Carotid Arteriography Research Articles

Risk of Diabetes Mellitus in Carotid Artery Involvement Among Coronary Artery Disease Patients Including History of Infection and Antibiotics Uses

Background: Diabetes mellitus causes involvement of coronary artery diseases. Objective: The purpose of the present study was to determine the risk of diabetes mellitus in the involvement of carotid artery among coronary artery disease patients. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2015 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75 gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. The mean height of the DM was 163.4±8.5 cm and in NDM was 160.6±7.1 cm, mean weight of DM 63.5±7.2 kg, in NDM was 62.0±15.4 kg and mean BMI in DM was 26.24±2.36 kg/m2 and in NDM was 26.38±2.05 kg/m2. The mean total cholesterol in DM was 236.9±34.1 mg/dL and in NDM was 208.0±36.4 mg/dL, mean serum TG in DM 240.5±76.3 mg/dl and in NDM was 207.6±57.8 mg/dl and mean serum IDL in DM was 166.1±130.6 mg/dL and in NDM was 142.8±30.4 mg/dL, no significant mean difference was observed between DM and NDM in height, weight and BMI (P>0.05). Concussion: In conclusion, significant mean difference is observed between DM and NDM in total cholesterol, serum triglycerides. Bangladesh Journal of Medical Microbiology, July 2023;17 (2):82-87

Characteristics of Carotid Artery among Ischemic Heart Disease Patients with or without Diabetes Mellitus

Background: Involvement of coronary artery can vary among the ischemic heart disease patients with or without diabetes mellitus. Objective: The purpose of the present study was to assess the characteristics of carotid artery among ischemic heart disease patients with or without diabetes mellitus. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study was carried out from July 2003 to June 2005 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. Morphological character of the lesion was also assessed. The mean age was found 57.48 years with 6.04 standard deviation (SD) in DM and 55.64 years with 6.34 standard deviation in NDM group and also 56.56 years with 6.49 standard deviation in the whole study population. The value of unpaired t-test was 0.158 and it was insignificant (p>0.05). The common site of lesion was bifurcation, internal carotid, common carotid and external carotid artery which were 13 cases, 9 cases, 4 cases and 1 case respectively. The individual vessel involvement was 9(18.0%) cases in right, 6(12.0%) cases in left, and 3(6.0%) cases in both in DM group whereas 5 (10.0%) cases in right, 3(6.0%) cases in left, and 1(2.0%) case in both in NDM group. It observed that out of 100 study subjects 10 had complex carotid lesion in DM and 4 in NDM. Concussion: In conclusion the common site of lesion was bifurcation and internal carotid artery mostly in right side. Journal of Current and Advance Medical Research, January 2023;10(1):7-12

The characteristics of carotid body tumors in high-altitude region: Analysis from a single center

Though carotid body tumors are rare, increasing attentions have been given because of malignant transformation and high surgical risk. However, at present, the characteristics and etiology still remain unclear. Our study was designed to describe the clinical features of carotid body tumors in our institution and to compare the results with previous reports. We retrospectively reviewed carotid body tumor patients diagnosed in our institution from January 2015 to May 2020. The demographics, comorbidities, lesion location, anatomic characteristics, complications, and postoperative outcomes were evaluated. Carotid body tumor measurements were determined from computed tomography, magnetic resonance imaging, and carotid arteriography examination. We described and compared the clinical features of carotid body tumors in our institution and other reports. We totally identified 122 carotid body tumor cases for the present analysis. The mean age was 50.26 years, with the majority being female (82%). The commonest presentation was a painless neck mass (68%). For the distribution of nationality, most patients were the Han nationality (69.7%). The mean altitude of habitat of patients was 2689.4 km; 19.7% patients suffered bilateral lesions. The main blood supply of carotid body tumors was from external carotid artery (54.1%). For patients who received operation, 11 (11.2%) patients experienced cranial nerve injury. The maximal diameter of tumors was 3.99 ± 1.98 cm in male and 3.38 ± 1.36 cm in female. The volume of tumors was 31.49 ± 29.76 cm3 in male and 15.27 ± 13.06 cm3 in female. The distance to base of skull of tumors was 3.39 ± 1.07 cm (3.99 ± 1.98 cm in male vs 3.38 ± 1.36 cm, P < 0.05). Two patients (2.04%) were identified as having malignant carotid body tumor. Though carotid body tumor had a low morbidity and multitudinous clinicopathologic features, it was apt to middle-aged women and the main blood supply was from external carotid artery. The painless neck mass was the commonest presentation of carotid body tumors. There were significant difference between male and female patients regarding platelet, hemoglobin, distance to base of skull, tumor volume, altitude of habitat, carotid body tumor location, and hypertension.

Retinal arterial occlusion with multiple retinal emboli and carotid artery occlusion disease. Haemodynamic changes and pathways of embolism

ObjectiveTo introduce a special subgroup, retinal artery occlusion (RAO) with multiple emboli, which is highly associated with ipsilateral carotid artery occlusion disease (CAOD).Methods and analysisThis is a cohort study. Cases...

Visual Outcome of Carotid Endarterectomy in Patients with Carotid Artery Stenosis

Carotid endarterectomy (CEA) is deemed to restore the blood flow of the carotid and ophthalmic arteries in patients with carotid artery stenosis. However, specific changes in visual function before and after CEA are not well understood; hence, this observational study aimed to investigate the functional and structural changes in vision after CEA in those patients. Patients with severe carotid artery stenosis (>70% with standard carotid duplex scanning or arteriography) scheduled to undergo CEA were consecutively recruited for the study between September 2015 and July 2016. All patients underwent a standardized ophthalmic examination, including intraocular pressure (IOP) measurement, slit-lamp examination, and fundus examination. Visual acuity, best corrected visual acuity (BCVA), and kinetic and static visual fields (VFs) were tested to evaluate subjective visual function. Flash and pattern visual evoked potentials (VEPs) and an electroretinogram (ERG) were measured for objective visual function. Retinal nerve fiber layer (RNFL) thickness was scanned using optical coherence tomography for structural evaluation. The study involved 15 patients (11 male and 4 female, corresponding to 30 eyes; mean age 62.8±5.0years). After CEA, both uncorrected visual acuity and BCVA improved, and IOP significantly decreased from 17.41±2.59 to 15.95±2.50mm Hg (P=0.0022). Kinetic VF range increased significantly (P=0.0126) as did mean sensitivity from 18.8±5.5 to 20.6±4.3dB(P=0.0208), whereas mean defect decreased from 8.2±5.3 to 6.5±4.2dB(P=0.025). RNFL thickness was not significantly altered. Latency of the P2 wave on flash VEP reduced significantly after CEA (P=0.0151), whereas the oscillatory potential amplitude of waveform 3 in the ERG significantly increased after CEA. Our results demonstrate that an improvement in carotid artery and ophthalmic artery blood flow after CEA does indeed enhance subjective and objective assessments of visual function in patients with carotid artery stenosis, including visual acuity, kinetic and static VF, P2 latency, and ocular pressure amplitude; however, it did not affect RNFL thickness.

Abstract WP136: Twisted Carotid Bifurcation is the Right Side Dominant Phenomenon Even in the Impartial Population

Background: The internal carotid artery (ICA) runs usually posterolateral to the external carotid artery (ECA) at their bifurcation. But some ICA is positioned medially to the ECA, so called twisted carotid bifurcation (TCB). Some reports have shown TCB to be more likely to occur on the right side in the patients with internal carotid stenosis (ICS), but the reason is not established. We evaluate the frequency of TCB sides. Methods: From January 2013 to the present, 584 consecutive patients (mean age, 65.2±11.5) who underwent cerebral angiography were reviewed. We evaluate their common carotid arteriography in the anteroposterior view. We defined the term TCB as the center of the ICA locates medially to the center of the ECA. Result: We evaluated a total number of 742 sides of the carotid bifurcation, and the TCB was found in 62 sides (8.4%). Among the 62 sides, 54 were on the right side (87%) and eight were on the left side (13%). The mean age of the TCB group was 72.0±9.0, while the non TCB group was 65.2±11.5. Male vs female sides were 25 vs 37 in the TCB group, and 350 vs 330 in the non TCB group. There were 43 sides of patients with hypertension in the TCB group (69.3%), while 301 sides in the non TCB group (44.3%). Discussion: TCB not only sometimes brings difficulty in performing carotid endarterectomy (CEA), but also may lead various symptoms. There are some reports which reveal the TCB has right side dominancy. However, most of those reports targeted patients with ICS, and have small cases. Our study showed TCB tend to occur on the right side, even in the more impartial population. There were no significant differences between the TCB group and the non TCB group in the demographic characteristics such as hypertension (p value = 0.48), male to female gender ratio (p value = 0.087), except for the mean age (p value = 0.027). Although some insist that the TCB is a congenital abnormality, our study showed TCB is related to age. Conclusion: The TCB is a right side dominant phenomenon, not only in the ICS patients, but also in the more impartial population. Further evaluation such as hemodynamics or investigating more demographic characteristics will be of our interest in the future to assume the basis of dominancy.

Histopathological features of middle cerebral artery and superficial temporal artery from patients with moyamoya disease and enlightenments on clinical treatment.

The histopathological features of the middle cerebral artery (MCA) and superficial temporal artery (STA) from moyamoya disease (MMD) and their relationships with gender, age, angiography stage were explored. The causes and the clinical significance of vasculopathy of STA were also discussed. The clinical data and specimens of MCA and STA from 30 MMD patients were collected. Twelve samples of MCA and STA from non-MMD patients served as control group. Histopathological examination was then performed by measuring the thickness of intima and media, and statistical analysis was conducted. The MCA and STA specimens from MMD group had apparently thicker intima and thinner media than those from the control group. There was no significant pathological difference between the hemorrhage group and non-hemorrhage group, and between the males and females in MMD patients. Neither the age nor the digital subtraction angiography (DSA) stage was correlated with the thickness of intima in MCA and STA. MMD is a systemic vascular disease involving both intracranial and extracranial vessels. Preoperative external carotid arteriography, especially super-selective arteriography of the STA, benefits the selection of donor vessel.

Novel classification of the posterior auricular artery based on angiographical appearance.

PurposeTo investigate the length variation of the posterior auricular artery and propose a novel classification of the posterior auricular artery based on angiographical appearance.Patients and MethodsA series of 234 consecutive patients who had undergone conventional cerebral angiography was analyzed. The posterior auricular artery was examined on the lateral projection of the external carotid or common carotid arteriography. The posterior auricular artery was classified into four groups by length, using the external auditory canal and the top of the helix as radiographical landmarks. Our proposed classification is as follows: Type A, posterior auricular artery terminates between its origin and the center of the external auditory canal; Type B, posterior auricular artery terminates between the center of the external auditory canal and the top of the helix; Type C, posterior auricular artery terminates between the top of the helix and the vertex; and Type D, posterior auricular artery reaches up to the vertex.ResultsA total of 424 (right, 214; left, 210) posterior auricular arteries were analyzed in 111 men and 123 women aged 11 to 91 years (mean, 61.0 years) examined for aneurysms in 78 cases, occlusive vascular diseases in 56, intracranial hemorrhages in 41, tumors in 35, and others in 24. Types A, B, C, and D were found in 15.1%, 34.9%, 48.8%, and 1.2% of the patients, respectively.ConclusionA novel classification of the posterior auricular artery identifies four types based on its length on cerebral angiography.

Dealing with a challenging carotid body tumor

A 30-year-old woman presented with a painless swelling in her right neck for 1 year. On physical examination, a large pulsatile and nontender mass (w15 10 cm in size) was present in the right anterolateral neck region. Selective carotid arteriography and computed tomography angiography confirmed an intensely enhancing mass at the bifurcation of the internal (ICA) and external carotid arteries (ECA), extending from the base of the skull and almost reaching the clavicle bone (A). The lesion encased the ICA, ECA, common carotid artery (CCA), and the regional nerves, although no symptoms of cranial neuropathy were detected. A temporary balloon occlusion test showed open collateral vessels through the anterior communicans artery. The operation was undertaken by a team of vascular surgeons and otolaryngologists. A 25-cm-long, S-shaped incision was made along the posterior border of the sternocleidomastoid muscle. We removed the mastoid and styloid processes to facilitate adequate skull base exposure. A large, hypervascular tumor (15 10 cm) was visualized extending from the level of the sternoclavicular joint to the base of the skull. As expected, the ICA and CCA were wholly enclosed in the tumor. The vascular walls were infiltrated without a dissection plane between the tumor and the vessel adventitia (white line of Gordon-Taylor). An autologous saphenous vein graft was indicated. After we obtained control of the petrous carotid artery and proximal CCA with vessel loops, the saphenous vein was anastomosed in an end-toside fashion into the CCA in 8 minutes, followed by the end-to-end anastomosis to the petrous portion of the ICA in 11 minutes (B). Finally, the tumor was removed, together with the ICA, after artery reconstruction. The ECA was ligated. The VII and XI cranial nerves were identified and well protected. The X and XII nerves were resected due to direct tumor involvement. Operative blood loss was 600 mL. Histologic analysis showed findings typical of a carotid body paraganglioma. The patient’s postoperative course was uneventful, with a slight XII cranial nerve deficit and temporary hoarseness. No recurrence or any further complications were noted at the 10-month follow-up.

CT Angiography–derived Duplex Ultrasound Velocity Criteria in Patients with Carotid Artery Stenosis

Validation of carotid duplex ultrasound velocity criteria (CDUS VC) to grade the severity of extracranial carotid artery stenosis has traditionally been based on conventional angiography measurements. In the last decade, computed tomographic angiography (CTA) has largely replaced conventional arch and carotid arteriography (CA) for diagnostic purposes. Given the low number of CA being performed, it is impractical to expect noninvasive vascular laboratories to be validated using this modality. CDUS VC have not been developed with the use of CTA-derived measurements. The objective was to determine optimal CDUS VC from CTA-derived measurements with the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method for 50% and 80% stenosis. A retrospective review of all patients who underwent CDUS and CTA from 2000 to 2009 was performed. Vessel diameters were measured on CTA, and corresponding CDUS velocities were recorded. Percent stenosis was calculated using the NASCET method. Receiver operating characteristic (ROC) curves were generated for internal carotid artery (ICA) peak systolic velocity (PSV), ICA end diastolic velocity (EDV), and ICA PSV to common carotid artery PSV ratio (PSVR) for 50% and 80% stenosis. Velocity cut points were determined with equal weighting of sensitivity and specificity. A total of 575 vessels were analyzed to create the ROC curves. A 50% stenosis analysis yielded ideal cut points for PSV, EDV, and PSVR of 130cm/sec, 42cm/sec, and 1.75. An 80% stenosis analysis yielded ideal cut points for PSV, EDV, and PSVR of 297cm/sec, 84cm/sec, and 3.06. CTA-derived CDUS VC appeared to be reliable in defining 50% and 80% stenosis in patients with carotid artery stenosis. Although CDUS VC defined in this study were different from many of the previously published VC for the same percent stenosis, there were many similarities to those reported by the Society of Radiologists in Ultrasound consensus conference. We feel that CTA should be the gold standard imaging technique for validating CDUS VC.

Coexistence of a Carotid Body Tumor and Thyroglossal Duct Carcinoma With Cervical Lymph Node Metastasis

Thyroglossal duct carcinoma is uncommon, occurring in approximately 1% of all thyroglossal duct remnants. This rare neoplasm is characterized by relatively nonaggressive behavior with infrequent lymph nodal spread. Another rare neoplasm of the head and neck region is a carotid body tumor. A 78-year-old woman with a 3-year history of midline and bilateral neck masses was referred to us. Fine needle aspiration biopsies and a computed tomography scan suggested the diagnosis of thyroglossal duct carcinoma with cervical lymph node metastasis. Interestingly, the left-side neck mass was found to be splaying the carotid bifurcation, on computed tomography imaging. Carotid arteriography demonstrated a highly vascular mass in the bifurcation of the carotid artery that was compressing the internal and external carotid arteries. To our knowledge, this is the first reported instance of a thyroglossal duct carcinoma with neck metastasis accompanied by a carotid body tumor. In addition, the carotid body tumor in this case mimicked neck metastasis from the thyroglossal duct carcinoma.

Application of sodium alginate microspheres in ischemic stroke modeling in miniature pigs.

The miniature pig is an optimal animal model for studying nervous system disease because of its physiologic and pathologic features. However, the rete mirabile composed of arteries and veins at the skull base limits their application as a model of ischemic stroke by middle cerebral artery occlusion. The present study investigated the possibility of establishing an ischemic stroke model in the miniature pig by blocking the skull base retia with sodium alginate microspheres. Three Bama miniature pigs were used. Using the monitor of C-arm X-ray machine, sodium alginate microspheres (100–300 μm), a novel embolic material, were injected through the femoral artery, aortic arch, common carotid artery, ascending pharyngeal artery and the retia. Results were evaluated using carotid arteriography, MRI, behavior observation and histology. The unilateral rete mirabile was completely blocked, resulting in disturbance in blood supply to the basal ganglia, astasia of the right hind limb and salivation. MRI and hematoxylin-eosin staining showed an evident infarction focus in the basal ganglia. These findings indicate that sodium alginate microspheres are a suitable embolic material for blocking the skull base retia in miniature pigs to establish an ischemic stroke models.

A rare occurrence of kinking and coiling of the bilateral vertebral arteries: a case report

A 24-year-old female was admitted to our internal medicine department with complaints of fatigue and hoarseness that had been prominent for the last two months. She was then recommended for admission to our clinic with a possible diagnosis of Takayasu arteritis. Color Doppler ultrasound (US) revealed a monophasic flow pattern within both subclavian arteries throughout the entire course, and selective arcus aortography was carried out. Bilateral selective carotid and subclavian arteriography was evaluated as normal. A bilateral vertebral angiogram showed two subsequent kinking lesions of the right vertebral artery containing a coiling lesion in the middle (Figure 1), and a left vertebral angiogram detected both coiling and kinking lesions as well (Figure 2). Our case was discharged with a recommendation that she be followed up by the

Macrovascular complication phenotypes in type 2 diabetic patients

BackgroundMacrovascular diseases (MVD) in type 2 diabetes mellitus (T2DM) are often considered all together, without discriminating the areas involved. The aim of our study was to analyse MVD prevalence in a large population of T2DM patients by dividing the cases into subgroups according to MVD sites (NMVD, no MVD; NSCS, non-significant carotid stenosis; CBVD, cerebrovascular disease; CAD, coronary artery disease; PAD, peripheral artery disease; PVD, polyvascular disease) and studying the anthropometric, clinical and laboratory parameters in each group.MethodsA diabetic outpatient cohort (n = 1199) was retrospectively studied. Demographic, clinical and laboratory parameters were included in analyses. A thorough cardiovascular history as documented by previous medical records (including medical and hospital records) and vascular laboratory studies (including standardised electrocardiogram, echocardiogram, provocative tests for cardiac ischaemia, ankle/brachial index, duplex ultrasonography of the carotid and lower limbs and, in selected cases, computed tomography angiography, carotid and peripheral arteriography and evaluation of transcutaneous oxygen pressure), was collected for all of the patients. Standardised procedures were used to assess microvascular complications as well as metabolic syndrome (Mets).ResultsThe unadjusted MVD prevalence was 46.4% among the participants. The majority of patients with MVD were in the PVD group. In the multivariate analysis, age, male sex and diabetes duration were independent risk factors for PAD and PVD (P < 0.01). A low HDL-C value was an independent risk factor in the CAD and PVD groups (P = 0.03). Very high frequencies of MetS were observed in the PAD and PVD groups (94.9 and 95.7% respectively). The most MetS diagnostic criteria were recorded among members of the CAD group (all or all-1 criteria were present in 73% of patients). The average age in the CAD group (64.5 y) was comparable to that of the NMVD group. Microvascular complications were more frequent in the PAD and PVD patients.ConclusionPhenotypic heterogeneity is associated with different macrovascular complications in T2DM patients. These findings might have clinical implications for developing diagnostic and therapeutic strategies targeting type 2 diabetes.

Local anaesthetic surgical treatment of severe objective pulsatile tinnitus: a useful technique

Objective pulsatile tinnitus is a rare condition with an often dramatic presentation. We present the case of a 70-year-old woman who presented with over two years' history of unilateral distressing objective pulsatile tinnitus. Carotid arteriography revealed a highly tortuous internal carotid artery. Computed tomography of the ipsilateral temporal bones showed a large jugular bulb. Internal jugular vein ligation under local anaesthetic yielded immediate resolution of her symptoms.

Invited commentary

This meticulous evaluation of the repeatability and reproducibility of venous duplex imaging by a distinguished group of investigators represents the first phase of the Investigating Venous Evaluation and Standardization of Testing (INVEST) study, the program initiated by the American Venous Forum to develop reporting standards for diagnostic venous studies. Given the extraordinarily widespread use of venous duplex imaging and its critical role in the diagnosis and treatment of chronic venous insufficiency, such standardization is vital for the clinical and research missions associated with this disease. All duplex examinations, as we know from our arterial experience, are highly operator dependant, and thus, establishment of their reliability is essential. On the arterial side, this has largely been accomplished through the application of standard methodologies to perform and report studies and validation by comparison with arteriography. The current study is the first step in such an effort for venous noninvasive diagnosis. It should be noted at the outset that this study is not designed to evaluate the accuracy of venous duplex imaging, but only its repeatability and reproducibility and the factors that can affect these end points. The key findings of this study were that the greatest repeatability was achieved when scans were performed in the morning with the individual standing, and that use of the shorter 0.5-second cut point improved agreement between interpretations of reflux (not validity). In addition, education by standardized training of technologists and the application of a single examination protocol improved reproducibility. This rigorously conducted study is a strong first step in the process of standardizing venous duplex imaging. From it we have learned that adhering to a standard protocol matters more than factors that cannot be controlled, that experience and precision matter, and that studies performed by different individuals in different laboratories on different patients can be compared in a meaningful way when standardization is applied. These important observations allow us to take the next steps in the process, which will involve formalizing performance and reporting standards and creating the expectation that they will be adhered to. Despite the accomplishments of this study in determining the repeatability and reproducibility of venous duplex imaging, there remains an important but unanswered question yet to be addressed: What is the validity of venous duplex imaging? This may prove quite challenging because we lack a gold standard, such as carotid arteriography, for comparison, but most certainly merits our further investigation. Multicenter assessment of venous reflux by duplex ultrasoundJournal of Vascular SurgeryVol. 55Issue 2PreviewThis prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test. Full-Text PDF Open Archive

Short- and Long-Term Hemodynamic and Clinical Effects of Carotid Artery Stenting

Stenosis of the carotid artery may cause reduced hemodynamic and neural function that may be ameliorated with CAS. The goal of this study was to evaluate short- and long-term hemodynamic and clinical effects after CAS. Hemodynamic parameters were acquired by PCT within 1 week before CAS and at 1 week and 1 year (10-13 months) after CAS. In ACA territory, MCA territory, PCA territory, basal ganglia, anterior and posterior CWS and IWS, the rCBF, rCBV, and rMTT were determined in 20 patients with unilateral carotid artery stenosis who underwent CAS. MR and noncontrast CT were performed within 1 week before CAS. Noncontrast CT and carotid arteriography were performed immediately after CAS. Carotid arteriography was performed 1 year after CAS. MRS was performed in 3 measurements. The variance analysis was performed to determine whether there were significant differences among the 3 measurements. No significant differences were found among rCBV in any territory (P > .05). In the non-PCA territories, rMTT decreased and rCBF increased at 1 week after CAS (P < .01), but there was no significant difference between 1-week and 1-year effects (P > .05). For MR spectroscopy, no significant differences were found between 1 week after CAS and pretreatment (P > .05); the 1-year scores improved significantly (P < .01). The long-term hemodynamic and clinical results after treatment validated that CAS is a durable procedure. The 1-week hemodynamic effects can predict long-term effects.

Percutaneous Superficial Temporal Artery Access for Carotid Artery Stenting in Patients With a Hostile Aortic Arch

To describe an entirely percutaneous treatment for carotid artery stenting in a type IIa aortic arch via the superficial temporal artery (STA) for through-and-through guidewire access. The technique is demonstrated in an 83-year-old man status post left carotid endarterectomy 3 months prior who presented with 2.5 hours of confusion and dysphasia following diagnostic carotid arteriography. The patient was known to have a type IIa bovine aortic arch and a severe 70% stenosis of the left internal carotid artery. The patient was referred for carotid artery stenting by his vascular surgeon. Due to the bovine arch, a percutaneous ultrasound-guided approach via the STA for through-and-through wire access facilitated carotid artery stenting from the right common femoral artery. The procedure was successful, and follow-up duplex ultrasound confirmed patency of the STA the next day. A percutaneous ultrasound-guided STA access can help facilitate transfemoral carotid artery stenting in an otherwise difficult type IIa aortic arch setting.

Duplex criteria for determining ≥50% and ≥80% internal carotid artery stenosis following carotid endarterectomy with patch angioplasty

The purpose of this study was to determine optimal velocities for detecting ≥50% and ≥80% restenosis prior to considering carotid intervention/carotid artery stenting (CAS) after carotid endarterectomy (CEA) with patching in symptomatic and asymptomatic patients. Two hundred CEA patients with 195 pairs of imaging (duplex ultrasound versus computed tomography angiography [CTA]/carotid arteriography) were analyzed. Peak systolic velocities (PSVs), end diastolic velocity (EDV) and internal carotid artery/common carotid artery (ICA/CCA) ratios were correlated to angiography. Receiver operator characteristic (ROC) curves determined optimal velocity criteria in detecting ≥50% and ≥80% restenosis. The mean PSVs for ≥50% and ≥80% restenosis were 248 and 404 c/s, respectively (P < 0.001). A PSV of ≥213 c/s was optimal for ≥50% restenosis with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of 99%, 100%, 100%, 98% and 99%, respectively. An ICA PSV of 274 c/s was optimal for ≥80% restenosis with sensitivity, specificity, PPV, NPV and OA of 100%, 91%, 99%, 100% and 99%, respectively. ROC analysis showed that PSVs were significantly better than EDVs and ICA/CCA ratios in detecting ≥50% restenosis. Standard duplex velocity criteria should be revised after CEA using patching. Specific carotid duplex velocities can be used to detect ≥50% and ≥80% restenosis after CEA with patch closure prior to carotid intervention/CAS.

Measurement of carotid artery stenosis: correlation analysis between B-mode ultrasonography and contrast arteriography

PurposeTo evaluate the efficacy of B-mode ultrasonography (US) in measurement of carotid stenosis% (CS%).MethodsOne hundred and thirth-three carotid arteries in 96 patients who underwent both carotid US and carotid arteriography (CA) were included in this retrospective study. To measure CS% on US, a cross sectional view of the most stenotic segment of the internal carotid artery was captured and residual diameter and original diameter of that segment were measured with electronic caliper on the same plane and in the same direction. To measure CS% on an angiogram, we used European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) methods. Pearson's correlation analysis and linear regression analysis were used to determine the correlation between CS% on an US and angiogram.ResultsPearson's correlation coefficient (R) between CS% measured in US and CA were 0.853 (ECST method, P < 0.001) and 0.828 (NASCET method, P < 0.001). Accuracies of B-mode US were 93.2%, 88.0%, and 81.2% for estimating CS% by ECST method and 86.5%, 82.7%, and 82% for estimating CS% by NASCET method.ConclusionCS% measured in B-mode US was simpler and showed a strong positive correlation with that measured on an arteriogram either ECST or NASCET method.