This experimental study was performed to evaluate the correlation between the stenosis of common carotid artery and the change of velocity wave form in sixteen mongrel dogs. With continuous directional Doppler the velocity waves were recorded from the common carotid artery, which was experimentally stenosed by the graded constrictor. Grouped according to carotid angiogram, there were 16 normals(I), 21 stenoses of less than 35%(II), 16 stenoses of 36-59%(III), 10 stnoses of 60-79%(IV), and 10 stenoses of more than 80%(V). From the analysis of carotid artery velocity tracings, six most discriminating variables were obtained, which were statistically significant between intergroup comparison except between group I and group II. Four best fit discriminant equations for group II, III, IV, or V were derived through the analysis of the combination of these six variables. Using these equations and the values for six variables, the overall accuracy rate of placing it into appropriate group was 84.2%. The accuracy rate of separating normal, stenosis less than 60%, and stenosis more than 60% was 94.8%. The carotid stenosis of 36-59% (group III) showed some change of carotid velocity wave form and could be diagnosed appropriately using the velocity wave form analysis. Therefore it is concluded that the velocity wave form anlaysis would be a useful and handy mehtod to evaluate the occlusive carotid artery disease.
Animals ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Artery, Common ; Carotid Stenosis ; Constriction, Pathologic ; Diagnosis* ; Dogs

OBJECTIVETo explore the specialty of diagnosis and surgery of tight carotid stenosis.

METHODFrom January 2000 to December 2009, 53 patients with tight carotid stenosis (> 95%) were operated on. All 53 patients had tight carotid stenosis more than 95% on one side in whom 28 had contralateral carotid stenosis or occlusion. The clinical and imaging data as well as surgical outcomes of the patients were retrospectively analyzed.

RESULTSForty-five patients had postoperatively done well without any complications. There were 3 cases of hemodynamic instability and one case of cardiac ischemia which resolved in one to two days. One patient developed mild hoarseness. One complicated with bacteremia due to deep vein catheter insertion. Two patients experienced brain hemorrhage. None of this series occurred perioperative brain ischemia.

CONCLUSIONSTight carotid stenosis indicates a need for expeditious carotid endarterectomy with very low rates of brain ischemia. Intraoperative shunting is seldom necessary. Postoperative hyperperfusion syndrome and brain hemorrhage should be worried. Micro-endarterectomy can effectively prevent from restenosis.

Adult ; Aged ; Carotid Stenosis ; diagnosis ; surgery ; Endarterectomy, Carotid ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents

Contrast-enhanced ultrasonography of the carotids has recently emerged as a complementary examination to conventional carotid Doppler ultrasonography. It is an examination providing improved visualization of the vascular lumen, more accurate and detailed delineation of the vascular wall, and identification of atherosclerotic plaques. Moreover, contrast-enhanced ultrasonography has specific advantages over conventional ultrasonography and plays an important role in the diagnosis of the vulnerable carotid plaque, as it can identify intraplaque neovascularization and carotid plaque ulceration. Given the specific advantages and improved imaging of the carotids provided by this method, radiologists should be familiar with it. This pictorial essay illustrates the advantages of this technique and discusses its value in the imaging of carotid arteries.
Carotid Arteries ; Carotid Stenosis ; Contrast Media ; Diagnosis ; Plaque, Atherosclerotic ; Ulcer ; Ultrasonography* ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color

OBJECTIVE: To evaluate of virtual angioscopy was implemented using MR(magnetic resonance) angiography image of carotid artery. METHODS: The endoscopy system provides a 3D volume rendered image as a navigation map and has the multi planar reformation image along the path and a 2D axial image as a reference image. We segmented the common carotid artery and internal, external carotid artery from the MR angiography image. We used the coordinates as a navigation path for virtual camera that were calculated from medial axis transformation. We used the perspective projection and marching cube algorithm to render the surface from volumetric MR angiography image data. RESULTS: The virtual angioscopy is highly recommended as a diagnosis tool with which the specific place of stenosis can be identified and the degree of stenosis can be measured qualitatively. CONCLUSION: Virtual angioscopy is one of the powerful tool for non-invasive carotid artery and many in-vitro, in-vivo studies have shown the artery stenosis detection. Inside of the carotid artery is one of the body region not accessible by real optical endoscopy but can be visualized with virtual endoscopy.
Angiography* ; Angioscopy* ; Arteries ; Axis, Cervical Vertebra ; Body Regions ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Stenosis ; Constriction, Pathologic ; Diagnosis ; Endoscopy

OBJECTIVE: The purpose of study is to help the diagnosis and define the management of the ischemic stroke with carotid stenosis. We report a clinical analysis of the clinical and radiological characteristics of extracranial carotid artery stenosis in patients presenting with ischemic stroke using non-invasive technique, magnetic resonance(MR) angiography. METHODS: The authors reviewed 232 patients with ischemic stroke, excluding cardiac origin, carrying out MR image and MR angiography at department of neurology and neurosurgery from May 1998 to May 2001. Stroke in this study were classified as carotid and vertebro-basilar stroke. According to clinical and radiological finding, carotid stroke was divided into lacunar and non-lacunar stroke. The patients with extracranial carotid artery stenosis were classified according to the symptoms, location, and the degree of stenosis. The locations of intracranial lesion and associated intracranial stenosis were analyzed also. RESULTS: Of 232 stroke patients, 23(9.9%) had extracranial carotid artery stenosis. Symptomatic stenosis were 9 and 14 patients were non-symptomatic. The locations of stenosis were 10 in carotid bifurcation, 11 in proximal internal carotid artery, and 2 in common carotid artery. Severe intracranial stenosis were observed in 16 patients(69.6%) among 23 patients with extracranial carotid artery stenosis. CONCLUSION: Intracranial stenosis were frequently observed in ischemic stroke patients than extracranial lesions. And the combined extra- and intracranial atherosclerotic lesions were frequently seen in the patients with carotid artery stenosis. And these charactreristics should be considered in surgical management of ischemic stroke.
Angiography ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Artery, Internal ; Carotid Stenosis* ; Constriction, Pathologic ; Diagnosis ; Humans ; Magnetic Resonance Angiography ; Neurology ; Neurosurgery ; Stroke*

OBJECTIVETo discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging (HRMR VWI) for intracranial arterial stenosis.

DATE SOURCESWe retrieved information from PubMed database up to December 2015, using various search terms including vessel wall imaging (VWI), high-resolution magnetic resonance imaging, intracranial arterial stenosis, black blood, and intracranial atherosclerosis.

STUDY SELECTIONWe reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI. We organized this data to explain the value of VWI in clinical application.

RESULTSVWI with black blood technique could provide high-quality images with submillimeter voxel size, and display both the vessel wall and lumen of intracranial artery simultaneously. Various intracranial vasculopathies (atherosclerotic or nonatherosclerotic) had differentiating features including pattern of wall thickening, enhancement, and vessel remodeling on VWI. This technique could be used for determining causes of stenosis, identification of stroke mechanism, risk-stratifying patients, and directing therapeutic management in clinical practice. In addition, a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy.

CONCLUSIONSThis review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.

Carotid Stenosis ; diagnosis ; Cerebral Angiography ; methods ; Humans ; Intracranial Arteriosclerosis ; diagnosis ; Magnetic Resonance Angiography ; methods

Obstructions in the extracranial cerebral arteries can be detected noninvasively by directional Doppler ultrasound technique. There are two types of Doppler technique, indirect and direct. The indirect test is based on measurement of flow direction in supraorbital or frontal arteries and responses to superficial temporal, facial, infraorbital and common carotid artery compression. In this study, the results of cerebrovascular Doppler examination were compared with cerebral angiographic findings in five patients of moyamoya disease. These patients were suspected of having extracranial carotid occlusive diseases according to cerebrovascular Doppler studies and the diagnoses were confirmed finally by the transfermoral carotid angiography. The results of supraorbital study and cerebral angiography were correlated in all six cases of internal carotid artery stenosis with more than 60% of narrowing in diameter, but the results of frontal study correlated in five of sis cases. Therefore it is suggested that the Doppler study can be used in screening the patients with the risk of stroke, without employing complicated, expensive and sometimes life thratening angiographic procedure.
Angiography ; Arteries ; Carotid Artery, Common ; Carotid Stenosis ; Cerebral Angiography ; Cerebral Arteries ; Diagnosis ; Humans ; Mass Screening ; Moyamoya Disease* ; Stroke ; Ultrasonography

Ocular ischemic syndrome is a chronic ischemic eye disease including a series of ischemic ocular and brain syndromes caused by carotid artery occlusion or stenosis. Because of the different degrees of ischemia, clinical manifestations of ocular ischemic syndrome are diverse, and it is difficult to diagnose in the initial stage. The main strategy to treat ocular ischemic syndrome is elimination of carotid stenosis. We presented a patient who recovered dramatically after carotid artery stenting. The pre-stenting arm-retinal circulation time of the patient’s left eye was prolonged, and a large amount of microaneurysm appeared at the posterior polar and mid-peripheral aspects of the left retina. The post-stenting arm-retinal circulation time of the left eye decreased to 16.3 seconds, and the microaneurysm almost disappeared.
Angioplasty ; Carotid Arteries ; surgery ; Carotid Stenosis ; surgery ; Female ; Humans ; Ischemia ; diagnosis ; Middle Aged ; Retinal Artery Occlusion ; surgery ; Retinal Diseases ; surgery

OBJECTIVETo investigate the relationship between a blood pressure variability (BPV)-based scoring system (BPVSS) and the target organ damage in patients with hypertension.

METHODSWe selected 95 consecutive inpatients with essential hypertension admitted between January and June, 2015 in the Department of Cardiology of Guangzhou General Hospital of Guangzhou Military Command. The BPV indices were analyzed for their correlation with the parameters of target organ damage (IVSd, LVPWd, baPWV_L/R, and IMT_L/R). The patients with a BPVSS of 3.9 or higher (control, 43 cases) and those with a lower BPVSS (observation group, 52 cases) were compared for differences in IVSd, LVPWd, baPWV_L/R, IMT_L/R and the proportion of carotid plaques.

RESULTSSimilar with the traditional BPV indices, BPVSS was negatively correlated with IMT_L/R (r=-0.278/-0.324, P<0.05). BPVSS was also negatively correlated with IVSd (r=-0.241), LVPWd (r=-0.223), and baPWV_L/R (r=-0.468/-0.373) (P<0.05). IVSd, LVPWd, baPWV_L/R and IMT_L/R were all significantly higher in the observation group than in the control group (t=2.307, 2.516, 3.250/2.790, and 2.372/3.425, respectively; P<0.05). The proportion of carotid plaques in the observation group was significantly higher than that in the control group (Χ(2)=27.833, P<0.001).

CONCLUSIONBPVSS indicates the severity of target organ damage in patients with hypertension. A greater BPV is correlated with a lower BPVSS score and more severe damages of the heart and blood vessels.

Blood Pressure ; Carotid Stenosis ; diagnosis ; pathology ; Essential Hypertension ; Humans ; Hypertension ; pathology

A 78-year-old right handed man with hypertension presented with sudden onset dysarthria and right hemiparesis. Magnetic resonance angiography revealed near-occlusion of left proximal internal carotid artery. Emergent carotid stenting was performed. On the 17th day after carotid stenting, he showed decreased consciousness. Magnetic resonance imaging (MRI) showed edematous change with high signal and increased perfusion in the left hemisphere. Our case shows that delayed cerebral hyperperfusion syndrome can occur even 2 weeks after carotid artery stenting and multimodal MRI can help accurate diagnosis.
Aged ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis ; Consciousness ; Diagnosis ; Dysarthria ; Hand ; Humans ; Hypertension ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging* ; Paresis ; Perfusion ; Stents*