Carotid Artery Tortuosity Research Articles

Influence of carotid tortuosity on internal carotid artery access time in the treatment of acute ischemic stroke.

Purpose Carotid artery anatomy is thought to influence internal carotid artery access time (ICA-AT) in patients requiring mechanical thrombectomy for acute ischemic stroke. This study investigates the association between ICA-AT and carotid anatomy. Material and methods Computed tomography angiography (CTA) data of 76 consecutive patients presenting with acute ischemic stroke requiring mechanical thrombectomy for middle cerebral artery or carotid T occlusion were evaluated. The supraaortic extracranial vasculature was analyzed regarding take-off angles and curvature of the affected side. Digital subtraction angiography data were primarily analyzed regarding ICA-AT and secondarily regarding recanalization time and radiographic result. Results ICA-AT was significantly influenced by vessel tortuosity. Take-off angle of the left common carotid artery ( p = 0.001) and the brachiocephalic trunk ( p = 0.002) as well as the tortuosity of the common carotid artery ( p = 0.002) had highest impact on ICA-AT. For recanalization time, however, we found only the take-off angle of the left common carotid artery to be of significance ( p = 0.020). There was a tendency for ICA-AT to correlate with successful (mTICI ≥ 2 b) revascularization (average time of successful results was 24.3 minutes, of unsuccessful was 35.6 minutes; p = 0.065). Every evaluated segment with less carotid tortuosity showed a carotid AT below 25 minutes. Conclusion Supraaortic vessel tortuosity significantly influences ICA-AT in mechanical thrombectomy for an acute large vessel. There furthermore was a trend for lower successful recanalization rates with increasing ICA-AT.

Study of correlation between carotid artery tortuosity and atherosclerotic carotid artery stenosis

Objective: To investigate the correlation between carotid artery tortuosity and atherosclerotic carotid artery stenosis. Methods: A total of 73 patients who underwent carotid computed tomography angiography with unilateral atherosclerotic carotid artery stenosis at Department of Neurosurgery of Beijing Hospital from January 2011 to June 2016 were retrospectively reviewed. There were 51 males and 22 females ranging from 48 to 90 years old, the average age was (65.9±9.5) years. There were 38 patients with carotid stenosis in the left carotid artery and 35 in the right, the stenosis degree of carotid artery ranged from 30% to 90% with the median was 44.0% (25.5%). According to the degree of carotid artery stenosis, the patients were classified into mild stenosis group and moderate/severe stenosis group. There were 43 patients in the mild stenosis group with an average stenosis degree of (37.5±5.4)%, there were 30 patients in moderate/severe stenosis group with an average stenosis degree of (65.6±10.9)%. The carotid artery (CCA) tortuosity, extracranial internal carotid artery (EICA) tortuosity and CCA-ICA bifurcation tortuosity were quantified by measuring the CCA tortuosity index, EICA tortuosity index and the internal carotid artery (ICA) angle, respectively. Comparison of diseased and normal carotid arteries was performed using t test or Wilcoxon signed-ranked test. Results: There were no statistically significant differences in CCA tortuosity index (Z=-0.584, P=0.559), ICA angle (t=0.278, P=0.781), and EICA tortuosity index (Z=-0.377, P=0.706) between diseased and normal carotid arteries in 73 patients. The diseased carotid arteries showed larger ICA angles (39.0° (19.0°) vs. 30.0° (15.0°)) (Z=-2.439, P=0.015) in the mild stenosis group, but smaller ICA angles ((31.5±11.7)° vs. (39.1±16.2)°) (t=-2.529, P=0.017) in the moderate/severe stenosis group, compared with the contralateral normal carotid arteries. There was no statistically significant difference in CCA (Z=-0.720, P=0.472; Z=-0.013, P=0.990) and EICA tortuosity index (Z=-0.349, P=0.727; Z=-0.114, P=0.909) between diseased and normal carotid arteries. Conclusions: Compared with normal carotid arteries, carotid arteries with mild atherosclerotic stenosis demonstrate a more tortuous CCA-ICA bifurcation, while those with moderate/severe stenosis demonstrate a straighter CCA-ICA bifurcation. There is no correlation between CCA, EICA tortuosity and carotid artery stenosis.

Intravenous Thrombolysis for Acute Ischemic Stroke in Patients with Cervicocephalic Dolichoarteriopathy

Cervicocephalic dolichoarteriopathy is not rare in patients with acute stroke. Results of intravenous (IV) tissue plasminogen activator (tPA) treatment have not been documented in this specific population. One hundred (58 females, age: 69 ± 13 years) consecutive patients treated with IV tPA for acute anterior circulation stroke were analyzed. Smoker's criteria were used to score basilar artery dolichoarteriopathy and combined criteria of Weibel-Fields and Metz for cervical carotid artery dolichoarteriopathy. Adjusted rates of effective response to tPA (defined as a decrease of the National Institutes of Health Stroke Scale [NIHSS] score to 1 or 0, or a total decrease ≥4 point by the end of the first 24 hours; in 51%); first-day dramatic response (≥8 NIHSS score decrease; seen in 27%); 3-month favorable (modified Rankin score ≤2; in 46%) and excellent (modified Rankin score ≤1; in 37%) functional prognosis, and hemorrhagic complications (any hemorrhage in 34%, significant Fiorelli's parenchymal hemorrhage type 2 in 8%) of IV tPA were not modified with presence and categories of the basilar and extracranial carotid artery dolichoarteriopathy. Univariate analysis documented that basilar artery dolichoarteriopathy was significantly more prevalent in patients with effective response to IV tPA (22% versus 6%, odds ratio: 4.22, P = .041). However, an exploratory multiple regression analysis disclosed that NIHSS (per 1 point, β = -.256, P = .009) and time to needle (per 15-minutes, β = -2.389, P = .019) were significant determiners of early favorable prognosis, whereas dolichoectasia was not (β = .141, P = .159). IV tPA is safe and effective in acute anterior circulation stroke coexistent with intracranial posterior circulation dolichoarteriopathy and cervical carotid artery kinking, tortuosity, or coiling.

Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy

Complex configuration of the aortic arch and internal carotid artery tortuosity increase the risk of cerebral ischemia during carotid artery stenting (CAS), but not during carotid endarterectomy (CEA). Vascular anatomy should be taken into account when selecting patients for stenting.

Association of age, gender and carotid artery atherosclerosis with carotid artery tortuosity

Objective To investigate the relationship of age, gender, carotid artery atherosclerosis with carotid artery tortuosity. Methods The data of patients with carotid computed tomography angiography(CTA)at Beijing Hospital from January 2014 to June 2016 were retrospectively reviewed.A total of 100 patients aged ≥50 years with normal carotid arteries and 100 patients with atherosclerotic carotid artery diseases were selected with age-and gender-stratified and random sampling method.Three-dimensional images of bilateral carotid arteries were reconstructed by using Mimics software.The common carotid artery(CCA)tortuosity index, extracranial internal carotid artery(EICA)tortuosity index, and the CCA-ICA bifurcation angle were measured.Association of laterality, age and gender with carotid artery tortuosity was analyzed and the differences in parameter values of carotid artery tortuosity were compared between normal carotid artery subjects and patients with atherosclerotic carotid artery. Results In normal carotid artery group, the EICA tortuosity index and ICA angle were larger in left-side than in right side(P 0.05). Manne-Whitney tests showed no statistically significant differences in EICA tortuosity, ICA angle or CCA tortuosity between patients with versus without atherosclerotic carotid artery stenosis(P>0.05). Conclusions The tortuosity in both EICA and CCA increases with age, and the EICA and CCA are more tortuous in female.There is no significant correlation between carotid artery tortuosity and atherosclerotic carotid artery disease. Key words: Carotid artery diseases; Age factors; Sex factors; Atherosclerosis

Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy.

Complex vascular anatomy might increase the risk of procedural stroke during carotid artery stenting (CAS). Randomized controlled trial evidence that vascular anatomy should inform the choice between CAS and carotid endarterectomy (CEA) has been lacking. One-hundred eighty-four patients with symptomatic internal carotid artery stenosis who were randomly assigned to CAS or CEA in the ICSS (International Carotid Stenting Study) underwent magnetic resonance (n=126) or computed tomographic angiography (n=58) at baseline and brain magnetic resonance imaging before and after treatment. We investigated the association between aortic arch configuration, angles of supra-aortic arteries, degree, length of stenosis, and plaque ulceration with the presence of ≥1 new ischemic brain lesion on diffusion-weighted magnetic resonance imaging (DWI+) after treatment. Forty-nine of 97 patients in the CAS group (51%) and 14 of 87 in the CEA group (16%) were DWI+ (odds ratio [OR], 6.0; 95% confidence interval [CI], 2.9-12.4; P<0.001). In the CAS group, aortic arch configuration type 2/3 (OR, 2.8; 95% CI, 1.1-7.1; P=0.027) and the degree of the largest internal carotid artery angle (≥60° versus <60°; OR, 4.1; 95% CI, 1.7-10.1; P=0.002) were both associated with DWI+, also after correction for age. No predictors for DWI+ were identified in the CEA group. The DWI+ risk in CAS increased further over CEA if the largest internal carotid artery angle was ≥60° (OR, 11.8; 95% CI, 4.1-34.1) than if it was <60° (OR, 3.4; 95% CI, 1.2-9.8; interaction P=0.035). Complex configuration of the aortic arch and internal carotid artery tortuosity increase the risk of cerebral ischemia during CAS, but not during CEA. Vascular anatomy should be taken into account when selecting patients for stenting. URL: http://www.isrctn.com/ISRCTN25337470. Unique identifier: ISRCTN25337470.

Тактика лечения больных со стенозом и извитостью внутренней сонной артерии

Рассмотрена тактика лечения больных со стенозом и извитостью внутренних сонных артерий, приведены литературные данные по открытым операциям при сочетании этих патологических изменений сонных артерий, а также интересные данные по эндоваскулярным вмешательствам, которые были выполнены в последнее время. Представлено собственное клиническое наблюдение диагностики и успешного хирургического лечения больного со стенозом и извитостью внутренней сонной артерии. Выбор операции основывался на степени стеноза, локализации извитости внутренней сонной артерии, гемодинамической значимости извитости, ишемического инсульта в анамнезе. Неосложненное послеоперационное течение подтвердило возможность эффективного хирургического лечения данной категории больных. Отмечена положительная динамика неврологического статуса с регрессом жалоб, что согласуется с данными ультразвуковых методов исследования, отражающих восстановление мозгового кровотока. HTML

Preoperative MRI diagnostics of the topographic features of neck arteries in the patients presenting with chronic tonsillitis

The objective of the present study was to determine the frequency of abnormalities of the major neck vessels and elucidate the specific features of blood supply of palatine tonsil based on the results of MRI performed in the vasculature-targeting regimen. A total of 109 patients presenting with chronic tonsillitis (including 64 women and 45 men at the age varying from 15 to 54 years) were available for the examination. All the patients underwent the MRI diagnostic study of the neck vessels by way of the preliminary evaluation of their condition at the pre-hospital stage. Abnormalities in the internal carotid artery were documented in 11.9% of the cases (including C- and S-shaped tortuosity of internal carotid artery in 6.88%, kinking and coiling of internal carotid artery in 4.13% and 0.92% of the patients, respectively). The majority of the detected abnormalities were located above the upper pole of the palatine tonsil which allowed to avoid the risk of the injury to the main neck vessels and prevented possible hemorrhage. One patient (0.46%) presented with kinking of the right internal carotid artery located in the immediate proximity to the capsule of the palatine tonsil close to its mid-third portion. There was no evidence that the present study gave rise to any malformation of the internal carotid artery and internal jugular vein. The proposed diagnostic method makes it possible to detect a rare anatomical feature of the development of the internal carotid artery discovered in a single patient (0.04%) out of the 2398 operated ones. This finding is of clinical significance and needs to be borne in mind when preparing the planned surgical intervention for the treatment of chronic tonsillitis. The results of the present study should be taken into consideration when prescribing the surgical treatment to the patients suffering not only from chronic tonsillitis but also from other ENT diseases, in the first place pharyngotympanic tube pathology.

COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF A RARE ANOMALY OF BRACHIOCEPHALIC ARTERIES

After presentation of focal neurologic symptoms due to acute or chronic ischemic brain disease all patients should undergo complex examination in order to identify the source that changed hemodynamics and define management strategy. We present a clinical case of multiple aortic and brachiocephalic arteries anomalies in patient with complaints for dizziness and hearing noise. Computed tomography revealed right aortic arch with anomaly of brachiocephalic vessels branching, hypoplasia of left common carotid artery, agenesis of left internal carotid artery with «adult” type of collateral supply, hypoplasia of left vertebral artery, fusiform aneurysm of left posterior cerebral artery and also right internal carotid artery tortuosity in extracranial segment. Perfusion computer tomography showed symmetric cerebral flow. Computed tomography enables to assess different vascular changes in patients with brachiocephalic arteries anomalies and therefor to optimize treatment strategy.

A comparative analysis of the reconstructive surgery and conservative treatment efficacy in patients with internal carotid artery tortuosity according to neurologic and ophthalmologic status

A comparative analysis of the reconstructive surgery and conservative treatment efficacy in patients with internal carotid artery tortuosity according to neurologic and ophthalmologic status

Quantitative Analysis of Extracranial Arterial Tortuosity in Patients with Sickle Cell Disease

Compared to the intracranial vasculature in sickle cell disease (SCD) patients, the morphologic changes of the extracranial vasculature in SCD patients are less well understood. The purpose of this study was to evaluate the tortuosity of the extracranial carotid and vertebral arteries in patients with SCD compared to age-matched controls. Following Institution Review Board approval, between January 2004 and December 2013, Magnetic resonance angiogram neck examinations were retrospectively reviewed on 56 patients with SCD and 56 age-matched controls. Vessel tortuosity was measured as curved vector lengths in the common carotid, extracranial internal carotid, and vertebral arteries bilaterally. Correlation of vessel tortuosity with age and hematocrit level was assessed. Paired and unpaired Student's t-tests were performed to determine within and between group differences. Greater tortuosity in extracranial carotid and vertebral arteries were noted in patients with SCD as compared to age-matched control patients (P < .001). Greater differences in tortuosity between carotid and vertebral arteries were noted in SCD patients as compared to differences in control patients. Incidence of infarction was significantly associated with greater tortuosity of right carotid (P = .002), right (P = .004), and left (P = .020) vertebral arteries. Extracranial carotid and vertebral arterial tortuosity is increased in SCD patients. This could be related to aberrations in hemodynamics from nonlaminar flow in these vessels. These increases in extracranial vascular tortuosity could potentially lead to alterations in intracranial vascular tortuosity and may be an independent risk factor for cerebral infarct.

Association between carotid artery tortuosity and carotid dissection: a case-control study.

Carotid artery dissections have long been associated with compromise of the structural integrity of the arterial wall from heritable connective-tissue disorders, hypertension, and trauma. However, an association between spontaneous internal carotid artery dissection and tortuous or redundant carotid anatomy has not been fully explored. Patients with CTA confirmed spontaneous cervical internal carotid artery dissections were compared to a group of age and sex matched controls who also received CTA of the neck. Patients with trauma or aortic dissections were excluded. Five radiologists reviewed the CTA images to evaluate internal carotid artery tortuosity (reported as loops, kinks or coils), retrojugular and retropharyngeal courses of the internal carotid artery, presence of fibromuscular dysplasia and presence of atherosclerotic disease. Baseline data collected included demographic characteristics (sex, age, smoking history) and cardiovascular comorbidities. A total of 83 cervical internal carotid artery dissection and their age and sex matched controls were included in this study. 46% of patients were female in each group and mean age was 49.2±10.6 years. The presence of any carotid tortuosity was 53% (N.=44) and 34% (N.=28) in the per-patient analysis of dissection and control groups, respectively (P=0.02). Loops were reported in 22% (N.=18) of dissection patients and 8% (N.=7) of controls (P=0.03). Retrojugular course of the internal carotid artery were seen in 23% (N.=38) of dissection patients and 9% (N.=15) of controls (P=0.0009) in the per-vessel analysis. Our study suggests that there is an association between the presence of tortuous carotid artery anatomy and spontaneous carotid artery dissection. This finding emphasizes the importance of the presence of tortuous arteries on CTA imaging to increase the index of suspicion for a potential dissection.

Vascular Tortuosity May Be Associated With Cervical Artery Dissection

Dissection is an increasingly recognized cause of ischemic stroke, which occurs spontaneously or after trauma, in relatively young patients. We hypothesized that there might be a predisposing factor weakening the vascular wall and that arterial tortuosity might be higher in patients with dissection. We consecutively enrolled cervical artery dissection (CerAD) patients who had undergone magnetic resonance angiography. Age- and sex-matched healthy subjects who underwent magnetic resonance angiography in a routine health examination were used as controls. The tortuosity was measured semiautomatically from the carotid artery and vertebral artery (VA) arteries. Tortuosity index was defined as: [(arc/chord)-1×100] in each arteries. Independent risk factors associated with CerAD were investigated using multivariable analysis. Subgroup analysis according to the dissected artery was performed. There were no differences in vascular risk factors between the 75 CerAD patients and the 75 controls. The tortuosity indexes of the contralesional VA (16.3±6.8 versus 12.1±4.5, respectively; P<0.001) and carotid artery (8.8±4.0 versus 7.3±2.9, respectively; P=0.01) were higher in patients with CerAD compared with those of control subjects. VA tortuosity (odds ratio, 1.175; P=0.001) was independently associated with the presence of CerAD. In subgroup analysis, VA tortuosity was significantly higher in 57 patients with VA dissection than in controls (P<0.001), and carotid artery tortuosity was marginally higher in 18 patients with carotid artery dissection (P=0.05). CerAD is associated with tortuous cervical arteries, which may implicate weakened cervical vascular structure in these patients.

In vivo evidence for long-term vascular remodeling resulting from chronic cerebral hypoperfusion in mice

We have characterized both acute and long-term vascular and metabolic effects of unilateral common carotid artery occlusion in mice by in vivo magnetic resonance imaging and positron emission tomography. This common carotid artery occlusion model induces chronic cerebral hypoperfusion and is therefore relevant to both preclinical stroke studies, where it serves as a control condition for a commonly used mouse model of ischemic stroke, and neurodegeneration, as chronic hypoperfusion is causative to cognitive decline. By using perfusion magnetic resonance imaging, we demonstrate that under isoflurane anesthesia, cerebral perfusion levels recover gradually over one month. This recovery is paralleled by an increase in lumen diameter and altered tortuosity of the contralateral internal carotid artery at one year post-ligation as derived from magnetic resonance angiography data. Under urethane/α-chloralose anesthesia, no acute perfusion differences are observed, but the vascular response capacity to hypercapnia is found to be compromised. These hemispheric perfusion alterations are confirmed by water [15O]-H2O positron emission tomography. Glucose metabolism ([18F]-FDG positron emission tomography) or white matter organization (diffusion-weighted magnetic resonance imaging) did not show any significant alterations. In conclusion, permanent unilateral common carotid artery occlusion results in acute and long-term vascular remodeling, which may have immediate consequences for animal models of stroke but also vascular dementia.

Willis covered stent for complex internal carotid aneurysms

Objective To investigate the safety and efficacy of the Willis covered stent system for the treatment of complex internal carotid aneurysms. Methods Eight patients with complex internal carotid aneurysm treated with Willis covered stent system at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from November 2013 to May 2015 were analyzed retrospectively. Among them, 3 patients had internal carotid artery blood blister like aneurysms, 2 had paraclinoid segment aneurysms, and 3 had cavernous segment aneurysms (1 traumatic pseudoaneurysm, 1 iatrogenic pseudoaneurysm, and 1 giant aneurysm). According to the intraoperative condition of the paren artery, the guiding catheters were placed as high as possible (near the cavernous segment) to provide adequate support. After the covered stents were implanted.the balloon were inflated to release the stent and the aneurysm were eliminated at the same time. Results Eight patients with complex internal carotid aneurysm (8 aneurysms) were implanted 8 covered stents, 7 of them were successfully released in the parent arteries. Angiography immediately after stenting in 5 patients showed that the lesions disappeared completely and the parent arteries were patent; After 1 stent was implanted, 1 patient with recurrent giant aneurysm at the cavernous segment after stent-assisted embolization, a small amount of contrast agent leaked into the aneurysm (endoleak). The stent system in place was difficult in 1 patent with blood blister like aneurysm because of his internal carotid artery tortuosity. Iatrogenic internal carotid cavernous fistula occurred during the operation. Bypass and occlusion of the parent artery was performed after balloon embolization. Other cases did not have operation-related complications. The 8 patients were followed up clinically at 2 to 12 months after procedure. They did not have any neurological deficits. The modified Rankin scale (mRS) scores were 0 in 5 cases, 1 in 2 cases, and 2 in 1 case. Three patients got DSA followed-up again at 6 month after procedure. No recurrence of aneurysms was observed, and their parent arteries were patent without stenosis. Conclusion Willis covered stents were safe and effective for the treatment of some complex internal carotid artery aneurysms. Key words: Intracranial aneurysm; Carotid artery, internal; Willis covered stents

Expression of matrix metalloproteinases and their inhibitors in the internal carotid artery wall in pathological tortuosity

The principal morphological sign of fibromuscular dysplasia in pathological tortuosity (PT) of the internal carotid artery (ICA) is the fragmentation of elastic fibers that are degraded by matrix metalloproteinases 2 and 9 (MMP-2, MMP-9). Nevertheless, the role of MMPs and their inhibitors in the pathogenesis of ICA PT remains completely unexplored. to investigate the expression of elastin-degrading MMPs and their inhibitors in the wall of the ICA in PT by immunohistochemistry and confocal laser scanning microscopy. Immunohistochemical examination was made using antibodies to MMP-2, MMP-9 and their tissue inhibitors TIMP-1 and TIMP-2. MMP-9 and TIMP-1 levels were determined by confocal laser scanning microscopy. Immunohistochemical examination revealed a statistically significant predominance of high concentrations of MMP-2 and MMP-9 and a low level of their inhibitor TIMP-1 in ICA PT, while simultaneous obvious accumulation of both markers was most often identified in the control group (p<0.05). Analysis of MMP-2/TIMP-2 and MMP-9/TIMP-2 ratios showed the prevalence of the simultaneously high expression of both proteins in ICA PT and in the control group too. The similar data were also obtained by confocal microscopy: the control group showed elevated MMP-9 and TIMP-1 expressions and the ICA PT control displayed a high proteinase and low inhibitor levels (p<0.05). Elastic fiber fragmentation in ICA PT is due to imbalance between MMPs and their inhibitors; namely, the prevalence of MMP-2 and MMP-9 over their inhibitor TIMP-1, which leads to the degradation of extracellular matrix components, primarily elastin.

REMODELING OF CEREBRAL ARTERIES IN DYSCIRCULATORY ENCEPHALOPATHY WITH ARTERIAL HYPERTENSION AND STROKE IN PATIENTS WITH RADIATION ANAMNESIS

Aim. To assess the specifics of brachiocephalic arteries (BCA) remodeling in patients with dyscirculatory encephalopathy (DE) with arterial hypertension (AH), and the prevalence among them of stroke according to anamnesis of ionizing radiation (IR). Material and methods. Totally, 536 Chernobyl liquidators included (main group) and 402 patients without radiation anamnesis (comparison group) with DE and AH; stroke had 109 liquidators and 50 comparisons. Duplex BCA scan was done, with velocity parameters of cerebral flow, anatomic configuration changes, intraluminal masses, vessel wall abnormalities. Then we checked the relation of BCA changes with stroke anamnesis. Results. The study of IR influence on BCA remodeling in liquidators with DE living in Altai Region, showed than even in DE of 1st grade they show systemic reaction of vascular endothelium with IMC thickening in 2 or more BCA (68,7%) with formation (in 91,1%) of atherosclerotic plaques. There is connection of DE with the development and severity of BCA remodeling markers: stenosis (19,6%) and pathological tortuosity (10,7%) of carotid arteries, combined with BCA lesion (21,9%). In the absence of radiation anamnesis the process of BCA remodeling starts only in DE of 2nd grade, is related to AH and is parallel to its progression. Conclusion. Liquidators have stroke 1,6 times more frequently than those not contacted with IR. Markers of BCA remodeling before stroke in liquidators are: thickening of IMC in 2 and more arteries (96,3%), heterogenic atheromas (100%), carotid arteries stenoses (93,5%), combination of BCA lesion (88,1%); in general population: thickening of IMC in 2 and more vessels (79,4%), plaques (100%), in lesser extent (64,0%) stenosis of carotid arteries.

Хирургическое лечение атеросклеротического стеноза сонных артерий в сочетании с патологической извитостью внутренней сонной артерии с целью профилактики ишемического инсульта

Хирургическое лечение атеросклеротического стеноза сонных артерий в сочетании с патологической извитостью внутренней сонной артерии с целью профилактики ишемического инсульта

Clinical analysis of carotid angioplasty stenting for high-grade extracranial carotid artery stenosis combined with severe tortuosity

To observe the feasibility and safety of carotid angioplasty stenting (CAS) for high-grade extracranial carotid artery stenosis combined with severe tortuosity. Twenty patients diagnosed with high-grade extracranial carotid artery stenosis combined with severe tortuosity by cerebral angiography, who were in hospital in neurology department of China-Janpan friendship from June 2011 to June 2014. Twelve of these patients were symptomatic. All cases weren't suit for or disagreed with carotid endarterectomy (CEA) to accept CAS. We retrospectively discussed the rates of technical success, the perioperative complications and clinical improvement. During the follow-up for 4 to 40 months we observed the events of cured carotid artery territory stroke and death, and record the plaque hyperplasia in stent, in-stent restenosis, stent deformation or fracture by color doppler ultrasonography or craniocervical CT angiography. (1) The results of operation: the rate of technical success was 19/20 and the rate of the distal protection device placement was 18/20. One stent and 2 distal protection device were difficult to pass the tortuous access vessels. The kinking was the most common in circuity classification of internal carotid artery. The stenosis was significantly improved after stenting, and the mean degree of stenosis was reduced from (82% ± 9%) before stenting to (7% ± 6%) after stenting. Although 5 patients were with perioperative complications, all symptoms disappeared within 1 weeks, and there was no stent related death and disability. There were 4 cases with vascular spasm, one of them was combined with carotid sinus reaction, and anther with transient ischemic attack (TIA) during operation. There was one with ipsilateral carotid territory minor stroke. (2) The results of prognosis and follow up: The clinical symptoms from 12 symptomatic patients were improved significantly on discharge, and the average NIHSS scores on admission were reduced from (4 ± 4) to (2 ± 2) on discharge. One patient experienced ipsilateral carotid territory minor stroke and another patient experienced ipsilateral carotid territory TIA during the follow-up for an average of 19 months, and there were 5 cases with mild plaque hyperplasia in stent and no in-stent restenosis, stent deformation or fracture. The severe tortuosity of extracranial carotid artery may affect the using of intervention materials and increase the complexity of CAS, but for the patients who disagree with CEA or were with the contraindications to CEA, CAS may be still a relatively safe, effective and alternative treatment.

Hemodynamic Effects of Pathological Tortuosity of the Internal Carotid Arteries Based on MRI and Ultrasound Studies

Our study was designed to determine the effect of different forms of pathological tortuosity of the internal carotid arteries on the formation of hemodynamic flow profile. Using a 1.5 T magnetic resonance imaging (MRI) device, 50 healthy volunteers and 43 patients with pathological tortuosity of the internal carotid arteries were studied by applying routine MRI protocol and quantitative phase-contrast MR angiography. Changes in the peak, linear and volumetric blood flow rates as well as the cross-sectional areas of the vessel were measured during the cardiac cycle within the cervical and intracranial segments of the internal carotid arteries. 20 patients with pathological tortuosity of the internal carotid arteries were subjected to ultrasound study. In both, the control group and the group with pathological tortuosity, the shape of the curves that reflects the change in the linear blood flow rate as a function of the cardiac cycle, obtained with ultrasound and MRI, qualitatively coincides and does not depend on the tested segment of the artery and its path. The correlation coefficient was low between the peak blood flow rate obtained by ultrasound and MRI. The quantitative values of the blood flow rate, obtained in the control group and the group with pathological tortuosity, differed significantly in different segments of the internal carotid arteries. However, no significant differences were observed in blood flow rates between various forms of ICA tortuosity. The cross-sectional area was significantly higher in the case of pathological tortuosity of the internal carotid arteries as compared to the control group.