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Background: Recipients of radiation therapy (RT) for head and neck cancer (HNC) are at significantly increased risk for carotid artery stenosis (CAS) and cerebrovascular disease (CVD). We sought to determine (1) cumulative incidences of CAS and CVD among HNC survivors after RT and (2) whether CAS is associated with a RT dose response effect. Methods: This single‐institution retrospective cohort study examined patients with nonmetastatic HNC who completed (chemo)RT from January 2000 through October 2020 and subsequently received carotid imaging surveillance ≤2 years following RT completion and, in the absence of CAS, every 3 years thereafter. Exclusion criteria included history of known CAS/CVD. Asymptomatic CAS was defined as ≥50% reduction of luminal diameter, symptomatic CAS as stroke or transient ischemic attack, and composite CAS as asymptomatic or symptomatic CAS. Results: Of 628 patients undergoing curative intent RT for HNC, median follow‐up was 4.8 years (interquartile range, 2.6–8.3), with 97 patients followed ≥10 years. Median age was 61 years and 69% of patients received concurrent chemotherapy and 28% were treated postoperatively. Actuarial 10‐year incidences of asymptomatic, symptomatic, and composite CAS were 29.6% (95% CI, 23.9–35.5), 10.1% (95% CI, 7.0–13.9), and 27.2% (95% CI, 22.5–32.1), respectively. Multivariable Cox models significant association between asymptomatic CAS and absolute carotid artery volume receiving ≥10 Gy (per mL: hazard ratio, 1.09; 95% CI, 1.02–1.16). Conclusions: HNC survivors are at high risk for post‐RT CAS. A dose response effect was observed for asymptomatic CAS at doses as low as 10 Gy. Plain Language Summary: Recipients of radiation therapy for head and neck cancer are at significantly increased risk for carotid artery stenosis and cerebrovascular disease. However, carotid artery screening is not routinely performed among head and neck survivors following radiation therapy.In this single‐institution retrospective cohort study, patients with head and neck cancer were initially screened for carotid artery stenosis ≤2 years following radiation therapy completion, then every 3 years thereafter.The 10‐year actuarial incidence of carotid artery stenosis was >25% and stroke/transient ischemic attack >10%. Multivariable analysis demonstrated significant associations between asymptomatic carotid artery stenosis and artery volumes receiving ≥10 Gy. Actuarial 10‐year incidences of carotid artery stenosis and cerebrovascular disease were >25% and >10%, respectively. A dose response effect was observed for carotid artery stenosis and was most pronounced for absolute carotid artery volumes receiving ≥30–50 Gy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Limb‐shaking transient ischemic attack (TIA) is a rare manifestation of carotid‐occlusive damage. This case report highlights the importance of accurate diagnosis and treatment of bilateral ballism as limb‐shaking TIA. Superficial cephalic artery and mid‐large artery anastomosis was performed after the initial acute treatment, and involuntary limb shaking disappeared. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between apical periodontitis (AP) and atherosclerotic cardiovascular disease (ASCDV). Methodology: A total of 65 periodontally and systemically healthy patients (age ≥ 40 years) were included in the study. Periapical status was assessed through dental examination and periapical radiographs; 33 subjects had AP (AP+), while 32 acted as control (AP−). Moreover, data regarding their periapical index (PAI) score and the Decayed, Missing, and Filled Teeth (DMFT) index were recorded. All subjects underwent echo‐colour Doppler assessment of carotid intima‐media thickness (CIMT), carotid plaques, degree of stenosis using the North American Symptomatic Carotid Surgery Trial (NASCET) method, maximum diameter of the abdominal aorta (maximum AA) and common iliac arteries (CIA) diameters. Furthermore, peripheral blood flow was also measured using the ankle‐brachial index (ABI). Simple and multiple regression analyses were performed. Results: Among AP+ patients, 57.58% disclosed at least one sign of subclinical carotid atherosclerosis. Multiple regression analysis identified AP as a significant risk indicator for carotid plaques [OR = 4.87 (1.27, 18.98; p =.021)] and marked carotid intima‐media thickenings (OR = 14.58 [1.22, 176.15], p =.035). A significant association was established between AP and other cardiovascular (CV) variables (CIMT, NASCET, and maximum AA). On the contrary, a higher PAI score does not correlate to increased odds of carotid alterations, and the presence of AP did not prove any significant change in CIA and ABI. No significant correlation was established between DMFT and other variables. Conclusions: Results from the current study highlight that the presence of AP may be regarded as a risk indicator for ASCVD, with AP being associated with 5‐fold increased odds of having carotid plaques and 15‐fold increased odds of having marked carotid intima‐media thickenings. Further studies should be conducted in order to verify whether AP treatment could be beneficial for ASCVD signs. [ABSTRACT FROM AUTHOR]

Background: Multidelay arterial spin labeling (ASL) generates time‐resolved perfusion maps, which may provide sufficient and accurate hemodynamic information in carotid stenosis. Purpose: To use imaging markers derived from multidelay ASL magnetic resonance imaging (MRI) and to determine the optimal strategy for predicting cerebral hyperperfusion after carotid endarterectomy (CEA). Study Type: Prospective observational cohort. Subjects: A total of 79 patients who underwent CEA for carotid stenosis. Field Strength/Sequence: A 3.0 T/pseudo‐continuous ASL with three postlabeling delays of 1.0, 1.57, and 2.46 seconds using fast‐spin echo readout. Assessment: Cerebral perfusion pressure, antegrade, and collateral flow were scored on a four‐grade ordinal scale based on preoperative multidelay ASL perfusion maps. Simultaneously, quantitative hemodynamic parameters including cerebral blood flow (CBF), arterial transit time (ATT), relative CBF (rCBF) and relative ATT (rATT; ipsilateral/contralateral values) were calculated. On the CBF ratio map obtained through dividing postoperative by preoperative CBF map, regions of interest were placed covering ipsilateral middle cerebral artery territory. Three neuroradiologists conducted this procedure. Cerebral hyperperfusion was defined as a CBF ratio >2. Statistical Tests: Weighted κ values, independent sample t test, chi‐square test, Mann–Whitney U‐test, multivariable logistic regression analysis, receiver‐operating characteristic curve analysis, and Delong test. Significance level was P < 0.05. Results: Cerebral hyperperfusion was observed in 15 (19%) patients. Higher blood pressure (odd ratio [OR] = 1.08) and carotid near‐occlusion (NO; OR = 7.31) were clinical risk factors for postoperative hyperperfusion. Poor ASL perfusion score (OR = 37.33), decreased CBF (OR = 0.74), prolonged ATT (OR = 1.02), lower rCBF (OR = 0.91), and higher rATT (OR = 1.12) were independent imaging predictors of hyperperfusion. ASL perfusion score exhibited the highest specificity (95.3%), while CBF exhibited the highest sensitivity (93.3%) for the prediction of hyperperfusion. When combined with ASL perfusion score, CBF and ATT, the predictive ability was significantly higher than using blood pressure and NO alone (AUC: 0.98 vs. 0.78). Data Conclusions: Multidelay ASL can accurately predict cerebral hyperperfusion after CEA with high sensitivity and specificity. Evidence Level: 2 Technical Efficacy: Stage 5 [ABSTRACT FROM AUTHOR]

Background and Purpose: Pituitary macroadenomas and meningiomas are common neoplasms arising within the cavernous sinus. Imaging characteristics on MRI can often distinguish these tumors from one another; however, some cases may be more difficult to differentiate. This study compares patterns of cavernous segment internal carotid artery (CS‐ICA) stenosis between the two tumor types to establish a novel radiographic method of differentiation. Methods: A retrospective analysis of patients with pathology‐confirmed meningioma and pituitary adenomas at Tufts Medical Center was performed. The diameter of the CS‐ICA at the narrowest point within the cavernous sinus was measured and compared to the ipsilateral petrous segment ICA and contralateral CS‐ICA. The mean and range of percent stenosis and frequency of cases of CS‐ICA stenosis >15% were determined. Statistical analysis to compare the groups was conducted using the Chi‐squared test, Fisher's exact test, and t‐test. Results: There were a total of 78 out of 231 patients who were included in the study. The mean % ICA stenosis for all meningiomas was 9.3%, with increasing stenosis with increasing World Health Organization grade. Of all meningioma cases, 13 (33%) had greater than 15% ICA stenosis. Mean ICA stenosis for pituitary adenomas was –1.48%. There were no cases of pituitary adenomas causing ICA stenosis >15%. Conclusions: Differentiating pituitary adenomas and intracavernous meningioma tumors can have important implications on surgical approach and outcome. Our study found that stenosis of the CS‐ICA greater than 15% is highly specific to meningiomas and can serve as a radiologic sign to distinguish between these two tumors. [ABSTRACT FROM AUTHOR]

Background and Purpose: Carotid angioplasty and stenting (CAS) could be considered for preventing stroke in patients with carotid artery stenosis. This study aimed to determine the incidence and the risk factors of the early and mid‐term complications associated with CAS. Methods: This is a retrospective cohort study conducted at Shiraz University of Medical Sciences from March 2011 to March 2019. Patients at high risk and standard risk for carotid endarterectomy were included. The primary composite outcome was defined as stroke, myocardial infarction (MI), and death in the first 30 days after CAS. All‐cause mortality, vascular mortality, and stroke were investigated during mid‐term follow‐up. Results: A total of 579 patients (618 CAS) were recruited (mean age: 71.52 years). Overall, 394 (68.40%), 211 (36.63%), 179 (31.07%), and 96 (16.72%) patients had hypertension, dyslipidemia, diabetes mellitus, or were cigarette smokers, respectively. Primary composite outcomes were observed in 2.59% of patients (1.55% stroke, 0.69% MI, and 1.72% death). Atrial fibrillation was a predictor of primary composite outcome in multivariate logistic regression (p =.048). The presence of total occlusion in the contralateral carotid artery was significantly associated with the risk of stroke in univariate logistic regression (p =.041). The patients were followed for a period ranging from 1 to 83 months. The overall survival rate for all‐cause mortality was 93.48% at 1 year, 77.24% at 5 years, and 52.92% at 8 years. All‐cause mortality was significantly higher among patients with symptomatic carotid stenosis (p =.014). Conclusion: CAS provides acceptable short‐term and mid‐term outcomes in a unique population of high‐ and standard‐surgical‐risk, symptomatic and asymptomatic, octogenarian, and nonoctogenarian patients. [ABSTRACT FROM AUTHOR]

Purpose Retinal vascular function was assessed in patients with carotid stenosis (CS) before and six months after carotid endarterectomy (CEA) and in controls at a six‐month interval. Methods: We studied 68 patients (81% male, mean age 69) and 41 healthy non‐medicated controls (77%, 68) from March 2015 to December 2018. Our ophthalmological examination included flicker‐induced arteriolar and venular measurements with a Dynamic Vessel Analyser in both eyes. Results: At baseline, flicker‐induced arteriolar and venular dilation was reduced in the ipsilateral eyes of the patients compared with dilation in the controls (arteriolar 1.0% versus 2.6%, p = 0.001 and venular 2.2% versus 2.8%, p = 0.049). These differences subsided after CEA. In patients' ipsilateral eyes, flicker‐induced arteriolar dilation was borderline postoperatively (preoperative 1.0% versus postoperative 1.6%, p = 0.06), whereas venular dilation increased (2.2% versus 2.8%, p = 0.025). We found various tentative associations with the change in flicker‐induced dilations after CEA, but not with the preoperative dilations. Conclusions: Postoperative recovery of the reduced flicker‐induced arteriolar and venular dilatation in the ipsilateral eye shows that, after CEA, the activity‐dependent vascular reactivity of haemodynamically compromised retinal tissue can improve. [ABSTRACT FROM AUTHOR]

Purpose: We describe hypoperfusion‐related and embolic ocular signs of carotid stenosis (CS) before and six months after carotid endarterectomy (CEA) in a CS population. Methods: We enrolled prospectively 70 CEA patients (81% male, mean age 69) and 41 non‐medicated control subjects (76%, 68), from March 2015 to December 2018, assessing intraocular pressure (IOP), best‐corrected visual acuity (BCVA) in logMAR units and performing a bio‐microscopy examination. Results: Main index symptoms included amaurosis fugax (Afx) (29, 41%) and hemispheric TIA (17, 24%), and 17 (24%) were asymptomatic. Of the 70, 17 patients (24%, 95% CI 16‐36) showed ocular signs of CS. Of four embolic (Hollenhorst plaques) findings, one small macular plaque disappeared postoperatively. Four had hypoperfusion, that is ocular ischaemic syndrome (OIS), requiring panretinal photocoagulation: one for multiple mid‐peripheral haemorrhages, two for iris neovascularization and one for neovascular glaucoma (NVG); only the NVG proved irreversible. Nine (de novo in three) showed mild OIS, that is only few mid‐peripheral haemorrhages, ranging pre‐ /postoperatively in ipsilateral eyes from one to eleven (median two)/ one to two (median one), and in contralateral eyes from three to nine (median five)/ one to six (median three). Pre‐ and postoperative median BCVA was 0 or better, and mean IOP was normal, except in the NVG patient. Temporary visual impairment from 0 to 0.3 occurred in one eye soon after CEA due to ocular hyperperfusion causing macular oedema. Conclusions: Ocular signs of CS are common in CEA patients, ranging from few mid‐peripheral haemorrhages to irreversible NVG. Clinicians should be aware of these signs in detecting CS. [ABSTRACT FROM AUTHOR]

Background: Transient ischemic attack (TIA) is a major risk factor for the occurrence of cerebral infarction (CI). This study aimed to evaluate the predictive value of the synthetic role of miR‐200b‐3p, ABCD2 score, and carotid ultrasound for CI onset in patients with TIA. Methods: Expression of miR‐200b‐3p was detected by reverse transcription quantitative PCR and carotid stenosis degree was evaluated using carotid ultrasound examination. Association of miR‐200b‐3p with ABCD2 scores and carotid stenosis degree was assessed using t‐test and chi‐square test. Logistic regression analysis was used to judge the ability of miR‐200b‐3p, ABCD2 score, and carotid ultrasound to predict the occurrence of CI. Receiver operating characteristic curve was used to analyze the diagnostic value of miR‐200b‐3p and the accuracy of miR‐200b‐3p, ABCD2 score, and carotid ultrasound in predicting CI development. Results: Expression of serum miR‐200b‐3p was significantly increased in TIA patients compared with healthy controls, and had diagnostic value in TIA patients. Serum miR‐200b‐3p was significantly associated with dyslipidemia, ABCD2 score, and carotid stenosis degree in TIA patients. ABCD2 score, carotid stenosis degree, and serum miR‐200b‐3p were independently associated with CI onset, and the synthetic role of these three indicators had the best accuracy in the prediction of CI onset in TIA patients. Conclusion: Serum miR‐200b‐3p expression was increased in TIA patients with considerable diagnostic value to screen TIA cases from healthy controls. Moreover, we speculated that the combination of miR‐200b‐3p, ABCD2 score, and carotid stenosis degree by ultrasound may propose as an efficient predictive strategy for the prediction of CI in TIA patients. [ABSTRACT FROM AUTHOR]

Introduction: Severe internal carotid stenosis, if left untreated, can pose serious risks for ischemic stroke and cognitive impairments. The effects of revascularization on any aspects of cognition, however, are not well understood, as conflicting results are reported, which have mainly been centered on paper‐based cognitive analyses. Here, we summarized and evaluated the publications to date of functional MRI (fMRI) studies that examined the mechanisms of functional brain activation and connectivity as a way to reflect cognitive effects of revascularization on patients with carotid stenosis. Methods: A PubMed and Google Scholar (covering the relevant literature until November 1, 2021) search yielded eight original studies of the research line, including seven resting‐state and one task‐based fMRI reports. Results: Findings demonstrated treatment‐related alterations in fMRI signal intensity and symmetry level, regional fMRI activation pattern, and functional brain network connectivity. The functional brain changes were associated largely with improvement in cognitive function assessed using standard cognitive test scores. Conclusions: These findings support the contribution of fMRI to the understanding of brain functional activation and connectivity changes revealing cognitive effects of revascularization in the management of severe carotid stenosis. The review also highlighted the importance of reproducibility through enhancing experimental designs and cognitive task applications with future research for potential clinical translation. [ABSTRACT FROM AUTHOR]

Background and Purpose: Neutrophil-to-lymphocyte ratio (NLR) has been suggested as an available systemic inflammatory biomarker. This study aims to evaluate whether intraplaque neovascularization assessed by contrast-enhanced ultrasound (CEUS) is associated with NLR in asymptomatic carotid stenosis patients.Materials and Methods: One hundred and forty-four asymptomatic patients with carotid luminal stenosis >30% were assessed using contrast-enhanced ultrasound imaging. The contrast enhancement within the plaque was classified on a visual semiquantitative grading scale. The data collected included the patient's risk factors, laboratory results, cardiovascular disease history, and drug use history. Univariate and multivariate analyses were assessed to identify independent factors related to intraplaque neovascularization with adjustment for potential confounders.Results: Patients with CEUS grade 2 plaques had a higher level of LDL-C (p < .001), neutrophil count (p < .001), and blood glucose (p = .005), but lower level of lymphocyte count (p = .021). The presence of grade 2 plaques was significantly associated with high NLR values (OR 1.21, 95% CI 1.03-1.43, p = .017). Patients were divided into four groups according to the quartile of NLR values. Compared to the patients in the first quartile of NLR (<1.73), the patients in the fourth NLR quartile (≥3.38) were characterized by the most prevalence of CEUS grade 2 plaques (OR 4.55, 95% CI 1.69-12.25, p = .003). Multivariate logistic regression analysis after adjusting various variables demonstrated NLR remained an independent risk factor for the presence of CEUS grade 2 plaques.Conclusion: Intraplaque neovascularization is significantly associated with NLR in asymptomatic carotid stenosis patients. [ABSTRACT FROM AUTHOR]

Alterations in cerebral blood flow are common in several neurological diseases among the elderly including stroke, cerebral small vessel disease, vascular dementia, and Alzheimer's disease. 4D flow magnetic resonance imaging (MRI) is a relatively new technique to investigate cerebrovascular disease, and makes it possible to obtain time‐resolved blood flow measurements of the entire cerebral arterial venous vasculature and can be used to derive a repertoire of hemodynamic biomarkers indicative of cerebrovascular health. The information that can be obtained from one single 4D flow MRI scan allows both the investigation of aberrant flow patterns at a focal location in the vasculature as well as estimations of brain‐wide disturbances in blood flow. Such focal and global hemodynamic biomarkers show the potential of being sensitive to impending cerebrovascular disease and disease progression and can also become useful during planning and follow‐up of interventions aiming to restore a normal cerebral circulation. Here, we describe 4D flow MRI approaches for analyzing the cerebral vasculature. We then survey key hemodynamic biomarkers that can be reliably assessed using the technique. Finally, we highlight cerebrovascular diseases where one or multiple hemodynamic biomarkers are of central interest. [ABSTRACT FROM AUTHOR]

Purpose To assess the consequence of the presence, grade, and asymmetry of carotid artery stenoses on the optic nerve sheath diameter (ONSD) measured by ultrasonography. Methods: ONSD was measured with B‐mode ultrasonography in 129 patients referred for duplex and color Doppler imaging of the carotid arteries. Internal carotid artery stenosis was graded on the basis of peak systolic flow velocity. Results: The mean ONSD was 3.04 ± 0.38 mm in the patients without or with <50% internal carotid artery stenosis and 2.46 ± 0.35 mm in those with >70% stenosis. There was an average difference of 0.58 mm between the ONSD of the patients with <50% and the patients with >70% stenosis. Conclusion: ONSD is lower in patients with carotid artery stenosis. Carotid arteries should be investigated, especially in patients with cardiovascular risk factors or diseases, before interpreting ONSD values. [ABSTRACT FROM AUTHOR]

Purpose: To compare subfoveal choroidal thickness (SFCT) and associated clinical variables in patients with carotid stenosis (CS) before and 6 months after carotid endarterectomy (CEA). Methods: The prospective non‐randomized Helsinki Carotid Endarterectomy Study – Brain and Eye Sub‐sTudy included seventy patients (81% male, mean age 69 years) and 40 control subjects (77% male, 68 years), from March 2015 to December 2018. Ophthalmological examination included SFCT measured with enhanced‐depth imaging‐optical coherence tomography. Carotid stenosis (CS) was more severe (≥70% stenosis in 92%) ipsilateral to the CEA than contralaterally (<50% stenosis in 74%; p < 0.001). Results: At baseline, patients had thinner mean SFCT than control subjects in both eyes (ipsilateral, 222 versus 257 μm and contralateral, 217 versus 258 μm, p ≤ 0.005). At follow‐up, SFCT did not change in ipsi‐ and contralateral eyes compared to baseline in patients (p = 0.68 and p = 0.77), or in control subjects (p = 0.59 and p = 0.79). Patients with coronary artery disease had thinner mean SFCT versus those without it in ipsilateral eyes before CEA (200 versus 233 μm, p = 0.027). In ipsilateral eyes of patients before CEA, thinner SFCT and ocular signs of CS, plaque and hypoperfusion related findings combined, were associated (p = 0.036), and the best‐corrected visual acuity, measured in logMAR, increased with increasing SFCT (r = −0.25; p = 0.046). Conclusions: Subfoveal choroidal thickness (SFCT) is thinner in patients with CS without association between SFCT and the grade of CS. Unchanged SFCT after CEA suggests, that choroidal vessels in severe CS are unable to react to increased blood flow. Bilaterally thin SFCT could be considered as yet another sign of CS. [ABSTRACT FROM AUTHOR]

Background: The incidental use of statins during radiation therapy has been associated with a reduced long-term risk of developing atherosclerotic cardiovascular disease. We examined whether irradiation causes chronic vascular injury and whether short-term administration of statins during and after irradiation is sufficient to prevent chronic injury compared with long-term administration., Methods and Results: C57Bl/6 mice were pretreated with pravastatin for 72 hours and then exposed to 12 Gy X-ray head-and-neck irradiation. Pravastatin was then administered either for an additional 24 hours or for 1 year. Carotid arteries were tested for vascular reactivity, altered gene expression, and collagen deposition 1 year after irradiation. Treatment with pravastatin for 24 hours after irradiation reduced the loss of endothelium-dependent vasorelaxation and protected against enhanced vasoconstriction. Expression of markers associated with inflammation (NFκB p65 [phospho-nuclear factor kappa B p65] and TNF-α [tumor necrosis factor alpha]) and with oxidative stress (NADPH oxidases 2 and 4) were lowered and subunits of the voltage and Ca 2+ activated K + BK channel (potassium calcium-activated channel subfamily M alpha 1 and potassium calcium-activated channel subfamily M regulatory beta subunit 1) in the carotid artery were modulated. Treatment with pravastatin for 1 year after irradiation completely reversed irradiation-induced changes., Conclusions: Short-term administration of pravastatin is sufficient to reduce chronic vascular injury at 1 year after irradiation. Long-term administration eliminates the effects of irradiation. These findings suggest that a prospective treatment strategy involving statins could be effective in patients undergoing radiation therapy. The optimal duration of treatment in humans has yet to be determined.

Extracranial carotid artery stenosis (ECAS) due to the presence of atherosclerotic plaque is a well‐known risk factor for stroke. Several structural imaging studies have investigated the effect of ECAS on the brain, focusing on structural damage (in particular cerebral small vessel disease) and on the rearrangement of the cerebral circulation. For example, it is known from the literature an association between carotid stenosis and cerebral small vessel disease, and it is also noted that a series of compensatory mechanisms are activated by the cerebrovascular system in order to overcome the cerebral hypoperfusion that is induced by the ECAS. Several neurocognitive studies have also investigated the association of ECAS with cognitive deficits. While the evidence tends to favor a direct association between ECAS and cognition, the actual relationship remains controversial. In the last decade, various resting‐state functional connectivity (rs‐fc) magnetic resonance (MR) studies have tried to elucidate the "in vivo" mechanisms underlying the cognitive impairment observed in these patients. Although these studies have been performed on small cohorts of patients without standardized protocols, it is plausible that in the future, such studies will help find early stage markers of cognitive impairment. This could permit an extension of indications for revascularization for the treatment of cognitive impairment in selected patients. The aim of this narrative review is to discuss the current knowledge on the effects of ECAS on brain and cognition by analyzing the main evidence from animal and clinical studies, with a special focus on rs‐fc MR studies. [ABSTRACT FROM AUTHOR]

Objectives: Stroke is a devastating complication following coronary artery bypass grafting, which thankfully occurs with low incidence. The role of preoperative carotid ultrasound remains unclear. Whilst it is a cheap and reliable way of diagnosing carotid stenosis (CS), it is unclear if and how this knowledge should impact on subsequent patient management.Methods: A systematic review of the literature was performed using the PRISMA guideline. A literature search was conducted on the MEDLINE database from 1950 to May 2020 using the OVID interface. Fifteen papers out of a total of 5931 were identified for inclusion.Results: The evidence overall suggests that patients with severe CS are likely to have an increased incidence of postoperative stroke-however, the prevalence of severe CS is low, and even in this cohort of patients, the incidence is not particularly high.Conclusion: In screened patients identified to have severe CS, there appears to be a generally low appetite for undertaking carotid intervention internationally either before or concurrently with the coronary artery bypass grafting. Putting this all together, the widespread screening of asymptomatic patients would appear to not be justified. [ABSTRACT FROM AUTHOR]

Background and purpose: Myeloperoxidase (MPO) is an important oxidative enzyme participating in different stages of cardiovascular disease and predicts prognosis. Little is known about its role in acute cerebrovascular events and carotid plaque vulnerability. In this study, the aim was to assess plasma MPO levels in acute stroke patients and their correlation to stroke severity and stroke outcome. Methods: Plasma MPO levels were assessed in patients presenting with acute brain ischaemia within 36 h of symptom onset (n = 144, mean age 64.7 ± 11.6 years, 67% men) and in patients with moderate‐to‐severe carotid stenosis undergoing carotid artery stenting (n = 51, mean age 66.3 ± 8.4 years, 75% men). Patients presenting with acute brain ischaemia were assessed serially for stroke severity and disability. Results: Plasma MPO concentrations (ng/ml) were associated with interleukin‐6 (r = 0.38, P < 0.0001) and gender (median interquartile range) of 68.6 (49.8–107.0) vs. 59.7 (42.7–85.5) in women vs. men (P = 0.02). In acute brain ischaemia, MPO concentrations were associated with non‐lacunar subtype (bottom, middle and top tertiles 37.5%, 71.7% and 71.7% respectively; P = 0.001), with stroke severity (baseline National Institutes of Health Stroke Scale score > 10, bottom, middle and top tertiles 6.3%, vs. 41.7% and 31.3%, respectively; P < 0.006) as well as with stroke severity at days 1–2, days 4–5 and at discharge (P < 0.05 for all), but less with disability at discharge (modified Rankin Scale score ≥ 2, 41.7% vs. 60.4% and 58.7% for the bottom, middle and top tertiles, respectively; P = 0.096). Conclusions: Amongst patients with acute brain ischaemia, plasma MPO concentrations were associated with stroke severity and non‐lacunar subtype, but not with long‐term functional disability. [ABSTRACT FROM AUTHOR]

Introduction: Limb‐shaking transient ischemic attack (LS‐TIA) is a clinical disease with severe carotid stenosis, which is characterized by unilateral rhythmic dance or tremor like involuntary movements of arms and/or legs, but facial muscles are usually unaffected. Methods: Today, we report a 42‐year‐old man with transient ischemic attack who suffered from right limb shaking and right facial muscle twitching due to the obvious stenosis of left internal carotid artery (ICA). Written informed consent was obtained from participants according to the Declaration of Helsinki, and a local ethic committee approved the study. ICA angioplasty and stent implantation were performed as treatment attempts. A brain protection device was navigated through the lesion and placed at the distal end of the stenosis. Result: The patient successfully completed the recanalization through stent placement, and the involuntary shaking of limbs and face was improved. During the 3‐month follow‐up, the patient's symptoms disappeared completely and did not attack again. Conclusion: This case report highlights the importance of accurate diagnosis and treatment, because treatment‐related carotid artery occlusion can not only eliminate the attack, but also reduce the risk of future stroke. [ABSTRACT FROM AUTHOR]

Background and purpose: Plaque neovascularization is a hallmark of carotid plaque vulnerability. With contrast‐enhanced ultrasound (CEUS) it is possible to visualize plaque neovessels in vivo. Our aim was to determine if CEUS‐detected neovessels were associated with stroke recurrences in patients with a recent stroke and carotid atherosclerosis. Methods: We conducted a prospective study of consecutive patients with a recent stroke and at least one atherosclerotic plaque in the internal carotid artery on the side consistent with symptoms. All of our patients underwent a carotid ultrasound examination including a CEUS study. Neovascularization was graded into three categories according to the extent of neovessels. During the follow‐up, we recorded stroke recurrences. A multivariable Cox regression analysis was performed to evaluate predictors of recurrence. Results: We included 78 patients whose mean age was 74.3 ± 10.4 years. There were 29 (37.2%) patients with a low‐grade stenosis (<50%). The remainder presented moderate (50%–69%) or high‐grade (≥70%) stenosis. CEUS was not interpretable in 35.9% of the patients, mainly due to calcium shadows. We detected neovascularization in 80% of the plaques. After a median follow‐up of 14.1 (interquartile range, 9.5‐19.6) months, there were 15 (19.2%) stroke recurrences. In the Cox regression analysis, CEUS‐detected neovascularization was independently associated with the risk of stroke recurrence, even after adjusting for the degree of stenosis (hazard ratio, 6.57; 95% confidence interval, 1.66–26.01). Conclusion: In patients with an anterior circulation ischaemic stroke and carotid atherosclerosis, plaque neovascularization detected with CEUS was an independent predictor of stroke recurrence. [ABSTRACT FROM AUTHOR]

Background: Radiation to the head and neck is a well‐established risk factor for the development of carotid artery stenosis. Our objective was to identify the prevalence, incidence, and degree of carotid stenosis in patients with a history of head and neck irradiation. Methods: This study was performed according to the PRISMA guidelines. A random effects model meta‐analysis was conducted. Results: Nineteen studies comprising 1479 patients were included. The prevalence of carotid stenosis >50%, >70%, and carotid occlusion was 25% (95% CI: 19%‐32%), 12% (95% CI: 7%‐17%), and 4% (95% CI: 2%‐8%), respectively. The cumulative 12‐month incidence of carotid stenosis >50% was 4% (95% CI: 2%‐5%), the 24‐month was 12% (95% CI: 9%‐15%), and the 36‐month was 21% (95% CI: 9%‐36%). Conclusions: The yearly incidence of carotid stenosis >50% increased every year during the first 3 years following radiotherapy. We propose routine yearly Doppler ultrasound screening beginning 1 year after head and neck radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Adenosine A3 receptor (ADORA3) belongs to the adenosine receptor families and the role of ADORA3 in vascular dementia (VaD) is largely unexplored. The present study sought to determine the therapeutic role of ADORA3 antagonist in a mouse model of VaD., Methods: The GSE122063 dataset was selected to screen the differential expression genes and pathways between VaD patients and controls. A mouse model of bilateral carotid artery stenosis (BCAS) was established. The cognitive functions were examined by the novel object recognition test, Y maze test, and fear of conditioning test. The white matter injury (WMI) was examined by 9.4 T MRI, western blot, and immunofluorescence staining. The mechanisms of ADORA3-regulated phagocytosis by microglia were examined using qPCR, western blot, dual immunofluorescence staining, and flow cytometry., Results: The expression of ADORA3 was elevated in brain tissues of VaD patients and ADORA3 was indicated as a key gene for VaD in the GSE122063. In BCAS mice, the expression of ADORA3 was predominantly elevated in microglia in the corpus callosum. ADORA3 antagonist promotes microglial phagocytosis to myelin debris by facilitating cAMP/PKA/p-CREB pathway and thereby ameliorates WMI and cognitive impairment in BCAS mice. The therapeutic effect of ADORA3 antagonist was partially reversed by the inhibition of the cAMP/PKA pathway., Conclusions: ADORA3 antagonist alleviates chronic ischemic WMI by modulating myelin clearance of microglia, which may be a potential therapeutic target for the treatment of VaD., (© 2024 The Authors. CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.)

Objectives: The peak systolic velocity (PSV) and end‐diastolic velocity (EDV) obtained by carotid duplex ultrasound (CDU) imaging of the internal carotid arteries (ICAs) are parameters used to determine the severity of ICA stenosis. Severe aortic stenosis (AS) results in a parvus‐et‐tardus pattern on spectral Doppler waveforms; however, the impact of severe AS on CDU velocities is unclear. The purpose of this study was to assess the impact of severe AS on CDU velocities by evaluating changes in CDU velocities before and after aortic valve replacement (AVR) Methods: A single‐center retrospective review of patients with severe AS who underwent surgical AVR and who had preoperative and postoperative CDU examinations performed within 12 months of each other was conducted. Patients with any carotid intervention between the preoperative and postoperative CDU were excluded. Results: We identified 92 patients who satisfied all inclusion criteria. The mean age was 72.2 years; 71.7% were men; the mean preoperative aortic valve area ± SD was 0.8 ± 0.2 cm2; and the mean time from preoperative to postoperative AVR CDU was 182.3 ± 98.4 days. The peak aortic valve gradient decreased from 62.5 to 22.0 mm Hg after AVR (P <.001); however, there were no significant changes in the PSV or EDV in either the right or left ICA. Conclusions: Although severe AS may cause characteristic changes in the spectral Doppler waveform on CDU imaging, there is no significant effect on the ICA PSV or EDV. Adjustments in velocity criteria to determine the degree of carotid artery stenosis in patients with substantial AS may not be necessary. [ABSTRACT FROM AUTHOR]

Objectives: We compared internal carotid artery Doppler peak systolic velocities (PSVs) measured with angle correction parallel to the artery wall (// wall) on grayscale images and parallel to the direction of blood flow (// flow) on color Doppler images. Methods: We studied 25 internal carotid lesions with PSVs higher than 125 cm/s. The PSVs were measured in the same imaging plane, at the stenosis orifice (0 cm) and at 0.5 and 1 cm downstream by both methods. Linear regression and correlation analyses were used to study the effects of the angle correction method on changes in PSVs as a function of the differences in angle adjustment and distance from the stenosis. Results: The 23 patients studied included 9 women and 14 men. There was a mean difference in absolute PSVs ± SD of −17.2 ± 29.5 cm/s (P < .008) between methods at the stenosis. The difference in the PSVs was associated with the angle difference between the flow jet and the artery wall (P < .01). At 1 cm from the stenosis, // flow PSVs were more strongly correlated with PSVs at the stenosis (r = 0.61; 95% confidence interval, 0.28, 0.82; P =.001) than // wall PSVs (r = 0.39; 95% confidence interval, –0.003, 0.68; P =.052). Conclusions: Blood flow velocity measurements made with angle correction parallel to the direction of the color Doppler blood flow lumen remain more consistent with the distance from the stenosis than blood flow velocity measurements made with angle correction parallel to the outer artery walls. [ABSTRACT FROM AUTHOR]

Background and purpose: The risk of recurrent stroke amongst patients with symptomatic carotid near‐occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24‐month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. Methods: A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography‐confirmed SCNO were included. The primary end‐point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. Results: The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24‐month cumulative incidence of the primary end‐point was 11.1% (95% confidence interval 5.8–16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log‐rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. Conclusions: The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near‐occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure. [ABSTRACT FROM AUTHOR]

Background: The coexistence of coronary artery disease (CAD) in patients undergoing coronary artery bypass surgery (CABG) is a risk factor for stroke and death. The aim of this study is to evaluate the potential of the SYNTAX score (SXscore) for predicting carotid stenosis in patients undergoing CABG.Methods: We retrospectively reviewed 291 patients (225 males, mean age 60.5 ± 8.5 years) who underwent CABG in a single center in 2014 and were screened for carotid artery preoperatively. The total SXscore was obtained by scoring every luminal narrowing greater than 50% in coronary vessels larger than 1.5 mm using the SXscore algorithm. Correlations between the severity of carotid stenosis and SXscore were analyzed.Results: As the degree of carotid artery stenosis increases (≤%50; ≥%50 vs ≥%70), the mean SXscore (19.06 ± 7.72, P > 0,05; 28.40 ± 6.89, P < 0,01; 31.02 ± 7.04, P < 0.01, respectively) were found to increase. Receiver operating characteristic analysis revealed a cut-off point of 27 or more in SXscore according to the presence of carotid stenosis greater than or equal to %70. The risk of existence of significant carotid stenosis was 58-fold greater in cases with SXscore greater than or equal to 27. In cases with SXscore greater than or equal to 27, the risk of existence of significant carotid stenosis was 58-fold greater with a confidence interval of 95%. Moreover, the presence of left main CAD was associated with the severity of carotid stenosis (<50% carotid stenosis, P > 0.05; ≥%50, P = 0.001; and ≥70, P = 0.001).Conclusion: This study suggests that the presence of left main coronary artery disease or SXscore greater than or equal to 27 should require preoperative carotid screening in patients undergoing CABG, regardless of the presence of risk factors. [ABSTRACT FROM AUTHOR]

Background: Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large‐volume stroke centre. Methods: All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome. Results: There were 510 CEAs performed during 2004–2014 and 95 CASs during 2003–2008. The proportion of patients undergoing CEA compared to CAS increased from 60% to 90% from 2004 to 2008 (P < 0.001). CAS patients were more likely to have cardiac co‐morbidities. From 2004 to 2014, the proportion of CEA patients aged ≥80 years increased (P = 0.001) and the proportion of asymptomatic patients decreased (P = 0.003) over time. Median time from symptom onset to surgery decreased from 52 days (Q1: 25, Q3: 74) in 2004 to 8 days (Q1: 5, Q3: 37) in 2014 (P < 0.001). Use of preoperative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (P < 0.001). Overall, 5.9% of CEAs were complicated by death, stroke or acute myocardial infarction with no significant change over time. Conclusion: The trends in CEA practice at our centre align with international trends and guidelines. This study provides a representative indicator of Australian hospital practice, and illustrates how evidence from research is translated into clinical care. [ABSTRACT FROM AUTHOR]

It is unclear whether incidental carotid artery calcification (CAC) on radiographs has a defined relationship to clinically significant carotid artery stenosis, and therefore risk of stroke. The primary objective of this study was to ascertain the relationship between dental radiograph detected carotid calcification and carotid artery stenoses ≥50% on carotid duplex ultrasound. We carried out an observational study of patients undergoing routine dental orthopantomogram (OPG) examinations. Consecutive patients with CAC on OPG were prospectively matched to those without CAC based on age and gender. Ultrasound of the carotid arteries was performed to determine the presence of stenosis (≥50%) in either vessel. Of 5780 consecutive OPG examinations with suitable images for analysis, CAC was detected in 10.8%. A total of 233 patients underwent carotid ultrasound (130 with and 103 without CAC on OPG). The prevalence of a clinically significant (≥50%) carotid stenosis on ultrasound was 15.4% (20/130) in those with CAC and 5.8% (6/103) for those without CAC on OPG. Incidental CAC detected on routine OPG requires both radiological reporting and clinical follow-up since 1 in 7 patients will have a clinically significant carotid artery stenosis as compared with 1 in 20 patients who do not have CAC. Trial Registration: Australian and New Zealand Clinical Trials Registry website (U1111-1148-1066). http://www.ANZCTR.org.au/ACTRN12613001038785.aspx. [ABSTRACT FROM AUTHOR]

Background: The utility of screening for the degree of common carotid artery (CCA) stenosis as a predictor of cardiovascular disease (CVD) in a general population remains unclear., Methods and Results: We studied 4775 Japanese men and women whose CCA was measured using bilateral carotid ultrasonography at baseline (April 1994-August 2001). We calculated the degree of stenosis as a percentage of the stenotic area of the lumen in the cross-section perpendicular to the long axis. The Cox proportional hazards model was used to calculate multivariable-adjusted hazard ratios (HRs) with 95% CIs for incident CVD and its subtypes according to the degree of CCA stenosis. During the median 14.2 years of follow-up, 385 incident CVD events (159 coronary heart disease and 226 stroke) were documented. The degree of CCA stenosis was associated with increased risks of incident CVD, coronary heart disease, and stroke, with multivariable-adjusted HRs (95% CIs) for <25%, 25%-49%, and ≥50% stenosis with plaque compared with no CCA plaque of 1.37 (1.07-1.76), 1.72 (1.23-2.40), and 2.49 (1.69-3.67), respectively. Adding the CCA stenosis degree to traditional CVD risk factors increased Harrell's C statistics (0.772 [95% CI, 0.751-0.794] to 0.778 [95% CI, 0.758-0.799]; P =0.04) and improved the 10-year risk prediction ability (integrated discrimination improvement, 0.0129 [95% CI, 0.0078-0.0179]; P <0.001; continuous net reclassification improvement, 0.1598 [95% CI, 0.0297-0.2881]; P =0.01)., Conclusions: The degree of CCA stenosis may be used as a predictive marker for the development of CVD in the general population.

Introduction: Gautier et al. demonstrated that a compression in the left paratracheal region (left paratracheal pressure, LPP) can be used to seal the oesophagus. However, at this level, the left common carotid artery is very close to the carotid that could be affected during the manipulation. This study aimed to assess the hemodynamic effects of LPP on the carotid blood flow., Methods: We prospectively included 47 healthy adult volunteers. We excluded pregnant women and people with anomalies of the carotid arteries. The common and internal carotid arteries were preliminarily studied with ultrasounds to exclude atheromatous plaques or vascular malformation. A planimetry of the common and internal carotid arteries was performed. Doppler echography served to measure the peak systolic (PSV) and end-diastolic velocities (EDV) in the common and internal carotid arteries. All measurements were repeated while applying LPP., Results: Forty-seven participants were enrolled (32 women; mean [SD] age: 42 [13] years). The mean PSV difference [95% CI] in the left common carotid artery before and after LPP at the group level was -15.30 [-31.09 to 0.48] cm s -1 (p = .14). The mean surface difference [95% CI] in the left common carotid artery before and after LPP was 24.52 [6.11-42.92] mm 2 (p = .11). Similarly, the same surface at the level of the left internal carotid artery changed by -18.89 [-51.59 to 13.80] mm 2 after LPP (p = .58)., Conclusions: Our results suggest that LPP does not have a significant effect on carotid blood flow in individuals without a carotid pathology. However, the safety of the manoeuvre should be evaluated in patients at risk of carotid anomalies., (© 2023 Acta Anaesthesiologica Scandinavica Foundation.)

Following cardiac disease and cancer, stroke continues to be the third leading cause of death and disability due to chronic disease in the developed world. Appropriate screening tools are integral to early detection and prevention of major cardiovascular events. In a carotid artery, the presence of increased intima‐media thickness, plaque, or stenosis is associated with increased risk of a transient ischemic attack or a stroke. Carotid artery ultrasound remains a long‐standing and reliable tool in the current armamentarium of diagnostic modalities used to assess vascular morbidity at an early stage. The procedure has, over the last two decades, undergone considerable upgrades in technology, approach, and utility. This review examines in detail the current state and usage of this integrally important means of extracranial cerebrovascular assessment. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine the incidences and rates of progression of varying degrees of carotid stenosis that do not require intervention according to the Asymptomatic Carotid Atherosclerosis Study, the European Carotid Surgery Trial, and the North American Symptomatic Carotid Endarterectomy Trial, and from this information, to provide evidence‐based recommendations for follow‐up imaging. Methods: A retrospective review was performed of all carotid ultrasound examinations performed at a single institution from January 1995 through April 2015. Examinations following endarterectomy or stenting were excluded. Stenoses were classified by a modification of the criteria of Bluth et al (Radiographics 1988; 8:487–506). A Kaplan‐Meier survival analysis was performed for stenosis progression and to provide information for follow‐up recommendations. Results: Most of the carotid arteries (91.6%) reviewed for this study showed 1% to 39% stenosis. However, only 6.8% of carotid arteries with 1% to 39% stenosis progressed compared to 38.9% of carotid arteries with 40% to 59% stenosis. A table of evidence‐based follow‐up recommendations is provided for patients with varying levels of stenosis. Conclusions: We provide evidence‐based follow‐up recommendations for patients who have low degrees of carotid stenosis. Different degrees of carotid stenosis progress at different rates and therefore should be followed at different intervals. Additionally, the most patients in our database showed 1% to 39% stenosis and did not have any follow‐up imaging, suggesting that carotid ultrasound may not be overused for low degrees of stenosis. [ABSTRACT FROM AUTHOR]

Objective Few data exist comparing the image quality and diagnostic accuracy of subtraction computed tomography ( CT) angiography ( SCTA) in carotid and cerebrovascular arteries with routine CT angiography ( RCTA). Patients and methods In this study, 56 patients underwent 128-row CT angiography of these vessels with review by two radiologists using routine, nonsubtracted, and SCTA protocols. Comparisons were made using a 4-point subjective rating scale in all patients. Eighteen patients were examined with both SCTA and invasive digital subtraction angiography ( DSA). The accuracy of SCTA and routine CTA reformations was assessed and compared by both patient-based and vessel-based analyses of intracranial aneurysms and intracranial and extracranial arterial stenotic lesions using DSA results as the reference standard. Results Diagnostic accuracy in the adjacent skull base portion of the internal carotid artery ( ICA) and reading time for cerebral aneurysms and vessel stenoses were obviously improved with SCTA protocol, but the accuracy in vertebro-basilar arteries was no different. The diagnostic accuracy in general was slightly increased compared with routine CTA. Conclusion Review of SCTA images is an effective means to remove bone close to vessels as seen on routine CTA and has good image quality and diagnostic accuracy. SCTA is superior to routine CTA in the visualization and diagnostic accuracy of adjacent skull base part of the ICA and decreases reading time for carotid and cerebrovascular arterial imaging. [ABSTRACT FROM AUTHOR]

Background& Purpose: Abnormalities in apparent diffusion coefficient (ADC), fractional anisotropy (FA), and mean diffusivity (MD) values can be used to assess microstructural damage to white matter tracts and could represent a quantitative marker of chronic ischemia and thereby potentially serve as a stroke risk factor or a measure of existing subclinical ischemic disease burden. We performed a systematic review and 3 separate meta-analyses to evaluate the association between unilateral carotid steno-occlusion and ipsilateral ADC, FA, or MD abnormality.Materials& Methods: A comprehensive literature search evaluating the association of carotid disease and quantitative white matter diffusion imaging was performed. The included studies examined patients for ADC, FA, and MD values ipsilateral and contralateral to the site of carotid artery disease. Three meta-analyses using standardized mean differences with assessment of study heterogeneity were performed.Results: Of the 2,920 manuscripts screened, 6 met eligibility for meta-analysis. Of the included manuscripts, 2 studied ADC values, 6 studied FA values, and 2 studied MD values. Our 3 meta-analyses showed standardized mean difference for ADC, FA, and MD values between cerebral hemispheres ipsilateral and contralateral to carotid artery disease site as 1.13 (95% CI: .79-1.47, P < .001), -.42 (95% CI: -.62 to -.21, P < .001), and .23 (95% CI: -.32 to -.77, P = .41), respectively. Measures of heterogeneity showed mild heterogeneity in the 3 meta-analyses.Conclusion: Carotid artery disease is associated with significant ADC and FA value changes, suggesting that carotid disease is associated with quantifiable white matter microstructural damage. [ABSTRACT FROM AUTHOR]

The accuracy of duplex ultrasound for grading of internal carotid artery stenosis has been widely tested and shown to be high. However, different methods for measurement of the degree of carotid stenosis with the golden standard conventional angiography have been used in the different studies. This, together with other factors, has led to some confusion regarding the relation between the ultrasonographically measured flow velocity and the angiographically measured degree of stenosis. The ultrasound criteria that are used in Sweden (and in Germany) differ in an important way from the criteria recommended in North America and the United Kingdom for the same degree of angiographic stenoses. Possible reasons for the discrepancies are discussed in this article. The authors recommend absolute agreement locally whether ECST or NASCET criteria shall be used in the communication between radiologists, clinical physiologists, vascular surgeons, neurologists and other physicians involved in patient management decisions. Angle-dependent ultrasound criteria should be used and flow velocity measurements with ultrasound should be combined with assessment of plaque burden on 2 D picture. [ABSTRACT FROM AUTHOR]

While brain connectivity analyses have been demonstrated to identify ill patients for a number of diseases, their ability to predict cognitive impairment after brain injury is not well established. Traditional post brain injury models, such as stroke, are limited for this evaluation because pre-injury brain connectivity patterns are infrequently available. Patients with severe carotid stenosis, in contrast, often undergo non-emergent revascularization surgery, allowing the collection of pre and post-operative imaging, may experience brain insult due to perioperative thrombotic/embolic infarcts or hypoperfusion, and can suffer post-operative cognitive decline. We hypothesized that a distributed function such as memory would be more resilient in patients with brains demonstrating higher degrees of modularity. To test this hypothesis, we analyzed preoperative structural connectivity graphs (using T1 and DWI MRI) for 34 patients that underwent carotid intervention, and evaluated differences in graph metrics using the Brain Connectivity Toolbox. We found that patients with lower binary component number, binary community number and weighted community number prior to surgery were at greater risk for developing cognitive decline. These findings highlight the promise of brain connectivity analyses to predict cognitive decline following brain injury and serve as a clinical decision support tool. Hum Brain Mapp 37:2185-2194, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background The origins of sex differences in cardiovascular diseases are not well understood. We examined the contribution of childhood risk factors to sex differences in adult carotid artery plaques and intima-media thickness (carotid IMT). Methods and Results Children in the 1985 Australian Schools Health and Fitness Survey were followed up when they were aged 36 to 49 years (2014-19, n=1085-1281). Log binomial and linear regression examined sex differences in adult carotid plaques (n=1089) or carotid IMT (n=1283). Childhood sociodemographic, psychosocial, and biomedical risk factors that might contribute to sex differences in carotid IMT/plaques were examined using purposeful model building with additional adjustment for equivalent adult risk factors in sensitivity analyses. Women less often had carotid plaques (10%) than men (17%). The sex difference in the prevalence of plaques (relative risk [RR] unadjusted 0.59 [95% CI, 0.43 to 0.80]) was reduced by adjustment for childhood school achievement and systolic blood pressure (RR adjusted 0.65 [95% CI, 0.47 to 0.90]). Additional adjustment for adult education and systolic blood pressure further reduced sex difference (RR adjusted 0.72 [95% CI, 0.49 to 1.06]). Women (mean±SD 0.61±0.07) had thinner carotid IMT than men (mean±SD 0.66±0.09). The sex difference in carotid IMT (β unadjusted -0.051 [95% CI, -0.061 to -0.042]) reduced with adjustment for childhood waist circumference and systolic blood pressure (β adjusted -0.047 [95% CI, -0.057 to -0.037]) and further reduced with adjustment for adult waist circumference and systolic blood pressure (β adjusted -0.034 [95% CI, -0.048 to -0.019]). Conclusions Some childhood factors contributed to adult sex differences in plaques and carotid IMT. Prevention strategies across the life course are important to reduce adult sex differences in cardiovascular diseases.

Background and purpose: The possible association between carotid stenosis and cognitive impairment in the Chinese population has been rarely investigated. The association between the severity of carotid stenosis and cognitive impairment amongst older Chinese people living in a rural area was assessed. Methods: This cross-sectional study included 1375 participants (age =60 years) from the Confucius Hometown Aging Project in Shandong. In 2010-2011, data were collected through interviews and clinical examinations. Carotid stenosis was assessed using ultrasonography. Cognitive impairment was defined according to the education-specific cutoff scores of the Mini-Mental State Examination. Data were analyzed using multinomial logistic models. Results: The overall prevalence was 7.0% for moderate carotid stenosis, 2.0% for severe stenosis and 6.0% for cognitive impairment. The multi-adjusted odds ratio of cognitive impairment was 1.43 (95% confidence interval 0.63- 3.22) for moderate carotid stenosis and 3.75 (1.24-11.40) for severe carotid stenosis (Ptrend = 0.023). Similar results were obtained in people without a history of cerebrovascular disease. Conclusions: Severe carotid stenosis, even asymptomatic, is associated with cognitive impairment independent of atherosclerotic risk factors and disorders amongst older Chinese people. [ABSTRACT FROM AUTHOR]

Purpose: Duplex ultrasound is the first-line mode of investigation for carotid stenosis, whose severity could be graded according to NASCET or St. Mary's ratio criteria. The aim of this study was to compare these two methods and review the literature.Methods: All patients who had carotid duplex ultrasound in a 1-month period were included. The reports and images were retrospectively reviewed, and the grade of carotid artery stenosis was then recalculated using the St. Mary's Ratio.Results: A total of 245 (160 men) patients with a mean age 70.4 years (±11.5) were assessed, and 469 extracranial carotid systems were analyzed. Pearson's Coefficient revealed strong correlation (r = 0.79, p = 0.05) between the two methods. In 114 (24.3%) internal carotid arteries, results were different. Of these, 26 (22.8%) would have gone for surgery had they been assessed using the St. Mary's Ratio and not the NASCET grading criteria. Conversely, two internal carotid arteries (1.75%) went for surgery using the NASCET grading criteria that would not have had to should the St. Mary's Ratio been used.Conclusions: Although there is a strong level of correlation between the two criteria, choosing one or the other would have a significant impact on the patient' selection for surgery. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND AND PURPOSE Cerebral vasomotor reserve (VMR) is the capability of cerebral arterioles to change their diameter in response to various stimuli, such hypercapnia. Changes of VMR due to transcranial direct current stimulation (tDCS) have been poorly studied. METHODS Twenty-five healthy subjects underwent anodal/cathodal and sham tDCS on right primary motor area. Before and after tDCS, we assessed VMR by Transcranial Color-Coded Sonography (TCCS) calculating trought Breath Holding Index (BHI) and Heart Rate Variability (HRV), in particular after Valsalva manouver. RESULTS A-tDCS decreased VMR and BHI (p < 0.05), whereas C-tDCS increased VMR, and BHI (p < 0.05); Sham doesn't provide statistically significant of both VMR, BHI and HRV (p > 0.05). CONCLUSIONS Our study confirms that tDCS induces a modification of bilateral VMR with a polarity-specific effect; based on this bilateral MFV and BHI modifications, we can speculate an involvement of the SNS in the VMR regulation. [ABSTRACT FROM AUTHOR]

Background The risk of early stroke recurrence amongst patients with symptomatic carotid near-occlusion with and without full collapse is unknown. Therefore, the aim of this study was to analyse the 90-day risk of recurrent ipsilateral ischaemic stroke in patients with symptomatic carotid near-occlusion both with and without full collapse. Methods This study was a secondary analysis of the Additional Neurological SYmptoms before Surgery of the Carotid Arteries: a Prospective study ( ANSYSCAP). We prospectively analysed 230 consecutive patients with symptomatic 50-99% carotid stenosis or near-occlusion. Based on the combination of several imaging modalities, 205 (89%) patients were classified as having 50-99% carotid stenosis, and 10 (4%) and 15 (7%) as having near-occlusion with and without full collapse, respectively. The 90-day risk of recurrent ipsilateral ischaemic stroke was compared between these three groups. Only events that occurred before carotid endarterectomy were analysed. Results The 90-day risk of recurrent stroke was 18% [95% confidence interval ( CI) 12-25%; n = 29] for patients with 50-99% carotid stenosis, 0% for patients with near-occlusion without full collapse and 43% (95% CI 25-89%; n = 4) for patients with near-occlusion with full collapse ( P = 0.035, log-rank test). The increased risk of recurrent ipsilateral ischaemic stroke for patients with symptomatic near-occlusion with full collapse remained significant after multivariable adjustment for age, sex and type of presenting event. Conclusions Patients with symptomatic carotid near-occlusion with full collapse might have a very high risk of stroke recurrence. Carotid endarterectomy could be considered for these patients. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND AND PURPOSE Multipurpose ultrasound probes combined with ultra-mobile ultrasound instrumentation have the potential to increase the availability and use of ultrasound examinations in the assessment of atherosclerotic burden and cardiac disease. The aim of this study was to compare the agreement of a newly developed multipurpose probe to a standard linear carotid probe in detection of atherosclerosis of the precerebral arteries. METHODS We examined 103 patients with a multipurpose probe (General Electric, G9L MPP-9 MHz) and a standard linear probe (General Electric, Vivid 7-M12L-14 MHz). Measurements included intima-media thickness (IMT) in the common carotid arteries (CCA), carotid bifurcations (BIF), internal carotid arteries (ICA), and detection of carotid plaques and stenoses. RESULTS We found a significant level of agreement between the two probes for all IMT measurements with intraclass correlation coefficients (ICC) of: left CCA .91, left BIF .68, left ICA .75, right CCA .84, right BIF .74, and right ICA .59. Agreement with regard to carotid plaque and stenosis detection had kappa values of .94 and .93. CONCLUSION The multipurpose probe showed agreement with a standard linear probe in detecting atherosclerosis of the carotid arteries and has therefore the potential for use in both cardiac and precerebral ultrasound examinations. [ABSTRACT FROM AUTHOR]

Background and purpose The association between vascular risk factors and dementia is of interest. Several studies have shown that cerebral small vessel disease ( SVD) is associated with dementia. However, the association between cerebral large vessel disease ( LVD) and dementia has not been thoroughly examined. Methods The Osaka Follow-up Study for Carotid Atherosclerosis, Part 2, was a prospective cohort study of cardiovascular events and dementia in which patients ( n = 1106) with vascular risk factors underwent carotid ultrasound. Of these patients, 600 who had normal cognitive function were included and underwent brain magnetic resonance imaging. The presence of lacunar infarction and carotid stenosis served as markers for SVD and LVD, respectively. Results Amongst 600 patients (mean 68 years, 57% men), 261 (44%) showed lacunar infarction and 94 (16%) showed carotid stenosis. During the follow-up period (median 8.0 years), 57 patients had incident dementia. Patients with carotid stenosis and lacunar infarction were significantly more likely to be diagnosed with dementia (log-rank test, P = 0.037 and P < 0.001, respectively). The association between lacunar infarction and dementia remained significant after adjusting for risk factors including stroke history, apolipoprotein E genotype and years of education (hazard ratio 2.64, 95% confidence interval 1.22-6.09). However, the presence of carotid stenosis was not associated with incident dementia after adjusting for age and sex ( P = 0.477). Conclusions This study demonstrated that carotid stenosis had little association with dementia, but lacunar infarction had a significant association. The impact of SVD on dementia could be much greater than that of LVD. [ABSTRACT FROM AUTHOR]

Background and purpose von Willebrand factor propeptide ( VWF: Ag II) is potentially a more sensitive marker of acute endothelial activation than von Willebrand factor antigen ( VWF:Ag). These biomarkers have not been simultaneously assessed in asymptomatic versus symptomatic carotid stenosis patients. The relationship between endothelial activation and cerebral microembolic signals ( MESs) detected on transcranial Doppler ultrasound is unknown. Methods In this multicentre observational analytical study, plasma VWF:Ag and VWF: Ag II levels in patients with ≥50% asymptomatic carotid stenosis were compared with those from patients with ≥50% symptomatic carotid stenosis in the 'early' (≤4 weeks) and 'late' (≥3 months) phases after transient ischaemic attack or ischaemic stroke. Endothelial activation was also longitudinally assessed in symptomatic patients during follow-up. Transcranial Doppler ultrasound monitoring classified patients as MES-positive or MES-negative. Results Data from 31 asymptomatic patients were compared with those from 46 early symptomatic and 35 late phase symptomatic carotid stenosis patients, 23 of whom had undergone carotid intervention. VWF: Ag II levels were higher in early (12.8 μg/ml; P < 0.001), late (10.6 μg/ml; P = 0.01) and late post-intervention (10.6 μg/ml; P = 0.038) symptomatic patients than asymptomatic patients (8.9 μg/ml). VWF:Ag levels decreased in symptomatic patients followed up from the early to late phase after symptom onset ( P = 0.048). Early symptomatic MES-negative patients had higher VWF: Ag II levels (13.3 vs. 9.0 μg/ml; P < 0.001) than asymptomatic MES-negative patients. Conclusions Endothelial activation is enhanced in symptomatic versus asymptomatic carotid stenosis patients, in early symptomatic versus asymptomatic MES-negative patients, and decreases over time in symptomatic patients. VWF: Ag II levels are a more sensitive marker of endothelial activation than VWF:Ag levels in carotid stenosis. The potential value of endothelial biomarkers and concurrent cerebral MES detection at predicting stroke risk in carotid stenosis warrants further study. [ABSTRACT FROM AUTHOR]

Objectives Nationwide practice patterns during the implementation of novel technology, such as carotid angioplasty and stenting ( CAS) and embolic protection devices ( EPD), and the clinical impact thereof have received less attention. Methods The Nationwide Inpatient Sample, constituting a 20% representative sample of non-federal US hospitals, was analyzed from years 1998 to 2007. Hospital outcome was stratified into in-hospital mortality ( IHM), long-term facility discharge, and home/ short-term facility discharge ( HSF). Results Discharge outcome improved for CAS over the decade. However, this improvement occurred in two phases with a period of worsening (2003-2005) in between. During this transition period, the risk of IHM following CAS was increased ( RR 1.29-2.43) and was lower for good outcome ( HSF: RR 0.97-0.99) when compared with 2002/2003. During the same transition period, carotid endarterectomy ( CEA) was associated with a lower risk of IHM ( RR 0.75-1.00), but also a lower risk of HSF ( RR 0.98-0.99). Conclusions The results lead to the hypothesis that the nationwide introduction of CAS- EPD may have been associated with temporary increases in in-hospital mortality and discharge morbidity. If such 'clinical opportunity costs' exist with the widespread introduction and adoption of new medical technology with proven efficacy in randomized trials, effective mechanisms are needed for mitigation or prevention during the transition period. [ABSTRACT FROM AUTHOR]

Objectives The goals of the study were to assess US nationwide trends in hospital outcome following carotid endarterectomy ( CEA) and carotid angioplasty and stenting ( CAS) and to determine potential predictors of outcome. Methods The Nationwide Inpatient Sample, constituting a 20% representative and stratified sample of non-federal US hospitals, was analyzed retrospectively from years 1998 to 2007. Results The annual number of CEA decreased (137,877-111,658) and increased for CAS (2318-14,415). Inhospital mortality following CEA decreased from 0.4% to 0.3% ( P < 0.001), whereas long-term facility (LTF) discharge increased from 8.2% to 10.5% ( P < 0.001). Discharge outcome improved for CAS in both categories (mortality 2-0.5%; LTF discharge 10.7-8.3%; both P < 0.001). The trend analysis revealed an increase in patient age and a worsening comorbid profile over time. Age, women, length of stay, atrial fibrillation, and carotid stenosis with infarction were important determinants of unfavorable hospital outcome. Conclusion From a nationwide practice perspective, the number of carotid revascularizations fell by 10%. CEA has resulted in stable hospital mortality rates. Meanwhile, CAS has been increasingly utilized with overall improvement in short-term outcome. Our results further suggest a decrease in the number of patients with treatment-eligible carotid disease over time. However, the increasing prevalence of high-risk comorbidity in the aging population may pose a challenge to revascularization strategies. [ABSTRACT FROM AUTHOR]

. Purpose: To examine retinal function in relation to retinal perfusion pressure in patients with carotid artery stenosis. Methods: Thirteen patients with carotid artery stenosis without clinical eye disease underwent assessment of ophthalmic artery systolic blood pressure (OSP) by ocular pneumoplethysmography, carotid artery obstructive disease by ultrasonography, intraocular pressure by applanation tonometry, retinal perfusion by fluorescein angiography and retinal function by multifocal electroretinography (mfERG). Data analysis compared the eye on the most stenotic side with the fellow eye in the same patient. Results: Ophthalmic systolic pressure was 95.8 ± 13.1 mmHg on the side with the highest degree of carotid artery stenosis (mean 94.0%) and 111.7 ± 10.3 mmHg in the fellow eyes on the side with the lesser degree of stenosis (mean 33.9%). Summed mfERG implicit times (N1 and P1) were 3.4% and 2.0% longer (p = 0.013 and 0.021), and N1 and P1 amplitudes were 18.0% and 16.0% (p = 0.0041 and 0.020) lower in eyes on the side with the higher stenosis compared with the contralateral eyes. Shorter implicit times and higher amplitudes were correlated with higher brachial systolic arterial blood pressure (p = 0.0028, 0.011, 0.041 for N1, P1, N2 implicit times, respectively, and p = 0.0086, 0.016, 0.040 for N1, P1, N2 for amplitudes, respectively, corrected for OSP). Conclusion: Cone function deviation was observed in clinically healthy eyes on the side with highest degree of carotid artery stenosis and was found correlated to arterial blood pressure. [ABSTRACT FROM AUTHOR]

Background and purpose High-grade cervical carotid stenosis (70-99%) or occlusion often accompanies reversed ophthalmic artery flow ( ROAF), but its potential clinical significances remain poor understood. This study assessed ROAF and the related variables caused by carotid hemodynamic compromise in patients with unilateral severe cervical carotid stenosis. Methods The study consisted of 200 patients diagnosed as unilateral high-grade cervical carotid stenosis/occlusion using ultrasonography. The hemodynamic parameters of 152 patients, excluding 48 with cervical carotid occlusion, were compared based on the presence of ROAF. Out of 200 patients, 159 underwent brain magnetic resonance imaging and were analysed for risk factors impacting functional outcomes including ROAF. Results The patients ( n = 48) with internal carotid artery occlusion had significantly higher incidence (62.5%) of ROAF compared with that of 25.0% in those patients ( n = 152) with unilateral high-grade carotid stenosis ( P < 0.001). In ROAF patients ( n = 38) with the unilateral high-grade stenosis, a significant retrobulbar arteries hemodynamic difference was observed between the stenotic and non-stenotic vessels. The patients ( n = 159) with history of stroke ( P = 0.035), ROAF ( P = 0.023) and intracranial stenosis ( P < 0.001) exhibited significantly higher incidence of poor functional outcome compared with the corresponding control groups. In the same patients ( n = 159), those with both cervical and intracranial stenosis showed sevenfold higher risk ( OR, 7.60; 95% CI, 3.44-16.81) for ROAF than those with only cervical stenosis. Conclusions ROAF may result from intracranial hemodynamic compromise. Patients with unilateral high-grade cervical carotid stenosis/occlusion in combination with intracranial stenosis appear to be a significant risk factor for poor functional outcome and increased incidence of ROAF. [ABSTRACT FROM AUTHOR]