Common Carotid Bifurcation Research Articles

Abstract 214: Carotid dissection and occlusion leading to acute ischemic stroke, hypotension and bradycardia

Introduction The carotid sinus regulates blood pressure and heart rate. Damage to the carotid sinus, whether from a surgical procedure or compression by a mass, can lead to hypotension and bradycardia. We report a case of carotid artery dissection resulting in symptomatic hypotension and bradycardia which has been uncommonly reported. Presentation A 65‐year‐old female presented with speech changes and altered mental status. On examination, the heart rate was in the 30s, fluctuating between the 40s and 50s. A CT scan revealed a subacute hypodensity in the territory of the left middle cerebral artery. CT angiography showed luminal irregularity in the distal common carotid artery and carotid bifurcation, occlusion of the internal carotid artery with reconstitution at the supraclinoid segment, suggesting a possible dissection. MRI identified an acute ischemic infarct in the anterior left insular cortex and adjacent left frontal lobe. MRA of the neck confirmed the occlusion of the left internal carotid artery, with no evidence of calcified or low‐density fatty plaque at the bifurcation. During her stay, the patient also developed hypotension with systolic blood pressure in the 80s and 90s requiring fluids. EKG showed sinus bradycardia. Patients did not have a history of bradycardia or hypotension. She was not on any medication at home or in hospital which could contribute to bradycardia. Cardiology was consulted who attribute this to carotid artery dissection. Discussion The carotid sinus is a neurovascular structure located at the bifurcation of the common carotid artery and extending into the proximal internal carotid artery. Hypotension and bradycardia are commonly observed in patients who undergo carotid artery stenting due to stretching of these baroreceptors. Patients with carotid body tumor or neck mass with compression of the carotid bifurcation and internal carotid artery. Similarly, there are case reports in literature with dissection of internal carotid artery presenting with syncope, bradycardia and hypotension. While dissection of the internal carotid artery has been documented to cause these symptoms, dissection involving the carotid bifurcation and associated occlusion is less commonly reported. Prior to associating dissection as etiology, complete workup to rule carotid body dysfunction, sinus node dysfunction, or carotid sinus hypersensitivity should be carried out. Conclusion Dissection of the carotid bifurcation and internal carotid artery has been associated with hypotension, bradycardia, and syncope. However, not all cases of carotid dissection result in these symptoms. Therefore, further investigation is needed to assess the dissection's characteristics, location, and the impact of any associated stenosis or atherosclerosis on symptom development.

Effect of glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on carotid intima-media thickness

Abstract Background/Introduction Type 2 diabetes mellitus (T2DM) is an additional factor for exacerbation of atherosclerosis increasing the risk for ischemic attacks such as coronary artery disease and ischemic stroke. Evaluation of carotid artery atherosclerosis through ultrasound techniques is a useful tool for risk stratification in type 2 diabetic patients. Purpose We investigated the effects of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on carotid intima-media thickness (cIMT) of T2DM patients. Methods A total of 320 T2DM patients were randomized to receive insulin (n = 80), liraglutide (n = 80), empagliflozin (n = 80) or their combination (GLP-1RA+SGLT-2i) (n = 80) as add-on to metformin. At baseline, at 6 and at 12 months of treatment, we measured the maximal thickness of six major points including right and left common carotid, carotid bifurcation and internal carotids. Finally, we calculated the average cIMT of all six segments (three on each side) to get mean cIMT. Results Compared to baseline, all patients had significantly reduced cIMT at 6 and at 12 months of treatment (p < 0.001; Table). A significant interaction of follow-up time with the type of treatment was observed regarding cIMT levels (F = 7.203, p for interaction < 0.001) in a model including age, sex, smoking, baseline body mass index, glucose levels, glycosylated hemoglobin, levels of blood lipids and their changes at 6 and 12 months of treatment as covariates. At 6 months, patients who were treated with GLP-1RA, SGLT-2i and those under the combination GLP-1RA+SGLT-2i showed a greater reduction of cIMT (-2.5%, -2.4% and -5.8%) compared to insulin (-0.8%; p = 0.008, p = 0.022, and p < 0.001, respectively). Moreover, at 12 months patients under GLP-1RA, SGLT-2i and their combination achieved remarkable reduction of cIMT (-7.4%, -4.9% and -10%) than those under insulin (-1.7%, p < 0.001 for all comparisons). Conclusions Twelve-month treatment with GLP-1RA, SGLT-2i and their combination resulted in reduction of cIMT in T2DM. The combined treatment was superior and additive to each regimen separately.Table

Intima-media thickness measured at the common carotid artery, carotid bifurcation, and internal carotid artery in cardiovascular risk assessment

Intima-media thickness measured at the common carotid artery, carotid bifurcation, and internal carotid artery in cardiovascular risk assessment

Rare Absent Right Common Carotid Anomaly: Case Report and Current Information

This case report provides a review of the occurrence, variations, signs/symptoms, and gender/side preferences of an absent common carotid artery (CCA) anatomical variant. Normal embryology of the carotid arteries and associated structures are also discussed. The relationship between absent common carotid bifurcations and the risk for plaque development is also considered but is limited due to the lack of empirical evidence. This report also outlines and demonstrates an absent right CCA with direct, separate origins of the right external carotid artery and right internal carotid artery from the right subclavian artery. An absent CCA is a rare vascular anomaly with multiple variations. There are typically no associated signs/symptoms, and there are no gender or side preferences.

Variations in external carotid artery branches and common carotid bifurcation level: a computed tomography angiography study

BackgroundThe common carotid bifurcation level is an important surgical landmark during head and neck surgery, especially endarterectomy, that could be omitted in patients with high bifurcation levels to reduce damage to neighboring structures like the hypoglossal nerve. Additionally, having a thorough understanding of the variations in the external carotid artery branches is crucial for head and neck cancer surgeries and thyroidectomy. However, cadavers were employed in the majority of studies on these variations. In previous research, there were significant disparities in the incidence of these variations according to gender, laterality, and ethnicity. In order to identify these changes in Egyptian patients and to compare them in terms of gender and laterality, we used computed tomographic angiography.MethodsThe level of the common carotid bifurcation was assessed in a cross-sectional study utilizing computed tomographic angiography, which included 80 patients (160 carotid sides) for comparing the common carotid artery bifurcation level with the relevant vertebrae and anterior neck structures, and they were compared with regard to gender and laterality. Variations in the external carotid artery branches were also evaluated.ResultsThe most frequent location of the common carotid bifurcation level was between C3 and C4 (33.8%). It was 36.9% between the thyroid and the hyoid. 47.5% of patients had a high common carotid bifurcation (higher than the C3/4 level). The highest bifurcation was at C2, while the lowest was at D1. For external carotid artery branches variations, the superior thyroid artery emerged at and below the level of the common carotid bifurcation, respectively, at 19.4% and 23.7%. The facial artery had the largest diameter (2.38 ± 0.44 mm), while the ascending pharyngeal artery had the smallest (1.17 ± 0.11 mm). Seven types of trunks were found; the ascending pharyngeal artery-occipital artery trunk was the most common (25%) and was followed by the lingual artery-facial artery trunk (20%).ConclusionsMultiple anatomical variations in the external carotid artery branches and the common carotid bifurcation level were found by computed tomographic angiography. As a result, it can be utilized as a useful imaging technique to evaluate these variations before surgery.

Association between Carotid Bifurcation Angle and Vulnerable Plaque Volume Using Black Blood Magnetic Resonance Imaging.

The morphology of the internal carotid artery (ICA) bifurcation is increasingly being recognized as the cause of atherosclerosis and vulnerable plaque leading to cerebral infarction. In this study, we investigated the relationship between carotid bifurcation angle and carotid plaque volume evaluated using black blood magnetic resonance imaging (BB-MRI). Among the 90 patients who underwent revascularization for atherosclerotic symptomatic carotid stenosis between April 2016 and October 2022 using BB-MRI, carotid plaque was evaluated in 57 patients. Relative overall signal intensity (roSI) was defined as the signal intensity of the plaque on T1-weighted images relative to the signal intensity of the sternocleidomastoid muscle in the same slice as the common carotid bifurcation. Regions showing roSI ≥ 1.0 were defined as plaque, and the plaque volume and relative plaque volume were measured from roSI ≥1.0 to ≥2.0 in 0.1 increments. We calculated the angles between the common carotid artery (CCA) and the ICA and between the CCA and the external carotid artery (ECA) on magnetic resonance angiography. We classified two groups according to carotid bifurcation angles based on the ICA angle: Group A = <35° and Group B = ≥35°. Compared with Group A (n = 42), Group B (n = 15) showed a greater relative plaque volume between roSI ≥ 1.3 and roSI ≥ 1.5. A significant correlation was identified between relative plaque volume with roSI ≥ 1.4 and ICA angle (p = 0.049). Vulnerable plaque was significantly more frequent in the group with an ICA angle of ≥35. Moreover, the ICA angle was significantly greater in patients with a roSI of ≥1.4.

SAT547 Hereditary Paraganglioma: The Rare Co-Existence Of Two Genetic Syndromes Associated With PPGL-pheochromocytoma

Abstract Disclosure: K. Samuel: None. Hereditary Paraganglioma: the rare co-existence of two genetic syndromes associated with PPGL-Pheochromocytoma Kelara Samuel MD, Bryan McIver MD, Colleen Veloski MD, Julie Hallanger-Johnson MD, Valentina D. Tarasova, John Tourtelot MD, George Q. Yang MD, Sarimar Agosto-Salgado MD Background: Paragangliomas are neuroendocrine tumors arising from neural crest chromaffin cells of the autonomic ganglia and can be parasympathetic or sympathetic in nature. Approximately 30 percent of all paragangliomas are hereditary either associated with familial paraganglioma syndromes and other autosomal dominant syndromes, such as multiple neuroendocrine neoplasia 2A and 2B, neurofibromatosis type 1, and von Hippel Lindau disease.Case: A 73-year-old Hispanic female with a past medical history of hypothyroidism, hypertension, hyperlipidemia, and Lupus presented with a large neck mass of 11 years of evolution. An evaluation revealed a large near 12cm hypervascular, hyperenhancing left neck mass that encased the distal common carotid artery, carotid bifurcation, and internal and external carotid arteries and their branches. The multidisciplinary team recommended, given the tumor's extent, a non-surgical localized treatment consisting of radiation. Clinically, the patient had compressive symptoms, including tenderness over the tumor region, hoarseness, dysphagia, and changes in phonation. The patient also had a positive family history of paraganglioma in her grandson and nephew, but specific genetic alteration data from relatives was unavailable. Plasma normetanephrines were 0.68 (normal range 0-0.89), and plasma metanephrines were 0.23 (normal range 0-0.49). Genetic testing was positive for germline alterations in both SDHB p.Q214 and NF1 c.2970_2972delAAT. At this time, there is no evidence of metastatic disease and no clinical manifestations of NF1, suggesting a mild neurofibromatosis phenotype. Restaging imaging revealed an ongoing partial response to radiation and clinically patient has noted a significant improvement in the prior compressive symptoms. Conclusion: We present a case where we see an uncommon presentation of a non-secretory, hereditary paraganglioma with two concomitant rare genetic syndromes. This case highlights the importance of genetic testing for patient-appropriate tumor surveillance and family counseling implications. Presentation Date: Saturday, June 17, 2023

Extremely Proximal Common Carotid Bifurcation

Extremely Proximal Common Carotid Bifurcation

THE GROSS AND MICROSCOPIC ANATOMY OF THE CAROTID BODY OF AN ENDOGENOUS DUCK

The carotid body in an endogenous duck was closely related to the ventral surface of the common carotid bifurcation zone caudal to the parathyroid glands. The carotid body was characterized by its compact and fusiform shape. Taking into account all carotid bodies, the mean length was 1.058 +0.95 micrometers. The blood supply of the carotid body in duck was not detected easily but caudal and cranial thyroid arteries gave many branches to it. Histologically, the carotid body of an endogenous duck was consisted of two types of cells; chief cells which occurred in groups and were invested by sustentacular cells. These cells were embedded within a connective tissue fibers to form glomic tissue. A collection of ganglionic cells were observed in the vicinity of the carotid body

Atherosclerotic Lesion of the Carotid Artery in Indonesian Cynomolgus Monkeys Receiving a Locally Sourced Atherogenic Diet.

The atherosclerotic lesion is a principal hallmark of atherosclerotic animal models. This study aimed to assess lesions of the carotid artery in Indonesian cynomolgus monkeys exposed to an IPB-1 atherogenic diet. A total of 20 adult male cynomolgus monkeys received the local IPB-1 diet for two years. Blood lipid profiles, morphology, and carotid ultrasound of monkeys were measured. Nine of them were euthanized to confirm atherosclerotic lesions. Common carotid arteries (CCA) and carotid bifurcation (BIF) samples were collected and stained using Verhoef-van Giessen and CD68 immunohistochemistry. The results reveal the presence of severe atherosclerosis plaques in six out of nine animals (66.7%) corresponding to intermediately and hyper-responsive groups. The hyper-responsive group displayed the highest response in the developing intimal area (IA) at the CCA (0.821 mm2), whereas the hyporesponsive group had the smallest IA (0.045 mm2) (p = 0.0001). At the BIF, the hyporesponsive group showed the smallest IA (p = 0.001), but there was no difference between the intermediately and hyper-responsive groups (p = 0.312). The macrophage marker CD68 was also expressed on the cartotid of the intermediately and hyper-responsive groups. These results indicate that severe atherosclerotic lesions with high infiltration of macrophages were formed in the carotid arteries of intermediately and hyper-responsive Indonesian cynomolgus monkeys fed with the local atherogenic diet IPB-1 over two years, thus confirming atherosclerosis in a nonhuman primate model.

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI).

The endovascular filament perforation model to mimic subarachnoid hemorrhage (SAH) is a commonly used model - however, the technique can cause a high mortality rate as well as an uncontrollable volume of SAH and other intracranial complications such as stroke or intracranial hemorrhage. In this protocol, a standardized SAH mouse model is presented, induced by endovascular filament perforation, combined with magnetic resonance imaging (MRI) 24 h after operation to ensure the correct bleeding site and exclude other relevant intracranial pathologies. Briefly, C57BL/6J mice are anesthetized with an intraperitoneal ketamine/xylazine (70 mg/16 mg/kg body weight) injection and placed in a supine position. After midline neck incision, the common carotid artery (CCA) and carotid bifurcation are exposed, and a 5-0 non-absorbable monofilament polypropylene suture is inserted in a retrograde fashion into the external carotid artery (ECA) and advanced into the common carotid artery. Then, the filament is invaginated into the internal carotid artery (ICA) and pushed forward to perforate the anterior cerebral artery (ACA). After recovery from surgery, mice undergo a 7.0 T MRI 24 h later. The volume of bleeding can be quantified and graded via postoperative MRI, enabling a robust experimental SAH group with the option to perform further subgroup analyses based on blood quantity.

ASSESSMENT OF CAROTID INTIMAL MEDIAL THICKNESS (CIMT) IN YOUNG PATIENTS WITH ISCHEMIC STROKE: A CASE CONTROL STUDY

Background: Incidence of ischemic stroke in younger patients in increasing leading to higher morbidity and mortality. Data on carotid intimal medial thickness (CIMT) as atherosclerotic marker in young ischemic stroke patients are scarce.&#x0D; Aims and Objective: To evaluate bilateral CIMT thickness and its correlation with various CVD risk factors in young ischemic stroke patients.&#x0D; Methods: Total 40 patients (15 to 45 age group) and age matched 40 controls were taken. Demographic profile and risk factors were evaluated. All subjects were taken for CIMT assessment by B mode ultrasonography scan in multiangle measurements in the common carotid artery (CCA), carotid bifurcation (BIF) and internal carotid artery (ICA).&#x0D; Results: 72.5% of patients were in 35- 45 years age group. Stroke incidence was higher in male. Age specific value of CIMT was higher in all cases as compared to age matched controls in all age group. (p? 0.01) Increasing age, smoking and hypertension were significantly associated with higher bilateral CIMT.&#x0D; Conclusion: Ischemic stroke young population is associated with increased CIMT. Risk factors burden is contributory in speeding up atherosclerotic process leading to higher CIMT with multiple co morbidities.&#x0D; Keywords: carotid intimal medial thickness, carotid bifurcation, ischemic stroke

Isoflavone biomarkers are inversely associated with atherosclerosis progression in adults: a prospective study

Many studies have examined associations between dietary isoflavones and atherosclerosis, but few used objective biomarkers. We examined the associations of isoflavone biomarkers (primary analyses) and equol production (secondary analyses) with the progression of carotid intima-media thickness (cIMT), and whether inflammation, systolic blood pressure (SBP), blood lipids, and sex hormone-binding globulin (SHBG) mediated these associations, in Chinese adults. This 8.8-y prospective study included 2572 subjects (40-75 y old) from the GNHS (Guangzhou Nutrition and Health Study; 2008-2019). The concentrations of daidzein, genistein, and equol were assayed by an HPLC-tandem MS in serum (n=2572) at baseline and in urine (n=2220) at 3-y intervals. The cIMT of the common carotid artery (CCA) and bifurcation segment were measured by B-mode ultrasound every 3 y, and the progressions of cIMT ( ∆cIMT) were estimated using the regression method. Multivariable linear mixed-effects models (LMEMs) and ANCOVA revealed that subjects with higher serum isoflavones tended to have lower increases of CCA-cIMT. The mean±SEM differences in 8.8-y ∆CCA-cIMT between extreme tertiles of serum isoflavones were -17.1±8.4, -20.6±8.3, and -23.3±10.4 μm for daidzein, total isoflavone, and equol (P-trends<0.05), respectively. LMEMs showed that the estimated yearly changes (95% CIs) (μm/y) in CCA-IMT were -2.0 (-3.8, -0.3), -1.9 (-3.6, -0.1), and -2.1 (-3.8, -0.3) in the highest (compared with the lowest) tertile of daidzein, genistein, and total isoflavones, respectively (P-interaction<0.05). Path analyses indicated that the serum equol-atherosclerosis association was mediated by increased SHBG and decreased SBP. Similar beneficial associations were observed in the secondary analyses. Serum isoflavones and equol exposure were associated with reduced cIMT progression, mediated by SHBG and SBP.

Anatomical Variations in the Origin of Superior Thyroid Artery and its Relation with External Laryngeal Nerve and their Clinical Importance-A Cadaveric Study

INTRODUCTION&#x0D; The major arterial supply of thyroid gland is from superior and inferior thyroid arteries. The superior thyroid artery (STA) usually arises from the external carotid artery. The external laryngeal nerve runs in close proximity to the origin of the superior thyroid artery later leaves the artery by turning medially above or below the upper pole of the thyroid gland.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; A descriptive study was undertaken on 20 embalmed cadavers. The anterior triangle of neck was dissected bilaterally. The site of origin of STA level of origin in relation to the upper border of lamina of thyroid cartilage and relation of the STA with external laryngeal nerve were observed and noted.&#x0D; &#x0D; RESULTS&#x0D; The STA arises from the external carotid artery in 27.5%, common carotid artery in 62.5%, common carotid bifurcation in 5% and arises by a common trunk with lingual artery at common carotid bifurcation in 5%. The distance from the upper pole to the point where external laryngeal nerve turns medially is more than 10 mm in 50%, less than 10 mm in 25% and 10 mm in 25%.&#x0D; &#x0D; CONCLUSION&#x0D; The variations in the pattern of origin of the superior thyroid artery and its relation to external laryngeal nerve is a very common phenomenon. The head and neck surgeons must be aware of all possible variations to avoid postoperative complications and legal issues.&#x0D;

Localización y carga de ateromatosis subclínica en población con un riesgo cardiovascular bajo-moderado: estudio ILERVAS

Introduction and objectivesThere is a discrepancy between risk assessment based on cardiovascular risk factors (CVRF) and atheromatosis burden. The objective was to identify the prevalence of subclinical diseases with common risk factors, such as atheromatosis, occult kidney disease, prediabetes, and diabetes in a middle-aged population with low-to-moderate cardiovascular risk; to assess the vascular distribution, and severity of subclinical atheromatosis. MethodsRandomized, interventional, longitudinal clinical trial. The intervention consisted of vascular ultrasound examination in the carotid and femoral arteries assessing 12 territories, combined with clinical, anthropometric, lifestyle, and biochemical parameters. Inclusion criteria consisted of women (aged 50-70 years) and men (aged 45-65 years) with at least 1 CVRF. Exclusion criteria consisted of a clinical history of diabetes, chronic kidney disease, or a prior CV event. Here, baseline characteristics of the ILERVAS cohort are shown. ResultsA total of 8330 middle-aged asymptomatic participants, 50.7% women, were enrolled. The presence of 1-2 CVRF was found in 74.8% and adherence to the Mediterranean diet was low in 52.8%. Several previously unknown chronic diseases were diagnosed, such as dyslipidemia (21.1%), hypertension (15.3%), kidney disease (15.4%), obesity (10.6%), and diabetes (2.3%). Subclinical atheromatosis was found in 71.4% of participants, localized in common femoral (54.5%), carotid bifurcation (41.1%) and internal carotid (22%). Intermediate atheromatosis (2-3 territories with atheroma plaque) was found in 32.6%, and generalized atheromatosis (>3 territories) in 19.7. Total plaque area was higher in men (0.97 cm2 vs 0.58 cm2, P<.001). Total plaque area was also higher in the femoral artery, and increased with the number of CVRF. ConclusionsSubclinical atheromatosis was highly prevalent in a middle-aged population with low-to moderate cardiovascular risk, with 1 in 5 participants having generalized atheromatosis.ClinicalTrials.gov Identifier: NCT03228459.

Subclinical atheromatosis localization and burden in a low-to-moderate cardiovascular risk population: the ILERVAS study

Introduction and objectivesThere is a discrepancy between risk assessment based on cardiovascular risk factors (CVRF) and atheromatosis burden. The objective was to identify the prevalence of subclinical diseases with common risk factors, such as atheromatosis, occult kidney disease, prediabetes, and diabetes in a middle-aged population with low-to-moderate cardiovascular risk; to assess the vascular distribution, and severity of subclinical atheromatosis. MethodsRandomized, interventional, longitudinal clinical trial. The intervention consisted of vascular ultrasound examination in the carotid and femoral arteries assessing 12 territories, combined with clinical, anthropometric, lifestyle, and biochemical parameters. Inclusion criteria consisted of women (aged 50-70 years) and men (aged 45-65 years) with at least 1 CVRF. Exclusion criteria consisted of a clinical history of diabetes, chronic kidney disease, or a prior CV event. Here, baseline characteristics of the ILERVAS cohort are shown. ResultsA total of 8330 middle-aged asymptomatic participants, 50.7% women, were enrolled. The presence of 1-2 CVRF was found in 74.8% and adherence to the Mediterranean diet was low in 52.8%. Several previously unknown chronic diseases were diagnosed, such as dyslipidemia (21.1%), hypertension (15.3%), kidney disease (15.4%), obesity (10.6%), and diabetes (2.3%). Subclinical atheromatosis was found in 71.4% of participants, localized in common femoral (54.5%), carotid bifurcation (41.1%) and internal carotid (22%). Intermediate atheromatosis (2-3 territories with atheroma plaque) was found in 32.6%, and generalized atheromatosis (>3 territories) in 19.7. Total plaque area was higher in men (0.97 cm2 vs 0.58 cm2, P<.001). Total plaque area was also higher in the femoral artery, and increased with the number of CVRF. ConclusionsSubclinical atheromatosis was highly prevalent in a middle-aged population with low-to moderate cardiovascular risk, with 1 in 5 participants having generalized atheromatosis.ClinicalTrials.gov Identifier: NCT03228459

Prediction of Risk Factors for Progressive and Non-Progressive Stroke by Transcranial Doppler Ultrasound Information Technology

Objective: To predict the risk factors of progressive and non-progressive stroke by the transcranial Doppler ultrasound information technology and the analysis of the comparative examination results. Methods: A total of 180 patients with ischemic stroke (IS) treated in the Neurology Department were included as the research objects. The Scandinavian Stroke Scale (SSS) was used to score the neurological functions of patients, and the patients were then divided into the progressive group (group P) and the non-progressive group (group NP). The carotid ultrasound examination was performed on the grouped patients, and the support vector machine (SVM) regression algorithm was used to classify the data obtained by the ultrasound examinations. The differences between the results of both groups were analyzed and discussed, as well as the carotid lesions and plaques. Results: The plaque detection rate was 96.7% in group P and 75.8% in group NP. In group P, the detection rate of the single plaque was 8.3%, and the detection rate of multiple plaques was 88.3%. In group NP, the detection rate of the single plaque was 19.2%, and the detection rate of multiple plaques was 56.7%. Besides, statistical differences existed between both groups (P &lt; 0.01). Carotid plaques in both groups were mainly distributed in common carotid artery (CA), bifurcation, internal CA, and external CA. Of all the biochemical indexes and CPS, the fasting plasma glucose (FPS), low density lipoprotein-cholesterol, lipoprotein (a), homocysteine, C-reactive protein, and fibrinogen had positive correlations. The major risk factors for the formation of vulnerable carotid plaques were increased levels of lipoprotein (a), homocysteine, and C-reactive protein. Conclusion: The pathogenesis of progressive and non-progressive stroke was closely related to vulnerable plaque. The vulnerable plague was a factor indicating the risk of progressing to early stroke. Besides, the formation of vulnerable plaques was closely correlated to the increase of lipoprotein (a), homocysteine, and C-reactive protein levels.

The circulating vascular endothelial growth factor is only marginally associated with an increased risk for atherosclerosis.

Vascular endothelial growth factor-A (VEGF-A) is a protein that plays a role in the formation and function of blood vessels, promotes increased vascular permeability or migration of monocytes through endothelial layers. We have tested the hypothesis that plasma levels of VEGF-A may be associated with biochemical and radiological parameters as a marker of cardiovascular risk in Caucasian patients with early-onset CAD. The study group included 100 patients: 75 men not older than 50 years and 25 women not older than 55 years at the moment of CAD diagnosis. The control group (patients without CAD) comprised 50 healthy cases. ELISA test was used to measure plasma concentrations of VEGF. Doppler ultrasound of carotid and peripheral arteries was carried out in each patient. Serum glucose, complete lipid profile, ApoA1, ApoB, Lp(a) and blood count were measured in each case. Only very weak correlations of plasma VEGF levels with biochemical cardiovascular risk factors in the CAD subjects have been demonstrated. In the study group, VEGF concentration was significantly positively correlated with the same blood parameters as white blood cells, platelets, plateletcrit, apolipoprotein B, total and LDL cholesterol fraction. The plaque of common carotid arteries and bifurcation was present in 39% of CAD patients, however, there was no significant association between VEGF plasma concentration and any measured parameters in Doppler ultrasound of carotid and peripheral arteries. The circulating VEGF is only marginally associated with an increased risk for atherosclerosis.

Endovascular treatment of acute tandem occlusion of the left internal carotid and middle cerebral arteries, which is a complication of carotid endarterectomy

Case of endovascular treatment of a patient with tandem left internal carotid artery (ICA) and middle cerebral artery (MCA), which was a complication of carotid endarterectomy, are presented. The rupture at the location of the suture in the bulb of the ICA during endovascular intervention required implantation of a graft-stent and subsequent removal of the hematoma in the neck soft tissues.A 51 year old man in the residual period of ischemic stroke in the left carotid basin with elements of sensory speech disorders, with subtotal stenosis in the bulb of the left ICA, stenosis 35 % in the bulb of the right ICA and severe hypoplasia of the A1-segment of the left anterior cerebral artery underwent left-side carotid endarterectomy. The next morning after surgery, 1 hour after awakening, a right-sided hemiparesis progressing to hemiplegia, total aphasia. The level of consciousness deteriorated to the sopor. A computer tomography was performed immediately. New ischemic lesions were not identified. Cerebral angiography revealed the occlusion from the mouth of the left ICA, occlusion in the M1-segment of the left MCA. Thrombospiration from MCA and ICA was performed with Sofia Plus distal approach catheter. The MCA was recanalized in one pass (mTICI 3), but the patency of the left ICA was not recovered. The anti-embolic device SpiderFX was introduced and opened in the C2-segment of the left ICA. Then, a slow inflation of the Submarine 5 × 20 mm balloon catheter was performed in the left ICA bulb. At a pressure of 4.0 atm, the balloon opened like an hourglass, indicating a rough rigid stenosis in the ICA bulb. At a pressure of 4.5 atm, the balloon fully opened. Immediately after balloon deflation, intense contrast extravasation is determined at the level of the ICA bulb. Inflation of the balloon at a pressure of 4 atm was performed again. Intubation of the trachea of ​​the patient was performed. Intravenous administration of 300 mg acetylsalicylic acid was initiated. The balloon catheter is deflated and withdrawn from vessels, the carotid stent Protégé 8–6×40 mm was implanted into the left ICA bulb and the left common carotid bifurcation segment. The bloodstream above the stent is not determined, but extravasation through the stent cells at the level of the former defect is determined. Stent graft Graftmaster 4×15 mm was implanted into the carotid stent at the level of the defect in the ICA. Stent graft was additionally opened in its lower part by a 5×20 mm balloon-catheter. Thrombaspiration from the left ICA was performed again. Patency of the ICA and intracranial arteries was totally restored – mTICI3, stenosis in the left ICA bulb was completely eliminated. The patient’s neurological status was restored to baseline. A large hematoma in the soft tissues of the neck to the left was determined. Only “old” ischemic foci in the left temporal lobe were determined on brain CT, a large hematoma laterally and anteriorly to the carotid artery was determined in the soft tissues of the left side of the neck on computer tomography. Ticagrelor was added to aspirin therapy. Hematoma was removed surgically. The postoperative period was unremarkable. The patient was discharged from the clinic in good condition with an level modified Rankin scale 1.In the presented case, the friendly work of different profiles specialists avoided the devastating consequences of such a relatively rare complication of carotid endarterectomy as cerebral arteries tandem thrombosis. The availability of graft-stents in access to interventional neuroradiologists is extremely important in such cases.

Association between erythrocyte membrane n-3 and n-6 polyunsaturated fatty acids and carotid atherosclerosis: A prospective study

Background and aimsThe relationship of polyunsaturated fatty acids (PUFAs) with cardiovascular risk is still controversial. We aimed to determine whether erythrocyte n-3 and n-6 PUFAs are related to the risk of carotid atherosclerosis. MethodsFrom 2008 to 2019, baseline erythrocyte n-3 and n-6 PUFAs were determined in a cohort of 4040 Chinese adults (40–75 ys). The intima-media thickness (IMT) at the common carotid artery (CCA) and bifurcation of the carotid artery (BIF) and carotid plaque were assessed using ultrasonography at baseline and every 3 years. ResultsDuring a median follow-up of 8.8 years, we identified the following newly diagnosed cases: 535 cases of CCAIMT thickening, 654 cases of BIFIMT thickening, and 850 cases of carotid plaque. Higher erythrocyte docosahexaenoic acid (DHA) and arachidonic acid (ARA) and lower gamma-linolenic acid (GLA) were associated with decreased risks of BIFIMT thickening. N-3 eicosatrienoic acid (ETrA), docosapentaenoic acid (DPA), and n-6 dodecylthioacetic acid (DTA) presented a significant beneficial association with carotid IMT thickening in the short-term (2.8 y) follow-up (all p trend <0.02), although the association was attenuated in the relatively long-term (8.8 y) follow-up. In addition, carotid plaque risk was found to be inversely associated with ETrA and DHA but positively associated with alpha-linolenic acid (ALA). N-6 linolenic acid (LA) and eicosadienoic acid (EDA) were not significantly associated with carotid atherosclerosis risk. ConclusionsHigher erythrocyte very-long-chain n-3 and n-6 PUFAs (especially DHA and ARA) and lower erythrocyte GLA are associated with lower carotid atherosclerosis risk, suggesting potential cardioprotective roles of very-long-chain PUFAs.