrease in PSV, EDV, MV and BFV of the contralateral ICA after CEA. RI is the only hemodynamic parameter without significant changes after CEA in both groups of patients. Comparing the values of hemodynamic parameters after CEA between the group of symptomatic and the group of asymptomatic patients no significant differences were found. Conclusion. The occlusion of the contralateral ICA is an important factor differentiating between symptomatic and asymptomatic patients with severe carotid stenosis. Successful surgery provides good recovery of cerebral hemodynamics in both symtomatic and asymptomatic patients.

  15. Morbi-mortalidad de la endarterectomía carotídea Morbidity and mortality of carotid endarterectomy

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    Virginia A. Pujol Lereis

    2011-10-01

    Full Text Available La endarterectomía carotídea (EC en adición al mejor tratamiento médico mostró reducción del riesgo de eventos cerebrovasculares en pacientes sintomáticos y asintomáticos con estenosis moderada-grave del vaso en ensayos clínicos en centros académicos con cirujanos altamente seleccionados. Las principales guías internacionales recomiendan que el procedimiento se realice en centros con morbi-mortalidad auditada menor al 6% para pacientes sintomáticos y 3% para asintomáticos. Evaluamos la morbi-mortalidad peri-procedimiento en nuestro centro. Esta fue definida como la presencia de accidente cerebrovascular, infarto de miocardio y/o muerte dentro de los 30 días de la cirugía. Se indicó el procedimiento en pacientes sintomáticos con estenosis > 50%. En pacientes asintomáticos o sintomáticos con estenosis ≤ 50% se decidió el tratamiento sobre una base caso por caso. Todos los pacientes fueron examinados por un neurólogo y un cardiólogo antes y después de la EC. Se utilizó en forma rutinaria monitoreo intraoperatorio con Doppler transcraneano en los pacientes con adecuada ventana ultrasónica. Se evaluaron 306 endarterectomías carotídeas. No se registraron muertes. La morbilidad perioperatoria fue de 2.6% tanto para individuos sintomáticos como asintomáticos. Estos índices se compararon favorablemente con informes de otros centros de Latinoamérica y Europa. En conclusión, este informe muestra que la EC puede realizarse en la práctica clínica cotidiana con morbi-mortalidad peri-procedimiento dentro de los niveles recomendados por las guías internacionales.Clinical trials in academic centers with high selected surgeons have demonstrated the effectiveness of carotid endarterectomy (CE in addition to best medical treatment in symptomatic and asymptomatic patients with moderate to severe stenosis. International guidelines recommend that the procedure should be done in centers with morbidity and mortality rates of less

  16. Reduction in hospitalisation rates following simultaneous carotid endarterectomy and coronary artery bypass grafting; experience from a single centre.

    Science.gov (United States)

    Hudorović, Narcis

    2006-08-01

    The aim of this study was to compare hospital, clinical, and health care cost among patients undergoing reversed staged procedure coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG) first and carotid endarterectomy (CEA) second (control group), compared with patients who had simultaneous CEA and off-pump CABG (study group). From January 1, 2000 to December 31, 2004, 53 consecutive patients underwent combined operations at a single institution. Reversed staged procedures were used in the first 23 patients (January 2000-September 2003), and the next 30 patients (September 2003-September 2004) received the one-stage operations. The two groups were similar with respect to baseline characteristics. An internal control system was implemented at the University Clinic Cardiovascular Department (UCCD) in order to compare staged versus simultaneous CEA/OPCABG. The objectives of the internal control system were two-fold: (1) to collect clinical outcomes, resource utilization on patients undergoing reverse-staged or simultaneous OPCABG/CEA and (2) to compare reverse-staged OPCABG/CEA patients, to patients receiving simultaneous CEA/OPCABG in a UCCD. Study patients spent statistically significantly less time in the hospital than control patients (10 vs. 17.9 days). The difference in the mean annual cost of simultaneous versus staged surgery was estimated to be -11.417 Euros (9.619 vs. 21.028 Euros). PMID:17670595

  17. Perioperative cerebral ischemic complications after carotid endarterectomy without shunting. A series of 400 consecutive CEA evaluated by intraoperative monitoring and post-operative diffusion-weighted imaging

    International Nuclear Information System (INIS)

    The use of intraluminal shunting during carotid endarterectomy (CEA) remains controversial. From January 2001 to September 2010, 400 CEAs without shunting were performed under general anesthesia by 14 neurosurgeons (2 consultants, 12 trainees). We used electroencephalography (EEG) and somatosensory evoked potential (SEP) to monitor under selective burst suppression using barbiturate or propofol administration during cross-clamping. In 66 of the 400 CEAs (16.5%), intraoperative monitoring demonstrated abnormalities after cross-clamping. In 26 (6.5%) of the 400 CEAs, new areas of diffusion hyperintensity were identified postoperatively. Within 30 days, the combined mortality and morbidity (symptomatic ischemia) rate was 2.8%. Thirteen (3.3%) patients presented with TIA. CEA without shunting can be safely performed with EEG and SEP monitoring under induced hypertention and selective burst suppression. (author)

  18. Syncope in Patient with Bilateral Severe Internal Carotid Arteries Stenosis/Near Occlusion: A Case Report and Literature Review

    Science.gov (United States)

    Miran, Muhammad Shah; Suri, M. Fareed K.; Qureshi, Mushtaq H.; Ahmad, Aamir; Suri, Mariam K.; Basreen, Rabia; Qureshi, Adnan I.

    2016-01-01

    Background Syncope is commonly worked up for carotid stenosis, but only rarely attributed to it. Considering paucity of such cases in literature, we report a case and discuss the pathophysiology. Design/methods We report a patient with high-grade bilateral severe internal carotid artery (ICA) stenosis who presented with syncopal episodes in the absence of stroke, orthostatic hypotension, significant cardiovascular disease, or vasovagal etiology. We reviewed all literature pertaining to syncope secondary to carotid stenosis and other cerebrovascular disease. Results A 67-year-old man presented with two brief syncopal episodes. History and physical examination was not suggestive of seizure or vasovagal syncope. Other workup was negative for any stroke or syncope secondary to cardiac or vasovagal etiology. Magnetic resonance angiography (MRA) revealed bilateral ICA severe stenosis. This was confirmed by transfemoral carotid vessels angiography. Internal carotid angioplasty and stenting was performed on one side. After this, the patient remained asymptomatic. After one month, carotid endarterectomy (CEA) of contralateral side was performed. Patient remained symptom free after that. On review of literature, we identified only 12 cases of syncope attributable to carotid stenosis and reviewed 24 cases attributable to other cerebrovascular disease. Conclusion Syncope secondary to carotid stenosis, especially in the absence of any focal ischemic events is rare. It can only be expected in those patients who have bilateral hemodynamically significant carotid disease, which is unlikely in the absence of any focal ischemic events. PMID:27403223

  19. Intradural vertebral endarterectomy with nonautologous patch angioplasty for refractory vertebrobasilar ischemia: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Timothy Uschold

    2014-01-01

    Full Text Available Background: The natural history of patients with symptomatic vertebrobasilar ischemic symptoms due to chronic bilateral vertebral artery occlusive disease is progressive, and poses significant challenges when refractory to medical therapy. Surgical treatment options depend largely on location and characteristics of the atheroma (s, and generally include percutaneous transluminal angioplasty (PTA with or without stent placement, posterior circulation revascularization (bypass, extracranial vertebral artery reconstruction, or vertebral artery endarterectomy. Case Description: We present the case of a 56-year-old male with progressive vertebrobasilar ischemia due to tandem lesions in the right vertebral artery at the origin and intracranially in the V4 segment. The contralateral vertebral artery was occluded to the level of posterior inferior cerebellar artery (PICA and posterior communicating arteries were absent. Following PTA and stent placement at the right vertebral artery origin, the patient was successfully treated with intradural vertebral artery endarterectomy (V4EA and patch angioplasty via the far lateral approach. Distal endovascular intervention at the V4 segment proved not technically feasible after multiple attempts. Conclusions: V4EA is an uncommonly performed procedure, but may be considered for carefully selected patients. The authors′ techniques and indications are discussed. Historical outcomes, relevant anatomic considerations, and lessons learned are reviewed from the literature.

  20. 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.

  1. Retropharyngeal internal carotid artery: case report

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    Figueiredo, Ricardo Rodrigues

    2009-03-01

    Full Text Available Introduction: Variations to the course of carotid arteries may lead to abnormal pharyngeal protrusions, to which the otorhinolaryngologist should always attentive. Objective: To report a case of abnormal pharyngeal protrusion due to vascular anomaly in the course of the internal carotid artery, with literature review. Case Report: A 73- year-old woman complained of globus pharyngeus and intermittent dysphonia. A pulsating convexity was observed at the right part of the oropharynx, associated to laryngoscopic signals of pharyngo-laryngeal reflux. The pharyngeal computed tomography scan showed an abnormal tortuous internal carotid in the retropharyngeal space. The patient was sent to the vascular surgeon, who, after a normal blood flow finding at the Doppler, opted for an expectation conduct. The pharyngeal symptoms improved with the antireflux treatment. Final Comments: Internal carotid vascular anomalies must always be recalled in the pharyngeal wall convexity differential diagnosis.

  2. Cirurgia de revascularização do miocárdio associada a endarterectomia de carótida Combined operation for myocardial revascularization and carotid endarterectomy

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    Januário M Souza

    1995-03-01

    RM, sendo a outra carótida operada em segundo tempo (em torno de uma semana. Considerando que nenhum dos pacientes apresentou AVC transoperatório, achamos ser a conduta adequada para essa associação de lesões.There are still controversies about the treatment of associated coronary artery disease and carotid artery obstruction. Between 1979 and 1994, 10940 patients were operated on for myocardial revascularization. Combined operations (myocardial revascularization and carotid endarterectomy were done in 46 (0.43% patients, during the same period. Patients age ranged from 48 to 76 years with an average of 65.2 yrs; 80.4% were male; 23 had had previous myocardial infarction. Associated diseases were diabetes mellitus in 10 patients, chronic renal insufficiency in 5; 29 were in functional class 111 or IV for angina; 4 patients had congestive cardiac insufficiency: left main carotid obstruction, and in 4 of them one carotid artery was completaly obstructed; 23 patients had had transient cerebral ischemic attack and 2 had had stroke with sequelae. Hospital mortality was 8.6% (4/46. Permanent stroke did not occur in the operative period; 3 of the 4 deaths occurred in patients 70 years or older. Carotid endarterectomy was done just before cardiopulmonary bypass in 42 patients and in 4 patients with one of the carotid arteries occluded, done after cardiopulmonary bypass was established and the patient temperature was 25ºC. Considering that no patient had perioperative stroke, we think that this strategy is adequate for this association of diseases.

  3. The use of intraoperative monitoring and treatment of symptomatic microemboli in carotid artery stenting: case report and discussion

    Energy Technology Data Exchange (ETDEWEB)

    Rangi, P.S.; Clifton, A. [St Georges Hospital, Department of Neuroradiology, Atkinson Morley Wing, Tooting, London (United Kingdom); Markus, H.S.; Punter, M.N.M. [St Georges University of London, Centre for Clinical Neuroscience, Cranmer Terrace, London (United Kingdom)

    2007-03-15

    Carotid artery stenting is a recently introduced treatment in symptomatic atherosclerotic carotid artery disease with acceptable complication rates. The major risk is perioperative embolic stroke. Transcranial Doppler ultrasonography (TCD) can be used to identify embolic signals and guide therapy. We present a case of symptomatic embolization in a 72-year-old female following carotid stent deployment complicated by haemodynamic changes. Despite concurrent dual antiplatelet medication significant symptomatic embolization occurred even after restoration of the blood pressure, and modulation of the rate of embolization was achieved using dextran-40 guided by TCD monitoring. The patient recovered from an initially profound hemiparesis and dysphasia to minor sensory changes. Microemboli are common following carotid artery stenting and there appears to be a threshold phenomenon associated with prolonged embolization and progression to cerebral infarction. TCD can be used to detect particulate microemboli and therefore may be useful in guiding antithrombotic therapy in this setting. Dextran-40 has been shown to reduce the embolic load following carotid endarterectomy and was used to good effect in this patient in terms of both embolic load and clinical outcome. This is the first case of embolization following carotid stenting successfully treated with dextran-40, and offers a further option for therapeutic intervention in microembolism detected by TCD and stresses the importance of perioperative monitoring of embolic load for postoperative stroke risk. (orig.)

  4. The use of intraoperative monitoring and treatment of symptomatic microemboli in carotid artery stenting: case report and discussion

    International Nuclear Information System (INIS)

    Carotid artery stenting is a recently introduced treatment in symptomatic atherosclerotic carotid artery disease with acceptable complication rates. The major risk is perioperative embolic stroke. Transcranial Doppler ultrasonography (TCD) can be used to identify embolic signals and guide therapy. We present a case of symptomatic embolization in a 72-year-old female following carotid stent deployment complicated by haemodynamic changes. Despite concurrent dual antiplatelet medication significant symptomatic embolization occurred even after restoration of the blood pressure, and modulation of the rate of embolization was achieved using dextran-40 guided by TCD monitoring. The patient recovered from an initially profound hemiparesis and dysphasia to minor sensory changes. Microemboli are common following carotid artery stenting and there appears to be a threshold phenomenon associated with prolonged embolization and progression to cerebral infarction. TCD can be used to detect particulate microemboli and therefore may be useful in guiding antithrombotic therapy in this setting. Dextran-40 has been shown to reduce the embolic load following carotid endarterectomy and was used to good effect in this patient in terms of both embolic load and clinical outcome. This is the first case of embolization following carotid stenting successfully treated with dextran-40, and offers a further option for therapeutic intervention in microembolism detected by TCD and stresses the importance of perioperative monitoring of embolic load for postoperative stroke risk. (orig.)

  5. DIFFICULT WEANING AFTER PULMONARY ENDARTERECTOMY FO R CHRONIC PULMONARY EMBOLISM: A CASE REPORT

    OpenAIRE

    Melchisedec; Sheetal; Bedi; Valsa; Anish G.

    2013-01-01

    SUMMARY: A 33 yrs old male presented with dyspnea on exertion since 6yrs was diagnosed to have chronic thromboembolic pulmonary hypertension (C TEPH) for which he underwent pulmonary endarterectomy (PEA) using deep hypothermic circulatory arrest (DHCA). After the operation the patient developed reperfusion edema and hypoxaemia because of which patient had delayed weaning from mechanical ventilation.

  6. Internal carotid artery rupture caused by carotid shunt insertion

    OpenAIRE

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

    2015-01-01

    Introduction: 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. Presentation of case: A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arteria...

  7. Contralateral Cerebral Infarction after Stent Placement in Carotid Artery: An Unexpected Complication

    OpenAIRE

    Park, Seong-Ho; Lee, Chang Young

    2008-01-01

    Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy (CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was diagnosed with an acute watershed infarct of the right hemisphere secondar...

  8. [A Case of Carotid Free-Floating Thrombus Treated by Carotid Ultrasonography-Guided Endovascular Approach].

    Science.gov (United States)

    Otawa, Masato; Kinkori, Takeshi; Watanabe, Kenichi; Ando, Ryo; Tambara, Masao; Arima, Toru

    2016-06-01

    We experienced a case of carotid free-floating thrombus treated by carotid ultrasonography-guided endovascular approach. A 63-year-old man was brought to our hospital with the chief complaint of sudden onset left hemiplegia. MRI revealed acute infarction of the right MCA territory due to the right M1 occlusion. Carotid ultrasonography showed a pedunculated, polypoid mobile plaque floating with the cardiac beat. We attempted ultrasonography-guided endovascular treatment. Under proximal balloon protection, the floating plaque was successfully aspirated into the Penumbra aspiration catheter. Carotid stent was also placed to stabilize the residual pedicle of the plaque. Aspirated plaque was identified as fresh thrombus by pathological examination. Carotid ultrasonography-guided endovascular approach was effective for getting the picture of real-time dynamics of the carotid FFT. PMID:27270147

  9. Thrombo endarterectomy in Chronic thromboembolic pulmonary hypertension.The first clinical case in Uruguay report

    International Nuclear Information System (INIS)

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a delayed diagnosed disease with high morbidity and mortality, especially when untreated. Ventilation/perfusion lung scan confirms the thromboembolic etiology, but pulmonary angiography is still the gold standard diagnostic procedure for defining the extension and location of the disease and surgical indication. Right heart catheterization provides accurate prognostic and disease severity information. Pulmonary endarterectomy represents a potentially curative option in illegible patients

  10. Anesthetic management of schwannoma mimicking carotid body tumor

    OpenAIRE

    Sivasankar C

    2012-01-01

    Chitra SivasankarDepartment of Anesthesiology, Guthrie Clinic, Sayre, PA, USAAbstract: Schwannomas are rare and slow-growing neurogenic tumors for which surgery is the standard of care. However, the anesthetic management of these tumors can be challenging. This case report describes the anesthetic management of a patient who underwent carotid endarterectomy and excision of a presumed carotid body tumor. Histopathologic examination showed that the excised tissue was a schwannoma, which in this...

  11. Common Carotid Artery Occlusion: A Case Series

    OpenAIRE

    Zoltán Bajkó; Rodica Bălaşa; Anca Moţăţăianu; Smaranda Maier; Octavia Claudia Chebuţ; Szabolcs Szatmári

    2013-01-01

    Subjects and Methods. We analysed 5000 cerebrovascular ultrasound records. A total of 0.4% of the patients had common carotid artery occlusion (CCAO). Results. The mean age was 59.8 ± 14.2 years, and the male/female ratio was 2.33. The most frequent risk factors were hypertension, ischaemic heart disease, dyslipidemia, diabetes mellitus, and smoking. Right-sided and left-sided CCAO occurred in 65% and 30% of the cases, respectively, and bilateral occlusion was detected in one case (5%). Paten...

  12. Carotid stenting

    International Nuclear Information System (INIS)

    Full text: The annual incidence of stroke is estimated around 2 cases per 1000 in the general population and 80% of strokes are ischemic. [1] Atherosclerotic disease resulting in stenosis of common and/or internal carotid arteries is an established risk factor for acute cerebrovascular events. [2] In the majority of the cases ischemic stroke is caused by atherosclerotic plaque rupture and subsequent thrombus formation resulting in carotid occlusion or/and distal thromboembolization. Today, two invasive methods are available in order to reduce the risk of severe ischemic events: surgical carotid artery endarterectomy (CEA) and percutaneous carotid artery stenting (CAS). More recently amassed high-level scientific data coming from randomized controlled trials (RCTs) and meta-analysis comparing CAS with CEA have emerged. [3] Initial RTCs included the French EVA 3S, which investigated 527 symptomatic patients in 30 different centers, the German SPACE investigating 1.200 patients and the International ICSS which randomized 1710 patients. In EVA 3S the 30-day rate of any stroke death was significantly lower in the CEA group (3.9 vs. 9.6%, HR: 2.5). However the trial was prematurely stopped and severely criticized. [4] The SPACE trial resulted in a similar rate of ipsilateral stroke or death at 30-days and 2 years follow-up (6.8% CAS vs. 6.3% CEA), while in the ICSS trial the primary endpoint of all strokes, death and myocardial infarction (MI) was significantly lower in the CAS group (5.2% vs. 8.5%). Finally, the most recent CREST (Carotid Revascularization Endarterectomy vs. Stenting) trial randomized 2.502 patients (1.321 symptomatic). The composite primary endpoint of any stroke, death and MI was similar between the two methods (CAS: 7.2% vs. CEA: 6.8%; HR=1.11), while both methods demonstrated similar short- and longer-term outcomes. However significant differences between the components were detected (stroke 4.1% vs. 2.3%, P=0.012; and MI 1.1% vs. 2.3%, p=0.032, CAS

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

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    Abid Ali

    2015-01-01

    Conclusion: 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.

  14. Cerebral Ischemia Due to Traumatic Carotid Artery Dissection: Case Report

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    Deniz Kamacı Şener

    2012-12-01

    Full Text Available Blunt injury to the neck region may lead to carotid artery dissection and cerebral ischemia. Blunt injury to carotid artery is not frequent but determination of the presence of trauma in the history of stroke patients will provide early diagnosis and treatment of them. In this article, a case with cerebral ischemia resulting from traumatic carotid artery dissection is presented and clinical findings, diagnostic procedures and choice of treatment are discussed in the light of the literature.

  15. Covered Stent-Graft Treatment of a Postoperative Common Carotid Artery Pseudoaneurysm

    International Nuclear Information System (INIS)

    Extracranial carotid artery pseudoaneurysms are rare cases resulting from trauma, mycotic infection, head and neck carcinomas or complications related to their treatment. Trauma is the most common cause of carotid artery pseudoaneurysms. They can also present after surgery, most commonly following endarterectomy, which is a rare cause with an estimated incidence of 0.3–0.6%. A 26-year-old male patient was admitted with swelling in his left neck after left carotid endarterectomy. Angiography confirmed pseudoaneursym in the left carotid bulb and it was treated successfully with two heparin-bonded covered stent grafts. Endovascular treatment of carotid pseudoaneurysms with covered stent-grafts is a safe and efficient method providing definitive arterial reconstruction. But series with longer follow-up periods are needed to evaluate patient compatibility to lifelong antiplatelet theraphy

  16. Carotid Stump Syndrome: Case Report and Endovascular Treatment.

    Science.gov (United States)

    Dakhoul, Lara Toufic; Tawk, Rabih

    2014-01-01

    Objectives. To highlight the case of a patient with multiple transient ischemic attacks and visual disturbances diagnosed with carotid stump syndrome and managed with endovascular approach. Case Presentation. We present the case of a carotid stump syndrome in an elderly patient found to have moderate left internal carotid artery stenosis in response to an advertisement for carotid screening. After a medical therapeutic approach and a close follow-up, transient ischemic attacks recurred. Computed tomographic angiography showed an occlusion of the left internal carotid artery and the presence of moderate stenosis in the right internal carotid artery, which was treated by endovascular stenting and balloon insertion. One month later, the patient presented with visual disturbances due to the left carotid stump and severe stenosis of the left external carotid artery that was reapproached by endovascular stenting. Conclusion. Considerations should be given to the carotid stump syndrome as a source of emboli for ischemic strokes, and vascular assessment could be used to detect and treat this syndrome. PMID:26425620

  17. Percutaneous transluminal angioplasty and stenting of carotid arteries: Early results

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    Čolić Momčilo

    2008-01-01

    Full Text Available INTRODUCTION Treatment of carotid stenosis could be surgical: eversion endarterectomy, conventional endarterectomy and patch-plasty, resection with graft interposition and bypass procedure or, in the past few years, carotid artery angioplasty (PTA with stent implantation. OBJECTIVE The aim of this study is to present early results of carotid artery angioplasty and stenting, as well as to identify indications for this procedure. METHOD Twenty-three patients with stenosis of internal carotid artery were included in the prospective study which was performed in the period from July 2006 to July 2007. For PTA and stenting of the carotid artery we used Balloon dilatation catheter Ultra-softTM SV and Carotid WallstentTM MonorailTM. During the procedure, brain protection by embolic protection system Filter Wire EZ was essentially performed. Descriptive statistical methods were performed to present and describe the patient characteristics, risk factors and results. RESULTS 23 patients were examined. In four (17.39% cases there was asymptomatic, while in 19 (82.61% there was symptomatic homodynamic significant stenosis of the internal carotid artery. Four of these 19 patients (17.39% had late restenosis following carotid endarterectomy, four (17.39% important respiratory failure, and 11 (47.83% important heart disease. Patients were followed up for the first 30 postopertive days. In that period, there were no mortality and no needs for surgical conversions. In one case (4.35%, residual stenosis of 30% remained. Two patients (8.70% had TIA and one (4.35% had CVI. CONCLUSION Main indications for PTA and stenting of carotid arteries are: surgically inaccessible lesions (at or above C2; or subclavial; radiation-induced carotid stenosis; prior ispilateral radical neck dissection; prior carotid endarterectomy (restenosis, severe cardiac and pulmonary conditions. Limitations and contraindications to carotid angioplasty and stentning include: significant

  18. High Resolution Contrast-enhanced MRA in the Evaluation of Rabbit Carotid Artery

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Introduction:Accurate lumen definition of carotid artery is crucial for determining patient treatment, because a 70% or greater stenosis of a carotid artery will benefit from carotid endarterectomy to reduce the incidence of stroke[1].

  19. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... Carotid endarterectomy as shown here is a surgical exposure of the carotid artery in which an incision ... anyway. But it may change my post-procedure management under -- if there are PO collaterals from posterior ...

  20. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... of flow to the brain. Many times during these procedures, there may be signs of low blood ... previous carotid surgery. And finally, neck irradiation. All these factors make patients higher risk for carotid endarterectomy ...

  1. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... with a five-millimeter balloon typically? 00:48:40 Y. PIERRE GOBIN, MD: I will -- before placing ... patients, carotid artery stenting versus carotid endarterectomy in 40 centers. And the trial was stopped early for ...

  2. CAROTID CAVERNOUS FISTULA: A RARE CASE REPORT

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    Satish Prasad

    2015-01-01

    Full Text Available Carotico - cavernous fistula represent abnormal communication between the carotid circulation and the cavernous sinus. They can be classified as direct or indirect which are separate conditions with different aetiologies. Direct Carotico - cavernous fistulas ( CCFs are often secondary to trauma, and as such the demographics reflect the distribution of head trauma, most commonly seen in the young male patients. Presentation is acute and symptoms develop rapidly. In contrast, indirect CCFs have a predilection for the postmenopausal female patient a nd the onset of symptoms is often insiduous. Other conditions that predispose to increased risk include . Ehlers - Danlos syndrome . Fibromuscular dysplasia .

  3. Non-detection of Chlamydia species in carotid atheroma using generic primers by nested PCR in a population with a high prevalence of Chlamydia pneumoniae antibody

    OpenAIRE

    Bamford Kathleen B; Wyatt Dorothy E; O'Neill Hugh J; Duprex W; McCluggage W Glenn; Barros D'Sa Aires AB; Coyle Peter V; Ong Grace M; O'Loughlin Barney; McCaughey Conall

    2001-01-01

    Abstract Background The association of Chlamydia pneumoniae with atherosclerosis is controversial. We investigated the presence of C. pneumoniae and other Chlamydia spp. in atheromatous carotid artery tissue. Methods Forty elective carotid endarterectomy patients were recruited (27 males, mean age 65 and 13 females mean age 68), 4 had bilateral carotid endarterectomies (n= 44 endarterectomy specimens). Control specimens were taken from macroscopically normal carotid artery adjacent to the ath...

  4. Carotid artery stenting

    International Nuclear Information System (INIS)

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  5. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, Jens [Universitaetsklinikum Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum

    2009-09-15

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  6. Procedimento combinado entre operação de revascularização do miocárdio e endarterectomia de carótida: análise dos resultados Combined carotid endarterectomy and coronary artery bypass grafting: analysis of the results

    Directory of Open Access Journals (Sweden)

    Márcio Luís Lucas

    2005-12-01

    Full Text Available OBJETIVO: Avaliar os resultados da cirurgia combinada (endarterectomia carotídea e cirurgia de revascularização do miocárdio em pacientes com doença carotídea e coronária concomitante. MÉTODOS: Os autores revisam 49 trabalhos que descrevem vários aspectos sobre a cirurgia combinada em um total de 4.788 pacientes, analisando eventos precoces no período peri-operatório. RESULTADOS: As taxas globais de acidente vascular cerebral (AVC, infarto agudo do miocárdio (IAM e mortalidade foram, respectivamente, de 4,3%; 2,2%; e 4,2%. Para os trabalhos mais recentes (entre 1990-2000, a ocorrência de AVC foi significativamente inferior àquela obtida por trabalhos publicados anteriormente (entre 1972-1989 (4,1% x 10,2%; p 100 (7,2% x 3,9%; p OBJECTIVE: To evaluate the results of combined surgery (carotid endarterectomy and coronary artery bypass grafting in patients with concomitant carotid and coronary artery disease. METHODS: The authors reviewed 49 different reports describing several aspects of the combined surgery in 4788 patients to analyze early events in the perioperative period. RESULTS: Overall stroke, acute myocardial infarction (AMI, and mortality rates were 4.3%, 2.2%, and 4.2%, respectively. Most recent papers (1990 to 2000 show significant lower incidence of strokes compared to those published earlier (1972 to 1989 (4.1% x 10.2%; p 100 (7.2% x 3.9%; p < 0.05, denoting the impact of surgeons' experience on postoperative results. CONCLUSION: In sum, we believe that combined carotid endarterectomy and coronary artery bypass grafting is a safe and effective procedure when performed by experienced and qualified surgeons.

  7. Management of asymptomatic carotid stenosis in patients undergoing general and vascular surgical procedures

    OpenAIRE

    Paciaroni, M; Caso, V; Acciarresi, M; Baumgartner, R.; Agnelli, G.

    2005-01-01

    Current available data do not seem to support the strategy for carotid endarterectomy prior to surgical intervention in patients with asymptomatic carotid stenosis. However, in patients with coronary artery disease, synchronous carotid endarterectomy and coronary artery bypass grafting should be considered where there is a proven surgical risk of 60% or bilateral carotid stenosis >75% on the same side as the most severe stenosis. Clarification of the optimal strategy requires an adequately po...

  8. Defective cerebrovascular autoregulation after carotid endarterectomy

    DEFF Research Database (Denmark)

    Jørgensen, L G; Schroeder, T V

    1993-01-01

    (130-332)% of the preoperative value (p < 0.0001), while the contralateral Vmean remained unchanged. After blood pressure was reduced in symptomatic patients with labetalol, ipsilateral Vmean decreased from 92 (69-124) to 56 (32-93) cm s-1 (p < 0.0001) as systemic arterial pressure decreased from 101...

  9. Computer simulation of the carotid artery

    OpenAIRE

    Santos, A.; Sousa, L. de; Tavares, J.; Santos, R.; Castro, P.; Azevedo, E.

    2012-01-01

    Background: Disturbed flow conditions at the bifurcation of common carotid artery and proximal internal carotid artery plays an important role in the development of local atherosclerotic plaques, which are important causes of stroke. Being able to build 3D models based on ultrasound imaging can improve diagnostic assessment and support interventions like endarterectomy or carotid stenting. Our aim was to describe a carotid segmentation algorithm to build these 3D models.Methods: We developed ...

  10. Stent-assisted angioplasty for atherosclerotic stenosis of the carotid artery. An overview

    International Nuclear Information System (INIS)

    For symptomatic stenosis of the carotid artery the invasive options for treatment (by means of stent or operation) are superior to conservative medical treatment. Recent multi-center randomized controlled trials, which will be presented here, indicate that stenting in the treatment of symptomatic carotid stenosis is neither safer nor more effective than carotid endarterectomy. When carried out by an experienced interventionalist stent-assisted angioplasty (CAS) is an alternative to carotid endarterectomy. Subgroup-analysis indicates that for patients older than 70 years of age invasive techniques should be the method of choice. In the case of contralateral high-grade stenosis or occlusion, CAS is the method of choice. For patients treated by stenting, the periprocedural complication rate is not influenced by the use of protection systems. The present results on symptomatic carotid stenosis should not be transferred to the therapy of asymptomatic carotid stenosis. A 3-armed study (SPACE2) on the comparison of the best medical treatment with the invasive treatment modalities (CAS or CEA) is in preparation and will be started in 2 months. (orig.)

  11. Brainstem infarction in a patient with internal carotid dissection and persistent trigeminal artery: a case report

    Science.gov (United States)

    2010-01-01

    Background The primitive trigeminal artery (PTA) is the most commonly described fetal anastomosis between the carotid and vertebrobasilar circulations. Case presentation We report a 42-year-old patient presenting with internal carotid dissection, and imaging features of brainstem infarction. Conclusion Based on the imaging studies we presume occlusive carotid dissection with extensive thrombosis within a persistent trigeminal artery as the cause of this brainstem ischemia. PMID:20598138

  12. Brainstem infarction in a patient with internal carotid dissection and persistent trigeminal artery: a case report

    Directory of Open Access Journals (Sweden)

    Iancu Daniela

    2010-07-01

    Full Text Available Abstract Background The primitive trigeminal artery (PTA is the most commonly described fetal anastomosis between the carotid and vertebrobasilar circulations. Case presentation We report a 42-year-old patient presenting with internal carotid dissection, and imaging features of brainstem infarction. Conclusion Based on the imaging studies we presume occlusive carotid dissection with extensive thrombosis within a persistent trigeminal artery as the cause of this brainstem ischemia.

  13. Carotid anatomy does not predict the risk of new ischaemic brain lesions on diffusion-weighted imaging after carotid artery stenting in the ICSS-MRI substudy

    OpenAIRE

    Doig, D; Hobson, B. M.; Müller, M; Jäger, H R; Featherstone, R. L.; Brown, M M; Bonati, L.H.; Richards, T.

    2015-01-01

    INTRODUCTION: The International Carotid Stenting Study (ICSS, ISRCTN25337470) randomized patients with recently symptomatic carotid artery stenosis > 50% to carotid artery stenting (CAS) or endarterectomy. CAS increased the risk of new brain lesions visible on diffusion-weighted magnetic resonance imaging (DWI-MRI) more than endarterectomy in the ICSS-MRI Substudy. The predictors of new post-stenting DWI lesions were assessed in these patients. METHODS: ICSS-MRI Substudy patients allocated to...

  14. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... as the thing becomes more complicated or more complex, the endarterectomy component or option becomes more prominent, ... to external carotid artery anastomotic stenosis? A pretty complex question here, Pierre. 01:14:48 Y. PIERRE ...

  15. Aberrant internal carotid artery in the middle ear : a case report

    International Nuclear Information System (INIS)

    Aberrant internal carotid artery in the middle ear is a rare disease which, if unrecognized on raiological studies, can lead to serious complications during tissue biopsy. We report the imaging features of a case with aberrant internal carotid artery in the middle ear. A 60-year-old woman visited our hospital because of hearing difficulty on the right side. Temporal bone CT showed a well-defined mass of the right middle ear and lateral bony defect in the carotid canal adjacent to the mass. After arterial phase temporal bone CT with spiral CT and angiography, the mass could be diagnosed as aberrant internal carotid artery in the middle ear

  16. Non-detection of Chlamydia species in carotid atheroma using generic primers by nested PCR in a population with a high prevalence of Chlamydia pneumoniae antibody

    Directory of Open Access Journals (Sweden)

    Bamford Kathleen B

    2001-08-01

    Full Text Available Abstract Background The association of Chlamydia pneumoniae with atherosclerosis is controversial. We investigated the presence of C. pneumoniae and other Chlamydia spp. in atheromatous carotid artery tissue. Methods Forty elective carotid endarterectomy patients were recruited (27 males, mean age 65 and 13 females mean age 68, 4 had bilateral carotid endarterectomies (n= 44 endarterectomy specimens. Control specimens were taken from macroscopically normal carotid artery adjacent to the atheromatous lesions (internal controls, except in 8 cases where normal carotid arteries from post mortem (external controls were used. Three case-control pairs were excluded when the HLA DRB gene failed to amplify from the DNA. Genus specific primers to the major outer membrane protein (MOMP gene were used in a nested polymerase chain reaction (nPCR in 41 atheromatous carotid specimens and paired controls. PCR inhibition was monitored by spiking with target C. trachomatis. Atheroma severity was graded histologically. Plasma samples were tested by microimmunofluorescence (MIF for antibodies to C. pneumoniae, C. trachomatis and C. psittaci and the corresponding white cells were tested for Chlamydia spp. by nPCR. Results C. pneumoniae was not detected in any carotid specimen. Twenty-five of 38 (66% plasma specimens were positive for C. pneumoniae IgG, 2/38 (5% for C. trachomatis IgG and 1/38 (3% for C. psittaci IgG. Conclusions We were unable to show an association between the presence of Chlamydia spp. and atheroma in carotid arteries in the presence of a high seroprevalence of C. pneumoniae antibodies in Northern Ireland.

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

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  19. Recanalização espontânea tardia de carótida interna: relato de caso Late spontaneous recanalization of internal carotid artery: case report

    Directory of Open Access Journals (Sweden)

    Glauco Fernandes Saes

    2007-09-01

    Full Text Available A recanalização espontânea tardia da carótida interna é um evento incomum e pouco estudado. Os autores relatam o caso de paciente de 73 anos, masculino, hipertenso, com antecedente de acidente vascular cerebral há 3 anos, com seqüela motora e sensitiva em membro superior direito, apresentando ao mapeamento dúplex e arteriografia oclusão total da carótida interna. Evoluiu após 2 anos com novos episódios de ataques isquêmicos transitórios de repetição. Submetido a novos exames de imagem para avaliação da circulação cerebral extra e intracraniana, evidenciou-se recanalização do vaso, com estenose severa. Foi realizada endarterectomia de carótida esquerda, sem intercorrências. Paciente evoluiu sem novos episódios após 1 mês de seguimento. Considerando a raridade do caso e a parca literatura sobre recanalização tardia de carótida, passível de reparo cirúrgico, optamos pela apresentação do caso enfocando a importância do acompanhamento de oclusões carotídeas.Late spontaneous recanalization of internal carotid artery is an unusual event that has received little attention. The authors report a case of a 73-year-old male patient, hypertensive, with previous history of cerebral vascular accident 3 years ago, with sensorimotor sequela in the right upper limb. Duplex scanning and arteriography showed total occlusion of the internal carotid artery. The patient progressed after 2 years with new episodes of recurrent transient ischemic attacks. When submitted to new imaging examinations to assess extra- and intracranial circulation, vessel recanalization was demonstrated, with severe stenosis. Left carotid endarterectomy was uneventfully performed. The patient progressed without new episodes after a 1-month follow-up. Considering the case rarity and the lack of literature on late carotid artery recanalization that can be surgically repaired, we decided to present this case focusing on the importance of following carotid

  20. An updated review of current concepts in the management of carotid stenosis

    OpenAIRE

    Hertzer, Norman R

    2010-01-01

    Several large randomized clinical trials in North America and Europe concluded over a decade ago that carotid endarterectomy plus medical management was significantly better than medical management alone for stroke prevention in either symptomatic or asymptomatic patients with severe carotid stenosis. Percutaneous carotid angioplasty now represents yet another treatment option that currently appears to have a higher risk than endarterectomy in symptomatic patients as well as in those who are ...

  1. Reflections by contrarians on the post-CREST evaluation of carotid stenting for stroke prevention.

    Science.gov (United States)

    Barnett, Henry J M; Pelz, David M; Lownie, Stephen P

    2010-12-01

    Carotid angioplasty and stenting has become a popular alternative to carotid endarterectomy for the treatment of carotid stenosis in stroke. Evidence from early randomized controlled trials comparing these interventions revealed mixed results. The largest such trial, the Carotid Revascularization Endarterectomy vs. Stenting Trial recently showed equivalence of the procedures in a mixed cohort of both symptomatic and asymptomatic patients. These results have been heralded in North America as definitively demonstrating the safety and efficacy of carotid angioplasty and stenting, making it an attractive alternative to carotid endarterectomy. It is therefore probable that many more asymptomatic patients will be subjected to Carotid angioplasty and stenting, perceived by many to be less invasive than carotid endarterectomy. The authors argue that the design of Carotid Revascularization Endarterectomy vs. Stenting Trial was flawed by the mixture of two dissimilar patient groups, thus violating the principle of ceteris paribus, essential for the validity of a randomized controlled trials. The evidence for any invasive treatment of asymptomatic carotid disease is weak, with recent data favouring purely medical management. The authors believe that carotid angioplasty and stenting in asymptomatic patients should cease until better evidence is available. PMID:21050401

  2. Distal migration of a floating carotid thrombus in a patient using oral contraceptives: a case report

    Directory of Open Access Journals (Sweden)

    Watanabe Masaki

    2009-07-01

    Full Text Available Abstract Introduction We report the case of a patient with distal migration of a floating carotid thrombus caused by oral contraceptives. Case presentation A 48-year-old woman using oral contraceptives suffered from dysarthria and gait disturbance. Examinations, including ultrasound and cerebral arteriogram, revealed a floating thrombus at the left carotid bifurcation with no stenosis. Despite antithrombotic therapy, the floating carotid thrombus migrated to the ipsilateral middle cerebral artery, resulting in a severe stroke. Conclusion Some floating thrombi are resistant to conservative therapy and have a risk of distal migration, which may cause a major stroke in the acute stage.

  3. Carotid revascularization: risks and benefits

    Directory of Open Access Journals (Sweden)

    O'Brien M

    2014-07-01

    Full Text Available Marlene O'Brien, Ankur Chandra Department of Surgery, Division of Vascular Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Abstract: Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid artery stenosis is implicated in 20%–30% of all strokes. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease. Evidence for the treatment of patients with symptomatic carotid stenosis greater than 70% with either carotid artery stenting (CAS or carotid endarterectomy (CEA is compelling, and several trials have demonstrated a benefit to carotid revascularization in the symptomatic patient population. Asymptomatic carotid stenosis is more controversial, with the largest trials only demonstrating a 1% per year risk stroke reduction with CEA. Although there are sufficient data to advocate for aggressive medical therapy as the primary mode of treatment for asymptomatic carotid stenosis, there are also data to suggest that certain patient populations will benefit from a stroke risk reduction with carotid revascularization. In the United States, consensus and practice guidelines dictate that CEA is reasonable in patients with high-grade asymptomatic stenosis, a reasonable life expectancy, and perioperative risk of less than 3%. Regarding CAS versus CEA, the best-available evidence demonstrates no difference between the two procedures in early perioperative stroke, myocardial infarction, or death, and no difference in 4-year ipsilateral stroke risk. However, because of the higher perioperative risks of stroke in patients undergoing CAS, particularly in symptomatic, female, or elderly patients, it is difficult to recommend CAS over CEA except in populations with prohibitive cardiac risk, previous carotid surgery, or prior neck radiation. Current treatment

  4. Molecular mediators linking stroke and carotid artery disease

    OpenAIRE

    Nuotio, Krista

    2007-01-01

    Carotid artery disease is the most prevalent etiologic precursor of ischemic stroke, which is a major health hazard and the second most common cause of death in the world. If a patient presents with a symptomatic high-grade (>70%) stenosis in the internal carotid artery, the treatment of choice is carotid endarterectomy. However, the natural course of radiologically equivalent carotid lesions may be clinically quite diverse, and the reason for that is unknown. It would be of utmost importance...

  5. Carotid angioplasty with cerebral protection

    International Nuclear Information System (INIS)

    Background. Carotid endarterectomy (CEA) is widely used in the management of high-grade carotid stenosis. It is a surgical procedure requiring general anaesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It may develop complications, such as stroke, death, cranial nerve palsies, wound haematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in patients with cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distal internal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anaesthesia and causes lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distal immobilisation of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intimal hyperplasia. CAS is a relatively new procedure; therefore, it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. Patients and methods. In Slovenia, we have also started with carotid angioplasty by the study: Slovenian Carotid Angioplasty Study (SCAS). We performed CAS in 17 patients (12 males and 5 females) aged from 69 to 82 years. All patients were symptomatic with stenosis greater than 70 %. 10 patients suffered transient ischemic attacks, 4 patients minor strokes and 3 patients amaurosis fugax. Results. Technical success (< 30 % residual stenosis) was achieved in all cases. In 14 patients, no residual stenosis was found, in 2 patients a 15 % residual

  6. A patient with a painless neck tumour revealed as a carotid paraganglioma: a case report.

    Science.gov (United States)

    Peric, Barbara; Marinsek, Ziva Pohar; Skrbinc, Breda; Music, Maja; Zagar, Ivana; Hocevar, Marko

    2014-01-01

    Carotid paragangliomas are usually slowly enlarging and painless lateral neck masses. These mostly benign lesions are recognized due to their typical location, vessel displacement and specific blood supply, features that are usually seen on different imaging modalities. Surgery for carotid paraganglioma can be associated with immediate cerebrovascular complications or delayed neurological impairment.We are reporting the case of a 36-year-old man who presented with a painless mass on the right side of his neck 11 months after being treated for testicular cancer. After a fine-needle aspiration biopsy, he was diagnosed with a testicular cancer lymph node metastasis. Neck US and fluorine [F-18]-fluorodeoxy-D-glucose (FDG) PET-CT showed no signs of hypervascularity or vessel displacement. The patient underwent a level II to V functional neck dissection. During the procedure, suspicion of a carotid paraganglioma was raised and the tumour was carefully dissected from the walls of the carotid arteries with minimal blood loss and no cranial nerve dysfunction.The histology report revealed carotid paraganglioma with no metastasis in the rest of the lymph nodes. The patient's history of testicular germ cell tumour led to a functional neck dissection during which a previously unrecognized carotid paraganglioma was removed.Surgery for carotid PG can be associated with complications that have major impact on quality of life. A thorough assessment of the patient and neck mass must therefore be performed preoperatively in order to perform the surgical procedure under optimal conditions. PMID:25141773

  7. A patient with a painless neck tumour revealed as a carotid paraganglioma: a case report

    OpenAIRE

    Peric, Barbara; Marinsek, Ziva Pohar; Skrbinc, Breda; Music, Maja; Zagar, Ivana; Hocevar, Marko

    2014-01-01

    Carotid paragangliomas are usually slowly enlarging and painless lateral neck masses. These mostly benign lesions are recognized due to their typical location, vessel displacement and specific blood supply, features that are usually seen on different imaging modalities. Surgery for carotid paraganglioma can be associated with immediate cerebrovascular complications or delayed neurological impairment. We are reporting the case of a 36-year-old man who presented with a painless mass on the righ...

  8. Surgery efficacy assessment at carotid artery stenosis using ultrasound duplex scanning

    International Nuclear Information System (INIS)

    Sixty-two patients aged 43-84 with high-grade carotid stenosis who in 2003-2011 were performed carotid angioplasty and stent grafting (CAS), of them in 5 with carotid endarterectomy, were investigated. According to the protocol, ultrasound investigation was performed one week before the surgery, during week 1 after CAS and 6-8 months later

  9. Early detection of asymptomatic carotid disease in patients with arteriosclerotic occlusive disease of the lower extremities

    Directory of Open Access Journals (Sweden)

    Rančić Zoran S.

    2002-01-01

    Full Text Available Prevalence of asymptomatic carotid artery stenosis in patients with lower extremities atherosclerosis is relatively high. Limiting screening of specific subgroups for any demographic or medical characteristics is ineffective. Screening for asymptomatic carotid artery stenosis is indicated in all patients with lower extremities atherosclerosis except in whom prophylactic carotid endarterectomy is not recommended because of comorbid disease or extreme age.

  10. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... EVA3S was a trial performed in France randomizing patients, carotid artery stenting versus carotid endarterectomy in 40 centers. And the trial was stopped early for reasons of safety and futility. Next. Because the trial showed that ...

  11. Indium Labeled Platelet Deposition Following CO2 Laser Or Surgical Endarterectomy

    Science.gov (United States)

    McVicker, John H.; Day, Arthur L.; Seeger, James M.

    1989-09-01

    Endovascular damage from CO2, Nd:YAG, or argon laser can be considerable, causing reduced vascular biosynthesis of prostacyclin and precipitating platelet aggregation. However, the degree of platelet thrombus formation has not been directly quantified. Using Indium labeled platelets, platelet accumulation after low radiant energy CO2 laser endarterectomy was compared to accumulation after standard microsurgical endarterectomy in normal canine carotid arteries. Undisturbed adjacent segments from the same arteries served as controls. Platelet deposition (Indium activity per minute per milligram arterial tissue) was significantly greater on laser treated segments than on surgical (p=0.002) or control (p=0.002) segments. This confirms prior histologic evidence of increased acute platelet deposition after CO2 laser endarterectomy and suggests the need for further investigation of the thrombogenicity of laser angioplasty.

  12. [Traumatic dissection of the internal carotid artery by a safety belt: a report of two cases].

    Science.gov (United States)

    López-Sánchez, M; Ballesteros-Sanz, M A; Pérez-Ceballos, A; González-Fernández, C; López-Espadas, F

    2009-10-01

    Traumatic internal carotid artery dissection secondary to blunt trauma is a rare event accounting for 0.08 to 0.4% of all traumatic lesions. The spectrum of traumatic lesions that can affect the internal carotid artery includes minor lesions like spasm, intimal tears, or mural contusions and serious lesions like pseudoaneurysms and complete occlusion. Delayed clinical presentation is typical and can include headache, hemiparesis, partial Horner's syndrome, and cranial nerve palsy. Embolization secondary to the dissection can have devastating effects because it may cause ischemic stroke. Traumatic internal carotid artery dissection after safety belt trauma is very rare; it is usually due to direct cervical trauma on the side of the shoulder fixation point, which causes external bruising along the pathway of the safety belt. We present two cases of traumatic internal carotid artery dissection with concomitant cerebral infarcts caused by safety belts; we discuss the clinical, diagnostic, and therapeutic aspects of this lesion. PMID:19828398

  13. Dural carotid cavernous sinus fistula presenting as isolated oculomotor nerve palsy: Case report

    Directory of Open Access Journals (Sweden)

    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.

  14. Surgical treatment of a giant extracranial internal carotid artery aneurysm: A case report

    Directory of Open Access Journals (Sweden)

    Pasternak Janko

    2007-01-01

    Full Text Available Introduction. True aneurysms of the extracranial internal carotid artery are rare lesions. Surgical treatment is considered to be the best therapeutic option. However, the use of the intraluminal shunt remains controversial. Case report. We reported a case of a giant extracranial internal carotid artery aneurysm treated by reconstructive surgery. A 76-year-old woman was referred with a pulsatile mass inside her mouth, associated with dizziness and dysarthria. There was no history of cerebrovascular symptoms, neck pain, or cervical trauma. A magnetic resonance scan showed a 45 mm aneurysm of the internal carotid artery (ICA, and kinking of ICA. Angiography demonstrated a saccular ICA aneurysm, with a lengthening and tortuosity of the ICA. The aneurysm and the carotid artery branches were easily exposed through a standard anterior cervical incision. After resection of the aneurysm, a Javid shunt was inserted between the common and internal carotid arteries, and end-to-end repair of ICA was easily performed due to ICA redundancy. The aneurysm was of atherosclerotic origin. Four months after the operation, the patient showed a complete recovery from peripheral neurological deficit. Discussion. Our results show that surgical reconstruction is a satisfactory therapeutic choice in the management of extracranial carotid artery aneurysms in order to avoid rupture, thromboembolism and cerebrovascular insufficiency. To date, there has been little experience with endoluminal exclusion techniques and the long-term effectiveness is still uncertain. .

  15. Evaluation of carotid artery stenosis with three-dimensional CT angiography and surgical revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Ohtaki, Masafumi; Tanabe, Sumiyoshi; Uede, Teiji; Hashi, Kazuo [Sapporo Medical Univ. (Japan). School of Medicine

    1996-11-01

    The accuracy of three-dimensional CT angiography (3D-CTA) for delineating atherosclerotic carotid stenosis was examined in comparison with digital subtraction angiography (DSA) in symptomatic patients. In cases undergoing carotid endarterectomy (CEA), the clinical usefulness of 3D-CTA for surgical planning was also evaluated in the light of intraoperative findings. From July 1992 to Jun 1995, 52 patients suffering from internal carotid ischemia and/or presenting carotid bruit were evaluated to detect carotid bifurcation stenosis by 3D-CTA. Shaded surface reconstruction (SSR) for three-dimensional display and maximum intensity projection (MIP) were employed in multiple projection to evaluate sites of stenosis. DSA was performed in 18 out of 31 patients having atherosclerotic carotid stenosis shown by 3D-CTA. MIP reconstructions accurately delineated sites of stenosis close to DSA and allowed precise depiction of ulcerated plaque and intramural calcification. The percentage of carotid stenosis was determined by comparing the narrowest point to the internal carotid artery (ICA) beyond the bulb on both 3D-CTA and DSA. Assessment of carotid stenosis was highly correlated between 3D-CTA and DSA (r=0.987, p< 0.0001). In this series, 9 carotid arteries in 8 patients underwent CEA for severe stenosis. 3 patients with ICA occlusion and 1 patient with elongated severe stenosis underwent STA-MCA anastomosis. Using MIP reconstructions and two-dimensional original images it was found that ICA occlusion was apparently distinguished from high grade ICA stenosis. SSR provided valuable informations during CEA for atherosclerotic plaque regarding anatomical relationship with the internal jugular vein and bony structures. This advanced means of 3D-CTA can be adequate as a screening method to detect carotid stenosis in symptomatic patients and useful for surgical planning of CEA and post-operative follow-up examination. (author)

  16. Evaluation of carotid artery stenosis with three-dimensional CT angiography and surgical revascularization

    International Nuclear Information System (INIS)

    The accuracy of three-dimensional CT angiography (3D-CTA) for delineating atherosclerotic carotid stenosis was examined in comparison with digital subtraction angiography (DSA) in symptomatic patients. In cases undergoing carotid endarterectomy (CEA), the clinical usefulness of 3D-CTA for surgical planning was also evaluated in the light of intraoperative findings. From July 1992 to Jun 1995, 52 patients suffering from internal carotid ischemia and/or presenting carotid bruit were evaluated to detect carotid bifurcation stenosis by 3D-CTA. Shaded surface reconstruction (SSR) for three-dimensional display and maximum intensity projection (MIP) were employed in multiple projection to evaluate sites of stenosis. DSA was performed in 18 out of 31 patients having atherosclerotic carotid stenosis shown by 3D-CTA. MIP reconstructions accurately delineated sites of stenosis close to DSA and allowed precise depiction of ulcerated plaque and intramural calcification. The percentage of carotid stenosis was determined by comparing the narrowest point to the internal carotid artery (ICA) beyond the bulb on both 3D-CTA and DSA. Assessment of carotid stenosis was highly correlated between 3D-CTA and DSA (r=0.987, p< 0.0001). In this series, 9 carotid arteries in 8 patients underwent CEA for severe stenosis. 3 patients with ICA occlusion and 1 patient with elongated severe stenosis underwent STA-MCA anastomosis. Using MIP reconstructions and two-dimensional original images it was found that ICA occlusion was apparently distinguished from high grade ICA stenosis. SSR provided valuable informations during CEA for atherosclerotic plaque regarding anatomical relationship with the internal jugular vein and bony structures. This advanced means of 3D-CTA can be adequate as a screening method to detect carotid stenosis in symptomatic patients and useful for surgical planning of CEA and post-operative follow-up examination. (author)

  17. Análise do comportamento do hemometabolismo cerebral durante endarterectomia carotídea com pinçamento transitório Análisis del comportamiento del hemometabolismo cerebral durante endarterectomia carotídea con pinzamiento transitorio Analysis of brain hemometabolism behavior during carotid endarterectomy with temporary clamping

    Directory of Open Access Journals (Sweden)

    Gastão Fernandes Duval Neto

    2004-04-01

    hipóxia oliguemica o desacoplamiento hemometabólico. El objetivo del presente estudio fue identificar las alteraciones del hemometabolismo cerebral, evaluados por medio de las alteraciones de la saturación de la oxihemoglobina en el bulbo de la vena yugular interna (SjO2, durante endarterectomia carotídea con pinzamiento, correlacionando esas alteraciones con factores con potencialidad de interferir con las mismas, principalmente la presión de CO2 expirada (P ET CO2 y la presión de perfusión cerebral (PPC. MÉTODO: Participaron del estudio 16 pacientes con enfermedad estenosante unilateral y sometidos al pinzamiento arterial transitorio durante endarterectomia carotídea. Los parámetros monitorizados (saturación de la oxihemoglobina en el bulbo de la vena yugular interna, stump pressure y la presión de CO2 expirado fueron analizados en los siguientes momentos: M1 - pre-pinzamiento; M2 - 3 minutos pos-pinzamiento; M3 - pre-despinzamiento; M4 - pos-despinzamiento. RESULTADOS: La comparación entre la SjO2 (%, Media ± DP en los períodos estudiados evidenció una diferencia entre la registrada en los momentos M1 (52,25 ± 7,87 y M2 (47,43 ± 9,19. Esa reducción inicial estabilizó durante el pinzamiento transitorio, con disminución en la comparación entre M2 y M3 (46,56 ± 9,25, sin significado estadístico (p = ns. En la fase pos despinzamiento, M4 (47,68 ± 9,12, la media de la SjO2 presentó una elevación, cuando comparada con los momentos de pinzamiento M2 e M3, más inferior al momento pre-pinzamiento M1 (M4 x M1 - p BACKGROUND AND OBJECTIVES: 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

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

    International Nuclear Information System (INIS)

    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

  19. Endovascular therapeutic occlusion following bilateral carotid artery bypass for radiation-induced carotid artery blowout. Case report

    International Nuclear Information System (INIS)

    A patients with breast cancer received radiation therapy to the upper chest wall. Twenty-two years later, she presented with repeated severe bleeding through a left lower neck ulcer. She was taken to surgery for hemostasis, which was not successful because the carotid artery was surgically inaccessible. To manage for explosive carotid blowout, we performed common carotid artery ligation and endovascular coil embolization after contralateral-external-carotid to ipsilateral-common-carotid artery bypass with a polytetrafluoroethylene (PTFE) graft. The patients has experienced no ischemic events or bleeding since this treatment. (author)

  20. Spontaneous internal carotid dissection in a 38-year-old woman: a case report

    Directory of Open Access Journals (Sweden)

    Kareem Abed

    2015-10-01

    Full Text Available This case report describes a patient found to have amaurosis fugax as a result of non-traumatic internal carotid dissection. Monocular blindness can be due to multiple causes including keratitis, acute glaucoma, vitreous hemorrhage, uveitis, retinal vascular occlusion, retinal detachment, optic neuropathy, trauma, or vascular malformations. In the setting of headache, neck pain, and an otherwise normal ophthalmic examination, this case report highlights the importance of recognizing transient ischemic attack and carotid artery dissection in the differential diagnosis. To further clarify the diagnosis, carotid ultrasound may aid diagnosis as was seen in this case, where decreased internal carotid artery velocities were found and subsequent CT angiography of the neck confirmed a diagnosis of carotid dissection. If a dissection is present, progression of symptoms may indicate impending cerebral infarction and warrant immediate attention. Antiplatelet therapy is the first-line treatment with anticoagulation, thrombolysis, and surgery reserved for cases of recurrent, progressive symptomatic episodes. Surgical options include endovascular repair such as angioplasty, stent placement, embolization, surgical revascularization, and bypass.

  1. Spontaneous internal carotid dissection in a 38-year-old woman: a case report.

    Science.gov (United States)

    Abed, Kareem; Misra, Amit; Vankawala, Viren

    2015-01-01

    This case report describes a patient found to have amaurosis fugax as a result of non-traumatic internal carotid dissection. Monocular blindness can be due to multiple causes including keratitis, acute glaucoma, vitreous hemorrhage, uveitis, retinal vascular occlusion, retinal detachment, optic neuropathy, trauma, or vascular malformations. In the setting of headache, neck pain, and an otherwise normal ophthalmic examination, this case report highlights the importance of recognizing transient ischemic attack and carotid artery dissection in the differential diagnosis. To further clarify the diagnosis, carotid ultrasound may aid diagnosis as was seen in this case, where decreased internal carotid artery velocities were found and subsequent CT angiography of the neck confirmed a diagnosis of carotid dissection. If a dissection is present, progression of symptoms may indicate impending cerebral infarction and warrant immediate attention. Antiplatelet therapy is the first-line treatment with anticoagulation, thrombolysis, and surgery reserved for cases of recurrent, progressive symptomatic episodes. Surgical options include endovascular repair such as angioplasty, stent placement, embolization, surgical revascularization, and bypass. PMID:26486115

  2. Standardization of the reports for carotid artery stenting

    International Nuclear Information System (INIS)

    Objective: Stroke is one of the leading causes of death. Carotid occlusive disease is responsible for 25% of the ischemic strokes. Surgical carotid endarterectomy has been accepted as the best management for the extracranial caroid occlusive disease. However, in recent years, with the development of the endovascular technology, carotid artery stenting becomes more and more popular accompanied by increase of articles in this field correspondingly. The practical difficulty exists in comparison between the carotid stenting and endarterectomy through randomized controlled trials. Standardized report including trial design, patient selection, outcomes, statistical disposition thus become extremely necessary. This article gives a detailed description concerning about the patient selection, pretreatment evaluation, treatment description, curative effect evaluation and complications of carotid artery stenting. The purpose of this article is to standardize the reports of carotid stenting so that the descriptive and statistical data from different authors and agents can be compared. (authors)

  3. Diagnostic workup in carotid stenosis - a neurologist's perspective

    International Nuclear Information System (INIS)

    Carotid artery stenosis is associated with the risk of stroke, myocardial infarction, and vascular death. In selected patients, revascularization of carotid narrowing by endarterectomy may reduce the risk of stroke distal to the stenosis. Carotid artery stenting has evolved as a potential alternative to endarterectomy. Four randomized clinical trials comparing safety and efficacy of endarterectomy versus stenting of symptomatic carotid stenosis have been published in recent years, but there remains some uncertainty about the implications of these trials for clinical routine. Both carotid stenting and endarterectomy are based on different treatment strategies which may result in different specific risk factors associated with each procedure. Hence, the procedural risk of either modality varies not only with the skills of the surgeon or the interventionalist but may depend on patient characteristics. It appears that the most important question is not whether one revascularization modality is superior but for which patient one modality is better than the other. A comprehensive diagnostic workup of patients with carotid stenosis based on a broad panel of covariates that affect the risk of vascular events may improve selection of patients for carotid revascularization and may help to decide for whom one revascularization modality is likely to be better than the other. (orig.)

  4. Cataract surgery in a case of carotid cavernous fistula

    Directory of Open Access Journals (Sweden)

    Akshay Gopinathan Nair

    2014-01-01

    Full Text Available A carotid-cavernous fistula (CCF is an abnormal communication between the cavernous sinus and the carotid arterial system. The ocular manifestations include conjunctival chemosis, proptosis, globe displacement, raised intraocular pressure and optic neuropathy. Although management of CCF in these patients is necessary, the ophthalmologist may also have to treat other ocular morbidities such as cataract. Cataract surgery in patients with CCF may be associated with many possible complications, including suprachoroidal hemorrhage. We describe cataract extraction surgery in 60-year-old female with bilateral spontaneous low-flow CCF. She underwent phacoemulsification via a clear corneal route under topical anesthesia and had an uneventful postoperative phase and recovered successfully. Given the various possible ocular changes in CCF, one must proceed with an intraocular surgery with caution. In this communication, we wish to describe the surgical precautions and the possible pitfalls in cataract surgery in patients with CCF.

  5. Carotid angioplasty and stenting in the elderly

    International Nuclear Information System (INIS)

    To investigate the technical success rate as well as the procedural and mid-term complication rates of carotid angioplasty and stenting in elderly patients, a group excluded from large randomized endarterectomy trials given their perceived high surgical risk. Of 200 consecutive carotid angioplasty and/or stenting procedures performed between March 1996 and March 2005, 21 procedures were performed without cerebral protection devices in 20 patients over the age of 79 years (mean age: 83 years, 12 men, eight women). These patients' medical records were retrospectively reviewed for vascular imaging reports and available clinical follow-up. Procedural and mid-term complication rates were calculated and compared to a previously published cohort of 133 consecutive patients ≤79 years of age who also underwent endovascular treatment at our institution. Carotid stenosis was reduced from a mean of 82% to no significant stenosis in all procedures. The procedural stroke rate was zero of 21 procedures. The procedural transient ischemic attack rate (TIA) was one of 21 procedures (4.8%). Mean follow-up was 24.6 months (range: 1.0-79.5 months) with at least a 30-day follow-up for 20 of the 21 procedures (95.2%). There were no new strokes. There was one recurrent ipsilateral TIA at 1.9 months. In five cases with follow-up carotid ultrasonography, no hemodynamically significant restenosis had occurred. There were three myocardial infarctions (MI) occurring at 0.5, 2.1, and 15.2 months, of which the last MI was fatal. The composite 30-day stroke and death rate was zero of 21 procedures (95% confidence interval: 0-14%). No significant difference was found in the 30-day rate of stroke, TIA, MI, or death between the elderly and younger patients. Carotid angioplasty and stenting in elderly patients can be performed successfully with acceptable procedural and mid-term complication rates comparable to younger patients. (orig.)

  6. Anaesthetic challenges in carotid body tumour resection: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Anuradha Malliwal

    2015-12-01

    Full Text Available Carotid body tumour (CBT is an extremely rare, non-chromaffin paraganglioma arising from chemoreceptor cells at the carotid bifurcation. Reported incidence is 1-2 per 100,000. Surgical excision of the tumour, the definitive treatment, poses several anaesthetic challenges and a high incidence of perioperative morbidity and mortality (20-40%. Very few cases have been reported so far. We report the anaesthetic management of a case of CBT excision with a review of recent literature on the same. [Int J Res Med Sci 2015; 3(12.000: 3897-3900

  7. Carotid intervention: stent or surgery? A prospective audit

    OpenAIRE

    Robbs, JV; Mulaudzi, T; Paruk, N; Pillay, B; Rajaruthnam, P

    2009-01-01

    Summary This study represents a prospective audit comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA), performed by a single surgical team. Between January 2005 and December 2008, 440 patients were referred; 177 had CAS and 263 CEA. Selection of procedure was individualised and contra-indications for CAS included internal carotid artery (ICA) stenosis > 85–90%, intraluminal thrombus, ICA tortuosity, gross surface ulceration of plaque and excessive calcification. Type III...

  8. Computed tomography angiography in the investigation of carotid stenosis

    International Nuclear Information System (INIS)

    The assessment of carotid atherosclerotic disease is an essential pre-requisite for determining a patients suitability for carotid endarterectomy to prevent ischaemic stroke. Catheter angiography is regarded as the most accurate investigative tool for this purpose. However, with its finite morbidity and invasiveness, there is an increasing reliance upon non-invasive methods to accurately assess carotid disease. We present a review of the technique and applications of computed tomography angiography. Goddard, A.J. P.et al. (2001)

  9. Computed tomography angiography in the investigation of carotid stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Goddard, A.J.P.; Mendelow, A.D.; Birchall, D

    2001-07-01

    The assessment of carotid atherosclerotic disease is an essential pre-requisite for determining a patients suitability for carotid endarterectomy to prevent ischaemic stroke. Catheter angiography is regarded as the most accurate investigative tool for this purpose. However, with its finite morbidity and invasiveness, there is an increasing reliance upon non-invasive methods to accurately assess carotid disease. We present a review of the technique and applications of computed tomography angiography. Goddard, A.J. P.et al. (2001)

  10. A case of carotid dissection having significant benefit from thrombolytic treatment

    Directory of Open Access Journals (Sweden)

    Sibel Güler

    2016-01-01

    Full Text Available Ischemic stroke due to carotid artery dissection is more common among young people and it accounts about 2-5% of all strokes. A 56 year old left landed male patient was evaluated for left-sided hemiparesis and aphasia in the emergency department. His cranial CT was assessed normal and NIH score was assessed 24 then he undergone thrombolytic therapy. His NIH score was decreased to 14 after 24 hours. At extracranial dupplex USG, cranial MRI and MR-Angiography, done the same day there were findings for carotid dissection. At MR-anjio repeated 5 days later, partial recanalization were seen. At control cranial CT only striocapsüler infarct was seen. There was no any evidence of bleeding as complication. Here we present a rare case of extracranial carotid artery dissection case undergone IV thrombolytic therapy and want to take attention that in carotid dissection IV thrombolytic therapy is quiet safe and there is no difference of complication such as hemorrhage and the prognosis is no different then those with no carotid dissection.

  11. [Spontaneous dissection of the internal carotid artery: description of a case with lower cranial nerve palsy].

    Science.gov (United States)

    Macarini, Luca; Zeppa, Pio; Genovese, Eugenio Annibale; Scialpi, Michele; Raucci, Antonio

    2012-11-01

    Spontaneous dissection of the extracranial internal carotid artery is a well recognized cause of headache and juvenile stroke; lower cranial nerve palsy as a complication of dissection is rare. We report the case of a female patient with bilateral dissecting aneurysm of the internal carotid artery, associated with unilateral cranial nerve XII palsy and oculosympathetic palsy. Neuroradiological findings, in particular those obtained by Magnetic Resonance imaging, allow the identification of the dissecting pathology and the correlation of the aneurysmal formation with nerve palsy. PMID:23096747

  12. Recurrent malignant carotid body tumor: report of one case and review of the literature

    Institute of Scientific and Technical Information of China (English)

    ZHENG Jia-wei; ZHU Han-guang; YUAN Rong-tao; LI Jiang; WANG Li-zhen; ZHANG Shan-yong; ZHANG Zhi-yuan

    2005-01-01

    @@ Carotid body tumor (CBT) is a rare tumor, which is composed of chromaffin cells, groups of cells associated with the autonomous system, occurring at the carotid bifurcation. This tumor grows slowly, usually with a history of several years and seldom undergoes malignant transformation. The majority of CBT are benign, only few cases of malignant CBTs were reported in the literature.1-3 Over a period of 10 years (1993-2004), 28 patients with CBT were diagnosed and surgically treated in the Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Stomatology, Shanghai Jiaotong University, only one was proven both clinically and histopathologically to be malignant CBT. This paper reports this unusual patient with recurrent malignant carotid body tumor as well as cervical lymph node metastases and reviews the relevant literature.

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

    International Nuclear Information System (INIS)

    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

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

    International Nuclear Information System (INIS)

    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)

  15. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

    International Nuclear Information System (INIS)

    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

  16. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

    Energy Technology Data Exchange (ETDEWEB)

    Köklü, Erkan, E-mail: drerkankoklu@gmail.com; Arslan, Şakir; Yüksel, İsa Öner; Bayar, Nermin [Antalya Education and Research Hospital, Clinic of Cardiology (Turkey); Koç, Pınar [Antalya Education and Research Hospital, Clinic of Radiology (Turkey)

    2015-08-15

    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.

  17. Transvenous embolization of indirect carotid-cavernous fistula via upper ophthalmic/facial vein - Case report and literature review

    International Nuclear Information System (INIS)

    Indirect carotid-cavernous fistula or dural arterio-venous fistula of cavernous sinus is relatively rare pathologic finding. Different classifications of carotid-cavernous fistulae are proposed. Now days more and more they are treated by endovascular approach. A case of authors' practice of transvenous embolization of carotid-cavernous fistula via upper ophthalmic vein in 52 year old female is presented with review of the literature. A week later ocular symptoms of the patient regressed. Control angiography at the third month follow up does not visualize fistula. The transvenous approach in management of carotid cavernous fistulae is safe and effective in cases direct arterial approach is absent or technically impossible. Key words: Indirect Carotid-Cavernous Fistula. Embolization. Transvenous Approach

  18. The 10-year Trend of Periprocedural Complication Following Carotid Artery Stenting; Single Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jeong-Ho [Keimyung University Dongsan Medical Center, Department of Neurology (Korea, Republic of); Kang, Jihoon; Yeo, Min-Ju; Kim, Beom Joon; Jang, Min Uk; Bae, Hee-Joon [Seoul National University College of Medicine, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital (Korea, Republic of); Kwon, O-Ki; Hwang, Gyo Jun; Oh, Chang Wan [Seoul National University Bundang Hospital, Department of Neurosurgery (Korea, Republic of); Jung, Cheolkyu [Seoul National University Bundang Hospital, Department of Radiology (Korea, Republic of); Lee, Ji Sung [Soonchunhyang University Medical Center, Biostatistical Consulting Unit (Korea, Republic of); Han, Moon-Ku, E-mail: mkhan@snu.ac.kr [Seoul National University College of Medicine, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital (Korea, Republic of)

    2015-04-15

    PurposeCarotid endarterectomy and stenting are used to treat carotid stenosis, with the volume of carotid artery procedures increasing over the past decade. We investigated the 10-year trend of periprocedural complications with an increasing procedure volume of carotid stenting at a single tertiary hospital.MethodsWe collected 416 consecutive cases (384 patients) of carotid artery stenting performed for either symptomatic (231 cases, 55.5 %) or asymptomatic (185 cases, 44.5 %) internal carotid artery stenosis at a single center. Periprocedural complication was defined as any stroke, myocardial infarction, or death. Procedure-related outcome included any dissection, hemodynamic event, or periprocedural complication.ResultsThe mean age was 68.8 years (82.8 % males; range of 20–89 years); 23.9 % were older than 75 years. Before the procedure, 99.3 and 56.0 % of patients received antiplatelet and lipid-lowering medication, respectively. The overall periprocedural complication rate was 3.6 % (1.6 and 5.2 % in the asymptomatic and symptomatic group, respectively). The composite outcome of any stroke or death was 3.4 %. Periprocedural complication and procedure-related outcome showed a decremental trend with increasing procedure volume, and this trend remained after adjusting for confounders.ConclusionsOur study suggests that carotid stenting at an experienced center might reduce the periprocedural complications. Our periprocedural complication rate of carotid artery stenting may be comparable to, or somewhat lower than, that reported in other clinical trials.

  19. Spontaneous internal carotid dissection in a 38-year-old woman: a case report

    OpenAIRE

    Abed, Kareem; Misra, Amit; Vankawala, Viren

    2015-01-01

    This case report describes a patient found to have amaurosis fugax as a result of non-traumatic internal carotid dissection. Monocular blindness can be due to multiple causes including keratitis, acute glaucoma, vitreous hemorrhage, uveitis, retinal vascular occlusion, retinal detachment, optic neuropathy, trauma, or vascular malformations. In the setting of headache, neck pain, and an otherwise normal ophthalmic examination, this case report highlights the importance of recognizing transient...

  20. Delayed rupture of common carotid artery following rugby tackle injury: a case report

    Directory of Open Access Journals (Sweden)

    Abbas Saleh

    2008-03-01

    Full Text Available Abstract Background Common Carotid Artery (CCA is an uncommon site of injury following a blunt trauma, its presentation with spontaneous delayed rupture is even more uncommon and a rugby tackle leading to CCA injury is a rare event. What makes this case unique and very rare is combination of all of the above. Case presentation Mr H. presented to the Emergency Department with an expanding neck haematoma and shortness of breath. He was promptly intubated and had contrast CT angiography of neck vessels which localized the bleeding spot on posteromedial aspect of his Right CCA. He underwent emergency surgery with repair of the defect and made an uneventful recovery post operatively. Conclusion Delayed post traumatic rupture of the CCA is an uncommon yet potentially life threatening condition which can be caused by unusual blunt injury mechanism. A high index of suspicion and low threshold for investigating carotid injuries in the setting of blunt trauma is likely to be beneficial.

  1. Giant Serpentine Internal Carotid Artery Aneurysm: Endovascular Parent Artery Occlusion: A Pediatric Case Report

    OpenAIRE

    Prochazka, V.; Chmelova, J.; Cizek, V.; Skoloudik, D.; Hrbac, T.

    2007-01-01

    We report on a case of a 14-year-old boy with a giant serpentine aneurysm of the left internal carotid artery cavernous segment with symptoms of acute mass-effect cranial nerve dysfunction. After a balloon occlusion test of the collateral circulation, the patient underwent parent artery occlusion with platinum Guglielmi detachable coils and fibered coils. An optimal angiographic result and successful clinical outcome were achieved with resolution of IIIrd, IVth and Vlth cranial nerve ischemic...

  2. CT angiography and Color Doppler ultrasonography features and sensitivity in detection of carotid arteries diseases

    Directory of Open Access Journals (Sweden)

    Samir Kamenjaković

    2013-04-01

    Full Text Available Introduction: The aim of this research was to compare specifi city and sensitivity of Color Doppler ultrasonographywith CT angiography.Methods: A total of one hundred patients suffering from carotid artery disease (n=200 were tested in this research in the period from June till October, 2011. Average age of the patients was 61.5 years, and most of the patients were in the age group ranging from 55 to 65 years. The level of carotid artery stenosis is measured according to Standards of the North America Symptomatic Carotid Endarterectomy Trail study,by method of Color Doppler ultrasonography and CT angiography.Results: Stenosis <50% registered by Doppler ultrasonography was found in 62% and by CT angiography in 64% patients. Stenosis from 70 to 79% registered by Doppler ultrasonography was found in 88% and by CT angiography in 82% patients. In patients with level of stenosis 70-79% there was a tendencyof registering the stenosis to be higher by Color Doppler ultrasonography, than by CT angiography. In the case of the occlusion, there was also the similar observation, with variation of 8% carotid arteries.Conclusion: Extracranial Doppler and color duplex ultrasound enable reliable detection of both stenosis and occlusion of carotid arteries and accordingly they occupy an important place in radiological algorithm. When it comes to CT angiography it can be concluded that it can provide accurate and exact information regarding the condition of blood vessels as good as Digital Subtractive Angiography can.

  3. Acute ischaemic stroke secondary to a mobile thrombus in the common carotid artery - case report

    Directory of Open Access Journals (Sweden)

    Bajkó Zoltán

    2015-04-01

    Full Text Available A mobile thrombus in the carotid arteries is a very rare ultrasonographic finding and is usually diagnosed after a neurological emergency, such as a transient ischemic attack or cerebral infarction. We present the case of a 54-year-old man with vascular risk factors (a heavy smoker, untreated hypertension who was admitted to the emergency unit with right sided hemiparesis and aphasia. A cerebral CT scan showed a left middle cerebral artery territory infarction. The duplex ultrasound examination revealed mild atherosclerotic changes in the right common and internal carotid arteries, right-sided complete subclavian steal phenomenon and a complicated hypoechoic atherosclerotic plaque in the left common carotid artery with a large mobile thrombus. Due to the high embolization risk, the patient was hospitalised and prescribed Aspirin together with low molecular weight Heparin. We recorded an improvement in the patient’s neurological status and the control duplex scan revealed disappearance of the thrombus. The presence of floating thrombus in a patient with clinical and imagistic evidence of stroke is a major therapheutic challenge for the neurologist. The treatment strategies are not standardized and must be individualized, however in our case parenteral anticoagulation proved to be successful.

  4. Diagnostic workup in carotid stenosis - a neurologist's perspective

    Energy Technology Data Exchange (ETDEWEB)

    Rosenkranz, Michael; Gerloff, Christian [University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg (Germany)

    2010-07-15

    Carotid artery stenosis is associated with the risk of stroke, myocardial infarction, and vascular death. In selected patients, revascularization of carotid narrowing by endarterectomy may reduce the risk of stroke distal to the stenosis. Carotid artery stenting has evolved as a potential alternative to endarterectomy. Four randomized clinical trials comparing safety and efficacy of endarterectomy versus stenting of symptomatic carotid stenosis have been published in recent years, but there remains some uncertainty about the implications of these trials for clinical routine. Both carotid stenting and endarterectomy are based on different treatment strategies which may result in different specific risk factors associated with each procedure. Hence, the procedural risk of either modality varies not only with the skills of the surgeon or the interventionalist but may depend on patient characteristics. It appears that the most important question is not whether one revascularization modality is superior but for which patient one modality is better than the other. A comprehensive diagnostic workup of patients with carotid stenosis based on a broad panel of covariates that affect the risk of vascular events may improve selection of patients for carotid revascularization and may help to decide for whom one revascularization modality is likely to be better than the other. (orig.)

  5. Angiographic features of unilateral nonbifurcating cervical carotid artery: A case report

    International Nuclear Information System (INIS)

    Nonbifurcating cervical carotid artery is a rare anomaly of the common carotid artery (CCA), in which the branches of the external carotid artery (ECA) arise directly from the CCA or proximal internal carotid artery without bifurcation, and therefore there is no proximal main trunk of the ECA. We report a unilateral nonbifurcating cervical carotid artery of a 67-year-old woman, incidentally found during cerebral aneurismal treatment

  6. Angiographic features of unilateral nonbifurcating cervical carotid artery: A case report

    Energy Technology Data Exchange (ETDEWEB)

    En, Na Lae [Dept. of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Seung Koo [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-08-15

    Nonbifurcating cervical carotid artery is a rare anomaly of the common carotid artery (CCA), in which the branches of the external carotid artery (ECA) arise directly from the CCA or proximal internal carotid artery without bifurcation, and therefore there is no proximal main trunk of the ECA. We report a unilateral nonbifurcating cervical carotid artery of a 67-year-old woman, incidentally found during cerebral aneurismal treatment.

  7. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... embolization. And that was some of the early work that was -- helped define the work when we compared carotid endarterectomy to maximum medical ... a larger catheter, which will allow us to work from that and keep a very stable environment ...

  8. Endovascular treatment of radiation-induced carotid blowout syndrome. Report of two cases

    International Nuclear Information System (INIS)

    Carotid Blowout Syndrome (CBS), or Carotid Artery Rupture (CAR), is a delayed complication with potentially fatal consequences occurring after the implementation of radiotherapy on head and neck tumors. In this report we describe two patients received endovascular treatment for severe hemorrhagic CBS developing 36 and 2 years, respectively, after radiotherapy. Both patients survived and responded positively to treatment. Case 1 was an 80-year-old woman found with minor hemorrhage near the bifurcation of the common carotid artery, 36 years after neck irradiation. She experienced frequent hemorrhagic events during the following years. Six years after the initial discovery of bleeding, she experienced massive hemorrhage, lapsed into shock, and was admitted to an Emergency Room. Connective tissue around the carotid artery was largely exposed due to neck skin defect. After hemorrhage was halted by manual compression, transient hemostasis was achieved with coil embolization of the aneurysm presumed to be the source of bleeding. Recurrent hemorrhage developed two weeks later with unraveled coil mass extrusion. Parent artery occlusion was performed by endovascular trapping, achieving permanent hemostasis. Case 2 presented massive nasal bleeding originating from the petrous segment of the internal carotid artery, 2 years after having been treated with heavy particle irradiation for olfactory neuroblastoma. Ischemic tolerance was confirmed by balloon occlusion test. Based on previous experiences, the bleeding was immediately halted by endovascular trapping. Both patients were subsequently discharged, free of new neurological symptoms. Emergent hemostatic treatment is required in CBS developing severe hemorrhage. However, within irradiation fields, temporal embolization devices hardly lead to complete resolution. This is due to the deteriorated condition of the vascular wall incapable to enduring the expansion power of coils, stents or balloons. Bypass grafting is also

  9. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    Science.gov (United States)

    Aktuerk, Dincer; Mishra, Pankaj Kumar; Luckraz, Heyman; Garnham, Andrew; Khazi, Fayaz Mohammed

    2016-01-01

    Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO2, etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our “work in progress,” and we aim to conduct a larger study. PMID:26750675

  10. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    Directory of Open Access Journals (Sweden)

    Dincer Aktuerk

    2016-01-01

    Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

  11. Stroke prevention-surgical and interventional approaches to carotid stenosis

    Directory of Open Access Journals (Sweden)

    Kumar Rajamani

    2013-01-01

    Full Text Available Extra cranial carotid artery stenosis is an important cause of stroke, which often needs treatment with carotid revascularization. To prevent stroke recurrence, carotid endarterectomy (CEA has been well-established for several decades for symptomatic high and moderate grade stenosis. Carotid stenting is a less invasive alternative to CEA and several recent trials have compared the efficacy of the 2 procedures in patients with carotid stenosis. Carotid artery stenting has emerged as a potential mode of therapy for high surgical risk patients with symptomatic high-grade stenosis. This review focuses on the current data available that will enable the clinician to decide optimal treatment strategies for patients with carotid stenosis.

  12. The relationship between the angiographic findings and the clinical features of carotid artery plaque.

    Science.gov (United States)

    Kim, D I; Lee, S J; Lee, B B; Kim, Y I; Chung, C S; Seo, D W; Lee, K H; Ko, Y H; Kim, D K; Do, Y S; Byun, H S

    2000-01-01

    The purpose of this study was to investigate the histological characteristics of atheromatous carotid plaque, and to analyze the relationship between the angiographic findings and the clinical features. We retrospectively reviewed 55 cases of carotid endarterectomy for extracranial internal carotid artery stenosis, who were treated at our institute from January 1995 to December 1997. The histological examination included hematoxylin-eosin staining, Masson-trichrome staining, and immunostaining for antismooth muscle antibody and anti-CD68 antibody. The main compositions of the carotid plaque included synthetic type vascular smooth muscle cells and extracellular matrix. The histological findings showed ulceration in 49 (89.1%) cases, calcium deposits in 42 (76.4%) cases, and an inflammatory reaction in 44 (80.0%) cases. Neurological abnormalities were strongly associated with plaque ulceration (P = 0.045) and an inflammatory reaction (P = 0.013), whereas no correlation existed regarding calcium deposits (P = 0.173). The angiographic findings showed ulceration in 46 (83.6%) cases. Plaque ulceration in the angiography findings showed no statistically significant correlation with the histologic findings (P = 0.410) and preoperative neurologic abnormalities (P = 0.059). All of the atherosclerotic risk factors such as hypertension, smoking, diabetes mellitus, hyperlipidemia, and myocardial infarction had no statistically significant correlation with the histological features of the carotid plaque. In conclusion, the main compositions of carotid plaque were synthetic-type vascular smooth muscle cells and extracellular matrix. The histological ulceration and inflammatory reaction of the plaque showed a statistically significant correlation with the preoperative neurologic symptoms, whereas no correlation was seen in the calcium deposits. Angiographic ulceration showed no correlation with the histological findings or preoperative neurologic abnormalities. In addition, the

  13. MRI-based Biomechanical Modeling of Carotid Atherosclerotic Plaques: The stable plaque paradigm

    OpenAIRE

    Nieuwstadt, Harm

    2015-01-01

    markdownabstract__Abstract__ Carotid atherosclerosis is a common cause of acute ischemic stroke and places a major burden on worldwide health-related quality of life. The currently-used stenosis-degree guidelines to decide on surgical intervention through carotid endarterectomy in order to prevent a future event are imperfect. This is because they insufficiently target plaque vulnerability. To provide an alternative carotid plaque vulnerability assessment, one can compute the biomechanical pe...

  14. In-vivo Attenuation and Equivalent Scatterer size parameters for Atherosclerotic Carotid Plaque: Preliminary Results

    OpenAIRE

    Shi, Hairong; Varghese, Tomy; Mitchell, Carol C; McCormick, Matthew; Dempsey, Robert J; Kliewer, Mark A.

    2009-01-01

    We have previously reported on the equivalent scatterer size, attenuation coefficient, and axial strain properties of atherosclerotic plaque ex-vivo. Since plaque structure and composition may be damaged during a carotid endarterectomy procedure, characterization of in-vivo properties of atherosclerotic plaque is essential. The relatively shallow depth of the carotid artery and plaque enables non-invasive evaluation of carotid plaque utilizing high frequency linear array transducers. We inves...

  15. 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.)

  16. Exploration of cervical carotid stenosis using helical CT angiography. A prospective trial on the detection of candidates for surgery in the Gujo area, Gifu

    International Nuclear Information System (INIS)

    To detect cervical carotid stenosis as a candidate for carotid endarterectomy (CEA), the authors attempted a prospective trial by exploring stenosis for one year in a rural district with a population of 20,000, employing helical CT angiography which apparently displayed three-dimensional reconstructed images of the carotid bifurcation. Thirty-three patients, 24 males and 9 females, with a mean age of 71.8 years, suffering from TIA, RIND or stroke were investigated for their carotid systems. The clinical symptoms of the patients were briefly as follows: motor weakness in 30 cases, dysarthria in 8 cases and aphasia in 4 cases; and 6 of 22 (27%) stroke cases had previously suffered an episode of TIA. The risk factors of the whole group of patients were hypertension in 13 cases, diabetes mellitus in 6, heart disease in 17, and hypercholesteremia in 4. Helical CT angiography was performed in 11 cases of TIA, 2 cases of RIND, and 16 cases of stroke. Only 3 cases of the TIA group and 3 cases of the stroke group were found to have extracranial carotid stenosis of more than 50%, which subsequently required conventional angiography. For the detection of stenosis, CT angiography was beneficial as well as conventional angiography. Finally, CEA was performed in 2 of 3 cases with severe carotid stonosis in the TIA group, while such cases in the stroke group were only observed. The above results meant that the occurrence of extracranial carotid stenosis was 6 out of 6,589 elderly inhabitants (over 60 years old), although the possible detection rate of candidates for CEA was 2 out of 20,000 population per year. (author)

  17. Exploration of cervical carotid stenosis using helical CT angiography. A prospective trial on the detection of candidates for surgery in the Gujo area, Gifu

    Energy Technology Data Exchange (ETDEWEB)

    Yamakawa, Hiroyasu; Sumi, Yasuhiko [Sumi Hospital, Gifu (Japan); Kaku, Yasuhiko; Sakai, Noboru; Yamada, Hiromu

    1995-04-01

    To detect cervical carotid stenosis as a candidate for carotid endarterectomy (CEA), the authors attempted a prospective trial by exploring stenosis for one year in a rural district with a population of 20,000, employing helical CT angiography which apparently displayed three-dimensional reconstructed images of the carotid bifurcation. Thirty-three patients, 24 males and 9 females, with a mean age of 71.8 years, suffering from TIA, RIND or stroke were investigated for their carotid systems. The clinical symptoms of the patients were briefly as follows: motor weakness in 30 cases, dysarthria in 8 cases and aphasia in 4 cases; and 6 of 22 (27%) stroke cases had previously suffered an episode of TIA. The risk factors of the whole group of patients were hypertension in 13 cases, diabetes mellitus in 6, heart disease in 17, and hypercholesteremia in 4. Helical CT angiography was performed in 11 cases of TIA, 2 cases of RIND, and 16 cases of stroke. Only 3 cases of the TIA group and 3 cases of the stroke group were found to have extracranial carotid stenosis of more than 50%, which subsequently required conventional angiography. For the detection of stenosis, CT angiography was beneficial as well as conventional angiography. Finally, CEA was performed in 2 of 3 cases with severe carotid stonosis in the TIA group, while such cases in the stroke group were only observed. The above results meant that the occurrence of extracranial carotid stenosis was 6 out of 6,589 elderly inhabitants (over 60 years old), although the possible detection rate of candidates for CEA was 2 out of 20,000 population per year. (author).

  18. An Unusual Origin of Proximal Coronary Bypass Anastomosis in a Patient with Carotid Disease

    Directory of Open Access Journals (Sweden)

    Dragan Nikolić

    2010-12-01

    Full Text Available Neurological complications constitute a major cause of morbidity and mortality following coronary artery bypass grafting. Extensive atherosclerosis of the aortic arch and carotid artery disease are associated with high incidence of stroke. Severe calcification of the ascending aorta (porcelain aorta is a very difficult condition in cardiac surgery because of high embolization potential during the process of cannulation, aortic cross-clamping, and is particularly difficult for suturing of proximal anastomosis. We describe a case of a 75-year-old male referred to our Clinic due to unstable angina. Further evaluation revealed a severe, high-grade multilevel fibrolipid symptomatic carotid stenosis, severe aortic valve stenosis and left anterior descending coronary artery stenosis and a highly calcified ascending aorta and aortic arch. We performed simultaneous carotid endarterectomy, revascularization of the left anterior descending coronary artery and aortic valve replacement. Proximal venous anastomosis was created in the left common carotid artery. The case suggests an alternative method for treating patients with severe aortic calcifications.

  19. Horner-s Syndrome following common carotid artery translocation in a horse: case report

    Directory of Open Access Journals (Sweden)

    C.M.M. Coelho

    2014-10-01

    Full Text Available Horner's syndrome (HS is a sympathetic dysfunction caused by injuries to the sympathetic pathway. A clinical case of HS following common carotid artery transposition and catheterization in a horse is described. The animal presented head and neck sweating with focal skin temperature elevation, facial paralysis and ptosis. Most clinical signs were transient and persisted for two hours following percutaneous catheter removal. Recurrence of clinical signs was observed at subsequent catheterizations. Ptosis endured for 10 months as a consequence of the first catheter placement which demonstrates the importance of careful manipulation of the anatomical structures of the neck when performing any surgical manipulation in this area.

  20. Bridge-therapy with enoxaparin in the preoperative period of endarterectomy.

    Science.gov (United States)

    Raso, Jair Leopoldo; Darwich, Rogério Zenóbio; Lucca Jr, Francisco de; Santana, Romeu Valle; Tanure, Marco Túlio; Cariri, Gustavo Agra; Furtado, Leopoldo Mandic Ferreira

    2010-10-01

    Cervical clot is one of the complications of endarterectomy. This risk may be higher in patients using aspirin or clopidogrel. On the other hand, stroke may occur if the medication is interrupted before surgery. We carried out a prospective study of 124 endarterectomies in 119 patients in which aspirin or clopidogrel was stopped and a bridge-therapy with enoxaparin was administered preoperatively. There was no case of stroke during the period of the bridge-therapy. One patient developed cervical clot (0.8%) in the fifth postoperative day. Mortality rate in this series was 0.8%. There was no complication directly related to the use of enoxaparin. Bridge-therapy with low molecular weight heparin is a safe strategy for patients elected for endarterectomy. PMID:21049192

  1. Hemiparesis in carotid cavernous fistulas (CCFs):a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    王慧晓; 白如林; 黄承光; 卢亦成; 张光霁

    2004-01-01

    @@ Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous anastamoses between the carotid artery and the cavernous sinus. These fistulas may be classified by cause (spontaneous or traumatic), flow velocity (high or low ), or pathogenesis (direct or indirect).

  2. A 64-year old man presenting with carotid artery occlusion and corticobasal syndrome: a case report

    Directory of Open Access Journals (Sweden)

    de Gans Jan

    2011-08-01

    Full Text Available Abstract Introduction Magnetic resonance imaging of the brain in patients with corticobasal degeneration typically shows focal or asymmetric atrophy, usually maximal in the frontoparietal cortex. Many patients who are diagnosed with corticobasal degeneration using current diagnostic criteria do not have classical corticobasal degeneration pathology. Our case is remarkable for the fact that the symptoms and the characteristic magnetic resonance imaging appearance were typical for corticobasal degeneration. However, we were quite convinced that the clinical picture had a vascular etiology. Only a few cases have been reported where the presumed cause for the corticobasal syndrome was multiple brain infarctions bilaterally. Case presentation A 64-year-old Caucasian man visited a neurologist because of profound asymmetric sensory and motor disturbances. A magnetic resonance imaging scan of his brain revealed occlusion of his internal carotid artery on the left side with multiple vascular lesions in his left hemisphere and notable atrophy of mainly the left parietal and frontal cortex. Conclusion We describe a patient with corticobasal syndrome caused by multiple infarctions, probably caused by emboli of the carotid stenosis. This patient illustrates the fact that the word 'syndrome' should be preferred above 'degeneration' in the name of this disease.

  3. Acquired infantile Horner syndrome and spontaneous internal carotid artery dissection: a case report and review of literature.

    Science.gov (United States)

    Pirouzian, Amir; Holz, Huck A; Ip, Kenneth C; Sudesh, Rattehalli

    2010-04-01

    Horner syndrome, a triad of ptosis, anisocoria, and anhidrosis, results from interruption in the oculosympathetic pathway. It is classically described as either congenital or acquired to depict its underlying pathophysiology and requisite work-up. We report a case of a 10-month-old infant presenting with an acute onset of left Horner syndrome secondary to a spontaneous extracranial internal carotid artery dissection. To the best of our knowledge, this is the first case report in the literature of acute onset of acquired infantile Horner syndrome in association with spontaneous carotid artery dissection confirmed with magnetic resonance angiogram. PMID:20451860

  4. Bilateral internal carotid artery dissection associated with prior syphilis: a case report and review of the literature.

    Science.gov (United States)

    Marangi, Antonio; Moretto, Giuseppe; Cappellari, Manuel; Micheletti, Nicola; Tomelleri, Giampaolo; Bovi, Paolo

    2016-01-01

    Bilateral internal carotid artery dissection is a rare entity, and its presentation may include cerebral ischemia. We describe the case of a 69-year-old man with ischemic stroke and radiological evidence of intimal flap of both internal carotid arteries suggestive for dissection. During the hospitalization, our patient was found positive for a previous syphilis infection. We conducted a review of the literature, with evidence of a few cases of ischemic stroke presumably related to a prior syphilis. The absence of major cardiovascular risk factors in our patient leads us to believe that an etiopathogenetic link may exist between these two conditions. PMID:27354805

  5. A Case of Severe Carotid Stenosis in a Patient with Familial Hypercholesterolemia without Significant Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Marcos Aurélio Lima Barros

    2014-01-01

    Full Text Available Familial hypercholesterolemia (FH is an inherited metabolic disorder characterized by elevated low-density lipoprotein cholesterol levels in the blood. In its heterozygous form, it occurs in 1 in 500 individuals in the general population. It is an important contributor to the early onset of coronary artery disease (CAD, accounting for 5–10% of cases of cardiovascular events in people younger than 50 years. Atherogenesis triggered by hypercholesterolemia generally progresses faster in the coronary arteries, followed by the subsequent involvement of other arteries such as the carotids. Thus, symptoms of CAD commonly appear before the onset of significant carotid stenosis. Herein, we report the case of a patient with untreated FH who had severe carotid atherosclerosis at the age of 46 years but had no evidence of significant CAD.

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

    International Nuclear Information System (INIS)

    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)

  7. Giant cavernous carotid aneurysm with spontaneous ipsilateral ICA occlusion: Report of 2 cases and review of literature

    Directory of Open Access Journals (Sweden)

    Savitr BV Sastri

    2013-01-01

    Full Text Available Giant aneurysms of the cavernous carotid artery are rare entities which present predominantly with features of compression of the adjacent neural structures, most commonly the III, IV, VI and V cranial nerves. Historically, treatment options included occlusion of the feeding vessel, direct surgery on the aneurysm, bypass procedures and in recent times, the use of endovascular devices. While intramural thrombus formation is commonly seen in giant aneurysms, we present 2 cases of giant cavernous aneurysms which on evaluation were found to have spontaneous occlusion of the feeding internal carotid artery secondary to thrombus formation, and review the available literature regarding the same.

  8. Cerebro-retinal ischemia after bilateral occlusion of internal carotid artery

    International Nuclear Information System (INIS)

    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.)

  9. Cutting Balloon-Assisted Angioplasty of an Anastomotic Carotid-Brachial Bypass Graft Stenosis: A Case Report

    International Nuclear Information System (INIS)

    Neointimal hyperplasia leads to anastomotic stenosis in bypass grafts. These stenoses are often resistant to conventional balloon dilatation. We present a case of a carotid-brachial bypass graft stenosis, which was treated by a 5-mm cutting balloon angioplasty with a good angiographic and clinical result

  10. Fifty-eight cases of ocular ischemic diseases caused by carotid artery stenosis

    Institute of Scientific and Technical Information of China (English)

    LUO Rong-jiang; LIU Shao-rui; LI Xiao-min; ZHUO Ye-hong; TIAN Zhen

    2010-01-01

    Background The blood supply to the eye comes from the retinal central vascular system of the ophthalmic artery and the ciliary vascular system. The ophthalmic artery stems from the ipsilateral internal carotid artery. If occlusion or stenosis occurs in the carotid artery, the blood perfusion to the ophthalmic artery becomes insufficient, leading to signs and symptoms of anterior and posterior ocular ischemia. The objective of this study was to evaluate the clinical characteristics and risk factors of ocular ischemic diseases caused by carotid artery stenosis.Methods This study was a retrospective review of 145 patients with carotid artery stenosis. Fifty-eight patients who had symptoms of ocular ischemic disease caused by carotid artery stenosis formed group A and the other 87 patients who only had carotid artery stenosis formed group B. We analyzed the causes and course of disease, and relative risk factors,by comparing the two groups.Results The degree of carotid artery stenosis in group A was higher than that in group B. And group A had a greater decrease of ophthalmic artery flow. Male, hypertension, hyperlipidemia, and smoking were significantly related to carotid artery stenosis. Amaurosis fugax was the most common ocular symptom in group A. The ocular ischemic diseases mainly included ischemic optic neuropathy, central/branch retinal artery occlusion, ophthalmoplegia externa, and ocular ischemic syndrome.Conclusions Carotid artery stenosis correlates with ocular ischemic diseases. Ophthalmologists must observe for ocular symptoms, which were the onset symptoms in some patients.

  11. Endovascular stenting for high risk patients with high grade internal carotid stenosis combined with occlusion of the contralateral carotid artery

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of endovascular therapy for high risk patients with high grade internal carotid artery stenosis combined with occlusion of the contralateral internal carotid artery. Methods: From October, 2000 to December, 2001, 8 patients with high grade stenosis of one internal carotid artery combined with occlusion of the other whose conditions were not suitable for carotid endarterectomy, were treated through endovascular approach. The stenotic degree of the lesions before procedures was (85.2±9.4)% (70%-98%). NIHSS was used to evaluate the neurological function before and after endovascular stenting, and modified Rakin scale was used before and 3 months after endovascular stenting. Carotid arterial ultrasound and transcranial Doppler (TCD) examinations were used before and 2 days, 3 months, 6 months, 12 months after procedure. The averaged follow-up duration was 9 months (6 - 14 months). Results: Predilation was made in 3 patients in whom the stenotic degree of the lesions was more than 90 %. Five Smart self-expanding stents and 3 Wallstent were applied in the 8 patients. All the procedures were technologically successful, and the residual stenosis after procedures were (5.3±2.2)% (5% - 9%). The carotid stenosis after procedure was improved significantly compared with that of preoperation (t = 4.79, P 0.05). Results of carotid ultrasound and TCD examinations showed that the stenotic arteries in which stents were placed were patent, the velocity of blood flow after procedures was markedly improved, and the blood perfusion improved not only at the procedure side but also at the carotid occlusive side in some patients. Neither new stroke nor TIA happened during the follow-up period. Conclusion: Endovascular stenting is an effective and safe method for the treatment of high risk internal carotid stenosis combined with occlusion of the contralateral internal carotid artery which is not suitable for carotid endarterectomy

  12. Postoperative Cervical Haematoma Complicated by Ipsilateral Carotid Thrombosis and Aphasia after Anterior Cervical Fusion: A Case Report

    Directory of Open Access Journals (Sweden)

    Kingsley R. Chin

    2013-01-01

    Full Text Available Hematoma alone is the most common vascular complication reported after anterior cervical decompression and fusion (ACDF. We present this case to report the occurrence of postoperative cervical hematoma complicated by ipsilateral carotid thrombosis and aphasia after an uncomplicated C4–6 ACDF. This is a case of a 65-year-old woman who underwent revision fusions of the C4-5 and C6-7 levels complicated by postoperative cervical hematoma and carotid thrombosis. The patient's history, clinical examination, imaging findings, and treatment are reported. The revision fusions were performed and deemed routine. Approximately eight hours later 200 mL of blood was evacuated from a postoperative cervical hematoma. The patient became unresponsive and disoriented a few hours after evacuating the hematoma. Computed tomography and magnetic resonance imaging of the brain were normal, but magnetic resonance angiography demonstrated total occlusion of the left carotid artery. Thrombectomy was performed and the patient was discharged without residual deficits. At the latest followup she is fully functional and asymptomatic in her neck. We suggest, after evacuating a cervical hematoma, an evaluation of the carotids be made with MRA or cerebral angiography, as this may demonstrate a clot before the patient develops symptoms.

  13. Advances in MRI for the evaluation of carotid atherosclerosis.

    Science.gov (United States)

    Makris, G C; Teng, Z; Patterson, A J; Lin, J-M; Young, V; Graves, M J; Gillard, J H

    2015-08-01

    Carotid artery atherosclerosis is an important source of mortality and morbidity in the Western world with significant socioeconomic implications. The quest for the early identification of the vulnerable carotid plaque is already in its third decade and traditional measures, such as the sonographic degree of stenosis, are not selective enough to distinguish those who would really benefit from a carotid endarterectomy. MRI of the carotid plaque enables the visualization of plaque composition and specific plaque components that have been linked to a higher risk of subsequent embolic events. Blood suppressed T1 and T2 weighted and proton density-weighted fast spin echo, gradient echo and time-of-flight sequences are typically used to quantify plaque components such as lipid-rich necrotic core, intraplaque haemorrhage, calcification and surface defects including erosion, disruption and ulceration. The purpose of this article is to review the most important recent advances in MRI technology to enable better diagnostic carotid imaging. PMID:25826233

  14. History of carotid surgery: from ancient greeks to the modern era.

    Science.gov (United States)

    Tallarita, Tiziano; Gerbino, Maurizio; Gurrieri, Carmelina; Lanzino, Giuseppe

    2013-12-01

    A relationship between decreased carotid arterial flow and apoplectic manifestations was already suspected by the ancient Greeks. Early attempts at carotid surgery, however, were limited to emergency arterial ligation in patients with neck trauma. Attempts to suture arterial stumps together to restore blood flow paved the way for Carrel's revolutionary idea of reconstructing the resected or injured arterial segment with an interposition vein graft. DeBakey and Eastcott were the first to perform carotid endarterectomy in North America and the United Kingdom, respectively. In 1959, DeBakey proposed a cooperative study to assess the effectiveness of carotid endarterectomy in the treatment and prevention of ischemic cerebrovascular disease. The study was officially designated the Joint Study of Extracranial Arterial Occlusion and represented the first trial in the United States in which large numbers of patients were randomly allocated to surgical or nonsurgical therapy. PMID:24357636

  15. Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT

    OpenAIRE

    Fisnik Jashari; Pranvera Ibrahimi; Elias Johansson; Jan Ahlqvist; Conny Arnerlöv; Maria Garoff; Eva Levring Jäghagen; Per Wester; Michael Y. Henein

    2015-01-01

    BACKGROUND AND AIM: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT). METHODS: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high ec...

  16. Carotid and femoral atherosclerotic plaques show different morphology. : Patterns of Peripheral Arterial Disease

    OpenAIRE

    Herisson, Fanny; Heymann, Marie-Françoise; Chétiveaux, Maud; Charrier, Céline; Battaglia, Séverine; Pilet, Paul; Rouillon, Thierry; Krempf, Michel; Lemarchand, Patricia; Heymann, Dominique; Gouëffic, Yann

    2011-01-01

    OBJECTIVE: Results of endovascular repair vary according to the arterial bed. We hypothesized that these differences may be related to the plaque features. To explore this hypothesis, we designed a prospective study that compared carotid and femoral atheroma. METHODS AND RESULTS: Patients that underwent femoral or carotid endarterectomy were included in our study. Demographic data and blood sampling were obtained prior to surgery. Plaques were evaluated for AHA grading, calcification and lipi...

  17. Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT

    Directory of Open Access Journals (Sweden)

    Fisnik Jashari

    2015-08-01

    Full Text Available Background and Aim: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT. Methods: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females, who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3 was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations. Results: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: <8; 8–35; 36–70 and >70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients. Conclusion: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification.

  18. Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT

    Science.gov (United States)

    Jashari, Fisnik; Ibrahimi, Pranvera; Johansson, Elias; Ahlqvist, Jan; Arnerlöv, Conny; Garoff, Maria; Levring Jäghagen, Eva; Wester, Per; Henein, Michael Y.

    2015-01-01

    Background and Aim: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT). Methods: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3) was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations. Results: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: 70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients. Conclusion: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification. PMID:26307978

  19. Monitoring Balloon Test Occlusion of the Internal Carotid Artery with Transcranial Doppler: A Case Report and Literature Review

    OpenAIRE

    Galego, Orlando; Nunes, César; Morais, Ricardo; Sargento-Freitas, João; Sales, Francisco; Machado, Egídio

    2014-01-01

    Angiographic balloon test occlusion (BTO) allows preoperative risk evaluation of patients undergoing permanent therapeutic occlusion of the internal carotid artery (ICA). The sensitivity of the BTO can be increased using different complementary techniques. Transcranial Doppler (TCD) stands out as a non-invasive, bedside method providing real-time monitoring of cerebral haemodynamics, therefore accurately identifying patients at risk of stroke. A case of a 30-year-old woman with a giant intrac...

  20. Cervical carotid pseudoaneurysm: A carotid artery stenting complication

    OpenAIRE

    Raso, Jair; Darwich, Rogerio; Ornellas, Carlos; Cariri, Gustavo

    2011-01-01

    Background: As carotid artery stenting becomes increasingly used, more complications are likely to occur. We present a case of Staphylococcus septicemia and pseudoaneurysm arising in the neck portion of the carotid artery after stenting. Case Description: A 51-year-old man was admitted with mild left hemiparesis. CT and MRI showed right hemisphere ischemia. Duplex Scan and MRA showed bilateral severe stenosis of the carotid arteries in the neck. A percutaneous angioplasty with stenting of the...

  1. Internal Carotid Artery Blister-Like Aneurysm Caused by Aspergillus – Case Report

    International Nuclear Information System (INIS)

    Blister-like aneurysm of the supraclinoid internal carotid artery (ICA) is a well-documented cause of subarachnoid hemorrhage. Generally, this type of aneurysm is associated with various conditions such as hypertension, arteriosclerosis, and ICA dissection. Although Aspergillus is the most common organism causing intracranial fungal aneurysmal formation, there is no report of a blister-like aneurysm caused by Aspergillus infection. An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus. Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4. Subsequent 3D computed tomography angiogram revealed a blister-like aneurysm at the superior wall of the left ICA. Six days later, the patient died of subarachnoid hemorrhage caused by the left ICA aneurysm rerupture. Autopsy revealed proliferation of Aspergillus hyphae in the wall of the aneurysm. Notably, that change was present more densely in the inner membrane than in the outer one. Thus, it was considered that Aspergillus hyphae caused infectious aneurysm formation in the left ICA via hematogenous seeding rather than direct invasion. The blister-like aneurysm is a rare but important cause of subarachnoid hemorrhage. This case report documents another cause of blister-like aneurysms, that is an infectious aneurysm associated with Aspergillus infection

  2. [Case of ruptured carotid-ophthalmic aneurysm splitting the optic nerve].

    Science.gov (United States)

    Sato, Taku; Sasaki, Tatsuya; Sakuma, Jun; Suzuki, Kyouichi; Matsumoto, Masato; Sato, Masanori; Itakura, Takeshi; Kodama, Namio

    2009-04-01

    A rare case of ruptured carotid-ophthalmic aneurysm splitting the optic nerve was reported. A 52-year-old man presented with a sudden severe headache and bilateral visual deterioration. His right visual acuity was hand motion and the left was 2.0. His left visual field revealed a partial defect of the temporal visual field. Three-dimensional CT angiography revealed an ophthalmic aneurysm of 9 mm projecting superior-medially, The operation was performed to preserve the visual function as much as possible. The C2 portion aneurysm splitting the right optic nerve was visible. Before aneurysm clipping, the right anterior clinoid process and optic canal were drilled out to reduce the tension of the optic nerve. Intraoperative monitoring of visual evoked potential (VEP) under propofol anesthesia was performed to prevent further visual disturbance. Electroretinogram (ERG) was introduced to ascertain the arrival of the light stimulus at the retina even when the VEP could not be recorded. The right ERG was recorded, but the right VEP was flat. Both ERG and VEP were reproducible on the left side. Six months after the operation, the right visual acuity had improved to 0.08 and the visual field revealed nasal hemianopsia. The left visual acuity was unchanged while the visual field had improved to upper temporal quadrant hemianopsia. Various attempts to preserve the visual function were discussed. PMID:19364029

  3. Sudden death due to rupture of the right internal carotid artery in neurofibromatosis type 1: A case report.

    Science.gov (United States)

    Liang, Yue; Tong, Fang; Zhang, Lin; Li, Wenhe; Zhou, Yiwu

    2016-07-01

    Vascular involvement is a well-recognized manifestation of neurofibromatosis type 1 (NF1) which has the potential to be fatal when disrupted. We here present a case of sudden death due to the fatal arterial rupture resulted from infiltration of the neurofibromas. A 42-year-old man who suffered from NF1 presented a 1-h history of sudden onset of pain in his right cervical region. His condition worsened and became unconscious on his way to the emergency room. Despite resuscitation efforts, he died 30min later without regaining consciousness. Autopsy examination showed that a neurofibroma located around the right internal carotid artery, confirmed immunohistochemically with S-100, vimentin and CD34. Furthermore, proliferation of spindle cells positive for S-100 was seen in the wall of right internal carotid artery, which was disrupted and resulted in a hemorrhage. These findings suggest that the artery was disrupted by neurofibromas in the vascular wall, which led to fragility of the vessel. On the basis of these findings, we concluded that the cause of death was asphyxia resulting from airway obstruction compressed by the hematoma due to the arterial rupture. As the locality of the neurofibroma and hemorrhage were closed to the carotid baroreflex, we considered another possible mechanism of his sudden death, which could be cardiac inhibition induced by vagal stimulation. We hope this case will increase recognition of NF-1 vasculopathy when encountering any sudden death in NF1 patients. PMID:27497331

  4. Aterofisiol® in carotid plaque evolution

    Directory of Open Access Journals (Sweden)

    Amato B

    2015-07-01

    Full Text Available Bruno Amato,1,2,* Rita Compagna,1,2,* Maurizio Amato,2 Luca Gallelli,3 Stefano de Franciscis,1,4,* Raffaele Serra1–4,*1Interuniversity Center of Phlebolymphology (CIFL, International Research and Educational Program in Clinical and Experimental Biotechnology, University Magna Graecia of Catanzaro, Catanzaro, 2Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, 3Department of Health Sciences, University of Catanzaro, Catanzaro, 4Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy*These authors contributed equally to this workBackground: In patients with carotid stenosis, the risk of plaque rupture is related to the composition of the atherosclerotic plaque rather than to its magnitude. In this regard, we evaluated the effects of a supplement, Aterofisiol,® containing omega-3 (EPA [eicosapen acid] DHA [docosahexaenoic acid], vitamin K2, vitamin B6, vitamin B12, oligomeric proanthocyanidins (OPC and resveratrol on the composition of atherosclerotic plaque and on neurological symptoms in patients with carotid stenosis undergoing carotid endarterectomy.Methods: The study was randomized, prospective, and double-blinded. Eligible patients were of both sexes, with carotid stenosis >70% who underwent endarterectomy. Enrolled patients were randomly allocated to receive either one tablet of acetylsalicylic acid 100 mg (Cardioaspirin® + one tablet of Aterofisiol every 24 hours or one tablet of Cardioaspirin + one tablet of placebo every 24 hours. Each treatment was started 30 days before the surgery and was stopped 5 days before the surgery. The plaques were removed “en bloc” using standard surgical technique.Results: During the study period, 214 patients (135 men and 79 women were enrolled for intent-to-treat and randomized in two groups: Group A: 107 patients (68 men and 39 women were treated with Cardioaspirin + Aterofisiol. Group B: 107 patients (67 men and 40

  5. Indium-111-labeled platelet scintigraphy in carotid atherosclerosis

    International Nuclear Information System (INIS)

    We evaluated platelet accumulation in carotid arteries by means of a dual-radiotracer method, using indium-111-labeled platelets and technetium-99m-labeled human serum albumin, in 123 patients (92 men, 31 women; median age 60 years). Sixty patients had symptoms of transient ischemic carotid artery disease, and 63 patients with peripheral arterial occlusive disease served as controls. Antiplatelet treatment with acetylsalicylic acid was taken by 53 of the 123 patients. In 36 of the 60 symptomatic patients, platelet scintigraphy was repeated 3-4 days after carotid endarterectomy. Comparison of different scintigraphic parameters (platelet accumulation index and percent of the injected dose of labeled platelets at the carotid bifurcation) showed no significant differences between symptomatic and asymptomatic patients, and the severity of stenosis and the presence of plaque ulceration also had no influence on the parameters. There was no difference between patients with a short (less than 4 weeks) or long (greater than 4 weeks) interval from the last transient ischemic attack to scintigraphy and no difference between patients with or without antiplatelet treatment. Classifying the patients according to plaque morphology judged by high-resolution real-time ultrasonography also demonstrated no differences. No significant correlation was found between any scintigraphic parameter and other platelet function parameters such as platelet survival time, platelet turnover rate, and concentration of platelet-specific proteins. Quantification of platelet deposition after carotid endarterectomy in 36 patients demonstrated a significant increase of the median platelet accumulation index and the percent injected dose index

  6. A Case of In-Stent Neoatherosclerosis 10 Years after Carotid Artery Stent Implantation: Observation with Optical Coherence Tomography and Plaque Histological Findings

    OpenAIRE

    Matsumoto, Hiroyuki; YAKO, Rie; Masuo, Osamu; HIRAYAMA, Katsuhisa; Uematsu, Yuji; Nakao, Naoyuki

    2013-01-01

    We report a patient's case of slow progressive in-stent restenosis 10 years after bare-metal stent implantation to his carotid artery. We treated the patient with an additional stent placement under a distal filter protection device. Optical coherence tomographic assessment and plaque histology during the carotid artery stenting (CAS) revealed atheromatous change at in-stent neointima, which contained lipid-rich plaque and calcification deposits. These findings suggest that in-stent neoathero...

  7. Clinical and Imaging Features Associated with an Increased Risk of Late Stroke in Patients with Asymptomatic Carotid Disease

    DEFF Research Database (Denmark)

    Naylor, A R; Schroeder, T V; Sillesen, H

    2014-01-01

    target CEA/CAS. METHODS: Review of clinical and/or imaging based scoring systems, predictive algorithms and imaging parameters that may be associated with an increased (or decreased) risk of stroke in patients with asymptomatic carotid disease. RESULTS: Parameters associated with an increased risk of......BACKGROUND: The 2011 American Heart Association Guidelines on the management of asymptomatic carotid disease recommends that carotid endarterectomy (CEA) (with carotid artery stenting (CAS) as an alternative) may be considered in highly selected patients with 70-99% stenoses. However, no guidance...... randomized trials in order to identify a "high risk for stroke" cohort in whom CEA/CAS could be prioritized....

  8. Data on TREM-1 activation destabilizing carotid plaques.

    Science.gov (United States)

    Rao, Velidi H; Rai, Vikrant; Stoupa, Samantha; Subramanian, Saravanan; Agrawal, Devendra K

    2016-09-01

    The data described herein are related to the article entitled "Tumor necrosis factor-α regulates triggering receptor expressed on myeloid cells-1-dependent matrix metalloproteinases in the carotid plaques of symptomatic patients with carotid stenosis" (Rao et al., 2016) [1]. Additional data are provided on the dose-response effect of TNF-α, TREM-1 antibody and recombinant rTREM-1/Fc fusion chimera (TREM-1/FC) on the expression of MMP-1 and MMP-9 in vascular smooth muscle cells (VSMCs) isolated from human carotid endarterectomy tissues. Data are also presented on the distribution of CD86+ M1- and CD206+ M2-macrophages and their co-localization with TREM-1 in symptomatic carotid plaques as visualized by dual immunofluorescence. The interpretation of this data and further extensive insights can be found in Rao et al. (2016) [1]. PMID:27331093

  9. [Unilateral visual field defect due to optic nerve compression by sclerotic internal carotid artery: a case report].

    Science.gov (United States)

    Uchino, M; Nemoto, M; Ohtsuka, T; Kuramitsu, T; Isobe, Y

    1999-02-01

    A case of unilateral visual field defect due to optic nerve compression by a sclerotic internal carotid artery was reported. A 71-year-old woman was admitted to our department because of constricted visual field of the right eye. MRI showed elevation of the right optic nerve compressed by an internal carotid artery. The right carotid angiography revealed elevation and distortion of the C1-2 portion. Frontal craniotomy was carried out and the optic nerve was visualized on this side. The right optic nerve was found to have been compressed by the sclerotic internal carotid artery. The optic canal was then unroofed. The post-operative course was uneventful. The visual field was improved. When last seen 6 months after surgery, her visual field remained in the improved condition. Nasal field abnormalities are most frequently encountered in retinal and anterior optic nerve pathology. Our success in improving the visual field disturbance may be accounted for by the fact that the preoperative period was short and the operation was performed before atrophy of ocular fundi occurred. Nasal field loss caused by intracranial lesions of the optic pathway is rare. It is probably impossible to determine degree of the symptomatology caused by direct-pressure compression as opposed to that caused by ischemia secondary to occlusion of small arterial supply branches. Vascular compressive neuropathy of optic nerve should not be diagnosed simply by the radiological finding of the optic nerve dislocation. However, optic nerve compression by surrounding arteries should be remembered as one of the possible causes of visual field defect which needs to be treated surgically. PMID:10065453

  10. Derivação carótido-carotídea por via retrofaríngea: seguimento tardio Retropharyngeal carotid-carotid crossover bypass: late follow-up

    Directory of Open Access Journals (Sweden)

    Newton Roech Aerts

    2005-01-01

    Full Text Available Existem diversas opções para o tratamento da doença oclusiva dos troncos supra-aórticos, de acordo com a apresentação clínica e a localização das lesões arteriais. As abordagens cervicais são aceitas como alternativas de baixa morbimortalidade, com elevada perviedade em longo prazo. Os autores relatam um caso tratado com sucesso através de derivação carótido-carotídea cruzada por via retrofaríngea associada à endarterectomia da bifurcação carotídea. São discutidos também os aspectos clínicos e as opções cirúrgicas ou endovasculares para o melhor tratamento desses pacientes.A variety of therapeutic options are available to manage the disease of supra-aortic trunks based on clinical presentations and anatomic location of the arterial lesions. The cervical approach is accepted as having low morbidity and mortality with elevated long-term patency. The authors report a successfully treated case of carotid-carotid crossover bypass by the retropharyngeal route associated with endarterectomy of carotid bifurcation. We also discuss clinical aspects, and surgical or endovascular options for the best treatment of these patients.

  11. A Retrospective Study of Combined Cardiac and Carotid Surgery

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2012-08-01

    Full Text Available Introduction: A combined carotid endarterectomy (CEA and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG and carotid endarterectomy (CEA procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male underwent combined operations (CEA-CABG on cardiopulmonary bypass (CPB as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2% had both venous and arterial revascularization; Group B: 8 patients (8.8% had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%, eversion (39.2%, patch enlargement (6%. Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A, where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6% and 2 had acute myocardial infarction (AMI (2.2%. There were 8 in-hospital deaths (8.8% and 1 late death (for stroke after five months. Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological

  12. [Spontaneous intracranial internal carotid artery dissection: 6 case reports and a review of 39 cases in the literature].

    Science.gov (United States)

    Nagumo, Kiyomi; Nakamori, Akitoshi; Kojima, Shigeyuki

    2003-06-01

    Angiographic, CT and MR findings, precipitating factors, and clinical features of spontaneous intracranial internal carotid artery dissection, in particular the terminal segment of the ICA, are described. Patients who had a possible posttraumatic dissection were excluded from the study. Six patients, 3 men and 3 women, mean age 25.8 years, were studied. Spontaneous ICA dissection accounted for 0.63 percent of 797 patients with ischemic stroke and 14 percent of 36 patients with ischemic stroke who were 45 years of age or younger. Headache was absent in two but clearly preceded the onset of cerebral stroke in four patients, the interval ranging from less than a few minutes to 6 hours. Focal cerebral ischemic symptoms were present in all six patients. Four presented with loss of consciousness. Only one patient had a subarachnoid hemorrhage (SAH). Dissection occurred at the level of the carotid knee portion just beyond the origin of the ophthalmic artery in all the patients. Moreover, there was additional involvement of the ipsilateral MCA in four and ipsilateral ACA in three. Angiographic features of the six ICAs that involved dissection were a smooth tapered luminal narrowing or occlusion in two patients, irregular narrowing in three, a pearl and string sign in one, and retention of the contrast media in three. Follow up angiography or magnetic resonance (MR) angiography was performed on all the patients. The interval from the initial to follow-up angiography was one to six months. Stenosis persisted in one artery but was resolved in the other five arteries. MR angiography showed segmental narrowing of the right supraclinoid internal carotid artery in one patient. MR angiographic source images showed a narrow lumen in the right intracavernous portion of the ICA and a crescent-shaped filling defect. Follow-up MR imaging and MR angiography, 6 months after the initial study, showed amelioration of the luminal narrowing and no filling defect. The filling defect is

  13. Assessment of 320-slice computed tomography angiography in distinguishing hemorrhage in carotid atherosclerotic plaques

    OpenAIRE

    Zhang, Xiao-Jie; Yu, Wei; Tao BI; Zi-xu YAN; Feng-ru SHI; SUN, Li-yuan; Zhao-qi ZHANG

    2014-01-01

    Objective To assess the value of 320⁃slice computed tomography angiography (CTA) in distinguishing hemorrhage/thrombus from lipid-rich necrotic core (LRNC) in atherosclerotic plaques of carotid artery. Methods Thirty-seven subjects who prepared to perform carotid endarterectomy (CEA), with stenosis rate about 50%-99% in at least unilateral carotid artery detected by ultrasound, were enrolled in this study. Both 320-slice CTA and 3.0T high-resolution MRI were conducted within one week before o...

  14. Intravascular treatment of a cavernous fistula by rupture of a traumatic carotid trigeminal aneurysm. Case reports

    Energy Technology Data Exchange (ETDEWEB)

    Flandroy, P.; Collignon, J.; Lacour, P.; Marsault, C.; Stevenaert, A.

    1987-05-01

    The authors report the particular treatment of a traumatic cavernous fistula caused by the rupture of an exceptional lesion: a false aneurysm of the C5 segment of the right carotid artery situated at the origin of a persistent trigeminal artery.

  15. Accordion effect during carotid artery stenting. Report of two cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Tsutsumi, Masanori; Kazekawa, Kiyoshi; Onizuka, Masanari; Aikawa, Hiroshi; Iko, Minoru; Kodama, Tomonobu; Nii, Kouhei; Matsubara, Shuko; Etou, Housei; Tanaka, Akira [Fukuoka University Chikushi Hospital, Department of Neurosurgery, Fukuoka (Japan)

    2007-07-15

    The term ''accordion effect'' is used to describe a mechanical distortion of tortuous arteries mimicking spasm or dissection. This phenomenon has been reported in patients undergoing percutaneous coronary intervention. To our knowledge, this is the first documentation of the accordion effect during carotid artery intervention. Two patients who developed the accordion effect during carotid artery stenting (CAS) are described. Angiograms obtained just after CAS showed a stenosing lesion with wall irregularity at the distal part of the stent. This lesion disappeared and tortuosity of the internal carotid artery developed after withdrawing the guidewire until its floppy segment rested equally on the lesion. In another patient, the lesion did not disappear completely until the guiding catheter had been withdrawn to the proximal portion of the common carotid artery. We conclude that these stenosing lesions reflected the accordion effect. It is essential to differentiate the accordion effect from dissection, spasm, and thrombosis because the management is importantly different. We report our findings and present a review of the literature. (orig.)

  16. Longitudinal assessment of carotid atherosclerosis after Radiation Therapy using Computed Tomography: A case control Study

    Energy Technology Data Exchange (ETDEWEB)

    Anzidei, Michele [Rome Univ. ' ' La Sapienza' ' (Italy). Dept. of Radiology; Suri, Jasjit S.; Piga, Mario [AtheroPoint TM LLC, Roseville, CA (United States). Monitoring and Diagnostic Div.; Global Biomedical Technologies, Inc., CA (United States). Point of Care Devices; Idaho Univ., Moscow, ID (United States). Electrical Engineering Dept.; Saba, Luca [Azienda Ospedaliero Universitaria (A.O.U.), Cagliari (Italy). Dept. of Radiology; Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria (A.O.U.), Cagliari (Italy). Dept. of Vascular Surgery; Laddeo, Giancarlo [New York Univ. Langone Medical Center, New York, NY (United States). Dept. of Radiology; Argiolas, Giovanni Maria [Azienda Ospedaliera Brotzu, Cagliari (Italy). Dept. of Radiology; Raz, Eytan [Rome Univ. ' ' La Sapienza' ' (Italy). Dept. of Radiology; New York Univ. Langone Medical Center, New York, NY (United States). Dept. of Radiology

    2016-01-15

    To study the carotid artery plaque composition and its volume changes in a group of patients at baseline and 2 years after head and neck radiation therapy treatment (HNXRT). In this retrospective study, 62 patients (41 males; mean age 63 years; range 52-81) who underwent HNXRT and 40 patients (24 males; mean age 65) who underwent surgical resection of neoplasm and did not undergo HNXRT were assessed, with 2-year follow-up. The carotid artery plaque volumes, as well as the volume of the sub-components (fatty-mixed-calcified), were semiautomatically quantified. Mann-Whitney and Wilcoxon tests were used to test the hypothesis. In the HNXRT group, there was a statistically significant increase in the total volume of the carotid artery plaques (from 533 to 746 mm{sup 3}; p = 0.001), in the fatty plaques (103 vs. 202 mm{sup 3}; p = 0.001) and mixed plaque component volume (328 vs. 419 mm{sup 3}; p = 0.034). A statistically significant variation (from 21.8 % to 27.6 %) in the percentage of the fatty tissue was found. of this preliminary study suggest that HNXRT promotes increased carotid artery plaque volume, particularly the fatty plaque component. (orig.)

  17. Coronary endarterectomy in left anterior descending artery combined with coronary artery bypass grafting – midterm mortality and morbidity

    Science.gov (United States)

    Domaradzki, Wojciech; Krauze, Jolanta; Kinasz, Leszek; Jankowska-Sanetra, Justyna; Świątkiewicz, Małgorzata; Paradowski, Krzysztof; Cisowski, Marek

    2015-01-01

    Introduction Completeness of myocardial revascularization is essential in surgical treatment of coronary artery disease. The aim of this study is to determine the effectiveness of coronary endarterectomy as an adjunct to coronary artery bypass grafting (CABG) in the most difficult cases. Material and methods Among 1559 patients who had CABG in our department, the cases of 17 who underwent an adjunct left anterior descending endarterectomy were analyzed. All procedures were performed with median sternotomy, extracorporeal circulation and in mild hypothermia (34°C), by the same surgeon. No coronary artery endarterectomy was planned before surgery. Results There was no infarction or cardiac arrest during hospitalization. Only one patient required mechanical circulatory support (intra-aortic balloon counterpulsation). Each patient was contacted and investigation for major adverse cardiac and cerebrovascular events (MACCE) was performed. Eleven patients (65%) already underwent midterm clinical evaluation. There was no death, myocardial infarction or cerebrovascular incident during the entire period (mean follow-up at 15.3 months). One patient required urgent coronarography due to chest pain. No other patient had chest pain or significant deterioration of ventricular function in echocardiography. Conclusions Outcomes and potential indications for performing left anterior descending coronary endarterectomy as an adjunct to CABG are discussed. PMID:26855644

  18. Development of Indirect Cavernous Dural Arteriovenous Fistula after Trapping for Direct Carotid Cavernous Fistula: A Case Report

    OpenAIRE

    YOSHINO, H.; Ishihara, H.; Oka, F.; S. Kato; M. Suzuki

    2011-01-01

    A 60-year-old man with direct carotid cavernous fistula (CCF) due to a motor vehicle accident underwent internal carotid artery trapping following high-flow external carotid to internal carotid artery bypass (EC-IC bypass). Follow-up angiography revealed ipsilateral complex indirect cavernous arteriovenous fistula. Although the traumatic indirect CCF angioarchitecture differs from cavernous-sinus dural arteriovenous fistula (CS-DAVF), the present indirect fistula was similar to the latter. Co...

  19. Carotid artery stenosis. Current state of therapy; Karotisstenose. Aktueller Stand der Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, K.I.; Papanagiotou, P.; Zimmer, A.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany); Schaefers, H.J. [Universitaetsklinikum des Saarlandes, Klinik fuer Thorax- und Herz-Gefaess-Chirurgie, Homburg/Saar (Germany)

    2010-07-15

    Ipsilateral occlusive or embolizing carotid artery stenoses are found in 20-30% of all cases of ischemic stroke. Several randomized studies revealed endarterectomy to be the gold standard in the therapy of severe symptomatic (NASCET, ESCT) and to some extent of asymptomatic carotid stenoses (ACAS, ACST). Stent angioplasty has been established as an alternative therapeutic option although non-inferiority of this procedure has not yet been proven. We provide an overview of both procedures as well of the state of current trials. (orig.) [German] Okkludierende oder embolisierende Stenosen der A. carotis interna sind in 20-30% der Faelle fuer einen ipsilateralen ischaemischen Schlaganfall verantwortlich. Nach Abschluss mehrerer randomisierter Studien erscheint die Karotisendarteriektomie als Therapie der Wahl bei hochgradigen symptomatischen (NASCET, ESCT) und z. T. auch asymptomatischen Stenosen (ACAS, ACST). Seit einigen Jahren hat sich die (Stent-)Angioplastie zunehmend als Therapiealternative etabliert, auch wenn die bislang veroeffentlichten Studien die Gleichwertigkeit beider Verfahren noch nicht zeigen konnten. Wir geben einen Ueberblick ueber beide Verfahren sowie ueber die derzeitige Studienlage. (orig.)

  20. Optical detection of structural changes in human carotid atherosclerotic plaque

    Science.gov (United States)

    Korol, R. M.; Canham, P. B.; Finlay, H. M.; Hammond, R. R.; Quantz, M.; Ferguson, G. G.; Liu, L. Y.; Lucas, A. R.

    2005-08-01

    Background: Arterial bifurcations are commonly the sites of developing atherosclerotic plaque that lead to arterial occlusions and plaque rupture (myocardial infarctions and strokes). Laser induced fluorescence (LIF) spectroscopy provides an effective nondestructive method supplying spectral information on extracellular matrix (ECM) protein composition, specifically collagen and elastin. Purpose: To investigate regional differences in the ECM proteins -- collagen I, III and elastin in unstable plaque by analyzing data from laser-induced fluorescence spectroscopy of human carotid endarterectomy specimens. Methods: Gels of ECM protein extracts (elastin, collagen types I & III) were measured as reference spectra and internal thoracic artery segments (extra tissue from bypass surgery) were used as tissue controls. Arterial segments and the endarterectomy specimens (n=21) were cut into 5mm cross-sectional rings. Ten fluorescence spectra per sampling area were then recorded at 5 sites per ring with argon laser excitation (357nm) with a penetration depth of 200 μm. Spectra were normalized to maximum intensity and analyzed using multiple regression analysis. Tissue rings were fixed in formalin (within 3 hours of surgery), sectioned and stained with H&E or Movat's Pentachrome for histological analysis. Spectroscopy data were correlated with immunohistology (staining for elastin, collagen types I, III and IV). Results: Quantitative fluorescence for the thoracic arteries revealed a dominant elastin component on the luminal side -- confirmed with immunohistology and known artery structure. Carotid endarterectomy specimens by comparison had a significant decrease in elastin signature and increased collagen type I and III. Arterial spectra were markedly different between the thoracic and carotid specimens. There was also a significant elevation (pcarotid specimens. Conclusion: Fluorescence spectroscopy is an effective method for evaluating ECM (collagen and elastin) associated

  1. Carotid Artery Screening

    Science.gov (United States)

    ... Resources Professions Site Index A-Z Carotid Artery Screening What is carotid artery screening? Who should consider ... about carotid artery screening? What is carotid artery screening? Screening examinations are tests performed to find disease ...

  2. Comparison among ultrasonography, multidetector-row CT and MRA for precise diagnosis of carotid stenosis

    International Nuclear Information System (INIS)

    We evaluated lesions at the common carotid artery bifurcation and in the internal carotid artery of patients with carotid stenosis employing carotid ultrasonography, multidetector-row CT (MDCT) and magnetic resonance angiography (MRA). We calculated the degree of stenosis with both the area methods and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) methods. The findings of MDCT and MRA were analyzed with reconstruction images as the multiplanar reconstruction (MPR) and maximum intensity projection (MIP). In the short axis area method, we recognized a strong correlation in stenosis rates between MDCT and MRA, and between MRA and ultrasonography. In the NASCET methods, a correlation of stenosis rates was noted only between MDCT and MRA. We recognized a correlation only between MRA and ultrasonography by the short axis area method in the calcification group. It is inferred that MDCT is as useful as the other two methods. (author)

  3. [Treatment of a ruptured giant internal carotid artery pseudoaneurysm following transsphenoidal surgery: case report and literature review].

    Science.gov (United States)

    Hattori, Itaro; Iwasaki, Koichi; Horikawa, Fumihiko; Tanji, Masahiro; Gomi, Masanori

    2006-11-01

    We report here a case of giant internal carotid artery (ICA) pseudoaneurysm as a complication of transsphenoidal surgery. This 50-year-old acromegalic male presented to our clinic with a status of hypovolemic shock due to serious epistaxis. Neuroradiological examinations at his admission revealed a giant aneurysm in the right cavernous portion projecting into the sphenoid sinus. Eight years before this presentation, he had undergone a transsphenoidal surgery for growth hormone producing pituitary tumor at the other clinic. Then intraoperative arterial bleeding was reported, probably as a result of carotid injury. His medical history and radiological findings suggested that his epistaxis resulted from a rupture of the iatrogenic pseudoaneurysm which had gradually grown after the ICA injury at the previous surgery over 8 years. Emergent coil embolization using Guglielmi detachable coils (GDCs) resulted in a successful homeostasis. Major part of the aneurysm dome was obliterated via the intervention, however small part of the aneurysm neck was unable to be obliterated due to a technical difficulty. His postoperative course was favorable, but he suffered from a recurrence of serious epitaxis 4 weeks after the embolization. Emergent angiography suggested a rupture of the un-obliterated aneurysm neck remnant. Thus, trapping of the aneurysm combined with high flow bypass was necessitated. Relevant literatures are reviewed, and possible therapeutic strategies for this rare lesion are discussed. PMID:17087269

  4. Bridge-therapy with enoxaparin in the preoperative period of endarterectomy Terapia-ponte com enoxaparina no período pré-operatório da endarterectomia

    OpenAIRE

    Jair Leopoldo Raso; Rogério Zenóbio Darwich; Francisco de Lucca Jr; Romeu Valle Santana; Marco Túlio Tanure; Gustavo Agra Cariri; Leopoldo Mandic Ferreira Furtado

    2010-01-01

    Cervical clot is one of the complications of endarterectomy. This risk may be higher in patients using aspirin or clopidogrel. On the other hand, stroke may occur if the medication is interrupted before surgery. We carried out a prospective study of 124 endarterectomies in 119 patients in which aspirin or clopidogrel was stopped and a bridge-therapy with enoxaparin was administered preoperatively. There was no case of stroke during the period of the bridge-therapy. One patient developed cervi...

  5. Bilateral indirect carotid cavernous fistula post trivial injury- A case report

    Institute of Scientific and Technical Information of China (English)

    Siti Hajar Mat Abu; Hanizasurana Hashim; Tara Mary George; Norfariza Ngah; Adil Hussein

    2013-01-01

    Fifty-seven years old Malay lady, post menopausal with co-morbid of diabetes mellitus and hypertension presented with three months history of bilateral painful red eyes associated with double vision. Examination revealed both eyes proptosis, corkscrew vessels with present of bruit, secondary narrow angle with raised intraocular pressure, 6th cranial nerve palsy, and bilateral venous stasis retinopathy. CT angiogram showed bilateral dilated superior ophthalmic veins with cerebral angiogram findings of bilateral indirect carotid cavernous fistula involving small meningeal vessels. Indirect or dural cavernous sinus Fistula can easily be missed or misdiagnosed. Trivial injury especially in the predisposing patient can initiate the occurrence.

  6. The accuracy of noninvasive imaging techniques in diagnosis of carotid plaque morphology

    International Nuclear Information System (INIS)

    The stroke is leading cause of death and severe disability worldwide. Atherosclerosis is responsible for over 30% of all ischemic strokes. It has been recently discovered that plaque morphology may help predict the clinical behavior of carotid atherosclerosis and determine the risk of stroke. The noninvasive imaging techniques have been developed to evaluate the vascular wall in an attempt to identify 'vulnerable plaques'. The purpose of the study is to investigate the diagnostic accuracy of ultrasound, multidetector computed tomography and magnetic resonance imaging in the identification of plaque components associated with plaque vulnerability. One hundred patients were admitted for carotid endarterectomy for high grade carotid stenosis. We defined the diagnostic value of B-mode ultrasound of carotid plaque in a half, and the accuracy of multidetector computed tomography and magnetic resonance imaging, in the other group, for detection of unstable carotid plaque. The reference standard was histology. Sensitivity of ultrasound, multidetector computed tomography and magnetic resonance imaging is 94%, 83% and 100%, and the specificity is 93%, 73% and 89% for detection of unstable carotid plaque. The ultrasound has high accuracy for diagnostics of carotid plaque morphology, magnetic resonance imaging has high potential for tissue differentiation and multidetector computed tomography determines precisely degree of stenosis and presence of ulceration and calcifications. The three noninvasive imaging modalities are complementary for optimal evaluation of the morphology of carotid plaque. This will help to determine the risk of stroke and to decide on the best treatment - carotid endarterectomy or carotid stenting. (authors) Key words: STROKE. NONINVASiVE IMAGING. VULNERABLE PLAQUE

  7. Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

    Directory of Open Access Journals (Sweden)

    Satomi Jyunichiro

    2009-11-01

    Full Text Available Abstract Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS, but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.

  8. Pseudoaneureysm of Carotid Artery and Its Branches Caused by Local Suppuration A Report of 6 Cases%颈部感染性假性动脉瘤

    Institute of Scientific and Technical Information of China (English)

    王义; 张金哲

    1987-01-01

    作者三十年间共收治了6例颈部感染性假性动脉瘤.本文就该症的病理临床表现进行了总结.提出了治疗意见.%Caused by pyogenic infection of deep cervical lymph nodes, the pseudoaneurysms of the carotid artery and its branches in the neck are rare. Six cases were handled in the past 30 years. They were three cases of aneurysm of lignual artery, one of external carotid artery, one of internal carotid artery and one of an unidentified branch of the external carotid artery. Outstanding symptoms and signs are as follows: infection in the neck; hematemesis with or without choking resulting from the ruptured aneurysm into the throat; hoarseness, dysphagia, and Horner's syndrome caused by pres sure on vagus, hypoglossal, glossopharyngeal or sympathetic nerves. Pseudoaneurysm as a complication of local suppuration usually lacks of typical findings of an aneurysm, such as expansile pulsation and systolic bruit. It might be misdiagnosed as an abscess. And if incorrectly treated with incision and drainage, blood would gush out terribly from the wound. It should be emphasized that a experimental puncture is preferable. During operation, a temporary occlusion on the proximal part of the feeding vessels must be done before the exploration and ligation of the perforated artery. Thus treated, all the six cases survired without permanent neurologic sequelae.

  9. The relationship of hydroxyeicosatetraenoic acids and F2-isoprostanes to plaque instability in human carotid atherosclerosis

    OpenAIRE

    Mallat, Ziad; Nakamura, Tatsuji; Ohan, Jeanny; Lesèche, Guy; Tedgui, Alain; Maclouf, Jacques; Murphy, Robert C.

    1999-01-01

    Evidence for increased oxidant stress has been reported in human atherosclerosis. However, no information is available about the importance of in situ oxidant stress in relation to plaque stability. This information is relevant because the morbidity and mortality of atherosclerosis are essentially the consequences of acute ischemic syndromes due to unstable plaques. We studied 30 carotid atherosclerotic plaques retrieved by endarterectomy from 18 asymptomatic (stable plaques) and 12 symptomat...

  10. [Characteristics and influence of different clinical forms on the development and prognosis of carotid sinus syndrome. Apropos of 215 cases].

    Science.gov (United States)

    Graux, P; Carlioz, R; Guyomar, Y; Lemaire, N; Rihani, R; Cornaert, P; Dutoit, A; Croccel, L

    1995-07-01

    The carotid sinus syndrome is a well-known cause of syncope: the cardio-inhibitory forms are the easiest to diagnose and probably the easiest to treat. However, the vasodepressive forms are as common but their outcome is mainly unknown. Eight hundred and fifty-three patients underwent endocavitary electrophysiological studies with invasive blood pressure measurement for unexplained syncope between October 1984 and January 1990. A carotid sinus syndrome was diagnosed in 215 cases. Fifty-two patients (24.2%) had a cardio-inhibitory form (ventricular standstill > or = 3 s during carotid sinus massage), 40 (18.6%) had a pure vasodepressive form (isolated fall of systolic blood pressure > 50 mmHg during massage) and 123 patients (57.2%) had a mixed form. The average age was 74.1 +/- 9.7 years with no difference between the different forms. A number of parameters was different on the cardio-inhibitory and vasodepressive forms: the number of men (75.6 vas 24.4%; p < 0.05) and the number of syncopes (83.3 vs 60%; p < 0.02) were greater in the cardio-inhibitory form; the vasodepressive forms were more often associated with a history of transient ischaemic attacks (15 vs 0%), a poor cardiovascular status (hypertension: 47.5 vs 15.7%; p < 0.01), coronary artery disease (47.5 vs 25.5%; p < 0.05), cardiac failure (27.5 vs 11.7%; p < 0.05), induction of sustained supraventricular tachycardia (50 vs 23.5%; p < 0.05) and a greater pacemaker effect (53.6 vs 34.8 mmHg; p < 0.01); of the 191 patients (84.9% of the population) followed up for an average of 21.2 months, 168 received treatment: implantation of a cardiac pacemaker in 108 patients, reduction of antihypertensive and/or potentially bradycardia-inducing drugs in 30 patients, prescription of antiarrhythmic therapy, in 30 patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7487332

  11. Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

    OpenAIRE

    Li-Qun Chi; Jian-Qun Zhang; Qing-Yu Kong; Wei Xiao; Lin Liang; Xin-Liang Chen

    2015-01-01

    Background: It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD. Methods: From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeo...

  12. Asymptomatic carotid artery stenosis in patients with severe peripheral vascular diseases

    Directory of Open Access Journals (Sweden)

    Rasoul Mirsharifi

    2009-04-01

    Full Text Available

    • BACKGROUND: The prevalence of carotid artery stenosis (CAS in the  eneral population is not high enough to justify screening programs. This study was done to determine the prevalence of asymptomatic carotid artery stenosis (ACAS among patients with severe peripheral vascular disease (PVD.
    • METHODS: Between March 2005 and February 2006, 54 consecutive  atients with severe PVD admitted at a vascular surgery unit and underwent carotid duplex scanning in a prospective study. A  uestionnaire was used to collect data concerning known risk factors. Significant CAS was defined as a stenosis of 70% or greater.
    • RESULTS: The mean age was 62.5 years (51-72. Out of 54 patients, 2 (3.7% had an occluded internal carotid artery. Significant CAS was found in 9 (16.7% and its presence was correlated with diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, coronary artery disease, severity of symptoms, ankle-brachial index, and carotid bruit. On multivariate analysis, only hypercholesterolemia and carotid bruit seemed to have independent influence.
    • CONCLUSION: The prevalence of significant ACAS is higher among  atients with severe PVD. This patient population may indicate a  uitable subgroup for screening of ACAS, especially when hypercholesterolemia and carotid bruit are present.
    • KEYWORDS: Carotid artery stenosis, duplex ultrasound scanning, peripheral vascular disease, carotid endarterectomy,
    • cerebrovascular accident.

  13. Case Report: Carotid–cavernous fistula due to aneurysmal rupture in a case of aortoaortitis with bilateral giant internal carotid artery aneurysms

    International Nuclear Information System (INIS)

    Takayasu aortoarteritis (TA) rarely affects the nervous system, but when it does, it usually manifests as cerebral ischemia or stroke. These strokes have mainly been attributed to stenotic extracranial vessels. Stenoses of intracranial vessels, although rare in TA, can occur due to either embolization into the vessel or because of the vasculitic process itself. Intracranial aneurysms are very rare in patients with TA. Bilateral cavernous internal carotid artery (ICA) aneurysms are rarer. They have been reported following radiation therapy and in association with fibromuscular dysplasia and juvenile Paget disease. Bilateral mycotic intracavernous aneurysms also occur. Bilateral giant cavernous ICA aneurysms with carotid-cavernous fistula (CCF) consequent to rupture into the cavernous sinus in a case of TA are extremely unusual. We report a case that fulfilled both American College of Rheumatology and European League against Rheumatology criteria for TA. The patient had bilateral cavernous sinus giant aneurysms and CCF because the right-sided aneurysm had ruptured and was leaking into the cavernous sinus

  14. Transarterial endovascular treatment of traumatic direct carotid-caveronous fistulas: a report of 51 cases

    International Nuclear Information System (INIS)

    Objective: To present our single-center experience in treating traumatic direct carotid-cavernous fistulas (TDCCFs) by using detachable balloon, coil and Willis covered stent via arterial route. Methods: During the last five years, transarterial endovascular treatment by using detachable balloon, coil and Willis covered stent was performed in fifty-one consecutive patients of traumatic direct carotid-cavernous fistulas, with a total of 54 TDCCFs. The detachable balloon was the material of first choice, while Willis covered stents and coils were regarded as the back-up materials. A clinical and angiographic follow-up for 3 - 48 months (mean 20.8 months) was conducted to evaluate the arterial patency and the stability of embolization. The clinical data were retrospectively analyzed. Results: By using the detachable balloon alone via transarterial route, 85% TDCCFs were successfully treated with good preservation of ICA. A total of 98% TDCCFs in this study were successfully treated by using detachable balloon, coil and / or Willis covered stent, the fistulas became occluded, and ICAs were preserved except one patient. Forty TDCCFs were treated with detachable balloons alone, two TDCCFs with the Willis covered stent alone, and one DCCF with coils alone. Eight TDCCFs were treated with detachable balloons together with Willis covered stent. Of these eight TDCCFs, two were treated with a single session, three were treated with detachable balloons in combination with coils, and one had to receive Willis covered stent. Second and third times of endovascular treatment were needed in 12 TDCCFs. The TDCCF-related symptoms were gradually relived or improved within 1 day to 6 months after treatment, except for five patients who suffered from ipsilateral moderate visual loss or cranial nerve deficit. No perioperative complications, such as vessel rupture, distal embolization or new neurologic deficits, occurred. During the follow-up period lasting for six months, neither delayed

  15. Optical coherence tomography of traumatic aneurysms of the internal carotid artery: report of 2 cases.

    Science.gov (United States)

    Griessenauer, Christoph J; Foreman, Paul M; Deveikis, John P; Harrigan, Mark R

    2016-02-01

    The pathophysiology of extracranial traumatic aneurysm formation has not been fully elucidated. Intraarterial optical coherence tomography (OCT), an imaging modality capable of micrometer cross-sectional resolution, was used to evaluate patients presenting with saccular traumatic aneurysms of the internal carotid artery (ICA). Two consecutive trauma patients diagnosed with saccular traumatic aneurysms of the cervical ICA, per the institutional screening protocol for traumatic cerebrovascular injury, underwent digital subtraction angiography (DSA) with OCT. Optical coherence tomography demonstrated disruption of the intima with preservation and stretching of the more peripheral layers. In 1 patient the traumatic aneurysm was associated with thrombus formation and a separate, more proximal dissection not visible on CT angiography (CTA) or DSA. Imaging with OCT indicates that saccular traumatic aneurysms may develop from disruption of the intima with at least partial preservation of the media and adventitia. This provides in vivo evidence that saccular traumatic aneurysms result from a partial arterial wall tear rather than complete disruption. Interestingly, OCT was also able to detect arterial injury and thrombi not visible on CTA or DSA. PMID:26252460

  16. Giant Thyroid Nodule Atypically Located in The Carotid Triangle of The Neck: A Case Report

    Directory of Open Access Journals (Sweden)

    Guclu Beritan

    2014-12-01

    Full Text Available Ectopic thyroid tissue is a rare pathology of the thyroid that is formed by the abnormal migration of the thyroid tissue. It is seen once in about every 100.000 to 300.000 births and is generally asymptomatic. Asymptomatic ectopic thyroid tissue may grow larger and become symptomatic in the form of a neck mass due to thyroid tissue hyperplasia. The thyroid gland, apart from its normal localization before the trachea, may lie between the tongue root and the trachea generally on the middle line at any level. A 71-year-old male patient presented to our ear- nose and throat clinic with a mass of 5x4x3 cm located in the right carotid triangle. The thin-needle aspiration biopsy specimen was reported as thyroid tissue and subsequently the mass was excised under general anesthesia.  The histopathological evaluation of the mass revealed that it was an atypically located ectopic thyroid nodule. No complications were seen within one year follow-up of the patient.

  17. Monitoring balloon test occlusion of the internal carotid artery with transcranial Doppler. A case report and literature review.

    Science.gov (United States)

    Galego, Orlando; Nunes, César; Morais, Ricardo; Sargento-Freitas, João; Sales, Francisco; Machado, Egídio

    2014-02-01

    Angiographic balloon test occlusion (BTO) allows preoperative risk evaluation of patients undergoing permanent therapeutic occlusion of the internal carotid artery (ICA). The sensitivity of the BTO can be increased using different complementary techniques. Transcranial Doppler (TCD) stands out as a non-invasive, bedside method providing real-time monitoring of cerebral haemodynamics, therefore accurately identifying patients at risk of stroke. A case of a 30-year-old woman with a giant intracavernous aneurysm of the left ICA presenting with subacute left VI nerve palsy is described. A pre-operative TCD- and EEG-monitored BTO of the left ICA was performed. The 16.7% drop found in the middle cerebral artery's peak systolic velocity (PSVMCA) predicts clinical and haemodynamic tolerance to the permanent loss of that vessel. This case illustrates the potential of TCD monitoring during temporary BTO of the ICA. It highlights its ability to provide a complete preclinical evaluation of collateralization and autoregulatory adaptation to unilateral ICA occlusion. TCD may also decrease the time of occlusion required for the BTO. PMID:24571842

  18. Noninvasive carotid plaque characterization by black blood MRI

    International Nuclear Information System (INIS)

    Management of atherosclerotic carotid arteries requires both plaque characterization and determination of the degree of stenosis, especially when carotid stenting (GAS) is being considered for severe carotid stenosis. Recent studies have demonstrated that high-resolution MRI can identify plaque components, such as the lipid-rich necrotic core, intraplaque hemorrhage, fibrous tissue, and the calcification present in human carotid atherosclerosis. The purpose of this study was to assess the feasibility of black blood MRI (BB-MRI) for accurately identifying the plaque components in vivo. Twenty-six consecutive patients scheduled for carotid endarterectomy (CEA) underwent a BB-MRI examination within 2 weeks before the surgical procedure using a 1.5-T Philips scanner with a protocol that generated 2 contrast weightings (T1 and T2). The MR images were acquired using cardiac gating to minimize motion artifact and fat suppression to reduce MR signals from subcutaneous fatty tissue. The plaque evaluations obtained by BB-MRI were compared with the intra-operative video recordings, the excised specimens, and the histological sections. With BB-MRI, the combination of the signal intensities in the T1- and T2- weighted images for each component (lipid deposits, intra-plaque hemorrhage, fibrous plaque, and calcification) showed findings that corresponded with the excised specimens. Complex morphological features could also be assessed by BB-MRI. BB-MRI is a useful method for noninvasively imaging and characterizing atherosclerotic carotid arteries. This MRI technique can provide valuable information that can be used to decide whether to perform a CEA or a GAS in patients with severe carotid stenosis. Furthermore, BB-MRI appears to be a useful tool for the investigation of the pathogenesis and natural history of carotid atherosclerosis. (author)

  19. Traumatic bilateral carotid artery dissection following severe blunt trauma: a case report on the difficulties in diagnosis and therapy of an often overlooked life-threatening injury

    OpenAIRE

    Crönlein, Moritz; Sandmann, Gunther H.; Beirer, Marc; Wunderlich, Silke; Biberthaler, Peter; Huber-Wagner, Stefan

    2015-01-01

    Background Traumatic carotid artery dissections are very rare, often overlooked and life-threatening injuries. Diagnosis and treatment are difficult especially in multiple injured patients. Case presentation We report on a 28-year-old female major trauma patient (injury severity score, ISS 50) who was involved in a motor vehicle accident. She was primarily transferred to a level II trauma center. After initial assessment and operative management, an anisocoria was diagnosed on the intensive c...

  20. STUDY OF CAROTID INTIMA MEDIA THICKNESS IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND ITS CORRELATION WITH RISK FACTORS OF ISCHEMIC STROKE - A CASE CONTROL STUDY

    Directory of Open Access Journals (Sweden)

    Rajeev

    2013-10-01

    Full Text Available ABSTRACT: Stroke is the leading cause of mortality worldwide. Carotid Intima Media Thickness (CIMT is a marker of atherosclerosis and is also a marker for ischemic stroke. AIMS: 1 To assess the value of carotid intima media thickness at which patients with risk factors can develop acute ischemic stroke. 2 To correlate carotid intima media thickness with risk factors of acute ischemic stroke. MATERIAL & METHODS: This study was done at KIMS Hospital, Bangalore between December 2010 to September 2012. This is a case control observational study which has a sample size of 50 cases and 50 controls. Method of collection of data was by patient evaluation which was done by taking detailed history, clinical examination and laboratory investigations throu gh a proforma specially designed for this study. Cases were subjects who had ischemic stoke and Infarct proven by CT/MRI of brain, Controls were subjects without stroke matched to cases by age, gender and risk factors like diabetes, hypertension, smoking a nd dyslipidemia. S ubjects in both groups underwent carotid Doppler investigation with 7.5 Mhz linear superficial array probe to determine CIMT and presence of plaques. RESULTS: Out of 50 cases, 46 had CIMT between 0.06 - 0.20 cm [92%] and out of 50 controls, 45 had CIMT between 0.06 - 0.20 cm[90%]. Most of our cases had CIMT above 0.06 cm, so we can hypothesize that people with risk factors having CIMT above 0.06 cm are more prone for ischemic cerebro vascular accidents. Mean CIMT in cases with risk factors is significantly increased when compared to controls with risk factors. CONCLUSION: People with risk factors [ age > 50 years, DM , HTN , Smoking and Dyslipidemia] having CIMT above 0.06 cm are more prone for ischemic CVA, so people with risk factors should u ndergo screening for CIMT measurement by Carotid Doppler which is non invasive and cost effective and if their CIMT is above 0.06 cm they should undergo early medical intervention to take care

  1. Improved MR imaging of extracranial carotid artery disease

    International Nuclear Information System (INIS)

    Flow-related and phase-encoding artifacts and a nonorthogonal vessel course frequently degrade MR images of the extracranial carotid artery. Employing out-of-field saturation pulses has significantly improved imaging of the vascular wall and lumen on spin-echo sequences. Flow-related and phase-encoding artifacts have virtually been eliminated. Oblique imaging of the proximal internal carotid has achieved truer axial views of this segment. Ten patients with documented extracranial vascular disease underwent MR evaluation with this imaging protocol. There was excellent correlation between the degree of luminal stenosis on the MR image and on the angiogram. Vessel wall pathology on the endarterectomy specimen correlated with the in vivo MR appearance of the wall. Signal alterations in the plaque representing hemorrhage and calcification were detected

  2. Fractional arm weakness as presentation of stroke due to posterior borderzone infarct: A report of two cases

    Directory of Open Access Journals (Sweden)

    Hassan Kaukab

    2010-01-01

    Full Text Available A 41-year-old male presented with acute onset weakness of the left hand. Magnetic resonance imaging (MRI of the brain showed hyperacute infarct in the right middle cerebral artery (MCA-posterior cerebral artery (PCA watershed territory. Magnetic resonance angiography (MRA, Doppler ultrasonography, and digital subtraction angiography revealed severe right internal carotid artery (ICA stenosis. The patient underwent carotid endarterectomy. The second patient was a 48-year-old male with acute onset right wrist drop. MRI of brain showed acute infarct in the left MCA-PCA watershed territory. MRA of brain and neck, Doppler ultrasonography of the neck vessels, and echocardiography were normal. Both the cases were not initially considered strokes by the referring physicians. Isolated hand palsy is a rare presentation of stroke, often mistaken for peripheral lesion. Fractional limb weakness as a presentation of acute ischemic stroke due to borderzone infarction involving parietal lobe is a rarely reported entity.

  3. Digital Image Analysis of Ultrasound B-mode images of Carotid Atherosclerotic Plaque: Correlation with Histological Examination

    DEFF Research Database (Denmark)

    Wilhjelm, Jens E.; Rosendal, Kim; Grønholdt, Marie-Louise Moes; Jespersen, Søren Kragh; Hansen, Lars Kai; Sillesen, Henrik

    This paper reports on a study of how well texture features extracted from B-mode images of atherosclerotic plaque correlates with histological results obtained from the same plaque after carotid endarterectomy. The study reveals that a few second order texture features (diagonal moment, standard...... deviation and autocorrelation) provide good correlation within the training set (p = 0.04); However, the correlation found so far is not so high, that the method can be used in clinical prediction of plaque constituents....

  4. Carotid body tumor: a 25-year experience.

    Science.gov (United States)

    Metheetrairut, Choakchai; Chotikavanich, Chanticha; Keskool, Phawin; Suphaphongs, Nit

    2016-08-01

    Carotid body tumor is an uncommon hypervascular benign tumor in the head and neck region. It usually presents as a slow growing mass at the carotid bifurcation. Because of the high rate of neurovascular complications, resection of this tumor is considered challenging for otolaryngologists. Between 1988 and 2013, 40 carotid body tumors from 38 patients were diagnosed and underwent resection at Siriraj Hospital (25 female and 13 male patients). Their age ranged from 15 to 59 years. Seven patients had bilateral tumors simultaneously whereas six cases had familial history of carotid body tumor. Carotid angiography was performed in 29 cases; other additional diagnostic studies included CT scan, MRI, and MRA to detect the widening of carotid bifurcation, its extension, and multifocal tumors. All diagnosed tumors were successfully removed. However, internal carotid artery and carotid bifurcation were injured in 11 cases (27.5 %). Shamblin class III and previous biopsy history were considered risk factors for vascular injury. Postoperative cranial nerves deficit was found in 20 % of the cases and CNS complication occurred in two patients (5 %). There was no surgical mortality. Additionally, upon the mean follow-up period of 36 months, no recurrence or malignant transformation was detected in this study. Multidisciplinary approach, early tumor detection, meticulous preoperative evaluation, and modern vascular surgical technique are the key success factors for tumor removal. PMID:26233244

  5. Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery?

    Directory of Open Access Journals (Sweden)

    Luciano Pedrini

    2012-01-01

    Full Text Available Guidelines do not include cerebral oximetry among monitoring for carotid endarterectomy (CEA. The purpose of this study was to evaluate the reliability of near-infrared spectroscopy (NIRS in the detection of clamping ischemia and in the prevention of clamping-related neurologic deficits using, as a cutoff for shunting, a 20% regional cerebral oxygen saturation (rSO2 decrease if persistent more than 4 minutes, otherwise a 25% rSO2 decrease. Bilateral rSO2 was monitored continuously in patients undergoing CEA under general anesthesia (GA. Data was recorded after clamping, declamping, during shunting and lowest values achieved. Preoperative neurologic, CT-scan, and vascular lesions were recorded. We reviewed 473 cases: 305 males (64.5% mean age 73.3±7.3. Three patients presented transient ischemic deficits at awakening, no perioperative stroke or death; 41 (8.7% required shunting: 30 based on the initial rSO2 value and 11 due to a decrease during surgery. Using the ROC curve analysis we found, for a >25% reduction from baseline value, a sensitivity of 100% and a specificity of 90.6%. Reliability, PPV, and NPV were 95.38%, 9%, and 100%, respectively. In conclusion, this study indicates the potential reliability of NIRS monitoring during CEA under GA, using a cutoff of 25% or a cutoff of 20% for prolonged hypoperfusion.

  6. Carotid-cavernous fistula caused by rupture of persistent primitive trigeminal artery trunk aneurysm--case report.

    Science.gov (United States)

    Yoshida, Masahiro; Ezura, Masayuki; Mino, Masaki

    2011-01-01

    A 60-year-old female presented with a carotid-cavernous fistula (CCF) manifesting as left abducens nerve palsy. Left internal carotid digital subtraction angiography showed a persistent primitive trigeminal artery (PPTA) near the CCF. Super-selective angiography showed direct shunt flow between the PPTA trunk aneurysm and the left cavernous sinus. The aneurysm was successfully occluded with detachable coils. The CCF disappeared and the PPTA was preserved. The abducens nerve paralysis had disappeared 6 months later. CCF caused by a PPTA trunk aneurysm is extremely rare. We speculate that the PPTA trunk aneurysm formed and then ruptured due to hemodynamic stress caused by hypoplasia of the basilar artery. PMID:21785245

  7. Stroke from an External Carotid: Lesion Pattern and Mechanisms.

    Science.gov (United States)

    Nicolas, Kagan; Hubert, Lathelyse; Leclère, Franck Marie; Etienne, Marchand; Robert, Martinez

    2016-04-01

    Traditionally, patients with symptomatic external carotid stenosis present with neck or face pain, retinal ischemic symptoms or jaw claudication and rarely as ipsilateral cerebrovascular events. In this present case, our patient suffered a stroke from a paradoxical embolism from the external carotid, without involvement of the internal carotid artery. A plaque ulceration of the external carotid's origin was the cause of this cerebral emboli. Duplex ultrasound showed a pathologic left external carotid, with a floating thrombus in the internal carotid. The diagnostic was confirmed by a computerized tomography scan. An external carotid thromboendarterectomy was performed 6 days after symptom onset, and intraoperative findings confirmed the plaque rupture with an extensive clot in the carotid bifurcation. PMID:26802301

  8. Evaluation of stenotic lesions in the carotid arteries using ultrasonography and three-dimension CT angiography

    International Nuclear Information System (INIS)

    Indications for carotid endarterectomy (CEA) depend on the severity of carotid stenosis, as well as the surface characteristics of the stenotic lesion. The purpose of this study was to evaluate a diagnostic validity of three-dimensional CT angiography (3D-CTA) in patients with carotid stenosis, and to assess its applicability before CEA. Sixty-four patients with carotid artery stenosis were investigated pre-operatively by ultrasonography (US), 3D-CTA and digital subtraction angiography (DSA). The evaluation of the degree of carotid artery stenosis and its surface characteristics was done separately by each diagnostic modality. Thereafter, the data obtained by 3D-CTA were compared with those of US, DSA and pathological findings. The degree of carotid artery stenosis defined by 3D-CTA correlated well with those seen on DSA. However, arterial well irregularity, ulceration and calcifications were visualized more precisely on 3D-CTA. Assessment of surface properties of the stenostic lesion by 3D-CTA significantly correlated with data obtained by US. Comparing with other diagnostic modalities 3D-CTA provides much more precise information about the degree of the carotid artery stenosis and its surface properties. Therefore, 3D-CTA may be considered as a new alternative diagnostic tool for determination of indications for CEA. (author)

  9. [Carotid endarterectomy. Experiences with shortening of interval between symptom and operation

    DEFF Research Database (Denmark)

    Rathenborg, L.K.; Baekgaard, N.; Jensen, Leif Pandora

    2008-01-01

    observing this recommendation, in 2005 the Department of Vascular Surgery, Gentofte Hospital, introduced an accelerated course of examinations, a fast track, prior to CEA. MATERIALS AND METHODS: A retrospective study of the course of all patients operated with CEA during the period from June 2003 through...

  10. Endarterectomia carotídea sob bloqueio loco-regional Carotid endarterectomy under locoregional anesthesia

    OpenAIRE

    Ana Terezinha Guillaumon; Nara Gelle Oliveira; Lucas Marcelo Dias Freire; Luis Baldini Neto; Aline Meira Martins; Eduardo Faccini Rocha

    2005-01-01

    OBJETIVO: Os autores objetivam descrever os resultados nas cirurgias de endarterectomia carotídea, utilizando-se anestesia loco-regional, emprego seletivo de shunt e proteção farmacológica intra-operatória. MÉTODO: Foram estudados doentes submetidos à endarterectomia carotídea sob bloqueio loco-regional, no Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP), no período de março de 1996 a maio de 2004. Este estudo é composto de 119 endarterectomias (108 doentes), sendo 69 doe...

  11. A 64-year old man presenting with carotid artery occlusion and corticobasal syndrome: a case report

    OpenAIRE

    de Gans Jan; Westhoff Dunja; Engelen Marc; Nederkoorn Paul J

    2011-01-01

    Abstract Introduction Magnetic resonance imaging of the brain in patients with corticobasal degeneration typically shows focal or asymmetric atrophy, usually maximal in the frontoparietal cortex. Many patients who are diagnosed with corticobasal degeneration using current diagnostic criteria do not have classical corticobasal degeneration pathology. Our case is remarkable for the fact that the symptoms and the characteristic magnetic resonance imaging appearance were typical for corticobasal ...

  12. Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Nadgir, R.N.; Ahmed, T. [University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, PA 19104, Philadelphia (United States); Loevner, L.A.; Moonis, G.; Slawek, K.; Imbesi, S. [Neuroradiology Section, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, PA 19104, Philadelphia (United States); Chalela, J. [Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, PA 19104, Philadelphia (United States)

    2003-05-01

    Single-vessel cervical arterial dissections typically occur in young adults and are a common cause of cerebral ischemia and stroke. Although the pathogenesis of multivessel dissection is unclear, it is thought to be a consequence of underlying collagen vascular disease. We present a 34-year-old previously healthy man who developed bilateral internal carotid and vertebral artery dissection following chiropractic manipulation. (orig.)

  13. Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature

    International Nuclear Information System (INIS)

    Single-vessel cervical arterial dissections typically occur in young adults and are a common cause of cerebral ischemia and stroke. Although the pathogenesis of multivessel dissection is unclear, it is thought to be a consequence of underlying collagen vascular disease. We present a 34-year-old previously healthy man who developed bilateral internal carotid and vertebral artery dissection following chiropractic manipulation. (orig.)

  14. Internal carotid artery dissection following rigid esophagoscopy

    OpenAIRE

    Ricchetti, Alma Paola; Becker, Minerva; Dulguerov, Pavel

    1999-01-01

    A case of internal carotid artery dissection that developed after rigid esophagoscopy is described. The diagnosis was suggested by the clinical presentation and confirmed by the findings of radiological examinations. Internal carotid artery dissection is a rare condition of controversial etiology. Most frequently, the cause is unknown and the condition is termed idiopathic. A few cases have occurred after forceful cervical extensions and manipulations. The pathogenesis in our case is uncertai...

  15. Lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report.

    Science.gov (United States)

    Westhout, Franklin; Hasso, Anton; Jalili, Mehrdad; Afghani, Behnoosh; Armstrong, William; Nwagwu, Chiedozie; Ackerman, Laurie L

    2007-01-01

    Lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections. The authors present an unusual case of Lemierre syndrome in a 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. Neuroimaging also demonstrated right jugular vein thrombosis. Cultures of samples from the blood proved positive for the presence of Fusobacterium necrophorum. The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome. PMID:17233314

  16. Carotid Artery Disease

    Science.gov (United States)

    ... brain with blood. If you have carotid artery disease, the arteries become narrow, usually because of atherosclerosis. ... one of the causes of stroke. Carotid artery disease often does not cause symptoms, but there are ...

  17. Carotid artery disease

    Science.gov (United States)

    ... you have had a stroke or TIA, a nervous system (neurological) exam will show other problems. You may also have the following tests: Blood cholesterol and triglycerides test Blood sugar (glucose) test Ultrasound of the carotid arteries ( carotid ...

  18. Long term follow up of carotid cavernous fistula patients treated with carotid occlusion

    International Nuclear Information System (INIS)

    Objective: To explore efficacy,durability and possible impacts on life quality of carotid occlusion treatment to carotid cavernous fistula (CCF) patients. Methods: CCF patients since 2001 were retrospectively analyzed, the clinical features, 2 weeks post procedure mRS score and ratio of carotid occlusion were recorded. Headache impact test (HIT-6) and Short form health survey (SF-36) were used to assess impact of sequelae in patients' daily life, by phone call, questionnaire and clinic recheck. Results: Total 96 cases were studied composed of 81 direct CCF and 15 dural AVF. Thirty-two direct CCF cases underwent carotid occlusion during procedure and many ophthalmologic signs but visual impairment got recovery after 2 weeks, the mRS score less than 2 were revealed. The one year post operation HIT-6 score more than 50 was more likely found in carotid occlusion cases comparing with those preserved carotid artery while the 3 year SF-36 scores of carotid occlusion cases revealed inferior to those with patent artery, especially in body pain, general health and vitality subscales. Conclusion: Carotid occlusion seems to be a feasible, effective and durable alternative for CCF treatment, but which could play a negative role on quality of patients' life in the long run. (authors)

  19. Traumatic carotid-cavernous fistula associated with persistent primitive trigeminal artery treated by transarterial coil embolization--case report.

    Science.gov (United States)

    Kobayashi, Nozomu; Miyachi, Shigeru; Oi, Sachie; Yamamoto, Naohito

    2011-01-01

    A 30-year-old woman presented with traumatic carotid-cavernous fistula associated with persistent primitive trigeminal artery (PPTA) manifesting as right conjunctival chemosis, exophthalmos, and diplopia. The lesion was treated successfully by trans-arterial coil embolization using the double catheter method with balloon assist. Injury to the PPTA is relatively rare and the PPTA should be sacrificed together with the fistula during the repair. PMID:21273742

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

    International Nuclear Information System (INIS)

    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

  1. 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)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    De Mendonca, J.L.F.; Viana, S.L.; Freitas, F.M.O.; Matos, V.L. [Magnetic Resonance Dept., Clinica Radiologica Vila Rica, Brasilia (Brazil)], E-mail: radiolog@uol.com.br; Viana, M.A.C.B. [Hospital de Base do Distrito Federal, Brasilia (Brazil); Silva, R.F. [Diagnostik, Hospital das Clinicas de Brasilia, Brasilia (Brazil); Quaglia, L.A.N. [Hospital Santa Lucia, Brasilia (Brazil); Guerra, J.G. [Hospital Regional de Taguatinga, Brasilia (Brazil)

    2008-04-15

    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)

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

    International Nuclear Information System (INIS)

    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)

  4. 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

    limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis. For example, identification of IPH on MRI in patients with low-grade carotid artery stenosis is a risk factor for failure of medical therapy, and studies have shown that such patients may fair better with carotid endarterectomy (CEA). MR plaque imaging has also been found to be useful in identifying revascularization candidates who would be better candidates for CEA than carotid artery stenting (CAS), as high intraplaque signal on time of flight imaging is associated with vulnerable plaque and increased rates of adverse events in patients undergoing CAS but not CEA. PMID:26230478

  5. The Potential Role of Optical Coherence Tomography in the Evaluation of Vulnerable Carotid Atheromatous Plaques: A Pilot Study

    International Nuclear Information System (INIS)

    Purpose. The decision to intervene surgically in patients with carotid artery disease is based on the presence of symptoms, along with the severity of carotid artery stenosis as assessed by ultrasound or X-ray computed tomography (CT). Optical coherence tomography (OCT) is a relatively new imaging technique that offers potential in the identification of, as well as the distinction between, stable and unstable atherosclerotic plaques. The purpose of our study was to evaluate whether OCT can be used as a noninvasive diagnostic tool to reveal the morphology of carotid stenosis from the adventitial surface of the carotid artery. To achieve this aim, excised atheromatous plaques were scanned by OCT from the external surface. Methods. Plaques removed at carotid endarterectomy were scanned by OCT from the external surface within 72 hr of surgery and then examined histologically. The images of the histologic slides and the scans were then compared. Results. We examined 10 carotid endarterectomy specimens and were able to identify calcification, cholesterol crystal clefts, and lipid deposits in the OCT images with histologic correlation. The strong light scattering from the calcified tissue and cholesterol crystal clefts limited the depth of light penetration, making observation of the intimal surface and the detail of the fibrous cap difficult. However, we were able to confidently identify the absence of an atherosclerotic plaque by OCT scans even from the external surface. Conclusion. The results of this pilot study demonstrate that OCT can reveal the main features of carotid stenosis but that plaque vulnerability cannot be reliably and precisely assessed if scanned from the external surface with OCT in its present form

  6. Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review.

    Science.gov (United States)

    Ozkan Arat, Yonca; Volpi, John; Arat, Anıl; Klucznik, Richard; Diaz, Orlando

    2011-01-01

    We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides. PMID:21341139

  7. Fístula carótido-cavernosa com epistaxe letal: relato de caso Carotid-cavernous fistula with lethal epistaxis: case report

    Directory of Open Access Journals (Sweden)

    Rover Borba

    2001-06-01

    Full Text Available A fístula carótido-cavernosa é uma comunicação patológica entre a artéria carótida interna e o seio cavernoso. Apresentamos o caso de um paciente de 32 anos de idade com fístula carótido-cavernosa devida a traumatismo crânio-encefálico. O tratamento preconizado é a embolização mas neste caso em especial houve falha devido às características próprias da fístula, e o paciente progrediu de maneira desfavorável evoluindo ao óbito por epistaxe incontrolável.We report the case of a 32 years old male patient with carotid-cavernous fistula caused by head injury who died from massive epistaxis. Treatment assesment of this case is faced with the literature.

  8. Delayed Carotid Dissection Following Lower Lip Revascularization in the Setting of Hyoid Fracture--A Case Report and Review of the Literature.

    Science.gov (United States)

    Misra, Shantum; Haas, Corbett A; August, Meredith; Eberlin, Kyle R

    2016-01-01

    Traumatic injuries to the lip are common, but injuries that require revascularization of the lower lip are infrequent and pose a major challenge to the reconstructive surgeon. This report describes the case of a 53-year-old woman who sustained a lower lip avulsion injury, a comminuted mandibular parasymphyseal fracture, and a hyoid bone fracture secondary to a bicycle accident. Trauma workup included computed tomographic angiography of the head and neck, which did not show vascular injury. Despite successful revascularization of the lower lip, on postoperative day 11 the patient developed a large internal carotid artery dissection and middle cerebral artery stroke. This case highlights the importance of careful postoperative monitoring after high-energy facial trauma, particularly in the setting of vascular and bony injuries. PMID:26435401

  9. Tensile and compressive properties of fresh human carotid atherosclerotic plaques.

    LENUS (Irish Health Repository)

    Maher, Eoghan

    2009-12-11

    Accurate characterisation of the mechanical properties of human atherosclerotic plaque is important for our understanding of the role of vascular mechanics in the development and treatment of atherosclerosis. The majority of previous studies investigating the mechanical properties of human plaque are based on tests of plaque tissue removed following autopsy. This study aims to characterise the mechanical behaviour of fresh human carotid plaques removed during endarterectomy and tested within 2h. A total of 50 radial compressive and 17 circumferential tensile uniaxial tests were performed on samples taken from 14 carotid plaques. The clinical classification of each plaque, as determined by duplex ultrasound is also reported. Plaques were classified as calcified, mixed or echolucent. Experimental data indicated that plaques were highly inhomogeneous; with variations seen in the mechanical properties of plaque obtained from individual donors and between donors. The mean behaviour of samples for each classification indicated that calcified plaques had the stiffest response, while echolucent plaques were the least stiff. Results also indicated that there may be a difference in behaviour of samples taken from different anatomical locations (common, internal and external carotid), however the large variability indicates that more testing is needed to reach significant conclusions. This work represents a step towards a better understanding of the in vivo mechanical behaviour of human atherosclerotic plaque.

  10. Gene expression and 18FDG uptake in atherosclerotic carotid plaques

    DEFF Research Database (Denmark)

    Pedersen, Sune Folke; Græbe, Martin; Hag, Anne Mette Fisker;

    2010-01-01

    PURPOSE: Metabolic assessment of vascular inflammation by 2-[F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG)-PET is a promising new approach for the evaluation of the vulnerability of atherosclerotic plaques. Quantitative real-time PCR allows measurement of gene expression of markers...... of atherosclerotic plaque vulnerability. These techniques were applied in advanced atherosclerotic disease to relate metabolism and inflammatory activity to the gene expression profile of the vulnerable atherosclerotic plaque. METHODS: Seventeen patients with clinical symptoms of cerebral vascular...... 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...

  11. 3T imaging of cervical carotid plaque using a 3D T1-weighted sequence. Experience of 130 consecutive cases

    International Nuclear Information System (INIS)

    Three-dimensional (3D) T1-weighted imaging is reported to depict hemorrhagic plaque of the carotid artery with high signal intensity. Using a 3-tesla MR imaging unit, we prospectively evaluated how often 3D T1-weighted imaging can detect such plaque in 130 consecutive patients with (Group A, 80 patients) and without (Group B, 50 patients) ischemic brain disease. We evaluated the presence or absence of carotid plaque (s) in each patient, compared the signal intensity of plaque to that of the sternocleidomastoid muscle, and calculated the signal ratio of plaque to muscle (plaque/muscle). High intensity was defined as a signal ratio of 2 or greater. The degree of intravascular nullity was visually rated as good or poor and evaluated quantitatively. We investigated factors including diabetes, hypertension, and hyperlipidemia to determine whether those factors affect the presence of high-signal plaques. The degree of intravascular nullity was poor in 30.8% of all patients. High-signal plaque was observed more frequently in Group A than Group B (p=0.003). No risk factor was significantly associated with the presence of high-signal plaques. The use of 3D T1-weighted plaque imaging with a 3T unit contributes to the screening of unstable plaque that might otherwise be missed in a clinical setting. (author)

  12. Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Li-Qun Chi

    2015-01-01

    Full Text Available Background: It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD. Coronary endarterectomy (CE offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG was discussed in the treatment for the diffused CAD. Methods: From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221 of the cohort. All these patients were divided into two groups: CE + CABG group (Group A and CABG alone group (Group B. All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student′s t-test respectively. Results: Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38, which was more often than that in Group B (3/183. At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50. There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions: Coronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.

  13. Carotid angiography

    Directory of Open Access Journals (Sweden)

    Arne Torkildsen

    1950-03-01

    Full Text Available After a brief review of the history of cerebral angiography, some of the most important points concerning the percutaneous angiographic technique have been described. The value of the angiographic examination in cases of cerebral gliomas has been studied, based upon a consecutive series of 127 verified cases of hemispherical gliomas. Of 31 cases of frontal glioma, 28 could be diagnosed by the angiographic method; of 33 cases of parietal glioma, the angiograms revealed the neoplasm in 27 instances; of 39 cases of temporal glioma, the tumor could be localized in 38 cases; of 13 cases of occipital glioma, the angiographic localization of the tumor was successfull in 9 instances; of 11. cases of glioma infiltrating the corpus callosum and (or the basal ganglia, the angiographic examination was successful in only 3 cases. The angiographic examination in cases of cerebral glioma, in my experience, yields a more satisfactory result as to the localization than does the pneumography. The only exception concerns the gliomas growing in the thalamus or in the basal ganglia. These are more easily localized by means of ventriculography. As to the differential diagnosis of the gliomas, tumor vessels could, be seen both in astrocytomas and in glioblastomas. Most cases of astrocytomas were however devoid of specific tumor vessels. When present they could not be definitely distinguished from those seen in glioblastomas, but the abnormal findings were far less numerous and definitely less pronounced in astrocytomas than in glioblastomas. In most cases the astrocytomas were characterized only by displacement of blood vessels of normal appearance, while the glioblastomas frequently-presented both displacement of normal appearing blood vessels and new formed blood vessels within the neoplasm itself. The pathological blood vessels in the tumor were frequently abnormal both regarding their topographical appearance and their type. Frequent findings were arterio

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

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Man Won; Kim, Hyeon Chul; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam Univ. Hospital, Kwangju (Korea, Republic of)

    1999-11-01

    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.

  16. Successful Reconstruction of Asymptomatic Bilateral External Carotid Artery Aneurysms.

    Science.gov (United States)

    Loja, Melissa N; Pevec, William C

    2016-04-01

    True aneurysms of the external carotid artery (ECA) are extremely rare with an unknown incidence and natural history. We present the successful operative management of an asymptomatic 65-year-old man found to have bilateral internal carotid artery stenosis and bilateral ECA aneurysms. His bilateral carotid arteries were reconstructed with bifurcated interposition grafts in a staged fashion. The patient recovered without sequelae and continues to be asymptomatic 1 year after reconstruction. We present the operative management of this rare case. PMID:26802292

  17. Identification of carotid plaque tissue properties using an experimental-numerical approach.

    Science.gov (United States)

    Heiland, Vincent M; Forsell, Caroline; Roy, Joy; Hedin, Ulf; Gasser, T Christian

    2013-11-01

    A biomechanical stress analysis could help to identify carotid plaques that are vulnerable to rupture, and hence reduce the risk of thrombotic strokes. Mechanical stress predictions critically depend on the plaque's constitutive properties, and the present study introduces a concept to derive viscoelastic parameters through an experimental-numerical approach. Carotid plaques were harvested from two patients during carotid endarterectomy (CEA), and, in total, nine test specimens were investigated. A novel in-vitro mechanical testing protocol, which allows for dynamic testing, keeping the carotid plaque components together, was introduced. Macroscopic pictures overlaid by histological stains allowed for the segmentation of plaque tissues, in order to develop high-fidelity and low-fidelity Finite Element Method (FEM) models of the test specimens. The FEM models together with load-displacement data from the mechanical testing were used to extract constitutive parameters through inverse parameter estimation. The applied inverse parameter estimation runs in stages, first addressing the hyperelastic parameters then the viscoelastic ones. Load-displacement curves from the mechanical testing showed strain stiffening and viscoelasticity, as is expected for both normal and diseased carotid tissue. The estimated constitutive properties of plaque tissue were comparable to previously reported studies. Due to the highly non-linear elasticity of vascular tissue, the applied parameter estimation approach is, as with many similar approaches, sensitive to the initial guess of the parameters. PMID:23790614

  18. Assessment of 320-slice computed tomography angiography in distinguishing hemorrhage in carotid atherosclerotic plaques

    Directory of Open Access Journals (Sweden)

    Xiao-jie ZHANG

    2014-01-01

    Full Text Available Objective To assess the value of 320⁃slice computed tomography angiography (CTA in distinguishing hemorrhage/thrombus from lipid-rich necrotic core (LRNC in atherosclerotic plaques of carotid artery. Methods Thirty-seven subjects who prepared to perform carotid endarterectomy (CEA, with stenosis rate about 50%-99% in at least unilateral carotid artery detected by ultrasound, were enrolled in this study. Both 320-slice CTA and 3.0T high-resolution MRI were conducted within one week before operation. CTA, MRI and pathological sections were matched with the carotid bifurcation and calcification features as the mark. According to American Heart Association (AHA modified classification, CT slices were selected and divided into 2 groups: Type Ⅳ -Ⅴ (lipid plaques and Type Ⅵ (hemorrhage plaques, and the density difference between lipid plaques and hemorrhage/thrombus plaques was analyzed. Results A total of 217 slices were included in final analysis, including 88 slices of Type Ⅳ -Ⅴ (lipid plaques and 129 slices of Type Ⅵ (hemorrhage plaques. There was statistically significant difference in CT value between 2 groups. The mean CT value of lipid necrosis core in Type Ⅳ -Ⅴ and hemorrhage/thrombus in Type Ⅵ was (28.07 ± 26.84 and (97.17 ± 35.82 HU respectively, and the former was significantly lower than the latter (t = 16.141, P = 0.000. Conclusions CTA can distinguish hemorrhage/thrombus from lipid-rich necrotic core in carotid atherosclerotic plaques.

  19. Postoperative internal carotid artery restenosis after local anesthesia: presence of risk factors versus intraoperative shunt.

    Science.gov (United States)

    Hudorovic, Narcis; Lovricevic, Ivo; Hajnic, Hrvoje; Ahel, Zaky

    2010-08-01

    Published data suggest that the regional anesthetic technique used for carotid endarterectomy (CEA) increases the systolic arterial blood pressure and heart rate. At the same time local anesthesia reduced the shunt insertion rate. This study aimed to analyze risk factors and ischemic symptomatology in patients with postoperative internal carotid artery restenosis. The current retrospective study was undertaken to assess the results of CEA in 8000 patients who were operated during a five-year period in six regional cardiovascular centers. Carotid color coded flow imaging, medical history, clinical findings and atherosclerotic risk factors were analyzed. Among them, there were 33 patients (0.4%) with postoperative re-occlusion after CEA. The patients with restenosis were re-examined with carotid color coded flow imaging and data were compared with 33 consecutive patients with satisfactory postoperative findings to serve as a control group. In the restenosis group eight risk factors were analyzed (hypertension, smoking, hyperlipidemia, diabetes mellitus, history of stroke, transitory ischemic attack, heart attack and coronary disease), and compared with risk factors in control group. Study results suggested that early postoperative internal carotid artery restenosis was not caused by atherosclerosis risk factors but by intraoperative shunt usage. PMID:20439301

  20. A Case of Graves’ Disease Diagnosed in the Course of Bilateral Carotid Artery Stenoses (Moyamoya Disease); A Case Report and Review of the Literature

    OpenAIRE

    Kamasaki, Hotaka; Takeuchi, Takako; Mikami, Takeshi; Komeichi, Katsuhide; Tsutsumi, Hiroyuki

    2013-01-01

    A 14-year-old boy was admitted to our hospital after being diagnosed at a local clinic with bilateral carotid artery stenoses (Moyamoya disease) and mild thyrotoxicosis. A blood examination showed suppressed TSH and elevated triiodothyronine and thyroxine levels; however, he was negative for anti-thyrotropin receptor antibody (TRAB) and thyroid stimulating antibody (TSAB). Concern about a possible thyroid crisis led us to administer thiamazole (MMI) and potassium iodide (KI), following which ...

  1. 9p21 locus rs10757278 is associated with advanced carotid atherosclerosis in a gender-specific manner.

    Science.gov (United States)

    Zivotić, Ivan; Djurić, Tamara; Stanković, Aleksandra; Djordjević, Ana; Končar, Igor; Davidović, Lazar; Alavantić, Dragan; Zivković, Maja

    2016-06-01

    Single nucleotide polymorphisms from the chromosome locus 9p21 are reported to carry a risk for various cardiovascular diseases. One of the lead single nucleotide polymorphisms, rs10757278, was mostly investigated in association with coronary artery disease but rarely with carotid atherosclerosis. In this study, we aimed to analyze the association of rs10757278 A/G polymorphism with carotid plaque presence in advanced carotid atherosclerosis. The study included 803 participants, 486 patients with high-grade stenosis (>70%) who were undergoing carotid endarterectomy and 317 controls from Serbian population. Genotypes were determined using the real-time polymerase chain reaction. According to the recessive model of inheritance, GG genotype was significantly and independently associated with carotid plaque in females only (odds ratio 2.42, CI = 1.20-4.90, P = 0.013). Odds ratio was adjusted for age, body mass index, hypertension, TC, LDLC, HDLC and TG, and P value was corrected for multiple comparisons. Our preliminary findings suggest a gender-specific association of rs10757278 polymorphism with carotid plaque. Further studies on larger sample and in genetically and environmentally similar populations are needed. PMID:26941057

  2. Persistent carotid-vertebrobasilar anastomosis: radiologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Il; Kim, Dong Ik; Jun, Pyoung; Yoon, Pyeong Ho; Hwang, Geum Ju; Cheon, Young Jik; Lim, Joon Seok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-11-01

    To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. Thirteen pateints with fourteen cases of carotid-vertebrobasilar anastomosis collected from January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography were cerebral infarction (n=3D3), intracranial hemorrhage (n=3D2), subarachnoid hemorrhage (n=3D1), brain tumor (n=3D3), arteriovenous malformation (n=3D3) and trigeminal neuralgia (n=3D1). Cerebral angiograms and clinical symptoms were retrospectively analyzed. The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases of persistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminal arteries were associated with anterior communicating artery aneurysm(n=3D1), posterior fossa arteriovenous malformation(n=3D2) and persistent trigeminal artery variant(n=3D5). Type I proatantal intersegmental arteries were associated with hypoplastic vertebral arteries(n=3D2): only proximal segment in one, and proximal and distal segments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosis which was trigeminal neuralgia. Knowledge of the anatomical and radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovascular disease and prevent possible complications during surgical and interventional procedures.=20.

  3. Persistent carotid-vertebrobasilar anastomosis: radiologic findings

    International Nuclear Information System (INIS)

    To evaluate the radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies. Thirteen pateints with fourteen cases of carotid-vertebrobasilar anastomosis collected from January 1992 to December 1997 were reviewed. Clinical diagnosis refered for cerebral angiography were cerebral infarction (n=3D3), intracranial hemorrhage (n=3D2), subarachnoid hemorrhage (n=3D1), brain tumor (n=3D3), arteriovenous malformation (n=3D3) and trigeminal neuralgia (n=3D1). Cerebral angiograms and clinical symptoms were retrospectively analyzed. The fourteen carotid-vertebrobasilar anastomsis consisted of eleven cases of persistent trigeminal artery and three cases of type I proatantal intersegmental artery. Persistent trigeminal arteries were associated with anterior communicating artery aneurysm(n=3D1), posterior fossa arteriovenous malformation(n=3D2) and persistent trigeminal artery variant(n=3D5). Type I proatantal intersegmental arteries were associated with hypoplastic vertebral arteries(n=3D2): only proximal segment in one, and proximal and distal segments in one case. Only one patient had clinical symptom related to the carotid-vertebrobasilar anastomosis which was trigeminal neuralgia. Knowledge of the anatomical and radiologic findings of carotid-vertebrobasilar anastomosis and associated anomalies will aid in the accurate diagnosis of neurovascular disease and prevent possible complications during surgical and interventional procedures.=20

  4. Hemodynamic stability, myocardial ischemia, and perioperative outcome after carotid surgery with remifentanil/propofol or isoflurane/fentanyl anesthesia.

    Science.gov (United States)

    Jellish, W Scott; Sheikh, Taqdees; Baker, William H; Louie, Eric K; Slogoff, Stephen

    2003-07-01

    This study compares remifentanil/propofol (remi/prop) with isoflurane/fentanyl (iso/fen) anesthesia to determine which provides the greater hemodynamic stability, lesser myocardial ischemia, and morbidity with better postoperative outcomes after carotid endarterectomy. Sixty patients undergoing unilateral carotid endarterectomy were randomized to receive either a remi/prop or iso/fen anesthetic. Hemodynamic variables were recorded during the surgical procedure. In addition, transesophageal echocardiography was used to assess evidence of intraoperative regional wall motion abnormalities suggestive of cardiac ischemia. Emergence and extubation times, recovery from anesthesia, hemodynamic instability, nausea, vomiting, and pain in post anesthesia recovery, discharge delays, ICU admittance, hospital discharge, and preoperative and postoperative troponin levels were compared using appropriate statistical methods with P < 0.05 considered significant. The groups were demographically alike. Hemodynamic variables were similar during intubation and throughout surgery. Twenty-two percent of patients receiving iso/fen developed intraoperative regional wall motion abnormalities suggestive of ischemia, whereas no remi/prop patients had changes (P < 0.05). There was no difference in ST-T wave changes after surgery, and no patient had an elevation in troponin I levels. Postoperative variables were similar except that patients who received iso/fen had lower Stewart recovery scores during the first 15 minutes after post anesthesia care unit admission and a higher incidence of nausea and vomiting the day after surgery, whereas patients receiving remi/prop had discharge delays secondary to hypertension. ICU admittance, time to first void, oral intake, and time to hospital discharge were similar between the groups. At 9 times the cost of an iso/fen anesthesia technique, remi/prop offers little advantage over inhalational anesthesia for carotid endarterectomy. PMID:12826964

  5. Pulmonary endarterectomy: the lancet first, tears for pills.

    Science.gov (United States)

    Morsolini, M; Boffini, M; Paciocco, G; Corsico, A G; Solidoro, P

    2014-11-14

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease due to the incomplete resolution of pulmonary emboli, leading to right heart failure, with a poor survival. Pulmonary endarterectomy (PEA) is the operation of choice for CTEPH. As there are no well-defined criteria to discriminate surgically accessible from inaccessible obstructive lesions, the operability assessment relies on the surgeon's experience. The recommended algorithms to perform a correct diagnosis of CTEPH still suggest the lung ventilation/perfusion scan, despite advances in computed tomography with 3-D reconstruction and magnetic resonance imaging. Selective pulmonary angiography is the gold standard to assess operability in CTEPH. Medical therapy should not be considered an alternative to PEA, as it should be reserved to patients with either peripheral disease, deemed inoperable by an experienced PEA surgeon, or persistent/recurrent pulmonary hypertension after PEA. Lung transplantation, when indicated, still represents a viable option for patients with either inoperable CTEPH or CTEPH with concomitant severe parenchymal lung disease that contraindicates PEA. The outcome of operable CTEPH is still best predicted after surgery. Remarkably, the recovery of exercise capacity is not as immediate as hemodynamic improvement, underlining the importance of early identification of surgical candidates before physical deconditioning. PMID:25396687

  6. Posture-dependent chronotropic effect of carotid sinus massage

    DEFF Research Database (Denmark)

    Møller, M; Oxhøj, H; Mickley, H; Hansen, K N

    1987-01-01

    The hypertensive carotid sinus can be divided into cardioinhibitory (chronotropic) and vasodepressor components; the former can be evaluated by carotid sinus massage performed in the supine position. We present the case of a patient in whom the abnormal cardioinhibitory response could only be dem...

  7. Sequential CT findings on giant aneurysms of the intracranial internal carotid artery after carotid ligation

    International Nuclear Information System (INIS)

    Twenty one patients with giant aneurysms of the intracranial carotid artery were experienced from 1961 to the end of 1980. Three out of 21 were given no treatment and the remaining 18 were treated by indirect surgery. At follow-up, 15 cases were living useful lives; nine of these cases were treated by carotid ligation, five by carotid ligation with STA-MCA anastomosis and one had no surgical treatment. Fourteen out of 15 living cases were examined by CT scan. Sequential CT findings of the giant aneurysm were as follows. The cavity of the giant aneurysm was filled with clots within one week after ligation. Most of the cavity was thrombosed and a small residual cavity was visualized within 2 to 3 weeks after surgery. A thick mural thrombus was organized gradually between 4 and 6 weeks but a narrowed residual aneurysmal cavity still existed. Further organization and calcification of the thrombus and aneurysmal wall progressed for several years. More than 5 years following carotid ligation, a small residual cavity was thrombosed and the aneurysm could not be detected by CT scan. CT findings which prove the effectiveness of indirect surgical treatment were observed in 11 out of 13 patients (84.6%). However, complications after carotid ligation cannot be neglected. Therefore, combined therapy consisting of neck internal carotid ligation and STA-MCA anastomosis is recommended to prevent complications due to carotid ligation. Sequential CT scans are very useful for observation of the fate of the giant aneurysm after carotid ligation and the effectiveness of therapy, and for evolution of the prognosis of patients. (J.P.N.)

  8. Sequential CT findings on giant aneurysms of the intracranial internal carotid artery after carotid ligation

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwara, S.; Kodama, N.; Suzuki, J. (Tohoku Univ., Sendai (Japan). School of Medicine)

    1982-04-01

    Twenty one patients with giant aneurysms of the intracranial carotid artery were experienced from 1961 to the end of 1980. Three out of 21 were given no treatment and the remaining 18 were treated by indirect surgery. At follow-up, 15 cases were living useful lives; nine of these cases were treated by carotid ligation, five by carotid ligation with STA-MCA anastomosis and one had no surgical treatment. Fourteen out of 15 living cases were examined by CT scan. Sequential CT findings of the giant aneurysm were as follows. The cavity of the giant aneurysm was filled with clots within one week after ligation. Most of the cavity was thrombosed and a small residual cavity was visualized within 2 to 3 weeks after surgery. A thick mural thrombus was organized gradually between 4 and 6 weeks but a narrowed residual aneurysmal cavity still existed. Further organization and calcification of the thrombus and aneurysmal wall progressed for several years. More than 5 years following carotid ligation, a small residual cavity was thrombosed and the aneurysm could not be detected by CT scan. CT findings which prove the effectiveness of indirect surgical treatment were observed in 11 out of 13 patients (84.6%). However, complications after carotid ligation cannot be neglected. Therefore, combined therapy consisting of neck internal carotid ligation and STA-MCA anastomosis is recommended to prevent complications due to carotid ligation. Sequential CT scans are very useful for observation of the fate of the giant aneurysm after carotid ligation and the effectiveness of therapy, and for evolution of the prognosis of patients.

  9. MR imaging in carotid artery atherosclerosis plaque characterization

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate the potential role of carotid artery atherosclerosis plaque magnetic resonance (MR) microimaging as magnetic resonance imaging (MRI) marker, ex vivo MR images were acquired at optimized parameters on 9.4T Bruker animal imager for occluded tissue resected by carotid endarterectomy (CEA) and corresponding histopathological analysis was made. For imaging, CEA tissues of size 2-6 cm long and 0.5-1.5 cm wide, were transferred to 15 ml co-polymer laboratory culture tubes containing either 10% formalin in phosphate buffered saline (PBS) or in 50% glycerol in PBS. Imaging protocol was set at echo time (TE)=30 ms, repetition time (TR)=1.5 s, matrix size=265 x 512, number of excitations (NEX)=128, slice thickness=1 mm and in-plane resolution=0.1 mm for total sample size 2.5 cm. Soon after imaging done, carotid artery tissues were cut into 5-mm segments and processed for histological section for successive 5-micrometer slices. To compare morphology of 5 μm thin CEA section with that of 1 mm MR slices, registration was obtained between histologic sections and MR slices. Contrast and magnetic resonance relaxation characteristics were analyzed. Total carotid artery area computed by MR imaging was correlated with areas determined from histologic sections (r2=0.989, p=0.0001). For the lumen area, the correlation between MR images and histologic area was (r2 0.942, p=0.0001). Relaxation times and T2 parametric images of different plaque components were determinant for contrast resolution. Scan parameters were optimized for fibrous cap and atheroma. Scan parameters were characteristic for comparison at 1.5T and 9.4T MR imagers. The observed correlation validated MR microimaging to assess morphological features of carotid artery plaques and contrast resolution highlighted the potential of in vivo MR imaging as non-invasive MRI marker to monitor carotid artery plaque morphometry and plaque composition. (author)

  10. Duplex scanning of carotid artery following thrombo-endarteriectomy and plastic dilation

    International Nuclear Information System (INIS)

    40 carotid arteries were studied in 32 patients following thrombo-endarteriectomy with plastic patching, with 27 cases having additional digital angiography findings available for control. Both the communal carotid arteries and the carotid bifurcations were sufficiently assessable in the B-image in 95%. Safe image diagnosis of the internal carotid arteries was possible in 82% only. Proximal formation of steps (40%) and stenoses of the external carotid artery (43%) were found most frequently. Only 4 cases revealed discrepancies to DSA findings. Duplex scanning should not be performed until a fortnight after operation due to soft tissue swellings. (orig.)

  11. Direct clipping of a blister-like aneurysm in the supraclinoid segment of the internal carotid artery: a clinical analysis of nine cases

    OpenAIRE

    Yu, Jinlu; Xu, Baofeng; Guo, Yunbao; Xu, Kan

    2015-01-01

    To investigate the method and outcome from direct clipping of a blister-like aneurysm (BBA) of the internal carotid artery supraclinoid segment. This study featured nine BBA patients, including eight females and one male. The patients presented subarachnoid hemorrhage (SAH) as the initial symptom and were diagnosed with BBA in the supraclinoid segment through a vascular exam and imaging. During the exam, the internal carotid artery was pressed to block the blood flow, and a transcranial Doppl...

  12. Evaluation of disease of the carotid bifurcation using magnetic resonance imaging

    International Nuclear Information System (INIS)

    Magnetic resonance angiography (MRA) provides a non-invasive method to evaluate disease of the carotid bifurcation. It has been shown by comparison with catheter-injection x-ray angiography (CA) to have high sensitivity and specificity. Nevertheless, determination of the true accuracy of MRA is limited when CA is used as the gold standard. We discuss the principles of MRA and the results of a study where the true measure of carotid disease was taken to be the stenosis values measured from the surgical specimen resected en bloc. Patients scheduled for endarterectomy surgery were evaluated with MRA, CA and Doppler ultrasound (DUS). The stenosis degree determined by each modality was compared with that measured from the excised specimen. The results of this analysis showed that MRA and DUS were more accurate than CA in assessing the degree of stenosis. We also discuss the use of MR and ultrasound methods to evaluate the composition of plaque at the carotid bifurcation, and show that these methods can differentiate between different plaque components. These results suggest that MRA, or DUS or a combination of both can be used to accurately evaluate disease of the carotid bifurcation. (author)

  13. Carotid Artery Disease

    Science.gov (United States)

    ... org Diagnosis Proteins in the wall of the aorta, called elastin and collagen The diagnosis of carotid ... a higher risk after age 75) • Smoking • Hypertension • Diabetes • High cholesterol, and especially high amounts of “low ...

  14. Recanalization of occlusive extracranial internal carotid artery dissection through medication of anticoagulant and antiplatelet agents: report of two cases with literature review

    International Nuclear Information System (INIS)

    Objective: To determine the effectiveness and safety of antiplatelet and anticoagulant agents in the treatment of extracranial internal carotid artery dissection (eICAD). Methods: Antiplatelet and anticoagulant agents were adopted to treat two cases of eICAD in our hospital. The clinical data were retrospectively analyzed and the medical literatures concerning eICAD, which were obtained from Pubmed database, were reviewed. Results: Most researches advocated the empirical use of antiplatelet and anticoagulant agents in eICAD. About 30% of occluded eICAD could be reopened in 8 days and about 60% - 80% in 3 months after the onset of the disease. During the period of treatment, the rate of ischemic stroke recurrence, disability or death was 8.3%-14.3% in anticoagulant group, while it was 7% - 23.7% in antiplatelet group. Conclusion: Antiplatelet agents can be used in patients with eICAD who are contraindicated to anticoagulants. Anticoagulants should be used as early as possible in patients who are not contraindicated to anticoagulants. (authors)

  15. Tratamento endovascular da doença obstrutiva carotídea em pacientes de alto risco: resultados imediatos Endovascular treatment of carotid obstructive disease in high risk patients: immediate results

    Directory of Open Access Journals (Sweden)

    Ricardo Augusto Carvalho Lujan

    2006-03-01

    patients for carotid endarterectomy surgery (CEA. This study reports our experience at Instituto de Cirurgia Vascular e Endovascular de São Paulo with regard to CAS in high risk patients. MATERIAL AND METHOD: A retrospective descriptive study was performed based on the analysis of 113 medical charts of patients (84 males and 29 females submitted to 130 CAS from March 2000 to June 2004. Mean age was 74 years (range, 51-86 years. Asymptomatic patients (55% presented stenosis > 75%, whereas in symptomatic patients (45% stenosis was > 70%. Indication for CAS included: high risk for CEA (45%, recurrent stenosis post-CEA (15%, contralateral internal carotid artery stenosis (14%, contralateral carotid occlusion (12%, high cervical bifurcation (6%, post-radiation stenosis (5%, anatomically limited access (3%. The lesions were located at: carotid bifurcation (46%, internal carotid artery (32%, common carotid artery origin (9%, brachiocephalic trunk (8%, and common carotid artery (5%. RESULT: Seven neurological events were observed (five cases of cerebral vascular accident and two patients who had a transitory ischemic attack. Death rate was 0%. Overall complication rate (cerebral vascular accident, transitory ischemic attack, death was 5.3%. CONCLUSION: CAS has proved to be a procedure with a low complication rate. Therefore, it is a safe and efficient option in high risk patients for CEA.

  16. 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

    2016-01-01

    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

  17. Unusual looping of the internal carotid artery in relation to an enlarged lymph node

    Directory of Open Access Journals (Sweden)

    Nayak SB

    2010-06-01

    Full Text Available Knowledge of variations of internal carotid artery is important to surgeons doing head and neck surgery as well as to radiologists doing imaging and invasive techniques. In the current case, the right internal carotid artery showed a characteristic loop at its beginning. An abnormal, enlarged lymph node was found at the carotid bifurcation, which was projecting into the loop. The left internal carotid artery was normal. The unusual looping of internal carotid artery at its beginning might result in altered blood flow to the brain and may lead to confusions in surgical, imaging and invasive techniques.

  18. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... with stroke per year. Stroke is the third leading cause of death in the U.S.A., and ... carotid stenting in stroke had to have 20 leading cases. Next. And then a patient -- then a ...

  19. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... to present today, and we're going to base our commentary and discussion around the case primarily, ... hypoplastic, so then the trilateral carotid artery will give both anterior cerebral arteries. 00:24:23 WILLIAM ...

  20. The relationship between cerebral infarctive CT findings and cervical carotid arterial abnormalities; The accumulation of contrast media in angiography and carotid angio-CT

    Energy Technology Data Exchange (ETDEWEB)

    Hatanaka, Mitsuaki (Towada City Hospital, Aomori (Japan)); Shimizu, Toshio; Manabe, Hiroshi; Suzuki, Naoya

    1990-04-01

    The relationship between cervical carotid arterial changes and cerebral occlusive or ischemic disease was discussed in 120 consecutive cases (60 abnormal and 60 normal CT findings) which had been examined by means both of angiography and of brain CT. Even the low-grade stenosis of the carotid artery (less than 50%) had influence on the infarctive changes in CT; in these low-grade stenotic cases, clinico-pathological study sometimes revealed intimal damage, calcification, and clot formation on the damaged inner wall. Angiographically, the focal accumulation of contrast media in the carotid pathological region is a radiological expression of focal circulatory disturbance, a transient staying of the carotid blood flow, of clot-formation. More dynamic circulatory findings were revealed by Cine-Angiography. In cases of positive brain CT findings, cortical and multiple lesions more frequently had carotid changes and the accumulation of contrast media than did the basal ganglia and subcortical lesions. Even in the cases of negative brain CT findings, carotid changes were observed in about 20% of the cases. Angiographical study has the limitation that it cannot reveal the abnormality of the carotid arterial wall itself. On the other hand, carotid angio-CT was able to reveal carotid wall changes - for instance, calcification at a high density and atheromatous change at a low density: it can also investigate the range and degree. It is also useful in the follow-up study of pre-operative and post-operative changes, or anti-platelet therapy. (author).

  1. Treatment of mechanically-induced vasospasm of the carotid artery in a primate using intra-arterial verapamil: a technical case report

    Directory of Open Access Journals (Sweden)

    Meyers Philip

    2004-07-01

    Full Text Available Abstract Background Despite improvements in the safety and efficacy of endovascular procedures, considerable morbidity may still be attributed to vasospasm. Vasospasm has proven amenable to pharmacological intervention such as nitrates, intravenous calcium channel blockers (CCBs, and intra-arterial papaverine, particularly in small vessels. However, few studies have focused on medium to large vessel spasm. Here we report the use of an intra-arterial CCB, verapamil, to treat flow-limiting mechanically-induced spasm of the common carotid artery (CCA in a primate. We believe this to be the first such report of its kind. Case presentation As part of a study assessing the placement feasibility and safety of a catheter capable of delivering intra-arterial cerebroprotective therapy, a female 16 kg baboon prophylaxed with intravenous nitroglycerin underwent transfemoral CCA catheterization with a metallic 6-Fr catheter without signs of acute spasm. The protocol dictated that the catheter remain in the CCA for 12 hours. Upon completion of the protocol, arteriography revealed a marked decrease in CCA size (mean cross-sectional area reduction = 31.6 ± 1.9% localized along the catheter length. Intra-arterial verapamil (2 mg/2cc was injected and arteriography was performed 10 minutes later. Image analysis at 6 points along the CCA revealed a 21.0 ± 1.7% mean increase in vessel diameter along the length of the catheter corresponding to a 46.7 ± 4.0% mean increase in cross-sectional area. Mean systemic blood pressure did not deviate more than 10 mm Hg during the procedure. Conclusions Intraluminal CCBs like verapamil may constitute an effective endovascular treatment for mechanically-induced vasospasm in medium to large-sized vessels such as the CCA.

  2. Transarterial detachable coil embolization combined with ipsilateral intermittent carotid oppression for traumatic carotid-cavernous fistula with small fistula

    Institute of Scientific and Technical Information of China (English)

    Qing Huang; Hongbing Zhang; Gang Wang; Jun Yang; Yanlong Hu; Jianxin Liu

    2015-01-01

    One case of traumatic carotid-cavernous fistula (TCCF) with small fistula treated by transarterial detachable coil embolization was reported.The intermittent ipsilateral carotid compression was used to identify the final blocking of the residual fistula.The follow-up digital subtraction angiography showed that the TCCF was cured finally, From this case, we conclude that this method may be an effective way to treat TCCF with small fistula.

  3. Displasia fibro-muscular de vasos cerebrais: relato de sete casos Fibromuscular dysplasia of cerebral vessels: report of seven cases

    Directory of Open Access Journals (Sweden)

    Ápio Cláudio M. Antunes

    1974-06-01

    Full Text Available Os autores apresentam sete casos de displasia fibro-muscular (DFM, sendo seis deles na artéria carótida e um na artéria vertebral, estudados pelas correspondentes angiografias. São relatadas as histórias clínicas que, em cinco pacientes, são de acidente vascular cerebral isquêmico e, em dois, de hemorragia sub-aracnóide por rotura de aneurisma. Dois pacientes foram à cirurgia: um deles sofreu ligadura de carótida primitiva e outro sofreu endarterectomia para retirada de placa de ateroma da artéria carótida contralateral a aquela com DFM. Finalmente é feita breve discussão sobre a referida patologia, quadro clínico, dignóstico e tratamento, sendo ressaltada a importância do estudo angiográfico carotídeo e vertebral quando encontrada DFM em outro território vascular.Seven cases of fibromuscular dysplasia, six of them of the carotid artery and one of the vertebral artery studied by angiography are reported. The clinical histories have been of ischemic cerebro-vascular accident in five patients and of subarachnoidal hemorrhage dependent on ruptured aneurism in the others. Two patients underwent surgery: a primitive carotid ligation in one and, in the other, an endarterectomy for ressection of an atheroma plaque of the contralateral carotid artery. The symptomatology, diagnosis and treatment are discussed, emphasizing the importance of the vertebral and carotid angiographic study in the cases in which there is a diagnosis of fibromuscular dysplasia in any other vascular territory.

  4. A Case of Severe Carotid Stenosis in a Patient with Familial Hypercholesterolemia without Significant Coronary Artery Disease

    OpenAIRE

    Marcos Aurélio Lima Barros; Hygor Ferreira-Fernandes; Ingrid Cristina Rêgo Barros; Adriel Rêgo Barbosa; Giovanny Rebouças Pinto

    2014-01-01

    Familial hypercholesterolemia (FH) is an inherited metabolic disorder characterized by elevated low-density lipoprotein cholesterol levels in the blood. In its heterozygous form, it occurs in 1 in 500 individuals in the general population. It is an important contributor to the early onset of coronary artery disease (CAD), accounting for 5–10% of cases of cardiovascular events in people younger than 50 years. Atherogenesis triggered by hypercholesterolemia generally progresses faster in the co...

  5. Natriuretic Peptide Receptor-C is Up-Regulated in the Intima of Advanced Carotid Artery Atherosclerosis

    Science.gov (United States)

    Zayed, Mohamed A; Harring, Scott D; Abendschein, Dana R; Vemuri, Chandu; Lu, Dongsi; Detering, Lisa; Liu, Yongjian; Woodard, Pamela K

    2016-01-01

    Objective Natriuretic peptide receptor-C (NPR-C/NPR-3) is a cell surface protein involved in vascular remodelling that is up-regulated in atherosclerosis. NPR-C expression has not been well characterized in human carotid artery occlusive lesions. We hypothesized that NPR-C expression correlates with intimal features of vulnerable atherosclerotic carotid artery plaque. Methods To test this hypothesis, we evaluated NPR-C expression by immunohistochemistry (IHC) in carotid endarterectomy (CEA) specimens isolated from 18 patients. The grade, location, and co-localization of NPR-C in CEA specimens were evaluated using two tissue analysis techniques. Results Relative to minimally diseased CEA specimens, we observed avid NPR-C tissue staining in the intima of maximally diseased CEA specimens (65%; p=0.06). Specifically, maximally diseased CEA specimens demonstrated increased NPR-C expression in the superficial intima (61%, p=0.17), and deep intima (138% increase; p=0.05). In the superficial intima, NPR-C expression significantly co-localized with vascular smooth muscle cells (VSMCs) and macrophages. The intensity of NPR-C expression was also higher in the superficial intima plaque shoulder and cap regions, and significantly correlated with atheroma and fibroatheroma vulnerable plaque regions (β=1.04, 95% CI=0.46, 1.64). Conclusion These findings demonstrate significant NPR-C expression in the intima of advanced carotid artery plaques. Furthermore, NPR-C expression was higher in vulnerable carotid plaque intimal regions, and correlate with features of advanced disease. Our findings suggest that NPR-C may serve as a potential biomarker for carotid plaque vulnerability and progression, in patients with advanced carotid artery occlusive disease.

  6. A rare variant of persistent trigeminal artery: cavernous carotid-cerebellar artery anastomosis--a case report and a systematic review.

    Science.gov (United States)

    Raphaeli, Guy; Bandeira, Alexandra; Mine, Benjamin; Brisbois, Denis; Lubicz, Boris

    2009-12-01

    We report a very rare anomalous anatomic variant of the cavernous internal carotid artery supplying directly the posterior inferior cerebellar artery, with no basilar artery opacification. A systematic review as well as a description of other variants of trigeminal-cerebellar anastomosis is given. PMID:19517204

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

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    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

  8. Chlamydia pneumoniae in atherosclerotic carotid artery plaques: high prevalence among heavy smokers.

    Science.gov (United States)

    Dobrilovic, N; Vadlamani, L; Meyer, M; Wright, C B

    2001-06-01

    This study was designed to determine the prevalence of Chlamydia pneumoniae in carotid artery plaques. Although there have been numerous studies evaluating coronary plaques for this bacterium fewer studies have assessed noncoronary vasculature. In addition we wished to evaluate whether correlation exists between the presence of C. pneumoniae in carotid plaques and established risk factors for atherosclerosis. Sixty intact carotid artery plaques removed during surgery (carotid endarterectomy) were formalin-fixed and paraffin-embedded according to conventional techniques. These samples were evaluated by polymerase chain reaction analysis to detect presence of C. pneumoniae DNA. Results were tabulated and compared against established risk factors for atherosclerosis: diabetes, hypertension, hyperlipidemia, age, and smoking. Forty-two (70.0%) of the 60 plaques that were evaluated tested positive for the presence of C. pneumoniae DNA by polymerase chain reaction analysis. In the sample defined as being from heavy smokers (greater than 15-pack-year history) 33 (94.3%) of 35 plaques tested positive whereas two (5.7%) tested negative. This correlation demonstrated statistical significance (P = 1.36 x 10(-6), two-tailed Fisher exact test). Presence of C. pneumoniae in carotid plaques demonstrated no statistically significant correlation with diabetes, hypertension, or hyperlipidemia. Age as a risk factor was examined but not statistically evaluated because of the narrow range within our patient sample. Analysis of the data reveals that C. pneumoniae is present in large numbers of atheromatous plaques as is consistent with emerging data. What is interesting though is that 33 (94.3%) of the 35 smokers had plaques that tested positive for the bacterium as opposed to only nine (36.0%) of the 25 nonsmokers. Identification of specific populations exhibiting a high prevalence of C. pneumoniae may serve to focus future studies. Ongoing investigation will seek to determine whether C

  9. Combination of Agatston Calcium Score and CTA: quantification and characterization of carotid calcium

    International Nuclear Information System (INIS)

    Objective: To quantify and characterize carotid calcification with combined Agatston Calcium Score and multidetector CT angiography (MDCTA) and to determine whether the combination could he applied as a useful decision- making tool for treatment. Methods: A total of 136 carotid arteries were examined with MDCTA (67.6±10.2 years; age range from 37-86 years; 11 women, 57 men). The calcium scores were determined using Agatston method from pre-contrast data. The stenosis was assessed based on North American Symptomatic Carotid Endarterectomy Trial criteria from post-contrast data. Results: Symptomatic patients had higher total calcium volume (TCV), total equiv mass (TEM) and total calcium score (TCS) than asymptomatic patients, but the differences did not reach statistical significance with or without taking the interactive effect of age and stenosis into account. TCV, TEM, and TCS differed significantly between high-grade and mild- grade stenotic vessels (P<0.001), and moderate-grade and mild-grade stenotic vessels (P<0.001); and they also differed statistically between age groups of 51-69 years and of ≥70 years (P<0.001). Pearson's correlation test showed a mild but significant correlation between stenotic grade of carotid bifurcation and ipsilateral ICA and total calcium volume (rbifurcation=0.322 and rICA=0.418 respectively, P<0.01). Conclusion: Combination of Agatston Calcium Score and CTA is likely to emerge as a noninvasive choice to accurately assess calcification and quantification of the burden in the carotid arteries. It can provide valuable insights into plaque characterization and stability, which is especially important for clinical decision-making. (authors)

  10. Carotid Artery Stenting: Retrospective Evaluation of Experience of an Invasive Tertiary Center

    Directory of Open Access Journals (Sweden)

    Faruk Ertaş

    2016-03-01

    Full Text Available Objective: Carotid artery stenting (CAS is being applied more frequently as an alternative mode of treatment to carotid endarterectomy. We aimed to present the short-term clinical outcomes of the patients admitted to our clinic with a diagnosis of carotid artery disease and revas­cularized by CAS. Methods: The study was retrospective and a single-centered study. Between June 2013-January 2016 the patients with an indication for carotid artery intervention and accepted CAS procedure were included in the study. Clinical characteristics and procedural data of the patients were obtained by scanning patient files. After discharge, hospital records were scanned and patients were called to learn whether or not patients were alive and that they have suffered a recent stroke. Results: We included 82 patients that meet the inclusion criteria in the study. 59% of patients were male with a mean age of 68±9 years. 56% of patients were symp­tomatic. In all patients, stents were used. 85% of patients distal embolic protection devices and 15% MOMA were used. 64 right, 18 left, and two bilateral carotid arteries were stented with a total of 82 patient of 84 successful CAS. Due to residual stenosis a second stent was im­planted only in one patient. One patient experienced a partial muscle weakening in upper extremity due to an air embolism and 2 patients received opac material which recovered spontaneously in 24 hours. Conclusion: CAS is being successfully applied with a very low risk of complications in experienced centers. Short-term clinical results of CAS are quite satisfactory.

  11. Multi-analyte profiling in human carotid atherosclerosis uncovers pro-inflammatory macrophage programming in plaques.

    Science.gov (United States)

    Shalhoub, Joseph; Viiri, Leena E; Cross, Amanda J; Gregan, Scott M; Allin, David M; Astola, Nagore; Franklin, Ian J; Davies, Alun H; Monaco, Claudia

    2016-05-01

    Molecular characterisation of vulnerable atherosclerosis is necessary for targeting functional imaging and plaque-stabilising therapeutics. Inflammation has been linked to atherogenesis and the development of high-risk plaques. We set to quantify cytokine, chemokine and matrix metalloproteinase (MMP) protein production in cells derived from carotid plaques to map the inflammatory milieu responsible for instability. Carotid endarterectomies from carefully characterised symptomatic (n=35) and asymptomatic (n=32) patients were enzymatically dissociated producing mixed cell type atheroma cell suspensions which were cultured for 24 hours. Supernatants were interrogated for 45 analytes using the Luminex 100 platform. Twenty-nine of the 45 analytes were reproducibly detectable in the majority of donors. The in vitro production of a specific network of mediators was found to be significantly higher in symptomatic than asymptomatic plaques, including: tumour necrosis factor α, interleukin (IL) 1β, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), macrophage colony-stimulating factor (M-CSF), CCL5, CCL20, CXCL9, matrix metalloproteinase (MMP)-3 and MMP-9. Ingenuity pathway analysis of differentially expressed analytes between symptomatic and asymptomatic patients identified a number of key biological pathways (p< 10(-25)). In conclusion, the carotid artery plaque culprit of ischaemic neurological symptoms is characterised by an inflammatory milieu favouring inflammatory cell recruitment and pro-inflammatory macrophage polarisation. PMID:26763091

  12. Multi-slice spiral CT diagnosis of carotid body tumor

    International Nuclear Information System (INIS)

    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)

  13. CAROTID ATHEROSCLEROTIC LESION IN YOUNG PATIENTS

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    N. V. Pizova

    2014-01-01

    Full Text Available Objective: to determine the incidence of atherosclerotic lesions in the carotid and vertebral arteries of young patients from Doppler ultrasound data and to compare the quantitatively assessed traditional risk factors of coronary heart disease (CHD with severe extracranial artery atherosclerotic lesion.Subjects and methods. Doppler ultrasound was carried out evaluating structural changes in the aortic arch branches in 1563 railway transport workers less than 45 years of age. A separate sample consisted of 68 young people with carotid atherosclerotic changes, in whom traditional risk factors for CHD were studied, so were in a control group of individuals without atherosclerotic changes (n = 38.Results. Among the examinees, carotid atherosclerotic lesion was detected in 112 (7.1 % cases, the increase in the rate of atherosclerotic plaques in patients aged 35–45 years being 9.08 %; that in the rate of local intima-media thickness in those aged 31–40 years being 5.1 %. Smoking (particularly that along with hypercholesterolemia and a family history of cardiovascular diseases, obesity (along with low activity, and emotional overstrain were defined as important risk factors in the young patients. Moreover, factor analysis has shown that smoking,hypertension, and early cardiovascular pathology in the next of kin makes the greatest contribution to the development of carotid atherosclerotic lesion.Conclusion. Among the patients less than 45 years of age, carotid and vertebral artery atherosclerotic changes were found in 112 (7.1 % cases, which were more pronounced in male patients. Smoking, particularly along with hypercholesterolemia and genetic predisposition to cardiovascular diseases, was a risk factor that had the highest impact on the degree of atherosclerotic lesion in the aortic arch branches of the young patients.

  14. 颈部大动脉出血急救及血管修复重建(附6例11次报告)%Emergency rescue and vascular reconstruction of carotid artery rupture: a report of 6 cases

    Institute of Scientific and Technical Information of China (English)

    朱敏辉; 郑宏良; 陈世彩; 陈东辉

    2012-01-01

    primary illness included vocal cord paralysis (2 cases) after operation of thyroid carcinoma, recurrent thyroid carcinoma (1 case), recurrent hypopharyngeal carcinoma (1 case), head and neck trauma (1 case) and carotid body tumord case). Four patients received radiotherapy (60-80 Gy) before second operation. One patient (2 times) had innominate artery blowout, 4 (8 times) had common carotid blowout, and one had internal carotid artery blowout. CAR occurred during or after surgical operations in 4 patients (8 times) and was caused by external injury in 1 case (1 time). Results Restore of CA after complete exposure of rupture was performed for 5 times, anastomosis by artificial blood vessel for 1 time, direct anastomosis for 1 time, reconstruction by great saphenous vein for 2 times, and ligation of total carotid artery for 2 times. Of all patients, 3 cases undergoing vascular reconstruction succeeded by one try, 2 by 2 tries, and 2 cases underwent ligation of artery because of suture falling off for radiotherapy of infection. Muscle flaps including pectoralis major myocutaneous flap ( 3 cases ) and sternocleidomastoid faps (2 cases) were used to protect vascular anastomosis. All cases were successfully rescued, without perioperative death. One patient developed hemiplegial after ligation of carotid artery. All cases had complete follow-up data. One patient died due to bleeding one week after discharge, 1 died due to recurrent tumor within one year after operation. By now one patient survived for 3 years and 3 for 5 years. Conclusion Once CAP occurs, prompt press by hands and quick anti-shock procedure are the prerequisites of successful rescue. Reconstruction or repair of carotid artery can prevent complications of the nervous system, and individualized vascular reconstruction strategy should be employed. Ligation of carotid is effective to rescue patients of CAR, but it should only be chosen when reconstruction is impossible.

  15. Occlusion of Internal Carotid Artery in Kimura's Disease

    OpenAIRE

    Node Yoji; Tomonori Tamaki

    2010-01-01

    We describe a unique case of Kimura's disease in which cerebral infarction was caused by occlusion of the right internal carotid artery. A 25-year-old man with Kimura's disease was admitted to our hospital because of left hemiparesis. Computed tomography and magnetic resonance imaging of the head showed infarction in the right frontal and temporal lobes. Cerebral angiography demonstrated right internal carotid artery occlusion affecting the C1 segment, with moyamoya-like collateral vessels ar...

  16. Multimodality imaging of carotid atherosclerotic plaque: Going beyond stenosis

    OpenAIRE

    Divyata Hingwala; Chandrasekharan Kesavadas; Sylaja, Padmavathy N; Bejoy Thomas; Tirur Raman Kapilamoorthy

    2013-01-01

    Apart from the degree of stenosis, the morphology of carotid atherosclerotic plaques and presence of neovascularization are important factors that may help to evaluate the risk and ′vulnerability′ of plaques and may also influence the choice of treatment. In this article, we aim to describe the techniques and imaging findings on CTA, high resolution MRI and contrast enhanced ultrasound in the evaluation of carotid atherosclerotic plaques. We also discuss a few representative cases from our in...

  17. Mycotic pseudo-aneurysm of the extracranial carotid artery.

    Science.gov (United States)

    Desimpelaere, J; Seynaeve, P; Kockx, M; Appel, B; Gyselinck, J; Mortelmans, L

    1997-08-01

    A rare case of mycotic pseudo-aneurysm of the common carotid artery as a complication in an immunosuppressed paediatric patient is presented. Treatment of pseudo-aneurysms of the common carotid artery is generally considered to be an emergency, necessitating quick and accurate diagnosis. In patients with septicemia, angiography has to be avoided. We were able to provide the surgeon with the exact diagnosis and accurate topographical information with helical CT with 3D reformation. PMID:9351308

  18. The relationship between cerebral infarctive CT findings and cervical carotid arterial abnormalities

    International Nuclear Information System (INIS)

    The relationship between cervical carotid arterial changes and cerebral occlusive or ischemic disease was discussed in 120 consecutive cases (60 abnormal and 60 normal CT findings) which had been examined by means both of angiography and of brain CT. Even the low-grade stenosis of the carotid artery (less than 50%) had influence on the infarctive changes in CT; in these low-grade stenotic cases, clinico-pathological study sometimes revealed intimal damage, calcification, and clot formation on the damaged inner wall. Angiographically, the focal accumulation of contrast media in the carotid pathological region is a radiological expression of focal circulatory disturbance, a transient staying of the carotid blood flow, of clot-formation. More dynamic circulatory findings were revealed by Cine-Angiography. In cases of positive brain CT findings, cortical and multiple lesions more frequently had carotid changes and the accumulation of contrast media than did the basal ganglia and subcortical lesions. Even in the cases of negative brain CT findings, carotid changes were observed in about 20% of the cases. Angiographical study has the limitation that it cannot reveal the abnormality of the carotid arterial wall itself. On the other hand, carotid angio-CT was able to reveal carotid wall changes - for instance, calcification at a high density and atheromatous change at a low density: it can also investigate the range and degree. It is also useful in the follow-up study of pre-operative and post-operative changes, or anti-platelet therapy. (author)

  19. Pulmonary Vascular and Right Ventricular Reserve in Patients With Normalized Resting Hemodynamics After Pulmonary Endarterectomy

    OpenAIRE

    Claessen, Guido; La Gerche, Andre; Dymarkowski, Steven; Claus, Piet; Delcroix, Marion; Heidbuchel, Hein

    2015-01-01

    Background-Patients with normalized mean pulmonary artery pressure (mPAP) after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) do not always regain normal exercise capacity. We evaluated right ventricular function, its interaction with both pulsatile and resistive afterload, and the effect of sildenafil during exercise in these patients. Methods and Results-Fourteen healthy controls, 15 CTEPH patients, and 7 patients with normalized resting mPAP (

  20. Outcome and Graft Patency in Coronary Artery Bypass Grafting with Coronary Endarterectomy

    OpenAIRE

    Nemati, Mohammad Hassan; Astaneh, Behrooz; Khosropanah, Shahdad

    2015-01-01

    Background Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. Methods This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After fo...

  1. Relationship Between Serum Fetuin-A Levels and Carotid Intima-media Thickness in Turkish Patients with Mild to Moderate Psoriasis. A Case-control Study

    OpenAIRE

    Belkız Uyar; Muhittin Akyıldız; Aynur Solak; Berhan Genç; Ali Saklamaz

    2015-01-01

    Previous studies have associated severe psoriasis and psoriatic arthritis with an increased risk of atherosclerosis. However, the association between patients with mild-to-moderate plaque-type psoriasis and atherosclerosis has yet to be studied in depth. This study investigates a) possible correlations between carotid intima-media thickness (CIMT) and serum fetuin-A levels in patients with mild-to-moderate psoriasis and b) correlations between psoriasis severity index (PASI) and fetuin-A leve...

  2. Case of Behçet's disease complicated by oculomotor nerve palsy associated with internal carotid artery-posterior communicating artery aneurysm.

    Science.gov (United States)

    Yamaoka, Toshifumi; Murota, Hiroyuki; Katayama, Ichiro

    2015-03-01

    Behçet's disease (BD) is a relapsing systemic inflammatory disorder of unknown etiology involving systemic vasculitis. Vasculitis in BD results from the involvement of arteries, veins and blood vessels of all sizes, which leads to the three major manifestations of this condition: venous occlusion, arterial occlusion and aneurysm formation. Therefore, whole-body vascular involvement should always be considered in BD patients. Here, we describe the first appearance of an internal carotid-posterior communicating artery aneurysm, resulting in complete oculomotor nerve palsy in a BD patient. A 44-year-old Japanese man suffered from recurrent episodes of erythema nodosum that had presented on the lower extremities for the past 2 years. His condition was diagnosed as an incomplete type of BD based on relapsing oral and genital ulcers, skin eruptions, such as erythema nodosum and folliculitis, a positive pathergy test and systemic arthralgia. Ten years after his initial clinical presentation, he had manifestations of right-sided ptosis and cyclic dull pain in his right temporal region. Magnetic resonance imaging and angiography revealed a right internal carotid artery-posterior communicating artery aneurysm. Although oculomotor nerve palsy associated with internal carotid artery-posterior communicating artery aneurysm in a BD patient has not been reported previously, our report highlights the fact that this abnormal manifestation should be considered in those with vasculo-BD. PMID:25573207

  3. Carotid chemoreceptor development in mice

    OpenAIRE

    Shirahata, Machiko; Kostuk, Eric W.; Pichard, Luis E

    2012-01-01

    Mice are the most suitable species for understanding genetic aspects of postnatal developments of the carotid body due to the availability of many inbred strains and knockout mice. Our study has shown that the carotid body grows differentially in different mouse strains, indicating the involvement of genes. However, the small size hampers investigating functional development of the carotid body. Hypoxic and/or hyperoxic ventilatory responses have been investigated in newborn mice, but these r...

  4. Agenesis of the internal carotid artery with a large hemangioma of the tongue

    International Nuclear Information System (INIS)

    Total developmental absence of the internal carotid artery is relatively rare, with only 54 cases previously reported. Most, being without neurological symptoms, were found by chance. For this patient with cavernous hemangiomas in the facial, oral and cervical regions, conventional treatment would be embolization of the feeding vessels, combined with ligation of the external carotid artery. Angiography, however, revealed agenesis of the left internal carotid artery, abnormal origin of the aortic arch and azygos anterior cerebral artery. (orig./MG)

  5. Carotid tomography with ultrasound

    International Nuclear Information System (INIS)

    It seemed desirable to develop an atraumatic method for a good visualization of carotid arteries. This examination should show, at an early stage, atheromatous plaques undetectable by other non-invasive tests, and complete doubtful arteriographies on which small plaques are suspected. Real-time high resolution echotomographies and Doppler blood flow visualization are the most interesting techniques under development in this new field. (orig./VJ)

  6. [Carotid surgery, indications, results and perspectives].

    Science.gov (United States)

    Kün, P; Battino, J; Cloarec, M; Witchitz, S; Vanet, R; Mergy, R

    1985-01-01

    A series of 215 patients who had undergone 250 carotid artery operations were followed up for a mean of 30 months. Perioperative mortality was 2%, neurologic morbidity was 7% but with permanent sequelae in 1.39% of cases. Recurrence of stenosis was detected in 0.8% of patients but there were no cases of postoperative thrombosis. Indications for surgery were based on the existence of hemispheric ischemic accidents corresponding to the territory supplied by the artery operated upon, and on anatomic and evolutive arguments drawn from results of non-invasive review examinations: ultrasonography and Doppler. Results obtained: 81.9% of patients were asymptomatic after 30 months, appear to be superior to those of the natural history of carotid artery lesions. PMID:4056617

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    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

  9. The transradial approach for selective carotid and vertebral angiography

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, S.; Ueda, K.; Sueyosi, S.; Nagasawa, M.; Ude, K. [Higashiosaka City General Hospital, Osaka (Japan). Dept. of Radiology; Yokoyama, K. [Higashiosaka City General Hospital, Osaka (Japan). Dept. of Neurosurgery; Takayama, K.; Nakagawa, H.; Kichikawa, K. [Nara Medical Univ., Osaka (Japan). Dept. of Radiology

    2002-11-01

    Purpose: The transradial approach is not so popular in cerebral angiography. The purpose of this study was therefore to present our experience of success rate and safety of this method. Material and Methods: From December 1998 to June 2001, 526 carotid and vertebral angiographies with DSA were performed via the radial artery. A 1.4-mm catheter was used through a 1.4-mm introducer sheath. We evaluated the procedure as successful if sufficient images for diagnosis were obtained of the bilateral carotid arteries and unilateral vertebral artery. Each patient was reassessed for any complications, occurring until the next morning. The length of time needed for an examination was measured in the last 10 cases. Results: In all but 5 cases, the procedures were evaluated as successful (99.0%). Unsuccessful cases manifested severe pain at the radial puncture, angiospasm at the radial artery, loop formation at the radial artery, occlusion at the subclavian artery, and an aberrant right subclavian artery. No severe complications including neurological ones were encountered. Minor complications were noted in 17 cases (3.2%): 4 cases of thrombus at the ulnar artery, 1 angiospasm at the radial artery, and 12 cases of small hematoma at the puncture site. The radial approach took 14 min less in the common carotid study and 3 min 30 s less in the internal carotid study than by the femoral approach. Conclusion: The transradial approach enabled selective studies for carotid and vertebral angiography with a high success rate and safety with few complications.

  10. 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. Studi...... orthograde flow any severe pressure reduction may be ruled out. In cases of inverted flow, analysis of distal ICA waveforms may identify patients with severe reduction in ICA perfusion pressure....

  11. Carotid Body Tumor Imaging:"Paraganglioma, Chemidectoma"

    Directory of Open Access Journals (Sweden)

    Jalal Jalalshokouhi

    2010-05-01

    appear and metastasize to the bone in 6-12.5% of the cases. The abdominal wall is another rare location of metastasis."nA sex-linked genetic trait is possible. "nAll bilateral tumor cases are benign. "n90% of tumors are unilateral and 10% are bilateral. "nSporadic forms are more common than the inherited variety."n65% of head and neck paragangliomas are carotid body tumors."nClassification is sporadic, familial and hyperplastic."nThe common age involvement is the fifth decade, but in MENS (multiple endocrine neoplasia syndrome, it develops in younger patients."nCarotid body tumors have been reported in siblings of a Turkish family together with the involvement of adrenal pheochromocytomas."nDifferential Diagnosis: The main differential diagnoses are lymphadenopathy, bronchial cleft cyst, metastatic carcinoma, lymphoma, neurogenic tumors, salivary gland tumors, aneurysm, giant cell arteries, hematoma, carotid calcification or stone.

  12. Correction of carotid-jugular traumatic fistula using a bovine pericardial patch

    Directory of Open Access Journals (Sweden)

    Werther Souza Sales

    2014-03-01

    Full Text Available Carotid-jugular fistulae are rare, but habitually cause morbidity and mortality. They are often linked with penetrating trauma, primarily caused by gunshots. This report describes the case of a patient who was the victim of a gunshot wound to the left cervical area, provoking a carotid-jugular arteriovenous fistula and occlusion of the common carotid artery. The fistula was corrected by ligature of the internal jugular vein and arteriorrhaphy of the left common carotid artery with a bovine pericardium patch.

  13. Diagnosis and therapy of dural arteriovenous fistula in carotid cavernous sinus region

    International Nuclear Information System (INIS)

    Objective: To investigate the diagnostic and therapeutic methods of dural arteriovenuoe fistula in carotid cavernous sinus region. Methods: Twenty five cases of clinical diagnosis of dural arteriovenous fistula of carotid cavernous sinus region were identified by whole cerebral angiography with seldingers technique. Among them 13 cases underwent endovascular embolized therapy due to large amount of shunt, and another 12 cases were undertaken conservative method of compressing carotid artery of affected side on basis of lesser amount of shunt with a few number of feeding arteries. Results: Conditions of the 25 cases revealed by DSA were selected for the proper indications and then underwent the formentioned therapy with all successful achievement. Conclusion Diagnosis of dural arteriovenous fistula of carotid cavernous sinus region is not difficult. Endovascular embolization is very effective, but the conservative compressing method of carotid artery of the affected side is also an efficient therapy. (authors)

  14. Carotid interventions (CEA and CAS) in acute stroke patients: which procedure on which patient.

    Science.gov (United States)

    Darling, Ralph C; Warner, Courtney; Yeh, Chin C; Shah, Melissa D; Hnath, Jeffrey C; Shah, Dhiraj M

    2016-02-01

    Treatment of carotid bifurcation disease in patients presenting with acute stroke has been a controversial issue over the past four decades. Classically, patients were asked to wait four to six weeks before intervention was entertained in order for the brain to stabilize and the risks of intervention to be minimized. Unfortunately, up to 20% of patients will have a secondary event after their index event and the window of opportunity to save potentially salvageable ischemic tissue will be missed. Early reports had demonstrated poor results with intervention. However, more recently, institutions such as ours have demonstrated excellent results with early intervention in patients who present with stable mild to moderate stroke with an NIH stroke scale less than 15 and preferably less than 10, present with stroke and ipsilateral carotid artery lesion of 50% or greater. Also more recently, we have been aggressively treating patients with larger ulcerative plaques even if the stenosis approaches 50%. In our and others experiences, patients who are treated at institutions that have comprehensive stroke centers (CSCs) where they have a multidisciplinary system that consists of vascular surgeons, neuro interventionalists, stroke neurologists, specifically trained stroke nursing staff and a neuro intensive ICU have had optimal results. Early assessment, diagnosis of stroke with recognition of cause of embolization is mandatory but patient selection is extremely important; finding those patients who will benefit the most from urgent intervention. Most studies have demonstrated the benefit of carotid endarterectomy in these patients. More recent studies have demonstrated acceptable results with carotid stenting, especially in smaller lesions, those less than 1.2 centimeters. Early intervention should be avoided in most patients who are obtunded or with an NIH stroke scale greater than 15 or who do not have any "brain at risk" to salvage. These patients may be better served by

  15. Intramural location and size of arterial calcification are associated with stenosis at carotid bifurcation

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Shigeki, E-mail: shigekiyamada3@gmail.com [Department of Neurosurgery and Stroke Center, Rakuwakai Otowa Hospital, Otowachinji-cho 2, Yamashina-ku, Kyoto 607-8602 (Japan); Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525 (Japan); Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505 (Japan); Oshima, Marie, E-mail: marie@iis.u-tokyo.ac.jp [Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505 (Japan); Watanabe, Yoshihiko, E-mail: ynabe@magic.odn.ne.jp [Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525 (Japan); Ogata, Hideki, E-mail: hidogata@gmail.com [Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525 (Japan); Hashimoto, Kenji, E-mail: hashiken8022@yahoo.co.jp [Department of Neurosurgery, Kishiwada Municipal Hospital, 1001 Gakuhara-cho, Kishiwada city, Osaka 596-8501 (Japan); Miyake, Hidenori, E-mail: hi-miyake@hamamatsuh.rofuku.go.jp [Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525 (Japan)

    2014-06-15

    Purpose: The purpose of this study was to investigate the association between internal carotid artery (ICA) stenosis and intramural location and size of calcification at the ICA origins and the origins of the cervical arteries proximal to the ICA. Method: A total of 1139 ICAs were evaluated stenosis and calcification on the multi-detector row CT angiography. The intramural location was categorized into none, outside and inside location. The calcification size was evaluated on the 4-point grading scale. The multivariate analyses were adjusted for age, serum creatinine level, hypertension, hyperlipidemia, diabetes mellitus, smoking and alcohol habits. Results: Outside calcification at the ICA origins showed the highest multivariate odds ratio (OR) for the presence of ICA stenosis (30.0) and severe calcification (a semicircle or more of calcification at the arterial cross-sectional surfaces) did the second (14.3). In the subgroups of >70% ICA stenosis, the multivariate OR of outside location increased to 44.8 and that of severe calcification also increased to 32.7. Four of 5 calcified carotid plaque specimens extracted by carotid endarterectomy were histologically confirmed to be calcified burdens located outside the internal elastic lamia which were defined as arterial medial calcification. Conclusions: ICA stenosis was strongly associated with severe calcification located mainly outside the carotid plaque. Outside calcification at the ICA origins should be evaluated separately from inside calcification, as a marker for the ICA stenosis. Additionally, we found that calcification at the origins of the cervical arteries proximal to the ICA was significantly associated with the ICA stenosis.

  16. Intramural location and size of arterial calcification are associated with stenosis at carotid bifurcation

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study was to investigate the association between internal carotid artery (ICA) stenosis and intramural location and size of calcification at the ICA origins and the origins of the cervical arteries proximal to the ICA. Method: A total of 1139 ICAs were evaluated stenosis and calcification on the multi-detector row CT angiography. The intramural location was categorized into none, outside and inside location. The calcification size was evaluated on the 4-point grading scale. The multivariate analyses were adjusted for age, serum creatinine level, hypertension, hyperlipidemia, diabetes mellitus, smoking and alcohol habits. Results: Outside calcification at the ICA origins showed the highest multivariate odds ratio (OR) for the presence of ICA stenosis (30.0) and severe calcification (a semicircle or more of calcification at the arterial cross-sectional surfaces) did the second (14.3). In the subgroups of >70% ICA stenosis, the multivariate OR of outside location increased to 44.8 and that of severe calcification also increased to 32.7. Four of 5 calcified carotid plaque specimens extracted by carotid endarterectomy were histologically confirmed to be calcified burdens located outside the internal elastic lamia which were defined as arterial medial calcification. Conclusions: ICA stenosis was strongly associated with severe calcification located mainly outside the carotid plaque. Outside calcification at the ICA origins should be evaluated separately from inside calcification, as a marker for the ICA stenosis. Additionally, we found that calcification at the origins of the cervical arteries proximal to the ICA was significantly associated with the ICA stenosis

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

    International Nuclear Information System (INIS)

    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)

  18. Non-traumatic carotid dissection and stroke associated with anti-phospholipid antibody syndrome: Report of a case and review of the literature

    Directory of Open Access Journals (Sweden)

    Kluger Benzi

    2008-01-01

    Full Text Available Young adults with stroke frequently do not have any of the traditional risk factors associated with stroke, prompting a search for other mechanical and hypercoagulable causes. The authors report a young man presenting with stroke and subsequently diagnosed with a carotid dissection. Recurrent strokes while on heparin prompted a search for a second etiology and the patient was found to have antiphospholipid antibody syndrome. Although these conditions may be coincidental, we propose that their interaction was significant in this patient′s presentation. Other reports of this association will also be reviewed.

  19. Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster

    Institute of Scientific and Technical Information of China (English)

    Hesham; Allam; R; Charles; Callison; Daniel; Scodary; Aws; Alawi; Daniel; W; Hogan; Amer; Alshekhlee

    2014-01-01

    Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.

  20. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

    Directory of Open Access Journals (Sweden)

    Jacek Brzost

    2015-01-01

    Full Text Available The extracranial internal carotid artery aneurysm (EICAA is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63×55×88 mm, stretching from the skull base to the angle of the mandible.

  1. Hyperperfusion syndrome after carotid stent angioplasty

    International Nuclear Information System (INIS)

    This study assesses the incidence and causes of hyperperfusion syndrome occurring after carotid artery stenting (CAS). We retrospectively reviewed the clinical database of 417 consecutive patients who were treated with CAS in our department to identify patients who developed hyperperfusion syndrome and/or intracranial hemorrhage. Magnetic resonance imaging (MRI) including fluid-attenuated inversion recovery and diffusion-weighted imaging was performed before and after CAS in 269 cases. A Spearman's rho nonparametric correlation was performed to determine whether there was a correlation between the occurrence/development of hyperperfusion syndrome and the patient's age, degree of stenosis on the stented and contralateral side, risk factors such as diabetes, smoking, hypertension, adiposity, gender and fluoroscopy time, and mean area of postprocedural lesions as well as preexisting lesions. Significance was established at p < 0.05. Of the 417 carotid arteries stented and where MRI was also completed, we found hyperperfusion syndrome in 2.4% (ten cases). Patients who had preexisting brain lesions (previous or acute stroke) were at a higher risk of developing hyperperfusion syndrome (p = 0.022; Spearman's rho test). We could not validate any correlation with the other patient characteristics. Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication. (orig.)

  2. Hyperperfusion syndrome after carotid stent angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Politi, M.; Reith, W.; Krick, C.; Karp, K.; Zimmer, A.; Struffert, T.; Kuehn, A.L.; Papanagiotou, P. [University of the Saarland, Department for Interventional and Diagnostic Neuroradiology, Homburg (Germany); Roth, C.; Haass, A. [University of the Saarland, Clinic for Neurology, Homburg (Germany)

    2009-03-15

    This study assesses the incidence and causes of hyperperfusion syndrome occurring after carotid artery stenting (CAS). We retrospectively reviewed the clinical database of 417 consecutive patients who were treated with CAS in our department to identify patients who developed hyperperfusion syndrome and/or intracranial hemorrhage. Magnetic resonance imaging (MRI) including fluid-attenuated inversion recovery and diffusion-weighted imaging was performed before and after CAS in 269 cases. A Spearman's rho nonparametric correlation was performed to determine whether there was a correlation between the occurrence/development of hyperperfusion syndrome and the patient's age, degree of stenosis on the stented and contralateral side, risk factors such as diabetes, smoking, hypertension, adiposity, gender and fluoroscopy time, and mean area of postprocedural lesions as well as preexisting lesions. Significance was established at p < 0.05. Of the 417 carotid arteries stented and where MRI was also completed, we found hyperperfusion syndrome in 2.4% (ten cases). Patients who had preexisting brain lesions (previous or acute stroke) were at a higher risk of developing hyperperfusion syndrome (p = 0.022; Spearman's rho test). We could not validate any correlation with the other patient characteristics. Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication. (orig.)

  3. A young pregnant woman with spontaneous carotid artery dissection––unknown mechanisms

    OpenAIRE

    Mohammed, Ishaq; Aaland, Maria; Khan, Nasrin; Crossley, Ian

    2014-01-01

    Spontaneous carotid artery dissection in pregnancy has not been reported before. We present a case of a 31-year-old Caucasian woman who was 11 weeks pregnant and presented with neck pain, headache, vomiting and left side Horner's syndrome. Subsequent investigations with MR angiography confirmed spontaneous left internal carotid artery dissection.

  4. Carotid plaque signal differences among four kinds of T1-weighted magnetic resonance imaging techniques: A histopathological correlation study

    International Nuclear Information System (INIS)

    Several magnetic resonance (MR) imaging techniques are used to examine atherosclerotic plaque of carotid arteries; however, the best technique for visualizing intraplaque characteristics has yet to be determined. Here, we directly compared four kinds of T1-weighted (T1W) imaging techniques with pathological findings in patients with carotid stenosis. A total of 31 patients who were candidates for carotid endarterectomy were prospectively examined using a 1.5-T MRI scanner, which produced four kinds of T1W images, including non-gated spin echo (SE), cardiac-gated black-blood (BB) fast-SE (FSE), magnetization-prepared rapid acquisition with gradient echo (MPRAGE), and source image of three-dimensional time-of-flight MR angiography (SI-MRA). The signal intensity of the carotid plaque was manually measured, and the contrast ratio (CR) against the adjacent muscle was calculated. CRs from the four imaging techniques were compared to each other and correlated with histopathological specimens. CRs of the carotid plaques mainly containing fibrous tissue, lipid/necrosis, and hemorrhage were significantly different with little overlaps (range: 0.92-1.15, 1.22-1.52, and 1.55-2.30, respectively) on non-gated SE. However, BB-FSE showed remarkable overlaps among the three groups (0.89-1.10, 1.07-1.23, and 1.01-1.42, respectively). MPRAGE could discriminate fibrous plaques from hemorrhagic plaques but not from lipid/necrosis-rich plaques: (0.77-1.07, 1.45-2.43, and 0.85-1.42, respectively). SI-MRA showed the same tendencies (1.01-1.39, 1.45-2.57, and 1.12-1.39, respectively). Among T1W MR imaging techniques, non-gated SE images can more accurately characterize intraplaque components in patients who underwent CEA when compared with cardiac-gated BB-FSE, MPRAGE, and SI-MRA images. (orig.)

  5. Carotid artery rupture and cervicofacial actinomycosis.

    Science.gov (United States)

    Kummer, Anne; Lhermitte, Benoît; Ödman, Micaela; Grabherr, Silke; Mangin, Patrice; Palmiere, Cristian

    2012-11-01

    Cervicofacial actinomycosis is an uncommon, progressive infection caused by bacilli of the Actinomyces genus. Actinomyces are common commensal saprophytes in the oral cavity which may have medical importance as facultative pathogens. Subsequent to local injuries to the oral mucosa, they may penetrate the deep tissues and be responsible for suppurative or granulomatous infections. We herein report a case of a 65-year-old man who underwent surgery followed by chemotherapy and radiotherapy for a tonsillar carcinoma. An ulcerous lesion in the base of the tongue developed and spread to the carotid artery wall. The man died of a massive hemorrhage due to left carotid artery rupture. Postmortem computed tomography angiography performed prior to autopsy allowed the precise localization of the source of bleeding to be detected. Postmortem biochemical investigations confirmed the presence of inflammation associated with local bacterial infection. Histological investigations revealed the rupture of the left carotid artery surrounded by numerous colonies of Actinomyces. Acute and chronic inflammation with tissue necrosis as well as post-actinic, fibrotic changes were also found in the tissues surrounding the ruptured artery wall. PMID:22819527

  6. Urgent stenting for patients with acute stroke due to atherosclerotic occlusive lesions of the cervical internal carotid artery

    International Nuclear Information System (INIS)

    Acute symptomatic occlusion of the cervical internal carotid artery (ICA) can be treated by intravenous administration of tissue plasminogen activator, percutaneous transluminal angioplasty, and carotid endarterectomy. Carotid artery stenting (CAS) is now indicated for cervical ICA stenosis, but the safety and the efficacy of urgent CAS have not been established. We retrospectively reviewed 10 patients treated by urgent CAS for atherosclerotic occlusive lesions of cervical ICA with acute stroke. Five patients had complete occlusions and five had near total occlusions. Five of the 10 patients had intracranial tandem occlusions. Indication for urgent CAS was determined by mismatch of diffusion-weighted and perfusion-weighted magnetic resonance imaging findings. Stents were successfully deployed in all lesions. Three of five patients with concomitant intracranial tandem occlusions were treated by additional intraarterial fibrinolysis after the CAS. Intracranial artery occlusions were completely recanalized in one patient, and partially recanalized in two by fibrinolysis. Hyperperfusion syndrome did not occur in any of the patients. A favorable outcome (modified Rankin Scale ≤1) was obtained in all of the five patients with isolated cervical ICA occlusion and one of the five patients with intracranial tandem occlusions. Urgent CAS is a safe and effective treatment in patients with isolated cervical ICA occlusion. Treatment of intracranial tandem occlusions is an issue that must be resolved. (author)

  7. Congenital Absence of the Internal Carotid Artery

    International Nuclear Information System (INIS)

    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

  8. Carotid plaque characterization using CT and MRI scans for synergistic image analysis

    Science.gov (United States)

    Getzin, Matthew; Xu, Yiqin; Rao, Arhant; Madi, Saaussan; Bahadur, Ali; Lennartz, Michelle R.; Wang, Ge

    2014-09-01

    Noninvasive determination of plaque vulnerability has been a holy grail of medical imaging. Despite advances in tomographic technologies , there is currently no effective way to identify vulnerable atherosclerotic plaques with high sensitivity and specificity. Computed tomography (CT) and magnetic resonance imaging (MRI) are widely used, but neither provides sufficient information of plaque properties. Thus, we are motivated to combine CT and MRI imaging to determine if the composite information can better reflect the histological determination of plaque vulnerability. Two human endarterectomy specimens (1 symptomatic carotid and 1 stable femoral) were imaged using Scanco Medical Viva CT40 and Bruker Pharmascan 16cm 7T Horizontal MRI / MRS systems. μCT scans were done at 55 kVp and tube current of 70 mA. Samples underwent RARE-VTR and MSME pulse sequences to measure T1, T2 values, and proton density. The specimens were processed for histology and scored for vulnerability using the American Heart Association criteria. Single modality-based analyses were performed through segmentation of key imaging biomarkers (i.e. calcification and lumen), image registration, measurement of fibrous capsule, and multi-component T1 and T2 decay modeling. Feature differences were analyzed between the unstable and stable controls, symptomatic carotid and femoral plaque, respectively. By building on the techniques used in this study, synergistic CT+MRI analysis may provide a promising solution for plaque characterization in vivo.

  9. The development and potential of acoustic radiation force impulse (ARFI) imaging for carotid artery plaque characterization.

    Science.gov (United States)

    Allen, Jason D; Ham, Katherine L; Dumont, Douglas M; Sileshi, Bantayehu; Trahey, Gregg E; Dahl, Jeremy J

    2011-08-01

    Stroke is the third leading cause of death and long-term disability in the USA. Currently, surgical intervention decisions in asymptomatic patients are based upon the degree of carotid artery stenosis. While there is a clear benefit of endarterectomy for patients with severe (> 70%) stenosis, in those with high/moderate (50-69%) stenosis the evidence is less clear. Evidence suggests ischemic stroke is associated less with calcified and fibrous plaques than with those containing softer tissue, especially when accompanied by a thin fibrous cap. A reliable mechanism for the identification of individuals with atherosclerotic plaques which confer the highest risk for stroke is fundamental to the selection of patients for vascular interventions. Acoustic radiation force impulse (ARFI) imaging is a new ultrasonic-based imaging method that characterizes the mechanical properties of tissue by measuring displacement resulting from the application of acoustic radiation force. These displacements provide information about the local stiffness of tissue and can differentiate between soft and hard areas. Because arterial walls, soft tissue, atheromas, and calcifications have a wide range in their stiffness properties, they represent excellent candidates for ARFI imaging. We present information from early phantom experiments and excised human limb studies to in vivo carotid artery scans and provide evidence for the ability of ARFI to provide high-quality images which highlight mechanical differences in tissue stiffness not readily apparent in matched B-mode images. This allows ARFI to identify soft from hard plaques and differentiate characteristics associated with plaque vulnerability or stability. PMID:21447606

  10. Direct clipping of a blister-like aneurysm in the supraclinoid segment of the internal carotid artery: a clinical analysis of nine cases.

    Science.gov (United States)

    Yu, Jinlu; Xu, Baofeng; Guo, Yunbao; Xu, Kan

    2015-01-01

    To investigate the method and outcome from direct clipping of a blister-like aneurysm (BBA) of the internal carotid artery supraclinoid segment. This study featured nine BBA patients, including eight females and one male. The patients presented subarachnoid hemorrhage (SAH) as the initial symptom and were diagnosed with BBA in the supraclinoid segment through a vascular exam and imaging. During the exam, the internal carotid artery was pressed to block the blood flow, and a transcranial Doppler (TCD) was performed to examine the blood flow in the (BBA) ipsilateral middle cerebral artery. The results showed that the blood flow was reduced by less than 40% in all nine patients. During surgery, a pterional craniotomy was used to fully expose the aneurysm for clipping. While clipping the aneurysm, the arterial wall at the root of the aneurysm was also clipped to improve stability. Intraoperative ultrasonography was performed before and after clipping to examine the blood flow in the parent artery, middle cerebral artery and anterior cerebral artery. Moreover, a TCD was performed within one week after surgery to monitor intracranial blood flow. During BBA clipping, four patients exhibited stenosis of the parent artery, but intraoperative ultrasonography showed adequate blood flow in the anterior cerebral artery and middle cerebral artery. TCD was performed within one week after surgery to examine the blood flow in the middle cerebral artery on the operative side; the TCD showed adequate blood flow. The patients recovered well after surgery and were discharged. Digital subtraction angiography (DSA) or computed tomography angiography (CTA) was performed six to 12 months after the surgery and showed no aneurysm relapse. Moreover, six patients exhibited no stenosis of the parent artery, 20% stenosis was observed in one patient, 30% stenosis was observed in one patient, and 50% stenosis was observed in one patient; none of the patients showed clinical symptoms, and all

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

    International Nuclear Information System (INIS)

    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)

  12. Quantitative assessment of blood flow reserve using {sup 99m}Tc-HMPAO in carotid stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Garai, I.; Varga, J.; Galuska, L. [Department of Nuclear Medicine, University of Debrecen Medical and Health Centre, Debrecen (Hungary); Szomjak, E. [3. Department of Internal Medicine, University of Debrecen Medical and Health Centre, Debrecen (Hungary); Toth, C.; Olvaszto, S. [1. Department of Surgery, University of Debrecen Medical and Health Centre, Debrecen (Hungary); Bank, J. [Department of Neurology, Kenezy Hospital (Hungary); Ficzere, A. [Department of Neurology, University of Debrecen Medical and Health Centre, Debrecen (Hungary)

    2002-02-01

    Dynamic imaging of the inflow of technetium-99m hexamethylpropylene amine oxime (HMPAO) to the brain has been proved to allow estimation of the hemispherical cerebral blood flow (CBF) using the Patlak plot. In this study, we compared the hemispherical CBF (in ml/min/100 g) of different patient groups. A total of 25 patients (comprising 13 with migraine and 12 scheduled for endarterectomy owing to angiographically confirmed severe stenosis of the internal carotid artery on at least one side) underwent baseline and acetazolamide {sup 99m}Tc-HMPAO brain perfusion studies. In addition, acetazolamide {sup 99m}Tc-HMPAO studies were performed in 12 healthy subjects (no baseline study was performed for ethical reasons.) Dynamic studies were acquired by means of a dual-detector gamma camera with a large field of view (HELIX, Elscint). Special difference images were created to make definition of the aortic arch and hemispherical brain regions easier and more reproducible. A semi-automatic method was developed to determine the transit time from the aorta to the brain, making the generation of the Patlak plot even more robust. The baseline CBF values did not significantly depend on the disease (P>0.1), whereas the CBF values obtained after acetazolamide provocation did do so (ANOVA, P<0.001). Patients suffering from migraine showed a significant increase in global CBF values after acetazolamide provocation (paired t test, P<0.05), but we could not find any effect of the provocation in patients awaiting carotid endarterectomy, indicating a lack of cerebrovascular reserve capacity. Comparison of the results of the acetazolamide study in patients and the control group revealed the CBF values to be significantly lower in patients with carotid stenosis (two-sample t-test, P<0.001), but not in those with migraine (P>0.1). In summary, using quantitative analysis of {sup 99m}Tc-HMPAO brain studies we could objectively compare the CBF of patients suffering from different diseases

  13. Worsening angle closure glaucoma and choroidal detachments subsequent to closure of a carotid cavernous fistula

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    Thinda Sumeer

    2012-07-01

    Full Text Available Abstract Background Carotid cavernous fistulas are abnormal communications between the cavernous sinus and the external or internal carotid arteries. Although rare, closure of carotid cavernous fistulas can lead to immediate ocular complications. To our knowledge, our case represents the first report of worsening angle closure glaucoma and choroidal detachments over an extended period of two months subsequent to closure of a carotid cavernous fistula. Case presentation A 70-year-old female with a history of primary angle closure glaucoma presented with 4 mm of proptosis, resistance to retropulsion, tortuous corkscrew blood vessels and an orbital bruit of the right eye. Diagnostic cerebral angiogram showed a small indirect Barrow type D right carotid cavernous fistula. Transarterial embolization was planned but repeat cerebral angiography prior to the procedure demonstrated spontaneous partial closure of the carotid cavernous fistula and the procedure was aborted. One month later, our patient was noted to have worsening vision and choroidal detachments of the right eye. She declined further testing and was thus started on self-administered manual carotid jugular compressions. One month later, she developed progressive worsening of her choroidal detachments and angle closure. She eventually opted for surgical intervention but repeat cerebral angiography showed significant thrombosis of the carotid cavernous fistula and no intervention was warranted. Examination two months later showed complete resolution of the choroidal detachments and open angles of both eyes. Conclusions Our patient demonstrated worsening angle closure glaucoma and choroidal detachments after spontaneous closure of her carotid cavernous fistula had been noted. Ocular complications, including acute angle closure, have been reported to occur immediately after closure of carotid cavernous fistulas, but not over months as in our patient. It is imperative that individuals who have

  14. Previous gestational diabetes is independently associated with increased carotid intima-media thickness, similarly to metabolic syndrome – a case control study

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    Freire Claudia Maria

    2012-05-01

    Full Text Available Abstract Background Women with previous gestational diabetes mellitus (pGDM face a higher risk of developing type 2 diabetes and, consequently, a higher cardiovascular risk. This study aimed to compare the carotid intima-media thickness (cIMT from young women with pGDM to those with metabolic syndrome (MS and to healthy controls (CG to verify whether a past history of pGDM could be independently associated with increased cIMT. Methods This is a cross-sectional study performed in two academic referral centers. Seventy-nine women with pGDM, 30 women with MS, and 60 CG aged between 18 and 47 years were enrolled. They all underwent physical examination and had blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDLc, and triglycerides determined. The cIMT was measured by ultrasound in several carotid segments. The primary endpoint was cIMT and clinically relevant parameters included as predictors were: age, systolic blood pressure, waist, BMI, total cholesterol, LDLc, triglycerides, fasting glucose, previous history of GDM as a whole group, previous history of GDM without MS, presence of DM, presence of MS, and parity. Results cIMT was significantly higher in pGDM when compared to CG in all sites of measurements (P  0.05 and an increased cIMT when compared to controls (P  Conclusions Previous GDM was independently associated with increased composite cIMT in this young population, similarly to those with MS and regardless the presence of established cardiovascular risk factors.

  15. 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.)

  16. Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials

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    Ouyang YA

    2015-10-01

    Full Text Available Yi-An Ouyang, Yugang Jiang, Mengqiang Yu, Yunze Zhang, Hao HuangDepartment of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People’s Republic of ChinaObjective: To investigate both short-term and long-term therapeutic efficacy and safety of carotid artery stenting (CAS and carotid artery endarterectomy (CEA for elderly patients with severe and symptomatic carotid artery stenosis.Methods: PubMed, EMBASE, Cochrane Library, Clinical Trials Register Centers, and Google Scholar were comprehensively searched. After identifying relevant randomized controlled trials, methodological quality was assessed by using Cochrane tools of bias assessment. Meta-analysis was performed by RevMan software, and subgroup analyses according to different follow-up periods were also conducted.Results: Sixteen articles of nine randomized controlled trials containing 6,984 patients were included. Compared with CEA, CAS was associated with high risks of stroke during periprocedural 30 days (risk ratio [RR]=1.47, 95% confidence interval [CI]: 1.15–1.88, 48 months (RR=1.37, 95% CI: 1.11–1.70, and >48 months (RR=1.76, 95% CI: 1.34–2.31. There was no significant difference in the aspects of death, disabling stroke, or death at any time between the groups. For other periprocedural complications, CAS decreased the risk of myocardial infarction (RR=0.44, 95% CI: 0.26–0.75, cranial nerve palsy (RR=0.09, 95% CI: 0.04–0.22 and hematoma (RR=0.31, 95% CI: 0.14–0.68 compared with CEA, while it increased the risk of bradycardia or hypotension (RR=8.45, 95% CI 2.91–24.58.Conclusion: Compared with CEA, CAS reduced hematoma, periprocedural myocardial infarction, and cranial nerve palsy, while it was associated with higher risks of both short-term and long-term nondisabling stroke. And they seemed to be equivalent in other outcome measures. As regards to its minimal invasion, it should be applied only in specific patients.Keywords: symptomatic

  17. Evolution of pulmonary scintigraphy after thrombo-endarterectomy (TE)

    International Nuclear Information System (INIS)

    The TE is an alternative to lung transplant in case of post-emboli pulmonary arterial hyper blood pressure (PE-PAHBP). This work describes the changes in the pulmonary perfusion scintigraphy (PS) in the follow-up of a TE. Twenty two patients afflicted by PE-PAHBP, benefited by a TE. The pre-surgery PS have shown an average of 8.5 ± 2.2 hypo-perfused or non-perfused segments (min. = 5, max. = 13). Fifteen patients have had an initial post-surgery PS in the first month (average = 16 days ± 2.1 after TE) and all have had ulterior examination at 4.4 ± 2.4 months after TE (from 3 to 11 months). Finally, 9 patients have been reviewed for a tardy PS to pursue the evolution after 1 year. A table gives the initial post-surgery results as follows: amelioration of > 3 segments without aggravation - 4 patients; aggravation of > 2 segments - 9 patients; stability of discrete amelioration of scintigraphic image - 2 patients. The aggravation concerns 6.4 ± 2.3 segments (min. = 4, max. = 11), and is associated always to an amelioration (on 5.2 ± 1.9 segments, min. = 3, max. = 4) what evokes a flux flip-flop. Neither the number of pre-surgery afflicted segments, or the number of segments ameliorated are different between the patients with flux flip-flop and the others. Concerning the evolution, 7/9 patients presenting a flip-flop, have had a PS at 4 months: 5 presented a disappearance or regression in the aspect of flip-flop, and 2 presented a feeble regression in the aspect of flip-flop. The PS at less then 1 year shows that the number of abnormal segments became 6.2 ± 2.4; the amelioration estimated on only PS was only 2.4 ± 3.4 segments, what is in contradiction with the favorable evolution of clinics and hemodynamics in all the patients of this study. Concerning the tardy evolution, the amelioration of scintigraphic images can occur up to 1 year (2 patients) and 2 years (2 patients) after TE. In conclusion, the post-surgery early scintigraphic images often evoke and

  18. Intercavernous portion of internal carotid artery occlusion resulting from snowboarding

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    Sudiptamohan Mukhopadhyay

    2010-04-01

    Full Text Available Sudiptamohan Mukhopadhyay1, Awen Iorwerth21Department of Orthopaedics, University Hospital of Wales, Cardiff, UK; 2Department of Orthopaedics, Royal Glamorgan Hospital, Wales, UKAbstract: A 33-year-old gentleman who was otherwise fit and healthy suffered repetitive low impact head injuries while snowboarding in Austria over a period of one week. During the fall he had several hyperextension injuries and presented with headache, nausea, vomiting, drowsiness (felt ‘drunk’ on Friday night despite not being drunk, diplopia, abnormal pupillary signs. A Horner’s syndrome was diagnosed and on investigation, the left intercavernous portion of internal carotid artery (ICA was found to be thrombosed. The symptoms gradually settled after conservative treatment for a month. Blunt head trauma is a recognized cause of carotid dissection and thrombosis and many neuromechanics studies have attempted to calculate the wall shear stress involved. Physicians treating snowboarders should be aware of the condition and should look for Horner’s syndrome and consider the possibility of carotid occlusion. With a thorough PubMed, Ovid, EMBASE search using ‘snowboarding’, ‘carotid dissection’, ‘Horner’s syndrome’ no such case was found to be reported. Proper training for such sport activities is essential to avoid serious consequences.Keywords: snowboarding, carotid dissection, Horner’s syndrome

  19. High reproducibility of histological characterization by whole virtual slide quantification; an example using carotid plaque specimens.

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    Joyce E P Vrijenhoek

    Full Text Available Tissue biobanks are an important source for discovery and validation studies aiming for new proteins that are causally related with disease development. There is an increasing demand for accurate and reproducible histological characterization, especially for subsequent analysis and interpretation of data in association studies. We assessed reproducibility of one semiquantative and two quantitative methods for histological tissue characterization. We introduce a new automated method for whole digital slide quantification. Carotid atherosclerotic plaques were used to test reproducibility.50 atherosclerotic plaques that were obtained during carotid endarterectomy were analysed. For the semiquantitative analysis, 6 different plaque characteristics were scored in categories by two independent observers, and Cohen's κ was used to test intra- and interobserver reproducibility. The computer-aided method (assessed by two independent observers and automated method were tested on CD68 (for macrophages and α smooth muscle actin (for smooth muscle cells stainings. Agreement for these two methods (done on a continuous scale was assessed by intraclass correlation coefficients (ICCs.For the semiquantitative analysis, κ values ranged from 0.55 to 0.69 for interobserver variability, and were slightly higher for intraobserver reproducibility in both observers. The computer-aided method yielded intra- and interobserver ICCs between 0.6 and 0.9. The new automated method performed most optimal regarding reproducibility, with ICCs ranging from 0.92 to 0.97.The analysis of performance of three methods for histological slide characterization on carotid atherosclerotic plaques showed high precision and agreement in repeated measurements for the automated method for whole digital slide quantification. We suggest that this method can fulfill the need for reproducible histological quantification.

  20. Distribution of alkaline phosphatase, osteopontin, RANK ligand and osteoprotegerin in calcified human carotid atheroma.

    Science.gov (United States)

    Higgins, Catherine L; Isbilir, Salim; Basto, Pamela; Chen, Iou Yih; Vaduganathan, Muthiah; Vaduganathan, Periyanan; Reardon, Michael J; Lawrie, Gerald; Peterson, Leif; Morrisett, Joel D

    2015-10-01

    Ectopic vascular calcification is a significant component of atherosclerotic disease. Osteopontin (OPN), Osteoprotegerin (OPG), Receptor Activator of NFκB Ligand (RANKL), and alkaline phosphatase (ALP) are each thought to play central roles in the calcification or demineralization of atherosclerotic lesions. Abnormalities in the balance of these proteins may lead to perturbations in bone remodeling and arterial calcification. The purpose of this study was to measure the distribution of these proteins in human carotid lesions and to elucidate possible mechanism(s) whereby they control the deposition or depletion of arterial calcification. Thirty-three patients who had undergone carotid endarterectomy (CEA) within the previous 18 months and 11 control patients were enrolled. CEA specimens were analyzed by EBCT for calcification content in terms of Agatston (AGAT) and Volume scores. CEA specimens were then cut into 5 mm segments which were homogenized and extracted. Extracts were analyzed for tissue levels of calcium, phosphorus, ALP, OPN, RANKL, and OPG. Fasting blood samples were analyzed for the same components. In CEA tissue segments, the calcification levels (CHA AGAT) were inversely associated with the levels of OPG (r = -0.432/-0.579, p < 0.05) and positively associated with the levels of RANKL (r = 0.332/0.415, p < 0.05). In turn, the tissue levels of OPG were associated with homologous serum levels of OPG (r = 0.820/0.389, p < 0.001), and the tissue levels of RANKL were associated with the serum levels of homologous RANKL (r = 0.739/0.666, p < 0.0001). This study suggests that serum levels of OPG and RANKL may be useful biomarkers for estimating the degree of calcification in carotid atherosclerotic lesions. PMID:26307009

  1. Correlation of Color Doppler with Multidetector CT Angiography Findings in Carotid Artery Stenosis

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    Živorad N. Savic

    2010-01-01

    Full Text Available The aim of this paper was to examine the correlation between the Color Doppler ultrasound (CD-US and multidetector CT angiography (MDCTA diagnostic methods, and to define the degree and extent of stenosis in patients with internal carotid artery stenosis. This was a cross-sectional study with a consecutive series of patients. All US examinations were always carried out by the same physician-angiologist, while all CT examinations were always carried out by the same physician-radiologist. Both worked independently from each other. The stenosis area was measured at the narrowest point by NASCET criteria for US/CT. Peak systolic velocity (PSV over 210 cm/sec and end diastolic velocity (EDV over 110 cm/sec criteria were applied for stenoses with lumen narrowed over 70%, while PSV under 130 cm/sec and EDV under 100 cm/sec criteria were applied for those with lumen narrowed under 70%. A total of 124 carotid arteries were observed; namely, 89 narrowed and 68 surgically treated. All patients were reviewed by US and then by MDCTA; patients with 70–99% stenosis underwent surgery. The correlation coefficient between stenosis degree measured by US and MDCTA was 0.922; p 0.05. The US and CT matching level for stenoses from 70 to 99% was very high (κ = 0.778, p < 0.01. In conclusion, there is a highly significant statistical correlation among both diagnostic methods when measuring stenosis degree and extent. US is more dependent on the physician, while MDCTA is more objective and independent from the physician. We think it would be appropriate to undertake an MDCTA exam for those patients who are candidates for carotid endarterectomy.

  2. Multimodality imaging of carotid atherosclerotic plaque: Going beyond stenosis

    Science.gov (United States)

    Hingwala, Divyata; Kesavadas, Chandrasekharan; Sylaja, Padmavathy N; Thomas, Bejoy; Kapilamoorthy, Tirur Raman

    2013-01-01

    Apart from the degree of stenosis, the morphology of carotid atherosclerotic plaques and presence of neovascularization are important factors that may help to evaluate the risk and ‘vulnerability’ of plaques and may also influence the choice of treatment. In this article, we aim to describe the techniques and imaging findings on CTA, high resolution MRI and contrast enhanced ultrasound in the evaluation of carotid atherosclerotic plaques. We also discuss a few representative cases from our institute with the related clinical implications. PMID:23986615

  3. Multimodality imaging of carotid atherosclerotic plaque: Going beyond stenosis

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    Divyata Hingwala

    2013-01-01

    Full Text Available Apart from the degree of stenosis, the morphology of carotid atherosclerotic plaques and presence of neovascularization are important factors that may help to evaluate the risk and ′vulnerability′ of plaques and may also influence the choice of treatment. In this article, we aim to describe the techniques and imaging findings on CTA, high resolution MRI and contrast enhanced ultrasound in the evaluation of carotid atherosclerotic plaques. We also discuss a few representative cases from our institute with the related clinical implications.

  4. Common carotid arterial thrombosis associated with ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Hitoshi Nogami; Tsuneo Iiai; Satoshi Maruyama; Tatsuo Tani; Katsuyoshi Hatakeyama

    2007-01-01

    A 26-year-old woman with ulcerative colitis was transferred to our hospital with left hemiparesis due to cerebral infarction. Cervical ultrasonography and magnetic resonance imaging angiography revealed thrombosis at the right common carotid artery and the right internal carotid artery. Antithrombotic and anticoagulant therapies were commenced. After about 2 wk of the treatment, the frequency of her diarrhea increased. She underwent emergency subtotal colectomy, but 10 d later an abundant hemorrhage from the remnant rectum occurred, so the remnant rectum was resected and an ileal pouch anal anastomosis was performed. Antithrombotic and anticoagulant therapies were continued, but neither her neurological status nor magnetic resonance imaging angiography findings showed subsequent changes. She was discharged 3 mon after operation. This is a rare case of common carotid arterial thrombosis occurring as a complication of ulcerative colitis, in which antithrombotic and anticoagulant therapies are considered to provoke a deterioration of the patient's bowel disease.

  5. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

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    Toischer Karl

    2009-09-01

    Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

  6. Persistent primitive trigeminal artery with cavernous carotid aneurysm

    International Nuclear Information System (INIS)

    A case of a 61 years old woman with persistent trigeminal artery associated with a giant carotid aneurysm is reported. It was studied with magnetic resonance and angiographic magnetic resonance. The angiographic and anatomic Saltzman classification and the frequent association of persistent trigeminal artery and vascular malformations were reviewed. (author)

  7. 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

  8. Incidental direct carotid-cavernous fistula in a patient with high-grade internal carotid artery stenosis

    International Nuclear Information System (INIS)

    The concurrent occurrence of internal carotid artery (ICA) stenosis and carotid-cavernous fistula (CCF) is infrequent. We report the case of a 59-year-old man with symptomatic high-grade stenosis of left ICA who was referred to our hospital for surgical treatment. An ipsilateral direct CCF was found incidentally during operation. Ultimately, the two lesions were successfully treated with a covered stent while the ICA was preserved. The result of our study may provide further insight into this rare combination of diseases. (author)

  9. Cardiovascular magnetic resonance in carotid atherosclerotic disease

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    Chen Huijun

    2009-12-01

    Full Text Available Abstract Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR of the carotid vessel wall is one promising modality in the evaluation of patients with carotid atherosclerotic disease. Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis. Although carotid vessel wall CMR has not been widely used to screen for carotid atherosclerotic disease, many trials support its potential for this indication. This review summarizes the current state of knowledge regarding carotid vessel wall CMR and its potential clinical application for management of carotid atherosclerotic disease.

  10. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    Science.gov (United States)

    Smith, M. L.; Ellenbogen, K. A.; Eckberg, D. L.

    1992-01-01

    Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position.

  11. Asymptomatic carotid disease and cardiac surgery consensus

    OpenAIRE

    Stansby, G.; MacDonald, S.; Allison, R; de Belder, M; Brown, MM; Dark, J; Featherstone, R; Flather, M; Ford, GA; Halliday, A.; Malik, I; R. Naylor; Pepper, J.; Rothwell, PM

    2011-01-01

    The Carotid Disease and Cardiac Surgery Consensus Meeting was convened as a multidisciplinary gathering to consider the management of patients undergoing cardiac surgery who are found to have asymptomatic carotid artery disease. There are no randomized trials concerning whether carotid interventions are of value in this situation and the natural history is unclear. Bilateral carotid artery disease (≥70% stenosis) should be regarded clinically relevant when considering hemodynamic and short-te...

  12. Ultrasound features of human carotid plaques

    OpenAIRE

    Östling, Gerd

    2013-01-01

    Atherosclerotic plaques in the carotid arteries are common in a middle-aged population. When a carotid plaque ruptures it may result in a cerebrovascular event. However, only a minor part of carotid plaques will eventually rupture. Finding those plaques is essential to decide the most appropriate treatment strategy. With non-invasive ultrasound the carotid plaques can be visualized for assessment of various features. Plaques that appear dark on the ultrasound image, i.e. echolucent plaques...

  13. Diffusion-weighted magnetic resonance imaging for the detection of lipid-rich necrotic core in carotid atheroma in vivo

    International Nuclear Information System (INIS)

    Research has shown that knowing the morphology of carotid atheroma improves current risk stratification for predicting subsequent thrombo-embolic events. Previous magnetic resonance (MR) ex vivo studies have shown that diffusion-weighted imaging (DWI) can detect lipid-rich necrotic core (LR/NC) and fibrous cap. This study aims to establish if this is achievable in vivo. Twenty-six patients (mean age 73 years, range 54-87 years) with moderate to severe carotid stenosis confirmed on ultrasound were imaged. An echo-planar DWI sequence was performed along with standard high-resolution MR imaging. Apparent diffusion coefficient (ADC) maps were evaluated. Two independent readers reported the mean ADC values from regions of interest defining LR/NCs and fibrous caps. For subjects undergoing carotid endarterectomy (n = 19), carotid specimens were obtained and stained using Nile red. The mean ADC values were 1.0 x 10-3 mm2/s (±SD 0.3 x 10-3 mm2/s) and 0.7 x 10-3 mm2/s (±SD 0.2 x 10-3 mm2/s) for fibrous cap and LR/NC, respectively; the difference was significant (p < 0.0001). The intra-class correlation coefficients summarising the agreement between the two independent readers were 0.84 and 0.60 for fibrous cap and LR/NC, respectively. Comparison of quantitative ADC values and histology (by subjective grading of lipid content) showed a significant correlation: heavier lipid staining matched lower ADC values (r = -0.435, p = 0.005). This study indicates that DWI can be used to distinguish LR/NC and the fibrous cap. The study also suggests that the mean ADC value may be linearly related to subjective graded LR/NC content determined by histology. (orig.)

  14. Internal carotid-cerebellar artery anastomosis. So-called persistent trigeminal artery variant

    Energy Technology Data Exchange (ETDEWEB)

    Tanohata, Kazunori; Maehara, Tadayuki; Noda, Masanobu; Katoh, Hiromi

    1987-09-01

    Five cases of internal carotid-cerebellar artery anastomosis are presented. These anomalous vessels are identical to the so-called persistent trigeminal artery variant (PTAV). In our cases, two superior cerebellar arteries (SCAs), two anterior inferior cerebellar arteries (AICAs) and one posterior inferior cerebellar artery (PICA) arose from the precavernous segment of the internal carotid artery. We discuss the embryolgical and neuroradiological aspects of this anomaly.

  15. Internal carotid artery dissection following chiropractic treatment in a pregnant woman with Systemic Lupus Erythematosus

    OpenAIRE

    Morton Adam

    2012-01-01

    Abstract A case of internal carotid artery dissection in a pregnant woman with Systemic Lupus Erythematosus (SLE) immediately following chiropractic treatment is presented. The literature regarding complications of neck manipulation during pregnancy, spontaneous dissection of craniocervical arteries in pregnancy and the postpartum period, and dissection of craniocervical arteries in SLE are reviewed. To the best of the author’s knowledge, this is the first case of carotid artery dissection fo...

  16. Prevention of ocular toxicity by the intra-carotid perfusion of anticancer agents in the treatment of malignant glioma

    International Nuclear Information System (INIS)

    It is a problem of great concern to prevent ocular toxicity from complicating intra-carotid administration of lipophil anticancer agents. Attempts to prevent such a side effect were made during intra-carotid chemotherapy using remodeled catheter tips for epidural anesthesia. Twenty nine patients with malignant glioma received intra-carotid administration of neocarzinostatin (NCS). Six out of 17 patients (35.3 %) who received intra-carotid perfusion through an original catheter without a remodeled tip, developed ocular toxicity. The catheter tip remained proximal to the ophthalmic artery in all cases. On the other hand, 12 patients with a remodeled catheter tip did not develop ocular toxicity. In the latter group the tip of the catheter was located in the internal carotid artery sufficiently distal to the ophthalmic artery, or beyond the carotid bifurcation in 3 cases. Another advantage of the remodeled catheter was that the intra-carotid perfusion was feasible for a longer period with higher doses of NCS, than treatment with the commercial catheter for superselective embolization, which was found to be easily occluded and often ejected out of the carotid artery. Prior to and during the intra-carotid perfusion selective injection of Angiografin was performed through the catheter and the tumor was enhanced in the area of arterial supply, indicating the extent of chemotherapy and the degree of destruction of the blood-brain barrier. (author)

  17. Throbbing tinnitus in aberrant internal carotid artery aggravated by elevation of the jugular bulb. A case report; Pulsierender Tinnitus bei aberranter Arteria carotis interna in Kombination mit Hochstand des Bulbus venae jugularis. Kasuistik

    Energy Technology Data Exchange (ETDEWEB)

    Wilhelm, T. [Inst. fuer Roentgendiagnostik, Klinikum der Technischen Univ. Muenchen (Germany); Kirsten, R. [Inst. fuer Roentgendiagnostik, Klinikum der Technischen Univ. Muenchen (Germany); Kau, R.J. [Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum der Technischen Univ. Muenchen (Germany)

    1995-04-01

    Vascular anomalies in the middle ear are rarely observed. They cause no symptoms in the majority of cases, although some may be associated with tinnitus. The false diagnosis of glomus tumour may lead to considerable problems, if surgery is performed. It is therefore necessary that precise pre-operative data are obtained, preferably based on contrast-enhanced computerized tomography. Subsequent 2D and 3D image reconstructions provide further vascular findings regarding the topographic and anatomic factors involved and eliminate the need for invasive angiography of the carotid artery or retrograde jugular venography to make a firm diagnosis. (orig.) [Deutsch] Gefaessanomalien im Mittelohr sind selten. Meist sind sie asymptomatisch, koennen aber assoziiert sein mit Tinnitus. Die Fehldiagnose eines Glomustumors kann im Rahmen einer Operation zu gravierenden Problemen fuehren. Eine exakte praeoperative Abklaerung ist deshalb notwendig und sollte als Computertomographie mit Kontrastmittelgabe durchgefuehrt werden. Die anschliessende 2D- und 3D-Bildwiedergabe klaert die topographisch-anatomischen Gefaessbeziehungen und erlaubt somit die Diagnosestellung ohne die frueher durchgefuehrte invasive Carotisangiographie oder retrograde Jugularisvenographie. (orig.)

  18. Carotid artery reconstruction following resection during radical neck dissection

    OpenAIRE

    Soulier, Christian Jacques Gérard; Dulguerov, Pavel; Maurice, Jean Pierre; Allal, Abdelkarim Said; Faidutti, Bernard; Lehmann, Willy

    1998-01-01

    From 1972 to 1991, 7 patients with advanced cancer of the head and neck and nodal metastasis with capsular rupture underwent radical neck dissection and sacrifice of the carotid artery. Vascular reconstruction was performed with either an autologous venous (8 cases) or arterial (1 case) graft. In all patients, the postoperative course was uneventful without neurologic complications. One patient is alive 4 years after the procedure. Six patients expired after a mean survival of 20 months. The ...

  19. Glaucoma secundário à fístula carótido-cavernosa espontânea com resolução após a embolização da fístula: relato de caso Secondary glaucoma following carotid cavernous fistula resolved after fistula's embolization: case report

    Directory of Open Access Journals (Sweden)

    Marcelo Jarczun Kac

    2010-08-01

    Full Text Available Fístulas carótido-cavernosas espontâneas são raras e ocorrem mais frequentemente em mulheres de meia-idade. Os autores relatam um caso de uma fístula carótido-cavernosa espontânea em mulher idosa evoluindo com glaucoma de difícil controle. Após a embolização cirúrgica da fístula a paciente apresentou regressão da sintomatologia e normalização da pressão intraocular.Spontaneous carotid cavernous fistulas are a rare entity occurring more frequently in middle aged women. The authors report a case of a spontaneous carotid cavernous fistula in an elderly woman resulting in glaucoma of hard management. After surgical embolization of the fistula, the symptoms regressed and the intraocular pressure moved back to regular levels.

  20. MRI-derived measurements of fibrous-cap and lipid-core thickness: the potential for identifying vulnerable carotid plaques in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Trivedi, Rikin A. [Addenbrooke' s Hospital, University Department of Radiology, Cambridge (United Kingdom); Addenbrooke' s Hospital, Academic Department of Neurosurgery, Cambridge (United Kingdom); U-King-Im, Jean-Marie; Graves, Martin J. [Addenbrooke' s Hospital, University Department of Radiology, Cambridge (United Kingdom); Horsley, Jo; Goddard, Martin [Papworth Hospital, Department of Histopathology, Papworth Everard (United Kingdom); Kirkpatrick, Peter J. [Addenbrooke' s Hospital, Academic Department of Neurosurgery, Cambridge (United Kingdom); Gillard, Jonathan H. [Addenbrooke' s Hospital, University Department of Radiology, Cambridge (United Kingdom); Addenbrooke' s Hospital, Hills Road, Box 219, Cambridge (United Kingdom)

    2004-09-01

    Vulnerable plaques have thin fibrous caps overlying large necrotic lipid cores. Recent studies have shown that high-resolution MR imaging can identify these components. We set out to determine whether in vivo high-resolution MRI could quantify this aspect of the vulnerable plaque. Forty consecutive patients scheduled for carotid endarterectomy underwent pre-operative in vivo multi-sequence MR imaging of the carotid artery. Individual plaque constituents were characterised on MR images. Fibrous-cap and lipid-core thickness was measured on MRI and histology images. Bland-Altman plots were generated to determine the level of agreement between the two methods. Multi-sequence MRI identified 133 corresponding MR and histology slices. Plaque calcification or haemorrhage was seen in 47 of these slices. MR and histology derived fibrous cap-lipid-core thickness ratios showed strong agreement with a mean difference between MR and histology ratios of 0.02 ({+-}0.04). The intra-class correlation coefficient between two readers for measurements was 0.87 (95% confidence interval, 0.73 and 0.93). Multi-sequence, high-resolution MR imaging accurately quantified the relative thickness of fibrous-cap and lipid-core components of carotid atheromatous plaques. This may prove to be a useful tool to characterise vulnerable plaques in vivo. (orig.)

  1. MRI-derived measurements of fibrous-cap and lipid-core thickness: the potential for identifying vulnerable carotid plaques in vivo

    International Nuclear Information System (INIS)

    Vulnerable plaques have thin fibrous caps overlying large necrotic lipid cores. Recent studies have shown that high-resolution MR imaging can identify these components. We set out to determine whether in vivo high-resolution MRI could quantify this aspect of the vulnerable plaque. Forty consecutive patients scheduled for carotid endarterectomy underwent pre-operative in vivo multi-sequence MR imaging of the carotid artery. Individual plaque constituents were characterised on MR images. Fibrous-cap and lipid-core thickness was measured on MRI and histology images. Bland-Altman plots were generated to determine the level of agreement between the two methods. Multi-sequence MRI identified 133 corresponding MR and histology slices. Plaque calcification or haemorrhage was seen in 47 of these slices. MR and histology derived fibrous cap-lipid-core thickness ratios showed strong agreement with a mean difference between MR and histology ratios of 0.02 (±0.04). The intra-class correlation coefficient between two readers for measurements was 0.87 (95% confidence interval, 0.73 and 0.93). Multi-sequence, high-resolution MR imaging accurately quantified the relative thickness of fibrous-cap and lipid-core components of carotid atheromatous plaques. This may prove to be a useful tool to characterise vulnerable plaques in vivo. (orig.)

  2. Dual energy computed tomography quantification of carotid plaques calcification: comparison between monochromatic and polychromatic energies with pathology correlation

    Energy Technology Data Exchange (ETDEWEB)

    Mannelli, Lorenzo [University of Washington, Departments of Radiology, Seattle, WA (United States); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (United States); MacDonald, Lawrence; Ferguson, Marina; Shuman, William P.; Xu, Dongxiang; Yuan, Chun; Mitsumori, Lee M. [University of Washington, Departments of Radiology, Seattle, WA (United States); Mancini, Marcello; Ragucci, Monica; Monti, Serena [IRCCS Fondazione SDN, Naples (Italy)

    2015-05-01

    We compared carotid plaque calcification detection sensitivity and apparent cross-sectional area on CT as a function of CT beam energy using conventional CT techniques and virtual mono-energetic CT images generated from dual-energy acquisitions. Five ex-vivo carotid endarterectomy (CEA) specimens were imaged with dual-energy computed tomography. Virtual monochromatic spectrum (VMS) CT images were reconstructed at energies between 40-140 keV. The same specimens were imaged using conventional polyenergetic spectrum (PS) CT with peak beam energies 80, 100, 120, and 140 kVp. The histological calcium areas on each corresponding CEA specimen were traced manually on digitized images of Toluidine-Blue/Basic-Fuchsin stained plastic sections. 40 keV VMS CT images provided high detection sensitivity (97 %) similar to conventional PS CT images (∝96 %). The calcification size measured on CT decreased systematically with increasing CT beam energy; the rate of change was larger for the VMS images than for PS images. From a single dual-energy CT, multiple VMS-CT images can be generated, yielding equivalent detection sensitivity and size correlations as conventional PS-CT in CEA calcification imaging. VMS-CT at 80-100 keV provided the most accurate estimates of calcification size, as compared to histology, but detection sensitivity was reduced for smaller calcifications on these images. (orig.)

  3. Short-term outcome of stent-assisted angioplasty for extracranial carotid stenosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the safety and short-term outcome of stent-assisted angioplasty for extracranial carotid stenosis. Methods: From October 2000 to September 2002, 93 cases of extracranial carotid stenosis, including 86 cases of carotid bifurcation stenosis, 4 of extracranial internal carotid stenosis, 2 of common carotid stenosis and 1 of functional external carotid stenosis, were treated by self-expandable stent placement and angioplasty. Results: Stent placement and angioplasty were successfully administered in all the 93 patients. The average stenosis rate was reduced from (79.5 ± 14.6)% before treatment to (11.2 ± 7.8)% after stent-assisted angioplasty. There were only 1 case of TIA (1.1%) and 1 case of minor stroke (1.1%) during the operation, without mortality or major stroke. No cerebral ischemic attach occurred in the 91 patients during clinical follow up for a period of 3-25 months with an average of 7.9 months. twenty-nine patients were angiographically followed up 6 months after treatment with only one asymptomatic restenosis (3.4%). Conclusions: Endovascular stent-assisted angioplasty for extracranial stenosis is safe and effective with considerable good short-term outcome

  4. Reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications

    Directory of Open Access Journals (Sweden)

    Vilson Lacerda Brasileiro Junior

    2014-02-01

    Full Text Available Objective The present study evaluated the reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Materials and Methods Thirty-five patients under high-risk for development of carotid artery calcifications who had digital panoramic radiography were referred to undergo ultrasonography. Thus, 70 arteries were assessed by both methods. The main parameters utilized to evaluate the panoramic radiography reliability in the diagnosis of carotid artery calcifications were accuracy, sensitivity, specificity and positive predictive value of this method as compared with ultrasonography. Additionally, the McNemar's test was utilized to verify whether there was a statistically significant difference between digital panoramic radiography and ultrasonography. Results Ultrasonography demonstrated carotid artery calcifications in 17 (48.57% patients. Such individuals presented with a total of 29 (41.43% carotid arteries affected by calcification. Radiography was accurate in 71.43% (n = 50 of cases evaluated. The degree of sensitivity of this method was 37.93%, specificity of 95.12% and positive predictive value of 84.61%. A statistically significant difference (p < 0.001 was observed between the methods evaluated in their capacity to diagnose carotid artery calcifications. Conclusion Digital panoramic radiography should not be indicated as a method of choice in the investigation of carotid artery calcifications.

  5. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... Maybe you can comment on that and its relationships to isolated territories and what that might mean ... endarterectomy. So you have to keep both in mind. 00:43:33 Y. PIERRE GOBIN, MD: This ...

  6. Increased Carotid Thickness in Subjects with Recently-Diagnosed Diabetes from Rural Cameroon

    OpenAIRE

    Nicola Napoli; Enrico Zardi; Rocky Strollo; Michele Arigliani; Andrea Daverio; Flaminia Olearo; Daniele Tosi; Giordano Dicuonzo; Filomena Scarpa; Claudio Pedone; Hervé Hilaire Tegue Simo; Giovanni Mottini; Paolo Pozzilli

    2012-01-01

    BACKGROUND: We have recently shown a high prevalence of diabetes and obesity in rural Cameroon, despite an improved lifestyle. Diabetes in rural Africa remains underdiagnosed and its role in increasing risk of atherosclerosis in these populations is unknown. We investigated the prevalence of carotid atherosclerosis and cardiovascular risk factors in a population of subjects with recently-diagnosed diabetes from rural Cameroon. METHODOLOGY/PRINCIPAL FINDINGS: In a case-control study, carotid i...

  7. 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.)

  8. Carotid and subclavian sonography in the diagnosis of takayasu arteritis

    International Nuclear Information System (INIS)

    Takayasu arteritis (TA) is an inflammatory disease of aorta and its major branches and pulmonary artery affecting young females in most cases. Diagnosis of TA in its early phase is important in prevention of serious complications. However, clinical diagnosis of TA may be difficult due to nonspecific symptoms. Thirty-three consecutive patients (aged 15 to 60 years; mean age, 44.6 years) with TA (19 in clinically active, 14 in inactive stage) were included in this study. Concentric wall thickening (1.2-4.0 mm ), stenosis or occlusion of one or both common carotid arteries or innominate artery was found in 78% (26/33) of patients with TA. Wall thickening or occlusion of one or both subclavian arteries was seen in 60.6% (20/33) of patients with TA. Most patients (91%, 31/33) except two chronic inactive patients with aortic stenosis had disease in at least one of four arteries at sonography. Because subclavian and carotid lesions are peculiar in young patients with TA. Carotid and subclavian US is sensitive and specific in diagnosis of TA as revealed in our study. Findings of carotid sonography in TA have been concentric wall thickening and calcifications. Early diagnosis mainly depends on detection of subtle mural thickening at sectional imaging studies, while stenosis or dilatation of aorta and its branches appears in the later stage. Changes in mural thickness after medical treatment could be assessed with sonography.

  9. [Revascularization of the carotid and vertebral arteries in the elderly].

    Science.gov (United States)

    Illuminati, G; Bezzi, M; D'Urso, A; Giacobbi, D; Ceccanei, G; Vietri, F

    2004-01-01

    From January 1994 to July 2004, 323 patients underwent 348 revascularization of carotid bifurcation for atherosclerotic stenoses. Eighty eight patients (group A) were 75 year-old or older, whereas 235 (group B) were younger than 75 years. Postoperative mortality/neurologic morbidity rate was 1% in group A, and 1.4% in group B. At 5 years, patency and freedom from symptoms/stroke were, respectively, 91% and 92% in group A, and 89% and 91% in group B. None of these differences was statistically significant. In the same time period, 26 internal carotid arteries were revascularized in 24 patients, 75 or more aged, for a symptomatic kinking. Postoperative mortality/morbidity rate was absent, whereas, at 5 years, patency and freedom from symptoms/stroke were, respectively, 88% and 92%. Twelve vertebral arteries were revascularized in 12 patients, 75 or more aged, for invalidating symptoms of vertebrobasilar insufficiency. Postoperative mortality/neurologic morbidity rate was absent. In one case postoperative recurrence of symptoms occurred, despite a patent revascularization. Patency and freedom from symptoms/stroke were 84% and 75%, at 5 years. Revascularization of carotid and vertebral arteries in the elderly can be accomplished with good results, superposable to those of standard revascularization of carotid bifurcation in a younger patients' population. PMID:15803810

  10. Giant thrombosed intracavernous carotid artery aneurysm presenting as Tolosa–Hunt syndrome in a patient harboring a new pathogenic neurofibromatosis type 1 mutation: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Conforti R

    2014-01-01

    Full Text Available Renata Conforti,1 Mario Cirillo,2 Valeria Marrone,1 Rosario Galasso,1 Guglielmo Capaldo,3 Teresa Giugliano,4 Assunta Scuotto,1 Giulio Piluso,4 Mariarosa AB Melone3,51Neuroradiology Unit, Department of Clinical and Experimental Medicine and Surgery, 2Radiology Unit, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, 3Division of Neurology, Department of Clinical and Experimental Medicine and Surgery, 4Department of Biochemistry, Biophysics and General Pathology, School of Medicine, Second University of Naples, Naples, Italy; 5Institute of Protein Biochemistry, National Research Council, Naples, ItalyAbstract: Neurofibromatosis type 1 (NF1 is a relatively common single-gene disorder, and is caused by heterozygous mutations in the NF1 gene that result in a loss of activity or in a nonfunctional neurofibromin protein. Despite the common association of NF1 with neurocutaneous features, its pathology can extend to numerous tissues not derived from the neural crest. Among the rare cerebrovascular abnormalities in NF1, more than 85% of cases are of purely occlusive or stenotic nature, with intracranial aneurysm being uncommon. Predominantly, the aneurysms are located in the internal carotid arteries (ICAs, being very rare bilateral aneurysms. This report describes a very unusual case of fusiform aneurysms of both ICAs in a Caucasian NF1 patient, with a new pathogenic intragenic heterozygous deletion of the NF1 gene, presenting at age 22 years with Tolosa–Hunt syndrome, because of partial thrombosis of the left giant intracavernous aneurysm. Medical treatment with anticoagulant therapy allowed a good outcome for the patient. In conclusion, early identification of cerebral arteriopathy in NF1 and close follow-up of its progression by neuroimaging may lead to early medical or surgical intervention and prevention of significant neurologic complications.Keywords: neurofibromatosis type 1, NF1 gene, multiplex ligation

  11. Carotid blood flow measured by an ultrasonic volume flowmeter in carotid stenosis and patients with dementia.

    OpenAIRE

    UEMATSU, S.; Folstein, M F

    1985-01-01

    The volume flowmeter is a simple, noninvasive Doppler ultrasound technique that provides accurate measurement of carotid artery diameter and flow. The device provides a useful laboratory test that can aid significantly in diagnosis of carotid stenosis and dementia.

  12. Carotid thin fluttering bands: A new element of arterial wall remodelling? An ultrasound study.

    Science.gov (United States)

    Costanzo, Luca; Sole, Andrea; Tamburino, Corrado; Di Pino, Luigi

    2015-10-01

    Carotid artery ultrasound is a non-invasive and reproducible technique used for early atherosclerotic assessment. Intimal flap has been described in the presence of dissection or mobile plaque rupture, however presence of carotid thin fluttering bands (TFBs) have not been described yet. To investigate frequency, characteristics and impact of TFBs in carotid lumen of patients who underwent carotid ultrasound scan (CUS). 3341 patients were admitted from January 2009 to January 2014. Patients with history of cerebral ischemia (CI) were excluded. In the cases in which TFBs were observed, a 3-months clinical and CUS follow-up (FU) was performed. TFBs were found in 71 patients (2.1%). The mean age was 63.41 ± 11.20 years (range 42-89). All patients showed a mean increase in intima-media thickness. We identified two subgroups: in 22 patients the TFB was related to a carotid plaque while in 49 no carotid plaque was found. TFB mostly originated in the carotid bulb (88.7%) and was similarly located in carotid arteries (49.3% left-side and 50.7% right-side). CUS and clinical FU were available for all patients (mean duration 25.34 months, median 19). CI occurred in none of the patients. TFB disappeared in 13 patients (18.3%) with no sign or symptoms of CI. In 3 of 49 patients without carotid plaque (6.1%), progressive thickening beneath TFB was observed. TFB is a rare finding. Longer FU is needed to evaluate its prognosis. To date, the pathophysiology is unknown, however it could be related to vascular remodeling. PMID:26179862

  13. Clinical experience of cerebral protection with balloon occlusion during carotid artery stenting

    International Nuclear Information System (INIS)

    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.)

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... on the prevention of further propagation of carotid disease. Carotid enarterectomy was first described in about 1953 ... the carotid bifurcation where the majority of the disease occurs. We will use special magnifying glasses to ...

  16. Left carotid steal. A new observation.

    Science.gov (United States)

    Shumacker, H B; Isch, J H

    1975-04-01

    A patient had an occlusion of the left subclavian artery just proximal to the takeoff of a previously placed subclavian-carotid graft. This caused reversal of flow in the graft and a symptomatic steal of blood via to the intracranial arteries. An axilloaxillary graft restored forward flow. In a second patient, a steal occurred from the right carotid and vertebral systems into the distal carotid system of the left side that has been isolated by a proximal carotide artery occlusion from arteriosclerosis. A saphenous vein, used as a bypass from the subclavian to the carotid artery, restored normal flow. Thus, the carotide system may be the low-pressure area responsible for the steal, although this is rarer than the subclavian. PMID:1147756

  17. Invasive treatment for carotid fibromuscular dysplasia

    OpenAIRE

    Tekieli, Łukasz M.; Maciejewski, Damian R.; Dzierwa, Karolina; Kabłak-Ziembicka, Anna; Michalski, Michał; Wójcik-Pędziwiatr, Magdalena; Brzychczy, Andrzej; Moczulski, Zbigniew; Żmudka, Krzysztof; Pieniążek, Piotr

    2015-01-01

    Introduction Fibromuscular dysplasia (FMD) is an infrequent non-inflamatory disease of unknown etiology that affects mainly medium-size arteries. The prevalence of FMD among patients scheduled for endovascular treatment of carotid artery stenosis is unknown. Aim To evaluate the prevalence and treatment options of carotid FMD in patients scheduled for carotid artery stenting (CAS). Material and methods Between Jan 2001 and Dec 2013, 2012 CAS procedures were performed in 1809 patients (66.1% me...

  18. Enhanced brain release of erythropoietin, cytokines and NO during carotid clamping.

    Science.gov (United States)

    Carelli, Stephana; Ghilardi, Giorgio; Bianciardi, Paola; Latorre, Elisa; Rubino, Federico; Bissi, Marina; Di Giulio, Anna Maria; Samaja, Michele; Gorio, Alfredo

    2016-02-01

    Although effective and safe, carotid endarterectomy (CEA) implies a reduced blood flow to the brain and likely an ischemia/reperfusion event. The high rate of uneventful outcomes associated with CEA suggests the activation of brain endogenous protection mechanisms aimed at limiting the possible ischemia/reperfusion damage. This study aims at assessing whether CEA triggers protective mechanisms such as brain release of erythropoietin and nitric oxide. CEA was performed in 12 patients; blood samples were withdrawn simultaneously from the surgically exposed ipsilateral jugular and leg veins before, during (2 and 40 min) and after clamp removal (2 min). Plasma antioxidant capacity, carbonylated proteins, erythropoietin, nitrates and nitrites (NOx) were determined. No changes in intraoperative EEG, peripheral and transcranial blood oxygen saturation were detectable, and no patients showed any neurologic sign after the intervention. Antioxidant capacity and protein carbonylation in plasma were unaffected. Differently, erythropoietin, VEGF, TNF-α and NOx increased during clamping in the jugular blood (2 and 40 min), while no changes were observed in the peripheral circulation. These results show that blood erythropoietin, VEGF, TNF-α, and NOx increased in the brain during uncomplicated CEA. This may represent an endogenous self-activated neuroprotective mechanism aimed at the prevention of ischemia/reperfusion damage. PMID:26494654

  19. Interventional therapy of traumatic pseudoaneurysms in internal carotid artery siphon

    International Nuclear Information System (INIS)

    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)

  20. Carotid artery lumen segmentation in 3D free-hand ultrasound images using surface graph cuts.

    Science.gov (United States)

    Lorza, Andrés M Arias; Carvalho, Diego D B; Petersen, Jens; van Dijk, Anouk C; van der Lugt, Aad; Niessen, Wiro J; Klein, Stefan; de Bruijne, Marleen

    2013-01-01

    We present a new approach for automated segmentation of the carotid lumen bifurcation from 3D free-hand ultrasound using a 3D surface graph cut method. The method requires only the manual selection of single seed points in the internal, external, and common carotid arteries. Subsequently, the centerline between these points is automatically traced, and the optimal lumen surface is found around the centerline using graph cuts. To refine the result, the latter process was iterated. The method was tested on twelve carotid arteries from six subjects including three patients with a moderate carotid artery stenosis. Our method successfully segmented the lumen in all cases. We obtained an average dice overlap with respect to a manual segmentation of 84% for healthy volunteers. For the patient data, we obtained a dice overlap of 66.7%. PMID:24579183

  1. Surgical management for retained distal embolic protection device and fractured guidewire after carotid artery stenting.

    Science.gov (United States)

    Li, Tongxun; Zha, Yuanting; Bo, Liyang; Wirthlin, Douglas J; Zhang, Qinyi

    2016-01-01

    Entrapment and fracture of carotid angioplasty and stenting hardware is a rare complication of percutaneous stenting procedures. We describe a case of a retained distal filter embolic protection device and guidewire in a 57-year-old male in Beijing, China. After unsuccessful attempts at removal via interventional methods, a second stent was deployed to secure the original hardware in situ, and the patient was discharged. He later experienced guidewire fragmentation in the carotid artery and aortic arch, with subsequent thrombus formation. We report partial removal of the guidewire and stent via carotid artery cutdown and open thoracotomy without complication. When efforts to retrieve stenting hardware are unsuccessful, it is never a suitable choice to leave them within the artery. We advocate for early surgical management of retained materials after unsuccessful carotid artery stenting. Furthermore, improved quality monitoring and assurance programs are needed to prevent such complications in the future. PMID:27316621

  2. In vivo and in vitro evidence that 99mTc-HYNIC-interleukin-2 is able to detect T lymphocytes in vulnerable atherosclerotic plaques of the carotid artery

    International Nuclear Information System (INIS)

    Recent advances in basic science have established that inflammation plays a pivotal role in the pathogenesis of atherosclerosis. Inflammatory cells are thought to be responsible for the transformation of a stable plaque into a vulnerable one. Lymphocytes constitute at least 20 % of infiltrating cells in these vulnerable plaques. Therefore, the interleukin-2 (IL-2) receptor, being overexpressed on activated T lymphocytes, may represent an attractive biomarker for plaque vulnerability. The aim of this study was to evaluate the specificity of radiolabelled IL-2 [99mTc-hydrazinonicotinamide (HYNIC)-IL-2] for imaging the lymphocytic infiltration in carotid plaques in vivo by planar and single photon emission computed tomography (SPECT)/CT imaging and ex vivo by microSPECT and autoradiography. For the in vivo study, ten symptomatic patients with advanced plaques at ultrasound who were scheduled for carotid endarterectomy underwent 99mTc-HYNIC-IL-2 scintigraphy. The images were analysed visually on planar and SPECT images and semi-quantitatively on SPECT images by calculating target to background (T/B) ratios. After endarterectomy, immunomorphological evaluation and immunophenotyping were performed on plaque slices. For the ex vivo studies, four additional patients were included and, after in vitro incubation of removed plaques with 99mTc-HYNIC-IL-2, autoradiography was performed and microSPECT images were acquired. Visual analysis defined clear 99mTc-HYNIC-IL-2 uptake in seven of the ten symptomatic plaques. SPECT/CT allowed visualization in eight of ten. A significant correlation was found between the number of CD25+ lymphocytes and the total number of CD25+ cells in the plaque and the T/B ratio with adjacent carotid artery as background (Pearson's r = 0.89, p = 0.003 and r = 0.87, p = 0.005, respectively). MicroSPECT imaging showed clear 99mTc-HYNIC-IL-2 uptake within the plaque wall and not in the lipidic core. With autoradiography, only CD3+ lymphocytes were found to

  3. Intradural vertebral endarterectomy with nonautologous patch angioplasty for refractory vertebrobasilar ischemia: Case report and literature review

    OpenAIRE

    Timothy Uschold; Adib A Abla; Wilson, David A.; McDougall, Cameron G.; Peter Nakaji

    2014-01-01

    Background: The natural history of patients with symptomatic vertebrobasilar ischemic symptoms due to chronic bilateral vertebral artery occlusive disease is progressive, and poses significant challenges when refractory to medical therapy. Surgical treatment options depend largely on location and characteristics of the atheroma (s), and generally include percutaneous transluminal angioplasty (PTA) with or without stent placement, posterior circulation revascularization (bypass), extracranial ...

  4. Quantification of carotid vessel atherosclerosis

    Science.gov (United States)

    Chiu, Bernard; Egger, Micaela; Spence, J. D.; Parraga, Grace; Fenster, Aaron

    2006-03-01

    Atherosclerosis is characterized by the development of plaques in the arterial wall, which ultimately leads to heart attacks and stroke. 3D ultrasound (US) has been used to screen patients' carotid arteries. Plaque measurements obtained from these images may aid in the management and monitoring of patients, and in evaluating the effect of new treatment options. Different types of measures for ultrasound phenotypes of atherosclerosis have been proposed. Here, we report on the development and application of a method used to analyze changes in carotid plaque morphology from 3D US images obtained at two different time points. We evaluated our technique using manual segmentations of the wall and lumen of the carotid artery from images acquired in two US scanning sessions. To incorporate the effect of intraobserver variability in our evaluation, manual segmentation was performed five times each for the arterial wall and lumen. From this set of five segmentations, the mean wall and lumen surfaces were reconstructed, with the standard deviation at each point mapped onto the surfaces. A correspondence map between the mean wall and lumen surfaces was then established, and the thickness of the atherosclerotic plaque at each point in the vessel was estimated to be the distance between each correspondence pairs. The two-sample Student's t-test was used to judge whether the difference between the thickness values at each pair corresponding points of the arteries in the two 3D US images was statistically significant.

  5. CT angiography in carotid stenosis

    International Nuclear Information System (INIS)

    Purpose: Prospective evaluation of the accuracy CT angiography (CTA) with different postprocessing for extracranial carotid artery in comparison with DSA. Method: one hundred patients were studied with standarized CTA. For postprocessing, MPR, MIP, and 3D reconstruction based on segmentation with upper and lower threshold were used. Intravascular density profiles were considered. All CTA studies were correlated with intra-arterial angiography. The degree and classification of stenoses was determined using the guidelines established by the NASCET collaborators. Results: Measurement of stenosis was possible by MPR in 82.5%, by MIP in 85%, and 3D in 100%. Correct classification was found in 65.5% for MPR, 66% for MIP and 88.5% for 3D. The sensitivity for severe stenoses was 74% for MPR, 82% for MIP, and 93% for 3D. The specificity of these methods was 98%, 96%, and 97%, respectively. All carotid occlusions were correctly identified, no carotid artery was wrongly classified as occluded. (orig./AJ)

  6. Complications of ENT infections: pseudoaneurysm of the internal carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Brochu, Bernard [Department of Radiology, Laval University, Quebec (Canada); Dubois, Josee; Garel, Laurent [Department of Medical Imaging, Sainte-Justine Hospital, 3175, Cote Ste-Catherine, H3T 1C5, Montreal, Quebec (Canada); Quintal, Marie-Claude [Department of Otorhinolaryngology, Sainte-Justine Hospital, Montreal, Quebec (Canada); Roy, Daniel [Department of Radiology, CHUM, Montreal, Quebec (Canada)

    2004-05-01

    Ear, nose and throat infections are common, especially in children and young adults. Since the advent of antibiotics, complications from tonsillitis and pharyngeal abscess are rare, but potentially lethal. Vascular complications can be imaged with Doppler ultrasound and CT scan. The treatment of infectious vascular complications represents a significant challenge. We describe the case of a young girl presenting with a pseudoaneurysm of the internal carotid and thrombosis of the internal jugular vein. Endovascular therapy was utilized to treat the patient. (orig.)

  7. Eagle syndrome presenting with external carotid artery pseudoaneurysm

    OpenAIRE

    Dao, Van Anh; Karnezis, Stellios; Lane, John S.; Fujitani, Roy M.; Saremi, Farhood

    2011-01-01

    Eagle syndrome refers to a clinical syndrome caused by the abnormal elongation of the styloid process with calcification/ossification of the stylohyoid ligament. We present the first reported case of Eagle syndrome resulting in an external carotid artery (ECA) pseudoaneurysm. A patient presented to emergency room with an expanding, painful right-neck mass. CT angiography with three-dimensional volume rendering showed a bilobed 4.0-cm right ECA pseudoaneurysm and bilateral ossification of the ...

  8. Bilateral blunt carotid artery trauma associated with a double lower thoracic spine fracture: a case report and review of the literature

    OpenAIRE

    Evangelopoulos, Dimitrios S; Athanasakopoulos, Michalis; Kokkinis, Konstantinos; Korres, Dimitrios; Spyros G. Pneumaticos

    2008-01-01

    Background A 26 year old female suffering from a double fracture of the lower thoracic spine, as a result of a car accident, was referred to the Spine Unit of our Department. No neurological deficit was detected during clinical examination. Due to the fracture's instability, posterior stabilization was performed. Case presentation Postoperatively, the patient presented a decrease in Glasgow Coma Scale (GCS) combined with motor and sensory deficit from the right upper and lower extremities. Ce...

  9. Isolated oculomotor nerve palsy inspontaneous internal carotid artery dissection: case report Paralisia isolada do nervo oculomotor na dissecção de artéria carótida interna: relato de caso

    Directory of Open Access Journals (Sweden)

    Cynthia Resende Campos

    2003-09-01

    Full Text Available Partial oculosympathetic palsy followed by ischemic manifestations in brain or retina are the main symptoms of extracranial internal carotid artery (ICA dissection. Unusually, cranial nerves may be affected. Isolated oculomotor nerve palsy is found only rarely. CASE: We present a 50-year-old nondiabetic man who experienced acute onset of right occipital headache which spread to the right retro-orbital region. Five days later he noticed diplopia and right blurred vision sensation. Neurologic examination disclosed only impaired adduction and upward gaze of right eye, slight ipsilateral pupillary dilatation, without ptosis. Brain MRI was normal. Angiography showed right internal carotid artery dissection with forward occlusion to the base of the skull. Intravenous heparin followed by warfarin was prescribed. The headache and the oculomotor nerve deficit gradually resolved in the next three weeks. DISCUSSION: Isolated oculomotor nerve palsy is underrecognized as a clinical presentation of extracranial ICA dissection. If the angiographic evaluation is incomplete without careful study of extracranial arteries, misdiagnosis may lead to failure to initiate early treatment to prevent thromboembolic complications. For this reason we draw attention to the need for careful evaluation of cervical arteries in patients with oculomotor nerve palsy. Mechanical compression or stretching of the third nerve are possible mechanisms, but the direct impairment of the blood supply to the third nerve seems to be the most plausible explanation.A paralisia oculosimpática parcial (síndrome de Horner seguida por manifestações isquêmicas cerebrais ou retinianas são os principais sintomas da dissecção da artéria carótida interna (ACI extracraniana. O acometimento de nervos cranianos é incomum. Apenas raramente a paralisia isolada do nervo oculomotor pode ser encontrada. CASO: homem de 50 anos, sem diabetes, apresentou cefaléia occipital de início s

  10. Dissection of Extracranial Internal Carotid Artery Due to Balloon Guiding Catheter Resulting in Asymptomatic Internal Carotid Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Akpinar

    2016-04-01

    Full Text Available Dissection of the internal carotid artery (ICA is a rare condition that accounts for a significant proportion of ischemic strokes in young adults. Iatrogenic dissection as a complication of neurointerventional procedures is a traumatic dissection which has been reported relatively rare in the literature. In this report, a case of dissection of the ICA is reported that was caused by repetitive movement of the balloon guiding catheter during stent-assisted thrombectomy (SAT, resulting in occlusion of the ICA.

  11. Bridge-therapy with enoxaparin in the preoperative period of endarterectomy Terapia-ponte com enoxaparina no período pré-operatório da endarterectomia

    Directory of Open Access Journals (Sweden)

    Jair Leopoldo Raso

    2010-10-01

    Full Text Available Cervical clot is one of the complications of endarterectomy. This risk may be higher in patients using aspirin or clopidogrel. On the other hand, stroke may occur if the medication is interrupted before surgery. We carried out a prospective study of 124 endarterectomies in 119 patients in which aspirin or clopidogrel was stopped and a bridge-therapy with enoxaparin was administered preoperatively. There was no case of stroke during the period of the bridge-therapy. One patient developed cervical clot (0.8% in the fifth postoperative day. Mortality rate in this series was 0.8%. There was no complication directly related to the use of enoxaparin. Bridge-therapy with low molecular weight heparin is a safe strategy for patients elected for endarterectomyHematoma cervical é uma das complicações graves de endarterectomia. O risco dessa complicação pode ser maior em pacientes em uso de antiagregante plaquetário. Por outro lado, a suspensão de antiagregante plaquetário no período pré-operatório de endarterectomia eleva o risco de acidente vascular cerebral (AVC. Realizamos estudo prospectivo de 119 pacientes submetidos a endarterectomia (124 procedimentos, nos quais foi suspenso antiagregante plaquetário (aspirina ou clopidogrel e foi administrada terapia-ponte com enoxaparina subcutânea no período pré-operatório. Nessa série, não houve ocorrência de AVC no período pré-operatório. Um paciente (0,8% desenvolveu hematoma cervical no quinto dia pós-operatório. A mortalidade nessa série foi de 0,8%. Não houve nenhuma complicação atribuída diretamente ao uso de enoxaparina. A terapia-ponte com heparina de baixo peso molecular demonstrou ser estratégia segura no preparo de pacientes para endarterectomia

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  13. Lower prevalence of carotid plaque hemorrhage in women, and its mediator effect on sex differences in recurrent cerebrovascular events.

    Directory of Open Access Journals (Sweden)

    Neghal Kandiyil

    Full Text Available Women are at lower risk of stroke, and appear to benefit less from carotid endarterectomy (CEA than men. We hypothesised that this is due to more benign carotid disease in women mediating a lower risk of recurrent cerebrovascular events. To test this, we investigated sex differences in the prevalence of MRI detectable plaque hemorrhage (MRI PH as an index of plaque instability, and secondly whether MRI PH mediates sex differences in the rate of cerebrovascular recurrence.Prevalence of PH between sexes was analysed in a single centre pooled cohort of 176 patients with recently symptomatic, significant carotid stenosis (106 severe [≥70%], 70 moderate [50-69%] who underwent prospective carotid MRI scanning for identification of MRI PH. Further, a meta-analysis of published evidence was undertaken. Recurrent events were noted during clinical follow up for survival analysis.Women with symptomatic carotid stenosis (50%≥ were less likely to have plaque hemorrhage (PH than men (46% vs. 70% with an adjusted OR of 0.23 [95% CI 0.10-0.50, P<0.0001] controlling for other known vascular risk factors. This negative association was only significant for the severe stenosis subgroup (adjusted OR 0.18, 95% CI 0.067-0.50 not the moderate degree stenosis. Female sex in this subgroup also predicted a longer time to recurrent cerebral ischemic events (HR 0.38 95% CI 0.15-0.98, P = 0.045. Further addition of MRI PH or smoking abolished the sex effects with only MRI PH exerting a direct effect. Meta-analysis confirmed a protective effect of female sex on development of PH: unadjusted OR for presence of PH = 0.54 (95% CI 0.45-0.67, p<0.00001.MRI PH is significantly less prevalent in women. Women with MRI PH and severe stenosis have a similar risk as men for recurrent cerebrovascular events. MRI PH thus allows overcoming the sex bias in selection for CEA.

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

    International Nuclear Information System (INIS)

    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

  15. Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

    OpenAIRE

    Ongom, Peter A; Kijjambu, Stephen C; Jombwe, Josephat

    2014-01-01

    Introduction Gunshot injuries of the head and neck from the AK-47 rifle (a common assault rifle, submachine gun type) are a significant contributor to morbidity and mortality among civilians in Sub-Saharan Africa. They may cause significant damage to the closely arranged structures in this region, and the bullet’s trajectory can be very difficult to determine. We present an unusual case of gunshot injury with an atypical bullet entry wound, profound injury to the face, lodgment in the right c...

  16. Physician-initiated prospective Italian Registry of carotid stenting with the C-Guard mesh-stent: the IRON-Guard registry. Rationale and design.

    Science.gov (United States)

    Setacci, C; Speziale, F; De Donato, G; Sirignano, P; Setacci, F; Capoccia, L; Galzerano, G; Mansour, W

    2015-10-01

    According to the World Health Organization, every year, 5 million peoples die for stroke and another 5 million are permanently disabled. Although there are many causes of acute stroke, a common treatable cause of acute stroke is atheromatous narrowing at the carotid bifurcation. Carotid endarterectomy is still the standard of car, even if carotid artery stenting (CAS) has become an effective, less invasive alterantive. Unfortunately, CAS procedure is not yet perfect; regardless the use of an embolic protection device (EPD), percutaneous treatment has been correlated with a risk of cerebral ischemic events related to distal embolization. The objective of the IRON-Guard Registry is to evaluate the clinical outcome of treatment by means of stenting with the C-Guard (InspireMD, Boston, MA, USA) in subjects requiring CAS due to significant extracranial carotid artery stenosis with a physician-initiated, Italian, prospective, multicenter, single-arm study. A total of 200 enrolled subjects divided over different centers are planned to be enrolled. CAS will performed by implanting of C-Guard stent. Procedure will be performed according to the physician's standard of care. Standard procedures will be followed based on the Instructions for Use, for the C-Guard device of Inspire. The primary endpoint of this study is the 30-day rate of major adverse events (MAE), defined as the cumulative incidence of any periprocedural (≤30 days postprocedure) death, stroke or myocardial infarction. Secondary endpoints are rate of late ipsilateral stroke (31 through 365 days), system technical success, device malfunctions, major adverse events (MAEs), serious device-related and procedure-related adverse events, target lesion revascularization, and in-stent restenosis rates. PMID:25996843

  17. The added value of longitudinal black-blood cardiovascular magnetic resonance angiography in the cross sectional identification of carotid atherosclerotic ulceration

    Directory of Open Access Journals (Sweden)

    Hippe Daniel S

    2009-08-01

    Full Text Available Abstract Background Carotid atherosclerotic ulceration is a significant source of stroke. This study evaluates the efficacy of adding longitudinal black-blood (BB cardiovascular magnetic resonance (CMR angiography to cross-sectional CMR images in the identification of carotid atherosclerotic ulceration. Methods Thirty-two subjects (30 males and two females with ages between 48 and 83 years scheduled for carotid endarterectomy were imaged on a 1.5T GE Signa scanner using multisequence [3D time-of-flight, T1, proton density, T2, contrast enhanced T1], cross-sectional CMR images and longitudinal BB CMR angiography (0.625 × 0.625 mm/pixel. Two rounds of review (round 1: cross-sectional CMR images alone and round 2: cross-sectional CMR images plus longitudinal BB CMR angiography were conducted for the presence and volume measurements of ulceration. Ulceration was defined as a distinct depression into the plaque containing blood flow signal on cross-sectional CMR and longitudinal BB CMR angiography. Results Of the 32 plaques examined by histology, 17 contained 21 ulcers. Using the longitudinal BB CMR angiography sequence in addition to the cross-sectional CMR images in round 2, the sensitivity improved to 80% for ulcers of at least 6 mm3 in volume by histology and 52.4% for all ulcers, compared to 30% and 23.8% in round 1, respectively. There was a slight decline in specificity from 88.2% to 82.3%, though both the positive and negative predictive values increased modestly from 71.4% to 78.6% and from 48.4% to 58.3%, respectively. Conclusion The addition of longitudinal BB CMR angiography to multisequence cross-sectional CMR images increases accuracy in the identification of carotid atherosclerotic ulceration.

  18. Ultrasonic echolucent carotid plaques predict future strokes

    DEFF Research Database (Denmark)

    Grønholdt, Marie-Louise; Nordestgaard, B G; Schroeder, T V; Vorstrup, S; Sillesen, H

    2001-01-01

    We tested prospectively the hypothesis that stroke development can be predicted by echolucency of carotid atherosclerotic plaques in previously symptomatic and asymptomatic patients.......We tested prospectively the hypothesis that stroke development can be predicted by echolucency of carotid atherosclerotic plaques in previously symptomatic and asymptomatic patients....

  19. Transient Ischemic Attack in the Setting of Carotid Atheromatous Disease with a Persistent Primitive Hypoglossal Artery Successfully Treated with Stenting: A Case Report.

    Science.gov (United States)

    Huang, Meng; Moisi, Marc; Zwillman, Michael E; Volpi, John J; Diaz, Orlando; Klucznik, Richard

    2016-01-01

    Fetal brain perfusion is supplied by the primitive dorsal aorta anteriorly, longitudinal neural arteries posteriorly, and anastomotic transverse segmentals. Most notable of these connections are the primitive trigeminal, otic, hypoglossal, and proatlantal arteries. With cranial-cervical circulatory maturation and development of the posterior communicating segments and vertebro-basilar system, these primitive segmental anastomoses normally regress. Anomalous neurovascular development can result in persistence of these anastomoses. Due to its territory of perfusion, the persistent primitive hypoglossal artery (PPHA) is associated with vertebral artery and posterior communicating artery hypoplasia or aplasia. As a consequence, primary blood supply to the hindbrain comes chiefly from this single artery. Although usually clinically silent, PPHA is susceptible to common cerebrovascular disorders including athero-ischemic disease and saccular aneurysmal dilation to name a few. We present a case of transient ischemic attack in a patient with a PPHA and proximal atherosclerotic disease treated by endovascular stenting. PMID:26929891

  20. Fístula carótido-cavernosa com epistaxe letal: relato de caso Carotid-cavernous fistula with lethal epistaxis: case report

    OpenAIRE

    Rover Borba; Ildo Sonda; Leandro Infantini Dini; Fernando Nora Calcagnotto; Nicole Marchett; Paula Cristina Cobalchini

    2001-01-01

    A fístula carótido-cavernosa é uma comunicação patológica entre a artéria carótida interna e o seio cavernoso. Apresentamos o caso de um paciente de 32 anos de idade com fístula carótido-cavernosa devida a traumatismo crânio-encefálico. O tratamento preconizado é a embolização mas neste caso em especial houve falha devido às características próprias da fístula, e o paciente progrediu de maneira desfavorável evoluindo ao óbito por epistaxe incontrolável.We report the case of a 32 years old mal...

  1. Tortuosity, kinking, and coiling of the carotid artery: expression of atherosclerosis or aging?

    Science.gov (United States)

    Del Corso, L; Moruzzo, D; Conte, B; Agelli, M; Romanelli, A M; Pastine, F; Protti, M; Pentimone, F; Baggiani, G

    1998-05-01

    The etiology of carotid abnormalities is both congenital than acquired. The aim of this study was to clarify the role of aging and atherosclerosis in the acquired cases, and the role of these abnormalities in hemodynamic alterations and neurologic symptoms. Over a 1-year period the authors studied all the subjects undergoing carotid examination by continuous-wave and color-coded Doppler sonography at an Angiology Unit. They evaluated neurologic symptoms; risk factors for atherosclerosis; number, sites, and kinds of carotid abnormalities; atherosclerotic lesions; stenosis; hemodynamic alterations of the carotid; and other localizations of atherosclerotic diseases. There were 469 subjects: 272 (58%) with abnormalities (group 1) and 197 (42%) without abnormalities (group 2). The total number of abnormalities was 479 (104 tortuosities, 262 kinkings, and 113 coilings). The abnormalities were more prevalent in the elderly (P<0.001) and in women (P<0.001). In group 1 they found significant prevalences of hyperlipemia (P<0.001), hypertension (P<0.01), chronic cigarette smoking (P<0.01), and ischemic heart disease (P<0.05). Carotid atherosclerotic lesions were more prevalent in group 1 than in group 2 (P<0.001); among the patients with atherosclerotic carotid lesions, those in group 1 were older than those in group 2 (P<0.001). Tortuosity seemed to be associated with fewer hemodynamic alterations. The authors conclude that atherosclerosis, hypertension, and aging may play an important role in producing carotid abnormalities. The aging seemed more important than atherosclerosis. Only a prospective study of patients with carotid abnormalities and no atherosclerotic lesion will clarify the role of hemodynamics and neurologic symptomatology. PMID:9591528

  2. Aberrant internal carotid artery in the middle ear

    International Nuclear Information System (INIS)

    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.

  3. 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. PMID:25917634

  4. Surgical complications of carotid body tumors surgery: a review.

    Science.gov (United States)

    Amato, B; Serra, R; Fappiano, F; Rossi, R; Danzi, M; Milone, M; Quarto, G; Benassai, G; Bianco, T; Amato, M; Furino, E; Compagna, R

    2015-12-01

    Carotid body tumor (CBT) is a rare neoplasm, although it represents about 65% of head and neck paragangliomas. Surgical excision is considered the appropriate therapy for CBTs. The aim of this study was to evaluate surgical outcomes on a large scale. We reviewed 19 studies between 2004 to 2014 with a total of 625 procedures. We observed a higher number of cases in women (62%). Only 3 (0,48%) deaths were reported as surgical complication. Total cranial nerve injuries were 302 (48,32%) of which 194 (31,04%) were transient and 108 (17,28%) were permanent. We found a total of 174 (27,84%) arterial injuries, most of which are external carotid artery (ECA) injuries. Cerebrovascular accident due to surgery were 15 (2,4%). We concluded that surgical resection remains the treatment of choice for these disease despite the related morbidity. PMID:26498887

  5. 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.

  6. 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.

  7. Clinical results of carotid artery stenting with a nitinol self-expanding stent (SMART stent)

    Energy Technology Data Exchange (ETDEWEB)

    Drescher, Robert; Mathias, Klaus D.; Jaeger, Horst J.; Bockisch, Georg; Demirel, Eren; Gissler, Martin H.; Hauth, Elke [Department of Radiology, Staedtische Kliniken Dortmund, Beurhausstrasse 40, 44139 Dortmund (Germany); Department of Radiology and Microtherapy, University Witten/Herdecke (Germany)

    2002-10-01

    Our objective was to assess the technical feasibility and the clinical results of internal carotid artery (ICA) stenting using a nitinol self-expanding stent (SMART stent). In 13 patients 13 high-grade stenoses of the internal carotid artery were treated via an implantation of a SMART stent. In all cases a predilation of the stenosis and a postdilation within the stent were performed. Follow-up examinations were carried out in all patients after a period of 6 months. In each case the implantation of the stent was performed without technical complications. In 12 of 13 cases the stent was placed in the patients' internal carotid artery, in 1 case from the internal to the common carotid artery (CCA). The average degree of stenosis of 78% (70-95%) was reduced to an average of 2.8% (0-21%). The 6-month follow-up angiography showed an average degree of restenosis of 11.8% (0-29%) in 8 of 13 patients. Duplex sonography in the remaining 5 patients demonstrated patent stents. One patient showed brief neurological symptoms during the intervention. No further complications occurred during follow-up time. Treatment of internal carotid artery stenosis with the SMART stent seems technically feasible, safe, and promises long-term patency. (orig.)

  8. Endovascular treatment in proximal and intracranial carotid occlusion 9 hours after symptom onset

    International Nuclear Information System (INIS)

    A debate is emerging over whether the treatment time window in acute stroke can be extended beyond 6 h if penumbral tissue can be identified. Treatment decisions are very difficult in cases of tandem proximal carotid occlusion with arterioarterial intracranial embolism. We enter this debate with the present report on a case of atherosclerotic proximal carotid occlusion and resulting periocclusional carotid T embolism that was successfully treated 9 h after symptom onset. The case of a 68-year-old man with fluctuating symptoms of right-hemispheric stroke is presented (NIHSS score 12-20 on admission). CT angiography demonstrated proximal carotid occlusion and periocclusional embolism of the entire internal carotid artery (ICA) including the carotid T segment. Penumbral tissue was diagnosed by nonenhanced and perfusion CT imaging 7.5 h after symptom onset. Treatment was initiated 9 h after symptom onset by passing the proximal occlusion with a microcatheter and local administration of recombinant tissue plasminogen activator (rt-PA) into the carotid T segment at the level of posterior communicating artery (PCoA) origin. Recanalization of the ICA and middle cerebral artery was accomplished within 1 h by flow establishment via the PCoA. The atherosclerotic proximal ICA occlusion was not stented due to the risk of embolism from remnant thrombi in the petrous and cavernous ICA segments. Follow-up MRI showed only mild haemorrhagic infarct transformation of the initial infarct core. The patient was discharged from hospital 18 days after treatment with NIHSS score 5. If penumbral tissue can be conclusively identified, endovascular treatment in proximal and intracranial tandem occlusion can be successful, even in treatments initiated 6-9 h after stroke onset. If the intracranial flow after recanalization can be established via the circle of Willis, the underlying proximal ICA occlusion may not require treatment. (orig.)

  9. Clinical study on external carotid artery infusion (trans-femoral) treatment of recurrent nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Objective: To evaluate the effect and safety of external carotid artery infusion treatment of recurrent nasopharyngeal carcinoma (NPC). Methods: 20 cases of recurrent NPC (13 male and 7 female, age 36-65 years, mean 50 years) diagnosed by clinical examination (including nasopharyngoscope), serology (VCA-IgA) and imaging (CT, MR) and treated by external carotid artery infusion (trans-femoral) with adriamycin (or epi-adriamycin), cisplatin (or carboplatin), Pingyangmycin and 5-Fluorouracil. Results: Of all the patients, 8 cases (40%) had a complete response (CR), 7 cases (35%) had a partial response (PR). The overall response rate (CR + PR) was 75%. Cumulative survival rates at 1, 3 years were 90% (18/20), 50%(10/20) respectively. No severe side-effects and complications found. Conclusion: External carotid artery infusion (trans-femoral) should be effective and safe in the treatment of recurrent NPC

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

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. Carotid Stump Syndrome: Pathophysiology and Endovascular Treatment Options

    International Nuclear Information System (INIS)

    Carotid stump syndrome is one of the recognised causes of recurrent ipsilateral cerebrovascular events after occlusion of the internal carotid artery. It is believed that microemboli arising from the stump of the occluded internal carotid artery or the ipsilateral external carotid artery can pass into the middle cerebral artery circulation as a result of patent external carotid–internal carotid anastomotic channels. Different pathophysiologic causes of this syndrome and endovascular options for treatment are discussed.

  13. Carotid Cavernous Fistula Associated with Persistent Trigeminal Artery

    Science.gov (United States)

    Hurst, Robert W.; Howard, Robert S.; Zager, Eric

    1998-01-01

    Carotid-cavernous fistula (CCF) associated with persistent trigeminal artery (PTA) is a rare but important clinical entity. We present a case treated by microcoil embolization with preservation of internal carotid, PTA, and hasilar artery flow following embolization. A 62-year-old female developed pulsatile tinnitus followed by left eye proptosis and diplopia. Examination revealed a cranial nerve VI palsy and an objective bruit over the left orbit. Angiographic evaluation revealed a carotid cavernous fistula originating from a persistent trigeminal artery. Placement of a detachable balloon across the fistula site while preserving the PTA proved impossible, and the fistula was treated with microcoils following placement of a microcatheter across the fistula into the cavernous sinus. Complete closure of the fistula was followed by resolution of the patient's symptoms. Preservation of all major vessels including the PTA was accomplished through the use of coil embolization. Careful evaluation of the angiogram is necessary to identify PTA associated with a CCF. Previous reports have described treatment of CCF with PTA by surgical or balloon ocolusion, some involving sacrifice of the PTA. Examination of the relevant embryology and anatomy reveals, however, that occlusion of the PTA must be approached with caution due to potential supply to the posterior circulation. ImagesFigure 1 PMID:17171071

  14. Diagnosis of carotid artery atheroma by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Atheroma appears as a very low signal intensity area on 2-dimensional time-of-flight (TOF) magnetic resonance (MR) images, and its components have various signal intensities on spin-echo (SE) images. The present study investigated atheroma of the carotid arteries in 37 subjects with risk factors (63±10 years of age; 19 men) by magnetic resonance imaging (MRI). On 2-dimensional (2D) TOF images, the carotid arteries were clearly demonstrated in all cases and atheroma was detected in 23 patients. The most common location of atheroma was at the origin of the internal carotid artery. There was vascular remodeling in all patients with atheroma. 2D-TOF images showed 97% agreement with ultrasonography. SE images clearly demonstrated atheroma in all 23 patients with atheroma. All patients with atheroma showing high signal intensity on T1-weighted images had hyperlipidemia. These findings indicate that the 2D-TOF imaging method is useful for detecting atheroma and SE-images are useful for its characterization. (author)

  15. Common carotid artery intima-media thickness, carotid plaques, and walking speed.

    OpenAIRE

    Elbaz, Alexis; Ripert, Mahaut; Tavernier, Béatrice; Février, Benoît; Zureik, Mahmoud; Gariépy, Jérôme; Alpérovitch, Annick; Tzourio, Christophe

    2005-01-01

    BACKGROUND AND PURPOSE: Gait dysfunction is an important cause of disability among the elderly and may be, in part, of vascular origin. We studied the association between carotid ultrasound parameters and measures of gait and balance in subjects 65 to 85 years of age who participated in the baseline phase of the Three-City Study in the Dijon center. METHODS: The study population comprised 2572 noninstitutionalized individuals. Carotid plaques and common carotid artery intima-media thickness (...

  16. Internal carotid artery dissection following chiropractic treatment in a pregnant woman with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Morton Adam

    2012-12-01

    Full Text Available Abstract A case of internal carotid artery dissection in a pregnant woman with Systemic Lupus Erythematosus (SLE immediately following chiropractic treatment is presented. The literature regarding complications of neck manipulation during pregnancy, spontaneous dissection of craniocervical arteries in pregnancy and the postpartum period, and dissection of craniocervical arteries in SLE are reviewed. To the best of the author’s knowledge, this is the first case of carotid artery dissection following chiropractic treatment in a pregnant woman published in the literature.

  17. Giant mycotic aneurysm of the internal carotid artery in a child: endovascular treatment

    International Nuclear Information System (INIS)

    We present a case of a giant mycotic aneurysm of the left internal carotid artery in a child, the result of direct extension of a deep neck space infection. This lesion is life threatening and may put the patient at risk of unwarranted biopsy or drainage if not recognized. Diagnosis and treatment planning rely heavily on cross-sectional imaging, and angiography is frequently necessary. This case is unique for two reasons: (1) we present for the first time the MRI findings and (2) we describe an alternative to surgical ligation -- neurointerventional embolotherapy. Minimally invasive transcatheter embolization was successfully performed on our patient to occlude the abnormal left internal carotid artery segment. (orig.)

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

    International Nuclear Information System (INIS)

    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.)

  19. Differences in carotid arterial morphology and composition between individuals with and without obstructive coronary artery disease: A cardiovascular magnetic resonance study

    Directory of Open Access Journals (Sweden)

    Takaya Norihide

    2008-06-01

    Full Text Available Abstract Objective We sought to determine differences with cardiovascular magnetic resonance (CMR in the morphology and composition of the carotid arteries between individuals with angiographically-defined obstructive coronary artery disease (CAD, ≥ 50% stenosis, cases and those with angiographically normal coronaries (no lumen irregularities, controls. Methods and results 191 participants (50.3% female; 50.8% CAD cases were imaged with a multi-sequence, carotid CMR protocol at 1.5T. For each segment of the carotid, lumen area, wall area, total vessel area (lumen area + wall area, mean wall thickness and the presence or absence of calcification and lipid-rich necrotic core were recorded bilaterally. In male CAD cases compared to male controls, the distal bulb had a significantly smaller lumen area (60.0 ± 3.1 vs. 79.7 ± 3.2 mm2, p 2; p 2; p = 0.006 and smaller total vessel area (64.0 ± 2.3 vs. 70.9 ± 2.4 mm2; p = 0.04. These metrics were not significantly different between female groups in the distal bulb and internal carotid or for either gender in the common carotid. Male CAD cases had an increased prevalence of lipid-rich necrotic core (49.0% vs. 19.6%; p = 0.003, while calcification was more prevalent in both male (46.9% vs. 17.4%; p = 0.002 and female (33.3% vs. 14.6%; p = 0.031 CAD cases compared to controls. Conclusion Males with obstructive CAD compared to male controls had carotid bulbs and internal carotid arteries with smaller total vessel and lumen areas, and an increased prevalence of lipid-rich necrotic core. Carotid calcification was related to CAD status in both males and females. Carotid CMR identifies distinct morphological and compositional differences in the carotid arteries between individuals with and without angiographically-defined obstructive CAD.

  20. Septic Bleeding of the Common Carotid Artery Following Total Thyroidectomy: An Atypical Complication

    Directory of Open Access Journals (Sweden)

    T. Jamaan

    2010-01-01

    Full Text Available Septic rupture of the common carotid artery following total thyroidectomy may rapidly lead to exsanguination. We present a case report of a 16-year-old girl, diagnosed with a questionable thyroglossal duct cyst. Following the initial operative intervention with local excision of the cyst including resection of the medial part of the hyoid bone, pathology revealed papillary carcinoma. Thus secondary total thyroidectomy with locoregional lymphadenectomy was performed. One week later, a wound infection developed, necessitating lavage and drainage. On the 8th postoperative day, a dramatic bleeding of the right common carotid artery occurred. To our knowledge, this is the first reported case in the literature with a septic bleeding of the common carotid artery following total thyroidectomy after one week.

  1. A STUDY OF MORPHOLOGY, MORPHOMETRY, SYMMETRY AND DEVELOPMENT OF EXTERNAL OPENING OF CAROTID CANAL WITH COMPARISON IN MALE, FEMALE AND FOETUS

    Directory of Open Access Journals (Sweden)

    Vaseemraja G. Shaikh

    2014-12-01

    Full Text Available Introduction: The Carotid Canal is an important structure at the base of skull as it conveys the internal carotid artery, along with a sympathetic nerve plexus and a venous plexus. Previous researches done on carotid canal suggest that abnormalities to this canal, such as fractures of carotid canal and carotid sympathetic plexus schwannoma have their effect on the internal carotid artery and the structures passing through it. Cases of absence of carotid canal have also been reported, which causes variations of the internal carotid artery. Attempt has been made in this study to give a detailed view of the ‘external opening of carotid canal’ (EOCC which is the gateway of the carotid canal at the skull base. This study shall be useful for Surgeons, Radiologists, Anatomists, Forensic Experts, Anthropologists, etc. Aim: This study aims at measuring the various dimensions of the external openings of the carotid canal pair present at the base of skull, and to observe the age changes, sexual dimorphism, and symmetry of the external opening of the carotid canal from the analysis of these measurements. Materials and methods: Total 235 dry skulls that included 181 adolescent to adult skulls of known age and sex (age ranging from 13 years up to old age skulls of 60 years or above and 54 foetal skulls were studied for this purpose. The longest & shortest diameter of each carotid canal, was measured using a screw adjusted compass and a Vernier Calliper. Their distance from pharyngeal tubercle and from the X axis and Y axis was measured. Observations and Results: In the present study, it was observed that external opening of each carotid canal was unique in its morphology and morphometry. The dimensions of external opening of carotid canal progressively increased from foetal age to 25 years of age, however after 25 years of age, it did not show any age change within same sex, but it showed age changes when adolescent female skulls of age less than 25 years

  2. Persistent trigeminal artery arising from the arterial ring/fenestration of the cavernous segment of the internal carotid artery.

    Science.gov (United States)

    Uchino, Akira; Saito, Naoko; Kurita, Hiroki; Ishihara, Shoichiro

    2012-09-01

    A persistent trigeminal artery (PTA) is the most common carotid-vertebrobasilar anastomosis, usually arising from the cavernous or precavernous segment of the internal carotid artery (ICA) and connecting to the distal basilar artery. There are two types of PTA, lateral and medial. We present the first case of a lateral-type PTA arising from the large arterial ring/fenestration of the cavernous segment of the left ICA with findings from both magnetic resonance angiography and selective catheter angiography. PMID:22215430

  3. Obesity and carotid artery remodeling

    DEFF Research Database (Denmark)

    Kozakova, M; Palombo, C; Morizzo, C;

    2015-01-01

    BACKGROUND/OBJECTIVE: The present study tested the hypothesis that obesity-related changes in carotid intima-media thickness (IMT) might represent not only preclinical atherosclerosis but an adaptive remodeling meant to preserve circumferential wall stress (CWS) in altered hemodynamic conditions...... and CCA LD (266 healthy subjects with wide range of body weight (24-159 kg)); (B) longitudinal associations between CCA LD and 3-year IMT progression rate (ΔIMT; 571 healthy non-obese subjects without increased cardiovascular (CV) risk); (C) the impact of obesity on CCA geometry and CWS (88 obese...... subjects without CV complications and 88 non-obese subjects matched for gender and age). RESULTS: CCA LD was independently associated with SV that was determined by body size. In the longitudinal study, baseline LD was an independent determinant of ΔIMT, and ΔIMT of subjects in the highest LD quartile was...

  4. Evaluation of Carotid Plaque Using Ultrasound Imaging

    Science.gov (United States)

    2016-01-01

    Traditional risk factors for predicting of cardiovascular disease are not always effective predictors for development of cardiovascular events. This review summarizes several newly developed noninvasive imaging techniques for evaluating carotid plaques and their role in cardiovascular disease risk.

  5. Ophthalmic masquerades of the atherosclerotic carotids

    Directory of Open Access Journals (Sweden)

    Anupriya Arthur

    2014-01-01

    Full Text Available Patients with carotid atherosclerosis can present with ophthalmic symptoms. These symptoms and signs can be due to retinal emboli, hypoperfusion of the retina and choroid, opening up of collateral channels, or chronic hypoperfusion of the globe (ocular ischemic syndrome. These pathological mechanisms can produce many interesting signs and a careful history can bring out important past symptoms pointing toward the carotid as the source of the patient′s presenting symptom. Such patients are at high risk for an ischemic stroke, especially in the subsequent few days following their first acute symptom. It is important for clinicians to be familiar with these ophthalmic symptoms and signs caused by carotid atherosclerosis for making an early diagnosis and to take appropriate measures to prevent a stroke. This review elaborates the clinical features, importance, and implications of various ophthalmic symptoms and signs resulting from atherosclerotic carotid artery disease.

  6. Determination of site-specific carotid-intima media thickness: common –carotid artery and carotid bifurcation in hypercholesterolemia patients

    OpenAIRE

    Perwaiz Khan, Samia; Gul, Pashmina; Khemani, Saleem; Yaqub, Zia

    2013-01-01

    Objective: To determine site specific carotid intima-media thickness: common–carotid artery and carotid bifurcation in hypercholesterolemia patients as a marker for atherosclerosis. Methods: Fifty patients with hypercholesterolemia and twenty controls were selected after getting informed consent regarding the investigation of carotid- intima media thickness by B-mode ultrasound. All the patients of hypercholesterolemia with LDL-C > 160mg/dL had family history of coronary artery diseases. This...

  7. Carotid artery disease : plaque features and vulnerability

    OpenAIRE

    Jashari, Fisnik

    2015-01-01

    Background: Atherosclerosis is an important cause of stroke. Ultrasound offers the convenience of real-time and detailed assessment of carotid plaque features as well as arterial wall thickening and composition. Evaluation of these features is important for determining patients’ risk of suffering vascular events and also contributes to selecting the best treatment strategy. Methods: Using ultrasound data analysis we have determined plaque features in the bifurcation and internal carotid arter...

  8. Shape optimization of the carotid artery bifurcation

    OpenAIRE

    Bressloff, N. W.; Forrester, A.I.J.; Banks, J.; Bhaskar, K.V.

    2004-01-01

    A parametric CAD model of the human carotid artery bifurcation is employed in an initial exploration of the response of shear stress to the variation of the angle of the internal carotid artery and the width of the sinus bulb. Design of experiment and response surface technologies are harnessed for the first time in such an application with the aim of developing a better understanding of the relationship between geometry (anatomy) and sites of arterial disease.

  9. Cardiovascular magnetic resonance in carotid atherosclerotic disease

    OpenAIRE

    Chen Huijun; Wang Jinnan; Li Rui; Ferguson Marina S; Kerwin William S; Dong Li; Canton Gador; Hatsukami Thomas S; Yuan Chun

    2009-01-01

    Abstract Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR) of the carotid vessel wall is one promi...

  10. Association of carotid plaque Lp-PLA(2 with macrophages and Chlamydia pneumoniae infection among patients at risk for stroke.

    Directory of Open Access Journals (Sweden)

    Berna Atik

    Full Text Available BACKGROUND: We previously showed that the burden of Chlamydia pneumoniae in carotid plaques was significantly associated with plaque interleukin (IL-6, and serum IL-6 and C-reactive protein (CRP, suggesting that infected plaques contribute to systemic inflammatory markers in patients with stroke risk. Since lipoprotein-associated phospholipase A2 (Lp-PLA(2 mediates inflammation in atherosclerosis, we hypothesized that serum Lp-PLA(2 mass and activity levels and plaque Lp-PLA(2 may be influenced by plaque C. pneumoniae infection. METHODOLOGY/PRINCIPAL FINDINGS: Forty-two patients underwent elective carotid endarterectomy. Tissue obtained at surgery was stained by immunohistochemistry for Lp-PLA(2 grade, macrophages, IL-6, C. pneumoniae and CD4+ and CD8+ cells. Serum Lp-PLA(2 activity and mass were measured using the colorimetric activity method (CAM and ELISA, respectively. Serum homocysteine levels were measured by HPLC. Eleven (26.2% patients were symptomatic with transient ischemic attacks. There was no correlation between patient risk factors (smoking, coronary artery disease, elevated cholesterol, diabetes, obesity, hypertension and family history of genetic disorders for atherosclerosis and serum levels or plaque grade for Lp-PLA(2. Plaque Lp-PLA(2 correlated with serum homocysteine levels (p = 0.013, plaque macrophages (p<0.01, and plaque C. pneumoniae (p<0.001, which predominantly infected macrophages, co-localizing with Lp-PLA(2. CONCLUSIONS: The significant association of plaque Lp-PLA(2 with plaque macrophages and C. pneumoniae suggests an interactive role in accelerating inflammation in atherosclerosis. A possible mechanism for C. pneumoniae in the atherogenic process may involve infection of macrophages that induce Lp-PLA(2 production leading to upregulation of inflammatory mediators in plaque tissue. Additional in vitro and in vivo research will be needed to advance our understanding of specific C. pneumoniae and Lp-PLA(2

  11. Analysis of the population at high risk of stroke detected with carotid artery ultrasonography in Tianjin urban communities

    Directory of Open Access Journals (Sweden)

    Wei YUE

    2015-04-01

    Full Text Available Objective To investigate the features of carotid atherosclerosis in a population at high risk of stroke in urban communities of Tianjin, so as to provide inspiration for carotid ultrasonography to play a greater role in the prevention and control of stroke.  Methods A total of 956 residents at high risk of stroke were selected from 4 urban communities in Tianjin using cluster random sampling method. Doppler ultrasound screening was performed in bilateral common carotid artery (CCA, internal carotid artery (ICA, external carotid artery (ECA, vertebral artery (VA, subclavian artery (SCA and innominate artery of the population. The intima-media thickness (IMT, atherosclerotic plaque formation and its location and size, vascular stenosis or occlusion, and flow spectrum were detected. The results and features of carotid ultrasound screening were analyzed and compared among different gender and age groups.  Results 1 The detection rate of carotid atherosclerosis was 71.55% (684/956, and the detection rate in males was significantly higher than that in females (79.08% vs 65.87%; χ2 = 20.067, P = 0.000. 2 Among the population with carotid atherosclerosis, the most common manifestation was the formation of atherosclerotic plaques (81.58%, 558/684, secondly intima-media thickening (13.01%, 89/684, followed by moderate to severe stenosis or occlusion (5.41%, 37/684. The proportion of intima-media thickening in males was lower than that in females (7.08% vs 18.38%; χ2 = 19.269, P = 0.000. The proportion of carotid atherosclerotic plaque formation in males was higher than that in females (86.46% vs 77.16%; χ2 = 9.824, P = 0.002. The median rating of carotid atherosclerosis was 1.79, with males higher than females [1.98 (0.70, 3.26 vs 1.52 (0.20, 2.84; Z = 2.304, P = 0.042]. The site of plaque formation was most commonly located in carotid bulb (36.61%, secondly SCA (22.18%. Of the type of carotid stenosis, ICA stenosis was detected in 30 cases, VA

  12. Ten years experience of carotid stenting

    International Nuclear Information System (INIS)

    Full text: Introduction: A retrospective analysis of our experience with stenting of total and subtotal carotid occlusions, including 18 months follow-up of 51 cases of patients for the period 2006-2010, showing the possibilities of endovascular treatment of this condition. Materials and Methods: Patients were selected according to two criteria - anatomic and clinical. Totally occlusions were 5 (9.8%), the criteria for inclusion in the group are: interruption of the lumen of the ICA, TIMI 0 distal occlusion and collateral filling of established intracranial area of the ipsilateral ICA. Subtotal occlusions were 46 (90.2%). The criteria for this group are: delayed filling of contrast in ICA ipsilateral compared with ECA, a reduced diameter of the ICA as compared to the contralateral ICA and of reduced diameter compared to the ICA in the ipsilateral ECA. Results: In all patients observed preprocedure progression of neurological deficit and ischemic episodes. In 31 patients (60.7%) has a preceding ipsilateral stroke and at 20 (39,3%) - TIA. In 14 patients (28%) were observed contralateral ICA stenosis over 50%. Post-procedure in 50 patients (98%) have achieved successful recanalization, as in 49 of them the distal protection is placed. In one case, the tortuosity of the distal area didn't allow placement of the EPD. Following the procedure in 48 (94 %) of patients developed residual stenosis of less than 20 %. In two of these cases the stenosis was 50-60 % due substantial calcification of artery. In 48 (94%) was recovered TIMI- 3 flow, and in 47 (92 %) to restore the circulation of the ipsilateral hemisphere. One patient was observed complication of ICA ( dissection without clinical significance)

  13. In vivo and in vitro evidence that {sup 99m}Tc-HYNIC-interleukin-2 is able to detect T lymphocytes in vulnerable atherosclerotic plaques of the carotid artery

    Energy Technology Data Exchange (ETDEWEB)

    Glaudemans, Andor W.J.M.; Vries, Erik F.J. de; Koole, Michel; Luurtsema, Gert; Slart, Riemer H.J.A. [University Medical Center Groningen (Netherlands). Dept. of Nuclear Medicine and Molecular Imaging; Bonanno, Elena [Univ. of Rome Tor Vergata (Italy). Dept. of Anatomic Pathology; Galli, Filippo [Sapienza Univ, Rome (Italy). Nuclear Medicine Unit; Zeebregts, Clark J. [University Medical Center Groningen (Netherlands). Surgery (Div. Vascular Surgery); Boersma, Hendrikus H. [University Medical Center Groningen (Netherlands). Dept. of Nuclear Medicine and Molecular Imaging; University Medical Center Groningen (Netherlands). Clinical and Hospital Pharmacy; Taurino, Maurizio [Sapienza Univ., Rome (Italy). Vascular Surgery Unit; Signore, Alberto [University Medical Center Groningen (Netherlands). Dept. of Nuclear Medicine and Molecular Imaging; Sapienza Univ, Rome (Italy). Nuclear Medicine Unit

    2014-09-15

    Recent advances in basic science have established that inflammation plays a pivotal role in the pathogenesis of atherosclerosis. Inflammatory cells are thought to be responsible for the transformation of a stable plaque into a vulnerable one. Lymphocytes constitute at least 20 % of infiltrating cells in these vulnerable plaques. Therefore, the interleukin-2 (IL-2) receptor, being overexpressed on activated T lymphocytes, may represent an attractive biomarker for plaque vulnerability. The aim of this study was to evaluate the specificity of radiolabelled IL-2 [{sup 99m}Tc-hydrazinonicotinamide (HYNIC)-IL-2] for imaging the lymphocytic infiltration in carotid plaques in vivo by planar and single photon emission computed tomography (SPECT)/CT imaging and ex vivo by microSPECT and autoradiography. For the in vivo study, ten symptomatic patients with advanced plaques at ultrasound who were scheduled for carotid endarterectomy underwent {sup 99m}Tc-HYNIC-IL-2 scintigraphy. The images were analysed visually on planar and SPECT images and semi-quantitatively on SPECT images by calculating target to background (T/B) ratios. After endarterectomy, immunomorphological evaluation and immunophenotyping were performed on plaque slices. For the ex vivo studies, four additional patients were included and, after in vitro incubation of removed plaques with {sup 99m}Tc-HYNIC-IL-2, autoradiography was performed and microSPECT images were acquired. Visual analysis defined clear {sup 99m}Tc-HYNIC-IL-2 uptake in seven of the ten symptomatic plaques. SPECT/CT allowed visualization in eight of ten. A significant correlation was found between the number of CD25+ lymphocytes and the total number of CD25+ cells in the plaque and the T/B ratio with adjacent carotid artery as background (Pearson's r = 0.89, p = 0.003 and r = 0.87, p = 0.005, respectively). MicroSPECT imaging showed clear {sup 99m}Tc-HYNIC-IL-2 uptake within the plaque wall and not in the lipidic core. With autoradiography

  14. Carotid artery blowout producing massive hematemesis in the emergency department

    Institute of Scientific and Technical Information of China (English)

    Harrison K Borno; Richard J Menendez; John C Chaloupka; Michael T Dalley; David A Farcy

    2016-01-01

    Carotid blowout syndrome (CBS) is a rare and fatal complication which arises from patients who have been treated for head and neck cancer. The incidence of CBS is rare and not commonly seen by emergency physicians. We review a case of a 68-year-old woman with a history of laryngectomy and chemo-radiation therapy presenting with massive oral bleeding and hypotension. Her course and treatments are highlighted, literature referring to CBS are described and we reintroduce the approach of managing such a patient in the emergency department.

  15. Delayed cerebral infarction due to stent folding deformation following carotid artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Kwon Duk; Lee, Kyung Yul; Suh, Sang Hyun [Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.

  16. Quantitative assessment of blood flow reserve using 99mTc-HMPAO in carotid stenosis

    International Nuclear Information System (INIS)

    Dynamic imaging of the inflow of technetium-99m hexamethylpropylene amine oxime (HMPAO) to the brain has been proved to allow estimation of the hemispherical cerebral blood flow (CBF) using the Patlak plot. In this study, we compared the hemispherical CBF (in ml/min/100 g) of different patient groups. A total of 25 patients (comprising 13 with migraine and 12 scheduled for endarterectomy owing to angiographically confirmed severe stenosis of the internal carotid artery on at least one side) underwent baseline and acetazolamide 99mTc-HMPAO brain perfusion studies. In addition, acetazolamide 99mTc-HMPAO studies were performed in 12 healthy subjects (no baseline study was performed for ethical reasons.) Dynamic studies were acquired by means of a dual-detector gamma camera with a large field of view (HELIX, Elscint). Special difference images were created to make definition of the aortic arch and hemispherical brain regions easier and more reproducible. A semi-automatic method was developed to determine the transit time from the aorta to the brain, making the generation of the Patlak plot even more robust. The baseline CBF values did not significantly depend on the disease (P>0.1), whereas the CBF values obtained after acetazolamide provocation did do so (ANOVA, P0.1). In summary, using quantitative analysis of 99mTc-HMPAO brain studies we could objectively compare the CBF of patients suffering from different diseases. Especially the CBF values obtained after acetazolamide provocation permitted effective differentiation of disease states. The quantitative results may be of assistance in therapy planning, e.g. in selection of the correct operative technique. (orig.)

  17. Krypton-81m single photon emission tomography and the collateral circulation in carotid occlusion

    International Nuclear Information System (INIS)

    Cerebral perfusion images were investigated in patients with carotid artery occlusion, using single photon emission computed tomography with the infusion of krypton-81m into the internal, common carotid and vertebral arteries. The contribution of the circle of Willis and cerebral cortical anastomoses to the maintenance of adequate blood supply into the involved hemisphere was analysed. It was concluded that the cerebral perfusion image is superior to angiography in evaluating collateral circulation, and in the case of carotid occlusion, the circle of Willis is important in preventing infarction in the territory of the perforating arteries, while the cerebral cortex mainly receives its blood supply through the cortical leptomeningeal anastomoses, illustrating the major role of the leptomeningeal anastomosis as a collateral channel. (orig.)

  18. Left common carotid artery arising from brachiocephalic trunk and their aberrant course displacing trachea

    Directory of Open Access Journals (Sweden)

    Pratiksha Yadav

    2016-09-01

    Full Text Available Bovine arch commonly refer a group of congenital variations in the branches of arch of aorta, in which there is aberrant origin of left common carotid artery. These are usually detected incidentally, however rarely they can cause dysphagia lusoria. We report a case of bovine arch and aberrant left common carotid artery in a 62 years old female who had come with complaint of mild dyspnea. On radiograph there was superior mediastinal widening and shift of trachea to right side. CT scan was advised for further evaluation. On CECT there was only two main branches arised from arch of aorta, brachiocephalic trunk and right subclavian artery. There was aberrant origin of left common carotid artery seen from brachiocephalic trunk. The brachiocephalic trunk was very tortuous and displacing trachea to right side. [Int J Res Med Sci 2016; 4(9.000: 4220-4222

  19. Endovascular self-expandable stent placement of complicated extracranial carotid stenosis with high surgical risk

    International Nuclear Information System (INIS)

    Objective: To study the safety and efficacy of endovascular therapy in the treatment of complicated extracranial carotid stenosis in patients with high surgical risk. Methods: Seven patients with high surgical risk of complicated extracranial carotid stenosis received endovascular stenting. Results: The stents were accurately implanted ,and total disappearance of stenosis was obtained in 4 patients and the degree of stenosis reduced more than 90% in other 3 patients. The clinical symptoms were improved significantly or disappeared after the procedure without any complications. Follow-up from 3 to 23 months, no restenosis and ischemic symptoms were noted in all cases. Conclusions: Endovascular stenting is a safe and valid method of choice for the treatment of complicated extracranial carotid stenosis in high surgical risk patients. (authors)

  20. Carotid artery disease in cerebrovasculas asymptomatic volunteerscorrelations with risk factors, CBF and CT findings

    International Nuclear Information System (INIS)

    In an effort to determine the prevalence of carotid artery disease in cerebrovascular asymptomatic volunteers, 125 randomly chosen active and retired employees of the state of Styria, Austria (82 men, 43 women, age 24 - 75, mean 49.6 +/- 10.5 years) were examined. High resolution Duplex-scanning reveales minimal to mild atherosclerotic plaques (<50% diameter stenosis), predominantly in the carotid bifurcation in 37/125 cases (29.6%). When controlling for age and sex, the incidences of hypertension, diabeter mallitus, cardiac disorders, peripheral vascular disease, cigarette smoking and elevated serum cholesterol were not significally different in the sonographycally affected and not affected group. Besides age (p=0.0002) to be significant predictors of the presence of asymptomatic atherosclerotic carotid artery disease. (author). 7 refs.; 2 tabs

  1. Ultrasonic Measurement of Carotid Intima–Media Thickness in a Group of Iranian with No Cardiovascular Risk Factors

    Directory of Open Access Journals (Sweden)

    M. Pourafkari

    2006-06-01

    Full Text Available Background/Objective: To obtaining reference values for intima–media thickness (IMT of the carotid arteries in the Iranian subjects without any known atherosclerosis risk factors. Patients and Methods: A total of 400 subjects (146 male and 254 female, mean age 36.3±14 years in men and 35.9±12 years in women, with normal body mass index and no history or evidence of cardiovascular or peripheral vascular disease, hypertension, diabetes, thyroid diseases or smoking were examined. IMT was measured on a longitudinal ultrasound image of the carotid artery. Mean thickness was evaluated for the right common carotid (RCCA, right internal carotid (RICA, left common carotid (LCCA and left internal carotid (LICA. Results: The mean value of carotid IMT was 0.38±0.11 in women and 0.41±0.13 in men. For different age groups, the lowest mean thickness was 0.305±0.045, seen in the RCCA among 20–29-year-old cases, and the highest was 0.645±0.125, seen in the LICA of cases over 60. The mean thickness was higher in men than in women, in all four locations (all p values< 0.02 Linear regression models for prediction of IMT by age, were separately done in different groups of anatomical location and gender, and all models’ R2 were higher than 0.5. Conclusion: Mean IMT in RCCA, RICA, LCCA and LICA in both genders and different age dec-ades was lower than many reports, which may be due to ethnic factors or different inclusion criteria. Reference values of carotid IMT increase significantly with age and IMT is higher in men than in women.

  2. Radiation-induced carotid artery atherosclerosis

    International Nuclear Information System (INIS)

    Purpose: Carotid arteries frequently receive significant doses of radiation as collateral structures in the treatment of malignant diseases. Vascular injury following treatment may result in carotid artery stenosis (CAS) and increased risk of stroke and transient ischaemic attack (TIA). This systematic review examines the effect of radiotherapy (RT) on the carotid arteries, looking at the incidence of stroke in patients receiving neck radiotherapy. In addition, we consider possible surrogate endpoints such as CAS and carotid intima-medial thickness (CIMT) and summarise the evidence for radiation-induced carotid atherosclerosis. Materials and methods: From 853 references, 34 articles met the criteria for inclusion in this systematic review. These papers described 9 studies investigating the incidence of stroke/TIA in irradiated patients, 11 looking at CAS, and 14 examining CIMT. Results: The majority of studies utilised suboptimally-matched controls for each endpoint. The relative risk of stroke in irradiated patients ranged from 1.12 in patients with breast cancer to 5.6 in patients treated for head and neck cancer. The prevalence of CAS was increased by 16–55%, with the more modest increase seen in a study using matched controls. CIMT was increased in irradiated carotid arteries by 18–40%. Only two matched-control studies demonstrated a significant increase in CIMT of 36% and 22% (p = 0.003 and <0.001, respectively). Early prospective data demonstrated a significant increase in CIMT in irradiated arteries at 1 and 2 years after RT (p < 0.001 and <0.01, respectively). Conclusions: The incidence of stroke was significantly increased in patients receiving RT to the neck. There was a consistent difference in CAS and CIMT between irradiated and unirradiated carotid arteries. Future studies should optimise control groups

  3. Pseudoaneurysm of the cervical internal carotid artery with associated hypoglossal nerve paralysis

    International Nuclear Information System (INIS)

    A case of pseudoaneurysm of the cervical internal carotid artery with associated hypoglossal nerve paralysis resulting from trauma is presented. CT and angiographic manifestations of this pseudoaneurysm and the resulting hypoglossal nerve paralysis are discussed. Correlative CT and angiographic findings of this association have not previously been described in the literature. (orig.)

  4. Recurrent epistaxis occurred shortly after superselective embolization of external carotid artery: its causes and prevention strategy

    International Nuclear Information System (INIS)

    Objective: To discuss the causes of recurrent epistaxis occurred shortly after superselective embolization of external carotid artery and to make some suggestions related to the prevention strategy. Methods: superselective embolization of external carotid artery was carried out in 62 patients with severe epistaxis. Recurrence occurred in 9 cases within one week and in 7 cases within two weeks after the treatment. And the selective angiography together with the embolization therapy was performed again. The initial angiograms and the detailed embolization procedures were carefully reviewed and the possible causes of epistaxis recurrence were analyzed. Results: In 10 patients the recurrent epistaxis was caused by recanalization of the branches of external carotid artery. The lesions were fed by multiple branches of external carotid artery, but in 4 cases some of them were missed to be occluded in initial embolization procedure, resulting in recurrent epistaxis. In another two cases the recurrent epistaxis was caused by the establishment of collateral blood supply to the lesions. Conclusion: Careful observation of angiograms to find out all feeding arteries to the lesion and complete embolization of all feeding arteries with un-absorbable embolic agents can avoid the recurrence of epistaxis. (authors)

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

    International Nuclear Information System (INIS)

    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.)

  6. Percutaneous embolization of arteriovenous fistulas of the external carotid and vertebral arteries

    International Nuclear Information System (INIS)

    The angiographic study of eight patients with nine arteriovenous fistulas (AVF) in the cervico-cranial area, seven in branches of the external carotid artery and two in the extracranial vertebral artery, is presented. The therapeutical strategy for these lesions is discussed, especially regarding the embolic agent to be used in each case. (M.A.C.)

  7. Analysis of IGF-1, Lp-PLA2, hs-CRP, Hcy levels in type 2 diabetes patients complicated with carotid atherosclerosis

    Institute of Scientific and Technical Information of China (English)

    Guan-Lun Ye; Zhuo-Zhang Luo; Wei-Ming Zheng

    2015-01-01

    Objective: To study the levels of IGF-1, Lp-PLA2, hs-CRP, Hcy in type 2 diabetes patients complicated with carotid atherosclerosis. Methods: 90 cases of type 2 diabetes patients complicated with carotid atherosclerosis in our hospital from May 2013 to August 2014 were enrolled in observation group and further divided into mild stenosis group, moderate stenosis group, severe stenosis group according to the judgment of color ultrasonography on carotid artery carotid artery stenosis, divided into mild sclerosis group, moderate sclerosis group, severe sclerosis group according to carotid artery plaque score. At the same time type 2 diabetic patients without complications in our hospital were enrolled in the control group. Then serums IGF-1, Lp-PLA2, hs-CRP, Hcy levels were assayed. Results: serum IGF-1, Lp-PLA2, hs-CRP, Hcy levels of observation group were higher than those of control group; as carotid artery stenosis and sclerosis degree got greater, serum IGF-1, Lp-PLA2, hs-CRP, Hcy levels were higher. Conclusion:serum IGF-1, Lp-PLA2, hs-CRP, Hcy levels in type 2 diabetes patients complicated with carotid atherosclerosis abnormally increased and it can reflect the degree of carotid stenosis and sclerosis.

  8. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... anatomy as well as their medical comorbidities, including coronary artery disease, pulmonary dysfunction, and renal dysfunction. We looked at ... endarterectomy high-risk are those patients with significant coronary artery disease. Again, many times general anesthesia is required, though ...

  9. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... with its appropriate branches, the bifurcation of the internal carotid there, and then the -- moving rightward on ... area of the proximal portion of the left internal carotid artery. The distal vessel is straight and ...

  10. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... There are different ways of collateralizing the carotid circuit, both extracranial -- that is, from the external carotid artery -- to the intracranial circuit, or intracranial to intracranial, which our next slide ...

  11. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available INNOVATIONS IN STROKE PREVENTION: AN UPDATE ON CAROTID STENTING NEW YORK-PRESBYTERIAN HOSPITAL NEW YORK, NY July ... MD: Good evening. Welcome to our webcast on innovations in stroke prevention: an update on carotid stenting. ...

  12. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... important thing also is that with the current role of using carotid stent angioplasty, we can get ... study results are pending, which will determine the role of carotid stenting in the healthier patients, the ...

  13. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... could be a loss of speech or the ability to name objects, especially the -- in the left ... an external carotid artery does not negate your ability to do carotid stent angioplasty. 00:37:59 ...

  14. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... a minimally invasive approach in which we will access from the groin and treat the carotid artery ... carotid stent angioplasty is multifactorial. First is the access is generally done, performed, from a groin access, ...

  15. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... catheter into the subclavian artery, just doing an x-ray, visualizing the one vertebral artery, the left one, ... a carotid occlusion and a neurosurgeon constructed a bypass from the external carotid artery and typically the ...

  16. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Science.gov (United States)

    ... catheter into the subclavian artery, just doing an x-ray, visualizing the one vertebral artery, the left one, ... a carotid occlusion and a neurosurgeon constructed a bypass from the external carotid artery and typically the ...

  17. Innovations in Stroke Prevention: An Update on Carotid Stenting

    Medline Plus

    Full Text Available ... receives about $450 million in annual NIH research funding. Its faculty of about 5,000 physicians provides ... carotid circuit, both extracranial -- that is, from the external carotid artery -- to the intracranial circuit, or intracranial ...

  18. Three-dimensional carotid ultrasound plaque texture predicts vascular events

    DEFF Research Database (Denmark)

    van Engelen, Arna; Wannarong, Thapat; Parraga, Grace;

    2014-01-01

    BACKGROUND AND PURPOSE: Carotid ultrasound atherosclerosis measurements, including those of the arterial wall and plaque, provide a way to monitor patients at risk of vascular events. Our objective was to examine carotid ultrasound plaque texture measurements and the change in carotid plaque...

  19. Differences in carotid arterial morphology and composition between individuals with and without obstructive coronary artery disease: A cardiovascular magnetic resonance study

    OpenAIRE

    Takaya Norihide; Oikawa Minako; Yu Wei; Chu Baocheng; Saam Tobias; Hatsukami Thomas S; Espeland Mark A; Chen Haiying; Terry James G; Yuan Chun; Underhill Hunter R; Yarnykh Vasily L; Kraft Robert; Carr J Jeffrey; Maldjian Joseph

    2008-01-01

    Abstract Objective We sought to determine differences with cardiovascular magnetic resonance (CMR) in the morphology and composition of the carotid arteries between individuals with angiographically-defined obstructive coronary artery disease (CAD, ≥ 50% stenosis, cases) and those with angiographically normal coronaries (no lumen irregularities, controls). Methods and results 191 participants (50.3% female; 50.8% CAD cases) were imaged with a multi-sequence, carotid CMR protocol at 1.5T. For ...

  20. External carotid artery embolization of dural arteriovenous malformations involving the cavernous sinus

    International Nuclear Information System (INIS)

    Nine patients with dural arteriovenous malformations (AVMs) in the region of the cavernous sinus were treated by means of external carotid artery (ECA) embolization using polyvinyl alcohol. All AVMs received vascular supply from both the ECA and the internal carotid artery. Seven cases were clinically cured after embolization, while 2 cases with cortical venous drainage and high flow through the shunt were not completely cured. Venous thrombosis was observed in 5 cases before and in 9 after embolization. In 6 cases the drainage pattern changed owing to venous thrombosis. Complete thrombosis of the cavernous sinus was found on a follow-up angiography in 2 cases. Formation of venous thrombosis and occlusion of feeding arteries are curcial factors for success of ECA embolization. Dural AVMs with cortical venous drainage and high flow cannot be relieved by ECA embolization alone owing to difficulty in obtaining thrombosis of the veins. (orig.)

  1. The relationship between AGT gene polymorphism and carotid ultrasound changes in elderly patients with hypertension and type-2 diabetes mellitus

    International Nuclear Information System (INIS)

    Objective: To observe the relation between angiotensinogen (AGT) gene polymorphism and carotid ultrasound change in the elderly hypertensive patients with type 2 diabetes mellitus (T2DM). Methods: Two hundred and three cases of hospitalization of the elderly were divided into three groups, 105 cases of elderly patients with hypertension; 38 cases of elderly hypertensive patients with T2DM; 60 cases of healthy elderly subjects (the control group) and lipids were measured after admission and carotid ultrasonography were performed. The M235T polymorphism detection was carried out by polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis. Results: (1) TT genotype of AGT gene and elderly hypertensive with T2DM group carotid ultrasound abnormal rate increased and multi vessel disease was the main occurrence. (2) Multiple vessel disease of the carotid artery ultrasound and their blood lipid level were significantly increased. Conclusion: Hypertension and T2DM in elderly patients, carotid artery ultrasound abnormalities are significantly increased, while the elevated lipid levels and the TT genotype of the AGT gene artery atherosclerosis is further enhanced. (authors)

  2. Pulsatility index in carotid arteries is increased in levothyroxine-treated Hashimoto disease.

    Science.gov (United States)

    Owecki, M; Sawicka-Gutaj, N; Owecki, M K; Ambrosius, W; Dorszewska, J; Oczkowska, A; Michalak, M; Fischbach, J; Kozubski, W; Ruchała, M

    2015-07-01

    The aim of this case-control study was to evaluate carotid hemodynamic variables and traditional cardiovascular risk factors in women with Hashimoto thyroiditis (HT). The study group consisted of 31 females with HT on levothyroxine (L-T4) and 26 euthyroid women with HT without L-T4 matched for age and body mass index (BMI) as controls. Carotid intima-media thickness (CIMT), carotid extra-media thickness (CEMT), and pulsatility indexes in common carotid artery (PI CCA) and in internal carotid artery (PI ICA) were measured. BMI, waist circumference, lipid profile, fasting glucose and insulin levels, and parameters of thyroid function [TSH, free thyroxine (FT4) and antithyroperoxidase antibodies (TPOAbs)] were assessed. The study and the control groups did not differ in age, BMI, waist circumference, lipid profile, fasting glucose, and insulin levels. Results are expressed as median (IQR). Treated HT group had higher FT4 levels than nontreated [17.13 (5.11) pmol/l vs. 14.7 (2.27) pmol/l; p=0.0011] and similar TSH [1.64 (2.08) IU/ml vs. 2.07 (3.14) IU/ml; p=0.5915]. PI CCA and PI ICA were higher in the study group than in controls (p=0.0224 and p=0.0477, respectively). The difference remained statistically significant for PI ICA and PI CCA after adjustment for other variables (coefficient=0.09487; standard error=0.04438; p=0.037 and coefficient=0.1786; standard error=0.0870; p=0.0449, respectively). CIMT and CEMT were similar in both groups (p=0.8746 and p=0.0712, respectively). Women with HT on L-T4 replacement therapy have increased PI in common and internal carotid arteries than nontreated euthyroid HT patients. Therefore, it seems that hypothyroidism, but not autoimmune thyroiditis per se, influences arterial stiffness. PMID:25671800

  3. The normal internal carotid artery: a computed tomography angiographic study

    Energy Technology Data Exchange (ETDEWEB)

    Koskinen, Suvi Maaria; Valanne, Leena; Silvennoinen, Heli [Helsinki University Central Hospital and University of Helsinki, Department of Radiology, HUS Medical Imaging Center, Helsinki (Finland); Soinne, Lauri [Helsinki University Central Hospital, Department of Neurology, Helsinki (Finland)

    2014-09-15

    Systematic computed tomography angiographic (CTA) studies investigating variation in internal carotid artery (ICA) luminal diameters (LDs) are scarce. Knowledge of the normal intra-individual LD variability would provide a cut-off value for detection of more subtle collapses. In addition, low intra-individual variability would allow using contralateral LD as a reference for estimation of stenosis degree in cases where ipsilateral measurement is hampered. Therefore, our aim was to investigate intra-individual LD variation of normal ICA. We retrospectively collected multidetector high-speed CTAs of 104 patients younger than 40 years who were considered not to have carotid pathology. We carried out independent measurements of the common carotid artery (CCA) and ICA LDs bilaterally from axial source images by two observers, analysing side-to-side LD differences from averaged double measurements with a paired t test. We discovered no significant side-to-side LD differences. In the female group, the mean differences (mm) with 95 % confidence intervals were 0.08 (0.00, 0.17) for CCA and 0.03 (-0.04, 0.11) for ICA, with ICA LD standard deviation of 0.4 mm. In the male group, these were: 0.06 (-0.04, 0.17), 0.02 (-0.07, 0.11) and 0.4 mm, respectively. We detected no ICA agenesis. The intrinsic intra-individual variation of the LD of normal ICA is minimal. This uniformity may serve as the basis for detection of subtle grades of side-to-side variation caused by pathology. (orig.)

  4. Carotid Body Tumor Imaging:"Paraganglioma, Chemidectoma"

    OpenAIRE

    Jalal Jalalshokouhi

    2010-01-01

    Introduction: Carotid body tumor is a rare benign tumor originating from cells of neural crest tissue. It could present with Horner's syndrome. This tumor is rare and comprises 0.5% of all neoplasms. A familial incidence with autosomal dominant transmission has been reported. "nI have a series of five patients from a known family with one death during surgery because of carotid artery rupturing, others were diagnosed by color Doppler US and dynamic CT scan. Generally, it is sporadic...

  5. Radiation-induced carotid artery disease

    International Nuclear Information System (INIS)

    Nine patients with atherosclerotic carotid artery disease associated with neck radiation were compared to 40 control patients. The data suggest that significant differences in age, incidence of coronary and peripheral vascular disease, elevated lipids and serum cholesterol, and the angiographic incidence of disseminated atherosclerosis justify the description of radiation-induced carotid disease as a clinical entity. Elevated serum cholesterol and hyperlipidemia may contribute to the development of radiation-induced vascular disease. Successful surgical reconstruction does not appear to be influenced by the prior radiotherapy, although periarterial fibrosis and increased difficulty in separating the plaques from the vascular media was encountered

  6. Angioplasty treatment and stent implant vs. surgical treatment in patients with stenosis of the cervical carotid artery

    International Nuclear Information System (INIS)

    Angioplasty with stent implant is a less invasive procedure than surgical intervention in the treatment of significant stenosis of the common cervical carotid artery (common and internal) (5). Currently the major published studies, in which angioplasty and surgical treatment are compared, show similar results in the major events, as cerebrovascular accidents and mortality, but a greater significant difference in the apparition of acute myocardial infarction, during surgical intervention (5,11). The objective of this study is to compare in both treatment methods the major and minor clinical events, like cerebrovascular accident, acute myocardial infarction, death, bradycardia, hypotension and encephalopathy during the intervention, the hospitalization and the follow-up year, as well as the re-intervention, the time of hospital stay and the complications of the surgical incision. Materials and methods: in this study of historical cohort, 46 patients with significant stenosis of the cervical carotid arteries, who were subjected to intervention from January 1st 2001 to December 31st 2003, were included. 21 patients were treated with angioplasty and stent implant and 25 with surgery (endarterectomy) Results: 1 (4.8%) major cerebrovascular accident occurred during angioplasty, whereas none occurred in the patients treated with surgery. 1 (4%) acute myocardial infarction occurred during intervention in the group of patients treated with surgery, and none in the patients treated with angioplasty. No deaths occurred in any of the groups during intervention, hospitalization and the follow-up year. After 8 months 1 (4%) patient treated with surgery was intervened again with angioplasty and stent implant. There were no statistically significant differences between both groups during hospitalization, and in the apparition of minor complications as bradycardia and hypotension. 2 (8%) complications related to the incision of the neck compromising cranial nerves, occurred in the

  7. Arteriosclerosis of carotid arteries in identical twins discordant in tobacco smoking

    International Nuclear Information System (INIS)

    Duplex Doppler US has proved to be an accurate method of evaluating the arteriosclerotic process in extracranial carotid arteries. Tobacco smoking is generally considered to be a factor promoting arteriosclerosis. The authors performed duplex US examinations of the carotid arteries of 48 pairs (96 individuals) of monozygotic twins discordant for smoking. The ages of the examinees ranged from 31 years to 77 years (mean, 52 years). Doppler measurements of femoral and popliteal arteries were also made. A difference in the grade of arteriosclerosis was perceived in 40 pairs of twins, in each case to the benefit of the nonsmoker. The most common change was a difference in intimal thickness. Carotid artery stenoses, 15%-60%, were found in seven cases. In addition, a difference in the size of minor plaques of the carotid bifurcations was verified in 26 pairs of twins. Three smokers were found to have an obstructive lesion in the lower extremity arteries. Arteriosclerotic changes were more common and more pronounced in smokers with a long exposure to tobacco

  8. Stenosis of calcified carotid artery detected on Panoramic Radiography

    Energy Technology Data Exchange (ETDEWEB)

    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.

  9. Stenosis of calcified carotid artery detected on Panoramic Radiography

    International Nuclear Information System (INIS)

    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.

  10. Diagnosis of carotid artery disease by CT scan. Intravenous CT carotid-angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kuriyama, Y.; Sawada, T.; Naito, H.; Karasawa, J. (National Cardiovascular Center, Osaka (Japan))

    1981-09-01

    Non-invasive methods, such as radioisotope angiography, oculoplethsmography, and ultrasonic Doppler flowmetry, are used for the detection of caroid artery lesion. However, these methods are qualitative, and diagnostic accuracies are inferior to arteriography. On the other hand arterography needs catheterization. So we tried to use CT scan and intravenous contrast enhancement for the diagnosis of carotid artery disease. A CT/T scanner (X-2) was used, which enabled to produce computer reconstruction image of the carotid artery by use of the arrange program. 12 sequential axial images of the neck (between heights of C2 and C5) were obtained before and during infusion of contrast material. Analysis of sequential axial images and reformatted images were obtained in patients with cerebrovascular disease. Carotid arteriography were made in 53 arteries, lesions with stenosis and/or occlusion were demonstrated in 26/53 arteries. Intravenous CT carotid-angiography revealed lesions with stenosis and/or occlusion in 25/53 arteries. Results of statistical analysis were as follows; overall diagnostic accuracy 52/53 (98%), diagnostic sensitivity 25/26 (96%) and diagnostic specificity 27/27 (100%), respectively. Moreover, intravenous CT carotid-angiography provided following benefits beyond arteriography. 1) Minimal calcification of the carotid wall and precise localisation of atheromatous plaque could be detected. 2) Patent arterial lumen above the occluded lesion could be found out. 3) CT carotid-angiography would be suitable for the follow-up study after carotid endoarterectomy because of the unneccessity of catheterization. 4) Thrombus formation in the internal jugular vein could be grasped.

  11. Aneurisma gigante do segmento intracavernoso da carótida interna associado a doença renal policística autossômica dominante: relato de caso Giant aneurysm of the intracavernous internal carotid artery associated with autosomal dominant polycystic kidney disease: case report

    Directory of Open Access Journals (Sweden)

    Keven F. Ponte

    2006-09-01

    Full Text Available Apresenta-se o caso de mulher de 60 anos com doença renal policística autossômica dominante (DRPAD que desenvolveu quadro de cefaléia e oftalmoplegia completa à direita. A TC levantou a hipótese de um aneurisma gigante do segmento intracavernoso da carótida interna direita, o que foi confirmado pela arteriografia. Realizou-se, então, tratamento endovascular por oclusão do vaso parental com molas destacáveis no segmento supraclinóideo. A paciente evoluiu com a interrupção da cefaléia e com redução parcial da ptose e da oftalmoplegia. Neste artigo, enfatiza-se a relação entre DRPAD e aneurismas intracranianos. Comenta-se a história natural dos aneurismas originados no segmento intracavernoso da artéria carótida interna e comparam-se as opções terapêuticas no manejo destas lesões.We report the case of a 60 years-old woman with autosomal dominant polycystic kidney disease (ADPKD that presented with headache and right complete ophthalmoplegia. The CT scan raised the possibility of a giant aneurysm of the right intracavernous internal carotid artery, confirmed by angiography. The patient underwent endovascular occlusion of parent vessel with detachable coils, then she presented interruption of headache and partial recovery of ptosis and ophthalmoplegia. We emphasize the relationship between ADPKD and intracranial aneurysms. We also discuss the natural history and compare the therapeutic options for the management of giant aneurysms of the cavernous portion of the carotid artery.

  12. Prospective study of screening for blunt intracranial carotid arterial injuries following basilar skull fractures

    International Nuclear Information System (INIS)

    Blunt intracranial carotid arterial injuries (BCIs) are considered rare, but have the potential for a devastating outcome. Early diagnosis of intracranial vascular injuries is extremely difficult, owing to the preferential use of computed tomographic (CT) scanning on its own as a method for the evaluation of head trauma cases. Patients are commonly referred for angiographies only when their clinical conditions become obvious. To diagnose BCIs at an early stage, we performed cerebral angiographies aggressively when initial head CT scanning revealed basilar skull fractures in the proximity to the carotid artery. From November 2000 to September 2002, 202 patients with blunt head trauma were admitted to the Nakakawachi Medical Center of Acute Medicine, a certified Level I trauma center. We investigated a total of 16 blunt head trauma patients with basilar skull fractures to determine the existence of BCIs. A total of 16 patients were angiographically examined, with 7 patients (44%) being identified as having BCIs. Five patients had unilateral BCIs, while 2 patients were found to have bilateral BCIs. We observed various types of BCIs, including 3 stenotic lesions of stenosis due to dissection, 3 cases of carotid-cavernous fistulas, 3 aneurysmal dilatation lesions and one case of occlusion, which were found at initial angiography. Two patients underwent endovascular surgery. One patient underwent craniotomy (wrapping). Both endovascular surgery and craniotomy (trapping with anastomosis) were performed on one patient. The other 3 patients managed conservatively. After the performance of initial angiographies, neurologically deteriorated patients were not observed. BCI is rare, but lethal, particularly when the diagnosis is delayed, thus aggressive screening is necessary to prevent deterioration. Basilar skull fractures near the carotid artery are the most important risk factor for BCI. When initial head CT scanning reveals basilar skull fracture near the carotid artery in

  13. Treatment of carotid artery aneurysms with covered stents; Aneurysmabehandlung der Arteria carotis interna mit gecoverten Stents

    Energy Technology Data Exchange (ETDEWEB)

    Rohr, A.; Alfke, K.; Doerner, L.; Jansen, O. [UKSH Kiel (Germany). Neurochirurgie Neuroradiologie; Bartsch, T.; Stingele, R. [UKSH Kiel (Germany). Neurologie

    2007-10-15

    Purpose: Evaluation of the use of covered stents in treating pseudoaneurysms of the cervical and intracranial/extradural carotid artery and determination of the periprocedural and short- to mid-term complication rate. Materials and Methods: 8 patients with 9 spontaneous dissecting aneurysms of the cervical carotid artery - 5 of which were symptomatic - plus one patient with ofthalmoplegia due to an aneurysm of the cavernous carotid artery were studied. While the latter was treated with a PTFE-covered balloon-mounted stainless steel stent (Jostent/Graftmaster), a self-expanding PTFE-covered Nitonol Stent (Symbiot) was used in all other cases. Intervention was performed with local anesthesia. Aspirin and Clopidogrel were both used as antiplatelet drugs. Clinical signs and symptoms and vascular imaging with DS, MR, CT angiography and ultrasound were recorded during patient follow-up, with a mean follow-up period of 14.6 months (4 - 30). Results: We were able to treat 8 out of 10 aneurysms (80 %) using covered stents. The aneurysms were immediately occluded and the associated stenoses of the parent vessel were eliminated. No clinically relevant complications occurred during the procedure or in the follow-up interval. In two cases, elongation of the carotid artery prevented the stent from being positioned over the aneurysm neck. These cases were shown to be stable with the use of antiplatelet drugs. Conclusion: Covered stents can be used in the treatment of pseudoaneurysms of the carotid artery as an alternative to long-term antithrombotic medication or surgery. In our study treatment was effective (80 %) and free of complications in the short- and mid-term follow-up. Possible indications, technique and the use of imaging modalities for patient follow-up are discussed. (orig.)

  14. Haemodynamic evaluation of carotid artery disease

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T

    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...

  15. Digital subtraction angiography of carotid bifurcation

    International Nuclear Information System (INIS)

    This study demonstrates the reliability of digital subtraction angiography (DSA) by means of intra- and interobserver investigations as well as indicating the possibility of substituting catheterangiography by DSA in the diagnosis of carotid bifurcation. Whenever insufficient information is obtained from the combination of non-invasive investigation and DSA, a catheterangiogram will be necessary. (Auth.)

  16. Automated carotid artery intima layer regional segmentation

    International Nuclear Information System (INIS)

    Evaluation of the carotid artery wall is essential for the assessment of a patient's cardiovascular risk or for the diagnosis of cardiovascular pathologies. This paper presents a new, completely user-independent algorithm called carotid artery intima layer regional segmentation (CAILRS, a class of AtheroEdge(TM) systems), which automatically segments the intima layer of the far wall of the carotid ultrasound artery based on mean shift classification applied to the far wall. Further, the system extracts the lumen-intima and media-adventitia borders in the far wall of the carotid artery. Our new system is characterized and validated by comparing CAILRS borders with the manual tracings carried out by experts. The new technique is also benchmarked with a semi-automatic technique based on a first-order absolute moment edge operator (FOAM) and compared to our previous edge-based automated methods such as CALEX (Molinari et al 2010 J. Ultrasound Med. 29 399-418, 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CULEX (Delsanto et al 2007 IEEE Trans. Instrum. Meas. 56 1265-74, Molinari et al 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CALSFOAM (Molinari et al Int. Angiol. (at press)), and CAUDLES-EF (Molinari et al J. Digit. Imaging (at press)). Our multi-institutional database consisted of 300 longitudinal B-mode carotid images. In comparison to semi-automated FOAM, CAILRS showed the IMT bias of -0.035 ± 0.186 mm while FOAM showed -0.016 ± 0.258 mm. Our IMT was slightly underestimated with respect to the ground truth IMT, but showed uniform behavior over the entire database. CAILRS outperformed all the four previous automated methods. The system's figure of merit was 95.6%, which was lower than that of the semi-automated method (98%), but higher than that of the other automated techniques.

  17. Intracranial Carotid Calcification on Cranial Computed Tomography

    Science.gov (United States)

    Subedi, Deepak; Zishan, Umme Sara; Chappell, Francesca; Gregoriades, Maria-Lena; Sudlow, Cathie; Sellar, Robin

    2015-01-01

    Background and Purpose— Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke. Methods— We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cranial computed tomographic scans were available electronically. Two raters measured semiautomatic quantitative Agatston score, and calcium volume, and performed qualitative visual scoring using the original 4-point Woodcock score and a modified Woodcock score, where each image on which the internal carotid arteries appeared was scored and the slice scores summed. Results— Intra- and interobserver coefficient of variations were 8.8% and 16.5% for Agatston, 8.8% and 15.5% for calcium volume, and 5.7% and 5.4% for the modified Woodcock visual score, respectively. The modified Woodcock visual score correlated strongly with both Agatston and calcium volume quantitative measures (both R2=0.84; P<0.0001); calcium volume increased by 0.47-mm/point increase in modified Woodcock visual score. Intracranial internal carotid artery calcification increased with age by all measures (eg, visual score, Spearman ρ=0.4; P=0.005). Conclusions— Visual scores correlate highly with quantitative intracranial internal carotid artery calcification measures, with excellent observer agreements. Visual intracranial internal carotid artery scores could be a rapid and practical method for epidemiological studies. PMID:26251250

  18. Automated carotid artery intima layer regional segmentation

    Science.gov (United States)

    Meiburger, Kristen M.; Molinari, Filippo; Rajendra Acharya, U.; Saba, Luca; Rodrigues, Paulo; Liboni, William; Nicolaides, Andrew; Suri, Jasjit S.

    2011-07-01

    Evaluation of the carotid artery wall is essential for the assessment of a patient's cardiovascular risk or for the diagnosis of cardiovascular pathologies. This paper presents a new, completely user-independent algorithm called carotid artery intima layer regional segmentation (CAILRS, a class of AtheroEdge™ systems), which automatically segments the intima layer of the far wall of the carotid ultrasound artery based on mean shift classification applied to the far wall. Further, the system extracts the lumen-intima and media-adventitia borders in the far wall of the carotid artery. Our new system is characterized and validated by comparing CAILRS borders with the manual tracings carried out by experts. The new technique is also benchmarked with a semi-automatic technique based on a first-order absolute moment edge operator (FOAM) and compared to our previous edge-based automated methods such as CALEX (Molinari et al 2010 J. Ultrasound Med. 29 399-418, 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CULEX (Delsanto et al 2007 IEEE Trans. Instrum. Meas. 56 1265-74, Molinari et al 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CALSFOAM (Molinari et al Int. Angiol. (at press)), and CAUDLES-EF (Molinari et al J. Digit. Imaging (at press)). Our multi-institutional database consisted of 300 longitudinal B-mode carotid images. In comparison to semi-automated FOAM, CAILRS showed the IMT bias of -0.035 ± 0.186 mm while FOAM showed -0.016 ± 0.258 mm. Our IMT was slightly underestimated with respect to the ground truth IMT, but showed uniform behavior over the entire database. CAILRS outperformed all the four previous automated methods. The system's figure of merit was 95.6%, which was lower than that of the semi-automated method (98%), but higher than that of the other automated techniques.

  19. Automated carotid artery intima layer regional segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Meiburger, Kristen M; Molinari, Filippo [Biolab, Department of Electronics, Politecnico di Torino, Torino (Italy); Acharya, U Rajendra [Department of ECE, Ngee Ann Polytechnic (Singapore); Saba, Luca [Department of Radiology, A.O.U. di Cagliari, Cagliari (Italy); Rodrigues, Paulo [Department of Computer Science, Centro Universitario da FEI, Sao Paulo (Brazil); Liboni, William [Neurology Division, Gradenigo Hospital, Torino (Italy); Nicolaides, Andrew [Vascular Screening and Diagnostic Centre, London (United Kingdom); Suri, Jasjit S, E-mail: filippo.molinari@polito.it [Fellow AIMBE, CTO, Global Biomedical Technologies Inc., CA (United States)

    2011-07-07

    Evaluation of the carotid artery wall is essential for the assessment of a patient's cardiovascular risk or for the diagnosis of cardiovascular pathologies. This paper presents a new, completely user-independent algorithm called carotid artery intima layer regional segmentation (CAILRS, a class of AtheroEdge(TM) systems), which automatically segments the intima layer of the far wall of the carotid ultrasound artery based on mean shift classification applied to the far wall. Further, the system extracts the lumen-intima and media-adventitia borders in the far wall of the carotid artery. Our new system is characterized and validated by comparing CAILRS borders with the manual tracings carried out by experts. The new technique is also benchmarked with a semi-automatic technique based on a first-order absolute moment edge operator (FOAM) and compared to our previous edge-based automated methods such as CALEX (Molinari et al 2010 J. Ultrasound Med. 29 399-418, 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CULEX (Delsanto et al 2007 IEEE Trans. Instrum. Meas. 56 1265-74, Molinari et al 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CALSFOAM (Molinari et al Int. Angiol. (at press)), and CAUDLES-EF (Molinari et al J. Digit. Imaging (at press)). Our multi-institutional database consisted of 300 longitudinal B-mode carotid images. In comparison to semi-automated FOAM, CAILRS showed the IMT bias of -0.035 {+-} 0.186 mm while FOAM showed -0.016 {+-} 0.258 mm. Our IMT was slightly underestimated with respect to the ground truth IMT, but showed uniform behavior over the entire database. CAILRS outperformed all the four previous automated methods. The system's figure of merit was 95.6%, which was lower than that of the semi-automated method (98%), but higher than that of the other automated techniques.

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

    International Nuclear Information System (INIS)

    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)