Extracranial Carotid Artery Research Articles

Comparative Analysis of Balloon Angioplasty Alone versus Carotid Artery Stenting for Severe Extracranial Carotid Artery Stenosis: A 4-Year Retrospective Study

This retrospective study aimed to compare the efficacy of balloon angioplasty alone (BAA) with carotid artery stenting (CAS) for severe extracranial carotid artery stenosis. The primary outcomes assessed were restenosis requiring retreatment and symptomatic stroke occurrence within a 4-year follow-up period. A total of 77 patients with 89 carotid artery stenoses undergoing endovascular carotid revascularization between January 2015 and December 2019 were included. Neuroradiologic evaluations, including computed tomography angiography or magnetic resonance angiography, were performed at defined intervals. Statistical analyses were conducted to compare patient characteristics, angiographic outcomes, and clinical outcomes between the BAA and CAS groups. The study demonstrated successful outcomes in both groups with low adverse event rates. The overall restenosis rate was 40.2%, but severe restenosis requiring retreatment occurred in only 10 cases (7 in BAA, and 3 in CAS). No significant difference was found in retreatment rates between the 2 groups (P= 0.53). Stroke occurrence within the 4-year follow-up period was observed in 3 patients, with no statistically significant difference between BAA and CAS groups. This study provides valuable insights into the comparative effectiveness of BAA and CAS for severe extracranial carotid artery stenosis. Despite slightly shorter intervals to restenosis in the BAA group, there was no significant difference in retreatment or stroke occurrence rates between the 2 procedures. BAA offers advantages in terms of retreatment options.

Symptomatic carotid webs and patent foramen ovale: RoPE score in competing stroke etiologies

BackgroundPatent foramen ovale (PFO)-associated stroke is diagnosed more frequently in young patients with infrequent vascular risk factors and embolic appearing infarcts. The risk of paradoxical embolism (RoPE) score is used to identify PFO-associated stroke. Patients with symptomatic carotid artery web (CaW) share a very similar risk profile and these lesions are frequently overlooked. In this study, we evaluate the RoPE score profile in patients with suspected symptomatic CaW. MethodsRetrospective analysis of prospectively collected data of patients with symptomatic CaW as the presumed cause of stroke presenting to 2 comprehensive stroke centers from 2014 to 2021. CaW was diagnosed using computed tomography angiography (CTA) of the neck & head. Shunt study was done using a transthoracic, transesophageal, and/or transcranial-Doppler with bubbles. RoPE score ≥7 was considered high. ResultsSeventy-five patients had stroke from a symptomatic ipsilateral CaW. Mean age was 49.7±11.2 years and 74.7 % were females. Median RoPE score was 7 [5–8], and 52.0 % had a high RoPE score. PFO was detected in 13.3 % of the patients and 20.5 % within the high RoPE score group. Ten percent of the cases would have been misclassified as PFO-associated strokes based on RoPE score. ConclusionHigh RoPE scores were observed in the majority of patients with CaW-attributed stroke, and it should not be used to differentiate CaW- versus PFO-associated stroke. Careful extracranial internal carotid artery evaluation for CaW is warranted in cryptogenic strokes, including in PFO positive patients before defining stroke etiology.

Correlation between Glycated Hemoglobin, Extra cranial Carotid Artery Disease, Peripheral Arterial Disease in Type ll Diabetic Patients with Coronary Artery Disease

Abstract Background Diabetes mellitus (DM) is the most common endocrine disorder where the body does not either produce enough insulin or has a resistance to the circulating insulin, and is characterized by high blood sugar levels over prolonged periods. DM is a growing global health issue. In 2000, DM affected an estimated 171 million people in the whole world increased on 2011 to more than 366 million people and expected to be more than 552 million by 2030. Aim of the Work to correlate between HBA1C, carotid, peripheral and coronary artery disease in type II DM patients. Patients and Methods This is an observational study conducted at the coronary care unit & coronary catheterization lab unit of National Institute of Diabetes and Endocrinology, Egypt. Its aim was to correlate between HBA1C, carotid, peripheral and coronary artery disease in type II DM patients. 122 patients with eligible criteria were recruited to the study after signing consent. A full history was taken from every patient, a full clinical examination, 12 lead-ECG, Echocardiography, Carotid duplex, ABI measurement, HbA1C and Invasive non emergent coronary angiography were done. Results Data was collected, tabulated, and analyzed, which revealed that carotid IMT in patients with HbA1C >7% was significantly higher than those with HbA1C<7, HbA1C had a significant positive correlation with carotid IMT, ABI was significantly lower in patients with HbA1C>7% compared to those with HbA1C<7%, ABI had a significant negative correlation with carotid IMT, Number of diseased coronary vessels was significantly higher in patients with higher HbA1C >7% compared to those with HbA1C>7%, ABI had a significant negative correlation with number of diseased coronary vessels and IMT had a significant positive correlation with number of diseased coronary vessels in patients with higher HbA1C >7% with no significant correlation in those with HbA1C<7%, HbA1C can significantly predict peripheral artery disease and carotid atherosclerosis. Conclusion HbA1C correlates significantly with Carotid atherosclerosis, PAD and CAD severity based on number of diseased coronary vessels in uncontrolled TIIDM patients. Also, PAD and carotid atherosclerosis correlate significantly with CAD severity based on number of diseased coronary vessels in uncontrolled TIIDM patients. Also, PAD correlates significantly with carotid atherosclerosis in uncontrolled TIIDM patients. HbA1C can significantly predict carotid artery disease and PAD.

Diagnostic accuracy of carotid plaque instability by noninvasive imaging: a systematic review and meta-analysis.

There is increasing evidence that plaque instability in the extracranial carotid artery may lead to an increased stroke risk independently of the degree of stenosis. We aimed to determine diagnostic accuracy of vulnerable and stable plaque using noninvasive imaging modalities when compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis. Medline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of noninvasive imaging modalities (CT, MRI, US) in the detection of 1) vulnerable/stable plaque, and 2) vulnerable/stable plaque characteristics, compared to histology. The quality of included studies was assessed by QUADAS-2 and univariate and bivariate random-effect meta-analyses were performed. We included 36 vulnerable and 5 stable plaque studies in the meta-analysis, and out of 211 plaque characteristics from remaining studies, we classified 169 as vulnerable and 42 as stable characteristics (28 CT, 120 MRI, 104 US characteristics). We found that MRI had high accuracy [90% (95% CI: 82-95%)] in the detection of vulnerable plaque, similar to CT [86% (95% CI: 76-92%); P > 0.05], whereas US showed less accuracy [80% (95% CI: 75-84%); P = 0.013]. CT showed high diagnostic accuracy in visualizing characteristics of vulnerable or stable plaques (89% and 90%) similar to MRI (86% and 89%; P > 0.05); however, US had lower accuracy (77%, P < 0.001 and 82%, P > 0.05). CT and MRI have a similar, high performance in detecting vulnerable carotid plaques, whereas US showed significantly less diagnostic accuracy. Moreover, MRI visualized all vulnerable plaque characteristics allowing for a better stroke risk assessment. PROSPERO ID CRD42022329690.

Quantitative flow ratio for the functional assessment of extracranial internal carotid artery stenosis.

In asymptomatic patients presenting with significant internal carotid artery (ICA) stenoses undergoing endovascular revascularization, a selective angiography before stenting (CAS) is required. Sometimes, angiographic findings could be discordant from non-invasive assessment and a tool able to evaluate functional relevance of the stenosis could be of value. We sought to evaluate the usefulness of quantitative flow ratio (QFR) as angiography-based tool for functional assessment of ICA stenoses. We prospectively enrolled 50 asymptomatic patients undergoing CAS. Peak systolic velocity (PSV, cm/s) assessed at color Doppler echocardiography was used to identify significant stenoses (PSV >125 cm/s). At angiography, assessment of ICA stenosis was obtained visually (%DS<inf>VISUAL</inf>) and according NASCET criteria (%DS<inf>NASCET</inf>). Stenoses were considered significant if >60%. After exclusion of 20 vessels, QFR, area stenosis (AS, %) and minimal lumen area (MLA, mm2) were obtained in the remaining 80 vessels. At linear regression analysis, QFR significantly correlated with PSV (r2=0.52, P<0.001) as well as with %DS<inf>NASCET</inf> (r2=0.68, P<0.001) and %DS<inf>VISUAL</inf> (r2=0.71, P<0.001). Using PSV as reference, QFR showed good accuracy to predict functionally significant stenosis (AUC=0.98, P<0.001) with a cut-off value of 0.93. As compared with %DS<inf>NASCET</inf> and %DS<inf>VISUAL</inf>, QFR showed a significantly higher accuracy (61% vs. 73% vs. 94%, respectively; P<0.05), sensitivity (43% vs. 61% vs. 93%, respectively; P<0.05) and negative predictive value (46% vs. 51% vs. 85%, respectively; P<0.05) for detecting hemodynamically significant ICA stenoses. This study suggest the potential benefit of adopting QFR for functional assessment of extracranial ICA stenoses. These data should be validated in larger studies.

ATHEROSCLEROTIC CHANGES OF BRACHIOCEPHALIC ARTERIES IN DIFFERENT AGE GROUPS ACCORDING TO SONOGRAPHY

Background. One of the most frequent causes of death is considered to be stroke on the back of atherosclerosis of the extracranial carotid arteries. Detection of atherosclerosis at an early stage facilitates timely prevention and reduces the risk of developing of an acute cardiovascular event in the future. Purpose. To evaluate the clinical significance of ultrasound in the diagnosis of atherosclerotic changes in the brachiocephalic arteries in people of different age groups. Materials and methods. Echography of brachiocephalic arteries was performed among 155 people aged 45 to 89 years, who were randomized into 3 age groups. The middle–aged group included 56 people; the elderly group – 54 people; the senile group - 45 people. The processing of the results of the study was carried out in the programs Statistica 10 (StatSoft, USA). Results. According to the data of sonography, atherosclerotic plaques were detected in 62.5% of the middle–aged group, 83.3% of the elderly group and 88.9% of senile age. Heterogeneous hypoechoic and calcified plaques are found only among people who are over 60 years old. Moderate stenosis was observed at the bifurcation of the common carotid artery in all age groups. Pronounced stenosis and critical vascular stenosis in the proximal part of the internal carotid artery are observed in senile age. The index of the maximum systolic velocity among people with atherosclerosis decreases with age. With increasing age, the level of vascular resistance increases. Conclusion. Considering significant changes in the indicators of atherosclerotic manifestations already in middle age, in order to reduce the increase in population mortality from cardiovascular diseases, the healthcare system should introduce early ultrasound screening of brachiocephalic arteries for patients from 18 years of age.

Anatomical variations of the extracranial internal carotid artery: prevalence, risk factors, and imaging insights from CT-angiography.

To determine the prevalence of different extracranial internal carotid artery (EICA) variations in CT angiography (CTA) of the neck and its predisposing factors. In this retrospective study from 2021 to 2023 conducted in the radiology department of Shafa Hospital, Kerman, Iran, all patients who had undergone neck CTA were included. Expert radiologists blindly examined each CTA image for the following: EICA variations-coiling, kinking, straight morphology, and tortuosity-and the distance between the internal carotid artery and the apex of the epiglottis and the C2 lower margin. Of the 106 patients, the mean age was 55.9 ± 16.9 years. 64.2% were men, and 35.8% were women. Considering each patient's bilateral anatomy, the reported 70.28% (149/212) frequency of EICA variations of all arteries. Tortuosity, kinking, and coiling variation were found in 61.8%, 4.2%, and 4.2% of arteries, respectively. Also, 54.72%, 1.89%, and 0.94% of the participants had bilateral tortuosity, kinking, and coiling, respectively. There was a significant relationship between the prevalence of EICA variations and female sex, age, and hypertension. The frequency of EICA variations in arteries and patients was 70.28% and 73.58%, respectively. Tortuosity was the most common variation. Female sex, old age, and hypertension were significant risk factors for EICA variations.

Covered stent placement for the treatment of mycotic extracranial carotid artery aneurysm: a case report and comprehensive review

Covered stent placement for the treatment of mycotic extracranial carotid artery aneurysm: a case report and comprehensive review

Isolated internal carotid artery dissection after a motorcycle accident: A case report

Extra cranial carotid artery dissection is one of the most important complications associated with blunt head and neck trauma. It is a major cause of ischemic stroke in young adults. We report a case of internal carotid artery dissection which caused transient hemiparesis, horizontal gaze to right and anisocoria in a 19-year-old male motorcyclist involved in a collision. Unenhanced brain computed tomography scan showed well defined infarction in the right frontotemporoparietal area. Digital subtraction angiography showed complete occlusion of the proximal cervical right internal carotid artery. Moreover, intimal dissection was observed in distal cervical left internal carotid artery which did not limit blood flow to the brain. A stent was placed at the site of dissection in the left internal carotid artery. Intravenous heparin was commenced to avoid further thrombosis. He was discharged home 40 days after the accident with oral anticoagulation. Extra cranial carotid artery dissection is a rare condition which may happen after a non-significant neck trauma. Accordingly, the diagnosis of a cervical vascular dissection requires strong clinical suspicion

Common and distinct risk profiles of asymptomatic extra- and intracranial atherosclerosis in the Nagahama cohort

Background and purposeAtherosclerotic burden increases the risk of both extracranial internal carotid artery stenosis (ICS) and intracranial large artery disease (ICAD). However, the differences in risk profiles have not been thoroughly investigated. MethodsParticipants were recruited from the Nagahama study cohort in Japan. Individuals over 60 years old who underwent 1.5-T head and neck magnetic resonance angiography (MRA) between July 2013 and February 2017 were included. ICAD was defined as WASID ≥ 50 %, and ICS was defined as NSCET ≥ 30 %. The prevalence and association of risk factors, including proatherogenic and proinflammatory factors, and the p.R4810K variant in the RNF213 gene, were investigated. Multivariable logistic regression analyses were performed. ResultsA total of 3089 individuals participated in the study, with a mean age of 68.1 ± 5.3 years, and 36.0 % were males. Among them, 52 (1.7 %) had ICS, 119 (3.8 %) had ICAD, and 15 (0.49 %) had both conditions. Alopecia areata was an independent predictor for both ICS (Odds ratio [OR] 3.5; 95 % CI 1.3-8.3) and ICAD (OR 2.1; 95 % CI 1.0-3.9). Diabetes (OR 3.7; 95 % CI 2.0-7.0) and older age (OR 2.4; 95 % CI 1.2-4.5) were associated only with ICS, while the RNF213 variant was associated with only ICAD (OR 5.7; 95 % CI 1.6-16.0). ICS and ICAD were also independently associated with each other. ConclusionsIn this MRA-based large scale study, alopecia areata, known as a systemic inflammatory disease, was shown to be a common risk factor for ICS and ICAD. While conventional atherosclerotic factors were associated with ICS, non-atherosclerotic factors appear to contribute to ICAD in Japan.

Endovascular and Hybrid Treatment of Extracranial Carotid Artery Aneurysms: Long- term Results From the multinational Carotid Aneurysm Registry

Endovascular and Hybrid Treatment of Extracranial Carotid Artery Aneurysms: Long- term Results From the multinational Carotid Aneurysm Registry

Long-Term Outcome Evaluation of Conservative Management for Extracranial Carotid Artery Aneurysms: Insights From the International Carotid Aneurysm Registry

Long-Term Outcome Evaluation of Conservative Management for Extracranial Carotid Artery Aneurysms: Insights From the International Carotid Aneurysm Registry

Classification and management strategy of spontaneous carotid artery dissection

ObjectiveSpontaneous carotid artery dissections (sCADs) are the common cause of stroke in middle-aged and young people. There is still a lack of clinical classification to guide the management of sCAD. We reviewed our experience with 179 patients with sCAD and proposed a new classification for sCAD with prognostic and therapeutic significance. MethodsThis is a retrospective review of prospectively collected data from June 2018 to June 2023 of patients with sCAD treated at a large tertiary academic institution in an urban city in China. Based on imaging results, we categorize sCAD into four types: type Ⅰ, intramural hematoma or dissection with <70% luminal narrowing; type Ⅱ, intramural hematoma or dissection with ≥70% luminal narrowing; type Ⅲ, dissecting aneurysm; type ⅣA, extracranial carotid artery occlusion; and type ⅣB, tandem occlusion. We compared the clinical data and prognostic outcomes among various types of sCADs. ResultsA total of 179 patients and 197 dissected arteries met the inclusion criteria. The mean age of the 179 patients with sCAD was 49.5 years, 78% were male, and 18 patients (10%) had bilateral sCAD. According to our classification, there were 56 type Ⅰ (28.4%), 50 type Ⅱ (25.4%), 60 type Ⅲ (30.5%), and 31 type Ⅳ (15.7%) dissections. During a mean hospitalization length of 11.4 ± 47.0 days, there were nine recurrent strokes (4.6%) after medical treatment, two type Ⅲ dissections (1.0%), seven type Ⅳ dissections (3.6%), all ipsilateral, and one death. Overall, there were seven (3.6%, 1 type Ⅰ dissection, 3 type Ⅱ dissections, 2 type Ⅲ dissections, and 1 type Ⅳ dissection) recurrent strokes and three (1.5%, all type Ⅲ dissections) recurrent transient ischemic attacks in patients treated with just medical therapy during the follow-up period, all ipsilateral, with a mean follow-up of 26 months (range, 3-59 months). These patients did not undergo further intervention due to the high difficulty associated with endovascular treatment (EVT) or the mild nature of recurrent cerebral ischemic symptoms. Twenty-nine type I dissections (51.8%) were completely recanalized after antithrombotic therapy. A total of 19 type II dissections (38%) and 44 type III dissections (73%) received EVT for persistent flow-limited dissections, enlargement of dissecting aneurysms, or aggravation of neurological symptoms despite antithrombotic therapy. Type Ⅳ dissections are more likely to lead to the occurrence of ischemic stroke and presented with more severe symptoms. Eight type IVB dissections (33%) received acute phase intervention due to distal thromboembolism or aggravation of neurological symptoms after medical treatment. In terms of cerebral ischemic events and mortality, there were no statistically significant differences among the four types of sCAD (all P > .05). Favorable outcome was achieved in 168 patients (93.9%). ConclusionsThis study proposed a novel and more comprehensive classification method and the modern management strategy for sCAD. Antithrombotic therapy is beneficial to reduce the risk of recurrent stroke for stable sCAD. Non-emergent EVT can be an alternative therapeutic approach for patients who meet indications as in type II to IVA dissections. Urgent procedure with neurovascular intervention is necessary for some type IVB dissections. The short-term results of EVT for sCAD are encouraging, and long-term device-related and functional outcomes should undergo further research.

Development of a Novel Statistical Model for Predicting Clinical Outcomes in Stroke Patients With Tandem Occlusions After Endovascular Therapy.

Tandem occlusions are intracranial large vessel occlusions (LVOs) with a concomitant ipsilateral extracranial internal carotid artery occlusionand can cause more severe stroke symptoms. To develop a simple, rigorously cross-validated novel tool to predict clinical outcomes following tandem occlusion in patients with acute LVO stroke, based on data that are easily available to clinicians. To have used machine learning approaches to utilize the available information from clinical and angiographic data to make predictive models able to distinguish between mortality versus survival and good (modified Rankin Scale (mRS) ≤ 2) versus unfavorable neurological outcomes (mRs ≥ 3) Materials and methods: Retrospective data from 87 consecutive patients with anterior circulation stroke and tandem occlusions who underwent mechanical thrombectomy and stenting between December 2009 and January 2020 were analyzed. Patients were stratified into three groups based on the location of their LVO, and these groups were compared using statistical tests. Predictive models were built and cross-validated 1000 times to estimate their predictive power, measured by accuracy and area under the receiver operating curve (AUROC). For distinguishing good outcome (mRS ≤ 2) versus poor outcome (mRS ≥ 3), the model comprised age, initial National Institute of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT Score (ASPECTS), NIHSS at 24 hours, NIHSS at discharge and intracranial haemorrhage and yielded an accuracy of 83% and the AUROC of 0.91. For mortality prediction, the model comprised age, initial NIHSS, intravenous thrombolysis, NIHSS at 24 hours and NIHSS at discharge and yielded an accuracy of 91% and an AUROC of 0.94. Models developed exhibit strong predictive performance and can distinguish between both the instances of survival versus mortality and good versus poor outcome with an aim to support clinicians in deciding on optimal management for these complex patients.The developed model will help identify those at risk of poorer outcomes and the prospective better selection of patients with acute ischaemic large vessel stroke secondary to tandem occlusions.

An update on the management of symptomatic extracranial carotid artery stenosis, CEA vs. TFCAS vs. TCAR

An update on the management of symptomatic extracranial carotid artery stenosis, CEA vs. TFCAS vs. TCAR

Predictability of Cardiovascular Risk Scores for Carotid Atherosclerosis in Community-Dwelling Middle-Aged and Elderly Adults.

Background: The assessment of future risk of cardiovascular diseases (CVD) is strongly recommended for all asymptomatic adults without CVD history. Carotid atherosclerosis (CA) is a preclinical phenotype of CVDs. However, data on estimated future CVD risks with respect to preclinical atherosclerosis are limited. This community-based study aimed to assess the relationships between predicted CVD risks and CA. Methods: We enrolled 3908 subjects aged 40-74 years without CVD history and calculated their 10-year CVD risks using the Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE). Carotid plaque (CP) at the extracranial carotid arteries was determined by high-resolution B-mode ultrasonography and further classified into mild or advanced CA. Results: The means of FRS for CP-negative and mild and advanced CA were 9.0%, 14.4%, and 22.1%, respectively (p-value < 0.0001). The corresponding values for PCE score were 4.8%, 8.8%, and 15.0%, respectively (p-value < 0.0001). The odds ratios (ORs) of having CP per 5.0% increase in FRS and PCE score were 1.23 (95% CI, 1.19-1.28) and 1.36 (95% CI, 1.28-1.44), respectively. The corresponding values of having advanced CA were 1.24 (95% CI, 1.19-1.29) and 1.38 (95% CI, 1.30-1.48), respectively. Among the models of FRS or PCE plus other conventional CVD risk factors, the FRS + age model had the highest discrimination for the presence of CP (AUROC, 0.7533; 95% CI, 0.7375-0.7691) as well as for the presence of advanced CA (AUROC, 0.8034; 95% CI, 0.7835-0.8232). The calibration of the FRS + age models for the presences of CP and advanced CA was excellent (χ2 = 8.45 [p = 0.49] and 10.49 [p = 0.31], respectively). Conclusions: Estimated future CVD risks were significantly correlated with risks of having CA. Both FRS and PCE had good discrimination for the presences of CP and advanced CA.

Clinical and radiological outcomes of extracranial carotid artery stent placement: A single-center study

Objectives: Carotid artery stenting (CAS) and carotid endarterectomy are established treatments for carotid artery stenosis. We evaluated the early and mid- to late-term clinical and radiological outcomes of patients who underwent CAS. Materials and Methods: This retrospective study included 98 patients (112 arteries), who underwent CAS. Baseline demographics, stent types, embolic protection devices, and procedural complication rates within 30-day and 3-year post-CAS, including transient ischemic attack (TIA), stroke, death, and stent restenosis, were analyzed. Results: The 30-day complication rates included TIA (5.1%), ipsilateral stroke (4.1%), and death (4.1%). At three-year follow-up, TIA (8.5%), ipsilateral stroke (2.1%), restenosis (1.1%), and death (6.4%) were observed. Contralateral carotid artery angiography revealed neointimal hyperplasia in two vessels (1.9%) and 70–99% restenosis 1 (1%). Notably, a significant association was observed between neointimal hyperplasia and stent geometry, with a higher incidence observed in open-cell stents compared to closed-cell stents (P = 0.03). Conclusion: Our study demonstrated comparable early-term and lower mid- to late-term complication rates compared to prior studies. A multidisciplinary approach with meticulous technique, appropriate materials, and careful patient selection can optimize CAS outcomes.

An evolution in carotid care: Contemporary TCAR data and optimization techniques

ObjectiveCarotid endarterectomy (CEA) is the gold standard for revascularization of atherosclerotic extra-cranial carotid artery lesions. The introduction of transfemoral carotid artery stenting (TFCAS) led to multiple randomized controlled trials to compare the safety and efficacy of an endovascular approach against traditional CEA in the management of carotid artery stenosis. The operative management of carotid artery stenosis continues to evolve, with the more recent introduction of TransCarotid artery revascularization (TCAR) and a novel flow-reversal neuroprotection system. This manuscript reviews a brief history regarding carotid artery revascularization, as well as the indications, technical considerations, and clinical outcomes of the TCAR procedure. Technical considerationsThe preoperative, intraoperative, and postoperative medical and technical considerations are explored. Topics of discussion will include the indications and contraindications for TCAR, anatomic requirements, instructions for use (IFU) and off-label utility, optimal pharmacologic regimen with carotid stent placement, standard deployment and suggestions for hostile anatomy, as well as recommended postoperative management and surveillance imaging. DiscussionThe Society for Vascular Surgery (SVS) has published a consensus statement on the pathways available to obtain clinical competency and maintain technical proficiency with TCAR. Meta-analyses reviewing the contemporary technical success and clinical outcomes of TCAR have demonstrated high rates of procedural success and low rates of stroke, myocardial infarction, and death. Studies have further illustrated comparable one-year rates of peri‑procedural stroke between TCAR and CEA, for asymptomatic and symptomatic carotid lesions, with both outperforming TFCAS. ConclusionManagement of extra-cranial carotid artery stenosis utilizing TCAR with the ENROUTE flow-reversal neuroprotection system has been widely adopted, yielding clinical outcomes and stroke prevention similar to traditional CEA and superior to TFCAS.

Extracranial Carotid Artery Aneurysm: An Institutuinal Review

Abstract Background: Extracranial carotid artery aneurysm (ECAA) is a rare condition, with varied symptoms and etiology. The current series describes the profile and treatment outcomes of those with ECCA. Materials and Methods: A record-based retrospective case study on 10 years of data from a hospital was done. Data on sociodemography including age and gender, symptoms, examination findings, radiological investigations, and management techniques were collected. Results: A case series of 12 cases presenting with different symptoms of extracranial internal carotid artery aneurysm are discussed. Age of the participants varied from being adolescents, adults, or elderly patients. Three-fourth of the cases were males. Pulsatile swelling in the neck was the most common presentation, though asymptomatic manifestations are also present. All 12 were managed by different techniques, with surgical resection and end-to-end anastomosis being the most common type of repair. All had good outcomes following treatment. Conclusion: ECCA has male predominance and occurs mainly in those above 50 years of age. The most common presentation is swelling in the neck and the most common management technique is open surgical repair.

Evaluating Total Atherosclerosis Burden of Baroreceptor-Resident Arteries after Ischemic Cerebrovascular Disease for Identifying Patients with Heavy Coronary Atherosclerosis Burden.

The carotid sinuses and aortic arch are baroreceptor-resident arteries (BRAs) and atherosclerosis-susceptible sites of brain-supplying arteries, which would impair baroreflex-mediated blood pressure (BP) regulation and prompt coronary atherosclerosis. We sought to determine the relationship between total atherosclerosis burden (TAB) of BRAs and coronary atherosclerosis burden (AB) in patients with ischemic cerebrovascular disease (ICVD) and explore the potential contribution of BP profiles to this relationship. In this cross-sectional analysis of patients with ICVD who simultaneously undertook computed tomography angiography and 24-hour ambulatory BP monitoring, TAB of BRAs was scored based on the atherosclerotic vessel circumference ratio of the carotid sinuses and aortic arch, while the ABs of the intracranial, cervical, aortic, and coronary arteries were scored based on stenosis severity and plaque complexity as routine. Among the 230 patients analyzed, coronary AB was significantly correlated with TAB of BRAs, independently of, and more tightly than the ABs of the intracranial, cervical, and aortic arteries, and the stenosis- and complexity-based AB of BRA-located arteries (bilateral common and extracranial internal carotid arteries and aortic arch). Both coronary AB and TAB of BRAs were negatively associated with the night-to-day BP dipping ratios, which was quite different from the relationship between intracranial AB and 24-hour BP characteristics. These findings were also true for patients with ICVD without a history of coronary artery disease. Evaluating TAB of BRAs might provide a new link between atherosclerosis of brain- and heart-supplying arteries, connected partially by BP circadian rhythm. It might facilitate identifying patients with ICVD with heavy coronary AB and comprehensively managing vascular risk.