Journal articles: 'Carotid stenosis'

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Khattak, Muhammad Ishaq, Faramoz Khan, Zahid Fida, and Adnan Zar. "CAROTID ARTERY STENOSIS." Professional Medical Journal 24, no. 08 (August 8, 2017): 1126–31. http://dx.doi.org/10.29309/tpmj/2017.24.08.1006.

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Objectives: The objective of this study is to determine the frequency of carotidartery atherosclerosis using color Doppler ultrasound in ischemic stroke patients. StudyDesign: Cross-sectional study. Period: July 2015 to June 2016. Setting: Khyber TeachingHospital, Peshawar. Method: Doppler ultrasonography was done to assess carotid artery statusin patients diagnosed with cerebral infarction. Results: Data comprised of 174 ischemic strokepatients between ages 37-95 years. 111 were males whereas 63 were males. Mean age wasfound to be 64.03±11.71 years. Doppler ultrasound revealed carotid artery atherosclerosis in52.3% (n=91) patients with 57% males and 34% females. Right carotid artery involvement wasfound in 28 patients and left carotid artery involvment in 38 patients. Both carotid arteries wereinvolved in 25 patients. Conclusion: We have concluded that carotid artery atherosclerosis is anindependent predictor for future vascular events. Our study reports carotif artery atherosclerosisin 52.3% patients with ischemic stroke.

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Ito, Hidemichi, Masashi Uchida, Taigen Sase, Yuichiro Kushiro, Tetsuya Ikeda, Hiroshi Takasuna, Ichiro Takumi, Kotaro Oshio, and Yuichiro Tanaka. "A case of tandem stenoses at the proximal common and internal carotid arteries treated with transbrachial stenting: a case report." Interventional Neuroradiology 25, no. 2 (November 4, 2018): 225–29. http://dx.doi.org/10.1177/1591019918806471.

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The transfemoral approach is a common technique for carotid artery stenting. However, it has the risk of distal embolism when stenting for a stenosis of the proximal common carotid artery because of poor stability of the guiding catheter resulting in difficulty in setting the embolic protection device prior to stenting. We present a novel therapeutic approach and technique for the treatment of tandem carotid stenoses including the proximal common carotid artery. A 63-year-old man presented with double stenoses at the common carotid artery and internal carotid artery. We used a transbrachial sheath guide that had a 6 Fr (2.24 mm, 0.088 inch) internal diameter and was 90 cm long, and was specifically designed for direct cannulation to the common carotid artery, like a modified Simmons catheter. Because the sheath guide positioned in the aortic arch made it possible to introduce safely the embolic protection device distal to the internal carotid artery stenosis without touching the plaque at the stenosis with no use of any coaxial catheters or guidewires, carotid artery stenting for tandem stenoses could be successfully carried out. The postoperative course was uneventful. In carotid artery stenting, especially for stenosis of the proximal common carotid artery, the sheath guide designed for transbrachial carotid cannulation was useful in stenting the tandem carotid stenoses.

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Brennan, Jeffrey W., Michael K. Morgan, William Sorby, and Verity Grinnell. "Recurrent stenosis of common carotid—intracranial internal carotid interposition saphenous vein bypass graft caused by intimal hyperplasia and treated with endovascular stent placement." Journal of Neurosurgery 90, no. 3 (March 1999): 571–74. http://dx.doi.org/10.3171/jns.1999.90.3.0571.

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✓ Intimal hyperplasia is a well-known cause of delayed stenosis in vein bypass grafts in all types of vascular surgery. Options for treatment of stenosis in peripheral and coronary artery bypass grafts include revision surgery and the application of endovascular techniques such as balloon angioplasty and stent placement. The authors present a case of stenosis caused by intimal hyperplasia in a high-flow common carotid artery—intracranial internal carotid artery (IICA) saphenous vein interposition bypass graft that had been constructed to treat a traumatic pseudoaneurysm of the intracavernous ICA. The stenosis recurred after revision surgery and was successfully treated by endovascular stent placement in the vein graft. The literature on stent placement for vein graft stenoses is reviewed, and the authors add a report of its application to external carotid—internal carotid bypass grafts. Further study is required to define the role of endovascular techniques in the management of stenotic cerebrovascular disease.

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Päivänsalo, M. J., T. M. J. Siniluoto, T. A. Tikkakoski, V. Myllylä, and I. J. I. Suramo. "Duplex US of the External Carotid Artery." Acta Radiologica 37, no. 1P1 (January 1996): 41–45. http://dx.doi.org/10.1177/02841851960371p108.

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The ratio between the systolic peak velocities of the internal and common carotid arteries (vpICA/vpCCA), vpICA and grey-scale imaging measurement are generally used to evaluate internal carotid stenosis against known flow criteria in order to differentiate non-significant from significant stenosis. The same criteria are also used for evaluating the external carotid artery (ECA). Our data on 707 normal or stenotic ECA nevertheless showed that the systolic peak velocity of the normal ECA (vpECA) and its ratio to the systolic velocity of the CCA (vpECA/vpCCA) are higher than vpICA and vpICA/vpCCA. vpECA/vpCCA is about 2 in >0–49% ECA stenosis. Only in severe stenosis are the peak velocities almost comparable. The ratio between the peak end diastolic velocities (edvECA/edvCCA) and edvECA proved to be unreliable, as did grey-scale imaging measurement of the external carotid stenosis. In addition, ipsilateral internal carotid stenosis greatly affects the non-stenotic external carotid flow values, and probably has the same effect on the flow values of a stenotic external artery. Thus, external carotid flow values must be considered carefully.

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Shichita, Takashi, Toshiyasu Ogata, Masahiro Yasaka, Kotaro Yasumori, Tooru Inoue, Setsuro Ibayashi, Mitsuo Iida, and Yasushi Okada. "Angiographic Characteristics of Radiation-Induced Carotid Arterial Stenosis." Angiology 60, no. 3 (June 2009): 276–82. http://dx.doi.org/10.1177/0003319709335905.

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Purpose This study aimed to clarify the angiographic characteristics of radiation-induced carotid stenosis. Methods We evaluated 11 carotid arteries of patients after radiotherapy (radiotherapy group) and 26 carotid arteries of age- and gender-matched patients without a history of radiotherapy (control group). All patients had carotid stenosis detected by digital subtraction angiography (DSA). We developed an original coordinate system on the DSA to determine the accurate length and location of the carotid lesion. Results Radiation-induced carotid lesions were significantly longer than carotid lesions caused by atherosclerosis. The maximal stenosis of radiation-induced carotid lesions tended to be at the end of the stenotic area and within a wider range than the nonradiation-induced lesions, including in the proximal common carotid artery (CCA). Conclusions Radiation-induced stenotic lesions seem to exist in a wide range of carotid artery, including the CCA, along the vessel, and show maximal stenosis near the end of the stenotic area.

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Terada, T., M. Tsuura, H. Yokote, H. Matsumoto, O. Masuo, K. Nakai, T. Itakura, et al. "Endovascular Treatment for Internal Carotid Stenoses." Interventional Neuroradiology 5, no. 1_suppl (November 1999): 43–46. http://dx.doi.org/10.1177/15910199990050s107.

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Seventy four cases of internal carotid stenoses greater than 60% were treated by PTA and/or stenting 86 times. Sixty one cases of cervical ICA stenosis were treated 71 times. 11 cases of high cervical - intracranial ICA stenosis were treated 13 times. Two cases of ICA dissection were treated by stent deployment. Stenotic ratio reduced from 79% to 29% in cervical ICA stenosis and 71 % to 32% in high cervical to intracranial ICA stenosis in average. Morbidity related to PTA and/or stenting was 2/74 (2.7%) and mortality was 0%. One was an ischemic complication and the other was a hemorrhagic complication due to hyperperfusion. Restenosis (stenosis greater than 70%) rate was 32%. Asymptomatic cerebral embolism were found in three cases (4.2%) on angiogram immediately after PTA and/or stenting. The complication rate related to PTA and/stenting was low but asymptomatic emboli were found in three cases. Considering these results, the indication for PTA and/stenting should be restricted to patients with high risk group, such as cases with high medical risks or difficult CEA cases, if appropriate protective systems for cerebral emboli were not available.

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Malkoff, Marc D., Linda S. Williams, and Jose Biller. "Advances in Management of Carotid Atherosclerosis." Journal of Intensive Care Medicine 12, no. 2 (March 1997): 55–65. http://dx.doi.org/10.1177/088506669701200201.

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Carotid artery stenosis is a common and potentially treatable cause of stroke. Stroke risk is increased as the degree of carotid stenosis increases, as well as in patients with neurological symptoms referable to the stenosed carotid artery. Carotid stenosis can be quantified by ultrasound imaging, magnetic resonance angiography, or conventional angiography. Medical treatment with platelet antiaggregants reduces stroke risk in some patients; other patients are best treated with carotid endarterectomy. Experimental treatments for carotid stenosis, including carotid angioplasty with or without stenting, are under investigation. We summarize the current literature and provide treatment recommendations for patients with atherosclerotic carotid artery disease.

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Koennecke. "Carotid stenosis - When is revascularization appropriate?" Vasa 38, no. 3 (August 1, 2009): 203–11. http://dx.doi.org/10.1024/0301-1526.38.3.203.

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Approximately 15% of ischemic strokes are caused by extracranial carotid stenoses. Revascularization of a symptomatic stenosis is very efficacious in carefully selected patients. This review outlines criteria which help to identify those who will benefit most from carotid endarterectomy (CEA) for symptomatic stenosis. Asymptomatic carotid stenosis is a common condition in the general population over 50 years, but nonetheless associated with a low risk of ischemic stroke. Consequently, the therapeutic yield of CEA is much lower in asymptomatic stenosis and women seem not to benefit at all. In the future, specific morphological MRI features may help to identify stenoses prone to become symptomatic. In addition to their significance for stroke, it has been demonstrated that atherosclerotic lesions can be regarded as an indicator of cardiovascular morbidity which may help to identify high-risk patients for cardiovascular events.

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Loree, H. M., R. D. Kamm, C. M. Atkinson, and R. T. Lee. "Turbulent pressure fluctuations on surface of model vascular stenoses." American Journal of Physiology-Heart and Circulatory Physiology 261, no. 3 (September 1, 1991): H644—H650. http://dx.doi.org/10.1152/ajpheart.1991.261.3.h644.

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Turbulence frequently develops when blood passes through a stenosis. To study the hypothesis that turbulence near a plaque surface can cause pressure fluctuations that may promote plaque rupture, models of intravascular stenoses were studied. Experimental conditions simulated peak flow in the coronary and carotid arteries through a stenosis of 80 or 90% diameter reduction and into a region where the plaque had widened distally to a 50-75% stenosis. For symmetric stenoses at carotid artery flow rates, peak pressure fluctuations were observed 1-1.5 upstream diameters distal to the stenosis, but there were no significant turbulent pressure fluctuations at coronary artery flow rates. Stenosis asymmetry strongly increased the intensity of turbulent pressure fluctuations at flows simulating carotid flow and resulted in significant pressure fluctuations for coronary flow conditions. Increasing stenosis severity from 80 to 90% increased the root mean square pressure fluctuations 3.6-fold. These studies predict peak to peak pressure fluctuations of 15 mmHg in a 90% asymmetric coronary stenosis; it is possible that turbulence may play a role in acute damage of atherosclerotic plaques, particularly in asymmetric stenoses.

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Imbesi, S. G., and C. W. Kerber. "Pressure Measurements across Vascular Stenoses." Interventional Neuroradiology 5, no. 2 (June 1999): 139–44. http://dx.doi.org/10.1177/159101999900500205.

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We describe and analyze pressure measurements across vascular stenoses in an atherosclerotic human carotid bulb replica using catheters of different diameters. Replicas of an atherosclerotic human carotid bulb were created using the lost wax technique, and were placed in a circuit of pulsating non-newtonian fluid. Flows were adjusted to replicate human physiologic flow profiles. Common carotid artery total flow volume of 600 milli-liters/minute was studied. A pressure recording device was calibrated; data were received from catheters placed longitudinally in the common carotid artery and internal carotid artery. The internal carotid artery pressures were obtained both through the stenosis as is usually performed in the angiography suite and through the vessel side-wall beyond the stenosis as a control. Internal carotid artery flow volumes were also measured with and without the catheter through the stenosis. Multiple pressure recordings and volume measurements were obtained in the replica using 7 French, 5 French, and 2.5 French catheters. Measurements of the replica showed a 58% diameter stenosis and an 89% area stenosis of the carotid bulb. All longitudinal pressure measurements in the common carotid artery agreed with control values regardless of the diameter of the catheter used. Pressure measurements were also in agreement with control values in the internal carotid artery using the 2.5 French catheter. However, when larger diameter catheters were employed, pressures measured with the catheter through the stenosis fell when compared to control values. Additionally, internal carotid artery flow volumes were also decreased when the larger diameter catheters were placed across the stenosis. Large diameter catheters when placed across vascular stenoses may cause an occlusive or near-occlusive state and artifactually increase the measured transstenotic vascular pressure gradient as well as decrease forward vascular flow.

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Sagatelyan, A. A., E. V. Konstantinova, A. A. Bogdanova, A. V. Svet, E. S. Pershina, I. V. Pershukov, and M. Yu Gilyarov. "Atherosclerosis of the carotid and coronary arteries in elderly patients with acute coronary syndrome." Kardiologiia 62, no. 8 (August 30, 2022): 38–44. http://dx.doi.org/10.18087/cardio.2022.8.n2149.

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Aim To study the relationship between severities of the carotid artery injury and the atherosclerotic process in coronary arteries of elderly patients with acute coronary syndrome (ACS).Material and methods The study included 110 patients aged >75 years. Based on the degree of maximal carotid stenosis according to data of duplex scanning (DS), all patients were divided into group I, (>50% stenosis) and group II (<50% stenosis).Results According to coronary angiographic data, multivessel disease was observed in 63.6 % of patients. Patients of group I more frequently had three-vessel coronary artery disease than patients of group II (35.8 and 5.3 %, р<0.001). Coronary angiography and DS showed that 82.7 % patients (in group II, not all carotid stenoses were hemodynamically significant) had a combined damage of coronary and carotid arteries; carotid artery stenoses of >50% were associated with three-vessel coronary artery disease. A correlation between atherosclerosis of carotid and coronary arteries was found. Considering this correlation, a scale was introduced that suggested the severity of coronary atherosclerosis based on DS of carotid arteries. The score was assigned by assessing the degree of maximal stenoses in carotid arteries. A ROC analysis has determined a threshold score suggestive of the severity of coronary atherosclerosis: score <6, absence of >70% coronary stenosis; score >6, likely presence of >70% coronary stenosis (sensitivity, 70 %; specificity, 89 %).Conclusion Combined coronary and carotid artery disease was detected in 82.7% of elderly patients with ACS. A correlation between the severity of atherosclerosis in carotid and coronary arteries was found. DS of carotid arteries can be extensively used in evaluation of elderly patients with ACS, which will allow additional stratification of patients at high risk of cerebrovascular and recurrent cardiovascular diseases.

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Macharzina, Roland Richard, Sascha Kocher, Steven R. Messe, Thomas Kammerer, Fabian Hoffmann, Matthias Vogt, Werner Vach, et al. "Improved Carotid Stenosis Quantification on Novel 4D/3D-Doppler Ultrasonography Indexing to the Common Carotid Artery." Ultraschall in der Medizin - European Journal of Ultrasound 41, no. 02 (May 29, 2019): 167–74. http://dx.doi.org/10.1055/a-0628-6459.

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Abstract Purpose The accuracy of internal carotid artery stenosis (ICAS) quantification depends on the method of stenosis measurement, impacting therapeutic decisions and outcomes. The NASCET method references the stenotic to the distal ICAS lumen, the ECST method to the local outer and the common carotid artery (CC) method to the CC diameter. Direct morphometric stenosis measurement with four-dimensionally guided three-dimensional ultrasonography (4D/3DC-US) demonstrated good validity for the commonly used NASCET method. The NASCET definition has clinically relevant drawbacks. Our purpose was to investigate the validity of the ECST and CC methods. Materials and Methods 4D/3DC-US percent-stenosis measures of 103 stenoses (80 patients) were compared to quantitative catheter angiography and duplex ultrasonography (DUS) in a blinded fashion. Results The 4D/3DC-US versus angiography intermethod standard deviation of differences (SDD, n = 103) was lower for the CC method (5.7 %) compared to the NASCET (8.1 %, p < 0.001) and ECST methods (9.1 %, p < 0.001). Additionally, it was lower than the NASCET angiography interrater SDD of 52 stenoses (SDD 7.2 %, p = 0.047) and non-inferior for the ECST method (p = 0.065). Interobserver analysis of equivalent grading methods showed no differences for the SDDs between angiography and 4D/3DC-US observers (p > 0.076). Binary comparison to angiography showed equal Kappa values > 0.7 and an accuracy ≥ 85 % for the NASCET and CC methods, higher than for the ECST method. The binary accuracy of ICAS grading did not differ from DUS for all methods. Conclusion The new 4D/3DC-US CC method is an accurate and well reproducible alternative to the NASCET and ECST methods and offers potential for clinical application.

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Pierro, Antonio, Pietro Modugno, Roberto Iezzi, and Savino Cilla. "Challenges and Pitfalls in CT-Angiography Evaluation of Carotid Bulb Stenosis: Is It Time for a Reappraisal?" Life 12, no. 11 (October 22, 2022): 1678. http://dx.doi.org/10.3390/life12111678.

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We aimed to perform an anatomical evaluation of the carotid bulb using CT-angiography, implement a new reliable index for carotid stenosis quantification and to assess the accuracy of relationship between NASCET and ECST methods in a large adult population. The cross-sectional areas of the healthy carotid at five levels were measured by two experienced radiologists. A regression analysis was performed in order to quantify the relationship between the areas of the carotid bulb at different carotid bulbar level. A new index (Regression indeX, RegX) for carotid stenosis quantification was proposed. Five different stenoses with different grade in three bulbar locations were simulated for all patients for a total of 1365 stenoses and were used for a direct comparison of the RegX, NASCET, and ECST methods. The results of this study demonstrated that the RegX index provided a consistent and accurate measure of carotid stenosis through the application of the ECST method, avoiding the limitations of NASCET method. Furthermore, our results strongly depart from the consolidated relationships between NASCET and ECST values used in clinical practice and reported in extensive medical literature. In particular, we highlighted that a major misdiagnosis in patient selection for CEA could be introduced because of the large underestimation of real stenosis degree provided by the NASCET method. A reappraisal of carotid stenosis patients’ work-up is evoked by the effectiveness of state-of-the-art noninvasive contemporary carotid imaging.

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Grotta, James C. "Carotid Stenosis." New England Journal of Medicine 369, no. 12 (September 19, 2013): 1143–50. http://dx.doi.org/10.1056/nejmcp1214999.

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Kellett, J. M., M. P. H. Doublet-Stewart, A. D. B. Chant, P. R. Jackson, P. A. Woodmansey, and Wai Choong Lye. "Carotid stenosis." Lancet 337, no. 8757 (June 1991): 1600–1601. http://dx.doi.org/10.1016/0140-6736(91)93293-i.

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&NA;. "Carotid Stenosis." Ultrasound Quarterly 28, no. 3 (September 2012): 170–71. http://dx.doi.org/10.1097/01.ruq.0000419388.10048.8a.

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Liapis, Christos D., John D. Kakisis, and Alkiviadis G. Kostakis. "Carotid Stenosis." Stroke 32, no. 12 (December 2001): 2782–86. http://dx.doi.org/10.1161/hs1201.099797.

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Terada, T., H. Yokote, Y. Kinoshita, M. Tsuura, O. Masuo, K. Nakai, and T. Itakura. "Endovascular Treatment for Tandem Internal Carotid Stenosis." Interventional Neuroradiology 3, no. 2_suppl (November 1997): 208–11. http://dx.doi.org/10.1177/15910199970030s245.

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Three patients with tandem internal carotid stenoses were treated in one operation including carotid endarterectomy (CEA) for the proximal stenosis and percutaneous transluminal angioplasty (PTA) for the distal stenosis. We devised a Y-shaped shunt tube which we used for CEA, while a PTA balloon catheter was introduced via the tube to perform PTA guided by portable digital subtraction angiography (DSA). No cerebrovascular events occurred during follow-up. Our approach avoids the risk of a second procedure while effectively treating tandem stenoses.

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Platzek, Ivan, Dominik Sieron, Philipp Wiggermann, and Michael Laniado. "Carotid Artery Stenosis: Comparison of 3D Time-of-Flight MR Angiography and Contrast-Enhanced MR Angiography at 3T." Radiology Research and Practice 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/508715.

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Purpose. The aim of this study was to assess the correlation of 3D time-of-flight MR angiography (TOF MRA) and contrast-enhanced MR angiography (CEMRA) for carotid artery stenosis evaluation at 3T.Material and Methods. Twenty-three patients (5 f, 18 m; mean age 61 y, age range 45–78 y) with internal carotid artery stenosis detected with ultrasonography were examined on a 3.0T MR system. The MR examination included both 3D TOF MRA and CEMRA of the carotid arteries. MR images were evaluated independently by two board-certified radiologists. Stenosis evaluation was based on a five-point scale. Stenosis grades determined by TOF and CEMRA were compared using Spearman’s rank correlation coefficient and the Wilcoxon test. Cohen’s Kappa was used to evaluate interrater reliability.Results. CEMRA detected stenosis in 24 (52%) of 46 carotids evaluated, while TOF detected stenosis in 27 (59%) of 46 carotids. TOF MRA yielded significantly higher results for stenosis grade in comparison to CEMRA (P=0.014). Interrater agreement was very good for both TOF MRA (κ=0.93) and CEMRA (κ=0.93).Conclusion. At 3T, 3D TOF MRA should not be used as replacement for contrast-enhanced MRA of the carotid arteries, as it results in significantly higher stenosis grades.

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Bulger, Christopher M., Weihua Gao, Chad Jacobs, and Walter J. McCarthy. "Beyond the Categories: A Formula-Driven Prediction of Carotid Stenosis." Journal for Vascular Ultrasound 29, no. 1 (March 2005): 15–20. http://dx.doi.org/10.1177/154431670502900102.

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Purpose Current methods to predict carotid stenosis from ultrasound duplex criteria involve assigning a category of stenosis on the basis of an individual laboratory-defined combination of peak systolic velocity (PSV), end diastolic velocity (EDV), and ratio of internal carotid artery velocity to common carotid artery velocity. This study will define a formula by use of regression analysis of the duplex ultrasound criteria compared with the angiographic results. This study will then compare the formula predictions of stenosis with the current means of combining categories to determine whether there is an increase in accuracy and correlation with angiographic findings. Methods A retrospective review of the duplex scans and NASCET-defined angiogram results from 209 patent carotid arteries in 114 patients over the course of 4 yr at a single institution was performed. Regression analysis comparing each of the PSV, EDV, and internal carotid artery/common carotid artery ratios (RATIO) with angiographic stenosis was performed. Simple and multiple linear regression equations were obtained. The equation was tested for validity. The data were then reanalyzed by use of the formulas, and predicted stenoses from the formulas were obtained. The formula-predicted stenoses (F1 and F2), category-based stenoses (READAS), and angiographic stenoses were compared. A determination was then made of their statistically significant difference by use of the Wilcoxon signed rank test and receiver operator curve (ROC) analysis. Results An r2 value of 0.7231, 0.6341, and 0.7262 was obtained, respectively, for the equations comparing PSV, EDV, and ICA/CCA ratio with angiographic stenosis. Limiting the data to stenosis >30% resulted in correlation coefficients between the regression formula predicted data and the angiographic data of 0.71. A statistically significant difference was demonstrated between the category results and angiography ( p < 0.0001). No statistically significant difference was demonstrated between the formula-predicted data and the angiographic data. ROC analysis and Area (AZ) test demonstrated a statistically significant difference and better prediction of a >60% stenosis by the regression equation than by the current category method ( p < 0.05). Conclusion Regression analysis of duplex data versus NASCET-defined angiographic findings allows formation of a model to predict carotid stenosis. This can be done with greater accuracy than the commonly accepted means of categorizing the duplex results.

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Liu, Xin, Heye Zhang, Lijie Ren, Huahua Xiong, Zhifan Gao, Pengcheng Xu, Wenhua Huang, and Wanqing Wu. "Functional assessment of the stenotic carotid artery by CFD-based pressure gradient evaluation." American Journal of Physiology-Heart and Circulatory Physiology 311, no. 3 (September 1, 2016): H645—H653. http://dx.doi.org/10.1152/ajpheart.00888.2015.

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The functional assessment of a hemodynamic significant stenosis base on blood pressure variation has been applied for evaluation of the myocardial ischemic event. This functional assessment shows great potential for improving the accuracy of the classification of the severity of carotid stenosis. To explore the value of grading the stenosis using a pressure gradient (PG)—we had reconstructed patient-specific carotid geometries based on MRI images—computational fluid dynamics were performed to analyze the PG in their stenotic arteries. Doppler ultrasound image data and the corresponding MRI image data of 19 patients with carotid stenosis were collected. Based on these, 31 stenotic carotid arterial geometries were reconstructed. A combinatorial boundary condition method was implemented for steady-state computer fluid dynamics simulations. Anatomic parameters, including tortuosity (T), the angle of bifurcation, and the cross-sectional area of the remaining lumen, were collected to investigate the effect on the pressure distribution. The PG is highly correlated with the severe stenosis ( r = 0.902), whereas generally, the T and the angle of the bifurcation negatively correlate to the pressure drop of the internal carotid artery stenosis. The calculation required <10 min/case, which made it prepared for the fast diagnosis of the severe stenosis. According to the results, we had proposed a potential threshold value for distinguishing severe stenosis from mild-moderate stenosis (PG = 0.88). In conclusion, the PG could serve as the additional factor for improving the accuracy of grading the severity of the stenosis.

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Haas, Leandro José, Bernardo Przysiezny, Thaize Regina Scramocin, Natalia Tozzi Marques, Leticia Saori Tutida, Marina Piquet Sarmento, Omar Ahmad Omar, et al. "Using the Casper Stent in Carotid Angioplasty: A Single Center Experience." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 41, no. 01 (January 4, 2022): e1-e6. http://dx.doi.org/10.1055/s-0041-1740405.

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Abstract Objectives To establish the success rate in endovascular internal carotid artery (ICA) stenosis recanalization using the double-layer stent Casper-RX (Microvention, Inc 35 Enterprise, Aliso Viejo, California, United States of America) and to identify the main comorbidities in individuals with ICA stenosis, morphological characteristics of the stenosis, diagnostic methods, intraoperative complications, as well as morbidity and mortality within 30 days of the surgical procedure. Materials and Methods Retrospective analysis of 116 patients undergoing ICA angioplasty with a degree of stenosis ≥ 70% using Casper-RX stenting who underwent this procedure from April 2015 to December 2019. Results Technical success was achieved in 99.1% of the patients. Three of them had postprocedural complications: one transient ischemic attack (TIA) and two puncture site hematomas. A cerebral protection filter was not used in only two procedures, as these consisted of dissection of the carotid. There was satisfactory recanalization and adequate accommodation of the stents in the previously stenosed arteries, with no restenosis in 99.4% of the cases. Conclusion The endovascular treatment of extracranial carotid stenoses using the Casper-RX stent showed good applicability and efficacy. Although only two cases of thromboembolic complications occurred during the procedure, further investigation and studies on the effectiveness of this new device are needed.

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Murakami, Tomoaki, Shingo Toyota, Takuya Suematsu, Yuki Wada, Takeshi Shimizu, and Takuyu Taki. "Carotid–carotid crossover bypass after mechanical thrombectomy for internal carotid artery occlusion due to plaque from stenosed innominate artery." Surgical Neurology International 12 (September 30, 2021): 480. http://dx.doi.org/10.25259/sni_749_2021.

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Background: The treatment for internal carotid artery occlusion (ICAO) due to innominate artery stenosis is not well established. We herein describe a case of carotid–carotid crossover bypass and common carotid artery (CCA) ligation after mechanical thrombectomy for ICAO due to a plaque from the stenosed innominate artery. Case Description: A 70-year-old man was transferred to our hospital because of left-sided hemiparalysis. Head magnetic resonance imaging/angiography showed a cerebral infarction in the right middle cerebral artery area and the right ICAO due to a plaque from the stenosed innominate artery. Immediately, we performed mechanical thrombectomy and successfully attained partial revascularization (Thrombolysis in Cerebral Infarction Grade 2B). After a conference with cardiovascular group, we performed carotid–carotid crossover bypass and the right CCA ligation. The treatment was successful, and no complications occurred. Conclusion: Carotid–carotid crossover bypass and CCA ligation may be a better option for innominate artery stenosis in selected patients.

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Anysienkova, V. Ju. "Comparative characteristics of atherogenesis factors in patients with symptomatic and asymptomatic atherosclerotic carotid stenosis." PROBLEMS OF UNINTERRUPTED MEDICAL TRAINING AND SCIENCE 41, no. 1 (April 2021): 70–76. http://dx.doi.org/10.31071/promedosvity2021.01.070.

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To study a comparative assessment of risk factors for atherogenesis in patients with different clinical manifestations of carotid atherosclerotic stenosis. The study included 106 patients (men — 74, women — 32) aged 39 to 79 years (mean age 62.6 ± 0.9), which devided to 3 clinical groups: Group I — 35 patients with acute atherothrombotic stroke with ipsilateral carotid stenosis, group II — 41 patients after acute cerebrovascular events and carotid endarterectomy, group III — 30 patients with asymptomatic atherosclerotic carotid stenosis and the control group, which consisted of 20 relatively healthy individuals. The degree of stenosis of the internal carotid arteries was highest (> 70 %) in the group of patients who underwent carotid endarterectomy. In addition in this group was prevalence younger men, compared with the group of asymptomatic stenosis and women (p = 0.00300), there was an older age of patients and moderate stenosis of 50–69 % (p = 0.00647). In patients with stenotic atherosclerosis of the internal carotid artery, there was a significant increase in the level of Lp-PLA2 compared with the control. This confirms that Lp-PLA2 can be considered as a marker of carotid atherosclerosis and influence the development of ischemic stroke. The highest level of Lp-PLA2 was observed in the clinical group of patients who underwent carotid endarterectomy after ischemic stroke and there was a tendency to a more significant increase in total cholesterol. This suggests a more aggressive course of the atherosclerotic process in patients in this group.

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Nishizaki, J., Y. Arakawa, A. Ishii, M. Morimoto, H. Yoshizumi, Y. Goto, S. S. Yamagata, and K. Mitsudo. "Percutaneous Transluminal Angioplasty (PTA) with Wallstent for Internal Carotid Artery Stenosis." Interventional Neuroradiology 4, no. 1_suppl (November 1998): 187–90. http://dx.doi.org/10.1177/15910199980040s138.

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A 67 year-old male who had suffered from myocardial infarction, was admitted to our clinic to examine his internal carotid artery stenosis revealed by preoperative study for heart surgery. Although he had no neurological symptoms, the angiograms showed severe stenosis of his right internal carotid artery. To improve stenotic internal carotid artery, PTA was performed employing a self-expanding stent. The stenotic right internal carotid artery was improved from 75% to 11% immediately after the stenting though restenosis mildly occurred up to 16% three months later. No complication occurred during this stenting procedure. Afterwards the patient uneventfully received coronary artery bypass grafting (CABG) surgery.

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Tarasova, Irina, Olga Trubnikova, Darya Kupriyanova, Irina Kukhareva, Irina Syrova, Anastasia Sosnina, Olga Maleva, and Olga Barbarash. "Effect of Carotid Stenosis Severity on Patterns of Brain Activity in Patients after Cardiac Surgery." Applied Sciences 13, no. 1 (December 20, 2022): 20. http://dx.doi.org/10.3390/app13010020.

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Background: The negative effects of high-grade carotid stenosis on the brain are widely known. However, there are still insufficient data on the brain state in patients with small carotid stenosis and after isolated or combined coronary and carotid surgery. This EEG-based study aimed to analyze the effect of carotid stenosis severity on associated brain activity changes and the neurophysiological test results in patients undergoing coronary artery bypass grafting (CABG) with or without carotid endarterectomy (CEA). Methods: One hundred and forty cardiac surgery patients underwent a clinical and neuropsychological examination and a multichannel EEG before surgery and 7–10 days after surgery. Results: The patients with CA stenoses of less than 50% demonstrated higher values of theta2- and alpha-rhythm power compared to the patients without CA stenoses both before and after CABG. In addition, the patients who underwent right-sided CABG+CEA had generalized EEG “slowdown” compared with isolated CABG and left-sided CABG+CEA patients. Conclusions: The on-pump cardiac surgery accompanied by specific re-arrangements of frequency–spatial patterns of electrical brain activity are dependent on the degree of carotid stenoses. The information obtained can be used to optimize the process of preoperative and postoperative management, as well as the search for neuroprotection and safe surgical strategies for this category of patients.

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Heck, Donald V., Gary S. Roubin, Kenneth G. Rosenfield, William A. Gray, Christopher J. White, Tudor G. Jovin, Jon S. Matsumura, et al. "Asymptomatic carotid stenosis." Neurology 88, no. 21 (April 26, 2017): 2061–65. http://dx.doi.org/10.1212/wnl.0000000000003956.

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Two positive randomized trials established carotid endarterectomy (CEA) as a superior treatment to medical management alone for the treatment of asymptomatic carotid artery stenosis. However, advances in medical therapy have led to an active and spirited debate about the best treatment for asymptomatic carotid stenosis. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST 2) trial aims to better define the best treatment for the average patient with severe asymptomatic carotid stenosis. Enrollment in the trial may be hampered by strong opinions on either side of the debate. It is important to realize that equipoise exists and that neither the old data on CEA nor the new data on optimal medical therapy provide a rigorous answer. The assumption that medical therapy has already been proven superior to revascularization procedures may hinder both enrollment in the trial and technical advancements in revascularization procedures.

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Salman Aslam Ramdan, Mohammad Rasidi Rasani, Thinesh Subramaniam, Ahmad Sobri Muda, Ahmad Fazli Abdul Aziz, Tuan Mohammad Yusoff Shah Tuan Ya, Hazim Moria, Mohd Faizal Mat Tahir, and Mohd Zaki Nuawi. "Blood Flow Acoustics in Carotid Artery." Journal of Advanced Research in Fluid Mechanics and Thermal Sciences 94, no. 1 (April 19, 2022): 28–44. http://dx.doi.org/10.37934/arfmts.94.1.2844.

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This paper aims to identify and study the blood flow and acoustics characteristics of different degrees of stenosis in the carotid artery. Blood flow will produce acoustics, but the presence of different levels of stenosis are expected to produce different acoustic characteristics. The blood flow and acoustic characteristics are simulated by using computational fluid dynamics software (CFD). Several three-dimensional models of carotid arteries that have different degrees of stenosis are used together with a normal/healthy carotid artery - i.e., 30% and 70% degrees of blockage. The geometry of 30% and 70% stenosed model are computationally generated from a normal carotid artery geometry. In addition, the blood viscosity level was also increased in this study to a value of 0.005 kgms-1 (from the normal viscosity of 0.004 kgms-1) to compare the effect of hyperglycaemia (i.e., diabetes mellitus) that may bring additional complications to blood flow. Pulsatile simulations are used for all cases in order to mimic the exact blood flow condition in which the inlet velocity and outlet pressure change with time. The present study shows that as the degree of stenosis increases at the common carotid artery (CCA), the velocity at the internal carotid artery (ICA) and external carotid artery (ECA) outlet increases. The maximum velocity changes for ICA at the systolic peak from normal to 70% degree of stenosis for carotid artery shows an increase by 8%, while an opposite trend is observed for the maximum velocity changes of ECA at the systolic peak, where a reduction by 3% occurs from normal to 70% degree of stenosis for carotid artery. In terms of viscosity, as the viscosity of the blood increases, the velocity of the blood flow decreases in all geometry carotid arteries and may potentially provide further complications on clinical problems. The acoustic simulation showed that the acoustic power increases by 5% and 20% for carotid artery geometry that has 30% and 70% degree of stenosis, respectively. The present study indicates potential for further developing non-invasive acoustic means to diagnose and measure stenosis in carotid arteries.

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Globa, M. V. "Ultrasound detection of cerebral microembolism in carotid stenoses: progress and perspective (A review of the literature)." Endovascular Neuroradiology 31, no. 1 (July 7, 2020): 56–67. http://dx.doi.org/10.26683/2304-9359-2020-1(31)-56-67.

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The review summarizes available information regarding the method of Transcranial doppler sonography (TCD) usage to record microembolism in patients with carotid artery stenosis, search for information was carried out in literature 1997–2020 (PUBMED, MEDLINE).History overview of TCD with embolodetection implementation is presented, as well as ways of its technical and methodological improvement. Evidence-based studies of the method clinical relevance in atherosclerotic carotid stenoses and their surgical treatment are outlined. Observation results of the intraoperative cerebral embolization during carotid endarterectomy and carotid artery stenting are presented along with comparison of TCD-embolodetection data, neuroimaging and clinical outcomes. Individual centres and multicenter study ACES data on prognostic value of registration of embolic signals in asymptomatic carotid stenosis, risk assessment of vascular events in diffe-rent groups of patients and in varying degrees of stenosis of the vessel lumen was analyzed. The role of embolodetection in predicting repeated cerebrovascular disorders in symptomatic carotid stenosis and its importance for monitoring antiplatelet therapy is set out (multicenter study CARESS). The evidence of the reliability of TCD embolodetection as tool for verificarion of at-risk patients with carotid stenosis who may benefit ftom surgical treatment is presented.Recent advances in ultrasound and other imaging techniques for assessing unstable plague are outlined along with prospects for the use of TCD monitoting for cerebrovascular disorders forecasting.

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Bez, Leonardo Ghizoni, and Túlio Pinho Navarro. "Study of carotid disease in patients with peripheral artery disease." Revista do Colégio Brasileiro de Cirurgiões 41, no. 5 (October 2014): 311–18. http://dx.doi.org/10.1590/0100-69912014005003.

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Objective: To study the stenosis of the carotid arteries in patients with symptomatic peripheral arterial disease.Methods: we assessed 100 consecutive patients with symptomatic peripheral arterial disease in stages of intermittent claudication, rest pain or ulceration. Carotid stenosis was studied by echo-color-doppler, and considered significant when greater than or equal to 50%. We used univariate analysis to select potential predictors of carotid stenosis, later taken to multivariate analysis.Results: The prevalence of carotid stenosis was 84%, being significant in 40% and severe in 17%. The age range was 43-89 years (mean 69.78). Regarding gender, 61% were male and 39% female. Half of the patients had claudication and half had critical ischemia. Regarding risk factors, 86% of patients had hypertension, 66% exposure to smoke, 47% diabetes, 65% dyslipidemia, 24% coronary artery disease, 16% renal failure and 60% had family history of cardiovascular disease. In seven patients, there was a history of ischemic cerebrovascular symptoms in the carotid territory. The presence of cerebrovascular symptoms was statistically significant in influencing the degree of stenosis in the carotid arteries (p = 0.02 at overall assessment and p = 0.05 in the subgroups of significant and non-significant stenoses).Conclusion: the study of the carotid arteries by duplex scan examination is of paramount importance in the evaluation of patients with symptomatic peripheral arterial disease, and should be systematically conducted in the study of such patients.

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Howard, Peter, Eric S. Bartlett, Sean P. Symons, Allan J. Fox, and R. I. Aviv. "Measurement of Carotid Stenosis on Computed Tomographic Angiography: Reliability Depends on Postprocessing Technique." Canadian Association of Radiologists Journal 61, no. 3 (June 2010): 127–32. http://dx.doi.org/10.1016/j.carj.2009.10.013.

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Purpose We previously demonstrated the validity of axial source (AxS) image quantification of computed tomographic angiography (CTA) visualized carotid stenosis. There is concern that AxS images may not accurately measure stenosis in patients with obliquely orientated stenosis and that measurements on axial oblique (AxO) multiplanar reformats (MPR), maximum intensity projections (MIP) images, or Doppler ultrasound (DUS) are superior. We tested the performance of AxS images against AxO MPRs, MIPs, and DUS techniques for stenosis quantification. Methods A total of 120 consecutive patients with CTA and DUS detected carotid disease were enrolled; carotids with occlusion, near occlusion, or stenosis <40% were excluded. Proximal and distal carotid diameters and North American Symptomatic Carotid Endarterectomy Trial (NASCET) style ratios were measured independently by 2 neuroradiologists on AxS, AxO, and MIP images on separate occasions in a blinded protocol. Intra- and interobserver agreements were determined for all measurements. The performance of different image types to identify ≥70% stenosis was assessed against a NASCET-style reference standard. Results Intra- and interobserver reliabilities for stenosis measurements were higher for both AxS (interclass correlation coefficients [ICC], 0.87–0.93 and 0.84–0.89) and AxO images (ICCs, 0.82–0.89 and 0.86–0.92) than for MIPs (ICCs, 0.66–0.86 and 0.79–0.82), respectively. Intra- and interobserver agreements on the NASCET ratio tended to be lower than proximal stenosis measurements. AxS and AxO image proximal stenosis measurements most accurately distinguished patients with ≥70% stenosis (0.90), followed by DUS (0.83) and MIP images (0.76). Conclusions A single AxS image stenosis measurement was highly reproducible and accurate in the estimation of carotid stenosis, which precluded the need for AxO MPRs.

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Thineshwaran Subramaniam and Mohammad Rasidi Rasani. "Pulsatile CFD Numerical Simulation to investigate the effect of various degree and position of stenosis on carotid artery hemodynamics." Journal of Advanced Research in Applied Sciences and Engineering Technology 26, no. 2 (April 10, 2022): 29–40. http://dx.doi.org/10.37934/araset.26.2.2940.

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This study is intended to investigate the effect of various degree and position (pre-bifurcation and post-bifurcation) of stenosis on carotid artery hemodynamics trough realistic CFD numerical simulations with appropriate turbulence model. The blood rheological properties were assumed as incompressible and Newtonian fluid. A 3 dimensional model of a non-stenotic carotid artery model was used this investigation. Several turbulence model were tested. The non-stenotic artery geometry was altered as 30% and 70%pre-bifurcation stenosis model, 30% and 70% post-bifurcation stenosis model. Pulsatile simulations were conducted for the non-stenotic and each stenotic artery models. The SST k-ω with Low-Reynolds number was found to be more appropriate for the simulation. As the degree of pre-bifurcation stenosis increases from 30% to 70%, the ICA maximum velocity increases from 12% to 65%. Also, the ECA maximum velocity increases from 5% to 45%. Besides, the ICA velocity ratio decreases by 22% but the ECA velocity ratioincreases by 101%. As the degree of post-bifurcation stenosis increases, the ICA maximum velocity takes a longer time to decrease after the peak systole velocity and the ECA maximum velocity becomes higher than a non-stenotic artery throughout the cardiac cycle. A mild stenosis at post-bifurcation does not show much effect on the carotid artery hemodynamics. However, even a mild stenosis at pre-bifurcation resulted in fluctuating maximum velocity at both ICA and ECA, especially during the diastole of the cardiac cycle

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Johansson, Elias, Hadas Benhabib, Wendy Herod, Julia Hopyan, Matylda Machnowska, Robert Maggisano, Richard Aviv, and Allan J. Fox. "Carotid near-occlusion can be identified with ultrasound by low flow velocity distal to the stenosis." Acta Radiologica 60, no. 3 (June 13, 2018): 396–404. http://dx.doi.org/10.1177/0284185118780900.

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Background Most carotid near-occlusions are indistinguishable from conventional ≥ 50% stenosis on ultrasound, demonstrating high peak systolic velocity (PSV) in the stenosis. Purpose To study whether the velocity distal to the stenosis can separate high PSV near-occlusion from conventional ≥ 50% stenosis. Material and Methods We included patients with ≥ 50% carotid stenosis with high PSV (≥125 cm/s), examined with both computed tomography angiography (CTA) and ultrasound within 30 days, and a distal velocity measurement was performed. Based on CTA, cases were divided into three groups: conventional stenosis; near-occlusion without full collapse (NwoC; normal-appearing albeit small distal artery); and near-occlusion with full collapse (NwC; threadlike distal artery). Distal Doppler ultrasound flow velocities were compared between these groups. Results Sixty patients were included: 33 patients with conventional stenosis; 20 patients with NwoC; and seven patients with NwC. Mean distal PSV was 93, 63, and 21 cm/s ( P < 0.001) and mean distal end-diastolic velocity was 30, 24, and 5 cm/s ( P < 0.001), respectively. A distal PSV < 50 cm/s was 63% sensitive and 94% specific for separating both types of near-occlusion from conventional stenosis. Conclusion In high PSV carotid stenoses, the distal velocity was lower in near-occlusions than conventional carotid stenosis. Distal velocities warrant further investigation in diagnostic studies.

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Mayberg, Marc R. "Carotid artery stenosis." Journal of Neurosurgery 99, no. 2 (August 2003): 225–27. http://dx.doi.org/10.3171/jns.2003.99.2.0225.

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Okuma, Yu. "Carotid artery stenosis." Okayama Igakkai Zasshi (Journal of Okayama Medical Association) 122, no. 3 (2010): 265–67. http://dx.doi.org/10.4044/joma.122.265.

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Woo, Edward Y., and Joshua Dearing. "Carotid Artery Stenosis." Vascular and Endovascular Review 2, no. 1 (April 5, 2019): 40–44. http://dx.doi.org/10.15420/ver.2018.14.2.

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Stroke is one of the leading causes of death in the world and carotid artery stenosis is a major cause of ischaemic strokes. Symptomatic patients are often treated with either carotid endarterectomy (CEA) or carotid artery stenting (CAS). Asymptomatic patients can be treated with best medical therapy, CEA or CAS. While guidelines exist for the management of carotid artery stenosis, the results of recent studies are controversial regarding the safety of CAS compared with CEA. This review aims to outline the current guidelines while reviewing up-to- date studies and analyses. Future studies and emerging technologies are outlined in an attempt to provide an evaluation of the current data and management of this complex problem.

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Kavitha, D. "Carotid Artery Stenosis." International Journal of Advances in Nursing Management 8, no. 1 (2020): 100. http://dx.doi.org/10.5958/2454-2652.2020.00024.4.

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Jaigobin, Cheryl S., and James R. Perry. "Carotid artery stenosis." Postgraduate Medicine 96, no. 5 (November 1994): 61–72. http://dx.doi.org/10.1080/00325481.1994.11945907.

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Kim, Uoo R., and Rae M. Allain. "Carotid Artery Stenosis." International Anesthesiology Clinics 54, no. 2 (2016): 33–51. http://dx.doi.org/10.1097/aia.0000000000000094.

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Alexandrov, Andrei V., and Laurence Needleman. "Carotid Artery Stenosis." Stroke 43, no. 3 (March 2012): 627–28. http://dx.doi.org/10.1161/strokeaha.111.645457.

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Sacco, Ralph L. "Extracranial Carotid Stenosis." New England Journal of Medicine 345, no. 15 (October 11, 2001): 1113–18. http://dx.doi.org/10.1056/nejmcp011227.

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DAS, MOHAN B., NORMAN R. HERTZER, and NORMAN B. RATLIFF. "Recurrent Carotid Stenosis." Annals of Surgery 202, no. 1 (July 1985): 28–35. http://dx.doi.org/10.1097/00000658-198507000-00004.

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PIEPGRAS, DAVID G., W. RICHARD MARSH, LYNN A. MUSSMAN, THORALF M. SUNDT, and NICOLEE C. FODE. "Recurrent Carotid Stenosis." Annals of Surgery 203, no. 2 (February 1986): 205–13. http://dx.doi.org/10.1097/00000658-198602000-00015.

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Bissacco, Daniele. "Carotid Artery Stenosis." Angiology 68, no. 1 (September 28, 2016): 87–88. http://dx.doi.org/10.1177/0003319716664609.

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Spence, J. David, David Pelz, and Frank J. Veith. "Asymptomatic Carotid Stenosis." Stroke 45, no. 3 (March 2014): 655–57. http://dx.doi.org/10.1161/strokeaha.111.626770.

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Meissner, Irene. "Symptomatic Carotid Stenosis." Journal of Neurosurgical Anesthesiology 8, no. 4 (October 1996): 308–9. http://dx.doi.org/10.1097/00008506-199610000-00010.

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&NA;. "Symptomatic Carotid Stenosis." Journal of Neurosurgical Anesthesiology 9, no. 1 (January 1997): 109. http://dx.doi.org/10.1097/00008506-199701000-00110.

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Jonas, S. "Asymptomatic carotid stenosis." Stroke 16, no. 5 (September 1985): 900–901. http://dx.doi.org/10.1161/01.str.16.5.900.

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Bladin, C. F., A. V. Alexandrov, J. Murphy, R. Maggisano, and J. W. Norris. "Carotid Stenosis Index." Stroke 26, no. 2 (February 1995): 230–34. http://dx.doi.org/10.1161/01.str.26.2.230.

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Moore, Wesley S., Richard F. Kempczinski, J. J. Nelson, and James F. Toole. "Recurrent Carotid Stenosis." Stroke 29, no. 10 (October 1998): 2018–25. http://dx.doi.org/10.1161/01.str.29.10.2018.

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Journal articles on the topic 'Carotid stenosis'

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