Left Carotid Stenosis Research Articles

Peri-Carotid Adipose Tissue and Atherosclerosis at Carotid Bifurcation.

Vulnerable carotid plaques are responsible for 20% of the ischemic strokes. The identification of these asymptomatic carotid plaques that will become symptomatic is essential but remains unclear. Our main goal was to investigate whether the amount of the peri-carotid adipose tissue, estimated by the extra-media thickness (EMT), is associated with the atherosclerotic characteristics at the carotid bifurcation in patients with PAD. An observational, prospective, single-center, longitudinal study was conducted. Overall, 177 patients were subjected to carotid Doppler ultrasound at the study admission. The following data were collected: EMT, intima-media thickness (IMT), the presence of carotid plaques, the area of the highest plaque, the presence of "acute culprit" carotid stenosis, and the grade of internal carotid stenosis. "Acute culprit" carotid stenosis was defined as a significant atherosclerotic plaque that leads to a neurologic event within 15 days. From each carotid bifurcation, a right and a left EMT were determined. We analyzed both the mean EMTs (calculated as the mean between the right and the left EMT) and the EMT ipsilateral to the carotid bifurcation. The presence of carotid plaques was associated with a higher mean EMT [Median = 1.14; IQR = 0.66 versus Median = 0.97; IQR = 0.40; p = 0.001]. A positive correlation was found between the mean EMT and IMT (right: ρ = 0.20; p = 0.010; left: ρ = 0.21; p = 0.007) and between the mean EMT and the area of the largest carotid plaque (right: ρ = 0.17; p = 0.036; left: ρ = 0.22; p = 0.004). Left carotid stenosis ≥ 70% was associated with higher ipsilateral EMT [Median = 1.56; IQR = 0.70 versus Median = 0.94; IQR = 0.42; p = 0.009]. Patients with "acute culprit" carotid stenosis had a higher ipsilateral EMT [left ipsilateral EMT: Median = 1.46; IQR = 0.63; "non-acute": Median = 0.94; IQR = 0.43; p = 0.009; right ipsilateral EMT: Median = 2.25; IQR = 0.62; "non-acute": Median = 1.00; IQR = 0.51; p = 0.015]. This difference was not found in the contra-lateral EMT. Six months after the neurologic event, EMT ipsilateral to an "acute culprit" carotid stenosis decreased (p = 0.036). The amount of peri-carotid adipose tissue, estimated with EMT, was associated with atherosclerosis at the carotid arteries. The mean EMT was associated with the features of chronic atherosclerosis lesions: the presence of carotid plaques, IMT, and the area of the highest plaque. Ipsilateral EMT was linked with "acute culprit" atherosclerotic plaque.

Abstract 13378: Identifiable Differences in Comorbidities and Surgical History Among Asian, Native Hawaiian, and Pacific Islander Stroke Patients With Carotid Artery Disease

Introduction: A detailed characterization of comorbidity prevalence among carotid artery disease patients has not been thoroughly explored in Asian, as well as Native Hawaiian and Pacific Islander (NHPI) populations. Research Question: This study investigated the types of comorbidities and surgical procedures associated with carotid artery disease in Asian and NHPI populations. Methods: This retrospective study utilized data from a stroke treatment center in Hawaii between the years 2020-21. Patients were identified with ICD-10 codes for stroke and only those ≥18 years old with either a completed carotid artery Doppler ultrasound or carotid angiography were included in the study. Collected data included demographics, location of stroke, degree and location of carotid stenosis, comorbidities, and previous surgical history. Wilcoxon rank sum test and Fisher's exact test were used as appropriate. Results: Overall, 117 patients were included with 74 of identifiable race (45% NHPI, 32% Asian, and 23% White). The average age at the time of stroke was 69 years and 40.0% (47/117) of patients were female. Amongst all races, there were no differences in the greatest degree of carotid stenosis (p=.15) or location of stenosis along the right carotid artery (p=.16), but there was a difference in the location of left carotid stenosis (p=.04). Endocrine conditions were the only comorbidity identified at significantly different rates between all racial groups (p=.02). Prior cardiac (p=.03), otolaryngological (0=.007), and orthopedic (p=.01) procedures differed significantly by race among the cohort. The majority of these differences were present when comparing NHPI or Asian patients against White patients, with no significant differences found between Asian and NHPI patients. Conclusions: Asian and NHPI stroke patients were found to have significantly different rates of left carotid stenosis, endocrine conditions, and prior cardiac, otolaryngological, or orthopedic surgeries when compared to White patients. Due to these race-specific differences in patient demographics and history, the implementation and investigation of carotid artery disease risk assessments should be pursued to best improve stroke outcomes among all patients.

Epidemiological Aspects of the Carotid Artery Disease in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Background and aims: Concomitant carotid artery disease (CaAD) in patients referred to coronary surgical revascularization is a strong hazard to perioperative stroke. The current study addressed the epidemiology features of concomitant CaAD in patients referred to a coronary surgical revascularization center. Methods: This descriptive-analytical cross-sectional study was conducted on all incoming patients to coronary surgical revascularization for two years at a single center who underwent a color duplex-sonography (CDS) interrogation. The demographic, clinical, echocardiographic, coronary angiographic, and color duplex-sonographic data were collected from patients’ medical records. Quantitative and qualitative data were expressed as means and standard deviations, as well as numbers and percentages, respectively. The relationships between quantitative and qualitative variables were investigated using Pearson’s correlation and chi-square test, respectively. Results: In total, 430 patients with a mean age of 66.3±9.9 years were included (35% females) in the study. Preoperative CDS was performed on 82% of patients; in addition, 29% of them presented with an increased intima-media ratio, and CtAD was observed in 51%. Based on the results, 77 and 143 patients were detected with unilateral and bilateral involvement, respectively. Severe carotid stenosis accounted for 4% of patients. Age older than 65 years (P=0.02), unstable angina (P=0.045), and the presence of an occluded coronary artery (P=0.002) were associated with the presence of CtAD. Finally, the severity of the left and right carotid stenosis was associated with diabetes mellitus (P<0.05). Conclusion: The prevalence of concomitant CtAD in patients referred to coronary surgical revascularization remains high. The current data warn of the necessity of performing preoperative CDS routinely.

Potential Biomarkers and Therapeutic Targets: Inflammation and Oxidative Stress in Left Carotid Artery Stenosis with Coronary Artery Disease.

Patients with left carotid artery atherosclerotic stenosis have an increased ischemic stroke risk. Left carotid stenosis, the most common cause of the transient ischemic attack, is related to a higher risk of acute stroke. Left carotid artery stenosis is also associated with cerebral artery infarction. The significant coronary stenosis promotes ST-segment elevation myocardial infarctions. The severe coronary stenosis plays an important role in development and progression of myocardial infarction. However, the dynamic changes of circulating oxidative stress and inflammatory markers in the carotid stenosis combined with coronary artery stenosis are not clear, and it also remains unknown whether markers of oxidative stress and inflammation are potential therapeutic targets for carotid stenosis combined with coronary artery stenosis. This study aims to explore the effects of oxidative stress combined with an inflammatory response on left carotid artery stenosis with coronary artery disease in patients. We, therefore, tested the hypothesis that levels of markers of oxidative stress and inflammation are associated with coexistent severe carotid and coronary artery stenosis in patients. We measured the circulating levels of malondialdehyde (MDA), oxidized low-density lipoprotein (OX-LDL), homocysteine (Hcy), F2-isoprostanes (F2-IsoPs), tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), prostaglandin E2 (PG-E2) and interferon-gamma (IFN-γ) in patients with combined carotid and coronary artery severe stenosis. We also assessed the relationships among oxidative stress, inflammation, and severe stenosis of the carotid with a coronary artery in patients. Levels of MDA, OX-LDL, Hcy, F2-IsoPs, TNF-α, hs-CRP, PG-E2, and IFN-γ were remarkably increased (P < 0.001) in patients with combined carotid and coronary artery severe stenosis. High levels of oxidative stress and inflammation may be related to severe stenosis of the carotid with coronary arteries in patients. Our observations indicated that measurements of oxidative stress and inflammatory markers may be valuable for the assessment of the degree of carotid with coronary artery stenosis. The biomarkers of oxidative stress and inflammatory response may become therapeutic targets for carotid artery stenosis with coronary artery stenosis in patients.

Thrombosis or vasospasm: The utility of intraoperative neuromonitoring during TCAR.

Transcarotid artery revascularization (TCAR) has become more prevalent as a treatment modality for carotid stenosis. Many centers perform TCAR without any adjunctive neuromonitoring, for example, somatosensory-evoked potential (SSEP) and electroencephalogram (EEG). We present a case of transcarotid artery revascularization (TCAR) performed with concomitant somatosensory-evoked potential (SSEP) and electroencephalogram (EEG) neuromonitoring in the setting of concerning intraoperative angiographic images. TCAR was undertaken for a 58year-old man presenting with symptomatic left carotid stenosis and right ICA occlusion. Based on his comorbidities, pre-existing conditions, and the need for dual antiplatelet therapy, TCAR was offered as an alternative to standard carotid endarterectomy. Intraoperatively, following stent delivery, no flow was appreciated through the carotid stent or distal ICA. Neuromonitoring remained stable and was reassuring for distal ICA spasm with no-reflow phenomenon. The patient tolerated the procedure well and has had no stent-related complications through 10months of follow-up. This case highlights the utility of neuromonitoring with TCAR as an adjunct to intraoperative decision-making in the setting of suspected internal carotid artery (ICA) vasospasm versus thrombosis after stent delivery.

Carotid Artery Stenting for a Nonagenarian Presenting as Stuttering Stroke.

Carotid artery stenting (CAS) is performed in patients with minor strokes and transient ischemic attacks (TIAs) to prevent further strokes. However, most operators do not intervene in older adults. We had a 92-year patient with recurrent minor strokes with two possible proximate causes – cardioembolism and significant symptomatic left carotid stenosis. This patient continued to have recurrent ischemic events in the left carotid territory despite optimum management of the cardioembolic source with dual antiplatelets and anticoagulation and was successfully treated with left CAS. The role of carotid revascularization in older patients with high-grade symptomatic carotid stenosis and cardiac comorbidities is discussed.

Altered functional connectivity is related to impaired cognition in left unilateral asymptomatic carotid artery stenosis patients

BackgroundAsymptomatic carotid artery stenosis (aCAS) impairs haemodynamic and cognitive functions; however, the relationship between these changes and brain network connectivity remains largely unknown. This study aimed to determine the relationship between functional connectivity and neurocognition in patients with aCAS.MethodsWe compared functional status in 14 patients with aCAS and 15 healthy controls using resting state functional magnetic resonance imaging sequences. The subjects underwent a full range of neuropsychological tests and a graphical theoretical analysis of their brain networks.ResultsCompared with controls, patients with aCAS showed significant decline in neuropsychological functions, particularly short-term memory (word-memory, p = .046 and picture-memory, p = .014). Brain network connectivity was lower in patients with aCAS than in the controls, and the decline of functional connectivity in aCAS patients was mainly concentrated in the left and right inferior frontal gyri, temporal lobe, left cingulate gyrus, and hippocampus. Decreased connectivity between various brain regions was significantly correlated with impaired short-term memory. Patients with aCAS showed cognitive impairment independent of known vascular risk factors for vascular cognitive impairment. The cognitive defects were mainly manifested in the short-term memory of words and pictures.ConclusionsThis study is the first of its kind to identify an association between disruption of functional connections in left carotid stenosis and impairment of short-term memory. The findings suggest that alterations in network connectivity may be an essential mechanism underlying cognitive decline in aCAS patients.Clinical trial registration-URLUnique identifier: 04/06/2019, ChiCTR1900023610.

Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note.

In carotid artery stenting (CAS) for highly tortuous carotid stenosis, it is often difficult to guide rigid devices such as carotid stents. There are various adjunctive techniques using a guidewire: the buddy wire technique, the sheep technique, and the stiff guide technique. We report a case in which the tortuous vessel was straightened and a stent could be inserted. A 64-year-old man with amaurosis had highly tortuous left carotid stenosis. Despite the best medical treatments, he often had transient cerebral ischemic symptoms, so we planned CAS. We could insert the first stent, but the proximal vessel was kinked by the placement of the stent. It was so tortuous that the second stent could not be inserted by adjunctive techniques. Therefore, the proximal balloon was inflated and pulled back to straighten the tortuous vessel, and then we could insert the stent. We named this technique the “snake hunt technique” because it was just like catching a snake given that the tortuous vessel was stretched. This technique could be a troubleshooting step when it is difficult to insert a stiff device such as a stent or balloon even with the use of various adjunctive techniques.

P715 When "wait and see" is the best option: a case report of a spontaneous coronary artery dissection

Abstract Introduction Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and is now being identified more frequently, in part because of increased awareness. Case report We present the case of a 63-year-old female, without cardiovascular risk factors or relevant past medical history. She complained of atypical chest pain in the last year. The patient was admitted due to acute chest pain at rest, hemodynamically stable, with unremarkable physical examination, including absence of heart failure signs. The EKG revealed a dynamic ST depression in leads V4-V6. The peak of high sensitivity troponin I was 13744pg/mL (ULN&amp;lt; 15.6) and CK 874U/l (ULN &amp;lt;168). The echocardiogram showed preserved left ventricular ejection fraction and hypokinesia of mid-apical segments of anterior wall. Considering the diagnosis of NSTEMI the patient underwent coronary angiography that revealed luminal narrowing of 70% in left main artery, 70% in proximal anterior descending artery (LAD) and 99% in first obtuse marginal. Given the absence of cardiovascular risk factors, the smooth angiographic appearance of coronary lesions and absence of calcium, we suspected of spontaneous dissection or vasculitis. Considering the absence of angina revascularization was delayed. A first coronary angio-CT confirmed the luminal narrowing and suggested a spontaneous dissection. Two weeks later the coronariography and the angio-CT were repeated with a significant improvement, showing only intermediate stenosis of proximal LAD. The additional imaging study revealed a 45mm ascending aortic dilation and a left primitive carotid stenosis without other vascular territory alterations, excluding fibromuscular dysplasia. The auto-immune study was unremarkable. With all these results it was assumed the diagnosis of a spontaneous coronary artery dissection and the patient was discharged asymptomatic under single antiplatelet therapy and Rivaroxaban. Three months later a new coronary angio-CT showed no significant coronary artery stenosis and the patient was asymptomatic. Discussion and conclusion The recognition of spontaneous coronary artery dissection is essential to the correct management of these cases because, unlike acute coronary syndrome due to atherosclerotic disease, the results of revascularization in these patients are suboptimal and conservative management is probably the best option. Abstract P715 Figure. angio-CT

Epidemiological Features of Ischemic Brain Stroke; a Cross-Sectional Hospital-Based Study

Background: Assessing the prevalence of brain stroke and its clinical patterns across countries and nations could be valuable. It is an important concern for Iran as one of the countries with a high rate of stroke. Objectives: The present study was aimed to assess the epidemiological aspects of ischemic brain stroke. Methods: This cross-sectional study was conducted in Loghman-e-Hakim Hospital, Tehran, Iran from January 2013 to December 2016. The data were gathered by retrospectively reviewing the hospital records. Results: In this study, 2041 cases were admitted that 1145 (56%) cases were male. The mean age of the patients was 66.50 ± 13.49 years. The most common underlying risk factor was hypertension in 73.7% followed by diabetes mellitus in 44.3%. Left carotid stenosis was reported in 17.2% of the cases and right carotid stenosis in 9.5%. Left ventricular ejection fraction < 40% was found in 8.6% of the cases. The most common areas involved in the brain CT scanning were periventricular areas in 20.5%, left middle cerebral artery in 15.4%, and lacunar infarction 8.8% of the cases. In addition, 214 patients died indicating a crude mortality rate of 10.5%. Conclusions: The prevalence of ischemic brain stroke in males is slightly higher than females and the mean age of the patients was estimated to be 66 years. The most common risk factors are comprised of hypertension, diabetes mellitus, and smoking. Carotid stenosis is evident in more than 25% of the patients, and the mortality rate was 10% in the studied population.

Navigation of a 6-French guiding sheath into the common carotid artery using a tri-axial catheter system in transbrachial carotid artery stenting.

Placement of a large-bore guiding sheath or catheter into the common carotid artery (CCA) is crucial in transbrachial carotid artery stenting (CAS). Herein, we describe technical tips for the navigation of a 6-French guiding sheath into the CCA using a tri-axial catheter system in transbrachial CAS. A total of 27 patients underwent transbrachial CAS. For the right side, a 6-French straight guiding sheath was navigated directly into the CCA using a tri-axial catheter system, with a 4-French Simmons catheter placed through a 6-French straight guiding catheter. For the left side, a 6-French Simmons guiding sheath was navigated into the CCA using a tri-axial catheter system, with a 4-French Simmons catheter placed through a 6-French Simmons guiding catheter. After the placement of a 6-French guiding sheath into the CCA, CAS was performed under distal filter or balloon protection. Fifteen patients had a right carotid stenosis and 12 patients had a left carotid stenosis. The 6-French guiding sheath was safely placed with ease and provided adequate stabilization for CAS. All procedures were successfully performed without any complications. The use of a tri-axial catheter system for the navigation of a 6-French guiding sheath into the CCA appears safe and efficient, allowing transbrachial CAS, with 6-French guiding sheath stabilization, to be performed without any complication.

Case of Asymptomatic Carotid Artery Stenosis in a Hypertensive Patient

This is the case of a hypertensive patient with an asymptomatic carotid stenosis. This is a very common situation that neurologists have to manage. The case is a 75-year-old man with an history of hypertension for 10 years, treated with amlodipine, 5 mg once a day, and perindopril, 8 mg once a day. His hypertension was considered to be controlled. He was also treated for a hyperlipidemia for 5 years with atorvastatin, 10 mg, once a day. His general practitioner recommended an echo-Doppler of cervical and intracranial arteries as part of a systematic screening because of his vascular risk factors. Echo-Doppler showed an atherosclerotic stenosis at the site of the left carotid bifurcation. On grayscale, this stenosis was characterized as a uniformly echogenic plaque (homogeneous plaque). On sonographic NASCET index (North American Symptomatic Carotid Endarterectomy Trial), there was a peak systolic velocity increase of 280 cm/s that translated to a high internal carotid artery/common carotid artery peak systolic velocity ratio of 4.5. Morphology and hemodynamic data were consistent with a severe carotid stenosis estimated about 70% per NASCET criteria. A computed tomographic angiography, already planned by the general practitioner, confirmed a calcified severe stenosis of the bifurcation. The degree of narrowing was also estimated to be about 70% according to NASCET criteria. Contralateral internal carotid artery and intracranial arteries were normal. Arterial work-up was consistent with an isolated severe asymptomatic left carotid stenosis. The patient had no previous history of cerebral vascular disease. His neurological examination was normal. His blood pressure was slightly elevated with systolic blood pressure of 160 mm Hg and a diastolic blood pressure of 95 mm Hg. His recent blood sample showed low-density lipoprotein cholesterol <1 g/L, and his glomerular filtration rate was normal. This case addresses several issues, in particular estimation of the absolute risk of ischemic …

Treatment of bovine type and type III aortic arch carotid stenosis with stent angioplasty via the right radial approach

Objective To investigate the feasibility and safety of the treatment of type III aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis with stent angioplasty via the right radial approach. Methods From September 2015 to February 2016, the clinical data of 16 patients with type III aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis treated with carotid stent angioplasty via the radial approach at the Cerebrovascular Interventional Therapy Center, Henan Provincial People's Hospital were analyzed retrospectively, including operation success rate, cardio-cerebrovascular complications, and radial artery puncture complications. All 16 patients were treated with endovascular treatment via right radial approach. The coaxial technique was used for guiding catheter to the super-select target vessels. From January 2014 to December 2015, 20 patients with type III aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis treated with carotid stent operation were selected at the same time. The ray irradiation time between the two groups were compared. The follow-up time was 3 months. Results The surgical success rate of the 16 patients was 100%. Three patients had decreased blood pressure and heart rate during the operation. None of them had radial artery occlusion or severe cardio-cerebrovascular events. The ray irradiation time (9.94±0.97 min) in patients with carotid artery stenosis stenting via the radial approach was less than those via the femoral artery approach(11.51±1.39 min). There was significant difference (P=0.001). Conclusion The success rate of the type III aortic arch right carotid and bovine type aortic arch left carotid stenosis with stent angioplasty via the right radial approach is high, safe and feasible. Key words: Carotid stenosis; Stents; Radial artery; Endovascular treatment

Intracranial atherosclerosis: Correlation between in-vivo 3T high resolution MRI and pathology

Background: High-resolution MRI (HRMRI) is a promising tool for studying intracranial atherosclerotic disease (ICAD) in-vivo, but its use to understand the pathophysiology of ICAD has been limited by a lack of correlation between MRI signal characteristics and pathology in intracranial arteries. Description of case: A patient with symptomatic left cavernous carotid stenosis underwent 3T HRMRI and died 4 days later. In-vivo HRMRI and postmortem histopathology images were compared. MRI signal characteristics consistent with atherosclerotic plaque composed of lipid and loose matrix, fibrous tissue, and calcium were correlated with pathology findings. Intraplaque hemorrhage was not present on HRMRI or pathology. Conclusions: This report demonstrates correlation between atherosclerotic plaque components visualized on 3T HRMRI images obtained in-vivo and pathological specimens of a symptomatic ICAD plaque, providing an important step in developing HRMRI as an in-vivo research tool to understand ICAD pathology.

Flow pattern analysis in a highly stenotic patient-specific carotid bifurcation model using a turbulence model

The aim of this study is to investigate the blood flow pattern in carotid bifurcation with a high degree of luminal stenosis, combining in vivo magnetic resonance imaging (MRI) and computational fluid dynamics (CFD). A newly developed two-equation transitional model was employed to evaluate wall shear stress (WSS) distribution and pressure drop across the stenosis, which are closely related to plaque vulnerability. A patient with an 80% left carotid stenosis was imaged using high resolution MRI, from which a patient-specific geometry was reconstructed and flow boundary conditions were acquired for CFD simulation. A transitional model was implemented to investigate the flow velocity and WSS distribution in the patient-specific model. The peak time-averaged WSS value of approximately 73 Pa was predicted by the transitional flow model, and the regions of high WSS occurred at the throat of the stenosis. High oscillatory shear index values up to 0.50 were present in a helical flow pattern from the outer wall of the internal carotid artery immediately after the throat. This study shows the potential suitability of a transitional turbulent flow model in capturing the flow phenomena in severely stenosed carotid arteries using patient-specific MRI data and provides the basis for further investigation of the links between haemodynamic variables and plaque vulnerability. It may be useful in the future for risk assessment of patients with carotid disease.

Cognitive Performance following Carotid Endarterectomy or Stenting in Asymptomatic Patients with Severe ICA Stenosis

Background. Endarterectomy (CEA) or stenting (CAS) of a stenotic carotid artery is currently undertaken to reduce stroke risk. In addition removal of the arterial narrowing has been hypothesized to improve cerebral hemodynamics and provide benefits in cognitive functions, by supposedly resolving a “hypoperfusion” condition. Methods. In this study we sought to test whether resolution of a carotid stenosis is followed by measurable changes in cognitive functions in 22 subjects with “asymptomatic” stenosis. Results. A main finding of the study was the statistically significant pre-post difference observed in the performance of phonological verbal fluency and Rey's 15-word immediate recall. Remarkably, there was a significant interaction between phonological verbal fluency performance and side of the carotid intervention, as the improvement in the verbal performance, a typical “lateralized” skill, was associated with resolution of the left carotid stenosis. Conclusion. The results reflect a substantial equivalence of the overall performance at the before- and after- CEA or CAS tests. In two domains, however, the postintervention performance resulted improved. The findings support the hypothesis that recanalization of a stenotic carotid could improve brain functions by resolving hypothetical “hypoperfusion” states, associated with the narrowing of the vessels.

Abstract WP121: Brain Structures Anormalites Detected By Voxel Based Morphometry In Individuals With Asymptomatic Carotid Stenosis.

Background: Studies of patients with asymptomatic carotid stenosis have shown significant cognitive decline in this individuals compared to groups without stenosis. Our study aims to investigate the occurrence of subtle gray and white matter decrease in patients with asymptomatic carotid stenosis through Voxel Based Morphometry (VBM) analysis. Methods: Twenty-seven patients (7 women, mean age of 71 years, range 51- 78 years) with unilateral asymptomatic carotid stenosis (&gt;70%) or occlusion, defined by angiotomography (CTA), were submitted to MRI and images were analyzed with VBM. MR images were acquired on a 3T-MR scanner, with sequence 3D sagittal T1-weighted (voxel size 1x1x1 mm,TR = 22 ms, TE = 9 ms, flip angle = 35°, matrix = 256x220). Images of patients with left carotid stenosis were flipped in the right-left orientation thus all hemispheres ipsilateral to the stenosis were aligned. For statistical comparisons, we used images of 27 healthy control subjects matched for sex and age with patient group (7 women, mean age of 68 years, range 54-82). VBM analysis was performed with VBM8/SPM8 toolbox (two-sample T-Test, P&lt;0.001 uncorrected). Results: VBM analysis demonstrated significant and diffuse gray matter reduction in both hemispheres of patient group. However, these abnormalities were more pronounced in the area correspondent to the anterior circulation of the hemisphere ipsilateral to the carotid stenosis. In contrast, white matter abnormalities detected by VBM were less evident and with symmetrical distribution in both hemispheres. Conclusion: Our findings suggest that asymptomatic carotid stenosis/occlusion is associated with subtle gray matter reduction predominantly in the ipsilateral hemisphere. This is in accordance with previous data demonstrating cognitive decline in these patients and it may imply that there is significant hemodynamic disturbance secondary to these stenosis.

頸部痛と発熱で発症した早期高安動脈炎の1例

We report herein on a 15-year-old girl with Takayasu's arteritis (TA) in the early pre-pulseless phase who presented with left neck pain and fever. Laboratory examination revealed a high level of C-reactive protein (CRP) and an elevated erythrocyte sedimentation rate (ESR). Findings of ultrasonography, computed tomography (CT), and magnetic resonance imaging and angiography (MRI, MRA) demonstrated a thickening of the left carotid artery but neither stenosis nor dilation of the large vessels. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) after twenty days duration of fever revealed an accumulation of 18F-fluorodeoxyglucose not only in the left carotid artery but also the wall of the ascending aorta, aortic arch, thoratic aorta, and part of abdominal aorta, which led to the diagnosis of TA in the early pre-pulseless phase. The patient was treated with prednisolone resulting in a marked improvement in both the clinical symptoms and laboratory parameters within a couple of weeks. Stenosis of the left carotid artery was found in MRI, MRA following four months and a definitive diagnosis was reached. We suggest early diagnosis of TA may permit early treatment and improve the prognosis.

Hemodynamic analysis of vascular stenting treatment outcome: Computational fluid dynamics method vs optical flow method

Computational fluid dynamics method (CFDM) and optical flow method (OFM) effectively provide the hemodynamic information based on the digital subtraction angiogram (DSA). However, the quantitative analysis in comparison of CFDM and OFM is still absent. The goal of this study is to apply CFDM and OFM in quantitative analysis of stenting treatment. A left carotid stenosis patient underwent stenting of percutaneous transluminal angioplasty was analyzed as an example. CFDM and OFM for hemodynamic analysis on digital subtraction angiography before and after stenting treatment were presented. Improvement gains of blood flow velocities on left internal carotid artery after stenting treatment for different initial conditions on the common carotid artery were 1.91 ∼ 2.13, 1.62 ∼ 2.09, and 0.69 by CFDM with Newtonian and non-Newtonian fluids and OFM, respectively. With the CFDM analysis, the flow mapping by OFM using time resolved DSA data on the fly to estimate hemodynamic significance of a cervical carotid stenosis was explained. Quantificative blood flow estimations by CFDM and OFM to evaluate the treatment outcomes to patient with carotid stenosis are practical. Both methods are able to provide quantitative information of blood flow for stenting treatment. It is advantagious to use both methods in treatment evaluation.

Carotid Endarterectomy Performed After Carotid Artery Restenosis Following Stent Migration

Right carotid occlusion and left carotid stenosis were determined in a patient who had undergone a cerebrovascular accident. We performed a carotid endarterectomy for the high-risk patient who developed middle cerebral artery occlusion during stenting and a restenosis owing to stent migration.