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
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
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:We investigated retinal and choroidal microvascular parameters as potential biomarkers for vascular cognitive impairment in patients with internal carotid artery stenosis(ICAS).Methods:We enrolled 123 asymp...Background:We investigated retinal and choroidal microvascular parameters as potential biomarkers for vascular cognitive impairment in patients with internal carotid artery stenosis(ICAS).Methods:We enrolled 123 asymptomatic ICAS patients and categorized them into vascular mild cognitive impairment(VMCI)and vascular dementia(VaD)groups using the Montreal Cognitive Assessment.Optical coherence tomography angiography was used to evaluate vessel densities and perfusion areas in various retinal layers.Magnetic resonance imaging-based neuroimaging biomarkers for cerebral small vessel disease(CSVD)were also assessed.Least absolute shrinkage and selection operator logistic regression identified predictor variables,and receiver operating curve analysis assessed the ability of key parameters to distinguish between VMCI and VaD.Results:Compared with VMCI patients,VaD patients had lower radial peripapillary capillary(RPC)perfusion area,higher CSVD burden score,and larger white matter hyperintensity volume(all p<0.05).Receiver operating curve analysis revealed that the RPC perfusion area of the affected eye had superior discriminatory power for distinguishing VaD from VMCI compared with both the CSVD burden score(Z=1.99,p=0.047)and white matter hyperintensity(Z=1.97,p=0.049).The optimal cutoff value for the 0-1 mm macular RPC perfusion area was determined as 0.068 mm^(2).Conclusion:The optical coherence tomography angiography-derived RPC perfusion area can effectively differentiate VaD from VMCI,suggesting its potential as a noninvasive diagnostic method to support clinical decision-making for ICAS patients.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 Direct carotid cavernous fistulas(CCFs)are typically the result of a severe traumatic brain injury.High-flow arteriovenous shunts secondary to rupture of an intracavernous aneurysm,resulting in direct CCFs,...BACKGROUND Direct carotid cavernous fistulas(CCFs)are typically the result of a severe traumatic brain injury.High-flow arteriovenous shunts secondary to rupture of an intracavernous aneurysm,resulting in direct CCFs,are rare.The use of a pipeline embolization device in conjunction with coils and Onyx glue for treatment of direct high-flow CCF resulting from ruptured cavernous carotid artery aneurysm in a clinical setting is not well documented.CASE SUMMARY A 58-year-old woman presented to our department with symptoms of blepharoptosis and intracranial bruits for 1 wk.During physical examination,there was right eye exophthalmos and ocular motor palsy.The rest of the neurological examination was clear.Notably,the patient had no history of head injury.The patient was treated with a pipeline embolization device in the ipsilateral internal carotid artery across the fistula.Coils and Onyx were placed through the femoral venous route,followed by placement of the pipeline embolization device with assistance from a balloon-coiling technique.No intraoperative or perioperative complications occurred.Preoperative symptoms of bulbar hyperemia and bruits subsided immediately after the operation.CONCLUSION Pipeline embolization device in conjunction with coiling and Onyx may be a safe and effective approach for direct CCFs.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
Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasoun...Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.展开更多
BACKGROUND Coronary heart disease is associated with coronary atherosclerosis indicated by carotid intima-media thickness(CIMT)thickening and altered vascular elasticity.The epicardial adipose layer can secrete proinf...BACKGROUND Coronary heart disease is associated with coronary atherosclerosis indicated by carotid intima-media thickness(CIMT)thickening and altered vascular elasticity.The epicardial adipose layer can secrete proinflammatory factors that promote the formation of coronary atherosclerosis.Thus,the epicardial fat layer thickness(EAT)may also predict coronary heart disease.AIM To determine the role of common carotid artery ultrasound parameters and EAT in the early diagnosis of coronary artery disease.METHODS Based on coronary angiography,patients with newly suspected coronary heart disease were divided into case(n=107)and control(n=41)groups.The carotid ultrasound parameters,including vascular stiffness(β),elastic coefficient(EP),pulse wave conduction velocity(PWV-β),CIMT,and EAT were compared between the case and control groups and among patients with different lesion numbers in the case group.Pearson correlation was used to evaluate the early diagnostic value of EAT,common carotid artery elasticity,and CIMT for coronary heart disease.RESULTS EP,β,PWV-β,CIMT,and EAT were significantly higher in the case group compared with the levels in the control group(all P<0.001).In the case group,lesions were detected in one vessel in 34 patients,two vessels in 38 patients,and three vessels in 35 patients.Within the case group,β,EP,PWV-β,CIMT,and EAT levels significantly increased with an increased number of lesions(all P<0.001).EAT positively correlated withβ,EP,PWV-β,and CIMT(all P<0.01).The area under the curve for diagnosing coronary heart disease using EAT combined with CIMT and carotid elasticity was 0.893,and the sensitivity and specificity were 0.890 and 0.837.CONCLUSION EAT correlated well with changes in carotid artery elasticity and CIMT in patients with coronary heart disease.The combination of EAT,carotid artery elasticity,and CIMT facilitates the early diagnosis of coronary heart disease.展开更多
BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct ...BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.展开更多
BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulatio...BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.展开更多
BACKGROUND Global and regional cerebral blood flow(CBF)changes in patients with unilateral internal carotid artery occlusion(ICAO)are unclear when the dual post-labeling delays(PLD)arterial spin labeling(ASL)magnetic ...BACKGROUND Global and regional cerebral blood flow(CBF)changes in patients with unilateral internal carotid artery occlusion(ICAO)are unclear when the dual post-labeling delays(PLD)arterial spin labeling(ASL)magnetic resonance imaging(MRI)technique is used.Manual delineation of regions of interest for CBF measurement is time-consuming and laborious.AIM To assess global and regional CBF changes in patients with unilateral ICAO with the ASL-MRI perfusion technique.METHODS Twenty hospitalized patients with ICAO and sex-and age-matched controls were included in the study.Regional CBF was measured by Dr.Brain's ASL software.The present study evaluated differences in global,middle cerebral artery(MCA)territory,anterior cerebral artery territory,and Alberta Stroke Program Early Computed Tomography Score(ASPECTS)regions(including the caudate nucleus,lentiform nucleus,insula ribbon,internal capsule,and M1-M6)and brain lobes(including frontal,parietal,temporal,and insular lobes)between ICAO patients and controls at PLD 1.5 s and PLD 2.5 s.RESULTS When comparing CBF between ICAO patients and controls,the global CBF in ICAO patients was lower at both PLD 1.5 s and PLD 2.5 s;the CBF on the occluded side was lower in 15 brain regions at PLD 1.5 s,and it was lower in 9 brain regions at PLD 2.5 s;the CBF in the contralateral hemisphere was lower in the caudate nucleus and internal capsule at PLD 1.5 s and in M6 at PLD 2.5 s.The global CBF in ICAO patients was lower at PLD 1.5 s than at PLD 2.5 s.The ipsilateral CBF at PLD 1.5 s was lower than that at PLD 2.5 s in 15 regions,whereas the contralateral CBF was lower at PLD 1.5 s than at PLD 2.5 s in 12 regions.The ipsilateral CBF was lower than the contralateral CBF in 15 regions at PLD 1.5 s,and in M6 at PLD 2.5 s.CONCLUSION Unilateral ICAO results in hypoperfusion in the global and MCA territories,especially in the ASPECTS area.Dual PLD settings prove more suitable for accurate CBF quantification in ICAO.展开更多
Dear Editor,We present a case of choroidal infarction along with retinal infarction after carotid artery stenting(CAS),which is a rare condition not reported in the literature.CAS has increasingly been accepted as the...Dear Editor,We present a case of choroidal infarction along with retinal infarction after carotid artery stenting(CAS),which is a rare condition not reported in the literature.CAS has increasingly been accepted as the mainstay reconstruction method for carotid artery stenosis compared with carotid endarterectomy(CEA)due to no need for general anesthesia.展开更多
AIM:To investigate the features of retinal ischemic injuries in a novel mouse model with bilateral carotid artery stenosis(BCAS).METHODS:BCAS was induced with microcoil implantation in 6-8-week-old C57BL6 mice.Cerebra...AIM:To investigate the features of retinal ischemic injuries in a novel mouse model with bilateral carotid artery stenosis(BCAS).METHODS:BCAS was induced with microcoil implantation in 6-8-week-old C57BL6 mice.Cerebral blood flow was monitored at 2,7,and 28d postoperatively.Retinal morphological changes were evaluated by fundus photography and hematoxylin-eosin staining.Fluorescein fundus angiography(FFA)was performed to detect retinal vascular changes and circulation.The levels of apoptosis,activation of neurogliosis,and expression of hypoxiainducible factor(HIF)-1αin the retina were assessed by Western blotting and immunofluorescence staining,followed by retinal ganglion cell(RGC)density detection.Additionally,electrophysiological examinations including photopic negative response(PhNR)was also performed.RESULTS:The mice demonstrated an initial rapid decrease in cerebral blood flow,followed by a 4-week recovery period after BCAS.The ratio of retinal artery and vein was decreased under fundus photography and FFA.Compared with the sham mice,BCAS mice showed thinner retinal thickness on day 28.Additionally,apoptosis was increased and RGC density was decreased mainly in peripheral retinal region.Neurogliosis was mainly located in the inner retinal layers,with a stable increase in HIF-1αexpression.The dark-adapted electroretinogram showed a notable reduction in the a-,b-,and oscillatory potential(OP)wave amplitudes between days 2 and 7;this gradually recovered over the following 4wk.However,the b-and OPwave amplitudes were still significantly decreased on PhNR examination on day 28.CONCLUSION:BCAS can result in relatively mild retinal ischemia injuries in mice,mainly in the inner layer and peripheral region.Our study provides a novel animal model for investigating retinal ischemic diseases.展开更多
The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of trauma...The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of traumatic brain injury.Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion.If not detected early and treated in time,the prognosis of patients is poor.This editorial makes a relevant analysis of this disease.展开更多
Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-yea...Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.展开更多
Background: Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or tearing) back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissect...Background: Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or tearing) back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissection has also been reported in rare cases and might be misdiagnosed due to its atypical symptoms leading to catastrophic outcomes. Case presentation: The patient was admitted to the hospital due to right limb weakness with speech inability for more than 10 hours. In the routine cardiac ultrasound examination, the avulsion intimal echo was found in the initial segment of the descending aorta. The rupture range was about 11 mm, and the lumen was separated into real and false lumen. Further computed tomography angiography (CTA) examination confirmed the major arterial dissection (De Bakey Type I). Conclusion: We report a case of painless aortic dissection with active carotid artery thrombosis diagnosed by ultrasound and CTA, and to improve the understanding of painless aortic dissection by reviewing relevant domestic and foreign literature.展开更多
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.
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.
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 the Medical Science and Technology Project of Zhejiang Province[Grant Nos.2022KY600 and 2024KY019]Zhejiang Provincial Natural Science Foundation of China[Grant No.LGF22H090020]+1 种基金Social Development Science and Technology Projects of Wenling City in 2023[Grant No.2023S00131]Social Development Science and Technology Projects of Wenling City in 2024[Grant No.2024S00181].
文摘Background:We investigated retinal and choroidal microvascular parameters as potential biomarkers for vascular cognitive impairment in patients with internal carotid artery stenosis(ICAS).Methods:We enrolled 123 asymptomatic ICAS patients and categorized them into vascular mild cognitive impairment(VMCI)and vascular dementia(VaD)groups using the Montreal Cognitive Assessment.Optical coherence tomography angiography was used to evaluate vessel densities and perfusion areas in various retinal layers.Magnetic resonance imaging-based neuroimaging biomarkers for cerebral small vessel disease(CSVD)were also assessed.Least absolute shrinkage and selection operator logistic regression identified predictor variables,and receiver operating curve analysis assessed the ability of key parameters to distinguish between VMCI and VaD.Results:Compared with VMCI patients,VaD patients had lower radial peripapillary capillary(RPC)perfusion area,higher CSVD burden score,and larger white matter hyperintensity volume(all p<0.05).Receiver operating curve analysis revealed that the RPC perfusion area of the affected eye had superior discriminatory power for distinguishing VaD from VMCI compared with both the CSVD burden score(Z=1.99,p=0.047)and white matter hyperintensity(Z=1.97,p=0.049).The optimal cutoff value for the 0-1 mm macular RPC perfusion area was determined as 0.068 mm^(2).Conclusion:The optical coherence tomography angiography-derived RPC perfusion area can effectively differentiate VaD from VMCI,suggesting its potential as a noninvasive diagnostic method to support clinical decision-making for ICAS patients.
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 Direct carotid cavernous fistulas(CCFs)are typically the result of a severe traumatic brain injury.High-flow arteriovenous shunts secondary to rupture of an intracavernous aneurysm,resulting in direct CCFs,are rare.The use of a pipeline embolization device in conjunction with coils and Onyx glue for treatment of direct high-flow CCF resulting from ruptured cavernous carotid artery aneurysm in a clinical setting is not well documented.CASE SUMMARY A 58-year-old woman presented to our department with symptoms of blepharoptosis and intracranial bruits for 1 wk.During physical examination,there was right eye exophthalmos and ocular motor palsy.The rest of the neurological examination was clear.Notably,the patient had no history of head injury.The patient was treated with a pipeline embolization device in the ipsilateral internal carotid artery across the fistula.Coils and Onyx were placed through the femoral venous route,followed by placement of the pipeline embolization device with assistance from a balloon-coiling technique.No intraoperative or perioperative complications occurred.Preoperative symptoms of bulbar hyperemia and bruits subsided immediately after the operation.CONCLUSION Pipeline embolization device in conjunction with coiling and Onyx may be a safe and effective approach for direct CCFs.
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.
文摘Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.
文摘BACKGROUND Coronary heart disease is associated with coronary atherosclerosis indicated by carotid intima-media thickness(CIMT)thickening and altered vascular elasticity.The epicardial adipose layer can secrete proinflammatory factors that promote the formation of coronary atherosclerosis.Thus,the epicardial fat layer thickness(EAT)may also predict coronary heart disease.AIM To determine the role of common carotid artery ultrasound parameters and EAT in the early diagnosis of coronary artery disease.METHODS Based on coronary angiography,patients with newly suspected coronary heart disease were divided into case(n=107)and control(n=41)groups.The carotid ultrasound parameters,including vascular stiffness(β),elastic coefficient(EP),pulse wave conduction velocity(PWV-β),CIMT,and EAT were compared between the case and control groups and among patients with different lesion numbers in the case group.Pearson correlation was used to evaluate the early diagnostic value of EAT,common carotid artery elasticity,and CIMT for coronary heart disease.RESULTS EP,β,PWV-β,CIMT,and EAT were significantly higher in the case group compared with the levels in the control group(all P<0.001).In the case group,lesions were detected in one vessel in 34 patients,two vessels in 38 patients,and three vessels in 35 patients.Within the case group,β,EP,PWV-β,CIMT,and EAT levels significantly increased with an increased number of lesions(all P<0.001).EAT positively correlated withβ,EP,PWV-β,and CIMT(all P<0.01).The area under the curve for diagnosing coronary heart disease using EAT combined with CIMT and carotid elasticity was 0.893,and the sensitivity and specificity were 0.890 and 0.837.CONCLUSION EAT correlated well with changes in carotid artery elasticity and CIMT in patients with coronary heart disease.The combination of EAT,carotid artery elasticity,and CIMT facilitates the early diagnosis of coronary heart disease.
文摘BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.
基金Supported by Huanhua Talent for Discipline Backbone of Sichuan Provincial People’s Hospital,No.SY2022017Science Fund for Distinguished Young Scholars of Sichuan Province,No.2021JDJQ0041+1 种基金Sichuan Science and Technology Program,No.2020YFQ0060National Natural Science and Technology Foundation of China,No.81800274.
文摘BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.
基金Supported by The Key Research and Development Program Projects of Shaanxi Province of China,No.S2023-YF-YBSF-0273Natural Science Foundation of Shaanxi Province of China,No.2022JQ-900.
文摘BACKGROUND Global and regional cerebral blood flow(CBF)changes in patients with unilateral internal carotid artery occlusion(ICAO)are unclear when the dual post-labeling delays(PLD)arterial spin labeling(ASL)magnetic resonance imaging(MRI)technique is used.Manual delineation of regions of interest for CBF measurement is time-consuming and laborious.AIM To assess global and regional CBF changes in patients with unilateral ICAO with the ASL-MRI perfusion technique.METHODS Twenty hospitalized patients with ICAO and sex-and age-matched controls were included in the study.Regional CBF was measured by Dr.Brain's ASL software.The present study evaluated differences in global,middle cerebral artery(MCA)territory,anterior cerebral artery territory,and Alberta Stroke Program Early Computed Tomography Score(ASPECTS)regions(including the caudate nucleus,lentiform nucleus,insula ribbon,internal capsule,and M1-M6)and brain lobes(including frontal,parietal,temporal,and insular lobes)between ICAO patients and controls at PLD 1.5 s and PLD 2.5 s.RESULTS When comparing CBF between ICAO patients and controls,the global CBF in ICAO patients was lower at both PLD 1.5 s and PLD 2.5 s;the CBF on the occluded side was lower in 15 brain regions at PLD 1.5 s,and it was lower in 9 brain regions at PLD 2.5 s;the CBF in the contralateral hemisphere was lower in the caudate nucleus and internal capsule at PLD 1.5 s and in M6 at PLD 2.5 s.The global CBF in ICAO patients was lower at PLD 1.5 s than at PLD 2.5 s.The ipsilateral CBF at PLD 1.5 s was lower than that at PLD 2.5 s in 15 regions,whereas the contralateral CBF was lower at PLD 1.5 s than at PLD 2.5 s in 12 regions.The ipsilateral CBF was lower than the contralateral CBF in 15 regions at PLD 1.5 s,and in M6 at PLD 2.5 s.CONCLUSION Unilateral ICAO results in hypoperfusion in the global and MCA territories,especially in the ASPECTS area.Dual PLD settings prove more suitable for accurate CBF quantification in ICAO.
基金Supported by 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(No.ZYJC21025)Sichuan University Education Foundation(No.23JZH038).
文摘Dear Editor,We present a case of choroidal infarction along with retinal infarction after carotid artery stenting(CAS),which is a rare condition not reported in the literature.CAS has increasingly been accepted as the mainstay reconstruction method for carotid artery stenosis compared with carotid endarterectomy(CEA)due to no need for general anesthesia.
基金Supported by The State Key Program of the National Natural Science Foundation of China(No.82030027)the National Natural Science Foundation of China(No.82101123).
文摘AIM:To investigate the features of retinal ischemic injuries in a novel mouse model with bilateral carotid artery stenosis(BCAS).METHODS:BCAS was induced with microcoil implantation in 6-8-week-old C57BL6 mice.Cerebral blood flow was monitored at 2,7,and 28d postoperatively.Retinal morphological changes were evaluated by fundus photography and hematoxylin-eosin staining.Fluorescein fundus angiography(FFA)was performed to detect retinal vascular changes and circulation.The levels of apoptosis,activation of neurogliosis,and expression of hypoxiainducible factor(HIF)-1αin the retina were assessed by Western blotting and immunofluorescence staining,followed by retinal ganglion cell(RGC)density detection.Additionally,electrophysiological examinations including photopic negative response(PhNR)was also performed.RESULTS:The mice demonstrated an initial rapid decrease in cerebral blood flow,followed by a 4-week recovery period after BCAS.The ratio of retinal artery and vein was decreased under fundus photography and FFA.Compared with the sham mice,BCAS mice showed thinner retinal thickness on day 28.Additionally,apoptosis was increased and RGC density was decreased mainly in peripheral retinal region.Neurogliosis was mainly located in the inner retinal layers,with a stable increase in HIF-1αexpression.The dark-adapted electroretinogram showed a notable reduction in the a-,b-,and oscillatory potential(OP)wave amplitudes between days 2 and 7;this gradually recovered over the following 4wk.However,the b-and OPwave amplitudes were still significantly decreased on PhNR examination on day 28.CONCLUSION:BCAS can result in relatively mild retinal ischemia injuries in mice,mainly in the inner layer and peripheral region.Our study provides a novel animal model for investigating retinal ischemic diseases.
基金Supported by the Science and Technology Program of Nantong Health Committee,No.MA2019003 and No.MA2021017Science and Technology Program of Nantong City,No.Key003 and No.JCZ2022040Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD019,and No.KD2022KYJJZD022.
文摘The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of traumatic brain injury.Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion.If not detected early and treated in time,the prognosis of patients is poor.This editorial makes a relevant analysis of this disease.
文摘Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.
文摘Background: Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or tearing) back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissection has also been reported in rare cases and might be misdiagnosed due to its atypical symptoms leading to catastrophic outcomes. Case presentation: The patient was admitted to the hospital due to right limb weakness with speech inability for more than 10 hours. In the routine cardiac ultrasound examination, the avulsion intimal echo was found in the initial segment of the descending aorta. The rupture range was about 11 mm, and the lumen was separated into real and false lumen. Further computed tomography angiography (CTA) examination confirmed the major arterial dissection (De Bakey Type I). Conclusion: We report a case of painless aortic dissection with active carotid artery thrombosis diagnosed by ultrasound and CTA, and to improve the understanding of painless aortic dissection by reviewing relevant domestic and foreign literature.
