The development of intravascular ultrasound (IVUS) techniques makes it possible to analyze the sectional information of the arteries and plaques. However, it can not precisely provide the biomechanical characterization of atheromas. The IVUS elastogram demonstrates tissue elasticity via estimating the axial stress-strain information of artery walls. With the help of such method, unstable lesions can be distinguished, the rupture inclination can be predicted, and the components of plaques are able to be classified. Compared with IVUS, elastogram is more objective. The constructing procedure and relative techniques as well as the preliminary clinical application, are reviewed in this article. The limitation at present and the probable future research direction are also mentioned.
Arteries ; diagnostic imaging ; Carotid Arteries ; diagnostic imaging ; Coronary Vessels ; diagnostic imaging ; Elasticity Imaging Techniques ; methods ; Femoral Artery ; diagnostic imaging

OBJECTIVETo investigate the dangerous anastomasis between the external carotid artery and the intracranial arteries.

METHODSAngiograms of the external carotid artery in 250 cases were analyzed, including 35 cases of moyamoya and 215 cases of head and neck lesions.

RESULTSThe 35 cases of moyamoya, 14 middle meningeal arteries (MMA) were found to participate in the blood supply of the brain. In addition, 11 superficial temporal arteries and 7 occipital arteries supplied the brain. All the cases with ligated external carotid artery (ECA) had the pharyngo-occipital anastomasis. Moreover, the ophthalmic arteries in three cases were found to originate from the MMA.

CONCLUSIONSThe external carotid artery has a variety of anastomasis with the internal carotid artery (ICA) and the vertebral artery. Under such circumstances, special measures must be taken to circumvent inadvertent intracranial embolization.

Carotid Artery Diseases ; diagnostic imaging ; Carotid Artery, External ; diagnostic imaging ; Cerebral Arteries ; diagnostic imaging ; Humans ; Radiography

Intracranial vertebrobasilar artery (VBA) dissection can be classified into three major clinical types: subarachnoid hemorrhage, headache, and nonhemorrhagic ischemic symptoms. And it has been more frequently identified since the introduction of advanced diagnostic imaging modalites including MR angiography and multidetector CT angiography. Aggressive treatment has been considered due to their tendency for early rebleeding and a fatal natural course. We describe approproiate neurointerventional options, based on he patterns of angiographic features and location of dissection.
Angiography ; Arteries* ; Diagnostic Imaging ; Embolization, Therapeutic ; Headache ; Subarachnoid Hemorrhage

Aged ; Carotid Arteries ; diagnostic imaging ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Stroke ; diagnosis ; diagnostic imaging

OBJECTIVETo investigate the difference in the vulnerability of carotid atherosclerotic plaques in patients with unilateral and bilateral intraplaque hemorrhage (IPH).

METHODSA retrospective analysis was conducted among 44 patients with unilateral IPH (30 cases) or bilateral IPH (14 cases) in the carotid plaques detected by magnetic resonance imaging (MRI) in our hospital between December, 2009 and December, 2012. The age, maximum wall thickness and incidence of fibrous cap rupture were compared between the two groups.

RESULTSCompared with those with unilateral IPH, the patients with bilateral IPHs had a significantly younger age (66.6∓9.4 years vs 73.7∓9.0 years, P=0.027), a significantly greater maximum plaque thickness (6.3∓1.9 mm vs 5.0∓1.3 mm, P=0.035) and a higher incidence of ulcers (50% vs 13.3%, P=0.025). Logistic regression analysis revealed a significant association between bilateral IPHs and the occurrence of ulcer with an odd ratio (OR) of 6.5 (95% confidence interval [CI]: 1.5-28.7, P=0.014). After adjustment for gender in Model 1, bilateral IPHs were still significantly associated with presence of ulcer (OR=5.7, 95%CI: 1.1-29.2, P=0.036). But after adjustment for age (P=0.131) or maximum plaque thickness (P=0.139) in model 2, no significant correlation was found between bilateral IPHs and the presence of ulcer.

CONCLUSIONCompared with patients with unilateral IPH, those with bilateral IPHs are at a younger age and have a greater plaque burden and a higher incidence of fibrous cap rupture, suggesting a greater vulnerability of the carotid plaques in patients with bilateral IPHs.

Aged ; Carotid Arteries ; diagnostic imaging ; Carotid Stenosis ; diagnostic imaging ; physiopathology ; Fibrosis ; Hemorrhage ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Odds Ratio ; Plaque, Atherosclerotic ; diagnostic imaging ; Retrospective Studies

OBJECTIVESTo determine the relative value of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in exploring the potential embolic source (PES) in heart and aortic arch and to study the clinical significance of aortic arch atherosclerosis (AAA).

METHODSForty-nine patients with cerebral embolism were included in this study. TEE and TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery. An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or mobile plaque.

RESULTSOf the 49 patients, 31 (63%) patients showed evidence of AAA: 7 (14.1%) patients were mild, 9 (18.4%) were moderate and 15 (30.6%) were severe. In those 15 patients, 11 had neither severe ICAA nor heart disease. Thirty-three patients had internal carotid arterial atherosclerosis (ICAA). The potential sources of embolization of heart and aortic arch is 48.98% by TEE, but only 18.4% by TTE; 9 patients had heart disease. Age and ICAA were significantly correlated with AAA.

CONCLUSIONAt present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta. AAA is an important potential source of cerebral embolic stroke.

Adult ; Aged ; Aorta, Thoracic ; diagnostic imaging ; pathology ; Aortic Diseases ; complications ; diagnostic imaging ; Arteriosclerosis ; diagnostic imaging ; Carotid Arteries ; diagnostic imaging ; pathology ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Diseases ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Myocardium ; pathology ; Risk Factors ; Stroke ; diagnostic imaging ; etiology

OBJECTIVETo investigate the effectiveness of microbubble-enhanced ultrasound (MEUS) for detecting perforators preoperatively in supraclavicular flap surgery.

METHODSFrom May 2009 to October 2013, there were 20 patients (26 flaps were involved) who planned to undergo supraclavicular artery based flap surgeries to recover the large-area defects in head and neck. The MEUS together with regular color Doppler ultrasound ( CDUS) were conducted preoperatively to determine the anatomical features of perforators branching from supraclavicular arteries (SCA). The perforator with wider caliber, faster flow speed, longer pedicles and closer pivot point was selected and the flap was designed according to the observed results.

RESULTSThere were 37 perforators of SCA detected by CDUS, whose calibers were ranging from 0.5 to 0.8 mm [Mean: (0.6 ± 0.1) mm]. There were 48 perforators of SCA detected by MEUS. Compared to CDUS, the caliber obtained from MEUS for same vessel is significantly increased [(0.7 ± 0.3) mm vs (0.6 ± 0.1) mm, P < 0.05]. According to the results of MEUS and three-dimensional reconstructive techniques, in at least 65.4% (17/26) of the flaps, thoracic branch of SCA (TBSA) has large caliber and good flow velocity which can be regarded as the predominant vessel and used as the pedicle of flap. The results of the operations confirmed the existences of all the marked vessels. 25 flaps were obtained according to the preoperative plans and one case used perforators of internal mammary artery as free flaps since the perforator of SCA was found improper. The contrast-related complication occurred in one patient which was manifested by gastrointestinal adverse effect like nausea and anorexia. The patient recovered 1 day later without treatment. All the patients have been followed up for 3 to 16 months (Mean: 8 months) with well-survived flaps.

CONCLUSIONSThe perforators of SCA demonstrated significant variations and preoperative mapping was vital for the success of surgery. MEUS is a valuable imaging modality for the preoperative assessment of the vascular supply for supraclavicular artery based flap.

Arteries ; diagnostic imaging ; Humans ; Mammary Arteries ; Microbubbles ; Neck ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; Ultrasonography ; methods

Intravascular ultrasound (IVUS) is widely used in coronary artery examination. Ultrasonic elastography combined with IVUS is very conspicuous in identifying plaque component and in detecting plaque vulnerability degree. In this study, a simulation model of the blood vessel based on finite element analysis (FEA) was established. The vessel walls generally have radial changes caused by different intravascular pressure. The signals at lower pressures were used as the pre-deformation data and the signals at higher pressure were used as the post-deformation data. Displacement distribution was constructed using the time-domain cross-correlation method, and then strain images. By comparison of elastograms under different pressures, we obtained the optimal pressure step. Furthermore, on the basis of the obtained optimize pressure step, the simulation results showed that this method could effectively distinguish characteristics between different component plaques, and could guide the later experiments and clinical applications.
Angiography ; Arteries ; diagnostic imaging ; pathology ; Elasticity Imaging Techniques ; Finite Element Analysis ; Humans ; Plaque, Atherosclerotic ; diagnostic imaging ; Pressure

Carotid Arteries ; diagnostic imaging ; surgery ; Feasibility Studies ; Head and Neck Neoplasms ; blood supply ; diagnostic imaging ; surgery ; Humans ; Radionuclide Imaging

Quantitative measurement of strain distribution of arterial vessel walls due to pulsatile blood flow within the vascular lumen is valuable for evaluating the elasticity of arterial wall and predicting the evolution of plaques. The present paper shows that the three-dimensional (3D) strain distribution are estimated through uni-directional coupling for 3D vessel and blood models reconstructed from intravascular ultrasound (IVUS) images with the computational. fluid dynamics (CFD) numerical simulation technique. The morphology of vessel wall and plaques as well as strain distribution can be visually displayed with pseudo-color coding.
Arteries ; diagnostic imaging ; physiology ; Elasticity ; Hemodynamics ; Humans ; Imaging, Three-Dimensional ; Pulsatile Flow ; Ultrasonography