Bilateral Internal Carotid Artery Research Articles

A Comparative Study of the Right and Left Carotid Arteries in Relation to Age for Patients With Diabetes and Hypertension

Introduction: Age, hypertension, and diabetes can cause significant alterations in arterial structure and function, including changes in lumen diameter (LD), intimal-medial thickness (IMT), flow velocities, and arterial compliance. These are also considered risk markers of atherosclerosis and cerebrovascular disease. A difference between right and left carotid artery blood flow and IMT has been reported by some researchers, and a difference in the incidence of nonlacunar stroke has been reported between the right and left brain hemispheres. The aim of this study was to determine whether there are differences between the right and left common carotid arteries and internal carotid arteries in patients with hypertension and diabetes for 2 age groups. Methods: We studied 250 patients with both diabetes and hypertension. Patients were divided into 2 age groups with the old age group being 56 to 75 years and the young age group 35 to 55 years. The bilateral common carotid and internal carotid arteries were evaluated with B-mode ultrasound and Doppler examinations. The LD and IMT were measured for both common carotid arteries, and spectral waveform parameters and indices were recorded for both internal carotid arteries. Results: The difference in LD between the left and right common carotid arteries for the old age group was 11.64% and for the young age group was 6.42%, with significant P values of <.05 for both age groups. The difference in IMT between the left and right common carotid arteries was 18.27% in the old age group compared with 15.38% in the young age group, with significant P values of <.05. There was a difference in peak systolic velocity between the left and right internal carotid arteries of 4.85% in the old age group which was not significant, compared with 14.28% in the young age group with a significant P value <.05, whereas the difference in end-diastolic velocity between the left and right internal carotid arteries was not significant for both age groups. Differences between the right and left internal carotid arteries for resistive index, pulsatility index, and pressure gradient were significant only in the young age group. Conclusion: We found significant differences between the right and left common carotid and internal carotid arteries in patients with diabetes and hypertension which were more prominent in the young age group. Values for common carotid IMT and LD were significantly higher in the left common carotid artery versus the right common carotid artery in both age groups. Differences between the 2 carotid sides may be attributed to anatomic variations in the common carotid artery origins which lead to differences in stress between the 2 sides.

O058 Characteristics and prognosis of cerebrovascular fibromuscular dysplasia (FMD) - a retrospective cohort study

Abstract Introduction Fibromuscular dysplasia (FMD) is a rare, non-atherosclerotic, non-inflammatory vascular disorder that primarily affects renal and cerebrovascular vessels. Limited data are available on the clinical characteristics of cerebrovascular FMD, particularly from the UK/Europe. Methods We performed a retrospective cohort analysis of all cases of carotid/cerebrovascular FMD presenting to our regional vascular service, by case-note review, and searching all relevant clinical databases. Results Eighty-six patients were identified between 1998–2020. Stroke or TIA was the most common mode of presentation. The most frequent vascular pattern was bilateral extracranial internal carotid artery FMD. Concomitant cerebrovascular complications - dissection, aneurysm or occlusive disease of the carotid, vertebral and cerebral vessels was common (41%) and included two cases of carotid cavernous fistula. FMD was also observed in the renal/visceral vessels and aorta in 13(15%) of the cohort (60% of those who had extracranial imaging), with 5% having aneurysm or dissection of other vessels. 19(22%) of patients required carotid/cerebrovascular intervention (mainly for intracranial aneurysm), with 10% requiring intervention for other vascular complications. Recurrent cerebrovascular events (stroke/TIAs and aneurysmal disease requiring intervention) was seen in 23% of cases. Overall mortality was 7% over a median follow-up period of 47 months. Conclusion The co-existence of intracranial aneurysm and other cerebrovascular complications in patients with carotid FMD is high and requires careful surveillance. Vascular complications in other vascular beds are also frequent and probably under-estimated. We would recommend a low threshold for routine imaging of all vascular beds in patients presenting with carotid/cerebrovascular FMD. Take-home message Fibromuscular dysplasia is rare but when presenting as a stroke, other vascular beds may be involved,

Cerebral infarction and risk factors in acute type A aortic dissection with arch branch extension.

Stanford type A aortic dissection (AAD) may affect the supra-aortic arteries, which are associated with acute ischemic stroke (AIS) or transient ischemic attack (TIA). This study aimed to investigate cerebral perfusion, the infarction incidence and risk factors in AAD patients. A total of 156 consecutive AAD patients were enrolled and divided into two groups according to whether the aortic arch branches were involved: the affected group (n = 90) and the unaffected group (n = 66). Clinical, echocardiographic/carotid Doppler data and cerebral infarction morbidity were compared between the groups. Independent predictors of 30-day AAD mortality were identified through multivariable Cox regression, and perioperative risk factors were analyzed. In total, 57.7% of AAD patients had aortic arch branch involvement. Abnormal Doppler waveforms were more common in the affected group (p <0.05). Regarding intracranial perfusion, the blood flow volumes (BFVs) of the bilateral internal carotid arteries (ICAs) and right vertebral artery (RVA) in the affected group were significantly reduced (p <0.05). The incidence of cerebral infarction in the affected group was significantly higher than that in the unaffected group (35.6% vs. 19.7%, p = 0.031). Multivariable analysis revealed that age >45 years old, right internal carotid artery (RICA) involvement and reduced left ventricular ejection fraction (LVEF) were significant predictors of perioperative death. Aortic arch branch involvement is common in patients with AAD and is associated with reduced cerebral blood flow (especially on the right side) and a higher incidence of cerebral infarction. Age, extension of the RICA dissection and LVEF impairment are independent risk factors for AAD-related death.

Normal Doppler Ultrasonography Indices of Bilateral Common and Internal Carotid Arteries”. A Cross Sectional Study

Carotid Arterial Intima Media Thickness (CA-IMT) is taken as an important indicator of atherosclerosis with increasing age and long-term exposure to particulate air pollution associated diseases like hypertension, diabetes, obesity, cigarette smoking, alcohol usage, drugs, deranged lipid profile and high cholesterol, high salt and fatty diet Objective: To evaluate the Doppler ultrasonography indices of common and internal carotid arteries on both sides in normal individuals. Methods: A prospective comparative cross sectional study was conducted at Imperial Diagnostic and Research Centre, Imperial College of Business Studies, Lahore, Pakistan for a period of four months after the approval of synopsis. Convenient sampling technique was used and all patients visiting us during study interval of and fulfilling the inclusion criteria were included. A total of 50 participants age range from15 to 68 years, were included. Aloka Prosound α 5 SV, equipped with linear array probe with frequency of 6-9MHz, was used. All the participants, who were normal volunteers, were subjected to B-mode imaging and color-coded Doppler ultrasonography of their common carotid arteries and internal carotid artery in supine position. Baseline investigation was taken for blood pressure (BP) during resting phase. Participant’s age, weight and height were also assessed and recorded on questionnaire forms. MedCalc was then used to apply relevant tests for statistical analysis. Repeated Measures ANOVA was performed to see the difference between the values taken during supine and standing position on each side. Results: The IMT showed significant positive correlation with the age in both right and left CCA and ICAs. EDV values of right CCA showed significant positive correlation and RI and PI showed significant negative correlation with age. PSV and SD values of left CCA and PSV of right ICA showed significant negative correlation with age. Left ICA diameter and PSV showed the significant positive correlation with age. Conclusion: The study provides the information about normal Doppler indices which might be useful in the evaluation of cases of carotid artery diseases. These figures can be used to gain a better understanding of the aetiology of ischemic strokes in the brain.

Endovascular Repair of an Intrathoracic Subclavian Artery Aneurysm in a Patient With Dextrocardia.

This manuscript describes an endovascular repair of a symptomatic, large proximal left subclavian artery aneurysm in a patient with dextrocardia and right-sided aortic arch and absent bilateral internal carotid arteries. The patient had surgical reconstruction as an infant for congenital heart disease with Ventricular Septal Defect, bifid sternum . Given her previous surgical history, we declined an open operation and performed an endovascular repair with stent grafts to successfully repair the subclavian artery aneurysm. The patient had an uneventful postoperative course and follow-up ultrasonography demonstrated successful repair with preservation of flow through the left subclavian and vertebral arteries with resolution of her symptoms.

Fibromuscular dysplasia: a rare adult case with aortic arch coarctation and bilateral subclavian artery and internal carotid artery stenosis

Fibromuscular dysplasia: a rare adult case with aortic arch coarctation and bilateral subclavian artery and internal carotid artery stenosis

Comparison of the clinical value of transcranial Doppler ultrasound and computed tomography angiography for diagnosing ischemic cerebrovascular disease.

ObjectiveTo compare the clinical value of transcranial Doppler (TCD) ultrasound and computed tomography angiography (CTA) for diagnosing ischemic cerebrovascular disease.MethodsA retrospective clinical study was conducted in 142 patients with ischemic cerebrovascular disease who were initially diagnosed by digital subtraction angiography. Under the single-blind condition, the patients were diagnosed by using TCD ultrasound and CTA independently. The accuracy of these two methods was compared.ResultsThe accuracy of diagnosing bilateral middle cerebral artery, bilateral vertebral artery and bilateral internal carotid artery lesions with a TCD examination was significantly higher than that with a CTA examination. There were no significant differences in the accuracy of diagnosing bilateral anterior cerebral artery, bilateral posterior cerebral artery or basilar artery lesions between TCD ultrasound and CTA. The accuracy of diagnosing all cerebral arterial ischemic lesions was significantly higher with a TCD examination (87.39%) than with a CTA examination (69.75%). The accuracy of diagnosing all cerebral arteries that cause ischemic encephalopathy (cerebrovascular + cervical blood vessels) was significantly higher with a TCD examination (88.03%) than with a CTA examination (69.01%).ConclusionsTCD ultrasound has several advantages over CTA. Therefore, TCD ultrasound is better for diagnosing ischemic encephalopathy than CTA.

Downregulation of mitochondrial pyruvate carrier 2 aggravates neuronal injury in the cortex following cerebral ischemia in rat

Cerebral ischemia is one of the most common disabling and lethal diseases worldwide, but its underlying mechanisms remain unclear. Mitochondrial pyruvate carrier 2 (MPC2), a subunit of MPC complex, plays pivotal roles in coordinating glycolytic and mitochondrial activities. In the present study, the expression of MPC2 was significantly reduced in the ischemic cerebral cortex of rats at 24 h after bilateral internal carotid artery occlusion (BICAO), and in the cortical neurons after 1 h oxygen-glucose deprivation (OGD)/24 h reoxygenation treatment. After MPC2 gene knockdown, the number and expression of neurons were remarkably decreased in the ischemic cerebral cortex of BICAO rats and OGD-treated neurons. UK5099 significantly reduced the number, expression and viability of OGD-treated neurons, and resulted in a significant decrease in length of neurite. Using RNA-sequencing (RNA-seq) technique, we further identified MPC2-related differential genes in the ischemic cerebral cortex of BICAO rats. In conclusion, our results suggested that the decrease in MPC2 expression aggravated ischemic injury, and MPC2-related genes might be a novel therapeutic target for cerebral ischemia.

Sensorineural hearing loss due to delayed cerebral ischemia in bilateral auditory cortices following aneurysmal subarachnoid hemorrhage: illustrative case.

BACKGROUNDRecognizing rare signs of delayed cerebral ischemia (DCI) is crucial to caring for patients with subarachnoid hemorrhage. The authors presented a case of central hearing loss that occurred during the clinical course of a patient treated for aneurysmal subarachnoid hemorrhage.OBSERVATIONSThe patient had a ruptured right posterior communicating artery aneurysm successfully treated with coil embolization but later developed severe vasospasm and DCI. She developed bilateral hearing loss, and imaging revealed DCI to the left temporal lobe and the right auditory cortex. Computed tomography angiography and digital subtraction angiography demonstrated severe vasospasm of bilateral internal carotid arteries, bilateral middle cerebral arteries, and bilateral anterior cerebral arteries. One month after hospitalization, the patient had recovered fully neurologically intact except for persistent hearing loss.LESSONSThis case serves to teach important neuroanatomical features and discuss the unique pathophysiology of DCI affecting the auditory cortex.

Genesis of Antibiotic Resistance (AR) LXXXV: Turbulence Modeling(TM) of Hemodynamics in Simplified Severe Sepsis Protocol‐2 (SSSP‐2)‐NCT01663701: Clinical Connotation of Monitoring ISP [BP(PP), MAP, CBF, ICP, CPPopt, Comatose GCS 3, and CCP] for Attenuation of IHM

Based on the theoretical inferences derived from industrial CFD modules: Flow‐3DÒ Hydro FD simulation Model 04; 05_sediment_transport FLOW‐3D HydroÒ, (Courtesy: Flow‐3D HydroÒ), The Beauty of Vortex Streets, May 5, 2021; Curve Fitting of Solution Data in COMSOL Multiphysics®, July 27, 2021 © 2021 BY COMSOL INC., https://earthobservatory.nasa.gov/images/90734/two‐views‐of‐von‐karman‐vortices (NASA). and hemodynamic data (SSSP‐2), here we present a plausible physiological basis for the benefit of monitoring ISP for attenuation 100% ihm in the usual care cohort of SSSP‐2 (PMID: 28973227). Hypothesis &amp; Rationale:Monitoring the ISP‐induced transient APG, eases the point of care clinical intervention for the recovery from GCS3 to homeostasis. Geometry: RBC, WBC, platelets, p47; Whole blood viscosity ~ 3 centipoise (cP) or ~0.003 Pascal second (Pa. s) p53; Blood velocity in the Human Blood Vessels: table 2.1 p63, Blood Vol. Distribution: Table 2.2, p64; Stress–Strain Curve, Fig 2.15 p 78; ISBN:9780128024089. Gov Eq: Segmental Cerebral Perfusion Pressure Equation for The Intracranial Compartment: SPP = Pd − ICP = FFR · CPP − Ge · (1 − FFR) · (ICP − Pe) (PMCID: PMC8032738; PMID: 33833266). Derivation &amp; Prospects:ISP has been shown to induce cerebral hypoperfusion in turn vasogenic edema altering contralateral/ipsilateral CBF due to increased blood flow through the anterior communicating artery (Acom). Case Report (PMCID: PMC7332508; PMID: 32637214): A 72‐year‐old male presented with the right‐sided hemiparesis and underwent MRI. MR imaging show an acute infarction of the left frontal lobe [Figure 1] and bilateral internal carotid artery (ICA) stenosis (NASCET: Rt: 90%, peak systolic velocity 425 cm/s and Lt: NASCET 70%, peak systolic velocity 212 cm/s). After 2 months, SPECT showed an decrease in CBF in the right cerebral hemisphere [Figure 2a]. INVOS‐4100 cerebral oximeter based determination of the effect of carotid clamping and shunting on oxygen saturation (rSO2) showed rSO2 readings were lower than ipsilateral rSO2 readings. SPECT showed a decrease in CBF around the infarction [Figure 2b]. SPECT indicated a contralateral increase in CBF [Figure 2b]. Tx, with free‐radical scavenger(Rx), showed an improvement in CBF, and laterality disappeared 2 weeks after CEA [Figure 2c and d]. The CBF of both sides equaled 2 weeks later [Figure 3]. Subsequent MR imaging with fluid‐attenuated inversion recovery (FLAIR) images showed a local high‐intensity lesion around a previous infarction in comparison with before CEA [Figure 4a and b]. FLAIR MR imaging 2 weeks after initial surgery confirmed the complete disappearance of the high‐intensity lesion [Figure 4c]. Taken together, the focal vasogenic edema induced neurologic impairment is shown to be alleviated by treating edema and cerebral ischemia while monitoring hemodynamic parameters. This model could be applied for the attenuation of fluid bolus augmented VKVS, collapsing of cerebral vessels leading to 100% ihm, in the usual care group in SSSP‐2 (PMID: 28973227).

Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions

Background Simultaneous multivessel occlusions (MVOs) are a rare condition, which may be encountered during endovascular thrombectomy (EVT) for acute ischemic stroke. This study aimed to investigate the prevalence, associated factors, and outcome of patients with acute ischemic stroke and MVO who underwent EVT. Methods Consecutive patients with acute ischemic stroke who received EVT between September 2014 and April 2021 were included. Acute MVO was defined as simultaneous occlusions of ≥2 intracranial or extracranial major vessels in either bilateral anterior circulation or anterior plus posterior circulation. Patients’ baseline characteristics and outcome of MVO were analyzed. Results Of 602 patients with acute ischemic stroke (mean age, 71±13 years; male, 53.1%) who received EVT, 11 patients (1.8%) had acute MVO. The involved vessels included bilateral internal carotid arteries in 3, bilateral middle cerebral arteries in 4, vertebral artery and distal middle cerebral artery in 1, and internal carotid artery and distal posterior cerebral artery in 3 patients. Preadmission dependence (modified Rankin scale score &gt;2), higher initial stroke severity, and posterior cerebral artery occlusion were more frequently found in MVO. The cause of MVO included large vessel atherosclerosis in 4, cardioembolic in 4, cancer‐related hypercoagulability in 2, and postpartum in 1 patient. Several patients had received simultaneous multitargeted EVT, but only 4 of them achieved optimal reperfusion in both vessels. Compared with patients without MVO, those with MVO had higher mortality (adjusted odds ratio, 6.75; 95% CI, 1.93–23.6) and poor functional outcome (common odds ratio for 1‐point improvement at modified Rankin scale, 0.14, 95% CI, 0.05–0.45) at 90 days. Conclusion Acute simultaneous MVO in patients who underwent EVT is a rare yet devastating condition. Multitarget mechanical thrombectomy to achieve reperfusion is challenging but still possible.

Intracranial Flow Volume Estimation in Patients with Internal Carotid Artery Occlusion.

(1) Background: Carotid artery occlusion (CAO) in population studies has a reported prevalence of about 6 per 100,000 people; however, the data may be underestimated. CAO carries a significant risk of stroke. Up to 15% of large artery infractions may be secondary to the CAO, and in 27–38% of patients, ischaemic stroke is a first presentation of the disease. The presence of sufficient and well-developed collateral circulation has a protective influence, being a good prognostic factor in patients with carotid artery disease, both chronic and acute. Understanding the mechanisms and role of collateral circulation may be very important in the risk stratification of such patients. (2) Materials and Methods: This study included 46 patients (mean age: 70.5 ± 6 years old; 15 female, mean age 68.5 ± 3.8 years old and 31 male, mean age 71.5 ± 6.7 years old) with unilateral or bilateral ICA occlusion. In all patients, a Doppler ultrasound (DUS) examination, measuring blood flow volume in the internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA), was performed. The cerebral blood flow (CBF) was compared to the previously reported CBF values in the healthy population >65 years old. (3) Results: In comparison with CBF values in the healthy population, three subgroups with CBF changes were identified among patients with ICA occlusion: patients with significant volumetric flow compensation (CBF higher than average + standard deviation for healthy population of the same age), patients with flow similar to the healthy population (average ± standard deviation), and patients without compensation (CBF lower than the average-standard deviation for healthy population). The percentage of patients with significant volumetric flow compensation tend to rise with increasing age, while a simultaneous decline was observed in the group without compensation. The percentage of patients with flow similar to the healthy population remained relatively unchanged. ICA played the most important role in volumetric flow compensation in patients with CAO; however, the relative increase in flow in the ICA was smaller than that in the ECA and VA. Compensatory increased flow was observed in about 50% of all patent extracranial arteries and was more frequently observed in ipsilateral vessels than in contralateral ones, in both the ECA and the VA. In patients with CAO, there was no decrease in CBF, ICA, ECA, and VA flow volume with increasing age. (4) Conclusions: Volumetric flow compensation may play an important predictive role in patients with CAO.

Ischemic Stroke with Multiple Cerebral Artery Stenosis in a Patient with an Anaplastic Astrocytoma during Bevacizumab Treatment: A Case Report

It has been reported that bevacizumab, an agent administered as an adjuvant therapy for high-grade gliomas, causes thromboembolic complications. We report a cerebral infarction with newly developed cerebral artery stenosis occurring during treatment with bevacizumab for an anaplastic astrocytoma. A 48-year-old female underwent excision surgery for an anaplastic astrocytoma on the right temporal lobe and received radiation therapy and chemotherapy with temozolomide. Twenty months after the maintenance therapy, treatment with bevacizumab was introduced for tumor recurrence. After the 14th course of bevacizumab at 6 months, 27 months after radiation therapy, the patient began experiencing mild right hemiparesis. Magnetic resonance imaging revealed scattered cerebral infarcts on the left frontal lobe and diffuse cerebral artery stenosis of the bilateral internal carotid artery system both inside and outside the radiation-treated area. Antiplatelet medication was commenced, and there was no recurrence of ischemic stroke. The morphological transition of the cerebral arteries should be carefully monitored via magnetic resonance angiography during post-radiation treatment with bevacizumab.

Carotid Intima-media Thickness/Diameter Ratio and Peak Systolic Velocity as Risk Factors for Neurological Severe Ischemic Events in Takayasu Arteritis

To characterize Takayasu arteritis (TA) with supra-aortic involvement and determine the associations between clinical features, carotid ultrasonographic (US) variables, and neurological severe ischemic events (SIEs). Patients with supra-aortic involvement including brachiocephalic trunk, bilateral common carotid artery and internal carotid artery, and bilateral subclavian and vertebral artery and baseline carotid US examination were enrolled from the East China TA cohort. Bilateral carotid diameter, intima-media thickness (IMT), and peak systolic velocity (PSV) were measured by US. Then, the IMT/diameter ratio (IDR) was calculated. Risk factors associated with neurological SIEs were analyzed by multivariate logistic regression. In total, 295 patients were included, of whom 260 (88.14%) were female, and 93 (31.53%) experienced neurological SIEs. Involved supra-aortic artery distribution (P = 0.04) and number (P < 0.01) differed between subjects with neurologic and nonneurologic SIEs, showing higher prevalence of common carotid and vertebral artery involvement after Bonferroni correction and 56.99% patients having ≥ 4 involved arteries in the neurological SIE group. The bilateral IDR (P < 0.01) differed between patients with and without neurological SIEs. The carotid IDR (left: cut-off value ≥ 0.55, OR 2.75, 95% CI 1.24-6.07, P = 0.01; right: ≥ 0.58, OR 2.70, 95% CI 1.21-6.02, P = 0.01) and left carotid PSV (≤ 76.00 cm/s, OR 3.09, 95% CI 1.53-6.27, P < 0.01), as well as involved supra-aortic artery number (≥ 4, OR 2.33, 95% CI 1.15-4.72, P = 0.02) were independently associated with neurological SIEs. The carotid IDR and PSV might be performed as valuable markers for recognizing neurological SIEs in patients with TA with supra-aortic lesions.

CT-based morphological and hemodynamics analysis for rupture risk of mirror intracranial aneurysm

Objective: To compare the morphological and hemodynamic features of mirror intracranial aneurysms (MIAs) on CT angiography (CTA), and to elucidate the rupture risk factors of MIAs. Methods: This study retrospectively collected 29 patients with 58 digital subtraction angiography (DSA) or surgically confirmed MIAs from January 2010 to December 2016 in Jinling Hospital, Medical School of Nanjing University. Among them, there are 6 males and 23 females, aged from 40 to 83 (61±11) years old. Based on the results of hemorrhagic manifestation, 58 MIAs were divided as the ruptured (n=29) group and unruptured group (n=29). In addition, according to the location of aneurysms, they were further divided into the subgroup of posterior communicating MIAs (n=32) and non-posterior communicating MIAs (n=26). Clinical data of the patients and the morphological parameters of the MIAs were collected. Computational fluid dynamics (CFD) analysis was performed to obtain hemodynamic parameters, such as pressure (P), wall shear stress (WSS), wall shear stress gradient (WSSG), and oscillatory shear index (OSI). The coefficient of variation (CV) was used to describe the aforementioned hemodynamic parameters of intracranial aneurysms, so the index after CV adjustment is expressed as PCV , WSSCV , WSSGCV , OSICV . Characteristics between ruptured and unruptured groups were compared. Conditional logistic regression analysis was conducted to evaluate the rupture risk factors of MIAs. Results: Among the 29 pairs of mirror aneurysms, 16 pairs were distributed in bilateral posterior communicating arteries (55%), 9 pairs distributed in bilateral middle cerebral arteries (31%), and 4 pairs distributed in bilateral internal carotid arteries (14%). Compared with the unruptured MIAs group, the ruptured aneurysms group usually had a larger maximum diameter, neck width, and size ratio (SR) [4.98 (3.18, 6.79) mm vs 3.20 (2.10, 4.31) mm, 4.19 (3.46, 5.95) mm vs 4.05 (3.23, 5.02) mm, 1.69 (0.81, 2.28) vs 0.96 (0.67, 1.49)] (all P<0.05). In the subgroup hemodynamic analysis of MIAs, the ruptured aneurysms had higher WSSCV and WSSGCV than the contralateral unruptured ones [1.00(0.87, 1.21) vs 0.65(0.57, 0.87), 1.09(0.56, 1.90) vs 0.57(0.50, 1.13), 1.52 (1.34, 1.80) vs 1.21 (1.07, 1.38), 1.52±0.46 vs 1.21±0.23] (all P<0.05), while the PCV was lower than the contralateral unruptured ones [0.004 (0.002, 0.008) vs 0.010 (0.006, 0.013), 0.003 (0.002, 0.011) vs 0.009 (0.002, 0.066)] (both P<0.05). Logistic regression analysis showed that high WSSGCV was an independent risk factor for MIAs rupture (OR=279.20(95%CI:1.10-71 028.28)). Conclusion: The maximum diameter, neck width, and SR were considered as a reliable morphological parameters to distinguish the ruptured status of MIAs, higher WSSGCV in the aneurysm sac are highly correlated with MIAs rupture.

Newborn with a Large Intracranial Mass.

Newborn with a Large Intracranial Mass.

Carotid Artery Stenosis and Ischemic Strokes in Patients with Giant Cell Arteritis: A Characteristic Pattern-Literature Review and Case Report.

Purpose Ischemic stroke is a relatively rare complication of giant cell arteritis often accompanied by vessel stenosis. Our purpose was to compare the location of internal carotid artery stenosis in GCA patients by performing a literature review suggesting a specific and characteristic pattern. Methods We performed a PubMed research including all articles and cited articles reporting cases and case series about giant cell arteritis patients with internal carotid artery stenosis and ischemic strokes. Results In this case series 39 cases were included. We found a clear tendency of giant cell arteritis-related stenosis to be in the intracranial segments (35/39 (89.7%)). Only in 8/39 (20.5%) patients there was further involvement of extracranial segments. Many cases (27/39 [69.2%]) showed a bilateral involvement. Discussion This literature review reveals a specific pattern of internal carotid artery involvement in patients with giant cell arteritis and ischemic strokes. To our knowledge this pattern has not been reported as a sign strongly pointing toward giant cell arteritis before. We have not found case reports mentioning other common types of vasculitis reporting this involvement pattern. Conclusion Internal carotid artery stenosis and ischemic stroke is a rare complication in patients with giant cell arteritis. Considering the characteristic features of bilateral distal internal carotid artery stenosis giant cell arteritis should be suspected which potentially leads to an early diagnosis and immunotherapy.

Bilateral Internal Carotid Artery Dissection as a Possible Complication in a patient with Covid-19 infections and coughing.

Background:Cervical carotid dissection is one of the causes of ischemic stroke in young people. Most of the patients with carotid dissection do not have connective tissue diseases (Marfan syndrome, Ehlers-Danlos syndrome). It seems that dissection may occur without an obvious cause or may follow environmental injuries like vigorous neck movements, chiropractic manipulation, emesis, severe coughs, and some infections. We present a case of bilateral carotid dissection in a patient following coronavirus infection and severe coughs.Case Presentation:A 38-year-old right-handed man presented with recurrent episodes of transient right hemiparesis and aphasia. He had a history of coronavirus infection and severe persistent, nonproductive cough 7 days before the onset of his symptoms. Carotid angiography showed tapered flame-like appearance in proximal segment of left ICA starting about 2 cm distal to the carotid bulb caused complete occlusion of left ICA and in right CCA angiography there is pseudo aneurysm in right cervical ICA just before the Petrous segment. In 3 months in follow up DSA there is evidence of complete occlusion of right pseudo aneurysm and recanalization of left ICA without stenosis.Conclusion: COVID-19 may have role in the processes that eventually led to CAD

Bilateral internal carotid artery dissection in a patient with Eagle’s syndrome

Angiología es una revista científica bimensual editada desde 1949. Está dedicada al estudio de las enfermedades vasculares, incluyendo todos los aspectos de la medicina vascular, el diagnóstico no invasivo, el tratamiento quirúrgico tradicional arterial y venoso, así como el mínimamente invasivo y/o endovascular.

Petrobasal Vein: A Previously Unrecognized Vein Directly Connecting the Superior Petrosal Sinus with the Emissary Vein of the Foramen Ovale.

The superior petrosal sinus terminates anteriorly at the cavernous sinus and posteriorly at the transverse sinus. Venous variations directly connecting the superior petrosal sinus and the emissary veins of the foramen ovale are not well-recognized. We present a connecting vein, provisionally named the petrobasal vein. Biplane cerebral angiography of the bilateral internal carotid arteries and the vertebral artery acquired in 267 patients was retrospectively reviewed by 2 neuroradiologists with special interest in the existence and course of the petrobasal vein. The petrobasal vein was observed to lie anterior-posteriorly on the superior surface of the petrosal bone and connected to the midportion of the superior petrosal sinus and the emissary veins of the foramen ovale in 41 patients (15%) and sides (7.9%); it drained into the pterygoid plexus. The petrobasal vein was observed on VAG in 21 patients, on ICAG alone in 8 patients (9 sides), on both VAG and ICAG in 12 patients, and on ICAG in 1 patient. In the patients in whom the petrobasal vein was visualized on the ICAs, the superficial middle cerebral vein drained into a combination of the pterygoid plexus via the emissary veins of the foramen ovale and the superior petrosal sinus. The petrobasal vein, an unknown vein directly connecting the superior petrosal sinus and the emissary veins of the foramen ovale and draining into the pterygoid plexus, can occasionally be identified on cerebral angiography as a variant drainage route from the cerebellum and brainstem veins and/or from the superficial middle cerebral vein. The petrobasal vein is thought to be a remnant of the primitive tentorial sinus.