Elongated internal carotid arteries in patients with severe carotid artery stenosis.

Objective: To investigate the risk factors and asymptomatic cerebrovascular diseases associated with elongated internal carotid arteries (ICAs), and the relationship between ICA elongation and severe carotid artery (CA) stenosis Methods: We evaluated risk factors for stroke and magnetic resonance imaging (MRI) findings in patients with severe CA stenosis compared with people without neurological disorders who underwent brain screening (controls). On Magnetic resonance angiography (MRA) images we measured the longest distance, defined as the ICA distance, from the most distant anterior wall of the cervical ICA at the site of bending or kinking to the line between the origin of the external CA and the anterior protrusion of the ICA near the petrosal bone. We retrospectively compared various asymptomatic findings, including cerebral microbleeds, lacunar infarctions, and deep white matter hyperintensities (WMHs), between participants with an ICA distance ≥ 1.2 cm vs. < 1.2 cm. The prevalence of findings and stroke risk factors were compared using multivariate logistic regression models. Results: We evaluated 53 patients (70.0 ± 8.1 years old, nine female) with severe CA stenosis treated by CA stenting and 400 controls (63.0 ± 9.2 years old, 227 females). Multivariate analyses showed that ICA distance ≥ 1.2 cm was associated with age ≥ 65 years (odds ratio [OR] = 1.8, p < 0.01), severe deep WMHs (OR = 2.0, p = 0.02), and severe CA stenosis (OR = 0.17, p < 0.01). Conclusion: ICA elongation, measured by ICA distance, was positively associated with age and deep WMHs and negatively associated with severe CA stenosis.

Moyamoya Syndrome in a Child with HbEβ-Thalassemia

Moyamoya is a progressive cerebrovascular disease associated with stenosis or occlusion of the arteries of the Circle of Willis. It is uncommon in thalassemia. We present a 9-year-old girl, with HbEβ-thalassemia, who presented with headache, vomiting and episodes of transient hemiparesis with complete occlusion internal carotid arteries.

Numerical simulation flow dynamics of an intracranial aneurysm

BACKGROUND: Computational fluid dynamics provides a new method for the study of the blood flow characteristics of the formation and development of intracranial aneurysms. OBJECTIVE: To compare blood flow characteristics between the healthy internal carotid artery and normal intracranial aneurysms. METHODS: The internal carotid arteries were simulated to obtain hemodynamic parameters in one patient. RESULTS: The internal carotid artery associated with aneurysm presents low wall shear stress, high oscillatory shear index, and high particle retention time compared with the normal internal carotid artery. CONCLUSIONS: There are differences in blood flow between the normal internal carotid artery and intracranial aneurysm. The vortex of the aneurysm will produce turbulence, indicating that it is unstable, which results in the growth and rupture of the aneurysm.

A case report on a rare disorder: Moyamoya

Moyamoya is a rare disease characterized by progressive endpoint stenosis of the internal carotid arteries of the internal intracranial portions due to smooth muscle hypertrophy in the vessel walls. Here, we present the case of a 17-year-old boy who has been admitted to a tertiary care hospital in India with complaints of major headache, multiple vomiting episodes, and difficulty in seeing the right half of things from the past 20 days. The computed tomography (CT) brain, magnetic resonance imaging, and cerebral angiogram were examined for the patient. He has been diagnosed with moyamoya disease based on the evaluation. The patient was, therefore, recommended for cerebral revascularization and performed successfully then discharged with stable condition.

Clinical Management of Moyamoya Patients

Moyamoya angiopathy (MMA) is a peculiar cerebrovascular condition characterized by progressive steno-occlusion of the terminal part of the internal carotid arteries (ICAs) and their proximal branches, associated with the development of a network of fragile collateral vessels at the base of the brain. The diagnosis is essentially made by radiological angiographic techniques. MMA is often idiopathic (moyamoya disease-MMD); conversely, it can be associated with acquired or hereditary conditions (moyamoya Syndrome-MMS); however, the pathophysiology underlying either MMD or MMS has not been fully elucidated to date, and this poor knowledge reflects uncertainties and heterogeneity in patient management. MMD and MMS also have similar clinical expressions, including, above all, ischemic and hemorrhagic strokes, then headaches, seizures, cognitive impairment, and movement disorders. The available treatment strategies are currently shared between idiopathic MMD and MMS, including pharmacological and surgical stroke prevention treatments and symptomatic drugs. No pharmacological treatment able to reverse the progressive disappearance of the ICAs has been found to date in both idiopathic and syndromic cases. Antithrombotic agents are usually prescribed in ischemic MMA, although the coexisting hemorrhagic risk should be considered. Surgical revascularization techniques, which are currently the best available treatment in symptomatic MMA, are associated with good long-term outcomes and reduced ischemic and hemorrhagic risks. Given the lack of dedicated randomized clinical trials, current treatment is mainly based on observational studies and physicians’ and surgeons’ expertise.