scholarly journals Bilateral non-bifurcating carotid arteries in a patient with recurrent cerebrovascular events

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Lina Palaiodimou ◽  
Georgia Papagiannopoulou ◽  
Aikaterini Theodorou ◽  
Eleni Bakola ◽  
Maria Chondrogianni ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Underlying Mechanism ◽  
Unknown Etiology ◽  
Left Middle Cerebral Artery ◽  
Extensive Literature ◽  
Prevention Therapy ◽  
Cerebrovascular Events ◽  
Complete Work ◽  
Ischemic Attack

Abstract Introduction Among congenital anomalies of the carotid artery circulation, the presence of a non-bifurcating carotid artery is extremely rare. Relevant cases with unilateral non-bifurcating carotid artery have scarcely been described in the literature. After extensive literature review, only one case with asymptomatic bilateral non-bifurcating carotid arteries associated with persistent proatlantal artery was identified. Methods We present the case of a 40-year-old man with recurrent cerebrovascular events presenting non-bifurcating carotid arteries bilaterally. Results A 40-year-old man presented in the emergency department with a transient ischemic attack. Past medical history included prior ischemic stroke of unknown etiology in the distribution of the left middle cerebral artery, untreated hyperlipidemia and tobacco use. Complete work-up in order to identify the underlying mechanism of the patient’s recurrent cerebrovascular events was negative, except for the finding of non-bifurcating carotid arteries bilaterally, associated with an extensive intracranial anastomosing arterial network. Long-term antiplatelet therapy and statins were administered as secondary stroke prevention therapy. Discussion Previous reports suggest that non-bifurcating carotid arteries may be associated with atherosclerotic plaque formation in symptomatic cases due to shear stress, tortuosity or other local factors. However, in the absence of atherosclerosis, the pathogenic association of bilateral non-bifurcating carotid arteries with cerebrovascular events remains questionable, but may be considered when other stroke etiologies are excluded.

scholarly journals Acute ischaemic stroke secondary to a mobile thrombus in the common carotid artery - case report

2015 ◽  
Vol 1 (2) ◽  
pp. 68-70 ◽  
Author(s):  
Zoltán Bajkó ◽  
Smaranda Maier ◽  
Silvia Rusu ◽  
Anca Moțățăianu
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
Treatment Strategies ◽  
Duplex Ultrasound ◽  
Neurological Status ◽  
Heavy Smoker ◽  
Left Middle Cerebral Artery ◽  
Ischemic Attack ◽  
The Right

Abstract A mobile thrombus in the carotid arteries is a very rare ultrasonographic finding and is usually diagnosed after a neurological emergency, such as a transient ischemic attack or cerebral infarction. We present the case of a 54-year-old man with vascular risk factors (a heavy smoker, untreated hypertension) who was admitted to the emergency unit with right sided hemiparesis and aphasia. A cerebral CT scan showed a left middle cerebral artery territory infarction. The duplex ultrasound examination revealed mild atherosclerotic changes in the right common and internal carotid arteries, right-sided complete subclavian steal phenomenon and a complicated hypoechoic atherosclerotic plaque in the left common carotid artery with a large mobile thrombus. Due to the high embolization risk, the patient was hospitalised and prescribed Aspirin together with low molecular weight Heparin. We recorded an improvement in the patient’s neurological status and the control duplex scan revealed disappearance of the thrombus. The presence of floating thrombus in a patient with clinical and imagistic evidence of stroke is a major therapheutic challenge for the neurologist. The treatment strategies are not standardized and must be individualized, however in our case parenteral anticoagulation proved to be successful.

scholarly journals Left-sided carotid arteries have a higher prevalence of intraplaque hemorrhage than right-sided: An asymmetric conundrum

2020 ◽  
Vol 33 (6) ◽  
pp. 494-500
Author(s):  
Anthony S Larson ◽  
Waleed Brinjikji ◽  
Luis Savastano ◽  
Eugene Scharf ◽  
John Huston ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Carotid Artery Disease ◽  
Underlying Mechanism ◽  
Intraplaque Hemorrhage ◽  
Asymmetric Distribution ◽  
Anterior Circulation ◽  
Asymptomatic Patients ◽  
Left And Right ◽  
Artery Disease

Purpose To assess whether an asymmetry exists in the prevalence of carotid artery intraplaque hemorrhage (IPH) between right- and left-sided arteries. Materials and methods The records of all patients with atherosclerotic carotid artery disease that underwent neck magnetic resonance angiography imaging with high-resolution plaque sequences between 2017 and 2020 at our institution were retrospectively reviewed. The prevalence of stenosis and IPH was determined for all patients and compared between the left and right carotid arteries of those with unilateral anterior circulation ischemic strokes. Multiple regression analysis was performed to determine potential independent associations of IPH laterality with ischemic strokes. Results A total of 368 patients were included overall and 241 were male (65.4%). There were a total of 125 asymptomatic patients and 211 patients with unilateral anterior circulation ischemic strokes. Of patients with ischemic strokes, 55.5% had left-sided strokes compared with 44.5% who had right-sided strokes ( p = 0.03). Patients with left-sided strokes had a higher prevalence of ipsilateral IPH than those with right-sided strokes (64.1% versus 36.2%, p < 0.0001), despite similar degrees of stenosis. Both age (odds ratio (OR): 1.0; 95% confidence interval (CI): 1.0–1.1; p = 0.007) and the presence of left-sided IPH (OR: 3.2; 95% CI: 1.5–6.8; p = 0.003) were independently associated with unilateral ischemic strokes. Conclusions Left-sided plaques more frequently have IPH and may be more likely to result in ipsilateral ischemic strokes compared with right-sided plaques. The underlying mechanism of asymmetric distribution of IPH between right and left carotids remains unclear.

Endovascular Treatment of Innominate Artery Occlusion With Simultaneous Vertebral and Carotid Artery Distal Protection

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. E843-E844 ◽  
Author(s):  
Michael F. Stiefel ◽  
Min S. Park ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Innominate Artery ◽  
Artery Occlusion ◽  
Left Middle Cerebral Artery ◽  
Arterial Access ◽  
Atherosclerotic Stenosis ◽  
Protection Devices ◽  
Distal Protection ◽  
The Right

Abstract OBJECTIVE Atherosclerotic stenosis or obstruction of the innominate artery is rare. Traditional surgical management is a technically demanding intervention with acceptable, but not negligible, rates of morbidity and mortality. Endovascular approaches to supraaortic lesions have been successful and are now the preferred treatment for stenoses of the brachiocephalic vessels. The use of cerebral protection devices in subclavian and innominate interventions is less established. CLINICAL PRESENTATION A 58-year-old woman had Takayasu giant cell arteritis with a history of a left middle cerebral artery stroke 3 weeks after undergoing placement of a left common carotid artery (CCA) stent and right innominate artery stent in 1998. She recently presented with worsening dizziness, ataxia, and right arm numbness and was referred to the endovascular neurosurgery service for management. INTERVENTION Initial angiography revealed left CCA stenosis and right innominate occlusion. The patient initially underwent left CCA angioplasty, planned as a staged procedure. This was followed by recanalization of the right innominate artery through an approach using both femoral arteries and the right brachial artery. This 3-site technique allowed simultaneous distal protection of both the right cervical vertebral and carotid arteries. CONCLUSION Reopening a chronically occluded innominate artery risks an embolic shower through both the right vertebral and carotid arteries. Using multiple sites of arterial access, distal protection devices can be deployed in both the cervical vertebral and carotid arteries to reduce the risk of stroke.

Homocysteine Associated With Low Cognitive Function Independent of Asymptomatic Intracranial and Carotid Arteries Stenoses in Chinese Elderly Patients: An Outpatient-Based Cross-Sectional Study

2021 ◽  
pp. 089198872098891
Author(s):  
Xiaona Wang ◽  
Tian Qiao ◽  
Min Liu ◽  
Xiang Wang
Keyword(s):  
Cognitive Function ◽  
Carotid Artery ◽  
Carotid Arteries ◽  
Cerebral Blood Flow Velocity ◽  
Underlying Mechanism ◽  
Cross Sectional Study ◽  
Total Serum ◽  
Sectional Study ◽  
Cross Sectional ◽  
Thcy Level

Introduction: A high homocysteine (Hcy) concentration is correlated with cognitive impairment; however, the exact underlying mechanism is still not fully elucidated. The present study aimed to investigate whether asymptomatic intracranial and carotid arteries stenoses are involved in Hcy-related low cognitive function. Methods: This was a cross-sectional study in outpatient clinics. Residents aged ≥60 years, who came to the Stroke and Rehabilitation Clinic of Shandong Provincial Third Hospital in Jinan, Shandong Province from December 2019 to May 2020 to seek consultation due to abnormal transcranial Doppler reports (eg., increased cerebral blood flow velocity) were eligible. Information including demographics, medical history, lifestyle habits were collected. Fasting blood was used to detect total serum homocysteine level (tHcy). Cerebrovascular magnetic resonance angiography and neck vascular ultrasound examination were used to confirm the diagnosis of intracranial and carotid artery stenoses. The Mini-Mental State Examination was used to assess the cognitive function of each participant. Logistic regression was used to evaluate the relationship between tHcy levels and cognitive function. Results: This study included 236 participants (mean age: 64.0 (SD, 7.5) years, female: 58.1%). Multivariable analyses adjusted for several potential confounders, including creatinine and cardiovascular risk factors, showed that tHcy was associated with carotid artery stenosis (CAS). After adjusting for CAS, ICAS and several potential confounders, the association between tHcy level and low cognitive function remained significant (odds ratio: 1.09, 95% confidence interval: (1.03, 1.16), P = 0.032) . Conclusion: Increased serum tHcy level was associated with low cognitive function independent of asymptomatic intracranial and carotid arteries stenoses.

Color Duplex Sonography Findings of the Carotid Arteries and Associated Risk Factors in Patients with Transient Ischemic Attack

2016 ◽  
Vol 70 (1) ◽  
pp. 35-38
Author(s):  
Anita Arsovska ◽  
Emilija Antova ◽  
Sasho Stojcev ◽  
Irena Gjorceva ◽  
Marija Babunska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
Carotid Arteries ◽  
Duplex Sonography ◽  
Low Grade ◽  
Color Duplex Sonography ◽  
Ischemic Attack ◽  
Associated Risk Factors

Abstract Introduction. A transient ischemic attack (TIA) is an acute episode of temporary neurologic dysfunction that typically lasts less than an hour. Atherosclerotic plaques in the carotid arteries may cause TIA by lumen stenosis or plaque-related thromboembolism. The aim of this paper was to analyze the changes of the carotid arteries in patients with TIA and associated risk factors. Methods. A retrospective analysis of 62 TIA patients was performed. Color duplex sonography of the carotid arteries and risk factor assessment was carried out in all patients. Results. We analyzed 15(24%) females and 47(76%) males with TIA, aged 45-79 years. The most frequent risk factor was hypertension, present in 57 patients (91.9%). The most common findings of the extracranial segments of the carotid arteries were atheromatous plaques present in 25.8% and low-grade stenosis (40-59%) visualized in 24.1% of patients. Multiple plaques predominated, mostly localized in the region of bifurcation and the beginning of the internal carotid artery (67.7%), with irregular surface (in 58.1%), heterogenous structure (70.9%) and mostly hypoechogenic (46.8%). Conclusion. These data have demonstrated a significant relationship between carotid artery ultrasound plaque characteristics and TIA occurrence. That is why color duplex sonography of the carotid arteries should be carried out in all TIA patients and risk factors should be evaluated, in order to take appropriate therapeutic measures for prevention of definitive stroke.

scholarly journals AB0142 ANTIPHOSPHOLIPID SYNDROME AND ATHEROSCLEROSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1371.2-1371
Author(s):  
N. Stoilov ◽  
V. Boyadzhieva
Keyword(s):  
Autoimmune Disease ◽  
Carotid Artery ◽  
Antiphospholipid Syndrome ◽  
Carotid Arteries ◽  
Calcium Score ◽  
Unknown Etiology ◽  
Healthy Controls ◽  
Lipid Panel ◽  
Increased Risk ◽  
Significant Difference

Background:Antiphospholipid syndrome (APS) is a systemic autoimmune disease with unknown etiology and complex pathogenesis. Recent studies have shown that the pathogenesis of the atherosclerotic process is related to the inflammatory component of the immune response, as well as to elements of autoimmunity. A number of autoimmune rheumatic diseases, including rheumatoid arthritis (RA), SLE and APS, are characterized by accelerated atherosclerosis and therefore at increased risk of cardiovascular disease and mortality. The risk of early atherosclerosis in patients with autoimmune disease is determined by traditional risk factors, chronic generalized inflammation, and target-specific autoimmune processes. These processes are complemented by the chronic use of drugs, such as KS, which worsen BMI, lead to hyperglycemia and hyperlipidemia.Objectives:The aim of this study is to investigate the incidence of atherosclerosis at selected typical sites in patients with APS.Methods:We examined 139 patients devided in to three groups: APS, SLE and healty controls. We performed US examination of carotid atheries with IMT measeurement and Calcium score of coronary artheries and aorta. All the patients were tested for: CBC, lipid panel, liver probes, ESR, anti-CL, anti-b2GPI anti-Prothrombin antibodies and ANA screen and ANA-profile as well.Results:With the Kruskall-Wallis analysis, we found a statistically significant difference in IMT between the study groups for left (p = 0.005) and right (p = 0.014) carotid arteries. Comparative analysis between the groups showed that pathological levels of IMT (> 900 µm) in the right carotid artery were the highest in patients with antiphospholipid syndrome 15 (26.3%). In healthy controls, 3 (7.3%) were identified and no cases were reported for patients with SLE. The data for the left carotid artery (LCCA) are similar. 15 (26.3%) were registered for AFS, 4 for healthy controls (9.2%), and no patients with pathological values for IMT were registered in the SLE group. We compared the results for intima-media ticking between groups with the Chi-square test, finding a statistically significant correlation for the two carotid arteries - IMT-RCCA p = <0.001 for IMT-LCCA p = 0.002.Descriptive statistics show that the highest frequency of positive calcium score is characterized by the APS group 12 (31.6%), in patients with SLE they are 3 (15%), in healthy controls the case is 3%.In our study, the AFS group had the highest incidence of positive CaScore, and its maximum values were significantly higher than the other two groups. The maximum agatson score for patients with antiphospholipid syndrome is 908 HU (Hounsfield Units), for SLE it is 2.1 HU, for healthy controls it is 233HU.With the Kruskall-Wallis statistical analysis we examined the relationship of calcium score with the individual groups. Aortic aortic valve score was negative in all subjects. We find statistically significant differences between the calcium score groups.Conclusion:The APS group is statistically significant in both pathologic IMT and higher plaque incidence compared to healthy controls and patients with SLE without the presence of anthophospholipid antibodies.Based on the data obtained we can conclude that the antiphospholipid antibodies tested and their serum levels did not directly influence the values of the coronary artery and aortic Agatson score.Disclosure of Interests:None declared

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

2013 ◽  
Vol 119 (6) ◽  
pp. 1620-1626 ◽  
Author(s):  
Marie-Luise Mono ◽  
Isabel Steiger ◽  
Oliver Findling ◽  
Simon Jung ◽  
Michael Reinert ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Recurrence Rate ◽  
Preventive Treatment ◽  
Optimal Timing ◽  
Recurrence Rates ◽  
Similar Frequency ◽  
Symptomatic Carotid ◽  
Cerebrovascular Events ◽  
Ipsilateral Recurrence ◽  
Ischemic Attack

Object The risk of recurrence of cerebrovascular events within the first 72 hours of admission in patients hospitalized with symptomatic carotid artery (CA) stenoses and the risks and benefits of emergency CA intervention within the first hours after the onset of symptoms are not well known. Therefore, the authors aimed to assess 1) the ipsilateral recurrence rate within 72 hours of admission, in the period from 72 hours to 7 days, and after 7 days in patients presenting with nondisabling stroke, transient ischemic attack (TIA), or amaurosis fugax (AF), and with an ipsilateral symptomatic CA stenosis of 50% or more, and 2) the risk of stroke in CA interventions within 48 hours of admission versus the risk in interventions performed after 48 hours. Methods Ninety-four patients were included in this study. These patients were admitted to hospital within 48 hours of a nondisabling stroke, TIA, or AF resulting from a symptomatic CA stenosis of 50% or more. The patients underwent carotid endarterectomy (85 patients) or CA stenting (9 patients). At baseline, the cardiovascular risk factors of the patients, the degree of symptomatic CA stenosis, and the type of secondary preventive treatment were assessed. The in-hospital recurrence rate of stroke, TIA, or AF ipsilateral to the symptomatic CA stenosis was determined for the first 72 hours after admission, from 72 hours to 7 days, and after 7 days. Procedure-related cerebrovascular events were also recorded. Results The median time from symptom onset to CA intervention was 5 days (interquartile range 3.00–9.25 days). Twenty-one patients (22.3%) underwent CA intervention within 48 hours after being admitted. Overall, 15 recurrent cerebrovascular events were observed in 12 patients (12.8%) in the period between admission and CA intervention: 3 strokes (2 strokes in progress and 1 stroke) (3.2%), 5 TIAs (5.3%), and 1 AF (1.1%) occurred within the first 72 hours (total 9.6%) of admission; 1 TIA (1.1%) occurred between 72 hours and 7 days, and 5 TIAs (5.3%) occurred after more than 7 days. The corresponding actuarial cerebrovascular recurrence rates were 11.4% (within 72 hours of admission), 2.4% (between 72 hours and 7 days), and 7.9% (after 7 days). Among baseline characteristics, no predictive factors for cerebrovascular recurrence were identified. Procedure-related cerebrovascular events occurred at a rate of 4.3% (3 strokes and 1 TIA), and procedures performed within the first 48 hours and procedures performed after 48 hours had a similar frequency of these events (4.5% vs 4.1%, respectively; p = 0.896). Conclusions The in-hospital recurrence of cerebrovascular events was quite low, but all recurrent strokes occurred within 72 hours. The risk of stroke associated with a CA intervention performed within the first 48 hours was not increased compared with that for later interventions. This raises the question of the optimal timing of CA intervention in symptomatic CA stenosis. To answer this question, more data are needed, preferably from large randomized trials.

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.

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.

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