Hemodynamic evaluation of contralateral vertebral artery in patients with subclavian steal syndrome by carotid ultrasound

Objective:To investigate the ultrasonographic characteristics of the hemodynamic changes of the contralateral vertebral artery(VA)in patients with different types of subclavian steal syndrome(SSS).Methods:A total of 152 cases of SSS diagnosed by carotid Doppler ultrasonography(CDU)and confirmed by CT angiography(CTA)were enrolled as the study group.The 152 cases of SSS were divided into type Ⅰ(47 cases of occult steal blood),type Ⅱ(60 cases of partial steal blood)and type Ⅲ(45 cases of complete steal blood).Meanwhile,46 cases of cardiovascular and cerebrovascular diseases were excluded from the health examination center as the control group.The diameter and hemodynamic changes of VA in healthy side of patients with different types of steal blood were analyzed and compared with the control group.Results:The hemodynamic parameters of VA on the contralateral side of three types of SSS in the study group were compared with those in the control group,there was no significant difference between type Ⅰ and the control group(P>0.05),and there was significant difference between type Ⅱ and type Ⅲ and the control group(P<0.05);The diameter and hemodynamic parameters of VA increased with the severity of steal blood(P<0.05).Conclusion:CDU examination of VA hemodynamic parameters in healthy side of SSS patients can be used to preliminarily evaluate SA lesions and VA-VA steal pathway.

Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population

Background:Metabolic syndrome(MetS)is relatively common worldwide and an important risk factor for cardiovascular diseases.It is closely linked to arterial stiffness of the carotid artery.However,the association of MetS with the safety of carotid revascularization has been rarely studied.The aim of this study was to observe the current status of MetS and its components in Chinese carotid revascularized patients,and investigate the impact on major adverse clinical events(MACEs)after carotid endarterectomy(CEA)or carotid artery stenting(CAS).Methods:From January 2013 to December 2017,patients undergoing CEA or CAS in the Neurosurgery Department of Xuanwu Hospital were retrospectively recruited.The changes in prevalence of MetS and each component with time were investigated.The primary outcome was 30-day post-operative MACEs.Univariable and multivariable analyses were performed to identify the impact of MetS on CEA or CAS.Results:A total of 2068 patients who underwent CEA(766 cases)or CAS(1302 cases)were included.The rate of MetS was 17.9%;the prevalence rate of MetS increased with time.The occurrence rate of MACEs in CEA was 3.4%(26 cases)and in CAS,3.1%(40 cases).There was no statistical difference between the two groups(3.4%vs.3.1%,P=0.600).For CEA patients,univariate analysis showed that the MACE(+)group had increased diabetes history(53.8%vs.30.9%,P=0.014)and MetS(34.6%vs.15.8%,P=0.023).For CAS patients,univariate analysis showed that the MACE(+)group had increased coronary artery disease history(40.0%vs.21.6%,P=0.006)and internal carotid artery tortuosity(67.5%%vs.37.6%,P<0.001).Furthermore,the MACE(+)group had higher systolic blood pressure(143.38±22.74 vs.135.42±17.17 mmHg,P=0.004).Multivariable analysis showed that the influencing factors for MACEs in CEA included history of diabetes(odds ratio[OR]=2.345;95%confidence interval[CI]=1.057-5.205;P=0.036)and MetS(OR=2.476;95%CI=1.065-5.757;P=0.035).The influencing factors for MACEs in CAS included systolic blood pressure(OR=1.023;95%CI=1.005-1.040;P=0.010),coronary artery disease(OR=2.382;95%CI=1.237-4.587;P=0.009)and internal carotid artery tortuosity(OR=3.221;95%CI=1.637-6.337;P=0.001).Conclusions:The prevalence rate of MetS increased with time in carotid revascularized patients.MetS is a risk for short-term MACEs after CEA,but not CAS.

Correlation analysis of internal jugular vein abnormalities and cerebral venous sinus thrombosis

Background Cerebral venous sinus thrombosis （CVST） is a special form of stroke with multiple causes and risk factors. However, there are still a portion of cases with unknown reasons. The aim of this study was to investigate the relationship between internal jugular vein （IJV） abnormalities and the development of CVST. Methods A total of 51 CVST patients and 30 healthy controls were enrolled. The diameter, the maximum velocity （Vmax） and the reflux time in bilateral IJVs were measured by color Doppler flow imaging （CDFI）. The paired t test was used to compare the numeric values between the bilateral IJVs. The Pearson chi-square test was used to evaluate the relationship between IJV abnormality and CVST, IJV abnormality and IJV reflux, respectively. Results Among the 51 CVST patients, 20 （39%） patients were with normal IJV and 31 （61%） patients were with abnormal IJV. The types of IJV abnormality included annulus stenosis 19 cases （61%）, hypoplasia 9 cases （29%）, thrombosis 2 cases （7%） and anomalous valve 1 case （3%）. In patients with unilateral IJV abnormality, the minimum diameter of the IJV on the lesion side was significantly smaller than that of the contralateral side （P 〈0.0001）. When compared with contralateral side, the Vmax of the lesion side with unilateral annulus stenosis was significant higher, however, it was obvious lower in patients with unilateral hypoplasia （P 〈0.05）. Furthermore, among 27 cases with unilateral IJV abnormality, all the CYST occurred on the same side as the IJV lesions.

Effect of haemodynamics on the risk of ischaemic stroke in patients with severe vertebral artery stenosis

Objectives Endovascular treatment strategies to optimise individualised care for patients with vertebral artery(VA)stenosis need to be revisited.This study aimed to investigate the relationship between net VA flow volume(NVAFV)and the risk of posterior circulation infarction(PCI)in a high-risk patient population.Methods We screened 1239 patients with extracranial VA stenosis,of whom 321 patients with severe VA V1 segment stenosis(≥70%)were enrolled in our study.We restratified the patients based on NVAFV and contralateral VA stenosis grades to analyse the proportion of each PCI mechanism-large artery atherosclerosis and branch artery occlusive disease.Furthermore,we estimated the incidence of recurrent ischaemic stroke between groups with different NVAFV over a follow-up period of 2 years.Results NVAFV was lower in the PCI group.Multiple logistic regression analysis showed that NVAFV is an independent risk factor for PCI and that the OR for PCI for the lowest NVAFV(<112.8 mL/min)was 4.19(1.76 to 9.95,p=0.001).In patients with severe carotid artery disease,the OR for the lowest NVAFV was 14.03(3.18 to 61.92,p<0.001).The lower NVAFV group had a higher incidence of recurrent ischaemic stroke events than the higher NVAFV group(HR 2.978,95%CIs 1.414 to 6.272).Conclusion Our study demonstrated that NVAFV,as estimated by colour duplex ultrasonography,was associated with the incidence of PCI and subsequent ischaemic events and that a high-risk population could be identified for further posterior circulation revascularisation.