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Sample records for cerebral artery stenosis

  1. Relationship of cerebral arterial stenosis to cognitive and memory disorders

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    Jifeng Li; Zhou Wang; Shenggang Sun; Gaomei Cai; Kejin Gu; Yaoqun Li

    2006-01-01

    BACKGROUND: Cerebral arterial stenosis can cause cerebral hypoperfusion, and than result in the decline of cognitive function, whereas the cognitive dysfunction induced by different cerebral arterial stenosis have different manifestations and types.OBJECTIVE: To observe the differences of cognitive and memory dysfunctions in patients with cerebral arterial stenosis of different types.DESIGN: A comparative observation.SETTING: Affiliated Hospital of Jining Medical College.PARTICIPANTS: Forty-two outpatients or inpatients with cerebral arterial stenosis were selected from the Department of Neurology, Affiliated Hospital of Jining Medical College from February 2005 to January 2006,including 25 males and 17 females. There were 18 cases of internal carotid arterial stenosis, 14 cases of vertebrobasilar arterial stenosis and 10 cases of whole cerebral arterial stenosis. The diagnostic standards for cerebral arterial stenosis were identified according to North American Symptomatic Carotid Endarterectomy Trial (NAS CET). Meanwhile, 18 healthy physical examinees were enrolled as the control group, including 10males and 8 females, aged 58-80 years old. All the enrolled subjects were informed and agreed with the detection and evaluation.METHODS: ① The memory function was evaluated using revised Wechsler memory scale for adults, including long-term memory (experience, orientation and counting), short-term memory (visual recognition, picture memory, visual regeneration, association and thigmesthesia) and sensory memory (forward and backward recitation of numbers). The scale scores were turned to memory quotients. The higher the scores, the better the memory function. ② The cognitive function was evaluated using revised Wechsler adult intelligence scale:It consisted of eleven subtests, including six language scales (information, digit span, vocabulary, arithmetics,apprehension, similarity) and five operation scales (picture completion, picture arrangement, block design

  2. Middle cerebral artery stenosis associated with moyamoya pattern collateralization

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    Randall Edgell

    2010-11-01

    Full Text Available Background and Purpose: Moyamoya disease is a well described phenomenon presenting with terminal internal carotid artery occlusion and rete pattern of collateralization around the occlusion. The development of moyamoya-like collaterals secondary to isolated middle cerebral artery stenosis or occlusion and the natural history of this entity in Caucasians have not been well described. Methods: Cerebral angiograms and CT angiograms performed between August 2004 and August of 2006 demonstrating moyamoya collateralization at a single US center were retrospectively reviewed. All cases of middle cerebral artery stenosis associated with a rete pattern of collateralization were included in this series. Demographic, clinical, and angiographic data were obtained. Results: There were 3 cases of middle cerebral artery stenosis associated with a moyamoya pattern of collateralization. The average age of the patients was 36 years old, 2 were male, and all were Caucasian. All patients presented with ischemic symptoms. The average degree of stenosis was 91%. No stenosis was seen in the supraclinoid internal carotid arteries or elsewhere in the intracranial vasculature. Conclusion: We describe a moyamoya-like pattern of anastomosis associated with isolated severe middle cerebral artery stenosis or occlusion in Caucasians.

  3. Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

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    Alkan, Ozlem [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey)], E-mail: yalinozlem@hotmail.com; Kizilkilic, Osman; Yildirim, Tulin [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey); Atalay, Hakan [Department of Cardiovascular Surgery, Baskent University, Faculty of Medicine, Ankara (Turkey)

    2009-09-15

    Purpose: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors. Methods: We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS {>=} 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or {<=}25%, 25-49%, and {>=}50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded. Results: ECAS < 70% in 42 patients and ECAS {>=} 70% in 141 patients. ICAS was found in 51 patients and ICAS {>=} 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS. Conclusions: We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.

  4. Follow-up of combined intervention for patients with both renal and cerebral artery stenosis

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    BIAN Xiao-xi; SUN Yu-heng

    2006-01-01

    @@ Renal artery stenosis (RAS) is a frequently overlooked clinical entity that can cause uncontrolled hypertension and lead to a progressive deterioration of renal function.1 We observed 20 patients with RAS complicated with cerebral artery stenosis (CAS), who underwent cerebral and renal artery angiography and combined intervening treatment. Clinical follow-up was performed for more than 3 years.

  5. A multimodal imaging study on spatial pattern of cerebral perfusion change caused by symptomatic unilateral carotid artery stenosis

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    Jian-rui LI

    2015-03-01

    Full Text Available Objective To investigate the spatial pattern of cerebral perfusion decrease resulting from symptomatic unilateral carotid artery stenosis and to assess the relationship between degrees of stenosis and cerebral blood flow (CBF.  Methods CT angiography (CTA and arterial spin labeling (ASL MRI cerebral perfusion were performed in 22 patients with symptomatic unilateral carotid artery stenosis. Diagnosis of carotid artery stenosis and measurement of stenosis degrees was performed by using CTA; cerebral perfusion was determined by ASL. Voxel-based analysis (VBA were applied to observe perfusion changes in patients with mild stenosis and moderate to severe stenosis, and spatial pattern of cerebral perfusion changes caused by carotid artery stenosis. Analysis based on region of interest (ROI was used to explore the relationship between degrees of stenosis and CBF. Results Twenty-two patients with symptomatic unilateral carotid artery stenosis (13 in the left side and 9 in the right included 13 cases with mild stenosis and 9 cases with moderate to severe stenosis. Compared to those with mild stenosis, patients with moderate to severe stenosis showed reduced CBF in bilateral (especially in the affected side parietal lobes (t = - 2.382, P = 0.014, frontal lobes (t = - 2.354, P = 0.015 and centrum semiovale (t = - 2.283, P = 0.017, and was basically located in bilateral cerebral watershed area. Furthermore, perfusion in these areas was negatively correlated with the degree of stenosis (r = - 0.479, P = 0.024.  Conclusions Symptomatic unilateral carotid artery stenosis may result in cerebral perfusion decreases in bilateral (particularly in the affected side watershed area and cerebral blood flow is negatively correlated with the degree of stenosis. DOI: 10.3969/j.issn.1672-6731.2015.02.006

  6. Angiotensin-converting enzyme gene polymorphism and middle cerebral artery stenosis in a Chinese Han population

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    Chunshu Rong; Yingqi Xing; Xinmei Jiang; Juan Wang; Baoshan Gao; Jianjun Zhao; Kangding Liu

    2013-01-01

    The angiotensin-converting enzyme gene is a candidate gene of stroke. The present study involved 62 healthy volunteers and 148 patients with middle cerebral artery stenosis as confirmed by brain color ultrasound from a Han population in North China, and determined the peripheral blood angiotensin-converting enzyme genotype using PCR-restriction fragment length polymorphism analysis. The results showed that the frequencies of the DD genotype and D allele were increased in patients with middle cerebral artery stenosis, but the difference was not statistically significant compared with healthy controls. The findings of this study on the relationship between stroke genes and middle cerebral artery stenosis indicate no significant correlation between the frequencies of the DD genotype and D allele of angiotensin-converting enzyme and middle cerebral artery stenosis in this Han population from North China. In the future, studies will be carried out to investigate correlations between multiple stroke candidate gene synergy and middle cerebral artery stenosis to provide a foundation for the development of gene therapy.

  7. Value of cerebral perfusion and vascular reserve for the treatment of symptomatic intracranial arterial stenosis

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    Li'an Huang; Xuewen Song; Anding Xu

    2008-01-01

    BACKGROUND: It is crucial to understand cerebral perfusion and vascular reserve in stegnotic arterial blood-supply regions to treat ischemic cerebrovascular diseases. However, effects on symptomatic intracrani-al arterial stenosis (SICAS) need to be further studied in additional applications. OBJECTIVE: To evaluate and summarize the effects of cerebral perfusion and vascular reserve on the treatment of SICAS. RETRIEVAL STRATEGY: A computer-based online search of English language publications from January 2000 to July 2007 was conducted in PubMed to identify publications that addressed cerebral perfusion and vascular reserve of SICAS. Search key words were "intracranial stenosis, perfusion, brain reserve". Relevant data were also searched with the China Journal Net, using the same key words in Chinese from January 2000 to January 2007. In total, 101 articles were retrieved. Inclusion criteria: ① Articles describing the current status for the diagnosis and treatment of SICAS; ② Articles concerning research developments of cerebral perfusion and vascular reserve of SICAS. Exclusion criteria: duplicated articles. LITERATURE EVALUATION: This study included 21 articles of experimental studies and conference re-ports.DATA SYNTHESIS: When performing interventional surgery in SICAS patients, it is important to under-stand cerebral perfusion and vascular reserve in addition to knowing the clinical symptoms and degrees of arterial stenosis. In recent years, there are a growing number of reports on measurements of vascular reserve through the use of magnetic resonance perfusion imaging (MR-PWI). Investigations demonstrate cerebral perfusion and vascular reserve decrease in many SICAS patients. Many studies show that both improve after surgical intervention. CONCLUSION: Cerebral perfusion could provide direct evidence of whether ischemia has occurred in the brain. Because of lateral circulation and cerebral vascular reserve, intracranial vascular stenosis and/or decreased

  8. Stenting for Atherosclerotic Stenosis of the Intracranial or Skull Base Cerebral Arteries: Effectiveness and Problems

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    Harakuni, T.; Hyodo, A.; Shingaki, T.; Kugai, M.; Kinjyo, T.; Tsuchida, H.; Sugimoto, K.; Yoshii, Y.; Matsumaru, Y.

    2004-01-01

    Since May 1992, we have performed percutaneous transluminal angioplasty (PTA) or stenting 70 times for 65 lesions in 62 patients with atherosclerotic stenosis of the intracranial or skull base cerebral arteries. Stenting was carried out nine times for nine lesions in nine cases. Stenting was performed on patients with an average age of 62. The patients were eight men and one woman. The stenotic lesions involved the internal carotid artery (petrous portion) in four cases, the internal carotid ...

  9. Studies on intracranial collateral circulation with multi-slice CT angiography in patients with symptomatic cerebral artery stenosis

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    Shu-qing ZHOU

    2011-06-01

    Full Text Available Objective To explore the features of intracranial collateral circulation in patients with symptomatic cerebral artery stenosis.Method Ninety-four patients with ischemic cerebrovascular disease admitted from Apr.2004 to Jun.2009 were involved in present study.All the patients were examined with cerebral multi-slice CT angiography,and the features of cerebral artery stenosis and intracranial collateral circulation were evaluated using maximum intensity projection(MIP and volume rendering(VR images of CT angiography.Result Of the 94 patients involved,48 were diagnosed as cerebral artery stenosis,including 29 cases of cerebral infarction,18 of transient ischemic attack(TIA and 1 of moyamoya disease(MMD.Among the 14 cases of severe cerebral artery stenosis or occlusion,cerebral infarction was found in 6 cases with lesser intracranial collateral vessels(including massive cerebral infarction in 4 cases and watershed infarction in 2 cases,and focal infarction of central semi-ovale in 1 case and TIA in 7 cases were found with abundant intracranial collateral vessels.Multiple lacunar infarction was found in 22 cases of mild or moderate cerebral artery stenosis,but there was no significant correlation between the stenosed arteries and infarction sites.Abundant intracranial collateral vessels were found in one patient with Moyamoya disease but no infarction was observed.Conclusions Intracranial collateral circulation plays an important role of compensation in patients with severe cerebral artery stenosis or occlusion.Cerebral angiography with multi-slice CT is of great significance in evaluation of cerebral artery stenosis and intracranial collateral circulation.

  10. Clinical significance of posterior cerebral artery stenosis/occlusion in moyamoya disease

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    Kuroda, Satoshi; Ishikawa, Tatsuya; Iwasaki, Yoshinobu [Hokkaido Univ., Sapporo (Japan). Graduate School of Medicine; Houkin, Kiyohiro [Sapporo Medical Univ. (Japan)

    2002-12-01

    The present study was aimed at clarifying the clinical significance of posterior cerebral artery (PCA) stenosis/occlusion in pediatric and adult moyamoya disease. This study included a total of 132 patients (52 children and 80 adults) who were diagnosed as by cerebral angiography having moyamoya disease. CT or MRI was performed to examine the location of cerebral infarction in all subjects. Cerebral blood flow and vasoreactivity to acetazolamide were measured in 80 patients before surgery, using single photon emission computed tomography (SPECT). Three-dimensional MR angiography (3D-MRA) was repeated in 32 pediatric patients after surgery in order to clarify the natural course of the PCA stenosis/occlusion. Of 264 sides in 132 patients, PCA stenosis/occlusion was observed in 50 sides of 40 patients (30.3%). Its incidence was significantly higher in ischemic-type patients than in hemorrhagic-type and asymptomatic patients, and was higher in patients in the advanced stage of the disease. The hemisphere ipsilateral to PCA stenosis/occlusion had higher incidence of ischemic symptoms, cerebral infarction, and impaired cerebral hemodynamics. Transient ischemic attack (TIA) (hemianopsia) or cerebral infarction in the occipital lobe was noted in 4 (10%) of 40 patients during follow-up periods after bypass surgery for anterior circulation. Of 32 pediatric patients, none showed progression of PCA stenosis on 3D-MRA during follow-up periods. The present study showed that the involvement of PCA could increase the risk of TIA and/or cerebral infarction in both anterior and posterior circulation areas, suggesting that the PCA plays an important collateral role in moyamoya disease. (author)

  11. Functional assessment of cerebral artery stenosis: A pilot study based on computational fluid dynamics.

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    Liu, Jia; Yan, Zhengzheng; Pu, Yuehua; Shiu, Wen-Shin; Wu, Jianhuang; Chen, Rongliang; Leng, Xinyi; Qin, Haiqiang; Liu, Xin; Jia, Baixue; Song, Ligang; Wang, Yilong; Miao, Zhongrong; Wang, Yongjun; Liu, Liping; Cai, Xiao-Chuan

    2016-10-04

    The fractional pressure ratio is introduced to quantitatively assess the hemodynamic significance of severe intracranial stenosis. A computational fluid dynamics-based method is proposed to non-invasively compute the FPRCFD and compared against fractional pressure ratio measured by an invasive technique. Eleven patients with severe intracranial stenosis considered for endovascular intervention were recruited and an invasive procedure was performed to measure the distal and the aortic pressure (Pd and Pa). The fractional pressure ratio was calculated as [Formula: see text] The computed tomography angiography was used to reconstruct three-dimensional (3D) arteries for each patient. Cerebral hemodynamics was then computed for the arteries using a mathematical model governed by Navier-Stokes equations and with the outflow conditions imposed by a model of distal resistance and compliance. The non-invasive [Formula: see text], [Formula: see text], and FPRCFD were then obtained from the computational fluid dynamics calculation using a 16-core parallel computer. The invasive and non-invasive parameters were tested by statistical analysis. For this group of patients, the computational fluid dynamics method achieved comparable results with the invasive measurements. The fractional pressure ratio and FPRCFD are very close and highly correlated, but not linearly proportional, with the percentage of stenosis. The proposed computational fluid dynamics method can potentially be useful in assessing the functional alteration of cerebral stenosis.

  12. [A Case of Middle Cerebral Artery Stenosis Presented with Limb-Shaking TIA].

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    Uno, Junji; Mineta, Haruyuki; Ren, Nice; Takagishi, Sou; Nagaoka, Shintarou; Kameda, Katsuharu; Maeda, Kazushi; Ikai, Yoshiaki; Gi, Hidefuku

    2016-07-01

    Involuntary movement is a rare clinical manifestation of transient ischemic attack (TIA). However, limb-shaking TIA is well described presentation of carotid occlusive disease. We present the case of a patient who developed limb-shaking TIA associated with high-grade stenosis of middle cerebral artery (M1), which was treated with percutaneous transluminal angioplasty (PTA). The procedure was performed successfully without complication and the symptom disappeared immediately after the procedure. The patient remained free of symptoms at the 38-month follow-up. There was no tendency of restenosis of M1. In this case, PTA was technically feasible and beneficial for limb-shaking TIA with M1 stenosis. Limb-shaking TIA can be a symptom of high-grade stenosis of M1.

  13. Relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis

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    Jiaping Wei; Shenmao Li; Zhiyong Zhang; Feng Ling; Kang Li; Hong Zhao; Jifang He; Liqing Xu; Jing Wen; Chunyan Zhou; Xiaoguang Wu; Jiarui Wang

    2008-01-01

    To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)

  14. Reproducibility of Middle Cerebral Artery Stenosis Measurements by DSA: Comparison of the NASCET and WASID Methods.

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    Luguang Chen

    Full Text Available To evaluate the intra- and inter-observer variability of the North American Symptomatic Carotid Endarterectomy Trial (NASCET and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID criteria for the evaluation of middle cerebral artery (MCA stenosis using digital subtraction angiography (DSA.DSA images of 114 cases with 131 stenotic MCAs were retrospectively analyzed. Two radiologists and a researcher measured the degree of MCA stenosis independently using both NASCET and WASID methods. To determine intra-observer agreement, all the observers reevaluated the degree of MCA stenosis 4 weeks later. The linear relation and coefficient of variation (CV between the measurements made by the two methods were assessed by correlation coefficient and multi-factor analysis of variance (ANOVA, respectively. Intra- and inter-observer variability of the two methods was evaluated by intraclass correlation coefficient (ICC, Spearman's R value, Pearson correlation coefficient and Bland-Altman plots.Despite the fact that the degree of MCA stenosis measured by NASCET was lower than measured using the WASID method, there was good linear correlation between the measurements made by the two methods (for the mean measurements of the 3 observers, NASCET% = 0.891 × WASID% - 1.89%; ICC, Spearman's R value and Pearson correlation were 0.874, 0.855, and 0.874, respectively. The CVs of both intra- and inter-observer measurements of MCA stenosis using WASID were significantly lower than that using NASCET confirmed by the multi-factor ANOVA results, which showed only the measurement methods of MCA stenosis had significant effects on the CVs both in intra- and inter-observer measurements (both P values < 0.001. Intra-observer measurements showed good or excellent agreement with respect to WASID and NASCET evaluation (ICC, 0.656 to 0.817 and 0.635 to 0.761, respectively. Good agreement for the WASID evaluation (ICC, 0.592 to 0.628 and for the NASCET evaluation (ICC, 0

  15. Cerebral blood flow and cerebrovascular reserve capacity in patients with occlusion or severe stenosis of cerebral arterial trunk

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    Yoshinaga, Shinya; Tanaka, Akira; Nakayama, Yoshiya; Tomonaga, Masamichi [Fukuoka Univ., Chikushino (Japan). Chikushi Hospital

    1997-12-01

    The cerebral blood flow (CBF) and the cerebrovascular reserve capacity (CVRC) were sequentially measured using a xenon enhanced CT scan in patients with transient ischemic attack or minor stroke due to an occlusion or a severe stenosis of the cerebral arterial trunk. The patients consisted of twelve males and one female ranging from 37 to 71 years of age (53 years on average). The vascular lesion was located in the internal carotid artery (7 patients) and in the middle cerebral artery (6 patients). Eleven patients received antiplatelet drug therapy, while two other patients underwent STA-MCA anastomosis. The CBF measurements were initially done within one month after the attack and then from 6 to 24 months (12 months on average) after the first study. Only one of 13 patients demonstrated a reattack during the period of observation and the CVRC decreased to 0% from the 14% level observed prior to the reattack, although the CBF was preserved. In the other twelve patients without a reattack, the CVRC was found to improve to 29.4% from 9.9% with statistical significance, even though the CBF remained the same in the first study. This study suggests hemodynamic insult to be closely related to the decreased in the CVRC, while STA-MCA anastomosis does not for prevent hemodynamic reattack based on a decrease in the CVRC in the early stage. (author)

  16. Percutaneous transluminal angioplasty for atherosclerotic stenosis of the intracranial cerebral arteries. initial results and long-term follow-up.

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    Hyodo, A; Kato, N; Nakai, Y; Anno, I; Sato, H; Okazaki, M; Matsumaru, Y; Nose, T

    1999-11-01

    Percutaneous transluminal angioplasty (PTA) was carried out 52 times for 49 lesions in 47 cases of atheroscrelotic stenosis of the intracranial or skull base cerebral arteries. The stenotic lesions involved the middle cerebral artery in 21 cases, the basilar artery in eight cases, the internal carotid artery (petrous-supraclinoid portion) in 15 cases, and the intracranial vertebral artery in five cases. Nearly all cases were symptomatic, such as TIA or stroke, and the degree of stenosis ranged from 70 to 99 percent, with a mean of 80 percent. PTA was performed using a STEALTH balloon angioplasty catheter. In these trials, PTA was successfully performed (as indicated by a residual stenosis under 50%) 41 times. The initial success rate was 79% and stenosis was reduced from 80% to 25%. Clinical follow-up was performed from 7 to 84 months with a mean of 44 months. During this period, death due to myocardial infarction or pneumonia occurred in five cases, stroke related to previous PTA occurred ih one case (due to re-stenosis) and stroke unrelated tl? previous PTA occurred in two cases. Angiographic follow-up was performed in 31 cases after 41 successful PTA procedures. Re-stenosis was seen in 20% of the cases, symptomrltic complications occurred in 6%, and asymptomatic complications occurred in 6% of the cases. One case suffered severe subarachnoid hemorrhage just after the PTA due to preexisting aneurysm rupture and he died a week after the PTA. So mortality in this series was 2%. From the results described here, we may conclude that PTA of the intracranial or skull base cerebral artery is technically feasible, and it can be performed with relatively low risk. From our results, it may be a useful method and effective for long-term survival of patients. But results from a larger number of patients and more long-term follow-up data are still necessary in order to evaluate the safety and usefulness of this method.

  17. Changes in regional cerebral hemodynamics and its significance after internal carotid artery stenting in patients with moderate/severe internal carotid artery stenosis

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    Jia-chuan YAN

    2011-08-01

    Full Text Available Objective To evaluate the cerebral hemodynamic changes before and after carotid artery angioplasty and stenting.Methods Thirty-eight patients with moderate/severe internal carotid artery stenosis underwent carotid artery angioplasty and stenting.CT perfusion imaging was performed pre-and post-surgery to determine the cerebral blood flow(CBF,cerebral blood volume(CBV and mean transit time(MTT in the ipsilateral and contralateral cerebrum.Results Before angioplasty and stenting,the CBF and CBV decreased,and MTT increased in the ipsilateral cerebrum than in contralateral cerebrum.After intervention,the CBF and CBV increased and CTT shortened obviously in comparison with that of pre-surgery(P 0.05.Conclusion Angioplasty and stenting may improve the cerebral hemodynamics of patients with severe/moderate internal carotid artery stenosis.

  18. The usefulness of percutaneous transluminal angioplasty of the middle cerebral artery stenosis in patients with transient ischemic attack

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    Lee, Young Chul; Lim, Hyo Soon; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam National Univ. Medical School, Kwangju (Korea, Republic of)

    2001-06-01

    To determine the effectiveness of percutaneous transluminal angioplasty(PTA) of atherosclerotic middle cerebral artery(MCA) stenosis in patients with transient ischemic attack (TIA). Ten patients with TIA who had undergone PTA were retrospectively investigated. In all ten, angiography revealed stenosis of the MCA. Mechanical dilatation was performed at the stenotic portion, and the angiographic findings after PTA, as well as peri/post-angioplastic complications, were evaluated. Four to 64 (mean, 23.5) months later, neurologic symptoms and the nature and timing of recurrent attacks were also assessed. The degree of stenosis before PTA was 50-75% in six patients and greater than 75% in four. Complete or partial angiographic recanalization of the stenotic segment occurred in nine patients (90%). During follow-up, seven patients recovered without recurrent TIA or cerebral stroke; one reported a tingling sensation and one experienced vertebrobasilar insufficiency. Motor aphasia developed in one patient after PTA, but after systemic heparinization, improved within 24 hours. One patient who suffered intracranial hemorrhage due to vascular rupture during PTA did three days later. PTA for atherosclerotic MCA stenosis in patients with TIA is an effective therapeutic method.

  19. Spiral computed tomography angiography (SCTA) and color coded duplex ultrasound (CCDUS): two complementary diagnostic techniques for assessment of extracranial cerebral artery stenosis.

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    Scaroni, Reana; Cardaioli, Gabriela; Pelliccioli, Gian Piero; Gallai, Virgilio

    2002-01-01

    Atherosclerotic lesions of the extracranial cerebral arteries account for ischemic stroke in over half of all cases. The risk of stroke associated with symptomatic carotid artery disease is related to the severity of the stenosis. Results of the two major clinical trials, North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST), showed that patients with symptomatic carotid artery disease may benefit from carotid endarterectomy. Therefore, detection and quantification of stenosis are essential. Discrepancies in the angiographic criteria used in both NASCET and ECST trials resulted in continued controversy about the most accurate method of measuring carotid artery stenosis. Moreover, to avoid complications related to the angiography procedure, a good evaluation of vessel wall and plaque composition need to be considered. Both SCTA and CCDUS are non invasive techniques that could overcome angiographic complications and give detailed information on stenosis grading and plaque characteristics. They have been used to evaluate carotid stenosis as a single or combined methods.

  20. Planning-free cerebral blood flow territory mapping in patients with intracranial arterial stenosis.

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    Arteaga, Daniel F; Strother, Megan K; Davis, L Taylor; Fusco, Matthew R; Faraco, Carlos C; Roach, Brent A; Scott, Allison O; Donahue, Manus J

    2016-07-07

    A noninvasive method for quantifying cerebral blood flow and simultaneously visualizing cerebral blood flow territories is vessel-encoded pseudocontinuous arterial spin labeling MRI. However, obstacles to acquiring such information include limited access to the methodology in clinical centers and limited work on how clinically acquired vessel-encoded pseudocontinuous arterial spin labeling data correlate with gold-standard methods. The purpose of this work is to develop and validate a semiautomated pipeline for the online quantification of cerebral blood flow maps and cerebral blood flow territories from planning-free vessel-encoded pseudocontinuous arterial spin labeling MRI with gold-standard digital subtraction angiography. Healthy controls (n = 10) and intracranial atherosclerotic disease patients (n = 34) underwent 3.0 T MRI imaging including vascular (MR angiography) and hemodynamic (cerebral blood flow-weighted arterial spin labeling) MRI. Patients additionally underwent catheter and/or CT angiography. Variations in cross-territorial filling were grouped according to diameters of circle of Willis vessels in controls. In patients, Cohen's k-statistics were computed to quantify agreement in perfusion patterns between vessel-encoded pseudocontinuous arterial spin labeling and angiography. Cross-territorial filling patterns were consistent with circle of Willis anatomy. The intraobserver Cohen's k-statistics for cerebral blood flow territory and digital subtraction angiography perfusion agreement were 0.730 (95% CI = 0.593-0.867; reader one) and 0.708 (95% CI = 0.561-0.855; reader two). These results support the feasibility of a semiautomated pipeline for evaluating major neurovascular cerebral blood flow territories in patients with intracranial atherosclerotic disease.

  1. [A surgical case of angina pectoris with a severe stenosis of Lt. mid-cerebral artery: the usefulness of the monitoring of cerebral blood flow].

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    Ayusawa, Y; Endo, M; Nishida, H; Tomizawa, Y; Uwabe, K; Maeda, T; Tei, I; Takiguchi, M; Ishida, T; Koyanagi, H

    1998-08-01

    A 64-year-old male patient had two episodes of transient ischemic attack and a cerebral infarction. Cerebral angiography showed 50% stenosis at the junction of left internal carotid artery and 90% stenosis at left mid-cerebral artery (MCA). Coronary angiography showed two vessel disease with arteriosclerotic change and underwent coronary artery bypass grafting. To prevent intraoperative cerebral infarction, we used brain protect solution just before starting ECC, set perfusion flow around 3 l/min/m2, monitored the flow of left MCA using Transcranial Doppler (TCD) and the saturation of left internal jugular vein (SjO2) continuously. PaCO2 was controlled around 45 mmHg. TCD showed good pulsatile flow, and SjO2 was kept over 60%. The patient recovered consciousness 2 hours after operation in the intensive care unit without paresthesia. We thought the number of open-heart cases with cerebrovascular disease increased, and pulsatile low of ECC by intraaortic balloon pumping and the monitoring of SjO2 are useful for the cases.

  2. Validation and absolute quantification of MR perfusion compared with CT perfusion in patients with unilateral cerebral arterial stenosis

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    Chiu, Fang-Ying, E-mail: fychiou@hotmail.com [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China); Kao, Yi-Hsuan, E-mail: yhkao@ym.edu.tw [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China); Teng, Michael Mu Huo, E-mail: mhteng@gmail.com [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China); School of Medicine, National Yang-Ming University, Taipei City, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China); Chung, Hsiao-Wen, E-mail: chung@cc.ee.ntu.edu.tw [Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan (China); Chang, Feng-Chi, E-mail: fcchang374@gmail.com [School of Medicine, National Yang-Ming University, Taipei City, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China); Cho, I-Chieh, E-mail: jessie8030@yahoo.com.tw [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China); Chen, Wen-Chun, E-mail: sky7408695@hotmail.com [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan (China)

    2012-12-15

    Objective: The aim of the study was to assess absolute quantification of dynamic susceptibility contrast-enhanced magnetic resonance perfusion (MRP) comparing with computed tomography perfusion (CTP) in patients with unilateral stenosis. Materials and methods: We retrospectively post-processed MRP in 20 patients with unilateral occlusion or stenosis of >79% at the internal carotid artery or the middle cerebral artery (MCA). Absolute quantification of MRP was performed after applying the following techniques: cerebrospinal fluid removal, vessel removal, and automatic segmentation of brain to calculate the scaling factors to convert relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) values to absolute values. For comparison between MRP and CTP, we manually deposited regions of interest in bilateral MCA territories at the level containing the body of the lateral ventricle. Results: The correlation between MRP and CTP was best for mean transit time (MTT) (r = 0.83), followed by cerebral blood flow (CBF) (r = 0.52) and cerebral blood volume (CBV) (r = 0.43). There was no significant difference between CTP and MRP for CBV, CBF, and MTT on the lesion side, the contralateral side, the lesion-contralateral differences, or the lesion-to-contralateral ratios (P > 0.05). The mean differences between MRP and CTP were as follows: CBV −0.57 mL/100 g, CBF 2.50 mL/100 g/min, and MTT −0.90 s. Conclusion: Absolute quantification of MRP is possible. Using the proposed method, measured values of MRP and CTP had acceptable linear correlation and quantitative agreement.

  3. [A Case of Ruptured Peripheral Cerebral Aneurysm at Abnormal Vessels Associated with Middle Cerebral Artery Stenosis:Similarity to Moyamoya Disease].

    Science.gov (United States)

    Miyazaki, Hajime; Kohno, Kanehisa; Tanaka, Hideo; Fukumoto, Shinya; Ichikawa, Haruhisa; Onoue, Shinji; Fumoto, Noriyuki; Ozaki, Saya; Maeda, Toshiharu

    2016-04-01

    We report a case of ruptured peripheral cerebral aneurysm at abnormal vessels associated with severe stenosis at the middle cerebral artery (MCA). A 66-year-old woman was admitted at our hospital with headache on foot. Computed tomography (CT) showed intracerebral hemorrhage in the left fronto-basal area. Three-dimensional-CT and conventional angiogram revealed abnormal vessels, which were similar to those seen in moyamoya disease, with a small enhancement close to the hematoma. On day 11, subsequent cerebral angiogram demonstrated an aneurysm at the peripheral portion of an abnormal vessel arising from the left A2. On day 17, soon after the diagnosis of the ruptured aneurysm was made (while still at the subacute stage), we operated on the aneurysm. Superficial temporal artery (STA)-MCA anastomosis was also performed to preserve cerebral blood flow and reduce hemodynamic stress. Several days after the operation, she had transient aphasia due to hyperperfusion of the MCA territory, but eventually recovered with no neurological deficit at discharge. Follow-up study revealed revascularization from the branches of the external carotid artery as well as the STA. On admission, we initially thought that this patient had abnormal vessels associated with arteriosclerotic MCA stenosis. However, the postoperative clinical course as well as the histopathological specimens of both the abnormal artery with the aneurysm and the STA revealed similar findings to those of moyamoya disease. Although this case did not satisfy the criteria for moyamoya disease, it is conceivable that a single arterial occlusive lesion associated with moyamoya-like vessels might develop in the same mechanism with that of moyamoya disease.

  4. Urgent endarterectomy using pretreatment with free radical scavenger, edaravone, and early clamping of the parent arteries for cervical carotid artery stenosis with crescendo transient ischemic attacks caused by mobile thrombus and hemodynamic cerebral ischemia. Case report.

    Science.gov (United States)

    Kobayashi, Masakazu; Ogasawara, Kuniaki; Inoue, Takashi; Saito, Hideo; Komoribayashi, Nobukazu; Suga, Yasunori; Ogawa, Akira

    2007-03-01

    A 68-year-old man with left cervical internal carotid artery stenosis suffered crescendo transient ischemic attacks caused by mobile thrombus detected by carotid echography and secondary impairment of cerebral hemodynamic reserve demonstrated by positron emission tomography. Urgent carotid endarterectomy (CEA) was performed following pretreatment with edaravone and early clamping of the carotid arteries without intraluminal shunting. The postoperative course was uneventful, and postoperative magnetic resonance imaging and single-photon emission computed tomography revealed no new cerebral ischemic lesions and no findings of cerebral hyperperfusion, respectively. The risks associated with CEA are higher for patients with evolving stroke or crescendo transient ischemic attacks than that for patients with stable disease. This case demonstrates that urgent endarterectomy for cervical carotid artery stenosis with crescendo transient ischemic attacks caused by mobile thrombi and hemodynamic cerebral ischemia can be successfully performed following pretreatment with edaravone and early clamping of the carotid arteries.

  5. Case with stenosis of internal carotid artery detected as a region of decreased blood flow by Tc-99m HMPAO cerebral blood flow scintigraphy

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    Hayashida, K.; Nishimura, T.; Uehara, T.; Imakita, S.; Yokota, I.; Ogura, H.; Oka, H.; Hayashi, M.; Kikuchi, H.

    1987-04-01

    Tc-99m hexamethylpropyleneamine oxime (= HMPAO) is expected to be an excellent agent as blood flow tracer of brain because it passes through blood brain barrier and is retained in brain parenchyma for several hours. Tc-99m HMPAO scintigraphy was applied to a patient complaining of transient ischemic attack without neurological findings. Left hemispheric hypoperfusion was detected by Tc-99m HMPAO cerebral blood flow scintigraphy. Although it was normal in CT and MRI, it was proved to be a 99 % stenosis of left internal carotid artery by digital subtraction angiography. Tc-99m HMPAO cerebral blood flow scintigraphy is useful for detecting abnormality of cerebral blood flow.

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

    Directory of Open Access Journals (Sweden)

    Huakun Liu

    2016-01-01

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

  7. 大脑中动脉狭窄程度与脑灌注的相关性研究%Correlation between stenosis of middle cerebral artery and cerebral perfusion

    Institute of Scientific and Technical Information of China (English)

    史文倩; 石进; 杨帆; 时惠平

    2015-01-01

    Objective To investigate the correlation between stenosis of middle cerebral artery (MCA) and cerebral perfusion in patients with unilateral MCA stenosis.Methods Computed tomography perfusion (CTP) was performed in 34 patients with unilateral MCA stenosis,admitted to our hospital trom April 2012 to March 2013.The CTP parameters of mean transit time,cerebral blood flow,cerebral blood volume and time to peak were measured in regions supplied by anterior cerebral artery,MCA and posterior cerebral artery.All patients were divided into severe stenosis group and moderate stenosis group; the correlation between MCA stenosis and cerebral perfusion was analyzed.Results A decreased perfusion was detected in 25 patients (73.5%),and it was more likely found in the severe stenosis group (18/20,90%) than that in the moderate stenosis group (7/14,50%,P=0.017).The degree ofMCA stenosis was positively correlated with the changes of cerebral perfusion (r=0.381,P=0.026).The ratio of patients with transient ischemic attack (TIA) between the normal cerebral perfusion group and decreased cerebral perfusion group had statistical difference (11.11% vs.72.00%,P=0.004).Conclusion Cerebral perfusion is significantly correlated with the severity of MCA stenosis in unilateral MCA stenosis patients; the proportion of TIA in the low cerebral perfusion patients is higher than that in the normal cerebral perfusion ones.%目的 探讨单侧大脑中动脉(MCA)狭窄患者MCA狭窄程度与脑灌注的相关性.方法 对自2012年4月至2013年3月在北京空军总医院神经内科住院的34例单侧MCA狭窄患者行CT灌注成像(CTP)检查:在双侧半球大脑前动脉、MCA及大脑后动脉供血区选择对称的感兴趣区,测量CTP参数如脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)及达峰时间(TTP)等.并将患者按MCA狭窄程度分组(重度、中度),对狭窄程度与MCA供血区的脑灌注进行等级相关性分析. 结果 34例患者中有25

  8. Improvement in Cerebral and Ocular Hemodynamics Early after Carotid Endarterectomy in Patients of Severe Carotid Artery Stenosis with or without Contralateral Carotid Occlusion

    Directory of Open Access Journals (Sweden)

    Jian Wang

    2016-01-01

    Full Text Available Purpose. To investigate the alternation in cerebral and ocular blood flow velocity (BFV in patients of carotid stenosis (CS with or without contralateral carotid occlusion (CO early after carotid endarterectomy (CEA. Patients and Methods. Nineteen patients underwent CEA for ≥50% CS. Fourteen patients had the unilateral CS, and five patients had the ipsilateral CS and the contralateral CO. Transcranial Doppler (TCD and Color Doppler Imaging (CDI were performed before and early after CEA. Results. In patients with unilateral CS, significant improvements in BFV were observed in anterior cerebral artery (ACA and middle cerebral artery (MCA on the ipsilateral side after CEA. In patients of ipsilateral CS and contralateral CO, significant improvements in BFV were observed in the ACA and MCA not only on the ipsilateral side but also on the contralateral side postoperatively. The ipsilateral ophthalmic artery (OA retrograde flows in two patients were recovered to anterograde direction following CEA. The BFV in short posterior ciliary artery (SPCA of the ipsilateral side significantly increased postoperatively irrespective of the presence of contralateral CO. Conclusions. CEA improved cerebral anterior circulation hemodynamics especially in patients of unilateral CS and contralateral CO, normalized the OA reverse flow, and increased the blood perfusion of SPCA.

  9. Treatment of symptomatic complex posterior circulation cerebral artery stenosis with balloon-mounted stents: technique feasibility and outcome

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Bin; Li, Gui-lin; Wang, Ren-zhi [Chinese Academy of Medical Science and Peking Union Medical College, Department of Neurosurgery, Peking Union Medical College Hospital, Beijing (China); Miao, Zhong-rong; Ji, Xun-min; Jiao, Li-qun; Ling, Feng [Capital University of Medical Science, Department of Neurosurgery, XuanWu Hospital, Beijing (China); Hua, Yang [Capital University of Medical Science, Department of Vascular Ultrasonography, XuanWu Hospital, Beijing (China)

    2009-05-15

    This study aimed to retrospectively analyze a series of patients with complex posterior circulation stenosis who underwent stent-assisted angioplasty to evaluate the feasibility of the procedure and summarize the experience with regard to complications. A total of 16 consecutive patients with 27 complex posterior circulation artery stenoses refractory to medical therapy were enrolled. Technical success rate, periprocedural complication, and long-term follow-up result were evaluated. The study population included 16 patients with 27 lesions. A total of 36 stents were successfully implanted. The technical success rate was 100%, and the overall periprocedural complication rate was 12.5% (2/16). During a median of 25.5 months of follow-up, three patients presented recurrent transient ischemic attacks, which were confirmed had restenosis more than 50% by control angiography or transcranial Doppler. Stent-assisted angioplasty is a feasible treatment method for complex posterior circulation artery stenosis. However, it appears to be associated with a relatively high periprocedural complication rate. Therefore, strict periprocedural management to reduce mortality and morbidity is needed. (orig.)

  10. Diagnosis and treatment of renal artery stenosis.

    NARCIS (Netherlands)

    Plouin, P.F.; Bax, L.

    2010-01-01

    A reduction in the diameter of the renal arteries can lead to hypertension, renal dysfunction and/or pulmonary edema. About 90% of patients with renal artery stenosis have atherosclerosis, and 10% have fibromuscular dysplasia. Atherosclerotic renal artery stenosis is a common condition that typicall

  11. 慢性大脑中动脉狭窄或闭塞的CT灌注成像%CT perfusion imaging in patients with chronic middle cerebral artery stenosis or occlusion

    Institute of Scientific and Technical Information of China (English)

    苏凯燕; 刘增韬

    2012-01-01

    Objective To evaluate the blood perfusion character of chronic middle cerebral artery stenosis or occlusion with CT perfusion imaging. Methods The clinical and imaging dala of 11 cases with unilateral chronic middle cerebral artery stenosis or occlusion were collected. All cases were examined with CT perfusion and MR (MR1 and MKA). Results The CT perfusion character of chronic middle cerebral artery stenosis or occlusion included CBV elevated, CBF decreased, and MTI prolonged. Conclusion CT perfusion imaging can describe the blood perfusion character of chronic middle cerebral artery stenosis or occlusion, and provide theoretical basis for therapeutic plan.%目的 利用CT灌注成像技术研究慢性大动脉狭窄或闭塞患者的脑血流灌注特征.方法 搜集具有完整临床资料的单侧慢性大脑中动脉重度狭窄或闭寨患者11例,行CT灌注成像及磁共振(MRI及MRA)检查.结果 慢性大脑中动脉狭窄或闭塞患者的脑CT灌注特征是患侧脑血流量(CBF)降低,脑血容量(CBV)升高,平均通过时间(MTT)延长.结论 CT灌注成像能反映慢性大脑中动脉狭窄或闭塞患者的脑血流灌注特征,为临床治疗方案的制订提供理论依据.

  12. Suture-induced right coronary artery stenosis.

    Science.gov (United States)

    Seltmann, Martin; Achenbach, Stephan; Muschiol, Gerd; Feyrer, Richard

    2010-01-01

    An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site. Invasive angiography confirmed the stenosis, and percutaneous intervention was successfully performed.

  13. Time constant of the cerebral arterial bed.

    Science.gov (United States)

    Kasprowicz, Magdalena; Diedler, Jennifer; Reinhard, Matthias; Carrera, Emmanuel; Smielewski, Peter; Budohoski, Karol P; Sorrentino, Enrico; Haubrich, Christina; Kirkpatrick, Peter J; Pickard, John D; Czosnyka, Marek

    2012-01-01

    We have defined a novel cerebral hemodynamic index, a time constant of the cerebral arterial bed (τ), the product of arterial compliance (C(a)) and cerebrovascular resistance (CVR). C(a) and CVR were calculated based on the relationship between pulsatile arterial blood pressure (ABP) and transcranial Doppler cerebral blood flow velocity. This new parameter theoretically estimates how fast the cerebral arterial bed is filled by blood volume after a sudden change in ABP during one cardiac cycle. We have explored this concept in 11 volunteers and in 25 patients with severe stenosis of the internal carotid artery (ICA). An additional group of 15 subjects with non-vascular dementia was studied to assess potential age dependency of τ. The τ was shorter (p = 0.011) in ICA stenosis, both unilateral (τ = 0.18 ± 0.04 s) and bilateral (τ = 0.16 ± 0.03 s), than in controls (τ = 0.22 ± 0.0 s). The τ correlated with the degree of stenosis (R = -0.62, p = 0.001). In controls, τ was independent of age. Further study during cerebrovascular reactivity tests is needed to establish the usefulness of τ for quantitative estimation of haemodynamics in cerebrovascular disease.

  14. 经颅多普勒超声检测脑动脉狭窄的临床研究%Clinical study on cerebral artery stenosis detected by transcranial Doppler ultrasound

    Institute of Scientific and Technical Information of China (English)

    周京晶; 史佳云; 任润涛; 张健

    2013-01-01

    目的 调查体检人群中脑动脉狭窄的发生率及分布规律,为其他影像检查及颈内动脉血管内膜剥脱手术(CEA)和支架置入血管成形术(CAS)提供依据.方法 以参加常规体检的3 953人为研究对象,采用经颅多普勒超声(TCD)检测颅内外动脉情况.结果 3 953位体检者中,男性2 687人(67.97%),女性1 266人(32.03%).检出动脉狭窄111人次(2.81%),134例次(3.39%).其中男性77人(69.37%),女性34人(30.63%),男性及女性发生动脉狭窄的比率与男性及女性体检人数占总人数的比率相当(P>0.05).发生狭窄者平均年龄(61.93±13.43)岁,男性发生狭窄平均年龄为63.21岁,女性发生狭窄平均年龄60.53岁,男性与女性发生动脉狭窄年龄无显著差异(P>0.05).134例次动脉狭窄患者中颅内血管狭窄85例(占狭窄血管的63.43%),颅外血管49例(占狭窄血管的36.57%).55岁以下组1 315人,脑动脉狭窄26人,占1.98%;>55岁组2 638人,发生脑动脉狭窄49人,占1.86%,≤55岁年龄组与>55岁年龄组发生脑动脉狭窄的比率差异无显著性(P>0.05).结论 TCD可检出无症状脑动脉狭窄,因无创、简便、准确、快速、经济、可实时评价等特点适宜于普查,可作为中老年人群体检的常规项目.%Objective To survey the incidence and distribution of stenosis in cerebral artery in order to provide the basis for other imaging methods and carotid artery endarterectomy ( CEA ) and stent angioplasty ( CAS ). Methods In a routine check - up of 3953 persons as research subjects, by using transcranial Doppler ultrasound (transcranial Doppler, TCD ) detection of intracranial and extracranial arterial conditions. Results Among 3953 persons in detection of arterial stenosis, 2687 were men accounted for 67.97 % ( 2687 ), and 1266 were women accounted for 32.03% ( 1266). Artery stenosis was found in 111 persons( 2.81% ), among them males were 77 ( 69.37% ) and females 34 ( 30. 63% ). The ratio for males and females

  15. 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.

  16. Stent treatment of symptomatic intracranial arterial stenosis

    Directory of Open Access Journals (Sweden)

    DONG Feng-ju

    2012-08-01

    Full Text Available Objective To investigate the safety, feasibility and efficacy of the Wingspan stent in treatment of symptomatic intracranial arterial stenosis. Methods Wingspan stenting was applied in 90 cases with symptomatic intracranial arterial stenosis. The surgical success rate and periprocedural neurological complications were observed. Digital subtraction angiography was performed at 6 months after stenting to detect the occurrence of restenosis. Results The technical success rate was 98.92% (92/93. Pre-treatment stenosis (83.42 ± 9.53% was improved to (21.82 ± 9.86% after stent placement. The difference was statistically significant (t = 3.280, P = 0.002. There were 5 patients (5.56% occurred major periprocedural neurological complications, 3 of them died within 30 days after the procedure. The restenosis rate at 6 months after operation was 19.10% (17/89. Conclusion Symptomatic intracranial arterial stenosis can be treated by Wingspan stenting with high technical success rate. The occurrence of complication is low and short-term efficacy is good. However, further study is needed to investigate long-term effect.

  17. 64层螺旋CT脑灌注成像联合CT血管造影评价颅内外血管搭桥术后疗效%Assessment of cerebral internal and external vascular bypass graft in patients with single middle cerebral artery stenosis or occlusion by combining 64-row CT cerebral perfusion with angiography

    Institute of Scientific and Technical Information of China (English)

    陈天金; 朱栓庄; 温有信; 王耀彬; 韩向东; 白莹; 于旋

    2012-01-01

    Objective To assess the curative effect of cerebral internal and external vascular bypass graft in patients with sin -gle middle cerebral artery (MCA) stenosis or occlusion by combining 64 -row CT cerebral perfusion (CTP) with angiography ( CTA ). Methods Patients with middle cerebral artery stenosis or occlusion were recruited and underwent superficial temporal artery and mid -die cerebral artery(STA -MCA) bypass graft between March 2009 and Mar 2011. CTP and CTA examinations were performed in all patients before and after operation. The cerebral perfusion parameters were analyzed quantitatively and qualitatively . The origin, travel and anastomotic stoma of bypass grafts were evaluated by reconstructed CTA images . Results 46 patients were found with severe MCA stenosis or occlusion. The time to peak (TTP) and relative mean transit time (rMTT) images before therapy displayed the existence of perfusion delay. The relative cerebral blood flow (rCBF) and relative cerebral blood volume (rCRV) images did not change significantly. The decrease of TTP and rMTT after therapy was of statistical significance ( P 0.05). In reconstructed CTA images , 82 bridge vessels were well displayed, including double bridges in 39 patients. The accuracy of CTA examination was 96.5%. All the bypass grafts were well shown and the anastomotic stomas were unobstructed. Conclusions It is feasible to evaluate the curative effects of cerebral internal and ex — ternal vascular bypass graft by combining CTP images of cerebral perfusion after therapy with CTA images of cerebral internal and exter -nal bypass grafts.%目的 探讨64层螺旋CT脑灌注成像(CT perfusion,CTP)联合CT血管造影(CT angiography,CTA)评价单侧大脑中动脉(middle cerebral artery,MCA)重度狭窄(闭塞)颅内外血管搭桥术后疗效的可行性.方法 46例拟行颅内外血管搭桥术患者,术前、后均行CTP及CTA检查.计算脑灌注参数图,对治疗前后脑灌注参数进行定量和定性对

  18. Fair灌注成像在一侧大脑中动脉狭窄或闭塞中的应用%Fair for evaluation of middle cerebral artery stenosis or occlusion in brian tissue perfusion imaging

    Institute of Scientific and Technical Information of China (English)

    刘玉涛; 李淑明; 阮骥

    2011-01-01

    目的 探讨Fair灌注成像对大脑中动脉狭窄或闭塞中灌注信息的诊断价值,为指导临床提供依据.方法 20例临床TIA患者或怀疑大脑血管的狭窄或闭塞患者,行常规MRI,DWI,MRA,Fair和DSC检查,确定病变范围,定量评价Fair与DSC的rCBF差异.结果 Fair CBF图显示患侧与健侧灌注程度改变对比t=4.46,P<0.05,有差异;Fair 的rCBF为0.84±0.52,DSC的rCBF为0.79±0.31,二者对比:t=0.705,P >0.05,无统计血差异.结论 Fair为无创性脑灌注成像,操作简单,能定量评估的大脑中动脉狭窄或闭塞引起的缺血性脑血管病的灌注信息.%Objective To disscuss diagnostic value of Fair in cerebral artery stenosis or occlusion reperfusion.Methods 20 patients of middle cerebral artery stenosis or occlusion were studied with rountine MRI,DWI,MRA,Fair and DSC examination, Showing the size of lesions were compared, The perfusion difference between Fair and DSC through the rCBF was compared.Results Fair showed the perfusion of abnomality of unilateral and contralateral changes in perfusion , t=4.46, P<0.05, with statistical significance.rCBF of Fair was 0.84±0.52, rCBF of DSC was 0.79±0.31, Comparison of DSC and Fair perfusionmethod showed no difference (t=0.705,P>0.05).Conclusion Fair, need no contrast injection of invasive operation, is convenient and useful method in assessing cerebral perfusion information of middle cerebral artery stenosis or occlusion.

  19. The study on vascular reserve of large cerebral arteries in acute cerebral ischemia patients with intracranial stenosis%伴有颅内动脉狭窄的缺血性脑卒中患者脑血管储备能力研究

    Institute of Scientific and Technical Information of China (English)

    黄立安; 董晓梅; 徐安定; 宋雪文; 凌雪英; 周环

    2011-01-01

    Objective To study the vascular reserve of large cerebral arteries in patients with acute cerebral thrombosis with more than 50% stenosis of the intracranial arteries. Methods Seventeen patients with acute cerebral thrombosis with magnetic resonance artery( MRA )/ transcranial doppler ultrasonography ( TCD ) confirmed stenosis of the intracranial arteries, were recruited in the study. Patients were examined by TCD before admission and 2 hour after oral Diamox treatment two days later. The changes of the blood flow before and after Diamox were compared in 187 large arteries.Results The cerehral blood flow was increased obviously following diamox. The blood flows in the right internal carotid artery( RICA ), right middle cerebral artery ( RMCA ) , right posterior cerebral artery( RPCA ) were increased after diamox but the difference did not reach statistically significance( P = 0.086,0.258 ,0.084 )but, other arteries increased cerebral blood flow significantly( P < 0.05 ). There was more increase in blood flow in non-stenosis arteries than in stenosis arteries but the difference did not reach statistically significance ( P = 0.08 ). There were no significant differences in the blood flow changes hetween moderate stenosis arteries and severe stenosis arteries ( P = 0.65 ). Conclusions Diamox test in TCD can precisely measure the large cerebral artery vascular reserve. Stenosis arteries have a decline tendency in vascular reserve compared with non-stenosis arteries. However,there is not significant difference in vascular reserve between moderate stenosis arteries and severe stenosis.%目的 对伴有颅内动脉狭窄的缺血性脑卒中患者采用口服乙酰唑胺实验研究颅内大动脉血流储备能力.方法 对17例经磁共振血管显影(magnetic resonance angiography, MRA)/或经颅多谱勒超声(transcranial doppler ultrasonography, TCD)证实颅内动脉狭窄大于50%的缺血性脑卒中患者,按TOAST分型为动脉粥样硬

  20. Heterogeneous cerebral vasoreactivity dynamics in patients with carotid stenosis.

    Directory of Open Access Journals (Sweden)

    Ting-Yu Chang

    Full Text Available Cerebral vasoreactivity (CVR can be assessed by functional MRI (fMRI using hypercapnia challenges. In normal subjects, studies have shown temporal variability of CVR blood oxygenation level-dependent responses among different brain regions. In the current study, we analyzed the variability of BOLD CVR dynamics by fMRI with a breath-holding task in 17 subjects with unilateral carotid stenosis before they received carotid stenting. Great heterogeneity of CVR dynamics was observed when comparing BOLD responses between ipsilateral and contralateral hemispheres in each patient, especially in middle cerebral artery (MCA territories. While some subjects (n=12 had similar CVR responses between either hemisphere, the others (n=5 had a poorly correlated pattern of BOLD changes between ipsilateral and contralateral hemispheres. In the latter group, defined as impaired CVR, post-stenting perfusion tended to be more significantly increased. Our data provides the first observation of divergent temporal BOLD responses during breath holding in patients with carotid stenosis. The development of collateral circulation and the derangement of cerebral hemodynamics can be detected through this novel analysis of the different patterns of BOLD changes. The results also help in prediction of robust increase of perfusion or hyperperfusion after carotid stenting.

  1. Duplex ultrasound for identifying renal artery stenosis

    DEFF Research Database (Denmark)

    Zachrisson, Karin; Herlitz, Hans; Lönn, Lars

    2017-01-01

    Background Renal artery duplex ultrasound (RADUS) is an established method for diagnosis of renal artery stenosis (RAS), but there is no consensus regarding optimal RADUS criteria. Purpose To define optimal cutoff values for RADUS parameters when screening for RAS using intra-arterial trans...... as PGM ≥15 mmHg and was found in 43 of the 76 arteries. RADUS parameters included renal artery peak systolic velocity (PSV) and the renal-aortic ratio (RAR) of flow velocities. Receiver operating characteristic curves (ROCs) and Youden's index were used to calculate optimal RADUS criteria for RAS...... The RAR ≥2.6 is a more sensitive criterion than traditional RADUS criteria when screening patients with clinical suspicion of RAS....

  2. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  3. Questions and Answers about Treating Arterial Stenosis and Preventing Stroke

    Science.gov (United States)

    ... and Answers About Treating Arterial Stenosis and Preventing Stroke A stroke is any sudden event affecting the ... and high cholesterol. How does stenosis contribute to stroke? Atherosclerosis can activate cells involved in blood clotting. ...

  4. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos;

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis.......The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  5. 仿真三维虚拟支架技术在脑动脉狭窄介入治疗中的作用%Value of 3D virtual stenting in the interventional therapy of cerebral artery stenosis

    Institute of Scientific and Technical Information of China (English)

    罗杰; 杨振九; 王皓; 廖煜君; 吴剑煌; 张朋

    2015-01-01

    目的:探讨仿真三维虚拟支架技术在脑动脉狭窄介入治疗中的作用。方法选取脑动脉狭窄支架介入治疗患者34例,分为2组。三维数字减影脑血管造影(3D-DSA)组22例,其中男性13例,女性9例;年龄48~74岁,平均年龄62.5岁;通过3D-DSA重建方法,确定脑动脉狭窄的程度和部位,运用虚拟支架血管分析程序,得到脑动脉狭窄的虚拟支架数据参数,并指导血管内治疗。对照组12例,其中男性8例,女性4例;年龄52~76岁,平均年龄64.3岁;采用普通脑血管造影指导血管内治疗。结果与普通DSA相比,3D-DSA重建图像能够多角度清晰地观察和显示脑动脉狭窄的部位、形态、狭窄程度;以虚拟支架技术的数据参数为依据,选择相应型号的支架行介入治疗效果更满意。结论3D-DSA虚拟支架技术对脑动脉狭窄支架成形术有指导价值,便于施术者正确地选择合适的支架。%Objective To investigate the interventional treatment role of three-dimensional (3D) virtual stenting in cerebral artery stenosis. Methods A total of 34 cases of cerebral artery stenosis with interventional treatment were enrolled, which were divided into 2 groups, 3D digital subtraction angiography(3D-DSA) group and control group. In 3D-DSA group, which included 13 males and 9 females, aged 48-74 years old with mean age of 62.5 years old, the location and degree of stenosis were determined by 3D-DSA reconstruction. Virtual stent analysis technology was applied to obtain data parameters of virtual cerebral stent and guide the endovascular therapy. In control group, which included 8 males and 4 females, aged 52-76 years old with mean age of 64.3 years old, the common cerebrovascular angiography was used to guide endovascular treatment. Results Compared with control group, the site, shape and degree of stenosis in 3D-DSA group were clearly demonstrated in 3D reconstruction images

  6. Young and middle-aged and elderly patients with cerebral infarction DSA analysis of the distribution of cerebral artery stenosis%中青年与老年脑梗死患者脑动脉狭窄分布的 DSA 分析

    Institute of Scientific and Technical Information of China (English)

    曾德华

    2016-01-01

    Objective to compare the young and middle-aged and elderly patients with cerebral infarction, cerebral artery stenosis of the distribution of digital subtraction angiography (DSA) as a result, analyzing the characteristic of the distribution of cerebral artery stenosis. Methods will our hospital 100 cases of cerebral infarction patients, according to the different age groups, divided into young group of 60 cases with elderly group, 40 cases were performed DSA examination, on two groups of patients with cerebral artery disease incidence, degree of stenosis vascular stenosis, distribution and attack part feature compar-ison. Results in patients with elderly group, the procyclic stenosis of extracranial artery disease incidence is significantly higher than in areas such as the young and middle-aged group of patients, and intracranial artery, posterior circulation narrow lesions were significantly lower than in areas such as the young and middle-aged group of patients, there is statistical significance dif-ference; Two groups of patients with vascular stenosis degree is given priority to with severe stenosis or occlusion, were signifi-cantly higher than in the same group the incidence of mild, moderate stenosis, the difference was statistically significant, and the outbreak of the main parts of vertebral artery opening, the incidence of vertebral artery open two groups of patients were signifi-cantly higher than that of group of middle cerebral artery MI incidence, as well as the internal carotid artery, the difference was statistically significant. Conclusion middle-aged and young cerebral infarction patients with senile cerebral infarction there was some difference of distribution of cerebral artery stenosis, the former is common with intracranial cerebral artery lesions, the latter is given priority to with cranial outside brain artery vascular lesions, but occurs in vertebral artery opening, and the degree of stenosis were severe or occlusion.%目的:比较中

  7. Horner syndrome due to vertebral artery stenosis.

    Science.gov (United States)

    Kim, Chul Han

    2013-11-01

    The author reports a rare case of Horner syndrome in a patient who resulted from stenosis of the vertebral artery after blunt trauma. A 31-year-old man was transferred to our department for evaluation of left medial orbital wall and nasal bone fractures. Five days ago, he was hospitalized due to multiple second to fourth rib fractures of the right chest following blunt trauma of the face, neck, and chest. Surgery was performed. Ten days later, he complained of drooping of the right eyelid. Physical examination revealed a discrete miosis and ptosis with normal levator function in the right eye. A workup for Horner syndrome was performed. Magnetic resonance angiography of the head and neck revealed a stenosis of the distal part of the right vertebral artery without the abnormality of carotid artery. He wore a cervical collar and underwent anticoagulation. However, Horner syndrome was not resolved over the next 12 months. Acute traumatic Horner syndrome may be associated with vertebral artery dissection in which the possibility of life-threatening injury can be masked.

  8. Immediate versus delayed treatment for recently symptomatic carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    Vladimir Vasconcelos

    Full Text Available ABSTRACT BACKGROUND: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. OBJECTIVES: To assess the risks and benefits of performing very early cerebral revascularization (within two days compared with delayed treatment (after two days for people with recently symptomatic carotid artery stenosis. METHODS: Search methods: We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1, MEDLINE (1948 to 26 January 2016, EMBASE (1974 to 26 January 2016, LILACS (1982 to 26 January 2016, and trial registers (from inception to 26 January 2016. We also handsearched conference proceedings and journals, and searched reference lists. There were no language restrictions. We contacted colleagues and pharmaceutical companies to identify further studies and unpublished trials Selection criteria: All completed, truly randomized trials (RCT that compared very early cerebral revascularization (within two days with delayed treatment (after two days for people with recently symptomatic carotid artery stenosis. Data collection and analysis: We independently selected trials for inclusion according to the above criteria, assessed risk of bias for each trial, and performed data extraction. We utilized an intention-to-treat analysis strategy. MAIN RESULTS: We identified one RCT that involved 40 participants, and addressed the timing of surgery for people with recently symptomatic carotid artery stenosis. It compared very early surgery with surgery performed after 14 days of

  9. Cerebral Arterial Fenestrations

    Science.gov (United States)

    Cooke, Daniel L; Stout, Charles E; Kim, Warren T; Kansagra, Akash P; Yu, John Paul; Gu, Amy; Jewell, Nicholas P; Hetts, Steven W; Higashida, Randall T; Dowd, Christopher F; Halbach, Van V

    2014-01-01

    Summary Arterial fenestrations are an anatomic variant with indeterminate significance. Given the controversy surrounding fenestrations we sought their prevalence within our practice along with their association with other cerebrovascular anomalies. We retrospectively reviewed 10,927 patients undergoing digital subtraction angiography between 1992 and 2011. Dictated reports were searched for the terms “fenestration” or “fenestrated” with images reviewed for relevance, yielding 228 unique cases. A Medline database search from February 1964 to January 2013 generated 304 citations, 127 cases of which were selected for analysis. Cerebral arterial fenestrations were identified in 228 patients (2.1%). At least one aneurysm was noted in 60.5% of patients, with an aneurysm arising from the fenestration in 19.6% of patients. Aneurysmal subarachnoid hemorrhage or non-aneurysmal subarachnoid hemorrhage were present in 60.1% and 15.8%, respectively. For the subset of patients with an aneurysm arising directly from a fenestration relative to those patients with an aneurysm not immediately associated with a fenestration, the prevalence of aneurysmal subarachnoid hemorrhage was 66.7% vs. 58.6% (p = 0.58). Fenestrations were more often within the posterior circulation (73.2%) than the anterior circulation (24.6%), though there was no difference in the prevalence of aneurysms within these groups (61.1% vs. 60.7%, p = 1.0). Cerebral arterial fenestrations are an anatomic variant more often manifesting at the anterior communicating arterial complex and basilar artery and with no definite pathological relationship with aneurysms. PMID:24976087

  10. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  11. 视网膜血管管径与颈动脉狭窄患者脑梗死发生的相关性分析%Relation between retinal vessel diameters and carotid artery stenosis patients with cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    赵露; 谢国丽; 王佳琳; 王艳玲

    2016-01-01

    目的 观察探讨视网膜血管管径与颈动脉狭窄患者脑梗死发生的相关性.方法 彩色多普勒血流显像检查确诊的颈动脉狭窄患者87例174只眼纳入研究.患者中,男性49例,女性38例;平均年龄(65.25±7.85)岁.以是否有脑梗死将患者分为脑梗死组和对照组,分别为34、53例.两组患者间年龄(t=1.916)、男性构成比(x2=0.142)、颈动脉狭窄程度(x2=0.785)比较,差异均无统计学意义(P=0.059、0.706、0.675).散瞳后拍摄以黄斑和视盘之间中点为中心周围45°彩色眼底像,包括视盘、黄斑、颞侧黄斑区上下血管弓以及距离视盘边缘2个视盘直径(DD)的鼻侧区域.应用IVAN计算机图像分析软件,测量距视盘边缘1/2~1DD范围内视网膜动静脉的血管直径.主要参数为视网膜中央动脉直径(CRAE)、视网膜中央静脉直径(CRVE)、视网膜动静脉比值(ARV).视网膜血管管径与脑梗死关系行logistic回归分析.结果 脑梗死组CRVE、CRAE、AVR分别为(132.90±20.67)、(243.47±43.92)μm和0.56±0.10;对照组分别为(145.26±21.59)、(224.99±32.35) μm和0.68±0.13.两组CRVE、CRAE、AVR比较,差异均有统计学意义(t=-2.648、2.257、-4.631,P<0.05).多因素logistic回归分析,控制年龄、吸烟、低密度脂蛋白混杂因素后,CRAE与脑梗死发生相关性降低,CRVE与脑梗死发生呈显著相关(P=0.015、0.011).结论 CRAE降低、CRVE增加是颈动脉狭窄患者脑梗死发生的危险因素;对颈动脉狭窄患者脑梗死发生有一定预测价值.%Objective To investigate the relationship between retinal vessel diameters and cerebral infarction of carotid artery stenosis patients.Methods Eighty seven patients (174 eyes) with carotid stenosis were included in this study.There were 49 males and 38 females,with an average age of (65.25±7.85) years.Thirty-four patients were suffered from cerebral infarction (cerebral infarction group),and the other 53 patients had no cerebral

  12. Evaluating non-invasive medical imaging for diagnosis of carotid artery stenosis with ischemic cerebrovascular disease

    Institute of Scientific and Technical Information of China (English)

    鲁晓燕; 张挽时; 桂秋萍; 喻敏; 郭英

    2003-01-01

    Objectives To assess the value of non-invasive medical imaging for diagnosis of carotid artery stenosis and to study the relationship between carotid stenosis and brain infarction. Methods Thirty-one patients with a total of 62 carotid arteries were studied using Doppler ultrasound (DUS) and magnetic resonance angiography (MRA). Eleven of the 31 patients were studied using CT angiography (CTA). CT and MRI of the brain were also done in all patients. The imaging results in 5 patients were compared with those of digital subtraction angiography (DSA). Eight patients with severe stenosis received carotid endarterectomy. The comparisons between the imaging results and pathological data were conducted in 2 patients. Results Of the 62 carotid arteries, mild stenosis was seen in 11, moderate in 14, severe in 21, obstructed in 4 and normal in 12. In 25 patients with severe stenosis or occlusion of carotid arteries, there were a total of 35 focal or multifocal infarcts on the ipsilateral cerebral hemisphere, and 15 infarcts on the contrary side. Compared with the results of the operations, DUS correctly diagnosed 6 stenoses, while MRA identified 7 correctly and CTA 8. Agreement on location of stenosis as performed by endarterectomy, DUS, MRA and CTA occurred in all patients. Histologically, areas of calcification and fibrousness were related to high densities on CTA, strong echoes on DUS, and low signal intensities on MRA. Relatively large amounts of necrotic material and foam cells filled with lipolytic materials on the intimal surface of arteries were observed during pathologically, corresponding to low and iso-densities on CTA, low echoes on DUS, and inhomogeneous signal intensities on MRA. Conclusions A strong link exists between carotid stenosis and brain infarction. The combined use of DUS, MRA and CTA can improve diagnostic accuracy for the assessment of carotid artery stenosis, as well as assist in ascertaining the nature of the plaque.

  13. Coronary Artery and Pulmonary Artery Fistula Originated from Significant Stenosis in the Left Anterior Descending Artery

    Directory of Open Access Journals (Sweden)

    Alper Sami Kunt

    2013-01-01

    Full Text Available Coronary artery fistula (CAF is defined as a rare anomalous connection between a coronary artery and a major vessel or a cardiac chamber. We report a case of a left anterior descending coronary (LAD stenosis and coronary artery fistula between the LAD coronary artery and the pulmonary artery (PA. CAF is often diagnosed by coronary angiogram. We describe our diagnostic approach and review the literature on the epidemiology, the pathophysiology, the diagnostic modalities, and the treatment options.

  14. Successful angioplasty during pregnancy for renal artery stenosis.

    Science.gov (United States)

    Margueritte, François; Velasco, Stephane; Pourrat, Olivier; Pierre, Fabrice

    2016-03-01

    Renal artery stenosis can be diagnosed during pregnancy and treated at the same time. A 30-year-old woman had a sudden, severe but asymptomatic hypertensive crisis at 21 weeks of gestation. The diagnosis of renal artery stenosis suspected on Doppler ultrasonography was confirmed and treated by renal angioplasty, which reduced her blood pressure. At 27 weeks of gestation, her blood pressure increased again, associated with significant proteinuria, suggesting pre-eclampsia. A cesarean section was performed giving birth to a healthy 940-g child. Renal artery stenosis should be considered when sudden and early-onset hypertension appears during pregnancy.

  15. Prevalence and risk factors of atherosclerotic renal artery stenosis

    Institute of Scientific and Technical Information of China (English)

    严健华

    2013-01-01

    Objective To explore the prevalence and risk factors of atherosclerotic renal artery stenosis(ARAS) in patients undergoing coronary angiography.Methods A total of 2506 patients with suspected and known coronary

  16. 大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄的关系%Relationship between the patterns of acute middle cerebral artery deep perforator infarctions and arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    郑晋华; 邵蓓; 牛晓婷; 吕志坤

    2010-01-01

    目的 探讨大脑中动脉深穿支供血区新鲜梗死的不同类型与相关动脉狭窄之间的关系.方法 回顾性连续分析2007年2月至2009年4月我院住院的152例脑梗死患者的临床资料.依据磁共振弥散加权成像(DWI)分为大脑中动脉深穿支小梗死组(小PAI组,直径≤3.20 cm)、大脑中动脉深穿支大梗死组(大PAI组,直径>3.20 cm)、大脑中动脉深穿支+大脑中动脉皮质支梗死组(PAI+PI组)、大脑中动脉深穿支+分水岭梗死组(PAI+BZ组)、大脑中动脉深穿支+大脑中动脉皮质支+分水岭梗死组(PAI+PI+BZ组).比较各组之间动脉狭窄检出率及动脉重度狭窄或闭塞检出率.结果 各组动脉狭窄检出率分别为16/87、9/11、17/17、11/12、23/25,小PAI组与其余4组相比差异有统计学意义(χ~2=21.780、48.065、30.567、55.523,P值均为0.000);各组动脉重度狭窄或闭塞检出率分别为1/87、2/11、12/17、9/12、21/25,小PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=56.505、55.465、79.283,P值均为0.000),大PAI组与PAI+PI组、PAI+BZ组及PAI+PI+BZ组相比差异有统计学意义(χ~2=7.337、7.425、11.633,P值分别为0.007、0.006、0.001);小PAI两亚组(2.00 cm<直径≤3.20 cm亚组与直径≤2.00 cm亚组)动脉狭窄检出率差异无统计学意义(χ~2=0.253,P=0.615).结论 小PAI组动脉狭窄检出率及动脉重度狭窄或闭塞检出率均较低;大PAI组、PAI+PI组、PAI+BZ组及PAI+PI+BZ组动脉狭窄检出率均较高,且PAI+PI组、PAI+BZ组、PAI+PI+BZ组动脉苇度狭窄或闭塞检出率均较高.%Objective To explor the relationship between the different types of perforating artery fresh infarcts of the middle cerebral artery and related arterial stenosis.Methods All 152 acute ischemic stroke patients hospitalized in our hospital from February 2007 to April 2009 were retrospectively reviewed.Lesions of middle cerebral artery were classified on diffusion weighted imaging

  17. Evaluation of renal artery stenosis using color Doppler sonography in young patients with multiple renal arteries

    Institute of Scientific and Technical Information of China (English)

    QIN Wei; ZHANG Xin; YANG Min; ZHONG Xu-hui; ZHAO Ming-hui

    2011-01-01

    Background Some individuals have multiple renal arteries. Severe stenosis in one of the arteries may cause refractory hypertension. The detection of stenosis within one of the multiple renal arteries usually required invasive procedures, such as computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). This study reported the application of color Doppler sonography (CDS) in the detection of severe stenosis in one of the multiple arteries.Methods Patients with multiple renal arteries and one of the arteries with severe stenosis were retrospectively studied. Peak systolic velocities (PSV) of renal arteries and the intrarenal CDS patterns were collected and compared. The diagnosis was confirmed by digital subtraction angiography (DSA).Results Four children with multiple renal arteries and one of the arteries with stenosis were investigated. They were admitted due to refractory hypertension. CDS screening identified two renal arteries in one kidney of each patient with one of the two renal arteries having stenosis >70%. The PSV of the stenosed arteries were much higher, and the intrarenal CDS patterns supplied by the stenosed arteries changed into T-P patterns.Conclusion Non-invasive CDS technology may be a useful method to identify severe stenosis in one of multiple renal arteries in young patients.

  18. CT measurement of changes in cerebral perfusion in patients with asymptomatic carotid artery stenosis undergoing carotid stenting prior to cardiac surgery: "proof of principle"

    NARCIS (Netherlands)

    Heyden, J. Van der; Waaijer, A.; Wouter, E.S. Van; Neerven, D. van; Sonker, U.; Suttorp, M.J.; Bal, E.T.; Prokop, M.

    2011-01-01

    AIMS: To identify asymptomatic patients with impaired cerebral perfusion using CT perfusion (CTP) technique during staged carotid stenting (CAS) and cardiac surgery. METHODS AND RESULTS: This is a prospective, non-randomised study in 16 neurologically asymptomatic patients designed to analyse cerebr

  19. The study of the correlation between the serum bilirubin level and the intracranial artery stenosis of the patients with cere-bral infarction%脑梗死患者血清胆红素含量与颅内动脉狭窄的相关性研究

    Institute of Scientific and Technical Information of China (English)

    王鸫霖

    2014-01-01

    Objective To analyze the correlation between the serum bilirubin level and the intracranial artery steno-sis of the patients with cerebral infarction by using DSA to observe the intracranial artery stenosis of the patients with cerebral infarction.Methods 200 patients with cerebral infarction were included as qualified cases.100 patients with mild stenosis or without stenosis were included into the control group.The research objects were divided into two groups according to whether there was the intracranial artery stenosis or not.At the same time,the subgroup analysis was employed to the degrees of stenosis.The differences and changes of the serum bilirubin levels in the different groups and subgroups were compared.The regression analysis on the related risk factors was employed.Results There were statistically significant differences of the total bilirubin SIB,the indirect bilirubin STB between the stenosis group and the control group(P <0.05).The total bilirubin SIB and the indirect bilirubin STB of the stenosis group were sig-nificantly lower than those of the control group.The total bilirubin SIB and the indirect bilirubin STB of the severe ste-nosis and the occlusion group were significantly lower than those of the moderate stenosis group.Multivariate regres-sion analysis showed that serum bilirubin,hypertension,diabetes related to intracranial artery stenosis.Conclusion A lower serum bilirubin level may be an important risk factor of cerebral infarction and correlate with the occurrence of in-tracranial atherosclerotic stenosis.%目的:采用 DSA 观察脑梗死患者颅内动脉狭窄情况,深入分析血清胆红素含量与与患者颅内动脉狭窄的相关性。方法纳入合格的脑梗死患者200例。对照组为无狭窄或轻度狭窄患者,例数为100例。根据颅内动脉有无狭窄分成两组。同时进行狭窄程度的亚组分析。比较不同组间及其亚组内的血清胆红素含量的差异与变化。对相关危险

  20. Imaging findings and cerebral perfusion in arterial ischemic stroke due to transient cerebral arteriopathy in children; Achados de imagem e perfusao arterial cerebral em acidente vascular cerebral isquemico devido a arteriopatia transitoria em crianca

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa Junior, Alcino Alves, E-mail: alcinojr@uol.com.br [Departamento de Diagnostico por Imagem, Hospital Israelita Albert Einstein - HIAE, Sao Paulo, SP (Brazil); Ellovitch, Saada Resende de Souza [Neuropediatria, Hospital Israelita Albert Einstein - HIAE, Sao Paulo, SP (Brazil); Pincerato, Rita de Cassia Maciel [Hospital Samaritano, Sao Paulo, SP (Brazil)

    2012-04-15

    We report the case of a 4-year-old female child who developed an arterial ischemic stroke in the left middle cerebral artery territory, due to a proximal stenosis of the supraclinoid internal carotid artery, most probably related to transient cerebral arteriopathy of childhood. Computed tomography scan, magnetic resonance imaging, perfusion magnetic resonance and magnetic resonance angiography are presented, as well as follow-up by magnetic resonance and magnetic resonance angiography exams. Changes in cerebral perfusion and diffusion-perfusion mismatch call attention. As far as we know, this is the first report of magnetic resonance perfusion findings in transient cerebral arteriopathy. (author)

  1. 中国缺血性脑血管病患者脑动脉狭窄分布与危险因素的荟萃分析%Meta-analysis of risk factors of Chinese patients with different cerebral artery stenosis locations

    Institute of Scientific and Technical Information of China (English)

    武剑; 赵璟妍; 黄镪; 宋晓微; 李青

    2015-01-01

    Objective We conducted a Meta-analysis to explore the relationship between different locations of cerebral artery stenosis and the risk factors in Chinese ischemic cerebral artery disease patients.Methods We systematically searched electronic literature databases (last search 31 December 2014) for studies reporting the association between cerebral artery stenosis locations and risk factors of ischemic cerebral artery disease.We grouped patients into two groups,only intracranial artery stenosis group and only extracranial artery stenosis group,by the location of cerebral artery stenosis.Meta-analysis was carried out by Review Manager (Version 5.2) provided by Cochrane Collaboration.After the heterogeneity test,the odds ratios (OR) or the mean differences (MD) and 95% confidence interval (95% C I) were combined.The publication bias and sensitivity analysis were tested as while.Results A total of thirteen studies were identified,which are including 1 672 patients with intracranial artery stenosis and 1 239 patients with extracranial artery stenosis.The only intracranial artery stenosis patients tend to be younger than the patients of the other group.The combined MD (95%CI) of age was-4.57(-8.22--0.91,P=0.01).Besides,the proportion of smokers in the only intracranial artery stenosis patients was higher than the other group.The combined OR (95%CI) of smoking was 0.08(0.68-0.93,P =0.005).Conclusions As to Chinese ischemic cerebral artery disease patients,visible differences of age and smoking were detected between the only intracranial artery stenosis group and extracranial group.However some risk factors of cerebral artery stenosis which were proved by large scale studies,such as hypertension,diabetes and dyslipidemia,were failed to test the visible difference between the two groups.%目的 探讨我国缺血性脑血管病患者中脑血管狭窄部位分布与缺血性脑血管病危险因素暴露情况的关系.方法 利用关键词系统检索截至2014

  2. Relationship between cerebral artery stenosis and obstructive sleep apnea%脑动脉狭窄与阻塞性睡眠呼吸暂停的关系研究

    Institute of Scientific and Technical Information of China (English)

    张冬萍; 王慧红

    2016-01-01

    目的:探讨阻塞性睡眠呼吸暂停( OSA )与动脉粥样硬化性脑动脉狭窄的关系。方法选择2014年4月至2015年12月我院就诊的大动脉粥样硬化的急性脑梗死患者为研究对象,经多导睡眠监测,睡眠呼吸暂停低通气指数( AHI )≥5次/h的60例患者为OSA组,选择AHI<5次/h的大动脉粥样硬化的急性脑梗死患者60例为非OSA组。比较OSA组与非OSA组患者脑动脉狭窄的程度、数量和分布的差别。结果两组患者的性别、年龄和美国国立卫生研究院卒中量表( NIHSS)评分以及糖尿病、冠心病、高脂血症、吸烟者等的比例比较差异均无统计学意义(均P>0.05)。 OSA组BMI[(26.07±2.39)比(23.59±2.73) kg/m2]、高血压发生率[70%(42/60)比43%(26/60)]均高于非OSA组,差异有统计学意义(t=5.304,χ2=7.603,均P<0.05)。 OSA组78.3%(47/60)患者存在脑动脉狭窄,非OSA组为45.0%(27/60),两组比较差异有统计学意义(χ2=16.535,P<0.05),且两组颅内动脉狭窄比例均较高(68.0%比81.5%,P>0.05);两组患者脑动脉狭窄前、后循环的分布差异也无统计学意义( P>0.05)。 OSA组脑动脉狭窄的程度重于非OSA组,两组比较差异有统计学意义(χ2=17.801,P<0.05)。随着OSA程度的加重,脑动脉狭窄的病变数量及程度比较差异无统计学意义(P>0.05)。结论 OSA与动脉粥样硬化性脑动脉狭窄存在密切关系。%Objective To investigate the relationship of obstructive sleep apnea and atherosclerotic cerebral artery stenosis.Methods One hundred and twenty patients with acute cerebral infarction were enrolled in the study.Patients underwent polysomnography monitoring;according to the results, the sleep apnea/hypopnea index ( AHI) was ≥5/h in 60 patients ( OSA group) and AHI was 0.05).The rates of increased

  3. Renal vein oxygen saturation in renal artery stenosis

    DEFF Research Database (Denmark)

    Nielsen, K; Rehling, M; Henriksen, Jens Henrik Sahl

    1992-01-01

    Renal vein oxygen-saturation was measured in 56 patients with arterial hypertension and unilateral stenosis or occlusion of the renal artery. Oxygen-saturation in blood from the ischaemic kidney (84.4%, range 73-93%) was significantly higher than that from the 'normal' contralateral kidney (81...

  4. Association between the Gensini Score and Carotid Artery Stenosis

    Science.gov (United States)

    Fidan, Serdar; Tabakçı, Mehmet Mustafa; Toprak, Cuneyt; Alizade, Elnur; Acar, Emrah; Bayam, Emrah; Tellice, Muhammet; Naser, Abdurrahman; Kargın, Ramazan

    2016-01-01

    Background and Objectives The aim of this study was to evaluate the association between the extent of coronary artery disease assessed by the Gensini score and/or the SYNTAX score and the significant carotid stenosis in patients undergoing coronary artery bypass grafting (CABG). Subjects and Methods A total of 225 patients who had carotid doppler ultrasonography prior to CABG were included retrospectively. Significant coronary artery disease was assumed as a lumen diameter stenosis of ≥50% in any of the major epicardial coronary arteries. The severity of carotid stenosis was determined by B-mode and duplex ultrasonography. Clinically significant carotid stenosis was defined as peak systolic velocity greater than 125 cm/s. Results The mean value of SYNTAX score and Gensini score was highest in patients allocated to significant carotid stenosis (22.98±7.32, p<0.001 and 77.40±32.35, p<0.001, respectively). The other risk factors for significant carotid stenosis were found to be male gender (p=0.029), carotid bruit (p<0.001), diabetes (p=0.021), left main disease (p=0.002), 3-vessel disease (p=0.008), chronic total coronary occlusion (p=0.001), and coronary artery calcification (p=0.001) in univariate analysis. However, only the Gensini score (odds ratio[OR]=1.030, p=0.004), carotid bruit (OR=0.068, p<0.001), and male gender (OR=0.190, p=0.003) were the independent predictors. The Gensini score cut off value predicting significant carotid stenosis was 50.5 with 77% sensitivity (p<0.001). Conclusion The Gensini score may be used to identify patients at high risk for significant carotid stenosis prior to CABG. PMID:27721854

  5. Drug-eluting stents in renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Zaehringer, M. [Marienhospital Stuttgart, Department of Radiology, Stuttgart (Germany); Pattynama, P.M.T. [Erasmus MC-University Medical Center Rotterdam, Rotterdam (Netherlands); Talen, A. [genae associates nv, Antwerp (Belgium); Sapoval, M. [Hopital Europeen Georges Pompidou, Service de Radiologie Cardio-Vasculaire, Paris (France); Inserm U 780 epidemiologie Cardio Vasculaire, Paris (France)

    2008-04-15

    Because of higher acute and long-term success rates compared with balloon angioplasty alone, percutaneous stent implantation has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis. Restenosis rates after successful renal stent placement vary from 6 up to 40%, depending on the definition of restenosis, the diameter of the treated vessel segment and comorbidities. The safety and efficacy of drug-eluting stents for the treatment of renal-artery stenosis is poorly defined. The recently published GREAT study is the only prospective study, comparing bare-metal and sirolimus-coated low profile stent systems in renal artery stenosis, showing a relative risk reduction of angiographic binary in-stent restenosis by 50%. This is an opinion paper on indications, current treatment options and restenosis rates following renal artery stenting and the potential use of drug-eluting stents for this indication. (orig.)

  6. Middle cerebral artery blood velocity during rowing

    DEFF Research Database (Denmark)

    Secher, Niels Henry; Pott, F; Knudsen, L.;

    1997-01-01

    original,arterial blood pressure,central venous pressure,cerebral blood flow, exercise, transcranial Doppler......original,arterial blood pressure,central venous pressure,cerebral blood flow, exercise, transcranial Doppler...

  7. Fenestration of the anterior cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Ito, J.; Washiyama, K.; Hong, K.C.; Ibuchi, Y.

    1981-08-01

    Three cases of angiographically demonstrated fenestration of the anterior cerebral artery are reported. Fenestration occurred at the medial half of the horizontal segment of the anterior cerebral artery in all cases. Its embryology and clinical significance are briefly discussed, and the anatomical and radiological literature on fenestration of the anterior cerebral artery is reviewed.

  8. Severe hypertension due to renal polar artery stenosis in an adolescent treated with coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Docx, Martine K. [Koningin Paola Kinderziekenhuis, Department of Paediatrics, Chronic Diseases and Hypertension, Antwerp (Belgium); Vandenberghe, Philippe [Koningin Paola Kinderziekenhuis, Department of Paediatric Cardiology, Antwerp (Belgium); Maleux, Geert [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Gewillig, Marc [University Hospitals Leuven, Department of Paediatric Cardiology, Leuven (Belgium); Mertens, Luc [Hospital for Sick Children, Paediatric Cardiology, Toronto (Canada)

    2009-11-15

    A 12-year-old boy presented with severe arterial hypertension due to a severe subsegmental renal artery stenosis. Treatment consisted of selective embolization of the stenosed polar artery, which resulted in near normalization of the arterial pressures. Renal artery stenosis should always be considered, even in young adolescents, as a cause for arterial hypertension. Only selective angiography was able to demonstrate the subsegmental artery stenosis in this patient. (orig.)

  9. Skin autofluorescence is increased in patients with carotid artery stenosis and peripheral artery disease.

    Science.gov (United States)

    Noordzij, Marjon J; Lefrandt, Joop D; Loeffen, Erik A H; Saleem, Ben R; Meerwaldt, Robbert; Lutgers, Helen L; Smit, Andries J; Zeebregts, Clark J

    2012-02-01

    Advanced glycation end products (AGEs) have a pivotal role in atherosclerosis. We evaluated skin autofluorescence (SAF), a non-invasive measurement of tissue AGE accumulation, in patients with carotid artery stenosis with and without coexisting peripheral artery occlusive disease (PAOD). SAF was measured using the AGE Reader™ in 56 patients with carotid artery stenosis and in 56 age- and sex-matched healthy controls without diabetes, renal dysfunction or known atherosclerotic disease. SAF was higher in patients with carotid artery stenosis compared to the control group: mean 2.81 versus 2.46 (P = 0.002), but especially in the younger age group of 50-60 years old: mean 2.82 versus 1.94 (P = 0.000). Patients with carotid artery stenosis and PAOD proved to have an even higher SAF than patients with carotid artery stenosis only: mean 3.28 versus 2.66 (P = 0.003). Backward linear regression analysis showed that age, smoking, diabetes mellitus, renal function and the presence of PAOD were the determinants of SAF, but carotid artery stenosis was not. SAF is increased in patients with carotid artery stenosis and PAOD. The univariate and multivariate associations of SAF with age, smoking, diabetes, renal insufficiency and PAOD suggest that increased SAF can be seen as an indicator of widespread atherosclerosis.

  10. Cone pathway function in relation to asymmetric carotid artery stenosis

    DEFF Research Database (Denmark)

    Kofoed, Peter Kristian; Munch, Inger Christine; Holfort, Stig K;

    2013-01-01

    in the same patient. Results:  Ophthalmic systolic pressure was 95.8 ± 13.1 mmHg on the side with the highest degree of carotid artery stenosis (mean 94.0%) and 111.7 ± 10.3 mmHg in the fellow eyes on the side with the lesser degree of stenosis (mean 33.9%). Summed mfERG implicit times (N1 and P1) were 3......Purpose:  To examine retinal function in relation to retinal perfusion pressure in patients with carotid artery stenosis. Methods:  Thirteen patients with carotid artery stenosis without clinical eye disease underwent assessment of ophthalmic artery systolic blood pressure (OSP) by ocular...... pneumoplethysmography, carotid artery obstructive disease by ultrasonography, intraocular pressure by applanation tonometry, retinal perfusion by fluorescein angiography and retinal function by multifocal electroretinography (mfERG). Data analysis compared the eye on the most stenotic side with the fellow eye...

  11. Prevalence of significant carotid artery stenosis in Iranian patients with peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Ghabili K

    2011-10-01

    Full Text Available Abolhassan Shakeri Bavil1, Kamyar Ghabili2, Seyed Ebrahim Daneshmand3, Masoud Nemati3, Moslem Shakeri Bavil4, Hossein Namdar5, Sheyda Shaafi61Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 3Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran; 4Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran; 5Department of Cardiology, Tabriz University of Medical Sciences, Tabriz, Iran; 6Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Generalized screening for carotid artery stenosis with carotid duplex ultrasonography in patients with peripheral arterial disease is controversial.Objectives: The aim of the present study was to determine the prevalence of significant internal carotid artery (ICA stenosis in a group of Iranian patients with peripheral arterial disease.Methods: We prospectively screened 120 patients with a known diagnosis of peripheral vascular disease for carotid artery stenosis. Based on the angiographic assessment of abdominal aorta and arteries of the lower extremities, patients with stenosis greater than 70% in the lower extremity arteries were included. A group of healthy individuals aged ≥50 years was recruited as a control. Risk factors for atherosclerosis including smoking, diabetes mellitus, hyperlipidemia, ischemic heart disease, and cerebrovascular disease were recorded. Common carotid arteries (CCAs and the origins of the internal and external arteries were scanned with B-mode ultrasonogaphy. Significant ICA stenosis, >70% ICA stenosis but less than near occlusion of the ICA, was diagnosed when the ICA/CCA peak systolic velocity ratio was ≥3.5.Results: Ninety-five patients, with a mean age of 58.52 ± 11.04 years, were studied. Twenty-five patients had a history of smoking, six

  12. Radiation induced renal arterial stenosis detected by color duplex ultrasonography: case report

    Institute of Scientific and Technical Information of China (English)

    Jing Gao; Byong K Park; Arnold Alday

    2005-01-01

    Renal artery stenosis as a complication from radiation therapy is not common, but it is life threatening and needs to be corrected urgently in order to prevent renal failure even losing kidney. The diagnostic criteria of renal artery stenosis in the adults by color duplex ultrasonography have been established, which may play an important role in screening radiation induced renal artery stenosis.

  13. Subclavian artery stenosis caused by a prominent first rib

    Directory of Open Access Journals (Sweden)

    Isabelle Claus

    2015-04-01

    Full Text Available Thoracic outlet syndrome is a mechanical space problem in which the brachial plexus and/or subclavian vessels are compressed. Arterial compression is least common and almost always associated with a bony anomaly. We present a case of a 49-year-old woman with a prominent first rib which caused a subclavian artery stenosis. There are many options for subclavian artery repair through open surgery. In high-risk patients, minimal invasive techniques are favorable. To date, few case reports exist on an endovascular artery repair combined with open first rib resection. While long-term follow-up will be necessary, our preliminary results seem promising.

  14. Model Validation for a Noninvasive Arterial Stenosis Detection Problem

    Science.gov (United States)

    2013-06-09

    equation, Journal of Scientific Computing, 27 (2006), 5–40. 15 [2] M. Akay, Noninvasive detection of coronary artery disease using advanced signal...Model validation for a noninvasive arterial stenosis detection problem H.T. Banks, Shuhua Hu and Zackary R. Kenz Center for Research in Scientific...qmul.ac.uk Blizard Institute, Barts and the London School of Medicine and Dentistry , Queen Mary, University of London, England. M. J. Birch m.j.birch

  15. How to manage hypertension with atherosclerotic renal artery stenosis?

    Science.gov (United States)

    Ricco, Jean-Baptiste; Belmonte, Romain; Illuminati, Guilio; Barral, Xavier; Schneider, Fabrice; Chavent, Bertrand

    2017-04-01

    The management of atherosclerotic renal artery stenosis (ARAS) in patients with hypertension has been the topic of great controversy. Major contemporary clinical trials such as the Cardiovascular Outcomes for Renal Artery lesions (CORAL) and Angioplasty and Stenting for Renal Atherosclerotic lesions (ASTRAL) have failed to show significant benefit of revascularization over medical management in controlling blood pressure and preserving renal function. We present here the implications and limitations of these trials and formulate recommendations for management of ARAS.

  16. Angioplasty and stent treatment of transplant renal artery stenosis.

    Science.gov (United States)

    Del Pozo, Maitane; Martí, Jordi; Guirado, Lluís; Facundo, Carme; Canal, Cristina; de la Torre, Pablo; Ballarín, José; Díaz, Joan M

    2012-07-17

    Transplant renal artery stenosis is a major complication that requires a therapeutic approach involving surgery or angioplasty. The aim of this study was to analyse the evolution of renal transplant patients with renal allograft artery stenosis treated by angioplasty and stent placement. Thirteen patients were diagnosed with transplant renal artery stenosis. Clinical suspicion was based on deterioration of renal function and/or poorly controlled hypertension with compatible Doppler ultrasound findings. The diagnosis was confirmed by arteriography, performing an angioplasty with stent placement during the same operation. A progressive improvement in renal function was observed during the first 3 months after the angioplasty, and renal function then remained stable over 2 years. In addition, blood pressure improved during the first 2 years, and as a consequence there was no need to increase the average number of anti-hypertensive drugs administered (2.5 drugs per patient). In conclusion, angioplasty with stent placement is a safe and effective procedure for the treatment of transplant renal artery stenosis.

  17. Clinical analysis of 132 patients with atherosclerotic renal artery stenosis

    Institute of Scientific and Technical Information of China (English)

    徐红

    2006-01-01

    Objective To evaluate the prognostic result of renal function on atherosclerotic renal artery stenosis (ARAS) patients after revascularization and medication therapy. Methods The clinical data of 132 AEIAS patients diagnosed by renal angiography were analysed. For comparing the differences of glomenilar filtration rate (GFR) be-

  18. Study on the screening program and risk factors of carotid artery stenosis with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    李庆祥

    2013-01-01

    Objective The purpose of this research project was to evaluate the relationship and risk factors between coronary artery disease and carotid artery stenosis (CAS) ,screened by duplex ultra-sonography.Methods 1339 patients with coronary artery disease were enrolled into this

  19. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS): prevalence and outcome

    NARCIS (Netherlands)

    Compter, A.; Hoeven, E.J. van der; Worp, H.B. van der; Vos, J.A.; Weimar, C.; Rueckert, C.M.; Kappelle, L.J.; Algra, A.; Schonewille, W.J.; Leeuw, F.E. de

    2015-01-01

    We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT an

  20. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS) : prevalence and outcome

    NARCIS (Netherlands)

    Compter, Annette; van der Hoeven, Erik J R J; van der Worp, H. Bart; Vos, Jan Albert; Weimar, Christian; Rueckert, Christina M.; Kappelle, L. Jaap; Algra, Ale; Schonewille, Wouter J.; Vergouwen, MD

    2015-01-01

    We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT an

  1. Evaluation of stenosis degree of the middle cerebral artery with high-resolution MRI and brian blood supply with MR perfusion weighted imaging%高分辨率MRI评价大脑中动脉狭窄程度与灌注加权成像评估脑供血的研究

    Institute of Scientific and Technical Information of China (English)

    崔恒; 程敬亮; 张勇

    2012-01-01

    Objective To study the value of high-resolution MRI(HRMRI) and MR perfusion weighted imaging(PWI) in evaluating the middle cerebral artery (MCA) stenosis degree and the brian blood supply. Methods PWI was performed in 30 patients with unilateral stenosis of MCA was diagnosed by HRMRI. The cerebral perfusion parameters including regional cerebral blood volume (rCBV) .regional cerebral blood flow(rCBF) .regional mean transit time(rMTT) and regional time to peak(rTTP) of the both cerebral hemispheres were quantitatively analysed. Results Among 30 patients, the MCA stenosis diagnosed by HRMRI as mild in 7, moderate in 9 and severe or acclusion in 14,respectively. Abnormal perfusion presented in all cases. The perfusion parameters (rCBF, rMTT and rTTP) had statistical significance. Between the rate of MCA moderate stenosis, severe stenosis or occlusion and the increase rate of rMTT showed a positive correlation(r=0. 897 and 0. 829 respectively,P<0. 01). Conclusion There is significantly value in evaluation of the MCA stenosis degree by HRMRI, which in combination with PWI to assess brain blood supply is of important value for clinic.%目的 探讨高分辨率MRI(high-resolution MRI,HRMRI)判定大脑中动脉(middle cerebral artery,MCA)狭窄程度与脑MRI灌注加权成像(perfusion weighted imaging,PWI)评价脑供血的价值.方法 对30例短暂性脑缺血(TIA)患者行HRMRI以判定单侧MCA狭窄程度,并行MRI PWI检查,得出患侧和镜像侧灌注参数,包括相对脑血容量(relative cerebral blood volume,rCBV)、相对脑血流量(relative cerebral blood flow,rBCF)、相对平均通过时间(relative mean transit time,rMTT)、相对达峰时间(relative time to peak,rTTP),并对其进行定量分析.结果 30例患者中,HRMRI判定MCA轻度狭窄7例,中度狭窄9例,重度狭窄或闭塞14例;30例灌注均出现异常,rCBF、rMTT、rTTP灌注参数均具有统计学意义,其中MCA中度、重度狭窄或闭塞组狭窄率与r

  2. Prediction of Carotid Artery Stenosis in Candidates of Coronary Artery Bypasses Surgery by A Scoring System.

    Directory of Open Access Journals (Sweden)

    Sh. Shirani

    2007-05-01

    Full Text Available Background and Objective: Up to 9% of coronary ar-tery bypass grafting (CABG patients suffer from stroke after the surgery. Although post CABG stroke has multiple etiologies, stenosis of cervical carotid arteries is an important factor. Many studies have evaluated carotid artery stenosis in CABG. Carotid stenosis and its related factors and a new scoring sys-tem for selection of CABG patients for Doppler study are introduced. Materials and methods: 1721 consecutive cases of non-urgent CABG were evaluated for presence of significant carotid stenosis (> 50% stenosis. The asso-ciation of age, sex, hypertension, smoking, diabetes, dislipidemia and left main coronary stenosis with ca-rotid stenosis was evaluated. For introducing a scor-ing method, absence of each related factor was scored by 1 and its presence by 2. The score range for each patient was from 5 (none of related factors up to 10 (all of related factors. Results: 7% of patients suffered from significant stenosis. Female gender, age more than 55 years old, hypertension, diabetes, and stenosis of left main coronary artery were the related risk factors in uni-variate analysis. A step type analysis revealed patients with score 5 have 98.3% negative predictive value (NPV for significant stenosis with 96.2% sensitivity and 13.9% specificity. Patients with score 10 have 93.9% NPV for significant stenosis with 99.9% speci-ficity. Conclusion: This scoring system may help for better selection of patients for Doppler study before CABG.

  3. Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

    Directory of Open Access Journals (Sweden)

    Min Li

    2015-01-01

    Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

  4. Acute upregulation of COX-2 by renal artery stenosis

    DEFF Research Database (Denmark)

    Mann, Birgitte; Hartner, A; Jensen, B L

    2001-01-01

    This study aimed to characterize the influence of acute renal artery stenosis on cyclooxygenase-2 (COX-2) and renin expression in the juxtaglomerular apparatus. For this purpose, male Sprague-Dawley rats received a left renal artery clip, and COX-2 mRNA, COX-2 immunoreactivity, plasma renin...... causal relationship between the changes of COX-2 and of renin expression, clipped rats were treated with the COX-2 blocker celecoxib (40 mg. kg(-1). day(-1)). This treatment, however, did not change renin mRNA either in the clipped or in the contralateral intact kidney. Our findings indicate that renal...... artery stenosis causes ipsilaterally an acute upregulation and contralaterally a downregulation of juxtaglomerular COX-2 expression. The lacking effect of celecoxib on renin gene expression does not support the concept of a direct mediator function of COX-2-derived prostaglandins in the control of renin...

  5. 脑血管重度狭窄患者脑代谢与脑血流损害特点初步研究%Initial research on the damaged characteristics of cerebral glucose metabolism and cerebral blood flow in patients with severe cerebral artery stenosis

    Institute of Scientific and Technical Information of China (English)

    崔璨; 马云川; 王曼; 苏玉盛; 彭程; 张琳瑛; 刘亭廷; 尚建文; 仇英

    2014-01-01

    目的:探讨脑血管重度狭窄或闭塞患者脑葡萄糖代谢与脑血流灌注的受损特点。方法采用18F-FDG和13N-Ammonia PET联合脑显像,对33例缺血性脑血管病(ICVD)患者进行检查,获得同期脑葡萄糖代谢和脑血流灌注影像。经半定量分析,得到脑代谢减低率、脑血流减低率和脑代谢/脑血流比值。结果①共发现病灶121个,18F-FDG显像阳性率为91.7%,13N-Ammonia显像阳性率为78.5%。②ICVD病灶呈多灶性和不对称性分布。③根据两种影像的匹配性,将病灶分为两大类(5种类型):匹配型(I型)病灶66个,占54.5%;不匹配型(II型~V型)病灶55个,占45.5%。④以脑代谢/脑血流比值为指标,匹配型病灶的比值为1.10±0.13;不匹配型病灶比值增高组的95%CI为1.28~1.56,比值减低组的95%CI为0.95~1.08。将脑代谢/脑血流比值1.1~1.3作为区分匹配型与不匹配型的标准。⑤以脑代谢减低率和脑血流减低率为指标,将66个匹配型病灶分为轻度、中度、重度受损3组,各组之间的脑代谢、脑血流减低率差异均有统计学意义(χ2=56.854和56.800,P均<0.01)。其中,轻度受损病灶27个,占40.9%;中度受损病灶15个病灶,占22.7%;重度受损病灶24个,占36.4%。⑥4例单侧脑内病变者可见交叉性小脑失联络。结论脑血管重度狭窄患者脑代谢与脑血流的匹配关系明显受损,但其中存在着不同程度的脑代谢与脑血流损害;脑代谢-脑血流联合PET显像在脑血管重度狭窄患者脑损伤程度的评估中具有重要意义和应用价值。%Objective To investigate the damaged characteristics of cerebral glucose metabolism (CGM)and cerebral blood flow (CBF)in ischemic cerebrovascular disease (ICVD)patients with severe cerebral artery stenosis or occlusion. Methods Thirty-three cases of ICVD patients were examined by 18F-FDG PET and 13N

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    Lučić-Prokin Aleksandra

    2015-01-01

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

  8. A case of William's syndrome associated peripheral pulmonary arterial stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Kyung Hwa; Hwang, Mi Soo; Kim, Sun Yong; Chang, Jae Chun; Park, Bok Hwan [College of Medicine, Yeungam University, Daegu (Korea, Republic of)

    1988-06-15

    William's syndrome, in order to more completely delineate the total spectrum of the disorder, indicates that 'infantile hypercalcemia', 'peculiar facies' and 'supravalvular aortic stenosis.' In has other many vascular anomalies, such as peripheral pulmonary arterial stenosis, coronary arterial stenosis, celiac arterial stenosis, and renal aterial stenosis. Only 32% of the patients have evidence of supravalvular aortic stenosis. And it is very rare disease entity that has been reported rarely in Korea. Recently authors experienced a case that was questioned William's syndrome with peripheral pulmonary arterial stenosis, clinically and preliminary radiologically and this case was confirmed by operation. Here we report a case of William's syndrome with peripheral pulmonary arterial stenosis and reviewed literatures.

  9. Effects of non Newtonian spiral blood flow through arterial stenosis

    Science.gov (United States)

    Hasan, Md. Mahmudul; Maruf, Mahbub Alam; Ali, Mohammad

    2016-07-01

    The spiral component of blood flow has both beneficial and detrimental effects in human circulatory system. A numerical investigation is carried out to analyze the effect of spiral blood flow through an axisymmetric three dimensional artery having 75% stenosis at the center. Blood is assumed as a Non-Newtonian fluid. Standard k-ω model is used for the simulation with the Reynolds number of 1000. A parabolic velocity profile with spiral flow is used as inlet boundary condition. The peak values of all velocity components are found just after stenosis. But total pressure gradually decreases at downstream. Spiral flow of blood has significant effects on tangential component of velocity. However, the effect is mild for radial and axial velocity components. The peak value of wall shear stress is at the stenosis zone and decreases rapidly in downstream. The effect of spiral flow is significant for turbulent kinetic energy. Detailed investigation and relevant pathological issues are delineated throughout the paper.

  10. [Role of angioplasty in the treatment of renal artery stenosis].

    Science.gov (United States)

    Armero, S; Bonello, L; Paganelli, F; Barragan, P; Roquebert, P-O; Commeau, P

    2011-12-01

    Atherosclerotic renal artery stenosis is frequent and is associated with a high incidence of morbidity and mortality, with a strong correlation with coronary artery disease, (Kalra et al., 2005; Cheung et al., 2002; Guo et al., 2007 [1-3]). The atherosclerotic renal artery stenosis is an independent predictive factor of death (Conlon et al., 1998 [4]). The treatment of this lesion does not have strong evidence. A lot of studies in this area suggest the angioplasty is superior in a big majority between surgery, and angioplasty with stent is superior between balloon angioplasty, but some studies fail to prove the superiority of angioplasty versus medical treatment. These studies have sadly a lot of mistakes and nowadays we don't know what is the treatment for our patients in a lot of cases. The angioplasty is indicated when there is a failure of antihypertensive medications for control of blood pressure, when it is associated with a renal insufficiency quickly progressive or when there is a lesion on each renal artery. Other studies must be organized for prove the superiority of angioplasty when there is a real stenosis, maybe with the use of fractional flow reserve.

  11. A case of valvular pulmonic stenosis and an aberrant coronary artery in a Brittany spaniel.

    Science.gov (United States)

    Estey, Chelsie

    2011-05-01

    Valvular pulmonic stenosis and aberrancy of the right coronary artery with subsequent subvalvular stenosis was found on echocardiographic evaluation of a 9-month-old Brittany spaniel. Previous echocardiography at 4 mo of age revealed the pulmonic stenosis; however, the aberrant coronary artery only became apparent during the second evaluation.

  12. Combined application of distal and proximal embolic protection devices in endovascular stenting for severe carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    Zhi-hua DU

    2011-09-01

    Full Text Available Objective To analyze and summarize methods and experiences of combined application of distal and proximal embolic protection devices(EPD in endovascular stenting for severe carotid artery stenosis.Methods Five patients with severe stenosis of the common carotid artery or with extracranial segment of the internal carotid artery diagnosed through digital subtraction angiography(DSA from March to July 2010 were involved in the present study.All patients received carotid angioplasty and stenting(CAS,with a combination of distal and proximal EPD via the percutaneous femoral artery approach.Results The operation failed in one patient,whereas technical success with no intraoperative complication was achieved in four patients.The symptoms disappeared or improved in the four cases that achieved technical success.The follow-up duration was one to three months,and no cerebral ischemia was found.Conclusion CAS with the combined application of distal and proximal EPD in some special cases of carotid artery stenosis may surmount the shortage of single EPD,reduce the risk of intraoperative embolization,decrease the time of intraoperative endovascular inflow occlusion,and reduce high-risk operations.CAS may be used as an individualized treatment strategy for patients with carotid artery stenosis.

  13. Clinical features of renal artery stenosis in elderly patients

    Institute of Scientific and Technical Information of China (English)

    TANG Ri-ning; LIU Bi-cheng; REN li-qun; WANG Yan-li; MA Gen-shan

    2007-01-01

    @@ Together with an increasingly aging world population there is also an increasing prevalence of atherosclerosis. Renal artery stenosis (RAS) is one of the systemic manifestations of atherosclerosis. Its incidence is about 15%-35%.1 RAS accounts for 5%-27% of all patients with end-stage renal disease (ESRD).2 Patients with renal dysfunction resulting from RAS are at risk of death from cardiovascular disease and ESRD.3

  14. Skin autofluorescence is increased in patients with carotid artery stenosis and peripheral artery disease

    NARCIS (Netherlands)

    Noordzij, Marjon J.; Lefrandt, Joop D.; Loeffen, Erik A. H.; Saleem, Ben R.; Meerwaldt, Robbert; Lutgers, Helen L.; Smit, Andries J.; Zeebregts, Clark J.

    2012-01-01

    Advanced glycation end products (AGEs) have a pivotal role in atherosclerosis. We evaluated skin autofluorescence (SAF), a non-invasive measurement of tissue AGE accumulation, in patients with carotid artery stenosis with and without coexisting peripheral artery occlusive disease (PAOD). SAF was mea

  15. 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.

  16. [Is there a role for asymptomatic carotid artery stenosis screening?].

    Science.gov (United States)

    Heldenberg, Eitan; Bass, Arie

    2014-08-01

    Screening for asymptomatic carotid artery stenosis (CAS) is highly controversial Many surgeons routinely screen their patients for carotid disease prior to major operations, yet the benefit of such practice was never demonstrated. The treatment of symptomatic patients has not changed much during the last twenty years, since the publication of the North American Symptomatic Carotid Endarterectomy Trial (NASCET). However, in contrast, the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST) failed to get the same acceptance among the multidisciplinary group treating CAS.The prevalence of asymptomatic 60-99% carotid artery stenosis among the general population is about 1%. Neither ACAS nor ACST showed that stenosis severity was associated with increasing stroke risk. The 'realpolitik' is that mass interventions in asymptomatic patients will probably only ever prevent about 1% of all strokes. This is even truer regarding patients scheduLed for major operation, in which the incidence of stroke is less than 1%. Moreover the current evidence in the literature suggests that the best medicaL treatment (BMT) results in 0.5% strokes per year, better than resuLts which can be offered by surgery. According to the current evidence, it seems that asymptomatic carotid artery screening should be discontinued, since it is a major waste of resources.

  17. Significance of coronary artery calcification demonstrated by computed tomography in detecting coronary artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Shiraki, Teruo; Akiyama, Yoko; Kita, Masahide [Iwakuni national Hospital, Yamaguchi (Japan)] [and others

    2002-02-01

    Serial 27 patients with angina attack were enrolled in this trial. Plain computed tomography (CT) of the chest and coronary angiogram were performed simultaneously. Calcification of main branch of coronary arteies (left main trunk, left anterior desending artery, left circumflex artery, right coronary artery) was judged visually. More than 50% stenosis was defined significant by quantitative coronary angiogram. Correlation between calcified lesions detected by CT and angiographic stenoses showed high specificity and negative predictive value was also high (sensitity=58%, specificity=80%, positive predictive value=27%, negative predictive value=94%, p<0.05). There was no significant correlation between patients with calcification of corornary artery and angiographic stenosis. The present study showed the low probability of significant stenosis without calcification and the high probability with multiple calcified lesions. (author)

  18. 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

  19. Waveform patterns and peak reversed velocity in vertebral arteries predict severe subclavian artery stenosis and occlusion.

    Science.gov (United States)

    Chen, Shun-Ping; Hu, Yuan-Ping

    2015-05-01

    This study investigated the value of analyzing spectral Doppler waveform patterns and measuring the peak reversed velocity (PRV) of the vertebral artery (VA) in predicting proximal severe subclavian artery (SA) stenosis and occlusion. Fifty-one patients with proximal SA stenosis were studied retrospectively. Based on the depth of the mid-systolic notch, the Doppler waveforms of the ipsilateral VA were divided into five subtypes (type I, n = 8; type II, n = 8; type III, n = 6; type IV, n = 13; and type V, n = 16). PRV was also measured. PRV receiver operating characteristic curves were constructed to obtain the best cutoff value for predicting severe SA stenosis or complete SA occlusion. The results indicated that both VA Doppler waveform and PRV were associated with the degree of SA stenosis (p waveform in the VA had similar accuracy in predicting SA occlusion (84.3%, 43/51). PRV was more accurate than VA waveforms in predicting severe SA stenosis (98%, 50/51 vs. 94.1%, 48/51). However, no significant differences between the two methods in predicting severe SA stenosis were observed (p = 0.84). Thus, with severe obstruction of the SA, typical Doppler waveform patterns of the VA could be observed. PRV is a helpful criterion in predicting severe stenosis and occlusion of the SA.

  20. EVALUATION OF CAROTID ARTERY STENOSIS IN STROKE/TRANSIENT ISCHAEMIC ATTACK

    OpenAIRE

    Nambakam Tanuja; Naveen Kumar; Girish P.

    2015-01-01

    BACKGROUND : Stroke remains the second leading cause of death worldwide, after ischaemic heart disease. Patients with carotid artery stenosis are at higher risk of development of stroke. Carotid atherosclerosis occurs in patients with atheros clerotic risk factors like diabetes mellitus, hypertension, smoking and hyperlipidemia. Carotid artery stenosis can be assessed by means of noninvasive high - resolution B - mode ultrasonography of the carotid arteries. ...

  1. Computational hemodynamic study of intracranial aneurysms coexistent with proximal artery stenosis

    Science.gov (United States)

    Castro, Marcelo A.; Peloc, Nora L.; Putman, Christopher M.; Cebral, Juan R.

    2012-03-01

    Intracranial aneurysms and artery stenosis are vascular diseases with different pathophysiological characteristics. However, although unusual, aneurysms may coexist in up to 5% of patients with stenotic plaque, according to a previous study. Another study showed that incidental detection of cerebral aneurysm in the same cerebral circulation as the stenotic plaque was less than 2%. Patients with concomitant carotid artery stenosis and unruptured intracranial aneurysms pose a difficult management decision for the physician. Case reports showed patients who died due to aneurysm rupture months after endarterectomy but before aneurysm clipping, while others did not show any change in the aneurysm after plaque removal, having optimum outcome after aneurysm coiling. The purpose of this study is to investigate the intraaneurysmal hemodynamic changes before and after treatment of stenotic plaque. Idealized models were constructed with different stenotic grade, distance and relative position to the aneurysm. Digital removal of the stenotic plaque was performed in the reconstructed model of a patient with both pathologies. Computational fluid dynamic simulations were performed using a finite element method approach. Blood velocity field and hemodynamic forces were recorded and analyzed. Changes in the flow patterns and wall shear stress values and distributions were observed in both ideal and image-based models. Detailed investigation of wall shear stress distributions in patients with both pathologies is required to make the best management decision.

  2. Massive cerebral arterial air embolism following arterial catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Yang, C.W. [Northwestem University Feinberg School of Medicine, Department of Radiology, Chicago, IL (United States); Yang, B.P. [Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, Chicago, IL (United States)

    2005-12-01

    Microscopic cerebral arterial air embolism (CAAE) has been described in many patients undergoing cardiac surgery as well as other invasive diagnostic and therapeutic procedures. However, massive CAAE is rare. We report a 42-year-old woman who initially presented with thalamic and basal ganglia hemorrhages. Shortly after a radial arterial catheter was inserted, the patient suffered a generalized seizure and CT demonstrated intra-arterial air in bilateral cerebral hemispheres. (orig.)

  3. Clinical significance of balloon dilatation angiography during cerebral venous sinus stenosis stenting

    Directory of Open Access Journals (Sweden)

    Xiang-yu CAO

    2016-12-01

    Full Text Available Objective To explore the clinical significance of balloon dilatation angiography during cerebral venous sinus stenosis stenting to predict the reflux of perforator veins after operation. Methods A total of 93 patients (including 51 with cerebral venous sinus stenosis and intracranial hypertension and 42 with intractable pulsatile tinnitus caused by cerebral venous sinus stenosis who were treated by stent implantation were analyzed retrospectively. Among those patients, the diameter of transverse and sigmoid sinuses of 63 cases were measured based on angiography, and stent was selected according to the measurement result. The other 30 cases were given angiography on ipsilateral carotid artery or vertebral artery when the balloon was dilated in the venous sinus to confirm the reflux of perforator veins. If the venous reflux decreased in the angiography, stent with diameter 1-2 mm less than that of venous sinus could be selected.  Results The success rate of stenting was 100% (93/93. In 63 cases, 45 cases were planted 9 mm × 40 mm stents, 15 were planted 8 mm × 40 mm stents, 3 were planted 7 mm × 40 mm stents. The average diameter of stents was (8.67 ± 0.68 mm. There were 11 cases (17.46% with slow perforator venous reflux after operation. In the other 30 cases, 3 cases were planted 8 mm × 40 mm stents, 11 were planted 7 mm × 40 mm stents, and 16 were planted 6 mm × 40 mm stents. The average diameter of stents was (7.57 ± 0.67 mm. There was only one case (3.33% with slow perforator venous reflux after operation. The difference of stent diameter between 2 groups was statistically significant (t = 15.632, P = 0.001. The occurrence rate of perforator vein occlusion after operation between 2 groups was significantly different (adjusted χ 2 = 60.065, P = 0.001.  Conclusions Perforator vein occlusion after cerebral venous sinus stenting is common complication. Balloon dilatation angiography could predict the possibility of perforator vein

  4. Conjunctival-corneal melt in association with carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    Rosalind MK Stewart

    2008-10-01

    Full Text Available Rosalind MK Stewart1, Say Aun Quah1, Dan Q Nguyen2, Stephen B Kaye11Royal Liverpool University Hospital, Liverpool, UK; 2Bristol Eye Hospital, Bristol, UKPurpose: To report a case of severe conjunctival-corneal melt in association with carotid artery stenosis.Methods: Observational case report.Results: A 76-year-old man with a history of bilateral severe carotid artery occlusion and nonarteritic ischemic optic neuropathy developed a spontaneous bulbar conjunctival defect. Despite intensive lubrication, and attempts at surgical closure including an amniotic membrane patch graft, it progressed with subsequent adjacent corneal perforation. Thorough investigations revealed no underlying disease, except markedly delayed episcleral vessel filling on anterior segment fluorescein angiography.Conclusions: Neovascularisation is a known factor in the inhibition of ulceration. In light of the findings in this report, ocular ischemia should be considered as a cause or contributing factor in the differential diagnosis of conjunctival-corneal melt.Keywords: conjunctival melt, corneal melt, ocular ischemia, carotid artery stenosis

  5. Diabetes is a predictor of coronary artery stenosis in patients hospitalized with heart failure.

    Science.gov (United States)

    Kosuga, Tsuneharu; Komukai, Kimiaki; Miyanaga, Satoru; Kubota, Takeyuki; Nakata, Kotaro; Suzuki, Kenichiro; Yamada, Takayuki; Yoshida, Jun; Kimura, Haruka; Yoshimura, Michihiro

    2016-05-01

    In patients with heart failure, coronary artery disease is the most common underlying heart disease, and is associated with increased mortality. However, estimating the presence or absence of coronary artery disease in patients with heart failure is sometimes difficult without coronary imaging. We reviewed 155 consecutive patients hospitalized with heart failure who underwent coronary angiography. The patients were divided into two groups: patients with (N = 59) and without (N = 96) coronary artery stenosis. The clinical characteristics and blood sampling data were compared between the two groups. The patients with coronary artery stenosis were older than those without. The prevalence of diabetes mellitus (DM), dyslipidemia and a history of revascularization was higher in the patients with coronary artery stenosis. Patients with coronary artery stenosis tended to have wall motion asynergy more frequently than those without. On the other hand, the prevalence of atrial fibrillation (AF) was lower in patients with coronary artery stenosis. The serum hemoglobin level and estimated glomerular filtration rate were lower in patients with coronary artery stenosis than in those without. In the multivariate analysis, DM (odds ratio 3.517, 95 % CI 1.601-7.727) was found to be the only the predictor of the presence of coronary artery stenosis in patients with heart failure. In conclusion, coronary imaging is strongly recommended for heart failure patients with DM to confirm the presence of coronary artery stenosis.

  6. Middle cerebral artery blood velocity during running

    DEFF Research Database (Denmark)

    Lyngeraa, Tobias; Pedersen, Lars Møller; Mantoni, T;

    2013-01-01

    Running induces characteristic fluctuations in blood pressure (BP) of unknown consequence for organ blood flow. We hypothesized that running-induced BP oscillations are transferred to the cerebral vasculature. In 15 healthy volunteers, transcranial Doppler-determined middle cerebral artery (MCA....... During running, rhythmic oscillations in arterial BP induced by interference between HR and step frequency impact on cerebral blood velocity. For the exercise as a whole, average MCA velocity becomes elevated. These results suggest that running not only induces an increase in regional cerebral blood flow...

  7. Hyperperfusion syndrome after stent implantation for stenosis of cerebral artery: report of 2 cases and literature review%脑动脉狭窄支架植入术后并发高灌注综合征2例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    阿不都拉艾沙; 徐锋; 宋冬雷

    2013-01-01

    Objective:To discuss the cause,risk factors and prophylactic measures for syndrome of hyperperfu-sion after stent implantation for stenosis of seribral artery. Method:Clinical data of 2 cases of arterial stenosis with the complication of Hyperperfusion syndrome after stent implantation and the pertinent literatures were reviewed. Result; A patient with stenosis in right initial segment of internal carotid artery and Ml segment of right Middle cerebral artery that was implanted with a stent each suffered from intracranial hemorrhage 4 hours after operation. The patient eventually died despite of active rescue. In another patient with stenosis in the initial segment of internal carotid artery,initial and cervical segment of veterbral artery that was treated with a stent each,subarachnoid hemorrhage occurred 6 hours after stent implantation. Conclusion:Old age,severe stenosis,decreased reserve capacity of blood flow or reactivity of blood vessels,occlusion of contralateral carotid artery concurrent with chronic iso-lateral low perfusion,preoperative and postoperative hypertension are risk factors responsible for postoperative hyperperfusion syndrome. Strict control of blood pressure and monitoring with transcranial doppler are important in-preventing the occurrence of postoperative hyperperfusion syndrome.%目的:探讨症状性脑动脉狭窄支架置入术后并发高灌注综合征的原因,高危因素及预防措施.方法:对2例支架置入术后出现脑内血肿及蛛网膜下腔出血患者进行原因分析并复习文献.结果:1例右侧颈内动脉起始段及右侧大脑中动脉M1段狭窄患者,各置入1个支架,术后4h后出现颅内出血,经积极救治仍死亡;另1例患者于右侧颈内动脉、右侧椎动脉颈段及起始部置入3个支架,术后6h出现蛛网膜下腔出血,对症处理后痊愈出院.结论:高龄患者,重度狭窄且侧支循环欠佳,血流量的储备能力或血管的反应性低下,对侧颈动脉闭塞,具有

  8. Treatment of patients older than 60 years with symptomatic vertebrobasilar artery stenosis

    Institute of Scientific and Technical Information of China (English)

    WANG Da-ming; CHEN Hai-bo; LIU Jia-chun; LIU Fang; WANG Li-jun; LU Jun

    2008-01-01

    Background Vertebrobasilar artery stenosis is an important cause of ischemic posterior circulation strokes.This study aimed at evaluating the safety and efficacy of treatment including conservative therapy alone and conservative plus endovascular therapy for elderly patients with symptomatic vertebrobasilar artery stenosis.Methods Patients older than 60 years with symptomatic vertebrobasilar artery stenosis (≥50%) confirmed by cerebral angiography were enrolled.All of them were treated with medical therapy and some with additional stent-assisted angioplasty (the stenting subgroup).Their clinical,imaging,intervention and follow-up data were analyzed.Results One hundred and seventeen consecutive elderly patients (100 men,mean age (68.1±5.1) years) were enrolled and followed up for a mean time of 28.4 months:81.7% of fhem were symptomatically resolved or improved;a stroke rate of 5.1% and a stroke-related death rate of 1.7% were found among them during the hospitalization and follow-up.In the stenting subgroup,78 balloon expandable stents were employed in the 70 patients with a technical success rate of 98.7% and the mean degree of stenosis was significantly reduced from (81.7±14.3)% before stenting to(8.3±4.2)% after stenting (P<0.001).Four (5.7%) periprocedural strokes occurred,of whom two Ied to death within 30 days after the procedure.During the follow-up(mean 27.7 months),sixty of the surviving 68 patients in the stenting subgroup were symptomatically resolved or improved.Only one(1.5%) posterior circulation stroke occurred,while duplex ultrasound scan of 34 patients demonstrated 10 (29.4%) in-stent restenosis.Conclusions Appropriate utilization of conservative therapy alone and conservative plus endovascular therapy may improve short-term clinical outcomes for elderly patients with symptomatic vertebrobasilar artery stenosis.Furthermore.stent-assisted angioplasty is technically feasible and relatively safe in elderly patients.

  9. Non-Newtonian model study for blood flow through a tapered artery with a stenosis

    Directory of Open Access Journals (Sweden)

    Noreen Sher Akbar

    2016-03-01

    Full Text Available The blood flow through a tapered artery with a stenosis is analyzed, assuming the blood as tangent hyperbolic fluid model. The resulting nonlinear implicit system of partial differential equations is solved analytically with the help of perturbation method. The expressions for shear stress, velocity, flow rate, wall shear stress and longitudinal impedance are obtained. The variations of power law index m, Weissenberg number We, shape of stenosis n and stenosis size δ are discussed different type of tapered arteries.

  10. When stenting in renal artery stenosis? Update on pathophysiology of ischemic nephropathy and management strategies

    Directory of Open Access Journals (Sweden)

    Alessandro Zuccalà

    2013-11-01

    Full Text Available In recent years, decisions taken on the optimal management of patients with renal artery stenosis have triggered off controversy and debate among clinicians dealing with renovascular disease. The main reason underlying this ongoing controversy may be the heterogeneity of the clinical entities that are normally associated with the umbrella definition of renal artery stenosis. Indeed a causal link between the stenosis and its clinical consequences (i.e. hypertension, renal failure can often demonstrated in some entities, such as fibromuscular dysplasia, truncal stenosis or arterial stenosis in the transplanted kidney, which can be defined as pure renal artery stenosis. On the contrary, the entity generally called ostial stenosis is a disease of the abdominal aorta where it encroaches the ostium of the renal artery at the end of a long process involving the entire vascular tree. Patients affected by ostial stenosis also suffer from generalized atherosclerosis, and kidney damage is often caused by the atherosclerotic environment with the stenosis acting as an innocent bystander. This may account for the low rate of renal function recovery in subjects with ostial stenosis. In our view, keeping the different entities separate along with a careful understanding of the mechanisms underpinning renal damage, particularly the intrarenal activation of the renin angiotensin system which in turn induces renal inflammation and oxidative stress, may enable clinicians to make the right decisions in regard to revascularization.

  11. Prevalence of significant carotid artery stenosis in patients with transient ischaemic attack

    DEFF Research Database (Denmark)

    Rappeport, Yael; Simonsen, Lene; Christiansen, Hanne Hjertmann;

    2002-01-01

    Carotid artery stenosis is one of the risk factors for transient ischaemic attack (TIA) and stroke. The purpose of this study was to investigate the prevalence of carotid artery stenosis and the prevalence of candidates for carotid endarterectomy in a hospital-based cohort of TIA patients under 71...

  12. Symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Zi-Liang [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China); Gao, Bu-Lang [Department of Medical Research Shijiazhuang First Hospital, Hebei Medical University (China); Li, Tian-Xiao, E-mail: litianxiaod@163.com [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China); Cai, Dong-Yang; Zhu, Liang-Fu; Bai, Wei-Xing; Xue, Jiang-Yu; Li, Zhao-Shuo [Stroke Center, Henan Provincial People’s Hospital, Zhengzhou University (China)

    2015-09-15

    Highlights: • Symptomatic vertebral artery stenosis can be treated with intracranial stenting. • Stenting for intracranial vertebral artery stenosis is safe and effective. • Stenting for intracranial vertebral artery stenosis can prevent long-term stroke. - Abstract: Purpose: To investigate the safety, effect and instent restenosis rate of Wingspan stenting in treating patients with intracranial vertebral artery atherosclerotic stenosis (70–99%) concurrent with contralateral vertebral artery atherosclerotic diseases. Materials and methods: Eighty-eight patients with severe symptomatic intracranial vertebral artery atherosclerotic stenosis (≥70%) combined with contralateral vertebral artery atherosclerotic diseases were treated with the Wingpsan stent. All the baseline, cerebral angiography, success rate, perioperative complications, clinical and imaging follow-up data were prospectively analyzed. Results: The success rate of stenting was 100%, and the mean stenotic rate was reduced from prestenting (84.9 ± 6.8)% to poststenting (17.2 ± 5.9)%. The perioperative stroke rate was 1.1%. Among eighty patients (90.9%) with clinical follow-up 8-62 months (mean 29.3 ± 17.2) poststenting, five (6.3%) had posterior circulation TIA only, three (3.8%) had mild stroke in the posterior circulation but recovered completely, and another five patients greater than 70 years old died of non-ischemic stroke. Imaging follow-up in 46 patients (52.3%) 5–54 months (mean 9.9 ± 9.9) following stenting revealed instent restenosis in 12 patients (26.1%) including 7 (58.3%) symptomatic restenosis. Age and residual stenosis were the two factors to significantly (P < 0.05) affect instent restenosis. Conclusion: Wingspan stenting in the intracranial vertebral artery atherosclerotic stenosis combined with contralateral vertebral artery atherosclerotic diseases has a low perioperative stroke rate and a good preventive effect on long-term ischemic stroke, but the instent restenosis

  13. Renal artery stenosis: Up-date on diagnosis and treatment.

    Science.gov (United States)

    Zeller, Thomas; Macharzina, Roland; Rastan, Aljoscha; Beschorner, Ulrich; Noory, Elias

    2014-01-01

    Significant renal artery stenosis (RAS) can cause or result in deterioration of arterial hypertension and may promote the development of renal insufficiency. The activation of the renin-angiotensin-aldosterone system results in structural heart disease and may impact patient survival. Technical improvements of diagnostic and interventional endovascular tools have led to a more widespread use of endoluminal renal artery revascularization and extension of the indications for this type of therapy during the past two decades. Whereas balloon angioplasty is still the method of choice for the treatment of fibromuscular dysplasia, stent implantation is indicated in ostial atherosclerotic RAS. However, none of the so far published or presented randomized controlled trials could prove a beneficial outcome of RAS revascularization compared to medical management. As a result of these negative trials including the largest published trial to date, the ASTRAL trial, referrals to endovascular renal artery revascularization have declined and, moreover, reimbursement of these procedures has become a matter of debate. Crucial for a clinical benefit following revascularization of RAS is proper patient selection, revascularization being only indicated after proof of hemodynamic relevance of RAS. This article summarizes the appropriate diagnostic work-up of patients with suspected RAS, discusses the limitations of the results published so far and their impact on the indication for RAS revascularization.

  14. Mathematical analysis of non-Newtonian blood flow in stenosis narrow arteries.

    Science.gov (United States)

    Sriyab, Somchai

    2014-01-01

    The flow of blood in narrow arteries with bell-shaped mild stenosis is investigated that treats blood as non-Newtonian fluid by using the K-L model. When skin friction and resistance of blood flow are normalized with respect to non-Newtonian blood in normal artery, the results present the effect of stenosis length. When skin friction and resistance of blood flow are normalized with respect to Newtonian blood in stenosis artery, the results present the effect of non-Newtonian blood. The effect of stenosis length and effect of non-Newtonian fluid on skin friction are consistent with the Casson model in which the skin friction increases with the increase of either stenosis length or the yield stress but the skin friction decreases with the increase of plasma viscosity coefficient. The effect of stenosis length and effect of non-Newtonian fluid on resistance of blood flow are contradictory. The resistance of blood flow (when normalized by non-Newtonian blood in normal artery) increases when either the plasma viscosity coefficient or the yield stress increases, but it decreases with the increase of stenosis length. The resistance of blood flow (when normalized by Newtonian blood in stenosis artery) decreases when either the plasma viscosity coefficient or the yield stress increases, but it decreases with the increase of stenosis length.

  15. The role of carotid artery stenting for recent cerebral ischemia.

    Science.gov (United States)

    Bosiers, M; Callaert, J; Deloose, K; Verbist, J; Keirse, K; Peeters, P

    2010-06-01

    Patients with cerebral ischemia as a result of acute cervical internal carotid artery occlusion are generally considered to have a poor prognosis. Despite maximal medical treatment, a better treatment for patients with acute ischemic stroke who present with serious neurologic symptoms on admission or continue to deteriorate neurologically due to a total occlusion, a dissection or a high-grade stenosis of the internal carotid artery is required. An effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established and represents a challenging and complex problem. Treatment of acute symptomatic occlusion of the cervical internal carotid artery includes intravenous administration of thrombolytic agent, carotid endarterectomy and an interventional approach (intra-arterial administration of thrombolytic agent, transluminal angioplasty with or without stenting). The endovascular interventional approach is becoming a part of the stroke therapy armamentarium for intracranial occlusion. It may also now be considered in select patients with acute internal carotid artery occlusion. Stenting and angioplasty for acute internal carotid artery occlusion appears to be feasible, safe and may be associated with early neurological improvement. The encouraging preliminary results await confirmation from prospective, randomized studies.

  16. Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting.

    Science.gov (United States)

    Tanaka, Akihito; Ishii, Hideki; Oshima, Hideki; Shibata, Yohei; Tatami, Yosuke; Osugi, Naohiro; Ota, Tomoyuki; Kawamura, Yoshihiro; Suzuki, Susumu; Usui, Akihiko; Murohara, Toyoaki

    2016-07-01

    Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.

  17. Computational modeling of fluid structural interaction in arterial stenosis

    Science.gov (United States)

    Bali, Leila; Boukedjane, Mouloud; Bahi, Lakhdar

    2013-12-01

    Atherosclerosis affects the arterial blood vessels causing stenosis because of which the artery hardens resulting in loss of elasticity in the affected region. In this paper, we present: an approach to model the fluid-structure interaction through such an atherosclerosis affected region of the artery, The blood is assumed as an incompressible Newtonian viscous fluid, and the vessel wall was treated as a thick-walled, incompressible and isotropic material with uniform mechanical properties. The numerical simulation has been studied in the context of The Navier-Stokes equations for an interaction with an elastic solid. The study of fluid flow and wall motion was initially carried out separately, Discretized forms of the transformed wall and flow equations, which are coupled through the boundary conditions at their interface, are obtained by control volume method and simultaneously to study the effects of wall deformability, solutions are obtained for both rigid and elastic walls. The results indicate that deformability of the wall causes an increase in the time average of pressure drop, but a decrease in the maximum wall shear stress. Displacement and stress distributions in the wall are presented.

  18. The prevalence and clinical predictors of incidental atherosclerotic renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ozkan, Ugur [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey)], E-mail: radugur@yahoo.com; Oguzkurt, Levent; Tercan, Fahri [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey); Nursal, Tarik Z. [Baskent University Faculty of Medicine, Department of General Surgery, Ankara/Turkey (Turkey)

    2009-03-15

    Objective: To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD). Materials and methods: To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%) (mean age {+-} S.D.: 61.5 {+-} 11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis ({>=}60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement). Results: Renal artery disease was found in 33% (207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n = 60) had significant ({>=}60%) renal artery stenosis. Only age and hypertension (blood pressure systolic >140 mmHg or diastolic >90 mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5 {+-} 8.9 years compared with 61 {+-} 11.2 years for patients without RAS (p < 0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p = 0.01). Conclusion: Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

  19. Coexistence of pheochromocytoma/praganglioma and renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Vijaya Sarathi

    2012-01-01

    Full Text Available Renal artery stenosis (RAS often coexists with pheochromocytoma (Pheo/paraganglioma (PGL and often alters the management of patients with Pheo/PGL. We have studied the prevalence of RAS in our Pheo/PGL patients. The study included 70 consecutive, histopathologically proven Pheo/PGL patients from a tertiary health care center. In 60 patients, tumors were limited to adrenal glands (54 unilateral and 6 bilateral while other 10 patients had extra-adrenal abdominal tumors. Five patients had RAS with an overall prevalence of 14%. Only two out of 60 patients with Pheo had RAS with a low prevalence of 3.3% while three out of 10 patients with extra-adrenal abdominal PGL had RAS with a prevalence of 30%. To conclude, RAS commonly coexists with Pheo/PGL, more often with extra-adrenal PGL.

  20. Mesenchymal stem cells and chronic renal artery stenosis.

    Science.gov (United States)

    Oliveira-Sales, Elizabeth B; Boim, Mirian A

    2016-01-01

    Renal artery stenosis is the main cause of renovascular hypertension and results in ischemic nephropathy characterized by inflammation, oxidative stress, microvascular loss, and fibrosis with consequent functional failure. Considering the limited number of strategies that effectively control renovascular hypertension and restore renal function, we propose that cell therapy may be a promising option based on the regenerative and immunosuppressive properties of stem cells. This review addresses the effects of mesenchymal stem cells (MSC) in an experimental animal model of renovascular hypertension known as 2 kidney-1 clip (2K-1C). Significant benefits of MSC treatment have been observed on blood pressure and renal structure of the stenotic kidney. The mechanisms involved are discussed.

  1. Pulmonary artery haemodynamic properties in patients with pulmonary hypertension secondary to rheumatic mitral stenosis.

    Science.gov (United States)

    Yan, Tao; Zhang, Guan-xin; Li, Bai-lin; Zhong, Keng; Xu, Zhi-yun; Han, Lin

    2012-12-01

    We sought to explore the pulmonary haemodynamic changes in rheumatic mitral stenosis patients with secondary pulmonary hypertension. The pulmonary artery resistance and compliance of 35 patients with rheumatic mitral stenosis and 12 controls without cardiopulmonary vascular disease were evaluated by using an improved method, which is based on making calculations with parameters obtained from right heart catheterisation. The results are as follows: (1) pulmonary artery compliance in patients with secondary pulmonary hypertension was significantly lower than that of the control group (P0.05) The walls of pulmonary artery vessels in patients with pulmonary hypertension secondary to rheumatic mitral stenosis appeared to be remodelled by varying degrees as indicated by their haemodynamic properties. Structural remodelling may be a factor affecting preoperative pulmonary artery pressure. Mitral stenosis patients with severe pulmonary hypertension have significantly lower responses to sodium nitroprusside possibly due to aggradation and deposition of collagen in the artery walls, decreasing constriction and dilation, or atrophy of smooth muscle cells.

  2. EVALUATION OF CAROTID ARTERY STENOSIS IN STROKE/TRANSIENT ISCHAEMIC ATTACK

    Directory of Open Access Journals (Sweden)

    Nambakam Tanuja

    2015-07-01

    Full Text Available BACKGROUND : Stroke remains the second leading cause of death worldwide, after ischaemic heart disease. Patients with carotid artery stenosis are at higher risk of development of stroke. Carotid atherosclerosis occurs in patients with atheros clerotic risk factors like diabetes mellitus, hypertension, smoking and hyperlipidemia. Carotid artery stenosis can be assessed by means of noninvasive high - resolution B - mode ultrasonography of the carotid arteries. AIMS AND O BJECTIVES: 1. To estimate the prevalence of carotid artery stenosis in ischaemic stroke/transient ishaemic attack patients. 2. To estimate whether there was any association between carotid artery stenosis and important risk factors such as diabetes mellitus, hypertension, hyper lipid emia with control group. METHODS AND MATERIALS : Acute ischaemic / TIA stroke patients with CT - Brain showing infarcts were enrolled for the study. All patients were subjected to CT scan brain study and colour Doppler study of extracranial carotid arteries. The systolic and diastolic velocity of blood flow, and the ratio of peak systolic velocities of common carotid arteries were assessed. RESULTS : DM, HTN, Smoking & Hyperlipidemia acted as risk factors for carotid stenosis. The prevalence of carotid stenosi s in our study was 60%. The prevalence of mild, moderate and severe stenosis were 34%, 10% and 16% respectively. The distribution of carotid stenosis was equal on both sides. The statistical significance was calculated using Chi - square test. Statistical si gnificance was taken when P value was <0.05. Statistical analysis was carried using standard formulae. Microsoft Excel 2007 and SPSS (Statistical Package for Social Sciences Version 17.0 software were used for data entry and analysis. CONCLUSIONS : Caroti d stenosis was one of the common causes of ischaemic stroke. There was a statistically significant correlation between increasing age, male gender, smoking, d iabetes mellitus, hypertension

  3. Cerebral vascular findings in PAPA syndrome: cerebral arterial vasculopathy or vasculitis and a posterior cerebral artery dissecting aneurysm.

    Science.gov (United States)

    Khatibi, Kasra; Heit, Jeremy J; Telischak, Nicholas A; Elbers, Jorina M; Do, Huy M

    2016-08-01

    A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.

  4. Association between Carotid Artery Stenosis and Cognitive Impairment in Stroke Patients: A Cross-Sectional Study

    Science.gov (United States)

    Zhu, Runxiu; Yan, Zhongrui; Zheng, Shouhuan; Wang, Jingwei; Huo, Jia; Liu, Yunlin; Li, Xin; Ji, Yong

    2016-01-01

    To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE) at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale) score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05–2.11, p<0.001). Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery. PMID:26751070

  5. Association between Carotid Artery Stenosis and Cognitive Impairment in Stroke Patients: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Wei Yue

    Full Text Available To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05-2.11, p<0.001. Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery.

  6. Prevalence of renal artery stenosis in patients undergoing cardiac catheterization.

    Science.gov (United States)

    Marcantoni, Carmelita; Carmelita, Marcantoni; Rastelli, Stefania; Stefania, Rastelli; Zanoli, Luca; Luca, Zanoli; Tripepi, Giovanni; Giovanni, Tripepi; Di Salvo, Marilena; Marilena, Di Salvo; Monaco, Sergio; Sergio, Monaco; Sgroi, Carmelo; Carmelo, Sgroi; Capodanno, Davide; Davide, Capodanno; Tamburino, Corrado; Corrado, Tamburino; Castellino, Pietro; Pietro, Castellino

    2013-08-01

    To investigate the prevalence of significant renal artery stenosis (RAS ≥50%), and to identify clinical predictors for significant RAS in patients with an elevated cardiovascular risk, such as those affected by ischemic heart disease. In patients with an elevated cardio-vascular risk, both atherosclerotic renovascular disease and coronary artery disease (CAD) are likely to occur. Prospectively from April 2007 to March 2008, all consecutive patients with ischemic heart disease undergoing non-emergent cardiac catheterization were also evaluated for atherosclerotic RAS by renal arteriography. A RAS ≥50% was considered as significant. A total of 1,298 patients underwent cardiac and renal angiography. Significant RAS was found in 70 out of 1,298 patients (5.4%). The presence of peripheral vascular disease, eGFR 66 years, dyslipidemia, CAD severity and pulse pressure >52 mmHg were independent clinical predictors of significant RAS, and jointly produced a ROC AUC of 0.79 (95% CI 0.73-0.85, P < 0.001). Based on these data, a prediction rule for significant RAS was developed, and it showed an adequate predictive performance with 64% sensitivity and 82% specificity. In a large cohort of patients undergoing coronary angiography, significant RAS is a relatively rare comorbidity (5.4%). A model based on simple clinical variables may be useful for the clinical identification of high CV risk patients who may be suitable for renal arteriography at the time of cardiac catheterization.

  7. Cerebral perfusion reserve in carotid stenosis: Prognostic role in surgical and rheological therapy

    Energy Technology Data Exchange (ETDEWEB)

    Ussov, W.; Shipulin, V.; Shvera, I. [and others

    1994-05-01

    The study was aimed to evaluate the usefulness of the quantitative cerebral perfusion reserve SPECT for the prognosis in patients with critical stenoses of the internal carotid arteries treated surgically or rheotherapeutically. 23 patients with angiographically verified mono (n=12) or bilateral (n=11) stenosis of the internal carotid artery for more than 75% and with recent (>30 days) minor stroke or TIA events in anamnesis were referred for the study. 6 age-matched healthy persons served as controls. In everybody the cerebral perfusion reserve was studied by using of the local cerebral blood volume to cerebral blood flow (rCBV/rCBF, sec) index using a double isotope technique which combined Tl-199 diethyidithiocarbamate (Tl-199-DDC) SPECT with Tc-99m red blood cells (Tc-99m-RBC) SPECT. 12 patients underwent carotid endartherectomy and 11 were treated rheotherapeutically by nonselective plasma substitution (5 times x 400 ml, >1800 nil in total). Patients were studied twicely: before and 10 days after the treatment, and then followed-up neurologically in the course of 1 year. Patients who had regional rCBV/rCBF index increased in the stenosed a.carotis int. - dependent region before treatment (normal value 5.2, sd 0.2 sec) have got it significantly decreased after intervention both in surgical group (from 7.1, sd 0.4 sec, down to 5.3, sd 0.3 sec, p<0.01 n=7) and in rheotherapeutical one (from 7.3, sd 0.5 sec, to 5.9, sd 0.4 sec, p<0.02 n=8). In everybody who expressed the rCBV/rCBF decreased below 5.6 sec after intervention there were no cerebrovascular ischemic events observed in the course of 12 months after carotid surgery and during 5 months in patients treated by plasmapheresis. We conclude that rCBV/rCBF SPECT index gives an independent prognostic information useful for both rheologic and surgical treatment of cerebrovascular disease; and that plasmapheresis suppress the short-term rise of cerebral ischemic events, which effect is predictable by SPECT.

  8. Wingspan 支架治疗症状性大脑中动脉严重粥样硬化狭窄的安全性和有效性%Safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent

    Institute of Scientific and Technical Information of China (English)

    蔡栋阳; 王子亮; 李天晓; 贺迎坤; 许斌; 薛绛宇; 吴立恒; 朱良付; 白卫星

    2014-01-01

    Objective To assess the safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent.Methods The medical records of Wingspan stenting for 102 cases with symptomatic middle cerebral artery high-grade stenosis from February 2008 to May 2012 in our hospital were reviewed retrospectively.All of the patients suffered from ischemic stroke or transient ischemic attack ( TIA ) attributed to the atherosclerotic high-grade stenosis in middle cerebral artery and the stenosis of 70%to 99%was confirmed by DSA before the stenting procedure.All the stroke, death, TIA within 30 days after the stenting procedure or during the follow-up beyond 30 days were observed and recorded.In-stent restenosis were recorded after DSA or CTA was performed 6 months later.χ2 test or Fisher exact test was used to compare in-stent restenosis rate among patients with different clinical and pathological conditions.Results Stenting procedure were successfully performed in 100 patients (98.0%,100/102).The mean degree of stenosis was reduced from (81.0 ±8.4)% to (15.3 ±6.7)%right after surgery.Eight adverse cardiovascular events (7.8 %, 8/102) occured within 30 days ,including seven stroke or death ( 6.9%, 7/102 ) and 1 TIA.The mean clinical follow-up duration was ( 29 ± 15) months in 82 patients, and 9 ischemic events were documented (4 cases of ipsilateral recurrent stroke , 3 cases of ipsilateral TIA, and 2 cases of contralateral ischemic stroke ).The mean radiological follow-up duration was (11 ±9) months in 55 patients.Among them, 8 patients (14.3%) had in-stent restenosis and 3 patients had symptomatic restenosis.The restenosis rate in patients with age ≤49 years.(25.0%,7/28) was higher than those with age >49 years ( 3.7%,1/27 ) ( P>0.05 ).The restenosis rate in patients with lesion size>7.5 mm(25.0%,7/28) was higher than those with lesion size ≤7.5 mm (3.7%,1/27)(P>0.05).Conclusions The treatment of symptomatic

  9. Flash pulmonary edema in patients with renal artery stenosis--the Pickering Syndrome

    DEFF Research Database (Denmark)

    Pelta, Anna; Andersen, Ulrik B; Just, Sven

    2010-01-01

    We report the prevalence of flash pulmonary edema in patients consecutively referred for balloon angioplasty of uni- or bilateral renal artery stenosis (PTRA), and describe the characteristics of this special fraction of the patients. We further report two unusual cases.......We report the prevalence of flash pulmonary edema in patients consecutively referred for balloon angioplasty of uni- or bilateral renal artery stenosis (PTRA), and describe the characteristics of this special fraction of the patients. We further report two unusual cases....

  10. Cerebral Arterial Thrombosis in Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Giovanni Casella

    2013-01-01

    Full Text Available Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD. We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature.

  11. Obstruction of cerebral arteries in childhood stroke

    Energy Technology Data Exchange (ETDEWEB)

    Velkey, I.; Lombay, B. (County Teaching Hospital, Miskolc (Hungary). Child Health Center); Panczel, G. (Semmelweis Medical Univ., Budapest (Hungary). Dept. of Psychiatry)

    1992-09-01

    Middle cerebral artery obstruction in children is reviewed by our two cases. Ischemic childhood stroke was caused by moyamoya disease in the first, and by fibromuscular dysplasia in the second patient. In both cases transcranial Doppler sonography and cranial CT were performed, but the final diagnosis was made by angiography. The importance of angiography in childhood stroke is emphasized. (orig.).

  12. Safety and efficacy of coronary drug eluting stent for atherosclerotic stenosis of the small renal artery

    Institute of Scientific and Technical Information of China (English)

    LI Chun-jie; WU Zheng; YAN Hong-bing; WANG Jian; ZHAO Han-jun

    2009-01-01

    @@ Small diameter renal artery refers to the renal artery with the cross-section diameter less than 5 mm, the incidence of which is approximately 8%.1 Small diameter renal artery is common in patients with congenital multi-branch renal arteries, diabetes and multi-coronary artery lesions. Renal artery bare-mental stent (BMS) implantation is the standard treatment for ostial renal artery stenosis.2,3 However, the restenosis rate4-6 is too high and becomes one of the relative contraindications for small diameter renal artery stent implantation. Clinical trials (e.g. RAVEL,7,8 SIRIUS9 and TAXUS-IV10) have proved that drug eluting stent (DES), compared with BMS, can reduce the restenosis rate after the percutanous coronary intervention (PCI). And Huda et al11 claimed that DES had the better results than BMS in the treatment of obstructive superficial femoral artery disease. However,there are few studies involved restenosis after the renal artery intervention. We hypothesized that coronary DES applied in renal artery stenosis might inhibit intimal proliferation effectively as in coronary artery disease;therefore we evaluated the results of 25 patients with atherosclerotic renal artery stenosis treated using coronary DES to assess the safety and efficacy of coronary DES in patients with small renal artery stenotic lesions.

  13. Bilateral renal artery stenosis and pheochromocytoma an uncommon association: A case report

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    Muhammad Sohail Anjum

    2010-10-01

    Full Text Available Pheochromocytoma and bilateral renal artery stenosis have a quite rare association. Although unilateral renal artery stenosis is reported in the literature with Pheochromocytoma but bilateral renal artery stenosis never reported before in Gulf region. A 56-years-old woman primarily referred to our facility for CABG for triple vessel disease but uncontrolled blood pressure and long standing history of hypertension rendered her for further investigations for secondary causes. The technical imaging techniques (USG, abdominal CT, magnetic resonance angiogram (MRA revealed bilateral renal artery stenosis and left supra-adrenal mass. Further hormonal assays confirmed high catecholamine and raised rennin and aldosterone secondary to Pheochromocytoma and bilateral renal artery stenosis. Laparoscopic removal of Pheochromocytoma with minimum invasive reconstructive surgery for bilateral renal artery stenosis was planned prior to CABG for triple vessel disease but patient declined any surgery or interventional and opted for conservative management inspite of repeated counselling sessions with the patient. Although these conditions co-existed simultaneously but differ in management.

  14. Transbrachial artery approach for selective cerebral angiography

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    Touho, Hajime; Karasawa, Jun; Shishido, Hisashi; Morisako, Toshitaka; Numazawa, Shinichi; Yamada, Keisuke; Nagai, Shigeki; Shibamoto, Kenji (Osaka Neurological Inst., Toyonaka (Japan))

    1990-02-01

    Transaxillary or transbrachial approaches to the cerebral vessels have been reported, but selective angiography of all four vessels has not been possible through one route. In this report, a new technique for selective cerebral angiography with transbrachial approach is described. One hundred and twenty three patients with cerebral infarction, vertebrobasilar insufficiency, intracerebral hemorrhage, epilepsy, or cerebral tumor were examined. Those patients consisted of 85 outpatients and 38 inpatients whose age ranged from 15 years old to 82 years old. The patients were examined via the transbrachial approach (97 cases via the right brachial, 29 cases via the left). Materials included a DSA system (Digital Fluorikon 5000, General Electric Co.), a 4 French tight J-curved Simmons 80-cm catheter, a 19-gauge extra-thin-wall Seldinger needle, and a J/Straight floppy 125-cm guide-wire. Generally, the volume of the contrast agent (300 mgI/ml iopamidol) used in the common carotid artery angiogram was 6 ml, while that used in the vertebral artery angiogram was 4 ml. If catheterization of the vertebral artery or right common carotid artery was unsuccessful, about 8 ml of the contrast agent was injected into the subclavian or branchiocephalic artery. Definitive diagnosis and a decision on proper treatment of the patients can be easily obtained, and the results were clinically satisfactory. Moreover, no complications were encountered in this study. This new technique making a transbrachial approach to the cerebral vessels using the DSA system is introduced here. Neurosurgeons can use this technique easily, and they will find that it provides them with all the information they need about the patient. (author).

  15. Aorta-LITA Bypass Grafting with Saphenous Vein in a Patient Undergoing Coronary Artery Surgery with Subclavian Artery Stenosis

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    Kerim Çağlı

    2011-12-01

    Full Text Available The internal thoracic artery (ITA is the primary graft for coronary artery bypass grafting and can not be used if there is subclavian artery stenosis (SAS. Aorto-axillary, carotid-subclavian bypass and also angioplasty with stenting or other interventional treatments are acceptable procedures for SAS treatment. Aorta-ITA bypass with saphenous vein can be alternative and simple technique for SAS to save Winslow pathway for patients with peripheral artery disease.

  16. Detection and treatment of transplant renal artery stenosis

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    Sriram Krishnamoorthy

    2009-01-01

    Full Text Available Purpose: To assess the effects of transplant renal artery stenosis (TRAS on blood pressure, renal function, and graft survival. To assess the usefulness of Doppler in predicting the clinical significance of TRAS and also to identify the predictive factors in Doppler that correlated with clinical features of TRAS. Materials and Methods: A prospective study was done on consecutive renal allograft recipients at Christian Medical College, over a period of 66 months from January 2002. All recipients underwent Doppler ultrasound (DUS evaluation on the fifth post-operative day. Subsequent evaluation was done if the patients had any clinical or biochemical suspicion of TRAS. Angiogram was done in case of a high index of suspicion of significant stenosis or before angioplasty and stenting. The clinical and radiological outcomes of the patients with symptomatic or asymptomatic TRAS were analyzed. Results: Five hundred and forty three consecutive renal allograft recipients were analyzed, of whom, 43 were found to have TRAS. Nine recipients (21% were detected to have TRAS on first evaluation. All had a high peak systolic velocities (PSV recorded while 25 of them had other associated features. Patients with only high PSV required no further intervention and were followed up. They had a pretransplant mean arterial pressure (MAP of 107.83 mmHg (SD = 13.32, ranging from 90 to 133 mm Hg and a posttransplant MAP of 106.56 mmHg (SD =16.51, ranging from 83 to 150 mm Hg. Their mean nadir serum creatinine was 1.16 mg% (SD = 0.24, at detection was 1.6 mg% (SD = 1.84 and at 6 months follow-up was 1.26 mg% (SD=0.52. Of the remaining 25 patients with other associated Doppler abnormalities, 11 required further intervention in the form of re-exploration in 2, angioplasty in 3 and stenting in 6 patients. One patient in the group of patients intervened, expired in the immediate post-operative period due to overwhelming urosepsis and consumption coagulopathy. The mean

  17. The relationships of carotid arthroscleroses with coronary artery stenosis in candidates for angiography

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    Mohammad Reza Saeidi

    2014-09-01

    Full Text Available Background: Coronary artery and carotid stenosis risk factors are frequently common in these two problems. The present study was aimed to determine the relationships between carotid arthroscleroses and coronary artery stenosis in candidates for cardiovascular angiography. Methods: In a cross sectional study, 218 candidates for cardiovascular angiography, visiting Imam Ali hospital of Kermanshah, were divided into two groups of case (158 subjects and control (60 subjects and were investigated by angiography and Doppler echo. Data were analyzed by Chi-square test (χ2 and multiple logistic regressions. Results: Totally, 47 subjects (21.6% had carotid stenosis with >50% plaque. The frequencies of this value in the case and control groups were 37 (23.4% and 10 (16.7% cases, respectively, indicating no significant difference between groups (P=0.27. There was a significant association between coronary artery and carotid stenosis, and female gender (P=0.008. However, no significant correlation was observed between smoking and history of hypertension in terms of age (P<0.05. Conclusion: There was no significant association between coronary artery and carotid stenosis occurrence. However, among independent risk factors, only females had an effective role in their co-occurrence. Therefore, considering the females with coronary artery or carotid stenosis and conducting preventive measures are recommended to prevent co-occurrence of these two problems.

  18. CXCL16 regulates renal injury and fibrosis in experimental renal artery stenosis.

    Science.gov (United States)

    Ma, Zhiheng; Jin, Xiaogao; He, Liqun; Wang, Yanlin

    2016-09-01

    Recent studies have shown that inflammation plays a critical role in the initiation and progression of hypertensive kidney disease, including renal artery stenosis. However, the signaling mechanisms underlying the induction of inflammation are poorly understood. We found that CXCL16 was induced in the kidney in a murine model of renal artery stenosis. To determine whether CXCL16 is involved in renal injury and fibrosis, wild-type and CXCL16 knockout mice were subjected to renal artery stenosis induced by placing a cuff on the left renal artery. Wild-type and CXCL16 knockout mice had comparable blood pressure at baseline. Renal artery stenosis caused an increase in blood pressure that was similar between wild-type and CXCL16 knockout mice. CXCL16 knockout mice were protected from RAS-induced renal injury and fibrosis. CXCL16 deficiency suppressed bone marrow-derived fibroblast accumulation and myofibroblast formation in the stenotic kidneys, which was associated with less expression of extracellular matrix proteins. Furthermore, CXCL16 deficiency inhibited infiltration of F4/80(+) macrophages and CD3(+) T cells in the stenotic kidneys compared with those of wild-type mice. Taken together, our results indicate that CXCL16 plays a pivotal role in the pathogenesis of renal artery stenosis-induced renal injury and fibrosis through regulation of bone marrow-derived fibroblast accumulation and macrophage and T-cell infiltration.

  19. Radiotherapy-induced concomitant coronary artery stenosis and mitral valve disease.

    Science.gov (United States)

    Akboga, Mehmet Kadri; Akyel, Ahmet; Sahinarslan, Asife; Cengel, Atiye

    2014-04-01

    Radiotherapy is extensively used in the treatment of Hodgkin's disease. One of its untoward effects is on heart. Coronary arteries and heart valves can be adversely affected from radiotherapy. However, co-existence of both conditions is very rare. In this report, we present a patient with Hodgkin's disease who developed both coronary artery stenosis and severe mitral valve regurgitation after radiotherapy.

  20. Differential analysis of clinical features in atherosclerotic renal artery stenosis and benign nephrosclerosis

    Institute of Scientific and Technical Information of China (English)

    郭云珊

    2006-01-01

    Objective To analyze and compare the clinical characteristics of atherosclerotic renal artery stenosis (ARAS) and benign nephrosclerosis (BN) in order to distinguish the ARAS from BN. Methods A retrospective study was performed on 82 hypertensive patients with renal injury. Patients were divided into BN and ARAS group according to renal artery doppler scanning. The

  1. Understanding the Impact of Arterial Stenosis on Blood Flow through a Tissue

    Science.gov (United States)

    Prakash, Elapulli Sankaranarayanan

    2015-01-01

    This article arises from the author's experience helping medical students apply core biophysical principles toward understanding cardiovascular physiology. The purpose of the article is illustrate how the effect of an arterial stenosis on blood flow to tissue supplied exclusively by the stenosed artery should be assessed. This discussion was…

  2. Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

    NARCIS (Netherlands)

    Vriens, Bianca H. R.; Pol, Robert A.; Hulsebos, Robin G.; van Det, Rob J.; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    2015-01-01

    BACKGROUND: To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. METHODS: Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inl

  3. Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

    NARCIS (Netherlands)

    Vriens, Bianca H.R.; Pol, Robert A.; Hulsebos, Robin G.; Det, van Rob J.; Palen, van der Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    2015-01-01

    Background To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. Methods Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inla

  4. Coefficient of variation: a powerful Doppler ultrasonographic parameter for detection of renal artery stenosis.

    Science.gov (United States)

    Eibenberger, K; Schima, H; Trubel, W; Temel, T; Schmidt, C; Scherer, R; Windberger, U; Dock, W; Grabenwöger, F

    1996-07-01

    The aim of our study was to objectively compare the effectiveness of various Doppler parameters in the diagnosis of renal artery stenosis. In three sheep, variable degrees of renal artery stenosis were induced and renal segmental arteries were investigated using pulsed Doppler sonography. In each animal the standard deviation of the instantaneous peak velocity within one cardiac cycle normalized by the mean peak velocity (coefficient of variation) had significantly higher normalized regression coefficients (k* = -0.215, average of three animals) when compared to resistive index (k* = -0.090) and acceleration index (k* = -0.069). In each individual animal, coefficient of variation detected lower pressure gradients (6.3 mm Hg, average value) than did resistive index (13.4 mm Hg) or acceleration index (17.3 mm Hg). The coefficient of variation may detect the presence of pressure gradients in renal artery stenosis more accurately than acceleration index or resistive index.

  5. Vertebral artery orifice stenosis: a report of 43 cases from northwest iran treated with angioplasty and stenting.

    Science.gov (United States)

    Mohammadian, R; Najaran, A; Sohrabi, B; Mansourizadeh, R; Mohammadian, F; Nasiri, B; Farhoudi, M

    2011-10-31

    More than one quarter of all transient ischemic attacks (TIA's) and ischemic strokes involve tissue supplied by the vertebrobasilar (VB) circulation. Vertebral artery stenotic lesion, particularly at the origin of the vertebral artery, is not uncommon but it is a less studied area. Here we present our endovascular treatment experience in a group of patients with vertebral artery orifice stenosis. We enrolled a group of patients with vertebral artery orifice stenosis who presented with confirmed posterior circulation stroke. Vertebrobasilar insufficiency syndrome was confirmed by imaging studies and clinical findings. Vertebral artery stenosis diagnosed by CT or MR Angiography and confirmed by Conventional and digital subtraction angiography (DSA). Angiography was performed by using of femoral or radial artery approach. From October 2008 to January 2010, forty-three consecutive patients (69.8% men) underwent stent placement for symptomatic vertebral artery orifice stenosis. Mean degree of stenosis was 70.45 +/- 7.455 percent and mean age was 71.65 +/- 7.743 years . In the 22 patients (22/43, 51.16%) stenosis were in left side. In the thirty patients (30/43, 69.6%) there was evidence of atherosclerotic disease in the internal carotid artery and in the 23% contra lateral vertebral artery was involved. There were five different cases with left renal artery stenosis especially in the men with left vertebral artery stenosis. Initial technical success rate was 100%. No cerebrovascular complications or embolic events occurred. Six months control angiography follow-up revealed one patient with stent occlusion and moderate (40%) restenosis in the another patient. According to our finding angioplasty and stenting for vertebral artery orifice stenosis is safe and effective. Patients with vertebral artery orifice disease frequently have coexistent atherosclerotic stenosis in the other major extracranial arteries including carotid and renal arteries.

  6. The Apoplectic Effective Prevention of Un-interferential Cerebric Arterial System in Percutaneous Transluminal Angioplasty and Stenting of Carotid Stenosis%颈动脉经皮血管内成形及支架置入术预防非干预脑动脉系统卒中效果

    Institute of Scientific and Technical Information of China (English)

    杜会山; 耿晓坤; 刘建国; 刘怀翔; 魏建朝; 张伟东; 孟繁花; 曾艳芳; 谈晓牧

    2012-01-01

    Objective To explore the secondary preventive effect of un-interferential cerebric arterial system in interven-tional therapy for the extracranial segment stenosis of carotid artery. Methods Among 213 patients with ischemic stroke combined with unilateral severe extracranial segment stenosis of carotid artery, 119 patients underwent percutaneous transluminal angioplasty and stenting (PTAS) by self expanding stent through femoral artery (interventional group) , while the other 94 patients only received medication (control group). There was no significant difference in the demographic data, apoplectic risk factors and combined with other cerebric arteriostenosis between the two groups (P>0.05). The two groups were followed up for 3 years, and the incidences of stroke and death were recorded and compared. Results 6 patients were lost in follow-up, including 1 patient of the interventional group and 5 patients of the control group. The total recurrence rate, symptomatic recurrence rate, non-symptomatic recurrence rate and multiple recurrence rates of stroke in interventional group were significantly lower than that of control group (P <0.01, P < 0.05). The apoplectic recurrence rate on the interferential domains of carotid artery system in interventional group by PTAS or no PTAS were significantly lower than that of control group (P<0.01, P <0.05). There were 2 deaths in interventional group and 4 deaths in control group during the follow up. Conclusion PTAS is an effective, safe and low-traumatic measure to treat extracranial angiostenosis. PTAS can show significant secondary preventive effects for patients with severe extracranial angiostenosis in stroke on the domains of the intervened carotid arteries and other cerebral arteries.%目的 探讨颈动脉颅外段狭窄介入治疗对非干预脑动脉系统卒中二级预防的效果.方法 选择在我院住院的213例缺血性卒中并单侧重度颈动脉颅外段狭窄,119例采用自膨式支架经股动脉入

  7. [The effect of carotid endarterectomy on cognitive disturbances in patients with atherosclerotic stenosis of carotid arteries].

    Science.gov (United States)

    Iakhno, N N; Fedorova, T S; Damulin, I V; Shcherbiuk, A N; Vinogradov, O A; Lavrent'ev, A V

    2011-01-01

    Clinical and neuropsychological features of non-dementia cognitive disturbances were studied in 102 patients with atherosclerotic carotid stenosis. Cognitive disturbances were assessed after the carotid endarterectomy (CEAE). Mild cognitive impairment was found in 37 (36,3%) of patients, moderate cognitive impairment was diagnosed in 36 (35,3%)patients. Moderate cognitive impairment was found more often in patients with symptomatic carotid stenosis with structural brain changes confirmed by neuroimaging data and with instable atherosclerotic plaques with the predomination of hypodensity component. It allows to suggest that both the reduction of perfusion and arterio-arterial microemboli may cause cognitive dysfunction in patients with atherosclerotic carotid stenosis. The data on the positive effect of CEAE on cognitive functions have been obtained. The positive changes were more distinct in patients with asymptomatic course of carotid stenosis. However CEAE may have a negative effect on cognitive functions in patients with moderate cognitive impairment of dysmnestic character and symptomatic carotid stenosis.

  8. Infra-optic Course of Both Anterior Cerebral Arteries Associated with a Middle Cerebral Artery Aneurysm and an Aortic Coarctation

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    Ji, Cheol; Ahn, Jae Geun; Cho, Song Mee [Catholic University, St. Paul' s Hospital, Seoul (Korea, Republic of)

    2009-06-15

    A ruptured aneurysm at the bifurcation of the left middle cerebral artery with an infra- optic course of the bilateral anterior cerebral arteries was found in a 28-year-old woman. Both abnormal anterior cerebral arteries arose from the ipsilateral internal carotid arteries, at the level of the origin of ophthalmic arteries, passed underneath the ipsilateral optic nerves and turned upward at the ventral portion of the optic chiasm. In addition, an aortic coarctation was found with the use of thoracic aortography. An infra-optic course of the bilateral anterior cerebral arteries is an extremely rare anomaly. An infra-optic course of the bilateral anterior cerebral arteries is frequently associated with cerebral aneurysms and possibly with a coarctation aorta. The clinical features, radiological findings and possible genesis of this anomaly are presented.

  9. Management of renal artery stenosis: What does the experimental evidence tell us?

    Institute of Scientific and Technical Information of China (English)

    Mohammed; Al-Suraih; Joseph; Peter; Grande

    2014-01-01

    Optimal management of patients with renal artery stenosis(RAS) is a subject of considerable controversy. There is incontrovertible evidence that renal artery stenosis has profound effects on the heart and cardiovascular system in addition to the kidney. Recent evidence indicates that restoration of blood flow alone does not improve renal or cardiovascular outcomes in patients with renal artery stenosis. A number of human and experimental studies have documented the clinical, hemodynamic, and histopathologic features in renal artery stenosis. New approaches to the treatment of renovascular hypertension due to RAS depend on better understanding of basic mechanisms underlying the development of chronic renal disease in these patients. Several groups have employed the two kidney one clip model of renovascular hypertension to define basic signaling mechanisms responsible for the development of chronic renal disease. Recent studies have underscored the importance of inflammation in the development and progression of renal damage in renal artery stenosis. In particular, interactions between the renin-angiotensin system, oxidative stress, and inflammation appear to play a critical role in this process. In this overview, results of recent studies to define basic pathways responsible for renal disease progression will be highlighted. These studies may provide the rationale for novel therapeutic approaches to treat patients with renovascular hypertension.

  10. Stenting for symptomatic vertebral artery stenosis associated with bilateral carotid rate mirabile: The long-term clinical and angiographic outcome

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jang Hyun; Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rate mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.

  11. Relationships between leukoaraiosis and internal carotid artery stenosis and ulcerated plaques in patients with acute cerebral infarction%急性脑梗死患者脑白质疏松与颈内动脉狭窄及溃疡性斑块的关系

    Institute of Scientific and Technical Information of China (English)

    王世芳; 肖卫民; 吴志强; 罗根培; 李润雄

    2012-01-01

    Objective To investigate the relationships between leukoaraiosis ( LA) and internal carotid artery stenosis and ulcerated plaques in patients with acute cerebral infarction. Methods A total of 102 consecutive patients with the first onset of acute cerebral infarction were enrolled in the study. They were all underwent neck vascular examinations with magnetic resonance imaging and digital subtraction an-giography ( DSA). The internal carotid artery lesions were identified. The patients were divided into LA or non-LA groups according to their MR, and they were redivided into a subcortical LA group and periventric-ular LA group according to the location of LA. The relationships between the location and severity of LA and internal carotid artery stenosis and ulcerated plaque were analyzed. Multivariate logistic regression analysis affected the relevant factors of different locations of LA. Results ①The incidences of internal carotid artery stenosis and ulcerated plaques had no significant difference between the LA group and the non-LA group (all P>0.05). ②In the subcortical LA group, 26. 1% patients (12/46) had ulcerated carotid plaques, which was higher than 10.7% (6/56) in the non-subcortical LA group (P0. 05). ③There was no significant difference in the incidence of ulcerated carotid plaques between the periventricular LA group and the periventricular non-LA group (P>0. 05). ④Multivariate analysis showed that age (OR = 1. 071 , 95% CI 1. 014 - 1. 131 ) , hypertension ( OR = 2. 953, 95% CI 1. 006 -8. 671 ) , and ulcerated carotid plaques ( OR = 1. 949 , 95% CI 1.286 -3.142) were the independent predictors of subcortical LA; the independently associated factors of periventricular LA were age ( OR = 1. 069, 95% CI 1.010-1.131) and hypertension (OR =3. 293, 95% CI 1.984 -11.020). Conclusion Among the patients with acute cerebral infarction , ulcerated carotid plaques are associated with the subcortical leukoaraiosis, and there is no significant relationship with

  12. Case Report: Calcific Aortic Valve Stenosis Due to Central Retinal Artery Occlusion

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    Ender Sener

    2013-10-01

    Full Text Available In this case, it was reported that a 48 year old male patient with spontaneous central retinal artery occlusion (CRAO due to calcific aortic valve stenosis. He had no other systemic disease. CRAO usually occurs in elder patients with systemic risk factors. CRAO results in sudden, painless and severe vision loss. Altough, CRAO is seen rarely under 50 year old, it may appear in younger patient with aortic valve disease and calcific aortic valve stenosis caused cardiac disease.

  13. 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.)

  14. Rapid Formation of Cerebral Microbleeds after Carotid Artery Stenting

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    Kousuke Kakumoto

    2012-03-01

    Full Text Available Background: Recent studies reported that cerebral microbleeds (CMBs, i.e. small areas of signal loss on T2*-weighted gradient-echo (GE imaging, could develop rapidly after acute ischemic stroke. We hypothesized that CMBs rapidly emerge after carotid artery stenting (CAS. Objective: We investigated the frequency of and predisposing factors for CMBs after CAS. Methods: We retrospectively examined MRI before and after CAS in 88 consecutive patients (average age: 71.7 ± 7.2 years, average rates of carotid stenosis: 72.6 ± 12.8% who underwent CAS for carotid artery stenosis between March 1, 2009, and September 30, 2010. We defined new CMBs as signal losses that newly appeared on the follow-up GE. We examined the association of new CMBs with demographics, risk factors, and baseline MBs. Results: Among 88 patients, 18 (20.5% had CMBs initially, and 7 (8.0% developed new CMBs right after CAS. New CMBs appeared on the same side of CAS in all of the 7 patients. New CMBs appeared significantly more frequently in the CMB-positive group than in the CMB-negative one (22% vs. 4%, p = 0.03 on the pre-CAS MRI. Multivariate analysis also revealed that the presence of CMBs before CAS was an independent predictor of new development of CMBs after CAS (odds ratio: 8.09, 95% confidence interval: 1.39–47.1. Conclusion: CMBs can develop rapidly after CAS, especially in patients with pre-existing CMBs. Since the existence of CMBs prior to CAS suggests a latent vascular damage which is vulnerable to hemodynamic stress following CAS, particular attention should be paid to the prevention of intracerebral hemorrhage due to hyperperfusion after CAS.

  15. Intestinal brucellosis associated with celiac artery and superior mesenteric artery stenosis and with ileum mucosa and submucosa thickening

    Science.gov (United States)

    Wang, Miaoqian; Zhu, Qingli; Yang, Qian; Li, Wenbo; Wang, Xinning; Liu, Wei; Zhou, Baotong; Li, Zhenghong; Yang, Hong

    2017-01-01

    Abstract Rationale: Brucellosis is a multisystem infection found worldwide that has a broad range of characteristics, which range from acute fever and hepatomegaly to chronic infections that most commonly affect the central nervous system, cardiovascular system, or skeletal system. Gastrointestinal and splanchnic artery involvements in brucellosis are relatively uncommon. Patient concerns: We report a case of brucellosis in an adolescent presenting as intermittent abdominal pain, diarrhea, and fever, with intestinal tract involvement. And stenosis of the celiac artery and the superior mesenteric artery was found after exposed to risk factors of Brucella infection. Splanchnic vessels stenosis and an endothelial lesion may exacerbate the prevalent symptom of abdominal pain, as a form of colic pain, occurring after eating. Diagnoses: The patient was diagnosed as brucellosis. The narrowing of the SMA and CA was suspected to be vasculitis secondary to the brucellosis. Interventions: The patient was treated with minocycline and rifampicin for 12 weeks totally. Outcomes: The gastrointestinal manifestations of brucellosis recovered rapidly under intensive treatment. However, follow-up imaging revealed that the superior mesenteric artery and celiac artery stenosis was unimproved. Lessons: In brucellosis, gastrointestinal manifestations may be the only observable features of the disease. Splanchnic arterial stenosis is a rare complication of brucellosis. Sonography and computed tomography may be useful for both diagnosis and follow-up. PMID:28079834

  16. A case of left main pulmonary artery aneurysm associated with valvular pulmonary stenosis in a child.

    Science.gov (United States)

    Lee, Ran; Son, Jae Sung; Park, Yong Mean

    2011-10-01

    Aneurysm of the main pulmonary artery is a rare clinical entity that can be congenital or acquired. Most cases occur in association with other congenital malformations, severe pulmonary hypertension, vasculitides, infectious agents, or collagen vascular disorders. We report here a pediatric case of left pulmonary artery aneurysm associated with valvular pulmonary stenosis and a hypoplastic right pulmonary artery, which we confirmed via multidetector computed tomography angiography.

  17. Microsurgical anatomy of the middle cerebral artery

    Directory of Open Access Journals (Sweden)

    Pai S

    2005-01-01

    Full Text Available Background: The microsurgical anatomy of the middle cerebral artery (MCA is of particular interest to the cerebrovascular surgeon. The purpose of this study was to define the microsurgical anatomy of the MCA and its various branches in the Indian population. Methods: Ten MCAs were studied from five cadaveric brain specimens. The authors studied the outer diameter, length, branches, perforators and site of these on the main trunk (M1, the division of the main trunk, the secondary trunks and their various cortical branches using the operating microscope under 5-20x magnification. Results: The outer diameter of the MCA main trunk ranges from 2.5 to 4 mm with a mean of 3.35 mm. The superolateral branches consisted of polar temporal artery and anterior temporal artery that had a common origin and sometimes the uncal artery or the accessory uncal artery. Perforators or lenticulostriate arteries were seen in the inferomedial surface all along the length of M1. Eight bifurcations and two trifurcations were noted. Cortical branches and their origin are discussed. Conclusion: Although the microsurgical anatomy of the MCA in Indian population correlated with the findings in the western literature, some structural and statistical variations were noted.

  18. 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.

  19. The influence of low and moderate carotid stenosis on neurophysiologic status of patients undergoing on-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Olga eTrubnikova

    2012-01-01

    Full Text Available Background: Significant (>70% extracranial stenosis of the internal carotid artery (ICA is a known risk factor for brain damage in patients with coronary heart disease (CHD undergoing coronary artery bypass grafting (CABG. There is no clear evidence of the low and moderate ICA stenoses influence on the neurophysiologic status of patients after CABG. This work was aimed at studying the influence ICA stenoses (<50% on the dynamics of neurophysiologic status in patients undergone CABG. Methods: We examined neurophysiologic functions and EEG in CHD patients (N=45 aged from 45 to 70 years. All patients were divided into two groups: with ICA stenosis (n=20 and without one (n= 25. Results: It was established that the group ICA stenosis had a negative dynamics of neurophysiologic status 6 months follow-up after CABG compared with patients without stenosis. Conclusions: Our results suggest that the presence of low and moderate ICA stenosis is one of the factors affecting the neurophysiologic status of CHD patients. It has been assumed that the patients with ≤50% ICA stenoses constitute a high-risk group for cerebral complications after on-pump CABG.

  20. A rare case of persistent hypoglossal artery associated with contralateral proximal subclavian stenosis

    Directory of Open Access Journals (Sweden)

    Romeo Antonio

    2016-01-01

    Full Text Available The persistent hypoglossal artery is rare vascular anomalies. We report the case of a 50-year old man with right hypoglossal artery, ipsilateral hypoplasic internal carotid artery, associated with left proximal subclavian stenosis with subclavian steal syndrome. Power-Doppler-Ultra-Sonography spectral images obtained after the patient exercised the left arm showed mid-systolic deceleration with retrograde late-systolic velocities. A Computed Tomography Angiography demonstrated a proximal stenosis of the left SA, a mild right ICA hypoplasia and an anomalous artery arising from right ICA at C2–C3 level, entering the cranium via the hypoglossal canal and joining the basilar artery. Usually the presence of PHA may be completely asymptomatic, and detected as an incidental finding by CTA or MRA, but in our case its diagnosis is extremely important because it is often the only vessel supplying blood to the basilar trunk and posterior circulation.

  1. Association factor analysis between osteoporosis with cerebral artery disease

    Science.gov (United States)

    Jin, Eun-Sun; Jeong, Je Hoon; Lee, Bora; Im, Soo Bin

    2017-01-01

    Abstract The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified

  2. Coarctation of the aorta and renal artery stenosis in tuberous sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Flynn, P.M.; Robinson, M.B.; Stapleton, F.B.; Roy, S. III; Koh, G.; Tonkin, I.L.D.

    1984-07-01

    Among neurocutaneous disorders, coarctation of the abdominal aorta and renal artery stenosis have traditionally been associated with neurofibromatosis. We report a 5-year-old girl who was discovered to have bilateral renal artery stenosis, coarctation of the abdominal aorta, renal cysts and typical skin lesions of tuberous clerosis during the evaluation of asymptomatic hypertension. Renal vascular hypertension has not been reported previously in tuberous sclerosis. We conclude that the tuberous sclerosis complex should be expanded to include vascular malformations and the hypertension should not be assumed to be secondary to renal hamartomata or cysts in patients with tuberous sclerosis.

  3. Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis.

    Science.gov (United States)

    Hashim, Peter W; Assi, Roland; Grecu, Loreta; Dardik, Alan

    2014-04-01

    Stenosis or occlusion of the brachiocephalic artery represents an uncommon cause of cerebrovascular insufficiency. We report a patient with combined brachiocephalic and left subclavian obstruction with clinical manifestations of lightheadedness, syncope, and left-sided weakness who remained misdiagnosed essentially because of symmetrical pressures in the upper extremities. Aortic valve replacement for aortic stenosis failed to provide symptomatic relief. Eventual stenting of the brachiocephalic trunk resolved the patient's symptoms. Our report highlights the diagnostic challenges in this case of bilateral supraaortic vessel disease and shows that equal upper extremity pressures do not rule out brachiocephalic artery obstruction.

  4. Pathophysiology and management of intracranial arterial stenosis around the circle of Willis associated with hyperthyroidism: case reports and literature review.

    Science.gov (United States)

    Matano, Fumihiro; Murai, Yasuo; Adachi, Koji; Kitamura, Takayuki; Teramoto, Akira

    2014-04-01

    Cases of moyamoya disease or intracranial arterial stenosis around the circle of Willis (M/IAS) associated with hyperthyroidism have been reported. However, most of these previous reports were of the ischemic form of M/IAS and primary hyperthyroidism. To the best of our knowledge, no studies have documented therapy for M/IAS associated with hyperthyroidism. We discuss four previously unreported cases, including those involving the intracerebral hemorrhage form and thyroid-stimulating hormone (TSH) secretion from a pituitary adenoma (secondary hyperthyroidism). We analyzed data from 52 previously reported cases, including the 4 cases presented here, and discuss M/IAS associated with hyperthyroidism, treatment options, pathophysiology, the ischemic and hemorrhagic forms, secondary hyperthyroidism, and the relevant literature. Hyperthyroidism results in thyrotoxicosis and the stimulation of the superior cervical ganglion by TSH antibodies and f-T3/f-T4. Consequently, hypercoagulability and stenosis of the cerebral artery can occur. There are many reports of ischemic M/IAS associated with hyperthyroidism. A conservative approach to treatment is important in such cases; for example, antithyroid therapy should be the first choice to treat ischemic M/IAS. There have been only a limited number of reports on hemorrhagic M/IAS. We presume that hemorrhagic M/IAS tears the weakened vasculature in a manner similar to that of normal M/IAS (with no complicating hyperthyroidism). The authors also reported M/IAS associated with secondary hyperthyroidism due to pituitary thyroid secreting hormone secreting adenoma.

  5. Visceral and renal arteries stenosis associated with Takayasu arteritis

    Institute of Scientific and Technical Information of China (English)

    ZHU Ting; FU Wei-guo; CHEN Bin; SHI Zhen-yu; GUO Da-qiao; JIANG Jun-hao; YANG Jue

    2006-01-01

    @@ Takayasu arteritis (TA) is a nonspecific granulomatous inflammatory arteriopathy of unknown cause that results in occlusive obliteration or less commonly aneurysm degeneration of large and medium-sized elastic arteries. Most descriptions of this disease have emphasized the "pulseless"syndrome, however, less attention has been paid to involvement of other segments of the aorta, renal arteries, and in particular the visceral arteries. We reported a case of type Ⅱ TA, in which both the visceral and the bilateral renal arteries were involved.

  6. Experience of endovascular treatment of occlusion-stenotic lesions of cerebral arteries

    Directory of Open Access Journals (Sweden)

    Cherednichenko Yu.V.

    2016-03-01

    Full Text Available Objective — to evaluate the efficacy of endovascular techniques in the treatment of occlusion and stenotic lesions of the brachiocephalic and cerebral arteries, to define the ways of complications prevention. Materials and methods. 594 patients with occlusion and stenotic lesions of the brachiocephalic and cerebral arteries were operated by endovascular methods in endovascular center of Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. 688 endovascular operations were carried out. Most part of the operations are carotid stenting (423 operations. All of these operations were carried out with the usage of different types of antiembolic protection systems: distal, proximal or their combination. Intracranial segments of cerebral arteries were operated in 43 cases. 169 operations of stenting of vertebral arteries in extracranial segments were performed. Subclavian arteries and brachiocephal truncus were operated in 53 cases. Results. Total removal of stenosis was achieved in 588 cases (98.99%. 509 patients (85.69% of cases had improvement in neurological status (on a scale NIHHS, Mrs., MoCA. 77 (12.96% patients had no deterioration of neurological status. Postoperative mortality was 1.01%. Common level of other complications was 4.3 %: cerebral complications - 2.7%. Discussion. The results of the endovascular treatment of occlusion and stenotic lesions of the cerebral arteries show high efficacy and low complication level. The ways of reduction complications level are identified. They are in a differentiated selection of antiembolic protection method, endovascular treatment planning, based on monitoring of changes in the brain hemoperfusion, the emphasis is on the use of the special neurologic deviсes. Conclusions. Endovascular treatment of occlusion and stenotic lesions of the cerebral arteries is effective with a small risk of complications. Risk can be reduced further by the differential choice of antiembolic protection

  7. Risk stratification in asymptomatic and symptomatic patients with carotid artery stenosis

    OpenAIRE

    den Hartog, A.G.

    2013-01-01

    The overall aim of this thesis is to explore and assess the risks that patients with carotid artery disease, whether asymptomatic or symptomatic, are exposed to, and to explore whether patients that may be subject to relatively higher risk can be identified by imaging. Although large randomized trials have proven carotid endarterectomy (CEA) to be beneficial compared to best medical treatment alone, revascularization of patients with asymptomatic carotid artery stenosis (ACAS) remains a matte...

  8. Endobronchial mucosal blanching due to a post-lung transplantation pulmonary artery stenosis.

    Science.gov (United States)

    Slebos, Dirk-Jan; Wolff, Rienhart F E; van der Bij, Wim

    2011-03-01

    A 45-year-old woman underwent a bronchoscopy shortly after lung transplantation. The airway mucosal appearance significantly differed between both lungs, with a pale aspect of the left bronchial tree. Computed tomography (CT) and perfusion scan confirmed a left pulmonary artery stenosis, improving with conservative treatment.

  9. Percutaneous radial intervention for complex bilateral renal artery stenosis using paclitaxel eluting stents.

    Science.gov (United States)

    Granillo, Gastón A Rodriguez; van Dijk, Lukas C; McFadden, Eugène P; Serruys, Patrick W

    2005-01-01

    Techniques used in the coronary circulation may be useful in peripheral intervention. We report a case of bilateral renal artery stenosis treated via a radial approach by direct stenting with distal protection at a right ostial lesion and modified crush stenting at a left renal bifurcation lesion using paclitaxel-eluting stents.

  10. Prevalence of asymptomatic carotid artery stenosis according to age and sex systematic review and metaregression analysis

    NARCIS (Netherlands)

    de Weerd, M.; Greving, J.P.; de Jong, A.W.F.; Buskens, E.; Bots, M.L.

    2009-01-01

    Background and Purpose-In the discussion on the value of population-wide screening for asymptomatic carotid artery stenosis (ACAS), reliable prevalence estimates are crucial. We set out to provide reliable age- and sex-specific prevalence estimates of ACAS through a systematic literature review and

  11. Renal Artery Stenosis in a Young Female without Fibromuscular Dysplasia with Literature Review.

    Science.gov (United States)

    Peralta, Paloma; Cholankeril, Matthew; Goldberg, Daniel; Koneru, Jayanth; Shamoon, Fayez

    2016-01-01

    Renal artery stenosis (RAS) is rare in young patients without fibromuscular dysplasia (FMD). RAS is primarily classified as having two major etiologies, namely, atherosclerosis and FMD, with 90% and 10%, respectively. We report a case of a female in her mid 20s who developed hypertension due to RAS with no evidence of FMD or underlying renal dysfunction and underwent successful angioplasty and stenting.

  12. Recirculation usually precedes malignant edema in middle cerebral artery infarcts

    DEFF Research Database (Denmark)

    Nielsen, T H; Ståhl, N; Schalén, W;

    2012-01-01

    In patients with large middle cerebral artery (MCA) infarcts, maximum brain swelling leading to cerebral herniation and death usually occurs 2-5 days after onset of stroke. The study aimed at exploring the pattern of compounds related to cerebral energy metabolism in infarcted brain tissue....

  13. 伴颈动脉狭窄的腔隙性脑梗死患者介入治疗术后的认知变化%Cognitive changes in patients with lacunar cerebral infarction and carotid stenosis after artery intervention therapy

    Institute of Scientific and Technical Information of China (English)

    赵雄飞; 赵志茹; 徐家萍; 张芮娟; 霍秀利; 王玉; 宋霄; 王拥军

    2016-01-01

    Objective To analyze the cognitive changes and influencing factors in patients with lacunar cerebral infarction after carotid artery intervention therapy. Methods Sixty lacunar cerebral infarction combined with carotid stenosis patients treated with artery intervention therapy (intervention therapy group) and 68 lacunar cerebral infarction without carotid stenosis patients treated with drug therapy (drug therapy group) were selected. The neuropsychological test was completed at entry and 1, 6, 12 months after entry, and the results were compared with 60 healthy controls (control group). The cognitive changes were observed. The neuropsychological test included mini mental state examination (MMSE), Montreal cognitive assessment scale (MoCA) and cognitive field test. Results There were statistical differences in other scores except the Stroop test C section and Wechsler adult intelligence scale (WAIS-RC) picture arrangement subtest at entry in intervention therapy group and drug therapy group compared with control group (P0.05). In intervention therapy group, the MMSE scores, MoCA total score, Rey-Osterrieth complex figure test (ROCFT), auditory verb learning test (AVLT), and the WAIS-RC picture arrangement subtest, verbal fluency test, WAIS-RC digit span backwards subtest of performing function 12 months after entry were significantly better than those at entry, and there were statistical differences (P0.05);the MMSE score, MoCA total score, ROCFT, the immediate recall, long-time delayed recall and short delayed recall of AVLT, WAIS-RC picture arrangement subtest, verbal fluency test, WAIS-RC digit span backwards subtest of performing function and digit span backwards subtest of WAIS-RC 12 months after entry were significantly better than those at entry, and there were statistical differences (P0.05). In patients intervention therapy group, Logistic regression analysis showed that the MoCA score was related with age, hypertension and low education level (P0

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

    Directory of Open Access Journals (Sweden)

    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. Multiple cerebral aneurysms of middle cerebral artery. Case report

    Directory of Open Access Journals (Sweden)

    D.A. Nica1, Tatiana Rosca1, A. Dinca2, M. Stroi3, Mirela Renta4, A.V. Ciurea5

    2010-11-01

    Full Text Available Multiple cerebral aneurysms present awide variation in incidence with averages of13% at angiographic studies and 22.7% atautopsy.High blood pressue, cigarette smoking,stress and possible also age and female sexseem to be risk factors for multipleintracranial aneurysms (MIAn in patientsof working age who have suffered asubarachnoid hemorrhage (SAH.Aneurysms were situated on the same sidein one-third of the patients with twoaneurysms and the most common site wasthe middle cerebral artery (MCA. Tomanage these challenging lesionsneurosurgeons must use all availableinnovations and advances, includingdiagnostic, technical and perioperativeadjuncts. The author presents a case ofmiddle age female, with two saccularaneurysms situated on the same side (rightMCA, who was operated in our clinic, 20days after first SAH episode, I grade onHunt/Hess scale. The angio MRI wasperformed before, and control DSangiography after operation. After pterionalapproach, the author used themagnification, microsurgical technics,temporal clip, and two permanent Yasargilcurved clips. A postoperative good recoveryenable the patient go to work and drive onemonth later.

  16. Association of atherosclerotic renal artery stenosis with major adverse cardiovascular events after acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Zheng Bin; Liu Jinghua; Ma Qin; Zhao Donghui; Wang Xin; Zheng Ze

    2014-01-01

    Background Patients with atherosclerotic renal artery stenosis (ARAS) are in substantial risk of cardiovascular adverse events.We investigated whether myocardial infarction patients with ARAS are in additional risk of cardiovascular events.Methods In this retrospective study,257 patients with type 1 myocardial infarction were enrolled.Median follow-up was 42 months.Composite endpoint events are analyzed by definitions of ARAS as ≥50% or ≥70% diameter stenosis.Results Defining ARAS as ≥70% diameter stenosis,ARAS was a significant predictor for composite endpoint events including death,non-fatal myocardial infarction,ischaemic stroke and intracranial haemorrhage,rehospitalisation for cardiac failure (HR:4.381; 95% Cl:1.770-10.842) by Cox regression analysis,but not for death.Diabetes mellitus was also a significant predictor for composite endpoint events (HR:2.756; 95% Cl:1.295-5.863).However,defining ARAS ≥50% diameter stenosis,ARAS was no longer a significant predictor for composite endpoint events or death.Conclusions Although not associated with mortality,ARAS ≥70% is associated with major adverse cardiac events after acute myocardial infarction.For prognosis,≥70% diameter stenosis is a more appropriate criteria for ARAS definition than ≥50% diameter stenosis.

  17. The micropolar fluid model for blood flow through a tapered artery with a stenosis

    Institute of Scientific and Technical Information of China (English)

    Kh. S. Mekheimer; M. A. El Kot

    2008-01-01

    A micropolar model for axisymmetric blood flow through an axially nonsymmetreic but radially symmetric mild stenosis tapered artery is presented. To estimate the effect of the stenosis shape, a suitable geometry has been considered such that the axial shape of the stenosis can be changed easily just by varying a parameter (referred to as the shape parameter). The model is also used to study the effect of the taper angle φ. Flow parameters such as the velo-city, the resistance to flow (the resistance impedance), the wall shear stress distribution in the stenotic region and its magnitude at the maximum height of the stenosis (stenosis throat) have been computed for different values of the shape parameter n, the taper angle φ, the coupling number N and the micropolar parameter m. It is shown that the resistance to flow decreases with increasing the shape parameter n and the micropolar parameter m while it increases with increasing the coupling number N. So, the magnitude of the resistance impedance is higher for a micropolar fluid than that for a Newtonian fluid model. Finally, the velocity profile, the wall shear stress distribution in the stenotic region and its magni-tude at the maximum height of the stenosis are discussed for different values of the parameters involved on the problem.

  18. Renal artery stenosis after radiotherapy for Ewing's sarcoma; Radiotherapieinduzierte Nierenarterienstenose nach Behandlung eines Ewing-Sarkoms

    Energy Technology Data Exchange (ETDEWEB)

    Tacconi, S.; Bieri, S. [Abt. fuer Radioonkologie, Centre Hospitalier du Centre du Valais (CHCVs), Hopital de Sion (Switzerland)

    2008-09-15

    Background: the fact that therapeutic irradiation can induce significant stenosis in the arteries of the head, neck, and chest, as welt as in the aorta and the iliac arteries, is familiar in daily practice and well documented in the literature. By contrast, radiation-induced renal artery stenosis seems to be a less widely known complication. Patients and methods: the sudden onset of medically refractory arterial hypertension and coma in a 27-year-old man is reported, who had been treated at age 20 with chemotherapy and radiotherapy for Ewing's sarcoma in the lumbar region. This treatment had been performed at the hospital of Sion, Switzerland in 2001. Also, the relevant literature from 1965 to 2007 is reviewed to underscore various aspects of this problem and to demonstrate the clinical relevance of renal artery stenosis as a potential long-term sequela of radiotherapy. Conclusion: radiation-induced renal artery stenosis has only rarely been described in the literature, but arterial hypertension due to radiation-induced renal artery stenosis is a serious long-term sequela that can appear at a latency of up to 20 years after treatment. The paucity of reports presumably reflects the lesser frequency of radiotherapy for retroperitoneal tumors as compared to head-and-neck cancers, as well as lower awareness of the problem due to diagnostic bias in the era before CT and MRI were in routine use: at that time, carotid artery stenosis was easy to diagnose by ultrasonography, while radiation-induced renal artery stenosis, whose real incidence may well be higher, probably often went undetected. Thus, when a patient with a history of abdominal or retroperitoneal radiotherapy unexpectedly develops intractable hypertension, radiation-induced renal artery stenosis must be included in the differential diagnosis. (orig.)

  19. Renal artery stenosis: An unusual etiology of hypertensive encephalopathy in a child with fanconi anemia

    Directory of Open Access Journals (Sweden)

    Radheshyam Purkait

    2015-01-01

    Full Text Available A 9-year-old girl, diagnosed case of Fanconi anemia, presented with generalized convulsion with altered sensorium. She had fever, severe pallor, sinus tachycardia, blood pressure of 180/120 mmHg in both upper and lower limb, pan-systolic murmur of grade 2/6, abdominal bruit and bilateral papilledema. A provisional diagnosis of hypertensive encephalopathy was made and managed with continuous labetalol infusion. Detailed evaluation including magnetic resonance angiography of renal artery detected underlying atrophic and non-functioning right kidney secondary to severe renal artery stenosis on the same side. She was started with multiple antihypertensives, but her blood pressure was maintained poorly. Later on, she underwent rightsided nephrectomy. Following surgery, she was doing well and maintaining normal blood pressure without any antihypertensives. Our child is the second reported case of Fanconi anemia associated with renal artery stenosis presenting with hypertensive encephalopathy.

  20. Thermal laser-assisted angioplasty of renal artery stenosis for renovascular hypertension.

    Science.gov (United States)

    Tani, M; Mizuno, K; Midorikawa, H; Igari, T; Egawa, M; Niimura, S; Fukuchi, S; Hoshino, S

    1993-01-01

    Percutaneous transluminal laser-assisted angioplasty of a renal artery stenosis was performed in a 16-year-old woman with renovascular hypertension. The stenotic portion of the renal artery was predilated by delivering Nd-YAG laser energy to the terminal tip of a laser catheter. Although the luminal diameter did not increase sufficiently with laser angioplasty alone, it allowed passage of the balloon catheter and subsequent successful balloon angioplasty. Immediately after dilatation, the patient's blood pressure fell to normal, and plasma renin activity decreased. There were no serious complications. Thermal laser angioplasty seems to be an effective adjunct technique for the treatment of severe renal artery stenosis which does not allow initial passage of a balloon catheter.

  1. Takayasu's arteritis with renal artery stenosis diagnosed in a patient with 65 years old.

    Science.gov (United States)

    Valente, Ellen Simionato; de Almeida, Rafael; Sacco, Alexander Gonçalves; Lazzarin, Mauricio Costa; da Silva, André Melchiades; Andreazza, Marcos

    2015-01-01

    Takayasu arteritis is a rare disease of unknown etiology that affects the aorta and its main branches. It is a condition, geographically more common in Southeast Asia, which mainly affects women of reproductive age. The clinical presentation is nonspecific, with signs and symptoms that vary according to the affected arterial segment. The most commonly affected vessel is the subclavian artery, while renal artery stenosis is relatively uncommon. Cardiac involvement and association with other diseases may also be present. We present in this report the case of an elderly patient with late diagnosis of Takayasu's arteritis and various comorbidities or related complications.

  2. Radiologic management of hepatic arterial stenosis or thrombosis following liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Byung Suck; Sung, Kyu Bo; Lim, Soo Mee; Yoon, Hyun Ki; Song, Ho Young [Asan Medical Center, Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-06-01

    To assess the results and usefulness of interventional procedures for hepatic arterial stenosis or thrombosis following liver transplantation. During the past five years, eight patients aged 1-59 (mean, 39) years among 187 liver transplant recipients showed elevated of liver enzyme levels (AST/ALT) and decreased arterial flow at Doppler ultrasound. Hepatic arteriography revealed luminal stenosis or occlusion at the proper hepatic artery, and six patients, one of whom required thrombolysis before the procedure, underwent percutaneous transluminal angioplasty (PTA) using a balloon. In two with thrombosis, thrombolysis without PTA was performed. In order to increase hepatic arterial flow, four patients underwent additional coil embolization of the gastroduodenal or splenic artery. Hepatic arterial flow recovered in all six patients after PTA. Three required repeat PTA for restenosis and one of these needed stent placement after repeated PTA. At follow-up, 6-17 months later, the three had good hepatic function. Within four days, the other three expired due to graft failure, hepatorenal syndrome and sepsis. One of the patients who underwent thrombolysis without PTA expired and the other required retransplantation. In this case there were no procedure - related complications. Radiologic interventions are useful for treatment of hepatic arterial stensis or thrombosis in patients with liver transplantations.

  3. Cardioembolic occlusion of the internal carotid artery presented with infarction in the posterior cerebral artery territory

    Institute of Scientific and Technical Information of China (English)

    XUE Su-fang; JIA Jian-ping

    2010-01-01

    @@ Posterior circulation stroke may rarely be associated with occlusive disease in the anterior circulation, such as in the context of a direct (fetal) origin of the posterior cerebral artery (PCA) from the internal carotid artery (ICA), or in the presence of a persistent trigeminal artery (PTA) or persistent hypoglossal artery (PHA).1,2

  4. Simulation of Blood Flow Coronary Artery with Consecutive Stenosis and Coronary-Coronary Bypass

    Directory of Open Access Journals (Sweden)

    Omid Arjmandi-Tash

    2011-08-01

    Full Text Available Introduction: In this research the behavior of coronary arteries has been studied with symmetric and asymmetric consecutive stenosis, and grafted vessels. Methods: The incompressible Navier-Stokes and energy equations were discretized with second-order upwind method. Assumptions such as Newtonian fluid, wall rigidity and steady-flow were used. Results: All the calculations showed the same results with Newtonians and non-Newtonian fluids. It was found that the possibility of stenosis be reduced by increasing the graft angle. However, there exists further stenosis possibility. Among the three graft angles 20, 30 ̊ and 40, the 30 ̊ was found to be the reliable ones. Conclusion: Based on these findings, it can be deduced that there would be a high risk of further atherosclerosis when the first stenose has the maximum percentage.

  5. Aortic arch and intra-/extracranial cerebral arterial atherosclerosis in patients suffering acute ischemic strokes

    Institute of Scientific and Technical Information of China (English)

    郭毅; 姜昕; 陈实; 张少文; 赵宏文; 吴瑛

    2003-01-01

    cerebral embolic strokes. The presence of carotid arterial plaques correlates with AAA incidence. Most of carotid artery lesion were plaques other than severe stenosis, it may be the character of carotid atherosclerosis of stroke patients. It appears that atherosclerosis does not mainly occur in the intracranial arteries in stroke patients as thought before. Aged, male, diabetes, and smoking are important risk factors to the AAA.

  6. 基底动脉狭窄与认知功能改变的临床分析%Relation between basilar artery stenosis and cognitive impairment

    Institute of Scientific and Technical Information of China (English)

    李慧英; 黄一宁; 叶长青; 白静

    2012-01-01

    Objective To study the relation between autoregulation of bilateral posterior cerebral artery flow and cognitive function in patients with basilar artery stenosis. Methods Fifteen patients with basilar artery stenosis were divided into stenosis group without cerebral infaction(n = 9) and stenosis group with cerebral infaction(n = 6). Ten healthy volunteers served as a control group. Autoregulation of bilateral posterior cerebral artery flow was assessed by transcranial Doppler ultrasound breath holding test and oblique test. Executive function,structural skill,auditory, visual and logical memory, information processing speed and visuospatial ability were assayed according to the overall neurophysiolgy test and Montreal cognitive assessment(MCA). Results The information processing speed and visuospatial ability were significantly lower in stenosis group with cerebral infarction than in control group(P<0. 05). The visuospatial ability was significantly higher in stenosis group with cerebral infarction than in stenosis group without cerebral infarction(P<0. 05). The breath holding index of posterior cerebral artery and the proportion of anterior and posterior circulating vascular motion reactivity were significantly lower in stenosis group with cerebral infarction and stenosis group without cerebral infarction than in control group (P<0. 05). The proportion of anterior and posterior circulating vascular motion reactivity was positively related with the visuospatial ability (r=0. 830, P<0. 05). Conclusion Patients with basilar artery stenosis may have cognitive impairment at different severity before cerebral infarction and its hemodynamic change is related with cognitive impairment.%目的 探讨基底动脉狭窄患者双侧大脑后动脉的脑血流自动调节变化与认知功能改变之间的关系.方法 选择基底动脉狭窄患者15例,并根据有无脑梗死分为狭窄无梗死组9例和狭窄梗死组6例,另选健康体检者10例为对照组.应用

  7. BILATERAL RENAL ARTERY STENOSIS IN A HYPERTENSIVE LUPUS PATIENT WITHOUT RENAL DYSFUNCTION: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Giulio Geraci

    2014-04-01

    Full Text Available Systemic lupus erythematosus (SLE is associated with a high prevalence of atherosclero-sis and an enhanced cardiovascular mortality. In adult subjects, several studies have shown the coexistence of SLE and renal artery stenosis, most of them with unilateral in-volvement or with renal dysfunction. We observed a 62-year-old man with SLE and a 10-year history of moderate-to-severe hy-pertension who was admitted to our hospital because of uncontrolled blood pressure val-ues (152/95 mmHg, despite drug therapy. No signs of renal impairment were evident. After an initial physical examination, which presented a periumbilical bruit, a renal ultra-sound was performed with evidence of bilateral renal artery stenosis. An angio-MR study also confirmed the diagnosis and showed a double renal artery on the right side. Many different factors can contribute to the bilateral renal artery stenosis in this patient. Chronic inflammatory state associated to SLE, metabolic alterations with dyslipidemia and steroid therapy may all be involved in the development of the renal atherosclerotic le-sions.

  8. Stent implantation of left main coronary artery stenosis in an infant: Effective long-term treatment?

    Directory of Open Access Journals (Sweden)

    Christian Paech

    2015-01-01

    Full Text Available Coronary artery stenosis is a rare phenomenon in children. Coronary stent implantation is generally not considered a standard treatment option due to technical difficulties and potential complications in this group of patients. Nevertheless, several pediatric cases reporting successful implantation with acceptable short-term experiences have been described. The following case presents a successful stent implantation for left main coronary artery (LMCA stenosis early after surgery for anomalous left coronary artery from pulmonary artery (ALCAPA at the age of 6 months. The excellent mid-term results and notably the procedure′s potential as a long-term treatment in small children are highlighted. A 6-month-old infant underwent surgery for ALCAPA. Due to sudden postoperative deterioration, cardiac catheterization was performed. Coronary angiography revealed severe (90% ostial LMCA stenosis. A PROMUS drug-eluting stent (Promus Element AL3.0 Χ 8 mm, Boston Scientific, Natick, Massachusetts, USA was implanted. The procedure was performed without complications. Antiplatelet therapy with acetylsalicylic acid and clopidogrel was initiated. Subsequently, cardiac function improved slowly. Cardiac catheterization 3 years 8 months after stent implantation showed no restenosis with a proximal LMCA diameter still at the 50 th percentile for age. Neither were signs of heart failure reported at the last follow-up at 7 years of age. Presupposing normal growth, the implanted stent would thus provide sufficient myocardial perfusion with a LMCA lumen at the 40 th percentile at the age of 16 years. In selected cases, coronary stent implantation may be an effective mid- to long-term treatment of coronary artery stenosis even in very young children.

  9. Successful percutaneous transluminal angioplasty and stenting for symptomatic intracranial vertebral artery stenosis using intravascular ultrasound virtual histology.

    Science.gov (United States)

    Takayama, Katsutoshi; Taoka, Toshiaki; Nakagawa, Hiroyuki; Myouchin, Kaoru; Wada, Takeshi; Sakamoto, Masahiko; Fukusumi, Akio; Iwasaki, Satoru; Kurokawa, Shinichiro; Kichikawa, Kimihiko

    2007-06-01

    This is the first report of percutaneous transluminal angioplasty (PTA) of an intracranial artery applying intravascular ultrasound virtual histology (IVUS-VH), which has been recently developed for tissue characterization of coronary artery plaque. We report a case of successful PTA and stenting for symptomatic intracranial vertebral artery stenosis using IVUS-VH.

  10. Systolic Pressure in Different Percents of Stenosis at Major Arteries

    CERN Document Server

    Mirzaee, Mohammad Reza; Firoozabadi, Bahar; Dandaneband, Meitham

    2016-01-01

    - Modeling Human cardiovascular system is always an important issue. One of the most effective methods is using lumped model to reach to a complete model of human cardiovascular system. Such modeling with advanced considerations is used in this paper. Some of these considerations are as follow: Exact simulating of ventricles as pressure suppliers, peristaltic motion of descending arteries as additional suppliers, and dividing each vessel into more than one compartment to reach more accurate answers. Finally a circuit with more than 150 RLC segments and different elements is made. Then the verification of our complex circuit is done and at the end, obstruction as an important abnormality is investigated. For this aim different percents of obstruction in vital arteries are considered and the results are brought as different graphs at the end. According to physiological texts the citation of our simulation and its results are obvious. To earn productive information about arteries characteristics a 36-vessels mod...

  11. Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries. Pt. 1. Anterior cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Gloger, S. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Gloger, A. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Vogt, H. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Kretschmann, H.J. (Dept. of Neuroanatomy, Hannover Medical School (Germany))

    1994-04-01

    We present a three-dimensional anatomical computer model of the terminal branches of the anterior cerebral artery, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries, which can help to identify them on conventional and magnetic resonance angiography. Our rendition of the cerebral arteries can also be matched with CT, MR or PET images to indicate the areas of extension of individual branches, allowing neuromorphological and functional correlation. (orig.)

  12. Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis

    DEFF Research Database (Denmark)

    Henein, Michael; Hällgren, Peter; Holmgren, Anders

    2015-01-01

    BACKGROUND: The underlying pathology in aortic stenosis (AS) and coronary artery stenosis (CAS) is similar including atherosclerosis and calcification. We hypothesize that coronary artery calcification (CAC) is likely to correlate with aortic root calcification (ARC) rather than with aortic valve...... calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue. MATERIAL AND METHODS: We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector...... cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve. RESULTS: CAC was present in 92%, AVC in 100% and ARC in 82...

  13. Unilateral symptomatic intracranial arterial stenosis and myopathy in an adolescent with Graves disease: a case report of an high-resolution magnetic resonance imaging study.

    Science.gov (United States)

    Yin, Jia; Zhu, Jiajia; Huang, Dongling; Shi, Changzheng; Guan, Yuqing; Zhou, Liang; Pan, Suyue

    2015-01-01

    Vascular and muscular involvements in Graves disease (GD) are rare. Here, we report a case of a 17-year-old patient with unilateral symptomatic middle cerebral artery stenosis concurrent with GD and myopathy. He presented with a 1-day history of acute severe right-sided hemiparesis and aphasia and a 3-week history of high metabolic syndrome. The pathogenesis of the stenosis is most likely vasculitis rather than atherosclerosis, based on contrast-enhanced high-resolution magnetic resonance imaging showing concentric wall enhancement. We suggest that lipid storage myopathy is secondary to GD, and it is likely mitochondrial dysfunction or immune dysfunction induced by GD responsible for the myopathy and that magnetic resonance spectroscopy (MRS) is capable of establishing the diagnosis of myopathy. Thus, MRS can be used for follow-up evaluations of the myopathy along with the pathology biopsy.

  14. Mechanical and vasomotor properties of piglet isolated middle cerebral artery

    DEFF Research Database (Denmark)

    Eriksen, Vibeke Ramsgaard; Abdolalizadeh, Bahareh; Trautner, Simon;

    2016-01-01

    Piglets are often used as experimental models for studying cerebrovascular responses in newborn infants. However, the mechanical characteristics of piglets’ middle cerebral arteries (MCA) are not well characterized. Additionally, the vessels’ response to dopamine, the most commonly used vasopress...

  15. KIR channels tune electrical communication in cerebral arteries

    DEFF Research Database (Denmark)

    Sancho, Maria; Samson, Nina C; Hald, Bjorn O

    2016-01-01

    hamster cerebral arteries. Focal KCl application induced a vasoconstriction that conducted robustly, indicative of electrical communication among cells. Inhibiting dominant K(+) conductances had no attenuating effect, the exception being Ba(2+) blockade of KIR Electrophysiology and Q-PCR analysis...

  16. Migraine pain associated with middle cerebral artery dilatation

    DEFF Research Database (Denmark)

    Friberg, L; Olesen, J; Iversen, H K

    1991-01-01

    The combination of measurements of regional cerebral blood flow (rCBF) and blood velocity in the middle cerebral arteries (MCA) by transcranial doppler sonography was used to investigate cerebrovascular involvement in migraine. Ten migraine patients with unilateral headache were studied during...... dilatation on the headache side. Sumatriptan predominantly had effects on the distended artery, which suggests that the 5-HT receptor system has a role in the pathogenesis of migraine....

  17. High-resolution Magnetic Resonance Vessel Wall Imaging for Intracranial Arterial Stenosis

    Institute of Scientific and Technical Information of China (English)

    Xian-Jin Zhu; Wu Wang; Zun-Jing Liu

    2016-01-01

    Objective:To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging (HRMR VWI) for intracranial arterial stenosis.Date Sources:We retrieved information from PubMed database up to December 2015,using various search terms including vessel wall imaging (VWI),high-resolution magnetic resonance imaging,intracranial arterial stenosis,black blood,and intracranial atherosclerosis.Study Selection:We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI.We organized this data to explain the value of VWI in clinical application.Results:VWI with black blood technique could provide high-quality images with submillimeter voxel size,and display both the vessel wall and lumen of intracranial artery simultaneously.Various intracranial vasculopathies (atherosclerotic or nonatherosclerotic) had differentiating features including pattern of wall thickening,enhancement,and vessel remodeling on VWI.This technique could be used for determining causes of stenosis,identification of stroke mechanism,risk-stratifying patients,and directing therapeutic management in clinical practice.In addition,a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy.Conclusions:This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.

  18. Middle cerebral artery blood velocity and plasma catecholamines during exercise

    DEFF Research Database (Denmark)

    Pott, F; Jensen, K; Hansen, H;

    1996-01-01

    During dynamic exercise, mean blood velocity (Vmean) in the middle cerebral artery (MCA) demonstrates a graded increase to work rate and reflects regional cerebral blood flow. At a high work rate, however, vasoactive levels of plasma catecholamines could mediate vasoconstriction of the MCA...

  19. Effect of Body Acceleration on Pulsatile Flow of Micropolar Fluid through an Irregular Arterial Stenosis

    Science.gov (United States)

    Abdullah, Ilyani; Amin, Norsarahaida

    2008-01-01

    The present study deals with the effect of body acceleration together with surface irregularities on blood flow in artery. Prolonged exposure to high level unintended acceleration may cause serious health problems in the cardiovascular system. The situations like riding in vehicles, flying in airplanes and fast body movements during sport activities can lead to the impairment of certain physiological functions. A micropolar model of blood flow through an irregular arterial stenosis is considered. The governing equations involving unsteady nonlinear two-dimensional partial differential equations are solved employing finite difference scheme. Computational results on the velocity profiles and the flow characteristics are presented.

  20. Endovascular rescue from arterial rupture and thrombosis during middle cerebral artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, J.Y.; Chung, Y.S. [Department of Neurosurgery, College of Medicine, Pundang CHA Hospital, 351 Yatap-ding, Pundang-gu, 463-712, Sungnam (Korea); Lee, B.H. [Department of Interventional Neuroradiology, College of Medicine, Pundang CHA Hospital, 351 Yatap-dong, Pundang-gu, 463-712, Sungnam (Korea); Kim, O.J. [Department of Emergency Medicine, College of Medicine, Pundang CHA Hospital, 351 Yatap-dong, Pundang-gu, 463-712, Sungnam (Korea)

    2003-08-01

    Intravascular stents are being used with increasing frequency in interventional neuroradiology. Iatrogenic arterial rupture is an uncommon but serious complication. We present a case of arterial rupture and subarachnoid haemorrhage during middle cerebral artery stenting, treated by emergency additional, overlapping stenting and balloon tamponade of the dissected vessel. Thrombotic occlusion of the artery was managed by intra-arterial abciximab. Normal vessel patency was re-established within 20 min and the patient recovered with no neurological deficit. (orig.)

  1. Increased level of glycated hemoglobin portends high risk of coronary artery stenosis

    Institute of Scientific and Technical Information of China (English)

    ZENG FAN-fang; WANG Li-li; LONG Juan; YI Wen-ya; LUO Ying

    2016-01-01

    Background Increased level of glycated hemoglobin (HbA1c) is associated with higher incidence of coronary artery disease (CAD) in the diabetics.However,the relationship between HbAlc and the risk of coronary artery stenosis in the non-diabetics is controversial.Methods A retrospective research was conducted on 338 enrolled participants who have undergone 2 times of coronary angiographic examination within the past year.Clinical and laboratory variables at the initial and the second time of admission were collected.According to the initial median HbA1c level,all participants were divided into two groups named lower and higher groups.The relationship between HbA1c level and the risk of coronary artery stenosis over time was evaluated.Results The initial values of HbA1c in lower and upper groups were 5.78 ± 0.35% and 6.21 ± 0.32% (P < 0.05).As compared to the lower group,the percentages of male and smoking participants,and the serum level of CRP were significantly higher in the higher group (P < 0.05).Other traditional risk factors were comparable between the two groups.There were 54.2% and 55.2% participants with single vessel stenosis,and 45.8% and 44.8% with multiple vessel stenoses,respectively in the two groups without significant difference.The second time of admission,were 308.5± 25.4 days (lower group) and 300.7 ± 30.1 days (higher group) from the initial admission.Although no significant changes of HbA1c level were observed when compared to initial,HbA1c level in the higher group was still significantly higher in comparison to the lower group (6.24 ± 0.39% vs.5.80 ± 0.36%,P =0.008).The percentage of new coronary artery stenosis (≥ 50% stenosis) was higher in the higher group than that in the lower group (41.7% vs.32.3%,P < 0.001).Multivariate regression analyses suggested that HbAlc remained independent factor associated with coronary artery stenoses after extensive adjustment for risk factors.Conclusion In the nondiabetics

  2. Renal artery stenosis presenting as crescendo angina pectoris.

    Science.gov (United States)

    Tami, L F; McElderry, M W; al-Adli, N M; Rubin, M; Condos, W R

    1995-07-01

    The coexistence of different clinical syndromes due to atherosclerosis in different organs is not rare and emphasizes the diffuse nature of this vascular process. Although renovascular disease may cause hypertension and/or renal insufficiency, it may also occur in the absence of the usual clinical markers that suggest renovascular hypertension. We report a patient with stable coronary anatomy who presented with crescendo angina pectoris. Diagnosis of renovascular hypertension was made by screening renal angiography at the time of the cardiac catheterization. Renal artery stenting resulted in stabilization of the coronary syndrome and obviated the need for further coronary intervention. To our knowledge, this is the first case of renovascular hypertension precipitating an unstable coronary syndrome in a patient with documented stable coronary anatomy. Review of the literature supports that patients undergoing cardiac catheterization are a high risk population for renovascular disease, particularly in the presence of other predictive factors such as documented coronary artery disease, older age, female gender, congestive heart failure, peripheral vascular disease, renal insufficiency, and smoking. Firm recommendations for routine screening renal angiography in patients undergoing peripheral or coronary angiography will need further studies.

  3. Cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma (HCC). The authors present a case of CLE that occurred after the second hepatic arterial chemoembolization for HCC, and attempt to introduce several plausible mechanisms of CLE, after reporting the clinical and radiological findings and reviewing the medical literature.

  4. Angioplasty and stenting for severe vertebral artery oriifce stenosis:effects on cerebellar function remodeling veriifed by blood oxygen level-dependent functional magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    Bo Liu; Zhiwei Li; Peng Xie

    2014-01-01

    Vertebral artery oriifce stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood lfow and perfusion in the posterior circulation after inter-ventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso-nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery oriifce stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat-ment only. The intervention group received vertebral artery oriifce angioplasty and stenting+identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent function-al magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery oriifce stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

  5. Large deep infarcts found in proximal middle cerebral artery steno-occlusive disease: MRI and angiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Yi, Bum Ha; Kim, Eui Jong; Choi, Woo Suk; Jang, Dae Il; Chung, Kyung Cheon; Oh, Joo Hyung; Yoon, Yup; Hong, Hoon Pyo [Kyunghee Univ. Hospital, Seoul (Korea, Republic of)

    1998-11-01

    To determine the nature of large deep-seated infarcts without cortical infarct in patients with steno-occlusive disease of the proximal middle cerebral artery (MCA) using magnetic resonance images (MRI) and angiography. By means of MRI and MR angiography (MRA), we examined 24 patients with large deep cerebral infarctions (>3cm in size) involving the basal ganglia, corona radiata and/or centrum semiovale, as well as steno-occlusive lesion of the proximal MCA. According to location, infarctions were classified into five groups, as follows:Group 1:basal ganlgia and corona radiata; 2:basal ganglia, corona radiata and centrum semiovale;3:corona radiata and centrum semiovale;4:corona radiata;5:basal ganglia only. We evaluated the topography of the lesions and correlated the results with the findings of angiography (all 24 MRA;the 13:conventional angiography). Involvement of the head of the caudate nucleus and the internal capsule were also evaluated. Fifteen of 24 cases (63%) were assigned to group 1 (4 proximal MCA(M1) occlusion and 11 stenosis), and five of 24 (21%) with M1 occlusions to group 2. Group 3 comprised only one case with M1 occlusion. Two cases with both occlusion and stenosis were included in group 4, and only one case-with M1 stenosis-in group 5. Infarctions at the caudate nucleus were seen in five cases, and at the internal capsule in two. On conventional angiography (13 cases) cortical branches of the MCA were delineated through the leptomeningeal collaterals of anterior or posterior cerebral arteries. Most large deep cerebral infarctions found in proximal MCA diseases are thought to extend cephalad to the corona radiata. When large deep-seated infarctions with proximal MCA occlusion is observed more frequently than stenosis.=20.

  6. Effect of labetalol on cerebral blood flow and middle cerebral arterial flow velocity in healthy volunteers

    DEFF Research Database (Denmark)

    Schroeder, T; Schierbeck, Jens; Howardy, P;

    1991-01-01

    in normotensive subjects. Neither does it affect CO2 reactivity. The uniform results obtained with the two methods suggest TCD as a usable alternative to conventional CBF technique in the assessment of cerebral vasoactivity of various drugs in subjects with a normal cerebral circulation.......The effect of labetalol, a combined alpha- and beta-adrenoceptor antagonist, on the cerebral circulation was investigated in 7 normotensive subjects. Cerebral blood flow (CBF) was measured with the intravenous 133Xe method and mean flow velocity (Vmean) in the middle cerebral artery was determined...

  7. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment

    Science.gov (United States)

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    Summary Background To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. Material/Methods Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. Results During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. Conclusions Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery. PMID:26150902

  8. Regulatory mechanism of endothelin receptor B in the cerebral arteries after focal cerebral ischemia

    DEFF Research Database (Denmark)

    Grell, Anne-Sofie; Thigarajah, Rushani; Edvinsson, Lars;

    2014-01-01

    drug targets to restore normal cerebral artery contractile function as part of successful neuroprotective therapy. METHODS: We have employed in vitro methods on human and rat cerebral arteries to study the regulatory mechanisms and the efficacy of target selective inhibitor, Mithramycin A (MitA...... arteries. RESULTS: Increased expression of specificity protein (Sp1) was observed in human and rat cerebral arteries after organ culture, strongly correlating with the ETBR upregulation. Similar observations were made in MCAO rats. Treatment with MitA, a Sp1 specific inhibitor, significantly downregulated...... vasoconstriction in focal cerebral ischemia via MEK-ERK signaling, which is also conserved in humans. The results show that MitA can effectively be used to block ETBR mediated vasoconstriction as a supplement to an existing ischemic stroke therapy....

  9. Turbulence intensity measurements using particle image velocimetry in diseased carotid artery models: effect of stenosis severity, plaque eccentricity, and ulceration.

    Science.gov (United States)

    Kefayati, Sarah; Holdsworth, David W; Poepping, Tamie L

    2014-01-01

    Clinical decision-making for the treatment of patients with diseased carotid artery is mainly based on the severity of the stenosis. However, stenosis severity alone is not a sensitive indicator, and other local factors for the assessment of stroke risk are required. Flow disturbance is of particular interest due to its proven association with increased thromboembolic activities. The objective of this study was to investigate the level of turbulence intensity (TI) with regards to certain geometrical features of the plaque - namely stenosis severity, eccentricity, and ulceration. A family of eight carotid-artery bifurcation models was examined using particle image velocimetry. Results showed a marked difference in turbulence intensity among these models; increasing degree of stenosis severity resulted in increased turbulence intensity, going from 0.12 m/s for mild stenosis to 0.37 m/s for severe stenosis (with concentric geometry). Moreover, independent of stenosis severity, eccentricity led to further elevations in turbulence intensity, increasing TI by 0.05-0.10 m/s over the counterpart concentric plaque. The presence of ulceration (in a 50% eccentric plaque) produced a larger portion of moderate turbulence intensity (~0.10 m/s) compared to the non-ulcerated model, more proximal to the bifurcation apex in the post-stenotic recirculation zone. The effect of plaque eccentricity and ulceration in enhancing the downstream turbulence has potential clinical implications for a more sensitive assessment of stroke risk beyond stenosis severity alone.

  10. Development of coronary artery stenosis in a patient with metastatic renal cell carcinoma treated with sorafenib

    Directory of Open Access Journals (Sweden)

    Pantaleo Maria

    2012-06-01

    Full Text Available Abstract Background Tyrosine kinase inhibitors (TKIs are currently approved for the treatment of metastatic renal cell carcinoma (mRCC. The cardiotoxic effects of sorafenib and sunitinib may cause hypertension, left ventricular ejection fraction (LVEF dysfunction and/or congestive heart failure (CHF, and arterial thrombo-embolic events (ATE. Only three cases of coronary artery disease related to sorafenib therapy have been described in the literature, and all were due to arterial vasospasm without evidence of coronary artery stenosis on angiography. Cardiotoxicity is commonly associated with the presence of cardiovascular risk factors, such as a history of hypertension or coronary artery disease. Case presentation We describe a patient who experienced an unusual cardiac event after 2 years of sorafenib treatment. A 58-year-old man with mRCC developed acute coronary syndrome (ischemia/infarction associated with critical sub-occlusion of the common trunk of the left coronary artery and some of its branches, which was documented on coronary angiography. The patient underwent triple coronary artery bypass surgery, and sorafenib treatment was discontinued. He did not have any cardiovascular risk factors, and his cardiac function and morphology were normal prior to sorafenib treatment. Conclusions Further investigation of a larger patient population is needed to better understand cardiac damage due to TKI treatment. Understanding the usefulness of careful cardiovascular monitoring might be important for the prevention of fatal cardiovascular events, and to avoid discontinuation of therapy for the underlying cancer.

  11. Computed tomography angiography and perfusion to assess coronary artery stenosis causing perfusion defects by single photon emission computed tomography

    DEFF Research Database (Denmark)

    Rochitte, Carlos E; George, Richard T; Chen, Marcus Y

    2014-01-01

    AIMS: To evaluate the diagnostic power of integrating the results of computed tomography angiography (CTA) and CT myocardial perfusion (CTP) to identify coronary artery disease (CAD) defined as a flow limiting coronary artery stenosis causing a perfusion defect by single photon emission computed ...

  12. Prevalence of renal artery stenosis in subjects with moderate hypertension. A population-based study

    DEFF Research Database (Denmark)

    Andersen, Ulrik B; Borglykke, Anders; Jørgensen, Torben

    2011-01-01

    to balloon angioplasty. Two patients had reduced size and function of the affected kidney. Among the non-invasively treated patients, one showed stenosis progression at the 2-year follow-up examination. Conclusion. In subjects aged 50-66 years with hypertension grade II-III, RAS is rare among men......Abstract Aim. To examine the prevalence of significant renal artery stenosis (RAS) in subjects with moderate to severe hypertension. Materials and methods. Subjects aged 50-66 years with blood pressure >160/100 mmHg or receiving antihypertensive treatment were selected from the population study......, but not among women. These women may suffer from fibromuscular dysplasia. They are at risk of losing kidney function and developing severe hypertension, but they would not have been considered for screening according to present criteria....

  13. Carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration

    Energy Technology Data Exchange (ETDEWEB)

    Montorsi, Piero; Galli, Stefano; Ravagnani, Paolo; Ghulam Ali, Sarah; Trabattoni, Daniela; Fabbiocchi, Franco; Lualdi, Alessandro; Ballerini, Giovanni; Andreini, Daniele; Pontone, Gianluca; Annoni, Andrea; Bartorelli, Antonio L. [Institute of Cardiology University of Milan, Centro Cardiologico Monzino, IRCCS, Milan (Italy)

    2009-08-15

    Unfavorable complex anatomy or congenital anomalies of supra-aortic vessel take-off may increase carotid artery stenting (CAS) procedural difficulties and complications through the femoral route. We assessed the feasibility, safety, and efficacy of CAS through the right brachial approach in patients in whom left internal carotid artery stenosis and bovine aortic arch configuration were identified with computed tomography (CT) angiography. Bovine configuration of the aortic arch and left carotid artery stenosis were easily identified by CT angiography and successfully treated through the right brachial approach technique. (orig.)

  14. Computer-assisted 3D reconstruction of the terminal branches of th cerebral arteries. Pt. 2. Middle cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Gloger, S. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Gloger, A. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Vogt, H. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Kretschmann, H.J. (Dept. of Neuroanatomy, Hannover Medical School (Germany))

    1994-04-01

    We present a three-dimensional anatomical computer model of the terminal branches of the middle cerebral artery, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries, which can help to identify them on conventional angiography and magnetic resonance angiography. The arteries can also be matched with CT, MR or PET images to indicate the areas of extension of individual branches, allowing neuromorphological and functional correlations. (orig.)

  15. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Marcelo A. Nakazone

    2010-01-01

    Full Text Available Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

  16. Correlation between US-PSV and 64-Row MDCTA with Advanced Vessel Analysis in the Quantification of 50–70% Carotid Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Matteo Stefanini

    2012-01-01

    Full Text Available Purpose. To correlate ultrasonographic peak systolic velocity (US-PSV and 64-row multidetector computed tomography angiography (MDCTA with advanced vessel analysis (AVA software in the quantification of 50–70% carotid artery stenosis. Materials and methods. 199 consecutive patients (247 arteries with internal carotid artery (ICA or third proximal bifurcation stenosis. Each patient was studied by duplex US (DUS and 64-row MDCTA with AVA software. Results. DUS showed PSV measurements less than 125 cm/s in 51 carotid stenosis and a value greater than this in 196 arteries. 64-row MDCTA AVA software showed a grade of stenosis less than 50% in 42 carotid arteries while a greater 70% was found in 4 carotid arteries; then, carotid arteries with stenosis percentage between 50% and 70% were 201. Linear regression analysis showed a good linear correlation (=0.88 between MDCTA-AVA software percentage stenosis and PSV: between 50% grade of stenosis and PSV value corresponding to 133,6 cm/sec and between 70% stenosis and PSV value corresponding to 268 cm/sec. The sensitivity, specificity, positive predictive value(PPV, negative predictive value(NPV of this analysis were 93%, 82%, 97%, 75%, respectively. Conclusion. Linear correlation between PSV data and grade of stenosis from 50% to 70% obtained with 64-row MDCTA AVA software. Main PSV value corresponding to 50% and 70% grade of stenosis at AVA analysis.

  17. Prognostic Value of Gai's Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis

    Institute of Scientific and Technical Information of China (English)

    Chuang Zhang; Shuang Yang; Lu-Yue Gai; Zhi-Qi Han; Qian Xin; Xiao-Bo Yang; Jun-Jie Yang

    2016-01-01

    Background:The prognostic values of the coronary computed tomography angiography (CCTA) score for predicting future cardiovascular events have been previously demonstrated in numerous studies.However,few studies have used the rich information available from CCTA to detect functionally significant coronary lesions.We sought to compare the prognostic values of Gai's plaque score and the coronary artery calcium score (CACS) of CCTA for predicting functionally significant coronary lesions,using fractional flow reserve (FFR) as the gold standard.Methods:We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients (mean age,59.6 ± 10.2 years;76.14% of males) who underwent CCTA,invasive coronary angiography,and invasive FFR measurement.An FFR <0.80 indicated hemodynamically significant coronary stenosis.Lesions were divided into two groups using an FFR cutoff value of 0.80.We compared Gai's plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR.The statistical methods included unpaired t-test,Mann-Whitney U-test,and Spearman's correlation coefficients.Results:Coronary lesions with FFR <0.80 had higher Gai's scores than those with FFR ≥0.80.Gai's score had the strongest correlation with FFR (r =-0.48,P < 0.01) and had a greater area under the curve =0.72 (95% confidence interval:0.61-0.82;P < 0.01) than the CACS of whole arteries and a single artery.Conclusions:Both CACS in a single artery and Gai's plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR.However,Gai's plaque score was more predictive of FFR <0.80.Gai's score can be easily calculated in daily clinical practice and could be used when considering revascularization.

  18. Prevalence of renal artery stenosis in flash pulmonary oedema: determination using gadolinium-enhanced MRA.

    LENUS (Irish Health Repository)

    McMahon, Colm J

    2012-02-01

    PURPOSE: The primary purpose was to determine the prevalence of renal artery stenosis (RAS) in patients presenting with acute ("flash") pulmonary oedema (FPE), without identifiable cause using contrast-enhanced magnetic resonance angiography (CE-MRA) of renal arteries. A secondary goal was to correlate clinical parameters at presentation with the presence or absence of RAS. MATERIALS AND METHODS: Patients presenting with acute pulmonary oedema without identifiable cause prospectively underwent CE-MRA. >50% renal artery stenosis was considered significant. Clinical parameters (blood pressure, serum creatinine, history of hypertension\\/hyperlipidaemia) were compared in patients with and without RAS using an unpaired t-test. Results expressed; mean (+\\/-SD). RESULTS: 20 patients (4 male, 16 female, age 78.5+\\/-11 years) underwent CE-MRA. 9 patients (45%) had significant RAS (6 (30%) bilateral, 3 (15%) unilateral). Systolic BP was higher in patients with RAS (192+\\/-38 mm Hg) than those without (134+\\/-30 mm Hg) (p<.005). Diastolic BP was higher in patients with RAS (102+\\/-23 mm Hg) than those without (76+\\/-17 mm Hg) (p<.01). All patients with RAS and 6\\/11(55%) patients without RAS had a history of hypertension. No significant difference in creatinine or hyperlipidaemia history was observed. CONCLUSION: The prevalence of RAS in patients presenting with FPE is 45%. The diagnosis should be considered in patients presenting with unexplained acute pulmonary oedema, particularly if hypertensive at presentation.

  19. Analysis of the Sensitivity and Specificity of Noninvasive Imaging Tests for the Diagnosis of Renal Artery Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Borelli, Flavio Antonio de Oliveira, E-mail: fborelli@cardiol.br; Pinto, Ibraim M. F.; Amodeo, Celso; Smanio, Paola E. P.; Kambara, Antonio M.; Petisco, Ana Claudia G.; Moreira, Samuel M.; Paiva, Ricardo Calil; Lopes, Hugo Belotti; Sousa, Amanda G. M. R. [Instituto Dante Pazzanese de Cardiologia, São Paulo, SP (Brazil)

    2013-11-15

    Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality. To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis. In a group of 61 patients recruited, 122 arteries were analized, thus permitting the definition of sensitivity, specificity, and the relative contribution of each imaging study performed (Doppler, scintigraphy and computed tomographic angiography in comparison to renal arteriography). The mean age was 65.43 years (standard deviation: 8.7). Of the variables related to the study population that were compared to arteriography, two correlated with renal artery stenosis, renal dysfunction and triglycerides. The median glomerular filtration rate was 52.8 mL/min/m{sup 2}. Doppler showed sensitivity of 82.90%, specificity of 70%, a positive predictive value of 85% and negative predictive value of 66.70%. For tomography, sensitivity was 66.70%, specificity 80%, positive predictive value 87.50% and negative predictive value 55.20%. With these findings, we could identify the imaging tests that best detected stenosis. Tomography and Doppler showed good quality and efficacy in the diagnosis of renal artery stenosis, with Doppler having the advantage of not requiring the use of contrast medium for the assessment of a disease that is common in diabetics and is associated with renal dysfunction and severe left ventricular dysfunction.

  20. Stenting for left main stenosis in a child with anomalous origin of left coronary artery: case report

    Institute of Scientific and Technical Information of China (English)

    CHEN Ming; HONG Tao; HUO Yong

    2005-01-01

    @@ Anomalous left coronary artery (LCA) arising from right cusp is an uncommon condition. Clinical evidence has shown that this coronary anomaly is consistently related to sudden death. Current treatment options include modification of behaviour, medicine or surgery. Stents have been successfully applied for left main stenosis for a decade. We report a case of LCA arising from right cusp with left main stenosis treated with coronary stent in a child patient.

  1. Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

    Science.gov (United States)

    Bejot, Yannick; Caillier, Marie; Osseby, Guy-Victor; Didi, Roy; Ben Salem, Douraied; Moreau, Thibault; Giroud, Maurice

    2008-02-01

    Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

  2. Low-flow aortic stenosis in asymptomatic patients: valvular-arterial impedance and systolic function from the SEAS Substudy

    DEFF Research Database (Denmark)

    Cramariuc, Dana; Cioffi, Giovanni; Rieck, Ashild E

    2009-01-01

    OBJECTIVES: This study sought to assess the impact of valvuloarterial impedance on left ventricular (LV) myocardial systolic function in asymptomatic aortic valve stenosis (AS). BACKGROUND: In atherosclerotic AS, LV global load consists of combined valvular and arterial resistance to LV ejection...... Ezetimibe in Aortic Stenosis) study evaluating placebo-controlled combined simvastatin and ezetimibe treatment in AS were used to assess LV global load as valvuloarterial impedance and LV myocardial function as stress-corrected midwall shortening. The study population was divided into tertiles of global...... preserved. (An Investigational Drug on Clinical Outcomes in Patients With Aortic Stenosis [Narrowing of the Major Blood Vessel of the Heart]; NCT00092677)....

  3. Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography

    Directory of Open Access Journals (Sweden)

    Ugo Fabrizio

    2010-05-01

    Full Text Available Abstract Background We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE. Wall motion (WM assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD, particularly in patients with isolated intermediate (50%-70% coronary stenosis. Methods We performed DASE with MPI in 150 patients with a suspected chest pain syndrome who were given clinical indication to coronary angiography. Results and discussion When CAD was defined as the presence of a ≥50% stenosis, the addition of MPI increased sensitivity (+30% and decreased specificity (-14%, with a final increase in total diagnostic accuracy (+16%, p Conclusions The addition of MPI on top of WM analysis during DASE increases the diagnostic sensitivity to detect obstructive CAD, whatever its definition (≥50% or > 70% stenosis, but it is mainly driven by the sensitivity increase in the intermediate group (50%-70% stenosis. The total diagnostic accuracy increased only when defining CAD as ≥50% stenosis, since in patients with severe stenosis (> 70% the decrease in specificity is not counterbalanced by the minor sensitivity increase.

  4. 颈动脉狭窄合并冠心病的分期介入治疗及随访研究%Staged interventional therapy for coexistent carotid artery stenosis and coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    段鸿洲; 李良; 张扬; 伊志强; 张家湧; 陈明; 刘兆平; 李建平; 鲍圣德

    2012-01-01

    Objective To investigate the effect of staged interventional therapy in treatment of coexistent carotid artery stenosis and coronary artery disease. Methods The data of fifty-seven patients with carotid artery stenosis and coronary artery disease confirmed by CT angiography (CTA) or Digital Subtraction Angiography (DSA) were analysed retrospectively. Percutaneous Coronary Intervention(PCI) was performed in all patients firstly, and Carotid Artery Stent (CAS) was done one week later. Hydration was performed perioperatively to protect the renal function. Neurological function (mRS) , renal function and complications were evaluated perioperatively. The patients were followed-up to observe if there was myocardial infarction or cerebral infarction and if there was stenosis in stent. Results Staged interventional therapy were performed successfully in all patients. Intraoperative angiography shew satisfied stenosis release and forward blood flow. There was no obvious alteration in mRS and renal function (P > 0.05). One patient with cerebral ischemia deteriorated 3 days after PCI and was quickly recovered after CAS immediately. Although carotid sinus reflection occurred in 16 patients during CAS, there was no myocardial infarction and cerebral infarction occurred postoperatively. There was also no myocardial infarction, cerebral infarcion corelated with stent and death during the following up. Conclusions For patients coexistent with carotid artery stenosis and coronary artery disease, staged PCI followed by CAS may be a safe and feasible strategy1.%目的 探讨分期介入治疗颈动脉狭窄合并冠心病患者的疗效,并发症及随访效果.方法 回顾性分析了57例经冠状动脉及脑血管造影或CT血管成像(CTA)证实的颈动脉狭窄合并冠心病患者的临床资料,所有患者均先行经皮冠状动脉介入治疗(PCI),术后1周左右再行颈动脉支架术(CAS),手术前后均进行水化以保护肾功能,观察手术前后患者的神

  5. Pericallosal lipoma and middle cerebral artery aneurysm: a coincidence?

    Energy Technology Data Exchange (ETDEWEB)

    Sommet, Julie; Schiff, Manuel; Evrard, Philippe [Hopital Robert Debre, APHP, Department of Paediatric Neurology and Metabolic Diseases, Paris Cedex 19 (France); Blanc, Raphael [Fondation Rothschild, Department of Interventional Radiology, Paris (France); Elmaleh-Berges, Monique [Hopital Robert Debre, Department of Paediatric Radiology, Paris (France)

    2010-08-15

    Intracranial lipomas are rare congenital malformations that can often be seen in association with other brain malformations; agenesis or dysgenesis of the corpus callosum is the most frequently associated brain anomaly. They are usually pericallosal asymptomatic midline lesions. Intracranial lipomas associated with a non-contiguous cerebral aneurysm are extremely rare. We report an infant with partial agenesis of the corpus callosum and pericallosal lipoma associated with cerebral haemorrhage due to a distal middle cerebral artery aneurysm. Such an association is probably not fortuitous and could suggest a pathogenic relationship. (orig.)

  6. Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience.

    Science.gov (United States)

    Antoniak, Robert; Grabowska-Derlatka, Laretta; Nawrot, Ireneusz; Cieszanowski, Andrzej; Rowiński, Olgierd

    2017-01-01

    Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk. Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings.

  7. Numerical simulation of pulsatile flow with newtonian and non-newtonian behavior in arterial stenosis

    Directory of Open Access Journals (Sweden)

    MM Movahedi

    2008-03-01

    Full Text Available Background: There is considerable evidence that vascular fluid dynamics plays an important role in the developmentand prevalence of atherosclerosis which is one of the most widespread disease in humans .The onset and prevalence of atherosclerosis hemodynamic parameter are largely affected by geometric parameters. If any obstacle interferes with the blood flow, the above parameters change dramatically. Most of the arterial diseases, such as atherosclerosis, occur in the arteries with complex patterns of fluid flow where the blood dynamics plays an important role. Arterial stenosis mostly occurs in an area with a complex pattern of fluid flow, such as coronary artery, aorta bifurcation, carotid and vessels of lower limbs. During the past three decades, many experimental studies have been performed on the hemodynamic role of the blood in forming sediment in the inner wall of the vessels. It has been shown that forming sediment in the inner wall of vessels depends on the velocity of fluid and also on the amount of wall shear stress.Methods: We have examined the effect on the blood flow of local stenosis in carotid artery in numerical form using the incompressible Navier-Stockes equations. The profile of the velocity in different parts and times in the pulsatile cycle, separation and reattachment points on the wall, the distance stability of flow and also alteration caused by the wall shear stress in entire vessel were shown and compared with two behaviors flow (Newtonian and Non-Newtonian.Finally we describe the influence of the severity of the stenosis on the separation and reattachmentpoints for a Non-Newtonian fuid. Results: In the present study, we have pointed very low and high oscillating WSS (Wall Shear Stress values play a significant role in the development of forming sediment in the inner wall of vessels. Also, we obtain this probability is higher for Newtonian than Non-Newtonian fluid behavior.Conclusion: Based on our results, the

  8. [A Case of Aplastic or Twig-Like Middle Cerebral Artery Presenting with an Intracranial Hemorrhage Two Years after a Transient Ischemic Attack].

    Science.gov (United States)

    Uchiyama, Taku; Okamoto, Hiroaki; Koguchi, Motofumi; Tajima, Yutaka; Suzuyama, Kenji

    2016-02-01

    Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare anatomical anomaly, which can be associated with intracranial hemorrhage and cerebral ischemia. A 52-year-old woman who presented with sudden headache was admitted to our hospital. Computed tomography (CT) and magnetic resonance imaging showed no abnormality; however, magnetic resonance angiogram revealed an occlusion or severe stenosis in the left middle cerebral artery. Three-dimensional CT angiography demonstrated severe stenosis in the left middle cerebral artery. The patient was discharged without any neurological deficit; however, she subsequently complained of temporary weakness in the right hand. It was possibly due to a transient ischemic attack; therefore, cilostazol 200 mg/day was administered for prevention of cerebral ischemia. Single photon emission computed tomography(with or without administration of acetazolamide)showed neither significant decrease in the cerebral blood flow nor cerebrovascular reactivity; hence, surgical revascularization was not performed. However, two years after the initial admission, she was urgently admitted to our hospital with sudden headache and nausea followed by aphasia and weakness of the right extremities. CT images showed diffuse subarachnoid hemorrhage and intracerebral hemorrhage in the left temporo-parietal lobe. Cerebral angiography revealed that the left middle cerebral artery was Ap/T-MCA without cerebral aneurysms. The patient was treated conservatively, and she eventually recovered without any neurological deficit except mild aphasia. Since Ap/T-MCA is associated with both hemorrhagic and ischemic stroke, antiplatelet therapy should be administered carefully. Moreover, it is necessary to consider extracranial-intracranial bypass to reduce hemodynamic stress on the abnormal vessels.

  9. Decrease of Glomerular Filtration Rate may be Attributed to the Microcirculation Damage in Renal Artery Stenosis

    Institute of Scientific and Technical Information of China (English)

    Hao-Jian Dong; Cheng Huang; De-Mou Luo; Jing-Guang Ye; Jun-Qing Yang; Guang Li; Jian-Fang Luo

    2015-01-01

    Background:The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS).But the gap between artery stenosis and the glomerular filtration ability is still unclear.Methods:Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing,level of estimated glomerular filtration rate (eGFR),respectively.The different levels of eGFR,renal microcirculation markers,and RAS severity were compared with each other,to determine the relationships among them.Results:A total of 215 consecutive patients were enrolled in the prospective cohort study.Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50%) and no RAS group (RAS < 50%) or did not change correspondingly to RAS severity.The value of eGFR in RAS group was lower than that in the no RAS group,but it did not decline parallel to the progressive severity of RAS.The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency,especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR,with strong (r =-0.713,P < 0.001) and moderate (r =-0.580,P < 0.001) correlations.In the subgroup analysis of severe RAS (RAS ≥ 80%),the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR,(r =-0.827,P < 0.001) and (r =-0.672,P < 0.001) correlations,respectively.Conclusions:Severity of RAS could not accurately predict the value of eGFR,whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.

  10. Ex vitro experimental study on concentration polari-zation of macromolecules (LDL) at an arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    To verify the previous theoretical prediction that the disturbed flow distal to a stenosis enhances lipid accumulation at the blood/arterial wall interface, we designed a canine carotid arterial stenosis model and measured ex vitro the luminal surface concentration of bovine serum albumin (as a tracer mac-romolecule) by directly taking liquid samples from the luminal surface of the artery. The experimental results showed that due to the presence of a filtration flow, the luminal surface albumin concentration cw was higher than the bulk concentration co as predicted by our theory. The measurement revealed that the luminal surface concentration of macromolecules was indeed enhanced significantly in re-gions of the disturbed flow. At Re = 50, the relative luminal surface concentration cw/co was 1.66 ± 0.10 in the vortex region, while the cw/co was 1.37 ± 0.06 in the laminar flow region. When Re increased to 100, the cw/co in the vortex flow region and the laminar flow region reduced to 1.39 ± 0.07 and 1.24 ± 0.04, respectively. The effect of the filtration rate, vw, on the luminal surface concentration of albumin was remarkably apparent. At Re = 50 and 100, when vw = 8.9 ± 1.7 × 10-6 cm/s, cw in the vortex region was 77% and 52% higher than co respectively, meanwhile when vw = 4.8 ± 0.6 × 10-6 cm/s, cw in the vortex region was only 66 % and 39% higher than co respectively. In summary, the present study has provided further experimental evidence that concentration polarization can occur in the arterial system and fluid layer with highly concentrated lipids in the area of flow separation point may be responsible for the formation and development of atherosclerosis.

  11. Ex vitro experimental study on concentration polarization of macromolecules (LDL) at an arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    ZHANG ZhiGuo; DENG XiaoYan; FAN YuBo; LI DeYu

    2007-01-01

    To verify the previous theoretical prediction that the disturbed flow distal to a stenosis enhances lipid accumulation at the blood/arterial wall interface, we designed a canine carotid arterial stenosis model and measured ex vitro the luminal surface concentration of bovine serum albumin (as a tracer macromolecule) by directly taking liquid samples from the luminal surface of the artery. The experimental results showed that due to the presence of a filtration flow, the luminal surface albumin concentration cw was higher than the bulk concentration co as predicted by our theory. The measurement revealed that the luminal surface concentration of macromolecules was indeed enhanced significantly in regions of the disturbed flow. At Re = 50, the relative luminal surface concentration cw/co was 1.66±0.10 in the vortex region, while the cw/co was 1.37±0.06 in the laminar flow region. When Re increased to 100,the cw/co in the vortex flow region and the laminar flow region reduced to 1.39±0.07 and 1.24±0.04,respectively. The effect of the filtration rate, vw, on the luminal surface concentration of albumin was remarkably apparent. At Re=50 and 100, when vw=8.9±1.7×10-6 cm/s, cw in the vortex region was 77% and 52% higher than co respectively, meanwhile when vw = 4.8±0.6×10-6 cm/s, cw in the vortex region was only 66% and 39% higher than co respectively. In summary, the present study has provided further experimental evidence that concentration polarization can occur in the arterial system and fluid layer with highly concentrated lipids in the area of flow separation point may be responsible for the formation and development of atherosclerosis.

  12. Ex vitro experimental study on concentration polarization of macromolecules (LDL) at an arterial stenosis.

    Science.gov (United States)

    Zhang, ZhiGuo; Deng, XiaoYan; Fan, YuBo; Li, DeYu

    2007-08-01

    To verify the previous theoretical prediction that the disturbed flow distal to a stenosis enhances lipid accumulation at the blood/arterial wall interface, we designed a canine carotid arterial stenosis model and measured ex vitro the luminal surface concentration of bovine serum albumin (as a tracer macromolecule) by directly taking liquid samples from the luminal surface of the artery. The experimental results showed that due to the presence of a filtration flow, the luminal surface albumin concentration c(w) was higher than the bulk concentration c(0) as predicted by our theory. The measurement revealed that the luminal surface concentration of macromolecules was indeed enhanced significantly in regions of the disturbed flow. At Re = 50, the relative luminal surface concentration c(w)/c(0) was 1.66 +/- 0.10 in the vortex region, while the c(w)/c(0) was 1.37 +/- 0.06 in the laminar flow region. When Re increased to 100, the c(w)/c(0) in the vortex flow region and the laminar flow region reduced to 1.39 +/- 0.07 and 1.24 +/- 0.04, respectively. The effect of the filtration rate, v(w), on the luminal surface concentration of albumin was remarkably apparent. At Re = 50 and 100, when v(w) = 8.9 +/- 1.7 x 10(-6) cm/s, c(w) in the vortex region was 77% and 52% higher than c(0) respectively, meanwhile when v(w) = 4.8 +/- 0.6 x 10(-6) cm/s, c(w) in the vortex region was only 66% and 39% higher than c(0) respectively. In summary, the present study has provided further experimental evidence that concentration polarization can occur in the arterial system and fluid layer with highly concentrated lipids in the area of flow separation point may be responsible for the formation and development of atherosclerosis.

  13. Decrease of Glomerular Filtration Rate may be Attributed to the Microcirculation Damage in Renal Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Hao-Jian Dong

    2015-01-01

    Full Text Available Background: The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS. But the gap between artery stenosis and the glomerular filtration ability is still unclear. Methods: Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate (eGFR, respectively. The different levels of eGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them. Results: A total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50% and no RAS group (RAS < 50% or did not change correspondingly to RAS severity. The value of eGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C (cysC and urinary microalbumin to creatinine ratio (mACR increased with the deterioration of eGFR, with strong (r = −0.713, P < 0.001 and moderate (r = −0.580, P < 0.001 correlations. In the subgroup analysis of severe RAS (RAS ≥ 80%, the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, (r = −0.827, P < 0.001 and (r = −0.672, P < 0.001 correlations, respectively. Conclusions: Severity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.

  14. HEMODYNAMIC INSIGNIFICANT CAROTID ARTERIES STENOSIS AND RISK OF EMBOLIC STROKE IN PATIENTS WITH ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    V. V. Semenova

    2009-01-01

    Full Text Available Aim. To assess a risk of vascular embolism in patients with ischemic heart disease (IHD and hemodynamic insignificant asymptomatic carotid stenosis.Material and methods. 100 patients with IHD were examined. Ultrasound scanning of the main cranial arteries and transcranial Dopplerography was performed in all patients as well as lipid spectrum, fibrinogen level and blood D-diameter concentration were evaluated.Results. 165 carotid atherosclerotic plaques (AP were detected in patients with IHD independently on angina severity. In IHD patients with nonhomogeneous hypoechogenic AP microembolic signals (MES were revealed in 44,78%, with nonhomogeneous hyperechogenic AP - in 25%, with homogeneous hypoechogenic AP - in 4,16% of patients. MES were not recorded in patients with homogeneous hyperechogenic AP. There were not relations between MES and parameters of lipid spectrum as well as fibrinogen and Ddiameter plasma levels.Conclusion. Thus, during transcranial dopplerographic monitoring MES were recorded in the third part (27,9% of IHD patients with hemodynamically insignificant carotid arteries stenosis. MES were predominantly observed in patients with nonhomogeneous AP especially with hypoechogenic components.

  15. Simulation of Variable Viscosity and Jeffrey Fluid Model for Blood Flow Through a Tapered Artery with a Stenosis

    Institute of Scientific and Technical Information of China (English)

    Noreen Sher Akbar; S. Nadeem

    2012-01-01

    Non-Newtonian fluid model for blood flow through a tapered artery with a stenosis and variable viscosity by modeling blood as Jeffrey fluid has been studied in this paper. The Jeffrey fluid has two parameters, the relaxation time A1 and retardation time A2. The governing equations are simplified using the case of mild stenosis. Perturbation method is used to solve the resulting equations. The effects of non-Newtonian nature of blood on velocity profile, temperature profile, wall shear stress, shearing stress at the stenotsis throat and impedance of the artery are discussed. The results for Newtonian fluid are obtained as special case from this model.

  16. Capsular warning syndrome and crescendo lacunar strokes after atherosclerotic stenosis of the recurrent artery of Heubner.

    Science.gov (United States)

    Cohen, José E; Rabinstein, Alejandro; Gomori, John M; Leker, Ronen R

    2012-12-01

    The stereotype of repetitive transient cerebral ischemia causing unilateral motor, sensory, or sensorimotor deficits that simultaneously affect the face, arm, and leg, clinically localized to the internal capsule, fits with the description of capsular warning syndrome (CWS). A high proportion of individuals with these symptoms develop subsequent capsular stroke, despite various proposed preventative measures. It has been postulated that the mechanism for such strokes is that of small-vessel single-penetrator disease. We present a patient with repetitive CWS intermingled with crescendo capsular strokes secondary to recurrent artery of Heubner disease. This report causally links CWS-crescendo lacunar strokes and Heubner artery atherosclerotic disease (intracranial branch atheromatous disease).

  17. The Vanishing Stenosis: ST Elevation Myocardial Infarction and Rhythm Disturbance due to Coronary Artery Spasm—Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    J. Gosai

    2010-01-01

    Full Text Available A 62-year-old lady was admitted with clinical and electrocardiograph features of acute myocardial infarction. Urgent coronary arteriography was performed, demonstrating a single discrete stenosis of one coronary artery. Following intracoronary injection of GTN, this stenosis completely resolved, as the symptoms did. The causes of acute myocardial infarction with normal coronary arteries are reviewed.

  18. Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Bashir, Asma; Andresen, Morten; Bartek, Jiri

    2016-01-01

    Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose...

  19. Differential vasoactive effects of sildenafil and tadalafil on cerebral arteries

    DEFF Research Database (Denmark)

    Kruuse, Christina Rostrup; Gupta, Saurabh; Nilsson, Elisabeth

    2012-01-01

    Phosphodiesterase 5 (PDE5) is associated with migraine pathophysiology, stroke recovery and vasospasm treatment. The potential vascular interplay of PDE5 inhibitors sildenafil, tadalafil and UK-114,542 was studied by intra- versus extra-luminal administration in rat middle cerebral arteries in vi...

  20. Renal angioplasty for atherosclerotic renal artery stenosis: Cardiologist′s perspective

    Directory of Open Access Journals (Sweden)

    A S Gulati

    2013-01-01

    Full Text Available Atherosclerotic renal artery stenosis (ARAS is frequently associated with concomitant coronary and peripheral arterial disease with a significant impact on cardiovascular morbidity and mortality. Renal angioplasty of ARAS is more challenging because of increased incidence of technical failures, complications, and restenosis; while there is barely perceptible control of hypertension and only marginal improvement in renal function. This is because most of the patient population in recent randomized trials had unmanifested or clinically silent renovascular disease. Manifestations of RAS should be looked for and incorporated in the management plan particularly before deciding for revascularization. In the absence of clinical manifestation like renovascular hypertension, ischemic nephropathy, left ventricular failure, or unstable coronary syndromes; mere presence of RAS is analogous to presence of concomitant peripheral arterial disease which increases risk of adverse coronary events. Dormant-RAS in the absence of any manifestations can be managed with masterly inactivity. Chronological sequence of events and clinical condition of the patient help in decision making by identifying progressive renovascular disease. Selecting patients for renal artery stenting who actually will benefit from revascularization shall also decrease the unnecessary complications inherent with any interventional procedure. The present review is an attempt to analyze the current view on the diagnostic and management issues more specifically about the need and rationale behind angioplasty.

  1. Chronic and acute anemia and extracranial internal carotid stenosis are risk factors for silent cerebral infarcts in sickle cell anemia.

    Science.gov (United States)

    Bernaudin, Françoise; Verlhac, Suzanne; Arnaud, Cécile; Kamdem, Annie; Vasile, Manuela; Kasbi, Florence; Hau, Isabelle; Madhi, Fouad; Fourmaux, Christine; Biscardi, Sandra; Epaud, Ralph; Pondarré, Corinne

    2015-03-05

    Early transcranial Doppler (TCD) screening of the Créteil sickle cell anemia (SCA)-newborn cohort, and rapid initiation of transfusion programs, resulted in successful prevention of overt strokes, but a high cumulative risk of silent cerebral infarcts (SCI) remained, suggesting that TCD screening does not identify all patients with SCA at risk for SCI. We hypothesized that episodes of hypoperfusion/hypoxia, as observed during acute chest syndromes or acute anemic events (AAE), and extracranial internal carotid artery (eICA) stenoses, detectable via submandibular Doppler sonography and cervical magnetic resonance angiography (MRA), could also be risk factors for SCI. This study includes 189 stroke-free patients with SCA from the Créteil newborn cohort (1992-2010) followed longitudinally by magnetic resonance imaging/MRA, including cervical MRA at the last assessment. All patients with abnormal TCD and/or intracranial stenoses were placed on a transfusion program. Mean follow-up was 9.9 years (range, 2.2-19.9 years; 1844 patient-years). Annual rates of clinical events were calculated. The cumulative risk for SCI was 39.1% (95% confidence interval [CI], 23.5%-54.7%) by age 18 years, with no plateau. We confirm that baseline hemoglobin level lower than 7 g/dL before age 3 years is a highly significant predictive risk factor for SCI (hazard ratio, 2.97; 95% CI, 1.43-6.17; P = .004). Furthermore, we show that AAE rate (odds ratio, 2.64 per unit increase; 95% CI, 1.09-6.38; P = .031) and isolated eICA stenosis (odds ratio, 3.19; 95% CI, 1.18-8.70; P = .023) are significant and independent risk factors for SCI.

  2. Migraine pain associated with middle cerebral artery dilatation

    DEFF Research Database (Denmark)

    Friberg, L; Olesen, J; Iversen, Helle Klingenberg

    1991-01-01

    The combination of measurements of regional cerebral blood flow (rCBF) and blood velocity in the middle cerebral arteries (MCA) by transcranial doppler sonography was used to investigate cerebrovascular involvement in migraine. Ten migraine patients with unilateral headache were studied during...... returned to normal after treatment with sumatriptan and recovery. Since rCBF in the MCA supply territory was unaffected, the lower velocity can be explained only by dilatation of the MCA. The mean MCA diameter increase was estimated to be 20%. Thus, headache was associated with intracranial large arterial...... dilatation on the headache side. Sumatriptan predominantly had effects on the distended artery, which suggests that the 5-HT receptor system has a role in the pathogenesis of migraine....

  3. Myocardial FFR (Fractional Flow Reserve in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience

    Directory of Open Access Journals (Sweden)

    Jagadish H. Ramaiah

    2013-02-01

    Full Text Available Background: The clinical significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of ¡I40% to ¡U70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Myocardial fractional flow reserve (FFR is an index of the functional severity of coronary stenosis that is calculated from pressure measurements made during coronary angiography. The objective of the study is to evaluate the usefulness of FFR in patients with angiographically intermediate coronary artery stenosis. Methods: 20 patients with intermediate coronary stenosis and chest pain of uncertain origin. The Exercise Electrocardiography (TMT, Myocardial Perfusion Imaging study (MPI, Quantitative Coronary Angiography (QCA were compared with the results of FFR measurements. Results: 20 patients were undergone FFR measurement during the study period. With the mean age of 57.25¡À11.2 and male patients were 16 (80%, female patients 4 (20%, in all 13 patients with an FFR of 0.75 tested negative for reversible myocardial ischemia on TMT and MPI study. No revascularization procedures were performed in 7 (35% patients, and no adverse cardiovascular events were noted in all these patients during 6 months of follow-up. Conclusions: In patients with coronary stenosis of intermediate severity, FFR

  4. Theoretical Analysis of Shear Thinning Hyperbolic Tangent Fluid Model for Blood Flow in Curved Artery with Stenosis

    Directory of Open Access Journals (Sweden)

    Sohail Nadeem

    2016-01-01

    Full Text Available In this paper, we have considered the blood flow in a curved channel with abnormal development of stenosis in an axis-symmetric manner. The constitutive equations for incompressible and steady non-Newtonian tangent hyperbolic fluid have been modeled under the mild stenosis case. A perturbation technique and homotopy perturbation technique have been used to obtain analytical solutions for the wall shear stress, resistance impedance to flow, wall shear stress at the stenosis throat and velocity profile. The obtained results have been discussed for different tapered arteries i.e., diverging tapering, converging tapering, non-tapered arteries with the help of different parameters of interest and found that tapering dominant the curvature of the curved channel.

  5. ACE inhibition is superior to angiotensin receptor blockade for renography in renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Karanikas, Georgios; Becherer, Alexander; Wiesner, Karoline; Dudczak, Robert; Kletter, Kurt [Department of Nuclear Medicine, University of Vienna (Austria)

    2002-03-01

    Angiotensin converting enzyme (ACE) inhibitors as well as angiotensin II receptor antagonists are able to prevent the vasoconstrictive effect of angiotensin II on the efferent renal vessels, which is believed to play an important role in renovascular hypertension. This effect is assumed to be essential for the demonstration of renovascular hypertension by captopril renography. In this study, renographic changes induced by captopril and the AT1 receptor antagonist valsartan were compared in patients with a high probability for renovascular hypertension. Twenty-five patients with 33 stenosed renal arteries (grade of stenosis >50%) and hypertension were studied. Captopril, valsartan and baseline renography were performed within 48 h using technetium-99m mercaptoacetyltriglycine. Blood pressure was monitored, plasma renin concentration before and after intervention was determined and urinary flow was estimated from the urinary output of the hydrated patients. Alterations in renographic curves after intervention were evaluated according to the Santa Fe consensus on ACE inhibitor renography. Captopril renography was positive, indicating renovascular hypertension, in 25 of the 33 stenosed vessels, whereas valsartan renography was positive in only ten. Blood pressure during captopril and valsartan renography was not different; reduction in blood pressure was the same after valsartan and captopril. Plasma renin concentration was comparable for valsartan and captopril studies, showing suppressed values after intervention in as many as 12 of the 25 patients. Urinary flow after valsartan was higher than after captopril (P<0.05). However, this difference could not explain the markedly higher sensitivity of captopril compared with valsartan in demonstrating renal artery stenosis. In 14 of the 25 patients, blood pressure response to revascularisation was monitored, showing a much better predictive value for captopril renography. It is concluded that captopril renography is much

  6. Renal artery stenosis in kidney transplants: assessment of the risk factors

    Directory of Open Access Journals (Sweden)

    Ghabili K

    2011-08-01

    Full Text Available Jalal Etemadi1, Khosro Rahbar2, Ali Nobakht Haghighi2, Nazila Bagheri2, Kianoosh Falaknazi2, Mohammad Reza Ardalan1, Kamyar Ghabili3, Mohammadali M Shoja31Department of Nephrology, Dialysis and Transplantation, Tabriz University of Medical Sciences, Tabriz, 2Department of Nephrology, Shaheed Beheshti University of Medical Sciences, Tehran, 3Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Transplant renal artery stenosis (TRAS is an important cause of hypertension and renal allograft dysfunction occurring in kidney transplant recipients. However, conflicting predisposing risk factors for TRAS have been reported in the literature.Objective: The aim of the present study was to assess the potential correlation between possible risk factors and TRAS in a group of living donor renal transplant recipients 1 year after the renal transplantation.Methods: We evaluated the presence of renal artery stenosis in 16 recipients who presented with refractory hypertension and/or allograft dysfunction 1 year after renal transplantation. Screening for TRAS was made by magnetic resonance angiography and diagnosis was confirmed by conventional renal angiography. Age, gender, history of acute rejection, plasma lipid profile, serum creatinine, blood urea nitrogen, serum uric acid, calcium phosphate (CaPO4 product, alkaline phosphatase, fasting blood sugar, hemoglobin, and albumin were compared between the TRAS and non-TRAS groups.Results: Of 16 kidney transplant recipients, TRAS was diagnosed in three patients (two men and one woman. High levels of calcium, phosphorous, CaPO4 product, and low-density lipoprotein (LDL cholesterol were significantly correlated with the risk of TRAS 1 year after renal transplantation (P < 0.05. Serum level of uric acid tended to have a significant correlation (P = 0.051.Conclusion: Correlation between high CaPO4 product, LDL cholesterol, and perhaps uric acid and TRAS in living

  7. Medial arterial calcification, calcific aortic stenosis and mitral annular calcification in a diabetic patient with severe autonomic neuropathy.

    LENUS (Irish Health Repository)

    Cronin, C C

    2012-02-03

    Medial arterial calcification (Monckeberg\\'s arteriosclerosis) is well described in diabetic patients with autonomic neuropathy. There is also a high prevalence of diabetes mellitus among subjects with calcific aortic stenosis and mitral annular calcification. We describe a diabetic patient with autonomic neuropathy and extensive medial arterial calcification who also had calcification of the aortic valve and of the mitral valve annulus. We propose that autonomic neuropathy may play a role in calcification of these structures at the base of the heart.

  8. Original Research: Sickle cell anemia and pediatric strokes: Computational fluid dynamics analysis in the middle cerebral artery.

    Science.gov (United States)

    Rivera, Christian P; Veneziani, Alessandro; Ware, Russell E; Platt, Manu O

    2016-04-01

    Children with sickle cell anemia (SCA) have a high incidence of strokes, and transcranial Doppler (TCD) identifies at-risk patients by measuring blood velocities in large intracerebral arteries; time-averaged mean velocities greater than 200 cm/s confer high stroke risk and warrant therapeutic intervention with blood transfusions. Our objective was to use computational fluid dynamics to alter fluid and artery wall properties, to simulate scenarios causative of significantly elevated arterial blood velocities. Two-dimensional simulations were created and increasing percent stenoses were created in silico, with their locations varied among middle cerebral artery (MCA), internal carotid artery (ICA), and anterior cerebral artery (ACA). Stenoses placed in the MCA, ICA, or ACA generated local increases in velocity, but not sufficient to reach magnitudes > 200 cm/s, even up to 75% stenosis. Three-dimensional reconstructions of the MCA, ICA, and ACA from children with SCA were generated from magnetic resonance angiograms. Using finite element method, blood flow was simulated with realistic velocity waveforms to the ICA inlet. Three-dimensional reconstructions revealed an uneven, internal arterial wall surface in children with SCA and higher mean velocities in the MCA up to 145 cm/s compared to non-SCA reconstructions. There were also greater areas of flow recirculation and larger regions of low wall shear stress. Taken together, these bumps on the internal wall of the cerebral arteries could create local flow disturbances that, in aggregate, could elevate blood velocities in SCA. Identifying cellular causes of these microstructures as adhered blood cells or luminal narrowing due to endothelial hyperplasia induced by disturbed flow would provide new targets to treat children with SCA. The preliminary qualitative results provided here point out the critical role of 3D reconstruction of patient-specific vascular geometries and provide qualitative insight to complex

  9. Multi-modal assessment of neurovascular coupling during cerebral ischaemia and reperfusion using remote middle cerebral artery occlusion

    DEFF Research Database (Denmark)

    Sutherland, Brad A; Fordsmann, Jonas C; Martin, Chris;

    2016-01-01

    how neurovascular coupling is affected hyperacutely during cerebral ischaemia and reperfusion. We have developed a remote middle cerebral artery occlusion model in the rat, which enables multi-modal assessment of neurovascular coupling immediately prior to, during and immediately following reperfusion....... Male Wistar rats were subjected to remote middle cerebral artery occlusion, where a long filament was advanced intraluminally through a guide cannula in the common carotid artery. Transcallosal stimulation evoked increases in blood flow, tissue oxygenation and neuronal activity, which were diminished...... by middle cerebral artery occlusion and partially restored during reperfusion. These evoked responses were not affected by administration of the thrombolytic alteplase at clinically used doses. Evoked cerebral blood flow responses were fully restored at 24 h post-middle cerebral artery occlusion indicating...

  10. Unilateral pulmonary artery stenosis and late-onset cataract in an adult: a case of suspected congenital rubella syndrome

    Institute of Scientific and Technical Information of China (English)

    LIU Yang; GUO Jun; ZHAO Rui-fu; WANG Lin

    2012-01-01

    Congenital rubella syndrome (CRS) is characterized by the triad of deafness,cataract and cardiovascular malformations.1 The great majority of the cases in the literature have been usually diagnosed in infancy and childhood because of various defects at birth.However,we report a rare case of suspected CRS in an adult with unilateral pulmonary artery stenosis and late-onset cataract.

  11. Ostial stenosis of the left main coronary artery in a young woman 10 years after radiation therapy.

    Science.gov (United States)

    Orzan, F; Bellis, D; Mollo, F; Brusca, A

    1995-01-01

    A 26-year-old woman developed critical stenosis of the left main coronary artery 10 years after radiation treatment for Hodgkins disease. She was operated on but died in the immediate postoperative period. At autopsy the pathological findings were indistinguishable from those described in "typical" atherosclerotic plaques.

  12. Arterial spin-labeling MR imaging of cerebral hemorrhages

    Energy Technology Data Exchange (ETDEWEB)

    Noguchi, Tomoyuki [Department of Radiology, National Center for Global Health and Medicine, Tokyo (Japan); Saga University, Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga (Japan); Nishihara, Masashi; Egashira, Yoshiaki; Azama, Shinya; Hirai, Tetsuyoshi; Kitano, Isao; Irie, Hiroyuki [Saga University, Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga (Japan); Yakushiji, Yusuke [Saga University, Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Saga (Japan); Kawashima, Masatou [Saga University, Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Saga (Japan)

    2015-11-15

    The purpose of this study is to identify the characteristics of brain perfusion measured by arterial spin-labeling magnetic resonance imaging (ASL-MRI) in cerebral hemorrhages. Brain blood flow values (CBF-ASL values) for cerebral and cerebellar hemispheres and segmented cerebral regions were measured by ASL-MRI in 19 putaminal hemorrhage patients and 20 thalamic hemorrhage patients in acute or subacute stages. We assessed the lateralities of CBF-ASL values and the relationships between CBF-ASL values and other imaging findings and clinical manifestations. Both the 19 putaminal hemorrhage patients and the 20 thalamic hemorrhage patients had significantly low CBF-ASL values of the contralateral cerebellum in subacute stage, suggesting that ASL-MRI might delineate crossed cerebellar diaschisis (CCD). Ipsilateral low CBF-ASL values were observed in frontal lobes and thalami with a putaminal hemorrhage and lentiform nuclei, temporal lobes, and parietal lobes with a thalamic hemorrhage, suggesting that ASL-MRI showed the ipsilateral cerebral diaschisis (ICD). In the putaminal hemorrhage patients, the hematoma volume negatively affected both the bilateral cerebellar and cerebral hemispheric CBF-ASL values. In the thalamic hemorrhage patients, a concomitant intraventricular hemorrhage caused low cerebral hemispheric CBF-ASL values. The use of ASL-MRI is sensitive to the perfusion abnormalities and could thus be helpful to estimate functional abnormalities in cerebral hemorrhage patients. (orig.)

  13. Microparticle-Induced Coagulation Relates to Coronary Artery Atherosclerosis in Severe Aortic Valve Stenosis.

    Directory of Open Access Journals (Sweden)

    Patrick Horn

    Full Text Available Circulating microparticles (MPs derived from endothelial cells and blood cells bear procoagulant activity and promote thrombin generation. Thrombin exerts proinflammatory effects mediating the progression of atherosclerosis. Aortic valve stenosis may represent an atherosclerosis-like process involving both the aortic valve and the vascular system. The aim of this study was to investigate whether MP-induced thrombin generation is related to coronary atherosclerosis and aortic valve calcification.In a cross-sectional study of 55 patients with severe aortic valve stenosis, we assessed the coronary calcification score (CAC as indicator of total coronary atherosclerosis burden, and aortic valve calcification (AVC by computed tomography. Thrombin-antithrombin complex (TATc levels were measured as a marker for thrombin formation. Circulating MPs were characterized by flow cytometry according to the expression of established surface antigens and by measuring MP-induced thrombin generation.Patients with CAC score below the median were classified as patients with low CAC, patients with CAC Score above the median as high CAC. In patients with high CAC compared to patients with low CAC we detected higher levels of TATc, platelet-derived MPs (PMPs, endothelial-derived MPs (EMPs and MP-induced thrombin generation. Increased level of PMPs and MP-induced thrombin generation were independent predictors for the severity of CAC. In contrast, AVC Score did not differ between patients with high and low CAC and did neither correlate with MPs levels nor with MP-induced thrombin generation.In patients with severe aortic valve stenosis MP-induced thrombin generation was independently associated with the severity of CAC but not AVC indicating different pathomechanisms involved in coronary artery and aortic valve calcification.

  14. Correlation of coronary artery stenosis evaluation with left heart structure and function by multi-slice computed tomography.

    Science.gov (United States)

    Song, L N; Cao, A D; Niu, Y J; Liu, N

    2014-08-07

    The aim of this study was to determine the impact of multi-slice computed tomography (MSCT) evaluation of coronary artery stenosis on left heart structure and systolic function. Coronary artery CT angiography was performed in 200 patients diagnosed with coronary heart disease, and then according to the AHA coronary artery 17-segment fractionation method, the Gensini score (GS) was determined for every narrow segment, and one-stop assessment of the correlation between left heart structure and function was performed. After the grouping of GS quartiles from low to high, there were differences between different patients with regard to LVDD, LADD, LVEDV, LVESV, MM, LVEF, and FS, while no difference in SV and CO. GS showed linear negative correlation with LVEF and FS, and linear positive correlation with LVDD, LADD, LVEDV, LVESV, and MM, while no correlation with SV and CO. That is, GS of coronary artery stenosis was negatively correlated with left ventricular systolic function and positively correlated with myocardial mass. The narrower the coronary artery, the worse the cardiac function and the higher the myocardial hypertrophy. Coronary artery stenosis was one of the important causes of the decrease in left ventricular systolic function and cardiac remodeling.

  15. A 16-year experience of carotid artery stenting for carotid artery stenosis.

    Science.gov (United States)

    Nano, Giovanni; Stegher, Silvia; Occhiuto, Maria Teresa; Muzzarelli, Lorenzo; Malacrida, Giovanni; Mazzaccaro, Daniela P

    2016-01-01

    Da più di 50 anni l’endoarteriectomia carotidea (CEA) è stata considerata il trattamento standard per le stenosi carotidee gravi asintomatiche e sintomatiche. Lo stenting carotideo (CAS) è progressivamente emerso negli ultimi 15 anni come alternativa alla chirurgia, specialmente nei pazienti ad alto rischio. Da allora, molti studi clinici randomizzati sono stati pubblicati per valutare la superiorità di un metodo rispetto all’altro, tuttavia i risultati dei trials hanno generato più dubbi che certezze nell’interpretazione dei loro risultati, gravati come sono da diverse limitazioni: la principale riguarda la ridotta competenza endovascolare richiesta per gli operatori che hanno eseguito lo stenting carotideo e partecipato ai trials. Inoltre questi trials sono stati eseguiti circa 10 anni fa, con materiali e farmaci differenti rispetto a quelli usati attualmente. Attualmente i registri su larga scala e le casistiche che riportano risultati a lungo termine sono maggiormente rappresentativi di una esperienza reale, che riflette ciò che accade di routine nella pratica clinica. Nella nostra Unità Operativa di Chirurgia Vascolare, il CAS è stato offerto dal 1999 come alternativa alla CEA per il trattamento delle stenosi carotidee sintomatiche e asintomatiche nei pazienti a rischio moderato-alto. Scopo del nostro lavoro è di riportare la nostra esperienza retrospettiva, con alcuni consigli e suggerimenti che derivano da ciò che abbiamo imparato in più di 16 anni. Abbiamo pertanto raccolto e analizzato retrospettivamente i dati di tutti i pazienti consecutivi che sono venuti per una stenosi carotidea significativa dal 1 ° gennaio 1999 al 31 agosto 2015. I risultati basilari sono stati la mortalità e la morbilità cerebrovascolare maggiore (MCE) sia a 30 giorni che a lungo termine. Lo studio è stato condotto su 1017 pazienti (677 maschi, 66.6%, età media 74 anni, IQR 69-79 anni) trattati sia per stenosi carotidea sintomatica (n=392, 38.5%) che

  16. Serum ox-LDL Level is Reduced with the Extent of Stenosis in Coronary Arteries

    Directory of Open Access Journals (Sweden)

    Mohammad Najafi

    2013-05-01

    Full Text Available Oxidized LDL (ox-LDL lipoproteins are proposed as important modified particles triggering pro-inflammatory events through receptor-mediated pathways. We evaluated the circulating ox-LDL level on the concept that the chronic immune events may affect ox-LDL clearance as the vessel stenosis develops in coronary arteries. One hundred sixty five subjects underwent coronary angiography and then, subdivided into four subgroups controls (n=85; SVD, 2VD and 3VD (n=80. The serum ox-LDL level and other biochemical parameters were measured using ELISA method and routine laboratory techniques, respectively. The serum ox-LDL level in the control group (4.81±1.41 mU/mg was significantly higher than patients (4.28±1.73 mU/mg, P<0.05. The ox-LDL/LDL ratio was conversely reduced with the extent of stenosis as compared with the controls (P<0.05. Furthermore, no difference was observed in the ox-LDL/LDL ratio between the 2VD and 3VD patients. We suggested the atherosclerosis process increases the total clearing capacities of the circulating ox-LDL particles.

  17. Microsurgical anatomy of the anterior cerebral artery in Indian cadavers

    Directory of Open Access Journals (Sweden)

    Shweta Kedia

    2013-01-01

    Full Text Available Background: The microanatomy features of cerebral arteries may be variable and may be different in different ethnic groups. Aim: To study the anterior cerebral artery (ACA anatomy in North-West Indian cadavers. Materials and Methods: Microanatomy features of the ACA were studied in 15 formalin fixed human cadaveric brains under microscope. The outer diameter, length, and number of perforating branches with respective anomalies were measured for each of the following vessels: ACA (proximal A1 segment to distal A2 segment, anterior communicating artery (ACoA, Recurrent artery of Heubner (RAH, and callosomarginal artery and photographed for documentation. Results: The mean length and external diameter of right and left A1 segment was 12.09 mm and 12.0 mm and 2.32 mm and 2.36 mm respectively. Narrowing, duplication, and median ACA were seen in 6.6%, 3.3% and 6.6% of the vessels respectively. Complex ACoA type was seen in 40% cadavers. RAH originated at an average point of 0.2 mm distal to ACoA, but in one cadaver it arose 5 mm proximal to ACoA. Double RAH was found in 26.6%. The course of RAH in relation to A1 was superiorly in 60%, in anteriorly 30% and posteriorly in 10% of cadavers. The orbitofrontal artery (OFA and frontopolar artery (FPA arose from A2 in 83.3% to 40% respectively. The mean distance of OFA and FPA from ACoA was 4.17 mm and 8.5 mm respectively. After giving rise to central, callosal and cortical branches, pericallosal artery terminated near the splenium of the corpus callosum or on the precuneus as the inferomedial parietal artery. Conclusion: Knowledge of the microvascular anatomy is indispensable and it is mandatory to be aware of the possible variations in the anomalies to minimize morbidity.

  18. 颈动脉狭窄与颅脑ADC值的相关性研究%Study on the correlation between carotid stenosis and cerebral ADC value

    Institute of Scientific and Technical Information of China (English)

    方慧; 周勇; 伍建林

    2012-01-01

    目的 探讨颈动脉狭窄程度与同侧脑区ADC值间的相关性.方法 收集经颈动脉三维对比增强磁共振血管成像证实颈动脉狭窄者116例和正常志愿者21例行T2 FLAIR和DWI检查,测量多脑区ADC值并分析狭窄程度与ADC值的相关性,P<0.05为有统计学意义.结果 颈动脉狭窄程度与侧脑室前部(r=0.260,P=0.000)、后部(r=0.149,P=0.014)、前角(r=0.194,P=0.001)、后角(r=0.188,P=0.002),周围脑实质、颞叶(r=0.186,P=0.002)及尾状核头(r=0.125,P=0.039)等脑区ADC值间相关性有统计学意义.结论 多脑区ADC值升高与颈动脉狭窄有关,以侧脑室前部周围脑实质相关性最高,可视为间接反映低灌注状态的最敏感区域.%Objective To investigate the relations between ADC values of interested cerebral regions and carotid stenosis using diffusion-weighted imaging and MR angiography. Methods 116 cases of carotid stenosis and 21 cases of matched healthy controls were recruited in this study On the basis of three-dimensional contrast enhanced MR angiography (MRA) of carotid artery and were checked with DWI and T2 FLAIR. ADC values of interested regions were measured on DWI (b = 0,1 000 s/mm2) images. The relationship between carotid stenosis and ADC values were analysed, P <0. 05 is of statistical significance. Results The ADC values around anterior ( r =0. 194, P =0. 001) and posterior horn ( r =0.188, P = 0. 002) of lateral ventricle and the ADC values of periventricular anterior ( r =0. 260, P =0. 000) and posterior ( r = 0. 149, P =0.014), the temporal lobe ( r =0. 186, P =0.002) and the caudate nucleus head ( r =0. 125, P =0. 039) were positively linearly correlated with the degree of stenosis with 274 branches of carotid arteries. Conclusion ADC values in the majority of cerebral regions positively correlated with the severeness of carotid stenosis. Especially, ADC values of periventricular anterior was most closely related to the carotid stenosis, which was most

  19. Non-contrast-enhanced MRA of renal artery stenosis: validation against DSA in a porcine model

    Energy Technology Data Exchange (ETDEWEB)

    Bley, T.A. [University of Wuerzburg, Department of Diagnostic and Interventional Radiology, Wuerzburg (Germany); University of Wisconsin, Department of Radiology, Madison, WI (United States); Francois, C.J.; Schiebler, M.L. [University of Wisconsin, Department of Radiology, Madison, WI (United States); Wieben, O.; Del Rio, A.M.; Grist, T.M. [University of Wisconsin, Department of Radiology, Madison, WI (United States); University of Wisconsin, Department of Medical Physics, Madison, WI (United States); Takei, N. [GE Healthcare, MR Applied Sciences Laboratory, Tokyo (Japan); Brittain, J.H. [University of Wisconsin, Department of Radiology, Madison, WI (United States); GE Healthcare, MR Applied Sciences Laboratory, Madison, WI (United States); Reeder, S.B. [University of Wisconsin, Department of Radiology, Madison, WI (United States); University of Wisconsin, Department of Medical Physics, Madison, WI (United States); University of Wisconsin, Department of Biomedical Engineering, Madison, WI (United States); University of Wisconsin, Department of Medicine, Madison, WI (United States); University of Wisconsin, Department of Emergency Medicine, Madison, WI (United States)

    2016-02-15

    To compare 3D-inversion-recovery balanced steady-state free precession (IR-bSSFP) non-contrast-enhanced magnetic resonance angiography (MRA) with 3D-contrast-enhanced MRA (CE-MRA) for assessment of renal artery stenosis (RAS) using digital subtraction angiography (DSA) as the reference standard. Bilateral RAS were surgically created in 12 swine. IR-bSSFP and CE-MRA were acquired at 1.5 T and compared to rotational DSA. Three experienced cardiovascular radiologists evaluated the IR-bSSFP and CE-MRA studies independently. Linear regression models were used to calibrate and assess the accuracy of IR-bSSFP and CE-MRA, separately, against DSA. The coefficient of determination and Cohen's kappa coefficient were also generated. Calibration of the three readers' RAS grading revealed R{sup 2} values of 0.52, 0.37 and 0.59 for NCE-MRA and 0.48, 0.53 and 0.71 for CE-MRA. Inter-rater agreement demonstrated Cohen's kappa values ranging from 0.25 to 0.65. Distal renal artery branch vessels were visible to a significantly higher degree with NCE-MRA compared to CE-MRA (p < 0.001). Image quality was rated excellent for both sequences, although image noise was higher with CE-MRA (p < 0.05). In no cases did noise interfere with image interpretation. In a well-controlled animal model of surgically induced RAS, IR-bSSFP based NCE-MRA and CE-MRA accurately graded RAS with a tendency for stenosis overestimation, compared to DSA. (orig.)

  20. Non-Newtonian effects of blood on LDL transport inside the arterial lumen and across multi-layered arterial wall with and without stenosis

    Science.gov (United States)

    Deyranlou, Amin; Niazmand, Hamid; Sadeghi, Mahmood-Reza; Mesri, Yaser

    2016-06-01

    Blood non-Newtonian behavior on low-density lipoproteins (LDL) accumulation is analyzed numerically, while fluid-multilayered arteries are adopted for nonstenotic and 30%-60% symmetrical stenosed models. Present model considers non-Newtonian effects inside the lumen and within arterial layers simultaneously, which has not been examined in previous studies. Navier-Stokes equations are solved along with the mass transport convection-diffusion equations and Darcy’s model for species transport inside the luminal flow and across wall layers, respectively. Carreau model for the luminal flow and the modified Darcy equation for the power-law fluid within arterial layers are employed to model blood rheological characteristics, appropriately. Results indicate that in large arteries with relatively high Reynolds number Newtonian model estimates LDL concentration patterns well enough, however, this model seriously incompetent for regions with low WSS. Moreover, Newtonian model for plasma underestimates LDL concentration especially on luminal surface and across arterial wall. Therefore, applying non-Newtonian model seems essential for reaching to a more accurate estimation of LDL distribution in the artery. Finally, blood flow inside constricted arteries demonstrates that LDL concentration patterns along the stenoses inside the luminal flow and across arterial layers are strongly influenced as compared to the nonstenotic arteries. Additionally, among four stenosis severity grades, 40% stenosis is prone to more LDL accumulation along the post-stenotic regions.

  1. Association of Lp-PLA2 Mass and Aysmptomatic Intracranial and Extracranial Arterial Stenosis in Hypertension Patients

    Science.gov (United States)

    Wang, Yan; Zhang, Jin; Qian, Yuesheng; Tang, Xiaofeng; Ling, Huawei; Chen, Kemin; Gao, Pingjin; Zhu, Dingliang

    2015-01-01

    Background and Purpose Intracranial arterial stenosis (ICAS) is a common cause of ischemic stroke in Asians, whereas whites tend to have more extracranial lesions. Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been associated with ischemic stroke by a large amount of work. However, there are few studies focusing on the relationship of Lp-PLA2 and asymptomatic ICAS or extracranial arterial stenosis (ECAS). Wehereby sought to explore the relationship of Lp-PLA2 and ICAS, ECAS and concurrent stenosis in stroke-free hypertensive patients in Chinese population. Methods All the subjects were evaluated for the presence and severity of ICAS and ECAS through computerized tomographic angiography (CTA) covered the whole brain down to the level of aortic arch. Lp-PLA2 mass was measured by enzyme linked immunoassay. The association of Lp-PLA2 and vascular stenosis was analyzed through multivariate logistic regression. Results Among 414 participants, 163 (39.4%) had no ICAS or ECAS, 63 (15.2%) had ECAS only, 111 (26.8%) had ICAS only and 77 (18.6%) had concurrent extraintracranial stenosis. Lp-PLA2 mass was significantly associated with isolated ICAS (OR: 2.3; 95% CI: 1.14-4.64), and concurrent stenosis (OR: 3.93; 95% CI: 1.62-9.51), but was not related to isolated ECAS (OR: 1.54; 95% CI: 0.68-3.48). Lp-PLA2 mass was also associated with moderate to severe ICAS no matter how was the ECAS. Moreover, patients with higher Lp-PLA2 mass showed more sever ICAS and had more intracranial arterial lesions. Conclusion This study revealed the association of Lp-PLA2 mass with ICAS in stroke-free hypertensive patients in Chinese population. The further long-term cohort study was warranted to elucidate the concrete effect of Lp-PLA2 on the asymptomatic ICAS. PMID:26098634

  2. Middle cerebral artery blood velocity and cerebral blood flow and O2 uptake during dynamic exercise

    DEFF Research Database (Denmark)

    Madsen, P L; Sperling, B K; Warming, T

    1993-01-01

    Results obtained by the 133Xe clearance method with external detectors and by transcranial Doppler sonography (TCD) suggest that dynamic exercise causes an increase of global average cerebral blood flow (CBF). These data are contradicted by earlier data obtained during less-well-defined conditions....... To investigate this controversy, we applied the Kety-Schmidt technique to measure the global average levels of CBF and cerebral metabolic rate of oxygen (CMRO2) during rest and dynamic exercise. Simultaneously with the determination of CBF and CMRO2, we used TCD to determine mean maximal flow velocity...... in the middle cerebral artery (MCA Vmean). For values of CBF and MCA Vmean a correction for an observed small drop in arterial PCO2 was carried out. Baseline values for global CBF and CMRO2 were 50.7 and 3.63 ml.100 g-1.min-1, respectively. The same values were found during dynamic exercise, whereas a 22% (P

  3. [Combined surgical treatment for coronary heart disease as well as heart valve diseases and carotid artery stenosis].

    Science.gov (United States)

    Reichart, B; Kemkes, B M; Klinner, W; Kreuzer, E; Becker, H M; Harrington, O B; Crosby, V G; Wolf, R Y

    1979-04-26

    This is an account on combined procedures in 124 patients suffering from arteriosclerotic vessel disease. In order to judge the proceedings and the results the patients were divided up into two groups. in 15 patients (group I) a carotid endarterectomy combined with an aorto-coronary bypass operation was performed; once a subclavian artery stenosis was resected at the same time. One patient of that group died after 31 days (7%). In group II 108 heart valve operations were performed together with a coronary artery revascularisation. Early and late mortality divided up as follows: aortic stenosis 6/44 (14%) respectively 2/44 (5%); aortic insufficiency 1/14 (7%) resp. 0; combined aortic disease 1/8 )13%) resp. 0; mitral stenosis 1/11 (9%) resp. 0; mitral insufficiency 6/26 (23%) resp. 2/26 (8%); combined mitral valve disease 1/2 (50%) resp. 0; three times both valves (aorta, mitral) were replaced without mortality. In our opinion combined procedures, resection of supraaortic artery stenosis respectively cardiac valve operations and aorto-coronary bypass are indicated especially since the functional long-term results are excellent. Though one should consider the high operative risk in patients with mitral insufficiency and combined mitral valve disease.

  4. Internal mammary artery dilatation in a patient with aortic coarctation, aortic stenosis, and coronary disease. Case report

    Directory of Open Access Journals (Sweden)

    Martinez Cereijo Jose M

    2011-04-01

    Full Text Available Abstract The ideal surgical approach is unclear in adult patients with coarctation of the aorta that is associated with other cardiovascular pathologies that require intervention. Standard median sternotomy allows simultaneous, coronary revascularization surgery, valve replacement and repair of aortic coarctation. However the collateral circulation and the anatomy of the mammary arteries must be determined, to avoid possible complications. We report a case of a 69 year-old man with aortic coarctation, aortic stenosis, coronary artery disease and internal mammary artery dilatation who underwent concomitant surgical procedures through a median sternotomy.

  5. Schizencephaly with occlusion or absence of middle cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez-Bouzas, A.; Harmony, T.; Santiago-Rodriguez, E.; Ricardo-Garcell, J.; Fernandez, T.; Avila-Acosta, D. [Instituto de Neurobiologia de la Universidad Nacional Autonoma de Mexico (UNAM) Campus Juriquilla, Juriquilla, QRO (Mexico)

    2006-03-15

    In a study of 160 infants with prenatal and/or perinatal risk factors for brain damage, we observed three cases of schizencephaly. All cases were unilateral, and the clefts had open lips. In two cases, magnetic resonance angiography showed occlusion or absence of the middle cerebral artery (MCA) on the affected side. Two of the patients, including one with absent flow in the MCA of the affected side, had ipsilateral cerebellar atrophy. (orig.)

  6. Efficacy of extracranial-intracranial bypass for progressive middle cerebral artery occlusion associated with active Sjögren's syndrome: case report.

    Science.gov (United States)

    Sakata, Hiroyuki; Fujimura, Miki; Sato, Kenichi; Shimizu, Hiroaki; Tominaga, Teiji

    2014-09-01

    Sjögren syndrome affecting the major cerebral arteries is rare, and an optimal therapeutic strategy to counteract such a lesion has not yet been established. We herein report a case of a 39-year-old woman with a history of primary Sjögren syndrome, which had previously been treated with immunosuppressive therapy, manifesting with a crescendo transient ischemic attack because of left middle cerebral artery stenosis. Despite the administration of high doses of prednisolone and azathioprine for active Sjögren syndrome, the frequency of crescendo transient ischemic attacks increased with the progression of stenosis and magnetic resonance imaging showed the development of subacute cerebral infarction. Single-photon emission computed tomography with N-isopropyl[(123)I]-p-iodoamphetamine revealed apparent hemodynamic compromise in the affected cerebral hemisphere. In light of the increased risk of further progression of cerebral infarction, we decided to perform surgical revascularization in spite of her active inflammatory condition. The patient underwent extracranial-intracranial bypass without complications and was treated with intensive immunosuppressive therapy during the perioperative period. Based on our findings, we recommend surgical revascularization for occlusive cerebrovascular disease with hemodynamic compromise in combination with intensive immunosuppressive therapy, even in the active inflammatory state of autoimmune diseases, if ischemic symptoms are medically uncontrollable.

  7. Development of Mechanical and Failure Properties in Sheep Cerebral Arteries.

    Science.gov (United States)

    Nye, Kevin S; Converse, Matthew I; Dahl, Mar Janna; Albertine, Kurt H; Monson, Kenneth L

    2017-04-01

    Traumatic brain injury (TBI) is a devastating problem for people of all ages, but the nature of the response to such injury is often different in children than in adults. Cerebral vessel damage and dysfunction are common following TBI, but age-dependent, large-deformation vessel response has not been characterized. Our objective was to investigate the mechanical properties of cerebral arteries as a function of development. Sheep middle cerebral arteries from four age groups (fetal, newborn, juvenile, and adult) were subjected to biaxial loading around physiological conditions and then to failure in the axial direction. Results show little difference among age groups under physiological loading conditions, but response varied significantly with age in response to large axial deformation. Vessels from all age groups reached the same ultimate stretch level, but the amount of stress carried at a given level of stretch increased significantly with age through the developmental period (fetal to juvenile). Our results are the first to identify changes in cerebral vessel response to large deformations with age and may lead to new insights regarding differences in response to TBI with age.

  8. Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries. Pt. 3. Posterior cerebral artery and circle of Willis

    Energy Technology Data Exchange (ETDEWEB)

    Gloger, S. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Gloger, A. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Vogt, H. (Dept. of Neuroanatomy, Hannover Medical School (Germany)); Kretschmann, H.J. (Dept. of Neuroanatomy, Hannover Medical School (Germany))

    1994-05-01

    We present a three-dimensional anatomical computer model of the terminal branches of the posterior cerebral artery and circle of Willis, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries. This can help to identify the arteries in conventional and magnetic resonance angiography. Our rendition of the cerebral arteries can be matched with CT, MR and PET images to indicate the areas of extension of the individual branches, allowing neuromorphological and functional correlations. (orig.)

  9. Impact of coexisting coronary artery disease on the occurrence of cerebral ischemic lesions after carotid stenting.

    Directory of Open Access Journals (Sweden)

    Kuo-Lun Huang

    Full Text Available BACKGROUND: Coronary artery disease (CAD may coexist with extracranial carotid artery stenosis (ECAS, but the influence of CAD on procedure-related complications after carotid artery stenting (CAS has not been well investigated. The study aimed to determine the impact of CAD on the occurrence of peri-CAS cerebral ischemic lesions on diffusion-weighted imaging (DWI scanning. METHODS: Coronary angiography was performed within six months before CAS. DWI scanning was repetitively done within 1 week before and after CAS. Clinical outcome measures were stroke, angina, myocardial infarction and death within 30 days. RESULTS: Among 126 patients (69.5±9.0 years recruited for unilateral protected CAS, 33 (26% patients had peri-CAS DWI-positive lesions. CAD was noted in 79% (26 in 33 and 48% (45 in 93 of patients with and without peri-CAS DWI-positive lesions (OR, 4.0; 95% CI, 1.6-10.0; P = .0018, and the number of concomitant CAD on coronary angiography was positively correlated with the risk for peri-CAS DWI-positive lesions (P = .0032. In patients with no CAD (n = 55, asymptomatic CAD (n = 41 and symptomatic CAD (n = 30, the occurrence rates of peri-CAS DWI-positive lesions were 13%, 41% and 30% (P = .0048, and the peri-CAS stroke rates were 2%, 7% and 0% (P = .2120. CONCLUSIONS: The severity of morphological CAD and the presence of either symptomatic or asymptomatic CAD are associated with the occurrence of peri-CAS cerebral ischemic lesions.

  10. Comparison of the renal hyperemic effects of papaverine and dopamine in patients with renal artery stenosis.

    Science.gov (United States)

    Protasiewicz, Marcin; Początek, Karol; Poręba, Rafał; Derkacz, Arkadiusz; Podgórski, Maciej; Gosławska, Katarzyna; Szymańska-Chabowska, Anna; Mazur, Grzegorz; Mysiak, Andrzej; Witkowski, Adam

    2015-01-01

    The purpose of this study was to assess the hyperemic effects of papaverine and dopamine in the renal microcirculation of hypertensive patients with renal artery stenosis (RAS). Although a poor correlation between angiographic lesion assessment and its hemodynamic significance is known, angiography is a major criterion for the decision of renal artery stenting. Assessment of the hyperemic translesional pressure gradient was recently shown to be conducive in identifying patients who may benefit from renal revascularization. The study included 14 patients (mean age, 66 ± 11.2 years) with resistant hypertension and moderate RAS. Using a pressure-sensing catheter, systolic, diastolic, and mean translesional pressure gradients, and the distal pressure (Pd):aortic pressure (Pa) ratio (Pd/Pa) were analyzed at baseline and after administration of 40 mg papaverine and 50 μg/kg dopamine. We did not observe significant changes in DG. Dopamine administration resulted in significant changes in systolic and mean translesional pressure gradients and Pd/Pa when compared with baseline (P dopamine or papaverine bolus administration.This study indicates that, compared with papaverine, the intrarenal bolus of dopamine in hypertensive patients with RAS remains a more powerful hyperemic agent.

  11. Accuracy of colour duplex sonography for the diagnosis of renal artery stenosis

    DEFF Research Database (Denmark)

    Saeed, Aso; Bergström, Göran; Zachrisson, Karin;

    2009-01-01

    with estimated glomerular filtration rate of less than 30 ml/min/1.73 m2 were 90 and 73% (for ACCmax) and 74 and 88% (for AImax). In addition, the transstenotic mean arterial pressure gradient showed a significant, though weak, negative correlation to ACCmax (r = -0.26, P = 0.02) and AImax (r = -0.29, P = 0.......01) in stenotic kidneys. CONCLUSION: ACCmax and AImax provide similar, good diagnostic accuracy in the detection of a haemodynamically significant RAS, even in patients with markedly reduced glomerular filtration rate. Presumably, the lack of superiority of the novel index AImax could be explained by a highly...... carried out at less than 4 months (mean 34 days) before renal angiography during a 6-year period (2002-2007). A significant RAS was defined as an at least 60% stenosis on angiography or a transstenotic mean arterial pressure gradient of at least 10 mmHg or both. RESULTS: In a total of 169 patients, 111...

  12. Biorheological Model on Flow of Herschel-Bulkley Fluid through a Tapered Arterial Stenosis with Dilatation

    Directory of Open Access Journals (Sweden)

    S. Priyadharshini

    2015-01-01

    Full Text Available An analysis of blood flow through a tapered artery with stenosis and dilatation has been carried out where the blood is treated as incompressible Herschel-Bulkley fluid. A comparison between numerical values and analytical values of pressure gradient at the midpoint of stenotic region shows that the analytical expression for pressure gradient works well for the values of yield stress till 2.4. The wall shear stress and flow resistance increase significantly with axial distance and the increase is more in the case of converging tapered artery. A comparison study of velocity profiles, wall shear stress, and flow resistance for Newtonian, power law, Bingham-plastic, and Herschel-Bulkley fluids shows that the variation is greater for Herschel-Bulkley fluid than the other fluids. The obtained velocity profiles have been compared with the experimental data and it is observed that blood behaves like a Herschel-Bulkley fluid rather than power law, Bingham, and Newtonian fluids. It is observed that, in the case of a tapered stenosed tube, the streamline pattern follows a convex pattern when we move from r/R=0 to r/R=1 and it follows a concave pattern when we move from r/R=0 to r/R=-1. Further, it is of opposite behaviour in the case of a tapered dilatation tube which forms new information that is, for the first time, added to the literature.

  13. Mesenchymal stem cells improve medullary inflammation and fibrosis after revascularization of swine atherosclerotic renal artery stenosis.

    Directory of Open Access Journals (Sweden)

    Behzad Ebrahimi

    Full Text Available Atherosclerotic renal artery stenosis (ARAS raises blood pressure and can reduce kidney function. Revascularization of the stenotic renal artery alone does not restore renal medullary structure and function. This study tested the hypothesis that addition of mesenchymal stem cells (MSC to percutaneous transluminal renal angioplasty (PTRA can restore stenotic-kidney medullary tubular transport function and attenuate its remodeling. Twenty-seven swine were divided into three ARAS (high-cholesterol diet and renal artery stenosis and a normal control group. Six weeks after ARAS induction, two groups were treated with PTRA alone or PTRA supplemented with adipose-tissue-derived MSC (10 × 10(6 cells intra-renal. Multi-detector computed tomography and blood-oxygenation-level-dependent (BOLD MRI studies were performed 4 weeks later to assess kidney hemodynamics and function, and tissue collected a few days later for histology and micro-CT imaging. PTRA effectively decreased blood pressure, yet medullary vascular density remained low. Addition of MSC improved medullary vascularization in ARAS+PTRA+MSC and increased angiogenic signaling, including protein expression of vascular endothelial growth-factor, its receptor (FLK-1, and hypoxia-inducible factor-1α. ARAS+PTRA+MSC also showed attenuated inflammation, although oxidative-stress remained elevated. BOLD-MRI indicated that MSC normalized oxygen-dependent tubular response to furosemide (-4.3 ± 0.9, -0.1 ± 0.4, -1.6 ± 0.9 and -3.6 ± 1.0 s(-1 in Normal, ARAS, ARAS+PTRA and ARAS+PTRA+MSC, respectively, p<0.05, which correlated with a decrease in medullary tubular injury score (R(2 = 0.33, p = 0.02. Therefore, adjunctive MSC delivery in addition to PTRA reduces inflammation, fibrogenesis and vascular remodeling, and restores oxygen-dependent tubular function in the stenotic-kidney medulla, although additional interventions might be required to reduce oxidative-stress. This study supports development of

  14. Clinical features in patients with simultaneous cerebral arterial and venous lesions (with literature survey

    Directory of Open Access Journals (Sweden)

    Lee Peng Chew

    2014-01-01

    Full Text Available Nowadays, only few cases of simultaneous cerebral arterial and venous thrombosis were reported. However, there might be high probability of coexisted cerebral arterial and venous changes. It is worthy to study the reasons and frequency of these coexisted vascular changes contributing to the development of clinical pictures. We analyzed 12 cases of simultaneous cerebral and/or neck vascular changes based on vascular images and ultrasonography which were divided into 4 groups: coexistence of simultaneous arterial and venous thrombosis; venous thrombosis with arterial hypoplasia; arterial thrombosis, arteritis or dissections with venous sinus hypoplasia; coexistence of arterial and venous hypoplasia.

  15. Losartan renography for the detection of renal artery stenosis: comparison with captopril renography and evaluation of dose and timing

    Energy Technology Data Exchange (ETDEWEB)

    Guenay, Emel Ceylan; Erguen, Eser Lay; Salanci, Bilge Volkan; Ugur, Oemer; Caner, Biray [Hacettepe University Faculty of Medicine, Department of Nuclear Medicine, Ankara (Turkey); Oeztuerk, M. Halil; Hekimoglu, Baki [Social Security Hospital Clinic of Radiology, Ankara (Turkey); Altun, Buelent [Hacettepe University Faculty of Medicine, Department of Nephrology, Ankara (Turkey); Cil, Barbaros [Hacettepe University Faculty of Medicine, Department of Radiology, Ankara (Turkey)

    2005-09-01

    Radionuclide renography with angiotensin converting enzyme (ACE) inhibition plays an important role in the diagnosis of haemodynamically significant renal artery stenosis. Angiotensin receptor antagonists inhibit the renin angiotensin system at different levels from ACE inhibitors by selectively blocking the binding of angiotensin II to AT1 receptors. The AT1 angiotensin receptor antagonist losartan has recently been used clinically in the treatment of hypertension. However, the available data on the use of losartan with renography for the detection of renovascular hypertension are limited and contradictory. The purpose of this prospective study was to compare the effectiveness of losartan renography and captopril scintigraphy in revealing renal artery stenosis. A total of 61 renal units in 32 patients with hypertension were studied in two groups based on the losartan dosage (50 mg in group A and 100 mg in group B). Group A consisted of 17 patients, in whom 19 renal units had angiographically proven renal artery stenosis ({>=}50%). In group B, there were 15 patients, in whom 20 renal arteries were stenotic. All of the patients underwent three renographies (baseline, captopril renography and early losartan renography). Early losartan renography was performed at 1 h after oral losartan administration in both groups. In group B, seven patients underwent additional losartan renography (late losartan) performed 3 h after oral losartan administration; these patients composed group B1. The sensitivities of captopril and losartan studies were 63.2% and 42% in group A, 65% and 65% in group B and 55.6% and 66.6% in group B1, respectively. From our preliminary results, we conclude that losartan is not superior to captopril renography for the detection of haemodynamically significant renal artery stenosis. However, a high dose (100 mg) of losartan provided higher sensitivity than the lower dose (50 mg). Late losartan scintigraphy provided similar diagnostic efficacy to early

  16. 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.

  17. Searching the perfect ultrasonic classification in assessing carotid artery stenosis: comparison and remarks upon the existing ultrasound criteria.

    Science.gov (United States)

    Mozzini, Chiara; Roscia, Giuseppe; Casadei, Alder; Cominacini, Luciano

    2016-01-01

    Doppler ultrasound scanning is the first line investigation for quantifying the internal carotid artery stenosis. Nevertheless, the lack of internationally accepted ultrasound criteria for describing the degree of stenosis has contributed to the different and confusing measurements ranges. The use of two different angiographic methods, the North American Symptomatic Carotid Endoarterectomy Study and the European Carotid Surgery Trial was probably the major initial source of confusion in deriving valid and reliable duplex ultrasound criteria worldwide. The consensus proposed in 2003 by the Society of Radiologists in Ultrasound has been a great attempt to create a conformity document, establishing grey scale and Doppler criteria in considering the different degrees of stenosis. According to this attempt, in 2010, the multi-parametric Deutsche Gesellschaft für Ultraschall in der Medizin ultrasound criteria have been proposed with a precise differentiation between main and additional criteria and depicted a different peak systolic velocity (PSV) threshold. In 2012, these criteria have been implemented, focusing on the multi-parametric approach, re-defining the PSV values and clearly introducing the concept of PSV average. Despite these attempts, a wide range of practice patterns still exists, with consistent disparities in patients' care. This paper collects these previous experiences and summarizes their strengths and weaknesses, to give a contribution in the carotid artery stenosis grading standardization using ultrasonic methods. Carotid ultrasound as the only diagnostic tool for the selection of patients for carotid surgery or stenting will be possible only with internationally accepted criteria.

  18. Application of large-eddy simulation to the study of pulsatile flow in a modeled arterial stenosis.

    Science.gov (United States)

    Mittal, R; Simmons, S P; Udaykumar, H S

    2001-08-01

    The technique of large-eddy simulation (LES) has been applied to the study of pulsatile flow through a modeled arterial stenosis. A simple stenosis model has been used that consists of a one-sided 50 percent semicircular constriction in a planar channel. The inlet volume flux is varied sinusoidally in time in a manner similar to the laminar flow simulations of Tutty (1992). LES is used to compute flow at a peak Reynolds number of 2000 and a Strouhal number of 0.024. At this Reynolds number, the flow downstream of the stenosis transitions to turbulence and exhibits all the classic features of post-stenotic flow as described by Khalifa and Giddens (1981) and Lieber and Giddens (1990). These include the periodic shedding of shear layer vortices and transition to turbulence downstream of the stenosis. Computed frequency spectra indicate that the vortex shedding occurs at a distinct high frequency, and the potential implication of this for noninvasive diagnosis of arterial stenoses is discussed. A variety of statistics have been also extracted and a number of other physical features of the flow are described in order to demonstrate the usefulness of LES for the study of post-stenotic flows.

  19. 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

  20. 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.

  1. Association of Lumbar Arterial Stenosis with Low Back Symptoms: A Cross-Sectional Study Using Two-Dimensional Time-of-Flight Magnetic Resonance Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Korkiakoski, A.; Niinimaeki, J.; Karppinen, J.; Korpelainen, R.; Haapea, M.; Natri, A.; Tervonen, O. (Inst. of Clinical Sciences, Dept. of Physical and Rehabilitation Medicine, Univ. of Oulu, Oulu (Finland))

    2009-01-15

    Background: Recent studies indicate that diminished blood flow may cause low back symptoms and intervertebral disc degeneration. Purpose: To explore the association between lumbar arterial stenosis as detected by two-dimensional time-of-flight magnetic resonance angiography (2D TOF-MRA) and lumbar pain symptoms in an occupational cohort of middle-aged Finnish males. Material and Methods: 228 male subjects aged 36 to 55 years (mean 47 years) were imaged with 2D TOF-MRA. Additionally, 20 randomly selected subjects were scanned with contrast-enhanced MRA (ceMRA). In each subject, the first (L1) to fourth (L4) segmental lumbar arteries were evaluated for lumbar artery stenosis using a dichotomic scale. One subject was excluded because of poor image quality, reducing the study population to 227 subjects. Logistic regression analysis was used to evaluate the association between arterial stenosis in 2D TOF-MRA and low back pain and sciatica symptoms (intensity, duration, frequency). Results: Comparing 2D TOF-MRA and ceMRA images, the kappa value (95% confidence interval) was 0.52 (0.31-0.73). The intraobserver reliability kappa value for 2D TOF-MRA was 0.85 (0.77-0.92), and interobserver kappa was 0.57 (0.49-0.65). The sensitivity of 2D TOF-MRA in detecting stenosis was 0.58, the accuracy 0.89, and the specificity 0.94. In 97 (43%) subjects all arteries were normal, whereas 130 (57%) had at least one stenosed artery. The left L4 artery was most often affected. The degree of arterial stenosis was associated with intensity of low back and sciatic pain, and sciatica pain duration during the past 3 months. Conclusion: 2D TOF-MRA is an acceptable imaging method for arterial stenosis compared to ceMRA. Arterial stenosis was associated with subjective pain symptoms, indicating a role of decreased nutrition in spinal disorders

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

    OpenAIRE

    Ederle, J; Dobson, J.; Featherstone, RL; Bonati, LH; van der Worp, HB; de Borst, GJ; lo, TH; Gaines, P.; Dorman, PJ; Macdonald, S; Lyrer, PA; Hendriks, JM; McCollum, C; Nederkoorn, PJ; Brown, MM

    2010-01-01

    Summary 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 Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were ra...

  3. Efficacy comparison of the treatment of vertebral artery ostium and intracranial vertebral artery stenosis with Apollo stents%Apollo支架治疗椎动脉起始部和颅内段狭窄的疗效比较

    Institute of Scientific and Technical Information of China (English)

    李立; 李天晓; 薛绛宇; 朱良付; 王子亮; 白卫星; 赵同源; 李钊硕; 许岗勤

    2012-01-01

    -stent restenosis rate and complications in both groups were compared. Results ①The stent in place rate was 100% and the technical success rate was 100% . Immediate postoperative angiography showed that the residual stenosis was < 10% in 86 sites and the residual stenosis rate was <20% in the remaining 16 sites. 1 case was obliterated by stent because of bleeding. ② Three patients had perioperative complications, accounting for 2.9% ( 3/103 ) , 1 of them complicated cerebral hemorrhage and 2 complicated infarctions. They were all in the intracranial vertebral artery group. There was no significant difference in the complication rate between the vertebral artery ostium group (0/33) and the intracranial vertebral artery group (3/70) ( P = 0. 549). ③Sixty seven patients were followed up with imaging at 6 months after procedure, 13 of them occurred in-stent restenosis,and the restenosis rate (32. 1% ,9/28) in vertebral artery ostium group was higher than that in the intracra-nial vertebral artery group (10. 3% ,4/39) . The difference was statistically significant ( P = 0. 025 ) . ④ Ninety four patients were clinically followed up for a mean of 9 months no mortality occurred. A total of 8 patients occurred posterior circulation cerebral infarction again,among them 3 were in the vertebral ostium group (3/30,10.0% ) and 5 were in the intracranial vertebral artery group (5/64,7. 8% ). There was no significant difference between the two groups. Conclusion The Apollo stent is safe and effective in the treatment of vertebral artery stenosis. The perioperative complication rate is higher in the intracranial vertebral artery group,but the restenosis rate is higher in (he vertebral artery ostium group.

  4. Association factor analysis between osteoporosis with cerebral artery disease: The STROBE study.

    Science.gov (United States)

    Jin, Eun-Sun; Jeong, Je Hoon; Lee, Bora; Im, Soo Bin

    2017-03-01

    The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified cerebral artery

  5. Direct visualization of a significant stenosis of the right coronary artery by transthoracic echocardiography. A case report

    Directory of Open Access Journals (Sweden)

    Wiseth Rune

    2007-10-01

    Full Text Available Abstract Non-invasive imaging of coronary arteries by transthoracic echocardiography is an emerging diagnostic tool to study the left main (LM, left descending artery (LAD, circumflex (Cx and right coronary artery (RCA. Impaired coronary circulation can be assessed by measuring coronary velocity flow reserve (CVFR by transthoracic Doppler echocardiography. Coronary artery stenoses can be identified as localized colour aliasing and accelerated flow velocities. We report a case with an acute coronary syndrome (ACS of a 46-year-old man. With non-invasive imaging of coronary arteries by transthoracic echocardiography (TTE, we identified a segment of the mid right coronary artery (RCA suggestive of stenosis with localized colour aliasing and accelerated flow velocity. We found a high ratio between the stenotic peak velocity and the prestenotic peak velocity, and a pathologic coronary flow velocity reserve (CFVR distal to the stenosis in the posterior interventricular descending branch (RDP. Subsequent coronary angiography demonstrated one vessel disease with a stenosis in segment 3 of RCA, which was successfully treated with percutaneos coronary intervention PCI. Two weeks following the PCI procedure he was readmitted to hospital with chest pain. A subacute stent thrombosis was questioned, and repeated echocardiography was preformed. The mid portion of RCA showed normal and laminar flow. The CVFR of RCA measured in the RDP showed normal vasodilatory response, confirming an open RCA without any flow limitation. A repeated coronary angiogram demonstrated only a mild in stent intimal hyperplasia. This case illustrates the value of transthoracic echocardiography as a tool both in the diagnosis and the follow-up of chest pain disorders and coronary flow problems. Transthoracic echocardiography allows both direct visualization of the various coronary segments and assessment of the CVFR.

  6. Endovascular treatment of posterior cerebral artery aneurysms using detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Hong Gee [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Konkuk University Hospital, Department of Radiology, Seoul (Korea); Kim, Sam Soo; Han, Heon [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Kang, Hyun-Seung [Konkuk University Hospital, Department of Neurosurgery, Seoul (Korea); Moon, Won-Jin [Konkuk University Hospital, Department of Radiology, Seoul (Korea); Byun, Hong Sik [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2008-03-15

    Aneurysms of the posterior cerebral artery (PCA) are rare, and most of the studies reported in the literature in which the endovascular approach was applied were carried out on a limited number of patients with PCA aneurysms. We retrospectively reviewed our cases of PCA aneurysms - at various locations and of differing shapes - that received endovascular treatment and evaluated the treatment outcome. From January 1996 to December 2006, 13 patients (eight females and five males) with 17 PCA aneurysms (nine fusiform and eight saccular) were treated using the endovascular approach. The age of the patients ranged from 20 to 67 years, with a mean age of 44 years. Of the 13 patients, ten presented with intracranial hemorrhage, and one patient, with a large P2 aneurysm, presented with trigeminal neuralgia; the aneurysms were asymptomatic in the remaining two patients. All 13 patients were successfully treated, with only one procedure-related symptomatic complication. Seven patients were treated by occlusion of the aneurysm and parent artery together; five patients, by selective embolization of the aneurysm; one patient, by partial coiling. Although infarctions were found in two patients treated with selective embolization and in three patients treated with parent artery occlusion, only one patient with a ruptured P2 aneurysm treated with parent artery occlusion developed transient amnesia as an ischemic symptom. Posterior cerebral artery aneurysms can be treated safely with either occlusion of the aneurysm together with the PCA or with a selective coil embolization. Infarctions may occur after endovascular treatment, but they are rarely the cause of a disabling symptom. (orig.)

  7. Gene expression profiling in the human middle cerebral artery after cerebral ischemia

    DEFF Research Database (Denmark)

    Vikman, P; Edvinsson, L

    2006-01-01

    MCA samples distributing to the ischemic area, 7-10 days post-stroke. The gene expression was examined with real-time polymerase chain reaction (PCR) and microarray, proteins were studied with immunohistochemistry. We investigated genes previously shown to be upregulated in animal models of cerebral...... with microarray and seven genes chosen for further investigation with real-time PCR; ELK3, LY64, Metallothionin IG, POU3F4, Actin alpha2, RhoA and smoothelin. Six of these were regulated the same way when confirming array expression with real-time PCR. Gene expression studies in the human MCA leading......We have investigated the gene expression in human middle cerebral artery (MCA) after ischemia. Ischemic stroke affects the perfusion in the affected area and experimental cerebral ischemia results in upregulation of vasopressor receptors in the MCA leading to the ischemic area. We obtained human...

  8. Suspension model for blood flow through a catheterized arterial stenosis with peripheral layer of plasma free from cells

    Science.gov (United States)

    Ponalagusamy, R.

    2016-06-01

    The present article describes the blood flow in a catheterized artery with radially symmetric and axially asymmetric stenosis. To understand the effects of red cell concentration, plasma layer thickness and catheter size simultaneously, blood is considered by a two-layered model comprising a core region of suspension of all the erythrocytes (particles) supposed to be a particle-fluid mixture and a peripheral zone of cell-free plasma. The analytical expressions for flow features, such as fluid phase and particle phase velocities, flow rate, wall shear stress and resistive force are obtained. It is witnessed that the presence of the catheter causes a substantial increase in the frictional forces on the walls of arterial stenosis and catheter, shear stress and flow resistance, in addition to that, have occurred due to the presence of red cells concentration (volume fraction density of the particles) and the absence of peripheral plasma layer near the wall of the stenosed artery. The introduction of an axially asymmetric nature of stenosis and plasma layer thickness causes significant reduction in flow resistance. One can notice that the two-phase fluid (suspension model) is more profound to the thickness of peripheral plasma layer and catheter than the single-phase fluid.

  9. Time constant of the cerebral arterial bed in normal subjects.

    Science.gov (United States)

    Kasprowicz, Magdalena; Diedler, Jennifer; Reinhard, Matthias; Carrera, Emmanuel; Steiner, Luzius A; Smielewski, Peter; Budohoski, Karol P; Haubrich, Christina; Pickard, John D; Czosnyka, Marek

    2012-07-01

    The time constant of cerebral arterial bed (in brief time constant) is a product of brain arterial compliance (C(a)) and resistance (CVR). We tested the hypothesis that in normal subjects, changes in end-tidal CO(2) (EtCO(2)) affect the value of the time constant. C(a) and CVR were estimated using mathematical transformations of arterial pressure (ABP) and transcranial Doppler (TCD) cerebral blood flow velocity waveforms. Responses of the time constant to controlled changes in EtCO(2) were compared in 34 young volunteers. Hypercapnia shortened the time constant (0.22 s [0.17, 0.26] vs. 0.16 s [0.13, 0.20]; p = 0.000001), while hypocapnia lengthened the time constant (0.22 s [0.17, 0.26] vs. 0.23 s [0.19, 0.32]; p time constant was negatively correlated with changes in EtCO(2) (R(partial) = -0.68, p time constant shortens with increasing EtCO(2). Its potential role in cerebrovascular investigations needs further studies.

  10. RENOVASCULAR HYPERTENSION DUE TO RENAL ARTERY STENOSIS IN KLIPPEL-FEIL SYNDROME

    Directory of Open Access Journals (Sweden)

    Foyaca-Sibat H. MD.

    2003-01-01

    Full Text Available ABSTRACT We report one patient with Klippel-Feil (KFS syndrome, other associated anomalies, uncontrolled arterial hypertension, and renal artery stenosis. Because this patient underwent for surgical revascularization with unsuccessful result, all proposed way of treatments are revised, and we have hypothesized that probably for patients with KFS and unilateral renal artery stenosis, medical treatment with ACE inhibitors can provide more benefits than surgical revascularization or percutaneous transluminal angioplasty. We considered that those patients should be manage by a team of medical doctors being aware of their common associated anomalies, identifying all of them when it is possible then, making an integral evaluation of the each individual situation for establishing their medical priorities in order, and then address its treatments accordingly. If at this stage any surgical treatment is required, is important to bring those problems to the anesthesiologist’s attention for a very careful manipulation of the neck and head during induction of anesthesia. The final results will be strongly related with the capacity of management of the underlying cardio-respiratory, renal, skeletal, urogenital, and nervous system problems. . We also propose the term of Klippel-Feil syndrome "Plus" for those patients with cervical vertebral fusion and many other associated deformities rather than to add new eponyms to the long list that already exist. _____________ RESUMEN: HIPERTENSION RENOVASCULAR DEBIDO A ESTENOSIS DE LA ARTERIA RENAL EN EL SÍNDROME DE KLIPPEL-FEIL Reportamos un paciente afectado por un syndrome de Klippel-Feil, otras anormalias congenitas, hipertension arterial incontrolada y una estenosis unilateral de la arteria renal. Este paciente fue sometido a un tratamiento quirÚrgico de la estenosis de la arteria renal, cuyos resultados fueron no satisfactorios por lo que revisamos todas las alternativas de tratamiento para la estenosis

  11. Cerebral arterial spasm. II. Etiology and treatment of experimental cerebral vasospasm.

    Directory of Open Access Journals (Sweden)

    Morooka,Hiroshi

    1978-04-01

    Full Text Available Delayed cerebral vasospams is caused by excessive accumulation of dopamine-beta-hydroxylase (DBH and noradrenaline in cerebral vessel walls. This study demonstrates the mechanisms of delayed spasm, particularly the role of red blood cell components, and the successful relief of delayed cerebral vasospasm. Spasmogenic substances which contained a heme component, such as methemoglobin, methemalbumin and catalase enhanced DBH activity in human serum as measured by a one step chemical spectrophotometric assay. The concentration which gave the highest DBH activity caused the maximum constriction of the basilar artery, when the substances were applied topically. Among components of red cells, methemoglobin, methemalbumin, catalase and nicotinamid adenin dinucleotide (NADH caused constriction of basilar artery in cats, when applied topically, whereas hematin, hemin and bilirubin caused no significant spasm. An oxyhemoglobin solution obtained by mixture with methemoglobin and ascorbic acid produced no significant vascular spasm either. Relief of delayed cerebral vasospasm was obtained with topical application of specific alpha adrenergic blocking drug such as phenoxybenzamine, specific inhibitors of DBH such as fusaric acid, o-phenanthroline and alphaalpha' dipyridyl beta2 adrenergic stimulants such as salbutamol, and a phosphodiesterase inhibitor, ascorbic acid.

  12. Long-term outcome of symptomatic severe ostial vertebral artery stenosis (OVAS)

    Energy Technology Data Exchange (ETDEWEB)

    Karameshev, Alexander [University of Bern, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern (Switzerland); University of Bern, Neurology, Bern (Switzerland); Medical University of Sofia, Department of Neurology, Sofia (Bulgaria); Schroth, Gerhard; Mordasini, Pasquale; Gralla, Jan; Brekenfeld, Caspar [University of Bern, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern (Switzerland); Arnold, Marcel; Mono, Marie-Luise; Mattle, Heinrich P. [University of Bern, Neurology, Bern (Switzerland); Do, Do-Dai [University of Bern, Angiology, Bern (Switzerland); Nedeltchev, Krassen [University of Bern, Neurology, Bern (Switzerland); Triemli Hospital, Department of Neurology, Zurich (Switzerland)

    2010-05-15

    The optimal management of patients with symptomatic severe ostial vertebral artery stenosis (OVAS) is currently unclear. We analyzed the long-term outcome of consecutive patients with OVAS who received either medical treatment (MT) or vertebral artery stenting (VAS). Thirty-nine (>70%) patients with severe OVAS were followed for a mean period of 2.8 years. The decision for VAS (n=10) or MT (n=29) was left to the clinician. The Kaplan-Meier method was used to assess the risk of recurrent stroke, transient ischemic attack (TIA), or death over the study period. Patients in the VAS group were significantly younger and more likely to have bilateral VA disease (P=0.04 and P=0.02). VAS was successfully performed in all ten patients. The periprocedural risk within 30 days was 10% (one TIA). The overall restenosis rate was 10%. One restenosis occurred after 9 months in a patient treated with bare-metal stent. At 4 years of follow-up, VAS showed a nonsignificant trend toward a lower risk for the combined endpoint of TIA and stroke in posterior circulation compared to medical treatment (10% vs. 45%, P=0.095; relative risk (RR)=0.24, 95% confidence interval (CI) 0.031-1.85). Patients with bilateral VA disease had a significantly lower recurrence risk after VAS compared with medical treatment (0% vs. 91% at 4 years, P=0.004; RR 0.10, 95% CI 0.022-0.49) VAS was performed without permanent complications in this small series of patients with symptomatic severe OVAS. The long-term benefit seems to be confined to patients with bilateral but not to those with unilateral VA disease. (orig.)

  13. A Prospective Comparison of Duplex Ultrasonography, Captopril Renography, MRA, and CTA in Assessing Renal Artery Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ekloef, H.; Ahlstroem, H.; Magnusson, A.; Andersson, L.G.; Andren, B.; Haegg, A.; Bergqvist, D.; Nyman, R. [Uppsala Univ. Hospital (Sweden). Depts. of Radiology, Clinical Physiology, Medicine, and Surgery

    2006-10-15

    Purpose: To prospectively compare the diagnostic accuracy of duplex ultrasonography, captopril renography, computed tomography angiography (CTA), and 3D Gd magnetic resonance angiography (MRA) in diagnosing hemodynamically significant renal artery stenosis (RAS). Material and Methods: The standard of reference was measurement of transstenotic pressure gradient. Fifty-eight hypertensive patients with suspicion of RAS were evaluated, when possible, by all five techniques. Sensitivity and specificity to detect RAS were compared for each technique on both a patient and kidney basis. Discrepancies were evaluated separately and classified as borderline, method dependent, or operator dependent. Results: The prevalence of RAS was 77%. The sensitivity/specificity of ultrasonography, captopril renography, CTA, and MRA in detecting kidneys with RAS was 73/71%, 52/63%, 94/62%, and 93/91%, respectively. Ultrasonography had a significantly lower sensitivity than CTA and MRA (P <0.001) but higher than captopril renography (P = 0.013). Borderline RAS was the main cause for discrepancies. Conclusion: MRA and CTA were significantly better than duplex ultrasonography and captopril renography in detecting hemodynamically significant RAS. The ultrasonography criteria for RAS based on the evaluation of renal peak systolic velocity and renal/aortic ratio are questionable. Captopril renography cannot be recommended for assessing RAS.

  14. Word and face recognition deficits following posterior cerebral artery stroke

    DEFF Research Database (Denmark)

    Kuhn, Christina D.; Asperud Thomsen, Johanne; Delfi, Tzvetelina

    2016-01-01

    Abstract Recent findings have challenged the existence of category specific brain areas for perceptual processing of words and faces, suggesting the existence of a common network supporting the recognition of both. We examined the performance of patients with focal lesions in posterior cortical...... areas to investigate whether deficits in recognition of words and faces systematically co-occur as would be expected if both functions rely on a common cerebral network. Seven right-handed patients with unilateral brain damage following stroke in areas supplied by the posterior cerebral artery were...... included (four with right hemisphere damage, three with left, tested at least 1 year post stroke). We examined word and face recognition using a delayed match-to-sample paradigm using four different categories of stimuli: cropped faces, full faces, words, and cars. Reading speed and word length effects...

  15. A tissue engineered renovascular graft composed of proteins, polymers, smooth muscle and endothelial cells for renal artery stenosis.

    Science.gov (United States)

    Yin, Hao; Wang, Xiao-Hui; Zhu, Xiang-Dong; Han, Huifang; Guo, Wen-Yuan; Ful, Zhi-Ren

    2013-08-01

    Endarterectomy and bypass surgery to treat renal artery stenosis are increasingly shunned these days due to high risks of complications during and after the surgery. Striving to find a sound alternative solution, we pioneered the construction of a tissue engineered renovascular graft that could immediately restore the normal blood flow to kidneys and sustain renal functions without suffering restenosis after the surgery. A highly porous scaffold was first constructed by electrospinning polycaprolactone, poliglecaprone, gelatin and elastin, giving the vast majority of non-woven fibers in the scaffold a diameter below 1200 nm. To recapitulate the anatomical and functional signatures of renal arteries, a bi-layer vasculature comprising a smooth muscle layer topped by an endothelial layer was built on the scaffold. The vasculature witnessed a sustained proliferation for up to 10 days in vitro and robustly secreted prostacyclin and endothelin-1, evidencing that the vasculature was functionally comparable to native renal arteries. After 30 days as a renovascular graft in mice, the luminal diameter of the graft remained clear without a restenosis and an increased confluence of the endothelial layer was observed. The tensile test confirmed that the renovascular graft was mechanically superior to native renal arteries and retained this advantage within 30 days in vivo. Also, this renovascular graft sustained renal functions as evidenced by normal levels of serum creatinine, urine creatinine and serum urea nitrogen and the lack of edema in the kidney cortex. These results demonstrate that this renovascular graft holds a great therapeutic promise for renal artery stenosis.

  16. Near-infrared transillumination back scattering sounding--new method to assess brain microcirculation in patients with chronic carotid artery stenosis.

    Directory of Open Access Journals (Sweden)

    Andrzej F Frydrychowski

    Full Text Available PURPOSE: The purpose of the study was to assess the responses of pial artery pulsation (cc-TQ and subarachnoid width (sas-TQ to acetazolamide challenge in patients with chronic carotid artery stenosis and relate these responses to changes in peak systolic velocity (PSV, cerebral blood flow (CBF, cerebral blood volume (CBV, mean transit time (MTT and time to peak response (TTP. METHODS: Fifteen patients with carotid artery stenosis ≥ 90% on the ipsilateral side and <50% on the contralateral side were enrolled into the study. PSV was assessed using colour-coded duplex sonography, CBF, CBV, MTT and TTP with perfusion computed tomography, cc-TQ and sas-TQ with near-infrared transillumination/backscattering sounding (NIR-T/BSS. RESULTS: Based on the ipsilateral/contralateral cc-TQ ratio after acetazolamide challenge two groups of patients were distinguished: the first group with a ratio ≥ 1 and the second with a ratio <1. In the second group increases in CBF and CBV after the acetazolamide test were significantly higher in both hemispheres (ipsilateral: +33.0% ± 8.1% vs. +15.3% ± 4.4% and +26.3% ± 6.6% vs. +14.3% ± 5.1%; contralateral: +26.8% ± 7.0% vs. +17.6% ± 5.6% and +20.0% ± 7.3% vs. +10.0% ± 3.7%, respectively, cc-TQ was significantly higher only on the ipsilateral side (+37.3% ± 9.3% vs. +26.6% ± 8.6% and the decrease in sas-TQ was less pronounced on the ipsilateral side (-0.7% ± 1.5% vs. -10.2% ± 1.5%, in comparison with the first group. The changes in sas-TQ following the acetazolamide test were consistent with the changes in TTP. CONCLUSIONS: The ipsilateral/contralateral cc-TQ ratio following acetazolamide challenge may be used to distinguish patient groups characterized by different haemodynamic parameters. Further research on a larger group of patients is warranted.

  17. Asymmetry of intracranial internal carotid artery on 3D TOF MR angiography: a sign of unilateral extracranial stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Naggara, Olivier; Seiller, Nicolas; Gobin-Metteil, Marie-Pierre; Meder, Jean-Francois; Oppenheim, Catherine [Faculte de Medecine Rene Descartes, Universite Paris 5. Centre Hospitalier Sainte-Anne, Department of Neuroradiology, Paris cedex 14 (France); Touze, Emmanuel; Mas, Jean-Louis [Faculte de Medecine Rene Descartes, Universite Paris 5. Centre Hospitalier Sainte-Anne, Department of Neurology, Paris cedex 14 (France)

    2008-05-15

    The purpose of this case-control study was to determine whether an asymmetry of size of the intracranial internal carotid artery (ICA) on 3D time-of-flight MR angiography (MRA) is predictive of a high-grade cervical ICA stenosis. Ninety-six stroke/TIA consecutive patients were recruited for the study, of whom 32 had unilateral high-grade ICA stenosis ({>=}70% NASCET) and were included into the case group, and the remaining 64 did not have such high-grade stenosis and were included in the control group. On intracranial MRA, two observers, blinded to the characteristics of cervical ICA stenosis, independently searched for qualitative size asymmetry between ICAs and measured the cross-sectional surface of the intracranial ICAs. An intracranial size asymmetry was seen in 28 of the 32 high-grade stenoses by both readers, and in 10 (reader{sub 1}) and 8 (reader{sub 2}) of the 64 controls (sensitivity = 88%, specificity = 84-88%). In patients without agenesia of the A1 segment of the circle of Willis (n = 70), sensitivity was {>=}90% and specificity = 96%. Surfaces ratios were significantly different (p < 0.001) between cases and controls. However, using ROC curves analysis, the quantitative processing did not improve the detection when compared with the qualitative assessment of intracranial ICA asymmetry. A size asymmetry of the intracranial ICAs reveals the presence of an underlying high-grade cervical stenosis, with a high degree of confidence, especially in patients without anatomical variant of the anterior part of the circle of Willis. This sign may allow an early detection of high-grade cervical carotid stenosis in stroke patients before dedicated neck imaging is performed. (orig.)

  18. Haemodynamic evaluation of the cerebral circulation by periorbital Doppler examination and cerebral blood flow (CBF) measurement in carotid artery disease

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T; Buchardt Hansen, H J

    1988-01-01

    To assess the haemodynamic significance of an internal carotid artery (ICA) stenosis, angiography or direct ultrasound examination should be supplemented by indirect physiologic testing of the collateral circulation. Among the tests proposed, we used the periorbital flow direction, assessed by Do...

  19. Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    Eun Jeong Cho; Sung-Ji Park; Sung-A Chang; Dong Seop Jeong; Sang-Chol Lee; Seung Woo Park; Pyo Won Park

    2014-01-01

    Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS),even in patients without significant coronary artery disease (CAD).However,the incidence of angina pectoris and related CAD in such patients is controversial.There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS.The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.Methods Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995.Clinical and echocardiographic follow-up data were recorded into the database annually.Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography.We excluded patients with multiple valve disease,significant aortic regurgitation,or prior CAD or valve surgery.Results Totally 574 patients with severe AS (mean age,(65.9±9.6) years) were enrolled in this study.Significant CAD was found in 61 patients (10.6%).Factors associated with increased likelihood of CAD were age,hypertension,diabetes mellitus,chronic renal failure,carotid disease,and aorta calcification.In Logistic regression analysis,the independent predictor of the presence of CAD was age (P=0.011).The incidence of CAD increased significantly at 69.2 years of age.Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.Conclusions There was a low incidence of significant CAD in a population of Korean patients with severe AS.Therefore,coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than

  20. Reperfusion does not improve impaired rapid-onset cortical plasticity in patients with severe stenosis of the internal carotid artery.

    Directory of Open Access Journals (Sweden)

    Jonathan List

    Full Text Available BACKGROUND: Severe stenosis of the internal carotid artery (ICA has been associated with impaired cognition in patients, but its effect on rapid-onset cortical plasticity is not known. Carotid endarterectomy (CEA in patients with severe ICA stenosis reduces stroke risk, but the impact on cognition or physiology of the respective hemisphere remains controversial. METHODS/RESULTS: 16 patients with severe stenosis of the ICA and 16 age and sex matched controls were included. Rapid-onset cortical plasticity was assessed using the paired-associative stimulation (PAS protocol. PAS models long-term synaptic potentiation in human motor cortex, combining repetitive stimulation of the peripheral ulnar nerve with transcranial magnetic stimulation of the contralateral motor cortex. Cognitive status was assessed with a neuropsychological test battery. In patients, verbal learning and rapid-onset cortical plasticity were significantly reduced as compared to controls. Identical follow-up tests in 9 of the 16 patients six months after CEA revealed no improvement of cognitive parameters or cortical plasticity. CONCLUSIONS: Decreased rapid-onset cortical plasticity in patients with severe stenosis of the ICA was not improved by reperfusion. Thus, other strategies known to increase plasticity should be tested for their potential to improve cortical plasticity and subsequently cognition in these patients.

  1. [Congenital anomalies of cerebral artery and intracranial aneurysm].

    Science.gov (United States)

    Nakajima, K; Ito, Z; Hen, R; Uemura, K; Matsuoka, S

    1976-02-01

    It is well known that congenital anomalies such as polycystic kidney, aortic coarctation, Marfan syndrome, Ehler-Danlos syndrome are apt to be complicated by intracranial aneurysms. In this report we attempt to reveal the relation and incidence between cerebrovascular anomalies and intracranial aneurysms. The etiology of aneurysms has been discussed, too. 12 cases of persistent trigeminl artery, 2 cases of persistent hypoglossal artery and 11 cases of fenestration were obtained from 3841 patients who were angiographically examined in our clinic for 5 years. The incidence is 0.31%, 0.05% and 0.29%, respectively. Persistent trigeminal arteries were complicated by 2 cases of intracranial aneurysms and one case of arterivenous malformations (AVM), persistent hypoglossal arteries were complicated by one case of aneurysm, and fenestrations were complicated by 2 cases of aneurysms and one case of AVM. One case of congenital agenesis of right internal carotid artery was obtained which was complicated by aneurysm of anterior communicating artery. Totally, 8 cases of aneurysms and AVM were obtained from 26 cases of cerebrovascular anomalies (incidence 30.8%). On the other hand, thalamic or caudate hemorrhage revealed the highest incidence of complication of intracranial aneurysms among intracerebral hematomas (10.7%). Compared with the incidence of aneurysms between cerebro vascular anomalies (30.8%) and thalamic or caudate hemorrhage (10.7%), the difference is statistically signigicant (P less than 0.05). The cause of intracranial aneurysm has not yet been clarified. But it is well accepted that the defect of tunica media vasorum is most responsible factor as to the occurrence of intracranial aneurysms. We concluded that the genetic error of cerebral vessels including defect of media caused intracranial aneurysms, and this result was supported from the evidence that cerebrovascular anomalies showed statistically high incidence of complication of intracranial aneurysms.

  2. Pharmacological and molecular comparison of K(ATP) channels in rat basilar and middle cerebral arteries

    DEFF Research Database (Denmark)

    Ploug, Kenneth Beri; Edvinsson, Lars; Olesen, Jes;

    2006-01-01

    ATP-sensitive potassium (K(ATP)) channels play an important role in the regulation of cerebral vascular tone. In vitro studies using synthetic K(ATP) channel openers suggest that the pharmacological profiles differ between rat basilar arteries and rat middle cerebral arteries. To address this issue...

  3. Subarachnoid hemorrhage induces enhanced expression of thromboxane A2 receptors in rat cerebral arteries

    DEFF Research Database (Denmark)

    Ansar, Saema; Larsen, Carl; Maddahi, Aida;

    2010-01-01

    after SAH in cerebral arteries. SAH was induced in rats by injecting 250 microl of blood into the prechiasmatic cistern. Two days after the SAH, cerebral arteries were harvested and contractile responses to the TP receptor agonist U46619 were investigated with myographs. In addition, the contractile...

  4. Endotoxemia reduces cerebral perfusion but enhances dynamic cerebrovascular autoregulation at reduced arterial carbon dioxide tension*

    DEFF Research Database (Denmark)

    Brassard, Patrice; Kim, Yu-Sok; van Lieshout, Johannes

    2012-01-01

    OBJECTIVE:: The administration of endotoxin to healthy humans reduces cerebral blood flow but its influence on dynamic cerebral autoregulation remains unknown. We considered that a reduction in arterial carbon dioxide tension would attenuate cerebral perfusion and improve dynamic cerebral......-104] mm Hg; p = .75), but increased cardiac output (8.3 [6.1-9.5] L·min vs. 6.0 [4.5-8.2] L·min; p = .02) through an elevation in heart rate (82 ± 9 beats·min vs. 63 ± 10 beats·min; p arterial carbon dioxide tension (37 ± 5 mm Hg vs. 41 ± 2 mm Hg; p artery mean...... in arterial carbon dioxide tension explains the improved dynamic cerebral autoregulation and the reduced cerebral perfusion encountered in healthy subjects during endotoxemia....

  5. Long-term outcome of endovascular treatment versus medical care for carotid artery stenosis in patients not suitable for surgery and randomised in the Carotid and Vertebral Artery Transluminal Angioplasty study (CAVATAS).

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-01-01

    Optimal treatment of carotid stenosis in patients not suitable for surgery is unclear. The Carotid and Vertebral Artery Transluminal Angioplasty study contained a trial comparing medical and endovascular treatment in patients not suitable for surgery.

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

    LENUS (Irish Health Repository)

    Kinsella, J A

    2012-09-27

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

  7. Cerebral small-resistance artery structure and cerebral blood flow in normotensive subjects and hypertensive patients

    Energy Technology Data Exchange (ETDEWEB)

    De Ciuceis, Carolina; Porteri, Enzo; Rizzoni, Damiano; Boari, Gianluca E.M.; Rosei, Enrico Agabiti [University of Brescia, Clinica Medica, Department of Clinical and Experimental Sciences, Brescia (Italy); Cornali, Claudio; Mardighian, Dikran; Fontanella, Marco M. [University of Brescia, Section of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia (Italy); Pinardi, Chiara [Spedali Civili, Medical Physics Unit, Brescia (Italy); University of Brescia, Section of Neuroradiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia (Italy); Rodella, Luigi F.; Rezzani, Rita [University of Brescia, Section of Anatomy, Department of Clinical and Experimental Sciences, Brescia (Italy); Gasparotti, Roberto [University of Brescia, Section of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia (Italy); University of Brescia, Section of Neuroradiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia (Italy)

    2014-12-15

    The aim of this study was to prospectively investigate whether the structure of cerebral small-resistance arteries is related to cerebral perfusion parameters as measured with dynamic susceptibility-weighted contrast magnetic resonance imaging (DSC-MRI) in a selected cohort of hypertensive and normotensive patients. Ten hypertensive and 10 normotensive patients were included in the study. All patients underwent neurosurgical intervention for an intracranial tumor and were investigated with DSC-MRI at 1.5 T. Cerebral small-resistance arteries were dissected from a small portion of morphologically normal cerebral tissue and mounted on an isometric myograph for the measurement of the media-to-lumen (M/L) ratio. A quantitative assessment of cerebral blood flow (CBF) and volume (CBV) was performed with a region-of-interest approach. Correlation coefficients were calculated for normally distributed variables. The institutional review board approved the study, and informed consent was obtained from all patients. Compared with normotensive subjects, hypertensive patients had significantly lower regional CBF (mL/100 g/min) in the cortical grey matter (55.63 ± 1.90 vs 58.37 ± 2.19, p < 0.05), basal ganglia (53.34 ± 4.39 vs 58.22. ± 4.33, p < 0.05), thalami (50.65 ± 3.23 vs 57.56 ± 4.45, p < 0.01), subcortical white matter (19.32 ± 2.54 vs 22.24 ± 1.9, p < 0.05), greater M/L ratio (0.099 ± 0.013 vs 0.085 ± 0.012, p < 0.05), and lower microvessel density (1.66 ± 0.67 vs 2.52 ± 1.28, p < 0.05). A statistically significant negative correlation was observed between M/L ratio of cerebral arteries and CBF in the cortical grey matter (r = -0.516, p < 0.05), basal ganglia (r = -0.521, p < 0.05), thalami (r = -0.527 p < 0.05), and subcortical white matter (r = -0.612, p < 0.01). Our results indicate that microvascular structure might play a role in controlling CBF, with possible clinical consequences. (orig.)

  8. [Prediction of coronary artery stenosis by measurement of total plaque area and thickness versus intima media thickness of the carotid artery].

    Science.gov (United States)

    Adams, Ansgar; Bojara, Waldemar

    2015-08-01

    Total plaque area (TPA), maximum plaque thickness and intima media thickness (IMT) in the carotid arteries of 431 patients aged 27-88 years were measured 1 day before a planned coronary artery angiography without any clinical knowledge about the patient. Age-related cut-off values of the TPA for the presence of coronary stenosis were evaluated. Using ultrasound four types of carotid artery atherosclerosis were identified. The accuracy of detection of cardiovascular coronary stenosis was 87% for types III and IVb. No type I patient had coronary stenosis. The IMT was significantly less predictive: the area under the curve (AUC) for TPA by age and plaque thickness was 0.82 (95% CI: 0.78-0.85) versus IMT 0.59 (95% CI: 0.54-0.64, p = 0.001). Prediction with TPA measurement by age and plaque thickness was better than TPA alone: AUC 0.82 (95% CI: 0.78-0.85) versus 0.77 (95% CI: 0.73-0.81, p = 0.0028), respectively. In a second cohort of 2566 healthy men and 1216 healthy women aged between 20 and 64 years who were examined in an occupational screening program, 11.2% of the men and 3.4% of the women showed a type III or IVb result. In the mean follow-up of period of 23.4 ± 14.4 months, 14 heart attacks, 7 bypass operations and 3 stent implantations occurred and 6 subjects showed coronary stenosis between 50% and 95% in coronary angiography. In the baseline examination 26 out of 30 patients showed a type III or IVb result. In the case of men and women with types III and IVb diagnosis by ultrasound, pharmaceutical treatment could be indicated in order to reduce the risk of cardiovascular events. Type I patients do not need preventive medication or coronary catheterization.

  9. Wingspan支架治疗症状性颅内动脉狭窄的临床研究%Clinical research on treatment of symptomatic intracranial arterial stenosis with Wingspan stent

    Institute of Scientific and Technical Information of China (English)

    马敏敏; 张仁良; 殷勤; 徐格林; 周志明; 朱武生; 樊新颖; 刘新峰

    2009-01-01

    Objective To investigate the safety,feasibility and long-term efficacy of the Wingspan stent in treatment of symptomatic intracranial arterial stenosis. Methods Treatment with Wing-span stent was attempted in 16 patients. The technical success rate,average stenosis before and af-ter treatment,major complications and clinical outcome were observed. Conventional cerebral an-giography was performed at 6 months after stenting. Results The average pretreatment stenosis was(80.6±12.1)%. After Wingspan stent placement, the average stenosis was(20.4±10.2)%.The technical success rate was 100%. The rate of ipsilateral stroke within 30 days and 6 months was 6.3% and 12. 5%, respectively. The symptoms were significantly improved in 68. 8% pa-tients. Five patients underwent conventional cerebral angiography reexamination,in-stent stenosis was detected in one patient with 80% restenosis. Conclusion Symptomatic intracranial artery ste-nosis can be treated with Wingspan stent with high rate of technical success,acceptable safety and clinic outcome.%目的 探讨Wingspan支架治疗症状性颅内动脉狭窄的安全性、可行性和远期疗效.方法 应用Wingspan支架治疗症状性颅内动脉狭窄患者16例,观察其手术成功率、手术前后狭窄率、症状改善及严重不良事件的发生情况.术后6个月行脑血管造影术观察支架内再狭窄发生率.结果 患者术前平均狭窄率为(80.6±12.1)%,Wingspan支架置入后平均残余狭窄率为(20.4±10.2)%,手术成功率100%.30天和6个月内同侧脑卒中的发生率分别为6.3%和12.5%.68.8%患者症状改善明显.5例患者行脑血管造影术复查,1例伴有80%再狭窄.结论 Wingspan支架治疗症状性颅内动脉狭窄成功率高,具有较好的安全性和临床疗效.

  10. Role of calcium in the constriction of isolated cerebral arteries

    Energy Technology Data Exchange (ETDEWEB)

    Wendling, W.W.

    1987-01-01

    Calcium entry blockers (CEB) have been used in the experimental treatment or prevention of many cerebrovascular disorders including stroke, post-ischemic hypoperfusion after cardiac arrest, cerebral vasospasm after subarachnoid hemorrhage, and migraine headache. However, the mechanism of action of these drugs on the cerebral circulation is poorly understood. This study examined the effects of calcium antagonists, Ca/sup 2 +/-deficient solutions, and vasocostrictors on cerebrovascular tone and /sup 45/Ca fluxes, to determine the role of calcium in cerebral arterial constriction. A Scatchard plot of /sup 45/Ca binding to BMCA showed that Ca/sup 2 +/ was bound at either low or high affinity binding sties. The four vasoconstrictors (potassium, serotonin, PGF/sub 2 ..cap alpha../, or SQ-26,655) each increased low affinity /sup 45/Ca uptake into BMCA. The results demonstrate that: (1) Potassium and serotonin constrict BMCA mainly by promoting Ca/sup 2 +/ influx through CEB-sensitive channels; (2) PGF/sub 2 ..cap alpha../ and SQ-26,655 constrict BMCA in part by promoting Ca/sup 2 +/ influx through CEB-sensitive channels, and in part by releasing Ca/sup 2 +/ from depletable internal stores; (3) The major action of CEB on BMCA is to block vasoconstrictor-induced Ca/sup 2 +/ uptake through both potential-operated (K/sup +/-stimulated) and receptor-operated channels.

  11. Pharmacological and molecular comparison of K(ATP) channels in rat basilar and middle cerebral arteries

    DEFF Research Database (Denmark)

    Ploug, Kenneth Beri; Edvinsson, Lars; Olesen, Jes;

    2006-01-01

    ATP-sensitive potassium (K(ATP)) channels play an important role in the regulation of cerebral vascular tone. In vitro studies using synthetic K(ATP) channel openers suggest that the pharmacological profiles differ between rat basilar arteries and rat middle cerebral arteries. To address this issue....... Densitometric measurements of the Western blot signals further showed higher expression levels of Kir6.1 and SUR2B proteins in rat middle cerebral arteries than was found in rat basilar arteries. In conclusion, our in vitro pharmacological studies showed no evidence for functional endothelial K(ATP) channels...

  12. Is it necessary to stent renal artery stenosis patients before cardiopulmonary bypass procedures?

    Institute of Scientific and Technical Information of China (English)

    ZHENG Bin; YAN Hong-bing; LIU Rui-fang; CHENG Shu-juan; WANG Jian; ZHAO Han-jun; SONG Li

    2011-01-01

    Background Acute kidney injury (AKI) is associated with poor prognosis after cardiopulmonary bypass. The aim of this retrospective study was to investigate whether stent implantation before cardiopulmonary bypass has beneficial effect on development of AKI in renal artery stenosis (RAS) patients.Methods In this retrospective study, patients with abnormal baseline serum creatinine (SCr, >106 μmol/L) were not included. Included patients (n=69) were divided into two groups. Group 1 included 31 RAS patients receiving no stent implantation before cardiopulmonary bypass. Group 2 included 38 RAS patients having received stent implantation just before cardiopulmonary bypass. To assess AKI after cardiopulmonary bypass, serum urea nitrogen, SCr and creatinine clearance were recorded at baseline, at the end of operation, during the first and second postoperative 24 hours.Results Baseline characteristics were similar between groups. Serum urea nitrogen, SCr, creatinine clearance before and after cardiopulmonary bypass were also similar class groups. Incidence of AKI in group 1 was not significantly different from group 2. In group 1, AKI defined by RIFLE between occurred in 7 (22.6%) patients: 5 (16.1%) with RIFLE-R,2 (6.5%) with RIFLE-I, and no patients with RIFLE-F. In group 2, 10 patients (26.3%) had an episode of AKI during hospitalization: 6 (15.8%) had RIFLE-R, 4 (10.5%) had RIFLE-I, and no patients had RIFLE-F.Conclusions There are no data suggesting that it is necessary to stent RAS patients with normal SCr before cardiopulmonary bypass. However, it cannot be concluded that RAS is not associated with AKI after cardiopulmonary bypass.

  13. A high prevalence of carotid artery stenosis in male patients older than 65 years, irrespective of presenting clinical manifestation of atherosclerotic diseases

    NARCIS (Netherlands)

    Kazemi-Bajestani, S.M.; Vlugt, M.J. van der; Leeuw, F.E. de; Blankensteijn, J.D.; Bredie, S.J.H.

    2013-01-01

    This study investigated the prevalence of carotid artery stenosis (CS) and the association with various risk factors in male patients (>65 years) diagnosed with cardiovascular diseases. Duplex sonography of the carotid arteries was performed in 434 of 473 eligible patients of whom 118 (27.8%) pat

  14. Bilateral brachial pull-through technique for stenting in a patient with stenosis of the vertebral artery origin: technical case report

    Energy Technology Data Exchange (ETDEWEB)

    Kusaka, N.; Nishiguchi, M.; Takayama, K.; Nishiura, T. [National Hospital Organization Iwakuni Clinical Center, Department of Neurosurgery, Iwakuni, Yamaguchi (Japan); Tamiya, T. [Kagawa University of Medicine, Department of Neurological Surgery, Kida-gun, Kagawa (Japan)

    2007-10-15

    Stenting for stenosis of the proximal vertebral artery (VA) is commonly performed via a femoral approach. However, iliofemoral occlusive disease such as arteriosclerosis obliterans sometimes prevents safe transfemoral access. In certain situations where both femoral access and ipsilateral brachial access are difficult because of a concomitant vascular diseases or particular anatomic setting, a contralateral brachial approach using the brachiobrachial pull-through technique may allow efficient and accurate stenting. A case of VA origin symptomatic stenosis successfully treated with stenting using the new pull-through technique from the contralateral brachial artery to the brachial artery on the affected side is described. (orig.)

  15. 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.

  16. [Surgical prevention of stroke in patients with carotid stenosis].

    Science.gov (United States)

    Pyshkina, L I; Khatagova, D T; Kabanov, A A; Darvish, N A; Alibekova, Zh M

    2014-01-01

    Objectives. To study the cerebral and central hemodynamics in patients with stenotic lesions of inner carotid arteries (ICA) before and after reconstructive surgery. Material and methods. Fifty-nine patients, aged from 46 to 78 years, with >50% atherosclerotic stenosis of ICA who underwent preventive carotid endarterectomy (CEAE) were examined. The isolate stenosis of ICA was identified in 13.6% of patients, concomitant lesions of brachiocephalic arteries in 86.4%. Atherosclerotic lesions of coronary arteries were found in 91.1% of patients and those of arteries of lower extremities in 45.8%. In 25.5% of patients, the heart surgery was performed before the current hospitalization. Heterogeneous atherosclerotic plaques with dense or hyperdense components were more frequents in symptomatic stenosis (63.3%). The maximal stenosis was identified in heterogeneous hyperechogenic plaques, the minimal ones in homogenous hypoechogenic plaques. Parameters of central hemodynamics were better in patients with 2nd stage of reconstructive surgeries. The emission fraction decreased proportionally to the degree of stenosis. The parameters of cerebral hemodynamics were significantly decreased in ICA stenosis and improved in the early post-surgery period. Results. CEAE promoted the improvement of cognitive functions and the recovery of motor functions. The best positive dynamics was recorded in asymptomatic ICA stenosis. Poor outcome (transitory ischemic attacks, urgent surgery, restenosis) was found in patients with low levels of central and cerebral hemodynamics 12-24 months after the discharge. Moreover, smoking and the degree of stenosis predicted poor outcome. Conclusions. Surgical treatment in combination with the complex pharmacotherapy (hypotensive drugs, antiaggregants and statins) had the maximal effect, including the remote period.

  17. Analysis of Renal Artery Stenosis in Patients with Heart Failure: A RASHEF Study

    Institute of Scientific and Technical Information of China (English)

    Bin Zheng; Qin Ma; Li-Hong Zheng; Qiang Yong; Yi-Hua He; Jing-Hua Liu

    2015-01-01

    Background:Previous data are controversial about the association of renal artery stenosis (RAS) with clinical outcome in patients with heart failure.Definition of RAS in previous studies might not be appropriate.By definition of RAS with renal duplex sonography,we investigated the association of RAS with clinical outcome in patients with heart failure.Methods:In this retrospective study,we identified 164 patients with heart failure (New York Heart Association classification ≥Ⅱ;left ventricular ejection fraction <50%) who had received renal duplex sonography during hospital stay.RAS was defined as renal-aortic ratio ≥3.5 or a peak systolic velocity ≥200 cm/s (or both),or occlusion of the renal artery.Categorical data of patients were compared using the Chi-square test or Fisher's exact test.Cox proportional hazards regression modeling technique was used to investigate the prognostic significance of possible predictors.Results:Finally,143 patients were enrolled.Median follow-up time was 32 months (1-53 months).Twenty-two patients were diagnosed as RAS by renal duplex sonography,including 13 unilateral RAS (3 left RAS,10 right RAS) and 9 bilateral RAS.There were more all-cause mortality and cardiovascular death in patients with RAS than patients without RAS.By multivariate analysis,RAS was a significant predictor for all-cause death and cardiovascular death (hazard ratio [HR] =4.155,95% confidence interval [CI]:1.546-11.164,P =0.005;and HR =3.483,95% CI:1.200-10.104,P =0.022,respectively).As for composite endpoint events,including death,nonfatal myocardial infarction,ischemic stroke or intracranial hemorrhage,rehospitalization for cardiac failure,and renal replacement therapy,only angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was significant predictor.RAS was not a significant predictor for composite endpoint events.Conclusions:Our data suggested that RAS is associated with a poorer clinical outcome in patients with heart

  18. Assessment of renal artery stenosis using both resting pressures ratio and fractional flow reserve: relationship to angiography and ultrasonography.

    Science.gov (United States)

    Kadziela, Jacek; Witkowski, Adam; Januszewicz, Andrzej; Cedro, Krzysztof; Michałowska, Ilona; Januszewicz, Magdalena; Kabat, Marek; Prejbisz, Aleksander; Kalińczuk, Lukasz; Zieleń, Piotr; Michel-Rowicka, Katarzyna; Warchoł, Ewa; Rużyłło, Witold

    2011-08-01

    BACKGROUND. Clinical benefit from renal artery revascularization remains controversial, probably because of inaccurate stenosis severity assessment. Objective. The aim of the study was to evaluate resting translesional pressures ratio and renal fractional flow reserve (rFFR) in relation to angiography and Doppler duplex ultrasonography in patients with at least moderate renal artery stenosis (RAS). METHODS. 44 hypertensive patients (48% of males, mean age 65 years) with at least moderate RAS were investigated. Translesional systolic pressure gradient (TSPG), resting Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were evaluated. Quantitative angiographic analysis of stenosis severity was performed including minimal lumen diameter (MLD) and percent diameter stenosis (DS) assessment. Renal/aortic ratio (RAR), resistive index (RI) and deltaRI (side-to side difference) were obtained in Doppler-duplex ultrasonography. The predictive value of selected variables was calculated using receiver-operating characteristics curves. RESULTS. Mean Pd/Pa ratio was 0.86 ± 0.12 and decreased to 0.79 ± 0.13 after papaverine administration. Both Pd/Pa ratio and rFFR strongly correlated with TSPG (r = -0.92, p ratio and 0.80 for rFFR. CONCLUSIONS. Mean Pd/Pa ratio and rFFR strongly correlated with angiographic data and in less pronounced manner with ultrasound parameters reflecting intrarenal blood flow. The best accuracy cut-off points for severe RAS predicting were 0.93 and 0.80, respectively.

  19. Non-modifiable Factors of Coronary Artery Stenosis in Late Onset Patients with Coronary Artery Disease in Southern Iranian Population

    Directory of Open Access Journals (Sweden)

    Seyeed Mohammad Bager Tabei

    2014-03-01

    Conclusion: These researches show that ageing increases the risk of coronary heart stenosis; also, females are more than men protected against this disease. The impact of family history of myocardial infarction and consanguineous marriage were not associated with of CAD.

  20. Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: Angioplasty versus stent placement

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hong Suk, E-mail: hongsukpark@gmail.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Do, Young Soo, E-mail: ysdo@skku.edu [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Park, Kwang Bo, E-mail: kbjh.park@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Kim, Duk-Kyung, E-mail: dukkyung.kim@samsung.com [Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Choo, Sung Wook, E-mail: sw.choo@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Shin, Sung Wook, E-mail: sw88.shin@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Cho, Sung Ki, E-mail: sungkismc@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Hyun, Dongho, E-mail: mesentery.hyun@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of); Choo, In Wook, E-mail: inwook.choo@samsung.com [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, 135-710 Seoul (Korea, Republic of)

    2013-11-01

    Purpose: To retrospectively evaluate and compare the long term patency and antihypertensive effect of angioplasty and stent insertion in renal artery stenosis caused by Takayasu arteritis, with CT angiography and clinical follow-up. Materials and methods: We retrospectively analyzed and compared effects on hypertension and patency of renal artery in 16 patients (age ranging from 16 to 58 years, mean: 32.1 years) with renovascular hypertension caused by Takayasu arteritis who underwent endovascular treatment including angioplasty (n = 13) and stent placement (n = 9) for 22 stenotic renal arteries. Results: Technical success was 95% (21/22) without major complications. In the last follow-up CT angiogram (mean 85 ± 41 months), restenosis was 8% (1/12) in angioplasty and 66% (6/9) in stent. Patency rates of angioplasty were 100%, 91.7%, 91.7% and primary unassisted and primary assisted patency rates of stent placement were 55.6%, 33.3%, 33.3% and 88.9%, 66.7%, 55.6% at 1-, 3- and 5-years, respectively. In clinical follow-up (mean 120 ± 37.8 months, range 48–183 months), beneficial effects on hypertension were obtained in 87% of patients (13/15) and there was no significant difference between the patients who were treated by only angioplasty and the patients who received stent placement in at least one renal artery, regardless of whether or not angioplasty had been performed in the other renal artery. Conclusion: Compared with stent placement, angioplasty demonstrated better long term patency and similar clinical benefit on renovascular hypertension in renal artery stenosis of Takayasu arteritis. We suggest that stent placement should be reserved for obvious angioplasty failure.

  1. The phosphodiesterase 3 inhibitor cilostazol dilates large cerebral arteries in humans without affecting regional cerebral blood flow

    DEFF Research Database (Denmark)

    Birk, Steffen; Kruuse, Christina Rostrup; Petersen, Kenneth A;

    2004-01-01

    in the middle cerebral arteries (VMCA) was measured with transcranial Doppler, and the superficial temporal and radial arteries diameters were measured with ultrasonography. During the 4-hour observation period, there was no effect on systolic blood pressure (P = 0.28), but diastolic blood pressure decreased...

  2. Quantitative relationship between coronary vasodilator reserve assessed by {sup 82}Rb PET imaging and coronary artery stenosis severity

    Energy Technology Data Exchange (ETDEWEB)

    Anagnostopoulos, Constantinos [Brigham and Women' s Hospital, Division of Nuclear Medicine/PET, Boston, MA (United States); Royal Brompton Hospital, Department of Nuclear Medicine, London (United Kingdom); Brigham and Women' s Hospital, Harvard Medical School, London (United Kingdom); Almonacid, Alexandra; Popma, Jeffrey J. [Brigham and Women' s Hospital, Division of Cardiovascular Medicine, Department of Medicine, Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, London (United Kingdom); El Fakhri, Georges [Brigham and Women' s Hospital, Division of Nuclear Medicine/PET, Boston, MA (United States); Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Curillova, Zelmira; Dorbala, Sharmila; Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine/PET, Boston, MA (United States); Brigham and Women' s Hospital, Cardiovascular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Division of Cardiovascular Medicine, Department of Medicine, Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, London (United Kingdom); Sitek, Arkadiusz [Brigham and Women' s Hospital, Division of Nuclear Medicine/PET, Boston, MA (United States); Brigham and Women' s Hospital, Harvard Medical School, London (United Kingdom); Roughton, Michael [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom)

    2008-09-15

    The relationship between myocardial blood flow (MBF) and stenosis severity has been determined previously using cyclotron-produced radiotracers such as {sup 15}O-H{sub 2}O and {sup 13}N-ammonia. An attractive alternative to overcome the limitations related to the use of cyclotron might be to use the generator-produced {sup 82}Rb as a flow tracer. The current study was undertaken to investigate the relationship between MBF and coronary vasodilator reserve (CVR) as measured by {sup 82}Rb positron emission tomography (PET) and the percent diameter stenosis as defined by quantitative coronary arteriography. We prospectively evaluated 22 individuals: 15 patients (60 {+-} 11 years of age) with angiographically documented coronary artery disease (CAD) and seven age-matched (56 {+-} 9 years) asymptomatic individuals without risk factors for CAD. Dynamic {sup 82}Rb PET was performed at rest and after dipyridamole vasodilation. MBF, CVR and an index of 'minimal coronary resistance' (MCR) were assessed in each of the three main coronary territories. Rest and stress MBF in regions subtended by vessels with less than 50% diameter stenosis was similar to that of the individuals with no risk factors for CAD. As a result, CVR was also similar in the two groups (1.9, interquartile [IQ] range from 1.7 to 2.7 vs. 2.2, IQ range from 2 to 3.4 respectively, p=0.09). CVR successfully differentiated coronary lesions with stenosis severity 70% to 89% from those with 50% to 69% stenosis (1, IQ range from 1 to 1.3 vs. 1.7, IQ range from 1.4 to 2), respectively, p=0.001. In addition, hyperaemic MBF (r{sup 2}=0.74, p<0.001), CVR (r {sup 2}=0.69, p<0.001) and MCR (r{sup 2}=0.78, p<0.001) measurements were inversely and non-linearly correlated to the percent diameter stenosis on angiography. MBF and CVR are inversely and non-linearly correlated to stenosis severity. Quantitative {sup 82}Rb PET can be a clinically useful tool for an accurate functional assessment of CAD. (orig.)

  3. Estimation of coronary artery stenosis by low-dose adenosine stress real-time myocardial contrast echocardiography: a quantitative study

    Institute of Scientific and Technical Information of China (English)

    ZHOU Xiao; ZHI Guang; XU Yong; WANG Jing; YAN Guo-hui

    2012-01-01

    Background Coronary microcirculation reserve is an important field in the research of coronary artery disease,but it is difficult to identify clinically.Currently it is widely accepted that myocardial contrast echocardiography (MCE) is a safe,inexpensive method and has comparatively high image resolution.The present study used quantitative low-dose adenosine stress real-time (RT)-MCE to estimate myocardial perfusion and the coronary stenosis.Methods Forty-nine left ventricular (LV) segments from 14 unselected patients were divided into three groups according to the coronary angiography or CT angiography results:group 1 (n=20,41%) without significant stenosis (<70%),group 2 (n=12,24%)with successful percutaneous coronary intervention (PCI),and group 3 (n=17,35%)with significant stenosis (>70%).RT-MCE was performed in these patients with low-dose adenosine stress and continuous infusion of Sonovue.The replenishing curves were drawn according to the contrast density measured at the end-diastolic frame of every cardiac circle by ACQ software.Results Forty-nine LV segments with satisfactory image quality were picked for quantitative contrast echo analysis.The replenishing curves were analyzed at baseline and after stress.Perfusion of group 3 did not decrease significantly at baseline,and showed no improvement during adenosine stress and was significantly different from groups 1 and 2 (P <0.05).The A·β and β increased more significantly in group 1 than in groups 2 and 3 (P <0.05).In a receiver operating characteristic (ROC) curve analysis,A·β under adenosine stress <1.74 dB/s had a sensitivity and specificity of 71% for diagnosis of coronary artery stenosis,reduced adenosine-induced rise (percentage of A·β <81%) had a sensitivity and specificity of 83% and 79% for the diagnosis of low-reserve,and β <54% had a sensitivity of 86% and specificity of 79%.Conclusions Rest perfusion of severely stenosed arteries may be normal

  4. Cerebral Arterial Time Constant Recorded from the MCA and PICA in Normal Subjects.

    Science.gov (United States)

    Kasprowicz, Magdalena; Czosnyka, Marek; Poplawska, Karolina; Reinhard, Matthias

    2016-01-01

    Cerebral arterial time constant (τ) estimates how quickly the cerebral arterial bed distal to the point of insonation is filled with arterial blood following a cardiac contraction. It is not known how τ behaves in different vascular territories in the brain. We therefore investigated the differences in τ of two cerebral arteries: the posterior inferior cerebellar artery (PICA) and the middle cerebral artery (MCA).Transcranial Doppler cerebral blood flow velocity (CBFV) in the PICA and left MCA along with Finapres arterial blood pressure (ABP) were simultaneously recorded in 35 young healthy volunteers. τ was estimated using mathematical transformations of pulse waveforms of ABP and the CBFV of the MCA and the PICA. Since τ is independent from the vessel radius, its comparison in different cerebral arteries was feasible. Mean ABP was 76.1 ± 9.6 mmHg. The CBFV of the MCA was higher than that of the PICA (59.7 ± 7.7 vs. 41.0 ± 4.5 cm/s; p time is needed to fill it with arterial blood volume. This study thus confirms the physiological validity of the τ concept.

  5. Arterial spin labeling in patients with chic cerebral artery steno-occlusive disease - Correlation with {sup 15}O-PET

    Energy Technology Data Exchange (ETDEWEB)

    Kamano, Hironori; Yoshiura, Takashi; Hiwatashi, Akio; Abe, Koichiro; Yamashita, Koji; Honda, Hiroshi [Dept. of Clinical Radiology, Graduate School of Medical Sciences, Kyushu Univ., Fukuoka (Japan)], e-mail: tsu@radiol.med.kyushu-u.ac.jp; Togao, Osamu [Dept. of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu Univ., Fukuoka (Japan)

    2013-02-15

    Background: Heterogeneity of arterial transit time due to cerebral artery steno-occlusive lesions hampers accurate regional cerebral blood flow measurement by arterial spin labeling (ASL). Purpose: To assess the feasibility of regional cerebral blood flow measurement by ASL with multiple-delay time sampling in patients with steno-occlusive diseases by comparing with positron emission tomography (PET), and to determine whether regional arterial transit time measured by this ASL technique is correlated with regional mean transit time, a PET index of perfusion pressure. Material and Methods: Sixteen patients with steno-occlusive diseases received both ASL and {sup 15}O-PET. The mean regional cerebral blood flow measured by ASL and PET, regional arterial transit time by ASL, and regional mean transit time by PET were obtained by a region-of-interest analysis. Correlation between regional cerebral blood flow by ASL and that by PET, and correlation between regional arterial transit time by ASL and regional mean transit time by PET were tested using Pearson's correlation coefficient for both absolute and relative values. A multivariate regression analysis was performed to test whether regional arterial transit time by ASL was a significant contributor in modeling regional mean transit time by PET after controlling the effect of regional cerebral blood flow by ASL. Results: A significant positive correlation was found between regional cerebral blood flow by ASL and that by PET for both absolute (r = 0.520, P < 0.0001) and relative (r = 0.691, P < 0.0001) values. A significant positive correlation was found between regional arterial transit time by ASL and regional mean transit time by PET both for absolute (r = 0.369, P = 0.0002) and relative (r = 0.443, P < 0.0001) values. The regression analysis revealed that regional arterial transit time by ASL was a significant contributor in modeling regional mean transit time by PET after controlling regional cerebral blood flow by

  6. Flow Characterization of Severe Carotid Artery Stenosis in Pre- and Post-operative Phantoms by Using Magnetic Resonance Velocimetry

    Science.gov (United States)

    Ko, Seungbin; Song, Simon; Kim, Doosang

    2016-11-01

    It is remained unknown that the flow characteristics changes between pre- and post-operative severe carotid artery stenosis could affect the long-term patency or failure. However, in-vivo clinical experiments to uncover the flow details are far from bed-side due to limited measurement resolutions, blurring artifact, etc. We studied detailed flow characteristics of more than 75% severe carotid artery stenosis before and after surgical treatments. Real-size flow phantoms for 10 patients, who underwent carotid endarterectomy with patch/no patch closure, were prepared by using a 3D rapid-prototype machine from CT scanned images. The working fluid is a glycerin aqueous solution, and patient-specific pulsatile flows were applied to the phantoms, based on ultrasonic flow rate measurements. The flows were visualized with magnetic resonance velocimetry (MRV). The detailed flow characteristics are presented for both pre- and post-operative carotid arteries along with visualization data of 3 dimensional, 3 component velocity fields. This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIP) (No. 2016R1A2B3009541).

  7. Subarachnoid hemorrhage enhances endothelin receptor expression and function in rat cerebral arteries

    DEFF Research Database (Denmark)

    Hansen-Schwartz, Jacob; Hoel, Natalie Løvland; Zhou, Mingfang;

    2003-01-01

    into the prechiasmatic cistern. After 2 days, the middle cerebral artery, basilar artery, and posterior communicating artery were harvested. Pharmacological studies were performed in vitro, and levels of messenger ribonucleic acid (mRNA) were quantified in real-time reverse transcriptase-polymerase chain reaction assays...

  8. Circulating Malondialdehyde-Modified LDL-Related Variables and Coronary Artery Stenosis in Asymptomatic Patients with Type 2 Diabetes

    OpenAIRE

    Kazuya Fujihara; Hiroaki Suzuki; Akira Sato; Satoru Kodama; Yoriko Heianza; Kazumi Saito; Hitoshi Iwasaki; Kazuto Kobayashi; Shigeru Yatoh; Akimitsu Takahashi; Naoya Yahagi; Hiroaki Yagyu; Hirohito Sone; Hitoshi Shimano

    2015-01-01

    Aims. To elucidate the levels of malondialdehyde-modified LDL (MDA-LDL)-related variables for predicting coronary artery stenosis (CAS) by coronary CT angiography (CCTA) in asymptomatic patients with type 2 diabetes (T2DM). Methods. Enrolled were 36 Japanese patients with T2DM who underwent CCTA and in whom MDA-LDL levels were measured. Definition of CAS was luminal narrowing of ≥50%. Trends through tertiles of each MDA-LDL-related variable were analyzed with a general linear model. The abili...

  9. Kidney transplant artery stenosis. Interrelationship between blood pressure, kidney function, renin-aldosterone system and body sodium content.

    Science.gov (United States)

    Kornerup, H J; Pedersen, E B; Fjeldborg, O

    1977-01-01

    Among 9 hypertensive recipients with kidney transplant artery stenosis (KTAS) evidence of increased activity of the renin system was present in 3. Surgical repair of KTAS in 4 recipients resulted in an increase in renal plasma flow and glomerular filtration rate associated with a decrease in exchangeable sodium and blood pressure. Peripheral plasma renin and aldosterone values were normal before and after operation in all. It is suggested that sodium retention may counterbalance increased activity of the renin system in KTAS. Preoperative determinations of plasma renin do not predict the effect of surgical repair of KTAS on hypertension.

  10. The influence of artery wall curvature on the anatomical assessment of stenosis severity derived from fractional flow reserve: a computational fluid dynamics study.

    Science.gov (United States)

    Govindaraju, Kalimuthu; Viswanathan, Girish N; Badruddin, Irfan Anjum; Kamangar, Sarfaraz; Salman Ahmed, N J; Al-Rashed, Abdullah A A A

    2016-11-01

    This study aims to investigate the influence of artery wall curvature on the anatomical assessment of stenosis severity and to identify a region of misinterpretation in the assessment of per cent area stenosis (AS) for functionally significant stenosis using fractional flow reserve (FFR) as standard. Five artery models of different per cent AS severity (70, 75, 80, 85 and 90%) were considered. For each per cent AS severity, the angle of curvature of the arterial wall varied from straight to an increasingly curved model (0°, 30°, 60°, 90° and 120°). Computational fluid dynamics was performed under transient physiologic hyperemic flow conditions to investigate the influence of artery wall curvature on the pressure drop and the FFR. The findings in this study may be useful in in vitro anatomical assessment of functionally significant stenosis. The FFR decreased with increasing stenosis severity for a given curvature of the artery wall. Moreover, a significant decrease in FFR was found between straight and curved models discussed for a given severity condition. These findings indicate that the curvature effect was included in the FFR assessment in contrast to minimum lumen area (MLA) or per cent AS assessment. The MLA or per cent AS assessment may lead to underestimation of stenosis severity. From this numerical study, an uncertainty region could be evaluated using the clinical FFR cutoff value of 0.8. This value was observed at 81.98 and 79.10% AS for arteries with curvature angles of 0° and 120° respectively. In conclusion, the curvature of the artery should not be neglected in in vitro anatomical assessment.

  11. Glomerular filtration rate measured by {sup 51}Cr-EDTA clearance: evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Chaves, Anna Alice Rolim; Buchpiguel, Carlos Alberto; Praxedes, Jose Nery; Bortolotto, Luiz Aparecido; Sapienza, Marcelo Tatit, E-mail: annaalice100@yahoo.com.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Dept. de Neurologia

    2010-07-01

    Introduction: renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid ({sup 51}Cr-EDTA) could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using {sup 51}Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis. Methods: this prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21) and without renal artery stenosis, (n=20). In vitro glomerular filtration rate analysis ({sup 51}Cr-EDTA) and {sup 99m}Tc-DMSA scintigraphy were performed before and after captopril administration in all patients. Results: the mean baseline glomerular filtration rate was 48.6+-21.8 ml/kg/1.73 m{sup 2} in the group with renal artery stenosis, which was significantly lower than the GFR of 65.1+-28.7 ml/kg/1.73m{sup 2} in the group without renal artery stenosis (p=0.04). Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6+-14.8 ml/kg/1.73m{sup 2}, p=0.001) and an insignificant change in the group without RAS (to 62.2+-23.6 ml/kg/1.73m{sup 2}, p=0.68). Scintigraphy with technetium-99m dimercapto

  12. Glomerular filtration rate measured by 51Cr-EDTA clearance: evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Anna Alice Rolim Chaves

    2010-01-01

    Full Text Available INTRODUCTION: Renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid (51Cr-EDTA could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using 51Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis. METHODS: This prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21 and without renal artery stenosis, (n=20. In vitro glomerular filtration rate analysis (51Cr-EDTA and 99mTc-DMSA scintigraphy were performed before and after captopril administration in all patients. RESULTS: The mean baseline glomerular filtration rate was 48.6±21.8 ml/kg/1.73 m² in the group wuth renal artery stenosis, which was significantly lower than the GFR of 65.1±28.7 ml/kg/1.73m² in the group without renal artery stenosis (p=0.04. Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6±14.8 ml/kg/1.73m², p=0.001 and an insignificant change in the group without RAS (to 62.2±23.6 ml/kg/1.73m², p=0.68. Scintigraphy with technetium-99m dimercapto-succinic acid (DMSA did not show

  13. Study of Doppler indices of umbilical artery and middle cerebral artery in pregnancies at and beyond forty weeks of gestation

    Directory of Open Access Journals (Sweden)

    Subhra Ghosh

    2016-12-01

    Conclusions: Vascular resistance in the umbilical artery and middle cerebral artery does not change abruptly when gestation exceeds 280 days. It also cannot be taken as the sole method of fetal surveillance when date is crossed. [Int J Reprod Contracept Obstet Gynecol 2016; 5(12.000: 4174-4179

  14. Convexity subarachnoid haemorrhage secondary to internal carotid stenosis: an indication for revascularisation.

    Science.gov (United States)

    Larrosa, Davinia; Ramon, Cesar; Benavente, Lorena; Calleja, Sergio

    2016-04-26

    With increasing prevalence due to an ageing population, carotid artery stenosis is a significant cause of stroke morbidity and mortality. The indication for revascularisation treatment in symptomatic carotid stenosis is widely documented and accepted in the scientific community. However, treatment of asymptomatic carotid stenosis remains controversial. We report a case of a 78-year-old woman who was admitted with a convexity subarachnoid haemorrhage (cSAH) secondary to an asymptomatic high-grade carotid artery stenosis. Two months later, she suffered an atherothrombotic ischaemic stroke and was referred to surgery. Transcranial Doppler studies showed impaired cerebral vasoreactivity and, after endarterectomy, the patient developed a reperfusion syndrome; both findings consisting of exhausted collaterals as the underlying mechanism. We propose that cSAH secondary to a high-grade internal carotid artery stenosis is a high risk marker for stroke, and revascularisation therapy should be considered.

  15. MRI evaluation of leptomeningeal anastomosis in middle cerebral artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Katsumata, Yasushi [Yokohama City Univ. (Japan). School of Medicine

    2001-05-01

    In steno-occlusive disease of the middle cerebral artery (MCA), there may be some discrepancy between the MRA and MRI findings, because the collateral flow via leptomeningeal anastomosis (LMA) from the anterior cerebral artery (ACA) to the MCA cannot be demonstrated in MRA. There is no simple method to evaluate the LMA non-invasively. We hypothesized that LMA could be identified as signal loss by flow void, so that the more LMA develops, the more the signal loss increases. We studied 18 patients with occlusive or markedly stenotic disease of the MCA, diagnosed by MRA. Although no collateral flow was demonstrated in MRA, several low signal spots suggesting flow void were noted in various degrees on the surface of the middle frontal gyrus, the border zone between the ACA and the MCA. These low signal spots were suspected to be LMA, and this was confirmed by angiography in 3 cases. Compared with the contralateral hemisphere, the spots were graded as ''-1'' (fewer), ''0'' (equal), ''+1'' (more), ''+2'' (markedly more). The number of Grades -1, 0, +1 and +2 was 0, 6, 5 and 7, respectively. MRI revealed infarct in the perforator territory in 16/18 cases. Cortical infarct was seen in 5/6 cases of Grade 0, 1/5 cases of Grade +1, and 0/7 cases of Grade +2. In Grade +1 and +2 cases, the cortex was spared by collateral flow via LMA, presumably. This result suggests that the flow void in the vicinity of the middle frontal gyrus may predict the development of LMA and the size of the infarct. (author)

  16. Symptomatic isolated middle cerebral artery dissection: High resolution MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Byon, Jung Hee; Kwak, Hyo Sung; Chung, Gyung Ho; Hwang, Seung Bae [Dept. of Radiology, Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2015-11-15

    To perform high-resolution magnetic resonance imaging (HRMRI) and determine clinical features of patients with acute symptomatic middle cerebral artery (MCA) dissection. Thirteen patients with acute symptomatic MCA dissection underwent HRMRI within 3 days after initial clinical onset. They also underwent routine brain MR imaging. HRMRI examinations included time-of-flight MR angiography (MRA), T2-weighted, T1-weighted, proton-density-weighted, and three-dimensional magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequences. Conventional angiography and MRA were used as reference standard to establish the diagnosis of MCA dissection. The angiographic findings and HRMRI findings such as intimal flap, double lumen, and intramural hematoma were analyzed in this study. All patients presented cerebral ischemia (median National Institutes of Health Stroke Scale score = 4, range = 0-18). String sign was seen on MRA in seven patients. However, double lumen was seen in all patients on HRMRI by intimal flap. High signal lesion on MPRAGE sequences around the dissection lumen due to intramural hematoma was seen in three patients. HRMRI can be used to easily detect the wall structure of MCA such as the intimal flap and double lumen in patients with acute symptomatic MCA dissection. MPRAGE can detect hemorrhage in false lumen of MCA dissection.

  17. Endothelial Repair in Childhood Arterial Ischaemic Stroke with Cerebral Arteriopathy

    Directory of Open Access Journals (Sweden)

    Despina Eleftheriou

    2015-06-01

    Full Text Available Background: We have previously shown that recurrent arterial ischaemic stroke (AIS in children with cerebral arteriopathy is associated with increased circulating endothelial cells and endothelial microparticles, consistent with ongoing endothelial injury. To date, however, little is known about endothelial repair responses in childhood AIS. We examined the relationship between the number and function of circulating endothelial progenitor cells (EPC, the levels of brain-derived neurotrophic factor (BDNF and AIS recurrence. Methods: Flow cytometry was used to identify peripheral blood mononuclear cells positive for CD34/kinase insert domain-containing receptor (KDR. In a subgroup of patients (5 in each group selected at random, monocytic EPC function was assessed by colony-forming unit (EPC-CFU capacity and incorporation into endothelial cell networks in Matrigel. BDNF was measured using ELISA. Results: Thirty-five children, aged 12 years (range: 5-16.5; 9 males, with AIS and cerebral arteriopathy were studied; 10 had recurrent AIS. CD34+/KDR+ cells were significantly higher in recurrent AIS compared to non-recurrent AIS patients (p = 0.005 and controls (p = 0.0002. EPC-CFU and EPC incorporation into endothelial cell networks were significantly reduced in recurrent compared to non-recurrent AIS patients (p = 0.04 and p = 0.01, respectively. Levels of BDNF were significantly higher in recurrent compared to non-recurrent AIS patients (p = 0.0008 and controls (p = 0.0002. Conclusions: Children with recurrent AIS and cerebral arteriopathy had increased circulating CD34+/KDR+ cells and BDNF consistent with an endothelial repair response. However, EPC function was impaired. Future studies are needed to examine whether suboptimal endothelial repair contributes to childhood AIS recurrence.

  18. Angiography for renal artery stenosis: no additional impairment of renal function by angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Lufft, Volkmar; Fels, Lueder M.; Egbeyong-Baiyee, Daniel; Olbricht, Christoph J. [Abteilung Nephrologie, Medizinische Hochschule Hannover (Germany); Hoogestraat-Lufft, Linda; Galanski, Michael [Abteilung Diagnostische Radiologie, Medizinische Hochschule Hannover (Germany)

    2002-04-01

    The aim of this study was to compare renal function between patients with renal angiography and patients with renal angiography and angioplasty (AP) for renal artery stenosis (RAS). Forty-seven patients with suspected RAS were prospectively investigated by digital subtraction angiography (DSA) using non-ionic low osmolar contrast media (CM). In 22 patients RAS was detected and in 16 cases an angioplasty was performed in the same session. The following parameters were determined 1 day prior to and after the DSA, respectively: serum creatinine (S-Crea, {mu}mol/l) and single-shot inulin clearance (In-Cl, ml/min) for the evaluation of renal function; and urine alpha 1-microglobuline (AMG, {mu}g/g Crea) and beta-N-acetyl-glucoseaminidase (beta-NAG, U/g Crea) as markers of tubular toxicity. Serum creatinine was measured additionally 2 days after CM had been injected. In both groups with and without AP 174{+-}65 and 104{+-}56 ml of CM (p<0.0005) were used, respectively. There were no differences with regard to renal function or risk factors for CM nephrotoxicity between both groups. In the group with AP S-Crea and In-Cl (each: mean{+-}SD) did not change significantly (before DSA: 171{+-}158 and 61{+-}24, after DSA: 189{+-}177 and 61{+-}25, respectively), beta-NAG (median) rose from 4 to 14 (p<0.05) and AMG from 8 to 55 (n.s., because of high SD). In the group without AP S-Crea increased from 134{+-}109 to 141{+-}113 (p<0.01), In-Cl dropped from 65{+-}26 to 62{+-}26 (p<0,01), beta NAG (median) rose from 4 to 8 (p=0.01), and AMG from 7 to 10 (n.s.). A rise in baseline S-Crea by more than 25% or 44 {mu}mol/l occurred in 4 and 2 patients in the group with and without AP, respectively. Creatinine increase was reversible in all cases within 7 days. In this study using sensitive methods to detect changes of renal function and tubular toxicity no additional renal function impairment in DSA with angioplasty for RAS compared with DSA alone could be demonstrated. Our data suggest

  19. Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  20. Does coronary calcium scoring with a SCORE better predict significant coronary artery stenosis than without? Correlation with computed tomography coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Durhan, Gamze; Hazirolan, Tuncay; Karcaaltincaba, Musturay; Akata, Deniz [Hacettepe University Medical School, Department of Radiology, Ankara (Turkey); Sunman, Hamza; Aytemir, Kudret [Hacettepe University Medical School, Department of Cardiology, Ankara (Turkey); Karakaya, Jale; Karaagaoglu, Ergun [Hacettepe University, Department of Biostatistics, Ankara (Turkey)

    2014-12-03

    To determine effectiveness of coronary artery calcium score (CACS) alone and combined with Systematic Coronary Risk Evaluation (SCORE) in adult patients for significant coronary artery stenosis by using computed tomography coronary angiography (CTCA) as reference standard. Two thousand twenty-one patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA. Patients were examined with dual-source CT and were grouped according to their age, gender, CACS, and estimated SCORE risk. Coronary plaque existence and degree of stenosis were assessed with CTCA. Sensitivity, specificity, and ROC curves were analyzed. CACS was the single independent variable in estimating relative risk of critical stenosis and had superior outcome when compared with SCORE risk in logistic regression and ROC curve. Area under the ROC curve was greatest in the interval between 50-59 years. When SCORE was combined with CACS in patients with zero CACS, percentage of significant stenosis increased from 1.4% to 7.0% in patients with high or very high SCORE risk, and decreased to 0.9 % in patients with low or moderate SCORE risk. CACS combination with SCORE risk predicts coronary artery stenosis. When CACS is zero, CTCA can be performed in patients with high or very high SCORE risk. (orig.)

  1. Study of Posterior Cerebral Artery in Human Cadaveric Brain

    Directory of Open Access Journals (Sweden)

    S. A. Gunnal

    2015-01-01

    Full Text Available Objective. Basilar artery (BA terminates in right and left posterior cerebral arteries (PCAs. Each PCA supplies respective occipital lobe of the cerebrum. The present study is designed to know the morphology, morphometry, branching pattern, and symmetry of PCA. Methods. The study included 340 PCAs dissected from 170 human cadaveric brains. Results. Morphological variations of P1 segment included, aplasia (2.35%, hypoplasia (5.29%, duplication (2.35%, fenestration (1.17%, and common trunk shared with SCA (1.76%. Morphological variations of origin of P2 segment included direct origin of it from BA (1.17% and ICA (2.35%. Unusually, two P2 segments, each arising separately from BA and ICA, were observed in 1.17%. Unilateral two P2 segments from CW were found in 0.58%. Morphological variations of course of P2 were duplication (0.58%, fenestration (0.58%, and aneurysm (1.76%. Unilateral P2 either adult or fetal was seen in 4.71%. The group II branching pattern was found to be most common. Asymmetry of P2 was 40%. Morphometry of P2 revealed mean length of 52 mm and mean diameter of 2.7 mm. Conclusion. The present study provides the complete anatomical description of PCA regarding morphology, morphometry, symmetry, and its branching pattern. Awareness of these variations is likely to be useful in cerebrovascular procedures.

  2. Development of chronic heart failure in a young woman with hypertension associated with renal artery stenosis with preserved renal function

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat

    2014-01-01

    A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated-glomerular fil......A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated......-glomerular filtration rate as well as urine test for protein were all normal. The patient had no peripheral oedema. The transthoracic echocardiography confirmed systolic and diastolic dysfunction and an ejection fraction of 25% and left ventricular hypertrophy. Ultrasound of renal arteries and renal CT angiography...... (renal CTA) revealed a significant stenosis and an aneurysm corresponding to the right renal artery with challenges to traditional interventions....

  3. Effects of heat transfer on MHD flow of blood through an inclined porous artery with stenosis having variable viscosity

    CERN Document Server

    Tripathi, Bhavya

    2016-01-01

    In this paper, effects of heat transfer on the blood flow through a stenosed, inclined non-tapered porous artery subject to the action of external magnetic field is investigated. Viscosity is assumed as variable viscosity with variable Hematocrit throughout the region of the artery. Governing equations have been modeled by taking blood as incompressible magnetohydrodynamic (MHD) Newtonian fluid. The energy equation is formulated by taking an extra factor of the heat source in its equation. The nonlinear momentum equations are simplified under the assumption of mild stenosis. Homotopy perturbation method (HPM) is used to solve nonlinear equations of velocity and temperature profiles. Effects of porosity parameter (Z), applied magnetic field parameter (M), variable hematocrit parameter(Hr), Brinkman number (Br), heat source parameter (Q) and the Grashof number (Gr) on velocity and temperature profiles are discussed graphically.

  4. VIP and PACAP display different vasodilatory effects in rabbit coronary and cerebral arteries

    DEFF Research Database (Denmark)

    Dalsgaard, Tórur; Hannibal, Jens; Fahrenkrug, Jan

    2003-01-01

    investigated using myographs, allowing isometric tension recordings. In order to evaluate the influence of steroid hormones, the rabbits were ovariectomized and randomized to treatment for 4 weeks with 17beta-estradiol (E(2)), Norethindrone Acetate (NETA), E(2)+NETA or placebo. Ring segments of the posterior...... cerebral artery, the right proximal coronary artery and the distal left coronary artery were examined. The highest concentrations of VIP/PACAP were observed in cerebral and coronary arteries: 5.0/5.7 and 2.8/3.5 pmol/g, respectively. The peptides were localized in nerve fibres innervating the arteries....... Both peptides produced dose-dependent vasodilatory responses in all vessels investigated. While the effects of PACAP were identical in cerebral and coronary arterial segments, the effects of VIP displayed significant differences (E(max), pI(2), Hill-slope). Treatment with sex steroids induced...

  5. Percutaneous transluminal renal angioplasty with stent is effective for blood pressure control and renal function improvement in atherosclerotic renal artery stenosis patients

    Institute of Scientific and Technical Information of China (English)

    LIAO Chuan-jun; YANG Bao-zhong; WANG Zhong-gao

    2012-01-01

    Background Percutaneous transluminal renal angioplasty with stent is an effective procedure for atherosclerotic renal artery stenosis.However,the decision to perform this procedure has recently raised considerable debate.The aim of this study was to assess the effects of percutaneous transluminal renal angioplasty with stent in atherosclerotic renal artery stenosis patients,especially as it relates to blood pressure control and renal function improvement.Methods A retrospective analysis was made of the clinical data from 125 atherosclerotic renal artery stenosis patients who underwent percutaneous transluminal renal angioplasty from July 2004 to June 2008 in the Department of Vascular Surgery of Beijing Chaoyang Hospital.We compared blood pressure,number of oral antihypertensive medications,and renal function changes pre and post-procedure at 24 months follow-up.Results A total of 125 atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 143 stents were placed.At 24 months follow-up,both systolic and diastolic blood pressure and the number of oral antihypertensive medications were significantly reduced (P <0.05).Overall,the estimated glomerular filtration rate did not change significantly (P >0.05); however,a significant increase in estimated glomerular filtration rate was observed in the subgroup of patients with a lower baseline estimated glomerular filtration rate and in the subgroup of patients with bilateral renal artery stenosis (P <0.05).Conclusion Percutaneous transluminal renal angioplasty is a safe procedure for atherosclerotic renal artery stenosis patients,providing a significant improvement in blood pressure control and reduction in the number of oral antihypertensive medications.

  6. RX Herculink Elite® renal stent system: a review of its use for the treatment of renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Colyer Jr

    2012-08-01

    Full Text Available William R Colyer JrDivision of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USAAbstract: The management of renal artery stenosis (RAS remains controversial. While some evidence suggests that treatment with stent placement is beneficial, randomized trials have failed to demonstrate a significant benefit. Ongoing clinical trials should help to better define the role for stenting of RAS while avoiding limitations seen with earlier trials. When it comes to stenting for RAS, several stents have been used; however, many stents which have been used previously and which are still being used are biliary stents that are used “off-label.” These stents have typically come onto the market through the 510(k pathway. To date, a total of five stents have been approved by the United States Food and Drug Administration for use in the renal arteries. Of the five stents that have received approval, the Bridge™ Extra Support (Medtronic CardioVascular, Santa Rosa, CA and the Palmaz® (Cordis Corporation, Bridgewater, NJ stents are no longer available. Currently, the Express® SD (Boston Scientific, Natick, MA, Formula™ (Cook Medical, Bloomington, IN, and Herculink Elite® (Abbott Vascular, Santa Clara, CA stents are Food and Drug Administration approved and available for use. The Herculink Elite is the most recently approved of the renal stents, having received approval in late 2011. The Herculink Elite stent is the only cobalt chromium stent approved for use in the renal arteries. Although trial data are limited and direct comparisons among renal stents is not possible, the Herculink Elite stent has demonstrated good performance. Additionally, the design of the Herculink Elite offers some advantages that may translate into improved outcomes.Keywords: renal artery stenosis, stenting, FDA approval

  7. Superficial temporal artery to proximal posterior cerebral artery bypass through the anterior temporal approach

    Directory of Open Access Journals (Sweden)

    Satoru Takeuchi

    2015-01-01

    Full Text Available Background: The superficial temporal artery (STA to proximal posterior cerebral artery (PCA (P2 segment bypass is one of the most difficult procedures to perform because the proximal PCA is located deep and high within the ambient cistern. STA to proximal PCA bypass is usually performed through a subtemporal approach or posterior transpetrosal approach, and rarely through a transsylvian approach. The aim of this study was to describe the operative technique of STA to proximal PCA bypass through a modified transsylvian approach (anterior temporal approach. Methods: STA to proximal PCA bypass was performed through an anterior temporal approach in three patients with intracranial aneurysm. We describe the details of the surgical technique. Results: The STA was successfully anastomosed to the proximal PCA in all cases. One patient suffered hemiparesis and aphasia due to infarction in the anterior thalamoperforating artery territory. Conclusions: STA to proximal PCA bypass can be performed through an anterior temporal approach in selected patients. We recommend that every precaution, including complete hemostasis, placement of cellulose sponges beneath the recipient artery to elevate the site of the anastomosis, and placement of a continuous drainage tube at the bottom of the operative field to avoid blood contamination during the anastomosis, should be taken to shorten the temporary occlusion time.

  8. 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).

  9. Noninvasive Detection of Coronary Artery Stenosis Using 16-slice Spiral CT: a Comparison with Selective X-ray Coronary Angiography

    Institute of Scientific and Technical Information of China (English)

    SHI Heshui; HAN Ping; KONG Xiangquan; FENG Gansheng; Martin HK Hoffmann

    2006-01-01

    The role of 16-slice spiral CT was evaluated in the diagnosis of coronary stenosis, with selective X-ray coronary angiography (SCA) serving as the reference standard. Sixty-five patients who were suspected of having coronary heart disease, without percutaneous transluminal coronary angioplasty or coronary bypass-grafting, were investigated using 16-slice CT. Eight patients with pre-scan heart rate of more than 80 beats/min were given β-blockers. After the retrospectively ECG-gated axial imaging reconstruction, volume redering (VR), multi-planar reconstruction (MPR), curved MPR and maximum intensity projection (MIP) were used to reconstruct. Every segment of coronary artery with a diameter ≥1.5 mm was assessed, and the presence on CT with a stenosis exceeding 50% diameter reduction was compared with that on SCA. The reasons which lead to some segments unevaluable were analysed. Compared with SCA, 93% coronary segments and 94 % main branches were evaluable. Residual cardiac motion artifacts, severe calcification and poor opacification made 58%, 28% and 14% of the remaining 60 segments unevaluable respectively. Without routine administration of β-blockers, good coronary imaging quality can be acquired using 16-slice spiral CT. It is a reliable noninvasive method for detection of obstructive coronary artery disease.

  10. Stenosis of the branches of the neopulmonary artery after the arterial switch operation: A cardiac magnetic resonance imaging study

    Directory of Open Access Journals (Sweden)

    Boban Thomas

    2013-01-01

    Conclusions: Cardiac MR can be used as a comprehensive non-invasive imaging technique to diagnose stenosis of the branches of the neopulmonary after the ASO, allowing evaluation of anatomy and function of the neoPA, its branches, and the differential perfusion to each lung, thus facilitating clinical decision making.

  11. Signal transduction in cerebral arteries after subarachnoid hemorrhage-a phosphoproteomic approach

    DEFF Research Database (Denmark)

    Parker, Benjamin; Larsen, Martin Røssel; Povlsen, Gro Klitgaard

    2013-01-01

    After subarachnoid hemorrhage (SAH), pathologic changes in cerebral arteries contribute to delayed cerebral ischemia and poor outcome. We hypothesize such changes are triggered by early intracellular signals, targeting of which may prevent SAH-induced vasculopathy. We performed an unbiased quanti......-induced signaling components downstream and upstream of ERK1/2.Journal of Cerebral Blood Flow & Metabolism advance online publication, 29 May 2013; doi:10.1038/jcbfm.2013.78....... quantitative analysis of early SAH-induced phosphorylations in cerebral arteries and evaluated identified signaling components as targets for prevention of delayed vasculopathy and ischemia. Labeled phosphopeptides from rat cerebral arteries were quantified by high-resolution tandem mass spectrometry. Selected...

  12. Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Kyriakos Neofytou

    2014-01-01

    Full Text Available Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis. Endoscopic control of the bleed was not possible, while the bleeding vessel embolization was able to control the haemorrhage only temporarily. An angiography during the embolization demonstrated the presence of stenosis of the coeliac artery and also hypertrophic inferior pancreaticoduodenal arteries supplying the proper hepatic artery via the gastroduodenal artery (GDA. The patient underwent emergency pancreatoduodenectomy with preservation of the gastroduodenal artery. The patient had an uneventful recovery and did not experience further bleeding. Also the blood flow to the liver was compromised as shown by the normal liver function tests (LFTs postoperatively. To the best of our knowledge, this is the first report of a preservation of the GDA during an emergency pancreatoduodenectomy.

  13. Angioplasty alone versus angioplasty and stenting for subclavian artery stenosis--a systematic review and meta-analysis.

    Science.gov (United States)

    Chatterjee, Saurav; Nerella, Nishant; Chakravarty, Saneka; Shani, Jacob

    2013-01-01

    Subclavian artery stenosis has long been treated with great success with bypass surgery. Percutaneous intervention, often used in combination with stent placement, has come into vogue for the past few years as a safe and effective therapeutic modality. This study aimed to compare angioplasty alone with angioplasty followed by stent placement by combining available data. The objective of this study was to perform a review of the available literature to compare the efficacy of percutaneous transluminal angioplasty (PTA) alone with PTA followed by stent placement for proximal subclavian artery stenosis. Successful recanalization was defined as patency at the end of 1 year, and reocclusions and restenoses were noted as events for the purpose of pooling the data. The authors searched the Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, PubMed, EMBASE, and CINAHL databases for relevant trials/studies comparing PTA and PTA with stenting. Review authors independently assessed the methodological quality of studies (focusing on the adequacy of the randomization process, allocation concealment, blinding, completeness of follow-up, and intention-to-treat analysis) and selected studies for inclusion. All retrospective observational studies were also included in the analysis in the absence of double-blinded randomized trials for increasing sample size. All analyses were done using RevMan 5.0. Odds ratio was calculated using Mantel-Haenszel test with a fixed effect model. All included studies were assessed by all authors for potential sources of bias. Eight studies were included in the analysis having 544 participants. Stenting after PTA was significantly superior to angioplasty alone for treatment of subclavian artery stenosis and maintenance of patency at 1 year, as indicated by absence of events (P = 0.004; 95% confidence interval, odds ratio 2.37 [1.32-4.26]) without significant complication rates for either

  14. [Dynamics of changes in the thickness of the choroid in patients with stenosis of the internal carotid artery].

    Science.gov (United States)

    Ivashina, A I; Ioffe, D I; Zolotarevskiĭ, A V; Mikhaĭlova, G D; Kuntsevich, G I

    1989-01-01

    Thirty-five patients suffering from atherosclerosis with carotid artery stenosis of varying severity have been examined. The thickness of the choroid has been paramacularly measured by the ultrasonic methods. The studies have revealed a significant decrease of the choroid thickness in both eyes of patients with bilateral hemodynamically significant stenoses of the carotid arteries and with bilateral stenoses on the point of occlusion. Of the 12 patients with hemodynamically insignificant stenoses, the choroid thickness has reduced only in 3. Surgical treatment (vascular restoration operations on the carotid arteries) has resulted in recovery of the choroid thickness in all the patients. This has lead the authors to a conclusion that isolated measurements of the choroid thickness in patients with impaired arterial extracranial blood stream cannot serve the diagnostic ophthalmologic test for the detection of patients with carotid insufficiency, but such measurements carried out by ultrasonic techniques, combined with other functional ophthalmologic methods, give valuable information on the time course of changes in the eyeball blood content.

  15. Giant pediatric aneurysm treated with ligation of the middle cerebral artery with the Drake tourniquet and extracranial-intracranial bypass.

    Science.gov (United States)

    Lansen, T A; Kasoff, S S; Arguelles, J H

    1989-07-01

    Saccular intracranial aneurysms occur infrequently in children, and the incidence of pediatric giant aneurysms is statistically in the same proportion as in adults. The management of these giant aneurysms can be treacherous. This paper presents a case of a 9-year-old boy with a giant aneurysm of the right middle cerebral artery that was successfully managed by ligation of the middle cerebral artery using a Drake tourniquet with the patient awake and by augmentation of the middle cerebral artery circulation with superficial temporal artery-middle cerebral artery anastomosis without excision of the lesion.

  16. Blood supply of the posterior cerebral artery by the carotid system on angiograms

    NARCIS (Netherlands)

    Jongen, JCF; Franke, CL; Soeterboek, AAJGM; Versteege, CWM; Ramos, LMP; van Gijn, J

    2002-01-01

    Background and Purpose Occipital lobe infarcts are traditionally attributed to vertebrobasilar disease. However, anatomical studies indicate that in some people the supply of the posterior cerebral artery is via the carotid system. We investigated how often such a developmental variant in the cerebr

  17. Effect of balloon atrial septostomy on cerebral oxygenation in neonates with transposition of the great arteries

    NARCIS (Netherlands)

    van der Laan, Michelle E.; Verhagen, Elise A.; Bos, Arend F.; Berger, Rolf M. F.; Kooi, Elisabeth M. W.

    2013-01-01

    BACKGROUND: The aim of this study was to determine the effect of balloon atrial septostomy (BAS) on cerebral oxygenation in neonates with transposition of the great arteries (TGA). METHODS: In term neonates with TGA, regional cerebral tissue oxygen saturation (r(c)SO(2)) was measured using, near-inf

  18. Low-profile stent system for treatment of atherosclerotic renal artery stenosis: The GREAT trial

    NARCIS (Netherlands)

    Sapoval, M.; Zahringer, M.; Pattynama, P.; Rabbia, C.; Vignali, C.; Maleux, G.; Boyer, L.; Szczerbo-Trojanowska, M.; Jaschke, W.; Hafsahl, G.; Downes, M.; Beregi, J.P.; Veeger, N.; Talen, A.

    2005-01-01

    PURPOSE: The Palmaz Genesis Peripheral Stainless Steel Balloon Expandable Stent in Renal Artery Treatment (GREAT) Trial was designed to assess the safety and performance of a low-profile stent for the treatment of obstructive renal artery disease by looking at 6-month renal artery patency uniformly

  19. Low-profile stent system for treatment of atherosclerotic renal artery stenosis : The GREAT trial

    NARCIS (Netherlands)

    Sapoval, M; Zahringer, M; Pattynama, P; Rabbia, C; Vignali, C; Maleux, G; Boyer, L; Szczerbo-Trojanowska, M; Jaschke, W; Hafsahl, G; Downes, M; Beregi, JP; Veeger, N; Talen, A

    2005-01-01

    PURPOSE: The Palmaz Genesis Peripheral Stainless Steel Balloon Expandable Stent in Renal Artery Treatment (GREAT) Trial was designed to assess the safety and performance of a low-profile stent for the treatment of obstructive renal artery disease by looking at 6-month renal artery patency uniformly

  20. Motor recovery by anterior choroidal artery territory in a patient with middle cerebral artery infarct

    Institute of Scientific and Technical Information of China (English)

    Ji Heon Hong; Sung Ho Jang

    2010-01-01

    In this study,the uninjured periventricular area of a female patient who presented with complete paralysis of the left extremities following middle cerebral artery infarction was analyzed using diffusion tensor tractography,transcranial magnetic stimulation,and functional magnetic resonance imaging.Diffusion tensor tractography revealed interrupted corticospinal tract at the infarct lesion in the corona radiata at 2 weeks after onset,which descended through the spared periventricular area at 6 months after onset.Transcranial magnetic stimulation and functional magnetic resonance imaging revealed a motor pathway of the affected hand that was compatible with the lateral corticospinal tract.At 6 months after onset,motor function in the affected extremities recovered to normal levels,which suggested that motor function in the affected hand recovered by the corticospinal tract that passed through the spared periventricular area.The arterial territory of the spared periventricular area corresponded with the anterior choroidal artery.These results suggest that care should be taken in spared periventricular areas in patients with lesions at the corona radiata level.

  1. Estenose do enxerto de veia safena magna reversa em revascularização arterial infrainguinal Stenosis of reverse great saphenous vein graft in infrainguinal arterial revascularization

    Directory of Open Access Journals (Sweden)

    Francesco Evangelista Botelho

    2011-04-01

    Full Text Available OBJETIVO: Avaliar a prevalência de estenose hemodinamicamente significativa na revascularização infrainguinal realizada com a veia safena magna reversa. MÉTODOS: No período compreendido entre março de 2008 e março de 2009, foram realizadas 56 revascularizações infrainguinais com a veia safena magna reversa em 56 pacientes, dos quais 32 foram avaliados com ultrassonografia vascular no 30º dia de pós- operatório. Foi analisada a prevalência de estenoses significativas nos enxertos e sua relação com as características clínico-cirúrgicas dos pacientes. Os parâmetros avaliados foram a localização das estenoses ao longo do enxerto, fatores de risco associados e a relação existente entre a ultrassonografia vascular e o índice tornozelo-braço no diagnóstico de estenoses. RESULTADOS: Houve prevalência de 48,4% de estenoses significativas nos enxertos avaliados, com 19,4% de estenoses graves e 29% de estenoses leve a moderada. Não foram encontradas associações significativas entre sexo, diabetes mellitus, hipertensão arterial, hipercolesterolemia, diâmetro do enxerto, localização da anastomose distal, composição do enxerto e a constatação de estenoses significativas. Observou-se fraca correlação entre os métodos no diagnóstico das estenoses em geral (K = 0,30; IC95% 0,232-0,473; p = 0,018, mas razoável concordância no diagnóstico das estenoses graves (K = 0,75; IC95% 0,655-0,811; p = 0,0001. CONCLUSÃO: Este estudo demonstrou elevada prevalência de estenoses no 30º dia do pós-operatório, com localização predominante na metade proximal do enxerto. O índice tornozelo-braço e a ultrassonografia vascular apresentaram concordância, sobretudo no diagnóstico das estenoses graves, mas o índice tornozelo-braço, isoladamente, mostrou-se insuficiente na vigilância dos enxertos de veia safena magna reversa.OBJECTIVE: The aim of this study was to evaluate the prevalence of hemodynamically significant

  2. MRI of cerebral ischaemia in rats with occlusion of the middle cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Thuomas, K.AA. [Dept. of Diagnostic Radiology, University Hospital, Uppsala (Sweden); Kotwica, Z. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden); Bergstroem, K. [Dept. of Diagnostic Radiology, University Hospital, Uppsala (Sweden); Bolander, H. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden); Hillered, L. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden)]|[Dept. of Clinical Chemistry, University Hospital, Uppsala (Sweden); Olsson, Y. [Dept. of Neuropathology, University Hospital, Uppsala (Sweden); Ponten, U. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden); Persson, L. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden)

    1991-11-01

    The development of ischaemic brain oedema caused by middle cerebral artery (MCA) occlusion was studied by serial magnetic resonance imaging (MRI) in rats. Multiple spin echo sequences were used with TR = 1500 ms and TE = 30-240 ms (8 echos). Substraction images were obtained by subtracting the last three echos from the first echo. Fourteen rats were studied 3, 6, and 12 h and 1, 1.5, 3, 4, 6, and 8 days after MCA occlusion, and 2 of them also 3 and 6 weeks later. Two T2 components could be separated, a fast one representing bound water and a slow one representing free bulk water. MR showed T2 prolongation even on the first examination, and the highest values were observed 24 h after occlusion. The subsequent examinations showed a slow reduction in oedema. MR studies 3 and 6 weeks after occlusion revealed an area of very long T2, which correlated well with infarction shown by histology. The substraction images demonstrated both the infarct location and the oedematous changes in the surrounding uninfarcted tissue. MRI imaging employing T2 components and subtraction images appears to be a valuable method for observing the time course of the development and resolution of oedema in cerebral infarction. (orig.)

  3. 缺血性卒中患者踝臂指数与颅内动脉狭窄数量的关系%Relationship between Ankle Brachial Index and Number of Intracerebral Artery Stenosis in Patients with Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    李轶; 孙海欣; 董可辉; 王拥军

    2011-01-01

    目的 探讨缺血性脑卒中患者踝臂指数(ABI)与颅内动脉狭窄支数的相关性.方法 测量314例行脑血管造影的缺血性卒中患者的ABI值,并收集其相关临床资料.结果 ABI异常、年龄与缺血性卒中患者颅内动脉狭窄数量有关.ABI值与患者具备的危险因素(高血压、糖尿病、冠心病及缺血性卒中史)数量之间存在负相关性,两者之间存在线性趋势(x2=36.35,P<0.001).ABI值与狭窄血管数量之间存在负相关性,两者之间存在线性趋势.结论 缺血性脑卒中患者ABI值与颅内动脉狭窄数量具有相关性.%Objective To investigate the relationship of ankle brachial index and the number of intracranial artery stenosis. Methods Ankle brachial index were measured in 314 patients with ischemic cerebrovascular disease received cerebral angiograpathy. Their data including general information and medical history were collected. Results Abnormality of ankle brachial index and age were associated with the number of intracranial artery stenosis in patients with ischemic stroke. Ankle brachial index was negative correlation with the number of risk factors( hyperten-tion/diabetes/coronary heart disease/ischemic stroke history) (r, = -0. 292,P <0. 001). Linear trend analysis showed linear trend between them(x2 =36. 35 ,P<0.001). Ankle brachial index was negative correlation with the number of intracranial artery stenosis(r, = -0. 161 ,P = 0.004). Trend analysis showed linear trend between them(x2 = 6. 53,P = 0. 01). Conclusion Ankle brachial index was associated with the number of intracerebral artery stenosis.

  4. Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Mijušković Dragan

    2012-01-01

    Full Text Available Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

  5. Fetal-Type Variants of the Posterior Cerebral Artery and Concurrent Infarction in the Major Arterial Territories of the Cerebral Hemisphere

    Directory of Open Access Journals (Sweden)

    Stephen L. Lambert BS

    2016-09-01

    Full Text Available Fetal-type or fetal posterior cerebral artery (FPCA is a variant of cerebrovascular anatomy in which the distal posterior cerebral artery (PCA territory is perfused by a branch of the internal carotid artery (ICA. In the presence of FPCA, thromboembolism in the anterior circulation may result in paradoxical PCA territory infarction with or without concomitant infarction in the territories of the middle (MCA or the anterior (ACA cerebral artery. We describe 2 cases of FPCA and concurrent acute infarction in the PCA and ICA territories—right PCA and MCA in Patient 1 and left PCA, MCA, and ACA in Patient 2. Noninvasive angiography detected a left FPCA in both patients. While FPCA was clearly the mechanism of paradoxical infarction in Patient 2, it turned out to be an incidental finding in Patient 1 when evidence of a classic right PCA was uncovered from an old computed tomography scan image. Differences in anatomical details of the FPCA in each patient suggest that the 2 FPCAs are developmentally different. The FPCA of Patient 1 appeared to be an extension of the embryonic left posterior communicating artery (PcomA. Patient 2 had 2 PCAs on the left (PCA duplication, classic bilateral PCAs, and PcomAs, and absent left anterior choroidal artery (AchoA, suggesting developmental AchoA-to-FPCA transformation on the left. These 2 cases underscore the variable anatomy, clinical significance, and embryological origins of FPCA variants.

  6. Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Karp Kjell

    2011-07-01

    Full Text Available Abstract Background Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications. Methods This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy. Results Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5% had a carotid stenosis - not significant over the 5% pre-specified threshold (p = 0.232, Binomial test. However, there was a significant sex difference (p = 0.008, as all stenoses were found in men. Among men, 12.5% (95%CI 4.2-20.8% had carotid stenosis - significantly over the 5% pre-specified threshold (p = 0.014, Binomial test. Conclusions The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy. Trial Registration The study was registered at http://www.clinicaltrials.gov; NCT00514644

  7. The efficacy of renal angioplasty in patients with renal artery stenosis and flash oedema or congestive heart failure: a systematic review.

    NARCIS (Netherlands)

    Berg, D.T.M. van den; Deinum, J.; Postma, C.T.; Wilt, G.J. van der; Riksen, N.P.

    2012-01-01

    AIMS: Recent randomized controlled trials have reported that angioplasty does not have a beneficial effect compared with pharmacological treatment on blood pressure and renal function in patients with atherosclerotic renal artery stenosis (RAS). We aimed to explore systematically the evidence that a

  8. Middle cerebral artery variations detected by magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A.; Kato, A.; Takase, Y.; Kudo, S. [Saga Medical School, Saga (Japan). Dept. of Radiology

    2000-04-01

    Middle cerebral artery (MCA) variations are found incidentally on cranial magnetic resonance angiography (MRA). Our goal was to examine the incidence and types of MCA variations detected by MRA. Between April 1996 and March 1999, cranial MRA was performed in 432 cases at our institution. Most of the patients examined had or were suspected to have cerebrovascular disease. After excluding 7 patients with moyamoya disease, we retrospectively reviewed 425 MRA results. A 1.5-T scanner was used in all studies, and maximum-intensity projection images obtained using the three-dimensional time-of-flight technique were displayed stereoscopically. In the 425 patients MRA revealed 16 anomalous MCAs, including 9 duplicated MCAs, 5 accessory MCAs, and 2 fenestrated MCAs, which is a rate of 3.8%. Thus, although the clinical significance is not great, we found a relatively high incidence of anomalous MCAs on MRA. We stress that knowledge and recognition of these variations are useful and important during the interpretation of cranial MRA. (orig.)

  9. Computed tomography angiography in the evaluation of carotid artery bifurcation stenosis: comparison with intraarterial digital subtraction angiography; Angio-TC en la evaluacion de estenosis de la bifurcacion arterial carotidea: comparacion con arteriografia por sustraccion digital intraarterial

    Energy Technology Data Exchange (ETDEWEB)

    Santos, A. L.; Ramos, M.; Delgado, F.; Cano, A.; Bravo, F. [Hospital Universitario Reina Sofia. Cordoba (Spain)

    2001-07-01

    To determine the value of computed tomography (CT) angiography in grading cervical carotid artery stenosis, comparing it with that of intraarterial digital subtraction angiography (IADSA), and to demonstrate the utility of CT angiography, under certain circumstances, as an alternative to carotid angiography in the diagnosis of arterial disease. Of the 428 patients who underwent CT andiography of the supraaortic trunk in our hospital between lily 1998 and September 2000, the results in the first 55 in whom Id's was performed concomitantly were reviewed, and the findings with two techniques compared. In the discrimination of stenosis >70%, CT angiography showed a sensitivity of 92%, a specificity of 98% and an overall precision of 95% with respect to IADSA. The good correlation of the grading of carotid artery stenosis by CT angiography with that of IADSA suggests its high diagnostic reliability. (Author) 38 refs.

  10. Cerebral arterial pulsation drives paravascular CSF-interstitial fluid exchange in the murine brain.

    Science.gov (United States)

    Iliff, Jeffrey J; Wang, Minghuan; Zeppenfeld, Douglas M; Venkataraman, Arun; Plog, Benjamin A; Liao, Yonghong; Deane, Rashid; Nedergaard, Maiken

    2013-11-13

    CSF from the subarachnoid space moves rapidly into the brain along paravascular routes surrounding penetrating cerebral arteries, exchanging with brain interstitial fluid (ISF) and facilitating the clearance of interstitial solutes, such as amyloid β, in a pathway that we have termed the "glymphatic" system. Prior reports have suggested that paravascular bulk flow of CSF or ISF may be driven by arterial pulsation. However, cerebral arterial pulsation could not be directly assessed. In the present study, we use in vivo two-photon microscopy in mice to visualize vascular wall pulsatility in penetrating intracortical arteries. We observed that unilateral ligation of the internal carotid artery significantly reduced arterial pulsatility by ~50%, while systemic administration of the adrenergic agonist dobutamine increased pulsatility of penetrating arteries by ~60%. When paravascular CSF-ISF exchange was evaluated in real time using in vivo two-photon and ex vivo fluorescence imaging, we observed that internal carotid artery ligation slowed the rate of paravascular CSF-ISF exchange, while dobutamine increased the rate of paravascular CSF-ISF exchange. These findings demonstrate that cerebral arterial pulsatility is a key driver of paravascular CSF influx into and through the brain parenchyma, and suggest that changes in arterial pulsatility may contribute to accumulation and deposition of toxic solutes, including amyloid β, in the aging brain.

  11. [Clinical aspects of arteriosclerotic stenosis of the left coronary artery main stem].

    Science.gov (United States)

    Volth, L; Csapó, K; Mihóczy, L

    1991-06-23

    Authors have found 37 significant (greater than 50%) or severe (greater than 75%) cases of left main stem stenosis (LMS) (3.4%, 35 male and 2 female) during 1097 consecutive selective coronarography. Retrospective analysis of the clinical data of the 35 male pts. showed severe effort or resting anginal complaints in the 2/3 of the pts., however this was not in tight connection with the degree of the LMS stenosis or the number of associated peripheral coronary stenoses respectively, similar to the ischaemic disorders of the resting ECG. In the bycicle ergometry ECG data lone the double index showed statistically significant difference between the groups of less than or equal to 2 and 3 vessel diseases connected to the severe LMS. Myocardium scintigraphy was performed out in 6 pts., all of them has given positive result. They emphasise the necessarity of urgent revascularisation against the higher risk of the intervention because of the pour results of the medical treatment.

  12. Middle cerebral artery occlusion in presence of low perfusion pressure increases infarct size in rats

    DEFF Research Database (Denmark)

    Sillesen, H; Nedergaard, Majken; Schroeder, T;

    1988-01-01

    A model was set up in order to evaluate the importance of hemispheric perfusion pressure when the middle cerebral artery (MCA) is occluded in anaesthetized rats. In 6 animals the internal carotid artery (ICA) was occluded prior to ipsilateral MCA occlusion; in 17 animals the MCA only was occluded...

  13. Validation of hyperintense middle cerebral artery sign in acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Gang Guo; Yonggui Yang; Weiqun Yang

    2012-01-01

    We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on magnetic resonance angiography and digital subtraction angiography. No patients in the non-hemorrhagic group had hyperintense middle cerebral artery sign on MRI. The sensitivity, specificity, and positive predictive values of the hyperintense middle cerebral artery sign on MRI T1-weighted image for subsequent hemorrhagic transformation were 54.5%, 100%, and 100% respectively. Hyperdense middle cerebral artery sign on non-contrast CT was observed in nine patients, five of who developed hemorrhagic transformation. These data suggest that hyperintense middle cerebral artery sign on MRI T1-weighted image is a highly specific and moderately sensitive indicator of subsequent hemorrhagic transformation in patients after acute ischemic stroke, and its specificity is superior to CT.

  14. Stent-induced coronary artery stenosis characterized by multimodal nonlinear optical microscopy

    Science.gov (United States)

    Wang, Han-Wei; Simianu, Vlad; Locker, Mattew J.; Cheng, Ji-Xin; Sturek, Michael

    2011-02-01

    We demonstrate for the first time the applicability of multimodal nonlinear optical (NLO) microscopy to the interrogation of stented coronary arteries under different diet and stent deployment conditions. Bare metal stents and Taxus drug-eluting stents (DES) were placed in coronary arteries of Ossabaw pigs of control and atherogenic diet groups. Multimodal NLO imaging was performed to inspect changes in arterial structures and compositions after stenting. Sum frequency generation, one of the multimodalities, was used for the quantitative analysis of collagen content in the peristent and in-stent artery segments of both pig groups. Atherogenic diet increased lipid and collagen in peristent segments. In-stent segments showed decreased collagen expression in neointima compared to media. Deployment of DES in atheromatous arteries inhibited collagen expression in the arterial media.

  15. Dipyridamole dilates large cerebral arteries concomitant to headache induction in healthy subjects

    DEFF Research Database (Denmark)

    Kruuse, Christina; Jacobsen, T B; Lassen, L H

    2000-01-01

    Dipyridamole is used for secondary prophylaxis in ischemic stroke and as a vasodilator agent in myocardial scintigraphy. An important side effect to administering dipyridamole is headache. The aim of the current study was to investigate the effects of dipyridamole on cerebral blood flow, large...... artery diameter, and headache induction. Twelve healthy subjects were included in this single-blind placebo-controlled study in which placebo (0.9% NaCl) and dipyridamole 0.142 mg/kg x min were administered intravenously over 4 minutes 1 hour apart. Blood flow velocity in the middle cerebral artery (Vmax......) was recorded by transcranial Doppler and regional cerebral blood flow in the middle cerebral artery (rCBFmca) was measured using single photon emission computed tomography and 133Xenon-inhalation. Blood pressure, heart rate, and pCO2 were measured repeatedly. Headache response was scored every 10 minutes...

  16. Endovascular therapy of ruptured distal anterior choroidal artery aneurysm associated with moyamoya pattern collateralization secondary to middle cerebral artery occlusion

    Directory of Open Access Journals (Sweden)

    Hidenori Oishi

    2013-01-01

    Full Text Available We report a case of a ruptured distal anterior choroidal artery (AChoA aneurysm associated with moyamoya pattern collateralization secondary to the middle cerebral artery occlusion. Patient was successfully treated with the coil embolization of the distal AChoA. This case supports the feasibility and efficacy of the endovascular therapy for the distal AChoA aneurysms in patients with MCA occlusion with moyamoya pattern collateralization.

  17. Transluminal Angioplasty of Transplanted Renal Artery Stenosis: A Review of the Literature for Its Safety and Efficacy

    Directory of Open Access Journals (Sweden)

    Polytimi Leonardou

    2011-01-01

    Full Text Available Transplant renal artery stenosis (TRAS is a well-known cause of posttransplant hypertension accompanied by possible graft dysfunction and is potentially curable when is diagnosed early. Colour Doppler Ultrasonography (CDU is the screening procedure of choice in most studies whereas some centers employ Magnetic Resonance Angiography (MRA, if available. Although both CDU and MRA can arouse suspicion of disease in less symptomatic cases, angiographic techniques are essential for confirmation of TRAS. Percutaneous Transluminal Angioplasty (PTA is a good and widespread therapeutic approach for the treatment of TRAS due to its acceptable complication rate and high technical success rate. The purpose of this paper is to assess the safety and efficacy of PTA in the treatment of TRAS, to compare the long-term outcomes between different reports, and to examine the role of PTA with stenting in inhibiting recurrence of the disease.

  18. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

    Directory of Open Access Journals (Sweden)

    Taylor J. Bergman

    2016-12-01

    Full Text Available Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

  19. Association of Inter-arm Blood Pressure Difference with Asymptomatic Intracranial and Extracranial Arterial Stenosis in Hypertension Patients

    Science.gov (United States)

    Wang, Yan; Zhang, Jin; Qian, Yuesheng; Tang, Xiaofeng; Ling, Huawei; Chen, Kemin; Li, Yan; Gao, Pingjin; Zhu, Dingliang

    2016-01-01

    Inter-arm blood pressure (BP) difference has been associated with ischemic stroke. Local atherosclerosis of stroke differ among vulnerable individuals, whereas intracranial arterial stenosis (ICAS) is more frequently affected Asians, and extracranial arterial stenosis (ECAS) is more prevalent among whites. We hereby sought to explore the association of inter-arm BP difference with ICAS and ECAS in stroke-free hypertensive patients in Chinese population. All the 885 subjects were evaluated of ICAS and ECAS through computerized tomographic angiography. Both arm BP was measured simultaneously by Vascular Profiler-1000 device. In the continuous study, ICAS was significantly associated with age, male, average brachial SBP, diabetes, anti-hypertensive treatment and inter-arm DBP difference. ECAS was associated with age, inter-arm SBP and LDL. In the categorical study, subjects with the top quartile of inter-arm DBP difference (≥4 mmHg) showed significantly higher risk of ICAS (OR = 2.109; 95% CI, 1.24–3.587). And the participants with the top quartile of inter-arm SBP difference (≥6 mmHg) showed significantly higher risk of ECAS (OR = 2.288; 95% CI, 1.309–3.998). In conclusion, we reported a diverse association of inter-arm SBP/DBP difference with the ICAS/ECAS. Inter-arm DBP difference might be the early symbol of ICAS in Chinese population, which need further verification in long-term cohort study. PMID:27412818

  20. Doppler sonography to monitor flow in different cerebral arteries in the rabbit.

    Science.gov (United States)

    Roatta, S; Roncari, S; Micieli, G; Bosone, D; Passatore, M

    2000-07-01

    Most of the transcranial Doppler (TCD) experimental studies on cerebral haemodynamics have been performed in the rabbit because of the similarity between its Willis circle and that of the human, but these studies have mainly been limited to the basilar artery. The present study was aimed at extending the use of TCD sonography to all other large cerebral arteries. In anaesthetised rabbits, these arteries were insonated from three different recording sites, i.e. top-cranial, suboccipital and orbital, using a two-channel pulsed Doppler device equipped with 4 and 8 MHz probes. First, discrimination between intra- and extracranial arteries was achieved through a standard 'rebreathing' test (hypercapnic-hypoxic stimulation). The distinctive blood velocity response patterns, reflecting the different extents of metabolic reactivity in intra- and extracranial territories, are described and discussed. Intracranial arteries were then identified on the basis of their response to ipsi- and contralateral common carotid artery occlusion. This procedure allowed recording from the following arteries: anterior common trunk, anterior cerebral, internal carotid, middle cerebral and basilar; the latter could be simultaneously monitored with any of the others. This study provides an experimental model allowing investigation of regional differences in the haemodynamic response to neurogenic and pharmacological stimuli.

  1. [Surgical treatment of a patient with coronary artery disease combined with stenosis of the left subclavian artery].

    Science.gov (United States)

    Sevastyanov, A V; Chernyavsky, A M; Chernyavsky, M A; Edemsky, A G; Nesmachnyi, A S; Tarkova, A R

    2016-01-01

    Presented in the article is a clinical case report regarding successfully used hybrid technology in combined lesions of the coronary arteries and the first segment of the left subclavian artery. The patient was subjected to simultaneous hybrid operation, i. e., transaortic angioplasty with stenting of the left subclavian artery by means of the Assurant stent accompanied by coronary artery bypass grafting. The early postoperative period turned out uneventful. The patient was discharged with no complications and in a satisfactory condition. At the 12-month follow-up visit, the patient presented no complaints, felling satisfactory as he stated, and there was no evidence of restenosis as revealed by the findings of ultrasonographic examination. This clinical case report demonstrates that in this type of combined lesion the use of hybrid technologies makes it possible to obtain a favourable surgical outcome both in the immediate and remote postoperative periods.

  2. Clinical utilization of microembolus detection by transcranial Doppler sonography in intracranial stenosis-occlusive disease

    Institute of Scientific and Technical Information of China (English)

    WU Xiu-juan; XING Ying-qi; WANG Juan; LIU Kang-ding

    2013-01-01

    Objective To discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler (TCD) sonography in intracranial stenosis-occlusive disease.Data sources All related articles in this review were mainly searched from PubMed published in English from 1996 to 2012 using the terms of microembolic signal,transcranial Doppler,intracranial stenosis,stroke.Study selection Original articles and reviews were selected if they were related to the clinical utilization of microembolus detection in intracranial stenosis-occlusive disease.Results Intracranial stenosis is a significant cause of cerebral emboli,and microembolus detection by TCD sonography were widely used in exploring the mechanisms of ischemic stroke with intracranial stenosis (including the middle cerebral artery stenosis and the vertebral-basilar stenosis),evaluating the prognosis of acute stroke,evaluating the therapeutic effects,and predicting the recurrent events of stroke.Conclusion Microembolus detection by TCD sonography plays an important role in the cerebral ischemic stroke patients with intracranial stenosis.

  3. Assessment of coronary artery disease using coronary computed tomography angiography in patients with aortic valve stenosis referred for surgical aortic valve replacement

    DEFF Research Database (Denmark)

    Larsen, Linnea Hornbech; Kofoed, K Fuglsang; Dalsgaard, M;

    2013-01-01

    BACKGROUND: In patients referred for aortic valve replacement (AVR) a pre-surgical assessment of coronary artery disease is mandatory to determine the possible need for additional coronary artery bypass grafting. The diagnostic accuracy of coronary computed tomography angiography (coronary CTA......) was evaluated in patients with aortic valve stenosis referred for surgical AVR. METHODS: Between March 2008 and March 2010 a total of 181 consecutive patients were included. All patients underwent pre-surgical coronary CTA (64- or 320-detector CT scanner) and invasive coronary angiography (ICA). The analyses...... with disagreement between ICA and coronary CTA in univariate analysis. CONCLUSION: In patients with aortic valve stenosis referred for surgical AVR the diagnostic accuracy of coronary CTA to identify significant coronary artery disease is moderate. Coronary CTA may be used successfully in a subset of patients...

  4. The relationship between the morphological features of A1 segment of anterior cerebral artery and anterior communicating artery aneurysms

    Institute of Scientific and Technical Information of China (English)

    冯文峰

    2013-01-01

    Objective To improve the predictability of surgical clipping and guide the steam shaping of microcatheters in endovascular embolization by analyzing the association of morphological features of A1 segment of anterior cerebral artery(ACA) with formation and classification of anterior

  5. MDCT and 3D evaluation of type 2 hypoplastic pulmonary artery sling associated with right lung agenesis, hypoplastic aortic arch, and long segment tracheal stenosis.

    Science.gov (United States)

    Lee, Edward Y

    2007-11-01

    The early diagnosis and complete anatomic evaluation of pulmonary artery sling, a congenital vascular anomaly in which left pulmonary artery arises from the right pulmonary artery, is paramount for proper patient management, because patients with this disorder frequently have other congenital anomalies resulting in high morbidity and mortality. Until recently, pulmonary artery sling in the neonate has been established with standard radiologic imaging studies such as plain radiographs, barium swallow studies, fluoroscopy-guided airway studies, and echocardiograms. However, with the development and widespread availability of multidetector computed tomography, pulmonary artery sling is increasingly evaluated with this newer technology. This case report presents a rare incidence of type 2 hypoplastic pulmonary artery sling in a neonate associated with right lung agenesis, hypoplastic aortic arch, and long segment tracheal stenosis. Multidetector computed tomography combined with 3-dimensional evaluation was particularly helpful in making a correct diagnosis of the complicated anatomic anomalies found in this case.

  6. Protective effect of extract of Cordyceps sinensis in middle cerebral artery occlusion-induced focal cerebral ischemia in rats

    Directory of Open Access Journals (Sweden)

    Tang Huiling

    2010-10-01

    Full Text Available Abstract Background Ischemic hypoxic brain injury often causes irreversible brain damage. The lack of effective and widely applicable pharmacological treatments for ischemic stroke patients may explain a growing interest in traditional medicines. From the point of view of "self-medication" or "preventive medicine," Cordyceps sinensis was used in the prevention of cerebral ischemia in this paper. Methods The right middle cerebral artery occlusion model was used in the study. The effects of Cordyceps sinensis (Caterpillar fungus extract on mortality rate, neurobehavior, grip strength, lactate dehydrogenase, glutathione content, Lipid Peroxidation, glutathione peroxidase activity, glutathione reductase activity, catalase activity, Na+K+ATPase activity and glutathione S transferase activity in a rat model were studied respectively. Results Cordyceps sinensis extract significantly improved the outcome in rats after cerebral ischemia and reperfusion in terms of neurobehavioral function. At the same time, supplementation of Cordyceps sinensis extract significantly boosted the defense mechanism against cerebral ischemia by increasing antioxidants activity related to lesion pathogenesis. Restoration of the antioxidant homeostasis in the brain after reperfusion may have helped the brain recover from ischemic injury. Conclusions These experimental results suggest that complement Cordyceps sinensis extract is protective after cerebral ischemia in specific way. The administration of Cordyceps sinensis extract significantly reduced focal cerebral ischemic/reperfusion injury. The defense mechanism against cerebral ischemia was by increasing antioxidants activity related to lesion pathogenesis.

  7. Protective effect of extract of Cordyceps sinensis in middle cerebral artery occlusion-induced focal cerebral ischemia in rats

    Science.gov (United States)

    2010-01-01

    Background Ischemic hypoxic brain injury often causes irreversible brain damage. The lack of effective and widely applicable pharmacological treatments for ischemic stroke patients may explain a growing interest in traditional medicines. From the point of view of "self-medication" or "preventive medicine," Cordyceps sinensis was used in the prevention of cerebral ischemia in this paper. Methods The right middle cerebral artery occlusion model was used in the study. The effects of Cordyceps sinensis (Caterpillar fungus) extract on mortality rate, neurobehavior, grip strength, lactate dehydrogenase, glutathione content, Lipid Peroxidation, glutathione peroxidase activity, glutathione reductase activity, catalase activity, Na+K+ATPase activity and glutathione S transferase activity in a rat model were studied respectively. Results Cordyceps sinensis extract significantly improved the outcome in rats after cerebral ischemia and reperfusion in terms of neurobehavioral function. At the same time, supplementation of Cordyceps sinensis extract significantly boosted the defense mechanism against cerebral ischemia by increasing antioxidants activity related to lesion pathogenesis. Restoration of the antioxidant homeostasis in the brain after reperfusion may have helped the brain recover from ischemic injury. Conclusions These experimental results suggest that complement Cordyceps sinensis extract is protective after cerebral ischemia in specific way. The administration of Cordyceps sinensis extract significantly reduced focal cerebral ischemic/reperfusion injury. The defense mechanism against cerebral ischemia was by increasing antioxidants activity related to lesion pathogenesis. PMID:20955613

  8. Subclavian artery stenosis caused by non-specific arteritis (Takayasu disease): treatment with Palmaz stent

    Energy Technology Data Exchange (ETDEWEB)

    Maskovic, J.; Jankovic, S.; Lusic, I.; Cambj-Sapunar, L.; Mimica, Z.; Bacic, A

    1999-09-01

    A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I Takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results.

  9. Calcification at orifices of aortic arch branches is a reliable and significant marker of stenosis at carotid bifurcation and intracranial arteries

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Shigeki, E-mail: shigekiyamada3@gmail.com [Department of Neurosurgery and Stroke Center, Rakuwakai Otowa Hospital, Kyoto (Japan); Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo (Japan); Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan); Hashimoto, Kenji, E-mail: hashiken8022@yahoo.co.jp [Department of Neurosurgery, Kishiwada Municipal Hospital, Osaka (Japan); Ogata, Hideki, E-mail: hidogata@gmail.com [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan); Watanabe, Yoshihiko, E-mail: ynabe@magic.odn.ne.jp [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan); Oshima, Marie, E-mail: marie@iis.u-tokyo.ac.jp [Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo (Japan); Miyake, Hidenori, E-mail: hi-miyake@hamamatsuh.rofuku.go.jp [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan)

    2014-02-15

    Purpose: Simple rating scale for calcification in the cervical arteries and the aortic arch on multi-detector computed tomography angiography (MDCTA) was evaluated its reliability and validity. Additionally, we investigated where is the most representative location for evaluating the calcification risk of carotid bifurcation stenosis and atherosclerotic infarction in the overall cervical arteries covering from the aortic arch to the carotid bifurcation. Method: The aortic arch and cervical arteries among 518 patients (292 men, 226 women) were evaluated the extent of calcification using a 4-point grading scale for MDCTA. Reliability, validity and the concomitant risk with vascular stenosis and atherosclerotic infarction were assessed. Results: Calcification was most frequently observed in the aortic arch itself, the orifices from the aortic arch, and the carotid bifurcation. Compared with the bilateral carotid bifurcations, the aortic arch itself had a stronger inter-observer agreement for the calcification score (Fleiss’ kappa coefficients; 0.77), but weaker associations with stenosis and atherosclerotic infarction. Calcification at the orifices of the aortic arch branches had a stronger inter-observer agreement (0.74) and enough associations with carotid bifurcation stenosis and intracranial stenosis. In addition, the extensive calcification at the orifices from the aortic arch was significantly associated with atherosclerotic infarction, similar to the calcification at the bilateral carotid bifurcations. Conclusions: The orifices of the aortic arch branches were the novel representative location of the aortic arch and overall cervical arteries for evaluating the calcification extent. Thus, calcification at the aortic arch should be evaluated with focus on the orifices of 3 main branches.

  10. In-Vitro Evaluation of Coronary Stents and 64-Detector-Row Computed Tomography Using a Newly Developed Model of Coronary Artery Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Schlosser, T.; Scheuermann, T.; Ulzheimer, S.; Mohrs, O.K.; Kuehling, M.; Albrecht, P.E.; Voigtlaender, T.; Barkhausen, J.; Schmermund, A. (Cardiovascular Center Bethanien (CCB), Frankfurt (DE))

    2008-02-15

    Background: Stent implantation is the predominant therapy for non-surgical myocardial revascularization in patients with coronary artery disease. However, despite substantial advances in multidetector computed tomography (MDCT) coronary imaging, a reliable detection of coronary in-stent restenosis is currently not possible. Purpose: To examine the ability of 64-detector-row CT to detect and to grade in-stent stenosis in coronary stents using a newly developed ex-vivo vessel phantom with a realistic CT density pattern, artificial stenosis, and a thorax phantom. Material and Methods: Four different stents (Liberte and Lunar ROX, Boston Scientific; Driver, Medtronic; Multi-Link Vision, Guidant) were examined. The stents were placed on a polymer tube with a diameter of 2.5, 3.0, 3.5, or 4.0 mm. Different degrees of stenosis (0%, 30%, 50%, 70-80%) were created inside the tube. For quantitative analysis, attenuation values were measured in the non-stenotic vessel outside the stent, in the non-stenotic vessel inside the stent, and in the stenotic area inside the stent. The grade of stenosis was visually assessed by two observers. Results: All stents led to artificial reduction of attenuation, the least degree of which was found in the Liberte stent (11.3+-10.2 HU) and the Multi-Link Vision stent (17.6+-17.9 HU; P 0.25). Overall, the non-stenotic vessel was correctly diagnosed in 55.5%, the low-grade stenosis in 58.3%, the intermediate stenosis in 63.8%, and the high-grade stenosis in 80.5%. In the 3.0-, 3.5-, and 4.0-mm vessels, in none of the cases was a non-stenotic or low-grade stenotic vessel misdiagnosed as intermediate or high-grade stenosis. The average deviation from the real grade of stenosis was 0.40 for the Liberte stent, 0.46 for the Lunar ROX stent, 0.45 for the Driver stent, and 0.58 for the Multi-Link Vision stent. Conclusion: Our ex-vivo data show that non-stenotic stents and low-grade in-stent stenosis can be reliably differentiated from intermediate and

  11. An unusual case of hematuria in a young female: renal artery embolism, mitral stenosis, and sinus rhythm

    Directory of Open Access Journals (Sweden)

    Ashok Kumar

    2016-01-01

    Full Text Available Renal artery embolism (RAE is an uncommon entity that is most often secondary to a cardiac source. Most reported cases have been in patients with underlying atrial fibrillation (AF, and occurrence of RAE, especially in patients with valvular heart disease, and sinus rhythm is very rare. We describe an unusual case of a young female who presented with sudden onset right flank pain, vomiting, anorexia, and hematuria, and was found to have thrombotic occlusion of the distal right renal artery. Although she denied any previous cardiac history, detailed cardiovascular examination revealed the presence of severe rheumatic mitral stenosis without any evidence of AF or left atrial clot. She was initially managed conservatively using low molecular weight heparin followed by oral anticoagulation with resolution of symptoms. A successful balloon mitral valvotomy was performed six weeks later. The patient is asymptomatic at her last follow-up of six months with preserved renal function. In symptomatic patients, clinicians need to consider the possibility of RAE even in patients of valvular heart disease with underlying sinus rhythm. Appropriate management of the underlying cardiac condition is imperative since embolism may be recurrent leading to compromise of renal function, if left untreated.

  12. The role of cGMP hydrolysing phosphodiesterases 1 and 5 in cerebral artery dilatation

    DEFF Research Database (Denmark)

    Kruuse, C; Rybalkin, S D; Khurana, T S;

    2001-01-01

    The aim was to investigate the presence and activity of cGMP hydrolysing phosphodiesterases in guinea pig basilar arteries and the effect of selective and non-selective phosphodiesterase inhibitors on cerebral artery dilatation involving the nitric oxide (NO)-guanosine cyclic 3'5-monophosphate (c...... by cGMP-independent mechanisms. Targeting the phosphodiesterases present in cerebral arteries, with selective inhibitors or activators of phosphodiesterase, may be a possible new way of treating cerebrovascular disease.......The aim was to investigate the presence and activity of cGMP hydrolysing phosphodiesterases in guinea pig basilar arteries and the effect of selective and non-selective phosphodiesterase inhibitors on cerebral artery dilatation involving the nitric oxide (NO)-guanosine cyclic 3'5-monophosphate (c......GMP) pathway. Immunoreactivity to phosphodiesterases 1A, 1B and 5, but not phosphodiesterase 1C was found in fractions of homogenised cerebral arteries eluted by high-pressure liquid chromatography (HPLC). Both the phosphodiesterase 1 inhibitor 8-methoxymethyl-1-methyl-3-(2methylpropyl)-xanthine (8-MM...

  13. Quantitative cerebral perfusion assessment using microscope-integrated analysis of intraoperative indocyanine green fluorescence angiography versus positron emission tomography in superficial temporal artery to middle cerebral artery anastomosis

    Directory of Open Access Journals (Sweden)

    Shinya Kobayashi

    2014-01-01

    Full Text Available Background: Intraoperative qualitative indocyanine green (ICG angiography has been used in cerebrovascular surgery. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope-integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS after STA-MCA anastomosis. Methods: Ten patients undergoing STA-MCA anastomosis due to unilateral major cerebral artery occlusive disease were included. Ten patients with normal cerebral perfusion served as controls. The ICG transit curve from six regions of interest (ROIs on the cortex, corresponding to ROIs on positron emission tomography (PET study, was recorded. Maximum intensity (I MAX , cerebral blood flow index (CBFi, rise time (RT, and time to peak (TTP were evaluated. Results: RT/TTP, but not I MAX or CBFi, could differentiate between control and study subjects. RT/TTP correlated (|r| = 0.534-0.807; P < 0.01 with mean transit time (MTT/MTT ratio in the ipsilateral to contralateral hemisphere by PET study. Bland-Altman analysis showed a wide limit of agreement between RT and MTT and between TTP and MTT. The ratio of RT before and after bypass procedures was significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.60 ± 0.032 and 0.80 ± 0.056, respectively; P = 0.017. The ratio of TTP was also significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.64 ± 0.081 and 0.85 ± 0.095, respectively; P = 0.017. Conclusions: Time-dependent intraoperative parameters from the ICG transit curve provide quantitative information regarding cerebral circulation time with quality and utility comparable to information obtained by PET. These parameters may help predict the occurrence of postoperative

  14. Relationship between pattern of ischemic manifestation and hemodynamics in symptomatic M1 stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Tokumitsu, Naoki; Sako, Kazuhiro; Aizawa, Shizuka; Shirai, Wakako [Nayoro City Hospital, Hokkaido (Japan)

    2002-07-01

    The mechanism through which ischemic manifestations develop in patients with middle cerebral artery (MCA) stenosis is still uncertain. It may cause ischemic symptoms through both embolic and hemodynamic mechanisms. In this study, we compared the findings from cerebral angiograms with single photon emission computed tomography (SPECT) in patients with M1 stenosis to determine the pathogenesis of ischema. At our hospital from 1994 to 2000, 14 patients (12 males and 2 females; mean age, 60.9; range, 31 to 85 years) with angiographically demonstrated symptomatic M1 stenosis were enrolled in this study. In 10, their stenotic lesion was located at the proximal site of the perforating arteries and for the other 4, stenosis was found at the distal site. Nine presented with transient ischemic attack (TIA) and 5 with completed stroke for an initial episode. The discrepancy in regional cerebral blood flow (rCBF) was evaluated in relation to the site and degree of stenosis, type of ischemic presentation, and frequency of ischemic events. There was no significant difference in CBF between the patients with stenosis involving the proximal site and those with distal stenosis; but the cortical CBF decreased significantly in those with severe stenosis compared with moderate stenosis. The cortical CBF of those who had a complete stroke is similar to that of the patients with TIA; but CBF of BGA decreased significantly in those with a complete stroke. The single ischemic event group showed a significant decrease in cortical CBF. On the other hand, the group with multiple ischemic events exhibited normal hemodynamics. We concluded that multiple ischemic events that occurred in M1 stenosis are caused by an embolic mechanism. (author)

  15. Atherosclerotic plaque volume and composition in symptomatic carotid arteries assessed with multidetector CT angiography; relationship with severity of stenosis and cardiovascular risk factors

    Energy Technology Data Exchange (ETDEWEB)

    Rozie, S.; Weert, T.T. de; Monye, C. de; Homburg, P.J.; Tanghe, H.L.J.; Lugt, A. van der [Erasmus MC, University Medical Center Rotterdam, Departments of Radiology, Rotterdam (Netherlands); Dippel, D.W.J. [Erasmus MC, University Medical Center Rotterdam, Department of Neurology, PO Box 2040, Rotterdam (Netherlands)

    2009-09-15

    The purpose of this study was to examine the volume and the composition of atherosclerotic plaque in symptomatic carotid arteries and to investigate the relationship between these plaque features and the severity of stenosis and the presence of cardiovascular risk factors. One hundred patients with cerebrovascular symptoms underwent CT angiography. We measured plaque volume (PV) and the relative contribution of plaque components (calcifications, fibrous tissue, and lipid) in the symptomatic artery. The contribution of different components was measured as the number of voxels within defined ranges of HU values (calcification >130 HU, fibrous tissue 60-130 HU, lipid core <60 HU). Fifty-seven patients had atherosclerotic plaque in the symptomatic carotid artery. The severity of stenosis and PV were moderately correlated. Age and smoking were independently related to PV. Patients with hypercholesterolemia had significantly less lipid and more calcium in their plaques than patients without hypercholesterolemia. Other cardiovascular risk factors were not significantly related to PV or plaque composition. Luminal stenosis of the carotid artery partly reflects the amount of atherosclerotic carotid disease. Plaque volume and plaque composition are associated with cardiovascular risk factors. (orig.)

  16. Pathologic findings of renal biopsy were a helpful diagnostic clue of stenosis of the iliac segment proximal to the transplant renal artery: a case report.

    Science.gov (United States)

    Aoyama, H; Saigo, K; Hasegawa, M; Akutsu, N; Maruyama, M; Otsuki, K; Matsumoto, I; Kawaguchi, T; Kitamura, H; Asano, T; Kenmochi, T; Itou, T; Matsubara, H

    2014-01-01

    Common iliac artery stenosis after renal transplantation is a rare complication; it can occur in the course of hypertension and renal dysfunction. We report a case of suspected renal allograft rejection with iliac artery stenosis proximal to a transplanted kidney. A 52-year-old man with a history of cadaveric kidney transplantation 26 years previously underwent a second cadaveric kidney transplantation in the left iliac fossa because of graft failure 3 years before. In June 2012, the patient had progressive renal dysfunction. In July, a percutaneous needle biopsy was taken, and it showed no rejection; however, his renal function continued to get worse through September. A percutaneous allograft renal biopsy was performed under ultrasound guidance and showed hyperplasia of the juxtaglomerular apparatus and renin granules. Magnetic resonance angiography was used to evaluate the arteries in the pelvis and showed left common iliac artery stenosis, and a stent was placed. After percutaneous intervention, the patient's ankle brachial pressure index was within the normal range and the allograft function had improved.

  17. Call-Fleming Syndrome (Reversible Cerebral Artery Vasoconstriction and Aneurysm Associated with Multiple Recreational Drug Use

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2013-01-01

    Full Text Available Drug abuse represents a significant health issue. Evidence suggests that recreational drug use has a direct effect on the cerebral vasculature and is of greater concern in those with undiagnosed aneurysms or vascular malformations. The authors report a case of thunderclap headache with a negative head CT and equivocal lumbar puncture after a drug-fueled weekend. The patient underwent diagnostic cerebral angiogram which demonstrated multisegmental, distal areas of focal narrowing of the middle, anterior, posterior, and posterior inferior cerebral artery and an incidental aneurysm. It is often difficult to determine the exact origin of symptoms; thus we were left with a bit of a chicken or the egg debate, trying to decipher which part came first. Either the aneurysm ruptured with associated concomitant vasospasm or it is a case of Call-Fleming syndrome (reversible cerebral artery vasoconstriction with an incidental aneurysm. The authors proposed their management and rationale of this complex case.

  18. Call-fleming syndrome (reversible cerebral artery vasoconstriction) and aneurysm associated with multiple recreational drug use.

    Science.gov (United States)

    Drazin, Doniel; Alexander, Michael J

    2013-01-01

    Drug abuse represents a significant health issue. Evidence suggests that recreational drug use has a direct effect on the cerebral vasculature and is of greater concern in those with undiagnosed aneurysms or vascular malformations. The authors report a case of thunderclap headache with a negative head CT and equivocal lumbar puncture after a drug-fueled weekend. The patient underwent diagnostic cerebral angiogram which demonstrated multisegmental, distal areas of focal narrowing of the middle, anterior, posterior, and posterior inferior cerebral artery and an incidental aneurysm. It is often difficult to determine the exact origin of symptoms; thus we were left with a bit of a chicken or the egg debate, trying to decipher which part came first. Either the aneurysm ruptured with associated concomitant vasospasm or it is a case of Call-Fleming syndrome (reversible cerebral artery vasoconstriction) with an incidental aneurysm. The authors proposed their management and rationale of this complex case.

  19. Ruptured Dissecting Aneurysm of the Middle Cerebral Artery with Spontaneous Resolution: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Ihn, Yon Kwon; Jung, Won Sang [Dept. of Radiology, St Vincent' s Hospital, The Catholic University of Korea College of Medicine, Suwon (Korea, Republic of)

    2011-11-15

    Dissecting aneurysms of the middle cerebral artery (MCA) are known to cause cerebral infarcts in younger people and can also cause subarachnoid hemorrhage (SAH) or intracranial hemorrhage. Bleeding caused by an isolated dissecting aneurysm of the MCA is relatively rare. We report the case of a young woman with SAH that occurred subsequent to a ruptured dissecting aneurysm of the MCA which resolved spontaneously as demonstrated by angiography.

  20. Endothelial Nitric Oxide Mediates Caffeine Antagonism of Alcohol-Induced Cerebral Artery Constriction.

    Science.gov (United States)

    Chang, Jennifer; Fedinec, Alexander L; Kuntamallappanavar, Guruprasad; Leffler, Charles W; Bukiya, Anna N; Dopico, Alex M

    2016-01-01

    Despite preventive education, the combined consumption of alcohol and caffeine (particularly from "energy drinks") continues to rise. Physiologic perturbations by separate intake of ethanol and caffeine have been widely documented. However, the biologic actions of the alcohol-caffeine combination and their underlying subcellular mechanisms have been scarcely studied. Using intravital microscopy on a closed-cranial window and isolated, pressurized vessels, we investigated the in vivo and in vitro action of ethanol-caffeine mixtures on cerebral arteries from rats and mice, widely recognized models to address cerebrovascular pathophysiology and pharmacology. Caffeine at concentrations found in human circulation after ingestion of one to two cups of coffee (10 µM) antagonized the endothelium-independent constriction of cerebral arteries evoked by ethanol concentrations found in blood during moderate-heavy alcohol intoxication (40-70 mM). Caffeine antagonism against alcohol was similar whether evaluated in vivo or in vitro, suggesting independence of systemic factors and drug metabolism, but required a functional endothelium. Moreover, caffeine protection against alcohol increased nitric oxide (NO•) levels over those found in the presence of ethanol alone, disappeared upon blocking NO• synthase, and could not be detected in pressurized cerebral arteries from endothelial nitric-oxide synthase knockout (eNOS(-/-)) mice. Finally, incubation of de-endothelialized cerebral arteries with the NO• donor sodium nitroprusside (10 µM) fully restored the protective effect of caffeine. This study demonstrates for the first time that caffeine antagonizes ethanol-induced cerebral artery constriction and identifies endothelial NO• as the critical caffeine effector on smooth muscle targets. Conceivably, situations that perturb endothelial function and/or NO• availability will critically alter caffeine antagonism of alcohol-induced cerebrovascular constriction without

  1. Impact of Intra-Extracranial Hemodynamics on Cerebral Ischemia by Arterial Hypertension (Part 1

    Directory of Open Access Journals (Sweden)

    Alexander G. Kruglov, PhD, ScD

    2012-06-01

    Full Text Available The present study was conducted to examine the interaction of biochemical parameters within the blood flow, their effect on the cerebral blood flow, as well as the mechanisms of cerebral ischemia by stable arterial hypertension. The hemodynamics and biochemical indicators of cerebral blood flow without the additives of the extracranial blood were obtained by the catheterization method via a probe wedged at the level of the bulb of the superior jugular vein. Sampling of the arterial blood was done in the thoracic aorta. Correlation and factor analysis of the relationship of the biochemical substances within the blood flow, and of the hemodynamic indicators of the cerebral inflow and outflow of blood were conducted by stable arterial hypertension compared with similar data of the control group. The differences thus identified led to the conclusion that by stable arterial hypertension, there is a loss of the homeostatic control of the factors determining the rheological and thrombogenic properties of the blood involved in the formation of cerebral ischemic events.

  2. Transluminal attenuation gradient in coronary computed tomography angiography for determining stenosis severity of calcified coronary artery: a primary study with dual-source CT

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Minwen; Wei, Mengqi; Wen, Didi; Zhao, Hongliang; Liu, Ying; Li, Jian [Fourth Military Medical University, Department of Radiology, Xijing Hospital, Xi' an, Shaanxi Province (China); Li, Jiayi [Fourth Military Medical University, Department of Cardiology, Xijing Hospital, Xi' an, Shaanxi Province (China)

    2015-05-01

    To evaluate the diagnostic accuracy of transluminal attenuation gradient (TAG) for stenosis severity of calcified lesions assessed by coronary computed tomography angiography (CCTA). One hundred seven patients who underwent CCTA and coronary angiography (CAG) were enrolled. TAGs of 309 major epicardial coronary arteries were measured. The impact of plaque composition, Agatston scores, and lesion length ratio on TAG were analyzed. Diagnostic performance vs. CAG of TAG, CCTA, and combined TAG/CCTA were evaluated, and incremental value of TAG for reclassification of CCTA stenosis severity in calcified lesions was also analyzed. TAG decreased consistently with stenosis severity. TAG was significantly lower in coronary arteries with calcification scores >300 and lesion length ratios >2/3. TAG improved diagnostic accuracy of CCTA (c-statistic =0.982 vs. 0.942, P = 0.0001) in calcified lesions, and the sensitivity, specificity, positive, and negative predictive values of TAG cutoff ≤ -11.33 were 72 %, 91 %, 88 %, and 78 %, respectively. The addition of TAG to CCTA resulted in significant reclassification (NRI =0.093, P = 0.022) in calcified vessels. Measurement of TAG may improve diagnostic performance and reclassification of CCTA in coronary stenosis caused by calcified lesions. (orig.)

  3. Systematization, distribution and territory of the caudal cerebral artery on the brain's surface of the turkey (Meleagris gallopavo

    Directory of Open Access Journals (Sweden)

    Amarílis Díaz de Carvalho

    2014-10-01

    Full Text Available Thirty Meleagris gallopavo heads with their neck segments were used. Animals were contained and euthanized with the association of mebezonium iodide, embutramide and tetracaine hydrochloride (T 61, Intervet by intravenous injection. The arterial system was rinsed with cold saline solution (15°C, with 5000IU heparin and filled with red-colored latex. The samples were fixed in 20% formaldehyde for seven days. The brains were removed with a segment of cervical spinal cord and after, the dura-mater was removed and the arteries dissected. The cerebral carotid arteries, after the intercarotid anastomosis, were projected around the hypophysis, until they reached the tuber cinereum and divided into their terminal branches, the caudal branch and the rostral branch. The rostral branch was projected rostrolateralwards and gave off, in sequence, two collateral branches, the caudal cerebral and the middle cerebral arteries and the terminal branch was as cerebroethmoidal artery. The caudal cerebral artery of one antimere formed the interhemispheric artery, which gave off dorsal hemispheric branches to the convex surface of both antimeres. Its dorsal tectal mesencephalic branch, of only one antimere, originated the dorsal cerebellar artery. In the interior of the cerebral transverse fissure, after the origin of the dorsal tectal mesencephalic artery, the caudal cerebral artery emitted occipital hemispheric branches, pineal branches and medial hemispheric branches, on both antimeres. The caudal cerebral artery's territory comprehended the entire surface of the dorsal hemioptic lobe, the rostral surface of the cerebellum, the diencephalic structures, the caudal pole and the medial surface of the cerebral hemisphere and in the convex surface, the sagittal eminence except for its most rostral third. Due to the asymmetry found in the caudal cerebral arteries' ramifications, the models were classified into three types and their respective subtypes.

  4. Risk stratification in asymptomatic and symptomatic patients with carotid artery stenosis

    NARCIS (Netherlands)

    den Hartog, A.G.

    2013-01-01

    The overall aim of this thesis is to explore and assess the risks that patients with carotid artery disease, whether asymptomatic or symptomatic, are exposed to, and to explore whether patients that may be subject to relatively higher risk can be identified by imaging. Although large randomized tria

  5. Tissue Doppler echocardiography improves the diagnosis of coronary artery stenosis in stable angina pectoris

    DEFF Research Database (Denmark)

    Hoffmann, Soren; Jensen, Jan Skov; Iversen, Allan Zeeberg

    2012-01-01

    Aim To determine if colour tissue Doppler imaging (TDI) performed at rest in patients with suspected stable angina pectoris (SAP) is able to predict the presence of significant coronary artery disease (CAD). METHODS AND RESULTS: This study comprises 296 consecutive patients with clinically...

  6. A simple technique for morphological measurement of cerebral arterial circle variations using public domain software (Osiris).

    Science.gov (United States)

    Ansari, Saeed; Dadmehr, Majid; Eftekhar, Behzad; McConnell, Douglas J; Ganji, Sarah; Azari, Hassan; Kamali-Ardakani, Shahab; Hoh, Brian L; Mocco, J

    2011-12-01

    This article describes a straightforward method to measure the dimensions and identify morphological variations in the cerebral arterial circle using the general-purpose software program Osiris. This user-friendly and portable program displays, manipulates, and analyzes medical digital images, and it has the capability to determine morphometric properties of selected blood vessels (or other anatomical structures) in humans and animals. To ascertain morphometric variations in the cerebral arterial circle, 132 brains of recently deceased fetuses, infants, and adults were dissected. The dissection procedure was first digitized, and then the dimensions were measured with Osiris software. Measurements of each vessel's length and external diameters were used to identify and classify morphological variations in the cerebral arterial circle. The most commonly observed anatomical variations were uni- and bilateral hypoplasia of the posterior communicating artery. This study demonstrates that public domain software can be used to measure and classify cerebral arterial circle vessels. This method could be extended to examine other anatomical regions or to study other animals. Additionally, knowledge of variations within the circle could be applied clinically to enhance diagnostic and treatment specificity.

  7. Extracranial-intracranial bypass for internal carotid/middle cerebral atherosclerotic steno-occlusive diseases in conjunction with carotid endarterectomy for contralateral cervical carotid stenosis: clinical results and cognitive performance.

    Science.gov (United States)

    Inoue, Tomohiro; Ohwaki, Kazuhiro; Tamura, Akira; Tsutsumi, Kazuo; Saito, Isamu; Saito, Nobuhito

    2016-10-01

    Clinical results as well as cognitive performances after extracranial to intracranial (EC-IC) bypass in conjunction with contralateral carotid endarterectomy (CEA) are poorly understood. Data from 14 patients who underwent unilateral EC-IC bypass for atherosclerotic internal carotid artery (ICA)/middle cerebral artery (MCA) steno-occlusive disease in conjunction with CEA for contralateral cervical carotid stenosis were retrospectively reviewed. Postoperative results were evaluated by MRI imagings. Nine patients also underwent neuropsychological examinations (NPEs), including assessment by the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R) before and about 6 months after bilateral surgeries. Postoperative MRI follow-up (median, 8 months; interquartile range, 7-8 months) confirmed successful bypass in all patients, with no additional ischemic lesions on T2WI when compared with preoperative imaging. Further, MRA showed patent bypass and contralateral smooth patency at CEA portion in all patients. In the group rate analysis, all five postoperative NPE scores (Verbal IQ, Performance IQ, WMS-memory, WMS-attention, and Average scores of all those four scores) were improved relative to preoperative NPE scores. Performance IQ and Average score improvements were statistically significant. Clinical results after EC-IC bypass in conjunction with contralateral CEA were feasible. Based on the group rate analysis, we conclude that successful unilateral EC-IC bypass and contralateral carotid endarterectomy does not adversely affect postoperative cognitive function.

  8. Dependency of cerebral blood flow upon mean arterial pressure in patients with acute bacterial meningitis

    DEFF Research Database (Denmark)

    Møller, Kirsten; Larsen, Fin Stolze; Qvist, Jesper;

    2000-01-01

    OBJECTIVE: Patients with acute bacterial meningitis are often treated with sympathomimetics to maintain an adequate mean arterial pressure (MAP). We studied the influence of such therapy on cerebral blood flow (CBF). DESIGN: Prospective physiologic trial. SETTING: The Department of Infectious...... Diseases, Copenhagen University Hospital, Denmark. PATIENTS: Sixteen adult patients with acute bacterial meningitis. INTERVENTION: Infusion of norepinephrine to increase MAP. MEASUREMENTS: During a rise in MAP induced by norepinephrine infusion, we measured relative changes in CBF by transcranial Doppler...... bacterial meningitis, CBF autoregulation is impaired. With recovery from meningitis, the cerebral vasculature regains the ability to maintain cerebral perfusion at a constant level despite variations in MAP....

  9. Analysis of the effects of phosphodiesterase type 3 and 4 inhibitors in cerebral arteries

    DEFF Research Database (Denmark)

    Birk, Steffen; Edvinsson, Lars; Olesen, Jes;

    2004-01-01

    Inhibitors of phosphodiesterases 3 and 4, the main cyclic AMP (cAMP) degrading enzymes in arteries, may have therapeutic potential in cerebrovascular disorders. We analysed the effects of such phosphodiesterases in guinea pig cerebral arteries with organ bath technique and cyclic nucleotide assays...... the major contributors to total cAMP hydrolysis in the arteries examined. The phosphodiesterase 3 inhibitors additionally attenuated cyclic GMP (cGMP) hydrolysis, but relaxant responses were not dependent on an intact endothelium or on the nitric oxide-cGMP pathway. Conversely, the phosphodiesterase 4....... Guinea pig and human cerebral arteries were used for phosphodiesterase assays. Cilostazol (6-[4-(1-cyclohexyl-1H-tetrazol-5-yl)butoxy]-3,4-dihydro-2(1H)-quinolinone), a phosphodiesterase 3 inhibitor, was compared to conventional phosphodiesterase 3 and 4 inhibitors. Phosphodiesterases 3 and 4 were...

  10. Unilateral fetal-type circle of Willis anatomy causes right-left asymmetry in cerebral blood flow with pseudo-continuous arterial spin labeling: A limitation of arterial spin labeling-based cerebral blood flow measurements?

    Science.gov (United States)

    Barkeij Wolf, Jurriaan Jh; Foster-Dingley, Jessica C; Moonen, Justine Ef; van Osch, Matthias Jp; de Craen, Anton Jm; de Ruijter, Wouter; van der Mast, Roos C; van der Grond, Jeroen

    2016-09-01

    The accuracy of cerebral blood flow measurements using pseudo-continuous arterial spin labeling can be affected by vascular factors other than cerebral blood flow, such as flow velocity and arterial transit time. We aimed to elucidate the effects of common variations in vascular anatomy of the circle of Willis on pseudo-continuous arterial spin labeling signal. In addition, we investigated whether possible differences in pseudo-continuous arterial spin labeling signal could be mediated by differences in flow velocities. Two hundred and three elderly participants underwent magnetic resonance angiography of the circle of Willis and pseudo-continuous arterial spin labeling scans. Mean pseudo-continuous arterial spin labeling-cerebral blood flow signal was calculated for the gray matter of the main cerebral flow territories. Mean cerebellar gray matter pseudo-continuous arterial spin labeling-cerebral blood flow was significantly lower in subjects having a posterior fetal circle of Willis variant with an absent P1 segment. The posterior fetal circle of Willis variants also showed a significantly higher pseudo-continuous arterial spin labeling-cerebral blood flow signal in the ipsilateral flow territory of the posterior cerebral artery. Flow velocity in the basilar artery was significantly lower in these posterior fetal circle of Willis variants. This study indicates that pseudo-continuous arterial spin labeling measurements underestimate cerebral blood flow in the posterior flow territories and cerebellum of subjects with a highly prevalent variation in circle of Willis morphology. Additionally, our data suggest that this effect is mediated by concomitant differences in flow velocity between the supplying arteries.

  11. Intraoperative dexmedetomidine and postoperative cerebral hyperperfusion syndrome in patients who underwent superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease

    Science.gov (United States)

    Seo, Hyungseok; Ryu, Ho-Geol; Son, Je Do; Kim, Jeong-Soo; Ha, Eun Jin; Kim, Jeong-Eun; Park, Hee-Pyoung

    2016-01-01

    Abstract Dexmedetomidine, a selective α2-agonist, reduces cerebral blood flow and has neuroprotective effects against cerebral ischemia/reperfusion injury in experimental animals. We examined whether intraoperative dexmedetomidine would reduce the incidence of postoperative cerebral hyperperfusion syndrome (CHS) after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with moyamoya disease. The electronic medical records of 117 moyamoya patients who underwent STA-MCA anastomosis were reviewed retrospectively. The patients were divided into 2 groups: 48 patients received intraoperative dexmedetomidine (Group D), while 69 patients did not (Group ND). The incidence (primary outcome), onset, and duration of postoperative CHS were noted. The incidence of postoperative CHS was 45.8% and 40.6% in groups D and ND, respectively (P = 0.708). The duration of postoperative CHS was shorter in group D than in group ND (median [Q1–Q3], 5 [3–7] vs 8 [5–10] days, P = 0.021). There was no significant difference in the onset of CHS between group D and group ND (0 [0–2] vs 1 [0–3] days, P = 0.226). In conclusion, intraoperative dexmedetomidine did not reduce the incidence of postoperative CHS, although it reduced the duration of CHS, in patients who had undergone direct revascularization surgery for moyamoya disease. PMID:28033272

  12. Atherosclerotic plaque volume and composition in symptomatic carotid arteries assessed with multidetector CT angiography; relationship with severity of stenosis and cardiovascular risk factors

    OpenAIRE

    Rozie, S.; de Weert, T. T.; de Monyé, C.; Homburg, P. J.; Tanghe, H L J; Dippel, D W J; van der Lugt, A

    2009-01-01

    The purpose of this study was to examine the volume and the composition of atherosclerotic plaque in symptomatic carotid arteries and to investigate the relationship between these plaque features and the severity of stenosis and the presence of cardiovascular risk factors. One hundred patients with cerebrovascular symptoms underwent CT angiography. We measured plaque volume (PV) and the relative contribution of plaque components (calcifications, fibrous tissue, and lipid) in the symptomatic a...

  13. Anesthetic management of hypertensive crisis in a three-year-old patient with undiagnosed severe renal artery stenosis: a case report.

    Science.gov (United States)

    Park, Sang-Hee; Lee, Yoon-Sook; Min, Too Jae; Kim, Woon Young; Kim, Jae Hwan; Park, Young Cheol

    2014-10-01

    Pediatric hypertensive crisis is a potentially life threatening medical emergency, usually secondary to an underlying disease. Hypertension commonly occurs during general anesthesia, and is usually promptly and appropriately treated by anesthesiologists. However in children with severe, unexplained, or refractory hypertension, it has the potential to cause morbidity and even mortality in susceptible patients. We report an anesthetic management of an unexpected hypertensive crisis that developed during general anesthesia in a three-year-old girl with undiagnosed severe left renal artery stenosis.

  14. A Markov model to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin on prevention of recurrent ischemic stroke due to intracranial artery stenosis

    Directory of Open Access Journals (Sweden)

    Jinqiu Yang

    2014-01-01

    Full Text Available Background: Given the importance of intracranial stenosis as a cause of recurrent ischemic stroke and the lack of evidence supporting a clear choice for prevention of recurrent ischemic events, a computer simulation model for prognostic prediction could be used to improve decision making. Aims: The aim of the following study is to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin for prevention of recurrent stroke due to atherosclerotic intracranial artery stenosis. Setting and Design: The cohort consisted of 206 patients from 2006 to 2011. Materials and Methods: A two-state Markov model was used to predict the prognosis of patients with stroke or transient ischemic attack (TIA caused by angiographically verified 50-99% stenosis of a major intracranial artery to receive aspirin, clopidogrel, or dual therapy. Statistical Analysis: Two tests were used: Pearson Chi-square test or Fisher′s exact test (for percentages and Kruskal Wallis test (for rank order data. Results: In the 10-year Markov cohort analysis, 36.24% of patients who were treated with clopidogrel plus aspirin developed to recurrent stroke while the probability for patients in the aspirin group and clopidogrel group was 42.60% and 48.39% respectively. Patients with clopidogrel plus aspirin had the highest quality-adjusted life years, followed by aspirin and clopidogrel. Conclusion: To prevent recurrent stroke in patients with intracranial artery stenosis, especially in those patients with a history of TIA or coronary artery disease, medical therapy with clopidogrel plus aspirin should be considered in preference to aspirin alone.

  15. Whole-brain perfusion imaging and angiography performed with 256-slice CTin evaluation of cerebrovascular reserve capacity in unilateral carotid artery stenosis%256层CT全脑灌注成像联合CTA评估单侧颈动脉狭窄的脑血管储备能力的价值

    Institute of Scientific and Technical Information of China (English)

    唐健; 常军; 侯海燕; 姜旭栋; 堵红群; 姜建威

    2012-01-01

    Objective To assess the value of combination of whole-brain perfusion imaging and CTA in evaluating cerebrovascular reserve capacity in unilateral carotid artery stenosis. Methods Twenty-seven patients with unilateral carotid artery stenosis of ≥50% were divided into 2 groups according to CTA results: carotid moderate stenosis groupfcarotid stenosis of 50%-69%, group A) and carotid severe stenosis or occlusion group(carotid stenosis of ≥70% , group B). The relative cerebral blood volume(rCBV) , the relative cerebral blood folw(rCBF) , the difference in mean transit time(dMTT) and the difference in time to peak(dTTP) in bilateral temporal white matter and gray matter supplied by middle cerebral artery were measured and calculated. CTA was used to assess the configuration of the circle of Willis and if primary collaterals were patent. Differences in perfusion parameters between group A and group B, and between patients with patent primary collaterals or not were determined by using one way ANOVA test. Results There were statistical differences in rCBV, rCBF, dMTT and dTTP between two groups in white matter. Statistical difference of dMTT and dTTP was found between two groups in gray matter. There was significant increase in dTTP in the group B of the patients without patent primary collaterals. Conclusion Combined whole-brain perfusion imaging and CTA is a good way to evaluate cerebrovascular reserve capacity in unilateral carotid artery stenosis, and to provide a reliable method for choice of clinic treatments.%目的 探讨256层CT全脑灌注成像联合CTA评估单侧颈动脉狭窄的脑血管储备能力的价值.方法 单侧颈动脉狭窄≥50%的患者27例,根据CTA结果 按颈动脉狭窄程度划分为第一组中度狭窄组(血管阻塞50%~69%)和第二组重度狭窄或闭塞组(血管阻塞≥70%).测量并计算2组大脑中动脉供血区的白质和灰质的相对脑血容量(relative cerebral blood volume,r

  16. Occult stenosis of the common carotid artery complicating mandibular reconstruction with a fibular free flap.

    Science.gov (United States)

    Bater, M C; Brennan, P A; Mellor, T K; Tilley, E

    2006-02-01

    An unsuspected severely stenosed common carotid artery that compromised a free flap for mandibular reconstruction is described. To our knowledge no one has advocated the assessment of the carotid tree before transfer of free tissue. We suggest that patients with several risk factors for peripheral vascular disease should have colour flow duplex imaging of the carotid system if transfer of free tissue is being considered.

  17. Hyper-reactivity of cerebral arteries from ovariectomized rats: therapeutic benefit of tamoxifen.

    Science.gov (United States)

    Thorin, Eric; Pham-Dang, Mylan; Clement, Robert; Mercier, Isabelle; Calderone, Angelino

    2003-12-01

    1. An increased incidence of systemic hypertension has been documented in postmenopausal women and identified as an independent risk factor in the development of cerebrovascular stroke. The present study examined whether cerebrovascular reactivity was increased in the hypertensive ovariectomized rat, and explored the potential therapeutic benefit of the partial estrogen receptor agonist tamoxifen. 2. Female Sprague-Dawley rats were subjected to bilateral ovariectomy (OVX, n=16) or a sham operation (n=8). At 6-week postsurgery, rats were anesthetized to assess ventricular contractility and blood pressure. In a second series of experiments, OVX rats (n=8) were given tamoxifen starting 3 weeks postsurgery, and continued for 3 weeks. At the end of each protocol, the middle cerebral artery was harvested and rings were mounted in wire-myographs to measure isometric tension. 3. Systolic arterial pressure (SAP) was significantly increased (PEmax), whereas a significant (PEmax). Lastly, vascular sensitivity (pD2) to sodium nitroprusside was significantly increased (P<0.05) in OVX rats, as compared to sham. 4. Tamoxifen therapy normalized the resting tension of isolated cerebral arteries from OVX rats, abrogated phenylephrine-mediated contraction, and modestly reduced SAP. By contrast, tamoxifen treatment of OVX rats did not attenuate L-NNA-mediated contractile response of cerebral arteries. 5. These data demonstrate that the cerebral artery isolated from the OVX rat was associated with an exaggerated vasoconstrictor response to phenylephrine, and altered NO-dependent vascular reactivity. The administration of tamoxifen to OVX rats normalized cerebral artery reactivity to phenylephrine. These findings provide the impetus to examine the potential therapeutic benefit of the partial estrogen receptor agonist tamoxifen to reduce the incidence of cerebrovascular stroke in postmenopausal women.

  18. Systematization, description and territory of the caudal cerebral artery of the brain in broad-snouted Caiman (Caiman latirostris

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    Lygia Almeida

    2011-09-01

    Full Text Available Thirty heads with the neck segment of Caiman latirostris were used. The animals were provided from a creation center called Mister Caiman, under the authorization of the Brazilian Institute of Environment and Renewable Natural Resources (Ibama. Animals were sacrificed according to the slaughtering routine of the abattoir, and the heads were sectioned at the level of the third cervical vertebra. The arterial system was washed with cold saline solution, with drainage through jugular veins. Subsequently, the system was filled with red colored latex injection. Pieces were than fixed in 20% formaldehyde, for seven days. The brains were removed, with a spinal cord segment, the duramater removed and the arteries dissected. At the level of the hypophysis, the internal carotid artery gave off a rostral branch, and a short caudal branch, continuing, naturally, as the caudal cerebral artery. This artery projected laterodorsalwards and, as it overpassed the optic tract, gave off its I (the first central branch. Penetrated in the cerebral transverse fissure, emitting the diencephalic artery and next its II (second central branch. Still inside the fissure, originated occipital hemispheric branches and a pineal branch. Emerged from the cerebral transverse fissure, over the occipital pole of the cerebral hemisphere. Projected rostralwards, sagital to the cerebral longitudinal fissure, as interhemispheric artery. This artery gave off medial and convex hemispheric branches to the respective surfaces of the cerebral hemispheres, anastomosed with its contralateral homologous, forming the common ethmoidal artery. This artery entered the fissure between the olfactory peduncles, emerging ventrally and dividing into ethmoidal arteries, right and left, which progressed towards the nasal cavities, vascularizing them. The territory of the caudal cerebral artery included the most caudal area of the base of the cerebral hemisphere, its convex surface, the olfactory

  19. Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review.

    Science.gov (United States)

    Anichini, G; Passacantilli, E; Lenzi, J; Guidetti, G; Santoro, A

    2012-04-01

    Aneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery.

  20. Diminished response to furosemide in I-123 Hippuran renal studies of renovascular hypertension caused by unilateral renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Flueckiger, F.M.; Fueger, G.F.; Einspieler, R.; Hausegger, K. (Department of Radiology, Graz (Austria))

    1990-09-01

    Dynamic I-123 Hippuran renal studies to measure furosemide response (FR) were performed in three groups of patients: (1) 57 patients with renovascular hypertension due to a poststenotic, ischemic kidney; (2) 23 patients with essential hypertension; and (3) 50 nonhypertensive patients with healthy kidneys (control group). FR was observed as renal parenchymal tracer washout within 10 minutes after the injection of 40 mg of furosemide. The retention index (RI) took into consideration the renal parenchymal tracer content before and 10 minutes after furosemide injection. In the control group, the FR was greater than 50% and the RI was less than 20. Patients with essential hypertension revealed no differences in the amounts of FR and RI compared with the control group. In renovascular hypertension, the FR was diminished and the RI was raised significantly. The values of FR and RI showed a good correlation to the degree of the renal artery stenosis before and after percutaneous transluminal angioplasty. It is concluded that the stimulation of diuresis with furosemide and its quantification represent an important additional step in the evaluation of dynamic I-123 Hippuran studies to detect renal ischemia.

  1. Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Da-Bing Zhao; Jie-Sheng Qian; Hong Shan; Zai-Bo Jiang; Ming-Sheng Huang; Kang-Shun Zhu; Gui-Hua Chen; Xiao-Chun Meng; Shou-Hai Guan; Zheng-Ran Li

    2007-01-01

    AIM: To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture.METHODS: Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases.RESULTS: Diffuse intra- and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION: Progressive, non-anastomosis, and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

  2. The influence of pregnancy and gender on perivascular innervation of rat posterior cerebral arteries

    NARCIS (Netherlands)

    Aukes, Annet M.; Bishop, Nicole; Godfrey, Julie; Cipolla, Marilyn J.

    2008-01-01

    The authors investigated the influence of pregnancy and gender on the density of trigeminal and sympathetic perivascular nerves in posterior cerebral arteries (PCA) and the reactivity to norepinephrine and calcitonin gene-related peptide (CGRP). PCAs were isolated from nonpregnant, late-pregnant, po

  3. Calibrated MRI to evaluate cerebral hemodynamics in patients with an internal carotid artery occlusion

    NARCIS (Netherlands)

    De Vis, Jill B.; Petersen, Esben T.; Bhogal, Alex; Hartkamp, Nolan S.; Klijn, Catharina J. M.; Kappelle, L. J.; Hendrikse, J.

    2015-01-01

    The purpose of this study was to assess whether calibrated magnetic resonance imaging (MRI) can identify regional variances in cerebral hemodynamics caused by vascular disease. For this, arterial spin labeling (ASL)/blood oxygen level-dependent (BOLD) MRI was performed in 11 patients (65 +/- 7 years

  4. Correcting partial volume artifacts of the arterial input function in quantitative cerebral perfusion MRI

    NARCIS (Netherlands)

    van Osch, MJP; Vonken, EJPA; Bakker, CJG; Viergever, MA

    2001-01-01

    To quantify cerebral perfusion with dynamic susceptibility contrast MRI (DSC-MRI), one needs to measure the arterial input function (AIF). Conventionally, one derives the contrast concentration from the DSC sequence by monitoring changes in either the amplitude or the phase signal on the assumption

  5. Hemicraniectomy in Older Patients with Extensive Middle-Cerebral-Artery Stroke

    DEFF Research Database (Denmark)

    Jüttler, Eric; Unterberg, Andreas; Woitzik, Johannes

    2014-01-01

    BACKGROUND. Early decompressive hemicraniectomy reduces mortality without increasing the risk of very severe disability among patients 60 years of age or younger with complete or subtotal space-occupying middle-cerebral-artery infarction. Its benefit in older patients is uncertain. METHODS. We...

  6. Low maternal middle cerebral artery Doppler resistance indices can predict future development of pre-eclampsia

    NARCIS (Netherlands)

    Belfort, M.; Van Veen, T.; White, G. L.; Kofford, S.; Allred, J.; Postma, I.; Varner, M.

    2012-01-01

    Objective To determine if decreased resistance (vasodilatation) in the maternal middle cerebral artery (MCA) in the second trimester can predict third-trimester development of pre-eclampsia. Methods Four-hundred and five low-risk gravidas had MCA transcranial Doppler (TCD) once in the second trimest

  7. The role of cGMP hydrolysing phosphodiesterases 1 and 5 in cerebral artery dilatation

    DEFF Research Database (Denmark)

    Kruuse, Christina; Rybalkin, S D; Khurana, T S;

    2001-01-01

    -IBMX) and the phosphodiesterase 5 inhibitors zaprinast and dipyridamole induced dilatation of cerebral arteries. The dilatory response to 8-MM-IBMX was reduced by 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) (10 microM) and endothelial removal and restored by sodium nitroprusside (0.1 microM) pretreatment, indicating...

  8. Quality of life after surgical decompression for space-occupying middle cerebral artery infarction: systematic review

    NARCIS (Netherlands)

    Middelaar, T. van; Nederkoorn, P.J.; Worp, H.B. van der; Stam, J.; Richard, E.

    2015-01-01

    BACKGROUND AND PURPOSE: In patients with space-occupying middle cerebral artery infarction, surgical decompression strongly reduces risk of death and increases the chance of a favorable outcome. This comes at the expense of an increase in the risk of survival with (moderately) severe disability. We

  9. Low Incidence of Early Postoperative Cerebral Edema After Coronary Artery Bypass Grafting

    NARCIS (Netherlands)

    Ottens, Thomas H.; Hendrikse, J; Slooter, Arjen J. C.; van Herwerden, LA; Dieleman, Stefan; van Dijk, Diederik

    2015-01-01

    Objective: Using magnetic resonance imaging, the authors studied the influence of a single high dose of intraoperative dexamethasone on the severity of cerebral edema that can occur early after coronary artery bypass grafting (CABG). It was hypothesized that high-dose intraoperative dexamethasone re

  10. Prognostic value of collateral circulation in patients with unilateral middle cerebral artery occlusion

    Institute of Scientific and Technical Information of China (English)

    梅雨晴

    2014-01-01

    Objective To investigate the characteristics of the collateral circulation in patients with acute cerebral infarction after the middle cerbral artery(MCA)occlusion,and to evaluate its prognostic value.Methods Consecutive series of 118 patients with first-ever stroke after MCA occlusions subjects were retrieved from our hospital and Nanjing Stroke Registry Program between April 2010 and

  11. Single center experience and technical nuances in the treatment of distal anterior cerebral artery aneurysms

    Directory of Open Access Journals (Sweden)

    Gherasim Dorin Nicolae

    2017-03-01

    Full Text Available Objective: This study presents the experience of one neurosurgical center in the treatment of 18 consecutive patients with distal anterior cerebral artery (DACA aneurysms during a 10 years period. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general, and to present technical nuances in surgical treatment.

  12. Traumatic distal anterior cerebral artery aneurysm in a child : a case report.

    Directory of Open Access Journals (Sweden)

    Raju B

    2001-07-01

    Full Text Available Traumatic intracranial aneurysms constitute less than 1% of all intracranial aneurysms. A case of traumatic distal anterior cerebral artery aneurysm in 18 months old child, treated successfully by microsurgical excision of aneurysm is being reported, along with review of the literature.

  13. Stent-assisted mechanical recanalization for symptomatic subacute or chronic middle cerebral artery occlusion

    Science.gov (United States)

    Guo, Dong; Ma, Ji; Li, Teng-Fei; Zhu, Ming; Han, Xin-Wei; Shui, Shao-Feng

    2015-01-01

    To assess the feasibility and short-term effects of treating patients with subacute or chronic middle cerebral artery (M1) occlusion by stent-assisted mechanical recanalization. Six patients with cerebral arteries occlusion underwent surgery. Six cerebral arteries occlusion in 5 patients were successfully recanalized. On postoperative day 1, four patients’ symptoms were relieved and two patients’ symptoms were exacerbated, of which one was significantly improved after 3 days, the other one’s symptoms were recovered to preoperative levels in 2 weeks. No patients died after surgery. No stroke or transient ischemic attack occurred. The average follow-up of was 4.2 months, no worsening of condition, recurrence or death occurred. The results indicate that for patients with subacute or chronic middle cerebral artery (M1) occlusion, mechanical recanalization was technically feasible under the premise of strict case screening. Mechanical recanalization is able to improve ischemic symptoms and promote dysfunction restoration. But its long-term effect remains to be evaluated by further large samples, long-term follow-up studies. PMID:26885148

  14. Epilepsy in Hemiplegic Cerebral Palsy Due to Perinatal Arterial Ischaemic Stroke

    Science.gov (United States)

    Wanigasinghe, Jithangi; Reid, Susan M.; Mackay, Mark T.; Reddihough, Dinah S.; Harvey, A. Simon; Freeman, Jeremy L.

    2010-01-01

    Aim: The aim of this study was to describe the frequency, risk factors, manifestations, and outcome of epilepsy in children with hemiplegic cerebral palsy (CP) due to perinatal arterial ischaemic stroke (AIS). Method: The study group comprised 63 participants (41 males, 22 females) from a population-based CP register whose brain imaging showed…

  15. In vitro shear stress measurements using particle image velocimetry in a family of carotid artery models: effect of stenosis severity, plaque eccentricity, and ulceration.

    Science.gov (United States)

    Kefayati, Sarah; Milner, Jaques S; Holdsworth, David W; Poepping, Tamie L

    2014-01-01

    Atherosclerotic disease, and the subsequent complications of thrombosis and plaque rupture, has been associated with local shear stress. In the diseased carotid artery, local variations in shear stress are induced by various geometrical features of the stenotic plaque. Greater stenosis severity, plaque eccentricity (symmetry) and plaque ulceration have been associated with increased risk of cerebrovascular events based on clinical trial studies. Using particle image velocimetry, the levels and patterns of shear stress (derived from both laminar and turbulent phases) were studied for a family of eight matched-geometry models incorporating independently varied plaque features - i.e. stenosis severity up to 70%, one of two forms of plaque eccentricity, and the presence of plaque ulceration). The level of laminar (ensemble-averaged) shear stress increased with increasing stenosis severity resulting in 2-16 Pa for free shear stress (FSS) and approximately double (4-36 Pa) for wall shear stress (WSS). Independent of stenosis severity, marked differences were found in the distribution and extent of shear stress between the concentric and eccentric plaque formations. The maximum WSS, found at the apex of the stenosis, decayed significantly steeper along the outer wall of an eccentric model compared to the concentric counterpart, with a 70% eccentric stenosis having 249% steeper decay coinciding with the large outer-wall recirculation zone. The presence of ulceration (in a 50% eccentric plaque) resulted in both elevated FSS and WSS levels that were sustained longer (∼20 ms) through the systolic phase compared to the non-ulcerated counterpart model, among other notable differences. Reynolds (turbulent) shear stress, elevated around the point of distal jet detachment, became prominent during the systolic deceleration phase and was widely distributed over the large recirculation zone in the eccentric stenoses.

  16. In vitro shear stress measurements using particle image velocimetry in a family of carotid artery models: effect of stenosis severity, plaque eccentricity, and ulceration.

    Directory of Open Access Journals (Sweden)

    Sarah Kefayati

    Full Text Available Atherosclerotic disease, and the subsequent complications of thrombosis and plaque rupture, has been associated with local shear stress. In the diseased carotid artery, local variations in shear stress are induced by various geometrical features of the stenotic plaque. Greater stenosis severity, plaque eccentricity (symmetry and plaque ulceration have been associated with increased risk of cerebrovascular events based on clinical trial studies. Using particle image velocimetry, the levels and patterns of shear stress (derived from both laminar and turbulent phases were studied for a family of eight matched-geometry models incorporating independently varied plaque features - i.e. stenosis severity up to 70%, one of two forms of plaque eccentricity, and the presence of plaque ulceration. The level of laminar (ensemble-averaged shear stress increased with increasing stenosis severity resulting in 2-16 Pa for free shear stress (FSS and approximately double (4-36 Pa for wall shear stress (WSS. Independent of stenosis severity, marked differences were found in the distribution and extent of shear stress between the concentric and eccentric plaque formations. The maximum WSS, found at the apex of the stenosis, decayed significantly steeper along the outer wall of an eccentric model compared to the concentric counterpart, with a 70% eccentric stenosis having 249% steeper decay coinciding with the large outer-wall recirculation zone. The presence of ulceration (in a 50% eccentric plaque resulted in both elevated FSS and WSS levels that were sustained longer (∼20 ms through the systolic phase compared to the non-ulcerated counterpart model, among other notable differences. Reynolds (turbulent shear stress, elevated around the point of distal jet detachment, became prominent during the systolic deceleration phase and was widely distributed over the large recirculation zone in the eccentric stenoses.

  17. Arterial pulsatility as an index of cerebral microangiopathy in diabetes type 2.

    Science.gov (United States)

    Agha, M S; Alboudi, A

    2014-01-09

    Transcranial doppler is an inexpensive, non-invasive investigation. This study assessed its validity in determining cerebral small vessel disease in patients with type 2 diabetes mellitus. Flow velocity and pulsatility index were measured in the middle cerebral, basilar and intracranial internal carotid arteries of a sample of 141 diabetic patients with no other risk factors, and 132 age- and sex-matched healthy controls. The patients were divided into 2 groups: 73 with complicated and 68 with uncomplicated diabetes. There was a statistically significant difference between the complicated diabetes and control groups for the 3 arteries and most indices. The differences between the uncomplicated diabetes patients and the controls were also statistically significant but less strongly. Transcranial doppler may be useful in early diagnosis of cerebral small vessel disease in patients with type 2 diabetes mellitus.

  18. Determination of Doppler Middle Cerebral Artery Waveform Indices in Normal 20 – 40 Weeks Pregnancies

    Directory of Open Access Journals (Sweden)

    S. Vahdinia

    2008-01-01

    Full Text Available Background/Objective: The aim of prenatal evaluation is to prevent fetal death. One of the main methods of evaluation of fetus health before delivery is Doppler flow velocity waveform analysis of fetus vessels. Increasing of resistance in fetal circulatory system causes the preferential shunt of blood flow from non-critical organs toward critical organs such as brain. The increase in brain blood flow leads to reduction of brain vessels resistance and results in changes of fetal cerebral arteries Doppler flow velocity indices. Evaluation of Doppler wave of middle cerebral artery can predict most of the at risk fetuses in high-risk pregnancies."nIn this study we tried to obtain normal value (and their changes across the progress of pregnancy of Doppler flow velocity indices (PI, RI, S/D ratio and PSV of middle cerebral artery in 20 - 40 weeks normal pregnancies in an Iranian population and evaluate the effect of fetus heart rate according to the above mentioned indices."nPatients and Methods: In this cross section study, 400 pregnant women with normal pregnancies and gestational age between 20 to 40 weeks were studied about middle cerebral artery Doppler examination. Mothers with preeclampsia, diabetes mellitus, hypertension, abnormal uterine bleeding, induction ovulation, multifetal pregnancy, major fetal anomalies, history of LD or any other OCP usage and intra uterine growth retardation were excluded from the study. All cases were evaluated by gray scale ultrasonography initially and then a Doppler study of middle cerebral artery was done."nResults: According to the results of this study, with progression of pregnancy PI, RI, S/D ratio values decrease and PSV value increases in middle cerebral artery. These changes were statistically significant and were more characteristic during late weeks of pregnancy. In addition, mean fetal heart rate had been significantly reduced with pregnancy progression."nConclusion: Values of RI, PI, S/D ratio and

  19. Effect of induced hypertension on experimentally-induced cerebral arterial spasm.

    Directory of Open Access Journals (Sweden)

    Shimata,Kenji

    1984-04-01

    Full Text Available Ten adult cats were anesthetized and ventilated by respirator. After the basilar artery was exposed transclivally and visualized with an operative microscope, mean arterial blood pressure (MABP was raised gradually by intravenous drip infusion of norepinephrine (5-20 micrograms/kg or angiotensin-II-amide (0.3-1.0 micrograms/kg. At various blood pressures, microphotographs were taken. There was no appreciable change in vessel diameter at a MABP ranging from 78 to 191 mmHg. The blood pressure was allowed to return to the initial baseline level. Arterial spasm was produced by the topical application of 0.2 M calcium gluconate, which decreased the arterial diameter by 13 to 58 percent for more than 60 min. Blood pressure was increased again after the production of the arterial spasm. Significant increases in the diameter of the arteries were produced by the drug-induced hypertension at levels of MABP ranging from 82 to 192 mmHg. The maximum arterial dilations ranged from 123 to 208 percent of the untreated control. The degree of dilation of the arteries almost paralleled the rise in MABP. Norepinephrine and angiotensin-II had a similar effect on both the blood pressure and the arterial diameter. Induced hypertension would be expected to improve blood flow parameters in the case of spastic cerebral arteries.

  20. [Post-radiotherapy stenosis of the supraclinoid internal carotid artery. Moyamoya network].

    Science.gov (United States)

    Benoit, P; Destée, A; Verier, A; Giraldon, J M; Warot, P

    1985-01-01

    A 36 year-old caucasian woman was operated and then irradiated for a pituitary adenoma. Two years later, a left anterior temporal lobectomy for a grade I astrocytoma was performed. Four years later, she experienced right hemiparesis and aphasia. CT scan showed a left temporo-occipital low density area. A left carotid angiogram showed a narrowing of the left carotid artery beginning in the lower part of the siphon and progressing to a complete supraclinoid occlusion. There was a collateral circulation of the Moyamoya type. Radiation-induced narrowing or occlusion of the intracranial internal carotid artery is an infrequent finding. Most cases appear in young subjects, several years after a high dose of radiation therapy (30 to 60 grays). Some cases may show a network of the Moyamoya type. Usually, the absence of vascular abnormalities prior to radiation cannot be demonstrated. In our case, as in 3 other cases of the literature, the intracranial vessels were of normal appearance before irradiation. The vascular lesions can thus be considered as acquired and secondary to radiation therapy.

  1. Association of Polymorphisms in Angiotensin-converting Enzyme and Type 1 Angiotensin Ⅱ Receptor Genes with Coronary Heart Disease and the Severity of Coronary Artery Stenosis

    Institute of Scientific and Technical Information of China (English)

    QIU Chunguang; HAN Zhanying; LU Wenjie; ZHANG Cuntai

    2007-01-01

    To explore the relation of angiotensin-converting enzyme (ACE) and angiotensin Ⅱ type 1 receptor (AT1R) gene polymorphism with coronary heart disease (CHD) and the severity of coronary artery stenosis, 130 CHD patients who underwent coronary angiography were examined for the number of affected coronary vessels (≥75% stenosis) and coronary Jeopardy score. The inser- tion/deletion of ACE gone polymorphism and ATIR gene polymorphism (an A→C transversion at nucleotide position 1166) were detected by using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) in CHD patients and 90 healthy serving as controls. The re- sults showed that DD genotype and of ACE were more frequent in CHD patients than that in control group (38.5% vs 14.4%, P<0.001). The frequency of the AT1R A/C genotypes did not differ between the patients and the controls (10% vs 13.1%, P0.05). The relative risk associated with the ACE-DD was increased by ATIR-AC genotype. Neither the number of affected coronary vessels nor the coro-nary score differed among the ACE I/D genotypes (P0.05). But the number of affected coronary vessels and the coronary score were significantly greater in the patients with the AT1R-AC genotype than in those with the AA genotype (P<0.05). In conclusion, DD genotype may he risk factor for CHD and MI in Chinese people, and is not responsible for the development of the coronary artery stenosis. The AT1R-C allele may increase the relative risk associated with the ACE-DD genotype, and may be involved in the development of the stenosis of coronary artery.

  2. Effects of ginsenosides on vascular reactivity in rat cerebral and renal arteries

    Institute of Scientific and Technical Information of China (English)

    WONG Wing-tak; LEUNG Fung-ping; YUNG Lai-hang; TIAN Xiao-yu; WONG Ricky Ngok Shun; HUANG Yu

    2008-01-01

    Objective To investigate possible mechanisms underlying the antioxidant property (1) and the in vitro vasodilator effects (2) of the two ginsenosides, Rb1 and Rg1, in isolated rat renal and cerebral arteries. Methods Arterial rings were mounted in a multi-channel myograph for recording of isometric tension. To examine the antioxidant activity, some rings were exposed to a free radical-generating reaction (hypoxan-thine and xanthine oxidase) with and without pre-treatment with ginsenosides. The calcium antagonistic effects were tested on rings contracted by membrane depolarization in elevated extracellular potassium ions, a condition that promoted Ca2+ influx in vascular smooth muscle cells. Results Ginsenosides protected endothelial function (endothelial nitric oxide-dependent relaxation) against oxidative stress; (2) ginsenoside Rb1 reduced the high K+ -induced contractions of both renal and cerebral arteries while ginsenoside Rgl relaxed the rat cerebral artery but not the renal artery. Conclusions Ginsenosides are vaso-protective via (1) the antioxidant activity which protects endothelial cell function and (2) the inhibition of Ca2+ influx through voltage-sensitive Ca2+ channels in vascular smooth muscle. The vasodilator effects may suggest the potential preventive or therapeutic values of ginsenosides against stroke and renal hypertension.

  3. Phosphodiesterase 5 and effects of sildenafil on cerebral arteries of man and guinea pig

    DEFF Research Database (Denmark)

    Kruuse, Christina; Khurana, Tejvir S; Rybalkin, Sergei D

    2005-01-01

    and UK-114,542, and a PDE1 inhibitor UK-90,234 on cGMP hydrolysis were investigated in human and guinea pig cerebral arteries. The vasoactive responses of the compounds were evaluated in guinea pig basilar arteries in vitro, with concomitant measurements of cAMP and cGMP. PDE5 was found in human middle...... cerebral arteries. Sildenafil and UK-114,542 inhibited cGMP hydrolysis concentration-dependently in both species. In guinea pig arteries, sildenafil induced an endothelium-dependent vasodilatation only at concentrations above 10 nM, which was augmented by sodium nitroprusside and attenuated by reduction...... of cGMP, but was cGMP independent at high concentrations. UK-114,542 was more and UK-90,234 was less potent than sildenafil. In conclusion, PDE5 is present in human and guinea pig cerebral arteries, and is inhibited by sildenafil at micromolar levels. Sildenafil in vitro is a poor dilator of guinea pig...

  4. Eugenol dilates rat cerebral arteries by inhibiting smooth muscle cell voltage-dependent calcium channels.

    Science.gov (United States)

    Peixoto-Neves, Dieniffer; Leal-Cardoso, Jose Henrique; Jaggar, Jonathan H

    2014-11-01

    Plants high in eugenol, a phenylpropanoid compound, are used as folk medicines to alleviate diseases including hypertension. Eugenol has been demonstrated to relax conduit and ear arteries and reduce systemic blood pressure, but mechanisms involved are unclear. Here, we studied eugenol regulation of resistance-size cerebral arteries that control regional brain blood pressure and flow and investigated mechanisms involved. We demonstrate that eugenol dilates arteries constricted by either pressure or membrane depolarization (60 mM K) in a concentration-dependent manner. Experiments performed using patch-clamp electrophysiology demonstrated that eugenol inhibited voltage-dependent calcium (Ca) currents, when using Ba as a charge carrier, in isolated cerebral artery smooth muscle cells. Eugenol inhibition of voltage-dependent Ca currents involved pore block, a hyperpolarizing shift (∼-10 mV) in voltage-dependent inactivation, an increase in the proportion of steady-state inactivating current, and acceleration of inactivation rate. In summary, our data indicate that eugenol dilates cerebral arteries by means of multimodal inhibition of voltage-dependent Ca channels.

  5. Noradrenergic constriction of cerebral arteries as detected by transcranial Doppler (TCD) in the rabbit.

    Science.gov (United States)

    Roatta, S; Canova, D; Bosone, D; Micieli, G; Passatore, M

    2003-10-01

    Interpretation of transcranial Doppler (TCD) recordings requires assumptions about flow or diameter of the insonated vessel. This study aimed at assessing if activation of the sympathetic system could affect blood velocity (bv) in basal cerebral arteries. In anaesthetized rabbits, stimulation of cervical sympathetic nerve (cervSN) was used selectively to activate the sympathetic pathway to the head while monitoring bv in all major cerebral arteries. cervSN stimulation at 10 Hz produced: 1. in internal carotid artery (ICA) and ICA-supplied arteries (ICA-s), a consistent bv increase ranging between 20 and 70%, 2. in the basilar artery, a transient decrease by 15-30%. These effects were mimicked, in both territories, by injection of phenylephrine into the ICA. Because cerebral blood flow is known to be reduced by cervSN stimulation, the increase in bv in ICA and ICA-s must be ascribed to constriction of the insonated vessels. These effects should be considered when monitoring bv during sympathetic activation tests or exercise.

  6. Instability of the middle cerebral artery blood flow in response to CO2.

    Directory of Open Access Journals (Sweden)

    Rosemary E Regan

    Full Text Available BACKGROUND: The middle cerebral artery supplies long end-artery branches to perfuse the deep white matter and shorter peripheral branches to perfuse cortical and subcortical tissues. A generalized vasodilatory stimulus such as carbon dioxide not only results in an increase in flow to these various tissue beds but also redistribution among them. We employed a fast step increase in carbon dioxide to detect the dynamics of the cerebral blood flow response. METHODOLOGY/PRINCIPAL FINDINGS: The study was approved by the Research Ethics Board of the University Health Network at the University of Toronto. We used transcranial ultrasound to measure the time course of middle cerebral artery blood flow velocity in 28 healthy adults. Normoxic, isoxic step increases in arterial carbon dioxide tension of 10 mmHg from both hypocapnic and normocapnic baselines were produced using a new prospective targeting system that enabled a more rapid step change than has been previously achievable. In most of the 28 subjects the responses at both carbon dioxide ranges were characterised by more complex responses than a single exponential rise. Most responses were characterised by a fast initial response which then declined rapidly to a nadir, followed by a slower secondary response, with some showing oscillations before stabilising. CONCLUSIONS/SIGNIFICANCE: A rapid step increase in carbon dioxide tension is capable of inducing instability in the cerebral blood flow control system. These dynamic aspects of the cerebral blood flow responses to rapid changes in carbon dioxide must be taken into account when using transcranial blood flow velocity in a single artery segment to measure cerebrovascular reactivity.

  7. Is misery perfusion still a predictor of stroke in symptomatic major cerebral artery disease?

    Science.gov (United States)

    Yamauchi, Hiroshi; Higashi, Tatsuya; Kagawa, Shinya; Nishii, Ryuichi; Kudo, Takashi; Sugimoto, Kanji; Okazawa, Hidehiko; Fukuyama, Hidenao

    2012-08-01

    Studies in the 1990s demonstrated that misery perfusion is a predictor of subsequent stroke in medically treated patients with symptomatic major cerebral artery disease. A recent randomized controlled trial demonstrated no benefit of bypass surgery for such patients. In this light, outcome in patients with misery perfusion has regained interest. The purpose of this study was to determine whether misery perfusion is still a predictor of subsequent stroke despite recent improvements in medical treatment for secondary prevention of stroke, and if so, whether the predictive value of misery perfusion has changed in recent years. We prospectively studied 165 non-disabled patients with symptomatic atherosclerotic internal carotid artery or middle cerebral artery occlusive diseases who underwent positron emission tomography from 1999 to 2008. Misery perfusion was defined as decreased cerebral blood flow, increased oxygen extraction fraction and decreased ratio of cerebral blood flow to blood volume in the hemisphere supplied by the diseased artery. All patients were followed up for 2 years until stroke recurrence or death. Bypass surgery was performed in 19 of 35 patients with and 16 of 130 patients without misery perfusion. The 2-year incidence of ipsilateral ischaemic stroke was six and four patients with and without misery perfusion, including two and one after surgery, respectively (P misery perfusion and 12 patients without (P misery perfusion in whole sample was 6.3 (95% confidence interval 1.7-22.4, P misery perfusion or bypass surgery did not differ. Between these periods, patients without misery perfusion demonstrated a decrease in stroke rate (from 16.2% to 0%), but patients with misery perfusion did not (26.3 and 25.0%). In symptomatic major cerebral artery disease, misery perfusion remains a predictor of subsequent stroke, although the recurrence rate was lower than the previous study. In patients without misery perfusion, the risk of stroke was reduced

  8. Serum uric acid is a risk factor for large-artery atherosclerosis cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    Jianjun Guo; Qingyu Shen; Jie Li; Xiaoming Rong; Ying Peng; Yamei Tang

    2011-01-01

    Using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification for acute ischemic stroke, 371 patients with either acute large-artery atherosclerosis or small-artery occlusion cerebral infarction were recruited to investigate the potential impact of elevated serum uric acid on cerebrovascular disorders. The results showed that patients who have suffered from large-artery atherosclerosis, relative to small-artery occlusion patients, were characterized by elevated serum uric acid but reduced high-density lipoprotein cholesterol and triglyceride levels. Logistic regression showed that elevated uric acid and lower triglyceride levels were the main risk factors for patients with large-artery atherosclerosis. The findings of this study suggest that hyperuricemia may be a risk factor for stroke.

  9. CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass)

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Yueqin [Hospital of Qingdao University, Department of Radiology, Qingdao (China); Hospital of Jining Medical College, CT Department, Jining (China); Xu, Wenjian [Hospital of Qingdao University, Department of Radiology, Qingdao (China); Guo, Xiang; Shi, Zhitao; Sun, Zhanguo; Wang, Jiehuan [Hospital of Jining Medical College, CT Department, Jining (China); Gao, Lingyun [Hospital of Jining Medical College, MR Department, Jining (China); Jin, Feng [Hospital of Jining Medical College, Department of Neurosurgery, Jining (China); Chen, Weijian; Yang, Yunjun [Hospital of Wenzhou Medical University, Department of Radiology, Wenzhou (China)

    2016-01-15

    To evaluate the utility of CT perfusion (CTP) for the assessment of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with Moyamoya syndrome (MMS). Twenty-four consecutive MMS patients, who underwent unilateral STA-MCA bypass surgery, received CTP before and after surgery. The relative perfusion parameter values of surgical hemispheres before treatment were compared with post-treatment values. All patients underwent CT angiography (CTA) before and after surgery in order to confirm the patency of bypass. The follow-up CTA after surgery clearly demonstrated 20 (20/24, 83.3 %) bypass arteries, whereas four (16.7 %) bypass arteries were occluded or very small. Postoperative rMTT and rTTP values (P < 0.05) of the surgical side were significantly lower than pre-operation. In patients (n = 20) with bypass patency, postoperative rCBF, rMTT and rTTP values (P < 0.05) of the surgical side were significantly improved. However, the differences of all parameters were not significant (P > 0.05) in the patients (n = 4) without bypass patency after revascularization. This study demonstrates that CTP can provide a crucial quantitative assessment of cerebral haemodynamic changes in MMS before and after STA-MCA anastomosis. (orig.)

  10. Central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections.

    Science.gov (United States)

    Hong, Jeong-Ho; Ahn, Seong Joon; Woo, Se Joon; Jung, Cheolkyu; Chang, Jun Young; Chung, Jin-Heon; Han, Moon-Ku

    2014-11-15

    We report 2 cases of central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections and a literature review. The 2 patients were two healthy women, in which cosmetic facial injections with autologous fat and filler were performed, respectively. The patients had no light perception at the final visit and their conditions led to memory retrieval disturbance in case 1 and right arm weakness, dysarthria, facial palsy, and ophthalmoplegia in case 2. Neuroimaging showed multifocal small infarctions in the ipsilateral frontal lobe with occlusion of the ophthalmic artery in case 1 and multiple infarctions in the ipsilateral anterior and middle cerebral artery territories with subsequent hemorrhagic transformation in case 2. Poor visual prognosis and neurological complications can occur in healthy adults undergoing cosmetic facial injection, and all patients should be informed of this risk before the procedure.

  11. COMPUTER SIMULATION OF NON-NEWTONIAN FLOW AND MASS TRANSPORT THROUGH CORONARY ARTERIAL STENOSIS

    Institute of Scientific and Technical Information of China (English)

    李新宇; 温功碧; 李丁

    2001-01-01

    A numerical analysis of Newtonian and non-Newtonian flow in an axi-symmetric tube with a local constriction simulating a stenosed artery under steady and pulsatile flow conditions was carried out. Based on these results, the concentration fields of LDL ( low density lipoprotein ) and Albumin were discussed. According to the results, in great details the macromolecule transport influences of wall shear stress, non-Newtonian fluid character and the scale of the molecule etc are given. The results of Newtonian fluid flow and non Newtonian fluid flow , steady flow and pulsatile flow are compared. These investigations can provide much valuable information about the correlation between the flow properties, the macromolecule transport and the development of atherosclerosis.

  12. CaV3.2 Channels and the Induction of Negative Feedback in Cerebral Arteries

    Science.gov (United States)

    Harraz, Osama F.; Abd El-Rahman, Rasha R.; Bigdely-Shamloo, Kamran; Wilson, Sean M.; Brett, Suzanne E.; Romero, Monica; Gonzales, Albert L.; Earley, Scott; Vigmond, Edward J.; Nygren, Anders; Menon, Bijoy K.; Mufti, Rania E.; Watson, Tim; Starreveld, Yves; Furstenhaupt, Tobias; Muellerleile, Philip R.; Kurjiaka, David T.; Kyle, Barry D.; Braun, Andrew P.; Welsh, Donald G.

    2015-01-01

    Rationale T-type (CaV3.1/CaV3.2) Ca2+ channels are expressed in rat cerebral arterial smooth muscle. Although present, their functional significance remains uncertain with findings pointing to a variety of roles. Objective This study tested whether CaV3.2 channels mediate a negative feedback response by triggering Ca2+ sparks, discrete events that initiate arterial hyperpolarization by activating large-conductance Ca2+-activated K+ channels. Methods and Results Micromolar Ni2+, an agent that selectively blocks CaV3.2 but not CaV1.2/CaV3.1, was first shown to depolarize/constrict pressurized rat cerebral arteries; no effect was observed in CaV3.2−/− arteries. Structural analysis using 3-dimensional tomography, immunolabeling, and a proximity ligation assay next revealed the existence of microdomains in cerebral arterial smooth muscle which comprised sarcoplasmic reticulum and caveolae. Within these discrete structures, CaV3.2 and ryanodine receptor resided in close apposition to one another. Computational modeling revealed that Ca2+ influx through CaV3.2 could repetitively activate ryanodine receptor, inducing discrete Ca2+-induced Ca2+ release events in a voltage-dependent manner. In keeping with theoretical observations, rapid Ca2+ imaging and perforated patch clamp electrophysiology demonstrated that Ni2+ suppressed Ca2+ sparks and consequently spontaneous transient outward K+ currents, large-conductance Ca2+-activated K+ channel mediated events. Additional functional work on pressurized arteries noted that paxilline, a large-conductance Ca2+-activated K+ channel inhibitor, elicited arterial constriction equivalent, and not additive, to Ni2+. Key experiments on human cerebral arteries indicate that CaV3.2 is present and drives a comparable response to moderate constriction. Conclusions These findings indicate for the first time that CaV3.2 channels localize to discrete microdomains and drive ryanodine receptor–mediated Ca2+ sparks, enabling large

  13. Therapeutic effects of different durations of acupuncture on rats with middle cerebral artery occlusion

    Directory of Open Access Journals (Sweden)

    Chao Zhang

    2015-01-01

    Full Text Available Acupuncture is regarded as an effective therapy for cerebral ischemia. Different acupuncture manipulations and durations may result in different therapeutic effects. In the present study, the Neiguan (PC6 acupoint of rats with occluded middle cerebral arteries was needled at a fixed frequency (3 Hz with different durations, i.e., 5, 60 and 180 seconds under a twisting-rotating acupuncture method. Results showed that different durations of acupuncture had different therapeutic effects, with 60 seconds yielding a better therapeutic effect than the other two groups. This duration of treatment demonstrated rapid cerebral blood flow, encouraging recovery of neurological function, and small cerebral infarct volume. Experimental findings indicated that under 3 Hz frequency, the treatment of needling Neiguan for 60 seconds is effective for ischemic stroke

  14. Arterial spin labeling perfusion MRI in cerebral ischaemia

    NARCIS (Netherlands)

    Bokkers, R.P.H.

    2011-01-01

    Cerebral perfusion is the basis for the delivery of oxygen and nutrients to the brain. Brain tissue can become damaged when there is a shortage in the blood supply. Basic physiological functions such as synaptic transmission, the membrane ion pump and energy metabolism are disrupted and within minut

  15. Imaging of cerebral hemodynamics with arterial spin labeling

    NARCIS (Netherlands)

    Hartkamp, N.S.

    2014-01-01

    A knowledge of the cerebral circulation is of great importance in the understanding cerebrovascular disease. The ability to visualize the brain vasculature has become key in the diagnosis and treatment of cerebrovascular disease. Modern imaging modalities, such as digital subtraction angiography, co

  16. Spontaneous dissections of the anterior cerebral artery: a meta-analysis of the literature and three recent cases

    Energy Technology Data Exchange (ETDEWEB)

    Hensler, Johannes; Jensen-Kondering, Ulf; Jansen, Olav [University Hospital Schleswig-Holstein (UKSH), Department of Radiology and Neuroradiology, Kiel (Germany); Ulmer, Stephan [Medical Radiological Institute, Neuroradiology, Zurich (Switzerland)

    2016-10-15

    Spontaneous dissections of intracranial arteries are rare, but important causes of stroke, especially in younger patients. Dissections of the anterior cerebral artery (ACA) have been reported only very rarely in the European and North American populations but might be more prevalent than previously thought. This paper describes the presenting pattern of the disease, the clinical and imaging findings, as well as endovascular therapeutical options with respect to a meta-analysis of cases reported in the literature. Additionally, own observations in three recent representative cases are discussed. Overall, 80 cases from recent literature were included to the meta-analysis. The median age was 51 (35-82) years. Ischemia alone was described in 58 cases (73 %), subarachnoid hemorrhage (SAH) in 8 cases (10 %), and a combination of both in 14 cases (17 %). Radiological diagnosis including use of thin-layered 3T-MRI vessel wall imaging with black blood technique was verified by double lumen, by a string sign or string and pearl sign, or by a vessel wall hematoma in 23 (32 %), 62 (89 %), and 14 (20 %) cases, respectively. Interventional or surgical treatment was performed in 7 cases. A good clinical recovery was achieved in 77 % of cases. Dissections of the ACA mostly cause ischemia, but can cause SAH or a combination of both in a relatively young population. Detailed neuroradiological diagnosis including 3T-MRI vessel wall imaging is required as a double lumen, isolated stenosis due to vessel wall hematoma, or the secondary development of a pseudoaneurysm might occur. Interventional therapy is the primary therapy for these vascular complications. (orig.)

  17. Long-term patency of superficial temporal artery to middle cerebral artery bypass for cerebral atherosclerotic disease: factors determining the bypass patent.

    Science.gov (United States)

    Matano, Fumihiro; Murai, Yasuo; Tateyama, Kojiro; Tamaki, Tomonori; Mizunari, Takayuki; Matsukawa, Hideoshi; Teramoto, Akira; Morita, Akio

    2016-10-01

    Long-term patency of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery for atherosclerotic disease and associated risk factors for loss of patency have rarely been discussed. We retrospectively analyzed long-term patency following STA-MCA bypass and evaluated various demographic and clinical factors to identify the ones predictive of postsurgical loss of patency using records of 84 revascularization procedures (58 patients, 45 males; mean age at surgery 63.6 years, range 31-78 years). Bypass patency was diagnosed based on magnetic resonance angiography or three-dimensional computed tomography. The mean follow-up period was 24.7 months (range 6-63 months). Decreased bypass patency was observed in 4 of 58 patients (6.9 %) who collectively underwent 6 bypasses (7.1 %) of 84. All cases of decreased bypass patency were first detected within 6 months of surgery. Bypass patency was not correlated with age, sex, number of anastomoses, postoperative cerebral infarction, or control of postoperative diabetes mellitus. We found a significant association of bypass patency with hyperperfusion (p = 0.01) and postoperative smoking (p = 0.0036). Furthermore, we found a significant association of hyperperfusion with STA diameter (p bypass patency in cerebral atherosclerotic disease patients. Careful monitoring of patency to prevent hyperperfusion and cessation of smoking are recommended, particularly within 6 months of the surgery.

  18. Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries.

    Science.gov (United States)

    Kefer, Joelle M; Coche, Emmanuel; Vanoverschelde, Jean-Louis J; Gerber, Bernhard L

    2007-01-01

    The purpose of this study was to assess the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for detecting in-stent restenosis. Fifty patients with 69 previously implanted coronary stents underwent 16-slice MDCT before quantitative coronary angiography (QCA). Diagnostic accuracy of MDCT for detection of in-stent restenosis defined as >50% lumen diameter stenosis (DS) in stented and nonstented coronary segments >1.5-mm diameter was computed using QCA as reference. According to QCA, 18/69 (25%) stented segments had restenosis. In addition, 33/518 (6.4%) nonstented segments had >50% DS. In-stent restenosis was correctly identified on MDCT images in 12/18 stents, and absence of restenosis was correctly identified in 50/51 stents. Stenosis in native coronary arteries was correctly identified in 22/33 segments and correctly excluded in 482/485 segments. Thus, sensitivity (67% vs 67% p=1.0), specificity (98% vs 99%, p=0.96) and overall diagnostic accuracy (90% vs 97%, p=0.68) was similarly high for detecting in-stent restenosis as for detecting stenosis in nonstented coronary segments. MDCT has similarly high diagnostic accuracy for detecting in-stent restenosis as for detecting coronary artery disease in nonstented segments. This suggests that MDCT could be clinically useful for identification of restenosis in patients after coronary stenting.

  19. Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kefer, Joelle M.; Vanoverschelde, Jean-Louis J.; Gerber, Bernhard L. [Cliniques Universitaires St. Luc UCL, Department of Cardiology, Brussels (Belgium); Coche, Emmanuel [Cliniques Universitaires St. Luc UCL, Department of Radiology, Brussels (Belgium)

    2007-01-15

    The purpose of this study was to assess the diagnostic accuracy of 16-slice multidetector-row computed tomography (MDCT) for detecting in-stent restenosis. Fifty patients with 69 previously implanted coronary stents underwent 16-slice MDCT before quantitative coronary angiography (QCA). Diagnostic accuracy of MDCT for detection of in-stent restenosis defined as >50% lumen diameter stenosis (DS) in stented and nonstented coronary segments >1.5-mm diameter was computed using QCA as reference. According to QCA, 18/69 (25%) stented segments had restenosis. In addition, 33/518 (6.4%) nonstented segments had >50% DS. In-stent restenosis was correctly identified on MDCT images in 12/18 stents, and absence of restenosis was correctly identified in 50/51 stents. Stenosis in native coronary arteries was correctly identified in 22/33 segments and correctly excluded in 482/485 segments. Thus, sensitivity (67% vs 67% p=1.0), specificity (98% vs 99%, p=0.96) and overall diagnostic accuracy (90% vs 97%, p=0.68) was similarly high for detecting in-stent restenosis as for detecting stenosis in nonstented coronary segments. MDCT has similarly high diagnostic accuracy for detecting in-stent restenosis as for detecting coronary artery disease in nonstented segments. This suggests that MDCT could be clinically useful for identification of restenosis in patients after coronary stenting. (orig.)

  20. Carotid artery surgery

    Science.gov (United States)

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