Assessment of ophthalmic artery collateral pathway in the hemispheric cerebral hemodynamics in patients with severe unilateral carotid stenosis

The role of ophthalmic artery collateral pathway in hemispheric hemodynamics in patients with severe carotid stenosis is controversial. The aim of the present study was to address this question comparing the asymmetry of the velocity in middle and anterior cerebral arteries (MCAs and ACAs) and cerebrovascular reactivity (CVR) in MCA on stenotic side in the patients with unilateral severe stenosis of internal carotid artery (ICA) in patients with and without ophthalmic artery collateral pathway. The cohort of 118 patients with carotid stenosis was prospectively assembled. Fifty patients who had severe unilateral ICA stenosis (71%-99%) by Duplex Ultrasound (DUS) were observed by transcranial Doppler (TCD). Cerebral blood flow velocity in MCA and ACA in both sides, direction of blood flow in ophthalmic artery (OA) and CVR on the side of stenosis were determined. There were 14 patients with retrograde blood flow in OA (Group I). The remaining 36 patients with anterograde flow in OA composed Group II. The degree of interarterial asymmetry of peak and mean velocity (Vpeak and Vmean) in MCA and ACA and CVR in MCA were compared in both groups. The degree of ACA asymmetry by Vpeak was 44.0% +/- 6.9% in Group I and 38.3% +/- 3.9% in Group II (p = 0.49), by Vmean 40.3% +/- 6.7% and 36.6% +/- 3.8% (p = 0.63) respectively. The degree of MCA asymmetry by Vpeak was 24.2% +/- 2.8% in Group I and 19.5% +/- 5.0% in Group II (p = 0.42), by Vmean 23.5% +/- 2.9% and 20.6% +/- 5.1% (p = 0.63) respectively. CVR in Group I was 26.1% +/- 6.1%, in Group II 29.0% +/- 6.7% (p = 0.65). The ophthalmic collateral pathway has no influence on hemispheric cerebral hemodynamics in patients with severe unilateral carotid stenosis.     

Correlating cognitive impairment with carotid atherosclerosis and carotid artery stenosis in patients with acute cerebral infarction

BACKGROUND:Studies have demonstrated that carotid atherosclerosis and carotid artery stenosis are closely associated with cognitive impairment in patients with and without clinically evident cerebrovascular disease. OBJECTIVE: To investigate the correlation between the degree of pathological changes in carotid atherosclerosis, carotid artery stenosis, and cognitive impairment in patients with acute cerebral infarction through the use of color Doppler imaging. DESIGN, TIME AND SETTING: The present concurrent...     

Correlating cognitive impairment with carotid atherosclerosis and carotid artery stenosis in patients with acute cerebral infarction*★

BACKGROUND：Studies have demonstrated that carotid atherosclerosis and carotid artery stenosis are closely associated with cognitive impairment in patients with and without clinically evident cerebrovascular disease. OBJECTIVE： To investigate the correlation between the degree of pathological changes in carotid atherosclerosis, carotid artery stenosis, and cognitive impairment in patients with acute cerebral infarction through the use of color Doppler imaging. DESIGN, TIME AND SETTING： The present concurrent, non-randomized, controlled experiment was performed at the Departments of Neurology and Ultrasound, Affiliated Hospital of North Sichuan Medical College between November 2006 and August 2007. PARTICIPANTS： Fifty-five patients with cerebral infarction, consisting of 35 males and 20 females, aged 50–82 years, were admitted to the hospital between November 2006 and August 2007 and recruited for this study. An additional 30 subjects consisting of 18 males and 12 females, aged 47–78 years, that concurrently received a health examination at the same hospital, were also included as normal controls. METHODS： Intima-media thickness （IMT）, plaque shape, size, and echo intensity of all subjects were detected by color Doppler flow imaging. Assessment criteria： IMT 〉 1.0 mm was considered to be intimal thickening, and IMT 〉 1.2 mm was determined to be formed atherosclerotic plaques. In the position of the largest plaque, the degree of carotid artery stenosis was determined by the following formula： （1-cross-sectional area of residual vascular luminal area/vascular cross-sectional area） × 100%. Less than 30% exhibited mild stenosis, 30%-40% moderate stenosis, and 〉 50% severe stenosis. MAIN OUTCOME MEASURES： IMT and the degree of carotid artery stenosis were evaluated by color Doppler flow imaging. The Mini-Mental State Examination （MMSE）, as well as the clinical memory scale, was compared between patients with cerebral infarction and normal controls. RESULTS： In the cerebral infarc     

无症状性ICA患者行颈动脉支架置入术对认知功能的影响

目的 探讨颈动脉支架置入术对无症状性颈动脉高度狭窄患者认知功能的影响。方法 以本院2012年2月～2014年2月治疗的96例行颈动脉支架置入术的无症状性颈动脉高度狭窄患者为研究组,以同期90例行常规内科治疗的无症状性颈动脉高度狭窄患者为对照组,分别在治疗前3 d和治疗后3个月采用连线测验(TMTa、TMTb)、简易智能量表(MMSE)、阿尔茨海默病评估量表认知部分(ADAS-Cog)评估患者的认知功能。结果 研究组患者治疗前3 d颈动脉狭窄为(79.51±6.02)%,治疗后3个月残余狭窄为(13.52±6.01)%,治疗后3个月狭窄程度较治疗前3 d有明显改善(P<0.05); 治疗后研究组狭窄程度显著低于对照组(P<0.05)。与治疗前3 d相比,研究组治疗后3个月患者的MMSE评分明显增加(P<0.05),TMTa、TMTb和ADAS-Cog评分均明显降低(P<0.05); 治疗3个月研究组各指标均显著优于对照组(P<0.05)。结论 颈动脉高度狭窄可能造成患者认知功能损伤,即使是无症状的此类患者,行颈动脉支架置入术对患者的认知功能也具有一定的改善作用,并且可降低颈动脉狭窄程度。     

Xenon-enhanced CT assessment of cerebral blood flow in stroke-in-progress patients with unilateral internal carotid artery or middle cerebral artery stenosis

Carotid or cerebral artery stenosis resulting in low perfusion is a major cause of ischemic stroke.Understanding the unique hemodynamic features in each patient undergoing a stroke-in-progress（SIP） and the correlation between progression and cerebral blood flow（CBF） status would help in the diagnosis and treatment of individual patients.We used xenonenhanced CT（Xe-CT） to examine cerebral perfusion in patients with or without SIP（30 patients/group）,recruited from October 2009 to October 2010.Only SIP patients with unilateral stenosis in the internal or middle cerebral artery were recruited.The occurrence of watershed infarction was higher in the SIP group than in the non-SIP group（P ＆lt;0.05）.In the SIP group,larger hypoperfused areas were found around the lesions than in the non-SIP group.In the SIP group,the CBF values in the ipsilateral areas were significantly lower than those in corresponding regions on the contralateral side.CBF values in the contralateral hemisphere were significantly lower in the SIP group than in the non-SIP group.In SIP patients,infarctions were surrounded by larger hypoperfused areas than in non-SIP patients.These larger hypoperfused areas may result in pathological damage to the brain that is responsible for the progression of stroke.     

颈动脉狭窄患者认知功能障碍临床分析

目的探讨颈动脉狭窄与认知功能障碍之间的关系。方法选取颈动脉狭窄组80例和对照组78例,两组患者年龄、性别和文化程度比较差异无统计学意义。所有患者均予颈部MRA及颈动脉彩超检查,并进行MMSE及MoCA评定,同时对脑血管病常见危险因素进行登记。所有数据采用SPSS13.0统计软件进行分析。结果 80例颈动脉狭窄患者均经颈部MRA及血管超声检查证实,其中轻度狭窄32例(40%),中度狭窄26例(32.5%),重度狭窄16例(20%),完全闭塞6例(7.5%)。颈动脉狭窄组无论MMSE还是MoCA评分均小于对照组,差异有统计学意义。随着颈动脉狭窄程度的加重,Mo-CA及MMSE评分越低,两两比较差异有统计学意义(P<0.05)。结论颈动脉狭窄存在认知功能障碍,且随着狭窄程度加重而加重,糖尿病、高血脂、高血压、吸烟是颈动脉狭窄的危险因素。     

Effects of uncomplicated carotid endarterectomy on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery by comparison with unoperated patients

Objective: The purpose of the present exploratory study was to evaluate the effects of uncomplicated carotid endarterectomy (CEA) on cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the internal carotid artery (ICA) by comparison with unoperated patients.

Methods: Patients with age ≤75 years and unilateral asymptomatic severe stenosis (≥70%) of the cervical ICA underwent CEA with antiplatelet therapy (surgically treated group: 116 patients) or antiplatelet therapy alone or neither (medically treated group: 45 patients). For the surgically treated group, neuropsychological testing and brain perfusion measurement using single-photon emission computed tomography were performed within one month before surgery and one month after surgery. For the medically treated group, the same testing and measurement were performed twice at an interval of 1 to 2 months.

Results: None of the operated patients developed new major ischemic events after surgery or intraoperative cerebral hyperperfusion. None of the patients in the medically treated group experienced neurological deficits including transient ischemic attacks during the study period. The incidence of patients with interval cognitive improvement was significantly greater in the surgically treated group (11 patients: 9%) than in the medically treated group (0%) (p = 0.0352). The incidence of patients with interval brain perfusion improvement in the ipsilateral cerebral hemisphere was significantly greater in the surgically treated group (24 patients: 21%) than in the medically treated group (0%) (p = 0.0003).

Conclusions: Uncomplicated CEA may improve cognitive function and brain perfusion in patients with unilateral asymptomatic severe stenosis of the ICA when compared with unoperated patients.     

脑梗死患者颈部动脉杂音与颈动脉狭窄的关系

目的 研究脑梗死患者颈部动脉杂音与颈动脉狭窄的关系.方法 对245例脑梗死患者进行颈部动脉听诊与血管造影检查.根据颈部动脉杂音部位分为锁骨上窝杂音、颈前弥漫杂音及颈前局限杂音,并根据杂音强度分为1～5级.对颈部动脉听诊及血管造影结果进行分析、比较.结果 听诊发现本组145例(59.2％)患者有颈部动脉杂音,其中锁骨上窝杂音62例、颈前弥漫杂音44例、颈前局限杂音39例,100例患者(40.8％)无杂音;1 ～5级杂音分别有28例、26例39例、34例及18例.有颈部动脉杂音的患者颈动脉狭窄的发生率(64.1％,93例)显著高于无杂音患者(49％,49例)(P＜0.05).颈前局限杂音患者颈动脉狭窄及重度狭窄的发生率显著高于锁骨上窝杂音及颈前弥漫杂音杂音患者(均P＜0.01).颈部动脉杂音分级越高,颈动脉重度狭窄率越高(P＜0.05).结论 有颈部动脉杂音的脑梗死患者颈动脉狭窄的发生率高,尤以颈前局限性杂音患者显著;杂音强度与颈动脉狭窄的程度有关.     

Time delay between symptom and surgery in patients with carotid artery stenosis

Andgren S, Sjöberg L, Norrving B, Lindgren A. Time delay between symptom and surgery in patients with carotid artery stenosis.
Acta Neurol Scand: 2011: 124: 329–333.
© 2011 John Wiley & Sons A/S. Objectives – Many severe strokes are preceded by warning signs such as a transient ischemic attack or stroke with minor deficits. Carotid endarterectomy (CEA) of a symptomatic carotid artery stenosis can prevent future strokes, but should be performed within 2 weeks after the initial symptom to maximize the benefit. The aim of this study was to determine the time delays between symptom and CEA. Methods – We performed a single center observational retrospective study at a tertiary stroke center. A total of 142 carotids in 139 patients with symptomatic stenoses between 2002 and 2006 were included. The main outcome measure was time between qualifying cerebrovascular symptom and CEA. Results – The median time between symptom and CEA was 26 days. The longest delays were between the last diagnostic examination and carotid conference, and between carotid conference and surgery. The median time was shorter for those who received emergency medical care (median 21 days) and for those who were admitted immediately to hospital (median 20 days). Conclusions – The time between symptom and surgery is often longer than desirable. There are several measures to improve the chain of procedures for patients with carotid artery stenosis. These may include omitting the formal carotid conference for uncomplicated cases and minimizing waiting time for surgery.     

颈动脉狭窄闭塞性病变后交通支开放与椎动脉起始段狭窄的关系

目的探讨颈动脉狭窄闭塞性病变(≥70%)患者后交通支开放与否与椎动脉起始段狭窄的关系。方法对160例经血管造影证实颈动脉动脉狭窄(≥70%)并行外科治疗(内膜剥脱术、颈动脉支架术)的患者分为后交通支开放组与后交通支未开放组,术前及术后均采用彩色多普勒血流成像(CDFI)检测双侧颈动脉及椎动脉,分别比较两组患者双侧椎动脉起始段狭窄的发生率。结果后交通支开放组椎动脉起始段局部流速术前(后交通支开放)明显高于术后(后交通支关闭)。后交通支关闭前后椎动脉起始段峰值流速(PSV)与舒张末流速(EDV)分别为100.76±74.84cm/s、81.54±54.29 cm/s(P=0.000);后交通支开放患者占50%(80/160),其中椎动脉起始段存在狭窄支数占45.6%(73/160),后交通支未开放患者占50%(80/160),其中椎动脉起始段存在狭窄支数占28.1%(45/160),两者之间存在显著差异(P=0.002)。结论颈动脉狭窄闭塞性病变后交通支开放患者,椎动脉起始段狭窄的发生率显著升高。     

血小板参数与缺血性脑卒中患者颈动脉狭窄的相关性分析

目的：探讨血小板参数与缺血性脑卒中患者颈动脉狭窄的相关性。方法选取2012-01-2013-10在我院住院治疗的急性缺血性脑卒中患者98例及同期健康体检者60例,动脉超声检查受检者有无颈动脉颅外段狭窄及其程度,全自动血细胞分析仪检测所有入组对象血小板参数各项值,并进行比较。结果伴颈动脉狭窄卒中组血小板计数（PL T ）最低,而血小板平均体积（MPV）、血小板分布宽度（PDW）最大（P＜0.05）;颈动脉狭窄患者PLT、MPV及PDW较不伴颈动脉狭窄者均有显著差异（P＜0.05）。缺血性脑卒中患者不伴动脉狭窄组血小板参数比较,仅MPV 水平差异有统计学意义（P＜0.05）。相关性分析发现MPV与颈动脉狭窄程度呈正相关（P＜0.05）。结论血小板参数与缺血性脑卒中颈动脉狭窄及程度密切相关。     

Pulsed Doppler: an evaluation of diameter, blood velocity and blood flow of the common carotid artery in patients with isolated unilateral stenosis of the internal carotid artery

Arterial diameter, blood velocity and blood flow of both common carotid arteries were studied in 24 patients with isolated unilateral internal carotid artery stenosis, without any other significant lesion of the carotid system. The methodology used a pulsed Doppler system with two original characteristics: an adjustable range-gated system and a double transducer probe enabling both the arterial diameter and blood velocity to be evaluated. On the involved side, the diameter, the blood velocity and the blood flow were significantly reduced (p less than 0.001) in comparison with the opposite side. The degree of the internal carotid artery stenosis judged on arteriography was negatively correlated with (i) the blood flow of the common carotid artery homolateral to the stenosis (r = -0.78, p less than 0.001); and (ii) the ratio of the common carotid artery blood flow between the involved and the opposite side (r = -0.80, p less than 0.001). The proposed quantitative evaluation can be suitable for the detection and for the follow up of patients with stenosis of the internal carotid artery who do not have any other lesion of the carotid system.     

Relationship between ophthalmic artery blood flow and recanalization of occluded carotid artery. Ultrasonic Doppler study

Ophthalmic artery blood flow in 5 patients with internal carotid artery occlusion of sudden onset was monitored by an ultrasonic Doppler flowmeter to investigate the possible relationship to spontaneous recanalization of the occluded artery. The occluded internal carotid arteries of 2 patients were confirmed angiographically to recanalize and the reversed flow of their ophthalmic arteries changed to physiological flow after the recanalization. The ophthalmic artery blood flow remained reversed in 2 patients whose occluded internal carotid arteries did not recanalize on the follow up angiograms. In the other patient, whose ophthalmic artery blood flow was not detected by the ultrasonic Doppler flowmeter in the acute stage, physiological flow through the ophthalmic artery was detected later. The occluded internal carotid artery did not recanalize and this physiological ophthalmic artery blood flow was filled through the circle of Willis.     

无脑梗死重度颈动脉狭窄患者伴血管性认知障碍的特点 及影响因素

目的 探索伴血管性认知障碍（VCI）的无脑梗死重度颈动脉狭窄（CAS）患者的认知受损 情况及特点，并分析患者伴VCI的危险因素。方法 选取2020年9月至2021年12月就诊于首都医科大学 附属北京天坛医院的 55 例重度 CAS 患者为研究对象。根据《2019 年中国血管性认知障碍诊治指南》评 估患者是否合并 VCI。采用连线试验 -A（TMT-A）、连线试验 -B（TMT-B）、波士顿命名测试第 2 版（BNT-2）、 中文版霍普金斯语言学习测试（HVLT）、画钟试验（CDT）和蒙特利尔认知评估量表（MoCA）比较伴或不 伴 VCI 患者的认知功能。采用多因素 Logistic 回归分析无脑梗死重度 CAS 患者合并 VCI 的影响因素。 结果 55 例无脑梗死重度 CAS 患者中，40 例（72.7%）患者伴 VCI。67.5%（27/40）的伴 VCI 患者的认知受 损维度＞ 3 个。单因素分析结果显示，伴或不伴 VCI 患者的年龄 ［（64.00±6.61）岁比（58.13±6.66）岁］、 受教育年限［9（9，12）年比 12（12，16）年］、有椎动脉狭窄占比［65.0%（26/40）比 5/15］比较，差异有统计 学意义（P＜ 0.05）。多因素 Logistic 回归分析显示，高龄（OR=1.165，95%CI：1.019～1.332，P＜ 0.05）是 CAS 患者伴 VCI 的危险因素，而受教育年限长（OR=0.681，95%CI：0.490～0.947，P＜ 0.05）和 Willis 环有 效代偿（OR=5.531，95%CI：1.027～29.797，P＜ 0.05）是伴 VCI 的保护因素。结论 无脑梗死重度 CAS 伴 VCI 患者存在认知功能下降，受教育年限长、Willis 环有效代偿是认知功能受损的保护因素，高龄是认知 功能受损的危险因素。     

Role of collateral flow on cerebral hemodynamics in patients with unilateral internal carotid artery occlusion

The objective of this study was to evaluate the role of collateral blood flow via the anterior and posterior communicating arteries (ACoA and PCoA) and via the ophthalmic artery (OphA) on cerebral hemodynamics, metabolism, and border zone infarcts in 57 patients with unilateral symptomatic occlusions of the internal carotid artery. Collateral flow via the ACoA and PCoA was determined with magnetic resonance angiography (MRA) and collateral flow via the OphA with transcranial Doppler (TCD). Volume flow was studied with MRA, metabolism with ¹H MR spectroscopy, CO₂ reactivity with TCD, and the incidence of border zone infarcts with MRI. Compared with controls, patients had deteriorated volume flow, metabolism, and CO₂ reactivity. No differences were found between patients with and patients without collateral flow through the ACoA and/or PCoA, or between patients with or without collateral flow via the OphA. Patients without collateral flow via any of these collaterals had decreased volume flow in the middle cerebral artery, decreased N -acetylaspartate/choline, and increased lactate/ N -acetylaspartate, compared with the other patients. Patients with symptomatic internal carotid artery occlusion have deteriorated cerebral hemodynamics and metabolism. Different collateral flow patterns via the ACoA, PCoA, or OphA have no effect on the hemodynamic and metabolic parameters, as long as one of these pathways is present.     

Effects of carotid endarterectomy on cerebral blood flow and neuropsychological test performance in patients with high-grade carotid stenosis

We examined the changes in cognitive function following carotid endarterectomy (CEA) in relation to the cerebral blood flow (CBF) in patients with high-grade carotid stenosis. The subjects consisted of 23 patients who underwent CEA and 17 controls matched by age and education. Single photon emission computed tomography (SPECT) and neuropsychological tests were performed 2 weeks before and 4 weeks after CEA in all patients. The preoperative CBF tests revealed a decreased vasodilatory reserve in the ipsilateral cerebral hemisphere in nine patients, which was increased after CEA. In these patients, the grade of carotid stenosis was significantly higher than in those with a normal perfusion reserve (90.2+/-8.1% vs. 78.6+/-11.3%, respectively, p<0.05). In the patient group, the postoperative scores (27.2+/-2.9) of the mini-mental state examination (MMSE) improved significantly over the preoperative ones (26.1+/-3.2, p<0.05). Moreover, the scores in the block-design test after CEA (86.8+/-19.8) were significantly higher than those before the operation (81.8+/-22.3, p<0.01). The error score in immediate retention improved from 9.0+/-3.1 to 7.7+/-4.0 following CEA (p<0.05). In the control group, none of the test scores showed significant improvement between the first and second tests. In the patients with an impaired vasodilatory reserve, the mean score of the block-design test significantly improved from 65.6+/-22.1 to 74.0+/-19.2 after CEA compared with those in patients without impairment (p<0.05). High-grade carotid stenosis was thus concluded to cause cognitive impairment due to cerebral hemodynamic failure, which is presumably reversed by CEA.     

颈动脉超声对颈动脉狭窄及脑卒中高危人群的应用价值

目的探讨颈动脉狭窄及脑卒中高危人群中应用颈动脉超声的临床价值。方法选取2013-03—2013-09我院神经内科接收脑卒中康复治疗140例患者的资料进行分析,运用颈部血管超声检测颈动脉内中膜厚度(IMT)及斑块等。结果140例脑卒中高危人群中,超声检出颈动脉狭窄率75.1%,其中男性颈动脉内膜增厚占70.4%,颈动脉斑块阳性占80.3%;女性颈动脉增厚占59.4%,颈动脉斑块阳性占78.3%。颈动脉狭窄患者糖尿病、高血压、吸烟、饮酒及血脂程度高于正常患者。经Pearson相关分析发现颈动脉狭窄与脑卒中危险因素相关。结论颈动脉狭窄是脑血管病发病的危险因素,超声是探查颈动脉狭窄的有效手段。