PurposeThe acceleration time (AcT) ratio of the internal carotid artery (ICA) is increased in ICA stenosis. However, there are few reports that have directly compared the AcT ratio to digital subtraction angiography (DSA) findings.MethodsWe evaluated 177 vessels with DSA and carotid artery ultrasonography. The AcT ratio was calculated as AcT of the ICA (ICA–AcT)/AcT of the ipsilateral common carotid artery (CCA). We evaluated the correlation of DSA–NASCET stenosis with the origin of the ICA or the peak systolic velocity (ICApsv) in the stenotic region, ICApsv/peak systolic velocity of the CCA (CCApsv), ICA–AcT, and AcT ratio. Sensitivity and specificity for stenosis ≥ 70% were calculated based on the ICApsv, ICApsv/CCApsv, ICA–AcT, and AcT ratio.ResultsUsing NASCET criteria, 34 vessels had 70% or greater stenosis. DSA–NASCET showed a significant positive correlation with ICApsv, ICApsv/CCApsv, ICA–AcT, and AcT ratio (p < 0.0001). When the cut-off value for ICApsv was set at 176 cm/s, ICApsv/CCApsv at 2.42, ICA–AcT at 0.095 s, and the AcT ratio at 1.35, the sensitivity was 97.1, 97.1, 82.4, and 97.1%, and the specificity was 94.4, 91.0, 83.2, and 83.2%, for DSA–NASCET ≥ 70%, respectively.ConclusionThe AcT ratio is a beneficial parameter for evaluating ICA stenosis as well as ICApsv and ICApsv/CCApsv.
We identified current smoking and hypertension as the most significant contributing factors to increased IMT-C in residents of Tochigi Prefecture, emphasizing the importance of routine blood pressure monitoring and anti-smoking education in this population.
Objective: Transarterial embolization (TAE) for dural arteriovenous fistula (dAVF) is sometimes risky because of dangerous anastomosis. We successfully treated orbital apex dAVF by blocking back-flow to the internal carotid artery and ophthalmic artery with coil and balloon. Case Presentation:A 51-year-old man had red right eye and exophthalmos, and was diagnosed with right orbital apex dAVF. TAE using n-butyl-2-cyanoacrylate (NBCA)/lipiodol mixture via the artery of the superior orbital fissure was performed under flow control of the internal carotid artery and ophthalmic artery with balloon microcatheter and temporary placing of detachable coil. After the treatment, the shunt disappeared and the symptoms were improved. Conclusion:A proper understanding of dangerous anastomosis is important for safe and effective use of TAE for dAVF.
Objective: The jet flow direction at the stenotic lesion is not always parallel to the blood vessel direction. Therefore, we examined the optimal angle correction. Methods: Among 50 subjects with stenosis at the internal carotid artery (ICA) bifurcation who underwent carotid ultrasonography and digital subtraction angiography (DSA). The measurement of peak systolic velocity (PSV) at the stenotic lesion site was performed according to the guideline of Japan Academy of Neurosonology. The subjects were divided into 2 groups: group A, angle was aligned parallel to the blood flow at the stenotic lesion (n = 23) and group B, angle was aligned parallel to the blood vessel (n = 30). ICA stenosis was diagnosed on DSA images according to NASCET criteria. Results: In groups A and B, there was a significant correlation between PSV and stenosis ratio. In diagnosing ICA stenosis (≥ 70%), the area under ROC curve, the sensitivity and specificity of PSV were 0.973, 100% and 85.7% with a cutoff level of 203.5 cm/s and 0.765, 70.0% and 80.0% with a cutoff level 256.9 cm/s, respectively. Conclusion: Our study suggests the angle-adjustment towards the blood flow at the stenotic lesion site is superior to the angle-adjustment parallel to the blood vessel for PSV measurement.
Background and ObjectivesGynecologic diseases such as uterine fibroids, endometriosis, and adenomyosis are common in women of reproductive age. Case reports and small case series have reported ischemic stroke in women with such common noncancerous gynecologic diseases, and their cause of stroke is frequently attributed to cryptogenic stroke or unconventional mechanisms related to hypercoagulability. However, stroke etiology and prognosis are not well known. We assessed the prevalence of and stroke mechanisms related to common noncancerous gynecologic diseases using hospital-based clinical data.MethodsWe retrospectively identified consecutive female patients with common noncancerous gynecologic diseases (uterine fibroids, endometriosis, and adenomyosis) diagnosed with ischemic stroke/transient ischemic attack (TIA) between the ages of 20 and 59 years admitted to 10 stroke centers in Japan by reviewing prospectively collected data between 2017 and 2019. The clinical, laboratory, and neuroimaging features were evaluated and compared between patients with conventional stroke mechanisms (CSMs) (large artery atherosclerosis, small vessel occlusion, cardioembolism, and other determined etiology) and non-CSMs (cryptogenic stroke and causes related to hypercoagulability such as nonbacterial thrombotic endocarditis and paradoxical embolism) according to the Trial of Org 10172 in Acute Stroke Treatment criteria.ResultsOf the 470 female patients with ischemic stroke/TIA, 39 (8%) (37 ischemic stroke and 2 TIA) had common noncancerous gynecologic diseases. The most common gynecologic diseases were uterine fibroids in 24 (62%) patients, followed by endometriosis in 9 (23%) and adenomyosis in 6 (15%). Twenty patients (51%) were assigned to the non-CSMs group, and 19 patients (49%) were assigned to the CSMs group. Adenomyosis and endometriosis were more frequent in the non-CSMs group than in the CSMs group. CA125 and D-dimer levels were higher in the non-CSMs group than in the CSMs group. Multiple vascular territory infarcts were frequent in patients with adenomyosis (60%) and endometriosis (43%) in the non-CSMs group. No stroke recurrence or death was observed within 3 months after discharge in both the CSMs and non-CSMs groups. Outcomes at 3 months after discharge were similar in both groups.DiscussionIn patients with common noncancerous gynecologic diseases, hypercoagulopathy may play a role in the pathogenesis of ischemic stroke/TIA without CSMs.
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