Diagnosis Of Carotid Artery Disease Research Articles

Clinical Parameters and Epigenetic Biomarkers of Plaque Vulnerability in Patients with Carotid Stenosis.

Atheromatous disease is the first cause of death and dependency in developed countries and carotid artery atherosclerosis is one of the main causes of severe ischaemic strokes. Current management strategies are mainly based on the degree of stenosis and patient selection has limited accuracy. This information could be complemented by the identification of biomarkers of plaque vulnerability, which would permit patients at greater and lesser risk of stroke to be distinguished, thus enabling a better selection of patients for surgical or intensive medical treatment. Although several circulating protein-based biomarkers with significance for both the diagnosis of carotid artery disease and its prognosis have been identified, at present, none have been clinically implemented. This review focuses especially on the most relevant clinical parameters to take into account in routine clinical practice and summarises the most up-to-date data on epigenetic biomarkers of carotid atherosclerosis and plaque vulnerability.

Basophil and Eosinophil Counts May Give Clues in the Differential Diagnosis of Carotid Artery Disease and Vasculitis: A Comparative Study

Basophil and Eosinophil Counts May Give Clues in the Differential Diagnosis of Carotid Artery Disease and Vasculitis: A Comparative Study

Carotid Artery Segmentation Using Convolutional Neural Network in Ultrasound Images

Cardiovascular disease (CVD) is one of the leading causes of death in urban areas. Carotid artery segmentation is the initial step in the automated diagnosis of carotid artery disease. The segmentation of carotid wall and lumen region boundaries are used as an essential part in assessing plaque morphology. In this paper, two types of Convolutional Neural Network (CNN) architectures are used for segmentation: U-Net and SegNet. The models used in this paper are applied on 257 ultrasound images containing a transverse section of the vessel acquired by ultrasound. Ultrasound imaging is noninvasive, completely unharming for the patient and a low-cost imaging method, but the main challenge when working with this kind of images is a very low signal to noise ratio and the process of imaging is highly dependent on the device operator. Different models are tested for various ranges of hyperparameter values and compared using different metrics. The model presented in this paper achieved over 94% Dice Coefficient for wall and lumen segmentation when trained during 100 epochs.

Serum Biomarkers in Carotid Artery Disease.

Carotid artery disease is considered a major cause of strokes and there is a need for early disease detection and management. Although imaging techniques have been developed for the diagnosis of carotid artery disease and different imaging-based markers have been proposed for the characterization of atherosclerotic plaques, there is still need for a definition of high-risk plaques in asymptomatic patients who may benefit from surgical intervention. Measurement of circulating biomarkers is a promising method to assist in patient-specific disease management, but the lack of robust clinical evidence limits their use as a standard of care. The purpose of this review paper is to present circulating biomarkers related to carotid artery diagnosis and prognosis, which are mainly provided by statistical-based clinical studies. The result of our investigation showed that typical well-established inflammatory biomarkers and biomarkers related to patient lipid profiles are associated with carotid artery disease. In addition to this, more specialized types of biomarkers, such as endothelial and cell adhesion, matrix degrading, and metabolic biomarkers seem to be associated with different carotid artery disease outputs, assisting vascular specialists in selecting patients at high risk for stroke and in need of intervention.

Diet and Lifestyle as Risk Factors for Carotid Artery Disease: A Prospective Cohort Study

Background: Stroke is one of the leading causes of death, and out of all stroke cases, 10–15% originate from a previously asymptomatic stenosis in the internal carotid artery. Aims: The aim of the study was to investigate whether dietary and lifestyle habits were associated with future risk of incident carotid artery disease (CAD). Methods: Baseline examinations on middle-aged individuals (n = 30,447) in the Malmö Diet and Cancer study (MDCS), a prospective cohort study, took place between 1991 and 1996 in Malmö, Sweden. Individuals with cardiovascular disease and diabetes mellitus were excluded at baseline, resulting in a total study population of 25,952 patients. Information on dietary intake was gathered through a 7-day food diary, a detailed questionnaire, and a 1-h interview. A diet quality index was calculated from adherence to recommended intake of 6 dietary components (saturated fat, polyunsaturated fat, fish and shellfish, fiber, vegetables and fruit, and sucrose). Individuals with a first registered diagnosis of CAD were identified from the Swedish National Patient register. Results: During a median follow-up of 21.8 years, 469 participants (1.8%) developed CAD. The diagnosis of incident CAD was validated and confirmed in 99% of a random sample of 100 individuals. Higher intake of vegetables and fruit was associated with a trend of decreased risk of CAD in a Cox regression analysis (hazard ratio of 0.76, 95% confidence interval 0.56–1.03; p = 0.080). Conclusions: In conclusion, the present study found a trend toward a protective effect of higher intake of vegetables and fruit against incident CAD. More prospective studies investigating the association between diet and CAD and stroke are needed in order to give firm recommendations.

Karotis Arter Hastalığı İçin Ümit Verici Bir Marker: Monositin High Density Lipoproteine Oranı (MHR)

Objectives : The aim of our study was to evaluate the relation between monocyte/high-density lipoprotein(HDL) ratio value and carotid artery stenosis in patients who underwent carotid angiography. Methods: To our study, 94 participants were enrolled (68 patients, 26 healthy individuals) who attended the cardiovascular surgery policlinic and had carotid angiography in between January 2017 and June 2018. Participants were divided into two groups, who have carotid artery disease and who don't. Peripheral venous blood results, taken from all patients before angiography for hematologic examination, were evaluated. Groups were compared according to their monocyte/high-density lipoprotein(HDL) values and other hematologic results. Results: Monocyte/high-density lipoprotein(HDL) ratio values were found to be higher in the group with a carotid artery disease compared to the group with a normal carotid angiography (72±10 ver 68±11 p=0.063). Yet again when the two groups were compared, there were differences with respect to existing hypertension, existing diabetes and gender (p=0.034, p=0.043, p=0.035 respectively). Conclusion: In our study, it was shown that high monocyte/high-density lipoprotein(HDL) ratio value can be a predictor for the diagnosis of carotid artery disease.

Carotid Artery Stenting: Retrospective Evaluation of Experience of an Invasive Tertiary Center

Objective: Carotid artery stenting (CAS) is being applied more frequently as an alternative mode of treatment to carotid endarterectomy. We aimed to present the short-term clinical outcomes of the patients admitted to our clinic with a diagnosis of carotid artery disease and revascularized by CAS. Methods: The study was retrospective and a single-centered study. Between June 2013-January 2016 the patients with an indication for carotid artery intervention and accepted CAS procedure were included in the study. Clinical characteristics and procedural data of the patients were obtained by scanning patient files. After discharge, hospital records were scanned and patients were called to learn whether or not patients were alive and that they have suffered a recent stroke. Results: We included 82 patients that meet the inclusion criteria in the study. 59% of patients were male with a mean age of 68±9 years. 56% of patients were symptomatic. In all patients, stents were used. 85% of patients distal embolic protection devices and 15% MOMA were used. 64 right, 18 left, and two bilateral carotid arteries were stented with a total of 82 patient of 84 successful CAS. Due to residual stenosis a second stent was implanted only in one patient. One patient experienced a partial muscle weakening in upper extremity due to an air embolism and 2 patients received opac material which recovered spontaneously in 24 hours. Conclusion: CAS is being successfully applied with a very low risk of complications in experienced centers. Short-term clinical results of CAS are quite satisfactory. Key words: stroke, carotid artery stenosis, carotid artery stenting, clinical outcomes

Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography

Stenosis of the internal carotid artery represents a major cause of stroke, with atherosclerosis representing the major pathophysiology of this stenosis. It is estimated that over 700,000 Americans suffer a stroke annually. A prompt and accurate diagnosis of carotid artery disease is critical when planning a therapeutic strategy. Physical examination is inaccurate in determining the presence and severity of carotid artery disease. Therefore, reliable imaging tests which offer little risk to the patient are required.

11. 超音波検査の進め方 頸動脈疾患のチェックポイント

11. 超音波検査の進め方 頸動脈疾患のチェックポイント

Three presentations of monocular vision loss

Background Carotid artery disease is estimated to affect 30% of persons older than 50. Risk factors include hypertension, cigarette smoking, hyperlipidemia and diabetes mellitus. Symptoms ascribed to carotid artery lesions with stenosis of the artery or plaque formation include monocular vision loss and transient ischemic attacks. Patients can present with transient monocular vision loss as their initial symptom. Case reports Three patients from a geriatric clinic in Wilmington, Delaware presented with different complaints of vision loss with similar overall outcomes. Patient A was an 87-year-old woman who presented with dimming of vision on extreme left head turn. Dilated fundus examination found a retinal arterial emboli in the left eye (O.S.). Carotid duplex examination found 50% to 79% left internal carotid stenosis with no hemodynamic stenosis of the right internal carotid. Patient B was a 78-year-old woman who presented with a right superior altitudinal defect and transient vision loss in the right eye. Dilated fundus examination found retinal arterial emboli in the right eye (O.D.). Carotid duplex examination found 50% to 79% carotid stenosis in both the left and right internal carotids. Patient C was an 84-year-old man who complained of a superior altitudinal visual field defect O.D. Dilated fundus examination found a retinal arterial emboli O.D. Carotid duplex results showed calcified atherosclerotic plaques present at the level of the common carotid artery bifurcations bilaterally, with 50% to 70% narrowing of the right internal carotid artery with no significant narrowing of the left internal carotid artery. Conclusions These 3 presentations show that in patients older than 50 who present with chief complaints of monocular vision loss, a differential diagnosis of carotid artery disease must be considered. Patients who exhibit retinal arterial emboli are at increased risk for stroke and vascular death. Appropriate measures for confirming a diagnosis include duplex ultrasound imaging, magnetic resonance angiography (MRA), and carotid angiography. Surgical techniques such as carotid angioplasty and carotid endarterectomy may be recommended.

Sonographic Examination of the Carotid Arteries

Ultrasonography (US) of the carotid arteries is a common imaging study performed for diagnosis of carotid artery disease. In the United States, carotid US may be the only diagnostic imaging modality performed before carotid endarterectomy. Therefore, the information obtained with carotid US must be reliable and reproducible. Technical parameters that can affect the accuracy of carotid US results include the Doppler angle, sample volume box, color Doppler sampling window, color velocity scale, and color gain. Important factors in diagnosis of atherosclerotic disease of the extracranial carotid arteries are the intima-media thickness, plaque morphology, criteria for grading stenosis, limiting factors such as the presence of dissection or cardiac abnormalities, distinction between near occlusion and total occlusion, and the presence of a subclavian steal. Challenges to the consistency of carotid US results may include lack of a standard protocol, poor Doppler technique, inexperience in interpretation of hemodynamic changes reflected in the Doppler waveform, artifacts, and physical challenges. Hindrances in the classification of problematic carotid artery stenoses may be overcome by following a standard protocol and optimizing scanning techniques and Doppler settings.

Diffusion-weighted MRI in patients with symptomatic internal carotid artery disease.

Beside the early detection of ischemia, there is an increasing body of evidence that diffusion-weighted imaging (DWI) can provide important information on stroke etiology. Against the background of an increased use of magnetic resonance angiography in patients being evaluated for carotid endarterectomy (CEA), the question arises if the additional performance of a DWI scan could also yield clinically relevant findings in these patients. In a prospective observational study we analysed the DWI data of 107 patients with high-grade symptomatic carotid artery disease (CAD) being evaluated for CEA. While no patient with a retinal TIA (n = 29) exhibited a DWI lesion, nineteen of the 42 patients with a hemisphere TIA and all patients with a minor stroke (n = 36) showed DWI lesion(s). In patients with TIAs the occurrence of DWI abnormalities was significantly more frequent in patients with long lasting TIAs. The majority of patients had multiple DWI lesions suggestive of acute large-artery thromboembolism as a common morphological phenotype of stroke. The finding of a similar lesion pattern in 4 patients with additional pre-existing atrial fibrillation suggested a symptomatic carotid stenosis. In contrast, unexpected bihemisphere lesions suggested cardioembolism in two patients with a normal circle of Willis and instigated thorough cardiac investigations. In both instances 24-h Holter monitoring revealed intermittent atrial fibrillation, so that a CEA was not performed. In conclusion, we demonstrate a common DWI lesion pattern in patients with symptomatic high-grade CAD eligible for CEA. In patients with known concomitant cardiac disorders the finding of this typical lesion pattern may support the diagnosis of a symptomatic CAD. In contrast, the additional performance of DWI can also reveal an unexpected cardiac source of embolism in some patients, which can substantially influence their further clinical management.

Carotid Dissection: A Clinical Review

Carotid artery dissection (CD) is an unusual pathological entity capable of producing devastating neurological deficits in affected patients. Symptoms include one or more of the clinical triad of headaches, oculosympathetic dysfunction, and retinal or cerebral ischemia. Cerebral angiography remains the gold standard for the diagnosis of carotid dissection. However, magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) are emerging as both sensitive and specific modalities for the diagnosis of carotid artery disease. Management of CD remains controversial; the efficacy of anticoagulation, the current standard of care for initial management of CD, has not been demonstrated in a clinical trial. The authors review management options to include anticoagulation, antiplatelet agents, endovascular stenting, and surgical management of carotid dissection.

Diabetes as a determinant of high-grade carotid artery stenosis: Evaluation of 1,058 cases by Doppler sonography

Our objective was to investigate the association of risk factors, especially diabetes mellitus, with high-grade carotid artery stenosis. The study group was chosen from the patients who were sent to our Doppler ultrasonography laboratory for detecting the vascular anatomy. Doppler sonography was performed in 1,058 patients. High-grade carotid artery stenosis with a diameter reduction of 70% to 99% was detected in 89 patients. In the moderate and mild stenosis groups, we had 85 and 884 patients, respectively. Patients in the moderate stenosis group had a 40% to 69% carotid stenosis, and patients in the mild group had a 0% to 39% stenosis or normal ultrasonographic findings. Parameters of age, sex, alcohol, smoking, ischemic heart disease, hypertension, and diabetes were considered potential risk factors for stenosis. Multivariate logistic regression model was used as the statistical test in comparing the 3 groups. In the high-grade stenosis group, sex distribution was 34.8% female and 65.2% male with a mean age of 64.48 ± 10.19 years. In the second and third groups these distributions were 51.8% female and 48.2% male with a mean age of 65.15 ± 9.66 years, and 54.30% female and 45.70% male with a mean age 59.56 ± 12.37, respectively. Diabetes mellitus (odds ratio [OR] = 2.77), ischemic heart disease (OR = 1.67), age (OR = 1.02), and male gender (OR = 1.75) were found to be significantly associated with high-grade carotid stenosis. As a cost-effective, noninvasive, easily performed, and fast technique, Doppler sonography is used in vascular evaluation of patients. Early diagnosis of carotid artery disease in patients with modifiable risk factors like diabetes may play an important role in the prevention of a consequent stroke. Copyright © 2001 by National Stroke Association

Diagnosis of Carotid Artery Disease

Diagnosis of Carotid Artery Disease

Evaluation of Time-of-Flight and Phase-Contrast Mra Sequences at 1.0 T for Diagnosis of Carotid Artery Disease

Evaluation of Time-of-Flight and Phase-Contrast Mra Sequences at 1.0 T for Diagnosis of Carotid Artery Disease

Non-selective digital subtraction angiography in comparison with selective conventional angiography in the diagnosis of carotid artery disease

In the recent past, non-selective arterial digital subtraction angiography (NSDSA) seemed a less invasive alternative to conventional filmscreen angiography (CFA) in the diagnosis of carotid artery disease. NSDSA obviated the need for selective catheterization with its associated risks but yet took advantage of the DSA method. However, this technique has not found general application although there are no reports that formally assess the (dis)advantages of NSDSA. The aim of our study was to compare the reliability of NSDSA with CFA in evaluation of carotid bifurcations in patients with transient ischemic attacks or partial stroke by reviewing prospectively collected data. Over a 2-year period, 40 patients (upper age limit 65 years) underwent both NSDSA and CFA. Bilateral NSDSA was performed in all 40 patients (80 bifurcations). Bilateral CFA was performed in 27 patients whereas unilateral CFA was carried out in 13 patients (67 bifurcations). Inter- and intra-observer variability for the degree of stenosis was determined by calculation of kappa-values for a 4-point and a 2-point scale. The proportion of interpretable studies was significantly lower in NSDSA. The inter- and intra-observer agreement was on average better in CFA examinations, though the difference was only statistically significant for the inter-observer agreement. The results of our study indicate that images obtained with NSDSA give less reliable information about carotid artery disease than images obtained with CFA. This is in accordance with the fact that NSDSA now seems an abandoned technique.

Diagnosis of carotid artery disease: preliminary experience with maximum-intensity-projection spiral CT angiography.

Spiral CT allows continuous data to be acquired rapidly, and if a correctly timed IV bolus of contrast material is given, spiral CT angiography can be performed. This study was designed to evaluate spiral CT angiography with maximum-intensity-projection reconstructions for assessing the degree of carotid artery stenosis. Spiral CT angiography (of 28 carotid bifurcations in 14 patients) was compared in a blinded fashion with conventional angiography (of 28 bifurcations) and with two-dimensional time-of-flight MR angiography (of 12 bifurcations) to assess degree of stenosis. A nonblinded comparison of the contour of the lumen at the site of stenosis was then made between conventional angiography, spiral CT angiography, and MR angiography. The degree of stenosis was measured in each internal carotid artery and categorized as mild (< 30%), moderate (30-69%), or severe (70-99%) stenosis or as occlusion. Maximum-intensity-projection images were used for the evaluations; however, if calcification was circumferential and the lumen of the carotid artery could not be analyzed in the area of the calcification, the axial source images were used. The results of CT angiography and conventional angiography agreed overall in 25 (89%) of 28 cases (r = .921, p = .05, Spearman rank correlation). The presence of severe stenosis or occlusion was correctly identified in seven of seven cases. In the moderate and mild stenosis categories, 18 (86%) of 21 were correctly identified (r = .802, p = .122). Three internal carotid arteries (11%) had circumferential calcification that necessitated evaluation of the axial source images, and the measurements obtained from the axial images agreed well with angiographic findings. MR angiography correlated well with the various categories of stenosis. However, when we compared MR angiography directly with CT angiography and conventional angiography, we found that the degree of stenosis was overestimated when MR angiography was used. Our results show that spiral CT angiography shows normal and abnormal carotid anatomy well when compared with conventional angiography. The short examination time and clear depiction of arterial caliber in areas of stenosis are significant advantages of spiral CT angiography compared with MR angiography.

Duplex scanning for carotid artery disease: Is angiographic confirmation required?

Requests for reprints should be addressed to Richard Sanders, MD, Rose Medical Center, 4545 East Ninth Avenue, Suite 240, Denver, Colorado 80220-3950. D uplex scanning has a reported accuracy of 87 to 95 percent in predicting carotid stenosis [1,2]. As a resuit, in selected patients, some surgeons in the United States are proceeding to endarterectomy on the basis of data from duplex scanning, which combines real-time Bmode ultrasound scanning, gated and pulsed Doppler ultrasound signal, and spectral analysis. The argument for Dr. Sanaers the duplex scan as a primary diagnostic tool includes the elimination of morbidity, mortality, and the increased cost associated with cerebral angiography [2,4]. Tables I and II list advantages and disadvantages of duplex scanning and cerebral arteriography for diagnosis of carotid artery disease.

Pulsed multigated Doppler ultrasonography in the diagnosis of carotid artery disease.

To evaluate the accuracy of a pulsed multigated Doppler system, 128 carotid arteries were examined. The spectral broadening index was calculated from the power spectrum of a small sample volume located in the center of the stream according to the flow profile and was related to the degree of stenosis as determined by contrast angiography. Even minor wall irregularities seen on the angiogram were classified as disease. The ability of the system to discriminate between normal and diseased vessels reached a sensitivity of 94% and a specificity of 91%. Classification of greater than 50% or less than 50% stenosis could be performed with a sensitivity of 90% and a specificity of 85%. Pulsed multigated Doppler ultrasonography allows identification of even minor degrees of stenosis of the carotid artery and provides an alternative to duplex scanning. Furthermore, the blood flow profile provided by a multigated Doppler system may add valuable information concerning blood flow characteristics not obtainable by single-gated systems.