Carotid Compression Research Articles

Noninavasive angiography for the diagnosis of carotid artery disease using Doppler ultrasound (carotid artery Doppler).

To detect stenosis in the carotid artery with a bidirectional continuous-wave Doppler ultrasound device, the following noninvasive procedure, applied on 800 patients and compared with 249 angiograms of 186 patients, has proved to be about 90% reliable. Measurements of flow signals were taken over the terminal branches of the ophthalmic artery (supratrochlear and supraorbital arteries) and averaged. Compression of superficial temporal and facial arteries revealed flow direction and common carotid artery compression revealed the supplying blood vessel and the effectiveness of the circle of Willis. Measurements over the common carotid arteries were used to evaluate peripheral resistance. A set of eight criteria was used; the diagnostic value of each criterion was calculated by comparing 138 pathological Doppler findings in 123 patients with the angiograms. If reverse flow direction in supratrochlear or supraorbital artery was used alone, only 43% correct diagnoses would have resulted. A more severe stenosis is not necessarily correlated with a more weighted criterion; a subset of criteria is less efficient than the combination of all criteria. Application during 32 extracranial endarterectomies on 28 patients informed the surgeon immediately about the hemodynamic effect of the surgical intervention. Rethrombosis was diagnosed in two patients by postoperative Doppler examination.

Two minute slope inhalation technique for cerebral blood flow measurement in man. 2. Clinical appraisal.

The two minute slope technique for measuring CBF was devised primarily to study the response of the cerebral circulation to physiological stimuli. In this paper, measurements of the precision of the technique when applied to various groups of people are described, and measurements on normal subjects of the global and regional CBF changes in response to hyperventilation and hypercapnia are presented. It is shown that CBF measured using this technique during percutaneous carotid compression may prove useful in the prediction of cerebral ischaemia in patients who are candidates for carotid ligation.

Noninvasive diagnosis of carotid occlusion by ocular pneumoplethysmography.

An ocular pneumoplethysmograph was devised to measure the systolic pressure in the ophthalmic artery and to obtain calibrated pulse volume changes from the ocular globe, with simultaneous recording from both eyes. The instrument is self-contained and portable. It can be applied by paramedical personnel, and the graphic recording is readily interpreted by the physician. It has proved to be 100% accurate in noninvasively detecting unilateral carotid occlusion or preocclusive stenosis. This technique, when combined with carotid compression, has been shown to be most valuable in assessing the tolerance of a cerebral hemisphere to proximal carotid occlusion. It was used to evaluate a wide variety of carotid arterial lesions. Elective carotid resection without graft replacement and urgent and elective carotid ligations were performed, based on the preoperative prediction that such procedures would be tolerated without neurological injury. The instrument and the technique of its application are simple, safe, and accurate.

Tachycardia- and bradycardia-dependent left bundle branch block associated with first degree a-v block. A study using his bundle electrogram during carotid sinus compression.

His bundle electrographic examination was performed during carotid sinus compression as well as atrial pacing in a patient who exhibited intermittent left bundle branch block (LBBB) and first degree A-V block. LBBB was observed at the corrected RR intervals below 920 msec and above 1600 msec. The QRS complexes showed normal intraventricular conduction between these 2 values. The critical cycle lengths could not be determined when ordinary RR intervals were used. The HQ interval remained constant at 70 msec regardless of the pattern of intraventricular condution. It was demonsrated that the patient had both tachycardia- and bradycardia-dependent LBBB with first degree A-V block due to HV block. The authors believe this to be the first case of tachycardia- and bradycardia-dependent bundle branch block studied by His bundle electrography. The important role of His bundle recordings and carotid sinus compression in the diagnosis of rate dependent intraventricular conduction disturbance was stressed and possible mechanisms underlying this rare condition were discussed.

Measurement of collateral cerebral hemispheric blood pressure by ocular pneumoplethysmography

A new technic of ocular pneumoplethysmography for the simultaneous determination of blood pressures in the ophthalmic artery branches of the internal carotid arteries is described. It provides a noninvasive, atraumatic method for assessing hemispheric blood flow. When performed with simultaneous carotid compression, it provides a means for assessing the availability of collateral blood flow to the ipsilateral cerebral hemisphere. Clinical applications related to carotid artery disease and carotid artery surgery are discussed.

Carotid compression tonography. Correlation with bilateral carotid arteriography in the diagnosis of extracranial carotid occlusive disease.

One hundred twenty two patients ahd carotid compression tonography (CCT) followed by bilateral carotid arteriogaraphy. Inthe group (82 patients) which was felt to have significant occlusive disease of internal carotid at the level of carotid bifurcation (smaller than 50 percent stenosis), the CCT showed a 92 per cent correlation with arteriography. Of the group (48 patients) that underwent endarterectomy, there was a 94 per cent correlation with CCT testing. In 40 patients, with normal arteriogram or with less than 50 percent stenotic lesions on arteriography, there was a larger number (25% of patients with a CCT test which appeared to indicate decreased flow. Various reasons for this are discussed. The high correlation of the CCT test and carotid arteriography in the patients with surgically amenable lesions would suggest that the CCT test is a good noninvasive screening technique for the detection of significant occlusive disease of the extracranialcarotid vascular system.

A method for predicting localised areas of cerebral ischemia from visual evoked responses

Responses to light flashes recorded from several scalp electrodes of a normal subject at rest and during alternate compression of the carotid arteries in the neck are analysed. The differences found in response characteristics between the subject at rest and during carotid compression may serve as indicatory of localised areas of cerebral ischemia. The results indicate a strong evidence that information about localised areas of cerebral ischemia is contained in the cepstra of the averaged visual evoked responses. The probability with which such areas can be localised using cepstral values as samples and linear multiple regression techniques for classification purposes has been estimated for our procedure and our sample size as being: Pa = 79 ± 17 per cent for left-right localisation, and Pb = 61 ± 16 per cent for left-none-right localisation.

Cardiac effects of carotid sinus massage in old age.

The effects of carotid sinus massage in aged subjects with a high incidence of arteriosclerosis are described. In 71 men and 315 women tested, a slowing of more than 10 per cent of the heart rate was found in 25 per cent of the men and 19 per cent of the women, which is not of statistical significance in relation to sex. Only men showed a significant increase with age and the women had a significant preponderance of a right-sided response. The technique was found to be safe, although a review of reported side-effects suggests care is advisable and carotid compression must not occur. The findings are discussed in relation to those reported in younger subjects and in carotid sinus syndrome with syncope. The fact that men have an acquired increase in response in old age, which is not seen in women, may be a factor of importance in the explanation of why carotid sinus syncope is almost always seen in men. Carotid sinus sensitivity appears to diminish in old age and some of the ageing factors which might influence the carotid sinus reflex are examined.

Localized enlargement of the thyroid gland presenting as a pyriform sinus mass.

AbstractThis paper gives a brief description of the etiology, diagnosis and treatment of extracranial arteriovenous fistulas.These fistulas may be either acquired or congenital in origin. Their natural history is one of progression which can result in severe hemodynamic changes. Extracranial arteriovenous fistulas usually occur between the terminal branches of the external carotid artery and the lateral sinus or jugular venous systems. The most common symptom, pulsatile tinnitus, can often be decreased by common carotid artery compression unless there is a significant contribution from the vertebral arterial system.Selective arteriography utilizing subtraction technique is the most important diagnostic study.The recommended treatment is complete surgical excision of the fistula and ligation of all feeding vessels. The recurrence rate is higher with the other methods of control, such as simple ligation, irradiation, injection of sclerosing agents and embolization.Two patients with congenital arteriovenous fistulas are presented.

Evaluation of Effectiveness of Digital Carotid Compression Test by Electroencephalography

Evaluation of Effectiveness of Digital Carotid Compression Test by Electroencephalography

Proximal carotid ligation for internal carotid aneurysms. A long-term follow-up study.

✓ The results of proximal carotid ligation for internal carotid aneurysms in 106 patients over a 20-year period are presented. These confirm the belief that carotid ligation is a useful definitive procedure in patients with aneurysms on the internal carotid artery, including its bifurcation. Common carotid ligation is effective protection against recurrent hemorrhage, at the same time being safer than internal carotid ligation. Matas' test has limited applicability in patients being prepared for carotid ligation. Cerebral vasospasm seen on arteriograms, cerebral circulation studies with and without carotid compression, and intravascular pressure determinations at the time of surgery are more reliable methods to decide the timing, rate, and degree of occlusion of the vessel, and to decrease the incidence of postoperative ischemic complications.

Carotid Cavernous Sinus Fistula Closure Following Angiography

Closure of a carotid cavernous sinus fistula occurred following angiography. Although previous reports of similar events have suggested that carotid artery compression, irritating and vasoconstrictor effects of radiopaque media, or embolization might explain the closure, these mechanisms seemed unlikely here. There is a possibility that hypotension was the primary cause for closure.

Periodic variation in A-V conduction time: The ‘supernormal’ phase of A-V conduction. A study in differential dual A-V pathway conductivity and refractoriness

Summary A case is reported which manifested with periods of relatively short and relatively long P-R intervals — a manifestation analagous, but not identical, to alternation of conduction time. The periods of relatively short P-R intervals could be precipitated by carotid sinus compression. The mechanism is explained on the basis of dual A-V pathways with differential refractoriness and conduction times.

Results of Carotid Compression Tonographic test in Carotid and Vertebrobasilar Occlusion

Results of Carotid Compression Tonographic test in Carotid and Vertebrobasilar Occlusion

Intraocular pressure and common carotid occlusion.

A semilogarithmic relationship has been established between changes in intraocular pressure and ocular vascular volume after acute common carotid occlusion. This relationship has been used to derive a series of equations that relate the ocular blood volume change after acute common carotid occlusion and the resultant pressure changes in the intraocular vascular compartment by a theoretical constant termed the coefficient of vascular rigidity and a variable, Pco, that reflects the pressure dynamics in the carotid system after acute carotid occlusion. A method for estimating Pco in patients using multiple weight carotid compression tonography is described. Pco was found to vary from normal values in patients with chronic cerebrovascular disease.

Vascular distensibility in the eye.

Distensibility of the intraocular vascular bed was studied in the living cat eye by measuring the alterations of ciliary artery blood pressure and intraocular pressure induced by varying degrees of acute common carotid artery occlusion. A semilogarithmic relationship was found between alterations in ciliary artery blood pressure and ocular volume changes. The slope of this relationship, termed the coefficient of vascular rigidity, was found to be approximately 1.5 times the ocular rigidity in all eyes tested. Similar values were obtained by direct perfusion of the ophthalmic artery in enucleated cat eyes when alterations in vascular perfusion pressure were induced from a baseline value of 50 mm Hg. The results indicate that measurements of intraocular volume changes after acute common carotid compression may offer a clinical method of determining vascular rigidity in the eye.

The Detection of Carotid Artery Obstruction: A Correlation With Arteriography

Intravenous radioisotope arteriography, carotid compression ocular plethysmography, and supraorbital Doppler studies were more accurate than ophthalmodynamometry in the detection of the presence or absence of carotid artery obstruction in 35 patients. Abnormal results were present in patients with carotid obstruction who did not have a carotid bruit. The isotope method provides information about relative blood flow through the two carotid arteries. Ocular plethysmography and supraorbital Doppler studies provide information about collateral circulatory pathways in patients with carotid obstruction. Currently, they are most useful clinically in patients who are erroneously thought to have only intracranial vascular disease since abnormal results suggest an extracranial carotid lesion. These methods will not reveal abnormalities in patients with small, ulcerated carotid plaques which are a source of embolic material but which are not decreasing carotid blood pressure and flow.

頸動脈圧迫の脳循環, 脳波に及ぼす影響

健康青年9例を対象に, 30秒間の頸動脈圧迫試験を行い正常者の内頸静脈O2分圧と脳血流量の変化域を検討した. 内頸静脈O2分圧 (PjO2) の変化域は0.3±1.0mmHgであり, 脳血流量 (CBF) の変化域は2.9±3.5ml/100g Brain/min であった. 健康青年9例において, 脳波上異常所見を認めた例は1例もなく, 頸動脈圧迫によっても徐波化を呈した例もなかった.脳血流正常群例 (CBF50以上) でCBFは前値59.9, 同側圧迫時62.9, 反対側圧迫時59.1と変化なく, PjO2は前値33.3, 同側圧迫時33.4, 反対側圧迫時32.9とCBF同様変化を示さなかった. また脳波上頸動脈圧迫時徐波化を認めた例は1例もなかった.脳血流低下群 (CBF49.9以下) でCBFは前値41.7, 同側圧迫時34.8, 反対側圧迫時40.0で, PjO2は前値35.4, 同側圧迫時32.3, 反対側圧迫時35.1であった. 同側圧迫時のΔCBFは-6.7, ΔPjO2は-3.1と減少傾向を示していた. また頸動脈圧迫により脳波に徐波化を示した例は7例存在した.7例の頸動脈圧迫時徐波化を示す例は頸動脈または頭蓋内の大きな動脈の病変を有する例に多く, 脳血流量も41.0と著明に減少しており, 頸動脈圧迫により32.0と著明な減少を示し, ΔCBFは-9.0であった. PjO2は頸動脈圧迫により33.1より29.6と減少傾向にあり, ΔPjO2は-3.5であった.すなわち頸動脈圧迫により脳内副血行路が十分か否かを判定するためにその変化を内頸静脈O2分圧または脳血流量の変化を指標にしうることを実証した.なお頸動脈圧迫時, 呼吸の変化, 血圧の変化を考慮する必要があると思われる.

Changes in the electroencephalogram and in systemic blood pressure associated with carotid compression

SUMMARYCarotid compression was performed in 32 patients with diagnosed cerebrovascular occlusive disease and in 33 elderly asymptomatic subjects. Recording of EEG, ECG, systolic blood pressure, and supraorbital plethysmography was performed simultaneously with the compression. In all the individuals included in this study, compression was considered effective as judged by a significant decrease in the amplitude of the plethysmogram on the side of the carotid being compressed. Eighteen percent of the asymptomatic subjects and 34% of the patients showed changes (the great majority unilaterally) in the EEG during carotid compression. The side of the EEG alteration showed a great tendency to coincide with the side of the carotid being compressed and not with the clinically more affected hemisphere. There was no correlation between EEG changes and changes in systolic blood pressure occurring during carotid compression. No complications were encountered. It is concluded that, when performed under careful observation of the EEG, the ECG, and continuous blood pressure recording, compression of the common carotid, applied at the base of the neck, is a safe test which gives an important indication of the functional condition of the large neck vessels and of the adequacy of some of the cerebrovascular autoregulatory mechanisms.

Evaluation of cerebrovascular disease. A new method, combining electroencephalograms, carotid compression, and plethysmography.

UNILATERAL compression of the carotid artery has been used for several years as a diagnostic test, most frequently in patients with cerebrovascular disease. 1,2 However, evaluation of the adequacy of the compression to produce a significant occlusion of the artery is a difficulty constantly encountered, which makes it difficult to render objective judgments and to compare results. Among the various criteria employed are disappearance of pulse to digital palpation of a vessel distal to the common carotid artery, presence or absence of the carotid sinus reflex, and sensation of collapse of the vessel. However, none of these has proven to be sufficiently reliable. With the view of obviating these difficulties, Toole and Bevilacqua 3 proposed to record the volumetric pulses of the ear lobe with photoplethysmograms during the carotid compression test. Using this technique, a much higher degree of reliability of common carotid compression is obtained. Nevertheless, under certain