Том 9, брой 2 - 2013/ Vol. 9, No. 2 - 2013

I. Koh 1, J. Lee 1, J. Park 2, S. Han 2, S. Hwang 3, S. Suk 4
1 National Medical Center – Seoul,
2 Sanggye Paik Hospital, Inje University College of Medicine – Seoul,
3 Kangnam Sacred Hospital, Hallym University College of Medicine – Seoul,
4 Wonkwang University Sanbon Medical Center – Seoul, South Korea

Background: The absence of the internal carotid artery (ICA) is a rare congenital anomaly, occurring in<0.01% of the population. Although many of these cases remain asymptomatic and go undetected, their recognition is of more than trivial interest.

Case Report: Case 1: A 47-year-old woman with a history of hypertension visited the hospital with a 3-day history of headache. The results of physical and neurological examinations were unremarkable. Color-coded duplex ultrasonography performed to evaluate the carotid and vertebral arteries revealed a normal configuration on the right side. No significant stenotic flow or plaque formation was observed in the right CCA, ECA, or ICA. However, ultrasonography revealed a left CCA of diminished caliber that terminated in the ECA, with no remnant of a cervical ICA. The MR angiographic findings were consistent with the ultrasonographic findings. The left CCA terminated into the ECA with no identifiable remnant of the ICA.

M. Yasaka, Y. Wakugawa, M. Mori, Y. Nakanishi, Y. Okada
Kyushu Medical Center – Fukuoka, Japan

Objective: We attempted ultrasonographic evaluation of the distal extracranial internal carotid artery (ICA) in patients with extracranial ICA dissection by using the transoral carotid ultrasonography (TOCU).

Material and Methods: The subjects consisted of 5 healthy volunteers (33 ± 5 years old) and 5 extracranial ICA dissection patients (45 ± 4 years old). Examinations were performed using a color Doppler flow imaging system equipped with thin and long convex array transducers (9-5 MHz). We inserted a probe covered with thin gum transorally, touching the tip to the pharyngeal postero-lateral wall. We then attempted to detect the ICA and measure ICA diameter and flow velocity of the distal extracranial ICA by TOCU.

M. Staneva 1, V. Chervenkoff 1, B. Minkova 1, G. Kirova 2, D. Markov 1, Ts. Tsvetanov 1, P. Antova 1
1 Department of Vascular Surgery and Angiology,
2 Department of Radiology, Tokuda Hospital – Sofia, Bulgaria

Objective: Takayashu arteriitis (TA) is a necrotizing and obliterative segmental, large-vessel panarteriitis of unknown cause, involving elastic arteries including tha aortic arch and its branches.The disease has a strong female predilection with peak incidence in the third decade of life. Two specific forms are reported in the literature – Japanease,involving the thoracic aorta and its branches and Indian, affecting the abdominal aorta and renal arteries.

Case Reports: We present two clinical cases-patients are over 50 years of age after vascular reconstruction of supra-aortic arteries with risk factors for atherosclerosis - arterial hypertension, dyslipidemia, stress, family history. Due to recurrence of symptoms after a clinical exam and Color-coded Duplex Ultrasound (CDU) was performed and restenosis of the arterial reconstructions was found. On this occasion Multidetector Computed Tomography (MDCT) of supra-aortic cerebral arteries was performed.

I. Koh 1, J. Lee 1, S. Hwang 2, S. Suk 3, J. Park 4
1 National Medical Center – Seoul,
2 Kangnam Sacred Hospital, Hallym University College of Medicine – Seoul,
3 Wonkwang University Sanbon Medical Center – Seoul,
4 Sanggye Paik Hospital, Inje University College of Medicine – Seoul, South Korea

Objective: Isolated left brachiocephalic artery and common carotid artery with right aortic arch(AA) is extremely rare congenital anormaly. This malformation can cause subclavian steal phenomenon.

Case Report: A 22-year-old female patient with dizziness visited the hospital. She has felt non-whirling type dizziness since she was twelve, and the symptom was aggravated about 3 months ago. Color-coded duplex ultrasonography revealed complete flow reversal of left vertebral artery(VA) with dampened systolic flow of left CCA. Percutaneous catheter aortogram showed right AA with normal brachiocephalic trunk and no connection with great vessels of left side. Left transradial subclavian angiogram showed isolated left SA and left CCA with competition flow of left VA

S. Andonova-Atanasova 1, F. Kirov 1, Ch. Bachvarov 2, V. Velinov 2
1 Department of Neurology, Second Clinic of Neurology,
2 Department of Radiology, University Hospital St. Marina – Varna, Bulgaria

Objective: The term dissection refers primarily to an elevation or separation of the intimal lining of an artery from the subjacent media and, less frequently, to separation of the media from the adventitia. Dissection is usually accompanied by hemorrhage into the arterial wall. According to the literature serious vascular injurie to the neck may be asymptomatic or masked by other life-threatening conditions.

Material and Methods: We observed one patient - 44 years old men, with multiple trauma to the neck and left leg, three months before the hospitalization, suffering from acute ischemic stroke. There were no risk factors for cerebrovascular disease. CT angiography was obtained by Spiral Scanner with reconstructions and interpretation by a radiologist. Color-coded duplex sonography was used to determine the extracranial blood flow velocity and the wall of carotid arteries.

F. Abd-Allah
Neurosonology Unit, Cairo University – Cairo, Egypt

Objective: A noninvasive method of visualization of the spinal cord vasculature such as ultrasound that can be utilized in different clinical setting of spinal cord ischemia. We assessed the feasibility of imaging and characterizing blood flow in the anterior spinal artery using Ultrasound with concurrent validation using a cadaveric model.

Material and Methods: We developed a protocol for ultrasonographic assessment of anterior spinal artery based on anatomic, morphologic, and physiologic characteristics of anterior spinal artery and determined the feasibility in 24 healthy research participants using high frequency probe (3-9 MHz) through the left lateral paramedian approach in the area between T8 and T12. We ascertained the detection rate, depth of insonation, and flow parameters, including peak systolic velocity, end diastolic velocity, and resistivity indexes for both segmental arteries and anterior spinal artery within the field of insonation. We validated the anatomical landmarks using simultaneous spinal angiography and simulated anterior spinal artery flow in a cadaveric set-up.

G.-M. von Reutern 1, I. Alpsoy 2, J. Allendörfer 2
1 Neurologische Praxis am Kardiologischen Zentrum – Bad Nauheim,
2 Asklepios Neurologische Klinik Bad Salzhausen – Nidda, Germany

Objective: Poststenotic peak systolic velocities (PSV) of < 50 cm/s of the distal internal carotid A. (ICA) were introduced as one of the main criteria to differentiate 70% vs 80% stenosis (NASCET definition) (NSRG consensus Stroke. 2012;43:916-921). There is only a sparse evidence for this threshold. Therefore we examined the PSV in patients with risk factors and arteriosclerosis (<50%). With reduced velocities the diameter of the ICA is reducing, a possible additional parameter for grading a stenosis.

Material and Methods: 100 consecutive patients (mean age 65,4 y, range 40-93, male 52%) were examined (GE Logic 7). PSV was measured as distal as possible, at least 2 cm distal to the origin. Due to the variable anatomy the exact distance was not prescribed. The distal diameter of the ICA was measured in systole, if possible with B-Mode, or B-flow imaging for its good spatial resolution.

Y. Asakawa, H. Takekawa, K. Suzuki, M. Yamamoto, M. Okamura, T. Nishihira, A. Iwasaki, K. Hirata
Dokkyo Medical University – Mibu, Japan

Objective: Dilatation of common carotid artery (CCA) has been indicated as an independent risk factor for thoracic and abdominal aortic aneurysm (AA); however, it has not been yet established in Japanese patients with AA. This study aimed to identify CCA diameter of preoperative patients with AA.

Material and Methods: We evaluated 40 AA patients and 40 controls. External and internal diameters of bilateral CCA during diastolic phase were measured in each group. Mann-Whitney U test was used to compare differences between two groups, and receiver operating characteristic curve (ROC) was used to evaluate optimal sensitivity and specificity for diagnosing the co-morbidity of AA.

T. Nishihira, M. Yamamoto, H. Takekawa, K. Suzuki, Y. Asakawa, A. Iwasaki, M. Okamura, K. Hirata
Dokkyo Medical University – Mibu, Japan

Objective: Recent studies have suggested increased diameters of the brachial artery may be a useful indicator for subclinical coronary artery diseases, and central artery dilation such as common carotid artery are associated with arteriosclerosis. However it remains unclear in patients with cerebral infarction. The present study aimed to investigate the relationship between the diameters of brachial artery (BAD) and common carotid artery (CAD) in patients with cerebral infarction.

Material and Methods: Thirty-three patients with acute atherothrombotic brain infarction (group ATBI), 33 cardiogenic cerebral embolism (group CE) and 31 normal controls (group NC) were enrolled. BAD and CAD at the end-diastolic phase were measured in each group by ultrasonography. Kruskal-Wallis test followed by Scheffe’s post-hoc test was used to compare differences among three groups.

H. Takekawa, K. Suzuki, T. Nishihira, A. Iwasaki, M. Okamura, Y. Asakawa, M. Yamamoto, R. Okabe, K. Hirata
Dokkyo Medical University – Mibu, Japan

Objective: The Doppler indices, such as systolic acceleration time (AcT) have been used as parameters for peripheral arterial stenosis. However, to our knowledge, the AcT ratio has not routinely been used to evaluate the degree of internal carotid artery (ICA) stenosis. To apply the AcT ratio in the assessment of carotid artery sonography as an additional marker for diagnosing ICA stenosis.

Material and Methods: Carotid artery sonography was performed in 140 consecutive patients with atherothrombotic brain infarction to evaluate extracranial ICA stenosis. The AcT ratio was calculated as the AcT of the internal carotid artery divided by the AcT of ipsilateral common carotid artery and compared with linear stenosis as calculated according to the European Carotid Surgery Trial criteria. Simple regression analysis was used to examine the relationship between the AcT ratio and ICA stenosis. The receiver operating characteristic (ROC) curve was used to calculate the optimal cutoff values of the AcT ratio for ICA stenosis ( > 65%).

P. Mineva 1, D. Hadjiev 2, V. Tsoneva 1, Zh. Andreev 2
1 Medical Faculty, Trakia University – Stara Zagora,
2 Medical Faculty, Medical University – Sofia, Bulgaria

Objective: The aim of this population-based study was to analyze the prevalence and correlations between the well-documented vascular risk factors (VRF) – asymptomatic carotid stenosis (ACS) and dyslipidemia, and their significance for the incidence of cerebral ischemic events.

Materials and Methods: A total of 500 randomly selected volunteers, 200 men and 300 women, without signs or symptoms of cerebrovascular disease, aged 50-79 years, were enrolled in the study in the University town of Stara Zagora. All participants underwent Duplex scanning of internal carotid arteries, structured questionnaires, a physical and neurological examination and a battery of laboratory tests.

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