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.

Correlation of restenosis after rabbit carotid endarterectomy and inflammatory cytokines

Objective:To establish rabbit model of restenosis after carotid endartereclomy surgery,and to study tissue inflammatory cytokines(TNF-α,IL-61 involved in restenosis.Methods:A total of 32 rabbits were randomly divided into two groups:model group and control group.The right common carotid artery in rabbits was damaged by carotid endar terectomy in model group.The tissues were harvested at different time points respectively,the pathological changes of the vascular wall after operation were observed at different time points.The changes of expression of tissue vascular wall inflammatory cytokines(TNF-α.IL-6)at different lime points after the surgery was observed by RT-PCR,and the changes of serum inflammatory cytokines(TNT-α,IL-6)were detected by F.I.1SA.Results:The new intima appeared after 7 days of the injury and reached the peak on 28 d which is uneven and significantly thicker than the control group(P<0.01).The tissue inflammatory cytokines(TNF-α,IL-6)were significantlv increased after the rabbit common carotid artery injury,which was significant difference compared with normal control group(P<0.05).Conclusions:The tissue inflammatory factors significantly increase after the rabbit carotid artery injury,which suggests the mutual concurrent effects of inflammatory cytokines can result in the proliferation of vascular restenosis.

Carotid artery stenting versus carotid endarterectomy in the treatment of symptomatic and asymptomatic carotid stenosis: a systematic review and meta-analysis

Purpose: To evaluate the short-term and intermediate-to long-term efficacy and safety of carotid artery stenting(CAS) compared with carotid endarterectomy(CEA). Materials and Methods: The published literature was electronically searched for randomized controlled trials(RCTs) between CAS and CEA for the treatment of carotid stenosis performed from January 2000 to January 2017. The short-term and intermediate-to long-term outcomes were evaluated. Results: We identified 10 RCTs including 7,183 participants with symptomatic or asymptomatic carotid stenosis. Our meta-analysis found different results between the patients with and those without symptoms. In patients with symptomatic carotid stenosis, the total stroke incidence in the CAS group was significantly higher than that in the CEA group within the 30-day periprocedural period(p<0.001); however, the myocardial infarction incidence in the CAS group was significantly lower than that in the CEA group(p<0.05). There was no significant difference between the two groups in the mortality within 30 days post-procedure, but the intermediate-to long-term incidence of stroke or death in the CAS group was higher than that of the CEA group(p<0.05). In contrast, for asymptomatic patients, there were no significant differences between the CAS and CEA groups in the short-and intermediate-to long-term outcomes. Conclusion: For patients with symptomatic carotid stenosis, CEA is associated with an increased risk of myocardial infarction, whereas CAS is correlated with an increased risk of procedurally related strokes. However, for patients with asymptomatic carotid stenosis, no significant difference was found in the efficacy or safety between CAS and CEA.

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.

One Case of Suspected Angiostenosis Revealed by MRA Following Carotid Endarterectomy Due to a Rare Cause

We herein report on a case in which magnetic resonance angiography (MRA) following carotid endarterectomy revealed the appearance of angiostenosis due to an artifact of metallic powder, which was thought to have come from an old surgical instrument. The patient was a 77-year-old male. Carotid endarterectomy (CEA) was performed for stenosis in the internal carotid artery of his left neck (82%). Upon observing a decline in renal function following CEA surgery, a postoperative cervical MRA revealed the appearance of high-grade stenosis at the common carotid artery on which surgery was performed. No stenosis was revealed upon carotid ultrasonography and angiography. In the original MRA image, an orbicular low intensity area was observed in concordance with the narrow segment. 3D computed tomography (3D-CT) revealed a metallic finding, suggesting it was an artifact caused by metal powder. Close inspection of the metal surgical instruments used during surgery revealed slight damage to a suture snare which had been used for 30 years. Going forward, it is necessary to pay attention to old surgical instruments, introduce a system by which the number of years and the frequency of use of each surgical instrument can be learned, and replace them with new equipment as necessary.

CAS and CEA in the Treatment of Severe Internal Carotid Artery Stenosis

Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe carotid artery stenosis who underwent CAS and CEA in the First People's Hospital of Changde City(hereafter referred as "our hospital")from January 2018 to December 2020 were selected as the research objects and divided into CAS group(n=43)and CEA group(n=45).To understand the clinical application value and feasibility of the two surgical schemes by comparing the general situation,cerebral blood flow,MMSE scale,MOCA scale score and serum miR-145,IGF1R levels of the two surgical schemes.Conclusions:CAS and CEA in the treatment of patients with severe internal carotid artery stenosis,have good curative effect,can effectively improve the patient's cerebral blood flow,regulate serum miR-145,IGF 1R levels,promote the recovery of cognitive function,but relatively speaking,the incidence of stroke and hypotension after CAS is higher,and the incidence of hypertension after CEA is higher.

Effect of cold weather on carotid artery stenosis and occlusion:A retrospective observational study

Objective:To investigate the effect of cold weather on carotid artery stenosis and occlusion.Methods:We conducted a retrospective observational study,in which 145 patients with carotid artery stenosis and occlusion were enrolled[115 men and 30 women;the mean age was 61.08 years(95%CI 59.27-62.88)].Patients were divided into the low-temperature group(n=98)(≤12℃)and the non-low temperature group(n=47)(>12℃).Clinical characteristics,blood pressure,National Institutes of Health Stroke Scale(NIHSS),blood fat,and blood viscositys were compared between the two groups.Correlation between NIHSS and mean daily temperature was analyzed.Results:There was no significant difference in the systolic and diastolic blood pressure between the two groups(P>0.05).The NIHSS score was slightly higher in the non-low temperature group compared to that of the low-temperature group(U=2984,P<0.01).Glycemia,cholesterol level,prothrombin time,fibrinogen,and International Normalized Ratio did not show any significant difference(P>0.05).Correlation analysis showed a very low positive and statistically significant correlation between ambient temperature and NIHSS score(r=0.18,P=0.029).Conclusion:Cold weather does not impact blood pressure,blood cholesterol,and coagulation factors of patients with carotid artery stenosis and occlusion.The neurological deficit is more severe in the non-low ambient temperature group.A potential relationship exists between ambient temperature and the level of neurological impairment.

Internal Jugular Vein Graft after Inadvertent Severing of the Internal Carotid Artery during Carotid Endarterectomy and an Urgent Re-Exploration for Immediate Post-Operative Wound Site Bleeding: A Case Report

Carotid endarterectomy is a well-established treatment for preventing stroke in selected patients. Although there is debate over whether patch angioplasty or primary closure should be used to reconstruct the bifurcation after carotid endarterectomy, there is growing evidence in the literature in favor of patch angioplasty. When compared to primary closure, patch angioplasty during conventional carotid endarterectomy is suggested to lower the incidence of restenosis and recurrent ipsilateral stroke. Various materials have been used as a patch in this procedure, including the saphenous vein, synthetic patches, or less frequently, an internal jugular vein patch where extensive narrowing of the internal carotid artery is evident. In our case, we used an internal jugular vein graft after inadvertent severing the internal carotid artery (ICA) during carotid endarterectomy after the failure of reconstruction with a saphenous vein patch. We also encountered immediate postoperative reactionary hemorrhage following anesthetic reversal, necessitating an urgent re-exploration. The purpose of this case report is neither an attempt to suggest all patients need angioplasty nor to state that an internal jugular vein patch or graft is superior to synthetic material or saphenous veins;rather, it is an attempt to emphasize a potentially effective rescue way to reconstruct inadvertent extensive vascular injury during carotid endarterectomy.

An Integrated Analysis of Risk Factors of Cognitive Impairment in Patients with Severe Carotid Artery Stenosis

Objective To investigate cognitive dysfunction in patients with carotid artery stenosis(CAS) and potential risk factors related to cognitive-especially memory-dysfunction. Methods Forty-seven patients with carotid artery stenosis were recruited into our study cohort. The Mini-Mental State Examination(MMSE) and the Montreal Cognitive Assessment(MoCA) were adopted to assess cognitive function, the Wechsler Memory Scale(WMS) to assess memory function, high-resolution MRI and enhanced ultrasound to evaluate carotid plaques, and computed tomography perfusion(CTP) imaging to evaluate intracranial blood perfusion. Single-factor analysis and multiple-factor regression analysis were used to analyze potential risk factors of cognitive impairment. Results Mini-Mental State Examination test results showed that 22 patients had cognitive impairment, and MoCA test results showed that 10 patients had cognitive impairment. Analysis of various risk factors indicated that the average memory quotient of female patients was higher than that of males(P = 0.024). The cognitive and memory performance of those with an educational background above high school were significantly better than those of participants with high school or lower(P = 0.045). Patients with abnormal intracranial perfusion performed worse on the MMSE test(P = 0.024), and their WMS scores were significantly lower(P = 0.007). The MMSE scores and the memory quotients were significantly lower in patients with a history of cerebral infarction(MMSE, P = 0.047, memory quotient score, P = 0.018). Conclusion A history of cerebral infarction and abnormal cerebral perfusion are associated with decline in overall cognitive function and memory in patients with carotid stenosis. Being female and having an educational background above high school may be protective factors in the development of cognitive dysfunction.

Detection of Asymptomatic Carotid Artery Stenosis in High-Risk Individuals of Stroke Using a Machine-Learning Algorithm

Objective Asymptomatic carotid stenosis(ACS)is closely associated to the incidence of severe cerebrovascular diseases.Early identifying the individuals with ACS and its associated risk factors could be beneficial for primary prevention of stroke.This study aimed to investigate a machine-learning algorithm for the detection of ACS among high-risk population of stroke based on the associated risk factors.Methods A novel model of machine learning was utilized to screen the associated predictors of ACS based on 30 potential risk factors.The algorithm of this model adopted a random forest pattern based on the training data and then was verified using the testing data.All of the original data were retrieved from the China National Stroke Screening and Prevention Project(CNSSPP),including demographic,clinical and laboratory characteristics.The individuals with high risk of stroke were enrolled and randomly divided into a training group and a testing group at a ratio of 4:1.The identification of carotid stenosis by carotid artery duplex scans was set as the golden standard.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)was used to evaluate the efficacy of the model in detecting ACS.Results Of 2841 high risk individual of stroke enrolled,326(11.6%)were diagnosed as ACS by ultrasonography.The top five risk fectors contributing to ACS in this model were identified as family history of dyslipidemia,high level of lowdensity lipoprotein cholesterol(LDL-c),low level of high-density lipoprotein cholesterol(HDL-c),aging,and low body.

Association of atherosclerotic plaque features with collateral circulation status in elderly patients with chronic carotid stenosis

Objective To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis.Methods Elderly patients(>60 years)with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups,and underwent magnetic resonance imaging and computed tomography imaging.The carotid plaque features including lipid-rich necrotic core,intraplaque hemorrhage,calcification,and fibrous cap rupture(FCR)were evaluated,and maximum wall thickness,normalized wall index(NWI),and luminal stenosis were measured.The association between these variables and collateral circulation status was analyzed.Results Of the 97 patients(78 males,mean age:69.0±6.1 years),19(19.6%)had poor collaterals.The poor collateral group had a significantly higher NWI(93.7%±5.0%vs.89.0%±7.9%,P=0.011),a greater extent of stenosis(80.0%±11.4%vs.75.3%±9.4%,P=0.036)and FCR(84.2%vs.55.1%,P=0.020)compared with good collateral group.Carotid NWI(OR=3.83,95%CI:1.36–10.82,P=0.011)and more FCR(OR=6.77,95%CI:1.35–33.85,P=0.020)were associated with poor collateral circulation after adjustment for the confounding factors.The combination of NWI,FCR,systolic blood pressure,and triglycerides had the highest area-under-the-curve(AUC=0.85)for detection of poor collaterals.Conclusions Carotid plaque features,specifically NWI and FCR,are independently associated with poor collateral circulation,and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.

Advances and progress of endarterectomy in the treatment of carotid stenosis

Carotid stenosis, one of the risk factors that tend to result in cerebral ischemia, infarction as well as ischemic manifestations. CEA (carotid endarterectomy), was initially designed delicately to excise of the thickened, atheromatous tunica intima from the focal stenosis segment, which therefore has been acknowledged as an efficacious way in the management of the prophylaxis of cerebral ischemia. During 1990’s, carotid endarterectomy (CEA) has matured to a widely performed, standard intervention with well defined successive steps. In the recent years, appearance of angioplasty, stenting, and distal protection procedures provides competitive alternatives to classical endarterectomy. However, long-term benefits of carotid angioplasty should be confirmed by larger, randomized, comparative clinical trials. [HJ]

Comparison of Perfusion Weighted Magnetic Resonance Imaging and Single Photon Emission Computed Tomography for Assessment of Cerebrovascular Reserve in Symptomatic Carotid Territory Stenosis

Background: Perfusion Weighted Magnetic Resonance Imaging (PW-MRI) and HMPAO Single Photon Emission Computed Tomography (SPECT) are both cerebral perfusion measurement techniques. Imaging before and after acetazolamide administration can assess cerebrovascular reserve in symptomatic haemodynamic cerebrovascular disease. We compared SPECT and PW-MRI parameters in this patient group. Methods: We identified 10 patients with haemody-namically induced symptoms and intra- or extra-cranial arterial stenoses with back-to-back acetazolamide challenge SPECT and PW-MRI, 4 of whom had resting studies. Regions of interest (ROIs) were applied to parameter maps using an ASPECTS template and perfusion parameters expressed relative to contralateral ROIs, giving 118 challenge and 48 resting ROIs. Results: SPECT relative cerebral blood flow (rCBF) correlated with PW-MRI time to peak (TTP) (r = ?0.568), mean transit time (MTT) (r = ?0.317), regional cerebral blood flow (rCBF) (r = 0.299) and cerebral blood volume (CBV) (r = 0.224). Bias between SPECT and PW-MRI rCBF was small (?0.018) with wide limits of agreement and a systematic measurement error. Pre- to post-acetazolamide PW-MRI rCBF change showed poor sensitivity and specificity for detecting change in SPECT rCBF. SPECT and PW-MRI rCBF had stronger correlation and smaller bias in unilateral stenosis than with bilateral stenosis. Conclusion: Systematic bias between techniques limits interchange- ability in cerebrovascular reserve measurement in patients with cerebrovascular stenosis.

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.

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.

Evaluation of the Protégé^(TM) stent in the treatment of carotid artery stenosis with adjunctive use of a filter Embolic Protection Device (PROCAR)-one-month follow-up data on 77 patients

Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.

Correlating cognitive impairment with carotid atherosclerosis and carotid artery stenosis in patients with acute cerebral infarction

BACKGROUND：Studies have demonstrated that carotid atherosclerosis and carotid artery stenosis are closely associated with cognitive impairment in patients with and without clinically evident cerebrovascular disease. OBJECTIVE： To investigate the correlation between the degree of pathological changes in carotid atherosclerosis, carotid artery stenosis, and cognitive impairment in patients with acute cerebral infarction through the use of color Doppler imaging. DESIGN, TIME AND SETTING： The present concurrent, non-randomized, controlled experiment was performed at the Departments of Neurology and Ultrasound, Affiliated Hospital of North Sichuan Medical College between November 2006 and August 2007. PARTICIPANTS： Fifty-five patients with cerebral infarction, consisting of 35 males and 20 females, aged 50–82 years, were admitted to the hospital between November 2006 and August 2007 and recruited for this study. An additional 30 subjects consisting of 18 males and 12 females, aged 47–78 years, that concurrently received a health examination at the same hospital, were also included as normal controls. METHODS： Intima-media thickness （IMT）, plaque shape, size, and echo intensity of all subjects were detected by color Doppler flow imaging. Assessment criteria： IMT 〉 1.0 mm was considered to be intimal thickening, and IMT 〉 1.2 mm was determined to be formed atherosclerotic plaques. In the position of the largest plaque, the degree of carotid artery stenosis was determined by the following formula： （1-cross-sectional area of residual vascular luminal area/vascular cross-sectional area） × 100%. Less than 30% exhibited mild stenosis, 30%-40% moderate stenosis, and 〉 50% severe stenosis. MAIN OUTCOME MEASURES： IMT and the degree of carotid artery stenosis were evaluated by color Doppler flow imaging. The Mini-Mental State Examination （MMSE）, as well as the clinical memory scale, was compared between patients with cerebral infarction and normal controls. RESULTS： In the cerebral infarction group, IMT was increased, the degree of carotid artery stenosis was aggravated, and the MMSE and MQ scores of clinical memory scale were decreased. In particular, orientation of time and place, attention, calculation, and short-time memory were decreased. There were statistically significant differences in MMSE and MQ of clinical memory scale between patients with cerebral infarction and normal controls （P 〈 0.01）. The scores from the two scales were significantly lower in patients with cerebral infarction with carotid plaque subgroup compared to the cerebral infarction with no carotid plaque subgroup （P 〈 0.01）. The scores from the two scales were also significantly lower in patients with IMT 〉 1.0 mm, as well as moderate and severe carotid artery stenosis, compared to patients with IMT ≤ 1.0 mm, and normal and mild stenosis group （P 〈 0.05）. CONCLUSION： More severe atherosclerotic and carotid artery stenosis leads to more obvious cognitive impairment.

Community-Based Screening and the Detection of Critical Carotid Artery Stenosis and Abdominal Aortic Aneurysm

Background: Community-based cardiovascular screening has the opportunity to detect critical cardiovascular disease and positively affect public health outcomes. Disease deemed to be critical or severe at detection requires appropriate medical follow-up. This article examined the self-reported outcomes of individuals who had undergone community-based cardiovascular screening and had critical findings for abdominal aortic aneurysm (AAA) or carotid artery stenosis (CAS). Methods: Over 390,000 screening records for AAA and over 490,000 screening records for CAS were reviewed to identify individuals with critical screening findings. A critical AAA is defined as an aneurysm ≥ 5cm and critical CAS is defined as a hemodynamically significant stenosis with recorded peak systolic velocities of ≥300 cm/s, in this population. Identified individuals were then contacted via phone and surveyed about the medical care they received after their screening. Results: Review of the screening records found a prevalence of critical AAA findings of 0.037% (146 participants) and critical CAS findings of 0.12% (579 participants). 61% of participants with critical findings were reached for follow-up from both groups. Over 96% of participants with critical AAA and over 92% of participants with critical CAS had some forms of medical follow-up. Conclusions: Community-based cardiovascular screening has the ability to detect critical levels of disease. Findings of critical disease in the reviewed population are similar to the findings from previously published studies. Importantly, medical treatment received by those who seek follow-up appears to be consistent with recommended treatment guidelines. Identification and management of critical disease represent meaningful public and individual health benefits and the possibility of cost-savings.

Effect of the Wall Thickness of the Vessel on FFRCT of Carotid Artery Stenosis

Fractional flow reserve(FFR)computed from computed tomography angiography(CTA),i.e.,FFRCT has been used in the clinic as a noninvasive parameter for functional assessment of coronary artery stenosis.It has also been suggested to be used in the assessment of carotid artery stenosis.The wall thickness of the vessel is an important parameter when establishing a fluid-structure coupling model of carotid stenosis.This work studies the effect of the vessel wall thickness on hemodynamic parameters such as FFRCT in carotid stenosis.Models of carotid stenosis are established based on CTA image data using computer-aided design software.It is assumed that the vessel wall is a linear elastic and isotropic material,and the blood an incompressible Newtonian fluid.Under the pulsating flow condition,ANSYS Transient Structural and CFX are used to simulate the blood flow of fluid-structure coupling in the carotid stenosis model in order to obtain hemodynamic parameters and the corresponding FFRCT.The results show that when the elastic modulus of the vessel wall is fixed,FFRCT will decrease with the increase of the wall thickness.Similarly,FFRCT will decrease with the increase of the elastic modulus when the wall thickness is fixed.The difference in hemodynamic parameters such as FFRCT,however,is relatively small if the stiffness of the two models are close.The results demonstrate that the effect of the vessel wall thickness,especially for a model with small elastic modulus,should be taken into account in using FFRCT for functional assessment of carotid stenosis.Moreover,under the linear elasticity and isotropic material assumptions,the stiffness coefficient may replace the elastic modulus and wall thickness as a parameter reflecting material property of the vessel wall in the carotid stenosis model.

Should We Be Concerned? Comparison of Catheter and CT Angiogram for Arterial Distensibility at the Site of Carotid Stenosis during Catheter Angiography

Purpose: During catheter angiogram (CA) there is momentary increase in intravascular volume and pressure due to intra-arterial injection that can potentially cause vascular distention at the stenotic site, whereas on CT angiogram (CTA) is unlikely due to intravenous administration. Methods: CA and CTA of the carotid artery from 29 patients were retrospectively studied. CA and CTA were obtained for each patient. Curved sagittal MPRs mirroring the carotid artery on CA were used to measure the diameter at stenosis and at the distal lumen. Mural plaque calcium content was graded on axial CTAs. Results: Accounting for repeated measurements, the likelihood that the lumen diameter from CA will be larger than CTA was higher at stenosis than distal to it but the difference in lumen diameters at stenosis was similar to CTA. There is insufficient evidence that intra-arterial hand-injection during CA leads to underestimation of the degree of stenosis. Percentage stenosis using the NASCET criteria differed between the 3 measurements, post hoc analysis showed significant difference between CA and axial CTA (p p > 0.99). The difference in lumen diameter did not depend on our calcium grading (p = 0.484). Conclusions: There is insufficient evidence to suggest that intra-arterial hand-injection contributes to vessel distention and underestimation of percent stenosis during CA in this study. Mural plaque calcium does not affect the degree of stenosis on CTA.