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Eversion carotid endarterectomy
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
judith c. lin, constantine g. saites
Since its introduction nearly 75 years ago, there have been few modifications to the technical approach of carotid endarterectomy (CEA). As medical management of atherosclerotic risk factors and perioperative care improve, the outcome differences attributed to these small, but significant technical details embody the “holy grail” of carotid atherosclerosis surgery. Conventional CEA with patch angioplasty has been the most widely practiced technique and is the standard to which the approach of eversion CEA (ECEA) is compared. Contemporary ECEA is an alternative technique used to facilitate the removal of plaque isolated to the carotid bulb and proximal internal carotid artery (ICA). Advantages of eversion versus standard endarterectomy include: the ability to shorten a redundant ICA; better visualized end point and easier detection of intimal flaps; faster closure by simple anastomosis of the ICA to the carotid bulb; an all autogenous reconstruction; and decreased restenosis rates in women. In the authors’ practice, most patients still undergo standard CEA with bovine or vein patch angioplasty; only a minority of selected patients undergo ECEA.
Case 13: Loss of Vision and a Maculopapular Rash
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
It is difficult to determine whether the patient's vision was truly lost suddenly, or if he only noticed this when driving. There are a limited number of conditions that lead to sudden visual loss, including central or branch retinal artery occlusion – this typically results in sudden and painless visual loss. Underlying causes include hypercoagulable states, diabetes mellitus, hypertension, hypercholesteroalemia and atherosclerosis (particularly carotid atherosclerosis). Giant cell arteritis may also lead to central retinal occlusion. Amaurosis fugax may precede visual loss. On fundoscopy, the disc will appear swollen and pale.
Overview of Imaging Atherosclerosis
Published in Robert J. Gropler, David K. Glover, Albert J. Sinusas, Heinrich Taegtmeyer, Cardiovascular Molecular Imaging, 2007
Vardan Amirbekian, Smbat Amirbekian, Juan Gilberto S. Aguinaldo, Valentin Fuster, Zahi A. Fayad
When compared to the coronary arteries, the carotid arteries are particularly amendable to imaging. This is because they are not particularly subject to significant motion and because of their superficial location. Many studies of carotid atherosclerosis have been performed using multi-contrast MRI (Fig. 1). As discussed earlier, multi-contrast MRI involves the use of T1-weighted, T2-weighted and proton-density-weighted imaging to obtain a composite of information regarding plaque composition. Many studies have utilized highresolution black-blood spin-echo and fast-spin-echo MRI sequences to investigate carotid atherosclerosis. In one of the first in-vivo studies, MRI was performed on patients with advanced carotid atherosclerosis who were scheduled to have carotid endarterectomy (43). In this study, the investigators were able to begin characterization of normal and abnormal areas of carotid wall. Part of the study involved characterization of short T2 components in vivo before carotid endarterectomy and correlating these values with ones obtained in vitro after carotid endarterectomy when large portions of the plaques were removed surgically for therapeutic benefit (43). In a different study, Yuan et al. examined carotid wall area and plaque size demonstrating the capabilities of MRI thereof (93). Carotid plaque size and wall area measurements may be useful in clinically following plaque progression and possible regression with appropriate treatment.
Rationale and design of the Brazilian diabetes study: a prospective cohort of type 2 diabetes
Published in Current Medical Research and Opinion, 2022
Joaquim Barreto, Vaneza Wolf, Isabella Bonilha, Beatriz Luchiari, Marcus Lima, Alessandra Oliveira, Sofia Vitte, Gabriela Machado, Jessica Cunha, Cynthia Borges, Daniel Munhoz, Vicente Fernandes, Sheila Tatsumi Kimura-Medorima, Ikaro Breder, Marta Duran Fernandez, Thiago Quinaglia, Rodrigo B. Oliveira, Fernando Chaves, Carlos Arieta, Gil Guerra-Júnior, Sandra Avila, Wilson Nadruz, Luiz Sergio F. Carvalho, Andrei C. Sposito
Trained cardiologists performed carotid Doppler ultrasound with a 5–13 MHz linear array transducer (Epiq CVX, Philips, Eindhoven, The Netherlands). Briefly, the longitudinal image of the bilateral common, internal, and external carotid artery, and the vertebral artery, was scanned for atherosclerotic plaque detection, following ASE guidelines32. The carotid intima-media thickness (CIMT) was measured from the common carotid artery 20 mm from the carotid bulb and at least 10 mm from the bifurcation using a semi-automated method. Carotid atherosclerosis was considered if participants presented any of the following: (i) atherosclerotic plaque, defined as a localized projection of more than 1.5 mm into the lumen or thickening of 50% of the artery compared with an adjacent wall; (ii) IMT ≥ 1 mm; or (iii) mean IMT above the 75th percentile, as previously determined for our population in the ELSA-Brazil study33.
Plasma pentraxin 3 is associated with progression of radiographic joint damage, but not carotid atherosclerosis, in female rheumatoid arthritis patients: 3-year prospective study
Published in Modern Rheumatology, 2020
Yu Funakubo Asanuma, Yoshimi Aizaki, Hisashi Noma, Kazuhiro Yokota, Mayumi Matsuda, Noritsune Kozu, Yoshitake Takebayashi, Hiroshi Nakatani, Tomoko Hasunuma, Shinichi Kawai, Toshihide Mimura
In the RA patients, we performed carotid ultrasound to assess subclinical atherosclerosis at baseline and after follow-up for 3 years. High-resolution B-mode ultrasonography (Aplio MX; Toshiba Medical Systems, Tochigi, Japan) of the bilateral carotid arteries was performed by trained and certified sonographers who had no knowledge of the patient’s clinical information. The sonographers scanned the right and left common carotid arteries (CCAs), the carotid bulb, and the internal carotid arteries. Trained readers measured the intima-media thickness (IMT) at 1 cm segments of the near and far walls of both CCAs and the far walls of the bilateral carotid bulbs and internal carotid arteries. The upper limit of normal for the IMT was set as 1.0 mm. The plaque was defined as an area with focal IMT >1.1 mm. The maximum IMT was defined as the maximum IMT including plaques. The severity of carotid atherosclerosis was evaluated in each patient by calculating the plaque score according to the previous study [21]. Briefly, this score was the sum of the maximum IMT (in millimeters) of the near and far walls in each of four segments of the bilateral carotid arteries.
Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Superficial temporal and maxillary arteries arise from ECA and stenosis of these vessels due to any cause such as GCA, atherosclerosis, thromboembolism result in ischemia of facial and masticatory muscles leading to headache, jaw pain, or claudication [9]. Our patient was thought to have these symptoms due to carotid atherosclerosis. However, as mentioned above, color-duplex ultrasound showed diffuse atherosclerosis and critical stenosis of left ICA but no significant disease of left ECA. This fact indicated further investigation for an alternate diagnosis such as GCA which can cause ‘skip’ lesions of arteries [10] and can be missed on a limited ultrasonography study. Recent data has shown promising results regarding use of color-duplex ultrasonography in diagnosis of GCA but only if done in detail on all the large arteries including temporal artery. This imaging modality can pick up signs such as ‘halo’ sign due to inflammatory edema of the arterial wall with sensitivity and specificity as high as 85% and 92%, respectively [11]. Alternatively, high resolution MRI can be done which has shown similar results [12]. Our patient did not get a temporal artery ultrasound but was found to have segmental irregular beaded appearance of left ICA and ECA secondary to arteritis on MRA neck (Figure 3).