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ABSTRACT Background: The earlobe crease (ELC) has been linked to coronary artery disease and other vascular conditions, but there is no information on its association with intracranial atherosclerosis. Objective: This study aimed to assess the association between high calcium content in the carotid siphons (as a surrogate of intracranial atherosclerosis) and ELC in community-dwelling adults living in rural Ecuador. Methods: Atahualpa residents aged ≥40 years underwent head CT to estimate calcium content in the carotid siphons, and visual inspection of both earlobes to evaluate the presence of ELC. The association between both variables was assessed by logistic regression models, after adjusting for demographics and cardiovascular risk factors. Results: Of 651 enrolled individuals (mean age: 59.7±12.8 years; 54% women), 225 (35%) had ELC, and 143 (22%) had high calcium content in the carotid siphons. Univariate logistic regression showed a borderline (non-significant) association between high calcium content in the carotid siphons and ELC presence (OR: 1.44; 95% C.I.: 0.99 - 2.12; p=0.057), which disappeared when age (OR: 0.98; 95% C.I.: 0.65 - 1.48; p=0.923) and other covariables (OR: 0.97; 95% C.I.: 0.63 - 1.49; p=0.890) were added to the model. Conclusion: This population study shows no association between high calcium content in the carotid siphons and ELC presence.
RESUMEN Antecedentes: El pliegue auricular se ha relacionado con enfermedad coronaria y otras patologías vasculares, pero no hay información sobre su asociación con aterosclerosis intracraneal. Objetivo: Este estudio tuvo como objetivo evaluar la asociación entre el contenido de calcio en los sifones carotideos (como un sustituto de aterosclerosis intracraneal) y el pliegue auricular en adultos viven en zonas rurales de Ecuador. Métodos: Los residentes de Atahualpa de 40 años o más fueron sometidos a TC de cerebro para estimar el contenido de calcio en los sifones carotideos. Además, ambas orejas fueron examinadas para detectar la presencia de pliegues auriculares. La asociación entre ambas variables se evaluó mediante modelos de regresión logística, ajustados por factores demográficos y de riesgo cardiovascular. Resultados: De 651 individuos enrolados (edad media: 59,7±12,8 años, 54% mujeres), 225 (35%) tuvieron pliegues auriculares y 143 (22%) tuvieron alto contenido de calcio en los sifones carotideos. La regresión logística univariada mostró una asociación limítrofe (no significativa) entre el contenido de calcio en los sifones carotideos y la presencia de pliegue auricular (OR: 1.44, 95%IC: 0.99 - 2.12, p=0.057), que desapareció cuando la edad (OR: 0.98; 95% I.C.: 0,65 - 1,48; p=0,923) y otras covariables (OR: 0,97; 95% I.C.: 0,63 - 1,49; p=0,890) fueron agregadas al modelo estadístico. Conclusión: El presente estudio no mostró asociación entre el contenido de calcio en los sifones carotídeos y la presencia de pliegue auricular.
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OBJECTIVE: An open cell stent system may offer better apposition of cell struts to vessel wall than a closed cell stent system in acute vasculature. The purpose of this study was to evaluate the feasibility of coiling using the jailing technique with the Neuroform EZ stent system. METHODS: The jailing technique using the open-cell stent system of the Neuroform EZ stent was planned in 22 consecutive patients with 22 cerebral aneurysms. We retrospectively evaluated the technical success of the jailing technique and the occurrence of interference between two microcatheters as well as the factors influencing this interference. RESULTS: The jailing technique was successful in 19/22 patients (86.4%), and interference between two microcatheters occurred in 6/21 (28.6%). The jailing technique failed in 3/22 patients, with problems that included failure of the stent delivery system to advance into the positioned microcatheter in one, interference between the microcatheters during the advancement of the stent delivery system in one, and failure of microcatheter insertion into the aneurysm sac in the remaining patient. Interference between the two microcatheters developed during the advance of the stent delivery system into the positioned microcatheter in all cases. One factor that influences interference between two microcatheters more than expected by chance is the carotid siphon angle (p = 0.019). CONCLUSION: The acuteness of the carotid siphon angle influences the interference between two microcatheters. Therefore, the jailing technique using the Neuroform EZ stent should be performed carefully in cerebral aneurysms with an acute carotid siphon angle because the procedure may possibly fail.
Subject(s)
Humans , Aneurysm , Carotid Artery, Internal , Intracranial Aneurysm , Retrospective Studies , StentsABSTRACT
This study evaluated anatomical variants in the carotid siphon and of the circle of Willis in patients with aneurysms. We performed a retrospective analysis of cerebral angiographies. The Control Group was composed of patients without aneurysms. Posterior communicating artery (PcomA) aneurysms were more common in women (p<0.05), and the anterior communicating artery (AcomA) aneurysms in men (p<0.1). The incidence of fetal-type PcomA was higher in cases with co-occurring PcomA aneurysm (24 versus 8%, p<0.05). Patients with AcomA aneurysm had higher incidence of A1 hypoplasia (p<0.0001, OR=32.13, 95%CI 12.95-79.71) and lower frequency of fetal-type PcomA compared to their control counterparts (p=0.0125). The angle of carotid siphon was narrower in patients with PcomA aneurysm (27.3±19.1 versus 34.8±22.6, p=0.028). In conclusion, a narrower carotid siphon or the presence of fetal-type PcomA or A1 hypoplasia may cause hemodynamic stress, thereby promoting the formation of aneurysms in susceptible individuals.
O presente estudo avaliou as variantes anatômicas do sifão carotídeo e da parte posterior do polígono de Willis em pacientes com aneurismas. Foi realizada uma análise retrospectiva de angiografias cerebrais. O Grupo Controle foi composto por pacientes sem aneurismas. Aneurismas da artéria comunicante posterior (ACP) foram mais frequentes em mulheres (p<0,05), e aqueles da anterior (ACA) em homens (p<0,1). A incidência do tipo fetal da ACP foi maior nos casos com co-ocorrência de aneurisma da ACP (24 versus 8%, p<0,05). Pacientes com aneurisma da ACA tiveram maior incidência de hipoplasia A1 (p<0,0001, OR=32,13, IC95% 12,95-79,71) e menor frequência do da ACP fetal comparados com os controles (p=0,0125). O ângulo do sifão carotídeo era mais estreito em pacientes com aneurismas da ACP (27,3±19,1 versus 34,8±22,6, p=0,028). Em conclusão, um sifão carotídeo estreito e a presença de ACP fetal ou hipoplasia A1 podem causar estresse hemodinâmico, promovendo a formação de aneurismas em indivíduos suscetíveis.
Subject(s)
Female , Humans , Male , Middle Aged , Carotid Artery, Internal , Circle of Willis/pathology , Intracranial Aneurysm/etiology , Case-Control Studies , Cerebral Angiography , Carotid Artery, Internal/pathology , Circle of Willis , Intracranial Aneurysm , Retrospective StudiesABSTRACT
Objective To establish a carotid siphon aneurysm model in dogs in order to test the mechanical features of a newly-designed Willis covered stent-graft and to investigate the histological reaction of the stent-implanted vessel during a follow-up period of 12 months.Methods Twenty-four saccular sidewall aneurysms were surgically created in twelve dogs(group A)and 12 carotid siphon aneurysms in another twelve dogs(group B).A Willis stent-graft was implanted in each aneurysm.Angiography was performed immediately after the procedure and 1,3,6 and 12 months after the implantation to investigate the aneurysm isolation,endoleak,stent angulation,and the patency or restenosis of the parent artery.Light and scanning electronic microscopy were used to identify aneurysmai sac thrombi,intima hyperplasia and endothelial progress of the stent-loaded arterial segment.Results In group B,postoperative immediate angiography demonstrated that two aneurysms had mild endoleak and three stents became angulated.Follow-up exam 12 months after the procedure revealed that all previous endoleaks disappeared,one parent artery became occluded and three parent arteries developed mild stenosis(＜50%).In group A.occlusion of parent artery was seen in one and mild stenosis(＜50%)in 2 cases.Electronic microscopy revealed new intima formation in all stents,and all aneurysmal sacs were filled with thrombi.In group B.the endothelialization process was not completed until 12 months after the stent implantation,and a marked correlation existed between endothelial cell arrangement and the hemodynamic orientation.Conclusion It is feasible to treat carotid-siphon aneurysm in dog with a Willis stent-graft.The complete endothelialization of the covered stent in tortuous vessel takes longer time than that in rather straight vessel.
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BACKGROUND: The aim of this study is to compare the diagnostic power of transorbital Doppler (TOD) and magnetic resonance angiography (MRA) in detecting carotid siphon disease (CSD) confirmed by conventional angiography (CA) and elucidate the diagnostic role of TOD in CSD. METHODS: We recruited the patients who underwent TOD, MRA and CA within 2 months. TOD velocities above 75cm/sec or no flow was defined as abnormal. Carotid siphon on MRA and CA was divided into C2 & C4 segments; stenosis more than 50% or occlusion on the segment corresponding to the flow direction of TOD was defined abnormal. RESULTS: Sixty patients (44 males and 16 females, mean age: 55.4+/-12.2 years) were recruited. In 117 available carotid siphons 16 vessels (13.7%) were detected as abnormal by CA, 23 vessels (19.7%) by TOD, and 29 vessels (24.8%) by MRA. When CA was used as a gold-standard, the sensitivity and specificity of TOD were 75.0% and 89.1% while those of MRA were 87.5% and 85.1%, respectively. Positive predictive value was about half (52.2% in TOD and 48.3% in MRA) and negative predictive value was over 95% (95.7% in TOD and 97.7% in MRA). The diagnostic accuracy was 87.2% in TOD and 85.5% in MRA. When TOD and MRA were normal, CA was also normal in 98.7% and when both tests were abnormal, CA was abnormal in 78.6%. But when one of two tests was abnormal, CA was abnormal only in 16.7%. Diagnostic consistency of TOD & MRA was acceptable (kappa value = 0.409). Among 23 carotid siphons, which were abnormal on TOD, 11 vessels were normal on CA; false positive rate was 47.8%. But we could find the presumed causes of false positive results in most of cases, such as contralateral proximal ICA occlusion, ipsilateral ICA stenosis just proximal to carotid siphon, etc. CONCLUSIONS: Transorbital Doppler is as good as MRA in noninvasive detection of carotid siphon disease. Despite of the relatively low positive predictive value of TOD and MRA, the combination of their results increases the diagnostic accuracy in carotid siphon disease and may reduce the need of conventional angiography.