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Carotid stenosis and Intravascular Ultrasound

Yumei Liu, Yang Hua, Wuwei Feng, Bruce Ovbiagele
Stroke is a leading cause of disability and mortality worldwide. Ultrasound is a real-time imaging technique that is inexpensive, portable, non-invasive, and safe, with high diagnostic accuracy. Ultrasonic imaging can provide useful direct and indirect information about the characteristics of various vessels in the both intracranial and extracranial segments. Areas covered: In this review, we will discuss multimodal applications of ultrasonic imaging in stroke prevention and management including checking carotid intima-media thickness progression, evaluating the plaque morphology, calibrating the degree of stenosis, detecting the presence of patent foramen ovale, monitoring microembolization, and screening for stroke risk in patients with sickle cell disease...
December 2016: Expert Review of Cardiovascular Therapy
Chris L de Korte, Stein Fekkes, Aart J Nederveen, Rashindra Manniesing, Hendrik Rik H G Hansen
Cardiovascular disease (CVD) is a leading cause of death and is in the majority of cases due to the formation of atherosclerotic plaques in arteries. Initially, thickening of the inner layer of the arterial wall occurs. Continuation of this process leads to plaque formation. The risk of a plaque to rupture and thus to induce an ischemic event is directly related to its composition. Consequently, characterization of the plaque composition and its proneness to rupture are of crucial importance for risk assessment and treatment strategies...
October 2016: IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control
Cyril Štěchovský, Petr Hájek, Martin Horváth, Miloslav Špaček, Josef Veselka
No abstract text is available yet for this article.
March 15, 2016: International Journal of Cardiology
Elizabeth Hitchner, Wei Zhou
For patients at high risk for surgery, carotid artery stenting (CAS) is a viable alternative to help reduce risk of stroke for patients with high-grade carotid artery stenosis; however, a higher incidence of perioperative stroke has been observed in patients undergoing stenting compared to those undergoing open surgery. Intravascular ultrasound (IVUS) is commonly used during coronary artery procedures to help evaluate lesions and to guide stent placement. Multiple groups have sought to determine whether IVUS could also be used during CAS...
September 2015: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Cyril Štěchovský, Petr Hájek, Martin Horváth, Miloslav Špaček, Josef Veselka
Limited insights into the pathophysiology of the atherosclerotic carotid stenosis are available in vivo. We conducted a prospective study to assess safety and feasibility of intravascular ultrasound (IVUS) combined with near-infrared spectroscopy (NIRS) in carotid arteries. In addition, we described the size and the distribution of lipid rich plaques in significant atherosclerotic carotid stenoses. In a prospective single centre study 45 consecutive patients (mean age 66 ± 8 years) with symptomatic (≥50 %) or asymptomatic (≥70 %) stenosis of internal carotid artery (ICA) amendable to carotid stenting were enrolled...
January 2016: International Journal of Cardiovascular Imaging
Yuki Shinohara, Makoto Sakamoto, Keita Kuya, Junichi Kishimoto, Naoki Iwata, Yasutoshi Ohta, Shinya Fujii, Takashi Watanabe, Toshihide Ogawa
INTRODUCTION: The present study compares the applicability of CT carotid plaque imaging using effective Z maps using gemstone spectral imaging (GSI) with that of conventional extracorporeal carotid ultrasound (US) and virtual histology-intravascular ultrasound (VH-IVUS). METHODS: We assessed stenosis in 31 carotid arteries of 30 patients. All patients underwent carotid CTA using GSI (Discovery CT750 HD, GE Healthcare). US and IVUS were examined with 25 and 8 vessels, respectively...
September 2015: Neuroradiology
Woong Choi, Yu Na Kim, Kyung-Hee Kim
INTRODUCTION: Moyamoya disease is characterized by progressive steno-occlusive changes of the distal internal carotid and developed collateral vasculature, so called 'moyamoya' vessels at the base of the brain. Variant angina is a rare occurrence in patients with moyamoya disease. CASE PRESENTATION: Here we report the case of a 41-year-old Korean woman who developed chest pain after indirect revascularization surgery of moyamoya disease. A treadmill test and an exercise stress echocardiograph showed positive results, but there was no significant major coronary arteries stenosis...
2015: Journal of Medical Case Reports
Mathias Kaspar, Sasan Partovi, Markus Aschwanden, Stephan Imfeld, Thomas Baldi, Heiko Uthoff, Daniel Staub
Contrast-enhanced ultrasound (CEUS) has emerged as a valuable imaging modality that complements and enhances standard vascular ultrasound imaging. Ultrasound contrast agents are gas-filled microbubbles that are injected intravenously and serve as intravascular tracers. Based on the properties to enhance and to quantify the macro- and microcirculation down to the capillary perfusion level in different vascular territories and organs, CEUS imaging has the potential to improve the diagnostic performance in the detection and characterisation of various vascular disorders reviewed in this article...
2015: Swiss Medical Weekly
Angelika Alonso, Dimitrios Artemis, Michael G Hennerici
BACKGROUND: Carotid endarterectomy (CEA) has been shown to be beneficial in patients with high-grade symptomatic carotid artery stenosis. Patients with high-grade asymptomatic stenosis may only exceptionally benefit from CEA during periods of increased plaque vulnerability. Imaging modalities to characterize unstable, vulnerable plaques are strongly needed for better risk stratification in these patients. SUMMARY: Contrast-enhanced ultrasound (CEUS) is a novel and noninvasive technique capable to identify several surrogate markers of vulnerable carotid plaques...
2015: Cerebrovascular Diseases
Norihiko Shinozaki, Nobuhiko Ogata, Yuji Ikari
BACKGROUND: Stroke is a major complication of carotid artery stenting (CAS) that can occur during the procedure and for up to 30 days after the procedure in the late phase. Although the cause of late stroke after CAS is unknown, plaque protrusion may be one of the potential causes. This study aims to assess the rate of plaque protrusion during CAS by intravascular ultrasound (IVUS). METHODS: We performed 77 consecutive CAS procedures using IVUS between May 2008 and December 2012...
November 2014: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Ani Manichaikul, Stephen S Rich, Heather Perry, Joseph Yeboah, Michelle Law, Molly Davis, Matthew Parker, Michael Ragosta, Jessica J Connelly, Coleen A McNamara, Angela M Taylor
AIMS: We previously identified association between the ID3 SNP rs11574 and carotid intima-media thickness in the Diabetes Heart Study, a predominantly White diabetic population. The nonsynonymous SNP rs11574 results in an amino acid substitution in the C-terminal region of ID3, attenuating the dominant negative function of ID3 as an inhibitor of basic HLH factor E12-mediated transcription. In the current investigation, we characterize the association between the functionally significant polymorphism in ID3, rs11574, with human coronary pathology...
2014: PloS One
Elizabeth Hitchner, Mohamed A Zayed, George Lee, Doug Morrison, Barton Lane, Wei Zhou
OBJECTIVE: Virtual histology intravascular ultrasound (VH IVUS) is valuable for estimating minimal lumen diameter and plaque characterization. The clinical use of IVUS in carotid intervention is not well characterized. We aim to evaluate the role of IVUS in carotid plaque characterization and determine whether it could be predictive of procedure-related microemboli. METHODS: From July 2010, patients with severe carotid stenosis who underwent elective carotid stenting procedures were prospectively enrolled...
March 2014: Journal of Vascular Surgery
Danja S Groves, Ulf Harding, Christian Lanckohr, Antje Gottschalk, John A Kern, Christoph Schmidt
A 65-year old woman presented with acute or chronic renal failure and signs of right heart failure. Renal replacement therapy—using a surgically placed dialysis catheter via the left jugular vein—was repeatedly complicated by altered flows of the dialysis unit, impaired consciousness, new onset of seizures and left-sided hemiparesis. The tip of the dialysis catheter was detected on transesophageal echocardiography within the lumen of the ascending aorta. Further imaging of the neck vessels demonstrated a primary placement of the catheter in the left common carotid artery...
2014: Echocardiography
Nikhil V Joshi, Alex T Vesey, Michelle C Williams, Anoop S V Shah, Patrick A Calvert, Felicity H M Craighead, Su Ern Yeoh, William Wallace, Donald Salter, Alison M Fletcher, Edwin J R van Beek, Andrew D Flapan, Neal G Uren, Miles W H Behan, Nicholas L M Cruden, Nicholas L Mills, Keith A A Fox, James H F Rudd, Marc R Dweck, David E Newby
BACKGROUND: The use of non-invasive imaging to identify ruptured or high-risk coronary atherosclerotic plaques would represent a major clinical advance for prevention and treatment of coronary artery disease. We used combined PET and CT to identify ruptured and high-risk atherosclerotic plaques using the radioactive tracers (18)F-sodium fluoride ((18)F-NaF) and (18)F-fluorodeoxyglucose ((18)F-FDG). METHODS: In this prospective clinical trial, patients with myocardial infarction (n=40) and stable angina (n=40) underwent (18)F-NaF and (18)F-FDG PET-CT, and invasive coronary angiography...
February 22, 2014: Lancet
Giuseppe Sangiorgi, Francesco Bedogni, Paolo Sganzerla, Giorgio Binetti, Luigi Inglese, Piotr Musialek, Giovanni Esposito, Alberto Cremonesi, Giorgio Biasi, Jacek Jakala, Alessandro Mauriello, Giuseppe Biondi-Zoccai
BACKGROUND: Carotid occlusive disease is the most common determinant of thromboembolic stroke. However, limited insights in vivo into the pathophysiology and pathology of carotid plaques are available. We designed a prospective multicenter registry to appraise the safety and feasibility of intravascular ultrasound (IVUS) and IVUS-virtual histology (IVUS-VH) imaging before and immediately after carotid stenting. METHODS: Symptomatic and asymptomatic patients scheduled for carotid stenting were included...
October 3, 2013: International Journal of Cardiology
Wojciech Witkiewicz, Piotr Klimeczek, Wojciech Iwanowski, Bernadetta Pasicka, Bartosz Dołega-Kozierowski, Stanisław Drelichowski, Krzysztof Dyś, Urszula Zaleska-Dorobisz
One of the most common causes of stroke is carotid atherosclerosis, stroke affects about 60 thousand Polish people each year and about 27% of them die within a year. About 72%-86% are ischemic strokes, whereas intracerebral or subarachnoid haemorrhages account for about 9-18% of strokes. Stroke is the third most common cause of death worldwide, after heart disease and cancer, and the most often cause of chronic disability in people over 40. Carotid atherosclerosis is one of the most important stroke risk factors...
2013: Przegla̧d Lekarski
Piotr Musialek, Wieslawa Tracz, Lukasz Tekieli, Piotr Pieniazek, Anna Kablak-Ziembicka, Tadeusz Przewlocki, Ewa Stepien, Przemyslaw Kapusta, Rafal Motyl, Jakub Stepniewski, Anetta Undas, Piotr Podolec
BACKGROUND AND PURPOSE: Several circulating biomarkers have been implicated in carotid atherosclerotic plaque rupture and thrombosis; however, their clinical utility remains unknown. The aim of this study was to determine the role of a large biomarker panel in the discrimination of symptomatic (S) vs. asymptomatic (A/S) subjects in a contemporary population with carotid artery stenosis (CS). METHODS: Prospective sampling of circulating cytokines and blood lipids was performed in 300 unselected, consecutive patients with ≥50% CS, as assessed by duplex ultrasound (age 47-83 years; 110 with A/S and 190 with S) who were referred for potential CS revascularization...
July 2013: Journal of Clinical Neurology
Nobuhiko Ogata, Katsuyuki Harashima, Koichi Kanetani, Shin-ichiro Iwahara
Carotid artery stenting (CAS) has been developed as an alternative therapeutic strategy for carotid endarterectomy (CEA) for the past several decades. One of the remaining issues of CAS is the relatively higher incidence of ipsi-lateral stroke after the procedure compared with CEA. Ischemic stroke after CAS sometimes occurred after catheterization, and a major cause of delayed stroke has been hypothesized to be stent-thrombosis. In this report, we present a case of a delayed plaque protrusion observed by contrast enhanced computed tomography and intravascular ultrasound, which could be the cause of the delayed recurrence of ischemic symptom...
January 2014: Cardiovascular Intervention and Therapeutics
Nobuhiko Ogata, Norihiko Shinozaki, Yuji Ikari
Carotid artery stenting (CAS) has been developed as an alternative therapeutic strategy of carotid endarterectomy (CEA) both for symptomatic and asymptomatic extra-cranial carotid artery stenosis. Some randomized clinical trial has been successfully proven the non-inferiority of CAS compared to CEA in terms of efficacy and safety regarding freedom from major adverse event (MAE). One of the remaining problems in CAS is a non-significant but relatively higher incidence of ipsi-lateral minor stroke related to the procedure, both during and soon after the procedure...
January 2014: Cardiovascular Intervention and Therapeutics
Alejandro González, Antonio López-Rueda, Isabel Gutiérrez, Francisco Moniche, Aurelio Cayuela, Alejandro Bustamante, Antonio Mayol, Jose Ramón Gonzalez-Marcos, Alberto Gil-Peralta
PURPOSE: To determine the incidence of vulnerable plaques characterized by virtual histology intravascular ultrasound (VH IVUS) in patients with severe internal carotid artery (ICA) stenosis and its relationship to the timing of protected carotid artery stenting (CAS). METHODS: The study included 141 patients (119 men; mean age 66.9 ± 9 years) with severe ICA stenosis undergoing CAS with cerebral protection. Patients were classified in 3 groups: 39 symptomatic early CAS (<14 days from clinical symptoms); 58 symptomatic delayed CAS (range 15-180 days), and 44 asymptomatic CAS...
December 2012: Journal of Endovascular Therapy
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