Carotid Artery Doppler Ultrasonography Research Articles

The Reliability of Carotid Artery Doppler Ultrasonography Indices in Predicting Fluid Responsiveness during Surgery for Geriatric Patients: A Prospective, Observational Study.

The reliability of determining fluid responsiveness during surgery in geriatric patients is challenging. Our primary outcome was to determine the reliability of Corrected Flow Time (FTc) in predicting fluid responsiveness. Elderly patients undergoing major surgery under general anesthesia were included. Measurements of common carotid artery diameter, velocity time integral, and systolic flow time (FT) were performed before and after a fluid challenge. FTc and carotid blood flow (CBF) were subsequently calculated. The median change in carotid diameter was significantly higher in the fluid-responder (R) compared to the non-responder (NR) (6.51% vs. 0.65%, p = 0.049). The median change in CBF was notably higher in R compared to NR (30.04% vs. 9.72%, p = 0.024). Prior to the fluid challenge, systolic FT was significantly shorter in R than NR (285 ms vs. 315 ms, p = 0.027), but after the fluid challenge, these measurements became comparable among the groups. The change in systolic FT was higher in R (15.38% vs. 7.49%, p = 0.027). FTc and the change in FTc exhibited similarities among the groups at all study time points. Receiver operating characteristic analysis demonstrated an area under the curve of 0.682 (95% CI: 0.509-0.855, p = 0.039) for carotid diameter, 0.710 (95% CI: 0.547-0.872, p = 0.011) for CBF, 0.706 (95% CI: 0.540-0.872, p = 0.015) for systolic FT, and 0.580 (95% CI = 0.389-0.770, p = 0.413) for FTc. In geriatric patients, potential endothelial changes in the carotid artery may influence the dynamic markers of fluid responsiveness. Despite the demonstrated effectiveness of FTc in predicting fluid responsiveness in the general population, this study underscores the limited reliability of carotid Doppler ultrasonography indices for prediction in a geriatric patient population.

Bilateral Internal Carotid Artery Agenesis : Very Rare Cause of Bilateral Pulsatile Tinnitus

Bilateral internal carotid artery agenesis is a very rare congenital anomaly. Intracranial blood circulation in the affected internal carotid artery side is provided by collateral vasculature, contralateral internal carotid artery through the anterior communicating artery, and from the vertebrobasilar system through the posterior communicating artery. People with this abnormality may be asymptomatic for many years. However, patients may also be present with ischemic stroke orsubarachnoid hemorrhage, headache, and blurred vision. Diagnosis is usually incidental by the performance of carotid artery doppler ultrasonography or cervical/cranial magnetic resonance imaging owing to other symptoms. We report a case of bilateral internal carotid artery agenesis with pulsatile tinnitus lasting five years in the light of clinical presentation and imaging findings.

Prevalence and clinical characteristics of renovascular hypertension associated with fibromuscular dysplasia in China.

The aim of this study was to investigate the clinical characteristics of renal artery fibromuscular dysplasia (FMD) in patients in China and identify the cure rate of hypertension after angioplasty. Consecutive hypertensive patients with renal artery stenosis caused by FMD who underwent catheter-based angiography, and were followed at two Chinese referral centres, were retrospectively analysed. All patients underwent a detailed investigation, including demographic characteristics, clinical characteristics, biochemical sampling, Doppler ultrasonography of carotid arteries, magnetic resonance angiography (MRA) of the intracranial artery, and CTA or MRA of the abdominal artery and catheter-based renal angiography. Patients were routinely followed up at 1 month, 6 months and every year after the procedure. Among 245 study participants, with a mean diagnosed age of 26.9 ± 9.9 years, 137 (55.9%) were women, and 38 (15.5%) were children. All patients were diagnosed with hypertension at a mean age of 23.4 ± 8.4 years. There were 73.5% focal and 15.2% multivessel cases. Aneurysms, arterial dissections and total occlusions were found in 21.6, 4.1 and 12.2% of patients, respectively. Patients with multifocal FMD were older (26.0 vs. 23.7 years, P = 0.021) and more often female (70.8 vs. 50.6%, P = 0.004). Among children with renal FMD, 55.2% were men, and 86.8% were focal. After a median follow-up of 7.0 years, multifocal FMD had a higher cure rate of hypertension than focal FMD after revascularization (71.7 vs. 55.8%, P = 0.032). In a cohort of mostly young Chinese patients, the prevalence of hypertension associated with renal FMD is similar in both sexes. Focal FMDs were more frequent than the multifocal ones and, after angioplasty, were associated with a worse blood pressure outcome.

A NOVEL METHOD TO DETECT CHANGING LEFT VENTRICULAR ASSIST DEVICE PUMP FLOW USING A WIRELESS, WEARABLE DOPPLER ULTRASOUND: PROOF-OF-CONCEPT

TYPE: Late Breaking Abstract TOPIC: Critical Care PURPOSE: A proof-of-concept study to assess the accuracy of common carotid artery Doppler ultrasonography for detecting clinically-significant changes in continuous-flow left ventricular assist device (LVADCF) pump speed. METHODS: LVADCF outpatients were enrolled; written and informed consent was obtained and the study was approved by the Research Ethics Board of the Mayo Clinic. Each patient underwent a 6-minute protocol while sitting – 2 minutes at their baseline LVAD pump speed (T1), 2-minutes with pump speed decreased by 5% (T2) and 2-minutes with pump speed increased to 5% above baseline (T3). The patients wore an FDA-cleared, wireless, wearable Doppler ultrasound (Flosonics Medical, Sudbury, Ontario, Canada) over the common carotid artery. Both total velocity time integral per 5-seconds (VTI5-SEC) and a corrected VTI for the non-pulsatile fraction of the VTI (VTICORR) were investigated (Figure 1). Sensitivity and specificity for both VTI measures were compared for their ability to distinguish clinically-insignificant pump speed change (i.e., T1-to-T2, 5% decrease) from a significant one (i.e., T2-to-T3, 10% increase). RESULTS: Exploratory analysis was performed on two patients; results are shown in Figure 1. CONCLUSIONS: Changing LVADCF flow, induced by pump speed change, was accurately detected by a wireless, wearable Doppler ultrasound. Novel measures that correct for the non-pulsatile fraction of the cardiac cycle may improve diagnostic accuracy. CLINICAL IMPLICATIONS: Caring for the critically-ill patient with a LVADCF is challenging given that pump flow is afterload sensitive and that mean arterial pressure can be labile. Therefore, an automated method to detect changing LVAD flow from a wearable Doppler ultrasound is promising. DISCLOSURE: JSK, ME, ZY, AME, JKE work for Flosonics Medical, a start-up building the wearable Doppler ultrasound. PS, BDJ, MLC report no conflicts KEYWORD: left ventricular assist device

The effect of vertebral artery characteristics on cervical discogenic pain and disability

Introduction : Cervical discogenic pain, which is characterized by a stiffness or pain in neck movement, generally occurs as a result of disc degeneration. On the other hand; vascular pathologies of the cervical region, especially vertebrobasilar insufficiency, may give rise to similar findings in patients; it can also be detected simultaneously with cervical disc pathologies. . In this study, it was aimed to investigate whether the circulatory properties of the vertebral arteries have an effect on the neck pain and functional status of the patients.
 Material and Method: Based on the participants’ medical history, physical examination and radiological examination, sixty five patients were diagnosed with cervical disc herniation. Twenty patients who met the inclusion criteria were completed the study. Vertebral artery and carotid artery doppler ultrasonography was performed in these patients, thus any stenosis or insufficiency in vascular systems of the neck was evaluated. Additionally; vertebral blood flow rate (ml / min),vessel diameter(mm), minimum blood flow velocity (Vmin) and maximum blood flow velocity (Vmax) parameters was measured by doppler ultrasonography. The obtained findings compared with patients' level of pain measured with the "VAS (Visual Analog Scale)" and the level of daily life activities measured by the "Neck Disability Index ". 
 Results: It was detected a statistically significant negative correlation between the VAS score and right vertebral artery diameter (p=0.019, r=-0.518). A significant reverse correlation between the VAS score and right vertebral arterial blood flow rate (p=0.011, r=-0.556) was also observed. No correlation was found between other vertebral artery parameters and VAS score or Neck Disability Index (p>0.05).
 Conclusion: The findings of this study revealed that there is a correlation between the vertebral artery flow rate and pain level. Clinicians must take into consideration vertebral pathologies in patients with neck pain because of this vital condition may accompany with various musculoskeletal pathologies such as cervical disc herniation.

Calcium Kidney Stones are Associated with Increased Risk of Carotid Atherosclerosis: The Link between Urinary Stone Risks, Carotid Intima-Media Thickness, and Oxidative Stress Markers.

Previous studies have suggested that kidney stone formers are associated with a higher risk of cardiovascular events. To our knowledge, there have been no previous examinations of the relationship between carotid intima-media thickness (IMT) and urinary stone risk factors. This study was aimed toward an investigation of the association between dyslipidemia, IMT, and 24-hour urinalysis in patients with calcium oxalate (CaOx) or calcium phosphate (CaP) stones. We prospectively enrolled 114 patients with kidney stones and 33 controls between January 2016 and August 2016. All patients were divided into four groups, according to the stone compositions—CaOx ≥ 50% group, CaP group, struvite group, and uric acid stones group. Carotid IMT and the carotid score (CS) were evaluated using extracranial carotid artery doppler ultrasonography. The results of a multivariate analysis indicated that a higher serum total cholesterol (TC) and low-density lipoprotein (LDL) were all associated with lower urinary citrate and higher CS in both the CaOx ≥ 50% and CaP groups. Higher serum TC and LDL were also associated with increased serum 8-OHdG levels in both groups. The levels of carotid IMT and CS in the CaOx ≥ 50% and CaP groups were all significantly higher than in the controls. These findings suggest a strong link between dyslipidemia, carotid atherosclerosis, and calcium kidney stone disease.

Transient Global Amnesia - Risk Factors and Putative Background.

Transient global amnesia (TGA) is a temporary short-term reversible memory loss. Etiology of TGA remains unclear with various hypotheses. We analyzed clinical characteristics, neuroimaging, and electrophysiological findings as well as comorbidities and seasonal variation in TGA patients with regard to possible background of the syndrome. A total of 56 patients (42 women and 14 men) with TGA hospitalized from 2008 to 2016 in the Department of Neurology, Wrocław Medical University. A total of 52 patients (92.9%) underwent their first-ever episode of TGA. The potential triggers or events before episode could be recognized in 22 patients (39.3%). 35.7% patients had TGA in summer and 26.8% in winter months. In 92.9% patients chronic diseases were found, included: Hypertension (60.7%), dyslipidemia (48.2%), autoimmune thyroiditis (17.9%), and ischemic heart disease (14.3%). One patient (1,8%) suffered from migraine. Doppler ultrasonography of carotid arteries revealed abnormalities in 29 patients (51.8%). Electroencephalography abnormalities were observed in 10 (17.6%) of patients. Our findings suggest a putative cerebrovascular background of transient global amnesia. No evidence has been provided for the association between TGA and epilepsy or migraine. Among comorbidities, autoimmune thyroiditis deserves further investigation with regard to its potential links with TGA.

Impaired cardiac and vascular motion in patients with Takayasu's arteritis: A velocity vector imaging-based study.

Takayasu's arteritis (TAK) is a chronic inflammatory vasculitis of the aorta and its major branches. In the present study, we aimed to evaluate the motion of the vascular wall and myocardial contractility by using a novel strain imaging method, velocity vector imaging (VVI), in patients with TAK. We also aimed to compare them with another inflammatory autoimmune disorder, systemic lupus erythematosus (SLE). We studied 33 patients with TAK, 18 patients with SLE, and 20 age- and sex-matched controls. All participants were subjected to carotid artery Doppler ultrasonography and transthoracic echocardiographic evaluation. VVI analysis was also performed to assess subclinical left ventricular (LV) systolic dysfunction and to determine tissue motion of the common carotid arteries (CCAs). Aortic strain and distensibility were significantly impaired in patients with TAK, while the aortic stiffness and carotid artery stiffness indexes were increased. Aortic distensibility was the only parameter that was decreased among SLE patients. The values of CCA peak longitudinal strain, strain rate, and total longitudinal displacement (TLD) were also impaired in patients with TAK. Peak radial velocity was decreased while time-to-peak radial velocity was increased. In the SLE group, peak longitudinal strain, strain rate, TLD, and peak radial velocity were impaired. LV longitudinal peak systolic strain and strain rate were reduced in patients with TAK. Similarly, we revealed impaired subclinical LV systolic function in patients with SLE. VVI is a novel strain imaging technique with additional value to determine early impairment in vascular and myocardial wall motion in patients with TAK.

The relationship between mean platelet volume and flow mediated dilatation and intima media thickness of carotid artery in patients with essantial hypertension

Aim: Hypertension is an important risk factor in the development of atherosclerosis . Our aim in this study was to determine the relationship between mean platelet volume (MPV) which is a risk factor of atherosclerosis and intima media thickness (IMT) of carotid artery and flow-mediated dilatation (FMD), markers of atherosclerosis, in patients with essential hypertension. Materials-Methods: 50 adults, applying to Kirikkale University Medical Faculty department of internal medicine, (outpatient) clinics, diagnosed as hypertensive for the first time Were included in the study. Their ages ranaed between 18 to 80 nd. We included 50 healthy participants to the study as control group. Carotid Artery Doppler ultrasonography and flow-mediated dilatation (FMD) with the brachial artery ultrasonographic measurment technique was performed by using Ecography (General Electric Vivid S5) and 12 L probe for each patient. Results: In this study statistically significant relationship was found between IMT and age. In the hypertensive group, IMT of carotid artery was found to be higher in comparison with the control group. However this result wasÂ’nt statistically significant. There were no statistically significant difference in MPV, FMD or IMT hypertensive and control groups. Small number of the participants and relatively younger mean age of the groups may lead to this result and can be considered as a limitation of this study. Conclusion: Determining atherosclerosis earlier in patients with essential hypertension may provide development of new treatment modalities. In order to conclude more confidentIy extended studies with larger patient groups are needed.

Doppler Ultrasonography of Carotid Arteries: Velocity Criteria Validated by Arteriography

Results: The patients’ average age was 69 years, 47 (64%) men, 27 (37%) with cerebrovascular accident, and 13 (18%), transient ischemic attack. The best criterion for stenoses of 50% 69% was ICA PSV ≥ 141 cm/s (sensitivity: 94%, specificity: 90%, accuracy: 93%) (AUC 0.97). For stenoses between 70% 99%, ICA PSV ≥ 176 cm/s presented sensitivity: 92%; specificity: 87%; accuracy: 90%; ICA PSV ≥ 230 cm/s presented sensitivity: 89%; specificity: 89%; accuracy: 89% (AUC 0.96); and ICA/CCA PSV ratio ≥ 4.0 presented sensitivity: 70%; specificity: 100%; and accuracy: 81% (AUC 0.96). Six ICA occlusions were detected by DU and arteriography. The DU and arteriography correlation was: PSV (0.81 – p < 0.001); EDV (0.78 – p < 0.001) and ICA/CCA PSV ratio (0.81 – p < 0.001).

Embolus characterization in branch retinal artery occlusion by optical coherence tomography.

T his retrospective study analysed cases of branch retinal artery occlusion (BRAO) who had been examined by spectral-domain optical coherence tomography (SD-OCT) (Willerslev et al. 2014) to assess the characteristics of the intraluminal content of retinal arteries at the site of occlusion in BRAO. This case series included a selected group of 11 patients with BRAO seen at the Department of Ophthalmology at Glostrup Hospital between January 2010 and June 2013 and Copenhagen University Hospital Roskilde between September 2012 and August 2013, who presented with sudden painless visual loss and a visible retinal arterial plaque/embolus. All BRAOs were isolated (only one per eye) and located in a branch of a temporal vascular arcade artery and had an ophthalmoscopically visible plaque. All patients had undergone infrared 30 degree fundus photography and SD-OCT (Spectralis, Heidelberg Engineering, Heidelberg, Germany) at variable times during work-up. Scans are shown with brighter areas representing higher signal intensity at the conventional 2:1 height:width ratio (Sander et al. 2005). Fluorescein angiography, carotid artery Doppler ultrasonography and echocardiography were available in selected patients. In all cases, SD-OCT demonstrated endoluminal material at the site of arterial occlusion, the structure of which was divided into two distinctly different categories (exemplified in Fig. 1). A flake of highly reflective, yet transparent material, oriented with its edge towards the direction of flow and positioned in the middle of the artery was seen in three cases (Fig. 1). The reflectivity profile of the blood above and below the flake on SD-OCT and the fluorescein angiograms were normal, indicating that these emboli had little or no effect on blood flow. Amorphous or gritty endoluminal material was seen in 8 cases, all of which showed perfusion centrally, in what may have been a recanalized portion of the embolus, the remaining embolus material giving the appearance of a grossly thickened artery wall. All but one patient had risk factors for thromboembolic disease such as arterial hypertension and/or hyperlipidemia and their medication included antiplatelet drugs and/or statin. Antiplatelet drugs and statin were initiated in one patient after diagnosis of BRAO. None of the patients had known carotid atherosclerosis or stenosis before the incidence of BRAO. After clinical work-up, 6 of 11 cases were diagnosed with carotid atherosclerosis or stenosis but none with need for carotid artery surgical intervention. The cases presented here demonstrate that SD-OCT can visualize retinal artery emboli and demonstrate perfusion characteristics and embolus structure, from totally occluded artery segments over recanalized emboli to crystalline emboli. Only two case reports have previously been published on this subject (Shah et al. 2010; Oster et al. 2009). The non-invasive nature of SD-OCT and its ability to image most patients without pupil dilation offers advantages over fluorescein angiography when time is of the essence. Emboli with crystalline characteristics (flat, angular outline, highly reflective, transparent) may be taken to indicate that these were cholesterol flakes dislodged from an atheromatous arterial lesion. The other emboli appeared to take the shape of the arterial lumen, indicating that they were soft. Theoretically such emboli could have originated as thrombi from the atria of patients with atrial fibrillation or from peripheral veins in patients with a patent foramen ovale (Hayreh 2011). Six of 11 patients had carotid artery atherosclerosis which could be a potential source of emboli to the retinal circulation. In the presence of a retinal artery occlusion such a potential source of emboli should mandate consideration of therapeutic options aimed at preventing new embolism (Chang et al. 2012), such as the administration of statins and antiplatelet therapy. Recanalization seemed to be present in all 8 amorphus emboli. The intravascular reflectivity profile depends on the rate of blood flow (Willerslev et al. 2014) and could therefore be turbulent or abnormally high at a vascular stenosis produced by a retinal embolus. However, given the small diameter of the lumen of the observed stenoses, such details could not be resolved. An

Correlation of coronary heart diseases with endogenous androgen level

Objective To investigate the relationship between elderly male patients with coronary heart diseases (CHD) and endogenous androgen level and other related factors.Methods 28 male patients with acute coronary syndrome (ACS) were chosen as research group,28 male patients with stable angina pectoris (SAP) were chosen as observation group,and 28 healthy male people were selected as control group.All of three groups were checked by carotid artery Doppler ultrasonography and the peripheral blood concentration of testosterone (T),TC,LDL-C,Glu,CRP were measured,BMI was calculated in all three groups.Results Peripheral blood concentration of T,TC,LDL-C,Glu in ACS group and SAP group were significantly higher than those of the control group(P ＜0.05).IMT and number,quality of plaque in patients with ACS and SAP were significantly different compared with the control group (P ＜ 0.05).T,Tc,LDL-C,CRP,BMI,IMT,unstable plaque were significantly different between ACS group and SAP group(P ＜ 0.05).Glu had no statistical difference between ACS group and SAP group (P ＞ 0.05).Conclusion Peripheral blood concentration of T was negatively correlated with arterosclerosis,unstable plaque,Tc,LDL-C,BMI in old male CHD patients Key words: Coronary heart diseases; Testosterone

Prevalence of severe carotid artery stenosis and its association with echocardiographic parameters in maintenance hemodialysis patients

We aimed to determine the prevalence of significant carotid stenosis in maintenance hemodialysis patients and to identify biochemical and echocardiographic predictors of significant carotid stenosis in those patients. One hundred and seventeen maintenance hemodialysis patients were included in this study. Echocardiography biochemical tests and carotid artery Doppler ultrasonography were performed in all patients. Data obtained from patients without severe carotid stenosis were compared with those obtained from patients with severe carotid stenosis. The mean age of the patients was 56.9±12.2 years. Eleven patients had carotid artery stenosis (9.4%). While there was a trend of higher left ventricle end diastolic diameter in severe carotid artery stenosis (p=0.06), no statistically significant biochemical or echocardiographic differences were noted between the patients. This study demonstrated that the prevalence of carotid artery stenosis is 5-10- fold higher than in the general population. All patients in a chronic hemodialysis program should be screened for carotid artery stenosis for prevention of cerebrovascular diseases.

Carotid artery Doppler ultrasonography in patients with chronic kidney disease

BackgroundWe investigated the changes in the values of carotid intima-media thickness (IMT) and Doppler index measurements in the autosomal dominant polycystic kidney disease (ADPKD), peritoneal dialysis (PD), and hemodialysis (HD) patients.Material/MethodsTwenty outpatients on HD (mean age 46.1±16.4), 27 outpatients on PD (mean age 45±12.4), and 26 normotensive outpatients with ADPKD (mean age 52.4±16.7) as the case groups and 21 healthy subjects (mean age 48.4±7.2), as the control group, were included. The participants underwent ultrasonography of the common, right, and left carotid arteries for the IMT and Doppler flow measurements.ResultsOverall, compared to the normal group, in the study groups, the IMT and peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatility index (PI) were significantly higher in common carotid arteries; however, their differences were not meaningful in internal carotid arteries (p<0.05).ConclusionsOverall, ADPKD, PD, and HD increase the IMT, PSV, EDV, RI, and PI values of CCA; however, their effect considerable less on the study parameters of ICA. There is no considerable difference among the effects of ADPKD, HD, and PD on the study parameters. Of CKD patients during the first diagnostic and follow-up workups, the measurements of carotid IMT and Doppler indices may provide valuable data for improving success of the clinical management.

Serum gamma glutamyl transferase and alanine transaminase concentrations predict endothelial dysfunction in patients with non-alcoholic steatohepatitis

Purpose. Cardiovascular diseases are the leading cause of death in patients with non-alcoholic steatohepatitis (NASH). We aimed to investigate the presence of endothelial dysfunction and whether serum concentrations of liver enzymes may reflect the severity of such an endothelial dysfunction in patients with NASH.Methods. Fifty patients with NASH diagnosed by liver biopsies and 30 healthy controls were included. Blood samples after fasting were harvested for measurements of glucose, insulin, cholesterol, triglyceride, and liver enzymes. All patients underwent transthoracic echocardiography and brachial and carotid artery Doppler ultrasonography to evaluate flow-mediated dilatation (FMD) and carotid artery intima-media thickness (CIMT).Results. Patients with NASH had impaired FMD (4.9 ± 2.8% to 9.3 ± 4.4%, P < 0.001) and higher CIMT (0.79 ± 0.16 mm to 0.64 ± 0.11 mm, P < 0.001) when compared with healthy controls. Linear regression analyses revealed that serum concentrations of gamma glutamyl transferase (GGT) and alanine transaminase (ALT) were associated with FMD and CIMT.Conclusions. Patients with NASH have impaired FMD and increased CIMT when compared with healthy controls. In patients with NASH, serum concentrations of GGT and ALT might have a predictive value for FMD and CIMT.

Relationship between Carotid Atherosclerosis and Cerebral Infarction

To study the relationship between carotid atherosclerosis and cerebral infarction (CI). Between November 2008 and March 2009, 147 CI patients (CI group) and 48 patients with non-cerebrovascular diseases (control group) were enrolled from inpatients of Neurology Department of our hospital. The diagnostic criterion of thickened carotid intima was set as 1.0 mm<intima-media thickness (IMT) < 1.5 mm and that of carotid plaque was as IMT 1.5 mm. Carotid atherosclerosis was divided into three levels: normal intima, thickened intima, and plaque formation. The color Doppler ultrasonography data of carotid arteries in all patients were analyzed and the severity of carotid atherosclerosis was compared between the two groups. In the CI group, 36 (24.5%) patients had normal carotid intima, 22 (15.0%) had thickened carotid intima, and 89 (60.5%) had carotid plaque. In the control group, 22 (45.8%) patients had normal carotid intima, 4 (8.3%) had thickened carotid intima, and 22 (45.8%) had carotid plaque. The severity of carotid atherosclerosis in the CI group was higher than that in the control group (P = 0.022). There was significant difference in the constitution of carotid plaque between the two groups (P = 0.001); the CI group mainly had the soft plaque (55/89, 61.8%), whereas the control group mainly had the hard plaque (17/22, 77.3%). The first three common locations of carotid plaque in both groups were carotid bifurcation (CI group: 73.7%; control group: 64.1%), common carotid artery (CI group: 20.4%; control group: 25.6%), and internal carotid artery (CI group: 5.9%; control group: 10.3%). The location of carotid plaque between the two groups was not significantly different (P = 0.438). There was no difference in the carotid inner diameter or resistance index between the two groups (P > 0.05). Carotid atherosclerosis is to some extent able to reveal the atherosclerotic condition of cerebral arteries and act as an important predictor for the risk of CI. The color Doppler ultrasonography of carotid arteries can provide a convenient way for the prevention and treatment of CI.

Relation between coronary artery disease, risk factors and intima-media thickness of carotid artery, arterial distensibility, and stiffness index.

Atherosclerosis is a diffuse process that involves vessel structures. In recent years, the relation of noninvasive parameters such as intima-media thickening (IMT), arterial distensibility (AD), and stiffness index (SI) to cardiovascular diseases has been researched. However, we have not found any study that has included all these parameters. The aim of this study is to examine the relation between the presence of coronary artery disease (CAD) and its risk factors to AD, SI, and IMT, which are the noninvasive predictors of atherosclerotic process in the carotid artery. Included in the study were 180 patients who were diagnosed as having CAD by coronary angiography (those with at least > or = 30% stenosis in the coronary arteries) and, as a control group, 53 persons who had normal appearing coronary angiographies. IMT, AD, and SI values of all the patients in the study were measured by echo-Doppler imaging (AD formula = 2 x (AoS - AoD)/PP x AoD, SI formula = (SBP/DBP)/([AoS - AoD]/AoD). Significantly increased IMT (0.82 +/- 0.1, 0.57 +/- 0.1, p<0.05), decreased AD (0.25 +/- 0.9, 0.37 +/- 0.1, p<0.05), and increased SI (13 +/- 4, 8 +/- 3, p<0.05) values were detected in the CAD group compared to the control group. A significant correlation was found between IMT and presence of diabetes mellitus (DM), systolic blood pressure, total cholesterol, and presence of plaque in carotids, and age. In the coronary artery disease group there was a significant correlation between AD and age, systolic blood pressure, and HDL cholesterol levels, while there was no significant correlation with plaque development. A significant correlation was also found between stiffness index and systolic blood pressure and age; however, there was no relation between number of involved vessels and IMT, AD, and SI. We found sensitivity, specificity, and positive predictive and negative predictive values for CAD diagnosis to be 70%, 75%, 77%, and 66%, respectively. In CAD cases, according to data in this study, IMT and SI increased while AD decreased, and this was detected by carotid artery Doppler ultrasonography. Therefore, it was concluded that these cheaper, noninvasive, and easily available parameters could be used in early diagnosis of CAD.

Carotid artery Doppler ultrasonography in retinal macroaneurysms.

It is postulated that retinal arterial macroaneurysms (RAMs) occur at the site of incomplete embolic occlusion of a branch retinal artery. Embolic events of the retinal vessels are related to the state of the carotid artery tree and therefore Doppler ultrasonography of the carotid arteries in these patients is of particular interest. We have examined 13 patients with retinal artery macroaneurysms with carotid artery Doppler ultrasonography (CADU). Eight of these patients (61.5%) exhibited atheromatous plaques on the same side as the RAM with a moderate degree of arterial narrowing. Although our group of patients did not show advanced carotid artery disease, alterations of the arterial wall found at the level of the carotid artery were higher than expected in a similar hypertensive population. To our knowledge this is the first study of the carotid arterial tree in these patients. Our results support the theory that RAMs may be of embolic origin. Furthermore they demonstrate that CADU is a useful investigation in patients with RAMs.