BACKGROUND The topography between the common carotid artery(CA),internal CA,and external CA(ECA)with the greater horn of the hyoid bone(GHHB)is of particular importance for anatomists,radiologists and neck surgeons.AI...BACKGROUND The topography between the common carotid artery(CA),internal CA,and external CA(ECA)with the greater horn of the hyoid bone(GHHB)is of particular importance for anatomists,radiologists and neck surgeons.AIM To investigate these topographical relationships emphasizing anatomical classification,sexual dimorphism,and clinical significance.METHODS A retrospective study was performed on 224 computed tomography angiographies from a cohort comprising 161 male and 63 female patients,with a mean age of 63.2 years.Multiplanar and three-dimensional reconstructions were executed utilizing Horos software.The spatial relationships between the CA and hyoid bone were categorized based on the 12-type classification system delineated by Manta et al in 2023.The data were subsequently stratified by sex and laterality.RESULTS Type 0(no arterial contact with the GHHB)was the most common configuration(46.9%),followed by type VI(ECA lateral to GHHB,23.9%)and type VIII(internal CA and ECA lateral to GHHB,13.2%).Bilateral symmetry was present in 54.02%of cases,mainly in males.Statistically significant sex-based differences were found(P=0.012),while laterality was not significant(P=0.779).CONCLUSION Carotid–hyoid topography displays significant anatomical variation with clinically essential patterns.Non-null variants,such as types VI and VIII,may increase the risk of dynamic carotid compression,especially in younger patients with cryptogenic cerebrovascular symptoms.Recognizing these variants during preoperative imaging is crucial to minimize surgical risk and inform patient care.展开更多
This study aimed to summarize therapy experience of carotid endarterectomy, carotid endarterec- tomy combined with Fogarty catheter embolectomy, and hybrid surgery for the treatment of extrac- ranial internal carotid ...This study aimed to summarize therapy experience of carotid endarterectomy, carotid endarterec- tomy combined with Fogarty catheter embolectomy, and hybrid surgery for the treatment of extrac- ranial internal carotid artery occlusion. The study included 65 patients with extracranial internal ca- rotid artery occlusion who underwent carotid endarterectomy, carotid endarterectomy combined with Fogarty catheter embotectomy, or hybrid surgery in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China between January 2006 and December 2012. Prior to surgery, all patients underwent perfusion CT or xenon CT to evaluate the occlusion. The procedure for each patient was chosen according to digital subtraction angiography data. The carotid artery was successfully recanalized in 46 of 51 patients who underwent carotid endarterectomy, 9 of 10 patients who underwent carotid endarterectomy combined with Fogarty catheter embolectomy, and 3 of 4 patients who underwent hybrid surgery. In patients with symptomatic carotid artery occlusion, the carotid artery can be recanalized by choosing a treatment procedure based on imaging ex- amination findings.展开更多
Background:Carotid artery pseudoaneurysm in children is rare;typically caused by trauma;surgical interventions and infection.These aneurysms can lead to signiffcant neurological and vascular risks;and their management...Background:Carotid artery pseudoaneurysm in children is rare;typically caused by trauma;surgical interventions and infection.These aneurysms can lead to signiffcant neurological and vascular risks;and their management remains challenging.While endovascular therapy has become the standard for giant pseudoaneurysms in adults;its use in children is limited.No established guidelines or long-term safety data exist for pediatric endovascular treatment.We present a child who developed a carotid artery pseudoaneurysm after venoarterial extracorporeal membrane oxygenation(VA-ECMO)support and heart transplantation;highlighting the management strategies and outcomes.Case Description:A 4-year-old boy with dilated cardiomyopathy was admitted for congestive heart failure and subsequently required VA-ECMO support due to worsening hemodynamics.After heart transplantation;the patient developed a persistent hoarseness and a rapidly enlarging neck mass.Imaging conffrmed the presence of a giant carotid artery pseudoaneurysm.Balloon occlusion-guided digital subtraction angiography(DSA)revealed adequate collateral circulation;allowing successful carotid artery ligation and pseudoaneurysm resection.Postoperative recovery was uneventful;with no neurological deffcits or complications;and regular follow-up conffrmed no further adverse sequelae.Conclusions:Management of carotid artery pseudoaneurysms in pediatric patients remains challenging.Under the guidance of DSA and with the assistance of balloon occlusion;precise aneurysm resection and vascular reconstruction can be achieved.In the event that vascular conditions limit the success of the repair;the balloon’s ability to occlude the parent artery and supplying vessels can safely facilitate the ligation of the parent artery of the aneurysm.展开更多
BACKGROUND Carotid atherosclerosis is a common complication in patients with type 2 diabetes mellitus(T2DM)and is closely associated with an increased risk of cardiovascular events.AIM To identify the key demographic,...BACKGROUND Carotid atherosclerosis is a common complication in patients with type 2 diabetes mellitus(T2DM)and is closely associated with an increased risk of cardiovascular events.AIM To identify the key demographic,clinical,and biochemical factors associated with carotid plaque formation in T2DM patients and evaluate their predictive value.METHODS This retrospective study included 266 T2DM patients(control group,n=158;observation group,n=108)recruited between January 2021 and July 2024.Participants underwent carotid ultrasonography to measure intima-media thickness(IMT)and detect carotid plaques.Comprehensive demographic and biochemical data,including age,body mass index(BMI),fasting plasma glucose(FPG),glycated hemoglobin(HbA1c),serum creatinine(Scr),urinary albumin-to-creatinine ratio(UACR),and serum uric acid(SUA),were collected.Statistical analyses,including Pearson correlation,logistic regression,and receiver operating characteristic(ROC)curve analysis,were performed to identify and evaluate factors associated with carotid plaque formation.RESULTS Significant differences in age,BMI,HbA1c,FPG,Scr,UACR,and SUA were observed between groups(all P<0.05).Pearson correlation analysis showed IMT was positively associated with age,FPG,HbA1c,Scr,UACR,and SUA,and negatively with HDL-C.Multivariate logistic regression identified age(OR=1.050,95%CI:1.015-1.087),FPG(OR=1.096,95%CI:1.006-1.192),HbA1c(OR=1.234,95%CI:1.057-1.445),SBP(OR=1.018,95%CI:1.002-1.034),Scr(OR=1.029,95%CI:1.011-1.046),UACR(OR=1.024,95%CI:1.010-1.037),SUA(OR=1.006,95%CI:1.003-1.009),and HDL-C(OR=0.329,95%CI:0.119-0.917)as independent predictors of IMT(all P<0.05).ROC analysis showed UACR(AUC=0.718)and SUA(AUC=0.651)had predictive value for carotid plaque.CONCLUSION This study highlights the multifactorial nature of carotid atherosclerosis in T2DM,with age,BMI,poor glycemic control,renal dysfunction,and metabolic disturbances identified as key risk factors.The findings underscore the importance of comprehensive risk assessment and targeted interventions to prevent vascular complications in this high-risk population.展开更多
Carotid artery plaques represent a major contributor to the morbidity and mortality associated with cerebrovascular disease,and their clinical significance is largely determined by the risk linked to plaque vulnerabil...Carotid artery plaques represent a major contributor to the morbidity and mortality associated with cerebrovascular disease,and their clinical significance is largely determined by the risk linked to plaque vulnerability.Therefore,classifying plaque risk constitutes one of themost critical tasks in the clinicalmanagement of this condition.While classification models derived from individual medical centers have been extensively investigated,these singlecenter models often fail to generalize well to multi-center data due to variations in ultrasound images caused by differences in physician expertise and equipment.To address this limitation,a Dual-Classifier Label Correction Networkmodel(DCLCN)is proposed for the classification of carotid plaque ultrasound images acrossmultiplemedical centers.TheDCLCNdesigns amulti-center domain adaptationmodule that leverages a dual-classifier strategy to extract knowledge from both source and target centers,thereby reducing feature discrepancies through a domain adaptation layer.Additionally,to mitigate the impact of image noise,a label modeling and correction module is introduced to generate pseudo-labels for the target centers and iteratively refine them using an end-to-end correction mechanism.Experiments on the carotid plaque dataset collected fromthreemedical centers demonstrate that the DCLCN achieves commendable performance and robustness.展开更多
The application of artificial intelligence(AI)in carotid atherosclerotic plaque detection via computed tomography angiography(CTA)has significantly ad-vanced over the past decade.This mini-review consolidates recent i...The application of artificial intelligence(AI)in carotid atherosclerotic plaque detection via computed tomography angiography(CTA)has significantly ad-vanced over the past decade.This mini-review consolidates recent innovations in deep learning architectures,domain adaptation techniques,and automated pl-aque characterization methodologies.Hybrid models,such as residual U-Net-Pyramid Scene Parsing Network,exhibit a remarkable precision of 80.49%in plaque segmentation,outperforming radiologists in diagnostic efficiency by reducing analysis time from minutes to mere seconds.Domain-adaptive fra-meworks,such as Lesion Assessment through Tracklet Evaluation,demonstrate robust performance across heterogeneous imaging datasets,achieving an area under the curve(AUC)greater than 0.88.Furthermore,novel approaches inte-grating U-Net and Efficient-Net architectures,enhanced by Bayesian optimi-zation,have achieved impressive correlation coefficients(0.89)for plaque quanti-fication.AI-powered CTA also enables high-precision three-dimensional vascular segmentation,with a Dice coefficient of 0.9119,and offers superior cardiovascular risk stratification compared to traditional Agatston scoring,yielding AUC values of 0.816 vs 0.729 at a 15-year follow-up.These breakthroughs address key challenges in plaque motion analysis,with systolic retractive motion biomarkers successfully identifying 80%of vulnerable plaques.Looking ahead,future directions focus on enhancing the interpretability of AI models through explainable AI and leveraging federated learning to mitigate data heterogeneity.This mini-review underscores the transformative potential of AI in carotid plaque assessment,offering substantial implic-ations for stroke prevention and personalized cerebrovascular management strategies.展开更多
Type 2 diabetes mellitus(T2DM)promotes a risk of the development of atherosclerosis and potentiates atherosclerotic cardiovascular events.Among these patients,chronic hyperglycemia,dyslipidemia,oxidative stress and sy...Type 2 diabetes mellitus(T2DM)promotes a risk of the development of atherosclerosis and potentiates atherosclerotic cardiovascular events.Among these patients,chronic hyperglycemia,dyslipidemia,oxidative stress and systemic inflammation has been found as triggers for accelerating plaque formation.Additionally,conventionally used risk factors,such as age,overweight/obesity,hypertension,poor glycemic control,renal dysfunction,and metabolic disturbances frequently underestimate the patients at the risk of asymptomatic carotid atherosclerosis.Further interventions may be required to prevent vascular complications.To note,asymptomatic carotid plaque in T2DM is associated with older age,increased body mass index,biomarkers of poor glycemic control(glycated hemoglobin,fasting glucose),kidney dysfunction[urinary albumin-to-creatinine ratio(UACR)],and metabolic abnormalities[high-density lipoprotein cholesterol,serum uric acid(SUA)].However,renal(UACR)and metabolic(SUA)biomarkers are likely to be investigated as promising biomarkers for early stage of asymptomatic coronary atherosclerosis,which as expecting could improve diagnostic value of intima-media thickness.展开更多
Background:Subcortical ischemic vascular dementia(SIVD)is a common subtype of vascular dementia.Currently,the bilateral common carotid artery stenosis(BCAS)mouse model is the most suitable SIVD rodent model.In this st...Background:Subcortical ischemic vascular dementia(SIVD)is a common subtype of vascular dementia.Currently,the bilateral common carotid artery stenosis(BCAS)mouse model is the most suitable SIVD rodent model.In this study,we investigated the functional and structural impairments in the hippocampus 1 month after BCAS.Methods:We used behavioral tests,laser speckle flowmetry,long-term potentiation,histochemical staining,molecular experiments,and voxel-based morphometry to evaluate the hippocampal impairments.Results:Behavioral studies revealed that BCAS mice exhibited worse performance.Laser speckle flowmetry detected an obvious decrease in cerebral blood flow.The synaptic plasticity of the perforant path-dentate gyrus pathway was inhibited.Decreased fractional anisotropy and increased mean diffusivity were detected in the hippocampus via diffusion tensor imaging data.A reduction in gray matter volume,which was most prominent in the hippocampus and its surrounding areas,was de-tected via voxel-based morphometry analysis.Impairments in cell morphology and myelin integrity were validated using histochemical staining and molecular biology techniques.In addition,the numbers of GFAP+astrocytes and Iba1+microglia in-creased in the hippocampus.Conclusions:Overall,our study demonstrates early functional and structural impair-ments in the hippocampus contributing to learning and memory deficits after 1 month of BCAS,indicating that the hippocampus is vulnerable to chronic cerebral ischemia.展开更多
BACKGROUND Carotid atherosclerosis is a complex disease involving multiple cellular and molecular pathways.Mesenchymal stem cells(MSCs)show therapeutic potential,but their optimal targets and efficacy are still under ...BACKGROUND Carotid atherosclerosis is a complex disease involving multiple cellular and molecular pathways.Mesenchymal stem cells(MSCs)show therapeutic potential,but their optimal targets and efficacy are still under study.MiR-126 enhances endothelial function and promotes angiogenesis by relieving vascular endothelial growth factor signaling suppression,suggesting its potential in vascular rege-neration.However,its role in directing stem cell differentiation toward endo-thelial lineages remains unclear.We hypothesize that miR-126 may influence MSCs’immunomodulatory and vascular reparative functions via the mitogen-activated protein kinases/extracellular signal-regulated kinase(MAPK/ERK)pathway,thereby improving carotid atherosclerosis.This study explores this mechanism to provide novel insights and support the development of miR-126-based therapeutic strategies.AIM To verify if miR-126 inhibits carotid atherosclerosis via the MAPK/ERK pathway.METHODS Rat bone marrow MSCs(product No.CP-R131,Wuhan,China)were verified by flow cytometry.The effects of miR-126 on MSCs’proliferation,migration,apoptosis,and cytokine expression were explored using microRNA mimics and inhibitors.Fluorescence staining quantified CD31+cells to evaluate endothelial differentiation.In vivo differentiation was assessed,and MSCs were transplanted into a rat carotid artery balloon dilatation model.Rats were randomly divided into five groups:Control,negative control mimics,miR-126 mimics,negative control inhibitor,and miR-126 inhibitor.RESULTS In vitro,MSCs treated with miR-126 mimics demonstrated enhanced proliferation,increased migration,and reduced apoptosis.These miR-126 mimics also significantly increased the secretion of vascular endothelial growth factor and basic fibroblast growth factor.Fluorescence and tissue staining indicated a higher proportion of CD31+cells in the miR-126 mimics group.Additionally,the expression of endothelial-related genes(von Willebrand factor,endothelial nitric oxide synthase,and vascular endothelial-cadherin)was upregulated in this group.In vivo,miR-126-transfected MSCs effectively reduced neointimal thickness and promoted endothelial coverage in rats.MiR-126 stimulated MSC proliferation in a dose-dependent manner and reduced p38 and ERK1/2 phosphorylation.Conversely,miR-126 inhibition or blank controls resulted in opposing effects.CONCLUSION MiR-126 exerts significant modulatory effects on the immunoregulatory and vascular reparative functions of MSCs through the MAPK/ERK signaling pathway,promoting their differentiation into endothelial cells and thereby mitigating atherosclerosis.展开更多
BACKGROUND Obesity is a major health problem due to its high prevalence.The relationship between obesity and cardiovascular disease is unclear.Some studies agree that certain conditions associated with obesity,such as...BACKGROUND Obesity is a major health problem due to its high prevalence.The relationship between obesity and cardiovascular disease is unclear.Some studies agree that certain conditions associated with obesity,such as physical inactivity or cardiovascular risk factors,are responsible for cardiovascular risk excess among obese people.Carotid intima-media thickness and carotid plaques(CP)have been associated with cardiovascular adverse events in healthy populations,and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients.However,there are no studies correlating subclinical atherosclerosis and adverse events(AE)in obese subjects.AIM To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography(EE).METHODS From January 1,2006 to December 31,2010,2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography.Exclusion criteria included previous vascular disease,left ventricular ejection fraction<50%,positive EE,significant valvular heart disease and inferior to submaximal EE.An AE was defined as all-cause mortality,myocardial infarction and cerebrovascular accident.Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus.RESULTS Of the 652 patients who fulfilled the inclusion criteria,226(34.7%)had body mass indexes≥30 kg/m2,and 76 of them(33.6%)had CP.During a mean follow-up time of 8.2(2.1)years,27 AE were found(11.9%).Mean event-free survival at 1,5 and 10 years was 99.1%(0.6),95.1%(1.4)and 86.5%(2.7),respectively.In univariate analysis,CP predicted AE[hazard ratio(HR)2.52,95%confidence interval(CI)1.17-5.46;P=0.019].In multivariable analysis,the presence of CP remained a predictor of AE(HR 2.26,95%CI 1.04-4.95,P=0.041).Other predictors identified were glomerular filtration rate(HR 0.98,95%CI 0.96-0.99;P=0.023),peak metabolic equivalents(HR 0.83,95%CI 0.70–0.99,P=0.034)and moderate mitral regurgitation(HR 5.02,95%CI 1.42–17.75,P=0.012).CONCLUSION Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE.These patients could benefit from aggressive prevention measures.展开更多
BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantag...BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke.Physical examination showed decreased strength(5-/5)in both lower limbs.Carotid artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,respectively.We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation.Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence.CTA six months postoperatively showed no significant increase in in-stent stenosis.Case 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by ultrasound.Physical examination showed no positive neurological signs.Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA dissection.CAS was performed and intraoperative IVUS suggested a large residual false lumen.Post-stent balloon dilatation was performed reducing the false lumen.DSA three months postoperatively indicated good stent expansion with mild stenosis.CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperatively.展开更多
BACKGROUND Acute carotid stent thrombosis(ACST)is a rare but devastating complication in the carotid artery stenting(CAS)procedure.The aim of this article is to report a case and review cases of ACST reported in the l...BACKGROUND Acute carotid stent thrombosis(ACST)is a rare but devastating complication in the carotid artery stenting(CAS)procedure.The aim of this article is to report a case and review cases of ACST reported in the literature,and investigate risk factors and management strategies for ACST.CASE SUMMARY We reviewed the treatment process of a patient with ACST after CAS.Then multiple databases were systematically searched to identify studies reporting ACST from 2005 to 2020.The demographic data,risk factors,treatment strategies,and prognosis were extracted and analyzed.CONCLUSION The reason for ACST is multifactorial.Proper patient selection,normative antiplatelet treatment,and perfect technical detail may decrease the incidence of ACST.Several treatment strategies such as thrombolysis,mechanical thrombectomy,and open surgery may be options for the treatment of ACST.Limited data have shown that carotid endarterectomy is effective with favorable results.展开更多
The optimal velocity encoding of phase-contrast magnetic resonance angiography （PC MRA） in measuring cerebral blood flow volume （BFV） ranges from 60 to 80 cm/s. To verify the accuracy of two-dimensional （2D） PC ...The optimal velocity encoding of phase-contrast magnetic resonance angiography （PC MRA） in measuring cerebral blood flow volume （BFV） ranges from 60 to 80 cm/s. To verify the accuracy of two-dimensional （2D） PC MRA, the present study localized the region of interest at blood vessels of the neck using PC MRA based on three-dimensional time-of-flight sequences, and the velocity encoding was set to 80 cm/s. Results of the measurements showed that the error rate was 7.0±6.0% in the estimation of BFV in the internal carotid artery, the external carotid artery and the ipsilateral common carotid artery. There was no significant difference, and a significant correlation in BFV between internal carotid artery ＋ external carotid artery and ipsilateral common carotid artery. In addition, the BFV of the common carotid artery was correlated with that of the ipsilateral internal carotid artery. The main error was attributed to the external carotid artery and its branches. Therefore, after selecting the appropriate scanning parameters and protocols, 2D PC MRA is more accurate in the determination of BFV in the carotid arteries.展开更多
In this commentary on the article entitled“Acute carotid stent thrombosis:A case report and literature review”,the key points of the article are discussed.Acute carotid stent thrombosis(ACST)in the setting of caroti...In this commentary on the article entitled“Acute carotid stent thrombosis:A case report and literature review”,the key points of the article are discussed.Acute carotid stent thrombosis(ACST)in the setting of carotid artery stenting(CAS)represents a rare but potentially catastrophic event.There is a wide range of treatment options available,including carotid endarterectomy,which is generally recommended for cases of refractory ACST.While there is no standard treatment regimen,dual antiplatelet therapy is typically recommended both before and after CAS to reduce risk of ACST.展开更多
Objective: To investigate the correlation between fundus atherosclerosis and carotid arterial atherosclerosis. Methods: A total of 516 people undergoing physical examination in Deyang People’s Hospital between June 2...Objective: To investigate the correlation between fundus atherosclerosis and carotid arterial atherosclerosis. Methods: A total of 516 people undergoing physical examination in Deyang People’s Hospital between June 2020 and December 2022 were randomly selected. Fundus atherosclerosis and carotid arterial atherosclerosis were evaluated by fundus photography and carotid artery ultrasonography, respectively. Results: Among the 516 physical examination patients, 198 (38.4%) had normal fundus examination, and 318 (61.6%) had fundus arteriosclerosis. Among them, 166 cases were of grade I (32.2%), 86 cases were of grade II (16.7%), and 66 cases were of grade III (12.8%). There were 286 cases (55.4%) without carotid atherosclerosis, 201 cases (38.9%) with carotid atherosclerotic plaque, and 33 cases (6.4%) with carotid stenosis. Fundus arteriosclerosis is independently associated with carotid artery intima-media thickness, vulnerable plaques, plaque scores, and carotid artery stenosis (P Conclusion: In summary, there is a close relationship between carotid artery disease and the degree of arteriosclerosis in the eyeground. Fundus photography is a simple, non-invasive, and easily acceptable method of inspection. The results obtained from it are useful in determining the severity of carotid atherosclerosis and guiding early detection and intervention in clinical cases. This can help reduce the incidence of cardiovascular and cerebrovascular diseases.展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Objectives: </strong>To study relationship between carotid artery plaques characteristics and ha...<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Objectives: </strong>To study relationship between carotid artery plaques characteristics and haemodynamic changes after carotid stenting. <strong>Patients and Methods: </strong>This observational prospective (pilot) study included 20 patients—who underwent CAS. The study was carried out in Ain shams university hospitals—Railway hospital (ERMED) and Suez insurance hospital from December 2018 to February 2020. Inclusion criteria, Symptomatic (defined as amaurosis fugax, TIA, Minor stroke or Major stroke) stenosis > 70%. Asymptomatic stenosis > 80% (accidentally discovered during pre-operative assessment for CABG and during full assessment for irrelevant stroke). <strong>Results:</strong> Regarding to plaque character for degree of stenosis, calcification and ulceration revealed significantly higher degree of stenosis in hemodynamic events group (P = 0.024). On the other hand, that there was no statistically significant difference between the two groups as regard calcification, ulceration and lesion location. <strong>Conclusion: </strong>The study revealed that HI is a common occurrence following CAS procedures and significantly higher degree of stenosis in hemodynamic events group. Plaque shape, ulcerations hardly affect haeodynamic instability after carotid stenting.</span> </div>展开更多
Objective: To make a further understanding of the DSA features of the carotid body tumor (CBT) and to explore the clinical value of DSA diagnosis and interventional treatment for CBT. Methods: Twelve cases of CBT with...Objective: To make a further understanding of the DSA features of the carotid body tumor (CBT) and to explore the clinical value of DSA diagnosis and interventional treatment for CBT. Methods: Twelve cases of CBT with DSA data were analyzed retrospectively. The DSA appearances in all of the patients were observed dynamically in a double blind manner by two experienced radiologists together and a consensus interpretation formed. Results: DSA could establish definitive diagnosis in all cases. The DSA features of the CBT were: the increase of bifurcation angles of internal and external carotid arteries in all cases; the CBT supplied by external carotid arteries in most cases and the significant increase of tumor vessels in bifurcation; invasion of internal or external carotid arteries in 6 cases. The tumor staining disappeared mostly after the supplying arteris were embolized in 2 cases, and the bleeding during the operation reduced significantly. Conclusion: The DSA is useful in the diagnosis of the CBT and for therapeutic planning. The pre-operation embolization of the CBT contributes to reduce the bleeding during operation.展开更多
Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe...Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe carotid artery stenosis who underwent CAS and CEA in the First People's Hospital of Changde City(hereafter referred as "our hospital")from January 2018 to December 2020 were selected as the research objects and divided into CAS group(n=43)and CEA group(n=45).To understand the clinical application value and feasibility of the two surgical schemes by comparing the general situation,cerebral blood flow,MMSE scale,MOCA scale score and serum miR-145,IGF1R levels of the two surgical schemes.Conclusions:CAS and CEA in the treatment of patients with severe internal carotid artery stenosis,have good curative effect,can effectively improve the patient's cerebral blood flow,regulate serum miR-145,IGF 1R levels,promote the recovery of cognitive function,but relatively speaking,the incidence of stroke and hypotension after CAS is higher,and the incidence of hypertension after CEA is higher.展开更多
AIM To investigate the association between carotid atherosclerosis and cystatin C(CysC) and to determine the optimal CysC cut-off value.METHODS One hundred twenty-eight subjects were included in this study. Atheroscle...AIM To investigate the association between carotid atherosclerosis and cystatin C(CysC) and to determine the optimal CysC cut-off value.METHODS One hundred twenty-eight subjects were included in this study. Atherosclerosis was defined as a maximum carotid plaque thickness(MCPT) of greater than 2 mm. A receiver operating characteristic curve analysis was used to determine the diagnostic value of serum CysC for atherosclerosis. The subjects were divided into two groups according to the CysC cut-off value. We screenedfor diabetes, hypertension, dyslipidemia, smoking status, alcohol consumption, and exercise behavior. The association between atherosclerosis and CysC levels was assessed using multivariate analysis.RESULTS The subjects were then divided into two groups according to the CysC cut-off value(0.73 mg/L). The median age of the high CysC group was 72 years(85% males), whereas that of the low CysC group was 61 years(63% males). The CysC levels were significantly correlated with Cr and estimated glomerular filtration rate(eGFR) values. Bodymass index, visceral fat area, hypertension, diabetes mellitus, and MCPT were significantly higher in the high CysC group than in the low CysC group. Furthermore, the eG FR was significantly lower in the high CysC group. Regarding lifestyle habits, only the exercise level was lower in the high CysC group than in the low CysC group. Multivariate analysis, adjusted for age and sex, revealed that high CysC levels were significantly associated with an MCPT of ≥ 2 mm(odds ratio: 2.92; 95%CI: 1.13-7.99).CONCLUSION Higher CysC levels were associated with an MCPT of ≥ 2 mm. The CysC cut-off value of 0.73 mg/L appears to aid in the diagnosis of atherosclerosis.展开更多
文摘BACKGROUND The topography between the common carotid artery(CA),internal CA,and external CA(ECA)with the greater horn of the hyoid bone(GHHB)is of particular importance for anatomists,radiologists and neck surgeons.AIM To investigate these topographical relationships emphasizing anatomical classification,sexual dimorphism,and clinical significance.METHODS A retrospective study was performed on 224 computed tomography angiographies from a cohort comprising 161 male and 63 female patients,with a mean age of 63.2 years.Multiplanar and three-dimensional reconstructions were executed utilizing Horos software.The spatial relationships between the CA and hyoid bone were categorized based on the 12-type classification system delineated by Manta et al in 2023.The data were subsequently stratified by sex and laterality.RESULTS Type 0(no arterial contact with the GHHB)was the most common configuration(46.9%),followed by type VI(ECA lateral to GHHB,23.9%)and type VIII(internal CA and ECA lateral to GHHB,13.2%).Bilateral symmetry was present in 54.02%of cases,mainly in males.Statistically significant sex-based differences were found(P=0.012),while laterality was not significant(P=0.779).CONCLUSION Carotid–hyoid topography displays significant anatomical variation with clinically essential patterns.Non-null variants,such as types VI and VIII,may increase the risk of dynamic carotid compression,especially in younger patients with cryptogenic cerebrovascular symptoms.Recognizing these variants during preoperative imaging is crucial to minimize surgical risk and inform patient care.
基金supported by a grant from the National 12~(th) Five-Year Science and Technology Support Plan Project,No.2011BAI08B00
文摘This study aimed to summarize therapy experience of carotid endarterectomy, carotid endarterec- tomy combined with Fogarty catheter embolectomy, and hybrid surgery for the treatment of extrac- ranial internal carotid artery occlusion. The study included 65 patients with extracranial internal ca- rotid artery occlusion who underwent carotid endarterectomy, carotid endarterectomy combined with Fogarty catheter embotectomy, or hybrid surgery in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China between January 2006 and December 2012. Prior to surgery, all patients underwent perfusion CT or xenon CT to evaluate the occlusion. The procedure for each patient was chosen according to digital subtraction angiography data. The carotid artery was successfully recanalized in 46 of 51 patients who underwent carotid endarterectomy, 9 of 10 patients who underwent carotid endarterectomy combined with Fogarty catheter embolectomy, and 3 of 4 patients who underwent hybrid surgery. In patients with symptomatic carotid artery occlusion, the carotid artery can be recanalized by choosing a treatment procedure based on imaging ex- amination findings.
基金Supported by the Scientiffc Research Project of Jiangsu Maternity and Child Health Care Association(FYX202201).
文摘Background:Carotid artery pseudoaneurysm in children is rare;typically caused by trauma;surgical interventions and infection.These aneurysms can lead to signiffcant neurological and vascular risks;and their management remains challenging.While endovascular therapy has become the standard for giant pseudoaneurysms in adults;its use in children is limited.No established guidelines or long-term safety data exist for pediatric endovascular treatment.We present a child who developed a carotid artery pseudoaneurysm after venoarterial extracorporeal membrane oxygenation(VA-ECMO)support and heart transplantation;highlighting the management strategies and outcomes.Case Description:A 4-year-old boy with dilated cardiomyopathy was admitted for congestive heart failure and subsequently required VA-ECMO support due to worsening hemodynamics.After heart transplantation;the patient developed a persistent hoarseness and a rapidly enlarging neck mass.Imaging conffrmed the presence of a giant carotid artery pseudoaneurysm.Balloon occlusion-guided digital subtraction angiography(DSA)revealed adequate collateral circulation;allowing successful carotid artery ligation and pseudoaneurysm resection.Postoperative recovery was uneventful;with no neurological deffcits or complications;and regular follow-up conffrmed no further adverse sequelae.Conclusions:Management of carotid artery pseudoaneurysms in pediatric patients remains challenging.Under the guidance of DSA and with the assistance of balloon occlusion;precise aneurysm resection and vascular reconstruction can be achieved.In the event that vascular conditions limit the success of the repair;the balloon’s ability to occlude the parent artery and supplying vessels can safely facilitate the ligation of the parent artery of the aneurysm.
基金Supported by the Zhejiang Traditional Chinese Medicine Science and Technology Plan Project,No.2021ZB133 and No.2017ZB049.
文摘BACKGROUND Carotid atherosclerosis is a common complication in patients with type 2 diabetes mellitus(T2DM)and is closely associated with an increased risk of cardiovascular events.AIM To identify the key demographic,clinical,and biochemical factors associated with carotid plaque formation in T2DM patients and evaluate their predictive value.METHODS This retrospective study included 266 T2DM patients(control group,n=158;observation group,n=108)recruited between January 2021 and July 2024.Participants underwent carotid ultrasonography to measure intima-media thickness(IMT)and detect carotid plaques.Comprehensive demographic and biochemical data,including age,body mass index(BMI),fasting plasma glucose(FPG),glycated hemoglobin(HbA1c),serum creatinine(Scr),urinary albumin-to-creatinine ratio(UACR),and serum uric acid(SUA),were collected.Statistical analyses,including Pearson correlation,logistic regression,and receiver operating characteristic(ROC)curve analysis,were performed to identify and evaluate factors associated with carotid plaque formation.RESULTS Significant differences in age,BMI,HbA1c,FPG,Scr,UACR,and SUA were observed between groups(all P<0.05).Pearson correlation analysis showed IMT was positively associated with age,FPG,HbA1c,Scr,UACR,and SUA,and negatively with HDL-C.Multivariate logistic regression identified age(OR=1.050,95%CI:1.015-1.087),FPG(OR=1.096,95%CI:1.006-1.192),HbA1c(OR=1.234,95%CI:1.057-1.445),SBP(OR=1.018,95%CI:1.002-1.034),Scr(OR=1.029,95%CI:1.011-1.046),UACR(OR=1.024,95%CI:1.010-1.037),SUA(OR=1.006,95%CI:1.003-1.009),and HDL-C(OR=0.329,95%CI:0.119-0.917)as independent predictors of IMT(all P<0.05).ROC analysis showed UACR(AUC=0.718)and SUA(AUC=0.651)had predictive value for carotid plaque.CONCLUSION This study highlights the multifactorial nature of carotid atherosclerosis in T2DM,with age,BMI,poor glycemic control,renal dysfunction,and metabolic disturbances identified as key risk factors.The findings underscore the importance of comprehensive risk assessment and targeted interventions to prevent vascular complications in this high-risk population.
基金supported by Shanghai Technical Service Computing Center of Science and Engineering,Shanghai University.
文摘Carotid artery plaques represent a major contributor to the morbidity and mortality associated with cerebrovascular disease,and their clinical significance is largely determined by the risk linked to plaque vulnerability.Therefore,classifying plaque risk constitutes one of themost critical tasks in the clinicalmanagement of this condition.While classification models derived from individual medical centers have been extensively investigated,these singlecenter models often fail to generalize well to multi-center data due to variations in ultrasound images caused by differences in physician expertise and equipment.To address this limitation,a Dual-Classifier Label Correction Networkmodel(DCLCN)is proposed for the classification of carotid plaque ultrasound images acrossmultiplemedical centers.TheDCLCNdesigns amulti-center domain adaptationmodule that leverages a dual-classifier strategy to extract knowledge from both source and target centers,thereby reducing feature discrepancies through a domain adaptation layer.Additionally,to mitigate the impact of image noise,a label modeling and correction module is introduced to generate pseudo-labels for the target centers and iteratively refine them using an end-to-end correction mechanism.Experiments on the carotid plaque dataset collected fromthreemedical centers demonstrate that the DCLCN achieves commendable performance and robustness.
基金Supported by Henan Province International Science and Technology Cooperation Project,2024,No.242102520054.
文摘The application of artificial intelligence(AI)in carotid atherosclerotic plaque detection via computed tomography angiography(CTA)has significantly ad-vanced over the past decade.This mini-review consolidates recent innovations in deep learning architectures,domain adaptation techniques,and automated pl-aque characterization methodologies.Hybrid models,such as residual U-Net-Pyramid Scene Parsing Network,exhibit a remarkable precision of 80.49%in plaque segmentation,outperforming radiologists in diagnostic efficiency by reducing analysis time from minutes to mere seconds.Domain-adaptive fra-meworks,such as Lesion Assessment through Tracklet Evaluation,demonstrate robust performance across heterogeneous imaging datasets,achieving an area under the curve(AUC)greater than 0.88.Furthermore,novel approaches inte-grating U-Net and Efficient-Net architectures,enhanced by Bayesian optimi-zation,have achieved impressive correlation coefficients(0.89)for plaque quanti-fication.AI-powered CTA also enables high-precision three-dimensional vascular segmentation,with a Dice coefficient of 0.9119,and offers superior cardiovascular risk stratification compared to traditional Agatston scoring,yielding AUC values of 0.816 vs 0.729 at a 15-year follow-up.These breakthroughs address key challenges in plaque motion analysis,with systolic retractive motion biomarkers successfully identifying 80%of vulnerable plaques.Looking ahead,future directions focus on enhancing the interpretability of AI models through explainable AI and leveraging federated learning to mitigate data heterogeneity.This mini-review underscores the transformative potential of AI in carotid plaque assessment,offering substantial implic-ations for stroke prevention and personalized cerebrovascular management strategies.
文摘Type 2 diabetes mellitus(T2DM)promotes a risk of the development of atherosclerosis and potentiates atherosclerotic cardiovascular events.Among these patients,chronic hyperglycemia,dyslipidemia,oxidative stress and systemic inflammation has been found as triggers for accelerating plaque formation.Additionally,conventionally used risk factors,such as age,overweight/obesity,hypertension,poor glycemic control,renal dysfunction,and metabolic disturbances frequently underestimate the patients at the risk of asymptomatic carotid atherosclerosis.Further interventions may be required to prevent vascular complications.To note,asymptomatic carotid plaque in T2DM is associated with older age,increased body mass index,biomarkers of poor glycemic control(glycated hemoglobin,fasting glucose),kidney dysfunction[urinary albumin-to-creatinine ratio(UACR)],and metabolic abnormalities[high-density lipoprotein cholesterol,serum uric acid(SUA)].However,renal(UACR)and metabolic(SUA)biomarkers are likely to be investigated as promising biomarkers for early stage of asymptomatic coronary atherosclerosis,which as expecting could improve diagnostic value of intima-media thickness.
基金supported by Tianjin Key Medical Discipline(Specialty)Construction Project(grant number TJYXZDXK-004A).
文摘Background:Subcortical ischemic vascular dementia(SIVD)is a common subtype of vascular dementia.Currently,the bilateral common carotid artery stenosis(BCAS)mouse model is the most suitable SIVD rodent model.In this study,we investigated the functional and structural impairments in the hippocampus 1 month after BCAS.Methods:We used behavioral tests,laser speckle flowmetry,long-term potentiation,histochemical staining,molecular experiments,and voxel-based morphometry to evaluate the hippocampal impairments.Results:Behavioral studies revealed that BCAS mice exhibited worse performance.Laser speckle flowmetry detected an obvious decrease in cerebral blood flow.The synaptic plasticity of the perforant path-dentate gyrus pathway was inhibited.Decreased fractional anisotropy and increased mean diffusivity were detected in the hippocampus via diffusion tensor imaging data.A reduction in gray matter volume,which was most prominent in the hippocampus and its surrounding areas,was de-tected via voxel-based morphometry analysis.Impairments in cell morphology and myelin integrity were validated using histochemical staining and molecular biology techniques.In addition,the numbers of GFAP+astrocytes and Iba1+microglia in-creased in the hippocampus.Conclusions:Overall,our study demonstrates early functional and structural impair-ments in the hippocampus contributing to learning and memory deficits after 1 month of BCAS,indicating that the hippocampus is vulnerable to chronic cerebral ischemia.
基金Supported by Hangzhou Bio-Medicine and Health Industry Development Support Science and Technology Project,No.2022WJC005,No.2024WJC105.
文摘BACKGROUND Carotid atherosclerosis is a complex disease involving multiple cellular and molecular pathways.Mesenchymal stem cells(MSCs)show therapeutic potential,but their optimal targets and efficacy are still under study.MiR-126 enhances endothelial function and promotes angiogenesis by relieving vascular endothelial growth factor signaling suppression,suggesting its potential in vascular rege-neration.However,its role in directing stem cell differentiation toward endo-thelial lineages remains unclear.We hypothesize that miR-126 may influence MSCs’immunomodulatory and vascular reparative functions via the mitogen-activated protein kinases/extracellular signal-regulated kinase(MAPK/ERK)pathway,thereby improving carotid atherosclerosis.This study explores this mechanism to provide novel insights and support the development of miR-126-based therapeutic strategies.AIM To verify if miR-126 inhibits carotid atherosclerosis via the MAPK/ERK pathway.METHODS Rat bone marrow MSCs(product No.CP-R131,Wuhan,China)were verified by flow cytometry.The effects of miR-126 on MSCs’proliferation,migration,apoptosis,and cytokine expression were explored using microRNA mimics and inhibitors.Fluorescence staining quantified CD31+cells to evaluate endothelial differentiation.In vivo differentiation was assessed,and MSCs were transplanted into a rat carotid artery balloon dilatation model.Rats were randomly divided into five groups:Control,negative control mimics,miR-126 mimics,negative control inhibitor,and miR-126 inhibitor.RESULTS In vitro,MSCs treated with miR-126 mimics demonstrated enhanced proliferation,increased migration,and reduced apoptosis.These miR-126 mimics also significantly increased the secretion of vascular endothelial growth factor and basic fibroblast growth factor.Fluorescence and tissue staining indicated a higher proportion of CD31+cells in the miR-126 mimics group.Additionally,the expression of endothelial-related genes(von Willebrand factor,endothelial nitric oxide synthase,and vascular endothelial-cadherin)was upregulated in this group.In vivo,miR-126-transfected MSCs effectively reduced neointimal thickness and promoted endothelial coverage in rats.MiR-126 stimulated MSC proliferation in a dose-dependent manner and reduced p38 and ERK1/2 phosphorylation.Conversely,miR-126 inhibition or blank controls resulted in opposing effects.CONCLUSION MiR-126 exerts significant modulatory effects on the immunoregulatory and vascular reparative functions of MSCs through the MAPK/ERK signaling pathway,promoting their differentiation into endothelial cells and thereby mitigating atherosclerosis.
文摘BACKGROUND Obesity is a major health problem due to its high prevalence.The relationship between obesity and cardiovascular disease is unclear.Some studies agree that certain conditions associated with obesity,such as physical inactivity or cardiovascular risk factors,are responsible for cardiovascular risk excess among obese people.Carotid intima-media thickness and carotid plaques(CP)have been associated with cardiovascular adverse events in healthy populations,and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients.However,there are no studies correlating subclinical atherosclerosis and adverse events(AE)in obese subjects.AIM To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography(EE).METHODS From January 1,2006 to December 31,2010,2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography.Exclusion criteria included previous vascular disease,left ventricular ejection fraction<50%,positive EE,significant valvular heart disease and inferior to submaximal EE.An AE was defined as all-cause mortality,myocardial infarction and cerebrovascular accident.Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus.RESULTS Of the 652 patients who fulfilled the inclusion criteria,226(34.7%)had body mass indexes≥30 kg/m2,and 76 of them(33.6%)had CP.During a mean follow-up time of 8.2(2.1)years,27 AE were found(11.9%).Mean event-free survival at 1,5 and 10 years was 99.1%(0.6),95.1%(1.4)and 86.5%(2.7),respectively.In univariate analysis,CP predicted AE[hazard ratio(HR)2.52,95%confidence interval(CI)1.17-5.46;P=0.019].In multivariable analysis,the presence of CP remained a predictor of AE(HR 2.26,95%CI 1.04-4.95,P=0.041).Other predictors identified were glomerular filtration rate(HR 0.98,95%CI 0.96-0.99;P=0.023),peak metabolic equivalents(HR 0.83,95%CI 0.70–0.99,P=0.034)and moderate mitral regurgitation(HR 5.02,95%CI 1.42–17.75,P=0.012).CONCLUSION Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE.These patients could benefit from aggressive prevention measures.
基金Supported by Shenzhen Second People’s Hospital Clinical Research Fund of the Shenzhen High-level Hospital Construction Project,No.20223357021 and 20223357030and Research Project of Teaching Reform in Shenzhen Second People’s Hospital,No.202209.
文摘BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke.Physical examination showed decreased strength(5-/5)in both lower limbs.Carotid artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,respectively.We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation.Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence.CTA six months postoperatively showed no significant increase in in-stent stenosis.Case 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by ultrasound.Physical examination showed no positive neurological signs.Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA dissection.CAS was performed and intraoperative IVUS suggested a large residual false lumen.Post-stent balloon dilatation was performed reducing the false lumen.DSA three months postoperatively indicated good stent expansion with mild stenosis.CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperatively.
基金Supported by Elite Medical Professionals Project of China-Japan Friendship Hospital,No.ZRJY2021-QM13。
文摘BACKGROUND Acute carotid stent thrombosis(ACST)is a rare but devastating complication in the carotid artery stenting(CAS)procedure.The aim of this article is to report a case and review cases of ACST reported in the literature,and investigate risk factors and management strategies for ACST.CASE SUMMARY We reviewed the treatment process of a patient with ACST after CAS.Then multiple databases were systematically searched to identify studies reporting ACST from 2005 to 2020.The demographic data,risk factors,treatment strategies,and prognosis were extracted and analyzed.CONCLUSION The reason for ACST is multifactorial.Proper patient selection,normative antiplatelet treatment,and perfect technical detail may decrease the incidence of ACST.Several treatment strategies such as thrombolysis,mechanical thrombectomy,and open surgery may be options for the treatment of ACST.Limited data have shown that carotid endarterectomy is effective with favorable results.
基金the Medical Program of Scientific & Technical Foundation in Xiamen in 2008, No. 3502Z20084028
文摘The optimal velocity encoding of phase-contrast magnetic resonance angiography （PC MRA） in measuring cerebral blood flow volume （BFV） ranges from 60 to 80 cm/s. To verify the accuracy of two-dimensional （2D） PC MRA, the present study localized the region of interest at blood vessels of the neck using PC MRA based on three-dimensional time-of-flight sequences, and the velocity encoding was set to 80 cm/s. Results of the measurements showed that the error rate was 7.0±6.0% in the estimation of BFV in the internal carotid artery, the external carotid artery and the ipsilateral common carotid artery. There was no significant difference, and a significant correlation in BFV between internal carotid artery ＋ external carotid artery and ipsilateral common carotid artery. In addition, the BFV of the common carotid artery was correlated with that of the ipsilateral internal carotid artery. The main error was attributed to the external carotid artery and its branches. Therefore, after selecting the appropriate scanning parameters and protocols, 2D PC MRA is more accurate in the determination of BFV in the carotid arteries.
文摘In this commentary on the article entitled“Acute carotid stent thrombosis:A case report and literature review”,the key points of the article are discussed.Acute carotid stent thrombosis(ACST)in the setting of carotid artery stenting(CAS)represents a rare but potentially catastrophic event.There is a wide range of treatment options available,including carotid endarterectomy,which is generally recommended for cases of refractory ACST.While there is no standard treatment regimen,dual antiplatelet therapy is typically recommended both before and after CAS to reduce risk of ACST.
文摘Objective: To investigate the correlation between fundus atherosclerosis and carotid arterial atherosclerosis. Methods: A total of 516 people undergoing physical examination in Deyang People’s Hospital between June 2020 and December 2022 were randomly selected. Fundus atherosclerosis and carotid arterial atherosclerosis were evaluated by fundus photography and carotid artery ultrasonography, respectively. Results: Among the 516 physical examination patients, 198 (38.4%) had normal fundus examination, and 318 (61.6%) had fundus arteriosclerosis. Among them, 166 cases were of grade I (32.2%), 86 cases were of grade II (16.7%), and 66 cases were of grade III (12.8%). There were 286 cases (55.4%) without carotid atherosclerosis, 201 cases (38.9%) with carotid atherosclerotic plaque, and 33 cases (6.4%) with carotid stenosis. Fundus arteriosclerosis is independently associated with carotid artery intima-media thickness, vulnerable plaques, plaque scores, and carotid artery stenosis (P Conclusion: In summary, there is a close relationship between carotid artery disease and the degree of arteriosclerosis in the eyeground. Fundus photography is a simple, non-invasive, and easily acceptable method of inspection. The results obtained from it are useful in determining the severity of carotid atherosclerosis and guiding early detection and intervention in clinical cases. This can help reduce the incidence of cardiovascular and cerebrovascular diseases.
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Objectives: </strong>To study relationship between carotid artery plaques characteristics and haemodynamic changes after carotid stenting. <strong>Patients and Methods: </strong>This observational prospective (pilot) study included 20 patients—who underwent CAS. The study was carried out in Ain shams university hospitals—Railway hospital (ERMED) and Suez insurance hospital from December 2018 to February 2020. Inclusion criteria, Symptomatic (defined as amaurosis fugax, TIA, Minor stroke or Major stroke) stenosis > 70%. Asymptomatic stenosis > 80% (accidentally discovered during pre-operative assessment for CABG and during full assessment for irrelevant stroke). <strong>Results:</strong> Regarding to plaque character for degree of stenosis, calcification and ulceration revealed significantly higher degree of stenosis in hemodynamic events group (P = 0.024). On the other hand, that there was no statistically significant difference between the two groups as regard calcification, ulceration and lesion location. <strong>Conclusion: </strong>The study revealed that HI is a common occurrence following CAS procedures and significantly higher degree of stenosis in hemodynamic events group. Plaque shape, ulcerations hardly affect haeodynamic instability after carotid stenting.</span> </div>
文摘Objective: To make a further understanding of the DSA features of the carotid body tumor (CBT) and to explore the clinical value of DSA diagnosis and interventional treatment for CBT. Methods: Twelve cases of CBT with DSA data were analyzed retrospectively. The DSA appearances in all of the patients were observed dynamically in a double blind manner by two experienced radiologists together and a consensus interpretation formed. Results: DSA could establish definitive diagnosis in all cases. The DSA features of the CBT were: the increase of bifurcation angles of internal and external carotid arteries in all cases; the CBT supplied by external carotid arteries in most cases and the significant increase of tumor vessels in bifurcation; invasion of internal or external carotid arteries in 6 cases. The tumor staining disappeared mostly after the supplying arteris were embolized in 2 cases, and the bleeding during the operation reduced significantly. Conclusion: The DSA is useful in the diagnosis of the CBT and for therapeutic planning. The pre-operation embolization of the CBT contributes to reduce the bleeding during operation.
文摘Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe carotid artery stenosis who underwent CAS and CEA in the First People's Hospital of Changde City(hereafter referred as "our hospital")from January 2018 to December 2020 were selected as the research objects and divided into CAS group(n=43)and CEA group(n=45).To understand the clinical application value and feasibility of the two surgical schemes by comparing the general situation,cerebral blood flow,MMSE scale,MOCA scale score and serum miR-145,IGF1R levels of the two surgical schemes.Conclusions:CAS and CEA in the treatment of patients with severe internal carotid artery stenosis,have good curative effect,can effectively improve the patient's cerebral blood flow,regulate serum miR-145,IGF 1R levels,promote the recovery of cognitive function,but relatively speaking,the incidence of stroke and hypotension after CAS is higher,and the incidence of hypertension after CEA is higher.
文摘AIM To investigate the association between carotid atherosclerosis and cystatin C(CysC) and to determine the optimal CysC cut-off value.METHODS One hundred twenty-eight subjects were included in this study. Atherosclerosis was defined as a maximum carotid plaque thickness(MCPT) of greater than 2 mm. A receiver operating characteristic curve analysis was used to determine the diagnostic value of serum CysC for atherosclerosis. The subjects were divided into two groups according to the CysC cut-off value. We screenedfor diabetes, hypertension, dyslipidemia, smoking status, alcohol consumption, and exercise behavior. The association between atherosclerosis and CysC levels was assessed using multivariate analysis.RESULTS The subjects were then divided into two groups according to the CysC cut-off value(0.73 mg/L). The median age of the high CysC group was 72 years(85% males), whereas that of the low CysC group was 61 years(63% males). The CysC levels were significantly correlated with Cr and estimated glomerular filtration rate(eGFR) values. Bodymass index, visceral fat area, hypertension, diabetes mellitus, and MCPT were significantly higher in the high CysC group than in the low CysC group. Furthermore, the eG FR was significantly lower in the high CysC group. Regarding lifestyle habits, only the exercise level was lower in the high CysC group than in the low CysC group. Multivariate analysis, adjusted for age and sex, revealed that high CysC levels were significantly associated with an MCPT of ≥ 2 mm(odds ratio: 2.92; 95%CI: 1.13-7.99).CONCLUSION Higher CysC levels were associated with an MCPT of ≥ 2 mm. The CysC cut-off value of 0.73 mg/L appears to aid in the diagnosis of atherosclerosis.
