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Clinical Cardiology Nov 2014Nonatherosclerotic vascular diseases of the mesenteric and renal arteries are considered to occur less frequently than those caused by occlusive atherosclerotic disease.... (Review)
Review
Nonatherosclerotic vascular diseases of the mesenteric and renal arteries are considered to occur less frequently than those caused by occlusive atherosclerotic disease. However, when present, they pose a significant diagnostic and therapeutic challenge. Such disorders include fibromuscular dysplasia, median arcuate ligament syndrome, the renal nutcracker syndrome, and some forms of acute and chronic mesenteric ischemia (embolic and thrombotic). This is a heterogeneous group of disorders with substantial differences in the pathogenesis and diagnostic approaches to these diseases. We provide an overview of the pathogenesis, clinical presentation, diagnosis, and current management of fibromuscular dysplasia, median arcuate ligament syndrome, and the renal nutcracker syndrome.
Topics: Celiac Artery; Constriction, Pathologic; Fibromuscular Dysplasia; Humans; Mesenteric Arteries; Mesenteric Vascular Occlusion; Renal Artery Obstruction; Renal Nutcracker Syndrome
PubMed: 25099891
DOI: 10.1002/clc.22305 -
Journal of Vascular Surgery Jun 2022Endurance athletes can develop intermittent claudication due to sports-related flow limitations of the iliac artery (FLIA) caused by arterial kinking. In the present...
OBJECTIVE
Endurance athletes can develop intermittent claudication due to sports-related flow limitations of the iliac artery (FLIA) caused by arterial kinking. In the present study, we investigated the short- and long-term efficacy of an operative release for iliac artery kinking.
METHODS
Between 1996 and 2015, all patients with a diagnosis of FLIA due to iliac artery kinking without substantial arterial stenosis (<15%) or an excessive arterial length (vessel length to straight ratio, <1.25) who had undergone surgery were included. The short-term follow-up protocol consisted of cycling tests, the ankle brachial index with a flexed hip, and Doppler echography examinations to determine the peak systolic velocity before and 6 to 18 months after surgery. Additionally, the short- and long-term efficacy were evaluated using questionnaires.
RESULTS
A total of 142 endurance athletes (155 legs; 88.4% male; median age, 26 years; interquartile range [IQR], 22-31 years) were available for analysis. In the short term, the symptoms had decreased in 83.9% of the patients, with an overall 80.3% satisfaction rate. Power during a maximal cycling test had improved from 420 W (IQR, 378-465 W) to 437 W (IQR, 392-485 W; P < .001). The symptom-free workload had increased from 300 W (IQR, 240-340 W) to 400 W (IQR, 330-448 W; P < .001). The postexercise ankle brachial index with a flexed hip had increased from 0.53 (IQR, 0.40-0.61) to 0.57 (IQR, 0.47-0.64; P = .002), and the peak systolic velocity with a flexed hip had decreased from 1.88 m/s (IQR, 1.45-2.50 m/s) to 1.52 m/s (IQR, 1.19-2.07 m/s; P < .001). Postoperative imaging studies revealed some degree kinking in 33.9%, mostly asymptomatic. The long-term results were evaluated after a median of 15.2 years (IQR, 10.9-19.5 years). The athletes had cycled an additional 125.500 km (IQR, 72.00-227.500 km), which was approximately equal to the 131.000 km (IQR, 98.250-220.000 km) cycled before the diagnosis of FLIA. On the long term, 63.9% of the athletes reported persistent reduction of complaints, with an overall 59.1% satisfaction rate. Eight patients had required reintervention, six because of treatment failure and two because of newly developed FLIA.
CONCLUSIONS
Operative iliac artery release for sports-related functional kinking in the absence of stenosis or an excessive vessel length was effective for most athletes in the short and long term.
Topics: Adult; Athletes; Constriction, Pathologic; Female; Humans; Iliac Artery; Intermittent Claudication; Male; Physical Endurance; Treatment Outcome; Young Adult
PubMed: 35085748
DOI: 10.1016/j.jvs.2021.12.082 -
European Review For Medical and... Jan 2023To detect the display rate and flow velocity of intracranial circle of Willis (anterior, middle, and posterior cerebral arteries) with transcranial contrast-enhanced...
OBJECTIVE
To detect the display rate and flow velocity of intracranial circle of Willis (anterior, middle, and posterior cerebral arteries) with transcranial contrast-enhanced transcranial color-coded sonography (CE-TCCS), using digital subtraction angiography (DSA) as the golden diagnostic standard.
PATIENTS AND METHODS
We collected data from 104 patients with suspected stroke treated in our hospital between December 2019 and October 2021. The detection rate of the intracranial circle of Willis, anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were analyzed based on routine TCCS and CE-TCCS data. Based on digital subtraction angiography (DSA) data, the degree of MCA stenosis was divided into mild stenosis (<50%), moderate stenosis (50-69%), severe stenosis (70-99%), and bilateral middle cerebral artery CE-TCCS examinations were performed. We evaluated MCA color blood flow on CE-TCCS, and recorded the peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean flow velocity (MFV).
RESULTS
The display rates of ACA, MCA, and PCA were significantly improved on the CE-TCCS, and the PSV, EDV and MFV of the MCA stenosis group were higher than those of the normal group. The flow velocity of each stenosis subgroup was increased compared to the normal group. The optimal cutoff values of normal and stenosis under the receiver operating characteristic (ROC) curve were PSV = 168.5 cm/s, EDV = 61.5 cm/s, and MFV = 110.5 cm/s. The optimal cutoff values for mild and moderate stenosis and for moderate and severe stenosis were PSV = 201.5 cm/s and 249.5 m/s, EDV = 95.2 cm/s and 141.5 cm/s, and MFV = 137.6 cm/s and 160.5 cm/s, respectively. PSV and MFV had the most significant sensitivity, specificity, and accuracy.
CONCLUSIONS
Transcranial contrast-enhanced ultrasonography can improve the display rate of intracranial blood vessels and can accurately diagnose MCA stenosis.
Topics: Humans; Middle Cerebral Artery; Constriction, Pathologic; Sensitivity and Specificity; Ultrasonography, Doppler, Transcranial; Blood Flow Velocity; Ultrasonography; Cerebrovascular Disorders
PubMed: 36647872
DOI: 10.26355/eurrev_202301_30875 -
Journal of Biomechanics Jan 2019The ankle-brachial index (ABI), a ratio of arterial blood pressure in the ankles and upper arms, is used to diagnose and monitor circulatory conditions such as...
The ankle-brachial index (ABI), a ratio of arterial blood pressure in the ankles and upper arms, is used to diagnose and monitor circulatory conditions such as coarctation of the aorta and peripheral artery disease. Computational simulations of the ABI can potentially determine the parameters that produce an ABI indicative of ischemia or other abnormalities in blood flow. However, 0- and 1-D computational methods are limited in describing a 3-D patient-derived geometry. Thus, we present a massively parallel framework for computational fluid dynamics (CFD) simulations in the full arterial system. Using the lattice Boltzmann method to solve the Navier-Stokes equations, we employ highly parallelized and scalable methods to generate the simulation domain and efficiently distribute the computational load among processors. For the first time, we compute an ABI with 3-D CFD. In this proof-of-concept study, we investigate the dependence of ABI on the presence of stenoses, or narrowed regions of the arteries, by directly modifying the arterial geometry. As a result, our framework enables the computation a hemodynamic factor characterizing flow at the scale of the full arterial system, in a manner that is extensible to patient-specific imaging data and holds potential for treatment planning.
Topics: Ankle Brachial Index; Arteries; Computer Simulation; Constriction, Pathologic; Hemodynamics; Humans; Hydrodynamics
PubMed: 30385003
DOI: 10.1016/j.jbiomech.2018.10.007 -
European Journal of Medical Research Aug 2023To investigate the safety and efficacy of Enterprise stent angioplasty and risk factors for the prognoses in treating symptomatic severe posterior circulation...
PURPOSE
To investigate the safety and efficacy of Enterprise stent angioplasty and risk factors for the prognoses in treating symptomatic severe posterior circulation atherosclerotic stenosis (SSPCAS).
MATERIALS AND METHODS
Patients with SSPCAS who were treated with the Enterprise stent angioplasty were retrospectively enrolled. The clinical data, peri-procedural complications, postoperative residual stenosis, in-stent restenosis and recurrent stroke at follow-up were analyzed.
RESULTS
262 patients with 275 stenotic lesions treated with the Enterprise stent angioplasty were enrolled. The stenosis degree was reduced from 86.3 ± 6.2% before to 19.3 ± 5.4% after stenting. Complications occurred in 14 (5.3%) patients. Clinical follow-up was performed in 245 (93.51%) patients for 16.5 ± 7.3 months. During 1 year follow-up, 7 patients (2.9%) had recurrent symptoms, including 4 patients with stenting in the intracranial vertebral artery and 3 in the basilar artery. Imaging follow-up was conducted in 223 (85.11%) patients. In-stent restenosis was present in 35 patients (15.7%), with the restenosis rate of 26.4% (n = 23) in the intracranial vertebral artery, which was significantly (P < 0.001) greater than in the basilar artery (8.8%). Six patients (17.1%) with in-stent restenosis were symptomatic. The stenotic length was the only significant (P = 0.026 and 0.024, respectively) independent risk factor for 1 year stroke or death events and in-stent restenosis.
CONCLUSION
The Enterprise stent can be safely and efficaciously applied in the treatment of symptomatic severe posterior circulation atherosclerotic stenosis, with a relatively low rate of in-stent restenosis and recurrent stroke within 1 year. The stenotic length was the only significant independent risk factor for 1 year stroke or death events and in-stent restenosis.
Topics: Humans; Constriction, Pathologic; Coronary Restenosis; Retrospective Studies; Stroke; Arteries
PubMed: 37592323
DOI: 10.1186/s40001-023-01260-x -
Journal of Cellular and Molecular... Aug 2019Multiterritorial atherosclerosis has dramatically increased annual risk of adverse cardiovascular events than atherosclerotic disease with single-artery affected. Serum...
Multiterritorial atherosclerosis has dramatically increased annual risk of adverse cardiovascular events than atherosclerotic disease with single-artery affected. Serum uric acid (SUA) is an important predictor of stroke and atherosclerosis; however, which is supported by few direct evidence based on cohort studies. A prospective cohort study including 2644 North Chinese adults aged ≥40 years was performed in 2010-2012 to investigate the association between SUA and multiterritorial vascular stenosis. Hyperuricaemia was defined as SUA levels >6 and >7 mg/dL for males and females, respectively. All participants underwent twice transcranial Doppler (TCD) and bilateral carotid duplex ultrasound to evaluate intracranial artery stenosis (ICAS) and extracranial arterial stenosis (ECAS) and peripheral arterial disease (PAD) was determined by ankle-brachial index (ABI) on January 2010 and January 2012 based on regular health check-ups. The cumulative incidence of vascular stenosis was significantly higher in subjects with hyperuricaemia than in those without hyperuricaemia (54.1% vs. 34.7%, P < 0.001). The adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for new on-set vascular stenosis due to hyperuricaemia and a 1-mg/dL change in SUA level were 1.75 (1.32-2.31) and 1.29 (1.21-1.38), respectively. Furthermore, in the gender-stratified analysis, the association between SUA levels and ICAS was statistically significant in males (OR: 2.02; 95% CI: 1.18-3.46), but not females (OR: 0.85, 95% CI: 0.41-1.76, P for interaction: 0.026).
Topics: Adult; Arteries; Asian People; Atherosclerosis; Cohort Studies; Constriction, Pathologic; Female; Humans; Hyperuricemia; Male; Middle Aged; Odds Ratio; Peripheral Arterial Disease; Prospective Studies; Time Factors; Uric Acid
PubMed: 31240862
DOI: 10.1111/jcmm.14337 -
Chinese Medical Journal Sep 2023The effect of arteriosclerotic intracranial arterial vessel wall enhancement (IAVWE) on downstream collateral flow found in vessel wall imaging (VWI) is not clear....
BACKGROUND
The effect of arteriosclerotic intracranial arterial vessel wall enhancement (IAVWE) on downstream collateral flow found in vessel wall imaging (VWI) is not clear. Regardless of the mechanism underlying IAVWE on VWI, damage to the patient's nervous system caused by IAVWE is likely achieved by affecting downstream cerebral blood flow. The present study aimed to investigate the effect of arteriosclerotic IAVWE on downstream collateral flow.
METHODS
The present study recruited 63 consecutive patients at the Second Hospital of Hebei Medical University from January 2021 to November 2021 with underlying atherosclerotic diseases and unilateral middle cerebral artery (MCA) M1-segment stenosis who underwent an magnetic resonance scan within 3 days of symptom onset. The patients were divided into 4 groups according to IAVWE and the stenosis ratio (Group 1, n = 17; Group 2, n = 19; Group 3, n = 13; Group 4, n = 14), and downstream collateral flow was analyzed using three-dimensional pseudocontinuous arterial spin labeling (3D-pCASL) and RAPID software. The National Institutes of Health Stroke Scale (NIHSS) scores of the patients were also recorded. Two-factor multivariate analysis of variance using Pillai's trace was used as the main statistical method.
RESULTS
No statistically significant difference was found in baseline demographic characteristics among the groups. IAVWE, but not the stenosis ratio, had a statistically significant significance on the late-arriving retrograde flow proportion (LARFP), hypoperfusion intensity ratio (HIR), and NIHSS scores ( F = 20.941, P <0.001, Pillai's trace statistic = 0.567). The between-subject effects test showed that IAVWE had a significant effect on the three dependent variables: LARFP ( R2 = 0.088, F = 10.899, P = 0.002), HIR ( R2 = 0.234, F = 29.354, P <0.001), and NIHSS ( R2 = 114.339, F = 33.338, P <0.001).
CONCLUSIONS
Arteriosclerotic IAVWE significantly reduced downstream collateral flow and affected relevant neurological deficits. It was an independent factor affecting downstream collateral flow and NIHSS scores, which should be a focus of future studies.
TRIAL REGISTRATION
ChiCTR.org.cn, ChiCTR2100053661.
Topics: Humans; Constriction, Pathologic; Magnetic Resonance Imaging; Middle Cerebral Artery; Tomography, X-Ray Computed
PubMed: 37545035
DOI: 10.1097/CM9.0000000000002307 -
The British Journal of Radiology 2016Endovascular stroke treatment is a neurointerventional emergency where the main goal is the early recanalization of the occlusion within the critical time window, as... (Review)
Review
Endovascular stroke treatment is a neurointerventional emergency where the main goal is the early recanalization of the occlusion within the critical time window, as safely as possible. Although the time window and rate of complications for endovascular stroke treatment differ with anterior and posterior circulation strokes, awareness of potential periprocedural complications is important, as they affect patient morbidity and mortality. Periprocedural complications are classified as haemorrhagic complications, procedure-/device-related, puncture site complications, and late-onset events including vascular stenosis. We present the digital subtraction angiography and CT imaging findings related to these complications in a study of 56 stroke patients, as they relate to previous findings in the literature.
Topics: Angiography, Digital Subtraction; Carotid Arteries; Cerebral Arteries; Constriction, Pathologic; Endovascular Procedures; Equipment Failure; Hemorrhage; Humans; Intraoperative Complications; Postoperative Complications; Punctures; Stroke; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26529228
DOI: 10.1259/bjr.20150267 -
Annals of Biomedical Engineering Jan 2015We reviewed existing methods for analyzing, in the time domain, physical mechanisms underlying the patterns of blood pressure and flow waveforms in the arterial system....
We reviewed existing methods for analyzing, in the time domain, physical mechanisms underlying the patterns of blood pressure and flow waveforms in the arterial system. These are wave intensity analysis and separations into several types of waveforms: (i) forward- and backward-traveling, (ii) peripheral and conduit, or (iii) reservoir and excess. We assessed the physical information provided by each method and showed how to combine existing methods in order to quantify contributions to numerically generated waveforms from previous cardiac cycles and from specific regions and properties of the numerical domain: the aortic root, arterial bifurcations and tapered vessels, peripheral reflection sites, and the Windkessel function of the aorta. We illustrated our results with numerical examples involving generalized arterial stiffening in a distributed one-dimensional model or localized changes in the model parameters due to a femoral stenosis, carotid stent or abdominal aortic aneurysm.
Topics: Aortic Aneurysm, Abdominal; Arterial Pressure; Arteries; Constriction, Pathologic; Humans; Models, Cardiovascular; Pulse Wave Analysis; Stents
PubMed: 25138163
DOI: 10.1007/s10439-014-1087-4 -
PloS One 2017Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with...
BACKGROUND
Asians have higher frequency of intracranial arterial stenosis. The present study aimed to compare the clinical features and outcomes of ischemic stroke patients with and without middle cerebral artery (MCA) stenosis, assessed by transcranial sonography (TCS), based on the Taiwan Stroke Registry (TSR).
METHODS
Patients with acute ischemic stroke or transient ischemic attack registered in the TSR, and received both carotid duplex and TCS assessment were categorized into those with stenosis (≥50%) and without (<50%) in the extracranial internal carotid artery (ICA) and MCA, respectively. Logistic regression analysis, Kaplan-Meier method and Cox proportional hazard model were applied to assess relevant variables between groups.
RESULTS
Of 6003 patients, 23.3% had MCA stenosis, 10.1% ICA stenosis, and 3.9% both MCA and ICA stenosis. Patients with MCA stenosis had greater initial NIHSS, higher likelihood of stroke-in-evolution, and more severe disability than those without (all p<0.001). Patients with MCA stenosis had higher prevalence of hypertension, diabetes and hypercholesterolemia. Patients with combined MCA and extracranial ICA stenosis had even higher NIHSS, worse functional outcome, higher risk of stroke recurrence or death (hazard ratio, 2.204; 95% confidence intervals, 1.440-3.374; p<0.001) at 3 months after stroke than those without MCA stenosis.
CONCLUSIONS
In conclusion, MCA stenosis was more prevalent than extracranial ICA stenosis in ischemic stroke patients in Taiwan. Patients with MCA stenosis, especially combined extracranial ICA stenosis, had more severe neurological deficit and worse outcome.
Topics: Aged; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Middle Cerebral Artery; Stroke
PubMed: 28388675
DOI: 10.1371/journal.pone.0175434