scholarly journals CT Angiography Manual Multiplanar Vessel Diameter Measurement vs. Semiautomated Perpendicular Area Minimal Caliber Computation of Internal Carotid Artery Stenosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Timo Siepmann ◽  
Kristian Barlinn ◽  
Thomas Floegel ◽  
Jessica Barlinn ◽  
Lars-Peder Pallesen ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Angiography ◽  
Internal Carotid ◽  
Vessel Diameter ◽  
Internal Carotid Artery Stenosis ◽  
Diameter Measurement ◽  
Acute Cerebral Ischemia ◽  
Stroke Center ◽  
Ica Stenosis

Objective: To determine the diagnostic agreement of CT angiography (CTA) manual multiplanar reformatting (MPR) stenosis diameter measurement and semiautomated perpendicular stenosis area minimal caliber computation of extracranial internal carotid artery (ICA) stenosis.Methods: We analyzed acute cerebral ischemia CTA at our tertiary stroke center in a 12-month period. Prospective NASCET-type stenosis grading for each ICA was independently performed using (1) MPR to manually determine diameters and (2) perpendicular stenosis area with minimal caliber semiautomated computation to grade luminal constriction. Corresponding to clinically relevant NASCET strata, results were grouped into severity ranges: normal, 1–49%, 50–69%, and 70–99%, and occlusion.Results: We included 647 ICA pairs from 330 patients (median age of 74 [66–80, IQR]; 38–92 years; 58% men; median NIHSS 4 [1–9, IQR]). MPR diameter and semiautomated caliber measurements resulted in stenosis grades of 0–49% in 143 vs. 93, 50–69% in 29 vs. 27, 70–99% in 6 vs. 14, and occlusion in 34 vs. 34 ICAs (p = 0.003), respectively. We found excellent reliability between repeated manual CTA assessments of one expert reader (ICC = 0.997; 95% CI, 0.993–0.999) and assessments of two expert readers (ICC = 0.972; 95% CI, 0.936–0.988). For the semiautomated vessel analysis software, both intrarater reliability and interrater reliability were similarly strong (ICC = 0.981; 95% CI, 0.952–0.992 and ICC = 0.745; 95% CI, 0.486–0.883, respectively). However, Bland–Altman analysis revealed a mean difference of 1.6% between the methods within disease range with wide 95% limits of agreement (−16.7–19.8%). This interval even increased with exclusively considered vessel pairs of stenosis ≥1% (mean 5.3%; −24.1–34.7%) or symptomatic stenosis ≥50% (mean 0.1%; −25.7–26.0%).Conclusion: Our findings suggest that MPR-based diameter measurement and the semiautomated perpendicular area minimal caliber computation methods cannot be used interchangeably for the quantification of ICA steno-occlusive disease.

scholarly journals Evaluation of Subfoveal Choroidal Thickness in Internal Carotid Artery Stenosis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Betül İlkay Sezgin Akçay ◽  
Esra Kardeş ◽  
Sultan Maçin ◽  
Cihan Ünlü ◽  
Engin Bilge Özgürhan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
The Mean ◽  
Group 2 ◽  
Ica Stenosis ◽  
Group 1

Purpose. To evaluate the relationship between internal carotid artery (ICA) stenosis and subfoveal choroidal thickness (SFCT) in the elderly population.Methods. A total of 42 eyes of 21 patients with more than 70% ICA stenosis (Group 1) on one side and less than 70% stenosis (Group 2) on the other side were recruited for this study. ICA stenosis was diagnosed using both the B-mode and Doppler ultrasound. The two groups were compared in terms of the percentage of stenosis, SFCT measurements, intraocular pressure, ocular perfusion pressure, refractive error, and peak systolic velocity. Eyes were examined with the RTVue-100 OCT device by the EDI-OCT technique.Results. The mean age of the patients was71.9±10.8years. The mean percentage of ICA stenosis was74±4.9% in Group 1 and47.5±7.7% in Group 2. The mean SFCT was231.9±44.6 μm in Group 1 and216.2±46.8 μm in Group 2, which was significantly lower (P=0.028). A statistically significant positive correlation was found between the percentage of internal carotid artery stenosis and SFCT (r=0896,P=0.001).Conclusions. Compensatory SFCT increase can be seen in ipsilateral internal carotid artery stenosis greater than 70%.

Abstract 3772: High Precision and Accuracy of B-flow Ultrasound Morphometry of Internal Carotid Artery Stenosis: Improved Non-invasive Stenosis Grading

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Roland R Macharzina ◽  
Tanja Böhme ◽  
Nian Fan ◽  
Aljosha Rastan ◽  
Charlotte Witzel ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Pearson Correlation ◽  
Internal Carotid Artery Stenosis ◽  
Imaging Method ◽  
Additional Tool ◽  
Reference Segment ◽  
Mean Differences ◽  
Ica Stenosis

Background: Evaluation of various imaging modalities for grading internal carotid artery (ICA) stenosis can be performed by comparison of minimal lumen diameters (MLD) as well as percent ICA-stenosis calculated with a healthy distal reference segment (NASCET method). The new B-Flow (BF) ultrasound (US) imaging method displays stenosis in a similar fashion as reference methods like catheter angiography (A) and multi-slice CT-angiography (MS CTA). Aim: to evaluate the accuracy of MSCTA by using multiplanar reformation (MPR) for measuring ICA stenosis compared with of A as well as accuracy and precision of BF-US compared with MSCTA at corresponding projections and locations. Methods and patients: CTA of ICA were compared with A in 37 low to high grade ICA stenoses of patients screened by doppler US velocity criteria. CTA were compared with US in 80 ICA stenoses of 63 patients in a similar fashion at identical projections. Diameters of stenosed ICA were rendered coaxial on CTA. A was made with AXIOM (Siemens, Germany), MSCTA with SOMATOM (Siemens, Germany); Ultrasound Logic 9 with 6-8 Mhz linear scanner, GE, USA. All readings were by two independent observers for each technique. Quantitative A was done with MEDIS software (Netherlands), Bland-Altman analysis and statistics with SPSS (Germany). Identical planes were confirmed by overlay technique. Results: MLD was slightly overestimated by CTA compared with angiography with mean differences (±SD) of 0.093 ± 0.25 mm for longitudinal sections. Pearson correlation coefficient (PCC) was 0.95. NASCET stenosis grade showed no bias between CTA and A (-0,5%±6.23% SD) and resulted in a PCC 0.93 for MPR's compared with A. MLD was slightly underestimated by parasaggital section (PSS) BF-US (0.031mm ± 0.23mm SD) compared with CTA, PCC = 0.96. NASCET ICA-stenoses were slightly underestimated by CTA, with mean differences of 1,16% ± 6,04% (SD), PCC was 0.92. In this cohort, discrimination of binary 50% NASCET stenosis with PSS BF-US had a 87%sensitivity, 86% specifity and an accuracy of 86%; discrimination of binary 70% NASCET stenosis with PSS BF-US had a sensitivity of 92%, specifity of 90% and an accuracy of 90%. Conclusion: diagnostic performance of CTA proved to be excellent compared with angiography and PSS 2D BF-US was highly accurate, when using corresponding projections. 2D BF-US may be a valuable additional tool for screening and confirmation of CAS for therapeutic stratification.

PTA for Internal Carotid Artery Stenosis

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 41-44 ◽  
Author(s):  
M. Ezura ◽  
A. Takahashi ◽  
M. Fukuchi ◽  
T. Yoshimoto
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Acute Stage ◽  
Internal Carotid Artery Stenosis ◽  
Arterial Dissection ◽  
Neurological Deficits ◽  
Chronic Stage ◽  
Ica Stenosis

Thirty-one lesions of internal carotid artery (ICA) stenosis were treated by percutaneous transluminal angioplasty (PTA). All the patients were males except two. There were 18 extracranial ICA stenosis and 13 intracranial ICA stenosis. Four patients were treated in acute stage and 27 were in chronic stage. In 27 patients in the chronic stage, clinical presentation was transient ischemic attack or reversible ischemic neurological deficits or minor completed stroke. Dilatation of any degree was observed in all patients except one in the chronic group. Good dilatation (stenosis ratio after PTA is less than 50%) was observed in 11 out of 13 intracranial lesions and in 10 out of 14 extracranial lesions. Restenosis was two out of 11 intracranial good dilated lesions and 6 out of 10 good dilated extracranial lesions. No patients but one have experienced recurrent symptoms. Symptomatic complications occurred in only one patient who encountered arterial dissection during PTA resulting in severe hemiparesis. In four patients in the acute stage, dilatation of any degree was observed in two and good dilatation was seen in two. In conclusion, PTA for chronic ICA stenosis is an effective and safe technique. However, extracranial lesions tend to develop restenosis. Self-expandable stent will be one of the solutions for extracranial lesions. Major complications of PTA are distal embolism and arterial dissection. PTA for acute ICA stenosis is a challenging technique.

scholarly journals Suitable methods of measuring acceleration time in the diagnosis of internal carotid artery stenosis

2020 ◽  
Vol 47 (2) ◽  
pp. 327-333
Author(s):  
Kentaro Iizuka ◽  
Hidehiro Takekawa ◽  
Akio Iwasaki ◽  
Haruki Igarashi ◽  
Keisuke Suzuki ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Peak Systolic Velocity ◽  
Internal Carotid Artery Stenosis ◽  
Acceleration Time ◽  
Symptomatic Carotid ◽  
Conventional Procedure ◽  
Stenosis Rate ◽  
Ica Stenosis

Abstract Purpose To enhance the utility of acceleration time (AcT) in the diagnosis of internal carotid artery (ICA) stenosis, we assessed the value of AcT measurements with different waveform patterns. Methods Ninety-three patients with acute atherothrombotic cerebral infarction were enrolled, and they underwent both carotid ultrasonography and digital subtraction angiography (DSA). AcT was determined by a conventional procedure (using the first peak point or the bending point) and the peak systolic velocity (PSV) procedure. The AcT ratio was calculated as (AcT of ICA)/(AcT of the ipsilateral common carotid artery). We evaluated the correlation of stenosis rate as assessed by the North American Symptomatic Carotid Endarterectomy Trial method using DSA (DSA-NASCET) with the AcT of ICA (ICA-AcT), the AcT ratio measured by the conventional procedure (conventional AcT ratio), and the AcT ratio measured by the PSV procedure (PSV AcT ratio). The area under receiver operating characteristic curves (AUC) for DSA-NASCET was calculated based on the ICA-AcT and AcT ratio. Results Forty-five vessels had 50% or greater ICA stenosis. DSA-NASCET was positively correlated with the conventional AcT ratio (r = 0.723), conventional ICA-AcT (r = 0.638), and PSV AcT ratio (r = 0.245). The corresponding AUCs for ICA stenosis ≥ 50% were 0.971, 0.886, and 0.572, respectively. Conclusion We demonstrated the usefulness of the conventional procedure for diagnosing stenosis of ICA origin using AcT and showed that the AcT ratio was a more beneficial parameter than AcT.

A CASE OF ATRAUMATIC CONVEXAL SUBARACHNOID HAEMORRHAGE DUE TO UNUSUAL CAUSE

2015 ◽  
Vol 86 (11) ◽  
pp. e4.98-e4
Author(s):  
SAH Zaidi ◽  
Amit Agrawal ◽  
Richard Davey
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Subarachnoid Haemorrhage ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Left Internal Carotid Artery ◽  
Female Smoker ◽  
Ica Stenosis

ObjectiveTo describe a rarely described case of severe internal carotid artery stenosis presented as convexal subarachnoid haemorrhage (SAH) in the setting of acute ischemic stroke.Case reportA 52 year old female, smoker, presented with right sided numbness, slurred speech and difficulty in walking. Neurological observation revealed mild expressive dysphasia and subtle right sided weakness. Brain imaging showed left cortical sulcal SAH with ischemia in the left corona radiata. Carotids ultrasound showed 90% stenosis of left internal carotid artery that was later confirmed by magnetic resonance angiogram. She was treated conservatively for acute ischemic stroke and later underwent left carotid endarterectomy.ConclusionsThis case shows that ICA stenosis can cause convexal SAH and it should therefore be added to the differential diagnosis of atraumatic SAH. The association is under recognised and can be missed due to the unusual location of the blood and failure to image the extra cranial carotid arteries.

Risk of internal carotid artery stenosis or occlusion after single-fraction radiosurgery for benign parasellar tumors

2020 ◽  
Vol 133 (5) ◽  
pp. 1388-1395 ◽  
Author(s):  
Christopher S. Graffeo ◽  
Michael J. Link ◽  
Scott L. Stafford ◽  
Ian F. Parney ◽  
Robert L. Foote ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Single Fraction ◽  
Cavernous Sinus Meningioma ◽  
Ica Stenosis

OBJECTIVEStereotactic radiosurgery (SRS) is an accepted treatment option for patients with benign parasellar tumors. Here, the authors’ objective was to determine the risk of developing new or progressive internal carotid artery (ICA) stenosis or occlusion after single-fraction SRS for cavernous sinus meningioma (CSM) or growth hormone–secreting pituitary adenoma (GHPA).METHODSThe authors queried their prospectively maintained registry for patients treated with single-fraction SRS for CSM or GHPA in the period from 1990 to 2015. Study criteria included no prior irradiation and ≥ 12 months of post-SRS radiological follow-up. Pre-SRS grading of ICA involvement was applied according to the 1993 classification schemes of Hirsch for CSM or Knosp for GHPA.RESULTSThe authors conducted a retrospective review of 283 patients, 155 with CSMs and 128 with GHPAs. Ninety-three (60%) CSMs were Hirsch category 2 and 3 tumors; 97 (76%) GHPAs were Knosp grade 2–4 tumors. Median follow-up after SRS was 6.6 years (IQR 1–24.9 years). No GHPA or category 1 CSM developed ICA stenosis or occlusion. Three (5.2%) patients with category 2 CSMs had asymptomatic ICA stenosis (n = 2) or occlusion (n = 1); 1 (1.1%) category 2 CSM patient had transient ischemic symptoms. Five (14.3%) category 3 CSMs progressed to ICA occlusion (4 asymptomatic, 1 symptomatic). The median time to stenosis/occlusion was 4.8 years (IQR 1.8–7.6). Five- and 10-year risks of ICA stenosis/occlusion in category 2 and 3 CSM patients were 7.5% and 12.4%, respectively. Five- and 10-year risks of ischemic stroke from ICA stenosis/occlusion in category 2 and 3 CSM patients were both 1.2%. Multivariate analysis showed patient age (HR 0.92, 95% CI 0.86–0.98, p = 0.01), meningioma pathology (HR and 95% CI not defined, p = 0.03), and pre-SRS carotid category (HR 4.51, 95% CI 1.77–14.61, p = 0.004) to be associated with ICA stenosis/occlusion. Internal carotid artery stenosis/occlusion was not related to post-SRS tumor growth (HR and 95% CI not defined, p = 0.41).CONCLUSIONSNew or progressive ICA stenosis/occlusion was common after SRS for CSM but was not observed after SRS for GHPA, suggesting a tumor-specific mechanism unrelated to radiation dose. Pre-SRS ICA encasement or constriction increases the risk of ICA stenosis/occlusion; however, the risk of ischemic complications is very low.

“Stroke-Stop” Formula: A Tool for Risk Index Determination in Development of Acute Cerebrovascular Disease in Patients with Asymptomatic Internal Carotid Artery Stenosis

2020 ◽  
Author(s):  
Ivan Kopolovets ◽  
Peter Berek ◽  
Peter Stefanic ◽  
Dmytro Lotnyk ◽  
Rastislav Mucha ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Atherosclerotic Plaque ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Risk Index ◽  
Morphological Structure ◽  
Cerebrovascular Diseases ◽  
Internal Carotid Artery Stenosis ◽  
Ica Stenosis

Abstract Background: Extracranial carotid artery disease is considered a risk factor for developing acute cerebrovascular diseases. The paper presents the “Stroke-Stop” formula proposed for the determination of the risk of developing stroke in patients with asymptomatic internal carotid artery (ICA) stenosis. The formula is based on a mathematical calculation of the major risk factors for stroke: the degree of ICA stenosis, the morphological structure of the atherosclerotic plaque and the level of lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration.Methods: The study included 70 patients with atherosclerotic ICA stenosis. Among vascular inflammatory markers, Lp-PLA2 was determined with concentration 252.7-328.6 mg/l. The obtained results were evaluated using descriptive statistics (the frequency, percentage ratio) as well as the one-way analysis of variance (ANOVA) and chi-square test. Results: The risk of stroke development is eminently increasing with the progression of ICA stenosis and elevation of Lp-PLA2 levels. In patients with soft atherosclerotic plaque, the risk of stroke development was significantly higher in correlation with patients with hard atherosclerotic plaque. Based on calculations using “Stroke-Stop” formula, three main groups were generated: low (<70 points), medium (70 – 100 points) and high (>100 points) risk of stroke development. Conclusions: The “Stroke-Stop” formula may serve as an additional criterion for individual selection of patients with asymptomatic ICA stenosis for carotid endarterectomy. This model could be used as a diagnostic and prognostic tool to identify patients with potentially high risk development of ischemic stroke in clinical praxis.

scholarly journals Internal Carotid Artery Stenosis Presenting with Limb Shaking TIA

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Awad Javaid ◽  
Mostafa Alfishawy
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Clinical Symptoms ◽  
Internal Carotid Artery Stenosis ◽  
Total Occlusion ◽  
Wide Range ◽  
Ischemic Attack ◽  
Ica Stenosis ◽  
Limb Shaking

Internal carotid artery (ICA) stenosis may lead to a wide range of clinical symptoms. We describe the case of a 66-year-old female who experienced a transient ischemic attack (TIA) with episodes of limb shaking caused by ICA stenosis. After epilepsy had been suspected and ruled out, studies of her left ICA showed extensive blockage as a result of atherosclerosis. Magnetic resonance angiography (MRA) revealed total occlusion of the left ICA and the patient was eventually medically managed due to the strong possibility of surgical complications. We reported this patient’s clinical course to shed light on a rare manifestation of carotid stenosis that may be confused with other diagnoses if not closely scrutinized.

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