Asymptomatic Internal Carotid Artery Research Articles

Guideline for the management of symptomatic and asymptomatic internal carotid artery stenosis

Stenoses of the internal carotid artery (ICA) with a≥ 50% degree of stenosis are common in the German population with aprevalence of approx. 4.2%. Furthermore, about 15% of ischemic strokes are due to stenosis or occlusion of the ICA. There are currently three approaches to the treatment of ICA stenoses: conventional therapy, endovascular treatment and surgical treatment. Summary of the S3guideline on the diagnosis, treatment and follow-up of extracranial carotid stenosis from 3February2020. Color-coded duplex sonography, computed tomography (CT) angiography and magnetic resonance (MR) angiography and, in exceptional cases, diagnostic subtraction angiography can be used to diagnose ICA stenoses, including the stenosis grade. The classification is into symptomatic and asymptomatic ICA stenoses. ICA stenoses can be treated conservatively, endovascularly with stenting or surgically by carotid endarterectomy. Invasive treatment should be carried out under inpatient conditions, whereby the hospital stay should be kept as short as possible. Color-coded duplex sonography should be performed regularly before discharge and at regular intervals thereafter to detect recurrent stenosis at an early stage and, if necessary, to initiate further invasive therapy. When choosing the treatment modality, particular attention must be paid to whether the stenosis is symptomatic or asymptomatic and the degree of stenosis. The S3guideline on the diagnosis, treatment and follow-up of extracranial carotid stenosis from 3February2020 provides guidance here.

Unilateral Agenesis of the Internal Carotid Artery: A Report of Two Rare Cases

Background: Internal carotid artery (ICA) agenesis occurs when one or both of the blood vessels that supply blood to the brain do not develop. Congenital agenesis of the ICA rarely occurs. It is usually asymptomatic but may sometimes associate with neurological symptoms such as migraine and pulsatile tinnitus. Moreover, differentiating it from occlusion of ICA is important in patients with stroke. Case Report: We report two cases (63-years-old man and 69-year-old woman) of asymptomatic unilateral ICA agenesis who were referred to our cardiovascular hospital for coronary artery bypass graft. Due to a suspicious history of transient ischemic attack, the patients underwent carotid ultrasonography. With findings suggestive of unilateral ICA agenesis at color Doppler, patients underwent computed tomography angiography that confirmed the diagnosis. Conclusion: Suspecting ICA agenesis at color Doppler imaging of the neck and differentiating it from occluded ICA at CT angiography is important for correct diagnosis and management of the patients.

Experience in surgical treatment of extra-intracranial tandem ICA stenosis at the National Medical Research Center for High Medical Technologies named after A. A. Vishnevsky of the Ministry of Defense of the Russian Federation

To date, the effectiveness and safety of reconstructive surgery for steno-occlusive lesions of the internal carotid artery (ICA) have been proven by multicenter cooperative studies Despite this, the indications and tactics of surgical treatment of patients with extra-intracranial tandem stenotic lesions of the ICA remain controversial. In the period 2010-2020, 32 patients with symptomatic (15 cases) and asymptomatic tandem ICA lesions were hospitalized for surgical treatment. The distribution of tandem lesions was as follows: 10 patients had bicarotid hemodynamically significant stenotic and occlusive lesions of the ICA ostium in combination with stenosis of more than 50% of the petrous (4 cases), cavernous (8 cases), and clinoid segments (5 cases), of these, four had bilateral intracranial stenosis; 22 patients with hemodynamically significant lesions of the ICA and vertebral artery (VA) in combination with stenosis of more than 50% of the petrous (10 cases), foramen lacerum (2 cases), cavernous (16 cases), clinoid (14 cases), and ophthalmic segments (1 cases), of these, six had bilateral intracranial stenosis of the ICA. All patients underwent staged surgical interventions on the arteries of the carotid and vertebrobasilar systems. In the postoperative period, there was one case of repeated ischemic stroke in the territory of the reconstructed artery after the application of extra-intracranial microanastomosis (EICMA). There were no relapses of restenosis or acute cerebrovascular accident (CVA) in the follow-up. Staged reconstructive and revascularization treatment is safe and effective for tandem extra-intracranial lesions of the ICA. It is necessaryto continue further study of this issue in order to develop unified tactics and methods of surgical treatment.

Stronger influence of systemic than local hemodynamic-vascular factors on resting-state BOLD functional connectivity

Correlated fluctuations in the blood oxygenation level dependent (BOLD) signal of resting-state functional MRI (i.e., BOLD-functional connectivity, BOLD-FC) reflect a spectrum of neuronal and non-neuronal processes. In particular, there are multiple hemodynamic-vascular influences on BOLD-FC on both systemic (e.g., perfusion delay) and local levels (e.g., neurovascular coupling). While the influence of individual factors has been studied extensively, combined and comparative studies of systemic and local hemodynamic-vascular factors on BOLD-FC are scarce, notably in humans. We employed a multi-modal MRI approach to investigate and compare distinct hemodynamic-vascular processes and their impact on homotopic BOLD-FC in healthy controls and patients with unilateral asymptomatic internal carotid artery stenosis (ICAS). Asymptomatic ICAS is a cerebrovascular disorder, in which neuronal functioning is largely preserved but hemodynamic-vascular processes are impaired, mostly on the side of stenosis. Investigated indicators for local hemodynamic-vascular processes comprise capillary transit time heterogeneity (CTH) and cerebral blood volume (CBV) from dynamic susceptibility contrast (DSC) MRI, and cerebral blood flow (CBF) from pseudo-continuous arterial spin labeling (pCASL). Indicators for systemic processes are time-to-peak (TTP) from DSC MRI and BOLD lags from functional MRI. For each of these parameters, their influence on BOLD-FC was estimated by a comprehensive linear mixed model. Equally across groups, we found that individual mean BOLD-FC, local (CTH, CBV, and CBF) and systemic (TTP and BOLD lag) hemodynamic-vascular factors together explain 40.7% of BOLD-FC variance, with 20% of BOLD-FC variance explained by hemodynamic-vascular factors, with an about two-times larger contribution of systemic versus local factors. We conclude that regional differences in blood supply, i.e., systemic perfusion delays, exert a stronger influence on BOLD-FC than impairments in local neurovascular coupling.

Dual- vs single-layer stents for endovascular treatment of symptomatic and asymptomatic internal carotid artery stenosis

BackgroundsPlaque protrusion is a common event among carotid artery stenting (CAS) patients and increases ischemic complication risk. Dual-layer stents (DLS) with micromesh technology may offer greater plaque protection compared to single-layer stents (SLS), but few data are available. The aim of the study is to compare clinical outcomes at 12 months for asymptomatic and symptomatic patients treated for primary CAS with DLS or SLS in a high-volume center. MethodsA retrospective analysis of consecutive symptomatic and asymptomatic patients treated with primary CAS for internal carotid artery (ICA) stenosis, with either DLS or SLS between 2015 and 2019, was performed. Primary endpoints included rates of ipsilateral transient ischemic attacks (TIA)/stroke and death within 1-year from CAS. Secondary endpoints included patency rates and survival according to stent type. ResultsOf the 301 patients who met inclusion criteria (74.8 % male; 73.6 mean age ± 8.7 years), most patients were asymptomatic (77.4 %). Among all patients DLS was most frequently deployed (66 %); also, among asymptomatic (62 %) and symptomatic patients (81 %), p < 0.01. Symptomatic patients had less comorbidities and severe disease than asymptomatic patients.Six peri-operative strokes were recorded and, within 1 year, 2 additional strokes were registered among symptomatic patients treated with SLS. No post-operative strokes were encountered in the DLS group (p = 0.04) among symptomatic patients. Higher rates of TIA were observed among asymptomatic patients treated with DLS compared to SLS while rates of TIA were reduced among symptomatic patients treated with DLS.There were no differences in patency rates for DLS and SLS in symptomatic and asymptomatic patients. Primary patency was similar among DLS stent types but differed among SLS stent types (p = 0.01).At a mean follow-up of 27 months ±17.6, survival was comparable between DLS and SLS groups (p = 0.98). ConclusionCAS with DLS seems to reduce the risk of post-procedural stroke for symptomatic patients compared to SLS whilst the choice of stent did not influence ipsilateral TIA, survival or patency rates. These data require confirmation from larger, randomized, prospective studies.

An Investigation of the Relationship Between Carotid Artery Stenosis and White Matter Hyperintensities.

Introduction White matter hyperintensities (WMHs) are frequently detected on magnetic resonance imaging (MRI) with age. Although the etiology of WMH has not been fully explained, it was reported to be associated with internal carotid artery (ICA) stenosis as well as small vessel diseases. The number and volume of these lesions might increase in cases of internal carotid artery (ICA) stenosis. The present study aimed to calculate the localization and volumes of white matter lesions in the VolBrain Program and investigate the relationship between age and sex in patients with symptomatic and asymptomatic internal carotid artery stenosis. Methods MRI scans of patients with carotid stenosis with T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences were performed retrospectively for the present study, which had a retrospective design. The patients were divided into two groups (<70% and ≥70%) because endovascular intervention was considered in patients with asymptomatic stenosis over 70%. Digital subtraction angiography was used to detect carotid artery stenosis. They were also divided into four groups.According to laterality and degree of stenosis, ICA stenosis was separated as those with <70% stenosis on both sides (group 1), right side ICA <70%, left side ≥70% stenosis (group 2), right side ICA ≥70%, left side <70% stenosis (group 3), and ≥70% stenosis on both sides (group 4). A total of 102 patient images were selected that met the inclusion criteria. The measurements of white matter lesion volumes were made using the LesionBrain application in the VolBrain Program. Results The MRI of 82 patients (mean age: 65.55 ± 9.28 years), 28 females and 54 males, were used in the present study. According to LesionBrain Analysis, the total WMH volume was seen in the first and third groups at most. When analyzed in regional terms, stenosis was mostly detected in the first and third groups in the periventricular region. WMH volume was less in all areas in group 4. When examined according to the number of lesions, the most lesions were detected in the third group in the juxtacortical region. When the difference between the groups was examined, a significant difference was detected only in the volume change in the deep white region (p=0.011). No significant differences were found between WMH volumes and age and gender (p>0.05). Conclusion Stenosis of the external internal carotid artery might cause hypoperfusion and silent embolization in the brain. As a result, as well as pathological conditions in cortical areas, ischemic areas in the white matter might also cause cognitive disorders.

Quantification of new intracerebral lesions on diffusion-weighted magnetic resonance imaging after transcarotid artery revascularization for treatment of carotid artery stenosis

Transcarotid artery revascularization (TCAR) has been used with increasing prevalence for treatment of carotid artery stenosis. TCAR holds potential benefits over traditional carotid endarterectomy (CEA) or transfemoral carotid artery stenting by its nature of being less invasive than CEA but more neuroprotective than transfemoral carotid artery stenting. The purpose of this pilot study is to evaluate the effectiveness of the neuroprotection system of TCAR with flow reversal by quantifying the incidence and degree of new intracerebral lesions using diffusion-weighted magnetic resonance imaging (DW-MRI). This study is the first to evaluate these findings in a real-world, high-risk cohort, who would have been excluded from the ROADSTER and ENROUTE transcarotid neuroprotection system DW-MRI studies. Patients undergoing unilateral TCAR for symptomatic or asymptomatic severe internal carotid artery disease were eligible and prospectively enrolled in the study. All patients had high risk features, including comorbidities or medications, which excluded them from industry-sponsored DW-MRI trials. Patients underwent a preoperative DW-MRI to obtain a baseline intracerebral evaluation within 1 week of the scheduled surgery. The follow-up DW-MRI occurred within 48hours postoperatively. The primary outcome was new, acute postoperative lesion(s) identified on DW-MRI. Secondary outcomes include any major stroke, myocardial infarction, or death during hospitalization. Five consecutive patients underwent TCAR with preoperative and postoperative imaging. All five patients were on dual antiplatelet therapy before their procedure and verified to be therapeutic on these agents. All patients underwent a right-sided TCAR and three were symptomatic as the indication for their procedure. All five patients demonstrated chronic lesions on the preoperative DW-MRI. Technical success was achieved in all five patients, with one operative complication involving a dissection of the common carotid at the access site, which was stented using the TCAR system. Postoperative DW-MRI did not identify any new intracerebral lesions in any patient following the procedure. No patient had a stroke, myocardial infarction, or death during hospitalization. In this real-world, high-risk cohort, TCAR was completed with no evidence of new, postoperative DW-MRI lesions. These data further demonstrate that TCAR with flow reversal is an effective neuroprotective strategy for carotid revascularization. Further study is warranted to evaluate DW-MRI differences between TCAR and CEA.

Abstract Number ‐ 66: Symptomatic Chronic Internal Carotid Artery Occlusion Managed With Bilateral Common Carotid Angioplasty: A Case Report

Introduction Several guidelines have addressed symptomatic or asymptomatic carotid artery stenosis treatment with intensive medical management and surgical management based on the severity of stenosis [1]. In acute occlusions, endovascular treatment (EVT) and carotid endarterectomy (CEA) with or without prior thrombolytics provide the best recanalization and functional outcomes when compared to intravenous or intra‐arterial thrombolysis alone. There is, however, less robust evidence on management of symptomatic chronic internal carotid artery (ICA) occlusion occurring in tandem with significant contralateral ICA stenosis [2]. In chronic ICA occlusion (ICAO), EVT and carotid endarterectomy (CEA) are technically unfeasible, but indirect procedures have been arising as safe and effective alternatives, notably CEA or stenting of contralateral stenotic ICA [3] and CEA or stenting of ipsilateral external carotid artery (ECA) [4]. We hereby report a case of symptomatic chronic ICAO that was managed with staggered angioplasty and stenting of bilateral common carotid artery (CCA) bifurcations. Methods We hereby present a case report. Results A 62‐year‐old male with atrial fibrillation and hypertension woke up with sudden dysarthria and right upper extremity and facial weakness. NIHSS at presentation was 4. Last seen normal 9 hours prior. Non‐contrast head computerized tomography (CT) did not show acute intracranial abnormality, CT angiogram of head and neck showed severe right ICA stenosis and complete occlusion of the left ICA at cervical, petrous and cavernous segments, with distal reconstitution at the supraclinoid segment with left proximal middle cerebral artery (MCA) thrombus. CT perfusion showed a core infarct volume of 8cc in left MCA territory, mismatch volume of 78cc and ratio of 10.8. Risks of acute neuro‐intervention were deemed to outweigh benefits. Given favorable perfusion imaging, and in concordance with the EXTEND trial [5], tPA was administered. The patient remained stable without hemorrhagic complications with residual deficits of mild right upper extremity weakness and mild expressive aphasia. MRI confirmed left ICA territory ischemic infarcts. Patient underwent stenting of the asymptomatic right ICA at the CCA bifurcation first, followed by left CCA stent after one month with impressive improvement in subsequent perfusion imaging. Conclusions Our case encourages consideration of well‐timed angioplasty and stenting in cases of chronic bilateral carotid artery disease especially when the asymptomatic side is also significantly stenotic

Complication Rate After Carotid Endarterectomy Comparing Patch Angioplasty and Primary Closure: Long-Term Outcome

Objective: In patients with symptomatic or asymptomatic severe internal carotid artery stenosis, carotid endarterectomy (CEA) has been shown to reduce risk for stroke. The optimal surgical technique remains subject of debate. In the latest European Society of Vascular Surgery (ESVS) guidelines on the management of atherosclerotic carotid disease, routine patching is preferred to routine primary closure. However, there are no RCT’s evaluating selective patching strategies. This follow-up study aimed to assess long term complication rate and restenosis after carotid endarterectomy with selective patching. Methods: Two hundred thirteen consecutive carotid endarterectomies over a 3-year period from January 5th 2011 to December 19th 2013 were prospectively analyzed in a follow-up study over 5 years (mean 4.6, range 3.17-6.17). Patient population consisted of 141 procedures on males and 72 on females with mean age 73 years at the time of surgery (standard deviation (SD) 8.57, range 53-95). There was a follow-up of 89%. Postoperative risk factors were assessed such as hypertension, diabetes mellitus, coronary artery disease and smoking. Postoperative symptoms of cranial nerve injury, transient ischemic events, cerebrovascular events and mortality were evaluated. Duplex ultrasound was performed by a radiologist blinded to the operative technique to evaluate patency of the carotid artery after carotid endarterectomy. Results: Primary closure was used in 110 operations, and patch angioplasty in 103 procedures (Dacron patch). Primary closure was performed when the carotid artery had a diameter above 5 mm, when there was a high carotid bifurcation or when the contralateral carotid artery was occluded. There were no significant differences among groups' baseline characteristics at the time of surgery. Primary closure was performed significantly more in male patients (P= .02). Overall complication rate was 3.76% postoperatively (1.8% after primary closure, 5.8% after patch angioplasty) and after 5 years 5.29% (2.0% after primary closure, 9.1% after patch angioplasty). There are no significant differences in results between the two groups (P= .09 and P= .05). In four cases patients experienced symptoms of cranial nerve damage postoperatively, two in each group. In one of the two cases in each group, the patient fully recovered and the other had persistent complaints (P-value= 1). None of the patients experienced amaurosis fugax during the 5-year follow up period. In five cases a patient had an ipsilateral cerebrovascular thrombosis in the group after patch angioplasty compared to zero in the primary closure group (P-value= .02). In the group of primary closure there was a mortality of 26 patients (23.6%) compared to 26 (25.2%) patients after patch angioplasty (P-value = .70). One was caused by cerebral hyperperfusion syndrome within one month postoperative after patch angioplasty and none were caused by an ipsilateral ischemic stroke. Objective duplex ultrasound showed no significant difference comparing restenosis in both groups (P-value= .43). In twelve cases patients showed a restenosis between 50-70% (6 primary closure and 6 patch angioplasty), none of the patients had high grade restenosis of more than 70%. Patient characteristics did not show a significant effect on long term outcomes. There was a correlation between postoperative use of antihypertensive medication and long-term stroke (P-value= .006), restenosis (P-value= .01) and mortality (P-value= .003). Conclusion: After long-term follow-up we found primary closure and patch angioplasty to be equivalent with respect to complication rate and restenosis when used in selected cases. Best medical treatment and especially the use of antihypertensive medication should be emphasized.

Quantification of New Intracerebral Lesions on Diffusion-weighted Magnetic Resonance Imaging After Transcarotid Artery Revascularization for Treatment of Carotid Stenosis

Quantification of New Intracerebral Lesions on Diffusion-weighted Magnetic Resonance Imaging After Transcarotid Artery Revascularization for Treatment of Carotid Stenosis

Does Current Evidence Support Carotid Artery Stenting for Asymptomatic Patients?

Carotid interventions, carotid endarterectomy and carotid artery stenting (CAS) have proven to be effective treatments for the prevention of ischaemic stroke in recently symptomatic patients. Most studies were conducted before the development of strict statin guidance and the systematic use of antiplatelet drugs. The advances in medical treatments have raised questions regarding the benefit of carotid endarterectomy or CAS, especially for high-grade asymptomatic internal carotid artery stenosis. Reviewing the literature indicates that carotid artery stenosis of any degree is a relatively weak predictor of ipsilateral stroke, in the absence of recent symptoms referable to the carotid disease. This risk does not appear reduced by revascularisation by CAS if added to modern day best medical therapy. On-going trials are key to understanding if current techniques can provide an additional benefit.

Natural History of Asymptomatic Moderate Carotid Artery Stenosis in a Large Community-Based Cohort.

Moderate carotid artery stenosis is a poorly defined risk factor for ischemic stroke. As such, practice recommendations are lacking. In this study, we describe the long-term risk of stroke in patients with moderate asymptomatic stenosis in an integrated health care system. All adult patients with asymptomatic moderate (50%-69%) internal carotid artery stenosis between 2008 and 2012 were identified, with follow-up through 2017. The primary outcome was acute ischemic stroke attributed to the ipsilateral carotid artery. Stroke rates were calculated using competing risk analysis. Secondary outcomes included disease progression, ipsilateral intervention, and long-term survival. Overall, 11 614 arteries with moderate stenosis in 9803 patients were identified. Mean age was 74.2±9.9 years with 51.4% women. Mean follow-up was 5.1±2.9 years. There were 180 ipsilateral ischemic strokes (1.6%) identified (crude annual risk, 0.31% [95% CI, 0.21%-0.41%]), of which thirty-one (17.2%) underwent subsequent intervention. Controlling for death and intervention as competing risks, the cumulative incidence of stroke was 1.2% (95% CI, 1.0%-1.4%) at 5 years and 2.0% (95% CI, 1.7%-2.4%) at 10 years. Of identified strokes, 50 (27.8%) arteries had progressed to severe stenosis or occlusion. During follow-up, there were 17 029 carotid studies performed in 5951 patients, revealing stenosis progression in 1674 (14.4%) arteries, including 1614 (13.9%) progressing to severe stenosis and 60 (0.5%) to occlusion. The mean time to stenosis progression was 2.6±2.1 years. Carotid intervention occurred in 708 arteries (6.1%). Of these, 66.1% (468/708) had progressed to severe stenosis. The overall mortality rate was 44.5%, with 10.5% of patients lost to follow-up. In this community-based sample of patients with asymptomatic moderate internal carotid artery stenosis followed for an average of 5 years, the cumulative incidence of stroke is low out to 10 years. Future research is needed to optimize management strategies for this population.

Intra-arterial infusion of fasudil hydrochloride for cerebral vasospasm secondary to carotid artery stenting: illustrative case

BACKGROUNDHypoperfusion due to intracranial cerebral vasospasm after carotid artery stenting (CAS) is rare. The authors presented a case of selective intraarterial infusion of fasudil hydrochloride for cerebral vasospasm after CAS.OBSERVATIONSA 73-year-old man received CAS for asymptomatic right cervical internal carotid artery stenosis. Twelve hours after CAS, disturbance of consciousness, left hemiplegia, and right conjugate deviation appeared in the patient. Head computed tomography angiography showed diffuse vasospasm of the right middle cerebral artery (MCA). The authors hypothesized that the cause of the symptoms was hypoperfusion due to intracranial cerebral vasospasm. Medical treatment was started; however, the focal symptoms worsened rapidly. Therefore, the authors decided to infuse fasudil intraarterially. This treatment resulted in a remarkable improvement in blood flow and gradual recovery from neurological symptoms. Head magnetic resonance angiography on the day after fasudil infusion showed improved visualization of the right MCA. The neurological symptoms almost completely disappeared 22 hours after fasudil infusion (40 hours after CAS).LESSONSAs a complication after CAS, the possibility of hypoperfusion due to cerebral vasospasm should be considered. If symptoms due to hypoperfusion worsen even after medical treatment, intraarterial infusion of fasudil may be an effective option.

The Impact of the First 11 Months of the COVID-19 Pandemic on Vascular Patients’ Care and Hospitalisation Rate in the Vascular Surgery Divisions of Southern Italy

The Impact of the First 11 Months of the COVID-19 Pandemic on Vascular Patients’ Care and Hospitalisation Rate in the Vascular Surgery Divisions of Southern Italy

Five-year outcome of non-shunting and primary closure technique during carotid endarterectomy: a longitudinal cohort study.

ObjectiveThe long-term outcomes of primary carotid artery closure after carotid endarterectomy (CEA) have not been sufficiently studied. This prospective study was performed to analyze the 5-year outcomes of the non-shunting and primary arterial repair technique for CEA.MethodsThis study involved 150 patients who underwent CEA with the primary arterial closure technique without arterial shunting and completed 5 years of follow-up.ResultsThe patients comprised 107 men and 43 women. The 30-day postoperative course was uneventful in 147 (98.0%) patients; however, cerebrovascular accidents occurred in 3 (2.0%) patients. With respect to the long-term results, most cases of restenosis at 5 years were <50%. Two patients developed asymptomatic total internal carotid artery occlusion. Eleven deaths occurred (mortality rate of 7.3%); one death (0.7%) occurred in the first 30 days.ConclusionPrimary arteriotomy closure provides very good long-term patency. Routine use of patch closure is unnecessary.

Asymptomatic right internal carotid artery pseudoaneurysm and Eagle's syndrome

A healthy 21-year-old man presented with a right neck palpable mass and calcifications diagnosed during a Panorex odontologic study. Computed tomography angiography imaging of the neck demonstrated a right common and internal carotid artery (ICA) pseudoaneurysm with irregular thrombus and calcifications causing severe right ICA stenosis (A, B). An elongated styloid process was identified adjacent to the pseudoaneurysm associated with ossification of the stylohyoid ligaments (C/Cover). A diagnosis of stylocarotid artery syndrome, a subtype of Eagle's syndrome, was considered and operative treatment recommended, given the pseudoaneurysm appearance with large thrombus and stenosis of the ICA.

Psychological Determinants of Attitude to Surgery in Internal Carotid Artery Stenosis Patients.

The basic way to prevent cerebral stroke in symptomatic 70–99% stenosis of internal carotid artery (ICA) is an open or endovascular surgical procedure. Psychological research done so far among ICA stenosis patients focused on cognitive functioning changes. The objective was to assess attitude to surgery in relation to self-efficacy, life quality perception, and health locus of control in ICA stenosis patients. Materials and Methods: The study involved 53 asymptomatic ICA stenosis patients, aged from 53 to 81. Four scales were applied: Generalized Self-Efficacy Scale (GSES); Satisfaction With Life Scale (SWLS); Multidimensional Health Locus of Control Scale (MHLC); and a simple scale to examine the attitude to surgery, where “−10” stands for the maximally negative attitude, “0”—neutral, and “+10”—maximally positive. The obtained results were put to statistical analysis. Results: It was found that women and men assessed their attitude to the surgery as positive (M = 7.92; SD = 3.094), though the men estimated it slightly higher (M = 8.03; SD = 3.02) than the women (M = 7.67; SD = 3.37). The mean value of self-efficacy was high (M = 32.53; SD = 6.231), and slightly higher for the men (M = 32.79; SD = 5.576) compared to the women (M = 31.87; SD = 7.836). The patients generally tended to manifest the external personal health locus of control (M = 28.62; SD = 3.17). The runner-up was internal health locus of control (M = 26.02; SD = 3.775), and the next one—external impersonal aspect (chance/luck) (M = 23.57; SD = 4.457). The mean assessment of the patients’ own life quality proved to be above average (M = 23.60) but varied (SD = 5.95). The women perceived the quality of their lives as better (M = 24.33; SD = 6.422) than the men (M = 23.32; SD = 5.818). Very strong positive correlations were found between self-efficacy and life quality assessment (p < 0.001) and between the internal and external personal aspects of health locus of control (p < 0.007) in the women, and positive correlations were found between the attitude to surgery and internal health locus of control (p < 0.021) in the men. Conclusions: When breaking the news of a need to have a surgical intervention due to ICA stenosis, the physician should strongly refer to the value of human life and health. The message should arise from external (in the case of women) or internal (in the case of men) motivation to undergo surgery, and enhance the patient’s conviction that the disease should be considered a challenge which must be taken to reverse their unfavorable situation and improve life quality.

STA-MCA Bypass in Carotid Stenosis after Radiosurgery for Cavernous Sinus Meningioma.

Simple SummaryWe present the case of a patient with a radiation-induced internal carotid artery stenosis after stereotactic radiosurgery for cavernous sinus meningioma. Our case presented with symptomatic vascular insufficiency two years after treatment. We carried out a review of the literature searching for vascular and non-vascular complications following the treatment of cavernous sinus meningiomas with radiosurgery or radiotherapy. As a result, two cases of stroke and one case of asymptomatic stenosis of the internal carotid artery were described, aside from non-vascular complications. We were able to conclude that radiosurgery and radiotherapy carry fewer complications than open surgery, with similar rates of tumor control. Altogether, our case and the associated review emphasize the importance of a multidisciplinary, extended follow-up of irradiated cavernous sinus meningiomas.Background: Cavernous sinus meningiomas (CSM) are mostly non-surgical tumors. Stereotactic radiosurgery (SRS) or radiotherapy (SRT) allow tumor control and improvement of pre-existing cranial nerve (CN) deficits. We report the case of a patient with radiation-induced internal carotid artery (ICA) stenosis. We complete the picture with a review of the literature of vascular and non-vascular complications following the treatment of CSMs with SRS or SRT. Methods: After a case description, a systematic literature review is presented, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2015 guidelines. Results: 115 abstracts were screened and 70 titles were retained for full-paper screening. A total of 58 articles did not meet the inclusion criteria. There were 12 articles included in our review, with a follow-up ranging from 33 to 120 months. Two cases of post-SRT ischemic stroke and one case of asymptomatic ICA stenosis were described. Non-vascular complications were reported in all articles. Conclusion: SRS and SRT carry fewer complications than open surgery, with similar rates of tumor control. Our case shows the importance of a follow-up of irradiated CSMs not only by a radio-oncologist, but also by a neurosurgeon, illustrating the importance of multidisciplinary management of CSMs.

Blood flow response to orthostatic challenge identifies signatures of the failure of static cerebral autoregulation in patients with cerebrovascular disease

BackgroundThe cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow.MethodsTranscranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol.ResultsAfter elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p < 0.001) or ICA stenosis (8.6% [3.1,14.0], p = 0.003)). MAP in AIS patients did not return to baseline values (2.6 mmHg [0.5, 4.7], p = 0.018), but in ICA stenosis patients and controls did. Instead ipsilesional but not contralesional CBF was correlated with MAP (AIS 6.0%/mmHg [− 2.4,14.3], p = 0.038; ICA stenosis 11.0%/mmHg [2.4,19.5], p < 0.001).ConclusionsThe observed associations between ipsilateral CBF and MAP suggest that short HOB position changes may elicit deficits in cerebral autoregulation in cerebrovascular disorders. Additional research is required to further characterize this phenomenon.

Результаты каротидного стентирования при асимптомных стенозах сонных артерий

Objective: prospective analysis of 30-day outcomes from stenting procedure in patients with asymptomatic internal carotid artery stenosis depending on the type of implanted stent. Material and Methods: the study included 108 patients who underwent endovascular surgical treatment for asymptomatic internal carotid artery stenosis from 2012 to 2017. Depending on the type of implanted stent the patients were divided into 4 groups (the first (n = 37) – steel, the second (n = 32) -nitilon, the third (n = 20) – doublelayered stents, the fourth (n = 19) – double-layer stents with an inner layer of polyethylene terephthalate. Results: there was no mortality in the studied groups for 30 days after surgery. The cumulative incidence of cerebral circulation disorders within 30 days of carotid angioplasty and stenting was 9.7% (n = 10), with ischemic stroke occurring in 1.85% (n = 2) cases. Conclusion: carotid angioplasty and stenting is a safe and effective method of secondary prevention of cerebral circulation disorders with the level of perioperative complications not exceeding other preventive procedures.