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NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS
Official Journal of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics
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carotid artery
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1.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, Vol. 1, 2005
,
,
,
Course of
carotid
artery
occlusion with impaired cerebrovascular reactivity.
Kleise B, Widder B.
Course of carotid artery occlusion with impaired cerebrovascular reactivity.
read the entire text >>
Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with
carotid
artery
stenosis and occlusion.
Markus H, Culliane M.
Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
read the entire text >>
Dynamic cerebral autoregulation testing as a diagnostic tool in patients with
carotid
artery
stenosis.
Reinhard M, Hetzel A, Lauk M, Lucking C.
Dynamic cerebral autoregulation testing as a diagnostic tool in patients with carotid artery stenosis.
read the entire text >>
Cerebral autoregulation in
carotid
artery
occlusive disease assessed from spontaneous blood pressure fluctuations by the Correlation Coefficient Index.
Reinhard M, Roth M, Muller DT, Czosnyca M, Hetzel.
Cerebral autoregulation in carotid artery occlusive disease assessed from spontaneous blood pressure fluctuations by the Correlation Coefficient Index.
read the entire text >>
Assessment of cerebral autoregulation using
carotid
artery
compression.
Smielewski P, Czosnyka M, Kirkpatrick P, McEroy H, Rutkowska H, Pickard JD.
Assessment of cerebral autoregulation using carotid artery compression.
read the entire text >>
Transcranial Doppler and Near –Infrared Spectroscopy Can Evaluate the Hemodynamic Effect of
Carotid
Artery
Occlusion.
Vernieri F, Tibuzzi F, Pasqualetti P, RosatoN, Passarelli F, Rossini PM, Silvestrini M.
Transcranial Doppler and Near –Infrared Spectroscopy Can Evaluate the Hemodynamic Effect of Carotid Artery Occlusion.
read the entire text >>
Transcranial Doppler CO2 test for the detection of hemodynamically critical
carotid
artery
stenoses and occlusions.
Widder B, Paulat K, Hacksprachner J, Mayer E.
Transcranial Doppler CO2 test for the detection of hemodynamically critical carotid artery stenoses and occlusions.
read the entire text >>
Impaired dynamic cerebral autoregulation in
carotid
artery
stenosis.
White RP, Markus HS.
Impaired dynamic cerebral autoregulation in carotid artery stenosis.
Stroke, 28, 1997: 1340 – 1344.
read the entire text >>
2.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 1, 2005, No. 2
,
,
,
The Present Status of Diagnosis and Treatment of
Carotid
Artery
Stenosis
The Present Status of Diagnosis and Treatment of Carotid Artery Stenosis
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The Present Status of Diagnosis and Treatment of
Carotid
Artery
Stenosis
The Present Status of Diagnosis and Treatment of Carotid Artery Stenosis
read the entire text >>
An important cause of transient ischemic attack (TIA) and stroke is atherosclerotic
carotid
artery
stenosis.
An important cause of transient ischemic attack (TIA) and stroke is atherosclerotic carotid artery stenosis.
It accounts for about 20% of cases of brain infarction and has the highest recurrent stoke risk compared to all other subtypes of stroke [2, 3]. Therefore, rapid intervention in this patient group is needed and they should be managed efficiently to minimize the incidence of stroke.
read the entire text >>
Intraarterial digital subtraction angiography (DSA) is the gold standard for identification and quantification of
carotid
artery
stenosis.
Intraarterial digital subtraction angiography (DSA) is the gold standard for identification and quantification of carotid artery stenosis.
Nonetheless, other non-invasive methods are
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The most common sites for plaque formation – the origin of the common
carotid
artery
(12.4%), the internal
carotid
artery
(ICA) just above the bifurcation (22.3%), the origin of the middle cerebral
artery
(4.1%) and the basilar
artery
(8.7%) – can be examined in large majority of patients.
also used: duplex ultrasound (DUS), computed tomography angiography (CTA) and contrast enhanced magnetic resonance angiography (CEMRA). Duplex and transcranial ultrasound examination is most often used in everyday practice. It is less expensive, reliable and suitable for bedside diagnosis.
The most common sites for plaque formation – the origin of the common carotid artery (12.4%), the internal carotid artery (ICA) just above the bifurcation (22.3%), the origin of the middle cerebral artery (4.1%) and the basilar artery (8.7%) – can be examined in large majority of patients.
read the entire text >>
reported that the most costeffective diagnostic strategy is the use of DUS and CEMRA in
carotid
artery
stenosis.
U-King-Im et al.
reported that the most costeffective diagnostic strategy is the use of DUS and CEMRA in carotid artery stenosis.
Only if the DUS is negative and the CEMRA is positive, DSA should be performed [6].
read the entire text >>
Patients with symptomatic
carotid
artery
stenosis should be treated in order to reduce their mostly embolic and in a lesser degree hemodynamic risk of stroke.
Patients with symptomatic carotid artery stenosis should be treated in order to reduce their mostly embolic and in a lesser degree hemodynamic risk of stroke.
Depending on the patient’s overall condition, his age and the degree of stenosis, medication, surgery and less invasive endovascular treatment may be considered.
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Carotid
artery
angioplasty with stenting is the second choice and is currently being used on selected patients who are at high risk for surgery and in controlled clinical trials.
The standard surgical treatment, carotid endarterectomy, has been widely used.
Carotid artery angioplasty with stenting is the second choice and is currently being used on selected patients who are at high risk for surgery and in controlled clinical trials.
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In 1954 the first endarterectomy has been performed in a patient with symptomatic
carotid
artery
stenosis.
In 1954 the first endarterectomy has been performed in a patient with symptomatic carotid artery stenosis.
Over the years it evolved and became a routine surgical treatment for carotid stenosis although no adequate clinical trials confirmed its benefits. In 1998, two large randomized controlled trials of endarterectomy versus medical treatment published their final results. Although their design was similar, differences in inclusion and exclusion criteria, methods of determining degree of stenosis and definitions of outcome events existed. The Veterans Affairs Trial was the third trial and was stopped when initial results of the two large trials were published in 1991.
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Diagnosis and treatment of
carotid
artery
stenosis
Diagnosis and treatment of carotid artery stenosis
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According to this overview, conventional angiography or one of the non-invasive investigations may be used to visualize and determine the degree of
carotid
artery
stenosis.
In 2003, the European Stroke Initiative (EUSI) Executive Committee updated an overview of established and widely used therapeutic strategies first published in 2000.
According to this overview, conventional angiography or one of the non-invasive investigations may be used to visualize and determine the degree of carotid artery stenosis.
The patients suitable for CEA are those with stenosis greater then 70% and without a severe neurological deficit with recent (
read the entire text >>
Diagnosis and treatment of
carotid
artery
stenosis
Diagnosis and treatment of carotid artery stenosis
read the entire text >>
Although several trials showed that
carotid
artery
is as safe and effective as CEA, its use
Although several trials showed that carotid artery is as safe and effective as CEA, its use
read the entire text >>
Updated rewiew of the global
carotid
artery
stent registry.
Wholey MH, Al-Mubarek N, Wholey MH;Peripheral Vascular Disease.
Updated rewiew of the global carotid artery stent registry.
read the entire text >>
Protected
carotid
-
artery
stenting versus endarterectomy in high-risck patients.
Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ et al; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators.
Protected carotid-artery stenting versus endarterectomy in high-risck patients.
read the entire text >>
Occipital lobe infarction from a
carotid
artery
embolic source.
Balcer L, Galetta S, Hurst R, et al.
Occipital lobe infarction from a carotid artery embolic source.
read the entire text >>
Clinical features of transient monocular blindness and the likelihood of atherosclerotic lesions of the internal
carotid
artery
.
Donders R.
Clinical features of transient monocular blindness and the likelihood of atherosclerotic lesions of the internal carotid artery.
read the entire text >>
Use of orbital color Doppler imaging for detecting internal
carotid
artery
stenosis in patients with amaurosis fugax.
Fujioka S.
Use of orbital color Doppler imaging for detecting internal carotid artery stenosis in patients with amaurosis fugax.
read the entire text >>
Venous stasis retinopathy in symptomatic
carotid
artery
occlusion: prevalance,cause and outcome.
Klijn C, Kapelle L, Schooneveld M, et al.
Venous stasis retinopathy in symptomatic carotid artery occlusion: prevalance,cause and outcome.
read the entire text >>
Ocular findings as predictors of
carotid
artery
occlusive disease: is
carotid
imaging justified?
McCullough H, Reinert C, Hynan L, et al.
Ocular findings as predictors of carotid artery occlusive disease: is carotid imaging justified?
read the entire text >>
The relation of retinal
artery
occlusion and
carotid
artery
stenosis.
Merchut M, Gupta S, Naheedy M.
The relation of retinal artery occlusion and carotid artery stenosis.
read the entire text >>
Carotid
artery
disease and the Eye.
Sanborn G, Magargal L.
Carotid artery disease and the Eye.
In: Clinical Ophthalmology, 1988, vol.3, Eds. Th. Duane and Ed. Jaeger, Lippincott Comp, Philadelphia, chap.14A, 1-12.
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Weber J, Kirsch E, Radu E, et al.Angioplasty in a patient with ocular ischemia due to occlusion of the internal and stenosis of the external
carotid
artery
.
Weber J, Kirsch E, Radu E, et al.Angioplasty in a patient with ocular ischemia due to occlusion of the internal and stenosis of the external carotid artery.
read the entire text >>
A case report of neovascular glaucoma due to
carotid
artery
occlusive disease diagnosis of neovascular glaucoma and histological characteristics.
Yoshinami M, Hamanaka T, Kawano H, et al.
A case report of neovascular glaucoma due to carotid artery occlusive disease diagnosis of neovascular glaucoma and histological characteristics.
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to reveal the role of the cerebrovascular risk factors (RF) separately or in combination for the appearance of microembolic signals (MES) in patients with
carotid
artery
diseases.
to reveal the role of the cerebrovascular risk factors (RF) separately or in combination for the appearance of microembolic signals (MES) in patients with carotid artery diseases.
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One hundred patients (85 men and 15 women, age range 50–92 years, mean age 69 years) with 120 internal
carotid
artery
obstructions were included: 69 were moderate grade (30–69%), 38 were high grade (70–99%) stenoses, and 13 were
carotid
thromboses.
One hundred patients (85 men and 15 women, age range 50–92 years, mean age 69 years) with 120 internal carotid artery obstructions were included: 69 were moderate grade (30–69%), 38 were high grade (70–99%) stenoses, and 13 were carotid thromboses.
Among them 74% were asymptomatic and 26%
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7 symptomatic), in 3 patients with moderate grade stenosis (1 asymptomatic and 2 symptomatic) and in 1 patient with asymptomatic
carotid
artery
thrombosis.
7 symptomatic), in 3 patients with moderate grade stenosis (1 asymptomatic and 2 symptomatic) and in 1 patient with asymptomatic carotid artery thrombosis.
No relationship was found between MES, age and sex of the patients and any of the studied cerebrovascular risk factors individually or in combination.
read the entire text >>
The existence of cerebrovascular factors (age, sex, dyslipidemia, smoking, diabetes, arterial hypertension, peripheral
artery
diseases and ischemic heart diseases) – individually or in combination, does not influence the appearance of MES in patients with symptomatic or asymptomatic
carotid
artery
diseases.
MES were more prevalent in patients with high grade stenoses as well as in those with symptomatic stenoses.
The existence of cerebrovascular factors (age, sex, dyslipidemia, smoking, diabetes, arterial hypertension, peripheral artery diseases and ischemic heart diseases) – individually or in combination, does not influence the appearance of MES in patients with symptomatic or asymptomatic carotid artery diseases.
read the entire text >>
Quantification of atheromatous stenosis in the extracranial internal
carotid
artery
.
De Bray J, Glatt B.
Quantification of atheromatous stenosis in the extracranial internal carotid artery.
read the entire text >>
G. Histologic characteristics of
carotid
artery
plaque.
G. Histologic characteristics of carotid artery plaque.
read the entire text >>
Low levels of highdensity lipoprotein cholesterol are associated with echolucent
carotid
artery
plaque: the Tromso study.
Mathiesen E, Bonaa K, Joakimsen O.
Low levels of highdensity lipoprotein cholesterol are associated with echolucent carotid artery plaque: the Tromso study.
read the entire text >>
Cerebral microembolism and the risk of ischemia in asymptomatic high-grade internal
carotid
artery
stenosis.
Siebler M, Nachtmann A, Sitzer M, Rose G, Kleinschmidt A, Raemacher J, Steinmetet H.
Cerebral microembolism and the risk of ischemia in asymptomatic high-grade internal carotid artery stenosis.
read the entire text >>
Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal
carotid
artery
stenosis.
Sitzer M, Muller W, Siebler M, Hort W, Kniemeyer H, Jancke L, Steinmetz H.
Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis.
read the entire text >>
Transcranial doppler detected cerebral microemboli in asymptomatic
carotid
artery
stenosis and in healthy elderly volunteers.
Watkins S, Levi C, Grosset D, Donnan G.
Transcranial doppler detected cerebral microemboli in asymptomatic carotid artery stenosis and in healthy elderly volunteers.
read the entire text >>
3.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 1
,
,
,
The results from a study of the polymorphism of the metalloproteinase gene (MMP-3) show structural and functional changes in the common
carotid
artery
(CCA) in homozygous for the 6A allele which contribute to formation of
carotid
plaques.
4 алела на APOE. Връзката между генетичните вариации на ензима метилен тетрахидрофолат редуктаза с каротидната атеросклероза е противоречива. Проучвания върху полиморфизма на гена за параоксоназа 1 (PON 1) са показали по-висок индекс на плаките при LL хомозиготите, по-често срещан L алел при случаите със стенози, по-висока стойност на дебелината на ИМК при лица с генотип LL/QQ. Установена е връзка между полиморфизма на E 298 D (894 GT) polymorphism of the endothelial nitric-oxide synthase (eNOS) and the atherosclerotic plaques in different carotid vessel segments and with carotid IMT.
The results from a study of the polymorphism of the metalloproteinase gene (MMP-3) show structural and functional changes in the common carotid artery (CCA) in homozygous for the 6A allele which contribute to formation of carotid plaques.
read the entire text >>
Relation between coronary
artery
disease, risk factors and intima-media thickness of
carotid
artery
, arterial distensibility, and stiffness index.
Alan S, Ulgen MS, Ozturk O, Alan B, Ozdemir L, Toprak N.
Relation between coronary artery disease, risk factors and intima-media thickness of carotid artery, arterial distensibility, and stiffness index.
read the entire text >>
Family history of coronary heart disease and pre-clinical
carotid
artery
atherosclerosis in African-Americans and whites: the ARIC study: Atherosclerosis Risk in Communities. Genet
Bensen JT, Li R, Hutchinson RG, Province MA, Tyroler HA.
Family history of coronary heart disease and pre-clinical carotid artery atherosclerosis in African-Americans and whites: the ARIC study: Atherosclerosis Risk in Communities. Genet
read the entire text >>
Relationship of the apolipoprotein E polymorphism with
carotid
artery
atherosclerosis.
de Andrade M, Thandi I, Brown S, Gotto A, Jr., Patsch W, Boerwinkle E.
Relationship of the apolipoprotein E polymorphism with carotid artery atherosclerosis.
read the entire text >>
J. Genetic basis of variation in
carotid
artery
wall thickness.
J. Genetic basis of variation in carotid artery wall thickness.
read the entire text >>
Genomewide linkage analysis for internal
carotid
artery
intimal medial thickness: evidence for linkage to chromosome 12.
Fox CS, Cupples LA, Chazaro I, Polak JF, Wolf PA, D’Agostino RB, Ordovas JM, O’Donnell CJ.
Genomewide linkage analysis for internal carotid artery intimal medial thickness: evidence for linkage to chromosome 12.
read the entire text >>
Genetic basis of variation in
carotid
artery
plaque in the San Antonio Family Heart Study.
Hunt KJ, Duggirala R, Goring HH, Williams JT, Almasy L, Blangero J, O’Leary DH, Stern MP.
Genetic basis of variation in carotid artery plaque in the San Antonio Family Heart Study.
read the entire text >>
Heritability of
carotid
artery
intima-medial thickness in type 2 diabetes.
Lange LA, Bowden DW, Langefeld CD, Wagenknecht LE, Carr JJ, Rich SS, Riley WA, Freedman BI.
Heritability of carotid artery intima-medial thickness in type 2 diabetes.
read the entire text >>
T. Heritability of
carotid
artery
atherosclerotic lesions.
T. Heritability of carotid artery atherosclerotic lesions.
read the entire text >>
Heritability of
carotid
artery
structure and function: the Strong Heart Family Study.
North KE, MacCluer JW, Devereux RB, Howard BV, Welty TK, Best LG, Lee ET, Fabsitz RR, Roman MJ.
Heritability of carotid artery structure and function: the Strong Heart Family Study.
read the entire text >>
Carotid
-
artery
intima and media thickness as a risk factor for myocardial infarction and stroke in older adults.
O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr.
Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults.
Cardiovascular Health Study Collaborative Research Group.
read the entire text >>
Stromelysin-1 and interleukin-6 gene promoter polymorphisms are determinants of asymptomatic
carotid
artery
atherosclerosis.
Rauramaa R, Vaisanen SB, Luong LA, Schmidt-Trucksass A, Penttila IM, Bouchard C, Toyry J, Humphries SE.
Stromelysin-1 and interleukin-6 gene promoter polymorphisms are determinants of asymptomatic carotid artery atherosclerosis.
read the entire text >>
Angiotensin-converting enzyme gene polymorphism and
carotid
artery
wall thickness.
Sayed-Tabatabaei FA, Houwing-Duistermaat JJ, van Duijn CM, Jacqueline C.M. Witteman JCM.
Angiotensin-converting enzyme gene polymorphism and carotid artery wall thickness.
read the entire text >>
4.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 2
,
,
,
Cerebral vasoreactivity in unilateral
carotid
artery
disease.
Dahl A, Russel D, Nyberg-Hansen R et al.
Cerebral vasoreactivity in unilateral carotid artery disease.
A comparison of blood flow velocity and regional cerebral blood flow measurements.
read the entire text >>
Course of
carotid
artery
occlusions with impaired cerebrovascular reactivity.
Kleiser B, Widder B.
Course of carotid artery occlusions with impaired cerebrovascular reactivity.
read the entire text >>
Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with
carotid
artery
stenosis and occlusion.
Markus H, Cullinane M.
Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
read the entire text >>
and L-Arginine in patients with severe internal
carotid
artery
stenosis; preand post-surgical evaluation with tran-
and L-Arginine in patients with severe internal carotid artery stenosis; preand post-surgical evaluation with tran-
read the entire text >>
Acetazolamide stimulation test in patients with unilateral internal
carotid
artery
obstructions using transcranial Doppler and 99mTcHMPAO-SPECT.
Rosenkranz K, Hierholzer J, Langer R et al.
Acetazolamide stimulation test in patients with unilateral internal carotid artery obstructions using transcranial Doppler and 99mTcHMPAO-SPECT.
read the entire text >>
Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic
carotid
artery
stenosis.
Silvestrini M, Vernieri F, Pasqualetti P et al.
Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis.
read the entire text >>
Evaluation by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal
carotid
artery
.
Vorstrup S, Brun B, Lassen NA.
Evaluation by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery.
read the entire text >>
Early Recanalization Rates and Clinical Outcomes in Patients With Tandem Internal
Carotid
Artery
/Middle Cerebral
Artery
Occlusion and Isolated Middle Cerebral
Artery
Occlusion.
Kim YS, Garami Z, Mikulik R, Molina CA, Alexandrov AV for the CLOTBUST Collaborators.
Early Recanalization Rates and Clinical Outcomes in Patients With Tandem Internal Carotid Artery/Middle Cerebral Artery Occlusion and Isolated Middle Cerebral Artery Occlusion.
read the entire text >>
5.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 1
,
,
,
The use of vasodilatating medication can cause ischemic attack in a region of subcompensated circulation (as in asymptomatic stenosis of the
carotid
artery
).
The use of vasodilatating medication can cause ischemic attack in a region of subcompensated circulation (as in asymptomatic stenosis of the carotid artery).
Giving vasodilatating drugs in vertebrobasilar insufficiency sometimes deepened the symptomatic, and this is not always the “steal
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Transcranial Doppler Ultrasonography of the Middle Cerebral
Artery
in the Hemodynamic Assessment of Internal
Carotid
Artery
Stenosis.
Kelley RE, Namon RA, Shing-Her-Juang, Lee SC, Chang JY.
Transcranial Doppler Ultrasonography of the Middle Cerebral Artery in the Hemodynamic Assessment of Internal Carotid Artery Stenosis.
Arch Neurol – Vol. 47, 1990.
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Association of transient ischemic attack/stroke symptoms assessed by standardized questionnaire and algorithm with cerebrovascular risk factors and
carotid
artery
wall thickness.
Chambless LE, Shahar E, Sharrett AR, Heiss G, Wijnberg L, Paton CC, Sorlie P, Toole JF.
Association of transient ischemic attack/stroke symptoms assessed by standardized questionnaire and algorithm with cerebrovascular risk factors and carotid artery wall thickness.
The ARIC Study, 1987-1989.
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The relationship between age and
carotid
artery
intima-media thickness, hemoglobin A1c in nondiabetic, healthy geriatric population.
Doruk H, Mas MR, Ateskan U, Isik AT, Saglam M, Kutlu M.
The relationship between age and carotid artery intima-media thickness, hemoglobin A1c in nondiabetic, healthy geriatric population.
read the entire text >>
6.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 2
,
,
,
Antithrombotic Drug Therapy in Patients with
Carotid
Artery
Stenosis
Antithrombotic Drug Therapy in Patients with Carotid Artery Stenosis
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Antithrombotic Drug Therapy in Patients with
Carotid
Artery
Stenosis
Antithrombotic Drug Therapy in Patients with Carotid Artery Stenosis
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Patients with
carotid
artery
stenosis need prevention, because the risk for vascular complications is high.
Patients with carotid artery stenosis need prevention, because the risk for vascular complications is high.
In symptomatic patients in the NASCET study [1], two-year stroke risk was 26% in the ipsilateral artery (stenosis >70%) in the medical group, and 10-year CHD-mortality has been estimated to be as high as 30% in the ECST trial [2]. In asymptomatic patients of the ACAS study [3], the annual risk of ipsilateral stroke was 2%. Annual risk of MI or cardiac death was as well 2%, but estimated 10-year CHD mortality rate was not less than 19% [2].
read the entire text >>
Symptomatic
carotid
artery
stenosis
Symptomatic carotid artery stenosis
read the entire text >>
Therefore, the best possible antithrombotictherapyforsecondaryprevention should be selected according to the individual needs,especiallytolerabilityinsymptomatic patients with
carotid
artery
stenosis, antithrombotic therapy should be initiated as soon as the diagnosis of a TIA or cerebral infarction has been made [5].
Patients with stroke are prone to a recurrent stroke [4].
Therefore, the best possible antithrombotictherapyforsecondaryprevention should be selected according to the individual needs,especiallytolerabilityinsymptomatic patients with carotid artery stenosis, antithrombotic therapy should be initiated as soon as the diagnosis of a TIA or cerebral infarction has been made [5].
Alternative choices are acetylsalicylic acid (ASA) [6], a combination of ASA and extended release dipyridamole (DP) [7, 8], or clopidogrel [9]. At present, the first choice is the combination of ASA + extended release DP. The regimen used in ESPS2 trial [7] (ASA 25 mg x 2/d + DP 200 mg x 2/d) diminished the risk of brain infarct 21.3% when compared with treatment with ASA alone without increasing the risk of bleeding (absolute risk reduction 3.0% dur-
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Asymptomatic
carotid
artery
stenosis
Asymptomatic carotid artery stenosis
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There is evidence that antithrombotic therapy is not effective in prevention of ischemic events in asymptomatic patients with
carotid
artery
stenosis [12, 13].
There is evidence that antithrombotic therapy is not effective in prevention of ischemic events in asymptomatic patients with carotid artery stenosis [12, 13].
However, the patient with asymptomatic carotid stenosis is at even higher risk of acute myocardial infarction and vascular death than for stroke itself. Therefore, ASA in small dose is recommended for those patients who have increased risk of cardiovascular disease. The benefit of the drug is greater than adverse events if the calculated 10-year risk of MI is more than 10% [14]. Asymptomatic carotid stenosis of >50% with or without other symptoms and/or signs of atherosclerosis could be considered as a CHD equivalent. In this in-
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Endarterectomu for asymptomatic
carotid
artery
stenosis.
Executive Committee for the the Asymptomatic Carptid Atherosclerosis study.
Endarterectomu for asymptomatic carotid artery stenosis.
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Carotid
artery
intimalmedial wall thickening and plasma homocysteine in asymptomatic adults.
Malinow MR, Nieto FJ, Szklo M et al.
Carotid artery intimalmedial wall thickening and plasma homocysteine in asymptomatic adults.
The Atherosclerosis Risk in Communities Study.
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sex) and some modifiable (hypertension, diabetes, atrial fibrillation or other cardiac conditions, dyslipidemia,
carotid
artery
stenoses, obesity) RF for CVD were evaluated.
sex) and some modifiable (hypertension, diabetes, atrial fibrillation or other cardiac conditions, dyslipidemia, carotid artery stenoses, obesity) RF for CVD were evaluated.
In 67 subjects with RF, 57 patients with CVD (31 with TIAs and 26 with CUI) and 16 healthy volunteers correlative clinical, neurosonographic and echocardiographic investigations were performed.
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Prevalence of significant
carotid
artery
stenosis in patients with transient ischemic attack.
Rappeport Y, Simonsen L, Christianen H, Boysen G.
Prevalence of significant carotid artery stenosis in patients with transient ischemic attack.
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7.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 1
,
,
,
Ultrasound B-flow Imaging of Spontaneous Internal
Carotid
Artery
Dissection
Ultrasound B-flow Imaging of Spontaneous Internal Carotid Artery Dissection
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detectable. Oscillating flow pattern in the middle cerebral
artery
correlated with the angiographic flow arrest at the internal
carotid
artery
.
detectable. Oscillating flow pattern in the middle cerebral artery correlated with the angiographic flow arrest at the internal carotid artery.
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In 205 patients a
carotid
stenosis of 60% and more was established for internal
carotid
artery
(ICA).
Using Color duplex sonogrpahy 1013 patients with peripheral arterial illness, ICH, transient ischemic attacks and cerebral ischemic stroke were screened for carotid pathology.
In 205 patients a carotid stenosis of 60% and more was established for internal carotid artery (ICA).
These patients were divided into three groups – patients with asymptomatic carotid stenosis (ACS), patients with symptomatic carotid stenosis (SCS) and patients with multifocal arteriosclerosis MFA – carotid
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de Virgilio C, Toosie K, Arnell T, Lewis RJ, Donayre CE, Baker JD.Asymptomatic
carotid
artery
stenosis screening in patients with lower extremity atherosclerosis: a prospective study.
de Virgilio C, Toosie K, Arnell T, Lewis RJ, Donayre CE, Baker JD.Asymptomatic carotid artery stenosis screening in patients with lower extremity atherosclerosis: a prospective study.
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Endarterectomy for asymptomatic
carotid
artery
stenosis.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.
Endarterectomy for asymptomatic carotid artery stenosis.
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Cerebrovascular disease assessed by colorflow and power Doppler ultrasonography: comparison with digital subtraction angiography in internal
carotid
artery
stenosis.
Griewig B, Morgenstern C, Driesner F, Kallwellis G, Walker ML, Kessler C.
Cerebrovascular disease assessed by colorflow and power Doppler ultrasonography: comparison with digital subtraction angiography in internal carotid artery stenosis.
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Safety of
carotid
artery
stenting for symptomatic
carotid
artery
disease: a metaanalysis.
Gurm HS, Nallamothu BK, Yadav J.
Safety of carotid artery stenting for symptomatic carotid artery disease: a metaanalysis.
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Sumner Prospective evaluation of new duplex criteria to identify 70% internal
carotid
artery
stenosis.
Hood D, Mattos M, Mansour A, Ramsey D, Hodgson K, Barkmeier LD.
Sumner Prospective evaluation of new duplex criteria to identify 70% internal carotid artery stenosis.
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Huston J 3rd, James EM, Brown RD Jr, Lefsrud RD, Ilstrup DM, Robertson EF, Meyer FB, Hallett JW.Redefined duplex ultrasonographic criteria for diagnosis of
carotid
artery
stenosis.
Huston J 3rd, James EM, Brown RD Jr, Lefsrud RD, Ilstrup DM, Robertson EF, Meyer FB, Hallett JW.Redefined duplex ultrasonographic criteria for diagnosis of carotid artery stenosis.
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Correlation of North American Symptomatic
Carotid
Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal
carotid
artery
stenosis with duplex scanning.
Moneta GL, Edwards JM, Chitwood RW, Taylor LM Jr, Lee RW,.
Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning.
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Assessment of
carotid
artery
stenosis by ultrasonography, conventional angiography, and magnetic resonance angiography: correlation with ex vivo measurement of plaque stenosis.
Pan X, Saloner D, Reilly L, Bowersox J, Murray S, Anderson C, Gooding G, Rapp J.
Assessment of carotid artery stenosis by ultrasonography, conventional angiography, and magnetic resonance angiography: correlation with ex vivo measurement of plaque stenosis.
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The value of internal
carotid
systolic velocity ratio for assessing
carotid
artery
stenosis with Doppler sonography.
Soulez G, Therasse E, Robillard P, Fontaine A, Denbow N, Bourgouin P and Oliva VL.
The value of internal carotid systolic velocity ratio for assessing carotid artery stenosis with Doppler sonography.
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B-mode flow imaging of the
carotid
artery
.
Umemura A, Yamada K.
B-mode flow imaging of the carotid artery.
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Transcranial Doppler Ultrasound Battery Reliably Identifies Sever Internal
Carotid
Artery
Stenosis.
Wilterdink JL, Feldmann E, Furie KL, Bragoni M, Benavides JG.
Transcranial Doppler Ultrasound Battery Reliably Identifies Sever Internal Carotid Artery Stenosis.
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Ultrasound B-flow Imaging of Spontaneous Internal
Carotid
Artery
Dissection
Ultrasound B-flow Imaging of Spontaneous Internal Carotid Artery Dissection
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: The aim of this study is to demonstrate the diagnostic abilities of B-flow imaging (BFI) as a relatively new ultrasound method for diagnosis of internal
carotid
artery
(ICA) dissection.
: The aim of this study is to demonstrate the diagnostic abilities of B-flow imaging (BFI) as a relatively new ultrasound method for diagnosis of internal carotid artery (ICA) dissection.
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Spontaneous
Carotid
Artery
Dissection
Spontaneous Carotid Artery Dissection
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Spontaneous
Carotid
Artery
Dissection
Spontaneous Carotid Artery Dissection
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History of spontaneous dissection of the cervical
carotid
artery
.
de Bray JM, Baumgartner RW.
History of spontaneous dissection of the cervical carotid artery.
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Stroke patterns of internal
carotid
artery
dissection in 40 patients.
Lucas C, Moulin T, Deplanque D, Tatu L, Chavot D.
Stroke patterns of internal carotid artery dissection in 40 patients.
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Traumatic
Carotid
Artery
Dissection and Pseudoaneurysm Treated With Endovascular Coils and Stent Journal of
Matsuura JH, Rosenthal D, Jerius H, Clark MD.
Traumatic Carotid Artery Dissection and Pseudoaneurysm Treated With Endovascular Coils and Stent Journal of
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B-flow imaging of low cervical internal
carotid
artery
dissection.
Tola M, Yurdakul M, Cumhur T.
B-flow imaging of low cervical internal carotid artery dissection.
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Ultrasound criteria for diagnosing a dissection of the internal
carotid
artery
.
Arning C.
Ultrasound criteria for diagnosing a dissection of the internal carotid artery.
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Head pain in non-traumatic
carotid
artery
dissection – a series of 65 patients.
Biousse V, D’Anglejan-Chatillon J, Massiou H, Bousser M.
Head pain in non-traumatic carotid artery dissection – a series of 65 patients.
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Internal
carotid
artery
Guillon B, Levy C, Bousser MG.
Internal carotid artery
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Stroke patterns of internal
carotid
artery
dissection in 40 patients.
Lucas С, Moulin T, Deplanque D, Tatu L, Chavot D.
Stroke patterns of internal carotid artery dissection in 40 patients.
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Transcranial doppler in the evaluation of internal
carotid
artery
dissection.
Srinivasan J, Newell D, Sturzenegger M et al.
Transcranial doppler in the evaluation of internal carotid artery dissection.
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Noninvasive monitoring of internal
carotid
artery
dissection.
Steinke W, Rautenberg W, Schwartz A, Hennerici M.
Noninvasive monitoring of internal carotid artery dissection.
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Ultrasound findings in
carotid
artery
dissection: analysis of 43 patients.
Sturzennegger M, Mattle H, Rivoir A, Baumgartner R.
Ultrasound findings in carotid artery dissection: analysis of 43 patients.
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8.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 2
,
,
,
The extracranial and transcranial Doppler sonography confirmed the existence of a cerebral circulatory arrest – systolic spikes or oscillating blood flow were recorded bilaterally from the internal and middle cerebral arteries at an interval of 30 min, while the blood circulation within the external
carotid
artery
was preserved.
Brain CT showed massive cerebral hemorrhage with blood within the ventricle system after rupture of aneurysm of the anterior communicating artery, proved by CT angiography. DSA demonstrated stop of the blood flow at the carotid siphons.
The extracranial and transcranial Doppler sonography confirmed the existence of a cerebral circulatory arrest – systolic spikes or oscillating blood flow were recorded bilaterally from the internal and middle cerebral arteries at an interval of 30 min, while the blood circulation within the external carotid artery was preserved.
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In 1 patient (0.99%) stroke developed as a result of thrombosis of internal
carotid
artery
.
Through transcranial Doppler sonography (TCD) a slight reduction in the brain blood circulation on the side of the stenosis was pre-operatively ascertained. In all patients CE of a. carotis interna was carried out with shunt. In 99 patients (98%) successful CE was carried out. By means of CCDS and TCD significant improvement of the regional carotid haemodynamics and the haemodynamic of the intracranial arteries on the side of the operation was ascertained.
In 1 patient (0.99%) stroke developed as a result of thrombosis of internal carotid artery.
In another patient transitory amaurosis fugas was developed. In both cases the complications were attributed to unstable plaques
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Quantification of atheromatous stenosis in the extracranial
carotid
artery
.
de Bray JM, Glatt B, for the International Consensus Conference, Paris, December 2–3.
Quantification of atheromatous stenosis in the extracranial carotid artery.
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Endarterectomy for asymptomatic
carotid
artery
stenosis.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.
Endarterectomy for asymptomatic carotid artery stenosis.
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Joint study of extracranial arterial occlusion, V: progress report of prognosis following surgery or nonsurgical treatment for transient cerebral ischemic attacks and cervical
carotid
artery
lesions.
Fields WS, Maslenikov V, Meyer JS, Hass WK, Remington RD, Macdonald M.
Joint study of extracranial arterial occlusion, V: progress report of prognosis following surgery or nonsurgical treatment for transient cerebral ischemic attacks and cervical carotid artery lesions.
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For the Asymptomatic
Carotid
Artery
Progression Study (ACAPS) Research Group.
Furberg CD, Adams HP Jr, Applegate WB, Byington RP, Espeland MA, Hartwell T, Hunninghake DB, Lefkowitz DS, Probstfield J, Riley WA, Young B.
For the Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group.
Effect of lovastatin on early carotid atherosclerosis and cardiovascular events.
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Comparison and meta-analysis of randomized trials of endarterectomy for symptomatic
carotid
artery
stenosis.
Goldstein LB, Hasselblad V, Matchar DB, McCrory DC.
Comparison and meta-analysis of randomized trials of endarterectomy for symptomatic carotid artery stenosis.
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Risk of stroke in the distribution of an asymptomatic
carotid
artery
.
The European Carotid Surgery Trialists Collaborative Group.
Risk of stroke in the distribution of an asymptomatic carotid artery.
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Time Rate of bloot pressure variation is associated with increased common
carotid
artery
intima-media thickness;
Zakopoulos NA, Tsivgoulis G, Barlas G.
Time Rate of bloot pressure variation is associated with increased common carotid artery intima-media thickness;
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Management of
carotid
artery
stenosis.
Louridas G, Junaid A.
Management of carotid artery stenosis.
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9.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 5, 2009, No. 1
,
,
,
The origin of the internal
carotid
artery
is the most frequent site of atherosclerosis in cerebrovascular disease.
The origin of the internal carotid artery is the most frequent site of atherosclerosis in cerebrovascular disease.
Therefore, in the extracranial sonographic examination, a reliable assessment of the proximal segments of the internal carotid artery is crucial in the management of patients with stroke risk [6]. Ultrasound contrast agents have proven useful in the quantification of highgrade stenoses of the internal carotid artery which can only be suboptimally imaged – if at all
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Therefore, in the extracranial sonographic examination, a reliable assessment of the proximal segments of the internal
carotid
artery
is crucial in the management of patients with stroke risk [6].
The origin of the internal carotid artery is the most frequent site of atherosclerosis in cerebrovascular disease.
Therefore, in the extracranial sonographic examination, a reliable assessment of the proximal segments of the internal carotid artery is crucial in the management of patients with stroke risk [6].
Ultrasound contrast agents have proven useful in the quantification of highgrade stenoses of the internal carotid artery which can only be suboptimally imaged – if at all
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Ultrasound contrast agents have proven useful in the quantification of highgrade stenoses of the internal
carotid
artery
which can only be suboptimally imaged – if at all
The origin of the internal carotid artery is the most frequent site of atherosclerosis in cerebrovascular disease. Therefore, in the extracranial sonographic examination, a reliable assessment of the proximal segments of the internal carotid artery is crucial in the management of patients with stroke risk [6].
Ultrasound contrast agents have proven useful in the quantification of highgrade stenoses of the internal carotid artery which can only be suboptimally imaged – if at all
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Occlusion of the right MCA in 26 years old patient with a dissection of the right internal
carotid
artery
.
Occlusion of the right MCA in 26 years old patient with a dissection of the right internal carotid artery.
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The intracranial segment of the right internal
carotid
artery
shows a weak signal due to a dissection at the origin.
Magnetic resonance angiogram of an occlusion of the right MCA (arrow).
The intracranial segment of the right internal carotid artery shows a weak signal due to a dissection at the origin.
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Time rate of bloot pressure variation is associated with increased common
carotid
artery
intima-media thickness.
Zakopoulos NA, Tsivgoulis G, Barlas G.
Time rate of bloot pressure variation is associated with increased common carotid artery intima-media thickness.
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The benign course of cavernous
carotid
artery
aneurisms.
Hurst R. Berenstein A. Sup Choi I. Jafar J. Ransohoff. J.
The benign course of cavernous carotid artery aneurisms.
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Lack of relationship between leukoaraiosis and
carotid
artery
disease,
Streifler JY, Eliaziw M, Benavente OR.
Lack of relationship between leukoaraiosis and carotid artery disease,
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10.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 5, 2009, No. 1
,
,
,
Common
Carotid
Artery
Hemodynamic Changes in Patients with
Common Carotid Artery Hemodynamic Changes in Patients with
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Common
Carotid
Artery
Hemodynamic Changes in Patients With Cerebral Infarction
Common Carotid Artery Hemodynamic Changes in Patients With Cerebral Infarction
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cerebral infarctions, color duplex sonography, common
carotid
artery
, risk factors,
cerebral infarctions, color duplex sonography, common carotid artery, risk factors,
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Hemodynamic Changes in Common
Carotid
Artery
Hemodynamic Changes in Common Carotid Artery
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Hemodynamic Changes in Common
Carotid
Artery
Hemodynamic Changes in Common Carotid Artery
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Hemodynamics of human
carotid
artery
bifurcation: computational studies with models reconstructed from magnetic resonance imaging of normal subjects.
Milner JS, Moore JA, Rutt BK, Steinman DA.
Hemodynamics of human carotid artery bifurcation: computational studies with models reconstructed from magnetic resonance imaging of normal subjects.
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Carotid
artery
thrombus associated with severe iron-deficiency anemia and thrombocytosis.
Akins PT, Glenn S, Nemeth PM, Derdeyn CP.
Carotid artery thrombus associated with severe iron-deficiency anemia and thrombocytosis.
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Intraluminal clot of the
carotid
artery
detected radiographically.
Caplan L, Stein R, Patel D, Amico L, Cashman N, Gewertz B.
Intraluminal clot of the carotid artery detected radiographically.
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B-mode imaging of intraluminal thrombus of the internal
carotid
artery
.
ckmann H, Ringelstein EB.
B-mode imaging of intraluminal thrombus of the internal carotid artery.
Examples of a diagnostic challenge.
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Bilateral
carotid
artery
occlusive disease.
Groch SN, Hurwitz LJ, McDowell F.
Bilateral carotid artery occlusive disease.
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Ultrasound characteristics of adherent thrombi in the common
carotid
artery
.
ny V, Jung DK, Devuyst G.
Ultrasound characteristics of adherent thrombi in the common carotid artery.
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Delayed bilateral internal
carotid
artery
thrombosis following accidental strangulation.
Kiani SH, Simes DC.
Delayed bilateral internal carotid artery thrombosis following accidental strangulation.
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The intravascular mobile structure detected with duplex
carotid
ultrasound in patients with cardioembolic
carotid
artery
occlusion.
Kimura K, Uchino M.
The intravascular mobile structure detected with duplex carotid ultrasound in patients with cardioembolic carotid artery occlusion.
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Sudden comma from acute bilateral internal
carotid
artery
territory infarction.
Kwon Su, Lee SH, Kim JS.
Sudden comma from acute bilateral internal carotid artery territory infarction.
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Bilateral common
carotid
artery
occlusion — A case report and literature review.
Lai S, Chen Y, Weng H, Chen S, Hsu S, Lee T.
Bilateral common carotid artery occlusion — A case report and literature review.
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Outcome in patients with stroke associated with internal
carotid
artery
occlusion.
Paciaroni M, Caso V, Venti M, Milia P, Kappelle LJ, Silvestrelli G, Palmerini F, Acciarresi M, Sebastianelli M, Agnelli G.
Outcome in patients with stroke associated with internal carotid artery occlusion.
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Ultrasound finding of a mobile atheroma in the common
carotid
artery
.
Schlachetzki F, Hoelscher T, Lange M, Kasprzak P.
Ultrasound finding of a mobile atheroma in the common carotid artery.
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11.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 1
,
,
,
Internal
carotid
artery
stenting in patients with symptomatic atheromatous pseudo-occlusion.
lez-Marcos JR.
Internal carotid artery stenting in patients with symptomatic atheromatous pseudo-occlusion.
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Feasibility of endovascular recanalization for symptomatic cervical internal
carotid
artery
occlusion.
Kao HL, Lin MS, Wang CS, Lin YH, Lin LC, Chao CL, Jeng JS, Yip PK, Chen SC.
Feasibility of endovascular recanalization for symptomatic cervical internal carotid artery occlusion.
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Long-term results of elective stenting for severe
carotid
artery
stenosis in Taiwan.
Kao HL, Lin LY, Lu CJ, Jeng JS, Yip PK, Lee YT.
Long-term results of elective stenting for severe carotid artery stenosis in Taiwan.
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occlusion of the internal
carotid
artery
.
occlusion of the internal carotid artery.
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Procedural Safety and Potential Vascular Complication of Endovascular Recanalization for Chronic Cervical Internal
Carotid
Artery
Occlusion.
M.-S. Lin, L.-C. Lin, H.-Y. Li.
Procedural Safety and Potential Vascular Complication of Endovascular Recanalization for Chronic Cervical Internal Carotid Artery Occlusion.
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Surgical treatment of internal
carotid
artery
occlusion
Paty PSK, Adeniyi JA, Mehta M, et al.
Surgical treatment of internal carotid artery occlusion
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Current status in cervical
carotid
artery
stent placement.
Wholey MH, Wholey M.
Current status in cervical carotid artery stent placement.
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Atherosclerotic Disease of the
Carotid
Artery
.
Singh N, O’Donnell SD, Gillespie DL, Goff JM.
Atherosclerotic Disease of the Carotid Artery.
Medscape Neurology, January, 2008.
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12.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 7, 2011, No. 1
,
,
,
Free-floating Thrombus in the Internal
Carotid
Artery
– Clinical, Diagnostic and Treatment Problems
Free-floating Thrombus in the Internal Carotid Artery – Clinical, Diagnostic and Treatment Problems
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Free-floating Thrombus in the Internal
Carotid
Artery
– Clinical, Diagnostic and Treatment Problems*
Free-floating Thrombus in the Internal Carotid Artery – Clinical, Diagnostic and Treatment Problems*
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carotid
artery
, color-coded duplex sonography,
carotid artery, color-coded duplex sonography,
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Complete concurrence in the results of conducted color-coded duplex sonography and CTA of
carotid
artery
was exposed.
Complete concurrence in the results of conducted color-coded duplex sonography and CTA of carotid artery was exposed.
Duplex ultrasound examination allows to view thrombus cyclical motion related to the cardiac cycles, which is of great advantage over other imaging methods of examination. Advantages and disadvantages of different modalities for treatment of this pathology are still discussed.
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A free-floating thrombus (FFT) in
carotid
artery
is an independent risk factor for embolic ischemic strokes (IS) and should be treated on an emergent basis.
A free-floating thrombus (FFT) in carotid artery is an independent risk factor for embolic ischemic strokes (IS) and should be treated on an emergent basis.
FFT is diagnosed by color-coded duplex sonography (CCDS) and angiography of the supraaortal arteries [1, 3].
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We present our own experience in two clinical cases with FFT in internal
carotid
artery
(ICA), detected by CCDS or computed tomographic angiography (CTA) of the supraaortal cerebral arteries.
We present our own experience in two clinical cases with FFT in internal carotid artery (ICA), detected by CCDS or computed tomographic angiography (CTA) of the supraaortal cerebral arteries.
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Color-coded duplex sonography showed a bifurcation thrombus with a distal-shaped tail creating highgraded stenosis, lying free in the lumen of the internal
carotid
artery
with a total thrombus length – about 4 cm (fig. 1A).
Four years ago he survived an IS in the left MCA territory with a complete recovery. He reported arterial hypertension with good medication control. Neurologic examination revealed right central hemiparesis, and motor aphasia. Laboratory tests revealed dyslipidemia. Echocardiography excluded the presence of thrombotic masses in the cardiac chambers.
Color-coded duplex sonography showed a bifurcation thrombus with a distal-shaped tail creating highgraded stenosis, lying free in the lumen of the internal carotid artery with a total thrombus length – about 4 cm (fig. 1A).
CTA of supraaortal arteries confirmed the presence of a free floating thrombus in the initial part of the left ICA (fig. 1B). Computed tomography of head showed small hypodense areas in the parenchyma of the left temporoparietal part of the brain. We began therapy with two antiplatelets (Aspirin, Clopidogrel), low molecular weight Heparin, statin and medications helping protection of the brain parenchyma.An urgent endarterectomy of the left CCA and left ICA with patch plastic was done.
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Free-floating thrombus in the internal
carotid
artery
Free-floating thrombus in the internal carotid artery
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Duplex ultrasound provides a sensitive and specific evaluation of plaque morphology and mobile structures in the
carotid
artery
lumen which is a significant advantage over other neuroimaging methods [3].
In our clinical cases we excluded any cardiogenic cause for the embolic IS. Patients did not have any previous heart disease and had normal echocardiographies. In both patients FFT were formed by ruptured ulcerated atherosclerotic plaques, which were found intraoperatively. We used CDS and CT of the supraaortal arteries to diagnose FFT.
Duplex ultrasound provides a sensitive and specific evaluation of plaque morphology and mobile structures in the carotid artery lumen which is a significant advantage over other neuroimaging methods [3].
When a free-floating cloth in carotid artery is established in most cases an operation is recommended – urgent carotid endarterectomy (CEA) or embolectomy because of the great risk of repeating embolic IS [1]. In rare cases treatment only with anticoagulants is considered [1, 5, 13 ]. Endovascular therapy is extremely rare in patients with prior carotid endarterectomy, due to a very high risk of embolization during the procedure [1, 2]. In both our cases we preferred surgical removal of thrombus and ulcerated atherosclerotic plaque aiming prevention of recurrence of IS, an anticoagulant treatment during hospitalization and long-term double antiplatelet therapy.
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When a free-floating cloth in
carotid
artery
is established in most cases an operation is recommended – urgent
carotid
endarterectomy (CEA) or embolectomy because of the great risk of repeating embolic IS [1].
In our clinical cases we excluded any cardiogenic cause for the embolic IS. Patients did not have any previous heart disease and had normal echocardiographies. In both patients FFT were formed by ruptured ulcerated atherosclerotic plaques, which were found intraoperatively. We used CDS and CT of the supraaortal arteries to diagnose FFT. Duplex ultrasound provides a sensitive and specific evaluation of plaque morphology and mobile structures in the carotid artery lumen which is a significant advantage over other neuroimaging methods [3].
When a free-floating cloth in carotid artery is established in most cases an operation is recommended – urgent carotid endarterectomy (CEA) or embolectomy because of the great risk of repeating embolic IS [1].
In rare cases treatment only with anticoagulants is considered [1, 5, 13 ]. Endovascular therapy is extremely rare in patients with prior carotid endarterectomy, due to a very high risk of embolization during the procedure [1, 2]. In both our cases we preferred surgical removal of thrombus and ulcerated atherosclerotic plaque aiming prevention of recurrence of IS, an anticoagulant treatment during hospitalization and long-term double antiplatelet therapy.
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Free-floating thrombus of the
carotid
artery
: Literature review and case reports.
Bhatti AF, Leon LR, Labropoulos N, Rubinas TL, Rodriguez H, Kalman PG, Schneck M, Psalms SB, Biller J.
Free-floating thrombus of the carotid artery: Literature review and case reports.
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Management of mobile floating
carotid
plaque using
carotid
artery
stenting.
Chakhtoura EY, Goldstein JE, Hobson RW.
Management of mobile floating carotid plaque using carotid artery stenting.
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Recurrent stroke onset precipitated during
carotid
ultrasound examination in a case of severe internal
carotid
artery
stenosis with soft, moving plaques.
Chan JL, Lee TH, Chen ST, Ryu SJ.
Recurrent stroke onset precipitated during carotid ultrasound examination in a case of severe internal carotid artery stenosis with soft, moving plaques.
In: Kodaira K, editor. Recent advances in neurosonology: proceedings of the Fourth Meeting of the Neurosonology Research Group of the World Federation of Neurology, Hiroshima 1991. Amsterdam: Elsevier; 1992. p. 441-443.
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Free floating thrombus of the extracranial internal
carotid
artery
.
Combe J, Poinsard P, Besancenot J, Camelot G, Cattin F, Bonneville JF.
Free floating thrombus of the extracranial internal carotid artery.
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Transient obstruction of the internal
carotid
artery
during angiography.
Cross DT 3rd, Allen BT.
Transient obstruction of the internal carotid artery during angiography.
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Free-floating thrombus in the internal
carotid
artery
Free-floating thrombus in the internal carotid artery
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cardioembolic
carotid
artery
occlusion.
cardioembolic carotid artery occlusion.
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sound finding of a mobile atheroma in the common
carotid
artery
.
sound finding of a mobile atheroma in the common carotid artery.
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A mobile lesion in the
carotid
artery
.
Stewart J, Gover J, Tridgell D, Frawley J.
A mobile lesion in the carotid artery.
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These findings are in favor of an independent influence of obstructive sleep apnea on
carotid
artery
atherosclerosis.
These findings are in favor of an independent influence of obstructive sleep apnea on carotid artery atherosclerosis.
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The study establishes the same frequency of RF for CVD in both groups, but a greater thickening of IMC of the common
carotid
artery
of the OSAS patients compared to the control group.
The study establishes the same frequency of RF for CVD in both groups, but a greater thickening of IMC of the common carotid artery of the OSAS patients compared to the control group.
In the patients with OSAS a significant correlation between the thickening of IMC of the common carotid artery and the severity of the apnea is observed, which is in accordance with other authors conclusions [14]. It is shown that the chronic intermittent hypoxemia is one of the basic factors for atherosclerosis in patients with OSAS [11, 15]. In those patients high serum levels of catecholamines and high oxidative stress are determined [7, 14], high levels of serum inflammatory markers such as C-reactive protein and cytokines [11] and high platelet aggregation and plasma fibrinogen are found [7]. Compared to the controls, patients with OSAS have a higher frequency of atherosclerotic plaques and high grade stenoses. This fact should be examined in a bigger group of patients in a future study.
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In the patients with OSAS a significant correlation between the thickening of IMC of the common
carotid
artery
and the severity of the apnea is observed, which is in accordance with other authors conclusions [14].
The study establishes the same frequency of RF for CVD in both groups, but a greater thickening of IMC of the common carotid artery of the OSAS patients compared to the control group.
In the patients with OSAS a significant correlation between the thickening of IMC of the common carotid artery and the severity of the apnea is observed, which is in accordance with other authors conclusions [14].
It is shown that the chronic intermittent hypoxemia is one of the basic factors for atherosclerosis in patients with OSAS [11, 15]. In those patients high serum levels of catecholamines and high oxidative stress are determined [7, 14], high levels of serum inflammatory markers such as C-reactive protein and cytokines [11] and high platelet aggregation and plasma fibrinogen are found [7]. Compared to the controls, patients with OSAS have a higher frequency of atherosclerotic plaques and high grade stenoses. This fact should be examined in a bigger group of patients in a future study.
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As a conclusion, in OSAS patients a significant thickening of IMC of the common
carotid
artery
is observed, which correlates with the level of the night hypoxemia.
As a conclusion, in OSAS patients a significant thickening of IMC of the common carotid artery is observed, which correlates with the level of the night hypoxemia.
This supports the thesis that the obstructive sleep apnea is an independent risk factor for CVD.
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Carotid
artery
ultrasound and echocardiography testing to lower the prevalence of Alzheimer‘s disease.
de la Torre JC.
Carotid artery ultrasound and echocardiography testing to lower the prevalence of Alzheimer‘s disease.
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Carotid
artery
stenosis: gray-scale and Doppler ultrasound diagnosis—Society of
Grant EG, Benson CB, Moneta GL, et al.
Carotid artery stenosis: gray-scale and Doppler ultrasound diagnosis—Society of
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Guidelines for patient selection and performance of
carotid
artery
stenting.
Guidelines for patient selection and performance of carotid artery stenting.
The Carotid Stenting Guidelines Committee. DOI: 10.1111/1445-2197.2010.05330.x© 2010 Journal compilation © 2010 Royal Australasian College of Surgeons.
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13.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 7, 2011, No. 2
,
,
,
We have also found it useful to monitor the velocity in the extracranial internal
carotid
artery
where it enters the skull base.
A reasonably good relationship between clinical vasospasm (patient has ischemic symptoms) and the TCD velocity in the spastic segment has also been documented by many studies. But frequently, patients with high velocities (>200 cm/s) do not have clinical symptoms. Since TCD was introduced, the change to very early aneurysm surgery combined with aggressive treatment (3H therapy and angioplasty) has allowed many patients to come through the vasospasm period without symptoms and ischemic damage.
We have also found it useful to monitor the velocity in the extracranial internal carotid artery where it enters the skull base.
A patient, in whom intracranial spasm velocities remain high, and, at the same time, those in the ICA drop, is at danger for ischemia.
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14.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 8, 2012, No. 1
,
,
,
Early Proximal Common
Carotid
Artery
Dissection after
Early Proximal Common Carotid Artery Dissection after
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Early Proximal Common
Carotid
Artery
Dissection after
Carotid
Endarterectomy
Early Proximal Common Carotid Artery Dissection after Carotid Endarterectomy
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A rare case of proximal common
carotid
artery
dissection after endarterectomy due to high-grade stenosis of internal
carotid
artery
is presented.
A rare case of proximal common carotid artery dissection after endarterectomy due to high-grade stenosis of internal carotid artery is presented.
Contemporary diagnostic and therapeutic algorithm is discussed.
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The aim of this study was to demonstrate the diagnostic abilities of ultrasound imaging in a patient with proximal common
carotid
artery
(CCA) dissection after CEA of the internal
carotid
artery
(ICA) on the same side.
The aim of this study was to demonstrate the diagnostic abilities of ultrasound imaging in a patient with proximal common carotid artery (CCA) dissection after CEA of the internal carotid artery (ICA) on the same side.
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The patient had general weakness and persistent pain along the
carotid
artery
in the left neck area.
The patient had general weakness and persistent pain along the carotid artery in the left neck area.
Somatic examination found calm surgical wound and blood pressure compensated. No neurologic abnormalities were detected.
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Early activation of intracranial collateral vessels influences the outcome of spontaneous internal
carotid
artery
dissection.
Silvestrini M, Altamura C.
Early activation of intracranial collateral vessels influences the outcome of spontaneous internal carotid artery dissection.
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15.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2012, No. 2
,
,
,
The cause was thrombosis of the left internal
carotid
artery
.
A 54-year-old patient with right-sided spastic hemiparesis 1 year and 8 months after ischemic stroke in the left middle cerebral artery was studied.
The cause was thrombosis of the left internal carotid artery.
The severity of paresis was evaluated by manual muscle testing (MMT).
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16.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 1
,
,
,
The presented figure in this paper only shows a transversal section through the IJV and the common
carotid
artery
, which both show a red signal, thereby suggesting a retrograde flow in the IJV.
0.88 seconds [67]. The Methods section states that: “For each assessment the direction of flow is [analyzed either with the pulsed wave mode and the sample placed in the vessel, at a 60° angle, or with the colour coded mode, by comparing the colour of the flow in the IJV/VV with that of the satellite carotid and/or vertebral artery, respectively. Either the IJVs or the VVs can be examined by using both the transversal and/or the longitudinal cervical access“. Again, from the methodological point of view, we strongly recommend assessment by pulsed-wave Doppler mode in addition to color-coded mode. The longitudinal oriented cervical veins have to be examined by ultrasound in longitudinal planes in each case, as due to the Doppler formula, reliable measurements are dependent on the ultrasound angle, and ultrasound application at 90° can misleadingly suggest zero flow.
The presented figure in this paper only shows a transversal section through the IJV and the common carotid artery, which both show a red signal, thereby suggesting a retrograde flow in the IJV.
Transversal IJV examination may be adequate for determining flow direction in hurried routine examinations especially as using this method the probe can be adjusted
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Extracranial color-coded duplexsonography of the internal jugular vein (IJV) and common
carotid
artery
(CCA) in a transverse (top) and longitudinal (bottom) plane.
Extracranial color-coded duplexsonography of the internal jugular vein (IJV) and common carotid artery (CCA) in a transverse (top) and longitudinal (bottom) plane.
Blood flow direction in the IJV seems to vary at different time points using a transverse insonation (top left: orthograde flow, blue coded; top right: retrograde flow, red-coded). Additional insonation in the longitudinal plane demonstrates the continuous orthograd flow, blue-coded.
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Note the orthograd flow in the vertebral
artery
(VA) and common
carotid
artery
(CCA)
Postural changes of blood flow direction in the vertebral vein (VV) and internal jugular vein (IJV in a healthy subject. Retrograde blood flow in the VV (top) and IJV (central) in supine position turning into a orthograd flow in both vessels after postural change towards the sitting position (bottom) (VV not shown).
Note the orthograd flow in the vertebral artery (VA) and common carotid artery (CCA)
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17.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2
,
,
,
Novel Probe Attached to the Cervix for Detection of Microembolic Signal at
Carotid
Artery
.
Novel Probe Attached to the Cervix for Detection of Microembolic Signal at Carotid Artery.
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Relationship Between Blood Pressure Control and Arterial Stiffness,
Carotid
Artery
and Retina Damages in Hypertensive Patients With and Without Type 2 Diabetes.
Relationship Between Blood Pressure Control and Arterial Stiffness, Carotid Artery and Retina Damages in Hypertensive Patients With and Without Type 2 Diabetes.
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3D Blood Flow and Common
Carotid
Artery
Hemodynamics in the
Carotid
Artery
Bifurcation with Stenosis.
3D Blood Flow and Common Carotid Artery Hemodynamics in the Carotid Artery Bifurcation with Stenosis.
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Duplex Ultrasonographic Findings in Congenital Absence of the Internal
Carotid
Artery
.
Duplex Ultrasonographic Findings in Congenital Absence of the Internal Carotid Artery.
read the entire text >>
Dissection of
Carotid
Artery
.
Dissection of Carotid Artery.
A Case Report.
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Flow Velocities and Vessel Diameter of the Distal Internal
Carotid
Artery
in Patients with Risk Factors.
Flow Velocities and Vessel Diameter of the Distal Internal Carotid Artery in Patients with Risk Factors.
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Relationship between Increased Common
Carotid
Artery
Diameter and Aortic Aneurysm.
Relationship between Increased Common Carotid Artery Diameter and Aortic Aneurysm.
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Relationship between Diameter of Brachial
Artery
and Common
Carotid
Artery
in Stroke Patients.
Relationship between Diameter of Brachial Artery and Common Carotid Artery in Stroke Patients.
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Acceleration Time Ratio for the Assessment of Extracranial Internal
Carotid
Artery
Stenosis.
Acceleration Time Ratio for the Assessment of Extracranial Internal Carotid Artery Stenosis.
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Intima-Media Thickness of the
Carotid
Artery
in Obstructive Sleep Apnoe Syndrome Patients with Asymptomatic Ischemic Disturbances of Cerebral Circulation.
Intima-Media Thickness of the Carotid Artery in Obstructive Sleep Apnoe Syndrome Patients with Asymptomatic Ischemic Disturbances of Cerebral Circulation.
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Sonographic Changes Before and After Stenting in
Carotid
Artery
.
Sonographic Changes Before and After Stenting in Carotid Artery.
read the entire text >>
Does Stent Design Influence Embolisation Detected by Transcranial Doppler During
Carotid
Artery
Stenting?
Does Stent Design Influence Embolisation Detected by Transcranial Doppler During Carotid Artery Stenting?
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Firstly, the peripheral cerebral
artery
properties-analysis system by the development of the QFM system for the quantitative measurements of flow volume in the common
carotid
artery
which was selected by the Science and Technology Agency as an invention of special attention in 1983.
Firstly, the peripheral cerebral artery properties-analysis system by the development of the QFM system for the quantitative measurements of flow volume in the common carotid artery which was selected by the Science and Technology Agency as an invention of special attention in 1983.
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Several non-invasive imaging modalities have shown their potential to identify unstable
carotid
artery
plaques.
Several non-invasive imaging modalities have shown their potential to identify unstable carotid artery plaques.
Echolucent plaques are thought to be more unstable than echo-rich plaques. Images can be evaluated either visually or by computer-assisted gray-scale median (GSM) measurements. Visual evaluation of plaque echogenicity has only fair reproducibility, whereas objective characterization is more reliable and less observer dependent. Plaque irregularity on ultrasound has also been reported to be a risk factor for stroke in general but not for ipsilateral stroke alone.
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Atherosclerotic
carotid
artery
disease is the cause of ischemic ischemic stroke in about 20% of cases.
Approximately 13 million deaths per year are caused by vascular diseases, ischemic heart disease and stroke account for 22.3% of the total yearly deaths in the world, 12.2% and 9.7% are due to ischemic heart disease and stroke respectively. Myocardial infarction is the leading cause of long-term mortality in stroke surviving patients, although stroke is the leading cause of disability in the world.
Atherosclerotic carotid artery disease is the cause of ischemic ischemic stroke in about 20% of cases.
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In contrary to
carotid
artery
disease where severity of the stenosis is the main player, rupture-prone plaques in coronary
artery
disease cause acute myocardial infarctions and sudden cardiac deaths.
The diagnosis of coronary artery disease (CAD) is often too late, because myocardial infarction or even death might be the first sign of CAD.
In contrary to carotid artery disease where severity of the stenosis is the main player, rupture-prone plaques in coronary artery disease cause acute myocardial infarctions and sudden cardiac deaths.
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NOVEL PROBE ATTACHED TO THE CERVIX FOR DETECTION OF MICROEMBOLIC SIGNAL AT
CAROTID
ARTERY
NOVEL PROBE ATTACHED TO THE CERVIX FOR DETECTION OF MICROEMBOLIC SIGNAL AT CAROTID ARTERY
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So we developed a novel probe attached to the cervix for detection of MES at
carotid
artery
which can be evaluated in almost all of the patients.
Transcranial Doppler (TCD) is useful for detection of micro embolic signal (MES), however, it is insufficient for Japanese patients without temporal bone window.
So we developed a novel probe attached to the cervix for detection of MES at carotid artery which can be evaluated in almost all of the patients.
Our purpose of this study is to evaluate clinical availability of this probe.
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2) We measured sonogram of
carotid
artery
using novel probe attached to the cervix in healthy volunteers for 30 minutes, and then evaluated fixation ability and comfortability.
Novel probe was 2MHz which had equal property with TCD, and the shape of probe was thin and square modified for attachment to the neck. 1) We measured MES using novel probe in the original circulation circuit model with artificial emboli.
2) We measured sonogram of carotid artery using novel probe attached to the cervix in healthy volunteers for 30 minutes, and then evaluated fixation ability and comfortability.
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2) In all three volunteers, we could measured stable sonogram of
carotid
artery
for 30 minutes.
1) MES of artificial emboli were measured by novel probe stably for two hours. The count number of MES was somewhat small in comparison with other TCD device.
2) In all three volunteers, we could measured stable sonogram of carotid artery for 30 minutes.
There was no skin trouble and discomfort of the cervix during monitoring. Fixation time of novel probe attached to the cervix was within a few minutes, which was fast and easy.
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carotid
artery
, micro embolic signal, new probe.
carotid artery, micro embolic signal, new probe.
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3D BLOOD FLOW AND COMMON
CAROTID
ARTERY
HEMODYNAMICS IN THE
CAROTID
ARTERY
BIFURCATION WITH STENOSIS
3D BLOOD FLOW AND COMMON CAROTID ARTERY HEMODYNAMICS IN THE CAROTID ARTERY BIFURCATION WITH STENOSIS
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The aim of the study is to perform 3D numerical analysis of blood flow in the
carotid
artery
bifurcation with and without stenoses.
The aim of the study is to perform 3D numerical analysis of blood flow in the carotid artery bifurcation with and without stenoses.
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Four cases of
carotid
bifurcation are considered: common
carotid
artery
(CCA) bifurcation without stenoses, with one, two and three stenoses are presented too.
The analysis is based on the numerical simulation of Navier-Stokes equations.
Four cases of carotid bifurcation are considered: common carotid artery (CCA) bifurcation without stenoses, with one, two and three stenoses are presented too.
The analysis is performed considering one pulse wave period and it is based on the finite volume discretization of the Navier-Stokes equations.
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The structures of the flow around the bifurcation from CCA to the internal (ICA) and external
carotid
artery
(ECA) are obtained considering characteristic time points for one pulse wave period.
The structures of the flow around the bifurcation from CCA to the internal (ICA) and external carotid artery (ECA) are obtained considering characteristic time points for one pulse wave period.
The axial velocity distribution and wall shear stress (WSS) distribution and contours are presented. The results manifest unsteady blood flow in the carotid bifurcation and dependence of the flow disturbances on the time and type of the stenoses. The recirculation zone behind the stenosis is the area of low WSS. Comparison of the peak WSS for the four different cases shows that it reaches the maximum value of about 6.7Pa at the characteristic point of T=0,2s for the cases with two and three stenoses.
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To assess the complex influence of blood viscosity and blood pressure on the neurosonographic parameters in the common
carotid
artery
(CCA) in patients with chronic unilateral cerebral infarctions (CUCI).
To assess the complex influence of blood viscosity and blood pressure on the neurosonographic parameters in the common carotid artery (CCA) in patients with chronic unilateral cerebral infarctions (CUCI).
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blood pressure, blood viscosity, cerebral infarctions, color duplex sonography, common
carotid
artery
.
blood pressure, blood viscosity, cerebral infarctions, color duplex sonography, common carotid artery.
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In-stent restenosis (ISR) is a major problem that can occur during long-term follow-up after
carotid
artery
stenting (CAS).
In-stent restenosis (ISR) is a major problem that can occur during long-term follow-up after carotid artery stenting (CAS).
Patients who undergo CAS are usually followed using three-dimensional enhanced computed tomography angiography (3D-CTA) for two years after the procedure, and with carotid duplex sonography (CDU) thereafter. However, it is not clear which factors serve as predictors of late-onset ISR or how to use data from CDU to make subsequent management decisions. Therefore, we compared the differences between patients without ISR (no-ISR group) and patients with highgrade ISR (defined as more than 40% stenosis according to the NASCET method).
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carotid
artery
stent,
carotid
duplex ultrasound, instent restenosis.
carotid artery stent, carotid duplex ultrasound, instent restenosis.
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To examine native
carotid
artery
without stenosis and
carotid
artery
after endarterectomy (CEA) without restenosis by Color-coded Duplex Ultrasound (CDU) in men, to compare the ultrasound findings and derive ultrasound criteria for postoperative follow-up.
To examine native carotid artery without stenosis and carotid artery after endarterectomy (CEA) without restenosis by Color-coded Duplex Ultrasound (CDU) in men, to compare the ultrasound findings and derive ultrasound criteria for postoperative follow-up.
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We have evaluated the diameter of the arteries (mm) (common
carotid
artery
(CCA), bifurcation of the CCA (CCAbif), distal internal
carotid
artery
(ICAdist); beginning, center and end of the patch), the peak systolic (PSV) and the end diastolic (EDV) velocities (cm/s) at the same points by using CDU.
– 40 men, mean aged 68,3 years without cerebrovascular desease.
We have evaluated the diameter of the arteries (mm) (common carotid artery (CCA), bifurcation of the CCA (CCAbif), distal internal carotid artery (ICAdist); beginning, center and end of the patch), the peak systolic (PSV) and the end diastolic (EDV) velocities (cm/s) at the same points by using CDU.
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This research have shown that there is no statistically significant difference in ultrasound findings between native
carotid
artery
without stenosis and
carotid
artery
after CEA without restenosis.
Color-coded Duplex ultrasound is a very accurate, noninvasive method that can be repeated at any time for grading carotid stenosis.
This research have shown that there is no statistically significant difference in ultrasound findings between native carotid artery without stenosis and carotid artery after CEA without restenosis.
Ultrasound criteria for evaluation of native carotid artery can be applied in followingup after CEA.
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Ultrasound criteria for evaluation of native
carotid
artery
can be applied in followingup after CEA.
Color-coded Duplex ultrasound is a very accurate, noninvasive method that can be repeated at any time for grading carotid stenosis. This research have shown that there is no statistically significant difference in ultrasound findings between native carotid artery without stenosis and carotid artery after CEA without restenosis.
Ultrasound criteria for evaluation of native carotid artery can be applied in followingup after CEA.
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DUPLEX ULTRASONOGRAPHIC FINDINGS IN CONGENITAL ABSENCE OF THE INTERNAL
CAROTID
ARTERY
DUPLEX ULTRASONOGRAPHIC FINDINGS IN CONGENITAL ABSENCE OF THE INTERNAL CAROTID ARTERY
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The absence of the internal
carotid
artery
(ICA) is a rare congenital anomaly, occurring in
The absence of the internal carotid artery (ICA) is a rare congenital anomaly, occurring in
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DISSECTION OF
CAROTID
ARTERY
.
DISSECTION OF CAROTID ARTERY.
A CASE REPORT
read the entire text >>
Angiographic examination revealed a dissection of left common (distal part) and left internal
carotid
artery
(proximal part) 6.5 cm long.
Angiographic examination revealed a dissection of left common (distal part) and left internal carotid artery (proximal part) 6.5 cm long.
Considerably higher peak systolic velocity (PCV) and asymmetry PSV left/right ratio of common carotid artery was found.
read the entire text >>
Considerably higher peak systolic velocity (PCV) and asymmetry PSV left/right ratio of common
carotid
artery
was found.
Angiographic examination revealed a dissection of left common (distal part) and left internal carotid artery (proximal part) 6.5 cm long.
Considerably higher peak systolic velocity (PCV) and asymmetry PSV left/right ratio of common carotid artery was found.
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sonography, CT angiography, dissection of
carotid
artery
.
sonography, CT angiography, dissection of carotid artery.
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FLOW VELOCITIES AND VESSEL DIAMETER OF THE DISTAL INTERNAL
CAROTID
ARTERY
IN PATIENTS WITH RISK FACTORS
FLOW VELOCITIES AND VESSEL DIAMETER OF THE DISTAL INTERNAL CAROTID ARTERY IN PATIENTS WITH RISK FACTORS
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grading
carotid
stenosis, internal
carotid
artery
, velocity.
grading carotid stenosis, internal carotid artery, velocity.
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RELATIONSHIP BETWEEN INCREASED COMMON
CAROTID
ARTERY
DIAMETER AND AORTIC ANEURYSM
RELATIONSHIP BETWEEN INCREASED COMMON CAROTID ARTERY DIAMETER AND AORTIC ANEURYSM
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Dilatation of common
carotid
artery
(CCA) has been indicated as an independent risk factor for thoracic and abdominal aortic aneurysm (AA); however, it has not been yet established in Japanese patients with AA.
Dilatation of common carotid artery (CCA) has been indicated as an independent risk factor for thoracic and abdominal aortic aneurysm (AA); however, it has not been yet established in Japanese patients with AA.
This study aimed to identify CCA diameter of preoperative patients with AA.
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aortic aneurysm, common
carotid
artery
diameter.
aortic aneurysm, common carotid artery diameter.
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RELATIONSHIP BETWEEN DIAMETER OF BRACHIAL
ARTERY
AND COMMON
CAROTID
ARTERY
IN STROKE PATIENTS
RELATIONSHIP BETWEEN DIAMETER OF BRACHIAL ARTERY AND COMMON CAROTID ARTERY IN STROKE PATIENTS
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Recent studies have suggested increased diameters of the brachial
artery
may be a useful indicator for subclinical coronary
artery
diseases, and central
artery
dilation such as common
carotid
artery
are associated with arteriosclerosis.
Recent studies have suggested increased diameters of the brachial artery may be a useful indicator for subclinical coronary artery diseases, and central artery dilation such as common carotid artery are associated with arteriosclerosis.
However it remains unclear in patients with cerebral infarction. The present study aimed to investigate the relationship between the diameters of brachial artery (BAD) and common carotid artery (CAD) in patients with cerebral infarction.
read the entire text >>
The present study aimed to investigate the relationship between the diameters of brachial
artery
(BAD) and common
carotid
artery
(CAD) in patients with cerebral infarction.
Recent studies have suggested increased diameters of the brachial artery may be a useful indicator for subclinical coronary artery diseases, and central artery dilation such as common carotid artery are associated with arteriosclerosis. However it remains unclear in patients with cerebral infarction.
The present study aimed to investigate the relationship between the diameters of brachial artery (BAD) and common carotid artery (CAD) in patients with cerebral infarction.
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brachial
artery
diameter, common
carotid
artery
diameter, differential diagnosis.
brachial artery diameter, common carotid artery diameter, differential diagnosis.
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ACCELERATION TIME RATIO FOR THE ASSESSMENT OF EXTRACRANIAL INTERNAL
CAROTID
ARTERY
STENOSIS
ACCELERATION TIME RATIO FOR THE ASSESSMENT OF EXTRACRANIAL INTERNAL CAROTID ARTERY STENOSIS
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However, to our knowledge, the AcT ratio has not routinely been used to evaluate the degree of internal
carotid
artery
(ICA) stenosis.
The Doppler indices, such as systolic acceleration time (AcT) have been used as parameters for peripheral arterial stenosis.
However, to our knowledge, the AcT ratio has not routinely been used to evaluate the degree of internal carotid artery (ICA) stenosis.
To apply the AcT ratio in the assessment of carotid artery sonography as an additional marker for diagnosing ICA stenosis.
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To apply the AcT ratio in the assessment of
carotid
artery
sonography as an additional marker for diagnosing ICA stenosis.
The Doppler indices, such as systolic acceleration time (AcT) have been used as parameters for peripheral arterial stenosis. However, to our knowledge, the AcT ratio has not routinely been used to evaluate the degree of internal carotid artery (ICA) stenosis.
To apply the AcT ratio in the assessment of carotid artery sonography as an additional marker for diagnosing ICA stenosis.
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Carotid
artery
sonography was performed in 140 consecutive patients with atherothrombotic brain infarction to evaluate extracranial ICA stenosis.
Carotid artery sonography was performed in 140 consecutive patients with atherothrombotic brain infarction to evaluate extracranial ICA stenosis.
The AcT ratio
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was calculated as the AcT of the internal
carotid
artery
divided by the AcT of ipsilateral common
carotid
artery
and compared with linear stenosis as calculated according to the European
Carotid
Surgery Trial criteria.
was calculated as the AcT of the internal carotid artery divided by the AcT of ipsilateral common carotid artery and compared with linear stenosis as calculated according to the European Carotid Surgery Trial criteria.
Simple regression analysis was used to examine the relationship between the AcT ratio and ICA stenosis. The receiver operating characteristic (ROC) curve was used to calculate the optimal cutoff values of the AcT ratio for ICA stenosis ( > 65%).
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The ROC curve revealed an AcT ratio cutoff level of 1.5, with 90.0% sensitivity and 93.5% specificity for internal
carotid
artery
stenosis greater than 65%.
There was a significant correlation between linear stenosis and the acceleration time ratio.
The ROC curve revealed an AcT ratio cutoff level of 1.5, with 90.0% sensitivity and 93.5% specificity for internal carotid artery stenosis greater than 65%.
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acceleration time ratio, internal
carotid
artery
, stenosis.
acceleration time ratio, internal carotid artery, stenosis.
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INTIMA-MEDIA THICKNESS OF THE
CAROTID
ARTERY
IN OSAS PATIENTS WITH ASYMPTOMATIC ISCHEMIC DISTURBANCES OF CEREBRAL CIRCULATION
INTIMA-MEDIA THICKNESS OF THE CAROTID ARTERY IN OSAS PATIENTS WITH ASYMPTOMATIC ISCHEMIC DISTURBANCES OF CEREBRAL CIRCULATION
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To evaluate the change of intima-media thickness of the
carotid
artery
in patients suffering by obstructive sleep apnea (OSAS) and asymptomatic ischemic disturbances of cerebral circulation.
To evaluate the change of intima-media thickness of the carotid artery in patients suffering by obstructive sleep apnea (OSAS) and asymptomatic ischemic disturbances of cerebral circulation.
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These findings are in favor of an independent influence of obstructive sleep apnea on
carotid
artery
atherosclerosis and asymtomatic changes of the brain in performet MRI.
These findings are in favor of an independent influence of obstructive sleep apnea on carotid artery atherosclerosis and asymtomatic changes of the brain in performet MRI.
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Nonmodifiable (age and sex) and some modifiable (hypertension, diabetes mellitus, atrial fibrillation or other cardiac conditions, dyslipidemia,
carotid
artery
stenoses and obesity) RF for CVDs were evaluated.
Color duplex sonography of carotid arteries was performed in 924 patients: 368 with RF for CVDs, 126 with transient ischemic attacks (TIAs), 287 with chronic unilateral infarction (CUI) and 143 with multiple infarctions. The intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured by B-mode and M-mode scanning.
Nonmodifiable (age and sex) and some modifiable (hypertension, diabetes mellitus, atrial fibrillation or other cardiac conditions, dyslipidemia, carotid artery stenoses and obesity) RF for CVDs were evaluated.
In 67 subjects with RF, 57 patients with CVDs (31 with TIAs and 26 with CUI) and 16 healthy volunteers correlative clinical, neurosonographic and echocardiographic investigations were performed.
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SONOGRAPHIC CHANGES BEFORE AND AFTER STENTING IN
CAROTID
ARTERY
SONOGRAPHIC CHANGES BEFORE AND AFTER STENTING IN CAROTID ARTERY
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DOES STENT DESIGN INFLUENCE EMBOLISATION DETECTED BY TRANSCRANIAL DOPPLER DURING
CAROTID
ARTERY
STENTING?
DOES STENT DESIGN INFLUENCE EMBOLISATION DETECTED BY TRANSCRANIAL DOPPLER DURING CAROTID ARTERY STENTING?
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We studied effects of stent design on embolisation detected by transcranial Doppler during
carotid
artery
stenting.
We studied effects of stent design on embolisation detected by transcranial Doppler during carotid artery stenting.
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18.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 1
,
,
,
Development of malignant cerebral infarction in distal portion of the internal
carotid
artery
or proximal middle cerebral
artery
thrombosis is a therapeutic challenge as the massive cerebral ischemia limits the effectiveness of medication therapy.
Development of malignant cerebral infarction in distal portion of the internal carotid artery or proximal middle cerebral artery thrombosis is a therapeutic challenge as the massive cerebral ischemia limits the effectiveness of medication therapy.
ln cases of supratentorial infarctions resulting in death, the autopsy shows severe
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The thickness of the
carotid
artery
intima-media complex was measured by B-mode imaging in real-time using a standard program for automatic averaging of values.
А 35-year-old male admitted for the first time in Second Neurology Сlinic in the University Hospital "St. Мarina" Varna with sudden weakness of the left extremities based on high blood pressure was examined. There were many risk factors for cerebrovascular disease: arterial hypertension, dyslipidemia, obesity. А pointed laboratory examination of complete blood count, biochemistry and coagulation status was performed. Мain head arteries were examined with Sonix SP (Сanada) by color coded duplex scanning using 7.5 Hz transducer.
The thickness of the carotid artery intima-media complex was measured by B-mode imaging in real-time using a standard program for automatic averaging of values.
With pulse Doppler sonography speed parameters of blood flow were measured. Neuroimaging examination of the brain was conducted by 1.5 Tesla МRl (GE HTХ Sigma
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19.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 2
,
,
,
Cerebrovascular Disorders (genetics, path-physiology of arteriosclerosisespecially the role of insulin resistance in atherogenesis, asymptomatic
carotid
artery
stenosis and vascular dementia, rare causes of stroke especially in young adults), Ultrasound Techniques in Neurology (Power Triplex Color Doppler, Transcranial Doppler, detection of the circulating micro emboli and cerebral vasomotor reactivity testing, sonothrombolysis), chronic headaches (co-morbidity of migraine, chronic tension type of headache, rare headaches-SUNCT, cluster headache, paroxysmal hemicranias), Neuropsychology and Dementia, Movement Disorders (neuroimaging techniques, brain parenchyma sonography).
Cerebrovascular Disorders (genetics, path-physiology of arteriosclerosisespecially the role of insulin resistance in atherogenesis, asymptomatic carotid artery stenosis and vascular dementia, rare causes of stroke especially in young adults), Ultrasound Techniques in Neurology (Power Triplex Color Doppler, Transcranial Doppler, detection of the circulating micro emboli and cerebral vasomotor reactivity testing, sonothrombolysis), chronic headaches (co-morbidity of migraine, chronic tension type of headache, rare headaches-SUNCT, cluster headache, paroxysmal hemicranias), Neuropsychology and Dementia, Movement Disorders (neuroimaging techniques, brain parenchyma sonography).
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Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic
carotid
artery
stenosis.
Silvestrini M, Vernieri F, Pasqualetti P, Matteis M, Passarelli F, Troisi E, Caltagirone C.
Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis.
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Ultrasound parameters, intima-media thickness (IMT), circumferential arterial stiffness, resistance, and pulsatility indexes of the common
carotid
artery
were found to be age-dependent.
Color Doppler Flow Imaging (CDFI) and functional Transcranial Doppler (fTCD) are the neurosonological methods most frequently used for the assessment of a patient's vascular status, and the information obtained is helpful in the diagnosis of various forms of dementia. CDFI may show evidence of impaired cerebral blood flow.
Ultrasound parameters, intima-media thickness (IMT), circumferential arterial stiffness, resistance, and pulsatility indexes of the common carotid artery were found to be age-dependent.
Thus, these parameters can be used to determine the actual vascular age of individuals [23, 17].
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One of the most common sources of ASCE is
carotid
artery
disease.
Transcranial Doppler also has a place in detecting asymptomatic spontaneous cerebral emboli (ASCE) which are common findings in patients with VaD and AD [28].
One of the most common sources of ASCE is carotid artery disease.
Embolic signals are often detected by TCD of the middle cerebral arteries when monitored for a number of hours in most patients with symptomatic and severe stenosis [29]. Results of large emboli are stroke and transient ischaemic attack, but repeated small asymptomatic emboli over a long period of time may cause progressive cerebral damage. During open heart surgery or carotid surgery microemboli entering the cerebral circulation might cause memory loss and cognitive impairment. [30, 31] Valvular heart disease, atrial fibrillation and paradoxal embolisation of venous emboli into the arterial circulation may also result in ASCE [32, 33].
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Transcranial Doppler Ultrasonography CO 2 Reactivity Does Not Predict Recurrent Ischaemic Stroke inPatients with Symptomatic
Carotid
Artery
Occlusion.
Jolink WM, Heinen R, Persoon S, Van der Zwan A, Kappelle LJ, Klijn CJ.
Transcranial Doppler Ultrasonography CO 2 Reactivity Does Not Predict Recurrent Ischaemic Stroke inPatients with Symptomatic Carotid Artery Occlusion.
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Reduced cerebrovascular reserve is associated with an increased risk of postoperative ischemic lesions during
carotid
artery
stenting.
Koyanagi M, Yoshida K , Kurosaki Y , Sadamasa N, Narumi O, Sato T, Chin M, Handa A, Yamagata S, Miyamoto S.
Reduced cerebrovascular reserve is associated with an increased risk of postoperative ischemic lesions during carotid artery stenting.
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Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with
carotid
artery
stenosis and occlusion.
Markus H, Cullinane M.
Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
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Comparison of oxygen-15 PET and transcranial Doppler CO2-reactivity measurements in identifying haemodynamic compromise in patients with symptomatic occlusion of the internal
carotid
artery
.
Persoon S, Kappelle LJ, Van Berckel BN, Boellaard R, Ferrier CH, Lammertsma AA, Klijn CJ.
Comparison of oxygen-15 PET and transcranial Doppler CO2-reactivity measurements in identifying haemodynamic compromise in patients with symptomatic occlusion of the internal carotid artery.
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20.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 11, 2015, No. 1
,
,
,
lntravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal
carotid
artery
occlusion.A systematic review of clinical outcomes.
Mokin M, Kass-Hout T, Kass-Hout O, Dumont TM, Kan Р, MD, Snyder KV, MD, Hopkins LN, Siddiqui AH, Levy El.
lntravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion.A systematic review of clinical outcomes.
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21.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 11, 2015, No. 2
,
,
,
Presence of plaques in the right and left common and internal
carotid
artery
.
Presence of plaques in the right and left common and internal carotid artery.
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With regard to this fact, the results could be explained by the fact that pronounced thickening of IMC in the
carotid
arteries attributes to a more pronounced and diffuse atherosclerotic process that leads to certain hemodynamic changes in cerebral circulation, even in the absence of high-grade
carotid
stenosis (most of our subjects had a diameter stenosis of the
carotid
artery
up to 50%).
A positive correlation between IMC thickness and time of MES appearance in the cerebral arteries was also observed. Some studies have shown that in patients with cryptogenic ischemic stroke, IMC thickness positively correlates with the degree of systemic atherosclerosis development, and IMC thickness > 0.78mm is considered indicative of the search for cardiovascular sources of embolus as causes of ischemic stroke [9].
With regard to this fact, the results could be explained by the fact that pronounced thickening of IMC in the carotid arteries attributes to a more pronounced and diffuse atherosclerotic process that leads to certain hemodynamic changes in cerebral circulation, even in the absence of high-grade carotid stenosis (most of our subjects had a diameter stenosis of the carotid artery up to 50%).
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P11 Numerical Analysis of the Blood Flow in the
Carotid
Artery
Bifurcation.
P11 Numerical Analysis of the Blood Flow in the Carotid Artery Bifurcation.
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A clot in the left common internal
carotid
artery
was found.
A clot in the left common internal carotid artery was found.
At the last minute the patient exacerbated symptoms to right-sided hemiplegia and aphasia. Intravenous thrombolysis according to the agreed algorithm was held. The patient was discharged without any focal neurological symptoms.
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carotid
artery
, clot, neurosonology, stroke.
carotid artery, clot, neurosonology, stroke.
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Stenting of the
carotid
artery
was performed in 16 patients,
carotid
endartherectomy – in 17, upper cervical sympathectomy – in 4, extra-intracranial arterial bypass
Thirty-nine patients (27 men and 12 women) with atherosclerotic stenosis or thrombosis of carotid arteries aged 48-78 years were studied. Critical stenosis was revealed in 28 patients. Severe stenosis was found in 5 patients, thrombosis – in 6. Fourteen patients had a history of stroke, 25 were always asymptomatic.
Stenting of the carotid artery was performed in 16 patients, carotid endartherectomy – in 17, upper cervical sympathectomy – in 4, extra-intracranial arterial bypass
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NUMERICAL ANALYSIS OF BLOOD FLOW IN THE
CAROTID
ARTERY
BIFURCATION
NUMERICAL ANALYSIS OF BLOOD FLOW IN THE CAROTID ARTERY BIFURCATION
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To study numerically the time-varying blood flow in the common
carotid
artery
(CCA) bifurcation on the basis of Navier-Stokes equations for four different cases, including cases without stenosis and with one, two and three stenoses at different sites in the vicinity of the bifurcation.
To study numerically the time-varying blood flow in the common carotid artery (CCA) bifurcation on the basis of Navier-Stokes equations for four different cases, including cases without stenosis and with one, two and three stenoses at different sites in the vicinity of the bifurcation.
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The multimodal ultrasound neuroimaging showed left optic disc drusen, slightly increased diameters of the left optic nerve/sheath complex and thickened intima-media of the left internal
carotid
artery
.
The ophthalmic status at the beginning of the disease showed left-sided retrobulbar pain with mild exophthalmos, edema of the left eyelid, conjunctival injection and restricted horizontal movement of the left eye. Head CT showed a pseudotumor formation in the left medial retrobulbar space with slight swelling of the left optic nerve. Four months later the local neuro-ophthalmic status established mild left exophthalmos, ptosis of the left eyelid, conjunctival hyporeflexia of the left eye and hyposmia associated with CT data for left ethmoid sinusitis. There were found periods of accelerated erythrocyte sedimentation rate (ESR), normalized after treatment with corticosteroids. Thyroid hormones and tumor markers (carcinoembryonic antigen and prostate specific antigen) were within reference ranges.
The multimodal ultrasound neuroimaging showed left optic disc drusen, slightly increased diameters of the left optic nerve/sheath complex and thickened intima-media of the left internal carotid artery.
The control MRT/MRA studies performed 6 months after the onset of the disease, established normal brain parenchyma, intracranial vascular system, orbits and retrobulbar spaces. The diagnosis of Tolosa-Hunt syndrome was based on the criteria of the Intrenational Headache Society.
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22.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 1
,
,
,
The application of mechanical thrombectomy in acute ischemic stroke (AIS) aims recanalization by removing thrombus in a large arterial vessel occlusion (intracranial occlusion of the distal internal
carotid
artery
(ICA), and/or middle cerebral
artery
(MCA) or the M2).
The application of mechanical thrombectomy in acute ischemic stroke (AIS) aims recanalization by removing thrombus in a large arterial vessel occlusion (intracranial occlusion of the distal internal carotid artery (ICA), and/or middle cerebral artery (MCA) or the M2).
The review summarizes the experience of experimental and clinical application of this method and presents the international consensus adopted in 2014 by the European Stroke Conference. The use of mechanical thrombectomy in patients with AIS allows to increase the therapeutic window for recanalization which in intravenous thrIombolysis (IVT) is limited to 4.5 hours.
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However, this treatment is with limited efficacy in patients with acute stroke as a result of proximal internal
carotid
artery
occlusion.
Thrombolysis (TL) using rt-PA currently is the only evidence-based pharmacologic treatment of AIS.
However, this treatment is with limited efficacy in patients with acute stroke as a result of proximal internal carotid artery occlusion.
Successful reperfusion is achieved only in 10% and for occlusion of the middle cerebral artery
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Intra-arterial treatment of patients with acute ischemic stroke and internal
carotid
artery
occlusion: A literature review.
Kappelhof M, Marquering HA, Berkhemer OA.
Intra-arterial treatment of patients with acute ischemic stroke and internal carotid artery occlusion: A literature review.
J Neurointerv Surg 7, 2015: 8–15.
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The multimodal ultrasound neuroimaging showed left optic disc drusen, slightly increased diameters of the left optic nerve/sheath complex and thickened intima-media of the left internal
carotid
artery
.
The ophthalmic status at the beginning of the disease showed left-sided retrobulbar pain with mild exophthalmos, edema of the left eyelid, conjunctival injection and restricted horizontal movement of the left eye. Head CT showed a pseudotumor formation in the left medial retrobulbar space with slight swelling of the left optic nerve. Four months later the local neuro-ophthalmic status established mild left exophthalmos, ptosis of the left eyelid, conjunctival hyporeflexia of the left eye and hyposmia associated with CT data for left ethmoid sinusitis. There were found periods of accelerated erythrocyte sedimentation rate (ESR), normalized after treatment with corticosteroids. Thyroid hormones and tumor markers (carcinoembryonic antigen and prostate specific antigen) were within reference ranges.
The multimodal ultrasound neuroimaging showed left optic disc drusen, slightly increased diameters of the left optic nerve/sheath complex and thickened intima-media of the left internal carotid artery.
The control MRT/MRA studies performed 6 months after the onset of the disease, established normal brain parenchyma, intracranial vascular system, orbits and retrobulbar spaces. The diagnosis of Tolosa-Hunt syndrome was based on the criteria of the Intrenational Hedache Society.
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Head trauma can lead to this condition, especially in the case of fracture of the base of the skull with engaging oculomotor nerve (IIIth), intracavernous part
carotid
artery
injury with subsequent aneurysm formation and
carotid
– cavernous fistula.
The diagnosis of Tolosa-Hunt syndrome is difficult and is based on the exclusion of other conditions presenting with painful ophthalmoplegia.
Head trauma can lead to this condition, especially in the case of fracture of the base of the skull with engaging oculomotor nerve (IIIth), intracavernous part carotid artery injury with subsequent aneurysm formation and carotid – cavernous fistula.
In differential – diagnostic plan had to be excluded
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Increased intima-media thickness of the left
carotid
artery
Increased intima-media thickness of the left carotid artery
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Recent randomized clinical trials show that best medical therapy (BMT) is better than
carotid
endarterectomy (CEA) or
carotid
artery
stenting (CAS) in preventing stroke.
Recent randomized clinical trials show that best medical therapy (BMT) is better than carotid endarterectomy (CEA) or carotid artery stenting (CAS) in preventing stroke.
On the contrary guidelines of practice should remain unchanged. Current recommendations indicate that only ‘highly-selected‘patients should undergo CEA/CAS.
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Narrowing of the common
carotid
artery
(CCA) or the internal
carotid
artery
(ICA) due to atherosclerosis represents
carotid
artery
stenosis.
Narrowing of the common carotid artery (CCA) or the internal carotid artery (ICA) due to atherosclerosis represents carotid artery stenosis.
Stenosis is asymptomatic if the diffusion-weighted magnetic resonance imaging (DW-MRI) do not reveal acute or subacute clinically (silent) ischemia [1]. ACAS affects approximately 7% of women and more than 12% of men older than 70 years [2]. ACAS carries a risk for stroke that is less than 1% per year with less than 50% stenosis and 1% to 5% per year with greater than 50% stenosis [3]. About 34% of all strokes occur due to ICA thromboembolism. However, about two-thirds of patients with ICA thromboembolism will not have an ICA stenosis >50%, leaving rests being due to thromboembolism from a high grade (50-99%) previously asymptomatic ICA stenosis.
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It is important to note that development of symptoms and the severity of stenosis are not necessarily directly related, due to collateral circulation from the contralateral
carotid
artery
and the posterior circulation.
Clinical presentation includes transient ischemic attacks (TIA) or retinal ischemia so that typical manifestations of extracranial carotid stenosis include amaurosis fugax (transient blindness in one eye), unilateral paresis, unilateral sensory disturbances, aphasia, and dysarthria.
It is important to note that development of symptoms and the severity of stenosis are not necessarily directly related, due to collateral circulation from the contralateral carotid artery and the posterior circulation.
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Current BMT for
carotid
artery
stenosis is the combination therapy, with antiplatelet, antihypertensive, antidiabetic agents, and treatment of hypercholesterolemia, together with smoking cessation.
Current BMT for carotid artery stenosis is the combination therapy, with antiplatelet, antihypertensive, antidiabetic agents, and treatment of hypercholesterolemia, together with smoking cessation.
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Aggressive treatment of vascular risk factors can reduce cardiovascular events in patients with
carotid
artery
disease.
Aggressive treatment of vascular risk factors can reduce cardiovascular events in patients with carotid artery disease.
It is necessary that blood pressure is below 140/90 mm Hg. Further, it is advisable to maintain the low-density lipoprotein (LDL) – cholesterol value less than 100 mg/dl, triglyceride levels less than 150 mg/ dl and increase HDL levels more than 40 mg/ dl with lipid-lowering agents such as statins. Weight loss, exercise, dietary precautions and smoking cessation are also extremely important. Treatment with statins lowers stroke risk by approximately 30% [13]. Atorvastatin reduced LDL levels to
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Stenosis may develop also on the contralateral
carotid
artery
and such patients have increased risk of stroke [29] indicating the importance of the monitoring of the contralateral
carotid
artery
[30].
Restenosis following CEA and leading to increased risk of stoke may occur and has been reported in up to 15% of cases [28].
Stenosis may develop also on the contralateral carotid artery and such patients have increased risk of stroke [29] indicating the importance of the monitoring of the contralateral carotid artery [30].
On the other hand, there are effective techniques that can reduce the incidence of restenosis.
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Prevalence of asymptomatic
carotid
artery
stenosis according to age and sex: systematic review and meta-regression analysis.
de Weerd M, Greving JP, de Jong AW, Buskens E, Bots ML.
Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and meta-regression analysis.
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Internal
carotid
artery
stenosis: natural history and management.
Lanzino G, Tallarita T, Rabinstein AA.
Internal carotid artery stenosis: natural history and management.
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Statins: an essential component in the management of
carotid
artery
disease.
Paraskevas KI, Hamilton G, Mikhailidis DP.
Statins: an essential component in the management of carotid artery disease.
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Asymptomatic
carotid
artery
stenosis and the risk of new vascular events in patients with manifest arterial disease: the SMART study.
Goessens BMB, Visseren FLJ, Kappelle LJ, Algra A, van der Graaf Y.
Asymptomatic carotid artery stenosis and the risk of new vascular events in patients with manifest arterial disease: the SMART study.
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Carotid
artery
stenting vs
carotid
endarterectomy: meta-analysis and diversity-adjusted trial sequential analysis of randomized trials.
Bangalore S, Kumar S, Wetterslev J, Bavry AA, Gluud C, Cutlip DE, Bhatt DL.
Carotid artery stenting vs carotid endarterectomy: meta-analysis and diversity-adjusted trial sequential analysis of randomized trials.
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Asymptomatic
carotid
artery
stenosis and the risk of new vascular events in patients with manifest arterial disease: the SMART Study.
Goessens BMB, Visseren FLJ, Kappelle LJ, Algra A, van der Graaf Y, for the SMART Study Group.
Asymptomatic carotid artery stenosis and the risk of new vascular events in patients with manifest arterial disease: the SMART Study.
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Stenting versus endarterectomy for treatment of
carotid
-
artery
stenosis.
Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF; CREST Investigators.
Stenting versus endarterectomy for treatment of carotid-artery stenosis.
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patients with asymptomatic internal-
carotid
-
artery
stenosis: North American Symptomatic
Carotid
Endarterectomy Trial Collaborators.
patients with asymptomatic internal-carotid-artery stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators.
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Natural history of asymptomatic
carotid
artery
disease.
Bock RW, Gray-Weale AC, Mock PA, App Stats M, Robinson DA, Irwig L, Lusby RJ.
Natural history of asymptomatic carotid artery disease.
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Carotid
artery
stenting has increased rates of post-procedure stroke, death and resource utilization than does
carotid
endarterectomy in the United States, 2005.
McPhee JT, Schanzer A, Messina LM, Eslami MH.
Carotid artery stenting has increased rates of post-procedure stroke, death and resource utilization than does carotid endarterectomy in the United States, 2005.
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Carotid
artery
angioplasty for restenosis following endarterectomy.
McDonnell CO, Legge D, Twomey E, Kavanagh EG, Dundon S, O'Donohoe MK, O'Malley MK, Corrigan TP.
Carotid artery angioplasty for restenosis following endarterectomy.
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A. Natural history of
carotid
artery
stenosis contralateral to endarterectomy: results from two randomized prospective trials.
A. Natural history of carotid artery stenosis contralateral to endarterectomy: results from two randomized prospective trials.
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Carotid
artery
stenting versus
carotid
endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes.
Economopoulos KP, Sergentanis TN, Tsivgoulis G, Mariolis AD, Stefanadis C.
Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes.
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Internal
carotid
artery
stenting in patients with near occlusion: 30-day and longterm outcome.
lez A, Gil-Peralta A, Mayol A, Gonzalez-Marcos JR, Moniche F, Aguilar M, Gutierrez I.
Internal carotid artery stenting in patients with near occlusion: 30-day and longterm outcome.
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23.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 2
,
,
,
Colored duplex sonography showed symmetrical narrowing of the internal
carotid
artery
(ICA) with diameter
Neurological examination found discrete weakness of the right extremities. Left basal ganglia ischemia was seen on CT scan.
Colored duplex sonography showed symmetrical narrowing of the internal carotid artery (ICA) with diameter
read the entire text >>
24.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 13, 2017, No. 1
,
,
,
Internal
Carotid
Artery
Changes
Internal Carotid Artery Changes
read the entire text >>
The aim of this study was to evaluate the relationship between common
carotid
artery
intima-media thickness and risk factors in patients who underwent coronary
artery
bypass grafting surgery (CABG) based on extent of coronary
artery
disease.
The aim of this study was to evaluate the relationship between common carotid artery intima-media thickness and risk factors in patients who underwent coronary artery bypass grafting surgery (CABG) based on extent of coronary artery disease.
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We found no statistically significant difference in the mean intima-media thickness of the common
carotid
artery
between these two groups (p= 0.5637), neither between C-IMT and the extent of the coronary
artery
disease (p=0.82612).
The study included 66 patients. There were 35 patients in the CABG3+ group and 31 patients in the CABG2group.
We found no statistically significant difference in the mean intima-media thickness of the common carotid artery between these two groups (p= 0.5637), neither between C-IMT and the extent of the coronary artery disease (p=0.82612).
The CABG 3+ group had higher incidence of arterial hypertension (p=0.0298) and hyperlipidemia (p=0.0388). No statistically significant difference was found between age, gender, previous ischemic stroke, and smoking between groups.
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Our study did not show statistically significant relationship between common
carotid
artery
(CCA) IMT and the extent of CABG surgery and coronary
artery
disease.
Our study did not show statistically significant relationship between common carotid artery (CCA) IMT and the extent of CABG surgery and coronary artery disease.
Arterial hypertension and hyperlipidemia are more important risk factors, more commonly present in patients with greater extent of CABG surgery.
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Atherosclerosis is the common pathophysiological cause for the development of coronary and
carotid
artery
disease [13].
Atherosclerosis is the common pathophysiological cause for the development of coronary and carotid artery disease [13].
Intima media thickness (IMT) represents mainly medial layer hypertrophy and increased IMT is considered the earliest sign of carotid atherosclerosis [2].
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The aim of this study was to evaluate the relationship between common
carotid
artery
intima-media (C-IMT) thickness and risk factors in patients who underwent coronary
artery
bypass grafting surgery (CABG) based on extent of coronary
artery
disease.
The aim of this study was to evaluate the relationship between common carotid artery intima-media (C-IMT) thickness and risk factors in patients who underwent coronary artery bypass grafting surgery (CABG) based on extent of coronary artery disease.
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The Atherosclerosis Risk in Communities study (ARIC) has shown that the risk of CAD gradually increases with higher values of IMT [3], but a recent analysis of the ARIC study showed that coronary heart disease (CHD) risk prediction could be improved by adding all
carotid
artery
segments IMT (A-C IMT) or common
carotid
artery
IMT (CCA-IMT) with plaque information to traditional risk factors [14].
Our study demonstrated that there is no statistically significant difference in CCA IMT in patients who underwent CABG of three or more vessels, and those who underwent CABG of two or less vessels. Previously, a great number of studies demonstrated the relationship between carotid IMT and coronary stenosis severity, what was not statistically significant in our study [6, 9, 11, 12]. The association between IMT and CAD remains debatable [1].
The Atherosclerosis Risk in Communities study (ARIC) has shown that the risk of CAD gradually increases with higher values of IMT [3], but a recent analysis of the ARIC study showed that coronary heart disease (CHD) risk prediction could be improved by adding all carotid artery segments IMT (A-C IMT) or common carotid artery IMT (CCA-IMT) with plaque information to traditional risk factors [14].
However, a recently published meta-analysis of 11 population-based studies has shown that the ultrasound assessment of carotid plaque has a significantly higher accuracy for predicting future myocardial infarction or CAD events compared with carotid IMT assessment [8]. The meta-analysis of 27 diagnostic cohort studies (4.878 patients) also showed a higher, but nonsignificant, diagnostic accuracy of carotid plaque compared with CIMT for the detection of CAD [8]. In uremic patients IMT does not appear to add more information regarding risk stratification of CAD [5]. IMT increases with advancing CAD, patients with mean IMT over 1.15 mm have a 94% likelihood of having CAD, and the coexistence of CAD with severe stenosis of aortic arch arteries is relatively high and was found in 16.6% of patients with three vessel CAD [9]. IMT incorporating data from common and internal carotid artery, carotid bifurcation and femoral artery are well correlated with the extent of coronary atherosclerosis, much better than individual IMT [11].
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IMT incorporating data from common and internal
carotid
artery
,
carotid
bifurcation and femoral
artery
are well correlated with the extent of coronary atherosclerosis, much better than individual IMT [11].
The Atherosclerosis Risk in Communities study (ARIC) has shown that the risk of CAD gradually increases with higher values of IMT [3], but a recent analysis of the ARIC study showed that coronary heart disease (CHD) risk prediction could be improved by adding all carotid artery segments IMT (A-C IMT) or common carotid artery IMT (CCA-IMT) with plaque information to traditional risk factors [14]. However, a recently published meta-analysis of 11 population-based studies has shown that the ultrasound assessment of carotid plaque has a significantly higher accuracy for predicting future myocardial infarction or CAD events compared with carotid IMT assessment [8]. The meta-analysis of 27 diagnostic cohort studies (4.878 patients) also showed a higher, but nonsignificant, diagnostic accuracy of carotid plaque compared with CIMT for the detection of CAD [8]. In uremic patients IMT does not appear to add more information regarding risk stratification of CAD [5]. IMT increases with advancing CAD, patients with mean IMT over 1.15 mm have a 94% likelihood of having CAD, and the coexistence of CAD with severe stenosis of aortic arch arteries is relatively high and was found in 16.6% of patients with three vessel CAD [9].
IMT incorporating data from common and internal carotid artery, carotid bifurcation and femoral artery are well correlated with the extent of coronary atherosclerosis, much better than individual IMT [11].
A high-risk IMT score predicted an extended coronary artery disease although a low or medium risk IMT score cannot exclude the possibility of multivessel disease [11]. The current guidelines prefer CABG surgery in patients with diabetes and multivessel diseases. [4, 7, 18]. According to the current studies, the number of diseased vessels is important, anatomical complexity may be more important in determining optimal treatment for patients with multivessel CAD, with PCI being reasonable for lower SYNTAX scores and CABG surgery for higher scores [4]. Trachiotis et al.
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Our study did not show statistically significant relationship between common
carotid
artery
(CCA) IMT and the extent of CABG surgery and coronary
artery
disease.
Our study did not show statistically significant relationship between common carotid artery (CCA) IMT and the extent of CABG surgery and coronary artery disease.
Arterial hypertension and hyperlipidemia are more important risk factors more commonly present in patients with greater extent of CABG surgery.
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Common
carotid
artery
intima-media thickness is as good as
carotid
intima-media thickness of all
carotid
artery
segments in improving prediction of coronary heart disease risk in the atherosclerosis risk in communities (aric) study.
Nambi V, Chambless L, He M, Folsom AR, Mosley T, Boerwinkle E, Ballantyne CM.
Common carotid artery intima-media thickness is as good as carotid intima-media thickness of all carotid artery segments in improving prediction of coronary heart disease risk in the atherosclerosis risk in communities (aric) study.
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Carotid
Artery
Changes
Carotid Artery Changes
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atherosclerosis,
carotid
artery
, collateral supply
atherosclerosis, carotid artery, collateral supply
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The aim of our study was to evaluate the relationship between collateral flow via different pathways and cerebral hemodynamic parameters in patients with unilateral high-grade internal
carotid
artery
(ICA) changes.
The aim of our study was to evaluate the relationship between collateral flow via different pathways and cerebral hemodynamic parameters in patients with unilateral high-grade internal carotid artery (ICA) changes.
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Severe atherosclerosis of the internal
carotid
artery
(ICA) may lead to symptoms of transient retinal or cerebral ischemia and an increased risk of stroke.
Severe atherosclerosis of the internal carotid artery (ICA) may lead to symptoms of transient retinal or cerebral ischemia and an increased risk of stroke.
Therefore, knowledge of hemodynamic status may be important to elucidate the hemodynamic contribution of the symptoms.
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In patients with occlusive disease of the internal
carotid
artery
(ICA), collateral circulation is important to maintain adequate cerebral perfusion.
In patients with occlusive disease of the internal carotid artery (ICA), collateral circulation is important to maintain adequate cerebral perfusion.
The primary collateral pathway is the circle of Willis, with the possibility of redistributing flow from the contralateral ICA via the anterior communicating artery or from the vertebrobasilar arteries via the posterior communicating artery. Secondary collateral pathways include the external carotid artery via the ophthalmic artery and leptomeningeal anastomoses at the brain surface. When these collateral pathways are not adequate to maintain normal blood flow, vasodilatation of arterioles occurs and reduces cerebrovascular resistance for sustaining normal cerebral perfusion [1–3].
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Secondary collateral pathways include the external
carotid
artery
via the ophthalmic
artery
and leptomeningeal anastomoses at the brain surface.
In patients with occlusive disease of the internal carotid artery (ICA), collateral circulation is important to maintain adequate cerebral perfusion. The primary collateral pathway is the circle of Willis, with the possibility of redistributing flow from the contralateral ICA via the anterior communicating artery or from the vertebrobasilar arteries via the posterior communicating artery.
Secondary collateral pathways include the external carotid artery via the ophthalmic artery and leptomeningeal anastomoses at the brain surface.
When these collateral pathways are not adequate to maintain normal blood flow, vasodilatation of arterioles occurs and reduces cerebrovascular resistance for sustaining normal cerebral perfusion [1–3].
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carotid
artery
(ICA) changes.
carotid artery (ICA) changes.
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Severe internal
carotid
artery
stenosis (85%); Color Doppler ultrasound; severe narrowing of
artery
lumen.
Severe internal carotid artery stenosis (85%); Color Doppler ultrasound; severe narrowing of artery lumen.
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Severe internal
carotid
artery
stenosis (85%); MRangiography; gad-fl3d-tof-MIP; interrupted flow signal from ICA proximal site.
Severe internal carotid artery stenosis (85%); MRangiography; gad-fl3d-tof-MIP; interrupted flow signal from ICA proximal site.
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Carotid
artery
disease was assessed and defined according to standardized criteria.
Color Doppler ultrasonography (CDUS) of the extracranial carotid and vertebral arteries was performed on the unit Toshiba Aplio 500, with 5–12MHz linear probes.
Carotid artery disease was assessed and defined according to standardized criteria.
Transcranial Doppler sonography (TCD) was performed on the Toshiba Aplio500 unit 2.1MHz probe.
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Of 71 eligible patients, 50 were symptomatic in the vascular territory of the middle cerebral
artery
(MCA) ipsilateral to the
carotid
artery
pathology.
Of 71 eligible patients, 50 were symptomatic in the vascular territory of the middle cerebral artery (MCA) ipsilateral to the carotid artery pathology.
Of these, 21 (30%) had a transient retinal or cerebral ischemia (TIA), and 29 (41%) suffered from stroke (12 of them minor stroke, Rankin Scale score 1 or 2). The symptomatic side was left in 40 cases (56%) and right in 31 (44%) cases. Patients with bilateral ICA high-grade changes were not included in the study. 21 (30%) patients with non-focal brain discirculation were defined as “asymptomatic” and were also enrolled.
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Left internal
carotid
artery
occlusion; MR-angiography, gad-fl3d-tof-MIP; absence of flow signal from ICA; compensatory enhancement of signal intensity at the contralateral
carotid
artery
and posterior circulation arteries.
Left internal carotid artery occlusion; MR-angiography, gad-fl3d-tof-MIP; absence of flow signal from ICA; compensatory enhancement of signal intensity at the contralateral carotid artery and posterior circulation arteries.
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The cerebral hemodynamic status of patients with severe occlusive
carotid
artery
disease has been reported to play a significant role in the occurrence of stroke.
The cerebral hemodynamic status of patients with severe occlusive carotid artery disease has been reported to play a significant role in the occurrence of stroke.
Two mechanisms of cerebral ischemia in this disease have been identified: vascular occlusion from an embolism or propagating thrombus from an atherosclerotic plaque of the carotid artery (artery-to-artery embolism), and watershed or border-zone ischemia caused by critically reduced perfusion pressure (hemodynamic stroke) [2, 4, 10, 11].
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Two mechanisms of cerebral ischemia in this disease have been identified: vascular occlusion from an embolism or propagating thrombus from an atherosclerotic plaque of the
carotid
artery
(
artery
-to-
artery
embolism), and watershed or border-zone ischemia caused by critically reduced perfusion pressure (hemodynamic stroke) [2, 4, 10, 11].
The cerebral hemodynamic status of patients with severe occlusive carotid artery disease has been reported to play a significant role in the occurrence of stroke.
Two mechanisms of cerebral ischemia in this disease have been identified: vascular occlusion from an embolism or propagating thrombus from an atherosclerotic plaque of the carotid artery (artery-to-artery embolism), and watershed or border-zone ischemia caused by critically reduced perfusion pressure (hemodynamic stroke) [2, 4, 10, 11].
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Patients with complete
carotid
artery
occlusion may show no evidence of intracranial hemodynamic compromise, because collateral circulation compensates for the decrease in cerebral blood flow (CBF).
Patients with complete carotid artery occlusion may show no evidence of intracranial hemodynamic compromise, because collateral circulation compensates for the decrease in cerebral blood flow (CBF).
When these collateral pathways are not adequate to maintain normal blood flow, vasodilatation of arterioles occurs and reduces cerebrovascular resistance in order to sustain normal cerebral perfusion. This phenomenon is known as cerebrovascular autoregulation. Compromised CBF plays an important role in causing ipsilateral ischemic events in patients with occlusion of the ICA. As fact, cerebral ischemia frequently develops in areas of collateral pathways for blood supply from bordering vascular territories. As a result our study showed prevalence of cortical (19/38%) and border-zone infarctions (10/20%) in cases of ICA occlusion [3, 8, 12, 13].
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Secondary collateral pathways include the external
carotid
artery
via the ophthalmic
artery
.
The results of our study are in overall agreement with previously published results. On the other hand, our data show that the mean net flow volume in the VAs is increased by almost 18% when compared with the control ones, confirming that the vertebrobasilar circulation is also important in collateral supply in cases of ICA occlusion. Our data suggest that the anterior circle is a preferential mode of collateral supply in patients with ICA unilateral occlusion. Patients with collateral flow via the anterior communicating artery have less impaired hemodynamic parameters than those with collateral flow via the PComA (85% infarction in group without AComA vs. 12% infarction in patients with patent AComA).
Secondary collateral pathways include the external carotid artery via the ophthalmic artery.
Other leptomeningeal or extracerebral anastomoses play minor role in
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M. Outcome of
carotid
artery
occlusion is predicted by cerebrovascular reactivity.
M. Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity.
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Risk of stroke in the distribution of an asymptomatic
carotid
artery
.
European Carotid Surgery Trialists` Collaborative Group.
Risk of stroke in the distribution of an asymptomatic carotid artery.
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Severe occlusive
carotid
artery
disease: hemodynamic assessment by MR perfusion imaging in symptomatic patients.
Maeda M, Yuh WTC, Ueda T, Maley JE, Crosby DL, Zhu MW, Magnotta VA.
Severe occlusive carotid artery disease: hemodynamic assessment by MR perfusion imaging in symptomatic patients.
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Collateral circulation via the ophthalmic
artery
or leptomeningeal vessels is associated with impaired cerebral vasoreactivity in patients with symptomatic
carotid
artery
occlusion.
Hofmeijer J, Klijn CJ, Kappelle LJ, Van Huffelen AC, Van Gijn J.
Collateral circulation via the ophthalmic artery or leptomeningeal vessels is associated with impaired cerebral vasoreactivity in patients with symptomatic carotid artery occlusion.
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Transcranial Doppler Sonography and Magnetic Resonance angiography in the assessment of Collateral Hemispheric Flow in patients with
carotid
artery
Disease.
Anzola GP, Gasparotti R, Magoni M, Prandini F.
Transcranial Doppler Sonography and Magnetic Resonance angiography in the assessment of Collateral Hemispheric Flow in patients with carotid artery Disease.
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Cerebral Hemodinamics in Asymptomatic Patients with Internal
Carotid
Artery
Occlusion: A Dynamic Susceptibility Contrast MR and Transcranial Doppler Study.
Apruzzese A, Silvestrini M, Floris R, Vernieri F, Bozzao A, Hagberg G, Caltagirone C, Masala S, Simonetti G.
Cerebral Hemodinamics in Asymptomatic Patients with Internal Carotid Artery Occlusion: A Dynamic Susceptibility Contrast MR and Transcranial Doppler Study.
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Carotid
artery
pathology and main risk-factor profile in patients with anterior circulation brain infarction (rus).
Todua F, Gachchiladze D, Akhvlediani M.
Carotid artery pathology and main risk-factor profile in patients with anterior circulation brain infarction (rus).
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Collateral pathways in Internal
carotid
artery
unilateral occlusion.
Neff A et al.
Collateral pathways in Internal carotid artery unilateral occlusion.
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25.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 13, 2017, No. 2
,
,
,
Stroke risk factors can be subdivided into non-modifiable (age, sex, race-ethnicity, genetic factors) and modifiable (hypertension, diabetes, dyslipidemia, atrial fibrillation,
carotid
artery
stenosis, smoking, poor diet, physical inactivity, and obesity).
It is defined by WHO (World Health Organization) as the clinical syndrome of rapid onset of focal or global cerebral deficit, lasting more than 24 hours or leading to death, with no apparent cause other than a vascular one. It is one of the most common causes of death and disability in the adult population of the modern society. Stroke is a life changing disease, affecting the quality of life of patients and their families. It is also a huge social and financial burden for the family as well as the society. In spite of huge development in the management of stroke, with stroke units, thrombolytic therapy, endovascular treatment, neurosurgical and vascular surgical treatment, primary prevention of stroke is still one of the most important contributors for stroke management.
Stroke risk factors can be subdivided into non-modifiable (age, sex, race-ethnicity, genetic factors) and modifiable (hypertension, diabetes, dyslipidemia, atrial fibrillation, carotid artery stenosis, smoking, poor diet, physical inactivity, and obesity).
The four most important keys for healthy brain are in our hands: healthy nutrition (Mediterranean Diet), regular physical activity, stress management and “brain fitness”.
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In the study, IMT of the
carotid
artery
and diet in elderly men were assessed.
A 3-year intervention study [8] showed that vitamin C consumption was associated with less progression in carotid IMT in elderly men.
In the study, IMT of the carotid artery and diet in elderly men were assessed.
Men were randomly assigned to 1 of 4 groups: dietary intervention, omega-3 supplementation, both or neither. Results previously showed that omega-3 supplementation did not influence the IMT, thus the dietary intervention and no dietary intervention groups were pooled. The
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Although this method is commonly used in many fields of medicine (cardiology, angiology, etc.), its application in neurology is restricted predominantly to the monitoring of
carotid
artery
motion and hand tremor frequency [25].
. It gives temporal changes in echoes of the moving structures in which the depth of echo-producing interfaces is displayed along one axis (toward and away from the transducer) with time along the second axis.
Although this method is commonly used in many fields of medicine (cardiology, angiology, etc.), its application in neurology is restricted predominantly to the monitoring of carotid artery motion and hand tremor frequency [25].
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26.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 1
,
,
,
The PSAN was closely related to the right common
carotid
artery
(CCA), but with no communication.
Vascular surgeon suggested CT angiography (CTA) as a further diagnostic procedure. On 3/2013 the patient underwent CTA, mostly confirming the previous findings of arteria thyroidea ima AVF with bisacular aneurysm. Due to contrast artifacts and protocol procedure, the venous structures and low orifice of ATI were not precisely demonstrated at CTA. CTA confirmed AVF next to the pseudoaneurysm.
The PSAN was closely related to the right common carotid artery (CCA), but with no communication.
Carotid arteries were normal (Fig. 1). Neither hematoma nor other complications were detected on CT.
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Iatrogenic Arteriovenous Fistula between the Common
Carotid
Artery
and Internal Jugular Vein: A Case Report.
lu Y.
Iatrogenic Arteriovenous Fistula between the Common Carotid Artery and Internal Jugular Vein: A Case Report.
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(4 bilateral
carotid
artery
, 4 bilateral vertebral
artery
)
(4 bilateral carotid artery, 4 bilateral vertebral artery)
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Standardized ultrasound intima-media thickness (IMT), maximum and minimum
carotid
artery
diameter and blood pressure were used to calculate elasticity (distensibility coefficient (DC), compliance coefficient (CC)) and stiffness (Young’s elastic modulus (YEM), beta stiffness index (
= 49.4 (6.45), classified into three risk categories (diabetes, hypertension, smoking cigarettes) and a control group of subjects without CVRF were examined.
Standardized ultrasound intima-media thickness (IMT), maximum and minimum carotid artery diameter and blood pressure were used to calculate elasticity (distensibility coefficient (DC), compliance coefficient (CC)) and stiffness (Young’s elastic modulus (YEM), beta stiffness index (
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Shortly before and during the measurement of the
carotid
arteries diameter, the blood pressure was also measured on the upper arm side that corresponded to the test of the current
carotid
artery
.
media area of close and far arterial wall was performed in maximum systolic expansion of the artery and minimal lumen width during the relaxation of the artery at the end of diastole [1]. It was performed 4 or 5 times on each artery, with the maximum magnification, along with the examination of previously recorded and stored images over 3 to 5 cardiac cycles [17]. The results of the measuring of the maximum and minimum diameter were an average of two maximal systolic and two minimal diastolic lumen diameters.
Shortly before and during the measurement of the carotid arteries diameter, the blood pressure was also measured on the upper arm side that corresponded to the test of the current carotid artery.
The measurement was carried out by automatic electronic sphygmomanometer (Omron M6 Comfort, Kyoto, Japan), which was validated according to the international protocol of the European Society of Hypertension [2, 4]. The conversion factor of the measured blood pressure from mmHg to kPa is 0.13.
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the difference in systolic and diastolic diameter of the common
carotid
artery
lumen, ∆P is pulse pressure, i.e.
In the expressions above DD is CCA lumen diameter at the intima-lumen distance at the end of diastole, ∆D is pulsatile diameter change, i.e.
the difference in systolic and diastolic diameter of the common carotid artery lumen, ∆P is pulse pressure, i.e.
the difference in systolic and diastolic pressure readings, E
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is Peterson's (elastic) modulus, ln is natural logarithm, and STRAIN is the change (expressed in percentage) in lumen diameter of the common
carotid
artery
during cardiac cycle.
is Peterson's (elastic) modulus, ln is natural logarithm, and STRAIN is the change (expressed in percentage) in lumen diameter of the common carotid artery during cardiac cycle.
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reported on conclusive correlation of smoking and lower stiffness of
carotid
artery
(based on YEM) and higher elasticity of
carotid
artery
(based on DC) [26].
– in detecting statistically significant differences in subclinical atherosclerotic alteration in women with diabetes and hypertension with respect to women without CVRF. Similar results for some of the ultrasound markers have been published before [5, 15, 18, 23]. Van Sloten’s research led to conclusion that YEM is valid indicator of difference in carotid stiffness of people with and without cardiovascular incident [29]. In our research YEM did not indicate significant differences in carotid stiffness of observed groups of women. Contrary to the effect of other CVRF, Sharett et al.
reported on conclusive correlation of smoking and lower stiffness of carotid artery (based on YEM) and higher elasticity of carotid artery (based on DC) [26].
Our DC results of vascular healthy women indicate higher elasticity and
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Common
carotid
artery
intima-media thickness is not increased but distensibility is reduced in normotensive patients with type 2 diabetes compared with control subjects.
Charvat J, Chlumsky J, Zakovicova E, Kvapil M.
Common carotid artery intima-media thickness is not increased but distensibility is reduced in normotensive patients with type 2 diabetes compared with control subjects.
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Carotid
Artery
Distensibility.
Cuadrado Godia E, Madhok R, Pittman J, Trocio S, Ramas R, Cabral D, et al.
Carotid Artery Distensibility.
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Longitudinal Effects of a Decade of Aging on
Carotid
Artery
Stiffness.
Gepner AD, Korcarz CE, Colangelo LA, Hom EK, Tattersall MC, Astor BC.
Longitudinal Effects of a Decade of Aging on Carotid Artery Stiffness.
The Multiethnic Study of Atherosclerosis.
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Heritability of
carotid
artery
distensibility in Hispanics the Nothern Manhattan Family Study.
Juo S, Rundek T, Liu H, Cheng R, Lan M, Huang JS, et al.
Heritability of carotid artery distensibility in Hispanics the Nothern Manhattan Family Study.
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Glucose-related arterial stiffness and
carotid
artery
remodeling: a study in normal subjects and type 2 diabetes patients.
Kozakova M, Morizzo C, Bianchi C, Di Filippi M, Miccoli R, Paterni M, et al.
Glucose-related arterial stiffness and carotid artery remodeling: a study in normal subjects and type 2 diabetes patients.
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Carotid
artery
structural and functional evaluation in relatives of type 2 diabetic patients.
Prado SS, Ribeiro ML, Cardoso GP, Bousquet–Santos K, Velarde LG, Nobrega AC.
Carotid artery structural and functional evaluation in relatives of type 2 diabetic patients.
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Risk factors for
carotid
artery
distensibility in middle-aged and elderly hemodialysis patients.
Ren H, Chen G, Cai Q, Li Y, Han S, Li L.
Risk factors for carotid artery distensibility in middle-aged and elderly hemodialysis patients.
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27.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 2
,
,
,
Spontaneous Dissection of the Internal
Carotid
Artery
– a Late Vascular Complication
Spontaneous Dissection of the Internal Carotid Artery – a Late Vascular Complication
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MES have been detected in a large number of clinical conditions, such as
carotid
artery
stenosis (especially due to unstable plaques) [25, 21, 31, 20, 19, 38, 23, 29], aortic arch plaques [25, 6], cardiac sources of cerebral embolism (i.e.
Transcranial Doppler (TCD) is a safe and sensitive technique for real-time detection of microembolic signals (MES) in the intracranial cerebral arteries. MES have been defined as short lasting (3 dB) transients within the Doppler frequency spectrum; they appear randomly during the cardiac cycle and produce a “whistle”, “chirp”, or “click” sound when passing through the sample volume; they have been proven to represent microemboli passing within cerebral arteries [24, 14, 7, 5, 22, 36]. Since its first application in the field of cerebrovascular diseases in the late 1990s, MES detection improved in several technical aspects, such as reliability of automated MES count and exclusion of artifacts during continuous TCD monitoring [3, 27, 1, 2, 18].
MES have been detected in a large number of clinical conditions, such as carotid artery stenosis (especially due to unstable plaques) [25, 21, 31, 20, 19, 38, 23, 29], aortic arch plaques [25, 6], cardiac sources of cerebral embolism (i.e.
atrial fibrillation, prosthetic heart valves, valvular thrombosis) [6, 4, 17, 12], patent foramen ovale (PFO) [32, 33], and during carotid surgery and endovascular procedures (i.e. stent implantation) [16, 26, 35, 34]. In all these conditions, the presence of MES within the cerebral circulation has shown to indicate an increased risk of stroke in both asymptomatic and symptomatic patients [36, 15, 13]. In symptomatic cases, after an index stroke, MES detection identifies patients at higher risk for recurrent stroke. Most studies about MES detection concern patients with carotid artery stenosis, but some tried to detect MES in different stroke subtypes disclosing a higher MES number when the underlying mechanism was a cardiac embolism [17, 12].
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Most studies about MES detection concern patients with
carotid
artery
stenosis, but some tried to detect MES in different stroke subtypes disclosing a higher MES number when the underlying mechanism was a cardiac embolism [17, 12].
MES have been detected in a large number of clinical conditions, such as carotid artery stenosis (especially due to unstable plaques) [25, 21, 31, 20, 19, 38, 23, 29], aortic arch plaques [25, 6], cardiac sources of cerebral embolism (i.e. atrial fibrillation, prosthetic heart valves, valvular thrombosis) [6, 4, 17, 12], patent foramen ovale (PFO) [32, 33], and during carotid surgery and endovascular procedures (i.e. stent implantation) [16, 26, 35, 34]. In all these conditions, the presence of MES within the cerebral circulation has shown to indicate an increased risk of stroke in both asymptomatic and symptomatic patients [36, 15, 13]. In symptomatic cases, after an index stroke, MES detection identifies patients at higher risk for recurrent stroke.
Most studies about MES detection concern patients with carotid artery stenosis, but some tried to detect MES in different stroke subtypes disclosing a higher MES number when the underlying mechanism was a cardiac embolism [17, 12].
There are few data about MES detection in patients with cryptogenic stroke, and about its relationship with the different stroke subtypes, especially with the recently proposed category of embolic stroke of undetermined source (ESUS) [10]. The aim of our study was to assess the reliability of TCD monitoring in the setting of cryptogenic stroke and to investigate the relationship between MES detection, stroke mechanism, and risk of recurrence.
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Asymptomatic embolization detected by Doppler ultrasound predicts stroke risk in symptomatic
carotid
artery
stenosis.
Markus HS, MacKinnon A.
Asymptomatic embolization detected by Doppler ultrasound predicts stroke risk in symptomatic carotid artery stenosis.
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Silent cerebral microembolism in asymptomatic and symptomatic
carotid
artery
stenoses of low and high degree.
Orlandi G, Parenti G, Bertolucci A, Murri L.
Silent cerebral microembolism in asymptomatic and symptomatic carotid artery stenoses of low and high degree.
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Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal
carotid
artery
stenosis.
ncke L, Steinmetz H.
Plaque ulceration and lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis.
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Prevalence of micro-emboli in symptomatic high grade
carotid
artery
disease: a transcranial Doppler study.
Zuromskis T, Wetterholm R, Lindqvist JF, Svedlund S, Sixt C, Jatuzis D, Obelieniene D, Caidahl K, Volkmann R.
Prevalence of micro-emboli in symptomatic high grade carotid artery disease: a transcranial Doppler study.
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Spontaneous Dissection of the Internal
Carotid
Artery
–
Spontaneous Dissection of the Internal Carotid Artery –
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carotid
artery
ultrasound radiation
carotid artery ultrasound radiation
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We present the case of a 52-year-old woman who developed internal
carotid
artery
dissection seven years after mastectomy and radiotherapy.
Radiation induced dissection is an uncommon late complication of radiotherapy.
We present the case of a 52-year-old woman who developed internal carotid artery dissection seven years after mastectomy and radiotherapy.
Initial examination revealed soreness on the left side of the neck. Carotid color Doppler flow imaging identified a subintimal hematoma in the enlarged left carotid bulb. She was treated with acetylsalicylic acid and statin. Forty five days after, carotid ultrasound showed complete resorption of the hematoma. Doppler ultrasound may have crucial role for the diagnosis and follow-up of carotid artery dissection due to its accessibility, promptness and noninvasiveness.
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Doppler ultrasound may have crucial role for the diagnosis and follow-up of
carotid
artery
dissection due to its accessibility, promptness and noninvasiveness.
We present the case of a 52-year-old woman who developed internal carotid artery dissection seven years after mastectomy and radiotherapy. Initial examination revealed soreness on the left side of the neck. Carotid color Doppler flow imaging identified a subintimal hematoma in the enlarged left carotid bulb. She was treated with acetylsalicylic acid and statin. Forty five days after, carotid ultrasound showed complete resorption of the hematoma.
Doppler ultrasound may have crucial role for the diagnosis and follow-up of carotid artery dissection due to its accessibility, promptness and noninvasiveness.
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The cause of
carotid
artery
dissection can be either traumatic or spontaneous.
the overall survival of patients [19]. However, it can cause numerous acute and chronic side effects in breast cancer survivors, affecting cutaneous, gastrointestinal, cardiac, respiratory and cerebrovascular systems [14].
The cause of carotid artery dissection can be either traumatic or spontaneous.
If spontaneous, it is usually induced by a trivial trauma (for example, coughing or vomiting) which would not normally lead to artery dissection unless there is a previous underlying condition [16]. The underlying conditions might be infection, hypercholesterolemia, fibromuscular dysplasia, Ehler–Danlos syndrome type IV, Marfan’s syndrome, autosomal dominant polycystic kidney disease, migraine, low body mass index, and osteogenesys imperfecta [6, 9, 10].
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Our aim was to present a patient with a dissection of the internal
carotid
artery
, as a rare late vascular complication of radiotherapy treatment.
Our aim was to present a patient with a dissection of the internal carotid artery, as a rare late vascular complication of radiotherapy treatment.
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carotid
artery
dissection with subintimal hematoma (6,3x24,2mm in size).
carotid artery dissection with subintimal hematoma (6,3x24,2mm in size).
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. The patient was subsequently referred for a neck ultrasound, which revealed a hypoechoic mass in the
carotid
bulb of the left internal
carotid
artery
, situated superficially and slightly lateral.
. The patient was subsequently referred for a neck ultrasound, which revealed a hypoechoic mass in the carotid bulb of the left internal carotid artery, situated superficially and slightly lateral.
The cross-sectional image revealed a fusiform appearance of the mass. Differential diagnosis included tumor of the carotid glomus or, less likely, an atherosclerotic plaque. The patient was afterwards referred for a carotid color Doppler flow imaging which showed a normal lumen in both common, internal and external carotid arteries with slightly thickened carotid artery walls and small marginal plaques. A hypoechoic mass corresponding primarily to a subintimal (mural) hematoma 6.3x24.2mm in size was found in the enlarged left carotid bulb (Figure 3). Hemodynamics were normal, with a physiological flow direction, with no hemodynamically significant stenosis.
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The patient was afterwards referred for a
carotid
color Doppler flow imaging which showed a normal lumen in both common, internal and external
carotid
arteries with slightly thickened
carotid
artery
walls and small marginal plaques.
. The patient was subsequently referred for a neck ultrasound, which revealed a hypoechoic mass in the carotid bulb of the left internal carotid artery, situated superficially and slightly lateral. The cross-sectional image revealed a fusiform appearance of the mass. Differential diagnosis included tumor of the carotid glomus or, less likely, an atherosclerotic plaque.
The patient was afterwards referred for a carotid color Doppler flow imaging which showed a normal lumen in both common, internal and external carotid arteries with slightly thickened carotid artery walls and small marginal plaques.
A hypoechoic mass corresponding primarily to a subintimal (mural) hematoma 6.3x24.2mm in size was found in the enlarged left carotid bulb (Figure 3). Hemodynamics were normal, with a physiological flow direction, with no hemodynamically significant stenosis. The morphology and hemodynamics of the vertebral arteries were normal. Several
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This case report reveals a potential uncommon vascular complication of radiotherapy – dissection of the internal
carotid
artery
in a patient with smoking and previous infection, which are important risk factors for the development of dissection.
This case report reveals a potential uncommon vascular complication of radiotherapy – dissection of the internal carotid artery in a patient with smoking and previous infection, which are important risk factors for the development of dissection.
Vascular abnormalities are an important cause of radiation-induced complications [22]. Patients with previous neck radiation have a tendency to develop radiation-induced carotid artery stenosis [1], but can also rarely lead to carotid artery dissections [13, 16].
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Patients with previous neck radiation have a tendency to develop radiation-induced
carotid
artery
stenosis [1], but can also rarely lead to
carotid
artery
dissections [13, 16].
This case report reveals a potential uncommon vascular complication of radiotherapy – dissection of the internal carotid artery in a patient with smoking and previous infection, which are important risk factors for the development of dissection. Vascular abnormalities are an important cause of radiation-induced complications [22].
Patients with previous neck radiation have a tendency to develop radiation-induced carotid artery stenosis [1], but can also rarely lead to carotid artery dissections [13, 16].
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In our case clinical picture and
carotid
Doppler ultrasound had an important role in diagnosis of the internal
carotid
artery
dissection, despite inconclusive finding of CTA, which is according to recent studies better alternative to magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) [8, 20].
In our case clinical picture and carotid Doppler ultrasound had an important role in diagnosis of the internal carotid artery dissection, despite inconclusive finding of CTA, which is according to recent studies better alternative to magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) [8, 20].
Intraplaque hemorrhage of the carotid atherosclerosis is a potential differential diagnosis [11]. A limitiation of the case report was that we could not perform fat-supressed MRI which offers direct visualization of the mural hematoma [7]. MRA and CTA might
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Doppler ultrasound is an accessible, rapid and noninvasive technique for diagnosing
carotid
artery
dissection, especially in midcervical region
Doppler ultrasound is an accessible, rapid and noninvasive technique for diagnosing carotid artery dissection, especially in midcervical region
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The clinical manifestations of
carotid
artery
dissection are often non-specific, therefore a thorough investigation of a patient's past medical history has a critical role in diagnosing radiation-induced
carotid
artery
dissection [21].
Recognition of associated factors facilitates identification of those at risk [17].
The clinical manifestations of carotid artery dissection are often non-specific, therefore a thorough investigation of a patient's past medical history has a critical role in diagnosing radiation-induced carotid artery dissection [21].
Those patients should be closely surveilled and screening may be considered [5, 18]. The condition may progress rapidly, therefore an early diagnosis and appropriate treatment are crucial. Ultrasonographic evaluation plays an important role in the assessment of further treatment and therapeutic procedures (endovascular treatment, antithrombotic therapy). The ultrasound signs of dissection are: mural hematoma and thrombus as a thickened hypoechoic wall, increase in the external caliber of the artery or an intimal flap; the non-specific signs are: stenosis or occlusion with repercussions on haemodynamics [2]. Ultrasound sensitivity is high for most internal carotid artery dissections, as they begin near the carotid bulb in the mid-neck where ultrasound has easier access to the vessel [12]; the principal limitation is the inability to examine the entire vascular axis [3].
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Ultrasound sensitivity is high for most internal
carotid
artery
dissections, as they begin near the
carotid
bulb in the mid-neck where ultrasound has easier access to the vessel [12]; the principal limitation is the inability to examine the entire vascular axis [3].
The clinical manifestations of carotid artery dissection are often non-specific, therefore a thorough investigation of a patient's past medical history has a critical role in diagnosing radiation-induced carotid artery dissection [21]. Those patients should be closely surveilled and screening may be considered [5, 18]. The condition may progress rapidly, therefore an early diagnosis and appropriate treatment are crucial. Ultrasonographic evaluation plays an important role in the assessment of further treatment and therapeutic procedures (endovascular treatment, antithrombotic therapy). The ultrasound signs of dissection are: mural hematoma and thrombus as a thickened hypoechoic wall, increase in the external caliber of the artery or an intimal flap; the non-specific signs are: stenosis or occlusion with repercussions on haemodynamics [2].
Ultrasound sensitivity is high for most internal carotid artery dissections, as they begin near the carotid bulb in the mid-neck where ultrasound has easier access to the vessel [12]; the principal limitation is the inability to examine the entire vascular axis [3].
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A historical prospective cohort study of
carotid
artery
stenosis after radiotherapy for head and neck malignancies.
Brown PD, Foote RL, Mclaughlin MP, Halyard MY, Ballman KV, Collie AC, Miller RC, Flemming KD, Hallett JW.
A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies.
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[mri with fat suppression in the visualization of wall hematoma in spontaneous dissection of the internal
carotid
artery
].
Fiebach J, Brandt T, Knauth M, Jansen O.
[mri with fat suppression in the visualization of wall hematoma in spontaneous dissection of the internal carotid artery].
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L. Atherosclerotic plaque rupture and intraplaque hemorrhage do not correlate with symptoms in
carotid
artery
stenosis.
L. Atherosclerotic plaque rupture and intraplaque hemorrhage do not correlate with symptoms in carotid artery stenosis.
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Imaging of
carotid
artery
dissection.
Mozayan M, Sexton C.
Imaging of carotid artery dissection.
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Common
carotid
artery
dissection caused by radiotherapy: A case report.
Wang J, Yue D, Chen X, Wei Z, Lu W, Wu D.
Common carotid artery dissection caused by radiotherapy: A case report.
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Radiation-induced
carotid
artery
stenosis: A comprehensive review of the literature.
Xu J, Cao Y.
Radiation-induced carotid artery stenosis: A comprehensive review of the literature.
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There have been contradictions regarding the optimal treatment of patients with asymptomatic severe internal
carotid
artery
stenosis (ACAS).
There have been contradictions regarding the optimal treatment of patients with asymptomatic severe internal carotid artery stenosis (ACAS).
From the one hand previous studies proved benefit from carotid intervention in ACAS patients, from the other hand due to the development of modern medical therapy there has been a significant reduction in stroke incidence in patients with only medical treatment. Recent calculations have suggested that the stroke risk with intensive medical therapy is lower or similar compared with that of carotid endarterectomy or carotid artery stenting in ACAS patients. Therefore, carotid reconstruction for the most patients with asymptomatic severe internal carotid artery stenosis has not been suggested recently. However, some special subgroups with high stroke risk were shown to benefit from carotid surgery. High-risk patients are characterised by poor collateral circulation with exhausted cerebrovascular reserve capacity, or by unstable plaque with cerebral microembolisation.
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Recent calculations have suggested that the stroke risk with intensive medical therapy is lower or similar compared with that of
carotid
endarterectomy or
carotid
artery
stenting in ACAS patients.
There have been contradictions regarding the optimal treatment of patients with asymptomatic severe internal carotid artery stenosis (ACAS). From the one hand previous studies proved benefit from carotid intervention in ACAS patients, from the other hand due to the development of modern medical therapy there has been a significant reduction in stroke incidence in patients with only medical treatment.
Recent calculations have suggested that the stroke risk with intensive medical therapy is lower or similar compared with that of carotid endarterectomy or carotid artery stenting in ACAS patients.
Therefore, carotid reconstruction for the most patients with asymptomatic severe internal carotid artery stenosis has not been suggested recently. However, some special subgroups with high stroke risk were shown to benefit from carotid surgery. High-risk patients are characterised by poor collateral circulation with exhausted cerebrovascular reserve capacity, or by unstable plaque with cerebral microembolisation. The present article summarizes the use of transcranial Doppler in selection of high-risk ACAS patients who may benefit from carotid intervention.
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Therefore,
carotid
reconstruction for the most patients with asymptomatic severe internal
carotid
artery
stenosis has not been suggested recently.
There have been contradictions regarding the optimal treatment of patients with asymptomatic severe internal carotid artery stenosis (ACAS). From the one hand previous studies proved benefit from carotid intervention in ACAS patients, from the other hand due to the development of modern medical therapy there has been a significant reduction in stroke incidence in patients with only medical treatment. Recent calculations have suggested that the stroke risk with intensive medical therapy is lower or similar compared with that of carotid endarterectomy or carotid artery stenting in ACAS patients.
Therefore, carotid reconstruction for the most patients with asymptomatic severe internal carotid artery stenosis has not been suggested recently.
However, some special subgroups with high stroke risk were shown to benefit from carotid surgery. High-risk patients are characterised by poor collateral circulation with exhausted cerebrovascular reserve capacity, or by unstable plaque with cerebral microembolisation. The present article summarizes the use of transcranial Doppler in selection of high-risk ACAS patients who may benefit from carotid intervention.
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Although the previous randomised studies before 2003 showed benefit of endarterectomy in patients with asymptomatic severe
carotid
artery
stenosis (ACAS) [6, 8, 13], there has been no consensus in the recent guidelines regarding the optimal management of this disease.
Although the previous randomised studies before 2003 showed benefit of endarterectomy in patients with asymptomatic severe carotid artery stenosis (ACAS) [6, 8, 13], there has been no consensus in the recent guidelines regarding the optimal management of this disease.
Its main cause is that due to the modern medical therapy the annual stroke risk in patients with asymptomatic carotid stenosis decreased below 1% [2, 12, 15]. The substantial reduction in stroke incidence in ACAS patients
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treated with the best medical therapy resulted in weak indication for
carotid
artery
reconstruction by endarterectomy or stenting in these patients [14].
treated with the best medical therapy resulted in weak indication for carotid artery reconstruction by endarterectomy or stenting in these patients [14].
Although intensive medical therapy has decreased the risk of ischemic stroke in most ACAS patients, some special subgroups have still elevated stroke risk despite modern medical treatment [16]. Since these high-risk patients may have benefit from carotid intervention, it is very important to select them by using appropriate examinations.
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In addition,
carotid
ultrasound may also help differentiate high-risk and low-risk plaques in the internal
carotid
artery
.
Transcranial Doppler (TCD) is an easy, noninvasive, relatively cheap tool to investigate the reactivity of cerebral microvessels to vasodilative stimuli (cerebral vasoreactivity), and thus it is able to assess the compensatory vasodilation of cerebral arterioles [1, 3, 10, 20, 23]. It should be mentioned that flow velocity is monitored in the main intracranial arteries (mostly in the middle cerebral artery), while the vasodilative stimuli change the diameter of the small resistance vessels (Fig. 1). TCD is an excellent method to detect cerebral microemboli as well [9, 11]. Unilateral presence of microembolic signals in the middle cerebral artery (MCA) indicates artery-to-artery embolisms from unstable carotid plaque.
In addition, carotid ultrasound may also help differentiate high-risk and low-risk plaques in the internal carotid artery.
Carotid plaques with irregular surface, intraplaque haemorrhage, decreased echogenicity and without echogenic cap belong to high-risk plaques. Rapid progression of carotid stenosis was also shown to be associated with an increased risk of ischemic stroke [16].
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It is well known that severe
carotid
artery
obstruction may result in decreased perfusion pressure if the cerebral collateral system is incomplete.
It is well known that severe carotid artery obstruction may result in decreased perfusion pressure if the cerebral collateral system is incomplete.
Regarding the cerebral collateral circulation, primary and secondary collaterals are differentiated. The primary collaterals are the communicating arteries that form
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(ICA – internal
carotid
artery
; PI – pulsatility index).
Lack of significant vasodilation after administration of vasodilative stimuli explains the only mild or the absence of flow velocity increase. Quite contrary, good collateral circulation prevents the decrease of perfusion pressure in ICA stenosis, therefore the diameter of microvessels do not change. Application of a vasodilative agent causes vasodilation of resistance vessels and consequently increases the cerebral blood flow and flow velocity. Different effect of vasodiative stimuli on flow velocity changes allows us to differentiate asymptomatic ICA stenosis with poor or good collateral circulation. The size of the circles indicates the diameter of arterioles.
(ICA – internal carotid artery; PI – pulsatility index).
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Endarterectomy for asymptomatic
carotid
artery
stenosis.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.
Endarterectomy for asymptomatic carotid artery stenosis.
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Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with
carotid
artery
stenosis and occlusion.
Markus H, Cullinane M.
Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion.
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Time to rethink management strategies in asymptomatic
carotid
artery
disease.
Naylor AR.
Time to rethink management strategies in asymptomatic carotid artery disease.
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Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic
carotid
artery
stenosis.
Silvestrini M, Vernieri F, Pasqualetti P, Matteis M, Passarelli F, Troisi E, Caltagirone C.
Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis.
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The pathology of the
carotid
artery
associated with an increased risk of stroke is treated successfully with endarterectomy (CEA) or stenting (CAS).
The pathology of the carotid artery associated with an increased risk of stroke is treated successfully with endarterectomy (CEA) or stenting (CAS).
The method
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The ratio of PSV Internal
Carotid
Artery
(ICA)/PSV Common
Carotid
Artery
(CCA) is calculated.
and every 6 months after the first year. This study is conducted according to a standard protocol (the arteries are examined sequentially on both sides, all along). The artery lumen should be insonated at least 2 cm before the area of revascularisation, as well as in the area itself and 2 cm after it, after which paek systolic velocity (PSV) and end diastolic velocity (EDV) are measured in the area before, inside (beginning, middle, end) and after CEA/CAS.
The ratio of PSV Internal Carotid Artery (ICA)/PSV Common Carotid Artery (CCA) is calculated.
The stent is visualized in the lumen of the vessel with a typical ultrasound artefact. In case of follow-up after CAS, the presence of the following is visualised: residual stenosis; restenosis; neointimal hyperplasia; recurrent plaque with stenosis; dislocation of the stent; straightening an elongated and curved ICA by a stent, which may cause a distal twist. In case of a synthetic patch after CEA, there is a typical hyperechogenic image without intima and the diameter of the artery is larger than the native (ectasia or aneurism). A relational stenosis occurs after a direct seam of CEA. Possible CEA complications that can be diagnosed with CCDS are: restenosis; neointimal proliferation; postoperative occlusion of the external carotid artery; intimal flap; progression of the plaque in the proximal part of the CEA; false aneurysm.
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Possible CEA complications that can be diagnosed with CCDS are: restenosis; neointimal proliferation; postoperative occlusion of the external
carotid
artery
; intimal flap; progression of the plaque in the proximal part of the CEA; false aneurysm.
The ratio of PSV Internal Carotid Artery (ICA)/PSV Common Carotid Artery (CCA) is calculated. The stent is visualized in the lumen of the vessel with a typical ultrasound artefact. In case of follow-up after CAS, the presence of the following is visualised: residual stenosis; restenosis; neointimal hyperplasia; recurrent plaque with stenosis; dislocation of the stent; straightening an elongated and curved ICA by a stent, which may cause a distal twist. In case of a synthetic patch after CEA, there is a typical hyperechogenic image without intima and the diameter of the artery is larger than the native (ectasia or aneurism). A relational stenosis occurs after a direct seam of CEA.
Possible CEA complications that can be diagnosed with CCDS are: restenosis; neointimal proliferation; postoperative occlusion of the external carotid artery; intimal flap; progression of the plaque in the proximal part of the CEA; false aneurysm.
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Also the brachial arterial blood pressure (BP) was measured and the hemodynamic variables in the common
carotid
artery
(CCA): tensile stress (TS) and wall shear stress (WSS) were assessed.
Changes of the examined neurosonographic parameters: blood flow velocity (BFV), vessel diameters (Ds), vessel wall intima-media thickness (IMT) and stiffness, vasomotor reactivity (VMR) were found and they were correlated to the altered hemorheological variables: hematocrit (HT), fibrinogen (FIB), plasma (PV) and whole blood viscosity (WBV).
Also the brachial arterial blood pressure (BP) was measured and the hemodynamic variables in the common carotid artery (CCA): tensile stress (TS) and wall shear stress (WSS) were assessed.
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The aim of this workshop is to present and discuss in details, together with the professional audience, nine cases of AIS patients treated at the Acibadem City Clinic: complicated
carotid
pathology (stenosis and atherothombosis), acute cardioembolic occlusion of internal
carotid
artery
(ICA) and middle cerebral
artery
(MCA), post-dissection type of aneurysm of ICA, vertebral origin stenosis, intracranial supraclinoid stenosis of ICA, basilar
artery
occlusion,
artery
of Percheron occlusion with brain-stem stroke, temporal arteritis, and finally a case of thrombotic thrombocytopenic purpura leading to TIAs and stroke.
The aim of this workshop is to present and discuss in details, together with the professional audience, nine cases of AIS patients treated at the Acibadem City Clinic: complicated carotid pathology (stenosis and atherothombosis), acute cardioembolic occlusion of internal carotid artery (ICA) and middle cerebral artery (MCA), post-dissection type of aneurysm of ICA, vertebral origin stenosis, intracranial supraclinoid stenosis of ICA, basilar artery occlusion, artery of Percheron occlusion with brain-stem stroke, temporal arteritis, and finally a case of thrombotic thrombocytopenic purpura leading to TIAs and stroke.
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The most important contributors to unstable atherosclerotic lesions such as plaque angiogenesis and intraplaque haemorrhage, plaques echolusency, spotty micro-calcifications and higher internal
carotid
artery
strain are analysed in the lecture according to different modalities of imaging.
Carotid plaque echolusency detected by Color Coded Doppler ultrasonography (CCDS) and intraplaque neovascularization (IPNV) by contrast enhanced ultrasound (CEUS) have been recognized as potential markers of plaque vulnerability. Application of Superb Microvascularisation Imaging (SMI) created by Toshiba to overcome the limitations of conventional Doppler technique for the visualisation of microvessels with low velocity flow has been effectively used in recent years.
The most important contributors to unstable atherosclerotic lesions such as plaque angiogenesis and intraplaque haemorrhage, plaques echolusency, spotty micro-calcifications and higher internal carotid artery strain are analysed in the lecture according to different modalities of imaging.
The effectiveness and limitations of different ultrasound techniques as CCDS, elastography, CEUS and SMI for the evaluation of plaques surface, echogenicity, IPNV and arterial wall stiffness are compared to Positron Emission Tomography, Computed Tomography and Magnetic Resonance Imaging.
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Effective Conservative Treatment of a Symptomatic Occlusion of the Internal
Carotid
Artery
.
Effective Conservative Treatment of a Symptomatic Occlusion of the Internal Carotid Artery.
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Multimodal Ultrasound Study of Central Retinal
Artery
Occlusion Associated with Severe Ipsilateral Internal
Carotid
Artery
Stenosis.
Multimodal Ultrasound Study of Central Retinal Artery Occlusion Associated with Severe Ipsilateral Internal Carotid Artery Stenosis.
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A Case with Spontaneous Dissection of the Internal
Carotid
Artery
.
A Case with Spontaneous Dissection of the Internal Carotid Artery.
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EFFECTIVE CONSERVATIVE TREATMENT OF A SYMPTOMATIC OCCLUSION OF THE INTERNAL
CAROTID
ARTERY
EFFECTIVE CONSERVATIVE TREATMENT OF A SYMPTOMATIC OCCLUSION OF THE INTERNAL CAROTID ARTERY
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We present two cases of symptomatic occlusion/thrombosis of the right internal
carotid
artery
(RICA) and the beneficial effect of antithrombotic treatment at the 1st month of follow-up.
We present two cases of symptomatic occlusion/thrombosis of the right internal carotid artery (RICA) and the beneficial effect of antithrombotic treatment at the 1st month of follow-up.
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Ultrasonography and carotidography showed complete recanalization of the
carotid
artery
.
As part of the diagnostic procedures a Doppler ultrasonography was performed, establishing significant stenosis/thrombosis of RICA. Additional imaging included CT and conventional carotidography. The two patients were discussed and put on conservative therapy. An antiplatelet therapy with Aspirin 300 mg/day and 20 mg/day of statin were initiated. At the end of the first month both patients improved their neurological deficit.
Ultrasonography and carotidography showed complete recanalization of the carotid artery.
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The two cases emphasize a possible beneficial effect of the conservative antiplatelet treatment of the severe stenosis/thrombosis of the
carotid
artery
.
The two cases emphasize a possible beneficial effect of the conservative antiplatelet treatment of the severe stenosis/thrombosis of the carotid artery.
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conservative treatment, thrombosis of internal
carotid
artery
conservative treatment, thrombosis of internal carotid artery
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INTERNAL
CAROTID
ARTERY
STENOSIS
INTERNAL CAROTID ARTERY STENOSIS
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It is seen in 60% of the cases with severe ipsilateral internal
carotid
artery
(ICA) obstruction.
Central retinal artery occlusion (CRAO) is an emergency condition due to ischemic stroke of the eye, clinically presented by acute painless monocular visual loss.
It is seen in 60% of the cases with severe ipsilateral internal carotid artery (ICA) obstruction.
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A CASE WITH SPONTANEOUS DISSECTION OF THE INTERNAL
CAROTID
ARTERY
A CASE WITH SPONTANEOUS DISSECTION OF THE INTERNAL CAROTID ARTERY
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A case report with a dissection of the internal
carotid
artery
(ICA) is a frequent cause of ischemic stroke (IS) or transitory ischemic attack (TIA) in young age is presented.
A case report with a dissection of the internal carotid artery (ICA) is a frequent cause of ischemic stroke (IS) or transitory ischemic attack (TIA) in young age is presented.
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28.
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 15, 2019, No. 1
,
,
,
Multimodal Longitudinal Ultrasound Study of Central Retinal
Artery
Occlusion Associated with Severe Ipsilateral Internal
Carotid
Artery
Stenosis
Multimodal Longitudinal Ultrasound Study of Central Retinal Artery Occlusion Associated with Severe Ipsilateral Internal Carotid Artery Stenosis
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with Severe Ipsilateral Internal
Carotid
Artery
Stenosis
with Severe Ipsilateral Internal Carotid Artery Stenosis
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It is seen in 60% of the cases with severe ipsilateral internal
carotid
artery
(ICA) obstruction.
Embologenic central retinal artery occlusion (CRAO) is an emergency condition due to ischemic stroke of the eye, clinically presented by acute painless monocular visual loss.
It is seen in 60% of the cases with severe ipsilateral internal carotid artery (ICA) obstruction.
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Carotid
endarterectomy with complete recanalization of the left internal
carotid
artery
was performed two months later.
Two-three hours after the onset the patient was able to recognize some light and hand movements. Fundoscopy showed pale left optic papilla, “cherry red” spot symptom of the macula, ischemic signs of the retina and attenuated arterioles. Multimodal ultrasound discovered severe (80%) stenosis of the left ICA, moderate (60%) stenosis of the right ICA, positive Doppler ophthalmic test on the left side and typical sings of CRAO – a small round hyperechoic artefact within the left optic nerve 14 mm behind the optic disc, increased vascular resistance of the left ophthalmic artery (OA) and increased venous flow within the CRAO territory. Collateral blood flow through ciliary artery branches and normalization of ophthalmic venous blood flow were recorded in the following days. These changes correlated with a mild subjective vision improvement.
Carotid endarterectomy with complete recanalization of the left internal carotid artery was performed two months later.
One month after the operation a persistent hyperechoic artefact in the left optic nerve and increased proximal vascular resistance in the left retinal artery were established with slightly progressive improvement in the vision.
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According to the literature, CRAO has a frequency of 1/100,000 population [19], with a prevalence of 1.67/100,000 in men [10], more commonly associated with high-grade ipsilateral stenosis of the internal
carotid
artery
[3, 11].
Embologenic central retinal artery thrombosis (CRAO) is an urgent condition resulting in ischemic stroke of the eye, clinically manifested by acute unilateral, non-painful loss of vision [13, 19]. It was first described by von Graefe in 1859 in a patient with multiple systemic endocarditis embolisms [7, 20].
According to the literature, CRAO has a frequency of 1/100,000 population [19], with a prevalence of 1.67/100,000 in men [10], more commonly associated with high-grade ipsilateral stenosis of the internal carotid artery [3, 11].
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ophthalmica – the first branch of the internal
carotid
artery
(ICA) (Fig.
The blood supply of the retina is mainly performed by two vascular systems: a. centralis retinae and aa. ciliares which originate from a.
ophthalmica – the first branch of the internal carotid artery (ICA) (Fig.
1). A. centralis retinae penetrates n. opticus approximately 1 cm behind bulbus oculi and continues in the center of the nerve toward papilla n. opticus. Aa. ciliares are divided into aa.
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The Doppler ophthalmic test was positive on left (a sign of collateral blood flow through the left external
carotid
artery
).
The Doppler ophthalmic test was positive on left (a sign of collateral blood flow through the left external carotid artery).
Degenerative changes in the vitreous body of the right ocular bulb, a typical CRA thrombosis image [6]: a small round hyperechoic artefact within the left optic nerve 14 mm behind the optical disc (Fig. 4 D), increased vascular resistance in the left ophthalmic artery and increased venous flow in the CRA territory were seen.
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Two months later
carotid
endarterectomy with complete recanalization of the left internal
carotid
artery
was performed (Fig. 6).
artery (branches of the aa. ciliares) and normalization of ophthalmic venous flow were recorded [8]. The changes correlated with a slightly intermittent subjective improvement in vision. One month after the symptoms’ onset local reperfusion in the left retinal pool was observed (Fig. 5).
Two months later carotid endarterectomy with complete recanalization of the left internal carotid artery was performed (Fig. 6).
One month after the operation a persistent hyperechoic artefact in the left optic nerve, proximally increased vascular resistance in the left ophthalmic artery and left retinal reperfusion, associated with emerging light perception temporally and silhouette recognition were detected.
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The invasive treatment method includes procedures aim the recanalization of the internal
carotid
artery
(
carotid
endarterectomy, endovascular stenting and/or mechanical thrombectomy) [12, 15] and the ophthalmic
artery
through selective intra-arterial thrombolysis.
The invasive treatment method includes procedures aim the recanalization of the internal carotid artery (carotid endarterectomy, endovascular stenting and/or mechanical thrombectomy) [12, 15] and the ophthalmic artery through selective intra-arterial thrombolysis.
In treatment with intra-arterial thrombolysis there is a 60-70% visual acuity improvement [19]. In some cases the use of anterior chamber paracentesis followed by aspiration of a small amount of fluid is recommended. Nd YAG laser (Neodymium: yttrium-aluminum-garnet laser) embolectomy and pars plana vitrectomy are not routinely used because of the high risk for vitreous hemorrhage. Late effects occur in 18% of patients with acute thrombosis: neovascularization of the optic papilla (usually between weeks 2 and 16 after the symptoms
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Multimodal ultrasound study of central retinal
artery
occlusion associated with severe ipsilateral internal
carotid
artery
stenosis.
Koleva Ts, Karakaneva S, Voynov L, Titianova E.
Multimodal ultrasound study of central retinal artery occlusion associated with severe ipsilateral internal carotid artery stenosis.
In: Fourth National Congress of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics with International Participation, 5–7.10.2018, Sofia.
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The relation of retinal
artery
occlusion and
carotid
artery
.
Merchut MP, Gupta SR, Naheedy MH.
The relation of retinal artery occlusion and carotid artery.
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. The intravascular analysis shows thickening of the wall of the aortic arch and the walls of the common
carotid
arteries with peripheral thrombosis in the aneurysms and a stenotic proximal segment of the right internal
carotid
artery
. The intravascular analysis shows thickening of the wall of the aortic arch and the walls of the common carotid arteries with peripheral thrombosis in the aneurysms and a stenotic proximal segment of the right internal carotid artery
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. The wall of the proximal internal
carotid
artery
is thickened at the left
. The wall of the proximal internal carotid artery is thickened at the left
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The wall of the left common
carotid
artery
is thickened just distally to its origin
and the vessel forms a kink resulting in a high-grade stenosis.
The wall of the left common carotid artery is thickened just distally to its origin
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After a three-month treatment (immunosuppressive therapy and corticosteroids) and normalization of immunological markers, a follow-up CTA shows a complete thrombosis of the aneurysm of the left common
carotid
artery
and a collateral filling of the internal
carotid
artery
at the left via the ipsilateral external
carotid
artery
.
The patient is referred to Rheumatology Clinic for therapy, where immunological tests confirm Takayasu decease.
After a three-month treatment (immunosuppressive therapy and corticosteroids) and normalization of immunological markers, a follow-up CTA shows a complete thrombosis of the aneurysm of the left common carotid artery and a collateral filling of the internal carotid artery at the left via the ipsilateral external carotid artery.
The internal carotid artery on the left is poorly filled along its entire length up to the circle of Willis (Fig. 5). At the right no differences with the previous imaging results are seen.
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The internal
carotid
artery
on the left is poorly filled along its entire length up to the circle of Willis (Fig. 5).
The patient is referred to Rheumatology Clinic for therapy, where immunological tests confirm Takayasu decease. After a three-month treatment (immunosuppressive therapy and corticosteroids) and normalization of immunological markers, a follow-up CTA shows a complete thrombosis of the aneurysm of the left common carotid artery and a collateral filling of the internal carotid artery at the left via the ipsilateral external carotid artery.
The internal carotid artery on the left is poorly filled along its entire length up to the circle of Willis (Fig. 5).
At the right no differences with the previous imaging results are seen.
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images show a complete thrombosis of the aneurysm of the common
carotid
artery
at the left up to the level of bifurcation.
images show a complete thrombosis of the aneurysm of the common carotid artery at the left up to the level of bifurcation.
The level of thrombosis is demonstrated of multiplanar reconstruction
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, which depicts also a thickened wall of the proximal segment of common
carotid
artery
.
, which depicts also a thickened wall of the proximal segment of common carotid artery.
The internal and external carotid arteries on the left are patent, poorly filled, the external carotid artery fills retrogradely from the contralateral external carotid artery and supplies the internal carotid artery at the left
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The internal and external
carotid
arteries on the left are patent, poorly filled, the external
carotid
artery
fills retrogradely from the contralateral external
carotid
artery
and supplies the internal
carotid
artery
at the left
, which depicts also a thickened wall of the proximal segment of common carotid artery.
The internal and external carotid arteries on the left are patent, poorly filled, the external carotid artery fills retrogradely from the contralateral external carotid artery and supplies the internal carotid artery at the left
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Endovascular stenting of extracranial
carotid
artery
aneurysm: A systematic review.
Endovascular stenting of extracranial carotid artery aneurysm: A systematic review.
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Ultrasound B-flow imaging of spontaneous internal
carotid
artery
dissection.
Titianova Е, Ramshev К, Karakaneva S, Petrov I, Ivanov А.
Ultrasound B-flow imaging of spontaneous internal carotid artery dissection.
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Keywords related to: '
carotid artery
'
●
dissection of
carotid
artery
●
common
carotid
artery
diameter
●
carotid
artery
ultrasound radiation
●
thrombosis of internal
carotid
artery
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