Aneurisma de arteria carótida interna. Caso clínico

Introducción: Los aneurismas de la arteria carótida extracraneal (ACEC) son poco frecuentes en comparación con las lesiones oclusivas. Los ACEC son menos del 1% de todos los aneurismas arteriales y solo el 10% son considerados aneurismas verdaderos. Caso Clínico: Paciente femenina de 84 años, en excelentes condiciones generales, hipertensa e hiperlipidémica, neurológicamente asintomática, con hallazgo de aneurisma de carótida interna derecha en el contexto de una arteria elongada, estenosis moderada ostial y oclusión de arteria carótida interna contralateral. Se realiza resección de aneurisma con anastomosis término terminal, endarterectomía del ostium y angioplastía con parche. Su evolución fue favorable, manteniéndose asintomática y con la reconstrucción permeable a 6 meses de seguimiento en eco duplex. Discusión: La elección del manejo del ACEC va a depender de sus características morfológicas, en este caso la presencia de tortuosidad extrema de la arteria carótida interna dificultaba la posibilidad de manejo endovascular, pero facilitaba la resección del aneurisma con anastomosis primaria término terminal. Conclusión: La aneurismectomía y reconstrucción es una modalidad de manejo disponible para los ACEC.

Introduction: Extracranial carotid artery aneurysms (ECAA) are rare compared to occlusive disease, less than 1% of all arterial aneurysms and only 10% are considered true aneurysms. Clinical case: A 84-year-old female, active and in excellent general health, with a prior history significant only for hypertension and hyperlipidemia was referred for a right internal carotid artery aneurysm and elongation in the context of contralateral internal carotid artery occlusion. The patient denied neurologic symptoms. Resection of the aneurysm and end-to-end anastomosis, endarterectomy of the ostium and patch angioplasty was performed. The patient had an uneventful recovery, remaining asymptomatic and the reconstruction patent on duplex scan at 6 month follow up. Discussion: The choice of repair alternatives for EICA depend on its morphological characteristics. The presence of extreme tortuosity of the internal carotid artery in this case, on one hand make difficult to consider endovascular alternatives, but facilitates aneurysm resection and primary end-to-end anastomosis. Conclusion: Aneurysmectomy and arterial reconstruction is a treatment alternative for EICA repair.

Morphological characteristics of clinically rare cerebral aneurysms and arterial bifurcations / 介入放射学杂志

Objective To discuss the morphological characteristics of three types of clinically rare cerebral aneurysms and arterial bifurcations.Methods A total of 17 patients with clinically rare cerebral aneurysms,including anterior cerebral artery-pericallosal artery aneurysms(ACA-PA aneurysms,n=8),internal carotid artery-anterior choroidal artery bifurcation aneurysms(ICA-AChA aneurysms,n=5)and vertebral artery-posterior inferior cerebellar artery bifurcation aneurysms(VA-PICA aneurysms,n=4),who received treatment in the Shijiazhuang People's Hospital between January 2017 and April 2020 were enrolled in this study.The clinical baseline data were recorded,and the morphological parameters of the aneurysms were determined.The bifurcation angle,small lateral angle and large lateral angle were defined as φ1,φ2 and φ3,respectively.D1,S1 and T1 represented the diameter,cross-sectional area and tortuosity of the main blood vessel,respectively.D2,S2 and T2 were defined as the corresponding parameters of the branch vessel forming small lateral angle with the main vessel.D3,S3 and T3 were the corresponding morphological parameters of the contralateral branch vessel.Results All of the ICA-AChA and VA-PICA bifurcation aneurysms were type D aneurysms and oriented towards the small lateral angle.Six ACA-PA bifurcation aneurysms were type C aneurysm,and 5 of them were oriented toward the small lateral angle.The S2 and φ2 of the ACA-PA and ICA-AChA bifurcations harboring aneurysms were significantly smaller than S3 and φ3(P＜0.05),while T2 was remarkably largerthan T3(P＜0.05).The VA-PICA bifurcations also showed a similar manifestations.Conclusion These three types of clinically rare cerebral aneurysms are mostly oriented towards the small lateral angle,and the diameter and cross-section area of the branch forming small lateral angle with parent artery were smaller than those of the contralateral branch vessel,while the tortuosity was greater than that of the contralateral branch.

Splenic artery tortuosity index on abdominal CT Scan: correlation with age, sex, BMI and abdominal cavity diameters / Índice de tortuosidad de la arteria esplénica en TC abdominal: correlación con la edad, el sexo, el IMC y los diámetros de la cavidad abdominal

Thorough knowledge of splenic artery course and morphology may help clinician to provide better practice. This Study aims at finding out if there was a relationship between splenic artery tortuosity index and age, sex, Body Mass Index (BMI) and abdominal cavity diameters. Routine abdominal Computerized Tomography (CT) scan images were retrospectively analyzed for 219 patients. Splenic artery tortuosity index was calculated. Abdominal cavity diameters were measured. Age, sex, and BMI were recorded. Splenic artery straight length (x) mean was 9.41 cm (SD 1.33). Splenic artery tortuous length mean was 15.15 cm (SD 3.31). Splenic artery tortuosity index mean was 1.63 (SD 0.36). Pearson correlation coefficient for Splenic artery tortuosity index vs. age was: 0.02 (P value 0.80). Splenic artery tortuosity index for females vs. males were 1.70 vs. 1.57 (P value 0.01). Pearson correlation coefficient for Splenic artery tortuosity index vs. BMI was 0.02 (P value 0.75). Pearson correlation coefficient for Splenic artery tortuosity index vs. abdominal cavity diameters were: Anterior-Posterior (AP) diameter -0.01 (P value 0.88) and transverse diameter 0.00 (P value 0.98). There may be a relationship between splenic artery tortuosity and female sex, but not with age, BMI and abdominal cavity diameters (AP and Transverse).

El conocimiento del curso y la morfología de la arteria esplénica puede ayudar al médico a proporcionar un diagnóstico y tratamiento oportuno al paciente. Este estudio tuvo como objetivo determinar si existe una relación entre el índice de tortuosidad de la arteria esplénica y la edad, el sexo, el índice de masa corporal (IMC) y los diámetros de la cavidad abdominal. Se tomaron imágenes retrospectivas, de rutina, de 219 pacientes de tomografía computarizada (TC) abdominal. Se calculó el índice de tortuosidad de la arteria esplénica. Se midieron los diámetros de la cavidad abdominal y se registró la edad, sexo y el IMC. La media de la longitud recta de la arteria esplénica (x) fue de 9,41 cm (DE 1,33). La longitud tortuosa de la arteria esplénica fue de 15,15 cm (DE 3,31). La media del índice de tortuosidad de la arteria esplénica fue de 1,63 (DE 0,36). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica vs. edad fue: 0,02 (valor de P 0,80). El índice de tortuosidad de la arteria esplénica para las mujeres frente a los hombres fue de 1,70 frente a 1,57 (valor de P 0,01). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica versus el IMC fue de 0,02 (valor de P 0,75). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica frente a los diámetros de la cavidad abdominal fue: diámetro anterior-posterior (AP) -0,01 (valor P 0,88) y diámetro transversal 0,00 (valor P 0,98). Puede existir una relación entre la tortuosidad de la arteria esplénica y el sexo femenino, sin embargo no se encontró relación con la edad, el IMC y los diámetros de la cavidad abdominal (AP y transversal).

Correlation between Coronary Artery Tortuosity and Stenosis in Patients with Myocardial Bridge / 中国医学科学院学报

Objective To analyze the correlation between tortuosity and stenosis in patients with myocardial bridge(MB)on the left anterior descending artery(LAD). Methods Data of patients with MB on the LAD,which was discovered by coronary computed tomography angiography(CCTA),in the Affiliated Hospital of North China University of Science and Technology from October 2015 to December 2018 were retrospectively analyzed.Among them 278 patients with tortuosity on LAD and 278 patients without tortuosity were selected.The clinical charateristics(age,gender,hypertension,hyperlipidemia,diabetes,smoking history,and family history)as well as the incidence and severity of stenosis of LAD were recorded and compared. Results The incidence of coronary artery stenosis in the non-tortuosity group(57.6%)was significantly lower than that in the tortuosity group(71.9%)($\bar{χ}$=12.608,

Related risk factors for tortuosity of vertebral artery based on magnetic resonance imaging / 中华神经医学杂志

Objective:To analyze the related risk factors for vertebral artery tortuosity, and explore the mechanism of vertebral artery tortuosity.Methods:Two hundred and eighty-two patients accepted head/neck and MR angiography in our hospital from October 2016 to October 2017 were selected. The tortuosity degrees of vertebral artery were measured and calculated by PACS system. The differences of tortuosity degrees of vertebral arteries in different age groups were compared. Correlation analysis was performed to determine the correlation between vertebral artery tortuosity and both clinical data and and biochemical levels, and multivariate linear regression analysis was performed to determine the independent risk factors for vertebral artery tortuosity.Results:The tortuosity degrees of the left and right vertebral arteries in these patients ranged from 5.1% to 72.6%. The tortuosity degrees of vertebral arteries in patients aged 40-49 years were significantly higher than those in patients aged 20-29 years and 30-39 years ( P<0.05). Correlation analysis showed that the tortuosity degree of the right vertebral artery was positively correlated with age and triglyceride level ( r=0.232, P=0.000; r=0.172, P=0.004); the tortuosity degree of the left vertebral artery was positively correlated with triglyceride level ( r=0.123, P=0.043). Multivariate regression analysis showed that age ( 95%CI: 0.059-0.194, P=0.000) and triglyceride level ( 95%CI: 0.173-1.942, P=0.019) were independent risk factors for right vertebral artery tortuosity. Triglyceride level ( 95%CI: 0.041-2.559, P=0.043) was independent risk factor for left vertebral artery tortuosity. Conclusion:There are congenital developmental factors associated with vertebral artery tortuosity; some nurture factor, as triglyceride level, may promote its development.

A Case Study on Idiopathic Intracranial Hypertension Management and Outcome.

Background: Pseudo Tumor Cerebri (PTC), also knownby the name Idiopathic Intracranial Hypertension (IIH),is a disorder with increased intracranial pressure (ICP) andassociated headache, nausea, vomiting, transient visualobscuration, double-vision, and visual field defects.Material and methods: Thirty-four cases of idiopathicintracranial hypertension reported to our institute, all reportedpeople are female, and all are over twenty years of age, witha diagnosis of IIH according to the Modified dandy criteriawere included and treated medically with oral acetazolamideat a dose of 500 mg/day.Results: All patients are started on oral acetazolamide 250 mgtwice daily; all patients got resolved of fundus changes andnerve palsy with the therapy within three months of follow up.Conclusions: In this study, administration of low doses ofacetazolamide 250mg twice daily for a duration of 3 monthsfor all the patients, and there were no signs of recurrenceafter cessation of acetazolamide and in the further followup. Acetazolamide plays an important role in cases of IIH forits best outcome. Early diagnosis and early treatment withacetazolamide gave good outcomes in all cases of IdiopathicIntracranial Hypertension.

Variations, relations and clinical significance of carotid arterial system in anterior neck: a cadaveric study

Background: The common carotid, internal and external carotid arteries and their branches serve as major source of blood supply in head-neck region of human and are often encountered during numerous surgical and clinical interventions of neck.Methods: We dissected and examined both sides of neck in 49 well embalmed cadavers (98 sides). We recorded the following anatomical parameters of carotid arterial system-level of bifurcation, the relation between internal and external carotid arteries, branching pattern of anterior branches of external carotid artery, tortuosity in carotid arterial system, and relation of hypoglossal nerve with the carotid arteries.Results: In 56.16 % cases, the common carotid arterial bifurcation took place at the upper border of thyroid cartilage though high bifurcation was quite common (43.88%). The external carotid artery was located antero-medial to internal carotid artery in most cases (93.87%). Abnormal tortuosity of carotid arterial system was detected in 2.04% cases only. In 86.73% cases, the hypoglossal nerve crossed the internal and external carotid artery superior to carotid bifurcation above the level of hyoid bone while in 1 case it crossed immediately inferior to carotid bifurcation. In branching pattern, following variations were observed- linguo-facial trunk in 15.3% cases, thyro-lingual trunk in 5.1% cases, origin of superior thyroid artery from common carotid in 10.02% cases and origin of superior thyroid from internal carotid in one case (1.02%).Conclusions: The carotid arterial system has complex and variable anatomy in neck and this information should be kept in mind to avoid unwanted damage during surgical procedures of neck.

Hybrid operation for symptomatic intracranial artery stenosis with proximal vascular tortuosity: report of two cases / 中国脑血管病杂志

Patient 1 was a 73-year-old female who was diagnosed as symptomatic severe stenosis of • left middle cerebral artery with left internal carotid artery tortuosity. Hersymptoms persisted despite the optimal medical therapy. Reconstruction of the left internal carotid artery was successfully performed by truncating the redundant segment and following end-to-end anastomosis, then intracranial steht was deployed via a new available approach. Patient's symptoms alleviated after operation and never reoccured in 12-month follow-up. Patient 2 was a 70-year-old male who had basilar artery severe stenosis with left vertebral artery. Tortuosity and contralateral one slendemess. He suffered from recurrent posterior circulation ischemia even with optimal medical therapy. During the hybrid operation, the left vertebral artery was exposed and cut open so that an available approach for endovascular procedure was created. No recurrence of symptoms in follow- up after operation with for 9 months. Relevant literature was reviewed. We concluded that for treatment of symptomatic severe intracranial artery stenosis with proximal vascular tortuosity, hybrid operation can be safe and effective.

Observing and detecting on blood flow in hepatic sinus in hepatic steatosis mice / 解剖学报

Objective Due to the distortion of hepatic cells in hepatic steatosis, the characteristics of blood flow in the liver could change. This study observed the morphology, blood flow velocity and tortuosity changes aimed to help the diagnosis and treatment in the hepatic steatosis. Methods The hepatic steatosis model was established by subcutaneous injection of carbon tetrachloride (CCl4) and olive oil in mice, and then liver tissue was stained with HE and oil red 0 staining. Laser ultrasound was used to measure the blood flow changes in the superficial hepatic vessels of the left lobe. The mice's tail veins were injected with Texas red fluorescent dye, then two-photon fluorescence microscopy were used to detect the flow of red blood cells in mice's hepatic sinusoids, blood vessel diameter, the hepatic sinusoidal tortuosity. Results After injected with CCl4 for two(n= 16) or four(n= 16) weeks, the oil red 0 staining indicated lipid accumulation in hepatic cells, especially around the central vein. HE staining indicated narrowing of the hepatic sinusoidal vessels, and more obviously in 4-weeks group. As the modeling time increased, the blood flow velocity decreased gradually in hepatic sinusoids and superficial hepatic vessels in the left lobe, and the diameter of the hepatic sinusoids became smaller. Conclusion In the hepatic steatosis, the internal diameter of hepatic sinus decreases, and the blood flow also decreases in the hepatic sinusoids, but hepatic sinusoidal tortuosity increases. All of this provide a visual morphological experimental basis for the early diagnosis and treatment to the hepatic steatosis.

Objective analysis of corneal subbasal nerve tortuosity and its changes in patients with dry eye and diabetes / 中华实验眼科杂志

Objective To construct an objective analysis system of corneal nerve tortuosity and detect the changes of corneal subbasal nerve tortuosity in patients with dry eye and diabetes. Methods GradeⅠtoⅣnerve tortuosity were evaluated and 80 photos of each grade were randomly chosen from the in vivo confocal microscopy library. Nerve fibers were extracted,segmented and then analyzed by 6 tortuosity related parameters including L C, Seg L C mean,Cur mean,Specific p,ICM and SCC mean. After verifying the validaty of parameters above,a cross-sectional study was conducted. Subjects were collected from June,2018 to February,2019 in Peking University Third Hospital,and were divided into healthy control group (28 persons 56 eyes),dry eye without diabetes group (28 patients 56 eyes),diabetes without dry eye group(24 patients 48 eyes),diabetes with dry eye group (23 patients 46 eyes) . Basic and dry eye information includes sex,age,ocular surface disease index ( OSDI) ,tear film break-up time (TBUT),Schirmer Ⅰ test (SⅠt) and corneal fluorescence staining (CFS) score. Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) were detected in diabetic patients. Cochet-Bonnet examination (C-BE) was detected to evaluate corneal sensation and 2 corneal subbasal nerve photos of each eye were selected for effective tortuosity and density related parameters analysis. Data was analyzed by SPSS and diagnostic test were perfomed by MedCalc. This study followed the Declaration of Helsinki. This study protocol was approved by Ethic Committee of Peking University Third Hospital ( No. IRB00006761-M2017354 ) . Written informed consent was obtained from each subject prior to entering study cohort. Results L C,Seg L C mean,Cur mean,Specific p,ICM and SCC mean increased as the nerve tortuosity increased from Grade Ⅰ to Grade Ⅳ,with an overall significance among 4 groups (F=39. 100, 36. 367,57. 743,4. 043,6. 818,33. 493;all at P<0. 01). Among the above 6 parameters,Cur mean and L C of any two groups were of significant difference (all at P<0. 01). Twenty three to twenty eight persons were enrolled in each group of the cross-sectional study. Sex and age were comparable among 4 groups. Diagnostic criteria were met in dry eye and diabetes. Corneal sensation parameter C-BE decreased in diabetes without dry eye group and diabetes with dry eye group compared with healthy control group ( all at Adj P<0. 05 ) , other than in dry eye without diabetes group (AdjP≥0. 05). Nerve density of diabetes without dry eye group and diabetes with dry eye group was lower compared with healthy control group(all at P<0. 001),while no significant difference between dry eye without diabetes group and healthy control group(P≥0. 05). Among the effective parameters of tortuosity,L C,Cur mean,Seg L C mean and SCC mean of dry eye without diabetes group,diabetes without dry eye group,diabetes with dry eye group were higher compared with healthy control group ( all at P<0. 05 ) . Diagnostic tests of tortuosity related parameters all showed an area under curve (AUC) from 0. 5 to 0. 7. Conclusions L C and Cur mean can be used to analyze corneal nerve curvature more reliably. Compared with normal volunteers,patients of dry eye or diabetes show higher corneal subbasal nerve tortuosity.

Effect of Coronary Artery Tortuosity on Coronary Hemodynamics Based on Case Study / 医用生物力学

Objective To investigate the hemodynamic changes in a tortuous coronary to elucidate the effects of tortuosity on coronary perfusion and wall shear stress (WSS). Methods A single tortuous and non-tortuous patient-specific left anterior descending (LAD) coronary artery cases were selected. Two LAD models with and without coronary tortuosity were reconstructed in Mimics software and then transferred to the ANSYS Fluent software for performing computational fluid dynamics (CFD) simulation. The hemodynamic characteristics of both the LAD models were compared. Results The vessel WSS of the tortuous coronary artery clearly decreased in the bend section where the maximum curvature was larger than 1 mm-1.Such a scenario could led to an inadequate blood supply in the downstream vessels. A low WSS (0-26 Pa) acted on the outer wall of the bend, whereas the inner wall of the bend had a high WSS (>100 Pa). The mean WSS of the non-tortuous and tortuous models was 10.79 Pa and 36.12 Pa, respectively. The overall WSS of the tortuous model was larger compared with that of the non-tortuous model. Conclusions Coronary tortuosity increased the overall WSS, which could delay the progress of coronary atherosclerosis.

Arterial Tortuosity Syndrome in a Neonate

Arterial tortuosity syndrome (ATS) is a very rare autosomal recessive connective tissue disease characterized by generalized elongation and tortuosity of the medium- to large-sized arteries, and other systemic connective tissue manifestations. To date, this disease entity has not been reported in Korea. We report a case of ATS diagnosed in a neonate who presented with severe elongation and tortuosity of the aorta and its major branches, as well as the intracranial arteries. Additionally, the patient presented with a tortuous dilatation of the inferior vena cava, an aneurysmal dilatation of the extra-hepatic bile ducts, and an inguinal and sliding hiatal hernia. The diagnosis was confirmed using DNA sequencing analysis, and the patient demonstrated a compound heterozygosity for two novel mutations (c.738delG [p.Gln247Serfs*33] and c.362T>C [p.Ile121Thr]) in exon 2 of the SLC2A10 gene. Genetic analysis also confirmed that both parents were heterozygous carriers of the responsible mutations. Owing to such clinical manifestations, ATS is often misdiagnosed as other connective tissue diseases including Loeys-Dietz syndrome, Marfan syndrome, and Ehlers-Danlos syndrome. In patients presenting with a high index of suspicion, thorough clinical evaluation and screening for ATS including computed tomography or magnetic resonance angiography and target gene analysis are necessary for early diagnosis and management.

Contrast-enhanced MRA in differential diagnosis of spinal cord vascular malformation and secondary vascular tortuosity caused by non vascular malformations on spinal cord / 中国医学影像技术

Objective To observe the value of CE-MRA in differentiating secondary vascular tortuosity of the spinal cord caused by spinal vascular malformations (SCVM) or non-vascular malformations.Methods A retrospective analysis was performed on 30 patients suspected as SCVM.Based on the results of DSA or surgery,the patients were divided into SCVM group (n=16) or non-vascular malformation group (n=14).CE-MRA features were compared between the two groups,including the number,length,position,tortuosity degree of spinal cord tortuous vascular and whether the abnormal feeding artery existed surrounding tortuous vascular.Results Compared with non-vascular malformation group,SCVM group showed more average number of tortuous vascular [(1.38 ± 0.16) vs 1,P=0.012],longer tortuous vascular lengthy [similar lengthy of (9.68 ± 1.18) vertebral body vs(4.14±0.62) vertebral body,P＜0.001),higher score of tortuosity degree [(2.23 ± 0.22) scores vs (0.86±0.10) scores,P＜0.001] and more easier to appear abnormal feeding artery surrounding tortuous vascular [75.00％(12/16) vs28.57％(4/14),P=0.014].Furthermore,only2 cases (2/16,12.50％) of tortuous vascular located in and limited to lower thoracic vertebra (T7 T12 vertebrae) in SCVM group,while 11 cases (11/14,78.57％) in non-vascular malformation group (P=0.020).Conclusion Spinal cord secondary vascular tortuosity of SCVM can be well distinguished from that caused by non-vascular malformation with CE MRA spinal angiography.

Tortuosidad discreta como medida morfométrica en tumores cerebrales / Discrete tortuosity as a morphometric measure in brain tumors

Resumen: Los tumores cerebrales pueden presentar cambios morfológicos dependiendo de su grado de malignidad. El objetivo de este trabajo es poder detectar y cuantificar estos cambios morfológicos a partir imágenes de resonancia magnética, ya que puede representar una ventaja importante para el diagnóstico no invasivo de los pacientes. Una forma de identificar dichos cambios morfológicos es a través de la medición de su tortuosidad. La tortuosidad discreta es un descriptor que caracteriza curvas bidimensionales, como el contorno de una región. En este trabajo se propone una variante para calcular la tortuosidad de superficies volumétricas. Esta técnica se basa en el uso del código cadena de cambios de pendientes del contorno superficial de un volumen y la denominamos como tortuosidad discreta tridimensional. Este descriptor se utiliza como un índice morfométrico para estudiar la tortuosidad de tumores cerebrales. Para ello se analizan imágenes de resonancia magnética de 20 pacientes con presencia de gliomas de bajo y alto grado de malignidad, considerando cuatro regiones de interés: edema, tumor entero, región activa y necrosis. Como resultado, se muestran los distintos grados de tortuosidad de las diversas regiones, encontrándose solo en algunas de ellas diferencias significativas. Cabe señalar que una desventaja que se tiene presente, es la dependencia de la medición a la utilización de un método robusto de segmentación de las regiones, sin embargo la propuesta de la tortuosidad discreta para superficies volumétricas es satisfactoria.

Abstract: A decision tree based system with heuristic weight factors oriented to diagnosis by Morphological changes in brain tumors may be related to their malignancy. The objective of this work is to be able to detect and quantify these changes in a magnetic resonance imaging, since it can represent an important advantage for the noninvasive diagnosis in patients. One way to identify such morphological changes can be through the measurement of their tortuosity. The discrete tortuosity is a descriptor that characterizes bi-dimensional curves, as the contour of a region. In this work an alternative procedure for calculating the volumetric tortuosity of a surface is proposed. This technique is based in the slope chain code of the surface contour of a volume, and here we call it tridimensional discrete tortuosity. This descriptor is used as a morphometric index to study the tortuosity of brain tumors. For this, magnetic resonance images from 20 patients with low and high malignancy levels were analyzed, considering four regions: edema, whole tumor, enhancing region, and necrotic region. As a result, the tortuosities of the different regions are presented, with significant differences only in some of them. It should be noted that a disadvantage that is present, is the dependence of the measurement to the use of a robust method of segmentation, nevertheless the proposal of the discrete tortuosity for volumetric surfaces is satisfactory.

Williams Syndrome with Ocular Manifestations

PURPOSE: To report two cases of Williams syndrome with ocular manifestations CASE SUMMARY: A 5-year-old boy who was diagnosed with Williams syndrome visited our hospital for ophthalmic examination. Best corrected visual acuity (BCVA) in both eyes was 0.6. He had myopic astigmatism and 8 prism diopters of esotropia. Oval-shaped pupil with a stellate pattern of the iris and increased retinal vascular tortuosity were seen in both eyes. Another case of an 8-year-old boy with Williams syndrome also had myopia in both eyes. BCVA was 0.7 in the right eye and 0.4 in the left eye. A stellate pattern of the iris and increased retinal vascular tortuosity were also seen in both eyes. CONCLUSIONS: Williams syndrome, deletion of 7q11.23, has ocular anomalies including a stellate pattern of the iris, refractive errors, amblyopia, and strabismus. Therefore, careful ophthalmic examination should be considered when children are diagnosed with Williams syndrome.

Study of correlation between carotid artery tortuosity and atherosclerotic carotid artery stenosis / 中华外科杂志

Objective@#To investigate the correlation between carotid artery tortuosity and atherosclerotic carotid artery stenosis.@*Methods@#A total of 73 patients who underwent carotid computed tomography angiography with unilateral atherosclerotic carotid artery stenosis at Department of Neurosurgery of Beijing Hospital from January 2011 to June 2016 were retrospectively reviewed. There were 51 males and 22 females ranging from 48 to 90 years old, the average age was (65.9±9.5) years. There were 38 patients with carotid stenosis in the left carotid artery and 35 in the right, the stenosis degree of carotid artery ranged from 30% to 90% with the median was 44.0% (25.5%). According to the degree of carotid artery stenosis, the patients were classified into mild stenosis group and moderate/severe stenosis group. There were 43 patients in the mild stenosis group with an average stenosis degree of (37.5±5.4)%, there were 30 patients in moderate/severe stenosis group with an average stenosis degree of (65.6±10.9)%. The carotid artery (CCA) tortuosity, extracranial internal carotid artery (EICA) tortuosity and CCA-ICA bifurcation tortuosity were quantified by measuring the CCA tortuosity index, EICA tortuosity index and the internal carotid artery (ICA) angle, respectively. Comparison of diseased and normal carotid arteries was performed using t test or Wilcoxon signed-ranked test.@*Results@#There were no statistically significant differences in CCA tortuosity index (Z=-0.584, P=0.559), ICA angle (t=0.278, P=0.781), and EICA tortuosity index (Z=-0.377, P=0.706) between diseased and normal carotid arteries in 73 patients. The diseased carotid arteries showed larger ICA angles (39.0° (19.0°) vs. 30.0° (15.0°)) (Z=-2.439, P=0.015) in the mild stenosis group, but smaller ICA angles ((31.5±11.7)° vs. (39.1±16.2)°) (t=-2.529, P=0.017) in the moderate/severe stenosis group, compared with the contralateral normal carotid arteries. There was no statistically significant difference in CCA (Z=-0.720, P=0.472; Z=-0.013, P=0.990) and EICA tortuosity index (Z=-0.349, P=0.727; Z=-0.114, P=0.909) between diseased and normal carotid arteries.@*Conclusions@#Compared with normal carotid arteries, carotid arteries with mild atherosclerotic stenosis demonstrate a more tortuous CCA-ICA bifurcation, while those with moderate/severe stenosis demonstrate a straighter CCA-ICA bifurcation. There is no correlation between CCA, EICA tortuosity and carotid artery stenosis.

Application of Navien catheter in intracranial aneurysm embolization / 中国脑血管病杂志

Objective To investigate the application technology and effect of Navien catheter in intracranial aneurysms embolization.Methods The clinical data of 15 patients with intracranial aneurysm treated with Navien catheter in Department of Neurosurgery of Yijishan Hospital Affiliated to Wannan Medical College from March to December 2016 were analyzed retrospectively. The extracranial segments of internal carotid arteries were seriously tortuous in all patients. The coaxial system was used during procedure. Whether the Navien catheter could be smoothly placed into the target artery or not was observed,and the coils or stent-assisted coils were used to embolize the intracranial aneurysms in the corresponding positions. The immediate embolization results were assessed by the Raymond grading. The intraoperative and postoperative complications were observed and the patients were followed up by imaging.Results All 15 patients had abnormal tortuosity of extracranial segments of internal carotid arteries. The Navien catheter was able to smoothly pass through the tortuous vessels and reach the desired position. The stent-assisted coil embolization was used in 9 patients,and the coil embolization was used in 6 patients. The success rate of the coil and stent placement technology was 100%. The stents were all accurately put in place without shift. According to the Raymond grading,the immediate embolization rate of aneurysms showed that 15 patients achieved Raymond gradeⅠ. One case developed internal carotid spasm during the procedure. The patient was improved after giving papaverine. Others did not have intraoperative complications,such as cerebral vasospasm,vascular dissection,in-stent thrombosis,and intraoperative aneurysm rupture. Five patients were followed up for 3 to 6 months with digital subtraction angiography (DSA). There was no recurrence of aneurysm and no in-stent stenosis and shift,No rebleeding or cerebral ischemia was observed.Conclusion Forpatients with severely tortuous in extracranial segments of internal carotid artery,using the Navien catheter may overcome artery tortuosity and other unfavorable factors of the patients and successfully reach the target vessel position,enable the embolization of intracranial aneurysms to be completed successfully.

Relationship between unsatisfactory release of LVIS stent and vascular tortuosity in the cavernous segment of internal carotid artery / 中国脑血管病杂志

Objective To investigate the effect of vascular tortuosity and bending radius on the new type knitting stents (LVIS stent ) releasing on the cavernous sinus segment of internal carotid artery. Methods From December 2015 to January 2016,31 consecutive patients with wide-neckedaneurysm treated with LVIS stents and the proximal end of the stent released in the cavernous segment at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled. According to whether the stents completely adhered to the walls or not after the first release,they were divided into two groups:a satisfactorily release group (n =23 )or an unsatisfactorily release group (n =8 ). The differences of vascular tortuosity and bending radius of the 2 groups were compared.Results Thevascular tortuosities of the satisfactorily release group and the unsatisfactorily release group were 118° ± 23° and 147° ± 19° respectively. There was significant difference (P=0. 028). The vascular bending radii were 3. 4 ± 0. 7 mm and 2. 8 ± 0. 7 mm respectively. There was significant difference (P=0. 042). The mean vascular tortuosity was larger and the mean vascular bending radius was smaller in the unsatisfactorily release group. Conclusions The greater the vascular tortuosity,the smaller the vascular bending radius may be connected with the unsatisfactorily release in the LVIS stent. The evaluation of vascular tortuosity is conductive to the guidance of the stent release technique before stent implantation.

Tortuous ulnar artery and Gantzer’s muscle: A rare presentation with clinical implications.

The ulnar artery, larger terminal branch of brachial artery is one of the principal arteries contributing to the vascular supply of forearm. It passes through a narrow tunnel, the Guyon’s canal, along with the ulnar nerve at the level of wrist. Ulnar artery is approached during surgical interventions like, coronary and cerebral angiography, ulnar-cephalic arteriovenous fistula etc., in situations where access to radial artery fails. The lesions of ulnar artery such as aneurysms, tortuosity, aberrancy, etc. may lead to entrapment neuropathies of the ulnar nerve. We have reported here a case of tortuous ulnar artery in the distal forearm and hand of the left side of a 62 years old male, which is a rare finding observed during routine educational cadaveric dissection. The tortuosity was observed in the form of twists and bends at various levels in 15cm long segment of ulnar artery in the distal forearm wrist and hand up to the commencement of superficial palmar arch. An aberrant head of flexor pollicis longus was seen crossing the ulnar artery. The ulnar artery of right side was normal and no other anatomical variations were seen. Such muscular variations may simulate soft tissue tumors resulting in nerve or vascular compressions and also influence the biomechanics of wrist and hand. An understanding of variations in the regional anatomy is essential for surgeons, cardiologists and neuroradiologists for preventing failure of surgical procedures.