Carotid Artery Diameter Research Articles

Quantitative analysis of cerebrovascular characteristics of Parkinson’s disease treated with acupuncture based on magnetic resonance angiography

Background: Acupuncture has become an important alternative clinical treatment for Parkinson’s disease (PD), but its efficacy and the underlying mechanisms remain debatable. Using a newly developed magnetic resonance angiography (MRA) method that has higher sensitivity for smaller and distal vessels and a novel tool that can trace vessels and extract vascular features, the immediate effects of acupuncture on intracranial vessels and blood flow in patients with PD as well as correlations with clinical outcomes were quantitatively evaluated. Methods: Fifteen PD patients received acupuncture at the Dazhui and Fengchi acupoint positions. MRA was performed before and after 30 min of treatment. The cerebral blood flow (CBF) and the length, volume, diameter, and signal intensity of the intracranial internal carotid artery (ICA) and middle cerebral artery (MCA) were measured. The Unified Parkinson’s Disease Rating Scale part III (UPDRS-III) and Visual Analogue Scale (VAS) were used to evaluate the motor symptoms and the subjective feelings of discomfort. Results: Acupuncture significantly reduced UPDRS-III and VAS scores. No significant changes were noted in the overall CBF before and after treatment. However, there was a significant extension effect on the length of the intracranial ICA and MCA and the distal MCA, and a significant increase in the number of branches of the MCA was found. Although acupuncture tended to increase the total volume of the intracranial ICA and the volume of the MCA, no statistical significance was reached. The total intensity was not altered, but the intensity and diameter of the M1 segment were significantly increased, whereas the intensity of the MCA was decreased. A positive correlation between M1 intensity changes and UPDRS-III changes was found. Conclusions: Angiographic evaluation suggested that acupuncture had a significant effect on intracranial blood vessels, which is one possible mechanism for acupuncture improving the motor symptoms of PD.

Defining carotid near-occlusion with full collapse: a pooled analysis

PurposeCreate a new definition of near-occlusion with full collapse to predicting recurrent stroke.MethodsPooled analysis of two studies. Patients with symptomatic ≥ 50% carotid stenoses were included. Outcome was preoperative recurrent ipsilateral ischemic stroke or retinal artery occlusion within 28 days of presenting event. We analyzed several artery diameters on computed tomography angiography and stenosis velocity on ultrasound.ResultsA total of 430 patients with symptomatic ≥ 50% carotid stenosis were included, 27% had near-occlusion. By traditional definition, 27% with full collapse and 11% without full collapse reached the outcome (p = 0.047). Distal internal carotid artery (ICA) diameter, ICA ratio, and ICA-to-external carotid artery ratio were associated with the outcome. Best new definition of full collapse was distal ICA diameter ≤ 2.0 mm and/or ICA ratio ≤ 0.42. With this new definition, 36% with full collapse and 4% without full collapse reached the outcome (p < 0.001).ConclusionsDefining near-occlusion with full collapse as distal ICA diameter ≤ 2.0 mm and/or ICA ratio ≤ 0.42 seems to yield better prognostic discrimination than the traditional appearance-based definition. This novel definition can be used in prognostic and treatment studies of near-occlusion with full collapse.

The Effects of Moderate‐to‐Vigorous Physical Activity on Arterial Stiffness during Pregnancy

Moderate-to-vigorous physical activity (MVPA) is associated with lower arterial stiffness in the general population. The objective of the present study was to investigate the relationship between MVPA and arterial stiffness in pregnancy. Thirty-nine women participated in this study resulting in 68 measurements in non-pregnant (NP; n=21), first (TM1; n=8), second (TM2; n=20), and third trimesters (TM3; n=19). Carotid to femoral (central) and carotid to finger (peripheral) pulse wave velocity (PWV) were assessed using finometer (proper digital artery), tonometer (carotid artery), and ultrasound (femoral artery). Carotid artery distensibility, compliance, elasticity, and ß-stiffness were calculated from carotid artery diameters at diastole and systole from three ultrasound images of the right carotid artery assessed using manual digital calipers. MVPA was measured during the waking hours of 7-consecutive days using accelerometry (Actigraph; model wGT3X-BT). Freedson accelerometer counts for MVPA were ≥ 1,952 cmp. Comparisons between pregnant and non-pregnant participants and according to gestational age (in pregnant participants only) were performed using multilevel linear regression models adjusted for multiple tests per participant during the study period (NP, TM1, TM2, or TM3) using random effects for modelling intra-cluster correlation to generate β coefficients and 95% confidence intervals (CI). Carotid artery distensibility, elasticity, and β-stiffness were not statistically different between the NP, TM1, TM2, and TM3 phases. However, carotid compliance was higher in TM2 compared to NP. Central and peripheral PWV did not differ between pregnant and non-pregnant participants. Though, meeting the MVPA guidelines (≥150minutes per week) was associated with a decrease in both central PWV (Adj. β coef.: -0.30; 95% CI: -0.58, -0.02, p=0.04) and peripheral PWV (Adj. β coef.: -0.54; 95% CI: -0.91, -0.16, p=0.005) in pregnant and non-pregnant assessments. Central PWV (β Coef: -0.14, 95% CI: -0.27, -0.02, p=0.024; n=42), varied according to gestational age with a decrease in mid-pregnancy and subsequent increase to late pregnancy while gestational age was not significantly associated with peripheral PWV. Adjustment for meeting the MVPA guidelines (β Coef: -0.34, 95% CI: -0.62, -0.06, p=0.016) reduced the association between gestational age and central-PWV (Figure 1). These results suggest that there is a relationship between MVPA and arterial stiffness throughout pregnancy. This may explain a proportion of the correlation between increased physical activity and a reduced risk of hypertension-related disorders in pregnancy.

COGNITIVE FUNCTION AND CAROTID STRUCTURE OVER LONG-TERM OBSERVATION IN PATIENTS WITH RESISTANCE HYPERTENSION

Objective: to investigate the changes of cognitive function and carotid structure in patients with résistance hypertension (RH) over 24 months observation Design and method: In 51 pts with RH (average age 52,3 ± 0,9; 27 males) we measured ultrasonographically diameter (D) of common carotid arteries (CCA), carotid intima-media thickness (IMT) value at the carotid bifurcations and at the level of CCA, blood flow velocities (BFV) of CCA, internal carotid arteries (ICA) and cognitive function by Montreal cognitive assessment (MoCA) test twice: at baseline and after 24 months. Changes in D CCA, IMT and MoCA test were defined as a difference between subject's baseline D CCA, IMT, MoCA test and subsequent measurements obtained 24 months later. All pts received 4 antihypertensive drugs during observation period Results: systolic and diastolic blood pressure were significantly decreased at the end of observation period. Carotid diameter and IMT value at the level of CCA were significantly decreased during observation period (DCCA from 8,6 ± 0,03 to 8,3 ± 0,03 mm, p = 0,02, CCA IMT from 1,24 ± 0,02 to 1,11 ± 0,02 mm, p = 0,01). IMT value at carotid bifurcation didn’t change significantly. We observed improvement in cognitive function: MoCA test results at baseline was 22,2 ± 0,5 after 24 months - 24,9 ± 0,5. The end diastolic BFV in CCA, ICA were significantly increased (accordingly: CCA – 0,14 ± 0,03 vs 0,34 ± 0,03m/s, p = 0,001, ICA – 0,23 ± 0,02 vs 0,48 ± 0,03m/s, p = 0,001) and resistance index (RI) of ICA was significantly decreased from 0,65 ± 0,02 to 0,61 ± 0,02. Changes of peak systolic BFV were not significant. Changes of MoCA results were related to IMT value at the level of CCA at baseline and at the end of observation (accordingly: r = -0,81; p &lt; 0,01 and r = -0,79; p &lt; 0,02). The same relations were between MoCA results and IMT value at bifurcation CCA. Conclusions: our 24 months study showed the positive dynamics of cognitive function and carotid structure such as decreasing of carotid diameters, intima-media thickness at level CCA and carotid resistance in patients with resistance hypertension who were receiving antihypertensive treatment.

Diagnostic Value of CT Angiography (CTA) in Carotid Cavernous Fistula (CCF) Patients Using the Digital Subtraction Angiography (DSA) as The Gold Standard: Observation in Dr. Soetomo General Hospital Surabaya from January 2016 to July 2020

Background: CT angiography (CTA) is the initial modality for diagnosing the Carotid Cavernous Fistula (CCF), identifying the type of CCF, measuring the diameter of the fistula and the diameter of the internal carotid artery (ICA) pre and post fistula, and then confirmed by Digital Subtraction Angiography (DSA) as the gold standard. CTA is expected to provide more information to improve the accuracy of CCF diagnosis to benefit therapy and prevent complications. This study aimed to determine the diagnostic value of CTA in CCF patients in Dr. Soetomo General Hospital Surabaya, using the DSA as a gold standard.&#x0D; Methods: An observational retrospective study of CCF patients met the inclusion and exclusion criteria and underwent CTA and DSA examinations at the Radiology Installation of Dr. Soetomo General Hospital, Surabaya, from January 2016 to July 2020.&#x0D; Results: In the comparison of types of CCF CTA to DSA, the direct group was 53.8% and 57.7%, respectively, while the indirect group was 46.1% and 42.3% with a very strong correlation (κ = 0.922; p = 0.000), sensitivity was 93.3%, specificity was 100 %, PPV of 100%, NPV of 91.7% and accuracy of 96.15%. Direct type evaluation on the DSA showed a large picture of the fistula diameter; the ICA pre fistula's size was enlarged; therefore, the ICA post fistula diameter was reduced or absent. There was a strong correlation of fistula diameter measurement results between CTA and DSA (r = 0.695, p = 0.006).&#x0D; Conclusion: CTA has a similarity rate of 92.2% with DSA in identifying the type of CCF. The accuracy value of CTA is close to DSA in fistula diameter measurements.

Diagnostic Value of CT Angiography (CTA) in Carotid Cavernous Fistula (CCF) Patients Using the Digital Subtraction Angiography (DSA) as The Gold Standard: Observation in Dr. Soetomo General Hospital Surabaya from January 2016 to July 2020

Introduction: CT angiography (CTA) is the initial modality for diagnosing theCarotid Cavernous Fistula (CCF), identifying the type of CCF, measuring thediameter of the fistula and the diameter of the internal carotid artery (ICA) pre andpost fistula, and then confirmed by Digital Subtraction Angiography (DSA) as thegold standard. CTA is expected to provide more information to improve theaccuracy of CCF diagnosis to benefit therapy and prevent complications. Thisstudy aimed to determine the diagnostic value of CTA in CCF patients in Dr.Soetomo General Hospital Surabaya, using the DSA as a gold standard. Methods:An observational retrospective study of CCF patients met the inclusion andexclusion criteria and underwent CTA and DSA examinations at the RadiologyInstallation of Dr. Soetomo General Hospital, Surabaya, from January 2016 toJuly 2020. Results: In the comparison of types of CCF CTA to DSA, the directgroup was 53.8% and 57.7%, respectively, while the indirect group was 46.1% and42.3% with a very strong correlation (κ = 0.922; p = 0.000), sensitivity was 93.3%,specificity was 100 %, PPV of 100%, NPV of 91.7% and accuracy of 96.15%. Directtype evaluation on the DSA showed a large picture of the fistula diameter; the ICApre fistula's size was enlarged; therefore, the ICA post fistula diameter wasreduced or absent. There was a strong correlation of fistula diametermeasurement results between CTA and DSA (r = 0.695, p = 0.006).Conclusion: CTA has a similarity rate of 92.2% with DSA in identifying the typeof CCF. The accuracy value of CTA is close to DSA in fistula diametermeasurements.

Three-dimensional ophthalmic artery model reconstruction and assessment captured by computed tomographic angiography in non-arteritic anterior ischemic optic neuropathy patients.

BackgroundThe ophthalmic artery (OA) was first reconstructed using computer software. The structural differences of ophthalmic arteries in non-arteritic anterior ischemic optic neuropathy (NAION) and normal eyes, in addition to hemodynamic alterations, were assessed.MethodsThirty-one NAION eyes, 19 uninvolved eyes with NAION, and a control group of 26 healthy eyes were retrospectively included. Computed tomographic angiography data were recorded, and corresponding three-dimensional OA models were constructed. Initial OA and internal carotid artery (ICA) diameters and the angle between them were analyzed. Three different OA models were used to evaluate hemodynamic performance. The statistical relationships between the initial diameters of the OA and ICA and the angle between the OA and ICA were described.ResultsOA diameters in NAION eyes were significantly smaller than those in both uninvolved and healthy eyes (P<0.05). There was no significant difference between uninvolved and healthy eyes (P=0.31). The initial ICA diameter and the angle between the OA and ICA did not significantly differ among the three groups. In the three models, the blood flow velocity in the initial ophthalmic arteries of uninvolved eyes was higher than that in the NAION eyes. The mass flows of the right and left ophthalmic arteries, accounting for the ipsilateral ICA in the control model, were 0.57%. However, these values in uninvolved and NAION eyes were 1.36% and 0.25%, respectively.ConclusionsNAION is associated with a smaller initial OA diameter, which may be related to hypoperfusion. To our knowledge, this is the first pilot study to analyze hemodynamic alterations using OA models.

CA.ME.LI.A. An epidemiological study on the prevalence of CArdiovascular, MEtabolic, LIver and Autoimmune diseases in Northern Italy

Background and aimsCA.ME.LI.A (CArdiovascular risks, MEtabolic syndrome, LIver and Autoimmune disease) is a cross-sectional, epidemiological study performed between 2009–2011 in Abbiategrasso (Milan, Italy) to estimate the prevalence of cardiovascular risk factors, metabolic syndrome, liver and autoimmune diseases in the general adult population. This report focuses on the description and presentation of baseline characteristics of the population. Methods and resultsCitizens were randomly selected from the city electoral registers (n = 30903), yielding a sample of 2554 subjects (M = 1257, F = 1297; age, 47 ± 15 yrs; range 18–77 yrs). Men had higher prevalence of overweight or obesity (60.8% vs 41.6%; p < 0.0001) and greater thickness of visceral adipose tissue (40 ± 19 vs 27 ± 17 mm; p < 0.0001); no gender difference was found in subcutaneous adipose tissue thickness. Men also showed higher levels of serum triglycerides, γ-GT, fasting blood glucose, insulin and Homa-IR Index, while HDL, CRP, and prevalence of elevated (>5.0 mg/L) CRP were lower. Compared to normal weight men, risk-ratio (RR) of CRP elevation was 1.32 (ns) in overweight and 2.68 (p < 0.0001) in obese subjects. The corresponding figures in females were 2.68 (p < 0.0001) and 5.18 (p < 0.0001). Metabolic syndrome was more frequent in men (32.7% vs 14.5%; RR: 2.24, p < 0.0001). Interadventitia common carotid artery diameter was higher in men and increased with age and BMI. ConclusionsThe present study reports on the overall characteristics of a large population from Northern Italy. It aims to identify the associations among cardiovascular risk factors to prevent their development and progression, improve healthy lifestyle and identify subjects liable to pharmacological interventions.

Implications of different definitions for aortic arch classification provided by contemporary guidelines on thoracic aortic repair.

Contemporary guidelines on thoracic aortic repair provide inconsistent reporting standards for the definition of aortic arch classification in Types I, II and III. The different reported criteria cannot be used interchangeably, due to a very low level of concordance, and this finding has relevant implications for the comparisons between studies using different classifications, and between different datasets of multicentre trials, which are not consistently analyzed with the same criteria. Also, the reported definitions, which were originally proposed for predicting difficult carotid stenting and therefore were conceived for healthy aortic arches, can be influenced by the pathological derangements of the aortic wall, including aneurysms and dissections. In this respect, the Madhwal's classification, which is based on the diameter of the left common carotid artery, appears to be the more suitable one for aortic arch classification in patients with thoracic aortic disease because it provides relevant clinical information along with an adequate reproducibility.

Respiratory alkalinization and posterior cerebral artery dilatation predict acute mountain sickness severity during 10h normobaric hypoxia.

What is the central question of this study? The pathophysiology of acute mountain sickness (AMS), involving the respiratory, renal and cerebrovascular systems, remains poorly understood. How do the early adaptations in these systems during a simulated altitude of 5000m relate to AMS risk? What is the main finding and its importance? The rate of blood alkalosis and cerebral artery dilatation predict AMS severity during the first 10 h of exposure to a simulated altitude of 5000m. Slow metabolic compensation by the kidneys of respiratory alkalosis attributable to a brisk breathing response together with excessive brain blood vessel dilatation might be involved in early development of AMS. The complex pathophysiology of acute mountain sickness (AMS) remains poorly understood and is likely to involve maladaptive responses of the respiratory, renal and cerebrovascular systems to hypoxia. Using stepwise linear regression, we tested the hypothesis that exacerbated respiratory alkalosis, as a result of a brisk ventilatory response, sluggish renal compensation in acute hypoxia and dysregulation of cerebral perfusion predict AMS severity. We assessed the Lake Louise score (LLS, an index of AMS severity), fluid balance, ventilation, venous pH, bicarbonate, sodium and creatinine concentrations, body weight, urinary pH and cerebral blood flow [internal carotid artery (ICA) and vertebral artery (VA) blood flow and diameter], in 27 healthy individuals (13 women) throughout 10h exposures to normobaric normoxia (fraction of inspired O2 = 0.21) and normobaric hypoxia (fraction of inspired O2 = 0.117, simulated 5000m) in a randomized, single-blinded manner. In comparison to normoxia, hypoxia increased the LLS, ventilation, venous and urinary pH, and blood flow and diameter in the ICA and VA, while venous concentrations of both bicarbonate and creatinine were decreased (P<0.001 for all). There were significant correlations between AMS severity and the rates of change in blood pH, sodium concentration and VA diameter and more positive fluid balance (P<0.05). Stepwise regression found increased blood pH [beta coefficient (β) = 0.589, P<0.001] and VA diameter (β = 0.418, P = 0.008) to be significant predictors of AMS severity in our cohort [F(2, 20) = 16.1, R2 = 0.617, P<0.001, n = 24], accounting for 62% of the variance in peak LLS. Using classic regression variable selection, our data implicate the degree of respiratory alkalosis and cerebrovascular dilatation in the early stages of AMS development.

Comparative Analysis of Patch Angioplasty Versus Selective Primary Closure during Carotid Endarterectomy Performed at a Single Vascular Center in China

One of the ongoing debates about carotid endarterectomy (CEA) is the closure technique of arterial wall in the operation. Current guidelines recommend routine patch closure (PAC); this recommendation is based on the evidence reported 10-20years ago. Therefore, the exact role of PAC and primary closure (PRC) remains uncertain. The objectives of this study were to compare the perioperative and long-term outcomes of patients who underwent CEA with different closure techniques. From January 2013 and December 2018, one senior vascular surgeon performed CEA for 126 patients in the First Affiliated Hospital, Sun Yat-sen University. The closure technique (PAC or PRC) was determined on the characteristics (diameter and level) of carotid arteries. Patient demographics and clinical data were retrospectively collected by two research fellows by reviewing the hospital medical records and relevant radiologic studies, as were carotid duplex reports, indications, intraoperative data, closure technique, and perioperative complications. Data of long-term outcomes were gathered by reviewing outpatient clinic visits and associated supplementary examinations. PRC was performed in 78 operations (61.9%), and PAC was performed in 48 operations (38.1%). There were no statistical differences in demographic and clinical data between the two groups. Carotid clamp time (P<0.001) and operating time (P<0.001) were significantly longer when performing PAC (P<0.001), and intraoperative blood loss was significantly more when performing PAC than that of PRC (P<0.001). The postoperative outcome and the follow-up results showed that there was no significant difference in the short-term and middle-term overall survival rate and restenosis-free survival rate between the two groups. There are no differences in postoperative and middle-term outcomes between PAC and selective PRC, whereas PRC technique can save operation time and shorten the intraoperative carotid clamp time. PRC can be safely applied in patients with a greater than 5mm internal carotid artery (ICA).

Management of patients after ischemic stroke

Rehabilitation and secondary prevention of ischemic stroke (IS) is the basis for the management of patients with ischemic stroke. The important role of non-drug methods of secondary prevention of IS should be noted: cessation of smoking and alcohol abuse, regular physical activity, proper nutrition, reduction of excess body weight. The normalization of blood pressure is one of the most effective areas of IS prevention. It is based on the regular intake of antihypertensive drugs in most cases. After noncardioembolic IS, antiplatelet agents are required: acetylsalicylic acid (ASA), clopidogrel, or a combination of dipyridamole and ASA. The possibility of taking a combination of clopidogrel and ASA for 21 days after IS with a subsequent switch to monotherapy with ASA or clopidogrel is discussed in patients with non-disabling IS. After cardiomoembolic IS, warfarin is required under the control of an international normalized ratio or with nonvalvular atrial fibrillation of new oral anticoagulants: apixaban, dabigatran or rivaroxaban. Most patients after IS require statins, and the doses are selected individually. Carotid endarterectomy is most effective in severe stenosis (narrowing of 70–99% of the diameter) of the internal carotid artery on the side of the involved hemisphere during the first 3–7 days after non-disabling IS. The data of multicenter placebo-controlled and open observational studies on the use of the metabolic drug Cytoflavin, which is widely used in our country in the rehabilitation of patients with IS, are presented.

Abstract 13020: Obesity-related Vascular Functional Change Becomes Apparent in Early Childhood

Background: Obesity is associated with structural and functional changes in the artery, but there is little information when arterial dysfunction begins to appear. The purpose of this study is to investigate the relationship between body mass index (BMI) z-score and arterial function from childhood to adolescence. Methods: Echocardiography was performed in 779 healthy children. Subjects were divided into 3 age groups: pre-school children group, 4 to 6 year (n =236); school children group, 7 to 12 years (n = 385); adolescents group, 13 to 20 years (n = 158). Stroke volume was calculated using aortic diameter and pulsed Doppler velocity profile. SV was indexed for body surface area (SVI). Effective arterial elastance (Ea) was estimated by end-systolic pressure/SVI and total arterial compliance (Ca) by pulse pressure/SVI. Quantitative B-mode ultrasound scans were used to measure intima-media thickness and diameters of the common carotid artery. Results: Intima-media thickness of carotid artery did not change with BMI z-score in the pre-school and school children groups (r = 0.09 and 0.11, p &gt; 0.05, respectively), but a weak but significant correlation between intima-media thickness of carotid artery and BMI z-score was found in the adolescents group (r = 0.20, p &lt; 0.05). In the pre-school children group, Ea and Ca did not correlate with BMI z-score, but there were significant relationships between BMI z-score and Ea and Ca in the school children (r = 0.27 and 0.16, p &lt; 0.01, respectively) and in the adolescents groups (r = 0.38 and 0.29, p &lt; 0.01, respectively). The slope of the relationship between BMI z-score and Ea in the adolescents group was significantly steeper compared with the school children group (p&lt;0.05). Conclusion: Obesity-related arterial functional changes begin to appear in younger school children, however, remodeling of the common carotid artery is not yet present. With advancing age, negative effects of obesity on vascular functional and morphological changes become apparent. Our findings suggest that primary prevention programs should be initiated in early childhood.

Acute Effects of Different Intensities of Cycling Acute Exercise on Carotid Arterial Apparent Elasticity and Hemodynamic Variables.

Background Cardiovascular disease (CVD) is closely related to arterial elasticity and hemodynamics. Exercises have been reported to immediately decrease arterial apparent elasticity and regulate hemodynamic variables. However, the relationship between them and exercise intensity remains elusive. The purpose of this study was to determine the acute effects of different intensities of acute cycling exercise on carotid arterial apparent elasticity and hemodynamics. Methods 32 healthy men (age: 19.4 ± 0.6 years) attended the laboratory on five occasions and completed cycling acute exercise for 20 minutes at five intensities (40%, 50%, 60%, 70%, and 80% heart rate reserve (HRR)). At the right carotid artery, center-line velocity and arterial inner diameter waveforms were examined before and immediately after exercise. Based upon the measured data, the classical hemodynamic theory was used to calculate the apparent elasticity and the local hemodynamic variables. Results The arterial apparent stiffness and the apparent elastic modulus following acute cycling exercise at 60% to 80% HRR were significantly higher than baseline. The mean center-line velocity accelerated from 50% to 80% HRR, but no intensity of intervention altered mean blood flow. Immediately after intervention, the mean wall shear stress and oscillatory shear index increased. Conclusions Aerobic cycling intervention, with intensity from 40% to 80% HRR, did not change the brain blood supply. A bout of cycling intervention decreased apparent elasticity, and there was an intensity-dependent effect on apparent elasticity and hemodynamic variables. This study would provide referable data for the further study on the effects of aerobic exercise on arterial hemodynamics and elasticity and underlying physiological mechanisms.

SAFETY OF ADEQUATE PREDILATATION IN CAROTID ANGIOPLASTY

Objective: In carotid angioplasty a lot of interventionists avoid predilatation or perform predilatation using smaller diameter balloons to avoid distal embolization. The objective of our study was to determine the procedural safety and complications of predilatation of carotid artery using adequate diameter balloon in patients undergoing angioplasty. Methodology: Symptomatic patients with greater than 50% common carotid artery (CCA) or internal carotid artery (ICA) stenosis, asymptomatic patients with 80% or more carotid stenosis, asymptomatic patients planned for Coronary Artery Bypass Graft Surgery (CABG) with bilateral severe carotid stenosis (70-99%) or a unilateral severe carotid stenosis with a contralateral occlusion undergoing CABG, were selected for carotid artery angioplasty. Cerebral angiogram was performed before and after carotid intervention. Results: A total of 25 patients were included in this study. Adequate diameter balloon used for predilatation before stenting in all cases. Post dilatation was required in 6 (24%) patients. Distal embolic protection device was used in all patients. No complication was seen after predilatation in any case. No mortality or neurological deficit was seen in the study. Conclusion: This study shows that proper predilatation with adequate diameter balloon, sized according to diameter of internal carotid artery, before carotid stent implantation is an effective and safe procedure. We believe that this leads to good stent expansion and full apposition with better long term outcomes. Moreover it is now important to adequately predilate carotid arteries, for proper sizing of carotid stents with close cell design, to avoid unnecessary longitudinal stent lengthening due to inadequately prepared carotid bed.

Characteristics of cerebral hemodynamics in patients with chronic brain ischemia

Background. Literature sources report conflicting results regarding the severity of clinical symptoms of hydrocephalus (HC) and their association with cerebral arterial blood flow (CABF); most studies do not show a direct relationship, while some suggest a link between clinical severity and progressive decrease in CABF. The study of hemodynamic changes in the brain of patients with chronic brain ischemia (CBI), elucidation of their relationship with cognitive impairments helps to improve diagnostic approaches and optimize the prognosis of the disease. The purpose of this study is to investigate the state of cerebral hemodynamics and to establish its relationship with changes in cognitive functions in patients with CBI and HC. Materials and Methods. A comprehensive examination of 110 patients with CBI and HC was performed. The localization of the HC and results of Montreal Cognitive Test (MoCA scale) were taken into account. Computed tomography of the brain was performed with subsequent determination of morphometric parameters and indices. The state of cerebral blood flow and structural changes of blood vessels were studied using transcranial color-coded duplex ultrasonography (TCCS) of intracranial vessels and extracranial divisions. Microsoft Excel 2011 and Statistica were used for statistical processing of the results. Results. It was found that there was a significantly larger diameter of both common carotid arteries (CCA), thickness of complex intima\media (CIM), maximum systolic velocity (Vs), velocity at the end of the diastolic cycle (Vd), as well as peripheral resistance (IR) in left CCA (p &lt;0,05) in patients with CBI and HC compared with patients with CBI without HC. Significantly larger diameter of left internal carotid artery (ICA), Vs, Vd and IR was revealed; Vs and Vd in the right ICA; Vd in the extracranial devision of vertebral artery (VA) in patients with HC. A significant relationship was found between the following blood flow parameters and the values of the MoCA scale: Vs MCA/MoCA (r = 0,45, p &lt;0,05), Vs ACA/MoCA (r = 0,38, p &lt;0.05), ICA diameter/MoCA (r = -0,51, p &lt;0,05). It was found that the diameter of CCA and the thickness of CIM were significantly larger in patients with CBI with internal HC in comparison with patients with CBI with external HC (p &lt;0,01). Vs and Vd in patients with internal hydrocephalus were significantly lower, and IR was significantly higher compared with patients with external hydrocephalus (p &lt;0,01). The diameter of ICA and IR in patients with CBI with internal HC was significantly higher, and Vs was significantly lower compared with patients with CBI and external HC (p &lt;0,01). Significantly different values were found in Vs and IR meanings in middle cerebral artery (MCA) and Vs in anterior cerebral artery (ACA) in patients with CBI with internal HC compared with patients with CBI with external HC.Conclusions. Functional parameters of blood flow and structural changes of cerebral arteries in patients with CBI with concomitant hydrocephalus differed significantly from those in patients without hydrocephalus and depended on the type and severity of hydrocephalus. ICA occlusion, ICA stenosis &gt;50%, and intracranial venous stasis were significantly more common in patients with severe and moderate HC compared with those with mild HC. A weak relationship was found between the structure of carotid arteries and blood flow in intracranial arteries in patients with CBI and HC. There was a significant relationship between blood flow indices and the values of the MoCA scale, which indicated the effect of changes in the vessels of the anterior circular basin on the cognitive functions and the lack of such connection with blood flow indices in vertebrobasilar basin.

Parametry morfologiczne tętnic obwodowych w ocenie ryzyka sercowo-naczyniowego

Introduction. The aim of the study was to test the hypothesis that ultrasound measurements of common carotid artery (CCAd) and brachial artery (BAd) diameters represent markers of higher coronary artery disease risk (CAD, defined as ≥ 50% reduction in diameter of at least one large coronary artery segment). Materials and methods. Seventy-one patients (pts) evaluated for suspected stable CAD (23.9% women, age 61.5 ± 7.5) underwent ultrasound measurements of averaged diameters of both common carotid arteries and the brachial artery diameter of dominant arm. Clinical protocol included also: standard medical examination, assessment of biochemical parameters, resting electrocardiography, treadmill exercise test and transthoracic echocardiography. Diagnosis was established using quantitative coronary angiography measurements and calculation of Gensini Score (GS). Results. Angiographic CAD was present in 43 (60.5%) patients. Average CCAd was larger in CAD group (7.97 ± 0.96 mm vs. 7.37 ± 0.67 mm, p = 0.0052), similar to BAd (5.06 ± 0.65 vs. 4.68 ± 0.75, p = 0.03), respectively. The peripheral arterial diameters correlated with values of GS index, more pronounced for CCAd ( ρ = 0.35, p = 0.0023) than for BAd ( ρ = 0.24, p = 0.0368). CCAd significantly more positively correlated with the distal coronary artery segments values of the GS index ( ρ = 0.35, p = 0.0024), whereas the diameter of BA with the proximal segments values of GS index ( ρ = 0.239, p = 0.045). CCA and BD diameters indexed to body surface area (BSA) showed a strong trend toward larger average diameters in CAD patients: CCAd/BSA index: 4.06 ± 0.46 mm/m 2 vs. 3.85 ± 0.56 mm/m 2 , p = 0.087, BAd/BSA index: 2.57 ± 0.29 mm/m 2 vs. 2.42 ± 0.35 mm/m 2 , p = 0.057. Gensini score significantly correlated with CCAd/BSA index ( ρ = 0.24, p = 0.043) with a strong trend of positive correlation between GS index and BAd/BSA index ( ρ = 0.21, p = 0.076). Conclusions. The diameters of common carotid arteries and the brachial artery of dominant arm are greater in CAD pts. Peripheral arteries ultrasound may complement classic diagnostic pathway of stable coronary artery disease.

Genetic Variants Associated with Non-Alcoholic Fatty Liver Disease Do Not Associate with Measures of Sub-Clinical Atherosclerosis: Results from the IMPROVE Study

Non-alcoholic fatty liver disease (NAFLD) and atherosclerosis-related cardiovascular diseases (CVD) share common metabolic pathways. We explored the association between three NAFLD-associated single nucleotide polymorphisms (SNPs) rs738409, rs10401969, and rs1260326 with sub-clinical atherosclerosis estimated by the carotid intima-media thickness (c-IMT) and the inter-adventitia common carotid artery diameter (ICCAD) in patients free from clinically overt NAFLD and CVD. The study population is the IMPROVE, a multicenter European study (n = 3711). C-IMT measures and ICCAD were recorded using a standardized protocol. Linear regression with an additive genetic model was used to test for association of the three SNPs with c-IMT and ICCAD. In secondary analyses, the association of the three SNPs with c-IMT and ICCAD was tested after stratification by alanine aminotransferase levels (ALT). No associations were found between rs738409, rs1260326, rs10401969, and c-IMT or ICCAD. Rs738409-G and rs10401969-C were associated with ALT levels (p < 0.001). In patients with ALT levels above 28 U/L (highest quartile), we observed an association between rs10401969-C and c-IMT measures of c-IMTmax and c-IMTmean-max (p = 0.018 and 0.021, respectively). In conclusion, NAFLD-associated SNPs do not associate with sub-clinical atherosclerosis measures. However, our results suggest a possible mediating function of impaired liver function on atherosclerosis development.

Poor concordance between definitions of type III arch and implications for risk prediction and assessment for carotid artery stenting

ObjectiveThe type III arch configuration has been inconsistently reported as a stroke risk factor during carotid artery stenting. However, at least three different methods for the definition of type III arch can be identified in the literature, related to the level of the origin of the innominate artery (IA). According to Casserly's definition, a type III arch presents with an origin of the IA below the horizontal plane of the inner curvature. According to Madhwal's definition, a type III arch has a distance greater than twice the diameter of the left common carotid artery between the highest point of the arch and the origin of the IA. According to MacDonald's definition, a type III arch presents with a distance of ≥2 cm between the highest point of the arch and the origin of the IA. Our aim was to assess the level of concordance between these different methods. MethodsAnonymized thoracic computed tomography scans of 100 healthy patients were reviewed. Two of us independently stratified the selected cases as a type I to III arch, according to the three considered definitions. The interobserver level of concordance for each type III arch classification and level of concordance among the three definitions were assessed. ResultsThe 100 selected patients (64% male) were 76 ± 7 years old. For each definition, the interobserver repeatability was almost perfect for all three (Madhwal, κ = 0.81; 95% confidence interval [CI], 0.71-0.99; MacDonald, κ = 0.82; 95% CI, 0.72-0.92; Casserly, κ = 0.84; 95% CI, 0.74-0.93). The level of concordance among the different definitions was very low (Madhwal vs MacDonald, 85% [P = .002]; 33% for type III arch; Madhwal vs Casserly, 60% [P < .0001]; 12% for type III arch; MacDonald vs Casserly, 75% [P < .0001]; 12% for type III arch). ConclusionsThe three definitions of the type III arch have a very low level of concordance, which might account for the varying clinical relevance of this configuration. Our findings have relevant implications for risk prediction for carotid artery stenting based on the presence of a type III arch, for comparisons of the results from different studies, and for comparisons of different datasets from multicenter trials.

Global REACH 2018: The carotid artery diameter response to the cold pressor test is governed by arterial blood pressure during normoxic but not hypoxic conditions in healthy lowlanders and Andean highlanders.

What is the central question of this study? What is the impact of oxygen on the circulatory responses to an isocapnic cold pressor test (CPT) in lowlanders and Andean highlanders? What is the main finding and its importance? Overall, the circulatory responses to an isocapnic CPT were largely unaltered with acute normobaric hypoxia and chronic hypobaric hypoxia exposure in lowlanders. However, the relationship between mean arterial pressure and common carotid artery diameter was dampened in hypoxic conditions. Furthermore, there were no differences in the circulatory responses to the CPT between lowlanders and Andean highlanders with lifelong exposure to high altitude. The impact of oxygen on the circulatory responses to a cold pressor test (CPT) in lowlanders and Andean highlanders remains unknown. Our hypotheses were as follows: (i) in lowlanders, acute normobaric and hypobaric hypoxia would attenuate the common carotid artery (CCA) diameter response to the CPT compared with normobaric normoxia; (ii) Andean highlanders would exhibit a greater CCA diameter response compared with lowlanders; and (iii) a positive relationship between CCA diameter and blood pressure in response to the CPT would be present in both lowlanders and highlanders. Healthy lowlanders (n=13) and Andean highlanders (n=8) were recruited and conducted an isocapnic CPT, which consisted of a 3min foot immersion into water at 0-1°C. Blood pressure (finger photoplethysmography) and CCA diameter and blood flow (Duplex ultrasound) were recorded continuously. The CPT was conducted in lowlanders at sea level in isocapnic normoxic and hypoxic conditions and after 10 days of acclimatization to 4300m (Cerro de Pasco, Peru) in hypoxic and hyperoxic conditions. Andean highlanders were tested at rest at high altitude. The main findings were as follows: (i) in lowlanders, normobaric but not hypobaric hypoxia elevated CCA reactivity to the CPT; (ii) no differences in response to the CPT were observed between lowlanders and highlanders; and (iii) although hypobaric hypoxaemia reduced the relationship between CCA diameter and blood pressure compared with normobaric normoxia (P=0.132), hypobaric hyperoxia improved this relationship (P=0.012), and no relationship was observed in Andean highlanders (P=0.261). These data demonstrate that the circulatory responses to a CPT were modified by oxygen in lowlanders, but were unaltered with lifelong hypoxic exposure.