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Sample records for resolution carotid black-blood

  1. Carotid plaque assessment using fast 3D isotropic resolution black-blood MRI.

    PubMed

    Balu, Niranjan; Yarnykh, Vasily L; Chu, Baocheng; Wang, Jinnan; Hatsukami, Thomas; Yuan, Chun

    2011-03-01

    Black-blood MRI is a promising tool for carotid atherosclerotic plaque burden assessment and compositional analysis. However, current sequences are limited by large slice thickness. Accuracy of measurement can be improved by moving to isotropic imaging but can be challenging for patient compliance due to long scan times. We present a fast isotropic high spatial resolution (0.7×0.7×0.7 mm3) three-dimensional black-blood sequence (3D-MERGE) covering the entire cervical carotid arteries within 2 min thus ensuring patient compliance and diagnostic image quality. The sequence is optimized for vessel wall imaging of the carotid bifurcation based on its signal properties. The optimized sequence is validated on patients with significant carotid plaque. Quantitative plaque morphology measurements and signal-to-noise ratio measures show that 3D-MERGE provides good blood suppression and comparable plaque burden measurements to existing MRI protocols. 3D-MERGE is a promising new tool for fast and accurate plaque burden assessment in patients with atherosclerotic plaque. Copyright © 2010 Wiley-Liss, Inc.

  2. Comparison between 2D and 3D high-resolution black-blood techniques for carotid artery wall imaging in clinically significant atherosclerosis.

    PubMed

    Balu, Niranjan; Chu, Baocheng; Hatsukami, Thomas S; Yuan, Chun; Yarnykh, Vasily L

    2008-04-01

    To compare two- (2D) and three-dimensional (3D) black-blood imaging methods for morphological measurements of the carotid artery wall and atherosclerotic plaque. A total of 18 subjects with 50% to 79% carotid stenosis were scanned with 2D (2-mm slice thickness) and 3D (1-mm/0.5-mm actual/interpolated slice thickness) T1-weighted fast spin-echo (FSE) black-blood imaging sequences with double inversion-recovery (DIR) blood suppression. Morphological measurements (lumen area, wall area, vessel area, mean wall thickness, and maximal wall thickness), signal-to-noise ratio (SNR) in the wall and lumen, and wall-lumen contrast-to-noise ratio (CNR) were compared between 2D and 3D images. The effect of improved slice resolution in 3D imaging was evaluated for visualization of small plaque components. Lumen SNR (P = 0.16), wall SNR (P = 0.65), and CNR (P = 0.94) were comparable between 2D/3D. There was no difference in average lumen area (P = 0.16), average wall area (P = 0.99), average vessel area (P = 0.0.58), mean wall thickness (P = 0.09), and maximum wall thickness (P = 0.06) between 2D/3D. Distributions of small plaque components such as calcification were better characterized by the 3D acquisition. There was a higher sensitivity to motion artifacts with 3D imaging, resulting in three examinations with low image quality. 2D and 3D protocols provided comparable morphometric measurements of the carotid artery. The major advantage of 3D imaging is improved small plaque component visualization, while the 2D technique provides higher reliability for image quality. (c) 2008 Wiley-Liss, Inc.

  3. Comparison Between 2D and 3D High-Resolution Black-Blood Techniques for Carotid Artery Wall Imaging in Clinically Significant Atherosclerosis

    PubMed Central

    Balu, Niranjan; Chu, Baocheng; Hatsukami, Thomas S.; Yuan, Chun; Yarnykh, Vasily L.

    2010-01-01

    Purpose To compare two- (2D) and three-dimensional (3D) black-blood imaging methods for morphological measurements of the carotid artery wall and atherosclerotic plaque. Materials and Methods A total of 18 subjects with 50% to 79% carotid stenosis were scanned with 2D (2-mm slice thickness) and 3D (1-mm/0.5-mm actual/interpolated slice thickness) T1-weighted fast spin-echo (FSE) black-blood imaging sequences with double inversion-recovery (DIR) blood suppression. Morphological measurements (lumen area, wall area, vessel area, mean wall thickness, and maximal wall thickness), signal-to-noise ratio (SNR) in the wall and lumen, and wall-lumen contrast-to-noise ratio (CNR) were compared between 2D and 3D images. The effect of improved slice resolution in 3D imaging was evaluated for visualization of small plaque components. Results Lumen SNR (P = 0.16), wall SNR (P = 0.65), and CNR (P = 0.94) were comparable between 2D/3D. There was no difference in average lumen area (P = 0.16), average wall area (P = 0.99), average vessel area (P = 0.0.58), mean wall thickness (P = 0.09), and maximum wall thickness (P = 0.06) between 2D/3D. Distributions of small plaque components such as calcification were better characterized by the 3D acquisition. There was a higher sensitivity to motion artifacts with 3D imaging, resulting in three examinations with low image quality. Conclusion 2D and 3D protocols provided comparable morphometric measurements of the carotid artery. The major advantage of 3D imaging is improved small plaque component visualization, while the 2D technique provides higher reliability for image quality. PMID:18383253

  4. Black-blood multicontrast imaging of carotid arteries with DANTE-prepared 2D and 3D MR imaging.

    PubMed

    Li, Linqing; Chai, Joshua T; Biasiolli, Luca; Robson, Matthew D; Choudhury, Robin P; Handa, Ashok I; Near, Jamie; Jezzard, Peter

    2014-11-01

    with nutation for tailored excitation -prepared T1-, T2-, and proton density-weighted sequences was 27.3, 14.7, and 25.7 mm(-1)min(-1/2), respectively; this represented an improvement of approximately 25%-100% (P < .05) when compared with the CNReff effective contrast-to-noise ratio attained with existing methods. The 3D three-dimensional DASH DANTE-prepared FLASH technique proved to be a fast (<2 seconds per section) and high-spatial-resolution (0.6 mm isotropic) BB black blood technique with higher (75%-100% improvement, P < .001) signal-to-noise ratio efficiency than the 3D three-dimensional MERGE MSDE-prepared FLASH technique. The DANTE delay alternating with nutation for tailored excitation -prepared multicontrast 2D two-dimensional BB black blood technique is a promising new tool for MR imaging of carotid artery walls. Additionally, the 3D three-dimensional DASH DANTE-prepared FLASH sequence enables 3D three-dimensional high-spatial-resolution fast T1-weighted imaging of carotid artery walls. ©RSNA, 2014 Online supplemental material is available for this article .

  5. Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation

    PubMed Central

    Xie, Yibin; Yang, Qi; Xie, Guoxi; Pang, Jianing; Fan, Zhaoyang; Li, Debiao

    2015-01-01

    Purpose The purpose of this work is to develop a 3D black-blood imaging method for simultaneously evaluating carotid and intracranial arterial vessel wall with high spatial resolution and excellent blood suppression with and without contrast enhancement. Methods DANTE preparation module was incorporated into SPACE sequence to improve blood signal suppression. Simulations and phantom studies were performed to quantify image contrast variations induced by DANTE. DANTE-SPACE, SPACE and 2D TSE were compared for apparent SNR, CNR and morphometric measurements in fourteen healthy subjects. Preliminary clinical validation was performed in six symptomatic patients. Results Apparent residual luminal blood was observed in 5 (pre-CE) and 9 (post-CE) subjects with SPACE, and only 2 (post-CE) subjects with DANTE-SPACE. DANTE-SPACE showed 31% (pre-CE) and 100% (post-CE) improvement in wall-to-blood CNR over SPACE. Vessel wall area measured from SPACE was significantly larger than that from DANTE-SPACE due to possible residual blood signal contamination. In patients DANTE-SPACE showed the potential to detect vessel wall dissection and identify plaque components. Conclusion DANTE-SPACE significantly improved arterial and venous blood suppression compared with SPACE. Simultaneous high-resolution carotid and intracranial vessel wall imaging to potentially identify plaque components was feasible with scan time under 6 minutes. PMID:26152900

  6. A purpose-built neck coil for black-blood DANTE-prepared carotid artery imaging at 7T.

    PubMed

    Papoutsis, Konstantinos; Li, Linqing; Near, Jamie; Payne, Stephen; Jezzard, Peter

    2017-07-01

    Atherosclerotic plaques in the bifurcation of the carotid arteries can pose a significant health risk due to possible plaque rupture and subsequent stroke. The assessment of plaques, and evaluation of the risk they pose, can be performed with Black-Blood (BB) vessel wall magnetic resonance imaging. However, resolution at standard clinical field strengths (up to 3T) is limited, hampering reliable assessment and diagnosis. The aim of this study was to investigate the benefits of 7T MRI using a BB application that has been successful at clinical field strengths. Therefore, for BB imaging, each sequence was preceded with 'Delay Alternating with Nutation for Tailored Excitation' (DANTE) preparation pulses for blood signal suppression. A coil comprising a 4-channel Tx array was designed and built to provide the required excitation coverage for the DANTE train; and a 4-channel Rx array was constructed to target the carotid bifurcation. Human and phantom results showed satisfactory blood suppression and comparable SNR and CNR to 3T, therefore demonstrating the feasibility of the application at 7T. However, the imposed SAR restrictions led to long scan times and subsequent motion artifacts. Thus, more accurate local SAR supervision schemes are required which could lead to a further improvement of BB DANTE vessel wall imaging at 7T. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation.

    PubMed

    Xie, Yibin; Yang, Qi; Xie, Guoxi; Pang, Jianing; Fan, Zhaoyang; Li, Debiao

    2016-06-01

    The purpose of this study was to develop a three-dimensional black blood imaging method for simultaneously evaluating the carotid and intracranial arterial vessel walls with high spatial resolution and excellent blood suppression with and without contrast enhancement. The delay alternating with nutation for tailored excitation (DANTE) preparation module was incorporated into three-dimensional variable flip angle turbo spin echo (SPACE) sequence to improve blood signal suppression. Simulations and phantom studies were performed to quantify image contrast variations induced by DANTE. DANTE-SPACE, SPACE, and two-dimensional turbo spin echo were compared for apparent signal-to-noise ratio, contrast-to-noise ratio, and morphometric measurements in 14 healthy subjects. Preliminary clinical validation was performed in six symptomatic patients. Apparent residual luminal blood was observed in five (pre-contrast) and nine (post-contrast) subjects with SPACE and only two (post-contrast) subjects with DANTE-SPACE. DANTE-SPACE showed 31% (pre-contrast) and 100% (post-contrast) improvement in wall-to-blood contrast-to-noise ratio over SPACE. Vessel wall area measured from SPACE was significantly larger than that from DANTE-SPACE due to possible residual blood signal contamination. DANTE-SPACE showed the potential to detect vessel wall dissection and identify plaque components in patients. DANTE-SPACE significantly improved arterial and venous blood suppression compared with SPACE. Simultaneous high-resolution carotid and intracranial vessel wall imaging to potentially identify plaque components was feasible with a scan time under 6 min. Magn Reson Med 75:2286-2294, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  8. Technical Note: Measurement of common carotid artery lumen dynamics using black-blood MR cine imaging.

    PubMed

    Dai, Erpeng; Dong, Li; Zhang, Zhe; Li, Lyu; Zhang, Hui; Zhao, Xihai; Wang, Jinnan; Yuan, Chun; Guo, Hua

    2017-03-01

    To demonstrate the feasibility of measuring the common carotid artery (CCA) lumen dynamics using a black-blood cine (BB-cine) imaging method. Motion-sensitized driven-equilibrium (MSDE) prepared spoiled gradient sequence was used for the BB-cine imaging. CCAs of eleven healthy volunteers were studied using this method. Lumen dynamics, including lumen area evolution waveforms and distension values, were measured and evaluated by comparing this method with bright-blood cine (BrB-cine) imaging. Compared with the BrB-cine images, flow artifacts were effectively suppressed in the BB-cine images. BrB-cine images generally show larger lumen areas than BB-cine images. The lumen area waveforms and distension measurements from BB-cine imaging showed smaller variances among different subjects than BrB-cine imaging. The proposed BB-cine imaging technique can suppress the flow artifacts effectively and reduce the partial volume effects from the vessel wall. This might allow more accurate lumen dynamics measurements than traditional BrB-cine imaging, which may further be valuable for investigating biomechanical and functional properties of the cardiovascular system. © 2017 American Association of Physicists in Medicine.

  9. Three-dimensional black-blood multi-contrast carotid imaging using compressed sensing: a repeatability study.

    PubMed

    Yuan, Jianmin; Usman, Ammara; Reid, Scott A; King, Kevin F; Patterson, Andrew J; Gillard, Jonathan H; Graves, Martin J

    2017-06-26

    The purpose of this work is to evaluate the repeatability of a compressed sensing (CS) accelerated multi-contrast carotid protocol at 3 T. Twelve volunteers and eight patients with carotid disease were scanned on a 3 T MRI scanner using a CS accelerated 3-D black-blood multi-contrast protocol which comprises T 1w, T 2w and PDw without CS, and with a CS factor of 1.5 and 2.0. The volunteers were scanned twice, the lumen/wall area and wall thickness were measured for each scan. Eight patients were scanned once, the inter/intra-observer reproducibility of the measurements was calculated. In the repeated volunteer scans, the interclass correlation coefficient (ICC) for the wall area measurement using a CS factor of 1.5 in PDw, T 1w and T 2w were 0.95, 0.81, and 0.97, respectively. The ICC for lumen area measurement using a CS factor of 1.5 in PDw, T 1w and T 2w were 0.96, 0.92, and 0.96, respectively. In patients, the ICC for inter/intra-observer measurements of lumen/wall area, and wall thickness were all above 0.81 in all sequences. The results show a CS accelerated 3-D black-blood multi-contrast protocol is a robust and reproducible method for carotid imaging. Future protocol design could use CS to reduce the scanning time.

  10. Three-dimensional black-blood T2 mapping with compressed sensing and data-driven parallel imaging in the carotid artery.

    PubMed

    Yuan, Jianmin; Usman, Ammara; Reid, Scott A; King, Kevin F; Patterson, Andrew J; Gillard, Jonathan H; Graves, Martin J

    2017-04-01

    To develop a 3D black-blood T2 mapping sequence with a combination of compressed sensing (CS) and parallel imaging (PI) for carotid wall imaging. A 3D black-blood fast-spin-echo (FSE) sequence for T2 mapping with CS and PI was developed and validated. Phantom experiments were performed to assess T2 accuracy using a Eurospin Test Object, with different combination of CS and PI acceleration factors. A 2D multi-echo FSE sequence was used as a reference to evaluate the accuracy. The concordance correlation coefficient and Bland-Altman statistics were calculated. Twelve volunteers were scanned twice to determine the repeatability of the sequence and the intraclass correlation coefficient (ICC) was reported. Wall-lumen sharpness was calculated for different CS and PI combinations. Six patients with carotid stenosis >50% were scanned with optimised sequence. The T2 maps were compared with multi-contrast images. Phantom scans showed good correlation in T2 measurement between current and reference sequence (r=0.991). No significant difference was found between different combination of CS and PI accelerations (p=0.999). Volunteer scans showed good repeatability of T2 measurement (ICC: 0.93, 95% CI 0.84-0.97). The mean T2 of the healthy wall was 48.0±9.5ms. Overall plaque T2 values from patients were 54.9±12.2ms. Recent intraplaque haemorrhage and fibrous tissue have higher T2 values than the mean plaque T2 values (88.1±6.8ms and 62.7±9.3ms, respectively). This study demonstrates the feasibility of combining CS and PI for accelerating 3D T2 mapping in the carotid artery, with accurate T2 measurements and good repeatability. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Relationship between the Carotid Plaque T1 Relaxation Time and the Plaque-to-Muscle Signal Intensity Ratio on Black-Blood Magnetic Resonance Imaging Scans.

    PubMed

    Eto, Ayumu; Kinoshita, Yoshimasa; Matsumoto, Yoshihisa; Kiyomi, Fumiaki; Iko, Minoru; Nii, Kouhei; Tsutsumi, Masanori; Sakamoto, Kimiya; Aikawa, Hiroshi; Kazekawa, Kiyoshi

    2016-11-01

    Black-blood magnetic resonance imaging (BB-MRI) is useful for the characterization and assessment of carotid artery plaques. The plaque-to-muscle signal intensity (SI) ratio (plaque/muscle ratio [PMR]) is used widely to evaluate plaques. However, the correlation between the PMR and the T1 relaxation time needs to be determined. We measured the T1 relaxation time of carotid plaques using T1 mapping and compared the results with the PMR on BB-MRI scans. Between April 2014 and July 2015, 20 patients with carotid artery stenosis were treated by carotid artery stenting. All patients underwent preoperative magnetic resonance plaque imaging. The ratio of the plaque SI to the sternocleidomastoid muscle was calculated on T1-weighted BB-MRI scans. T1 mapping was performed in the region where the vessel was narrowest using the inversion recovery technique. The T1 relaxation time was recorded to determine whether there was a correlation with the PMR. The plaque T1 value was 577.3 ± 143.2 milliseconds; the PMR value obtained on BB-MRI scans was 1.23 ± .27. There was a statistically significant decrease in the T1 value as the PMR increased (P < .0001). As the T1 relaxation time was well correlated with the PMR on BB-MRI scans, the evaluation of vulnerable plaques using the PMR was reliable and convenient. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Turbo fast three-dimensional carotid artery black-blood MRI by combining three-dimensional MERGE sequence with compressed sensing.

    PubMed

    Li, Bo; Dong, Li; Chen, Bin; Ji, Shuangxi; Cai, Wenchao; Wang, Ye; Zhang, Jue; Zhang, Zhaoqi; Wang, Xiaoying; Fang, Jing

    2013-11-01

    In this study, we sought to investigate the feasibility of turbo fast three-dimensional (3D) black-blood imaging by combining a 3D motion-sensitizing driven equilibrium rapid gradient echo sequence with compressed sensing. A pseudo-centric phase encoding order was developed for compressed sensing-3D motion-sensitizing driven equilibrium rapid gradient echo to suppress flow signal in undersampled 3D k-space. Nine healthy volunteers were recruited for this study. Signal-to-tissue ratio, contrast-to-tissue ratio (CTR) and CTR efficiency (CTReff ) between fully sampled and undersampled images were calculated and compared in seven subjects. Moreover, isotropic high resolution images using different compressed sensing acceleration factors were evaluated in two other subjects. Wall-lumen signal-to-tissue ratio or CTR were comparable between the undersampled and the fully sampled images, while significant improvement of CTReff was achieved in the undersampled images. At an isotropic high spatial resolution of 0.7 × 0.7 × 0.7 mm(3) , all undersampled images exhibited similar level of the flow suppression efficiency and the capability of delineating outer vessel wall boundary and lumen-wall interface, when compared with the fully sampled images. The proposed turbo fast compressed sensing 3D black-blood imaging technique improves scan efficiency without sacrificing flow suppression efficiency and vessel wall image quality. It could be a valuable tool for rapid 3D vessel wall imaging. Copyright © 2012 Wiley Periodicals, Inc.

  13. High-resolution magnetic resonance imaging of carotid atherosclerosis identifies vulnerable carotid plaques.

    PubMed

    Millon, Antoine; Mathevet, Jean-Louis; Boussel, Loic; Faries, Peter L; Fayad, Zahi A; Douek, Philippe C; Feugier, Patrick

    2013-04-01

    Carotid magnetic resonance imaging (MRI) may be a useful tool in characterizing carotid plaque vulnerability, but large studies are still lacking. The purpose of this study was to assess carotid MRI features of vulnerable plaque in a large study and the changes in carotid plaque morphology with respect to time since the neurological event. We included 161 patients with carotid plaque more than 3 mm thick. All patients underwent carotid MRI to obtain 3-T high-resolution magnetic resonance sequences. Large lipid core, intraplaque hemorrhage (IPH), fibrous cap rupture (FCR), and gadolinium enhancement (GE) were assessed and classified as present or absent. Prevalences of these features were then compared between symptomatic and asymptomatic patients and time since stroke. Seven patients were excluded because of poor image quality. Of the remaining 154 patients, 52 were symptomatic and 102 were asymptomatic. The prevalences of IPH (39 vs 16%; P = .002), FCR (30 vs 9%; P = .001), and GE (75 vs 55%; P = .015) were significantly higher in symptomatic than asymptomatic patients. After multivariate analysis, the prevalences of IPH (odds ratio, 2.6; P = .023) and FCR (odds ratio, 2.8; P = .038) were still significantly higher. The prevalence of IPH was significantly higher in symptomatic patients with plaque regardless of the time since the neurological event. For FCR, the difference between symptomatic and asymptomatic patients was significant only during the first 15 days after the neurological event. Carotid MRI can identify plaque features that are associated with symptomatic presentation and may be indicative of plaque vulnerability. These features may ultimately be used in the management of extracranial carotid stenosis. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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

    PubMed Central

    2012-01-01

    Background Components of carotid atherosclerotic plaques can reliably be identified and quantified using high resolution in vivo 3-Tesla CMR. It is suspected that lipid apheresis therapy in addition to lowering serum lipid levels also has an influence on development and progression of atherosclerotic plaques. The purpose of this study was to evaluate the influence of chronic lipid apheresis (LA) on the composition of atherosclerotic carotid plaques. Methods 32 arteries of 16 patients during chronic LA-therapy with carotid plaques and stenosis of 1–80% were matched according to degree of stenosis with 32 patients, who had recently suffered an ischemic stroke. Of these patients only the asymptomatic carotid artery was analyzed. All patients underwent black-blood 3 T CMR of the carotids using parallel imaging and dedicated surface coils. Cardiovascular risk factors were recorded. Morphology and composition of carotid plaques were evaluated. For statistical evaluation Fisher’s Exact and unpaired t-test were used. A p-value <0.05 was considered statistically significant. Results Patients in the LA-group were younger (63.5 vs. 73.9. years, p<0.05), had a higher prevalence of hypercholesterolemia and of established coronary heart disease in patients and in first-degree relatives (p<0.05, respectively). LA-patients had smaller maximum wall areas (49.7 vs. 59.6mm2, p<0.05), showed lower prevalence of lipid cores (28.1% vs. 56.3%, p<0.05) and the lipid content was smaller than in the control group (5.0 vs. 11.6%, p<0.05). Minimum lumen areas and maximum total vessel areas did not differ significantly between both groups. Conclusion Results of this study suggest that, despite a severer risk profile for cardiovascular complications in LA-patients, chronic LA is associated with significantly lower lipid content in carotid plaques compared to plaques of patients without LA with similar degrees of stenosis, which is characteristic of clinically stable plaques. PMID:23194143

  15. Is high-resolution magnetic resonance imaging or ultrasonography better for prediction of clinical events induced by carotid vulnerable lesions?

    PubMed

    Qin, Haiqiang; Sui, Binbin; Zhang, Wei; Zhao, Xingquan; Wang, Guihong; Zhou, Yong; Gao, Peiyi; Wang, Yongjun

    2008-05-01

    To find a better way to predict the clinical events caused by carotid vulnerable lesions via comparison study on high-resolution magnetic resonance imaging (MRI) and ultrasonography (US). Twenty-seven symptomatic stroke patients were recruited, all of which were given both high-resolution MRI and US at bilateral carotids. Respective correlations of high-resolution MRI and US outcomes with clinical events were performed and the lesion numbers identified by high-resolution MRI and US were statistically analysed. Six carotid arteries in six patients were excluded because of uninterpretable high-resolution MRI findings or patients' intolerance. In the remaining 48 carotids analysed, the number of carotid with vulnerable/stable lesion was 17/31 by high-resolution MRI and 25/23 by US, respectively. Contingency coefficient was 0.40 between vulnerable lesion by high-resolution MRI and clinical event (p=0.004), and 0.19 (p=0.221) by US and clinical event, respectively. The difference of detected lesion numbers between high-resolution MRI and US was statistically significant p=0.039) through matched chi-square test. High-resolution MRI may be a better way than US in predicting the clinical events caused by carotid vulnerable lesions.

  16. Mineral volume and morphology in carotid plaque specimens using high-resolution MRI and CT.

    PubMed

    Wolf, Ronald L; Wehrli, Suzanne L; Popescu, Andra M; Woo, John H; Song, Hee Kwon; Wright, Alexander C; Mohler, Emile R; Harding, John D; Zager, Eric L; Fairman, Ronald M; Golden, Michael A; Velazquez, Omaida C; Carpenter, Jeffrey P; Wehrli, Felix W

    2005-08-01

    High-resolution MRI methods have been used to evaluate carotid artery atherosclerotic plaque content. The purpose of this study was to assess the performance of high-resolution MRI in evaluation of the quantity and pattern of mineral deposition in carotid endarterectomy (CEA) specimens, with quantitative micro-CT as the gold standard. High-resolution MRI and CT were compared in 20 CEA specimens. Linear regression comparing mineral volumes generated from CT (VCT) and MRI (VMRI) data demonstrated good correlation using simple thresholding (VMRI=-0.01+0.98VCT; R2=0.90; threshold=4xnoise) and k-means clustering methods (VMRI=-0.005+1.38VCT; R2=0.93). Bone mineral density (BMD) and bone mineral content (BMC [mineral mass]) were calculated for CT data and BMC verified with ash weight. Patterns of mineralization like particles, granules, and sheets were more clearly depicted on CT. Mineral volumes generated from MRI or CT data were highly correlated. CT provided a more detailed depiction of mineralization patterns and provided BMD and BMC in addition to mineral volume. The extent of mineralization as well as the morphology may ultimately be useful in assessing plaque stability.

  17. Hybrid microscopy of human carotid atheroma by means of optical-resolution optoacoustic and non-linear optical microscopy

    NASA Astrophysics Data System (ADS)

    Seeger, Markus; Karlas, Angelos; Soliman, Dominik; Pelisek, Jaroslav; Ntziachristos, Vasilis

    2017-03-01

    Carotid atheromatosis is causally related to stroke, a leading cause of disability and death. We present the analysis of a human carotid atheroma using a novel hybrid microscopy system that combines optical-resolution optoacoustic (photoacoustic) microscopy and several non-linear optical microscopy modalities (second and third harmonic generation, as well as, two-photon excitation fluorescence) to achieve a multimodal examination of the extracted tissue within the same imaging framework. Our system enables the label-free investigation of atheromatous human carotid tissue with a resolution of about 1 μm and allows for the congruent interrogation of plaque morphology and clinically relevant constituents such as red blood cells, collagen, and elastin. Our data reveal mutual interactions between blood embeddings and connective tissue within the atheroma, offering comprehensive insights into its stage of evolution and severity, and potentially facilitating the further development of diagnostic tools, as well as treatment strategies.

  18. Asymmetric radial expansion and contraction of rat carotid artery observed using a high-resolution ultrasound imaging system.

    PubMed

    Nam, Kweon-Ho; Bok, Tae-Hoon; Jin, Changzhu; Paeng, Dong-Guk

    2014-01-01

    The geometry of carotid artery bifurcation is of high clinical interest because it determines the characteristics of blood flow that is closely related to the formation and development of atherosclerotic plaque. However, information on the dynamic changes in the vessel wall of carotid artery bifurcation during a pulsatile cycle is limited. This pilot study investigated the cyclic changes in carotid artery geometry caused by blood flow pulsation in rats. A high-resolution ultrasound imaging system with a broadband scanhead centered at 40 MHz was used to obtain longitudinal images of the rat carotid artery. A high frame rate retrospective B-scan imaging technique based on the use of electrocardiogram to trigger signal acquisition was used to examine precisely the fast arterial wall motion. Two-dimensional geometry data obtained from nine rats showed that the rat carotid artery asymmetrically contracts and dilates during each cardiac cycle. Systolic/diastolic vessel diameters near the upstream and downstream regions from the bifurcation were 0.976 ± 0.011/0.825 ± 0.015 mm and 0.766 ± 0.015/0.650 ± 0.016 mm, respectively. Their posterior/anterior wall displacement ratios in the radial direction were 41.0 ± 14.9% and 2.9 ± 1.6%, respectively. These results indicate that in the vicinity of bifurcation, the carotid artery favorably expands to the anterior side during the systolic phase. This phenomenon was observed to be more prominent in the downstream region near the bifurcation. The cyclic variation pattern in wall movement varies depending on the measurement site, which shows different patterns at far upstream and downstream of the bifurcation. The asymmetric radial expansion and contraction of the rat carotid artery observed in this study may be useful in studying the hemodynamic etiology of cardiovascular diseases because the pulsatile changes in vessel geometry may affect the local hemodynamics that determines the spatial distribution of wall shear stress

  19. Free-breathing 3D whole-heart black-blood imaging with motion sensitized driven equilibrium.

    PubMed

    Srinivasan, Subashini; Hu, Peng; Kissinger, Kraig V; Goddu, Beth; Goepfert, Lois; Schmidt, Ehud J; Kozerke, Sebastian; Nezafat, Reza

    2012-08-01

    To assess the efficacy and robustness of motion sensitized driven equilibrium (MSDE) for blood suppression in volumetric 3D whole-heart cardiac MR. To investigate the efficacy of MSDE on blood suppression and myocardial signal-to-noise ratio (SNR) loss on different imaging sequences, seven healthy adult subjects were imaged using 3D electrocardiogram (ECG)-triggered MSDE-prep T(1) -weighted turbo spin echo (TSE), and spoiled gradient echo (GRE), after optimization of MSDE parameters in a pilot study of five subjects. Imaging artifacts, myocardial and blood SNR were assessed. Subsequently, the feasibility of isotropic spatial resolution MSDE-prep black-blood was assessed in six subjects. Finally, 15 patients with known or suspected cardiovascular disease were recruited to be imaged using a conventional multislice 2D double inversion recovery (DIR) TSE imaging sequence and a 3D MSDE-prep spoiled GRE. The MSDE-prep yielded significant blood suppression (75%-92%), enabling a volumetric 3D black-blood assessment of the whole heart with significantly improved visualization of the chamber walls. The MSDE-prep also allowed successful acquisition of black-blood images with isotropic spatial resolution. In the patient study, 3D black-blood MSDE-prep and DIR resulted in similar blood suppression in left ventricle and right ventricle walls but the MSDE-prep had superior myocardial signal and wall sharpness. MSDE-prep allows volumetric black-blood imaging of the heart. Copyright © 2012 Wiley Periodicals, Inc.

  20. Unprotected parasphenoidal carotid artery studied by high-resolution computed tomography

    SciTech Connect

    Johnson, D.M.; Hopkins, R.J.; Hanafee, W.N.; Fisk, J.D.

    1985-04-01

    A retrospective review was made of 500 consecutive thin-section axial CT scans of the adult sphenoid sinus using contrast enhancement and the bone algorithm to determine whether there was exposure of the cavernous sinus and the carotid arteries along their parasphenoidal course. At least one cavernous-carotid complex that could be considered at risk during sphenoid sinus surgery was seen in 31.4% of the patients. Of this group, 14.4% of the patients had no bony covering on one or both sides of some point along the parasphenoidal course. In 17% the bony covering was so thin it would give minimal, if any, protection from surgical trauma. A patient who had laceration of an unprotected carotid artery with development of post-traumatic aneurysm is discussed.

  1. Flow-independent T(2)-prepared inversion recovery black-blood MR imaging.

    PubMed

    Liu, Chia-Ying; Bley, Thorsten A; Wieben, Oliver; Brittain, Jean H; Reeder, Scott B

    2010-01-01

    To develop a magnetization preparation method to achieve robust, flow-independent blood suppression for cardiac and vascular magnetic resonance imaging (MRI). T(2)Prep-IR sequence consists of a T(2) preparation followed by a nonselective adiabatic inversion pulse. T(2)Prep separates the initial longitudinal magnetization of arterial wall from lumen blood. After the inversion recovery pulse the imaging acquisition is then delayed for a period that allows the blood signal to approach the zero-crossing point. Compared to the conventional double inversion recovery (DIR) preparation, T(2)Prep-IR prepares all the spins regardless of their velocity and direction. T(2)Prep-IR was incorporated into the fast spin echo and fast gradient echo acquisition sequences and images in various planes were acquired in the carotid arteries, thoracic aorta, and heart of normal volunteers. Blood suppression and image quality were compared qualitatively between two different preparations. For in-plane flow carotid images, persistent flow-related artifacts on the DIR images were removed with T(2)Prep-IR. For cardiac applications, T(2)Prep-IR provided robust blood suppression regardless of the flow direction and velocity, including the cardiac long-axis views and the aorta that are often problematic with DIR. T(2)Prep-IR may overcome the flow dependence of DIR by providing robust flow-independent black-blood images. (c) 2009 Wiley-Liss, Inc.

  2. Effects of Pitavastatin on Lipid-rich Carotid Plaques Studied Using High-resolution Magnetic Resonance Imaging.

    PubMed

    Feng, Tao; Huang, Xiaoxing; Liang, Qundi; Liang, Yun; Yuan, Yong; Feng, Li; Wu, Wenjun; Xiao, Xuehong; Han, Ying

    2017-03-01

    This study evaluates the effectiveness of pitavastatin in patients with atherosclerosis. Sixty patients with atherosclerosis with lipid-rich carotid plaques were included and allocated into low-dose (2 mg/d) and high-dose (4 mg/d) pitavastatin groups with 48 weeks of treatment. Total cholesterol, LDL-C, HDL-C, triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein (a), and the inflammation-related factors interleukin 6, high-sensitivity C-reactive protein, and homocysteine were determined. High-resolution (3.0-T) magnetic resonance imaging was used to evaluate the lipid core area, plaque thickness, total vessel area, lumen area, wall area, and normalized wall index. After the treatment period, the blood serum values were improved in both groups, but the improvement was significantly better for total cholesterol (P < 0.009), HDL-C, LDL-C, triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein (a), and homocysteine (all P < 0.001) in the high-dose group. The high-resolution magnetic resonance images revealed great improvements in both groups, although significantly better for the lipid core area (P < 0.001), plaque thickness (P < 0.001), wall area (P < 0.05), normalized wall index (P < 0.001), and lumen area (P < 0.05) in the HD group. Further analyses revealed a close correlation between lipid-rich plaques and changes in blood lipid components. Pitavastatin had significant lipid-lowering and anti-inflammatory effects in patients with atherosclerosis. It also reduced the lipid components and plaques of lipid rich carotid plaques. The effect was obviously stronger in the high-dose than in the low-dose group. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

  3. To assess the intimal thickness, flow velocities, and luminal diameter of carotid arteries using high-resolution B-mode ultrasound doppler imaging

    NASA Astrophysics Data System (ADS)

    Vemuru, Madhuri; Jabbar, Afzal; Chandra, Suman

    2004-04-01

    Carotid imaging is a Gold Standard test that provides useful information about the structure and functions of carotid arteries. Spectral imaging helps to evaluate the vessel and hemodynamic changes. High resolution B-mode imaging has emerged as one of the methods of choice for determining the anatomic extent of atherosclerosis and its progression and for assessing cardiovascular risks. The measurements made with Doppler correlate well with pathologic measurements. Recent prospective studies have clearly demonstrated that these measurements of carotid intimal thickness are potent predictors of Myocardial Infarction and Stroke. This method appears very attractive as it is non-invasive, extremely safe, well accepted by the patient and relatively inexpensive. It can be performed serially and has the advantage of visualizing the arterial wall in contrast to angiographic techniques which provide only an outline of the arterial lumen. Recently, there has been an interest in the clinical use of this technique in making difficult clinical decisions like deciding on preventive therapies. 30 subjects aged 21-60 years and 30 subjects aged 61-85 years of both sexes are selected after doing a baseline study to exclude Hypertension, Diabetes, Obesity and Hyperlipidemia. The carotid arteries were examined for intimal thickening, blood flow velocities and luminal diameter. With aging there is a narrowing of the carotid vessels and significant increase in intimal thickening with a consequent increase in the blood flow velocities. Inter-observer, intra-observer and instrument variations are seen and there is no significant change in the values when the distal flow pattern is considered for measurements. Aging produces major cardiovascular changes including decreased elasticity and compliance of great arteries leading to structural and functional alterations in heart and vessels. With aging there is increased intimal thickness and increased pulse wave velocity which is clearly

  4. 4D retrospective black blood trueFISP imaging of mouse heart.

    PubMed

    Miraux, Sylvain; Calmettes, Guillaume; Massot, Philippe; Lefrançois, William; Parzy, Elodie; Muller, Bernard; Arsac, Laurent M; Deschodt-Arsac, Véronique; Franconi, Jean-Michel; Diolez, Philippe; Thiaudière, Eric

    2009-11-01

    The purpose of this study was to demonstrate the feasibility of steady-state True fast imaging with steady precession (TrueFISP) four-dimensional imaging of mouse heart at high resolution and its efficiency for cardiac volumetry. Three-dimensional cine-imaging of control and hypoxic mice was carried out at 4.7 T without magnetization preparation or ECG-triggering. The k-space lines were acquired with the TrueFISP sequence (pulse repetition time/echo time = 4/2 ms) in a repeated sequential manner. Retrospective reordering of raw data allowed the reconstruction of 10 three-dimensional images per cardiac cycle. The acquisition scheme used an alternating radiofrequency phase and sum-of-square reconstruction method. Black-blood three-dimensional images at around 200 mum resolution were produced without banding artifact throughout the cardiac cycle. High contrast to noise made it possible to estimate cavity volumes during diastole and systole. Right and left ventricular stroke volume was significantly higher in hypoxic mice vs controls (20.2 +/- 2 vs 15.1 +/- 2; P < 0.05, 24.9 +/- 2 vs 20.4 +/- 2; P < 0.05, respectively). In conclusion, four-dimensional black-blood TrueFISP imaging in living mice is a method of choice to investigate cardiac abnormalities in mouse models. c) 2009 Wiley-Liss, Inc.

  5. Relaxation enhanced compressed sensing three-dimensional black-blood vessel wall MR imaging: Preliminary studies.

    PubMed

    Li, Bo; Li, Hao; Li, Jun; Zhang, Yuchen; Wang, Xiaoying; Zhang, Jue; Dong, Li; Fang, Jing

    2015-09-01

    In this study, we sought to investigate the feasibility of a new technique termed relaxation enhanced compressed sensing three-dimensional motion-sensitizing driven equilibrium prepared 3D rapid gradient echo sequence (RECS-3D MERGE). The RECS-3D MERGE sequence consisted of a 3D MERGE sequence for imaging, a period of delay time (TD) for relaxation enhancement, and a pseudo-centric phase encoding order used for under-sampling acquisition to maintain scan efficiency. Seven healthy volunteers and six patients with 40% to 75% carotid artery stenosis were recruited in this study. Healthy subjects underwent 3D MERGE, RECS-3D MERGE and two-dimensional (2D) T1-weighted double inversion recovery fast spin echo (T1W DIR-FSE) scans. The signal ratio (SR) values of 21 RECS-3D MERGE scans were compared in order to determine the optimal scan parameter set of acceleration factor (AF) and delay time (TD) for RECS-3D MERGE sequence. Patients then underwent 3D MERGE, RECS-3D MERGE using the aforementioned optimal scan parameter set and 2D T1W DIR-FSE scans. Two radiologists, blinded to the imaging technique, qualitatively graded each image on a six-point ordinal scale. The highest value of SR occurred with the scan parameter set of 3-fold AF and 800ms TD. Compared to 3D MERGE, RECS-3D MERGE with the parameter set significantly improved the image quality for both healthy subjects and patients experiments, while the scan efficiency was not sacrificed. And no significant differences were observed in the subjective scores of RECS-3D MERGE and 2D T1W DIR-FSE image qualities. RECS-3D MERGE technique achieved significant improvement in black-blood image quality compared with 3D MERGE. And the image quality of this 3D rapid carotid black-blood imaging technique is comparable to 2D T1W DIR-FSE while it has much higher scan efficiency. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. The carotid plaque imaging in acute stroke (CAPIAS) study: protocol and initial baseline data

    PubMed Central

    2013-01-01

    Background In up to 30% of patients with ischemic stroke no definite etiology can be established. A significant proportion of cryptogenic stroke cases may be due to non-stenosing atherosclerotic plaques or low grade carotid artery stenosis not fulfilling common criteria for atherothrombotic stroke. The aim of the CAPIAS study is to determine the frequency, characteristics, clinical and radiological long-term consequences of ipsilateral complicated American Heart Association lesion type VI (AHA-LT VI) carotid artery plaques in patients with cryptogenic stroke. Methods/Design 300 patients (age >49 years) with unilateral DWI-positive lesions in the anterior circulation and non- or moderately stenosing (<70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. Carotid plaque characteristics will be determined by high-resolution black-blood carotid MRI at baseline and 12 month follow up. Primary outcome is the prevalence of complicated AHA-LT VI plaques in cryptogenic stroke patients ipsilateral to the ischemic stroke compared to the contralateral side and to patients with defined stroke etiology. Secondary outcomes include the association of AHA-LT VI plaques with the recurrence rates of ischemic events up to 36 months, rates of new ischemic lesions on cerebral MRI (including clinically silent lesions) after 12 months and the influence of specific AHA-LT VI plaque features on the progression of atherosclerotic disease burden, on specific infarct patterns, biomarkers and aortic arch plaques. Discussion CAPIAS will provide important insights into the role of non-stenosing carotid artery plaques in cryptogenic stroke. The results might have implications for our understanding of stroke mechanism, offer new diagnostic options and provide the basis for the planning of targeted interventional studies. Trial Registration NCT01284933 PMID:24330333

  7. Carotid Ultrasound

    MedlinePlus

    ... 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 ...

  8. Improvements in carotid plaque imaging using a new eight-element phased array coil at 3T.

    PubMed

    Balu, Niranjan; Yarnykh, Vasily L; Scholnick, Joshua; Chu, Baocheng; Yuan, Chun; Hayes, Cecil

    2009-11-01

    To design and compare an eight-channel phased array (PA) coil for carotid imaging to an established four-channel PA design at 3T. An eight-channel PA (8PA) coil was designed specifically for imaging the carotid bifurcation and compared with the existing four-channel (4PA) design using a phantom and by in vivo black-blood magnetic resonance imaging (MRI). The 8PA and 4PA were compared in terms of coverage, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The 8PA showed up to 1.7-fold improvement in SNR at a depth of 3.5 cm and greater longitudinal coverage at a given SNR on a phantom. The 8PA showed improved vessel wall SNR for high spatial resolution (0.63 mm(2)) PD, T1, and T2 (1.7, 1.7, 1.6 times, respectively; P resolution (0.27 mm(2)) T1-weighted images showed better SNR and CNR (1.4 times, P Carotid imaging studies may benefit from the improved SNR and larger coverage provided by use of the 8PA.

  9. Improvements in Carotid Plaque Imaging Using a New Eight-Element Phased Array Coil at 3T

    PubMed Central

    Balu, Niranjan; Yarnykh, Vasily L.; Scholnick, Joshua; Chu, Baocheng; Yuan, Chun; Hayes, Cecil

    2010-01-01

    Purpose To design and compare an eight-channel phased array (PA) coil for carotid imaging to an established four-channel PA design at 3T. Materials and Methods An eight-channel PA (8PA) coil was designed specifically for imaging the carotid bifurcation and compared with the existing four-channel (4PA) design using a phantom and by in vivo black-blood magnetic resonance imaging (MRI). The 8PA and 4PA were compared in terms of coverage, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Results The 8PA showed up to 1.7-fold improvement in SNR at a depth of 3.5 cm and greater longitudinal coverage at a given SNR on a phantom. The 8PA showed improved vessel wall SNR for high spatial resolution (0.63 mm2) PD, T1, and T2 (1.7, 1.7, 1.6 times, respectively; P ≤ 0.002) and improved CNR (1.7, 1.6, 1.5 times, respectively; P ≤ 0.002). Ultrahigh-resolution (0.27 mm2) T1-weighted images showed better SNR and CNR (1.4 times, P ≤ 0.0001) on 8PA compared to 4PA. Conclusion Carotid imaging studies may benefit from the improved SNR and larger coverage provided by use of the 8PA. PMID:19780187

  10. Carotid artery surgery

    MedlinePlus

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

  11. Multi-contrast MRI registration of carotid arteries based on cross-sectional images and lumen boundaries

    NASA Astrophysics Data System (ADS)

    Wu, Yu-Xia; Zhang, Xi; Xu, Xiao-Pan; Liu, Yang; Zhang, Guo-Peng; Li, Bao-Juan; Chen, Hui-Jun; Lu, Hong-Bing

    2017-02-01

    Ischemic stroke has great correlation with carotid atherosclerosis and is mostly caused by vulnerable plaques. It's particularly important to analysis the components of plaques for the detection of vulnerable plaques. Recently plaque analysis based on multi-contrast magnetic resonance imaging has attracted great attention. Though multi-contrast MR imaging has potentials in enhanced demonstration of carotid wall, its performance is hampered by the misalignment of different imaging sequences. In this study, a coarse-to-fine registration strategy based on cross-sectional images and wall boundaries is proposed to solve the problem. It includes two steps: a rigid step using the iterative closest points to register the centerlines of carotid artery extracted from multi-contrast MR images, and a non-rigid step using the thin plate spline to register the lumen boundaries of carotid artery. In the rigid step, the centerline was extracted by tracking the crosssectional images along the vessel direction calculated by Hessian matrix. In the non-rigid step, a shape context descriptor is introduced to find corresponding points of two similar boundaries. In addition, the deterministic annealing technique is used to find a globally optimized solution. The proposed strategy was evaluated by newly developed three-dimensional, fast and high resolution multi-contrast black blood MR imaging. Quantitative validation indicated that after registration, the overlap of two boundaries from different sequences is 95%, and their mean surface distance is 0.12 mm. In conclusion, the proposed algorithm has improved the accuracy of registration effectively for further component analysis of carotid plaques.

  12. Isotropic 3D Black Blood MRI of Abdominal Aortic Aneurysm Wall and Intraluminal Thrombus

    PubMed Central

    Zhu, Chengcheng; Haraldsson, Henrik; Faraji, Farshid; Owens, Christopher; Gasper, Warren; Ahn, Sinyeob; Liu, Jing; Laub, Gerhard; Hope, Michael D.; Saloner, David

    2015-01-01

    Introduction The aortic wall and intraluminal thrombus (ILT) have been increasingly studied as potential markers of progressive disease with abdominal aortic aneurysms (AAAs). Our goal was to develop a high resolution, 3D black blood MR technique for AAA wall and ILT imaging within a clinically acceptable scan time. Methods Twenty two patients with AAAs (maximal diameter 4.3±1.0cm), along with five healthy volunteers, were imaged at 3T with a 3D T1-weighted fast-spin-echo sequence using variable flip angle trains (SPACE) with a preparation pulse (DANTE) for suppressing blood signal. Volunteers and ten patients were also scanned with SPACE alone for comparison purposes. The signal to noise ratio (SNR) and the aortic wall/ILT to lumen contrast to noise ratio (CNR) were measured. Qualitative image scores (1–4 scale) assessing the inner lumen and outer wall boundaries of AAA were performed by two blinded reviewers. In patients with ILT, the ratio of ILT signal intensity (ILTSI) over psoas muscle SI (MuscleSI) was calculated, and the signal heterogeneity of ILT was quantified as standard deviation (SD) over the mean. Results All subjects were imaged successfully with an average scan time of 7.8±0.7 minutes. The DANTE preparation pulse for blood suppression substantially reduced flow artifacts in SPACE with lower lumen SNR (8.8 vs. 21.4, p<0.001) and improved the wall/ILT to lumen CNR (9.9 vs. 6.3, p<0.001) in patients. Qualitative assessment showed improved visualization of lumen boundaries (73% higher scores on average, p=0.01) and comparable visualization of outer wall boundary (p>0.05). ILT was present in ten patients, with relatively high signal and a wide SD (average ILTSI/MuscleSI 1.42±0.48 (range 0.75–2.11) ) and with SD/mean of 27.7%±6.6% (range 19.6% – 39.4%). Conclusion High resolution, 3D black blood MRI of AAAs can be achieved in a clinical accepted scan time with reduction of flow artifacts using the DANTE preparation pulse. Signal characteristics

  13. High spatial and temporal resolution observations of pulsatile changes in blood echogenicity in the common carotid artery of rats.

    PubMed

    Nam, Kweon-Ho; Bok, Tae-Hoon; Kong, Qi; Paeng, Dong-Guk

    2013-09-01

    Previous studies have found that ultrasound backscatter from blood in vascular flow systems varies under pulsatile flow, with the maximum values occurring during the systolic period. This phenomenon is of particular interest in hemorheology because it is contrary to the well-known fact that red blood cell (RBC) aggregation, which determines the intensity of ultrasound backscatter from blood, decreases at a high systolic shear rate. In the present study, a rat model was used to provide basic information on the characteristics of blood echogenicity in arterial blood flow to investigate the phenomenon of RBC aggregation under pulsatile flow. Blood echogenicity in the common carotid arteries of rats was measured using a high-frequency ultrasound imaging system with a 40-MHz probe. The electrocardiography-based kilohertz visualization reconstruction technique was employed to obtain high-temporal-resolution and high-spatial-resolution time-course B-mode cross-sectional and longitudinal images of the vessel. The experimental results indicate that blood echogenicity in rat carotid arteries varies during a cardiac cycle. Blood echogenicity tends to decrease during early systole and reaches its peak during late systole, followed by a slow decline thereafter. The time delay of the echogenicity peak from peak systole in the present results is the main difference from previous in vitro and in vivo observations of backscattering peaks during early systole, which may be caused by the very rapid heart rates and low RBC aggregation tendency of rats compared with humans and other mammalian species. The present study may provide useful information elucidating the characteristics of RBC aggregation in arterial blood flow.

  14. Carotid duplex

    MedlinePlus

    ... moved around your neck. The pressure should not cause any pain. You may also hear a "whooshing" sound. This is normal. ... clotting (thrombosis) Narrowing in the arteries (stenosis) Other ... an abnormal sound called a bruit over the carotid neck arteries. ...

  15. Carotid Endarterectomy

    MedlinePlus

    ... is not a cure. Your arteries can become blocked again if your underlying condition, such as high ... or cut, on your neck to expose the blocked section of the carotid artery. Your surgeon will ...

  16. Complete resolution of postoperative hemiparesis following carotid endarterectomy with therapeutic hypothermia: a case study and literature review.

    PubMed

    Usach, Irina; Sakopoulos, Andreas; Razavi, Hossein

    2015-08-01

    Therapeutic hypothermia is indicated in a number of traumatic brain injuries as well as for cardiovascular shock (Warner DS, James ML, Laskowitz, et al. Translational research in acute central nervous system injury: lessons learned and the future. JAMA Neurol 2014;71:1311-1318), but it has been limited in its application to acute ischemic stroke. We present the case of a 65-year-old woman with a clinical cerebrovascular accident following a right carotid endarterectomy who was treated with a 24-hr hypothermia protocol and had a full recovery. The hypothermia protocol utilized on this patient and a review of the literature surrounding hypothermia in the setting of ischemic stroke are presented. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Carotid Artery Screening

    MedlinePlus

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

  18. High-resolution steady state magnetic resonance angiography of the carotid arteries: are intravascular agents necessary?: feasibility and preliminary experience with gadobenate dimeglumine.

    PubMed

    Anzidei, Michele; Napoli, Alessandro; Marincola, Beatrice Cavallo; Kirchin, Miles A; Neira, Cristina; Geiger, Daniel; Zaccagna, Fulvio; Catalano, Carlo; Passariello, Roberto

    2009-12-01

    To prospectively evaluate the potential of gadobenate dimeglumine for high-resolution steady-state (SS) contrast-enhanced magnetic resonance angiography (CE-MRA) of the carotid arteries as an adjunct to conventional first-pass (FP) MRA, with computed tomography angiography (CTA) and digital subtraction angiography (DSA) as reference. Institutional ethics committee approval and written informed consent were obtained. Forty consecutive patients underwent conventional FP MRA with 15 mL gadobenate dimeglumine, using a conventional 3D FLASH sequence (14 sec acquisition time). Immediately afterward, SS images were obtained using a high resolution coronal 3D FLASH sequence (240 sec acquisition time). All patients also underwent CTA and conventional DSA within 8 +/- 3 days. Three experienced radiologists assessed FP and SS image quality and calculated sensitivity, specificity, accuracy, and predictive values for stenosis grade and length, plaque morphology, and tandem lesions using DSA as reference. Detected stenoses were quantified and compared (Spearman rank correlation coefficient, [R(s)]; McNemar test) with DSA and CTA findings. Inter-read variability was assessed using kappa (kappa) statistics. The impact of SS acquisitions on diagnostic confidence and patient management was assessed. MRA FP and SS image quality was excellent in 63 (78.8%) and 46 (57.5%) vessels, adequate in 11 (13.8%) and 20 (25.0%) vessels, and poor in 6 (7.5%) and 14 (17.5%) vessels, respectively. Area under the curve analysis revealed no significant differences between MRA FP, MRA FP + SS, and CTA for the grading of stenoses (P = 0.838; accuracy values of 97.4%, 97.4%, and 98.7%, respectively). Greater accuracy (P < 0.001) was noted for FP + SS images over FP images alone for the assessment of plaque morphology (96.1% for FP + SS images vs. 83.3% for FP). Increased diagnostic confidence was noted for 49 (61.3%) vessels because of additional SS images whereas an impact on final diagnosis was noted

  19. Carotid Ultrasound Imaging

    MedlinePlus

    ... Index A-Z Ultrasound - Carotid Carotid ultrasound uses sound waves to produce pictures of the carotid arteries ... pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or ...

  20. Carotid bypass for carotid occlusion.

    PubMed

    Hage, Ziad A; Behbahani, Mandana; Amin-Hanjani, Sepideh; Charbel, Fady T

    2015-07-01

    The 2-year risk of ipsilateral ischemic stroke following internal carotid artery occlusion (ICAO) in a patient undergoing maximal medical therapy is 5-8% per year. While medical therapy may reduce the risk of stroke, it does not completely eliminate it. Since the 1985 extracranial-intracranial (EC-IC) bypass study, additional trials have been conducted to further investigate the usefulness of EC-IC bypass surgery in more selected patients with cerebral ischemia and impaired hemodynamic reserve. These important studies will be briefly reviewed in this article, as well as a discussion regarding the utility of bypass surgery for ICAO in current clinical practice. In addition, a short discussion regarding the pathophysiology of carotid occlusion will be presented. We will also highlight our own institutional patient selection criteria based on the latest methods for hemodynamic assessment, as well as our intraoperative flow assisted surgical techniques (FAST), and post-operative patient follow-up.

  1. Carotid artery stenting versus carotid endarterectomy.

    PubMed

    Nanna, Michael G; Gomes, Paulina; Njoh, Roland F; Ward, Charisse; Attaran, Robert R; Mena, Carlos

    2016-09-01

    Stroke remains a significant contributor to morbidity and mortality in developed countries. Carotid artery stenosis is a major cause of stroke. Advances in medical therapy, surgical technique and endovascular maturation has resulted in options for the treatment of carotid stenosis. Here, we present a review of carotid artery stenting and carotid endarterectomy as it applies to trials comparing and contrasting the two treatment options. We also explore the intricacies surrounding reimbursement of these treatment strategies in the USA.

  2. Optimal MR Plaque Imaging for Cervical Carotid Artery Stenosis in Predicting the Development of Microembolic Signals during Exposure of Carotid Arteries in Endarterectomy: Comparison of 4 T1-Weighted Imaging Techniques.

    PubMed

    Sato, Y; Ogasawara, K; Narumi, S; Sasaki, M; Saito, A; Tsushima, E; Namba, T; Kobayashi, M; Yoshida, K; Terayama, Y; Ogawa, A

    2016-06-01

    Preoperative identification of plaque vulnerability may allow improved risk stratification for patients considered for carotid endarterectomy. The present study aimed to determine which plaque imaging technique, cardiac-gated black-blood fast spin-echo, magnetization-prepared rapid acquisition of gradient echo, source image of 3D time-of-flight MR angiography, or noncardiac-gated spin-echo, most accurately predicts development of microembolic signals during exposure of carotid arteries in carotid endarterectomy. Eighty patients with ICA stenosis (≥70%) underwent the 4 sequences of preoperative MR plaque imaging of the affected carotid bifurcation and then carotid endarterectomy under transcranial Doppler monitoring of microembolic signals in the ipsilateral middle cerebral artery. The contrast ratio of the carotid plaque was calculated by dividing plaque signal intensity by sternocleidomastoid muscle signal intensity. Microembolic signals during exposure of carotid arteries were detected in 23 patients (29%), 3 of whom developed new neurologic deficits postoperatively. Those deficits remained at 24 hours after surgery in only 1 patient. The area under the receiver operating characteristic curve to discriminate between the presence and absence of microembolic signals during exposure of the carotid arteries was significantly greater with nongated spin-echo than with black-blood fast spin-echo (difference between areas, 0.258; P < .0001), MPRAGE (difference between areas, 0.106; P = .0023), or source image of 3D time-of-flight MR angiography (difference between areas, 0.128; P = .0010). Negative binomial regression showed that in the 23 patients with microembolic signals, the contrast ratio was associated with the number of microembolic signals only in nongated spin-echo (risk ratio, 1.36; 95% confidence interval, 1.01-1.97; P < .001). Nongated spin-echo may predict the development of microembolic signals during exposure of the carotid arteries in carotid

  3. Carotid artery anatomy (image)

    MedlinePlus

    There are four carotid arteries, two on each side of the neck: right and left internal carotid arteries, and right and left external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to the head and brain.

  4. Efficient global optimization based 3D carotid AB-LIB MRI segmentation by simultaneously evolving coupled surfaces.

    PubMed

    Ukwatta, Eranga; Yuan, Jing; Rajchl, Martin; Fenster, Aaron

    2012-01-01

    Magnetic resonance (MR) imaging of carotid atherosclerosis biomarkers are increasingly being investigated for the risk assessment of vulnerable plaques. A fast and robust 3D segmentation of the carotid adventitia (AB) and lumen-intima (LIB) boundaries can greatly alleviate the measurement burden of generating quantitative imaging biomarkers in clinical research. In this paper, we propose a novel global optimization-based approach to segment the carotid AB and LIB from 3D T1-weighted black blood MR images, by simultaneously evolving two coupled surfaces with enforcement of anatomical consistency of the AB and LIB. We show that the evolution of two surfaces at each discrete time-frame can be optimized exactly and globally by means of convex relaxation. Our continuous max-flow based algorithm is implemented in GPUs to achieve high computational performance. The experiment results from 16 carotid MR images show that the algorithm obtained high agreement with manual segmentations and achieved high repeatability in segmentation.

  5. Carotid Artery Disease

    MedlinePlus

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

  6. Carotid artery surgery - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100124.htm Carotid artery surgery - series—Normal anatomy To use the sharing ... out of 4 Overview There are four carotid arteries, with a pair located on each side of ...

  7. Evaluation of internal carotid artery segmentation by InsightSNAP

    NASA Astrophysics Data System (ADS)

    Spangler, Emily L.; Brown, Christopher; Roberts, John A.; Chapman, Brian E.

    2007-03-01

    Quantification of cervical carotid geometry may facilitate improved clinical decision making and scientific discovery. We set out to evaluate the ability of InsightSNAP (ITK-SNAP), an open-source segmentation program for 3D medical images (http://www.itksnap.org, version 1.4), to semi-automatically segment internal carotid arteries. A sample of five individuals (three normal volunteers, and two diseased patients) were imaged with an MR exam consisting of a MOTSA TOF MRA image volume and multiple black blood images acquired with different contrast weightings. Comparisons were made to a manual segmentation created during simultaneous evaluation of the MOTSA image and the various black blood images (typically PD-weighted, T1-weighted, and T2-weighted). These individuals were selected as a training set to determine acceptable parameters for ITK-SNAP's semi-automatic level sets segmentation method. The conclusion from this training set was that the initial thresholding (assigning probabilities to the intensities of image pixels) in the image pre-processing step was most important to obtaining an acceptable segmentation. Unfortunately no consistent trends emerged in how this threshold should be chosen. Figures of percent over- and under-segmentation were computed as a means of comparing the hand segmented and semi-automatically segmented internal carotids. Overall the under-segmentation by ITK-SNAP (voxels included in the manual segmentation but not in the semiautomated segmentation) was 10.94% +/- 6.35% while the over-segmentation (voxels excluded in the manual segmentation but included in the semi-automated segmentation) was 8.16% +/- 4.40% defined by reference to the total number of voxels included in the manual segmentation.

  8. Evaluation of carotid intima-media thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy.

    PubMed

    Çiftel, Murat; Demir, Berrin; Kozan, Günay; Yılmaz, Osman; Kahveci, Hasan; Kılıç, Ömer

    2016-02-01

    Adenotonsillar hypertrophy can produce cardiopulmonary disease in children. However, it is unclear whether adenotonsillar hypertrophy causes atherosclerosis. This study evaluated carotid intimamedia thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy. The study included 40 children with adenotonsillar hypertrophy (age: 5-10 years) and 36 healthy children with similar age and body mass index. Systolic blood pressure, diastolic blood pressure, and pulse pressure were measured in all subjects. Carotid intima-media thickness, carotid arterial systolic diameter, and carotid arterial diastolic diameter were measured using a high-resolution ultrasound device. Based on these measurements, carotid arterial strain, carotid artery distensibility, beta stiffness index, and elasticity modulus were calculated. Carotid intima-media thickness was greater in children with adenotonsillar hypertrophy (0.36±0.05 mm vs. 0.34±0.04 mm, P=0.02) compared to healthy controls. Beta stiffness index (3.01±1.22 vs. 2.98±0.98, P=0.85), elasticity modulus (231.39±99.23 vs. 226.46±83.20, P=0.88), carotid arterial strain (0.17±0.06 vs. 0.17±0.04, P=0.95), and carotid artery distensibility (13.14±3.88 vs. 12.92±3.84, P=0.75) were similar between children with adenotonsillar hypertrophy and the healthy controls. The present study revealed increased carotid intima-media thickness in children with adenotonsillar hypertrophy. The risk of subclinical atherosclerosis may be higher in children with adenotonsillar hypertrophy.

  9. Varicella-Zoster Virus Vasculopathy: A Case Report Demonstrating Vasculitis using Black-Blood MRI

    PubMed Central

    Shah, Jay; Poonawala, Husain; Keay, Susan K; Serulle, Yafell; Steven, Andrew; Gandhi, Dheeraj; Cole, John W

    2016-01-01

    Infections are rare but important causes of stroke. Among these, varicella zoster virus has been known to cause ischemic stroke. During an attack of herpes zoster ophthalmicus, it has been hypothesized that the virus replicates in the trigeminal ganglion and travels via the trigeminal nerve centrally to cause cerebral vasculopathy. Here we present a case of a 69 year-old Caucasian immunocompromised woman who suffered recurrent ischemic infarcts within the same vascular distribution following an episode of zoster ophthalmicus three months prior. An imaging technique termed black-blood magnetic resonance imaging was utilized to aid in the diagnosis of cerebral vasculitis. The case is used to provide a literature review of the pathogenesis, diagnosis, and treatment of cerebral varicella zoster vasculopathy. In situations where an isolated unilateral cerebral vasculopathy is identified, neurologists are urged to consider varicella zoster as a treatable etiologic agent, as untreated vasculopathy can lead to further strokes. PMID:27065314

  10. MRI-determined carotid artery flow velocities and wall shear stress in a mouse model of vulnerable and stable atherosclerotic plaque.

    PubMed

    van Bochove, Glenda S; Straathof, Roel; Krams, Rob; Nicolay, Klaas; Strijkers, Gustav J

    2010-04-01

    We report here on the pre-clinical MRI characterization of an apoE-/- mouse model of stable and vulnerable carotid artery atherosclerotic plaques, which were induced by a tapered restriction (cast) around the artery. Specific focus was on the quantification of the wall shear stress, which is considered a key player in the development of the plaque phenotype. In vivo MRI was performed at 9.4 T. The protocol consisted of time-of-flight angiography, high-resolution T1- and T2-weighted black-blood imaging and phase-contrast flow velocity imaging as function of time in the cardiac cycle. Wall shear stress was determined by fitting the flow profile to a quadratic polynomial. Time-of-flight angiography confirmed preservation of blood flow through the carotid arteries in all cases. T1- and T2-weighted MRI resulted in high-resolution images in which the position of the cast, luminal narrowing introduced by cast and plaque, as well as the arterial wall could be well identified. Laminar flow with low wall shear stress (11.2+/- 5.2 Pa) was measured upstream to the cast at the position of the vulnerable plaque. Downstream to the cast at the position of the stable plaque, the apparent velocities were low, which is consistent with vortices and an oscillatory nature of the flow. Flow velocities and wall shear stress were successfully measured in this mouse model of stable and unstable plaque. The presented tools can be used to provide valuable insights in the pathogenesis of atherosclerosis.

  11. Carotid labyrinth of amphibians.

    PubMed

    Kusakabe, Tatsumi

    2002-11-01

    The amphibian carotid labyrinth is a characteristic maze-like vascular expansion at the bifurcation of the common carotid artery into the internal and external carotid arteries. The carotid labyrinths of anurans are spherical and those of urodeles are oblong. In the intervascular stroma of both anuran and urodelan carotid labyrinths, the glomus cells (type I cells, chief cells) are distributed singly or in clusters between connective tissue cells and smooth muscle cells. In fluorescence histochemistry, the glomus cells emit intense fluorescence for biogenic monoamines. In fine structure, the glomus cells are characterized by a number of dense-cored vesicles in their cytoplasm. The glomus cells have long, thin cytoplasmic processes, some of which are closely associated with smooth muscle cells, endothelial cells, and pericytes. Afferent, efferent, and reciprocal synapses are found on the glomus cells. The morphogenesis of the carotid labyrinth starts in the larvae at the point where the carotid arch descends to the internal gills. Through the early stages of larval development, the slightly expanded region of the external carotid artery becomes closely connected with the carotid arch. By the end of the foot stage, the expanded region becomes globular, and at the final stage of metamorphosis the carotid labyrinth is close to its adult form. In fine structure, the glomus cells appear as early as the initial stage of larval development. At the middle stages of development, the number of dense-cored vesicles increases remarkably. Distinct afferent synapses are found in juveniles, although efferent synapses can be seen during metamorphosis. The carotid labyrinth is innervated by nerve fibers containing several kinds of regulatory neuropeptides. Double-immunolabeling in combination with a multiple dye filter system demonstrates the coexistence of two different neuropeptides. The amphibian carotid labyrinth has been electrophysiologically confirmed to have arterial chemo

  12. Living with Carotid Artery Disease

    MedlinePlus

    ... from the NHLBI on Twitter. Living With Carotid Artery Disease If you have carotid artery disease, you can take steps to manage the ... treatment plan, and getting ongoing care. Having carotid artery disease raises your risk of having a stroke . ...

  13. What Is Carotid Artery Disease?

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Carotid Artery Disease? Carotid artery disease is a disease in ... blood to your face, scalp, and neck. Carotid Arteries Figure A shows the location of the right ...

  14. Accuracy of phase contrast, black-blood, and bright-blood pulse sequences for measuring compliance and distensibility coefficients in a human-tissue mimicking phantom.

    PubMed

    Taviani, Valentina; Patterson, Andrew J; Worters, Pauline; Sutcliffe, Michael P F; Graves, Martin J; Gillard, Jonathan H

    2010-01-01

    To assess the accuracy of MR-derived luminal diameter variations and its implications for compliance (CC) and distensibility coefficients (DC) by comparison with high-resolution digital photography (HRDP) in a tissue-mimicking phantom with pulsatile flow. Diameters, CC, and DC extracted using cine phase-contrast (CPC), cine bright-blood (CBrB), and a cine black-blood (CBB) sequence were compared. The diameter in the left-right direction was compared against HRDP, as the gold-standard. The experiments were performed using 256(2) and 512(2) matrix sizes. Bland-Altman analysis was performed to compare each sequence with the gold-standard in terms of diameter changes over the simulated cardiac cycle. The bias and 95% limits of agreement (LOA) for CBB and CBrB were comparable. The bias for CPC was larger, however, the LOA were comparable. Increasing spatial resolution improved agreement with HRDP for all sequences. CBrB-derived CC and DC were within 3% of the high resolution CBB values while CPC CC and DC were underestimated but still within 11%. CPC images were found to underestimate the luminal area over the cardiac cycle. CBrB-derived diameters were more accurate in diastole while CBB-derived diameters gave the best results in systole. CC and DC varied depending on the pulse sequence. (c) 2009 Wiley-Liss, Inc.

  15. Black-blood T2* mapping with delay alternating with nutation for tailored excitation.

    PubMed

    Su, Shi; Ren, Yanan; Shi, Caiyun; Zhang, Xiaoyong; Ji, Jim X; Zhang, Yongqin; Liu, Xin; Xie, Guoxi

    2017-07-01

    To develop a black-blood T2* mapping method using a Delay Alternating with Nutation for Tailored Excitation (DANTE) preparation combined with a multi-echo gradient echo (GRE) readout (DANTE-GRE). Simulations of the Bloch equation for DANTE-GRE were performed to optimize sequence parameters. After optimization, the sequence was applied to a phantom scan and to neck and lower extremity scans conducted on 12 volunteers at 3T using DANTE-GRE, Motion-Sensitized Driven Equilibrium (MSDE)-GRE, and multi-echo GRE. T2* values were measured using an offset model. Statistical analyses were conducted to compare the T2* values between the three sequences. Simulation results showed that blood suppression can be achieved with various DANTE parameter adjustments. T2* maps acquired by DANTE-GRE were consistent and comparable to those acquired with multi-echo GRE in phantom experiments. In the in vivo experiments, DANTE-GRE was more comparable to multi-echo GRE than MSDE-GRE regarding the measurement of muscle T2* values. Due to its high signal intensity retention and effective blood signal suppression, DANTE-GRE allows for robust and accurate T2* quantification, superior to that of MSDE-GRE, while overcoming blood flow artifacts associated with traditional multi-echo GRE. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Elevated red blood cell 2,3-diphosphoglycerate levels in black blood donors.

    PubMed

    Wallas, C H

    1978-01-01

    Mean levels of 2,3-diphosphoglycerate (DPG) were significantly increased in erythrocytes (RBC) from 43 nonanemic black blood donors (4.80 +/- 0.06 micromoles/l RBC) compared with 22 white donors 4.47 +/- 0.08 micromoles/l RBCs from eight of the 12 black donors with DPG levels greater than 5 micromoles/l RBC. Although a potentially hemolytic disorder could be defined in four (AS hemoglobin, beta-Thalassemia minor, G6PD deficiency), reticulocyte counts were normal. However, when RBCs from the subgroup were compared to RBCs from an additional 25 unselected white donors, the following suggested an abnormally large population of young RBCs in the subgroup: 1) normal or elevated RBC-ATP with normal serum phosphate level; 2) significantly increased activities of RBC age-dependent enzymes hexokinase (p less than 0.02), pyruvate kinase (p less than 0.05), and glutamicoxaloacetic transaminase (p less than 0.01), with normal activity of phosphoglycerate kinase, an age-independent enzyme; 3) decreased dense (older) RBCs as determined by sedimentation in phthalate esters. Since DPG is increased in young RBCs and falls as the RBC ages, loss of older relatively DPG depleted RBCs due to shortened survival could account for the elevated DPG levels seen in the subgroup.

  17. Cholesterol Is Associated with the Presence of a Lipid Core in Carotid Plaque of Asymptomatic, Young-to-Middle-Aged African Americans with and without HIV Infection and Cocaine Use Residing in Inner-City Baltimore, Md., USA

    PubMed Central

    Du, Jiefu; Wasserman, Bruce A.; Tong, Weijing; Chen, Shaoguang; Lai, Shenghan; Malhotra, Saurabh; Lai, Hong

    2012-01-01

    Background Stroke remains a leading cause of death in the United States. While stroke-related mortality in the USA has declined over the past decades, stroke death rates are still higher for blacks than for whites, even at younger ages. The purpose of this study was to estimate the frequency of a lipid core and explore risk factors for its presence in asymptomatic, young-to-middle-aged urban African American adults recruited from inner-city Baltimore, Md., USA. Methods Between August 28, 2003, and May 26, 2005, 198 African American participants aged 30-44 years from inner-city Baltimore, Md., were enrolled in an observational study of subclinical atherosclerosis related to HIV and cocaine use. In addition to clinical examinations and laboratory tests, B-mode ultrasound for intima-media thickness of the internal carotid arteries was performed. Among these 198, 52 were selected from the top 30th percentile of maximum carotid intima-media thickness by ultrasound, and high-resolution black blood MRI images were acquired through their carotid plaque before and after the intravenous administration of gadodiamide. Of these 52, 37 with maximum segmental thickness by MRI >1.0 mm were included in this study. Lumen and outer wall contours were defined using semiautomated analysis software. The frequency of a lipid core in carotid plaque was estimated and risk factors for lipid core presence were explored using logistic regression analysis. Results Of the 37 participants in this study, 12 (32.4%) were women. The mean age was 38.7 ± 4.9 years. A lipid core was present in 9 (17%) of the plaques. Seventy percent of the study participants had a history of cigarette smoking. The mean total cholesterol level was 176.1 ± 37.3 mg/dl, the mean systolic blood pressure was 113.1 ± 13.3 mm Hg, and the mean diastolic blood pressure was 78.9 ± 9.5 mm Hg. There were 5 participants with hypertension (13.5%). Twelve (32%) participants had a history of chronic cocaine use, and 23 (62%) were

  18. Cholesterol is associated with the presence of a lipid core in carotid plaque of asymptomatic, young-to-middle-aged African Americans with and without HIV infection and cocaine use residing in inner-city Baltimore, Md., USA.

    PubMed

    Du, Jiefu; Wasserman, Bruce A; Tong, Weijing; Chen, Shaoguang; Lai, Shenghan; Malhotra, Saurabh; Lai, Hong

    2012-01-01

    Stroke remains a leading cause of death in the United States. While stroke-related mortality in the USA has declined over the past decades, stroke death rates are still higher for blacks than for whites, even at younger ages. The purpose of this study was to estimate the frequency of a lipid core and explore risk factors for its presence in asymptomatic, young-to-middle-aged urban African American adults recruited from inner-city Baltimore, Md., USA. Between August 28, 2003, and May 26, 2005, 198 African American participants aged 30-44 years from inner-city Baltimore, Md., were enrolled in an observational study of subclinical atherosclerosis related to HIV and cocaine use. In addition to clinical examinations and laboratory tests, B-mode ultrasound for intima-media thickness of the internal carotid arteries was performed. Among these 198, 52 were selected from the top 30th percentile of maximum carotid intima-media thickness by ultrasound, and high-resolution black blood MRI images were acquired through their carotid plaque before and after the intravenous administration of gadodiamide. Of these 52, 37 with maximum segmental thickness by MRI >1.0 mm were included in this study. Lumen and outer wall contours were defined using semiautomated analysis software. The frequency of a lipid core in carotid plaque was estimated and risk factors for lipid core presence were explored using logistic regression analysis. Of the 37 participants in this study, 12 (32.4%) were women. The mean age was 38.7 ± 4.9 years. A lipid core was present in 9 (17%) of the plaques. Seventy percent of the study participants had a history of cigarette smoking. The mean total cholesterol level was 176.1 ± 37.3 mg/dl, the mean systolic blood pressure was 113.1 ± 13.3 mm Hg, and the mean diastolic blood pressure was 78.9 ± 9.5 mm Hg. There were 5 participants with hypertension (13.5%). Twelve (32%) participants had a history of chronic cocaine use, and 23 (62%) were HIV positive. Among the

  19. Carotid artery disease

    MedlinePlus

    ... a stroke recover most or all of their functions. Others die of the stroke itself or from complications. About half of people ... patients with extracranial carotid and vertebral artery disease: executive summary: ... American Association of Neuroscience Nurses, American Association ...

  20. Carotid dissection (image)

    MedlinePlus

    ... This leaking of blood into the artery wall (dissection) may cause a clot to form, reducing blood ... the neck, which means stroke secondary to carotid dissection may occur in young people as well as ...

  1. [Carotid ultrasonography: evaluation of carotid ultrasonography].

    PubMed

    Taniuchi, Ryosui

    2007-02-01

    Carotid ultrasonography is a laboratory procedure showing how arteriosclerosis screening can diagnose carotid artery occlusion and high-grade stenosis. It is useful for inspection in general practice because of its non-invasiveness, development of sonography equipment, laboratory methods and the establishment of an evaluation method. We generally use a linear array probe of around 7-8MHz for carotid observation and combine the B mode method, color and power Doppler method, and pulsed Doppler method for inspection. At vessel analysis, the intima-media thickness, the property of plaque and stenotic ratio are evaluated. We observe the direction of bloodstream and presence of stricture by Doppler color flow imaging and measure flow velocity and the wave pattern by pulsed Doppler method and, with the B mode method, evaluate the extent or degree of stricture. This can be depicted well using a convex array probe and sector array probe when the mental change caused by disease is deep, and depiction is difficult by linear array probe.

  2. Screening for Carotid Artery Stenosis

    MedlinePlus

    ... Task Force learned about the potential benefits and harms of screening for carotid artery stenosis: Health professionals ... blood flow through the arteries. Potential Benefits and Harms of Carotid Artery Stenosis Screening and Treatment The ...

  3. Prevalence and distribution of calcified nodules in carotid arteries in correlation with clinical symptoms.

    PubMed

    Paprottka, Karolin Johanna; Saam, Damiana; Rübenthaler, Johannes; Schindler, Andreas; Sommer, Nora Navina; Paprottka, Philipp Marius; Clevert, Dirk André; Reiser, Maximilian; Saam, Tobias; Helck, Andreas

    2017-06-01

    Calcified nodules ("CN") are responsible for up to 5% of coronary-infarcts and, therefore, classified as minor criteria of "vulnerable" atherosclerotic plaque. We sought to evaluate prevalence and distribution of CN in carotid arteries in correlation with clinical symptoms. 178 consecutive patients with unilateral ischemic stroke and carotid plaques ≥2 mm by duplex ultrasound underwent a carotid-black-blood-3T-MRI with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using dedicated surface-coils. CN were defined as distinct calcification with an irregular, protruding, and convex luminal surface. Prevalence of CN was determined in common carotid artery ("CCA") and internal carotid artery ("ICA") in consensus by two reviewers blinded to clinical information. Thirty seven CN in 28 arteries of 26 patients were identified. Prevalence of CN in CCA compared to ICA was slightly higher (59 vs. 41%), but nearly similar in 66 arteries with ≥30% compared to 290 arteries with <30% stenosis (9.1 vs. 7.6%) and in the artery ipsilateral versus contralateral to stroke (7.9 vs. 7.9%; P values n.s.). Prevalence of CN was significantly higher in 40 symptomatic arteries with ≥30% stenosis compared to asymptomatic 26 arteries (15.6 vs. 0%; P = 0.04). There was a significantly higher prevalence of hypercholesterolemia and hypertension in patients with CN (57.7 vs. 36.0 and 88.5 vs. 66.7%; P values <0.05). CN were found in 7.9% of arteries with carotid-plaques ≥2 mm by duplex-ultrasound; prevalence was significantly higher in symptomatic arteries with ≥30% stenosis compared to asymptomatic with <30% stenosis, suggesting that CN play a role in pathogenesis of ischemic stroke in a small subset of patients.

  4. [Grafting of carotid arteries].

    PubMed

    Belov, Iu V; Stepanenko, A B; Gens, A P; Bazylev, V V; Seleznev, M N; Savichev, D D

    2005-01-01

    Over 5-years, 167 reconstructive surgeries for stenosis of internal carotid arteries (ICA) were performed in 124 patients. Mean age of the patients was 63.5 years. One hundred and twenty-nine carotid endarterectomies (CEAE) in 86 patients and 38 reconstructive operations of ICA in 38 patients were performed. There were no lethal outcomes in short- and long-term postoperative period. In short-term period after prosthesis of ICA restenosis was revealed in 3% patients, after eversion CEAE in 3% patients the embolism was seen, after standard CEAE restenosis were diagnosed in 8% patients and thrombosis -- in 3%. In long-term period after grafting of ICA the strokes were seen in 3%, stenosis -- in 6% patients, after eversion endarterectomy -- in 0 and 3% patients, and after standard CEAE -- in 3 and 24% patients, respectively. It is concluded that grafting of ICA is adequate surgical method of reconstruction and stroke prevention in specific variants of carotid atherosclerosis.

  5. Black-blood Steady State Free Precession (SSFP) coronary wall MRI for cardiac allografts: A feasibility study

    PubMed Central

    Lin, Kai; Bi, Xiaoming; Liu, Ying; Taimen, Kirsi; Lu, Biao; Li, Debiao; Carr, James

    2014-01-01

    Purpose To assess the hypothesis that steady-state free procession (SSFP) allows for imaging of the coronary wall under the conditions of fast heart rate in patients of heart transplantation (HTx). Materials and methods With the approval of our institutional review board, 28 HTx patients were scanned with a 1.5T scanner. Cross-sectional black-blood images of the proximal portions of the left main artery, left anterior descending artery and right coronary artery were acquired with both two-dimensional (2D), double inversion recovery (DIR) prepared TSE sequence and 2D DIR SSFP sequence. Image quality (scored 0–3), vessel wall area, thickness, signal-to-noise ratio (SNR, vessel wall) and contrast-to-noise ratio (CNR, wall-lumen) were compared between TSE and SSFP. Results The overall image quality of SSFP was higher than TSE (1.23 ± 0.95 vs. 0.88 ± 0.69, P < 0.001). SSFP had a higher coronary wall SNR (20.1 ± 8.5 vs. 14.9 ± 4.8, P < 0.001) and wall-lumen CNR (8.2 ± 4.6 vs. 6.8 ± 3.7, P = 0.005) than TSE. Conclusion Black-blood SSFP coronary wall MRI provides higher image quality, SNR and CNR than traditional TSE does in HTx recipients. It has the potential to become an alternative means to noninvasive imaging of cardiac allografts. PMID:22282170

  6. Carotid surgery following previous carotid endarterectomy is safe and effective.

    PubMed

    Abou-Zamzam, Ahmed M; Moneta, Gregory L; Landry, Gregory J; Yeager, Richard A; Edwards, James M; McConnell, Donald B; Taylor, Lloyd M; Porter, John M

    2002-01-01

    With the perceived high risk of repeat carotid surgery, carotid angioplasty and stenting have been advocated recently as the preferred treatment of recurrent carotid disease following carotid endarterectomy. An experience with the operative treatment of recurrent carotid disease to document the risks and benefits of this procedure is presented. A review of a prospectively acquired vascular registry over a 10-year period (Jan. 1990-Jan. 2000) was undertaken to identify patients undergoing repeat carotid surgery following previous carotid endarterectomy. All patients were treated with repeat carotid endarterectomy, carotid interposition graft, or subclavian-carotid bypass. The perioperative stroke and death rate, operative complications, life-table freedom from stroke, and rates of recurrent stenosis were documented. During the study period 56 patients underwent repeat carotid surgery, comprising 6% of all carotid operations during this period. The indication for operation was symptomatic disease recurrence in 41 cases (73%) and asymptomatic recurrent stenosis >/=80% in 15 cases (27%). The average interval from the prior carotid endarterectomy to the repeat operation was 78 months (range 3 weeks-297 months). The operations performed included repeat carotid endarterectomy with patch angioplasty in 31 cases (55%), interposition grafts in 19 cases (34%), and subclavian-carotid bypass in 6 cases (11%). There were three perioperative strokes with one resulting in death for a perioperative stroke and death rate of 5.4%. One minor transient cranial nerve (CN IX) injury occurred. Mean follow-up was 29 months (range, 1-116 months). Life-table freedom from stroke was 95% at 1 year and 90% at 5 years. Recurrent stenosis (>/=80%) developed in three patients (5.4%) during follow-up, including one internal carotid artery occlusion. Two patients (3.6%) underwent repeat surgery. Repeat surgery for recurrent cerebrovascular disease following carotid endarterectomy is safe and

  7. [Syncope and carotid paraganglioma].

    PubMed

    Bizueto-Rosas, Héctor; Salazar-Reyes, Anabel; Moran-Reyes, Ely Guadalupe; González-Arcos, Gregorio; Hernández-Pérez, Noemí A; Solorio-Rosette, Hugo F; Soto-Hernández, Gabriel

    2014-01-01

    Syncope is a medical emergency, which is more or less frequent. Its prevalence increases with age. It is defined as the loss of consciousness and postural tone resulting from a transient alteration of cerebral flow. It appears suddenly, but it does not leave behind any sequela or after-effects. Out of two groups, the neutrally mediated (or neuromediated) syncope, especially the one called carotid sinus hypersensitivity, is related to the carotid sinus paraganglioma. It is triggered by sinus pressure, which results in sudden death by overstimulation. In the next article, we show the case of a sexagenarian female patient with a disabling syncope and a 7 cm carotid body paraganglioma, which did not allow her the minimum movement of lateral dorsiflexion or extension of the neck. For this reason, the patient had to remain hospitalized, in a dorsal decubitus position with semiflexion of the neck. Before the surgery was practiced, a temporary pacemaker was used, and after the resection of the carotid body paraganglioma, in accordance to the patient's studies of cardiac electrophysiology, she was discharged without electrical nerve stimulation.

  8. Carotid Artery Screening

    MedlinePlus

    ... or radiologist then places the transducer on the skin in various locations, sweeping over the area of interest or angling the sound beam from a different location to better see an area of concern. Doppler sonography and Carotid IMT US are performed using the ...

  9. Carotid Body Tumor.

    PubMed

    Bakshi, Satvinder S; Kumar T, Lokesh

    2017-08-14

    A 17 year old girl presented with a progressively increasing swelling in her neck since 9 months. On examination a2*3 cm, firm, pulsatile swelling was felt in the left anterior triangle. The CT scan of the mass was suggestive of a carotid body tumor and urinary cathecholamines were negative. The mass was excised completely.

  10. Carotid endarterectomy in patients with contralateral carotid artery occlusion.

    PubMed

    Dalainas, Ilias; Nano, Giovanni; Bianchi, Paolo; Casana, Renato; Malacrida, Giovanni; Tealdi, Domenico G

    2007-01-01

    The aim of this study was to evaluate the 30-day outcome of carotid endarterectomy in patients with contralateral carotid artery occlusion and compare it to that in patients with patent contralateral carotid artery. We compared 2,959 carotid endarterectomies performed in patients with patent contralateral internal carotid artery to 373 carotid endarterectomies performed in patients with occlusion of the contralateral carotid artery in the same institute between 1988 and 2004. Patient demographics, surgical and anesthesiological strategy, perioperative neurological and cardiac events, and deaths were compared. The patients were grouped and analyzed according to the presence or absence of symptoms and to their gender. No significant difference was shown in perioperative cardiological and neurological events and deaths in patients with contralateral carotid occlusion versus patients without contralateral carotid occlusion. Females had significant more neurological events than males, in both the asymptomatic (P < 0.001) and symptomatic (P = 0.02) groups. Concomitant occlusion of the contralateral carotid artery was not associated with increased risk of perioperative cardiological or neurological adverse events. However, female gender was associated with higher risk for adverse neurological events.

  11. 3-D carotid multi-region MRI segmentation by globally optimal evolution of coupled surfaces.

    PubMed

    Ukwatta, Eranga; Yuan, Jing; Rajchl, Martin; Qiu, Wu; Tessier, David; Fenster, Aaron

    2013-04-01

    In this paper, we propose a novel global optimization based 3-D multi-region segmentation algorithm for T1-weighted black-blood carotid magnetic resonance (MR) images. The proposed algorithm partitions a 3-D carotid MR image into three regions: wall, lumen, and background. The algorithm performs such partitioning by simultaneously evolving two coupled 3-D surfaces of carotid artery adventitia boundary (AB) and lumen-intima boundary (LIB) while preserving their anatomical inter-surface consistency such that the LIB is always located within the AB. In particular, we show that the proposed algorithm results in a fully time implicit scheme that propagates the two linearly ordered surfaces of the AB and LIB to their globally optimal positions during each discrete time frame by convex relaxation. In this regard, we introduce the continuous max-flow model and prove its duality/equivalence to the convex relaxed optimization problem with respect to each evolution step. We then propose a fully parallelized continuous max-flow-based algorithm, which can be readily implemented on a GPU to achieve high computational efficiency. Extensive experiments, with four users using 12 3T MR and 26 1.5T MR images, demonstrate that the proposed algorithm yields high accuracy and low operator variability in computing vessel wall volume. In addition, we show the algorithm outperforms previous methods in terms of high computational efficiency and robustness with fewer user interactions.

  12. Management of Carotid Artery Trauma

    PubMed Central

    Lee, Thomas S.; Ducic, Yadranko; Gordin, Eli; Stroman, David

    2014-01-01

    With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention. PMID:25136406

  13. Breath-hold black blood quantitative T1rho imaging of liver using single shot fast spin echo acquisition

    PubMed Central

    Chan, Queenie; Wáng, Yì-Xiáng J.

    2016-01-01

    Background Liver fibrosis is a key feature in most chronic liver diseases. T1rho magnetic resonance imaging is a potentially important technique for noninvasive diagnosis, severity grading, and therapy monitoring of liver fibrosis. However, it remains challenging to perform robust T1rho quantification of liver on human subjects. One major reason is that the presence of rich blood signal in liver can cause artificially high T1rho measurement and makes T1rho quantification susceptible to motion. Methods A pulse sequence based on single shot fast/turbo spin echo (SSFSE/SSTSE) acquisition, with theoretical analysis and simulation based on the extended phase graph (EPG) algorithm, was presented for breath-hold single slice quantitative T1rho imaging of liver with suppression of blood signal. The pulse sequence was evaluated in human subjects at 3.0 T with 500 Hz spinlock frequency and time-of-spinlock (TSL) 0, 10, 30 and 50 ms. Results Human scan demonstrated that the entire T1rho data sets with four spinlock time can be acquired within a single breath-hold of 10 seconds with black blood effect. T1rho quantification with suppression of blood signal results in significantly reduced T1rho value of liver compared to the results without blood suppression. Conclusions A signal-to-noise ratio (SNR) efficient pulse sequence was reported for T1rho quantification of liver. The black blood effect, together with a short breath-hold, mitigates the risk of quantification errors as would occur in the conventional methods. PMID:27190769

  14. An 8-channel RF coil array for carotid artery MR imaging in humans at 3 T.

    PubMed

    Hu, Xiaoqing; Zhang, Lei; Zhang, Xiaoliang; Zhu, Huabin; Chen, Xiao; Zhang, Yongqin; Chung, Yiu-Cho; Liu, Xin; Zheng, Hairong; Li, Ye

    2016-04-01

    Carotid artery diseases due to plaque buildup at the carotid bifurcation are a leading cause of stroke. Accurate plaque quantification and characterization of plaque composition and morphology by magnetic resonance imaging (MRI) is essential to identifying high-risk patients. Difficulties in detecting plaque, which is physically small, and the unique physiological structure of the carotid artery make use of a radio frequency (RF) coil array with high resolution, large longitudinal coverage, and deep penetration ideal for clinical examinations. The goal of this project was to design and fabricate a sensitive RF coil array with sufficient imaging coverage and signal-to-noise ratio (SNR) for carotid artery imaging at 3 T. Based on clinical requirements and the anatomical structure of the human carotid artery, an 8-channel carotid coil array was designed and fabricated for 3 T MRI of the carotid artery in humans. The performance of the proposed 8-channel carotid coil array was validated through bench tests and MR imaging experiments on a 3 T whole body MRI scanner. Its performance was also compared experimentally to the performance of a commercial 4-channel phased array carotid coil designed by Machnet BV (Machnet BV coil, Roden, Netherlands). The 8-channel carotid coil array performed significantly better in imaging the carotid artery than the commercial 4-channel Machnet BV coil in terms of the SNR, coverage, and penetration depth. In parallel imaging, the proposed 8-channel carotid coil array demonstrated a much lower maximum value and average value of the geometry factor in the region of interest. Carotid artery images acquired in vivo using the proposed 8-channel carotid artery coil and the commercial 4-channel Machnet BV coil were also compared, demonstrating the former's potential for clinical diagnosis. Based on the analyses of phantom and in vivo imaging studies, the proposed 8-channel carotid coil array has the potential for use in clinical diagnosis

  15. How Is Carotid Artery Disease Treated?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Carotid Artery Disease Treated? Treatments for carotid artery disease may ... plaque removed and normal blood flow restored. Carotid Artery Angioplasty and Stenting Doctors use a procedure called ...

  16. How Can Carotid Artery Disease Be Prevented?

    MedlinePlus

    ... from the NHLBI on Twitter. How Can Carotid Artery Disease Be Prevented? Taking action to control your risk factors can help prevent or delay carotid artery disease and stroke . Your risk for carotid artery ...

  17. Endovascular treatment of the carotid stump syndrome.

    PubMed

    Nano, Giovanni; Dalainas, Ilias; Casana, Renato; Malacrida, Giovanni; Tealdi, Domenico G

    2006-01-01

    In patients with an occluded internal carotid artery, the carotid stump syndrome is a potential source of microemboli that pass through the ipsilateral external carotid artery and the ophthalmic artery to the territory of the middle cerebral artery. Thus, the syndrome is associated with carotid territory symptoms although the internal carotid artery is occluded. Surgical exclusion of the internal carotid artery associated with endarterectomy of the external carotid artery has been described as the gold standard of treatment by many authors. This report is the second case, to our knowledge, of endovascular treatment of the carotid stump syndrome with the use of a stent-graft.

  18. Carotid Artery Stenting versus Endarterectomy

    PubMed Central

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

    2012-01-01

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

  19. Preliminary experience with MRA in evaluating the degree of carotid stenosis and plaque morphology using high-resolution sequences after gadofosveset trisodium (Vasovist) administration: comparison with CTA and DSA.

    PubMed

    Anzidei, M; Napoli, A; Geiger, D; Cavallo Marincola, B; Zini, C; Zaccagna, F; Di Paolo, P; Catalano, C; Passariello, R

    2010-06-01

    The authors performed a preliminary study with blood-pool contrast-enhanced magnetic resonance angiography (MRA) in evaluating the degree of carotid artery stenosis and plaque morphology, comparing the diagnostic performance of first-pass (FP) and steady-state (SS) acquisitions with 64-slice computed tomography angiography (CTA) and using digital subtraction angiography (DSA) as the reference standard. Twenty patients with >or=50% carotid artery stenosis at Doppler sonography underwent blood-pool contrast-enhanced MRA, CTA and DSA. Two independent radiologists evaluated MRA and CTA examinations to assess the degree of stenosis and characterise plaque morphology. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for FP, SS and CTA. The McNemar and Wilcoxon tests were used to determine significant differences (p<0.05) between the diagnostic performance of the three modalities. Forty carotid bifurcations were studied. For stenosis grading, accuracy, sensitivity, specificity, PPV and NPV were 90%, 89%, 90%, 89% and 90%, respectively, at FP; 95%, 95%, 95%, 95% and 95%, respectively, at SS; and 97.5%, 95%, 100%, 100% and 95%, respectively, at CTA. SS and CTA were superior to FP for evaluating the degree of stenosis (p<0.05). For evaluating plaque morphology, accuracy, sensitivity, specificity, PPV and NPV were 87.5%, 89%, 86%, 85% and 90%, respectively, at FP; 97.5%, 100%, 95%, 95% and 100%, respectively, at SS; and 100%, 100%, 100%, 100% and 100%, respectively, at CTA. There were no significant differences between FP, SS and CTA for plaque assessment (p>0.05). Blood-pool contrast-enhanced MRA with SS sequences allow improved diagnostic evaluation of the degree of carotid stenosis and plaque morphology compared with FP and is substantially equal to CTA and DSA.

  20. Iodide Mumps Complicating Coronary and Carotid Angiography.

    PubMed

    Elder, Alexander M M; Ng, Martin K C

    2017-02-01

    We report a case of asceptic sialadenitis that occurred in a patient with end-stage renal failure following administration of iodinated contrast for coronary and carotid angiography. This is a rare but important complication of iodinated contrast. Early diagnosis of iodide mumps following angiography avoids unnecessary investigations and treatment. In this case the patient underwent haemodialysis with subsequent complete resolution of the sialadenitis, a treatment that has previously not been reported for this condition. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  1. [Carotid duplex ultrasonography for neurosurgeons].

    PubMed

    Sadahiro, Hirokazu; Ishihara, Hideyuki; Oka, Fumiaki; Suzuki, Michiyasu

    2011-12-01

    Carotid duplex ultrasonography (CDU) is one of the most well-known imaging methods for arteriosclerosis and ischemic stroke. For neurosurgeons, it is very important for the details of carotid plaque to be thoroughly investigated by CDU. Symptomatic carotid plaque is very fragile and easily changes morphologically, and so requires frequent CDU examination. Furthermore, after carotid endarterectomy (CEA) and carotid artery stenting (CAS), restenosis is evaluated with CDU. CDU facilitates not only morphological imaging in the B mode, but also allows a flow study with color Doppler and duplex imaging. So, CDU can help assess the presence of proximal and intracranial artery lesions in spite of only having a cervical view, and the patency of the extracranial artery to intracranial artery bypass is revealed with CDU, which shows a rich velocity and low pulsatility index (PI) in duplex imaging. For the examiner, it is necessary to ponder on what duplex imaging means in examinations, and to summarize all imaging finding.

  2. Clinical results of carotid artery stenting versus carotid endarterectomy

    PubMed Central

    Akinci, Tuba; Derle, Eda; Kibaroğlu, Seda; Harman, Ali; Kural, Feride; Cınar, Pınar; Kilinc, Munire; Akay, Hakki T.; Can, Ufuk; Benli, Ulku S.

    2016-01-01

    Objective: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Methods: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (≥70%) or symptomatic stenosis (≥50%). Demographic data, procedural details, and clinical outcomes were recorded. Primary outcome measures were in 30-day stroke/transient ischemic attacks (TIA)/amaurosis fugax or death. Secondary outcome measures were nerve injury, bleeding complications, length of stay in hospital, stroke, restenosis (ICA patency), and all-cause death during long-term follow-up. Results: One hundred ninety-four CEA and 115 CAS procedures were performed for symptomatic and/or asymptomatic carotid artery stenosis. There is no significant differences 30-day mortality and neurologic morbidity between CAS (13%) and CEA procedures (7.7%). Length of stay in hospital were significantly longer in CEA group (p=0.001). In the post-procedural follow up, only in symptomatic patients, restenosis rate was higher in the CEA group (p=.045). The other endpoints did not differ significantly. Conclusions: Endovascular stent treatment of carotid artery atherosclerotic disease is an alternative for vascular surgery, especially for patients that are high risk for standard CEA. The increasing experience, development of cerebral protection systems and new treatment protocols increases CAS feasibility. PMID:27744460

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

    PubMed

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

    2016-01-01

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

  4. Carotid Disease Management: Surgery, Stenting, or Medication.

    PubMed

    Khandelwal, Priyank; Chaturvedi, Seemant

    2015-09-01

    Internal carotid artery stenosis accounts for about 7-10 % of ischemic strokes. Conventional risk factors such as aging, hypertension, diabetes mellitus, and smoking increase the risk for carotid atherosclerosis. All patients with carotid stenosis should receive aggressive medical therapy. Carotid revascularization with either endarterectomy or stenting can benefit select patients with severe stenosis. New clinical trials will examine the contemporary role of carotid revascularization relative to optimal medical therapy.

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

    SciTech Connect

    Minar, E.; Ehringer, H.; Dudczak, R.; Schoefl, R.J.; Jung, M.; Koppensteiner, R.; Ahmadi, R.; Kretschmer, G.

    1989-01-01

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

  6. [Carotid endarterectomy under local anesthesia].

    PubMed

    Kuz'min, A L; Belov, Iu V

    2001-01-01

    Results of carotid endarterectomy (CEAE) in 193 patients with different degree of cerebrovascular insufficiency were analyzed. All the patients were men with carotid atherosclerosis (age from 39 to 68 years, mean age 53.6 +/- 0.4). A total of 253 CEAEs were performed under local anesthesia (60 patients underwent consecutive bilateral operations). In early postoperative period 3 patients died, one of them--of ischemic stroke due to thrombosis of internal carotid artery on the side of the operation. Non-fatal stroke was in 1 patient. There were no intraoperative cerebral complications. This testifies to reliability of cerebral circulation control through direct contact with patient.

  7. Carotid body disease and the physician--chronic carotid glomitis.

    PubMed Central

    Heath, D.; Khan, Q.; Nash, J.; Smith, P.

    1989-01-01

    There are three types of histological change in the carotid bodies which appear to have physiological and clinical associations. A prominence of the dark variant of chief cells with their contents of met-enkephalin and other peptides appears to be associated with acute exposure to hypoxia. Proliferation of sustentacular cells around the clusters of chief cells appears to be related to ageing and also to systemic hypertension. Recently we have described a new condition of chronic carotid glomitis which is characterized by follicles of lymphocytes and may have a basis in auto-immunity. In the present review we report for the first time plasma cell activity in the carotid bodies of an elderly man, especially around nerve fibrils and unmyelinated axons ensheathed in sustentacular cells. Such appearances are consistent with the view that ageing nerve fibrils may be the antigenic stimulus for the development of chronic carotid glomitis. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:2692011

  8. Structural MRI of carotid artery atherosclerotic lesion burden and characterization of hemispheric cerebral blood flow before and after carotid endarterectomy.

    PubMed

    Jones, C E; Wolf, R L; Detre, J A; Das, B; Saha, P K; Wang, J; Zhang, Y; Song, H K; Wright, A C; Mohler, E M; Fairman, R M; Zager, E L; Velazquez, O C; Golden, M A; Carpenter, J P; Wehrli, F W

    2006-04-01

    Collateral circulation plays a major role in maintaining cerebral blood flow (CBF) in patients with internal carotid artery (ICA) stenosis. CBF can remain normal despite severe ICA stenosis, making the benefit of carotid endarterectomy (CEA) or stenting difficult to assess. Before and after surgery, we assessed CBF supplied through the ipsilateral (stenotic) or contralateral ICA individually with a novel hemisphere-selective arterial spin-labeling (ASL) perfusion MR technique. We further explored the relationship between CBF and ICA obstruction ratio (OR) acquired with a multislice black-blood imaging sequence. For patients with unilateral ICA stenosis (n = 19), conventional bilateral labeling did not reveal interhemispheric differences. With unilateral labeling, CBF in the middle cerebral artery (MCA) territory on the surgical side from the ipsilateral supply (53.7 +/- 3.3 ml/100 g/min) was lower than CBF in the contralateral MCA territory from the contralateral supply (58.5 +/- 2.7 ml/100 g/min), although not statistically significant (p = 0.09). The ipsilateral MCA territory received significant (p = 0.02) contralateral supply (7.0 +/- 2.7 ml/100 g/min), while ipsilateral supply to the contralateral side was not reciprocated. After surgery (n = 11), ipsilateral supply to the MCA territory increased from 57.3 +/- 5.7 to 67.3 +/- 5.4 ml/100 g/min (p = 0.03), and contralateral supply to the ipsilateral MCA territory decreased. The best predictor of increased CBF on the side of surgery was normalized presurgical ipsilateral supply (r(2) = 0.62, p = 0.004). OR was less predictive of change, although the change in normalized contralateral supply was negatively correlated with OR(excess) (=OR(ipsilateral) - OR(contralateral)) (r(2) = 0.58, p = 0.006). The results demonstrate the effect of carotid artery stenosis on blood supply to the cerebral hemispheres, as well as the relative role of collateral pathways before surgery and redistribution of blood flow through these

  9. CT angiography ofthe carotid arteries.

    PubMed

    Prokop, M; Waaijer, A; Kreuzer, S

    2004-01-01

    The introduction of multislice scanning has made CT angiography (CTA) a serious competitor to MR angiography (MRA) as a second line method for the evaluation of the carotid arteries. For optimum display of the morphology of stenoses, it is necessary to apply the thinnest possible section collimation (ideally [symbol: see text] 1.25mm). While the scan range is limited for single slice CTA, it is possible to cover the whole supraaortic circulation from the aortic arch to the intracranial vessels using multislice scanning. Timing of contrast injection is important, however, the injection technique for carotid CTA is more forgiving than for other body regions. Image evaluation is mainly based on axial sections and curved planar reformations (CPR). Other techniques only serve as an adjunct to better be able to demonstrate the findings. Most potential pitfalls can be avoided by using the appropriate technique. CTA has been shown to have a pooled sensitivity of 95% and specificity of 98% for the detection of >70% stenoses, even if only older single-slice techniques are used. Differentiation between lipid, fibrous and calcified plaques may be possible, especially with multislice scanning. Multislice CTA can in addition detect tandem stenoses in the region of the carotid origin from the aorta, the carotid siphon, and the intracranial portion of the carotids. CT is able to provide a comprehensive evaluation of patients with acute stroke by using a combined approach of pre-contrast CT to detect hemorrhage and manifest infarction, CT brain perfusion measurements to differentiate between penumbra and infarct and CTA to detect the occluded vessel as well as potential concomitant carotid abnormalities. In summary, carotid CTA has come of age and can be used to quantify stenoses more precisely than ultrasound, to detect tandem stenoses and for the workup of acute stroke patients. The learning objectives include learning how to chose acquisition parameters for carotid CTA, how to

  10. The validity of internal carotid back pressure measurements during carotid endarterectomy for unilateral carotid stenosis.

    PubMed

    Lord, R S; Graham, A R

    1986-06-01

    Peri-operative neurological deficits in 212 patients undergoing carotid endarterectomy for unilateral carotid stenosis were examined to determine whether the internal carotid back pressure (ICBP) correctly predicted the need for a protective shunt during temporary carotid occlusion. Three strokes occurred in 149 patients who were not shunted. In one of these the ICBP indicated the need for a shunt, but shunting was not possible for technical reasons and a stroke due to hypoperfusion occurred. In another patient a stroke occurred as a result of embolism. There was only one patient where the ICBP possibly incorrectly predicted that a shunt would not be necessary. Four strokes due to various causes occurred in the 63 shunted patients. Shunting was not withheld from these patients in order to prove that ICBP would correctly predict their vulnerability to hypoperfusion since to have done so would be unethical. The results indicate that in patients with unilateral carotid stenosis the ICBP is an accurate indicator of which patients can undergo carotid endarterectomy without the need for shunting.

  11. Evidence for Shear Stress-Mediated Dilation of the Internal Carotid Artery in Humans.

    PubMed

    Carter, Howard H; Atkinson, Ceri L; Heinonen, Ilkka H A; Haynes, Andrew; Robey, Elisa; Smith, Kurt J; Ainslie, Philip N; Hoiland, Ryan L; Green, Daniel J

    2016-11-01

    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 increases carotid shear stress, a known stimulus to vasodilation in other conduit arteries. To explore the hypothesis that shear stress contributes to hypercapnic internal carotid dilation in humans, temporal changes in internal and common carotid shear rate and diameter, along with changes in middle cerebral artery velocity, were simultaneously assessed in 18 subjects at rest and during hypercapnia (6% carbon dioxide). Middle cerebral artery velocity increased significantly (69±10-103±17 cm/s; P<0.01) along with shear in both the internal (316±52-518±105 1/s; P<0.01) and common (188±40-275±61 1/s; P<0.01) carotids. Diameter also increased (P<0.01) in both carotid arteries (internal: +6.3±2.9%; common: +5.8±3.0%). Following hypercapnia onset, there was a significant delay between the onset of internal carotid shear (22±12 seconds) and diameter change (85±51 seconds). This time course is associated with shear-mediated dilation of larger conduit arteries in humans. There was a strong association between change in shear and diameter of the internal carotid (r=0.68; P<0.01). These data indicate, for the first time in humans, that shear stress is an important stimulus for hypercapnic vasodilation of the internal carotid artery. The combination of a hypercapnic stimulus and continuous noninvasive, high-resolution assessment of internal carotid shear and dilation may provide novel insights into the function and health of the clinically important extracranial arteries in humans. © 2016 American Heart Association, Inc.

  12. Angioplasty and stent placement - carotid artery

    MedlinePlus

    ... in your carotid artery. Moving x-ray pictures (fluoroscopy) are used to see the artery and guide ... 18403765 . Kinlay S, Bhatt DL. Treatment of noncoronary obstructive ... versus surgery for asymptomatic carotid stenosis. N Engl J Med . ...

  13. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

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

  14. Sympathoinhibition and hypotension in carotid sinus hypersensitivity

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

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

  15. Carotid bruits as predictor for carotid stenoses detected by ultrasonography: an observational study

    PubMed Central

    Johansson, Elias P; Wester, Per

    2008-01-01

    Background Carotid surgery in asymptomatic subjects with carotid stenosis is effective to prevent ischemic stroke. There is, however, uncertainty how to find such persons at risk, because mass screening with carotid artery ultrasonography (US) is not cost-effective. Signs of carotid bruits corresponding to the carotid arteries may serve as a tool to select subjects for further investigation. This study is thus aimed at determining the usefulness of carotid bruits in the screening of carotid stenoses. Methods 1555 consecutive carotid ultrasonography investigations from 1486 cases done between January 2004 and March 2006 at Norrlands University Hospital, Sweden, were examined. 356 subjects, medium age 69 (27–88) years, had a significant (≥ 50%) US-verified carotid stenosis uni- or bilaterally, 291 had been examined for signs of carotid bruits. The likelihood ratios for carotid bruits to predict US-verified carotid stenoses were calculated and expressed as likelihood percentages. Results Thirty-one out of 100 persons (31%) with carotid bruit as an indication to perform carotid US had a significant (≥ 50%) carotid stenosis. 281 of the 356 (79%) cases with significant carotid stenoses were found among patients with cerebrovascular disease (CVD). 145 of 226 (64%) CVD patients with a significant carotid stenosis had a carotid bruit. In patients with 50–99% carotid stenoses carotid bruits had an accuracy of 75% (436/582), a sensitivity of 71% (236/334), a specificity of 81% (200/248), a positive likelihood ratio at 3.65 and a negative likelihood at 0.36. Patients with 70–99% stenoses had the highest sensitivity at 77% (183/238). In patients with 100% carotid stenoses, carotid bruits had a sensitivity of 26% (15/57) and a specificity of 49% (256/525). Conclusion Although carotid bruits are not accurate to confirm or to exclude significant carotid stenoses, these signs are appropriate for directed screening for further investigation with carotid US if the patient

  16. Ultrasound-Based Carotid Elastography for Detection of Vulnerable Atherosclerotic Plaques Validated by Magnetic Resonance Imaging.

    PubMed

    Huang, Chengwu; Pan, Xiaochang; He, Qiong; Huang, Manwei; Huang, Lingyun; Zhao, Xihai; Yuan, Chun; Bai, Jing; Luo, Jianwen

    2016-02-01

    Ultrasound-based carotid elastography has been developed to estimate the mechanical properties of atherosclerotic plaques. The objective of this study was to evaluate the in vivo capability of carotid elastography in vulnerable plaque detection using high-resolution magnetic resonance imaging as reference. Ultrasound radiofrequency data of 46 carotid plaques from 29 patients (74 ± 5 y old) were acquired and inter-frame axial strain was estimated with an optical flow method. The maximum value of absolute strain rate for each plaque was derived as an indicator for plaque classification. Magnetic resonance imaging of carotid arteries was performed on the same patients to classify the plaques into stable and vulnerable groups for carotid elastography validation. The maximum value of absolute strain rate was found to be significantly higher in vulnerable plaques (2.15 ± 0.79 s(-1), n = 27) than in stable plaques (1.21 ± 0.37 s(-1), n = 19) (p < 0.0001). Receiver operating characteristic curve analysis was performed, and the area under the curve was 0.848. Therefore, the in vivo capability of carotid elastography to detect vulnerable plaques, validated by magnetic resonance imaging, was proven, revealing the potential of carotid elastography as an important tool in atherosclerosis assessment and stroke prevention.

  17. Detection of small metastatic brain tumors: comparison of 3D contrast-enhanced whole-brain black-blood imaging and MP-RAGE imaging.

    PubMed

    Park, Jaeseok; Kim, Jinna; Yoo, Eunhye; Lee, Hyunyeol; Chang, Jong-Hee; Kim, Eung Yeop

    2012-02-01

    Early and accurate diagnosis of small metastatic brain tumors may affect outcomes and treatment strategies. For this reason, 3-dimensional (3D) thin-section imaging is preferred. However, with conventional contrast-enhanced (CE) 3D imaging, such as magnetization-prepared rapid gradient echo (MP-RAGE), many visually enhanced vessels may mimic small metastatic tumors, hindering tumor detection. CE black-blood single-slab 3D turbo-spin echo imaging (BB-ssTSE) was recently developed, which uses variable refocusing flip angles and flow-sensitizing gradient schemes, to enhance metastatic brain tumors while selectively suppressing blood vessels. The purpose of this work was to investigate the efficiency of the proposed CE BB-ssTSE in detecting small metastatic brain tumors as compared with conventional MP-RAGE. Numerical comparisons of MP-RAGE and BB-ssTSE were performed by simulation studies to investigate the signal/contrast behaviors of flowing blood and stationary CE tumors. For in vivo studies, we enrolled 35 patients (18 women; mean age, 58.1 years) with breast or lung cancer who underwent brain magnetic resonance imaging. After administering a double dose of contrast medium, whole-brain 2-dimensional T1-weighted imaging followed by high-resolution isotropic 3D BB-ssTSE and MP-RAGE was performed at 3.0 T. Two reviewers independently evaluated the presence of metastatic brain tumors using: (1) MP-RAGE; (2) BB-ssTSE; and (3) MP-RAGE + BB-ssTSE sequentially in 3 review sessions, 2 weeks apart. The lesions were classified by size into 2 groups: large (≥5 mm) and small (<5 mm). Both reviewers marked all tumors detected at each session. Another reviewer combined the results of the 2 reviewers and compared the detection rates of metastatic brain tumors between BB-ssTSE and MP-RAGE by using follow-up imaging. Intraclass correlation coefficients between the 2 reviewers were measured. Numerical simulations showed that the proposed BB-ssTSE effectively attenuated the signal

  18. Blood flow changes after unilateral carotid artery ligation monitored by optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Ma, Yushu; Liang, Chengbo; Suo, Yanyan; Zhao, Yuqian; Wang, Yi; Xu, Tao; Wang, Ruikang; Ma, Zhenhe

    2016-03-01

    Unilateral carotid artery ligation which could induce adaptive improvement is a classic model that has been widely used to study pathology of ischemic disease. In those studies, blood flow is an important parameter to characterize the ischemia. Optical coherence tomography (OCT) is a powerful imaging modality which can provide depth resolved images in biological tissue with high spatial and temporal resolution. SPF rats was anesthetized with isoflurane and divided into two groups. In first group, bilateral carotid artery was surgically exposed, and then left carotid artery was ligated. Blood flow changes of the contralateral carotid artery was monitored using high speed spectral domain optical coherence tomography, including the absolute flow velocity and the flow volume. In the other group, skull window was opened at the ipsilateral cerebral cortex of ligation and blood supply of small artery was measured before and after the ligation. The measured results demonstrate the blood supply compensation process after unilateral carotid artery ligation. With the superiority of high resolution, OCT is an effective technology in monitoring results of carotid artery after ligation.

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

    PubMed

    Huibers, A; Halliday, A; Bulbulia, R; Coppi, G; de Borst, G J

    2016-03-01

    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 intervention. Within the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), this study aimed at assessing the current use of antiplatelet therapy before, during, and after CEA and CAS in patients with asymptomatic carotid stenosis. Questionnaires were sent to ACST-2 collaborators seeking information about the use of antiplatelet therapy during the pre-, peri-, and post-operative periods in patients undergoing carotid intervention at 77 participating sites and also whether sites tested for antiplatelet therapy resistance. The response rate was 68/77 (88%). For CAS, 82% of sites used dual antiplatelet therapy (DAPT) pre-operatively and 86% post-operatively with a mean post-procedural duration of 3 months (range 1-12), while 9% continued DAPT life-long. For CEA only 31% used DAPT pre-operatively, 24% post-operatively with a mean post-procedural duration of 3 months (range 1-5), while 10% continued DAPT life-long. For those prescribing post-procedural mono antiplatelet (MAPT) therapy (76%), aspirin was more commonly prescribed (59%) than clopidogrel (6%) and 11% of centres did not show a preference for either aspirin or clopidogrel. Eleven centres (16%) tested for antiplatelet therapy resistance. There appears to be broad agreement on the use of antiplatelet therapy in ACST-2 patients undergoing carotid artery stenting and surgery. Although evidence to help guide the duration of peri-procedural antiplatelet therapy is limited, long-term treatment with DAPT appears similar between both treatment arms. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  20. Endovascular management of symptomatic cerebral malperfusion due to carotid dissection after type A aortic dissection repair.

    PubMed

    Casana, R; Tolva, V; Majnardi, A Robecchi; Bianchi, P G; Addobati, L; Bertoni, G B; Cireni, L V; Silani, V

    2011-10-01

    Type A acute aortic dissection is a surgical emergency, and supra-aortic trunk involvement may be complicated by stroke in 6% to 20% of cases. A 66-year-old Caucasian female patient underwent a composite repair of the ascending aorta for type A aortic dissection. Postoperative period was complicated by episodes of "drop attack." Doppler ultrasound of supra-aortic trunks revealed an intimal flap occluding right internal carotid artery. Multiple stenting was performed from carotid bifurcation to internal carotid artery in order to exclude the dissection intimal flap. After endovascular procedure physiatrist considered that motor functional improvement was better than expected, and we support that endovascular resolution of carotid malperfusion led to a better outcome. According to other experience, endovascular procedure resulted as a safe and effective way. Moreover, ultrasound monitoring of supra-aortic trunks in postoperative period is recommended.

  1. Urinary Sodium and Potassium Excretion and Carotid Atherosclerosis in Chinese Men and Women

    PubMed Central

    Dai, Xiao-Wei; Wang, Cheng; Xu, Ying; Guan, Ke; Su, Yi-Xiang; Chen, Yu-Ming

    2016-01-01

    Limited studies have examined the association between sodium (Na) and potassium (K) levels and the risk of atherosclerosis. This study examined whether higher Na and Na/K levels and low K levels were independent risk factors for atherosclerosis. This community-based cross-sectional study included 3290 subjects (1067 men and 2223 women) 40 to 75 years of age in Guangzhou, China, between 2011 and 2013. Urinary excretion of Na and K were measured from the first morning void, and creatinine-adjusted values were used. The intima-media thickness (IMT) of the carotid common artery and the carotid bifurcation was measured with high-resolution B-mode ultrasonography. Dietary K and Na intake and other covariates were obtained by face-to-face interviews. A significant positive association was seen between urinary Na excretion and carotid atherosclerosis after adjustment for age, sex, and other lifestyle covariates. The odds ratios (OR) and 95% confidence interval (CI) of the highest (vs. lowest) quartile of urinary Na were 1.32 (1.04–1.66) for carotid plaques, 1.48 (1.18–1.87) for increased common carotid artery IMT, and 1.55 (1.23–1.96) for increased carotid bifurcation IMT (all p-trend < 0.01). A similar positive association was observed between urinary Na/K levels and carotid plaque and increased IMT, and between dietary Na intake and increased bifurcation IMT. Regarding potassium data, we only found a significantly lower presence of carotid plaque (OR 0.72, 95% CI 0.57–0.91) for quartile 2 (vs. 1) of urinary K. Our findings suggest that higher levels of urinary excretion Na and Na/K are significantly associated with greater presence of carotid atherosclerosis in Chinese adults. PMID:27706075

  2. Urinary Sodium and Potassium Excretion and Carotid Atherosclerosis in Chinese Men and Women.

    PubMed

    Dai, Xiao-Wei; Wang, Cheng; Xu, Ying; Guan, Ke; Su, Yi-Xiang; Chen, Yu-Ming

    2016-10-01

    Limited studies have examined the association between sodium (Na) and potassium (K) levels and the risk of atherosclerosis. This study examined whether higher Na and Na/K levels and low K levels were independent risk factors for atherosclerosis. This community-based cross-sectional study included 3290 subjects (1067 men and 2223 women) 40 to 75 years of age in Guangzhou, China, between 2011 and 2013. Urinary excretion of Na and K were measured from the first morning void, and creatinine-adjusted values were used. The intima-media thickness (IMT) of the carotid common artery and the carotid bifurcation was measured with high-resolution B-mode ultrasonography. Dietary K and Na intake and other covariates were obtained by face-to-face interviews. A significant positive association was seen between urinary Na excretion and carotid atherosclerosis after adjustment for age, sex, and other lifestyle covariates. The odds ratios (OR) and 95% confidence interval (CI) of the highest (vs. lowest) quartile of urinary Na were 1.32 (1.04-1.66) for carotid plaques, 1.48 (1.18-1.87) for increased common carotid artery IMT, and 1.55 (1.23-1.96) for increased carotid bifurcation IMT (all p-trend < 0.01). A similar positive association was observed between urinary Na/K levels and carotid plaque and increased IMT, and between dietary Na intake and increased bifurcation IMT. Regarding potassium data, we only found a significantly lower presence of carotid plaque (OR 0.72, 95% CI 0.57-0.91) for quartile 2 (vs. 1) of urinary K. Our findings suggest that higher levels of urinary excretion Na and Na/K are significantly associated with greater presence of carotid atherosclerosis in Chinese adults.

  3. Assessing carotid atherosclerosis by fiber-optic multispectral photoacoustic tomography

    NASA Astrophysics Data System (ADS)

    Hui, Jie; Li, Rui; Wang, Pu; Phillips, Evan; Bruning, Rebecca; Liao, Chien-Sheng; Sturek, Michael; Goergen, Craig J.; Cheng, Ji-Xin

    2015-03-01

    Atherosclerotic plaque at the carotid bifurcation is the underlying cause of the majority of ischemic strokes. Noninvasive imaging and quantification of the compositional changes preceding gross anatomic changes within the arterial wall is essential for diagnosis of disease. Current imaging modalities such as duplex ultrasound, computed tomography, positron emission tomography are limited by the lack of compositional contrast and the detection of flow-limiting lesions. Although high-resolution magnetic resonance imaging has been developed to characterize atherosclerotic plaque composition, its accessibility for wide clinical use is limited. Here, we demonstrate a fiber-based multispectral photoacoustic tomography system for excitation of lipids and external acoustic detection of the generated ultrasound. Using sequential ultrasound imaging of ex vivo preparations we achieved ~2 cm imaging depth and chemical selectivity for assessment of human arterial plaques. A multivariate curve resolution alternating least squares analysis method was applied to resolve the major chemical components, including intravascular lipid, intramuscular fat, and blood. These results show the promise of detecting carotid plaque in vivo through esophageal fiber-optic excitation of lipids and external acoustic detection of the generated ultrasound. This imaging system has great potential for serving as a point-ofcare device for early diagnosis of carotid artery disease in the clinic.

  4. Selection of treatment for patients with carotid artery disease: medication, carotid endarterectomy, or carotid artery stenting.

    PubMed

    Bosiers, Marc; Peeters, Patrick; Deloose, Koen; Verbist, Jürgen; Sprouse, Richard L

    2005-01-01

    Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case. This algorithm was then employed to determine therapy in 308 consecutive patients presenting to a single institution during one calendar year. Ninety-five (30.8%) patients presented with an asymptomatic carotid stenosis of more than 80% and 213 (69.2%) with a symptomatic stenosis of more than 50%. According to our algorithm, 59 (62.1%) of the 95 asymptomatic patients received CAS, 20 (21.1%) received CEA, and 16 (16.8%) received medical therapy. All symptomatic patients underwent intervention; 153 (71.8%) were treated with CAS and 60 (28.2%) with CEA. Combined 30-day stroke and death rates after CAS were 1.7% in asymptomatic patients and 2.6% in symptomatic patients. After CEA, these rates were 0% and 3.3%, respectively. Careful selection of treatment modality according to predetermined criteria can result in improved outcomes.

  5. Effects of carotid endarterectomy and carotid artery stenting on high-risk carotid stenosis patients.

    PubMed

    Wang, Peifu; Liang, Chunyang; Du, Jichen; Li, Jilai

    2013-11-01

    To analyze the clinical effects and safety of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in the treatment of high-risk carotid stenosis patients. Total 63 patients who underwent CEA or CAS in our hospitals from January 2007 to December 2012 were selected in this study, and were randomly divided into an observation group and a control group. The patients in the observation group were subjected to CAS and those in the control group were subjected to CEA to compare the primary and secondary endpoints of the treatment. The arrival rates of the primary and secondary endpoints were 7.14% and 10.71% respectively in the observation group, while those were 11.43% and 11.43% respectively in the control group. There were no significant differences in the arrival rates of primary and secondary endpoints between the two groups (P>0.05). The efficacies and safety of CAS and CEA are similar in treating high-risk carotid stenosis patients.

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

    PubMed

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

    2015-10-01

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

  7. Multimodal optoacoustic and multiphoton microscopy of human carotid atheroma.

    PubMed

    Seeger, Markus; Karlas, Angelos; Soliman, Dominik; Pelisek, Jaroslav; Ntziachristos, Vasilis

    2016-09-01

    Carotid artery atherosclerosis is a main cause of stroke. Understanding atherosclerosis biology is critical in the development of targeted prevention and treatment strategies. Consequently, there is demand for advanced tools investigating atheroma pathology. We consider hybrid optoacoustic and multiphoton microscopy for the integrated and complementary interrogation of plaque tissue constituents and their mutual interactions. Herein, we visualize human carotid plaque using a hybrid multimodal imaging system that combines optical resolution optoacoustic (photoacoustic) microscopy, second and third harmonic generation microscopy, and two-photon excitation fluorescence microscopy. Our data suggest more comprehensive insights in the pathophysiology of atheroma formation and destabilization, by enabling congruent visualization of structural and biological features critical for the atherosclerotic process and its acute complications, such as red blood cells and collagen.

  8. Carotid endarterectomy and carotid artery stenting utilization trends over time.

    PubMed

    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 < 0.0001). Throughout the study period, endarterectomy was the much more widely employed procedure. Its use displayed a significant downward trend (P < 0.0001), with the lowest rates of intervention occurring in 2007. In contrast, carotid artery stenting displayed a significant increase in use over the study period (P < 0.0001), with the highest intervention rates occurring in 2006. Among the specific patient factors analyzed that may have altered utilization of CEA and CAS over time, the proportion of white patients who received intervention decreased significantly (P < 0.0001). In multivariate modeling, increased age, male 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

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

    PubMed

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

    2011-02-01

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

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

    PubMed

    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.

  11. Recanalization of acute carotid stent occlusion using Penumbra 4Max aspiration catheter: technical report and review of rescue strategies for acute carotid stent occlusion.

    PubMed

    Munich, Stephan; Moftakhar, Roham; Lopes, Demetrius

    2013-10-14

    Carotid artery stenting (CAS) has become a widely used treatment for carotid artery stenosis, especially in high-risk patients. Acute in-stent and distal protection device occlusion are potentially catastrophic complications of this procedure. Previously described rescue strategies have included administration of antiplatelet agents (eg, abciximab) with/without thrombolytics and removal of the filter. Here we describe the successful resolution of in-stent occlusion by mechanical thrombolysis using the Penumbra 4Max aspiration catheter. Distal flow was subsequently restored with minimal residual stenosis. The patient did not suffer any consequent neurological deficits. The different strategies that could be used in this critical situation are reviewed.

  12. Carotid and Vagal Body Paragangliomas

    PubMed Central

    del Guercio, Luca; Narese, Donatella; Ferrara, Doriana; Butrico, Lucia; Padricelli, Andrea; Porcellini, Massimo

    Between 1972 and 2012, 25 patients presenting 32 paragangliomas of the neck were observed. Tumor locations included the carotid body (CBTs) in 21 patients and the vagus nerve in 4. Four patients had bilateral CBT and one a bilateral vagal tumor; a metachronous bilateral jugulare paraganglioma was diagnosed in one patient with bilateral CBT Shamblin type III. Five patients presented CBTs type II and three type III. Preoperative embolization was performed in 5 CBTs, with no significant difference in blood loss. Twenty-nine paragangliomas were resected (with three internal carotid artery resection): there were no cerebrovascular accident or perioperative death. Nine patients (36%) had cranial nerve palsy prior to surgery and a postoperative nerve dysfunction occurred in four other tumors (16%). Persistent nerve deficits occurred in 3 patients (12%). No evidence of malignancy was shown, intraoperatively or during a postoperative follow-up period (9 months to 18 years; mean: 8 years). PMID:24251239

  13. Advantages of Selective Use of Intraluminal Shunt in Carotid Endarterectomy: A Study of 122 Cases

    PubMed Central

    Usman, Rashid; Ghaffar, Salma

    2016-01-01

    Objectives: To assess the advantage of selective use of shunt in carotid endarterectomy (CEA) under local anesthesia. Materials and Methods: A total of 122 consecutive patients fulfilling international guidelines were included. Shunt was used selectively only in cases of bilateral severe carotid artery occlusive disease or in those patients who developed neurological symptoms on clamping of carotid artery. Follow up was done weekly for one month; then every month for 3 months; and then every 3 months for a year. Results: Shunt was used only in 5% (n = 6) patients. Of these, 2.5% (n = 3) patients were those who developed neurological symptoms on clamping the internal carotid and deployment of shunt resulted in complete resolution of symptoms. 2.5% (n = 3) had severe bilateral carotid stenosis and shunt was deployed. One of these patients developed stroke which was permanent. There was no mortality. The mean procedure time was 170 min in patients in whom shunt was used, when compared with 100 min in patients without shunt (P = 0.003). Conclusion: Use of shunt in carotid endarterectomy under local anesthesia as selective policy has an advantage in terms of cost effectiveness, operation time and prevention of potential complications. PMID:28018499

  14. What Are the Signs and Symptoms of Carotid Artery Disease?

    MedlinePlus

    ... What Are the Signs and Symptoms of Carotid Artery Disease? Carotid artery disease may not cause signs or symptoms until it severely narrows or blocks a carotid artery. Signs and symptoms may include a bruit, a ...

  15. Headache after carotid artery stenting.

    PubMed

    Suller Marti, A; Bellosta Diago, E; Velázquez Benito, A; Tejero Juste, C; Santos Lasaosa, S

    2017-04-18

    Headache after carotid artery stenting is a headache with onset during the procedure or in the first few hours after it, and where there is no evidence to suggest a complication of that procedure. The purpose of this study is to describe the main features of these headaches based on our clinical experience. Observational prospective study of a sample of patients undergoing carotid artery stenting at Hospital Clínico Universitario Lozano Blesa, in Zaragoza, Spain. We recorded sociodemographic characteristics, cardiovascular risk factors, carotid artery disease, and history of primary headache; data were gathered using structured interviews completed before and 24hours after the procedure. We included 56 patients (mean age 67±9.52 years); 84% were men. Twelve patients (21.4%) experienced headache, 83.3% of whom were men; mean age was 60.58±9.31 years. Headache appeared within the first 6hours in 7 patients (58.4%) and during the procedure in 4 (33.3%). Pain lasted less than 10minutes in 4 patients (33.3%) and between 10 and 120minutes in 5 (41.7%). Headache affected the frontotemporal area in 7 patients (58.3%); 7 patients (58.3%) described pain as unilateral. It was oppressive in 8 patients (66.7%) and of moderate intensity in 6 (50%). Nine patients (75%) required no analgesics. We found no statistically significant associations with any of the variables except for age (P=.007; t test). In our sample, headache after carotid artery stenting was mild to moderate in intensity, unilateral, oppressive, and short-lasting. Further studies are necessary to gain a deeper knowledge of its characteristics and associated risk factors. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Carotid endarterectomy: current consensus and controversies.

    PubMed

    Meerwaldt, Robbert; Hermus, Linda; Reijnen, Michel M P J; Zeebregts, Clark J

    2010-10-01

    Stroke is the third most common cause of mortality, and carotid artery stenosis causes 8% to 29% of all ischemic strokes. Best medical treatment forms the basis of carotid stenosis treatment, and carotid endarterectomy (CEA) has an additional beneficial effect in high-grade stenosis. Carotid angioplasty and stenting (CAS) has challenged CEA as a primary carotid intervention. At present, CEA remains the gold standard, but in the future, CAS techniques will evolve and might become beneficial for subgroups of patients with carotid stenosis. This chapter briefly describes the history of carotid interventions and current consensus and controversies in CEA. In the last two years, several meta-analyses were published on a variety of aspects of best medical treatment, CEA, and CAS. It is still a matter of debate as to whether asymptomatic patients with carotid stenosis should undergo a carotid intervention. Especially because medical treatment has dramatically evolved since the early carotid trials. On the other hand, it is clear that carotid interventions in symptomatic patients with a high-grade stenosis should be performed as early as possible after the initial neurological event in order to achieve optimal stroke risk reduction. In CEA, the use of patching is advocated above primary closure, while the role of selective patching is still unclear. No differences in stroke and mortality rates are observed for routine versus selective shunting, for conventional versus eversion CEA, or for local versus general anesthesia. It is anticipated that in the future, there will be several interesting developments in carotid interventions such as plaque morphology analysis, acute interventions during stroke in progress, and further evolvement of CAS techniques.

  17. Carotid artery stenting: current and emerging options

    PubMed Central

    Morr, Simon; Lin, Ning; Siddiqui, Adnan H

    2014-01-01

    Carotid artery stenting technologies are rapidly evolving. Options for endovascular surgeons and interventionists who treat occlusive carotid disease continue to expand. We here present an update and overview of carotid stenting devices. Evidence supporting carotid stenting includes randomized controlled trials that compare endovascular stenting to open surgical endarterectomy. Carotid technologies addressed include the carotid stents themselves as well as adjunct neuroprotective devices. Aspects of stent technology include bare-metal versus covered stents, stent tapering, and free-cell area. Drug-eluting and cutting balloon indications are described. Embolization protection options and new direct carotid access strategies are reviewed. Adjunct technologies, such as intravascular ultrasound imaging and risk stratification algorithms, are discussed. Bare-metal and covered stents provide unique advantages and disadvantages. Stent tapering may allow for a more fitted contour to the caliber decrement between the common carotid and internal carotid arteries but also introduces new technical challenges. Studies regarding free-cell area are conflicting with respect to benefits and associated risk; clinical relevance of associated adverse effects associated with either type is unclear. Embolization protection strategies include distal filter protection and flow reversal. Though flow reversal was initially met with some skepticism, it has gained wider acceptance and may provide the advantage of not crossing the carotid lesion before protection is established. New direct carotid access techniques address difficult anatomy and incorporate sophisticated flow-reversal embolization protection techniques. Carotid stenting is a new and exciting field with rapidly advancing technologies. Embolization protection, low-risk deployment, and lesion assessment and stratification are active areas of research. Ample room remains for further innovations and developments. PMID:25349483

  18. Carotid Stenosis and Ocular Blood Pressure Modelling

    PubMed Central

    Jullian, M.; Kinsner, W.

    1984-01-01

    A model of the human carotid vascular system was developed to study the effects of carotid stenosis on ocular blood pressure and ocular pulse waveform. The model incorporates a non-linear element representing a stenosis. A state variable representation of a reduced model is used in a computer simulation. Results show that carotid stenosis as low as 20% are detectable in the ocular blood pressure waveform.

  19. Quantification of carotid vessel atherosclerosis

    NASA Astrophysics Data System (ADS)

    Chiu, Bernard; Egger, Micaela; Spence, J. D.; Parraga, Grace; Fenster, Aaron

    2006-03-01

    Atherosclerosis is characterized by the development of plaques in the arterial wall, which ultimately leads to heart attacks and stroke. 3D ultrasound (US) has been used to screen patients' carotid arteries. Plaque measurements obtained from these images may aid in the management and monitoring of patients, and in evaluating the effect of new treatment options. Different types of measures for ultrasound phenotypes of atherosclerosis have been proposed. Here, we report on the development and application of a method used to analyze changes in carotid plaque morphology from 3D US images obtained at two different time points. We evaluated our technique using manual segmentations of the wall and lumen of the carotid artery from images acquired in two US scanning sessions. To incorporate the effect of intraobserver variability in our evaluation, manual segmentation was performed five times each for the arterial wall and lumen. From this set of five segmentations, the mean wall and lumen surfaces were reconstructed, with the standard deviation at each point mapped onto the surfaces. A correspondence map between the mean wall and lumen surfaces was then established, and the thickness of the atherosclerotic plaque at each point in the vessel was estimated to be the distance between each correspondence pairs. The two-sample Student's t-test was used to judge whether the difference between the thickness values at each pair corresponding points of the arteries in the two 3D US images was statistically significant.

  20. Endothelial Function and Carotid Intimal Medial Thickness in Asymptomatic Subjects With and Without Cardiovascular Risk Factors

    PubMed Central

    Ananthakrishna, Rajiv; Shankarappa, Ravindranath K; Rangan, Kapil; Chandrasekaran, Dhanalakshmi; Nanjappa, Manjunath C

    2012-01-01

    Background The study was performed to assess endothelial function and carotid intimal-medial thickness (IMT) in asymptomatic patients, with and without risk factors for cardiovascular disease. Methods A cross sectional survey of asymptomatic patients, aged 21 - 60 years, with and without risk factors for cardiovascular disease was recruited from the outpatient department of Cardiology. Endothelial function was evaluated by flow mediated dilatation (FMD) of the brachial artery and carotid IMT was determined using a high resolution B mode ultrasonography system. Results A total of 104 patients were included in the study. The mean carotid IMT was 0.67 ± 0.05 mm in the group without risk factors and 0.78 ± 0.12 mm in the group with risk factors (P value < 0.05). Endothelial dysfunction (ED) and increased carotid IMT were more significant in the group with risk factors (P value < 0.001). Age, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, blood pressure, body mass index and HbA1c had a significant correlation with both IMT and FMD response. A higher proportion of subjects with diabetes mellitus (87%), metabolic syndrome (86%) and family history of premature coronary artery disease (78%) had ED. In subjects with normal coronary angiogram, 71% had abnormal FMD response and 36% had increased carotid IMT. Conclusion In asymptomatic subjects, risk factors for cardiovascular disease are significantly associated with objective evidence of ED and increased carotid IMT. FMD response and carotid IMT values are likely to yield additional information beyond traditional risk factors for classifying patients in regard to the likelihood of cardiovascular event. Therapeutic measures with the aim of improving endothelial function and reducing carotid IMT may reduce the burden of cardiovascular disease.

  1. Carotid Stump Syndrome: Pathophysiology and Endovascular Treatment Options

    SciTech Connect

    Lakshminarayan, Raghuram; Scott, Paul M.; Robinson, Graham J.; Ettles, Duncan F.

    2011-02-15

    Carotid stump syndrome is one of the recognised causes of recurrent ipsilateral cerebrovascular events after occlusion of the internal carotid artery. It is believed that microemboli arising from the stump of the occluded internal carotid artery or the ipsilateral external carotid artery can pass into the middle cerebral artery circulation as a result of patent external carotid-internal carotid anastomotic channels. Different pathophysiologic causes of this syndrome and endovascular options for treatment are discussed.

  2. Endarterectomy for a symptomatic carotid web.

    PubMed

    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.

  3. High-resolution black-blood contrast-enhanced T1 weighted images for the diagnosis and follow-up of intracranial arteritis

    PubMed Central

    Saam, T; Habs, M; Pollatos, O; Cyran, C; Pfefferkorn, T; Dichgans, M; Dietrich, O; Glaser, C; Reiser, M F; Nikolauo, K

    2010-01-01

    Primary arteritis of the central nervous system (CNS) comprises a heterogeneous group of CNS disorders, which is characterised by non-atheromatous inflammation and necrosis of the arterial wall. The clinical presentation is highly variable, with stroke being the most common manifestation. Conventional angiography is considered to be the best imaging tool for diagnosing the disease. However, angiographic findings, which usually show lumen irregularities and stenosis, are often unspecific and can occur with a variety of other vascular disorders, such as atherosclerosis and arterial dissection. Therefore, brain biopsies are often needed to confirm the diagnosis. Recent reports have shown that MRI is able to visualise contrast enhancement in subjects with known primary CNS arteritis. PMID:20739338

  4. Habitual fish intake and clinically silent carotid atherosclerosis

    PubMed Central

    2014-01-01

    Background Fish consumption is recommended as part of a healthy diet. However, there is a paucity of data concerning the relation between fish consumption and carotid atherosclerosis. We investigated the association between habitual fish consumption and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness (≥ 0.90 mm), in non-diabetic participants. Methods Nine hundred-sixty-one (range of age: 18–89 yrs; 37.1% males) adult participants without clinically known atherosclerotic disease were randomly recruited among the customers of a shopping mall in Palermo, Italy, and cross-sectionally investigated. Each participant answered a food frequency questionnaire and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Routine laboratory blood measurements were obtained in a subsample of 507 participants. Results Based on habitual fish consumption, participants were divided into three groups: non-consumers or consumers of less than 1 serving a week (24.0%), consumers of 1 serving a week (38.8%), and consumers of ≥ 2 servings a week (37.2%). Age-adjusted prevalence of carotid atherosclerosis (presence of plaques or intima media thickness ≥ 0.9 mm) was higher in the low fish consumption group (13.3%, 12.1% and 6.6%, respectively; P = 0.003). Multivariate analysis evidenced that carotid atherosclerosis was significantly associated with age (OR = 1.12; 95% CI = 1.09-1.14), hypertension on pharmacologic treatment (OR = 1.81; 95% CI = 1.16-2.82), and pulse pressure (OR = 1.03; 95% CI = 1.01-1.04), while consuming ≥2 servings of fish weekly was protective compared with the condition of consumption of <1 serving of fish weekly (OR = 0.46; 95% CI = 0.26-0.80). Conclusions High habitual fish consumption seems to be associated with less carotid atherosclerosis, though adequate interventional trials are necessary to confirm the role of fish

  5. Management of carotid near-occlusion and acute carotid occlusion.

    PubMed

    Fisch, Loraine; Brown, Martin M

    2016-04-01

    As a stenosis becomes more severe, blood flow through it increases in velocity to maintain volume, flow and pressure. But there is a critical point beyond which further increase in stenosis no longer allows sufficient blood to pass through to maintain volumetric flow, and the carotid artery beyond the stenosis begins to decrease in diameter. This is the near occlusion. To maintain a sufficient blood flow in affected area, there is a progressive recruitment of collaterals followed by an activation of cerebral autoregulation with dilatation of resistance vessels. When this process fails to maintain normal cerebral blood flow, oxygen extraction fraction of the affected brain tissue increases to maintain normal cerebral metabolism. Near occlusion has been described as involving 1 to 10% of all severe stenosis, but the potential for stroke from such critical stenosis is less than its appearance would suggest. The optimum management of near-occlusion therefore remains a matter of debate. Although endarterectomy for carotid stenosis of 70-99% was associated with an absolute risk reduction in any stroke or death of 16% in the original randomized trials, the benefit was less in patients with near-occlusion. In 2015, a meta-analysis focused on patients with near-occlusion confirmed only a small benefit of carotid endarterectomy or stenting compared to medical treatment in patients with near occlusion. In patients with near-occlusion and compromised hemodynamics, revascularization should improve cerebral blood flow and consequently prevent ischemic stroke. Nevertheless the effect of improved cerebral hemodynamics after revascularization on prevention of ischemic stroke is uncertain.

  6. Artificial embolization of carotid-cavernous fistula with post-operative patency of internal carotid artery

    PubMed Central

    Isamat, Fabian; Salleras, V.; Miranda, A. M.

    1970-01-01

    This report deals with a patient of 86 who developed a carotid-cavernous fistula. Artificial embolization alone was considered the safest treatment for this patient and proved to be adequate. Post-operative preservation of the patency of the internal carotid artery was demonstrated by angiography. We believe this method is particularly appropriate for carotid-cavernous fistulas if it is demonstrated by angiography that the major blood flow of the carotid artery pours into the fistula. A soft-iron clip attached to the muscle can be used for external and forceful guidance of the embolus into the fistula with the help of an electromagnet, hence the patency of the internal carotid artery can be preserved. The embolus should be introduced through the external carotid artery. This is the only case known to us in which patency of the internal carotid artery was post-operatively maintained. We have reviewed 545 reported cases of surgically treated carotid-cavernous fistulas and analysed the results from simple cervical carotid ligation to the more sophisticated methods of artificial embolizations. The results obtained by artificial embolization have been consistently good, while the other techniques have failed in large percentages. Artificial embolization should be used as the primary treatment for carotid-cavernous fistula, since ligation of the internal carotid artery precludes its embolization at a later date. Images PMID:5478949

  7. Feasibility of carotid artery PET/MRI in psoriasis patients

    PubMed Central

    Rajiah, Prabhakar; Hojjati, Mojgan; Lu, Ziang; Kosaraju, Vijaya; Partovi, Sasan; O’Donnell, James K; Longenecker, Christopher; McComsey, Grace A; Golden, Jackelyn B; Muakkassa, Fuad; Santilli, Scott; McCormick, Thomas S; Cooper, Kevin D; Korman, Neil J

    2016-01-01

    We report our initial experience of performing integrated PET/MR imaging of the carotid arteries in psoriatic patients. Eleven patients with psoriasis and ten controls underwent carotid PET/MRI. Following injection of the FDG tracer, 3d T1w gradient echo sequence (atMR) was obtained for attenuation correction of PET data. High resolution images of carotid artery were then obtained, including pre-and post-contrast T1-w, T2-w and proton-density images as well as TOF images followed by PET imaging of the torso. From the fused axial PET/MRI, the arterial wall SUVmax and TBRmax was quantified in each slice. MRI images were also evaluated for vessel wall volume, plaque and internal composition. SUVmax and TBRmax were respectively, 1.72 ± 0.38 & 1.17 ± 0.27 in L- CCA, 1.75 ± 0.39 & 1.24 ± 0.19 in R-CCA, 1.59 ± 0.24 & 1.08 ± 0.14 in L-ICA and 1.62 ± 0.27 & 1.15 ± 0.17 in R-ICA in psoriatic patients and 1.74 ± 0.22 & 1.28 ± 0.44 in L- CCA, 1.74 ± 0.33 & 1.07 ± 0.28 in R-CCA, 1.78 ± 0.32 & 1.29 ± 0.39 in L-ICA and 1.60 ± 0.29 & 0.98 ± 0.25 in R-ICA in the controls. No discrete plaques were identified in any of the vessel segments in MRI. PET/MRI is feasible in evaluation of carotid arteries in psoriatic patients. PMID:27648374

  8. The contralateral carotid disease in patients with internal carotid artery occlusion.

    PubMed

    Lovrencić-Huzjan, Arijana; Strineka, Maja; Aiman, Drazen; Strbe, Sanja; Sodec-Simicević, Darja; Demarin, Vida

    2009-09-01

    The one-year incidence of carotid occlusion is 6/100 000 inhabitants in general population. Stroke incidence and mortality rate in these patients vary. Patients that underwent carotid endarterectomy (CES) are at a higher risk of progression of contralateral carotid stenosis. The aim of the study was to investigate the management and natural history of the contralateral internal carotid artery disease in patients with internal carotid artery occlusion (ICAO). During one year, 297 patients with ICAO were investigated. Follow up examinations were retrospectively analyzed and patients were divided into groups according to contralateral carotid disease. Out of 297 patients, only one investigation was performed in 90 patients with carotid occlusion. Thirty three patients were followed up due to postoperative ICAO. In 14 patients, ICAO developed during ultrasonographic follow up. In this group of patients, 9 had unchanged contralateral findings, whereas in 5 patients disease progression was observed. Out of 44 patients with ICAO and contralateral subtotal stenosis at initial investigation, 42 underwent carotid surgery. Postoperatively, 32 patients had normal findings, 6 developed mild carotid stenosis, 2 developed moderate carotid stenosis, and 2 had postoperative carotid occlusion. Two patients were followed-up without intervention. Nine patients with bilateral ICAO were followed-up for years. Follow up was continued in 106 patients with ICAO and contralateral mild to moderate changes. The finding was unchanged in 68 patients. In 21 (30%) patients the disease progressed to subtotal stenosis and 18 patients underwent carotid surgery. Accordingly, contralateral carotid disease progression was observed in one third of patients with carotid occlusion. Additional studies on the issue are needed.

  9. Carotid revascularization and medical management for asymptomatic carotid stenosis: Protocol of the CREST-2 clinical trials.

    PubMed

    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 <70 mg/dl and systolic blood pressure <140 mmHg. Study outcomes The primary outcome is the composite of stroke and death within 44 days following randomization and stroke ipsilateral to the target vessel thereafter, up to four years. Change in cognition and differences in major and minor stroke are secondary outcomes. Sample size Enrollment of 1240 patients in each trial provides 85% power to detect a treatment difference if the event rate in the intensive 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

  10. Monitoring of hemodynamic change in patients with carotid artery stenosis during the tilt test using wearable near-infrared spectroscopy.

    PubMed

    Igarashi, Takahiro; Sakatani, Kaoru; Fujiwara, Norio; Murata, Yoshihiro; Suma, Takeshi; Shibuya, Tadashi; Hirayama, Teruyasu; Katayama, Yoichi

    2013-01-01

    Transient ischemic attack (TIA) is a major complication in patients with carotid artery stenosis. Patients with severe stenosis sometimes complain of orthostatic dizziness, such as syncope. The purpose of this study was to examine the usefulness of near-infrared spectroscopy (NIRS) for evaluating cerebral circulation in patients with carotid artery stenosis during head-up tilt test (HUTT). Fourteen patients with carotid artery stenosis and nine normal control subjects participated. In addition to blood pressure monitoring, hemoglobin (Hb) values (oxy-Hb, deoxy-Hb, and total Hb) were recorded by a wearable NIRS instrument with a high time resolution during HUTT. Oxy-Hb, which decreased initially when the test table was elevated, subsequently increased in normal volunteers and patients with carotid artery stenosis and did not differ significantly between the two groups. However, the oxy-Hb reduction in the carotid artery stenosis group (-0.02 ± 0.03 a.u.) at 30 s after elevation of the table was significantly larger than in the normal group (0.02 ± 0.02 a.u., P < 0.01). Our results indicate that oxy-Hb reduction in patients with carotid artery stenosis may be related to orthostatic dizziness. We concluded that NIRS monitoring is useful for evaluating cerebral autoregulation in patients with severe carotid artery stenosis.

  11. Carotid Intima Media Thickness as a Reflection of Generalized Atherosclerosis is Related to Body Mass Index in Ischemic Stroke Patients.

    PubMed

    Singh, Amit Shankar; Atam, Virendra; Patel, Munna Lal; Chaudhary, Shyam Chand; Sawlani, Kamal Kumar; Das, Liza

    2013-03-01

    Carotid artery intima media thickness reflects the ongoing process of atherosclerosis in the body. The pathologic process occurring in the obese patients in the vascular system is atherosclerosis which is an important cause of ischemic stroke. Body mass index is an indirect measure of obesity in general population. The study was to assess the role of carotid artery intima media thickness as a marker of atherosclerosis and its relation with body mass index in ischemic stroke patients. Body mass index of the all stroke patients was calculated by using formula body mass in kilograms divided by the square of height in meters. The patients were classified in four groups of body mass index according to Indian standards. Carotid sonography was done to assess the common carotid artery intima media thickness in millimeters by using high resolution 7.5 MHz sonography technique. The average Carotid intima media thickness in this study was 9.23mm. There was a significant association found between increasing carotid artery intima media thickness and groups of body mass index (P- <0.05) in ischemic stroke patients. Body mass index as an indicator of obesity and carotid intima media thickness both are very important risk factors for ischemic stroke and are associated with each other.

  12. Myocardial hypertrophy induces carotid body hyperplasia.

    PubMed

    Sivridis, Efthimios; Pavlidis, Pavlos; Fiska, Aliki; Pitsiava, Dimitra; Giatromanolaki, Alexandra

    2011-01-01

    The carotid bodies tend to enlarge after long-standing cardiopulmonary disease. Our objective was to investigate whether cardiac hypertrophy is associated with carotid body hyperplasia. Fifteen autopsy cases with combined left and right ventricular hypertrophy were examined and compared with two control groups (16 cases). The study involved a meticulous dissection of carotid bifurcations, thin serial sections, and morphometric analysis of carotid body volume and cell types (progenitor, dark, light, and sustentacular). There was a significant increase in sustentacular cells in all individuals with cardiac hypertrophy, which was not drug-induced, and accompanied by a similar increase in carotid body volume. Dark or light cell accumulation was detected focally and only in three instances. It appears that the generalized sustentacular cell hyperplasia is the result of long-standing hypoxia, while a superimposed focal prominence of dark or light cells may be proliferative or metaplastic in nature and attributed to short-term hypoxia.

  13. Carotid Endarterectomy at the Millennium

    PubMed Central

    LaMuraglia, Glenn M.; Brewster, David C.; Moncure, Ashby C.; Dorer, David J.; Stoner, Michael C.; Trehan, Samir K.; Drummond, Elizabeth C.; Abbott, William M.; Cambria, Richard P.

    2004-01-01

    Objectives: Carotid endarterectomy (CEA) is supported by level 1 evidence as the standard treatment of severe carotid stenosis in both symptomatic and asymptomatic patients. As interventional techniques are emerging for treatment of this disease, this study was undertaken to provide a contemporary surgical standard for comparison to carotid stenting. Patients and methods: During the interval 1989 to 1999, 2236 isolated CEAs were performed on 1897 patients (62% male, 36% symptomatic, 4.6% reoperative procedures). Study endpoints included perioperative events, patient survival, late incidence of stroke, anatomic durability of CEA, and resource utilization changes during the study. Variables associated with complications, long-term and stroke free survival, restenosis, and resource utilization were analyzed by univariate and multivariate analysis. Results: Perioperative complications occurred in 5.5% of CEA procedures, including any stroke/death (1.4%), neck hematoma (1.7%), cardiac complications (0.5%), and cranial nerve injury (0.4%). Actuarial survival at 5 and 10 years was 72.4% (95% confidence interval [CI] 69.3-73.5) and 44.7% (95% CI 41.7-47.9) respectively, with coronary artery disease (P < 0.0018), chronic obstructive pulmonary disease (P < 0.00018) and diabetes mellitus (P < 0.0011) correlating with decreased longevity. The age- and sex-adjusted incidence of any stroke during follow-up was reduced by 22% (upper 0.35, lower 0.08) of predicted with the patient classification of hyperlipidemia (P < 0.0045) as the only protective factor. Analysis of CEA anatomic durability during a median follow-up period of 5.9 years identified a 7.7% failure rate (severe restenosis/occlusion, 4.5%; or reoperative CEA, 3.2%) with elevated serum cholesterol (P < 0.017) correlating with early restenosis. Resource utilization diminished (first versus last 2-year interval periods) for average hospital length of stay from 10.3 ± 1.5 days to 4.3 ± 0.7 days (P < 0.01) and

  14. Carotid Vascular Abnormalities in Primary Hyperparathyroidism

    PubMed Central

    Walker, M. D.; Fleischer, J.; Rundek, T.; McMahon, D. J.; Homma, S.; Sacco, R.; Silverberg, S. J.

    2009-01-01

    Context: Data on the presence, extent, and reversibility of cardiovascular disease in primary hyperparathyroidism (PHPT) are conflicting. Objective: This study evaluated carotid structure and function in PHPT patients compared with population-based controls. Design: This is a case-control study. Setting: The study was conducted in a university hospital metabolic bone disease unit. Participants: Forty-nine men and women with PHPT and 991 controls without PHPT were studied. Outcome Measures: We measured carotid intima-media thickness (IMT), carotid plaque presence and thickness, and carotid stiffness, strain, and distensibility. Results: IMT, carotid plaque thickness, carotid stiffness, and distensibility were abnormal in PHPT patients, and IMT was higher in patients than controls (0.959 vs. 0.907 mm, P < 0.0001). In PHPT, PTH levels, but not calcium concentration, predicted carotid stiffness (P = 0.04), strain (P = 0.06), and distensibility (P = 0.07). Patients with increased carotid stiffness had significantly higher PTH levels than did those with normal stiffness (141 ± 48 vs. 94.9 ± 44 pg/ml, P = 0.002), and odds of abnormal stiffness increased 1.91 (confidence interval = 1.09–3.35; P = 0.024) for every 10 pg/ml increase in PTH, adjusted for age, creatinine, and albumin-corrected calcium. Conclusions: Mild PHPT is associated with subclinical carotid vascular manifestations. IMT, a predictor of cardiovascular outcomes, is increased. Measures of carotid stiffness are associated with extent of PTH elevation, suggesting that those with more severe PHPT may have impaired vascular compliance and that PTH, rather than calcium, is the mediator. PMID:19755478

  15. [Aberrant internal carotid artery as a cause of pulsatile tinnitus: a difficult diagnosis in MRI?].

    PubMed

    Soyka, M B; Schuknecht, B; Huber, A M

    2010-02-01

    We present the case of a 43-year-old patient with sensorineural hearing loss and the finding of an aberrant internal carotid artery in the left tympanic cavity that was causing pulsatile tinnitus. The aberrant vessel was initially invisible on magnetic resonance imaging (MRI) and was confirmed by high-resolution computed tomography and MR angiography (MRA). Recognition of an aberrant course of an internal carotid artery often requires a combination of MRI and MRA to establish the diagnosis and rule out other differential diagnoses.

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

    PubMed Central

    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

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

    PubMed

    Hoiland, Ryan L; Smith, Kurt J; Carter, Howard H; Lewis, Nia C S; Tymko, Michael M; Wildfong, Kevin W; Bain, Anthony R; Green, Daniel J; Ainslie, Philip N

    2017-07-01

    Evidence for shear stress as a regulator of carotid artery dilation in response to increased arterial CO2 was recently demonstrated in humans during sustained elevations in CO2 (hypercapnia); however, the relative contributions of CO2 and shear stress to this response remains unclear. We examined the hypothesis that, after a 30-s transient increase in arterial CO2 tension and consequent increase in internal carotid artery shear stress, internal carotid artery diameter would increase, indicating shear-mediated dilation, in the absence of concurrent hypercapnia. In 27 healthy participants, partial 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 < 0.03). Increases in internal carotid artery shear stress preceded increases in diameter in both transient (time: 16.8 ± 13.2 vs. 59.4 ± 60.3 s, P < 0.01) and steady-state (time: 18.2 ± 14.2 vs. 110.3 ± 79.6 s, P < 0.01) tests. Internal carotid artery dilation was positively correlated with shear rate area under the curve in the transient (r(2) = 0.44, P < 0.01) but not steady-state (r(2) = 0.02, P = 0.53) trial. Collectively, these results suggest that hypercapnia induces shear-mediated dilation of the internal carotid artery in humans. This study further promotes the application and development of hypercapnia as a clinical strategy for the assessment of cerebrovascular vasodilatory function and health in humans.NEW & NOTEWORTHY Shear stress dilates the internal carotid artery in humans. This vasodilatory response occurs independent

  18. [Treatment of carotid cavernous fistulas].

    PubMed

    Solymosi, L

    2004-11-01

    The diagnosis and treatment of carotid cavernous fistulas (CCF) is an interdisciplinary challenge for both ophthalmologists and interventional neuroradiologists. According to the clinical signs and symptoms the tentative diagnosis is made by the ophthalmologist. It is the task of the neuroradiologist to ascertain this diagnosis by intra-arterial angiography. If a fistula is suspected this invasive diagnostic procedure is indispensable, not only to establish the diagnosis but also to classify those types of fistula with an unfavourable spontaneous course possibly resulting in intracranial haemorrhage. The indication for therapy is based on the clinical symptoms and the angiographic findings. In a number of cases no therapy is required. Since a fistula may change over time, these patients have to be under close ophthalmological surveillance. In many patients a conservative therapeutic approach with manual compression of the carotid artery is sufficient as a fIrst step. Invasive treatment is performed via the endovascular approach in almost all cases. Direct CCF are predominantly treated transarterially with detachable balloons and/or coils. Recently, intracranial stents have been used increasingly. The embolisation of indirect CCF is most effective using the transvenous access with coils. There are several approaches to the cavernous sinus. The interventional occlusion of CCF is nowadays a very effective treatment associated with a comparatively high cure rate and low incidence of complications. By close cooperation between ophthalmologists and neuroradiologists the patients can be protected against visual loss, the development of a secondary glaucoma, and, most importantly, against intracranial haemorrhage.

  19. The relationship between carotid intima-media thickness and carotid plaque in the Northern Manhattan Study.

    PubMed

    Rundek, Tatjana; Gardener, Hannah; Della-Morte, David; Dong, Chuanhui; Cabral, Digna; Tiozzo, Eduardo; Roberts, Eugene; Crisby, Milita; Cheung, Kuen; Demmer, Ryan; Elkind, Mitchell S V; Sacco, Ralph L; Desvarieux, Moise

    2015-08-01

    Carotid intima-media thickness (cIMT) and carotid plaque (CP) are proposed biomarkers of subclinical atherosclerosis associated with stroke risk. Whether cIMT and CP are distinct phenotypes or single traits at different stages of atherosclerotic development is unclear. We explored the relationship between these markers in the population-based Northern Manhattan Study. We used high-resolution ultrasound and validated imaging protocols to study the cross-sectional (N = 1788 stroke-free participants) and prospective relationship (N = 768 with follow-up scan; mean years between examinations = 3.5) between CP and cIMT measured in plaque-free areas. The mean age was 66 ± 9 (40% male, 19% black, 17% white, 61% Hispanic). The mean baseline cIMT was 0.92 ± 0.09 mm, 0.94 ± 0.09 mm among the 58% with prevalent plaque, 0.90 ± 0.08 mm among the 42% without prevalent plaque (p < 0.0001). Each 0.1 mm increase in baseline cIMT was associated with a 1.72-fold increased odds of plaque presence (95%CI = 1.50-1.97), increased plaque thickness (effect on the median = 0.46 mm, p < 0.0001), and increased plaque area (effect on the median = 3.45 mm(2), p < 0.0001), adjusting for demographics and vascular risk factors. Elevated baseline cIMT was associated with an increased risk of new plaque in any location at follow-up, but after adjusting for demographics and vascular risk factors this association was no longer present. No association was observed in carotid segment-specific analyses. Increased cIMT was associated with baseline prevalent plaque but did not predict incident plaque independent of other vascular risk factors. This finding suggests that increased cIMT is not an independent predictor of plaque development although these atherosclerotic phenotypes often coexist and share some common vascular determinants. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Increased carotid artery intima-media thickness may be associated with stroke in primary antiphospholipid syndrome

    PubMed Central

    Medina, G; Casaos, D; Jara, L; Vera-Lastra, O; Fuentes, M; Barile, L; Salas, M

    2003-01-01

    Objective: To investigate the prevalence and clinical significance of carotid artery intima-media thickness (IMT) in patients with primary antiphospholipid syndrome (APS). Methods: 28 patients with primary APS with at least a five year follow up, and 28 healthy subjects, matched by age and sex, were included in the study. Colour Doppler with high resolution B mode carotid ultrasonography and spectral analysis were performed in patients and controls. Information on cardiovascular risk factors and the clinical course were collected. Results: The mean (SD) age of patients and controls (12 male, 16 female in each group) was 40 (8.5) years; the mean (SD) disease duration 7.7 (3) years. Carotid artery IMT was found in 23/28 patients (2.6 (1.14) mm) and 7/28 controls (1.2 (0.44)) (p=0.0001). A decrease in the lumen diameter was also found in 11/28 patients with primary APS without carotid atherosclerotic plaque, and 2/28 controls (p=0.004). Hyperlipidaemia, diabetes, smoking, obesity, and hypertension were not associated with carotid artery IMT. Patients with carotid artery IMT had arterial vascular disease more often than patients without: 9/23 v 0/5 (p<0.009). These patients had stroke (seven patients), myocardial infarction (one), and mesenteric thrombosis (one). Subjects with IMT had a threefold higher risk for stroke than those without IMT (95% CI 0.78 to 14.3). Conclusions: Patients with primary APS have a high prevalence of carotid artery IMT and a decreased lumen diameter. IMT in primary APS may be associated with stroke. Patients with primary APS with IMT must be considered as carriers of atherosclerosis. PMID:12810420

  1. Carotid extra-medial thickness in childhood: early life effects on the arterial adventitia.

    PubMed

    Skilton, Michael R; Sullivan, Tim R; Ayer, Julian G; Harmer, Jason A; Toelle, Brett G; Webb, Karen; Marks, Guy B; Celermajer, David S

    2012-06-01

    Structural modification of the arterial adventitia may be an early event in atherosclerosis. Carotid extra-medial thickness is a new measure of arterial adventitial thickness. We examined the association of cardiovascular risk factors with extra-medial thickness, in childhood. Carotid extra-medial thickness was assessed by high-resolution ultrasound in 389 non-diabetic children aged 8-years. A non-fasting blood sample was collected from 314 participants. Associations of gender, age, lipoproteins, blood pressure, BMI z-score, waist:height ratio and parental history of early vascular disease, with extra-medial thickness were examined. Carotid extra-medial thickness was lower in girls (r=-.163, P=.001) and directly associated with systolic (r=.128, P=.009), diastolic blood pressure (r=.130, P=.009), and height (r=.170, P=.0006). These associations remained after adjustment for carotid intima-media thickness. In multivariable analysis including carotid intima-media thickness, only gender and height were significantly associated with carotid extra-medial thickness. In gender-stratified analysis, the strongest associations with extra-medial thickness were BMI z-score (r=.181, P=.01), height (r=.210, P=.003) and diastolic blood pressure (r=.167, P=.02) for boys; and systolic blood pressure (r=.153, P=.03) and parental history of premature cardiovascular disease (r=.139, P=.05) for girls. The association of BMI z-score with extra-medial thickness differed by gender (P-interaction=.04). Carotid extra-medial thickness is independently associated with gender and height in childhood. Extra-medial thickness may provide important information concerning early arterial health, particularly related to the arterial adventitia. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  2. 3D reconstruction of a carotid bifurcation from 2D transversal ultrasound images.

    PubMed

    Yeom, Eunseop; Nam, Kweon-Ho; Jin, Changzhu; Paeng, Dong-Guk; Lee, Sang-Joon

    2014-12-01

    Visualizing and analyzing the morphological structure of carotid bifurcations are important for understanding the etiology of carotid atherosclerosis, which is a major cause of stroke and transient ischemic attack. For delineation of vasculatures in the carotid artery, ultrasound examinations have been widely employed because of a noninvasive procedure without ionizing radiation. However, conventional 2D ultrasound imaging has technical limitations in observing the complicated 3D shapes and asymmetric vasodilation of bifurcations. This study aims to propose image-processing techniques for better 3D reconstruction of a carotid bifurcation in a rat by using 2D cross-sectional ultrasound images. A high-resolution ultrasound imaging system with a probe centered at 40MHz was employed to obtain 2D transversal images. The lumen boundaries in each transverse ultrasound image were detected by using three different techniques; an ellipse-fitting, a correlation mapping to visualize the decorrelation of blood flow, and the ellipse-fitting on the correlation map. When the results are compared, the third technique provides relatively good boundary extraction. The incomplete boundaries of arterial lumen caused by acoustic artifacts are somewhat resolved by adopting the correlation mapping and the distortion in the boundary detection near the bifurcation apex was largely reduced by using the ellipse-fitting technique. The 3D lumen geometry of a carotid artery was obtained by volumetric rendering of several 2D slices. For the 3D vasodilatation of the carotid bifurcation, lumen geometries at the contraction and expansion states were simultaneously depicted at various view angles. The present 3D reconstruction methods would be useful for efficient extraction and construction of the 3D lumen geometries of carotid bifurcations from 2D ultrasound images.

  3. Reversible Cerebral Vasoconstriction Syndrome With Involvement of External Carotid Artery Branches

    PubMed Central

    Shaik, S.; Chhetri, S. K.; Roberts, G.; Wuppalapati, S.

    2014-01-01

    A 44-year-old woman presented with recurrent episodes of thunderclap headache. Neurological examination and computed tomography brain imaging were unremarkable. Cerebrospinal fluid findings were consistent with subarachnoid hemorrhage. Computed tomography angiography of the circle of Willis showed multiple areas of segmental vasoconstriction. This finding was confirmed on cerebral catheter angiography, with segmental vasoconstriction involving bilateral internal carotid, posterior cerebral, and external carotid branches. No aneurysm or other vascular abnormality was identified. She received treatment with nimodipine. A selective serotonin reuptake inhibitor, started 4 weeks earlier, was discontinued. Follow-up angiography after 3 months demonstrated complete resolution of the segmental vasoconstriction, confirming the diagnosis of reversible cerebral vasoconstriction syndrome (RCVS). She remained headache free at follow-up. To our knowledge, external carotid artery branch involvement in RCVS has been described only in one previous occasion. PMID:24982719

  4. Management of Bilateral Carotid Occlusive Disease

    PubMed Central

    Jadhav, Ashutosh P.; Ducruet, Andrew F.; Jankowitz, Brian T.; Jovin, Tudor G.

    2016-01-01

    Background Symptomatic bilateral internal carotid occlusive disease is a rare but potentially devastating entity. Medical therapy alone is associated with high rates of mortality and recurrent stroke. The optimal management of this disease remains poorly understood. Methods A retrospective review of a prospectively maintained database was conducted for patients who presented with an acute stroke in the setting of bilateral carotid occlusive disease between May and October 2013. Results We identified 3 patients. The admission National Institutes of Health Stroke Scale score ranged from 4 to 7. All patients had small- to moderate-sized infarcts in the anterior circulation on presentation. Angiography confirmed bilateral internal carotid occlusions with collateral filling via the posterior communicating artery and retrograde filling via external carotid artery supply to the ophthalmic artery. All patients were initially managed with permissive hypertension and anticoagulation followed by carotid angioplasty and stenting. At 1-year follow-up, all patients demonstrated a modified Rankin scale score of 0-1. Conclusions Carotid stenting may be a safe and effective therapy for patients presenting with symptomatic bilateral carotid occlusions. PMID:27051405

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

    PubMed

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

    2011-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  7. Calcium at the carotid siphon as an indicator of internal carotid artery stenosis.

    PubMed

    Gotovac, Nikola; Išgum, Ivana; Viergever, Max A; Biessels, Geert J; Fajdić, Josip; Velthuis, Birgitta K; Prokop, Mathias

    2013-06-01

    Carotid siphon calcification is often visible on unenhanced head CT (UCT), but the relation to proximal carotid artery stenosis (CAS) is unclear. We investigated the association of carotid siphon calcification with the presence of CAS. This IRB-waived retrospective study included 160 consecutive patients suspected of stroke (age 64 ± 14 years, 63 female) who underwent head UCT and CTA of the head and neck. CAS was rated on CTA as not present or present with non-significant (<50 %), moderate (50-69 %) or significant (≥70 %) stenosis. Presence, shape (on UCT) and volume (on CTA) of carotid siphon calcifications were related to CAS. Carotid siphon calcification was absent in 41 % of patients and bilateral in 94 % of those with calcifications. Presence, shape and volume of calcification resulted in odds ratios for having significant CAS of 10.1, 3.9 and 8.4, with 95 % CIs of 1.3-79.6, 1.1-14.1 and 2.6-26.8, respectively. Corresponding NPVs were 0.98, 0.98 and 0.96, while PPVs were 0.14, 0.07 and 0.29, respectively. Absence of calcification in the carotid artery siphon on UCT has high negative predictive value for carotid artery stenosis in patients with suspected stroke. However, siphon calcification is not a reliable indicator of significant carotid artery stenosis. • Many stroke patients do not have calcification in the carotid artery siphon. • Carotid stenosis ≥50 % is unlikely in stroke patients without siphon calcification. • Carotid siphon calcium is a poor indicator of significant carotid artery stenosis.

  8. [Outcomes of carotid endarterectomy and stenting in patients with carotid artery stenosis].

    PubMed

    Gavrilenko, A V; Ivanov, V A; Piven', A V; Kuklin, A V; Kravchenko, A A; Miklashevich, É R; Abugov, S A

    2012-01-01

    Analysed in the article are the outcomes of treating a total of 156 patients diagnosed with carotid artery stenosis. Of these, carotid endarterectomy was performed in 82 patients and stenting of carotid arteries was carried out in the remaining 74 patients. The incidence rate of perioperative stroke in the carotid endarterectomy group amounted to 3.6%, being in the stenting group 4.8%, P = 0.57. Multifactorial analysis was used to reveal risk factors for each method. Thus, in the carotid endarterectomy group, the risk factors for cerebrovascular complications appeared to be contralateral occlusion in patients with a history of stroke endured within less than six previous months (P<0.05), as well as the age over 75 years amongst the patients requiring placement of a temporary intraluminal bypass graft (P<0.05). For carotid stenting, risk factors of cerebrovascular complications included a hypoechogenic heterogeneous type of an atherosclerotic plaque (P<0.05) and ulceration of its surface (P<0.05). The presence of the patient's baseline functional class III angina of effort appeared to be a risk factor for the development of cardiovascular complications for carotid endarterectomy (P<0.05). No cardiovascular risk factors for carotid stenting were revealed. Based on the assessment of the risk factors thus detected, the authors worked out an algorithm of choosing an optimal treatment policy for patients presenting with carotid artery stenosis.

  9. Episodes of flushing, dyspnea and hypertension after carotid stenting for severe carotid stenosis.

    PubMed

    Giani, L; Lovati, C; Rosa, S; Gambaro, P; De Angeli, F; Mariani, C

    2015-12-01

    Carotid angioplasty and stenting (CAS) is a treatment option for carotid stenosis in high surgical risk patients. As it implies instrumentation of the carotid bulb, baroreceptors dysfunction may be provoked with consequent hemodynamic instability. An 83-year-old woman treated by CAS presented with episodes of flushing, dyspnea and palpitations accompanied by transitory desaturation, hypertension, agitation and anxiety. Symptoms started 12h after the procedure. Each episode lasted 10 min. Five episodes in 3 days were observed. A dysfunction of the carotid baroreceptors and chemoreceptors was hypothesized. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Modeling the Carotid Sinus Baroreceptor

    PubMed Central

    Srinivasan, Ramachandra; Nudelman, Harvey B.

    1972-01-01

    A mathematical model that describes the relationship between sinus pressure and nerve discharge frequency of the carotid sinus baroreceptor is presented. It is partly based upon the single-fiber data obtained by Clarke from the sinus nerve of a dog. The model takes into account what is currently known about the physiology of the baroreceptor. It consists of two nonlinear ordinary differential equations and eight free parameters. With one set of values for these eight parameters, the model reproduces well the experimental results reported by Clarke for positive ramp pressure inputs. Only three parameters needed to be adjusted in order to fit the dynamic data. The remaining five were obtained from static and steady-state data. PMID:5056961

  11. Race-gender differences in the association of trait anger with subclinical carotid artery atherosclerosis: the Atherosclerosis Risk in Communities Study.

    PubMed

    Williams, Janice E; Couper, David J; Din-Dzietham, Rebecca; Nieto, F Javier; Folsom, Aaron R

    2007-06-01

    This paper examines the association between trait anger and subclinical carotid artery atherosclerosis among 14,098 Black or White men and women, aged 48-67 years, in the Atherosclerosis Risk in Communities Study cohort, 1990-1992. Trait anger was assessed using the 10-item Spielberger Trait Anger Scale. Carotid atherosclerosis was determined by an averaged measure of the wall intimal-medial thickness (IMT) of the carotid bifurcation and of the internal and common carotids, measured by high-resolution B-mode ultrasound. In the full study cohort, trait anger and carotid IMT were significantly and positively associated (p = 0.04). In race-gender stratified analysis, the association was strongest and independent only in Black men, among whom a significant trait anger-carotid IMT relation was observed for both the overall trait anger measure (p = 0.004) and the anger reaction dimension (p = 0.001). In Black men, carotid IMT levels increased across categories of overall trait anger and anger reaction, resulting in clinically significant differences (67 microm (95% confidence interval: 23, 110) and 82 microm (95% confidence interval: 40, 125), respectively) from low to high anger. Sociodemographic, lifestyle, anthropometric, and biologic cardiovascular disease risk factors appear to mediate the relation in Black women, White men, and White women. In conclusion, these findings document disparate race-gender patterns in the association of trait anger with subclinical carotid artery atherosclerosis.

  12. Free-breathing black-blood CINE fast-spin echo imaging for measuring abdominal aortic wall distensibility: a feasibility study

    NASA Astrophysics Data System (ADS)

    Lin, Jyh-Miin; Patterson, Andrew J.; Chao, Tzu-Cheng; Zhu, Chengcheng; Chang, Hing-Chiu; Mendes, Jason; Chung, Hsiao-Wen; Gillard, Jonathan H.; Graves, Martin J.

    2017-05-01

    The paper reports a free-breathing black-blood CINE fast-spin echo (FSE) technique for measuring abdominal aortic wall motion. The free-breathing CINE FSE includes the following MR techniques: (1) variable-density sampling with fast iterative reconstruction; (2) inner-volume imaging; and (3) a blood-suppression preparation pulse. The proposed technique was evaluated in eight healthy subjects. The inner-volume imaging significantly reduced the intraluminal artifacts of respiratory motion (p  =  0.015). The quantitative measurements were a diameter of 16.3  ±  2.8 mm and wall distensibility of 2.0  ±  0.4 mm (12.5  ±  3.4%) and 0.7  ±  0.3 mm (4.1  ±  1.0%) for the anterior and posterior walls, respectively. The cyclic cross-sectional distensibility was 35  ±  15% greater in the systolic phase than in the diastolic phase. In conclusion, we developed a feasible CINE FSE method to measure the motion of the abdominal aortic wall, which will enable clinical scientists to study the elasticity of the abdominal aorta.

  13. Free-breathing black-blood CINE fast-spin echo imaging for measuring abdominal aortic wall distensibility: A feasibility study.

    PubMed

    Lin, Jyh-Miin; Patterson, Andrew; Chao, Tzu-Cheng; Zhu, Chengcheng; Chang, Hing-Chiu; Mendes, Jason; Chung, Hsiao-Wen; Gillard, Jonathan; Graves, Martin

    2017-03-22

    The paper reports a free-breathing black-blood CINE fast-spin echo (FSE) technique for measuring abdominal aortic wall motion. The free-breathing CINE FSE includes the following MR techniques: 1) variable-density sampling with fast iterative reconstruction; 2) inner-volume imaging; and 3) a blood-suppression preparation pulse. The proposed technique was evaluated in eight healthy subjects. The inner-volume imaging significantly reduced the intraluminal artifacts of respiratory motion (p = 0.015). The quantitative measurements were a diameter of 16.3 ± 2.8 mm and wall distensibility of 2.0 ± 0.4 mm (12.5 ± 3.4%) and 0.7 ± 0.3 mm (4.1 ± 1.0%) for the anterior and posterior walls, respectively. The cyclic cross-sectional distensibility was 35 ± 15% greater in the systolic phase than in the diastolic phase. In conclusion, we developed a feasible CINE FSE method to measure the motion of the abdominal aortic wall, which will enable clinical scientists to study the elasticity of the abdominal aorta.

  14. Anatomical variations in human carotid bodies.

    PubMed Central

    Khan, Q; Heath, D; Smith, P

    1988-01-01

    The variations in anatomical structure and position of both carotid bodies were noted in 100 consecutive subjects who came to necropsy. Considerable variations in form were found. Although most carotid bodies (83% on the right and 86% on the left) were of the classic ovoid type, an appreciable minority was bilobed (9% on the right and 7% on the left) or double (7% on the right and 6% on the left); 1% were leaf shaped. All these anatomical variants have to be distinguished from the pathologically enlarged carotid body that may have a smooth or finely nodular surface. Anatomical variants (such as the bilobed) may themselves enlarge as a consequence of carotid body hyperplasia. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6 Fig 7 Fig 8 PMID:3209707

  15. Evaluation of Carotid Plaque Using Ultrasound Imaging

    PubMed Central

    2016-01-01

    Traditional risk factors for predicting of cardiovascular disease are not always effective predictors for development of cardiovascular events. This review summarizes several newly developed noninvasive imaging techniques for evaluating carotid plaques and their role in cardiovascular disease risk. PMID:27358696

  16. Stroke risk and critical carotid stenosis.

    PubMed Central

    Norris, J W; Zhu, C Z

    1990-01-01

    The risk of stroke from carotid stenosis is proportionate to the degree of stenosis, but whether this is a direct and linear relationship is unknown. Using the degree of carotid stenosis in 500 patients with asymptomatic carotid bruits as a continuous variable, we plotted the frequency distribution and related this to the risk of ischaemic cerebral events and the progression of the arterial lesion. There was a bi-modal distribution, with the junction of the two populations at 85% stenosis. The frequency of ischaemic cerebral events was maximal at 75-90% stenosis. Our data suggest that there is a critical degree of carotid stenosis at which stroke risk becomes maximal. This may represent a window of therapeutic opportunity. PMID:2182782

  17. Ophthalmic masquerades of the atherosclerotic carotids

    PubMed Central

    Arthur, Anupriya; Alexander, Anika; Bal, Simerpreet; Sivadasan, Ajith; Aaron, Sanjith

    2014-01-01

    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. PMID:24817748

  18. Timing of carotid endarterectomy: a comprehensive review.

    PubMed

    Bruls, S; Van Damme, H; Defraigne, J-O

    2012-01-01

    Some controversy exists on the best moment to treat symptomatic carotid artery disease. This controversy concerns mainly neurologically unstable patients and patients who suffered a minor stroke. The authors discuss recent literature data on the feasibility and the safety of performing urgent (within 24 to 72 hours) carotid endarterectomy (CEA) in patients presenting repetitive transient ischaemic attacks or progressing stroke. Neurologically unstable patients, suffering ischemic brain deficit caused by carotid artery stenosis, are defined according to the following criteria: two or more transient ischaemic attacks (crescendo TIAs) or a fluctuating neurological deficit evolving no longer than 24 hours (progressing stroke), no impairment of consciousness, cerebral infarct of limited size on diffusion-weighted magnetic resonance imaging of the brain and a carotid artery stenosis of 70% or more on the appropriate side. In the past, these patients were often considered at too high risk to undergo immediate carotid surgery. Many neurologists remain reluctant to confine these neurologically unstable patients for urgent carotid endarterectomy and prefer to stabilise the neurological status, arguing the increased stroke morbidity in the urgent setting. Nevertheless, the natural history of stroke- in-evolution or repetitive transient ischemic attacks is far from benign, exposing the patient to a high risk of subsequent spontaneous stroke, even under best medical treatment. Another controversy exists on the timing of surgery in patients who suffered a minor, non-disabling stroke. Is a waiting period of 6 weeks safe? Once more, the operative risk should be balanced against the anticipated natural history. Published series, and sub-analysis of the recent carotid surgery trials (NASCET, ECST) plaid for carotid surgery within two weeks of a minor stroke. Contemporary literature argues that neurologically unstable patients, presenting repetitive transient ischaemic attacks or

  19. Carotid sheath haematoma: a case report.

    PubMed

    Yadav, Jayanthi; Badkur, D S; Arora, Arneet

    2009-10-01

    Carotid sheath haematoma is a rare finding, sometimes the only injury found in cases of manual strangulation without any associated external or internal injury to the neck. One such rare case is reported in an 8 year old female victim where presence of carotid sheath haematoma not only helped to ascertain the cause of death but also helped in the reconstruction of mechanism of infliction of force on the neck. 2009 Elsevier Ltd and Faculty of Forensic and Legal Medicine.

  20. Correlation of carotid blood flow and corrected carotid flow time with invasive cardiac output measurements.

    PubMed

    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.

  1. Combined endovascular and surgical treatment of infected carotid-carotid bypass graft.

    PubMed

    Younis, George; Reul, George J; Krajcer, Zvonimir

    2006-10-01

    To present a complex case involving an infected carotid-carotid bypass graft that was successfully treated with a stent-graft and subsequent surgical removal of the infected graft. A 75-year-old woman presented with persistent purulent drainage of an infected and exposed carotid-carotid prosthetic bypass graft. Wound cultures revealed methicillin-resistant Staphylococcus aureus. She was treated with appropriate intravenous antibiotic therapy without improvement in wound drainage. Because of her comorbid conditions, a decision was made to pursue endovascular revascularization of her left and right common carotid arteries (CCA), with subsequent surgical removal of the infected prosthetic graft. The patient underwent balloon angioplasty; a 7x18-mm Omnilink stent was deployed in the innominate artery and a 7x18-mm Herculink stent in the ostial left CCA. During the same procedure, the carotid-carotid bypass graft was excluded with deployment of an 8x50-mm Viabahn stent-graft in the right CCA. Several days later, the infected and now thrombosed carotid-carotid bypass graft was surgically removed, and an area of adjacent muscle was used to patch the previously excluded connection of the bypass from the right CCA. A saphenous vein patch was used to repair the defect in the left CCA. Her postoperative course was uneventful. At 1 year, the clinical and duplex examinations revealed satisfactory wound healing and patent left and right CCAs. This case indicates that a combined endovascular and surgical approach may be a safe and effective option in the treatment of carotid-carotid bypass graft infection.

  2. G proteins in carotid body chemoreception.

    PubMed

    Prabhakar, N R; Kou, Y R; Kumar, G K

    1995-01-01

    G proteins are signal coupling molecules that play major roles in mediating the effects of transmitters as well as certain sensory signals. In the present study we examined whether oxygen chemoreception in the carotid body is coupled to G proteins. Experiments were performed on carotid bodies isolated from anesthetized cats. Presence of G proteins was examined with ADP-ribosylation of the carotid body membranes. Pertussis toxin (PTX), which inactivates G proteins in neuronal tissues, ADP-ribosylated a single band of carotid body protein with a molecular mass of 41 kDa. With cholera toxin (CTX) only a faint band of protein corresponding to approximately 45 kDa was evident. Perfusing the isolated carotid bodies with PTX (2.5 micrograms/min; 60 min) attenuated the sensory response to hypoxia by 52% of the controls. Perfusion with CTX (50 micrograms/min; for 60 min), on the other hand, increased baseline activity and potentiated the hypoxic response by 125% of controls. Heat-inactivated toxins, however, had no influence on the carotid body sensory response to hypoxia. These results suggest that G proteins are present in the chemoreceptor tissue and they seem to be coupled to the transduction and/or to the transmission of the hypoxic stimulus.

  3. Economic evaluation of carotid artery stenting versus carotid endarterectomy for the treatment of carotid artery stenosis.

    PubMed

    Pawaskar, Manjiri; Satiani, Bhagwan; Balkrishnan, Rajesh; Starr, Jean E

    2007-09-01

    The clinical effectiveness of carotid endarterectomy (CEA) is well established. But the economic impact of CEA and carotid artery stenting (CAS) is still uncertain. The objective of this study was to compare hospital costs and reimbursement for CAS and CEA. We performed a retrospective database analysis on pair-matched patients who underwent CEA (n = 31) and CAS (n = 31) at the Richard M Ross Heart Hospital in Columbus, OH. The hospital's clinical and financial databases were used to obtain patient-specific information and procedural charges. Cost data were generated by applying the hospital's ratio of cost to charges for all DRG charges. The Wilcoxon signed-rank test was used to examine the differences between costs of these procedures. Data are reported as mean +/- SD. The mean age of patients in CAS group was 70.14 years (+/- 1.60 years) versus 68.64 years (+/- 1.75 years) for CEA patients (p < 0.05). The total direct cost associated with CEA ($3,765.12+/-$2,170.82) was significantly lower than the CAS cost ($8,219.71+/-$2,958.55, p < 0.001). The mean procedural cost for CAS ($7,543.61+/-$2,886.54) was significantly higher than that for CEA ($2,720.00+/-$926.38, p < 0.001). The hospital experienced cost savings of $9,690.87 for CEA versus $4,804.79 for CAS from private insurance. Similarly, savings obtained by Medicare-enrolled CEA patients were higher than those for CAS patients ($1,497.79). CAS is significantly more expensive than CEA, with a major portion of cost attributed to the total procedural cost. The hospital experienced significant savings from CEA procedures compared with CAS under all DRG classifications and insurers. Hospitals must develop new financial strategies and improve the efficiency of infrastructure to make CAS financially viable.

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

    PubMed

    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. Internal carotid artery rupture caused by carotid shunt insertion

    PubMed Central

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

    2015-01-01

    Introduction Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. Presentation of case A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an 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. Discussion 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. Conclusion Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. PMID:26255001

  6. Salivary inflammatory cytokines may be novel markers of carotid atherosclerosis in a Japanese general population: the Suita study.

    PubMed

    Kosaka, Takayuki; Kokubo, Yoshihiro; Ono, Takahiro; Sekine, Shinichi; Kida, Momoyo; Kikui, Miki; Yamamoto, Masaaki; Watanabe, Makoto; Amano, Atsuo; Maeda, Yoshinobu; Miyamoto, Yoshihiro

    2014-11-01

    Salivary biomarkers have been recently useful of periodontal disease, which is also risk factor of atherosclerosis. However, there are few studies of the association between salivary inflammatory cytokines and carotid atherosclerosis. We aimed to clarify the association between salivary inflammatory cytokines and periodontal disease and carotid atherosclerosis in a general urban population. We studied 608 Japanese men and women (mean age: 65.4 years) in the Suita study. Carotid atherosclerosis was evaluated by high-resolution ultrasonography with atherosclerotic indexes of intima-media thickness (IMT). Periodontal status was evaluated by the Community Periodontal Index (CPI). Salivary levels of interleukin-1β, interleukin-6, tumor necrosis factor-α (TNF-α), and prostaglandin E2 (PGE2) were measured by enzyme linked immunosorbent assay. The risks of carotid atherosclerosis (≥75th percentiles of mean- [0.88 mm] and Max-IMT [1.50 mm]) according to the quartiles of salivary inflammatory cytokines were compared using of adjusted-logistic regression models. All salivary inflammatory cytokines were positively associated with CPI. The adjusted odds ratios for carotid atherosclerosis of mean-IMT in the highest quartile of interleukin-6 and TNF-α were higher than those in the lowest quartiles (OR = 2.32 and 2.88; 95% confidence intervals = 1.19-4.51 and 1.51-5.49, respectively). The adjusted odds ratio for carotid atherosclerosis of mean-IMT in the highest quartile of PGE2 was greater than those in the lowest quartile in women (OR = 2.78; 95% confidence intervals = 1.11-6.95). In conclusion, higher levels of salivary inflammatory cytokines were associated with both periodontal disease and carotid atherosclerosis. Selected salivary inflammatory cytokines may be useful screening markers for periodontal disease and carotid atherosclerosis. Copyright © 2014. Published by Elsevier Ireland Ltd.

  7. MR imaging of focal lung lesions: elimination of flow and motion artifact by breath-hold ECG-gated and black-blood techniques on T2-weighted turbo SE and STIR sequences.

    PubMed

    Yamashita, Y; Yokoyama, T; Tomiguchi, S; Takahashi, M; Ando, M

    1999-05-01

    Respiratory and cardiac motion correction may result in better turbo spin-echo (SE) imaging of the lung. To compare breath-hold cardiac-gated black-blood T2-weighted turbo SE and turbo short-inversion-time inversion-recovery (STIR) magnetic resonance (MR) imaging pulse sequences with conventional breath-hold turbo SE and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences for lesion conspicuity of focal lung lesions, 42 patients with focal lung lesions were prospectively studied with MR imaging at 1.5 T. Helical computed tomography was used as a reference. In comparison with the conventional breath-hold turbo SE sequence, all black-blood sequences had fewer image artifacts arising from the heart and blood flow. The overall image quality for the black-blood turbo SE and turbo STIR sequences was superior to that for the breath-hold turbo SE and HASTE sequence (P < 0.01). Not only focal lung lesions but also surrounding inflammatory changes were clearly visualized with these two sequences. With the HASTE sequence, although several slices could be obtained in one breath-hold, both the tumor and vessels appeared blurred. We conclude that T2-weighted turbo SE and turbo STIR imaging of the lung with effective suppression of flow and motion artifacts provide high-quality images in patients with focal lung lesions.

  8. Obesity and carotid artery remodeling

    PubMed Central

    Kozakova, M; Palombo, C; Morizzo, C; Højlund, K; Hatunic, M; Balkau, B; Nilsson, P M; Ferrannini, E

    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 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 and CCA LD (266 healthy subjects with wide range of body weight (24–159 kg)); (B) longitudinal associations between CCA LD and 3-year IMT progression rate (ΔIMT; 571 healthy non-obese subjects without increased cardiovascular (CV) risk); (C) the impact of obesity on CCA geometry and CWS (88 obese subjects without CV complications and 88 non-obese subjects matched for gender and age). Results: CCA LD was independently associated with SV that was determined by body size. In the longitudinal study, baseline LD was an independent determinant of ΔIMT, and ΔIMT of subjects in the highest LD quartile was significantly higher (28±3 μm) as compared with those in the lower quartiles (8±3, 16±4 and 16±3 μm, P=0.001, P<0.05 and P=0.01, respectively). In addition, CCA CWS decreased during the observational period in the highest LD quartile (from 54.2±8.6 to 51.6±7.4 kPa, P<0.0001). As compared with gender- and age-matched lean individuals, obese subjects had highly increased CCA LD and BP (P<0.0001 for both), but only slightly higher CWS (P=0.05) due to a significant increase in IMT (P=0.005 after adjustment for confounders). Conclusions: Our findings suggest that in obese subjects, the CCA wall thickens to compensate the luminal enlargement caused by body size-induced increase in SV, and therefore, to normalize the wall stress. CCA diameter in obesity could

  9. Carotid plaque is a new risk factor for peripheral vestibular disorder: a retrospective cohort study

    PubMed Central

    Wada, Masaoki; Takeshima, Taro; Nakamura, Yosikazu; Nagasaka, Shoichiro; Kamesaki, Toyomi; Kajii, Eiji

    2016-01-01

    Abstract Many chronic diseases are associated with dizziness or vertigo, as is peripheral vestibular disorder (PVD). Although carotid plaque development is linked to atherosclerosis, it is unclear whether such plaques can lead to the development of PVD. We therefore conducted this study to investigate the presence of an association between carotid plaque and new PVD events. In this retrospective study, we consecutively enrolled 393 patients ≥20 years old who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for ≥6 months at a primary care clinic (Oki Clinic, Japan) between November 2011 and March 2013. Carotid plaque presence was measured with high-resolution ultrasonography for all patients. During a 1-year follow-up period, an otorhinolaryngologist diagnosed and reported any new PVD events (the main end point). Hazard ratios (HRs) and 95% confidence intervals (CIs) for new PVD occurrence were estimated using the Cox proportional hazard regression model. The mean age of the participants was 65.5 years; 33.8% were men, and 12.7%, 82.4%, and 93.1% had diabetes mellitus, hypertension, and dyslipidemia, respectively. There were 76 new PVD events; patients with carotid plaque had a greater risk of such events (crude HR: 3.25; 95% CI: 1.62–6.52) compared to those without carotid plaque. This risk was even higher after adjusting for traditional risk factors for atherosclerosis (adjusted HR: 4.41; 95% CI: 1.75–11.14). Carotid plaques are associated with an increased risk of new PVD events. PMID:27495105

  10. Association Between the Presence of Carotid Artery Plaque and Cardiovascular Events in Patients With Genetic Hypercholesterolemia.

    PubMed

    Bea, Ana M; Civeira, Fernando; Jarauta, Estíbaliz; Lamiquiz-Moneo, Itziar; Pérez-Calahorra, Sofía; Marco-Benedí, Victoria; Cenarro, Ana; Mateo-Gallego, Rocío

    2017-07-01

    The equations used in the general population to calculate cardiovascular risk are not useful in genetic hypercholesterolemia (GH). Carotid plaque detection has proved useful in cardiovascular prediction and risk reclassification but there have been no studies of its usefulness in GH. The aim of this study was to determine the association between the presence of carotid artery plaque and the occurrence of cardiovascular events in patients with GH. This study included 1778 persons with GH. The mean follow-up until the occurrence of cardiovascular events was 6.26 years. At presentation, the presence of carotid artery plaque was studied by high-resolution ultrasound. Carotid artery plaque was found in 661 (37.2%) patients: 31.9% with familial hypercholesterolemia, 39.8% with familial combined hyperlipidemia, 45.5% with dysbetalipoproteinemia, and 43.2% with polygenic hypercholesterolemia. During follow-up, 58 patients had a cardiovascular event. Event rates were 6354/100 000 (95%CI, 4432.4-8275.6) in the group with plaque and 1432/100 000 (95%CI, 730.6-2134.3) in the group without plaque, with significant differences between the 2 groups (P < .001). The relative risk of an event was 4.34 (95CI%, 2.44-7.71; P < .001) times higher in patients with plaque and was 2.40 (95%CI, 1.27-4.56; P = .007) times higher after adjustment for major risk factors. The number of carotid artery plaques was positively associated with the risk of cardiovascular events. Most cardiovascular events occur in a subgroup of patients who can be identified by carotid plaque detection. These results support the use of plaque screening in this population and should help in risk stratification and treatment in GH. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  11. Carotid plaque is a new risk factor for peripheral vestibular disorder: a retrospective cohort study.

    PubMed

    Wada, Masaoki; Takeshima, Taro; Nakamura, Yosikazu; Nagasaka, Shoichiro; Kamesaki, Toyomi; Kajii, Eiji

    2016-08-01

    Many chronic diseases are associated with dizziness or vertigo, as is peripheral vestibular disorder (PVD). Although carotid plaque development is linked to atherosclerosis, it is unclear whether such plaques can lead to the development of PVD. We therefore conducted this study to investigate the presence of an association between carotid plaque and new PVD events.In this retrospective study, we consecutively enrolled 393 patients ≥20 years old who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for ≥6 months at a primary care clinic (Oki Clinic, Japan) between November 2011 and March 2013. Carotid plaque presence was measured with high-resolution ultrasonography for all patients. During a 1-year follow-up period, an otorhinolaryngologist diagnosed and reported any new PVD events (the main end point). Hazard ratios (HRs) and 95% confidence intervals (CIs) for new PVD occurrence were estimated using the Cox proportional hazard regression model.The mean age of the participants was 65.5 years; 33.8% were men, and 12.7%, 82.4%, and 93.1% had diabetes mellitus, hypertension, and dyslipidemia, respectively. There were 76 new PVD events; patients with carotid plaque had a greater risk of such events (crude HR: 3.25; 95% CI: 1.62-6.52) compared to those without carotid plaque. This risk was even higher after adjusting for traditional risk factors for atherosclerosis (adjusted HR: 4.41; 95% CI: 1.75-11.14).Carotid plaques are associated with an increased risk of new PVD events.

  12. IN VITRO AND PRELIMINARY IN VIVO VALIDATION OF ECHO PARTICLE IMAGE VELOCIMETRY IN CAROTID VASCULAR IMAGING

    PubMed Central

    Zhang, Fuxing; Lanning, Craig; Mazzaro, Luciano; Barker, Alex J.; Gates, Philip; Strain, W. David; Fulford, Jonathan; Gosling, Oliver E.; Shore, Angela C.; Bellenger, Nick G.; Rech, Bryan; Chen, Jiusheng; Chen, James; Shandas, Robin

    2012-01-01

    Non-invasive, easy-to-use and accurate measurements of wall shear stress (WSS) in human blood vessels have always been challenging in clinical applications. Echo particle image velocimetry (Echo PIV) has shown promise for clinical measurements of local hemodynamics and wall shear rate. So far, however, the method has only been validated under simple flow conditions. In this study, we validated Echo PIV under in-vitro and in-vivo conditions. For in-vitro validation, we used an anatomically-correct, compliant carotid bifurcation flow phantom with pulsatile flow conditions, using optical particle image velocimetry (optical PIV) as the reference standard. For in-vivo validation, we compared Echo PIV-derived two dimensional velocity fields obtained at the carotid bifurcation in 5 normal subjects against phase-contrast MRI-derived velocity measurements obtained at the same locations. For both studies, time-dependent, two-dimensional two-component velocity vectors, peak/centerline velocity, flow rate and wall shear rate (WSR) waveforms at the common carotid artery (CCA), carotid bifurcation and distal internal carotid artery (ICA) were examined. Linear regression, correlation analysis and Bland-Altman analysis were used to quantify the agreement of different waveforms measured by the two techniques. In-vitro results showed that Echo PIV produced good images of time-dependent velocity vector maps over the cardiac cycle with excellent temporal (up to 0.7 msec) and spatial (~0.5 mm) resolutions and quality, on par with optical PIV results. Further, good agreement was found between Echo PIV and optical PIV results for velocity and WSR measurements. In-vivo results also showed good agreement between Echo PIV velocities and PC-MRI velocities. We conclude that Echo PIV provides accurate velocity vector and WSR measurements in the carotid bifurcation and has significant potential as a clinical tool for cardiovascular hemodynamics evaluation. PMID:21316562

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

    PubMed Central

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

    2011-01-01

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

  14. [Prevalence of carotid atherosclerosis in a cohort of Mexico City].

    PubMed

    Rodríguez Saldaña, J; Cantú Brito, C; Sosa Espinosa, P; Reynoso Marenco, M T; Zuckermann Foullón, D; Barinagarrementería Aldatz, F

    1998-01-01

    In order to investigate the prevalence of atherosclerosis in Mexico, high resolution ultrasound and color Doppler flow imaging of carotid arteries were carried out in a group of participants in CUPA project, a cohort study started in 1989 among persons 60 years and older living permanently in a high rise in México City. Imaging studies included identification of 4 atherosclerosis related abnormalities: 1) intima media thickness; 2) kinkings and tortuousness; 3) non-stenosing plaques; and 4) significant carotid stenosis (> 50%). Analysis of 198 Doppler ultrasonographic studies in 56 males and 142 females showed an overall prevalence of atherosclerosis related lesions of 65.6%, with increasing frequency by age groups: 33% in younger than 65 year-old, 71% in 65-74 years, and up to 88% in the 75 years and older group. The prevalence of high grade stenosis was low (6%) whereas the overall frequency of non-stenosing plaques and intima-media thickness was higher than 60%. Intima-media thickness was more common in males while non-stenosing plaques and high grade stenosis were more frequent in females. However, there were not significant differences among women and men when atherosclerotic lesions were analyzed by age groups. This is the first report on the prevalence of atherosclerosis in a Mexican population using ultrasonography. Findings of the investigation document the high prevalence of atherosclerosis among elderly resident in Mexico City.

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

    MedlinePlus

    ... 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 ...

  16. Carotid artery disease following external cervical irradiation

    SciTech Connect

    Elerding, S.C.; Fernandez, R.N.; Grotta, J.C.; Lindberg, R.D.; Causay, L.C.; McMurtrey, M.J.

    1981-11-01

    A retrospective study of 910 patients surviving at least five years after cervical irradiation for Hodgkin's disease, non-Hodgkin's lymphoma, or primary head and neck neoplasms showed the incidence of stroke following cervical irradiation was 63 of 910 patients (6.3%) during a mean period of observation of nine years. This represents a trend toward an increased risk for this population over the expected incidence of 38 strokes for a matched population observed over the same period of time (p = 0.39). A prospective study of 118 similar patients currently living five years after cervical radiotherapy was performed to determine the incidence of carotid artery disease occurring as a consequence of neck irradiation. Abnormal carotid phonoangiograms (CPA) were found in 25% of the patients and abnormal oculoplethysmographs (OPG) were found in 17%. These studies represent significant carotid lesions that are not expected in such a population. It is concluded that the carotid stenoses demonstrated are most likely a consequence of prior irradiation. Patients that are five-year survivors of cervical irradiation should have noninvasive vascular laboratory studies performed as part of their routine follow-up examinations in order to detect these carotid lesions while they are occult.

  17. Carotid intraplaque neovascularization quantification software (CINQS).

    PubMed

    Akkus, Zeynettin; van Burken, Gerard; van den Oord, Stijn C H; Schinkel, Arend F L; de Jong, Nico; van der Steen, Antonius F W; Bosch, Johan G

    2015-01-01

    Intraplaque neovascularization (IPN) is an important biomarker of atherosclerotic plaque vulnerability. As IPN can be detected by contrast enhanced ultrasound (CEUS), imaging-biomarkers derived from CEUS may allow early prediction of plaque vulnerability. To select the best quantitative imaging-biomarkers for prediction of plaque vulnerability, a systematic analysis of IPN with existing and new analysis algorithms is necessary. Currently available commercial contrast quantification tools are not applicable for quantitative analysis of carotid IPN due to substantial motion of the carotid artery, artifacts, and intermittent perfusion of plaques. We therefore developed a specialized software package called Carotid intraplaque neovascularization quantification software (CINQS). It was designed for effective and systematic comparison of sets of quantitative imaging biomarkers. CINQS includes several analysis algorithms for carotid IPN quantification and overcomes the limitations of current contrast quantification tools and existing carotid IPN quantification approaches. CINQS has a modular design which allows integrating new analysis tools. Wizard-like analysis tools and its graphical-user-interface facilitate its usage. In this paper, we describe the concept, analysis tools, and performance of CINQS and present analysis results of 45 plaques of 23 patients. The results in 45 plaques showed excellent agreement with visual IPN scores for two quantitative imaging-biomarkers (The area under the receiver operating characteristic curve was 0.92 and 0.93).

  18. [Prevention of cerebral ictus, of carotid origin].

    PubMed

    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.

  19. Carotid artery disease following external cervical irradiation

    SciTech Connect

    Elerding, S.C.; Fernandez, R.N.; Grotta, J.C.; Lindberg, R.D.; Causay, L.C.; McMurtrey, M.J.

    1981-01-01

    A retrospective study of 910 patients surviving at least five years after cervical irradiation for Hodgkin's disease, non-Hodgkin's lymphoma, or primary head an neck neoplasms showed the incidence of stroke following cervical irradiation was 63 of 910 patients (6.3%) during a mean period of observation of nine years. This represents a trend toward an increased risk for this population observed over the same period of time (p . 0.39). A prospective study of 118 similar patients currently living five years after cervical radiotherapy was performed to determine the incidence of carotid artery disease occurring as a consequence of neck irradiation. Abnormal carotid phonangiograms (CPA) were found in 25% of the patients and abnormal oculoplethysmographs (OPG) were found in 17%. These studies represent significant carotid lesions that are not expected in such a population. It is concluded that the carotid stenoses demonstrated are most likely a consequence of prior irradiation. Patients that are five-year survivors of cervical irradiation should have noninvasive vascular laboratory studies performed as part of their routine follow-up examinations in order to detect these carotid lesions while they are occult.

  20. Compressed sensing based simultaneous black- and gray-blood carotid vessel wall MR imaging.

    PubMed

    Li, Bo; Li, Hao; Kong, Hanjing; Dong, Li; Zhang, Jue; Fang, Jing

    2017-05-01

    In this study, we sought to demonstrate the blood suppression performance, image quality and morphological measurements for compressed sensing (CS) based simultaneous 3D black- and gray-blood imaging sequence (CS-siBLAG) in carotid vessel wall MR imaging. Seven healthy volunteers and five patients were recruited. Healthy subjects underwent five CS-siBLAG scans with 1, 2, 3, 4 and 5-fold accelerations. Signal-to-tissue ratio (STR) and contrast-to-tissue ratio (CTR) were computed as the measures of flowing signal suppression performance and the image quality for black-blood imaging of the technique. Vessel lumen area (LA) and wall area (WA) were compared between fully sampled acquisition and each accelerated acquisition. Patients underwent three CS-siBLAG scans with 1, 3 and 5-fold accelerations as well as a 3D time of flight (3D TOF) scan. Two radiologists reviewed the under-sampled black- and gray-blood image quality. STR and CTR values obtained with 2 to 5-fold accelerations were not significantly different from those with full acquisition. LA and WA measured at 2×, 3×, 4× and 5× were all highly correlated to the corresponding values at 1×. For patients imaging, two radiologists both found that the dual-contrast images at 3× acceleration exhibited comparable image quality to that of the fully sampled acquisition, and that the images at 5× exhibited slightly blurred vessel wall and outer vessel wall boundaries. By combining the CS under-sampling pattern and reconstruction, pseudo-centric phase encoding order and dual blood contrast sequences, this technique provides spatially registered black- and gray-blood images and excellent visualization for vessel wall imaging and gray-blood imaging in a short scan time. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Safety Outcomes Using a Proximal Protection Device in Carotid Stenting of Long Carotid Stenoses

    PubMed Central

    Atchaneeyasakul, Kunakorn; Khandelwal, Priyank; Ambekar, Sudheer; Ramdas, Kevin; Guada, Luis; Yavagal, Dileep

    2016-01-01

    Background Embolic protection devices can prevent atherosclerotic emboli during carotid stenting. Newer proximal protection devices reverse flow in the internal carotid artery (ICA), leading to reduction in perioperative microemboli. The risk of stroke is high for carotid stenting of ICA lesions with a length >10 mm and/or angiographic string sign. Objective We aimed to evaluate the safety outcomes of proximal embolic protection device usage in this high-risk group. Methods This is a retrospective analysis of patients who underwent carotid stenting procedures with proximal embolic protection devices at a tertiary care center. High-risk features for adverse events with carotid stenting were identified. Peri- and postprocedural outcomes were recorded. We further compared outcomes in patients with a carotid stenosis length >10 mm to those with shorter stenosis. Results From January 2011 to December 2014, we included 27 patients; 96.3% were symptomatic and 3.7% were asymptomatic. There was a stent placement technical success rate of 100%. No major stroke or coronary events were recorded. One minor stroke event developed in one patient. A carotid lesion length >10 mm and/or angiographic string sign was noted in 21/27 patients, with an average lesion length of 14.4 mm. One patient (4.8%) in this group developed a minor stroke event. Neither a coronary nor a major stroke event was recorded in this group. There was no significant difference in the complication rate between the long lesion and the control group. Conclusion In our patient cohort, it was found that a proximal embolic protection device is safe for patients with carotid stenosis, including those with a carotid lesion length >10 mm and/or angiographic string sign. PMID:27781040

  2. Recanalization of acute carotid stent occlusion using Penumbra 4Max aspiration catheter: technical report and review of rescue strategies for acute carotid stent occlusion.

    PubMed

    Munich, Stephan; Moftakhar, Roham; Lopes, Demetrius

    2014-10-01

    Carotid artery stenting (CAS) has become a widely used treatment for carotid artery stenosis, especially in high-risk patients. Acute in-stent and distal protection device occlusion are potentially catastrophic complications of this procedure. Previously described rescue strategies have included administration of antiplatelet agents (eg, abciximab) with/without thrombolytics and removal of the filter. Here we describe the successful resolution of in-stent occlusion by mechanical thrombolysis using the Penumbra 4Max aspiration catheter. Distal flow was subsequently restored with minimal residual stenosis. The patient did not suffer any consequent neurological deficits. The different strategies that could be used in this critical situation are reviewed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. Current status of carotid ultrasound in atherosclerosis

    PubMed Central

    2016-01-01

    Cardiovascular disease (CVD) primarily caused by atherosclerosis is a major cause of death and disability in developed countries. Sonographic carotid intima-media thickness (CIMT) is widely studied as a surrogate marker for detecting subclinical atherosclerosis for risk prediction and disease progress to guide medical intervention. However, there is no standardized CIMT measurement methodology in clinical studies resulting in inconsistent findings, thereby undermining the clinical value of CIMT. Increasing evidences show that CIMT alone has weak predictive value for CVD while CIMT including plaque presence consistently improves the predictive power. Quantification of plaque burden further enhances the predictive power beyond plaque presence. Sonographic carotid plaque characteristics have been found to be predictive of cerebral ischaemic events. With advances in ultrasound technology, enhanced assessment of carotid plaques is feasible to detect high-risk/vulnerable plaques, and provide risk assessment for ischemic stroke beyond measurement of luminal stenosis. PMID:27429912

  4. Early angiographic changes after carotid endarterectomy.

    PubMed

    Diaz, F G; Patel, S; Boulos, R; Mehta, B; Ausman, J I

    1982-02-01

    This report reviews the angiographic evaluation of 41 patients who underwent a carotid endarterectomy at Henry Ford Hospital. Postoperative angiograms were performed after 48 endarterectomies. Changes included the development of postoperative intimal flaps, common carotid stenosis, carotid occlusions, areas of corrugation, surface irregularities, and postendarterectomy dilatation. The development of dilatation, or the pantaloon effect, on the endarterectomized segment contributed to the limited use of angioplastic procedures. The benefits derived from a postoperative angiogram include the objective evaluation of the endarterectomized segment, the demonstration of a potentially complicating problem such as intimal flaps that could lead to restenosis, and recognition of the possible development of associated local problems. The procedure can be done with limited risks to the patients and in competent hands has low morbidity and mortality.

  5. Photoacoustic imaging of carotid artery atherosclerosis

    NASA Astrophysics Data System (ADS)

    Kruizinga, Pieter; van der Steen, Antonius F. W.; de Jong, Nico; Springeling, Geert; Robertus, Jan Lukas; van der Lugt, Aad; van Soest, Gijs

    2014-11-01

    We introduce a method for photoacoustic imaging of the carotid artery, tailored toward detection of lipid-rich atherosclerotic lesions. A common human carotid artery was obtained at autopsy, embedded in a neck mimicking phantom and imaged with a multimodality imaging system using interstitial illumination. Light was delivered through a 1.25-mm-diameter optical probe that can be placed in the pharynx, allowing the carotid artery to be illuminated from within the body. Ultrasound imaging and photoacoustic signal detection is achieved by an external 8-MHz linear array coupled to an ultrasound imaging system. Spectroscopic analysis of photoacoustic images obtained in the wavelength range from 1130 to 1250 nm revealed plaque-specific lipid accumulation in the collagen structure of the artery wall. These spectroscopic findings were confirmed by histology.

  6. Carotid intima-media thickness: an early marker of cardiovascular disease.

    PubMed

    Polak, Joseph F

    2009-06-01

    Carotid artery intima-media thickness (IMT) measurements are now recognized as a surrogate measure of atherosclerosis. The measurement is performed on high-resolution ultrasound images of the carotid artery at the level of the carotid bifurcation. Increased IMT values indicate a higher likelihood of having had a stroke or myocardial infarction. In epidemiological studies, IMT measurements made in asymptomatic individuals also predict future cardiovascular events. Intima-media thickness measurements have also been used in clinical trials as a means of gauging the effects of interventions that modify cardiovascular risk factors, low-density lipoprotein cholesterol for example. A positive response to the intervention is defined as a measurable difference in IMT values of the treated group as compared with a control group.The technique has also shown the possibility of identifying certain high-risk individuals with evidence of more advanced atherosclerosis or with a high risk for cardiovascular events. This paper reviews the basic history of the development of carotid artery IMT measurements and discusses some technical aspects of the measurement.

  7. Serum soluble RAGE levels and carotid atherosclerosis: the Northern Manhattan Study (NOMAS).

    PubMed

    Hudson, Barry I; Gardener, Hannah; Liu-Mares, Wen; Dong, Chuanhui; Cheung, Ken; Elkind, Mitchell S V; Wright, Clinton B; Sacco, Ralph L; Rundek, Tatjana

    2015-05-01

    Recent cohort studies suggested that serum levels of soluble Receptor for Advanced Glycation End-products (sRAGE) are associated with the risk of cardiovascular disease. We hypothesized that sRAGE levels are associated with subclinical atherosclerosis in a racially and ethnically diverse population. 828 stroke-free participants from the Northern Manhattan Study (mean age 71.1±8.7yrs; 64% Hispanic, 19% black, and 17% white) underwent high-resolution carotid B-mode ultrasound to measure carotid plaque (present in 62% of subjects) and intima-media thickness (IMT) (mean Total=0.96±0.10 mm). Serum sRAGE was measured by ELISA and associations tested between sRAGE with IMT and plaque presence. Soluble RAGE levels were not associated with plaque presence or IMT after adjusting for sociodemographic, vascular risk factors and medication use. Stratification by race-ethnicity did not reveal any associations with carotid IMT or plaque. In the present study, sRAGE levels were not associated with carotid atherosclerosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Adiponectin and carotid intimal medial thickness in subjects with and without glucose intolerance (CURES-82).

    PubMed

    Gokulakrishnan, K; Indulekha, K; Ganesan, S; Anuradha, S; Mohan, V

    2010-02-01

    This study assessed the association of serum adiponectin with carotid intimal medial thickness (IMT) in Asian Indians with different grades of glucose intolerance. Subjects with normal glucose tolerance (NGT) (n = 520), impaired glucose tolerance (IGT) (n = 115), and type 2 diabetes mellitus (T2DM) (n = 540) were recruited from the Chennai Urban Rural Epidemiology Study, in south India. Adiponectin levels were measured using radioimmunoassay. Carotid IMT was assessed by high resolution B-mode ultrasonography. Insulin resistance was calculated using the homeostasis assessment model. Subjects with glucose intolerance (i.e., IGT and T2DM) were older compared to subjects with NGT. Waist circumference, systolic blood pressure, and serum triglycerides were higher among subjects with IGT and T2DM compared to subjects with NGT (P < 0.001). Subjects with glucose intolerance had significantly higher mean carotid IMT values and lower adiponectin compared to subjects with NGT (P < 0.001). Serum adiponectin levels were significantly correlated with IMT among NGT (P = 0.005) and IGT (P = 0.005) subjects but not in subjects with diabetes. Linear regression analysis revealed adiponectin to be negatively associated with IMT (P < 0.001) even after adjusting for age, gender, body mass index, insulin resistance, and glucose intolerance (P < 0.001). Carotid IMT is associated with lower serum adiponectin levels independent of conventional cardiovascular risk factors in urban South Indians.

  9. Orosomucoid, Carotid Plaque, and Incidence of Stroke.

    PubMed

    Berntsson, John; Östling, Gerd; Persson, Margaretha; Smith, J Gustav; Hedblad, Bo; Engström, Gunnar

    2016-07-01

    Orosomucoid (α-1-acid glycoprotein) is an acute-phase protein that has been implicated in anti-inflammatory, immunomodulating, and angiogenic pathways. Orosomucoid has also been associated with coronary disease and stroke. The relationship between orosomucoid, carotid plaque, and stroke incidence were explored in this study. Plasma levels of orosomucoid were assessed in 4285 subjects (39.8% men; mean age 57.5±5.9 years) without cardiovascular disease, who participated in the Malmö Diet and Cancer Study, between 1991 and 1994. The right carotid artery was examined for plaque using B-mode ultrasound examination. Incidence of stroke was followed up during a median follow-up time of 17.7 years. Carotid plaque was present in 43.5% at baseline. Orosomucoid was significantly higher in subjects with carotid plaque (mean±SD: 0.72±0.22 versus 0.69±0.20 g/L; P<0.001). A total of 234 subjects were diagnosed with ischemic stroke during follow-up. Orosomucoid was associated with ischemic stroke after adjustment for risk factors, with hazard ratio 1.48 (95% confidence interval, 1.02-2.16) comparing the third versus first tertile. In subjects with plaque and belonging to the top tertile of orosomucoid, the hazard ratio was 2.07 (95% confidence interval, 1.38-3.11) compared with those without plaque and with orosomucoid in the first and second tertiles, after adjustment for C-reactive protein and other risk factors. Elevated levels of orosomucoid are associated with increased occurrence of carotid plaque and increased incidence of ischemic stroke. The combination of high orosomucoid and carotid plaque substantially increase the risk of stroke. © 2016 American Heart Association, Inc.

  10. Carotid Artery Stenting 2013: Thumbs up

    PubMed Central

    Wagdi, Philipp

    2013-01-01

    It has been customary for interventional cardiologists involved in carotid artery stenting, to underline non-inferiority of the percutaneous technique versus surgical carotid endarterectomy. To that end, all cause morbidity and mortality figures of both methods are compared. Surgery has, in most large randomized studies, had an edge over stenting in terms of cerebrovascular adverse events. This may have partly been due to occasional indiscriminate indication for stenting in lesions and/or vessels with unfavourable characteristics (severe target vessel tortuosity and calcification, Type III aortic arch, and so on). On one hand, the author pleads for improvement of the excellent results of endarterectomy, by subjecting all patients planned for surgery to a thorough preoperative cardiological work up, including generous invasive investigation, thus reducing the incidence of perioperative myocardial infarction, heart failure and cardiac death. On the other hand, we are convinced that the results of carotid stenting should then be compared to best practice surgery. The rate of neurological adverse event rate after carotid endarterectomy at our institution lies under 0.7% at 30 days postoperatively. Specifically, the goal should be that carotid stenting underbids surgical endarterectomy, also and mainly, in terms of cerebral and cerebrovascular adverse events. Cardiac morbidity and mortality as well as laryngeal nerve palsy should no more be the main arguments for the percutaneous approach. This should easily be possible if patient selection for carotid revascularisation would be approached according to morphological criteria, in analogy with the “Syntax”-score used to optimise revascularisation strategies in coronary artery disease.

  11. [Internal carotid aneurysm of dysphasic origin].

    PubMed

    Ouldsalek, E; El Idrissi, R; Elfatemi, B; Zahdi, O; El Khaloufi, S; Lekehal, B; Sefiani, Y; El Mesnaoui, A; Bensaid, Y

    2014-12-01

    Extracranial carotid aneurysms are rare, but are of significant clinical interest due to the high risk of cerebral embolism. Despite considerable progress in endovascular techniques, surgical treatment of these aneurysms remains the golden standard. We report the case of a 50-year-old man who presented an aneurysm of the left internal carotid artery measuring 46 × 26 mm. Resection of the aneurysm with interposition of a prosthetic graft was performed. The postoperative course was uneventful. Pathology reported that the aneurysmal sac probably had a dysplastic origin. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. First bite syndrome following ipsilateral carotid endarterectomy.

    PubMed

    Wang, Tom Kai Ming; Bhamidipaty, Venu; MacCormick, Murray

    2013-02-01

    First bite syndrome (FBS) is characterized by unilateral pain in the parotid region after the first bite of each meal, usually following ipsilateral neck surgery. The proposed mechanism is sympathetic denervation of the parotid gland, from iatrogenic injury to the sympathetic trunk supplying this gland. Local botulinum toxin injection has emerged as a promising treatment option with favorable results. To date, there are 3 published cases in the literature describing FBS after carotid endarterectomy. We present a case of a 75-year-old gentleman who developed FBS after carotid endarterectomy, to raise the awareness of this unusual and uncommon complication.

  13. Management of Carotid Blowout from Radiation Necrosis.

    PubMed

    Gleysteen, John; Clayburgh, Daniel; Cohen, James

    2016-06-01

    Although the incidence of carotid blowout has decreased with the advent of better reconstructive techniques, it remains a real risk after major head and neck surgery, especially in an irradiated field. A systematic, multidisciplinary approach incorporating appropriate history and physical examination, adequate resuscitation, diagnostic computed tomography, and diagnostic and therapeutic angiography can manage most of these patients in a safe and effective manner. Surgery has a limited role in acute management, although surgical techniques are useful both for prevention of this problem and for wound management after carotid blowout. Published by Elsevier Inc.

  14. Transoral carotid ultrasonography using a micro convex probe with B-flow imaging for extracranial internal carotid artery dissection.

    PubMed

    Sakima, Hirokuni; Isa, Katsunori; Anegawa, Takahiro; Kokuba, Kazuhito; Nakachi, Koh; Goya, Yoshino; Tokashiki, Takashi; Ishiuchi, Shogo; Ohya, Yusuke

    2012-11-01

    We report on transoral carotid ultrasonography using a micro convex probe with B-flow imaging for determining spontaneous extracranial internal carotid artery dissection just below the petrous portion. A 49-year-old man suffered cortical and subcortical infarction in the region of the right middle cerebral artery. Magnetic resonance angiography on the third day of admission revealed spontaneous recanalization of the right internal carotid artery associated with an intimal flap-like structure at the petrous portion. Transoral carotid ultrasonography using a micro convex probe revealed right extracranial internal carotid artery dissection, showing an increased diameter of the right extracranial internal carotid artery with double lumen formation, stenosis of the true lumen, and a mobile intimal flap in B-flow imaging. Transoral carotid ultrasonography using a micro convex probe was helpful to attempt a self-expanding stent for recanalizing right extracranial internal carotid artery dissection. The patient recovered and was discharged ambulatory. The size of the micro convex probe was optimum for transoral carotid ultrasonography in our patient. Micro convex probe is more commonly used than the standard transoral carotid ultrasonography probe, which lacks versatility. We consider that transoral carotid ultrasonography using a micro convex probe could be routinely used for ultrasonographic evaluation of extracranial internal carotid artery dissection.

  15. Internal carotid false aneurysm after thermocoagulation of the gasserian ganglion.

    PubMed

    Schmerber, Sébastien; Vasdev, Ashok; Chahine, Karim; Tournaire, Romain; Bing, Fabrice

    2008-08-01

    To identify petrous internal carotid bleeding aneurysm as a complication of gasserian ganglion thermocoagulation. A single case presenting with epistaxis and otorrhagia 1 month after gasserian ganglion thermocoagulation in the treatment of refractory trigeminal neuralgia. Gasserian ganglion thermocoagulation, computed tomographic scan, and angiocomputed tomographic scan revealing petrous internal carotid ruptured aneurysm and internal carotid embolization. Radiologic diagnosis of the vascular injury after gasserian ganglion thermocoagulation. Radiologic identification of ruptured internal carotid artery as the cause of simultaneous epistaxis and otorrhagia. Gasserian ganglion thermocoagulation may cause aneurysm and rupture of the petrous portion of the internal carotid artery.

  16. Carotid body tumours. A 20-year single-institution experience.

    PubMed

    Dalainas, Ilias; Nano, Giovanni; Casana, Renato; Bianchi, Paolo; Stegher, Silvia; Malacrida, Giovanni; Tealdi, Domenico Giuseppe

    2006-01-01

    The aim of this single-institution retrospective study was to review the surgical outcomes of resection of carotid body tumours over the last 20 years in our hospital. From January 1985 to December 2004, 17 patients were admitted to our institution with carotid body tumours. All patients were treated by surgical resection of the tumour. No perioperative deaths occurred. Perioperative comorbidities were more frequent in patients with large carotid body tumours intimately associated with the carotid vessels. Surgical excision of carotid body tumours is safe and effective even in the long term.

  17. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

    PubMed Central

    Demartini Jr., Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha Jr., 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. PMID:26955353

  18. Tasting arterial blood: what do the carotid chemoreceptors sense?

    PubMed

    Prabhakhar, Nanduri R; Joyner, Michael J

    2014-01-01

    The carotid bodies are sensory organs that detect the chemical composition of the arterial blood. The carotid body sensory activity increases in response to arterial hypoxemia and the ensuing chemoreflex regulates vital homeostatic functions. Recent studies suggest that the carotid bodies might also sense arterial blood glucose and circulating insulin levels. This review focuses on how the carotid bodies sense O2, glucose, and insulin and some potential implications of these sensory functions on physiological regulation and in pathophysiological conditions. Emerging evidence suggests that carbon monoxide (CO)-regulated hydrogen sulfide (H2S), stemming from hypoxia, depolarizes type I cells by inhibiting certain K(+) channels, facilitates voltage-gated Ca(2+) influx leading to sensory excitation of the carotid body. Elevated CO and decreased H2S renders the carotid bodies insensitive to hypoxia resulting in attenuated ventilatory adaptations to high altitude hypoxia, whereas reduced CO and high H2S result in hypersensitivity of the carotid bodies to hypoxia and hypertension. Acute hypoglycemia augments the carotid body responses to hypoxia but that a prolonged lack of glucose in the carotid bodies can lead to a failure to sense hypoxia. Emerging evidence also indicates that carotid bodies might sense insulin directly independent of its effect on glucose, linking the carotid bodies to the pathophysiological consequences of the metabolic syndrome. How glucose and insulin interact with the CO-H2S signaling is an area of ongoing study.

  19. Tasting arterial blood: what do the carotid chemoreceptors sense?

    PubMed Central

    Prabhakhar, Nanduri R.; Joyner, Michael J.

    2015-01-01

    The carotid bodies are sensory organs that detect the chemical composition of the arterial blood. The carotid body sensory activity increases in response to arterial hypoxemia and the ensuing chemoreflex regulates vital homeostatic functions. Recent studies suggest that the carotid bodies might also sense arterial blood glucose and circulating insulin levels. This review focuses on how the carotid bodies sense O2, glucose, and insulin and some potential implications of these sensory functions on physiological regulation and in pathophysiological conditions. Emerging evidence suggests that carbon monoxide (CO)-regulated hydrogen sulfide (H2S), stemming from hypoxia, depolarizes type I cells by inhibiting certain K+ channels, facilitates voltage-gated Ca2+ influx leading to sensory excitation of the carotid body. Elevated CO and decreased H2S renders the carotid bodies insensitive to hypoxia resulting in attenuated ventilatory adaptations to high altitude hypoxia, whereas reduced CO and high H2S result in hypersensitivity of the carotid bodies to hypoxia and hypertension. Acute hypoglycemia augments the carotid body responses to hypoxia but that a prolonged lack of glucose in the carotid bodies can lead to a failure to sense hypoxia. Emerging evidence also indicates that carotid bodies might sense insulin directly independent of its effect on glucose, linking the carotid bodies to the pathophysiological consequences of the metabolic syndrome. How glucose and insulin interact with the CO-H2S signaling is an area of ongoing study. PMID:25642193

  20. Proteomic Profile of Unstable Atheroma Plaque: Increased Neutrophil Defensin 1, Clusterin, and Apolipoprotein E Levels in Carotid Secretome.

    PubMed

    Aragonès, Gemma; Auguet, Teresa; Guiu-Jurado, Esther; Berlanga, Alba; Curriu, Marta; Martinez, Salomé; Alibalic, Ajla; Aguilar, Carmen; Hernández, Esteban; Camara, María-Luisa; Canela, Núria; Herrero, Pol; Ruyra, Xavier; Martín-Paredero, Vicente; Richart, Cristóbal

    2016-03-04

    Because of the clinical significance of carotid atherosclerosis, the search for novel biomarkers has become a priority. The aim of the present study was to compare the protein secretion profile of the carotid atherosclerotic plaque (CAP, n = 12) and nonatherosclerotic mammary artery (MA, n = 10) secretomes. We used a nontargeted proteomic approach that incorporated tandem immunoaffinity depletion, iTRAQ labeling, and nanoflow liquid chromatography coupled to high-resolution mass spectrometry. In total, 162 proteins were quantified, of which 25 showed statistically significant differences in secretome levels between carotid atherosclerotic plaque and nondiseased mammary artery. We found increased levels of neutrophil defensin 1, apolipoprotein E, clusterin, and zinc-alpha-2-glycoprotein in CAP secretomes. Results were validated by ELISA assays. Also, differentially secreted proteins are involved in pathways such as focal adhesion and leukocyte transendothelial migration. In conclusion, this study provides a subset of identified proteins that are differently expressed in secretomes of clinical significance.

  1. [Strategy for revascularization of chronic carotid occlusion with contralateral carotid stenosis].

    PubMed

    Fukumitsu, Ryu; Yoshida, Kazumichi; Sadamasa, Nobutake; Narumi, Osamu; Chin, Masaki; Yamagata, Sen

    2010-02-01

    The optimal therapeutic approach for chronic carotid occlusion with contralateral carotid stenosis (ICO-ICS) remains uncertain. The aim of this study was to elucidate the safety and efficacy of initial vascular reconstruction for ICS in patients with ICO-ICS. Eleven patients with ICO-ICS who demonstrated severe cerebral hypoperfusion in the hemisphere ipsilateral to ICO were treated in our institution between February 2003 and November 2007. Revascularization for ICS after measuring cerebral blood flow (CBF) by single photon emission computed tomography (SPECT) was performed either by carotid endarterectomy or carotid stenting. External carotid artery-internal carotid artery (EC-IC) bypass for ICO was also performed when SPECT after revascularization for ICS still demonstrated marked hypoperfusion. In 6 patients with collateral flow via the anterior communicating artery and/or who had high-grade ICS (>70%), sufficient improvement of CBF solely by revascularization for ICS was confirmed. With regard to perioperative complications, 2 patients suffered bradycardia and hypotension and another 2 showed asymptomatic cerebral infarction on diffusion-weighted magnetic resonance imaging. Overall results for revascularization of ICS prior to that for ICO in patients with ICO-ICS were acceptable. CBF of bilateral hemispheres was sufficiently improved in more than half of the patients solely by revascularization for ICS. This strategy might be both efficient and effective for ICO-ICS.

  2. Common Carotid Artery Stump Syndrome Due to Mobile Thrombus Detected by Carotid Duplex Ultrasonography.

    PubMed

    Omoto, Shusaku; Hasegawa, Yuki; Sakai, Kenichiro; Matsuno, Hiromasa; Arai, Ayumi; Terasawa, Yuka; Mitsumura, Hidetaka; Iguchi, Yasuyuki

    2016-10-01

    Carotid stump syndrome is a cause of recurrent embolic stroke following occlusion of the ipsilateral internal carotid artery. The present report describes a case of recurrent cerebral embolism ipsilateral to a chronically occluded left common carotid artery (CCA), i.e., "CCA stump syndrome." Doppler color flow imaging showed anterograde flow in the left internal and external carotid arteries, which were supplied by collateral flow from the superior thyroid artery inflowing just proximal to the left carotid bifurcation. According to carotid duplex ultrasonography (CDU), a low-echoic mobile thrombus was noted at the distal stump of the occluded CCA, which presumably caused distal embolism. The low-echoic mobile thrombus dramatically changed to a homogenously high-echoic thrombus, and there was no recurrence of stroke after antiplatelet and anticoagulant therapy. This is the first report to demonstrate a CDU-verified temporal change in the thrombus at the stump in CCA stump syndrome. CDU is a noninvasive and useful technique to characterize hemodynamics, thrombus morphology, and the response to therapy.

  3. The relationship between carotid blood pressure reactivity to mental stress and carotid intima-media thickness.

    PubMed

    Spartano, Nicole L; Augustine, Jacqueline A; Lefferts, Wesley K; Gump, Brooks B; Heffernan, Kevin S

    2014-10-01

    Brachial blood pressure (BP) reactivity to stress predicts large artery damage and future cardiovascular (CV) events. Central BP is an emerging risk factor associated with target organ damage (TOD). Currently, little is known about the central BP response to mental stress and its association to TOD. Twenty-five healthy, non-obese adults completed a computerized mental stress test. Brachial and carotid systolic (S)BP reactivity to stress were calculated as SBP during stress minus resting SBP. Resting carotid intima-media thickness (IMT) was also measured. Carotid SBP reactivity to stress was significantly associated with carotid IMT, independent of age, sex, body mass index, non-high density lipoprotein cholesterol and brachial SBP reactivity to stress (r = 0.386, p < 0.05). The relationship between carotid SBP reactivity and carotid IMT suggests that the central BP response to stress may prove to be an early risk marker for potential subclinical TOD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Neurovascular complications following carotid body paraganglioma resection.

    PubMed

    Lamblin, E; Atallah, I; Reyt, E; Schmerber, S; Magne, J-L; Righini, C A

    2016-11-01

    The present consecutive case series reports our experience in the management of carotid body paraganglioma and aims to assess whether the Shamblin classification or tumor size are predictive of early and late postoperative neurovascular complications. A retrospective study included 54 carotid body tumor resections in 49 patients, between 1980 and 2011. Data comprised early (<1month) and late (18 months) postoperative neurovascular complications. Early postoperative complications occurred in 31 cases, including 30 cases of cranial nerve deficit (56%). Cranial nerve deficit occurred in 83% of Shamblin III carotid body paragangliomas and was associated with significantly larger mean tumor size (4±1.4cm versus 2.9±1.3cm; P<0.01). Shamblin III tumor and tumor size>3.2cm emerged as predictive factors for early postoperative peripheral neurological complications. Eight patients (17%) showed no cranial nerve deficit recovery, even after 18 months' follow-up; no predictive factors could be identified for this. Surgical resection remains the only curative treatment in carotid body paraganglioma, with low vascular morbidity. However, early postoperative nerve deficit remains frequent (56%), although mostly temporary, with 17% definitive sequelae at 18 months. Tumor size and Shamblin classification are predictive of early neurovascular complications. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Bilateral hypoplasia of the internal carotid artery

    PubMed Central

    Bhat, Dhananjaya I; Somanna, Sampath; Kovoor, Jerry ME

    2011-01-01

    Agenesis and hypoplasia of the internal carotid artery (ICA) are rare congenital anomalies, occurring in less than 0.01% of the population. We report a rare case of bilateral hypoplasia of the ICA in a patient with post-traumatic subarachnoid hemorrhage. We describe the embryological development of the cerebral vasculature and present a review of literature. PMID:22223934

  6. [Calf carotids in experimental vascular surgery].

    PubMed

    Vidal Conde, V; Muncunill Gil, J; Bernat Landoni, R; Mañosa Bonamich, J; Delgado Daza, R; Moga Donadeu, L

    1992-01-01

    Use of calf [correction of sheep] carotids maintained on 98% glycerol is described as a material of substitution of aorta and femoral arteries in the dog, in experimental surgery. Taking, maintenance and application technics of such heterografts are described. Also, histology after 24 months following the surgical procedure was studied in 10 cases of dog aortic grafts and its results are presented.

  7. Rheoreceptors in the carotid sinus of dog.

    PubMed Central

    Hajduczok, G; Chapleau, M W; Abboud, F M

    1988-01-01

    The arterial baroreceptors are known to be sensitive to changes in pressure but there are no known sensors in the cardiovascular system for changes in flow. We tested the hypothesis that changes in flow at constant pressure alter carotid sinus multi-unit nerve activity. In anesthetized dogs with vascularly isolated carotid sinuses, increases in flow at constant pressure resulted in increases in carotid sinus nerve activity in relation to the increase in flow. The increased activity during flow was not caused by an increase in strain of the sinus wall but was directly related to the increase in shear stress (36.6 +/- 11.7% increase in activity per dyne/cm2; 1 dyne = 0.1 MN). The pressure threshold of single baroreceptor units was determined during a slow pressure ramp with and without flow. Flow caused a significant decrease in pressure threshold from 81.1 +/- 6.1 mmHg (1 mmHg = 1.333 x 10(2) Pa) in the absence of flow to 69.3 +/- 5.7 mmHg with flow. We conclude that there are arterial "rheoreceptors" in the carotid sinus that respond to flow at constant pressure and strain. The results with single baroreceptor units indicate also that baroreceptors may be sensitized by increases in flow. Thus, changes in flow per se in addition to changes in arterial pressure may be important determinants of reflex circulatory adjustments. PMID:3174642

  8. Depressive symptoms and carotid intima-media thickness in South American Hispanics: results from the PREVENCION study.

    PubMed

    Chirinos, Diana A; Medina-Lezama, Josefina; Salinas-Najarro, Belissa; Arguelles, William; Llabre, Maria M; Schneiderman, Neil; Paz-Manrique, Roberto; Bolanos, Juan F; Khan, Zubair; Chirinos, Julio A

    2015-04-01

    This study aimed to: (1) examine the relationship between depressive symptoms and subclinical atherosclerosis, measured by carotid intima-media thickness (IMT); and, (2) Determine the moderating effect of gender in this relationship among South American Hispanics. We studied 496 adults enrolled in the population-based PREVENCION study. Carotid IMT was measured with high-resolution ultrasonography. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale. Mean carotid IMT was 0.66 mm. (SD = 0.17) and mean depression score was 5.6 (SD = 3.5). Depressive symptoms were not associated with carotid IMT (β = 0.04, p = 0.222) in multivariate analyses. A significant moderating effect of gender was found (β for interaction = 0.10, p = 0.030), resulting from a significant association between depressive symptoms and carotid IMT in men but not women. Depressive symptoms were associated with subclinical atherosclerosis in South American Hispanic men but not women after controlling for demographic characteristics and traditional cardiovascular risk factors.

  9. Facial pigmentation as a biomarker of carotid atherosclerosis in middle-aged to elderly healthy Japanese subjects.

    PubMed

    Miyawaki, S; Kohara, K; Kido, T; Tabara, Y; Igase, M; Miki, T; Sayama, K

    2016-02-01

    Perceived age may be a better predictor of mortality rate than chronological age. We have demonstrated that perceived age was a significant biomarker for carotid atherosclerosis in Japanese. However, it remains to be determined which skin parameter is associated with atherosclerosis. The purpose of this study is to analyze the relationship between 10 facial skin-aging parameters and atherosclerosis in 169 middle-aged to elderly Japanese women who participated. Facial photographs were taken under a shadowless lamp from three directions using a high-resolution digital camera. The digital images of each subject were analyzed using computer software and various parameters of skin aging such as pigmentation, wrinkles, and skin color were quantified. Carotid intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) were measured as indices for atherosclerosis. Facial pigmentation showed a significant correlation with carotid IMT, even after correction for age (r = 0.13, P = 0.03), and with visceral fat area. Stepwise regression analysis indicated that facial pigmentation was associated with carotid IMT via visceral fat area. Facial pigmentation may be a useful biomarker for carotid atherosclerosis in Japanese women. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Assessment of carotid plaque composition in hypertensive patients by ultrasonic tissue characterization: a validation study.

    PubMed

    Ciulla, Michele M; Paliotti, Roberta; Ferrero, Stefano; Vandone, Pierluigi; Magrini, Fabio; Zanchetti, Alberto

    2002-08-01

    Ultrasonic tissue characterization of epi-aortic vessels may be useful to define the composition of atherosclerotic plaques. Videodensitometry provides a histogram representing the frequency distribution of gray levels corresponding to different compositions of the carotid wall. However, lack of standardization limits the clinical application of this technique. In the present study, the echoreflectivity (ER) pattern of atherosclerotic plaques in vivo was compared with their histological pattern after surgical removal, and the reproducibility of measurement was tested. We studied 19 hypertensive patients with a carotid artery stenosis >or= 70%, eligible for carotid thromboendarterectomy (TEA). Before TEA, all patients underwent standard high-resolution B-mode carotid ultrasound. ER parameters (mean gray level, broad band, skewness, and kurtosis) were obtained in a region of interest selected along the whole plaque, between the intima-blood and the media-adventitia interfaces. The plaques removed during TEA were examined by a histologist and classified into three groups on the basis of fibrous tissue (FT) content: lipidic (FT < 20%), fibrolipidic (20 50%). Discriminant function analysis was used to evaluate classification efficacy of different histological groups based on ER parameters. Histologically, five lesions were classified as lipidic, six as fibrolipidic and eight as fibrous. Analysis of variance showed significant between group differences in all ER parameters. The combined use of all ER parameters provided correct classification of plaques in 94.73% of cases (P < 0.0001), improving the classification made using single parameters. Intra-observer and inter-observer variabilities (Bland-Altman method) of mean gray level measurements were small. Videodensitometry can discriminate between tissue composition of carotid lesions and complement the quantitative assessment of intima-media thickness by additionally providing a well

  11. Embolism to the brain during carotid stenting and surgery.

    PubMed

    Gossetti, B; Gattuso, R; Irace, L; Faccenna, F; Venosi, S; Bozzao, L; Fiorelli, M; Andreoli, R; Gossetti, C

    2007-01-01

    The aim of this study was to assess the prevalence and clinical relevance of microembolism in one hundred unselected patients submitted to 50 carotid endarterectomy (CEA) and 50 carotid stenting (CAS) procedures from January 2005 to January 2006 for hemodynamic lesions of the carotid bifurcation (> 70% stenosis). High-resolution Colour-Flow Mapping (CFM), Transcranial Doppler (TCD), cerebral computed tomography (CT) or magnetic resonance (MR) and four psychometric tests (Mini mental state, Beck depression inventory, Zung anxiety inventory, SF-12) were carried out in the preoperative evaluation in all the patients. In the CEAs loco-regional anesthesia (100%), patch angioplasty (84%) and Pruitt- Inahara shunt (4%) were employed; in the CASs local anesthesia (100%), three different carotid stents (Precise-Cordis, Acculink-Guidant and Carotid Wallstent-Boston Scientific) and three temporary distal filter protection devices (Angioguard-Cordis, Accunet-Guidant, Filterwire-EZ- Boston Scientific), without pre-dilatation, were employed. TCD monitoring was used intra-operatively and 12 hours post-operatively to evaluate the presence and the number of microembolic events (ME's) and to investigate the efficiency of neuroprotective filter devices. The efficacy of the in situ opened filter was judged evaluating the decrease of mean blood velocity in ipsilateral middle cerebral artery and the reduction rate of microembolic events (number of microemboli detected during the entire procedure/number of microemboli detected during the filter positioning). Diffusion-weighted magnetic resonance imaging (DWI) of the brain was obtained within 24 to 48 hours after the procedures to detect new ischemic brain lesions. Psychometric tests were repeated at the discharge of the patient and after two months to evaluate cognitive faculties. During postoperative period (30 days) and follow-up, no procedure-related death and three regressive minor strokes occurred : 1 in CEA (2%) and 2 in CASs (4

  12. Application of full field optical studies for pulsatile flow in a carotid artery phantom

    PubMed Central

    Nemati, M.; Loozen, G. B.; van der Wekken, N.; van de Belt, G.; Urbach, H. P.; Bhattacharya, N.; Kenjeres, S.

    2015-01-01

    A preliminary comparative measurement between particle imaging velocimetry (PIV) and laser speckle contrast analysis (LASCA) to study pulsatile flow using ventricular assist device in a patient-specific carotid artery phantom is reported. These full-field optical techniques have both been used to study flow and extract complementary parameters. We use the high spatial resolution of PIV to generate a full velocity map of the flow field and the high temporal resolution of LASCA to extract the detailed frequency spectrum of the fluid pulses. Using this combination of techniques a complete study of complex pulsatile flow in an intricate flow network can be studied. PMID:26504652

  13. Intracranial Carotid Calcification on Cranial Computed Tomography

    PubMed Central

    Subedi, Deepak; Zishan, Umme Sara; Chappell, Francesca; Gregoriades, Maria-Lena; Sudlow, Cathie; Sellar, Robin

    2015-01-01

    Background and Purpose— Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke. Methods— We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cranial computed tomographic scans were available electronically. Two raters measured semiautomatic quantitative Agatston score, and calcium volume, and performed qualitative visual scoring using the original 4-point Woodcock score and a modified Woodcock score, where each image on which the internal carotid arteries appeared was scored and the slice scores summed. Results— Intra- and interobserver coefficient of variations were 8.8% and 16.5% for Agatston, 8.8% and 15.5% for calcium volume, and 5.7% and 5.4% for the modified Woodcock visual score, respectively. The modified Woodcock visual score correlated strongly with both Agatston and calcium volume quantitative measures (both R2=0.84; P<0.0001); calcium volume increased by 0.47-mm/point increase in modified Woodcock visual score. Intracranial internal carotid artery calcification increased with age by all measures (eg, visual score, Spearman ρ=0.4; P=0.005). Conclusions— Visual scores correlate highly with quantitative intracranial internal carotid artery calcification measures, with excellent observer agreements. Visual intracranial internal carotid artery scores could be a rapid and practical method for epidemiological studies. PMID:26251250

  14. Management of carotid stenosis. History and today

    PubMed Central

    Jargiełło, Tomasz; Drelich-Zbroja, Anna

    2013-01-01

    Internal carotid stenosis constitutes a significant clinical challenge, since it is the cause of 20–25% of ischemic brain strokes. The management of the internal carotid stenosis for many years has been raising controversies amongst neurologists, vascular surgeons and interventional radiologists mainly due to the introduction of endovascular stenting as an alternative to surgical treatment. Its application, however, requires knowledge of specific selection criteria for this kind of treatment as well as of the methods of monitoring patients after stent implantation into the internal carotid artery. Duplex Doppler ultrasound examination is currently a basis for the diagnosis of the arterial stenosis of precranial segments of the carotid arteries. It allows a reliable assessment of not only the course and morphology of the walls, but also of the hemodynamics of blood flow. Interventional treatment is applicable in patients with internal carotid stenosis of ≥70%, which is accompanied by an increase of the systolic flow velocity above 200 cm/s and the end-diastolic velocity above 50–60 cm/s in the stenotic lumen. In most cases, such a diagnosis in duplex Doppler ultrasound examination does not require any confirmation by additional diagnostic methods and if neurological symptoms are also present, it constitutes a single indication for interventional treatment. When deciding about choice of surgical or endovascular method of treatment, the following factors are of crucial importance: morphology of atherosclerotic plaque, its size, echogenicity, homogeneity of its structure, its surface and outlines. By means of ultrasound examinations, patients can be monitored after endovascular stent implantation. They enable evaluation of the degree of stent patency and allow for an early detection of symptoms indicating stenosis recurrence or presence of in-stent thrombosis. When interpreting the findings of the US checkup, it is essential to refer to the initial examination

  15. Management of carotid stenosis. History and today.

    PubMed

    Szczerbo-Trojanowska, Małgorzata; Jargiełło, Tomasz; Drelich-Zbroja, Anna

    2013-03-01

    Internal carotid stenosis constitutes a significant clinical challenge, since it is the cause of 20-25% of ischemic brain strokes. The management of the internal carotid stenosis for many years has been raising controversies amongst neurologists, vascular surgeons and interventional radiologists mainly due to the introduction of endovascular stenting as an alternative to surgical treatment. Its application, however, requires knowledge of specific selection criteria for this kind of treatment as well as of the methods of monitoring patients after stent implantation into the internal carotid artery. Duplex Doppler ultrasound examination is currently a basis for the diagnosis of the arterial stenosis of precranial segments of the carotid arteries. It allows a reliable assessment of not only the course and morphology of the walls, but also of the hemodynamics of blood flow. Interventional treatment is applicable in patients with internal carotid stenosis of ≥70%, which is accompanied by an increase of the systolic flow velocity above 200 cm/s and the end-diastolic velocity above 50-60 cm/s in the stenotic lumen. In most cases, such a diagnosis in duplex Doppler ultrasound examination does not require any confirmation by additional diagnostic methods and if neurological symptoms are also present, it constitutes a single indication for interventional treatment. When deciding about choice of surgical or endovascular method of treatment, the following factors are of crucial importance: morphology of atherosclerotic plaque, its size, echogenicity, homogeneity of its structure, its surface and outlines. By means of ultrasound examinations, patients can be monitored after endovascular stent implantation. They enable evaluation of the degree of stent patency and allow for an early detection of symptoms indicating stenosis recurrence or presence of in-stent thrombosis. When interpreting the findings of the US checkup, it is essential to refer to the initial examination

  16. Metrics of carotid plaque-surface morphology

    NASA Astrophysics Data System (ADS)

    Yim, Peter J.; Demarco, J. Kevin

    2005-04-01

    Studies of the coronary and carotid arteries have found that plaques with irregular surfaces are more likely to produce cardiac infarction and stroke, respectively. The aim of this project was the development of methods for quantifying irregularity of plaque surface. Three metrics for quantifying surface irregularity were developed that are insensitive to variability of vessel diameter. These metrics include (1) Ratio of surface area to square-root of volume (RSASRV) (2) Mean of absolute value of minor principal curvature (MAVMPC) and (3) Radial variation within vessel cross sections (RVWVCS). For computing RVWVCS, a vessel axis was determined by Ordered Region Growing Skeletonization. RVWVCS is the within-group mean-square-error of the distance of the surface to the vessel axis where the vertices are grouped according to their match to the closest point on the vessel axis. These metrics are applied to triangulated surface of the carotid artery in the vicinity of the stenosis. The surface was reconstructed from contrast-enhanced magnetic resonance angiography by the Isosurface Deformable Model. The stenotic region was selected by manual placement of a 2-cm-long bounding box around the region, excluding the external carotid artery if necessary. The metrics were applied to three carotid arteries with a moderate degree of stenosis. These three cases exhibited mild, moderate and severe plaque-surface irregularity, respectively, as determined by visual impression. The ranking of the irregularity of the carotid arteries was in 100% agreement with visual impression for all three metrics. All three metrics should be given further consideration for quantification of plaque-surface irregularity.

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

    PubMed

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

    2016-11-01

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

  18. Anatomical Considerations on Surgical Anatomy of the Carotid Bifurcation

    PubMed Central

    Michalinos, Adamantios; Chatzimarkos, Markos; Arkadopoulos, Nikolaos; Safioleas, Michail

    2016-01-01

    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. PMID:27047690

  19. Carotid baroreflex responsiveness in heat-stressed humans

    NASA Technical Reports Server (NTRS)

    Crandall, C. G.

    2000-01-01

    The effects of whole body heating on human baroreflex function are relatively unknown. The purpose of this project was to identify whether whole body heating reduces the maximal slope of the carotid baroreflex. In 12 subjects, carotid-vasomotor and carotid-cardiac baroreflex responsiveness were assessed in normothermia and during whole body heating. Whole body heating increased sublingual temperature (from 36.4 +/- 0.1 to 37.4 +/- 0.1 degrees C, P < 0.01) and increased heart rate (from 59 +/- 3 to 83 +/- 3 beats/min, P < 0. 01), whereas mean arterial blood pressure (MAP) was slightly decreased (from 88 +/- 2 to 83 +/- 2 mmHg, P < 0.01). Carotid-vasomotor and carotid-cardiac responsiveness were assessed by identifying the maximal gain of MAP and heart rate to R wave-triggered changes in carotid sinus transmural pressure. Whole body heating significantly decreased the responsiveness of the carotid-vasomotor baroreflex (from -0.20 +/- 0.02 to -0.13 +/- 0.02 mmHg/mmHg, P < 0.01) without altering the responsiveness of the carotid-cardiac baroreflex (from -0.40 +/- 0.05 to -0.36 +/- 0.02 beats x min(-1) x mmHg(-1), P = 0.21). Carotid-vasomotor and carotid-cardiac baroreflex curves were shifted downward and upward, respectively, to accommodate the decrease in blood pressure and increase in heart rate that accompanied the heat stress. Moreover, the operating point of the carotid-cardiac baroreflex was shifted closer to threshold (P = 0.02) by the heat stress. Reduced carotid-vasomotor baroreflex responsiveness, coupled with a reduction in the functional reserve for the carotid baroreflex to increase heart rate during a hypotensive challenge, may contribute to increased susceptibility to orthostatic intolerance during a heat stress.

  20. Carotid baroreflex responsiveness in heat-stressed humans

    NASA Technical Reports Server (NTRS)

    Crandall, C. G.

    2000-01-01

    The effects of whole body heating on human baroreflex function are relatively unknown. The purpose of this project was to identify whether whole body heating reduces the maximal slope of the carotid baroreflex. In 12 subjects, carotid-vasomotor and carotid-cardiac baroreflex responsiveness were assessed in normothermia and during whole body heating. Whole body heating increased sublingual temperature (from 36.4 +/- 0.1 to 37.4 +/- 0.1 degrees C, P < 0.01) and increased heart rate (from 59 +/- 3 to 83 +/- 3 beats/min, P < 0. 01), whereas mean arterial blood pressure (MAP) was slightly decreased (from 88 +/- 2 to 83 +/- 2 mmHg, P < 0.01). Carotid-vasomotor and carotid-cardiac responsiveness were assessed by identifying the maximal gain of MAP and heart rate to R wave-triggered changes in carotid sinus transmural pressure. Whole body heating significantly decreased the responsiveness of the carotid-vasomotor baroreflex (from -0.20 +/- 0.02 to -0.13 +/- 0.02 mmHg/mmHg, P < 0.01) without altering the responsiveness of the carotid-cardiac baroreflex (from -0.40 +/- 0.05 to -0.36 +/- 0.02 beats x min(-1) x mmHg(-1), P = 0.21). Carotid-vasomotor and carotid-cardiac baroreflex curves were shifted downward and upward, respectively, to accommodate the decrease in blood pressure and increase in heart rate that accompanied the heat stress. Moreover, the operating point of the carotid-cardiac baroreflex was shifted closer to threshold (P = 0.02) by the heat stress. Reduced carotid-vasomotor baroreflex responsiveness, coupled with a reduction in the functional reserve for the carotid baroreflex to increase heart rate during a hypotensive challenge, may contribute to increased susceptibility to orthostatic intolerance during a heat stress.

  1. Micro-CT of Carotid Arteries: A Tool for Experimental Studies

    SciTech Connect

    Mohr, Andreas; Wenke, Ruediger; Roemer, Frank W.; Lynch, John A.; Gatzka, Christian; Priebe, Markus; Guermazi, Ali; Grigorian, Mikayel; Heller, Martin; Mueller-Huelsbeck, Stefan

    2004-11-15

    Micro-computed tomography (micro-CT) is a high-resolution, nondestructive tool for two- and three-dimensional imaging and quantification. The ability of this technique to assess atherosclerosis of the carotid artery was evaluated in three human cadaver samples based on the original axial acquisitions, multiplanar reconstructions and volume rendering techniques. Quantitative analysis included the calculation of: (1) the original lumen perimeter, original lumen area, plaque area, residual lumen area, calcified area and gross sectional area reduction of the vascular lumen from two-dimensional slices; (2) the total tissue volume, soft tissue volume and calcified tissue volume from the three-dimensional data set. This preliminary study demonstrates the potential of micro-CT as a supplementary method for the two- and three-dimensional ex vivo evaluation of carotid atherosclerosis.

  2. Recurrent syncope caused by compression of internal carotid artery by an anomalous hyoid bone.

    PubMed

    Janczak, Dariusz; Skora, Jan; Rucinski, Artur; Szuba, Andrzej

    2012-05-01

    In rare cases a syncope can be caused by compression or irritation of the carotid artery and the carotid sinus due to congenital anatomical anomalies of cervical structures like the hyoid bone. We present the case a of 36 year old man with recurrent syncopes when turning his head. Clinical investigations revealed a hyoid bone anomaly with elongated lesser cornua, especially on the right symptomatic side. Surgical resection of the right lesser cornu led to complete resolution of symptoms over a two year follow-up. Syncope especially in younger subjects may be caused by congenital anomalies of the musculoskeletal system in the cervical region and should be considered in the differential diagnosis of syncope, transient cerebral ischemia and stroke.

  3. Speckle noise removal applied to ultrasound image of carotid artery based on total least squares model.

    PubMed

    Yang, Lei; Lu, Jun; Dai, Ming; Ren, Li-Jie; Liu, Wei-Zong; Li, Zhen-Zhou; Gong, Xue-Hao

    2016-10-06

    An ultrasonic image speckle noise removal method by using total least squares model is proposed and applied onto images of cardiovascular structures such as the carotid artery. On the basis of the least squares principle, the related principle of minimum square method is applied to cardiac ultrasound image speckle noise removal process to establish the model of total least squares, orthogonal projection transformation processing is utilized for the output of the model, and the denoising processing for the cardiac ultrasound image speckle noise is realized. Experimental results show that the improved algorithm can greatly improve the resolution of the image, and meet the needs of clinical medical diagnosis and treatment of the cardiovascular system for the head and neck. Furthermore, the success in imaging of carotid arteries has strong implications in neurological complications such as stroke.

  4. Flow and distension in the carotid artery from magnetic resonance imaging

    NASA Astrophysics Data System (ADS)

    Yim, Peter J.; Demarco, J. K.

    2004-04-01

    Hemodynamic conditions in the carotid artery may be associated with progression of carotid artery (CA) disease and with the risk of stroke. A methodology for objective measurement of distension (DCA) and blood-flow (QCA) waveform from phase-contrast (PC) magnetic resonance (MR) imaging is presented. Measurement of DCA is obtained using a modified Hough Transform (mHT) applied to the magnitude-component of the PC MR. The mHT is based on the optimization of an objective function which is the sum of the gradient magnitude of the image sampled at 10° increments around the circle using bilinear interpolation. The mHT detects the boundary of the vessel in the cross-sectional image at 0.05-pixel resolution. Measurement of QCA is obtained by integration of the image intensity in the phase-component of the PC MR within the circular region detected by the mHT.

  5. Fetal carotid blood flow during videofetoscopy.

    PubMed

    Fauza, D O; Fishman, S J

    1998-12-01

    Intracranial bleeding has been reported as one of the complications of both open and minimally invasive fetal surgery and putatively attributed to intraoperative fluctuations of carotid blood flow. The aim of this study was to look at fetal carotid blood flow and its relationship with umbilical blood flow, blood pressure, oxygen delivery, and acid-base status in the fetus at various intraamniotic pressures with both liquid and gas media during fetoscopic surgery. Six 115- to 130-day-gestation ewes underwent continuous invasive systemic blood pressure monitoring in the descending aorta. A hysterotomy was performed. A 6-mm ultrasonic blood flow probe was placed around the common umbilical artery at its origin from the fetal aorta. This was followed by placement of a double-lumen, 4F catheter in the fetal descending aorta through a femoral artery. A 4-mm ultrasonic blood flow probe was then placed around the fetal left common carotid artery. A pressure-monitoring, multiperforated catheter was placed inside the amniotic cavity. The fetus was repositioned inside the uterus, which was then closed. The abdominal wall was closed loosely. No further manipulation was performed for 1 hour. Intraamniotic pressure was raised from 0 to 30 mm Hg at 5-mm Hg intervals by infusing either warmed saline or medical air. Common umbilical artery and left carotid artery blood flows, blood pressure, blood gases, bicarbonate, sodium, and hematocrit were recorded in all fetuses at each 5-mm Hg interval. Maternal systemic blood pressure, O2 saturation, and temperature were kept constant. Carotid blood flow remained stable within the intra-amniotic pressure range studied (0 to 30 mm Hg), despite the significant drop in common umbilical artery blood flow uniformly observed above 20 mm Hg when saline was infused and above 15 mm Hg when air was infused. There was fetal hypoxemia and hypercarbia concomitant with decreased common umbilical artery blood flow (however, without fetal acidosis, because

  6. Micro-CT Technique Is Well Suited for Documentation of Remodeling Processes in Murine Carotid Arteries

    PubMed Central

    Schürmann, Christoph; Gremse, Felix; Jo, Hanjoong; Kiessling, Fabian; Brandes, Ralf P.

    2015-01-01

    Background The pathomechanisms of atherosclerosis and vascular remodelling are under intense research. Only a few in vivo tools to study these processes longitudinally in animal experiments are available. Here, we evaluated the potential of micro-CT technology. Methods Lumen areas of the common carotid arteries (CCA) in the ApoE-/- partial carotid artery ligation mouse model were compared between in vivo and ex vivo micro-CT technique and serial histology in a total of 28 animals. AuroVist-15 nm nanoparticles were used as in vivo blood pool contrast agent in a Skyscan 1176 micro-CT at resolution of 18 μmeter voxel size and a mean x-ray dose of 0.5 Gy. For ex vivo imaging, animals were perfused with MicroFil and imaged at 9 μmeter voxel size. Lumen area was evaluated at postoperative days 7, 14, and 28 first by micro-CT followed by histology. Results In vivo micro-CT and histology revealed lumen loss starting at day 14. The lumen profile highly correlated (r = 0.79, P<0.0001) between this two methods but absolute lumen values obtained by histology were lower than those obtained by micro-CT. Comparison of in vivo and ex vivo micro-CT imaging revealed excellent correlation (r = 0.83, P<0.01). Post mortem micro-CT yielded a higher resolution than in vivo micro-CT but there was no statistical difference of lumen measurements in the partial carotid artery ligation model. Conclusion These data demonstrate that in vivo micro-CT is a feasible and accurate technique with low animal stress to image remodeling processes in the murine carotid artery. PMID:26086218

  7. Is carotid sonography a useful tool for predicting functional capabilities in ischemic stroke patients following carotid artery stenting?

    PubMed Central

    Lin, Chih-Ming; Su, Jian-Chi; Chang, Yu-Jun; Liu, Chi-Kuang; Lu, Henry Horng-Shing; Jong, Yuh-Jyh

    2017-01-01

    Abstract Carotid stenosis is a major cause of stroke and timely intervention with stenting manipulation can significantly reduce the risk of secondary stroke. The impact of stenting procedures on patient functional capabilities has not yet been explored. The primary aim of this study was to examine associations between periprocedural carotid sonography parameters and post-treatment functional capabilities in stroke patients. Sixty-seven patients who received carotid stenting at 1 angiography laboratory were included. Prestenting and poststenting carotid duplex data were recorded and resistance index (RI) differences at various carotid system locations were compared. The modified Rankin Scale (mRS) was used to assess functional capability. All of the studied parameters were analyzed by SPSS (version 16.0, SPSS Inc, Chicago, IL). Following stenting, mRS scores improved (n = 44) or remained stationary (n = 23). Net contralateral internal carotid artery (ICA) RI for patients with improved mRS was lower compared to that for patients with stationary mRS (median = 0.040 vs 0.11; P = 0.003). The contralateral common carotid artery RI before and after stenting differed significantly (P < 0.050) in both. The ipsilateral ICA RI differed (P < 0.050) only in patients with improved mRS. The difference in mean transit time, Barthel index, net ipsilateral ICA RI, net contralateral external carotid artery RI, postipsilateral common carotid artery RI, and postipsilateral ICA RI differed significantly between different baseline stroke severity groups (P < 0.050). Carotid artery stenting improved physical function in a proportion of ischemic stroke patients with carotid stenosis. Carotid ultrasound is a useful assessment tool to predict likely functional outcomes following carotid artery stenting. PMID:28328821

  8. Effective intraluminal shunt in carotid endarterectomy for carotid artery near occlusion: A technical report.

    PubMed

    Kawamura, Yoichiro; Maruyama, Daisuke; Akagi, Yojiro; Iihara, Koji

    2017-07-21

    Carotid artery near occlusion is a critical degree of stenosis whereby blood flow is decreased and the distal cervical and intracranial internal carotid arteries (ICAs) are prone to collapse. Considering the diminished perfusion and the risk of progression to total occlusion and periocclusive embolism, we performed carotid endarterectomy (CEA) for carotid artery near occlusion. Accurate evaluation of tandem stenosis or patency of the post-stenotic ICA in carotid artery near occlusion is often difficult preoperatively. Thus, we performed CEA in a hybrid operating room where intraoperative digital subtraction angiography (DSA) and endovascular angioplasty or stenting for distal lesions can be performed if necessary. In addition, to evaluate the distal ICA intraoperatively, we used an intraluminal shunt for shunt angiography, with injection of contrast material through the shunt tube, as a replacement for conventional DSA. Furthermore, an intraluminal shunt held the collapsed lumen open and provided a scaffold for suturing, which prevented postoperative stenosis of the distal ICA. The present report is intended to underline the merits of intraluminal shunt as a replacement for conventional DSA and as a scaffold for suturing. Copyright © 2017. Published by Elsevier Inc.

  9. An internal carotid artery aneurysm presenting with dysarthria.

    PubMed

    Davey, P T; Rychlik, I; O'Donnell, M; Baker, R; Rennie, I

    2013-10-01

    A 72-year-old woman presented to her general practitioner with a 4-week history of right neck swelling. Clinical examination elicited a pulsatile mass consistent with a carotid artery aneurysm. Five days later the patient noticed her tongue movements had become awkward with associated dysarthria. Computed tomography confirmed a 4cm internal carotid artery aneurysm arising just distally to the carotid bifurcation. She proceeded to transfemoral diagnostic carotid angiography. Balloon occlusion of the right internal carotid artery origin was performed for a ten-minute period without any neurological deficit. The decision was taken to proceed to surgical ligation of the origin of the internal carotid artery. Her symptoms of dysarthria have resolved.

  10. Sexual asphyxia causing blunt carotid artery injury and Horner's syndrome.

    PubMed

    Muddaiah, A; Banigo, A; Galli, F; Latif, M A

    2012-12-01

    To highlight a rare cause of Horner's syndrome, and to review the management of blunt carotid artery injury. Literature search via PubMed for related articles. Horner's syndrome and blunt carotid artery injury are rare phenomena; sexual asphyxia as a cause has not previously been reported. This case is also the first of its kind to have radiological evidence of injury to the external carotid artery but not the internal carotid artery. In Horner's syndrome, additional symptoms of ipsilateral headache or neck pain, tinnitus, or any cerebral ischaemic symptoms should raise suspicion of blunt carotid injury. Blunt carotid artery injury is a potentially fatal condition and can present without radiological evidence. Early recognition and management with anticoagulants or antiplatelet drugs is crucial to prevent mortality and morbidity.

  11. Carbon monoxide: a role in carotid body chemoreception.

    PubMed

    Prabhakar, N R; Dinerman, J L; Agani, F H; Snyder, S H

    1995-03-14

    Carbon monoxide (CO), produced endogenously by heme oxygenase, has been implicated as a neuronal messenger. Carotid bodies are sensory organs that regulate ventilation by responding to alterations of blood oxygen, CO2, and pH. Changes in blood gases are sensed by glomus cells in the carotid body that synapse on afferent terminals of the carotid sinus nerve that projects to respiratory-related neurons in the brainstem. Using immunocytochemistry, we demonstrate that heme oxygenase 2 is localized to glomus cells in the cat and rat carotid bodies. Physiological studies show that zinc protoporphyrin IX, a potent heme oxygenase inhibitor, markedly increases carotid body sensory activity, while copper protoporphyrin IX, which does not inhibit the enzyme, is inactive. Exogenous CO reverses the stimulatory effects of zinc protoporphyrin IX. These results suggest that glomus cells are capable of synthesizing CO and endogenous CO appears to be a physiologic regulator of carotid body sensory activity.

  12. Estimation of Stiffness Parameter on the Common Carotid Artery

    NASA Astrophysics Data System (ADS)

    Koya, Yoshiharu; Mizoshiri, Isao; Matsui, Kiyoaki; Nakamura, Takashi

    The arteriosclerosis is on the increase with an aging or change of our living environment. For that reason, diagnosis of the common carotid artery using echocardiogram is doing to take precautions carebropathy. Up to the present, several methods to measure stiffness parameter of the carotid artery have been proposed. However, they have analyzed at the only one point of common carotid artery. In this paper, we propose the method of analysis extended over a wide area of common carotid artery. In order to measure stiffness parameter of common carotid artery from echocardiogram, it is required to detect two border curves which are boundaries between vessel wall and blood. The method is composed of two steps. The first step is the detection of border curves, and the second step is the calculation of stiffness parameter using diameter of common carotid artery. Experimental results show the validity of the proposed method.

  13. Symptomatic carotid ischaemic events: safest and most cost effective way of selecting patients for angiography, before carotid endarterectomy.

    PubMed Central

    Hankey, G J; Warlow, C P

    1990-01-01

    OBJECTIVE: To determine the safest, least costly, and most effective way to select patients with symptomatic carotid ischaemic events for carotid angiography before carotid endarterectomy. DESIGN: Prospective cohort study. SETTING: University departments of clinical neurosciences and clinical neurology. PATIENTS: 485 Patients with carotid territory transient ischaemic attacks of the brain (n = 224) or eye (n = 162) or retinal infarction (n = 99) were referred to a single neurologist between 1976 and 1986. INTERVENTIONS: Clinical examination by auscultation over the precordium, supraclavicular fossae, and neck vessels (all patients). Cerebral angiography of patients suitable for carotid endarterectomy. MAIN OUTCOME MEASURES: Financial cost and number of disabling strokes after angiography. RESULTS: 296 Patients were investigated by cerebral angiography. Ischaemic symptoms had occurred in the distribution of 298 internal carotid arteries (symptomatic) that were imaged, two patients having bilateral symptoms. The presence or absence of a carotid bruit and the maximum percentage diameter stenosis of the origin of the symptomatic internal carotid artery were correlated. The prevalence of mild disease (diameter stenosis greater than or equal to 25%) of the symptomatic internal carotid artery was 57%, and if an ipsilateral carotid bruit was heard the probability of mild stenosis rose to 92%. The prevalence of moderate disease of the symptomatic internal carotid artery (stenosis greater than or equal to 50%) was 39%, and if a bruit was heard the probability doubled to 78%. The prevalence of severe internal carotid disease (stenosis greater than or equal to 75%) was 22%, and if a bruit was heard the probability was more than double, at 49%. The direct cost to both the NHS and the private health sector of investigating patients with symptomatic carotid ischaemia was estimated for several strategies of carotid artery imaging and expressed in terms of financial cost and number

  14. [An unusual case of carotid arrosion bleeding].

    PubMed

    Zengel, P; Mees, K; Müller-Schunk, S; Suckfüll, M

    2009-11-01

    Carotid bleeding is one of the most severe complications in ear, nose and throat (ENT) surgery. It is a rare complication in patients with cancer of the head and neck after radiochemotherapy. We report the case of a 65-year-old man who suffered from cancer of the tonsils (pT2pN1M0) and was treated in 1987 with surgery and local chemotherapy. Since then he reported recurrent bleeding in the left cervical region especially during physical exertion. The patient was re-operated and during surgery the tip of a catheter was found in the external carotid artery, obviously a remnant from a catheter for intra-arterial chemotherapy. The tip was removed, the defect closed and covered with a pectoralis major muscle flap.

  15. Review of stents for the carotid artery.

    PubMed

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

    2006-04-01

    The individual characteristics of a stent may make it an attractive choice in some circumstances, but render it a less desirable option in others. The applicability depends primarily on the arterial anatomy and the specific details of the lesion being treated. A careful assessment by the interventionalist is required to select the proper type of stent that is of appropriate size. Certainly, personal preferences and familiarity with a specific device may legitimately influence the decision to choose one stent over another. Finally, stent design can play a role in the selection procedure. Although carotid stents are often functionally equivalent in the clinical setting and have been used successfully to treat a wide variety of lesions, a basic knowledge of stent geometry can contribute to make up your mind in certain carotid cases.

  16. The Development of Carotid Stent Material

    PubMed Central

    He, Dongsheng; Liu, Wenhua; Zhang, Tao

    2015-01-01

    Endovascular angioplasty with stenting is a promising option for treating carotid artery stenosis. There exist a rapidly increasing number of different stent types with different materials. The bare-metal stent is the most commonly used stent with acceptable results, but it leaves us with the problems of thrombosis and restenosis. The drug-eluting stent is a breakthrough as it has the ability to reduce the restenosis rate, but the problem of late thrombosis still has to be addressed. The biodegradable stent disappears after having served its function. However, restenosis and degradation rates remain to be studied. In this article, we review every stent material with its characteristics, clinical results and complications and point out the standards of an ideal carotid stent. PMID:26019710

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

    PubMed

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

    1985-01-01

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

  18. Carotid Baroreflex Activation: Past, Present, and Future

    PubMed Central

    Scheffers, Ingrid J. M.; Kroon, Abraham A.

    2010-01-01

    Electrical activation of the carotid baroreceptor system is an attractive therapy for the treatment of resistant hypertension. In the past, several attempts were made to directly activate the baroreceptor system in humans, but the method had to be restricted to a few selected patients. Adverse effects, the need for better electrical devices and better surgical techniques, and the lack of knowledge about long-term effects has greatly hampered developments in this area for many years. Recently, a new and promising device was evaluated in a multicenter feasibility trial, which showed a clinically and statistically significant reduction in office systolic blood pressure (>20 mm Hg). This reduction could be sustained for at least 2 years with an acceptable safety profile. In the future, this new device may stimulate further application of electrical activation of the carotid baroreflex in treatment-resistant hypertension. PMID:20424959

  19. Management of infected carotid artery rupture.

    PubMed

    Liu, Jie; Zeng, Quan; Huang, Jiang-Ju; Hu, Guo-Hua

    2014-06-01

    Carotid artery rupture (CAR) is a life-threatening complication of head and neck cancer, and infection complicates its management. The purpose of this study was to review our experience with the treatment of infected CAR and to summarize the existing literature on this topic. We retrospectively reviewed the medical records of patients treated in our department from 2000 to 2011 and re-analyzed cases reported in the literature during the same time period. We analyzed etiology, anatomic location, treatment, and rates of recurrent hemorrhage for each case. A total of 46 episodes of infected CAR occurred in the four patients in our own records and 27 patients described in the literature. Twenty-eight patients suffered from various head and neck cancers and underwent surgical resection, and 27 of them subsequently received radiotherapy or radiotherapy combined with chemotherapy (the 28th patient died before radiotherapy due to severe blood loss). The most common site of bleeding was the common carotid artery (33/46, 71.7%). Seventeen cases (17/45, 37.8%) were treated with surgical ligation, 20 (44.4%) with stent placement, and 7 (15.6%) with embolization. Surgical ligation had a lower rate of recurrent bleeding (2/17, 11.8%) than stent placement (12/20, 60.0%) when used for the treatment of infected CAR (P = 0.037, Chi squared test). Our results suggest that surgical ligation is an effective option in the management of infected CAR and may be the best choice to prevent recurrent hemorrhage. The complication rates, however, may be high when the common carotid or the internal carotid arteries are ligated.

  20. Are Carotid Stent Fractures Clinically Significant?

    SciTech Connect

    Garcia-Toca, Manuel; Rodriguez, Heron E.; Naughton, Peter A.; Keeling, Aiofee; Phade, Sachin V.; Morasch, Mark D.; Kibbe, Melina R.; Eskandari, Mark K.

    2012-04-15

    Purpose: Late stent fatigue is a known complication after carotid artery stenting (CAS) for cervical carotid occlusive disease. The purpose of this study was to determine the prevalence and clinical significance of carotid stent fractures. Materials and Methods: A single-center retrospective review of 253 carotid bifurcation lesions treated with CAS and mechanical embolic protection from April 2001 to December 2009 was performed. Stent integrity was analyzed by two independent observers using multiplanar cervical plain radiographs with fractures classified into the following types: type I = single strut fracture; type II = multiple strut fractures; type III = transverse fracture; and type IV = transverse fracture with dislocation. Mean follow-up was 32 months. Results: Follow-up imaging was completed on 106 self-expanding nitinol stents (26 closed-cell and 80 open-cell stents). Eight fractures (7.5%) were detected (type I n = 1, type II n = 6, and type III n = 1). Seven fractures were found in open-cell stents (Precise n = 3, ViVEXX n = 2, and Acculink n = 2), and 1 fracture was found in a closed-cell stent (Xact n = 1) (p = 0.67). Only a previous history of external beam neck irradiation was associated with fractures (p = 0.048). No associated clinical sequelae were observed among the patients with fractures, and only 1 patient had an associated significant restenosis ({>=}80%) requiring reintervention. Conclusions: Late stent fatigue after CAS is an uncommon event and rarely clinically relevant. Although cell design does not appear to influence the occurrence of fractures, lesion characteristics may be associated risk factors.

  1. 3D carotid plaque MR Imaging

    PubMed Central

    Parker, Dennis L.

    2015-01-01

    SYNOPSIS There has been significant progress made in 3D carotid plaque magnetic resonance imaging techniques in recent years. 3D plaque imaging clearly represents the future in clinical use. With effective flow suppression techniques, choices of different contrast weighting acquisitions, and time-efficient imaging approaches, 3D plaque imaging offers flexible imaging plane and view angle analysis, large coverage, multi-vascular beds capability, and even can be used in fast screening. PMID:26610656

  2. Surgery for paraclinoidal carotid artery aneurysms.

    PubMed

    Batjer, H H; Kopitnik, T A; Giller, C A; Samson, D S

    1994-04-01

    Aneurysms arising from the proximal carotid artery between the roof of the cavernous sinus and the origin of the posterior communicating artery pose conceptual and technical surgical problems with regard to acquisition of proximal control and safe intracranial exposure. Over the past 3 1/2 years, 89 patients with paraclinoidal aneurysms have been treated at the University of Texas Southwestern Medical Center. Thirty-nine (44%) of these patients presented with subarachnoid hemorrhage. A total of 149 aneurysms and six arteriovenous malformations have been identified in this patient group such that 38 (43%) of the patients suffered multiple vascular anomalies. Temporary artery occlusion has been employed during operation in 48 cases (54%), permanent carotid artery occlusion in four (4%), and hypothermic circulatory arrest in two (2%). Twenty-two patients harbored giant aneurysms, seven of which had ruptured. Outcome was considered good in 77 patients (86.5%), fair in eight (9%), and poor in three (3%); one patient died. This concentrated experience permitted a practical anatomical grouping of aneurysms into three types: carotid-ophthalmic artery aneurysms with a superior or superomedial projection (44 cases); superior hypophyseal aneurysms with a medial or inferomedial projection (26 cases); and proximal posterior carotid artery wall aneurysms projecting posteriorly or posterolaterally (19 cases). Despite the fact that paraclinoidal aneurysms often disobey the traditional teachings of aneurysm development, having no vessel of origin or clear hemodynamic cause, this practical grouping has allowed individualized and focused operative approaches unique to each aneurysm projection with good visual function and outcome in most patients.

  3. Cranial nerve injuring during carotid endarterectomy.

    PubMed Central

    Verta, M J; Applebaum, E L; McClusky, D A; Yao, J S; Bergan, J J

    1977-01-01

    Injury to the greater auricular, hypoglossal and superior laryngeal nerves during carotid endarterectomy is preventable. A knowledge of regional anatomy and the mechanisms of such injury allows prevention of this complication. Unilateral individual nerve injury is generally well tolerated, but bilateral or combined nerve injuries can pose a serious threat to life. Minor modifications in technique aid greatly in avoiding nerve injury. Images Fig. 1. PMID:836092

  4. Acute carotid baroreflex resetting in conscious dogs.

    PubMed Central

    Tan, W; Zucker, I H

    1989-01-01

    1. Acute baroreflex resetting in the control of arterial pressure was studied in six chronically instrumented, conscious dogs. Following aortic baroreceptor denervation, the carotid sinuses were surgically prepared for reversible vascular isolation. 2. During the experiments both carotid sinuses were temporarily isolated from the systemic circulation and conditioned with a pulsatile pressure. The carotid sinus conditioning pressure (CPCSP) was at a level of 100, 140 or 60 mmHg for 20 min each. Carotid sinus pressure (CSP) versus mean arterial pressure (MAP) baroreflex curves were constructed after each conditioning period. 3. The baroreflex curves were shifted downward and to the left at low CPCSP and upward and to the right at high CPCSP. 4. We used four parameters to quantify baroreflex resetting. These were: (1) the set point pressure (PSP), (2) the threshold pressure (PTh), (3) BP50 or mid-point pressure and (4) the CSP at maximum gain (PGmax). At high CPCSP, these four parameters were increased by 18.5 +/- 4.0, 23.4 +/- 4.3, 21.7 +/- 5.0 and 22.0 +/- 5.1 mmHg, respectively (P less than 0.05). 5. Resetting was not complete in these studies. The extent of resetting was approximately 50% for upward and 35% for downward baroreflex conditioning. 6. Analysis of the present experimental data indicates that when the cardiovascular system is exposed to a short-term hyper- or hypotension, the baroreflex is capable of correcting the baseline arterial pressure while preserving its ability to buffer transient disturbances as a result of partial resetting. PMID:2607463

  5. Aterofisiol(®) in carotid plaque evolution.

    PubMed

    Amato, Bruno; Compagna, Rita; Amato, Maurizio; Gallelli, Luca; de Franciscis, Stefano; Serra, Raffaele

    2015-01-01

    In patients with carotid stenosis, the risk of plaque rupture is related to the composition of the atherosclerotic plaque rather than to its magnitude. In this regard, we evaluated the effects of a supplement, Aterofisiol,(®) containing omega-3 (EPA [eicosapen acid] DHA [docosahexaenoic acid]), vitamin K2, vitamin B6, vitamin B12, oligomeric proanthocyanidins (OPC) and resveratrol on the composition of atherosclerotic plaque and on neurological symptoms in patients with carotid stenosis undergoing carotid endarterectomy. The study was randomized, prospective, and double-blinded. Eligible patients were of both sexes, with carotid stenosis >70% who underwent endarterectomy. Enrolled patients were randomly allocated to receive either one tablet of acetylsalicylic acid 100 mg (Cardioaspirin(®)) + one tablet of Aterofisiol every 24 hours or one tablet of Cardioaspirin + one tablet of placebo every 24 hours. Each treatment was started 30 days before the surgery and was stopped 5 days before the surgery. The plaques were removed "en bloc" using standard surgical technique. During the study period, 214 patients (135 men and 79 women) were enrolled for intent-to-treat and randomized in two groups: Group A: 107 patients (68 men and 39 women) were treated with Cardioaspirin + Aterofisiol. Group B: 107 patients (67 men and 40 women) were treated with Cardioaspirin + placebo. At the end of the study, 202 patients participated fully (103 patients in Group A and 99 patients in Group B), making up the protocol evaluation population (94.4%). The mean lipid content of removed plaques was significantly lower (P<0.05) in Group A. We recorded a significantly lower incidence of neurological symptoms in Group A in comparison with Group B (P<0.05). In the study, Aterofisiol showed to be effective in reducing the amounts of cholesterol and lipids in the plaques and in reducing adverse neurological events in the study group with respect to controls.

  6. Aterofisiol® in carotid plaque evolution

    PubMed Central

    Amato, Bruno; Compagna, Rita; Amato, Maurizio; Gallelli, Luca; de Franciscis, Stefano; Serra, Raffaele

    2015-01-01

    Background In patients with carotid stenosis, the risk of plaque rupture is related to the composition of the atherosclerotic plaque rather than to its magnitude. In this regard, we evaluated the effects of a supplement, Aterofisiol,® containing omega-3 (EPA [eicosapen acid] DHA [docosahexaenoic acid]), vitamin K2, vitamin B6, vitamin B12, oligomeric proanthocyanidins (OPC) and resveratrol on the composition of atherosclerotic plaque and on neurological symptoms in patients with carotid stenosis undergoing carotid endarterectomy. Methods The study was randomized, prospective, and double-blinded. Eligible patients were of both sexes, with carotid stenosis >70% who underwent endarterectomy. Enrolled patients were randomly allocated to receive either one tablet of acetylsalicylic acid 100 mg (Cardioaspirin®) + one tablet of Aterofisiol every 24 hours or one tablet of Cardioaspirin + one tablet of placebo every 24 hours. Each treatment was started 30 days before the surgery and was stopped 5 days before the surgery. The plaques were removed “en bloc” using standard surgical technique. Results During the study period, 214 patients (135 men and 79 women) were enrolled for intent-to-treat and randomized in two groups: Group A: 107 patients (68 men and 39 women) were treated with Cardioaspirin + Aterofisiol. Group B: 107 patients (67 men and 40 women) were treated with Cardioaspirin + placebo. At the end of the study, 202 patients participated fully (103 patients in Group A and 99 patients in Group B), making up the protocol evaluation population (94.4%). The mean lipid content of removed plaques was significantly lower (P<0.05) in Group A. We recorded a significantly lower incidence of neurological symptoms in Group A in comparison with Group B (P<0.05). Conclusion In the study, Aterofisiol showed to be effective in reducing the amounts of cholesterol and lipids in the plaques and in reducing adverse neurological events in the study group with respect to controls

  7. Comparative Review of the Treatment Methodologies of Carotid Stenosis

    PubMed Central

    Bae, Coney; Szuchmacher, Mauricio; Chang, John B.

    2015-01-01

    The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Trial (ACST) trials. When CAS is compared with CEA, the CREST resulted in similar rates of ipsilateral stroke and death rates regardless of symptoms. However, CAS not only increased adverse effects in women, it also amplified stroke rates and death in elderly patients compared with CEA. CAS can maximize its utility in treating focal restenosis after CEA and patients with overwhelming cardiac risk or prior neck irradiation. When performing CEA, using a patch was equated to a more durable result than primary closure, whereas eversion technique is a new methodology deserving a spotlight. Comparing the three major treatment strategies of carotid stenosis has intrinsic drawbacks, as most trials are outdated and they vary in their premises, definitions, and study designs. With the newly codified best medical management including antiplatelet therapies with aspirin and clopidogrel, statin, antihypertensive agents, strict diabetes control, smoking cessation, and life style change, the current trials may demonstrate that asymptomatic carotid stenosis is best treated with best medical therapy. The ongoing trials will illuminate and reshape the treatment paradigm for symptomatic and asymptomatic carotid stenosis. PMID:26417191

  8. Endovascular Treatment of Extracranial Internal Carotid Aneurysms Using Endografts

    SciTech Connect

    Baldi, Sebastian Rostagno, Roman D.; Zander, Tobias; Llorens, Rafael; Schonholz, Claudio; Maynar, Manuel

    2008-03-15

    Aneurysms of the extracranial internal carotid artery (EICA) are infrequent. They are difficult to treat with conventional surgery because of their distal extension into the skull base. We report three cases of EICA aneurysms in two symptomatic patients successfully treated with polytetrafluoroethylene self-expanding endografts using an endovascular approach. The aneurysms were located distal to the carotid bifurcation and extended to the subpetrous portion of the internal carotid artery.

  9. Depressive symptoms are independently predictive of carotid atherosclerosis.

    PubMed

    Haas, Donald C; Davidson, Karina W; Schwartz, Daniel J; Rieckmann, Nina; Roman, Mary J; Pickering, Thomas G; Gerin, William; Schwartz, Joseph E

    2005-02-15

    The investigators tested whether depressive symptoms were predictive of carotid atherosclerosis, a marker of coronary atherosclerosis. Healthy participants (n = 219) underwent the baseline assessment of cardiovascular risk factors, including self-reported depressive symptoms, and were assessed for carotid plaque at 10-year follow-up. Adjusting for baseline cardiovascular risk factors, participants with elevated depression scores at baseline were >2 times as likely as those with no depressive symptoms to have carotid plaque.

  10. A big floating thrombus in the common carotid artery.

    PubMed

    La Spada, Michele; Stilo, Francesco; Barillà, David; Spinelli, Francesco

    2011-11-01

    The management of the free-floating thrombus (FFT) is difficult, and it is unclear whether surgical or medical treatment is superior. The common carotid artery is rarely involved. An 80-year-old woman presented with right hand weakness and syncope. Ultrasound showed the presence of FFT in the left common carotid artery. A carotid endarterectomy with Dacron patch angioplasty was immediately performed without complications. In the presence of symptoms, the interventional management of FFT is advised.

  11. Carotid artery access for transcatheter aortic valve replacement.

    PubMed

    Guyton, Robert A; Block, Peter C; Thourani, Vinod H; Lerakis, Stamatios; Babaliaros, Vasilis

    2013-10-01

    We report three patients who had successful transcatheter aortic valve replacement (TAVR) via carotid artery access. None were candidates for thoracotomy (including minimal access incisions) and had no other vascular access sites that would accommodate the transcatheter valve sheath. Antegrade carotid perfusion and retrograde insertion of the delivery sheath maintained cerebral blood flow without sequelae. Carotid access for TAVR is an option for unusual patients without other access.

  12. Carotid Endarterectomy: Current Concepts and Practice Patterns

    PubMed Central

    Saha, Sibu P.; Saha, Subhajit; Vyas, Krishna S.

    2015-01-01

    Background Stroke is the number one cause of disability and third leading cause of death among adults in the United States. A major cause of stroke is carotid artery stenosis (CAS) caused by atherosclerotic plaques. Randomized trials have varying results regarding the equivalence and perioperative complication rates of stents versus carotid endarterectomy (CEA) in the management of CAS. Objectives We review the evidence for the current management of CAS and describe the current concepts and practice patterns of CEA. Methods A literature search was conducted using PubMed to identify relevant studies regarding CEA and stenting for the management of CAS. Results The introduction of CAS has led to a decrease in the percentage of CEA and an increase in the number of CAS procedures performed in the context of all revascularization procedures. However, the efficacy of stents in patients with symptomatic CAS remains unclear because of varying results among randomized trials, but the perioperative complication rates exceed those found after CEA. Conclusions Vascular surgeons are uniquely positioned to treat carotid artery disease through medical therapy, CEA, and stenting. Although data from randomized trials differ, it is important for surgeons to make clinical decisions based on the patient. We believe that CAS can be adopted with low complication rate in a selected subgroup of patients, but CEA should remain the standard of care. This current evidence should be incorporated into practice of the modern vascular surgeon. PMID:26417192

  13. Preoperative imaging diagnosis of carotid body tumors.

    PubMed

    Pacheco-Ojeda, Luis A; Martínez-Viteri, Miguel A

    2010-01-01

    Carotid body tumors (CBTs) are relatively frequent lesions encountered at high altitudes, such in as the Andean Mountains. A correct preoperative diagnosis is essential for surgical planning and performance. For this reason, we have reviewed the evolution of our experience in the imaging diagnosis of these tumors. Between 1980 and June 2008, 160 CBTs were diagnosed. A total of 138 tumors were operated on, 4 are waiting for surgery, and 18 were not operated on because of age, medical conditions, or patient refusal. We have reviewed retrospectively the modalities of imaging diagnosis in our patients who underwent operation. Among the 138 tumors operated on, a correct preoperative diagnosis was done in 127 cases (92%). The preoperative diagnosis of the remaining 11 patients was unspecified benign tumor for 6 patients and neck lymph node for 5 patients. The imaging methods performed by different radiologists were conventional ultrasound, color Doppler ultrasound, carotid conventional angiography (CA), axial tomography, magnetic resonance and magnetic resonance angiography, and computed tomographic angiography (CTA). Most patients had more than one image study. Review of radiologist reports revealed a correct diagnosis in all carotid CA, magnetic resonance studies, and CTA. Additionally, CTA appeared to be a valuable method to predict the Shamblin group. Clinical suspicion and current image techniques permit a correct diagnosis in practically all cases of CBT.

  14. [Morbidity and mortality of carotid endarterectomy].

    PubMed

    Rodríguez Pérez, A; Cabrera Morán, V; Abad Vázquez, C; Muñoz Falcón, L; Hernández Ruiz, A; Hermida Anllo, M; Cárdenes Romero, I

    1993-01-01

    In order to investigate the peroperative complications in carotid surgery, a cohort of 64 patients operated of carotid endarterectomy (EC) were evaluated. A total 78 EC were performed, 56 unilateral (EC-U) and 11 bilateral (EC-B). All the cases were managed in a similar manner regarding surgical technique, monitoring, anesthetic management and pre and postoperative care. A temporary shunt was inserted in 6 cases. The hospital mortality has been 0. We registered the following postoperative complications: arterial hypertension in 23.1 of EC-U and 18.2% of EC-B, cervical hematoma in 5.3% (EC-U) and 13.6% (EC-B), TIA in 5.3% (EC-U) and 4.5% (EC-B), stroke 1.7% (EC-U) and 4.5% (EC-B), vocal cord injury in 3.5% of EC-U and chest pain with angina in 1.7% of EC-U. A review of the mortality and morbidity in carotid surgery is done.

  15. Iatrogenic injuries of the carotid arteries.

    PubMed

    Dorobisz, A T; Rybak, Z; Skóra, J; Pupka, A; Patrzałek, D; Stepiński, P; Korta, K; Barć, P

    2005-08-01

    Iatrogenic trauma of the carotid artery (CA) is a dangerous intraoperative complication, especially during oncological and endocrinological procedures. In these cases massive hemorrhage and severe neurological complications may occur. The outcome of reconstructive procedures is often fatal because of the long delay of surgery after the injuries occuring in non-vascular centers. In this paper 22 cases of iatrogenic CA trauma will be presented, operated in the period of 1980-2003. Different methods of operation were performed according to the extent of trauma and anatomical changes. In spite of emergency help two patients died. In three cases cerebral stroke was observed. Additionally peripheral nervous damages were noted. Iatrogenic CA trauma is one of the most dangerous vascular injuries, connected with hemorrhage and neurological complications. We recommend intravenous administration of 5000 units unfractionated Heparin, anatomical artery preparation, then shunt inserting. Autogenous material should be used if possible. For reconstruction of the initial part of internal carotid artery the transposition of the external carotid artery is useful.

  16. Carotid Stenting for Restenosis after Endarterectomy

    SciTech Connect

    Counsell, Andrew; Ghosh, Jonathan McCollum, Charles C. N.; Ashleigh, Raymond

    2011-06-15

    Introduction: Restenosis after carotid endarterectomy (CEA) has been described in 8-19% of patients, 14-23% of whom become symptomatic. This study analyzes our experience with carotid artery stenting (CAS) for post-CEA recurrent stenoses.MethodRetrospective database and case-note review. Results: Between January 2000 and September 2008, a total of 27 patients (15 symptomatic) with hemodynamically significant internal carotid artery post-CEA restenosis underwent CAS. Median stenosis of target vessels was 90% (range 75-95%). There was one periprocedural death (3.7%); no others occurred during the median 34-month follow-up (range 0.1-84 months). There was one late transient ischemic attack 12 months after CAS that was not associated with in-stent restenosis. One 90% restenosis and one occlusion were detected during follow-up at 38 and 57 months after CAS. The remaining patients had no evidence of further restenosis and remained free from cerebrovascular symptoms. Conclusion: CAS offers a feasible option for the management of carefully selected patients with symptomatic and asymptomatic restenosis after CEA.

  17. [Eversion carotid endarterectomy: advantages and disadvantages].

    PubMed

    Kazanchian, P O; Popov, V A; Rudakova, T V; Gaponova, E N

    1998-01-01

    A comparative analysis of results of 70 operations fulfilled by the method of classical with autovein plasty of the internal carotid artery (ICA) and of 103 operations by the method of eversion carotid endarterectomy (CEAE) was made. The time of compression of the carotid artery during the eversion CEAE proved to be considerably less (22.5 +/- 6.5) min, than when using the "classical" method (32.5 +/- 5.3) min. In the nearest postoperative period no neurological complications of embologenic genesis or those associated with acute thrombosis of ICA after the eversion CEAE were noted while after the "classical" method they developed in 3 patients and 2 of them died. After the eversion CEAE 1 patients died of myocardial infarction. In remote periods after the "classical" CEAE the restenosis and reocclusions appeared in 6 patients, while after the eversion method--in 3 patients. CEAE fulfilled by the eversion technique is an effective operation reducing the amount of postoperative neurological complications as well as of late restenosis and reocclusions. It can be used without the applying of the internal bypass.

  18. Atypical Arteritis in Internal Carotid Arteries: A Novel Concept of Isolated Internal Carotid Arteritis

    PubMed Central

    Fukuma, Kazuki; Kowa, Hisanori; Nakayasu, Hiroyuki; Nakashima, Kenji

    2016-01-01

    We presented a 38-year-old woman suffering from acute cerebral infarction due to arteritis limited to bilateral internal carotid arteries without a condition of giant cell arteritis or granulomatosis with polyangitis. Our case is unprecedented and characterized by a young woman with wall enhancement in the internal carotid arteries on contrast-enhanced magnetic resonance imaging (MRI), therapeutic effects of steroids, and positive status for human leucocyte antigen-B39, -B51 and -DR4. These disease characteristics were not in accordance with existing diagnostic criteria of vasculitis, such as Takayasu’s arteritis, giant cell arteritis, granulomatosis with polyangiitis, and Behcet’s disease. We suggested consideration of a novel “isolated internal carotid arteritis” disease concept. PMID:27708542

  19. The first derivative of the carotid displacement pulse.

    NASA Technical Reports Server (NTRS)

    Khan, A. H.; Spodick, D. H.

    1972-01-01

    The amplitude and time relationships of the carotid derivative in normal individuals and unselected cardiac patients is investigated together with the effects of different contraction strengths in patients with pulsus alternans and subjects challenged with isoproterenol and propranolol. Data regarding the relationship between the preejection period (PEP) and the ratio of peak to total amplitude of the carotid displacement pulse derivative are presented. It is found that cardiac abnormality tends to reduce the rate of rise of the carotid displacement pulse. The results obtained show that the PEP is a somewhat more sensitive index of the changes studied than the carotid displacement derivative.

  20. The first derivative of the carotid displacement pulse.

    NASA Technical Reports Server (NTRS)

    Khan, A. H.; Spodick, D. H.

    1972-01-01

    The amplitude and time relationships of the carotid derivative in normal individuals and unselected cardiac patients is investigated together with the effects of different contraction strengths in patients with pulsus alternans and subjects challenged with isoproterenol and propranolol. Data regarding the relationship between the preejection period (PEP) and the ratio of peak to total amplitude of the carotid displacement pulse derivative are presented. It is found that cardiac abnormality tends to reduce the rate of rise of the carotid displacement pulse. The results obtained show that the PEP is a somewhat more sensitive index of the changes studied than the carotid displacement derivative.

  1. Carotid blowout syndrome in patients treated by larynx cancer.

    PubMed

    Chiesa Estomba, Carlos Miguel; Betances Reinoso, Frank Alberto; Osorio Velasquez, Alejandra; Castro Macia, Olalla; Gonzalez Cortés, Maria Jesus; Araujo Nores, Jesus

    2016-09-29

    Carotid blowout syndrome is an uncommon complication for patient treated by head and neck tumours, related with a high mortality rate. The aim of this study was to study the risk of carotid blowout in a large cohort of patients treated only by larynx cancer. Retrospective analysis of patients older than 18 years, treated by larynx cancer who developed a carotid blowout syndrome in a tertiary academic centre. 197 patients met the inclusion criteria, 192 (98.4%) were male and 5 (1.6%) were female. 6 (3%) patients developed a carotid blowout syndrome, 4 patients had a carotid blowout syndrome located in the internal carotid artery and 2 in the common carotid artery. According to the type of rupture, 3 patients suffer a type I, 2 patients a type III and 1 patient a type II. Five of those patients had previously undergone radiotherapy and all patients underwent total laryngectomy. We found a statistical correlation between open surgical procedures (p=0.004) and radiotherapy (p=0.023) and the development of a carotid blowout syndrome. Carotid blowout syndrome is an uncommon complication in patients treated by larynx tumours. According to our results, patient underwent radiotherapy and patients treated with open surgical procedures with pharyngeal opening have a major risk to develop this kind of complication. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  2. Duplex scanning on admission prevents unnecessary carotid endarterectomies.

    PubMed

    Dalainas, I; Nano, G; Casana, R; Bianchi, P; Stegher, S; Malacrida, G; Tealdi, D G

    2006-06-01

    This retrospective single Institution study, aims to evaluate the performance of duplex scanning on admission of patients with carotid artery disease to avoid unnecessary carotid endarterectomies. From 1 January 1997 until 31 Decem-ber 2004, 1 504 patients were admitted to our Institution to undergo carotid endarterectomy. A duplex scan on admission was performed in all of them. A total of 1 369 from these patients (91%) underwent surgery, while 135 (9%) were dismissed because there was no indication for surgical treatment. They were put in conservative treatment and periodic duplex control appointments. In 9% of the patients, unnecessary carotid endarterectomy was avoided.

  3. Pathogenic Roles of the Carotid Body Inflammation in Sleep Apnea

    PubMed Central

    2014-01-01

    Breathing difficulties in sleep are a hallmark of sleep-disordered breathing commonly observed in patients with sleep disorders. The pathophysiology of sleep apnea is in part due to an augmented activity of the carotid body chemoreflex. Arterial chemoreceptors in the carotid body are sensitive to inflammatory cytokines and immunogenic molecules in the circulation, because cytokine receptors are expressed in the carotid body in experimental animals and human. Intriguingly, proinflammatory cytokines are also locally produced and released in the carotid body. Also, there are significant increases in the expression of proinflammatory cytokines, cytokine receptors, and inflammatory mediators in the carotid body under hypoxic conditions, suggesting an inflammatory response of the carotid body. These upregulated cytokine signaling pathways could enhance the carotid chemoreceptor activity, leading to an overactivity of the chemoreflex adversely effecting breathing instability and autonomic imbalance. This review aims to summarize findings of the literature relevant to inflammation in the carotid body, with highlights on the pathophysiological impact in sleep apnea. It is concluded that local inflammation in the carotid body plays a pathogenic role in sleep apnea, which could potentially be a therapeutic target for the treatment of the pathophysiological consequence of sleep apnea. PMID:25276055

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

    PubMed

    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.

  5. Percutaneous Injection of Lidocaine Within the Carotid Body Area in Carotid Artery Stenting: An 'Old-New' Technique

    SciTech Connect

    Mourikis, Dimitrios; Chatoupis, Konstantinos; Katsenis, Konstantinos; Vlahos, Lampros; Chatziioannou, Achilles

    2008-07-15

    Severe bradycardia is a common untoward effect during balloon angioplasty when performing carotid artery stenting. Therefore atropine injection even before dilatation and the presence of an anesthesiologist are advocated in all patients. In the surgical literature, injection of a local anesthetic agent into the carotid sinus before carotid endarterectomy was performed in an attempt to ameliorate perioperative hemodynamic instability. This study was undertaken to test the hypothesis that percutaneous infiltration of the carotid sinus with local anesthetic immediately before balloon dilatation reduces bradycardia and ameliorates the need for atropine injection or the presence of an anesthesiologist. Infiltration of the carotid sinus with 5 ml of 1% lidocaine, 3 min before dilatation, was performed in 30 consecutive patients. No one exhibited any significant rhythm change that required atropine injection. The anesthesiologist did not face any hemodynamic instability during the carotid artery stenting procedure.

  6. Numerical analysis of 3D blood flow and common carotid artery hemodynamics in the carotid artery bifurcation with stenosis.

    PubMed

    Antonova, N; Dong, X; Tosheva, P; Kaliviotis, E; Velcheva, I

    2014-01-01

    The results for blood flow in the carotid artery bifurcation on the basis of numerical simulation of Navier-Stokes equations are presented in this study. Four cases of carotid bifurcation are considered: common carotid artery (CCA) bifurcation without stenoses and cases with one, two and three stenoses are also presented. The results are obtained by performing numerical simulations considering one pulse wave period based on the finite volume discretization of Navier-Stokes equations. The structures of the flow around the bifurcation are obtained and the deformation of the pulse wave from common carotid artery (CCA) to the internal carotid artery (ICA) and external carotid artery (ECA) is traced. The axial velocity and wall shear stress (WSS) distribution and contours are presented considering the characteristic time points. The results of the WSS distribution around the bifurcation allow a prediction of the probable sites of stenosis growth.

  7. The assessment of carotid intima-media thickness, lipid profiles and oxidative stress markers in Helicobacter pylori-positive subjects.

    PubMed

    Başyığıt, Sebahat; Akbaş, Halide; Süleymanlar, İnci; Kemaloğlu, Didem; Koç, Serkan; Süleymanlar, Gültekin

    2012-01-01

    Helicobacter pylori infection has been suggested to be associated with atherosclerosis. The issue is still controversial. It is well known that abnormal lipid profile and oxidative stress are related to atherosclerosis and the measurement of carotid intima-media thickness. The aim of this study was to investigate carotid intima-media thickness and oxidative stress along with lipid parameters in Helicobacter pylori-positive and -negative subjects. Thirty Helicobacter pylori-positive subjects and 31 Helicobacter pylori-negative subjects were enrolled. Helicobacter pylori infection was diagnosed by noninvasive tests. Serum total oxidant status and total antioxidant capacity levels were measured. Oxidative stress index was calculated based on total oxidant status/total antioxidant capacity ratio. Traditional cardiovascular risk factors were recorded, and laboratory analysis included measurement of serum triglycerides, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. carotid intima media thickness was assessed by high-resolution ultrasound. We found that the mean and maximum values of right and overall carotid intima-media thickness in Helicobacter pylori-positive subjects were significantly thicker than in Helicobacter pylori-negatives (p < 0.05). Serum triglycerides levels of Helicobacter pylori-positive subjects were significantly higher than in Helicobacter pylori-negatives (p < 0.05). Total oxidant status, total antioxidant capacity and oxidative stress index values were significantly higher in Helicobacter pylori-positive subjects compared with negatives (p < 0.05). No significant correlation was observed between oxidative stress markers and carotid intima-media thickness values. Carotid intima-media thickness, total oxidant status, total antioxidant capacity, oxidative stress index, and triglycerides values are increased in Helicobacter pylori-positive subjects compared to Helicobacter pylori-negatives. These data indicated that

  8. Absence of relation between depressive symptoms and carotid intimal medial thickness in the Baltimore Longitudinal Study of Aging.

    PubMed

    Rice, S Carrington; Zonderman, Alan B; Metter, E Jeffrey; Najjar, Samer S; Waldstein, Shari R

    2009-01-01

    To examine the relation between longitudinal trajectories of depressive symptoms as well as history of significant symptoms and subsequent carotid intimal medial thickness (IMT) among participants enrolled in the Baltimore Longitudinal Study of Aging and to assess longitudinal covariation of depressive symptoms and carotid IMT over two time points. Prior literature has identified inconsistent cross-sectional associations between depressive symptoms and carotid IMT in healthy persons, and existing longitudinal work has relied on depression assessment at a single time point. A total of 556 participants (303 women and 253 men), aged 20 to 93 years (mean +/- standard deviation = 55.8 +/- 15.9 years), completed the Center for Epidemiological Studies-Depression (CES-D) scale from one to eight times over 1 to 15 years. Participants later underwent high-resolution B-mode ultrasonography to assess IMT of the far wall of the common carotid artery. A subset of these participants (n = 68) underwent reassessment of IMT an average of 3.9 years later. Linear and mixed-effects regression models were adjusted for sex, race, education, systolic blood pressure, low-density lipoprotein cholesterol, body mass index, diabetes, smoking, and antihypertensive, lipid-lowering, and antidepressant medications. There was no relation between trajectory of depressive symptoms or history of significant depressive symptoms and future carotid IMT. There was also no evidence for longitudinal covariation of depressive symptoms and IMT over time. Additional analyses similarly revealed a lack of significant associations. There is no association between depressive symptoms and carotid IMT in the present sample of healthy community-dwelling volunteers.

  9. Multispectral optoacoustic tomography of matrix metalloproteinase activity in vulnerable human carotid plaques.

    PubMed

    Razansky, Daniel; Harlaar, Niels J; Hillebrands, Jan Luuk; Taruttis, Adrian; Herzog, Eva; Zeebregts, Clark J; van Dam, Gooitzen M; Ntziachristos, Vasilis

    2012-06-01

    Elevated expression of cathepsins, integrins and matrix metalloproteinases (MMPs) is typically associated with atherosclerotic plaque instability. While fluorescent tagging of such molecules has been amply demonstrated, no imaging method was so far shown capable of resolving these inflammation-associated tags with high fidelity and resolution beyond microscopic depths. This study is aimed at demonstrating a new method with high potential for noninvasive clinical cardiovascular diagnostics of vulnerable plaques using high-resolution deep-tissue multispectral optoacoustic tomography (MSOT) technology. MMP-sensitive activatable fluorescent probe (MMPSense™ 680) was applied to human carotid plaques from symptomatic patients. Atherosclerotic activity was detected by tuning MSOT wavelengths to activation-dependent absorption changes of the molecules, structurally modified in the presence of enzymes. MSOT analysis simultaneously provided morphology along with heterogeneous MMP activity with better than 200 micron resolution throughout the intact plaque tissue. The results corresponded well with epi-fluorescence images made from thin cryosections. Elevated MMP activity was further confirmed by in situ zymography, accompanied by increased macrophage influx. We demonstrated, for the first time to our knowledge, the ability of MSOT to provide volumetric images of activatable molecular probe distribution deep within optically diffuse tissues. High-resolution mapping of MMP activity was achieved deep in the vulnerable plaque of intact human carotid specimens. This performance directly relates to pre-clinical screening applications in animal models and to clinical decision potential as it might eventually allow for highly specific visualization and staging of plaque vulnerability thus impacting therapeutic clinical decision making.

  10. Incorporating Carotid Plaque Imaging into Routine Clinical Carotid Magnetic Resonance Angiography.

    PubMed

    Moody, Alan R; Singh, Navneet

    2016-02-01

    The incorporation of a short, easy-to-acquire and simple to read sequence to visualize the vessel wall and detect intraplaque hemorrhage (IPH) is achievable now. Demonstration of IPH may be helpful in primary or secondary prevention of neuroischemic events, assessment prior to carotid intervention and the general definition of an individual's vascular phenotype. The addition of an IPH-detecting vessel wall sequence only adds 5 to 6 minutes to a standard carotid MRI examination making clinical translation feasible and achievable. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  11. Review: Mechanical Characterization of Carotid Arteries and Atherosclerotic Plaques.

    PubMed

    de Korte, Chris L; Fekkes, Stein; Nederveen, Aart J; Manniesing, Rashindra; Hansen, Hendrik Rik H G

    2016-10-01

    radiation force impulse (ARFI) imaging also provides characterization of local plaque components based on mechanical properties. However, both elastography and ARFI provide an indirect measure of the elastic modulus of tissue. With shear wave imaging, the elastic modulus can be quantified, although the carotid artery is one of the most challenging tissues for this technique due to its size and geometry. Prospective studies still have to establish the predictive value of these techniques for the individual patient. Validation of ultrasound-based mechanical characterization of arteries and plaques remains challenging. Magnetic resonance imaging is often used as the "gold" standard for plaque characterization, but its limited resolution renders only global characterization of the plaque. CT provides information on the vascular tree, the degree of stenosis, and the presence of calcified plaque, while soft plaque characterization remains limited. Histology still is the gold standard, but is available only if tissue is excised. In conclusion, elastographic ultrasound techniques are well suited to characterize the different stages of vascular disease.

  12. Surgical Exposure to Control the Distal Internal Carotid Artery at the Base of the Skull during Carotid Aneurysm Repair.

    PubMed

    Davis, Laura; Zeitouni, Anthony; Makhoul, Nicholas; Steinmetz, Oren K

    2016-07-01

    Extracranial carotid artery aneurysms are rare. Treatment options for these lesions include endovascular interventions, such as coiling and stenting, or surgical reconstruction, such as resection and primary reanastomosis, or interposition bypass grafting. In this report, we describe the surgical technique used to perform surgical repair of an internal carotid artery aneurysm extending up to the base of the skull. Anterior exposure of the infratemporal fossa and distal control of the carotid artery at the level of the carotid canal was achieved through a transcervical approach, performing double mandibular osteotomies with superior reflection of the middle mandibular section. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Predictors of change in carotid atherosclerotic plaque inflammation and burden as measured by 18-FDG-PET and MRI, respectively, in the dal-PLAQUE study

    PubMed Central

    Woodward, Mark; Samber, Daniel; Bucerius, Jan; Tawakol, Ahmed; Kallend, David; Rudd, James H. F.; Abt, Markus; Fayad, Zahi A.

    2014-01-01

    Baseline predictors of response to treatment of patients with coronary heart disease (CHD) with respect to vascular inflammation and atherosclerotic plaque burden are poorly understood. From post hoc analysis of the dal-PLAQUE study (NCT00655473), 18F–fluorodeoxyglucose-positron emission tomography (18-FDG-PET) imaging and carotid black blood magnetic resonance imaging (MRI) were used to track changes in these vascular parameters. Baseline demographics, imaging, and biomarkers were collected/measured in 130 patients with CHD or CHD risk-equivalents, and imaging follow-up at 6 months (PET) and 24 months (MRI) was performed. Using stepwise linear regression, predictors of change in carotid plaque inflammation by PET [target-to-background ratio (TBR), n = 92] and plaque burden by MRI [wall area (WA) and total vessel area (TVA), n = 89] were determined. Variables with p < 0.05 in multivariable models were considered independently significant. Interleukin-6, systolic blood pressure and standard deviation of wall thickness (WT) at baseline were independently positively associated with 18-FDG uptake (mean of maximum [MeanMax] TBR change over 6 months). Mean of mean TBR, phospholipase A2, apolipoprotein A-I, and high-sensitivity C-reactive protein at baseline were independently negatively associated with MeanMax TBR change over 6 months. Mean WT and plasminogen activator inhibitor-1 (PAI-1) activity at baseline, and age, were independently associated with change in WA over 24 months. For TVA changes; mean WA and PAI-1 activity at baseline, age, and female gender were independent predictors. These findings may help determine patients most suitable for clinical trials employing plaque inflammation or burden changes as endpoints. PMID:24458953

  14. Endovascular treatment of penetrating traumatic injuries of the extracranial carotid artery.

    PubMed

    Herrera, Diego A; Vargas, Sergio A; Dublin, Arthur B

    2011-01-01

    To describe the clinical and angiographic results of endovascular therapy for traumatic injuries of the extracranial carotid artery. The clinical and angiographic features of 36 traumatic injuries of the carotid artery during a 12-year period were reviewed. There were 35 male patients (97.2%) and 1 female patient (2.8%) with an average age of 28.8 years (range 13-60 years). Of the 36 lesions of the carotid artery, 29 (80.6%) were the result of gunshot injury, and 7 (19.4%) were secondary to stab wounds. In 24 (66.7%) instances, the injury resulted in a pseudoaneurysm; in 7 (19.4%), in an arteriovenous fistula (AVF); in 4 (11.1%), in a dissection; and in 1 (2.8%), in inactive bleeding. All patients were treated with an endovascular approach using different techniques (balloon occlusion, embolization, or stent deployment). Endovascular therapy resulted in documented lesion occlusion in 34 (94.4%) patients. Two patients declined any follow-up postprocedural imaging; however, they have remained asymptomatic. Clinical improvement was documented in 35 (97.2%) patients, and there was one procedure-related complication with fatal consequences. In this series, endovascular techniques were an effective method of treatment. It was possible to use different endovascular reconstructive techniques or parent artery occlusion depending on the degree of vessel damage, with resolution of clinical symptoms and avoidance of surgery in most cases. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  15. Diagnosis of atherosclerosis in human carotid artery by FT-Raman spectroscopy: Principal Components Analysis algorithm

    NASA Astrophysics Data System (ADS)

    Nogueira, Grazielle V.; Silveira, Landulfo, Jr.; Martin, Airton A.; Zangaro, Renato A.; Pacheco, Marcos T.; Chavantes, Maria C.; Zampieri, Marcelo; Pasqualucci, Carlos A. G.

    2004-07-01

    FT- Raman Spectroscopy (FT-Raman) could allow identification and evaluation of human atherosclerotic lesions. A Raman spectrum can provide biochemical information of arteries which can help identifying the disease status and evolution. In this study, it is shown the results of FT-Raman for identification of human carotid arteries in vitro. Fragments of human carotid arteries were analyzed using a FT-Raman spectrometer with a Nd:YAG laser at 1064nm operating at an excitation power of 300mW. Spectra were obtained with 250 scans and spectral resolution of 4 cm-1. Each collection time was approximately 8 min. A total of 75 carotid fragments were spectroscopically scanned and FT-Raman results were compared with histopathology. Principal Components Analysis (PCA) was used to model an algorithm for tissue classification into three categories: normal, atherosclerotic plaque without calcification and atherosclerotic plaque with calcification. Non-atherosclerotic (normal) artery, atherosclerotic plaque and calcified plaque exhibit different spectral signatures related to biochemicals presented in each tissue type, such as, bands of collagen and elastin (proteins), cholesterol and its esters and calcium hydroxyapatite and carbonate apatite respectively. Results show that there is 96% match between classifications based on PCA algorithm and histopathology. The diagnostic applied over all 75 samples had sensitivity and specificity of about 89% and 100%, respectively, for atherosclerotic plaque and 100% and 98% for calcified plaque.

  16. Increased carotid intima media thickness is associated with prolactin levels in subjects with untreated prolactinoma: a pilot study.

    PubMed

    Jiang, Xiao-Bing; Li, Cui-Ling; He, Dong-Sheng; Mao, Zhi-Gang; Liu, Dong-Hong; Fan, Xiang; Hu, Bin; Zhu, Yong-Hong; Wang, Hai-Jun

    2014-06-01

    Hyperprolactinemia is associated with endothelial dysfunction and atherogenic risk factors, but carotid intima media thickness (IMT) has not been studied in hyperprolactinemic patients. To determine whether untreated hyperprolactinemia contributes to increased carotid IMT. Thirty-one prolactinoma patients and 60 healthy controls were respectively studied. Participants underwent hormone evaluation. Anthropometric parameters (body mass index and blood pressure), inflammatory markers (high-sensitivity C-reactive protein and fibrinogen), serum glucose, insulin, lipid and apolipoprotein profiles were also determined. Endothelial function measured as the flow-mediated dilation (FMD) of a brachial artery and carotid IMT were evaluated using high-resolution ultrasonography. Multivariate linear regression analysis was applied to identify independent determinants of FMD and carotid IMT. Triglycerides, homeostasis model assessment of insulin resistance, apolipoprotein (apo)B/apoA-I ratio, high-sensitivity C-reactive protein (hsCRP) and fibrinogen were significantly higher, while apoA-I was significantly lower in patients with prolactinomas than in the controls. Meanwhile, decreased FMD and increased carotid IMT were observed in hyperprolactinemic group. Serum prolactin was positively correlated with triglycerides, apoB/apoA-I ratio, hypogonadal, hsCRP and fibrinogen (P < 0.05), but inversely associated with apoA-I and HDL-C (P ≤ 0.001). Moreover, prolactin was found negatively correlated with FMD (r = -0.576, P < 0.0001), and positively correlated with mean carotid IMT (r = 0.652, P < 0.0001). Multivariate regression analysis revealed that prolactin determined, independent of traditional risk factors, FMD (B = -0.589, 95% confidence interval (CI) -2.525 to -0.804, P = 0.001) and mean carotid IMT (B = 0.527, 95% CI 0.027-0.069, P < 0.0001). Hyperprolactinemia may be involved in the preclinical increase in carotid IMT, directly or by promoting atherogenic factors, including

  17. Association between behavior-dependent cardiovascular risk factors and asymptomatic carotid atherosclerosis in a general population.

    PubMed

    Luedemann, Jan; Schminke, Ulf; Berger, Klaus; Piek, Marion; Willich, Stefan N; Döring, Angela; John, Ulrich; Kessler, Christof

    2002-12-01

    Physical inactivity and unfavorable dietary and lifestyle patterns are related to cardiovascular disease and premature death. Their relationship to atherosclerosis of the carotid arteries and subsequent stroke is unclear. The objective of this study was to investigate the association between those behavioral cardiovascular risk factors and asymptomatic atherosclerosis of the carotid arteries in a population of former East Germany. The Study of Health in Pomerania (SHIP) is a cross-sectional survey in northeast Germany. In 1632 individuals aged 45 to 70 years, high-resolution B-mode ultrasound was used to assess the mean intima-media thickness of the right and left common carotid arteries. Carotid plaques and stenosis were recorded. Physical activity, dietary patterns, and cardiovascular risk factors were assessed in interviews with the use of standardized scales. Physically active participants with optimal dietary patterns were classified in the optimal lifestyle group, and those inactive with unfavorable diet were classified in the unfavorable group. After adjustment for sex and age, significant decreasing trends were found for both intima-media thickness and severe asymptomatic atherosclerosis from unfavorable to optimal lifestyle patterns in never smokers but not in smokers. Regression analysis revealed an increased risk of severe asymptomatic atherosclerosis in subjects with an unfavorable lifestyle pattern compared with those with an optimal pattern (odds ratio 2.68; 95% CI, 1.13 to 6.37), following a significant linear trend. Physical activity and optimal diet are associated with reduced risk of early atherosclerosis in subjects who never smoked, while no benefit of an otherwise optimal lifestyle is observed in smokers.

  18. Association between carotid intima-media thickness and aortic arch plaques.

    PubMed

    Tessitore, Elena; Rundek, Tatjana; Jin, Zhezhen; Homma, Shunichi; Sacco, Ralph L; Di Tullio, Marco R

    2010-07-01

    Large aortic arch plaques are associated with ischemic stroke. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and a strong predictor of cardiovascular disease and stroke. The association between CIMT and aortic arch plaques has been studied in patients with strokes, but not in the general population. The aim of this study was to investigate this association in an elderly asymptomatic cohort and to assess the possibility of using CIMT to predict the presence or absence of large aortic arch plaques. Stroke-free control subjects from the Aortic Plaque and Risk of Ischemic Stroke (APRIS) study underwent transesophageal echocardiography and high-resolution B-mode ultrasound of the carotid arteries. CIMT was measured at the common carotid artery, bifurcation, and internal carotid artery. The association between CIMT and aortic arch plaques was analyzed using multivariate regression models. The positive and negative predictive values of CIMT for large (>or=4 mm) aortic arch plaques were calculated. Among 138 subjects, large aortic arch plaques were present in 35 (25.4%). Only CIMT at the bifurcation was associated with large aortic arch plaques after adjustment for atherosclerotic risk factors (P=.007). The positive and negative predictive values of CIMT for aortic arch plaque>or=4 mm at the bifurcation above the 75th percentile (>or=0.95 mm) were 42% and 80%, respectively. The negative predictive value increased to 87% when the median CIMT value (0.82 mm) was used. CIMT at the bifurcation is independently associated with aortic arch plaque>or=4 mm. Its strong negative predictive value for large plaques indicates that CIMT may be used as an initial screening test to exclude severe arch atherosclerosis in the general population. Copyright (c) 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

  19. ASSOCIATION BETWEEN CAROTID INTIMA-MEDIA THICKNESS AND AORTIC ARCH PLAQUES

    PubMed Central

    Tessitore, Elena; Rundek, Tatjana; Jin, Zhezhen; Homma, Shunichi; Sacco, Ralph L.; Di Tullio, Marco R.

    2010-01-01

    Objectives To evaluate the association between carotid intima-media thickness (CIMT) and the presence of aortic arch plaques (AP) in a community-based cohort. Background Large AP are associated with ischemic stroke. CIMT is a marker of subclinical atherosclerosis and a strong predictor of cardiovascular disease and stroke. The association between CIMT and AP has been studied in stroke patients, but not in the general population. Aim of this study was to investigate this association in an elderly asymptomatic cohort, and the possibility to use CIMT to predict the presence or absence of large AP. Methods Stroke-free control subjects from the Aortic Plaque and Risk of Ischemic Stroke (APRIS) Study underwent transesophageal echocardiography and high-resolution B-mode ultrasound of the carotid arteries. CIMT was measured at the common carotid artery, bifurcation and internal carotid artery. The association between CIMT and AP was analyzed by multivariate regression models. Positive and negative predictive values of CIMT for large (≥ 4 mm) AP were calculated. Results Among 138 subjects, large AP was present in 35 (25.4%) subjects. Only CIMT at the bifurcation was associated with large AP after adjustment for atherosclerotic risk factors (p=0.007). Positive and negative predictive value for AP ≥ 4 mm of CIMT at the bifurcation above the 75th percentile (≥ 0.95 mm) were 42% and 80%, respectively. Negative predictive value increased to 87% when the median CIMT value (0.82 mm) was used. Conclusions CIMT at the bifurcation is independently associated with AP ≥ 4 mm. Its strong negative predictive value for large arch plaque indicates that CIMT may be used as an initial screening test to exclude severe arch atherosclerosis in the general population. PMID:20510582

  20. Validation of a computer-aided diagnosis system for the automatic identification of carotid atherosclerosis.

    PubMed

    Bonanno, Lilla; Marino, Silvia; Bramanti, Placido; Sottile, Fabrizio

    2015-02-01

    Carotid atherosclerosis represents one of the most important causes of brain stroke. The degree of carotid stenosis is, up to now, considered one of the most important features for determining the risk of brain stroke. Ultrasound (US) is a non-invasive, relatively inexpensive, portable technique, which has an excellent temporal resolution. Computer-aided diagnosis (CAD) has become one of the major research fields in medical and diagnostic imaging. We studied US images of 44 patients, 22 patients with and 22 without carotid artery stenosis, by using US examination and applying a CAD system, an automatic prototype software to detect carotid plaques. We obtained 287 regions: 60 were classified as plaques, with an average signal echogenicity of 244.1 ± 20.0 and 227 were classified as non-plaques, with an average signal echogenicity of 193.8 ± 38.6 compared with the opinion of an expert neurologist (golden test). The receiver operating characteristic (ROC) analysis revealed a highly significant area under the ROC curve difference from 0.5 (null hypothesis) in the discrimination between plaques and non-plaques; the diagnostic accuracy was 89% (95% CI: 0.85-0.92), with an appropriate cut-off value of 236.8, sensitivity was 83% and specificity reached a value of 85%. The experimental results showed that the proposed method is feasible and has a good agreement with the expert neurologist. Without the need of any user-interaction, this method generates a detection out-put that may be useful in second opinion.

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

    PubMed

    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.

  2. 21 CFR 870.3850 - Carotid sinus nerve stimulator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Carotid sinus nerve stimulator. 870.3850 Section 870.3850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3850 Carotid...

  3. 21 CFR 870.3850 - Carotid sinus nerve stimulator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Carotid sinus nerve stimulator. 870.3850 Section 870.3850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3850 Carotid...

  4. 21 CFR 870.3850 - Carotid sinus nerve stimulator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Carotid sinus nerve stimulator. 870.3850 Section 870.3850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3850 Carotid...

  5. Huge Free-Floating Thrombus in the Internal Carotid Artery.

    PubMed

    Tanriverdi, Uygur; Kizilkilic, Osman; Ince, Birsen

    2017-08-25

    Free-floating thrombus in the carotid artery is extremely rare. A 70-year-old male patient with pre-existing Crohn's disease admitted to our clinic with recurrent transient ischemic attacks. Angiography showed a huge thrombus in internal carotid artery. He responded to anticoagulation treatment and delayed endovascular intervention. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  6. Carotid baroreceptor-muscle sympathetic relation in humans.

    PubMed

    Rea, R F; Eckberg, D L

    1987-12-01

    The purpose of this study was to define the relation between carotid distending pressure and muscle sympathetic activity in humans. Carotid baroreceptors of nine healthy subjects were compressed or stretched for 5 s with graded neck pressure or suction (+40 to -65 mmHg), and muscle sympathetic nerve activity was recorded. The results delineate several features of human baroreflex function. First, the carotid-muscle sympathetic relation is well described by an inverse sigmoid function. Second, a linear relation exists between carotid distending pressure and sympathetic outflow over a range of approximately 25 mmHg. Third, sympathetic responses to changes of carotid pressures are asymmetric; increases of sympathetic activity during carotid compression are much greater than reductions of sympathetic activity during carotid stretch. Fourth, at rest, normal subjects operate near the threshold level for sympathetic excitation. Thus the carotid-muscle sympathetic baroreflex is poised to oppose reductions more effectively than elevations of arterial pressure, and the range of pressures over which the reflex is active is wider than thought hitherto.

  7. [Cardiovascular risk factors and carotid atherosclerosis detected by ultrasonography].

    PubMed

    Cantú-Brito, C; Rodríguez-Saldaña, J; Reynoso-Marenco, M T; Marmolejo-Henderson, R; Barinagarrementeria-Aldatz, F

    1999-01-01

    To assess the frequency of carotid atherosclerosis and its relation to cardiovascular risk factors in a general elderly population of Mexico City. B-mode ultrasonography was performed to investigate carotid atherosclerosis in 145 CUPA (a research project) participants, between July 1993 and January 1996. The outcome was then related to cardiovascular risk factors. Prevalence of ultrasound-detected carotid atherosclerosis was 64.8%. Intimal-medial thickening was detected in 64 subjects (44.1%) and carotid plaques in 82 (56.5%); Fifty-two subjects had both intimal-medial thickening and plaques. However, only 8 subjects had carotid plaques with severe stenosis (5.5%). There were no significant differences in the prevalence of atherosclerotic lesions (male 61.9%, female 66.0%). Carotid atherosclerosis was significantly associated with age (p < 0.0001), high blood pressure (p < 0.001), isolated systolic hypertension (p = 0.01), hypercholesterolemia (p = 0.04), and diabetes mellitus (p = 0.06). Prevalence of carotid atherosclerosis increased progressively with the number of vascular risk factors. There was a high prevalence of carotid atherosclerosis in this general elderly population of Mexico City, and was almost equal to that reported in developed western countries. Age, hypertension, hypercholesterolemia, and diabetes were the strongest predictors of atherosclerosis.

  8. 21 CFR 870.3850 - Carotid sinus nerve stimulator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Carotid sinus nerve stimulator. 870.3850 Section 870.3850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3850 Carotid sinus...

  9. 21 CFR 870.3850 - Carotid sinus nerve stimulator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Carotid sinus nerve stimulator. 870.3850 Section 870.3850 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3850 Carotid sinus...

  10. Congenital horner syndrome and hemiplegia secondary to carotid dissection.

    PubMed

    Gupta, Mohit; Dinakaran, Subramanian; Chan, Tan K

    2005-01-01

    A 5-month-old infant had right Horner syndrome and left hemiplegia. Magnetic resonance imaging confirmed smaller cerebral hemisphere and magnetic resonance angiography showed reduced blood flow in the internal carotid artery on the right. A diagnosis of congenital hemiplegia and carotid occlusion secondary to maternal trauma during pregnancy was made.

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

    PubMed

    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 <2 days before and not later than five days after the procedure. Values of microembolic signs during dissection were summarised with arithmetic means and standard deviations. For further analysis non parametric Wilcoxon test was performed between both methods. P-values <0.05 were considered as statistically significant. Wilcoxon test was performed to compare both methods concerning clamp- and procedure times. We performed EEA 26

  12. Local versus general anaesthesia for carotid endarterectomy.

    PubMed

    Vaniyapong, Tanat; Chongruksut, Wilaiwan; Rerkasem, Kittipan

    2013-12-19

    Carotid endarterectomy may significantly reduce the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant perioperative risks that may be reduced by performing the operation under local rather than general anaesthetic. This is an update of a Cochrane Review first published in 1996, and previously updated in 2004 and 2008. To determine whether carotid endarterectomy under local anaesthetic: (1) reduces the risk of perioperative stroke and death compared with general anaesthetic; (2) reduces the complication rate (other than stroke) following carotid endarterectomy; and (3) is acceptable to patients and surgeons. We searched the Cochrane Stroke Group Trials Register (September 2013), MEDLINE (1966 to September 2013), EMBASE (1980 to September 2013) and Index to Scientific and Technical Proceedings (ISTP) (1980 to September 2013). We also handsearched relevant journals, and searched the reference lists of articles identified. Randomised trials comparing the use of local anaesthetic to general anaesthetic for carotid endarterectomy were considered for inclusion. Three review authors independently assessed trial quality and extracted data. We calculated a pooled Peto odds ratio (OR) and corresponding 95% confidence interval (CI) for the following outcomes that occurred within 30 days of surgery: stroke, death, stroke or death, myocardial infarction, local haemorrhage, cranial nerve injuries, and shunted arteries. We included 14 randomised trials involving 4596 operations, of which 3526 were from the single largest trial (GALA). In general, reporting of methodology in the included studies was poor. All studies were unable to blind patients and surgical teams to randomised treatment allocation and for most studies the blinding of outcome assessors was unclear. There was no statistically significant difference in the incidence of stroke within 30 days of surgery between the local anaesthesia group and the general

  13. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae

    PubMed Central

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Singhara Na Ayudya, Sirintara (Pongpech)

    2016-01-01

    PURPOSE The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. METHODS We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. RESULTS Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. CONCLUSION Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow. PMID:27767958

  14. Does a contralateral carotid occlusion adversely impact carotid artery stenting outcomes?

    PubMed

    Keldahl, Mark L; Park, Michael S; Garcia-Toca, Manuel; Wang, Chih-Hsiung E; Kibbe, Melina R; Rodriguez, Heron E; Morasch, Mark D; Eskandari, Mark K

    2012-01-01

    Carotid artery stenting (CAS) has grown as a possible alternative for the treatment of extracranial cerebrovascular disease in the past decade. A preexisting contralateral carotid artery occlusion has been described as a risk factor for inferior outcomes after carotid endarterectomy, but its impact on CAS outcomes is less understood. A retrospective review of 417 CAS procedures performed between May 2001 and July 2010 at a single center using self-expanding nitinol stents and mechanical embolic protection devices was conducted. Patients were divided into two groups, those with a preexisting contralateral carotid occlusion (group A, n = 39) versus those without a contralateral occlusion (group B, n = 378). Patient demographics and comorbidities as well as 30-day and late death, stroke, and myocardial infarction (MI) rates were analyzed. Mean follow-up was 4 years (range: 0-9.4 years). Overall, mean age of the 314 men and 103 women was 70.5 years. In group A, there were two (5.1%) octogenarians and nine patients (23.1%) with symptomatic disease as compared with group B with 53 (14%) octogenarians and 121 (32%) patients with symptomatic disease. The overall 30-day death, stroke, and MI rates were 0.5%, 1.9%, and 0.7%, respectively. When comparing group A with group B, these results were not significantly different: death (0% vs. 0.5%), stroke (2.6% vs. 1.9%), and MI (0% vs. 0.8%). Long-term outcomes for groups A and B were also not significantly different: death (25.6% vs. 22.2%), stroke (5.3% vs. 3.4%), and MI (15.4% vs. 14%) (p = nonsignificant). A preexisting contralateral carotid artery occlusion does not seem to adversely impact CAS outcomes. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  15. Carotid artery disease after head and neck radiotherapy.

    PubMed

    Thalhammer, Christoph; Husmann, Marc; Glanzmann, Christoph; Studer, Gabriela; Amann-Vesti, Beatrice R

    2015-01-01

    Radiation induced atherosclerosis of the carotid artery is a clinically relevant late complication after head and neck radiotherapy. Improved long-term survival after multimodality therapy in neck malignancies result in an increased risk of carotid artery disease in patients after radiotherapy (RT). This review focuses on the current knowledge of occlusive carotid disease after head and neck radiotherapy and highlights the exceeding morphologic post-radiation vessel wall pathologies. More severe and extensive carotid artery atherosclerosis with plaque in all segments including the common carotid artery is a frequent finding after RT. Therefore, colour coded duplex ultrasound surveillance in patients after head and neck RT is recommended. Some histopathological studies indicate differences to “classical” atherosclerosis, and pathogenesis of chronic radiation vasculopathy is still under discussion.

  16. Mathematical model of carotid artery for stent placement

    NASA Astrophysics Data System (ADS)

    Rahman, Tengku Husna Tengku Abdul; Din, Ummul Khair Salma; Ahmad, Rokiah @ Rozita

    2016-11-01

    The carotid artery stenting is one of the methods used to reduce the effect of artherosclerosis which caused by the thickening of the artery wall. In most of the studies, the measure of wall elasticity, shear stress and the blood pressure through the blood flow were considered. The aim of this study is to determine the position to place the stent inside the carotid artery. A mathematical model is reconstructed to determine the suitable location of the stent in the carotid artery. Throughout the study, differences in fluid flow between a normal carotid artery wall and stenosed carotid artery wall are investigated. Since the existence of the stenosis provides a resistance in the flow, it is important to identify the right position to place the stent. The stent will be placed in the position where stenosis exists to ease the blood to flow normally. Later after the stent placement, the blood flow normally through the blood vessel.

  17. Dynamics of collateral circulation in progressive asymptomatic carotid disease.

    PubMed

    Moll, F L; Eikelboom, B C; Vermeulen, F E; van Lier, H J; Schulte, B P

    1986-03-01

    Inadequacy of collateral arterial flow is the major risk factor for hemispheric infarction in association with spontaneous occlusion of the ipsilateral carotid artery. This prospective study was designed to measure the adaptation of collateral cerebral circulation through the circle of Willis in patients in whom a unilateral carotid stenosis of hemodynamic consequence develops asymptomatically. The collateral cerebral potential is assessed by ocular pneumoplethysmography (OPG) during proximal common carotid artery compression, measuring the collateral ophthalmic artery pressure (COAP). During an average follow-up of almost 3 years (maximum more than 7 years), 45 patients showed asymptomatic development of a unilateral hemodynamically significant carotid stenosis according to OPG evidence. In these patients the mean index COAP/brachial artery pressure did not change on the side of stenosis progression (p greater than 0.05). The developed carotid stenosis had only reduced collateral circulation to the contralateral hemisphere. The risk of inadequate collateral cerebral circulation remained during progression of asymptomatic extracranial arterial obstructive disease.

  18. Bilateral atherosclerotic internal carotid artery occlusion and recurrent ischaemic stroke.

    PubMed

    Amin, Osama S M

    2015-06-08

    Bilateral internal carotid artery occlusion (BICAO) is a rare disease that carries a gloomy prognosis. We report a case of a 52-year-old man who developed ischaemic infarction at the region of the right middle cerebral artery; he was found to have atherosclerotic occlusion of both internal carotid arteries on Doppler-duplex examination. He received medical treatment only. After 1 year, he developed a new infarction at the region of the left middle cerebral artery. Conventional angiography revealed bilateral occlusion of internal carotid arteries at their origin, approximately 50% stenosis of the common carotid bulbs and mild stenosis of the origin of external carotid arteries. The patient did not undergo any form of surgical revascularisation procedures and died of severe aspiration pneumonia approximately 2 months after the second stroke. BICAO portends a poor outcome and carries a risk of recurrent ischaemic events. The best management strategy for this vascular occlusion remains unclear.

  19. Internal carotid artery stenosis associated with giant cell arteritis: case report and discussion

    PubMed Central

    Zarar, Amna; Zafar, Taqi T; Khan, Asif A; Suri, M Fareed K; Qureshi, Adnan I

    2014-01-01

    Background Cerebrovascular ischemic events associated with giant cell arteritis (GCA) are uncommon and have been reported in 3%–4% of patients. We describe a case report of GCA associated with intracranial stenosis and review various angiographic findings. Case presentation A 66-year-old man presented with worsening headache and vision loss. A recent magnetic resonance angiogram of the head and neck showed multiple intracranial stenosis. Cerebrospinal fluid (CSF) analysis demonstrated increased protein of 135.6 mg/dL, with two white blood cells/µL. No bacteria were observed in the CSF on gram staining, and cultures were negative for bacterial growth. Erythrocyte sedimentation rate was noted to be 14 mm/h, and C-reactive protein was 1.514 mg/L at admission. Human immunodeficiency virus (HIV) and hepatitis panels were negative. On digital subtraction angiography, patient had predominantly narrowing and irregularities in petrous and cavernous segments of the internal carotid arteries bilaterally. The diagnosis of GCA was confirmed by temporal artery biopsy. He was treated with steroids, and a followup angiogram 6 weeks later showed minimal resolution of the angiographic findings. Patient reported complete resolution of headaches and visual loss. Conclusion Bilateral internal carotid arteries stenosis may be seen in patients presenting with typical symptoms of GCA and may persist after steroid treatment despite resolution of clinical symptoms. PMID:25566338

  20. Spatial mapping of dynamic cerebral autoregulation by multichannel near-infrared spectroscopy in high-grade carotid artery disease

    NASA Astrophysics Data System (ADS)

    Reinhard, Matthias; Schumacher, F. Konrad; Rutsch, Sebastian; Oeinck, Maximilian; Timmer, Jens; Mader, Irina; Schelter, Björn; Weiller, Cornelius; Kaller, Christoph P.

    2014-09-01

    The exact spatial distribution of impaired cerebral autoregulation in carotid artery disease is unknown. In this pilot study, we present a new approach of multichannel near-infrared spectroscopy (mcNIRS) for noninvasive spatial mapping of dynamic autoregulation in carotid artery disease. In 15 patients with unilateral severe carotid artery stenosis or occlusion, cortical hemodynamics in the bilateral frontal cortex were assessed from changes in oxyhemoglobin concentration using 52-channel NIRS (spatial resolution ˜2 cm). Dynamic autoregulation was graded by the phase shift between respiratory-induced 0.1 Hz oscillations of blood pressure and oxyhemoglobin. Ten of 15 patients showed regular phase values in the expected (patho) physiological range. Five patients had clearly outlying irregular phase values mostly due to artifacts. In patients with a regular phase pattern, a significant side-to-side difference of dynamic autoregulation was observed for the cortical border zone area between the middle and anterior cerebral artery (p<0.05). In conclusion, dynamic cerebral autoregulation can be spatially assessed from slow hemodynamic oscillations with mcNIRS. In high-grade carotid artery disease, cortical dynamic autoregulation is affected mostly in the vascular border zone. Spatial mapping of dynamic autoregulation may serve as a powerful tool for identifying brain regions at specific risks for hemodynamic infarction.

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

    NASA Astrophysics Data System (ADS)

    Ko, Seungbin; Song, Simon; Kim, Doosang

    2016-11-01

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

  2. Dextran reduces embolic signals after carotid endarterectomy.

    PubMed

    Levi, C R; Stork, J L; Chambers, B R; Abbott, A L; Cameron, H M; Peeters, A; Royle, J P; Roberts, A K; Fell, G; Hoare, M C; Chan, A T; Donnan, G A

    2001-10-01

    One hundred fifty patients undergoing carotid endarterectomy were randomly assigned to receive intravenous 10% dextran 40 or placebo. Transcranial Doppler monitoring of the ipsilateral middle cerebral artery 0 to 1 hour postoperatively detected embolic signals in 57% of placebo and 42% of dextran patients, with overall embolic signal counts 46% less for dextran (p = 0.052). Two to 3 hours postoperatively, embolic signals were present in 45% of placebo and 27% of dextran patients, with embolic signal counts 64% less for dextran (p = 0.040). We conclude that dextran reduces embolic signals within 3 hours of CEA.

  3. Congenital Absence of the Internal Carotid Artery

    SciTech Connect

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

    1999-01-15

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

  4. Pulsatile Flow Studies in Atherosclerotic Carotid Bifurcations

    NASA Astrophysics Data System (ADS)

    Bale-Glickman, Jocelyn; Selby, Kathy; Saloner, David; Savas, Omer

    2001-11-01

    Particle image velocimetry and flow visualization techniques are used to study flows in models of atherosclerotic carotid bifurcations. The flow models exactly replicate the interior geometry of plaque excised from patients. The input flows are physiological wave forms derived from Doppler Ultrasound scans done on patients before surgery. The systolic and diastolic Reynolds numbers are 300 and 900. The complex internal geometry of the diseased artery combined with the pulsatile input flow results in exceedingly complex flow patterns. These flow patterns include internal jets, three-dimensional shear layers, stagnation lines, and multiple recirculation and separation regions. The physiological input flows are compared to flows when the wave form is sinusoidal.

  5. Recommendations for Carotid Stenting in Korea

    PubMed Central

    Chang, Hyuk Won; Suh, Sang-il; Jeong, Hae Woong; Suh, Dae Chul

    2015-01-01

    Carotid artery angioplasty with stenting (CAS) is being performed in many hospitals in Korea. Most of the guidelines which are being used are similar, but the practical aspects such as techniques are different between hospitals. For example, usage of various protective devices, the oral antiplatelet regimen prior to procedure and placing of temporary pacemaker to prevent bradycardia are different between hospitals. In this article, we summarize and propose the guidelines for CAS which is currently being accepted in Korea. These guidelines may be helpful in providing protocol to neurointerventionalist who perform CAS and to standardize the process including reporting of CAS in the future comparative trials in Korea. PMID:25763292

  6. [Internal carotid artery dissection after laparoscopic surgery].

    PubMed

    Martín-Mateos, Esperanza; Gómez-Ríos, Manuel Ángel; Freire-Vila, Enrique

    2017-05-22

    Headache is a common symptom in the postoperative period and may be attributable to, dehydration, sleep deprivation, intentional or inadvertent dural puncture during a neuraxial anesthesia technique, from an inhaled anesthetic agent, or from specific surgical procedures, among other etiologies. However, more serious, uncommon and life-threatening conditions as carotid artery dissection can be associated with severe neurologic sequelae in otherwise young, healthy patients. For these reasons, clinicians involved with postoperative patients should be familiar with the presentation and management strategies for this complication. Copyright © 2017. Publicado por Elsevier Editora Ltda.

  7. Carotid endarterectomy may be required in addition to best medical treatment for some patient subgroups with asymptomatic carotid stenosis.

    PubMed

    Paraskevas, Kosmas I; Nicolaides, Andrew N; Veith, Frank J

    2015-02-01

    Several guidelines recommend carotid endarterectomy for patients with severe asymptomatic carotid stenosis to reduce the risk of a future cerebrovascular event, as long as the perioperative stroke/death rate is <3%. Based on improvements in best medical treatment, it was argued that currently best medical treatment alone should comprise the treatment-of-choice for asymptomatic carotid stenosis patients and that no intervention is warranted in these individuals. While it is true that best medical treatment should be used for the management of all asymptomatic carotid stenosis patients, emerging evidence suggests that best medical treatment alone may not prevent disease progression and the development of symptoms in some asymptomatic carotid stenosis patient subgroups. This article analyzes the results of two recent independent studies demonstrating that medical therapy alone may not be adequate for stroke prevention in some asymptomatic carotid stenosis patient subgroups. These results suggest that besides best medical treatment, additional carotid endarterectomy should be considered for specific asymptomatic carotid stenosis patients. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Hyperglycemia and Inflammatory Property of Circulating Monocytes are Associated with Inflammatory Property of Carotid Plaques in Patients Undergoing Carotid Endarterectomy

    PubMed Central

    Tanaka, Masashi; Masuda, Shinya; Matsuo, Yoshiyuki; Sasaki, Yousuke; Yamakage, Hajime; Muranaka, Kazuya; Wada, Hiromichi; Hasegawa, Koji; Tsukahara, Tetsuya; Shimatsu, Akira

    2016-01-01

    Aim: This study aims to determine the association between glucose metabolism and proinflammatory/anti-inflammatory properties of circulating monocytes or those of carotid plaques in patients who underwent carotid endarterectomy. Methods: Clinical characteristics and expression levels of proinflammatory/anti-inflammatory markers in circulating monocytes/carotid plaques were examined in 12 patients with diabetes and 12 patients without diabetes. Results: Circulating monocytes from patients with diabetes revealed higher tumor necrosis factor (TNF)-α and lower interleukin (IL)-10 expression levels compared with those from patients without diabetes, which was also observed in carotid plaques from patients with diabetes. Hyperglycemia revealed positive and negative correlations with the ratios of IL-6+ and IL-10+ cells in carotid plaques, respectively. Moreover, we determined a positive correlation between circulating monocytes and carotid plaques with respect to TNF-α and IL-6 expressions. Conclusions: The inflammatory property of circulating monocytes was associated with that of carotid plaques. Hyperglycemia increased inflammatory properties and decreased anti-inflammatory properties of carotid plaques. PMID:27001002

  9. Risk Factors Associated With Cerebrovascular Recurrence in Symptomatic Carotid Disease: A Comparative Study of Carotid Plaque Morphology, Microemboli Assessment and the European Carotid Surgery Trial Risk Model

    PubMed Central

    Altaf, Nishath; Kandiyil, Neghal; Hosseini, Akram; Mehta, Rajnikant; MacSweeney, Shane; Auer, Dorothee

    2014-01-01

    Background The European Carotid Surgery Trial (ECST) risk model is a validated tool for predicting cerebrovascular risk in patients with symptomatic carotid disease. Carotid plaque hemorrhage as detected by MRI (MRIPH) and microembolic signals (MES) detected by transcranial Doppler (TCD) are 2 emerging modalities in assessing instability of the carotid plaque. The aim of this study was to assess the strength of association of MES and MRIPH with cerebrovascular recurrence in patients with symptomatic carotid artery disease in comparison with the ECST risk prediction model. Methods and Results One hundred and thirty‐four prospectively recruited patients (mean [SD]: age 72 [9.8] years, 33% female) with symptomatic severe (50% to 99%) carotid stenosis underwent preoperative TCD, MRI of the carotid arteries to assess MES, PH, and the ECST risk model. Patients were followed up until carotid endarterectomy, recurrent cerebral event, death, or study end. Event‐free survival analysis was done using backward conditional Cox regression analysis. Of the 123 patients who had both TCD and MRI, 82 (66.7%) demonstrated PH and 46 (37.4%) had MES. 37 (30.1%) cerebrovascular events (21 transient ischemic attacks, 6 amaurosis fugax, and 10 strokes) were observed. Both carotid PH (HR=8.68; 95% CI 2.66 to 28.40, P<0.001) as well as MES (HR=3.28; 95% CI 1.68 to 6.42, P=0.001) were associated with cerebrovascular event recurrence. Combining MES and MRIPH improved the strength of association (HR=0.74, 95% CI 0.65 to 0.83; P<0.001). The ECST risk model was not associated with recurrence (HR=0.86; 95% CI 0.45 to 1.65; P=0.65). Conclusions The presence of carotid plaque hemorrhage is better associated with recurrent cerebrovascular events in patients with symptomatic severe carotid stenosis than the presence of microembolic signals; combining MES and MRIPH, further improves the association while the ECST risk score was insignificant. PMID:24895159

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

    SciTech Connect

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

    2005-04-15

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

  11. Recent developments of imaging modalities of carotid artery stenting.

    PubMed

    Umemoto, Tomoyuki; Pacchioni, Andrea; Nikas, Dimitrios; Reimers, Bernhard

    2017-02-01

    Compared with conventional angiogram-guided procedure, intravascular imaging modalities give us a lot of useful information to make the procedure better. Intravascular imaging modalities give us the information about lesion characters, reference vessel diameter and the interaction between the stent strut and the plaque such as stent strut malapposition or plaque prolapse in real time during the procedure. We can change our strategy according to this information. Intravascular ultrasound (IVUS) is a most common intravascular imaging modality during carotid artery stenting (CAS) in these days. Its advantage is easy to use compared with optical coherence tomograpy (OCT) which has been reported recently in some case reports or case series. However, due to its high resolution, OCT provides more detailed information especially about plaque prolapse and strut malapposition. IVUS and OCT have a potential to improve acute result and reduce the procedural complication by providing the data of lesion character, reference vessel diameter and the interaction of stent strut and vessel wall. Interventionalists who perform CAS procedure should acquire proficiency in imaging modalities during CAS procedure.

  12. Parental history of premature myocardial infarction is a stronger predictor of increased carotid intima-media thickness than parental history of hypertension.

    PubMed

    Barra, S; Gaeta, G; Cuomo, V; Guarini, P; Cuomo, S; Capozzi, G; Tudisca, G; Madrid, A; Trevisan, M

    2011-06-01

    An increased carotid intima-media thickness (IMT) is detectable in young subjects with parental history of premature myocardial infarction (PHPMI) or hypertension (PHH). In this study we evaluated if PHPMI and PHH exert a different influence on carotid IMT and if their conjunction produces additive effects. High-resolution B-mode ultrasonographic evaluation of common carotid artery IMT was acquired from 48 subjects without PHPMI and PHH (22 males, 26 females; mean age 22.1±4.9 years; controls), 24 age- (±1 year) and sex-matched subjects with PHH without PHPMI (PHH-positive/PHPMI-negative subjects), 24 age- and sex-matched subjects with PHPMI without PHH (PHH-negative/PHPMI-positive subjects) and 24 age- and sex-matched subjects with both PHPMI and PHH (PHH/PHPMI-positive subjects). Lipid profile, resting blood pressure, smoking behaviour and body mass index (BMI) were also assessed. Carotid IMT was smaller in controls (0.41±0.07mm) compared to PHH-positive/PHPMI-negative subjects (0.47±0.10, p=0.023), to PHH-negative/PHPMI-positive subjects (0.54±0.11, p<0.001) and to PHH/PHPMI-positive subjects (0.52±0.10mm, p<0.001). Carotid IMT was greater in PHH-negative/PHPMI-positive (p=0.006) and in PHH/PHPMI-positive (p=0.031) than in PHH-positive/PHPMI-negative subjects. No difference in carotid IMT was evident between PHH-negative/PHPMI-positive and PHH/PHPMI-positive subjects (p=0.549). In the comparison among subjects using multiple regression analysis, only PHPMI, age and BMI were independently associated with carotid IMT. In healthy young subjects with PHPMI and/or PHH, carotid IMT is increased. PHPMI is a stronger predictor of increased carotid IMT than PHH. PHH in conjunction with PHPMI does not add any further detrimental effect on carotid IMT.

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

    PubMed

    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.

  14. Carotid Stenting Versus Carotid Endarterectomy: What Did the Carotid Revascularization Endarterectomy Versus Stenting Trial Show and Where Do We Go From Here?

    PubMed

    Lal, Brajesh K; Meschia, James F; Howard, George; Brott, Thomas G

    2017-09-01

    Although rapidly expanding in its use, carotid artery stenting remains a relatively new procedure. Its growth is due, at least in part, to the perceived advantages of a less invasive technique. However, the clinical effectiveness and specific role for stenting in the treatment of carotid occlusive disease are still under evaluation. The primary aim of the randomized clinical trial, Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), was to contrast the relative efficacy of carotid stenting versus carotid endarterectomy in preventing stroke, myocardial infarction, or death during a 30-day periprocedural period or ipsilateral stroke over the follow-up period in patients with symptomatic and asymptomatic extracranial carotid stenosis. The secondary goals were to describe the differential efficacy of the 2 procedures in men and women, contrast periprocedural (30-day) morbidity and postprocedural morbidity and mortality, estimate and contrast the restenosis rates of the 2 procedures, evaluate differences in measures of health-related quality of life and cost-effectiveness, and identify subgroups of participants at differential risk of stenting or surgery. This report summarizes the results obtained from CREST with respect to its primary and secondary aims.

  15. Common Carotid Artery Occlusion: A Case Series

    PubMed Central

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

    2013-01-01

    Subjects and Methods. We analysed 5000 cerebrovascular ultrasound records. A total of 0.4% of the patients had common carotid artery occlusion (CCAO). Results. The mean age was 59.8 ± 14.2 years, and the male/female ratio was 2.33. The most frequent risk factors were hypertension, ischaemic heart disease, dyslipidemia, diabetes mellitus, and smoking. Right-sided and left-sided CCAO occurred in 65% and 30% of the cases, respectively, and bilateral occlusion was detected in one case (5%). Patent bifurcation was observed in 10 cases of CCAO in which the anterograde flow in the ICA was maintained from the external carotid artery with reversed flow. In two of the cases, the occluded CCA was hypoplastic. The aetiology of CCAO in the majority of cases was the atherosclerosis (15 cases). The male/female ratio was higher in the patients with occluded distal vessels, and the short-term outcome was poorer. Only two cases from this series underwent revascularisation surgery. Spontaneous recanalisation was observed in one case. Conclusions. The most frequent cause of CCAO was atherosclerosis. The outcome is improved in the cases with patent distal vessels, and spontaneous recanalisation is possible. Treatment methods have not been standardised. Surgical revascularisation is possible in cases of patent distal vessels, but the indications are debatable. PMID:24167740

  16. Hypothermia during Carotid Endarterectomy: A Safety Study

    PubMed Central

    Candela, Serena; Dito, Raffaele; Casolla, Barbara; Silvestri, Emanuele; Sette, Giuliano; Filippi, Federico; Taurino, Maurizio; Brancadoro, Domitilla; Orzi, Francesco

    2016-01-01

    Background CEA is associated with peri-operative risk of brain ischemia, due both to emboli production caused by manipulation of the plaque and to potentially noxious reduction of cerebral blood flow by carotid clamping. Mild hypothermia (34–35°C) is probably the most effective approach to protect brain from ischemic insult. It is therefore a substantial hypothesis that hypothermia lowers the risk of ischemic brain damage potentially associated with CEA. Purpose of the study is to test whether systemic endovascular cooling to a target of 34.5–35°C, initiated before and maintained during CEA, is feasible and safe. Methods The study was carried out in 7 consecutive patients referred to the Vascular Surgery Unit and judged eligible for CEA. Cooling was initiated 60–90 min before CEA, by endovascular approach (Zoll system). The target temperature was maintained during CEA, followed by passive, controlled rewarming (0.4°C/h). The whole procedure was carried out under anesthesia. Results All the patients enrolled had no adverse events. Two patients exhibited a transient bradycardia (heart rate 30 beats/min). There were no significant differences in the clinical status, laboratory and physiological data measured before and after CEA. Conclusions Systemic cooling to 34.5–35.0°C, initiated before and maintained during carotid clamping, is feasible and safe. Trial Registration ClinicalTrials.gov NCT02629653 PMID:27058874

  17. Hypothermia during Carotid Endarterectomy: A Safety Study.

    PubMed

    Candela, Serena; Dito, Raffaele; Casolla, Barbara; Silvestri, Emanuele; Sette, Giuliano; Filippi, Federico; Taurino, Maurizio; Brancadoro, Domitilla; Orzi, Francesco

    2016-01-01

    CEA is associated with peri-operative risk of brain ischemia, due both to emboli production caused by manipulation of the plaque and to potentially noxious reduction of cerebral blood flow by carotid clamping. Mild hypothermia (34-35°C) is probably the most effective approach to protect brain from ischemic insult. It is therefore a substantial hypothesis that hypothermia lowers the risk of ischemic brain damage potentially associated with CEA. Purpose of the study is to test whether systemic endovascular cooling to a target of 34.5-35°C, initiated before and maintained during CEA, is feasible and safe. The study was carried out in 7 consecutive patients referred to the Vascular Surgery Unit and judged eligible for CEA. Cooling was initiated 60-90 min before CEA, by endovascular approach (Zoll system). The target temperature was maintained during CEA, followed by passive, controlled rewarming (0.4°C/h). The whole procedure was carried out under anesthesia. All the patients enrolled had no adverse events. Two patients exhibited a transient bradycardia (heart rate 30 beats/min). There were no significant differences in the clinical status, laboratory and physiological data measured before and after CEA. Systemic cooling to 34.5-35.0°C, initiated before and maintained during carotid clamping, is feasible and safe. ClinicalTrials.gov NCT02629653.

  18. Cognitive and emotional effects of carotid stenosis.

    PubMed

    Everts, Regula; Wapp, Manuela; Burren, Yuliya; Kellner-Weldon, Frauke; El-Koussy, Marwan; Jann, Kay; Delameilluer Lenoir, Jessica; Michel, Patrik; Schroth, Gerhard

    2014-01-01

    Patients with carotid artery stenosis (CAS) are at risk of ipsilateral stroke and chronic compromise of cerebral blood flow. It is under debate whether the hypo-perfusion or embolism in CAS is directly related to cognitive impairment. Alternatively, CAS may be a marker for underlying risk factors, which themselves influence cognition. We aimed to determine cognitive performance level and the emotional state of patients with CAS. We hypothesised that patients with high grade stenosis, bilateral stenosis, symptomatic patients and/or those with relevant risk factors would suffer impairment of their cognitive performance and emotional state. A total of 68 patients with CAS of ≥70% were included in a prospective exploratory study design. All patients underwent structured assessment of executive functions, language, verbal and visual memory, motor speed, anxiety and depression. Significantly more patients with CAS showed cognitive impairments (executive functions, word production, verbal and visual memory, motor speed) and anxiety than expected in a normative sample. Bilateral and symptomatic stenosis was associated with slower processing speed. Cognitive performance and anxiety level were not influenced by the side and the degree of stenosis or the presence of collaterals. Factors associated with less cognitive impairment included higher education level, female gender, ambidexterity and treated hypercholesterolemia. Cognitive impairment and increased level of anxiety are frequent in patients with carotid stenosis. The lack of a correlation between cognitive functioning and degree of stenosis or the presence of collaterals, challenges the view that CAS per se leads to cognitive impairment.

  19. Medical treatment in carotid artery intervention.

    PubMed

    Kolkert, J L; Meerwaldt, R; Lefrandt, J D; Geelkerken, R H; Zeebregts, C J

    2011-12-01

    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 therapy has evolved tremendously. Next to aspirin, antiplatelet regimens acting on a different level in the modulation of platelet aggregation have made their entry. Moreover, statin therapy has been introduced. These changes among others in secondary stroke prevention, along with better understanding in life-style adjustments and perioperative medical management, have led to a decrease in stroke recurrence. Secondary prevention is therefore now the most important pillar of medical therapy. It consists of antiplatelet therapy, statins and blood pressure lowering agents in all patients. Small adjustments are recommended for those patients referred for invasive treatment. Moreover, long-term medical treatment is imperative. In this article, we summarize current evidence in literature regarding medical management in patients with previous stroke or TIA.

  20. Should patients with asymptomatic significant carotid stenosis undergo simultaneous carotid and cardiac surgery?

    PubMed Central

    Ogutu, Peter; Werner, Raphael; Oertel, Frank; Beyer, Michael

    2014-01-01

    A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether patients with severe asymptomatic carotid and coronary artery diseases should undergo simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). A total of 624 papers were found using the reported search, of which 20 represent the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study results of these papers are tabulated. Previous cohort studies showed mixed results, while advocating for the necessity of a randomized controlled trial (RCT). A recent RCT showed that patients undergoing prophylactic or simultaneous CEA + CABG had lower rates of stroke (0%) compared with delayed CEA 1–3 months after CABG (7.7%), without significant perioperative mortality difference. This study included patients with unilateral severe (>70%) asymptomatic carotid stenosis requiring CABG. An earlier partly randomized trial also showed better outcomes for patients undergoing simultaneous procedures (P = 0.045). Interestingly, systematic reviews previously failed to show compelling evidence supporting prophylactic CEA. This could be partly due to the fact that these reviews collectively analyse different cohort qualities. Neurological studies have, however, shown reduced cognitive and phonetic quality and function in patients with unilateral and bilateral asymptomatic carotid artery stenosis. Twenty-one RCTs comparing lone carotid artery stenting (CAS) and CEA informed the American Heart Association guidelines, which declared CAS comparable with CEA for symptomatic and asymptomatic carotid stenosis (CS). However, the risk of death/stroke for CAS alone is double that for CEA alone in the acute phase following onset of symptoms, while CEA alone is associated with a doubled risk of myocardial infarction. There is

  1. Effects of active and passive smoking on the development of cardiovascular disease as assessed by a carotid intima-media thickness examination in patients with type 2 diabetes mellitus.

    PubMed

    Jiang, Fei; Wang, Jie; Zhang, Rong; Chen, Miao; Peng, Danfeng; Sun, Xue; Yan, Jing; Luo, Yi; Tang, Shanshan; Hu, Cheng; Jia, Weiping

    2015-05-01

    Carotid intima-media thickness has been widely used as a surrogate end-point for cardiovascular disease, myocardial infarction, and stroke. This study aimed to assess the effects of active and passive smoking exposure on the development of cardiovascular disease in patients with type 2 diabetes mellitus. Seven hundred twenty-two patients with type 2 diabetes mellitus were recruited for the study. A standardized questionnaire on smoking status, pack-years of smoking, and the number of years of smoking cessation was provided to the patients, and their responses were collected for analysis. The carotid intima-media thickness, carotid plaque, and the internal diameter of the common carotid artery were determined by high-resolution B-mode ultrasonography. Compared to non-smokers, passive female smokers had a higher risk of cardiovascular disease (odds ratio = 3.50, 95% confidence interval: 1.29-9.49, P = 0.009); they also had a significantly larger common carotid artery (P = 0.041) and risk of carotid plaque (odds ratio = 2.20, 95% confidence interval: 1.1980-4.0505, P = 0.01). Both active and passive male smokers had a significantly greater carotid intima-media thickness than non-smokers (P = 0.003 and P = 0.005, respectively). Male active smokers had a significantly higher risk of carotid plaque (odds ratio = 2.88, 95% confidence interval: 1.4788-5.6094, P = 0.001). In conclusion, cumulative active and passive smoking exposures are significant risk factors for carotid atherosclerosis in patients with type 2 diabetes mellitus. Our results highlight the importance of endorsing a smoke-free environment for patients with type 2 diabetes mellitus.

  2. Peripheral Chemoreceptors: Function and Plasticity of the Carotid Body

    PubMed Central

    Kumar, Prem; Prabhakar, Nanduri R.

    2014-01-01

    The discovery of the sensory nature of the carotid body dates back to the beginning of the 20th century. Following these seminal discoveries, research into carotid body mechanisms moved forward progressively through the 20th century, with many descriptions of the ultrastructure of the organ and stimulus-response measurements at the level of the whole organ. The later part of 20th century witnessed the first descriptions of the cellular responses and electrophysiology of isolated and cultured type I and type II cells, and there now exist a number of testable hypotheses of chemotransduction. The goal of this article is to provide a comprehensive review of current concepts on sensory transduction and transmission of the hypoxic stimulus at the carotid body with an emphasis on integrating cellular mechanisms with the whole organ responses and highlighting the gaps or discrepancies in our knowledge. It is increasingly evident that in addition to hypoxia, the carotid body responds to a wide variety of blood-borne stimuli, including reduced glucose and immune-related cytokines and we therefore also consider the evidence for a polymodal function of the carotid body and its implications. It is clear that the sensory function of the carotid body exhibits considerable plasticity in response to the chronic perturbations in environmental O2 that is associated with many physiological and pathological conditions. The mechanisms and consequences of carotid body plasticity in health and disease are discussed in the final sections of this article. PMID:23728973

  3. Carotid Plaque Morphology and Ischemic Vascular Brain Disease on MRI.

    PubMed

    van den Bouwhuijsen, Q J A; Vernooij, M W; Verhaaren, B F J; Vrooman, H A; Niessen, W J; Krestin, G P; Ikram, M A; Franco, O H; van der Lugt, A

    2017-09-01

    Vulnerable carotid plaque components are reported to increase the risk of cerebrovascular events. Yet, the relation between plaque composition and subclinical ischemic brain disease is not known. We studied, in the general population, the association between carotid atherosclerotic plaque characteristics and ischemic brain disease on MR imaging. From the population-based Rotterdam Study, 951 participants underwent both carotid MR imaging and brain MR imaging. The presence of intraplaque hemorrhage, lipid core, and calcification and measures of plaque size was assessed in both carotid arteries. The presence of plaque characteristics in relation to lacunar and cortical infarcts and white matter lesion volume was investigated and adjusted for cardiovascular risk factors. Stratified analyses were conducted to explore effect modification by sex. Additional analyses were conducted per carotid artery in relation to vascular brain disease in the ipsilateral hemisphere. Carotid intraplaque hemorrhage was significantly associated with the presence of cortical infarcts (OR, 1.9; 95% confidence interval, 1.1-3.3). None of the plaque characteristics were related to the presence of lacunar infarcts. Calcification was the only characteristic that was associated with higher white matter lesion volume. There was no significant interaction by sex. The presence of carotid intraplaque hemorrhage on MR imaging is independently associated with MR imaging-defined cortical infarcts, but not with lacunar infarcts. Plaque calcification, but not vulnerable plaque components, is related to white matter lesion volume. © 2017 by American Journal of Neuroradiology.

  4. Carotid Stenting vs Endarterectomy: New Results in Perspective

    PubMed Central

    Perkins, William J.; Lanzino, Guiseppe; Brott, Thomas G.

    2010-01-01

    Carotid artery stenosis is a major risk factor for stroke, and treatments for this condition to decrease the risk of stroke include medical therapy, carotid endarterectomy (CEA), and, more recently, carotid angioplasty and stenting (CAS). Randomized controlled trials comparing the efficacy of CEA vs medical therapy showed a clear benefit for CEA in patients with symptomatic carotid artery stenosis of greater than 70% and a lesser benefit in patients with 50% to 69% stenosis. Treatments have evolved in the ensuing 20 years, and a new method, CAS, has emerged as a possible alternative to CEA. In early results, CAS proved feasible but did not compare favorably with CEA. Later and larger-scale studies comparing CAS to CEA failed to reach conclusions regarding a clear neurologic outcome advantage of one method over the other. This subject was of sufficient interest that 2 larger-scale randomized controlled trials comparing CAS and CEA, the Carotid Revascularization Endarterectomy vs Stenting Trial and the International Carotid Stenting Study, were undertaken to further explore this issue. This brief review places the new data arising from these studies in the context of prior efforts to address the problem of carotid artery stenosis and explores further opportunities for improvement and patient recommendations in light of these new findings. PMID:21123637

  5. Simultaneous Endovascular Treatment of Tandem Internal Carotid Lesions: Case Report and Review of Literature.

    PubMed

    Cvetic, Vladimir; Dragas, Marko; Colic, Momcilo; Vukasinovic, Ivan; Radmili, Oliver; Ilic, Nikola; Koncar, Igor; Bascarevic, Vladimir; Ristanovic, Natasa; Davidovic, Lazar

    2016-07-01

    The incidence of concomitant extracranial carotid artery stenosis and ipsilateral intracranial carotid aneurysm has been reported to vary between 2.8% and 5%. These complex lesions may present a challenge for treatment decision-making. This case report describes an asymptomatic male patient with severe carotid bifurcation stenosis, coupled with an unruptured supraclinoid internal carotid aneurysm. Both lesions were treated simultaneously. Patient underwent carotid stenting followed by aneurysm coiling in the same setting without any complication.

  6. Hydrocortisone supresses inflammatory activity of metalloproteinase - 8 in carotid plaque

    PubMed Central

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

    2015-01-01

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

  7. Morphological age-dependent development of the human carotid bifurcation.

    PubMed

    Seong, Jaehoon; Lieber, Baruch B; Wakhloo, Ajay K

    2005-03-01

    The unique morphology of the adult human carotid bifurcation and its sinus has been investigated extensively, but its long-term, age-dependent development has not. It is important fundamentally and clinically to understand the hemodynamics and developmental forces that play a role in remodeling of the carotid bifurcation and maturation of the sinus in association with brain maturation. This understanding can lead to better prognostication and therapy of carotid disease. We analyzed the change of sinus morphology and the angle of the carotid bifurcation in four postnatal developmental stages (Group I: 0-2 years, Group II: 3-9 years, Group III: 10-19 years, and Group IV: 20-36 years, respectively) using multiprojection digital subtraction angiograms and image post-processing techniques. The most significant findings are the substantial growth of the internal carotid artery (ICA) with age and the development of a carotid sinus at the root of the ICA during late adolescence. The bifurcation angle remains virtually unchanged from infancy to adulthood. However, the angle split between the ICA and external carotid artery (ECA) relative to the common carotid artery (CCA) undergoes significant changes. Initially, the ICA appears to emanate as a side branch. Later in life, to reduce hydraulic resistance in response to increased flow demand by the brain, the bifurcation is remodeled to a construct in which both daughter vessels are a skewed continuation of the parent artery. This study provides a new analysis method to examine the development of the human carotid bifurcation over the developmental years, despite the small and sparse database. A larger database will enable in the future a more extensive analysis such as gender or racial differences.

  8. Hydrocortisone supresses inflammatory activity of metalloproteinase-8 in carotid plaque.

    PubMed

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

    2015-01-01

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

  9. Comparison of aortic and carotid baroreflexes in the dog

    PubMed Central

    Donald, David E.; Edis, Anthony J.

    1971-01-01

    1. Experiments with vascularly isolated, blood-perfused aortic arch and carotid sinus preparations in sixteen dogs have provided evidence which suggests that, in the reflex regulation of normal arterial blood pressure, the aortic and carotid baroreflexes are not equivalent. 2. Two different techniques were used. In one, a steel cannula was inserted into the ascending aorta and arch and fixed in position by ligatures about the aorta. The blood-filled space (aortic jacket) thus created could be distended with known pressures; the cardiac output passed through the cannula into the descending aorta. In the other, an extracorporeal circulation utilizing an isolated heart—lung preparation was used to separately perfuse the carotid sinuses, aortic arch, and systemic circulation of a test dog. 3. Independent open-loop analysis of the aortic and carotid baroreflexes in each dog indicated that they were essentially similar in their over-all modus operandi but that there were quantitative differences between them which would suggest a predominant role for the carotid sinus reflex in the control of normal blood pressure. 4. The carotid sinus Blutdruck-charakteristik curve was symmetrical about the range of normal blood pressure for the dog while the aortic arch curve was displaced to the right. 5. The carotid sinus system had the greater gain (with reference to limb vascular resistance) and exhibited a greater maximal capacity to alter vascular resistance reflexly. 6. When the carotid and aortic systems were activated simultaneously by distension, the reflex depressor responses were summed, essentially by a process of simple addition. A carotid-induced pressor response obscured a simultaneous aortic-induced depressor response of equal magnitude. 7. In five dogs studied, the functional reflexogenic area of the aortic arch did not extend distally beyond the origin of the left subclavian artery. PMID:5145730

  10. [Carotid dislocation. The pictures with computed tomography and magnetic resonance].

    PubMed

    Liessi, G

    1997-11-01

    Prevertebral retropharyngeal soft tissue widening can be recognized in acute trauma patients in the presence of acute bleeding from cervical vertebral fracture. Abscesses, tumors and neoplastic effusions from nearby cervical spaces can also widen precervical soft tissues and a new cause has been recently suggested, that is the so-called carotid transposition. We examined eight patients (six women and two men) aged 65 to 75 years. Carotid transposition was found in four patients during examination for acute cervical trauma, while four cases were detected at CT studies performed for other indications, mostly lymphoma staging. CT was always performed with the i.v. injection of a contrast agent and volume scans were used in four cases. MR angiography (MRA) was also used in two patients to study an internal carotid artery stenosis previously detected at color Doppler. Lateral radiographs of the cervical spine of our acute trauma patients showed widened soft tissues in three cases, but no calcific arterial plaques were found. The common carotid arteries were displaced in five patients and the internal carotid arteries in three. Carotid transposition was bilateral in six patients while only the right common and the left internal carotids were involved in two patients. No traumatic hemorrhagic effusion was found on CT images. Carotid transposition is a mostly asymptomatic abnormality, but it must be considered in acute cervical trauma patients where the precervical soft tissues are widened because hemorrhagic effusion could be misdiagnosed. Thus, this unusual location of the carotid arteries is important because these vessels may be injured during emergency or surgical procedures.

  11. The role of nitric oxide in carotid chemoreception.

    PubMed

    Wang, Z Z; Dinger, B G; Stensaas, L J; Fidone, S J

    1995-01-01

    Immunocytochemical and histochemical studies of cat and rat carotid bodies have revealed a plexus of nitric oxide synthase (NOS)-positive nerve fibers associated with lobules of chemosensory type I cells as well as with the carotid body vasculature. NOS-positive fibers originate from (1) autonomic neurons located in the carotid body and distributed along the carotid sinus nerve (CNS) and IXth cranial nerve which terminate in the adventitial layer of carotid body blood vessels, and (2) from unipolar sensory neurons of the petrosal (IXth nerve) ganglion. Carotid bodies incubated with the NO precursor, 3H-arginine, yield 3H-citrulline, the detectable coproduct of NO synthesis. Furthermore, electrical stimulation of the CNS or exposure of carotid bodies to hypoxic incubation media elevates 3H-citrulline formation. Millimolar concentrations of L-arginine inhibit chemoreceptor activity evoked by hypoxia, an effect which is reversed by the specific NOS antagonist, L-NG-nitroarginine methylester (L-NAME, 0.1 mM). Electrical stimulation of CNS C fibers elevates cyclic GMP in the carotid body vasculature and lobules of type I cells. Cyclic GMP production is reduced during stimulation in the presence of L-NAME, a finding consistent with the known ability of NO to activate a soluble form of guanylate cyclase. Further studies showed that brief (< 1 min) stimulation of CNS C fibers inhibits basal chemoreceptor discharge in a perfused/superfused in vitro carotid body preparation, whereas prolonged (> 5 min) stimulation is required to inhibit the response to hypoxia. The inhibitory effect is reversed by L-NAME. Our combined anatomical, neuropharmacological and electrophysiological data suggest that NO plays a dual role in mediating CNS inhibition, one via its actions on the organ's vasculature and the other through direct effects on the chemosensory type I cells. The former pathway involves cholinergic/NOS presumptive parasympathetic autonomic neurons, while the latter may be

  12. Measurement of cortical thickness asymmetry in carotid occlusive disease.

    PubMed

    Asllani, Iris; Slattery, Pamelia; Fafard, Alexander; Pavol, Marykay; Lazar, Ronald M; Marshall, Randolph S

    2016-01-01

    Despite being considered an important anatomical parameter directly related to neuronal density, cortical thickness is not routinely assessed in studies of the human brain in vivo. This paucity has been largely due to the size and convoluted shape of the human cortex, which has made it difficult to develop automated algorithms that can measure cortical thickness efficiently and reliably. Since the development of such an algorithm by Fischl and Dale in 2000, the number of studies investigating the relationship between cortical thickness and other physiological parameters in the brain has been on the rise. There have been no studies however that have validated cortical asymmetry against known vascular anatomy. To this aim, using high-resolution MRI, we measured cortical thickness and volume in the primary motor (M1) and primary visual (V1) cortex in patients with unilateral, high-grade carotid occlusive disease (n = 29, age = 74 ± 10 years). These regions were selected based on the hypothesis that there will be thinning of the cortical thickness of M1 in the territory supplied by the occluded carotid artery, whereas V1 will show no asymmetry since its blood supply is provided by unaffected posterior arteries. To test for an effect of handedness, cortical thickness and volume were also measured in healthy volunteers (n = 8, age = 37 ± 13 years). In patients, we found thinner cortex in M1 on the occluded side (mean = 2.07 ± 0.19 mm vs 2.15 ± 0.20 mm, p = 0.0008) but no hemispheric difference in V1 (1.80 ± 0.17 mm in occluded vs 1.78 ± 0.16 mm in unoccluded, p = 0.31). Although the mean cortical volume of M1 in the occluded hemisphere was also lower, the difference did not reach statistical significance (p = 0.09). Similarly, in healthy controls, the results showed no hemispheric asymmetry in either cortical thickness or volume in either region (p > 0.1). To test for an orientation bias in the method, the analysis was repeated

  13. Simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) imaging: Comparison with contrast-enhanced MR angiography for measuring carotid stenosis.

    PubMed

    Shu, Hongge; Sun, Jie; Hatsukami, Thomas S; Balu, Niranjan; Hippe, Daniel S; Liu, Haining; Kohler, Ted R; Zhu, Wenzhen; Yuan, Chun

    2017-02-06

    To evaluate in a proof-of-concept study the feasibility of Simultaneous Noncontrast Angiography and intraPlaque hemorrhage (SNAP) imaging as a clinical magnetic resonance angiography (MRA) technique for measuring carotid stenosis. There is a growing interest in detecting intraplaque hemorrhage (IPH) during the clinical management of carotid disease, yet luminal stenosis has remained indispensable during clinical decision-making. SNAP imaging has been proposed as a novel IPH imaging technique that provides carotid MRA with no added scan time. Flowing blood shows negative signal on SNAP because of phase-sensitive inversion recovery. In all, 58 asymptomatic subjects with 16-79% stenosis on ultrasound were scanned at 3T by SNAP with 0.8 mm isotropic resolution and 16 cm longitudinal coverage. Two readers measured luminal stenosis of bilateral carotid arteries (n = 116) on minimum intensity projections of SNAP using the NASCET criteria. In the subset (48 arteries) with contrast-enhanced (CE) MRA available for comparison, luminal stenosis was also measured on maximum intensity projections of CE-MRA. Intraclass correlation coefficients (ICCs) with 95% confidence intervals were 0.94 (0.90-0.96) and 0.93 (0.88-0.96) for intra- and interreader agreement on stenosis measurements, respectively. Corresponding kappas for grading stenosis (0-29%, 30-69%, 70-99%, and 100%) were 0.79 (0.67-0.89) and 0.80 (0.68-0.90). Agreement between SNAP and CE-MRA was high (ICC: 0.95 [0.90-0.98]; kappa: 0.82 [0.71-0.93]). As a dedicated IPH-imaging sequence, SNAP also provided carotid stenosis measurement that showed high intra- and interreader consistency and excellent agreement with CE-MRA. Further comparisons with digital subtraction angiography and other noninvasive techniques are warranted. 4 J. Magn. Reson. Imaging 2016. © 2017 International Society for Magnetic Resonance in Medicine.

  14. High urinary sodium is associated with increased carotid intima-media thickness in normotensive overweight and obese adults.

    PubMed

    Njoroge, Jennifer N; El Khoudary, Samar R; Fried, Linda F; Barinas-Mitchell, Emma; Sutton-Tyrrell, Kim

    2011-01-01

    Increased dietary sodium has been reported to increase cardiovascular disease (CVD) risk, perhaps through blood pressure (BP)-independent vascular remodeling. Carotid intima-media thickness (IMT) is an accepted measure of structural vascular remodeling and a strong predictor of CVD. This study aimed to determine whether urinary sodium is positively associated with carotid IMT in normotensive overweight and obese adults. We evaluated baseline data from 258 participants in the Slow Adverse Vascular Effects (SAVE) clinical trial. Urinary sodium was measured from one 24-h urine collection from each individual. Carotid IMT was measured using high-resolution B-mode ultrasonography. Participants were categorized into quartiles of urinary sodium. There was a significant positive trend with greater IMT associated with increasing urinary sodium quartile in univariate linear regression (P = 0.047). This trend was significant when adjusting for age, sex, race, and systolic BP (SBP) (P = 0.03) as well as in a fully adjusted model (P = 0.04). In pairwise comparisons, the highest urinary sodium quartile had a significantly greater mean IMT (0.62 mm) than the lowest urinary sodium quartile (0.59 mm) after adjustment for age, sex, race, and SBP (P = 0.04). This comparison lost significance after the addition of BMI. In our community-based sample of normotensive overweight and obese adults, we observed a significant positive trend in carotid IMT with increasing quartile of urinary sodium. If the ongoing clinical trial confirms this relationship between sodium and carotid IMT, it would lend support to efforts to decrease sodium intake in overweight and obese individuals.

  15. High urinary sodium is associated with increased carotid intima-media thickness in normotensive overweight and obese adults

    PubMed Central

    Njoroge, J.N.; El Khoudary, S.R.; Fried, L.F.; Barinas-Mitchell, E.; Sutton-Tyrrell, K

    2010-01-01

    BACKGROUND Increased dietary sodium has been reported to increase cardiovascular disease (CVD) risk, perhaps through blood pressure (BP) independent vascular remodeling. Carotid intima-media thickness (IMT) is an accepted measure of structural vascular remodeling and a strong predictor of CVD. This study aimed to determine whether urinary sodium is positively associated with carotid IMT in normotensive overweight and obese adults. METHODS We evaluated baseline data from 258 participants in the Slow Adverse Vascular Effects (SAVE) Clinical Trial. Urinary sodium was measured from one 24-hour urine collection from each individual. Carotid IMT was measured using high resolution B-mode ultrasonography. Participants were categorized into quartiles of urinary sodium. RESULTS There was a significant positive trend with greater IMT associated with increasing urinary sodium quartile in univariate linear regression (P=0.047). This trend was significant when adjusting for age, sex, race, and systolic BP (SBP) (P=0.03) as well as in a fully adjusted model (P=0.04). In pairwise comparisons, the highest urinary sodium quartile had a significantly greater mean IMT (0.62 mm) than the lowest urinary sodium quartile (0.59 mm) after adjustment for age, sex, race, and SBP (P=0.04). This comparison lost significance after the addition of BMI. CONCLUSIONS In our community-based sample of normotensive overweight and obese adults, we observed a significant positive trend in carotid IMT with increasing quartile of urinary sodium. If the ongoing clinical trial confirms this relationship between sodium and carotid IMT, it would lend support to efforts to decrease sodium intake in overweight and obese individuals. PMID:20508622

  16. SCAI/SVM expert consensus statement on carotid stenting: Training and credentialing for carotid stenting.

    PubMed

    Aronow, Herbert D; Collins, Tyrone J; Gray, William A; Jaff, Michael R; Kluck, Bryan W; Patel, Rajan A G; Rosenfield, Kenneth A; Safian, Robert D; Sobieszczyk, Piotr S; Wayangankar, Siddharth A; White, Christopher J

    2016-02-01

    Carotid artery stenting (CAS) has become an integral part of the therapeutic armamentarium offered by cardiovascular medicine programs for the prevention of stroke. The purpose of this expert consensus statement is to provide physician training and credentialing guidance to facilitate the safe and effective incorporation of CAS into clinical practice within these programs. Since publication of the 2005 Clinical Competence Statement on Carotid Stenting, there has been substantial device innovation, publication of numerous clinical trials and observational studies, accumulation of extensive real-world clinical experience and widespread participation in robust national quality improvement initiatives [5]. Collectively, these advances have led to substantial evolution in the selection of appropriate patients, as well as in the cognitive, technical and clinical skills required to perform safe and effective CAS. Herein, we summarize published guidelines, describe training pathways, outline elements of competency, offer strategies for tracking outcomes, specify facility, equipment and personnel requirements, and propose criteria for maintenance of CAS competency.

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

    SciTech Connect

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

    2011-02-15

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

  18. Glomus tissue in the vicinity of the human carotid sinus.

    PubMed Central

    Garfia, A

    1980-01-01

    Three of 60 cadavers have shown, in the adventitia or in the adipose tissue from the human carotid sinus region, small islands of tissue richly and typically vascularized and with nerve endings contacting cells like the tissue of the principal carotid body. In two of the cases such 'miniglomera' were single but in the third there were several all on the same side. A modified en bloc silver nitrate reduction stain was used to demonstrate the microvascular arrangements and the nerve endings by light microscopy of serial tangential sections of the carotid bifurcation. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 PMID:7364653

  19. Carotid Stenting in a Case of Combined Kinking and Stenosis

    SciTech Connect

    Ahmadi, Ramazan-Ali; Schillinger, Martin; Haumer, Markus; Willfort, Andrea; Minar, Erich

    2001-05-15

    Endarterectomy is currently the preferred treatment for severe carotid stenosis. The technique of eversion endarterectomy allows correction of severe vessel elongation and kinking. The latter is generally believed to be a relative contraindication for endovascular stent placement. We report successful percutaneous transluminal angioplasty and stenting of a left internal carotid artery with high-grade stenosis and severe kinking which was not amenable to endarterectomy because of the distal location of the stenosis. Advanced stent technology with flexible materials makes endovascular treatment of carotid stenosis feasible even in cases of kinking.

  20. Traumatic carotid artery dissection caused by bungee jumping.

    PubMed

    Zhou, Wei; Huynh, Tam T; Kougias, Panagiotis; El Sayed, Hosam F; Lin, Peter H

    2007-11-01

    Bungee jumping is a popular recreational activity in which participant experiences transient freefall while connected to a bungee cord. The rapid freefall and the resultant rebound force created by the bungee cord can result in a variety of bodily injuries. We report herein a case of traumatic carotid artery dissection caused by bungee jumping. The symptoms related to carotid artery dissection were successfully treated with anticoagulation. The etiology of carotid dissection related to bungee jumping is discussed. Physicians should be cognizant of this potential injury due to the force created by the freefall and rebound motion associated in this recreational sport.

  1. Wall shear stress evolution in carotid artery bifurcation

    NASA Astrophysics Data System (ADS)

    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.

  2. Novel flow quantification of the carotid bulb and the common carotid artery with vector flow ultrasound.

    PubMed

    Pedersen, Mads Møller; Pihl, Michael Johannes; Haugaard, Per; Hansen, Kristoffer Lindskov; Lange, Theis; Lönn, Lars; Nielsen, Michael Bachmann; Jensen, Jørgen Arendt

    2014-11-01

    Abnormal blood flow is usually assessed using spectral Doppler estimation of the peak systolic velocity. The technique, however, only estimates the axial velocity component, and therefore the complexity of blood flow remains hidden in conventional ultrasound examinations. With the vector ultrasound technique transverse oscillation the blood velocities of both the axial and the transverse directions are obtained and the complexity of blood flow can be visualized. The aim of the study was to determine the technical performance and interpretation of vector concentration as a tool for estimation of flow 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 (US) using a commercial vector flow ultrasound scanner (ProFocus, BK Medical, Denmark) with a linear 5 MHz transducer transverse oscillation vector flow software. CCA and CB areas were marked in one cardiac cycle from each volunteer. The complex flow was assessed by medical expert evaluation 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 concentrations in CCA (0.96 ± 0.16) indicated mainly laminar flow and in CB (0.83 ± 0.07) indicated mainly turbulence. Both methods were thus able to clearly distinguish the flow patterns of CCA and CB in systole. Vector concentration from angle-independent vector velocity estimates is a quantitative index, which is simple to calculate and can differentiate between laminar and complex flow. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by

  3. Endovascular Management of Long-Segmental Petrocavernous Internal Carotid Artery (Carotid S) Occlusion

    PubMed Central

    Park, Soonchan; Park, Eun Suk; Kwak, Jae Hyuk; Lee, Dong-Geun; Suh, Dae Chul; Kwon, Sun U.; Lee, Deok Hee

    2015-01-01

    Background and Purpose Long-segmental thrombotic occlusion of the distal internal carotid artery (ICA) sparing the cervical segment proximally and the supraclinoid segment distally, which could be termed ’Carotid S occlusion’, has an unusual clinical presentation. However, endovascular management of this lesion is challenging. The purpose of our study is to report our endovascular treatment clinical experience of the disease. Methods From March 2008 to June 2013, we could identify 14 patients (average age: 62.1, median age: 62, range: 50-79) with ‘Carotid S occlusion’, who underwent endovascular recanalization procedures. Patient’s clinical presentations were collected and the imaging findings also analyzed. The technical success rate, 24-hour and follow-up imaging outcome, and the clinical outcome using the 90-day mRS (modified Rankin scale) score were evaluated. Results Patients presented with gradually progressing (n = 8), fluctuating (n = 3), transient ischemic attack (n = 2) and stationary (n = 1) symptoms. DWI showed internal and external border-zone lesions in six patients, only internal ICA border-zone lesions in three patients, and only external border-zone lesions in two patients. Underlying distal ICA stenosis was noted in 12 patients. The technical success rate was 92.8% (13/14). Luminal patency was noted in all patients (100%) after 24 hours and in nine of 10 (90%) on long-term follow-up (median: 6.5, average: 15.1, range: 1-39 months). A 90-day, good functional outcome (mRS ≤ 2) was noted in 13 of 14 patients (92.8%). Conclusions ‘Carotid S occlusion’ usually presented with border-zone infarction and endovascular management of the lesions was feasible. A relatively successful clinical outcome could be achieved after successful revascularization. PMID:26437999

  4. Common carotid artery intima-media thickness, carotid plaques, and walking speed.

    PubMed

    Elbaz, Alexis; Ripert, Mahaut; Tavernier, Béatrice; Février, Benoît; Zureik, Mahmoud; Gariépy, Jérôme; Alpérovitch, Annick; Tzourio, Christophe

    2005-10-01

    Gait dysfunction is an important cause of disability among the elderly and may be, in part, of vascular origin. We studied the association between carotid ultrasound parameters and measures of gait and balance in subjects 65 to 85 years of age who participated in the baseline phase of the Three-City Study in the Dijon center. The study population comprised 2572 noninstitutionalized individuals. Carotid plaques and common carotid artery intima-media thickness (CCA-IMT) were measured using ultrasonography. Gait and balance measures included walking speed and a modified version of the Tinetti scale. Mean maximum walking speed (MWS) decreased with increasing CCA-IMT and number of plaques (P<10(-4)). Compared with subjects in the lowest CCA-IMT quintile, the odds ratio (95% CI) for being in the lowest MWS quartile was 1.1 (0.8 to 1.6) in the second, 1.3 (0.9 to 1.8) in the third, 1.7 (1.2 to 2.4) in the fourth, and 2.2 (1.6 to 3.1) in the higher CCA-IMT quintile (P<10(-4)). Mean (SD) CCA-IMT was 0.716 (0.118) mm in subjects with a modified Tinetti score <16 (25th percentile) and 0.685 (0.109) mm in subjects with a score of > or =16 (P=0.006). The proportion of subjects in the lowest MWS quartile (P=0.006) or with a modified Tinetti score <16 (P=0.05) increased with the number of plaques. These relations were attenuated after adjustment for vascular risk factors. Carotid plaques and higher CCA-IMT values are associated with worse performances on gait and balance tests. Our results suggest that vascular factors may play an important and under-recognized role in motor function.

  5. Effect of menopausal status on carotid intima-media thickness and presence of carotid plaque in Chinese women generation population.

    PubMed

    Zhou, Yong; Wang, Dandan; Yang, Xin; Wang, Anxin; Gao, Xiang; Guo, Yuming; Wu, Shouling; Zhao, Xingquan

    2015-01-28

    Menopause is an important physiological stage in women's life. The potential association of menopause with carotid intima-media thickness as well as with occurrence and stability of carotid plaque in Chinese female population is unclear. We conducted a population-based, cross-sectional study by recruiting 2,131 participants aged above 40 years from northeast of China. Carotid intima-media thickness (CIMT), presence of carotid plaque and its stability were evaluated by carotid duplex sonography. Among the participants, 1,133 (53.2%) were identified to be postmenopausal. After adjusting for potential confounding factors, presence of CIMT at 50(th-) 75(th) and ≥75(th) percentiles, carotid plaque and its unstable status were found to be significantly associated with the postmenopausal status (P < 0.001). When matched the participants by age, post-menopausal status was still associated with a higher risk of having unstable plaque. Moreover, our data show that postmenopausal status is a risk factor for intracranial arterial stenosis when compared with premenopausal status in the univariate analysis (OR = 1.314, P = 0.043), and such relationship is lost when the confounding factors are adjusted (OR = 0.828, P = 0.225). In conclusion, the vascular risk factors increase as the menopausal status changes. Compared with premenopausal status, postmenopausal status is associated with higher morbidity of CIMT, carotid plaque and its unstable status.

  6. The Nationwide Inpatient Sample may contain inaccurate data for carotid endarterectomy and carotid stenting.

    PubMed

    Hertzer, Norman R

    2012-01-01

    The Nationwide Inpatient Sample (NIS) contains information from discharge abstracts submitted by hundreds of community hospitals across the United States, and it frequently has been used as a resource for population-based research comparing the safety of carotid artery stenting (CAS) to that of carotid endarterectomy (CEA). However, at least two findings from the NIS dataset seem open to question. First, several NIS studies have indicated that more than 90% of CEAs and CAS procedures now are being done in asymptomatic patients, a figure that substantially exceeds the prevalence of asymptomatic patients that has been reported elsewhere. Second, these studies also have suggested that the periprocedural stroke rate for CEA and CAS is lower at community hospitals contributing to the NIS than it was in the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST), even though the surgeons and interventionalists participating in CREST were stringently selected according to their previous experience and results. Neither of these two findings seems to pass the test of face validity. Furthermore, some unexpectedly low stroke-to-death (STD) ratios are present in the NIS data, especially for CAS. These issues may be related to poor documentation of preprocedural symptoms and periprocedural strokes in the medical records and to subsequent coding errors in the hospital discharge abstracts on which the NIS is based. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  7. Neurocognitive Improvement in Patients Undergoing Carotid Endarterectomy for Atherosclerotic Occlusive Carotid Artery Disease

    PubMed Central

    Jamil, Muhammad; Haq, Imran Ul; Memon, Amir Ali

    2016-01-01

    Objectives: To assess the improvement in neurocognitive functions after carotid endarterectomy (CEA) under local anesthesia (LA) in patients with carotid bifurcation occlusive disease. Place and duration of study: Department of Vascular Surgery, Combined Military Hospital Lahore from January 2013 to January 2015. Patients and Methods: A total of 79 patients with carotid artery occlusive disease, having no history of major stroke, depression, or dementia underwent CEA under LA. Cognitive functions were assessed 3 days before surgery and then 4 weeks and 12 weeks after the surgery using the Addenbrookes cognitive examination (ACE) score and General Practitioner Assessment of Cognition (GPCOG) Score. Results: In ACE score, Attention, Memory, Fluency, Language, and Visuospatial orientation improved by 33.3%, 30.7%, 21.4%, 38.4%, and 31.2%, respectively, by the end of 12 weeks. An overall improvement in neurocognition was 32% (P = 0.03). In GPCOG score, Orientation, Recall, and Memory improved by 33%, 20%, and 100%, respectively, with an overall improvement of 33.3% at the end of 12 weeks (P = 0.02). Conclusion: Both scoring systems show an overall improvement in neurocognition as well as improvements in all the subcategories in each system. Hence, we conclude statistically significant improvement in neurocognitive functions after CEA. PMID:28018503

  8. Impact of contralateral carotid occlusion on in-hospital outcomes of carotid artery stenting: Results from the Carotid Artery Revascularization and Endarterectomy (CARE) Registry

    PubMed Central

    Mercado, Nestor; Cohen, David J.; Spertus, John A.; Chan, Paul S.; House, John; Kennedy, Kevin; Brindis, Ralph G.; White, Christopher J.; Rosenfield, Kenneth A.; Marso, Steven P.

    2014-01-01

    Background: Contralateral carotid artery occlusions (CCO) are associated with adverse neurologic events following carotid endarterectomy (CEA). The characteristics and outcomes of patients with CCO undergoing elective carotid artery stenting (CAS) have not been completely studied. Methods: In-hospital outcomes were examined in patients with and without CCO undergoing elective CAS in the Carotid Artery Revascularization and Endarterectomy (CARE Registry®). A CCO was defined as a 100% occlusion of the contralateral internal carotid artery. The primary endpoint was a composite of in-hospital death, nonfatal myocardial infarction, and nonfatal stroke. Results: Between 2005 and 2010, 8,416 patients underwent elective CAS, of whom 900 (12%) had CCO. Patients with CCO were younger (69 vs. 71 years, p<0.001), more often male (68% vs. 61%, p<0.001), more frequently had symptoms due to the target lesion (46% vs. 39%, p<0.001), had a prior neurologic event (56% vs. 45%, p<0.001), and more frequently had restenosis in a target lesion after previous CAS (5% vs. 3%, p<0.001). The primary composite endpoint occurred in 14 (1.6%) and 211 (2.8%) patients with and without CCO, respectively (adjusted OR 0.58, 95% CI 0.33-1.00, p=0.052). Conclusion: In the CARE registry, there was no evidence that the presence of a CCO was associated with an increased risk of in-hospital death, non-fatal myocardial infarction or stroke in patients undergoing elective carotid artery stenting. These findings may have implications on the selection of carotid revascularization procedures for such patients. PMID:23347862

  9. Ex vivo differential phase contrast and magnetic resonance imaging for characterization of human carotid atherosclerotic plaques.

    PubMed

    Meletta, Romana; Borel, Nicole; Stolzmann, Paul; Astolfo, Alberto; Klohs, Jan; Stampanoni, Marco; Rudin, Markus; Schibli, Roger; Krämer, Stefanie D; Herde, Adrienne Müller

    2015-10-01

    Non-invasive detection of specific atherosclerotic plaque components related to vulnerability is of high clinical relevance to prevent cerebrovascular events. The feasibility of magnetic resonance imaging (MRI) for characterization of plaque components was already demonstrated. We aimed to evaluate the potential of ex vivo differential phase contrast X-ray tomography (DPC) to accurately characterize human carotid plaque components in comparison to high field multicontrast MRI and histopathology. Two human plaque segments, obtained from carotid endarterectomy, classified according to criteria of the American Heart Association as stable and unstable plaque, were examined by ex vivo DPC tomography and multicontrast MRI (T1-, T2-, and proton density-weighted imaging, magnetization transfer contrast, diffusion-weighted imaging). To identify specific plaque components, the plaques were subsequently sectioned and stained for fibrous and cellular components, smooth muscle cells, hemosiderin, and fibrin. Histological data were then matched with DPC and MR images to define signal criteria for atherosclerotic plaque components. Characteristic structures, such as the lipid and necrotic core covered by a fibrous cap, calcification and hemosiderin deposits were delineated by histology and found with excellent sensitivity, resolution and accuracy in both imaging modalities. DPC tomography was superior to MRI regarding resolution and soft tissue contrast. Ex vivo DPC tomography allowed accurate identification of structures and components of atherosclerotic plaques at different lesion stages, in good correlation with histopathological findings.

  10. The relationship between preoperative serum cortisol level and the stability of plaque in carotid artery stenosis patients undergoing carotid endarterectomy.

    PubMed

    Qin, Feng; Sun, Yudong; Hu, Wenping; Wei, Xiaolong; Li, Zhenjiang; Zhou, Jian; Zhao, Zhiqing; Jing, Zaiping

    2016-07-01

    Stability of plaque has been implicated as risk factor for stroke. Serum cortisol regulates lipoprotein metabolism and immune response, contributing to plaque stability in atherosclerosis. However, the relationship between serum cortisol and stability of carotid plaque has not been well characterized. We conducted a serology analysis to identify the relationship between serum cortisol and carotid plaque stability. Between May 2013 to October 2015, 73 patients with carotid stenosis patients undergoing carotid endarterectomy (CEA) were enrolled in our study. Serum cortisol was analyzed at 8:00 AM in the morning before surgery via liquid chromatography tandem mass spectrometry. According to the classification made by the American Heart Association, hematoxylin-and-eosin staining was performed to divide these patients into either a stable or unstable group, according to the morphology of fibrous cap, lipid core and intima layer. A curve fitting method was used to identify the relationship between preoperative serum cortisol and stability of carotid plaque. Univariate and multivariate logistic regression analysis were used to identify carotid plaque stability-associated serum cortisol. Curve fitting's result represents a U-shape characteristic. A total of 314.92 and 395.23 nmol/L were considered as the cut point for preoperative serum cortisol when trisected the patients. When adjusted for degree of stenosis, hyperlipemia, smoking and low-density lipoprotein (LDL), univariate and multivariate logistic regression analysis' results demonstrated that preoperative serum cortisol can significantly affect carotid plaque stability. The odds ratio values in multivariate logistic regression analysis for C reactive protein (CRP), white blood cell (WBC), interleukin-6 (IL-6) and preoperative serum cortisol level were 7.67 and 20.86 respectively. Preoperative serum cortisol was associated with stability of carotid plaque in patients undergoing CEA. Low or high levels of

  11. Pulsatile Flow Studies in Atherosclerotic Carotid Bifurcation

    NASA Astrophysics Data System (ADS)

    Bale-Glickman, Jocelyn; Selby, Kathy; Saloner, David; Savas, Omer

    2002-11-01

    Particle image velocimetry and flow visualization techniques are used to study flow in models of atherosclerotic carotid bifurcations. The models exactly replicate the interior geometry of plaque excised from patients. The input flow is a physiological waveform derived from Doppler Ultrasound scans done on the patients before surgery. The systolic and diastolic Reynolds numbers are 200 and 900 respectively. The complex internal geometry of the diseased artery combined with the pulsatile input flows give exceedingly complex flow patterns. These flow patterns include internal jets, three-dimensional shear layers, stagnation lines, and multiple recirculation and separation regions. Ensemble averaged and instantaneous flow fields are compared. Wall shear stresses at the stenoses are estimated to be on the order of 10 PA. The physiological input flows are also compared to flows when the waveform is sinusoidal.

  12. Effectiveness of a handmade "New Carotid Catheter" in transradial carotid angiography: A comparison with conventional multipurpose catheters.

    PubMed

    Balaban, Yakup

    2017-10-11

    The incidence and severity of carotid atherosclerosis increases in proportion with coronary artery disease and its severity. A special catheter specifically used for transradial carotid angiography has not yet been marketed. In this study, we investigate the feasibility and safety of our carotid catheter, which was made by reshaping currently available catheters. Between 2010 and 2017, a total of 921 patients with indications for carotid angiography were identified after angiographic examinations and included in the study. Carotid angiography was performed in 403 patients (female, n = 161) using the 3.5 JL catheter, while in 518 (female, n = 207) patients, new catheters were employed. The new catheter was shaped like a hook in the laboratory with a heat gun. Demographic information and angiographic data from the patients in both groups were retrospectively analyzed. The baseline characteristics of both groups were comparable. When compared with the use of a 3.5 JL catheter, right transradial carotid angiographies performed with our new handmade catheter resulted in lesser amounts of opaque material used (55 mL vs 66 mL, P < 0.001) and shorter total fluoroscopy time, (3.60 ± 1.85 min vs 3.14 ± 1.55 min, P < 0.001). The handmade catheter also resulted in a higher success rate of selective visualization (97% vs 40%, P < 0.001). Rates of minor complication were comparable between the two catheters (6.5% vs 6.6% P = 234). Neither permanent damage nor morbidity or mortality was observed in either arm. Currently available catheters and methods are inadequate for routine transradial carotid angiography. For routine transradial carotid angiography, innovatively designed catheters are required. The catheter we developed for transradial carotid angiography was more successful than the conventional catheter in obtaining satisfactory images. High quality images can be obtained with the newly designed catheters. Transradial carotid

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

    PubMed Central

    Koh, Jun Seok; Choi, Woo Suk

    2006-01-01

    We report here on a rare case of carotid artery angioplasty and stenting in a patient with spontaneous recanalization after complete occlusion of the proximal internal carotid artery (ICA). The patient initially showed severe stenosis at the left proximal ICA on MR angiography (MRA). Digital subtraction angiography (DSA) performed three days after MRA showed complete occlusion of the proximal ICA. The follow-up DSA after four weeks showed recanalization of the ICA, and then carotid artery stenting was successfully performed. There has been no neurologic complication during more than one year follow-up. PMID:17143034

  14. Cardiac Iodine-123-Meta-Iodo-Benzylguanidine Uptake in Carotid Sinus Hypersensitivity.

    PubMed

    Tan, Maw Pin; Murray, Alan; Hawkins, Terry; Chadwick, Thomas J; Kerr, Simon R J; Parry, Steve W

    2015-01-01

    Carotid sinus syndrome is the association of carotid sinus hypersensitivity with syncope, unexplained falls and drop attacks in generally older people. We evaluated cardiac sympathetic innervation in this disorder in individuals with carotid sinus syndrome, asymptomatic carotid sinus hypersensitivity and controls without carotid sinus hypersensitivity. Consecutive patients diagnosed with carotid sinus syndrome at a specialist falls and syncope unit were recruited. Asymptomatic carotid sinus hypersensitivity and non-carotid sinus hypersensitivity control participants recruited from a community-dwelling cohort. Cardiac sympathetic innervation was determined using Iodine-123-metaiodobenzylguanidine (123-I-MIBG) scanning. Heart to mediastinal uptake ratio (H:M) were determined for early and late uptake on planar scintigraphy at 20 minutes and 3 hours following intravenous injection of 123-I-MIBG. Forty-two subjects: carotid sinus syndrome (n = 21), asymptomatic carotid sinus hypersensitivity (n = 12) and no carotid sinus hypersensitivity (n = 9) were included. Compared to the non- carotid sinus hypersensitivity control group, the carotid sinus syndrome group had significantly higher early H:M (estimated mean difference, B = 0.40; 95% confidence interval, CI = 0.13 to 0.67, p = 0.005) and late H:M (B = 0.32; 95%CI = 0.03 to 0.62, p = 0.032). There was, however, no significant difference in early H:M (p = 0.326) or late H:M (p = 0.351) between the asymptomatic carotid sinus hypersensitivity group and non- carotid sinus hypersensitivity controls. Cardiac sympathetic neuronal activity is increased relative to age-matched controls in individuals with carotid sinus syndrome but not those with asymptomatic carotid sinus hypersensitivity. Blood pressure and heart rate measurements alone may therefore represent an over simplification in the assessment for carotid sinus syndrome and the relative increase in cardiac sympathetic innervation provides additional clues to

  15. Anesthetic approaches in carotid body tumor surgery

    PubMed Central

    Kavakli, Ali Sait; Ozturk, Nilgun Kavrut

    2016-01-01

    OBJECTIVE: Carotid body tumors (CBT) are benign tumors that originate from neural non-chromaffin cells that are typically localized near carotid bifurcation. Surgical removal of the tumor is the most appropriate treatment. General anesthesia is preferred anesthetic technique for CBT surgery. Basic elements of anesthetic management are protection of hemodynamic stability and maintaining cerebral perfusion pressure (CPP). The aim of this study was to evaluate anesthetic management of CBT surgery and present the literature knowledge. METHODS: The study included 10 consecutive patients with diagnosis of CBT who underwent surgery at Antalya Training and Research Hospital, in Antalya, Turkey, between 2013 and 2016. Preoperative demographic details; comorbidities; side of surgical site; duration of operation; length of intensive care unit (ICU) and hospital stay; change of intraoperative blood pressure; use of inotropic drugs, blood products, and analgesics; postoperative visual analogue scale (VAS) pain score; and complications were recorded. RESULTS: According to Shamblin classification, 3 tumors were type I and the remaining 7 were type II. Tumors were located on right side in 6 patients, and on left in 4. Blood loss sufficient to require transfusion was observed in 1 patient. Average intraoperative blood loss was 287±68 mL. Tachycardia and hypertension were observed in 1 patient; bradycardia and hypotension were seen in 4 patients. Infusion for inotropic support was administered to 1 patient. Mean duration of operation was 109±20 minutes. Mean VAS score was 4±1, mean ICU tramadol consumption was 80±25 mg. Duration of stay in ICU and hospital were 2.4±1.1 hours and 3.8±0.7 days, respectively. Mortality and neurological complications were not seen in postoperative period. CONCLUSION: CBT surgery requires close and complex anesthesia management. Protection of hemodynamic stability against sudden hemodynamic changes, monitoring, and maintaining CPP are the most

  16. Cost-effectiveness of carotid artery stent placement versus endarterectomy in patients with carotid artery stenosis.

    PubMed

    Khan, Asif A; Chaudhry, Saqib A; Sivagnanam, Kamesh; Hassan, Ameer E; Suri, M Fareed K; Qureshi, Adnan I

    2012-07-01

    The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) demonstrated that the risk of the primary composite outcome of stroke, myocardial infarction (MI), or death did not differ significantly in patients with an average surgical risk undergoing carotid artery stenting (CAS) and those undergoing carotid endarterectomy (CEA). However, the cost associated with CAS may limit its broad applicability. The authors' goal in this paper was to determine the cost-effectiveness of CAS with an embolic-protection device versus CEA in patients with moderate to severe carotid artery stenosis who are at average surgical risk. The probability of the primary outcome was obtained from the results of the CREST trial. The quality-adjusted life years (QALYs) associated with each treatment modality were estimated by adjusting for the incidence of each quality-adjusted outcome (QALY weights of ipsilateral stroke, MI, death, and postprocedure QALYs). The total cost associated with each intervention was derived from hospitalization cost and cost associated with primary outcomes including stroke, MI, and death in each group. Costs are expressed in US dollars accounting for inflation up to October 2010. Incremental cost-effectiveness ratios (ICERs) were estimated for the 4-year period after the procedure. All values are expressed as means and 95% confidence intervals. The estimated net costs for patients after treatment with CAS and CEA after consideration of the primary outcome were $18,335 and $13,276, respectively, from the definitive presimulation analysis. Postsimulation values were $19,210 (range $18,264-$20,156) and $14,080 (range $13,076-$15,084), respectively. Overall, QALYs for the CAS and CEA groups were 0.712 and 0.702, respectively (ranging from 0.0 [death] to 0.815 [no adverse events]). The estimated ICER for CAS versus CEA treatment was $229,429. Although the CREST demonstrated equivalent results with CAS (compared with CEA) in patients at average surgical

  17. Spontaneous thrombosis of giant cavernous internal carotid artery aneurysm in a neonate. Case report and review of the literature.

    PubMed

    Kasliwal, Manish Kumar; Suri, Ashish; Sai Kiran, Narayanam Anantha; Sharma, Bhawani Shanker

    2008-01-01

    Neonatal intracranial aneurysms are rare, with only 20 cases being reported in the literature. No case of spontaneous resolution of a giant intracranial cavernous segment aneurysm in a neonate is reported till date. The authors describe a 3-week-old male child who presented with a left-sided tonic seizure episode and was diagnosed as having a right-sided giant cavernous internal carotid artery aneurysm. The aneurysm was found to be totally thrombosed on angiography done before planning definitive treatment. The child is doing well at 2 years of follow-up. Spontaneous thrombosis, an exceptionally rare but fortunate outcome in a rare case of giant neonatal internal carotid artery aneurysm, has led the authors to report this case. The need of repeat imaging or angiography should be considered to rule out this rare outcome, more so if there is any delay between the ictus and treatment. 2008 S. Karger AG, Basel

  18. Endovascular treatment of carotid cavernous sinus fistula: A systematic review

    PubMed Central

    Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman

    2013-01-01

    Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions. PMID:23671750

  19. [Surgical treatment of the internal carotid artery atherosclerotic occlusion].

    PubMed

    Galkin, P V; Gushcha, A O; Antonov, G I

    2014-01-01

    Internal carotid artery occlusion is the cause of carotid territory transient ischemic attacks or infarction approximately in 15% of patients. Extracranial-lntracranial (EC-IC) Bypass Study and Carotid Occlusion Surgery Study (COSS) failed to show a benefit of EC-IC bypass over medical therapy in patients with symptomatic carotid artery occlusion. Weak sides of COSS were investigators reliance on post hoc analysis, use of specific thresholds in the definition of impaired cerebral hemodynamics and high perioperative morbidity. In selected subset of patients with medically refractory ischemic symptoms, EC-IC bypass, can provide benefit from surgery performed with sufficiently low perioperative morbidity. The potential of functional and cognitive improvement after cerebral revascularization needs further investigation.

  20. Carotid sinus hypersensitivity in patients presenting with syncope.

    PubMed Central

    Davies, A B; Stephens, M R; Davies, A G

    1979-01-01

    In 23 patients (ages 44 to 81) presenting with syncope, vertigo, or transient amnesia, carotid sinus massage produced a significant bradycardia in association with symptoms. The 10 most severely symptomatic patients were studied electrophysiologically, including measurement of intracardiac conduction times and corrected sinus node recovery times, as well as with carotid sinus massage before and after atropine. The only detectable abnormality in five of this group was asystole produced by carotid sinus massage; the other five had, in addition, evidence of either sinuatrial disease or an intracardiac conduction defect. Cardiac pacing in these 10 patients completely abolished their symptoms. In a control group of 52 asymptomatic patients (ages 36 to 87), an abnormal response to carotid sinus massage was uncommon (2%). PMID:518783

  1. Assessment of Carotid Artery Stenosis and the Use of Statins

    PubMed Central

    Whayne, Thomas F.

    2015-01-01

    General thinking has previously centered on managing carotid artery stenosis (CAS) by carotid endarterectomy and subsequently, stenting for higher risk patients. However for CAS and other forms of vascular disease, especially when asymptomatic, there is new emphasis on defining underlying mechanisms. Knowledge of these mechanisms can lead to medical treatments that result in possible atherosclerotic plaque stabilization, and even plaque regression, including in the patient with CAS. For now, the key medication class for a medical approach are the statins. Their use is supported by good cardiovascular clinical trial evidence including some directed carotid artery studies, especially with a demonstrated decrease in carotid intima-media thickness. Procedural controversy still exists but the current era in medicine offers significant support for medical management of asymptomatic CAS while techniques to recognize the vulnerable plaque evolve. If CAS converts to a symptomatic status, early referral for endarterectomy or stenting is indicated. PMID:26417184

  2. Isolated supraclinoid occlusive disease of the internal carotid artery.

    PubMed

    Lagrèze, H L; Hartmann, A; Ries, F; Wappenschmidt, J; Hanisch, E

    1987-01-01

    Isolated supraclinoid occlusive disease of the internal carotid artery is a rare cause of cerebral ischemia. The authors of the only review of this subject concluded that it is caused predominantly by factors other than atherosclerosis. We examined 6 patients with isolated supraclinoid occlusive lesions. Five of them had one or more risk factors for atherosclerosis. Thus, the isolated stenosis of that part of the internal carotid artery does not seem to represent a particular pathologic entity.

  3. Extracranial carotid artery aneurysm due to Behcet's disease.

    PubMed

    Albeyoglu, Sebnem; Cinar, Bayer; Eren, Tunc; Filizcan, Ugur; Bayserke, Olgar; Aslan, Cenk

    2010-12-01

    Behçet's disease is a chronic systemic inflammatory disorder associated with recurrent oral and genital ulcers and iritis. Vascular lesions are encountered in 7%-29% of patients, gravely affecting the course of the disease. Extracranial carotid aneurysms due to Behçet's disease are extremely rare. We describe a surgically treated case of Behçet's disease in a 28-year-old man who presented with a rapidly enlarging left common carotid artery aneurysm.

  4. Carotid inflammation is unaltered by exercise in hypercholesterolemic swine

    PubMed Central

    Masseau, Isabelle; Davis, Michael J.; Bowles, Douglas K.

    2012-01-01

    Introduction Reduction of vascular inflammation might contribute to the beneficial effects of exercise. We hypothesized that 1) exercise would reduce carotid endothelial vascular cell adhesion molecule-1 (VCAM-1) and that 2) in vivo detection of carotid inflammation can be achieved in a large animal model using contrast-enhanced ultrasound (CEU) with VCAM-1 targeted microbubbles. Methods Familial Hypercholesterolemic (FH) swine were divided into sedentary (Sed) and exercise-trained (Ex) groups. Ex pigs underwent 16–20 wk of treadmill aerobic exercise. At the end of the study, in vivo CEU with VCAM-1 targeted microbubbles and assessment of endothelial-dependent dilation (EDD) were performed in carotid arteries. VCAM-1 mRNA and protein expression were compared to markers of atherosclerotic disease and health, and in vitro EDD was assessed in carotid arteries. Results Exercise training did not reduce inflammation nor did it improve EDD in carotid arteries of FH swine. Markers of atherosclerosis including VCAM-1 were prominent in the bifurcation compared to the proximal or distal common carotid artery (CCA) and inversely associated with phosphorylated- and total-eNOS. Signal intensity from VCAM-1-to-control microbubbles positively correlated with carotid VCAM-1 protein expression, validating our technique. Conclusion These results first demonstrate that aerobic exercise has no effect on carotid endothelial inflammatory markers and EDD in FH swine. Second, our findings indicate that CEU using VCAM-1 targeted microbubbles can detect inflammation in vivo, providing strong foundations for longitudinal studies examining the effect of therapeutic interventions on the inflammatory status of the endothelium. PMID:22776877

  5. Chronic hyperoxic effects on cat carotid body catecholamines and structure.

    PubMed

    Mokashi, A; Di Guilio, C; Morelli, L; Lahiri, S

    1994-06-01

    To account for the loss of O2 chemoreception in the cat carotid body during chronic hyperoxia, we studied the putative neurotransmitter correlates. Also, we studied the structural aspect of the carotid body tissues. We found that catecholamine concentrations increased and that the densecored vesicles in the glomus cells were not depleted, indicating that a lack of transmitters was not the cause for the loss of O2 chemoreception.

  6. Galactorrhoea amenorrhoea syndrome due to internal carotid artery aneurysm.

    PubMed Central

    Garg, S. K.; Dash, R. J.

    1985-01-01

    A 32 year old female with hyperprolactinaemia-galactorrhoea-amenorrhoea due to a right internal carotid artery aneurysm just before its bifurcation is described. She had two episodes of subarachnoid haemorrhage necessitating an emergency internal carotid artery ligation. She responded to bromocriptine treatment with restoration of her menses, normalization of circulating prolactin and disappearance of galactorrhoea. Images Figure 1 Figure 2 Figure 3 PMID:4040632

  7. Dissection of a non-bifurcating cervical carotid artery.

    PubMed

    Nas, Omer Fatih; Karakullukcuoglu, Zeynel; Hakyemez, Bahattin; Erdogan, Cuneyt

    2016-06-01

    A non-bifurcating cervical carotid artery is a rare anomaly in the population. Radiologic diagnosis of pathologies seen together with this anomaly can be challenging. Despite not being diagnostic all the time, digital subtraction angiography is accepted as the gold standard method for the diagnosis of dissection. We present a case of a non-bifurcating cervical carotid artery and concomitant dissection, which presented to the hospital with trauma and ischemic findings.

  8. Management of carotid 'blowout' with endovascular stent grafts.

    PubMed

    Warren, Frank M; Cohen, James I; Nesbit, Gary M; Barnwell, Stanley L; Wax, Mark K; Andersen, Peter E

    2002-03-01

    Since 1992, endovascular techniques for vascular occlusion and stenting have evolved significantly. Endovascular occlusion of the carotid artery has been used in the management of carotid "blowout." Although it seems logical to expand this application to the use of arterial stents to repair rather than occlude the artery when cerebral cross-circulation is inadequate, concerns remain regarding the placement of a foreign body in a contaminated field. The purpose of the present report is to describe our experience with endovascular stents for control of carotid hemorrhage. Retrospective case review. Retrospective review of three cases of acute or threatened carotid hemorrhage managed with endovascular stent placement. Two patients presented with acute carotid blowout, and one patient with a probable sentinel bleed. All patients previously had been heavily treated with surgery and irradiation: Two had developed pharyngocutaneous fistulas, and one had an open wound filled with tumor that surrounded the carotid artery. All were thought to be at significant risk for stroke if the carotid artery was occluded. In all three patients, stent placement resolved the acute hemorrhage. Mean duration of follow-up was 8.3 months. In two patients, the stent became exposed, ultimately thrombosed or extruded, or both. The third patient had no residual sequelae of stenting but died 3 months later. When an unacceptable risk of cardiovascular accident makes occlusion unwise, acute carotid hemorrhage can be successfully managed with directed placement of endovascular stents, but the long-term sequelae of placing these foreign bodies in a field with ongoing contamination make this a temporizing rather than permanent measure for use while more definitive long-term solutions are pursued.

  9. Endovascular Treatment of Iatrogenic and Traumatic Carotid Artery Dissection

    SciTech Connect

    Schulte, Stefan; Donas, Konstantinos P. Pitoulias, Georgios A.; Horsch, Svante

    2008-09-15

    This paper reports on the early and midterm results of endovascular treatment of acute carotid artery dissections, its specific problems, and its limitations. We encountered seven patients with symptomatic extracranial carotid artery dissection, three cases of which occurred after carotid endarterectomy, two after carotid angioplasty and stenting, and two after trauma. Balloon-expandable and self-expanding stents were placed using a transfemoral approach. Success in restoring the carotid lumen was achieved in all patients. No procedure-related complications occurred. All patients experienced significant clinical improvement while in the hospital and achieved complete long-term recovery. At follow-up (mean, 22.4 months), good luminal patency of the stented segments was observed. In conclusion, in this small series, primary stent-supported angioplasty seems to be a safe and effective strategy in the treatment of selected patients having acute traumatic extracranial carotid artery dissection, with excellent early and midterm results. Larger series and longer-term follow-up are required before definitive recommendations can be made.

  10. Imaging of the Fibrous Cap in Atherosclerotic Carotid Plaque

    SciTech Connect

    Saba, Luca; Potters, Fons; Lugt, Aad van der; Mallarini, Giorgio

    2010-08-15

    In the last two decades, a substantial number of articles have been published to provide diagnostic solutions for patients with carotid atherosclerotic disease. These articles have resulted in a shift of opinion regarding the identification of stroke risk in patients with carotid atherosclerotic disease. In the recent past, the degree of carotid artery stenosis was the sole determinant for performing carotid intervention (carotid endarterectomy or carotid stenting) in these patients. We now know that the degree of stenosis is only one marker for future cerebrovascular events. If one wants to determine the risk of these events more accurately, other parameters must be taken into account; among these parameters are plaque composition, presence and state of the fibrous cap (FC), intraplaque haemorrhage, plaque ulceration, and plaque location. In particular, the FC is an important structure for the stability of the plaque, and its rupture is highly associated with a recent history of transient ischaemic attack or stroke. The subject of this review is imaging of the FC.

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

    PubMed

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

    2010-06-01

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

  12. Carotid endovascular interventions: patient selection, devices, techniques and tips.

    PubMed

    Bosiers, M; Deloose, K; Peeters, P

    2010-02-01

    The optimal treatment of patients with asymptomatic or symptomatic carotid artery disease (CAD) has been a long-lasting debate. The choice between carotid endarterectomy (CEA), carotid artery stenting (CAS) and/or optimal medical therapy to treat patients with CAD, depends on their risk profile. Recent data from EVA-3S, SPACE randomized trials failed to demonstrate non-inferiority for CAS over CEA. However, other publications suggest that with growing experience and the development of dedicated CAS technology, CAS can be performed safely and efficiently. The success of carotid stenting does not solely depend on the operator's skills and experience, but also on the adequate selection of carotid stents and cerebral protection devices. Currently, CAS practitioners are confronted with a large number of dedicated CAS devices (stents and embolic protection devices). This wide array of products makes individual treatment strategies difficult to generalise as no single device possesses all of the optimal features to treat all types of carotid plaques and patients. This article reviews the principles of patient selection and device selection in contemporary CAS practice.

  13. A case of carotid body tumor concomitant with carcinoid tumor.

    PubMed

    Mun, Mi Jin; Lee, Jin Choon; Lee, Byung Joo

    2015-02-01

    Neuroendocrine tumors typically fall into two broad categories: those of epithelial origin and those of neural derivation. The former group includes carcinoid tumors and the latter includes paraganglioma. Although paraganglioma and carcinoid tumor have different biologic behaviors, their overlapping histological appearance can pose diagnostic challenges. Carcinoid tumors are rare, slow-growing neuroendocrine tumors arising from the enterochromaffin cells disseminated throughout the gastrointestinal and bronchopulmonary systems. Carotid body tumor is the most common type of extra-adrenal paraganglioma. Paraganglioma tends to grow slowly but can compress adjacent vessel and nerve. A 63-year-old woman showed huge mass extending from carotid body to skull base, encircling internal and external carotid arteries on magnetic resonance image. Surgical removal of carotid body tumor was done after embolization procedure. Postoperative histopathologic examination and immunohistochemical analysis were consistent with paraganglioma concomitant with carcinoid tumor in carotid body. Primary cervical carcinoid tumor is extremely rare, and to the best of our knowledge, this is the first case of concomitant existence of paraganglioma and carcinoid tumor in carotid body.

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

    PubMed Central

    Mendonça, Célio Teixeira; Fortunato Jr, Jerônimo A.; de Carvalho, Cláudio A.; Weingartner, Janaina; Filho, Otávio R. M.; Rezende, Felipe F.; Bertinato, Luciane P.

    2014-01-01

    Objective To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. Methods One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). Results A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). Conclusion Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates. PMID:25714212

  15. Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster.

    PubMed

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

    2014-12-28

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

  16. Influence of Preoperative Risk Factors on Outcome After Carotid Endarterectomy

    PubMed Central

    Sternbergh, W. Charles; Money, Samuel R.

    2003-01-01

    As supported by level 1 multicenter randomized trial data, carotid endarterectomy (CEA) has a very low risk of perioperative morbidity and excellent durability, and provides significant long-term reductions of the risk of stroke. At Ochsner, our 1.1% risk of major stroke or death after CEA (n=366) is a demonstration of the safety of this procedure in experienced hands. This treatment modality continues to be the gold standard for most patients with carotid artery occlusive disease. Almost half of these patients treated with CEA were considered “high-risk” as defined by ineligibility for past or present randomized carotid trials. Importantly, these “high-risk” patients had outcomes that were not statistically different from “low-risk” trial-eligible patients. Thus, evidence-based decision-making does not support the routine use of investigational carotid stenting in “high-risk” trial-ineligible patients. However, carotid stenting is clearly a valuable alternative for selected patients. Our challenge is to precisely define which patients will most benefit from medical, surgical, or catheter-based therapy for carotid artery occlusive disease. PMID:22470252

  17. Recommendations for Management of Patients with Carotid Stenosis

    PubMed Central

    Lovrencic-Huzjan, Arijana; Rundek, Tatjana; Katsnelson, Michael

    2012-01-01

    Stroke is a one of the leading causes of morbidity and mortality in the world. Carotid atherosclerosis is recognized as an important factor in stroke pathophysiology and represents a key target in stroke prevention; multiple treatment modalities have been developed to battle this disease. Multiple randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting, a newer treatment option, presents a less invasive alternative to the surgical intervention on carotid arteries. Advances in medical therapy have also enabled further risk reduction in the overall incidence of stroke. Despite numerous trials and decades of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. We will attempt to highlight some of the pivotal trials already completed, discuss the current controversies and complexities in the treatment decision-making, and postulate on what likely lies ahead. This paper will highlight the complexities of decision-making optimal treatment recommendations for patients with symptomatic and asymptomatic carotid stenosis. PMID:22645702

  18. Cerebral monitoring during carotid endarterectomy by transcranial Doppler ultrasonography

    PubMed Central

    2017-01-01

    Purpose To evaluate the efficacy and safety of cerebral monitoring by transcranial Doppler ultrasonography (TCD) for the detection of cerebral ischemia during carotid endarterectomy (CEA). Methods From August 2004 to December 2013, 159 CEAs were performed in a tertiary hospital. All procedures were performed under general anesthesia. Intraoperative TCD was routinely used to detect cerebral ischemia. Of the 159 patients, 102 patients were included in this study, excluding 27 patients who had a poor transtemporal isonation window and 30 patients who used additional cerebral monitoring systems such as electroencephalography or somatosensory evoked potentials. When mean flow velocity in the ipsilateral middle cerebral artery decreased by >50% versus baseline during carotid clamping carotid shunting was selectively performed. The carotid shunt rate and incidence of perioperative (<30 days) stroke or death were investigated by reviewing medical records. Results Carotid shunting was performed in 31 of the 102 patients (30%). Perioperative stroke occurred in 2 patients (2%); a minor ischemic stroke caused by embolism in one and an intracerebral hemorrhage in the other. Perioperative death developed in the latter patient. Conclusion TCD is a safe cerebral monitoring tool to detect cerebral ischemia during CEA. It can reduce use of carotid shunt. PMID:28203558

  19. Association of Blood Monocyte and Platelet Markers with Carotid Artery Characteristics: The Atherosclerosis Risk in Communities Carotid MRI Study

    PubMed Central

    Matijevic, N.; Wu, K.K.; Howard, A.G.; Wasserman, B.; Wang, W.Y.-W.; Folsom, A.R.; Sharrett, A.R.

    2011-01-01

    Background Atherosclerosis is characterized by infiltration of inflammatory cells from circulating blood. Blood cell activation could play an important role in plaque formation. Methods We analyzed the relationship between blood cellular markers and quantitative measures of carotid wall components in 1,546 participants from the ARIC (Atherosclerosis Risk in Communities) Carotid MRI Study. Carotid imaging was performed using a gadolinium contrast-enhanced MRI and cellular phenotyping by flow cytometry. Results Monocyte Toll-like receptor (TLR)-2 is associated with larger plaques, while CD14, myeloperoxidase, and TLR-4 associate with smaller. Platelet CD40L is associated with smaller plaques and thinner caps, while P-selectin is associated with smaller core size. Conclusions Blood cell activation is significantly associated with atherosclerotic changes of the carotid wall. PMID:21487219

  20. The Early Effect of Carotid Artery Stenting on Antioxidant Capacity and Oxidative Stress in Patients with Carotid Artery Stenosis

    PubMed Central

    Ambrosius, Wojciech; Dziarmaga, Mieczyslaw; Juszkat, Robert; Wykretowicz, Andrzej; Kozubski, Wojciech

    2016-01-01

    The treatment of carotid artery stenosis is associated with the risk of complications, which may include stroke after carotid artery stenting (CAS) and myocardial infarction after carotid endarterectomy (CEA). The imbalance between prooxidative mechanisms and antioxidant capacity creates a milieu of factors, which may increase the risk of complications after endovascular procedures. We have examined 43 consecutive patients with carotid artery stenosis. Sera were analyzed for the activity of paraoxonase (PON) and arylesterase (ARE), sulfhydryl groups (SG), malondialdehyde (MDA), and conjugated dienes (CD) concentrations by means of spectrophotometric methods before and next day after CAS. We have found lowered PON (P = 0.0032), increase in ARE activity (P = 0.0058), and decrease in sulfhydryl groups concentration (P = 0.0267). No effect on absolute MDA and CD concentrations was observed. The degree of carotid artery stenosis correlated negatively with PON/ARE ratio after CAS (rS = −0.507, P = 0.0268). To conclude, CAS influences both enzymatic (differently, PON and ARE activity) and nonenzymatic antioxidant defense. Females are more susceptible to lipid peroxidation after CAS. PON/ARE ratio after CAS correlated with the degree of carotid artery stenosis. The changes (deltas) in ARE activity, SG, and MDA concentrations correlated with the severity of neurological deficit and disability. PMID:28058087

  1. Automated calculation of bifurcation carotid angle for analyzing the risk of carotis plaques by using carotid CT angiographic images

    NASA Astrophysics Data System (ADS)

    Demir, N.; Demir, S.

    2015-05-01

    The aim of this study is calculation of bifurcation carotid angle by detection of vessel boundaries to assist the medical doctors if this angle is a risk factor about formation of carotid plaques.Carotid ct angiography images are clustered automatically by ISODATA unsupervised classification algorithm. Since the spectral digital numbers (DN) of vessel pixels are bigger than the other part of the images, the cluster which has the biggest median value of DN among all other classes gives the vessel class. The cluster image in raster format is converted into the vector format which allows working on the vessel geometry. The converted vector vessel cluster dataset has been simplified using Douglas-Peucker algorithm to eliminate the zigzag effects of pixel data which are remained on the vector form dataset. Then the cluster polygon is converted to lines and the vertices which will be used for the calculation of bifurcation carotid angle. For sorting the vertex points to calculate the angle on each vertex, alpha-shapes algorithm is applied along the boundary. Then all the angles on each vertex point along the boundary of vessels are calculated. It is also visually clear that the angle which has the minimum value among all the calculated angles, gives the bifurcation carotid angle for one projected plane. The final carotid angle has calculated and 18 sample datasets are used to test the method.

  2. Whole-brain black-blood imaging with magnetization-transfer prepared spin echo-like contrast: a novel sequence for contrast-enhanced brain metastasis screening at 3T.

    PubMed

    Yoneyama, Masami; Nakamura, Masanobu; Tabuchi, Takashi; Takemura, Atsushi; Obara, Makoto; Tatsuno, Satoshi; Sawano, Seishi

    2013-07-01

    In contrast-enhanced (CE) brain metastasis screening, coexistence of enhanced blood vessel suppression and higher tumor-to-parenchyma contrast may improve radiologists' performances in detecting brain metastases compared with conventional sequences. In this study, we propose a new scheme, allowing both suppression of blood signals and improvement of tumor-to-parenchyma contrast, using motion-sensitized driven equilibrium prepared 3D low-refocusing flip-angle turbo spin echo (TSE) ("magnetization transfer prepared spin echo"-like contrast volume examination: MATLVE) for brain metastasis screening at 3.0 T, and we compare MATLVE to conventional three-dimensional (3D)-gradient recalled echo (GRE) and 3D-TSE sequences. With the use of MATLVE, the signal intensity of CE blood decreased substantially. Furthermore, the contrast ratio of tumor-to-white matter was significantly higher than in either conventional 3D-GRE or 3D-TSE. MATLVE can be used for 3D volumetric post-CE black-blood imaging, and it may be effective in detecting small brain metastases by selectively enhancing tumor signals while suppressing blood signals.

  3. Extravascular optical coherence tomography: evaluation of carotid atherosclerosis and pravastatin therapy.

    PubMed

    Wicks, Robert T; Huang, Yong; Zhang, Kang; Zhao, Mingtao; Tyler, Betty M; Suk, Ian; Hwang, Lee; Ruzevick, Jacob; Jallo, George; Brem, Henry; Pradilla, Gustavo; Kang, Jin U

    2014-04-01

    Extravascular optical coherence tomography (OCT), as a noninvasive imaging methodology with micrometer resolution, was evaluated in a murine model of carotid atherosclerosis by way of assessing the efficacy of pravastatin therapy. An OCT device was engineered for extravascular plaque imaging. Wild-type mice and apolipoprotein E-deficient (ApoE(-/-)) mice were randomized to 3 treatment groups: (1) wild-type on a diet of standard rodent chow (n=13); (2) ApoE(-/-) on a high-fat, atherosclerotic diet (HFD; n=13); and (3) ApoE(-/-) on a HFD given daily pravastatin (n=13). Mice were anesthetized and the left common carotid was surgically exposed. Three-dimensional (3D; 2 spatial dimensions+time) and 4D (3 spatial dimensions+time) OCT images of the vessel lumen patency were evaluated. After perfusion, in situ OCT imaging was performed for statistical comparison with the in vivo results and final histology. Intraoperative OCT imaging positively identified carotid plaque in 100% of ApoE(-/-) mice on HFD. ApoE(-/-) mice on HFD had a significantly decreased lumen patency when compared with that in wild-type mice (P<0.001). Pravastatin therapy was found to increase lumen patency significantly in ApoE(-/-) mice on HFD (P<0.01; compared with ApoE(-/-) on HFD). The findings were confirmed with OCT imaging after perfusion and histology. OCT imaging offers the potential for real-time, detailed vessel lumen evaluation, potentially improving surgical accuracy and outcomes during cerebrovascular neurosurgical procedures. Pravastatin significantly increases vessel lumen patency in the ApoE(-/-) mouse on HFD.

  4. Levels of circulating neopterin in patients with severe carotid artery stenosis undergoing carotid stenting.

    PubMed

    Chen, Yung-Lung; Tsai, Tzu-Hsien; Sung, Pei-Hsun; Wang, Hui-Ting; Lin, Hung-Sheng; Chang, Wen-Neng; Lu, Cheng-Hsien; Chen, Shu-Feng; Huang, Chi-Ren; Tsai, Nai-Wen; Wu, Chiung-Jen; Yip, Hon-Kan

    2014-01-01

    The association between an elevated serum neopterin level and the development of coronary artery complex lesions has been extensively assessed; however, the correlation between the serum neopterin level and the development of carotid artery stenosis has seldom been reported. This study tested whether this biomarker is increased in patients with severe carotid artery stenosis(≥70%) undergoing carotid artery(CA) stenting and investigated independent predictors of an increased circulating neopterin level. Fifty patients with severe CA stenosis(CAS) undergoing CA stenting were consecutively enrolled in this study from January 2009 through December 2011. The serum neopterin levels of age- and gender-matched acute ischemic stroke(AIS) patients(n=120) and control subjects(CS)(n=33) were also measured. A blood sample was prospectively collected from each patient in the catheterization room. The serum levels of neopterin were significantly higher in the CAS patients than in the AIS patients or CS and significantly higher in the AIS patients than in the CS(all p<0.001). An analysis of the variables of 170 patients(CAS+AIS) demonstrated that age, a previous history of stroke and severe CAS were significantly correlated with an increased serum level of neopterin(all p<0.005). A multivariate binary logistic regression analysis of the severe CAS patients(n=50) demonstrated that age and the creatinine level were independent predictors of a high neopterin level(neopterin level ≥16.52 ng/dL, i.e., according to the median value of neopterin)(all p<0.05). The circulating neopterin levels are significantly higher in patients with severe CAS than in those with AIS. The presence of CAS, age and the creatinine level were significantly correlated with an increased serum neopterin level.

  5. Creating accountable care for carotid angioplasty and stenting: A multidisciplinary carotid revascularization board

    PubMed Central

    Kole, Maximilian K.; Khan, Muhib; Marin, Horia; Sanders, William; Shepard, Alexander; Katramados, Angelos M.; Russman, Andrew N.; Gellman, Steven; Nypaver, Timothy; Malik, Ghaus; Mitsias, Panayiotis D.

    2012-01-01

    Background: We tested the feasibility of a mandated multidisciplinary carotid revascularization board (MDCB) to review, approve and monitor all carotid artery and stenting (CAS) procedures and outcomes at our institution. Methods: The board was composed of vascular surgeons, cardiologists, interventional neuroradiologists, neurosurgeons, and neurologists, who met weekly to facilitate an evidence-based, consensus recommendation to ensure appropriate CAS referral. Results: The board successfully reviewed and continues to review and approve all CAS procedures at our center. Of the 69 patients considered high risk for standard surgical treatment, 42 patients were symptomatic and 27 patients were asymptomatic. Their mean age was 70.5-year-old and the median degree of stenosis was 79%. In the 74 procedures, periprocedural complications occurred at the following rates: 2.7% death, 2.7% major stroke, 2.7% minor stroke, and 2.7% myocardial infarction (MI) within 30 days of the procedure. At 1 year the primary endpoints of ipsilateral stroke and neurovascular-related death were observed in 8.1% and 2.7% of the patients, respectively. At mean follow-up of 21 months, 18.8% of the patients (13/69) had died (including all causes), and 14.5% (10/69) experienced stroke (including nontarget strokes). Target vessel revascularization was needed in 2.9% patients. Conclusions: A mandated multidisciplinary carotid revascularization board MDCB is feasible and potentially advantageous in real clinical practice. It establishes a model for accountable care by providing a mechanism for institutional oversight, credentialing operators, quality review, standardizing care, cost containment and eliminating the “subspecialty silo mentality.” PMID:23459852

  6. Proposed clinical internal carotid artery classification system

    PubMed Central

    Abdulrauf, Saleem I; Ashour, Ahmed M; Marvin, Eric; Coppens, Jeroen; Kang, Brian; Hsieh, Tze Yu Yeh; Nery, Breno; Penanes, Juan R; Alsahlawi, Aysha K; Moore, Shawn; Al-Shaar, Hussam Abou; Kemp, Joanna; Chawla, Kanika; Sujijantarat, Nanthiya; Najeeb, Alaa; Parkar, Nadeem; Shetty, Vilaas; Vafaie, Tina; Antisdel, Jastin; Mikulec, Tony A; Edgell, Randall; Lebovitz, Jonathan; Pierson, Matt; Pires de Aguiar, Paulo Henrique; Buchanan, Paula; Di Cosola, Angela; Stevens, George

    2016-01-01

    Introduction: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system. Materials and Methods: We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography. We identified specific anatomic landmarks to define the beginning and end of each ICA segment. Results: The ICA was classified into eight segments based on the cadaver and imaging findings: (1) Cervical segment; (2) cochlear segment (ascending segment of the ICA in the temporal bone) (relation of the start of this segment to the base of the styloid process: Above, 425 sides [80%]; below, 2 sides [0.4%]; at same level, 107 sides [20%]; P < 0.0001) (relation of cochlea to ICA: Posterior, 501 sides [85%]; posteromedial, 84 sides [14%]; P < 0.0001); (3) petrous segment (horizontal segment of ICA in the temporal bone) starting at the crossing of the eustachian tube superolateral to the ICA turn in all 10 samples; (4) Gasserian-Clival segment (ascending segment of ICA in the cavernous sinus) starting at the petrolingual ligament (PLL) (relation to vidian canal on imaging: At same level, 360 sides [63%]; below, 154 sides [27%]; above, 53 sides [9%]; P < 0.0001); in this segment, the ICA projected medially toward the clivus in 275 sides (52%) or parallel to the clivus with no deviation in 256 sides (48%; P < 0.0001); (5) sellar segment (medial loop of ICA in the cavernous sinus) starting at the takeoff of the meningeal hypophyseal trunk (ICA was medial into the sella in 271 cases [46%], lateral without touching the sella in 127 cases [23%], and abutting the sella in 182 cases [31%]; P < 0.0001); (6) sphenoid segment (lateral loop of ICA within the

  7. Association of carotid atherosclerosis and left ventricular hypertrophy.

    PubMed

    Roman, M J; Pickering, T G; Schwartz, J E; Pini, R; Devereux, R B

    1995-01-01

    This study was undertaken to determine the prevalence of carotid atherosclerosis in a large group of asymptomatic hypertensive and normotensive adults and to examine its relation to the presence of left ventricular hypertrophy. Both electrocardiographic and echocardiographic left ventricular hypertrophy predict an increased risk of cardiovascular events and mortality, including cerebrovascular disease, but the mechanism of association is unknown. Four hundred eighty-six (277 normotensive and 209 untreated hypertensive) adults, free of clinical evidence of cardiovascular disease, were studied prospectively with echocardiography to determine left ventricular mass and carotid ultrasound to detect atherosclerosis and to measure common carotid artery dimensions. Carotid atherosclerosis was present in 16% of normotensive and 23% of hypertensive participants (p < 0.05) and was associated with older age, higher systolic and pulse pressures and larger left ventricular mass index ([mean +/- SD] 91 +/- 19 vs. 82 +/- 18 g/m2, p < 0.0001). The difference in mass persisted after adjustment for baseline differences in age and blood pressure. Subjects with left ventricular hypertrophy were twice as likely to have carotid atheromas (35% vs. 18%, p < 0.01). Logistic regression analyses, including standard risk factors, indicated that only age and left ventricular mass index independently predicted the presence of carotid plaque, both in the entire study group and when normotensive and hypertensive subjects were considered separately. We believe that the present study provides the first evidence that higher left ventricular mass as detected by echocardiography is associated with the presence of carotid plaque. The association between cardiac hypertrophy and systemic atherosclerosis may contribute to the pathogenesis of the high incidence of vascular events that is well documented in patients with left ventricular hypertrophy.

  8. Carotid artery protrusion and dehiscence in patients with acromegaly.

    PubMed

    Sasagawa, Yasuo; Tachibana, Osamu; Doai, Mariko; Hayashi, Yasuhiko; Tonami, Hisao; Iizuka, Hideaki; Nakada, Mitsutoshi

    2016-10-01

    Acromegaly is a systemic disease which causes multiple bony alterations. Some authors reported that acromegalic patients have risk factors for an intraoperative vascular injury due to the specific anatomical features of their sphenoid sinus. The objective of our study was to analyze the anatomic characteristics of sphenoid sinus in acromegalic patients compared with controls, by evaluation of computed tomography (CT) findings. We examined 45 acromegalic (acromegaly group) and 45 non-acromegalic patients (control group) with pituitary adenomas who were matched for sex, age, height, tumor size, and cavernous sinus invasion (Knosp grade). Preoperative CT of the pituitary region including the sphenoid sinus was used to evaluate the following anatomic characteristics: type of sphenoid sinus (sellar or pre-sellar/conchal); intrasphenoid septa (non/single or multiple); carotid artery protrusion; carotid artery dehiscence; intercarotid distance. Sixteen acromegalic patients (35.5 %) and 6 controls (13.3 %) had carotid artery protrusion. Additionally, 10 acromegalic patients (22.2 %) and 3 controls (6.6 %) had carotid artery dehiscence. Carotid artery protrusion and dehiscence were more frequent in the acromegaly group than in control group (p = 0.013 and 0.035, respectively). Other anatomic characteristics (type of sphenoid sinus, intrasphenoid septa, and intracarotid distance) showed no significant differences between acromegaly and control groups. Our study suggests that carotid artery protrusion and dehiscence occur more frequently among acromegalic patients, compared with non-acromegalic patients. It is important for surgeons to be aware of these anatomic variations to avoid vital complications, such as carotid injuries, during surgery.

  9. The carotid rete and artiodactyl success.

    PubMed

    Mitchell, G; Lust, A

    2008-08-23

    Since the Eocene, the diversity of artiodactyls has increased while that of perissodactyls has decreased. Reasons given for this contrasting pattern are that the evolution of a ruminant digestive tract and improved locomotion in artiodactyls were adaptively advantageous in the highly seasonal post-Eocene climate. We suggest that evolution of a carotid rete, a structure highly developed in artiodactyls but absent in perissodactyls, was at least as important. The rete confers an ability to regulate brain temperature independently of body temperature. The net effect is that in hot ambient conditions artiodactyls are able to conserve energy and water, and in cold ambient conditions they are able to conserve body temperature. In perissodactyls, brain and body temperature change in parallel and thermoregulation requires abundant food and water to warm/cool the body. Consequently, perissodactyls occupy habitats of low seasonality and rich in food and water, such as tropical forests. Conversely, the increased thermoregulatory flexibility of artiodactyls has facilitated invasion of new adaptive zones ranging from the Arctic Circle to deserts and tropical savannahs.

  10. Solitary fibrous tumor surrounding the carotid sheath.

    PubMed

    Gómez-Oliveira, Guillermo; Alvarez-Flores, Modesto; Arribas-García, Ignacio; Martínez-Gimeno, Carlos

    2010-03-01

    Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that are mostly found arising from the pleura. Although SFTs recently have been reported in other regions, they are rare in the head and neck and have often been misdiagnosed due to their rarity. SFTs are benign in most cases. Clinically, SFTs usually manifest as well-circumscribed, slow-growing, smooth and painless masses. Symptoms are often minimal, although they may include sore throat, difficulty in swallowing, change of voice or trismus. CT-Scan and MRI are the most sensitive imaging procedures used. The treatment of choice is complete surgical excision of the lesion. Because recurrences have been noted up to 30 years after surgery, long-term follow up is mandatory. In this article, we present a case of a Solitary Fibrous Tumor arising in the parapharyngeal space in a 20-year-old man, involving the carotid sheath, treated by surgical excision with no recurrence after 1 year. The clinical presentation, surgical management and pathological findings are described.

  11. Inelasticity of human carotid atherosclerotic plaque.

    PubMed

    Maher, Eoghan; Creane, Arthur; Sultan, Sherif; Hynes, Niamh; Lally, Caitríona; Kelly, Daniel J

    2011-09-01

    Little mechanical test data exists regarding the inelastic behavior of atherosclerotic plaques. As a result finite element (FE) models of stenting procedures commonly use hyperelastic material models to describe the soft tissue response thus limiting the accuracy of the model to the expansion stage of stent implantation and leave them unable to predict the lumen gain. In this study, cyclic mechanical tests were performed to characterize the inelastic behavior of fresh human carotid atherosclerotic plaque tissue due to radial compressive loading. Plaques were classified clinically as either mixed (M), calcified (Ca), or echolucent (E). An approximately linear increase in the plastic deformation was observed with increases in the peak applied strain for all plaque types. While calcified plaques generally appeared stiffest, it was observed that the clinical classification of plaques had no significant effect on the magnitude of permanent deformation on unloading. The test data was characterized using a constitutive model that accounts for both permanent deformation and stress softening to describe the compressive plaque behavior on unloading. Material constants are reported for individual plaques as well as mean values for each plaque classification. This data can be considered as a first step in characterizing the inelastic behavior of atherosclerotic plaques and could be used in combination with future mechanical data to improve the predictive capabilities of FE models of angioplasty and stenting procedures particularly in relation to lumen gain.

  12. Carotid artery occlusion by rhinoorbitocerebral mucormycosis.

    PubMed

    Al-Otaibi, Faisal; Albloushi, Monirah; Alhindi, Hindi; Timms, Michael S

    2012-01-01

    Mucormycosis is the third most common invasive fungal infection that particularly occurs in immunocompromised patients. Intracranial and extracranial arteriovenous vasculopathy is a complication that makes this disease more complex and difficult to treat. We describe a 23-year-old female, who presented to her local hospital with acute blindness and diabetic ketoacidosis-induced coma requiring intensive care treatment. She was found to have lesions in the nasal sinuses, orbit, and frontal base. The left carotid artery was occluded from its origin in the neck to the supraclinoid segment and left cavernous sinus involvement. No cerebral infarction was noted. Biopsies obtained by endonasal debridement confirmed mucormycosis. In addition to antimicrobial therapy, she underwent several multidisciplinary approaches to treat her disease. Multiple endonasal, and cranial procedures were done including bilateral orbital exenteration. After prolonged treatment on the intensive care unit she made a remarkable recovery to the point where she was communicating verbally and had normal limb movements and later discharged home. She remained alive and well for two months, but later succumbed to a recurrence of her disease. In conclusion, mucormycosis-induced vasculopathy is a complex problem, which merits aggressive treatment of this invasive disease. It is normally regarded as an indicator of grave prognosis.

  13. Parotid or carotid? Misled by site.

    PubMed

    Tyagi, Ruchita; Munjal, Manish; Kaur, Pavneet; Kaur, Harpreet; Sood, Neena

    2017-03-06

    We present an interesting scenario where a 64 years old male presented with a long standing painless, infra-auricular swelling, which had progressively increased in size. Based on the site, the clinical impression was of a salivary gland lesion and FNAC was performed. The smears were unusually cellular and had necrotic background. The cytological diagnosis was a cystic neoplasm of salivary gland, possibly mucoepidermoid carcinoma. Warthin's tumor was also kept in differential. However, the radiological investigations, which were made available after the FNAC report were conflicting with cytological diagnosis of a malignancy and were characteristic of a carotid body tumor, generally a benign neoplasm. Surgical excision of the tumor with regional lymph node sampling was done and histopathological examination solved the puzzle by revealing metastasis of paraganglioma to right posterior triangle lymph nodes. This case is unique because of the unusual presentation of a malignant paraganglioma as an infra-auricular swelling, which was clinically considered as a parotid tumor. The clinician as well as the pathologist need to be aware of such diagnostic pitfall. Diagn. Cytopathol. 2017. © 2017 Wiley Periodicals, Inc.

  14. Carotid ultrasound for pulmonary arteriovenous malformation screening

    PubMed Central

    Schneider, Günther; Maßmann, Alexander; Gräber, Stefan; Geisthoff, Urban W.

    2015-01-01

    Objective In patients with hereditary hemorrhagic telangiectasia (HHT), pulmonary arteriovenous malformations (PAVMs) can cause serious neurological complications. Our aim was to evaluate the potential of contrast-enhanced Doppler ultrasound (CE-US) of the common carotid artery as a screening test for detection of PAVMs. Methods A total of 124 consecutive patients with HHT or a positive family history underwent screening for PAVMs with CE-US and thoracic contrast-enhanced magnetic resonance angiography (CE-MRA). CE-US was performed after receiving (D)-galactose microparticulate, and CE-MRA with gadobenate dimeglumine. Twenty-five patients with confirmed PAVMs were referred to conventional pulmonary catheter angiography (PA). Findings on CE-US and CE-MRA were evaluated using contingency tables and McNemar’s test. Results Using CE-MRA as the reference test, CE-US had a sensitivity of 100%, a specificity of 87%, and a negative predictive value of 100%. In 25 patients who underwent PA, PAVMs that had been diagnosed on CE-US and CE-MRA were confirmed. Of the PAVMs detected by CE-MRA, 24% were not identified on PA. Conclusion CE-US is a simple, minimally invasive screening method that can easily be performed in different settings. CE-US can predict PAVMs with high probability of success. CE-US may be a simple alternative to transthoracic echocardiography in the assessment of PAVMs in certain HHT-patients. PMID:28352707

  15. Blood Flow in the Stenotic Carotid Bifurcation

    NASA Astrophysics Data System (ADS)

    Rayz, Vitaliy

    2005-11-01

    The carotid artery is prone to atherosclerotic disease and the growth of plaque in the vessel, leading often to severe occlusion or plaque rupture, resulting in emboli and thrombus, and, possibly, stroke. Modeling the flow in stenotic blood vessels can elucidate the influence of the flow on plaque growth and stability. Numerical simulations are carried out to model the complex flows in anatomically realistic, patient-specific geometries constructed from magnetic resonance images. The 3-D unsteady Navier-Stokes equations are solved in a finite-volume formulation, using an iterative pressure-correction algorithm. The flow field computed is highly three-dimensional, with high-speed jets and strong recirculating secondary flows. Sharp spatial and temporal variations of the velocities and shear stresses are observed. The results are in a good agreement with the available experimental and clinical data. The influence of non-Newtonian blood behavior and arterial wall compliance are considered. Transitional and turbulent regimes have been looked at using LES. This work supports the conjecture that numerical simulations can provide a diagnostic tool for assessing plaque stability.

  16. [Microsurgical treatment of internal carotid bifurcation aneurysms].

    PubMed

    González-Darder, J M; González-López, P; Botella-Maciá, L

    2010-06-01

    Clinical and imaging findings of a series of 14 internal carotid artery bifurcation aneurysms microsurgically treated are presented. A total of 10 lesions were diagnosed before rupture and 4 patients presented with subarachnoidal hemorrhage and frontobasal intracerebral bleeding. Diagnosis was done using neuroimaging (CT scan, angio-CT-3D, angio-MRI, angiography) but patients with ruptured aneurysms were treated with the sole information provided by the angio-CT-3D. The average fundus size was 8.4mm (3-13.3) and the average neck size was 6.8mm (3-9.6), being the fundus-to-neck ratio 1.32 (0.46-2.05). All lesions were microsurgically treated through a pterional approach with the help of temporary clipping of the afferent vessels in all cases. We used peroperative neuroprotective, neuromonitorization and micro-doppler cerebral flow measurement. Clinical results were excellent with 13 patients GOS grade 5 and one grade 4 three month afterwards of hospital discharge and complete exclusion of the lesion in angiographic controls done solely in patients with ruptured lesions.

  17. Effect of age on carotid arterial intima-media thickness in childhood.

    PubMed

    Ishizu, Tomoko; Ishimitsu, Toshiyuki; Yanagi, Hisako; Seo, Yoshihiro; Obara, Kenichi; Moriyama, Naoko; Watanabe, Shigeyuki; Yamaguchi, Iwao

    2004-07-01

    To investigate relationships between carotid arterial intima-media thickness (IMT) and age in childhood, we performed high-resolution carotid arterial ultrasonography in 60 healthy children (27 boys, 33 girls; age range, 5-14 years) determined by screening to have no dyslipidemia or hypertension. No plaque formation was found, and irregularity of IMT (root mean square roughness of IMT) did not correlate with age. Mean IMT increased in a linear manner with age [IMT in millimeters = (0.009 x age in years) + 0.35] ( r = 0.39, P = 0.002). This correlation remained significant after adjustment for gender, parental smoking, systolic and diastolic blood pressure, body mass index, and serum concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. None of these known cardiovascular disease risk factors in adults had a significant relationship with age-adjusted IMT in children. While circumferential wall stress and diastolic blood pressure were not correlated with age, mean IMT and lumen diameter showed significant positive relationships with circulating blood volume, which was calculated as the function of height and weight. These data suggested that age-dependent physiologic thickening of arterial walls begins in childhood.

  18. Reversible and Asymptomatic Gyral and Subarachnoid Contrast Enhancement after Carotid Stenting

    PubMed Central

    Vangosa, Alessandra Briatico; Tortora, Domenico; Modestino, Francesco; Cotroneo, Antonio R

    2015-01-01

    The presence of sulcal hyperdensity in patients after endovascular procedures is not necessarily attributable to hemorrhage. It may frequently indicate the absolute or concomitant extravasation of contrast material into the subarachnoid spaces. This case report describes the clinical case of an 84-year-old patient with 90% stenosis of the right internal carotid who presented with a diffuse gyral and sulcal hyperdensity in the right temporal-occipital and frontal lobes at routine post-carotid stenting (CAS) brain CT scan. The patient was asymptomatic and CT findings were interpreted as contrast enhancement hyperattenuation and no therapeutic decisions were made. A 24-hour follow-up brain CT demonstrated the complete resolution of the hyperdensity, confirming the diagnosis. In this patient we considered the concomitant presence of gyral and sulcal hyperdensity as the consequence of reversible damage to the blood-brain barrier (BBB) determining a transitory extravasation of contrast material. Asymptomatic gyral and subarachnoid contrast enhancement following CAS is generally indicative of benign and transitory damage to the BBB and is not to be misinterpreted as hemorrhage. PMID:25923674

  19. Quest for the Vulnerable Atheroma: Carotid Stenosis and Diametric Strain--A Feasibility Study.

    PubMed

    Xu, Canxing; Yuan, Chun; Stutzman, Edward; Canton, Gador; Comess, Keith A; Beach, Kirk W

    2016-03-01

    The Bernoulli effect may result in eruption of a vulnerable carotid atheroma, causing a stroke. We measured electrocardiography (ECG)-registered QRS intra-stenotic blood velocity and atheroma strain dynamics in carotid artery walls using ultrasonic tissue Doppler methods, providing displacement and time resolutions of 0.1 μm and 3.7 ms. Of 22 arteries, 1 had a peak systolic velocity (PSV) >280 cm/s, 4 had PSVs between 165 and 280 cm/s and 17 had PSVs <165 cm/s. Eight arteries with PSVs <65 cm/s and 4 of 9 with PSVs between 65 and 165 cm/s had normal systolic diametric expansion (0% and 7%) and corresponding systolic wall thinning. The remaining 10 arteries had abnormal systolic strain dynamics, 2 with diametric reduction (>-0.05 mm), 2 with extreme wall expansion (>0.1 mm), 2 with extreme wall thinning (>-0.1 mm) and 4 with combinations. Decreases in systolic diameter and/or extreme systolic arterial wall thickening may indicate imminent atheroma rupture.

  20. External carotid stenting for symptomatic stenosis in a patient with patent EDAS for Moyamoya disease

    PubMed Central

    Schmidt, Eric; Parker, Lindsey; Fraser, Justin F

    2014-01-01

    Background Moyamoya disease is characterized by progressive narrowing of the internal carotid artery (ICA). Symptomatic patients typically undergo cerebrovascular intervention via extracranial–intracranial (EC–IC) bypass, most often with the use of the superficial temporal artery. This case of Moyamoya disease is of particular interest as the patient presented with a unilateral atherosclerotic external carotid artery (ECA) stenosis after EC–IC bypass that eliminated the benefit of his original surgery, resulting in a symptomatic presentation. Clinical presentation A 53-year-old man presenting with Moyamoya disease and known left ICA occlusion had received a bilateral encephaloduroarteriosynangiosis (EDAS) bypass 10 years previously. He re-presented complaining of right-sided tingling, weakness, and numbness radiating up the arm. CT angiography indicated significant stenosis of the left ECA. ECA angioplasty and stenting with a distal protection device resulted in resolution of his symptoms. Conclusions This case illustrates that a patient presenting with Moyamoya disease and concurrent symptomatic ECA stenosis post-EDAS can be effectively and safely treated with ECA stenting. PMID:25085947

  1. QUEST FOR THE VULNERABLE ATHEROMA: CAROTID STENOSIS AND DIAMETRIC STRAIN—A FEASIBILITY STUDY

    PubMed Central

    Xu, Canxing; Yuan, Chun; Stutzman, Edward; Canton, Gador; Comess, Keith A.; Beach, Kirk W.

    2016-01-01

    The Bernoulli effect may result in eruption of a vulnerable carotid atheroma, causing a stroke. We measured electrocardiography (ECG)-registered QRS intra-stenotic blood velocity and atheroma strain dynamics in carotid artery walls using ultrasonic tissue Doppler methods, providing displacement and time resolutions of 0.1 μm and 3.7 ms. Of 22 arteries, 1 had a peak systolic velocity (PSV) >280 cm/s, 4 had PSVs between 165 and 280 cm/s and 17 had PSVs <165 cm/s. Eight arteries with PSVs <65 cm/s and 4 of 9 with PSVs between 65 and 165 cm/s had normal systolic diametric expansion (0% and 7%) and corresponding systolic wall thinning. The remaining 10 arteries had abnormal systolic strain dynamics, 2 with diametric reduction (>−0.05 mm), 2 with extreme wall expansion (>0.1 mm), 2 with extreme wall thinning (>−0.1 mm) and 4 with combinations. Decreases in systolic diameter and/or extreme systolic arterial wall thickening may indicate imminent atheroma rupture. PMID:26705891

  2. Independent Association of Muscular Strength and Carotid Intima-Media Thickness in Children.

    PubMed

    Melo, X; Santa-Clara, H; Santos, D A; Pimenta, N M; Minderico, C S; Fernhall, B; Sardinha, L B

    2015-07-01

    The aim of this cross-sectional study was to examine the influence of muscular strength on carotid intima-media thickness (cIMT) in children, controlling for the effect of cardiorespiratory fitness (CRF) and central adiposity and to examine if differences among muscular strength tertiles translate to physiological differences. We assessed cIMT of the common carotid artery in 366 children between 11-12 years of age (191 girls). Measures included cIMT assessed with high-resolution ultrasonography, a maximal handgrip strength test, body fat mass and lean mass from DXA and CRF determined using a maximal cycle ergometer test. Association between muscular strength and cIMT adjusted for CRF and central adiposity, as measured by trunk fat, was tested with multiple linear regression analysis. Differences in risk factors among muscular strength groups were tested with ANOVA. The Muscular Strength Index (MSI) was inversely associated with cIMT independently of CRF and central adiposity (p<0.05). The low MSI group had the highest values of cIMT, waist circumference and systolic blood pressure and the lowest CRF (p<0.05). There was an inverse and independent association between muscular strength and cIMT. Low muscular strength was associated with higher levels of cardiovascular disease risk factors in children.

  3. Carotid endarterectomy: update on the gold standard treatment for carotid stenosis.

    PubMed

    Harthun, Nancy L; Baglioni, A J; Kongable, Gail L; Meakem, Timothy D; Cherry, Kenneth J

    2005-08-01

    Many prospective, randomized clinical trials evaluating the safety and efficacy of carotid endarterectomy (CEA) versus medical management in the prevention of ischemic stroke were performed in the 1990s. Clinical trials are underway that will compare CEA outcomes to carotid stenting; however, relatively few studies have examined the outcomes of modern CEA. The purpose of this report is to examine current outcomes of CEA and evaluate hospital costs and length of stay. Statewide results were collected for all hospitals, except Veterans Administration hospitals, by Virginia Health Information (VHI). Data for the years 1997-2001 were evaluated, and data were based on the All Patient Refined Diagnostic Related Group (APR-DRG; 3M Company). A total of 14,095 CEAs were performed in a 5-year period. The mortality of patients undergoing CEA was 0.5 per cent. The stroke rate was 1 per cent overall and decreased each year of the study. Mean and median lengths of hospital stay were 3 and 2 days, respectively. Length of stay decreased over the course of this study. Mean and median hospital costs were 14,331 dollars and 11,268 dollars. Higher rates of mortality and stroke and higher costs were observed at low-volume hospitals. The need for CEA is substantial. CEA is safe and inexpensive. The data presented here demonstrates continued refinement in CEA, leading to a very low rate of perioperative adverse events, declining lengths of stay, and low hospital costs.

  4. In vivo MRI-based simulation of fatigue process: a possible trigger for human carotid atherosclerotic plaque rupture

    PubMed Central

    2013-01-01

    Background Atherosclerotic plaque is subjected to a repetitive deformation due to arterial pulsatility during each cardiac cycle and damage may be accumulated over a time period causing fibrous cap (FC) fatigue, which may ultimately lead to rupture. In this study, we investigate the fatigue process in human carotid plaques using in vivo carotid magnetic resonance (MR) imaging. Method Twenty seven patients with atherosclerotic carotid artery disease were included in this study. Multi-sequence, high-resolution MR imaging was performed to depict the plaque structure. Twenty patients were found with ruptured FC or ulceration and 7 without. Modified Paris law was used to govern crack propagation and the propagation direction was perpendicular to the maximum principal stress at the element node located at the vulnerable site. Results The predicted crack initiations from 20 patients with FC defect all matched with the locations of the in vivo observed FC defect. Crack length increased rapidly with numerical steps. The natural logarithm of fatigue life decreased linearly with the local FC thickness (R2 = 0.67). Plaques (n=7) without FC defect had a longer fatigue life compared with those with FC defect (p = 0.03). Conclusion Fatigue process seems to explain the development of cracks in FC, which ultimately lead to plaque rupture. PMID:23617791

  5. Childhood family psychosocial environment and carotid intima media thickness: the CARDIA study.

    PubMed

    Loucks, Eric B; Taylor, Shelley E; Polak, Joseph F; Wilhelm, Aude; Kalra, Preety; Matthews, Karen A

    2014-03-01

    Little is known about whether the childhood family psychosocial environment (characterized by cold, unaffectionate interactions, conflict, aggression, neglect and/or low nurturance) affects coronary heart disease (CHD) risk. Objectives were to evaluate associations of childhood family psychosocial environment with carotid intima media thickness (IMT), a subclinical measure of atherosclerosis. The study population included 2659 CARDIA study participants, aged 37-52 years. Childhood family psychosocial environment was measured using a risky family questionnaire via self-report. Carotid IMT was calculated using the average of 20 measurements of mean common carotid, bulb and internal carotid IMT, assessed using high-resolution B-mode ultrasound images. Utilizing linear regression analyses adjusted for age, a 1-unit (range 0-21) increase in risky family score was associated with 0.0036 (95% CI: 0.0006,0.0066 mm) and 0.0020 (95% CI: 0.0002,0.0038) mm increase in mean IMT in white males and females, respectively. Formal mediation analyses and covariate adjustments suggested childhood socioeconomic position and smoking may be important mechanisms in white males and females, as well as education and depressive symptomatology in white males. No associations were found in black participants. Formal statistical tests for interaction between risky family score and sex, and between risky family score and race/ethnicity, demonstrated borderline evidence of interactions for both sex (p = 0.12) and race/ethnicity (p = 0.14) with risky family score for associations with mean IMT. In conclusion, childhood family psychosocial environment was positively associated with IMT in white participants, with little evidence of association in black participants. Mechanisms in white participants may include potential negative impacts of socioeconomic constraints on parenting quality, potentially influencing offspring's cardiovascular risk factors (e.g. smoking), socioeconomic position (e

  6. The role of contrast-enhanced ultrasound in imaging carotid arterial diseases.

    PubMed

    Clevert, Dirk A; Paprottka, Philipp; Sommer, Wieland H; Helck, Andreas; Reiser, Maximilian F; Zengel, Pamela

    2013-06-01

    The standard of care for the initial diagnosis of carotid artery bifurcation diseases is carotid duplex ultrasound. Carotid abnormalities or difficult examinations may represent a diagnostic challenge in patients with clinical symptoms as well as in the follow-up after carotid endarterectomy, carotid artery stenting or other interventions. A promising new method in the diagnosis and follow-up of pathologic carotid diseases is contrast-enhanced ultrasound (CEUS). In comparison with magnetic resonance imaging or computed tomography, the contrast agents used for CEUS remain within the vascular space and hence can be used to study vascular disease and could provide additional information on carotid arterial diseases. This review describes the current carotid duplex ultrasound examination and compares the pathologic findings with CEUS. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Endovascular repair for an extracranial internal carotid aneurysm with cervical access: A case report

    PubMed Central

    Rivera-Chavarría, Ignacio J.; Alvarado-Marín, Juan C.

    2015-01-01

    Background Carotid aneurysms are a rare pathology. This vascular disorder can be asymptomatic or it can cause local compression. The disorder poses a high risk of embolization and rupture. Presentation of case A 79 years old female, presents with a right internal carotid fusiform aneurysm, approximately 3.8 cm in diameter, localized 3.30 cm from the common carotid artery bifurcation with an extremely tortuous common carotid artery. Discussion Surgical management of the extracranial internal carotid artery remains varying and challenging, particularly with a distal internal carotid aneurysm and with anatomical difficulties. Conclusion Endovascular management of an internal carotid aneurysm with cervical access using an expanded polytetrafluoroethylene covered stent with Heparin Bioactive Surface in the carotid area, is safe and effective. PMID:26706595

  8. Carotid Artery Stenting Trials: Conduct, Results, Critique, and Current Recommendations

    SciTech Connect

    Macdonald, Sumaira

    2012-02-15

    The carotid stenting trialists have demonstrated persistence and determination in comparing an evolving technique, carotid artery stenting (CAS), against a mature and exacting standard for carotid revascularisation, carotid endarterectomy (CEA). This review focuses on their endeavours. A total of 12 1-on-1 randomised trials comparing CAS and CEA have been reported; 6 of these can be considered major, and 5 of these reflect (in part) current CAS standards of practice and form the basis of this review. At least 18 meta-analyses seeking to compare CAS and CEA exist. These are limited by the quality and heterogeneity of the data informing them (e.g., five trials were stopped prematurely such that they collectively failed to reach recruitment target by >4000 patients). The Carotid Stenting Trialists' Collaboration Publication represents a prespecified meta-analysis of European trials that were sufficiently similar to allow valid conclusions to be drawn; these trials and conclusions will be explored. When the rate of myocardial infarction (MI) is rigorously assessed, CAS and CEA are equivalent for the composite end point of stroke/death and MI, with more minor strokes for CAS and more MIs for CEA. These outcomes have a discrepant impact on quality of life and subsequent mortality. The all-stroke death outcomes for patients <70 years old are equivalent, with more minor strokes occurring in the elderly during CAS than CEA. There are significantly more severe haematomas and cranial nerve injuries after CEA. The influence of experience on outcome cannot be underestimated.

  9. Surgery of the carotid artery: local anaesthesia versus general anaesthesia.

    PubMed

    Kalko, Y; Kafali, E; Aydin, U; Kafa, U; Kosker, T; Basaran, M; Ugurlucan, M; Nargileci, E; Yasar, T

    2007-01-01

    Carotid artery surgery is safely and commonly performed under general, regional or local anaesthesia. The aim of the study was to compare local and general anaesthesia in carotid artery surgery in order to establish whether differences exist in terms of peri-operative results, use of intra-operative shunts and costs. We retrospectively reviewed the data on 426 patients who underwent carotid endarterectomy with either local or general anaesthesia at our institution over a four-year period. All available clinical, pathologic and postoperative data were reviewed and analyzed for postoperative results. Surgical indications, outcome, operative techniques, and complications were compared. A total of 306 carotid endarterectomy operations under local, and 127 under general anaesthesia were performed and analyzed. Groups were similar in terms of age, sex and pre-operative risk factor distribution. The local anaesthesia group was associated with a lower incidence of shunt placement and operative time when compared to the general anaesthesia group. Postoperative intensive care unit requirement, hospital stay and costs were also lower with local anaesthesia. Significant difference in neurological complications and mortality rate was not observed between the two groups. Carotid endarterectomy performed under local or general anaesthesia is associated with low morbidity and mortality rates. Local anaesthesia enables the surgeon to assess the neurological status during the procedure. It is also associated with decreased shunt usage, decreased operative time and, in high risk patients, lower intensive care unit requirement and hospital stay.

  10. Intracranial Pseudoaneurysms, Fusiform Aneurysms and Carotid-Cavernous Fistulas

    PubMed Central

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Lv, Ming; Zhang, Jingbo; Wu, Zhongxue

    2008-01-01

    Summary The study assessed the effectiveness and safety of endovascular covered stents in the management of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Fourteen endovascular covered stents were used to repair three pseudoaneurysms, six fu-siform aneurysms and six direct carotid-cavernous fistulas. Aneurysms were in the carotid artery in seven cases, in the vertebral artery two cases. It was not possible to treat two additional cases transcutaneously for technical reasons
2/15. Percutaneous closure of the lesions with an endovascular covered stent was successful in 13 of 15 cases. Initial follow-up showed good stent patency. No complications were observed after stent implantation. During follow-up, stent thromboses were detected in two of nine patients with follow-up digital subtracted angiography. One carotid-cavernous fistula of Barrow Type A transformed into Barrow Type D at nine month follow-up study was cured with a procudure of Onyx-18 injection. Endovascular covered stents may be an option for percutaneous closure of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Endoluminal vascular repair with covered stents offers an alternative therapeutic approach to conventional modalities. PMID:20557743

  11. Carotid artery stenting: which stent for which lesion?

    PubMed

    Bosiers, Marc; Deloose, Koen; Verbist, Jürgen; Peeters, Patrick

    2005-01-01

    The different geometries and working principles of carotid stents (nitinol or cobalt chromium, open- or closed-cell configuration) provide each product with unique functional properties. The individual characteristics of each device may make it an attractive choice in one circumstance but render it less desirable in other situations. In approximately 75% of all procedures, all types of stents will achieve similar outcomes, making adequate device selection unnecessary. For the remaining quarter, careful preoperative screening is mandatory. In addition to eventual access issues, the choice of the optimal carotid stent depends mainly on arterial anatomy and lesion morphology. When treating a tortuous anatomy, stents with a flexible and comformable open-cell configuration are preferred. In arteries with a significant mismatch between common carotid artery and internal carotid artery diameter, cobalt chromium (Elgiloy) or tapered nitinol stents are selected. Lesions with suspected high emboligenicity are best covered with stents with a closed-cell configuration, whereas highly calcified lesions need treatment with nitinol stents. Thorough knowledge of the characteristics, advantages and disadvantages, and working principles of the different available stents is mandatory to optimally select the materials to be used for patients eligible for carotid revascularization.

  12. Carotid artery phantom designment and simulation using field II

    NASA Astrophysics Data System (ADS)

    Lin, Yuan; Yang, Xin; Ding, Mingyue

    2013-10-01

    Carotid atherosclerosis is the major cause of ischemic stroke, a leading cause of mortality and disability. Morphology and structure features of carotid plaques are the keys to identify plaques and monitoring the disease. Manually segmentation on the ultrasonic images to get the best-fitted actual size of the carotid plaques based on physicians personal experience, namely "gold standard", is a important step in the study of plaque size. However, it is difficult to qualitatively measure the segmentation error caused by the operator's subjective factors. In order to reduce the subjective factors, and the uncertainty factors of quantification, the experiments in this paper were carried out. In this study, we firstly designed a carotid artery phantom, and then use three different beam-forming algorithms of medical ultrasound to simulate the phantom. Finally obtained plaques areas were analyzed through manual segmentation on simulation images. We could (1) directly evaluate the different beam-forming algorithms for the ultrasound imaging simulation on the effect of carotid artery; (2) also analyze the sensitivity of detection on different size of plaques; (3) indirectly reflect the accuracy of the manual segmentation base on segmentation results the evaluation.

  13. Pulp Stone, Haemodialysis, End-stage Renal Disease, Carotid Atherosclerosis

    PubMed Central

    Patil, Santosh; Sinha, Nidhi

    2013-01-01

    Objectives: The aim of this study was to determine the relationship between the presence of pulp calcification and carotid artery calcification on the dental panoramic radiographs in End Stage Renal Disease (ESRD) patients who were on haemodialysis. Methods: A total of 112 End Stage Renal Disease (ESRD) patients on who were haemodialysis participated in this study. The periapical and the panoramic radiographs for all the patients were evaluated for the presence or absence of the narrowing of the dental pulps and for pulp stones in the pulp chambers and the pulp canals. The panoramic radiographs were also evaluated to determine the carotid calcification. Results: Carotid calcifications were detected in none of the patients. 84 (74.99%) patients had dental pulp narrowing, and 38 (33.92%) patients had pulp stones. There was no statistical correlation between pulp narrowing and Carotid Artery Calcification (CAC) in the haemodialysis patient group. There was also no statistical correlation between pulp stones and CAC in the haemodialysis patients. Conclusion: However, the incidental finding of CAC on a panoramic radiograph can provide life-saving information for the vascular disease patients, but in the present study, no significant relationship was found between the presence of the pulpal calcification and CAC in the ESRD patients who were on haemodialysis. Therefore, the presence of pulp calcification does not seem to serve as a diagnostic marker for carotid atherosclerosis. PMID:23905147

  14. [Carotid body paraganglioma in a teenager. Case report].

    PubMed

    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.

  15. Anatomical and functional characteristics of carotid sinus stimulation in humans

    NASA Technical Reports Server (NTRS)

    Querry, R. G.; Smith, S. A.; Stromstad, M.; Ide, K.; Secher, N. H.; Raven, P. B.

    2001-01-01

    Transmission characteristics of pneumatic pressure to the carotid sinus were evaluated in 19 subjects at rest and during exercise. Either a percutaneous fluid-filled (n = 12) or balloon-tipped catheter (n = 7) was placed at the carotid bifurcation to record internal transmission of external neck pressure/neck suction (NP/NS). Sustained, 5-s pulses, and rapid ramping pulse protocols (+40 to -80 Torr) were recorded. Transmission of pressure stimuli was less with the fluid-filled catheter compared with that of the balloon-tipped catheter (65% vs. 82% negative pressure, 83% vs. 89% positive pressure; P < 0.05). Anatomical location of the carotid sinus averaged 3.2 cm (left) and 3.6 cm (right) from the gonion of the mandible with a range of 0-7.5 cm. Transmission was not altered by exercise or Valsalva maneuver, but did vary depending on the position of the carotid sinus locus beneath the sealed chamber. These data indicate that transmission of external NP/NS was higher than previously recorded in humans, and anatomical variation of carotid sinus location and equipment design can affect transmission results.

  16. Magnetic resonance of carotid artery ageing in healthy subjects.

    PubMed

    Keenan, Niall G; Locca, Didier; Varghese, Anitha; Roughton, Michael; Gatehouse, Peter D; Hooper, James; Firmin, David N; Pennell, Dudley J

    2009-07-01

    To assess how the arterial wall of the carotid artery changes with age in normal subjects by cardiovascular magnetic resonance (CMR). Carotid CMR was performed in 100 normal subjects (10 per sex per decade) who were free of atherosclerotic risk factors and carotid atherosclerosis. Using three-dimensional computer modeling, the volumes of the arterial wall, lumen, and the total vessel were calculated, and the wall/outer wall (W/OW) ratio was derived. Wall volume and total vessel volume increased significantly with age in both sexes (p<0.006), and this was more marked in males. The W/OW ratio also increased significantly with age (p<0.001). Lumen volume increased significantly with age in males (p<0.001), but not in females (p=0.1). In normal subjects, carotid wall volume increases with age. In men, this vessel wall volume increase is associated with significant remodeling of the lumen and outer wall. These data relating normal carotid findings with ageing are important for further CMR studies of early atherosclerosis.

  17. Mechanisms of neurologic deficits and mortality with carotid endarterectomy.

    PubMed

    McKinsey, J F; Desai, T R; Bassiouny, H S; Piano, G; Spire, J P; Zarins, C K; Gewertz, B L

    1996-05-01

    To evaluate the incidence and etiology of perioperative complications of carotid endarterectomy. Retrospective review of carotid endarterectomies performed over 13 years. Risk factors, indications, results of electroencephalographic (EEG) monitoring, and outcomes were evaluated. University medical center. Three hundred sixty-seven consecutive primary carotid endarterectomies were performed on 336 patients. Indications for operation included transient ischemic attack (48.5%), asymptomatic stenosis (24%), stroke (17%), nonlateralizing ischemia (9.5%), and stroke-in-evolution (1%). Postoperative neurologic deficits (permanent and transient) and deaths were correlated with preoperative symptoms, probable mechanism of the neurologic event, intraoperative EEG changes, and the use of intraoperative shunts. Four new permanent neurologic deficits (1.1%) and one transient postoperative deficit were noted. Of the five deficits, three were related to undiagnosed intraoperative cerebral ischemia and two were related to perioperative emboli. Three perioperative deaths (0.8%) occurred: two of myocardial infarction and one of an intracerebral hemorrhage from a ruptured arteriovenous malformation. Intraoperative EEG tracings for the most recent consecutive 175 procedures were analyzed. Shunts were used in 45 patients (26%), 38 of whom demonstrated significant EEG changes with carotid clamping. Carotid endarterectomy can be performed with a low risk of stroke (1.1%) and death (0.8%). Stroke was due to cerebral ischemia or embolization. With meticulous surgical technique, death is due to myocardial ischemia and not neurologic events.

  18. Calcification of the external carotid arteries and their branches

    PubMed Central

    MacDonald, D S; Zhang, L; Gu, Y

    2012-01-01

    This patient had longstanding hypercalcaemia and hyperphosphataemia owing to chronic renal disease, then finally failure, inducing tertiary hyperparathyroidism. He also had long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. He then reported a painful expansile swelling of the anterior mandible which was diagnosed as a “brown tumour”. Subsequent review of the CT data set by an oral and maxillofacial radiologist revealed two patterns of calcification of the carotid arteries. A pipestem pattern was observed bilaterally along almost the entire lengths of the external carotid artery, a muscular artery, and its branches whereas plaque-like calcification was observed in the common and internal carotid arteries (elastic arteries). The pipestem pattern, hitherto an unreported feature affecting the external carotid artery, may represent a metastatic calcified deposit owing to hypercalcaemia and hyperphosphataemia in the tunica media of muscular arteries, resulting in arteriosclerosis, which maintains a patent lumen. The plaque-like pattern is representative of lumen-occluding calcified atherosclerosis associated with the long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. As this patient did not have any symptoms and/or signs of myofacial pain, facial dysfunction or numbness, the calcification of his external carotid arteries and branches were considered as arteriosclerosis. The brown tumour responded to the parathyroidectomy and the renal transplant. PMID:22241884

  19. Calcification of the external carotid arteries and their branches.

    PubMed

    Macdonald, D S; Zhang, L; Gu, Y

    2012-10-01

    This patient had longstanding hypercalcaemia and hyperphosphataemia owing to chronic renal disease, then finally failure, inducing tertiary hyperparathyroidism. He also had long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. He then reported a painful expansile swelling of the anterior mandible which was diagnosed as a "brown tumour". Subsequent review of the CT data set by an oral and maxillofacial radiologist revealed two patterns of calcification of the carotid arteries. A pipestem pattern was observed bilaterally along almost the entire lengths of the external carotid artery, a muscular artery, and its branches whereas plaque-like calcification was observed in the common and internal carotid arteries (elastic arteries). The pipestem pattern, hitherto an unreported feature affecting the external carotid artery, may represent a metastatic calcified deposit owing to hypercalcaemia and hyperphosphataemia in the tunica media of muscular arteries, resulting in arteriosclerosis, which maintains a patent lumen. The plaque-like pattern is representative of lumen-occluding calcified atherosclerosis associated with the long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. As this patient did not have any symptoms and/or signs of myofacial pain, facial dysfunction or numbness, the calcification of his external carotid arteries and branches were considered as arteriosclerosis. The brown tumour responded to the parathyroidectomy and the renal transplant.

  20. Outcome of Carotid Artery Stenting for Radiation-Induced Stenosis

    SciTech Connect

    Dorresteijn, Lucille; Vogels, Oscar; Leeuw, Frank-Erik de; Vos, Jan-Albert; Christiaans, Marleen H.; Ackerstaff, Rob; Kappelle, Arnoud C.

    2010-08-01

    Purpose: Patients who have been irradiated at the neck have an increased risk of symptomatic stenosis of the carotid artery during follow-up. Carotid angioplasty and stenting (CAS) can be a preferable alternative treatment to carotid endarterectomy, which is associated with increased operative risks in these patients. Methods and Materials: We performed a prospective cohort study of 24 previously irradiated patients who underwent CAS for symptomatic carotid stenosis. We assessed periprocedural and nonprocedural events including transient ischemic attack (TIA), nondisabling stroke, disabling stoke, and death. Patency rates were evaluated on duplex ultrasound scans. Restenosis was defined as a stenosis of >50% at the stent location. Results: Periprocedural TIA rate was 8%, and periprocedural stroke (nondisabling) occurred in 4% of patients. After a mean follow-up of 3.3 years (range, 0.3-11.0 years), only one ipsilateral incident event (TIA) had occurred (4%). In 12% of patients, a contralateral incident event was present: one TIA (4%) and two strokes (12%, two disabling strokes). Restenosis was apparent in 17%, 33%, and 42% at 3, 12, and 24 months, respectively, although none of the patients with restenosed vessels became symptomatic. The length of the irradiation to CAS interval proved the only significant risk factor for restenosis. Conclusions: The results of CAS for radiation-induced carotid stenosis are favorable in terms of recurrence of cerebrovascular events at the CAS site.

  1. Pathophysiology of carotid artery disease and related clinical syndromes.

    PubMed

    De Reuck, J L

    2004-02-01

    The severity of internal carotid artery lesion per se is a poor indicator of the cerebral haemodynamic status of the brain. Positron emission tomography (PET) of the brain allows to study the different pathophysiological changes related to carotid artery disease. Several stages of impairment of cerebral blood flow and metabolism can be shown such as the compensatory phases by the haemodynamic and the metabolic reserve, the transition to reversible (penumbra) and irreversible ischaemia and the phase of luxury perfusion. Distinct PET patterns correlate with certain clinical outcomes. PET studies found evidence for an embolic origin rather than for a low-flow status as most frequent cause of stroke in severe carotid artery disease. Except for deep borderzone infarcts in the centrum semi-ovale, most cortical borderzone infarcts are not due to chronic misery perfusion. Recent silent and recurrent infarcts can be demonstrated with Cobalt-55 PET, which is of importance for the therapeutical decision. The PET studies argue that carotid endarterectomy is successful probably by removing the source of emboli rather than by restoring the cerebral perfusion in severe carotid artery stenosis.

  2. Contemporary management of carotid blowout syndrome utilizing endovascular techniques.

    PubMed

    Manzoor, Nauman F; Rezaee, Rod P; Ray, Abhishek; Wick, Cameron C; Blackham, Kristine; Stepnick, David; Lavertu, Pierre; Zender, Chad A

    2017-02-01

    To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS). Retrospective chart review. Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied. Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable. The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist. 4. Laryngoscope, 2016 127:383-390, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  3. [Cerebral hemorrhage after carotid endarterectomy in a young adult].

    PubMed

    Parra, J; Sancho, J; Santonja, J M; Pareja, A; Peiró, C

    1997-02-01

    Cerebral haemorrhage after carotid endarterectomy is a rare complication. It follows 0.5% to 20% of all endarterectomies, but should be borne in mind because of the morbidity and mortality seen in most cases. We describe the case of a 42 year old man in whom carotid endarterectomy had been done 7 days before to treat a stenosis of 80%. He complained of a sudden onset of weakness of the right half of his body and changes in his speech. Physical examination showed right inferior facial paresia, right hemiparesia and right extensor cutaneous plantar reflex. On admission to the Emergency Department, before treatment, blood pressure was 80/60. Carotid auscultation and palpation were normal. Cerebral TRC showed a left lenticular haematoma. The patient progressed satisfactorily. We review the literature on the subject as well as the factors which should be considered as possibly predisposing to bleeding after carotid endarterectomy, such as arterial hypertension and occlusion or severe stenosis of the contralateral carotid artery. The detection of patients with the risk of postendarterectomy bleeding by simple noninvasive investigations, such as the transcranial doppler and the acetazolamide test, and early diagnosis of a clinical picture compatible with a hyperperfusion syndrome may contribute to the relief and prevention of sequelae in these patients.

  4. Amaurosis fugax: risk factors and prevalence of significant carotid stenosis

    PubMed Central

    Kvickström, Pia; Lindblom, Bertil; Bergström, Göran; Zetterberg, Madeleine

    2016-01-01

    Purpose The purpose of this study was to describe clinical characteristics and prevalence of carotid stenosis in patients with amaurosis fugax (AF). Method Patients diagnosed with AF and subjected to carotid ultrasound in 2004–2010 in Sahlgrenska University Hospital, Gothenburg (n=302), were included, and data were retrospectively collected from medical records. Results The prevalence of significant carotid stenosis was 18.9%, and 14.2% of the subjects were subjected to carotid endarterectomy. Significant associations with risk of having ≥70% stenosis were male sex (adjusted odds ratio [aOR]: 2.62; 95% confidence interval [CI]: 1.26–5.46), current smoking (aOR: 6.26; 95% CI: 2.62–14.93), diabetes (aOR: 3.68; 95% CI: 1.37–9.90) and previous vasculitis (aOR: 10.78; 95% CI: 1.36–85.5). A majority of the patients (81.4%) was seen by an ophthalmologist prior to the first ultrasound. Only 1.7% of the patients exhibited retinal artery emboli at examination. Conclusion The prevalence of carotid stenosis among patients with AF is higher than has previously been demonstrated in stroke patients. An association with previously reported vascular risk factors and with vasculitis is seen in this patient group. Ocular findings are scarce. PMID:27826182

  5. Anatomical and functional characteristics of carotid sinus stimulation in humans

    NASA Technical Reports Server (NTRS)

    Querry, R. G.; Smith, S. A.; Stromstad, M.; Ide, K.; Secher, N. H.; Raven, P. B.

    2001-01-01

    Transmission characteristics of pneumatic pressure to the carotid sinus were evaluated in 19 subjects at rest and during exercise. Either a percutaneous fluid-filled (n = 12) or balloon-tipped catheter (n = 7) was placed at the carotid bifurcation to record internal transmission of external neck pressure/neck suction (NP/NS). Sustained, 5-s pulses, and rapid ramping pulse protocols (+40 to -80 Torr) were recorded. Transmission of pressure stimuli was less with the fluid-filled catheter compared with that of the balloon-tipped catheter (65% vs. 82% negative pressure, 83% vs. 89% positive pressure; P < 0.05). Anatomical location of the carotid sinus averaged 3.2 cm (left) and 3.6 cm (right) from the gonion of the mandible with a range of 0-7.5 cm. Transmission was not altered by exercise or Valsalva maneuver, but did vary depending on the position of the carotid sinus locus beneath the sealed chamber. These data indicate that transmission of external NP/NS was higher than previously recorded in humans, and anatomical variation of carotid sinus location and equipment design can affect transmission results.

  6. The modified operative technique of partial eversion carotid endarterectomy.

    PubMed

    McBride, Richard; Porter, Johnathan; Al-Khaffaf, Haytham

    2017-01-01

    We report a modified operative technique termed partial eversion carotid endarterectomy (PECE). During a 9-year period (2006-2015), 352 patients underwent PECE. Indications for surgery, intraoperative details, and outcomes were recorded. The initial 185 patients had carotid duplex ultrasound imaging at 6 weeks and then at 6, 12, and 24 months. Subsequent patients had carotid imaging at 4 to 6 weeks. Indications included stroke (76), transient ischemic attack (153), and amaurosis fugax (33); 58 patients were asymptomatic, and 32 patients had surgery before cardiac surgery. Median clamp time was 14 minutes (interquartile range, 11.5-17 minutes). Median total operation time was 41 minutes (interquartile range, 31-72 minutes). Outcomes included four transient ischemic attacks (1.2%), five strokes (1.4%), and two deaths at 30 days (0.5%). No significant cranial nerve injuries or carotid restenosis was detected during follow-up. PECE is technically straightforward, with outcomes comparable to those of current operative techniques. Its advantages included reduced operative and carotid clamping time. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  7. Arterial function of carotid and brachial arteries in postmenopausal vegetarians

    PubMed Central

    Su, Ta-Chen; Torng, Pao-Ling; Jeng, Jiann-Shing; Chen, Ming-Fong; Liau, Chiau-Suong

    2011-01-01

    Background: 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 omnivores. Prevention of vitamin B12 deficiency might be beneficial for cardiovascular health in vegetarians. PMID:21915169

  8. Arterial function of carotid and brachial arteries in postmenopausal vegetarians.

    PubMed

    Su, Ta-Chen; Torng, Pao-Ling; Jeng, Jiann-Shing; Chen, Ming-Fong; Liau, Chiau-Suong

    2011-01-01

    Vegetarianism is associated with a lower risk of cardiovascular disease. However, studies of arterial function in vegetarians are limited. 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. 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. Apparently healthy postmenopausal vegetarians are not significantly better in terms of carotid beta stiffness index, BAC, and BAD, but have significantly decreased BAR than omnivores. Prevention of vitamin B12 deficiency might be beneficial for cardiovascular health in vegetarians.

  9. Feature selection applied to ultrasound carotid images segmentation.

    PubMed

    Rosati, Samanta; Molinari, Filippo; Balestra, Gabriella

    2011-01-01

    The automated tracing of the carotid layers on ultrasound images is complicated by noise, different morphology and pathology of the carotid artery. In this study we benchmarked four methods for feature selection on a set of variables extracted from ultrasound carotid images. The main goal was to select those parameters containing the highest amount of information useful to classify the pixels in the carotid regions they belong to. Six different classes of pixels were identified: lumen, lumen-intima interface, intima-media complex, media-adventitia interface, adventitia and adventitia far boundary. The performances of QuickReduct Algorithm (QRA), Entropy-Based Algorithm (EBR), Improved QuickReduct Algorithm (IQRA) and Genetic Algorithm (GA) were compared using Artificial Neural Networks (ANNs). All methods returned subsets with a high dependency degree, even if the average classification accuracy was about 50%. Among all classes, the best results were obtained for the lumen. Overall, the four methods for feature selection assessed in this study return comparable results. Despite the need for accuracy improvement, this study could be useful to build a pre-classifier stage for the optimization of segmentation performance in ultrasound automated carotid segmentation.

  10. Reversible cerebral vasoconstriction syndrome with concurrent bilateral carotid artery dissection.

    PubMed

    Bayer-Karpinska, Anna; Patzig, Maximilian; Adamczyk, Christopher; Dimitriadis, Konstantinos; Wollenweber, Frank A; Dichgans, Martin; Jahn, Klaus; Opherk, Christian

    2013-05-01

    The pathophysiological basis of reversible cerebral vasoconstriction syndrome is poorly understood but carotid artery dissection has been discussed as a rare possible cause. So far, only single cases of unilateral carotid artery dissection and reversible cerebral vasoconstriction syndrome have been reported. Here, we describe the case of a 54-year old patient presenting to the emergency department with right hemiparesis, hypaesthesia and dysarthria. Furthermore, he reported two episodes of thunderclap headache after autosexual activity. Cerebral imaging showed ischaemic infarcts, slight cortical subarachnoid haemorrhage, bilateral carotid artery dissection and fluctuating intracranial vessel irregularities, compatible with reversible cerebral vasoconstriction syndrome. An extensive diagnostic work-up was normal. No typical trigger factors of reversible cerebral vasoconstriction syndrome could be found. The patient received intravenous heparin and the calcium channel blocker nimodipine. Follow-up imaging revealed no vessel irregularities, the left internal carotid artery was still occluded. This case supports the assumption that carotid artery dissection should be considered as a potential trigger of reversible cerebral vasoconstriction syndrome, possibly by altering sympathetic vascular tone.

  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

    PubMed Central

    2010-01-01

    Summary Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4·0%) events of disabling stroke or death in the stenting group compared with 27 (3·2%) events in the endarterectomy group (hazard ratio [HR] 1·28, 95% CI 0·77–2·11). The incidence of stroke, death, or procedural myocardial infarction was 8·5% in the stenting group compared with 5·2% in the endarterectomy group (72 vs 44 events

  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.

    PubMed

    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

    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. The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006). Risks of any

  13. Gasotransmitter Regulation of Ion Channels: A Key Step in O2 Sensing By the Carotid Body

    PubMed Central

    Prabhakar, Nanduri R.

    2014-01-01

    Carotid bodies detect hypoxia in arterial blood, translating this stimulus into physiological responses via the CNS. It is long established that ion channels are critical to this process. More recent evidence indicates that gasotransmitters exert powerful influences on O2 sensing by the carotid body. Here, we review current understanding of hypoxia-dependent production of gasotransmitters, how they regulate ion channels in the carotid body, and how this impacts carotid body function. PMID:24382871

  14. Angiographic anatomy of the extracranial and intracranial portions of the internal carotid arteries in donkeys.

    PubMed

    Khairuddin, Nurul Hayah; Sullivan, Martin; Pollock, Patrick J

    2017-01-01

    In horses, the extracranial and intracranial pathway of the internal carotid artery has been described. The extracranial pathway of the internal carotid artery begins at the carotid termination and runs on the dorsal surface of the medial compartment of the guttural pouch. Thereafter the internal carotid artery passes through the foramen lacerum to continue intracranially, forming part of the rostrolateral quadrants of the cerebral arterial circle (Circle of Willis). The objectives of this study were to define and record the anatomy of the carotid arterial tree and the internal carotid artery in donkeys using angiographic techniques. This is a prospective descriptive study on 26 cadaveric donkeys. Twenty six donkey cadavers of mixed, age, sex and use presented for reasons unrelated to disease of the guttural pouch were subjected to carotid and cerebral angiography using rotational angiography. Rotational angiographic and 3 dimensional multiplanar reconstructive (3D-MPR) findings were verified with an arterial latex casting technique followed by dissection and photography. The following variations of the carotid arterial tree were identified: [1] the internal carotid and occipital arteries shared a common trunk, [2] the linguofacial trunk originated from the common carotid artery causing the common carotid artery to terminate as four branches, [3] the external carotid artery was reduced in length before giving rise to the linguofacial trunk, mimicking the appearance of the common carotid artery terminating in four branches, [4] the internal carotid artery originated at a more caudal position from the common carotid artery termination. Veterinarians should be aware that considerable variation exists in the carotid arterial tree of donkeys and that this variation may differ markedly from that described in the horse.

  15. Genetic association and gene-smoking interaction study of carotid intima-media thickness at five GWAS-indicated genes: the Bogalusa Heart Study.

    PubMed

    Li, Changwei; Chen, Wei; Jiang, Fan; Simino, Jeannette; Srinivasan, Sathanur R; Berenson, Gerald S; Mei, Hao

    2015-05-15

    To examine the associations of five GWAS-identified genes with carotid intima-media thickness (IMT) in a biracial sample from the Bogalusa Heart Study, and evaluate their participation in gene-smoking interactions. Far wall IMTs of common carotid arteries were measured using high-resolution B-mode ultrasound. Both the gene-smoking interactions and single-marker associations were evaluated by linear models of carotid IMT levels, while the gene-based analyses were assessed through the truncated product method. A Bonferroni multiple testing correction was applied. Marker rs7840785 (PINX1) was significantly associated with right carotid IMT (p=0.0003) using all participants; mean levels for the CC, TC, and TT genotypes were 0.74 (0.73 to 0.75), 0.76 (0.75 to 0.78), and 0.78 (0.75, 0.81), respectively. Similar trends were observed in blacks (p=0.0031) and whites (p=0.0118). Marker rs7844465 (ZHX2) was significantly associated with left carotid IMT in whites (p=0.0005); mean IMT levels for the GG, TG, and TT genotypes were 0.73 (0.71 to 0.74), 0.75 (0.74 to 0.77) and 0.78 (0.75 to 0.81), respectively. Marker rs6841473 (EDNRA) modified the association between smoking and left carotid IMT in blacks (p=2.79×10(-5)). In addition, gene-based analysis demonstrated that EDNRA and ZHX2 were associated with left carotid IMT in the white and overall participants, respectively, while PINX1 was associated with right carotid IMT in both blacks and whites. We identified two novel markers that were associated with IMT in both blacks and whites. One gene-smoking interaction was identified in blacks only. Three genes showed gene-based associations with IMT levels. However, genetic markers with small effects may have been missed due to the limited number of black participants. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Perspective: carotid stenting and the history of disruptive technology in vascular surgery.

    PubMed

    Veith, Frank J

    2008-06-01

    This article defines disruptive technology and discusses such technologies in Vascular Surgery. It considers the question: Is carotid artery stenting (CAS) a disruptive technology? Although CAS will impact positively on the treatment of carotid bifurcation disease, it will probably never displace carotid endarterectomy in the majority of patients. The precise role of CAS remains to be determined.

  17. Delayed carotid pseudoaneurysm: a life-threatening complication after endoscopic sinus surgery.

    PubMed

    Golinelli, Gloria; Toso, Andrea; Taranto, Fausto; Aluffi, Paolo; Pia, Francesco

    2012-11-01

    Internal carotid artery pseudoaneurysm is a rare but potentially lethal complication of sinus surgery. We present 2 cases of delayed carotid pseudoaneurysm development after internal carotid laceration during functional sinus surgery for chronic sinusitis to emphasize the need to follow up the patients with profuse bleeding perioperatively and to identify when to suspect iatrogenic vascular malformations.

  18. Left or Right Carotid Endarterectomy in Patients with Atherosclerotic Disease: Ipsilateral Effects on Cognition?

    ERIC Educational Resources Information Center

    Brand, N.; Bossema, E. R.; van Ommen, M.; Moll, F. L.; Ackerstaff, R. G. A.

    2004-01-01

    We evaluated hemispheric functions ipsilateral to the side of carotid endarterectomy (CEA) in patients with a severe stenosis in the left or right carotid artery. Assessments took place 1 day before and 3 months after CEA. Only right-handed males were included. Nineteen patients underwent surgery of the left carotid artery and 17 of the right.…

  19. Left or Right Carotid Endarterectomy in Patients with Atherosclerotic Disease: Ipsilateral Effects on Cognition?

    ERIC Educational Resources Information Center

    Brand, N.; Bossema, E. R.; van Ommen, M.; Moll, F. L.; Ackerstaff, R. G. A.

    2004-01-01

    We evaluated hemispheric functions ipsilateral to the side of carotid endarterectomy (CEA) in patients with a severe stenosis in the left or right carotid artery. Assessments took place 1 day before and 3 months after CEA. Only right-handed males were included. Nineteen patients underwent surgery of the left carotid artery and 17 of the right.…

  20. Hemodynamic effects of long-term morphological changes in the human carotid sinus.

    PubMed

    Seong, Jaehoon; Jeong, Woowon; Smith, Nataliya; Towner, Rheal A

    2015-04-13

    Previous investigations of morphology for human carotid artery bifurcation from infancy to young adulthood found substantial growth of the internal carotid artery with advancing age, and the development of the carotid sinus at the root of the internal carotid artery during teenage years. Although the reasons for the appearance of the carotid sinus are not clearly understood yet, it has been hypothesized that the dilation of the carotid sinus serves to support pressure sensing, and slows the blood flow to reduce pulsatility to protect the brain. In order to understand this interesting evolvement at the carotid bifurcation in the aspects of fluid mechanics, we performed in vitro phase-contrast MR flow experiments using compliant silicone replicas of age-dependent carotid artery bifurcations. The silicone models in childhood, adolescence, and adulthood were fabricated using a rapid prototyping technique, and incorporated with a bench-top flow mock circulation loop using a computer-controlled piston pump. The results of the in vitro flow study showed highly complex flow characteristics at the bifurcation in all age-dependent models. However, the highest magnitude of kinetic energy was found at the internal carotid artery in the child model. The high kinetic energy in the internal carotid artery during childhood might be one of the local hemodynamic forces that initiate morphological long-term development of the carotid sinus in the human carotid bifurcation.

  1. Aortic arch and common carotid artery plaques with soft components pose a substantial risk of cerebral embolization during carotid stenting

    PubMed Central

    Boda, Krisztina; Rarosi, Ferenc; Thury, Attila; Barzó, Pál; Németh, Tamás; Vörös, Erika

    2016-01-01

    Objectives A higher rate of embolization is considered a disadvantage of carotid stenting (CAS), when compared with carotid endarterectomy. Plaques in the aortic arch (AA) and the common carotid artery (CCA) may be additional sources of embolization to stented internal carotid plaques during CAS. In this study, we aimed to investigate the relationship between these plaques and intracerebral embolization. Methods We analyzed the occurrence and composition of plaques in the AA and CCA by computed tomography angiography (CTA) in 101 consecutive cases of CAS. Cases of peri-procedural embolization were detected on diffusion-weighted imaging as lesions demonstrating diffusion restriction. We applied the χ2 and Fisher’s exact tests, as well as logistic regression models. Results The occurrence of plaques in the AA and CCA was significantly related to the appearance of new diffusion-weighted imaging lesions (p = 0.013 and p = 0.004, respectively). Patients with soft plaques in the AA or CCA had a significantly higher risk of embolization than those without plaques (p = 0.012 and p = 0.006, respectively). In contrast, homogeneously calcified plaques did not pose significantly higher risks. Conclusions Soft plaques in the AA and CCA result in a substantial risk of embolization during CAS. Use of a CTA examination of the AA and the CCA in patients with carotid stenosis may help to select lower-risk patients for CAS. PMID:26921167

  2. Diminished Omega-3 Fatty Acids are Associated with Carotid Plaques from Neurologically Symptomatic Patients: Implications for Carotid Interventions

    PubMed Central

    Bazan, Hernan A.; Lu, Yan; Thoppil, Deepu; Fitzgerald, Tamara N.; Hong, Song; Dardik, Alan

    2009-01-01

    The omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are prevalent in fish oil and their cardioprotective effects are thought to be mediated by anti-inflammatory mechanisms. The aim of this study is to determine whether omega-3 fatty acids are associated with carotid plaques from neurologically symptomatic patients. Plaques were obtained from 41 patients (mean age 62 [44 – 84]; 24-asymptomatic, 17-symptomatic). Intra-plaque lipids were assessed with mass spectrometry. Compared to asymptomatic patients, significantly diminished omega-3 fatty acids DHA (545.8 ± 98 ng/g vs. 270.7 ± 19.6 ng/g, p=0.0096) and EPA (385.9 ± 68 ng/g vs. 216.4 ± 17.6 ng/g, p=0.0189) were found in carotid plaques from neurologically symptomatic patients. However, no differences were found in the levels of the omega-6 fatty acid arachidonic acid (p=0.2003). Immunohistochemistry and ELISA analysis (CD68+ cells, 0.461 ± 0.04 vs. 0.312 ± 0.03, p=0.003) demonstrated an increased inflammatory infiltrate in plaques from neurologically symptomatic, compared to asymptomatic, patients. Carotid plaques from neurologically symptomatic patients are inflammatory and have decreased intra-plaque levels of omega-3 fatty acids. Future trials will determine whether interventions that increase omega-3 fatty acid incorporation into carotid plaques prevent stroke and improve the safety of carotid interventions. PMID:19733689

  3. Assessment of Influences of Stenoses in Right Carotid Artery on Left Carotid Artery Using Wall Stress Marker

    PubMed Central

    Ghagare, Dushali; Chattopadhyay, Himadri

    2017-01-01

    Purpose. Atherosclerosis is a diseased condition of blood vessel. It causes partial blockage in lumen of vessel and affects hemodynamic of localized flowing blood. Complex geometries like region of bifurcation also affects hemodynamic to a larger extent. Complexity further increases in presence of stenoses at region of bifurcation. Such morphological change in vessel largely affects parent as well as corresponding sister and daughter vessels. In this paper, complexity in hemodynamic of blood in pair of carotid arteries (left and right carotid arteries) is evaluated in presence of stenoses at basilar segment of right artery in three-dimensional domain using reconstructed tomographic images of patient. Methods. Transient information of blood flow is obtained using four-dimensional phase-contrast MRI technique. Haematocrit component of blood at diseased condition is considered using Power Law and Quemada model. Numerical techniques are used to solve pressure-coupled governing equations of flowing blood. Results. Dysfunctions of endothelial cells near the wall are characterised by evaluating shear stress markers. Wall shear stress and its gradient based and harmonic based descriptors are calculated over complete geometry during one cardiac cycle. Conclusion. Internal branch of left carotid artery and external branch of right carotid artery are found prone to secondary stenoses in presence of primary stenoses at basilar segment of right carotid artery. PMID:28191460

  4. Carotid Endothelial VCAM-1 Is an Early Marker of Carotid Atherosclerosis and Predicts Coronary Artery Disease in Swine

    PubMed Central

    Masseau, I.; Bowles, D. K.

    2015-01-01

    Objective The aim was to determine if endothelial VCAM-1 (eVCAM-1) expression in the common carotid artery (CCA) would correlate with predictive markers of atherosclerotic disease, would precede reduction of markers of endothelial cell function and would predict coronary artery disease (CAD). Methods and results Carotid arterial segments (bifurcation, proximal and distal CCA) were harvested from 14 and 24 month-old male castrated familial hypercholesterolemic (FH) swine, a model of spontaneous atherosclerosis. Quantification of local expression of eVCAM-1, intimal macrophage accumulation, oxidative stress, intima-media (I/M) ratio, intima-media thickness (IMT), endothelial nitric oxide synthase (eNOS) and phosphorylated eNOS (p-eNOS) in selected regions of the carotids revealed a relationship between local inflammation and atheroscle-rotic plaque progression. Importantly, inflammation was not uniform throughout the CCA. Endo-thelial VCAM-1 expression was the greatest at the bifurcation and increased with age. Finally, eV-CAM-1 best estimated the severity of CAD compared to blood levels of glucose, hypercholestero-lemia, carotid IMT, and p-eNOS. Conclusion Our data suggested that eVCAM-1 was closely associated with atherosclerotic plaque progression and preceded impairment of EDD. Thus, this study supported the use of carotid VCAM-1 targeting agents to estimate the severity of CAD. PMID:26702331

  5. Current surgical management of carotid body tumors.

    PubMed

    Davila, Victor J; Chang, James M; Stone, William M; Fowl, Richard J; Bower, Thomas C; Hinni, Michael L; Money, Samuel R

    2016-12-01

    Carotid body tumors (CBTs) are rare. Management guidelines may include genetic testing for succinate dehydrogenase (SDH) mutations. We performed an institutional review of the surgical management of CBT. A retrospective analysis (1994-2015) of CBT excisions at our institution was performed. Data obtained included demographics, genetic testing (if performed), intraoperative details, postoperative morbidity, and long-term outcomes. Data from the first CBT excision were included in patients with bilateral tumors. Genetic testing was routinely offered in patients with a family history of CBT or multiple paragangliomas. A total of 183 CBTs (124 female [67.7%]) were excised. A neck mass was present in 106 patients (57.9%), 24 patients (12.1%) presented with tenderness or neck pain, and 3 (1.6%) presented with cranial nerve dysfunction. Computed tomography (57.9%) or magnetic resonance imaging (51.3%) were the most commonly used imaging modalities. Preoperative angiography was performed in 73 patients (39.8%), and 62 of them (84.5%) underwent embolization or internal carotid balloon occlusion testing, or both. Mean tumor diameter was 3.2 cm (range, 0.6-7.2 cm). There were 71 (38.8%), 75 (41%), and 37 (20.2%) Shamblin type 1, 2, and 3 tumors, respectively. Average operating time was 224 minutes (range, 52-696 minutes). Average blood loss was 143.9 mL (range, 10-2000 mL). Arterial reconstruction with an interposition graft was required in 10, and patch angioplasty was performed in four. Cranial nerve injury was permanent in 10 (5.5%), and the rate of stroke was 1% (n = 2). A total of 382 lymph nodes were excised, and all were benign. There were no deaths ≤30 days. Only one patient presented with malignant disease 2 years after CBT excision, and this patient did not undergo genetic testing. Thirty-four (18.6%) had a family history of CBT. SDH testing was performed in 18 patients, and 17 tested positive. Positive genetic testing had a correlation with earlier age

  6. Carotid intervention 3: the evidence for cerebral protection.

    PubMed

    Fanelli, Fabrizio; Bezzi, Mario; Boatta, Emanuele; Passariello, Roberto

    2007-06-01

    Carotid stenting is a safe alternative option to conventional carotid endarterectomy in the treatment of carotid artery stenosis in patients considered poor candidates for surgery or who choose not to have open surgery. During the stenting procedure, however, distal embolization may occur with neurological sequelae. To reduce the incidence of this, several cerebral-protection devices (CPDs) have been developed. Different types of CPDs are now commercially available: distal occlusion balloons, distal filters, and proximal protection devices with or without reversal of flow. But complications can occur with their use and are usually associated with an inability to cross the lesion, failure to capture the emboli, vasospasm, and vessel wall injury. Because protection devices are currently the focus of interest by manufacturers and physicians, several trials are going on worldwide to analyze the characteristics of each of them and to evaluate their efficacy in reducing the rate of distal embolization.

  7. Use of absorbable sutures in canine carotid arteries.

    PubMed

    Rey, A R; Carrillo-Farga, J; Velasco, C O; Valencia, M O

    1990-01-01

    To study the functional and microstructural characteristics of polydioxanone sutures in vascular surgery, we created 48 vascular anastomoses in the right and left common carotid arteries of 24 mongrel dogs. In each animal, polydioxanone sutures were used in 1 carotid artery, and polypropylene sutures were used in the contralateral carotid artery. Twelve groups of 2 animals each were then formed. The 1st group was observed for 1 month, the 2nd for 2 months, the 3rd for 3 months, and so on until the 12th group, which was observed for 12 months. At the end of each observation period, reoperation was undertaken to evaluate the vascular anastomoses by means of angiography and microscopy. The polypropylene anastomoses showed a marked deformity, with tissue retraction and a foreign body reaction. In contrast, the polydioxanone anastomoses exhibited satisfactory healing, without deformity, and were well tolerated histologically. We believe that polydioxanone may be a useful, alternative vascular suture material.

  8. Border Detection of Common Carotid Artery Using Hough Transform

    NASA Astrophysics Data System (ADS)

    Koya, Yoshiharu; Nagahara, Yoshihiro

    The arteriosclerosis is on the increase with an aging or change of our living environment. For that reason, diagnosis of the common carotid artery using echocardiogram is doing to take precautions carebropathy. The arteriosclerosis of the common carotid artery is diagnosed using Intima-Media Thickness (IMT) which is obtained from echocardiogram. In order to measure IMT from echocardiogram, it is required to detect a border which is a boundary between vessel tissue layers. The method of border detection requires reproducibility and high accuracy. The conventional methods to detect the border curve depend on differential value of brightness on the common carotid artery. Therefore, we can't extract a good candidate point by influence of a noise. In this paper, we propose the high-accuracy detection method by Hough Transform. About high-accuracy, it realized by attaching importance to high reliable candidate point of border.

  9. Carotid Baroreflex Function During Prolonged Exercise

    NASA Technical Reports Server (NTRS)

    Raven, P. B.

    1999-01-01

    Astronauts are often required to work (exercise) at moderate to high intensities for extended periods while performing extra-vehicular activities (EVA). Although the physiologic responses associated with prolonged exercise have been documented, the mechanisms involved in blood pressure regulation under these conditions have not yet been fully elucidated. An understanding of this issue is pertinent to the ability of humans to perform work in microgravity and complies with the emphasis of NASA's Space Physiology and Countermeasures Program. Prolonged exercise at a constant workload is know to result in a progressive decrease in mean arterial pressure (MAP) concomitant with a decrease in stroke volume and a compensatory increase in heart rate. The continuous decrease in MAP during the exercise, which is related to the thermoregulatory redistribution of circulating blood volume to the cutaneous circulation, raises the question as to whether there is a loss of baroreflex regulation of arterial blood pressure. We propose that with prolongation of the exercise to 60 minutes, progressive increases on central command reflect a progressive upward resetting of the carotid baroreflex (CBR) such that the operating point of the CBR is shifted to a pressure below the threshold of the reflex rendering it ineffectual in correcting the downward drift in MAP. In order to test this hypothesis, experiments have been designed to uncouple the global hemodynamic response to prolonged exercise from the central command mediated response via: (1) continuous maintenance of cardiac filling volume by intravenous infusion of a dextran solution; and (2) whole body surface cooling to counteract thermoregulatory cutaneous vasodialation. As the type of work (exercise) performed by astronauts is inherently arm and upper body dependent, we will also examine the physiologic responses to prolonged leg cycling and arm ergometry exercise in the supine positions with and without level lower body negative

  10. Carotid Baroreflex Function During Prolonged Exercise

    NASA Technical Reports Server (NTRS)

    Raven, P. B.

    1999-01-01

    Astronauts are often required to work (exercise) at moderate to high intensities for extended periods while performing extra-vehicular activities (EVA). Although the physiologic responses associated with prolonged exercise have been documented, the mechanisms involved in blood pressure regulation under these conditions have not yet been fully elucidated. An understanding of this issue is pertinent to the ability of humans to perform work in microgravity and complies with the emphasis of NASA's Space Physiology and Countermeasures Program. Prolonged exercise at a constant workload is know to result in a progressive decrease in mean arterial pressure (MAP) concomitant with a decrease in stroke volume and a compensatory increase in heart rate. The continuous decrease in MAP during the exercise, which is related to the thermoregulatory redistribution of circulating blood volume to the cutaneous circulation, raises the question as to whether there is a loss of baroreflex regulation of arterial blood pressure. We propose that with prolongation of the exercise to 60 minutes, progressive increases on central command reflect a progressive upward resetting of the carotid baroreflex (CBR) such that the operating point of the CBR is shifted to a pressure below the threshold of the reflex rendering it ineffectual in correcting the downward drift in MAP. In order to test this hypothesis, experiments have been designed to uncouple the global hemodynamic response to prolonged exercise from the central command mediated response via: (1) continuous maintenance of cardiac filling volume by intravenous infusion of a dextran solution; and (2) whole body surface cooling to counteract thermoregulatory cutaneous vasodialation. As the type of work (exercise) performed by astronauts is inherently arm and upper body dependent, we will also examine the physiologic responses to prolonged leg cycling and arm ergometry exercise in the supine positions with and without level lower body negative

  11. Relationship Between Brachial Artery Flow-Mediated Dilation, Carotid Artery Intima-Media Thickness and Coronary Flow Reserve in Patients With Coronary Artery Disease

    PubMed Central

    Oz, Fahrettin; Elitok, Ali; Bilge, Ahmet Kaya; Mercanoglu, Fehmi; Oflaz, Huseyin

    2012-01-01

    Background The aim of this study was to assess the relationship between brachial artery flow mediated dilation (FMD), carotid artery intima-media thickness (IMT) and coronary flow reserve (CFR) in patients with coronary artery disease (CAD). Methods Fifty patients with coronary artery disease, except left anterior descending artery (LAD), who showed no cardiac symptoms and 45 control subjects underwent assessment of brachial artery FMD, carotid artery intima-media thickness by high-resolution ultrasound. In addition, transthoracic second harmonic Doppler echocardiography was used to measure CFR. Results All of the parameters were found to be correlated with each other. CFR correlated with brachial artery FMD (r = 0.232, P < 0.05) and with carotid IMT (r = -0.403, P < 0.001). Carotid IMT correlated with brachial artery FMD (r = -0.211, P < 0.05). Conclusion Transthoracic CFR correlated with well-established noninvasive predictors of atherosclerosis and we suggest that it can be used as a surrogate for coronary atherosclerosis.

  12. Egg consumption and carotid atherosclerosis in the Northern Manhattan study.

    PubMed

    Goldberg, Sharon; Gardener, Hannah; Tiozzo, Eduard; Ying Kuen, Cheung; Elkind, Mitchell S V; Sacco, Ralph L; Rundek, Tatjana

    2014-08-01

    The evidence supporting recommendations to limit intake of cholesterol rich foods is inconclusive. We aimed to examine the association between egg consumption and carotid atherosclerosis phenotypes, and the association with clinical vascular events in a prospective, urban, multi-ethnic population. The Northern Manhattan Study is a population based cohort to determine stroke incidence, risk factors and prognosis. A sub-cohort of 1429 NOMAS participants with both carotid ultrasounds and comprehensive dietary information was evaluated (mean ± SD age of participants 65.80 ± 8.80, 40% male, 18% white, 20% black, 60% Hispanic). The association between egg consumption and carotid intima media thickness (cIMT) was assessed with linear regression. Logistic and quantile regression was used to examine the association between egg consumption and carotid plaque presence, thickness, and area. The relation between egg consumption and clinical vascular events (N = 2669) was examined with Cox models. The mean total cIMT was 0.91 ± 0.08 mm and 58% had carotid plaque present. Increasing egg consumption was inversely associated with cIMT, plaque presence, thickness, and area, in models adjusted for demographics, vascular risk factors and diet. For every additional egg consumed per week, the risk of plaque decreased by 11% (95% CI 3%-18%). No association was detected between egg consumption and risk of clinical vascular outcomes, over a mean follow up of 11 years and after adjustment for covariates. Frequency of egg consumption in the low to moderate range was inversely related to several markers of carotid atherosclerosis. No association with clinical vascular events, including stroke, was detected. Our findings do not support current vascular health guidelines suggesting the extreme limitation or avoidance of egg consumption due to its cholesterol content. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. A Specialized device designed for eversion carotid endarterectomy.

    PubMed

    Lavrent'ev, A V; Vinogradov, O A; Shcherbiuk, A N

    2011-01-01

    Carotid endarterectomy (CEAE) is currently considered to be one of the most efficient methods of treatment for chronic cerebrovascular insufficiency and prevention of recurrent acute impairments of cerebral blood supply. Methodically, the manipulation concerned is in the majority of cases carried out by one of two most commonly employed techniques, i. e., classical CEAE from the longitudinal arteriotomy with plasty with a synthetic patch, and the so-called eversion CEAE implying removal of an atherosclerotic plaque (ASP) by means of eversion of the internal carotid artery (ICA). Many Russian and foreign authors point out indisputable advantages of eversion CEAE, consisting in a shorter duration of ICA clamping, no need to use synthetic materials, preservation of the anatomical geometry of the bifurcation of the common carotid artery (CCA), a lower incidence rate of restenoses in the remote period. Along with it, eversion CEAE also possesses certain disadvantages consisting in namely complicated revision of the distal intima of the ICA (the zone wherein the ASP is tapering), the necessity of traction by the ASP, which may might lead to its premature detachment, impossibility of ICA eversion distal to the endarterectomy zone and repeat eversion of the already endarterectomised portion of the ICA. Hence, eversion carotid endarterectomy still remains the area of skilled and experienced vascular surgeons, thus giving prerequisites for further levelling its technical disadvantages shortcomings, which was the objective of the present study. The authors describe herein a new specially designed surgical device intended to facilitate the operation of eversion carotid endarterectomy, as well as the technique of application thereof. Based on a comparative example comprising a total of eighty-six eversion carotid endarterectomic procedures performed both with and without the new device, we demonstrated efficiency of using the proposed technique.

  14. Fate of the reconstructed carotid artery after extracorporeal membrane oxygenation.

    PubMed

    Levy, M S; Share, J C; Fauza, D O; Wilson, J M

    1995-07-01

    Reconstruction of the right common carotid artery has been shown to be feasible in neonates after extracorporeal membrane oxygenation (ECMO). However, the long-term outcome after carotid artery reconstruction (CAR) remains unknown. The purpose of this study was to evaluate the natural progression of the anastomotic site after CAR. Between February 1990 and June 1993, 201 patients received ECMO. All veno-arterial (VA) ECMO patients (n = 172) were considered candidates for reconstruction unless a significant neurological event (ie, intracranial hemorrhage, stroke) had occurred; the duration of ECMO exceeded 10 days, making carotid mobilization difficult; or the patient's prognosis was deemed poor. Reconstruction was performed by excising the arteriotomy site, followed by primary end-to-end anastomosis. Reconstruction was abandoned and the artery ligated if an intimal flap, arterial thrombosis, or excessive tension was encountered. After reconstruction all patients had early carotid ultrasonography and either head computed tomography (CT) or magnetic resonance imaging (MRI). Subsequent ultrasound examinations were performed at approximately 6-month intervals. Diameter index (DI) (a measure of anastomotic narrowing) was calculated using ultrasound by dividing the anastomotic diameter by the diameter of the carotid artery 5 mm proximal to the anastomosis. Forty-three of 172 VA ECMO patients (25%) had successful reconstruction. Long-term follow-up data were available on 27 patients. These 27 patients had 39 ultrasound examinations, with an average follow-up time of 7.3 months (range, 4 days to 29 months). All carotid arteries were patent. Linear regression analysis showed significant improvement in the DI with time (P = .0001, r2 = .382).(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Chronic Interactions Between Carotid Baroreceptors and Chemoreceptors in Obesity Hypertension.

    PubMed

    Lohmeier, Thomas E; Iliescu, Radu; Tudorancea, Ionut; Cazan, Radu; Cates, Adam W; Georgakopoulos, Dimitrios; Irwin, Eric D

    2016-07-01

    Carotid bodies play a critical role in protecting against hypoxemia, and their activation increases sympathetic activity, arterial pressure, and ventilation, responses opposed by acute stimulation of the baroreflex. Although chemoreceptor hypersensitivity is associated with sympathetically mediated hypertension, the mechanisms involved and their significance in the pathogenesis of hypertension remain unclear. We investigated the chronic interactions of these reflexes in dogs with sympathetically mediated, obesity-induced hypertension based on the hypothesis that hypoxemia and tonic activation of carotid chemoreceptors may be associated with obesity. After 5 weeks on a high-fat diet, the animals experienced a 35% to 40% weight gain and increases in arterial pressure from 106±3 to 123±3 mm Hg and respiratory rate from 8±1 to 12±1 breaths/min along with hypoxemia (arterial partial pressure of oxygen=81±3 mm Hg) but eucapnia. During 7 days of carotid baroreflex activation by electric stimulation of the carotid sinus, tachypnea was attenuated, and hypertension was abolished before these variables returned to prestimulation values during a recovery period. After subsequent denervation of the carotid sinus region, respiratory rate decreased transiently in association with further sustained reductions in arterial partial pressure of oxygen (to 65±2 mm Hg) and substantial hypercapnia. Moreover, the severity of hypertension was attenuated from 125±2 to 116±3 mm Hg (45%-50% reduction). These findings suggest that hypoxemia may account for sustained stimulation of peripheral chemoreceptors in obesity and that this activation leads to compensatory increases in ventilation and central sympathetic outflow that contributes to neurogenically mediated hypertension. Furthermore, the excitatory effects of chemoreceptor hyperactivity are abolished by chronic activation of the carotid baroreflex. © 2016 American Heart Association, Inc.

  16. In-111 platelet scintigraphy: carotid atherosclerosis and stroke

    SciTech Connect

    Powers, W.J.

    1984-05-01

    An association between atherosclerosis of the internal carotid artery and ischemia or infarction of the ipsilateral cerebral hemisphere has been demonstrated by numerous radiographic and pathologic studies. The precise mechanism by which carotid atherosclerosis causes these problems, however, remains unclear. Several observations suggest that fibrin-platelet thrombi form on atherosclerotic plaques in the neck arteries and then embolize distally into the intracranial circulation. Unfortunately, platelet embolization does not adequately explain a variety of clinical and pathological findings in patients with cerebrovascular disease. This editorial will discuss these findings. It is obvious that the understanding of the role of platelets in the pathogenesis of ischemic cerebrvascular disease is far from complete.

  17. Spontaneous Healing of Iatrogenic Direct Carotid Cavernous Fistula

    PubMed Central

    Kwon, H-J.; Jin, S-C.

    2012-01-01

    Summary Direct carotid-cavernous fistula (CCF) by selective navigation using a microcatheter or microwire is a rare complication, and its timing of treatment has not been elucidated. We report two cases of direct CCFs resulting from injury to the cavernous posterior segment of the internal carotid artery during selective navigation. We did not plan to perform emergent endovascular treatment for these direct CCFs because no symptoms related to direct CCFs developed. Follow-up angiography revealed spontaneous healing of both direct CCFs. Close observation rather than emergent treatment may represent another option for direct CCF by selective navigation during the endovascular procedure. PMID:22681734

  18. [Horner syndrome as a manifestation of carotid artery dissection].

    PubMed

    Rohrweck, S; España-Gregori, E; Gené-Sampedro, A; Pascual-Lozano, A M; Aparici-Robles, F; Díaz-Llopis, M

    2011-11-01

    A 42-year-old man presented with ptosis and miosis in his left eye and a history of headache over the last 20 days. An angioresonance showed dissection of internal carotid artery. "Painful Horner's Syndrome" is considered to be a medical emergency due possible onset of an internal carotid artery dissection. We consider that awareness of neuro-ophthalmologic emergencies is very important in the clinical praxis of an ophthalmologist. Multidisciplinary treatment and follow-up of these patients is required. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  19. [An automatic system controlled by microcontroller for carotid sinus perfusion].

    PubMed

    Yi, X L; Wang, M Y; Fan, Z Z; He, R R

    2001-08-01

    To establish a new method for controlling automatically the carotid perfusion pressure. A cheap practical automatic perfusion unit based on AT89C2051 micro controller was designed. The unit, LDB-M perfusion pump and the carotid sinus of an animal constituted an automatic perfusion system. This system was able to provide ramp and stepwise updown perfusion pattern and has been used in the research of baroreflex. It can insure the precision and reproducibility of perfusion pressure curve, and improve the technical level in corresponding medical field.

  20. [Computer-based training exemplified by the carotid artery].

    PubMed

    Eckstein, H H; Dörfler, A; Klemm, K; Schumacher, H; Winter, R; Bardenheuer, H J; Weigand, M; Werner, U; Mehrabi, A; Schwarzer, H; Kallinowski, F; Allenberg, J R

    1998-01-01

    The purpose of computer-based training (CBT) is interactive use of multimedia components, such as text, graphics, animation, sound, digital slide shows, and videos. This CD-ROM illuminates different aspects of carotid surgery: cerebrovascular insufficiency, sonographic and neuroradiological diagnostics, indications and results of carotid surgery in the literature, perioperative complications and new developments such as interventional procedures. Digital imaging (60 minutes of video sequences and 250 graphics) especially focus on operative standard procedures (conventional and eversion technique) and alternative methods. CBT is an evolving supplement to improve education programs in vascular surgery.

  1. Tissue Characterization on Common Carotid Artery using AR Model

    NASA Astrophysics Data System (ADS)

    Koya, Yoshiharu; Mizoshiri, Isao

    This study uses one image with a echocardiography and detects arteriosclerosis on the common carotid artery by tissue characterization. The conventional methods are measurement of thickness on the vessel wall or stiffness on the common carotid artery. However, they need frames of several beats and great calculation times. But, we detect the arteriosclerosis with only one image. Our method estimate the grade of arteriosclerosis by AR model parameters fitted to the texture on the lumen-intima wall. Experimental results show the validity of the proposed method.

  2. Intravenous DSA of extracranial carotid lesions: comparison with other techniques and specimens

    SciTech Connect

    Sheldon, J.J.; Janowitz, W.; Leborgne, J.M.; Sivina, M.; Rojo, N.

    1984-12-01

    Intravenous digital subtraction arteriography (DSA) was performed in 306 patients with suspected ischemic cerebrovascular disease. Forty-eight carotid endarterectomies were performed in 43 of these patients. The percentage stenosis as determined on the intravenous DSA examination concurred with the surgical findings in 83.3%. Nine surgical lesions had both intravenous DSA and conventional arteriography. Intravenous DSA was correct in six and arteriography in seven of these lesions. There were four surgically confirmed ulcerations. Two were evaluated by intravenous DSA alone. Two had intravenous DSA and arteriography. Thirty-seven surgical lesions had both intravenous DSA and high-resolution real-time sonographic imaging. Sonography agreed in 67.5% and intravenous DSA in 83.7% of these lesions. When an abnormal supraorbital Doppler or an abnormal oculopneumoplethysmography/Gee examination is added to the sonographic examination, an overall sensitivity of 93% was obtained in detecting a surgical lesion.

  3. Isolated Internal Carotid Artery Thrombus and Cerebral Infarction in a Patient with Necrotizing Pancreatitis: Case Report.

    PubMed

    Ludwig, Daniel R; Austin, Matthew J; Wallace, Adam N; Kamran, Mudassar; Kansagra, Akash P; Osbun, Joshua W; Cross, DeWitte T; Moran, Christopher J

    2017-09-08

    Isolated internal carotid artery (ICA) thrombus in the absence of underlying atherosclerotic disease is a rare entity. We report a case of a patient presenting with right arm weakness, slurred speech, and altered mental status in the setting of acute on chronic pancreatitis. The patient was found to have scattered left cerebral hemisphere cortical infarctions, and catheter angiography confirmed the presence of intraluminal left ICA thrombus, with no evidence of atherosclerotic disease in the cervical or intracranial vasculature. Further workup also demonstrated the presence of anemia of chronic disease. The patient was initiated on anticoagulation, and follow-up imaging demonstrated a complete resolution of the left ICA thrombus. In the reported case, coagulopathy in the setting of acute on chronic pancreatitis was presumably the primary etiology. Anemia of chronic disease, related to a proinflammatory state, may also play a contributory role. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. Numerical Simulation of Blood Flow in the Stenotic Carotid Artery Bifurcation

    NASA Astrophysics Data System (ADS)

    Stroud, Jenn S.; Berger, Stanley A.

    1999-11-01

    Flow through severely stenotic vessels is of great interest. Atherosclerotic plaque both occludes blood vessels and poses the threat of plaque rupture, which may cause embolic particles to float downstream or into the brain, causing a stroke. It is difficult to characterize the risk posed by a particular plaque. This study involves numerical simulation of blood flow through extremely realistic models of the carotid artery bifurcation. Geometries are obtained through high-resolution magnetic resonance imaging of surgically removed atherosclerotic plaques. The plaque morphologies are then used as boundaries for numerical simulations. The resulting computational data may be compared with experiments and available in vivo data from MRI and Doppler Ultrasound. The incompressible Navier-Stokes equations are solved for steady and pulsatile flows, using a finite volume formulation and the SIMPLE algorithm. The effects of turbulence are considered.

  5. Transvenous embolization of a dural carotid-cavernous sinus fistula via the inferior ophthalmic vein.

    PubMed

    Michels, Kevin S; Ng, John D; Falardeau, Julie; Roberts, Warren G; Petersen, Bryan; Nesbit, Gary M; Barnwell, Stanley L

    2007-01-01

    A 76-year-old woman presented with an acute onset of right periocular pain, diplopia, ocular injection, progressive proptosis, and periocular swelling. She had an unremarkable past medical history, and the erythrocyte sedimentation rate and complete blood count were normal. A carotid-cavernous sinus fistula was suspected, and an MRI demonstrated enlargement of the superior ophthalmic vein posterior to the globe and enlargement of the inferior ophthalmic vein throughout its entire course. Cerebral arteriography demonstrated a dural cavernous sinus fistula. The inferior ophthalmic vein was accessed via the inferonasal orbital space and was catheterized for delivery of multiple platinum coils to the cavernous sinus fistula. Follow-up venograms demonstrated occlusion of the fistula. At 2-month follow-up, there was a residual sixth nerve palsy and resolution of symptoms, including proptosis and periocular swelling.

  6. A cohort study of duplex Doppler examinations of the carotid artery in primary open angle glaucoma

    PubMed Central

    Marmion, Vincent J; Aldoori, Munther I; Woodcock, John P

    2014-01-01

    Objectives To explore the possibility of pathological change in the common carotid artery at the bifurcation and in the internal carotid artery beyond the bifurcation which could contribute to a reduced diastolic pressure as observed in primary open angle glaucoma. Design Duplex ultrasonic examinations of carotid bifurcations were conducted on 80 patients. Carotid artery defects were allocated into three types: no demonstrable flow defects, internal carotid artery abnormalities and disease in the carotid bulb. Setting Bristol Royal Infirmary Vascular Laboratory. Participants Eighty patients (mean age 69.6 years) providing a total of 160 sides to the analysis. Main outcome measures An estimated central retinal artery pressure, intraocular pressure and field loss were recorded for each side measured. Results Doppler investigations revealed significant levels of pathological change in the internal carotid distinct from changes at the carotid bulb. The disease revealed in the internal carotid artery was significantly associated with intraocular pressure (p = 0.032), with an effect small to medium in magnitude. The Q2 measure, derived from mean arterial pressure and intraocular pressure, was also substantively associated with disease in the internal carotid artery. Both intraocular pressure and the Q2 measure effectively discriminated between groups, with field loss providing rather less discriminating capability. There was a strong trend towards a higher intraocular pressures and a greater visual field loss with internal carotid artery disease. Conclusions Pathological changes in the extra cranial carotid artery in primary open angle glaucoma exceed those in the arteries classified as normal. The presence of disease specifically in the internal carotid artery emphasised the need for a mechanism for the evaluation of the internal carotid apart from the carotid bulb. A basis for clarifying the presence of an ischaemic zone is proposed. PMID:25289141

  7. Systematic Review and Meta-Analysis of Carotid Artery Stenting Versus Endarterectomy for Carotid Stenosis

    PubMed Central

    Zhang, Lei; Zhao, Zhiqing; Ouyang, Yaoming; Bao, Junmin; Lu, Qingsheng; Feng, Rui; Zhou, Jian; Jing, Zaiping

    2015-01-01

    Abstract There are disparities among the results of meta-analyses under different circumstances of carotid artery stenting (CAS) versus endarterectomy (CEA) for carotid stenosis. This study aimed to assess the efficacies of CAS and CEA for carotid stenosis at 5-year intervals and worldwide. Comparative studies simultaneously reporting CAS and CEA for carotid stenosis with at least 10 patients in each group were identified by searching PubMed and Embase in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, and by reviewing the reference lists of retrieved articles. The studies were stratified into different subgroups according to the publication year, location in which the study was mainly performed, and randomized and nonrandomized study designs. Thirty-five comparative studies encompassing 27,525 patients were identified. The risk ratios (RRs) of stroke/death when CAS was compared with CEA within 30 d of treatment were 1.51 (95% CI 1.32–1.74, P < 0.001) for overall, 1.50 (95% CI 1.14–1.98, P = 0.004) from 2011 to 2015, 1.61 (95% CI 1.35–1.91, P < 0.001) from 2006 to 2010, 1.59 (95% CI 1.27–1.99, P < 0.001) in North America, 1.50 (95% CI 1.24–1.81, P < 0.001) in Europe, 1.63 (95% CI 1.31–2.02, P < 0.001) for randomized, and 1.44 (95% CI 1.20–1.73, P < 0.001) for nonrandomized comparative studies. CEA decreased the risks of transient ischemic attack at 30 d (RR: 2.07, 95% CI 1.50–2.85, P < 0.001) and restenosis at 1-year (RR: 1.97, 95% CI 1.28–3.05, P = 0.002). Data from follow-up showed that the RRs of stroke/death were 0.74 (95% CI 0.55–0.99, P = 0.04) at 1 year, 1.24 (95% CI 1.04–1.46, P = 0.01) at 4 year, and 2.27 (95% CI 1.39–3.71, P = 0.001) at 10 year. This systematic review, compared with those of other meta-analyses, included all available comparative studies and analyzed them at 5-year intervals, in different continents, and under different

  8. Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy

    PubMed Central

    Plaza-Martínez, Angel; Hernández-Cádiz, Maria J.; Soliveres-Ripoll, Juan; Solaz-Roldán, Cristina; Morales-Suarez-Varela, María M.

    2012-01-01

    Introduction To assess the possible role and the interaction of cerebrovascular disease and vascular stenosis on the necessity of shunt insertion during carotid endarterectomy (CEA). Material and methods Eighty consecutive patients undergoing CEA under regional anaesthesia were prospectively enrolled. Patients were divided into two groups depending on whether they were shunted or not. The measured end-points were co-morbidities degree of contralateral and carotid stenosis and other intra- and postoperative outstanding parameters. ANOVA, Student's t and χ2 tests were used (p<0.05). Variables differing significantly between groups and potential confounders were used in backward stepwise logistic regression to estimate the relative risk (RR, 95% CI) of shunt. In addition Wald's test (p<0.05) with and without adjustments for potential confounders was used with various different multivariate analysis models. Results Contralateral stenosis and cerebral vascular accidents (CVA) were more frequently observed in shunted patients. The RR for patients with contralateral stenosis ≥ 50% was 1.3 (95% CI 1.0-1.5) and for patients with previous CVA was 1.2 (95% CI 1.0-1.4). For contralateral stenosis and CVA together the RR increased to 7.7 (95% CI 1.0-14.4). A model based on contralateral stenosis and CVA was found to be statistically significant (p=0.003) for shunt (RR=1.1, 95% CI 1.0-2.1). Relative excess risk due to interaction of both factors was 6.2. Conclusions The findings suggest that patients with contralateral stenosis ≥ 50% and previous CVA have a higher risk of requiring shunt use during CEA than patients with these risk factors separately. PMID:22661995

  9. Common Reasons That Asymptomatic Patients Who Are 65 Years and Older Receive Carotid Imaging.

    PubMed

    Keyhani, Salomeh; Cheng, Eric M; Naseri, Ayman; Halm, Ethan A; Williams, Linda S; Johanning, Jason; Madden, Erin; Rofagha, Soraya; Woodbridge, Alexandra; Abraham, Ann; Ahn, Rosa; Saba, Susan; Eilkhani, Elnaz; Hebert, Paul; Bravata, Dawn M

    2016-05-01

    National guidelines do not agree on the role of carotid screening in asymptomatic patients (ie, patients who have not had a stroke or transient ischemic attack). Recently, several physician organizations participating in the Choosing Wisely campaign have identified carotid imaging in selected asymptomatic populations as being of low value. However, the majority of patients who are evaluated for carotid stenosis and subsequently revascularized are asymptomatic. To better understand why asymptomatic patients who undergo revascularization receive initial carotid imaging. Retrospective cohort study of 4127 Veterans Health Administration patients 65 years and older undergoing carotid revascularization for asymptomatic carotid stenosis between 2005 and 2009. Indications for carotid ultrasounds were extracted using trained abstractors. Frequency of indications and appropriateness of initial carotid ultrasound imaging for patients within each rating category after the intervention were reported. The mean (SD) age of this cohort of 4127 patients was 73.6 (5.9) years; 4014 (98.8%) were male. Overall, there were 5226 indications for 4063 carotid ultrasounds. The most common indications listed were carotid bruit (1578 [30.2% of indications]) and follow-up for carotid disease (stenosis/history of carotid disease) in patients who had previously documented carotid stenosis (1087 [20.8% of indications]). Multiple vascular risk factors were the next most common indication listed. Rates of appropriate, uncertain, and inappropriate imaging were 5.4% (227 indications), 83.4% (3387 indications), and 11.3% (458 indications), respectively. Among the most common inappropriate indications were dizziness/vertigo and syncope. Among the 4063 patients, 3373 (83.0%) received a carotid endarterectomy. Overall, 663 procedures were performed in patients 80 years and older. Carotid bruit and follow-up for carotid disease accounted for approximately half of all indications provided by physicians for

  10. Bilateral internal carotid artery occlusion associated with the antiphospholipid antibody syndrome.

    PubMed

    Anand, Pria; Mann, Sharan K; Fischbein, Nancy J; Lansberg, Maarten G

    2014-01-01

    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.

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

    PubMed Central

    Anand, Pria; Mann, Sharan K.; Fischbein, Nancy J.; Lansberg, Maarten G.

    2014-01-01

    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. PMID:24707268

  12. Can carotid angiography be performed by vascular surgeons? A critical evaluation of indications, technique, and results.

    PubMed

    Sullivan, Timothy M; Patel, Ajay; Langan, Eugene M; Gray, Bruce H; Mackrell, Peter J; Taylor, Spence M; Carsten, Christopher G; Cull, David L; Snyder, Bruce A; Miskulin, Joseph; Youkey, Jerry

    2004-11-01

    The purpose of this report is to examine the contemporary indications for diagnostic carotid arteriography and evaluate its utility and safety when performed by vascular surgeons. The records of all patients having selective carotid arteriography from September 2000 through March 2002 at our institution were reviewed. One hundred sixty-four consecutive patients had selective arteriography of the extracranial carotid arteries for the following indications: hemispheric symptoms with stenosis <80% by duplex ultrasound (20.6%), suspected brachiocephalic trunk stenosis (15.8%), unclear anatomy by duplex (10.3%), recurrent carotid stenosis (10.3%), symptomatic high-grade (>80% by duplex) internal carotid stenosis (9.8%), ipsilateral internal carotid artery occlusion (7.1%), bilateral high-grade internal carotid artery stenoses (7.1%), vertebral-basilar ischemia (7.0%), contralateral internal carotid occlusion (5.4%), duplex ultrasound from a nonaccredited vascular laboratory (3.3%), and evaluation of nonatherosclerotic carotid disease (3.3%). There were no transient ischemic attacks, strokes, or deaths related to the index procedure. Selective angiography of the extracranial carotid arteries remains an important adjunct in the evaluation of patients with carotid disease. This procedure can be performed safely by vascular surgeons.

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

    PubMed Central

    Carignano, Guido; Balderi, Alberto; Novali, Claudio

    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 feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters. PMID:28487806

  14. The Moving Carotid Artery: A Retrospective Review of the Retropharyngeal Carotid Artery and the Incidence of Positional Changes on Serial Studies.

    PubMed

    Lukins, D E; Pilati, S; Escott, E J

    2016-02-01

    Retropharyngeal carotid arteries are a clinically relevant anatomic variant. Prior studies have documented their incidence, but only a single case report has discussed the change in position of the carotid artery to and from a retropharyngeal location. The purpose of this study was to determine the prevalence of retropharyngeal carotid arteries and to evaluate the change in position of retropharyngeal carotid arteries over serial CT examinations of the neck. A retrospective review of 306 CT examinations of the neck in 144 patients was performed. Patients with previous neck surgery or neck masses displacing the carotid arteries were excluded. The position of each carotid artery was evaluated on each examination. In patients with prior examinations, change or lack of change in position was recorded. The data were reviewed to assess changes in the position of the carotid arteries. Of the 144 patients evaluated, 34 were excluded. The final number of examinations included in the study was 249. Sixty-three of 110 patients had at least 1 comparison study. Twenty-three retropharyngeal carotid arteries were present on the baseline examination in 17 (15.5%) of 110 patients. There was documented change to or from a retropharyngeal position in 4 (6.3%) of 63 patients with comparison studies. The phenomenon of migration of the carotid arteries to and from a retropharyngeal position with time is confirmed by our study. It is important for physicians to be aware of this phenomenon to avoid potential procedural complications. © 2016 by American Journal of Neuroradiology.

  15. Carotid Artery Stenting, Endarterectomy, or Medical Treatment Alone: The Debate Is Not Over

    PubMed Central

    Kassaian, Seyed Ebrahim; Goodarzynejad, Hamidreza

    2011-01-01

    The management of carotid artery stenosis reduces the risk of stroke and its related deaths. Management options include risk factor modification and medical therapy, carotid endarterectomy (CEA), and carotid artery stenting (CAS). Although several randomized controlled trials (RCTs), mostly conducted in late-1980s and mid-1990s, have proved CEA to be effective in the prevention of ipsilateral ischemic events in selected patients with carotid artery stenosis, aggressive risk factor modification and medical therapy with recently introduced antiplatelet agents, statins, and more effective antihypertensive medications may have reduced compelling indications for immediate surgery in asymptomatic populations. Also recently, due to improvements in percutaneous techniques and carotid stents, CAS has received wide attention as a potential alternative to CEA. Herein, we review the recent data on the management options of carotid artery stenosis and seek to identify the most appropriate treatment strategy in selected patients with carotid artery stenosis. PMID:23074598

  16. Internal carotid artery agenesis: A case report and review of literature.

    PubMed

    Li, Shuo; Hooda, Kusum; Gupta, Nishant; Kumar, Yogesh

    2017-04-01

    Congenital agenesis of the internal carotid artery is a very rare anomaly. Intracranial circulation in the involved internal carotid artery territory is maintained by collateral circulation from the contralateral internal carotid artery through the anterior communicating artery and from the vertebrobasilar system through the posterior communicating artery. Usually, patients with internal carotid artery agenesis are asymptomatic due to collateral circulation, but they may present with headache, seizures, or transient ischemic attack. Aneurysms have also been reported to be associated with this entity. Computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography are commonly used modalities to make the diagnosis. Unenhanced skull base computed tomography will show the absence of carotid canal, thus differentiating from carotid hypoplasia. We report on a case of right internal carotid artery agenesis with discussion of embryogenesis, clinical presentation, and imaging findings.

  17. Long-Term Outcomes of Carotid Endarterectomy and Carotid Artery Stenting for Carotid Artery Stenosis: Real-World Status in Japan.

    PubMed

    Imahori, Taichiro; Hosoda, Kohkichi; Fujita, Atsushi; Yamamoto, Yusuke; Mizowaki, Takashi; Miyake, Shigeru; Kimura, Hidehito; Kohta, Masaaki; Kohmura, Eiji

    2016-02-01

    We investigated long-term outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in our institute to evaluate the outcomes of real-world practice in Japan. Between August 2006 and July 2013, 203 consecutive carotid revascularizations with either CEA or CAS were performed in our institute. The initial treatment was regarded as the starting point in the cases of the patients who received treatment by bilateral carotid artery stenosis or retreatment. We assessed the long-term outcomes with survival analyses. A total of 182 patients (CEA 111, CAS 71), including 86 symptomatic patients, were included in the current study with a mean follow-up period of 42.9 months. The periprocedural stroke/death/myocardial infarction (MI) rate was 3.6% for CEA and 5.6% for CAS groups (P = .71). Estimates of the 4-year event-free rate from the primary end point (the composite of any stroke, death, or MI within 30 days, and any ipsilateral stroke thereafter) using competing risk analysis were 3.6% for CEA and 7.1% for CAS (P = .156). Kaplan-Meier estimates of the 4-year event-free rate from the secondary end point (the composite of any stroke, death, or MI within 30 days, and any stroke or death thereafter) were 13.8% for CEA and 19.1% for CAS (P = .072). Age was the only significant predictor for the primary end po