Association between carotid artery tortuosity and carotid dissection: a case-control study

Introduction: Despite considered being a safe and efficacious procedure in patients with moderate to severe symptomatic carotid artery stenosis, carotid endarterectomy (CEA) carries a risk of postoperative cerebrovascular accident (POCVA). There is currently a lack of evidence pertaining to the relationship between cranial vascular integrity and its interaction with intraoperative haemodynamic fluctuations and risk of POCVA. Methods: In this retrospective case-control study, we utilised data collected from patients undergoing CEA for symptomatic carotid artery disease between Dec’05 and Oct’19 in the South Mersey Arterial Centre, UK. Patients with three-dimensional CT angiogram (3D-CTA) and evidence of POCVA were considered as cases, matched with those without such evidence that were considered as controls. 3D-CTAs were analysed following a structured proforma, and haemodynamic changes were obtained from operative notes. Results: Out of 951 patients, a total of 21 cases and 55 matched controls were identified. Presence of atherosclerotic disease in the vertebral arteries (VA) in either side, intracranial atherosclerosis (ICAS) (81% vs 40% and 57% vs 27%; <0.01, p<0.05 respectively), and drop in the systolic blood pressure (mean + SD 61 + 23 mmHg vs. 44 + 20 mmHg, p<0.01) were significantly different between the cases and the controls (fig 1). A multivariate logistic regression model showed that odds of stroke were increased with VA stenosis on either side (OR 6·5, 95% CI 1·7-24·6, p=0.006) and intraoperative systolic blood pressure drop greater than 44 mmHg (OR 6·6, 95% CI 1·6-27·6, p=0.01). Conclusions: These findings highlight the importance of routinely identifying posterior circulation abnormalities during the preoperative assessment, and judicious blood pressure management during the intraoperative period, both of which have the potential to help to develop a personalised risk stratification pre-CEA and greater intraoperative monitoring during CEA.

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Common Carotid Artery Intima-Media Thickness Reflects the Cumulative Burden of Atherosclerosis and Predicted Well by Total-C/HDL-C Ratio in Type-II Diabetic Patients- A Case Control Study Based from Kolkata, India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v5i1.8450 ◽

2013 ◽

Vol 5 (1) ◽

pp. 9-14

Author(s):

Tanmay Jyoti Sau ◽

Sandip Kumar Dey ◽

Arun Kumar ◽

Utpal Kumar Biswas

Keyword(s):

Carotid Artery ◽

Common Carotid Artery ◽

Case Control Study ◽

Intima Media Thickness ◽

Case Control ◽

Diabetic Patients ◽

Type Ii ◽

Medical College ◽

Media Thickness ◽

Control Study

Background: Diabetes Mellitus (DM) is frequently associated with the development of premature atherosclerotic vascular disease and is the major cause of morbidity and mortality. Approximately 80% of all deaths and more than 75% of all hospitalizations are due to CAD. Individuals with DM are usually associated with accelerated atherosclerosis. Common Carotid artery intima-media thickness (CCAIMT) is now also considered as a surrogate marker of atherosclerosis. Materials and Methods: This case-control study was conducted from Jan, 2011 to June, 2012 among Type-II diabetes, aged between 30-80yrs. Patients with Type-I diabetes, aged <30yrs or >80yrs and other secondary causes of diabetes, hypertensive, smokers and patients under therapy with lipid lowering drugs were excluded from this study. The biochemical tests were done in the department of Biochemistry, Nilratan Sarkar Medical College and Hospital, using standardized reagent kits. CCAIMT was measured by high resolution imaging using 10MHz transducer in the department of Radiodiagnosis, Nilratan Sarkar Medical College and Hospital. Results: The results of our study indicate that dyslipidemic diabetic patients had significantly higher blood glucose at any phase along with glycated haemoglobin compared to controls. The lipid variables were also significantly higher in the diabetes patients with dyslipidemia compared to controls except HDL levels were significantly higher in control. CCAIMT was higher in the dyslipidemic group (1.71 ± 0.57mm) compared to the non-dyslipidemic group (0.77 ± 0.10) which was statistically significant (p value <0.001). Conclusion: CCAIMT reflects the cumulative burden of atherosclerosis and is highly correlated and predicted well by Total-C/HDL-C ratio in Type-II diabetic patients. So it is advised that a direct examination of the vessel wall is extremely essential for early detection of the affected individuals so that the cost burden in Intensive coronary care unit can be minimized and also the individual can be advised to control the extensive dyslipidemia through dietary restrictions and exercise. DOI: http://dx.doi.org/10.3126/ajms.v5i1.8450 Asian Journal of Medical Science Vol.5(1) 2014 pp.9-14

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