Carotid Artery Wall Research Articles

Atherogenic potential of microgravity hemodynamics in the carotid bifurcation: a numerical investigation

Long-duration spaceflight poses multiple hazards to human health, including physiological changes associated with microgravity. The hemodynamic adaptations occurring upon entry into weightlessness have been associated with retrograde stagnant flow conditions and thromboembolic events in the venous vasculature but the impact of microgravity on cerebral arterial hemodynamics and function remains poorly understood. The objective of this study was to quantify the effects of microgravity on hemodynamics and wall shear stress (WSS) characteristics in 16 carotid bifurcation geometries reconstructed from ultrasonography images using computational fluid dynamics modeling. Microgravity resulted in a significant 21% increase in flow stasis index, a 22–23% decrease in WSS magnitude and a 16–26% increase in relative residence time in all bifurcation branches, while preserving WSS unidirectionality. In two anatomies, however, microgravity not only promoted flow stasis but also subjected the convex region of the external carotid arterial wall to a moderate increase in WSS bidirectionality, which contrasted with the population average trend. This study suggests that long-term exposure to microgravity has the potential to subject the vasculature to atheroprone hemodynamics and this effect is modulated by subject-specific anatomical features. The exploration of the biological impact of those microgravity-induced WSS aberrations is needed to better define the risk posed by long spaceflights on cardiovascular health.

Motion estimation of the common carotid artery wall in ultrasound images using an improved sub-pixel block matching method

To improve the accuracy of the two-dimensional motion estimation of the common carotid artery (CCA) wall, a modified sub-pixel block matching method is proposed in this study. First, the directional asymmetric search (DAS) method is used for the block matching, and the sum of absolute error criterion combined with fuzzy set theory is used to determine the similar blocks. After obtaining the best block matching position, a combination of grid slope and parabolic interpolation (GS15PI) method is used for sub-pixel estimation. Then, the best matching position (point) obtained in the previous step and all points in its 3×3 neighborhood need to be determined. The blocks with the same size as the reference block centered on these points are used for block matching with the reference block from the search frame − 2. After obtaining the best block matching position, the GS15PI method is used for sub-pixel estimation. Finally, the average of sub-pixel positions obtained in the two previous steps is calculated as the final sub-pixel estimation. In simulation experiments, the two-dimensional motion errors of proposed method for simulated ultrasound sequences with the center frequencies of 5 MHz, 7.5 MHz, and 10 MHz are decreased by 8.41%，4.65%, and 11.25%, respectively, compared with the state-of-the-art method. In clinical experiments, as compared with the state-of-the-art method, the radial and longitudinal motion estimation results of proposed method are more consistent with the actual movement trend of the human CCA. In conclusion, the proposed method has good performance and can be used for motion estimation of the CCA wall in ultrasound images.

Fluid shear stress on the endothelium of the carotid artery wall and coronary artery calcinosis in patients with arterial hypertension

Objective: to study the interconditionality of changes in the fluid shear stress on the endothelium (FSE) of the common carotid artery (CCA) wall which is intact from atherosclerosis with the value of the Cardiac Calcium Score (CCS) among patients with e arterial hypertension (AH).Materials and methods: the study included 99 patients with AH, 52 of them had atherosclerotic lesions of the brachiocephalic arteries (BCA). The ultrasound investigation of the carotid arteries with the determination of FSE in the intact area of the CCA, multispiral computed tomography of the coronary arteries with the determination of CCS were performed to all patients.Results: the prevalence of BCA atherosclerotic lesion in the study was 53%. The mean value of FSE for patients with AH and BCA atherosclerosis (group 1) were 660.7 (185.6) c-1, for patients with AH without its (group 2) — 735.8 (149.8) c-1, p = 0.009. The parameters of the lipid spectrum in patients of both groups were comparable. Мedian value of CCS in patients with atherosclerotic lesions of the BCA were statistically significantly higher (15.00 (0.00; 178.00),) compared with patients of the group 2 (0.00 (0.00; 171.00), at p = 0.001. The chances of detecting coronary artery calcification among patients of group 1 are in 2 times higher (OR = 2.25, 95% CI: 1.58-8.33) than among patients of group 2. Low FSE values correlated with male gender (rs = 0.40 (95% CI: 0.22; 0.55) p <0.001) and increasing of CCS (rs = -0.23 (95% CI: -0.41; -0.04) p = 0.022).Conclusions: the prevalence of atherosclerotic lesions of the BCA among patients with AH without a history of symptomatic diseases associated with atherosclerosis was 53%. In the group of patients with AH and atherosclerotic lesions of the BCA, median values of CCS were significantly higher, and coronary artery lesions were detected significantly more often (OR = 2.25, 95% CI: 1.58-8.33) than among patients with AH and intact BCA. The mean value of FSE for patients with AH and BCA atherosclerosis were statistically significantly lower than for patients with AH without it and amounted to 660.7 (185.6) c-1 and 735.8 (149.8) c-1, respectively, p = 0.009. Low FSE values correlated with male gender and increasing of CCS

Automated Force-Coupled Ultrasound Method for Calibration-Free Carotid Artery Blood Pressure Estimation.

We develop, automate and evaluate a calibration-free technique to estimate human carotid artery blood pressure from force-coupled ultrasound images. After acquiring images and force, we use peak detection to align the raw force signal with an optical flow signal derived from the images. A trained convolutional neural network selects a seed point within the carotid in a single image. We then employ a region-growing algorithm to segment and track the carotid in subsequent images. A finite-element deformation model is fit to the observed segmentation and force via a two-stage iterative non-linear optimization. The first-stage optimization estimates carotid artery wall stiffness parameters along with systolic and diastolic carotid pressures. The second-stage optimization takes the output parameters from the first optimization and estimates the carotid blood pressure waveform. Diastolic and systolic measurements are compared with those of an oscillometric brachial blood pressure cuff. In 20 participants, average absolute diastolic and systolic errors are 6.2 and 5.6 mm Hg, respectively, and correlation coefficients are r = 0.7 and r = 0.8, respectively. Force-coupled ultrasound imaging represents an automated, standalone ultrasound-based technique for carotid blood pressure estimation, which motivates its further development and expansion of its applications.

Antithrombotic Activity of an Indolinone Derivative – a Soluble Guanylate Cyclase Stimulator

Introduction . The article presents the results of studying the antithrombotic activity of a novel drug, a soluble guanylate cyclase stimulator (codename – GRS), in experimental models of arterial and venous thrombosis and thromboembolism. Aim . Study the antithrombotic action of GRS compound in comparison with clopidogrel and rivaroxaban in the following models: arterial thrombosis induced by iron chloride application to carotid artery wall in rats; thromboembolism induced by intravenous administration of thrombin solution in mice; venous thrombosis induced by the ligature of inferior vena cava in rats. Materials and methods . Arterial thrombosis was modelled in rats by applying a pad soaked in iron chloride (FeCl 3 ) to the carotid artery, GRS compound was administered orally in median effective dose of 10 mg/kg once 3 hours before pad application. Blood flow in carotid arteries and blood clot mass were registered. Thromboembolism was induced in mice by intravenous administration of thrombin solution, GRS in dose 10 mg/kg or the reference drug clopidogrel were administered once orally daily for 3 days. Animal mortality, survival time and blood clot size were registered. Venous thrombosis was induced in rats by the ligature of inferior vena cava below renal veins, GRS in dose 10 mg/kg, reference drug rivaroxaban in 5 mg/kg dose or their combination in these doses were administered once orally 1 hour before vein ligature. The mass of dry and wet blood clots was registered. Results and discussion . In arterial thrombosis model GRS compound in 10 mg/kg, administered 3 hours before iron chloride application, increased the time to blood flow cessation in the carotid artery by 35 % and reduced the frequency of complete artery occlusion by 2 times compared to the control group ( р < 0.05). 60 min after arterial thrombosis modelling complete occlusion was observed in 28 % of animals in GRS group and in 75 % of control animals, while after 24 hours the occlusion was observed in 14 % of animals in GRS group and in 50 % of control group animals ( p < 0.05). In thrombin-induced thromboembolism model in mice GRS did not reduce the size of blood clots in pulmonary vessels, while clopidogrel reduced it by 48 %. In GRS group 80 % of animals died of thrombosis, compared to 30 % in clopidogrel group and 90 % in the control group. In ligature-induced venous thrombosis in rats GRS after single oral administration reduced the mass of dry blood clot, being as potent as rivaroxaban. Combined administration of GRS and rivaroxaban did not enhance their antithrombotic action. Conclusion . GRS after single oral administration in 10 mg/kg dose had potent antithrombotic action in models of arterial and venous thrombosis in rats, while not preventing pulmonary vessel thrombosis in mice after thrombin administration. Therapeutic action of GRS in experimental venous thrombosis was as potent as that of rivaroxaban. Antithrombotic action of GRS compound results not only from its antiplatelet action, but also from the alleviation of endothelial dysfunction in arteries and veins.

Association of contrast enhancement of proximal internal carotid artery wall and champagne bottle neck sign with ipsilateral stroke in moyamoya disease patients

ObjectiveTo investigate the characteristics of the proximal internal carotid artery (ICA) and their relationships with ipsilateral intracranial stroke in sufferers of moyamoya disease (MMD) with champagne bottle neck sign (CBNS). Patients and methodsForty-four patients with MMD（mean age 43.98 ± 10.54 years, 21 males）confirmed by digital subtraction angiography were enrolled and carotid magnetic resonance vessel wall imaging was introduced in this study. CBNS was defined as the ratio of the diameters of proximal ICA to the common carotid artery (CCA) (DpICA/CCA) < 0.5. The wall thickness and enhancement of the proximal ICA was measured on postcontrast T1-VISTA images. The correlations between these characteristics of the proximal ICA and ipsilateral intracranial stroke were analysed. ResultsAmong the 44 patients with MMD, twelve patients (27.3 %) had bilateral CBNS and fourteen patients (31.8 %) without CBNS. Compared with normal extracranial arteries, in arteries with CBNS, the proximal ICA had a smaller diameter (3.03 ± 1.05 mm vs 3.95 ± 1.10 mm, p < 0.001), the maximum wall thickness of the proximal ICA was thicker (1.34 ± 0.31 mm vs 1.06 ± 0.26 mm, p < 0.001), and arterial wall contrast enhancement was more frequently observed (66.7 % vs 2 %, p = 0.001). Logistic regression analysis revealed that the wall enhancement of the proximal ICA with CBNS (OR = 15.16, 95 % CI, 2.32–99.02; P = 0.005) was independently associated with intracranial multiple lesions. The AUC of the wall enhancement of the proximal ICA with CBNS was 0.79(P = 0.003). ConclusionsVessel wall enhancement of the proximal ICA with CBNS is independently associated with intracranial stroke in the ipsilateral hemispheres of patients with MMD, particularly those with multiple lesions.

The effect of aging on carotid artery wall mechanics during maximal resistance exercise.

Age-related stiffening of the large elastic arteries (e.g., common carotid artery [CCA]) may impair wall dynamics (i.e., strain) and amplify transmission of pulsatile blood flow into the brain with large increases in pressure that occur during maximal resistance exercise (RE). The purpose of this study was to compare CCA arterial wall dynamics, central hemodynamics, and cerebral blood velocity responses during maximal RE between young and older adults. Thirty-one young (YA; 26 ± 5 yrs; 23.8 ± 3.3kg/m2) and 25 older adults (OA; 60 ± 6 yrs; 30.0 ± 5.5kg/m2) performed a unilateral maximal isokinetic knee flexion/extension exercise protocol (i.e., maximal RE). All measures were recorded at baseline and during the last 10s of maximal RE. Common carotid artery strain, CCA strain time to peak, and CCA strain rate (i.e., variables of arterial wall dynamics) were analyzed using 2D speckle tracking software from circumferential ultrasound images. Transcranial Doppler was used to measure right middle cerebral artery (MCA) blood velocity. Non-invasive arterial blood pressure measurements were obtained using finger photoplethysmography. Older adults had greater reductions in CCA strain time to peak from baseline to maximal RE (345 ± 39 to 242 ± 52ms) than YA (308 ± 35 to 247 ± 42ms; interaction effect, p < 0.01). MCA velocity was similar between YA and OA during maximal RE (p = 0.48), despite a greater arterial pressor response in OA (p < 0.01). These data suggest cerebral blood velocity responds similarly during maximal RE among OA compared to YA, despite subtle age-related differences in the pressor and extracranial vascular response during maximal RE.

Orbital inflammatory syndrome after mechanical thrombectomy of acute carotid occlusion

Introduction: Orbital ischemic syndrome (OIS) is a rare disorder that presents with acute loss of visual acuity, chemosis, proptosis, ptosis and ophtalmoparesis. We present a case with acute onset of orbital inflammation following mechanical thrombectomy that mimicked an OIS, except for the absence of vision loss. Case report: A 65-year-old woman presented to our emergency department after an episode of transient dysarthria and left-sided hemiparesis and paresthesia that lasted about forty minutes. Head computed tomography showed no signs of intracranial bleeding or acute ischemia. CT angiogram showed occlusion of the right ICA terminus. Mechanical thrombectomy was then performed and the clot was removed with combined technique. Eight hours later, she developed orbital pain, ptosis, chemosis and complete ophthalmoplegia of the right eye. She had no diplopia, visual acuity and funduscopic examination were normal and there was no audible bruit in the orbit. Brain MRI performed showed hyperintensity of orbital fat along with hyperintensity and enlargement of all the extraocular There were no signs of orbital infarction and the optic nerve was structurally normal. Time of flight magnetic resonance angiography revealed reduced calibre of the distal portion of ICA, with associated contrast enhancement on vessel wall imaging. She was started on intravenous dexamethasone with full recovery two days later. Discussion: We present the case of an orbital inflammatory syndrome after mechanical thrombectomy. The mechanical stress exerted by endovascular devices has been associated with endothelial damage that correlates with vessel wall thickening and contrast enhancement in high resolution MRI studies. The temporal correlation with mechanical thrombectomy, the absence of vision loss or orbital infarction and the good clinical response to steroids support the hypothesis of an internal carotid artery wall inflammation due to endovascular manipulation of the stent retriever to be responsible for this acute orbital syndrome. This case highlights the need for close postprocedural monitoring after MT and the consideration of orbital inflammation secondary to endovascular devices in the differential diagnosis of an acute orbital syndrome. Further studies are needed to understand the long-term consequences of arterial wall lesions associated with these devices.

АОРТОАРТЕРІЇТ І ТЯЖКА АОРТАЛЬНА НЕДОСТАТНІСТЬ У ПАЦІЄНТКИ ПІСЛЯ COVID-19

Aortoarteritis is a rare cause of the aortic insuffi ciency, but it should be considered among the other causes of aortic regurgitation. A number of cases of autoimmune aortoarteritis have been reported during the COVID-19 pandemic. We present a case report of aortoarteritis with severe aortic insuffi ciency, which developed in a patient after a mild form of coronavirus infection and an episode of arthritis. Echocardiography revealed severe aortic regurgitation, dilatation of the thoracic aorta and thickening of the aortic walls. Ultrasonography showed thickening of the carotid arterial walls. Computed tomography confi rmed the diagnosis of aortoarteritis. Elevated C-reactive protein indicated an acute infl ammatory process. Aortoarteritis was treated with methylprednisolone with good clinical response. Possible causes of aortoarteritis are discussed: Takayasu arteritis, giant cell arteritis, ankylosing spondylitis and polychondritis. After exclusion of all possible causes, aortoarteritis in the patient was diagnosed as an autoimmune process caused by coronavirus infection. Cases of arteritis in patients related to COVID-19 are discussed. Multimodality diagnostics (echocardiography, contrast-enhanced computed tomography, ultrasonography of aortic branches) play a central role in detecting aortic lesions and evaluating the extent of the pathological process in aortitis. A laboratory workup is needed to identify the cause of the aortitis. The fi nal diagnosis should be made on the analysis of clinical manifestations, diagnostic and laboratory fi ndings.

Associations between pericarotid fat density and image-based risk characteristics of carotid plaque

ObjectivesIn this study, we aimed to evaluate the associations between pericarotid fat density (PFD) and various risk characteristics of carotid plaque. MethodsWe retrospectively evaluated consecutive patients who were subjected to both high-resolution MRI and carotid artery CT angiography CTA at our institution between January 2016 and April 2021. The section of the carotid artery with the most severe lumen stenosis was selected from each patient for analysis. Two separated regions of interest (ROI) (each with an area of 2.5 mm2 and located at least 1 mm from the outer margin of the carotid artery wall) were defined in the perivascular fat tissue. The mean value of PFD (mean HU) was measured on the plaque side and the same axial non-plaque side. Then, the bilateral difference (D-value HU) was calculated (plaque side mean HU minus non-plaque side mean HU). According to carotid plaque risk characteristics (American Heart Association VI type [AHA VI], intraplaque hemorrhage [IPH], thinning and/or rupture of the fibrous cap [TRFC], lipid-rich necrotic core [LRNC], and calcification [CA]), the associations between PFD and five different risk characteristic subgroups were analyzed. The Student’s t-test, Mann-Whitney U test, and Chi-square test were used to compare differences between different risk subgroups. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive efficacy of PFD for carotid plaque risk characteristics. P < 0.05 was considered statistically significant. ResultsA total of 71 eligible patients (mean age 61.25 ± 10.35 years, 57 male) were examined in this study. For the plaque side and the non-plaque side, the mean PFD values were −36.25 ± 20.65 HU and −66.87 ± 15.00 HU, respectively. In the non-AHA VI and AHA VI subgroups, the values for the mean HU of the plaque side were −49.50 ± 20.53 and –33.55 ± 19.78, respectively (P = 0.014). The D-value HU was higher for the AHA VI group compared to the non-AHA VI group (33.61 ± 16.72 vs. 15.91 ± 14.52, respectively; P = 0.001). Compared to the non-IPH subgroup, the IPH subgroup had a higher mean HU value for the plaque side (-47.68 ± 18.26 vs. −29.63 ± 19.16, respectively; P < 0.001) and a higher D-value HU (17.80 ± 13.27 vs. 38.03 ± 15.46, respectively; P < 0.001). Compared to the low risk non-TRFC subgroup, the TRFC subgroup had a higher D-value HU (24.51 ± 16.16 vs. 33.55 ± 17.65, respectively; P = 0.042). The D-value of PFD was found to be a significant predictor of both AHA VI classification (AUC: 0.79; SE: 64.41%; SP: 83.33%; P = 0.0001) and IPH (AUC: 0.83; SE: 88.89%; SP: 65.38%; P < 0.0001). ConclusionOur study found that PFD was significantly associated with high risk AHA VI plaque characterization, IPH, and TRFC. Therefore, PFD has the potential to be used as an indirect clinical marker of plaque instability.

The predictive value of internal carotid artery wall thickness in computed tomography angiography to avoid complications of plaque removal failure in modified eversion carotid endarterectomy.

The benefits of computed tomography carotid angiography (CTA) in terms of evaluating the anatomical structure of the carotid arteries, surgical planning, and evaluating possible risks were reported in previous studies. This study aimed to calculate the predictive value of internal carotid wall thickness in CTA that can predict whether a modified carotid eversion endarterectomy (MCEE) will result in a successful or not. This study was designed in a retrospective cross-sectional format. Consecutive 83 symptomatic carotid surgery patients who were operated in our hospital and had CTA were included in this study. The wall thickness of the internal carotid artery (ICA) 20mm distal from the carotid bifurcation was calculated in axial sections using a three-dimensional imaging technique. In addition, all patients' characteristics and laboratory findings were recorded. Patients who failed MCEE and required classical carotid endarterectomy were compared with patients who had successful MCEE. MCEE technique was applied to 62 patients. In 21 patients, the MCEE technique failed and the classical endarterectomy technique was required. Preoperative clinical and laboratory characteristics were similar in both groups. The mean ICA wall thickness was 0.65mm 20mm distal to from the carotid bifurcation and it was lower in the group with successful MCEE (1.03 ± 0.21mm vs. 0.56 ± 0.08mm) (p < 0.001). The critical ICA wall thickness was calculated as 0.76mm in the group that MCEE failed and classical carotid endarterectomy was required. Cut-off analysis of ICA wall thickness was calculated as 0.755mm in ROC analysis (p < 0.001), (95% confidence interval, curve area; 0.985). Successful carotid endarterectomy with the MCEE method is associated with distal ICA wall thickness and distal extension of the atheroma plate. The use of ICA wall thickness 20mm distal to from the bifurcation as a predictive value for the success of the MCEE technique is beneficial to avoid serious complications.

Cardiovascular/Stroke Risk Assessment in Patients with Erectile Dysfunction-A Role of Carotid Wall Arterial Imaging and Plaque Tissue Characterization Using Artificial Intelligence Paradigm: A Narrative Review.

Purpose: The role of erectile dysfunction (ED) has recently shown an association with the risk of stroke and coronary heart disease (CHD) via the atherosclerotic pathway. Cardiovascular disease (CVD)/stroke risk has been widely understood with the help of carotid artery disease (CTAD), a surrogate biomarker for CHD. The proposed study emphasizes artificial intelligence-based frameworks such as machine learning (ML) and deep learning (DL) that can accurately predict the severity of CVD/stroke risk using carotid wall arterial imaging in ED patients. Methods: Using the PRISMA model, 231 of the best studies were selected. The proposed study mainly consists of two components: (i) the pathophysiology of ED and its link with coronary artery disease (COAD) and CHD in the ED framework and (ii) the ultrasonic-image morphological changes in the carotid arterial walls by quantifying the wall parameters and the characterization of the wall tissue by adapting the ML/DL-based methods, both for the prediction of the severity of CVD risk. The proposed study analyzes the hypothesis that ML/DL can lead to an accurate and early diagnosis of the CVD/stroke risk in ED patients. Our finding suggests that the routine ED patient practice can be amended for ML/DL-based CVD/stroke risk assessment using carotid wall arterial imaging leading to fast, reliable, and accurate CVD/stroke risk stratification. Summary: We conclude that ML and DL methods are very powerful tools for the characterization of CVD/stroke in patients with varying ED conditions. We anticipate a rapid growth of these tools for early and better CVD/stroke risk management in ED patients.

Contribution of UltraFast™ Ultrasound and Shear Wave Elastography in the Imaging of Carotid Artery Disease.

Carotid artery disease is one of the main global causes of disability and premature mortality in the spectrum of cardiovascular diseases. One of its main consequences, stroke, is the second biggest global contributor to disability and burden via Disability Adjusted Life Years after ischemic heart disease. In the last decades, B-mode and Doppler-based ultrasound imaging techniques have become an indispensable part of modern medical imaging of carotid artery disease. However, they have limited abilities in carotid artery plaque and wall characterization and are unable to provide simultaneous quantitative and qualitative flow information while the images are burdened by low framerates. UltraFast™ ultrasound is able to overcome these obstacles by providing simultaneous quantitative and qualitative flow analysis information in high frame rates via UltraFast™ Doppler. Another newly developed ultrasound technique, shear wave elastography, is based on the visualization of induced shear waves and the measurement of the shear wave propagation speed in the examined tissues which enables real-time carotid plaque and wall analysis. These newly developed ultrasound modalities have potential to significantly improve workflow efficiency and are able to provide a plethora of additional imaging information of carotid artery disease in comparison to conventional ultrasound techniques.

Ultra-high frequency ultrasound delineated changes in carotid and muscular artery intima-media and adventitia thickness in obese early middle-aged women.

Obesity is linked to increased arterial size, carotid intima-media thickness and arterial stiffness. The effects of obesity and body composition on muscular artery intima-media and adventitia thickness has previously not been established. The aim of this study was to explore associations between carotid and muscular artery wall layer thickness with body composition and cardiovascular risk factors in early middle-aged women. This is a cross-sectional study including 199 women aged 40±4 years. Arterial lumen (LD), intima-media (IMT) and adventitia thickness (AT) were measured from carotid, brachial and radial arteries using ultra-high frequency ultrasound (22-71 MHz). Women with obesity had increased IMT in carotid (0.47 vs 0.45 mm), brachial (0.19 vs 0.17 mm) and radial arteries (0.16 vs 0.15 mm) and increased brachial AT (0.14 vs 0.13 mm). In multiple regression models all arterial LD (β-range 0.02-0.03 mm/kg/m2), IMT (β-range 0.91-3.37 µm/kg/m2), AT (β-range 0.73-1.38 µm/kg/m2) were significantly associated with BMI. The IMT of all arteries were significantly associated with systolic blood pressure (β-range 0.36-0.85 µm/mmHg), attenuating the association between IMT and BMI (β-range 0.18-2.24 µm/kg/m2). Obese early middle-aged women have increased arterial intima media thickness and brachial artery adventitia thickness compared to non-obese counterparts. The association between BMI and intima-media thickness is partly mediated through blood pressure levels.

Utility of computed tomography findings as a predictor of carotid artery invasion by metastatic lymph nodes in head and neck squamous cell carcinoma.

Carotid artery invasion by metastatic lymph nodes in head and neck squamous cell carcinoma (HNSCC) is one of the diagnostic criteria for unresectable tumors. However, to date, the diagnostic criteria for carotid artery invasion have not been well documented. This study investigated the utility of computed tomography (CT) findings as a predictor of carotid artery invasion by metastatic lymph nodes in HNSCC. Twenty-eight patients who had metastatic lymph nodes of HNSCC attached to the carotid artery as seen on CT images before neck dissection from January 2011 to November 2017 were included. Five imaging parameters (angle of contact [AC], length of contact [LC], haziness of the carotid artery wall [HW], size of the lymph node, and involvement of the bifurcation of the carotid artery [IB]) were assessed using CT to predict carotid artery invasion. Furthermore, the utility of the combination of these five parameters was evaluated. There were significant differences in AC, LC, and IB between patients with and without carotid artery invasion. There were significant differences in all combinations of the two image findings between patients with and without carotid artery invasion. In particular, the combinations of LC and HW, and LC and IB could clearly predict carotid artery invasion. AC, LC, and IB were useful predictors of carotid artery invasion of metastatic lymph nodes in HNSCC. This study is the first to report that IB is a useful predictor of carotid artery invasion in HNSCC.

Periodontitis exacerbates endothelial dysfunctions partly via endothelial-mesenchymal transition in streptozotocin-induced diabetes rats.

Periodontal infections are related to the expansion of diabetes cardiovascular problems. However, the pathological process and probable mechanism remain unexplained. This study investigated the impact of periodontitis on streptozotocin (STZ)-induced diabetes rats' carotid artery. We randomized 24 Sprague-Dawley (SD) rats into four groups: control, chronic periodontitis (CP), diabetes mellitus (DM), and DM +CP groups. Fasting blood glucose (FBG) and hemoglobin A1c (HBA1c ) were measured to verify the establishment of the DM model. After euthanasia, the maxillary was collected for further studies like hematoxylin-eosin (HE), Masson staining, and micro-computed tomography (micro-CT) analysis. Immunofluorescence (IF) staining was used to detect endothelial-mesenchymal transition (EndMT)-related markers in carotid artery wall. We further used ELISA and quantitative real-time PCR to investigate the effect of high glucose (HG) and Porphyromonas gingivalis lipopolysaccharide (P.g-LPS) on human umbilical vein endothelial cells (HUVECs). Compared with DM and CP groups, bone resorption and pathological changes of the vascular wall were the most serious in the DM+CP group. The vascular wall of the DM+CP group had a higher level of interleukin (IL)-6 and vascular cell adhesion molecule 1 (VCAM-1). The carotid artery vascular wall of the DM+CP group contained more cells that expressed both mesenchymal and endothelial cell markers, along with elevated transcription factor levels. Furthermore, P.g-LPS and HG upregulated the inflammatory cytokines expression and caused phenotypic changes of HUVECs in vitro. Periodontitis exacerbates endothelial dysfunctions partly via endothelial-mesenchymal transition in STZ-induced diabetes rats.

Recurrent Carotid artery blow out in a head &amp; neck patient

Introduction and importanceCarotid artery blowout syndrome is a rare complication of head and neck cancer treatment. It defines a rupture of the carotid artery wall through vessel wall necrosis. This is typically precipitated by radiotherapy, direct tumour invasion, or a combination of these factors. We describe a rare case of three consecutive carotid artery blowouts in a head and neck cancer patient.Case presentationA 58-year-old man with a history of T3NO hypopharyngeal squamous cell carcinoma (SCC) treated with chemotherapy and radiation presented with a four-month history of progressive dysphagia and right sided neck pain. Flexible nasendoscopy revealed laryngeal oedema and slough. A panendoscopy and biopsy showed no evidence of tumour recurrence. The patient was discharged and represented with worsening dyspnoea. He subsequently experienced a large volume hemorrhage necessitating ligation of his right external carotid artery. He underwent pharyngolaryngectomy indicated due to the extent of laryngeal radiation necrosis. Thereafter he suffered two additional acute carotid bleeds from his right common carotid necessitating ligation in theatre.Clinical discussion and conclusionThis case report illustrates the key issues to be considered in patients with locally advanced hypopharyngeal squamous cell carcinoma and subsequent management of acute carotid blowout syndrome, which without prompt management, can be fatal.

Carotid Doppler Ultrasonography in Patients with Co-existing Type 2 Diabetes Mellitus and Hypertension in Nigeria

Background: The co-existence of diabetes mellitus (DM) and hypertension (HTN) has been rising globally with subclinical atherosclerotic complications. These vascular changes can be detected using carotid ultrasonography.&#x0D; Objectives: To determine and compare the carotid arterial structural wall changes and blood flow velocities of adults with co-existing DM and HTN with age- and sex-matched non-diabetic, non-hypertensive controls.&#x0D; Methods: A cross-sectional comparative study of 300 participants comprising 200 adults with co-existing DM and HTN and 100 age- and sex-matched controls was done. Their carotid arteries were examined bilaterally for plaques, carotid intima media thickness (CIMT) and flow velocities – peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistive index (RI) using 4–12MHz linear array transducer. Visceral obesity and serum lipids were also assessed.&#x0D; Results: The mean age of the subjects was 56.13 ± 6.93 years; they comprised 38% males and 62% females. The subjects’ CIMT was statistically significantly higher (p = 0.001) with a three-fold mean increase (45.5%) compared to the controls (13.7%). Lower flow velocities but higher indices were also observed in the subjects. Strong and significant correlations were observed between EDV and PI (r =-0.663, p =&gt;0.001), EDV and RI (r = -0.661, p =&gt;0.001) and PI and RI (r =0.988, p = &gt;0.001) among the subjects.&#x0D; Conclusion: Significant reduction in flow velocities with increased CIMT may be an early indication of subclinical atherosclerosis. Therefore, carotid ultrasonography should be mandatory in individuals at risk for early detection and possible prevention of atherosclerotic complications.

Low serm Fibroblast Growth Factor-21 levels is not associated with Carotid intima-media thickness in acromegaly patients.

Elevated fibroblast growth factor-21 (FGF-21) levels are related to carotid intima-media thickness (CIMT), a well-established marker of atherosclerosis. Acromegaly has also been linked to increased CIMT. There has been no data considering the association between FGF-21 levels and atherosclerosis in acromegaly patients. This study aimed to evaluate FGF-21 levels and CIMT in acromegalic patients in relation to atherosclerotic complications. Case-control study. The study group included 70 acromegaly patients and 72 healthy volunteers from the Department of Endocrinology and Metabolism Disease, Marmara University Medical School. FGF-21, growth hormone, insulin-like growth factor I, lipids, glucose, insulin levels were assessed. CIMT was measured from the common carotid artery wall on B-mode ultrasound. Median FGF-21 levels were significantly lower in the acromegaly group than in the control group. CIMT was higher in acromegaly patients compared to controls. Although there was no correlation between FGF-21 levels and CIMT in patients with acromegaly, a positive correlation was found between high-density lipoprotein-cholesterol and FGF-21 levels. Glucose metabolic markers were the determining factors of the FGF-21 levels in acromegaly patients. Our study is the first to examine the relationship between serum FGF-21 levels and atherosclerosis in acromegaly patients. The lower serum FGF-21 levels in acromegaly subjects might be associated with the improving effects of growth hormone on liver fat. Acromegaly was linked to higher CIMT, but there was no correlation between FGF-21 levels and CIMT. The role of FGF-21 in acromegaly as a marker of atherosclerosis requires additional research.

Sodium thiosulfate acts as a hydrogen sulfide mimetic to prevent intimal hyperplasia via inhibition of tubulin polymerisation.

SummaryBackgroundIntimal hyperplasia (IH) remains a major limitation in the long-term success of any type of revascularisation. IH is due to vascular smooth muscle cell (VSMC) dedifferentiation, proliferation and migration. The gasotransmitter Hydrogen Sulfide (H2S), mainly produced in blood vessels by the enzyme cystathionine- γ-lyase (CSE), inhibits IH in pre-clinical models. However, there is currently no H2S donor available to treat patients. Here we used sodium thiosulfate (STS), a clinically-approved source of sulfur, to limit IH.MethodsLow density lipoprotein receptor deleted (LDLR−/−), WT or Cse-deleted (Cse−/−) male mice randomly treated with 4 g/L STS in the water bottle were submitted to focal carotid artery stenosis to induce IH. Human vein segments were maintained in culture for 7 days to induce IH. Further in vitro studies were conducted in primary human vascular smooth muscle cells (VSMCs).FindingsSTS inhibited IH in WT mice, as well as in LDLR−/− and Cse−/− mice, and in human vein segments. STS inhibited cell proliferation in the carotid artery wall and in human vein segments. STS increased polysulfides in vivo and protein persulfidation in vitro, which correlated with microtubule depolymerisation, cell cycle arrest and reduced VSMC migration and proliferation.InterpretationSTS, a drug used for the treatment of cyanide poisoning and calciphylaxis, protects against IH in a mouse model of arterial restenosis and in human vein segments. STS acts as an H2S donor to limit VSMC migration and proliferation via microtubule depolymerisation.FundingThis work was supported by the Swiss National Science Foundation (grant FN-310030_176158 to FA and SD and PZ00P3-185927 to AL); the Novartis Foundation to FA; and the Union des Sociétés Suisses des Maladies Vasculaires to SD, and the Fondation pour la recherche en chirurgie vasculaire et thoracique.