Carotid Artery Research Articles

An Audit of Carotid Dopplers in Sligo University Hospital

Abstract Background Stroke is a common and often disabling condition impacting thousands of individuals in Ireland annually 1. Timely screening for underlying etiologies is important in all patients presenting with stroke or transient ischaemic attack (TIA) to reduce recurrence risk. Carotid artery disease is frequently implicated as the cause 3. The 2023 National Clinical Guideline for Stroke for the United Kingdom and Ireland recommends carotid imaging be completed within one week of diagnosis of ischemic stroke or TIA for patients in whom potential carotid intervention would be appropriate. We aimed to assess the timing of Carotid Doppler scans in our hospital for patients presenting clinically with stroke or TIA. Methods The National Integrated Medical Imaging System (NIMIS) was used to generate a list of patients that had a Carotid Doppler scan over a six- month period (1st July 2022 to 31st December 2022). NIMIS was also used to identify the indication, setting, requesting department and timeliness of scans. Results A total of 96 Carotid & Vertebral Dopplers were performed. Majority of studies were performed on males (65%). The mean age of patients was 70 (±11.5) years. Most studies (55%) were done in an inpatient setting. Of all Carotid Dopplers performed, 94 (97%) had an appropriate indication. With regards to timeliness of carotid imaging, the median time from order to study completion varied between inpatients [2 days (IQR 1-3)] and outpatients [16 days (IQR 9-38)]. The majority (95%) of inpatient studies were completed within 7-days of order, while only 14% of outpatient studies were performed in this timeframe. Of the untimely outpatient scans done to investigate stroke or TIA, 2/33 (6%) had significant carotid stenosis. Conclusion Majority of Carotid Dopplers were done for appropriate indications. While inpatients studies were largely done in a timely manner, there is a significant delay in the completion of most outpatient studies.

An Audit of Best Medical Therapy Adherence Among Patients with Carotid Artery Stenosis Attending a Tertiary Stroke Centre

Abstract Background Carotid artery stenosis (CAS) is estimated to cause 11-28% of ischaemic strokes annually. The primary objective of this audit was to assess current adherence to best medical therapy (BMT) to patients with CAS in a tertiary stroke centre. Our secondary aim was to assess stability, regression or progression of CAS whilst on BMT. Methods A retrospective chart review was conducted in a tertiary stroke centre over a six-week period. Patients were included if they were aged over 18 years, presenting to an outpatient stroke clinic, and had a known diagnosis of either symptomatic or asymptomatic CAS. The European Stroke Organisation Guidelines were used to define BMT. Results A total of 56 charts were reviewed at three weekly outpatient clinics. Of the 27 patients meeting our inclusion criteria 66% (n=18) were male, median degree of CAS was 50-70% and 78% (n=20) had symptomatic CAS. 89% were on BMT but only 56% achieved a low-density lipoprotein cholesterol (LDL-C) target of <1.8 (median 1.6 (range: 0.7-4.2) and only 66% (n=18) had a documented smoking status. 81% of patients with symptomatic CAS on BMT had stable stenosis, 5% had regression and 14% had progression of stenosis. 50% of asymptomatic patients had progression of the degree of their stenosis. Conclusion Overall adherence to BMT was good at 89% but there is room for improvement particularly in terms of lipid target level and documentation of risk factor status. BMT resulted in stable stenosis and low progression rates particularly in patients with symptomatic CAS. BMT and early detection are essential for management to control progression of CAS, but we have highlighted the opportunity to improve LDL-C targets. Further research is needed to evaluate if the results of this study are translatable to the stroke population in general.

The value of contrast-enhanced ultrasonography in predicting stroke occurrence: A prospective study

ObjectivesThis study aimed to investigate the association between contrast-enhanced ultrasound-detected (CEUS) perfusion patterns of carotid plaque and the occurrence of stroke. Materials and methodsThis prospective observational study finally enrolled 256 patients (151 of them having undergone CEUS) from 7851 patients who underwent carotid artery ultrasound from May 2019 to December 2019 with the endpoint being the occurrence of stroke. The risk factors and carotid ultrasound fetures was obtained from those patients. Analyze the relationship between these variables and stoke occurrence. ResultsPatients in the recurrent stroke group and those in the no-recurrent stroke group were statistically different in stenosis rate, plaque echo, fibrous cap integrity, calcification of fibrous cap, hypoechoic area within the plaque, and the pattern of neovascularization perfusion from plaque surface to plaque interior (P < 0.05). Upon adjusting for variables, in all subjects, Cox regression analysis showed that symptoms experienced within the past 6 months (RR = 2.486, 95 % CI: 1.282–4.821), moderate-to-severe carotid stenosis (RR = 2.407, 95 % CI: 1.480–4.593), calcification of fibrous cap (RR = 1.599, 95 % CI: 0.727–3.516) and patchy hypoechoic areas within plaque (RR = 2.486, 95 % CI: 1.107–5.578)independently predicted stroke occurrence across all subjects.; Among subjects underwent CEUS, Cox regression analysis demonstrated that moderate-to-severe carotid artery stenosis (RR = 2.105, 95 % CI: 1.425–4.510) and microbubbles entering the interior of the plaque from its surface (RR = 2.323, 95 % CI: 1.175–4. 594) were independent predictors of stroke occurrence. ConclusionsThe neovascularization perfusion pattern from the plaque surface to its interior serves as an independent predictor of stroke occurrence, thereby potentially enhancing clinical decision-making.

Retrospective Analysis of a Novel Grading System for Evaluating the Long-Term Benefit of Revascularization on Carotid Artery Stenosis

ObjectiveTo estimate revascularization benefit for carotid artery stenosis, with a novel grading system containing symptoms, stenosis, plaque, and collaterals collateral compensation (SSPC grading system). MethodsA retrospective multicenter study examined 945 consecutive patients diagnosed with carotid stenosis from January 2013 to December 2017. The cohort was classified into two groups: the revascularization group and the best medical therapy (BMT) group. Demographic, clinical, and lesion characteristics of all patients were recorded and five-year non-procedural stroke survival was calculated using Kaplan-Meier curve analyses. ResultsOf the 945 patients, 514 underwent carotid revascularization (483 for carotid endarterectomy [CEA] and 31 for transfemoral-carotid artery stenting [TF-CAS]) and 431 patients were treated with BMT. Patients in the revascularization group had a significantly higher proportion of preprocedural stroke/transient ischemic attack (TIA) and grades of stenosis. Of the patients in the revascularization group, 3.1% were classified as SSPC I, 10.3% as SSPC II, 41.4% as SSPC III, and 45.1% as SSPC IV. Meanwhile, 17.9% were classified as SSPC I, 19.7% as SSPC II, 49.2% as class III, and 13.2% had class IV in the BMT group. Procedural stroke developed in 13 patients (2.5%) following revascularization (10 of them were non-disabling). The overall rate of freedom from any non-procedural stroke was 94.1±1.1% in the revascularization group and 89.5±1.6% in the BMT group (P=0.01). Subgroup analysis was conducted for asymptomatic carotid stenosis (ACS) and carotid near-occlusion (CNO) patients. Non-significance was noted in the rate of freedom from any non-procedural stroke between revascularization and BMT in both ACS and CNO subgroups (P=0.09 and 0.12, respectively). Of note, in ACS patients graded as SSPC III, a significant difference in stroke survival was found between the revascularization and BMT group (96.0±2.0% vs. 89.1±2.4%, P=0.04). Meanwhile, in symptomatic CNO patients, similar results were found regarding SSPC classification (94.8±3.6% vs. 63.8±14.9%, P=0.01). ConclusionsThe SSPC grading system stratifies the patients with carotid artery stenosis and predicts the long-term benefits of revascularization. Meanwhile, potential revascularization benefits could be better attained via SSPC classes in specific patients with ACS and CNO.

Cerebral perfusion in patients with unilateral internal carotid artery occlusion by dual post-labeling delays arterial spin labeling imaging.

Global and regional cerebral blood flow (CBF) changes in patients with unilateral internal carotid artery occlusion (ICAO) are unclear when the dual post-labeling delays (PLD) arterial spin labeling (ASL) magnetic resonance imaging (MRI) technique is used. Manual delineation of regions of interest for CBF measurement is time-consuming and laborious. To assess global and regional CBF changes in patients with unilateral ICAO with the ASL-MRI perfusion technique. Twenty hospitalized patients with ICAO and sex- and age-matched controls were included in the study. Regional CBF was measured by Dr. Brain's ASL software. The present study evaluated differences in global, middle cerebral artery (MCA) territory, anterior cerebral artery territory, and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) regions (including the caudate nucleus, lentiform nucleus, insula ribbon, internal capsule, and M1-M6) and brain lobes (including frontal, parietal, temporal, and insular lobes) between ICAO patients and controls at PLD 1.5 s and PLD 2.5 s. When comparing CBF between ICAO patients and controls, the global CBF in ICAO patients was lower at both PLD 1.5 s and PLD 2.5 s; the CBF on the occluded side was lower in 15 brain regions at PLD 1.5 s, and it was lower in 9 brain regions at PLD 2.5 s; the CBF in the contralateral hemisphere was lower in the caudate nucleus and internal capsule at PLD 1.5 s and in M6 at PLD 2.5 s. The global CBF in ICAO patients was lower at PLD 1.5 s than at PLD 2.5 s. The ipsilateral CBF at PLD 1.5 s was lower than that at PLD 2.5 s in 15 regions, whereas the contralateral CBF was lower at PLD 1.5 s than at PLD 2.5 s in 12 regions. The ipsilateral CBF was lower than the contralateral CBF in 15 regions at PLD 1.5 s, and in M6 at PLD 2.5 s. Unilateral ICAO results in hypoperfusion in the global and MCA territories, especially in the ASPECTS area. Dual PLD settings prove more suitable for accurate CBF quantification in ICAO.

Hematological parameters in patients with internal carotid artery atherosclerotic stenosis during tooth extraction.

Hematological parameters in patients with internal carotid artery atherosclerotic stenosis during tooth extraction.

PK Papyrus covered stent to treat traumatic pseudoaneurysm of the internal carotid artery – A technical note and review of the literature

Intracranial pseudoaneurysms account for approximately 1% of all intracranial aneurysms and are associated with high rebleeding risk and mortality. Traditional treatments of these lesions include microsurgical or endovascular reconstruction and parent vessel sacrifice. Reconstruction of the vessel is challenging due to poor vessel integrity and incomplete wall structure. An alternative endovascular reconstructive treatment includes deployment of a covered stent. Original covered stents such as the Jostent Graftmaster and the Willis stent suffer from stiff constructs that limit deployment in tortuous anatomy. The PK Papyrus covered coronary stent may be a satisfactory treatment alternative for these lesions. We present a case of an enlarging traumatic distal cavernous segment internal carotid artery pseudoaneurysm treated with trans-radial deployment of a PK Papyrus stent at our institution. We propose that the PK Papyrus covered stent may be an alternative reconstructive endovascular treatment for intracranial pseudoaneurysms. Further larger scale prospective case series would provide further support for this management strategy.

Research on carotid artery plaque anomaly detection algorithm based on ultrasound images

Carotid artery plaque is a key factor in stroke and other cardiovascular diseases. Accurate detection and localization of carotid artery plaque are essential for early prevention and treatment of diseases. However, current carotid artery ultrasound image anomaly detection algorithms face several challenges, such as scarcity of anomaly data in carotid arteries and traditional convolutional neural networks (CNNs) overlooking long-distance dependencies in image processing. To address these issues, we propose an anomaly detection algorithm for carotid artery plaques based on ultrasound images. The algorithm innovatively introduces an anomaly sample pair generation method to increase dataset diversity. Moreover, it employs an improved adaptive recursive gating pyramid pooling module to extract image features. This module significantly enhances the model’s capacity for high-order spatial interactions and adaptive feature fusion, thereby greatly improving the neural network’s feature extraction ability. The algorithm uses a Sigmoid layer to map each pixel’s feature vector to a probability distribution between 0 and 1, and anomalies are detected through probability threshold binarization. Experimental results show that our algorithm’s AUROC index reached 90.7% on a carotid artery dataset, improving by 2.1% compared to the FPI method. This research is expected to provide robust support for the early prevention and treatment of cardiovascular diseases.

The Evolution of Carotid Surgery

This review traces the evolution of carotid surgery from its ancient roots to modern practice. The first significant appreciation of the carotid arteries’ role in cerebral ischemia was made by Johann Jakob Wepfer in his 1658 book on apoplexy, which described the separate blood supply to each cerebral hemisphere by the carotid arteries. The 16th-19th centuries saw initial attempts at carotid ligation, while the 20th century marked significant advancements. The first carotid endarterectomy (CEA) by DeBakey, Cooley, and Eastcott in the 1950s paved the way for a new technique in carotid surgery and many subsequent refinements in surgical techniques related to CEA. The latter half of the 20th century brought innovations such as patch angioplasty, microsurgical techniques, and intraoperative shunting, significantly improving outcomes. Pivotal clinical trials established CEA as the standard treatment for symptomatic carotid stenosis. The emergence of carotid artery stenting (CAS) in the 1980s introduced a less invasive alternative, sparking ongoing debates about optimal treatment strategies. Recent developments include transcarotid artery revascularization (TCAR) and transfemoral CAS, with studies comparing their efficacy to traditional CEA. Current research focuses on plaque morphology and novel diagnostic factors to further personalize treatment strategies for carotid artery stenosis.

The role of inflammation biomarkers in carotid artery stenosis procedures

BackgroundCarotid revascularization procedures, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS), can lead to restenosis. Monitoring restenosis onset through biomarkers is crucial in clinical practice. This study aimed to evaluate inflammation biomarkers in CEA and CAS to determine their predictive value for restenosis risk post-procedure. MethodsA retrospective analysis was conducted on the clinical records of patients with carotid stenosis who underwent CEA or CAS over one year at the Vascular Surgery departments of an interuniversity center. Eligible asymptomatic patients with carotid stenosis (70-99%) underwent revascularization. Differences between pre- and early post-procedural inflammation indices were assessed, and restenosis risk was evaluated using Receiver Operating Curve analysis and logistic regression. ResultsThe cohort comprised 100 patients, 68 undergoing CEA and 32 undergoing CAS. Significant values were observed for inflammation ratios post-CEA: neutrophils to lymphocytes ratio (NLR) (p=0.036), platelets to lymphocytes ratio (PLR) (p=0.009), monocytes to lymphocytes ratio (MLR) (p<0.001), systemic inflammation index (SII) (p=0.024), systemic immune response index (SIRI) (p=0.003), and aggregate inflammation response index (AISI) (p<0.001). At 12-month follow-up, 12% of patients experienced restenosis; 50% were men and 50% women. Women showed a higher restenosis rate (26.1% vs 7.8%). Pre-intervention NLR (OR [95% CI] = 13.38 [1.88 to 95.44], p=0.010) and SIRI (OR [95% CI] = 10.22 [2.65 to 39.43], p=0.001) remained significantly associated with restenosis after adjusting for sex and smoking. ConclusionThe study provided a predictive model for restenosis, identifying pre-intervention NLR and SIRI as independent predictors of restenosis at 12-month follow-up.

Treatment of Symptomatic Carotid Webs

The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America. Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023. 10 patients had carotid webs, six (60%) were females. Median age was 54.5 years (range: 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n=9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range: 3 days- 108 months). Four (40%) patients underwent surgical treatment within one month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range: 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range: 6 - 108 months). These six patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and three (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range: 6-46 months), one patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequalae of their initial strokes, and another patient has suffered 3 non-ischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other seven patients remain without new neurological events. Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.

Arterial spin labeling detects trapped labeled spins in flow-diverted aneurysms and it reflects intra-aneurysmal flow stasis.

This study evaluated arterial spin labeling (ASL) imaging findings in flow-diverted aneurysms (FD-ANs). Twenty-one patients with internal carotid artery aneurysms treated with flow-diverter stent (FDS) were included. Time-of-flight magnetic resonance angiography (TOF-MRA) and ASL were performed before and after follow-up digital subtraction angiography (DSA) on the day, 6 months, and/or 1 year after treatment. Two radiologists rated the clarity of the depiction of FD-ANs for MRA on a 3-point scale and the ASL signal intensity of the aneurysm as negative or positive. A neurosurgeon assessed DSA findings using the O'Kelly-Marotta (OKM) grading scale, categorizing them into filling and stasis grades. The 23 examinations were classified according to the OKM grading scale, and the proportion of ASL-positive cases and the proportion of cases with MRA scores of 1-2 (detectable) were calculated for each grade. The relationship between the OKM grading scale and ASL positivity or MRA detectable was examined using Fisher's exact test. Of seven examinations where the statis grade was 1 or 2, no examinations showed ASL positivity. However, among the 16 examinations in which the stasis grade was 3, 9 examinations showed ASL positivity. A significant association was observed between stasis grade and ASL positivity (p = 0.035). In contrast, no significant relationship was observed between the OKM grading scale and the MRA 3-point scale. High-signal ASL in FD-ANs could reflect stasis within the aneurysm; therefore, noninvasive ASL can indicate reduction in intra-aneurysmal blood flow after treatment and reperfusion during posttreatment observation.

Contemporary Management and Outcomes of Carotid Artery Dissection

Carotid artery dissection is a significant cause of stroke and the leading etiology of ischemic stroke in young and middle-aged individuals. The management of carotid artery dissection is continually evolving and varies based on the patient's clinical presentation. While carotid dissection is typically managed medically, endovascular intervention may be warranted in certain cases, and open surgical intervention is rarely employed.This qualitative review examines contemporary management strategies for cervical carotid artery dissection, highlighting three illustrative cases where endovascular intervention was utilized. We present one case of traumatic etiology with acute stroke symptoms, another traumatic case with progressing dissection and pseudoaneurysm evident on imaging, and a case of iatrogenic carotid dissection. Through these cases, we aim to elucidate the decision-making process and outcomes associated with endovascular treatment in the context of carotid artery dissection.

Τhe styloid process length and the stylohyoid chain ossification affect its relationship with the carotid arteries

PurposeThe elongated styloid process (SP) is associated with internal carotid artery (ICA) dissection, due to its close relationship with the vessel. However, the relationship with the variable ossified stylohyoid chain (SHC) has been scarcely studied. The current study investigated the relationship between the temporal bone's SP and the external and internal carotid arteries (ECA and ICA). The hypothesis was that the morphological variants of the SP influence this relationship. MethodsSixty multidetector computed tomography angiographies (120 heminecks) were randomly selected and retrospectively analyzed. SP elongation and the degree of SHC ossification were assessed. The distances (mm) between the SP and the carotid arteries (CAs) were measured. ResultsElongated SPs were present in 21 patients (35%), while 18 patients (30%) exhibited variable degrees of SHC ossification. The mean distance from the SP tip and ECA was 5.45±3.01mm from the ECA and 6.16±3.11mm to the ICA. The minimum distance between SP and ECA was 3.96±2.74mm, and between SP and ICA was 4.72±2.73mm. A statistically significant reduction in SP-ICA distance was observed in cases with elongated SP and SHC ossification, while the SP-ECA distance was statistically significantly shorter in cases of SP elongation. Additionally, three novel topographical patterns between the SP and surrounding vascular structures were identified. ConclusionsSP elongation and variable SHC ossification may impact the spatial relationship between the SP and the ICA/ECA. The proximity of the SP to the carotid arteries, particularly the ICA, holds clinical significance, as a reduced distance may predispose patients to carotid artery dissection, increasing the risk of stroke.

Assessment of image-derived input functions from small vessels for patlak parametric imaging using total-body PET/CT.

The image-derived input function (IDIF) from the descending aorta has demonstrated performance comparable to arterial blood sampling while avoiding its invasive nature in parametric imaging. However, in conventional PET, large vessels may not always be within the imaging field of view (FOV). This study aims to evaluate the efficacy of dynamic parametric Ki imaging using image-derived input functions (IDIFs) extracted from various arteries, facilitated by total-body PET/CT. Twenty-three participants underwent a 60-minute total-body [18F]FDG PET scan. Data from each subject were used to reconstruct both total-body PET images and short-axis field-of-view PET images at different bed positions, each with a 25cm axial field-of-view (AFOV). Partial volume correction (PVC) was performed using the blurred Van Cittert iterative deconvolution. IDIFs extracted from the descending aorta, carotid artery, abdominal aorta, and iliac artery were employed for Patlak analysis. The resulting Ki images were compared using quantification indicators and subjective assessment. Linear regression analysis was conducted to examine the correlation of Ki values among IDIFs in normal organ and lesion regions of interest (ROIs). High similarities were observed in Ki images derived from the IDIFs from the descending aorta and other arteries, with a median structural similarity index measure (SSIM) above 0.98 and a median peak signal-to-noise ratio (PSNR) above 37dB. Linear regression analysis revealed strong correlations in Ki values (r² > 0.88) between the descending aorta and the three alternative vessels, with slopes of the linear fits close to 1. No significant difference in lesion detectability among IDIFs was found, as assessed visually and using metrics such as tumor-to-background ratio (TBR) and contrast-to-noise ratio (CNR) (P < 0.05). IDIFs from smaller vessels can reliably reconstruct parametric Ki images without compromising lesion detectability, providing clinically relevant information.

Left versus right carotid artery IMT: differential impact of age, gender, and cardiovascular risk factors.

Carotid artery intima-media thickness (IMT), an important clinical marker of atherosclerosis, is used widely in screening for cardiovascular risk and prognosis. Measurements of carotid artery IMT are made on both the left and right sides of the body, however as per the Mannheim consensus, an average of these measurements is usually reported. Nevertheless, there is considerable debate whether there are side differences in the carotid artery IMT in terms of both measurements and determinants. In a large sample of Caucasian patients (n = 1888) referred for cardiovascular risk assessment, we compared the left and the right common carotid artery IMT measurements, and assessed whether age, gender and cardiovascular risk factors have differential effects. We found that the left common carotid artery IMT (0.7141 ± 0.1733mm) is larger than the right (0.6861 ± 0.1594, p < 0.0001), but not in the young (< 30years) or the elderly (> 69years), and that this side difference is less in women (0.019 ± 0.116mm) than in men (0.036 ± 0.148mm, p < 0.001). In addition to age (p < 0.0001) and gender (p < 0.0001), the left common carotid artery IMT was determined by dyslipidaemia (protective, p = 0.016) and diabetes mellitus (p = 0.022); whereas the right common carotid artery IMT was determined by hypertension (p = 0.0002). The differential determinants of left versus right common carotid artery IMT were similar in men and women, and in young and old. In conclusion, side differences in measurements of the common carotid artery IMT depend upon age and gender. In addition, cardiovascular risk factors have differential effects on the left and right common carotid artery IMT.

Differentiating extradural head and neck arterial fenestrations from other intraluminal abnormalities

Background and PurposeArterial fenestrations are a benign entity arising from a failure of fetal fusion. However, fenestrations in the head and neck may be misinterpreted as carotid webs or dissections. Given differences in clinical management, the differentiation of these entities is imperative. We aim to document the prevalence of these entities on CTA imaging and highlight imaging features for confident differentiation. Materials and MethodsWe retrospectively reviewed head and neck CTA studies performed at our institution over an 18-month period. The extradural common carotid, internal carotid, external carotid, and vertebral arteries were inspected for intraluminal abnormalities. These abnormalities were classified as fenestration, web, or dissection. Location and associated non-atherosclerotic calcification, pseudoaneurysm, or thrombosis were also documented. ResultsA total of 1800 head and neck CTAs were examined. Normal extradural arteries were seen in 1731 patients (1731/1800; 96.2 %). An intraluminal abnormality was evident in the remaining 69 patients (69/1800; 3.8 %). There were 16 carotid webs (16/1800; 0.9 %), 46 dissections (46/1800; 2.6 %), and 7 fenestrations (7/1800; 0.4 %). An associated non-atherosclerotic pattern of calcification was only identified in a single fenestration case (1/7; 14.3 %). Thrombosis was not identified in any fenestration case. ConclusionArterial fenestrations of the extradural head and neck arterial vasculature are evident on 0.4 % of CTAs. It is important to differentiate these benign entities from carotid webs and arterial dissections. With the appropriate knowledge and interpretive tools, characteristic imaging findings on CTA can be used for reliable differentiation.

The Relationship Between NLRP3 Inflammasome and Its Downstream Inflammatory Factors in Obstructive Sleep Apnea Patients with Carotid Atherosclerosis Under Cigarette Exposure

Aim: To study the relationship between NLRP3 (nucleotide oligomerization domain [NOD]-, leucine-rich repeats [LRR]-, and pyrin domain-containing protein 3) inflammasome and its downstream inflammatory factors in obstructive sleep apnea (OSA) patients with carotid atherosclerosis (CAS) under cigarette exposure, further exploring the risk factors of CAS in OSA patients. Methods: A total of 109 adult males who underwent polysomnography and carotid artery ultrasonography in our hospital from October 2019 to December 2021 were selected. According to the detection results, they were divided into the OSA group, the CAS group, and the OSA combined CAS group; additionally, 29 healthy subjects who underwent a physical examination were also included. According to whether they were smoking, the groups were further divided into smoking and non-smoking groups. The age, body mass index (BMI), blood pressure, apnea-hypopnea index (AHI), lowest blood oxygen saturation (LSaO2), carotid intima-media thickness (CIMT), levels of blood sugar, blood low-density lipoprotein cholesterol (LDLc), and serum NLRP3, interleukin-1β (IL-1β), and interleukin-18 (IL-18) of all subjects were recorded. Results: The OSA combined CAS group had higher LDLc levels and AHI and lower LSaO2 than the OSA group and CAS group. The levels of serum NLRP3, IL-1β, and IL-18 in the OSA group were higher than those in the normal control group (P &lt; 0.05); and those in the OSA combined CAS group were higher than the OSA group and CAS group (P &lt; 0.05), regardless of cigarette exposure. Considering cigarette exposure, serum NLRP3, IL-1β, and IL-18 levels were higher in the OSA, CAS, and OSA combined CAS smoking groups than those in the non-smoking group (P &lt; 0.05). Under cigarette exposure, AHI, LDLc, NLRP3, IL-1β, and IL-18 were significantly positively correlated (P &lt; 0.05), and LSaO2 was negatively correlated with CAS in OSA (P &lt; 0.05). AHI, LSaO2, LDLc, NLRP3, and IL-1β are the risk factors for OSA combined with CAS. Conclusion: LSaO2, AHI, LDLc, NLRP3, and IL-1β are the important risk factors for OSA combined with CAS under cigarette exposure, and their levels can be used to predict the occurrence of CAS in OSA.

Molecular profiling of a rat model of vascular dementia: Evidences from proteomics, metabolomics and experimental validations

Decrease of cerebral blood flow is the primary cause of vascular dementia (VD), but its pathophysiological mechanisms are still not known. This study aims to profile the molecular changes of a rat model of VD induced by bilateral common carotid artery ligation. The Morris water maze and new object recognition tasks were used to test the cognitive function of rats. Hematoxylin and Eosin (HE) staining was used to detect pathological changes in the hippocampus. After confirming the model, proteomics was used to detect differentially expressed proteins in the hippocampus, and metabolomics was used to detect differential metabolites in rat serum. Thereafter, bioinformatics were used to integrate and analyze the potential molecular profile. The results showed that compared with the sham control group, the spatial and recognition memory of the rats were significantly reduced, and pathological changes were observed in the hippocampal CA1 region of the model group. Proteomic analysis suggested 206 differentially expressed proteins in the hippocampus of VD rats, with 117 proteins upregulated and 89 downregulated. Protein-protein interaction network analysis suggested that those differentially expressed proteins might play crucial roles in lipid metabolism, cell adhesion, intracellular transport, and signal transduction. Metabolomics analysis identified 103 differential metabolites, and comparison with the human metabolome database revealed 22 common metabolites, which predicted 265 potential targets. Afterwards, by intersecting the predicted results from metabolomics with the differentially expressed proteins from proteomics, we identified five potential targets, namely ACE, GABBR1, Rock1, Abcc1 and Mapk10. Furthermore, western blotting confirmed that compared with control group, hippocampal GABBR1 and Rock1 were enhanced in the model group. Together, this study showed the molecular profile of VD rats through a combination of proteomics, metabolomics, and experimental confirmation methods, offering crucial molecular targets for the diagnosis and treatment of VD.

Soluble Glycoprotein VI Levels Assessed Locally within the Extra- and Intracerebral Circulation in Hyper-Acute Thromboembolic Stroke: A Pilot Study.

Background: Severe acute ischemic stroke (AIS) is mainly caused by thromboembolism originating from symptomatic carotid artery (ICA) stenosis or in the heart due to atrial fibrillation. Glycoprotein VI (GPVI), a principal platelet receptor, facilitates platelet adherence and thrombus formation at sites of vascular injury such as symptomatic ICA stenosis. The shedding of GPVI from the platelet surface releases soluble GPVI (sGPVI) into the circulation. Here, we aimed to determine whether sGPVI can serve as a local biomarker to differentiate between local atherosclerotic and systemic cardiac thromboembolism in AIS. Methods: We conducted a cohort study involving 105 patients undergoing emergency endovascular thrombectomy (EVT) for anterior circulation stroke. First, sGPVI concentrations were measured in systemic arterial plasma samples collected at the ipsilateral ICA level, including groups with significantly (≥50%) stenotic and non-stenotic arteries. A second sample, taken from the intracerebral pial circulation, was used to assess GPVI shedding locally within the ischemic brain. Results: Our analysis revealed no significant increase in systemic sGPVI levels in patients with symptomatic ≥ 50% ICA stenosis (3.2 [95% CI 1.5-5.0] ng/mL; n = 33) compared with stroke patients without significant ICA stenosis (3.2 [95% CI 2.3-4.2] ng/mL; n = 72). Additionally, pial blood samples, reflecting intravascular molecular conditions during collateral flow, showed similar sGPVI levels when compared to the systemic ICA samples in both groups. Conclusions: Our findings indicate that GPVI is not locally cleaved and shed into the bloodstream in significant amounts during hyper-acute ischemic stroke, neither at the level of symptomatic ICA nor intracranially during collateral blood supply. Therefore, sGPVI does not appear to be suitable as a local stroke biomarker despite strong evidence of a major role for GPVI-signaling in stroke pathophysiology.