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1. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, Vol. 1, 2005 , , ,

Different stimuli for alteration of the mean blood pressure (MBP) during the autoregulatory tests have been applied: thigh cuff, Valsalva, carotid compression, neck suction, orthostatic stress, cognitive tasks.
The use of transcranial Doppler sonography (TCD) with monitoring of the mean flow velocity (MFV) in the middle cerebral artery (MCA) gives possibility for noninvasive evaluation of the autoregulatory response when assessing the cerebral autoregulation (CA). Different stimuli for alteration of the mean blood pressure (MBP) during the autoregulatory tests have been applied: thigh cuff, Valsalva, carotid compression, neck suction, orthostatic stress, cognitive tasks. CA could also be examined by calculation of the phase shift between the spontaneous oscillations of the MBP and the MFV in the MCA.
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CA and VMR are impaired in patients with carotid stenoses and occlusions, in recent and subcortical cerebral infarctions, arteriovenous malformations, subarachnoid hemorhages, traumatic brain injuries, in orthostatic intolerance.
CA and VMR are impaired in patients with carotid stenoses and occlusions, in recent and subcortical cerebral infarctions, arteriovenous malformations, subarachnoid hemorhages, traumatic brain injuries, in orthostatic intolerance. The CA impairment is associated with increased risk of stroke in carotid occlusions and with poor prognosis in cerebral infarctions and subarachnoid hemorhages.The autoregulation of the cerebral arteries is improved after carotid endarterectomy or stenting.
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The CA impairment is associated with increased risk of stroke in carotid occlusions and with poor prognosis in cerebral infarctions and subarachnoid hemorhages.The autoregulation of the cerebral arteries is improved after carotid endarterectomy or stenting.
CA and VMR are impaired in patients with carotid stenoses and occlusions, in recent and subcortical cerebral infarctions, arteriovenous malformations, subarachnoid hemorhages, traumatic brain injuries, in orthostatic intolerance. The CA impairment is associated with increased risk of stroke in carotid occlusions and with poor prognosis in cerebral infarctions and subarachnoid hemorhages.The autoregulation of the cerebral arteries is improved after carotid endarterectomy or stenting.
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The assessment of the CA and the VMR with estimation of the vasomotor capacity of the cerebral arteries and the efficacy of the collateral blood flow is particularly important for evaluation of the prognosis and the therapeutic behaviour in patients with carotid occlusions and with cerebral infarctions.
The assessment of the CA and the VMR with estimation of the vasomotor capacity of the cerebral arteries and the efficacy of the collateral blood flow is particularly important for evaluation of the prognosis and the therapeutic behaviour in patients with carotid occlusions and with cerebral infarctions.
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Risk of stroke, transient ischemic attack, and vessel occlusion before endarterectomy in patients with symptomatic severe carotid stenosis.
3, Blaser T, Hofmann K, Buerger T, Effenberg O, Wallesch C, Goertler M. Risk of stroke, transient ischemic attack, and vessel occlusion before endarterectomy in patients with symptomatic severe carotid stenosis.
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Course of carotid artery occlusion with impaired cerebrovascular reactivity.
Kleise B, Widder B. Course of carotid artery occlusion with impaired cerebrovascular reactivity.
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Clonidine combined with flunitrazepam before carotid enarterectomy decreases cerebrovascular CO2 reactivity.
Laffon M, Sauvagnac X, Ferrandiere M, Jaber W, Gautier T, Martinez R, Mercier C, Fusciardi J. Clonidine combined with flunitrazepam before carotid enarterectomy decreases cerebrovascular CO2 reactivity.
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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.
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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.
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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.
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Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation.
Reinhard M, Roth M, Muller T, Guschlbauer B, Timmer J, Czosnyka M, Hetzel A. Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation.
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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.
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Cerebral hemodynamics in asymptomatic and symptomatic patients with high – grade carotid stenosis undergoing carotid endarterectomy.
Sonnie L, Helenius J, TatlisumakT, Saimanen E, Salonen O, Lindsberg PJ, Kaste M. Cerebral hemodynamics in asymptomatic and symptomatic patients with high – grade carotid stenosis undergoing carotid endarterectomy.
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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.
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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.
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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.
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Classical topics such as carotid plaque characterization, emboli detection monitoring, ultrasound contrast imaging, ultrasound diagnosis of foramen ovale, ultrasound application during carotid surgery and functional assessment of cerebral hemodynamics were also presented.
The 10th Meeting of the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) focused the attention in different topics. Specific sessions were devoted to emerging problems as the role of the ultrasounds in stroke units (perfusion imaging and sonothrombolysis) is known to be very important. Ultrasounds in non vascular brain diseases, hyperbaric medicine, imaging brain parenchyma and cerebral venous system were another innovative topics along with arterial wall imaging including intima-media tichkness (IMT) and distensibility studies. Classical topics such as carotid plaque characterization, emboli detection monitoring, ultrasound contrast imaging, ultrasound diagnosis of foramen ovale, ultrasound application during carotid surgery and functional assessment of cerebral hemodynamics were also presented. The advance in neurosonology, connected with echo-contrast bolus traking for analysis of cerebral circulation time, the assessment of the global cerebral blood volume and ultrasound evaluation of movement disorders, was discussed in a separate session. Proper time was dedicated to training and certification in Neurosonology in the European community.
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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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Ophthalmologic Symptomatology in Carotid Occlusive Disease
Ophthalmologic Symptomatology in Carotid Occlusive Disease
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in Patients with Carotid Obstructions
in Patients with Carotid Obstructions
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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
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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.
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Patients presenting with these symptoms should be examined and screened for carotid stenosis, within 24–48 hours after onset of symptoms.
Unfortunately, only 15% of stroke patients first present with classic TIA symptoms – slurred speech (dysarthia), limb weakness or numbness, transient monocular blindness (amaurosis fugax), unsteadiness (ataxia) or difficulty speaking (dysphasia) [4]. Patients presenting with these symptoms should be examined and screened for carotid stenosis, within 24–48 hours after onset of symptoms.
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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.
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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].
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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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The standard surgical treatment, carotid endarterectomy, has been widely used.
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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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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Carotid Endarterectomy (CEA)
Carotid Endarterectomy (CEA)
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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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Over the years it evolved and became a routine surgical treatment for carotid stenosis although no adequate clinical trials confirmed its benefits.
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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Final results of both trials, European Carotid Surgery Trial (ECST) and North American
Final results of both trials, European Carotid Surgery Trial (ECST) and North American
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Diagnosis and treatment of carotid artery stenosis
Diagnosis and treatment of carotid artery stenosis
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ECST (Еuropean Carotid Surgery Trial) и NASCET (North American Symptomatic EndarterectomyTrial) проучвания
ECST (Еuropean Carotid Surgery Trial) и NASCET (North American Symptomatic EndarterectomyTrial) проучвания
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Symptomatic Carotid Endarterectomy Trial (NASCET), have shown that CEA, when performed with low surgical morbidity and mortality, reduces the risk of stroke in patients with high-grade carotid stenosis [7, 8].
Symptomatic Carotid Endarterectomy Trial (NASCET), have shown that CEA, when performed with low surgical morbidity and mortality, reduces the risk of stroke in patients with high-grade carotid stenosis [7, 8]. Both studies showed that approximately 8 patients with more then 70% stenosis would have to be treated to prevent one ipsilateral stroke in a five-year period after surgery.
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In both trials no significant benefit of endarterectomy has been showed for patients with symptomatic carotid stenosis of less then
For patients with moderate symptomatic stenosis (50 to 69 percent), NASCET reported greater benefit of endarterectomy compared with medically treated patients, whereas ECST showed no significant benefit. NASCET showed that 15 patients with 50 to 69% stenosis would have to be treated to prevent one stroke within five years. In both trials no significant benefit of endarterectomy has been showed for patients with symptomatic carotid stenosis of less then
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These results established CEA as the gold standard procedure for the prevention of a recurrent ischemic event in symptomatic patients with ipsilateral carotid stenosis greater then 70%.
50 percent. These results established CEA as the gold standard procedure for the prevention of a recurrent ischemic event in symptomatic patients with ipsilateral carotid stenosis greater then 70%.
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Studies suggested that a higher risk of preoperative ischemic event or death exists in patients with diabetes, elevated blood pressure, contralateral carotid occlusion and left-sided disease.
Both studies showed that the benefit of endarterectomy is greater for men then for women, for patients aged 75 and older and for patients with hemispheric symptoms. Also, the patients who have had stroke three months prior to procedure will benefit more from surgery then those with TIA. Studies suggested that a higher risk of preoperative ischemic event or death exists in patients with diabetes, elevated blood pressure, contralateral carotid occlusion and left-sided disease. Also, patients randomized for surgical treatment within 2 weeks after their last ischemic event, benefit more from surgery [9].
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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 (
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Carotid angioplasty with stenting is a relatively new endovascular treatment for carotid stenosis.
Carotid angioplasty with stenting is a relatively new endovascular treatment for carotid stenosis. Although it does not have a long history, it has become an established alternative to CEA for high-risk patients not suitable for surgery. It is a minimally invasive procedure requiring only a small incision in the groin and local anaesthesia.
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Diagnosis and treatment of carotid artery stenosis
Diagnosis and treatment of carotid artery stenosis
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Проучването CAVATAS (Carotid and Vertebral Artery Transluminal Angioplasty) показва, че не съществуват значими различия в крайните резултати между ендоваскуларното лечение и КЕ, но смъртността и честотата на инсултите в 30 дневен период след хирургичното лечение е по-висока от желаната – 10% срещу 9.9% при КЕ [12].
За по-добро разграничаване на индикациите за КАС и за КЕ са проведени няколко проспективни, рандомизирани клинични проучвания. Проучването CAVATAS (Carotid and Vertebral Artery Transluminal Angioplasty) показва, че не съществуват значими различия в крайните резултати между ендоваскуларното лечение и КЕ, но смъртността и честотата на инсултите в 30 дневен период след хирургичното лечение е по-висока от желаната – 10% срещу 9.9% при КЕ [12]. Съобщава се, че високостепенна каротидна рестеноза се наблюдава по-често след КАС отколкото след КЕ. В друго клинично проучване SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) са включени 334 пациенти (96 със симптомни и
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В Северна Америка е инициирано клиничното проучване CREST (Carotid Revascularisation Endarterectomy versus Stent Trial), което цели да рандомизира 1200–1600 симптомни пациенти.
210 с асимптомни каротидни стенози) [13]. Проучването предполага, че стентирането с протекция е не по-малко ефективен метод и дори може да превъзхожда КЕ в случаите, когато се оценява рискът от мозъчен инсулт, миокарден инфаркт и смърт. В Северна Америка е инициирано клиничното проучване CREST (Carotid Revascularisation Endarterectomy versus Stent Trial), което цели да рандомизира 1200–1600 симптомни пациенти. В Европа се провеждат няколко проучвания SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), които набират пациенти за рандомизация между КЕ и КАС. Планира се в SPACE да се включат 1200 болни до края на 2005 г. Първите междинни анализи и резултати се очакват да бъдат публикувани до края на 2006 г.
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В Европа се провеждат няколко проучвания SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), които набират пациенти за рандомизация между КЕ и КАС.
210 с асимптомни каротидни стенози) [13]. Проучването предполага, че стентирането с протекция е не по-малко ефективен метод и дори може да превъзхожда КЕ в случаите, когато се оценява рискът от мозъчен инсулт, миокарден инфаркт и смърт. В Северна Америка е инициирано клиничното проучване CREST (Carotid Revascularisation Endarterectomy versus Stent Trial), което цели да рандомизира 1200–1600 симптомни пациенти. В Европа се провеждат няколко проучвания SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), които набират пациенти за рандомизация между КЕ и КАС. Планира се в SPACE да се включат 1200 болни до края на 2005 г. Първите междинни анализи и резултати се очакват да бъдат публикувани до края на 2006 г.
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Carotid and Vertebral Artery Transluminal Angioplasti Study (CAVATAS) showed no difference in major outcome events between endovascular treatment and carotid endarterectomy, but 30-day death and stroke rate of carotid surgery was higher than desirable – 10% versus 9.9% of CEA [12].
To better define the indications for CAS versus CEA several randomized prospective trials have been designed. Carotid and Vertebral Artery Transluminal Angioplasti Study (CAVATAS) showed no difference in major outcome events between endovascular treatment and carotid endarterectomy, but 30-day death and stroke rate of carotid surgery was higher than desirable – 10% versus 9.9% of CEA [12]. This study also reported that high grade carotid restenosis was more frequent one year after CAS then after carotid surgery. In SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endearterectomy) study, 334 patients were included (96 symptomatic and 219 asymptomatic) [13]. This trial suggested that stenting with protection is not inferior and may be superior to CEA in terms of a combined end point including stroke, myocardial infarction and death.
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This study also reported that high grade carotid restenosis was more frequent one year after CAS then after carotid surgery.
To better define the indications for CAS versus CEA several randomized prospective trials have been designed. Carotid and Vertebral Artery Transluminal Angioplasti Study (CAVATAS) showed no difference in major outcome events between endovascular treatment and carotid endarterectomy, but 30-day death and stroke rate of carotid surgery was higher than desirable – 10% versus 9.9% of CEA [12]. This study also reported that high grade carotid restenosis was more frequent one year after CAS then after carotid surgery. In SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endearterectomy) study, 334 patients were included (96 symptomatic and 219 asymptomatic) [13]. This trial suggested that stenting with protection is not inferior and may be superior to CEA in terms of a combined end point including stroke, myocardial infarction and death.
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In North America, the CREST (Carotid Revascularisation Endarterectomy versus Stent Trial) protocol has been initiated.
In North America, the CREST (Carotid Revascularisation Endarterectomy versus Stent Trial) protocol has been initiated. Its randomization goal is 1200 to 1600 symptomatic patients. In Europe, three ongoing trials, SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), are recruiting symptomatic patients for randomization between CEA and CAS.
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In Europe, three ongoing trials, SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), are recruiting symptomatic patients for randomization between CEA and CAS.
In North America, the CREST (Carotid Revascularisation Endarterectomy versus Stent Trial) protocol has been initiated. Its randomization goal is 1200 to 1600 symptomatic patients. In Europe, three ongoing trials, SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), are recruiting symptomatic patients for randomization between CEA and CAS.
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According to this recommendation, carotid PTA with stenting may be performed in patients with contraindications to CEA or with stenosis at surgically inaccessible sites and in patients with re-stenosis after initial CEA or stenosis following radiation.
As well as for CEA, EUSI made specific recommendations for selection of patient eligible for endovascular procedure. According to this recommendation, carotid PTA with stenting may be performed in patients with contraindications to CEA or with stenosis at surgically inaccessible sites and in patients with re-stenosis after initial CEA or stenosis following radiation. All patient undergoing CAS should receive a combination of clopidogrel and aspirin immediately before, during and at least one month after the procedure.
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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
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Cost-effectiveness of Diagnostic Strategies Prior to Carotid Endarterectomy.
U-King-Im JM, Hollingworth W, Trivedi RA, Cross JJ, Higgins NJ, Graves MJ et al. Cost-effectiveness of Diagnostic Strategies Prior to Carotid Endarterectomy.
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European Carotid Surgery Trialist’s Collaborative Group.
European Carotid Surgery Trialist’s Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).
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Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).
European Carotid Surgery Trialist’s Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).
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North American Symptomatic Carotid Endarterectomy Trialist’s Collaborative Group.
North American Symptomatic Carotid Endarterectomy Trialist’s Collaborative Group. The final results of the NASCET
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Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJM, for the Carotid Endarterectomy Trialists Collaboration.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJM, for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
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Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJM, for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
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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.
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Cremonesi a, Manetti R, Setacci F, Setacci C, Castriota F; Protected Carotid Stenting.
Cremonesi a, Manetti R, Setacci F, Setacci C, Castriota F; Protected Carotid Stenting. Clinical Advantages and Complication of embolic Protection Devices in 442 Consecutive Patients.
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Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial.
Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial.
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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.
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carotid occlusion, ophthalmologic symptomatology
carotid occlusion, ophthalmologic symptomatology
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Ophthalmologic Symptomatology in Carotid Occlusive Disease
Ophthalmologic Symptomatology in Carotid Occlusive Disease
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Various ophthalmologic disorders as an isolated independent manifestation or in combination with concomitant neurologic symptomatology can be observed in patients with carotid occlusive disease (carotid stenosis or thrombosis).
Various ophthalmologic disorders as an isolated independent manifestation or in combination with concomitant neurologic symptomatology can be observed in patients with carotid occlusive disease (carotid stenosis or thrombosis). Some of these symptoms are transient like amaurosis fugax (transient monocular blindness), which is very frequent predictor of the carotid occlusive disease. Other are a result of definite choroidal, retinal, optic nerve, visual sensory pathways damage, to wit: central retinal artery or branch central retinal artery occlusion, ischemic optic neuropathy, unilateral venous-stasis retinopathy, ischemic ocular syndrome, contralateral homonymous hemianopias and quadrantanopias. Their exact interpretation, especially of the transient ophthalmologic symptoms, supports the early diagnosis of carotid pathology and prevents the late definite neurologic and ophthalmologic complications.
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Some of these symptoms are transient like amaurosis fugax (transient monocular blindness), which is very frequent predictor of the carotid occlusive disease.
Various ophthalmologic disorders as an isolated independent manifestation or in combination with concomitant neurologic symptomatology can be observed in patients with carotid occlusive disease (carotid stenosis or thrombosis). Some of these symptoms are transient like amaurosis fugax (transient monocular blindness), which is very frequent predictor of the carotid occlusive disease. Other are a result of definite choroidal, retinal, optic nerve, visual sensory pathways damage, to wit: central retinal artery or branch central retinal artery occlusion, ischemic optic neuropathy, unilateral venous-stasis retinopathy, ischemic ocular syndrome, contralateral homonymous hemianopias and quadrantanopias. Their exact interpretation, especially of the transient ophthalmologic symptoms, supports the early diagnosis of carotid pathology and prevents the late definite neurologic and ophthalmologic complications.
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Their exact interpretation, especially of the transient ophthalmologic symptoms, supports the early diagnosis of carotid pathology and prevents the late definite neurologic and ophthalmologic complications.
Various ophthalmologic disorders as an isolated independent manifestation or in combination with concomitant neurologic symptomatology can be observed in patients with carotid occlusive disease (carotid stenosis or thrombosis). Some of these symptoms are transient like amaurosis fugax (transient monocular blindness), which is very frequent predictor of the carotid occlusive disease. Other are a result of definite choroidal, retinal, optic nerve, visual sensory pathways damage, to wit: central retinal artery or branch central retinal artery occlusion, ischemic optic neuropathy, unilateral venous-stasis retinopathy, ischemic ocular syndrome, contralateral homonymous hemianopias and quadrantanopias. Their exact interpretation, especially of the transient ophthalmologic symptoms, supports the early diagnosis of carotid pathology and prevents the late definite neurologic and ophthalmologic complications.
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Ophthalmologic symptomatology in carotid occlusive disease
Ophthalmologic symptomatology in carotid occlusive disease
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Ophthalmologic symptomatology in carotid occlusive disease
Ophthalmologic symptomatology in carotid occlusive disease
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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.
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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.
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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.
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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.
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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?
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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.
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of carotid Doppler ultrasound: an ophthalmic perspective.
of carotid Doppler ultrasound: an ophthalmic perspective.
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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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Noninvasive imaging of carotid plaque inflammation.
Trivedi R, King U, Graves M, et al. Noninvasive imaging of carotid plaque inflammation.
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Re-evaluation of carotid duplex for visual complaints: who really needs to be studied?
Wakefield M, O’Donnell S, Goff J. Re-evaluation of carotid duplex for visual complaints: who really needs to be studied?
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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.
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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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Cerebrovascular Risk Factors and Brain Microembolism in Patients with Carotid Obstructions
Cerebrovascular Risk Factors and Brain Microembolism in Patients with Carotid Obstructions
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doppler sonography, carotid stenosis, microembolic signals
doppler sonography, carotid stenosis, microembolic signals
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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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MES were registered in 9 patients with high-grade carotid stenosis (2 asymptomatic and
in 54.2%, diabetes – in 29.2%, ischemic heart diseases in 33.3%, dislipidemia in 40%, peripheral artery diseases – in 32.5%, ischemic heart diseases – in 33.3%. MES were registered in 9 patients with high-grade carotid stenosis (2 asymptomatic and
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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.
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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.
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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.
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Embolus detection in different degrees of carotid disease.
Eicke B, Lorentz J, Paulus W. Embolus detection in different degrees of carotid disease.
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G. Histologic characteristics of carotid artery plaque.
G. Histologic characteristics of carotid artery plaque.
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Intracranial microembolic signals in 500 patients with potential cardiac or carotid embolic source and in normal controls.
Georgiadis D, Lindner A, Manz M, Sonntag M, Zunker P, Zerkowski H, Borggrefe M. Intracranial microembolic signals in 500 patients with potential cardiac or carotid embolic source and in normal controls.
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Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography.
Groulakos G, Ramaswami G, Nicolaides A. Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography.
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Echolucent carotid plaques predict future coronary events in patients with coronary artery disease.
Honda O, Sugiyama S, Kugiyama K, Nakamura S, Koide S, Kojima S, Hirai N, Kawano H, Soejima H, Sakamoto T, Yoshimura M, Ogawa H. Echolucent carotid plaques predict future coronary events in patients with coronary artery disease.
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M. Ultrasonic correlates of carotid atherosclerosis in transient ischemic attack and stroke.
M. Ultrasonic correlates of carotid atherosclerosis in transient ischemic attack and stroke.
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Frequency and determinants of microembolic signals on transcranial doppler in unselected patients with acute carotid territory ischemia.
Koennecke H, Mast H, Trocio S. Frequency and determinants of microembolic signals on transcranial doppler in unselected patients with acute carotid territory ischemia.
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The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries.
Langsfield M, Gray-Weale A, Lusby R. The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries.
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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.
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Microembolic signals and carotid plaque morphology: a study of 71 patients with moderate or high grade carotid stenosis.
Mayor I, Comelli M, Vassileva E, Burkhard P, Sztajzel R. Microembolic signals and carotid plaque morphology: a study of 71 patients with moderate or high grade carotid stenosis.
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North American Symptomatic Carotid Endarterectomy Trial Collaborators.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefical effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
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Benefical effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefical effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
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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.
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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.
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Ultrasonographic features of carotid plaque and the risk of subsequent neurologic deficits.
Sterpetii A, Schultz R, Feldhaus R, Davenport K, Richardson M, Farina C, Hunter J. Ultrasonographic features of carotid plaque and the risk of subsequent neurologic deficits.
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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.
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Blood lipids and carotid plaques.
Zaletel M, Zvan B. Blood lipids and carotid plaques.
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Interpretation of carotid duplex studies.
Tegeler C. Interpretation of carotid duplex studies. In: Neroimaging Vol 13. Education program syllabus an acad neurol 51st annual meeting, April 17-24 1999. Toronto, Ontario Canada, 7SW001-9-7SW001-17.
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Effect of dynamic exercise on human carotid-cardiac baroreflex latency.
Pott J, Raven P. Effect of dynamic exercise on human carotid-cardiac baroreflex latency.
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Carotid baroreflex responsiveness during dynamic exercise in humans.
Pott J, Shi X, Raven P. Carotid baroreflex responsiveness during dynamic exercise in humans.
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3. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 1 , , ,

for Carotid Atherosclerosis
for Carotid Atherosclerosis
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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.
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.
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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.
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Since IMT and carotid stenoses as intermediate phenotypes also influence the genetic risk profile in coronary heart disease and dyslipidemia, their specific role in the pathogenesis of stroke should be elucidated.
Since IMT and carotid stenoses as intermediate phenotypes also influence the genetic risk profile in coronary heart disease and dyslipidemia, their specific role in the pathogenesis of stroke should be elucidated.
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Genetic Risk Factors for Carotid Atherosclerosis
Genetic Risk Factors for Carotid Atherosclerosis
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Genetic Risk Factors for Carotid Atherosclerosis
Genetic Risk Factors for Carotid Atherosclerosis
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Genetic Risk Factors for Carotid Atherosclerosis
Genetic Risk Factors for Carotid Atherosclerosis
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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.
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Effect of polymorphism of the endothelial nitric oxide synthase and apolipoprotein E genes on carotid atherosclerosis in hemodialysis patients.
Asakimori Y, Yorioka N, Tanaka J, Kohno N. Effect of polymorphism of the endothelial nitric oxide synthase and apolipoprotein E genes on carotid atherosclerosis in hemodialysis patients.
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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
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Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study.
Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study.
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The A677V methylenetetrahydrofolate reductase gene polymorphism and carotid atherosclerosis.
Bova I, Chapman J, Sylantiev C, Korczyn AD, Bornstein NM. The A677V methylenetetrahydrofolate reductase gene polymorphism and carotid atherosclerosis.
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Polymorphism of the apolipoprotein E gene and early carotid atherosclerosis defined by ultrasonography in asymptomatic adults.
Cattin L, Fisicaro M, Tonizzo M, Valenti M, Danek GM, Fonda M, Da Col PG, Casagrande S, Pincetri E, Bovenzi M, Baralle F. Polymorphism of the apolipoprotein E gene and early carotid atherosclerosis defined by ultrasonography in asymptomatic adults.
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Polymorphisms in the angiotensinogen gene are associated with carotid intimal-medial thickening in females from a community-based population.
Chapman CM, Palmer LJ, McQuillan BM, Hung J, Burley J, Hunt C, Thompson PL, Beilby JP. Polymorphisms in the angiotensinogen gene are associated with carotid intimal-medial thickening in females from a community-based population.
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Increased carotid intima-media thickness in children-adolescents, and young adults with a parental history of premature myocardial infarction.
Cuomo S, Guarini P, Gaeta G, De Michele M, Boeri F, Dorn J, Bond M, Trevisan M. Increased carotid intima-media thickness in children-adolescents, and young adults with a parental history of premature myocardial infarction.
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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.
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Atherosclerosis of carotid arteries and the ace insertion/deletion polymorphism in subjects with diabetes mellitus type 2.
Diamantopoulos EJ, Andreadis E, Kakou M, Vlachonikolis I, Vassilopoulos C, Giannakopoulos N, Tarassi K, Papasteriades C, Nicolaides A, Raptis S. Atherosclerosis of carotid arteries and the ace insertion/deletion polymorphism in subjects with diabetes mellitus type 2.
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Influence of apolipoprotein E, smoking, and alcohol intake on carotid atherosclerosis: National Heart, Lung, and Blood Institute Family Heart Study.
Djousse L, Myers RH, Province MA, Hunt SC, Eckfeldt JH, Evans G, Peacock JM, Ellison RC. Influence of apolipoprotein E, smoking, and alcohol intake on carotid atherosclerosis: National Heart, Lung, and Blood Institute Family Heart Study.
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J. Genetic basis of variation in carotid artery wall thickness.
J. Genetic basis of variation in carotid artery wall thickness.
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A paraoxonase gene polymorphism, PON 1 (55), as an independent risk factor for increased carotid intima-media thickness in middle-aged women.
Fortunato G, Rubba P, Panico S, Trono D, Tinto N, Mazzaccara C, De Michele M, Iannuzzi A, Vitale DF, Salvatore F, Sacchetti L. A paraoxonase gene polymorphism, PON 1 (55), as an independent risk factor for increased carotid intima-media thickness in middle-aged women.
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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.
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Absence of association between polymorphisms in the hemostatic factor pathway genes and carotid intimal medial thickness: the Framingham Heart Study.
Fox CS, Larson MG, Corey D, Feng D, Lindpaintner K, Polak JF, Wolf PA, D’Agostino RB, Tofler GH, O’Donnell CJ. Absence of association between polymorphisms in the hemostatic factor pathway genes and carotid intimal medial thickness: the Framingham Heart Study.
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Genetic and environmental contributions to atherosclerosis phenotypes in men and women: heritability of carotid intima-media thickness in the Framingham Heart Study.
Fox CS, Polak JF, Chazaro I, Cupples A, Wolf PA, D’Agostino RA, O’Donnell CJ. Genetic and environmental contributions to atherosclerosis phenotypes in men and women: heritability of carotid intima-media thickness in the Framingham Heart Study.
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Genetic variation in human stromelysin gene promoter and common carotid geometry in healthy male subjects.
Gnasso A, Motti C, Irace C, Carallo C, Liberatoscioli L, Bernardini S, Massoud R, Mattioli PL, Federici G, Claudio Cortese C. Genetic variation in human stromelysin gene promoter and common carotid geometry in healthy male subjects.
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Association of NAD(P)H oxidase p22 phox gene variation with advanced carotid atherosclerosis in Japanese type 2 diabetes.
Hayaishi-Okano R, Yamasaki Y, Kajimoto Y, Sakamoto K, Ohtoshi K, Katakami N, Kawamori D, Miyatsuka T, Hatazaki M, Hazama Y, Hori M. Association of NAD(P)H oxidase p22 phox gene variation with advanced carotid atherosclerosis in Japanese type 2 diabetes.
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Angiotensin-converting enzyme gene polymorphism and carotid wall thickening in a community population.
Hung J, McQuillan BM, Nidorf M, Thompson PL, Beilby JP. Angiotensin-converting enzyme gene polymorphism and carotid wall thickening in a community population.
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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.
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Association of methylenetetrahydrofolate reductase gene polymorphism with carotid atherosclerosis depending on smoking status in a Japanese general population.
Inamoto N, Katsuya T, Kokubo Y, Mannami T, Asai T, Baba S, Ogata J, Tomoike H, Ogihara T. Association of methylenetetrahydrofolate reductase gene polymorphism with carotid atherosclerosis depending on smoking status in a Japanese general population.
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Carotid thickening, cardiac hypertrophy, and angiotensin converting enzyme gene polymorphism in patients with hypertension.
Jeng JR. Carotid thickening, cardiac hypertrophy, and angiotensin converting enzyme gene polymorphism in patients with hypertension.
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Early carotid atherosclerosis and family history of vascular disease: specific effects on arterial sites have implications for genetic studies.
Jerrard-Dunne P, Markus HS, Steckel DA, Buehler A, von Kegler S, Sitzer M. Early carotid atherosclerosis and family history of vascular disease: specific effects on arterial sites have implications for genetic studies.
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Leucine7 to proline7 polymorphism in the preproneuropeptide Y is associated with the progression of carotid atherosclerosis, blood pressure and serum lipids in Finnish men.
Karvonen MK, Valkonen VP, Lakka TA, Salonen R, Koulu M, Pesonen U, Tuomainen TP, Kauhanen J, Nyyssonen K, Lakka HM, Uusitupa MI, Salonen JT. Leucine7 to proline7 polymorphism in the preproneuropeptide Y is associated with the progression of carotid atherosclerosis, blood pressure and serum lipids in Finnish men.
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Association between angiotensin converting enzyme gene polymorphism and carotid atherosclerosis.
Kauma H, Paivansalo M, Savolainen MJ, Rantala AO, Kiema TR, Lilja M, Reunanen A, Kesaniemi YA. Association between angiotensin converting enzyme gene polymorphism and carotid atherosclerosis.
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An interaction between systolic blood pressure and angiotensin-converting enzyme gene polymorphism on carotid atherosclerosis.
Kawamoto R, Kohara K, Tabara Y, Miki T. An interaction between systolic blood pressure and angiotensin-converting enzyme gene polymorphism on carotid atherosclerosis.
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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.
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Paraoxonase gene polymorphisms are associated with carotid arterial wall thickness in subjects with familial hypercholesterolemia.
Leus FR, Wittekoek ME, Prins J, Kastelein JJ, Voorbij HA. Paraoxonase gene polymorphisms are associated with carotid arterial wall thickness in subjects with familial hypercholesterolemia.
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Polymorphism in methylenetetrahydrofolate reductase gene: its impact on plasma homocysteine levels and carotid atherosclerosis in ESRD patients receiving hemodialysis.
Lim PS, Hung WR, Wei YH. Polymorphism in methylenetetrahydrofolate reductase gene: its impact on plasma homocysteine levels and carotid atherosclerosis in ESRD patients receiving hemodialysis.
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Low potentiality of angiotensin-converting enzyme gene insertion/deletion polymorphism as a useful predictive marker for carotid atherogenesis in a large general population of a Japanese city: the Suita study.
Mannami T, Katsuya T, Baba S, Inamoto N, Ishikawa K, Higaki J, Ogihara T, Ogata J. Low potentiality of angiotensin-converting enzyme gene insertion/deletion polymorphism as a useful predictive marker for carotid atherogenesis in a large general population of a Japanese city: the Suita study.
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Genetic Risk Factors for Carotid Atherosclerosis
Genetic Risk Factors for Carotid Atherosclerosis
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of ultrasonographic carotid atherosclerosis.
of ultrasonographic carotid atherosclerosis.
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J. Hyperhomocysteinemia but not the C677T mutation of methylenetetrahydrofolate reductase is an independent risk determinant of carotid wall thickening.
J. Hyperhomocysteinemia but not the C677T mutation of methylenetetrahydrofolate reductase is an independent risk determinant of carotid wall thickening. The Perth Carotid Ultrasound Disease Assessment Study (CUDAS).
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The Perth Carotid Ultrasound Disease Assessment Study (CUDAS).
J. Hyperhomocysteinemia but not the C677T mutation of methylenetetrahydrofolate reductase is an independent risk determinant of carotid wall thickening. The Perth Carotid Ultrasound Disease Assessment Study (CUDAS).
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T. Heritability of carotid artery atherosclerotic lesions.
T. Heritability of carotid artery atherosclerotic lesions.
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Carotid intimamedia thickness and ACE-gene polymorphism in hemodialysis patients.
Nergizoglu G, Keven K, Gurses MA, Aras O, Erturk S, Duman N, Ates K, Akar H, Akar N, Karatan O, et al. Carotid intimamedia thickness and ACE-gene polymorphism in hemodialysis patients.
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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.
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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.
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APOC3, CETP, fibrinogen, and MTHFR are genetic determinants of carotid intima-media thickness in healthy men (the Stanislas cohort).
Pallaud C, Sass C, Zannad F, Siest G, Visvikis S. APOC3, CETP, fibrinogen, and MTHFR are genetic determinants of carotid intima-media thickness in healthy men (the Stanislas cohort).
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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.
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Carotid intima-media thickness is associated with allelic variants of stromelysin-1, interleukin-6, and hepatic lipase genes: the Northern Manhattan Prospective Cohort Study.
Rundek T, Elkind MS, Pittman J, Boden-Albala B, Martin S, Humphries SE, Juo SH, Sacco RL. Carotid intima-media thickness is associated with allelic variants of stromelysin-1, interleukin-6, and hepatic lipase genes: the Northern Manhattan Prospective Cohort Study.
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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.
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Plasma homocysteine, methylenetetrahydrofolate reductase gene polymorphism and carotid intima-media thickness in Italian type 2 diabetic patients.
Scaglione L, Gambino R, Rolfo E, Lillaz E, Gai M, Cassader M, Pagano G, Cavallo-Perin P. Plasma homocysteine, methylenetetrahydrofolate reductase gene polymorphism and carotid intima-media thickness in Italian type 2 diabetic patients.
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Paraoxonase PON1 polymorphism leu-Met54 is associated with carotid atherosclerosis: results of the Austrian Stroke Prevention Study.
Schmidt H, Schmidt R, Niederkorn K, Gradert A, Schumacher M, Watzinger N, Hartung HP, Kostner GM. Paraoxonase PON1 polymorphism leu-Met54 is associated with carotid atherosclerosis: results of the Austrian Stroke Prevention Study.
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Plasma homocyst(e)ine concentration, but not MTHFR genotype, is associated with variation in carotid plaque area.
Spence JD, Malinow MR, Barnett PA, Marian AJ, Freeman D, Hegele RA. Plasma homocyst(e)ine concentration, but not MTHFR genotype, is associated with variation in carotid plaque area.
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The determination of carotid intima medial thickness in adults—a population-based twin study.
Swan L, Birnie DH, Inglis G, Connell JM, Hillis WS. The determination of carotid intima medial thickness in adults—a population-based twin study.
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Risk factor-gene interaction in carotid atherosclerosis: effect of gene polymorphisms of renin-angiotensin system.
Tabara Y, Kohara K, Nakura J, Miki T. Risk factor-gene interaction in carotid atherosclerosis: effect of gene polymorphisms of renin-angiotensin system.
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Carotid intima-media thickness is associated with premature parental coronary heart disease: the Framingham Heart Study.
Wang TJ, Nam BH, D’Agostino RB, Wolf PA, Lloyd-Jones DM, MacRae CA, Wilson PW, Polak JF, O’Donnell CJ. Carotid intima-media thickness is associated with premature parental coronary heart disease: the Framingham Heart Study.
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Marburg I polymorphism of factor VII–activating protease: a prominent risk predictor of carotid stenosis.
Willeit J, Kiechl S, Weimer T, Mair A, Santer P, Wiedermann CJ, Roemisch J. Marburg I polymorphism of factor VII–activating protease: a prominent risk predictor of carotid stenosis.
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Endothelial nitric oxide synthase glu298asp gene polymorphism,carotid atherosclerosis, and intima-media thickness in a general population sample.
Wolff B, Braun C, Schluter C, Grabe HJ, Popowski K, Volzke H, Ludemann J, John U, Cascorbi I. Endothelial nitric oxide synthase glu298asp gene polymorphism,carotid atherosclerosis, and intima-media thickness in a general population sample.
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Interleukin-1 receptor antagonist gene polymorphisms in carotid atherosclerosis.
Worrall BB, Azhar S, Nyquist PA, Ackerman RH, Hamm TL, DeGraba TJ. Interleukin-1 receptor antagonist gene polymorphisms in carotid atherosclerosis.
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Genetics strongly determines the wall thickness of the left and right carotid arteries.
Zannad F, Visvikis S, Gueguen R, Sass C, Chapet O, Herbeth B, Siest G. Genetics strongly determines the wall thickness of the left and right carotid arteries.
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Differential association of common carotid intima-media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease: the EVA study.
Zureik M, Touboul PJ, Bonithon-Kopp C, Courbon D, Ruelland I, Ducimetiere P. Differential association of common carotid intima-media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease: the EVA study.
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Noninvasive detection of occlusive disease of the carotid siphon and middle cerebral artery.
Ley-Pozo J, Ringelstein EB. Noninvasive detection of occlusive disease of the carotid siphon and middle cerebral artery.
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4. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 2 , , ,

[8] used L-arginine as a vasodilatory agent for pre and post-surgical evaluations of VMR in patients with severe carotid stenosis undergoing carotid endarterectomy (CEA).
Although the exact mechanisms by which Diamox acts as a vasodilatory agent and increases the CBF remain controversial, it is most probable that these effects are stimulated by metabolic acidosis and by the direct effect of intravenous administration of 1000 mg acetazolamide on cerebral vessels. Dahl et al. [5] noted that a dose at least 15 mg/kg body weight (corresponding to 1200 mg in a patient weighing 80 kg) is needed for obtaining the maximal vasodilatory effect. In 1999, Micieli et al. [8] used L-arginine as a vasodilatory agent for pre and post-surgical evaluations of VMR in patients with severe carotid stenosis undergoing carotid endarterectomy (CEA). L-arginine induces the vasodilation of resistance vessels, a process which is mediated by nitric oxide (NO) at the endothelial level. Intravenous infusion of L-arginine at a dose of 500 mg/kg/30min significantly increases BFV as measured by TCD. Vasodilatory response can be calculated as:
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1. To evaluate the intracranial hemodynamic status in patients with carotid occlusive disease with the intent of predicting the occurrence of
1. To evaluate the intracranial hemodynamic status in patients with carotid occlusive disease with the intent of predicting the occurrence of
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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.
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Course of carotid artery occlusions with impaired cerebrovascular reactivity.
Kleiser B, Widder B. Course of carotid artery occlusions with impaired cerebrovascular reactivity.
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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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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-
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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.
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Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis.
Silvestrini M, Troisi E, Matteis M et al. Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis.
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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.
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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.
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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.
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Is endarterectomy ever justified in asymptomatic carotid stenosis?
Norris JW, Bornstein NM. Is endarterectomy ever justified in asymptomatic carotid stenosis? In: Meyer JS et al, editors Cerebral Vascular Disease 6:45-49; 1986, Amsterdam: Elsevier Science Publishers.
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Krajewski A, Norris JW, Bornstein NM.Intracranial hemodynamics of carotid occlusion.
Krajewski A, Norris JW, Bornstein NM.Intracranial hemodynamics of carotid occlusion. In: Meyer JS, Lechner H, Reivich R (eds) Cerebral Vascular Disease 7; 58-61, 1988, Amsterdam: Excerpta Medica.
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Management of patients with asymptomatic neck bruits and carotid stenosis.
Bornstein NM, Norris JW. Management of patients with asymptomatic neck bruits and carotid stenosis. Neurologic Clinics, North America, 269-280; 1992, London:
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The natural history of patients with asymptomatic carotid stenosis.
Bornstein NM, Norris JW . The natural history of patients with asymptomatic carotid stenosis. In: Moore WS (ed) Surgery for Cerebrovascular Disease, 264-267; 1996, Philadelphia: W.B. Saunders.
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Cardian and carotid-related stroke.
Wein TH. Bornstein NM. Stroke prevention. Cardian and carotid-related stroke. In: Morgenstern LB. Neurologic Clinics, Stroke 18; 321-341: 2000, Philadelphia:
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Бяха представени и протичащите 4 клинични ултразвукови мултицентрови проучвания – Asymtomatic Carotid Emboly Study (ACES), The ELIGIBLE Study (използване на цветното транскраниално дуплексскениране в първите 3 часа от началото на мозъчния инфаркт), Neurosonological Monitoring in Acute stroke (MEMO) и Dynamic Vascular Analysis (DVA).
зъчна исхемия, за оценка на мозъчната перфузия и за диагноза на персистиращия дефект на междупредсърдната преграда (foramen ovale), ултразвуковата характеристика на мозъчния паренхим, лечението на екстраи интракраниалните артериални стенози и диагностичните и терапевтични аспекти на приложението на ултразвуковите методи. Специално внимание бе отделено на сонотромболизата с и без използване на тъканен рекомбинантен плазминоген активатор. В отделна сесия бе дискутирана ролята на ултразвуковото мониториране по време на стентиране на екстракраниални и интракраниални артерии. Бяха представени и протичащите 4 клинични ултразвукови мултицентрови проучвания – Asymtomatic Carotid Emboly Study (ACES), The ELIGIBLE Study (използване на цветното транскраниално дуплексскениране в първите 3 часа от началото на мозъчния инфаркт), Neurosonological Monitoring in Acute stroke (MEMO) и Dynamic Vascular Analysis (DVA).
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5. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 1 , , ,

multiple channels of supply), instead on the basis of perfect functioning of one line (there are four cerebral blood flow magistrals, two carotid and two vertebral).
The whole cerebral circulation system essential variable is again the blood flow. It is maintained by varying P and R, but here are valid some more principles and mechanisms: (1) Security on the basis of multiplicity (multiple line of performance e.g. multiple channels of supply), instead on the basis of perfect functioning of one line (there are four cerebral blood flow magistrals, two carotid and two vertebral). (2) Mechanism of equalizing the pressure of four channels by the circle of Willis. The anterior and the two posterior communicating arteries in which the flow is on 0-point in case of equal pressure in the four magistrals, automatically opened when the pressure differs. (3) Mechanism of compensation, through collateral systems (external carotid
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(3) Mechanism of compensation, through collateral systems (external carotid
The whole cerebral circulation system essential variable is again the blood flow. It is maintained by varying P and R, but here are valid some more principles and mechanisms: (1) Security on the basis of multiplicity (multiple line of performance e.g. multiple channels of supply), instead on the basis of perfect functioning of one line (there are four cerebral blood flow magistrals, two carotid and two vertebral). (2) Mechanism of equalizing the pressure of four channels by the circle of Willis. The anterior and the two posterior communicating arteries in which the flow is on 0-point in case of equal pressure in the four magistrals, automatically opened when the pressure differs. (3) Mechanism of compensation, through collateral systems (external carotid
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ophthalmic internal carotid, and others).
ophthalmic internal carotid, and others). (4) Portal mechanism at the beginning of the large cerebral vessels, and their neural feedback regulation.
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Here the neuronal control of the autonomous nervous system is superimposed as (1) a negative feedback (based on the pressure receptors of the carotid sinus), and results in suppression of the cardiac output and systemic (aortic) blood pressure, and (2) as a positive feedback to the
while maintaining the overall cerebral blood flow. The aforesaid local subsystems and the whole cerebral system are working as parts of the whole body circulation system, which driving forces are the cardiac output and systemic blood pressure. These directly influenced the pressure and blood flow at the beginning of the cerebral magistrals. Here the neuronal control of the autonomous nervous system is superimposed as (1) a negative feedback (based on the pressure receptors of the carotid sinus), and results in suppression of the cardiac output and systemic (aortic) blood pressure, and (2) as a positive feedback to the
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In some pathologic conditions as hyperperfusion syndrome, after carotid embolectomy, this is the supposed causative mechanism of cerebral edema and related symptoms (headache, nausea, vomiting).
in the venous capillaries, where this pressure is O or minus, by the oncotic pressure from the tissue to the blood. This enables not only the oxidative processes, but prevent the cerebral edema. In some pathologic conditions as hyperperfusion syndrome, after carotid embolectomy, this is the supposed causative mechanism of cerebral edema and related symptoms (headache, nausea, vomiting).
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However the cases of asymptomatic stenosis and even obstruction of carotid arteries proves the effectiveness of aforementioned mechanisms to maintain the flow and 0-point in changed (in relatively wide diapason) conditions, or to restore the balance in a short time, as in TIA.
, because of diminished quantity of blood. However the cases of asymptomatic stenosis and even obstruction of carotid arteries proves the effectiveness of aforementioned mechanisms to maintain the flow and 0-point in changed (in relatively wide diapason) conditions, or to restore the balance in a short time, as in TIA.
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Minciotti et al (1991) support the opinion that is no direct correlation between carotid lesions and brain hemodynamic alterations, since less than half of the patients examined showed TCD signs of CBF reduction.
Minciotti et al (1991) support the opinion that is no direct correlation between carotid lesions and brain hemodynamic alterations, since less than half of the patients examined showed TCD signs of CBF reduction. The explanation is given with the modeling the system.
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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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haemodynamic impairment in patient with carotid stenosis: a transcranial Doppler study. 1991.
haemodynamic impairment in patient with carotid stenosis: a transcranial Doppler study. 1991.
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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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blood viscosity, carotid ateries,
blood viscosity, carotid ateries,
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By means of ultrasound duplex-scanning of the common carotid (CCA) and internal carotid arteries (ICA) the presence and type of atheroscle
index of erythrocyte aggregation (IEA) and the index of oxygen transport to tissues (TO2) were calculated. By means of ultrasound duplex-scanning of the common carotid (CCA) and internal carotid arteries (ICA) the presence and type of atheroscle
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The results confirm the adverse effects оf age on some risk factors for CVD, associated with pathological changes in the cerebral circulation and carotid walls.
The results confirm the adverse effects оf age on some risk factors for CVD, associated with pathological changes in the cerebral circulation and carotid walls. Among them the hemorheological and lipid factors and the carotid atheroscle
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Among them the hemorheological and lipid factors and the carotid atheroscle
The results confirm the adverse effects оf age on some risk factors for CVD, associated with pathological changes in the cerebral circulation and carotid walls. Among them the hemorheological and lipid factors and the carotid atheroscle
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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.
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Carotid plaque, aging, and risk factors.
Fabris F, Zanocchi M, Bo M, Fonte G, Poli L, Bergoglio I, Ferrario E, Pernigotti L. Carotid plaque, aging, and risk factors. A study of 457 subjects. Stroke. Fabris F, Zanocchi M, Bo M, Fonte G, Poli L, Bergoglio I, Ferrario E, Pernigotti
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L. Carotid plaque, aging, and risk factors.
L. Carotid plaque, aging, and risk factors. A study of 457 subjects.
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Associations between carotid intimamedia thickness, plaque and cardiovascular risk factors.
Lee YH, Cui LH, Shin MH, Kweon SS, Park KS, Jeong SK, Chung EK, Choi JS. Associations between carotid intimamedia thickness, plaque and cardiovascular risk factors.
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Asymptomatic carotid lesions and aging: Role of hypertension and other traditional and emerging risk factors.
Milio G, Corrado E, Sorrentino D, Muratori I, La Carrubba S,Mazzola G, Tantillo R, Vitale G, Mansueto S, Novo S. Asymptomatic carotid lesions and aging: Role of hypertension and other traditional and emerging risk factors.
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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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Carotid Pathology and Risk Factors for Cerebrovascular Disease – Correlative Clinical, Neurosonographic
Carotid Pathology and Risk Factors for Cerebrovascular Disease – Correlative Clinical, Neurosonographic
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antithrombotic drug threpay, carotid stenosis prophylaxis
antithrombotic drug threpay, carotid stenosis prophylaxis
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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].
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Symptomatic carotid artery stenosis
Symptomatic carotid artery stenosis
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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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When carotid endarterectomy is considered, antiplatelet therapy should always be started before surgery.
ing the 2-year follow-up in ESPS2 2, NNT=33). The results of a multicenter study ESPRIT [8] confimed the results of ESPS2 about the superiority of ASA+DP over ASA alone. Clopidogrel may be a suitable alternative for those who can not tolerate aspirin or dipyridamole. In a Cochrane analysis [10], antiplatelet therapy during and after CEA reduced the outcome of stroke. When carotid endarterectomy is considered, antiplatelet therapy should always be started before surgery. ASA should be given before, during and following endarterectomy [11]. Clopidogrel should be terminated 5 days before surgery. A combination of clopidogrel plus Aspirin should be initiated prior to carotid stenting and continued for 3 months
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A combination of clopidogrel plus Aspirin should be initiated prior to carotid stenting and continued for 3 months
Clopidogrel may be a suitable alternative for those who can not tolerate aspirin or dipyridamole. In a Cochrane analysis [10], antiplatelet therapy during and after CEA reduced the outcome of stroke. When carotid endarterectomy is considered, antiplatelet therapy should always be started before surgery. ASA should be given before, during and following endarterectomy [11]. Clopidogrel should be terminated 5 days before surgery. A combination of clopidogrel plus Aspirin should be initiated prior to carotid stenting and continued for 3 months
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In the case of recurrent TIAs, the aetiology of the attacks should be evaluated (cardiac origin, carotid stenosis or other reason, e.g.
In the case of recurrent TIAs, the aetiology of the attacks should be evaluated (cardiac origin, carotid stenosis or other reason, e.g. thrombophilia and especially phospholipid antibody syndrome) and appropriate diagnostic investigations performed before starting a therapy with a new drug.
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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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However, the patient with asymptomatic carotid stenosis is at even higher risk of acute myocardial infarction and vascular death than for stroke itself.
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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Asymptomatic carotid stenosis of >50% with or without other symptoms and/or signs of atherosclerosis could be considered as a CHD equivalent.
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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Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy.
Engelter S, Lyrer P. Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy.
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Low-dose acetylsalicylic acis for patients undergoing carotid endarterectomy: a randomised controlled trial.
Taylor DW, Barnett HJM, Haynes RB, Feguson GG, Sackett DL, Thorpe KE, et al. Low-dose acetylsalicylic acis for patients undergoing carotid endarterectomy: a randomised controlled trial.
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Can recurrent stenosis after carotid endarterectomy be prevented by low-doseacetylsalicylic acid?
Hansen F, Lindblad B, Persson NH, Bergqvist D. Can recurrent stenosis after carotid endarterectomy be prevented by low-doseacetylsalicylic acid? A double-blind, randomised and placebo-controlled study.
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Lack of effect of aspirin in asymptomatic patients with carotid bruits and substantial carotid narrowing.
Cote R, Battista RN, Abrahamowicz M, Langlois Y, Bourque F, Mackey A. Lack of effect of aspirin in asymptomatic patients with carotid bruits and substantial carotid narrowing. The Asymptomatic Cervical Bruit Study Group.
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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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Carotid Pathology and Risk Factors
Carotid Pathology and Risk Factors
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duplex scan, echocardiography, carotid pathology,
duplex scan, echocardiography, carotid pathology,
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To study the relationship between carotid pathology and risk factors (RF) for cerebrovascular disease (CVD).
To study the relationship between carotid pathology and risk factors (RF) for cerebrovascular disease (CVD).
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Color duplex sonography of carotid arteries was performed in 924 patients: 368 with RF for CVD, 126 with transient ischemic attacks (TIAs), 287 with chronic unilateral infarction (CUI) and 143 with multiple infarctions.
Color duplex sonography of carotid arteries was performed in 924 patients: 368 with RF for CVD, 126 with transient ischemic attacks (TIAs), 287 with chronic unilateral infarction (CUI) and 143 with multiple infarctions. The intima media tickness (IMT) of the common carotid (CCA) and the internal carotid (ICA) arteries was measured in B-mode and M-mode scanning. Nonmodifiable (age and
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The intima media tickness (IMT) of the common carotid (CCA) and the internal carotid (ICA) arteries was measured in B-mode and M-mode scanning.
Color duplex sonography of carotid arteries was performed in 924 patients: 368 with RF for CVD, 126 with transient ischemic attacks (TIAs), 287 with chronic unilateral infarction (CUI) and 143 with multiple infarctions. The intima media tickness (IMT) of the common carotid (CCA) and the internal carotid (ICA) arteries was measured in B-mode and M-mode scanning. Nonmodifiable (age and
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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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Mild stenoses of ICA predominated in all groups while moderate and severe carotid stenoses were relatively rare.
Arterial hypertension was the most common RF in all patients. An asymmetrical hypertrophy of the left ventricle of the heart and a decrease of its contractility was found as a typical cardiac dysfunction in most of them. Mild stenoses of ICA predominated in all groups while moderate and severe carotid stenoses were relatively rare. Symptomatic thromboses of ICA were seen in 4.5% from the patients with CUI. IMT of the ICA on the side of infarction correlated positively with the arterial blood pressure (r=+0.60, p
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North American Symptomatic Carotid Endarterectomy Trial Collaborators.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med
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Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med
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asymptomatic carotid stenosis.
asymptomatic carotid stenosis.
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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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Predictors of carotid stenosis in older adults with and without isolated systolic hypertension. Stroke
Sutton-Tyrrell K, Alcorn H, Wolfson S, Kesley Sh, Kuller L. Predictors of carotid stenosis in older adults with and without isolated systolic hypertension. Stroke
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CCA 2007 – 7th International Course on Carotid Angioplasty and
CCA 2007 – 7th International Course on Carotid Angioplasty and
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7. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 1 , , ,

Evaluation of the Possibilities of Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Evaluation of the Possibilities of Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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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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Dissection of Aorta and Both Carotid Arteries in a Patient with Transient Ischemic Attack
Dissection of Aorta and Both Carotid Arteries in a Patient with Transient Ischemic Attack
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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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The diagnosis established by the intracranial examination must be confirmed by the extracranial bilateral recording of the common carotid arteries, internal carotid arteries and vertebral arteries.
The cause of coma must be established and must be sufficient to account for a permanent loss of brain function. Other conditions such as intoxication, hypothermia, severe arterial hypotension, metabolic disorders and others have been excluded. Clinical evaluation by two experienced examiners must show no evidence of cerebral or brainstem functions. Cerebral circulatory arrest can be confirmed if certain extraand intracranial Doppler sonographic findings have been recorded and documented bilaterally on two examinations at an interval of at least 30 min. These findings are systolic spikes or oscillating flow in any cerebral artery which can be recorded by bilateral transcranial insonation for anterior circulation, or any intracranial vertebral or basilar artery which can be recorded by suboccipital insonation for the posterior circulation. The diagnosis established by the intracranial examination must be confirmed by the extracranial bilateral recording of the common carotid arteries, internal carotid arteries and vertebral arteries. Ventricular drains or large openings of the skull like in decompressive craniectomy possibly interfering with the development of the intracranial pressure should not be present. During the examination blood pressure should be monitored, documented, and hypotension should be avoided.
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Evaluation of the Possibilities of Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Evaluation of the Possibilities of Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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carotid endarterectomy, chronic arterial insufficiency of the limbs, color duplex,
carotid endarterectomy, chronic arterial insufficiency of the limbs, color duplex,
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to study the possibilities for application of ultrasound diagnostics – color duplex and transcranial Doppler sonography (TCD) in patients with asymptomatic and symptomatic carotid stenosis and multifocal arteriosclerosis (MFA) chronic arterial insufficiency of the limbs (CAIL) or ischemic condition of the heart (ICH), undergone to carotid endarterectomy (CEA).
to study the possibilities for application of ultrasound diagnostics – color duplex and transcranial Doppler sonography (TCD) in patients with asymptomatic and symptomatic carotid stenosis and multifocal arteriosclerosis (MFA) chronic arterial insufficiency of the limbs (CAIL) or ischemic condition of the heart (ICH), undergone to carotid endarterectomy (CEA).
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Using Color duplex sonogrpahy 1013 patients with peripheral arterial illness, ICH, transient ischemic attacks and cerebral ischemic stroke were screened for carotid pathology.
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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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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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
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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Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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Two hundred and five patients with critical carotid stenosis, proved by colour duplex sonography, underwent surgery.
Two hundred and five patients with critical carotid stenosis, proved by colour duplex sonography, underwent surgery. The average degree of ICA stenosis was 81%. Before the carotid surgery a slight reduction in the blood circulation on the side of stenosis was found in all patients’ groups. In 201 patients (98%) the CEA was successfully performed. The preoperative diagnosis was confirmed in 100% by the intraoperative finding. Using color Duplex sonography and TCD a significant improvement of the regional and cerebral hemodynamics on the side of CEA was established.
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Before the carotid surgery a slight reduction in the blood circulation on the side of stenosis was found in all patients’ groups.
Two hundred and five patients with critical carotid stenosis, proved by colour duplex sonography, underwent surgery. The average degree of ICA stenosis was 81%. Before the carotid surgery a slight reduction in the blood circulation on the side of stenosis was found in all patients’ groups. In 201 patients (98%) the CEA was successfully performed. The preoperative diagnosis was confirmed in 100% by the intraoperative finding. Using color Duplex sonography and TCD a significant improvement of the regional and cerebral hemodynamics on the side of CEA was established. In 4 patients (1.95%) a perioperative stroke was developed. The complications were associated with the removed unstable plaques of type I, the existence of a high degree ICA stenosis (> 90%), a recent cerebral stroke (less then 1 month prior to CEA), the presence of a counterlateral ICA thrombosis or existance of MFA.
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Color duplex sonography and TCD are methods of choice for both the screening of carotid pathology and the preoperative and postoperative diagnostics in CEA.
Color duplex sonography and TCD are methods of choice for both the screening of carotid pathology and the preoperative and postoperative diagnostics in CEA. The CEA in patients with asymptomatic and symptomatic carotid stenosis and a concurrent MFA is an effective treatment method for removing the carotid pathology with a minimum percentage of vascular complications. Carotid stenoses exceeding 70% are indicative for CEA Stenosis more than 60% can be operated in the case of a concurrent counterlateral ICA thrombosis or the existance of MFA when the postoperative complications are below 3%.
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The CEA in patients with asymptomatic and symptomatic carotid stenosis and a concurrent MFA is an effective treatment method for removing the carotid pathology with a minimum percentage of vascular complications.
Color duplex sonography and TCD are methods of choice for both the screening of carotid pathology and the preoperative and postoperative diagnostics in CEA. The CEA in patients with asymptomatic and symptomatic carotid stenosis and a concurrent MFA is an effective treatment method for removing the carotid pathology with a minimum percentage of vascular complications. Carotid stenoses exceeding 70% are indicative for CEA Stenosis more than 60% can be operated in the case of a concurrent counterlateral ICA thrombosis or the existance of MFA when the postoperative complications are below 3%.
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Carotid stenoses exceeding 70% are indicative for CEA Stenosis more than 60% can be operated in the case of a concurrent counterlateral ICA thrombosis or the existance of MFA when the postoperative complications are below 3%.
Color duplex sonography and TCD are methods of choice for both the screening of carotid pathology and the preoperative and postoperative diagnostics in CEA. The CEA in patients with asymptomatic and symptomatic carotid stenosis and a concurrent MFA is an effective treatment method for removing the carotid pathology with a minimum percentage of vascular complications. Carotid stenoses exceeding 70% are indicative for CEA Stenosis more than 60% can be operated in the case of a concurrent counterlateral ICA thrombosis or the existance of MFA when the postoperative complications are below 3%.
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Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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В едно от най-големите мултицентрови изследвания – North American Symptomatic Carotid Endarterectomy Trial (NASCET) [19,21] са изследвани 658 пациента със СКС от 70% до 99%.
В едно от най-големите мултицентрови изследвания – North American Symptomatic Carotid Endarterectomy Trial (NASCET) [19,21] са изследвани 658 пациента със СКС от 70% до 99%. Ранните и късните резултати по безпорен начин доказват ефективността и превантивния ефект на КЕ при СКС над 70%. Комулативният риск от исхемичен мозъчен инсулт за две годишен
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Друго голямо мултицентрово проучване, изследващо ефекта на КЕ – European Carotid Surgery Trial (ECST) [7], включва 778 пациенти със симптоматични КС.
Друго голямо мултицентрово проучване, изследващо ефекта на КЕ – European Carotid Surgery Trial (ECST) [7], включва 778 пациенти със симптоматични КС. Честотата на периоперативния инсулт и смърт е 7.5%, а комулативният процент от инсулт и смърт при КЕ е 12.3% срещу 21.9% в групата с медикаментозно лекувани болни. Така КЕ намалява близо два пъти риска от мозъчен инсулт при симптоматичните каротидни стенози над 70%. При изследването на общо 2295 АКС се установява риск от инсулт под 2% при стенози под 80%, 9.8% при стенози между 80 и 89% и 14.4% риск от мозъчен инсулт при стенози над 90%. Студията посочва като абсолютна индикация за КЕ наличието на АКС над 80%.
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Мултицентровото проучване – Asymptomatic Carotid Atherosclerosis Study (ACAS) [8], обхващащо 1662 пациенти със стенози над 60%, установява, че КЕ редуцира над 2 пъти четотата на исхемичния инсулт и смърт за период от 2.7 г.
Мултицентровото проучване – Asymptomatic Carotid Atherosclerosis Study (ACAS) [8], обхващащо 1662 пациенти със стенози над 60%, установява, че КЕ редуцира над 2 пъти четотата на исхемичния инсулт и смърт за период от 2.7 г.
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Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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L. Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials.
L. Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials.
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Correlation of peak systolic velocity and angiographic measurement of carotid stenosis revisited.
Alexandrov AV, Brodie DS, McLean A, Hamilton P, Murphy J, Burns PN. Correlation of peak systolic velocity and angiographic measurement of carotid stenosis revisited.
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Duplex ultrasonography criteria for internal carotid stenosis of more tha70% diameter: angiographic correlation and receiver operating characteristic curve analysis.
Browman MW, Cooperberg PL, Harrison PB, Marsh JI, Mallek N. Duplex ultrasonography criteria for internal carotid stenosis of more tha70% diameter: angiographic correlation and receiver operating characteristic curve analysis.
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Carotid duplex ultrasonography: importance of standardisation.
Byrd S, Robless P, Baxter A, Emson M, Halliday A. Carotid duplex ultrasonography: importance of standardisation.
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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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European Carotid Surgery Trialists’ Collaborative Group.
European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis.
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MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis.
European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis.
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Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis.
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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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Carotid duplex criteria for a 60% or greater angiographic stenosis: variation according to equipment.
Fillinger M, Baker R, Zwolak R, Musson A, Lenz J, Mott J, Bech F, Walsh D, Cronenwett J. Carotid duplex criteria for a 60% or greater angiographic stenosis: variation according to equipment.
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Diagnosing Carotid Stenosis by Doppler Sonography.
Gaitini D, Soudack M. Diagnosing Carotid Stenosis by Doppler Sonography.
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Doppler sonographic parameters for detection of carotid stenosis: is there an optimum method for their selection?
EG Grant, AJ Duerinckx, S El Saden, ML Melany, G Hathout, Zimmerman P, Cohen SN, Singh R, Baker JD. Doppler sonographic parameters for detection of carotid stenosis: is there an optimum method for their selection?
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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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Randomized Clinical Trials: Impact on Clinical Practice for Symptomatic and Asymptomatic Extracranial Carotid Occlusive Disease.
Hobson RW. II. Randomized Clinical Trials: Impact on Clinical Practice for Symptomatic and Asymptomatic Extracranial Carotid Occlusive Disease.
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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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An approach for the use of Doppler ultrasound as a screening tool for hemodynamically significant stenosis (despite heterogeneity of Doppler performance): a multicenter experience—Asymptomatic Carotid Atherosclerosis Study Investigators.
Howard G, Baker WH, Chambless LE, Howard VJ, Jones AM, Toole JF. An approach for the use of Doppler ultrasound as a screening tool for hemodynamically significant stenosis (despite heterogeneity of Doppler performance): a multicenter experience—Asymptomatic Carotid Atherosclerosis Study Investigators.
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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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Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice.
Johnston DC, Eastwood JD, Nguyen T, Goldstein LB. Contrast-enhanced magnetic resonance angiography of carotid arteries: utility in routine clinical practice.
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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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Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.
Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, Caplan LR, Day A, Goldstone J, Hobson RW II, Kempczinski RF, Matchar DB, Mayberg MR, Nicolaides AN, Norris JW, Ricotta JJ, Robertson JT, Rutherford RB, Thomas D, Toole JF, Trout HH III, Wiebers DO. Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.
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North American Symptomatic Carotid Endarterectomy Trial collaborators.
North American Symptomatic Carotid Endarterectomy Trial collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
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Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
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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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Carotid duplex imaging: variation and validation.
Perkins JM, Galland RB, Simmons MJ, Magee TR. Carotid duplex imaging: variation and validation.
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Standardization of carotid ultrasound: a hemodynamic method to normalize for interindividual and interequipment variability.
Ranke C, Creutzig A, Becker H, Trappe HJ. Standardization of carotid ultrasound: a hemodynamic method to normalize for interindividual and interequipment variability.
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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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Duplex accuracy compared with angiography in the Veterans Affairs Cooperative Studies Trial for Symptomatic Carotid Stenosis.
Srinivasan J, Mayberg MR, Weiss DG, Eskridge J. Duplex accuracy compared with angiography in the Veterans Affairs Cooperative Studies Trial for Symptomatic Carotid Stenosis.
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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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Correlation of high-resolution, B-mode, and continuous-wave Doppler sonography with arteriography in the diagnosis of carotid stenosis.
Zweibel WJ, Austin CW, Sackett JF, Strother CM. Correlation of high-resolution, B-mode, and continuous-wave Doppler sonography with arteriography in the diagnosis of carotid 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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B-flow imaging, carotid dissection, digital subtraction angiography, stenting
B-flow imaging, carotid dissection, digital subtraction angiography, stenting
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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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False negative result was obtained during routine CTA study – the carotid dissection was interpretated as a plaque.
False negative result was obtained during routine CTA study – the carotid dissection was interpretated as a plaque. By comparison with CCDS B-flow imaging showed more precisely the intimal flap and the visualization of flow within the true and false lumens. The ultrasound data corresponded with the finding from DSA before stenting. Retrospectively the results from CTA were additionally analysed to prove the ICA dissection. A complete recanalization was observed after stenting using DSA, CCDS and B-flow.
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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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Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate.
Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE Jr, Johnson JL, Moore JB, Burch JM. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate.
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Blunt Carotid Injury.
Fabian TC, Patton JH, Croce MA, Minard G, Kudsk KA, Pritchard FE. Blunt Carotid Injury. Importance of early
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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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Schievink WI.Spontaneous dissection of the carotid and vertebral arteries.
Schievink WI.Spontaneous dissection of the carotid and vertebral arteries.
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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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Dissection of Aorta and Both Carotid Arteries in a Patient with Transiеnt Ischemic Attack and Marfan-Like Habitus
Dissection of Aorta and Both Carotid Arteries in a Patient with Transiеnt Ischemic Attack and Marfan-Like Habitus
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aortic dissection, carotid dissection, neurosonology, stroke, trombolysis
aortic dissection, carotid dissection, neurosonology, stroke, trombolysis
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Dissection of Aorta and Both Carotid Arteries
Dissection of Aorta and Both Carotid Arteries
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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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Bonnin P, Giannesini C, Amah G, Kevorkian JP, Woimant F, Levy BI, Doppler sonograpy with dynamic testing in a case of aortic dissection extending to the innominate and right common carotid arteries.
Bonnin P, Giannesini C, Amah G, Kevorkian JP, Woimant F, Levy BI, Doppler sonograpy with dynamic testing in a case of aortic dissection extending to the innominate and right common carotid arteries.
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IV thrombolysis in patients with acute stroke due to spontaneous carotid dissection.
Georgiadis D, Lanczik O, Schwab S, Engelter S, Sztajzel R, Arnold M, Siebler M, Schwarz S, Lyrer P, Baumgartner RW. IV thrombolysis in patients with acute stroke due to spontaneous carotid dissection.
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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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Spontaneous dissection of the carotid and vertebral arteries.
Schievink W. Spontaneous dissection of the carotid and vertebral arteries.
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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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Prof. Haralanov’s scientific activity contains more than 200 publications, including coauthorship in 3 Neurology books and 2 monographs – “Pathology of carotid circulation” (1970) and “Insufficiency of basal circulation” (1974).
Prof. Haralanov’s scientific activity contains more than 200 publications, including coauthorship in 3 Neurology books and 2 monographs – “Pathology of carotid circulation” (1970) and “Insufficiency of basal circulation” (1974). These monographs along with his PhD thesis “Problems of the brain circulation” (1981), show his main direction of interest: investigation of the brain circulation and more specific – the main cerebral vessels. Prof. Haralanov presents his personal conception concerning some vascular
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8. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 2 , , ,

Efficacy of Carotid Endarterectomy
Efficacy of Carotid Endarterectomy
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for Treatment of Asymptomatic Carotid Stenosis
for Treatment of Asymptomatic Carotid Stenosis
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Drug and Surgical Therapy of the Carotid Atherosclerosis
Drug and Surgical Therapy of the Carotid Atherosclerosis
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and Therapeutic Strategy in Carotid Pathology
and Therapeutic Strategy in Carotid Pathology
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Brain computer tomography (CT), digital subtraction angiography (DSA) and multirange Doppler sonography monitoring of the blood flow velocity in carotid and basal
А 17 years old men with clinical diagnosis of brain death is described – by repeated examination the loss of brainstem reflexes was confirmed. Brain computer tomography (CT), digital subtraction angiography (DSA) and multirange Doppler sonography monitoring of the blood flow velocity in carotid and basal
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DSA demonstrated stop of the blood flow at the carotid siphons.
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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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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Efficacy of Carotid Endarterectomy
Efficacy of Carotid Endarterectomy
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for Treatment of Asymptomatic Carotid Stenosis
for Treatment of Asymptomatic Carotid Stenosis
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carotid endarterectomy, Color Doppler, TCD
carotid endarterectomy, Color Doppler, TCD
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To study the effect of carotid endarterectomy (CE) in the treatment of asymptomatic carotid stenosis.
To study the effect of carotid endarterectomy (CE) in the treatment of asymptomatic carotid stenosis.
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Screening of the carotid pathology in the patients was also carried out.
Using color-coded duplex sonography (CCDS) patients with peripheral occlusive arterial disease and ischemic heart disease were examined. Screening of the carotid pathology in the patients was also carried out. Patients with a degree of ACS over 60% were subjected to CE.
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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.
The average degree of the stenosis ascertained was 81.9%. 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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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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CEA in ACS is an efficacious method of removal of the carotid pathology with a minimum per cent of blood vessel complications.
CEA in ACS is an efficacious method of removal of the carotid pathology with a minimum per cent of blood vessel complications. The method can be successfully applied in the prophylaxis of the ischemic brain stroke in case of patients with critical carotid stenosis.
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The method can be successfully applied in the prophylaxis of the ischemic brain stroke in case of patients with critical carotid stenosis.
CEA in ACS is an efficacious method of removal of the carotid pathology with a minimum per cent of blood vessel complications. The method can be successfully applied in the prophylaxis of the ischemic brain stroke in case of patients with critical carotid stenosis.
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Treatment of Asymptomatic Carotid Stenosis
Treatment of Asymptomatic Carotid Stenosis
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Treatment of Asymptomatic Carotid Stenosis
Treatment of Asymptomatic Carotid Stenosis
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Treatment of Asymptomatic Carotid Stenosis
Treatment of Asymptomatic Carotid Stenosis
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Microsurgical carotid endarterectomy.
Bailes JE, Spetzler FR. Microsurgical carotid endarterectomy. Lippincott-Raven, 1995.
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Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis.
Cooperative Studies Program 309 Trialist Group. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis.
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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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European Carotid Surgery Trialists’ Collaborative Group.
European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis.
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MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis.
European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis.
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Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial.
European CarotidTrialists’Collaborative Group. Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial.
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Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis.
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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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Effect of lovastatin on early carotid atherosclerosis and cardiovascular events.
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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A comparison of quality control methods applied to carotid endarterectomy.
Gaunt ME, Smith JL, Ratliff DA, Bell PRF, Naylor AR. A comparison of quality control methods applied to carotid endarterectomy.
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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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Efficasy of Carotid Endarterectomy for Asymptomatic Carotid Stenosis.
B. Wright, for Veterans Affairs Cooperative Study Group. Efficasy of Carotid Endarterectomy for Asymptomatic Carotid Stenosis.
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Wong Guidelines for the use of carotid endarterectomy: current recommendation from the Canadian Neurosurgical Society.
M. C. Wallace, and J. H. Wong Guidelines for the use of carotid endarterectomy: current recommendation from the Canadian Neurosurgical Society.
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Guidelines for Carotid Endarterectomy.
Donald Easton, MD; Harold P. Adams, Jr, MD; Lawrence M. Brass, MD; Robert W. Hobson, II, MD; Thomas G. Brott, MD; Linda Sternau, MD. Guidelines for Carotid Endarterectomy.
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Does low-dose acetylsalicylic acid prevent stroke after carotid surgery?
Lindblad B, Persson NH, Takolander R, Bergqvist D. Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double-blind, placebo-controlled randomized trial.
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Transcranial Doppler evaluation of cerebral hyperperfusion syndrome after carotid endarterectomy.
Magee TR, Davies AH, Horrocks M. Transcranial Doppler evaluation of cerebral hyperperfusion syndrome after carotid endarterectomy.
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Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, Colling C, Eskridge J, Deykin D, Winn HR, for the Veterans Affairs Mayo Asymptomatic Carotid Endarterectomy Study Group.
Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, Colling C, Eskridge J, Deykin D, Winn HR, for the Veterans Affairs Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
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Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, Colling C, Eskridge J, Deykin D, Winn HR, for the Veterans Affairs Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
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Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.
Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, Caplan LR, Day A, Goldstone J, Hobson RW II, Kempczinski RF, Matchar DB, Mayberg MR, Nicolaides AN, Norris JW, Ricotta JJ, Robertson JT, Rutherford RB, Thomas D, Toole JF, Trout HH III,Wiebers DO. Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.
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Carotid endarterectomy: practice guidelines.
Moore WS, Mohr JP, Najafi H, Robertson JT, Stoney RJ, Toole JF. Carotid endarterectomy: practice guidelines. Report of the Ad Hoc Committee to the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery.
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Seizures following carotid endarterectomy in patients with severely compromised cerebral circulation.
Nielsen TG, Sillesen H, Schroeder TV. Seizures following carotid endarterectomy in patients with severely compromised cerebral circulation.
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North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.
North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
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Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
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North American Symptomatic Carotid Endarterectomy Trial Collaborators.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy symptomatic patients with high-grade carotid stenosis.
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Beneficial effect of carotid endarterectomy symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy symptomatic patients with high-grade carotid stenosis.
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for the Carotid Endarterectomy Trialists Collaboration.
Rothwell PM, Eliasziv M. et all. for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
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Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
Rothwell PM, Eliasziv M. et all. for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
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The European Carotid Surgery Trialists Collaborative Group.
The European Carotid Surgery Trialists Collaborative Group. Risk of stroke in the distribution of an asymptomatic carotid artery.
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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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Symptomatic patients: the European Carotid Surgery Trial (ECST).
Warlow CP. Symptomatic patients: the European Carotid Surgery Trial (ECST).
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To evaluate the changes of carotid arteries and cerebral parenchima in patients with asymptomatic ischaemic disturbances of cerebral circulation (AIDCC) using comparative neurosonographic and neuroimaging studies.
To evaluate the changes of carotid arteries and cerebral parenchima in patients with asymptomatic ischaemic disturbances of cerebral circulation (AIDCC) using comparative neurosonographic and neuroimaging studies.
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common carotid arteries (CCA), the presence of atherosclerotic plaques, their severity, echogenicy and stability.
common carotid arteries (CCA), the presence of atherosclerotic plaques, their severity, echogenicy and stability. A paralell magnetic resonance imaging (MRI) was applied in 32 patients with AIDCC, 28 patients with RF for CVD and 10 healthy controls. The main quantitative parameters for evaluation of external and internal ventricle and the type of white matter changes were determined.
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In AIDCC the changes in carotid blood flow and cerebral parehchima progressed with the increase in duration, severity and non-systemic treatment of AH.
Healthy persons were without RF for CVD and had normal sonographic and MRI parameters. In both patient groups AH stage І and ІІ, hypercholesterolemia, smoking and obesity were the most frequent RF for CVD. The combination of AH and dyslipidemia, AH and obesity, AH and heart diseases were predominated. In AIDCC the combination of AH and diabetes was more frequent than in patients with RF for CVD. Compared to controls and patients with RF for CVD in the group with AIDCC a significant enlargement of the ventricles was found. In AIDCC the changes in carotid blood flow and cerebral parehchima progressed with the increase in duration, severity and non-systemic treatment of AH.
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Evaluation of carotid atherosclerosis by B’mode ultrasonographic study in hypertensive patients compared with normotensive patients
Adaikkappan M, Sampath R, Felix AJW, Sethupathy S. Evaluation of carotid atherosclerosis by B’mode ultrasonographic study in hypertensive patients compared with normotensive patients
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Carotid intima-media thickness measurements: what defines an abnormality?
Аminbakhsh A; Mancini GB. Carotid intima-media thickness measurements: what defines an abnormality? A systematic
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Common carotid intimamedia thickness measurement.
Baldassare D, Werba JP, Tremoli E. Common carotid intimamedia thickness measurement. A method to improve accuracy and precision,
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Reproducibility of carotid vessel wall thickness measurements: the Rotterdam Study.
Bots ML, Mulder PG, Van Es GA. Reproducibility of carotid vessel wall thickness measurements: the Rotterdam Study.
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Noninvasive study of arterial hypertension and carotid atherosclerosis.
Luisiani L, Visona A. Noninvasive study of arterial hypertension and carotid atherosclerosis.
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Рrevalence of carotid atherosclerosis in middle
Paivansalo M. Рrevalence of carotid atherosclerosis in middle
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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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Drug and Surgical Therapy of the Carotid Atherosclerosis
Drug and Surgical Therapy of the Carotid Atherosclerosis
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carotid atherosclerosis, carotid endarterectomy, therapy
carotid atherosclerosis, carotid endarterectomy, therapy
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The update strategies for complex treatment of carotid atherosclerosis are reviewed.
The update strategies for complex treatment of carotid atherosclerosis are reviewed. They include drug and surgical therapy in cases with progression of carotid stenosis over 60-70%. Drug therapy includes antiplatelet therapy and reduction of the risk factors for atherosclerosis. It decreases the frequency of ischemic stroke and vascular dead. Surgical treatment (carotid endarterectomy) decreases also the frequency of ischemic stroke. It is successful when includes preand postoperative drug therapy.
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They include drug and surgical therapy in cases with progression of carotid stenosis over 60-70%.
The update strategies for complex treatment of carotid atherosclerosis are reviewed. They include drug and surgical therapy in cases with progression of carotid stenosis over 60-70%. Drug therapy includes antiplatelet therapy and reduction of the risk factors for atherosclerosis. It decreases the frequency of ischemic stroke and vascular dead. Surgical treatment (carotid endarterectomy) decreases also the frequency of ischemic stroke. It is successful when includes preand postoperative drug therapy. The article presents the complex treatment of 205 patients with carotid atherosclerosis.
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Surgical treatment (carotid endarterectomy) decreases also the frequency of ischemic stroke.
The update strategies for complex treatment of carotid atherosclerosis are reviewed. They include drug and surgical therapy in cases with progression of carotid stenosis over 60-70%. Drug therapy includes antiplatelet therapy and reduction of the risk factors for atherosclerosis. It decreases the frequency of ischemic stroke and vascular dead. Surgical treatment (carotid endarterectomy) decreases also the frequency of ischemic stroke. It is successful when includes preand postoperative drug therapy. The article presents the complex treatment of 205 patients with carotid atherosclerosis. The good early and late results are based on the combination of drug and surgical treatment. Algorithm for therapeutic strategy in patients with carotid atherosclerosis is discussed.
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The article presents the complex treatment of 205 patients with carotid atherosclerosis.
They include drug and surgical therapy in cases with progression of carotid stenosis over 60-70%. Drug therapy includes antiplatelet therapy and reduction of the risk factors for atherosclerosis. It decreases the frequency of ischemic stroke and vascular dead. Surgical treatment (carotid endarterectomy) decreases also the frequency of ischemic stroke. It is successful when includes preand postoperative drug therapy. The article presents the complex treatment of 205 patients with carotid atherosclerosis. The good early and late results are based on the combination of drug and surgical treatment. Algorithm for therapeutic strategy in patients with carotid atherosclerosis is discussed.
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Algorithm for therapeutic strategy in patients with carotid atherosclerosis is discussed.
It decreases the frequency of ischemic stroke and vascular dead. Surgical treatment (carotid endarterectomy) decreases also the frequency of ischemic stroke. It is successful when includes preand postoperative drug therapy. The article presents the complex treatment of 205 patients with carotid atherosclerosis. The good early and late results are based on the combination of drug and surgical treatment. Algorithm for therapeutic strategy in patients with carotid atherosclerosis is discussed.
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Treatment of Carotid Atherosclerosis
Treatment of Carotid Atherosclerosis
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Treatment of Carotid Atherosclerosis
Treatment of Carotid Atherosclerosis
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Place of Drug Therapy in the treatment of Carotid Stenosis.
Andaluz N, Zuccarello M. Place of Drug Therapy in the treatment of Carotid Stenosis.
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Aspirin resistance among long-term aspirin users after carotid endarterectomy and controls.
Assadian A, Lax J, Meixner-Loicht U, Hagmuller GW. Aspirin resistance among long-term aspirin users after carotid endarterectomy and controls.
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Perioperative statine and diuretic use influence the presentation of patients undergoing carotid endarterectomy: Results of a large single – institution case study.
Brooke B, M McGirt, G Woodworth. Perioperative statine and diuretic use influence the presentation of patients undergoing carotid endarterectomy: Results of a large single – institution case study.
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How Good Is the Management of Vascular Risk after Stroke, Transient Ischaemic Attack or Carotid Endarterectomy?
Johnson P, Rosewell M, James MA. How Good Is the Management of Vascular Risk after Stroke, Transient Ischaemic Attack or Carotid Endarterectomy?
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Dual Antiplatelet Therapy with Clopidogrel and Aspirin in Symptomatic Carotid Stenosis Evaluated Using Doppler Embolic Signal Detection.
Marcus HS, Droste DW, Kappes M, Lees KR. Dual Antiplatelet Therapy with Clopidogrel and Aspirin in Symptomatic Carotid Stenosis Evaluated Using Doppler Embolic Signal Detection. CARRESS Trial.
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Management of carotid artery stenosis.
Louridas G, Junaid A. Management of carotid artery stenosis.
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New developments in diagnostic and therapy of asymptomatic carotid stenosis.
Sander D, Wolf O, Sander K, Poppert H. New developments in diagnostic and therapy of asymptomatic carotid stenosis.
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AHA Updates Guidelines for Carotid Endarterectomy.
Morey SS. AHA Updates Guidelines for Carotid Endarterectomy.
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Beneficial effects of Clopidogrel combined with Aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy.
Payne D, C Jones, P Hayes. Beneficial effects of Clopidogrel combined with Aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy.
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carotid pathology, therapy,
carotid pathology, therapy,
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and Therapeutic Strategy in Carotid Pathology
and Therapeutic Strategy in Carotid Pathology
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Резултатите от проучването North American Symptomatic Carotid Endarterectomy Trial (NASCET)* сочат, че при симптомните пациенти с каротидни стенози над 70% рискът от ипсилатерален мозъчен инфаркт в следващите две години е 26%.
Резултатите от проучването North American Symptomatic Carotid Endarterectomy Trial (NASCET)* сочат, че при симптомните пациенти с каротидни стенози над 70% рискът от ипсилатерален мозъчен инфаркт в следващите две години е 26%. Проучването ECST** от своя страна показва, че коронарната сърдечна смърт при такива болни достига до 30% за период от 10 години.
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* North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.
* North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg 83, 1995: 778–782.
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Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
* North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg 83, 1995: 778–782.
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Symptomatic patients: the European Carotid Surgery Trial (ECST).
** Warlow CP. Symptomatic patients: the European Carotid Surgery Trial (ECST). J Mal Vasc 18, 1993: 198–201.
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Algorithm for Ultrasound Diagnostics and Therapeutic Strategy in Carotid Pathology
Algorithm for Ultrasound Diagnostics and Therapeutic Strategy in Carotid Pathology
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Algorithm for Ultrasound Diagnostics and Therapeutic Strategy in Carotid Pathology
Algorithm for Ultrasound Diagnostics and Therapeutic Strategy in Carotid Pathology
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Algorithm for Ultrasound Diagnostics and Therapeutic Strategy in Carotid Pathology
Algorithm for Ultrasound Diagnostics and Therapeutic Strategy in Carotid Pathology
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ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting.
*Bates E. et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting. Vasc Med. 2007,12, 1, 35-83.
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Carotid and multifocal atherothrombosis.
Carotid and multifocal atherothrombosis.
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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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То evaluate the correlation between the arterial hypertension and changes of carotid arteries and cerebral parenchima in patients with asymptomatic ischaemic disturbances of cerebral circulation (AIDSS) using comparative neurosonographic and neuroimaging studies.
То evaluate the correlation between the arterial hypertension and changes of carotid arteries and cerebral parenchima in patients with asymptomatic ischaemic disturbances of cerebral circulation (AIDSS) using comparative neurosonographic and neuroimaging studies.
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Colour-coded duplex sonography was used to determine the extracranial blood flow velocity and the intima media thickness (IMT) of common carotid arteries (CCA), the
Colour-coded duplex sonography was used to determine the extracranial blood flow velocity and the intima media thickness (IMT) of common carotid arteries (CCA), the
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In AIDCC the changes in carotid blood flow and cerebral parenchyma progressed with the increase in duration, severity and non-systemic treatment of AH.
Healthy persons were without RF for CVD and had normal sonographic and MRI parameters. In AIDCC the changes in carotid blood flow and cerebral parenchyma progressed with the increase in duration, severity and non-systemic treatment of AH. There is a negative correlation between duration of AH and cerebral blood flow velocity in AIDCC. Compared to controls and patients with RF for CVD in the group with AIDCC enlargement of the ventricles and trend to confluens of white matter lesions in patients AH stage ІІІ was found.
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Carotid intima medial thickness: distribution in general population as evaluated by B-mode ultrasound.
ARIC investigators, Howard G, Sharett R, Evans GW, Chambless LE, Riley WA,Burke GL. Carotid intima medial thickness: distribution in general population as evaluated by B-mode ultrasound.
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Reproducibility of carotid vessel wall thickness measurements: the Rotterdam Study.
Bots ML, Mulder PG, Van Es GA. Reproducibility of carotid vessel wall thickness measurements: the Rotterdam Study.
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Common carotid intimamedia thickness measurement.
Baldassare D, Werba JP, Tremoli E. Common carotid intimamedia thickness measurement. A method to improve accuracy and precision,
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Noninvasive study of arterial hypertension and carotid atherosclerosis.
Luisiani L, Visona A. Noninvasive study of arterial hypertension and carotid atherosclerosis.
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Рrevalence of carotid atherosclerosis in middle
Paivansalo M. Рrevalence of carotid atherosclerosis in middle
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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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Bilateral thrombosis of the carotid arteries – clinical, neurosonological, neurophysiological and neuroimaging examinations
Bilateral thrombosis of the carotid arteries – clinical, neurosonological, neurophysiological and neuroimaging examinations
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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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to investigate the changes of the common carotid local hemodynamic factors like wall shear stress and tensile forces in patients with cerebrovascular disease (CVD).
to investigate the changes of the common carotid local hemodynamic factors like wall shear stress and tensile forces in patients with cerebrovascular disease (CVD).
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The blood flow velocities (BFV), the diameters (D) and the vessel wall intima-media thickness (IMT) in the common carotid arteries (CCA) were recorded with color duplex sonography.
The study was carried out in 16 patients with unilateral cerebral infarctions (UCI), 58 patients with risk factors (RF) for CVD and 25 healthy control subjects. The blood flow velocities (BFV), the diameters (D) and the vessel wall intima-media thickness (IMT) in the common carotid arteries (CCA) were recorded with color duplex sonography. Systolic (SBP) and diastolic (DBP) blood pressure were measured and mean blood pressure (MBP) was calculated by the formula of Wiggers. Whole blood viscosity (WBV) at the shear rate of 94.5 s-1 was measured on the day of the Doppler ultrasound examination with a rotational viscometer Contraves Low shear 30. Wall shear stress (WSS), the circumferential wall tension (T) and the tensile stress (
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The study confirms the complex influence of the changes in WBV and blood pressure for the development of carotid atherosclerosis.
The study confirms the complex influence of the changes in WBV and blood pressure for the development of carotid atherosclerosis.
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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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Quantitative morphologic study of intimal thickening at the human carotid bifurcation, II: the compensatory enlargement response and the role of the intima in tensile support.
Masawa N, Glagov S, Zarins CK. Quantitative morphologic study of intimal thickening at the human carotid bifurcation, II: the compensatory enlargement response and the role of the intima in tensile support.
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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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A novel risk factor for early carotid atherosclerosis.
Sitzer M, Puac D, Buehler A, Steckel D, Kegler S, Markus H, Steinmetz H. A novel risk factor for early carotid atherosclerosis.
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Variation in the carotid bifurcation geometry of young versus older adults.
Thomas J, Antiga L, Che S, Milner J, Steinman D, Spence J, Rutt B. Variation in the carotid bifurcation geometry of young versus older adults.
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Bilateral thrombosis of the carotid arteries – clinical, neurosonological, neurophysiological and neuroimaging examinations
Bilateral thrombosis of the carotid arteries – clinical, neurosonological, neurophysiological and neuroimaging examinations
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bilateral carotid thrombosis,
bilateral carotid thrombosis,
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to perform comparative clinical, neurosonological, neurophysiological and neuroimaging examinations in chronic bilateral carotid thrombosis and to assess the brain abilities for compensation of the circulation deficit.
to perform comparative clinical, neurosonological, neurophysiological and neuroimaging examinations in chronic bilateral carotid thrombosis and to assess the brain abilities for compensation of the circulation deficit.
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A case of 62-year-old woman with bilateral thrombosis of the common and internal carotid arteries determined by color-coded duplex scan of
A case of 62-year-old woman with bilateral thrombosis of the common and internal carotid arteries determined by color-coded duplex scan of
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Chronic thrombosis of the common and internal carotid arteries caused by confluent heterogenic plaques and collateral circulation through the external carotid arteries, the vertebral arteries and the posterior part of the circle of Willis were demonstrated by color-coded duplex scan.
Non-specific features and mild neurological and cognitive impairment were found by clinical examination. Modifiable risk factors for cerebrovascular diseases (arterial hypertension, hyperlipidemia and regular smoking) were registered. Hypertonic angiopathy with cholesterol emboli in the retinal vessels were seen by ophtalmoscopy. Chronic thrombosis of the common and internal carotid arteries caused by confluent heterogenic plaques and collateral circulation through the external carotid arteries, the vertebral arteries and the posterior part of the circle of Willis were demonstrated by color-coded duplex scan. A good correlation between the neurosonographic and angiographic findings was established. Focal leucoencephalopathy and ventriculomegaly were detected by MRI. Irregular alpha rhythm from the parietooccipital regions and mild intraocular asymmetry with relatively prolonged P 100 latency on the right side were registered electrophysiologically.
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The combination of neurosonological, neurophysiological and neuroimaging methods enables to assess the complex relation between the severity, location and predilection of vascular pathology, the efficacy of collateral circulation, morphological brain changes and individual human abilities for brain reorganization in presence of chronic circulation deficit, caused by bilateral carotid thrombosis.
The combination of neurosonological, neurophysiological and neuroimaging methods enables to assess the complex relation between the severity, location and predilection of vascular pathology, the efficacy of collateral circulation, morphological brain changes and individual human abilities for brain reorganization in presence of chronic circulation deficit, caused by bilateral carotid thrombosis.
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Correlative studies in bilateral carotid thrombosis
Correlative studies in bilateral carotid thrombosis
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Correlative studies in bilateral carotid thrombosis
Correlative studies in bilateral carotid thrombosis
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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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Viable brain with bilateral internal carotid occlusion, a case report.
Basiri K, Ghadiri F, Saadatnia M. Viable brain with bilateral internal carotid occlusion, a case report.
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Delayed TIAs distal to bilateral occlusion of carotid arteries – evidence for embolic and hemodynamic mechanisms.
Bogousslavsky J, Regli F. Delayed TIAs distal to bilateral occlusion of carotid arteries – evidence for embolic and hemodynamic mechanisms.
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Doppler sonograpy with dynamic testing in a case of aortic dissection extending to the innominate and right common carotid arteries.
Bonnin P, Giannesini C, Amah G, Kevorkian P, Woimante F, Levvy BI. Doppler sonograpy with dynamic testing in a case of aortic dissection extending to the innominate and right common carotid arteries.
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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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Carotid thrombosis.
Chandaburi KS. Carotid thrombosis. An evaluation and followup study of 65 cases
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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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Complete occlusion of common or internal carotid arteries.
Dyken ML, Klatte E, Kolar OJ, Spurgeon C. Complete occlusion of common or internal carotid arteries. Clinical significance.
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Bilateral carotid artery occlusive disease.
Groch SN, Hurwitz LJ, McDowell F. Bilateral carotid artery occlusive disease.
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Bilateral common carotid occlusion without neurological deficit.
se S, Karabacakoglu A, Solak H. Bilateral common carotid occlusion without neurological deficit.
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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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Bilateral top of carotid occlusion presenting as basilar thrombosis.
Liberato B, Harel NY, Krakauer JW. Bilateral top of carotid occlusion presenting as basilar thrombosis.
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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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Clinical and angiographic features of carotid circulation thrombus.
Pessin MS, Abbott BP, Prager RJ, Batson RA, Scott RM. Clinical and angiographic features of carotid circulation thrombus.
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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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Disappearing carotid defects.
Yarnell P, Earnest M, Kelly G, Sanders B. Disappearing carotid defects.
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S. A case of simultaneous bilateral carotid occlusion.
S. A case of simultaneous bilateral carotid occlusion.
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Bulgarian experience in carotid endarterectomy.
Bulgarian experience in carotid endarterectomy.
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11. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 1 , , ,

Recanalization and Stenting of Preocclusive Stenoses and Thromboses of Carotid Arteries
Recanalization and Stenting of Preocclusive Stenoses and Thromboses of Carotid Arteries
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Carotid stenting – results and prospects
Carotid stenting – results and prospects
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carotid pathology, neurovascular symptoms, neurosonology
carotid pathology, neurovascular symptoms, neurosonology
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In a recent “scientific statement of the American Heart Association” concerning imaging of acute ischemic stroke the use of “carotid ultrasound” for detecting surgical lesions was classified as a screening tool, which is not sufficient to be used as the sole methodology for the definite diagnosis.
In a recent “scientific statement of the American Heart Association” concerning imaging of acute ischemic stroke the use of “carotid ultrasound” for detecting surgical lesions was classified as a screening tool, which is not sufficient to be used as the sole methodology for the definite diagnosis. Summarising the relevant comparative studies this report concluded that using ultrasound alone “almost 1 of every 6 patients evaluated may undergo an unneeded or may not have a needed surgery” (R.E. Latchaw et.al: Stroke 2009; 40: 3646-3678). This reminds me the discussion after my first international presentation in the late seventies about our results comparing Doppler sonography and angiography. The comment was, in the end we need conventional angiography anyway”. Has nothing changed in more than 30 years?
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Neurosonology is more than the question: Is it possible to select patients for surgery using ultrasound alone by separating out those with a =/>70% carotid stenosis.
This reminds me the discussion after my first international presentation in the late seventies about our results comparing Doppler sonography and angiography. The comment was, in the end we need conventional angiography anyway”. Has nothing changed in more than 30 years? Was all the technical progress in ultrasonic imaging and understanding of hemodynamics useless? Is ultrasound still only a comparably inexpensive screening method or a decision making tool? Neurosonology is more than the question: Is it possible to select patients for surgery using ultrasound alone by separating out those with a =/>70% carotid stenosis. This question however is central because carotid surgery is one of the best proven and frequent therapies. I would like to shed light on some of its multiple facets.
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This question however is central because carotid surgery is one of the best proven and frequent therapies.
The comment was, in the end we need conventional angiography anyway”. Has nothing changed in more than 30 years? Was all the technical progress in ultrasonic imaging and understanding of hemodynamics useless? Is ultrasound still only a comparably inexpensive screening method or a decision making tool? Neurosonology is more than the question: Is it possible to select patients for surgery using ultrasound alone by separating out those with a =/>70% carotid stenosis. This question however is central because carotid surgery is one of the best proven and frequent therapies. I would like to shed light on some of its multiple facets.
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Двуизмерната рентгенова сянка не може да покаже това толкова добре, колкото ултразвуковото изследване, което включва морфологични и хемодинамични критерии.Конвенционалната ангиография обаче е посочена като златен стандарт, защото това е бил методът на избор, когато през 90-те години на миналия век са проведени мащабни проучвания относно симптоматичните каротидни ендартеректомии (NASCET – North American Symptomatic Carotid Endarterectomy Trial).
При конвенционална ангиография е видно, че профилактичният ефект на каротидните операции корелира със степента на каротидната стеноза. Патогенетичен субстрат е плаката и нейният хемодинамичен ефект чрез намаляване на площта и/или нарушение на повърхностната структура. Двуизмерната рентгенова сянка не може да покаже това толкова добре, колкото ултразвуковото изследване, което включва морфологични и хемодинамични критерии.Конвенционалната ангиография обаче е посочена като златен стандарт, защото това е бил методът на избор, когато през 90-те години на миналия век са проведени мащабни проучвания относно симптоматичните каротидни ендартеректомии (NASCET – North American Symptomatic Carotid Endarterectomy Trial). Никой няма да поеме отговорността и огромните разходи да повтори подобно проучване за да докаже, че резултатите от ултразвуковото изследване са същите. Нещо повече, това няма да бъде възможно и от етична гледна точка. Намаляването на диаметъра на съда при конвенционалната ангиография е следствие от развиващата се патогенна плака, която се установява и с цветно В-скениране и измерване на стойностите на кръвния ток. Двата метода представят параметри, които се базират до известна степен на различни биологични показатели, така че пълно съответствие не е възможно. Все още е открит въпросът кой от тези два метода представя по-добре естеството на плаката, вземайки под внимание всички комплексни въздействия върху крайния ултразвуков резултат, вкл.
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The prophylactic effect of carotid surgery correlated with the degree of carotid stenosis as seen on X ray angiography.
The prophylactic effect of carotid surgery correlated with the degree of carotid stenosis as seen on X ray angiography. The pathogenetic substrate is a plaque characterized by its hemodynamic effect due to area reduction and/or a complicated structure and broken surface. The 2 dimensional X ray shadow does not elucidate this better than the ultrasound examination which includes morphological and hemodynamic criteria. The X ray angiography however is taken as gold standard because this was the method of choice at the time of the study design of NASCET and ECST. Nobody will take the trouble and expense to repeat these studies to prove that the results will be the same based on ultrasound. In addition it will be no more possible ethically.
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The term “carotid duplex” is telling.
Make it easy can be misleading. The term “carotid duplex” is telling. For a symptomatic pa-
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tient the routine neurovascular examination must include in addition an evaluation of the carotid arteries, the vertebral arteries at multiple levels, the branches of the ophthalmic arteries and the intracranial circulation.
tient the routine neurovascular examination must include in addition an evaluation of the carotid arteries, the vertebral arteries at multiple levels, the branches of the ophthalmic arteries and the intracranial circulation. Any decision based on a carotid bifurcation scan only does not meet the clinical requirements.
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Any decision based on a carotid bifurcation scan only does not meet the clinical requirements.
tient the routine neurovascular examination must include in addition an evaluation of the carotid arteries, the vertebral arteries at multiple levels, the branches of the ophthalmic arteries and the intracranial circulation. Any decision based on a carotid bifurcation scan only does not meet the clinical requirements.
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Unfortunately there is no agreement how to measure and to document the degree of carotid stenosis.
Unfortunately there is no agreement how to measure and to document the degree of carotid stenosis. It starts with the different methods to calculate the diameter narrowing, following the ECST (local diameter narrowing with the original diameter at the level of stenosis as denominator) or the NASCET study (with the distal diameter as denominator). Considerable confusion could be avoided if the method is indicated in every report for external use. There is no uniformity in the use and allotted relative weight of the different ultrasonic criteria. All this reduces the acceptance of Neurosonology.
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Members of the Association took part in different activities of the Bulgarian Society of Neurology and in interdisciplinary symposia on endovascular therapy in carotid pathology, organized by the Bulgarian Societies of Cardiology and Interventional Cardiology.
Scientific Meeting of the Society held on October 3-4, 2009 in Hotel Rodina, Sofia with the participation of leading foreign specialists was devoted to thrombolysis [11, 12]. Workshops with the assistance of local hospital managers were organized in the towns of Gabrovo (2009) and Gotze Delchev (2010). Members of the Association took part in different activities of the Bulgarian Society of Neurology and in interdisciplinary symposia on endovascular therapy in carotid pathology, organized by the Bulgarian Societies of Cardiology and Interventional Cardiology.
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Recanalization and Stenting of Preocclusive Stenoses and Thromboses of Carotid Arteries
Recanalization and Stenting of Preocclusive Stenoses and Thromboses of Carotid Arteries
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carotid pathology, interventional therapy, stenting
carotid pathology, interventional therapy, stenting
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to analyse our experience in stanting of preocclusive carotid stenoses
to analyse our experience in stanting of preocclusive carotid stenoses
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We present the results of stenting of 51 occlusions and tight stenoses of carotid arteries for 2001 – 2009.
We present the results of stenting of 51 occlusions and tight stenoses of carotid arteries for 2001 – 2009. They represent 21.9% of the total 232 carotid stenting procedures in this period 5 (9.8%) chronic carotid occlusions and 46 (90.2%) tight carotid stenoses.
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They represent 21.9% of the total 232 carotid stenting procedures in this period 5 (9.8%) chronic carotid occlusions and 46 (90.2%) tight carotid stenoses.
We present the results of stenting of 51 occlusions and tight stenoses of carotid arteries for 2001 – 2009. They represent 21.9% of the total 232 carotid stenting procedures in this period 5 (9.8%) chronic carotid occlusions and 46 (90.2%) tight carotid stenoses.
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The stdy confirms that carotid stenting is a good therapeutic method with a low risk for early and late complications.
The stdy confirms that carotid stenting is a good therapeutic method with a low risk for early and late complications.
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Interventional treatment of carotid obstructions
Interventional treatment of carotid obstructions
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Interventional treatment of carotid obstructions
Interventional treatment of carotid obstructions
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European Carotid Surgery Trialists’Collaborative Group.
European Carotid Surgery Trialists’Collaborative Group. Randomised trial ofendarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).
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Randomised trial ofendarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).
European Carotid Surgery Trialists’Collaborative Group. Randomised trial ofendarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).
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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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Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion.
Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ. Importance of hemodynamic factors in the prognosis of symptomatic carotid 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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North American Symptomatic Carotid Endarterectomy Trialists’ Collaborative Group.
North American Symptomatic Carotid Endarterectomy Trialists’ Collaborative Group. The final results of the NASCET trial.
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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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Performance of the ABCD and ABCD2 scores in TIA patients with carotid stenosis and atrial fibrillation.
Koton S, Rothwell PM. Performance of the ABCD and ABCD2 scores in TIA patients with carotid stenosis and atrial fibrillation.
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Inflammatory markers, rather than conventional risk factors, are different between carotid and MCA atherosclerosis.
Bang Y, Lee PH, Yoon SR, Lee MA, Joo IS, Huh K. Inflammatory markers, rather than conventional risk factors, are different between carotid and MCA atherosclerosis.
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Population-Based Study of ABCD2 Score, Carotid Stenosis, and Atrial Fibrillation for Early Stroke Prediction After Transient Ischemic Attack.
Sheehan OC, Kyne L, Kelly LA, Hannon N, Marnane M, Merwick A, McCormack PM, Duggan J, Moore A, Moroney J, Daly L, Harris D, Horgan G, Williams EB, Kelly PJ. Population-Based Study of ABCD2 Score, Carotid Stenosis, and Atrial Fibrillation for Early Stroke Prediction After Transient Ischemic Attack. The North Dublin TIA Study.
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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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Depression in older people with mild stroke, carotid stenosis and peripheral vascular disease: a comparison with healthy controls.
Rao R, Jackson S, Howard R. Depression in older people with mild stroke, carotid stenosis and peripheral vascular disease: a comparison with healthy controls.
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Carotid stenting – results and prospects
Carotid stenting – results and prospects
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12. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 2 , , ,

Konstantin and Elena, Varna, 2006), “Algorithm of ultrasound diagnostics and therapeutic strategy in carotid pathology” (Grand Hotel Sofia, Sofia, 2007), “Dissection
organizes annual scientific meetings with international participation. The International symposia are devoted to contemporary problems in Neurology and Neurosonology such as: “Neurointerventional therapy of cerebrovascular diseases and cerebral aneurysms” (Grand Hotel Varna, St. Konstantin and Elena, Varna, 2006), “Algorithm of ultrasound diagnostics and therapeutic strategy in carotid pathology” (Grand Hotel Sofia, Sofia, 2007), “Dissection
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in carotid pathology, published in Issue 2/2008 of the Journal.
in carotid pathology, published in Issue 2/2008 of the Journal. It helps the experts to follow uniform rules for sonographic examinations and result interpretation, related to target groups, study frequency, location, type and severity of vascular pathology, follow up of the effect of treatment. Proposals for upgrading the postgraduate training programs "Neurosonology” and “Investigation of Autonomic Nervous System” were also made.
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carotid pathology, diabetes mellitus, duplex scan, echocardiography, risk factors,
carotid pathology, diabetes mellitus, duplex scan, echocardiography, risk factors,
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to evaluate the relationship between carotid and cerebral blood flow and cardiac function in patients with diabetes mellitus (DM) in accordance with the type, the severity and the treatment of the disease.
to evaluate the relationship between carotid and cerebral blood flow and cardiac function in patients with diabetes mellitus (DM) in accordance with the type, the severity and the treatment of the disease.
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Color carotid and transcranial duplex sonography was used for evaluation of the major arteries of the head and basal cerebral arteries, intima media tickness (IMT) of common carotid
63 patients with DM withouth a hystory for cerebrovascular disease (CVD), divided into three groups: 10 patients with type 1 DM, 22 patients with type 2 DM on oral medication and 31 patients with type 2 DM on insulin therapy. Color carotid and transcranial duplex sonography was used for evaluation of the major arteries of the head and basal cerebral arteries, intima media tickness (IMT) of common carotid
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and internal carotid arteries and the presence, severity and stability of atherosclerotic plaques.
and internal carotid arteries and the presence, severity and stability of atherosclerotic plaques. Nonmodifiable and the main modifiable risk factors for CVD were estimated. Transthoracal echocardiography was applied for assessment of cardiac function.
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Mild carotid stenoses predominated in the subgroups with type 2 DM, more frequently in the patients on oral medication.
The patients with type 1 DM were younger and had longer duration of DM than other two groups. In comparison to controls all patients with DM had unsatisfactory glycemic and lipid control, increased IMT and intracranial vascular resistance, more pronounced in type 2 DM on insulin therapy. Mild carotid stenoses predominated in the subgroups with type 2 DM, more frequently in the patients on oral medication. The cardiac ejection fraction were preserved in all subjects with DM.
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The type of DM seems to have a significant impact on the glycemic and lipid control, carotid atherosclerosis and intracranial vascular resistance.
The study shows that patients with DM have a synergy of similar modifiable risk factors for CVD. The type of DM seems to have a significant impact on the glycemic and lipid control, carotid atherosclerosis and intracranial vascular resistance.
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Increased Echolucency of Carotid Plaques in Patients With Type 2 Diabetes.
alves I. Increased Echolucency of Carotid Plaques in Patients With Type 2 Diabetes.
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Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes Mellitus.
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes Mellitus.
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Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes.
Parka SW, Kima SK, Choa Y-W, Kimb DJ, Songc Y-D, Choid YJ, Huhd BW, Choie SH, Jeef SH, Chog MA, Leeg EJ, Huhd KB. Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes.
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Diagnostic and therapeutic aspects of carotid atherothrombosis.
Diagnostic and therapeutic aspects of carotid atherothrombosis.
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13. 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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Intima-Media Thickness of Carotid
Intima-Media Thickness of Carotid
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on Prevalence, Significance and Behavior in Carotid Atherosclerosis
on Prevalence, Significance and Behavior in Carotid Atherosclerosis
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of Carotid Stenoses.
of Carotid Stenoses.
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on Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology
on Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology
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Extracranial Carotid Pathology
Extracranial Carotid Pathology
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havior in Extracranial Carotid Pathology give us an overview of the current state of progress and demonstrate how close technical development, clinical research and practical application are: “translational” Neurosonology, a term presently used all-around.
havior in Extracranial Carotid Pathology give us an overview of the current state of progress and demonstrate how close technical development, clinical research and practical application are: “translational” Neurosonology, a term presently used all-around.
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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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to review clinical cases with free floating thrombus in the internal carotid
to review clinical cases with free floating thrombus in the internal carotid
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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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56 year old) with ischemic stroke in the middle cerebral artery (MCA) territory detected by carotid duplex sonography and confirmed by CTA.
56 year old) with ischemic stroke in the middle cerebral artery (MCA) territory detected by carotid duplex sonography and confirmed by CTA.
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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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In world literature single cases of free-floating thrombus in carotid arteries connected mostly
One of the first known publications on FFT is by Chiari in 1905, in which postmortem intramural thrombus with length of 1.5 cm, which may cause IS to the patient was described [1]. In world literature single cases of free-floating thrombus in carotid arteries connected mostly
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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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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 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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The Intravascular mobile structure detected with duplex carotid ultrasound in patients with
Kimura K, Uchino M. The Intravascular mobile structure detected with duplex carotid ultrasound in patients with
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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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Carotid floating plaques associated with multiple cerebral embolic strokes: Case reports.
Ko PT, Lin SK, Chang YJ, Ryu SJ, Chu CC. Carotid floating plaques associated with multiple cerebral embolic strokes: Case reports.
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Doppler and M mode sonography of mobile carotid plaque.
Kotval PS, Barakat K. Doppler and M mode sonography of mobile carotid plaque.
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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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Mobile carotid plaques: The natural history of two asymptomatic and non-operated cases.
Szendro G, Sabetai MM, Tegos TJ, Dhanjil S, Lennox AF, Nicolaides AN. Mobile carotid plaques: The natural history of two asymptomatic and non-operated cases.
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Intima-Media Thickness of Carotid Arteries in Obstructive Sleep Apnea
Intima-Media Thickness of Carotid Arteries in Obstructive Sleep Apnea
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Color duplex sonography of carotid arteries was performed in 27 patients with OSAS (mean age 55.7±1.4 years) and 27 control subjects (mean age 56.1±1.4 years), with risk facktors (RF) for cerebrovascular diseases (CVD) but not OSAS.
Color duplex sonography of carotid arteries was performed in 27 patients with OSAS (mean age 55.7±1.4 years) and 27 control subjects (mean age 56.1±1.4 years), with risk facktors (RF) for cerebrovascular diseases (CVD) but not OSAS. The IMT of the common carotid arteries (CCA) was measured in B-mode at the far wall of both arteries. Furthermore, the presence of plaques and stenoses of the extracranial vessels was determined.
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The IMT of the common carotid arteries (CCA) was measured in B-mode at the far wall of both arteries.
Color duplex sonography of carotid arteries was performed in 27 patients with OSAS (mean age 55.7±1.4 years) and 27 control subjects (mean age 56.1±1.4 years), with risk facktors (RF) for cerebrovascular diseases (CVD) but not OSAS. The IMT of the common carotid arteries (CCA) was measured in B-mode at the far wall of both arteries. Furthermore, the presence of plaques and stenoses of the extracranial vessels was determined.
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Additionally, the formation of plaques was more pronounced and carotid stenoses were more common in the OSAS patients.
In the OSAS group, CCA-IMT was significantly increased when compared with the non-OSAS patients. Additionally, the formation of plaques was more pronounced and carotid stenoses were more common in the OSAS patients.
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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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That fact supposes a connection between OSAS and the progression of atherosclerotic cerebrovascular disease [11], whose early marker is the thickening of the intima media complex of the carotid arteries [6, 8].
hemorrheologic changes which are potential promoters of stroke in patients with risk factors for CVD. Experimental studies show that the oxygen desaturation that accompanies the apnoeic episodes, can lead to degenerative changes of arterial wall. That fact supposes a connection between OSAS and the progression of atherosclerotic cerebrovascular disease [11], whose early marker is the thickening of the intima media complex of the carotid arteries [6, 8].
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Carotid IMT in obstructive sleep apnea
Carotid IMT in obstructive sleep apnea
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A real time В-mode imaging is used to measure the thickness of the intima media complex of the carotid arteries (mm) by a standard method using a program for automatic value averaging.
Neurosonographic examination: The main arteries of the head are examined by a color – coded duplex sonography using а 7.5 MHz transduser Sonix SP (Canadа). A real time В-mode imaging is used to measure the thickness of the intima media complex of the carotid arteries (mm) by a standard method using a program for automatic value averaging. The rate of stenoses is determined by the morphologic method in longitudinal and
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Carotid IMT in obstructive sleep apnea
Carotid IMT in obstructive sleep apnea
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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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Evaluation of Carotid Atherosclerosis by B’Mode Ultrasonographic Study in Hypertensive Patients Compared with Normotensive Patients.
Adaikkappan M, Sampath R, Felix AJW, Sethupathy S. Evaluation of Carotid Atherosclerosis by B’Mode Ultrasonographic Study in Hypertensive Patients Compared with Normotensive Patients.
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Carotid intima-media thickness measurements: what defines an abnormality?
Аminbakhsh A; Mancini GB. Carotid intima-media thickness measurements: what defines an abnormality? A systematic review.
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Reproducibility of carotid vessel wall thickness measurements: the Rotterdam Study.
Bots ML, Mulder PG, Van Es GA. Reproducibility of carotid vessel wall thickness measurements: the Rotterdam Study.
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Common carotid intimamedia thickness measurement.
Baldassare D, Werba JP, Tremoli E. Common carotid intimamedia thickness measurement. A method to improve accuracy and precision,
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According to the guideline for the diagnosis and management of syncope, version 2009 [4], syncope classification includes reflex syncope (with subgroups vasovagal, situational, carotid sinus syncope and atypical forms), syncope due to orthostatic hypotension (primary and secondary autonomic failure, drug-induced orthostatic hypotension and volume depletion) and cardiovascular syncope (rhythm-conduction disturbances or structural diseases).
Syncope is defined as a transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery [4]. According to the guideline for the diagnosis and management of syncope, version 2009 [4], syncope classification includes reflex syncope (with subgroups vasovagal, situational, carotid sinus syncope and atypical forms), syncope due to orthostatic hypotension (primary and secondary autonomic failure, drug-induced orthostatic hypotension and volume depletion) and cardiovascular syncope (rhythm-conduction disturbances or structural diseases). Syncope is common in the general population with occurrence of 18 to 40 per 1000 individuals [4]. Prognosis in patients with syncope varies considerably with etiology. Recurrences have a great impact on quality of life.
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Assessment of the hemispheric dominance of language before carotid endarterectomy is another important application of fMRI [73].
Assessment of the hemispheric dominance of language before carotid endarterectomy is another important application of fMRI [73].
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Changes in the reactivity of brain blood vessels may be important for reduction of cognitive capacity related to the hemisphere ipsilateral to carotid stenosis.
Changes in the reactivity of brain blood vessels may be important for reduction of cognitive capacity related to the hemisphere ipsilateral to carotid stenosis. Indications for surgical treatment of asymptomatic carotid stenosis should therefore be specified more precisely [72, 78].
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Indications for surgical treatment of asymptomatic carotid stenosis should therefore be specified more precisely [72, 78].
Changes in the reactivity of brain blood vessels may be important for reduction of cognitive capacity related to the hemisphere ipsilateral to carotid stenosis. Indications for surgical treatment of asymptomatic carotid stenosis should therefore be specified more precisely [72, 78].
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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 intima-media thickness as a predictor of response to cholinesterase inhibitors in Alzheimer‘s disease: an open-label trial.
Modrego PJ, Rios C, Perez Trullen JM, Garcia-Gomara MJ, Errea JM. Carotid intima-media thickness as a predictor of response to cholinesterase inhibitors in Alzheimer‘s disease: an open-label trial.
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Cerebral hemodynamics and cognitive performance in patients with asymptomatic carotid stenosis.
Silvestrini M, Paolino I, Vernieri F, Pedone C, Baruffaldi R, Gobbi B, Cagnetti C, Provinciali L, Bartolini M. Cerebral hemodynamics and cognitive performance in patients with asymptomatic carotid stenosis.
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Functional Magnetic Resonance Imaging to Determine Hemispheric Language Dominance Prior to Carotid Endarterectomy.
Smits M, Wieberdink RG, Bakker SL, Dippel DW. Functional Magnetic Resonance Imaging to Determine Hemispheric Language Dominance Prior to Carotid Endarterectomy.
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Carotid stenosis and the cognitive function.
Sztriha LK, Nemeth D, Sefcsik T, Vecsei L. Carotid stenosis and the cognitive function.
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Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial.
Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, Ringelstein EB. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial.
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Carotid Atherosclerosis“
Carotid Atherosclerosis“
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„Ultrasound Classification of Carotid Stenoses“
„Ultrasound Classification of Carotid Stenoses“
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First National Consensus on Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology
First National Consensus on Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology
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At the iniciative of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics on March 11, 2011 in Sofia Kempinski Hotel Zografski an Iinternational symposium entitled: „Ultrasound classification of carotid stenoses is there a problem?
At the iniciative of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics on March 11, 2011 in Sofia Kempinski Hotel Zografski an Iinternational symposium entitled: „Ultrasound classification of carotid stenoses is there a problem? “ was held. The guest lecturer was Prof. Manfred Kaps President of the Neurosonology Research Group of the World Federation of Neurology.
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During the symposium the “First National Consensus on the Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology” was accepted.
During the symposium the “First National Consensus on the Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology” was accepted. It was organized by Bulgarian Society of Neurosonology and Cerebral Hemodynamics (chaired by Prof. E. Titianova, MD, DSc); Bulgarian Society of Neurology (chaired by Prof.
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The Consensus regulates the ultrasound diagnostics of different types of carotid pathology and principles of diagnostic and therapeutic approach depending on its location, type, severity and clinical characteristics.
The Consensus regulates the ultrasound diagnostics of different types of carotid pathology and principles of diagnostic and therapeutic approach depending on its location, type, severity and clinical characteristics. It is a practical guide for early diagnosis, prevention, right therapeutic approach and long-term monitoring of patients with carotid pathology. Its application by different medical specialists contribute to the high quality of diagnostic, therapeutic and preventive health services in all units of outpatient and inpatient care. The algorhitm is consistent with the level of competence of each hospital and the individual characteristics of vascular pathology.
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It is a practical guide for early diagnosis, prevention, right therapeutic approach and long-term monitoring of patients with carotid pathology.
The Consensus regulates the ultrasound diagnostics of different types of carotid pathology and principles of diagnostic and therapeutic approach depending on its location, type, severity and clinical characteristics. It is a practical guide for early diagnosis, prevention, right therapeutic approach and long-term monitoring of patients with carotid pathology. Its application by different medical specialists contribute to the high quality of diagnostic, therapeutic and preventive health services in all units of outpatient and inpatient care. The algorhitm is consistent with the level of competence of each hospital and the individual characteristics of vascular pathology.
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Participants in the First National Consensus for Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology.
Participants in the First National Consensus for Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology.
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for Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology
for Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology
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for Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology
for Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology
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carotid pathology, carotid endarterectomy, consensus, drugs, endovascular treatment, ultrasound diagnosis
carotid pathology, carotid endarterectomy, consensus, drugs, endovascular treatment, ultrasound diagnosis
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At the initiative of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics, the Bulgarian Society of Neurology, the Bulgarian National Society of Angiology and Vascular Surgery, the Bulgarian Society of Endovascular Therapy and Bulgarian Stroke Prevention Foundation on March 11, 2011 in Sofia was accepted the First National Consensus for Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology.
At the initiative of the Bulgarian Society of Neurosonology and Cerebral Hemodynamics, the Bulgarian Society of Neurology, the Bulgarian National Society of Angiology and Vascular Surgery, the Bulgarian Society of Endovascular Therapy and Bulgarian Stroke Prevention Foundation on March 11, 2011 in Sofia was accepted the First National Consensus for Ultrasound Diagnostics and Behavior in Extracranial Carotid Pathology.
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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The consensus regulates noninvasive ultrasound diagnosis of carotid pathology and principles of behavior depending on its location, type, severity and functional characteristics.
The consensus regulates noninvasive ultrasound diagnosis of carotid pathology and principles of behavior depending on its location, type, severity and functional characteristics. It serves as a practical guide for early diagnosis, adequate prevention, choosing the right therapeutic approach and long-term monitoring of threatened stroke risk population. Its application by different professionals contribute for high quality diagnostic, therapeutic and preventive health services in all units of outpatient and hospital care that are consistent with the level of competence of the hospital and the individual characteristics of the vascular pathology. The Consensus includes recommendations based on results of multicenter randomized clinical trials or meta-analysis (level of evidence A), single-center or non-randomized studies (level of evidence B) and expert advice or therapeutic standards (level of evidence C). Therapeutic and procedural recommendations are graded as required (class I), recommended (Class
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Резултатите от проучването North American Symptomatic Carotid Endarterectomy Trial (NASCET)
Резултатите от проучването North American Symptomatic Carotid Endarterectomy Trial (NASCET)
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Проучването European Carotid Surgery Trial (ECST) [14] от своя страна показва, че коронарната сърдечна смърт при такива болни достига до 30% за пери-
[11] сочат, че при симптомните каротидни стенози над 70% рискът от ипсилатерален мозъчен инфаркт в следващите две години е 26%. Проучването European Carotid Surgery Trial (ECST) [14] от своя страна показва, че коронарната сърдечна смърт при такива болни достига до 30% за пери-
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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„локален”, използван в European Carotid Surgery Trial (ECST) – съотношение между диаметъра на остатъчния лумен към целия диаметър на артерията в участъка на стеноза;
„локален”, използван в European Carotid Surgery Trial (ECST) – съотношение между диаметъра на остатъчния лумен към целия диаметър на артерията в участъка на стеноза;
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„дистален”, използван в North American Symptomatic Carotid Endarterectomy Trial (NASCET) – съотношение между диаметъра на остатъчния лумен в стенотичния участък към дисталния диаметър на артерията.
„дистален”, използван в North American Symptomatic Carotid Endarterectomy Trial (NASCET) – съотношение между диаметъра на остатъчния лумен в стенотичния участък към дисталния диаметър на артерията. Използва се от Европейската организация за мозъчен инсулт за определяне на степента на каротидна стеноза. За критична се приема стеноза ≥70%, при която е показана реваскуларизация.
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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National Consensus in Extracranial Carotid Pathology
National Consensus in Extracranial Carotid Pathology
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of Patients With Extracranial Carotid and Vertebral Artery Disease.
of Patients With Extracranial Carotid and Vertebral Artery Disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery.
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ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting.
Bates E. et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting.
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Invasive Treatment for Carotid Stenosis: Indications, Techniques.
ESVS Guidelines. Invasive Treatment for Carotid Stenosis: Indications, Techniques. Liapis CD, PRF Bell, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes J e Fernandes, Biasi G, Norgren L, on behalf of the ESVS Guidelines Collaborators
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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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The Carotid Stenting Guidelines Committee.
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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North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.
North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
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Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
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Symptomatic patients: the European Carotid Surgery Trial (ECST).
Warlow CP. Symptomatic patients: the European Carotid Surgery Trial (ECST).
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14. 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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In the early years, TCD was also applied to the evaluation of the intracranial collateral circulation in carotid stenosis.
In the early years, TCD was also applied to the evaluation of the intracranial collateral circulation in carotid stenosis. In the 1990’ties the transcranial color imaging Doppler was introduced. As this instrumentation became more sensitive, it is currently preferred in many centers for the routine examination. The advantage is that the image makes artery identification easier for the operator. However, the diagnosis is still based on spectral analysis of the Doppler signal like in the conventional TCD examination.
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in the Prevention and Treatment of Carotid Atherosclerosis
in the Prevention and Treatment of Carotid Atherosclerosis
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15. 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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Carotid Endarterectomy
Carotid Endarterectomy
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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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B-flow, CEA, proximal carotid dissection
B-flow, CEA, proximal carotid dissection
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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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Carotid endarterectomy (CEA) and endovascular dilatation followed by stenting are leading non-pharmacological methods in the treatment of significant carotid pathology.
Carotid endarterectomy (CEA) and endovascular dilatation followed by stenting are leading non-pharmacological methods in the treatment of significant carotid pathology. Although rarely found, carotid dissections are serious postoperative complication after CEA, puncture and stenting of the cervical arteries and veins. They result from traumatic splitting of the vessel wall due to penetration of blood between its layers the stratification of intima and media leads to the formation of "false" lumen or intramural thrombus, and invasion of blood between the media and tunica adventicia predisposes to the formation of pseudoaneurysm [6]. The most commonly dissection is spread distaly, but depending on the hemodynamic gradient between the "real" and the "false" lumen, it can spread proximally. The initial dissection dynamically changes over time
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Although rarely found, carotid dissections are serious postoperative complication after CEA, puncture and stenting of the cervical arteries and veins.
Carotid endarterectomy (CEA) and endovascular dilatation followed by stenting are leading non-pharmacological methods in the treatment of significant carotid pathology. Although rarely found, carotid dissections are serious postoperative complication after CEA, puncture and stenting of the cervical arteries and veins. They result from traumatic splitting of the vessel wall due to penetration of blood between its layers the stratification of intima and media leads to the formation of "false" lumen or intramural thrombus, and invasion of blood between the media and tunica adventicia predisposes to the formation of pseudoaneurysm [6]. The most commonly dissection is spread distaly, but depending on the hemodynamic gradient between the "real" and the "false" lumen, it can spread proximally. The initial dissection dynamically changes over time
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In clinical aspect carotid dissections are important etiological factor for stroke in the postoperative period but can remain completely asymptomatic with good collateral circulation [13].
In clinical aspect carotid dissections are important etiological factor for stroke in the postoperative period but can remain completely asymptomatic with good collateral circulation [13].
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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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Carotid dissection after CEA
Carotid dissection after CEA
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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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Carotid endarterectomy is associated with different types of periprocedure and postoperative complications fluctuation in blood pressure, stroke, venous thrombembolism, infections, restenosis, cranial nerves lesions or death.
Carotid endarterectomy is associated with different types of periprocedure and postoperative complications fluctuation in blood pressure, stroke, venous thrombembolism, infections, restenosis, cranial nerves lesions or death. Their frequency and etiology differ in individual studies. Some of the incidents are from emboli of the synthetic patch [8]. According to Archie and Rosenthal two/thirds of the postoperative cerebral events (stroke and transient ischemic attacks) after CEA are due to dissections, intimal fleps or vessel wall damage by clamps, detected by ultrasound in 27% of the patients during CEA [11]. Dissections occur most frequently in the first hours after blood flow restoration following the eversion CEA, they appear distally to CEA and often are symptomatic – cause lesions of the cranial nerves (58%), stroke (8%) or death (2%) [6, 7, 8, 10]. Proximal dissections are rare complication after CEA with shunt [9].
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Carotid dissection after CEA
Carotid dissection after CEA
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Pain is the first symptom of spontaneous carotid dissection
It is known that the clinical characteristics of dissections are diverse and variable. Pain is the first symptom of spontaneous carotid dissection
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carotid dissection causes ischemic stroke without preceding symptoms and/or symptoms of cerebral edema.
carotid dissection causes ischemic stroke without preceding symptoms and/or symptoms of cerebral edema. The Initial thrombosis can quickly pass into arterial stenosis or spontaneous improvement. Dissection can be completely asymptomatic in case with good collateral circulation or complicated with atherothrombosis, which is a potential source of emboli to the brain. In 60% of cases with acute carotid dissections the neuroimaging methods detect ischemic changes in the brain parenchyma.
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In 60% of cases with acute carotid dissections the neuroimaging methods detect ischemic changes in the brain parenchyma.
carotid dissection causes ischemic stroke without preceding symptoms and/or symptoms of cerebral edema. The Initial thrombosis can quickly pass into arterial stenosis or spontaneous improvement. Dissection can be completely asymptomatic in case with good collateral circulation or complicated with atherothrombosis, which is a potential source of emboli to the brain. In 60% of cases with acute carotid dissections the neuroimaging methods detect ischemic changes in the brain parenchyma.
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A mobile hyperechoic intimal flap and double vascular lumen causing carotid stenosis with an irregular shape and flame-type end is detected [3, 4].
Ultrasonic methods are the fastest, cheapest and highly informative tool for noninvasive diagnosis of periand postoperative complications associated with CEA or stenting [2]. For the experienced researcher using multimodal ultrasound (a combination of duplex-scan, B-flow imaging and transcranial Doppler sonography), the sensitivity of the method to the DSA for diagnosis of postoperative distal dissections is over 95%. A mobile hyperechoic intimal flap and double vascular lumen causing carotid stenosis with an irregular shape and flame-type end is detected [3, 4]. The formation of distal fenestra causes return of part of the flow from false to true lumen. The absence of fenestra induces the deposition of embolic material at the bottom of the false lumen. In a large intimal defect (more than 6-8 mm) intramural hematoma is most commonly found, whose echogenicity is determined by its limitation
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Carotid stenoses caused by dissections are long and irregular in shape, have eccentric or flame type, after which the arterial lumen sharply recovered.
Carotid stenoses caused by dissections are long and irregular in shape, have eccentric or flame type, after which the arterial lumen sharply recovered. Sometimes, with color-duplex scanning and/or B-flow imaging cavity into the intramural thrombus is visualized, from where a weak flow with high pulsatility index is recorded [12]. Doppler signal depends on the place of insonation, the type of dissection and the severity of obstruction [1].
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Carotid dissection after CEA
Carotid dissection after CEA
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Behavior in cases of carotid dissections depends on their clinical characteristics and evolution.
Behavior in cases of carotid dissections depends on their clinical characteristics and evolution. In symptomatic carotid dissection anticoagulation with parenteral low molecular weight heparin followed by oral anticoagulant is recommended, or using oral anticoagulant without prior heparin for 3 to 6 months followed by antiplatelet therapy with aspirin (80 to 325 mg daily) or clopidogrel 75 mg daily) (class IIa, level of evidence C). Carotid angioplasty or stenting could be considered when ischemic neurological symptoms have not responded to anticoagulant treatment after acute carotid dissection (class IIb, level of evidence C) [4]. CEA is used in the presence of contraindication for thrombolytic therapy, persistence of highgrade stenosis, occurrence of a new stenosis and detection of symptomatic aneurysm in the area of dissection with dimensions 2 times bigger than normal vascular lumen. Surgical treatment is difficult in distal dissections and often requires cutting of m. digastricus, subluxation of the mandible and fracture of the processus stiloideus.
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In symptomatic carotid dissection anticoagulation with parenteral low molecular weight heparin followed by oral anticoagulant is recommended, or using oral anticoagulant without prior heparin for 3 to 6 months followed by antiplatelet therapy with aspirin (80 to 325 mg daily) or clopidogrel 75 mg daily) (class IIa, level of evidence C).
Behavior in cases of carotid dissections depends on their clinical characteristics and evolution. In symptomatic carotid dissection anticoagulation with parenteral low molecular weight heparin followed by oral anticoagulant is recommended, or using oral anticoagulant without prior heparin for 3 to 6 months followed by antiplatelet therapy with aspirin (80 to 325 mg daily) or clopidogrel 75 mg daily) (class IIa, level of evidence C). Carotid angioplasty or stenting could be considered when ischemic neurological symptoms have not responded to anticoagulant treatment after acute carotid dissection (class IIb, level of evidence C) [4]. CEA is used in the presence of contraindication for thrombolytic therapy, persistence of highgrade stenosis, occurrence of a new stenosis and detection of symptomatic aneurysm in the area of dissection with dimensions 2 times bigger than normal vascular lumen. Surgical treatment is difficult in distal dissections and often requires cutting of m. digastricus, subluxation of the mandible and fracture of the processus stiloideus. In these cases it is appropriate to use a flexible stent that is resistant to mechanical damage in the neck.
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Carotid angioplasty or stenting could be considered when ischemic neurological symptoms have not responded to anticoagulant treatment after acute carotid dissection (class IIb, level of evidence C) [4].
Behavior in cases of carotid dissections depends on their clinical characteristics and evolution. In symptomatic carotid dissection anticoagulation with parenteral low molecular weight heparin followed by oral anticoagulant is recommended, or using oral anticoagulant without prior heparin for 3 to 6 months followed by antiplatelet therapy with aspirin (80 to 325 mg daily) or clopidogrel 75 mg daily) (class IIa, level of evidence C). Carotid angioplasty or stenting could be considered when ischemic neurological symptoms have not responded to anticoagulant treatment after acute carotid dissection (class IIb, level of evidence C) [4]. CEA is used in the presence of contraindication for thrombolytic therapy, persistence of highgrade stenosis, occurrence of a new stenosis and detection of symptomatic aneurysm in the area of dissection with dimensions 2 times bigger than normal vascular lumen. Surgical treatment is difficult in distal dissections and often requires cutting of m. digastricus, subluxation of the mandible and fracture of the processus stiloideus. In these cases it is appropriate to use a flexible stent that is resistant to mechanical damage in the neck. Such stents are made of nitinol (nickeltitanium special alloy with thermal and mechanical memory).
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Patients experienced carotid dissection, are subject to active monitoring, modification of vascular risk factors and periodic sonographic control.
Patients experienced carotid dissection, are subject to active monitoring, modification of vascular risk factors and periodic sonographic control.
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Emergency stenting to treat neurological complications occurring after carotid endarterectomy.
Carlino M, Pagnotta P, Mario CD, Sheiban I, Magnani G, Jannello A, Melissano G, Chiesa R, Colombo A. Emergency stenting to treat neurological complications occurring after carotid endarterectomy.
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Microsurgical carotid endarterectomy.
Bailes J, Spetzler R. Microsurgical carotid endarterectomy. Lippincott-Raven, 1995:128.
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Proximal shunt dissection: a potential problem in carotid endarterectomy.
Calhoun TR, Kitten CM. Proximal shunt dissection: a potential problem in carotid endarterectomy.
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Carotid patch angioplasty: immediate and long-term results.
Rosenthal D, Archie J. Carotid patch angioplasty: immediate and long-term results.
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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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Neurosonologic examination showed multifocal atherosclerosis irregularly thickened intima-media complex with low-grade non-stenotic and unstable plaques in both carotid bifurcations and lower limbs arteries.
and polyphasic action potentials with longer duration and higher amplitude. EMG findings were typical for secondary neurogenic lesions of muscle, unlike EMG in primary muscle damage no evidence of denervation and reinervation and presence of action potentials of short duration, low amplitude and turns. Neurosonologic examination showed multifocal atherosclerosis irregularly thickened intima-media complex with low-grade non-stenotic and unstable plaques in both carotid bifurcations and lower limbs arteries.
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Carotid sinus syncope.
Carotid sinus syncope.
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Cardio-vascular system evaluation is of paramount importance for the further diagnostic and therapeutic work-up, as well as for prognosis, and includes: 12-lead ECG, continuous ECG monitoring – in-hospital or ambulatory with Holter ECG, implantable loop-event recorders, telemonitoring, electrophysiological study, signal-averaged ECG, carotid sinus massage, echocardiography, stress ECG test, tilt-table test.
syncope includes a thorough anamnesis, physical examination and some basic laboratory parameters. Cardio-vascular system evaluation is of paramount importance for the further diagnostic and therapeutic work-up, as well as for prognosis, and includes: 12-lead ECG, continuous ECG monitoring – in-hospital or ambulatory with Holter ECG, implantable loop-event recorders, telemonitoring, electrophysiological study, signal-averaged ECG, carotid sinus massage, echocardiography, stress ECG test, tilt-table test. It has been proved that liquor investigation, Doppler-sonography of carotid arteries, cerebral angiography, brain computed tomography and electroencephalography do not contribute to the diagnostic work-up in the absence of clinical signs of a neurological disease. Nevertheless neurological examination is warranted in case of a clinical suspicion of neurological disease, as well as when traumatic brain damage could not be ruled out. Psychiatric patients’ evaluation is appropriate in cases of multifold recurrent episodes of loss of consciousness in young adults and other co-existing nonspecific complaints.
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It has been proved that liquor investigation, Doppler-sonography of carotid arteries, cerebral angiography, brain computed tomography and electroencephalography do not contribute to the diagnostic work-up in the absence of clinical signs of a neurological disease.
syncope includes a thorough anamnesis, physical examination and some basic laboratory parameters. Cardio-vascular system evaluation is of paramount importance for the further diagnostic and therapeutic work-up, as well as for prognosis, and includes: 12-lead ECG, continuous ECG monitoring – in-hospital or ambulatory with Holter ECG, implantable loop-event recorders, telemonitoring, electrophysiological study, signal-averaged ECG, carotid sinus massage, echocardiography, stress ECG test, tilt-table test. It has been proved that liquor investigation, Doppler-sonography of carotid arteries, cerebral angiography, brain computed tomography and electroencephalography do not contribute to the diagnostic work-up in the absence of clinical signs of a neurological disease. Nevertheless neurological examination is warranted in case of a clinical suspicion of neurological disease, as well as when traumatic brain damage could not be ruled out. Psychiatric patients’ evaluation is appropriate in cases of multifold recurrent episodes of loss of consciousness in young adults and other co-existing nonspecific complaints.
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Haralanov’s scientific activity contains more than 200 publications, including coauthorship in 3 Neurology books and 2 monographs – “Pathology of carotid circulation” (1970 and “Insufficiency of basal circulation” (1974).
(1960), Clinical Neurophysiology in Burdenko Institute of Neurosurgery (Moscow, 1960-61), Clinical and Experimental Otoneurology with Prof. Bourgeat (Paris) who at that time was the President of the European Association of Space Medicine (1970). Prof. Haralanov’s scientific activity contains more than 200 publications, including coauthorship in 3 Neurology books and 2 monographs – “Pathology of carotid circulation” (1970 and “Insufficiency of basal circulation” (1974). These monographs along with his PhD thesis “Problems of the brain circulation” (1981), show his main direction of interest: investigation of the brain circulation and more specific – the main cerebral vessels.
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The scientific program included lectures in current Neurosonology criteria for carotid stenoses, telesonology, new diagnostic ultrasound methods, sonotrombolysis, ultrasonic emboli detection etc.
The forum was attended by over 350 sonologists worldwide. The scientific program included lectures in current Neurosonology criteria for carotid stenoses, telesonology, new diagnostic ultrasound methods, sonotrombolysis, ultrasonic emboli detection etc. Speakers at the meeting were M. Kaps (Germany),
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16. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2012, No. 2 , , ,

beside the descriptions of plaque morphology and risk factors, grading of carotid stenosis, microemboli detection, acute stroke managment, brain tissue imaging and cerebral autoregulation.
beside the descriptions of plaque morphology and risk factors, grading of carotid stenosis, microemboli detection, acute stroke managment, brain tissue imaging and cerebral autoregulation. The technical development of the US equipment demonstrates further improvements of the image quality and fast processing leading to increased spacial and temporal resolution, improved contrast imaging, elasthography and easy to use application to support the application of the US technology even in the daily routine with high quality. Ultrasound application in other than neurological indication extended more and more the diagnostic field in competition to CT/MRI e.g. analysis of tumour tissue using ultrasound contrast agents, searching for lymph node pathology and future aspects of local drug application by loaded microbubbles and treatment via sonovaporation [14].
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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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The thickness of intima– media complex of carotid arteries was measured by B–mode imaging in real time using a standard method with programs for automatic averaging of the values.
Main head arteries were examined with Sonix SP (Canada) by color coded duplex scanning using 7.5 Hz transducer. The thickness of intima– media complex of carotid arteries was measured by B–mode imaging in real time using a standard method with programs for automatic averaging of the values. The velocity parameters of blood flow were defined by pulse Doppler sonography.
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Future ideas were revealed in the rich variety of lectures covering topics in various sessions: “Heart and Mind” (arterial fibrillations in stroke, role of Neurosonology in the therapeutic approach in patients with asymptomatic carotid pathology, correlation between carotid pathology and cardiovascular diseases), “Unstable Carotid Plaque “(identification of the stability of carotid plaques by duplex scanning, assessment of their vascularization, risk of stroke, etc.), “Neuromyosonology” and others.
E. Ringelstein (Germany), K. Niederkorn (Austria), E. Bartels (Germany) and others. Future ideas were revealed in the rich variety of lectures covering topics in various sessions: “Heart and Mind” (arterial fibrillations in stroke, role of Neurosonology in the therapeutic approach in patients with asymptomatic carotid pathology, correlation between carotid pathology and cardiovascular diseases), “Unstable Carotid Plaque “(identification of the stability of carotid plaques by duplex scanning, assessment of their vascularization, risk of stroke, etc.), “Neuromyosonology” and others. In this session, Professor E. Ti-
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17. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 1 , , ,

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.
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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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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Moreover, one other ultrasound study done in 10 healthy volunteers measuring CSA of the IJV just above the carotid bifurcation showed a range of CSA on the right IJV between 0.11 and 0.77 cm
without pathological meaning. Furthermore, interpretation was already limited as the study focused on patients in intensive care and did not include healthy subjects. Therefore, Zamboni et al. based their conclusions on misinterpretation of a previous study. It has also to be mentioned that in this work the area of the IJV was measured 15 mm above the cricoid cartilage which does not exclude smaller areas at more proximal or distal locations. Moreover, one other ultrasound study done in 10 healthy volunteers measuring CSA of the IJV just above the carotid bifurcation showed a range of CSA on the right IJV between 0.11 and 0.77 cm
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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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Other authors have found that increased blood pressure in the acute phase of stroke influences positively the cognition of patients with carotid stenosis [21].
The effect of concomitant modifiable vascular risk factors on cognitive impairment in the acute period of stroke is debatable [10, 21, 34, 37]. We have found that systolic blood pressure on admission is a significant predictor of post-stroke cognitive deficit at discharge. Some indirect evidence exists, that the higher blood pressure is on admission, the greater is the risk of post-stroke dementia [37]. According to the PROGRESS study decreasing of blood pressure reduces the risk of stroke recurrence, respectively the risk of cognitive disturbances [37]. Other authors have found that increased blood pressure in the acute phase of stroke influences positively the cognition of patients with carotid stenosis [21].
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18. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2 , , ,

Diagnosis of Occlusive Disease of the Carotid and Vertebral Artery System, Vessel Wall Pathology.
Diagnosis of Occlusive Disease of the Carotid and Vertebral Artery System, Vessel Wall Pathology.
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Measuring the Degree of Carotid and Vertebral Artery Stenosis.
Measuring the Degree of Carotid and Vertebral Artery Stenosis.
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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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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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Counterproductive Results with the Use of an Emboli Protection Device in the Prevention of Microembolism Detected by Transcranial Doppler in Carotid Stent Placement.
Counterproductive Results with the Use of an Emboli Protection Device in the Prevention of Microembolism Detected by Transcranial Doppler in Carotid Stent Placement.
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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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Carotid Pathology in Cerebral Infarctions: Effects of Blood Pressure and Blood Viscosity.
Carotid Pathology in Cerebral Infarctions: Effects of Blood Pressure and Blood Viscosity.
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Measurement of Carotid Plaque Volume with VOCALTMII Technique by 3-Dimensional Ultrasound.
Measurement of Carotid Plaque Volume with VOCALTMII Technique by 3-Dimensional Ultrasound.
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Juxtaluminal Echogenicity as a Marker of Carotid Plaque Instability.
Juxtaluminal Echogenicity as a Marker of Carotid Plaque Instability.
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Aftercare Management Based on Carotid Duplex Sonography for Patients with Stented Vessels Reaching the End of the Scheduled Three-Dimensional Enhanced Computed Tomography Angiography Follow-up Periods.
Aftercare Management Based on Carotid Duplex Sonography for Patients with Stented Vessels Reaching the End of the Scheduled Three-Dimensional Enhanced Computed Tomography Angiography Follow-up Periods.
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Diagnostic Role of Color-Coded Duplex Sonography in Following-up after Carotid Endarterectomy in Men.
Diagnostic Role of Color-Coded Duplex Sonography in Following-up after Carotid Endarterectomy in Men.
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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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Evaluation of Internal Carotid Arterial Dissection by Transoral Carotid Ultrasonography.
Evaluation of Internal Carotid Arterial Dissection by Transoral Carotid Ultrasonography.
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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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The Significance of Asymptomatic Carotid Stenosis and Dyslipidemia for TIA and Ischemic Strokes in Patients with Multiple Vascular Risk Factors – Population-Based Study.
The Significance of Asymptomatic Carotid Stenosis and Dyslipidemia for TIA and Ischemic Strokes in Patients with Multiple Vascular Risk Factors – Population-Based Study.
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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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Carotid Blood Flow, Cardiac Function and Risk Factors for Cerebrovascular Disease – Correlative Clinical and Ultrasound Studies.
Carotid Blood Flow, Cardiac Function and Risk Factors for Cerebrovascular Disease – Correlative Clinical and Ultrasound Studies.
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Correlation between Carotid Ultrasound and Exercise Stress Test for Assessing the Subclinical Vascular Diseases in Patients with Cardiovascular Disease.
Correlation between Carotid Ultrasound and Exercise Stress Test for Assessing the Subclinical Vascular Diseases in Patients with Cardiovascular Disease.
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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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Recanalization and Stenting of Occluded and Nearly Occluded Carotid Stenoses.
Recanalization and Stenting of Occluded and Nearly Occluded Carotid Stenoses.
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the carotid and the vertebral arteries will be discussed as well as the intracranial arteries.
This tutorial will cover the basic knowledge of the arterial blood supply of the brain. The extracranial anterior and posterior system, i.e. the carotid and the vertebral arteries will be discussed as well as the intracranial arteries. Special attention will be paid to the concept of endarteries versus collateral blood supply. The latter comprises of course the circle of Willis. Also, there will be a short reflection on the anatomical properties of the vessel wall, which are the prerequisite for their functional behaviour.
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DIAGNOSIS OF OCCLUSIVE DISEASE OF THE CAROTID AND VERTEBRAL ARTERY SYSTEM, VESSEL WALL PATHOLOGY
DIAGNOSIS OF OCCLUSIVE DISEASE OF THE CAROTID AND VERTEBRAL ARTERY SYSTEM, VESSEL WALL PATHOLOGY
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Diagnosis of stenosis and occlusion in the carotid system.
Diagnosis of stenosis and occlusion in the carotid system.
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Carotid vessel wall pathologyplaque characterization.
Carotid vessel wall pathologyplaque characterization.
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Follow-up ofter carotid and vertebral artery stenting.
Follow-up ofter carotid and vertebral artery stenting.
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carotid occlusion, carotid stenosis, degree of stenosis, plaque characterization, stenting.
carotid occlusion, carotid stenosis, degree of stenosis, plaque characterization, stenting.
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MEASURING THE DEGREE OF CAROTID AND VERTEBRAL ARTERY STENOSIS
MEASURING THE DEGREE OF CAROTID AND VERTEBRAL ARTERY STENOSIS
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Following aspects will be presented: brief introduction on: risk factors / strokes due to internal carotid and vertebral artery
Following aspects will be presented: brief introduction on: risk factors / strokes due to internal carotid and vertebral artery
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Carotid atherosclerotic disease plays a large role in the etiology of stroke.
Carotid atherosclerotic disease plays a large role in the etiology of stroke. B-mode carotid ultrasound has been widely used to detect subclinical carotid atherosclerosis by quantifying carotid intima–media thickness (cIMT) and carotid plaque (CP). Both cIMT and CP have been accepted surrogate imaging biomarkers of subclinical atherosclerosis until recently when it became increasingly clear that cIMT and CP may be genetically and biologically distinct atherosclerotic phenotypes with evidence of heterogeneous etiology. In addition, carotid atherosclerotic plaque burden, defined as the
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B-mode carotid ultrasound has been widely used to detect subclinical carotid atherosclerosis by quantifying carotid intima–media thickness (cIMT) and carotid plaque (CP).
Carotid atherosclerotic disease plays a large role in the etiology of stroke. B-mode carotid ultrasound has been widely used to detect subclinical carotid atherosclerosis by quantifying carotid intima–media thickness (cIMT) and carotid plaque (CP). Both cIMT and CP have been accepted surrogate imaging biomarkers of subclinical atherosclerosis until recently when it became increasingly clear that cIMT and CP may be genetically and biologically distinct atherosclerotic phenotypes with evidence of heterogeneous etiology. In addition, carotid atherosclerotic plaque burden, defined as the
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In addition, carotid atherosclerotic plaque burden, defined as the
Carotid atherosclerotic disease plays a large role in the etiology of stroke. B-mode carotid ultrasound has been widely used to detect subclinical carotid atherosclerosis by quantifying carotid intima–media thickness (cIMT) and carotid plaque (CP). Both cIMT and CP have been accepted surrogate imaging biomarkers of subclinical atherosclerosis until recently when it became increasingly clear that cIMT and CP may be genetically and biologically distinct atherosclerotic phenotypes with evidence of heterogeneous etiology. In addition, carotid atherosclerotic plaque burden, defined as the
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carotid atherosclerosis, carotid IMT, carotid plaque.
carotid atherosclerosis, carotid IMT, carotid plaque.
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To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
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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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They will undergo to blood tests, ECG, brain CT, carotid US, TCCD or TCD.
This is a multicenter, interventional, controlled, randomized study. Patients older than 18 years will be enrolled if presenting with acute IS within 4.5 of symptom onset. They will undergo to blood tests, ECG, brain CT, carotid US, TCCD or TCD. Patients should have an occlusion of the middle cerebral artery documented by TCD, TCCD or CTA. Exclusion criteria will be: cerebral hemorrhage on CT and dramatic spontaneous neurologic improvement. Informed consent will be obtained from all patients or their next of kin. Patients will be randomized to receive either tPA alone or tPA
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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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Multisequence MRI is able to quantify carotid plaque components.
Symptomatic patients with microembolic signals (MES), assessed by TCD, have been shown to be at high risk for developing ipsilateral stroke. Whether MES positive asymptomatic patients also are at increased risk has not been clarified. The use of ultrasound contrast agents may be helpful in determining plaque surface and plaque neovascularization. Multisequence MRI is able to quantify carotid plaque components. The use of a contrast agent improves quantification of total plaque burden, and contrast between fibrous cap and lipid core. Dynamic contrast-enhanced MRI allows assessment of plaque neovascularization.
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Currently, there are few in vivo human studies on functional imaging of carotid plaques.
Currently, there are few in vivo human studies on functional imaging of carotid plaques. These initial studies have shown the potential of USPIO -enhanced MRI, 18F-FDG PET, IL2 scintigraphy, and low-density lipoprotein scintigraphy to identify inflammation, the potential of annexin A5 scintigraphy to identify cell death, and platelet scintigraphy to depict plaque thrombosis. Biomarkers have been shown to improve prediction independent of conventional risk factors. High sensitivity C-reactive protein (hs-CRP) and lipoprotein-phospholipase A2 (PLA2) are two such candidates
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Blood transfusions decrease stroke risk in patients deemed high risk by transcranial Doppler (TCD) by evidence of elevated intracranial internal carotid or middle cerebral artery velocity.
Stroke is an important complication of sickle cell disease. Approximately twenty-four percent of patients have a stroke by the age of 45 years. Blood transfusions decrease stroke risk in patients deemed high risk by transcranial Doppler (TCD) by evidence of elevated intracranial internal carotid or middle cerebral artery velocity. A follow-up of neurologically symptomatic and asymptomatic sickle cell patients increased other factors were significant in the identification of patients at risk that could include: velocity in the ophthalmic artery > that of the ipsilateral MCA, maximum velocity in the posterior cerebral (PCA), vertebral, or basilar arteries > maximum velocity in the MCA, turbulence, PCA visualized without the MCA. These news observations in TCD exams have been included in a practical way and will be discussed. TCD screening itself only stratifies stroke risk, but does not prevent stroke; stroke prevention depends on the implementation of chronic transfusion therapy. However, access to vascular laboratories appears to be a barrier to the implementation of this highly effective stroke prevention strategy, even among children with comprehensive health insurance. The difficulties in performing the examination, differences in imaging and nonimaging techniques, and interpretation guidelines are the main problems.
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Extracranial circulation (carotid and vertebral arteries) can be assessed by means of color Doppler flow imaging (CDFI).
CVDs affect millions of people worldwide, regardless of age, and represent a group of very important medical and social problems. Therefore, their prevention is becoming an imperative. Risk factors, such as age, gender, genetic factors, hypertension, diabetes mellitus, hypercholsterolemia, atrial fibrillation, orlifestyle,are causing changes of vessel walls which lead to CVD. Early changes of the blood vessel wall can be detected by early ultrasound screening methods which allow us to detect changes before the disease becomes clinically evident. Intracranial hemodynamics can be assessed by Transcranial Doppler Sonography (TCD), functional TCD with various functional tests, and TCD detection of cerebral emboli. Extracranial circulation (carotid and vertebral arteries) can be assessed by means of color Doppler flow imaging (CDFI). Novel ultrasound technology enables us non-invasive, bedside detection ofearly vascular changes such as arterial stiffness,
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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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Patients with carotid pathology, neuro-ophthalmic syndromes, neuropathy, myopathy, cervical tumors, calf muscle trauma and chronic spastic paralysis were studied by multimodal 2D/3D/4D sonography.
Patients with carotid pathology, neuro-ophthalmic syndromes, neuropathy, myopathy, cervical tumors, calf muscle trauma and chronic spastic paralysis were studied by multimodal 2D/3D/4D sonography. The results were compared to the findings from other diagnostic methods.
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Normal structures (carotid vessels, eye and muscles) have typical 2D/3D/4D images.
Normal structures (carotid vessels, eye and muscles) have typical 2D/3D/4D images. In presence of plaques, aneurysms or stents the 4D imaging gave additional information for their dimension, surface and structure. In contrast to the normal optic disc image (with a smooth and sharp contour without swelling), papilledema was presented as a hyperechoic prominence into the vitreous, retinal detachment
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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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COUNTERPRODUCTIVE RESULTS WITH THE USE OF AN EMBOLI PROTECTION DEVICE IN THE PREVENTION OF MICROEMBOLISMS DETECTED BY TRANSCRANIAL DOPPLER IN CAROTID STENT PLACEMENT
COUNTERPRODUCTIVE RESULTS WITH THE USE OF AN EMBOLI PROTECTION DEVICE IN THE PREVENTION OF MICROEMBOLISMS DETECTED BY TRANSCRANIAL DOPPLER IN CAROTID STENT PLACEMENT
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This study was conducted to determine if the use of an emboli protection device prevented distal embolisation in carotid stenting procedures.
This study was conducted to determine if the use of an emboli protection device prevented distal embolisation in carotid stenting procedures.
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We retrospectively analyzed data of 837 carotid stent procedures between December 1997 and January 2012.
We retrospectively analyzed data of 837 carotid stent procedures between December 1997 and January 2012. Cerebral embolisation was monitored using transcranial Doppler of the ipsilateral middle cerebral artery. Isolated microembolic signals and microembolic showers (cardiac cycles with too many embolisms to count separately) were counted.
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In >90% of the patients the carotid stenosis was >70%.
76% of the patients were male. 493 patients were asymptomatic. In >90% of the patients the carotid stenosis was >70%.
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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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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 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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The use of imaging investigation with mapping of WSS distribution in the carotid arteries in parallel with numerical analysis could help to demonstrate the risks of embolism or plaque rupture posed by particular plaque deposits.
The obtained distribution of the WSS around the bifurcation allows a prediction of the probable sites of stenosis growth. The use of imaging investigation with mapping of WSS distribution in the carotid arteries in parallel with numerical analysis could help to demonstrate the risks of embolism or plaque rupture posed by particular plaque deposits.
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blood flow 3D numerical analysis, carotid bifurcation, stenosis, wall shear stress.
blood flow 3D numerical analysis, carotid bifurcation, stenosis, wall shear stress.
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CAROTID PATHOLOGY IN CEREBRAL INFARCTIONS: EFFECTS OF BLOOD PRESSURE AND BLOOD VISCOSITY
CAROTID PATHOLOGY IN CEREBRAL INFARCTIONS: EFFECTS OF BLOOD PRESSURE AND BLOOD VISCOSITY
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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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Significant correlations of WBV with the carotid diameters predominating in the subgroups with MBP ≥ 100 were revealed.
The main RF in the patients` groups were hypertension and hyperlipidemia. Heterogenous atherosclerotic plaques, greater IMT and larger diameters of the CCA were measured. The SBP and WBV were significantly higher in the patients with CUCI and RF for CVD in comparison to controls. Lower systolic WSS, τ and higher T were established in the patients with CUCI. Significant correlations of WBV with the carotid diameters predominating in the subgroups with MBP ≥ 100 were revealed. The IMT correlated with WSS and τ.
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The study confirms the complex influence of the changes in WBV and blood pressure for the development of carotid atherosclerosis.
The study confirms the complex influence of the changes in WBV and blood pressure for the development of carotid atherosclerosis.
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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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MEASUREMENT OF CAROTID PLAQUE VOLUME WITH VOCALTMII TECHNIQUE BY 3-DIMENSIONAL ULTRASOUND
MEASUREMENT OF CAROTID PLAQUE VOLUME WITH VOCALTMII TECHNIQUE BY 3-DIMENSIONAL ULTRASOUND
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Measurement of carotid plaque volume and its progression are important tools for research and patient management.
Measurement of carotid plaque volume and its progression are important tools for research and patient management. In this study, we investigate the observer reproducibility in the measurement of plaque volume as determined with VOCALTMII technique by 3-dimensional (3D) ultrasound (US). We also investigate the effect of plaque size and position on measurement reproducibility.
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Intraand inter-observer variabilities were small for measurement of Carotid Plaque Volume with VOCALTMII technique by 3-Dimensional Ultrasound.
Intraand inter-observer variabilities were small for measurement of Carotid Plaque Volume with VOCALTMII technique by 3-Dimensional Ultrasound.
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carotid plaque volume, 3-dimensional ultrasound.
carotid plaque volume, 3-dimensional ultrasound.
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JUXTALUMINAL ECHOGENICITY AS A MARKER OF CAROTID PLAQUE INSTABILITY
JUXTALUMINAL ECHOGENICITY AS A MARKER OF CAROTID PLAQUE INSTABILITY
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Previous studies concluded that symptomatic carotid plaques are echolucent on ultrasound, whereas asymptomatic ones are echogenic.
Previous studies concluded that symptomatic carotid plaques are echolucent on ultrasound, whereas asymptomatic ones are echogenic. The aim of this study was to determine whether juxtaluminal plaque echogenicity (juxtaluminal 25% plaque area) constitutes a better discriminator of the symptomatic and asymptomatic status, as compared to global plaque echogenicity, in various degrees of stenosis.
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of 100 carotid plaques of more than 50% stenosis (86 patients,
of 100 carotid plaques of more than 50% stenosis (86 patients,
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Our results suggested that juxtaluminal 25% plaque echogenicity might have a more adequate ability over global plaque echogenicity in separating symptomatic and asymptomatic carotid plaques, only in the presence of significant stenosis.
Our results suggested that juxtaluminal 25% plaque echogenicity might have a more adequate ability over global plaque echogenicity in separating symptomatic and asymptomatic carotid plaques, only in the presence of significant stenosis. This position might be solidified in natural history studies of asymptomatic individuals with carotid plaques, having as an end point the development of stroke.
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This position might be solidified in natural history studies of asymptomatic individuals with carotid plaques, having as an end point the development of stroke.
Our results suggested that juxtaluminal 25% plaque echogenicity might have a more adequate ability over global plaque echogenicity in separating symptomatic and asymptomatic carotid plaques, only in the presence of significant stenosis. This position might be solidified in natural history studies of asymptomatic individuals with carotid plaques, having as an end point the development of stroke.
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carotid, plaque, stroke, ultrasound.
carotid, plaque, stroke, ultrasound.
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AFTERCARE MANAGEMENT BASED ON CAROTID DUPLEX SONOGRAPHY FOR PATIENTS WITH STENTED VESSELS REACHING THE END OF THE SCHEDULED THREE-DIMENSIONAL ENHANCED COMPUTED TOMOGRAPHY ANGIOGRAPHY FOLLOW-UP PERIODS
AFTERCARE MANAGEMENT BASED ON CAROTID DUPLEX SONOGRAPHY FOR PATIENTS WITH STENTED VESSELS REACHING THE END OF THE SCHEDULED THREE-DIMENSIONAL ENHANCED COMPUTED TOMOGRAPHY ANGIOGRAPHY FOLLOW-UP PERIODS
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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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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.
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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Among 70 carotid arteries that had undergone CAS at our institution, patients who were evaluated with a final 3D-CTA at two years of CAS and who subsequently underwent CDU were analyzed in this study.
Among 70 carotid arteries that had undergone CAS at our institution, patients who were evaluated with a final 3D-CTA at two years of CAS and who subsequently underwent CDU were analyzed in this study. A total of 22 vessels met the study’s inclusion criteria at the date of IRB approval (Study#1171).
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carotid artery stent, carotid duplex ultrasound, instent restenosis.
carotid artery stent, carotid duplex ultrasound, instent restenosis.
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DIAGNOSTIC ROLE OF COLOR-CODED DUPLEX SONOGRAPHY IN FOLLOWING-UP AFTER CAROTID ENDARTERECTOMY
DIAGNOSTIC ROLE OF COLOR-CODED DUPLEX SONOGRAPHY IN FOLLOWING-UP AFTER CAROTID ENDARTERECTOMY
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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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Color-coded Duplex ultrasound is a very accurate, noninvasive method that can be repeated at any time for grading carotid stenosis.
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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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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carotid endarterectomy, color-coded duplex ultrasound.
carotid endarterectomy, color-coded duplex ultrasound.
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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
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Color-coded duplex sonography was used to determine the extracranial blood flow velocity and the wall of carotid arteries.
We observed one patient 44 years old men, with multiple trauma to the neck and left leg, three months before the hospitalization, suffering from acute ischemic stroke. There were no risk factors for cerebrovascular disease. CT angiography was obtained by Spiral Scanner with reconstructions and interpretation by a radiologist. Color-coded duplex sonography was used to determine the extracranial blood flow velocity and the wall of carotid arteries.
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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.
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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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According to our study CT angiography of the carotid arteries and color-coded duplex sonography in cervical trauma may be used as an accurate decisive tools for a needed surgical intervention.
According to our study CT angiography of the carotid arteries and color-coded duplex sonography in cervical trauma may be used as an accurate decisive tools for a needed surgical intervention. More studies with larger number of patients and comparison with angiography and sonography are needed.
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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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< 50 cm/s of the distal internal carotid A.
< 50 cm/s of the distal internal carotid A. (ICA) were introduced as one of the main criteria to differentiate 70% vs 80% stenosis (NASCET definition) (NSRG consensus Stroke. 2012;43:916-921). There is only a sparse evidence for this threshold. Therefore we examined the PSV in patients with risk factors and arteriosclerosis (
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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.
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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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THE SIGNIFICANCE OF ASYMPTOMATIC CAROTID STENOSIS AND DYSLIPIDEMIA FOR TIA AND ISCHEMIC STROKES IN PATIENTS WITH MULTIPLE VASCULAR RISK FACTORS – POPULATION-BASED STUDY
THE SIGNIFICANCE OF ASYMPTOMATIC CAROTID STENOSIS AND DYSLIPIDEMIA FOR TIA AND ISCHEMIC STROKES IN PATIENTS WITH MULTIPLE VASCULAR RISK FACTORS – POPULATION-BASED STUDY
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The aim of this population-based study was to analyze the prevalence and correlations between the welldocumented vascular risk factors (VRF) – asymptomatic carotid stenosis (ACS) and dyslipidemia, and their significance for the incidence of cerebral ischemic events.
The aim of this population-based study was to analyze the prevalence and correlations between the welldocumented vascular risk factors (VRF) – asymptomatic carotid stenosis (ACS) and dyslipidemia, and their significance for the incidence of cerebral ischemic events.
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All participants underwent Duplex scanning of internal carotid arteries, structured questionnaires, a physical and neurological examination and a battery of laboratory tests.
A total of 500 randomly selected volunteers, 200 men and 300 women, without signs or symptoms of cerebrovascular disease, aged 50-79 years, were enrolled in the study in the University town of Stara Zagora. All participants underwent Duplex scanning of internal carotid arteries, structured questionnaires, a physical and neurological examination and a battery of laboratory tests.
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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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The morphology of the artery wall – the thickness of the intima media complex (IMT) of the common carotid arteries (CCA), the presence of atherosclerotic plaques, their magnitude, echogenicity and stabilityare determined by a color-coded duplex sonography of the main arteries of the head.
The participants of the study are divided into 2 groups: 12 patients suffering from OSAS and asymptomatic ischemic disturbances of cerebral circulation (mean age 50.7±8.4 years), and a control group of 10 participants (mean age 50.4±8.4 years), having risk factors (RF) for cerebrovascular diseases (CVD) and asymptomatic ischemic disturbances of cerebral circulation but not OSAS. The morphology of the artery wall – the thickness of the intima media complex (IMT) of the common carotid arteries (CCA), the presence of atherosclerotic plaques, their magnitude, echogenicity and stabilityare determined by a color-coded duplex sonography of the main arteries of the head.
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Additionally, the formation of plaques was more pronounced and carotid stenoses were more common in the OSAS patients.
In the OSAS group, CCA-IMT was significantly increased when compared with the non-OSAS patients and asymptomatic ischemic disturbances of cerebral circulation, having risk factors (RF) for CVD and asymptomatic ischemic disturbances of cerebral circulation, which correlated with night hypoxemia level. Additionally, the formation of plaques was more pronounced and carotid stenoses were more common in the OSAS patients.
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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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CAROTID BLOOD FLOW, CARDIAC FUNCTION AND RISK FACTORS FOR CEREBROVASCULAR DISEASE – CORRELATIVE CLINICAL AND ULTRASOUND STUDIES
CAROTID BLOOD FLOW, CARDIAC FUNCTION AND RISK FACTORS FOR CEREBROVASCULAR DISEASE – CORRELATIVE CLINICAL AND ULTRASOUND STUDIES
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To study the relationship between carotid pathology, cardiac function and risk factors (RF) for cerebrovascular diseases (CVDs).
To study the relationship between carotid pathology, cardiac function and risk factors (RF) for cerebrovascular diseases (CVDs).
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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.
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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The intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured by B-mode and M-mode scanning.
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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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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Mild ICA stenoses predominated in all groups while moderate and severe carotid stenoses were relatively rare.
Arterial hypertension was the most common RF in all patients. An asymmetrical hypertrophy of the left ventricle of the heart and a decrease of its contractility were found as a typical cardiac dysfunction in most of them. Mild ICA stenoses predominated in all groups while moderate and severe carotid stenoses were relatively rare. Symptomatic ICA thromboses were seen in 4.5% from the patients with CUI. IMT of the ICA on the side of infarction correlated positively with the arterial blood pressure (r=+0.60, p
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CORRELATION BETWEEN CAROTID ULTRASOUND AND EXERCISE STRESS TEST FOR ASSESSING THE SUBCLINICAL VASCULAR DISEASES IN PATIENTS WITH CARDIOVASCULAR DISEASE
CORRELATION BETWEEN CAROTID ULTRASOUND AND EXERCISE STRESS TEST FOR ASSESSING THE SUBCLINICAL VASCULAR DISEASES IN PATIENTS WITH CARDIOVASCULAR DISEASE
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To study the relationship between carotid pathology and exercise stress-test in patients with new onset symptoms for cardiovascular diseases (CVDs).
To study the relationship between carotid pathology and exercise stress-test in patients with new onset symptoms for cardiovascular diseases (CVDs).
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Color duplex sonography of both carotid arteries was performed in transverse and longitudinal planes and intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured.
Exercise stress-test (EST) and echocardiography were performed in 503 patients (mean age 54±17 years) with symptoms for CVD in two cardiological centers. Based on EST the patients were classified in three groups with positive, negative or questionable results. Color duplex sonography of both carotid arteries was performed in transverse and longitudinal planes and intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured. No modifiable (age and sex) and some modifiable (hypertension, diabetes, atrial fibrillation, dyslipidemia, carotid stenosis, obesity, hemorheological variables – leucocytes (Leuc) hemoglobin (Hb), hematocrit (Ht), FR for CVD were evaluated. The pts with positive EST were on PTCA undergone and pts with questionable EST the decision for PTCA was taken after severity of carotid pathology and clinical exam.
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No modifiable (age and sex) and some modifiable (hypertension, diabetes, atrial fibrillation, dyslipidemia, carotid stenosis, obesity, hemorheological variables – leucocytes (Leuc) hemoglobin (Hb), hematocrit (Ht), FR for CVD were evaluated.
Exercise stress-test (EST) and echocardiography were performed in 503 patients (mean age 54±17 years) with symptoms for CVD in two cardiological centers. Based on EST the patients were classified in three groups with positive, negative or questionable results. Color duplex sonography of both carotid arteries was performed in transverse and longitudinal planes and intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured. No modifiable (age and sex) and some modifiable (hypertension, diabetes, atrial fibrillation, dyslipidemia, carotid stenosis, obesity, hemorheological variables – leucocytes (Leuc) hemoglobin (Hb), hematocrit (Ht), FR for CVD were evaluated. The pts with positive EST were on PTCA undergone and pts with questionable EST the decision for PTCA was taken after severity of carotid pathology and clinical exam.
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The pts with positive EST were on PTCA undergone and pts with questionable EST the decision for PTCA was taken after severity of carotid pathology and clinical exam.
Exercise stress-test (EST) and echocardiography were performed in 503 patients (mean age 54±17 years) with symptoms for CVD in two cardiological centers. Based on EST the patients were classified in three groups with positive, negative or questionable results. Color duplex sonography of both carotid arteries was performed in transverse and longitudinal planes and intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured. No modifiable (age and sex) and some modifiable (hypertension, diabetes, atrial fibrillation, dyslipidemia, carotid stenosis, obesity, hemorheological variables – leucocytes (Leuc) hemoglobin (Hb), hematocrit (Ht), FR for CVD were evaluated. The pts with positive EST were on PTCA undergone and pts with questionable EST the decision for PTCA was taken after severity of carotid pathology and clinical exam.
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Mild ICA stenoses predominated in all groups while the moderate or severe carotid stenoses were relatively rare, especially with positive EST.
Arterial hypertension (AH) was the most common risk factor (RF) in 75% of all patients, dyslipidemia in 64% and diabetes mellitus in 28%. A symmetrical hypertrophy of the left ventricle and a decrease of its contractility was found as typical diastolic dysfunction. Mild ICA stenoses predominated in all groups while the moderate or severe carotid stenoses were relatively rare, especially with positive EST. ICA symptomatic thromboses were seen in 4,5% with positive EST. The IMT of the ICA correlated positively with the AH (r=+0.60,p0,05). Asymptomatic thrombosis are 67 (87%), and symptomatic-10 (13 %), p
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All the patients underwent ultrasound examination of the carotid arteries.The statistical analysis was performed with the Statistical Package for Social Sciences version 19.0 (SPSS) and Statgraphics plus 4.1 for
We examined 88 patients with sICH admitted to the Neurology clinic of UMHAT “Dr Georgi Stranski”, Pleven within 48 hours after the symptoms onset. The neurological deficit was assessed by the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS) on admission. Clinical outcome on the 30-th day of sICH was evaluated by the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS). Hemorrhage volume was measured on computed tomography (CT) by a simplified formula for the volume of an ellipsoid, (AxBxC)/2. All the patients underwent ultrasound examination of the carotid arteries.The statistical analysis was performed with the Statistical Package for Social Sciences version 19.0 (SPSS) and Statgraphics plus 4.1 for
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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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Carotid arterial stenosis becomes more common and important risk factor for stroke patients in Asian area.