Aneurysm, False ; therapy ; Carotid Artery Diseases ; therapy ; Carotid Artery, Internal ; pathology ; Humans

This report documents the treatment of a giant aneurysm of the internal carotid artery bifurcation with a fistula to the cavernous sinus, which appeared following closed head trauma. A 39-year-old man suffered from a blunt head trauma in an automobile accident. Two weeks after the trauma, progressive chemosis of left eye was presented. Four months after the trauma, digital subtraction angiography showed an internal carotid artery bifurcation aneurysm, with drainage into the cavernous sinus. The lesion was successfully obliterated with preservation of the parent artery by using coils in conjunction with Onyx. Follow-up angiography obtained 3 months postoperatively revealed persistent obliteration of the aneurysm and fistula as well as patency of the parent artery. Endovascular treatment involving the use of coils combined with Onyx appears to be a feasible and effective option for treatment of this hard-to-treat lesion.
Adult ; Carotid Artery Diseases ; diagnosis ; therapy ; Carotid Artery, Internal ; Cavernous Sinus ; pathology ; Drainage ; Humans ; Intracranial Aneurysm ; diagnosis ; etiology ; Male

We report an exceptional case of a de novo giant fusiform aneurysm of the basilar trunk, which developed shortly after the therapeutic occlusion of the right internal carotid artery for a fusiform carotid aneurysm. It would appear to be appropriate to call this entity a sequential giant fusiform aneurysm. The patient was successfully treated with endovascular occlusion of the giant basilar trunk aneurysm following bypass surgery.
Adult ; Carotid Artery Diseases/therapy ; Carotid Artery, Internal ; Cerebral Angiography ; Female ; Humans ; Intracranial Aneurysm/diagnosis/*surgery ; Magnetic Resonance Imaging

OBJECTIVE: To examine the effect of niacin on the progression of carotid intima-media thickness (IMT) in patients with high level of lipoprotein (Lp) (a). METHODS: Patients at low-density lipoprotein-cholesterol goal but with Lp (a) >25 mg/dL and mean carotid IMT >0.75 mm were included. Eligible patients were randomized at a 1:2 ratio into one of two groups for 24 months: control or 1,500 mg extended release niacin. The primary study outcomes were the percentage changes in mean and maximal carotid IMT. The percentage change in lipid profiles including Lp (a) was analyzed as a secondary study outcome. RESULTS: Among 96 randomized patients, 31 completed the study (mean age: 65 years; male: 44%). At follow-up, the percentage change in mean carotid IMT was not significantly different between the two groups (−1.4%±15.5% and −1.1%±7.3% in the control and niacin groups, respectively, p=0.95). The percentage change in maximal carotid IMT was also similar in the two groups (0.7%±16.5% and −4.4%±11.6%, respectively, p=0.35). Elevation of high-density lipoprotein-cholesterol tended to be higher in the niacin group (p=0.07), and there was a significant difference in the percentage change in hemoglobin A1c between the two groups (−1.9%±2.2% and 3.3%±6.7%, respectively, p=0.02). Reduction of Lp (a) was greater in the niacin-treated group compared to placebo, but the difference was not statistically significant. CONCLUSION: Treatment with niacin for two years did not inhibit the progression of carotid intima-media thickening in patients with high Lp (a) level. However, this study may have been underpowered to evaluate the primary study outcome.
Arteries ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Drug Therapy ; Follow-Up Studies ; Humans ; Lipoprotein(a) ; Lipoproteins ; Male ; Niacin

OBJECTIVETo observe effect of acupuncture and moxibustion on carotid plaque in the patient of carotid atherosclerosis due to ischemic cerebrovascular disease.

METHODSSixty cases were randomly divided into an acup-mox group and a drug group, 30 cases in each group. Plaque of carotid atherosclerosis and quality of the plaque were investigated by color B-ultrasonography and the thickness and area of the plaque were calculated.

RESULTSThe resolution rate of the plaque was 53.9% in the acup-mox group and 10.0% in the drug group with a significant difference between the two groups (P < 0.01), and with better effects on flat plaque and soft plaque. And the thickness and area of the plaque of corotid atherosclerosis were significantly reduced.

CONCLUSIONAcupuncture and moxibustion can improve the plaque of corotid atherosclerosis, so as to alleviate and prevent from occurrence and development of ischemic cerebrovascular diseases.

Acupuncture ; Acupuncture Therapy ; Carotid Artery Diseases ; Humans ; Medicine, Chinese Traditional ; Moxibustion

Aged ; Arterial Occlusive Diseases ; therapy ; Carotid Artery Diseases ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Stents ; adverse effects

Carotid atherosclerosis is one the main risk factors for ischemic stroke. Based on NASCET and ECST results, carotid endarterectomy is strongly recommended for severe symptomatic stenosis. However, in the past several years, carotid artery stenting has emerged as a potential therapeutic alternative to carotid endarterectomy. The main limitation of carotid stenting is the potential risk of thromboembolic complication. Recently, cerebral protection during carotid stenting is technically feasible and clinically safe. In the published data of prospective registry with cerebral protection, the incidence of periprocedural neurologic complications was lower than in registries without cerebral protection and similar to the best results reported for carotid endarterectomy. The future status of the endovascular approach will be determined by randomized trials directly comparing carotid artery stenting with cerebral protection and endarterectomy. Occlusive atherosclerotic disease involving the intracranial cerebral vessels can be managed medically with antiplatelet and anticoagulant drug therapy or surgically. However, in patients who are unresponsive to medical therapy or who have unacceptable surgical risks, percutaneous angioplasty with stenting is an attractive alternative that can be performed in selected patients with relatively low risk and good clinical outcome.
Angioplasty ; Atherosclerosis ; Carotid Arteries ; Carotid Artery Diseases ; Constriction, Pathologic ; Drug Therapy ; Embolism ; Endarterectomy ; Endarterectomy, Carotid ; Humans ; Incidence ; Registries ; Risk Factors ; Stents ; Stroke

Carotid Artery Diseases ; drug therapy ; Carotid Artery, Internal ; Child ; Female ; Humans ; Injections ; Leukemia, Promyelocytic, Acute ; complications ; Rupture, Spontaneous ; Thrombin ; administration & dosage ; Ultrasonography, Interventional

BACKGROUND: Cardiovascular disease is the leading cause of death in postmenopausal women. The use of hormone replacement therapy (HRT) preventing for cardiovascular disease in postmenopausal women remains controversial. We investigated the effect of HRT on carotid intima-media thickness (IMT) according to the HRT duration in healthy postmenopausal women. METHODS: One hundred and twenty postmenopausal women (mean age: 55.4 +/- 3.3 years) were classified into never users, short-term, and long-term users according to the HRT duration. Carotid IMT was measured, and the clinical and biochemical cardiovascular risk factors were examined. RESULTS: The mean IMT was significantly thinner in the long-term users than that in the never users (0.62 +/- 0.11 vs. 0.71 +/- 0.14 mm, P < 0.01). Also, the maximal IMT was significantly thinner in the short-term and the long-term users. However, there is no significant difference in the mean and maximal IMTs between the estrogen alone and estrogen plus progestins used group. The period exposed to menopause was significantly shorter in the long-term users than that in the never users (1.8 +/- 2.3 vs. 4.3 +/- 3.3 years, P < 0.001). CONCLUSION: Our findings suggest that if HRT is initiated during early postmenopausal period before the onset of atherosclerosis, HRT may have a beneficial effect on the prevention of carotid atherosclerosis.
Atherosclerosis ; Cardiovascular Diseases ; Carotid Artery Diseases ; Carotid Intima-Media Thickness* ; Cause of Death ; Estrogens ; Female ; Hormone Replacement Therapy* ; Humans ; Menopause ; Postmenopause ; Progestins ; Risk Factors

OBJECTIVETo assess the impacts of acupuncture and moxibustion on carotid arterial vascular structure and blood flow parameters for the patients with carotid arteriosclerosis.

METHODSSixty-eight cases were randomized into an acupuncture-moxibustion group (35 cases) and a medication group (33 cases). In the acupuncture-moxibustion group, Renying (ST 9), Neiguan (PC 6), Zusanli (ST 36), etc. were selected, moxibustion was applied at Zusanli (ST 36). In the medication group, Enteric-coated aspirin was taken orally. The high-frequency ultrasonography was applied to detect common carotid artery (CCA), intima-media thickness (IMT), peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and resistance index (RI) before and after treatment for the comparative analysis.

RESULTSAfter treatment, in comparison between acupuncture-moxibustion group and medication group, CCA got bigger [(8.16 +/- 0.80) mm vs (7.69 +/- 0.61) mm, P < 0.01], IMT became thinner [(1.05 +/- 0.09) mm vs (1.10 +/- 0.09) mm, P < 0.05], PSV and EDV were accelerated (all P < 0.01), and PI and RI were down-regulated (P < 0.05, P < 0.01).

CONCLUSIONAcupuncture and moxibustion provides a good efficacy on the improvement in carotid arteriosclerosis and blood flow in carotid artery, which contributes to the alleviation of ischemic cerebrovascular diseases and prevention from the occurrence and development of them.

Acupuncture Therapy ; Adult ; Aged ; Carotid Arteries ; physiopathology ; Carotid Artery Diseases ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Regional Blood Flow