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Sample records for proximal internal carotid

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

    Science.gov (United States)

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

    2014-01-01

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

  2. Association between proximal internal carotid artery steno-occlusive disease and diffuse wall thickening in its petrous segment: a magnetic resonance vessel wall imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Xiaoyi; Li, Dongye [Capital Medical University and Beijing Institute for Brain Disorders, Center for Brain Disorders Research, Beijing (China); Tsinghua University School of Medicine, Center for Biomedical Imaging Research, Department of Biomedical Engineering, Beijing (China); Zhao, Huilin [Shanghai Jiao Tong University, Department of Radiology, Renji Hospital, School of Medicine, Shanghai (China); Chen, Zhensen; Qiao, Huiyu; He, Le; Li, Rui [Tsinghua University School of Medicine, Center for Biomedical Imaging Research, Department of Biomedical Engineering, Beijing (China); Cui, Yuanyuan [PLA General Hospital, Department of Radiology, Beijing (China); Zhou, Zechen [Philips Research China, Healthcare Department, Beijing (China); Yuan, Chun [Tsinghua University School of Medicine, Center for Biomedical Imaging Research, Department of Biomedical Engineering, Beijing (China); University of Washington, Department of Radiology, Seattle, WA (United States); Zhao, Xihai [Tsinghua University School of Medicine, Center for Biomedical Imaging Research, Department of Biomedical Engineering, Beijing (China); Beijing Institute for Brain Disorders, Center for Stroke, Beijing (China)

    2017-05-15

    Significant stenosis or occlusion in carotid arteries may lead to diffuse wall thickening (DWT) in the arterial wall of downstream. This study aimed to investigate the correlation between proximal internal carotid artery (ICA) steno-occlusive disease and DWT in ipsilateral petrous ICA. Symptomatic patients with atherosclerotic stenosis (>0%) in proximal ICA were recruited and underwent carotid MR vessel wall imaging. The 3D motion sensitized-driven equilibrium prepared rapid gradient-echo (3D-MERGE) was acquired for characterizing the wall thickness and longitudinal extent of the lesions in petrous ICA and the distance from proximal lesion to the petrous ICA. The stenosis degree in proximal ICA was measured on the time-of-flight (TOF) images. In total, 166 carotid arteries from 125 patients (mean age 61.0 ± 10.5 years, 99 males) were eligible for final analysis and 64 showed DWT in petrous ICAs. The prevalence of severe DWT in petrous ICA was 1.4%, 5.3%, 5.9%, and 80.4% in ipsilateral proximal ICAs with stenosis category of 1%-49%, 50%-69%, 70%-99%, and total occlusion, respectively. Proximal ICA stenosis was significantly correlated with the wall thickness in petrous ICA (r = 0.767, P < 0.001). Logistic regression analysis showed that proximal ICA stenosis was independently associated with DWT in ipsilateral petrous ICA (odds ratio (OR) = 2.459, 95% confidence interval (CI) 1.896-3.189, P < 0.001). Proximal ICA steno-occlusive disease is independently associated with DWT in ipsilateral petrous ICA. (orig.)

  3. Grading of proximal internal carotid artery (ICA) stenosis by Doppler/duplex ultrasound (DUS) and computed tomographic angiography (CTA): correlation and interrater reliability in real-life practice.

    Science.gov (United States)

    Matz, Oliver; Nikoubashman, Omid; Rajkumar, Parajuli; Keuler, Andreas; Wiesmann, Martin; Schulz, Jörg B; Reich, Arno

    2017-03-01

    Doppler/duplex ultrasound (DUS) and computed tomographic angiography (CTA) are frequently applied methods to assess the degree of proximal internal carotid artery (ICA) stenoses in patients with acute ischemic stroke. This study evaluated the agreement and interrater reliability (IR) of both methods using a revised DUS grading system as well as different criteria (ECST/NASCET) under real-life conditions. CTA and DUS data of 281 proximal ICA stenoses [143 patients; 65.7 % male; age (mean (years) ± SD, range) 72.2 ± 11.1, 40-99] were retrospectively analyzed. For both methods, two independent raters estimated the degree of stenosis according to NASCET and ECST criteria. DUS raters applied revised German DUS criteria. For agreement and IR assessment, the linear weighted Kappa statistic was used. Correlation between DUS and CTA was substantial irrespective of the applied classification [weighted Kappa: 0.77 (NASCET)/0.79 (ECST)]. IR for DUS was almost perfect (weighted Kappa: 0.94) and better than for CTA [weighted Kappa: 0.78 (NASCET)/0.78 (ECST)]. In a real-life setting, CTA and DUS assessments of the degree of proximal ICA stenoses agreed substantially irrespective of the criteria applied (ECST/NASCET). For DUS, IR was better than for CTA.

  4. [Stenting of subtotal conclusion of internal carotid artery and comparing the cerebral embolic load of proximal balloon protection device with distal filter protection device].

    Science.gov (United States)

    Yang, Qing-wei; Ji, Xun-ming; Li, Shen-mao; Zhu, Feng-shui; Chen, Yan-fei; Ye, Ming; Jiao, Li-qun

    2013-07-16

    To study the safety, efficacy and perioperative complications of endovascular therapy in the treatment of subtotal conclusion of internal carotid artery(ICA) in patients. To compare the cerebral embolic load of proximal balloon protection device versus distal filter protection device during the operation. Review all the operations of stenting for subtotal conclusion of ICA in Xuanwu hospital. New cerebral infarction after stenting was assessed by diffusion-weighted magnetic resonance imaging. Count the number of new ischemic lesions of every patient. 35 patients with subtotal conclusion of ICA received endovascular stenting. Proximal protective device was used for 21 patients. Distal protective device was used for 14 patients. All procedures succeeded. 32 patients received the cerebral MRI 1 week before and within 48 hours after the operation. Compared with filter protection(n = 14), proximal balloon device(n = 18) resulted in a significant reduction in the incidence of new cerebral infarction (6/18 vs 10/14, P = 0.03). The number of new cerebral ischemic lesions were significant reduced by proximal balloon device (1/18 vs 4/14, P = 0.0006) . There were no serious cardiovascular events in 35 patients during the operation and the following up 3 months. 3 patients had restenosis which was demonstrated by ultrasound of ICA at 3 months after stenting. Endovascular stenting may be a safe and valid method for the treatment of subtotal occlusion of ICA. For the stenting of subtotal occlusion of ICA, proximal balloon protection device as compared with filter protection may reduce the embolic load to the brain more effectively. The stenting of subtotal occlusion of ICA still needs the randomized trails to confirm the safety and validity.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-11-15

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

  6. Endovascular treatment in proximal and intracranial carotid occlusion 9 hours after symptom onset

    Energy Technology Data Exchange (ETDEWEB)

    Jakubowska, Malgorzata M.; Michels, Peter; Mueller-Jensen, Axel [Asklepios Clinic Altona, Department of Neurology, Hamburg (Germany); Leppien, Andreas; Eckert, Bernd [Asklepios Clinic Altona, Department of Neuroradiology, Hamburg (Germany)

    2008-07-15

    A debate is emerging over whether the treatment time window in acute stroke can be extended beyond 6 h if penumbral tissue can be identified. Treatment decisions are very difficult in cases of tandem proximal carotid occlusion with arterioarterial intracranial embolism. We enter this debate with the present report on a case of atherosclerotic proximal carotid occlusion and resulting periocclusional carotid T embolism that was successfully treated 9 h after symptom onset. The case of a 68-year-old man with fluctuating symptoms of right-hemispheric stroke is presented (NIHSS score 12-20 on admission). CT angiography demonstrated proximal carotid occlusion and periocclusional embolism of the entire internal carotid artery (ICA) including the carotid T segment. Penumbral tissue was diagnosed by nonenhanced and perfusion CT imaging 7.5 h after symptom onset. Treatment was initiated 9 h after symptom onset by passing the proximal occlusion with a microcatheter and local administration of recombinant tissue plasminogen activator (rt-PA) into the carotid T segment at the level of posterior communicating artery (PCoA) origin. Recanalization of the ICA and middle cerebral artery was accomplished within 1 h by flow establishment via the PCoA. The atherosclerotic proximal ICA occlusion was not stented due to the risk of embolism from remnant thrombi in the petrous and cavernous ICA segments. Follow-up MRI showed only mild haemorrhagic infarct transformation of the initial infarct core. The patient was discharged from hospital 18 days after treatment with NIHSS score 5. If penumbral tissue can be conclusively identified, endovascular treatment in proximal and intracranial tandem occlusion can be successful, even in treatments initiated 6-9 h after stroke onset. If the intracranial flow after recanalization can be established via the circle of Willis, the underlying proximal ICA occlusion may not require treatment. (orig.)

  7. Treatment of a symptomatic intrathoracic internal carotid artery

    Directory of Open Access Journals (Sweden)

    Christopher R. Brown

    2017-09-01

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

  8. 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

  9. Microanatomy of the Supracavernous Internal Carotid - Anterior ...

    African Journals Online (AJOL)

    This anatomic variety is often associated with aneurysms and other vascular anomalies. The discovery of a case and the review of the literature allow us to evoke some embryological hypotheses. Keywords: Anterior cerebral artery, Internal carotid artery, Optic nerve, Aneuryom, Artère cérébrale antérieure, Artère carotide ...

  10. Predicting ischemic stroke after carotid artery stenting based on proximal calcification and the jellyfish sign.

    Science.gov (United States)

    Ichinose, Nobuhiko; Hama, Seiji; Tsuji, Toshio; Soh, Zu; Hayashi, Hideaki; Kiura, Yoshihiro; Sakamoto, Shigeyuki; Okazaki, Takahito; Ishii, Daizo; Shinagawa, Katsuhiro; Kurisu, Kaoru

    2017-07-07

    OBJECTIVE Carotid artery stenting (CAS) has been considered to prevent ischemic strokes caused by stenosis of the cervical carotid artery. The most common complication of CAS is new cerebral infarction. The authors have previously reported that the jellyfish sign-the rise and fall of the mobile component of the carotid plaque surface detected by carotid ultrasonography-suggests thinning and rupture of the fibrous cap over the unstable plaque content, such as the lipid-rich necrotic core or internal plaque hemorrhage. The authors' aim in the present study was to evaluate the risk of a new ischemic lesion after CAS by using many risk factors including calcification (size and location) and the jellyfish sign. METHODS Eighty-six lesions (77 patients) were treated with CAS. The presence of ischemic stroke was determined using diffusion-weighted imaging (DWI). Risk factors included calcification of the plaque (classified into 5 groups for size and 3 groups for location) and the jellyfish sign, among others. Multiple linear regression analysis (stepwise analysis and partial least squares [PLS] analysis) was conducted, followed by a machine learning analysis using an artificial neural network (ANN) based on the log-linearized gaussian mixture network (LLGMN). The additive effects of the jellyfish sign and calcification on ischemic stroke after CAS were examined using the Kruskal-Wallis test, followed by the Steel-Dwass test. RESULTS The stepwise analysis selected the jellyfish sign, proximal calcification (proximal Ca), low-density lipoprotein (LDL) cholesterol, and patient age for the prediction model to predict new DWI lesions. The PLS analysis revealed the same top 3 variables (jellyfish sign, proximal Ca, and LDL cholesterol) according to the variable importance in projection scores. The ANN was then used, showing that these 3 variables remained. The accuracy of the ANN improved; areas under the receiver operating characteristic curves of the stepwise analysis, the PLS

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

    NARCIS (Netherlands)

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

    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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  13. 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.

  14. Acute internal carotid artery occlusion after carotid endarterectomy

    Directory of Open Access Journals (Sweden)

    Masatoshi Yunoki

    2016-09-01

    Full Text Available We report two cases of acute carotid artery (CA occlusion following carotid endarterectomy (CEA. Case 1: a 58-year-old man was admitted with transient right-sided hemiparesis. Magnetic resonance imaging (MRI and MR angiography (MRA revealed cerebral infarction in the left cerebral hemisphere and left CA stenosis. Ten days after admission, he underwent CEA. 24 h after surgery, he developed right hemiplegia. MRI and MRA demonstrated a slightly enlarged infarction and left internal carotid artery (ICA occlusion. Emergency reoperation was performed and complete recanalization achieved. The patient made a clinically significant recovery. Case 2: a 65 year-old man underwent a right-sided CEA for an asymptomatic 80% CA stenosis. 48 h after surgery, his family noticed he was slightly disorientated. MRI and MRA revealed multiple infarctions and right ICA occlusion. He was treated with antiplatelet therapy without reoperation because sufficient cross-flow from the left ICA through the anterior communicating artery was demonstrated by angiography, and his neurological symptoms were mild. His symptoms gradually alleviated and he was discharged 14 days after surgery. With ICA occlusion after CEA, immediate re-operation is mandatory with severe neurological symptoms, whereas individualized judgement is needed when the symptoms are mild.

  15. INTERNAL CAROTID ENDARTERECTOMY UNDER LOCAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Andrej Šikovec

    2004-12-01

    Full Text Available Background. Endarterectomy of the internal carotid artery, supported by medicamental treatment, is the best method used to prevent stroke with symptomatic patients with an over 70-percent narrowing of the ipsilateral carotid artery. With patients who have successfully passed the operation the occurrence of the stroke is less often than with non-operated patients (1% vs. 6–10% per year. Therefore, it is important that the operation is carried out as safely as possible. Currently, the average acceptable rate of death and/ or severe stroke risk stands at between 2–4%. Greatest problems faced during carotid artery surgery are embolism of the affected artery during preparation, brain ischaemia during the blockade of the carotid artery, and embolism and intimal tearing due to injury of the internal carotid artery by the temporary internal shunt. Due to the risk of causing an embolism and intimal tearing, the use of the internal shunt can be dangerous. Therefore, selective usage of the shunt is recommended when necessary due to brain ischaemia.Methods. Under block/conduction anaesthesia (deep and superficial cervical block we have performed surgery on 23 patients (16 males, 7 females because of severe stenosis of the internal carotid artery (over 70%. A mixture of Xylocain 1% and Marcain 1.5% was used for the cervical block. Cerebral blood circulation was monitored by neurological testing of the patient awake during the procedure. During the procedure, we performed standard monitoring of the vital functions including the blood pressure. Additionally, the transcranial Doppler monitoring of the blood flow through the middle cerebral artery was used with 20 of the patients.Results. Even after placing the artery clamp and cutting off the blood flow through the internal carotid artery no neurological deficits were observed with 18 patients, neither did we use temporary internal shunt with them. Five patients suffered problems with loss of consciousness

  16. CrossFit-related cervical internal carotid artery dissection.

    Science.gov (United States)

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

    2015-08-01

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

  17. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

    Directory of Open Access Journals (Sweden)

    Jacek Brzost

    2015-01-01

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

  18. The importance of internal carotid artery occlusion tolerance test in carotid endarterectomy under locoregional anesthesia.

    Science.gov (United States)

    Dellaretti, Marcos; de Vasconcelos, Laura T; Dourado, Jules; de Souza, Renata F; Fontoura, Renato R; de Sousa, Atos A

    2016-06-01

    Carotid endarterectomy is considered a safe and effective method for preventing stroke in the short and long term in patients with severe carotid stenosis. The internal carotid artery (ICA) occlusion tolerance test was performed to evaluate cerebral tolerance during temporary carotid occlusion, defined as the capacity of the cerebral hemisphere to maintain adequate cerebral blood flow during occlusion of the ICA. Thus, the aim of the present study is to determine the importance of this test in patients undergoing carotid endarterectomy. From August 2008 to May 2015, 115 consecutive patients (39 female, 77 male) were referred for carotid endarterectomy at the Santa Casa de Belo Horizonte by the main author. Of the 115 patients who participated in the study, 107 were submitted to carotid endarterectomy. Morbi-mortality was 2.7 %. The presence of deficits during the ICA occlusion tolerance test in less than 30 s was associated with the presence of complications. Among the 104 patients who showed no deficits during the test, only one case (0.9 %) presented complications, while among the three cases that showed deficits during the test and who were submitted to carotid endarterectomy, two cases presented complications (p carotid endarterectomy under locoregional anesthesia is a safe surgical procedure. The internal carotid artery occlusion tolerance test can help identify high-risk patients who have been assigned this treatment.

  19. Correlation Between the Intima-Media Thickness of the Proximal and Distal Common Carotids

    Energy Technology Data Exchange (ETDEWEB)

    Roelke, Leonard Hermann, E-mail: leonardhr@terra.com.br; Rodrigues, Sergio Lamego [Universidade Federal do Espírito Santo, Vitória, ES (Brazil); Lotufo, Paulo Andrade [Universidade de São Paulo, São Paulo, SP (Brazil); Mill, Jose Geraldo [Universidade Federal do Espírito Santo, Vitória, ES (Brazil)

    2013-09-15

    Increased IMT (intima-media thickness) in carotids is used as an early atherosclerosis marker and to evaluate the risk of cardiovascular problems. Ultrasound is used in the evaluation because it is accessible and low cost. Measurements for different carotid regions are described. To compare the proximal and distal region IMTs for the bilateral common carotid and guide its use in clinical practice. The IMT was measured in the proximal and distal common carotid arteries of 798 individuals (35-74 years old) of both genders using high-resolution ultrasound. Pearson's correlation coefficient was used to establish associations. The analyses were initially performed for the entire sample as well as subgroups with IMT <0.90 mm (49% of the sample) and ≥0.90 mm for at least one measurement site. The statistical significance was p < 0.05. The correlations investigated were significant. In the group with an IMT <0.90 mm, the correlations were between 0.44 and 0.62. In the subgroup with an IMT ≥0.90 mm, the correlations were significantly reduced to between 0.20 and 0.40. The data suggest that the IMT is more uniform along the carotid during early development and tends develop focally as it progresses. Therefore, in clinical evaluations of patients, the common carotid length should be investigated bilaterally to better use the available software and discern the IMT.

  20. Bilateral hypoplasia of the internal carotid arteries with basilar aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Briganti, F.; Tortora, F.; Elefante, A. [Universita di Napoli Federico II, Dipartimento di Scienze Neurologiche, Cattedra di Neuroradiologia, 80131, Napoli (Italy); Maiuri, F. [Universita di Napoli Federico II, Department of Neurological Sciences, Neurosurgery Service, Napoli (Italy)

    2004-10-01

    We report a rare case of bilateral hypoplasia of the internal carotid arteries with an associated aneurysm of the basilar tip, studied by CT angiography, MR angiography and digital angiography. The patient became symptomatic with an episode of loss of consciousness, likely due to reduced blood perfusion. The other 20 reported cases of bilateral carotid hypoplasia (only four of which with an associated aneurysm) are reviewed. The findings of noninvasive procedures (including narrowing of the carotid canals on CT) may lead to a correct diagnosis before angiography is performed; they may also help to differentiate angiographic narrowing of the hypoplastic internal carotids from the string sign often observed in some acquired conditions. (orig.)

  1. A giant internal carotid artery aneurysm: case report

    Directory of Open Access Journals (Sweden)

    Dilcan Kotan

    2013-12-01

    Full Text Available Aneurysms greater than 2.5 cm in diameter are classified as giant aneurysms and represent 5-8% of all intracranial aneurysms. Giant intracranial aneurysms demonstrates the clinical course with symptoms related to subarachnoid haemorrhage, mass effect, thromboembolism and seizures. Not only because of their large sizes, but also because of their usually wide and calcified aneurysm neck, existing thrombus within and its proximity to cranial nerves; giant aneurysms causes serious surgical difficulties. Giant aneurysms of the anterior intracranial circulation are rare, slowly progressive vascular abnormalities, often presenting with neuro-ophthalmological symptoms before they rupture. Herein, a case of 77-year-old woman with a giant aneurysm originated from intracavernous segment of internal carotid artery detected in magnetic resonance angiography who presented symptoms due to affected multiple cranial nerves related to mass effect.

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

    Science.gov (United States)

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

    2010-06-01

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

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

    Science.gov (United States)

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

    2017-06-13

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

  4. Internal carotid artery rupture caused by carotid shunt insertion.

    Science.gov (United States)

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

    2015-01-01

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

  5. 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....

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

    Directory of Open Access Journals (Sweden)

    Tomonori Tamaki

    2010-01-01

    Full Text Available We describe a unique case of Kimura's disease in which cerebral infarction was caused by occlusion of the right internal carotid artery. A 25-year-old man with Kimura's disease was admitted to our hospital because of left hemiparesis. Computed tomography and magnetic resonance imaging of the head showed infarction in the right frontal and temporal lobes. Cerebral angiography demonstrated right internal carotid artery occlusion affecting the C1 segment, with moyamoya-like collateral vessels arising from the right opthalamic artery. Kimura's disease is a chronic disease characterized by the clinical triad of slowly enlarging subcutaneous masses with lymphoid hyperplasia in the head and neck. It often occurs in young Asian men. In our patient, the pathogenesis of internal carotid artery occlusion was unknown. There have only been a few case reports in which occlusion of the internal carotid artery was associated with autoimmune disease, and no previous cases of internal carotid occlusion associated with Kimura's disease have been reported. We suspected that occlusion of this patient's internal carotid artery may be caused by the autoimmune mechanism that underlies Kimura's disease.

  7. Subclinical ischemic events in patients undergoing carotid artery stent placement: comparison of proximal and distal protection techniques.

    Science.gov (United States)

    Aytac, Emrah; Gürkaş, Erdem; Akpinar, Cetin Kursad; Saleem, Muhammad A; Qureshi, Adnan I

    2017-10-01

    To determine the relative effectiveness of proximal and distal protection in prevention of cerebral ischemic events during carotid artery stent (CAS) placement using diffusion-weighted MRI (DW-MRI). We analyzed data from patients who had undergone DW-MRI before and within 24 hours of CAS for symptomatic internal carotid artery (ICA) stenosis (with last ischemic events within 3 months). The study was performed prospectively; patients were not randomized, and were treated either with a proximal balloon occlusion system (Mo.Ma; Invatec, Roncadelle, Italy) or filter-type distal protection device (Spider device; ev3, Plymouth, Minnesota, USA). Of the 45 patients (mean age±SD: 66.9±9.8 years; 73.3% were men) who underwent CAS, 19 had proximal protection and 26 distal protection. New ischemic lesions were detected in 26/45 patients on DW-MRI scans obtained within 24 hours after CAS. The proportion of patients with new lesions on DW-MRI at 24 hours was not different between the two groups (47.4% vs 65.4% for proximal and distal protection, respectively). The mean number of new ischemic lesions on post-CAS DW-MRI was non-significantly higher in patients who underwent CAS with distal protection (2.80±3.54 for proximal protection vs 4.96±5.11 for distal protection; p=0.12). The proportion of patients with new lesions >1 cm did not differ between the two groups (5.3% for proximal protection vs 11.5% for distal protection; p=0.62). There was no difference in the rates of ischemic stroke between patients who underwent CAS treatment using proximal and distal protection (5.3% vs 7.7%; p=1.000). We found a relatively high rate of new ischemic lesions in patients undergoing CAS with cerebral protection. There was no difference in the proportion of patients with new lesions between patients treated using distal protection and those treated using proximal protection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  8. Hemodynamic significance of internal carotid artery disease

    DEFF Research Database (Denmark)

    Schroeder, T

    1988-01-01

    a significant improvement in baseline flow occur. Flow reserve determined by cerebral vasodilation, however, will improve in most patients with hemodynamic failure. In addition, some patients in the low-pressure group develop marked, but temporary, hyperperfusion after reconstruction of very high grade carotid...

  9. [Traumatic common carotid-internal jugular fistula: positive aspect].

    Science.gov (United States)

    Avrahami, R; Levinzon, M; Haddad, M; Zelikovsky, A

    1997-06-15

    A 42-year-old man presented with a penetrating neck injury from a pellet gun. Physical examination showed an open 1 cm wound on the right side of the neck, hematoma of the right sternocleidomastoid muscle, and carotid artery injury. He was hemodynamically stable and there was no neurological deficit. Arteriogram of the neck disclosed a pseudoaneurysm with an arteriovenous fistula between the common carotid artery and internal jugular vein. At surgery, the tears in the carotid artery and jugular vein were sutured and a vacuum drain was introduced. The postoperative course was uneventful, and the patient was discharged 5 days later. Instead of the expected results of a penetrating carotid artery injury, such as blood loss, airway obstruction or neurological deficit, the arteriovenous fistula caused by the pellet actually saved the patient's life. Blood flow from the artery via the pseudoaneurysm to the jugular vein kept the patient in stable condition.

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

    Science.gov (United States)

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

    2009-01-01

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

  11. Circle of Willis Collateral During Temporary Internal Carotid Artery Occlusion II: Observations From Computed Tomography Angiography.

    Science.gov (United States)

    Wang, Bill Hao; Leung, Andrew; Lownie, Stephen P

    2016-07-01

    The Circle of Willis (CoW) is the most effective collateral circulation to the brain during internal carotid artery (ICA) occlusion. Carotid stump pressure (CSP) is an established surrogate measure of the cerebral collateral circulation. This study aims to use hemodynamic and computed tomography angiography measurements to determine the strongest influences upon the dependent variable, CSP. These findings could help clinicians noninvasively assess the adequacy of the collateral circulation and facilitate surgical risk assessment in an outpatient setting. CSP and mean arterial pressure were measured during carotid endarterectomy or during carotid balloon test occlusion in 92 patients. Intracranial arterial diameters were measured on computed tomography angiography at 16 different locations. Univariate and multivariate analyses were used to determine the key factors associated with CSP. In a subgroup of individuals (n=27) with severe (>70% North American Symptomatic Carotid Endarterectomy Trial) contralateral stenosis or occlusion, the same analysis was performed. The contralateral anterior cerebral artery proximal to anterior communicating artery (A1) of the CoW had the strongest influence upon CSP, followed by the mean arterial pressure, the contralateral ICA diameter, and the anterior communicating artery diameter (R 2=0.364). In the subgroup with high-grade contralateral ICA stenosis, the ipsilateral posterior communicating artery exerted the strongest influence (R 2=0.620). During ICA occlusion, the anterior CoW dominates in preserving collateral flow, especially the contralateral A1 segment. In individuals with high-grade contralateral carotid stenosis, the posterior communicating artery calibre becomes a dominant influence. The most favourable anatomy consists of large contralateral A1 and anterior communicating arteries, and no contralateral carotid stenosis.

  12. Aneurysm flow characteristics in realistic carotid artery aneurysm models induced by proximal virtual stenotic plaques: a computational hemodynamics study

    Science.gov (United States)

    Castro, Marcelo A.; Peloc, Nora L.; Chien, Aichi; Goldberg, Ezequiel; Putman, Christopher M.; Cebral, Juan R.

    2015-03-01

    Cerebral aneurysms may rarely coexist with a proximal artery stenosis. In that small percent of patients, such coexistence poses a challenge for interventional neuroradiologists and neurosurgeons to make the best treatment decision. According to previous studies, the incidence of cerebral aneurysms in patients with internal carotid artery stenosis is no greater than five percent, where the aneurysm is usually incidentally detected, being about two percent for aneurysms and stenoses in the same cerebral circulation. Those cases 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 aim of this study is to investigate the intra-aneurysmal hemodynamic changes before and after treatment of stenotic plaque. Virtually created moderate stenoses in vascular models of internal carotid artery aneurysm patients were considered in a number of cases reconstructed from three dimensional rotational angiography images. The strategy to create those plaques was based on parameters analyzed in a previous work where idealized models were considered, including relative distance and stenosis grade. Ipsilateral and contralateral plaques were modeled. Wall shear stress and velocity pattern were computed from finite element pulsatile blood flow simulations. The results may suggest that wall shear stress changes depend on relative angular position between the aneurysm and the plaque.

  13. Surgical treatment of internal carotid and posterior communicating artery aneurysms.

    Science.gov (United States)

    Pikus, H J; Heros, R C

    1998-10-01

    Saccular aneurysms of the subarachnoid segment of the internal carotid artery (ICA) are very common. Although some of the aneurysms arising from the subarachnoid ICA have earned the reputation of easy to treat surgically, aneurysms in this region may be complex and quite difficult to repair. Even a simple aneurysm associated with the posterior communicating artery may harbor surprises for the unwary or inexperienced surgeon. This article details the pertinent anatomy of the subarachnoid internal carotid artery and associated saccular aneurysms, provides a guide to their diagnosis and surgical treatment, and briefly reviews some of the published surgical results. Pitfalls and technique tips are highlighted.

  14. Hemodynamic significance of internal carotid artery disease

    DEFF Research Database (Denmark)

    Schroeder, T

    1988-01-01

    . Examination of periorbital flow direction or oculoplethysmography could be used as a screening procedure. Negative tests most certainly rule out any severe pressure gradient across the stenosis, irrespective of the luminal reduction. A positive result, on the other hand, should be further quantified since...... a significant improvement in baseline flow occur. Flow reserve determined by cerebral vasodilation, however, will improve in most patients with hemodynamic failure. In addition, some patients in the low-pressure group develop marked, but temporary, hyperperfusion after reconstruction of very high grade carotid...

  15. Location of the internal carotid artery and ophthalmic artery ...

    African Journals Online (AJOL)

    Yasin Hamarat

    2017-10-06

    Oct 6, 2017 ... There are some published results of OA anatomical studies [18,20-22]. .... right eye) and the depth of intracranial segment of ophthal- mic artery ... internal carotid artery and segments of ophthalmic artery in high tension glaucoma patients. No. of glaucoma patients. Eye. ICA edge, mm. IOA, mm. EOA, mm.

  16. Regional Topography of the Internal Carotid Artery | Kipyator ...

    African Journals Online (AJOL)

    We studied the extra cranial portion of the internal carotid artery and structures associated with it, which are vulnerable to iatrogenic injury during surgical approach to the neck region in 18 individuals. Distances from the origin of the artery to hypoglossal nerve and posterior belly of digastric muscle were measured.

  17. A Novel Antegrade Approach for Simultaneous Carotid Endarterectomy and Angioplasty of Proximal Lesions in Patients with Tandem Stenosis of Supraaortic Arch Vessels.

    Science.gov (United States)

    Radak, Djordje; Tanaskovic, Slobodan; Sagic, Dragan; Antonic, Zelimir; Gajin, Predrag; Babic, Srdjan; Neskovic, Mihailo; Matic, Predrag; Kovacevic, Vladimir; Nenezic, Dragoslav; Ilijevski, Nenad

    2017-10-01

    To date, all published studies analyzing simultaneous treatment of carotid and proximal atherosclerotic lesions are describing retrograde approach and several technical variations. In the presented study, for the first time, antegrade approach is described for simultaneous carotid endarterectomy (CEA) and associated brachiocephalic trunk (BCT) or common carotid artery (CCA) angioplasty in the hybrid operating room. From January 2012 till January 2016, antegrade hybrid procedures were performed in 18 patients. All patients were admitted to our institute for elective supraaortic arch multidetector computed tomography angiography when significant simultaneous proximal and distal supraaortic arch lesions were revealed. After surgical exposure of carotid arteries, proximal lesions were crossed by antegrade approach. Prior to stent placement, internal carotid artery (ICA) is clamped at its origin with the guidewire placed in the external carotid artery (ECA). After primary stenting and control arteriography, CCA and ECA are clamped and the ICA clamp moved more distally. An arteriotomy is performed in the CCA, with flushing of possible debris and thrombus before performance of the eversion CEA, once again flushing before completion of the anastomosis. Follow-up ranged from 6 to 36 months with average follow-up of 22.15 ± 11.31 months. All procedures went uneventfully. Out of 18 patients, 11 were males and 7 females, mean age 66.6 ± 3.82 years. In 10 patients (55.5%), simultaneous CEA and CCA angioplasty was performed, in 7 patients (38.9%) CEA and BCT angioplasty, and in 1 patient (5.5%) tubular graft interposition between the CCA and the ICA and CCA angioplasty. In 6 patients (33.3%), CCA/BCT balloon angioplasty alone was performed simultaneously with CEA. None of the patient had postoperative transient ischemic attack, stroke, hematoma, dissection, myocardial infarction, or ischemia in the early postoperative period and during the follow-up. There were no

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

    Directory of Open Access Journals (Sweden)

    Sudiptamohan Mukhopadhyay

    2010-04-01

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

  19. THREE-DIMENSIONAL ULTRASOUND AND STENOSIS OF INTERNAL CAROTID ARTERY

    Directory of Open Access Journals (Sweden)

    Vojko Flis

    2003-12-01

    Full Text Available Background. Elucidation of the ultrasound structure of the atherosclerotic plaque in stenosis of internal carotid artery may have important implications for carotid surgery. This study compares the ability of computer derived 3D ultrasound gray scale volumetric measurements to diferentiate between ultrasonic structure of symptomatic and asymptomatic carotid plaque causing more than 70% stenosis.Methods. Eightysix internal carotid artery stenoses (70–99%, 45 symptomatic, 41 asymptomatic were imaged with 3D ultrasound to obtain the whole volume of the atherosclerotic plaque. Digitalized sonograms were computerized and normalized to the gray scale median (GSM of blood (0 and vessel adventitia (200. Plaque GSM was obtained for the whole volume by computing the volume ratio between echolucent and echogenic areas. The plaque heterogeneity was obtained by computing the density of echogenic areas per volume unit. Parametric t test was used for statistic analysis.Results. Minimum volume GSM ratio (determining echolucency was higher for asymptomatic plaque (0.6 – CI 0.48– 0.91 versus 0.3 – CI 0.21–0.75: p = 0.002. Greater GSM heterogeneity was present in symptomatic plaque (6.8 – CI 2.5– 18.3 versus 0.41 – CI 0.2–3.4;.p = 0.0001.Conclusions. Volume ultrasound imaging that enables objective assessment of whole ultrasonic plaque structure is more sensitive that single longitudinal view sonography for differentiating between ultrasonic structure of symptomatic and asymptomatic plaque.

  20. Association between internal carotid artery dissection and arterial tortuosity

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-18

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

  1. [Intraluminal Thrombus in Internal Carotid Artery Successfully Treated with Adjuvant Anticoagulant Therapy Followed by Carotid Endarterectomy:A Case Report].

    Science.gov (United States)

    Minamide, Hisato; Hayashi, Yutaka; Ueno, Megumi

    2016-10-01

    An intraluminal thrombus in the carotid artery is relatively rare. A high frequency of perioperative symptomatic stroke has been reported in patients undergoing carotid endarterectomy, and no standard therapy has yet been developed. A 69-year-old woman, with no history of trauma, presented with ischemic stroke and mild right hemiparesis. Computed tomography and MRI showed an infarction in the left parietal region. A carotid Doppler study showed carotid stenosis on the left side. Further investigation with digital subtraction angiography confirmed significant carotid artery stenosis with an intraluminal thrombus in the left internal carotid artery. She was treated with initial intravenous anticoagulant therapy followed by carotid endarterectomy with thrombus removal 14 days after admission(subacute phase). There was no postoperative complication and she had uneventful course over 3 years of follow-up. Initial adjuvant anticoagulant therapy for symptomatic intraluminal thrombus followed by carotid revascularization is an effective surgical strategy. A meticulous surgical procedure is required to perform a carotid endarterectomy in patients with an intraluminal thrombus.

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

    Directory of Open Access Journals (Sweden)

    Nayak SB

    2010-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Ilijevski Nenad

    2006-01-01

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

  4. Bilateral Internal Carotid Artery Occlusion Associated with the Antiphospholipid Antibody Syndrome

    Directory of Open Access Journals (Sweden)

    Pria Anand

    2014-03-01

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

  5. Safety and effectiveness of emergency carotid artery stenting for a high-grade carotid stenosis with intraluminal thrombus under proximal flow control in hyperacute and acute stroke.

    Science.gov (United States)

    Iwata, Tomonori; Mori, Takahisa; Tajiri, Hiroyuki; Miyazaki, Yuichi; Nakazaki, Masahito

    2013-01-01

    A study was undertaken to investigate the feasibility, safety and effectiveness of emergency carotid artery stenting (eCAS) for a high-grade carotid stenosis with intraluminal thrombus (ILT) with or without proximal flow control (PFC). Patients with acute ischemic stroke included in the analysis were those who were admitted between 2001 and 2010 with serious neurological symptoms, without a large high-intensity area of diffusion-weighted images and who underwent eCAS for a high-grade carotid stenosis with ILT. Patients underwent eCAS without PFC until 2004 (group C) and under PFC after 2004 (group P). The National Institutes of Health Stroke Scale (NIHSS) score on admission, just before CAS and 7 days after CAS as well as the 3-month modified Rankin Scale were investigated. Fifty-six patients underwent eCAS, eight of whom had a high-grade stenosis with ILT. Four of the eight patients were in group C and four were in group P. Probable distal embolism associated with eCAS occurred in two cases in group C and in none in group P. In groups C and P the median 7-day NIHSS scores were 15 and 5, respectively (padmission and just before CAS. In stroke patients with a high-grade carotid stenosis with ILT, eCAS under PFC is safer and more effective in achieving a favorable clinical outcome than eCAS without PFC.

  6. Aberrant internal carotid artery in the middle ear

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-15

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

  7. [Surgical treatment of tumors of the carotid body with reconstruction of the internal carotid artery].

    Science.gov (United States)

    Reparaz, L; Magallón, P; Riera, L; Capilla, M T; Merino, M J; Martínez, I; Hernández, A; Sáez, L; Alamo, O; Jiménez Cossío, J A

    1990-01-01

    The experience about treatment in infiltrating tumors of Carotid Corpus, III Degree (Shamblin), is presented. Different methods of carotid reconstruction, and biologic and evolutive characteristics are emphasized, discussing preoperatory study and surgical technics.

  8. Assessment of the contribution of the external carotid artery to brain perfusion in patients with internal carotid artery occlusion.

    Science.gov (United States)

    van Laar, Peter Jan; van der Grond, Jeroen; Bremmer, Jochem P; Klijn, Catharina J M; Hendrikse, Jeroen

    2008-11-01

    The purpose of this study was to prospectively investigate the contribution of the ipsilateral external carotid artery (ECA) to cerebral perfusion in patients with internal carotid artery occlusion. Institutional Review Board approval and informed consent were obtained. Thirty functionally independent patients (24 men, 6 women; mean age, 63 years) with an angiographically proven unilateral internal carotid artery occlusion and transient or minor disabling ischemic attacks ipsilateral to the side of the internal carotid artery occlusion were included. Grading of ECA collateral flow was performed with intraarterial digital subtraction angiography. The contribution of the ECA to regional cerebral blood flow was assessed with selective arterial spin labeling MRI. Differences in regional cerebral blood flow were analyzed with Student t test. Twenty percent of the patients had ECA Grade 0 collateral flow (no filling of ophthalmic artery), 20% Grade 1 (filling of carotid siphon), and 60% Grade 2 (filling of anterior and/or middle cerebral artery) as demonstrated on digital subtraction angiography. Although in the Grade 1 group, the ECA supplied a smaller region of the brain compared with the Grade 2 group, the mean regional cerebral blood flow of the perfusion territory supplied by the ECA is similar (P=0.70) in the Grade 1 group (mean+/-SD 57+/-16 mL/min/100 g) and the Grade 2 group (60+/-12 mL/min/100g). In patients with symptomatic internal carotid artery occlusion, focal brain regions may strongly depend on the contribution to cerebral perfusion of the ECA ipsilateral to the side of the internal carotid artery occlusion, even in patients with limited ECA collateral supply as demonstrated on digital subtraction angiography.

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

    NARCIS (Netherlands)

    Bonati, Leo H.; Dobson, Joanna; Featherstone, Roland L.; Ederle, Jörg; van der Worp, H. Bart; de Borst, Gert J.; Mali, Willem P. Th M.; Beard, Jonathan D.; Cleveland, Trevor; Engelter, Stefan T.; Lyrer, Philippe A.; Ford, Gary A.; Dorman, Paul J.; Brown, Martin M.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Clifton, A.; Gaines, P.; Collins, R.; Molyneux, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Coward, L.; Dobson, J.; Doig, D.; Ederle, J.; Featherstone, R. F.; Kennedy, F.; Tindall, H.; Turner, E.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Than, P. G.; Gett, S.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Atkinson, N.; Cambell, W.; Davis, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; Hendriks, J. M. H.; van, P.; St, A. Z.; Bosiers, M.; Deloose, K.; Brugge-Oostende, A. Z. Sint Jan; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verhelst, R.; Ziekenhuis, Imelda; DeJaegher, L.; Daneault, N.; Lanthier, S.; Lebrun, L.-H.; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Hill, M.; Hu, W.; Hudion, M.; Wong, J.; Albäck, A.; Curtze, S.; Harno, H.; Ijäs, P.; Lappalainen, K.; Lepäntalo, M.; Meretoja, A.; Mustanoja, S.; Paananen, T.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; 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.; Pattynama, P. M. T.; van Dijk, L. C.; van Sambeek, H. M.; van Urk, H.; Verhagen, H. J. M.; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H.; Wever, J.; van Hasselt, A. A. M.; Zeilstra, D. J.; Boiten, J.; Lycklama, G. J.; Blankensteijn, J. D.; de Leeuw, F. E.; Schultze, L. J.; de Borst, G. J.; de Kort, G. A. P.; Kapelle, L. J.; Lo, T. H.; Mali, W. P. Th M.; Moll, F.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Bakke, S. J.; Krohg, K.; Skjelland, M.; Tennøe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Buczek, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; San, L.; Branera, J.; Canovas, D.; Perendreu, J.; Björses, K.; Gottsäter, A.; Mätzsch, T.; Sonesson, B.; Berg, B.; Delle, M.; Formgren, J.; 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.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Varty, K.; Adam, D.; Bell, J.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, J. A.; Enevoldson, T. P.; Gilling-Smith, G.; Gould, D. A.; Harris, P. L.; McWilliams, R. G.; White, R.; Prakash, K. G.; Serracino-Inglott, F.; Subramanian, G.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dorman, P.; Dyker, A.; Ford, G.; Golkar, A.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Stansby, G.; Wyatt, M.; Baker, T.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Cleveland, T.; Dodd, D.; Nair, R.; Nassef, A.; Nawaz, S.; Belli, A.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Jäger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.; Rogers, P.

    2015-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Murotani, K.; Hiramoto, M.

    1985-07-01

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

  11. Severity and presence of atherosclerosis signs within the segments of internal carotid artery: CBCT's contribution

    NARCIS (Netherlands)

    Damaskos, S.; da Silveira, H.L.D.; Berkhout, E.W.R.

    2016-01-01

    Objectives. This study aims to assess with cone-beam computed tomography the distribution and interrelation of the presence of calcifications along the course of the internal carotid artery and to associate their severity with their allocation within the segments of internal carotid artery, gender,

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

    Science.gov (United States)

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

    2010-01-01

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

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    the hypothesis that, after a 30-s transient increase in arterial CO2 tension and consequent increase in internal carotid artery shear stress, internal carotid artery diameter would increase, indicating shear-mediated dilation, in the absence of concurrent hypercapnia. In 27 healthy participants, partial...... pressures of end-tidal O2 and CO2, ventilation (pneumotachography), blood pressure (finger photoplethysmography), heart rate (electrocardiogram), internal carotid artery flow, diameter, and shear stress (high-resolution duplex ultrasound), and middle cerebral artery blood velocity (transcranial Doppler......) were measured during 4-min steady-state and transient 30-s hypercapnic tests (both +9 mmHg CO2). Internal carotid artery dilation was lower in the transient compared with steady-state hypercapnia (3.3 ± 1.9 vs. 5.3 ± 2.9%, respectively, P internal carotid artery shear stress...

  14. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Young; Han, Moon Hee; Yu, In Gyu; Chang, Ki Hyun [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Eui Jong [Kyunghee Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Dae Ho [Soonchunhyang Univ. College of Medicine, Asan(Korea, Republic of)

    1997-06-01

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

  16. Case report: Thrombosed giant cavernous carotid artery aneurysm secondary to cervical internal carotid artery dissection: An unusual entity

    Directory of Open Access Journals (Sweden)

    Sachin S Baldawa

    2011-01-01

    Full Text Available Spontaneous thrombosis of a giant intracranial aneurysm with parent artery occlusion is known. The exact mechanism is however unclear and various theories have been proposed. We present an unusual case of an angiographically documented cervical internal carotid artery (ICA dissection, which led to total occlusion of the ICA distal to the dissected site, with acute cessation of forward blood flow. This resulted in acute upstream thrombosis of the giant cavernous carotid artery aneurysm and an acute cavernous sinus syndrome-like presentation.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    Haris Vukas

    2016-06-01

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

  19. Extracranial Internal Carotid Artery Tortuosity and Body Mass Index

    Directory of Open Access Journals (Sweden)

    Hai-Feng Wang

    2017-09-01

    Full Text Available BackgroundExtracranial internal carotid artery (eICA tortuosity may trigger cerebral ischemia, and body mass index (BMI is a measure of body mass based on height and weight. The main purpose of this study is to determine the influence of BMI on the tortuosity of eICA.MethodsA total of 926 carotid artery angiograms were performed in 513 patients, of which 116 cases and matched controls were selected. Arterial tortuosity was defined as simple tortuosity, kinking, or coiling. The severity of tortuosity was measured by tortuosity index, formula: [(actual length/straight-line length − 1 × 100].ResultsBMIs were different between the two groups [tortuosity: 27.06 kg/m2 (SD 2.81 kg/m2 versus none: 23.3 kg/m2 (SD 2.78 kg/m2; p < 0.001]. BMI was independently and significantly associated with eICA tortuosity (odds ratio 1.59; 95% confidence interval, 1.35–1.86; p < 0.001. eICA tortuosity index is linearly associated with BMI (exponential coefficient β = 1.067, p < 0.001. The optimal predictive threshold of BMI for eICA tortuosity was 25.04 kg/m2. The physiological mechanism underlying the reasons why higher BMI has negative influence on extracranial carotid artery tortuosity may be an intra-abdominal hypertension caused by a much higher amount of body fat stored in visceral adipose tissue.ConclusionOur result reveals a novel role for greater BMI on the presence of eICA tortuosity. For each increase in BMI of 1 kg/m2, there is a corresponding 1.59-fold increase in the risk of developing eICA tortuosity. The severity of eICA tortuosity increases linearly with increased BMI.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Increases in arterial carbon dioxide tension (hypercapnia) elicit potent vasodilation of cerebral arterioles. Recent studies have also reported vasodilation of the internal carotid artery during hypercapnia, but the mechanism(s) mediating this extracranial vasoreactivity are unknown. Hypercapnia ...

  1. Safety and Feasibility of Simultaneous Ipsilateral Proximal Carotid Artery Stenting and Cerebral Aneurysm Coiling

    Directory of Open Access Journals (Sweden)

    Aamir Badruddin

    2010-10-01

    Full Text Available Background: Coexistence of cerebral aneurysm and carotid artery disease may be encountered in clinical practice. Theoretical increase in aneurysmal blood flow may increase risk of rupture if carotid artery disease is treated first. If aneurysm coiling is performed first, stroke risk may increase while repeatedly crossing the diseased artery. It is controversial which disease to treat first, and whether it is safe to treat both simultaneously via endovascular procedures. We document the safety and feasibility of such an approach. Methods: Review of collected neurointerventional database at our institution was performed for patients who underwent both Carotid artery stenting (CAS and aneurysm coil embolization (ACE simultaneously. All patients underwent carotid stenting followed by aneurysm coiling in the same setting. Demographic, clinical data and outcome measures including success rate and periprocedural complications were collected. Results: 590 aneurysms coiling were screened for patients who underwent combined CAS and ACE. Ten patients were identified. Mean age was 67.7 years (range 51 to 89. The success rate for stenting and coiling was 100% with no immediate complications. No stroke, TIAs, or aneurysmal rebleeding was found on their most recent follow up. Conclusions: Our case series demonstrates that it is safe and feasible to perform CAS and ACE simultaneously as one procedure which may avoid unwanted risk of treating either disease at two separate time sessions.

  2. [Anatomic variations of the internal carotid artery: implications for the neurologic endovascular therapist].

    Science.gov (United States)

    Zenteno, Marco; Leeb, Angel; Moscote-Salazar, Luis Rafael

    2013-01-01

    Tortuosity of the cervical segment of the internal carotid artery (ICA) can hinder navigation intravascular devices for treating intracranial aneurysms and even complex ICA access techniques can fail. Variations in the course of the internal carotid artery are known as coiling, kinking or tortuosity of the vessel. Such failures have clinical relevance. During endovascular procedures these anomalies difficult the intravascular surgical procedure. A potential alternative is the reconstruction of these anatomic anomalies of the carotid artery using neuro-interventional methods. We present a practical review of the literature.

  3. Bilateral dissection of the internal carotid artery at the base of the skull due to blunt trauma: incidence and severity.

    Science.gov (United States)

    Alimi, Y; Di Mauro, P; Tomachot, L; Albanese, J; Martin, C; Alliez, B; Juhan, C

    1998-11-01

    Between January 1, 1992 and December 31, 1996, a total of 1095 head trauma vicims were admitted in our intensive care unit. If CT scans demonstrated ischemic brain lesions, arteriography to visualize supraaortic vessels was performed. Carotid artery dissection was observed in ten patients (0.91%) and was bilateral in eight patients (0.73%). In the bilateral carotid artery dissection (BCAD) group, there were five women and three men, with a mean age of 35.2 years (range: 17 to 54 years). Injuries resulted from traffic accidents in seven patients and a fall in one patient. Upon admission, six patients presented with alteration of consciousness and three with hemiplegia or hemiparesia, associated with aphasia in two cases. In two other cases, hemiplegia occurred 24 hr and 13 days after the accident. All patients had brain infarction, which was unilateral in five cases and bilateral in three cases. The severity of lesions was graded on the basis of arteriographic findings as follows: Type I, wall involvement without significant stenosis or dilation; Type II, arterial dissection with stenosis >70% (Type IIA) or dilatation >50% (Type IIB) and the normal diameter of the proximal or distal internal carotid artery; and Type III, thrombosis of the internal carotid artery. Lesions were asymmetrical in six patients, including two with Type II and III lesions and four with Type I and II lesions, and symmetrical in two patients, including one with bilateral Type III lesions and one with bilateral Type II lesions. Surgery was performed in two patients with Type II lesions, including one case associated with contralateral carotid thrombosis. The intrapetrous carotid artery was exposed by an ear-nose-throat (ENT) surgeon and repaired by interposition grafting. Follow-up in these two surgical cases was 28 and 31 months. In the remaining six cases, medical treatment was performed. Outcome in nonsurgical cases was variable: death in two cases at 31 and 43 days after the accident

  4. Anevrysme de la carotide interne a propos d'un cas | Pio | Journal ...

    African Journals Online (AJOL)

    Introduction : L'anévrysme de la carotide interne est une pathologie rare et leur étiologie est variée. Observation : Nous rapportons un cas d'anévrysme de la carotide interne chez une patiente de 59 ans. L'étiologie post-traumatique a été retenue. L'échodoppler transcrânien a constitué l'examen de dépistage. A partir de ce ...

  5. Modeling of internal carotid artery aneurysm and blood flow simulation.

    Science.gov (United States)

    Xu, Bingqiang; Zhong, Hua; Duan, Shaoyin

    2015-01-01

    The rupture of aneurysm is quite common in the clinics, and is hazardous to patients. Its occurrence is considered to be related to the hemodynamic abnormalities. To construct the model of internal carotid artery aneurysm (ICA-A), and have a simulation of blood flow. Based on the CTA data from spiral CT scan, the ICA-A model was constructed, and the types of blood flow, wall shear stress (WSS), Von Mises stress (VMS) and pressure were simulated and calculated. ICA-A model has been built and shape is the same morphology as CT 3D-image. In the whole cardiac cycle, the blood flow of aneurysm body is swirl, its velocity is slower than that of aneurysm neck; the maximum deformation, wall shear stress, pressure and von mises stress of aneurysm wall is at the neck, the minimum is at the top. The highest value appeared at 0.52 s in the cardiac cycle of 0.74 s, the lowest is at 0.21 s. It is effective and practical to construct the model of ICA-A base on CTA data. Blood flow simulation of ICA-A will provide new basis for the study on the occurrence and development of aneurysm.

  6. Internal carotid occlusion in a patient with previous history of periodontitis: case report.

    Science.gov (United States)

    Puhar, Ivan; Lovrencić-Huzjan, Arijana; Plancak, Darije; Sodec-Simicević, Darja; Strineka, Maja; Demarin, Vida

    2012-09-01

    Although inflammatory periodontal disease has been proven to be related to carotid intima media thickness, it has been recently suggested that even an alteration of carotid hemodynamics might contribute to atherosclerosis in patients with periodontal disease. A 52-year-old female patient was referred to periodontology department due to painful alveolar mucosa. On the basis of dental history, we concluded that the patient had a severe form of generalized aggressive periodontitis that led to complete edentulism. The patient was advised to undergo ultrasonography of carotid arteries with arterial stiffness measurements at neurology department. A diagnosis of the right internal carotid artery occlusion was established. Inflammatory periodontal disease may affect arterial hemodynamics and even lead to artery occlusion. It is advisable that patients with a severe form of periodontitis should be referred for carotid artery ultrasonography.

  7. Ocular and cerebral ischemic mechanisms in disease of the internal carotid artery.

    Science.gov (United States)

    Ross, R T; Morrow, I M

    1984-05-01

    Stenosis of the internal carotid artery reduces the flow velocity in the ophthalmic artery. Lowered velocity permits increased red cell aggregation and decreased red cell deformability which increases viscosity. Contrary to the theory of remotely originating emboli, this is an alternate hypothesis regarding transient attacks of ocular and cerebral ischemia. The ophthalmic artery circulation time was measured in two groups of patients. The circulation time was defined as the interval between the appearance of contrast media in the siphon of the internal carotid artery and in the ocular choroid. The measurement was made on 151 angiograms of 108 subjects. These vessels were normal. An additional 76 patients had 108 angiograms which showed various amounts of internal carotid artery stenosis. These 76 patients had transient ischemic attacks; retinal, cerebral, or both. There is a significant difference in the ophthalmic artery circulation time in the two groups. The slowing in the ophthalmic artery is related to the degree of internal carotid artery narrowing. The circulation time in a cerebral branch of the internal carotid was not measured. It is presumed that stenosis of the internal carotid artery would have the same effect on a cerebral artery as on the ophthalmic artery.

  8. Effect of internal carotid artery stenting on superior thyroid artery Doppler flow.

    Science.gov (United States)

    Gunduz, Yasemin; Akdemir, Ramazan; Varim, Perihan; Ayhan, Lacin Tatli; Cakar, Mehmet Akif; Vatan, Mehmet Bulent; Kilic, Harun

    2014-10-01

    Patients with carotid disease are frequently referred for carotid artery stenting based on the results of carotid duplex studies. During carotid artery stenting, the stent is usually extended into the common carotid artery, thereby crossing the external carotid artery. Previous studies have shown conflicting results regarding internal carotid stenting and external carotid artery flow velocities, but the effect of stenting on ipsilateral superior thyroid artery velocities has not been defined. This study examined the effect of internal carotid angioplasty and stenting on the ipsilateral superior thyroid artery Doppler-derived flow parameters. We prospectively studied preinterventional and postinterventional duplex scans obtained from 41 patients (mean age ± SD, 64 ± 10 years) who underwent carotid artery stenting. The Doppler-defined preprocedural peak systolic velocity (PSV) end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) in the ipsilateral external carotid and superior thyroid arteries were compared with postprocedural values. Among patients with stenting, the preprocedural PSV, EDV, RI, and PI in the ipsilateral superior thyroid artery were 30 ± 11 cm/s, 13 ± 6 cm/s, 0.62 ± 0.11, and 1.04 ± 0.28,respectively; after stenting, they were 36 ± 8 cm/s, 14 ± 9 cm/s, 0.71 ± 0.07, and 1.11 ± 0.19. The preprocedural PSV, EDV, RI, and PI in the ipsilateral external carotid artery were 79 ± 24 cm/s, 17 ± 7 cm/s, 0.77 ± 0.26, and 1.27 ± 0.22; after stenting, they were 94 ± 31 cm/s, 20 ± 6 cm/s, 0.80 ± 0.4, and 1.25 ± 0.31. Despite a slight increase in superior thyroid and external carotid artery flow, there was no statistically significant change from before to after stenting. This study showed no differences in blood velocity profiles in the ipsilateral superior thyroid and external carotid arteries after stenting. © 2014 by the American Institute of Ultrasound in Medicine.

  9. Successful Coil Embolization of Pediatric Carotid Cavernous Fistula Due to Ruptured Posttraumatic Giant Internal Carotid Artery Aneurysm.

    Science.gov (United States)

    Wajima, Daisuke; Nakagawa, Ichiro; Park, Hun Soo; Yokoyama, Shohei; Wada, Takeshi; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2017-02-01

    The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery. However, for the ipsilateral posttraumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high-flow direct CCF is better for the prevention of hyperperfusion syndrome and intracranial hemorrhage. We experienced such a case and managed it successfully. A 6-year-old boy had severe head trauma caused by being hit by a car. He was transferred to our department and diagnosed as having left acute subdural hematoma and acute brain swelling. Emergent evacuation of hematoma and external decompression were performed. He was treated for severe brain swelling in the intensive care unit for 2 months. Cranioplasty was performed 3 months after the injury. His right hemiparesis and aphasia persisted, so he was transferred to a rehabilitation hospital. However, 2 years after the head injury, he was referred to our department because of abducens nerve palsy. He was diagnosed as having a symptomatic posttraumatic direct CCF, which was caused by a ruptured left cavernous giant internal carotid artery aneurysm. The direct CCF was treated with coil embolization of the giant aneurysm and parent artery occlusion. Coil embolization of the aneurysm and parent artery occlusion for the posttraumatic direct CCF was a good option to manage the abducens nerve palsy and to prevent postoperative hyperperfusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Internal carotid artery stenting for blunt carotid artery injuries with an associated pseudoaneurysm.

    Science.gov (United States)

    Berne, John D; Reuland, Kurt R; Villarreal, David H; McGovern, Thomas M; Rowe, Stephen A; Norwood, Scott H

    2008-02-01

    Blunt carotid artery injuries (BCI) are being recognized and treated with increasing frequency because of improved screening protocols. Recent advances in endovascular techniques using microcoils, angioplasty, and stenting offer a new treatment strategy for those patients with traumatic pseudoaneurysms (PA) (BCI and PA). Experience with these techniques is limited because of the rarity of these injuries. Early anticoagulation (AC) or antiplatelet (AP) therapy combined with carotid artery stenting is a safe alternative to AC alone for the treatment of grade III carotid artery injuries (BCI and PA). Prospective cohort study. A rural, community Level I trauma center. All patients with a nonocclusive BCI and PA during a 5.5 year period from June 23, 2000 to December 31, 2005 were included in the study. : Eleven patients with grade BCI and PA underwent endovascular repair. Nine patients (81%) had associated traumatic intracranial hemorrhage. AC (heparin drip) or AP therapy (clopidogrel or aspirin or both) was initiated in all patients within 48 hours of diagnosis of BCI. Time from admission to AC or AP was 21 +/- 9.5 hours (mean +/- SD). Mortality rate was 18% (2 of 11). One death was attributed to severe brain injury. The other was attributed to a stroke from the carotid injury. No patient had radiologic progression of traumatic intracranial hemorrhage on head computed tomography despite AP or AC. One patient sustained a mild embolic cerebrovascular ischemic event before stenting. No other survivors developed a stroke or any other evidence of cerebral ischemic symptoms. Two recurrent PAs developed during hospitalization and were successfully managed with an additional stent. All survivors were discharged with a good neurologic outcome. Seven patients had follow-up from 6 months to 4 years: one developed asymptomatic 50% stenosis at 6 months requiring successful angioplasty. All others showed complete healing without stenosis. Carotid artery stenting is safe and

  11. Copper in silicon: Quantitative analysis of internal and proximity gettering

    Energy Technology Data Exchange (ETDEWEB)

    McHugo, S.A. [Lawrence Berkeley National Lab., CA (United States); Flink, C.; Weber, E.R. [Univ. of California, Berkeley, CA (United States)] [and others

    1997-08-01

    The behavior of copper in the presence of a proximity gettering mechanism and a standard internal gettering mechanism in silicon was studied. He implantation-induced cavities in the near surface region were used as a proximity gettering mechanism and oxygen precipitates in the bulk of the material provided internal gettering sites. Moderate levels of copper contamination were introduced by ion implantation such that the copper was not supersaturated during the anneals, thus providing realistic copper contamination/gettering conditions. Copper concentrations at cavities and internal gettering sites were quantitatively measured after the annealings. In this manner, the gettering effectiveness of cavities was measured when in direct competition with internal gettering sites. The cavities were found to be the dominant gettering mechanism with only a small amount of copper gettered at the internal gettering sites. These results reveal the benefits of a segregation-type gettering mechanism for typical contamination conditions.

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

    African Journals Online (AJOL)

    Journal of Surgical Technique and Case Report | Jul-Dec 2010 | Vol-2 | Issue-2. 73. Spontaneous Recanalization of Complete ... up with periodic carotid ultrasound, Magnetic Resonance. Angiography (MRA) or CT angiography, ... identified high-risk predictive factors for delayed stroke in those treated medically (90 to 94% ...

  13. Neurofibromatosis-associated massive right internal carotid artery aneurysm with a coexisting arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Marlin Wayne Causey, MD

    2016-12-01

    Full Text Available A 47-year-old woman presented with a right cervical mass that had been slowly enlarging for 6 years, causing pulsatile tinnitus and dizziness with compression. Computed tomography angiography demonstrated a partially thrombosed 8-cm right internal carotid artery aneurysm with a coexisting arteriovenous fistula. Conventional angiography demonstrated a vertebrojugular fistula (right vertebral artery to right internal jugular vein and retrograde flow in the right vertebral artery to the fistula. Successful repair was performed in a staged fashion: operative repair of the internal carotid artery aneurysm with interposition bypass, followed by endovascular embolization of the vertebrojugular fistula through a bilateral vertebral artery approach.

  14. Computed tomography angiography intraluminal filling defect is predictive of internal carotid artery free-floating thrombus

    Energy Technology Data Exchange (ETDEWEB)

    Jaberi, A.; Lum, C.; Stefanski, P.; Iancu, D. [University of Ottawa, Faculty of Medicine, Ottawa, Ontario (Canada); The Ottawa Hospital, Department of Radiology, Neuroradiology Section, Ottawa, Ontario (Canada); Thornhill, R. [Neurosciences and Clinical Epidemiology Program/Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario (Canada); The Ottawa Hospital, Department of Radiology, Neuroradiology Section, Ottawa, Ontario (Canada); Petrcich, W. [Neurosciences and Clinical Epidemiology Program/Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario (Canada); Momoli, F. [Children' s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario (Canada); University of Ottawa, Department of Epidemiology and Community Medicine, Ottawa, Ontario (Canada); Torres, C.; Dowlatshahi, D. [University of Ottawa, Faculty of Medicine, Ottawa, Ontario (Canada); University of Ottawa, Division of Neurology, Department of Medicine, Ottawa, Ontario (Canada)

    2014-01-15

    Filling defects at the internal carotid artery (ICA) origin in the work-up of stroke or transient ischemic attack may be an ulcerated plaque or free-floating thrombus (FFT). This may be challenging to distinguish, as they can appear morphologically similar. This is an important distinction as FFT can potentially embolize distally, and its management differs. We describe a series of patients with suspected FFT and evaluate its imaging appearance, clinical features, and evolution with therapy. Between 2008 and 2013, we prospectively collected consecutive patients with proximal ICA filling defects in the axial plane surrounded by contrast on CT/MR angiography. We defined FFT as a filling defect that resolved on follow-up imaging. We assessed the cranial-caudal dimension of the filling defect and receiver operating characteristics to identify clinical and radiological variables that distinguished FFT from complex ulcerated plaque. Intraluminal filling defects were identified in 32 patients. Filling defects and resolved or decreased in 25 patients (78 %) and felt to be FFT; there was no change in 7 (22 %). Resolved defects and those that decreased in size extended more cranially than those that remained unchanged: 7.3 mm (4.2-15.9) versus 3.1 mm (2.7-3.7; p = 0.0038). Receiver operating characteristic analysis established a threshold of 3.8 mm (filling defect length), sensitivity of 88 %, specificity of 86 %, and area under the curve of 0.86 (p < 0.0001) for distinguishing FFT from plaque. Filling defects in the proximal ICA extending cranially >3.8 mm were more likely to be FFT than complex ulcerated plaque. Further studies evaluating filling defect length as a predictor for FFT are warranted. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-03-15

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

  16. Elasticity of the carotid artery walls as a prognostic factor for the occurrence of restenosis after a surgery for internal carotid artery stenosis.

    Science.gov (United States)

    Eberhardt, Andrzej; Madycki, Grzegorz; Hendiger, Włodzimierz; Staszkiewicz, Walerian; Lewszuk, Adam

    2015-01-01

    Restoration of carotid artery patency is one of the most frequently performed operations in vascular surgery. One of the most important problems that occur both short- and long-term after carotid endarterectomy is recurrent stenosis. Despite advances in imaging studies and better knowledge of the mechanisms of atherogenesis, the mechanism of restenosis remains unclear. Patients with internal carotid artery atherosclerosis experience decreased elasticity of the intima-media complex, resulting in increased vessel wall stiffness. In the future, measurement of carotid artery elasticity may become a marker for the development of post-surgical stenosis occurring after endarterectomy of both the carotid artery and other peripheral vessels. To assess the elasticity of carotid artery walls as a prognostic factor for the occurrence of restenosis after a surgery for common carotid artery stenosis. Classic carotid artery endarterectomy was performed in 180 patients selected on the basis of standard, ultrasound- based recommendations. The phenomenon of restenosis was examined using ultrasound techniques at 3, 6, 9 and 12 months after the surgery. Measurements of carotid artery elasticity were performed using a Vascular Echo Doppler device, and patients were divided into two groups depending on the occurrence (or non-occurrence) of restenosis. Group I (without restenosis) included 156 (86.6%) patients, and Group II (with restenosis) included 24 (13.4%) patients. At 3 and 6 months after the surgery, an increase of the elasticity of vessel walls (coefficient a) was observed in both groups, but the differences in the elasticity of the carotid arteries were not significant. At 12 months after the surgery, all patients in Group II (with restenosis) had significantly increased coefficient a values as compared to Group I patients (p elasticity as measured using coefficient a may be associated with the process leading to the occurrence of restenosis after the surgery. Further research

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

    Directory of Open Access Journals (Sweden)

    Niku Oksala

    2014-06-01

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

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

    Science.gov (United States)

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

    2003-02-01

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

  19. Isolated origin of the left internal carotid artery from the pulmonary artery.

    Science.gov (United States)

    Hurley, Michael C; Nguyen, Pamela H; DiPatri, Arthur J; Shaibani, Ali

    2008-09-01

    The authors describe what is, to their knowledge, the first reported case of the anomalous origin of an internal carotid artery from the pulmonary artery. An otherwise asymptomatic 6-year-old girl, who presented with headaches and hypertension, underwent a comprehensive workup that revealed extensive meningeal and cerebral artery anastomoses to the left internal carotid artery--itself arising from the origin of the left pulmonary artery. This unique anatomical anomaly, caused by a disturbed pattern of aortic arch regression, resulted in a right-to-left vascular shunt into the pulmonary artery and a disturbance of intracranial artery flow patterns, complicating the management options.

  20. Risk Factors for Stroke, Myocardial Infarction, or Death Following Carotid Endarterectomy : Results from the International Carotid Stenting Study

    NARCIS (Netherlands)

    Doig, D.; Turner, E. L.; Dobson, J.; Featherstone, R. L.; De Borst, G. J.; Stansby, G.; Beard, J. D.; Engelter, S. T.; Richards, T.; Brown, M. M.

    2015-01-01

    Objectives Carotid endarterectomy (CEA) is standard treatment for symptomatic carotid artery stenosis but carries a risk of stroke, myocardial infarction (MI), or death. This study investigated risk factors for these procedural complications occurring within 30 days of endarterectomy in the

  1. Risk Factors For Stroke, Myocardial Infarction, or Death Following Carotid Endarterectomy: Results From the International Carotid Stenting Study

    NARCIS (Netherlands)

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

    2015-01-01

    Objectives: Carotid endarterectomy (CEA) is standard treatment for symptomatic carotid artery stenosis but carries a risk of stroke, myocardial infarction (MI), or death. This study investigated risk factors for these procedural complications occurring within 30 days of endarterectomy in the

  2. Carotid Space Mass Proximal to Vagus Nerve Causing Asystole and Syncope

    Directory of Open Access Journals (Sweden)

    Julie Leviter

    2016-01-01

    Full Text Available Manipulation of vagal nerve rootlets, whether surgical or through mass effect of a neoplasm, can result in asystole and hypotension, accompanied by ST depression and right bundle branch block. There are few case reports of a neoplasm causing these effects, and this case describes a patient with such a mass presenting with syncopal episodes. A 43-year-old man with a past medical history of HIV, bipolar disorder, and epilepsy was admitted to the neurology service for a video electroencephalogram (vEEG to characterize syncopal episodes that were felt to be epileptic in origin. During the study, he experienced symptoms of his typical aura, which correlated with a transient symptomatic high degree AV block on telemetry, and an absence of epileptic findings on vEEG. Magnetic Resonance Imaging (MRI of the brain showed a mass in the left posterior carotid space at the skull base. The patient underwent permanent dual chamber MRI-compatible pacemaker placement for his heart block. His syncopal episodes resolved, but presyncopal symptoms persisted. We discuss the presentation and treatment of vagal neoplasms.

  3. Primary internal carotid artery aneurysm in a 15-year-old male: case report and review of the literature.

    Science.gov (United States)

    Lopez, Daniel; Sarac, Timur; Lorenz, Robert

    2015-01-01

    Extracranial internal carotid artery aneurysms are a rare entity in the adult population. Very little information is known in the pediatric population. We present a case of a 15-year-old male with an isolated internal carotid artery aneurysm and a review of the literature. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Morton Adam

    2012-12-01

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

  6. Congenital horner syndrome with heterochromia iridis associated with ipsilateral internal carotid artery hypoplasia.

    Science.gov (United States)

    Deprez, Fabrice C; Coulier, Julie; Rommel, Denis; Boschi, Antonella

    2015-04-01

    Horner syndrome (HS), also known as Claude-Bernard-Horner syndrome or oculosympathetic palsy, comprises ipsilateral ptosis, miosis, and facial anhidrosis. We report herein the case of a 67-year-old man who presented with congenital HS associated with ipsilateral hypoplasia of the internal carotid artery (ICA), as revealed by heterochromia iridis and confirmed by computed tomography (CT). CT evaluation of the skull base is essential to establish this diagnosis and distinguish aplasia from agenesis/hypoplasia (by the absence or hypoplasia of the carotid canal) or from acquired ICA obstruction as demonstrated by angiographic CT.

  7. Goldenhar syndrome associated with contralateral agenesis of the internal carotid artery.

    Science.gov (United States)

    Ventura, Elisa; Ormitti, Francesca; Crisi, Girolamo; Sesenna, Enrico

    2014-04-01

    Congenital absence of the internal carotid artery (ICA) is an extremely rare vascular anomaly. Aplasia and displacement of the horizontal portion of the petrous carotid artery have been described in a patient with mandibulofacial dysostosis. To the best of our knowledge, the association between Goldenhar syndrome and ipsilateral ICA agenesis has emerged only in one case documented in the medical literature to date. We describe here a case that illustrates the association of Goldenhar syndrome with contralateral agenesis of the ICA incidentally detected on brain magnetic resonance imaging and subsequently confirmed on magnetic resonance angiography and high resolution computed tomography.

  8. Methodology to study intimal failure mechanics in human internal carotid arteries.

    Science.gov (United States)

    Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A

    2005-12-01

    While the incidence of blunt carotid artery injuries is low, the mortality rate is extremely high (40%). Clinical evidence indicates that the intimal region of the artery often sustains failure, while maintaining the integrity of the outer layers. This condition may lead to delayed ischemic symptoms, commonly reported in clinical literature. To date, the mechanical properties of the intima relative to the outer vessel layers have not been quantified in the human carotid artery. The purpose of the present study was to develop a methodology to determine the longitudinal mechanical properties of the human internal carotid artery in tension, with an emphasis on intimal failure. This was accomplished by opening the vessel at the mid-diameter level, creating an 'I'-shaped testing specimen, subjecting the specimen to failure loading, documenting the stretch characteristics of the intimal and adventitial sides in the temporal domain, and correlating the synchronized videography with mechanical loading. Intimal failure data were quantified using stress and strain parameters in conjunction with digital videography of the intimal and adventitial sides. The present methodology can be used to determine the mechanical properties of the intima relative to ultimate carotid artery failure. These data will assist in the understanding of blunt carotid artery injuries, its diagnosis and treatment.

  9. Posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis.

    Science.gov (United States)

    Fontela, Patricia S; Tampieri, Donatella; Atkinson, Jeffrey D; Daniel, Sam J; Teitelbaum, Jeanne; Shemie, Sam D

    2006-05-01

    To report a case of posttraumatic pseudoaneurysm of the intracavernous internal carotid artery presenting with massive epistaxis and to discuss its pathophysiology and management. Case report and literature review. Pediatric intensive care unit in a tertiary-care center. Twelve days after a motor vehicle accident causing a head injury and facial fractures, this patient presented with massive epistaxis due to a pseudoaneurysm of the intracavernous internal carotid artery . Nasal packing was performed and subsequent angiography demonstrated the vascular lesion that had dissected into the sphenoid sinus. Endovascular stent and coil occlusion of the vascular lesion was performed, and the patient's condition improved without any ischemic or thromboembolic sequelae. Posttraumatic aneurysms of the intracavernous internal carotid artery can be associated with delayed and sometimes lethal massive epistaxis. This vascular lesion should be considered in patients with traumatic brain injury presenting with basal skull fractures in the region of the carotid canal or cavernous sinus and/or orbital fractures and compromise of the optical nerves. Knowledge of these risk factors and early diagnosis can minimize the high mortality risk.

  10. Quantitative flow measurement after placing a flow diverter for a distal internal carotid artery aneurysm.

    Science.gov (United States)

    Chen, Chien-Wei; Wong, Ho-Fai; Ye, Yu-Ling; Chen, Yao-Liang; Chen, Wei-Liang; Ou, Chang-Hsien; Tsai, Yuan-Hsiung

    2017-12-01

    To evaluate the differences in arterial flow after flow diverter placement using quantitative flow measurements based on digital subtraction angiography (DSA). Between November 2013 and November 2015, all patients who had flow diverters placed for distal internal carotid artery (ICA) aneurysms were reviewed. Patients in whom the stent was placed across the ostia of the ophthalmic artery (OphA) and anterior choroidal artery (AChA) were enrolled. Five regions of interest were selected: the proximal ICA (as a reference), terminal ICA, middle cerebral artery (MCA), anterior cerebral artery (ACA), OphA, and AChA. The values of the peak, time-to-peak (TTP), and area under the curve (AUC) were analyzed using a quantitative DSA technique. The study enrolled 13 patients. The quantitative flow analysis showed improved flow in the terminal ICA (peak and AUC, p=0.036 and p=0.04, respectively), MCA (AUC, p=0.023), and ACA (AUC, p=0.006), and decreased flow in the OphA (peak and AUC, p=0.013 and p=0.005, respectively) and AChA (peak and subtracted TTP, p=0.023 and p=0.050, respectively) after flow diverter placement. Larger aneurysm volume was significantly correlated with decreased OphA flow after the procedure (peak and AUC, p=0.049 and p=0.037, respectively). Larger aneurysm volume also had a marginal correlation with increased distal ICA flow after the procedure, but this did not reach significance (peak and AUC, p=0.195 and p=0.060, respectively). Without using extra contrast medium or radiation dosages, color-coded DSA enables quantitative monitoring of the cerebral circulation after flow-diverting treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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

    Science.gov (United States)

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

    2008-01-01

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

  12. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): a randomised controlled trial with cost-effectiveness analysis.

    Science.gov (United States)

    Featherstone, Roland L; Dobson, Joanna; Ederle, Jörg; Doig, David; Bonati, Leo H; Morris, Stephen; Patel, Nishma V; Brown, Martin M

    2016-03-01

    Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for the treatment of carotid stenosis, but safety and long-term efficacy were uncertain. To compare the risks, benefits and cost-effectiveness of CAS versus CEA for symptomatic carotid stenosis. International, multicentre, randomised controlled, open, prospective clinical trial. Hospitals at 50 centres worldwide. Patients older than 40 years of age with symptomatic atheromatous carotid artery stenosis. Patients were randomly allocated stenting or endarterectomy using a computerised service and followed for up to 10 years. The primary outcome measure was the long-term rate of fatal or disabling stroke, analysed by intention to treat (ITT). Disability was assessed using the modified Rankin Scale (mRS). A cost-utility analysis estimating mean costs and quality-adjusted life-years (QALYs) was calculated over a 5-year time horizon. A total of 1713 patients were randomised but three withdrew consent immediately, leaving 1710 for ITT analysis (853 were assigned to stenting and 857 were assigned to endarterectomy). The incidence of stroke, death or procedural myocardial infarction (MI) within 120 days of treatment was 8.5% in the CAS group versus 5.2% in the CEA group (72 vs. 44 events) [hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.16 to 2.45; p = 0.006]. In the analysis restricted to patients who completed stenting, age independently predicted the risk of stroke, death or MI within 30 days of CAS (relative risk increase 1.17% per 5 years of age, 95% CI 1.01% to 1.37%). Use of an open-cell stent conferred higher risk than a closed-cell stent (relative risk 1.92, 95% CI 1.11 to 3.33), but use of a cerebral protection device did not modify the risk. CAS was associated with a higher risk of stroke in patients with an age-related white-matter changes score of 7 or more (HR 2.98, 95% CI 1.29 to 6.93; p = 0.011). After completion of follow-up with a median of 4.2 years, the number

  13. Proximal balloon occlusion versus distal filter protection in carotid artery stenting: A meta-analysis and review of the literature.

    Science.gov (United States)

    Omran, Jad; Mahmud, Ehtisham; White, Christopher J; Aronow, Herbert D; Drachman, Douglas E; Gray, William; Abdullah, Obai; Abu-Fadel, Mazen; Firwana, Belal; Mishkel, Gergory; Al-Dadah, Ashraf S

    2017-04-01

    Carotid artery stenting (CAS) is typically performed using embolic protection devices (EPDs) as a means to reduce the risk of procedure-related stroke. In this study, we compared procedural morbidity and mortality associated with distal (D-EPD) vs. proximal (P-EPD) protection. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1998 through May 2015. Only studies comparing (D-EPD) and (P-EPD) were included. Two independent reviewers selected and appraised studies and extracted data in duplicate. Random-effects meta-analysis was used to pool outcomes across studies. Heterogeneity of treatment effect among studies was assessed using the I2 statistics. Publication bias was assessed using inspection of funnel plots. The primary endpoints included 30-day mortality and stroke. Secondary endpoints included new cerebral lesions on diffusion-weighted magnetic resonance imaging (DW-MRI) and contralateral lesions on DW-MRI. A total of 12,281 patients were included from 18 studies (13 prospective and 5 retrospective) comparing (D-EPD) and (P-EPD) in the setting of CAS. The mean patient age was 69 years and 64% of patients were male. No evidence of publication bias was detected. There was no significant difference between the two modalities in terms of the risk of stroke (risk difference [RD] 0.0, 95% confidence interval [CI] -0.01 to 0.01) or mortality (RD 0.0, 95% CI -0.01 to 0.01) nor was there any difference in the incidence of new cerebral lesions on DW-MRI or contralateral DW-MRI lesions. In patients undergoing CAS, both D-EPD and P-EPD provide similar levels of protection from peri-procedural stroke and 30 days mortality. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Cost-utility analysis of stenting versus endarterectomy in the International Carotid Stenting Study.

    Science.gov (United States)

    Morris, Stephen; Patel, Nishma V; Dobson, Joanna; Featherstone, Roland L; Richards, Toby; Luengo-Fernandez, Ramon; Rothwell, Peter M; Brown, Martin M

    2016-06-01

    The International Carotid Stenting Study was a multicenter randomized trial in which patients with symptomatic carotid artery stenosis were randomly allocated to treatment by carotid stenting or endarterectomy. Economic evidence comparing these treatments is limited and inconsistent. We compared the cost-effectiveness of stenting versus endarterectomy using International Carotid Stenting Study data. We performed a cost-utility analysis estimating mean costs and quality-adjusted life years per patient for both treatments over a five-year time horizon based on resource use data and utility values collected in the trial. Costs of managing stroke events were estimated using individual patient data from a UK population-based study (Oxford Vascular Study). Mean costs per patient (95% CI) were US$10,477 ($9669 to $11,285) in the stenting group (N = 853) and $9669 ($8835 to $10,504) in the endarterectomy group (N = 857). There were no differences in mean quality-adjusted life years per patient (3.247 (3.160 to 3.333) and 3.228 (3.150 to 3.306), respectively). There were no differences in adjusted costs between groups (mean incremental costs for stenting versus endarterectomy $736 (95% CI -$353 to $1826)) or adjusted outcomes (mean quality-adjusted life years gained -0.010 (95% CI -0.117 to 0.097)). The incremental net monetary benefit for stenting versus endarterectomy was not significantly different from zero at the maximum willingness to pay for a quality-adjusted life year commonly used in the UK. Sensitivity analyses showed little uncertainty in these findings. Economic considerations should not affect whether patients with symptomatic carotid stenosis undergo stenting or endarterectomy. © 2016 World Stroke Organization.

  15. Unilateral congenital hypoplasia of the internal carotid artery in a newborn: a rare case report

    Directory of Open Access Journals (Sweden)

    Liliana Valentino

    2015-04-01

    Full Text Available Hypoplasia of one or both internal carotid artery (ICA is a rare congenital developmental abnormality. The early neurological presentation of this disorder is rare because many of these cases remain asymptomatic and go undetected due to the presence of collateral vessels. We describe a newborn that presented with seizures at 27 hours after birth. Extended ischemia of the right hemisfere was observed on computed tomography (CT, while the 3D MIP reconstruction showed hypoplasia of right internal carotid artery. After about 3 weeks, the rapid improvement of the newborn’s cerebral ultrasound and EEG allowed to discontinue corticosteroid and sedative therapy. The infant was discharged after 40 days of life in good clinical condition.

  16. Severe optochiasmatic arachnoiditis after rupture of an internal carotid artery aneurysm

    Directory of Open Access Journals (Sweden)

    Ricardo Ramina

    1989-06-01

    Full Text Available The case of a 24-year-old man with progressive visual loss due to optochiasmatic arachnoiditis is presented. The cause of the arachnoiditis was subarachnoidal bleeding due to rupture of an internal carotid artery aneurysm. The aneurysm was clipped 5 years after the first episode of bleeding. The diagnosis of optochiasmatic arachnoiditis was confirmed during the operation. This case, is presented in order to discuss the causes, the symptoms and the therapeutical possibilities of this rare condition.

  17. Hemicrania continua-like headache associated with internal carotid artery dissection may respond to indomethacin.

    Science.gov (United States)

    Ashkenazi, Avi; Abbas, Muhammad A; Sharma, Dinesh K; Silberstein, Stephen D

    2007-01-01

    Hemicrania continua (HC) is an idiopathic, chronic disorder characterized by a continuous, strictly unilateral headache associated with ipsilateral cranial autonomic symptoms. The symptoms of HC typically respond dramatically to indomethacin therapy. We describe a patient with traumatic internal carotid artery dissection, who presented with a clinical picture mimicking HC that initially responded to indomethacin. Patients with a clinical picture similar to HC should be managed with a high index of suspicion for a possible cervical arterial dissection.

  18. Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion: case report.

    Science.gov (United States)

    Frenkel, Mark B; Renfrow, Jaclyn J; Singh, Jasmeet; Garg, Nitin; Wolfe, Stacey Q

    2017-11-17

    Tandem internal carotid artery (ICA) origin occlusion and middle cerebral artery (MCA) thromboembolism is a life-threatening condition with poor neurological outcome. The authors report on a patient presenting with acute ischemic stroke from a tandem ICA and MCA occlusion with penumbra. Emergency MCA mechanical thrombectomy was performed through percutaneous cervical ICA access due to the inability to cross the cervical carotid occlusion. Emergency carotid endarterectomy to reperfuse the poorly collateralized hemisphere and repair the ICA access site was performed 2 hours after completion of tissue plasminogen activator (tPA) infusion. This case illustrates the shortest reported interval between tPA infusion and open surgical intervention for carotid revascularization, as well as the role of direct carotid artery access for mechanical thrombectomy. The authors also describe the use of a temporizing femoral artery-to-ICA shunt to maintain cerebral perfusion in the setting of ICA occlusion.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-09-15

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

  20. Validation of ultrasound parameters to assess collateral flow via ophthalmic artery in internal carotid artery occlusion.

    Science.gov (United States)

    Tanaka, Tomotaka; Doijiri, Ryosuke; Saito, Kozue; Kajimoto, Katsufumi; Ihara, Masafumi; Yamagami, Hiroshi; Miyashita, Kotaro; Nagatsuka, Kazuyuki

    2014-01-01

    This study aimed to characterize the flow patterns using ultrasound (US) in the external carotid artery (ECA) in patients with total occlusion of internal carotid artery (ICA) and characterize collateral retrograde flow through the ophthalmic artery (OA, secondary collateral, internalization). This study was performed on 45 patients who were retrospectively selected with total occlusion of the ICA, who underwent digital subtraction angiography (DSA), magnetic resonance angiography (MRA), and US (43 men; mean age 68.1 ± 7.9 years). Collateral retrograde flow and collateral flow through the circle of Willis (primary collateral) were determined by DSA and MRA. We compared several US parameters such as ECA peak systolic velocity, mean velocity, end-diastolic (ED) velocity, pulsatility index (PI), and pulsatility transmission index (PTI). PTI was defined as the ratio of ipsilateral ECA PI to the ipsilateral common carotid artery (CCA). In this patient group, 27 patients showed retrograde flow through OA as assessed by DSA. The presence of primary collateral flow was significantly lower in patients with retrograde flow than without (P ECA ED velocity was significantly higher, and PI and PTI were significantly lower with retrograde flow through OA than without (P ECA because a collateral pathway through OA in cases of ICA occlusion had less primary collateral pathways. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Popov Petar

    2009-01-01

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

  2. Treatment strategies for complex internal carotid artery (ICA) aneurysms: direct ICA sacrifice or combined with extracranial-to-intracranial bypass.

    Science.gov (United States)

    Zhu, Wei; Tian, Yan-Long; Zhou, Liang-Fu; Song, Dong-Lei; Xu, Bin; Mao, Ying

    2011-01-01

    Direct surgery for complex internal carotid artery (ICA) aneurysms can be difficult. In certain situations, sacrificing the parent artery is a unique way to obliterate the aneurysm and extracranial-to-intracranial (EC-IC) bypass is indispensable to prevent postoperative cerebral ischemia. This article discusses the indications for direct ICA occlusion, and the strategies, techniques, and outcomes in a series of patients treated for complex ICA aneurysms in a single institution. During a 7-year period, 49 patients with complex ICA aneurysms underwent direct ICA sacrifice, or ICA sacrifice combined with EC-IC bypass. The appropriate type of bypass was determined by the results of balloon occlusion test and computed tomographic perfusion. The technique of ICA sacrifice used was selected based on the evaluation of retrograde filling of the aneurysm during balloon occlusion test. Ten patients underwent direct ICA sacrifice and no ischemia-related complications were evident during the 5-12 months of follow-up. A total of 39 patients were treated by ICA sacrifice combined with EC-IC bypass, including 21 cases of superficial temporal artery-radial artery-middle cerebral artery and 18 cases of external carotid artery-radial artery-middle cerebral artery. ICA sacrifice was achieved in 38 patients by using prolonged occlusion (25 cases) or acute occlusion (13 cases). Five patients presented with minor ischemia after surgery, but four patients recovered completely. Two patients developed brain swelling postoperatively and one developed intracranial hemorrhage, which required evacuation of the hematoma. Balloon occlusion test combined with computed tomographic perfusion can be an efficient way to evaluate the compromised cerebrovascular reserve in patients with complex ICA aneurysms after ICA occlusion. In conjunction with EC-IC bypass, ICA proximal occlusion or trapping can be an effective treatment strategy. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Incidental internal carotid artery calcifications on temporal bone CT in children

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

    2007-02-15

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

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

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    Bogousslavsky, J.; Regli, F.

    1985-05-01

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

  5. [Study of the hypoplasic internal carotid artery by use of multislice spiral computed tomography. Two case reports].

    Science.gov (United States)

    Ibarra de Grassa, B; Romero-Vidal, F J; Alarcón-Alcaraz, M M; Arenillas-Lara, J F; Fernández-Lara, L J; Coscojuela-Santaliestra, P

    Hypoplastic internal carotid artery (HICA) is a rare benign congenital malformation. Its angiographic image string sign is shared by entities that may be either medically or surgically treated. We report two cases diagnosed by helical computerized tomography (HCT). Case 1: woman diagnosed clinically and by magnetic resonance (MR) of Chiari I malformation with associated syringomyelia. An HCT of the craniocervical junction was done to rule out osseous malformations. An hypoplastic posterior fossa (PF) with small right carotid foramen was diagnosed. An arteriography with HCT was done that showed the carotid string sign. Case 2: a 82 years old hypertensive woman with left hemiparesia and homonymous hemianopsia was diagnosed of right temporooccipital infarct. An HCT arteriography disclosed occlusion of the right posterior cerebral artery, calcification of the left carotid siphon and stenosis of the right siphon. Bi and tridimensional reconstructions of the circle of Willis, cranial base and distal cervical carotid arteries showed an hypoplastic right carotid artery and foramen. Multislice HCT is a recently incorporated diagnostic tool that allows a volumetric study in a short period of time, seconds. An angiographic study can be done intravenously in cases of vascular anomaly suspiction, hypoplastic carotid artery in the reported cases. HCT is the only current imaging tool that can diagnose this anomaly without the aid of other imaging studies.

  6. [Study on correlation between retinal vessel morphology or ocular hemodynamic parameter and internal carotid artery stenosis].

    Science.gov (United States)

    Li, H Y; Wang, H; Zhang, X J; Feng, Y H; Wang, Z C; Wang, Y L

    2016-12-11

    Objective: To analyze the correlation between retinal vascular calibers, ocular blood flow parameters and internal carotid artery stenosis and to evaluate the effect of internal carotid artery stenosis on ocular blood vessels comprehensively. Methods: A retrospective case-control study. The clinical data of 141 patients who underwent head-and-neck computed tomography (CT) angiography examinations of the ICA were collected at Beijing Friendship Hospital, Capital Medical University from January 2014 to January 2016. According to diagnostic criteria, the patients were divided into four groups: the non-stenosis group, the mild stenosis group, the moderate stenosis group, and the severe stenosis andocclusion group. The retinal vascular caliber was measured in color fundus photograph by IVAN software. Color Doppler ultrasonography was used to measure the parameters of ocular blood flow, including the peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI). The enumeration data were analyzed with chi-square test, the measurement data were analyzed with rank-sum test, and the correlation test was performed with spearman. Results: The gender ratio of the patients without stenosis, mild stenosis, moderate stenosis, severe stenosis and occlusion was 12/7, 31/19, 28/25, 12/7, χ(2) test was not statistically significant (χ(2)= 0.79, P=0.85); There was no statistically significant difference between the different groups (χ(2)= 0.15, P=0.68), the age of four groups were (64.1±8.3), (54.3±14.3), (68.9±11.8) and (59.1±8.0) y, respectively. In the no internal carotid artery stenosis group, the arteries diameter is (164.5±15.6) μm ,the vein diameter is (245.6±20.0) μm and the arteriovenous ratio is 0.7±0.1. There is no difference among the mild stenosis group, moderate stenosis group and the severe stenosis (χ(2)artery caliber=6.92, Partery caliber=0.08; χ(2)vein diameter=4.16, Pvein diameter=0.25; χ(2)arteriolar

  7. Internal fixation of proximal humerus fractures using the T2-proximal humeral nail.

    Science.gov (United States)

    Popescu, Dragos; Fernandez-Valencia, Jenaro A; Rios, Moisés; Cuñé, Jordi; Domingo, Anna; Prat, Salvi

    2009-09-01

    Surgical management of proximal humerus fractures remains controversial and there is an increasing interest in intramedullary nailing. Created to improve previous designs, the T2-proximal humeral nail (PHN) (Stryker) has been recently released, and the English literature lacks a series evaluating its results. We present a clinical prospective study evaluating this implant for proximal humeral fractures. We evaluated the functional and radiological results and possible complications. Twenty-nine patients with displaced fractures of the proximal humerus were treated with this nail. One patient was lost right after surgery and excluded from the assessment. Eighteen patients were older than 70 years. There were 21 fractures of the proximal part of the humerus and 7 fractures that also involved the shaft; 15 of the fractures were two-part fractures (surgical neck), 5 were three-part fractures, and 1 was a four-part fracture. All fractures healed in a mean period of 2.7 months. There was one delayed union that healed in 4 months. One case of avascular necrosis of the humeral head was observed (a four-part fracture), but remained asymptomatic and did not require further treatment. In one case a back-out of one proximal screw was observed. A final evaluation with a minimum 1 year follow-up was performed by an independent observer; in 18 patients, the mean Constant score was 65.7 or 76.1% with the adjustment of age and gender; in 19 patients, the mean Oxford Shoulder Score was 21.7. The results obtained with the T2-PHN nail indicate that it represents a safe and reliable method in the treatment of two- and three-part fractures of the proximal humerus. The proximal fixation mechanism diminishes the rate of back-out of the screws, a frequent complication described in the literature. Better functional results were obtained from the patients younger than 70 years, but these were not statistically significant.

  8. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

    Directory of Open Access Journals (Sweden)

    Jaiswal Atin

    2013-12-01

    Full Text Available 【Abstract】Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic dis- placed proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome. Key words: Humeral fractures; Shoulder fractures; Fracture fixation, internal

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-12-15

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

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

    Directory of Open Access Journals (Sweden)

    Kenneth Chan

    2010-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Zenteno M.

    2014-03-01

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

  12. Bilateral internal carotid artery agenesis with artery compression of the brain parenchyma.

    Science.gov (United States)

    Sun, Jihong; Jiang, Dingyao; Zhang, Shizheng

    2008-09-15

    Bilateral internal carotid artery (ICA) agenesis is an extremely rare congenital anomaly. The most common type of collateral circulation is developed through the circle of Willis via the basilar and posterior communicating arteries. Both anterior circulations are usually supplied by enlarged posterior communicating arteries (PCOMs). We present an unusual case of bilateral ICA agenesis, which is associated with dolichoectatic left PCOM and left posterior cerebral artery (PCA) compression of left basal ganglia and thalamus. These complex cerebral and vascular anomalies can be noninvasively revealed and evaluated by CT and MR.

  13. Current status of revascularization surgery for Moyamoya disease: special consideration for its 'internal carotid-external carotid (IC-EC) conversion' as the physiological reorganization system.

    Science.gov (United States)

    Fujimura, Miki; Tominaga, Teiji

    2015-05-01

    Moyamoya disease is a chronic cerebrovascular disease with unknown etiology, which is characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. Moyamoya disease is known to have unique and dynamic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging established in 1969. Insufficiency of this 'IC-EC conversion system' may result in cerebral ischemia, as well as in intracranial hemorrhage from inadequate collateral vascular network, both of which represent the clinical presentation of moyamoya disease. Therefore, surgical revascularization by extracranial-intracranial bypass is the preferred procedure for moyamoya disease to complement 'IC-EC conversion' and thus to avoid cerebral infarction and/or intracranial hemorrhage. Long-term outcome of revascularization surgery for moyamoya disease is favorable, but rapid increase in cerebral blood flow on the affected hemisphere could temporarily cause unfavorable phenomenon such as cerebral hyperperfusion syndrome. We would review the current status of revascularization surgery for moyamoya disease based on its basic pathology, and sought to discuss the significance of measuring cerebral blood flow in the acute stage and intensive perioperative management.

  14. 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.

  15. A New Anatomic Variation: Coexistence of Both Dandy-Walker Variant and Ophthalmic Artery Originating From Contralateral Internal Carotid Artery.

    Science.gov (United States)

    Ogul, Hayri; Havan, Nuri; Gedikli, Yusuf; Pirimoglu, Berhan; Kantarci, Mecit

    2016-06-01

    The authors report on 1 patient of variant origin of right ophthalmic artery (OA) from ophthalmic segment of the left internal carotid artery. A 41-year-old man was performed magnetic resonance (MR) imaging and MR angiography. Cerebral MR imaging revealed a Dandy-Walker variant. In MR angiography the authors observed this unusual variant of origin of OA and a complete occlusion of right internal carotid artery. To the authors' knowledge, this is the first patient who has coincidence of both Dandy-Walker variant and origin of OA from contralateral internal carotid artery. Careful observation of MR angiography images with maximum intensity projection is very important for detecting rare vascular variations.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-06-15

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

  17. The critical role of the external carotid artery in cerebral perfusion of patients with total occlusion of the internal carotid artery.

    Science.gov (United States)

    Dalainas, I; Avgerinos, E D; Daskalopoulos, M E; Papapetrou, A; Papasideris, C P; Katsikas, V; Xiromeritis, K; Moulakakis, K; Gianakopoulos, T; Liapis, C D

    2012-02-01

    The ipsilateral external carotid artery (ECA) can potentially provide an important collateral pathway for cerebral blood flow in the presence of occlusion or severe stenosis of the internal carotid artery (ICA), recovering up to 15% of the middle cerebral arterial flow. The aim of the study is to elucidate the role of ECA in cerebral flow of patients with total ICA occlusion. Retrospective study of prospectively collected data of 139 patients with total ICA occlusions. The patients were divided to symptomatic and asymptomatic and were categorized in four subgroups according to the stenosis rates: A) ipsilateral ECAECA stenosis ECA stenosis ≥70% and contralateral ICA stenosis ECA stenosis ≥70% and contralateral ICA stenosis ≥75%. Fifty eight (41.7%) patients were asymptomatic. The highest rate (48.2%) of asymptomatic patients was in Group A. Among patients with strokes, the highest rate belonged in groups C and D (44.4% and 50% respectively) where ipsilateral ECA stenosis was ≥70% irrespectively of the contralateral ICA patency. Ipsilateral external carotid artery stenosis ≥70% proved to be and independent risk factor for symptom presentation (P=0.013). The study reveals the significant role of ECA patency in cerebral flow in patients with ICA occlusion.

  18. Carotid artery surgery - slideshow

    Science.gov (United States)

    ... right- and left-internal carotid arteries, and the right- and left-external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to both the head and brain. Review Date 6/1/2015 Updated by: Daniel ...

  19. Semi-automatic quantitative measurements of intracranial internal carotid artery stenosis and calcification using CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Bleeker, Leslie; Berg, Rene van den; Majoie, Charles B. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Marquering, Henk A. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam (Netherlands); Nederkoorn, Paul J. [Academic Medical Center, Department of Neurology, Amsterdam (Netherlands)

    2012-09-15

    Intracranial carotid artery atherosclerotic disease is an independent predictor for recurrent stroke. However, its quantitative assessment is not routinely performed in clinical practice. In this diagnostic study, we present and evaluate a novel semi-automatic application to quantitatively measure intracranial internal carotid artery (ICA) degree of stenosis and calcium volume in CT angiography (CTA) images. In this retrospective study involving CTA images of 88 consecutive patients, intracranial ICA stenosis was quantitatively measured by two independent observers. Stenoses were categorized with cutoff values of 30% and 50%. The calcification in the intracranial ICA was qualitatively categorized as absent, mild, moderate, or severe and quantitatively measured using the semi-automatic application. Linear weighted kappa values were calculated to assess the interobserver agreement of the stenosis and calcium categorization. The average and the standard deviation of the quantitative calcium volume were calculated for the calcium categories. For the stenosis measurements, the CTA images of 162 arteries yielded an interobserver correlation of 0.78 (P < 0.001). Kappa values of the categorized stenosis measurements were moderate: 0.45 and 0.58 for cutoff values of 30% and 50%, respectively. The kappa value for the calcium categorization was 0.62, with a good agreement between the qualitative and quantitative calcium assessment. Quantitative degree of stenosis measurement of the intracranial ICA on CTA is feasible with a good interobserver agreement ICA. Qualitative calcium categorization agrees well with quantitative measurements. (orig.)

  20. Wall shear stress evolution in carotid artery bifurcation

    Science.gov (United States)

    Bernad, S. I.; Bosioc, A. I.; Totorean, A. F.; Petre, I.; Bernad, E. S.

    2017-07-01

    The steady flow in an anatomically realistic human carotid bifurcation was simulated numerically. Main parameters such as wall shear stress (WSS), velocity profiles and pressure distributions are investigated in the carotid artery, namely in bifurcation and sinusoidal enlargement regions. Flow in the carotid sinus is dominated by a single secondary vortex motion accompanied by a strong helical flow. This type of flow is induced primarily by the curvature and asymmetry of the in vivo geometry. Low wall shear stress concentration occurs at both the anterior and posterior aspects of the proximal internal bulb.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-05-01

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

  2. CT angiography helps to differentiate acute from chronic carotid occlusion: the ''carotid ring sign''

    Energy Technology Data Exchange (ETDEWEB)

    Michel, Patrik; Ntaios, George [Centre Hospitalier Universitaire Vaudois and University of Lausanne, Neurology Service, Lausanne (Switzerland); Delgado, Montserrat G. [Hospital Universitario Central de Asturias, Oviedo (Spain); Bezerra, Daniel C. [Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD (United States); Meuli, Reto; Binaghi, Stefano [Centre Hospitalier Universitaire Vaudois and University of Lausanne, Department of Radiology, Lausanne (Switzerland)

    2012-02-15

    Currently, there is no reliable method to differentiate acute from chronic carotid occlusion. We propose a novel CTA-based method to differentiate acute from chronic carotid occlusions that could potentially aid clinical management of patients. We examined 72 patients with 89 spontaneously occluded extracranial internal carotids with CT angiography (CTA). All occlusions were confirmed by another imaging modality and classified as acute (imaging <1 week of presumed occlusion) orchronic (imaging >4 weeks), based on circumstantial clinical and radiological evidence. A neuroradiologist and a neurologist blinded to clinical information determined the site of occlusion on axial sections of CTA. They also looked for (a) hypodensity in the carotid artery (thrombus), (b) contrast within the carotid wall (vasa vasorum), (c) the site of the occluded carotid, and (d) the ''carotid ring sign'' (defined as presence of a and/or b). Of 89 occluded carotids, 24 were excluded because of insufficient circumstantial evidence to determine timing of occlusion, 4 because of insufficient image quality, and 3 because of subacute timing of occlusion. Among the remaining 45 acute and 13 chronic occlusions, inter-rater agreement (kappa) for the site of proximal occlusion was 0.88, 0.45 for distal occlusion, 0.78 for luminal hypodensity, 0.82 for wall contrast, and 0.90 for carotid ring sign. The carotid ring sign had 88.9% sensitivity, 69.2% specificity, and 84.5% accuracy to diagnose acute occlusion. The carotid ring sign helps to differentiate acute from chronic carotid occlusion. If further confirmed, this information may be helpful in studying ischemic symptoms and selecting treatment strategies in patients with carotid occlusions. (orig.)

  3. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique.

    Science.gov (United States)

    Konrad, G; Bayer, J; Hepp, P; Voigt, C; Oestern, H; Kääb, M; Luo, C; Plecko, M; Wendt, K; Köstler, W; Südkamp, N

    2010-03-01

    The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate. One hundred and eighty-seven patients (mean age, 62.9 +/- 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six month,and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up. Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 +/- 13.7 points, corresponding to 85.1% +/- 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 +/- 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture. Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the

  4. Bilateral internal carotid artery occlusion. Comparison among MRI, hemodynamics and clinical feature

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Yasumasa; Tsuda, Harumi; Nabatame, Hidehiko; Akiguchi, Ichiro; Kameyama, Masakuni

    1987-10-01

    Four cases of bilateral internal carotid occlusion are reported with respect to clinical features, hemodynamics and various image diagnosis. MRI is applied to three cases. The patients comprised 2.08 % of all cerebral occlusive diseases treated during the past five years at our clinic. One case is of abrupt onset and three cases are progressing profiles. In one of these cases, collateral circulation is supplied mainly by leptomeningeal anastomosis of the posterior cerebral artery and posterior pericallosal artery branching from the basilar artery. In two of them, they are supplied through the circle of Willis. Middle cerebral artery occlusion, occlusion supra occlusionem, however, causes decisive ischemic lesion in its teritory. Applying MRI, complicated ischemic lesions, such as lacunar infarction, paraventricular lesion, deep white matter lesion and border zone infarction can clearly be identified. In the case of total aphasia, the lesions responsible are demonstrated clearly by MRI, but only vaguely by X-ray CT.

  5. Minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS).

    Science.gov (United States)

    Brunner, Alexander; Thormann, Sebastian; Babst, Reto

    2012-08-01

    This study evaluated our results after minimally invasive percutaneous plating of proximal humeral shaft fractures with the Proximal Humerus Internal Locking System (PHILOS, Synthes, Switzerland). Between 2005 and 2008, 15 patients with unilateral displaced proximal humeral shaft fractures were treated and followed up over a median period of 27 months (range, 12-38 months). The final follow-up included anteroposterior and lateral x-rays, range of shoulder motion, pain by visual analog scale (VAS), the Constant-Murley shoulder score, the Disabilities of Arm, Shoulder and Elbow (DASH) score, and the Short Form 36 (SF36) assessment. No intraoperative or postoperative complications occurred. No secondary fracture displacement or radial neuropathy was observed postoperatively. One patient had open reduction and internal fixation for pseudoarthrosis 16 months after the initial surgery. At the final follow-up, the median range of motion of the operated shoulder was flexion, 145°; extension, 45°; internal rotation, 40°; external rotation, 70°; and abduction, 135°. Median results on outcome assessments were VAS pain score, 0 points; Constant-Murley score, 74 points, representing 87.5% of the median Constant-Murley score of the unaffected shoulder; DASH score, 34 points, and the SF36, 83 points. Minimally invasive percutaneous plating with the PHILOS offers a valid option in the treatment of proximal humeral shaft fractures with comparable rates of nonunion and lower rates of radial neuropathy compared with open procedures. Furthermore, the results indicate that this method is associated with lower rates of wound infection and a shorter stay in the hospital for the patient. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Intrasphenoid septations inserted into the internal carotid arteries: a frequent and risky relationship in transsphenoidal surgeries.

    Science.gov (United States)

    Ramalho, Clauder Oliveira; Marenco, Horacio Armando; de Assis Vaz Guimarães Filho, Francisco; da Costa, Marcos Devanir Silva; de Oliveira Santos, Bruno Fernandes; de Paula Santos, Rodrigo; Zymberg, Samuel Tau

    When an expanded endonasal transsphenoidal surgical approach is performed, intrasphenoid septations must be completely resected. If these structures are close to the internal carotid artery (ICA), then their manipulation might cause vascular injury. The objective of this study is to describe the frequency of intrasphenoid septations in the internal carotid artery protuberance (ICAp). Computed tomography (CT) scans of 421 patients were analysed. Intrasphenoid septations (classified as intersphenoid or accessory) and their relationship to the ICAp were described. Additionally, a sphenoid sinus classification was performed based on their degree of pneumatisation to determine whether a difference exists in the frequency of intrasphenoid septations inserted into ICAp with regard to sinus type. The patient mean age was 39±21.4 years. Overall, 219 patients (52%) had septations in the ICAp; 359 patients (85.3%) had intersphenoid septations; of the latter, 135 (37.6%) had septations in the ICAp. This frequency was higher among patients with sphenoid sinus type 4 or 5 (44.7% and 43.5%, respectively). Accessory septations were found in 255 patients (60.6%); 140 of these septations (54.9%) were in the ICAp. Among 351 patients with types 3, 4 or 5 sphenoid sinuses (i.e., only well-pneumatised sphenoid sinuses), 219 (62.4%) had septations in the ICAp. These frequencies are higher than those reported in most previous studies. The frequency of intrasphenoid septations in the ICAp found is considerable. It is higher among patients with more pneumatised sinuses. This finding justifies an appropriate pre-operative study, and careful attention must be paid during transsphenoidal surgery. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. Retrograde suction decompression of a large internal carotid aneurysm using a balloon guide catheter combined with a blood-returning circuit and STA-MCA bypass: a technical note.

    Science.gov (United States)

    Matano, Fumihiro; Mizunari, Takayuki; Kominami, Shushi; Suzuki, Masanori; Fujiki, Yu; Kubota, Asami; Kobayashi, Shiro; Murai, Yasuo; Morita, Akio

    2017-04-01

    It is difficult to treat large internal carotid aneurysms with simple surgical clipping. Here, we present a retrograde suction decompression (RSD) procedure for large internal carotid aneurysms using a balloon guide catheter combined with a blood-returning circuit and a superficial temporal artery to middle cerebral artery (STA-MCA) bypass.All patients underwent an STA-MCA bypass before the temporary occlusion of the internal carotid artery (ICA). A 6-French sheath was inserted into the common carotid artery (CCA), and a 6-French Patrive balloon catheter was placed into the ICA 5 cm past the bifurcation. Aneurysm exposure was obtained; temporary clips were placed on the proximal M1, A1, and posterior communicating (Pcom) segments; and an extension tube was then connected to the balloon catheter. A three-way stopcock was placed, and aspiration was performed through the device to collapse the aneurysm. The aspirated blood was returned to a venous line with an added heparin to prevent anemia after aspiration. During the decompression, the blood flow to the cortical area was supplied through the STA-MCA bypass. After the aneurysm collapse, the surgeon carefully dissected the perforating artery from the aneurysm dome or neck, and permanent clips were then placed on the aneurysm neck. Our procedure has several advantages, such as STA-MCA bypass without external carotid artery occlusion for preventing ischemic complications of the cortical area, anemia may be avoided because of the return of the aspirated blood, and a hybrid operation room is not required to perform this method.

  8. Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment

    Energy Technology Data Exchange (ETDEWEB)

    Sogabe, Shu; Satomi, Junichiro; Tada, Yoshiteru; Kanematsu, Yasuhisa; Kuwayama, Kazuyuki; Yagi, Kenji; Yoshioka, Shotaro; Mizobuchi, Yoshifumi; Mure, Hideo; Yamaguchi, Izumi; Kitazato, Keiko T.; Nagahiro, Shinji [Tokushima University Graduate School, Department of Neurosurgery, Tokushima (Japan); Abe, Takashi; Harada, Masafumi [Tokushima University Graduate School, Department of Radiology, Tokushima (Japan); Yamamoto, Nobuaki; Kaji, Ryuji [Tokushima University Graduate School, Department of Clinical Neurosciences, Institute of Biomedical Biosciences, Tokushima (Japan)

    2017-06-15

    Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site. (orig.)

  9. Rationale for graft selection in patients with complex internal carotid artery aneurysms treated with extracranial to intracranial high-flow bypass and therapeutic internal carotid artery occlusion.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Miyata, Shiro; Tsuboi, Toshiyuki; Noda, Kosumo; Ota, Nakao; Takahashi, Osamu; Takeda, Rihee; Tokuda, Sadahisa; Kamiyama, Hiroyasu; Tanikawa, Rokuya

    2017-06-02

    OBJECTIVE After internal carotid artery (ICA) sacrifice without revascularization for complex aneurysms, ischemic complications can occur. In addition, hemodynamic alterations in the circle of Willis create conditions conducive to the formation of de novo aneurysms or the enlargement of existing untreated aneurysms. Therefore, the revascularization technique remains indispensable. Because vessel sizes and the development of collateral circulation are different in each patient, the ideal graft size to prevent low flow-related ischemic complications (LRICs) in external carotid artery (ECA)-middle cerebral artery (MCA) bypass with therapeutic ICA occlusion (ICAO) has not been well established. Authors of this study hypothesized that the adequate graft size could be calculated from the size of the sacrificed ICA and the values of MCA pressure (MCAP) and undertook an investigation in patients with complex ICA aneurysms treated with ECA-graft-MCA bypass and therapeutic ICAO. METHODS In the period between July 2006 and January 2016, 80 patients with complex ICA aneurysms were treated with ECA-MCA bypass and therapeutic ICAO. Preoperative balloon test occlusion (BTO) was performed, and the BTO pressure ratio was defined as the mean stump pressure/mean preocclusion pressure. Low flow-related ischemic complications were defined as new postoperative neurological deficits and ipsilateral cerebral blood flow reduction. Initial MCAP (iMCAP), MCAP after clamping the ICA (cMCAP), and MCAP after releasing the graft (gMCAP) were intraoperatively monitored. The MCAP ratio was defined as gMCAP/iMCAP. Based on the Hagen-Poiseuille law, the expected MCAP ratio ([expected gMCAP]/iMCAP) was hypothesized as follows: (1 - cMCAP/iMCAP)(graft radius/ICA radius)2 + (cMCAP/iMCAP). Correlations between the BTO pressure ratio and cMCAP/iMCAP, and between the actual and expected MCAP ratios, were evaluated. Risk factors for LRICs were also evaluated. RESULTS The mean BTO pressure ratio was

  10. Correlation of Folic Intake and Internal Carotid Artery Intima-Media Thickness Changes In Post Ischemic Stroke Patients

    Directory of Open Access Journals (Sweden)

    Dodik Tugasworo

    2015-03-01

    Full Text Available The thickness of the carotid artery intima media / intima-media thickness (IMT is one of atherosclerosis markers. Atherosclerosis is one of the causes of ischemic stroke. Some studies suggest that low folate intake is predicted to affect the atherosclerotic process, but this remains controversial. Our objective is to analyze the relationship between folate intake with changes in the internal carotid artery IMT after ischemic stroke patients.The study is one group pretest posttest design with 72 post ischemic stroke subjects from neurology polyclinic of Kariadi Hospital, from June to December 2013. Folate intake was measured by Food Frequency Questionnaire and the internal carotid artery IMT by duplex ultrasonography. Measurements were taken at two periods with 6 months interval. Other factors that affect atherosclerosis consisting of age, obesity, hypertension, dyslipidemia, diabetes mellitus. The analysis in this study using Spearman correlation, chi-square and logistic regression. Resultwas significant if the p value were <0.05.There were 44 male subjects (61.1% and 28 female subjects (38.9%. The mean age was 61.6 (SD = 7.99 years. The mean intake of folate was 178.10 (SD = 38.875 mg / day. Median serum folic acid level 8.43 (4.96 to 55.01 NML / L. The mean change in ICA IMT was 0.10 (SD = 0.156 mm. Folate intake was not correlated with serum levels of folic acid. Serum folic acid levels are not correlated with changes in the internal carotid artery IMT. There was correlation between the risk factors of age, BMI, hypertension, diabetes and dyslipidemia with changes in the internal carotid artery IMT.

  11. Clinical and imaging features associated with intracranial internal carotid artery calcifications in patients with ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, Arda [Mersin University, Department of Neurology, Faculty of Medicine, Mersin (Turkey); Akpinar, Erhan [Hacettepe University, Department of Radiology, Faculty of Medicine, Ankara (Turkey); Topcuoglu, Mehmet Akif; Arsava, Ethem Murat [Hacettepe University, Department of Neurology, Faculty of Medicine, Ankara (Turkey)

    2015-05-01

    Intracranial internal carotid artery calcifications (ICAC), a frequent finding on imaging studies, are predictive of future stroke risk in population-based studies. The clinical significance of this observation among ischemic stroke patients is however less clear. In this study, we analyzed ICAC burden in relation to vascular risk factor profile, stroke etiology, and extent of craniocervical vascular calcifications in a consecutive series of ischemic stroke patients. The burden of ICAC was determined both on non-contrast CT and CT-angiography source images by semiquantitative scoring algorithms. The distribution of vascular risk factors, etiologic stroke subtype, and calcification burden in other craniocervical arteries was assessed among patients with no ICAC, mild-moderate ICAC, and severe ICAC. Of 319 patients included into the study, 28 % had no ICAC, 35 % had mild-moderate ICAC, and 37 % had severe ICAC on CT angiography. Independent factors associated with ICAC burden in multivariate analysis included age (p < 0.001), diabetes mellitus (p = 0.006), and coronary artery disease (p < 0.001). Furthermore, a stroke etiology of large artery atherosclerosis or cardioaortic embolism was significantly related to higher ICAC burden (p = 0.006). Patients with severe ICAC were more likely to harbor calcifications in other vascular beds (p < 0.001). All of these findings persisted when analyses were repeated with CT-based ICAC burden assessments. ICAC burden reflects a continuum of atherosclerotic disease involving carotid arteries together with other craniocervical vascular beds. ICAC is significantly associated with stroke of large vessel or cardioembolic origin. This information might help the clinician in prioritizing etiologic work-up in the acute period. (orig.)

  12. Outcome following carotid endarterectomy: lessons learned from a large international vascular registry

    DEFF Research Database (Denmark)

    Menyhei, G; Björck, M; Beiles, B

    2011-01-01

    The aim of the study was to assess if technical and patient-related factors are related to outcome after carotid surgery.......The aim of the study was to assess if technical and patient-related factors are related to outcome after carotid surgery....

  13. Beyond Linguistic Proximity: Galicia and Portugal in International Negotiation

    Directory of Open Access Journals (Sweden)

    Ana Belén Fernández-Souto

    2016-04-01

    Full Text Available Studying the actions of several institutions, as well as the popular belief according to which Galician people and Portuguese people have enough common ground as to fully understand each other, this article considers the reality of the matter in the context of international negotiation. We will study the use of the Galician language in international business, and then refute—or not—the hypothesis which indicates that the use of Galician can be the first step in a mutual understanding, but that it is necessary to be more deeply immersed in the language before facing an international negotiation—immersed in a way that also includes cultural knowledge.

  14. The presence of calcifications along the course of internal carotid artery in Greek and Brazilian populations: a comparative and retrospective cone beam CT data analysis

    NARCIS (Netherlands)

    da Silveira, H.L.D.; Damaskos, S.; Arús, N.A.; Tsiklakis, K.; Berkhout, E.W.R.

    2016-01-01

    Objectives. We aimed to retrospectively compare the prevalence of soft tissue calcifications (STCs) depicted incidentally along the extra- and intracranial course of the internal carotid artery (ICA) on cone beam computed tomography examinations in 2 different populations (Greeks and Brazilians).

  15. Internal carotid artery pseudoaneurysm with life-threatening epistaxis as a complication of deep neck space infection.

    Science.gov (United States)

    da Silva, Paulo Sérgio Lucas; Waisberg, Daniel Reis

    2011-05-01

    Pseudoaneurysm of the cervical internal carotid artery is a very rare, potentially fatal complication of a neck space infection in children associated with high mortality and morbidity. A 3-year-old boy presented with spontaneous massive epistaxis 45 days after a deep neck space infection caused by a peritonsillar abscess. During nasopharyngeal packing, he evolved with cardiac arrest. Intra-arterial angiography was then performed that revealed a large pseudoaneurysm. Endovascular treatment using detachable balloons achieved complete exclusion of the pseudoaneurysm. The child made an uneventful recovery and was discharged with mild left hemiparesis and no deficit of sensory or cognitive functions. Pseudoaneurysms of the internal carotid artery after a deep neck space infection can be associated with delayed and potentially fatal massive epistaxis. Furthermore, a regional (ie, extranasal) blood vessel should be promptly investigated when there are signs of hypovolemic shock. A high level of suspicion and definitive treatment are essential for successful management of these patients.

  16. A Lumped Parameter Method to Calculate the Effect of Internal Carotid Artery Occlusion on Anterior Cerebral Artery Pressure Waveform

    Directory of Open Access Journals (Sweden)

    Abdi M.

    2016-03-01

    Full Text Available Background and Objective: Numerical modeling of biological structures would be very helpful tool to analyze hundreds of human body phenomena and also diseases diagnosis. One physiologic phenomenon is blood circulatory system and heart hemodynamic performance that can be simulated by utilizing lumped method. In this study, we can predict hemodynamic behavior of one artery of circulatory system (anterior cerebral artery when disease such as internal carotid artery occlusion is occurred. Method: Pressure-flow simulation is one the leading common approaches for modeling of circulatory system behavior and forecasts of hemodynamic in numerous physiological conditions. In this paper, by using lumped model (electrical analogy, CV system is simulated in MATLAB software (SIMULINK environment. Results: The performance of healthy blood circulation and heart is modeled and the obtained results used for further analyses. The stenosis of internal carotid artery at different rates was, then, induced in the circuit and the effects are studied. In stenosis cases, the effects of internal carotid artery occlusion on left anterior cerebral artery pressure waveform are investigated. Conclusion: The findings of this study may have implications not only for understanding the behavior of human biological system at healthy condition but also for diagnosis of diseases in circulatory and cardiovascular system of human body.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-04-01

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

  18. Ocular Image and Haemodynamic Features Associated with Different Gradings of Ipsilateral Internal Carotid Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Hui Wang

    2017-01-01

    Full Text Available Objectives. To analyse the changes of ocular haemodynamics and morphology in Chinese patients with internal carotid artery (ICA stenosis in the current study. Methods. A retrospective case-control study was conducted with 219 patients. The haemodynamic characteristics, the calibre of retinal vessels, and the subfoveal choroidal thickness (SFChT were compared. We analysed the correlations with the degree of ipsilateral ICA stenosis. Results. There were no significant differences among the groups in the central retinal artery equivalent (CRAE, central retinal vein equivalent (CRVE, and AVR (p=0.073, p=0.188, and p=0.738, resp.. The peak systolic velocity (PSV and end diastolic velocity (EDV in the central retinal artery (CRA and the posterior ciliary artery (PCA were significantly lower than normal eyes (p<0.001. The outer retinal layer thickness and SFChT values of the ICA stenosis groups were significantly lower than normal eyes (p=0.030 and p<0.001, resp.. Conclusion. The PSV and EDV in CRA and PCA and the SFChT and outer retinal layer thickness of ICA eyes were significantly lower than normal eyes. ICA stenosis may impact choroidal haemodynamics, and decreased choroidal circulation might affect the discordance of the SFChT and the outer retinal layer thickness.

  19. Vision Loss and RNFL Thinning after Internal Carotid Arter Occlusion and Middle Cerebral Artery Infarction.

    Science.gov (United States)

    Gunes, Alime; Demirci, Seden; Umul, Ayse

    2014-12-01

    Ischaemic, traumatic or neoplasmic damage to the optic chiasm, optic tract or lateral geniculate nucleus affects the retinal ganglion cell (RGC) axons, detected as reduced retinal nerve fiber layer (RNFL) thickness around the optic nerve head. We report a case of vision loss and reduced RNFL thickness after internal carotid artery (ICA) occlusion and middle cerebral artery (MCA) infarction. A 33-year-old woman with a 3-month history of vision loss in right eye and left hemiplegia. The best corrected visual acuity was 1.0 in left eye and there was no light perception in the right eye. Ocular motility, intra-ocular pressure, anterior segments were normal in the both eyes. Her fundus examinations were normal except optic atrophy in the right eye. Visual field test was not performed because of cooperation difficulties. Magnetic resonance imaging (MRI) revealed an infarction of the right MCA. Computed tomographic angiography showed right ICA occlusion. Optical coherence tomography (OCT) demonstrated 6 clock hours of RNFL thinning in the right eye. Average RNFL thickness of the right and left eyes were 53µm, 96 µm respectively. Our findings show that a relatively short period of ICA occlusion and MCA infarction can cause vision loss and thinning of the RNFL.

  20. Hemodynamics model of fluid-solid interaction in internal carotid artery aneurysms.

    Science.gov (United States)

    Bai-Nan, Xu; Fu-Yu, Wang; Lei, Liu; Xiao-Jun, Zhang; Hai-Yue, Ju

    2011-01-01

    The objective of this study is to present a relatively simple method to reconstruct cerebral aneurysms as 3D numerical grids. The method accurately duplicates the geometry to provide computer simulations of the blood flow. Initial images were obtained by using CT angiography and 3D digital subtraction angiography in DICOM format. The image was processed by using MIMICS software, and the 3D fluid model (blood flow) and 3D solid model (wall) were generated. The subsequent output was exported to the ANSYS workbench software to generate the volumetric mesh for further hemodynamic study. The fluid model was defined and simulated in CFX software while the solid model was calculated in ANSYS software. The force data calculated firstly in the CFX software were transferred to the ANSYS software, and after receiving the force data, total mesh displacement data were calculated in the ANSYS software. Then, the mesh displacement data were transferred back to the CFX software. The data exchange was processed in workbench software. The results of simulation could be visualized in CFX-post. Two examples of grid reconstruction and blood flow simulation for patients with internal carotid artery aneurysms were presented. The wall shear stress, wall total pressure, and von Mises stress could be visualized. This method seems to be relatively simple and suitable for direct use by neurosurgeons or neuroradiologists, and maybe a practical tool for planning treatment and follow-up of patients after neurosurgical or endovascular interventions with 3D angiography.

  1. Hemodynamics model of fluid–solid interaction in internal carotid artery aneurysms

    Science.gov (United States)

    Fu-Yu, Wang; Lei, Liu; Xiao-Jun, Zhang; Hai-Yue, Ju

    2010-01-01

    The objective of this study is to present a relatively simple method to reconstruct cerebral aneurysms as 3D numerical grids. The method accurately duplicates the geometry to provide computer simulations of the blood flow. Initial images were obtained by using CT angiography and 3D digital subtraction angiography in DICOM format. The image was processed by using MIMICS software, and the 3D fluid model (blood flow) and 3D solid model (wall) were generated. The subsequent output was exported to the ANSYS workbench software to generate the volumetric mesh for further hemodynamic study. The fluid model was defined and simulated in CFX software while the solid model was calculated in ANSYS software. The force data calculated firstly in the CFX software were transferred to the ANSYS software, and after receiving the force data, total mesh displacement data were calculated in the ANSYS software. Then, the mesh displacement data were transferred back to the CFX software. The data exchange was processed in workbench software. The results of simulation could be visualized in CFX-post. Two examples of grid reconstruction and blood flow simulation for patients with internal carotid artery aneurysms were presented. The wall shear stress, wall total pressure, and von Mises stress could be visualized. This method seems to be relatively simple and suitable for direct use by neurosurgeons or neuroradiologists, and maybe a practical tool for planning treatment and follow-up of patients after neurosurgical or endovascular interventions with 3D angiography. PMID:20812022

  2. Pre-operative embolisation of internal carotid artery branches and pial vessels in hypervascular brain tumours.

    Science.gov (United States)

    Yoon, Y S; Ahn, J Y; Chang, J H; Cho, J H; Suh, S H; Lee, B H; Lee, K S

    2008-05-01

    Pre-operative embolisation is an effective method used to reduce intra-operative bleeding and operative difficulty in hypervascular brain tumour surgery. However, embolisation of the internal carotid artery (ICA) and pial tumour feeding branches has certain limitations. From March 2000 to November 2006, 8 patients underwent superselective embolisation for hypervascular brain tumour. Seven tumours were extra-axial (6 meningiomas, 1 solitary fibrous tumour) and 1 was intra-axial (metastatic hepatocellular carcinoma). In all patients, feeding vessels from ICA branches or pial arteries were successfully embolised using superselective microcatheterisation. A provocative test was applied in 4 patients who had tumours adjacent to the motor cortex. Angiographic devascularisation was slight to extensive. Mean devascularisation on post-embolisation MRI ranged from 40 to 80% (mean 63.8%). One patient (12.5%) suffered an embolisation-related complication (loss of choroidal brush), but was not clinically worse because of the pre-existing blindness. Superselective embolisation of ICA branches or pial vessels should be performed if several conditions are met, especially angiographic findings, pre-existing neurologic deficits, provocative test, and technical feasibility. If the ICA embolisation for hypervascular tumour is successfully achieved, the bleeding loss and operative risk can be reduced.

  3. Anatomical nuances of the internal carotid artery in relation to the quadrangular space.

    Science.gov (United States)

    Dolci, Ricardo L L; Ditzel Filho, Leo F S; Goulart, Carlos R; Upadhyay, Smita; Buohliqah, Lamia; Lazarini, Paulo R; Prevedello, Daniel M; Carrau, Ricardo L

    2018-01-01

    OBJECTIVE The aim of this study was to evaluate the anatomical variations of the internal carotid artery (ICA) in relation to the quadrangular space (QS) and to propose a classification system based on the results. METHODS A total of 44 human cadaveric specimens were dissected endonasally under direct endoscopic visualization. During the dissection, the anatomical variations of the ICA and their relationship with the QS were noted. RESULTS The space between the paraclival ICAs (i.e., intercarotid space) can be classified as 1 of 3 different shapes (i.e., trapezoid, square, or hourglass) based on the trajectory of the ICAs. The ICA trajectories also directly influence the volumetric area of the QS. Based on its geometry, the QS was classified as one of the following: 1) Type A has the smallest QS area and is associated with a trapezoid intercarotid space, 2) Type B corresponds to the expected QS area (not minimized or enlarged) and is associated with a square intercarotid space, and 3) Type C has the largest QS area and is associated with an hourglass intercarotid space. CONCLUSIONS The different trajectories of the ICAs can modify the area of the QS and may be an essential parameter to consider for preoperative planning and defining the most appropriate corridor to reach Meckel's cave. In addition, ICA trajectories should be considered prior to surgery to avoid injuring the vessels.

  4. Internal jugular vein/common carotid artery cross-sectional area ratio and central venous pressure.

    Science.gov (United States)

    Hossein-Nejad, Hooman; Mohammadinejad, Payam; Ahmadi, Faezeh

    2016-06-01

    To investigate the accuracy of the sonographic assessment of internal jugular vein/common carotid artery (IJV/CCA) cross-sectional area ratio in predicting central venous pressure (CVP) in critically ill patients. In adult patients who underwent central venous catheterization for monitoring of hemodynamic status, we used bedside sonography for diameter and cross-sectional area measurement of IJV and CCA. The IJV/CCA ratio was then calculated, and its correlation with CVP as well as its sensitivity, specificity, and positive and negative predictive values were analyzed. We enrolled 52 patients with a mean age of 58.8 ± 10.7 years. The mean IJV/CCA ratio was 1.89 ± 0.83 and 1.90 ± 0.83, respectively, at inspiration and expiration. A significant correlation was observed between IJV/CCA ratio and CVP (r = 0.728, p central venous catheterization in order to evaluate the hemodynamic status of critically ill patients. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:312-318, 2016. © 2016 Wiley Periodicals, Inc.

  5. Semi-automatic quantitative measurements of intracranial internal carotid artery stenosis and calcification using CT angiography

    NARCIS (Netherlands)

    Bleeker, Leslie; Marquering, Henk A.; van den Berg, René; Nederkoorn, Paul J.; Majoie, Charles B.

    2012-01-01

    Intracranial carotid artery atherosclerotic disease is an independent predictor for recurrent stroke. However, its quantitative assessment is not routinely performed in clinical practice. In this diagnostic study, we present and evaluate a novel semi-automatic application to quantitatively measure

  6. Internal carotid artery dissection after anterior cervical disc replacement: first case report and literature review of vascular complications of the approach.

    Science.gov (United States)

    Loret, Jean-Edouard; Francois, Patrick; Papagiannaki, Chrysanthi; Cottier, Jean-Philippe; Terrier, Louis-Marie; Zemmoura, Ilyess

    2013-07-01

    We report the case of a 41-year-old woman who underwent cervical total disc replacement at C4C5 and C5C6 levels and fusion at C6C7 level through an anterior right-side approach. After anesthesia recovery, the patient presented left hemiparesia and facial palsy due to large right hemispheric stroke. Diffusion-weighted magnetic resonance imaging was performed as soon as the patient developed neurologic symptoms of stroke and revealed a right internal carotid artery dissection. Digital substraction angiography, endovascular stenting, angioplasty and thrombectomy were performed. Six months after treatment, clinical examination showed mild left-arm spasticity. To the best of our knowledge, only two cases of internal carotid artery stroke without dissection or thrombosis are reported. In conclusion, although vascular complications are rare after anterior cervical spine procedure, internal carotid artery dissection can occur. Suspected risk factors are prolonged retraction of the carotid artery and neck extension.

  7. Effects of uncomplicated carotid endarterectomy on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery by comparison with unoperated patients.

    Science.gov (United States)

    Kojima, Daigo; Ogasawara, Kuniaki; Kobayashi, Masakazu; Yoshida, Kenji; Kubo, Yoshitaka; Chida, Kohei; Oshida, Sotaro; Yoshida, Jun; Fujiwara, Shunro; Terasaki, Kazunori

    2016-07-01

    The purpose of the present exploratory study was to evaluate the effects of uncomplicated carotid endarterectomy (CEA) on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery (ICA) by comparison with unoperated patients. Patients with age ≤75 years and unilateral asymptomatic severe stenosis (≥70%) of the cervical ICA underwent CEA with antiplatelet therapy (surgically treated group: 116 patients) or antiplatelet therapy alone or neither (medically treated group: 45 patients). For the surgically treated group, neuropsychological testing and brain perfusion measurement using single-photon emission computed tomography were performed within one month before surgery and one month after surgery. For the medically treated group, the same testing and measurement were performed twice at an interval of 1 to 2 months. None of the operated patients developed new major ischemic events after surgery or intraoperative cerebral hyperperfusion. None of the patients in the medically treated group experienced neurological deficits including transient ischemic attacks during the study period. The incidence of patients with interval cognitive improvement was significantly greater in the surgically treated group (11 patients: 9%) than in the medically treated group (0%) (p = 0.0352). The incidence of patients with interval brain perfusion improvement in the ipsilateral cerebral hemisphere was significantly greater in the surgically treated group (24 patients: 21%) than in the medically treated group (0%) (p = 0.0003). Uncomplicated CEA may improve cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the ICA when compared with unoperated patients.

  8. [Clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures].

    Science.gov (United States)

    Liu, Junchuan; Di, Jun; Zhao, Changping; Yao, Shuangquan; Zhu, Lian; Wang, Bo; Ren, Dong

    2014-12-23

    To explore the clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures. A total of 284 hospitalized patients of proximal humerus fractures over 60 years of age cases from October 2009 to February 2012 were randomly divided into two groups of locking proximal humeral plate (LPHP) and PHILOS (n = 142 each). And the clinical efficacies of two groups were compared. For PHILOS and LPHP groups, the fracture healing periods were (11.64 ± 3.81) and (14.95 ± 3.95) weeks. And there was statistical significance (P 0.05). Both PHILOS and LPHP are effective in the treatment of senile proximal humeral fractures.However, the former is conducive to fracture healing and has shorter healing time and lowered postoperative pain.

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

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    Michel Nasser

    2013-06-01

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

  10. Carotid Stump Syndrome

    Directory of Open Access Journals (Sweden)

    Lara Toufic Dakhoul MD

    2014-08-01

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

  11. Surgical treatment of large and giant cavernous carotid aneurysms

    Science.gov (United States)

    Sriamornrattanakul, Kitiporn; Sakarunchai, Ittichai; Yamashiro, Kei; Yamada, Yasuhiro; Suyama, Daisuke; Kawase, Tsukasa; Kato, Yoko

    2017-01-01

    Cavernous carotid aneurysms (CCAs) are uncommon pathologic entities. Extradural place and the skull base location make this type of an aneurysm different in clinical features and treatment techniques. Direct aneurysm clipping is technically difficult and results in a significant postoperative neurological deficit. Therefore, several techniques of indirect surgical treatment were developed with different surgical outcomes, such as proximal occlusion of internal carotid artery (ICA) or trapping with or without bypass (superficial temporal artery-middle cerebral artery bypass or high-flow bypass). High-flow bypass with proximal ICA occlusion seems to be the most appropriate surgical treatment for CCA because of the high rate of symptom improvement, aneurysm thrombosis, and minimal postoperative complications. However, in cases of CCA presented with direct carotid-cavernous fistula, the appropriate surgical treatment is high-flow bypass with aneurysm trapping, which the fistula can be obliterated immediately after surgery. PMID:28761512

  12. Cervical Rotatory Manipulation Decreases Uniaxial Tensile Properties of Rabbit Atherosclerotic Internal Carotid Artery

    Science.gov (United States)

    Qi, Ji; Zhang, Lei; Chen, Chao; Mondal, Shubhro; Ping, Kaike; Chen, Yili

    2017-01-01

    Objective. To investigate the effects of one of the Chinese massage therapies, cervical rotatory manipulation (CRM), on uniaxial tensile properties of rabbit atherosclerotic internal carotid artery (ICA). Methods. 40 male purebred New Zealand white rabbits were randomly divided into CRM-Model group, Non-CRM-Model group, CRM-Normal group, and Non-CRM-Normal group. After modeling (atherosclerotic model) and intervention (CRM or Non-CRM), uniaxial tensile tests were performed on the ICAs to assess the differences in tensile mechanical properties between the four groups. Results. Both CRM and modeling were the main effects affecting physiological elastic modulus (PEM) of ICA. PEM in CRM-Model group was 1.81 times as much as Non-CRM-Model group, while the value in CRM-Model group was 1.34 times as much as CRM-Normal group. Maximum elastic modulus in CRM-Model group was 1.80 times as much as CRM-Normal group. Max strains in CRM-Model group and Non-CRM-Model group were 30.98% and 28.71% lower than CRM-Normal group and Non-CRM-Normal group, respectively. However, whether treated with CRM or not, the uniaxial tensile properties of healthy ICAs were not statistically different. Conclusion. CRM may decrease the uniaxial tensile properties of rabbit arteriosclerotic ICA, but with no effect on normal group. The study will aid in the meaningful explanation of the controversy about the harmfulness of CRM and the suitable population of CRM. PMID:28303160

  13. Endoscopic endonasal nasopharyngectomy: tensor veli palatine muscle as a landmark for the parapharyngeal internal carotid artery.

    Science.gov (United States)

    Liu, Chiung-Lin; Hsu, Ning-I; Shen, Ping-Hung

    2017-06-01

    Endoscopic endonasal nasopharyngectomy(EEN) can be a promising option for select patients with recurrent nasopharyngeal carcinoma, but serious complications can occur in terms of parapharyngeal internal carotid artery (PPICA) injury. Several landmarks have been proposed for locating the PPICA. In this study, we investigated the spatial relationship between the tensor veli palatini (TVP) muscle and the PPICA in a cadaveric model. Seven fresh cadaver heads were available for anatomic study. Eustachian tube and the levator veli palatine (LVP) muscle were partially sacrificed or truncated to maximize the surgical field, and the TVP muscle was carefully preserved. Complete dissection was defined as when the PPICA could be visualized. We then measured the distance between the posterior margin of the TVP muscle and PPICA (z-axis), and the distance from the midline of the nasopharynx to the PPICA (x-axis). Thirteen sides of the PPICA were successfully identified. The mean distance between the posterior margin of the TVP to the PPICA (z) was 20.3 mm (range, 12 to 28 mm), and the mean distance between the midline of the nasopharynx to the PPICA (x) was 19.6 mm (range, 15 to 24 mm). The PPICA was located in the same sagittal plane as the TVP muscle during dissection posteriorly. The PPICA appeared to lie around 2 cm laterally from the midline at around 2 cm in depth from the posterior margin of the TVP muscle. However, the exact position of the PPICA should be assessed using preoperative magnetic resonance imaging and intraoperative image-guided systems. © 2017 ARS-AAOA, LLC.

  14. Dissection of internal carotid and vertebral arteries: clinical presentation, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    Lyudmila Andreevna Kalashnikova

    2013-01-01

    Full Text Available The paper gives the data available in the literature and the author’s results of an examination of almost 140 patients with dissection of the internal carotid and vertebral arteries (ICA and VA. Dissection is blood penetration through an intimal tear from the lumen of an artery into its wall to develop intramural hematoma (IMH. The cause of dissection is the weakness of the arterial wall presumably due to mitochondrial cytopathy. IMH narrows/occludes the arterial lumen or is a source of arterioarterial embolism, which in turn leads to ischemic stroke. Stroke as a result of dissection generally develops in young patients, who are not prone to traditional vascular risk factors, frequently after the influence of provocative factors (mild head/neck injury, head jerks, physical strain, contraceptives, etc.. The characteristics of stroke are head/neck pain on the side of dissection that appears a few days prior to stroke or simultaneously with the latter; quite often a good recovery of impaired functions; and low recurrence rates. Another major manifestation, isolated cervicocephalic pain, is encountered in PA dissection more frequently (in almost a third of cases and in ICA dissection less frequently (about 5%. Magnetic resonance (MR angiography and fat-saturated T1-weighted MR imaging play a leading role in the verification of dissection. Dissection should be treated with anticoagulants/antiaggregants in its acute phase, as well as with trophic drugs, primarily actovegin, in both acute and chronic phases.

  15. Association between leukoaraiosis and cerebral blood flow territory alteration in asymptomatic internal carotid artery stenosis.

    Science.gov (United States)

    Chen, Y-F; Kuo, Y-S; Wu, W-C; Tang, S-C; Jiang, S-F

    2018-01-09

    To test the hypothesis that leukoaraiosis (also known as white matter lesion) is associated with cerebral blood flow territory change as revealed by territorial arterial spin-labeling (TASL) magnetic resonance imaging (MRI) in patients with asymptomatic internal carotid artery stenosis (aICAS). The institutional review board approved this study. Thirty-three patients with aICAS were included prospectively and divided into high-grade (ultrasonographic stenosis ≥70%, n=17) and low-grade (n=16) groups; 16 healthy subjects were also included. Cerebral flow territory was delineated for left ICA, right ICA, and vertebral arteries using TASL MRI and fuzzy clustering. Two licensed neuroradiologists independently and dichotomously rated the hemispherical asymmetry of flow territories. Flow territories were finalised by consensus, and when asymmetry was present, these were divided into normal and abnormal areas where the raters separately assessed leukoaraiosis based on fluid-attenuated inversion recovery images and the Fazekas scale. The inter-rater agreement in the evaluation of flow territory asymmetry with TASL imaging in conjunction with time-of-flight angiogram is substantial (Cohen's kappa=0.82). Multinomial logistic regression (reference group=healthy subjects) indicates that global leukoaraiosis is not a predictor of aICAS after controlling for age, whereas in high-grade patients, the deep white matter lesion is more severe in the area receiving collateral circulation than in the area with normal flow territory (Wilcoxon signed-rank test, p=0.03). TASL MRI is clinically feasible in aICAS and shows that more severe deep white matter lesions are associated with collateral circulation in high-grade patients. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  16. Atherosclerotic plaques in the internal carotid artery and associations with lung function assessed by different methods.

    Science.gov (United States)

    Frantz, Sophia; Nihlén, Ulf; Dencker, Magnus; Engström, Gunnar; Löfdahl, Claes-Göran; Wollmer, Per

    2012-03-01

    Previous studies on associations between reduced lung function and cardiovascular disease (CVD) have mainly been based on forced expiratory volume in 1-s (FEV(1) ) and vital capacity (VC). This study examined potential associations between five different lung function variables and plaques in the internal carotid artery (ICA). Subjects (n = 450) from a previous population-based respiratory questionnaire survey [current smokers without lower respiratory symptoms, subjects with a self-reported diagnosis of chronic obstructive pulmonary disease (COPD) and never-smokers without lower respiratory symptoms] were examined using spirometry, body plethysmography and measurements of diffusing capacity for CO (D(L,CO) ). Plaques in the ICA were assessed by ultrasonography. Two hundred and twenty subjects were current smokers, 139 ex-smokers and 89 never-smokers. COPD was diagnosed in 130 subjects (GOLD criteria). Plaques in the ICA were present in 231 subjects (52%). General linear analysis with adjustment for established risk factors for atherosclerosis, including C-reactive protein, showed that D(L,CO) was lower [77.4% versus 83.7% of predicted normal (PN), P = 0.014] and residual volume (RV) was higher (110.3% versus 104.8% of PN, P = 0.020) in subjects with than without plaques in the ICA. This analysis did not show any statistically significant association between plaques and FEV(1) or VC. The occurrence of plaques in the ICA was associated with low D(L,CO) and high RV, but not significantly with FEV(1) or COPD status. The results suggest that the relationships between reduced lung function, COPD and CVD are complex and not only linked to bronchial obstruction and low-grade systemic inflammation. © 2011 The Authors. Clinical Physiology and Functional Imaging © 2011 Scandinavian Society of Clinical Physiology and Nuclear Medicine.

  17. Cervical Rotatory Manipulation Decreases Uniaxial Tensile Properties of Rabbit Atherosclerotic Internal Carotid Artery

    Directory of Open Access Journals (Sweden)

    Shaoqun Zhang

    2017-01-01

    Full Text Available Objective. To investigate the effects of one of the Chinese massage therapies, cervical rotatory manipulation (CRM, on uniaxial tensile properties of rabbit atherosclerotic internal carotid artery (ICA. Methods. 40 male purebred New Zealand white rabbits were randomly divided into CRM-Model group, Non-CRM-Model group, CRM-Normal group, and Non-CRM-Normal group. After modeling (atherosclerotic model and intervention (CRM or Non-CRM, uniaxial tensile tests were performed on the ICAs to assess the differences in tensile mechanical properties between the four groups. Results. Both CRM and modeling were the main effects affecting physiological elastic modulus (PEM of ICA. PEM in CRM-Model group was 1.81 times as much as Non-CRM-Model group, while the value in CRM-Model group was 1.34 times as much as CRM-Normal group. Maximum elastic modulus in CRM-Model group was 1.80 times as much as CRM-Normal group. Max strains in CRM-Model group and Non-CRM-Model group were 30.98% and 28.71% lower than CRM-Normal group and Non-CRM-Normal group, respectively. However, whether treated with CRM or not, the uniaxial tensile properties of healthy ICAs were not statistically different. Conclusion. CRM may decrease the uniaxial tensile properties of rabbit arteriosclerotic ICA, but with no effect on normal group. The study will aid in the meaningful explanation of the controversy about the harmfulness of CRM and the suitable population of CRM.

  18. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-09-15

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

  19. Trombose de artéria carótida comum: tratamento cirúrgico com anastomose subclávio-carotidea Occlusion of the common carotid artery treated with a subclavian-internal carotid artery bypass

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    Marcos Antônio Dellaretti Filho

    2003-06-01

    Full Text Available Descrevemos o caso de mulher de 62 anos, com história de vários ataques isquêmicos transitórios. Os exames complementares revelaram oclusão da artéria carótida comum e revascularização da artéria carótida interna (ACI através de anastomose com a artéria tiroidiana inferior, bem como aneurisma na ACI supraclinoidea. A paciente foi tratada com "bypass" entre a artéria subclávia e a artéria carótida interna cervical, ocorrendo regressão completa dos sintomas de isquemia cerebral no pós-operatório.We describe the case of a 62 years old woman with several transient isquemic attacks. The neuroradiological study demonstrated occlusion of the common carotid artery with revascularization of the internal carotid artery by anastomosis with the inferior thyroid artery and an aneurysm of internal carotid artery at the emergency of the anterior choroidal artery. The patient was treated with a bypass between the subclavian artery and the internal carotid artery with complete regression of the symptoms.

  20. Bilateral spontaneous internal carotid artery dissection managed with endovascular stenting – A case report

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    Manoj Kumar Agarwala

    2016-09-01

    We describe a patient with ischemic stroke from spontaneous bilateral ICAD with completely occluded left ICA. Having failed medical therapy with antiplatelets and anticoagulants due to extensive loss of carotid vascular supply, he was managed successfully with endovascular stenting with good neurological recovery.

  1. Application of 3-Dimensional Computerized Tomography Angiography for Defining Cavernous Sinus Aneurysms and Intradural Aneurysms Involving the Internal Carotid Artery Around the Anterior Clinoid Process.

    Science.gov (United States)

    Cheng, Quan; Huang, Chun-Bo; Wang, Jun-Yu; Jiang, Bing; Zhang, Long-Bo; Zeng, Ming; Chen, Yuan-Bing; Zhang, Hong-Fu; Chen, Feng-Hua

    2017-10-01

    This study aimed to investigate the application of 3-dimensional computed tomography angiography (3D-CTA) for defining cavernous sinus aneurysms and intradural aneurysms involving the internal carotid artery around the anterior clinoid process. Results from 42 patients with an aneurysm of the internal carotid artery around the anterior clinoid process who underwent 3D-CTA were reviewed and compared with those of observed clinical operations. Among the 42 patients, there was a total of 45 aneurysms of the internal carotid artery around the anterior clinoid process. After surgery, 33 of the 45 aneurysms were confirmed as intradural aneurysms, and the other 12 were confirmed as aneurysms in the cavernous sinus. 3D-CTA imaging of the medial sagittal plane showed that 31 out of 31 (100%) intradural aneurysms of the internal carotid artery were above the virtual line between the inferior border of the anterior clinoid process and the tuberculum sellae, and 12 out of 14 (86%) cavernous sinus aneurysms were below the virtual line (P cavernous sinus aneurysms from intradural aneurysms involving the internal carotid artery around the anterior clinoid process. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Carotid Ultrasound

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. Carotid Ultrasound Also known as carotid duplex. Carotid ultrasound is a painless imaging test that uses high- ... of your carotid arteries. This test uses an ultrasound machine, which includes a computer, a screen, and ...

  3. Extracranial internal carotid artery dissection caused by compression from a giant osteophyte due to atlantoaxial osteoarthritis: case report.

    Science.gov (United States)

    Ikedo, Taichi; Nakamura, Kazuhito; Sano, Noritaka; Nagata, Manabu; Okada, Yumiko; Kawakami, Taichiro; Murata, Takaho

    2017-10-01

    Deformed osseous structures have been reported as rare causes of extracranial internal carotid artery (ICA) dissection, including the styloid process and the hyoid bone. Here, the authors describe the first known case of symptomatic ICA dissection caused by a giant osteophyte due to atlantoaxial osteoarthritis. The left ICA was fixed at the skull base and at the ICA portion compressed by the osteophyte, and it was highly stretched and injured between the two portions during neck rotation. The patient was successfully treated with ligation of the affected ICA following balloon test occlusion. Atlantoaxial osteoarthritis should be considered in the differential diagnosis of ICA dissection in patients with a severely deformed cervical spine.

  4. High-flow bypass and wrap-clipping for ruptured blood blister-like aneurysm of the internal carotid artery using intraoperative monitoring of cerebral hemodynamics

    Directory of Open Access Journals (Sweden)

    Kubo Y

    2015-06-01

    Full Text Available Yoshitaka Kubo, Takahiro Koji, Kenji Yoshida, Hideo Saito, Akira Ogawa, Kuniaki Ogasawara Department of Neurosurgery, Iwate Medical University, Morioka, Japan Abstract: Aneurysms at non-branching sites in the supraclinoid internal carotid artery (ICA can be classified as “blood blister-like aneurysms” (BBAs, which have blood blister-like configurations and fragile walls. While surgical treatment for the BBA in the acute stage is recommended, the optimal surgical procedure remains controversial. In the study reported here, we describe the case of a 37-year-old woman with a ruptured BBA in the ophthalmic segment of the right ICA who underwent wrap-clipping with external carotid artery–internal carotid artery bypass by intraoperative estimation of the measurement of cortical cerebral blood flow (CoBF using a thermal diffusion flow probe. Trapping of the ICA in the acute stage of subarachnoid hemorrhage may result in ischemic complications secondary to hemodynamic hypoperfusion or occlusion of the perforating artery, and/or delayed vasospasm, even with concomitant bypass surgery. We believe that it is important to perform scheduled external carotid artery–internal carotid artery bypass before trapping of the ICA in patients with a ruptured BBA in the acute stage of subarachnoid hemorrhage and to perform wrap-clipping rather than trapping. This would provide much more CoBF if a reduction of CoBF occurs after trapping occlusion of the ICA including a ruptured BBA according to intraoperative CoBF monitoring. As far as we are aware, the case reported here is the first report on high-flow bypass and wrap-clipping for a ruptured BBA of the ICA using intraoperative monitoring of cerebral hemodynamics. Keywords: surgery, cortical blood flow, external carotid artery–internal carotid artery bypass, subarachnoid hemorrhage

  5. A rare complication of middle ear cholesteatoma – Pseudoaneurysm of petrous internal carotid artery

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    L.Y. Lim

    2017-07-01

    Full Text Available Objectives: To report a rare complication of middle ear cholesteatoma resulting pseudoaneurysm of petrous internal carotid artery (ICA. Case report: A 39 year old lady presented with sudden profuse bleeding from the right ear. Previously, she had been having bilateral intermittent foul smelling ear discharge for a year. Otoscope finding was insignificant as only blood seen. Computed tomography of temporal bone and magnetic resonance imaging of brain suggested locally aggressive cholesteatoma. Right ICA angiography showed pseudoaneurysm of petrous part of ICA. She underwent coil embolisation followed by bilateral modified radical mastoidectomy a month later. She recovered well after surgery and remained symptoms free. Conclusions: Pseudoaneurysm of petrous ICA as a complication of middle ear cholesteatoma is extremely rare. Spontaneous profuse bleeding maybe the only clinical presentation. Radiological imaging is important to diagnose and assist in treatment. Endovascular technique may be required, followed by surgical treatment for infection control Keywords: Cholesteatoma, Middle ear, Aneurysm, False, Angiography, Carotid artery, Internal

  6. Intraoperative radiation of canine carotid artery, internal jugular vein, and vagus nerve. Therapeutic applications in the management of advanced head and neck cancers

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    Mittal, B.B.; Pelzer, H.; Tsao, C.S.; Ward, W.F.; Johnson, P.; Friedman, C.; Sisson, G.A. Sr.; Kies, M. (Northwestern Univ., Chicago, IL (USA))

    1990-12-01

    As a step in the application of intraoperative radiotherapy (IORT) for treating advanced head and neck cancers, preliminary information was obtained on the radiation tolerance of the canine common carotid artery, internal jugular vein, and vagus nerve to a single, high-dose electron beam. Both sides of the neck of eight mongrel dogs were operated on to expose an 8-cm segment of common carotid artery, internal jugular vein, and vagus nerve. One side of the neck was irradiated, using escalating doses of 2500, 3500, 4500, and 5500 cGy. The contralateral side of the neck served as the unirradiated control. At 3 and 6 months after IORT, one dog at each dose level was killed. None of the dogs developed carotid bleeding at any time after IORT. Light microscopic investigations using hematoxylin-eosin staining on the common carotid artery and internal jugular vein showed no consistent changes that suggested radiation damage; however, the Masson trichrome stain and hydroxyproline concentration of irradiated common carotid artery indicated an increase in the collagen content of the tunica media. Marked changes in the irradiated vagus nerve were seen, indicating severe demyelination and loss of nerve fibers, which appeared to be radiation-dose dependent. Four patients with advanced recurrent head and neck cancer were treated with surgical resection and IORT without any acute or subacute complications. The role of IORT as a supplement to surgery, external beam irradiation, and chemotherapy in selected patients with advanced head and neck cancer needs further exploration.

  7. Association Between Macrominerals Intake and Changes in Internal Carotid Artery-Intima Media Thickness in POST Ischemic Stroke Patients

    Science.gov (United States)

    Pudjonarko, Dwi; Tugasworo, Dodik; Silaen, Rumintang

    2017-02-01

    Carotid Intima Media Thickness (C-IMT) has been widely used as marker for atherosclerosis. Previous studies on minerals intake and its association with C-IMT revealed various. Most of the studies showed inconsistent results. The aim of this study is to determine wether macro minerals intake is related to internal carotid-intima media thickness (IC-IMT). This is a longitudinal study, pre test post test design conducted in Neurology clinic, Kariadi hospital, Semarang from June to December 2014. Subjects were 22 post ischemic stroke patients. Minerals intake and IC-IMT was measured using Food Frequency Questionnaire and Duplex Carotid Ultrasonography. Statistical analysis was performed using Chi-Square, Fisher Exact and Logistic Regression test. Subjects included in this study were 17 male subjects (77.3%) and 5 female subjects (22.7%). Mean of IC-IMT in female subjects was found to be higher than in male. Mean of total IC-IMT was increased after a period of six months (0.96±0.80 to 0.97±0.21 mm). There were significant association between calcium as well as sodium intakes and IC-IMT. In contrast, there were no association between magnesium as well as potassium intake and IC-IMT. Multivariate analysis suggest that sodium intake (OR=26.828) was the most influencing factor for IC-IMT, followed by calcium intake (OR=0.042). Calcium as well as potassium intake were independently associated with IC-IMT. Magnecium as well as sodium intake were not independently associated with IC-IMT changes. Sodium intake was the most influencing variable to IC-IMT changes, followed by calcium intake.

  8. 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.

  9. Remifentanil decreases oral tissue blood flow while maintaining internal carotid artery blood flow during sevoflurane anesthesia in rabbits.

    Science.gov (United States)

    Hirata, Atsushi; Kasahara, Masataka; Matsuura, Nobuyuki; Ichinohe, Tatsuya

    2017-12-22

    The aim of this study was to investigate the effect of remifentanil infusion on oral tissue blood flow including submandibular gland tissue blood flow (SBF) and internal carotid artery blood flow (ICBF) in rabbits during sevoflurane anesthesia. Twelve male Japan White rabbits were anesthetized with sevoflurane and remifentanil. Remifentanil was infused at 0.2 and 0.4 µg/kg/min. Measurements included circulatory variables, common and external carotid artery blood flow (CCBF, ECBF), ICBF, tongue mucosal blood flow (TMBF), masseter muscle tissue blood flow (MBF), mandibular bone marrow tissue blood flow (BBF), tongue muscle tissue blood flow (TBF), and SBF. Vascular resistances for each tissue, including the tongue mucosa, masseter muscle, mandibular bone marrow, tongue muscle, and submandibular gland, were calculated by dividing the mean arterial pressure by the respective tissue blood flow. Remifentanil infusion decreased oral tissue blood flow and circulatory variables. CCBF, ECBF, and ICBF did not change. The calculated vascular resistance in each oral tissue, except for the tongue mucosa, increased in an infusion-rate-dependent manner. These results showed that remifentanil infusion reduced TMBF, MBF, BBF, TBF, and SBF in an infusion-rate-dependent manner without affecting ICBF under sevoflurane anesthesia.

  10. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus

    NARCIS (Netherlands)

    Wijgman, A. J.; Roolker, W.; Patt, T. W.; Raaymakers, E. L. F. B.; Marti, R. K.

    2002-01-01

    BACKGROUND: Controversy persists concerning the preferred treatment of displaced fractures of the proximal part of the humerus. The present study was undertaken to evaluate the results of open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus and

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

    NARCIS (Netherlands)

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

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

  12. De Novo Vertebral Artery Dissection after Endovascular Trapping for Ruptured Dissecting Internal Carotid Artery Aneurysm: Case Report

    Science.gov (United States)

    HORIE, Nobutaka; SADAKATA, Eisaku; IZUMO, Tsuyoshi; HAYASHI, Kentaro; MORIKAWA, Minoru; NAGATA, Izumi

    The authors present an extremely rare case of a 54-year-old female patient with subarachnoid hemorrhage due to a rupture of a dissecting internal carotid artery (ICA) aneurysm, who developed de novo vertebral artery dissection in the spasm period after endovascular trapping of the ICA. Interestingly, postoperative cardiopulmonary monitoring showed high global end-diastolic volume index and mean arterial pressure, which could contribute to this de novo dissection via hemodynamic stress in the cerebral circulation. Spontaneous intracranial artery dissection of more than two arteries is rare, and we believe this is the first case of de novo dissection occurring on a circulating vessel different from that of the initial dissection. The clinical implications are discussed in relation to postoperative hemodynamic stress with a review of the literature. PMID:24418785

  13. Distal flow protection during carotid stenting. a prospective study to quantify the embolic debris retrieved in the internal carotid artery territory.

    Science.gov (United States)

    Sugiu, K; Martin, J B; Pache, J C; Gulmaraens, L; Theron, J; Rüfenacht, D A

    1999-11-01

    This study was conducted to evaluate presence of embolic debris during ICA stent procedures. Nine patients with severe carotid atheromatous stenosis were treated by stent implantation under distal flow protection using a non-detachable balloon. After stent implantation, the lumen of the ICA was cleaned by aspiration of 50 cc of blood before further flush cleaning and deflation of the protection balloon. The blood samples obtained from each patient were analyzed using a microscope to check quantity and aspect of embolic debris. Significant numbers of embolic debris were recovered from blood samples in all nine stenting cases, but very few were found in four out of the five control cases. This observation demonstrates the high risk of producing embolic debris during carotid stenting. Distal balloon occlusion and cleaning procedures are techniques to provide protection from thromboembolic complications to the brain.

  14. Carotid stenting and endarterectomy.

    Science.gov (United States)

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

    2016-07-01

    Stroke, either ischemic or hemorrhagic, remains the second commonest cause of death worldwide in the last decade. Etiologies for ischemic stroke (IS) vary widely. Atherothrombotic occlusion is an essential cause to which carotid artery stenosis (CAS) is a major contributor. Administration of anti-platelet agent to patients with CAS has been shown to reduce incidence of long-term IS. In additional, in patients with symptomatic CAS, clinical trials have demonstrated that carotid endarterectomy (CEA) is superior to medical therapy for prevention of future CAS-related IS. However, CEA is not suitable for CAS post-radiotherapy or those located at higher level of the internal carotid artery; and major complications of this procedure including cranial nerve injuries have stimulated the interest of using percutaneous transfemoral carotid stenting as an alternative approach. Although transfemoral arterial approach of carotid stenting is not inferior to CEA in improving clinical outcomes, it has been reported to be associated with vascular complication and has its limitations in patients with athero-occlusive disease of abdominal aorta or bilateral iliac arteries, level II or III aortic arch, or bovine type carotid arterial anatomy. Therefore, transradial/transbrachial arterial approach has emerged as a novel method for carotid stenting. This article provides a critical review on interventional approaches for the treatment of CAS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Mycotic aneurysm of the extracranial internal carotid artery - report of a case and review of the literature; Aneurisma micotico da arteria carotida interna extracraniana - relato de um caso e revisao da literatura

    Energy Technology Data Exchange (ETDEWEB)

    Nascimento, Edilene Cristina do; Silva, Ivone Martins da [Pernambuco Univ., Recife, PE (Brazil). Hospital das Clinicas. Servico de Radiologia; Albuquerque, Silvio Cavalcanti de [Instituto Materno Infantil de Pernambuco, Recife, PE (Brazil). Servico de Radiologia; Abath, Carlos [Angiorad, Recife, PE (Brazil)

    1998-08-01

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

  16. 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.)

  17. Variant termination of the common carotid artery: Cases of ...

    African Journals Online (AJOL)

    In all cases of trifurcation, superior thyroid artery was the third branch. The common carotid artery quadrifurcated into external, internal carotid, superior thyroid and ascending pharyngeal arteries. The pentafurcations comprised internal carotid, external carotid, superior thyroid, occipital and posterior auricular arteries.

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

    NARCIS (Netherlands)

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

    2013-01-01

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  20. Hemodynamic study of superficial temporal artery-middle cerebral artery bypass in treatment of severe internal carotid artery or middle cerebral artery stenosis

    Directory of Open Access Journals (Sweden)

    Hui LIU

    2017-07-01

    Full Text Available Objective To explore the value of dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI in superficial temporal artery-middle cerebral artery (STA-MCA bypass and to provide radiological evidence for hemodynamic changes in STA-MCA bypass in the treatment of severe internal carotid artery (ICA and MCA stenosis and/or occlusion.  Methods A total of 76 cases (65 males and 11 females with average age of 55 who underwent STA-MCA bypass from January 2011 to February 2016 were included. Routine MRI and DSC-PWI were performed within one month before operation and within one week after operation. Hemodynamic changes [relative cerebral blood flow (rCBF, relative cerebral blood volume (rCBV, relative mean transit time (rMTT and relative time to peak (rTTP] of MCA blood supplying area at basal ganglia section (proximal end and centrum semiovale section (distal end were compared before and after operation.  Results Compared with before operation, rCBF was significantly increased after operation at ipsilateral basal ganglia section (proximal end, P = 0.000 and centrum semiovale section (distal end, P = 0.001. rCBV at basal ganglia section was significantly increased after operation (P = 0.021, while rCBV at centrum semiovale section had no significant difference compared with before operation (P = 0.844. rMTT (P = 0.000, 0.000 and rTTP (P = 0.000, 0.000 at ipsilateral basal ganglia section and centrum semiovale section were significantly reduced after operation.  Conclusions STA-MCA bypass can improve cerebral blood perfusion of MCA blood supplying area. DSC-PWI could assess the hemodynamics of ischemic area, so it is the optimal noninvasive technology to evaluate the curative effect of bypass and observe cerebral hemodynamic changes dynamically. DOI: 10.3969/j.issn.1672-6731.2017.06.010

  1. High-flow bypass and wrap-clipping for ruptured blood blister-like aneurysm of the internal carotid artery using intraoperative monitoring of cerebral hemodynamics.

    Science.gov (United States)

    Kubo, Yoshitaka; Koji, Takahiro; Yoshida, Kenji; Saito, Hideo; Ogawa, Akira; Ogasawara, Kuniaki

    2015-01-01

    Aneurysms at non-branching sites in the supraclinoid internal carotid artery (ICA) can be classified as "blood blister-like aneurysms" (BBAs), which have blood blister-like configurations and fragile walls. While surgical treatment for the BBA in the acute stage is recommended, the optimal surgical procedure remains controversial. In the study reported here, we describe the case of a 37-year-old woman with a ruptured BBA in the ophthalmic segment of the right ICA who underwent wrap-clipping with external carotid artery-internal carotid artery bypass by intraoperative estimation of the measurement of cortical cerebral blood flow (CoBF) using a thermal diffusion flow probe. Trapping of the ICA in the acute stage of subarachnoid hemorrhage may result in ischemic complications secondary to hemodynamic hypoperfusion or occlusion of the perforating artery, and/or delayed vasospasm, even with concomitant bypass surgery. We believe that it is important to perform scheduled external carotid artery-internal carotid artery bypass before trapping of the ICA in patients with a ruptured BBA in the acute stage of subarachnoid hemorrhage and to perform wrap-clipping rather than trapping. This would provide much more CoBF if a reduction of CoBF occurs after trapping occlusion of the ICA including a ruptured BBA according to intraoperative CoBF monitoring. As far as we are aware, the case reported here is the first report on high-flow bypass and wrap-clipping for a ruptured BBA of the ICA using intraoperative monitoring of cerebral hemodynamics.

  2. Non-Newtonian blood flow dynamics in a right internal carotid artery with a saccular aneurysm

    Science.gov (United States)

    Valencia, Alvaro; Zarate, Alvaro; Galvez, Marcelo; Badilla, Lautaro

    2006-02-01

    Flow dynamics plays an important role in the pathogenesis and treatment of cerebral aneurysms. The temporal and spatial variations of wall shear stress in the aneurysm are hypothesized to be correlated with its growth and rupture. In addition, the assessment of the velocity field in the aneurysm dome and neck is important for the correct placement of endovascular coils. This work describes the flow dynamics in a patient-specific model of carotid artery with a saccular aneurysm under Newtonian and non-Newtonian fluid assumptions. The model was obtained from three-dimensional rotational angiography image data and blood flow dynamics was studied under physiologically representative waveform of inflow. The three-dimensional continuity and momentum equations for incompressible and unsteady laminar flow were solved with a commercial software using non-structured fine grid with 283 115 tetrahedral elements. The intra-aneurysmal flow shows complex vortex structure that change during one pulsatile cycle. The effect of the non-Newtonian properties of blood on the wall shear stress was important only in the arterial regions with high velocity gradients, on the aneurysmal wall the predictions with the Newtonian and non-Newtonian blood models were similar.

  3. Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures.

    Science.gov (United States)

    Siebenbürger, Georg; Van Delden, Dustin; Helfen, Tobias; Haasters, Florian; Böcker, Wolfgang; Ockert, Ben

    2015-10-01

    Open reduction and internal fixation is one established method for treatment of displaced fractures of the proximal humerus. However, the timing of surgery and its effect on complications have not yet been investigated in the literature. Hence, aim of this study was to analyze the occurrence of complication following locked plating of proximal humeral fractures when surgery was delayed in comparison to early intervention. Between February 2002 and November 2010, 497 patients with displaced proximal humeral fractures were treated by open reduction and locked plating. 329 patients were available for follow-up with a minimum of 12 months after surgery. Outcome analysis included radiographic evidence of loss of fixation (> 10° of secondary displacement), screw-cutout and avascular head necrosis. Outcomes were analyzed with regards to age, gender and fracture pattern and were compared between time intervals in which the primary surgery had been conducted; early intervention (5 days). Of 329 patients (68.4% women; median age at time of surgery: 69.9 years, 95% Confidence Interval (CI) 68.2, 71.2) the median time between fracture incident and surgical intervention was 3.2 days (95%CI: 3.1, 3.3). Surgery was performed in a 2-part fracture at a median of 3.3 days (95%CI: 3.2, 3.4) after trauma, in a 3-part fracture after 3.3 days (95%CI: 3.1, 3.4), in a 4-part fracture 2.9 days (95%CI: 2.8, 3.0), in head split type fracture 2.2 days (95%CI: 2.0, 2.4) and in dislocation type fracture 0.8 days after trauma (95%CI: 0.7, 0.9, p = 0.40). Loss of fixation was observed in 12.8% (n = 42 patients), of which in 4.9% (n = 16) screw cutout was evident and in 6.8% of cases (n = 20) avascular head necrosis was diagnosed. Patients in which complication was observed were treated at median 2.5 days after trauma (95% CI, 1.8, 3.2), in comparison, patients without evidence of complications were treated at a median of 3.2 days (95% CI, 2.8-3.8, p = 0.35). The odds ratio regarding occurrence

  4. Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur?

    Science.gov (United States)

    Koval, Kenneth J; Oh, Chong K; Egol, Kenneth A

    2008-01-01

    The standard radiographic series for evaluation of a suspected hip fracture in most centers includes an anteroposterior (AP) radiograph of the pelvis, as well AP and cross-table lateral views of the hip. The natural femoral neck anteversion, as well as the fracture deformity, however, may make accurate fracture classification difficult. We have noted that inexperienced physicians sometimes misclassify hip fractures based on the initial radiographic series, which may lead to errors both in surgical planning and implant choice. At our institution, we routinely obtain a physician-assisted traction-internal rotation radiograph of the affected hip in all fractures of the proximal femur. The purpose of the current study was to examine the usefulness of the traction-internal rotation radiograph for the classification of hip fractures by junior residents in our department. Forty-seven sets of complete radiographs (AP pelvis, AP hip, cross-table lateral, traction- internal rotation views) of patients who sustained a proximal femur fracture were identified. Fifteen first year orthopaedic residents (PGY2) individually reviewed the cases and classified them as one of six possible choices: 1. nondisplaced femoral neck fracture, 2. displaced femoral neck fracture, 3. stable intertrochanteric fracture, 4. unstable intertrochanteric fracture, 5. intertrochanteric fracture with subtrochanteric extension, or 6. subtrochanteric fracture. Each fracture case was classified after first reviewing the standard hip series (AP pelvis, AP hip, and cross-table lateral). A traction-internal rotation radiograph was then added to each case, and any changes in the initial classification were noted. The resident's classification was then compared with those of the senior investigators (KJK, KAE), who used all four views for classification. Reviewing a traction-internal rotation radiograph led to a statistically significant increase in agreement between the resident and senior investigators

  5. DYNAMICS OF HIGHGER MENTAL FUNCTION IN PATIENTS WITH OBLITERATING LESIONS OF INTERNAL CAROTID ARTERIES IN SURGICAL BRAIN REVASCUL

    Directory of Open Access Journals (Sweden)

    R. A. Vinogradov

    2017-01-01

    Full Text Available Obliterating atherosclerosis of internal carotid arteries is one of the main causes of ischemic stroke and discirculatory encephalopathy. It causes up to 40% of ischemic disorders of cerebral circulation. Currently, the strategy for stroke prevention is determined by the intensive development of surgical methods of treatment, primarily methods for managing lesions of brachiocephalic arteries. Based on the results of a number of international multicenter randomized studies, indications for reconstructive operations for BCA, tactics for managing patients in the postoperative period were formulated. A number of patients with atherosclerotic lesions of brachiocephalic arteries have reduced cognitive functions. The aim of the study is to compare cognitive functions (CF in patients who underwent different surgical approaches in the treatment of obliterating atherosclerotic lesion of internal carotid arteries (ICA.MATERIAL AND METHODS. We studied higher mental functions (HMFs in 116 patients with obliterating unilateral or bilateral lesion of ICA. The study of cognitive functions (MF was performed prior to carotid endarterectomy (CE, group 1, n=73 and transluminal balloon angioplasty of ICAs (TBA of ICA, group 2, n=43, and on days 5–7 and 30–31 after cerebral revascularization (CR. To assess the overall severity of cognitive impairment, the summary indicators of main screening neuropsychological tests were used: MMSE; MoCA; Frontal Assessment Battery (FAB; Beck Depression Inventory and Hamilton Depression Rating Scale.RESULTS. Results Neuropsychologic disorders were reavealed in 98% of patients prior to surgery. An initially comparable condition of HMF in groups with CE and TBA of ICA was revealed. MMSE2 revealed a significant improvement in the results in group 1 both in comparison with the initial data (p<0.05 and in comparison with the results of the second test of group 2. The results of MMSE1 and MMSE2 in group 2 did not show significant

  6. Augmenting regional cerebral blood flow using external-to-internal carotid artery flow diversion method.

    Science.gov (United States)

    Divani, Afshin A; Berezina, Tamara L; Vazquez, Gabriela; Zaets, Sergey B; Tummala, Ramachandra; Qureshi, Adnan I

    2009-12-01

    The objective of this study was to assess the effect of flow diversion by external carotid artery (ECA) occlusion on ipsilateral regional cerebral blood flow (rCBF). Local cerebral hyperperfusion in rats (n = 12) was induced by ligating the right ECA. Ipsilateral rCBF was determined pre- and post-ligation for 120 min using a laser Doppler flow meter. Sham animals (n = 6) were subjected to the craniotomy without ligation of the right ECA. In a separate series of rats (n = 5), brain tissue oxygen levels (pO(2)) in the right and left brain hemispheres were determined before and 90 min after ligation of the right ECA using a tissue oxygenation monitoring unit. We investigated the effect of ECA occlusion hemispheric changes in rCBF in one clinical case as a proof of concept. Ligation of ECA resulted in a statistically significant increase in rCBF on the ipsilateral side compared to the sham-operated rats (p group compared with sham-operated rats. There was no significant variation in MAP for the treated animals. Vascular permeability and cerebral water content in the right hemisphere after ligation of ECA did not significantly differ from the contralateral hemisphere. Ipsilateral hemisphere tissue pO(2) was significantly higher compared to the contralateral area (p ECA resulted in 3.6% and 12.1% increase in peak value and rise-time of the time-density curves. Flow diversion by temporary occlusion of the ECA can result in increased rCBF and cerebral pO(2) on the ipsilateral side. The strategy may represent a viable option to augment rCBF in focal cerebral ischemia.

  7. Is endoprosthesis safer than internal fixation for metastatic disease of the proximal femur? A systematic review.

    Science.gov (United States)

    Di Martino, Alberto; Martinelli, Nicolò; Loppini, Mattia; Piccioli, Andrea; Denaro, Vincenzo

    2017-10-01

    Metastases to the proximal femur are usually managed surgically by tumor resection and reconstruction with an endoprosthesis, or by fixation with osteosynthesis. Still controversy remains regarding the most appropriate surgical treatment. We posed the following questions: (1) Is the frequency of surgical revision greater in patients treated with internal fixation than endoprosthetic reconstruction, and (2) Do complications that do not require surgery occur more frequently in patients treated with internal fixation rather than in those with endoprosthetic reconstruction? A systematic review was performed of those studies reporting on surgical revision and complication rates comparing the two surgical methods. Ten studies including 1107 patients met the inclusion criteria, three with high methodological quality, three intermediate, and four with lowquality, according to the STROBE guidelines. At present, prosthetic dislocation is the most common complication observed in patients managed by prosthesis replacement of the proximal femur, while loosening was the main cause of reoperation in the fixation group. Time to reintervention ranged from 3 to 11.6 months for the prosthetic replacement and from 7.8 to 22.3 months for the fixation group. Non surgical complications, (mainly dislocations and infections) were more commonly observed in patients operated on by prosthetic replacement. Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery. © 2017 Elsevier Ltd. All rights reserved.

  8. Epistaxe tardia secundária a pseudoaneurisma intracavernoso de carótida interna Delayed epistaxis secondary to intracavernous pseudoaneurysm of internal carotid artery

    Directory of Open Access Journals (Sweden)

    Paula M. de Sá

    2003-10-01

    Full Text Available Pseudoaneurisma traumático da artéria carótida interna é uma causa rara de epistaxe, porém potencialmente fatal. O diagnóstico precoce é essencial para um adequado manejo da patologia. Os autores relatam um caso de pseudoaneurisma da carótida interna que se apresentou como epistaxe maciça após seis meses de trauma craniano prévio.Post-traumatic pseudoaneurysm of the internal carotid artery is a very rare but potentially fatal cause of epistaxis. Early diagnosis is essential for an adequate management of this entity. The authors present a case of pseudoaneurysm of the internal carotid artery that developed massive epistaxis six months after skull base trauma.

  9. A preliminary study of brain macrovascular reactivity in impaired glucose tolerance and type-2 diabetes: Quantitative internal carotid artery blood flow using magnetic resonance phase contrast angiography.

    Science.gov (United States)

    Selvarajah, Dinesh; Hughes, Timothy; Reeves, Josie; Boland, Elaine; Marques, Jefferson; Gandhi, Rajiv; Griffiths, Paul D; Tesfaye, Solomon; Wilkinson, Iain D

    2016-09-01

    The aims of this study were (1) to examine cerebrovascular autoregulation in subjects with impaired glucose tolerance and type 2 diabetes and (2) to clarify whether cardiovascular autonomic nerve function is associated with abnormal cerebrovascular autoregulation. Totally, 46 subjects were recruited (12 = impaired glucose tolerance, 17 = type 2 diabetes and 17 = healthy volunteers). Arterial blood flow was assessed within the internal carotid artery at baseline and 20 min after intravenous pharmacological stress (1 g acetazolamide), using quantitative magnetic resonance phase-contrast angiography. Internal carotid artery vascular reactivity and pulsatility index was determined. All subjects underwent baroreceptor reflex sensitivity assessment. Subjects with impaired glucose tolerance and type 2 diabetes had significantly lower internal carotid artery vascular reactivity [40.2%(19.8) and 41.5%(18.7)], respectively, compared with healthy volunteers [57.0%(14.2); analysis of variance, p = 0.02]. There was no significant difference in internal carotid artery vascular reactivity between type 2 diabetes and impaired glucose tolerance groups (p = 0.84). There was a significant positive correlation between baroreceptor reflex sensitivity (low frequency:high frequency) with cardiac rhythm variability (ρ = 0.47, p = 0.04) and PI (ρ = 0.46, p = 0.04). We have demonstrated significant cerebrovascular haemodynamic abnormalities in subjects with type 2 diabetes and impaired glucose tolerance. This was associated with greater sympathovagal imbalance. This may provide an important mechanistic explanation for increased risk of cerebrovascular disease in diabetes. It also highlights that these abnormalities may already be present in prediabetes. © The Author(s) 2016.

  10. Intra-arterial therapy for cardio embolic internal carotid artery terminus occlusion: The past and present status in real practice

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Guk; Jung, Cheol Kyu; KIm, Jae Hyoung; Choi, Byung Se; Kim, Beomn Joon; Han, Moon Ku; Bae, Hee Joon [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Kwon, Bae Ju [Dept. of Radiology, Myongji Hospital, Goyang (Korea, Republic of); Cha, Sang Hoon [Dept. of Radiology, Chungbuk National University College of Medicine, Daejeon (Korea, Republic of)

    2015-10-15

    There is little data on the effect of intra-arterial therapy (IAT) in acute cardioembolic internal carotid artery terminus (ICAT) occlusion that has poor prognosis. We determined procedural and clinical outcomes in patients with acute cardioembolic ICAT occlusion treated with different methods of IAT. On retrospective review of our registry, patients with cardioembolic ICAT occlusion were categorized as thrombolytic-based IAT group (TLG) and thrombectomy-based IAT group (TEG) according to the primary endovascular technique. Subsequently, procedural and clinical outcomes were compared. Fifty-five patients had cardioembolic ICAT occlusion and 18 patients were assigned to TLG and 37 patients to TEG. The rate of complete reperfusion was significantly higher and the groin puncture to reperfusion time was significantly shorter in TEG than those in TLG. There was a trend towards functional outcome at 3 months in the TEG group; however, it was not statistically significant (p = 0.06). Age, baseline Albert Stroke program early CT score and puncture to reperfusion time were factors affecting unfavorable outcome at 3 months, on multivariable analysis. Thrombectomy-based IAT has advantages over thrombolytic-based IAT in terms of the reduction of groin puncture to reperfusion time and improvement of the rate of complete reperfusion.

  11. Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.

    Science.gov (United States)

    Reig, Adam S; Simon, Scott; Mericle, Robert A

    2009-11-01

    Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.

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

    Directory of Open Access Journals (Sweden)

    Anna Machalińska

    2017-01-01

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

  13. A case of central diabetes insipidus after ketamine infusion during an external to internal carotid artery bypass.

    Science.gov (United States)

    Gaffar, Sharib; Eskander, Jonathan P; Beakley, Burton D; McClure, Brian P; Amenta, Peter; Pierre, Nakeisha

    2017-02-01

    We report the first teenage case of ketamine-induced transient central diabetes insipidus. The patient was an 18-year-old woman with moyamoya disease undergoing an external carotid to internal carotid bypass and given a low-dose ketamine infusion. After approximately 2 hours in the supine position, with 0.5 Minimum Alveolar Concentration (MAC) of sevoflurane, a propofol infusion at 50 μg/kg/min, a remifentanil infusion at 0.5 μg/kg/min, and a ketamine infusion at a dose of 10 μg/kg/min, this patient had an excessive urine output. Initially, the Foley catheter contained 50 mL of urine. She was given 1500 mL of crystalloid during the case but produced 2700 mL of urine output. Increasing urine output was noted 1 hour into the procedure around the time that the patient experienced a 2-minute Cushing-like response characterized by bradycardia and hypertension. Several I-Stat samples revealed a worsening hypernatremia. The decision was made to check the urine osmolality and treat the patient with 4 μg of desmopressin (DDAVP). Urine output began to slow down to a normal rate of 2 mg/kg/h, as the patient was transferred from the operating room to the computed tomographic (CT) scanning room for a CT and CT angiogram; both were unremarkable. The neurosurgery team waited until the next day to complete the procedure. The procedure was completed successfully and uneventfully the next day without a ketamine infusion as part of the general anesthetic plan. The Naranjo Adverse Drug Reaction score of 4 suggested a possible relationship between the patient's ketamine infusion and subsequent central diabetes insipidus. The 2 previous cases on this topic have suggested that ketamine, as an N-methyl-d-aspartate receptor antagonist, inhibits vasopressin release in the neurohypophysis. Urine output, urine osmolarity, and serum osmolarity should be monitored in patients given ketamine anesthetic; desmopressin should be present to prevent dangerous long-term sequela. Copyright © 2016

  14. Early Endarterectomy Carries a Lower Procedural Risk Than Early Stenting in Patients With Symptomatic Stenosis of the Internal Carotid Artery: Results From 4 Randomized Controlled Trials.

    Science.gov (United States)

    Rantner, Barbara; Kollerits, Barbara; Roubin, Gary S; Ringleb, Peter A; Jansen, Olaf; Howard, George; Hendrikse, Jeroen; Halliday, Alison; Gregson, John; Eckstein, Hans-Henning; Calvet, David; Bulbulia, Richard; Bonati, Leo H; Becquemin, Jean-Pierre; Algra, Ale; Brown, Martin M; Mas, Jean-Louis; Brott, Thomas G; Fraedrich, Gustav

    2017-06-01

    Patients undergoing carotid endarterectomy (CEA) for symptomatic stenosis of the internal carotid artery benefit from early intervention. Heterogeneous data are available on the influence of timing of carotid artery stenting (CAS) on procedural risk. We investigated the association between timing of treatment (0-7 days and >7 days after the qualifying neurological event) and the 30-day risk of stroke or death after CAS or CEA in a pooled analysis of individual patient data from 4 randomized trials by the Carotid Stenosis Trialists' Collaboration. Analyses were done per protocol. To obtain combined estimates, logistic mixed models were applied. Among a total of 4138 patients, a minority received their allocated treatment within 7 days after symptom onset (14% CAS versus 11% CEA). Among patients treated within 1 week of symptoms, those treated by CAS had a higher risk of stroke or death compared with those treated with CEA: 8.3% versus 1.3%, risk ratio, 6.7; 95% confidence interval, 2.1 to 21.9 (adjusted for age at treatment, sex, and type of qualifying event). For interventions after 1 week, CAS was also more hazardous than CEA: 7.1% versus 3.6%, adjusted risk ratio, 2.0; 95% confidence interval, 1.5 to 2.7 (P value for interaction with time interval 0.06). In randomized trials comparing stenting with CEA for symptomatic carotid artery stenosis, CAS was associated with a substantially higher periprocedural risk during the first 7 days after the onset of symptoms. Early surgery is safer than stenting for preventing future stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00190398; URL: http://www.controlled-trials.com. Unique identifier: ISRCTN57874028; Unique identifier: ISRCTN25337470; URL: http://www.clinicaltrials.gov. Unique identifier: NCT00004732. © 2017 American Heart Association, Inc.

  15. Large aneurysm in a nonbifurcating cervical carotid artery: an aneurysm associated with a rare anomaly treated with radial artery graft bypass: case report.

    Science.gov (United States)

    Tokugawa, Joji; Yoshida, Kensaku; Yamamoto, Munetaka; Kamiyama, Hiroyasu; Oishi, Hidenori; Arai, Hajime

    2011-03-01

    A nonbifurcating cervical carotid artery is an extremely rare type of carotid artery anomaly. We present a patient with a nonbifurcating cervical carotid artery and a large aneurysm of the cavernous internal carotid artery (ICA). The patient was successfully treated with combined microsurgical and endovascular techniques. We describe this case with reference to the relevant literature. A 66-year-old woman with progressive left external ocular movement dysfunction was found to have a large left cavernous ICA aneurysm. Serial magnetic resonance angiography revealed progressive growth of the lesion. In addition, conventional angiography showed a nonbifurcating cervical carotid artery and a persistent primitive trigeminal artery. The aneurysm was found unsuitable for direct surgery because of its size and location and for endovascular intervention because of extreme tortuosity of both carotid and right vertebral arteries. Surgery was performed in 2 stages. First, we performed an extracranial-intracranial high-flow bypass using radial artery graft, followed by proximal occlusion of the carotid artery. As the second stage, the patient underwent intravascular parent artery occlusion via the radial artery graft bypass to approach the intracranial carotid artery. The carotid artery was successfully coil embolized, and the aneurysm was undetectable on a postprocedure angiogram. Serial follow-up magnetic resonance imaging revealed thrombosis of the aneurysm. We report a rare case that involves the novel use of the radial artery graft bypass as an approach for parent vessel occlusion.

  16. Painful Horner syndrome due to arteritis of the internal carotid artery

    NARCIS (Netherlands)

    Bollen, AE; Krikke, AP; de Jager, AEJ

    1998-01-01

    A 44-year-old man presented with painful Horner syndrome: severe periorbital pain, ptosis, and miosis of his right eye, with intact facial sweating. Lymphadenitis at the right side of his neck preceded the symptoms. MRI and magnetic resonance angiography showed thickening of the right internal

  17. Endovascular management of iatrogenic cervical internal carotid artery pseudoaneurysm in a 9-year-old child: Case report and literature review.

    Science.gov (United States)

    Pinzón, Martín; Lobelo, Nelson Oswaldo; Rodríguez, María Claudia; Villamor, Perla; Otoya, Ana María

    2017-04-01

    Extracranial internal carotid artery (ICA) pseudoaneurysms are uncommon in the pediatric population and are usually secondary to direct trauma to the vessel. Treatment options include surgery (ligation), anticoagulation therapy and endovascular treatment. Endovascular covered stents have shown good results in adult populations, resulting in occlusion of the aneurysm and preservation of the artery without significant complications. However, there have been only limited reports in the literature reporting endovascular carotid stent placement in the pediatric population. We report a case of a 9-year-old boy patient, who developed a cervical ICA pseudoaneurysm after a parapharyngeal tumor resection. He was successfully treated by primary endovascular covered stent placement. During a follow-up of 6 months the patient has been asymptomatic, without any adverse event. Additionally, a literature review is done. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Intracerebral haemorrhage after carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Boesen, J

    1987-01-01

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

  19. Treatment and experience of traumatic carotid artery injury with massive epistaxis

    Directory of Open Access Journals (Sweden)

    RAO Hai-cheng

    2013-09-01

    Full Text Available A retrospective analysis was made on 5 cases who had the traumatic carotid artery injury with massive epistaxis (from September 2007 to June 2011. All of them were finally diagnosed by digital substraction angiography (DSA. Among them, 2 cases of traumatic pesudoaneurysm from internal maxillary artery were embolized with polyvinyl alcohol particles and gelatin sponge. One case was carotid-cavernous fistula (CCF with traumatic pesudoaneurysm located in the sphenoid sinus. This patient's internal carotid artery (ICA and fistula was blocked with balloon, and then ICA was clipped proximal to the posterior communicating artery. One case with injuried ICA was treated with blocking by balloon. The pesudoaneurysm located in ICA cavernous segment of one case was embolized with coil and liquid glue. No recurrence was found after successful surgeries. Patients with massive epistaxis or recurrent epistaxis after craniofacial trauma should undergo CT angiography (CTA or DSA examination so as to get proper diagnosis and treatment as early as possible.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-07-01

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

  1. Plate fixation of the proximal humerus: an international multicentre comparative study of postoperative complications

    NARCIS (Netherlands)

    Beeres, Frank J. P.; Hallensleben, N. D. L.; Rhemrev, S. J.; Goslings, J. C.; Oehme, F.; Meylaerts, S. A. G.; Babst, R.; Schep, N. W. L.

    2017-01-01

    The primary aim was to evaluate the number of complications following locking plate fixation of proximal humeral fractures in country X and in country Y. The secondary aim was to identify risk factors for complications. Multicentre retrospective case series of 282 consecutive patients with proximal

  2. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med . 2016;374(11):1021- ...

  3. 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. © 2015 by The American Society of Hematology.

  4. Simple classification of carotid bifurcation: is it possible to predict twisted carotid artery during carotid endarterectomy?

    Science.gov (United States)

    Kamide, Tomoya; Nomura, Motohiro; Tamase, Akira; Mori, Kentaro; Seki, Shunsuke; Kitamura, Yoshihisa; Nakada, Mitsutoshi

    2016-12-01

    The internal carotid artery (ICA) usually runs posterolaterally to the external carotid artery (ECA), but occasionally we encounter the twisted carotid bifurcation, a variant in which the ICA courses medially to the ECA during carotid endarterectomy (CEA). Prediction of this anomaly in the preoperative evaluation is mandatory, although descriptions in the literature are limited. We reviewed the clinical features of patients who underwent CEA and analyzed preoperative cerebral angiography, especially the anteroposterior (AP) view to determine whether it could be a predictive modality. In 58 consecutive CEA cases, we simply classified them into three groups; type 1 (the ICA runs laterally and the ECA runs medially), type 2 (the ICA and ECA run to overlap each other), and type 3 (the ICA runs medially and the ECA runs laterally), based on the findings of AP view of cerebral angiography. We compared the clinical features and intraoperative findings of these groups. Of 58 cases, types 1-3 were 24, 30, and four cases, respectively. Twisted carotid bifurcations were recognized in seven cases (12.4 %), including three cases in type 2 and four in type 3, and all twisted cases were found on the right side. Twisted carotids and right-sided lesion were significantly frequent in type 3, but no statistical differences of coexisting diseases were recognized among the three groups. CEAs of twisted carotid bifurcations were performed successfully with correction of the carotid position in three and as it was in four cases. Twisted carotid bifurcations were observed during operation in 10 % in type 2 and 100 % in type 3. CEA of twisted carotid bifurcations can be performed safely with or without correction of the carotid position. AP view of cerebral angiography could be useful for preoperative evaluation.

  5. Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

    Energy Technology Data Exchange (ETDEWEB)

    Zelenak, Kamil, E-mail: zelenak@unm.sk [University Hospital, Department of Radiology (Slovakia); Zelenakova, Jana [University Hospital, Department of Neurology (Slovakia); DeRiggo, Julius [University Hospital, Department of Neurosurgery (Slovakia); Kurca, Egon; Kantorova, Ema [University Hospital, Department of Neurology (Slovakia); Polacek, Hubert [University Hospital, Department of Radiology (Slovakia)

    2013-08-01

    Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet-Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX-XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits.

  6. [Anterior choroidal artery territory infarction with transcortical sensory aphasia after a neck clipping of left internal carotid artery aneurysms: a case report].

    Science.gov (United States)

    Takei, A; Kubokura, T; Hotta, J; Ozawa, H; Inamori, S

    1996-01-01

    Anterior choroidal artery (Ach A) syndrome is widely known to be composed of a triad of hemiparesis, hemisensory loss and homonymous hemianopia. The authors report a case of Ach A-territory infarction after a direct operation for internal carotid artery aneurysms, which presented transcortical sensory aphasia in association with the characteristic triad. The literature and several previously reported cases with dominant and nondominant cerebral hemisphere signs in AcH A infarction are reviewed. The danger of Ach A occlusion and the importance of preserving it during aneurysm surgery are emphasized.

  7. Open reduction and Internal Fixation of Displaced Proximal Humerus Fractures with AO Stainless Steel T-Plate

    Directory of Open Access Journals (Sweden)

    Hussain S

    2014-03-01

    Full Text Available Background: Proximal humeral fractures are considered the last unsolved fractures in orthopaedics. The treatment is controversial and various operative modalities have been reported in the literature. The aim of the present study was to evaluate functional outcome and complication rate after open reduction and internal fixation of displaced proximal humerus fractures by proximal humerus AO stainless steel Tplate. Twenty-five (25 patients with displaced proximal humerus fractures treated with proximal humerus T-plate between May 2005 and June 2008 were included in the study. Fractures were classified according to the Neer classification into displaced 2-part, 3-part, and 4-part fractures. Patients were followed-up for a minimum period of two years. Functional evaluation was done according to the Neer scoring system. Scores were compared with other studies in the literature using similar implant. Twenty patients had 2-part fracture, four had 3-part fracture, and one had 4-part fracture. Eighty-eight [88% (n = 22] patients had good to excellent result, eight [8% (n = 2] had fair, and four [4% (n = 1] had poor result. Difference in Neer’s score between 2-part and 3-part fractures was not significant. Complications encountered in this series were screw backout in 8% (n = 2, superficial infection in 12% (n= 3, and avascular necrosis in 4% (n = 1 of cases. We conclude that proximal humerus AO T- plate is a cheap and easily available implant, aspects which are particularly relevant in third world countries like India. It gives reliable fixation for 2-part and 3-part fractures. Its use in more complicated fracture patterns of 4-part fractures is not recommended.

  8. Carotid stenosis, x-ray of the right artery (image)

    Science.gov (United States)

    ... the right carotid artery showing a severe narrowing (stenosis) of the internal carotid artery just past the ... artery or ulceration in the area after the stenosis in this close-up film. Note the narrowed ...

  9. Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Qing-Hua, E-mail: ddqinghua-tian@163.com; He, Cheng-Jian, E-mail: tianhechengjian@163.com; Wu, Chun-Gen, E-mail: 649514608@qq.com; Li, Yong-Dong, E-mail: tianliyongdong@163.com; Gu, Yi-Feng, E-mail: tianyifenggu@163.com; Wang, Tao, E-mail: tianandwangtao@163.com; Xiao, Quan-Ping, E-mail: tianxiaoquanping@163.com; Li, Ming-Hua, E-mail: tianminghuali@163.com [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China)

    2016-01-15

    PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.

  10. Spontaneous thrombosis of internal carotid artery: a natural history of giant carotid cavernous aneurysms Trombose espontânea da artéria carótida interna: a história natural dos aneurismas gigantes intracavernosos

    Directory of Open Access Journals (Sweden)

    Lucas Perez de Vasconcellos

    2009-06-01

    Full Text Available OBJECTIVE: To describe five cases of giant carotid cavernous aneurysms which evolved with spontaneous thrombosis of internal carotid artery (STICA, with emphasis at epidemiology, clinical presentation, natural history, related factors and neurological outcome. METHOD: There were 711 consecutives patients with 802 aneurysms with and without surgical treatment during a period of 19 years. We selected 35 patients with 40 carotid cavernous aneurysms (5% of which 20 (50% were giant aneurysms. Among those cases, 5 patients evolved with STICA (25%. Symptoms and findings at presentation were recorded and compared with those at outcome. RESULTS: Clinical presentation was commonly related to atherosclerotic factors such as elevated blood pressure (80%, diabetes mellitus (40% and dislipidemy (40%. All patients presented with hemicranial headache, ophthalmparesy and retro bulbar pain, and after STICA all presented improvement of symptoms. After STICA, 4 patients had regression of deficit, 2 partial and 2 complete. Four patients had sensorial trigeminal neuropathy in V1 and V2 territories, also showing improvement of symptoms after STICA. CONCLUSION: STICA is a common outcome in giant carotid cavernous aneurysms, and is related with significant improvement of symptoms; however, it may be catastrophic for those patients without efficient collateral circulation.OBJETIVO: Relatar cinco casos de aneurismas gigantes intracavernosos que evoluíram com trombose espontânea da artéria carótida interna (TEACI, estudando-se: prevalência, apresentação clínica, história natural, fatores associados e prognóstico neurológico. MÉTODO: Análise de 711 pacientes consecutivos com diagnóstico de 802 aneurismas cerebrais submetidos a tratamento clínico ou cirúrgico num período de 19 anos. Foram identificados 40 aneurismas intracavernosos, sendo que 20 desses eram gigantes. Dentre esses, 5 pacientes com aneurismas gigantes intracavernosos que evoluíram com TEACI

  11. Computational fluid dynamics in three dimensional angiography: Preliminary hemodynamic results of various proximal geometry

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ha Youn; Park, Sung Tae; Bae, Won Kyoung; Goo, Dong Erk [Dept. of Radiology, Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2014-12-15

    We studied the influence of proximal geometry on the results of computational fluid dynamics (CFD). We made five models of different proximal geometry from three dimensional angiography of 63-year-old women with intracranial aneurysm. CFD results were analyzed as peak systolic velocity (PSV) at inlet and outlet as well as flow velocity profile at proximal level of internal carotid artery (ICA) aneurysm. Modified model of cavernous one with proximal tubing showed faster PSV at outlet than that at inlet. The PSV of outlets of other models were slower than that of inlets. The flow velocity profiles at immediate proximal to ICA aneurysm showed similar patterns in all models, suggesting that proximal vessel geometries could affect CFD results.

  12. Delayed aneurysm rupture due to residual blood flow at the inflow zone of the intracranial paraclinoid internal carotid aneurysm treated with the Pipeline embolization device: Histopathological investigation.

    Science.gov (United States)

    Ikeda, Hiroyuki; Ishii, Akira; Kikuchi, Takayuki; Ando, Mitsushige; Chihara, Hideo; Arai, Daisuke; Hattori, Etsuko; Miyamoto, Susumu

    2015-12-01

    Cerebral aneurysm rupture is a serious complication that can occur after flow diverter (FD) placement, but the underlying mechanisms remain unclear. We encountered a case in which direct stress on the aneurysm wall caused by residual blood flow at the inflow zone near the neck during the process of thrombosis after FD placement appeared associated with aneurysm rupture. The patient was a 67-year-old woman with progressive optic nerve compression symptoms caused by a large intracranial paraclinoid internal carotid aneurysm. The patient had undergone treatment with a Pipeline embolization device (PED) with satisfactory adherence between the PED and vessel wall. Surgery was completed without complications, and optic nerve compression symptoms improved immediately after treatment. Postoperative clinical course was satisfactory, but the patient suddenly died 34 days postoperatively. Autopsy confirmed the presence of subarachnoid hemorrhage caused by rupture of the internal carotid aneurysm that had been treated with PED. Although the majority of the aneurysm lumen including the outflow zone was thrombosed, a non-thrombosed area was observed at the inflow zone. Perforation was evident in the aneurysm wall at the inflow zone near the neck, and this particular area of aneurysm wall was not covered in thrombus. Macrophage infiltration was not seen on immunohistochemical studies of the aneurysm wall near the perforation. A hemodynamically unstable period during the process of complete thrombosis of the aneurysm lumen after FD placement may be suggested, and blood pressure management and appropriate management with antiplatelet therapy may be important. © The Author(s) 2015.

  13. Artéria carótida interna aberrante na orelha média Aberrant internal carotid artery in the middle ear

    Directory of Open Access Journals (Sweden)

    Corintho Viana

    2003-12-01

    Full Text Available Malformações vasculares na orelha média são raras, e a artéria carótida interna (ACI aberrante deve ser lembrada no diagnóstico diferencial, visto o grande risco trazido por uma intervenção cirúrgica inadvertidamente realizada na cavidade timpânica. O paciente pode apresentar-se assintomático ou, comumente, com hipoacusia e/ou zumbido pulsátil. As imagens fornecidas pela tomografia computadorizada (TC e ressonância magnética (RM, incluindo a angiorressonância, firmam o diagnóstico. Os autores descrevem um caso em criança de 13 anos, em que o diagnóstico foi feito através de exames de imagens, direcionados por uma importante suspeita clínica.Vascular anomalies of the middle ear are uncommon and, because aberrant internal carotid artery, among others, implies great risk at middle ear surgery, it must be remembered at the differential diagnosis. The patient may be asymptomatic, or complains of pulsatile tinnitus and conductive hearing loss. Computer tomography of the temporal bones and magnetic resonance imaging supplemented with magnetic resonance angiography can make the diagnosis. The authors present an aberrant internal carotid artery on a 13-year-old patient, whose diagnosis was performed by otoscopic examination, and imaging methods based on a previous clinical suspicion.

  14. Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature.

    Science.gov (United States)

    Sylvester, Peter T; Moran, Christopher J; Derdeyn, Colin P; Cross, DeWitte T; Dacey, Ralph G; Zipfel, Gregory J; Kim, Albert H; Uppaluri, Ravi; Haughey, Bruce H; Tempelhoff, Rene; Rich, Keith M; Schneider, John; Chole, Richard A; Chicoine, Michael R

    2016-11-01

    OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by coil placement, 2 underwent lesion embolization (coil or stent-assisted coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion embolization was primarily performed by coil embolization without stenting (16 cases) and stent-assisted coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was

  15. [Sports-related carotid artery dissection].

    Science.gov (United States)

    Berrouschot, J; Bormann, A; Routsi, D; Stoll, A

    2009-09-01

    Sports-related carotid artery dissection are very rare and were described in different kinds of sports. We report on a 45-year old man who suffered bilateral brain infarctions caused by bilateral extracranial internal carotid artery dissection after excessive weight lifting in a gym. As possible trigger factors for the dissections we assumed the abrupt extension of the neck during weight lifting and the frequent Valsalva manoeuvers with massive rise in the pressure in the carotid artery system. The patient underwent angioplasty and stenting of the stenosis of right carotid artery, the primarily occluded left carotid artery recanalized spontaneously. Secondary prevention was established by platelet aggregation inhibitors. The patient recovered completely. The pathogenesis of sports-related dissections is multifactorial. In addition to sporting activities hereditary or acquired structural aberrations in the arterial walls could be discussed. Acute focal neurological symptoms after sport should always focus on carotid or vertebral artery dissection. (c) Georg Thieme Verlag KG Stuttgart-New York.

  16. Associations between Carotid Artery Plaque Score, Carotid Hemodynamics and Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Huiping Zhang

    2015-11-01

    Full Text Available Background: The carotid artery plaque score (PS is an independent predictor of Coronary Heart Disease (CHD. This study aims to evaluate the combination of PS and carotid hemodynamics to predict CHD. Methods: A total of 476 patients who underwent carotid ultrasonography and coronary angiography were divided into two groups depending on the presence of CHD. PS, carotid intima-media thickness, and carotid blood flow were measured. Receiver operating characteristic curve analysis was performed to establish the best prediction model for CHD presence. Results: Age, sex, carotid intima-media thickness of internal carotid artery and carotid bifurcation, PS, peak systolic velocity (PSA of right internal carotid artery (RICA, and most resistance index data were significantly related with the presence of CHD. The area under the curve for a collective model, which included factors of the PS, carotid hemodynamics and age, was significantly higher than the other model. Age, PS, and PSA of RICA were significant contributors for predicting CHD presence. Conclusions: The model of PS and PSA of RICA has greater predictive value for CHD than PS alone. Adding age to PS and PSA of RICA further improves predictive value over PS alone.

  17. Associations between Carotid Artery Plaque Score, Carotid Hemodynamics and Coronary Heart Disease

    Science.gov (United States)

    Zhang, Huiping; Liu, Mengxue; Ren, Tiantian; Wang, Xiangqian; Liu, Dandan; Xu, Mingliang; Han, LingFei; Wu, Zewei; Li, Haibo; Zhu, Yu; Wen, Yufeng; Sun, Wenjie

    2015-01-01

    Background: The carotid artery plaque score (PS) is an independent predictor of Coronary Heart Disease (CHD). This study aims to evaluate the combination of PS and carotid hemodynamics to predict CHD. Methods: A total of 476 patients who underwent carotid ultrasonography and coronary angiography were divided into two groups depending on the presence of CHD. PS, carotid intima-media thickness, and carotid blood flow were measured. Receiver operating characteristic curve analysis was performed to establish the best prediction model for CHD presence. Results: Age, sex, carotid intima-media thickness of internal carotid artery and carotid bifurcation, PS, peak systolic velocity (PSA) of right internal carotid artery (RICA), and most resistance index data were significantly related with the presence of CHD. The area under the curve for a collective model, which included factors of the PS, carotid hemodynamics and age, was significantly higher than the other model. Age, PS, and PSA of RICA were significant contributors for predicting CHD presence. Conclusions: The model of PS and PSA of RICA has greater predictive value for CHD than PS alone. Adding age to PS and PSA of RICA further improves predictive value over PS alone. PMID:26569275

  18. A Case of Pseudoaneurysm of the Internal Carotid Artery Following Endoscopic Endonasal Pituitary Surgery: Endovascular Treatment with Flow-Diverting Stent Implantation

    Directory of Open Access Journals (Sweden)

    Ali Karadag

    2017-10-01

    Full Text Available Internal carotid artery (ICA pseudoaneurysm is a rare complication of endoscopic endonasal surgery occurring in 0.4–1.1% of cases. Pseudoaneurysms can subsequently result in other complications, such as subarachnoid hemorrhage, epistaxis, and caroticocavernous fistula with resultant death or permanent neurologic deficit. In this case, we illustrate endovascular treatment with a flow-diverting stent for an ICA pseudoaneurysm after endoscopic endonasal surgery for a pituitary adenoma in a 56-year-old male. Surgery was complicated by excessive intraoperative bleeding and emergent CT angiography confirmed an iatrogenic pseudoaneurysm on the anteromedial surface of the ICA. The pseudoaneurysm was treated endovascularly with flow-diverting stent implantation only. Follow-up CT angiography after three months demonstrated occlusion of the pseudoaneurysm.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1996-06-01

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

  20. Mid-cervical flame-shaped pseudo-occlusion: diagnostic performance of mid-cervical flame-shaped extracranial internal carotid artery sign on computed tomographic angiography in hyperacute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Prakkamakul, Supada; Pitakvej, Nantaporn [King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Department of Radiology, Bangkok (Thailand); Dumrongpisutikul, Netsiri; Lerdlum, Sukalaya [King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Department of Radiology, Bangkok (Thailand); Chulalongkorn University, Department of Radiology, Faculty of Medicine, Bangkok (Thailand)

    2017-10-15

    Flame-shaped pseudo-occlusion of the extracranial internal carotid artery (ICA) is a flow-related phenomenon that creates computed tomographic angiography (CTA) and digital subtraction angiography (DSA) findings that mimic tandem intracranial-extracranial ICA occlusion or dissection. We aim to determine the diagnostic performance of mid-cervical flame-shaped extracranial ICA sign on CTA in hyperacute ischemic stroke patients. We retrospectively included consecutive anterior circulation ischemic stroke patients presenting within 6 h of symptom onset who underwent 4D brain CTA and arterial-phase neck CTA using a 320-detector CT scanner during August 2012 to July 2015. Two blinded readers independently reviewed arterial-phase neck CTA and characterized the extracranial ICA configurations into mid-cervical flame-shaped, proximal blunt/beak-shaped, and tubular-shaped groups. 4D whole brain CTA was used as a reference standard for intracranial ICA occlusion detection. Diagnostic performance of the mid-cervical flame-shaped extracranial ICA sign and interobserver reliability were calculated. Of the 81 cases, 11 had isolated intracranial ICA occlusion, and 6 had true extracranial ICA occlusion. Mid-cervical flame-shaped extracranial ICA sign was found in 45.5% (5/11) of isolated intracranial ICA occlusions but none in the true extracranial ICA occlusion group. The sensitivity, specificity, PPV, NPV, and accuracy of the mid-cervical flame-shaped extracranial ICA sign for the detection of isolated intracranial ICA occlusion were 45.5, 100, 100, 92.1, and 92.6%, respectively. Interobserver reliability was 0.90. The mid-cervical flame-shaped extracranial ICA sign may suggest the presence of isolated intracranial ICA occlusion and allow reliable exclusion of tandem extracranial-intracranial ICA occlusion in hyperacute ischemic stroke setting. (orig.)

  1. 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.

  2. Technique of Open Reduction and Internal Fixation of Comminuted Proximal Humerus Fractures With Allograft Femoral Head Metaphyseal Reconstruction.

    Science.gov (United States)

    Parada, Stephen A; Makani, Amun; Stadecker, Monica J; Warner, Jon J P

    2015-10-01

    Proximal humerus fractures are common injuries that can require operative treatment. Different operative techniques are available, but the hallmark of fixation for 3- and 4-part fractures is a locking-plate-and-screw construct. Despite advances in this technology, obtaining anatomical reduction and fracture union can be difficult, and complications (eg, need for revision) are not uncommon. These issues can be addressed by augmenting the fixation with an endosteally placed fibular allograft. Although biomechanical and clinical results have been good, the technique can lead to difficulties in future revision to arthroplasty, a common consequence of failed open reduction and internal fixation. The technique described, an alternative to placing a long endosteal bone graft, uses a trapezoidal, individually sized pedestal of allograft femoral head to facilitate the reduction and healing of the humeral head and tuberosity fragments in a displaced 3- or 4-part fracture of the proximal humerus. It can be easily incorporated with any plate-and-screw construct and does not necessitate placing more than 1 cm of bone into the humeral intramedullary canal, limiting the negative effects on any future revision to arthroplasty.

  3. ASSESSMENT OF VERTEBRAL ARTERIES BLOOD FLOW SPECTRAL DOPPLER INDICES IN COMPARISON WITH INTERNAL AND COMMON CAROTID ARTERIES BLOOD FLOW SPECTRAL DOPPLER INDICES

    Directory of Open Access Journals (Sweden)

    H. Mazaher

    2007-05-01

    Full Text Available Vertebrobasilar insufficiency is the cause of cerebrovascular accidents in 20% of cases. There are few reports regarding spectral Doppler indices (SDIs of vertebral arteries (VAs normal blood flow. The objective of this study was to provide basic reference data about SDIs of VAs normal blood flow separately and in comparison with internal carotid arteries (ICAs and common carotid arteries (CCAs normal blood flows SDIs. This cross-sectional study performed on 70 normal patients. Color Doppler sonography (CDS and spectral Doppler sonography (SDS of right and left VAs (RVA and LVA, right and left CCAs (RCCA and LCCA, right and left ICAs (RICA and LICA, were performed. The mean PSV, EDV, and RI values of RVA blood flow were as 41.60 ± 9.6 cm/s, 14.60 ± 3.7 cm/s and 0.65 ± 0.06, and the mean PSV, EDV and RI values of LVA blood flow were as 42.20 ± 10.2 cm/s, 15.20 ± 4.2 cm/s, and 0.64 ± 0.05, respectively. There was not statistically significant difference between the mean PSV, EDV and RI values of RVA and LVA blood flows. The mean PSV and EDV values of VAs blood flows were significantly lower than the values of CCAs and ICCAs blood flows, respectively. The mean RI value of VAs blood flows was significantly lower than the mean RI Value of CCAs blood flows, but there was not statistically significant difference between the mean RI value of VAs blood flows and the mean RI value of ICAs blood flows.

  4. Cerebral hyperperfusion following carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Sørensen, O

    1987-01-01

    Serial measurements of cerebral blood flow (CBF) were performed in 56 patients before and one to four times after uncomplicated carotid endarterectomy. The findings were related to the ratio between internal carotid artery (ICA) and common carotid artery (CCA) mean pressures. Within the 1st...... postoperative day CBF increased by a median of 37% in the ipsilateral and 33% in the contralateral hemisphere. Later recordings showed a gradual return of CBF toward the preoperative level. Sixteen patients with an ICA/CCA pressure ratio below 0.7 showed a significantly more pronounced and longer-lasting flow......, occurred in the low pressure ratio group, while the hemispheric asymmetry on average was unchanged in the high pressure ratio group. This relative hyperemia was most pronounced 2 to 4 days following reconstruction. The marked hyperemia, absolute as well as relative, in patients with a low ICA/CCA pressure...

  5. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation.

    Science.gov (United States)

    Demartini, Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha, Carlos; Santos, Alex Marques Borges; Koppe, Gelson Luis

    2015-01-01

    Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.

  6. Recanalization with subsequent near-total occlusion of an internal carotid artery aneurysm after immediate thrombotic occlusion using a flow-diverting stent.

    Science.gov (United States)

    Wong, George Kwok Chu; Yu, Simon Chun Ho; Siu, Deyond Yung Woon; Poon, Wai Sang

    2012-04-01

    A flow-diverting stent is placed in the parent artery to reduce blood flow in the aneurysm sac to facilitate progressive thrombosis and neointimal remodeling while maintaining outflow in the side branches and perforators. All international multicenter registries have reported on the progressive occlusion of aneurysms with time and have implied that an occluded aneurysm would not recanalize given the protective effect of the altered hemodynamics. Recanalization of an occluded aneurysm after placement of a flow-diverting stent has not been reported in the literature. The authors here describe a case of aneurysm recanalization after immediate thrombotic occlusion of the aneurysm with a flow-diverting stent. A 46-year-old male chronic smoker with chronic hypertension and hypercholesterolemia had a recurrent internal carotid artery aneurysm 1 year after embolization. Immediate thrombotic occlusion of the aneurysm and cessation of blood flow to the posterior communicating artery (PCoA) occurred immediately after activating a flow-diverting stent, with corresponding ischemic complications. However, 3 months after insertion of the stent, follow-up MR angiography showed recanalization of the aneurysm as well as of the PCoA. Additional angiography studies at 6 months showed near-total occlusion of the aneurysm with the restoration of blood flow to the PCoA.

  7. Anatomical Considerations on Surgical Anatomy of the Carotid Bifurcation

    Directory of Open Access Journals (Sweden)

    Adamantios Michalinos

    2016-01-01

    Full Text Available Surgical anatomy of carotid bifurcation is of unique importance for numerous medical specialties. Despite extensive research, many aspects such as precise height of carotid bifurcation, micrometric values of carotid arteries and their branches as their diameter, length, and degree of tortuosity, and variations of proximal external carotid artery branches are undetermined. Furthermore carotid bifurcation is involved in many pathologic processes, atheromatous disease being the commonest. Carotid atheromatous disease is a major predisposing factor for disabling and possibly fatal strokes with geometry of carotid bifurcation playing an important role in its natural history. Consequently detailed knowledge of various anatomic parameters is of paramount importance not only for understanding of the disease but also for design of surgical treatment, especially selection between carotid endarterectomy and carotid stenting. Carotid bifurcation paragangliomas constitute unique tumors with diagnostic accuracy, treatment design, and success of operative intervention dependent on precise knowledge of anatomy. Considering those, it becomes clear that selection and application of proper surgical therapy should consider anatomical details. Further research might ameliorate available treatment options or even lead to innovative ones.

  8. Location of the internal carotid artery and ophthalmic artery segments for non-invasive intracranial pressure measurement by multi-depth TCD.

    Science.gov (United States)

    Hamarat, Yasin; Deimantavicius, Mantas; Kalvaitis, Evaldas; Siaudvytyte, Lina; Januleviciene, Ingrida; Zakelis, Rolandas; Bartusis, Laimonas

    2017-12-01

    The aim of the present study was to locate the ophthalmic artery by using the edge of the internal carotid artery (ICA) as the reference depth to perform a reliable non-invasive intracranial pressure measurement via a multi-depth transcranial Doppler device and to then determine the positions and angles of an ultrasonic transducer (UT) on the closed eyelid in the case of located segments. High tension glaucoma (HTG) patients and healthy volunteers (HVs) undergoing non-invasive intracranial pressure measurement were selected for this prospective study. The depth of the edge of the ICA was identified, followed by a selection of the depths of the IOA and EOA segments. The positions and angles of the UT on the closed eyelid were measured. The mean depth of the identified ICA edge for HTG patients was 64.3 mm and was 63.0 mm for HVs (p = 0.21). The mean depth of the selected IOA segment for HTG patients was 59.2 mm and 59.3 mm for HVs (p = 0.91). The mean depth of the selected EOA segment for HTG patients was 48.5 mm and 49.8 mm for HVs (p = 0.14). The difference in the located depths of the segments between groups was not statistically significant. The results showed a significant difference in the measured UT angles in the case of the identified edge of the ICA and selected ophthalmic artery segments (p = 0.0002). We demonstrated that locating the IOA and EOA segments can be achieved using the edge of the ICA as a reference point. OA: ophthalmic artery; IOA: intracranial segments of the ophthalmic artery; EOA: extracranial segments of the ophthalmic artery; ICA: internal carotid artery; UT: ultrasonic transducer; HTG: high tension glaucoma; SD: standard deviation; ICP: intracranial pressure; TCD: transcranial Doppler.

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

    Science.gov (United States)

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

    2017-01-17

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

  10. Carotid Artery Disease

    Science.gov (United States)

    ... head with blood. If you have carotid artery disease, the arteries become narrow or blocked, usually because ... other substances found in the blood. Carotid artery disease is serious because it can block the blood ...

  11. 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.

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

    Science.gov (United States)

    Stefanini, Matteo; Gaspari, Eleonora; Boi, Luca; Del Giudice, Costantino; Mastrangeli, Roberta; Nucera, Francesca; Simonetti, Giovanni

    2012-01-01

    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 (r = 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.

  13. The Occipital Artery as an Alternative Donor for Low-Flow Bypass to Anterior Circulation After Internal Carotid Artery Occlusion Failure prior to Exenteration for an Atypical Cavernous Sinus Meningioma.

    Science.gov (United States)

    Hanakita, Shunya; Lenck, Stéphanie; Labidi, Moujahed; Watanabe, Kentaro; Bresson, Damien; Froelich, Sébastien

    2018-01-01

    In skull base tumors involving the cavernous sinus, indications for aggressive resection are sparse and must be carefully examined because of their invasiveness. With careful evaluation, techniques including internal carotid artery sacrifice with or without extracranial-intracranial bypass may still be an option in some cases. Moreover, previous surgery with the sacrifice of potential donor vessels requires adjusting the revascularization strategy. We describe an occipital artery-middle cerebral artery bypass before skull base tumor resection. A 47-year-old woman with a recurrent cavernous sinus meningioma was referred to our department. Because of tumor recurrence after radiotherapy and its rapid progression, radical resection, including part of the cavernous sinus, was planned. A balloon test occlusion was performed and showed good tolerance. An endovascular internal carotid artery occlusion was performed. The patient eventually experienced motor deficits and aphasia after surgery. Therefore, bypass surgery using an occipital artery-middle cerebral artery anastomosis was performed. The patient showed no exacerbation of symptoms after bypass surgery and subsequently underwent tumor resection. The reliability of balloon test occlusion in the management of giant aneurysms may not be similarly applicable to skull base tumors. If hypoperfusion symptoms occur after occlusion of the internal carotid artery, a surgical revascularization procedure should be considered because of the risk of ischemic stroke following tumor resection. For patients whose superficial temporal artery is not available, the occipital artery can be a valuable alternative donor for low-flow bypass. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Microsurgical Relations between Internal Carotid Artery-Posterior Communicating Artery (ICA-PComA) Segment Aneurysms and Skull Base: An Anatomoclinical Study.

    Science.gov (United States)

    González-Darder, José M; Quilis-Quesada, Vicent; Talamantes-Escribá, Fernando; Botella-Maciá, Laura; Verdú-López, Francisco

    2012-10-01

    Purpose The study of the clinical, anatomic, imaging, and microsurgical characteristics of the aneurysms of the internal carotid-posterior communicating artery (ICA-PComA) segment and their relationships with the skull base structures. Methods The anatomic relationships of PComA with neurovascular elements and skull base structures were studied in cadavers. The clinical, imaging, and microsurgical findings of 84 microsurgically treated ICA-PComA aneurysms compiled in a prospective database were reviewed. Results The most important anatomic relations of the PComA and ICA-PComA aneurysms are with the oculomotor nerve around the oculomotor triangle that forms the roof of the cavernous sinus. Aneurysms of the ICA-PComA are classified according to the orientation of the aneurysmal sac in infratentorial, supratentorial, and tentorial. Infratentorial aneurysms frequently present with subarachnoid hemorrhage (SAH) and oculomotor nerve paralysis. They have relations with skull base structures that often make it necessary to totally or partially resect the anterior clinoid process (6.7%) or anterior petroclinoid dural fold (15%). Supratentorial aneurysms course with SAH and without oculomotor nerve involvement, but they often are associated with intracranial hematoma. Conclusion ICA-PComA aneurysms have complex anatomic relations. The orientation of the aneurysmal fundus induces relevant differences in the anatomic relations, clinical presentation, and microsurgical approach to ICA-PComA aneurysms.

  15. Successful treatment of a blood blister-like aneurysm of the internal carotid artery by trapping with a high-flow bypass.

    Science.gov (United States)

    Kawashima, Akitsugu; Okada, Yoshikazu; Kawamata, Takakazu; Onda, Hideaki; Kubo, Osami; Hori, Tomokatsu

    2008-07-01

    Treatment of blood blister-like aneurysms of the internal carotid artery (ICA) is difficult because the wall of the aneurysm is fragile and there is a high risk of rebleeding. There has been no consensus on the best way to treat these aneurysms. A 32-year-old woman presented with subarachnoid hemorrhage (SAH) caused by a ruptured blood blister-like aneurysm of the ICA. The site of the aneursym was clipped. Although angiography 1week after the operation showed that the aneurysm had been treated successfully, 3 weeks after the initial operation, the aneurysm was found to have recurred to the distal side. In a second operation, the aneurysm was successfully treated by trapping with a high-flow bypass. This case shows that clipping of the rupture site can be insufficient to treat blood blister-like aneurysm of the ICA causing SAH, even if the aneurysm seems to have resolved in follow-up angiographic studies. Trapping of the ICA with a bypass, if necessary a high-flow bypass, is recommended.

  16. Recurrent extracranial internal carotid artery vasospasm diagnosed by serial magnetic resonance angiography and superselective transarterial injection of a calcium channel blocker.

    Science.gov (United States)

    Shimoda, Yoshiteru; Fujimura, Miki; Kimura, Naoto; Ezura, Masayuki; Uenohara, Hiroshi; Tominaga, Teiji

    2014-01-01

    Recurrent vasospasm of the extracranial internal carotid artery (ICA) is extremely rare, and optimal management is unclear. A 25-year-old woman developed transient dysarthria and left-sided hemiparesis. Initial magnetic resonance (MR) imaging showed spotty acute infarction in the right temporal lobe, and MR angiography revealed right ICA occlusion. ICA occlusion was spontaneously resolved within 6 days of its onset, whereas transient left ICA narrowing was evident at 12 days. Because recurrent occlusion of the right ICA occurred at 14 days when the contralateral ICA was still narrowed, we attempted a local intra-arterial injection of a calcium channel blocker based on the diagnosis of recurrent extracranial ICA vasospasm. The local injection of 1 mg of nicardipine partially dilated the affected ICA, which confirmed the diagnosis of vasospasm. After the introduction of oral medication with benidipine hydrochloride, bilateral ICA vasospasm was completely resolved 23 days after its onset, as shown by MR angiography. In conclusion, we recommend intensive radiologic follow-up at the acute stage and therapeutic catheter angiography when the bilateral lesion is evident because bilateral occlusion of the ICA could lead to a catastrophic condition. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Outcomes of correction of internal hip rotation in patients with spastic cerebral palsy using proximal femoral osteotomy.

    Science.gov (United States)

    de Morais Filho, Mauro César; Kawamura, Cátia Miyuki; dos Santos, Carlos Alberto; Mattar, Rames

    2012-06-01

    Internal hip rotation (IHR) is the major cause of intoeing gait in patients with cerebral palsy (CP). Femoral derotation osteotomy (FDO) is the preferred treatment to correct excessive anteversion, however the condition may persist or recur postoperatively. Retrospective clinical and kinematic evaluation of 75 spastic diplegic CP patients was conducted for a mean duration of 22 months following proximal FDO. The patients were divided into two groups depending on the correction or persistence of IHR evident at kinematics after surgery. If corrected, mean patient follow-up was extended to 53 months. Outcomes were analyzed using Two Proportions Equality, Mann-Whitney and Wilcoxon tests. IHR persisted in 33.3% of cases at mean follow-up of 22 months and subtrochanteric femur osteotomy was more frequent in this group (p=0.033). Thirty-five of the fifty-four patients with first-round gait correction were monitored during the extended follow-up. Those for whom IHR recurred (9.5%) had undergone FDO at a comparatively younger age. Patient gender, operations prior to or at the time of femoral osteotomy, topographic classification, GMFCS level, or the extent of preoperative clinical and kinematic abnormalities had no apparent influence on persistence or recurrence of abnormal gait. Copyright © 2012 Elsevier B.V. All rights reserved.

  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. Carotid canal dehiscence in the human skull

    Energy Technology Data Exchange (ETDEWEB)

    Pastor Vazquez, J.F.; Gil Verona, J.A. [Department of Anatomy, Faculty of Medicine, University of Valladolid, Ramon y Cajal, 7, E-47005 Valladolid (Spain); Garcia Porrero, M. [Department of Radiology, Faculty of Medicine, University of Valladolid (Spain)

    1999-06-01

    Abnormalities of the floor of the carotid canal have been studied in 538 skulls. These abnormalities range from a fissure to total absence of the floor. This variation may be caused by abnormalities of the internal carotid artery or deficiencies in ossification of the skull base. CT suggests that these changes should be taken into account by surgeons working on the skull base. (orig.) With 4 figs., 8 refs.

  20. Evaluation of Endarterectomy Recanalization under Ultrasound Guidance in Symptomatic Patients with Carotid Artery Occlusion.

    Directory of Open Access Journals (Sweden)

    Yumei Liu

    Full Text Available Rigorous screening and good imaging would help perform surgery on carotid artery occlusion CAO safely and effectively. The purpose of this study was to retrospectively evaluate carotid endarterectomy (CEA recanalization in patients with common carotid artery occlusion (CCAO or internal carotid artery occlusion (ICAO with color Doppler flow imaging (CDFI. A total of 59 patients undergoing CEA were enrolled. According to the results of CEA, the patients were divided into successful recanalization (group A and unsuccessful recanalization (group B groups. The original diameter, lesion length, proximal-to-distal diameter ratio and echo characteristics of the lesion within the lumen of the carotid artery were recorded before CEA and compared between the two groups. In regards to the achievement of repatency by CEA, the overall success rate was 74.6% (44/59, the success rate in CCAO patients was 75.9% (22/29 and the success rate in ICAO patients was 73.3% (22/30. There was no significant difference in the success rates between the CCAO and ICAO patients (χ2 = 0.050, P = 0.824. The overall rate of stroke and death within 30 postoperative days was 5.1% (3/59. For the CCAO patients, the lesion length in group A was shorter than that in group B (t = 3.221, P = 0.004. For the ICAO patients, the original diameter of the distal ICA was broader (t = 6.254, P = 0.000 and the proximal-to-distal ICA diameter ratio was smaller (t = 8.036, P = 0.000 in group A than in group B. The rate of recanalization for lumens with a homogeneous echo pattern (hypoecho or isoecho was significantly higher than that for lumens with echo heterogeneity for both the CCAO and ICAO patients (χ2 = 14.477, P = 0.001; χ2 = 10.519, P = 0.003. However, for both the CCAO and ICAO patients, there was no difference in the rate of recanalization between patients with hypoecho and isoecho lesions (χ2 = 0.109, P = 0.742; χ2 = 0.836, P = 0.429. The original diameter, proximal-to-distal ICA

  1. Attitude towards one's illness vs. attitude towards a surgical operation, displayed by patients diagnosed with asymptomatic abdominal aortic aneurysm and asymptomatic internal carotid artery stenosis.

    Science.gov (United States)

    Stanisić, M; Rzepa, T

    2012-08-01

    Two most frequent asymptomatic diseases qualifying for vascular surgery are abdominal aortic aneurysm (AAA) and internal carotid artery stenosis (ICAS). Emotions experienced by the patient activate processes of dealing with the cognitive dissonance of asymptomatic disease. The aim of this paper was to compare the reasons involved in decision making on surgery in two asymptomatic vascular pathologies. Fifty patients were divided into two groups: the ICAS group-27 (CAS or CEA) and the AAA group-23 (EVAR or open surgical operation (OSR). Specific questionnaire regarding: 1) self-image; 2) attitude to one's illness; 3) reasons for decision on surgery was applied for the study. The χ² test was used to for the analysis. The AAA patients reacted emotionally (88.2%) comparing to ICAS patients reacting "rationally" (59.3%) (α=0.05). In AAA patients attitude towards themselves had worsened (α=0.001) AAA patients were less likely to seek support in decision on surgery (α=0.01). ICAS patients are internally motivated (78.7%), whereas AAA patients are externally motivated (63.9%) (α=0.001). Reasons underlying the decision on surgery, were predominantly rational (55.8%). In the process of decision-making on surgery by asymptomatic patients, evolutionary transformation takes place - the emotional attitude to one's illness leads to rationally evaluated decision. Regardless of the causes the process of making a decision on surgical operation tended to run more smoothly in ICAS patients. The ICAS patients tended to display a rational attitude to their illness. AAA patients displayed a distinctly emotional attitude towards their illness.

  2. Free Floating Thrombus in Carotid Artery in a Patient with Recurrent Strokes

    Directory of Open Access Journals (Sweden)

    Moni Roy

    2017-01-01

    Full Text Available We present a case of 72-year-old male with reported past medical history of recurrent transient ischemic attacks (TIAs presenting with myriad of neurological symptoms. Patient was transferred from outlying hospital with complaints of right sided facial droop and dysarthria. Computed tomography angiography (CTA showed high grade proximal left internal carotid artery (ICA stenosis along with interesting finding of a free floating thrombus (FFT in the left ICA. After discussion with the neurosurgical team, our case was treated conservatively with combination of antiplatelet therapy with Aspirin and anticoagulation with Warfarin without recurrence of TIAs or strokes on six-month follow-up.

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

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T; Rasmussen, L

    1987-01-01

    Recent reports on the outcome of carotid endarterectomy in patients with contralateral occlusion have been conflicting. Therefore, we reviewed 51 cases identified, among 675 consecutive carotid endarterectomies. A perioperative mortality of 2% and a permanent morbidity rate of 16% was observed...... severe strokes when compared to patients with only minor reduction in CPP. In addition, the internal carotid artery blood flow following endarterectomy was significantly higher in the low pressure group (P less than 0.02). No patients were lost during follow-up, for a mean of 34 months. The cumulative....... Compared with a complication rate of about 5% previously reported from this institution, this clearly indicates contralateral carotid occlusion as a major risk factor in carotid surgery. Though not statistically significant, patients with severely reduced cerebral perfusion pressure (CPP) had suffered more...

  4. Aneurisma da artéria carótida interna extracraniana: relato de caso Aneurysm of the extracranial internal carotid artery: a case report

    Directory of Open Access Journals (Sweden)

    Marcio Ricardo Taveira Garcia

    2004-08-01

    Full Text Available Os aneurismas verdadeiros da artéria carótida interna extracraniana são raros, ao contrário dos supraclinóideos, somando menos de 4% dos aneurismas periféricos. Eles se apresentam clinicamente como massas palpáveis cervicais, junto à margem inferior do ângulo da mandíbula, causando rouquidão, disfagia e dor por compressão nervosa. Há freqüente associação desta doença com outros aneurismas periféricos devido à sua etiologia principal (aterosclerose. Os aneurismas periféricos são comumente identificados à ultra-sonografia Doppler, quando na vigência de janela acústica adequada. Nesta situação, os aneurismas podem ser avaliados tanto morfológica como hemodinamicamente. Sua identificação e estudo são importantes para prevenir graves complicações, como tromboses, infartos maciços ou embólicos da área correspondente no sistema nervoso central, ruptura e dissecção, além de auxiliar na indicação da melhor conduta terapêutica.Unlike supraclinoid aneurysms, true aneurysms of the extracranial internal carotid artery are extremely rare (less than 4% of the peripheral aneurysms. The commonest presentation is a pulsatile neck swelling below the angle of the jaw associated with hoarseness, dysphagia and pain (neural compression. Concomitance with other peripherical aneurysms is frequent and caused by atherosclerosis. The morphological and hemodynamic features are very well evaluated by Doppler ultrasound, when the acoustic window is satisfactory. Identification and evaluation of these aneurysms are very important to prevent thrombosis, rupture, dissections, massive strokes and embolic brain infarcts, besides helping in the decision of the best treatment.

  5. Cervical Internal Carotid Occlusion versus Pseudo-occlusion at CT Angiography in the Context of Acute Stroke: An Accuracy, Interobserver, and Intraobserver Agreement Study.

    Science.gov (United States)

    Diouf, Ange; Fahed, Robert; Gaha, Mehdi; Chagnon, Miguel; Khoury, Naïm; Kotowski, Marc; Guilbert, François; Landry, David; Raymond, Jean; Roy, Daniel; Weill, Alain

    2017-10-25

    Purpose To evaluate the diagnostic accuracy and reliability of computed tomographic (CT) angiography to distinguish true cervical internal carotid artery (ICA) occlusion from pseudo-occlusion (defined as an isolated intracranial thrombus that impedes ascending blood flow) in the context of acute stroke. Materials and Methods This was a retrospective study of patients who underwent thrombectomy with preprocedural CT angiography that helps to demonstrate a lack of attenuation in the cervical ICA on the symptomatic side (24 men and 13 women; mean age, 63 years; age range, 30-86 years). Seven readers, including five neuroradiologists and two interventional neuroradiology fellows, independently reviewed the CT angiography images to assess whether there was true cervical ICA occlusion. Their results were compared with digital subtraction angiography (DSA) as the reference standard. Sensitivity and specificity for detecting true occlusion as well as accuracy and diagnostic odds ratio were calculated, with inter- and intraobserver κ statistics. Results Cervical ICA pseudo-occlusion occurred in 12 of 37 patients (32.4%) with nonattenuation of the cervical ICA on the symptomatic side. Interobserver agreement coefficients did not reach the substantial value of 0.61 for either pairs or groups of readers. The cohort's average sensitivity and specificity was 68% (95% confidence interval [CI]: 59%, 76%) and 75% (95% CI: 71%, 80%), respectively, with a diagnostic odds ratio of 8 (95% CI: 3, 18) and only fair interobserver agreement (κ = 0.32; 95% CI: 0.16, 0.47). Conclusion In the context of acute ischemic stroke with ipsilateral ICA nonattenuation at single-phase CT angiography, even specialized radiologists may not reliably distinguish true cervical occlusion from pseudo-occlusion. © RSNA, 2017 Online supplemental material is available for this article.

  6. The anatomic relationship between the internal jugular vein and the carotid artery in children after laryngeal mask insertion. An ultrasonographic study.

    Science.gov (United States)

    Nagaraja, Ravi G; Wilson, Morven; Wilson, Graham; Marciniak, Bruno; Engelhardt, Thomas

    2011-01-01

    Central venous cannulation, although challenging in children and prone to complications, is frequently required for total parenteral nutrition and infusion of drugs. The aim of this study was to determine the anatomic relationship between the internal jugular vein (IJV) and carotid artery (CA) before, and after, insertion of laryngeal mask airway (LMA) in children using ultrasound. Patients aged 2-16 were recruited to this prospective study and divided into three groups of 20 patients each: group 1: LMA size 2, group 2: LMA size 2½, and group 3: LMA size 3. Prior to, and following, LMA insertion, the position and depth of the vessels, and time to locate them were recorded. All measurements were taken at the level of the cricoid cartilage in a neutral head position in the spontaneously breathing patient during expiration. The IJV position in relation to the CA was noticed as anterior (A), anterolateral (AL), lateral (L), or medial (M). The position of the IJV was found to be in the anterolateral (AL) or anterior (A) position to the CA in the majority of cases. The anatomic relationship changed in 10/120 (8.3%) following insertion of the LMA. The mean depth was 0.80 (± 0.15) cm for the right IJV before LMA insertion and 0.84 (± 0.17) cm after insertion. Similar measurements were taken on the left side [0.81 (± 0.14) cm and 0.83 (± 0.18) cm]. The diameter as well as the depth of the IJV increased with the age and weight of the patient. This study demonstrates that the IJV is anterior or anterolateral to the artery in the majority of cases and that the anatomic relationship may change following the insertion of the LMA. It supports the need for using ultrasound-guided techniques for IJV cannulation following LMA insertion in spontaneously breathing children. © 2010 Blackwell Publishing Ltd.

  7. Objective Validation of Perfusion-Based Human Cadaveric Simulation Training Model for Management of Internal Carotid Artery Injury in Endoscopic Endonasal Sinus and Skull Base Surgery.

    Science.gov (United States)

    Shen, Jasper; Hur, Kevin; Zhang, Zhipeng; Minneti, Michael; Pham, Martin; Wrobel, Bozena; Zada, Gabriel

    2017-12-29

    The emergence of minimally invasive endoscopic endonasal skull base surgery has necessitated reproducible and realistic simulators of rare vascular injuries. To assess the face and content validity of an innovative perfusion-based cadaveric model developed to simulate internal carotid artery (ICA) injury during endoscopic surgery. Otolaryngology and neurosurgery trainees attempted 3 consecutive trials of endoscopic control of a parasellar ICA injury, with standardized technical feedback. Time to hemostasis (TTH) and blood loss were trended. All participants completed validated questionnaires using a 5-point Likert scale to assess the domains of confidence gain, face validity, content validity, and curriculum applicability. Among all participants (n = 35), TTH and mean blood loss significantly decreased between first vs second attempt (P = .005), and first vs third attempt (P = .03). Following the first attempt, trainees experienced an average 63% reduction in blood loss and 59% reduction in TTH. In the quartile of most improved participants, average blood loss reduction was 1115 mL (84% reduction) and TTH of 259 s (84% reduction). There were no significant differences between trainees of varying postgraduate year or specialty. Average pre and postprocedural confidence scores were 1.38 and 3.16, respectively (P < .0001). All trainees reported model realism, which achieved mean face validity 4.82 ± 0.41 and content validity 4.88 ± 0.33. The perfusion-based human cadaveric ICA injury model achieves high ratings of face and content validity across all levels of surgical trainees, and enables safe, realistic simulation for standardized skull base simulation and future curriculum development. Objective improvements in performance metrics may translate to improved patient outcomes.

  8. Internal carotid arterial canal size and scaling in Euarchonta: Re-assessing implications for arterial patency and phylogenetic relationships in early fossil primates.

    Science.gov (United States)

    Boyer, Doug M; Kirk, E Christopher; Silcox, Mary T; Gunnell, Gregg F; Gilbert, Christopher C; Yapuncich, Gabriel S; Allen, Kari L; Welch, Emma; Bloch, Jonathan I; Gonzales, Lauren A; Kay, Richard F; Seiffert, Erik R

    2016-08-01

    Primate species typically differ from other mammals in having bony canals that enclose the branches of the internal carotid artery (ICA) as they pass through the middle ear. The presence and relative size of these canals varies among major primate clades. As a result, differences in the anatomy of the canals for the promontorial and stapedial branches of the ICA have been cited as evidence of either haplorhine or strepsirrhine affinities among otherwise enigmatic early fossil euprimates. Here we use micro X-ray computed tomography to compile the largest quantitative dataset on ICA canal sizes. The data suggest greater variation of the ICA canals within some groups than has been previously appreciated. For example, Lepilemur and Avahi differ from most other lemuriforms in having a larger promontorial canal than stapedial canal. Furthermore, various lemurids are intraspecifically variable in relative canal size, with the promontorial canal being larger than the stapedial canal in some individuals but not others. In species where the promontorial artery supplies the brain with blood, the size of the promontorial canal is significantly correlated with endocranial volume (ECV). Among species with alternate routes of encephalic blood supply, the promontorial canal is highly reduced relative to ECV, and correlated with both ECV and cranium size. Ancestral state reconstructions incorporating data from fossils suggest that the last common ancestor of living primates had promontorial and stapedial canals that were similar to each other in size and large relative to ECV. We conclude that the plesiomorphic condition for crown primates is to have a patent promontorial artery supplying the brain and a patent stapedial artery for various non-encephalic structures. This inferred ancestral condition is exhibited by treeshrews and most early fossil euprimates, while extant primates exhibit reduction in one canal or another. The only early fossils deviating from this plesiomorphic

  9. Capillary Transit Time Heterogeneity Is Associated with Modified Rankin Scale Score at Discharge in Patients with Bilateral High Grade Internal Carotid Artery Stenosis.

    Directory of Open Access Journals (Sweden)

    Sibu Mundiyanapurath

    Full Text Available Perfusion weighted imaging (PWI is inherently unreliable in patients with severe perfusion abnormalities. We compared the diagnostic accuracy of a novel index of microvascular flow-patterns, so-called capillary transit time heterogeneity (CTH to that of the commonly used delay parameter Tmax in patients with bilateral high grade internal carotid artery stenosis (ICAS.Consecutive patients with bilateral ICAS ≥ 70%NASCET who underwent PWI were retrospectively examined. Maps of CTH and Tmax were analyzed with a volumetric approach using several thresholds. Predictors of favorable outcome (modified Rankin scale at discharge 0-2 were identified using univariate and receiver operating characteristic (ROC curve analysis.Eighteen patients were included. CTH ≥ 30s differentiated best between patients with favorable and unfavorable outcome when both hemispheres were taken into account (sensitivity 83%, specificity 73%, area under the curve [AUC] 0.833 [confidence interval (CI 0.635; 1.000]; p = 0.027. The best discrimination using Tmax was achieved with a threshold of ≥ 4s (sensitivity 83%, specificity 64%, AUC 0.803 [CI 0.585;1.000]; p = 0.044. The highest AUC was found for left sided volume with CTH ≥ 15s (sensitivity 83%, specificity 91%, AUC 0.924 [CI 0.791;1.000]; p = 0.005.The study suggests that CTH is superior to Tmax in discriminating ICAS patients with favorable from non-favorable outcome. This finding may reflect the simultaneous involvement of large vessels and microvessels in ICAS and underscore the need to diagnose and manage both aspects of the disease.

  10. Internal fixation versus nonoperative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Yongchuan Li

    Full Text Available BACKGROUND: A few studies focused on open reduction and internal fixation (ORIF or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients have been published, all of whom had a low number of patients. In this meta-analysis of randomized controlled trials (RCTs, we aimed to assess the effect of ORIF or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients on the clinical outcomes and re-evaluate of the potential benefits of conservative treatment. METHODS: We searched PubMed and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing ORIF and nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients. Our outcome measures were the Constant scores. RESULTS: Three randomized controlled trials with a total of 130 patients were identified and analyzed. The overall results based on fixed-effect model did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures (WMD -0.51, 95% CI: -7.25 to 6.22, P = 0.88, I(2 = 0%. CONCLUSIONS: Although our meta-analysis did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures, this result must be considered in the context of variable patient demographics. Only a limited recommendation can be made based on current data. Considering the limitations of included studies, a large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of shoulder function is required to more adequately assess the role for ORIF or

  11. Head direction cell representations maintain internal coherence during conflicting proximal and distal cue rotations: Comparison with hippocampal place cells

    OpenAIRE

    Yoganarasimha, D.; Yu, Xintian; Knierim, James J.

    2006-01-01

    Place cells of the hippocampal formation encode a spatial representation of the environment, and the orientation of this representation is apparently governed by the head direction cell system. The representation of a well-explored environment by CA1 place cells can be split when there is conflicting information from salient proximal and distal cues, as some place fields rotate to follow the distal cues while others rotate to follow the proximal cues (Knierim, 2002a). In contrast, the CA3 rep...

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

    Science.gov (United States)

    Dakhoul, Lara Toufic; Tawk, Rabih

    2014-01-01

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

  13. Comparison of two different locking plates for two-, three- and four-part proximal humeral fractures--results of an international multicentre study.

    Science.gov (United States)

    Konrad, Gerhard; Hirschmüller, Anja; Audige, Laurent; Lambert, Simon; Hertel, Ralf; Südkamp, Norbert P

    2012-05-01

    The aim of this study was to compare the functional outcome, quality of restoration, and complication rate after open reduction and internal fixation (ORIF) of displaced or unstable 2-, 3- and 4-part humeral fractures using two different locking plates. The data used in this analysis was prospectively collected in two large multicentre studies in 15 European Level 1 trauma centres. A total of 318 patients with proximal humeral fractures were treated with ORIF using either the locking proximal humerus plate (LPHP) or proximal humeral internal locking system (PHILOS). Outcome measurements included Constant and Neer scores, evaluation of local pain at the fracture site and complications, and radiographic assessment at one year. At one year, the mean Constant scores (relative to the contralateral shoulder) improved significantly for both groups and were above 80% for 2-, 3-, and 4-part fractures. A significantly shorter surgical time, less pain at the fracture site, and better functional outcome was achieved by PHILOS-treated patients with 2-part fractures throughout the one-year follow-up month and with 3-part fractures at three months (p fractures, and no difference in the complication rates (p > 0.05). PHILOS and LPHP can be considered as useful implants for ORIF of displaced and unstable proximal humeral fractures. There was a slight advantage of the PHILOS system with regard to operative time and functional outcome, especially for the treatment of 2- and 3-part fractures.

  14. Differential effects of carotid artery stenting versus carotid endarterectomy on external carotid artery patency.

    Science.gov (United States)

    Woo, Edward Y; Karmacharya, Jagajan; Velazquez, Omaida C; Carpenter, Jeffrey P; Skelly, Christopher L; Fairman, Ronald M

    2007-04-01

    To determine the effect of stent coverage of the external carotid artery (ECA) after carotid artery stenting (CAS) compared to eversion endarterectomy of the ECA after carotid endarterectomy (CEA). The records of 101 CAS and 165 CEA procedures performed over 2 years were reviewed. Duplex velocities and history and physical examinations were taken prior to the procedure, at 1 month, and at 6-month intervals subsequently. CAS was performed by extending the stent across the internal carotid artery (ICA) lesion into the common carotid artery (CCA) thereby covering the ECA. CEA was performed with eversion endarterectomy of the ECA. The mean peak systolic velocities (PSV) in the ICA pre-CAS and pre-CEA were 361 and 352 cm/s, respectively. In terms of CAS, there was a significant increase in ECA velocities versus baseline at 12 (p = 0.009), 18 (p = 0.00001), and 24 (p = 0.005) months. In the CEA group, there was a significant decrease in ECA velocities versus baseline at 1 (p = 0.01) and 6 (p = 0.004) months. There were 2 occluded ECAs in follow-up in the CAS group and none in the CEA group. No significant differences were noted when comparing preprocedural ICA or ECA velocities. However, at the 1-, 6-, and 12-month intervals, the ECA velocities in the CAS group were significantly higher than in the CEA group (p = 0.03, p = 0.001, and p = 0.0004, respectively). There were no neurological symptoms in any patients during the study period. Although progressive stenosis of the ECA is noted during CAS, the ECA usually does not occlude. Furthermore, there are no associated neurological symptoms. Thus, apprehension for progressive ECA occlusion should not be a contraindication to CAS. In addition, concern for ECA coverage should not deter stent extension from the ICA to the CCA during CAS.

  15. Risk factors for neurological worsening and symptomatic watershed infarction in internal carotid artery aneurysm treated by extracranial-intracranial bypass using radial artery graft.

    Science.gov (United States)

    Matsukawa, Hidetoshi; Tanikawa, Rokuya; Kamiyama, Hiroyasu; Tsuboi, Toshiyuki; Noda, Kosumo; Ota, Nakao; Miyata, Shiro; Oda, Jumpei; Takeda, Rihee; Tokuda, Sadahisa; Kamada, Kyousuke

    2016-08-01

    OBJECT The revascularization technique, including bypass created using the external carotid artery (ECA), radial artery (RA), and M2 portion of middle cerebral artery (MCA), has remained indispensable for treatment of complex aneurysms. To date, it remains unknown whether diameters of the RA, superficial temporal artery (STA), and C2 portion of the internal carotid artery (ICA) and intraoperative MCA blood pressure have influences on the outcome and the symptomatic watershed infarction (WI). The aim of the present study was to evaluate the factors for the symptomatic WI and neurological worsening in patients treated by ECA-RA-M2 bypass for complex ICA aneurysm with therapeutic ICA occlusion. METHODS The authors measured the sizes of vessels (RA, C2, M2, and STA) and intraoperative MCA blood pressure (initial, after ICA occlusion, and after releasing the RA graft bypass) in 37 patients. Symptomatic WI was defined as presence of the following: postoperative new neurological deficits, WI on postoperative diffusion-weighted imaging, and ipsilateral cerebral blood flow reduction on SPECT. Neurological worsening was defined as the increase in 1 or more modified Rankin Scale scores. First, the authors performed receiver operating characteristic curve analysis for continuous variables and the binary end point of the symptomatic WI. The clinical, radiological, and physiological characteristics of patients with and without the symptomatic WI were compared using the log-rank test. Then, the authors compared the variables between patients with and without neurological worsening at discharge and at the 12-month follow-up examination or last hospital visit. RESULTS Symptomatic WI was observed in 2 (5.4%) patients. The mean MCA pressure after releasing the RA graft (< 55 mm Hg; p = 0.017), mean (MCA pressure after releasing the RA graft)/(initial MCA pressure) (< 0.70 mm Hg; p = 0.032), and mean cross-sectional area ratio ([RA/C2 diameter](2) < 0.40 mm [p < 0.0001] and [STA/C2

  16. Deglutition syncope: a manifestation of vagal hyperactivity following carotid endarterectomy.

    Science.gov (United States)

    Endean, Eric D; Cavatassi, William; Hansler, Joseph; Sorial, Ehab

    2010-09-01

    A 61-year-old man with left amaurosis fugax and bilateral >80% internal carotid artery stenoses underwent a left carotid endarterectomy. On the first postoperative day, he developed hypotension, bradycardia, and chest pain with food ingestion. He was diagnosed as having deglutition syncope and was treated with oral anticholinergics. Similar symptoms occurred when he underwent a right carotid endarterectomy. Deglutition syncope is a neurally mediated situational syncope resulting from vagus nerve over-activity. This is the first report of deglutition syncope associated with carotid endarterectomy. It is important to recognize and differentiate these symptoms from other causes of postendarterectomy hemodynamic instability.

  17. Spontaneous carotid artery dissection causing a juvenile cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-11-01

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

  18. A curve model for association of serum homocysteine with carotid ...

    African Journals Online (AJOL)

    The adjusted regression analysis showed that the threshold values of Hcy with end diastolic velocity (EDV) of right common carotid artery (CCA) were 12.50 and 19.00, while for the EDV of right internal carotid artery (ICA), the values were 11.50 and 22.00. U-shaped curves were observed between Hcy and peak systolic ...

  19. EXTERNAL CAROTID-ARTERY REVASCULARIZATION - INDICATIONS, OPERATIVE TECHNIQUES AND RESULTS

    NARCIS (Netherlands)

    BOONTJE, AH

    1992-01-01

    The external carotid artery (ECA) is an important collateral pathway in patients with ipsilateral internal carotid artery (ICA) occlusion and recurrent symptoms. An ipsilateral ECA revascularization can improve cerebral perfusion or eliminate an embolic source. In the past 11 years 11 patients

  20. Fate of the external carotid artery following carotid interventions.

    Science.gov (United States)

    Casey, Kevin; Zhou, Wei; Tedesco, Maureen M; Al-Khatib, Weesam K; Hernandez-Boussard, Tina; Bech, Fritz

    2009-01-01

    The external carotid artery (ECA) is an important collateral pathway for cerebral blood flow. Carotid artery stenting (CAS) typically crosses the ECA, while carotid endarterectomy (CEA) includes deliberate ECA plaque removal. The purpose of the present study was to compare the long-term patency of the ECA following CAS and CEA as determined by carotid duplex ultrasound. Duplex ultrasounds and hospital records were reviewed for consecutive patients undergoing CAS between February 2002 and April 2008, and were compared with those undergoing CEA in the same time period. Preoperative and postoperative ECA peak systolic velocities were normalized to the common carotid artery (CCA) as ECA/CCA ratios. A significant (80% or greater) ECA stenosis was defined as an ECA/CCA ratio of 4.0. A change of ratio by more than 1 was defined as significant. Data were analyzed using Student's t test and χ(2) analysis. A total of 86 CAS procedures in 83 patients were performed (81 men, mean age 69.9 years). Among them, 38.4% of patients had previous CEA, 9.6% of whom had contralateral internal carotid artery occlusion. Sixty-seven CAS and 65 CEA patients with complete duplex data in the same time period were included in the analyses. There was no difference in the incidence of severe ECA stenosis on preoperative ultrasound evaluations. During a mean follow-up of 34 months (range four to 78 months), three postprocedure ECA occlusions were found in the CAS group. The likelihood of severe stenosis or occlusion following CAS was 28.3%, compared with 11% following CEA (PECA status. Reduction in the patient's degree of ECA stenosis was observed in 9.4% of CAS versus 26.6% of CEA patients. Overall, immediate postoperative ratios of both groups were slightly improved, but there was a trend of more disease progression in the CAS group during follow-up. CAS is associated with a higher incidence of post-procedure ECA stenosis. Despite the absence of neurological symptoms, a trend toward late

  1. Relationship between variations in the circle of Willis and flow rates in internal carotid and basilar arteries determined by means of magnetic resonance imaging with semiautomated lumen segmentation: reference data from 125 healthy volunteers.

    Science.gov (United States)

    Tanaka, H; Fujita, N; Enoki, T; Matsumoto, K; Watanabe, Y; Murase, K; Nakamura, H

    2006-09-01

    Volume flow rates in the feeding arteries of the brain are measured to evaluate blood flow dynamics in vascular disease. Although these flow values are thought to be effected by anatomic variations in the circle of Willis, few reports have described the effect. This study reports on the relationship between variations in the circle of Willis and volume flow rates in the bilateral internal carotid and basilar arteries of normal volunteers. We prospectively examined 125 healthy volunteers by MR imaging. Variations in the circle of Willis were classified as "textbook" type, hypoplasia of the precommunicating segment of the anterior cerebral artery (A1), hypoplasia of the precommunicating segment of the posterior cerebral artery (P1), or "other." Volume flow rates were measured by 2D cine phase-contrast MR imaging. Lumen boundaries and volume flow rates were semiautomatically determined by pulsatility-based segmentation. Of the 117 subjects (61 men, 56 women; mean age, 23.6 years) considered suitable for flow measurement, 105 showed textbook type, and 6 each showed A1 hypoplasia and P1 hypoplasia. Total flow rates for the 3 variations were 781 +/- 151 mL/min (mean +/- SD), 744 +/- 119, and 763 +/- 129, respectively. Relative contributions by flow rates of the internal carotid arteries and the basilar artery for the 3 variations were 39.8%:38.9%:21.3%, 31.8%:49.1%:19.0%, and 46.6%:41.6%:11.7%, respectively, showing statistically significant differences. Variations in the circle of Willis correlate significantly with relative contributions by the flow rates of the bilateral internal carotid and basilar arteries.

  2. Usefulness of contrast-enhanced ultrasound for detection of carotid plaque ulceration in patients with symptomatic carotid atherosclerosis.

    Science.gov (United States)

    ten Kate, Gerrit L; van Dijk, Anouk C; van den Oord, Stijn C H; Hussain, Burhan; Verhagen, Hence J M; Sijbrands, Eric J G; van der Steen, Antonius F W; van der Lugt, Aad; Schinkel, Arend F L

    2013-07-15

    Previous data have indicated that carotid plaque ulceration is a strong predictor of cerebrovascular events. Standard ultrasound and color Doppler ultrasound (CDUS) scans have poor diagnostic accuracy for the detection of carotid plaque ulceration. The aim of the present prospective study was to assess the value of contrast-enhanced ultrasound (CEUS) scans for the detection of carotid plaque ulceration. The Institutional Ethics Committee approved the study protocol, and all patients provided informed consent. The patients had symptomatic stenosis of the internal carotid artery and underwent carotid computed tomographic angiography as part of their clinical evaluation. All patients underwent a CDUS examination in conjunction with CEUS. Carotid plaque ulceration was defined as the presence of ≥1 disruptions in the plaque-lumen border ≥1 × 1 mm. Carotid computed tomographic angiography was used as reference technique. The study population consisted of 20 patients (mean age 64 ± 9 years, 80% men), and 39 carotid arteries were included in the present analysis. Computed tomographic angiography demonstrated that the plaque surface was smooth in 15 (38%), irregular in 7 (18%) and ulcerated in 17 (44%) carotid arteries. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CDUS for the detection of ulceration was 29%, 73%, 54%, 46%, and 57%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CEUS for the detection of ulceration was 88%, 59%, 72%, 63%, and 87%, respectively. CEUS had superior sensitivity and diagnostic accuracy for the assessment of carotid plaque ulceration compared with CDUS. CEUS improved the intrareader and inter-reader variability for the assessment of carotid plaque ulceration compared with CDUS. In conclusion, CEUS could be an additional method for the detection of carotid plaque ulceration. The role of CDUS for the assessment of carotid

  3. Carotid angioplasty-assisted mechanical thrombectomy without urgent stenting may be a better option in acute tandem occlusions.

    Science.gov (United States)

    Akpinar, Cetin K; Gürkaş, Erdem; Aytac, Emrah

    2017-08-01

    Background The aim of the study was to assess the efficacy of balloon angioplasty-assisted mechanical thrombectomy without urgent stenting in the carotid artery as another approach for endovascular treatment of tandem occlusions. Methods Fifteen consecutive cases of tandem occlusions treated with the endovascular approach between January 2014 and May 2016 were reviewed. The study cohort included patients with an etiology of large vessel atherosclerosis. Extracranial carotid stenting was performed in another session if post-thrombectomy mRS modified Rankin Score (mRS) was 0-2. Good clinical outcome was determined by follow-up at 7-10, 30 and 90 days according to the mRS. Results Most patients (80%) were male. Eight (53.4%) patients received intravenous thrombolysis before angiography. Proximal revascularization was successful in 100% of cases with balloon angioplasty internal carotid artery (ICA) origin. Successful recanalization (modified thrombolysis in cerebral infarction (mTICI) 2b-3) (mTICI 2 b-3) occurred in 12 cases (80%) and good clinical outcomes were achieved in 10 patients (66.7%). Cervical ICA stent placement was performed in 10 patients with good clinical outcomes. No symptomatic intracranial hemorrhage occurred after delayed ICA stenting Conclusions This is the first reported case series to evaluate this approach for endovascular treatment of tandem occlusions. Carotid angioplasty-assisted mechanical thrombectomy without urgent stenting seems to be a safer approach.

  4. Evaluation of Freehand B-Mode and Power-Mode 3D Ultrasound for Visualisation and Grading of Internal Carotid Artery Stenosis.

    Directory of Open Access Journals (Sweden)

    Johann Otto Pelz

    Full Text Available Currently, colour-coded duplex sonography (2D-CDS is clinical standard for detection and grading of internal carotid artery stenosis (ICAS. However, unlike angiographic imaging modalities, 2D-CDS assesses ICAS by its hemodynamic effects rather than luminal changes. Aim of this study was to evaluate freehand 3D ultrasound (3DUS for direct visualisation and quantification of ICAS.Thirty-seven patients with 43 ICAS were examined with 2D-CDS as reference standard and with freehand B-mode respectively power-mode 3DUS. Stenotic value of 3D reconstructed ICAS was calculated as distal diameter respectively distal cross-sectional area (CSA reduction percentage and compared with 2D-CDS.There was a trend but no significant difference in successful 3D reconstruction of ICAS between B-mode and power mode (examiner 1 {Ex1} 81% versus 93%, examiner 2 {Ex2} 84% versus 88%. Inter-rater agreement was best for power-mode 3DUS and assessment of stenotic value as distal CSA reduction percentage (intraclass correlation coefficient {ICC} 0.90 followed by power-mode 3DUS and distal diameter reduction percentage (ICC 0.81. Inter-rater agreement was poor for B-mode 3DUS (ICC, distal CSA reduction 0.36, distal diameter reduction 0.51. Intra-rater agreement for power-mode 3DUS was good for both measuring methods (ICC, distal CSA reduction 0.88 {Ex1} and 0.78 {Ex2}; ICC, distal diameter reduction 0.83 {Ex1} and 0.76 {Ex2}. In comparison to 2D-CDS inter-method agreement was good and clearly better for power-mode 3DUS (ICC, distal diameter reduction percentage: Ex1 0.85, Ex2 0.78; distal CSA reduction percentage: Ex1 0.63, Ex2 0.57 than for B-mode 3DUS (ICC, distal diameter reduction percentage: Ex1 0.40, Ex2 0.52; distal CSA reduction percentage: Ex1 0.15, Ex2 0.51.Non-invasive power-mode 3DUS is superior to B-mode 3DUS for imaging and quantification of ICAS. Thereby, further studies are warranted which should now compare power-mode 3DUS with the angiographic gold standard

  5. Blunt-mechanism facial fracture patterns associated with internal carotid artery injuries: recommendations for additional screening criteria based on analysis of 4,398 patients.

    Science.gov (United States)

    Mundinger, Gerhard S; Dorafshar, Amir H; Gilson, Marta M; Mithani, Suhail K; Manson, Paul N; Rodriguez, Eduardo D

    2013-12-01

    Blunt internal carotid artery injuries (BCAIs) can result from craniofacial trauma, yet the association between craniofacial fractures and BCAIs is poorly understood. A retrospective cohort study of patients with blunt-mechanism facial fracture(s) presenting to a large trauma center was undertaken to identify facial fracture patterns predictive of BCAIs. Predictor variables included specific facial fracture patterns. Additional variables included demographic, injury mechanism, and associated injury classifications. Outcome variables included the presence or absence of BCAIs. All radiographic fracture patterns were confirmed by author review of computed tomographic imaging. BCAIs were confirmed and graded using the Biffl system. Differences in fracture patterns and demographic parameters in patients who presented with versus without concomitant BCAIs were compared, and relative risks for BCAI were calculated. Existing Eastern Association for the Surgery of Trauma Level III Blunt Cerebrovascular Injury (BCVI) screening criteria then were applied to the dataset to determine if additional fracture patterns would be useful in BCAI screening as determined by alterations in screening sensitivity and specificity. Seventy BCAIs were identified in 54 of 4,398 patients with facial fractures (1.2%). Bilateral fractures in each facial third, complex midface, Le Fort, and subcondylar fractures, fractures in association with the cervical spine, and basilar skull fractures were high risk for concomitant BCAI. Twenty percent of BCAIs would not have been captured by existing Eastern Association for the Surgery of Trauma Level III BCVI screening criteria. When patients meeting these screening criteria were removed from the study population, Le Fort I and subcondylar fractures were the only fracture patterns conferring increased risk for BCAI. Addition of these criteria to existing criteria improved the screening negative predictive value. Specific facial fracture patterns, including

  6. Evaluation of Freehand B-Mode and Power-Mode 3D Ultrasound for Visualisation and Grading of Internal Carotid Artery Stenosis.

    Science.gov (United States)

    Pelz, Johann Otto; Weinreich, Anna; Karlas, Thomas; Saur, Dorothee

    2017-01-01

    Currently, colour-coded duplex sonography (2D-CDS) is clinical standard for detection and grading of internal carotid artery stenosis (ICAS). However, unlike angiographic imaging modalities, 2D-CDS assesses ICAS by its hemodynamic effects rather than luminal changes. Aim of this study was to evaluate freehand 3D ultrasound (3DUS) for direct visualisation and quantification of ICAS. Thirty-seven patients with 43 ICAS were examined with 2D-CDS as reference standard and with freehand B-mode respectively power-mode 3DUS. Stenotic value of 3D reconstructed ICAS was calculated as distal diameter respectively distal cross-sectional area (CSA) reduction percentage and compared with 2D-CDS. There was a trend but no significant difference in successful 3D reconstruction of ICAS between B-mode and power mode (examiner 1 {Ex1} 81% versus 93%, examiner 2 {Ex2} 84% versus 88%). Inter-rater agreement was best for power-mode 3DUS and assessment of stenotic value as distal CSA reduction percentage (intraclass correlation coefficient {ICC} 0.90) followed by power-mode 3DUS and distal diameter reduction percentage (ICC 0.81). Inter-rater agreement was poor for B-mode 3DUS (ICC, distal CSA reduction 0.36, distal diameter reduction 0.51). Intra-rater agreement for power-mode 3DUS was good for both measuring methods (ICC, distal CSA reduction 0.88 {Ex1} and 0.78 {Ex2}; ICC, distal diameter reduction 0.83 {Ex1} and 0.76 {Ex2}). In comparison to 2D-CDS inter-method agreement was good and clearly better for power-mode 3DUS (ICC, distal diameter reduction percentage: Ex1 0.85, Ex2 0.78; distal CSA reduction percentage: Ex1 0.63, Ex2 0.57) than for B-mode 3DUS (ICC, distal diameter reduction percentage: Ex1 0.40, Ex2 0.52; distal CSA reduction percentage: Ex1 0.15, Ex2 0.51). Non-invasive power-mode 3DUS is superior to B-mode 3DUS for imaging and quantification of ICAS. Thereby, further studies are warranted which should now compare power-mode 3DUS with the angiographic gold standard imaging

  7. Blind endovascular catheterization and direct access of an occluded superior ophthalmic vein for treatment of carotid cavernous fistula

    Science.gov (United States)

    Alaraj, Ali; Kim, Bobby; Oh, Gerald; Aletich, Victor

    2013-01-01

    We describe a case of an elderly patient who presented with right-sided ophthalmoplegia, proptosis, chemosis, and increased intraocular pressure. An angiogram showed feeding vessels from the bilateral internal and external carotid arteries. Our initial attempt to blindly probe the inferior petrosal sinus was unsuccessful. This was followed by a right anterior orbitotomy exposing the superior ophthalmic vein which was directly cannulated with an 18 gauge angiocatheter. However, a proximal third of the superior ophthalmic vein within the orbit which was thrombosed was probed blindly. The thrombosed vein was cannulated with a microcatheter to obtain coil embolization of the carotid cavernous fistula. The implications of the procedure are discussed, given that, to our knowledge, such an endeavor has never been performed. PMID:23761619

  8. DURAL CAROTID-CAVERNOUS FISTULAS

    Directory of Open Access Journals (Sweden)

    Barbara Cvenkel

    2002-12-01

    Full Text Available Background. Dural carotid-cavernous sinus fistulas (CCF are communications fed by meningeal branches of the intracavernous internal carotid artery (ACI or/and external carotid artery (ACE. In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause.Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical presentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present (»redeyed shunt syndrome«. Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion (»white-eyed shunt syndrome«. Also different therapeutic approaches as well as possible complications are described.Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.

  9. Effect of locking plate internal fixation system treatment on the levels of bone turnover biomarkers and inflammatory factors in patients with proximal humeral fractures

    Directory of Open Access Journals (Sweden)

    Chun-Cong Huang1,

    2017-04-01

    Full Text Available Objective: To study the effect of locking plate internal fixation system treatment on the levels of bone turnover biomarkers and inflammatory factors in patients with proximal humeral fractures. Methods: 62 patients with proximal humeral fractures who received surgical treatment in the hospital between May 2013 and February 2016 were selected and divided into the control group (n=34 who received traditional common anatomical bone plate internal fixation treatment and the observation group (n=28 who received locking plate internal fixation system treatment. 4 weeks after operation, enzyme-linked immunosorbent assay (ELISA was used to detect the serum levels of bone formation indexes, bone resorption indexes, pro-inflammatory factors and anti-inflammatory factors of two groups of patients. Results: 4 weeks after operation, serum bone formation indexes osteocalcin (OC, N-terminal propeptide of procollagen type I (P1NP, bone alkaline phosphatase (BALP and bone gla protein (BGP levels of observation group were higher than those of control group while bone resorption indexes pyridinoline (PYD, tartrate-resistant acid phosphatase (TRAP, cross-linked C-terminal telopeptides of type I collagen (CTX and deoxypyridinoline crosslink (D-pyr levels were lower than those of control group (P<0.05; serum pro-inflammatory factors interleukin 1β (IL-1β, interleukin-6 (IL-6 and interleukin-22 (IL-22 levels of observation group were lower than those of control group while anti-inflammatory factors soluble tumor necrosis factor receptor I (sTNF-RI, interleukin-4 (IL-4 and interleukin-13 (IL-13 levels were higher than those of control group (P<0.05. Conclusion: Locking plate internal fixation system treatment of proximal humeral fractures can promote the fracture end healing and improve the bone metabolism without causing strong systemic inflammatory reaction.

  10. Relationship between carotid artery stenosis and ischemic ocular diseases

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    Qian Chen

    2015-01-01

    Full Text Available AIM: To investigate the relationship between carotid artery stenosis and ischemic ocular diseases.METHODS: The clinical data of 30 cases(37 eyesof patients with ischemic eye diseases were collected from November 2010 to May 2014, and they were accepted the fundus fluorescein angiography(FFA, transcranial Doppler(TCDultrasonic blood vessels of the eye, neck vascular color Doppler flow imaging(CDFI, the neck CT angiography(CTAand carotid artery digital subtraction angiography(DSAexamination, and then the ischemic eye disease patients with ocular symptoms were analyzed. The peak systolic velocity(PSVand resistance index(RIof ophthalmic artery and central retinal artery were compared. Correlation between the internal carotid artery intima-media thickness(IMTand ophthalmic artery, central retinal artery PSV and RI correlation risk; ipsilateral internal carotid artery plaque and ophthalmic artery PSV and RI; PSV and RI associated ipsilateral internal carotid artery plaque and central retinal artery were analyzed. RESULTS: Eye symptoms: a black dim, reduced vision, the eyes flash, and around the eye pain were 75.7%, 83.8%, 51.4% and 32.4%; The eye signs: the dilatation of retinal vein, retinal hemorrhage, arterial stenosis and cotton spot and the contralateral side were regarded as main signs. Ophthalmic artery PSV and RI value of the differences were statistically significant(PPP>0.05; The ipsilateral internal carotid artery plaque and ophthalmic artery PSV had no correlation with RI values(P>0.05; PSV and RI and the ipsilateral internal carotid artery plaque and central retinal artery had no correlation(P>0.05.CONCLUSION: The incidence of ischemic eye diseases and internal carotid artery stenosis is associated with very close, the clinical can regard the degree of internal carotid artery stenosis as an important basis for diagnosis and treatment of eye diseases.

  11. Current Approaches for Carotid Endarterectomy

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    Cengiz Köksal

    2010-12-01

    Full Text Available Permanent neurologic injuries and death following stroke, necessitates more vigorous treatment of carotid disease. Carotid stenting and carotid endarterectomy are treatment options in many centers besides medical treatment. Whether the patient is symptomatic or asymtomatic, indications and management strategies for treatment remain controversial. Despite the debate, carotid endarterectomy is still accepted to be the most efficientintervention to decrease risk of stroke due to carotid artery stenosis.

  12. For-Profit Hospital Status and Carotid Artery Stent Utilization in US Hospitals Performing Carotid Revascularization.

    Science.gov (United States)

    Chandler, Justin V; George, Benjamin P; Kelly, Adam G; Holloway, Robert G

    2017-11-01

    Carotid artery stenting may be an economically attractive procedure for hospitals and physicians. We sought to identify the association of hospital ownership (nonprofit versus for-profit) on carotid artery stenting (CAS) versus carotid endarterectomy utilization in US hospitals. Using the Nationwide Inpatient Sample admissions for cerebrovascular disease from 2008 to 2011, we identified all private, nonfederal US hospitals performing at least 20 carotid revascularization procedures annually, including carotid artery stenting (International Classification of Diseases-Ninth Revision 00.63) or carotid endarterectomy (International Classification of Diseases-Ninth Revision 38.12). We used a multilevel multivariable logistic regression controlling for patient demographics, comorbidities, and hospital characteristics, to assess the effect of hospital ownership on CAS use. Across 723 hospitals (600 nonprofit, 123 for-profit), 66 731 carotid revascularization admissions were identified. Approximately 1 in 5 (n=11 641; 17.4%) revascularizations received CAS. The mean CAS rate among nonprofit hospitals was 17.5 per 100 revascularizations (median, 11.5; interquartile range, 5.2-24.5), and the mean CAS rate among for-profit hospitals was 24.2 per 100 revascularizations (median, 16.0; interquartile range, 6.7-33.3; Pprofit hospital designation was associated with greater odds of CAS (adjusted odds ratio, 1.45; 95% confidence interval, 1.07-1.98). For-profit hospital ownership is associated with a higher rate of CAS compared to nonprofit hospitals in those receiving carotid revascularization. Further research is needed to understand the individual- and system-level factors driving this difference. © 2017 American Heart Association, Inc.

  13. Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

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    Ali Sadighi

    2017-03-01

    Full Text Available Background: Proximal humeral fractures are among common types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three- vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate. Material and Methods: In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. The constant score was evaluated 6 months later in follow-up. The P<0.05 was considered significant. Results: Four-part fractures were mainly caused by trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P=0.01. Open fractures were only observed in patients with a four-part fracture (P=0.018. No significant differences were noticed regarding gender, cause, and side of the fracture. The presence of other fractures, fracture of the implant, reduction loss, avascular necrosis (AVN of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures. The mean constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P=0.006. Conclusion: Open reduction and internal fixation with Philos® plate yield acceptable results in both types of fractures, however, the prognosis of this intervention is poorer four-part fractures.

  14. Haemodynamic evaluation of carotid artery disease

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T

    1989-01-01

    Cerebral ischaemia in the region of an internal carotid artery (ICA) stenosis may be caused by embolism or cerebral hypoperfusion. A severe ICA stenosis may be well compensated by collateral blood supply, however, in some patients the capacity of the collateral blood supply is insufficient. Studi...

  15. The presence of some cytokines and Chlamydia pneumoniae in the atherosclerotic carotid plaque in patients with carotid artery stenosis

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    Dariusz Janczak

    2015-02-01

    Full Text Available Background: Over the last few years the role of microorganisms in the pathogenesis of atherosclerosis has been widely discussed. Chlamydia pneumoniae activates immune cells to produce cytokines that are responsible for the formation of atheromatous carotid lesions.Material and methods: The study was carried out at the Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, in 2002-2003, on 100 consecutive symptomatic patients with internal carotid stenosis, who underwent an endarterectomy procedure. Each patient had their carotid artery sampled in order to find C. pneumoniae DNA using the nested PCR method and some cytokines (TGF-β, VEGF, FGF, TNF-α using immunohistochemical examination. The control group consisted of 20 young organ donors who had been diagnosed with brain death and who had their healthy carotid artery harvested. Analogous genetic and immunohistochemical tests were performed.Results: We did not confirm the presence of either cytokines or C. pneumoniae in the healthy carotid arteries. The presence of FGF was probably due to intima fibroblast activity, which is responsible for elastin and collagen synthesis for the extracellular matrix. C. pneumoniae was discovered in 68% of patients with carotid plaques. Three cytokines (TGF-β, FGF, TNF-α were detected in atherosclerotic internal carotid arteries as well.Conclusion: Chronic infection by C. pneumoniae may exacerbate carotid plaque development and may lead to its destabilization.

  16. Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus

    Science.gov (United States)

    Grawe, Brian; Le, Toan; Lee, Thomas; Wyrick, John

    2012-01-01

    Introduction: Treatment of complex fracture patterns of the proximal humerus continues to be a challenging and controversial clinical scenario. The aim of this study was to report on the outcomes of complex displaced 3- and 4-part fractures of the proximal humerus treated with locked plating and compare the functional results of patients on the basis of age at time of injury. Methods: A retrospective review was completed to identify patients whom had sustained a 3- or 4-part fracture of the proximal humerus (Neer classification), treated surgically with locked compression plating. Patients were recruited for a final follow-up, with clinical (Constant and Disabilities of the Arm, Shoulder, Hand [DASH] scores) and radiographic outcome analysis. Results were compared (t test and Wilcoxon test) with fracture type (3- vs 4-part) and patient age at time of fracture (65years) as the primary outcome measure. The presence or absence of a complication and presence or absence of a concomitant osseous injury at the time of presentation were evaluated as secondary outcome measures, in regard to overall functional results of the treatment in question. Complications were defined as posttraumatic osteoarthritis, avascular necrosis of the humeral head, and screw cutout with chondrolysis. The null hypothesis being that age of the patient at the time of injury would not greatly affect functional outcome measurements. Results: Forty-five fractures were identified in 45 patients, with 31 three-part fractures and 14 four-part fractures, and 17 patients were available for final follow-up (9 three-part and 8 four-part). Twelve patients were identified as under the age of 65 years and were compared with 5 patients who were identified as older than 65 years of age. The relative Constant score, at final follow-up, for those under the age of 65 was 88.58, while the score for those above the age of 65 was 82.5. In a similar fashion, the DASH score for those younger than 65 was 11.67, while the

  17. Proximal Hypospadias

    Science.gov (United States)

    Kraft, Kate H.; Shukla, Aseem R.; Canning, Douglas A.

    2011-01-01

    Hypospadias results from abnormal development of the penis that leaves the urethral meatus proximal to its normal glanular position. Meatal position may be located anywhere along the penile shaft, but more severe forms of hypospadias may have a urethral meatus located at the scrotum or perineum. The spectrum of abnormalities may also include ventral curvature of the penis, a dorsally redundant prepuce, and atrophic corpus spongiosum. Due to the severity of these abnormalities, proximal hypospadias often requires more extensive reconstruction in order to achieve an anatomically and functionally successful result. We review the spectrum of proximal hypospadias etiology, presentation, correction, and possible associated complications. PMID:21516286

  18. Relative latency of responses of chemoreceptor afferents from aortic and carotid bodies.

    Science.gov (United States)

    Lahiri, S; Nishino, T; Mulligan, E; Mokashi, A

    1980-02-01

    Discharges from aortic and carotid body chemoreceptor afferents were simultaneously recorded in 18 anesthetized cats to test the hypothesis that aortic chemoreceptors, because of their proximity to the heart, respond to changes in arterial blood gases before carotid chemoreceptors. We found that carotid chemoreceptor responses to the onset of hypoxia and hypercapnia, and to the intravenously administered excitatory drugs (cyanide, nicotine, and doxapram), preceded those of aortic chemoreceptors. Postulating that this unexpected result was due to differences in microcirculation and mass transport, we also investigated their relative speed of responses to changes in arterial blood pressure. The aortic chemoreceptors responded to decreases in arterial blood pressure before the carotid chemoreceptors, supporting the idea that the aortic body has microcirculatory impediments not generally present in the carotid body. These findings strengthened the concept that carotid bodies are more suited for monitoring blood gas changes due to respiration, whereas aortic bodies are for monitoring circulation.

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

    Directory of Open Access Journals (Sweden)

    Čolić Momčilo

    2008-01-01

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

  20. Carotid baroreceptor stimulation blood pressure response mapped in patients undergoing carotid endarterectomy (C-Map study).

    Science.gov (United States)

    Kansal, Nikhil; Clair, Daniel G; Jaye, Deborah A; Scheiner, Avram

    2016-12-01

    Continuous stimulation of the carotid baroreceptors has been shown to evoke a sustained systolic blood pressure (SBP) reduction in hypertensive subjects. This study conducted a detailed mapping of the SBP and heart rate response to electrical stimulus at different locations in the carotid sinus region in patients undergoing a carotid endarterectomy (CEA). The Carotid Sinus Autonomic Response Mapping (C-Map) Study is a multicenter, prospective, non-randomized, acute feasibility study conducted in 10 hypertensive subjects undergoing CEA. Electrode pairs were placed in multiple locations in the region of the carotid sinus for acute stimulation, and the tests were repeated after plaque removal and vessel repair. The configuration that elicited the largest pressure reduction in 8 of 10 patients was with the electrodes arranged longitudinally along the medial (in relation to the bifurcation) wall of the internal carotid artery (ICA) near the bifurcation (11.2±8.1mmHg, pEndarterectomy surgery did not affect maximal acute stimulation response but improved baroreflex sensitivity acutely. Acute extravascular baroreceptor stimulation (BRS) mapping demonstrated that blood pressure reductions are dependent on electrode location and orientation. In most subjects, the largest SBP reductions were elicited in the region of the medial wall of the ICA. This area can be targeted for future BRS lead design and implant. Copyright © 2016 Elsevier B.V. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    1990-01-01

    Follow-up information was obtained on 185 patients who consecutively underwent carotid endarterectomy eight to ten years previously. Doppler ultrasound examination was performed in 59 patients who were still alive and living within 100 miles of the hospital. Using lifetable analysis, the annual...... of restenosis and the development of symptoms, perhaps with the exception of internal carotid artery occlusion, which is not an accepted indication for carotid endarterectomy. Together with recent data from the literature, these observations challenge the indication for reoperative carotid surgery....... rate of focal strokes was estimated to be 2% and 1.5% on the operated and the contralateral, non-operated carotid artery, respectively. Doppler examination revealed 48% re-stenoses, including 14% occlusion and 15% greater than 50% stenosis. However, there was no association between the occurrence...

  2. Oclusão bilateral das artérias carótidas internas, sífilis meningovascular e SIDA: relato de caso Internal carotid bilateral occlusion, meningovascular syphilis and AIDS: case report

    Directory of Open Access Journals (Sweden)

    FLORISBERTO LAMBRECHT

    1999-06-01

    Full Text Available Relatamos um caso de obstrução bilateral na origem das artérias carótidas internas, apresentando como sinais/sintomas associados hemiparesia e hipoestesia superficial e profunda à direita, associada a sífilis meningovascular em paciente com SIDA. Tomografia de crânio apresentou pequenas lesões hipodensas, com predomínio à esquerda, e arteriografia evidenciou oclusão bilateral das artérias carótidas. A associação entre lues e SIDA não é infrequente, porém o quadro oligossintomático do paciente, provavelmente devido a oclusão arterial lenta e gradual chama a atenção.We report a case of bilateral occlusion of internal carotid arteries ,presenting with right hemiparesis and hypoesthesia, associated to meningovascular syphilis in a patient with AIDS. CT scan showed few small hypodense lesions, with a predominance on the left side, and the angiography showed bilateral occlusion of the carotid arteries. The association between syphilis and AIDS is not unusual, but the paucity of symptoms, probably due to a slow and gradual occlusion is not commonly reported.

  3. Receptor-associated protein blocks internalization and cytotoxicity of myeloma light chain in cultured human proximal tubular cells.

    Science.gov (United States)

    Sengul, Sule; Erturk, Sehsuvar; Khan, Altaf M; Batuman, Vecihi

    2013-01-01

    Free light chains (LCs) are among the many ligands that bind to cubilin/megalin for endocytosis via the clathrin-dependent endosomal/lysosomal pathway. Receptor associated protein (RAP), is a 39 kDA high-affinity, chaperone-like ligand for megalin that assists in the proper folding and functioning of megalin/cubilin. Although RAP is known to inhibit ligand binding to megalin/cubilin, its effect on LC endocytosis has not been shown directly. We investigated whether RAP can block the endocytosis of LC in cultured human proximal tubule cells and whether this can prevent LC cytotoxicity. Immunofluorescence microscopy and flow cytometry showed that fluorescently labeled LC endocytosis was markedly inhibited in HK-2 cells pretreated with human RAP. The effect of RAP was dose-dependent, and was predominantly on endocytosis as it had no effect on the small acid-washable fraction of LC bound to cell membrane. RAP significantly inhibited LC induced cytokine production and phosphorylation of ERK1/2 and p38 MAPK. Prolonged exposure to LC for 48 h resulted in epithelial-to-mesenchymal transformation in HK-2 cells as evidenced by marked reduction in the expression of the epithelial cell marker E-cadherin, and increased the expression of the mesenchymal marker α-SMA, which was also prevented by RAP in the endocytosis medium. RAP inhibited LC endocytosis by ∼88% and ameliorated LC-induced cytokine responses and EMT in human PTCs. The results not only provide additional evidence that LCs endocytosis occurs via the megalin/cubilin endocytic receptor system, but also show that blocking LC endocytosis by RAP can protect proximal tubule cells from LC cytotoxicity.

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

    NARCIS (Netherlands)

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

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

  5. Eversion carotid endarterectomy generates fewer microemboli than standard carotid endarterectomy

    DEFF Research Database (Denmark)

    Nielsen, Mingyuan; Sillesen, H H; Lorentzen, Jørgen E

    2000-01-01

    to test whether the occurrence of microembolism differed between eversion and standard carotid endarterectomy (CEA).......to test whether the occurrence of microembolism differed between eversion and standard carotid endarterectomy (CEA)....

  6. Avaliação funcional retrospectiva de pacientes com fratura proximal de úmero fixada com placa com parafusos de ângulo fixo para região proximal no úmero Retrospective functional assessment of patients with humerus proximal fractures internally fixed with a fixed-angle plate for proximal humerus area

    Directory of Open Access Journals (Sweden)

    Rafael Inácio Barbosa

    2008-01-01

    Full Text Available As fraturas do úmero proximal são lesões comuns, levando seus pacientes a importantes limitações funcionais além de algumas complicações. Atualmente existem algumas opções de tratamentos cirúrgicos visando à melhor estabilização da lesão através de técnicas de ostessíntese, dependendo do grau de gravidade da lesão. Dentre eles, tem-se utilizado a placa com parafusos de ângulo fixo para região proximal do úmero, a qual possui o intuito de preservar a integridade biológica da cabeça umeral associada à redução anatômica segura utilizando múltiplos parafusos de fixação com estabilidade angular, permitindo assim a mobilização precoce do membro fraturado. Foram estudados retrospectivamente 11 pacientes com fratura proximal do úmero, tratados com esse modelo de placa entre os anos de 2004 e 2005. Na avaliação funcional foram utilizados o questionário de Constant e o índice DASH. Os resultados sugerem o aparecimento de perda funcional residual no membro superior após esse tipo de trauma, apesar da fixação estável e o tratamento fisioterapêutico.Proximal humeral fractures are common injuries leading to severe functional restrictions and complications for patients. Today, there are several surgical alternatives aimed at achieving better injury stabilization by means of osteosynthesis techniques, depending on injury severity. One of these is the fixed-angle plate fixation of the proximal humerus. This bone fixation system is intended to preserve the biologic integrity of the humeral head associated with a safe anatomical reduction, employing several fixating screws with angle stability, thereby allowing an early mobilization of the fractured limb. Eleven patients with proximal humeral fractures treated with the method of fixed-angle plate fixation of the proximal humerus in the period of 2004 to 2005 were retrospectively studied. The patients were subjected to the Constant questionnaire and the DASH index for

  7. Screening for Carotid Artery Stenosis

    Science.gov (United States)

    Understanding Task Force Recommendations Screening for Carotid Artery Stenosis The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Carotid Artery Stenosis. This final recommendation statement applies to adults who ...

  8. Stent Placement for Carotid Web.

    Science.gov (United States)

    Martinez-Perez, Rafael; Lownie, Stephen P; Pandey, Sachin K; Boulton, Mel R

    2017-02-01

    The carotid web is an intraluminal shelf-like projection arising from the posterior wall of the carotid bifurcation and an uncommon etiology of ischemic strokes. We describe the feasibility of endovascular stent placement to treat this condition. A 47-year-old woman presented with a sudden occlusion of the right middle cerebral artery. Computed tomography angiography and digital subtraction angiography showed a carotid web in the ipsilateral carotid bifurcation. Treatment included mechanical thrombectomy for the middle cerebral artery occlusion and carotid stent placement to prevent further ischemic episodes from the carotid web. At the 6-month follow-up, good apposition of the stent against the artery wall was noted, and the patient was free of neurologic symptoms. Carotid artery stent placement is a feasible option in the management of carotid webs. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch

    OpenAIRE

    Alessandro Robaldo; Guido Carignano; Alberto Balderi; Claudio Novali

    2017-01-01

    Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the fea...

  10. Childhood Age and Associations Between Childhood Metabolic Syndrome and Adult Risk for Metabolic Syndrome, Type 2 Diabetes Mellitus and Carotid Intima Media Thickness: The International Childhood Cardiovascular Cohort Consortium.

    Science.gov (United States)

    Koskinen, Juha; Magnussen, Costan G; Sinaiko, Alan; Woo, Jessica; Urbina, Elaine; Jacobs, David R; Steinberger, Julia; Prineas, Ronald; Sabin, Matthew A; Burns, Trudy; Berenson, Gerald; Bazzano, Lydia; Venn, Alison; Viikari, Jorma S A; Hutri-Kähönen, Nina; Raitakari, Olli; Dwyer, Terence; Juonala, Markus

    2017-08-16

    There is paucity of knowledge concerning the specific age in youth when the associations of metabolic syndrome (MetS) begin to be operative. Thus, we investigated the relation of age to the associations of childhood MetS with adult MetS, type 2 diabetes mellitus and high carotid intima-media thickness. Five thousand eight-hundred three participants were analyzed in 4 cohort studies (Cardiovascular Risk in Young Finns, Bogalusa Heart Study, Princeton Lipid Research Study, Insulin Study). International cutoffs and previously used 75th percentile cutoffs were used for children to define MetS and its components. Mean follow-up period was 22.3 years. Logistic regression was used to calculate risk ratios and 95% confidence intervals. Childhood MetS and overweight were associated with over 2.4-fold risk for adult MetS from the age of 5 years onward. Risk for type 2 diabetes mellitus was increased from the age of 8 (risk ratio, 2.6-4.1; 95% confidence interval, 1.35-6.76 and 1.12-7.24, respectively) onward for the 2 childhood MetS criteria based on international cut-off values and for childhood overweight. Risk for high carotid intima-media thickness was significant at ages 11 to 18 years in relation to childhood MetS or overweight (risk ratio, 2.44-4.22; 95% confidence interval, 1.55-3.55 and 2.55-5.66, respectively). Continuous childhood MetS score was associated with adult MetS from the age of 5, with type 2 diabetes mellitus from the age of 14 and with high carotid intima-media thickness from the age of 11 years onward. Adult MetS was predicted by MetS in childhood beginning at age 5. However, adult type 2 diabetes mellitus and subclinical atherosclerosis were not predicted by childhood data until after age 8. Body mass index measurement alone at the same age points provided similar findings. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  11. Antiplatelet Therapy in Carotid Artery Stenting and Carotid Endarterectomy in the Asymptomatic Carotid Surgery Trial-2

    NARCIS (Netherlands)

    Huibers, A; Halliday, A; Bulbulia, R; Coppi, G; de Borst, G J|info:eu-repo/dai/nl/237108151

    OBJECTIVE: Strokes are infrequent but potentially serious complications following carotid intervention, but antiplatelet therapy can reduce these risks. There are currently no specific guidelines on dose or duration of peri-procedural antiplatelet treatment for patients undergoing carotid

  12. Experiences with carotid endarterectomy at Sree Chitra Tirunal Institute

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    Unnikrishnan Madathipat

    2008-01-01

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

  13. Staged bilateral carotid endarterectomy

    DEFF Research Database (Denmark)

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

    1986-01-01

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

  14. The role of carotid ultrasound in assessing carotid atherosclerosis in individuals at low-to-intermediate cardiovascular risk.

    Science.gov (United States)

    Coll, Blai; Betriu, Angels; Feinstein, Steve B; Valdivielso, Jose M; Zamorano, Jose L; Fernández, Elvira

    2013-12-01

    Detection of carotid atherosclerosis might help to better identify individuals susceptible to cardiovascular events. We aimed to quantify the number of participants with carotid atherosclerosis and low-to-intermediate cardiovascular risk according to the traditional risk factor scoring, and therefore with an elevated risk of cardiovascular events. Cross-sectional, observational study performed during a cardiovascular screening program. From a total of 3778 volunteers, low-to-intermediate cardiovascular risk individuals (N=2354) were identified and studied. Physical examination, blood test, and carotid ultrasound followed standard procedures. Common, bulb, and internal carotid arteries were examined and common carotid intima-media thickness was measured. SCORE risk value was calculated for all participants. Univariate and multivariate statistical analysis was performed. Mean age of participants was 58.9 (15) years, 43.8% were men, 23.7% had hypertension, and 20.5% had hypercholesterolemia. The mean SCORE value was 1.47 (1.4). Both carotid intima-media thickness and the prevalence of carotid plaques increased steadily and significantly (P<.005) as advanced decades of life were analyzed. Variables significantly related with the presence of carotid atherosclerosis were age, male sex, and systolic blood pressure. Interestingly, 592 (25.1%) individuals were reclassified to a higher risk due to the presence of carotid atherosclerosis. There was a clear dissociation between cardiovascular risk scoring and the presence of atherosclerosis, because 1 of 4 study participants at low-to-intermediate cardiovascular risk had carotid atherosclerosis. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  15. Avaliação funcional retrospectiva de pacientes com fratura proximal de úmero fixada com placa com parafusos de ângulo fixo para região proximal no úmero Retrospective functional assessment of patients with humerus proximal fractures internally fixed with a fixed-angle plate for proximal humerus area

    OpenAIRE

    Rafael Inácio Barbosa; Alexandre Márcio Marcolino; Marisa de Cássia Registro Fonseca; Nilton Mazzer; Salomão Chade Zatiti

    2008-01-01

    As fraturas do úmero proximal são lesões comuns, levando seus pacientes a importantes limitações funcionais além de algumas complicações. Atualmente existem algumas opções de tratamentos cirúrgicos visando à melhor estabilização da lesão através de técnicas de ostessíntese, dependendo do grau de gravidade da lesão. Dentre eles, tem-se utilizado a placa com parafusos de ângulo fixo para região proximal do úmero, a qual possui o intuito de preservar a integridade biológica da cabeça umeral asso...

  16. Carotid Endarterectomy to Remove Retained Solitaire Stent Retriever inside Carotid Stent after Mechanical Thrombectomy.

    Science.gov (United States)

    Cobb, Mary In-Ping Huang; Smith, Tony P; Brown, Patrick A; Gonzalez, L Fernando; Zomorodi, Ali R

    2017-05-01

    Tandem occlusions of the internal carotid artery (ICA) and middle cerebral artery (MCA) occur in up to a third of patients with acute ischemic strokes undergoing endovascular mechanical thrombectomy. Understanding open neurosurgical management of associated complications with this procedure is important. A 67-year-old man with acute onset of left hemiparesis and a tandem right ICA and MCA occlusion. He underwent carotid stent angioplasty of a stenotic ICA, followed by attempted Solitaire stent retrieval of an MCA clot. On withdrawal, the tines of the Solitaire stent lodged inside the Precise carotid stent. The patient was started on aspirin, Plavix, and heparin infusion, and underwent a carotid endarterectomy (CEA) with safe removal of the stents and primary vessel repair. This is the first case reported to date of a Solitaire stent becoming lodged inside a Precise carotid stent, salvaged by CEA with safe removal of the stents and primary vessel repair. We discuss the timing, indication, alternatives, and technical nuances of a CEA in this setting. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Carotid Artery Screening

    Science.gov (United States)

    ... that look for inherited genetic markers linked to disease, and imaging tests that produce pictures of the inside of the body. These ... a risk factor. Risk factors for carotid artery disease include: age high blood pressure diabetes tobacco smoking high cholesterol coronary artery disease (CAD) obesity ...

  18. Treatment of traumatic carotid cavernous fistulas using detachable balloons

    Energy Technology Data Exchange (ETDEWEB)

    Han, Moon Hee; Han, Joon Koo; Chang, Kee Hyun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-10-15

    Since the introduction of the concept of detachable balloon technique to occlude arteriovenous fistulas, this technique has become the treatment of choice in the management of traumatic carotid cavernous fistulas (CCF). We tried the occlusion of fistula using detachable balloons in 30 consecutive cases of traumatic CCF and the result of our experience is reported. Transarterial approach with manually-tied latex balloons is tried in all cases and the fistulas were successfully occlude in 28 cases of all. In 20 cases, internal carotid artery was preserved and the arterial lumen was occluded along with fistula opening in 9 cases. In rest of 2 cases, surgical ligation was done because of procedure-related thromboembolism and incomplete occlusion of fistula. We experienced hemiparesis as a major complication in 3 cases. In one of them, the symptom developed during occlusion tolerance test, one just after insertion of guiding catheter into the internal carotid artery, and in one case 2 days after the occlusion of internal carotid artery. In one case, the procedure was performed by the direct puncture of carotid artery because of the ligation of common carotid artery by previous surgery. It is suggested that the systemic heparinization during the procedure is indispensable and starting the procedure with No 9 balloon is considered reasonable.

  19. Asymptomatic carotid lesions after endarterectomy of contralateral carotid artery. Five-year follow-up study and prognosis

    DEFF Research Database (Denmark)

    Schroeder, T; Helgstrand, U J; Egeblad, M R

    1987-01-01

    Of 185 patients who consecutively underwent carotid endarterectomy five years ago, 135 had a patent asymptomatic contralateral internal carotid artery (ICA). During follow-up (median, 59 months), 36 patients developed new neurologic symptoms (18 strokes and 18 transient ischemic attacks). Thirtee...... of stroke without warning was increased in these subgroups, we did not consider the risk high enough to warrant prophylactic endarterectomy. An exception enough to warrant prophylactic endarterectomy. An exception may be the patient with a more than 90% stenosis....

  20. High-flow bypass with radial artery graft followed by internal carotid artery ligation for large or giant aneurysms of cavernous or cervical portion: clinical results and cognitive performance.

    Science.gov (United States)

    Ono, Hideaki; Inoue, Tomohiro; Tanishima, Takeo; Tamura, Akira; Saito, Isamu; Saito, Nobuhito

    2017-09-27

    High-flow bypass followed by ligation of the internal carotid artery (ICA) is an effective treatment, but the impact of abrupt occlusion of the ICA is unpredictable, especially on postoperative cognitive function. The present study evaluated the clinical results as well as cognitive performances after high-flow bypass using radial artery graft (RAG) with supportive superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, followed by ICA ligation. Ten consecutive patients underwent high-flow bypass surgery for large or giant ICA aneurysms of cavernous or cervical portion. Demographics, clinical information, magnetic resonance (MR) imaging, computed tomography, digital subtraction angiography (DSA), intraoperative somatosensory evoked potentials, neuropsychological examinations including the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised (WMS-R), and follow-up data were analyzed. The aneurysm was located on the cavernous segment in eight cases and cervical segment in two cases, and mean aneurysm size was 27.9 mm. Postoperative DSA demonstrated robust bypass flow from the external carotid artery to MCA via the RAG, and no anterograde flow into the aneurysm. No patient showed new symptoms after the operation. Follow-up clinical study and MR imaging were performed in nine patients and showed no additional ischemic lesion compared with preoperative imaging. Seven patients completed neuropsychological examinations before and after surgery. All postoperative scores except WMS-R composite memory score slightly improved. High-flow bypass followed by ICA ligation can achieve good clinical outcomes. Successful high-flow bypass using RAG with supportive STA-MCA bypass and ICA ligation does not adversely affect postoperative cognitive function.

  1. Race-ethnic variation in carotid bifurcation geometry.

    Science.gov (United States)

    Koch, Sebastian; Nelson, Donoffa; Rundek, Tatjana; Mandrekar, Jay; Rabinstein, Alejandro

    2009-01-01

    Disturbances in local blood flow influenced by arterial geometry contribute to atherogenesis. Carotid bifurcation hemodynamics depend on the relative sizes of the common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA), which vary considerably among individuals. The prevalence of carotid bifurcation atherosclerosis differs among race-ethnic groups and is generally lower in African Americans despite a more adverse vascular risk factor profile. We here examine whether there are race-ethnic differences in carotid bifurcation anatomy. The diameters of the CCA, carotid bulb, ICA, and ECA were measured from consecutive cerebral angiograms of African American, white, and Caribbean Hispanic patients. The bulb/CCA, ICA/CCA, ECA/CCA, ECA/ICA, and total cross-sectional outflow/inflow ratio ([ICA(2) + ECA(2)]/CCA(2)) were calculated. The final analysis included 272 bifurcations of which 103 were among white, 87 Hispanic, and 82 African American patients. The mean age of the population was 59.8 +/- 15.8 years and 148 (54.4%) were men. African Americans had a lower ICA/CCA ratio (P ECA ratio (P ECA/CCA ratio (P groups. We found significant differences in the relative sizes of the ICA, ECA, and CCA among race-ethnic groups. African Americans had a proportionally smaller ICA and larger ECA in comparison with whites and Caribbean Hispanics.

  2. Straight artery sign in extracranial carotid artery dissection.

    Science.gov (United States)

    Suwanwela, Nijasri C; Phanthumchinda, Kammant; Suwanwela, Nitaya

    2003-06-01

    Magnetic resonance imaging (MRI) has become generally accepted as a non-invasive method to provide the definitive diagnosis of cervicocerebral vessel dissection. The finding of an intramural hematoma on axial MR images is the characteristic sign of the disease. However, there has been no previous report of the characteristic magnetic resonance angiographic (MRA) findings. The authors retrospectively reviewed MRI and MRA findings of patients with spontaneous extracranial carotid dissection. The most striking finding on MRA was the straightness of the affected artery when compared to the non-affected side of the same patient. For quantitative measurement, "Carotid Straightness Index (CSI)" was developed to measure the straightness of the arteries and compared the indices of both extracranial internal carotid arteries in the same patient. The patients' age range was from 21-55 years (mean 38 years). There were 6 males and 3 females. All patients had the classical "Straight artery sign" on the MRA. The carotid straightness index was significantly higher in the affected artery when compared to the normal side of the same patient. The straight artery sign and the carotid straightness index can be very useful for early detection of the extracranial carotid dissection. It can be found in early stage disease or in less severe forms of carotid dissection where significant narrowing is not demonstrated.

  3. Stenting of Extracranial Carotid Artery Stenosis

    Science.gov (United States)

    Koshimae, N.; Morimoto, T.; Nagata, K.

    2003-01-01

    Summary The purpose of this study is to evaluate our cases of cervical internal carotid artery stenosis for safty stenting. We investigate the preoperative internal carotid artery stenosis using by integrated backscatter (IBS) method of ultra sonography, comparing with the thirty five surgical specimens as to their nature, histological structure, thickness of fibrous cap. We choose the protection method according to plaque structure, and placed Easy-Wall stent or Smart stent after prePTA. We added post PTA according to the extent of expansion and IVUS findings. Calibrated IBS = IBS value (ROI) /intinal IBS value of ‘bleeding’, ‘lipiď, ‘thrombus’, fiber, ‘hyalinization’ were -27.5, -22.5, -15.2, -11.1, +2.1. That of the thin fibrous cap were -10.9*, that of thic fibrous cap were -2.4 (*p safty stenting. PMID:20591243

  4. Utilization of the less-invasive stabilization system internal fixator for open fractures of the proximal tibia: A multi-center evaluation

    Directory of Open Access Journals (Sweden)

    Stannard James

    2008-01-01

    Full Text Available Background: Locked plating has become popular and has clear biomechanical advantages when compared with conventional plating. When combined with minimally invasive surgical techniques, locked plating may cause substantially less iatrogenic tissue damage when compared with conventional plating. These characteristics may make locked plating an attractive option for treating open fractures of the tibial plateau and proximal tibia for which coverage over the plate can be obtained. The purpose of this study was to evaluate the use of the Less-Invasive Stabilization System (LISS for high-energy open fractures involving either the tibial plateau or proximal tibia. Materials and Methods: This study is a retrospective evaluation of a consecutive multicenter series of 52 consecutive patients operated by seven surgeons, who used LISS plating in open proximal tibia or tibial plateau fractures seen at one of four Level I Trauma Centers. All patients were treated using a locked plating system that was implanted using minimally invasive submuscular surgical techniques. The primary outcome measure was the incidence of deep and superficial infection. Results: Fifty-two patients with open fractures have been evaluated, with a mean follow-up of 16.8 (12-36 months. Three patients (5.8% developed deep infections. Two patients (6.3% with tibial plateau and one (4.3% of patients with a tibial shaft fracture developed deep infections. Fifteen patients required flap coverage of their open wounds. The incidence of deep infection as per Gustilo and Anderson classification was Type I and II - 0 (0%; Type IIIA - 2 (7.7%; Type IIIB - 1 (7.1%; and Type IIIC - 0 (0%. Conclusions: Biomechanically, the LISS functions as an "internal-external fixator" rather than a plate. Traditional plate osteosynthesis has yielded rates of infection between 18% and 35%. Our data indicate that locked plating using minimally invasive techniques yield deep infections rates that are no worse than

  5. Characteristics of duplex sonographic parameters over time after successful carotid artery stenting.

    Science.gov (United States)

    Kim, Esther S H; Sun, Zhiyuan; Kapadia, Samir; Bajzer, Christopher; Arrigain, Susana; Gornik, Heather L

    2012-08-01

    Carotid duplex sonography is the primary tool for surveillance after carotid artery stenting, but the course of sonographic velocities over time after successful stenting is unclear. The purpose of this study was to describe carotid duplex sonographic velocity parameters after successful carotid artery stenting and to determine the predictors of poststent sonographic velocities. We queried institutional carotid stent and noninvasive vascular laboratory databases for internal carotid artery stents placed between January 2004 and June 2007. We included patients with stenosis of 20% or less on completion angiograms who had carotid duplex sonography within 30 days before and 7 days after stenting. The prestent peak systolic velocity (PSV), end-diastolic velocity (EDV), internal-to-common carotid artery PSV ratio, contralateral internal carotid artery velocities, stent type, open- versus closed-cell stent design, and days of follow-up were tested as potential predictors of poststent velocities. Eighty-two of 498 patients met inclusion criteria. The mean PSV and PSV ratio decreased from 423.6 cm/s and 7.1 before stenting to 98.5 cm/s and 1.3 after stenting (both P PSV, EDV, and PSV ratio) were dependent on prestent ipsilateral and contralateral velocities. The poststent EDV was dependent on the type of stent. The upper range for 0% to 20% stenosis in the stented internal carotid artery was a PSV of 141 cm/s, an EDV of 42 cm/s, and a PSV ratio of 2.1 or lower. With a median follow-up of 1 year, the PSV and PSV ratio remained stable over time in successfully stented carotid arteries. Deviations in sonographic parameters after initial poststent carotid duplex sonography should prompt an investigation for possible in-stent restenosis.

  6. How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction-internal fixation of proximal humeral fractures.

    Science.gov (United States)

    Spross, Christian; Zeledon, Rebeca; Zdravkovic, Vilijam; Jost, Bernhard

    2017-09-01

    With the introduction of the deltoid tuberosity index (DTI), a simple radiographic tool has become available to measure bone mineral density of the proximal humerus. The aim of this study was to assess the influence of local bone mineral density on the early failure rate after angular stable open reduction-internal fixation of proximal humeral fractures (PHFs). We retrospectively followed up all patients treated with angular stable implants for PHFs from 2007 to 2014. The fractures were classified according to Neer, and the DTI, metaphyseal head extension (MHE), medial hinge displacement, and quality of reduction were assessed. Failures were defined as head screw cutouts. The study included 146 patients (mean age, 66 years; range, 20-94 years). The mean follow-up period was 11 months (range, 3-94 months). Of the fractures, 91% were classified as 2- or 3-part fractures and 9% as 4-part fractures. The mean DTI was 1.44 (range, 1.19-2.11), and the mean MHE was 12 mm (range, 0-48 mm). The reduction result was at least acceptable in 80% of fractures. Screw cutouts were found in 23%. The DTI and MHE were the most significant preoperative predictors for the reduction result. The DTI (P = .036) and age (P = .02) were independent preoperative factors, and a good reduction (P = .001) was the only intraoperative factor influencing cutout. This study proves that good bone quality and a long MHE are helpful for the reduction. Furthermore, good bone quality, a younger age, and a good reduction prevent later cutout. We conclude that local bone quality is a relevant factor in the treatment plan for PHFs. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Carotid revascularization: risks and benefits

    Directory of Open Access Journals (Sweden)

    O'Brien M

    2014-07-01

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

  8. Carotid endarterectomy: The procedure of choice for carotid stenosis

    Directory of Open Access Journals (Sweden)

    B.V. Savitr Sastri

    2013-01-01

    Full Text Available Ischemic stroke is the commonest cause of neurological morbidity and mortality. Carotid endarterectomy has been shown to be beneficial in preventing ischemic strokes in patients with significant stenosis of the carotid artery, both in symptomatic and asymptomatic patients. Carotid artery stenting has been proposed as an alternative to CEA for this population. This paper reviews the available literature on carotid endarterectomy comparing it to the best medical therapy and carotid artery stenting in the prevention of ischemic strokes in patients with carotid stenosis. The use of newer imaging techniques and tools to redefine the existing idea of "asymptomatic" stenosis and post procedural strokes has also been reviewed. We present a concise review of existing data that shows unequivocally that endarterectomy still remains superior to stenting and best medical therapy as of now.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    by carotid endarterectomy. The gene expression of markers of vulnerability - CD68, IL-18, matrix metalloproteinase 9, cathepsin K, GLUT-1, and hexokinase type II (HK2) - were measured in plaques by quantitative PCR. RESULTS: In a multivariate linear regression model, GLUT-1, CD68, cathepsin K, and HK2 gene......) and an additional ipsilateral internal carotid artery stenosis of greater than 60% were recruited. FDG uptake in the carotids was determined by PET/computed tomography and expressed as mean and maximal standardized uptake values (SUVmean and SUVmax). The atherosclerotic plaques were subsequently recovered...... destabilization. Accordingly, FDG-PET could prove to be an important predictor of cerebrovascular events in patients with carotid plaques....

  10. Common carotid artery occlusion presenting with recurrent syncopal episodes

    Directory of Open Access Journals (Sweden)

    Imran Kader

    2017-01-01

    Full Text Available Symptomatic common carotid artery (CCA occlusion is an uncommon occurrence that may require surgical intervention. We aim to describe a case of CCA occlusion that presented with the unusual symptom of recurrent syncope. A 69-year-old lady presented with a history of recurrent syncopal episodes and amaurosis fugax associated with left leg weakness. She was found to have a right CCA occlusion on duplex ultrasound and angiography. She underwent a right common carotid endarterectomy and intraoperative findings revealed a heavily calcified plaque in the CCA just proximal to the bifurcation with organised thrombus filling the CCA proximally. CCA occlusion can rarely present with recurrent syncopal episodes. Surgery may be curative.

  11. [The management of carotid reestenosis--an experience with the conventional surgery].

    Science.gov (United States)

    Martins, Carlos; Almeida, Paulo; Castelobranco, Orlanda; Romero, Madalena; Cabral, Gonçalo; Dinis da Gama, A

    2010-01-01

    The authors report a series of 26 consecutive patients, 20 men and 6 women, age range 47-80 years, average age of 66 years, who underwent conventional surgery for the treatment of carotid reestenosis. The surgical management consisted in the resection of a segment of the common carotid-internal carotid arteries and interposition of a prosthetic graft, followed by ligation of the external carotid, in 3 patients; in the remainder 23 cases a venous bypass graft was interposed from the common carotid to the internal carotid artery, above the lesion, with preservation of the external carotid artery flow and ligation of the internal carotid, just below the anastomosis. There was no operative mortality and the significant morbility consisted in a cervical hematoma in one patient, transient disphonia in two cases and transient disphagia in one patient. During the mean follow up time of 43 months, one patient developed a significant reestenosis of the venous graft and another patient developed an aneurysm of the venous graft, both conditions requiring surgical repair. Based on the early and late results of this experience, the authors elect the open conventional surgery as the method of choice for the treatment of carotid reestenosis.

  12. Clinical experience with Thera DR rate-drop response pacing algorithm in carotid sinus syndrome and vasovagal syncope. The International Rate-Drop Investigators Group.

    Science.gov (United States)

    Benditt, D G; Sutton, R; Gammage, M D; Markowitz, T; Gorski, J; Nygaard, G A; Fetter, J

    1997-03-01

    This study examined the effectiveness of cardiac pacing using the Thera DR rate-drop response algorithm for prevention of recurrent symptoms in patients with carotid sinus syndrome (CSS) or vasovagal syncope. The algorithm comprises both diagnostic and treatment elements. The diagnostic element consists of a programmable "window" used to identify heart rate changes compatible with an evolving neurally mediated syncopal episode. The treatment arm consists of pacing at a selectable rate and for a programmable duration. Forty-three patients (mean age 53 +/- 20.4 years) with CSS alone (n = 8), CSS in conjunction with vasovagal syncope (n = 4), or vasovagal syncope alone (n = 31) were included. Thirty-nine had recurrent syncope, while the remaining four reported multiple presyncopal events. Prior to pacing, 40 +/- 152 syncopal episodes (range from 1 to approximately 1,000 syncopal events) over the preceding 56 +/- 84.5 months. Postpacing follow-up duration was 204 +/- 172 days. Three patients have been lost to follow-up and in one patient the algorithm was disabled. Among the remaining 39 individuals, 31 (80%) indicated absence or diminished frequency of symptoms, or less severe symptoms. Twenty-three patients (23/29, or 59%) were asymptomatic with respect to syncope or presyncope. Sixteen patients had symptom recurrences. Of these, seven experienced syncope (7/39, or 18%) and 9 (29%) had presyncope: the majority of patients with recurrences (6/7 syncope and 7/9 presyncope) were individuals with a history of vasovagal syncope. Consequently, although symptoms were observed during postpacing follow-up, they appeared to be of reduced frequency and severity. Thus, our findings suggest that a transient period of high rate pacing triggered by the Thera DR rate-drop response algorithm was beneficial in a large proportion of highly symptomatic patients with CSS or vasovagal syncope.

  13. Angioplasty and stent placement - carotid artery

    Science.gov (United States)

    ... and stenting; CAS; Angioplasty - carotid artery; Carotid artery stenosis - angioplasty; ... Stenting versus endarterectomy for treatment of carotid-arery stenosis. N Engl J Med . 2010;363(1):11- ...

  14. Carotid artery stenosis -- self-care

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000717.htm Carotid artery stenosis - self-care To use the sharing features on ... feel their pulse under your jawline. Carotid artery stenosis occurs when the carotid arteries become narrowed or ...

  15. Spontaneous carotid dissection

    Directory of Open Access Journals (Sweden)

    Carolina Dutra Queiroz Flumignan

    Full Text Available Summary Carotid dissection is a rare occurrence but it is the main cause of stroke in individuals aged less than 45 years, and can be the etiology in up to 25% of strokes in young adults. We report a case with classic image of ying yang on vascular ultrasound, which was treated according to the best available medical evidence, yielding a favorable outcome.

  16. Carotid versus coronary atherosclerosis burdens in acute compared with chronic symptomatic coronary artery disease.

    Science.gov (United States)

    LeBlanc, Stéphanie; Bibeau, Karine; Bertrand, Olivier F; Lévesque, Valérie; Deschênes St-Pierre, Béatrice; Pibarot, Philippe; Després, Jean-Pierre; Larose, Eric

    2017-08-01

    Prediction of coronary events remains elusive. Carotid atherosclerosis may be a surrogate for coronary risk, as carotid and coronary diseases occur simultaneously - albeit at times with a weak association - depending on clinical presentation. We investigated carotid and coronary atherosclerosis in men with new-onset unstable coronary artery disease (CAD) presenting with acute ST-segment elevation myocardial infarction (STEMI) vs. long-standing severe chronic stable angina (CSA). Bilateral carotid artery and 3-vessel coronary artery atherosclerosis burdens were measured within 1 month, respectively, by 3D-volumetric carotid magnetic resonance imaging and coronary angiography-derived modified CASS-50 score. Men with STEMI (n = 50) and long-standing CSA (n = 50), matched for age, were enrolled (58.6 ± 8.8 years). All of them had carotid atherosclerosis. Atherosclerosis burden was greater in the carotid arteries of STEMI vs. CSA (wall volume: 196.2 ± 44.4 vs. 169.2 ± 38.0 mm3/4 mm, p = 0.002), but greater in the coronary arteries of CSA vs. STEMI (modified CASS-50 score: 3 vs. 1, p < 0.0001). Normalized wall index (NWI) of internal carotid was associated with modified CASS-50 score in STEMI (ρ = 0.40, p = 0.022) and in CSA (ρ = -0.39, p = 0.031). Carotid atherosclerosis was observed in all CAD patients, and atherosclerosis burden in carotid and in coronary arteries varied according to clinical presentation.

  17. Fixação interna de fratura de epífise proximal de tíbia em potro Internal fixation of the tibial proximal epiphyses fracture in a foal

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Maciel Brunner

    2006-02-01

    Full Text Available A fratura Salter Harris tipo II ocorre comumente na epífise proximal de tíbia em potros e tem reparação difícil mas com o advento das técnicas de fixação interna, o prognóstico tem melhorado. No caso descrito, em um potro da raça árabe de 26 dias de idade, com fratura proximal de tíbia direita tipo Salter Harris II, foram utilizadas as placas de compressão para garantirem estabilização e aproximação dos fragmentos fraturados, porém com risco de ocasionar distúrbios no desenvolvimento esquelético. No caso relatado, através do controle radiológico, não foi evidenciada diminuição da radioluscência na região correspondente à cartilagem de conjugação proximal da tíbia. O artigo tem como objetivo discutir o tratamento empregado que se mostrou como alternativa viável pelo resultado favorável com bons resultados.The most frequent fracture is tibia’s proximal epiphysis in foals is Salter Harris type II although its difficult to repair. The development of the inner fixation technique has been made the prognosis better. The dynamic compression bone plate allow guaranteed reduction and stabilization of the bone’s fragments, but it can promote development disturbs. In this case, by the radiological control, it has not shown less radiolucency in the proximal tibia’s growth plate. The treatment used showed itself as a feasible alternative because of the favourable good results.

  18. Trombose de artéria carótida interna relacionada a trauma de palato em criança Internal carotid artery thrombosis related to trauma of palate in a child

    Directory of Open Access Journals (Sweden)

    Fernando de Souza Almeida

    2012-01-01

    Full Text Available OBJETIVO: Relatar um caso de trombose de artéria carótida interna secundária relacionada a trauma de palato mole em criança. DESCRIÇÃO DO CASO: Criança admitida com quadro de alteração do nível de consciência, sonolência, afasia e hemiplegia direita; tinha antecedente de trauma corto contuso leve em palato mole há oito horas. A investigação tomográfica evidenciou acidente vascular isquêmico secundário à interrupção do fluxo sanguíneo em território de artéria cerebral média esquerda. A arteriografia mostrou oclusão da artéria carótida interna imediatamente distal à sua origem, com aspecto radiológico de "ponta de lápis", obstruindo o fluxo sanguíneo na região. A paciente foi submetida à investigação para doença pró-trombótica e cardíaca, contudo, não foi detectada nenhuma alteração. A administração de enoxaparina em dose terapêutica por três semanas conduziu à melhora clínica progressiva. Após três semanas de seguimento, a paciente não mostrava sequelas motoras. COMENTÁRIOS: As lesões intraorais são frequentes em crianças e a maioria evolui sem complicações. A trombose da artéria carótida interna é uma complicação rara, mas bem documentada destas lesões e decorre da compressão do vaso com trombogênese localizada. A taxa de mortalidade relatada é de 30% e as sequelas ocorrem em 85% dos casos.OBJECTIVE: To describe a child with internal carotid artery thrombosis secondary to trauma of the soft palate. CASE DESCRIPTION: Child presented with altered level of consciousness, drowsiness, aphasia, right hemiplegia, and a history of trauma, with mild concussion of the soft palate eight hours prior to admission. CT scan showed ischemic stroke secondary to interruption of blood flow in the area of the left middle cerebral artery. Arteriography showed occlusion of the carotid artery just distal to its origin, with radiological appearance of "pencil tip", obstructing blood flow in the region

  19. Doppler examination of the periorbital arteries adds valuable hemodynamic information in carotid artery disease

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T; Steenberg, H J

    1987-01-01

    The periorbital flow direction and internal carotid artery (ICA) angiogram were compared to the ICA pressure gradient across the stenosis and the distal ICA pressure in 51 patients subjected to carotid endarterectomy. All 17 patients with inverted periorbital flow had stenoses exceeding 50...

  20. Residual high-grade stenosis after recanalization of extracranial carotid occlusion in acute ischemic stroke

    NARCIS (Netherlands)

    Luitse, M.J.; Velthuis, B.K.; Dauwan, M.; Dankbaar, J.W.; Biessels, G.J.; Kappelle, L.J.; Meijer, F.J.; Dijk, E.J. van

    2015-01-01

    BACKGROUND AND PURPOSE: Residual stenosis after recanalization of an acute symptomatic extracranial occlusion of the internal carotid artery (ICA) might be an indication for carotid endarterectomy. We evaluated the proportion of residual high-grade stenosis (>/=70%, near occlusions not included)

  1. Awake carotid endarterectomy to decrease stroke rate in high-risk ...

    African Journals Online (AJOL)

    Adele

    As there were no symptoms of cerebral ischaemia, the decision was taken to proceed without an internal carotid artery (ICA) shunt. Dur- ing the carotid artery clamp, the patient had two episodes of dysarthria. The systolic blood pressure was 110 mmHg on both occasions. Administration of 100mcg phenylephrine intrave-.

  2. A noisy zygoma fracture--complication of carotid-cavernous sinus fistula: total recovery of monocular blindness and frozen-eye after endoarterial coil embolization.

    NARCIS (Netherlands)

    Bierenbroodspot, F.; Damme, P.A. van; Cruysberg, J.R.M.

    2005-01-01

    A case of a patient with a zygoma fracture in combination with a carotid-cavernous sinus fistula--an arterio-venous fistula between the internal carotid artery and the cavernous sinus--is presented. The most frequent cause is trauma, but the carotid-cavernous sinus fistula itself may have been the

  3. Stroke caused by a myxoma stenosing the common carotid artery.

    Science.gov (United States)

    Cortés-Vicente, Elena; Delgado-Mederos, Raquel; Bellmunt, Sergi; Borras, Xavier F; Gómez-Ansón, Beatriz; Bagué, Silvia; Camps-Renom, Pol; Martí-Fàbregas, Joan

    2015-04-01

    We report a case of stroke due to stenosis caused by a myxoma in the common carotid artery with no evidence of a cardiac origin. Only 1 such case has been reported previously in the literature. A previously healthy 37-year-old woman presented with repeated episodes of acute focal deficits together with motor, sensory, and language symptoms typical of left internal carotid territory involvement. Brain magnetic resonance imaging showed acute and subacute ischemic lesions in the territory of the left middle cerebral artery and border zone infarcts (middle cerebral artery with anterior and posterior cerebral arteries). Magnetic resonance angiography showed a filling defect in the distal portion of the left common carotid artery causing stenosis over 70%. Transesophageal echocardiography showed no embolic sources. Blood tests ruled out a prothrombotic state. The image was initially interpreted as a possible subacute thrombus and anticoagulation was started. No changes were observed in the follow-up carotid ultrasound examination after 12 days of treatment. A gelatinous mass was removed during carotid surgery. No subjacent lesion was observed in the vessel wall. Pathology examination showed a spindle cell fibromyxoid tissue with fibrinoid material typical of myxoma. We hypothesize that the myxoma originated in the vessel, or alternatively, that a cardiac myxoma embolized without leaving a residual cardiac tumor. Although exceptional, myxoma should be added to the list of unusual causes of carotid artery stenosis causing stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Macroadenoma pituitário não hemorrágico produzindo oclusão reversível de artéria carótida interna: a respeito de um caso Non-hemorragic pituitary macroadenoma producing reversible internal carotid artery occlusion: case report

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Cavalcanti

    1997-09-01

    Full Text Available Os autores relatam o caso de uma paciente com macroadenoma pituitário não hemorrágico produzindo oclusão reversível de artéria carótida interna. A obstrução da artéria carótida interna por tumor pituitário é rara, particularmente na ausência de apoplexia hipofisária. A correlação neurorradiológica torna-se de fundamental importância para demonstrar a oclusão completa ou trombose do vaso afetado. O completo restabelecimento pós-cirúrgico do fluxo sangüíneo da artéria carótida interna torna-se imperativo para a completa regressão sintomatológica.The case of woman with diagnosis on non-hemorragic pituitary macroadenoma producing reversible occlusion of the internal carotid artery is presented. The obstruction of the internal carotid artery by a pituitary tumor is rare, particularly in the absence of hypophyseal apoplexy. The neuroradiological correlation becomes fundamentally important to demonstrate the complete occlusion or thrombosis of the affected vessel. The complete restablishment of blood flow of the internal carotid artery after surgery becomes imperative for the complete symptomatological regression.

  5. Numerical simulation of blood flow and plaque progression in carotid-carotid bypass patient specific case.

    Science.gov (United States)

    Filipovic, Nenad; Saveljic, Igor; Nikolic, Dalibor; Milosevic, Zarko; Kovacevic, Pavle; Velicki, Lazar

    2015-01-01

    This study describes computer simulation of blood flow and plaque progression pattern in a patient who underwent surgical treatment for infected carotid prosthetic tube graft using carotid-carotid cross-over bypass. The 3D blood flow is governed by the Navier-Stokes equations, together with the continuity equation. Mass transfer within the blood lumen and through the arterial wall is coupled with the blood flow and is modelled by the convection-diffusion equation. Low-density lipoprotein (LDL) transport in lumen of the vessel is described by Kedem-Katchalsky equations. The inflammatory process is solved using three additional reaction-diffusion partial differential equations. Calculation based on a computer simulation showed that flow distribution in the left carotid artery (CA) was around 40-50% of the total flow in the right common CA. Also, the left CA had higher pressure gradient after surgical intervention. Plaque progression simulation predicted development of the atherosclerotic plaque in the position of the right common CA and the left internal CA. A novel way of atherosclerotic plaque progression modelling using computer simulation shows a potential clinical benefit with significant impact on the treatment strategy optimization.

  6. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    -displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  7. Mesh-covered (Roadsaver stent as a new treatment modality for symptomatic or high-risk carotid stenosis

    Directory of Open Access Journals (Sweden)

    Roman Machnik

    2017-05-01

    Full Text Available Introduction : Prevention of periprocedural stroke has a crucial role in carotid artery stenting (CAS procedures. Aim : To assess retrospectively 30-day safety and effectiveness of 41 procedures of internal and common carotid artery stenting using the Roadsaver double nitinol layer micromesh stent in 40 non-consecutive patients with symptomatic or high-risk carotid artery stenosis. Material and methods : The patients were men (n = 31 and women (n = 9; mean age was 67.8 ±7.9 years. Femoral access was used in 39 cases, whereas radial access was used in 2. Proximal (n = 27 or distal (n = 14 embolic neuroprotection was used. Results : The Roadsaver stents (nominal diameter 7, 8 or 9 mm, length 25 or 30 mm were implanted successfully in all cases. One minor stroke occurred after common carotid artery intubation with a guiding catheter (before stent deployment and one transient postprocedural ischemic attack (TIA of the ipsilateral cerebral hemisphere was observed. Internal/common carotid artery stenosis severity was evaluated by duplex Doppler. Maximal peak systolic velocity (PSV before CAS was in the range: 2.0–7.0 m/s, mean: 3.9 ±1.0 m/s, at 24–48 h after stenting mean PSV was 1.1 ±0.4 m/s (p < 0.05, and at 30 days 1.1 ±0.3 m/s (p < 0.05. Maximal end-diastolic velocity (EDV was 0.85–3.5 m/s, mean 1.4 ±0.5 m/s, at 24–48 h after stenting mean EDV was 0.3 ±0.1 m/s (p < 0.05, and at 30 days 0.4 ±0.1 m/s (p < 0.05. No restenosis or thrombosis was observed. Angiographic stenosis decreased from 82.9 ±9.1% (range: 61–97% to 19.3 ±7.3% (range: 0–34% (p < 0.05. Conclusions : The CAS using the Roadsaver stent seems to be safe and effective. Further studies involving larger patient populations and longer follow-up are needed.

  8. Cognitive changes after carotid artery stenting

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Politi, M.; Struffert, T.; Krick, C.; Backens, M. [University of the Saarland, Department for Diagnostic and Interventional Neuroradiology, Homburg (Germany); Supprian, T.; Falkai, P.; Reith, W. [University of the Saarland, Clinic for Psychiatry and Psychotherapy, Homburg (Germany)

    2006-05-15

    We aimed to test changes in cognitive performance after carotid artery stenting (CAS). Ten patients were neuropsychologically tested at least 24 h before and 48 h after CAS. To diminish thromboembolic events, we used a proximal protection device. The following neuropsychological tests were selected: The Mini Mental State Examination (MMSE), symbol digit test and subtests of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery (verbal fluency, constructional practice, word list memory and delayed recall). Affective state was determined by the Beck Depression Score (BDS). No patient suffered from depression (BDS <1) or dementia (MMSE 29.9{+-}1.5). Nine of the ten patients (P=0.12) showed increased speed in the Number Connection Test (NCT) (corresponding to trail making test). Most patients showed better or similar results concerning delayed recall (P=0.31). No change was observed in the symbol digit test, word list memory, verbal fluency or constructional practice. Better results concerning NCT and delayed recall after carotid stenting might be due to improved brain perfusion. After CAS, cognitive and memory performance seem to improve. Further studies with different time intervals and more refined testing, as well as perfusion-weighted imaging, are needed. (orig.)

  9. Segment-specific carotid intima-media thickness and cardiovascular risk factors in Koreans: the Healthy Twin Study.

    Science.gov (United States)

    Lee, Kayoung; Sung, Joohon; Lee, Sang Cheol; Park, Seung Woo; Kim, Youn Sic; Lee, Joo Yeon; Ebrahim, Shah; Song, Yun-Mi

    2012-10-01

    Increased carotid intima-media thickness is associated with higher cardiovascular disease risk. This study aimed to evaluate the contributions of cardiovascular risk factors and inheritance to segment-specific carotid intima-media thickness. Cross-sectional observational study. A total of 706 Korean adults was selected from the Healthy Twin Study. The intima-media thickness of common, carotid bifurcation, and internal carotid artery were measured using B-mode ultrasound. Behavioral and biological cardiovascular risk factors were measured. Quantitative genetic and linear mixed analyses were performed to examine inherited and environmental contributions to intima-media thickness variation. Heritability of intima-media thickness was moderately high with estimates (95% confidence intervals) of 0.48 (0.37, 0.59), 0.38(0.27, 0.49), and 0.45(0.34, 0.55) for common, carotid bifurcation, and internal carotid artery, respectively. The additive genetic cross-trait correlations between the segments ranged between 0.43 and 0.75, suggesting a shared genetic influence on the three carotid segments. Additive inherited effects contributed 21% and 31% (common and internal carotid, respectively) to the total variance of the intima-media thickness, while measured cardiovascular risk factors accounted for 46% and 26% (common and internal carotid, respectively). The cardiovascular risk factors significantly associated with carotid intima-media thickness were as follows: in men, alcohol use (bifurcation); physical activity (common and internal); BMI (all segments); diabetes (bifurcation and internal); hypertension (internal); and HDL-cholesterol (common and bifurcation); and in women, smoking (bifurcation), hypertension (common), total and LDL cholesterol (bifurcation and internal), and hs-CRP (common and internal). Individual cardiovascular risk factors were differentially associated with carotid intima-media thickness by segments and sex. Inherited effects made a heterogeneous

  10. The haemodynamic effect of carotid endarterectomy.

    Science.gov (United States)

    Nielsen, M-Y; Sillesen, H H; Jørgensen, L G; Schroeder, T V

    2002-07-01

    to assess the haemodynamic effect of carotid artery surgery, and to relate postoperative changes to the state of cerebral circulation before revascularisation. using transcranial Doppler we studied bilateral middle cerebral artery (MCA) flow velocities before and on 1st day, 2nd or 3rd day and 4th or 5th day and 3 months after carotid surgery in 61 patients. In addition, ipsilateral MCA flow velocity was monitored continuously during surgery. Data were related to the internal carotid artery (ICA) perfusion pressure (cerebral perfusion pressure index, CPPI), measured directly before ICA clamping. postoperatively, MCA flow velocities increased significantly overall (pCPPICPPI, whereas MCA flow velocities remained increased in the group of patients with low CPPI. At 3 months flow velocities in both groups were normalised. New neurological symptoms occurred in four patients, who all had low CPPI preoperatively (22% (4/18) vs 0%; Fisher's exact test: p=0.006). some degree of hyperperfusion was seen in most patients, but the changes were significantly more pronounced in patients with preoperative hypoperfusion, who also suffered significantly more neurological complications.

  11. Comprehensive and rapid assessment of carotid plaques in acute stroke using a new single sweep method for three-dimensional carotid ultrasound.

    Science.gov (United States)

    Kalashyan, Harapet; Saqqur, Maher; Shuaib, Ashfaq; Romanchuk, Helen; Nanda, Navin C; Becher, Harald

    2013-04-01

    We describe a 68-year-old man with acute stroke in whom the newly developed single sweep method for three-dimensional (3D) carotid ultrasound provided a rapid and comprehensive assessment of atherosclerotic plaque burden in the internal carotid artery. The two-dimensional duplex carotid scan diagnosed 50-69% stenosis, and with the three-dimensional method, the markedly hypoechogenic plaque (total volume 1.42 mL) was shown to occupy 77% of the total arterial volume (1.84 mL), consistent with severe lesion. The ultrasound findings were confirmed by computed tomographic angiography and subsequent carotid endarterectomy. The new single sweep 3D carotid ultrasound has the potential to become a valuable clinical tool in the assessment of stroke patients. © 2013, Wiley Periodicals, Inc.

  12. Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Karimi Fatemeh

    2007-01-01

    Full Text Available Abstract Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8% had significant ( Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

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

    Directory of Open Access Journals (Sweden)

    Rasoul Mirsharifi

    2009-04-01

    Full Text Available

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

  14. Carotid duplex ultrasound and transcranial Doppler findings in commercial divers and pilots.

    Science.gov (United States)

    Dormanesh, Banafshe; Vosoughi, Kia; Akhoundi, Fahimeh H; Mehrpour, Masoud; Fereshtehnejad, Seyed-Mohammad; Esmaeili, Setareh; Sabet, Azin Shafiee

    2016-12-01

    The risky working environments of divers and pilots, and the possible role of extreme ambient pressure in carotid stenosis, make ischemic stroke an important occupational concern among these professionals. In this study, we aimed to evaluate the association of being exposed to hyperbaric or hypobaric conditions with carotid artery stenosis by comparing common carotid intima-media thickness (CCIMT) and blood flow velocities of cerebral arteries in divers and pilots using carotid duplex ultrasound (CDUS) and transcranial Doppler (TCD). CDUS and transtemporal TCD were performed in 29 divers, 36 pilots and 30 control participants. Medical history, blood pressure, lipid profile and blood sugar were recorded to control the previously well-known risk factors of atherosclerosis. Findings of the CDUS and TCD [including: CCIMT and blood flow velocities of internal carotid artery (ICA), common carotid artery (CCA), and middle cerebral artery (MCA)] of divers and pilots were compared with those of the control group using regression analysis models. Both right and left side CCIMT were significantly higher in divers (P < 0.05) and pilots (P < 0.05) in comparison with the control group. Carotid index [peak systolic velocity (PSV) of ICA/PSV of CCA) of divers and pilots were also higher than the control group. TCD findings were not significantly different between divers, pilots, and the control group. Increased CCIMT and carotid index in diver and pilot groups appear to be suggestive of accelerated atherosclerosis of carotid artery in these occupational groups.

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

    Directory of Open Access Journals (Sweden)

    Marković Dragan M.

    2008-01-01

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

  16. MR imaging of carotid webs

    Energy Technology Data Exchange (ETDEWEB)

    Boesen, Mari E. [University of Calgary, Department of Biomedical Engineering, Calgary (Canada); Foothills Medical Centre, Seaman Family MR Research Centre, Calgary (Canada); Eswaradass, Prasanna Venkatesan; Singh, Dilip; Mitha, Alim P.; Menon, Bijoy K. [University of Calgary, Department of Clinical Neurosciences, Calgary (Canada); Foothills Medical Centre, Calgary Stroke Program, Calgary (Canada); Goyal, Mayank [Foothills Medical Centre, Calgary Stroke Program, Calgary (Canada); University of Calgary, Department of Radiology, Calgary (Canada); Frayne, Richard [Foothills Medical Centre, Seaman Family MR Research Centre, Calgary (Canada); University of Calgary, Hotchkiss Brain Institute, Calgary (Canada)

    2017-04-15

    We propose a magnetic resonance (MR) imaging protocol for the characterization of carotid web morphology, composition, and vessel wall dynamics. The purpose of this case series was to determine the feasibility of imaging carotid webs with MR imaging. Five patients diagnosed with carotid web on CT angiography were recruited to undergo a 30-min MR imaging session. MR angiography (MRA) images of the carotid artery bifurcation were acquired. Multi-contrast fast spin echo (FSE) images were acquired axially about the level of the carotid web. Two types of cardiac phase resolved sequences (cineFSE and cine phase contrast) were acquired to visualize the elasticity of the vessel wall affected by the web. Carotid webs were identified on MRA in 5/5 (100%) patients. Multi-contrast FSE revealed vessel wall thickening and cineFSE demonstrated regional changes in distensibility surrounding the webs in these patients. Our MR imaging protocol enables an in-depth evaluation of patients with carotid webs: morphology (by MRA), composition (by multi-contrast FSE), and wall dynamics (by cineFSE). (orig.)

  17. A cardiologist in the carotids.

    Science.gov (United States)

    Gray, William A

    2004-05-05

    Carotid endarterectomy for stroke prevention has been the standard of care for 50 years in patients with extra-cranial carotid bifurcation disease. Over the past decade, carotid stenting has emerged as a viable alternative to surgery. Combined with filter embolic protection devices, both a randomized control trial (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy registry [SAPPHIRE]) as well as registry data (ACCULINK for Revascularization of Carotids in High Risk Patients registry [ARCHeR] and Registry Study to evaluate the Neuroshield Bare-Wire Cerebral Protection System and X-Act Stent in patients at high risk for Carotid Endarterectomy [SECuRITY]) have compared favorably to endarterectomy in patients at high risk for operative revascularization. Conditions associated with high operative risk included patients with significant cardiac, pulmonary, and renal disease; previous neck operation; previous radiation; and anatomically difficult surgical access. On the basis of these results, a carotid stent system approved by the Food and Drug Administration (FDA) is anticipated in 2004. Although this will be a welcome addition to endarterectomy in the armamentarium of therapeutic options for patients with carotid disease, several challenges lie ahead. Coverage and reimbursement for the carotid stenting has been severely restricted to include only those procedures performed as part of an FDA investigational device exemption trial protocol, and a national noncoverage decision will have to be reckoned with before broader coverage can be put into place (assuming FDA approval). In addition, the level of national expertise in carotid endovascular intervention is limited, and training will need to be tailored to the three specialties likely to perform the procedure: cardiology, radiology, and vascular surgery. Each of these specialties will have specific, and different, requirements for their training, further complicating the task of

  18. Clipping Surgery for Paraclinoid Carotid Aneurysm.

    Science.gov (United States)

    Horiuchi, Tetsuyoshi; Yamamoto, Yasunaga; Suzuki, Yota; Kobayashi, Masayoshi; Ichinose, Shunsuke; Hongo, Kazuhiro

    2016-01-01

    Paraclinoid carotid aneurysm is widely treated with coil embolization. However, all paraclinoid carotid aneurysms cannot be obliterated by the endovascular approach. Our direct surgical procedure was presented. The clinical data of surgically treated paraclinoid carotid aneurysms were retrospectively reviewed. One hundred ninety paraclinoid carotid aneurysms in 181 patients were directly obliterated at the Shinshu University Hospital and its affiliated hospitals between 1991 and 2013. Direct surgical repair of the paraclinoid carotid aneurysm is still useful, even in the era of endovascular treatment.

  19. Use of Suture-Mediated Closure Device in Percutaneous Direct Carotid Puncture During Chimney-Thoracic Endovascular Aortic Repair

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Gabriel, E-mail: dr.changabriel@gmail.com; Quek, Lawrence Hwee Han, E-mail: lawrence-quek@ttsh.com.sg [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore); Tan, Glenn Leong Wei, E-mail: glenn-tan@ttsh.com.sg [Tan Tock Seng Hospital, Department of General Surgery (Singapore); Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2016-07-15

    BackgroundInsertion of a carotid chimney graft during thoracic endovascular aortic repair (Ch-TEVAR) is a recognized technique to extend the proximal landing zone into the aortic arch in the treatment of thoracic aortic disease. Conventional technique requires surgical exposure of the carotid artery for insertion of the carotid chimney graft.MethodologyWe describe our experience in the use of a suture-mediated closure device in percutaneous Ch-TEVAR in four patients.ResultsSuccessful hemostasis was achieved in all four patients. No complications related to the carotid puncture were recorded.ConclusionWe conclude that using suture-mediated closure device for carotid closure appears feasible and deserves further studies as a potential alternative to conventional surgical approach.

  20. Proximal renal tubular acidosis

    Science.gov (United States)

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  1. Protective effect of posterior cerebral circulation on carotid body ischemia.

    Science.gov (United States)

    Aydin, M D; Ozkan, U; Gündoğdu, C; Onder, A

    2002-04-01

    Carotid Bodies (CB) are fed mainly by External Carotid Artery (ECA) and rarely by Internal Carotid Artery (ICA). We aimed to investigate the effect of Bilateral Common Carotid Artery ligation and BCCAL plus bilateral external carotid artery ligation on CB. This study has been conducted on 30 hybrid male rabbits. Normal CB analyses were made in six of these animals and others divided into two groups. BCCAL has been applied to the 1st group, and the 2nd group has undergone bilateral ECA ligation in addition to BCCAL. After sacrificing the animals, both sides CB were histopathologically observed. Normal and ischemic cells were counted. Bilateral Common Carotid Artery ligation did not cause total atrophy in CB. Partial reversible atrophy of CB was seen in group I, but that atrophy was found to be irreversible and all animals died within one week after ligation in group II. Retrograde blood flow mechanisms and collateral circulation impede the oligemic CB atrophy after BCCAL. But bilateral ECA ligation, in addition to BCCAL, causes both sides irreversible CB atrophy and death of animals within one week of ligation. The CB are parasympathetic paraganglia. They are chemoreceptors and located at the bifurcation zone of common carotid arteries. They are fed mainly by ECA or by its branches and rarely by ICA. As a consequence of this, BCCAL and/or ligation of external branches of common carotid artery may lead to an ischemic impairment of CB. In order to analyse the effect of carotid stenosis on CB, CB were directly examined in 6 of 30 hybrid rabbits. BCCAL was applied to twelve rabbits (group I) with ligation of both ECA in addition to BCCAL were made to the others (group II). Animals were followed up four months in group I; but all of the animals in group II died within one week. From both sides the CB were taken including the carotid bifurcation and histopathological changes were evaluated. As a result, it has been observed that incomplete ischemic lesions have developed

  2. Isolated oculomotor nerve palsy inspontaneous internal carotid artery dissection: case report Paralisia isolada do nervo oculomotor na dissecção de artéria carótida interna: relato de caso

    Directory of Open Access Journals (Sweden)

    Cynthia Resende Campos

    2003-09-01

    Full Text Available Partial oculosympathetic palsy followed by ischemic manifestations in brain or retina are the main symptoms of extracranial internal carotid artery (ICA dissection. Unusually, cranial nerves may be affected. Isolated oculomotor nerve palsy is found only rarely. CASE: We present a 50-year-old nondiabetic man who experienced acute onset of right occipital headache which spread to the right retro-orbital region. Five days later he noticed diplopia and right blurred vision sensation. Neurologic examination disclosed only impaired adduction and upward gaze of right eye, slight ipsilateral pupillary dilatation, without ptosis. Brain MRI was normal. Angiography showed right internal carotid artery dissection with forward occlusion to the base of the skull. Intravenous heparin followed by warfarin was prescribed. The headache and the oculomotor nerve deficit gradually resolved in the next three weeks. DISCUSSION: Isolated oculomotor nerve palsy is underrecognized as a clinical presentation of extracranial ICA dissection. If the angiographic evaluation is incomplete without careful study of extracranial arteries, misdiagnosis may lead to failure to initiate early treatment to prevent thromboembolic complications. For this reason we draw attention to the need for careful evaluation of cervical arteries in patients with oculomotor nerve palsy. Mechanical compression or stretching of the third nerve are possible mechanisms, but the direct impairment of the blood supply to the third nerve seems to be the most plausible explanation.A paralisia oculosimpática parcial (síndrome de Horner seguida por manifestações isquêmicas cerebrais ou retinianas são os principais sintomas da dissecção da artéria carótida interna (ACI extracraniana. O acometimento de nervos cranianos é incomum. Apenas raramente a paralisia isolada do nervo oculomotor pode ser encontrada. CASO: homem de 50 anos, sem diabetes, apresentou cefaléia occipital de início s

  3. [Ways to improve immediate and remote results of carotid endarterectomy].

    Science.gov (United States)

    Kuzhuget, R A; Karpenko, A A; Kamenskaya, O V; Ignatenko, P V; Starodubtsev, V B; Postnov, V G

    2016-01-01

    The authors analysed the results of carotid endarterectomy in a total of 469 patients with the use of simultaneous assessment of the oxygen status and collateral blood flow of the brain in order to determine feasibility of placing a temporary bypass, carried out at the Centre of Vascular and Hybrid Surgery of the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin in 2008-2012. It was shown that it is more appropriate to use a temporary bypass based on simultaneous assessment of the oxygen status and collateral blood flow of the brain: in synchronous decrease of the degree of cerebral oxygenation during tentative occlusion by more than 20% of the baseline level, or in absolute values of cerebral oxygenation below 40% and simultaneous decrease of retrograde pressure below 40 mm Hg. It was determined that simultaneous assessment of tolerance of the brain to ischaemia significantly decreased the incidence of using a temporary bypass from 16 to 3% (χ2=22.51; pcarotid endarterectomy after 4 years showed that a decrease in the number of temporary shunts did not influence cumulative survival (log-rank test; p=0.73), the incidence of stroke (log-rank test; p=0.68) and patency of the reconstructed carotid arteries in the remote period (log-rank test; p=0.70). It was determined that in the remote period of carotid endarterectomy restenoses of reconstructed carotid arteries were encountered statistically significantly less often in the group of eversion carotid endarterectomy as compared with classic carotid endarterectomy (OR 0.23; 95% CI 0.07-070; p=0.009) and with prosthetic repair of the internal carotid artery (OR 0.13; 95% CI 0.02-0.83; p=0.03).

  4. Level-Set Based Carotid Artery Segmentation for Stenosis Grading

    NARCIS (Netherlands)

    van Bemmel, C.M.; Spreeuwers, Lieuwe Jan; Viergever, M.A.; Niessen, W.J.

    2002-01-01

    A semi-automated method is presented for the determination of the degree of stenosis of the internal carotid artery (ICA) in 3D contrast-enhanced (CE) MR angiograms. Hereto, we determined the central vessel axis (CA), which subsequently is used as an initialization for a level-set based segmentation

  5. Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures

    OpenAIRE

    Thyagarajan David; Haridas Samarth; Jones Denise; Dent Colin; Evans Richard; Williams Rhys

    2009-01-01

    Aim: To assess the functional outcome following internal fixation with the PHILOS (proximal humeral interlocking system) for displaced proximal humeral fractures. Patients and Methods: We reviewed 30 consecutive patients treated surgically with the proximal humeral locking plate for a displaced proximal humeral fracture. Functional outcome was determined using the American Shoulder and Elbow Society (ASES) score and Constant Murley score. Results: Average age of the patients was 58 years...

  6. Mechanical stresses in carotid plaques using MRI-based fluid-structure interaction models

    DEFF Research Database (Denmark)

    Kock, Samuel A; Nygaard, Jens Vinge; Eldrup, Nikolaj

    2008-01-01

    fluid-structure interaction (FSI) simulations of carotid atherosclerotic plaques were performed facilitating in-vivo estimation of longitudinal internal fibrous cap stresses. The FSI simulation combined finite element analysis (FEA) with computational fluid dynamics (CFD) simulations of blood...

  7. Mapping white matter diffusion and cerebrovascular reactivity in carotid occlusive disease

    NARCIS (Netherlands)

    Conklin, J.; Fierstra, J.; Crawley, A. P.; Han, J. S.; Poublanc, J.; Silver, F. L.; Tymianski, M.; Fisher, J. A.; Mandell, D. M.; Mikulis, D. J.

    Objective: To characterize the relationship between cerebrovascular reactivity (CVR) and white matter (WM) diffusion in patients with internal carotid artery (ICA) occlusive disease. Methods: In this exploratory observational study, 41 patients with severe stenosis or occlusion of the extracranial

  8. Influence of intranasal and carotid cooling on cerebral temperature balance and oxygenation

    DEFF Research Database (Denmark)

    Nybo, Lars; Wanscher, Michael; Secher, Niels H.

    2014-01-01

    The present study evaluated the influence of intranasal cooling with balloon catheters, increased nasal ventilation, or percutaneous cooling of the carotid arteries on cerebral temperature balance and oxygenation in six healthy male subjects. Aortic arch and internal jugular venous blood temperat......The present study evaluated the influence of intranasal cooling with balloon catheters, increased nasal ventilation, or percutaneous cooling of the carotid arteries on cerebral temperature balance and oxygenation in six healthy male subjects. Aortic arch and internal jugular venous blood...

  9. [Carotid body paraganglioma in a teenager. Case report].

    Science.gov (United States)

    López-Vázquez, María Elisa; Llamas-Macías, Francisco Javier; Nuño-Escobar, César; González-Ojeda, Alejandro; Fuentes-Orozco, Clotilde; Macías-Amezcua, Michel Dassaejv

    2014-01-01

    Paragangliomas of the head and neck are neuroendocrine tumors. They have a low incidence (0.6%), are generally benign, have a poorly defined etiology, and multiple factors have been associated with their origin. Humans and other species living at high altitudes (>2000 m above sea level) are subjected to a relatively chronic hypoxia and there is a high prevalence of the development of carotid body hyperplasia and eventually paragangliomas. This disease is usually seen in patients in their 50s and in their 30s if there is a family history. We present the case of a 16 year-old female with acute pharyngitis and growing tumor located on the left side of the neck, without symptoms. A duplex Doppler ultrasound showed a solid nodular lesion on the left carotid bifurcation. A left lateral cervicotomy was performed, finding a highly vascularized tumor of 4 × 3 × 3 cm involving the common carotid from its middle third, the internal carotid up to the cranial base, and the external carotid to its upper third, and intimately related to the trachea, esophagus and cervical spine. The tumor was completely resected and the histopathological analysis corroborated the presence of paragangliomas. The publication of this case is relevant and of clinical interest due to the uncommon age of presentation and the fact that it should be considered as a diagnostic possibility.

  10. Visualization of the superior opthalmic vein on carotid angiography

    Energy Technology Data Exchange (ETDEWEB)

    Servo, A.

    1982-05-01

    Visualization of the superior ophthalmic vein (SOV) on carotid angiography was investigated based on a prospective sample of 452 carotid angiograms performed during one year. The SOV with normal blood flow direction, from facial veins into the cavernous sinus (CS), was seen on 26% and with reversed flow direction in 7% of the angiograms. A hypothesis was suggested that the anatomical variations of the moddle cerebral (MCV) and uncal veins (UV) affected the visualization. When both the MCV and UV drained into the CS, the SOV was seen in 11% of 179 angiograms. If the MCV and UV bypassed the CS, the SOV was seen on 51% of 118 angiograms. The difference is significant. Intubation of the patient increased the visualization of the SOV with normal flow direction but did not affect the visualization of the SOV with reversed flow. No SOV with normal blood flow direction was seen on selective internal carotid angiography.

  11. Correlation between aortic/carotid atherosclerotic plaques and cerebral infarction.

    Science.gov (United States)

    Wang, Baojun; Sun, Shaoli; Liu, Guorong; Li, Yuechun; Pang, Jiangxia; Zhang, Jingfen; Yang, Lijuan; Li, Ruiming; Zhang, Hui; Jiang, Changchun; Li, Xiue

    2013-08-01

    The aim of this study was to investigate the correlation between aortic/carotid atherosclerotic plaques and cerebral infarction. We examined 116 cases of cerebral infarction using transcranial Doppler ultrasound in order to exclude cerebrovascular stenosis. Transesophageal echocardiography and color Doppler ultrasound were used to detect aortic atherosclerotic plaques (AAPs) and carotid atherosclerotic plaques (CAPs). AAPs were detected in a total of 70 of the 116 cases (60.3%), including 56 with moderate/severe atherosclerotic changes (48.3%). The difference in the incidence of various types of infarction between APP severity levels was significant (PCAPs (55.2%), including 46 with unstable plaque (39.7%). The difference in the incidence of various types of infarction between CAP stability levels was significant (PCAP are significant causes of embolic infarction without stenosis in the internal carotid arteries.

  12. Case of radiation induced aneurysm of extracranial carotid artery

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-08-01

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

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

    Science.gov (United States)

    O'Brien, Haley D; Bourke, Jason

    2015-12-07

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

  14. Carotid Stenting in Patients With High Risk Versus Standard Risk for Open Carotid Endarterectomy (REAL-1 Trial).

    Science.gov (United States)

    De Haro, Joaquin; Michel, Ignacio; Bleda, Silvia; Cañibano, Cristina; Acin, Francisco

    2017-07-15

    Carotid stenting (CAS) has been mainly offered to those patients considered at "high risk" for open carotid endarterectomy based on available data from large randomized clinical trials. However, several recent studies have called medical "high risk" into question for CAS indication. The REAL-1 trial evaluated the safety and perioperative and long-term effectiveness in patients with significant carotid artery stenosis with "high-risk" criteria treated with CAS and proximal protection device (MOMA) compared with those with standard surgical-risk features. This nonrandomized double-arm registry included 125 patients (40% symptomatic), 71 (56%) with "standard-risk" and 54 (44%) with "high-risk" criteria. The primary end point was the cumulative incidence of any major adverse event, a composite of stroke, myocardial infarction, and death within 30 days after the intervention or ipsilateral stroke after 30 days and up to 4 years. There was no significant difference in primary end point rate at 30 days between patients at "standard risk" and those with "high risk" (1.4% vs 1.9% respectively; hazard ratio for "standard risk" 1.1; 95% CI 0.8 to 1.2, p = 0.77) nor estimated 4-year rate of ipsilateral stroke (1.3% vs 1.8%; hazard ratio for "standard risk" 1.05, 95% CI 0.86 to 1.14, p = 0.9). In conclusion, 4-year postprocedure results demonstrated that CAS with proximal device (MOMA) is safe and effective for patients with and without "high-risk" for carotid endarterectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. The influence of obesity on the assessment of carotid intima-media thickness.

    Science.gov (United States)

    Gállego Pérez-Larraya, Jaime; Irimia, Pablo; Martínez-Vila, Eduardo; Barba, Joaquín; Guembe, María Jesús; Varo, Nerea; Castellano, José María; Viñes, José Javier; Díez, Javier

    2012-10-01

    The assessment of carotid intima-media thickness (CIMT) may improve cardiovascular risk prediction. The optimal protocol for CIMT measurement is unclear. CIMT may be measured in the common carotid artery (CCA), carotid bifurcation (CB), and internal carotid artery (ICA), but measurements from CB and ICA are more difficult to obtain. We studied the influence of body mass index (BMI) and atheroma plaques on the capacity to obtain CIMT measurements at different carotid sites. Using an automatic system, CIMT was measured in 700 subjects aged 45-75, in the near and far walls of CCA, CB, and ICA bilaterally. The presence of atheroma plaques, BMI and vascular risk factors were recorded. CIMT measurements in CCA were possible in all except one subject. It was not possible to obtain CIMT measurements at CB or ICA in 24.1% of normal weight and 58.8% of obese subjects. The likelihood of obtaining CIMT measurement at all carotid sites decreased as the BMI increased. Atheroma plaques in a carotid segment did not preclude CIMT measurement at this site. CIMT measurements in distal carotid segments are more challenging in obese subjects. Measuring CIMT at CCA remains feasible in obese subjects and should be the primary endpoint in these subjects. Nevertheless, CB and ICA measurements, when feasible, would improve risk classification. Copyright © 2012 Wiley Periodicals, Inc.

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

    LENUS (Irish Health Repository)

    Edmundson, S P

    2012-01-31

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

  17. A case of Behcet's disease with aneurysms of common carotid arteries and abdominal aorta

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Yeon Myung; Chang, Kee Hyun; Choi, Sung Jae [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1984-06-15

    One case of Behcet's disease with multiple aneurysms in both common carotid arteries and abdominal aorta is presented with brief review of the literatures. A 26-year-old woman had slowly enlarging pulsatile masses in both sides of neck and recurrent ulcerations in oral cavity and genitalia. One day prior to admission, aphasia, right facial nerve palsy and right hemiplegia suddenly developed. Brain CT showed acute infarction in left basal ganglia. Both Carotid Angiography and abdominal Aortography demonstrated multiple aneurysms in both common carotid arteries and abdominal aorta with organizing thrombi and thromboembolism of internal carotid artery.

  18. The carotid bodies in spontaneously hypertensive (SHR) and normotensive rats--a study concerning size, location and blood supply.

    Science.gov (United States)

    Habeck, J O; Honig, A; Pfeiffer, C; Schmidt, M

    1981-01-01

    Size, anatomical position and blood supply of the carotid bodies were studied by light microscopic methods in spontaneously hypertensive rats of the Okamoto-strain (SHR) and in normotensive Wistar rats (NWR) of a random-bred strain. In both groups of animals the single carotid body was usually supplied by only one glomic artery which most frequently derived from the external carotid artery, more rarely from the occipital artery and very seldom from the internal carotid artery. In general the carotid bodies were of ellipsoide shape and compact structure and as a rule closely located to the internal carotid artery. In the NWR at the origins of their glomic arteries almost regularly circular intraarterial cushions were found; in the SHR such cushions were only seen in a few cases, and if so than they were less clearly developed. In the SHR, never in the NWR, within the carotid body the lumen of some branches of the glomic arteries was narrowed by pad-like structures. When compared with the NWR the SHR showed enlarged carotid bodies and a respiratory alcalosis, suggesting that systemic hypertension leads to morphologically and functionally detectable alterations of both carotid body structure and function.

  19. Dynamic cerebral autoregulation is unrelated to decrease in external carotid artery blood flow during acute hypotension in healthy young men

    DEFF Research Database (Denmark)

    Ogoh, Shigehiko; Sørensen, Henrik; Hirasawa, Ai

    2016-01-01

    New Findings: What is the central question of this study? Dynamic cerebral autoregulation (CA) is impaired by sympathetic blockade, and the external carotid artery (ECA) vascular bed may prevent adequate internal carotid artery blood flow. We examined whether α1-receptor blockade-induced attenuat...

  20. Cardiovascular magnetic resonance in carotid atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Chen Huijun

    2009-12-01

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

  1. Carotid plaque thickness and carotid plaque burden predict future cardiovascular events in asymptomatic adult Americans

    DEFF Research Database (Denmark)

    Sillesen, Henrik; Sartori, Samantha; Sandholt, Benjamin

    2018-01-01

    Introduction: Prediction of cardiovascular events improves using imaging, i.e. coronary calcium score and ultrasound assessment of carotid plaque. This study analysed the predictive value of two ultrasound measures of carotid plaque size: carotid plaque thickness and carotid and intima......-media thickness (IMT). Methods and results: A total of 6102 asymptomatic persons underwent assessment of conventional risk factors and imaging by carotid ultrasound. Carotid plaque burden (cPB) and maximum carotid plaque thickness (cPTmax) were measured from 'cross-sectional sweep' video acquisition...

  2. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.

    2005-01-01

    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  3. Biomechanical evaluation of a new fixation technique for internal fixation of three-part proximal humerus fractures in a novel cadaveric model.

    Science.gov (United States)

    Brianza, Stefano; Plecko, Michael; Gueorguiev, Boyko; Windolf, Markus; Schwieger, Karsten

    2010-11-01

    The optimal surgical treatment for displaced proximal humeral fractures is still controversial. A new implant for the treatment of three-part fractures has been recently designed. It supplements the existing Expert Humeral Nail with a locking plate. We developed a novel humeral cadaveric model and the existing implant and the prototype were biomechanically compared to determine their ability in maintaining interfragmentary stability. The bone mineral density of eight pairs of cadaveric humeri was assessed and a three-part proximal humeral fracture was simulated with a Greater Tuberosity osteotomy and a surgical neck wedge ostectomy. The specimens were randomly assigned to either treatment. A bone anchor simulated part of a rotator cuff tendon pulling on the Greater Tuberosity. Specimens were initially tested in axial compression and afterward with a compound cyclic load to failure. An optical 3D motion tracking system continuously monitored the relative interfragmentary movements. The specimen stabilized with the prototype demonstrated higher stiffness (P=0.036) and better interfragmentary stability (P valuesplate assembly must be confirmed in vivo but the current study provides a biomechanical rationale for its use in the treatment of three-part proximal humeral fractures. The improved stability could be advantageous in particular when medial buttress is missing, even in osteoporotic bone. Copyright © 2010 Elsevier Ltd. All rights reserved.

  4. Arterial function of carotid and brachial arteries in postmenopausal vegetarians

    Directory of Open Access Journals (Sweden)

    Su T

    2011-08-01

    Full Text Available Ta-Chen Su1, Pao-Ling Torng2, Jiann-Shing Jeng3, Ming-Fong Chen1, Chiau-Suong Liau1,41Division of Cardiology, Department of Internal Medicine, 2Department of Obstetrics and Gynecology, 3Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, 4Cardiovascular Center, Taipei Buddist Tzu-Chi Hospital, Hsin-Dian, Taipei, TaiwanBackground: Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited.Methods: This study investigated arterial function in vegetarianism by comparing 49 healthy postmenopausal vegetarians with 41 age-matched omnivores. The arterial function of the common carotid artery was assessed by carotid duplex, while the pulse dynamics method was used to measure brachial artery distensibility (BAD, compliance (BAC, and resistance (BAR. Fasting blood levels of glucose, lipids, lipoprotein (a, high-sensitivity C-reactive protein, homocysteine, and vitamin B12 were also measured.Results: Vegetarians had significantly lower serum cholesterol, high-density and low-density lipoprotein, and glucose compared with omnivores. They also had lower vitamin B12 but higher homocysteine levels. Serum levels of lipoprotein (a and high-sensitivity C-reactive protein were no different between the two groups. There were no significant differences in carotid beta stiffness index, BAC, and BAD between the two groups even after adjustment for associated covariates. However, BAR was significantly lower in vegetarians than in omnivores. Multiple linear regression analysis revealed that age and pulse pressure were two important determinants of carotid beta stiffness index and BAD. Vegetarianism is not associated with better arterial elasticity.Conclusion: Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than

  5. Asymptomatic carotid arterial stenosis - population based screening

    NARCIS (Netherlands)

    2010-01-01

    Screening for asymptomatic carotid artery stenosis in the general population is discussed in many countries because of the benefits of carotid endarterectomy in the three trials. Many factors influence the cost-effectiveness of screening. These factors are the prevalence of carotid stenosis, the

  6. Carotid artery stenting : a 2009 update

    NARCIS (Netherlands)

    Zeebregts, Clark J.; Meerwaldt, Robbert; Geelkerken, Robert H.

    2009-01-01

    Purpose of review Carotid endarterectomy (CEA) is is still considered the gold standard in the treatment of patients with significant carotid stenosis and has proven its value over the past decades. Endovascular techniques have evolved, and carotid artery stenting (CAS) is challenging CEA to become

  7. The Interaction Between Carotid Baroreceptor and Chemoreceptor ...

    African Journals Online (AJOL)

    Hypertension and hypoxia often occur together in the clinical setting implying that the carotid baroreceptor and carotid chemoreceptors are affected simultaneously. This work was designed to study the effects of increased reflex sympathetic activity following carotid baroreceptor and chemoreceptor stimulation on reflex ...

  8. Carotid endarterectomy with regional anesthesia.

    Science.gov (United States)

    Harbaugh, R E; Pikus, H J

    2001-09-01

    The senior author (REH) has changed his technique for performing carotid endarterectomy from the use of general anesthesia to the use of cervical block anesthesia. Because a randomized study was not performed, it is difficult to separate effects of increased surgical experience from those caused by a change in anesthetic regimen. Nonetheless, there has been a substantial decrease in complications, length of hospital stay, and costs concomitant with the change to regional anesthesia; we think there is a causal relationship. The use of cervical block anesthesia has practically eliminated the non-stroke-related complications associated with carotid endarterectomy in our practice. The technique for performing carotid endarterectomy under cervical block anesthesia is described in detail.

  9. Brain Oxygen Supply Parameters in the Risk Assessment of Cerebral Complications During Carotid Endarterectomy.

    Science.gov (United States)

    Kamenskaya, Oksana V; Loginova, Irina Yu; Lomivorotov, Vladimir V

    2017-06-01

    To determine whether preoperative regional cerebral oxygen saturation (rSO2) and the decrease in rSO2 during carotid clamping were predictive of the risk for neurologic complications in carotid endarterectomy and to determine the cutoff values of the studied parameters. Cohort, prospective, nonrandomized trial. Research Institute of Circulation Pathology, Novosibirsk, Russia. The study comprised 466 adults who underwent carotid endarterectomy since 2012. None. Patient characteristics, postoperative complications, and brain oxygen supply during carotid endarterectomy were analyzed. The primary endpoints were the perioperative and early postoperative neurologic complications. Ischemic stroke was diagnosed in 1.5% of patients, and cognitive disorders were reported in 2.6% of patients. Preoperative rSO2 of 50% was the cutoff value for the prediction of stroke outcome after carotid endarterectomy, with a sensitivity of 90.7% and specificity of 66.7%. A 20% decrease in rSO2 during temporary carotid clamping was the cutoff value for the prediction of stroke, with a sensitivity of 86.0% and specificity of 57.1%, and for the prediction of cognitive disorders, with a sensitivity of 88.1% and specificity of 58.3%. Preoperative rSO2 less than 50% and a decrease in rSO2 of at least 20% during temporary carotid artery clamping caused a significant increase in the hospitalization period. A 20% or more decrease in rSO2 during temporary internal carotid artery clamping during carotid endarterectomy caused a 10-fold increased risk of ischemic stroke and an 8-fold increased risk of cognitive disorders, whereas preoperative rSO2 less than 50% resulted in a 6-fold increased risk of ischemic stroke in the perioperative and early postoperative periods of carotid endarterectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra for the early recovery of urinary continence after retropubic radical prostatectomy: a prospective case-control study.

    Science.gov (United States)

    Brunocilla, Eugenio; Schiavina, Riccardo; Pultrone, Cristian Vincenzo; Borghesi, Marco; Rossi, Martina; Cevenini, Matteo; Martorana, Giuseppe

    2014-02-01

    To evaluate the influence of preservation of the muscular internal sphincter and proximal urethra on continence recovery after radical prostatectomy. This was a prospective single-center, case-control study. A total of 40 consecutive patients with organ-confined prostate cancer were submitted to radical prostatectomy with the preservation of the muscular internal sphincter and the proximal urethra (group 1), and their outcomes were compared with those of 40 patients submitted to a standard procedure (group 2). Continence rates were assessed using a self-administrated questionnaire at 3, 7 and 30 days, and 3 and 12 months after removal of the catheter. Group 1 had a faster recovery of early continence than group 2 at day 3 (45% vs 22%; P = 0.029) and at day 7 (75% vs 50%; P = 0.018). Considering the number of pads, group 1 had a faster recovery of continence at 3, 7 and 30 days, and also had less incidence of severe incontinence. There was no statistically significant difference in terms of continence at 3 and 12 months among the two groups. Multivariate logistic regression analysis showed that surgical technique and young age were significantly associated with earlier time to continence at 3 and 7 days. The two groups had no significant differences in terms of surgical margins. Our modified technique of radical retropubic prostatectomy with preservation of the smooth muscular internal sphincter, as well as of the proximal urethra during bladder neck dissection, results in a significantly increased urinary continence at 3, 7 and 30 days after catheter removal, with a minor incidence of severe incontinence. The technique is also oncologically safe, and it does not increase the operative duration of the procedure. © 2013 The Japanese Urological Association.

  11. Noninvasive characterization of carotid plaque strain.

    Science.gov (United States)

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

    2017-06-01

    Current risk stratification of internal carotid artery plaques based on diameter-reducing percentage stenosis may be unreliable because ischemic stroke results from plaque disruption with atheroembolization. Biomechanical forces acting on the plaque may render it vulnerable to rupture. The feasibility of ultrasound-based quantification of plaque displacement and strain induced by hemodynamic forces and their relationship to high-risk plaques have not been determined. We studied the feasibility and reliability of carotid plaque strain measurement from clinical B-mode ultrasound images and the relationship of strain to high-risk plaque morphology. We analyzed carotid ultrasound B-mode cine loops obtained in patients with asymptomatic ≥50% stenosis during routine clinical scanning. Optical flow methods were used to quantify plaque motion and shear strain during the cardiac cycle. The magnitude (maximum absolute shear strain rate [MASSR]) and variability (entropy of shear strain rate [ESSR] and variance of shear strain rate [VSSR]) of strain were combined into a composite shear strain index (SSI), which was assessed for interscan repeatability and correlated with plaque echolucency. Nineteen patients (mean age, 70 years) constituting 36 plaques underwent imaging; 37% of patients (n = 7) showed high strain (SSI ≥0.5; MASSR, 2.2; ESSR, 39.7; VSSR, 0.03) in their plaques; the remaining clustered into a low-strain group (SSI <0.5; MASSR, 0.58; ESSR, 21.2; VSSR, 0.002). The area of echolucent morphology was greater in high-strain plaques vs low-strain plaques (28% vs 17%; P = .018). Strain measurements showed low variability on Bland-Altman plots with cluster assignment agreement of 76% on repeated scanning. Two patients developed a stroke during 2 years of follow-up; both demonstrated high SSI (≥0.5) at baseline. Carotid plaque strain is reliably computed from routine B-mode imaging using clinical ultrasound machines. High plaque strain correlates with known

  12. The prognostic role of carotid plaque ultrasonography in cardiac damage after carotid endarterectomy: carotid plaque and cardiac risk.

    Science.gov (United States)

    Galyfos, George; Toutouzas, Konstantinos P; Benetos, George; Konstadoulakis, Manousos; Theodorou, Dimitrios; Katsaragakis, Stilianos; Stefanadis, Christodoulos; Zografos, Georgios; Filis, Konstantinos

    2016-10-01

    This study evaluates the correlation of ultrasound determined carotid plaque morphology with coronary risk and cardiac damage after carotid endarterectomy. Fifty patients (in a series of 162) scheduled for carotid endarterectomy had the indication for coronary CT-angiography preoperatively and were included in this study. Patients were classified according to ultrasonographic characteristics of carotid plaque. The Duke Criteria were used to assess the degree of coronary risk (low, medium and high risk). Cardiac damage after carotid endarterectomy was evaluated based on symptoms, cardiac Troponin I measurement and electrocardiographic findings. There were no deaths, strokes or symptomatic myocardial infarctions postoperatively (30-day results). Ten patients (20%) showed asymptomatic cardiac damage postoperatively. Cardiac damage after surgery did not show any difference between the three cardiac risk groups. Echogenic and specifically Type IV carotid artery plaques (Gray-Weale Criteria) were associated with high cardiac risk preoperatively and with postoperative cardiac damage. The degree of carotid artery stenosis, and echolucent carotid plaques were not associated with postoperative cardiac damage. Asymptomatic postoperative cardiac damage occurs often after carotid endarterectomy and presents independently from coronary risk. Carotid plaques of higher echogenicity are associated with severity of coronary artery disease and cardiac damage after carotid endarterectomy.

  13. Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature”

    Directory of Open Access Journals (Sweden)

    Giannoudis Peter V

    2012-12-01

    Full Text Available Abstract Background The purpose of this study is to evaluate the functional outcome, union and complication rates after surgical treatment of unstable or displaced proximal humeral fractures using the Polarus intramedullary nail, by reviewing our institutional experience and the relevant current literature. Methods Twenty-seven patients were treated operatively for proximal humeral fracture using the Polarus nail. Fractures were classified according to Neer’s classification. A number of parameters including patient demographics, mechanism of injury, operative time, time to union and complications were recorded. Functional outcome was evaluated using the Constant Shoulder Score. A comparison among functional outcomes in patients >60 years in relation to the younger ones was performed. Moreover, a review of the literature was carried out to evaluate the overall union and complication rates. Results Two patients lost to follow-up were excluded from the analysis. For the twenty-five patients (mean age: 61 years, the mean follow-up was 36 months. There were 7 complications (28%, including one fixation failure, four protruded screws, one superficial infection and one case of impingement. The union rate was 96% (mean time to union: 4.2 months. The mean Constant score was 74.5 (range: 48–89. Patients under the age of 60 had a better functional outcome compared to patients >60 years of age (p0.05. From the literature review and from a total of 215 patients treated with a Polarus nail, the mean union rate was 95.8%, the overall reported complication rate, including both minor and major complications, ranged widely from 9.3% up to 70%. Conclusions The Polarus nail was found to be an effective implant for stabilisation of proximal humeral fractures. Functional outcome is for the vast majority of the cases excellent or good, but in elderly patients a lower Constant score can be expected.

  14. Carotid cavernous fistula after elective carotid endarterectomy: Case report

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    Andres Asser

    2014-12-01

    This is a case to illustrate a rare complication of carotid artery surgery. The patient had atherosclerotic vessel damage of ICA visible on earlier CT scans. This combined with abrupt increase of transmural pressure due to the revascularization procedure could possibly lead to arterial wall rupture and fistula formation.

  15. Experimental model for creation of carotid artery aneurysms in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Hyun; Han, Moon Hee; Yu, In Kyu; Lee, Sang Hyun; Chang, Kee Hyun [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-11-01

    To describe the detailed technique for producing experimental carotid aneurysms in dogs and the success rate, cause of failure and remedy, based on our experience. Fourteen male dogs weighing 12-15kg were anesthetized with inhalation of 1-2% halothane and 50% nitrous oxide. Each surgical procedure was performed under sterile condition with the aid of an operating microscope. A paramidline incision 7-8cm in length was made parallel to and medial to the external jugular vein in the dog's neck. The external jugular vein was harvested as a 1cm vein pouch by ligation and division of the proximal and distal ends. The ipsilateral common carotid artery was exposed and clamped at both ends by a vascular clamp. A 5-mm long elliptical arteriotomy was made at the mid portion of the artery, and then end to side anastomosis between the artery and vein sac was performed by using interrupted 7-0 monofilament prolene sutures. Carotid arteriography or Doppler sonography was performed 1-6 weeks after aneurysm construction. Twenty experimental aneurysms were constructed, and 17 aneurysms were patent on follow up study, but one dog with two aneurysms died from hemorrhagic pneumonia 17 days after surgery. The overall patency rate was 75%. We demonstrated the feasibility of creating experimental aneurysm models in the dog and expect that the technique presented will help to avoid failure in the construction of aneurysms.

  16. Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus: Does Age Really Matter?

    Science.gov (United States)

    Grawe, Brian; Le, Toan; Lee, Thomas; Wyrick, John

    2012-03-01

    Treatment of complex fracture patterns of the proximal humerus continues to be a challenging and controversial clinical scenario. The aim of this study was to report on the outcomes of complex displaced 3- and 4-part fractures of the proximal humerus treated with locked plating and compare the functional results of patients on the basis of age at time of injury. A retrospective review was completed to identify patients whom had sustained a 3- or 4-part fracture of the proximal humerus (Neer classification), treated surgically with locked compression plating. Patients were recruited for a final follow-up, with clinical (Constant and Disabilities of the Arm, Shoulder, Hand [DASH] scores) and radiographic outcome analysis. Results were compared (t test and Wilcoxon test) with fracture type (3- vs 4-part) and patient age at time of fracture (65years) as the primary outcome measure. The presence or absence of a complication and presence or absence of a concomitant osseous injury at the time of presentation were evaluated as secondary outcome measures, in regard to overall functional results of the treatment in question. Complications were defined as posttraumatic osteoarthritis, avascular necrosis of the humeral head, and screw cutout with chondrolysis. The null hypothesis being that age of the patient at the time of injury would not greatly affect functional outcome measurements. Forty-five fractures were identified in 45 patients, with 31 three-part fractures and 14 four-part fractures, and 17 patients were available for final follow-up (9 three-part and 8 four-part). Twelve patients were identified as under the age of 65 years and were compared with 5 patients who were identified as older than 65 years of age. The relative Constant score, at final follow-up, for those under the age of 65 was 88.58, while the score for those above the age of 65 was 82.5. In a similar fashion, the DASH score for those younger than 65 was 11.67, while the score for those older than 65

  17. Targeted particle tracking in computational models of human carotid bifurcations.

    Science.gov (United States)

    Marshall, Ian

    2011-12-01

    A significant and largely unsolved problem of computational fluid dynamics (CFD) simulation of flow in anatomically relevant geometries is that very few calculated pathlines pass through regions of complex flow. This in turn limits the ability of CFD-based simulations of imaging techniques (such as MRI) to correctly predict in vivo performance. In this work, I present two methods designed to overcome this filling problem, firstly, by releasing additional particles from areas of the flow inlet that lead directly to the complex flow region ("preferential seeding") and, secondly, by tracking particles both "downstream" and "upstream" from seed points within the complex flow region itself. I use the human carotid bifurcation as an example of complex blood flow that is of great clinical interest. Both idealized and healthy volunteer geometries are investigated. With uniform seeding in the inlet plane (in the common carotid artery (CCA)) of an idealized bifurcation geometry, approximately half the particles passed through the internal carotid artery (ICA) and half through the external carotid artery. However, of those particles entering the ICA, only 16% passed directly through the carotid bulb region. Preferential seeding from selected regions of the CCA was able to increase this figure to 47%. In the second method, seeding of particles within the carotid bulb region itself led to a very high proportion (97%) of pathlines running from CCA to ICA. Seeding of particles in the bulb plane of three healthy volunteer carotid bifurcation geometries led to much better filling of the bulb regions than by particles seeded at the inlet alone. In all cases, visualization of the origin and behavior of recirculating particles led to useful insights into the complex flow patterns. Both seeding methods produced significant improvements in filling the carotid bulb region with particle tracks compared with uniform seeding at the inlet and led to an improved understanding of the complex

  18. Bayes Clustering and Structural Support Vector Machines for Segmentation of Carotid Artery Plaques in Multicontrast MRI

    Directory of Open Access Journals (Sweden)

    Qiu Guan

    2012-01-01

    Full Text Available Accurate segmentation of carotid artery plaque in MR images is not only a key part but also an essential step for in vivo plaque analysis. Due to the indistinct MR images, it is very difficult to implement the automatic segmentation. Two kinds of classification models, that is, Bayes clustering and SSVM, are introduced in this paper to segment the internal lumen wall of carotid artery. The comparative experimental results show the segmentation performance of SSVM is better than Bayes.

  19. Carotid revascularization and medical management for asymptomatic carotid stenosis: Protocol of the CREST-2 clinical trials.

    Science.gov (United States)

    Howard, Virginia J; Meschia, James F; Lal, Brajesh K; Turan, Tanya N; Roubin, Gary S; Brown, Robert D; Voeks, Jenifer H; Barrett, Kevin M; Demaerschalk, Bart M; Huston, John; Lazar, Ronald M; Moore, Wesley S; Wadley, Virginia G; Chaturvedi, Seemant; Moy, Claudia S; Chimowitz, Marc; Howard, George; Brott, Thomas G

    2017-10-01

    Rationale Trials conducted decades ago demonstrated that carotid endarterectomy by skilled surgeons reduced stroke risk in asymptomatic patients. Developments in carotid stenting and improvements in medical prevention of stroke caused by atherothrombotic disease challenge understanding of the benefits of revascularization. Aim Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) will test whether carotid endarterectomy or carotid stenting plus contemporary intensive medical therapy is superior to intensive medical therapy alone in the primary prevention of stroke in patients with high-grade asymptomatic carotid stenosis. Methods and design CREST-2 is two multicenter randomized trials of revascularization plus intensive medical therapy versus intensive medical therapy alone. One trial randomizes patients to carotid endarterectomy plus intensive medical therapy versus intensive medical therapy alone; the other, to carotid stenting plus intensive medical therapy versus intensive medical therapy alone. The risk factor targets of centrally directed intensive medical therapy are LDL cholesterol medical therapy alone arm is 4.8% higher or 2.8% lower than an anticipated 3.6% rate in the revascularization arm. Discussion Management of asymptomatic carotid stenosis requires contemporary randomized trials to address whether carotid endarterectomy or carotid stenting plus intensive medical therapy is superior in preventing stroke beyond intensive medical therapy alone. Whether carotid endarterectomy or carotid stenting has favorable effects on cognition will also be tested. Trial registration United States National Institutes of Health Clinicaltrials.gov NCT02089217.

  20. Mechanical Stresses in Carotid Plaques

    DEFF Research Database (Denmark)

    Samuel, Samuel Alberg

    simulationer, som tillod beregning af longitudinelle stress-niveauer i den fibrøse kappe. Afhandlingen indeholder tre artikler, som beskriver denne metode. Den første; “Mechanical Stresses in Carotid Plaques using MRI-Based Fluid Structure Interaction Models”, beskriver i detaljer metoden til at danne de...

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

    Directory of Open Access Journals (Sweden)

    Zahra Allameh

    2013-01-01

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

  2. 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.)

  3. [Revascularization of the carotid and vertebral arteries in the elderly].

    Science.gov (United States)

    Illuminati, G; Bezzi, M; D'Urso, A; Giacobbi, D; Ceccanei, G; Vietri, F

    2004-01-01

    From January 1994 to July 2004, 323 patients underwent 348 revascularization of carotid bifurcation for atherosclerotic stenoses. Eighty eight patients (group A) were 75 year-old or older, whereas 235 (group B) were younger than 75 years. Postoperative mortality/neurologic morbidity rate was 1% in group A, and 1.4% in group B. At 5 years, patency and freedom from symptoms/stroke were, respectively, 91% and 92% in group A, and 89% and 91% in group B. None of these differences was statistically significant. In the same time period, 26 internal carotid arteries were revascularized in 24 patients, 75 or more aged, for a symptomatic kinking. Postoperative mortality/morbidity rate was absent, whereas, at 5 years, patency and freedom from symptoms/stroke were, respectively, 88% and 92%. Twelve vertebral arteries were revascularized in 12 patients, 75 or more aged, for invalidating symptoms of vertebrobasilar insufficiency. Postoperative mortality/neurologic morbidity rate was absent. In one case postoperative recurrence of symptoms occurred, despite a patent revascularization. Patency and freedom from symptoms/stroke were 84% and 75%, at 5 years. Revascularization of carotid and vertebral arteries in the elderly can be accomplished with good results, superposable to those of standard revascularization of carotid bifurcation in a younger patients' population.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-08-15

    Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication.

  5. Multiset proximity spaces

    Directory of Open Access Journals (Sweden)

    A. Kandil

    2016-10-01

    Full Text Available A multiset is a collection of objects in which repetition of elements is essential. This paper is an attempt to explore the theoretical aspects of multiset by extending the notions of compact, proximity relation and proximal neighborhood to the multiset context. Examples of new multiset topologies, open multiset cover, compact multiset and many identities involving the concept of multiset have been introduced. Further, an integral examples of multiset proximity relations are obtained. A multiset topology induced by a multiset proximity relation on a multiset M has been presented. Also the concept of multiset δ- neighborhood in the multiset proximity space which furnishes an alternative approach to the study of multiset proximity spaces has been mentioned. Finally, some results on this new approach have been obtained and one of the most important results is: every T4- multiset space is semi-compatible with multiset proximity relation δ on M (Theorem 5.10.

  6. Ultrasonographic and histological evaluation of the effects of long-term carotid catheterization on cardiac function in NMRI mice

    DEFF Research Database (Denmark)

    Teilmann, Anne C; Thomsen, Morten B; Ihms, Elizabeth A

    2018-01-01

    Catheterization of laboratory mice is commonly performed in biomedical research to infuse substances and for blood sampling. One approach is to catheterize the right common carotid artery and advance the catheter until the tip is positioned in the aorta or the proximal brachiocephalic trunk. Owing...

  7. Atherosclerotic plaque in carotid arteries in systemic lupus erythematosus: frequency and associated risk factors

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    Alexandre Wagner Silva de Souza

    Full Text Available CONTEXT AND OBJECTIVE: Atherosclerotic disease is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE patients. No previous study has estimated carotid disease prevalence in such patients in Brazil. The aim was to evaluate the prevalence of atherosclerotic plaque in carotid arteries, in SLE patients and controls, and to verify possible associations between risk factors and carotid plaque. DESIGN AND SETTING: Cross-sectional study, at Universidade Federal de São Paulo - Escola Paulista de Medicina. METHODS: Carotid plaque prevalence was assessed by B-mode ultrasound in 82 female SLE patients of mean age 34.0 years and 62 controls of mean age 35.7 years. Plaque was defined as a distinct area of hyperechogenicity and/or focal protrusion of the vessel wall into the lumen. Risk factors for coronary disease and SLE-related variables were determined. RESULTS: 50% of patients and 29% of controls presented carotid plaque. Older age, longer disease duration, higher Systemic Lupus International Collaborating Clinics (SLICC score, higher levels of low-density lipoprotein and greater diabetes, obesity, premature ovarian failure and family history of coronary artery disease were found in patients with carotid plaque than in those without plaque. Patients with plaque were younger than controls with plaque. SLE diagnosis, obesity, older age, higher SLICC score and longer disease duration were independent risk factors for carotid plaque. CONCLUSION: Young patients with SLE present higher prevalence of carotid plaque than controls. SLE diagnosis was a significant risk factor for carotid atherosclerosis.

  8. Correlation analysis between the carotid artery ather osclerosis severity of patients with lacunar infarct and the level of serum uric acid, high-sensitivity C-reactive protein

    Directory of Open Access Journals (Sweden)

    WANG Shu

    2013-01-01

    Full Text Available Background Nowadays, clinical practice shows that the number of patients with cerebral infarction increases year by year in young and middle-aged adults with unclear causes. This paper aims to investigate the correlation between the level of serum uric acid (UA, high-sensitivity C-reactive protein (hsCRP and the degree of carotid atherosclerosis by detecting the level of UA, hsCRP and carotid intima-media thickness (IMT in young and middle-aged patients with lacunar infarct. Methods By using Holland Philips HT-11 color Doppler ultrasonic diagnostic apparatus with linear type probe and 7.50MHz frequency, IMT of end-diastolic distal and bifurcation of arteria carotis communis and proximal internal carotid artery were measured respectively on 186 patients with definitely diagnosed lacunar infarct. As a result, average values were taken as the IMT values. IMT < 1.00 mm was regarded as negative result and 1.00 mm ≤IMT < 1.20 mm was thickening of carotid artery intima. Carotid artery plaque formation was regarded with echo structure existing in the lumen or abnormal blood flow deficits into the lumen, or local IMT ≥1.20 mm at vertical and horizontal scan. At the same time, the levels of UA and hsCRP were detected, and correlation analysis was made between them and IMT. Results The values of UA, hsCRP and IMT in the case group were higher than that in the control group (P = 0.000. The differences among the case subgroups including IMT thickening group, plaque formation group and IMT normal group were statistically significant (P < 0.01, for all. There was linear correlation between the levels of UA, hsCRP and IMT ( r = 0.923, P = 0.000; r = 0.955, P = 0.008. Conclusion UA and hsCRP involve in the formation of atherosclerosis plaque and play an important role in the first-onset lacunar infarct patients without hypertension and other risk factors.

  9. Mechanisms for the proximity between the perspectives of the Shiite jurisprudence and the International Human Rights System regarding Corporal Punishment of Children

    Directory of Open Access Journals (Sweden)

    Seyed Javad Hoseynikhah

    2011-11-01

    Full Text Available One of the challenging issues which families and societies face in rearing and upbringing is how to treat children’s misbehavior In Islamic perspective, especially Shiite jurisprudence, which is considered to be the main source of legislation in the Islamic republic of Iran, in addition to paying special attention to children’s education and their development and happiness, much emphasis has been put on their dignity, being kind to them, their expedience, preventing any harm and injury to them. Also, it is prohibited to punish and abuse them. However, in some cases corporal punishment of children is permissible and permitted because of their expedience. On the contrary, the international human rights system seeks to eliminate the use of all forms of corporal punishment from all societies. Using different types of instruments and documents, it tries to promote this view. It considers corporal punishment as being against the child’s human dignity and physical integrity. Furthermore, sometimes it is considered inhumane, cruel and humiliating. Therefore, initially and apparently, the two approaches appear to be contradictory. Thus, we try to explain the true nature of the two approaches and to provide some solutions for their proximity considering the interests of the society as well as children's expedience, interests, education, rights and development. از جمله‌ی مسائل حسّاس و مهمّ تربیتی که خانواده‌ها و جوامع بشری دچار آن هستند، چگونگی برخورد با اعمال و کردارهای ناروای کودکان است. در دیدگاه اسلامی و به خصوص فقه سترگ شیعه که در کشور ما منبع الهام‌بخش جهت قانونگذاری محسوب می‌گردد، علاوه بر توجّه خاص به امور تربیتی کودکان و رشد و سعادت آنان، بر کرامت کودکان، مهروزی و مصلحت

  10. Carotid endarterectomy and carotid artery stenting utilization trends over time.

    Science.gov (United States)

    Skerritt, Matthew R; Block, Robert C; Pearson, Thomas A; Young, Kate C

    2012-03-29

    Carotid endarterectomy (CEA) has been the standard in atherosclerotic stroke prevention for over 2 decades. More recently, carotid artery stenting (CAS) has emerged as a less invasive alternative for revascularization. The purpose of this study was to investigate whether an increase in stenting parallels a decrease in endarterectomy, if there are specific patient factors that influence one intervention over the other, and how these factors may have changed over time. Using a nationally representative sample of US hospital discharge records, data on CEA and CAS procedures performed from 1998 to 2008 were obtained. In total, 253,651 cases of CEA and CAS were investigated for trends in utilization over time. The specific data elements of age, gender, payer source, and race were analyzed for change over the study period, and their association with type of intervention was examined by multiple logistic regression analysis. Rates of intervention decreased from 1998 to 2008 (P use displayed a significant downward trend (P use over the study period (P time, the proportion of white patients who received intervention decreased significantly (P gender, white race, and earlier in the study period were significant positive predictors of CEA use. Rates of carotid revascularization have decreased over time, although this has been the result of a reduction in CEA despite an overall increase in CAS. Among the specific patient factors analyzed, age, gender, race, and time were significantly associated with the utilization of these two interventions.

  11. Screening with doppler ultrasound for carotid artery stenosis in patients with stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Kristensen, Tatiana; Hovind, Peter; Iversen, Helle K

    2017-01-01

    INTRODUCTION: Carotid endarterectomy of symptomatic internal carotid artery stenosis in patients with stroke or transient ischaemic attack reduces the risk of recurrent stroke, particularly if performed within 2 weeks from the first event. We evaluated the efficiency of a screening programme based...... on Doppler ultrasound in patients hospitalized with stroke or transient ischaemic attack in the stroke centre at Rigshospitalet, Glostrup, Denmark, concerning timeliness of referral to the vascular surgeon and performance of carotid endarterectomy according to national recommendations. METHODS: Prospective...... stenosis or occlusion was found in 171 patients (12·3%) and was hemisphere related in 78 patients (5·6%). Among these, 68 (87%) were referred to the vascular department, 94% within 4 days of admission. Carotid endarterectomy was performed in 16 patients, all within 14 days from admission...

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

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    Şehnaz Arıcı

    2015-04-01

    Full Text Available Indirect (dural carotid cavernous fistula is formed by the connection between meningeal branches of the internal carotid artery and the cavernous sinüs, and low flow circulation with low pressure is occured. Proptosis, ophtalmoplegia, headache, scleral and conjuctival hyperemia expanding around the eyeball can be observed. A forty-eight year old female patient with a background of diabetes mellitus and hypertension was admitted with complaints of double vision. Isolated oculomotor nerve palsy was found in neurological examination and an indirect carotid cavernous fistula was revealed by digital subtraction angiography. Our case with carotid cavernous fistula as a rare cause of isolated oculomotor nerve palsy is worth to be reported.

  13. Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy.

    Science.gov (United States)

    Müller, Mandy D; Ahlhelm, Frank J; von Hessling, Alexander; Doig, David; Nederkoorn, Paul J; Macdonald, Sumaira; Lyrer, Philippe A; van der Lugt, Aad; Hendrikse, Jeroen; Stippich, Christoph; van der Worp, H Bart; Richards, Toby; Brown, Martin M; Engelter, Stefan T; Bonati, Leo H

    2017-05-01

    Complex vascular anatomy might increase the risk of procedural stroke during carotid artery stenting (CAS). Randomized controlled trial evidence that vascular anatomy should inform the choice between CAS and carotid endarterectomy (CEA) has been lacking. One-hundred eighty-four patients with symptomatic internal carotid artery stenosis who were randomly assigned to CAS or CEA in the ICSS (International Carotid Stenting Study) underwent magnetic resonance (n=126) or computed tomographic angiography (n=58) at baseline and brain magnetic resonance imaging before and after treatment. We investigated the association between aortic arch configuration, angles of supra-aortic arteries, degree, length of stenosis, and plaque ulceration with the presence of ≥1 new ischemic brain lesion on diffusion-weighted magnetic resonance imaging (DWI+) after treatment. Forty-nine of 97 patients in the CAS group (51%) and 14 of 87 in the CEA group (16%) were DWI+ (odds ratio [OR], 6.0; 95% confidence interval [CI], 2.9-12.4; Pcarotid artery angle (≥60° versus carotid artery angle was ≥60° (OR, 11.8; 95% CI, 4.1-34.1) than if it was carotid artery tortuosity increase the risk of cerebral ischemia during CAS, but not during CEA. Vascular anatomy should be taken into account when selecting patients for stenting. URL: http://www.isrctn.com/ISRCTN25337470. Unique identifier: ISRCTN25337470. © 2017 American Heart Association, Inc.

  14. Changes to the geometry and fluid mechanics of the carotid siphon in the pediatric Moyamoya disease.

    Science.gov (United States)

    Jamil, Muhammad; Tan, Germaine Xin Yi; Huq, Mehnaz; Kang, Heidi; Lee, Zhi Rui; Tang, Phua Hwee; Hu, Xi Hong; Yap, Choon Hwai

    2016-12-01

    The Moyamoya disease is a cerebrovascular disease that causes occlusion of the distal end of the internal carotid artery, leading to the formation of multiple tiny collateral arteries. To date, the pathogenesis of Moyamoya is unknown. Improved understanding of the changes to vascular geometry and fluid mechanics of the carotid siphon during disease may improve understanding of the pathogenesis, prognosis techniques and disease management. A retrospective analysis of Magnetic Resonance Angiography (MRA) images was performed for Moyamoya pediatric patients (MMD) (n = 23) and control (Ctrl) pediatric patients (n = 20). The Ctrl group was composed of patients who complained of headache and had normal MRA. We performed segmentation of MRA images to quantify geometric parameters of the artery. Computational fluid dynamics (CFD) was performed to quantify the hemodynamic parameters. MMD internal carotid and carotid siphons were smaller in cross-sectional areas, and shorter in curved vascular length. Vascular curvature remained constant over age and vascular size and did not change between Ctrl and MMD, but MMD carotid siphon had lower tortuosity in the posterior bend, and higher torsion in the anterior bend. Wall shear stress and secondary flows were significantly lower in MMD, but the ratio of secondary flow kinetic energy to primary flow kinetic energy were similar between MMD and Ctrl. There were alterations to both the geometry and the flow mechanics of the carotid siphons of Moyamoya patients but it is unclear whether hemodynamics is the cause or the effect of morphological changes observed.

  15. Proximal Probes Facility

    Data.gov (United States)

    Federal Laboratory Consortium — The Proximal Probes Facility consists of laboratories for microscopy, spectroscopy, and probing of nanostructured materials and their functional properties. At the...

  16. A Case of Hybrid Carotid Revascularization

    Directory of Open Access Journals (Sweden)

    Hari Prasad

    2017-04-01

    Full Text Available Cerebral infarction attributed to extracranial carotid and vertebral artery disease is defined as clinical stroke with evidence of infarction on brain imaging associated with >50% stenosis or occlusion of an extracranial carotid or vertebral artery documented by noninvasive imaging or angiography. Radiation to the neck poses a high risk for developing carotid stenosis. Even though the standard treatment for extracranial artery stenosis is carotid endarterectomy (CEA, higher rates of cranial nerve injury and wound complications including infection limit CEA applications in patients with prior radiation. Carotid angioplasty and stenting (CAS should be considered as an alternative to CEA for those patients with high surgical risk. We report a case of CAS in a patient who had prior neck radiation for malignancy, presenting with carotid stenosis.

  17. [Intracranial carotid artery bifurcation aneurysms].

    Science.gov (United States)

    Vega-Basulto, S D; Montejo-Montejo, J

    Intracranial carotid artery bifurcation aneurysms are infrequent but its clinical behavior, high risk of bleeding and complex anatomic relationships of the sac permit to consider these lesions as a challenge cases. 497 patients harboring intracranial aneurysms were operated on at Manuel Ascunce Domenech Hospital, Camagüey, Cuba between January 1982 to august 2001. We utilized microsurgical procedures, optical magnification, specialized neuroanesthesia and Intensive Care Unit postoperatory following. All patients were evaluated clinically with World Federation Neurological Surgeon Scale and Glasgow Outcome Scale. There were 16 patients with intracranial carotid artery bifurcation aneurysms (3.2 %). 12 patients were under 40 years and 50% were between 16 and 30 years old. All patients present intracranial bleeding. There was 87.5% of total or partial recuperation. There was one death only. Postoperative deficit were observed at 44% but 31% disappeared three month later. Intracranial carotid artery bifurcation aneurysms are complex anatomoclinical lesions. Clinically, we observed high tendency to bleed and multiplicity. Anatomically, these sacs have complex arterial relationship that difficult dissection and clipping. They have frequent postoperative morbidity. Multiple or bilateral aneurysmal sacs will be clipped by one surgical procedure.

  18. Carotid stenosis measurement on colour Doppler ultrasound: Agreement of ECST, NASCET and CCA methods applied to ultrasound with intra-arterial angiographic stenosis measurement

    Energy Technology Data Exchange (ETDEWEB)

    Wardlaw, Joanna M. [Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU (United Kingdom)]. E-mail: jmw@skull.dcn.ed.ac.uk; Lewis, Steff [Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU (United Kingdom)

    2005-11-01

    Purpose: Carotid stenosis is usually determined on Doppler ultrasound from velocity readings. We wondered if angiography-style stenosis measurements applied to ultrasound images improved accuracy over velocity readings alone, and if so, which measure correlated best with angiography. Materials and methods: We studied prospectively patients undergoing colour Doppler ultrasound (CDU) for TIA or minor stroke. Those with 50%+ symptomatic internal carotid artery (ICA) stenosis had intra-arterial angiography (IAA). We measured peak systolic ICA velocity, and from the ultrasound image, the minimal residual lumen, the original lumen (ECST), ICA diameter distal (NASCET) and CCA diameter proximal (CCA method) to the stenosis. The IAAs were measured by ECST, NASCET and CCA methods also, blind to CDU. Results: Amongst 164 patients (328 arteries), on CDU the ECST, NASCET and CCA stenosis measures were similarly related to each other (ECST = 0.54 NASCET + 46) as on IAA (ECST = 0.6 NASCET + 40). Agreement between CDU- and IAA-measured stenosis was similar for ECST (r = 0.51), and CCA (r = 0.48) methods, and slightly worse for NASCET (r = 0.41). Adding IAA-style stenosis to the peak systolic ICA velocity did not improve agreement with IAA over peak systolic velocity alone. Conclusion: Angiography-style stenosis measures have similar inter-relationships when applied to CDU, but do not improve accuracy of ultrasound over peak systolic ICA velocity alone.

  19. Endarterectomy for a symptomatic carotid web.

    Science.gov (United States)

    Phair, John; Trestman, Eric B; Yean, Chetra; Lipsitz, Evan C

    2017-10-01

    Background We report a symptomatic carotid web successfully treated with carotid endarterectomy. A healthy 43-year-old woman presented with acute-onset left-sided weakness. Carotid web was evident on computed tomography angiography as a focal filling defect in the right common carotid artery. This right common carotid artery web extended into the ICA created an eddy resulting in turbulent flow. Subsequent acute embolus formation led to embolization and acute stroke. Method Review of the literature was performed using Medline Plus and PubMed databases. Result The patient underwent carotid endarterectomy with primary closure. Procedure was well tolerated and there was an uneventful recovery. Conclusion Arterial webs are a rare arteriopathy and a usual arrangement of fibromuscular intralumenal in-growth with unclear etiology. It is however, an important potential etiology of stroke in patients without traditional atherosclerotic risk factors. Carotid web and atypical carotid fibromuscular dysplasia should be considered in young, otherwise healthy patients presenting with stroke and without the typical risk factors for atherosclerotic carotid disease and stroke.

  20. Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

    Directory of Open Access Journals (Sweden)

    Michael Kelly

    2008-11-01

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

  1. Improved correlation between carotid and coronary atherosclerosis SYNTAX score using automated ultrasound carotid bulb plaque IMT measurement.

    Science.gov (United States)

    Ikeda, Nobutaka; Gupta, Ajay; Dey, Nilanjan; Bose, Soumyo; Shafique, Shoaib; Arak, Tadashi; Godia, Elisa Cuadrado; Saba, Luca; Laird, John R; Nicolaides, Andrew; Suri, Jasjit S

    2015-05-01

    Described here is a detailed novel pilot study on whether the SYNTAX (Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score, a measure of coronary artery disease complexity, could be better predicted with carotid intima-media thickness (cIMT) measures using automated IMT all along the common carotid and bulb plaque compared with manual IMT determined by sonographers. Three hundred seventy consecutive patients who underwent carotid ultrasound and coronary angiography were analyzed. SYNTAX score was determined from coronary angiograms by two experienced interventional cardiologists. Unlike most methods of cIMT measurement commonly used by sonographers, our method involves a computerized automated cIMT measurement all along the carotid artery that includes the bulb region and the region proximal to the bulb (under the class of AtheroEdge systems from AtheroPoint, Roseville, CA, USA). In this study, the correlation between automated cIMT that includes bulb plaque and SYNTAX score was found to be 0.467 (p correlation between the sonographer's IMT reading and SYNTAX score. The correlation between the automated cIMT and the sonographer's IMT was 0.882. When compared against the radiologist's manual tracings, automated cIMT system performance had a lumen-intima error of 0.007818 ± 0.0071 mm, media-adventitia error of 0.0179 ± 0.0125 mm and automated cIMT error of 0.0099 ± 0.00988 mm. The precision of automated cIMT against the manual radiologist's reading was 98.86%. This current automated algorithm revealed a significantly stronger correlation between cIMT and coronary SYNTAX score as compared with the sonographer's cIMT measurements with multiple cardiovascular risk factors. We benchmarked our correlation between the automated cIMT that includes bulb plaque and SYNTAX score against a previously published (Ikeda et al. 2013) AtheroEdgeLink (AtheroPoint) correlation between the automated cIMT that does not include bulb plaque and

  2. Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.

    Science.gov (United States)

    Dellaretti, Marcos; de Vasconcelos, Laura T; Dourado, Jules; de Souza, Renata F; Fontoura, Renato R; de Sousa, Atos A

    2016-03-01

    During carotid endarterectomy (CEA), carotid cross-clamping is performed to allow for artery incision and plaque removal. A small subgroup of patients can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurologic deficit. These patients are described as having ''cross-clamp intolerance.'' The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition. From August 2008 to May 2010, 115 consecutive patients were submitted to CEA under locoregional anesthesia at the Santa Casa de Belo Horizonte; the procedure was performed by the main author. Patients who showed intolerance to internal carotid artery (ICA) occlusion for intolerance. Among the 115 participating patients, 9.6% (11 patients) showed intolerance to ICA occlusion and developed deficits in intolerance). The factor that was associated with cross-clamp intolerance was the mean degree of contralateral carotid stenosis, which was 57.5% for those who presented intolerance and 27.8% for those who tolerated ICA occlusion. Locoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Ultrasonic tissue characterization of vulnerable carotid plaque: correlation between videodensitometric method and histological examination

    Directory of Open Access Journals (Sweden)

    Cherri Jesualdo

    2006-08-01

    Full Text Available Abstract Background To establish the correlation between quantitative analysis based on B-mode ultrasound images of vulnerable carotid plaque and histological examination of the surgically removed plaque, on the basis of a videodensitometric digital texture characterization. Methods Twenty-five patients (18 males, mean age 67 ± 6.9 years admitted for carotid endarterectomy for extracranial high-grade internal carotid artery stenosis (≥ 70% luminal narrowing underwent to quantitative ultrasonic tissue characterization of carotid plaque before surgery. A computer software (Carotid Plaque Analysis Software was developed to perform the videodensitometric analysis. The patients were divided into 2 groups according to symptomatology (group I, 15 symptomatic patients; and group II, 10 patients asymptomatic. Tissue specimens were analysed for lipid, fibromuscular tissue and calcium. Results The first order statistic parameter mean gray level was able to distinguish the groups I and II (p = 0.04. The second order parameter energy also was able to distinguish the groups (p = 0,02. A histological correlation showed a tendency of mean gray level to have progressively greater values from specimens with 75% of fibrosis. Conclusion Videodensitometric computer analysis of scan images may be used to identify vulnerable and potentially unstable lipid-rich carotid plaques, which are less echogenic in density than stable or asymptomatic, more densely fibrotic plaques.

  4. Assessing the blood pressure waveform of the carotid artery using an ultrasound image processing method

    Energy Technology Data Exchange (ETDEWEB)

    Soleimani, Effat; Mokhtari-Dizaji, Manijhe [Dept. of Medical Physics, Tarbiat Modares University, Tehran (Iran, Islamic Republic of); Fatouraee, Nasser [Dept. of Medical Engineering, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Saben, Hazhir [Dept. Radiology, Imaging Center of Imam Khomaini Hospital, Tehran Medical Sciences University, Tehran (Iran, Islamic Republic of)

    2017-04-15

    The aim of this study was to introduce and implement a noninvasive method to derive the carotid artery pressure waveform directly by processing diagnostic sonograms of the carotid artery. Ultrasound image sequences of 20 healthy male subjects (age, 36±9 years) were recorded during three cardiac cycles. The internal diameter and blood velocity waveforms were extracted from consecutive sonograms over the cardiac cycles by using custom analysis programs written in MATLAB. Finally, the application of a mathematical equation resulted in time changes of the arterial pressure. The resulting pressures were calibrated using the mean and the diastolic pressure of the radial artery. A good correlation was found between the mean carotid blood pressure obtained from the ultrasound image processing and the mean radial blood pressure obtained using a standard digital sphygmomanometer (R=0.91). The mean absolute difference between the carotid calibrated pulse pressures and those measured clinically was -1.333±6.548 mm Hg. The results of this study suggest that consecutive sonograms of the carotid artery can be used for estimating a blood pressure waveform. We believe that our results promote a noninvasive technique for clinical applications that overcomes the reproducibility problems of common carotid artery tonometry with technical and anatomical causes.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-04-15

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

  6. The haemodynamic effect of carotid endarterectomy

    DEFF Research Database (Denmark)

    Nielsen, Ming-Yuan; Sillesen, H H; Jørgensen, Lisbeth

    2002-01-01

    to assess the haemodynamic effect of carotid artery surgery, and to relate postoperative changes to the state of cerebral circulation before revascularisation.......to assess the haemodynamic effect of carotid artery surgery, and to relate postoperative changes to the state of cerebral circulation before revascularisation....

  7. Angioplasty and stent placement - carotid artery - discharge

    Science.gov (United States)

    ... E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 60. Read More Carotid artery disease Carotid artery surgery Recovering after stroke Risks of tobacco Smoking - tips on how to quit Stent Stroke ...

  8. Medical treatment in carotid artery intervention

    NARCIS (Netherlands)

    Kolkert, J. L.; Meerwaldt, R.; Lefrandt, Johan; Geelkerken, R. H.; Zeebregts, C. J.

    2011-01-01

    Medical treatment has a pivotal role in the treatment of patients with occlusive carotid artery disease. Large trials have provided the justification for operative treatment besides medical treatment in patients with recent significant carotid artery stenosis two decades ago. Since then, medical

  9. High-flow venous pouch aneurysm in the rabbit carotid artery: A model for large aneurysms.

    Science.gov (United States)

    Krähenbühl, Anna K; Gralla, Jan; Abu-Isa, Janine; Mordasini, Pasquale; Widmer, Hans R; Raabe, Andreas; Reinert, Michael

    2015-06-01

    Currently one of the most widely used models for the development of endovascular techniques and coiling devices for treatment of aneurysm is the elastase-induced aneurysm model in the rabbit carotid artery. Microsurgical techniques for creating an aneurysm with a venous pouch have also been established, although both techniques usually result in aneurysms less than 1 cm in diameter. We investigated whether an increase in blood flow toward the neck would produce larger aneurysms in a microsurgical venous pouch model. Microsurgical operations were performed on 11 New Zealand white rabbits. Both carotid arteries and the right jugular vein were dissected, and the right carotid artery was temporarily clipped followed by an arteriotomy. The left carotid artery was also clipped proximally, ligated distally, and sutured onto the proximal half of the arteriotomy in the right carotid artery. The venous graft was sutured onto the distal half of the arteriotomy. Digital subtraction angiography was also performed. Angiography showed patent anastomosed vessels and aneurysms in the seven surviving rabbits. Mean aneurysm measurements among surviving rabbits with patent vessels were: 13.9 mm length, 9.3 mm width, and neck diameter 4.7 mm. The resulting mean aspect ratio was 3.35 and the mean bottleneck ratio was 3.05. A large venous graft and increased blood flow toward the base of the aneurysm seem to be key factors in the creation of large venous pouch aneurysms. These large aneurysms allow testing of endovascular devices designed for large and giant aneurysms. © The Author(s) 2015.

  10. Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate.

    Science.gov (United States)

    Sun, Jing-Cheng; Li, Yu-Lin; Ning, Guang-Zhi; Wu, Qiang; Feng, Shi-Qing

    2013-08-01

    The purpose of this study was to evaluate the effectiveness and complications of the locking proximal humerus plate to treat proximal humerus fractures. A retrospective clinical trial. Department of Orthopaedics, Tianjin Medical University General Hospital. Sixty-eight consecutive patients with three- or four-part fractures of the proximal humerus were treated with locking proximal humerus plates. The deltopectoral anterolateral acromial approach was used to the proximal humerus; open reduction and locking proximal humerus plate were applied. Constant Score was used to measure the shoulder functional recovery, and Visual Analog Scale (VAS) was used to measure subjective evaluation of pain. The radiology was observed. After average 26.7 months, the average Constant Score was 72.6 ± 13.2 points and the average VAS was 1.2 ± 0.8 points. All the complications such as screw perforation into the glenohumeral joint, screws loosening, soft tissue infections, avascular necrosis and delayed union occurred in eight cases (11.8 %). The effectiveness of the locking proximal humerus plate was similar to other published literatures on treating fractures of the proximal humerus; however, a lower complications rate in short follow-up time was observed in this study. It may potentially provide a favorable option for treating three- or four-part fractures of the proximal humerus. Dealing with each particular fracture pattern, surgeons should have a decision of appropriate way to internal fixation.

  11. Obesity and carotid artery remodeling

    DEFF Research Database (Denmark)

    Kozakova, M; Palombo, C; Morizzo, C

    2015-01-01

    characterized by body size-dependent increase in stroke volume (SV) and blood pressure (BP). SUBJECTS/METHODS: Common carotid artery (CCA) luminal diameter (LD), IMT and CWS were measured in three different populations in order to study: (A) cross-sectional associations between SV, BP, anthropometric parameters...... the luminal enlargement caused by body size-induced increase in SV, and therefore, to normalize the wall stress. CCA diameter in obesity could represent an additional biomarker, depicting the impact of altered hemodynamics on arterial wall....

  12. Complete transposition of carotid bifurcation: can it be an additional risk factor of injury to the cranial nerves during carotid endarterectomy?

    Science.gov (United States)

    Marcucci, Giustino; Accrocca, Federico; Gabrielli, Roberto; Antonelli, Roberto; Giordano, Alessandro G; De Vivo, Gennaro; Siani, Andrea

    2011-11-01

    The internal carotid artery (ICA) usually, lies posterolaterally to the external carotid artery (ECA). Sometimes a complete carotid transposition can occur, with the ECA in a lateral position and the ICA on the medial side can occur. Our study evaluated the significance and impact that this anomaly may have on cranial nerve injuries. From January 2008 to November 2010, 296 patients underwent 360 consecutive primary carotid endarterectomy (CEA) procedures. During carotid isolation, we detected an unexpected lateral position of the ECA in 11 cases (3.6%). χ(2) analysis and the Student's t-test were used to compare the incidence of cranial nerve injuries between the 11 patients with the lateral ECA who underwent CEA (group A) and 11 randomized patients with a normal bifurcation (group B). Statistical significance was inferred at χ(2)>3.84 and Pgroups A and B (18.1%, 2/11 in group A vs. 0%, 0/11 in group B; χ(2)>3.84; PECA and ICA is needed to perform CEA, but superior laryngeal nerve injury can occur despite the use of a safe and meticulous surgical technique.

  13. The Impact of Carotid Artery Stenting on Cerebral Perfusion, Functional Connectivity, and Cognition in Severe Asymptomatic Carotid Stenosis Patients

    Directory of Open Access Journals (Sweden)

    Tao Wang

    2017-08-01

    Full Text Available Background and purposeAsymptomatic carotid artery stenosis can lead to not only stroke but also cognition impairment. Although it has been proven that carotid artery stenting (CAS can reduce the risk of future strokes, the effect of CAS on cognition is conflicting. In recent years, pulsed arterial spin labeling (pASL MRI and resting-state functional MRI (R-fMRI have been employed in cognitive impairment studies. For the present study, cognition is evaluated in severe asymptomatic carotid artery stenosis patients undergoing CAS, and the mechanisms underlying the cognitive change are explored by pASL MRI and R-fMRI.Materials and methodsWe prospectively enrolled 24 asymptomatic, severe (≥70%, unilateral internal carotid artery stenosis patients, who were expecting the intervention of CAS. Cognition assessment (including the Montreal Cognitive Assessment Beijing Version, the Minimum Mental State Examination, the Digit Symbol Test, the Rey Auditory Verbal Learning Test, and the Verbal Memory Test and an integrated MRI program (pASL MRI, and R-fMRI were administered 7 days before and 3 months after CAS.Results16 subjects completed the follow-up study. After stenting, significant improvement in the scores of the MMSE, the Verbal Memory test, and the delayed recall was found. No significant difference was found in the scores of the Montreal Cognitive Assessment Beijing Version, the Digit Symbol Test, and the immediate recall. After CAS treatment, asymptomatic carotid artery stenosis patients showed increased perfusion in the left frontal gyrus, increased amplitude of low-frequency fluctuation (ALFF in the right precentral gyrus, and increased connectivity to the posterior cingulate cortex (PCC in the right supra frontal gyrus. However, no significant correlations were found between these imaging changes and cognition assessments.ConclusionSuccessful CAS can partly improve cognition in asymptomatic carotid artery stenosis patients. The cognition

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

    LENUS (Irish Health Repository)

    Maher, Eoghan

    2009-12-11

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

  15. The significance of the pharyngeal veins during carotid endarterectomy: description of an anatomical triangle.

    Science.gov (United States)

    Aldoori, J; Mahadevan, V; Aldoori, M

    2018-02-01

    Injuries to the hypoglossal and vagus nerves are the most commonly reported injuries during carotid endarterectomy. While unilateral single nerve injury is usually well tolerated, bilateral or combined nerve injuries can pose a serious threat to life. This study aims to increase awareness of the inferior pharyngeal vein, which usually passes posterior to the internal carotid artery but sometimes crosses anterior to it. Injury to either or both hypoglossal and vagus nerves can occur during control of unexpected haemorrhage from the torn and retracted edges of the inferior pharyngeal vein. We recommend careful ligation and division of this vein. In addition, we observed in 9 (17.3%) of the 52 operations that the pharyngeal vein formed a triangle with the vagus and hypoglossal nerves when it passes anterior to the internal carotid artery.

  16. 21 CFR 882.5175 - Carotid artery clamp.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Carotid artery clamp. 882.5175 Section 882.5175...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Therapeutic Devices § 882.5175 Carotid artery clamp. (a) Identification. A carotid artery clamp is a device that is surgically placed around a patient's carotid artery...

  17. Aneurisma gigante do segmento intracavernoso da carótida interna associado a doença renal policística autossômica dominante: relato de caso Giant aneurysm of the intracavernous internal carotid artery associated with autosomal dominant polycystic kidney disease: case report

    Directory of Open Access Journals (Sweden)

    Keven F. Ponte

    2006-09-01

    Full Text Available Apresenta-se o caso de mulher de 60 anos com doença renal policística autossômica dominante (DRPAD que desenvolveu quadro de cefaléia e oftalmoplegia completa à direita. A TC levantou a hipótese de um aneurisma gigante do segmento intracavernoso da carótida interna direita, o que foi confirmado pela arteriografia. Realizou-se, então, tratamento endovascular por oclusão do vaso parental com molas destacáveis no segmento supraclinóideo. A paciente evoluiu com a interrupção da cefaléia e com redução parcial da ptose e da oftalmoplegia. Neste artigo, enfatiza-se a relação entre DRPAD e aneurismas intracranianos. Comenta-se a história natural dos aneurismas originados no segmento intracavernoso da artéria carótida interna e comparam-se as opções terapêuticas no manejo destas lesões.We report the case of a 60 years-old woman with autosomal dominant polycystic kidney disease (ADPKD that presented with headache and right complete ophthalmoplegia. The CT scan raised the possibility of a giant aneurysm of the right intracavernous internal carotid artery, confirmed by angiography. The patient underwent endovascular occlusion of parent vessel with detachable coils, then she presented interruption of headache and partial recovery of ptosis and ophthalmoplegia. We emphasize the relationship between ADPKD and intracranial aneurysms. We also discuss the natural history and compare the therapeutic options for the management of giant aneurysms of the cavernous portion of the carotid artery.

  18. Assessment of risk of carotid occlusion with balloon Matas testing and dynamic computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Terada, Tomoaki; Okuno, Takashi; Moriwaki, Hiroshi; Nakai, Ekini; Nishiguchi, Takashi; Hayashi, Seiji; Komai, Norihiko.

    1988-02-01

    Temporary occlusion of the internal carotid artery with a balloon catheter (balloon Matas test) and simultaneous dynamic computed tomographic scanning (DCT) were performed in four patients with intracranial aneurysms to determine their tolerance for permanent carotid occlusion. Five DCT parameters were evaluated: appearance time, peak time, peak height fitting, first effective moment, and transit time. The patients were characterized into three types: type I (2 patients) - lack of neurological deficit during the balloon Matas test and equally preserved cerebral blood flow (CBF) in the two hemispheres on DCT during carotid occlusion, type II (one patient) - a decreased CBF on the occluded side on DCT despite the lack of neurological deficit; type III (one patient) - neurological signs, such as disturbance of consciousness, aphasia, and right hemiparesis occuring immediately after the start of the balloon Matas test, and a decreased CBF in the region of the middle and anterior cerebral arteries on the occluded side. In the type III patient, occlusion of the internal carotid artery is contraindicated unless an EC-IC bypass procedure that can rapidly provide a large supply of blood is performed. It can be concluded that the balloon Matas/DCT method offers a reliable means of predicting the risk of carotid ligation. (Namekawa, K.).

  19. Dual antiplatelet therapy (clopidogrel and aspirin) is associated with increased all-cause mortality after carotid revascularization for asymptomatic carotid disease.

    Science.gov (United States)

    Alcocer, Francisco; Novak, Zdenek; Combs, Bart R; Lowman, Bruce; Passman, Marc A; Mujib, Marjan; Jordan, William D

    2014-04-01

    Despite the established guidelines, there is not a clear consensus about how to manage antiplatelet therapy after carotid surgery. It is a common practice in vascular surgery to use the combination of aspirin and clopidogrel in the treatment of such patients. In this work, we analyzed the impact on long-term survival of antiplatelet therapy in patients treated for carotid stenosis at a single institution over a 10-year period. Outcomes of 471 patients who underwent carotid intervention (1999-2008) were analyzed. Discharge prescription summaries were retrieved, and patients were divided into two groups according to their antiplatelet regimen: aspirin-only group and aspirin plus clopidogrel group. Only patients with a minimum of 30 days of confirmed antiplatelet therapy were included. All-cause mortality during follow-up represented the primary outcome, whereas stroke and bleeding at 30 days and during follow-up represented secondary end points. When local records were sparse, the Social Security Death Index was queried to confirm mortality. The International Classification of Diseases, 9th Revision (ICD-9 codes), was reviewed for treatment related to a bleeding condition. When divided by indication, there was an increased mortality rate in patients with asymptomatic carotid disease receiving dual antiplatelet therapy as compared with aspirin alone (47% vs 40%; P = .05). Patients with symptomatic carotid disease had a nonsignificant decrease in all-cause mortality if they received dual antiplatelet therapy (38% vs 39%; P = .53). In a subgroup analysis, there was a significant increase in the rate of all-cause mortality among patients older than 75 years receiving dual antiplatelet therapy for asymptomatic carotid disease (82% vs 56%; P = .001), whereas there was a nonsignificant decrease in mortality in patients older than 75 years receiving dual antiplatelet therapy for symptomatic carotid disease (47% vs 63%; P = .50). There was no difference in secondary outcomes

  20. Midazolam depresses carotid body chemoreceptor activity.

    Science.gov (United States)

    Kim, C; Shvarev, Y; Takeda, S; Sakamoto, A; Lindahl, S G E; Eriksson, L I

    2006-02-01

    Although the contribution of the gamma-aminobutyric acid (GABA) receptor system in peripheral chemosensation is unclear, immunohistochemistry has demonstrated the presence of GABA-ergic receptors in mammalian carotid bodies. We hypothesized that an activation of the carotid body GABA receptors would counteract the depolarizing effect of hypoxia. The carotid body with arterial supply and the carotid sinus nerve was removed en bloc from New Zealand White rabbits and placed in a perfusion chamber. The carotid body preparation was perfused via the cut common carotid artery with a modified Tyrode's solution at a rate of 3.5-4.5 ml/min with a constant pressure of 45 cmH2O. The carotid sinus nerve firing frequency (Hz) was recorded at two different oxygen tension levels during perfusion with midazolam of 1, 10 and 100 microg/l. The frequency was decreased by midazolam in a dose-dependent manner (n = 8). Firing frequencies (mean +/- SEM) at the low oxygen tension level decreased from 643.13 +/- 67.2 Hz in the control to 554.5 +/- 67.7 Hz (P = 0.054 vs. control), 509.01 +/- 100.5 Hz (P chemoreceptor activity in a dose-dependent manner.

  1. Carotid artery stenting vs carotid endarterectomy: meta-analysis and diversity-adjusted trial sequential analysis of randomized trials

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Kumar, Sunil; Wetterslev, Jørn

    2011-01-01

    The role of carotid artery stenting (CAS) when compared with carotid endarterectomy (CEA) is controversial, with recent trials showing an increased risk of harm with CAS.......The role of carotid artery stenting (CAS) when compared with carotid endarterectomy (CEA) is controversial, with recent trials showing an increased risk of harm with CAS....

  2. [Diagnostic and treatment of carotid bodies tumors].

    Science.gov (United States)

    Tonev, A; Zakhariev, T

    2007-01-01

    Carotid body tumor is rare neoplasm (about 0,5 per cent of all tumors).[28]. The tumor arise from paraganglionic cells of carotid body, which develops from both mesodermal elements of the third branchial arch and neural elements originating from the neural crest ectoderm.[25]. Mathews warned: "this rare tumor presents unusual difficulties to the surgeon, and should one encounter it without having suspected the diagnosis, the experience will not soon be forgotten".[19]. The aim of this retrospective study is to investigate the frequency, number of spreading and results from the treatment in patients with carotid bodies tumors. Eleven patients (2,58%) with carotid bodies tumors were diagnosed and operated under upon from January 1990 to June 2007 at the "Department of Vascular surgery and Angiology" of "St. Ekaterina" University hospital - Sofia, from commonly 427 surgical intervention in the area of carotid triangle for the same period. The clinical picture, operating time and blood loss during the surgery were examined. Careful subadventitial dissection was used like a method, which have to reduce the number of postoperative complications and blood loss. All 11 patients were operated upon with endotrachial anesthesia and in two of them there was intracranial nerves injure, reconstruction of carotid artery has established in two of the patients. In the early postoperative period there was disphagia in three of the patients, four were with partial damage of n. hypoglossus, two- with damage of the face branch of n. facialis and six with parasthesia at the operated side. CT angiography of carotid bifurcation has established as basic method in the diagnostic. Total extirpation of the tumor remains the basic method of treatment from high quality specialists in carotid surgery. Careful subadvetitial dissection and accuracy excision allow the whole separation of the tumor from the carotid bifurcation without traumatic lesion. [28].

  3. Carotid artery stenosis after neck radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shimamura, Munehisa; Hashimoto, Yoichiro; Kasuya, Junji; Terasaki, Tadashi [Kumamoto City Hospital (Japan); Uchino, Makoto

    2000-02-01

    Carotid artery stenosis sometimes occurs after cervical radiotherapy. We report a 70-year-old woman with a history of radiotherapy for thyroid cancer at the age of 28 years. She had no signs and symptoms except the skin lesion at the irradiation site. Duplex ultrasonography revealed heterogeneous plaques showing 50% stenosis of bilateral common carotid arteries. Those lesions were observed within segment of irradiation, where atheromatous plaque usually seldom occurs. These indicated that the carotid stenosis was induced by radiotherapy. Although the efficacy of antiplatelet therapy for radiation-induced plaque is not clear, the plaques remained unchanged for 4 years in spite of aspirin administration. (author)

  4. General principles of carotid Doppler ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Whal [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2014-03-15

    Carotid Doppler ultrasonography is a popular tool for evaluating atherosclerosis of the carotid artery. Its two-dimensional gray scale can be used for measuring the intima-media thickness, which is very good biomarker for atherosclerosis and can aid in plaque characterization. The plaque morphology is related to the risk of stroke. The ulceration of plaque is also known as one of the strong predictors of future embolic event risk. Color Doppler ultrasonography and pulse Doppler ultrasonography have been used for detecting carotid artery stenosis. Doppler ultrasonography has unique physical properties. The operator should be familiar with the physics and other parameters of Doppler ultrasonography to perform optimal Doppler ultrasonography studies.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-04-01

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

  6. PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy - evaluation of a double embolic protection approach in endovascular stroke treatment.

    Science.gov (United States)

    Maegerlein, Christian; Mönch, Sebastian; Boeckh-Behrens, Tobias; Lehm, Manuel; Hedderich, Dennis M; Berndt, Maria Teresa; Wunderlich, Silke; Zimmer, Claus; Kaesmacher, Johannes; Friedrich, Benjamin

    2017-12-08

    Stent retriever-based mechanical thrombectomy (MT) for emergent large vessel occlusions (ELVO) is often complicated by thrombus fragmentation causing distal embolization and embolization to new vascular territories. Well-established embolic protection approaches include proximal flow arrest and distal aspiration techniques during stent retriever maneuvers. Aiming at the reduction of thrombus fragmentation during MT we evaluated a technical approach combining proximal balloon occlusion together with direct thrombus aspiration during MT: the PROTECT technique. We performed a case-control study comparing the PROTECT technique with sole distal aspiration during MT regarding technical and procedural parameters, n=200 patients with ELVO of either the terminus of the internal carotid artery or the proximal middle artery were included. PROTECT resulted in a shorter procedure time (29 vs 40 min; P=0.002), in a higher rate of successful recanalizations (100% vs 78%; P=0.001) and a higher rate of complete reperfusions (70% vs 39%; P<0.001) compared with sole distal aspiration during MT. The PROTECT technique is a promising new approach to significantly reduce thrombus fragmentation and, hence distal embolization during MT. This safe and efficient technique needs to be validated in larger trials to confirm our results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Standard duplex criteria overestimate the degree of stenosis after eversion carotid endarterectomy.

    Science.gov (United States)

    Benzing, Travis; Wilhoit, Cameron; Wright, Sharee; McCann, P Aaron; Lessner, Susan; Brothers, Thomas E

    2015-06-01

    The eversion technique for carotid endarterectomy (eCEA) offers an alternative to longitudinal arteriotomy and patch closure (pCEA) for open carotid revascularization. In some reports, eCEA has been associated with a higher rate of >50% restenosis of the internal carotid when it is defined as peak systolic velocity (PSV) >125 cm/s by duplex imaging. Because the conformation of the carotid bifurcation may differ after eCEA compared with native carotid arteries, it was hypothesized that standard duplex criteria might not accurately reflect the presence of restenosis after eCEA. In a case-control study, the outcomes of all patients undergoing carotid endarterectomy by one surgeon during the last 10 years were analyzed retrospectively, with a primary end point of PSV >125 cm/s. Duplex flow velocities were compared with luminal diameter measurements for any carotid computed tomography arteriography or magnetic resonance angiography study obtained within 2 months of duplex imaging, with the degree of stenosis calculated by the methodology used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) as well as cross-sectional area (CSA) reduction. Simulations were generated and analyzed by computational model simulations of the eCEA and pCEA arteries. Eversion and longitudinal arteriotomy with patch techniques were used in 118 and 177 carotid arteries, respectively. Duplex follow-up was available in 90 eCEA arteries at a median of 16 (range, 2-136) months and in 150 pCEA arteries at a median of 41 (range, 3-115) months postoperatively. PSV >125 cm/s was present at some time during follow-up in 31% of eCEA and pCEA carotid arteries, each, and in the most recent duplex examination in 7% after eCEA and 21% after pCEA (P = .003), with no eCEA and two pCEA arteries occluding completely during follow-up (P = .29). In 19 carotid arteries with PSV >125 cm/s after angle correction (median, 160 cm/s; interquartile range

  8. Capacitive proximity sensor

    Science.gov (United States)

    Kronberg, James W.

    1994-01-01

    A proximity sensor based on a closed field circuit. The circuit comprises a ring oscillator using a symmetrical array of plates that creates an oscillating displacement current. The displacement current varies as a function of the proximity of objects to the plate array. Preferably the plates are in the form of a group of three pair of symmetric plates having a common center, arranged in a hexagonal pattern with opposing plates linked as a pair. The sensor produces logic level pulses suitable for interfacing with a computer or process controller. The proximity sensor can be incorporated into a load cell, a differential pressure gauge, or a device for measuring the consistency of a characteristic of a material where a variation in the consistency causes the dielectric constant of the material to change.

  9. Neighborhoods and manageable proximity

    Directory of Open Access Journals (Sweden)

    Stavros Stavrides

    2011-08-01

    Full Text Available The theatricality of urban encounters is above all a theatricality of distances which allow for the encounter. The absolute “strangeness” of the crowd (Simmel 1997: 74 expressed, in its purest form, in the absolute proximity of a crowded subway train, does not generally allow for any movements of approach, but only for nervous hostile reactions and submissive hypnotic gestures. Neither forced intersections in the course of pedestrians or vehicles, nor the instantaneous crossing of distances by the technology of live broadcasting and remote control give birth to places of encounter. In the forced proximity of the metropolitan crowd which haunted the city of the 19th and 20th century, as well as in the forced proximity of the tele-presence which haunts the dystopic prospect of the future “omnipolis” (Virilio 1997: 74, the necessary distance, which is the stage of an encounter between different instances of otherness, is dissipated.

  10. Why carotid endarterectomy is method of choice in treatment of carotid stenosis

    Directory of Open Access Journals (Sweden)

    Radak Đorđe

    2008-01-01

    Full Text Available Procedures used in treatment of carotid stenosis are endarterectomy, PTA with stent implantation, resection with graft interposition and by-pass procedure. Segmental lesions are found more often and treated by the first two mentioned procedures. In case of longer lesions and extension to the greater part of the common carotid artery, the other two procedures are performed. For the past few years, the main dilemma has been whether to perform carotid endarterectomy or PTA with stent implantation. Both early and long-term results speak in favour of carotid endarterectomy, regardless of an increased number of PTA and carotid stenting. At the same time, PTA and carotid stenting are more expensive procedures. Both methods have their defined and important roles in treatment of segmental occlusive carotid lesions. Severe cardiac, pulmonary and renal conditions, which increase the risk of general anaesthesia, are not an absolute indication for PTA and stenting, since endarterectomy can be done in regional anaesthesia. Main indications for PTA with stent implantation are: surgically inaccessible lesions (at or above C2; or subclavian; radiation- induced carotid stenosis; prior ipsilateral radical neck dissection; prior carotid endarterectomy (restenosis.

  11. Novel flow quantification of the carotid bulb and the common carotid artery with vector flow ultrasound

    DEFF Research Database (Denmark)

    Pedersen, Mads Møller; Pihl, Michael Johannes; Haugaard, Per

    2014-01-01

    complexity. A secondary aim was to establish accuracy parameters to detect flow changes/patterns in the common carotid artery (CCA) and the carotid bulb (CB). The right carotid bifurcation including the CCA and CB of eight healthy volunteers were scanned in a longitudinal plane with vector flow ultrasound...... and by vector concentration calculation. A vortex with complex flow was found in all carotid bulbs, whereas the CCA had mainly laminar flow. The medical experts evaluated the flow to be mainly laminar in the CCA (0.82 +/- 0.14) and mainly complex (0.23 +/- 0.22) in the CB. Likewise, the estimated vector...

  12. Obesity and carotid artery remodeling

    DEFF Research Database (Denmark)

    Kozakova, M; Palombo, C; Morizzo, C

    2015-01-01

    BACKGROUND/OBJECTIVE: The present study tested the hypothesis that obesity-related changes in carotid intima-media thickness (IMT) might represent not only preclinical atherosclerosis but an adaptive remodeling meant to preserve circumferential wall stress (CWS) in altered hemodynamic conditions...... and CCA LD (266 healthy subjects with wide range of body weight (24-159 kg)); (B) longitudinal associations between CCA LD and 3-year IMT progression rate (ΔIMT; 571 healthy non-obese subjects without increased cardiovascular (CV) risk); (C) the impact of obesity on CCA geometry and CWS (88 obese subjects...... without CV complications and 88 non-obese subjects matched for gender and age). RESULTS: CCA LD was independently associated with SV that was determined by body size. In the longitudinal study, baseline LD was an independent determinant of ΔIMT, and ΔIMT of subjects in the highest LD quartile...

  13. Cerebral foreign body reaction after carotid aneurysm stenting

    DEFF Research Database (Denmark)

    Lorentzen, Anastasia Orlova; Nome, Terje; Bakke, Søren Jacob

    2016-01-01

    Flow diverter stents are new important tools in the treatment of large, giant, or wide-necked aneurysms. Their delivery and positioning may be difficult due to vessel tortuosity. Common adverse events include intracranial hemorrhage and ischemic stroke, which usually occurs within the same day......, or the next few days after the procedure. We present a case where we encountered an unusual intracerebral complication several months after endovascular treatment of a large left internal carotid artery aneurysm, and where brain biopsy revealed foreign body reaction to hydrophilic polymer fragments distally...

  14. Atrofia muscular proximal familiar

    Directory of Open Access Journals (Sweden)

    José Antonio Levy

    1962-09-01

    Full Text Available Os autores relatam dois casos de atrofia muscular proximal familiar, moléstia caracterizada por déficit motor e atrofias musculares de distribuição proximal, secundárias a lesão de neurônios periféricos. Assim, como em outros casos descritos na literatura, foi feito inicialmente o diagnóstico de distrofia muscular progressiva. O diagnóstico correto foi conseguido com auxílio da eletromiografia e da biopsia muscular.

  15. Application of a time-resolved optical brain imager for monitoring cerebral oxygenation during carotid surgery

    Science.gov (United States)

    Kacprzak, Michal; Liebert, Adam; Staszkiewicz, Walerian; Gabrusiewicz, Andrzej; Sawosz, Piotr; Madycki, Grzegorz; Maniewski, Roman

    2012-01-01

    Recent studies have shown that time-resolved optical measurements of the head can estimate changes in the absorption coefficient with depth discrimination. Thus, changes in tissue oxygenation, which are specific to intracranial tissues, can be assessed using this advanced technique, and this method allows us to avoid the influence of changes to extracerebral tissue oxygenation on the measured signals. We report the results of time-resolved optical imaging that was carried out during carotid endarterectomy. This surgery remains the ``gold standard'' treatment for carotid stenosis, and intraoperative brain oxygenation monitoring may improve the safety of this procedure. A time-resolved optical imager was utilized within the operating theater. This instrument allows for the simultaneous acquisition of 32 distributions of the time-of-flight of photons at two wavelengths on both hemispheres. Analysis of the statistical moments of the measured distributions of the time-of-flight of photons was applied for estimating changes in the absorption coefficient as a function of depth. Time courses of changes in oxy- and deoxyhemoglobin of the extra- and intracerebral compartments during cross-clamping of the carotid arteries were obtained. A decrease in the oxyhemoglobin concentration and an increase in the deoxyhemoglobin concentrations were observed in a large area of the head. Large changes were observed in the hemisphere ipsilateral to the site of clamped carotid arteries. Smaller amplitude changes were noted at the contralateral site. We also found that changes in the hemoglobin signals, as estimated from intracerebral tissue, are very sensitive to clamping of the internal carotid artery, whereas its sensitivity to clamping of the external carotid artery is limited. We concluded that intraoperative multichannel measurements allow for imaging of brain tissue hemodynamics. However, when monitoring the brain during carotid surgery, a single-channel measurement may be

  16. Diagnosis Of The Risk For Carotid Artery Stenos Based On Thermal Model In Infrared Images

    Directory of Open Access Journals (Sweden)

    Fatemeh Valipoori Goodarzi

    2017-02-01

    Full Text Available Background and purpose: Ischemic stroke is the third leading cause of death and a common cause of hospitalization in the United States of America and is also an important factor for Inability of patients and carotid stenos is one of the most important factors in creating it. Now, Imaging studies include: Angiography, MRI, CT scan and Doppler ultrasonography , are used to detect carotid artery stenos that is one of the most important causes of ischemic stroke. However, each method has unique advantages and disadvantages, that many of them will have a compromise between performance and accuracy versus easy usage and cost considerations. In contrast, in this paper, thermography is used as a non-invasive and cost effective to detect carotid artery Stenos and thus the risk of stroke. Materials and methods: This study is done on a series of thermal images obtained from the Clinical Center in California. In this imaging, the automatic detection of carotid artery stenos and thus Risk for stroke was done, based on: (1 the difference of average temperature between the right and left carotid arteries in the neck (2 The presence or absence of internal and external carotid arteries. Results: In this study, with the survey conducted by a specialist brain of patients had been previously, the accuracy of this work is confirmed. the techniques and points that are Experimental and  scientifically based  and obtained in this study, can help to doctors for Early detection of Artery disease, based on analysis of thermal images . Conclusion: The method presented in this paper is considered as a non-invasive and cost-effective method that automatically operates to detect the carotid arteries and prevent the Risk for stroke.

  17. Overestimation of carotid artery stenosis with magnetic resonance angiography compared with digital subtraction angiography

    NARCIS (Netherlands)

    Nederkoorn, Paul J.; Elgersma, Otto E. H.; Mali, Willem P. Th M.; Eikelboom, Bert C.; Kappelle, L. Jaap; van der Graaf, Yolanda

    2002-01-01

    BACKGROUND AND PURPOSE: Three-dimensional time-of-flight (3D TOF) magnetic resonance angiography (MRA) is generally considered to overestimate the degree of stenosis in the internal carotid artery (ICA) in comparison with the reference standard intraarterial digital subtraction angiography (DSA). We

  18. Ophthalmic masquerades of the atherosclerotic carotids

    Directory of Open Access Journals (Sweden)

    Anupriya Arthur

    2014-01-01

    Full Text Available Patients with carotid atherosclerosis can present with ophthalmic symptoms. These symptoms and signs can be due to retinal emboli, hypoperfusion of the retina and choroid, opening up of collateral channels, or chronic hypoperfusion of the globe (ocular ischemic syndrome. These pathological mechanisms can produce many interesting signs and a careful history can bring out important past symptoms pointing toward the carotid as the source of the patient′s presenting symptom. Such patients are at high risk for an ischemic stroke, especially in the subsequent few days following their first acute symptom. It is important for clinicians to be familiar with these ophthalmic symptoms and signs caused by carotid atherosclerosis for making an early diagnosis and to take appropriate measures to prevent a stroke. This review elaborates the clinical features, importance, and implications of various ophthalmic symptoms and signs resulting from atherosclerotic carotid artery disease.

  19. Defective cerebrovascular autoregulation after carotid endarterectomy

    DEFF Research Database (Denmark)

    Jørgensen, L G; Schroeder, T V

    1993-01-01

    Correction of high grade carotid artery stenosis may result in cerebral hyperperfusion because of defective vascular autoregulation. Thus, transcranial Doppler was used to determine mean arterial flow velocity (Vmean) of the middle cerebral artery in 95 patients before and after carotid endartere......Correction of high grade carotid artery stenosis may result in cerebral hyperperfusion because of defective vascular autoregulation. Thus, transcranial Doppler was used to determine mean arterial flow velocity (Vmean) of the middle cerebral artery in 95 patients before and after carotid......th postoperative day, respectively. The mean pressure difference across the stenosis was 31 (0-63) mmHg in the symptomatic group (n = 18) as opposed to only 10 (0-60) mmHg in the asymptomatic group (n = 77) (p surgery, ipsilateral Vmean increased to 177...

  20. Fusiform aneurysm model in rabbit carotid artery.

    Science.gov (United States)

    Reinald, Nicoleta; Fournier, Benjamin; Naveau, Adrien; Couty, Ludovic; Lemitre, Mathilde; Seguier, Sylvie; Coulomb, Bernard; Gogly, Bruno; Lafont, Antoine; Durand, Eric

    2010-01-01

    To develop a reproducible and accessible model of elastase-induced fusiform aneurysm in carotid rabbit arteries. Elastase, at a concentration of 1-30 U, was incubated into the lumen of carotid rabbit arteries. Four weeks later, angiography, histomorphometry, immunohistochemistry and zymography were performed. The optimal concentration of elastase in this model was 3 U according to the balance between mortality and thrombosis rates. Indeed, at 3 U, external carotid diameter increased from 1.9 +/- 0.1 to 3.1 +/- 0.4 mm (p < 0.0001) associated with degradation of elastic fibers, matrix metalloproteinase-9 secretion, apoptosis and macrophage infiltration. Our study underlines that abdominal aortic aneurysm can be reliably duplicated in an elastase-induced aneurysm in carotid artery, a much more accessible vessel. Copyright 2009 S. Karger AG, Basel.

  1. Modelo experimental estável de aneurisma sacular em artéria carótida de suínos utilizando veia jugular interna Stable experimental model of carotid artery saccular aneurysm in swine using the internal jugular vein

    Directory of Open Access Journals (Sweden)

    Severino Lourenço da Silva Júnior

    2013-04-01

    Full Text Available OBJETIVO: Desenvolver um modelo experimental estável de aneurisma sacular em carótida de suínos utilizando veia jugular interna. MÉTODOS: Em 12 suínos sadios, com peso variando entre 25 e 50kg, cinco machos e sete fêmeas, foi confeccionado aneurisma na artéria carótida comum direita. Após arteriotomia elíptica, foi realizada anastomose terminolateral com coto distal de veia jugular interna. O volume do aneurisma era calculado de maneira que o valor não excedesse em 27 vezes o valor da área da arteriotomia. Após seis dias, era realizada angiografia e análise microscópica do aneurisma para avaliar perviedade e trombose parcial ou total. RESULTADOS: Houve ganho de peso significante dos suínos no intervalo de tempo entre a confecção do aneurisma e a angiografia (p = 0,04. Foi observada perviedade aneurismática em dez suínos (83%. Ocorreram infecções de feridas operatórias em dois animais (16,6%, ambas com início de aparecimento em três dias após a confecção do aneurisma. Análise histológica dos aneurismas mostrou trombos ocluindo parcialmente a luz em nove suínos (75%. Nesses animais, observou-se que, em média, 9% da luz aneurismática estava preenchida por trombos. CONCLUSÃO: Pôde ser desenvolvido um modelo experimental estável de aneurisma sacular em carótida de suínos utilizando veia jugular interna.OBJECTIVE: To develop an experimental model of stable saccular aneurysm in carotid of pigs using the internal jugular vein. METHODS: In 12 healthy pigs, weighing between 25 and 50kg, five males and seven females, we made a right common carotid artery aneurysm. After elliptical arteriotomy, we carried out a terminolateral anastomosis with the distal stump of the internal jugular vein. Aneurysm volume was calculated so that the value did not exceed 27 times the area of the arteriotomy. After six days angiography and microscopic examination were performed to assess patency of the aneurysm and the presence of total or

  2. Endovascular Coil Occlusion of Traumatic Intradural Aneurysm with Presentation as Carotid Cavernous Fistula

    Directory of Open Access Journals (Sweden)

    Lakshmi S P Karanam

    2014-01-01

    Full Text Available Carotid cavernous fistulae (CCF are abnormal communication between cavernous segment of the internal carotid artery and cavernous sinus. These entities are usually encountered in 0.2-0.8% of patients with traumatic skull base fractures. Traumatic cerebral aneurysms are rare and account for less than 1% of intracranial aneurysms. CCF due to ruptured intradural traumatic aneurysm is very rare and difficult to treat by surgical methods. We present one such case of a 40-year-old man with post-traumatic CCF due to a ruptured intradural aneurysm successfully treated with endovascular embolization.

  3. Atherosclerotic disease in axial spondyloarthritis: increased frequency of carotid plaques.

    Science.gov (United States)

    Rueda-Gotor, Javier; Corrales, Alfonso; Blanco, Ricardo; Fuentevilla, Patricia; Portilla, Virginia; Expósito, Rosa; Mata, Cristina; Pina, Trinitario; González-Juanatey, Carlos; Llorca, Javier; González-Gay, Miguel A

    2015-01-01

    To establish whether subclinical atherosclerosis is increased in patients with axial spondyloarthritis (ax-SpA). A set of 149 consecutive patients with no history of cardiovascular disease that fulfilled the Assessment of SpondyloArthritis International Society classification criteria for ax-SpA was studied by carotid ultrasonography. Carotid intima-media thickness (cIMT) and plaques were assessed. A series of 181 community-based controls with no cardiovascular disease were studied for comparison. To establish whether ax-SpA might have a direct effect on the risk of carotid plaques or an indirect effect via its putative influence on hypertension, dyslipidaemia or obesity, we obtained adjusted odds ratios (OR) for each clinical factor by the development of adjusted models. cIMT was increased in patients (0.621±0.123 mm) when compared to controls (0.607±0.117 mm) but the difference was not significant (p=0.30). Nevertheless, carotid plaques were more commonly observed in patients with ax-SpA than in controls (41.6% vs. 26.4%; p=0.003). Patients with plaques had longer duration of the disease than those without plaques (20.5±11.2 years vs. 12.0±8.6 years; p<0.001). Plaques were more frequent in patients with hip involvement (crude odds ratio 3.15, 95% confidence interval [CI] 1.02-9.75; p=0.05), syndesmophytes (crude OR 4.94, 95% CI 2.14-11.4; p<0.001), in patients with higher functional limitation and mobility index measured by BASFI (crude OR 1.16, 95% CI 1.02-1.33; p=0.03) and BASMI (crude OR 1.45, 95% CI 1.19-1.77; p<0.001), and in those with psoriasis (crude OR 3.94, 95% CI 1.31-11.84; p=0.02. However, except for psoriasis that continued being a strong risk factor for plaques after adjustment, the relationship between other clinical features of ax-SpA and carotid plaques disappeared in the adjusted models. Our results confirm the presence of subclinical atherosclerosis in patients with ax-SpA.

  4. Cervical sympathetic chain schwannoma masquerading as a carotid body tumour with a postoperative complication of first-bite syndrome.

    LENUS (Irish Health Repository)

    Casserly, Paula

    2012-01-31

    Carotid body tumours (CBT) are the most common tumours at the carotid bifurcation. Widening of the bifurcation is usually demonstrated on conventional angiography. This sign may also be produced by a schwannoma of the cervical sympathetic plexus. A 45-year-old patient presented with a neck mass. Investigations included contrast-enhanced CT, MRI and magnetic resonance arteriography with contrast enhancement. Radiologically, the mass was considered to be a CBT due to vascular enhancement and splaying of the internal and external carotid arteries. Intraoperatively, it was determined to be a cervical sympathetic chain schwannoma (CSCS). The patient had a postoperative complication of first-bite syndrome (FBS).Although rare, CSCS should be considered in the differential diagnosis for tumours at the carotid bifurcation. Damage to the sympathetic innervation to the parotid gland can result in severe postoperative pain characterised by FBS and should be considered in all patients undergoing surgery involving the parapharyngeal space.

  5. Computational solution of the velocity and wall shear stress distribution inside a left carotid artery under pulsatile flow conditions

    Science.gov (United States)

    Arslan, Nurullah; Turmuş, Hakan

    2014-08-01

    Stroke is still one of the leading causes for death after heart diseases and cancer in all over the world. Strokes happen because an artery that carries blood uphill from the heart to the head is clogged. Most of the time, as with heart attacks, the problem is atherosclerosis, hardening of the arteries, calcified buildup of fatty deposits on the vessel wall. In this study, the fluid dynamic simulations were done in a left carotid bifurcation under the pulsatile flow conditions computationally. Pulsatile flow waveform is given in the paper. In vivo geometry and boundary conditions were obtained from a patient who has stenosis located at external carotid artery (ECA) and internal carotid artery (ICA) of his common carotid artery (CCA). The location of critical flow fields such as low wall shear stress (WSS), stagnation regions and separation regions were detected near the highly stenosed region and at branching region.

  6. [Experimental proximal carpectomy. Biodynamics].

    Science.gov (United States)

    Kuhlmann, J N

    1992-01-01

    Proximal carpectomy was performed in 10 fresh cadavre wrists. Dynamic x-rays were taken and the forces necessary to obtain different movements before and after the operation were measured. Comparison of these parameters clearly defines the advantages and limitations of carpectomy and indicates the reasons.

  7. Proximate Analysis of Coal

    Science.gov (United States)

    Donahue, Craig J.; Rais, Elizabeth A.

    2009-01-01

    This lab experiment illustrates the use of thermogravimetric analysis (TGA) to perform proximate analysis on a series of coal samples of different rank. Peat and coke are also examined. A total of four exercises are described. These are dry exercises as students interpret previously recorded scans. The weight percent moisture, volatile matter,…

  8. Proximal Tibial Bone Graft

    Science.gov (United States)

    ... the Big Toe Ailments of the Smaller Toes Diabetic Foot Treatments Currently selected Injections and other Procedures Treatments ... from which the bone was taken if the foot/ankle surgeries done at the same time allow for it. ... problems after a PTBG include infection, fracture of the proximal tibia and pain related ...

  9. Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements.

    Science.gov (United States)

    Ma, Irene W Y; Caplin, Joshua D; Azad, Aftab; Wilson, Christina; Fifer, Michael A; Bagchi, Aranya; Liteplo, Andrew S; Noble, Vicki E

    2017-12-01

    Non-invasive measures that can accurately estimate cardiac output may help identify volume-responsive patients. This study seeks to compare two non-invasive measures (corrected carotid flow time and carotid blood flow) and their correlations with invasive reference measurements of cardiac output. Consenting adult patients (n = 51) at Massachusetts General Hospital cardiac catheterization laboratory undergoing right heart catheterization between February and April 2016 were included. Carotid ultrasound images were obtained concurrently with cardiac output measurements, obtained by the thermodilution method in the absence of severe tricuspid regurgitation and by the Fick oxygen method otherwise. Corrected carotid flow time was calculated as systole time/√cycle time. Carotid blood flow was calculated as π × (carotid diameter)2/4 × velocity time integral × heart rate. Measurements were obtained using a single carotid waveform and an average of three carotid waveforms for both measures. Single waveform measurements of corrected flow time did not correlate with cardiac output (ρ = 0.25, 95% CI -0.03 to 0.49, p = 0.08), but an average of three waveforms correlated significantly, although weakly (ρ = 0.29, 95% CI 0.02-0.53, p = 0.046). Carotid blood flow measurements correlated moderately with cardiac output regardless of if single waveform or an average of three waveforms were used: ρ = 0.44, 95% CI 0.18-0.63, p = 0.004, and ρ = 0.41, 95% CI 0.16-0.62, p = 0.004, respectively. Carotid blood flow may be a better marker of cardiac output and less subject to measurements issues than corrected carotid flow time.

  10. Carotid artery remodelling in relation to body fat distribution, inflammation and sustained weight loss in obesity.

    Science.gov (United States)

    Kardassis, D; Schönander, M; Sjöström, L; Karason, K

    2014-05-01

    Obesity is known to be associated with carotid artery remodelling, but less is known about how body fat distribution, inflammation and weight loss may affect this relation. Ultrasonography, dual-energy X-ray absorptiometry and computed tomography were performed to evaluate carotid artery intima-media thickness (IMT), body composition and fat distribution, respectively. Participants were divided into three matched study groups (n = 44 per group): obese patients with sustained weight loss 10 years after bariatric surgery [surgery group, body mass index (BMI) 31.5 kg m(-2)]; obese patients who maintained stable weight during the same time period (obese group, BMI 42.5 kg m(-2)); and normal weight subjects (lean group, BMI 24.4 kg m(-2)). Patients in the surgery group, compared with those in the obese group, had slightly lower common carotid artery (CCA) IMT (0.75 ± 0.18 vs. 0.78 ± 0.17 mm) and common carotid bulb (CCB) IMT (0.92 ± 0.32 vs. 0.97 ± 0.32 mm); however, these differences were not statistically significant. Lean individuals, compared with those in the surgery group, had significantly lower CCA and CCB IMT values (P Obese patients with long-term sustained weight loss did not have thinner carotid artery walls compared with their weight-stable obese counterparts. © 2013 The Association for the Publication of the Journal of Internal Medicine.

  11. 3D Isotropic MR Culprit Plaque Visualization of Carotid Plaque Edema and Hemorrhage with Motion Sensitized Blood Suppression

    DEFF Research Database (Denmark)

    Søvsø Szocska Hansen, Esben; Pedersen, Steen Fjord; Bloch, Lars Ø.

    2014-01-01

    hemorrhage and plaque edema may represent advanced stages of atherosclerosis[1, 2]. In this study, we present a novel multi-contrast 3D motion sensitized black-blood CMR imaging sequence, which detects both plaque edema and hemorrhage with positive contrast. Subjects and Methods The 3D imaging sequence...... formatting in all three dimensions was possible to provide a comprehensive and exhaustive evaluation of the vessel wall. For the symptomatic carotid artery plaque, hyperintensive signal intensity was detected with a signal-to-noise ratio (SNR) that was significantly higher compared to the vessel wall...... proximal to the bifurcation (43.36±8.01 versus 16.91±3.49, respectively P plaque compared to the proximal carotid vessel wall was 26.45±4.60 and CNR plaque...

  12. [Retinal and brain infarctions secondary to acute carotid thrombosis in ovarian hyperstimulation syndrome].

    Science.gov (United States)

    Querol, L; Martínez-Corral, M; Martí, E; Martí-Fábregas, J

    2008-06-01

    Ovarian hyperstimulation syndrome (OHSS) is an uncommon but potentially life-threatening iatrogenic condition that may appear following ovulation induction in the course of some fertility treatments. This may lead to further complications, some of which may be severe, such as thromboembolic events. Though rarely, it can therefore be a potential cause of stroke. We report the case of a 34-year old woman under ovulation induction treatment who developed retinal and brain infarctions secondary to internal carotid occlusion. Oral anticoagulation was administered and recovery was good in spite of the persistence of carotid occlusion in follow-up magnetic ressonance imaging- angiographies. This is the first case of carotid occlusion following an OHSS reported in Spain and the eighth one published in the literature. Current literature on cerebrovascular complications in OHSS is also briefly reviewed.

  13. Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space.

    Science.gov (United States)

    Lemos-Rodriguez, Ana M; Sreenath, Satyan B; Rawal, Rounak B; Overton, Lewis J; Farzal, Zainab; Zanation, Adam M

    2017-03-01

    To investigate the extent of carotid artery exposure attained, including the identification of the external carotid branches and lower cranial nerves in five sequential external approaches to the parapharyngeal space, and to provide an anatomical algorithm. Anatomical study. Six latex-injected adult cadaver heads were dissected in five consecutive approaches: transcervical approach with submandibular gland removal, posterior extension of the transcervical approach, transcervical approach with parotidectomy, parotidectomy with lateral mandibulotomy, and parotidectomy with mandibulectomy. The degree of carotid artery exposure attained, external carotid branches, and lower cranial nerves visualized was documented. The transcervical approach exposed 1.5 cm (Standard Deviation (SD) 0.5) of internal carotid artery (ICA) and 1.25 cm (SD 0.25) of external carotid artery (ECA). The superior thyroid and facial arteries and cranial nerve XII and XI were identified. The posterior extension exposed 2.9 cm (SD 0.7) of ICA and 2.7 cm (SD 1.0) of ECA. Occipital and ascending pharyngeal arteries were visualized. The transparotid approach exposed 4.0 cm (SD 1.1) of ICA and 3.98 cm (SD 1.8) of ECA. Lateral mandibulotomy exposed the internal maxillary artery, cranial nerve X, the sympathetic trunk, and 4.6 cm (SD 2.4) of ICA. Mandibulectomy allowed for complete ECA exposure, cranial nerve IX, lingual nerve, and 6.9 cm (SD 1.3) of ICA. Approaches for the parapharyngeal space must be based on anatomic and biological patient factors. This study provides a guide for the skull base surgeon for an extended approach based on the desired anatomic exposure. N/A. Laryngoscope, 127:585-591, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  14. The relation of carotid calcium volume with carotid artery stenosis in symptomatic patients

    NARCIS (Netherlands)

    Marquering, H. A.; Majoie, C. B. L. M.; Smagge, L.; Kurvers, A. G.; Gratama van Andel, H. A.; van den Berg, R.; Nederkoorn, P. J.

    2011-01-01

    Recent research showed a strong correlation of calcium volume scores with degree of stenosis, suggesting that calcium volume could be used in the diagnosis of carotid artery stenosis. We investigated the accuracy of the use of calcium volume scores to diagnose carotid artery stenosis in our target

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

    Directory of Open Access Journals (Sweden)

    Sanjeev Sehrawat

    2012-01-01

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

  16. Reversal of severe SPECT asymmetry after venous extra-intracranial high flow bypass in a patient submitted to therapeutic internal carotid occlusion: case report Reversão de importante assimetria ao SPECT após bypass venoso de alto fluxo extra-intracraniano em paciente submetido a oclusão terapêutica da carótida interna: relato de caso

    Directory of Open Access Journals (Sweden)

    Jorge Marcondes

    2001-09-01

    Full Text Available Therapeutic occlusion of the internal carotid artery is the main option for the treatment of the symptomatic intracavernous internal carotid artery aneurysms, but the issue of the best way of doing the balloon test occlusion (BTO regarding prediction of future ischemic events remains debatable. Single photon emission computerized tomography (SPECT has been offered as one of the best option of monitoring regional cerebral blood flow (rCBF during the BTO, where severe asymmetry is predictive of delayed ischemia. We describe a case of important SPECT asymmetry during BTO clinically negative and its complete reversal with carotid occlusion after extra-intracranial bypass with high flow safenous vein bypass between the cervical carotid artery and the middle cerebral artery.Oclusão terapêutica carotídea ainda é a principal escolha para o tratamento dos aneurismas sintomáticos da artéria carótida interna ao nível do seio cavernoso.Existem controvérsias em relação à obtenção de testes com maior valor preditivo em relação à complicações isquêmicas futuras durante a realização do teste de oclusão carotídeo por balão. A tomografia computorizada de emissão de fóton único (SPECT tem sido defendida como uma opção para a melhor avaliação do fluxo sanguíneo regional cerebral, onde evidente assimetria é indicativa de isquemia tardia. Descrevemos um caso de importante assimetria ao SPECT durante o teste clinicamente negativo e sua reversão completa após anastomose extra-intracraniana com interposição de veia safena magna (alto fluxo entre a artéria carótida cervical e a artéria cerebral média.

  17. Early and late results of carotid endarterectomy: retrospective study of 70 operations

    Directory of Open Access Journals (Sweden)

    Eduardo Toledo de Aguiar

    tomography scan or magnetic resonance imaging. CONCLUSIONS: Carotid endarterectomy was done in accordance with international standards. The most frequent cause of late death was myocardial infarction, and recurrences were related to stroke. Patients should be followed up closely.

  18. Carotid endarterectomy should not be based on consensus statement duplex velocity criteria.

    Science.gov (United States)

    Columbo, Jesse A; Suckow, Bjoern D; Griffin, Claire L; Cronenwett, Jack L; Goodney, Philip P; Lukovits, Timothy G; Zwolak, Robert M; Fillinger, Mark F

    2017-04-01

    Randomized trials support carotid endarterectomy (CEA) in asymptomatic patients with ≥60% internal carotid artery (ICA) stenosis. The widely referenced Society for Radiologists in Ultrasound Consensus Statement on carotid duplex ultrasound (CDUS) imaging indicates that an ICA peak systolic velocity (PSV) ≥230 cm/s corresponds to a ≥70% ICA stenosis, leading to the potential conclusion that asymptomatic patients with an ICA PSV ≥230 cm/s would benefit from CEA. Our goal was to determine the natural history stroke risk of asymptomatic patients who might have undergone CEA based on consensus statement PSV of ≥230 cm/s but instead were treated medically based on more conservative CDUS imaging criteria. All patients who underwent CDUS imaging at our institution during 2009 were retrospectively reviewed. The year 2009 was chosen to ensure extended follow-up. Asymptomatic patients were included if their ICA PSV was ≥230 cm/s but less than what our laboratory considers a ≥80% stenosis by CDUS imaging (PSV ≥430 cm/s, end-diastolic velocity ≥151 cm/s, or ICA/common carotid artery PSV ratio ≥7.5). Study end points included freedom from transient ischemic attack (TIA), freedom from any stroke, freedom from carotid-etiology stroke, and freedom from revascularization. Criteria for review were met by 327 patients. Mean follow-up was 4.3 years, with 85% of patients having >3-year follow-up. Four unheralded strokes occurred during follow-up at carotid artery. Ipsilateral TIA occurred in 17 patients. An additional 12 strokes occurred that appeared unrelated to ipsilateral carotid disease, including hemorrhagic events, contralateral, and cerebellar strokes. Revascularization was undertaken in 59 patients, 1 for stroke, 12 for TIA, and 46 for asymptomatic disease. Actuarial freedom from carotid-etiology stroke was 99.7%, 98.4%, and 98.4% at 1, 3, and 5 years, respectively. Freedom from TIA was 98%, 96%, and 95%, freedom from any stroke was 99%, 96%, and

  19. Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery.

    Science.gov (United States)

    Illuminati, Giulio; Belmonte, Romain; Schneider, Fabrice; Pizzardi, Giulia; Calió, Francesco G; Ricco, Jean-Baptiste

    2017-06-01

    The objective of this study was to evaluate the results of prosthetic carotid bypass (PCB) with polytetrafluoroethylene (PTFE) grafts as an alternative to carotid endarterectomy (CEA) in treatment of restenosis after CEA or carotid artery stenting (CAS). From January 2000 to December 2014, 66 patients (57 men and 9 women; mean age, 71 years) presenting with recurrent carotid artery stenosis ≥70% (North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria) were enrolled in a prospective study in three centers. The study was approved by an Institutional Review Board. Informed consent was obtained from all patients. During the same period, a total of 4321 CEAs were completed in the three centers. In these 66 patients, the primary treatment of the initial carotid artery stenosis was CEA in 57 patients (86%) and CAS in nine patients (14%). The median delay between primary and redo revascularization was 32 months. Carotid restenosis was symptomatic in 38 patients (58%) with transient ischemic attack (n = 20) or stroke (n = 18). In this series, all patients received statins; 28 patients (42%) received dual antiplatelet therapy, and 38 patients (58%) received single antiplatelet therapy. All PCBs were performed under general anesthesia. No shunt was used in this series. Nasal intubation to improve distal control of the internal carotid artery was performed in 33 patients (50%), including those with intrastent restenosis. A PTFE graft of 6 or 7 mm in diameter was used in 6 and 60 patients, respectively. Distal anastomosis was end to end in 22 patients and end to side with a clip distal to the atherosclerotic lesions in 44 patients. Completion angiography was performed in all cases. The patients were discharged under statin and antiplatelet treatment. After discharge, all of the patients underwent clinical and Doppler ultrasound follow-up every 6 months. Median length of follow-up was 5 years. No patient died, sustained a stroke, or presented with a

  20. Proximal humeral fractures

    OpenAIRE

    Mauro, Craig S.

    2011-01-01

    Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percuta...

  1. The Proximal Priority Theory: An Updated Technique in Low Level Laser Therapy with an 830 nm GaAlAs Laser.

    Science.gov (United States)

    Ohshiro, Toshio

    2012-12-26

    The 830 nm GaAlAs diode laser has played an extremely active role in low level laser therapy (LLLT) since the early 1980's. Recently, the author modified his original proximal priority laser technique (PPLT), and the current article set out to explain the improved approach and show scientific evidence for its efficacy. Laser Therapy System: The laser therapy system used was based on the GaAlAs diode (OhLase-3D1, JMLL, Japan), delivering 60 mW in continuous wave at a wavelength of 830 nm in the near infrared with a power density at the tip of the probe head of approximately 1.2 W/cm(2). Proximal Priority Laser Technique: Under the author's PPLT concept, the brain is the control center for the body so every other part of the body is distal to the head. The main blood supply to the head is through the carotid arteries, and the deep penetration of the 830 nm beam applied to the side of the neck can involve and photoactivate the external and internal carotids, increasing the blood supply to the brain and creating a systemic parasympathetic system-mediated whole-body effect. The author has added gentle neck-stretching, trunk-stretching and his distal tissue softening approaches concomitant with the irradiation which enhance treatment efficacy. Real-time fine-plate thermography has revealed whole-body warming as a result of the PPLT, with applications including chronic pain attenuation, female infertility and functional training of paraplegic cerebral palsy patients. The warming effect had a latency from hours to days, increasing in intensity and latency with subsequent PPLT sessions. Both Doppler flowmetry and SPECT have shown increased cerebral and systemic blood flow following PPLT. PPLT is easy to deliver and offers tangible results in a large range of conditions, enhancing the efficacy of diode laser LLLT.

  2. The effect of an external hip joint stabiliser on gait function after surgery for tumours located around the circumference of the pelvis: analysis of seven cases of internal hemipelvectomy or proximal femur resection.

    Science.gov (United States)

    Akiyama, Toru; Saita, Kazuo; Ogura, Koichi; Kawai, Akira; Imanishi, Jungo; Yazawa, Yasuo; Kawashima, Noritaka; Ogata, Toru

    2016-03-01

    Limb-sparing resection of malignant pelvic tumours provides the opportunity for patients to obtain better post-operative mobility. However, because few studies have examined in detail the gait function of patients following pelvic tumour resection, the factors affecting gait performance remain to be clarified. Here, with the laboratory-based computer-assisted gait analysis, we evaluated these patients' gait objectively and the impact of a hip-stabilising supporter on gait improvement was simultaneously examined. Three-dimensional gait analysis was performed to obtain cross-sectional data for seven post-operative patients (mean age, 42.7 years; range, 20-61 years) who underwent various types of resection, including P1/4 internal hemipelvectomy (IH), P1/2/3 IH, and proximal femur resection with prosthetic reconstruction. To assess the immediate effects of a hip joint stabiliser, we instructed subjects to walk at their self-selected preferred speed and compared gait parameters with and without use of the hip stabiliser. At baseline, the average walking speed was 0.75 m/s (95% CI 0.53-0.97). As shown by the intra-subject comparison, the hip stabiliser increased walking speed in all but one subject, increasing both temporal and spatial parameters. Ground reaction force of operated limbs increased for some subjects, while step length increased on at least one side in all subjects. Improvement in the gait parameters is indicative of better control provided by the external hip stabiliser over the affected limb. Moreover, our findings show the potential of a biomechanical approach to improve gait function following pelvic tumour resection.

  3. [Disorders of sex development and proximal hypospadias].

    Science.gov (United States)

    Oswald, J

    2016-01-01

    Children with ambiguous genitalia due to different chromosome or gonadal sex are a particular challenge concerning the diagnostic and therapeutic implications. Proximal hypospadias patients with normal gonadal development should be distinguished from children with DSD (disorders of sex development) to guarantee normal gender identity and the best possible surgical therapy. This paper focuses on the terminology, embryology, and pathophysiology of the different manifestations of DSD. The state of knowledge about this disease pattern with particular emphasis on proximal hypospadias based on national and international scientific discussions is presented. The different clinical pictures as well as therapeutic options of DSD with a special focus on recent literature and giving particular attention to patients with proximal hypospadias are presented. Because of the complexity of patients suffering from disorders of sex development an interdisciplinary DSD healthcare team including a paediatric endocrinologist as well as paediatric urologist should be provided. These specialists enable an accurate diagnosis in severe hypospadias patients without reference to DSD diseases patterns.

  4. Gender differences in patients with carotid stenosis.

    Science.gov (United States)

    Stoberock, Konstanze; Debus, Eike Sebastian; Atlihan, Gülsen; Daum, Günter; Larena-Avellaneda, Axel; Eifert, Sandra; Wipper, Sabine

    2016-01-01

    This overview analyses gender differences in prevalence, epidemiology, risk factors and therapy in patients with carotid stenosis in a systematic review. Ischemic stroke is a leading cause of death in Western society, where about 20% of cases are triggered by a carotid stenosis or occlusion, which occurs more frequently in men than in women. The stroke-protective effect of carotid endarterectomy is greater in men. Men have lower peri-procedural stroke and death rates. Particularly men with carotid stenosis and a life expectancy of at least 5 years benefit from surgical treatment. Also, the recurrence rate of ipsilateral stroke 5 years after initial surgery is lower in men than in women. It is not yet fully clarified whether there are significant gender differences regarding the outcome after endovascular versus surgical treatment. Gender differences in the outcome of carotid artery repair may be caused by biological, anatomical (smaller vessel diameter in women) or hormonal differences as well as a protracted development of atherosclerotic changes in women and different plaque morphology. Moreover, women are on average older at the time of surgery and their surgical treatment is often delayed. To reduce the risk of stroke and to improve treatment outcome especially for women, further research on gender differences and their causes is mandatory and promising.

  5. [Prevention of cerebral ictus, of carotid origin].

    Science.gov (United States)

    Tovar Martín, E

    2001-01-01

    The current incidence of stroke in Europe and the USA is about 200 per 100,000 population per annum. Eighty percent of strokes are ischaemic and 20% are due to hemorrhage. Approximately half the patients with ischaemic strike have carotid artery stenosis and about one third (10% all stroke victims) have had no warning symptoms such as transient ischaemi attacks. The European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) have effectively shown that carotid endarterectomy (CEA) can prevent strokes in symptomatic patients. The benefit of operation is, at present, confined to those with at least 70% stenosis; for 30-69%, the trials have not yet reported a result. In asymptomatic patients the Veterans Administration Study and the Asymptomatic Carotid Atherosclerosis Study (ACAS) have yielded promising results that surgery may reduce the risk of TIA and minor stroke. There is as yet no convincing evidence in asymptomatic patients that moderate or severe stroke (or death) can be prevented by CEA. The aim of this trial is to determine whether CEA and appropriate best medical treatment (BMT) can improve stroke free survival time when compared with BMT alone.

  6. Direct Carotid Exposure for Neuroendovascular Approaches.

    Science.gov (United States)

    Shin, Dong Seong; Yilmaz, Ali; Ozkul, Ayca; Yeo, Dong Kyu; Hwang, Sun-Chul; Kim, Bum-Tae

    2016-11-01

    Objective The transfemoral approach is a common route for catheterization of the supra-aortic vessels in neuroendovascular therapy. However, in some cases, the patient's anatomy prevents transfemoral catheterization or distal access to the carotid s. In such cases, direct carotid exposure (DCE) for neuroendovascular approaches may be used to treat cerebrovascular diseases. Methods We present 11 cases in which we were unable to perform the distal approach and DCE was the preferred neuroendovascular treatment procedure. Results DCE was performed on 11 patients with cerebral aneurysm (n = 8), carotid cavernous fistula (CCF) (n = 1), malignant brain tumor (n = 1), and carotid angioplasty and stenting (n = 1). Ten patients were female; one was male. Ages ranged from 63 to 87 years (mean: 71.36 years). Coil embolization was performed on patients with cerebral aneurysm and CCF. The patient with a malignant brain tumor underwent polyvinyl alcohol particle embolization. The only complication was a carotid artery dissection that occurred in one patient during stenting. Conclusion DCE for neuroendovascular approaches can be used as an alternative for patients with tortuous vasculature access in the femoral route. In such patients, a combination of neuroendovascular treatment and surgery in a hybrid operating room with angiography is preferred. Georg Thieme Verlag KG Stuttgart · New York.

  7. A Bullet Lying Next to the Common Carotid Artery in the Neck of a Young Boy.<