scholarly journals Carotid webs produce greater hemodynamic disturbances than atherosclerotic disease: a DSA time–density curve study

2021 ◽  
pp. neurintsurg-2021-017588
Author(s):  
Charlie C Park ◽  
Retta El Sayed ◽  
Benjamin B Risk ◽  
Diogo C Haussen ◽  
Raul G Nogueira ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Carotid Artery ◽  
Carotid Arteries ◽  
Region Of Interest ◽  
Hemodynamic Parameters ◽  
Density Curve ◽  
Atherosclerotic Lesions ◽  
Clinically Significant ◽  
Flow Stasis ◽  
Time Density

BackgroundCarotid webs (CaWs) are associated with ischemic strokes in younger patients without degrees of stenosis that are traditionally considered clinically significant.ObjectiveTo compare the hemodynamic parameters in the internal carotid artery (ICA) bulbar segment in patients with CaW with those in patients with atherosclerotic lesions using time–density curve (TDC) analysis of digital subtraction angiography (DSA) images.MethodsWe retrospectively assessed DSA images of 47 carotid arteries in 41 adult patients who underwent ICA catheter angiography for evaluation after ischemic stroke. Hemodynamic parameters, including full width at half maximum (FWHM) and area under the time–density curve (AUC) as proxies for increased flow stasis, were calculated using TDC analyses of a region of interest (ROI) in the ICA bulb immediately rostral to the web/atherosclerotic plaque, relative to a standardized ROI in the ipsilateral distal common carotid artery (eg, relative FWHM (rFWHM)). Hemodynamic parameters were compared using non-parametric Kruskal-Wallis tests. Logistic regression was used to predict CaW versus mild/moderate atherosclerosis for each hemodynamic parameter, adjusting for degree of stenosis.ResultsMean age of patients was 56.0±13 years, with 22 (53.7%) women. 17 CaWs, 22 atherosclerotic plaques (15 mild/moderate and 7 severe), and eight normal carotid arteries were assessed. Significant between-group differences were present in the relative total AUC (p<0.001), relative AUC at wash out (p=0.031), and relative FWHM (p=0.001). Logistic regression to predict CaW versus mild/moderate atherosclerosis showed that rAUC total had the highest predictive value (pAUC=0.96, 95% CI 0.90 to 1.00), followed by rFWHM (0.87, 95% CI 0.74 to 1.00), and rAUC WO (0.74, 95% CI (0.57 to 0.91).ConclusionCaW results in larger local hemodynamic disruption, characterized by flow stasis, than mild/moderate carotid atherosclerotic lesions, suggesting that CaWs may produce larger regions of thrombogenic flow stasis.

Adaptation of Cardinal Points Symmetry Landmarks Distribution Model to in-vivo B-Mode Ultrasound Images of Transverse Cross-section of Carotid Arteries

2021 ◽  
Vol 6 (7) ◽  
pp. 107-113
Author(s):  
Charles Nnamdi Udekwe ◽  
Akinlolu Adediran Ponnle
Keyword(s):  
Carotid Artery ◽  
Cross Section ◽  
Carotid Arteries ◽  
Region Of Interest ◽  
Transverse Cross Section ◽  
Transverse Plane ◽  
Distribution Model ◽  
Ultrasound Images ◽  
Symmetry Line

The geometry of the imaged transverse cross-section of carotid arteries in in-vivo B-mode ultrasound images are most times irregular, unsymmetrical, full of speckles and usually non-uniform. We had earlier developed a technique of cardinal point symmetry landmark distribution model (CPS-LDM) to completely characterize the Region of Interest (ROI) of the geometric shape of thick-walled simulated B-mode ultrasound images of carotid artery imaged in the transverse plane, but this was based on the symmetric property of the image. In this paper, this developed technique was applied to completely characterize the region of interest of the geometric shape of in-vivo B-mode ultrasound images of non-uniform carotid artery imaged in the transverse plane. In order to adapt the CPS-LD Model to the in-vivo carotid artery images, the single VS-VS vertical symmetry line common to the four ROIs of the symmetric image is replaced with each ROI having its own VS-VS vertical symmetry line. This adjustment enables the in-vivo carotid artery images possess symmetric properties, hence, ensuring that all mathematical operations of the CPS-LD Model are conveniently applied to them. This adaptability was observed to work well in segmenting the in-vivo carotid artery images. This paper shows the adaptive ability of the developed CPS-LD Model to successfully annotate and segment in-vivo B-mode ultrasound images of carotid arteries in the transverse cross-sectional plane either they are symmetrical or unsymmetrical.

Abstract 2771: Incidence of High Risk Atherosclerotic Lesions in Intracranial and Extracranial Carotid Arteries in Patients with Acute Ischemic Stroke: A 3.0T Magnetic Resonance Imaging Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Xihai Zhao ◽  
Huilin Zhao ◽  
Feiyu Li ◽  
Jie Sun ◽  
Ye Cao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Carotid Arteries ◽  
Atherosclerotic Plaques ◽  
Slice Thickness ◽  
Atherosclerotic Lesions ◽  
Vascular Beds

Introduction Rupture of vulnerable atherosclerotic plaques in the intracranial and extracranial carotid arteries could trigger ischemic stroke. However, the incidence of high risk atherosclerotic lesions in these vascular beds is not well known. This study sought to investigate the incidence of high risk atherosclerotic lesions in intracranial and extracranial carotid arteries in stroke patients using magnetic resonance (MR) imaging. Methods Seventy-five patients (mean age 62.7 years, 56 males) with acute ischemic stroke underwent MR imaging for index carotid arteries, assigned as the same side as the brain lesions, with a Philips 3.0T MR scanner. Intracranial carotid MR angiography was performed using 3D TOF sequence with FOV of 23 × 23 cm 2 , matrix of 256 × 256, and a slice thickness of 1mm. The multi-contrast vessel wall images (3D TOF, T1W, T2W, and MP-RAGE) were acquired for extracranial carotid arteries with FOV of 14 × 14 cm 2 , matrix of 256 × 256, and slice thickness of 2 mm. The intracranial artery includes middle cerebral artery (MCA), anterior cerebral artery (ACA), and posterior cerebral artery (PCA). The extracranial carotid artery was divided into internal carotid artery (ICA), bulb, and common carotid artery (CCA). Luminal stenosis for each intracranial and extracranial carotid segment was measured and graded (normal or mild = 0-29%, moderate =30-69%, severe=70-99%). Normalized wall index (NWI = wall area/total vessel area × 100%), and presence/absence of calcification, lipid-rich necrotic core (LRNC), and intraplaque hemorrhage (IPH) and/or fibrous cap rupture in each extracranial carotid segment were determined. Results MCAs developed more severe stenotic lesions (24.6%), followed by extracranial carotids (16.5%), PCAs (5.4%), and ACAs (4.1%) in stroke patients ( Figure 1 A). For extracranial carotid arteries, ICAs showed the largest plaque burden as measured by NWI (44.3%±13.1%), followed by bulbs (39.4%±13%), and CCAs (37%±6.8%). Compared to CCAs, ICAs and bulb regions had more LRNCs (38.4% and 49.3% for ICA and bulb respectively) and IPH and/or rupture (11% and 9.6% for ICA and bulb respectively) ( Figure 1 B). Conclusions In patients with acute ischemic stroke, high risk atherosclerotic plaques can be found in both intracranial and extracranial carotid arteries, particularly in the MCA, ICA and bulb regions. Compared to extracranial carotid arteries, intracranial arteries develop more high risk lesions. The findings of this study suggest the necessity for early screening to detect high risk atherosclerotic lesions in these carotid vascular beds prior to cerebravascular events.

scholarly journals INDICATIONS TO SURGICAL TREATMENT OF ATHEROSCLEROTIC IMPACT OF THE CAROTID ARTERIES

2020 ◽  
pp. 76-80
Author(s):  
I. S. Puliayeva
Keyword(s):  
Ischemic Stroke ◽  
Surgical Treatment ◽  
Carotid Artery ◽  
Carotid Arteries ◽  
Recurrent Stroke ◽  
Comprehensive Treatment ◽  
Hemorrhagic Complication ◽  
Atherosclerotic Lesions ◽  
Asymptomatic Patients ◽  
Ica Stenosis

Summary. Goal. To analyze the indications for surgical treatment of symptomatic and asymptomatic stenosis of the internal carotid artery. Materials and methods. The well-known tactics of performing carotid endarterectomy in symptomatic and asymptomatic patients still need to be divided into groups with symptomatic and asymptomatic ICA stenosis, depending on the clinical course of the disease and the risk of developing stroke. Of the 140 patients enrolled in the study, 60 patients formed patients with symptomatic ICA lesions, namely: a) 50 patients with symptomatic ICA stenosis; b) 10 patients with visual impairment and ICA stenosis. Of 80 asymptomatic patients with verified atherosclerotic lesions of the carotid arteries without manifestations of acute ischemic cerebral circulation during the last 6 months, of which. Discussion and results. Patients with symptomatic ICA lesions are the most at-risk group for the development of recurrent stroke, they require comprehensive treatment depending on the size of the lesion and the risk of hemorrhagic complication. Conclusions. Patients with multifocal atherosclerosis should be screened for carotid artery screening to reduce the risk of ischemic stroke in the postoperative period. Patients with ischemic stroke should perform an MRI to confirm the focus of the first stage, followed by ultrasound examination of the carotid arteries. In the case of carotid lesions, patients undergo carotid CT scans to establish indications for surgical treatment.

scholarly journals Application of Cardinal Points Symmetry Landmarks Distribution Model to B-Mode Ultrasound Images of Transverse Cross-section of Thin-walled Phantom Carotid Arteries

2019 ◽  
Vol 4 (12) ◽  
pp. 96-101
Author(s):  
Charles Nnamdi Udekwe ◽  
Akinlolu Adeniran Ponnle
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Region Of Interest ◽  
Transverse Plane ◽  
Geometric Shape ◽  
Distribution Model ◽  
Optimum Number ◽  
Ultrasound Images ◽  
North East ◽  
Thin Walled

We had earlier developed a technique based on cardinal point symmetry landmark distribution model (CPS-LDM) to completely characterize the Region of Interest (ROI) of the geometric shape of thick-walled simulated B-mode ultrasound images of carotid artery imaged in the transverse plane. In this paper, this developed technique was applied to completely characterize the region of interest of the geometric shape of B-mode ultrasound images of thin-walled phantom carotid artery imaged in the transverse plane. The developed model employs a combination of fixed landmarks (FLs) and movable landmarks (MLs) to obtain the total landmarks (TLs) that can sufficiently segment the shape of the ROI of the carotid artery. For the phantom carotid arteries, three FLs are fixed on each of the four ROIs determined by the cardinal points North (N), South (S), East (E) and West (W) drawn on the ROIs of the phantom carotid artery. The MLs are determined by the inter-cardinal directions such as North-East (NE), North-West (NW) and so on. The obtained CPS-LDM equation developed allows graphical visualization the optimum number of points that can sufficiently segment the ROIs. ImageJ2 software was used to generate the Cartesian coordinates for each landmark which were then used to generate the Shape Space Pattern (SSP) of the phantom carotid artery ready for further statistical analysis. The results showed that the CPS-LD model is generic and adaptable to a variety of transverse cross-sectional B-mode ultrasound images of thin-walled phantom carotid artery

Does Carotid Artery Tortuosity Play a Role in Stroke?

2021 ◽  
pp. 084653712199105
Author(s):  
Luca Saba ◽  
Roberto Sanfilippo ◽  
Jasjit S. Suri ◽  
Filippo Cademartiri ◽  
Giuseppe Corrias ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Logistic Regression Analysis ◽  
Carotid Arteries ◽  
Final Analysis ◽  
P Value ◽  
Anterior Circulation ◽  
Age Range

Purpose: To explore the association between carotid artery length and tortuosity, and the occurrence of stroke. Material and Methods: In this retrospective study, IRB approved, 411 consecutive patients (males: 245; median age: 56 ± 12 years, age range: 21-93 years) with anterior circulation ischemic stroke were included. Only patients that underwent CTA within 7 days were considered and stroke caused by cardiac embolism and thoracic aorta embolism were excluded. For each patient, both carotid arteries were considered, and the ICA, CCA-ICA length and tortuosity were calculated. Inter-observer analysis was quantified with the Bland-Altman test. Mann-Whitney test and logistic regression analysis were also calculated to test the association between length and tortuosity with the occurrence of stroke. Results: In the final analysis, 166 patients (males: 72; median age: 54 ± 12 years, age range: 24-89 years) with anterior circulation ischemic stroke that were admitted to our hospital between February 2008 and December 2013 were included. The results showed a good concordance for the length of the vessels with a mean variation of 0.7% and 0.5% for CCA-ICA and ICA length respectively an for the tortuosity with a mean variation of 0.2% and -0.4% for CCA-ICA and ICA respectively. The analysis shows a statistically significant association between the tortuosity index of the ICA and CCA-ICA sides with stroke ( P value = 0.0001 in both cases) and these findings were confirmed also with the logistic regression analysis. Conclusion: Results of this study suggest that tortuosity index is associated with the presence of stroke whereas the length of the carotid arteries does not play a significant role.

Screening tool for extracranial carotid lesions detection in patients of outpatient vascular clinic

2019 ◽  
Vol 91 (5) ◽  
pp. 1-5
Author(s):  
Piotr Każmierski ◽  
Michał Pająk ◽  
Justyna Kruś-Hadała ◽  
Mateusz Jęckowski ◽  
Katarzyna Bogusiak
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Arteries ◽  
Artery Occlusion ◽  
Artery Stenosis ◽  
Asymptomatic Group ◽  
Symptomatic Carotid ◽  
Atherosclerotic Lesions ◽  
Group A

Purpose The objective of the study was to evaluate the frequency and severity of atherosclerotic lesions in extracranial sections of carotid arteries and to determine the level of the correlation between these lesions and symptoms of cerebral ischemia. Secondly, to identify the most common risk factors of ischaemic stroke occurrence in population of patients of vascular outpatient clinic. Material and Methods Prospective study was conducted on a group of 1,000 people (217 women and 783 men), aged 50 to 86 years, the average age was 62 years (± 9.95). Results Atherosclerotic lesions of carotid arteries were observed in 670 examined people (67%). In 63 cases (6.3%) carotid artery occlusion was revealed. Patients with symptomatic carotid artery stenosis more frequently were addicted to cigarettes and suffered from hypertension in comparison to asymptomatic group. A statistically significant correlation between the TIA or ischemic stroke and smoking were noticed, as well as between TIA/ischemic stroke and hypertension Conclusions Among patients with atherosclerosis of peripheral arteries atherosclerotic lesions in the extracranial carotid sections occur with a high frequency. Statistically significant differences in the incidence and severity of atherosclerotic lesions in the carotid arteries were observed in this group. A statistically significant correlation was revealed between the prevalence and severity of atherosclerosis in the carotid arteries in symptomatic patients and smoking and hypertension. Performing screening in patients with atherosclerosis of the abdominal aorta and/or lower limb arteries may detect significant carotid artery stenosis, requiring surgical intervention.

Clinical features of ocular ischemic syndrome in atherosclerotic lesions of the internal carotid artery

2018 ◽  
Vol 16 (5) ◽  
pp. 173-178
Author(s):  
V. V. Tuzlaev ◽  
◽  
V. V. Egorov ◽  
I. Z. Kravchenko ◽  
G. P. Smoliakova ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Features ◽  
Internal Carotid ◽  
Ocular Ischemic Syndrome ◽  
Atherosclerotic Lesions ◽  
Ischemic Syndrome

scholarly journals Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Alessandro Robaldo ◽  
Guido Carignano ◽  
Alberto Balderi ◽  
Claudio Novali
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
High Risk Patient ◽  
Carotid Bifurcation ◽  
Left Common Carotid Artery ◽  
The Right ◽  
Bovine Aortic Arch ◽  
Common Carotid Arteries

Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters.

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