Evaluation of carotid plaque vulnerability by contrast-enhanced ultrasound and superb microvascular imaging / 中华老年医学杂志

Objective@#To observe the plaque surface morphology and neo-vascularization within the plaque using superb microvascular imaging(SMI)and contrast-enhanced ultrasound(CEUS), and to compare the correlation and consistency of the two technologies based on making clinical diagnosis of symptomatic carotid artery plaque as the standard.@*Methods@#A total of 92 patients undergoing carotid ultrasonography in Beijing Tiantan Hospital from August 2016 to October 2017 were recruited, including 61 males and 31 females, aged(63.5 ± 7.7)years(range, 42-80 years.A total of 105 plaques were found.According to whether or not to have plaque-induced ipsilateral ischemic symptoms, patients were divided double-blindly into the symptom group and the non-symptom group.The features of plaque(including surface morphology and neo-vascularization)were recorded.The ultrasonographic findings were chi-squarely tested.@*Results@#There were statistically significant differences in the surface morphology and enhancement degree of CEUS between carotid artery plaque-induced ischemic symptom group and the non-symptom group(χ2=6.865, P=0.032; χ2=22.494, P<0.001). The SMI-detected surface morphology and neo-vascularization had statistically significant differences between the two groups(χ2=10.367, P=0.006; χ2=8.186, P=0.041). The correlations of plaque surface morphology(r=0.856, P<0.001)and diagnostic consistency(r=0.802, P<0.001)between SMI and CEUS were higher.In the symptom group, SMI-showed plaque fissures and small surface pitting were in 33.9%(20/59)of patients, and CEUS-showed plaque fissures and small surface pitting were in 25.4%(15/59)of patients.And SMI had a better detection rate of slight and irregular appearances on plaque surface.Taking the first grade of the plaque surface as the standard, CEUS showed a sensitivity of 42.4% and specificity of 80.4% for detecting symptomatic plaques, and SMI showed a sensitivity of 54.2% and specificity of 76.1%.The two methods had similar specificity, and SMI had a slightly higher sensitivity than did CEUS.CEUS and SMI had a good correlation of plaque neo-vascularization(r=0.802, P<0.001)and a moderate diagnostic consistency(r=0.539, P<0.001). Taking the enhancement level of 2 as the standard, CEUS showed a sensitivity of 75.8% and specificity of 67.4% for detecting the symptomatic plaque, and SMI showed a sensitivity of 58.6% and specificity of 69.5%.The two methods had similar specificity, and CEUS had a higher sensitivity than did SMI.@*Conclusions@#SMI and CEUS have a good consistency for detecting plaque surface morphology.SMI and CEUS are more correlated with plaque-induced symptoms than is two-dimensional ultrasound.The SMI has a higher display rate and repeatability than does CEUS for detecting the small fissures and the surface features of plaques.Compared with SMI-detected neo-vascularization, the degree of CEUS enhancement is more correlated with the symptoms.The specificity of CEUS and SMI is similar, and the sensitivity of CEUS is higher than that of SMI.

Evaluation of carotid plaque vulnerability by contrast-enhanced ultrasound and superb microvascular imaging / 中华老年医学杂志

Objective To observe the plaque surface morphology and neo-vascularization within the plaque using superb microvascular imaging(SMI) and contrast-enhanced ultrasound(CEUS),and to compare the correlation and consistency of the two technologies based on making clinical diagnosis of symptomatic carotid artery plaque as the standard.Methods A total of 92 patients undergoing carotid ultrasonography in Beijing Tiantan Hospital from August 2016 to October 2017 were recruited,including 61 males and 31 females,aged(63.5 ± 7.7) years(range,4 2-80 years.A total of 105 plaques were found.According to whether or not to have plaque-induced ipsilateral ischemic symptoms,patients were divided double-blindly into the symptom group and the non-symptom group.The features of plaque (including surface morphology and neo-vascularization) were recorded.The ultrasonographic findings were chi-squarely tested.Results There were statistically significant differences in the surface morphology and enhancement degree of CEUS between carotid artery plaque-induced ischemic symptom group and the non-symptom group(x2 =6.865,P =0.032;x2 =22.494,P ＜ 0.001).The SMI-detected surface morphology and neo-vascularization had statistically significant differences between the two groups (x2 =10.367,P =0.006;x2 =8.186,P =0.041).The correlations of plaque surface morphology(r =0.856,P ＜ 0.001)and diagnostic consistency(r=0.802,P＜0.001)between SMI and CEUS were higher.In the symptom group,SMI-showed plaque fissures and small surface pitting were in 33.9 ％ (20/59) of patients,and CEUS-showed plaque fissures and small surface pitting were in 25.4％ (15/59)of patients.And SMI had a better detection rate of slight and irregular appearances on plaque surface.Taking the first grade of the plaque surface as the standard,CEUS showed a sensitivity of 42.4％ and specificity of 80.4％ for detecting symptomatic plaques,and SMI showed a sensitivity of 54.2 ％ and specificity of 76.1％.The two methods had similar specificity,and SMIhad a slightly higher sensitivity than did CEUS.CEUS and SMI had a good correlation of plaque neo-vascularization(r =0.802,P ＜ 0.001)and a moderate diagnostic consistency(r=0.539,P ＜0.001).Taking the enhancement level of 2 as the standard,CEUS showed a sensitivity of 75.8 ％ and specificity of 67.4 ％ for detecting the symptomatic plaque,and SMI showed a sensitivity of 58.6％ and specificity of 69.5％.The two methods had similar specificity,and CEUS had a higher sensitivity than did SMI.Conclusions SMI and CEUS have a good consistency for detecting plaque surface morphology.SMI and CEUS are more correlated with plaque-induced symptoms than is two-dimensional ultrasound.The SMI has a higher display rate and repeatability than does CEUS for detecting the small fissures and the surface features of plaques.Compared with SMI-detected neo-vascularization,the degree of CEUS enhancement is more correlated with the symptoms.The specificity of CEUS and SMI is similar,and the sensitivity of CEUS is higher than that of SMI.

Carotid plaque load evaluation: comparison high resolution MR imaging with ultrasound / 中华放射学杂志

Objective To compare the image quality produced by MR high resolution vessel wall imaging (HR?VWI) and ultrasound (US) in evaluating carotid plaque load. Methods This prospective study enrolled 21 patients with carotid plaques undergoing HR?VWI and subsequent 2D US between August 2016 to January 2017 in Hebei General Hospitial. The plaque thickness (PT), lumen area (LA), wall area (WA) and total vessel area (TVA) of the plaques were measured and normalized wall index (NWI) was calculated on both HR?VWI images and US for those plaques with image quality score≥3 and matching between the two methods. The plaque load index was compared by using the independent sample t test or the non?parametric Wilcoxon test, and the correlation between the indexes was based on the Pearson test. Results Forty?five carotid plaques were matched with HR?VWI and US. There was no significant difference in PT, LA, WA, TVA and NWI detected by HR?VWI and ultrasound (P>0.05). The parameters measured by two methods were correlated (r values were 0.83, 0.85, 0.32, 0.83 and 0.59, P<0.05). Conclusion There is a good consistency between HR?VWI and conventional ultrasound in the measurement of carotid plaque load.

Influence of pitavastatin on vascular endothelial function in young and middle-aged patients with hyperlipidemia complicated carotid plaques / 心血管康复医学杂志

Objective: To explore therapeutic effect of pitavastatin on young and middle-aged patients with hyperlipidemia complicated carotid plaques and its influence on vascular endothelial function. Methods: A total of 126 young and middle-aged patients with hyperlipidemia complicated carotid plaques [carotid intima-media thickness (IMT) ＞ 1. 5mm]were selected, and were randomly divided into no lipid lowering treatment group (n=62) and pitavastatin group (n=64). Flow-mediated dilation of brachial artery (FMD), carotid IMT and blood lipid levels before and 12 months after medication, and incidence rate of adverse events were recorded and compared between two groups. Results: Compare with before treatment and no lipid lowering treatment group after treatment, there was significant rise in FMD [(6. 70±2. 10) ％, (6. 60±2. 35) ％ vs. (8. 90±3. 60) ％], and significant reductions in levels of total cholesterol [(6. 05±1. 40) mmol/L, (5. 67±1. 90) mmol/L vs. (4. 05±1. 20) mmol/L], triglyceride [(2. 18± 0. 72) mmol/L, (2. 08±0. 68) mmol/L vs. (1. 77±0. 65) mmol/L]and low density lipoprotein cholesterol [(4. 65±1. 50) mmol/L, (4. 41±1. 36) mmol/L vs. (2. 01±1. 30) mmol/L]in pitavastatin group, P＜0. 05 or＜0. 01; there were no significant changes in IMT in two groups. No obvious adverse reaction was found in pitavastatin group. Conclusion: Pitavastatin can significantly improve lipid levels and vascular endothelial function in young and middle-aged patients with hyperlipidemia complicated carotid plaques.

Multi-Factor Analysis of Influencing Factors of Youth Carotid Artery Thrombosis / 昆明医科大学学报

Objective To research the risk factors of youth carotid artery thrombosis,to provide some basis for its clinical prevention and treatment.Methods Twenty-three patients of youth carotid artery thrombosis (experimental group),40 patients without youth carotid artery thrombosis (control group) were selected,and we collected the data including age,sex,body mass index,smoking,drinking history,hypertension,neck trauma,C reactive protein,total cholesterol,triglyceride,LDL-C,HDL-C,uric acid,syphilis antibody,HIV antibody,then we did statistical analysis.Results The basic situation of the two groups:there were statistical differences in sex and BMI (P ＜0.05);past medical history and personal history of patients in two groups:diabetes,high blood pressure,smoking,drinking,history of neck injury,syphilis antibody had statistical differences (P＜0.05);biochemical indicators of two groups of patients:there were statistical differences in HDL and uric acid (P＜0.05);multi factor analysis:risk factors were hypertension (0R=6.43),smoking (OR=4.63) and neck injury history (OR=3.13).Conclusions The risk factors of youth carotid artery thrombosis are hypertension,smoking,neck injury history,the prevention and cure of hypertension,smoking and neck injury should be strengthened,so as to reduce the incidence of carotid artery thrombosis.

Differentiating Carotid Terminus Occlusions into Two Distinct Populations Based on Willisian Collateral Status / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: The outcomes of acute internal carotid artery (ICA) terminus occlusions are poor. We classified ICA terminus occlusions into 2 groups according to the occlusion pattern of the circle of Willis and hypothesized that clinical outcomes would significantly differ between them. METHODS: Consecutive patients with acute ICA terminus occlusions evaluated by baseline computed tomographic angiography were enrolled. We investigated the occlusion patterns in the circle of Willis, retrospectively classified patients into simple ICA terminus occlusion (STO; with good Willisian collaterals from neighboring cerebral circulation) and complex ICA terminus occlusion (CTO; with one or more of A2 anterior cerebral artery, fetal posterior cerebral artery occlusion, or hypoplastic/absent contralateral A1; or with poor collaterals from anterior communicating artery) groups, and compared their baseline characteristics and outcomes. RESULTS: The STO group (n=58) showed smaller infarct volumes at 72 hours than the CTO group (n=34) (median, 81 mL [interquartile range, 38-192] vs. 414 mL [193-540], P<0.001) and more favorable outcomes (3-month modified Rankin Scale 0-3, 44.8% vs. 8.8%, P<0.001; 3-month mortality, 24.1% vs. 67.6%, P<0.001). In multivariable analyses, STO remained an independent predictor for favorable outcomes (odds ratio 6.1, P=0.010). CONCLUSIONS: Favorable outcomes in STO group suggested that the outcomes of acute ICA terminus occlusions depend on Willisian collateral status. Documenting the subtypes on computed tomographic angiography would help predict patient outcome.

Trombose de artéria carótida interna relacionada a trauma de palato em criança / Internal carotid artery thrombosis related to trauma of palate in a child

Relatar um caso de trombose de artéria carótida interna secundária relacionada a trauma de palato mole em criança. DESCRIÇÃO DO CASO: Criança admitida com quadro de alteração do nível de consciência, sonolência, afasia e hemiplegia direita; tinha antecedente de trauma corto contuso leve em palato mole há oito horas. A investigação tomográfica evidenciou acidente vascular isquêmico secundário à interrupção do fluxo sanguíneo em território de artéria cerebral média esquerda. A arteriografia mostrou oclusão da artéria carótida interna imediatamente distal à sua origem, com aspecto radiológico de "ponta de lápis", obstruindo o fluxo sanguíneo na região. A paciente foi submetida à investigação para doença pró-trombótica e cardíaca, contudo, não foi detectada nenhuma alteração. A administração de enoxaparina em dose terapêutica por três semanas conduziu à melhora clínica progressiva. Após três semanas de seguimento, a paciente não mostrava sequelas motoras. COMENTÁRIOS: As lesões intraorais são frequentes em crianças e a maioria evolui sem complicações. A trombose da artéria carótida interna é uma complicação rara, mas bem documentada destas lesões e decorre da compressão do vaso com trombogênese localizada. A taxa de mortalidade relatada é de 30 por cento e as sequelas ocorrem em 85 por cento dos casos.

To describe a child with internal carotid artery thrombosis secondary to trauma of the soft palate. CASE DESCRIPTION: Child presented with altered level of consciousness, drowsiness, aphasia, right hemiplegia, and a history of trauma, with mild concussion of the soft palate eight hours prior to admission. CT scan showed ischemic stroke secondary to interruption of blood flow in the area of the left middle cerebral artery. Arteriography showed occlusion of the carotid artery just distal to its origin, with radiological appearance of "pencil tip", obstructing blood flow in the region. Patient underwent investigation for pro-thrombotic and heart diseases, which was negative. The child received enoxaparin at therapeutic dose for three weeks, showing progressive clinical improvement. After three weeks, the patient did not show motor problems. COMMENTS: Intraoral lesions are common in children, but most of them evolve without complications. However, the internal carotid artery thrombosis is a rare but well documented complication of these lesions and results from the vessel compression with localized thrombogenesis. The mortality rate is about 30 percent, and sequels are seen in 85 percent of cases.

Comparison of the Framingham Risk Score, UKPDS Risk Engine, and SCORE for Predicting Carotid Atherosclerosis and Peripheral Arterial Disease in Korean Type 2 Diabetic Patients / 가정의학회지

BACKGROUND: To compare the predictability of the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes Study (UKPDS) risk engine, and the Systematic Coronary Risk Evaluation (SCORE) for carotid atherosclerosis and peripheral arterial disease in Korean type 2 diabetic patients. METHODS: Among 1,275 registered type 2 diabetes patients in the health center, 621 subjects with type 2 diabetes participated in the study. Well-trained examiners measured the carotid intima-media thickness (IMT), carotid plaque, and ankle brachial index (ABI). The subject's 10-year risk of coronary heart disease was calculated according to the FRS, UKPDS, and SCORE risk scores. These three risk scores were compared to the areas under the curve (AUC). RESULTS: The odds ratios (ORs) of all risk scores increased as the quartiles increased for plaque, IMT, and ABI. For plaque and IMT, the UKPDS risk score provided the highest OR (95% confidence interval) at 3.82 (2.36, 6.17) and at 6.21 (3.37, 11.45). For ABI, the SCORE risk estimation provided the highest OR at 7.41 (3.20, 17.18). However, no significant difference was detected for plaque, IMT, or ABI (P = 0.839, 0.313, and 0.113, respectively) when the AUCs of the three risk scores were compared. When we graphed the Kernel density distribution of these three risk scores, UKPDS had a higher distribution than FRS and SCORE. CONCLUSION: No significant difference was observed when comparing the predictability of the FRS, UKPDS risk engine, and SCORE risk estimation for carotid atherosclerosis and peripheral arterial disease in Korean type 2 diabetic patients.

Aspiration Clot Removal by Mannual Compression of Common Carotid Artery for Acute Internal Carotid Occlusion: a Case Report / 신경중재치료의학

Acute occlusion of the intracranial internal carotid artery (ICA) bifurcation, so-called "carotid T occlusion," extends from distal portion of the internal carotid into the proximal segments of the middle and anterior cerebral arteries. This carotid T occlusion has been associated with low recanalization rates and poor prognosis. An 83-year-old man underwent successful transarterial suction thrombectomy using manual compression of ipsilateral common carotid artery for the treatment of acute carotid T-occlusion. Herein, we report this case and discuss the technical aspect.

The Association between Obesity Indices in Adolescence and Carotid Intima-media Thickness in Young Adults: Kangwha Study / 예방의학회지

OBJECTIVES: The aim of this study is to investigate the association between obesity indices (body mass index, weight, waist-hip ratio and waist circumference) in adolescents and the carotid intima-media thickness (C-IMT) in early adulthood. We also wanted to identify the best predictor for C-IMT among these obesity indices. METHODS: This study used community-based prospective cohort study, known as the Kangwha Study, and the data we used were from subjects who were 16-years old in 1996 (defined as "adolescencec") and 25 years-old in 2005 (defined as "early adulthoodc"). The 256 subjects (113 men and 143 women) who were used for analysis participated in both follow-ups, and they underwent B-mode ultrasonography of the carotid arteries at the early adulthood follow-up. Obesity indices were defined as the body mass index, weight, waist-hip ratio and waist circumference. The C-IMT was defined as the mean of the maximal IMT of each common carotid artery. The C-IMT and obesity indices associations were evaluated via multivariable regression, logistic regression and the receiver-operator characteristic curve analyses. RESULTS: In men, all the obesity indices in adolescence were showed to have statistically significant positive association with C-IMT in early adulthood. However, no such relationship was showed in women. On multiple regression and logistic regression analysis, the waist-hip ratio showed the biggest relationship with the C-IMT among the 4 obesity indices. However, there were no statistical significant differences and no best predictor was found. For the women, the obesity incidences and C-IMT showed no relationships. CONCLUSIONS: This study suggested that obesity in adolescence was related to an increase C-IMT in healthy young Korean men.

Urgent Recanalization Using Stents for Acute Internal Carotid Artery Occlusion in Progressive Stroke Patients with Contralateral Chronic Carotid Occlusion / 신경중재치료의학

The prognosis of symptomatic bilateral internal carotid artery occlusion is extremely poor. To our knowledge, there are few reports regarding the proper management of this catastrophic event. We present two cases of progressive stroke with acute internal carotid artery occlusion and contralateral chronic carotid occlusion, who were treated by urgent recanalization using stents. In two cases, complete recanalization was achieved and the clinical outcomes were favorable. We suggest that early endovascular treatment using stents may salvage the occluded vessel and may also offer a more successful clinical outcome. Further study will be necessary in order to define the proper management of this catastrophic event.

A CT study of the prevalence of carotid artery calcification in dental patients / 대한구강악안면방사선학회지

PURPOSE: Stroke is one of the leading causes of death in Korea. Atherosclerotic disease in the carotid artery bifurcation is the most common cause of stroke. The carotid artery calcification is easily appreciated by CT (Computed tomography). CT is often taken in a dental hospital for the diagnosis of inflammation, injury, cyst or tumor on maxillofacial region. However, there was no report of carotid artery calcification on CT in dental patients. This study was to determine the prevalence of carotid artery calcification on CT in dental patients. MATERIALS AND METHODS: The presence of carotid artery calcification was evaluated by an experienced radiologist on CT scans of 287 patients (166 males, 121 females, average age 42, range 6 to 86 years) and the medical history of the patient and the interpretation of CT were reviewed. RESULTS: Carotid artery calcification was detected on CT scans of 57 patients (19.8%; 35 males, 22 females). All the male patients with carotid artery calcification were older than 50, and all the female patients with carotid artery calcification were older than 60. Among the 57 patients, 10 had Diabetes mellitus, 20 had cardiovascular disease, 3 had history of stroke and 3 underwent radiation therapy for head and neck cancer. Carotid artery calcification was not included in the interpretation of CT of dental patients except one patient. CONCLUSION: The prevalence of carotid artery calcification on CT of dental patients was about 20% in this study. Carotid artery calcification should be included in the interpretation of CT of dental patients.

Trombosis de la arteria carótida interna después de un trauma cerrado de cuello / Thrombosis of the internal carotid artery after blunt neck trauma

Los traumas de las arterias carótidas son raros, asociados a una muy alta mortalidad, son aún menos frecuentes los que se producen por traumas externos cerrados. Presentamos un caso con trombosis de la carótida interna derecha, producto de un trauma de la región anterior del cuello, como consecuencia de una golpiza. Nuestro paciente fue admitido en el servicio de politraumatología de nuestro centro, donde se le realizó el diagnóstico por los elementos clínicos, en los cuales predominaba una hemiplejía izquierda. Se confirmó por una arteriografía carotídea realizada de urgencia, en la que se demostró obstrucción del vaso, en su porción cervical. Nuestro paciente fallece a las cuatro horas de su ingreso con el diagnóstico de infarto cerebral constatado en la necropsia, con este caso esperamos llamar la atención hacia una afección poco frecuente, pero de una alta mortalidad, que debe tener presente el facultativo que se enfrenta a estos pacientes.

Carotid artery traumas are rare, associated to a very high mortality, are still less frequent those produced by closed external traumas. We present a patient with thrombosis of the rigth internal carotid, product of trauma of the anterior region of the rick, as a consequence of a blow. Our patient was admitted in the poly wounded service of our centre, carrying out diagnosis for clinical elements, in wich left hemiplegia prevailed; it was confirmed through a carotid arteriography as an emergency. It was a shown obstruction of the vessel in its cervical portion. Our patint died after four hours of his admission with diagnosis of cerebral infarction proved in the necropsy. With this case, we want to reflect a pathology less frequent but with a high mortality, wich doctors should take into account when assiting these patients.

EFFECTS OF THE COMBINATION OF ASPIRIN AND VERAPAMIL ON PLATELET AGGREGATION AND THROMBOGENESIS / 中国药理学通报

The effects of Verapamil ( Ver ) . Aspirin ( ASA ) and ASA+ Ver on platelet aggregation and generation of thrombosis were studied. ASA and Ver inhibited rabbit platelet aggregation in vitro and rat platelet aggregation in vivo induced by ADP, also prolonged the occlusion time of thrombosis that was induced electrically in the carotid artery of the rat, and reduced the death rate resulted from pulmonary thrombosis that was induced with inducer composed of collagen and epinephrine iv in mice. The effects of Ver and ASA were markedly increased when combined, meanwhile all showed good dose-dependant manner.