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Carotid stenosis and Intravascular Ultrasound

Esther Bae, Trung Duong Vo
Atherosclerotic carotid stenosis associated with a mobile carotid plaque (MCP) is a relatively rare entity, observed in less than 1 in 2,000 carotid ultrasound examinations. As such, the natural history of this lesion and risk for neurological thromboembolic complications are not well defined. Small case reports have described treatment varying from medical management with anticoagulation, to carotid endarterectomy, and more recently, carotid stenting. We present two patients with carotid stenosis associated with a MCP...
May 2018: Annals of Vascular Surgery
Piotr Musiałek, L Nelson Hopkins, Adnan H Siddiqui
Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay - but it does not abolish - CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
Masashi Kotsugi, Katsutoshi Takayama, Kaoru Myouchin, Takeshi Wada, Ichiro Nakagawa, Hiroyuki Nakagawa, Toshiaki Taoka, Shinichiro Kurokawa, Hiroyuki Nakase, Kimihiko Kichikawa
OBJECTIVES: This study sought to clarify the incidence and prognosis of PP in carotid artery stenting (CAS). BACKGROUND: Projections thought to be plaque may be observed inside the stent on angiography or intravascular ultrasound (IVUS) during CAS. Known as plaque protrusion (PP), the incidence and prognosis of this complication are unclear. METHODS: A total of 354 consecutive carotid atherosclerotic stenoses in 328 patients (285 men, 43 women; age range 51 to 97 years [mean age 73...
April 24, 2017: JACC. Cardiovascular Interventions
Bartosz Dołęga-Kozierowski, Piotr Klimeczek, Michał Lis, Róża Krycińska, Anna Chrapusta, Urszula Zaleska-Dorobisz, Jerzy Garcarek, Wojciech Witkiewicz
BACKGROUND: One of the main risk factors for cerebral ischemic events is atherosclerotic disease of the internal carotid artery (ICA). Nowadays, increasing attention is being paid to the relationship between the morphological features of atherosclerotic plaque and the occurrence of stroke. Several studies have demonstrated that the presence of specific vulnerable plaque types, with a large lipid core and thin fibrous cap, can be used as an independent risk predictor of cerebral ischemic events...
January 2017: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Thomas R Porter, Feng Xie, John Lof, Jeffry Powers, Francois Vignon, William Shi, Matthew White
BACKGROUND: Acute ischemic stroke is often due to thromboembolism forming over ruptured atherosclerotic plaque in the carotid artery (CA). The presence of intraluminal CA thrombus is associated with a high risk of thromboembolic cerebral ischemic events. The cavitation induced by diagnostic ultrasound high mechanical index (MI) impulses applied locally during a commercially available intravenous microbubble infusion has dissolved intravascular thrombi, especially when using longer pulse durations...
August 2017: Investigative Radiology
Ichiro Nakagawa, Hun Soo Park, Shohei Yokoyama, Takeshi Wada, Syuichi Yamada, Yasushi Motoyama, Kimihiko Kichikawa, Hiroyuki Nakase
OBJECTIVE: Carotid artery stenting (CAS) is a less invasive alternative to carotid endarterectomy, but it is essential to prevent thromboembolic complications during CAS and to suppress in-stent restenosis (ISR) after CAS because of the relatively high risk of periprocedural and follow-up stroke events. Clinical trials have demonstrated the strong relationship of carotid plaque vulnerability with the subsequent risk of ipsilateral ischemic stroke and thromboembolic complications during CAS...
July 2017: Journal of Vascular Surgery
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
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