High-degree Stenosis Research Articles

ANALYSIS OF THE EFFECTIVENESS OF INDIRECT SPINAL CANAL DECOMPRESSION IN THE TREATMENT OF BURST FRACTURES AT THE THORACOLUMBAR JUNCTION

Indirect decompression of the spinal canal through ligamentotaxis is one of the methods for remodeling the spinal canal in traumatic stenosis. Objective: To evaluate the effectiveness of indirect decompression of the spinal canal for different morphological types of burst fractures of vertebral bodies at the thoracolumbar junction. Methods. A preoperative and postoperative analysis of computed tomography scans was performed on 59 patients who were treated at the«Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine» for burst fractures at the thoracolumbar junction. The criterion for the effectiveness of indirect decompression was the area of the spinal canal, measured at the level of injury in the zone of maximum compression. The grading of burst fractures was performed using the classification by F. Magerl et al. (1994). Results. In the preoperative period, the median degree of stenosis in the group of patients was 43.47 % (95 % confidence interval (CI): 37.53–46.22 %). For damage type A3.1, it was 36.9 % (95 % CI: 28.1‒40.5 %), for type A3.2 — 46.1 % (95 % CI: 32.1‒54.5 %), and for type A3.3 — 47.6 % (95 % CI: 37.5‒56.5 %). After surgical treatment, the degree of stenosis decreased by 20.14 % (95 % CI: 15.93‒21.56 %). For type A3.1, the effectiveness was 20.1 % (95 % CI: 9.5‒22.7 %), for type A3.2 — 15.2 % (95 % CI: 7.51‒17.3 %), and for type A3.3 — 21.7 % (95 % CI: 20.8‒26.4 %). The difference between types A3.2 and A3.3 was statistically significant (p = 0.0018). It was found that indirect decompression is most effective with higher degrees of stenosis. For Grade I by D. Wolter (1988), the canalexpansion achieved was 7.07 % (95 % CI: 5.69‒8.65 %), for Grade II — 21.6 % (95 % CI: 20.4‒22.7 %), and for Grade III — 30.3 % (95 % CI: 27.0‒33.6 %). Conclusions. Closed remodeling of the spinal canal with transpedicular fixation and the effect of ligamentotaxis is an effective method for correcting traumatic spinal canal stenosis at the thoracolumbar junction. The effectiveness of the technique is determined by many factors, including the type of burst fracture, the initial degree of stenosis, and the level of injury.

Артериальное и венозное кровообращение у пациентов с выраженным стенозом внутренних сонных артерий до и в разные сроки после проведения каротидной эндартерэктомии

In continuation of earlier studies of the features of venous outflow from the head and neck in patients with varying degrees of stenosis of the internal carotid arteries (ICA), in this article the authors present data on the features of arterial inflow and venous outflow in patients with a high degree of stenosis before and at different periods after carotid endarterectomy. Material and methods 30 patients with stenosis ˃ 60%, were examined before and after surgery at 10-14 days, 6 months and 1 year. The control group consisted of 30 patients without ICA stenosis and signs of systemic and regional phlebohypertension. The results were compared with the control and between the groups. Results The study has shown that venous outflow through the PV in orthostasis at different times after CEAE prevailed over venous outflow in clinostasis. The average values of the total volumetric blood flow through the PV statistically significantly increase after surgery in both clinostasis and orthostasis. Conclusions The presence of phlebohypertension with severe stenosis of the ICA may indicate a relationship between atherosclerotic lesions of the ICA and changes in venous outflow and the formation of systemic or regional phlebohypertension. When restoring blood flow through the ICA with stenosis ˃ 60% after CEAE, the predominance of venous outflow remains in the horizontal position along the IJV system.

Analysis of cerebral venous sinus stenosis by flat panel angiographic CT (FP-CT) to guide treatment for idiopathic intracranial hypertension.

Cerebral venous sinus stenting (CVSS) is an effective treatment for idiopathic intracranial hypertension (IIH) secondary to dural venous sinus stenosis. Traditional selection of patients for CVSS has been made by microcatheter manometry, but pressure measurements are often equivocal. Here we present the results of a series of cases in which venous flat-panel CT (FP-CT) was used as an adjunct to microcatheter manometry to improve decision making and precise stent placement during CVSS. Ten consecutive patients with IIH underwent angiography with microcatheter manometry and venous FP-CT, with CVSS if indicated by the results. Cross-sectional measurements of the narrowed sinus were obtained on FP-CT before and after stenting. After the procedure, clinical outcomes were tracked. Follow-up with quantitative MRA with sinus flow measurements was also performed, when available. There was an exponential correlation between measured pressure gradient and degree of stenosis calculated using venous FP-CT. All patients with both a high degree of stenosis measured by FP-CT and a high pressure gradient across the stenosis showed a clinical benefit from stenting. True measurement of the cross-sectional area of the dural sinus, made by venous phase FP-CT, has a high degree of correlation with elevated venous pressure gradient across the point of stenosis. Even in a limited series of cases, we found an exponential decrease in flow with increasing severity of stenosis. Furthermore, patients with both an elevated venous pressure gradient and critical stenosis of the sinus on FP-CT showed symptomatic improvement after stenting.

Balloon dilatation of subglottic stenoses, especially in granulomatosis with polyangiitis

Subglottic stenoses (SGS) are constrictions in the region below the vocal folds, that can pose a life-threatening problem for those affected. The aim of this research project was to identify the patient group for which the treatment of SGS by balloon dilatation can lead to long-term success. 14 patients with SGS were examined (before and up to12 months after intervention) using pulmonary function tests, laryngoscopies and two questionnaires (Clinical Chronic Obstructive Pulmonary Disease Questionnaire), (modified Medical Research Council Dyspnoea Scale) regarding the respiratory situation. Additionally, the number of necessary interventions, the degree of stenosis (according to Myer Cotton and measured in millimeters) were documented. Four patients who required only one intervention with the balloon showed better pre-interventional respiratory function and a higher subjective stress level. Lung function tests and evaluation of the questionnaires showed an improvement in the respiratory situation and state of health of all 14 patients after the initial intervention. The degree of stenosis measured in millimeters shows that patients with a stenosis diameter of less than 4 mm only required one intervention. All patients who received an intervention using a 12-mm-balloon had to be treated several times. Patients with a high degree of stenosis and a tendency towards greater subjective stress and less objective restriction of the respiratory function appear to have a higher probability of long-term successful treatment with the balloon. Furthermore, the choice of balloon size seems to be an additional decisive factor for the success of an intervention.

ASSESSMENT OF GROWTH AND RUPTURE OF CAROTID ATHEROSCLEROSIS AND PLAQUE WITH DIFFERENT DEGREES OF STENOSIS

In this study, the growth and rupture of plaque were investigated to predict the development of carotid atherosclerosis and plaque. Realistic 3D models of multi-component plaque and carotid artery were established in healthy, mild, moderate, and severe stenosis. Fluid–structure interaction (FSI) simulations were performed on these models, and the wall shear stress (WSS), time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and wall tensile stress (WTS) in a natural cardiac cycle were analyzed to assess the epidermal rupture, growth tendency, and internal rupture of plaques in a natural state. Results show that in severe stenosis, the WSS at the stenosis sites exceeds the threshold of rupture during almost the entire cardiac cycle, thus causing an epidermal injury, bringing about plaque detachment and thrombosis. TAWSS decreased and OSI and RRT increased in the bifurcation region and the downstream region of the plaque. The deposition is more likely to occur in these regions. A higher degree of stenosis will increase the OSI and RRT in the downstream region of the plaque, leading to continuous deterioration of the plaque, while the degree of stenosis has little effect on the upstream region of the plaque. The fibrous cap is the starting point for rupture within the plaque, and calcification increases the stress on the fibrous cap, thereby increasing the risk of rupture.

Short-term glycemic variability and intracranial atherosclerotic plaque stability assessed by high-resolution MR vessel wall imaging in type 2 diabetes mellitus

ObjectiveTo investigate the relationship between short-term glycemic variability in patients with T2DM and the vulnerability of intracranial atherosclerotic plaques using HR-MR-VWI. Materials and methodsIn total, 203 patients with acute ischemic stroke (AIS)/transient ischemia (TIA) combined with T2DM were enrolled. All of them underwent HR-MR-VWI during the period between July 2020 and July 2023. 203 patients were divided into groups with higher (1,5-AG≤ 30.7 μmol/L) and lower (1,5-AG> 30.7 μmol/L) short-term glycemic variability. Patients were also divided into the T1WI and non-T1WI hyperintensity groups. Associated factors(FBG, HbA1c, and 1,5-AG)for the T1WI hyperintensity were analyzed by binary logistic regression. We used the area under the curve (AUC), while the sensitivity and specificity were calculated at the optimal threshold. The Delong test was employed to compare the quality of the AUC of the predictors. ResultsThe group with higher short-term glycemic variability had a higher incidence of the hyperintensity on T1WI, higher degree of enhancement, higher degree of stenosis and smaller lumen area (P < 0.05). The T1WI hyperintensity group had higher HbA1c levels, higher hemoglobin levels and lower 1,5-AG levels(P < 0.05). 1,5-AG (OR = 0.971, 95 % CI: 0.954∼0.988, P = 0.001), HbA1c (OR=1.305, 95 % CI: 1.065∼1.598, P = 0.01) and male sex (OR = 2.048, 95 % CI: 1.016∼4.128, P = 0.045)/(OR=2.102, 95 % CI: 1.058∼4.177, P = 0.034) were independent risk factors for the hyperintensity on T1WI. 1,5-AG demonstrated enhanced performance and yielded the highest AUC of the receiver operator characteristic curve (AUC = 0.726), with sensitivity and specificity values of 0.727 and 0.635 respectively. Conclusion1,5-AG, HbA1c and male sex are independent predictors of intracranial plaques with T1WI hyperintensity, the greater short-term glycemic variability, the higher incidence of vulnerable plaques.

Abstract 1155: Symptomatic Low- And High-degree Carotid Stenoses Exhibit Similar Features Of Plaque Instability

Background: Carotid endarterectomy (CEA) for symptomatic carotid stenosis is recommended for patients with the &gt;70% (NASCET) stenosis but not for those with &lt;50%. Since low-degree stenoses may still cause strokes, refined risk stratification is necessary, which could be improved by incorporating biological features of plaque instability. In order to challenge risk-stratification by the degree of stenosis, we compared biological features of carotid plaques from symptomatic patients with &lt;50% stenosis vs. &gt;70% and explored mechanisms behind plaque instability in low-degree stenoses. Methods: CEA specimens were retrieved from symptomatic patients with &gt;70% (n=204) and &lt;50% stenosis (n=34), all part of the Biobank of Karolinska Endarterectomies (BiKE). Patient demographics, plaque morphology from image analyses of preoperative computed tomography angiography (CTA), and RNA-seq analyses of lesions were used for comparisons. Plaque biology was assessed by transcriptomics using principal component analyses (PCA), differential gene expression (DGE)- and gene-set enrichment analyses (GSEA). Immunohistochemistry (IHC) was used to study proteins corresponding to upregulated genes. Results: The demographics of the two groups were statistically similar. They also showed similar plaque morphology with respect to intraplaque hemorrhage (IPH), plaque burden and fibrous cap thickness, whereas calcification was higher in the &lt;50% group and lipid-rich necrotic core higher in the &gt;70% group. PCA analysis indicated poor clustering, while DGE and GSEA identified enrichment of genes and pathways related to tissue hypoxia and angiogenesis in &lt;50% lesions. Corresponding proteins were detected by IHC in neo-vascularized plaque regions. Conclusions: Plaques from symptomatic patients with &lt;50% carotid stenoses exhibit largely similar morphological and biological features as those from &gt;70% stenoses, emphasizing the need for improved stratification of patients for CEA of symptomatic carotid stenosis. However, pathways associating plaque burden, hypoxia and angiogenesis were particularly enriched in low-grade stenosis lesions suggesting mechanisms behind plaque instability and symptoms in patients with both low- and high-degree stenosis.

Airway collapse hinders recovery in bronchoscopy therapy for postintubation tracheal stenosis patients.

Expiratory central airway collapse (ECAC) following postintubation airway stenosis (PITS) is a rare phenomenon. The impact of airway malacia and collapse on the prognosis and the success rate of bronchoscopic interventional therapy in patients with PITS had been inadequately investigated. The aim of this research was to assess the influence of airway malacia and collapse on the efficacy of bronchoscopic interventional therapy in patients with PITS. This retrospective analysis examined the medical documentation of individuals diagnosed with PITS who underwent bronchoscopic intervention at the tertiary interventional pulmonology center of Emergency General Hospital from 2014 to 2021. Data pertaining to preoperative, perioperative, and postoperative stages were documented and subjected to analysis. The patients in malacia and collapse group (MC group) exhibited a higher frequency of perioperative complications, including intraoperative hypoxemia, need for reoperation within 24h, and postoperative intensive care unit admission rate (P < 0.05, respectively). Meanwhile, patients in group MC demonstrated significantly worse postoperative scores (higher mMRC score and lower KPS score) compared to those in pure stenosis group (P < 0.05, respectively), along with higher degrees of stenosis after treatment and a lower success rate of bronchoscopic intervention therapy cured (P < 0.05, respectively). Pearson analysis results showed that these terms were all significantly correlated with the occurrence of airway malacia and collapse in the airway (P < 0.05, respectively). The presence of malacia or collapse in patients with PITS was associated with increased perioperative complications following bronchoscopic interventional therapy, and significantly reduced the long-term cure rate compared to patients with pure tracheal stenosis. Trial registration Chinese Clinical Trial Registry on 06/12/2021. ChiCTR2100053991.

Cephalic Vein Cutdown Is Superior to Subclavian Puncture as Venous Access for Patients with Cardiac Implantable Devices after Long-Term Follow-Up.

Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the most commonly used access sites for transvenous lead placement of cardiac implantable electronic devices (CIEDs). Limited knowledge exists about the long-term patency of the vascular lumen housing the leads. Among the 2703 patients who underwent CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1-69%, Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized stenosis categorization exists, experienced physicians in consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of stenosis Type III or IV in the CVC group and in the SVP group. In total, 162 patients with venography were enrolled in this study. The prevalence of high-degree stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%) than in the SVP group (median 42%). The present study showed that the long-term patency of the subclavian vein is higher after CVC than after SVP for venous access in patients with CIED.

Abstract WP116: Plaque Features and Infarct Pattern in Ischemic Stroke With Bilateral Carotid Artery Atherosclerosis

Objective: to compare the carotid artery plaque characteristics between ipsilateral and contralateral infarct in ischemic stroke with bilateral carotid artery atherosclerosis, and explore the association between plaque characteristics and infarct pattern. Methods: a total of 186 ischemic stroke patients with bilateral carotid artery atherosclerosis were included, carotid artery plaque burden (the degree of stenosis, maximum wall thickness, lumen area, wall area, normalized wall index (NWI=wall area/[lumen area+ wall area]), and eccentricity index), and vulnerability (intraplaque hemorrhage [IPH], calcification, irregular surface, thin or ruptured fibrous cap[TRFC], and lipid-rich necrotic core[LRNC]) were obtained by MR vessel wall imaging, infarct pattern was divided as single and multiple/recurrent infarcts in infarct ipsilateral carotid artery. Ipsilateral and contralateral carotid artery plaque features were compared, then the carotid artery plaque characteristics on the infarct side were correlated with the infarct pattern. Results: the mean age of subjects included was 68 years old, 79.6% of them were male. Compared with contralateral carotid artery plaque, plaque burden at the ipsilateral carotid artery was much heavy, presented with a higher degree of stenosis, smaller lumen area (0.22±0.15 vs. 0.28±0.15), larger wall area (0.50±0.19 vs.0.42±0.17), and higher eccentricity index (0.67±0.13 vs. 0.58±0.23), all p values&lt;0.05. The vulnerable plaques were also more prevalent at ipsilateral infarct, with a high percentage of IPH (47.8% vs. 19.8%), irregular surface (36.3% vs. 17.5%), TRFC (38.5% vs.12.3%), and LRNC (38.1% vs. 15.9%), all p values were &lt;0.05. After adjusting for covariates, the degree of stenosis (OR=1.590, 95% CI 1.048-2.410) and LRNC (OR=0.259, 95% CI 0.087-0.769) were associated with multiple or recurrent infarcts independently. Conclusion: in ischemic stroke with bilateral carotid atherosclerosis, the atherosclerotic plaque burden at ipsilateral infarct was much heavier and more vulnerable. Both lumen stenosis and plaque components were correlated with multiple or recurrent infarcts in this population.

Aortic Valve Planimetry in Aortic Stenosis Quantification: Reliability of Three-Dimensional-Multiplane Reconstruction and Comparison With Established Methods

We aim to evaluate the reliability and consistency of measuring the aortic valve area (AVA) using 3-dimensional (3D) transesophageal echocardiography and compare it with invasive and noninvasive methods using a continuity equation (CE). Measurements were taken from 119 patients with different severity of aortic stenosis and with normal aortic valve who underwent elective transesophageal echocardiography encompassing the whole spectrum of aortic opening. Three methods were compared to determine AVA. First, the effective AVA was calculated with the standard CE, where the left ventricular outflow tract area was calculated from its 2-dimensional diameter (AVA-CEstd). Second, a modified CE method (AVA-CEmod) was used, in which the left ventricular outflow tract area was measured using 3D-multiplane reconstruction. Third, the geometric AVA was directly measured using 3D-multiplane reconstruction planimetry (AVA-3D). Interobserver and intraobserver variability were analyzed using intraclass correlation coefficients (ICCs). The values were measured by two blinded readers for interobserver variability and by one observer on the same dataset. AVA-3D was significantly larger than AVA-CEmod and AVA-CEstd (1.87 ± 1.00 cm2 vs 1.81 ± 0.92 cm2 p = 0.03 and 1.87 ± 1.00 cm2 vs 1.71 ± 0.85 cm2 p <0.001). However, in the subset of patients with AVA-3D <1.5 cm2, there was no significant difference between AVA-3D and AVA-CEmod (1.06 ± 0.24 vs 1.08 ± 0.26 cm2, paired t test: t=0.77, degree of freedom=58, p=0.44). The ICC between the measurements of AVA-3D and AVA-CEmod (ICC 0.979), and AVA-3D and AVA- CEstd (ICC 0.940), were excellent. AVA-3D delivers very similar results as compared with more established echocardiographic parameters. The difference between effective and geometric AVA did not appear to be clinically relevant in patients with a higher degree of stenosis.

Abstract 16364: Presence of Ramus Intermedius Artery is Associated With Higher Atherosclerotic Plaque Burden in the Left Main Stem in Coronary CT Angiography

Introduction: Ramus intermedius (RI) is a variant vessel arising from left main (LM) bifurcation that supplies the lateral wall. It is thought that presence of RI would result in increased coronary turbulence in LM which in return could affect atherosclerotic plaque formation process. We aimed to investigate the association of presence of RI with presence of atherosclerotic plaque and stenosis in left main (LM). Hypothesis: Presence of RI artery associates with higher frequency of atherosclerotic plaque formation in LM Methods: We performed a large retrospective single-center study, including consecutive subjects who completed a CTA exam from October 2006 to December 2022 in Los Angeles, California to determine if presence of RI associated with higher LM coronary plaque burden. Chi-Square test was used to examine level of left main plaque burden and percent stenosis in subjects where the Ramus is present versus absent. Results: Among the 11,497 subjects, the average age was 62.0±12.4 years, 64% male, and 11% had the Ramus segment present. Those with a Ramus segment present were more likely to have mild, moderate or severe plaque burden (41% versus 26%, p=&lt;0.0001) in their left main. (Table 1). Additionally, subjects with RI has higher prevalence of any degree of LM stenosis compared to those without RI (P-Value&lt;0.0001). Conclusions: Our results suggest that the presence of RI is associated with higher prevalence of atherosclerotic plaques and higher degree of stenosis in LM stem.

Effect of stenotic shapes and arterial wall elasticity on the hemodynamics

The present study employs an arbitrary Lagrangian–Eulerian fluid–structure interaction approach to investigate pulsatile blood flow through a deformable stenosed channel. The flow is modeled by solving the incompressible continuity and momentum equations using finite element-based commercial solver COMSOL Multiphysics®. In this work, we explore the effects of different stenotic shapes—elliptical, round, and sinusoidal, degrees of stenosis (30%, 50%, and 70%), and arterial wall stiffnesses—0.5, 1.5, and 2.5 MPa on the velocity profile, pressure and wall shear stress distribution, and wall deformation. The oscillatory shear index (OSI) is analyzed to predict further plaque formation in the stenosed artery. We find that the flow velocity, wall shear stress, and pressure difference across the stenosed region increase with an increase in the stenotic severity and artery stiffness. The velocity profiles intersect at a radial location in the stenotic region termed critical radius, where relative magnitudes get reversed. With the increase in stenotic severity, the wall displacement decreases at the throat and increases at the upstream side. With the increase in wall stiffness, the wall deformation decreases, and shear stress increases, thereby increasing the pressure drop across the stenosed region. At a lower mass flow rate and a higher degree of stenosis, the vortices are formed upstream and downstream of the stenosed region for all stenotic shapes. The vorticity magnitude is found to be more than 21% higher for sinusoidal stenotic shape than round and elliptical ones. The effect of stenotic profile on the pressure drop characteristics shows that blood experiences maximum wall shear stress for the sinusoidal stenotic geometry, whereas the pressure drop is the maximum for the elliptical stenotic shape. The elliptical stenotic shape is more prone to further plaque formation than round and sinusoidal stenotic shapes. At lower Womersley number (Wo=2.76) corresponding to 60 beats per min heart beat rate, secondary vortices are formed downstream of the channel, causing higher OSI.

Extracranial Carotid Plaque Calcification and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis.

Although coronary calcification quantification is an established approach for cardiovascular risk assessment, the value of quantifying carotid calcification is less clear. As a result, we performed a systematic review and meta-analysis to evaluate the association between extracranial carotid artery plaque calcification burden and ipsilateral cerebrovascular ischemic events. A comprehensive literature search was performed in the following databases: Ovid MEDLINE(R) 1946 to July 6, 2022; OVID Embase 1974 to July 6, 2022; and The Cochrane Library (Wiley). We performed meta-analyses including studies in which investigators performed a computed tomography assessment of calcification volume, percentage, or other total calcium burden summarizable in a single continuous imaging biomarker and determined the association of these features with the occurrence of ipsilateral stroke or transient ischemic attack. Our overall meta-analysis consisted of 2239 carotid arteries and 9 studies. The presence of calcification in carotid arteries ipsilateral to ischemic stroke or in stroke patients compared with asymptomatic patients did not demonstrate a significant association with ischemic cerebrovascular events (relative risk of 0.75 [95% CI, 0.44-1.28]; P=0.29). When restricted to studies of significant carotid artery stenosis (>50%), the presence of calcification was associated with a reduced risk of ischemic stroke (relative risk of 0.56 [95% CI, 0.38-0.85]; P=0.006). When the analysis was limited to studies of patients with mainly nonstenotic plaques, there was an increased relative risk of ipsilateral ischemic stroke of 1.72 ([95% CI, 1.01-2.91]; P=0.04). Subgroup meta-analyses of total calcium burden and morphological features of calcium showed wide variability in their strength of association with ischemic stroke and demonstrated significant heterogeneity. The presence of calcification in carotid plaque confers a reduced association with ipsilateral ischemic events, although these results seem to be limited among carotid arteries with higher degrees of stenosis. Adoption of carotid calcification measures in clinical decision-making will require additional studies providing more reproducible and standardized methods of calcium characterization and testing these imaging strategies in prospective studies.

Correlation of the middle cerebral artery atherosclerotic plaque characteristics with ischemic stroke recurrence: a vessel wall magnetic resonance imaging study.

This study aims to analyze the imaging features of atherosclerotic plaques in the middle cerebral artery (MCA) of patients with recurrent ischemic stroke using vessel wall magnetic resonance imaging (VWMRI) and investigate the correlation between these imaging features and the recurrence of ischemic stroke. Consecutive patients with ischemic stroke caused by atherosclerotic stenosis of the MCA were collected. The patients were divided into recurrent and non-recurrent ischemic stroke groups. We obtained VWMRI images of MCA plaques using 3.0T MRI by black-blood sequences, and the differences in VWMRI characteristics and clinical information between the two groups were compared. A binary Logistic regression model was used to analyze the VWMRI characteristics and clinical information related to ischemic stroke recurrence. 179 patients were collected from August 2018 to May 2020, and 81 patients were included in the study. The recurrent ischemic stroke group patients had a higher stenosis rate (0.69 vs 0.64). Meanwhile, the rate of centripetal wall thickening was significantly higher in patients with recurrent ischemic stroke (33.3% vs 11.7%). Binary Logistic regression analysis showed that sex (P=0.036, OR:2.983, CI:1.075-8.279), stenosis rate (P=0.038, OR:148.565, CI:1.331-16583.631), and vessel wall thickening pattern (P=0.012, OR:0.171, CI:0.043-0.678) were related to ischemic stroke recurrence. The patients with ischemic stroke caused by atherosclerotic stenosis of MCA, female patients, and those with concentric wall thickening and a high degree of stenosis have a higher risk of recurrence. Our results suggest that VWMRI is a valuable tool for predicting the risk of ischemic stroke recurrence in patients with MCA plaques.

Greater burden of white matter lesions and silent infarcts ipsilateral to carotid stenosis

ObjectivesCarotid stenosis may cause silent cerebrovascular disease (CVD) through atheroembolism and hypoperfusion. If so, revascularization may slow progression of silent CVD. We aimed to compare the presence and severity of silent CVD to the degree of carotid bifurcation stenosis by cerebral hemisphere. Materials and methodsPatients age ≥40 years with carotid stenosis >50% by carotid ultrasound who underwent MRI brain from 2011-2015 at Mayo Clinic were included. Severity of carotid stenosis was classified by carotid duplex ultrasound as 50-69% (moderate), 70-99% (severe), or occluded. White matter lesion (WML) volume was quantified using an automated deep-learning algorithm applied to axial T2 FLAIR images. Differences in WML volume and prevalent silent infarcts were compared across hemispheres and severity of carotid stenosis. ResultsOf the 183 patients, mean age was 71±10 years, and 39.3% were female. Moderate stenosis was present in 35.5%, severe stenosis in 46.5% and occlusion in 18.0%. Patients with carotid stenosis had greater WML volume ipsilateral to the side of carotid stenosis than the contralateral side (mean difference, 0.42±0.21cc, p=0.046). Higher degrees of stenosis were associated with greater hemispheric difference in WML volume (moderate vs. severe; 0.16±0.27cc vs 0.74±0.31cc, p=0.009). Prevalence of silent infarct was 23.5% and was greater on the side of carotid stenosis than the contralateral side (hemispheric difference 8.8%±3.2%, p=0.006). Higher degrees of stenosis were associated with higher burden of silent infarcts (moderate vs severe, 10.8% vs 31.8%; p=0.002). ConclusionsWML and silent infarcts were greater on the side of severe carotid stenosis.

Update on the hemodynamic significance of stenotic lesion of the extracranial carotid arteries according to ultrasonic examination of the internal jugular vein

Aim. To study changes in the size and linear velocities of the blood flow of internal jugular veins in patients with high degree stenosis of the extracranial carotid artery.Methods. The study included 28 patients: 14 patients with high degree stenoses of the internal carotid arteries (70% and more by NASCET criteria) constituted group 1, 14 patients with “small” stenoses of the ICA (less than 30%) – group 2. The state of blood flow in the extracranial sections of the main arteries of the head were evaluated using ultrasound.Results. When studying the features of venous blood flow, the following was found: in the group with unilateral hemodynamically significant stenosis, in contrast to the group of patients with “small” stenoses, the venous pressure measured on the arm was statistically significantly lower, and therefore the calculated central venous pressure, while the linear velocities of the peaks S and T were statistically significantly higher by 1 the group on the side of hemodynamically significant stenosis. On the side of contralateral stenosis in group 1, there was statistically significantly less area of VAV, and the ratio S1/S2, than in patients of group 2. Intra-group analysis revealed a statistically significant difference in almost all indicators in patients with hemodynamically significant stenosis compared with the contralateral side: the diameters of the vein and its area were larger, and the linear rates of the A, S and T peaks were higher. Whereas there were no statistically significant differences in the group of “small” stenoses.Conclusion. Changes in venous blood flow in the jugular veins are interrelated with the development of high degree carotid stenosis and have diagnostic significance, can be used as an additional sign of the hemodynamic significance of carotid stenosis.

Numerical modeling of varying hemodynamic features with changing internal carotid artery bifurcation angles and degrees of stenosis

Atherosclerosis is a disease clinically categorized as a silent killer as its symptoms only become pronounced after the buildup has extensively progressed. Therefore, early detection, prediction and treatment become of great priority. The focus of this study is to develop a deeper understanding of plaque formation and the role of key structural variations, specifically the bifurcation angle and degree of stenosis, on its progression in a numerical carotid artery model. A two-way coupled Fluid–Solid Interaction (FSI) numerical approach has been implemented, with the consideration of isotropic elasticity for the artery wall. Geometrically induced hemodynamic flow variations were monitored by tracking changes in hemodynamic indicators, such as the wall shear stress (WSS) and vortex structures. The numerical results demonstrate general trends of the bifurcation angle amplifying recirculation zones, reducing WSS at the sinus far walls, and inhibiting wall deformations about the apex. Meanwhile, progressive stenosis is shown to induce new vortices, increase and decrease WSS at the outer walls and the inner walls respectively, and promote larger deformations. These hemodynamic flow and structural variations hint at increased risk of further plaque buildup with the increase of bifurcation angle at lower degrees of stenosis, while an increased risk of plaque rupture was associated with higher degrees of stenosis.

PREVALENCE AND DISEASE SPECTRUM OF FIBROMUSCULAR DYSPLASIA IN PATIENTS WITH SPONTANEOUS CEREBROVASCULAR ARTERY DISSECTION

Objective: Spontaneous cervical artery dissection (sCeAD) is the most frequent cause of ischemic stroke in young adults and has been associated to various arteriopathies, such as fibromuscular dysplasia (FMD). The aim of this study was to assess the prevalence of both cervical and extra-cervical FMD in patients with a diagnosis of CeAD. Design and method: All patients discharged from the Stroke Unit of A.O.U. Città della Salute e della Scienza of Turin from 2016 to 2020 with a diagnosis of CeAD underwent a contrast-enhanced CTA from chest to pelvis to look for FMD-related lesions (multifocal stenosis, aneurysms, dissections, arterial tortuosity). FMD diagnosis was assessed in the presence of at least a multifocal stenosis in one of the vascular beds explored. Results: Among 56 patients with spontaneous CeAD, 72.7% were male of middle age (52±8.5 y.o.). According to radiological findings, 43.2% of patients showed extra-cervical arterial lesions, with a prevalence of overall FMD (defined as the presence of at least a multifocal stenosis) reaching 47.3% of the studied sample and affecting carotid (36.4%), renal (18.9%), visceral (16.2%), iliac (22.2%) and coronary arteries (2.7%) respectively. Renal involvement included multifocal renal stenosis (13.5%) and arterial aneurysms (5.4%). Visceral involvement included multifocal stenosis (13.5%), visceral aneurysms (2.7%) and silent mesenteric artery dissection (5.4%). Iliac involvement included multifocal stenosis (2.7%), silent artery dissection (2.7%) and tortuosity (16.7%). Furthermore, two spontaneous dissections, one of the left external iliac artery and the other of the coeliac trunk, clinically asymptomatic, were reported in two males with no multifocal stenosis. Two women suffered also from SCAD. Multivascular extra-cervical involvement was observed in almost one third of the patients (27.0%) with sever lesions (multifocal high degree stenosis and/or arterial dissections) affecting 13.5% of the population. Conclusions: According to our results, we demonstrated that FMD is frequently associated to CeAD and that silent FMD-related lesions, even severe as arterial dissections, may coexist in such patients. Therefore, FMD should always be taken in consideration in the differential diagnosis of spontaneous arterial dissection, especially in young subjects without major cardiovascular risk factors.

Karotid Arter Darlık Oranı ile Perioperatif Stent Komplikasyonları İlişkisi

Objective: This study aimed to examine complications that may occur after carotid artery stenting (CAS) and their relationships with carotid artery stenosis rate.&#x0D; Materials and Methods: Complications, such as cerebral hyperperfusion, stroke, death, stent thrombosis or occlusion and restenosis, were evaluated on the 30th day after CAS and at the end of the first year. &#x0D; Results: Of the 205 CAS procedures, complications developed in 12 patients. The complication rate for the first 30 days after the procedure was 4,87%, and at the end of the first year, it was 5,85%. Of the 12 patients with complications, 8 had carotid stenosis of ≥90%. Death occurred in 4 of 195 patients with carotid artery stenosis. The mortality rate within the first 30 days and during the 1-year follow-up period was 1,53% and 2,05%, respectively. Ischemic stroke occurred in 6 of 195 patients with carotid artery stenosis. After the first 30 days and one year follow-up, ischemic stroke had occurred in 3,07% of patients. Stent thrombosis and occlusion rate was 4,87% in 205 CAS procedures, and 7 of them occurred in the first 24 hours and another 3 occurred within the first 30 days. Restenosis rates were 0,48% and 0,97% at 6 months and the first year, respectively. &#x0D; Conclusion: The complications of CAS have been associated with the urgency of treatment (emergency), symptom presence (symptomatic patients) and high degree of stenosis (≥90%); whereas bilateral stenosis is not associated with complications. In addition, stent thrombosis and occlusion were observed as the most common CAS complication.