DOCSLIB.ORG

Transoral Ultrasonographic Evaluation of Carotid Flow in Predicting Cerebral Hemodynamics After Carotid Endarterectomy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Transoral Ultrasonographic Evaluation of Carotid Flow in Predicting Cerebral Hemodynamics After Carotid Endarterectomy Transoral Ultrasonographic Evaluation of Carotid Flow in Predicting Cerebral Hemodynamics after ORIGINAL RESEARCH Carotid Endarterectomy M. Kamouchi PURPOSE: We investigated whether measurement of blood flow in the extracranial distal internal K. Kishikawa carotid artery (ICA) by transoral carotid ultrasonography (TOCU) can predict the cerebral hemodynam- ics and the hemodynamic effect of carotid endarterectomy (CEA) in patients with unilateral carotid Y. Okada stenosis. T. Inoue K. Toyoda METHODS: Forty-nine patients with unilateral ICA stenosis who underwent CEA were studied. Preop- erative blood flow in the poststenotic portion of the extracranial ICA was studied by using TOCU. S. Ibayashi Regional cerebral blood flow (rCBF) and vasoreactivity to acetazolamide (VR) in the territory of the M. Iida middle cerebral artery were investigated by using single-photon emission CT (SPECT) before, 2 weeks after, and 3 months after CEA. RESULTS: Doppler flow velocities in the extracranial distal ICA measured transorally by TOCU corre- lated with baseline as well as postacetazolamide rCBF in the ipsilateral side (regression analysis, P Ͻ .05). Diameter and blood flow volume in the extracranial distal ICA were associated with ipsilateral postacetazolamide rCBF and VR (regression analysis, P Ͻ .05). When the patients were divided into 2 groups according to the ICA volume flow distal to a carotid stenosis, group I Ͻ 3.5 mL/s and group II Ͼ 3.5 mL/s, ipsilateral postacetazolamide rCBF in group I was significantly lower than that in group II (P ϭ .008). Ipsilateral postacetazolamide rCBF (analysis of variance [ANOVA], P ϭ .02) and VR (ANOVA, P ϭ .03) significantly improved after CEA for 3 months in group I but not in group II. CONCLUSION: TOCU can detect the decrease in poststenotic flow of the distal extracranial ICA that is indicative of impaired intracranial hemodynamics and predictive for improvement of cerebral blood flow after CEA in patients with unilateral carotid stenosis. HEAD & NECK arotid endarterectomy (CEA) is beneficial for the preven- sonation, intrastenotic flow increase, and turbulent flow. A Ction of ischemic stroke in symptomatic patients.1,2 The recent study reported that poststenotic blood flow of the distal main mechanism for the prevention of an ischemic event is ICA can be measured transorally by using transoral carotid probably removal of the embolic source.3 However, the elim- ultrasonography (TOCU) and is potentially indicative of the ination of cerebral hypoperfusion may additionally play a role development of intracranial collaterals and asymmetry of ce- in the prevention, because a decrease in cerebral perfusion is rebral blood flow (CBF) determined by single-photon emis- ORIGINAL RESEARCH associated with the risk of ischemic stroke in patients with sion CT (SPECT).21 In the present study, we measured the 4-7 carotid stenosis. Thus, the evaluation of cerebral perfusion poststenotic blood flow in the extracranial distal ICA by using would be helpful also to estimate the additional benefit for the TOCU and investigated its relation to cerebral hemodynamics prevention of an ischemic event. and the hemodynamic change after CEA. The aims of the The hemodynamic change related to high-grade internal present study were to elucidate whether preoperative transoral carotid artery (ICA) stenosis remains a matter of controver- measurement of poststenotic blood flow can assess cerebral sy.5,7-11 Moreover, data concerning the hemodynamic benefit 8,12-20 hemodynamics and predict the long-term effects of CEA on of CEA are conflicting in the short and long term. These CBF in patients with carotid stenosis. discrepancies can be explained in part by the use of different measurement methods and different time periods after the surgery. More importantly, the degree of reduction in postste- Subjects and Methods notic blood flow in addition to the presence of collateral path- Patients ways seems to cause the difference. However, little is known The subjects were recruited from patients who had unilateral carotid concerning the relationship between poststenotic flow and ce- stenosis in the origin of the ICA and underwent CEA at the National rebral perfusion. Kyushu Medical Center. Forty-nine consecutive patients who had (1) Measurement of the poststenotic portion of the ICA with no stenosis greater than 50% in the carotid or vertebrobasilar system, duplex carotid ultrasonography by using a conventional ap- as determined by the method used in the North American Symptom- proach is sometimes inaccurate because of inadequate in- atic Carotid Endarterectomy Trial (NASCET), other than that of the Received July 17, 2005; accepted after revision October 13. unilateral ICA origin, and (2) no history of infarct involving cortical From the Department of Cerebrovascular Disease (M.K., K.K., Y.O., K.T.) and Neurosurgery region or lacunar infarct larger than 1.5 cm in middle cerebral artery (T.I.), Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical (MCA) territory revealed by MR imaging were selected for further Center; and Department of Medicine and Clinical Science (M.K., S.I., M.I.), Graduate School analyses. Twelve patients were asymptomatic. All subjects gave in- of Medical Sciences, Kyushu University. formed consent to be examined by various neuroradiologic tests. All Address correspondence to Masahiro Kamouchi, MD, PhD, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, patients had a preoperative cranial CT and/or MR imaging and cere- Higashi-ku, Fukuoka 812-8582, Japan. bral angiography. AJNR Am J Neuroradiol 27:1295–99 ͉ Jun-Jul 2006 ͉ www.ajnr.org 1295 Ultrasonography Table 1: Correlation between poststenotic parameters of Conventional carotid duplex ultrasonography was done with a color- extracranial distal internal carotid artery and ipsilateral cerebral coded duplex ultrasonographic device (Hitachi-ATL HDI 5000, To- hemodynamics kyo, Japan). A 5- to 10-MHz sonography beam was used for conven- Post- tional carotid imaging. The lumen area at the point of greatest Baseline acetazolamide stenosis was measured, and the percentage stenosis was calculated by rCBF (mL/ rCBF (mL/ using the cross-sectional area. Although carotid stenosis was also con- 100 g/min) 100 g/min) VR firmed by flow velocity measurements, the cross-sectional area was rPr P rP adopted for grading the severity of stenosis. PSV (cm/s) 0.32 .02 0.39 .006 NS TOCU was performed by using the 5- to 9-MHz convex array EDV (cm/s) 0.38 .006 0.42 .003 NS transducer. The methods for TOCU have been described previous- TMV (cm/s) 0.38 .007 0.44 .002 NS ly.22,23 In brief, the tip of the probe was placed on the posterior pha- Diameter (mm) NS 0.33 .02 0.40 .005 Blood flow volume (mL/s) NS 0.48 .0006 0.39 .006 ryngeal wall of the patient in a supine position. The properties of the Note:—rCBF indicates regional cerebral blood flow; VR, vasoreactivity to acetazolamide; extracranial distal ICA could be evaluated by the B-mode as well as by PSV, peak systolic velocity; EDV, end diastolic velocity; TMV, time-averaged mean velocity; color flow imaging. The peak-systolic (PSV), end-diastolic (EDV), NS, not significant. and time-averaged mean velocities (TMV) were also measured. The diameter and Doppler flow of the ICA was measured at the point Results nearest the surface of the posterior pharyngeal wall.22-24 Measure- The average age of the subjects (39 men, 10 women) was ment of the diameter and Doppler flow was performed 3 times, and 69.5 Ϯ 6.8 (mean Ϯ SD) years old. The average degree of the median value was adopted. Blood flow was estimated by the for- stenosis evaluated by conventional ultrasonography or the mula diameter2 ϫ ␲ϫ TMV/4 (ml/s). An experienced examiner as- NASCET method was 89 Ϯ 10% (45%–99%) or 77 Ϯ 14% sessed all measurements blindly. (44%–99%), respectively. The correlation between Doppler flow parameters or the diameter of the poststenotic distal ICA Angiographic Assessment and cerebral hemodynamics was investigated with regression Conventional selective angiography was performed before surgery, analysis. Poststenotic flow velocities, including PSV (65.1 Ϯ and the findings were reviewed by a neuroradiologist blinded to all 26.6 cm/s, mean Ϯ SD), EDV (24.3 Ϯ 9.5 cm/s), and TMV information. The degree of carotid stenosis on angiography was as- (37.3 Ϯ 14.4 cm/s) correlated with ipsilateral baseline rCBF sessed by the NASCET method.2,25 (40.7 Ϯ 5.3 mL/100 g/min) as well as ipsilateral postacetazol- amide rCBF (48.3 Ϯ 9.2 mL/100 g/min; Table 1). The diameter Analysis of CBF of the poststenotic ICA (3.6 Ϯ 0.7 mm) and blood flow vol- The cerebral circulation was examined by SPECT. SPECT was per- ume (4.0 Ϯ 2.4 mL/s) in the poststenotic portion of the ICA formed by using a PRISM 2000XP (2-head SPECT system, Picker, were not significantly associated with ipsilateral baseline rCBF Cleveland, Ohio), and the tracer was technetium Tc99m ethyl cystein- but with ipsilateral postacetazolamide rCBF and VR (1.19 Ϯ ate dimmer (Tc99m-ECD). Regional CBF (rCBF) within the territory 0.17; Table 1 and Fig 1). of the MCA was quantitatively measured before and after the intra- The patients were divided into 2 groups with the postste- venous administration of acetazolamide (0.017 g/kg). The baseline notic blood flow below (group I, n ϭ 24) and above (group II, mean CBF was measured from a graphic analysis of the time-activity n ϭ 25) 3.5 mL/s, which was the mode of values of the post- curve for the brain and aortic arch obtained from radionuclide an- stenotic flow, and subsequent analysis was done. The degrees giography by an injection of Tc99m-ECD, and the rCBF was calcu- of stenosis calculated by the cross-sectional area or NASCET lated by using the Lassen correction algorithm.26,27 Vasoreactivity method in group I (cross-sectional area, 93 Ϯ 5%; NASCET, (VR) was estimated by postacetazolamide rCBF/baseline rCBF.
Load more

Recommended publications
  • Vulnerable Atherosclerotic Plaque–A Review of Current Concepts And
    Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018 Mar; 162(1):10-17. Vulnerable atherosclerotic plaque – a review of current concepts and advanced imaging Miloslav Spaceka, David Zemanekb, Martin Hutyraa, Martin Slukaa, Milos Taborskya Atherosclerosis is the most common cause of both carotid and coronary steno-occlusive disease. Rupture of an ath- erosclerotic plaque may lead to the formation of an overlying thrombosis resulting in complete arterial occlusion or downstream embolism. Clinically, this may manifest as a stroke or acute myocardial infarction, the overall leading causes of mortality and disability in developed countries. In this article, we summarize current concepts of the develop- ment of vulnerable plaque and provide an overview of commonly used imaging methods that may suggest/indicate atherosclerotic plaque vulnerability. Key words: atherosclerosis, vulnerable plaque, carotid artery, coronary artery, imaging Received: September 18, 2017; Accepted with revision: February 6, 2018; Available online: February 21, 2018 https://doi.org/10.5507/bp.2018.004 aDepartment of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic b2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic Corresponding author: David Zemanek, e-mail: [email protected] INTRODUCTION INITIATION OF ATHEROSCLEROTIC
    [Show full text]
  • Electron Beam Computed Tomography for the Diagnosis of Cardiac Disease
    REFERENCES Review Article 1. Preble E. Impact of HIV/AIDS on African children. Sac Sci Med 1990; 31: 671 4 680. 2. Adjortolo-Johnson G, De Kock K, Ekpini E, et al. Prospective comparison of mother-ta-child transmission of HIV-l and HIV-2 in Abidjan, Ivory Coast. JAMA Electron beam computed 1994; 272: 462-466. 3. Marurn LH, Bagenda 0, Guay L, et al. Three-year mortality in a cohort of HIV-l infected and uninfected Ugandan children. Abstract, 11 th International tomography for the Conference on AIDS, Vancouver, 1996. 4. Vetter KM, Djomand G, Zadi F, et al. Clinical spectrum of human immunodeficiency virus disease in children in a West African city. Pediatr Infect diagnosis of cardiac Dis J 1996; 15: 438-442. 5. NicoH A, Timaeus I, Kigadye AM, Walraven G. Killewo J. The impact of HIV-l infection on mortality in children under 5 years of age in sub-Saharan Africa: a disease demographic and epidemiologic analysis. AIDS 1994; 8: 995-1005. 6. Walraven G, Nicoll A, Njau M, Timaeus l. The impact of HIV-1 infection on child health in sub-Saharan Africa: the burden on the health services. Trap Med Int Health 1996; 1: 3-14. Yadon Arad 7. Department of Health. Sixth national HIV survey of women attending antenatal clinics of the public health services in the Republic of South Africa, October 1996. Epidemiological Comments 1996; 23: 3-17. 8. Friedland IR, Mclntyre JA. AIDS - the Baragwanath experience. S Afr Med J Electron beam computed tomography (EBCT) of the heart 1992; 82: 90-94.
    [Show full text]
  • Crucial Role of Carotid Ultrasound for the Rapid Diagnosis Of
    m e d i c i n a 5 2 ( 2 0 1 6 ) 3 7 8 – 3 8 8 Available online at www.sciencedirect.com ScienceDirect journal homepage: http://www.elsevier.com/locate/medici Clinical Case Report Crucial role of carotid ultrasound for the rapid diagnosis of hyperacute aortic dissection complicated by cerebral infarction: A case report and literature review a a, b a Eglė Sukockienė , Kristina Laučkaitė *, Antanas Jankauskas , Dalia Mickevičienė , a a c a Giedrė Jurkevičienė , Antanas Vaitkus , Edgaras Stankevičius , Kęstutis Petrikonis , a Daiva Rastenytė a Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania b Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania c Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania a r t i c l e i n f o a b s t r a c t Article history: Aortic dissection is a life-threatening rare condition that may virtually present by any organ Received 24 January 2016 system dysfunction, the nervous system included. Acute cerebral infarction among multiple Received in revised form other neurological and non-neurological presentations is part of this acute aortic syndrome. 14 September 2016 Rapid and correct diagnosis is of extreme importance keeping in mind the possibility of Accepted 8 November 2016 thrombolytic treatment if a patient with a suspected ischemic stroke arrives to the Emergency Available online 19 November 2016 Department within a 4.5-h window after symptom onset. Systemic intravenous thrombolysis in the case of an acute brain infarction due to aortic dissection may lead to fatal outcomes.
    [Show full text]
  • Screening for Carotid Artery Stenosis: an Update of the Evidence for the U.S
    Clinical Guidelines Annals of Internal Medicine Screening for Carotid Artery Stenosis: An Update of the Evidence for the U.S. Preventive Services Task Force Tracy Wolff, MD, MPH; Janelle Guirguis-Blake, MD; Therese Miller, DrPH; Michael Gillespie, MD, MPH; and Russell Harris, MD, MPH Background: Cerebrovascular disease is the third leading cause of Data Extraction: All studies were reviewed, abstracted, and rated death in the United States. The proportion of all strokes attributable for quality by using predefined Task Force criteria. to previously asymptomatic carotid artery stenosis (CAS) is low. In 1996, the U.S. Preventive Services Task Force concluded that evi- Data Synthesis: No RCTs of screening for CAS have been done. dence was insufficient to recommend for or against screening of According to systematic reviews, the sensitivity of ultrasonography asymptomatic persons for CAS by using physical examination or is approximately 94% and the specificity is approximately 92%. carotid ultrasonography. Treatment of CAS in selected patients by selected surgeons could lead to an approximately 5–percentage point absolute reduction in Purpose: To examine the evidence of benefits and harms of strokes over 5 years. Thirty-day stroke and death rates from carotid screening asymptomatic patients with duplex ultrasonography and endarterectomy vary from 2.7% to 4.7% in RCTs; higher rates treatment with carotid endarterectomy for CAS. have been reported in observational studies (up to 6.7%). Data Sources: MEDLINE and Cochrane Library (search dates Jan- Limitations: Evidence is inadequate to stratify people into catego- uary 1994 to April 2007), recent systematic reviews, reference lists ries of risk for clinically important CAS.
    [Show full text]
  • Research Progress in Ultrasound Use for the Diagnosis and Treatment of Cerebrovascular Diseases
    REVIEW ARTICLE Research progress in ultrasound use for the diagnosis and treatment of cerebrovascular diseases Li Yan,I,II Xiaodong Zhou,I,* Yu Zheng,II Wen Luo,I Junle Yang,III Yin Zhou,II Yang HeIV I Department of Ultrasonography, Xijing Hospital, The Fourth Military Medical University, Xi’an , China. II Department of Ultrasonography, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China.III Department of CT & MRI, Xi’an Central Hospital, The Third Affiliated Hospital of JiaoTong University, Xi’an, China. IV Department of General Surgery, Xi'an Medical University, Xi'an, China. Yan L, Zhou X, Zheng Y, Luo W, Yang J, Zhou Y, et al. Research progress in ultrasound use for the diagnosis and treatment of cerebrovascular diseases. Clinics. 2019;74:e715 *Corresponding author. E-mail: [email protected] Cerebrovascular diseases pose a serious threat to human survival and quality of life and represent a major cause of human death and disability. Recently, the incidence of cerebrovascular diseases has increased yearly. Rapid and accurate diagnosis and evaluation of cerebrovascular diseases are of great importance to reduce the incidence, morbidity and mortality of cerebrovascular diseases. With the rapid development of medical ultrasound, the clinical relationship between ultrasound imaging technology and the diagnosis and treatment of cerebrovascular diseases has become increasingly close. Ultrasound techniques such as transcranial acoustic angiography, doppler energy imaging, three-dimensional craniocerebral imaging and ultrasound thrombolysis are novel and valuable techniques in the study of cerebrovascular diseases. In this review, we introduce some of the new ultrasound techniques from both published studies and ongoing trials that have been confirmed to be convenient and effective methods.
    [Show full text]
  • GM Saleh Essex County Hospital, Lexden Road Colchester
    Central retinal vein and ophthalmic artery occlusion L Pek-Kiang Ang et al 439 Correspondence: GM Saleh autoimmune and procoagulant disorders. Pertinent Essex County Hospital, Lexden Road laboratory investigations were as follows: the erythrocyte Colchester, CO3 3NB, UK sedimentation rate was 57 mm/h; IgG anticardiolipin Tel: + 44 208 302 2678 was raised to 33 GPL units/ml; antinuclear antibody and E-mail: [email protected] lupus anticoagulants were negative. Serum total complement, C3, C4, and protein S, protein C and antithrombin III were normal. The diagnosis of primary antiphospholipid syndrome was established and the Sir, patient was started on anticoagulation with warfarin. Central retinal vein and ophthalmic artery occlusion in After 1 month, she presented with sudden primary antiphospholipid syndrome deterioration of her right vision to perception of light only. A right relative afferent pupillary defect was Eye (2004) 18, 439–440. doi:10.1038/sj.eye.6700685 present. There was neovascularization of the iris, with a raised intraocular pressure of 26 mmHg. Fundus examination revealed the presence of a right ophthalmic Primary antiphospholipid syndrome is characterized by artery occlusion, with severe whitening of the retina and the production of moderate to high levels of markedly attenuated retinal arterioles and venules antiphospholipid antibodies, associated with thrombotic (Figure 1). Fundus fluorescein angiography phenomena (arterial or venous) and recurrent demonstrated blocked choroidal and retinal artery filling. spontaneous abortion due to placental vascular Transcranial doppler ultrasound of the ophthalmic insufficiency, in the absence of any other recognizable arteries revealed an absent signal over the right autoimmune disease.1 ophthalmic artery and a normal signal from the left.
    [Show full text]
  • Carotid Artery Artery Carotid Contrast Enhanced Enhanced Contrast Carotid Artery Contrast Enhanced Ultrasound Luit Ten Kate Ultrasound
    Luit ten Kate Artery Enhanced Enhanced Carotid Contrast Ultrasound Carotid Artery Contrast Enhanced Ultrasound • Luit ten Kate Carotid Artery Contrast Enhanced Ultrasound Luit ten Kate ISBN 978-94-6169-475-1 CAROTID ARTERY CONTRAST ENHANCED ULTRASOUND Contrast echo van de arteria carotis Proefschrift ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de rector magnificus Prof.dr H.A.P. Pols en volgens besluit van het College voor Promoties. De openbare verdediging zal plaatsvinden op Woensdag 19 februari 2014 om 15.30 uur door Gerrit Luit ten Kate geboren te Uithoorn PROMOTIECOMMISSIE Promotoren : Prof.dr. E.J.G. Sijbrands Prof.dr.ir. A.F.W. van der Steen Overige leden : Prof.dr. P.J. de Feyter Prof.dr. A. van der Lugt Prof.dr. M.J.A.P. Daemen Copromotor : Dr. A.F.L. Schinkel Financial support for the publication of this thesis was generously provided by Bracco Suisse SA Financial support by the Dutch Heart Foundation for the publication of this thesis is gratefully acknowledged This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine (www.ctmm.nl), Eindhoven, The Netherlands, project Plaque-at-risk (PARISk) (grant 01C-202), and supported by a grant of the Dutch Heart Foundation (DHF 2008 T 94). TABLE OF CONTENTS Part I: Introduction: Current status of non-invasive imaging of atherosclerosis Chapter 1. General introduction and aims 9 Chapter 2. Non-invasive imaging of the vulnerable atherosclerotic 15 plaque Chapter 3. Current status and future developments of contrast enhanced 39 ultrasound of carotid atherosclerosis Part II: Contrast enhanced ultrasound for imaging atherosclerosis Chapter 4.
    [Show full text]
  • Limitations of Carotid Ultrasound
    Challenges & Pitfalls in Imaging of Carotid Stenosis Faezeh Jean S. Noreen Osvaldo Jonathan Brittany Razjouyan Rowe Islam Mercado Nakata Bryant Faezeh Razjouyan, MS2; Jean S. Rowe, BS2; Noreen Islam, MPH2; Brittany Bryant, BS2; Isaac M. E. Dodd, MS2; Sanchez Colo, PharmD-MBA2; Weonpo Yarl, MS2; Shakita Crichlow, BS2; Osvaldo Mercado, BS2; Jonathan Nakata, BS2; Kamyar Sartip, MD1; Han Y. Kim, MD1; Bonnie Davis, MD1; Andre J. Duerinckx, MD-PhD1 Isaac E Sanchez Weonpo Shakita Kamyar A. Han Y. Bonnie Dodd Colo Yarl Crichlow 1 2 Andre J. Department of Radiology , Howard University College of Medicine , Washington, D.C. 20059 Sartip Kim Davis Duerinckx Goals 1. Reporting Error 2. Limitation in Analysis • Access the results of novel research and world (Satisfaction of Search) (High Resistance Flow) literature on the usage and pitfalls of ultrasound in the evaluation of carotid anatomy and disease. • Recognize the standard practice guidelines for carotid ultrasonography and optimal scanning techniques and Doppler settings. • Better understand the potential for operator-and patient-related pitfalls and discrepancies during (a) (b) (c) the performance of carotid ultrasound. (b) Challenges & Background Pitfalls • Stroke is the fourth leading cause of death in the of (a) United States according to the Centers for Disease Control and Prevention (CDC). Carotid (e) (d) (c) • Evaluating carotid artery disease (or carotid artery Sonography stenosis) is an important step in investigating the A 66 y/o woman presented in Nov 2014 with acute stroke An 87 y/o woman presented to the ED with headaches. The symptoms. MRI confirmed acute stroke in the left hemisphere (a, initial CT (not shown) revealed a chronic left middle cerebral etiology of stroke.
    [Show full text]
  • High-Resolution Magnetic Resonance Imaging of Carotid Atherosclerosis Identifies Vulnerable Carotid Plaques
    CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector From the Society for Vascular Surgery High-resolution magnetic resonance imaging of carotid atherosclerosis identifies vulnerable carotid plaques Antoine Millon, MD,a Jean-Louis Mathevet, MD,a Loic Boussel, MD, PhD,b Peter L. Faries, MD,c Zahi A. Fayad, PhD,d Philippe C. Douek, MD, PhD,b and Patrick Feugier, MD, PhD,a Lyon, France; and New York, NY Objective: Carotid magnetic resonance imaging (MRI) may be a useful tool in characterizing carotid plaque vulnerability, but large studies are still lacking. The purpose of this study was to assess carotid MRI features of vulnerable plaque in a large study and the changes in carotid plaque morphology with respect to time since the neurological event. Methods: We included 161 patients with carotid plaque more than 3 mm thick. All patients underwent carotid MRI to obtain 3-T high-resolution magnetic resonance sequences. Large lipid core, intraplaque hemorrhage (IPH), fibrous cap rupture (FCR), and gadolinium enhancement (GE) were assessed and classified as present or absent. Prevalences of these features were then compared between symptomatic and asymptomatic patients and time since stroke. Results: Seven patients were excluded because of poor image quality. Of the remaining 154 patients, 52 were symptomatic and 102 were asymptomatic. The prevalences of IPH (39 vs 16%; P [ .002), FCR (30 vs 9%; P [ .001), and GE (75 vs 55%; P [ .015) were significantly higher in symptomatic than asymptomatic patients. After multivariate analysis, the prevalences of IPH (odds ratio, 2.6; P [ .023) and FCR (odds ratio, 2.8; P [ .038) were still significantly higher.
    [Show full text]
  • Appendix A: Doppler Ultrasound and Ankle–Brachial Pressure Index
    Appendix A: Doppler Ultrasound and Ankle–Brachial Pressure Index Camila Silva Coradi, Carolina Dutra Queiroz Flumignan, Renato Laks, Ronald Luiz Gomes Flumignan, and Bruno Henrique Alvarenga Abstract The ankle–brachial index is one of the simplest, costless, and with utmost importance tool for the diagnosis, screening, and segment of peripheral arterial disease and we need to know how to use it. The simplicity of the examination with Doppler ultrasound is undoubtedly the factor that most contributes to the adoption of this device as vascular preliminary tool. As a blood velocity detec- tor, Doppler ultrasound can be used to determine the systolic pressure of the arteries, which are the targets of the study. In this case, a sphygmomanometer is also required. They will be used in determined limb segments (upper and lower limbs) to temporarily occlude the blood flow and consequently assess the related blood pressure. The normal value of the index is 0.9–1.1. Values less than 0.9 indicate peripheral arterial disease and it is correlated with increased risk of future cardiac events. The index can be related with symptoms accord- ing to its value. When the ABI falls to 0.7–0.8 it is associated with lameness, 0.4–0.5 indicates pain, and 0.2–0.3 is typically associated with gangrene and nonhealing ulcers. Doppler Ultrasound The Austrian physicist Johann Christian Andreas Doppler (1803–1853) observing the different colorations that certain stars had questioned why this phenomenon. In 1842, he discovered the modifying effect of the vibration frequency caused by the relative movement between the source and the observer.
    [Show full text]
  • Comparison of Carotid Plaque Tissue
    Bando et al. Cardiovascular Ultrasound (2015) 13:34 DOI 10.1186/s12947-015-0031-6 CARDIOVASCULAR ULTRASOUND RESEARCH Open Access Comparison of carotid plaque tissue characteristics in patients with acute coronary syndrome or stable angina pectoris: assessment by iPlaque, transcutaneous carotid ultrasonography with integrated backscatter analysis Mika Bando1, Hirotsugu Yamada1,2*, Kenya Kusunose1, Daiju Fukuda1, Rie Amano2, Rina Tamai2, Yuta Torii2, Yukina Hirata2, Susumu Nishio2, Koji Yamaguchi1, Takeshi Soeki1, Tetsuzo Wakatsuki1 and Masataka Sata1,2 Abstract Background: The association of the tissue characteristics of carotid plaques with coronary artery disease has attracted interest. The present study compared the tissue characteristics of carotid plaques in patients with acute coronary syndrome (ACS) with those in patients with stable angina pectoris (SAP) using the iPlaque system, which is based on ultrasound integrated backscatter. Methods and results: Carotid ultrasound examinations were performed in 26 patients with ACS, and 38 age- and gender-matched patients with SAP. Neither plaque area nor maximal intima-media thickness differed significantly between the two groups. However, the average integrated backscatter value within the plaque was greater in the ACS patients than in the SAP patients. iPlaque analysis revealed that the percentage blue area (lipid pool) was greater in the ACS patients than in the SAP patients (43.4 ± 11.2 vs 18.3 ± 10.3 %, p < 0.0001), and that the percentage green area (fibrosis) was lower in the ACS than in the SAP patients (7.5 ± 7.5 % vs 20.7 ± 11.7 %, p < 0.0001). Conclusions: The lipid component of carotid plaques is greater in ACS patients than in SAP patients.
    [Show full text]
  • Altitudinal Visual Field Defects Following Diagnostic Transfemoral Cerebral Angiography
    medicina Case Report Altitudinal Visual Field Defects Following Diagnostic Transfemoral Cerebral Angiography Kyungwoo Yoon 1, Soo Young Chae 2 and Kiyoung Kim 1,* 1 Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul 02447, Korea; [email protected] 2 Departments of Radiology, Seoul Saint Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02447, Korea; [email protected] * Correspondence: [email protected]; Tel.: +82-02-958-8455 or +82-02-966-7340 Abstract: Transfemoral cerebral angiography (TFCA) has been increasingly used as diagnostic method for the evaluation of cerebral vessels. Ophthalmologic complication after TFCA has rarely been reported, and most complications are associated with an intraoperative thrombo-embolic event. We reported a patient who developed a superior altitudinal visual field defect one day after diagnostic TFCA. The ophthalmic exam revealed a prominent inferior optic disc edema, and the fluorescein angiographic showed the non-perfusion of the corresponding inferior sectoral optic disc. Diffusion- weighted MRI on the day following cerebral angiography revealed multiple focal scattered acute infarctions. Even one month after steroid pulse therapy, the superior nasal field defect remained with minimal improvement. We believe this case was consistent with an acute anterior ischemic optic neuropathy (AION) due to thrombo-embolism after TFCA. Ophthalmic examinations and a visual field test should be performed before and immediately after the TFCA, particularly in the case with a high risk of thromboembolic events. Citation: Yoon, K.; Chae, S.Y.; Kim, K. Altitudinal Visual Field Defects Keywords: transfemoral cerebral angiography; intracranial aneurysm; ischemic optic neuropathy; Following Diagnostic Transfemoral visual field defect Cerebral Angiography.
    [Show full text]