Selective Carotid Angiography Research Articles

Platelet to lymphocyte ratio predicts all-cause mortality in patients with carotid arterial disease.

Platelet to lymphocyte ratio (PLR) has been demonstrated as a risk and prognostic marker in many of cardiovascular diseases. A relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease. This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of platelets to lymphocytes. The end point of the study was all-cause mortality. During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients (34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7 ± 1.6 g/dL vs. 13.7 ± 1.7 g/dL, p = 0.031) and they were older than survivors (74.2 ± 8.4 years vs. 68.6 ± 8.5 years, p = 0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3 ± 85.6 and 126.8 ± 53.8, p = 0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis. In our study, higher PLR was associated with increased all-cause mortality.

Effectiveness of endo-vascular treatment in carotid artery stenosis: A single center study

Aim: To investigate the safety and effectiveness of endo-vascular stents to treat carotid artery stenosis (CAS).Material and Methods: One-hundred fourteen patients who underwent selective endo-vascular stenting following selective carotid angiography between 2000 and 2014 were analyzed retrospectively. Demographic characteristics; stenosis degree; stent type; use of anti-coagulants and embolism protection system (EPS) during the procedure; pre-dilation and post-dilation during the procedure; use of a vascular occlusion device after the procedure; early complications (30 days); prevalence of re-stenosis of the stent; sixth-month, first-year, second-year, and fifth-year controls; radiologic imaging results; and discharge time were analyzed.Results: Among the patients, 83 (72.8%) were males and 31 (27.2%) were females, and the age range was 41–86 years (mean age: 69±8.7 years). The proportion of concurrent hypertension was higher among females with CAS (p 0.01). The proportion of early complications was higher among the patients with the Nitinol stent than among those with the Wall stent (p = 0.062). Embolic events and infarct development were observed in 13 (11.4%) patients within the first 30 days. Occlusion was detected in 4 of 97 patients (4.1%) who represented controls. While less than 50% stenosis that did not require intervention developed in four (4.1%) patients, more than 50% stenosis was detected in three (3.09%) patients. The likelihood of not developing stenosis was found to be 98% at the end of the first year, 96% at the end of the second year, and 87% at the end of the fifth year. The mean duration of stenosis was 4.86±0.11 years.Conclusion: The proportions of potency and early complications in endo-vascular treatment applied for CAS were similar to those in the literature. Further studies with a larger patient number and a longer duration of follow-up would provide better data concerning the effectiveness of treatment and complications. Keywords: Carotid artery; stenosis; stenting.

DIAGNOSIS OF CAROTID PARAGANGLIOMA: MULTIDISCIPLINARY ASPECTS

Objective: to enhance the efficiency of diagnosis and treatment of carotid paragangliomas, by introducing of a multidisciplinary approach into clinical practice.Material and methods. A total of 15 cases of paragangliomas have been followed up for 10 years. The age of the patients was 18 to 58 years (mean age 38±12 years). Primary multiple sites of chemodectomas were noted in 2 cases. Bilateral involvement was observed in one case. In the other, two unilateral vascular tumors successively developed with an interval of almost 6 years. A set of studies was conducted, which embraced ultrasound duplex scanning (USDS) of the neck vessels, computed tomography (CT), and selective carotid angiography (SCAG) in various combinations. The investigators made a successive examination of the symmetrical areas of the face and neck and polypositional scanning of the zone of interest and studied quantitative parameters, including linear blood flow velocity (LBFV) and volumetric blood flow velocity. Native and contrast-enhanced X-ray CT and magnetic resonance imaging (MRI) were carried out. SCAG was performed as digital subtraction angiography.Results.USDS can confirm the hypervascular nature of the tumor and its close relationship with the carotid artery branches and measure blood flow velocity (LBFVmean, 0.46 m/sec). X-ray CT and MRI examinations in combination with vessel contrasting make it possible to accurately determine the localization and topography of the tumor, its association with the carotid artery system and to type afferent vessels. SCAG is a highly informative technique that can identify the afferent vessels of the tumor and its relationship with the great vessels and, if technically possible, perform selective microembolization of the afferent tumor vessels, which will further facilitate surgical treatment, reducing the risk of intraoperative bleeding. Conclusion.The multidisciplinary approach to diagnosing carotid paragangliomas in the maxillofacial area and neck makes it possible to determine the type, size, and velocity characteristics, to verify the diagnosis, and to work out optimal treatment policy. Among the non-invasive techniques, CT angiography and MR angiography are most valuable for final diagnosis. Selective angiography of the branches of the external carotid arteries remains the gold standard and is the final and most important stage of the study, which make it possible to detail angioarchitectonics, to determine afferent vessels, and to plan further treatment, including endovascular embolization. The diagnosis of carotid paragangliomas requires a multidisciplinary approach with the equal attraction of endovascular diagnosis and treatment specialists, maxillofacial surgeons, angiologists, ultrasound and radiology diagnosticians, and pathologists both at the stages of diagnosis and subsequent treatment. This problem can be effectively solved in a multidisciplinary hospital that has skilled staff with sufficient clinical experience in diagnosing vascular masses and is equipped with modern equipment, which allows optimization of further treatment.

Surgical treatment of patients with arteriovenous head and neck angiodisplasia

The aim of the study was to assess the results of surgical treatment in 74 patients with extensive arteriovenous angiodisplasia in the head and neck area. All patients underwent complex examination including ultrasound, CT and MRI with contrast and selective carotid angiography. The lesions excision was performed after endovascular embolization and soft tissue defects were restored by various methods selected according to prevalent vascular lesion type (arterial, arteriovenous, venous, capillary) and blood flow values (high flow, low flow, mixed). Good and satisfactory esthetic results were seen in 95.2% of cases, lesion relapse was detected in 4.8% of cases by 12-18 months follow-up. Endovascular embolization proved to decrease the intraoperative bleeding risk, prevent lesion relapse and minimize the size of the lesion improving the results of radical treatment. Local flap reconstruction usually results in good esthetic results. By local soft tissue deficiency distant free flaps or microsurgical complex flaps may be used.

Fenestration of the vertebral artery: case presentation

Fenestrations of vertebral arteries are considered to be rare abnormalities observed in angiographic and autopsy studies. They result from vascular abnormalities that occur during the embryological development of vertebral artery. Fenestrations of the vertebral artery are vascular structures having 2 different lumens and endothelium layers, sharing either the same or separate adventitia layers. As a result of the carotid Doppler ultrasonography performed on a 65-year-old woman applying to the Neurology Clinic of Cumhuriyet University Faculty of Medicine, Research and Practice Hospital with the complaints of vertigo and numbness in the head, a plaque leading to 60% stenosis in the right internal carotid artery, close to the place of initiation was seen. The patient, whose vertebral artery lumen structures and calibrations have found to be normal in the Doppler ultrasonography of vertebral artery, was scheduled for double-sided selective carotid and vertebral artery angiography. With the performed digital subtraction angiography imaging method, an atheroma plaque, extending to internal carotid artery proximal starting from sinus caroticus through the right internal carotid artery and leading to 50% stenosis, having the appearance of an ulcer, was observed. In the vertebral artery angiography of the case, while the right vertebral artery was found to be normal, fenestration in the upper cervical segment was observed in the left vertebral artery. This situation has been presented in this paper with radiological and embryological evaluation.

Surgical treatment of carotid body tumors

In this study, we report our clinical experience in a series of patients with carotid body tumors along with diagnosis, treatment and follow-up procedures in the light of related literature data. Between November 2001 and May 2012, 10 patients (5 males, 5 females; mean age 53.2 years; range 27 to 80 years) who underwent surgery due to a carotid body tumor in our clinic were included. Diagnosis was based on ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance angiography, selective carotid angiography, balloon occlusion test, biochemical tests and preoperative embolization. Complications were also recorded. Balloon occlusion test was performed in all patients preoperatively, while embolization was implemented in seven patients. All masses were dissected by carotid artery subadventitial approach. Carotid integrity was maintained in nine patients, while a vein graft was used in one patient. Neurological disorder was observed in one patient, whereas transient hypoglossal paresis was in one patient who underwent saphenous vein grafting. Our study results suggest that (i) carotid body tumors should be handled with multidisciplinary approach; (ii) balloon occlusion test should be performed in all patients undergoing surgery; (iii) a particular attention should be paid to cranial and phrenic nerves, if it is necessary to extend the surgical field while removing the tumor; and (iv) pathological examination should be carried out by an experienced team and in a multi-centered fashion, if necessary.

Porcine carotid artery replacement with biodegradable electrospun poly-e-caprolactone vascular prosthesis

There is a continuous search for shelf-ready small-caliber vascular prostheses with satisfactory early and late results. Biodegradable scaffolds, repopulated by recipient's cells regenerating a neovessel, can be a suitable option for adult and pediatric, urgent and elective cardiovascular procedures. This was a short-term experimental assessment of a new biodegradable vascular prosthesis for arterial replacement in the pig. Eleven pigs underwent bilateral carotid artery replacement with biodegradable electrospun poly-ε-caprolactone (PCL) nanofiber prostheses (internal diameter, 4 mm; length, 5 cm); or expanded polytetrafluoroethylene (ePTFE) prostheses as control. Perioperative anticoagulation was achieved with intravenous heparin (double baseline activated clotting time). Postoperatively, until conclusion of the study at 1 month, animals received aspirin and clopidogrel daily. Transit time flow was measured intraoperatively and at sacrifice. Doppler ultrasound (1 and 4 weeks) and a selective carotid angiography (4 weeks) were performed to assess patency. All explanted grafts were analyzed by histology, morphometry, and scanning electron microscopy in order to study graft-host interaction. Surgical handling and hemostasis of the new prostheses were excellent. Patency rate was 78% (7/9) for PCL grafts, compared with 67% (4/6) for ePTFE grafts. Transit time flow and Doppler ultrasound showed no significant changes in flow and velocity or diameter over time in both groups. Both prostheses showed no detectable in vivo compliance as compared with native carotid artery. Percent neoendothelialization was 86% for PCL and 58% for ePTFE grafts (P = .008). Neointima formation was equal in both grafts. More adventitial infiltration of macrophages, myofibroblasts, and capillaries was seen in PCL grafts with a milder foreign-body reaction when compared with ePTFE implants. Both grafts showed similar endoluminal thrombus formation. Biodegradable, electrospun PCL grafts showed good surgical and mechanical properties, no aneurysm formation, and similar short-term patency compared with ePTFE grafts. Rapid endothelialization and cell ingrowth confirms favorable PCL graft-recipient biological interaction. Despite good early results, long-term follow-up is required before clinical application.

Letter to the Editor Fracture of a carotid stent and restenosis of common carotid artery

Letter to the Editor Fracture of a carotid stent and restenosis of common carotid artery

Results of combined preoperative direct percutaneous embolization and surgical excision in treatment of carotid body tumors

Carotid body tumors are infrequent neoplasms in daily practice. Diagnostic difficulties exist because of their slow growth and asymptomatic progress. The surgical treatment is complicated and difficult due to their proximity to vascular and neural structures. In this study we present the results of 12 patients operated for carotid body tumor that underwent preoperative percutaneous direct embolization. The data of 12 patients, diagnosed with carotid body tumor and surgically treated at our department between 2000 and 2010, was retrospectively analyzed. Duplex ultrasound, computerized tomography and selective carotid angiography were the applied diagnostic tools. Two days before the planned surgery all patients underwent percutaneous direct embolization to achieve devascularization of the tumor. Afterwards, surgical excision of the mass under general anesthesia was performed in all cases. Five tumors were classified as Shamblin type I (41.7%), and the others were type II (58.3%). All masses were removed sub-adventitially and no vascular reconstruction was necessary. There was no mortality and no permanent neural damage. Malfunction of the tongue was observed in only one case, which recovered completely in one month. There was one recurrence detected by Duplex ultrasound and angiography during the follow up period. Surgical excision is mandatory to be performed as soon as diagnosed in carotid body tumors. Preoperative direct percutaneous embolization of the mass helps to devascurize the tumor, enabling an optimal surgical procedure. The outcomes of such a combined intervention are excellent and neurovascular structure preservation decreases complication and morbidity rates.

Transradial and Transbrachial Arterial Approach for Simultaneous Carotid Angiographic Examination and Stenting Using Catheter Looping and Retrograde Engagement Technique

The purpose of this study was to introduce a novel and safe technique with high procedural success for carotid artery stenting (CAS). From April 2004 to May 2009, 161 patients underwent CAS using either a high transradial arterial approach (TRA, defined as 10 cm above styloid process) or a transbrachial arterial approach (TBA) with a 7F arterial sheath. Selective carotid angiography was performed using a 6F Kimny guiding catheter and Teflon wire (260 cm in length) by Catheter Looping And Retrograde Engagement Technique (CLARET) with the guiding catheter seated on the right coronary cusp and its tip engaged into the common carotid artery (CCA). Teflon wire was introduced into the CCA again after the diagnostic procedure, followed by replacement of the 6F Kimny guiding catheter by a 7F Kimny catheter for CAS using one of the following techniques: (1) direct-engagement method, i.e., from right innominate artery into the right CCA; (2) looping method plus double-wire technique (utilized two Teflon wires to provide an adequate support) for both the right and left CCA; and (3) looping method plus a PercuSurge balloon anchoring at the external carotid artery. This distinctive technique offered 100% diagnostic success and 99.4% CAS success. Two patients (1.2%) experienced major ischemic stroke after CAS and two (1.2%) died during hospitalization. The results of the present study showed that high TRA/TBA using CLARET for CAS in patients with severe carotid artery stenosis is safe and technically feasible with an extremely high success rate.

Orbital venous malformation: percutaneous treatment using an electrolytically detachable fibred coil

To report the efficacy of percutaneous treatment of an orbital venous malformation with an electrolytically detachable fibred coil. We report an instance of radiography-guided percutaneous treatment with an electrolytically detachable fibred coil in a 16-year-old boy with acute, spontaneous, painless proptosis on the left side, which progressed with time. Magnetic resonance imaging, angiography and orbitophlebography revealed a low-flow, intraorbital venous malformation. Percutaneous puncture and drainage were followed by a short remission. Following an acute recurrence, a single detachable fibred coil was deployed via a percutaneous approach under angiographic guidance. No radiological or clinical recurrences were observed over 4 years. Embolization of a deep orbital venous malformation with detachable fibred coils via a percutaneous approach can be highly effective, and may be considered before proceeding with open surgery.

Massive Repeated Nose Bleeding After Bimaxillary Osteotomy

In LeFort I surgery, the separation of the pterygomaxillary junction is done by osteotomy. Although the osteotome is positioned too close to the maxillary artery and its branches during pterygomaxillary separation, postoperative complications from vascular injuries are uncommon. We describe an unusual occurrence of a maxillary artery pseudoaneurysm after LeFort I and bilateral sagittal split osteotomies for maxillary advancement and mandibular setback as well as (anterior sliding) genioplasty. In a patient with class III occlusion and midface retrusion, the significant bleeding began 10 days postoperatively, which was controlled by anterior and posterior nasal packing. The bleeding recurred 28 days after surgery; thus, vascular anatomy in the pterygomaxillary area is reviewed, pseudoaneurysm was diagnosed on selective carotid angiography and successfully treated by embolization; and 2-year follow up was uneventful.

Endovaskuläre Versorgung einer traumatischen duralen arterio-venösen Fistel unter Beteiligung der Arteria meningea media und facialer Venen

Dural arterio-venous fistulas are rare lesions. Traumatic dural AV-fistulas in particular, are very rare complications of head and neck trauma.We report on a 59-year old man with a severe facial and head trauma. Initial computed tomography demonstrated a left frontal subdural hematoma, leading to progressive midline shift. Additionally, a complex skull base fracture was present, involving the frontal, temporal and sphenoid bone. A few days after the accident the patient reported a left pulsatile tinnitus. Subsequent selective carotid angiography revealed a high flow dural arterio-venous fistula involving the middle meningeal artery and facial veins. Complete endovascular embolization was performed by a transarterial approach using microparticles and an electrolytically detachable coil resulting in an immediate disappearance of the tinnitus.Remarkably, this case nicely illustrates possible “dangerous” collateral circulation to the ophthalmic artery–a feature that should be kept in mind during endovascular treatment of this entity.

Detection of carotid artery plaque rupture by multidetector-row computed tomography

A-72-year-old man who had been pointed out to have a bruit on his right neck was referred to our hospital. He had no neurological symptoms. Ultrasonography revealed moderate stenosis in the right common carotid artery and an attenuation in the right internal carotid artery (Fig. 1a). He underwent selective right carotid angiography, which disclosed moderate stenosis of the proximal portion of the internal carotid artery with a flap-like structure, suggesting ulceration due to plaque rupture (Fig.

Initial Experience with Routine Selective Carotid Arteriography by Vascular Surgeons

We report the results of our first 2 years of experience with routine carotid angiography with an emphasis on technique and complications. We reviewed the hospital records, office charts, and prospective quality-assurance database records of 336 patients undergoing cerebrovascular arteriograms and collected data on the indications, complications, and technical aspects of the procedures. Indications for angiography included carotid stenosis in 331 (95%) patients, subclavian steal syndrome in 9 patients, vertebrobasilar insufficiency in 6 patients, and carotid body tumor in 2 patients. Selective catheterizations were performed on 654 common carotid arteries, 63 subclavian arteries, and 63 vertebral arteries. Both common carotid arteries were not selectively catheterized in 34 (9.8%) patients. Reasons for not selecting one or both common carotid arteries included physician choice to limit contrast administration in patients with renal insufficiency in 16 cases, proximal occlusion in 4 cases, proximal stenosis thought to be at risk of embolization if instrumented in 3 cases, imaging equipment malfunction in 2 cases, and in only 9 (2.6%) cases was selective carotid catheterization attempted but unsuccessful. There were no procedure-related deaths. Complications were documented in six (1.8%) patients, including cerebrovascular accident (CVA) in 1 (0.3%) patient. One hundred forty-two (41%) patients went on to carotid endarterectomy, and we performed 16 carotid bifurcation stents during the study period. Routine selective carotid angiography is a low-risk procedure that can be performed safely by vascular surgeons with catheter/guide wire skills.

Percutaneous endovascular treatment of acute sequential systemic emboli

A 65-year-old woman was evaluated for acute right lower-extremity ischemia secondary to embolization from atrial fibrillation and subtherapeutic anticoagulation. Her symptoms quickly evolved in a dynamic fashion to involve multiple vascular beds, including a transient ischemic attack, abdominal pain secondary to mesenteric ischemia, and contralateral lower-extremity ischemia. Synchronous emboli were treated by using mechanical and pharmacologic thrombolysis via an endovascular approach under local anesthesia. This intervention allows prompt evaluation of multiple vascular beds with good short-term outcomes and minimal morbidity.

Changes in Internal Carotid Blood Flow after CEA Evaluated by Transit-time Flowmeter

Aim The aim of this study was to investigate whether there was an association between the degree of the stenosis of the internal carotid artery (ICA) and post-operative increase of blood flow. Methods and materials In 200 out of 660 patients undergoing carotid endarteriectomy (CEA) for a high-degree ICA stenosis, pre-operatively a bilateral selective carotid and intracerebral angiography was performed. The degree of the ipsilateral and contralateral stenosis was digitally assessed by using computer software according to the CC-Index. Intraoperatively, the pressure ratio over the stenosis (ICA/CCA) was measured by direct arterial puncture. Blood flow in the ICA was measured before and after CEA with an ultrasound flowmeter using the transit-time principle. These findings were correlated to the degree of stenosis revealed by angiographic analysis and the pressure ratio. Results Before CEA the median blood flow in the ICA was 171 ml/min (range 620 ml/min) with a significant ( p<0.001) post-operative increase to 250 ml/min (range 875 ml/min). The median relative increase of flow (post-flow–pre-flow/pre-flow) was 42%. The pre-CEA flow volumes were dependent on the degree of stenosis and also the pressure ratio. The increase of flow following CEA correlated better with pressure ratio ( r=−0.435, p<0.001), than the stenosis severity ( r=0.319, p<0.001). Analysis of variance identified only the pressure gradient as an independent determinant of flow changes following CEA. Conclusions The blood flow increase following CEA is mainly determined by the pressure gradient across the stenosis.

Safety of Arch Aortography for Assessment of Carotid Arteries

Purpose To retrospectively review the safety of arch aortography and compare complication rates with published figures for selective catheter angiography. Methods The medical records of patients undergoing arch aortography over the last 3 years ( n=311; 180 male, 131 female; mean±SD age 71.0±9.2 years, range 42–90 years) were retrospectively reviewed. Any peri-procedural (0–48 h) complications were recorded. A certified neurologist (MSR/GSV) classified all questionable neurological events. Results There were no focal neurological events or deaths ( n=0; 0%; CI: 0–0.96%). Non-focal neurological events included mild disorientation ( n=2; 0.6%; CI: 0.176–2.31) and unequal pupils ( n=1; 0.3%; CI: 0.056–1.79%). Cardiovascular events included symptomatic hypotension ( n=4; 1.3%; CI: 0.50–3.25%), angina ( n=1; 0.3%; CI: 0.056–1.79%) and arrhythmia ( n=4; 1.3%; CI: 0.50–3.25). There were 27 minor access site complications (8.7%; CI: 6.0–12.3). None of these complications extended hospital stay. None of the arch angiograms had to be followed by selective carotid angiography. Conclusion Arch aortography appears to have a lower neurological complication rate than selective carotid angiography.

抜歯後に生じた外傷性動脈りゅうによると思われる出血に対して動脈塞栓術を施行した１例

Transcatheter arterial embolization (TAE) is an effective and minimally invasive treatment againstuncontrolled arterial bleeding. We report a traumatic aneurysm that occurred after tooth extraction and was treatedby TAE. A 48-year-old woman was referred to our hospital because of uncontrolled intraoral arterial bleeding 4days after third molar extraction. In her medical history, she had been treated for liver cirrhosis and hepatocellularcarcinoma. A pseudoaneurysm of the inferior alveolar artery was found on selective carotid angiography. Massive arterial bleeding from the aneurysm was successfully treated by TAE. TAE and selective carotid angiographywere useful for the management of hemorrhage probably caused by a traumatic aneurysm after toothextraction.

Response: Combined testing of cardiac and carotid artery stenosis?

Response: Combined testing of cardiac and carotid artery stenosis?