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Naito Gomi M, Iwasaki K, Sasaki I. Carotid web arising in the common carotid artery and adjacent to a transverse process of the cervical spine: A case report. Neuroradiol J 2024; 37:513-517. [PMID: 37903491 PMCID: PMC11366194 DOI: 10.1177/19714009231212371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE A carotid web (CaW) is an intraluminal membrane-like filling defect typically located in the posterior wall of the proximal internal carotid artery and is increasingly recognized as a potential cause of embolic stroke. We herein reported a case of a CaW that has an unusual location at the CCA; furthermore, an elongated transverse process of the cervical spine was adjacent to the CaW at the CCA. CLINICAL PRESENTATION An 87-year-old woman with a history of minor stroke underwent thorough radiological examinations of her CCA lesion. Radiological examinations, including duplex ultrasonography, digital subtraction angiography (DSA), computed tomography, and magnetic resonance angiography, revealed that the morphological characteristics of the lesion were compatible with those of a typical CaW except for its location at the CCA. Furthermore, three-dimensional DSA revealed that the lesion was adjacent to the transverse process of the sixth cervical spine (C6), suggesting mechanical damage by the spinal transverse process as a possible pathogenesis of this CaW. CONCLUSION This is the rare case of a CaW located in the CCA, far from the carotid bulb. Arterial dissection due to mechanical damage by the spinal transverse process may be a possible causative mechanism of the CaW in the present case.
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Affiliation(s)
| | - Koichi Iwasaki
- Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
| | - Isao Sasaki
- Department of Neurosurgery, Ainomiyako Neurosurgical Hospital, Osaka, Japan
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Borg DD, Crockett DM. Common carotid artery dissection from sportive choking. BJR Case Rep 2023; 9:20230048. [PMID: 37928702 PMCID: PMC10621583 DOI: 10.1259/bjrcr.20230048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023] Open
Abstract
Tandem occlusions of the anterior circulation refer to the simultaneous presence of a cervical carotid artery occlusion or high-grade stenosis and an ipsilateral large vessel occlusion involving the intracranial internal carotid artery, M1 or proximal M2 middle cerebral artery. Whilst carotid occlusion usually results from progressive atherosclerotic disease, in younger individuals it may arise secondary to a dissection for which there are multiple aetiologies, with trauma being an important cause in patients having a relevant history. We present a rare case of traumatic left common carotid artery dissection in a young professional Jiu-Jitsu fighter presenting with delayed stroke symptoms and angiographic findings of a tandem occlusion. This case was successfully managed with endovascular clot retrieval and antiplatelet medication.
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Affiliation(s)
- Dr Daniel Borg
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
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Association of Contrast Enhancement of Proximal Internal Carotid Artery Wall and Champagne Bottle Neck Sign with Ipsilateral Stroke in Moyamoya Disease Patients. Eur J Radiol 2022; 155:110501. [DOI: 10.1016/j.ejrad.2022.110501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
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Yang T, Yoshida K, Maki T, Fushimi Y, Yamada K, Okawa M, Yamamoto Y, Takayama N, Suzuki K, Miyamoto S. Prevalence and site of predilection of carotid webs focusing on symptomatic and asymptomatic Japanese patients. J Neurosurg 2021; 135:1370-1376. [PMID: 33668027 DOI: 10.3171/2020.8.jns201727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Carotid webs (CWs) have increasingly been recognized as a cause of recurrent ischemic stroke. However, the natural history and clinical course of CWs remain unclear. The authors aimed to clarify the prevalence, imaging features, and optimal treatment of CWs in a Japanese cohort study. METHODS A series of 444 consecutive Japanese patients who had undergone CTA of the head and neck between April 2011 and October 2016 was retrospectively reviewed. CW was diagnosed on CT angiograms as a membrane-like intraluminal filling defect along the posterior wall of the carotid bulb or the origin of the internal carotid artery (ICA) on oblique sagittal images and a corresponding thin septum on axial images. RESULTS Two patients with CWs were identified among 132 patients with suspected stroke. The prevalence of CWs among symptomatic patients with suspected stroke was 1.5%. The prevalence of asymptomatic CWs was 2.2% (7 of 312 cases). The CWs were located in the posterior wall of the carotid bulb in 7 patients and just distal to the ICA origin in 2 patients. There were no apparent differences in the location or lesion length between symptomatic and asymptomatic CWs. Four of the 7 asymptomatic CWs remained asymptomatic for at least 2 years of follow-up. Two patients with symptomatic CWs developed recurrent cerebral infarction and transient ischemic attack despite being on a regimen of oral antiplatelet agents, and carotid endarterectomy was performed as radical treatment. Patients with CWs were younger than controls (median age 55 vs 69 years, p = 0.003) and were less frequently male than controls (33% vs 72%, p = 0.025). CW cases showed significantly fewer common atherosclerosis risk factors than the control group (p < 0.05). CONCLUSIONS Although limited to CTA patients, this study reported on the prevalence and common site of CWs, focusing on symptomatic and asymptomatic Japanese patients. Extensive cross-sectional and prospective observational studies are warranted to elucidate the overall prevalence and natural history of CWs.
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Affiliation(s)
| | | | | | - Yasutaka Fushimi
- 3Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sakai K, Saito K, Takada A, Suzuki H. Unexpected death in a young child associated with anomalous aortic origin of the left main coronary artery without physical exertion: A case of an anomalous coronary artery with highly abundant elastic fibers. Leg Med (Tokyo) 2021; 53:101965. [PMID: 34543823 DOI: 10.1016/j.legalmed.2021.101965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/15/2022]
Abstract
Sudden death due to anomalous aortic origin of a coronary artery is far less common among young children in the absence of exercise stress. This report describes the case of a 2-year-old boy with a lower respiratory tract infection who suffered sudden cardiac arrest in his bed at home. The autopsy revealed that the left coronary artery (LCA) originated from the right sinus of Valsalva with an acute angle takeoff and traveled between the aorta and the pulmonary trunk (an interarterial course). Upon histological examination, the LCA, before reaching its major branches, was located adjacent to the outside of the aortic wall without an intramural passage, and the arterial wall was composed almost exclusively of elastic fibers without media containing smooth muscle cells throughout the entire length of the abnormal running. Screening tests for respiratory virus infection detected enterovirus in the lung tissue. In association with an acute angle takeoff and interarterial course, the wall structure with highly abundant elastic fibers that are more flexible tissues among blood vessel components might suggest their vulnerability to compression during the great vessels' systolic expansion in the sympathetic activation induced by the viral infection, leading to fatal myocardial ischemia without physical exertion.
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Affiliation(s)
- Kentaro Sakai
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan; Department of Forensic Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Kazuyuki Saito
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan; Department of Forensic Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Aya Takada
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan; Department of Forensic Medicine, Saitama Medical University, Moroyama, Japan
| | - Hideto Suzuki
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan
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Pescetelli I, Zimarino M, Basso C, Ghirarduzzi A, Thiene G, De Caterina R. Extent and progression of atherosclerosis in carotid and subclavian arteries: the Carotid Artery Subclavian Artery study. J Cardiovasc Med (Hagerstown) 2021; 22:652-656. [PMID: 33867507 DOI: 10.2459/jcm.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To define the prevalence, progression, and the relationship between carotid and subclavian artery atherosclerosis and to identify factors associated with disease progression in a population of asymptomatic patients. METHODS Among all consecutive patients without a history of cardiovascular disease admitted to our hospital for duplex ultrasound examinations of the supra-aortic arteries, from January to December 2012, we retrospectively identified 530 patients with two evaluations at least 3 years apart. Each artery was graded according to stenosis degree, as absent or less than 20%, 20-49%, 50-69%, 70-99% and total occlusion. Disease progression was defined for any class increase at any time interval. Patients were grouped according to the presence of a more than 20% stenosis of the supra-aortic district at baseline, as controls, without atherosclerosis: n = 111, 21%; isolated carotid artery disease: n = 390, 74%; concomitant subclavian artery-carotid artery disease: n = 29, 5%. There were no cases with isolated subclavian artery atherosclerosis. RESULTS The mean time-lapse between the two evaluations was 3.1 ± 0.3 years; we documented disease progression in 32 patients (6%), all limited to the carotid artery (P = 0.009 vs. controls, with no differences between isolated carotid artery disease and concomitant carotid and subclavian artery disease). Hypertension was significantly (P < 0.001) associated with disease progression, regardless of the single or double district involvement. CONCLUSION The subclavian artery is far less prone to atherosclerosis than the carotid artery, and features lesser disease progression. Understanding factors for the different susceptibility to atherosclerosis in these two close arterial districts provides insight into local factors prompting vascular disease.
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Affiliation(s)
- Irene Pescetelli
- Institute of Cardiology and Centro di Scienze dell'Invecchiamento (Ce.S.I.Met), 'G. d'Annunzio' University, Chieti.,Interventional Cardiology, Cardiovascular Department, Ospedale Papa Giovanni XXIII Bergamo
| | - Marco Zimarino
- Institute of Cardiology and Centro di Scienze dell'Invecchiamento (Ce.S.I.Met), 'G. d'Annunzio' University, Chieti
| | - Cristina Basso
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova Medical School, Padova
| | - Angelo Ghirarduzzi
- Division of Internal Medicine, Arcispedale S. Maria Nuova-IRCCS-Reggio Emilia, Emilia
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova Medical School, Padova
| | - Raffaele De Caterina
- Institute of Cardiology, University of Pisa, Pisa.,Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy
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Kato Y, Mizutani T, Otsuka N, Ezure H, Inoue Y. Quantitative analysis of the elastic fiber in the tunica media at the carotid bifurcation. Okajimas Folia Anat Jpn 2018; 95:23-27. [PMID: 30504647 DOI: 10.2535/ofaj.95.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this study, the results of our previously reported technique of quantitative analysis by using microscopic image analysis of tissue image slices to calculate the proportion of the area of the tunica media occupied by of elastic fibers was compared with Janzen et al.'s technique at the carotid bifurcation. This particularly analyzed the area of transition between the common carotid and the internal carotid, to observe the quantitative changes in elastic fiber content. The data obtained from our quantitative analysis of elastic fibers were clearly at variance with those obtained by counting the number of elastic fibers. The amount of elastic fibers in the tunica media (the elastic fiber ratio) decreased from the proximal carotid artery (the common carotid) to the bifurcation, then peaked in the internal carotid immediately after the bifurcation before declining again.
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Affiliation(s)
- Yu Kato
- Department of Neurosurgery, Showa University School of Medicine
| | - Tohru Mizutani
- Department of Neurosurgery, Showa University School of Medicine
| | | | | | - Yuriko Inoue
- Department of Anatomy, Showa University School of Medicine
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Yasuda C, Arakawa S, Shimogawa T, Kanazawa Y, Sayama T, Haga S, Morioka T. Clinical Significance of the Champagne Bottle Neck Sign in the Extracranial Carotid Arteries of Patients with Moyamoya Disease. AJNR Am J Neuroradiol 2016; 37:1898-1902. [PMID: 27231227 DOI: 10.3174/ajnr.a4815] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/18/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The champagne bottle neck sign represents a rapid reduction in the extracranial ICA diameters and is a characteristic feature of Moyamoya disease. However, the clinical significance of the champagne bottle neck sign is unclear. We investigated the relationship between the champagne bottle neck sign and the clinical and hemodynamic stages of Moyamoya disease. MATERIALS AND METHODS We analyzed 14 patients with Moyamoya disease before revascularization (5 men, 9 women; age, 43.2 ± 19.3 years). The ratio of the extracranial ICA and common carotid artery diameters was determined using carotid ultrasonography or cerebral angiography; a ratio of < 0.5 was considered champagne bottle neck sign-positive. The clinical disease stage was determined using the Suzuki angiographic grading system. CBF and cerebral vasoreactivity also were measured. RESULTS The ICA/common carotid artery ratio (expressed as median [interquartile range]) decreased as the clinical stage advanced (stages I-II, 0.71 [0.60-0.77]; stages III-IV, 0.49 [0.45-0.57]; stages V-VI, 0.38 [0.34-0.47]; P < .001). Lower ICA/common carotid artery ratio tended to occur in symptomatic versus asymptomatic arteries (0.47 [0.40-0.53] versus 0.57 [0.40-0.66], respectively; P = .06). Although the ICA/common carotid artery ratio was not related to cerebral perfusion, it decreased as cerebral vasoreactivity decreased (P < .01). All champagne bottle neck sign-positive arteries were classified as Suzuki stage ≥III, 73% were symptomatic, and 89% exhibited reduced cerebral vasoreactivity. In contrast, all champagne bottle neck sign-negative arteries were Suzuki stage ≤III, 67% were asymptomatic, and all showed preserved cerebral vasoreactivity. CONCLUSIONS The champagne bottle neck sign was related to advanced clinical stage, clinical symptoms, and impaired cerebral vasoreactivity. Thus, detection of the champagne bottle neck sign might be useful in determining the clinical and hemodynamic stages of Moyamoya disease.
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Affiliation(s)
- C Yasuda
- From the Departments of Cerebrovascular Disease (C.Y., S.A., Y.K.)
| | - S Arakawa
- From the Departments of Cerebrovascular Disease (C.Y., S.A., Y.K.)
| | - T Shimogawa
- Neurosurgery (T.Shimogawa, T.Sayama, S.H., T.M.), Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Y Kanazawa
- From the Departments of Cerebrovascular Disease (C.Y., S.A., Y.K.)
| | - T Sayama
- Neurosurgery (T.Shimogawa, T.Sayama, S.H., T.M.), Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - S Haga
- Neurosurgery (T.Shimogawa, T.Sayama, S.H., T.M.), Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - T Morioka
- Neurosurgery (T.Shimogawa, T.Sayama, S.H., T.M.), Japan Labour Health and Welfare Organization, Kyushu Rosai Hospital, Kitakyushu, Japan
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Intra-individual comparison of carotid and femoral atherosclerotic plaque features with in vivo MR plaque imaging. Int J Cardiovasc Imaging 2015; 31:1611-8. [PMID: 26296806 DOI: 10.1007/s10554-015-0737-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to evaluate differences of plaque composition and morphology within the same patient in different vascular beds using non-invasive MR-plaque imaging. 28 patients (67.8 ± 7.4 years, 8 females) with high Framingham general cardiovascular disease 10-year risk score and mild-to-moderate atherosclerosis were consecutively included in the study. All subjects underwent a dedicated MRI-plaque imaging protocol using TOF and T1w and T2w black-blood-sequences with fat suppression at 1.5 T. The scan was centered on the carotid bulb of the carotid arteries and on the most stenotic lesion of the ipsilateral femoral artery, respectively. Plaques were classified according to the American Heart Association (AHA) lesion type classification and area measurements of lumen, wall and the major plaque components, such as calcification, necrotic core and hemorrhage were determined in consensus by two blinded reviewers using dedicated software (Cascade, Seattle, USA). Plaque components were recorded as maximum percentages of the wall area. Carotid arteries had larger maximum wall and smaller minimum lumen areas (p < 0.001) than femoral arteries, whereas no significant difference was find with respect to the max. NWI (p = 0.87). Prevalence of lipid-rich AHA lesion type IV/V and complicated AHA lesion type VI with hemorrhage/thrombus/fibrous cap rupture was significantly higher in the carotid arteries compared to the femoral arteries. Plaque composition as percentage of the vessel wall differed significantly between carotid and femoral arteries: Max. %necrotic core and max. %hemorrhage were significantly higher in the carotid arteries compared to the femoral arteries (p = 0.001 and p = 0.02, respectively). Max. %calcification did not differ significantly. Average stenotic degree of carotid arteries at duplex was 49.7 ± 12.5 (%). Non-invasive MR plaque-imaging is able to visualize differences in plaque composition across the vascular tree. We observed significant differences in quantitative and qualitative plaque features between carotid and femoral arteries within the same patient, which in the future could help to improve risk stratification in patients with atherosclerosis.
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Katsuno M, Tanikawa R, Hashimoto M, Matsuno A. Distal internal carotid artery dissection due to the carotid shunt during carotid endarterectomy. Br J Neurosurg 2015; 29:862-4. [DOI: 10.3109/02688697.2015.1054357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shimogawa T, Morioka T, Sayama T, Hamamura T, Yasuda C, Arakawa S. Champagne bottle neck sign in a patient with Moyamoya syndrome. World J Clin Cases 2014; 2:474-477. [PMID: 25232554 PMCID: PMC4163773 DOI: 10.12998/wjcc.v2.i9.474] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/20/2014] [Accepted: 07/15/2014] [Indexed: 02/05/2023] Open
Abstract
The champagne bottle neck (CBN) sign refers to a reduction in the diameter of the proximal portion of the internal carotid artery that resembles a CBN, and is a characteristic feature of Moyamoya disease. A 43-year-old woman with an infarction of the posterior limb of the left internal capsule was diagnosed with Moyamoya syndrome associated with Graves’ disease. The CBN sign was observed bilaterally. Cerebral revascularization surgery was performed, including left-sided superficial temporal artery to middle cerebral artery anastomosis. During four years of follow-up, she maintained a euthyroid state and did not have any further cerebral ischemic events. The CBN signs remained unchanged on both sides during this time. This is the first report of the CBN sign in a patient with Moyamoya syndrome associated with Graves’ disease.
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Matsuo Y, Takumi T, Mathew V, Chung WY, Barsness GW, Rihal CS, Gulati R, McCue ET, Holmes DR, Eeckhout E, Lennon RJ, Lerman LO, Lerman A. Plaque characteristics and arterial remodeling in coronary and peripheral arterial systems. Atherosclerosis 2012; 223:365-71. [PMID: 22721702 DOI: 10.1016/j.atherosclerosis.2012.05.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/07/2012] [Accepted: 05/22/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Few studies have examined plaque characteristics among multiple arterial beds in vivo. The purpose of this study was to compare the plaque morphology and arterial remodeling between coronary and peripheral arteries using gray-scale and radiofrequency intravascular ultrasound (IVUS) at clinical presentation. METHODS AND RESULTS IVUS imaging was performed in 68 patients with coronary and 93 with peripheral artery lesions (29 carotid, 50 renal, and 14 iliac arteries). Plaques were classified as fibroatheroma (VH-FA) (further subclassified as thin-capped [VH-TCFA] and thick-capped [VH-ThCFA]), fibrocalcific plaque (VH-FC) and pathological intimal thickening (VH-PIT). Plaque rupture (13% of coronary, 7% of carotid, 6% of renal, and 7% of iliac arteries; P = NS) and VH-TCFA (37% of coronary, 24% of carotid, 16% of renal, and 7% of iliac arteries; P = 0.02) were observed in all arteries. Compared with coronary arteries, VH-FA was less frequently observed in renal (P < 0.001) and iliac arteries (P < 0.006). Lesions with positive remodeling demonstrated more characteristics of VH-FA in coronary (84% vs. 25%, P < 0.001), carotid (72% vs. 20%, P = 0.001), and renal arteries (42% vs. 4%, P = 0.001) compared with those with intermediate/negative remodeling. There was positive relationship between remodeling index and percent necrotic area in all four arteries. CONCLUSIONS Atherosclerotic plaque phenotypes were heterogeneous among four different arteries; renal and iliac arteries had more stable phenotypes compared with coronary artery. In contrast, the associations of remodeling pattern with plaque phenotype and composition were similar among the various arterial beds.
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Affiliation(s)
- Yoshiki Matsuo
- The Division of Cardiovascular Disease, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Zach V, Zhovtis S, Kirchoff-Torres KF, Weinberger JM. Common Carotid Artery Dissection: A Case Report and Review of the Literature. J Stroke Cerebrovasc Dis 2012; 21:52-60. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/07/2010] [Accepted: 05/05/2010] [Indexed: 11/25/2022] Open
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MASUOKA T, HAYASHI N, HORI E, KUWAYAMA N, OHTANI O, ENDO S. Distribution of Internal Elastic Lamina and External Elastic Lamina in the Internal Carotid Artery: Possible Relationship With Atherosclerosis. Neurol Med Chir (Tokyo) 2010; 50:179-82. [PMID: 20339265 DOI: 10.2176/nmc.50.179] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Toru MASUOKA
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Nakamasa HAYASHI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Emiko HORI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Naoya KUWAYAMA
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Osamu OHTANI
- Department of Anatomy, Faculty of Medicine, University of Toyama
| | - Shunro ENDO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
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A development of atheromatous plaque is restricted by characteristic arterial wall structure at the carotid bifurcation. ACTA ACUST UNITED AC 2008; 69:586-90; discussion 590-1. [PMID: 18261781 DOI: 10.1016/j.surneu.2007.05.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 05/09/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is said atheromatous plaque is located very focally, but there have been few reports regarding this matter. Various aspects of the pathogenesis of the development of atheromatous plaque at the carotid bifurcation have previously been discussed. We have noted the correlation of plaque localization with characteristics of the cervical carotid artery wall. METHODS Morphological and histopathologic changes in the carotid bifurcation were examined in 72 cadaver cases with or without atheromatous plaque. We determined the level at which the wall structure changed to muscular artery from elastic artery and analyzed its influence on the development of atheromatous plaque. RESULT Atheromatous plaques at the distal site of the ICA extended within 0 to 37 mm from the carotid bifurcation. The proximal side of the CCA more than 5 mm away from the bifurcation was elastic artery, whereas the distal side of the ICA more than 15 mm from the bifurcation was muscular artery. The area of the carotid bifurcation between elastic artery and muscular artery was a transitional zone. Approximately 80% of them were located within 15 mm, and these areas were coincident with the transitional zone. CONCLUSION Most atheromatous plaque was located in the transitional zone. The arterial wall structure is related to the development of atheromatous plaque at the cervical carotid bifurcation.
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Bai CH, Chen JR, Chiu HC, Pan WH. Lower blood flow velocity, higher resistance index, and larger diameter of extracranial carotid arteries are associated with ischemic stroke independently of carotid atherosclerosis and cardiovascular risk factors. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:322-30. [PMID: 17471583 DOI: 10.1002/jcu.20351] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To investigate the association between diameter and flow velocity of the carotid arteries and ischemic stroke. METHODS Peak systolic velocity, end diastolic velocity, Pourcelot resistance index, blood flow volume, luminal diameter, and carotid plaque burden were measured and compared in 240 ischemic stroke (IS) patients without history of stroke, 163 chronic stable IS patients, and 236 nonstroke controls (age, >or=40 years). Data were also compared between stroke subtypes (large artery atherosclerosis, lacunar, cardioembolic, or undetermined origin). RESULTS Acute as well as chronic stable IS patients had significantly lower flow velocities and flow volume, higher resistance index than nonstroke controls in the common carotid artery (CCA), internal carotid artery and external carotid artery, and larger common carotid artery diameter. The differences were found across all IS subtypes and in stroke patients with as well as without carotid plaque. Comparisons between these subgroups showed significant differences in end diastolic velocity, resistance index, flow velocity, and diameter that were more prominent in the CCA. After adjusting for carotid plaque and cardiovascular risk factors, the associations between the above-mentioned parameter and stroke remained significant. CONCLUSIONS Stroke patients in acute as well as chronic stable phase appeared to have larger CCA diameters, lower carotid flow velocities and volume, and higher resistance index than nonstroke patients independently of extracranial carotid atherosclerosis. These findings need to be confirmed by a prospective study.
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MESH Headings
- Adult
- Aged
- Atherosclerosis/complications
- Atherosclerosis/pathology
- Blood Flow Velocity/physiology
- Blood Volume/physiology
- Brain Ischemia/complications
- Brain Ischemia/physiopathology
- Carotid Arteries/pathology
- Carotid Arteries/physiopathology
- Carotid Artery Diseases/complications
- Carotid Artery Diseases/pathology
- Carotid Artery, Common/pathology
- Carotid Artery, Common/physiopathology
- Carotid Artery, External/pathology
- Carotid Artery, External/physiopathology
- Carotid Artery, Internal/pathology
- Carotid Artery, Internal/physiopathology
- Case-Control Studies
- Female
- Heart Diseases/complications
- Humans
- Male
- Middle Aged
- Myocardial Contraction/physiology
- Risk Factors
- Stroke/complications
- Stroke/physiopathology
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Duplex
- Vascular Resistance/physiology
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Affiliation(s)
- Chyi-Huey Bai
- Central Laboratory, Shin Kong WHS Memorial Hospital, Taipei 111, Taiwan
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