Internal Carotid Artery In Patients Research Articles

Predictors of a Favorable Outcome after Emergent Carotid Artery Stenting in Acute Anterior Circulation Stroke Patients.

PurposeThis study aimed to identify independent predictors of favorable outcomes associated with emergent carotid artery stenting (CAS) in patients with acute anterior circulation stroke.Materials and MethodsThis study included 93 patients with acute stroke who underwent emergent CAS to treat stenoocclusive lesions in the cervical internal carotid artery (ICA) within 6 hours of the onset of the associated symptoms. Data were compared between patients with and without favorable outcomes. The independent predictors of a favorable outcome were determined via logistic regression analysis (modified Rankin Scale 0–2 at 90 days).ResultsIntracranial tandem occlusion was noted in 81.7% of patients (76/93) among which (76/93), 55 of whom underwent intracranial recanalization therapy. Intracranial reperfusion was successful in 74.2% (69/93) and favorable outcomes were noted in 51.6% of patients (48/93). The mortality rate was 6.5% (6/93). In logistic regression analysis, diffusion-weighted imaging-Alberta Stroke Program Early CT Score [odds ratio (OR), 1.487; 95% confidence interval (CI), 1.018–2.173, p = 0.04], successful reperfusion (OR, 5.199; 95% CI, 1.566–17.265, p = 0.007), and parenchymal hemorrhage (OR, 0.042; 95% CI, 0.003–0.522, p = 0.014) were independently associated with a favorable outcome.ConclusionBaseline infarct size, reperfusion status, and parenchymal hemorrhage were independent predictors of favorable outcomes after emergent CAS to treat stenoocclusive lesions in the cervical ICA in patients with acute anterior circulation stroke.

Early Carotid Endarterectomy for Symptomatic Stenosis of Internal Carotid Artery in Patients Affected by Transient Ischemic Attack or Minor-to-Moderate Ischemic Acute Stroke: A Single-Center Experience

In the setting of carotid transient ischemic attack (TIA) or minor/moderate ischemic stroke, early surgical endarterectomy (CEA) seems to decrease the number of recurrences. The aim of the present study was to report a single-center experience with early surgical carotid revascularization in patients affected by TIA and minor/moderate ischemic acute stroke. A retrospective data collection was carried out on all consecutive patients surgically treated for an extracranial internal carotid artery (ICA) hemodynamic NASCET stenosis in the Vascular Unit of Foch Hospital, in Suresnes (France) between January 2011 and July 2016. All patients undergoing ICA endarterectomy for symptomatic carotid stenosis (SCS) within 48 hours and 14 days after the acute neurologic onset were included in the present study. Outcomes were evaluated by a prospective follow-up. Primary outcomes were the rate of postoperative ipsilateral stroke and myocardial infarction (MI) and the death/stroke/MI at 30-day and at the long-term follow-up. Secondary outcomes were local and systemic complications' rate. Outcomes were stratified according to NIHSS score and comorbidities, and a univariate analysis and multivariate analysis were performed to define any correlation between preoperative data and postoperative outcomes. A total of 249 consecutive patients (45.4%, 113 symptomatic vs. 54.6%, 136 asymptomatic) underwent CEA for hemodynamically significant ICA stenosis at our institution. According to inclusion criteria, 72 patients affected by SCS (27.7% women vs. 72.3% men; median age 71.9 years, range: 42-89; median preoperative NIHSS score 3, range 1-17) were enrolled in the present study. Median delay for surgery was 4 days (range: 2-14). No in-hospital stroke, nor myocardial infarction nor death were detected during in-hospital post-operative period. The combined death/stroke/MI rate was 0% and 5.5 % at 30-days at 6 years follow-up respectively. In-hospital NIHSS score improved post-operatively of more than 2 points (range 0-15) in 47.2% of cases. A total of 10 patients (13.8%) experienced a local complication (hematoma, permanent or regressive nerve injury). No systemic complications (renal/respiratory failure, urinary tract infection, pneumoniae) were registered. At long-term follow-up a total of four patients (5.5%) died and six patients (8.3%) were lost. The stratification of outcomes according to NIHSS status, sex, comorbidities and preoperative surgical procedure did not show any statistical relation neither at 30 days nor at the long term-follow up. Diabetes was statistically correlated to a higher rate of complication at the long-term follow-up (P 0.049). In properly selected patients affected by minor/moderate ischemic acute stroke and TIA early carotid endarterectomy can be performed without any worsening of neurological status.

P6507ST2L and sST2: relationship in the carotid plaque - a study on 76 cases underwent endarterectomy

Abstract Background ST2 receptor (suppression of tumorigenity) has been described as receptor for the interleukin 33 (IL-33), a member of the IL-1 family of cytokines. This receptor is associated in various way to coronary artery disease, all-causes mortality and cardiovascular mortality. It's role in the pathogenesis of atherosclerosis is not well-defined yet. Purpose The present study was designed to assess the relationship between serum level of sST2, a decoy receptor, and immunohistochemicalespression of ST2L in atherosclerotic plaques of formalin fixed paraffin-embedded internal carotid arteries of patients underwent endarterectomy, accepted the predictive value of ST2 in atherosclerosis. Methods The study involved 76 cases (31 symptomatic= 41%, 45 asymptomatic= 59%), age range from 47 to 86 years old, underwent endarterectomy for the treatment of internal carotid stenosis in our vascular surgery of polyclinic, all procedures performed by the same physician. Patients were divided into three groups, depending on the presence of ST2Ltransmembrane receptor on the carotid plaque after immunoistochemical evaluation (group low presence of ST2L= 0–1+; moderate presence of ST2= 2+; high presence of ST2= 3+). Serum level of sST2 were defined through the use of an ELISA-kit, specific for ST2 and ready-to-use. Results There was a relationship between ST2L and sST2 values: if considering sST2 mean and median value referring to specific subgroup (low, moderate and high), this is lower if the group (i.e. ST2L presence on the atherosclerotic plaque) is higher, and vice-versa. This shows an inverse relationship between this two parameters. Moreover, using Pearson correlation coefficient, all the three sub-group show a strong correlation to the leukocytes value (low=0.658, moderate= 0.434, high= 0.358). Conclusions The ST2L immunohistochemical expression was for the first time investigated in a large number of human carotid atherosclerotic plaques. The inverse relationship between ST2L and sST2 supports the pathogenetic hypothesis that ST2L/IL33 axis could drive the mechanism of plaque development and eventually rupture. Correlation with leukocytes provides a further strong evidence confirming inflammatory pathogenesis of atherosclerosis, but most of all leukocytes' high value could be associated to a greater plaque instability. Acknowledgement/Funding None

Impact of the laryngeal tube as supraglottic airway device on blood flow of the internal carotid artery in patients undergoing general anaesthesia

IntroductionLaryngeal tubes (LT) are supraglottic airway devices routinely used in emergency airway management. During cardiac arrest in a swine model, the carotid artery blood flow is reduced after insertion of a LT. A compression of the internal carotid (ICA) artery by the inflated cuff was shown. Up to now there is no information if the LT has similar effects in humans with possible negative implications for use of the LT in case of cardiac arrest. ObjectiveWe hypothesized that the use of a LT in humans significantly reduces the blood flow in the ICA compared facemask ventilation. A significant reduction was defined as a 25% reduction from baseline values. Material and methodsAfter induction of general anaesthesia and reaching a haemodynamic steady state (stable heart rate >50/min and mean arterial pressure >60 mmHg), blood flow within the ICA was measured via doppler sonography during pressure-controlled ventilation with facemask-, laryngeal tube- and laryngeal mask. ResultsWe found no differences in the carotid blood flow. Neither between the facemask ventilation (right side 419 ± 159 ml min−1, left side 355 ± 120 ml min−1) and the laryngeal tube ventilation (right side 400 ± 131 ml min−1, left side 384 ± 124 ml min−1. p = 0.86 and p = 0.12), nor the facemask-ventilation and the laryngeal mask ventilation (right ICA 415 ± 150 ml min−1, left ICA 485 ± 274 ml min−1, p = 0.49 and 0.26). ConclusionsIn humans the LT does not impair blood flow of the internal carotid artery during ventilation in general anaesthesia. Further studies are needed to confirm our findings under the conditions of cardiac arrest.

Hemodynamic characteristics associated with cerebral aneurysm formation in patients with carotid occlusion.

The pathogenesis of cerebral aneurysms in patients with internal carotid artery (ICA) occlusion is hypothesized to be hemodynamic. For the first time, the authors quantify the hemodynamic characteristics associated with aneurysm formation in patients with ICA occlusion. Records of patients with unilateral ICA stenosis or occlusion ≥ 90% who underwent hemodynamic assessment before treatment using quantitative MR angiography were retrospectively reviewed. The patients were classified into 2 groups based on the presence or absence of aneurysms. The hemodynamic parameters of flow volume rate, flow velocity, and wall shear stress (WSS) were measured in each vessel supplying collateral flow-bilateral A1 segments and bilateral posterior communicating arteries-and then compared between the groups. A total of 36 patients were included (8 with and 28 without aneurysms). The mean flow (72.3 vs 48.9 ml/min, p = 0.10), flow velocity (21.1 vs 12.7 cm/sec, p = 0.006), and WSS (22.0 vs 12.3 dynes/cm2, p = 0.003) were higher in the A1 segment contralateral to the side of the patent ICA in patients with versus without aneurysms. All de novo or growing aneurysms in our cohort were located on the anterior communicating artery (ACoA) or P1 segment. Flow velocity and WSS are significantly higher across the ACoA in patients who harbor an aneurysm, and de novo or growing aneurysms are often located on collateral vessels. Thus, robust primary collaterals after ICA occlusion may be a contributing factor in cerebral aneurysm formation.

Progression of Mild to Moderate Stenosis in the Internal Carotid Arteries of Patients With Ischemic Stroke.

Background and purpose: Severe stenosis in the internal carotid artery may increase the risk of ischemic stroke. The factors that affect the progression of carotid artery stenosis in patients with ischemic stroke are poorly studied. No guidelines for the duration of follow-up of patients with ischemic stroke through carotid ultrasonography exist.Methods: In this retrospective study, 179 patients (108 men; mean age, 68 years) with ischemic stroke and mild to moderate stenosis in the internal carotid artery (ICA) were recruited. Carotid artery ultrasonography was performed over the period of January 2013 to June 2016 with a median follow-up of 36 months (mean 36.5 ± 3.5 months). The severity of carotid artery stenosis was estimated with the following equation: 1– (narrowest ICA diameter/total lumen diameter at the narrowest site). The severity of stenosis was categorized into grades I (0–29%), II (30–49%), III (50–59%), and IV (60–69%). The patient's stenosis grade was defined on the basis of the stenosis rate of the ICA side with most severe stenosis.Results: Stenosis progressed in 17.9% (64/358) of the vessels in 30.7% (55/179) of patients. The risk of stenosis progression increased as the severity of ICA stenosis increased. Patients with stenosis rates of above 50% are at a higher risk of stenosis progression than those with stenosis rate of < 50%. Relative to the patient group with an ICA stenosis rate of 0–29%, the adjusted odds ratios of stenosis progression were 2.33 (p = 0.03; 95% CI: 1.05~5.17), 3.50 (p = 0.09; 95% CI: 0.81~15.84), and 6.61 (p = 0.03; 95% CI: 1.01~39.61) in patient groups with ICA stenosis rates of 30–49%, 50–59%, and 60–69%, respectively. Hyper-LDL-cholesterolemia (Hyper-LDL-c) also increased the risk of stenosis progression, with an adjusted odds ratio of 2.22 (p = 0.03; 95% CI: 1.05~4.71).Conclusion: The rate of ICA stenosis progression increases with stenosis grade. Patients with ICA stenosis severity >50% and Hyper-LDL-c have high rates of stenosis progression. For the patients with stroke and ICA stenosis severity >50%, annual follow up through carotid artery ultrasonography may be necessary.

Proximal internal carotid artery stenosis associates with diffuse wall thickening in petrous arterial segment of moyamoya disease patients: a three-dimensional magnetic resonance vessel wall imaging study.

To investigate the association between proximal internal carotid artery (ICA) luminal narrowing and diffuse wall thickening (DWT) in ipsilateral petrous ICA in moyamoya disease (MMD) patients. Forty-one MMD (mean age 42.8 ± 11.0years, 19 males) and 36 atherosclerotic patients (mean age 61.5 ± 7.1years, 31 males) and 41 healthy controls were recruited and underwent carotid MR vessel wall imaging. The luminal narrowing of proximal ICA was evaluated by the diameter ratio of ICA to common carotid artery (DRICA/CCA). The wall thickness of petrous ICA was measured on T1-VISTA images. The enhancement degree of petrous ICA was recorded and graded into four grades (none to marked) on the CE-T1-VISTA images. The correlation between wall thickness in petrous ICA and DRICA/CCA was analyzed. RESULTS: In total, 81 arteries of MMD patients and 64 arteries of atherosclerotic patients were included for analysis. The DRICA/CCA was significantly correlated with the wall thickness in petrous ICA in MMD (r = - 0.434, P < 0.001) and atherosclerotic groups (r = - 0.604, P < 0.001). Logistic regression analysis revealed that odds ratio (OR) of DRICA/CCA was 4.433 (95% CI 1.980-9.925, P < 0.001) and 2.212 (95% CI 1.253-3.905, P = 0.006) in MMD and atherosclerotic groups in discriminating petrous ICA DWT after adjusting for confounding factors. An increasing trend was found in prevalence of DWT and wall thickness with enhancement grades in petrous ICA in MMD (P = 0.02 and P = 0.01) and atherosclerotic groups (P < 0.001 and P < 0.001), respectively. The proximal ICA luminal narrowing is significantly associated with wall thickness and diffuse wall thickening in ipsilateral petrous ICA in patients with carotid steno-occlusive diseases regardless of MMD or atherosclerosis.

Cav-1 (Caveolin-1) and Arterial Remodeling in Adult Moyamoya Disease.

Background and Purpose- Moyamoya disease (MMD) is a unique cerebrovascular occlusive disease characterized by progressive stenosis and negative remodeling of the distal internal carotid artery (ICA). We hypothesized that cav-1 (caveolin-1)-a protein that controls the regulation of endothelial vesicular trafficking and signal transduction-is associated with negative remodeling in MMD. Methods- We prospectively recruited 77 consecutive patients with MMD diagnosed via conventional angiography. Seventeen patients with intracranial atherosclerotic stroke and no RNF213 mutation served as controls. The outer distal ICA diameters were examined using high-resolution magnetic resonance imaging. We evaluated whether the degree of negative remodeling in the patients with MMD was associated with RNF213 polymorphism, cav-1 levels, or various clinical and vascular risk factors. We also investigated whether the derived factor was associated with negative remodeling at the cellular level using the tube formation and apoptosis assays. Results- The serum cav-1 level was lower in the patients with MMD than in the controls (0.47±0.29 versus 0.86±0.68 ng/mL; P=0.034). The mean ICA diameter was 2.48±0.98 mm for the 126 affected distal ICAs in patients with MMD and 3.84±0.42 mm for the asymptomatic ICAs in the controls ( P<0.001). After adjusting for confounders, cav-1 levels (coefficient, 1.018; P<0.001) were independently associated with the distal ICA diameter in patients with MMD. In vitro analysis showed that cav-1 downregulation suppressed angiogenesis in the endothelial cells and induced apoptosis in the smooth muscle cells. Conclusions- Our findings suggest that cav-1 may play a major role in negative arterial remodeling in MMD.

Carotid Plaque Vulnerability Assessment Using Ultrasound Elastography and Echogenicity Analysis

The purpose of this study was to evaluate ultrasound elastography and echogenicity analysis to discriminate between carotid plaques in patients with symptomatic internal carotid artery (ICA) stenosis versus patients with asymptomatic stenosis. Patients with symptomatic and asymptomatic ICA stenosis of more than 50% were recruited for the study. After both carotid arteries were scanned, plaque translation and elastography and echogenicity features were assessed. Parameters of index stenosis (i.e., symptomatic or more severe stenosis) were compared between populations. For further validation, parameters of index stenosis were also compared with those of the contralateral artery for segments with plaque. Segments without plaque on the index side were also evaluated between populations. ROC curve analyses were performed using a cross-validation method with bootstrapping to calculate sensitivity and specificity. Sixty-six patients with symptomatic (n = 26) or asymptomatic (n = 40) carotid stenoses were included. The maximum axial strain (p < 0.001), maximum axial shear strain magnitude (p = 0.03), and percentage of low-intensity of gray level (p = 0.01) of the index ICA were lower for patients with symptoms than for those without symptoms. In both groups, the contralateral ICA had translation and elastography and echogenicity parameters similar to those of the index ICA in patients with asymptomatic stenosis. The ROC curve for the detection of vulnerable plaques in patients with symptomatic stenosis was higher when ultrasound elastography and ultrasound echogenicity were used in combination than when each method was used alone (p < 0.001); a sensitivity of 71.6% and a specificity of 79.3% were obtained. This pilot study establishes the usefulness of combining elastography with echogenicity analysis to discriminate plaques in patients with symptomatic ICA stenosis versus asymptomatic stenosis.

Smaller caliber of the internal carotid artery in patients with ipsilateral aplasia of the A1 segment of the anterior cerebral artery: a study with CTA.

To measure the diameter and the transsectional area of the internal carotid arteries (ICA) on CT Angiography (CTA) in patients with aplasia of the A1-segment of the ACA (A1) and in patients with symmetrical A1, the mean diameter and area of the ICA on both sides were measured at a level of 2cm below the skull base with a commercially available CT software in 41 consecutive patients with aplasia of A1 observed during a 12-month period on CTA and in 41 control patients with symmetrical A1. The mean diameter of the ipsilateral ICA was 3.83 ± 0.60mm versus 4.86 ± 0.60mm as mean diameter of the contralateral ICA and versus 4.40 ± 0.60mm as mean diameter of both ICAs in the control group of patients. The mean area of the ipsilateral ICA was 11.58 ± 3.80 mm2 versus 18. 82 ± 7.39 mm2 as mean area of the contralateral ICA and versus 15.29 ± 4.42 mm2 as mean area of both ICA in the control group of patients. These differences are statistically highly significant. In patients with symmetrical A1, there was no statistical difference between the diameter or area of both internal carotid arteries. In conclusion, in patients with aplasia of A1, the ipsilateral diameter and area of the cervical ICA is smaller than the diameter and area of the contralateral ICA and smaller than the diameter and area of both internal carotid arteries in patients with symmetrical A1.

Intermittent mydriasis associated with carotid vascular occlusion

PurposeTo describe two cases of stereotyped, intermittent, neurologically isolated, unilateral mydriasis in patients with a history of acquired internal carotid artery (ICA) occlusive disease on the ipsilateral side.PatientsTwo patients with intermittent mydriasis.MethodsCase Series.ResultsCase one: A 78-year-old man experienced 10 episodes of intermittent, unilateral, and painless mydriasis in the left eye and had 100% occlusion of the left ICA artery due to atherosclerotic disease. Case two: A 26-year-old woman with history of migraine developed new painless, intermittent episodes of unilateral mydriasis after sustaining chest trauma and was diagnosed with subsequent dissection and 65% occlusion of the ipsilateral ICA. Neither patient developed permanent anisocoria.ConclusionBenign episodic unilateral mydriasis (BEUM) typically presents in young women with a history of migraine. To our knowledge, these are the first cases of episodic, unilateral, neurologically isolated mydriasis associated with occlusive disease of the ICA in the English language ophthalmic literature. We hypothesize that transient dysfunction of the autonomic nervous system related to the ICA disease may account for the intermittent mydriatic episodes in these patients and we recommend consideration for imaging of the ICA in patients with atypical features for BEUM (for example, old age or males, non-isolated mydriasis, or recent trauma).

Роль неалкогольной жировой болезни печени в формировании атеросклеротического поражения сосудистой стенки у пациентов с абдоминальным ожирением

Aim of investigation. To study the vascular wall changes of common carotid artery and internal carotid arteries in patients with abdominal obesity (AO) and different forms of nonalcoholic fatty liver disease (NAFLD). Material and methods. The study involved 60 patients with AO (waist circumference ≥80 cm in women and ≥94 cm in men) and NAFLD who provided written informed consent to participate in the study. The age of the patient ranged from 18 to 59 years. Patients’ symptoms, past history, were evaluated to exclude alcoholic or drug-induced liver disease, anthropometric parameters were studied. All patients underwent a complex of laboratory and instrumental tests required by the Russian guidelines for diagnosis and treatment of NAFLD (2015). Severity of pathological changes in the liver tissue (fibrosis and steatosis) was assessed by noninvasive Steatoskrin diagnostic method (Biopredictive laboratory, France). Measurement of the intima-media complex thickness of the common carotid artery (IMT CCA) was performed by standard procedures at Voluson 730 Expert device, equipped with 7,5 MHz linear phased array transducer. The presence of early atherosclerotic markers was evaluated by local thickening of the IMT CCA over 0.86 mm in any point of the carotid artery (IMT CCA max). The data were processed by comparative and correlation analysis. Results. The relationship between the presence of NAFLD, initial manifestations of atherosclerosis and insulin resistance was established. This resulted in the rank of prognostic factors based on severity of carotid artery changes, making it possible to conclude individual atherosclerotic risk score for AD and different forms of NAFLD. Conclusion. The results of the study require more profound examination of patients with NAFLD to evaluate both liver and cardiovascular diseases risk.

ST2L Transmembrane Receptor Expression: An Immunochemical Study on Endarterectomy Samples.

BackgroundST2 (suppression of tumorigenity) has been described as a receptor for the interleukin-33, a member of the IL-1 family of cytokines. It is associated to coronary artery disease, all-causes mortality and cardiovascular mortality.AimsThe present study was designed to assess the immunohistochemical expression of the ST2 receptor (ST2L/Il-1R) in atherosclerotic plaques of formalin fixed paraffin-embedded internal carotid arteries of patients with and without cerebro-vascular symptoms.Methods and ResultsThe study involved 41 cases (23 asymptomatic and 18 symptomatic). All the clinical and morphological parameters examined were uniformly distributed between the two groups, with a mild predominance of degree of calcification in asymptomatic cases (p = 0.01). ST2L expression was found to be more evident as a membrane pattern in macrophages when observing carotid atherosclerotic plaques of symptomatic patients, rather than in asymptomatic patients’ plaques (77.7% vs 39.1%; p = 0.015), and its expression was particularly remarkable in VI type plaque (AHA). Significantly, ST2L was marked by the endothelium of neoangiogenetic vessels on the shoulder region of the plaque, but not (apart from a few cases) in the endothelium covering the residual lumen of the vessel.ConclusionsThe ST2L immunohistochemical expression was for the first time investigated in a large number of human carotid atherosclerotic plaques, as for its pattern of distribution in the different plaque cell populations. Furthermore, ST2L was particularly remarkable on macrophages, as a membrane pattern, of symptomatic patients’ plaque. Considering our data, we hypothesize that ST2L/IL33 axis could drive the mechanism of plaque development and eventually rupture.

ASSESSMENT OF EFFICACY OF SURGICAL CEREBRAL REVASCULARIZATION IN PATIENTS WITH LARGE POST-STROKE CYSTS

Background: At present, efficacy of carotid endarterectomy for prevention of cerebrovascular accidents has been convincingly proven. Its results in patients with a history of an ischemic stroke depend on multiple factors. Aim: To study results of reconstructive interventions on internal carotid arteries in patients with post-stroke cerebral cysts. Materials and methods: We analyzed data from 210 patients who had undergone an intervention (159 men and 51 women, aged 61 ± 2.7 years) with occluding lesions of the internal carotid artery and a history of an ischemic stroke. Depending on the size of a post-stroke lesion, patients were divided into 5 groups: patients from group 1 had a lesion of more than 5 cm in diameter, from group 2, from 2 to 5 cm, from group 3, ≤ 2 cm, patients from group 4 had a lacunar cysts and patients from group 5 had no focal lesions. Results: A clear positive correlation between the size of a post-stroke cyst and the degree of hemodynamic abnormalities in internal carotid arteries was found. The most prominent asymmetry of blood flow in the middle cerebral artery (on average, 34.1%) was seen in patients from the group 1. Patients from the group 1 more often had low and critical brain tolerance to ischemia (42.9%). In patients with large post-stroke cysts (group 1) mean Barthell index was 69 ± 8.1, and NIHSS score 8.2 ± 1.6. In patients from other groups neurological deficiency was less pronounced: 80 ± 6.8 and 7.6 ± 1.9 in the group 2, 82 ± 5.7 and 4.1 ± 1.3 in the group 3, 94 ± 4.6 and 3.2 ± 1 in the groups 4 and 5. The differences between groups in the rates of postoperative complications were not statistically significant (p > 0.5). However, signs of hyperperfusion without any clinical manifestations were more often observed in patients from the group 1 (19%). Assessment of changes in neurological status at 1 year after the intervention, depending on the size of post-stroke lesions, showed that in patients with large cysts the regression of neurological deficiency was less obvious, than in other groups (NIHSS 7.5 ± 1.7, Barthell index 76 ± 7.7). The best restoration of impaired neurological functions was seen in patients with small cysts (NIHSS 2.2 ± 0.7, Barthell index 91 ± 3.4). Conclusion: In patients with large and intermediate post-stroke cerebral cysts surgery is associated with a higher complication rate, and, first of all, of hyperperfusion syndrome. However, the risk of these complications is significantly smaller than the probability of repeated acute cerebrovascular accidents.

Management of the cervico-petrous internal carotid artery in class C tympanojugular paragangliomas.

Management of the cervical and petrous internal carotid artery (ICA) is frequently required in Fisch class C tympanojugular paragangliomas (TJPs). The purpose of this study was to discuss the perioperative intervention of the ICA in patients who underwent surgical resection of a TJP. A retrospective study of 237 patients surgically treated for Fisch class C TJPs was done to identify cases that required ICA management. Management of the ICA was required in 176 patients (74.2%). Forty-two patients required just an ICA decompression, 88 underwent a subperiosteal dissection, 19 underwent subadventitial dissection without intraluminal stenting, 17 underwent subadventitial dissection with intraluminal stenting, and 12 underwent arterial resection after permanent balloon occlusion. There were no complications associated with the endovascular procedures. Gross total tumor resection was achieved in 91.5% of the cases. Preoperative endovascular intervention, in selected cases, facilitates gross total tumor removal and significantly reduces the risk of an intraoperative ICA injury. © 2015 Wiley Periodicals, Inc. Head Neck 38: 899-905, 2016.

MR derived volumetric flow rate waveforms of internal carotid artery in patients treated for unruptured intracranial aneurysms by flow diversion technique.

Little is known about the hemodynamic disturbances induced by the cerebral aneurysms in the parent artery and the effect of flow diverter stents (FDS) on these latter. A better understanding of the aneurysm-parent vessel complex relationship may aid our understanding of this disease and to optimize its treatment. The ability of volumetric flow rate (VFR) waveform to reflect the arterial compliance modifications is well known. By analyzing the VFR waveform and the pulsatility in the parent vessel, this study aimed to test the hypotheses that (1) intracranial aneurysms might disrupt the blood flow of the parent vessel and (2) the treatment by FDS might have measurable corrective effect on these changes. Ten patients followed for unruptured intracranial aneurysms treated by FDS and ten healthy volunteers as control group were included in this study. Two-dimensional quantitative phase-contrast magnetic resonance imaging (MRI) was performed on each patient on the ICA artery upstream and downstream to the aneurysm, and on each volunteer at similar locations. The aneurysms altered significantly the parent vessel pulsatility and this effect was correlated to their volume. The aneurysms treatment by FDS allowed for the restoration of a normally modulated flow and pulsatility correction in the parent vessel.

The S curve: a novel morphological finding in the internal carotid artery in patients with fibromuscular dysplasia.

Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disease commonly affecting the renal and internal carotid arteries (ICAs). A previously unrecognized finding is a redundancy of the mid-distal ICA in FMD patients causing an 'S'-shaped curve. Carotid artery duplex ultrasounds were reviewed in 116 FMD patients to determine S-curve prevalence. FMD patients with an S curve were matched to four control patients divided equally into two groups: (1) age and sex-matched and (2) age ≥70 and sex-matched. S curves were present in 37 (32%) FMD patients. Of these, nine (24%) had angiographic evidence of FMD in their ICA only, 13 (35%) had renal artery FMD only, and 15 (41%) had both ICA and renal FMD. Two patients in the age and sex-matched group had S curves (odds ratio 16.86, 95% CI 3.92-72.48; p<0.0001) while 12 (16.2%) patients in the age ≥70 and sex-matched group had S curves (odds ratio 2.42, 95% CI 1.16-5.03; p=0.016). In conclusion, the S curve is a novel morphological pattern of the mid-distal ICA. While the S curve may not be specific, its presence in individuals <70 years old should alert the clinician to the possibility that FMD is present.

Free-floating thrombus in stroke patients with nonstenotic internal carotid artery-an ultrasonographic study.

There are multiple causes of free-floating thrombus (FFT) formation in carotid arteries. The purpose of this study was to evaluate the incidence and natural history of FFT in nonstenotic internal carotid arteries of patients with acute ischemic stroke. During a 50-month period, 3,200 consecutive patients with acute ischemic stroke were evaluated for internal carotid artery stenosis and the presence of FFT by color-coded duplex ultrasonography. Diagnostic workup included brain CT, transthoracic echocardiography, Holter electrocardiogram, and hypercoagulability state evaluation. We found an FFT in 5 (0.18%) of 2,757 patients with acute stroke and nonstenotic internal carotid artery (mean age 44 years). The underlying pathology was hypercoagulable state in active pulmonary tuberculosis (n = 1), essential thrombocythemia (n = 1), thrombotic complications of nonstenotic plaques (n = 1), unknown (n = 2). All patients clinically improved under antiplatelet therapy. Follow-up color-coded duplex ultrasonography showed complete dissolution of FFT in all cases. There was no stroke recurrence. Internal carotid artery FFT could be found in young stroke patients without identifiable arterial disease and could be resolved with antithrombotic treatment.

INTRAVASCULAR CHANGES IN PATIENTS WITH ARTERIAL HYPERTENSION COMPLICATED WITH ISCHEMIC STROKE

Aim. To study the extensiveness and character of intravascular auto rosette formation and to measure the thickess of intima-media of internal carotid artery in patients with AH complicated with stroke. Material and methods. Totaly 102 patients included (39 males, 63 females, mean age 67,1) with AH, complicated with ischemic stroke. Comparison group consisted of 121 patient with non-complicated AH of 2-3 stage (61 males, 60 females, mean age 63,9). All patients underwent laboratory sampling of capillary blood, and in blood smears the following were evaluated: total leucocytes, total number of auto rosettes and autorosettes with lysis. Also the intima-media thickness was measured in intrinsic carotid artery (by Philips IU-22, Netherlands). Control group consisted of 44 healthy volunteers (men 21, women 23, mean age 47,45). Results. It was shown that in AH with ishemic stroke extensiveness of intravascular auto rosette formation (21,7 and 1,2 times, resp.) and intima-media thickness (1,6 and 1,2 times, resp.) were higher than in healthy volunteers and patients with non­ complicated AH. First time there were rosette forming stab neutrofiles found in ischemic stroke, basophils and in quite large amounts platelets. The significant correlation is found for auto rosette formation and intima-media thickness of intrinsic carotid artery in non-complicated AH (r=0,45; p=0,005) and compicated by ischemic stroke (r=0,78; p=0,001).

Effect of the +781C/T Polymorphism in the Interleukin-8 Gene on Atherosclerotic Cerebral Infarction, and Its Interaction with Smoking and Drinking

ObjectiveThe aims of this study were to investigate the association between the +781C/T polymorphism of interleukin-8 (IL-8) and atherosclerotic cerebral infarction and the interaction between the +781C/T polymorphism and smoking or drinking in cerebral infarction in the Han Chinese population.MethodsWe investigated the +781C/T polymorphism of IL-8 in 308 consecutive Han Chinese patients who were diagnosed with atherosclerotic cerebral infarction and in 294 age- and gender-matched healthy control subjects. The patients were classified using the Oxfordshire Community Stroke Project (OCSP) classification. The patients and subjects’ histories of smoking and drinking were recorded, and atherosclerosis (AS) of the internal carotid artery (ICA) was evaluated in the patients. The +781C/T polymorphism was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis.ResultsThe +781C/T polymorphism and allele frequencies were not significantly different between the patients and controls and were not significantly associated with the OCSP classifications. We found that the 781C allele was significantly associated with AS of the ICA in the patients (p = 0.017), and the CT genotype was more prevalent in patients without AS of the ICA (p = 0.035). No interactions were observed between the +781C/T polymorphism and smoking or drinking.ConclusionOur results demonstrated that the +781C/T polymorphism of IL-8 did not play a role and had no interaction with smoking or drinking in the occurrence of cerebral infarction in the Han Chinese population. However, the C allele and the CT genotype might be associated with AS of the ICA in patients with ischemic stroke.