Clinical Significance of Hemodynamic Parameters Identified by Ultrasound in the Extracranial Internal Carotid Artery and Posterior Cerebral Artery of Patients with Moyamoya Disease

Abstract BackgroundDigital subtraction angiography (DSA), magnetic resonance angiography (MRA) and other imaging methods are limited in the long-term and dynamic examination of hemodynamic changes in moyamoya disease (MMD). The aim of this study was to investigate the hemodynamic changes using ultrasound according to DSA findings and explore the association between ultrasound parameters and clinical manifestations of MMD.MethodsHemodynamic parameters of the extracranial internal carotid artery (EICA) and posterior cerebral artery (PCA) identified by ultrasound were classified into 3 groups according to DSA findings, and differences in ultrasound parameters among DSA stages were compared. Then, according to clinical manifestations, 30 patients were divided into the stroke group and the transient ischemic attack (TIA) group. We compared the differences in the EICA and PCA ultrasound parameters between the two groups, and receiver operating characteristic (ROC) curves were used to evaluate the value of ultrasound parameters in diagnosing stroke and TIA in MMD patients.ResultsThe diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV) and flow volume (FV) of EICA decreased as the Suzuki stage advanced (D: p༜0 .001, PSV: p = 0.002, EDV: p = 0.001, FV: p༜0.001). The PSV and EDV of PCA increased as the scores of the leptomeningeal system from the PCA to the anterior cerebral artery (ACA) and middle cerebral artery (MCA) territory advanced (PSV: p = 0.002, EDV: p༜0.001). Comparing the ultrasound parameters between the stroke group and the TIA group, the D and FV of EICA, the PSV and EDV of PCA were significantly different. ROC analysis showed that the area under the curve (AUC) based on the FV of EICA, the PSV of PCA and the combination of the two parameters were 0.676, 0.737 and 0.787, respectively, to diagnose stroke and TIA in MMD patients.ConclusionsOur results suggest that ultrasound parameters are related to DSA results, and that ultrasound is useful in predicting the clinical severity of MMD.Trial registration:Clinical Trial Registration-URL: http://www.chictr.org. Unique identifier: ChiCTR1900026075

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Clinical Significance of Ultrasound-Based Hemodynamic Assessment of Extracranial Internal Carotid Artery and Posterior Cerebral Artery in Symptomatic and Angiographic Evolution of Moyamoya Disease: A Preliminary Study

Frontiers in Neurology ◽

10.3389/fneur.2021.614749 ◽

2021 ◽

Vol 12 ◽

Author(s):

Shuai Zheng ◽

Peicong Ge ◽

Zhiyong Shi ◽

Jingzhe Wang ◽

Yi Li ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Roc Analysis ◽

Internal Carotid ◽

Posterior Cerebral Artery ◽

Stroke Patients ◽

Extracranial Internal Carotid Artery ◽

Ultrasound Parameters

Objective: To investigate the hemodynamic changes using ultrasound according to digital subtraction angiography (DSA) findings and explore the association between ultrasound parameters and clinical symptoms of moyamoya disease (MMD).Methods: Hemodynamic parameters of extracranial internal carotid artery (EICA) and posterior cerebral artery (PCA) were evaluated by ultrasound. According to DSA findings, EICA parameters among Suzuki stages (stage I-II, III-IV, and V-VI), and PCA parameters among leptomeningeal system scores (score 0–2, 3–4, and 5–6) were compared, respectively. ROC analysis was performed based on the ultrasound parameters to distinguish stroke from non-stroke patients.Results: Forty patients with MMD were included in our study (16 men; median age, 37 years). The diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV) and flow volume (FV) of EICA decreased as the Suzuki stage advanced (D: P < 0.001; PSV: P < 0.001; EDV: P < 0.001; FV: P < 0.001). The PSV and EDV of PCA increased as the leptomeningeal system scores advanced (PSV: P < 0.001; EDV: P < 0.001). ROC analysis showed that the area under the curves (AUCs) based on the D and FV of EICA, the PSV and EDV of PCA and their combination were 0.688, 0.670, 0.727, 0.684, and 0.772, respectively, to distinguish stroke from non-stroke patients.Conclusions: Ultrasound parameters were related to Suzuki stages and leptomeningeal system scores. Ultrasound may be useful in predicting the occurrence of stroke in patients with MMD. Future prospective studies with large sample sizes and long-term follow-up are needed to confirm our preliminary findings.

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EVALUATION OF VASOMOTOR RESPONSE IN OPHTHALMIC MIGRAINE PATIENTS

Romanian Journal of Neurology ◽

10.37897/rjn.2016.2.4 ◽

2016 ◽

Vol 15 (2) ◽

pp. 75-79

Author(s):

Adriana Bulboaca ◽

◽

Corina Ursu ◽

A. Bulboaca ◽

◽

...

Keyword(s):

Plasma Concentration ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Posterior Cerebral Artery ◽

Pathophysiological Mechanism ◽

Vasomotor Response ◽

Hemodynamic Changes ◽

Flow Velocities

Introduction. Hemodynamic changes of the cerebral arteries in ophthalmic migraine may be an important pathophysiological mechanism of the disease. The nitric oxide (NO) synthesis plays a significant role in hemodynamic changes due to vasodilatation effect. The purpose of this study is to evaluate the possible hemodynamic changes by Doppler measurements and their correlation with NO synthesis in ophthalmic migraine. Method. 37 ophthalmic migraine patients were compared with 35 healthy volunteers. Other cerebral and ophthalmic diseases were excluded by ophthalmological, neurological, and cranial MRI examinations. The migraine assessment scale (MIDAS) was used for clinical evaluation. Transcranial Doppler ultrasonography (TCD) was performed using 2 and 4 MHz frequencies transducers. The flow velocities of the internal carotid artery, middle cerebral artery, posterior cerebral artery, and NO plasma concentration were assessed 2 hours after migraine attacks. Results. The NO synthesis was significantly increased compared to the control group. The flow velocities decreased in internal carotid artery, middle cerebral artery, and posterior cerebral artery. The correlation between decreased flow velocities and NO plasma concentration was significant. Conclusions. Autonomic nervous system dysfunction in ophthalmic migraine is an important pathophysiological mechanism. The flow velocity status may reflect the vasomotor response and endothelial reactivity induced by NO synthesis. Further studies on the vasomotor response are necessary for the evaluation of this pathophysiological mechanism implication in ophthalmic migraine.

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Carotid artery web with fetal posterior cerebral artery variant masquerading as recurrent ipsilateral cryptogenic ischaemic strokes

BMJ Case Reports ◽

10.1136/bcr-2021-246421 ◽

2021 ◽

Vol 14 (12) ◽

pp. e246421

Author(s):

Rohit Mehra ◽

Vikram Patra ◽

Rishi Dhillan

Keyword(s):

Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Medical Literature ◽

Posterior Cerebral Artery ◽

Surgical Excision ◽

Patch Angioplasty ◽

History Of ◽

Carotid Artery Endarterectomy ◽

Multidisciplinary Teamwork

A 31-year-old woman was referred to vascular surgeons with the history of recurrent ischaemic strokes in two cerebral artery territories over a span of 1 year. On investigation, she was found to have a right internal carotid artery web, with thrombus and a fetal right posterior cerebral artery (PCA), which explained the ischaemic strokes in right middle cerebral and PCA territory. The rare association of these two infrequent entities makes the case a singular one in the medical literature. Successful surgical excision was done after multidisciplinary teamwork. The carotid web was excised as part of carotid artery endarterectomy and repaired with great saphenous vein patch angioplasty. The patient made a good recovery.

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A case of posterior cerebral artery aneurysm associated with idiopathic bilateral internal carotid artery occlusion: case report

Surgical Neurology ◽

10.1016/s0090-3019(99)00134-2 ◽

1999 ◽

Vol 52 (6) ◽

pp. 617-622 ◽

Cited By ~ 16

Author(s):

Tadashi Shibuya ◽

Nariyuki Hayashi

Keyword(s):

Case Report ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Posterior Cerebral Artery ◽

Artery Aneurysm ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Cerebral Artery Aneurysm

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Successful Endovascular Mechanical Thrombolysis in a Patient with Hyperacute Tandem Occlusions of Middle Cerebral Artery and Extracranial Internal Carotid Artery

Korean Journal of Stroke ◽

10.5853/kjs.2011.13.3.147 ◽

2011 ◽

Vol 13 (3) ◽

pp. 147

Author(s):

Dong-Woo Ryu ◽

Si-Baek Lee ◽

Siryung Han ◽

Bum-Soo Kim ◽

Hyung-Eun Park ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Mechanical Thrombolysis ◽

Extracranial Internal Carotid Artery

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Competitive flow diversion of multiple P1 aneurysms: proposed classification

BMJ Case Reports ◽

10.1136/bcr-2019-015581 ◽

2020 ◽

Vol 13 (6) ◽

pp. e015581

Author(s):

Mark Alexander MacLean ◽

Thien J Huynh ◽

Matthias Helge Schmidt ◽

Vitor M Pereira ◽

Adrienne Weeks

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Posterior Cerebral Artery ◽

Flow Diversion ◽

Endovascular Coiling ◽

Ruptured Aneurysms ◽

The Right

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.

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