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The American Journal of Emergency... Mar 2017
Topics: Abdominal Pain; Adult; Aortic Dissection; Arteritis; Celiac Artery; Constriction, Pathologic; Contrast Media; Dilatation, Pathologic; Humans; Male; Mesenteric Arteries; Mesenteric Vascular Occlusion; Tomography, X-Ray Computed
PubMed: 27742517
DOI: 10.1016/j.ajem.2016.09.036 -
European Journal of Vascular and... May 2021The benefit of preventive treatment for superior mesenteric artery (SMA) stenosis remains uncertain. The latest European Society for Vascular Surgery (ESVS) guidelines...
OBJECTIVE
The benefit of preventive treatment for superior mesenteric artery (SMA) stenosis remains uncertain. The latest European Society for Vascular Surgery (ESVS) guidelines remain unclear given the lack of data in the literature. The aim of this study was to evaluate asymptomatic SMA stenosis prognosis according to the presence of associated coeliac artery (CA) and/or inferior mesenteric artery (IMA) stenosis.
METHODS
This was a single academic centre retrospective study. The entire computed tomography (CT) database of a single tertiary hospital was reviewed from 2009 to 2016. Two groups were defined: patients with isolated > 70% SMA stenosis (group A) and patients with both SMA and CA and/or IMA > 70% stenosis (group B). Patient medical histories were reviewed to determine the occurrence of mesenteric disease (MD) defined as development of acute mesenteric ischaemia (AMI) or chronic mesenteric ischaemia (CMI).
RESULTS
Seventy-seven patients were included. Median follow up was 39 months. There were 24 patients in group A and 53 patients in group B. In group B, eight (10.4%) patients developed MD with a median onset of 50 months. AMI occurred in five patients with a median of 33 months and CMI in three patients with a median of 88 months. Patients of group B developed more MD (0% vs. 15.1%; p = .052). The five year survival rate was 45% without significant difference between groups.
CONCLUSION
Patients with SMA stenosis associated with CA and/or IMA seem to have a higher risk of developing mesenteric ischaemia than patients with isolated SMA stenosis. Considering the low life expectancy of these patients, cardiovascular risk factor assessment and optimisation of medical treatment is essential. Preventive endovascular revascularisation could be discussed for patients with non-isolated > 70% SMA stenosis, taking into account life expectancy.
Topics: Adult; Aged; Asymptomatic Diseases; Celiac Artery; Computed Tomography Angiography; Constriction, Pathologic; Endovascular Procedures; Follow-Up Studies; Heart Disease Risk Factors; Humans; Male; Mesenteric Artery, Inferior; Mesenteric Artery, Superior; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Middle Aged; Practice Guidelines as Topic; Prognosis; Retrospective Studies; Risk Assessment; Survival Rate
PubMed: 33810975
DOI: 10.1016/j.ejvs.2021.03.003 -
Journal of Integrative Neuroscience Jan 2022The relationship between the severity of intracranial atherosclerotic disease and the circle of Willis integrity is unclear. In this brief report, we investigate the...
The relationship between the severity of intracranial atherosclerotic disease and the circle of Willis integrity is unclear. In this brief report, we investigate the associations between symptomatic intracranial atherosclerotic disease and the integrity of the circle of Willis. Patients with symptomatic intracranial atherosclerosis were enrolled and underwent intracranial artery magnetic resonance vessel wall imaging and time-of-flight angiography. The presence or absence of an intracranial atherosclerotic plaque and its maximum wall thickness and stenosis were evaluated. The presence or absence of the A1 segment of the bilateral anterior cerebral arteries (from the internal carotid artery to the anterior communicating artery segment is called anterior cerebral artery A1 segment), and anterior communicating artery, the P1 segment of the bilateral posterior cerebral arteries (The P1 segment of the posterior cerebral artery is a horizontally outward segment), and bilateral posterior communicating arteries were determined. The associations of the intracranial plaque features with the integrity of the circle of Willis were analyzed. Of the 110 recruited subjects (57.2 ± 11.1 years; 65% males), 51 had intracranial plaques, and 44 had stenosis. In patients with bilateral A1 and P1 segments (n = 85), intracranial stenosis was more severe in patients with an anterior communicating artery than those without an anterior communicating artery (19.7% ± 21.7% vs. 1.4% ± 3.3%, = 0.046). In patients with bilateral A1 and P1 segments and an anterior communicating artery (n = 79), intracranial stenosis was more severe in patients with posterior communicating arteries than those without posterior communicating arteries (27.9% ± 23.7% vs. 13.5% ± 17.9%, = 0.007). The odds ratio of intracranial stenosis was 1.214 (95% confidence interval (CI), 1.054-1.398; = 0.007) in discriminating for the presence of posterior communicating arteries in patients with bilateral A1 and P1 segments and an anterior communicating artery after adjusting for confounding factors. The severity of intracranial atherosclerosis was independently associated with the presence of posterior communicating arteries in patients with a complete anterior part of the circle of Willis.
Topics: Adult; Aged; Circle of Willis; Constriction, Pathologic; Female; Humans; Intracranial Arteriosclerosis; Ischemic Attack, Transient; Ischemic Stroke; Magnetic Resonance Imaging; Male; Middle Aged
PubMed: 35164438
DOI: 10.31083/j.jin2101002 -
Journal of Clinical Ultrasound : JCU Sep 2022Ischemic stroke (IS) exhibits a high disability rate, mortality, and recurrence rate, imposing a serious threat to human survival and health. Its occurrence is affected... (Review)
Review
Ischemic stroke (IS) exhibits a high disability rate, mortality, and recurrence rate, imposing a serious threat to human survival and health. Its occurrence is affected by various factors. Although the previous research has demonstrated that the occurrence of IS is mainly associated with lumen stenosis caused by carotid atherosclerotic plaque (AP), recent studies have revealed that many patients will still suffer from IS even with mild carotid artery lumen stenosis. Blood supply disturbance causes 10% of IS to the corresponding cerebral blood supply area caused by carotid vulnerable plaque. Thrombus blockage of distal branch vessels caused by rupture of vulnerable carotid plaque is the main cause of ischemic stroke. Therefore, how to accurately evaluate vulnerable plaque and intervene as soon as possible is a problem that needs to be solved in clinic. The vulnerability of plaque is determined by its internal components, including thin and incomplete fibrous cap, necrotic lipid core, intra-plaque hemorrhage, intra-plaque neovascularization, and ulcerative plaque formation. The development of imaging technology enables the routine detection of AP vulnerability. By analyzing the pathological changes, characteristics, and formation mechanism of carotid plaque vulnerability, this article aims to explore the modern imaging methods which can be used to identify plaque composition and plaque vulnerability to provide a reference basis for disease diagnosis and differential diagnosis.
Topics: Carotid Arteries; Carotid Stenosis; Constriction, Pathologic; Humans; Ischemic Stroke; Magnetic Resonance Imaging; Plaque, Atherosclerotic; Risk Factors
PubMed: 35801515
DOI: 10.1002/jcu.23266 -
Scientific Reports Nov 2023Early neurological deterioration (END) in lenticulostriate artery (LSA) infarction is associated with perforating artery hypoperfusion. As middle cerebral artery (MCA)... (Review)
Review
Early neurological deterioration (END) in lenticulostriate artery (LSA) infarction is associated with perforating artery hypoperfusion. As middle cerebral artery (MCA) tortuosity may alter hemodynamics, we investigated the association between MCA tortuosity and END in LSA infarction. We reviewed patients with acute LSA infarction without significant MCA stenosis. END was defined as an increase of ≥ 2 or ≥ 1 in the National Institutes of Health Stroke Scale (NIHSS) total or motor score, respectively, within first 72 h. The MCA tortuosity index (actual /straight length) was measured. Stroke mechanisms were categorized as branch atheromatous disease (BAD; lesions > 10 mm and 4 axial slices) and lipohyalinotic degeneration (LD; lesion smaller than BAD). Factors associated with END in LD and BAD were investigated. END occurred in 104/390 (26.7%) patients. A high MCA tortuosity index (adjusted odds ratio, aOR 10.63, 95% confidence interval [2.57-44.08], p = 0.001) was independently associated with END. In patients with BAD, high initial NIHSS score (aOR 1.40 [1.03-1.89], p = 0.031) and presence of parental artery disease (stenosis < 50%; aOR 10.38 [1.85-58.08], p = 0.008) were associated with END. In patients with LD, high MCA tortuosity (aOR 41.78 [7.37-237.04], p < 0.001) was associated with END. The mechanism causing END in patients with LD and BAD may differ.
Topics: United States; Humans; Middle Cerebral Artery; Constriction, Pathologic; Stroke; Infarction
PubMed: 37963951
DOI: 10.1038/s41598-023-47281-8 -
Journal of Stroke and Cerebrovascular... Oct 2022Non-stenotic plaques have been observed in intracranial arteries but are less understood compared to those in coronary and carotid arteries. We sought to compare plaque...
OBJECTIVES
Non-stenotic plaques have been observed in intracranial arteries but are less understood compared to those in coronary and carotid arteries. We sought to compare plaque distribution and morphology between stenotic and non-stenotic intracranial plaques with MR vessel wall imaging (VWI) and quantitative image analysis.
MATERIALS AND METHODS
Twenty-four patients with intracranial arterial stenosis or luminal irregularity on clinical imaging were scanned with a multi-contrast VWI protocol. Plaques were detected as focal wall thickening on co-registered multiplanar reformats of multi-contrast VWI, with assessment of the location and morphology. TOF-MRA was independently reviewed for any appreciable stenosis using the WAISD criteria.
RESULTS
Across 504 arterial segments, a total of 80 plaques were detected, including 23 (29%) with stenosis on TOF-MRA, 56 (70%) without, and 1 (1%) not covered by TOF-MRA. Plaques involving the ICA were more likely to be non-stenotic than those involving other segments (80% versus 55%, p = 0.030) whereas the basilar artery (40%) and PCA (33%) had the lowest proportions of non-stenotic plaques. Maximum wall thickness, indicative of plaque burden, correlated poorly with degree of stenosis (p = 0.10) and overlapped substantially between stenotic and non-stenotic plaques (1.9 [1.5, 2.4] versus 2.0 [1.5, 2.2] mm, p = 0.074).
CONCLUSIONS
Intracranial plaques without appreciable stenosis on TOF-MRA represent a large proportion of lesions throughout arterial segments but disproportionately affect the ICA. Morphological characterization of plaques with and without stenosis shows that luminal stenosis is a poor indicator of the underlying burden of intracranial atherosclerosis.
Topics: Cerebral Arteries; Constriction, Pathologic; Humans; Intracranial Arteriosclerosis; Magnetic Resonance Angiography; Plaque, Amyloid; Plaque, Atherosclerotic
PubMed: 35994880
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106719 -
Clinical Neurology and Neurosurgery Sep 2022Patients with intracranial aneurysms treated with stent-assisted coil embolization (SACE) require radiological and clinical follow-up in view of in-stent stenosis (ISS)....
BACKGROUND AND PURPOSE
Patients with intracranial aneurysms treated with stent-assisted coil embolization (SACE) require radiological and clinical follow-up in view of in-stent stenosis (ISS). The aim of the study was to evaluate transcranial Doppler (TCD) as an alternative to more invasive digital subtraction angiography (DSA) in monitoring patients with SACE.
METHODS
Over the course of 72 months, from January 2016 to December 2021, we analyzed 49 patients treated with SACE because of internal carotid artery (ICA) aneurysms (C6 ophthalmic segment or C7 communicating segment). DSA was performed in all patients at 24-months and TCD was examined preoperatively and at 3, 6, 12, and 24-months postoperatively. The degree of stenosis found on TCD was compared with the results of DSA. Preoperative and postoperative blood flow velocities, including peak systolic blood flow velocity (Vs), end diastolic velocity (Vd), and mean velocity (Vm), were compared and the optimal cutoff velocities for detecting stenosis were calculated.
RESULTS
Pre-embolization middle cerebral artery (MCA) and intracranial terminal internal cerebral arteries (TICA) velocities and pulsatility index (PI) did not significantly differ between the ipsilateral and contralateral sides. The blood flow velocities, Vs, Vd, and Vm, on the operation side significantly increased after SACE (P < 0.05). Over the 24-month study period, 7 of the 49 patients (14.3%) exhibited angiographic ISS. ISS of TCD and DSA results at 24-months were compared and found to correlate well; the Cohen's κ coefficient was 0.851 (95% CI 0.651-1.051). The optimal cutoff velocity for detecting ISS was MCA Vs = 173.5 cm/s.
CONCLUSIONS
TCD is a potentially useful adjunct for evaluating ISS after SACE.
Topics: Blood Flow Velocity; Constriction, Pathologic; Humans; Middle Cerebral Artery; Stents; Ultrasonography, Doppler, Transcranial
PubMed: 35841863
DOI: 10.1016/j.clineuro.2022.107347 -
Circulation. Cardiovascular Imaging Mar 2022Whether information on carotid plaque composition contributes to prediction of incident atherosclerotic cardiovascular disease (ASCVD) remains to be investigated. We...
BACKGROUND
Whether information on carotid plaque composition contributes to prediction of incident atherosclerotic cardiovascular disease (ASCVD) remains to be investigated. We determined the sex-specific added value of carotid plaque components for predicting incident ASCVD events, beyond traditional cardiovascular risk factors.
METHODS
Between 2007 and 2012, participants from the population-based Rotterdam Study with asymptomatic carotid wall thickening >2.5 mm on ultrasonography were invited for carotid magnetic resonance imaging. Among 1349 participants (mean age: 72 years [SD±9.3], 49.5% women) without cardiovascular disease, we assessed plaque thickness, luminal stenosis (>30%), presence of intraplaque hemorrhage, lipid-rich necrotic core, and calcification. Follow-up for ASCVD was complete until January 1, 2015. Using Cox proportional hazards models, we fitted sex-specific prediction models including traditional cardiovascular risk factors (base model). We extended the base model by single and simultaneous additions of plaque characteristics and calculated improvement of model performance by the statistics.
RESULTS
During a median follow-up of 4.8 years, 60 men and 48 women developed ASCVD. In women, presence of intraplaque hemorrhage was associated with incident ASCVD (adjusted hazard ratio, 3.37 [95% CI, 1.81-6.25]). The statistic (95% CI) improved from 0.73 (0.66-0.79) to 0.76 (0.70-0.83) after single addition of intraplaque hemorrhage to the base model. Simultaneous addition of plaque components, plaque thickness, and stenosis did not change the results. In men, only carotid stenosis was statistically significantly associated with incident ASCVD (adjusted hazard ratio, 1.75 [95% CI, 1.00-3.08]); yet, the association diminished after the addition of other plaque characteristics, and no improvements were observed in statistics.
CONCLUSIONS
Presence of intraplaque hemorrhage contributes to the prediction of incident ASCVD in women, beyond traditional cardiovascular risk factors, other plaque components, plaque size, and stenosis.
Topics: Aged; Atherosclerosis; Cardiovascular Diseases; Carotid Arteries; Carotid Stenosis; Constriction, Pathologic; Female; Hemorrhage; Humans; Magnetic Resonance Imaging; Male; Plaque, Atherosclerotic; Risk Factors
PubMed: 35196868
DOI: 10.1161/CIRCIMAGING.121.013602 -
NeuroImage. Clinical 2022We aimed to detect microstructural changes in the brains of patients with unilateral middle cerebral artery (MCA) stenosis and to assess the integrity of the fiber...
OBJECTIVE
We aimed to detect microstructural changes in the brains of patients with unilateral middle cerebral artery (MCA) stenosis and to assess the integrity of the fiber structure and the small-world networks using diffusion spectrum imaging (DSI).
METHODS
A total of 21 healthy controls and 48 patients with unilateral MCA stenosis underwent 3.0 T MRI examination using DSI technique. Differential tractography, diffusion connectometry, and structural networks were performed by using DSI software. The correlation between the stenosis and quantitative anisotropy (QA) were analyzed using multiple regression models in the correlation tractography.
RESULTS
Differential tractography analysis showed that the left or right MCA stenosis group had decreased fiber connectivity in the brain network compared with the control group. The correlation tractography analysis of the patients with MCA stenosis showed that QA was negatively correlated with stenosis in the bilateral arcuate fasciculus, bilateral corticostriatal and corticothalamic pathway, bilateral corticopontine and corticospinal tract, right superior longitudinal fasciculus, right cingulum, corpus callosum, and left frontal aslant tract. Statistically significant differences were shown between the MCA stenosis groups and control group in graph density, global efficiency, network path length, and rich club coefficient.
CONCLUSION
DSI revealed that stroke-free patients with unilateral MCA stenosis have a disrupted structural network and damaged white matter fibers. Furthermore, the fiber connection disruption is more severe in the ipsilateral hemisphere and less prominent in the contralateral hemisphere in patients with unilateral MCA stenosis. Therefore, microstructural impairment has happened to patients with unilateral MCA stenosis even at a subclinical stage.
Topics: Humans; Constriction, Pathologic; Middle Cerebral Artery; Diffusion Magnetic Resonance Imaging; White Matter; Anisotropy; Brain
PubMed: 35973283
DOI: 10.1016/j.nicl.2022.103133 -
Computer Methods and Programs in... Jun 2021The main objective of the work is to examine the curvature effects of stenosis/dilatation region pertaining to left coronary artery. The hemodymamic features during the...
BACKGROUND AND OBJECTIVE
The main objective of the work is to examine the curvature effects of stenosis/dilatation region pertaining to left coronary artery. The hemodymamic features during the cardiac cycle is thoroughly examined.
METHODS
A numerical fluid structure interaction model incorporating multi- layered elastic artery wall, non-Newtonian blood viscosity and pulsating boundary conditions is developed. The composite arterial wall consists of a thin layer tunica intima, atheroma and a thick wall. Higher stiffness of atheroma is captured by using higher Young's modulus. The CFD and FSI models are validated with available experimental and analytical data. Computations are done with five different non-Newtonian models and arterial wall with various elasticity levels. The local and time averaged WSS, velocity contours downstream of stenosis, wall pressure and pressure drop during various phases of cardiac cycle are provided in detail.
RESULTS
The influence of non-Newtonian effects of blood viscosity is found to be significant especially at stenosis regions. The flexible wall caused wall deformation and the associated flow and pressure wave propagation affecting WSS and pressure drop compared to the rigid wall. Flow recirculation is noticed at stenosis downstream locations and its strength increases with increased severity of the stenosis. A stenosis is characterised by a sudden drop in wall pressure and a slower two stage recovery during peak velocity periods of the cardiac cycle.
CONCLUSIONS
The pressure drop, local WSS at stenosis centre, and radial velocity increase are significantly higher for stenosis cases and the effect is severe during peak diastole. The variation in hemodynamic parameters is found to be less significant for dilatation. Significantly lower WSS is noticed for the recirculation regions downstream of stenosis which can enhance the tendency for monocytes to attach to the endothelium. The radius of curvature of the stenosis is found to be the most sensitive parameter affecting the hemodynamic characteristics rather than the detailed geometry of the stenosis. The main effect of variation of artery wall stiffness is noted at recirculation regions present downstream of stenosis. The results from the study may be useful for predicting wall shear stress signatures associated with stenosis/dilatation changes and the management of specific cases.
Topics: Blood Flow Velocity; Constriction, Pathologic; Coronary Stenosis; Coronary Vessels; Dilatation; Hemodynamics; Humans; Models, Cardiovascular; Stress, Mechanical
PubMed: 33789214
DOI: 10.1016/j.cmpb.2021.106052