Carotid Stenosis Research Articles

The imaging presentation of head and neck oncologic emergencies

This review describes the radiographic findings in emergencies of head and neck cancers (HNCs) in both undiagnosed and previously treated patients, with an emphasis on the temporal urgency of each presentation and in association with the relevant clinical presentation and necessary treatments to enhance understanding and recognition. The various presentations of HNC will be described by the organ system of their presenting complaint. The development and complications of each will be elaborated, with a focus on the clinical presentation in the emergency department and the imaging findings that are critical to recognize in making the diagnosis. Each presentation will be exhibited with a specific patient case and the exact computed tomography, magnetic resonance imaging, ultrasound, or digital subtraction angiography images obtained will be shown. Cases include airway obstruction due to glottic tumor or metastatic cervical lymphadenopathy; airway obstruction due to surgical complications of hematoma, or post-radiation soft-tissue edema; vascular complications of tumor or nodal compression, carotid blowout, carotid stenosis, or occlusion; orbital complications of compartment syndrome; and orthopedic complications of osteomyelitis and osteoradionecrosis. Eleven HNC patient cases are presented with their associated 32 images. HNC patients present with challenging imaging features in the emergent setting. Difficulty in discerning the correct diagnosis arises from the complex head and neck anatomy, often compounded by an advanced stage at presentation and poor functional status. Radiologist familiarity with common HNC emergent presentations is essential for accurate diagnosis and timely treatment.

Surgical outcomes of subclavian steal syndrome combined with carotid artery stenosis: A single-center retrospective observational study.

To explore the prevalence and risk factors of carotid artery (CA) stenosis among subclavian steal syndrome (SSS) patients and to record their prognoses. This observational study was retrospective. From January 2015 to October 2022, 169 patients were diagnosed with SSS. Among them, 51 combined with CA stenosis have surgical indications for both diseases. In this cohort, 24 were treated for subclavian artery (23 endovascular, 1 open), 12 for CA (6 endovascular, 6 open), and 5 for both (1 endovascular, 1 open, 3 hybrid). The primary end point was mortality, and the secondary end points were vessel re-stenosis and other complications. Patients were followed up through outpatient, online, or telephone. Compared with simple SSS, patients who suffered from both were older (60.51 ± 9.304 versus 66.69 ± 7.921, P < 0.001) and more males (57.6% versus 86.3%, P < .001). Besides, they presented a higher prevalence of hyperhomocysteinemia (P = .015), diabetes mellitus (P = .036), and CVA/TIA (P = .036). No patient died within 30 days after surgery; four complications occurred (1 stroke, 1 hearing loss, 1 TIA, 1 infection). During a median follow-up of 37.6 months, two patients died without relation to the operation, three appeared in-stent restenosis, and one developed contrast nephropathy. This study observed and analyzed different intervention methods and their prognosis in SSS combined with CA stenosis patients, and due to the limited number of participants, more data support would be needed. The management of SSS patients combined with CA stenosis is more challenging compared to simple SSS. Our research demonstrated different surgical methods and their prognosis.

Carotid Ultrasound Assessment prior to Coronary Artery Bypass Grafting – an Irish Cardiac Surgery Centre’s Experience

IntroductionCarotid stenosis is a risk factor for cerebrovascular accident(CVA) following coronary artery bypass grafting(CABG). Guidelines recommend selective pre-operative screening with Doppler US but non-selective application is commonplace. Recent data has questioned the efficacy of peri-operative carotid intervention, challenging the value of this practice. AimTo analyse the utility of carotid US assessment prior to CABG in our institution. MethodsThis was a retrospective review of all patients over 18 that underwent a non-emergency CABG in a single Irish cardiac surgery centre from January 2019 to December 2022. Results1161 subjects were included. 1084/1161(93.36%) underwent US assessment. 41/1084(3.8%) had ≥70% stenosis and 189/1084(17.5%) had ≥50% stenosis. 32/1084(2.95%) underwent confirmatory imaging and 7/1084(0.64%) underwent carotid intervention. Post-operative CVA occurred in 18/1161(1.55%) and ≥70%(p=0.024) and ≥50%(p<0.001) carotid stenosis were associated with same.Chronic kidney disease (OR=1.66,p=0.01), decreasing haemoglobin (OR=1.13,p=0.019), increasing age (OR=1.03,p=0.011) and being a current (OR=3.21,p<0.001) or ex- smoker (OR=1.82,p=0.004) were risk factors for ≥50% carotid stenosis on logistic regression. Multivessel coronary artery disease was not associated with carotid stenosis (p=0.563).Of those that underwent carotid intervention, 0/7(0%) suffered a CVA, but this protective effect failed to reach statistical significance for those with ≥70%(p=1) or ≥50%(p=1) carotid stenosis. ConclusionCarotid US screening altered the management of only a small proportion of CABG patients despite near universal application, challenging the effectiveness of this practice. Multivessel coronary artery disease was not associated with carotid stenosis despite European guidelines listing it as a screening criteria. Predictive models must be developed using identified risk factors to enable targeted pre-operative screening.

Abstract TP329: Hospital encounters in the 7 days and 30 days before first-ever stroke: An observational study using data linkage

Background/Aim: Up to 20% of people have a hospital encounter in the 30 days before a first ever stroke, suggesting opportunities for better primary prevention. The reasons for these healthcare encounters before stroke have been largely unexplored. We aimed to describe diagnoses in hospital encounters within 7 days and 30 days before a first-ever stroke. Methods: We used a statewide (Tasmania, ~500,000 population) linked dataset comprising emergency department [ED] presentations, hospital admissions and deaths in Australia from 2007-2020. An 8-year look back period was used to identify first ever strokes. ICD 10-AM codes in the principal diagnosis field were used to determine diagnoses in hospital encounters before stroke. We describe the distribution of diagnosis groups for each hospital encounters, separately for ED presentations and hospital admissions, in the 7 days and 30 days before stroke. Results: Out of 4907 first-ever stroke patients, 202 (4.12%) people had 234 hospital admissions within 7 days before stroke and 507 (10.33%) people had 724 hospital admissions within 30 days before stroke. Among 339 (7%) people, there were 351 ED presentations within the 7 days before stroke and among 676 (13.78%) people, there were 765 ED presentations in the 30 days before stroke. In event-level analyses, the most common diagnoses for hospital admissions were dialysis, diseases of circulatory system (e.g. carotid artery stenosis and unruptured cerebral aneurysm), abnormal symptoms or pathological findings (e.g. convulsions and headache), nervous system disorders (e.g. migraine) and respiratory diseases (Table 1). The most common diagnoses for ED presentations were circulatory system disorders, abnormal pathological findings and nervous system disorders in the 7 days and 30 days before stroke. Conclusion: Hospital encounters in the period immediately before stroke are common and associated with a broad range of health conditions. These may represent potentially high-risk groups requiring more intensive primary stroke prevention interventions.

Abstract TP219: Pathological and Clinical Findings of Calcified Nodules in Carotid Artery Stenosis

Abstract TP219: Pathological and Clinical Findings of Calcified Nodules in Carotid Artery Stenosis

Abstract TP128: Association Between Hospital Volume and Outcomes of Surgical Procedures for Carotid Stenosis in Japan

Background: Postoperative complication rates of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis are recommended to be maintained below a certain threshold. While the association between hospital volume and the complications has been reported, the situation is uncertain in Japan, one of the countries with the highest density of neuro-specialists. This study aimed to investigate the association between hospital volume and outcomes in patients who underwent CEA or CAS in Japan. Methods: We retrospectively analyzed data from the Japanese nationwide inpatient database on CEA and CAS procedures performed between 2018 and 2021. Hospitals were categorized into four quartiles based on surgical volume, ranging from highest (Q1) to lowest (Q4), with approximately equal numbers of procedures in each quartile. The association between hospital volume and moderate to severe disability (modified Rankin scale &gt; 2 at discharge), in-hospital mortality, perioperative stroke, perioperative pneumonia, and length of hospital stay (LHS) was investigated using multivariate logistic regression and other appropriate analyses. Results: The analysis included 26,675 CEA or CAS procedures performed in 681 hospitals. The overall rates of disability, mortality, perioperative stroke, and pneumonia were 7.4%, 0.5%, 6.6%, and 5.0%, respectively. The rates of disability in Q1, Q2, Q3, and Q4 quartiles were 6.0%, 7.5%, 8.5%, and 7.4%, respectively (Table 1). After adjusting for covariates, Q3 and Q4 were associated with a higher risk of disability (Q3: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.22 – 1.64, Q4: OR 1.41, 95% CI 1.00 - 1.37). Furthermore, Q2, Q3, and Q4 quartiles were associated with a higher risk of perioperative stroke (Q2: OR 1.46, 95% CI 1.26 - 1.70, Q3: OR 1.45, 95% CI 1.25 - 1.69, Q4: OR 2.04, 95% CI 1.77 – 2.36) and pneumonia (Q2: OR 2.01, 95% CI 1.68 – 2.39, Q3: OR 1.89, 95% CI 1.59 – 2.26, Q4: OR 1.79, 95% CI 1.50 – 2.14). The mortality rate was comparable among the four quartiles (Table 2). Additionally, Q2, Q3, and Q4 quartiles were associated with longer LHS. Similar results were observed in patients aged 80 and above. Conclusions: Our findings suggest an association between lower hospital volume and poorer patient outcomes following CEA or CAS. This study indicates the importance of considering surgical volume as a factor to improve outcomes of CEA and CAS in Japan.

Abstract TP220: Per-segment Evaluation of Atherosclerostic Stenosis of Intracranial Internal Carotid Artery: A hospital-based cross-sectional study

Abstract TP220: Per-segment Evaluation of Atherosclerostic Stenosis of Intracranial Internal Carotid Artery: A hospital-based cross-sectional study

Abstract WP63: Bilateral carotid artery stenosis causes synaptic changes in the retina of aged mice

Abstract WP63: Bilateral carotid artery stenosis causes synaptic changes in the retina of aged mice

Impact of perioperative cerebral blood flow evaluation using arterial spin labeling in a patient undergoing carotid artery stenting.

Hyperperfusion syndrome (HPS) is one of the most serious complications after carotid artery stenting (CAS). Arterial spin labeling (ASL) is a noninvasive method for assessing cerebral perfusion. This study aimed to evaluate the utility of ASL compared to that of SPECT in evaluating changes in intracranial blood flow during the perioperative period of CAS. We retrospectively reviewed prospectively collected data from 49 cases of CAS conducted for symptomatic and asymptomatic carotid artery stenosis. We calculated the relative cerebral blood flow (rCBF) from ASL (post labeling delay [PLD] of 1500ms and 2500ms) and SPECT, both pre- and post-CAS. Cerebrovascular reactivity (CVR) was assessed using SPECT with an acetazolamide challenge. We defined the change rate from PLD 1500ms to 2500ms before CAS as ΔrASL. Hyperperfusion phenomenon was observed in four cases (8.2%), with one case (2.0%) resulting in cerebral hemorrhage and diagnosed as HPS. Positive correlations were noted between ASL and SPECT at both pre- and post-CAS (r=0.42-0.65, p<0.01). A negative correlation was found between ΔrASL obtained from the two PLDs before CAS and CVR (r=-0.41, p<0.01). ASL using two PLDs is a useful method for evaluating changes in CBF during the perioperative period of CAS.

Abstract TP29: Cognitive Impairment in Patients with Comorbid Carotid Stenosis and Cardiac Disease

Abstract TP29: Cognitive Impairment in Patients with Comorbid Carotid Stenosis and Cardiac Disease

Abstract TP318: Comparison of Lipid-Lowering Therapies Regimens and LDL-C Profiles in Patients with Asymptomatic versus Acute Symptomatic Atherosclerotic Carotid Stenosis

Abstract TP318: Comparison of Lipid-Lowering Therapies Regimens and LDL-C Profiles in Patients with Asymptomatic versus Acute Symptomatic Atherosclerotic Carotid Stenosis

Abstract TP349: Deleted NLRP3 inflammasome improves functional outcome and improves cerebral blood flow in an experimental model of Vascular Cognitive Impairment and Dementia

Background: Inflammation, a key player in both acute and chronic cerebral ischemia, is activated in brain tissues by bilateral carotid stenosis (BCAS)- induced chronic cerebral hypoperfusion. Our study aimed to investigate whether the deletion of the NLRP3inflammasome could abolish the deleterious effects of BCAS-induced chronic hypoperfusion in an experimental model of VCID. Methods: Microcoil-induced BCAS was used to induce chronic hypoperfusion. Middle-young (8-10 mice per group,4-5 months old, male) NLRP3WT and NLRP3KO were randomly assigned to BCAS-induced chronic hypoperfusion for four weeks. Cerebral blood flow was measured by laser speckle contrast imaging (LCSI) and CBF-ASL perfusion by MRI, and novel object recognition (NOR) and wire-hanging tests were also measured. Biochemical and histopathological staining was also assessed on the brain tissues. Results: At four weeks, there was a significant increase in CBF by LSCI and CBF-ASL perfusion by MRI in NLRP3KO mice compared to NLRP3WT groups. More importantly, the cognitive and motor function, as measured by NOR and wire-hanging tests, showed a remarkable improvement in NLRP3KO mice compared to WT. Conclusions: The findings suggest that deletion of NLRP3 inflammasome not only mitigates the cognitive impairment and motor effects of chronic hypoperfusion but also significantly improves cerebral blood flow. This indicates that targeting the NLRP3 inflammasome may be a new therapeutic approach against VCID.

Correlation of Imaging Characteristics of Carotid Plaque with Clinical and Histopathological Features and Application of Artificial Intelligence Techniques in Identifying Carotid Disease

Introduction: Stroke is the third-leading cause of death. Carotid artery stenosis (CAS) accounts for 8%–37% of strokes. Landmark carotid trials have shown carotid endarterectomy (CEA) superior to best medical therapy (BMT) for symptomatic moderate stenosis and asymptomatic high-grade stenosis. This study aims to correlate imaging characteristics of vulnerable plaque (VP) with clinical and histopathological features and to assess the ability of artificial intelligence (AI) techniques to identify VP and disease burden using duplex ultrasound (DU) data. Materials and Methods: This prospective study from August 2022 to April 2024 used DU and computerized tomographic angiography (CTA) or magnetic resonance angiography (MRA) to assess carotid plaques in patients planned for CEA and subjected plaques to histology. We also imaged carotid plaques using DU in asymptomatic patients on BMT. YOLOv8 deep learning and U-Net AI models were used to analyze ultrasound (US) images. Results: One hundred and fiftyOne hundred and fifty patients were included in the study. Sixty (40%) were symptomatic. The age range was 33–84 years (mean 58.9). One hundred and fifteen (76.7%) were males. Hypertension, diabetes, dyslipidemia, and smoking were seen in 59%, 56%, 49%, and 40%, respectively and were more prevalent in patients with VP (90%, 60%, 70%, and 50%). Of the 70 patients who underwent CEA, 60 were symptomatic and 10 asymptomatic. 70% of symptomatic patients had a RANKIN (mRS) score of 2–3. All surgical patients underwent DU, 49 CTA, and 21 MRA. Based on the US, 53/60 (88%) symptomatic patients had VP. 56/60 (93%) were confirmed VP on histology. Positive predictive value (PPV) for VP was highest for DU (95%), followed by MRA (89%) and CTA (73%). PPV of DU screening in operated asymptomatic patients was 100%. AI showed 96% PPV for identifying &gt;50% stenosis. Model training in identifying VP accuracy increased from 0.73 to 0.94 metrics. Conclusion: DU is an excellent modality to identify the nature of carotid plaque and can be a good tool to identify VP in asymptomatic CAS. More data will improve AI accuracy.

Carotid artery stenosis and ischemic cerebrovascular events after radiotherapy in patients with head and neck cancer.

Radiotherapy is the main treatment for patients with head and neck cancer (HNC) and is associated with an increased risk of ischemic cerebrovascular events (ICVE). The purpose of this cross-sectional study was to determine the incidence of ICVE and carotid artery stenosis (CAS) in patients with HNC who receive radiotherapy and the risk factors for CAS. We enrolled 907 patients with HNC who underwent radiotherapy between February 2011 and June 2022 and obtained information on their clinical and tumor characteristics and their treatment from the clinical records. Data on risk factors for atherosclerosis, medications used, and radiotherapy were also collected. The patients were followed through to the end of 2023 unless they died or were lost to follow-up. The overall incidence of ICVE was 1.98%, with a cumulative incidence of 1.65% over 5 years. In patients who did not have a preexisting carotid artery lesion, the cumulative incidence of significant CAS was 1.3% at 12 months, 2.2% at 24 months, and 2.5% at 36 months post-radiotherapy. The most important risk factors for new CAS were age >65 years (aHR = 2.60, p = 0.008, 95% confidence Interval: 1.28-5.30), laryngeal cancer (aHR = 2.36, p<0.017, 95% confidence Interval: 1.01-5.55), and total plaque score (aHR = 1.38, p<0.001, 95% confidence Interval: 1.23-1.56). There was a significant increase in stenosis, plaque score, and wall thickness in all areas in the carotid artery (p<0.001). The incidence of ICVE and the cumulative incidence of CAS was found to be lower in the Thai population than in other populations. The main risk factors for new CAS were age >65 years, laryngeal cancer, and total plaque score. Changes in the carotid artery were detected early and affected all areas in the artery. Patients with HNC treated by radiotherapy should be assessed for risk factors for CAS and undergo vascular surveillance during follow-up.

Combined Treatment for Locally Advanced Cardioesophageal Cancer in a Comorbid Patient with Internal Carotid Artery Stenosis

Combined Treatment for Locally Advanced Cardioesophageal Cancer in a Comorbid Patient with Internal Carotid Artery Stenosis

Extracranial carotid plaque calcification and its association with risk factors for cerebrovascular events: insights from the ANTIQUE study

IntroductionExtracranial carotid calcification is a common marker of advanced atherosclerosis. However, its impact on stroke risk is not consistent across studies, and examining the type of calcification and the presence of systemic diseases might be helpful. We aimed to investigate extracranial carotid calcification and its association with risk factors for ischemic cerebrovascular diseases.Materials and methodsAmong 1,863 consecutive patients in the Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the Carotid Bifurcation Plaque Study (ANTIQUE), 132 symptomatic or asymptomatic patients (177 carotid plaques) with &amp;gt;30% carotid stenosis examined through computed tomography (CT) and magnetic resonance imaging (MRI) were included. Statistical data were assessed using the χ2-test, Fisher’s exact test, t-test, and Mann–Whitney test to investigate the calcification risk factors.ResultsCompared to the absence of calcifications, spotty calcifications were associated with male sex [odds ratio (OR): 3.72, 95% confidence interval (CI): 1.06–13.05], while large calcifications were associated with older patients (OR: 1.60 per 5 years of age, 95% CI: 1.20–2.13). Large calcifications were also strongly associated with coronary heart disease (OR: 4.07, 95% CI: 1.15–14.44) and atrial fibrillation (p = 0.025). In comparison between only spotty and large calcifications, spotty calcifications were associated with male sex (OR: 3.72, 95% CI: 1.06–13.05), smoking (p = 0.020) in more significant quantities (p = 0.014), and lipid plaque (p &amp;lt; 0.001), while large calcifications with contralateral stenosis degree (p = 0.044). No significant relationship was found between cerebrovascular events and the type of calcification.ConclusionAlthough the presence and type of extracranial carotid calcification were not related to ipsilateral ischemic events, large calcifications were strongly associated with coronary heart disease and atrial fibrillation.Clinical trial registrationClinicalTrials.gov, identifier NCT02360137.

Association of familial ATTR amyloidosis and hyperlipoprotein(a)emia in a patient with spinal stenosis. A case report

Introduction: Transthyretin (ATTR) amyloidosis is a rare disease with cardiac involvement, peripheral nervous system involvement, and spinal stenosis. Elevated plasma lipoprotein(a) (Lpa) levels are recognized as a significant risk factor for atherosclerotic cardiovascular and cerebrovascular diseases. Currently, information on the relationship between ATTR amyloidosis and Lpa is very limited. Clinical case: A female patient had suffered from arterial hypertension with an increase in blood pressure (BP) to 150/90 mmHg for 5 years since the age of 45. After suffering from the new coronavirus infection COVID-19 from 02.06 to 25.06.2021, patient began to notice an increase in blood pressure to 290/150 mm Hg, stabbing pains in the left half of the chest lasting up to 20-30 minutes without any connection with physical activity, which are relieved after taking Corvalol, pain in the cervical and thoracic spine. Due to antihypertensive therapy, stabilization of blood pressure at 110/70 mm Hg was noted. Further examination revealed dyslipidemia (low-density lipoprotein cholesterol 4.53 mmol/l), atherosclerosis of the extracranial parts of the brachiocephalic arteries with stenosis of the right internal carotid artery up to 20%, hyperlipoprotein(a)emia 1.46 g/l (normal up to 0.5 g/l). Echocardiography revealed left ventricular wall thickening and preserved ejection fraction, thickening of the interatrial septum, mitral valve cusps. MRI of the spine revealed stenosis of the spinal canal at the level of C5-6 - the "red flag" of amyloidosis. Genetic testing revealed a variant of the nucleotide sequence of the transthyretin gene (Chr18: 29171879 GA, p.Arg5His) in a heterozygous state in the patient and her blood relatives. The issue of specific antiamyloid therapy with tafamidis was considered, lipid-lowering therapy was prescribed. Conclusion. In patients with spinal canal stenosis syndrome and left ventricular wall thickening, even in the presence of arterial hypertension, a comprehensive examination is necessary for timely diagnosis and adequate therapy of amyloid cardiomyopathy. The combination of familial ATTR amyloidosis and familial hyperlipoprotein(a)emia has been described for the first time.

Novel Fusion Imaging of Muscle, Plaque, Arteries, and Bone Using MR Imaging for Carotid Endarterectomy Patients.

Indications for carotid endarterectomy (CEA) and reduction of complications require evaluation of the plaque properties and location of the distal end of the plaque. High cervical location can be predicted from the anatomy of the vertebral body and mandibular bones, and the locations of the posterior belly of the digastric muscle and stylohyoid muscle. Magnetic resonance (MR) imaging without contrast medium is useful for preoperative evaluation of the plaque, arteries, and bone characterization. However, no method for simultaneous evaluation of the muscle, plaque, arteries, and bone using MR imaging has been established. Five patients with moderate or higher carotid artery stenosis underwent CEA in our institute. Noncontrast MR imaging/MR angiography and computed tomography (CT) angiography were performed before surgery in all cases. The fusion images of the muscle, plaque, arteries, and bone (M-PAB image) acquired from MR imaging/MR angiography, CT angiography, and the intraoperative view were compared. M-PAB image, CT angiography, and intraoperative view were acquired in all cases with no obvious differences. M-PAB imaging using MR imaging without contrast medium is useful for preoperative evaluation of CEA. This method does not require contrast agents and avoids radiation exposure.

Ide Copy Number Variant Does Not Influence Stroke Severity in 2 C57BL/6J Mouse Models nor in Humans: An Exploratory Study.

Contrary to the common belief, the most commonly used laboratory C57BL/6J mouse inbred strain presents a distinctive genetic and phenotypic variability, and for several traits, the genotype-phenotype link remains still unknown. Recently, we characterized the most important stroke survival factor such as brain collateral plasticity in 2 brain ischemia C57BL/6J mouse models (bilateral common carotid artery stenosis and middle cerebral artery occlusion) and observed a Mendelian-like fashion of inheritance of the posterior communicating artery (PcomA) patency. Interestingly, a copy number variant (CNV) spanning Ide locus was reported to segregate in an analogous Mendelian-like pattern in the C57BL/6J colonies of the Jackson Laboratory. Given IDE critical role in vascular plasticity, we hypothesized Ide CNV may have explained PcomA variability in C57BL/6J inbred mice. We applied a combination of techniques (T2-weighted magnetic resonance imaging, time-of-flight angiography, cerebral blood flow imaging, and histology) to characterize the collaterome in 77 C57BL/6J bilateral common carotid artery stenosis, middle cerebral artery occlusion, naive, and sham mice and performed on these Taqman genotyping, exome sequencing, and RNA sequencing. We then investigated the hypothesis that IDE structural variants (CNVs, gain/loss of function mutations) may have influenced the cerebrovascular phenotype in a large cohort of 454 040 cases and controls (UK Biobank, Genomics England). We detected an Ide CNV in a bilateral common carotid artery stenosis mouse with 2 patent PcomAs (minor allele frequency, 1.3%), not segregating with the PcomA patency phenotype. In addition, 2 heterozygous IDE CNVs, resulting in loss of function were found in 1 patient with hereditary ataxia, a patient with hereditary congenital heart disease, and 2 healthy individuals (minor allele frequency 9×10-6). Moreover, we report 4 IDE loss of function point mutations (p.Leu5X, p.Met394ValfsX29, p.Pro14SerfsX26, p.Leu889X, minor allele frequency 0.02%) present also in controls or inherited from healthy parents. Ide CNV and loss of function variants are rare, do not crucially influence PcomA variability in C57BL/6J inbred mice, and do not cause a vascular phenotype in humans.

Multimodal monitoring in carotid endarterectomy

Patients with carotid artery stenosis have high risk of ischemic stroke. Carotid endarterectomy is the method of choice for ischemic stroke prevention in patients with symptomatic and asymptomatic carotid artery stenosis. Such stages of carotid endarterectomy as selection, artery clamping, and placement of a temporary intraluminal shunt can be accompanied by ischemic complications due to embolism and insufficient collateral blood flow. Multimodal intraoperative neurophysiological monitoring consisting of cerebral oximetry, somatosensory and motor evoked potentials monitoring,electroencephalography, and transcranial Doppler ultrasound allows to perform direct and indirect monitoring of cerebral perfusion during the whole surgery and can be used for prediction of surgical outcomes. Multimodal approach to intraoperative neurophysiological monitoring is the most sensitive and specific approach for predicting and minimizing postoperative neurologic deficit.