Comparison of Elastic Properties of Bilateral Carotid Arteries in Relation to Site of Acute Ischemic Stroke Using Velocity Vector Imaging

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.

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A RARE CASE OF ACUTE ISCHEMIC STROKE AS A RESULT OF SCLEROSING SYPHILITIC LESION OF THE CAROTID ARTERIES

Fundamental and Clinical Medicine ◽

10.23946/2500-0764-2017-2-1-121-126 ◽

2017 ◽

Vol 2 (1) ◽

pp. 121-126

Author(s):

A.V. Subbotin ◽

◽

V.A. Semenov ◽

D.A. Etenko ◽

S.V. Moschnegootz ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Rare Case ◽

Carotid Arteries

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Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of Undetermined Source

Stroke ◽

10.1161/strokeaha.120.029404 ◽

2020 ◽

Vol 51 (6) ◽

pp. 1743-1749 ◽

Cited By ~ 4

Author(s):

Johanna M. Ospel ◽

Nishita Singh ◽

Martha Marko ◽

Mohammed Almekhlafi ◽

Dar Dowlatshahi ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Computed Tomography Angiography ◽

Embolic Stroke ◽

Large Artery ◽

Carotid Plaques ◽

Stroke Etiology ◽

Bilateral Carotid ◽

Multicenter Prospective Study

Background and Purpose— Embolic stroke of undetermined source (ESUS) constitutes a large proportion of acute ischemic stroke. It is crucial to identify possible stroke etiologies in this patient subgroup to individually tailor secondary stroke prevention strategies. This study aimed to assess the prevalence of carotid plaques causing <50% stenosis in ESUS patients on computed tomography angiography and the association of these plaques with ipsilateral strokes. Methods— Patients from INTERRSeCT—a multicenter prospective study of patients with acute ischemic stroke—were included in this study if their stroke etiology was not large artery atherosclerosis (>50% stenosis), and neck computed tomography angiography was obtained. Degree of stenosis (<30% versus 30%–50%), maximum plaque thickness, degree of plaque calcification (<50% versus ≥50%), plaque irregularity, ulceration, hypodensity, carotid web, and focal vessel outpouching were assessed for both carotid arteries on computed tomography angiography. Prevalence of carotid plaques with <50% stenosis (nonstenotic plaques), ipsilateral and contralateral to the stroke, in ESUS patients was determined and compared with non-ESUS patients. Features of these plaques with versus without ipsilateral stroke in ESUS patients were compared. Uni- and multivariable logistic regression was performed to determine associations between nonstenotic carotid plaque, plaque characteristics, and ipsilateral stroke in ESUS patients. Results— Four hundred forty-six patients were included in the study (median age, 73 years; 218 men), 138 of which were ESUS patients (median age, 70 years; 61 men). Nonstenotic carotid plaques (with <50% stenosis) were present in 54 of 138 (39.1%) ESUS patients. Twelve (8.7%) patients had bilateral carotid plaques. Forty (60.6%) of these plaques were ipsilateral and 26 (39.4%) contralateral to the side of the stroke ( P =0.004). Nonstenotic carotid plaques were significantly associated with ipsilateral strokes (adjusted odds ratio, 1.83 [95% CI, 1.05–3.18]). Conclusions— In patients with ESUS, nonstenotic carotid plaques were significantly more common on the side of the ischemic stroke, suggesting that these plaques could be a potential stroke etiology in patients in whom the ischemic stroke is classified currently as ESUS.

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Velocity Vector Imaging to Assess Longitudinal Wall Motion of Adult Carotid Arteries

Journal of Ultrasound in Medicine ◽

10.1002/jum.15501 ◽

2020 ◽

Author(s):

Jing Gao ◽

Juhyun Lee ◽

Andrew Phan ◽

J. Brian Fowlkes

Keyword(s):

Velocity Vector ◽

Wall Motion ◽

Carotid Arteries ◽

Velocity Vector Imaging ◽

Longitudinal Wall

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The Feasibility of Velocity Vector Imaging by Transesophageal Echocardiography for Assessment of Elastic Properties of the Descending Aorta in Aortic Valve Disease

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2010.06.021 ◽

2010 ◽

Vol 23 (9) ◽

pp. 985-992 ◽

Cited By ~ 22

Author(s):

Johan Petrini ◽

Mohamed Yousry ◽

Anette Rickenlund ◽

Jan Liska ◽

Anders Hamsten ◽

...

Keyword(s):

Aortic Valve ◽

Transesophageal Echocardiography ◽

Elastic Properties ◽

Aortic Valve Disease ◽

Velocity Vector ◽

Valve Disease ◽

Descending Aorta ◽

Velocity Vector Imaging

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An Extensive Stanford Type A Aortic Dissection Involving Bilateral Carotid and Iliac Arteries

Case Reports in Radiology ◽

10.1155/2013/607012 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

E. W. Lee ◽

N. Jourabchi ◽

S. C. Sauk ◽

D. Lanum

Keyword(s):

Ischemic Stroke ◽

Aortic Dissection ◽

Thrombolytic Therapy ◽

Carotid Arteries ◽

Signs And Symptoms ◽

Chronic Hypertension ◽

Bilateral Carotid ◽

History Of ◽

The Right ◽

Common Carotid Arteries

We present a rare case of continuous, extensive aortic dissection (AD) involving the bilateral common carotid arteries, the ascending, thoracic, and abdominal aorta, and bifurcation of the right common iliac artery. A 61-year-old man with history of chronic hypertension presented with a one-day history of chest pain, vertigo, left facial drooping, and left hemiparesis. Despite the presence of bilateral carotid bruits, doppler ultrasound of the neck was postponed, and the patient was treated with thrombolytic therapy for a presumed ischemic stroke. The patient's symptoms began to resolve within an hour of treatment, at which time treatment was withheld. Ultrasound performed the following day showed dissection of bilateral common carotid arteries, and CT angiography demonstrated extensive AD as described earlier. The patient subsequently underwent cardiovascular surgery and has been doing clinically well since then. AD has a myriad of manifestations depending on the involvement of aortic branches. Our paper illustrates the importance of having a high index of suspicion for AD when a patient presents with a picture of ischemic stroke, since overlapping signs and symptoms exist between AD and stroke. Differentiating between the two conditions is central to patient care as thrombolytic therapy can be helpful in stroke, but detrimental in AD.

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