PURPOSE: Detecting laryngeal cartilages (triticeous and thyroid cartilages) on panoramic radiographs is important because they may be confused with carotid artery calcifications in the bifurcation region, which are a risk factor for stroke. This study assessed the efficiency of panoramic radiography in the diagnosis of calcified laryngeal cartilages using cone-beam computed tomography (CBCT) as the reference standard. MATERIALS AND METHODS: A total of 312 regions (142 bilateral, 10 left, 18 right) in 170 patients (140 males, 30 females) were examined. Panoramic radiographs were examined by an oral and maxillofacial radiologist with 11 years of experience. CBCT scans were reviewed by 2 other oral and maxillofacial radiologists. The kappa coefficient (κ) was calculated to determine the level of intra-observer agreement and to determine the level of agreement between the 2 methods. Diagnostic indicators (sensitivity, specificity, accuracy, and false positive and false negative rates) were also calculated. P values < .05 were considered to indicate statistical significance. RESULTS: Eighty-two images were re-examined to determine the intra-observer agreement level, and the kappa coefficient was calculated as 0.709 (P < .05). Statistically significant and acceptable agreement was found between the panoramic and CBCT images (κ=0.684 and P < .05). The sensitivity, specificity, diagnostic accuracy rate, the false positive rate, and the false negative rate of the panoramic radiographs were 85.4%, 83.5%, 84.6%, 16.5%, and 14.6%, respectively. CONCLUSION: In most cases, calcified laryngeal cartilages could be diagnosed on panoramic radiographs. However, due to variation in the calcifications, diagnosis may be difficult.
Carotid Arteries ; Cone-Beam Computed Tomography ; Diagnosis ; Humans ; Laryngeal Cartilages ; Male ; Radiography, Panoramic ; Risk Factors ; Sensitivity and Specificity ; Stroke ; Thyroid Gland

Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rete mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.
Adult ; Angioplasty, Balloon ; Carotid Arteries/pathology/*radiography/*surgery ; Cerebral Angiography ; Female ; Humans ; *Stents ; Syncope/etiology ; Treatment Outcome ; Vertebrobasilar Insufficiency/*radiography/*surgery ; Young Adult

OBJECTIVE: The dual microcatheter technique is common practice for coil embolization of a wide-necked aneurysm, due to safety and efficacy. However, technical limitations of some complex configurations may necessitate additional microcatheters to bolster coil stability, compact the coil, or for protection. Described herein is a triple microcatheter technique for endovascular management of wide-necked intracranial aneurysms. MATERIALS AND METHODS: Data accruing prospectively between January 2006 and October 2014 on simultaneously executed triple microcatheter coil embolization procedures done in 38 saccular aneurysms were reviewed. Clinical and morphological outcomes were assessed, with emphasis on technical aspects of treatment. RESULTS: The triple microcatheter technique was successfully applied to all 38 saccular aneurysms, involving the posterior communicating artery (n = 13), the middle cerebral artery (n = 10), the basilar tip (n = 7), the anterior cerebral artery (n = 5), and the internal carotid artery (n = 3). Stent protection was added in four patients and balloon remodeling in one. Dual microcatheters (n = 24) were usually deployed to deliver the coil within sacs of aneurysms, with the additional microcatheter used for protection. Otherwise, triple microcatheters were deployed for coil delivery (n = 11) or coils were delivered via a single microcatheter, with dual microcatheters deployed for protection (n = 3). Successful occlusion of aneurysms was achieved in 89.5% of cases, with no procedure-related morbidity or mortality. Stable occlusion was maintained in 72.2% (26/36) of the aneurysms at the final follow-up (mean interval, 30.2 +/- 22.7 months). CONCLUSION: The outcomes of this limited study suggest that the triple microcatheter technique may be an effective and safe therapeutic option for wide-necked aneurysms, using technical strategies tailored to complex angio-anatomic configurations.
Aged ; Angiography ; Carotid Arteries/radiography ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Aneurysm/*therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; *Stents

PURPOSE: This study was performed to investigate the interobserver agreement on the detection of carotid artery calcifications on panoramic radiographs. MATERIALS AND METHODS: This study consisted of panoramic radiographs acquired from 634 male patients of the age of 50 years or older. Having excluded carotids of no diagnostic quality, 1008 carotids from the panoramic radiographs of the patients were interpreted by two oral and maxillofacial radiologists independently for the presence of carotid artery calcifications. Statistical analysis was used to calculate the interobserver agreement. RESULTS: Interobserver agreement was obtained for 932 carotids (92.4%). Inconsistent interpretation of 76 carotids (7.5%) between the two observers was found. Cohen's kappa value was 0.688 (p<0.001). CONCLUSION: The probability of a match between the two observers was substantially high.
Atherosclerosis ; Carotid Arteries* ; Diagnosis* ; Humans ; Male ; Radiography, Panoramic

We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.
Aged ; Anticoagulants/therapeutic use ; Carotid Arteries/radiography ; Cerebral Infarction/*diagnosis/therapy ; Humans ; Male ; Platelet Aggregation Inhibitors/therapeutic use ; Stents/*adverse effects ; Thrombosis/drug therapy/*etiology ; Ticlopidine/analogs & derivatives/therapeutic use ; Tomography, X-Ray Computed

PURPOSE: During carotid angioplasty and stenting (CAS), hemodynamic instability (HDI) can occur, possibly causing post-procedural ischemic complications. The goal of this study was to investigate the risk factors of HDI focusing on characteristics of plaque. MATERIALS AND METHODS: Thirty nine CAS patients were retrospectively evaluated for HDI. Prolonged HDI that lasted over 30 minutes was analyzed in relation to characteristics of calcified plaque. RESULTS: Nineteen (48.7%) patients had HDI. Ten of the 19 had both bradycardia and hypotension, and nine had only bradycardia. All bradycardia was treated well with a transcutaneous temporary cardiac pacemaker. But eight patients presented with prolonged hypotension in spite of recovery of bradycardia. Calcified plaque was a related factor associated with HDI (odds ratio, 8.571; 95% confidence interval, 1.321-55.62; p=0.024). Extensive and eccentric type calcified plaques were associated with prolonged hypotension (p=0.04, and p=0.028, respectively). CONCLUSION: The calcification of plaque is a predictable factor of HDI during CAS, and its extensive and eccentric calcified plaques may be related to prolonged HDI.
Aged ; Angioplasty/*adverse effects ; Bradycardia/complications ; Carotid Arteries/*surgery ; Carotid Stenosis/*physiopathology ; Female ; *Hemodynamics ; Humans ; Hypotension/complications ; Intraoperative Complications/*etiology/radiography ; Intraoperative Period ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Stents ; Tomography, X-Ray Computed

Endovascular repair of inflammatory aortic aneurysms has been reported as an alternative to open surgical treatment. In selective cases, adjunctive bypass surgery may be required to provide an adequate landing zone. We report a case of endovascular repair of an inflammatory aortic aneurysm in a patient with Behcet's disease using a carotid-carotid bypass graft to provide an adequate landing zone. A 45-yr-old man with a voice change was referred to our hospital with the diagnosis of saccular aneurysm of the distal aortic arch resulting from vasculitis. Computed tomography showed a thoracic aortic aneurysm with thrombosis. Right to left carotid-carotid bypass grafting was performed. After 8 days, the patient underwent an endovascular stent graft placement distal to the origin of the innominate artery. The patient was discharged with medication and without postoperative complications after 5 days. Hybrid endovascular treatment may be suitable a complementary modality for repairing inflammatory aortic aneurysms.
Aortic Aneurysm, Thoracic/complications/radiography/*surgery ; Behcet Syndrome/*complications/surgery ; Blood Vessel Prosthesis Implantation/*methods ; Carotid Arteries/physiopathology/*surgery ; Coronary Artery Bypass ; Endovascular Procedures ; Humans ; Male ; Middle Aged ; Stents ; Thrombosis/complications ; Tomography Scanners, X-Ray Computed ; Vasculitis/complications

Bilateral carotid and vertebral rete mirabile (CVRM) is a very rare condition. We report a new case of CVRM initially detected by magnetic resonance imaging (MRI) of the cervical spine. MRI demonstrated tortuous vascular signal voids limited to the anterior cerebrospinal fluid space mimicking spinal dural arteriovenous fistula. A diagnosis of CVRM was confirmed on the basis of angiographic findings of rete formation associated with bilateral aplasia of the cavernous internal carotid and vertebral arteries without abnormal arteriovenous connection.
Adult ; Carotid Arteries/*abnormalities/pathology/radiography ; Central Nervous System Vascular Malformations/*diagnosis ; Cervical Vertebrae/pathology ; Humans ; *Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed ; Vertebral Artery/*abnormalities/pathology/radiography

PURPOSE: The aim of this study was to examine the relationship between tooth loss and sub-clinical atherosclerosis in Korean adults. MATERIALS AND METHODS: The subjects were part of a cohort study conducted in Ansan city by the Korea University medical school as part of the Korean Genome project. 749 subjects over than 40 years old were evaluated. After taking panoramic radiography, the amount of tooth loss was calculated. The intima-media thickness (IMT) was assessed by using ultrasonography at the common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated. The relationship between tooth loss and the IMT was evaluated using ANOVA with Scheffe's multiple comparison method in univariate analysis. Multiple regression analysis was also performed to determine the significance between the IMT and tooth loss. RESULTS: With age, tooth loss increased, but there was no significant increase in other traditional cardiovascular risk factors. Univariate analysis revealed the IMT to be positively related with the amount of tooth loss. Regression analysis of the IMT in the anterior and posterior tooth loss revealed that only the posterior tooth loss was significantly related with the IMT at all sites of the common carotid artery (right far wall, P = .015; left far wall, P = .008; right near wall, P < .001; left near wall, P = .001). CONCLUSION: This study verified the positive relationship between the increased tooth loss at the posterior area and the accumulation of atheroma in arteries.
Adult ; Arteries ; Atherosclerosis ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Cohort Studies ; Genome ; Humans ; Korea ; Plaque, Atherosclerotic ; Radiography, Panoramic ; Risk Factors ; Schools, Medical ; Tooth ; Tooth Loss

Distal protection devices such as FilterWire EX have been widely used in carotid artery stenting, however, the large amount of atherothrombotic debris entrapped in the filter could reduce or stop antegrade flow. We present a case of pseudo-no-reflow phenomenon after postdilatation of the stent in a patient with asymptomatic carotid artery stenosis. After several passes using an Export Aspiration catheter, normal flow in the internal carotid artery was restored. Aspiration thrombectomy can successfully recover pseudo-no-reflow phenomenon.
Aged ; Blood Vessel Prosthesis Implantation ; Carotid Arteries/radiography/surgery ; Carotid Stenosis/diagnosis/radiography/*surgery ; Humans ; Male ; *No-Reflow Phenomenon ; Stents ; Thrombectomy/*instrumentation