Carotid Artery Stenosis In Patients Research Articles

Karotis Arter Stenozlu Hastalarda Asetilsalisilik Asit+Pentoksifilin ile Silostazol Tedavilerinin Etkilerinin Karşılaştırılması

Amaç: İnme Amerika Birleşik Devletleri (ABD)'nde en sık ölüm nedenleri arasında üçüncü sırada olup, %80'i iskemik tiptedir. İskemik inmelerin de yaklaşık %30'u karotis arter stenozuna sekonderdir. Bu çalışmanın amacı, revaskülarizasyona uygun olmayan karotis arter stenozlu hastaların medikal tedavisinde kullanılan güncel ilaçların altı ay süreyle hastalığın prognozuna, karotis arter çapı, stenoz yüzdesi, intimal kalınlık, akım hızı, direnç artışı ve plak büyüklüğüne ve semptomatoloji üzerine etkilerinin ve bu etkilerin farklılıklarının araştırılmasıdır. Gereç ve Yöntemler: Çalışmaya revaskülarizasyona uygun olmayan karotis arter stenozlu toplam 40 hasta dâhil edildi. Hastalar önerilen medikal tedaviye göre gruplandırıldı (silostazol 2x100 mg veya asetilsalisilik asit 1x150 mg+pentoksifilin 2x600 mg). Hastaların başlangıç parametreleri ve klinik durumları kayıt edildikten sonra önerilen medikal tedavinin altıncı ayındaki kontrol parametreleri ve klinik durumları da kayıt edildi. Bulgular: Medikal tedavinin altıncı ayındaki kontrollerde internal karotis arter akım hızı, stenoz yüzdesi, plak büyüklüğü ve intimal kalınlık parametrelerinde her iki grup da azalma saptandı. Silostazol grubundaki azalma miktarı aynı zamanda istatistiksel açıdan anlamlı olarak değerlendirildi. Kontrol internal karotis arter çapı her iki grup da artmış bulundu ve yine silostazol grubundaki çap artışı istatistiksel olarak daha anlamlı idi. Kontrol internal karotis arter direnç miktarı parametresi silostazol grubunda azalmış, asetilsalisilik asit+pentoksifilin grubunda ise artmış olarak saptandı. Bu çalışmada gözlenen kombinasyon tedavisi etkinliği, eks vivo çalışmaların sonuçlarından öngörülebilir ve yırtılma ile indüklenen platelet P-selektin ekspresyonu üzerine olan etkisi ile açıklanabilir. Sonuç: Bu çalışmanın sonuçları bize, karotis arter stenozu medikal tedavisinde risk faktörlerinin tedavisi yanı sıra silostazol tedavisinin de etkili olabileceği yönünde bulgular göstermiştir.

Effect of carotid artery stenting on cognitive function in patients with carotid artery stenosis: a prospective, 3-month-follow-up study.

Background and PurposeCarotid artery stenting (CAS) is emerging as an alternative to carotid endarterectomy for the treatment of carotid artery stenosis (CS), but the effect of CAS on the cognitive function of patients with severe CS has not been fully investigated. The aim of this study was to use comprehensive neuropsychological tests to determine the effect of CAS on cognitive function from baseline to 3 months postprocedure in patients with severe CS.MethodsThirty-one patients due to undergo CAS due to high-grade CS (≥70%) and 11 control subjects who were diagnosed with CS, but who did not undergo CAS, and who visited the clinic or emergency room between February 2009 and February 2012 were recruited consecutively at baseline (i.e., pre-CAS). Follow-up neuropsychological evaluations after 3 months were completed by 23 of the 31 patients who underwent CAS, and by 10 of the 11 control subjects. The primary cognitive outcome was assessed using a neuropsychological test containing subcategories designed to test general cognitive function, attention, visuospatial function, language and related functions, memory, and frontal lobe/executive function.ResultsOf the 23 patients undergoing CAS who completed the 3-month follow-up tests, 12 had asymptomatic CS. During the 3-month follow-up period, the patients who underwent CAS and those with asymptomatic CS achieved similar results to the control group on all cognitive tests. However, symptomatic CS patients (n=11) who underwent CAS exhibited improvements in visuospatial function (p=0.046) and total Seoul Neuropsychological Screening Battery-Dementia Version scores (p=0.010) in comparison with both the asymptomatic CS patients and the control group.ConclusionsThe findings of this study suggest that CAS has a positive effect on cognitive function in patients with symptomatic CS over a 3-month follow-up period. A long-term, multicenter, prospective case-control study would be helpful to predict quality of life and prognoses for patients undergoing CAS.

Evaluating the risk of ischemic cerebral vascular disease with ocular hemodynamics in carotid artery stenosis patients

To evaluate the association between the ocular hemodynamic and the incidence of ischemic cerebral vascular diseases in carotid artery stenosis patients. Case-control study. Seventy-two cases patients with carotid artery stenosis including 22 cases of cerebral infarction group, 14 cases of lacunar cerebral infarction group and the control group of the other 36 patients without cerebral infarction were recruited. All patients were measured with hemodynamic parameters of the ophthalmic artery, central retinal artery and posterior ciliary artery. PSV, EDV, PI and RI were also measured. The other risk ischemic cerebral vascular factors were obtained through the questionnaire and venous blood sampling. The differences of 3 groups and the influences of the other risk factor of hemodynamic were calculated. PSV of ophthalmic artery was (25.96 ± 12.63)cm/s in cerebral infarction group, (32.63 ± 13.25) cm/s in lacunar infarction group and (39.46 ± 14.97) cm/s in control group. EDV of ophthalmic artery was(6.09 ± 3.10) cm/s in cerebral infarction group, (6.57 ± 2.85) cm/s in lacunar infarction group and (9.73 ± 5.02) cm/s in control group. PSV of central retinal artery was (8.06 ± 2.98) cm/s in cerebral infarction group, (8.91 ± 2.76) cm/s in lacunar infarction group and (9.71 ± 2.60) cm/s in control group. The differences were statistically significant (F = 13.393, 12.609, 5.027, P < 0.01). EDV of central retinal artery was (2.46 ± 0.77) cm/s in cerebral infarction group, (2.35 ± 0.89) cm/s in lacunar infarction group and (2.73 ± 0.86) cm/s in control group. There was no statistical difference of EDV of CRA in three group (F = 2.405, P = 0.094). There was association between the ocular hemodynamic parameters and the incidence of ischemic cerebrovascular disease in the carotid artery stenosis patients. Increased level of PSV and EDV of the ophthalmic artery raised the risk of the incidence of ischemic cerebrovascular disease.

Delay between Symptoms and Surgery for Carotid Artery Stenosis: Modification of Our Practice

Recent data from the literature concerning symptomatic carotid stenosis show that the long-term benefits of surgery are greater when the surgery is performed soon after the neurologic event, ideally within 2 weeks. Since 2009, following recommendations, we decided to perform surgery as quick as possible. The aim of the study was to determine whether this approach increased postoperative morbimortality and the way it could change our practice. Using a prospective database containing a consecutive and continuous series of 1,500 carotid endarterectomies performed between 2003 and 2012, we extracted the records concerning the 417 symptomatic carotid stenoses (27.8%). We compared the 30-day and long-term outcome in 3 groups of patients: those operated within 2 weeks of the neurologic event (early surgery group [ESG], n = 158, 37.9%), those operated between 16 days and 6 weeks after the event (deferred surgery group [DSG], n = 79, 18.9%), and those operated more than 6 weeks after the event (late surgery group [LSG], n = 180, 43.2%). In the second part, to assess the new management beginning 2009, patients were divided in 2 periods 2003-2008 (period A) and 2009-2012 (period B) and we compared the 2 period's descriptive data and outcome. The primary outcome was the 30-day combined stroke and death rate. Secondary end points were follow-up freedoms from mortality and stroke. The mean time between symptom onset and surgery was 7.7 ± 3.8 days for the ESG, 28.3 ± 8.6 days for the DSG, and 89.4 ± 36.7 days for the LSG. In the 3 groups, the types of symptoms leading to the indication for carotid surgery were comparable, with a stroke in 221 cases (53.0%), a transient ischemic attack in 146 cases (35.40%), and amaurosis fugax in 50 cases (12.0%). The groups were comparable in terms of comorbidities. The overall 30-day stroke rate was 1.4% (6 cases), the 30-day death rate was 1.7% (7 cases), and the combined stroke and death rate was 3.4% (3.2% in the ESG, 5.1% in the DSG, and 2.8% in the LSG [P = 0.808]). Survival rates at 24, 48, and 60 months were, respectively, 95%, 78%, and 78% in ESG, 86%, 81%, and 81% in DSG, and 91%, 83%, and 74% in LSG (P = 0.78). Freedom from stroke at 60 months showed to be, respectively, 97% in ESG, 96% in DSG, and 91% in LSG (P = 0.32). During the period A (2003-2008), we had taken care of 217 symptomatic carotid artery stenosis patients (22.3% of stenosis) and during the period B (2009-2012), 200 symptomatic stenosis (37.9% of stenosis). During the period A, an early surgery (<15 days) had place in 31 cases (14.3%), and during the period B, in 127 cases (63.5%). The 30-day stroke and death rate was of 3.7% during the period A and of 3.0% during the period B (P = 0.455). The 24-month survival and stroke-free survival rates were comparable between the 2 periods. In our experience, surgery for symptomatic carotid stenosis can be performed early without increasing the rate of postoperative and long-term outcome. We have modified our practice, performing more and more early surgery for symptomatic stenosis without any impact on the outcome.

Statins Reduce Peri-procedural Complications in Carotid Stenting

In primary and secondary prevention, statins significantly reduce cardiovascular and cerebrovascular events. Pre-interventional statin medication shows a benefit in carotid artery stenosis patients treated with endarterectomy; however, there are few data available for patients treated with stent-angioplasty. The aim of this study was to investigate whether pre-interventional statin therapy is associated with decreased peri-interventional risk of stroke, myocardial infarction, and mortality in patients undergoing stent-angioplasty for internal carotid stenosis. Data for 344 consecutively documented patients with internal carotid artery stenosis treated with stent-angioplasty in the years 2002-2012 at the same stroke center were collected in a prospectively defined database. Risk factors, medication, and indication for therapy were documented. Univariate and multivariate analysis was performed to investigate independent reduction of peri-interventional stroke, myocardial infarction, or death by statin medication prior to stent-angioplasty. The median age was 70 years (p25: 63, p75: 76), 75.5% of patients were male, and the median stenosis was 85% according to ECST criteria (p25: 80%, p75: 90%). 20.1% of patients had asymptomatic stenoses, and 60.2% had statin medication before stenting. As per multivariate analysis, pre-interventional statin medication was a predictor for significant peri-interventional risk reduction regarding primary endpoint ischemic stroke, myocardial infarction (MI), or death (odds ratio (OR) 0.31, p = .006). Statins also had a significant protective effect in secondary endpoint ischemic stroke, intracranial bleeding or death (OR 0.39, p = .014), and ischemic stroke or myocardial infarction (OR 0.20; p = .002). This study shows that pre-interventional statin medication has a protective effect against peri-interventional stroke, MI, or death in patients with internal carotid artery stenosis treated with stent-angioplasty. Accordingly, statins could be considered as a standard pre-interventional medical therapy in carotid stenting.

Role of rs1466535 low density lipoprotein receptor-related protein 1 (LRP1) gene polymorphism in carotid artery disease

ObjectiveAn association between rs1466535 low density lipoprotein receptor-related protein 1 (LRP1) gene polymorphism and abdominal aortic aneurysm (AAA) was recently demonstrated. It has not yet been defined if this association is specific for AAA or related to atherosclerosis per se. Therefore, we aimed to evaluate the role of the rs1466535 polymorphism in conferring genetic susceptibility for carotid artery stenosis (CAS). MethodsThe rs1466535 polymorphism was evaluated in n = 814 patients with CAS and n = 814 subjects without evidence of carotid atherosclerosis by TaqMan technology. ResultsThe percentage of T allele rs1466535 carriers was significantly higher in CAS patients (49.3%) than in controls (43.9%, p = 0.032). At the multiple logistic regression analysis, the allele T carrier status did not remain a significant determinant of CAS. ConclusionsThe rs1466535 LRP1 polymorphism is not a significant and independent risk factor for CAS. Our result suggests this polymorphism in the LRP1 gene is not associated with atherosclerosis in general as it is not associated with CAS (this study), whereas it is strictly associated with AAA (our previous paper).

Screening Asymptomatic Patients for Carotid Artery Stenosis

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)Target Audience: Primary care cliniciansBackground and ObjectiveMortality from

Prevalence and predictors of carotid artery stenosis in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation.

Our aim was to analyze the prevalence and predictors of Carotid artery stenosis (CAS) in patients undergoing transcatheter aortic valve implantation (TAVI). CAS is associated with the risk of periprocedural stroke in patients undergoing cardiac surgery. However, little is known about the prevalence of and clinical significance of CAS in the setting of TAVI. Consecutive patients undergoing a carotid Doppler study the day before TAVI were followed prospectively. CAS was defined in accordance with current practice guidelines. Logistic regression models were used to identify independent correlates of CAS. The study included 171 patients (age 82 ± 6, male gender 47%). Carotid atherosclerosis (CA, defined as any carotid plaque) was present in 164 (96%) of patients, and CAS (peak systolic velocity [PSV] ≥ 125 cm/sec; ≥50% diameter stenosis) in 57 (33%) patients. Severe CAS (PSV ≥ 230 cm/sec; ≥70% stenosis, or near occlusion) was found in 15 (9%) patients. By multivariate analysis, smoking and a higher Euroscore independently predicted the presence of CAS. Patients in the present TAVI cohort had a significantly higher prevalence of both unilateral and bilateral CAS ≥ 50% than those in a previously reported cohort (n = 494 patients, age ≥ 70) undergoing clinically driven coronary angiography (33% vs. 20%, OR = 1.9, P = 0.001; and, 13% vs. 6%, OR = 2.3, P = 0.003, respectively). CAS was not independently associated with 30-day mortality or stroke rates. The prevalence of CAS in patients undergoing TAVI is high, exceeding that observed in patients undergoing catheterization for coronary indications. The impact of CAS on clinical outcomes following TAVI merits further research.

Safety of early endarterectomy in patients with symptomatic carotid artery stenosis: an international multicenter study.

Although the latest recommendations suggest that carotid endarterectomy (CEA) should be performed in symptomatic carotid artery stenosis (sCAS) patients within 2 weeks of the index event, only a minority of patients undergo surgery within the recommended time-frame. The aim of this international multicenter study was to prospectively evaluate the safety of early CEA in patients with sCAS in everyday clinical practice settings. Consecutive patients with non-disabling acute ischaemic stroke (AIS) or transient ischaemic attack (TIA) due to sCAS (≥ 70%) underwent early (≤ 14 days) CEA at five tertiary-care stroke centers during a 2-year period. Primary outcome events included stroke, myocardial infarction (MI) or death occurring during the 30-day follow-up period and were defined according to the International Carotid Stenting Study criteria. A total of 165 patients with sCAS [mean age 69 ± 10 years; 69% men; 70% AIS; 6% crescendo TIA; 8% with contralateral internal carotid artery (ICA) occlusion] underwent early CEA (median elapsed time from symptom onset 8 days). Urgent CEA (≤ 2 days) was performed in 20 cases (12%). The primary outcomes of stroke and MI were 4.8% [95% confidence interval (CI) 1.5%-8.1%] and 0.6% (95% CI 0%-1.8%). The combined outcome event of non-fatal stroke, non-fatal MI or death was 5.5% (95% CI 2.0%-9.0%). Crescendo TIA, contralateral ICA occlusion and urgent CEA were not associated (P > 0.2) with a higher 30-day stroke rate. Our findings indicate that the risk of early CEA in consecutive unselected patients with non-disabling AIS or TIA due to sCAS is acceptable when the procedure is performed within 2 weeks (or even within 2 days) from symptom onset.

Perivascular and subcutaneous adipose tissue differ in internal carotid artery (ACI) Stenosis patients

Background: There is growing evidence for a vasoregulatory and atherosclerosis-inducing role of local fat deposits around vessels. Aim of the study was to investigate gene expression profiles in paired human samples of subcutaneous (sc) and perivascular (pv) adipose tissue (AT) and to link it to clinical and anthropometric characteristics of carotid stenosis patients.

Comparison of Color Doppler Ultrasound and CT Angiography in Carotid Artery Stenosis: A Four Years’ Experience from a Single Medical Center

: Background: Carotid artery stenosis is the main cause of stroke, and evaluating the degree of carotid artery stenosis is of utmost importance in this regard. Objectives: The objective of this study is to compare color Doppler ultrasound (CD-US) and CT angiography in diagnosing carotid artery stenosis in patients referred to a medical imaging center. Patients and Methods: A total of 198 carotid arteries were evaluated in 99 patients. Patients older than 40 years of age, who were referred to our medical imaging center for the evaluation of carotid stenoses between 2008 and 2012, were enrolled in this study. All patients were examined by CD-US, and if the plaque were present in CD-US, the patients were also examined by CT angiography. In our study, carotid stenosis location, degree of stenosis, stenosis length, calcification, ulcer, and dissection were evaluated. Sensitivity, specificity, and agreement of the two methods were assessed. Results: Comparison results of CD-US and CT findings showed a specificity of 80.6%, sensitivity of 84.7%, and kappa coefficient of 0.60. The most common stenosis location was in the proximal portion of the internal carotid artery. Moreover, the agreement of the two methods in the 4th (70–99%) and 5th (100%) degrees stenosis was very good. Conclusions: The agreement of the two methods was very good for stenosis degree. CD-US had low sensitivity in comparison with CTA in the evaluation of calcification and ulcer. As a result, CTA is a complementary method for CD-US to show calcified plaques and ulcers.

Carotid artery stenosis in patients with chronic kidney disease undergoing dialysis: Epidemiological aspects, main risk factors and appropriate diagnostic criteria

Knowledge of the epidemiology and risk profile of peripheral vascular disease among patients with chronic kidney disease (CKD) has a potential role for determining its outcome. This study assessed the epidemiological aspects and risk factors of carotid artery stenosis (CAS), assessed by clinical ankle brachial index (ABI), in patients on dialysis. This study was performed on 84 patients with CKD undergoing hemodialysis (HD; n = 65) or peritoneal dialysis (PD; n = 19). The ABI was measured using a concurrent oscillometric method and Color Doppler sonography. An ABI value >0.9 was defined as normal. Severity of the stenosis was determined using B-Mode sonography. Overall, CAS was seen in 51.2% of the study patients. No significant difference was found in the overall prevalence of CAS between the HD and PD groups (50.8% vs. 52.6%, P = 0.552). The mean ABI in the HD and PD groups was 1.13 and 1.06, respectively. Among patient characteristics, advanced age was found to be a predictor of CAS in the study patients. Gender, type of dialysis or underlying risk factors could not predict CAS. ABI measurement was an acceptable predictor of CAS, with a receiver operator characteristic of 0.645. The optimal cut-off for ABI for predicting CAS was identified at 1.0; this yielded a sensitivity of 70.8% and a specificity of 63.6% for the test. In conclusion, a notable number of patients undergoing dialysis for CKD had CAS. The main predictive factor was advanced age. ABI measurement seems to be an acceptable tool to diagnose CAS.

Co-Existence of Carotid Artery Disease, Renal Artery Stenosis, and Lower Extremity Peripheral Arterial Disease in Patients With Coronary Artery Disease

In atherosclerosis, carotid artery stenosis (CAS), renal artery stenosis (RAS), lower extremity peripheral arterial disease (PAD), and coronary artery disease (CAD) are common pathologic lesions; their interrelationship is, however, unclear. We studied concomitant multiple atherosclerotic lesions in patients with CAD to understand their prevalence and relations. A cross-sectional analysis was performed on data from consecutive patients who underwent nonemergent coronary angiography. Simultaneous carotid and renal artery Doppler studies and ankle-brachial systolic pressure measurements were reviewed to diagnose concomitant lesions and their severity. The study included 1,734 patients (aged 71 ± 9 years; 70% men), with prevalences of CAS, RAS, lower extremity PAD, and CAD of 6%, 7%, 13%, and 72%, respectively. In patients with CAD (n = 1,253), the prevalences of CAS, RAS, and lower extremity PAD were 7%, 9%, and 16%, respectively; 24% CAD patients had ≥1 additional atherosclerotic lesion. Significant interactions among the prevalences of these lesions were found. In addition, the extent of CAD and the prevalences of CAS, RAS, and lower extremity PAD were significantly correlated. Multivariate analysis supported these relationships. In conclusion, the prevalences of CAS, RAS, lower extremity PAD, and CAD were strongly interrelated in the study population; CAD severity was related to that of other atherosclerotic lesions. Additional systematic screening of other concomitant atherosclerotic lesions is recommended, especially in CAD patients having multivessel disease, left main disease, and/or already diagnosed with other concomitant atherosclerotic lesions.

Levels of Circulating Neopterin in Patients with Severe Carotid Artery Stenosis Undergoing Carotid Stenting

The association between an elevated serum neopterin level and the development of coronary artery complex lesions has been extensively assessed; however, the correlation between the serum neopterin level and the development of carotid artery stenosis has seldom been reported. This study tested whether this biomarker is increased in patients with severe carotid artery stenosis(≥70%) undergoing carotid artery(CA) stenting and investigated independent predictors of an increased circulating neopterin level. Fifty patients with severe CA stenosis(CAS) undergoing CA stenting were consecutively enrolled in this study from January 2009 through December 2011. The serum neopterin levels of age- and gender-matched acute ischemic stroke(AIS) patients(n=120) and control subjects(CS)(n=33) were also measured. A blood sample was prospectively collected from each patient in the catheterization room. The serum levels of neopterin were significantly higher in the CAS patients than in the AIS patients or CS and significantly higher in the AIS patients than in the CS(all p＜0.001). An analysis of the variables of 170 patients(CAS＋AIS) demonstrated that age, a previous history of stroke and severe CAS were significantly correlated with an increased serum level of neopterin(all p＜0.005). A multivariate binary logistic regression analysis of the severe CAS patients(n=50) demonstrated that age and the creatinine level were independent predictors of a high neopterin level(neopterin level ≥16.52 ng/dL, i.e., according to the median value of neopterin)(all p＜0.05). The circulating neopterin levels are significantly higher in patients with severe CAS than in those with AIS. The presence of CAS, age and the creatinine level were significantly correlated with an increased serum neopterin level.

Significance of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting

Significance of asymptomatic carotid artery stenosis in patients undergoing coronary artery bypass grafting

GW24-e3052 Ultrasonographic evaluation over the hypercomplex wavelet on the change of vortex-mediated vascular endothelial cadherin

ObjectivesUltrasonogram treated by hypercomplex wavelet transform (HWT) can maintain the image spectral characteristics,integrate spatial information and effectively avoid the flow of image noise; however, the evaluation of the flow shear...

Staying Smart on Statins

Asymptomatic carotid artery stenosis patients given statins have a lower incidence of stroke and cognitive dysfunction after surgery.

Cerebral perfusion in patients with carotid stenosis undergoing carotid endarterectomy

Objective We evaluated perfusion parameters of symptomatic and asymptomatic patient groups before and after CEA by Dynamic Susceptibility Contrast (DSC-MRI).Methods 35 independent patients with a unilateral high-grade carotid stenosis,underwent DSC-MRI evaluation before CEA as well as in 7 and 180 days after CEA.Quantitative perfusion parameters were calculated separately in each hemisphere.Results The improving trend over time was greater in the symptomatic carotid stenosis group and was best seen in MMT(P ＜ 0.05).Conclusions According to the data of DSC-MRI examination in both preoperation and postoperation,the cerebral perfusion changes are significantly difference between symptomatic and asymptomatic carotid artery stenosis patients. Key words: Carotid stenosis; Hemodynamics; Dynamic susxeptibility contrast MR imaging

Application of pressure wire in carotid artery stenting

Background Nowadays, critical carotid stenosis lacks appropriate treatment standards, and carotid artery stenting (CAS) needs more direct guidance. This study aims to investigate the possibility of applying pressure wire in CAS, and the guidance of pressure gradients in choosing indications of CAS. Methods From May 2012 to October 2012, 32 consecutive cases with carotid stenosis undergoing CAS were enrolled. Preoperative and postoperative carotid ultrasound and CT perfusion imaging were performed, and intraoperative measurements of endovascular pressure gradients before and after stent implantation were recorded to evaluate intracranial circulation compensation. Results Preoperative carotid ultrasound showed the rate of stenosis in 32 cases was ≥ 70% or nearly total occlusion. Doppler measurement of peak systolic velocity (PSV) of the stenosed vessel ranged 184-718 cm/s. Digital subtraction angiography (DSA) examination showed the stenosis rates were 50%-70% in 7 cases, 70%-90% in 16 and > 90% in 9. The coincidence rate of carotid ultrasound and DSA was 84.38% (27/32), and the acquisition rate of intraoperative carotid pressure gradients was 100% . Pressure gradients before stent implantation were 10-92 mm Hg, with an average of (41.45 ± 25.50) mm Hg, and pressure gradients after stent implantation were 0-15 mm Hg, with an average of (3.44 ± 3.47) mm Hg. DSA revealed 4 cases with good intracranial circulation compensation and 28 cases with poor intracranial circulation compensation. Conclusion Pressure wire can be safely and effectively used in CAS to acquire pressure gradients between the two ends of stenosis segment. For carotid artery stenosis patients lacking of intracranial circulation compensation, pressure gradients become higher as stenosis rate increases within a certain range. Therefore, CAS for stenosis with lower pressure gradients should be reconsidered.

Calcium at the carotid siphon as an indicator of internal carotid artery stenosis

Carotid siphon calcification is often visible on unenhanced head CT (UCT), but the relation to proximal carotid artery stenosis (CAS) is unclear. We investigated the association of carotid siphon calcification with the presence of CAS. This IRB-waived retrospective study included 160 consecutive patients suspected of stroke (age 64 ± 14 years, 63 female) who underwent head UCT and CTA of the head and neck. CAS was rated on CTA as not present or present with non-significant (<50 %), moderate (50-69 %) or significant (≥70 %) stenosis. Presence, shape (on UCT) and volume (on CTA) of carotid siphon calcifications were related to CAS. Carotid siphon calcification was absent in 41 % of patients and bilateral in 94 % of those with calcifications. Presence, shape and volume of calcification resulted in odds ratios for having significant CAS of 10.1, 3.9 and 8.4, with 95 % CIs of 1.3-79.6, 1.1-14.1 and 2.6-26.8, respectively. Corresponding NPVs were 0.98, 0.98 and 0.96, while PPVs were 0.14, 0.07 and 0.29, respectively. Absence of calcification in the carotid artery siphon on UCT has high negative predictive value for carotid artery stenosis in patients with suspected stroke. However, siphon calcification is not a reliable indicator of significant carotid artery stenosis. • Many stroke patients do not have calcification in the carotid artery siphon. • Carotid stenosis ≥50 % is unlikely in stroke patients without siphon calcification. • Carotid siphon calcium is a poor indicator of significant carotid artery stenosis.