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Stenosis carotid

Yamaan S Saadeh, Luis E Savastano, Julian L Gendreau, Aditya S Pandey
Optimal management of patients with stroke due to symptomatic carotid artery disease coexistent with bacterial endocarditis is still not well established. We report the case of a patient who presented with multifocal left middle cerebral artery stroke in the setting of Enterococcus faecalis endocarditis and was found to have near-occlusive ipsilateral carotid artery stenosis in stroke workup. Carotid artery endarterectomy was performed, and atheroma material demonstrated complicated plaque with cultures positive for E...
March 15, 2018: BMJ Case Reports
Chuanjie Wu, Chuanhui Li, Wenbo Zhao, Nanchang Xie, Feng Yan, Yajun Lian, Li Zhou, Xiaoya Xu, Yong Liang, Lu Wang, Ming Ren, Sijie Li, Xuan Cheng, Lu Zhang, Qingfeng Ma, Haiqing Song, Ran Meng, Xunming Ji
OBJECTIVES: To investigate whether the plasma level of trimethylamine N -oxide (TMAO), a proatherosclerotic intestinal microbiota metabolite, can be a predictor of ischemic brain injury secondary to carotid artery stenting (CAS). METHODS: In this multicenter, prospective cohort study, we enrolled patients with severe carotid artery stenosis (>70%) who were prepared for CAS. Plasma TMAO level was measured within 3 days before CAS, and MRI was performed 1 to 3 days after CAS...
March 14, 2018: Neurology
Giulio Illuminati, Giulia Pizzardi, Rocco Pasqua, Francesca Frezzotti, Piergaspare Palumbo, Francesco Macrina, Francesco Calio
BACKGROUND: Tandem stenoses of the internal carotid artery (ICA) and proximal, ipsilateral common carotid artery (CCA) or innominate artery can be treated with a hybrid approach, combining conventional carotid endarterectomy (CEA) and retrograde stenting of the proximal stenosis, through surgical exposure of the carotid bifurcation. The purpose of this study was to evaluate the results of combining eversion CEA with retrograde CCA/innominate artery stenting. MATERIAL AND METHODS: From January 2015 to July 2017, 7 patients, 6 men of a mean age of 72 years (range 59-83 years) underwent simultaneous, retrograde stenting of the proximal CCA/innominate artery and an eversion CEA of the ipsilateral ICA, through surgical exposure of the carotid bifurcation, for severe tandem stenoses...
March 10, 2018: International Journal of Surgery
Nupoor Narula, Daniella Kadian-Dodov, Jeffrey W Olin
Fibromuscular dyplasia (FMD) is an under-recognized non-atherosclerotic, non-inflammatory arteriopathy that occurs most commonly in middle-aged women, but may affect individuals of all age groups. FMD may result in stenosis, aneurysm, dissection, occlusion, or arterial tortuosity. Recently published data demonstrated a genetic association of FMD with a variant in the phosphatase and actin regulator 1 gene (PHACTR1), substantiating that the pathogenesis of this condition has genetic contribution. The renal and extracranial carotid and vertebral arteries are most often involved, although any arterial bed may be affected...
March 10, 2018: Progress in Cardiovascular Diseases
Zhu Zhang, Jun-Wei Gong, Ming Wen, Li-Qiang Zhang
Objective To assess the value of internal carotid artery stenosis in differentiating invasive pituitary adenoma (IPA) from invasive meningiomas (IM). Methods The clinical and imaging data of 28 IPA patients and 15 IM patients who were treated in our center from January 2012 to December 2016 were retrospectively analyzed. The magnetic resonance imaging (MRI) features were analyzed. The narrowest diameter (Dstenosis ) and area (Astenosis ) of internal carotid artery around the tumor were measured by computed tomography angiography (CTA),followed by the calculation of the stenosis score (%stenosis )...
February 28, 2018: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Dong Zhang, Pengcheng Xu, Hongyu Qiao, Xin Liu, Liangping Luo, Wenhua Huang, Heye Zhang, Changzheng Shi
BACKGROUND: Cerebrovascular events are frequently associated with hemodynamic disturbance caused by internal carotid artery (ICA) stenosis. It is challenging to determine the ischemia-related carotid stenosis during the intervention only using digital subtracted angiography (DSA). Inspired by the performance of well-established FFRct technique in hemodynamic assessment of significant coronary stenosis, we introduced a pressure-based carotid arterial functional assessment (CAFA) index generated from computational fluid dynamic (CFD) simulation in DSA data, and investigated its feasibility in the assessment of hemodynamic disturbance preliminarily using pressure-wired measurement and arterial spin labeling (ASL) MRI as references...
March 12, 2018: Biomedical Engineering Online
Yoko Kaneko, Takamoto Yanagawa, Yoshinori Taru, Sonoko Hayashi, Hong Zhang, Tomoki Tsukahara, Tsuneaki Matsunaga, Takashi Ishizu
INTRODUCTION: We describe a hemodialysis patient who developed subclavian steal syndrome via an arteriovenous fistula after percutaneous transluminal angioplasty. CASE DESCRIPTION: A 55-year-old female with end-stage renal failure due to polycystic kidney disease had been treated with hemodialysis for 10 years. Because of an autologous arteriovenous fistula stenosis, percutaneous transluminal angioplasty was performed. After successful treatment with percutaneous transluminal angioplasty, the patient developed dizziness...
March 1, 2018: Journal of Vascular Access
Kazumasa Tsuda, Norihiko Shiiya, Naoki Washiyama, Katsushi Yamashita, Kazuhiro Ohkura, Daisuke Takahashi, Yumi Kando, Kayoko Natsume, Ken Yamanaka, Yuki Takeuchi
OBJECTIVES: To prevent haemodynamic stroke during cardiovascular surgery in patients with carotid stenosis, we routinely evaluated magnetic resonance angiography and selectively evaluated brain perfusion single-photon emission computed tomography with acetazolamide challenge. Off-pump surgery was preferred when cerebral blood flow reserve was impaired. This strategy's usefulness was investigated. METHODS: Among the 1059 consecutive patients who underwent preoperative carotid screening by magnetic resonance angiography, 84 (7...
February 26, 2018: Interactive Cardiovascular and Thoracic Surgery
Arkadiusz Szarmach, Mariusz Kaszubowski, Agnieszka Sabisz, Andrzej F Frydrychowski, Grzegorz Halena, Maciej Piskunowicz, Jarosław Dzierzanowski, Michał Studniarek, Edyta Szurowska, Pawel J Winklewski
The aim of this study was to assess regional perfusion at baseline and regional cerebrovascular resistance (CVR) to delayed acetazolamide challenge in subjects with chronic carotid artery stenosis. Sixteen patients (ten males) aged 70.94±7.71 with carotid artery stenosis ≥ 90% on the ipsilateral side and ≤ 50% on the contralateral side were enrolled into the study. In all patients, two computed tomography perfusion examinations were carried out; the first was performed before acetazolamide administration and the second 60 minutes after injection...
March 12, 2018: Acta Biochimica Polonica
Koji Tanaka, Toshiyuki Uehara, Kazumi Kimura, Yasushi Okada, Yasuhiro Hasegawa, Norio Tanahashi, Akifumi Suzuki, Jyoji Nakagawara, Kazumasa Arii, Shinji Nagahiro, Kuniaki Ogasawara, Shinichiro Uchiyama, Masayasu Matsumoto, Koji Iihara, Kazunori Toyoda, Kazuo Minematsu
BACKGROUND: A transient visual symptom (TVS) is a clinical manifestation of transient ischemic attack (TIA). The aim of this study was to investigate differences in clinical characteristics among subtypes of TVS using multicenter TIA registry data. MATERIALS AND METHODS: Patients with TIA visiting within 7 days of onset were prospectively enrolled from 57 hospitals between June 2011 and December 2013. Clinical characteristics were compared between patients with 3 major subtypes of TVS (transient monocular blindness [TMB], homonymous lateral hemianopia [HLH], and diplopia)...
March 8, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Cecilia Becattini, Francesco Dentali, Giuseppe Camporese, Agnese Sembolini, Elena Rancan, Chiara Tonello, Giorgia Manina, Seena Padayattil, Giancarlo Agnelli
BACKGROUND AND AIMS: Whether carotid atherosclerosis is associated with an increased risk for ischemic stroke in patients with atrial fibrillation (AF) on anticoagulant treatment is undefined. To explore this association, patients with AF on treatment with vitamin K antagonists were included in a multicenter, prospective study. METHODS: At inclusion in the study, patients underwent Doppler-ultrasonography for the assessment of carotid atherosclerosis and then were prospectively followed...
March 2, 2018: Atherosclerosis
Kouichi Misaki, Naoyuki Uchiyama, Anri Inaki, Seigo Kinuya, Iku Nambu, Tomoya Kamide, Masanao Mohri, Yasuhiko Hayashi, Mitsutoshi Nakada
BACKGROUND AND PURPOSE: Hemodynamic impairments are considered risk factors of cerebral hyperperfusion after carotid artery stenting (CAS); measurement by SPECT using a subjective ROI method lacks consistency and reproducibility. MATERIALS AND METHODS: The present study compared objective perfusion analysis (stereotactic extraction estimation [SEE] method) with the ROI method for preoperative SPECT to predict the hyperperfusion phenomenon (HPP) after CAS. Preoperative resting asymmetry index (CBF ratio from the affected to unaffected hemisphere) and cerebrovascular reactivity (CVR) to acetazolamide were measured by N-isopropyl-p-[123 I]-iodoamphetamine SPECT using the SEE and ROI method in 84 patients...
March 7, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Panagiota Birmpili, Laura Porter, Usman Shaikh, Francesco Torella
OBJECTIVES: To test the accuracy and reproducibility of CT Angiography (CTA) and compare the measurements derived from this method with those obtained by Doppler Ultrasound (DUS). METHODS: Images of 100 carotid arteries of patients who underwent carotid DUS at our unit and CTA of the carotids within a 28-day period were identified retrospectively from multidisciplinary team meeting records. CTAs were assessed by 2 investigators, each using a manual and a semi-automated method...
March 6, 2018: Annals of Vascular Surgery
Nianfang Lu, Li Jiang, Bo Zhu, Wenyong Han, Yingqi Zhao, Yuntao Shi, Fashuang Guo, Xiuming Xi
OBJECTIVE: To explore the accuracy of fluid responsiveness assessment by variability of peripheral arterial peak velocity and variability of inferior vena cava diameter (ΔIVC) in patients with septic shock. METHODS: A prospective study was conducted. The patients with septic shock undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Beijing Electric Power Hospital from January 2016 to December 2017 were enrolled. According to sepsis bundles of septic shock, volume expansion (VE) was conducted...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
H Y Zhao, Z C Jia, D S Fan
Objective: To analyze the incidence of intracranial unruptured aneurysms in patients with internal carotid artery (ICA) stenosis (≥30%), the characteristics of aneurysms and risk factors in patients with ICA stenosis and intracranial aneurysm. Methods: Clinical data of patients receiving digital subtraction angiography (DSA) at Peking University Third Hospital between January 2012 and June 2015 were retrospectively reviewed to identify patients with ICA stenosis and unruptured intracranial aneurysm. Results: Among 247 patients with ICA stenosis, 16 patients (6...
March 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Tomohiro Tsunekawa, Motoshi Sawada, Takayoshi Kato, Yusuke Motoji, Tatsuomi Kinoshita, Akihiro Hirakawa, Yasuhide Okawa, Shinji TomitaMD
OBJECTIVES: Intracranial cerebral atherosclerosis is a significant predictor of stroke after coronary artery bypass grafting (CABG). However, there is limited information on intracranial occlusive lesions in patients undergoing CABG. The purpose of the study was to elucidate the precise prevalence and distribution of occlusive lesions of the extracranial and intracranial arteries in patients undergoing CABG. METHODS: Between 2009 and 2016, 205 patients underwent preoperative magnetic resonance angiography (MRA) and elective CABG...
March 5, 2018: Seminars in Thoracic and Cardiovascular Surgery
K C Fok, Y C Chan, Y Law, S W Cheng
Infected carotid patch are rare. We present a gentleman who had an elective carotid endarterectomy with Dacron patch closure for symptomatic carotid stenosis under regional anaesthesia, and presented one month later with a discharging sinus at the lower aspect of the neck wound. CT scan showed a rim enhancing collection next to the carotid bifurcation. He subsequently underwent patch excision and repair with autologous saphenous vein graft, with good recovery. Of significance was that he had dental extraction for a loose tooth one day before the index operation as advised by the anesthestist...
March 5, 2018: Annals of Vascular Surgery
R Espert, M Gadea, M Alino, J Oltra-Cucarella, C Perpina
INTRODUCTION: Moyamoya disease (MMD) is an occlusive cerebrovascular disease characterized by progressive stenosis or occlusion in the terminal portion of the bilateral internal carotid arteries, affecting both children and adults. AIM: To conduct a review and update on MMD from a clinical, neuroradiological, neuropsychological and genetic perspective. DEVELOPMENT: In this pathology, which occurs with ischemia or cerebral hemorrhage, an unusual compensatory vascular network (moyamoya vessels) develops at the base of the brain in the form of collateral channels...
March 1, 2018: Revista de Neurologia
Takakuni Maki, Anna Morancho, Pablo Martinez-San Segundo, Kazuhide Hayakawa, Hajime Takase, Anna C Liang, Marina Gabriel-Salazar, Esperanza Medina-Gutiérrez, Kazuo Washida, Joan Montaner, Josephine Lok, Eng H Lo, Ken Arai, Anna Rosell
BACKGROUND AND PURPOSE: Endothelial progenitor cells (EPCs) have been extensively investigated as a therapeutic approach for repairing the vascular system in cerebrovascular diseases. Beyond vascular regeneration per se, EPCs may also release factors that affect the entire neurovascular unit. Here, we aim to study the effects of the EPC secretome on oligovascular remodeling in a mouse model of white matter injury after prolonged cerebral hypoperfusion. METHODS: The secretome of mouse EPCs was analyzed with a proteome array...
March 6, 2018: Stroke; a Journal of Cerebral Circulation
Aleksander Falkowski, Iwona Gorący, Mariusz Kaczmarczyk, Marcin Szemitko, Hubert Bogacki, Julia Kostka
BACKGROUND: To compare the results of computer estimation of atherosclerotic plaque with biochemical data and ascertain any relationship with the occurrence of stroke. METHODS: The study involved 20 atherosclerotic plaques causing 70-99% stenosis of internal carotid arteries (ICA). Ultrasonographic examination (USG) images of plaques were analyzed using a computer program. A histogram was obtained for each plaque and a gray scale median (GSM) was determined for each histogram in order to measure the echogenicity of an examined plaque...
March 6, 2018: International Angiology: a Journal of the International Union of Angiology
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