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Bilateral common carotid artery stenosis

Daniele Bissacco, Maurizio Domanin, Giuseppina Schinco, Livio Gabrielli
Anatomical variations of carotid arteries may be related to their development (agenesis, aplasia, hypoplasia) or course (coiling, kinking, tortuosity). Partial or total aberrancies in carotid vessel anatomy rarely occur. We describe the case of a 95-year-old woman presented with sudden onset of confusion and disorientation together with upper limb clonus. Computed tomography (CT)-scan revealed a left frontal brain injury with a not conclusive carotid doppler ultrasound. CT angiography reported a bovine aortic arch with bilateral retroesophageal course of both common carotid arteries and left severe (>70%) internal carotid artery stenosis...
September 2016: Vascular Specialist International
Xiaodan Wei, Zhuang Liu, Min Li, Chunhua Yang, Wenming Wang, Xianglin Li, Shuping Zhang, Xuri Li, Geng Tian, Jonas Bergquist, Bin Wang, Jia Mi
BACKGROUND: The severity of ischemic stroke symptoms varies among patients and is a critical determinant of patient outcome. To date, the association between the number of stenotic intracranial arteries and stroke severity remains unclear. AIMS: We aimed to investigate the association between the number of stenotic major intracranial arteries (NSMIA) and ischemic stroke severity, as well as the degree of stenosis and common stroke risk factors. METHODS: We performed a retrospective analysis of patients with digital subtraction angiography (DSA)-confirmed ischemic stroke...
2016: PloS One
Jürgen Bohlender, Jürg Nussberger, Beate Bohlender
OBJECTIVE: In elderly hypertensive patients, systolic blood pressure (sBP) goals recommended by US and European guidelines (ESH) for the initiation of treatment are more liberal than in younger patients because of an increased risk of treatment-associated side-effects and hypotension. Carotid stenosis increases with age and poses a risk of brain ischemia if hypotension occurs. Its relevance for the routine care of elderly hypertensives, however, remains unclear. We analyzed data on precerebral artery morphology and BP evolution from a survey of aged hospitalized patients...
September 2016: Journal of Hypertension
Yorito Hattori, Jun-Ichiro Enmi, Satoshi Iguchi, Satoshi Saito, Yumi Yamamoto, Kazuyuki Nagatsuka, Hidehiro Iida, Masafumi Ihara
The bilateral common carotid artery stenosis (BCAS) mouse model, which replicates chronic cerebral hypoperfusion and white matter ischemic lesions, is considered to model some aspects of vascular cognitive impairment. Cerebral blood flow (CBF) changes in the brain surface post-BCAS have been demonstrated by laser speckle flowmetry, but CBF levels in the brain parenchyma remain unknown. Adult C57BL/6J male mice were subjected to BCAS using external microcoils. Brain magnetic resonance angiography (MRA) was conducted to visualize the intracranial main arteries while arterial spin labeling (ASL) was used to measure cortical and subcortical parenchymal CBF levels before and after BCAS...
2016: Scientific Reports
Hui Shi, Kuang Zheng, Zulu Su, Hai Su, Ming Zhong, Xuenong He, Changlong Zhou, Hao Chen, Qijiang Xiong, Yi Zhang
Microglia activation played a vital role in the pathogenesis of white matter lesions (WMLs) by chronic cerebral hypoperfusion. In addition, hypoxia induced up-regulated expression of MCP-1, promotes the activation of microglia. However, the role of MCP-1 mediated microglia activation in chronic cerebral ischemia is still unknown. To explore that, chronic cerebral hypoperfusion model was established by permanent stenosis of bilateral common carotid artery in mice. The activation of microglia and the related signal pathway p38MAPK/PKC in white matter, and working memory of mice were observed...
August 12, 2016: Molecular and Cellular Neurosciences
Yi Yang, Shihoko Kimura-Ohba, Jeffrey Thompson, Gary A Rosenberg
Vascular cognitive impairment dementia (VCID), which is an increasingly important cause of dementia in the elderly, lacks effective treatments. Many different types of vascular disease are included under the diagnosis of VCID, including large vessel disease with multiple strokes and small vessel disease with lacunar infarcts and white matter disease. Animal models have been developed to study the multiple forms of VCID. Because of its progressive course, small vessel disease (SVD) is thought to be the optimal form of VCID for treatment...
October 2016: Translational Stroke Research
Raman Saggu, Toni Schumacher, Florian Gerich, Cordula Rakers, Khalid Tai, Andrea Delekate, Gabor C Petzold
Vascular cognitive impairment is the second most common form of dementia. The pathogenic pathways leading to vascular cognitive impairment remain unclear but clinical and experimental data have shown that chronic reactive astrogliosis occurs within white matter lesions, indicating that a sustained pro-inflammatory environment affecting the white matter may contribute towards disease progression. To model vascular cognitive impairment, we induced prolonged mild cerebral hypoperfusion in mice by bilateral common carotid artery stenosis...
2016: Acta Neuropathologica Communications
Muhammad Shah Miran, M Fareed K Suri, Mushtaq H Qureshi, Aamir Ahmad, Mariam K Suri, Rabia Basreen, Adnan I Qureshi
BACKGROUND: Syncope is commonly worked up for carotid stenosis, but only rarely attributed to it. Considering paucity of such cases in literature, we report a case and discuss the pathophysiology. DESIGN/METHODS: We report a patient with high-grade bilateral severe internal carotid artery (ICA) stenosis who presented with syncopal episodes in the absence of stroke, orthostatic hypotension, significant cardiovascular disease, or vasovagal etiology. We reviewed all literature pertaining to syncope secondary to carotid stenosis and other cerebrovascular disease...
June 2016: Journal of Vascular and Interventional Neurology
Sung Min Ahn, Yu Ri Kim, Ha Neui Kim, Yong-Il Shin, Hwa Kyoung Shin, Byung Tae Choi
We modeled prolonged cerebral hypoperfusion in mice using bilateral common carotid artery stenosis (BCAS) and electroacupuncture (EA) stimulation was applied at two acupoints, Baihui (GV20) and Dazhui (GV14). In behavioral tests of memory, BCAS produced impairments in spatial and short-term memory in mice that were attenuated by therapeutic EA stimulation. Therapeutic use of EA in BCAS also enhanced oligodendrocyte (OL) differentiation from oligodendrocyte precursor cells (OPCs), in association with white matter improvements in the corpus callosum (CC)...
2016: Scientific Reports
Sibu Mundiyanapurath, Peter Arthur Ringleb, Sascha Diatschuk, Mikkel Bo Hansen, Kim Mouridsen, Leif Østergaard, Wolfgang Wick, Martin Bendszus, Alexander Radbruch
BACKGROUND AND PURPOSE: Perfusion weighted imaging (PWI) is inherently unreliable in patients with severe perfusion abnormalities. We compared the diagnostic accuracy of a novel index of microvascular flow-patterns, so-called capillary transit time heterogeneity (CTH) to that of the commonly used delay parameter Tmax in patients with bilateral high grade internal carotid artery stenosis (ICAS). METHODS: Consecutive patients with bilateral ICAS ≥ 70%NASCET who underwent PWI were retrospectively examined...
2016: PloS One
Yun Zhai, Toru Yamashita, Yumiko Nakano, Zhuoran Sun, Jingwei Shang, Tian Feng, Ryuta Morihara, Yusuke Fukui, Yasuyuki Ohta, Nozomi Hishikawa, Koji Abe
Recently, aging societies have been showing an increasingly strong relationship between Alzheimer's disease (AD) and chronic cerebral hypoperfusion (HP). In the present study, we created a new mouse model for AD with HP, and investigated its clinical and pathological characteristics. Alzheimer's disease transgenic mice (APP23) were subjected to bilateral common carotid arteries stenosis with ameroid constrictors for slowly progressive cerebral HP. In contrast to simple APP23 mice, cerebral HP exacerbated motor and cognitive dysfunctions with white matter lesions and meningo-parenchymal amyloid-β (Aβ) burdens...
June 13, 2016: Journal of Alzheimer's Disease: JAD
W Darrin Clouse, Emel A Ergul, Richard P Cambria, David C Brewster, Christopher J Kwolek, Glenn M LaMuraglia, Virendra I Patel, Mark F Conrad
OBJECTIVE: Concomitant carotid bifurcation and proximal ipsilateral arch branch disease is uncommon. A combined approach using carotid endarterectomy (CEA) with ipsilateral proximal endovascular (IPE) intervention (CEA+IPE) has been proposed as safe and durable, with similar results to isolated CEA. This study was conducted to identify diagnostic modalities and outcomes of this uncommon procedure at our institution. METHODS: Operative records were used to identify patients who underwent CEA+IPE between May 2003 and July 2014...
June 2016: Journal of Vascular Surgery
Yun Zhai, Toru Yamashita, Yumiko Nakano, Zhuoran Sun, Ryuta Morihara, Yusuke Fukui, Yasuyuki Ohta, Nozomi Hishikawa, Koji Abe
A rapidly progressing aging society has raised attention to white matter lesions in Alzheimer's disease. In the present study, we applied an AD plus cerebral hypoperfusion (HP) mouse model and investigated the alternation of key protein molecules in the nodal, paranodal, and intermodal sites in the white matter as well as the efficacy of galantamine. Cerebral HP was induced in APP23 mice by bilateral common carotid arteries stenosis with ameroid constrictors. Compared with the wild type and simple APP23 mice, APP23 + HP mice showed a progressive loss of MAG and NF186 from 6 to 12 months, broken misdistribution of MBP, and extended relocation of Nav1...
April 12, 2016: Journal of Alzheimer's Disease: JAD
Jingwei Shang, Toru Yamashita, Yun Zhai, Yumiko Nakano, Ryuta Morihara, Yusuke Fukui, Nozomi Hishikawa, Yasuyuki Ohta, Koji Abe
Although chronic cerebral hypoperfusion (CCH) may affect Alzheimer's disease (AD) pathogenesis, the mechanism remains elusive. In the present study, we investigated the role of CCH on an AD mouse model in neurovascular unit, cerebrovascular remodeling, and neurovascular trophic coupling. Moreover, examined protective effect of galantamine. Alzheimer's disease transgenic mice (APP23) were subjected to bilateral common carotid arteries stenosis with ameroid constrictors for slowly progressive cerebral hypoperfusion...
March 5, 2016: Journal of Alzheimer's Disease: JAD
Jennifer Gooch, Donna M Wilcock
Vascular cognitive impairment and dementia (VCID) is the most common etiology of dementia in the elderly. Both, vascular and Alzheimer's disease, pathologies work synergistically to create neurodegeneration and cognitive impairments. The main causes of VCID include hemorrhage/microbleed (i.e., hyperhomocysteinemia), cerebral small vessel disease, multi-infarct dementia, severe hypoperfusion (i.e., bilateral common carotid artery stenosis), strategic infarct, angiopathy (i.e., cerebral angiopathy), and hereditary vasculopathy (i...
March 2016: Cellular and Molecular Neurobiology
Hui Fang, Bo Song, Bo Cheng, Ka Sing Wong, Yu Ming Xu, Stella Sin Yee Ho, Xiang Yan Chen
BACKGROUND: Collateral pathways are important in maintaining adequate cerebral blood flow in patients with carotid stenosis. We aimed to evaluate the hemodynamic patterns in relation to carotid stenosis in acute stroke patients. METHODS: Consecutive 586 stroke patients in a hospital based cohort were included in the present study. Carotid duplex was performed to identify patients with absolute minimal diameter reductions of 50% or greater in their internal carotid arteries (ICAs)...
2016: BMC Neurology
Claudia Aramendi, Alain Cubero, Andrés Cortés, Daniel Rivas, Alejandro Crespo, José I Aramendi
A 54-year-old man presented with unstable angina and stroke with right hemiplegia and aphasia due to left main coronary plus 3-vessel disease, severe stenosis of bilateral internal carotid, proximal left common carotid, and proximal left subclavian arteries. Simultaneous complete revascularization was undertaken with the use of conventional cardiopulmonary bypass and moderate hypothermia (25℃). The left internal mammary artery and two saphenous vein grafts were used for coronary artery bypass, and brain revascularization consisted of a left aorta-to-common carotid Dacron graft and bilateral carotid endarterectomy...
September 2016: Asian Cardiovascular & Thoracic Annals
Nusrat Matin, Courtney Fisher, William F Jackson, Anne M Dorrance
Chronic cerebral hypoperfusion is a risk factor for cognitive impairment. Reduced blood flow through the common carotid arteries induced by bilateral carotid artery stenosis (BCAS) is a physiologically relevant model of chronic cerebral hypoperfusion. We hypothesized that BCAS in 20-wk-old Wistar-Kyoto (WKY) rats would impair cognitive function and lead to reduced endothelium-dependent dilation and outward remodeling in the parenchymal arterioles (PAs). After 8 wk of BCAS, both short-term memory and spatial discrimination abilities were impaired...
May 15, 2016: American Journal of Physiology. Heart and Circulatory Physiology
Anil Nanda, Subhas K Konar, Tanmoy K Maiti, Shyamal C Bir, Bharat Guthikonda
OBJECTIVE: Meningiomas of the clinoidal region pose significant surgical challenges due to their close proximity and intimate relation with surrounding critical neurovascular structures. Our aim was to describe our institution's experience with the management of clinoidal meningiomas, identify predictive factors and develop a comprehensive grading system to assess the extent of resection. METHODS: The medical records of 36 consecutive patients underwent surgery from 1995 to 2015 with clinoidal meningiomas were retrospectively reviewed...
March 2016: Clinical Neurology and Neurosurgery
Lingling Fang, Jia Huang, Qian Zhang, Raymond C K Chan, Rong Wang, Weiqing Wan
OBJECTIVE Dysexecutive syndrome is common in patients with moyamoya disease (MMD), a chronic cerebrovascular disease that is characterized by stenosis of the bilateral internal carotid arteries and progressive collateral revascularization, and MMD can be classified as ischemic or hemorrhagic according to the disease presentation and history. In this study, the authors aimed to determine which aspects of executive function are impaired in patients with MMD, in addition to the specific dysexecutive functions present among its clinical subtypes and the mechanisms underlying dysexecutive function in these patients...
August 2016: Journal of Neurosurgery
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