Association between Fundus Atherosclerosis and Carotid Arterial Atherosclerosis

Objective: To investigate the correlation between fundus atherosclerosis and carotid arterial atherosclerosis. Methods: A total of 516 people undergoing physical examination in Deyang People’s Hospital between June 2020 and December 2022 were randomly selected. Fundus atherosclerosis and carotid arterial atherosclerosis were evaluated by fundus photography and carotid artery ultrasonography, respectively. Results: Among the 516 physical examination patients, 198 (38.4%) had normal fundus examination, and 318 (61.6%) had fundus arteriosclerosis. Among them, 166 cases were of grade I (32.2%), 86 cases were of grade II (16.7%), and 66 cases were of grade III (12.8%). There were 286 cases (55.4%) without carotid atherosclerosis, 201 cases (38.9%) with carotid atherosclerotic plaque, and 33 cases (6.4%) with carotid stenosis. Fundus arteriosclerosis is independently associated with carotid artery intima-media thickness, vulnerable plaques, plaque scores, and carotid artery stenosis (P Conclusion: In summary, there is a close relationship between carotid artery disease and the degree of arteriosclerosis in the eyeground. Fundus photography is a simple, non-invasive, and easily acceptable method of inspection. The results obtained from it are useful in determining the severity of carotid atherosclerosis and guiding early detection and intervention in clinical cases. This can help reduce the incidence of cardiovascular and cerebrovascular diseases.

Segmentation of carotid arterial walls using neural networks

BACKGROUND Automated,accurate,objective,and quantitative medical image segmentation has remained a challenging goal in computer science since its inception.This study applies the technique of convolutional neural networks(CNNs)to the task of segmenting carotid arteries to aid in the assessment of pathology.AIM To investigate CNN’s utility as an ancillary tool for researchers who require accurate segmentation of carotid vessels.METHODS An expert reader delineated vessel wall boundaries on 4422 axial T2-weighted magnetic resonance images of bilateral carotid arteries from 189 subjects with clinically evident atherosclerotic disease.A portion of this dataset was used to train two CNNs(one to segment the vessel lumen and the other to segment the vessel wall)with the remaining portion used to test the algorithm’s efficacy by comparing CNN segmented images with those of an expert reader.Overall quantitative assessment between automated and manual segmentations was determined by computing the DICE coefficient for each pair of segmented images in the test dataset for each CNN applied.The average DICE coefficient for the test dataset(CNN segmentations compared to expert’s segmentations)was 0.96 for the lumen and 0.87 for the vessel wall.Pearson correlation values and the intra-class correlation coefficient(ICC)were computed for the lumen(Pearson=0.98,ICC=0.98)and vessel wall(Pearson=0.88,ICC=0.86)segmentations.Bland-Altman plots of area measurements for the CNN and expert readers indicate good agreement with a mean bias of 1%-8%.CONCLUSION Although the technique produces reasonable results that are on par with expert human assessments,our application requires human supervision and monitoring to ensure consistent results.We intend to deploy this algorithm as part of a software platform to lessen researchers’workload to more quickly obtain reliable results.

Close Correlations Between Carotid Arterial Mean Blood Flow Velocity,Body Mass Index,and Temperature in Normal Individuals

Objective:Assessing carotid and radial pulses is an essential sphygmology method in traditional Chinese medicine(TCM).It is believed in TCM and by doctors that pulse force is markedly linked with the physiological state of a human,including body mass index(BMI)and temperature.However,comprehensive analysis elucidating these potential correlations remains undetermined.Therefore,this investigation aimed to assess the association of pulse strength with human metabolism.Materials and Methods:The mean blood flow velocity(MBFV)of the carotid artery and pulse force of 122 healthy adults included in this investigation were assessed using ultrasound and manual palpation.Their thermal texture map was also acquired.Results:No substantial variation was observed in the carotid arterial MBFV among normal individuals(P>0.05)regardless of body side and gender.However,young individuals had higher blood velocity than middle-aged individuals(P<0.05).Furthermore,it was identified that MBFV was negatively associated with BMI and torso temperature;however,it was positively linked with hand temperature.Conclusions:This investigation revealed that carotid arterial MBFV could indicate the physical state of humans,including BMI and temperature,and therefore,is valuable for elucidating the effect of TCM on yin–yang.The data validated some TCM beliefs and supported the implementation of sphygmology in TCM.

Ultrafast pulse wave velocity technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis patients with euthyroidism

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.

Early diagnostic value of carotid artery ultrasound parameters combined with epicardial adipose layer thickness in coronary heart disease

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.

Imaging characteristics and treatment strategies for carotid artery occlusion caused by skull base fracture:Three case reports

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.

Massive Epistaxis Revealing a Post-Traumatic Aneurysm of the Internal Carotid Artery: A Clinical Case and Review of the Literature

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.

Ultrasound Combined with CTA in Diagnosis of Painless Aortic Dissection Combined with Carotid Artery Active Thrombosis: A Case Report

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.

Evaluation of carotid intima-media thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy

Background:Adenotonsillar hypertrophy can produce cardiopulmonary disease in children.However,it is unclear whether adenotonsillar hypertrophy causes atherosclerosis.This study evaluated carotid intimamedia thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy.Methods:The study included 40 children with adenotonsillar hypertrophy(age:5-10 years)and 36 healthy children with similar age and body mass index.Systolic blood pressure,diastolic blood pressure,and pulse pressure were measured in all subjects.Carotid intima-media thickness,carotid arterial systolic diameter,and carotid arterial diastolic diameter were measured using a high-resolution ultrasound device.Based on these measurements,carotid arterial strain,carotid artery distensibility,beta stiffness index,and elasticity modulus were calculated.Results:Carotid intima-media thickness was greater in children with adenotonsillar hypertrophy(0.36±0.05 mm vs.0.34±0.04 mm,P=0.02)compared to healthy controls.Beta stiffness index(3.01±1.22 vs.2.98±0.98,P=0.85),elasticity modulus(231.39±99.23 vs.226.46±83.20,P=0.88),carotid arterial strain(0.17±0.06 vs.0.17±0.04,P=0.95),and carotid artery distensibility(13.14±3.88 vs.12.92±3.84,P=0.75)were similar between children with adenotonsillar hypertrophy and the healthy controls.Conclusions:The present study revealed increased carotid intima-media thickness in children with adenotonsillar hypertrophy.The risk of subclinical atherosclerosis may be higher in children with adenotonsillar hypertrophy.

Metformin effect on internal carotid artery blood flow assessed by area under the curve of carotid artery Doppler in women with polycystic ovarian syndrome

BACKGROUND Insulin resistance(IR)was reported in most polycystic ovarian syndrome(PCOS)cases.Metformin,a biguanide drug,successfully reduced IR.Homeostatic Model Assessment for IR(HOMA-IR)and Doppler parameters assessed metformin's effectiveness.AIM To verify whether the area under the curve of the internal carotid artery(AUC-ICA)Doppler wave can be a useful marker for assessing IR among PCOS cases who presented with menstrual irregularity and were treated with metformin over 6 mo.METHODS An observational,cross-sectional study recruited 54 eligible PCOS women;the anthropometrics were as follows:age,body mass index(BMI),menstrual cycle days,biochemical serum cholesterol,low and high-density lipoprotein,sex hormone-binding globulin,fasting blood glucose,and HOMA-IR,hormonal testosterone,luteinizing hormone over follicle-stimulating hormone ratio,and ultrasonic pulsatility index(PI)and resistance index(RI),carotid artery intima-media thickness(CIMT)and(AUC-ICA)parameters were initially recorded and repeated 3 mo and 6 mo later with metformin tab 500 mg;three times/day for 6 mo.In addition,AUC-ICA was assessed by taking repeated systolic and diastolic wave height measurements.RESULTS Metformin caused a progressive reduction in BMI,menstrual cycle days,biochemical hormonal,and Doppler parameters(CIMT,PI,RI,and AUC-ICA).AUC-ICA correlated strongly to all PCOS parameters.AUC-ICA correlated inversely with treatment time(r=-0.98,P<0.001)and positively with HOMA-IR(r=0.98,P<0.0001).Via the best subset regression model,the AUC-ICA had the highest predictive value for HOMA-IR.CONCLUSION AUC-ICA preceded PI,RI,and CIMT with a strong,meaningful correlation to all PCOS parameters,making it a reliable marker for the assessment of IR,especially during metformin therapy.Further studies are recommended to promote the application in practice.

Idiopathic steno-occlusive disease with bilateral internal carotid artery occlusion:A Case Report

BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We report a 4-year-old girl with left hemiparesis after an acute ischemic stroke.Her history was also significant for repeated left or right focal motor seizures,generalized tonic-clonic convulsions and transient ischemic attacks.Her magnetic resonance imaging and computed tomography(CT)of the brain and magnetic resonance angiography,CT angiography and venography on the cerebral vessels revealed evidence of bilateral fronto-parietal ischemic infarctions,occlusion of the right and left internal carotid arteries started at its bifurcation and non-visualization of right and left anterior and middle cerebral arteries.There was evidence of progression in angiography manifested as development of collaterals from the basal perforating vessels,increase in the extent of large intracranial arterial stenosis/occlusion and extensive collateral circulation with predominance from the posterior circulation.Physical and neurological evaluation and comprehensive laboratory investigations excluded an obvious comorbid disease or risk factor for the child’s condition.The diagnosis of MMD was highly suggested as a cause of the child’s steno-occlusive condition.She was treated symptomatically with levetiracetam,an antiepileptic medication.Aspirin was prescribed for secondary prevention.Her clinical manifestations were improved during the three years of follow-up.Revascularization surgery was postponed.CONCLUSION Up to our knowledge,this is the first report for MMD in a child in our country.The clinical improvement and the stabilization of the child’s condition over the 3 years of follow-up could be attributed to the rapid and extensive recruitment of collaterals and absence of risk factors or comorbidities.Revascularization surgery is highly recommended.

Efficacy of Willis covered stent of intracranial pseudoaneurysms in the internal carotid artery: A systematic review and meta-analysis

Objective:To evaluate the efficacy of a novel coated stent in the treatment of intracranial pseudoaneurysm.Methods:MEDLINE,EMBASE,and PubMed databases were searched for literature published between 1990 and April 2022 according to PRISMA guidelines.All studies with≥10 patients reporting successful implantation of Willis covered stent,therapeutic effect,complications,and postoperative follow-up were included.The combined incidence and corresponding 95%confidence intervals were assessed using a generalized linear mixed method and random effects model.Results:Five studies(116 patients with pseudoaneurysms)were included.The experimental groups in the selected studies showed a combined technical success rate of 81.03%(OR=18.31,95%CI=9.39-35.69,I^(2)=79%,P<0.001).Clinical follow-up showed that the complete cure rate was as high as 94.4%after the follow-up(OR=106.81,95%CI=39.08-291.88,I^(2)=0%,P=0.71).Conclusions:Willis covered stent is feasible,safe,and effective in the treatment of intracranial pseudoaneurysm.

Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports

BACKGROUND One of the major perioperative complications for coronary artery bypass graft(CABG)is stroke.The risk of perioperative stroke after CABG is approximately 2%.Carotid stenosis(CS)is considered an independent predictor of perioperative stroke risk in CABG patients.The optimal management of such patients has been a source of controversy.One of the possible surgical options is synchronous carotid endarterectomy(CEA)and CABG.Here,we have presented 4 cases of successful synchronous CEA and CABG.Our center’s experience with 4 cases of significant carotid artery stenosis,which were successfully managed with combined CEA and CABG,are detailed.The first case was a female who presented for CABG after a ST-elevation myocardial infarction.She had right internal carotid artery(ICA)occlusion and 90%left ICA stenosis.The second case was a male who was electively admitted for CABG.It was discovered that he had left ICA occlusion and 90%right ICA stenosis.The third case was a male with a history of stroke,two months prior to admission.He presented with non-ST-elevation myocardial infarction.Preoperatively,it was discovered that he had>90%right ICA stenosis.The final case was a male who was electively admitted for CABG.It was discovered that he had bilateral>90%ICA stenosis.We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG.CONCLUSION Our case series demonstrated that synchronous CEA and CABG was safe.A multicenter study with additional patients is needed.It is necessary for clinicians to screen for CS in high-risk patients with features.

Initial clinical experience with Xpert-Pro peripheral self-expanding stent system for internal carotid artery dissection:Two case reports

Background:The standard treatment for internal carotid artery(ICA)dissection is obscure.Current therapeutic strategies include the use of antiplatelet drugs,anticoagulant drugs,intravenous thrombolysis,and endovascular treatment.Endovascular treatment is important in acute internal carotid artery dissection.This study reports two acute internal carotid artery dissection cases that were treated successfully using the Xpert-Pro peripheral selfexpanding stent system.Case summary:The first case was of a 38-year-old male patient with transient speechlessness and paralysis of the right limb in July 2021.Cervical computed tomographic angiography(CTA)showed ICA occlusion on the left side.Digital subtraction angiography(DSA)showed severe stenosis of the C1 segment of the left internal carotid artery with intermural hematoma.The patient subsequently underwent Xpert-Pro peripheral self-expanding stent implantation,and his condition stabilized.The second case was of a 56-year-old male patient with speechlessness and paralysis of the right limb.Cervical CTA showed a dissected left ICA,and DSA showed an occluded left ICA and middle cerebral artery.The patient subsequently underwent stent implantation,and his condition stabilized.

Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports

BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke.Physical examination showed decreased strength(5-/5)in both lower limbs.Carotid artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,respectively.We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation.Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence.CTA six months postoperatively showed no significant increase in in-stent stenosis.Case 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by ultrasound.Physical examination showed no positive neurological signs.Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA dissection.CAS was performed and intraoperative IVUS suggested a large residual false lumen.Post-stent balloon dilatation was performed reducing the false lumen.DSA three months postoperatively indicated good stent expansion with mild stenosis.CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperatively.

Commentary on a case report and literature review of acute carotid stent thrombosis

In this commentary on the article entitled“Acute carotid stent thrombosis:A case report and literature review”,the key points of the article are discussed.Acute carotid stent thrombosis(ACST)in the setting of carotid artery stenting(CAS)represents a rare but potentially catastrophic event.There is a wide range of treatment options available,including carotid endarterectomy,which is generally recommended for cases of refractory ACST.While there is no standard treatment regimen,dual antiplatelet therapy is typically recommended both before and after CAS to reduce risk of ACST.

Carotid-cavernous fistula following mechanical thrombectomy of the tortuous internal carotid artery:A case report

BACKGROUND A carotid-cavernous fistula(CCF)is an abnormal connection between the internal carotid artery(ICA)and the cavernous sinus.Although direct CCFs typically result from trauma or as an iatrogenic complication of neuroendovascular procedures,they can occur as surgery-related complications after mechanical thrombectomy(MT).With the widespread use of MT in patients with acute ischemic stroke complicated with large vessel occlusion,it is important to document CCF following MT and how to avoid them.In this study,we present a case of a patient who developed a CCF following MT and describe in detail the characteristics of ICA tortuosity in this case.CASE SUMMARY A 60-year-old woman experienced weakness in the left upper and lower limbs as well as difficulty speaking for 4 h.The neurological examination revealed left central facial paralysis and left hemiplegia,with a National Institutes of Health Stroke Scale score of 9.Head magnetic resonance imaging revealed an acute cerebral infarction in the right basal ganglia and radial crown.Magnetic resonance angiography demonstrated an occlusion of the right ICA and middle cerebral artery.Digital subtraction angiography demonstrated distal occlusion of the cervical segment of the right ICA.We performed suction combined with stent thrombectomy.Then,postoperative angiography was performed,which showed a right CCF.One month later,CCF embolization was performed,and the patient’s clinical symptoms have significantly improved 5 mo after the operation.CONCLUSION Although a CCF is a rare complication after MT,it should be considered.Understanding the tortuosity of the internal carotid-cavernous sinus may help predict the complexity of MT and avoid this complication.

Carotid-subclavian bypass and endovascular aortic repair of Kommerell’s diverticulum with aberrant left subclavian artery:A case report

BACKGROUND Kommerell’s diverticulum(KD)with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it(35%of case study).There are three types of aortic arch diverticulum.Even literature concerning the treatment options are limited.CASE SUMMARY We present a case report of a 50-year-old male with KD in the right aortic arch with aberrant left subclavian artery.We conducted a total endovascular repair procedure,which is innovative and will spread more light in the medical world.Our patient has no past medical history and is a non-smoker and non-alcoholic.Patient presented with shortness of breath,chest pain and dizziness for six months.Blood tests were done and computerized tomography(CT)angiogram of the chest confirmed the diagnosis,illustrating showed a 3.9 cm KD.On Day 1,the CT angiogram showed mild dilatation of the thoracic aorta,adjacent esophagus,trachea was compressed and displaced.Surgery was planned as the treatment modality.Carotid-Subclavian artery bypass and endovascular aortic repair was conducted.We used prolene 5-0 C1 sutures to precisely anastomose a 6-mm Dacron graft to the left subclavian artery.Haemostasis was secured and wounds were closed.Protamine was administered and patient was shifted to intensive care unit.Post-operative,patient responded favorably and was discharged.Regular follow-up is done.CONCLUSION The procedure we performed is novel.This will help the cardio-thoracic surgeons a better insight about the full procedures we conducted,thereby bringing more light and better treatment options in managing KD with aberrant subclavian artery.

Endovascular Therapy of Internal Carotid Artery Tandem Occlusions and Literature Review

Acute large vessel occlusion is a common cause of acute ischemic stroke (AIS), with high rates of disability and lethality. The incidence of tandem occlusion of the internal carotid artery accounts for about 20% of patients with large vessel occlusion of the anterior circulation in acute ischemic stroke. The low rate of recanalization by intravenous thrombolysis in AIS due to internal carotid artery tandem occlusion, the poor establishment of collateral circulation within a short time, and the complex pathogenesis often suggest a poor prognosis for patients. Mechanical thrombectomy (MT) is beneficial for the opening of intracranial large vessel occlusion with internal carotid artery tandem occlusion, there are many problems regarding the emergency management of carotid artery occlusion or stenosis after mechanical thrombectomy, and there are currently no standardized treatment recommendations;The sequential approach to the management of carotid tandem occlusion, the timing of carotid stenting, and the use of antiplatelet agents remain controversial. The current state of research on carotid tandem occlusion is analyzed in the literature to promote clinical understanding of endovascular treatment for patients with acute ischemic stroke due to carotid tandem occlusion.

Research Progress in Surgical Management of Head and Neck Tumors Involving the Carotid Artery

The surgeons adopt the comprehensive treatment method basing on surgery When head and neck tumors involve the carotid artery. At present, there are four surgical treatments, namely, dissection of carotid artery tumor, resection of carotid artery, revascularization after carotid resection, endoarterial implantation of covered stent combined with surgical resection. However, there is currently no consensus on the standard surgical approach to choose. This paper describes the four surgical methods, which are expected to be helpful for head and neck surgeons to choose the surgical methods for head and neck tumors involving the carotid artery.