Fluid-Structure Interaction Simulation of Carotid Plaque / 医用生物力学

Objective To propose a two-way fluid-structure interaction (FSI) method based on real patients with carotid artery stenosis, and analyze the hemodynamic parameters of carotid plaques with different types at the lesion as well as deformation and stress changes of the plaque itself. Methods Three-dimensional ( 3D) modeling was performed based on computed tomography angiography ( CTA) data of patients with moderate carotid artery stenosis. The carotid artery wall model and plaque model were separated, and transient fluid structure coupling calculation was performed. The situation from early stage of carotid atherosclerosis to formation of the plaque was simulated. The plaque types were divided into thickened plaques, lipid plaques, mixed plaques and calcified plaques, among which thickened plaques were regarded as non-plaque conditions for representing the thickening of vascular intima-media. The stenotic carotid arteries with different plaque types were compared and analyzed. Results The plaques with different types had little effect on the overall blood flow, but the wall shear stress of lipid plaques at the lesion was lower than that of other plaques. With thickened plaques as a control, concurrence of the plaque would inhibit artery expansion, and lipid plaques were the most obvious. Calcified plaques had the highest average plaque structure stress, while lipid plaques had the lowest average plaque structure stress. Conclusions The method proposed in this study can analyze fluid area and solid area at the same time. The results can contribute to better understanding the influence of different plaque types on carotid artery diseases.

Carotid endarterectomy combined with vertebral artery transposition treating vertebral artery V1 segment stenosis combined with ipsilateral carotid artery stenosis / 中国胸心血管外科临床杂志

@#Objective    To explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery. Methods    From June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed. Results    Finally 12 patients were enrolled, including 10 males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3% (P<0.001). The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0% (P<0.001). Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes. Conclusion    Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery  stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients' symptoms and has high promotion value.

Comparison between carotid ultrasound and digital subtraction angiography in the diagnosis of carotid artery stenosis in patients with cerebral infarction / Comparación entre la ecografía carotídea y la angiografía por sustracción digital en el diagnostic de estenosis de la arteria carótida en pacientes con infarto cerebral

SUMMARY: This study aimed to compare the clinical value of carotid ultrasound and digital subtraction angiography (DSA) for carotid artery stenosis in patients with cerebral infarction. Sixty patients with cerebral infarction underwent carotid ultrasound and DSA. Carotid artery stenosis, degree of stenosis (mild, moderate, severe, and occlusion), and carotid artery plaques were recorded and compared. Carotid stenosis rate was 96.67 % (58/60) and 91.67 % (55/60) on DSA and carotid ultrasound, respectively, and the difference was not statistically significant. Mild, moderate, and severe carotid artery stenosis and occlusion were diagnosed in 35, 28, 20, and 17 arteries, respectively, with DSA, and in 39, 25, 10, and 9 arteries, respectively, with carotid ultrasound. There was a statistically significant difference in the degree of carotid stenosis between the two methods (p<0.05). The kappa value of carotid plaques detected by carotid ultrasound and DSA was 0.776, indicating good consistency. Both carotid ultrasound and DSA are effective for screening carotid artery stenosis and carotid atherosclerotic plaques. While carotid ultrasound is faster and more convenient, DSA can more accurately detect the degree of stenosis and presence of occlusion. Thus, our recommendation is a combination of carotid ultrasound and DSA in clinical settings to improve the convenience and accuracy of diagnosis.

Este estudio tuvo como objetivo comparar el valor clínico de la ecografía carotídea y la angiografía por sustracción digital (DSA) para la estenosis de la arteria carótida en pacientes con infarto cerebral. Sesenta pacientes con infarto cerebral fueron sometidos a ecografía carotídea y DSA. Se registraron y compararon la estenosis de la arteria carótida, el grado de estenosis (leve, moderada, grave y oclusión) y las placas de la arteria carótida. La tasa de estenosis carotídea fue del 96,67 % (58/60) y del 91,67 % (55/60) en DSA y ecografía carotídea, respectivamente, y la diferencia no fue estadísticamente significativa. Se diagnosticaron estenosis y oclusión de la arteria carótida leve, moderada y grave en 35, 28, 20 y 17 arterias, respectivamente, con DSA, y en 39, 25, 10 y 9 arterias, respectivamente, con ecografía carotídea. Hubo una diferencia estadísticamente significativa en el grado de estenosis carotídea entre los dos métodos (p<0,05). El valor kappa de las placas carotídeas detectadas por ecografía carotídea y DSA fue de 0,776, lo que indica una buena consistencia. Tanto la ecografía carotídea como la DSA son eficaces para detectar la estenosis de la arteria carótida y las placas ateroscleróticas carotídeas. Si bien la ecografía carotídea es más rápida y conveniente, la DSA puede detectar con mayor precisión el grado de estenosis y la presencia de oclusión. Por lo tanto, nuestra recomendación es una combinación de ecografía carotídea y DSA en entornos clínicos para mejorar la conveniencia y precisión del diagnóstico.

Research progress of miRNA in ischemic stroke-related risk factors / 国际生物医学工程杂志

Stroke is an important cause of global population death and long-term disability. The incidence, disability, and mortality of ischemic stroke are high, which brings a heavy social and economic burden to society and families. MiRNA is involved in a variety of biological processes, such as proliferation, differentiation, metabolism, synaptic formation, angiogenesis, apoptosis, and so on. MiRNA plays an indispensable regulatory role in the risk factors of a variety of cerebrovascular diseases. In particular, some circulating miRNA have significant changes in the peripheral blood of patients with acute stroke, which may become an important biomarker for rapid diagnosis and treatment of stroke. Intervention on stroke risk factors provides an important way for the prevention of cerebrovascular disease. In this review, the studies on the expression and mechanism of miRNA related to common stroke risk factors, including hypertension, diabetes, coronary heart disease, atherosclerosis, carotid stenosis, depression, age, and stimulating hormones, were summarized to provide new ideas for disease prevention and diagnosis.

Clinical prognosis of staged coronary artery bypass grafting and carotid stent implantation in patients with preoperative stroke / 中国胸心血管外科临床杂志

@#Objective    To analyze the short-term and long-term efficacy of staged coronary artery bypass grafting (CABG) and carotid artery stenting (CAS) compared with CABG alone in patients with coronary heart disease with preoperative history of stroke and carotid stenosis. Methods    We reviewed the clinical data of 55 patients (48 males, 7 females, aged 67.62±7.06 years) with coronary heart disease and carotid stenosis who had a history of stroke and underwent CABG+CAS or CABG alone in Zhongshan Hospital from 2008 to 2017. There were 13 patients in the staged CABG+CAS group and 42 patients in the CABG alone group. The differences in the incidence of perioperative adverse events and long-term survival between the two groups were studied, and univariate and multivariate analyses were carried out to determine the independent risk factors of long-term adverse events. Results     Perioperative adverse events occurred in 1 (7.69%) patient of the staged CABG+CAS group, and 4 (9.52%) patients of the CABG alone group (P=0.84). During the follow-up period (67.84±37.99 months), the long-term survival rate of patients in the staged CABG+CAS group was significantly higher than that in the CABG alone group (P=0.02). The risk of long-term adverse events in the staged CABG+CAS group was 0.22 times higher than that in the CABG alone group (95%CI 0.05-0.92, P=0.04). Conclusion    Staged CABG+CAS can significantly improve the long-term survival prognosis without increasing the perioperative risk. It is a safe and effective treatment, but prospective randomized studies are still needed to further confirm this finding.

Tongdu Tiaoshen acupuncture combined with carotid endarterectomy for carotid artery stenosis: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect of Tongdu Tiaoshen acupuncture combined with carotid endarterectomy (CEA) and simple CEA on carotid artery stenosis (CAS).@*METHODS@#A total of 60 patients with CAS were randomized into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 3 cases dropped off). Both groups were treated with eversion CEA (eCEA). The conventional treatment of internal medicine and antiplatelet drugs i.e. aspirin enteric-coated tablet and clopidogrel hydrogen sulfate tablet were given in the control group for 4 weeks. On the basis of the treatment in the control group, Tongdu Tiaoshen acupuncture was applied at Baihui (GV 20), Fengfu (GV 16), Yamen (GV 15), cervical Jiaji (EX-B 2), Dazhui (GV 14), etc. in the observation group, once a day, 1-day rest was taken after 6-day treatment, 2 weeks were as one course and totally 2 courses were required. The carotid intima-media thickness (IMT) before and after treatment was detected by ultrasonic diagnostic apparatus, the TCM symptom score was compared before and after treatment and in the follow-up of 6 months after treatment, the clinical efficacy was evaluated in the two groups. The occurrence of endpoints within 1 year was recorded.@*RESULTS@#After treatment, the carotid IMT and TCM symptom scores were decreased compared before treatment in the both groups (P<0.05), and the changes in the observation group were greater than the control group (P<0.05). In the follow-up, the TCM symptom scores were decreased compared before treatment in the both groups (P<0.05). The total effective rate was 96.4% (27/28) in the observation group, which was superior to 88.9% (24/27) in the control group (P<0.05). There were 1 case of stoke in the observation group and 2 cases of stroke in the control group within 1-year follow-up, and there was no significant difference in the number of endpoints between the two groups within 1 year (P>0.05).@*CONCLUSION@#Tongdu Tiaoshen acupuncture combined with CEA can effectively reduce the IMT in patients with CAS, improve the TCM symptom score, the efficacy is superior to simple CEA treatment.

The Effect from Elastic Modulus of Vessels on Fractional Flow Reserve of Carotid Artery Stenosis / 医用生物力学

Objective To explore the feasibility of applying fractional flow reserve (FFR) into the assessment of carotid stenosis, and analyze the effects from elastic modulus of vessel wall on hemodynamic parameters of carotid artery stenosis model and FFR calculation results. Methods The standard models of carotid bifurcation and stenosis models with different stenosis rates were established by computer-aided design software. Assuming that the vessel wall was linear elastic material and the blood was incompressible Newtonian fluid, the fluid-structure coupling simulation of blood flow in carotid artery stenosis model under the pulsating flow was carried out by finite element analysis, and the relevant hemodynamic parameters were obtained, and the corresponding FFR was calculated. Results When the elastic modulus was fixed, the FFR for narrow part of the model decreased gradually with the increase of the stenosis rate, and the relative difference between the FFR of elastic wall and rigid wall increased with the increase of the stenosis rate; when the stenosis rate was fixed at 70%, the FFR decreased gradually with the increase of elastic modulus. Conclusions The effect of vascular wall elasticity should be considered in the process of functional assessment on carotid stenosis with FFR; the larger stenosis rate will lead to the greater influence from elastic modulus of vessel wall on FFR.

Cerebral Autoregulation in Patients with Unilateral Carotid Artery Stenosis / 中国医学科学院学报

To investigate cerebral autoregulation(CA)in patients with severe unilateral carotid artery stenosis by near infrared spectroscopy. Thirty patients who underwent general anesthesia in our hospital from January 2015 to February 2017 were enrolled in this study.The stenosis group included 15 patients with severe unilateral internal carotid artery stenosis,and the control group included 15 patients without carotid artery stenosis.Both groups were matched in sex and age.Cerebral tissue oxygenation index(TOI)and mean arterial pressure were recorded continuously under stable general anesthesia.The Pearson correlation coefficient()was calculated to judge the CA status. TOI was not significantly different between the stenosis side and the non-stenosis side in the stenosis group(66.52±6.50 65.23±4.50;=0.93, =0.368)or between the stenosis side in the stenosis group and the stenosis side in the control group(66.52±6.50 64.22±3.87;=1.18, =0.248).The values of stenosis side and non-stenosis side in the stenosis group were 0.36±0.12 and 0.17±0.11,respectively,and the values of the stenosis side in the stenosis group and the stenosis side of the control group were 0.36±0.12 and 0.13±0.08,respectively.In the stenosis group,5 patients had transient ischemic attack and 2 patients had a history of stroke within 3 months before operation.When an value of 0.342 was used as the judgment point of CA abnormality,the sensitivity and specificity were 0.625 and 0.909,respectively. Within the range of normal blood pressure fluctuation,cerebral blood flow is linked to blood pressure at the stenosis side in patients with severe unilateral carotid artery stenosis.

Role of Carotid Artery Stenting in Prevention of Stroke for Asymptomatic Carotid Stenosis: Bayesian Cross-Design and Network Meta-Analyses

BACKGROUND AND OBJECTIVES: There is insufficient evidence regarding the optimal treatment for asymptomatic carotid stenosis.METHODS: Bayesian cross-design and network meta-analyses were performed to compare the safety and efficacy among carotid artery stenting (CAS), carotid endarterectomy (CEA), and medical treatment (MT). We identified 18 studies (4 randomized controlled trials [RCTs] and 14 nonrandomized, comparative studies [NRCSs]) comparing CAS with CEA, and 4 RCTs comparing CEA with MT from MEDLINE, Cochrane Library, and Embase databases.RESULTS: The risk for periprocedural stroke tended to increase in CAS, compared to CEA (odds ratio [OR], 1.86; 95% credible interval [CrI], 0.62–4.54). However, estimates for periprocedural myocardial infarction (MI) were quite heterogeneous in RCTs and NRCSs. Despite a trend of decreased risk with CAS in RCTs (OR, 0.70; 95% CrI, 0.27–1.24), the risk was similar in NRCSs (OR, 1.02; 95% CrI, 0.87–1.18). In indirect comparisons of MT and CAS, MT showed a tendency to have a higher risk for the composite of periprocedural death, stroke, MI, or nonperiprocedural ipsilateral stroke (OR, 1.30; 95% CrI, 0.74–2.73). Analyses of study characteristics showed that CEA-versus-MT studies took place about 10-year earlier than CEA-versus-CAS studies.CONCLUSIONS: A similar risk for periprocedural MI between CEA and CAS in NRCSs suggested that concerns about periprocedural MI accompanied by CEA might not matter in real-world practice when preoperative evaluation and management are working. Maybe the benefits of CAS over MT have been overestimated considering advances in medical therapy within10-year gap between CEA-versus-MT and CEA-versus-CAS studies.

Changes of choroidal thickness and vascular index in patients with internal carotid artery stenosis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the macular subfoveal choroidal thickness(SFCT)and choroidal vascular index(CVI)between the patients with internal carotid artery stenosis(ICAS)but without ocular symptoms and controlled healthy people.<p>METHODS: This is a retrospective comparative study. Forty eyes(grouped as ICAS group)from 40 ICAS patients and 40 eyes(grouped as control group)from 20 matched healthy people were included in this study. All included eyes were received OCT scanning to measure the SFCT. And OCT images were binarized with Image J software to measure CVI values. These values were compared between the two groups.<p>RESULTS: SFCT of ICAS group and control group were 208±66μm and 234±77μm respectively, with no statistical difference between the two groups(<i>P</i>=0.27). The CVI of ICAS group(64.5%±1.7%)was significantly lower compared with that of control group's(66.1%±2.7%)(<i>P</i>=0.04). The area under the curve(AUC)of CVI in the ROC curve was 0.76 <i>(P</i>=0.005), while the AUC of SFCT was 0.58(<i>P</i>=0.41). <p>CONCLUSION: It is suggested that compared with the detection of SFCT, the detection of CVI is more helpful to the early discovering of the changes of choroidal circulation in this kind of patients.

Analysis of diagnosis and treatment for acute thromboembolism occlusion caused by severe internal carotid artery stenosis: A case report / 中国脑血管病杂志

Ultrasonography revealed that a ease of acute internal carotid artery (ICA) occlusion caused by acute thrombosis due to severe stenosis and intraplaque hemorrhage. The patient is male and 81 years old with blurred vision in the right eye. Carotid artery ultrasound ( CDU) showed that severe stenosis of right proximal ICA, the discontinuous fibrous cap at the top of atherosclerotic plaques, and intraplaque hemorrhage. Besides, the blood flow of the right distal ICA disappeared suddenly during the examination. Therefore, ICA occlusion caused by acute thrombosis was detected by CDU. The patient was followed-up day by day using ultrasonography and treated with dual antiplatelet therapy. Three days later, CDU showed that the right ICA was re-open but still accompanied by severe stenosis. The patient was treated by carotid endarterectomy for revascularization after six days of admission. According to this process of diagnosis and treatment, carotid ultrasound provides an important clinical role for the diagnosis, treatment, and follow-up of acute thrombosis with carotid artery stenosis.

A study on prevalence of carotid artery stenosis in acute ischaemic stroke patients in Amalapuram, Andhra Pradesh, India

Background: Extra cranial carotid disease due to arteriosclerosis is usually associated with hypercholesterolemia and hyperlipidemia. Extra cranial carotid stenosis has been found to be less prevalent in black American and in Egyptians while intracranial disease is far more common Various methods includes transcranial doppler (TCD) ultrasonography, cerebral angiography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA).Methods: All patients with ischaemic stroke of acute onset admitted in the medical wards of Konaseema institute of medical sciences between June 2018 and January 2019 were included in the study. All patients were subjected to CT scan brain study and colour Doppler study of extra cranial carotid arteries and vertebral arteries. Systolic and diastolic velocity of blood flow, carotid intimal medial thickness, presence of athermanous plaque and thrombus was looked for and then the percentage of stenosis of the affected arteries was calculated.Results: In the present study 0ut of 23 patients with carotid stenosis 9 patients had mild carotid stenosis, 8 patients had moderate stenosis and 6 patients had severe stenosis. Out of 23 patients with carotid stenosis the 11 patients have stenosis in the right carotid and 12 patients had stenosis in the left side. The site of stenosis is ICA in 17 patients and CCA in 6 patients.Conclusions: In present study every patient with carotid artery stenosis had one or the other risk factor for carotid atherosclerosis. In other words, there was no patient with carotid artery stenosis, without any risk factor in present study. Hence asymptomatic patients with these risk factors should be screened for carotid stenosis to prevent stroke.

Association between Serum Alkaline Phosphatase and Carotid Atherosclerosis in a Chinese Population: A Community-based Cross-sectional Study / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to investigate the relationship between alkaline phosphatase (ALP) and common carotid intima media thickness (IMT), carotid plaque, and extracranial carotid artery stenosis (ECAS).@*METHODS@#A total of 3,237 participants aged ⪖ 40 years were recruited from Jidong community in 2013-2014. Participants were divided into five quintile groups based on their serum ALP levels. Carotid atherosclerosis was assessed using ultrasound. Abnormal IMT, carotid plaque, and ECAS were defined as IMT > 0.9 mm, IMT > 1.5 mm, and ⪖ 50% stenosis in at least one extracranial carotid artery, respectively.@*RESULTS@#Common carotid IMT values and the prevalence of carotid plaque increased across serum ALP quintiles. Higher ALP quintiles were correlated with an increased risk of abnormal IMT [fourth quintile: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.13-2.82, P = 0.0135; fifth quintile: OR = 1.82, 95% CI: 1.15-2.87, P = 0.0110] and ECAS compared to the lowest quintile (fifth quintile: OR = 1.47, 95% CI: 1.09-1.97, P = 0.0106). The association between ALP and prevalence of carotid plaque became insignificant after adjustment for confounders.@*CONCLUSION@#Serum ALP levels were independently associated with abnormal common carotid IMT and ECAS. These conclusions need to be further corroborated in future prospective cohort studies.

Asymptomatic Bilateral Internal Carotid Artery Occlusion with Ring Finger Protein 213 Gene Polymorphism

No abstract available.

Coronary Artery Bypass Grafting Combined with Total Arch Replacement for Severe Coronary Disease Complicated with Multiple Arch Vessel Stenosis / 日本心臓血管外科学会雑誌

A 72-year-old man was referred to our hospital for coronary artery bypass grafting (CABG) due to asymptomatic severe coronary artery disease. A preoperative CT revealed 99% stenosis of the aberrant right subclavian artery, 90% stenosis at the origin of right common carotid artery, and 75% stenosis at the origin of the left subclavian artery. As he had high risk of a perioperative cerebral ischemic event for CABG, it was difficult to perform a carotid artery stent. We performed a total aortic arch replacement combined with CABG. The postoperative course was uneventful, and he was discharged on the 12th postoperative day.

Hybrid operation for stylocarotid artery syndrome: A case report and literature review / 中国脑血管病杂志

Stylocarotid artery syndrome is a rare condition resulted from compression of the internal or external carotid artery by the styloid process of temporal bone. Patient was presented with left limbs weakness, then compression of the right carotid artery by elongated styloid process was found. He was treated by styloid process truncation with hybrid technique. After operation, compression of carotid artery was relieved. No arterial perforation or dissection happened. This case demonstrated that treatment of carotid artery stylocarotid syndrome with hybrid operation that combines endovascular techniques, radiological imaging and surgical resection can be minimally invasive, safe and effective.

A feasibility study of fractional flow reserve assessment for carotid artery stenosis interventional therapy / 中国脑血管病杂志

Objective This study aimed to evaluate the feasibility and safety of interventional therapy for carotid atherosclerotic stenosis using fractional flow reserve (FFR). Methods All 30 consecutive patients with symptomatic severe carotid artery stenosis (lumen stenosis > 70%) and stent implantation were retrospectively recruited. Among them, 25 patients were with cerebral infarction and 5 patients with transient ischemic attack. The blood flow of carotid atherosclerotic stenosis was measured by pressure wire. The stenosis rate,FFR (distal/proximal pressure ratio) and translesional pressure gradient (proximal pressure-distal pressure) were measured before and after intervention. Correlation between stenosis rate and FFR or translesional pressure gradient was analyzed by the Pearson correlation test. Results All 30 patients had pressure wire successfully pass the stenosis, and FFR and translesional pressure gradients were measured. Before intervention, the mean stenosis rate, FFR and translesional pressure gradients were (84 ± 6) %,0. 67 ±0. 15 and (32 ± 7) mmHg. Corresponding post-intervention measurements were (30 ± 10)%,0. 82 ± 0. 11 and (18 ± 9) mmHg respectively. The post-intervention vascular stenosis rate and translesional pressure gradient were significantly lower than those before intervention with statistically significant differences (all P <0. 01). Before intervention,vascular stenosis rate was significantly correlated with FFR and translesional pressure gradient (r was - 0 . 8 6 and 0.96, respectively, all P < 0. 01). No intracerebral hemorrhage and vascular dissection occurred by vascular puncture rupture in patients during FFR and translesional pressure gradient measurement by pressure wire. Conclusion Application of FFR is feasible and safe to evaluate the interventional treatment of carotid atherosclerosis stenosis,but more studies are needed for further verification.

Correlation between intracranial carotid artery stenosis and ocular arterial blood flow and retinal vascular morphology / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the correlation between intracranial internal carotid artery stenosis and ocular arterial blood flow and retinal vascular morphology.<p>METHODS: Totally, 251 patients admitted to our hospital due to suspected cerebral ischemia from January 2017 to June 2018 were selected. According to the degree of internal carotid artery stenosis, the patients were divided into non-stenosis group(39 cases), mild stenosis group(80 cases), moderate stenosis group(83 cases), and severe stenosis group(49 cases). The ocular hemodynamic indexes and retinal vascular diameters of the four groups were compared. The correlation and diagnostic value were analyzed between eye blood flow parameters and severe intracranial internal carotid artery stenosis.<p>RESULTS: In the severe stenosis group, the peak systolic velocity(PSV)and diastolic peak velocity(EDV)of ophthalmic artery(OA), central retinal artery(CRA)and posterior ciliary artery(PCA)were significantly lower than those of the other three groups. In the blood flow parameters of OA, CRA and PCA, PSV and EDV were significantly negatively correlated with severe intracranial internal carotid artery stenosis. The optimal diagnostic thresholds of PCA PSV and PCA EDV for severe intracranial internal carotid artery stenosis were 11.26cm/s and 5.21cm/s, respectively.<p>CONCLUSION: Intracranial internal carotid artery stenosis was significantly negatively correlated with PSV and EDV in the ocular arteries. PCA PSV and PCA EDV were most sensitive to intracranial internal carotid artery stenosis under the same index.

Incremental diagnostic value of neck vessel wall imaging technique with T1?weighted three?dimensional variable?flip?angle turbo spin?echo before revascularization in patients with carotid atherosclerotic disease / 中华放射学杂志

Objective To determine the feasibility of neck vessel wall imaging technology with three?dimensional variable?flip?angle turbo spin?echo (3D T1w?SPACE) for the detection of carotid atherosclerotic disease before revascularization. Methods Thirty?one patients who underwent carotid endarterectomy (CEA) and fifty?three patients who underwent carotid stenting (CAS) were enrolled prospectively. Neck vessel wall imaging examination were performed in all patients whilecarotid artery DSA were performed in all CAS patients. Quantitative measurements including stenosis, lesion length, and the presence or absence of plaque ulceration obtained with 3D T1w?SPACE and DSA were independently determined. And images of the 3D T1w?SPACE were compared with corresponding histology to identify major plaque components including intraplaque hemorrhage (IPH), lipid rich necrotic core (LRNC), and calcification (CA). The consistency rate, sensitivity, specificity, positive predictive value and negative predictive value were used to assess diagnostic value. Bland?Altman plots, intraclass correlation coefficient (ICC), and Cohen Kappa were determined. Results DSA was served as the reference standard. There was an excellent correlation between 3D T1w?SPACE and DSA images in measuring stenosis (r=0.984, P<0.01) and luminal stenosis [ICC=0.98 (95% confidence interval: 0.96-0.99)]. Bland?Altman plots showed that the two examinations were in good consistency in evaluating the extent of stenosis. Sensitivity (89.5%) and specificity (95.1%) was high in 3D T1w?SPACE images compared to DSA for the detection of ulcers. The consistency rate between 3D T1w?SPACE images and histological results for IPH, LRNC and CA detection were 85.7%, 82.1% and 92.9%, respectively. Sensitivity and specificity were 90.0% and 75.0% for IPH;83.3% and 80.0% for LRNC; 91.3% and 100.0% for CA respectively. However, lesion length measurements by using 3D T1w?SPACE were longer than those measured by using DSA (P<0.01).Conclusion Neck vessel wall imaging technology with 3D T1w?SPACE is a noninvasive and accurate technique for the diagnosis of carotid artery atherosclerotic disease before revascularization.

Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature

OBJECTIVE: To compare peri-operative any symptomatic stroke after carotid angioplasty and stenting (CAS), based on the application or absence of a cerebral protection device.METHODS: A systematic literature review using PubMed, Embase, and the Cochrane Central was done across an online data base from January 1995 to October 2016. Procedures which were performed due to carotid dissection or aneurysm, procedures using covered stents or conducted in an emergency, were excluded. The primary endpoint was perioperative any symptomatic stroke within 30 days after the procedure. A fixed effect model was used in cases of heterogeneity less than 50%.RESULTS: In the 25 articles included in this study, the number of stroke events was 326 (2.0%) in protected CAS and 142 (3.4%) in unprotected CAS. The use of cerebral protection device significantly decreased stroke after CAS (odds ratio [OR] 0.633, 95% confidence interval [CI] 0.479–0.837, p=0.001). In the publication bias analysis, Egger’s regression test disclosed that the intercept was -0.317 (95% CI -1.015–0.382, p=0.358). Regarding symptomatic patients (four studies, 539 CAS procedures), the number of stroke was six (1.7%) in protected CAS and 11 (5.7%) in unprotected CAS. The protective effect against stroke events by cerebral protection device did not have a statistical significance (OR 0.455, 95% CI 0.151–1.366, p=0.160).CONCLUSION: The use of protection device significantly decreased stroke after CAS. However, its efficacy was not demonstrated in symptomatic patients. Routine use of protection device during CAS should be critically assessed before mandatory use.