Pressure Drop in Tortuosity/Kinking of the Internal Carotid Artery: Simulation and Clinical Investigation

Wang, Lijun; Zhao, Feng; Wang, Daming; Shen, Huiyong; Liu, Jiachun; Zhou, Zhenming; Qi, Peng; Song, Shalei

doi:10.1155/2016/2428970

Cited by 27 publications

(29 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…If a patients’ BMI increases from 20 to 30 kg/m 2 , AICATI will increase 0.67; it means that the actual length of eICA is 0.67-fold longer than straight length from the bifurcation point of the carotid artery to the point where eICA entered the carotid canal in the skull. Because eICA tortuosity may lead to a reduction in artery pressure and the level of blood pressure drop is related to the severity of tortuosity ( 4 ). It means obesity itself may cause insufficient blood flow to the brain.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of eICA tortuosity ranges from 4 to 66%, while eICA tortuosity accounts for 4–16% symptomatic cerebrovascular insufficiency ( 2 , 3 ). eICA tortuosity may lead to a reduction in artery pressure distal to the tortuosity, and the level of blood pressure drop is related to the severity of tortuosity ( 4 ). eICA tortuosity may also give rise to intermittent stenosis or occlusion by head rotation, trigger cerebral ischemia, and make intimal ulceration ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Extracranial Internal Carotid Artery Tortuosity and Body Mass Index

Wang

et al. 2017

Front. Neurol.

Self Cite

View full text Add to dashboard Cite

BackgroundExtracranial internal carotid artery (eICA) tortuosity may trigger cerebral ischemia, and body mass index (BMI) is a measure of body mass based on height and weight. The main purpose of this study is to determine the influence of BMI on the tortuosity of eICA.MethodsA total of 926 carotid artery angiograms were performed in 513 patients, of which 116 cases and matched controls were selected. Arterial tortuosity was defined as simple tortuosity, kinking, or coiling. The severity of tortuosity was measured by tortuosity index, formula: [(actual length/straight-line length − 1) × 100].ResultsBMIs were different between the two groups [tortuosity: 27.06 kg/m2 (SD 2.81 kg/m2) versus none: 23.3 kg/m2 (SD 2.78 kg/m2); p < 0.001]. BMI was independently and significantly associated with eICA tortuosity (odds ratio 1.59; 95% confidence interval, 1.35–1.86; p < 0.001). eICA tortuosity index is linearly associated with BMI (exponential coefficient β = 1.067, p < 0.001). The optimal predictive threshold of BMI for eICA tortuosity was 25.04 kg/m2. The physiological mechanism underlying the reasons why higher BMI has negative influence on extracranial carotid artery tortuosity may be an intra-abdominal hypertension caused by a much higher amount of body fat stored in visceral adipose tissue.ConclusionOur result reveals a novel role for greater BMI on the presence of eICA tortuosity. For each increase in BMI of 1 kg/m2, there is a corresponding 1.59-fold increase in the risk of developing eICA tortuosity. The severity of eICA tortuosity increases linearly with increased BMI.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extracranial Internal Carotid Artery Tortuosity and Body Mass Index

Wang

et al. 2017

Front. Neurol.

Self Cite

View full text Add to dashboard Cite

show abstract

“…DICAs can reduce the blood supply to the brain through decreases in blood pressure, which often do not lead to cerebral ischemia due to compensation of the self-regulatory mechanism in the cerebral blood supply. However, when the self-regulatory mechanism is weakened or decompensation occurs due to factors such as atherosclerosis, hypertension, diabetes or old age, cerebral ischemia can occur 18 , 19 . In fact, cerebral ischemia from DICAs occurs through two mechanisms: a thromboembolic mechanism from endothelial lesions due to changes in the local flow at the site of arterial bending, and a hemodynamic mechanism that plays an important role under both neutral and dynamic conditions 20 .…”

Section: Hemodynamicsmentioning

confidence: 99%

Current Understanding of Dolichoarteriopathies of the Internal Carotid Artery: A Review

et al. 2017

Int. J. Med. Sci.

View full text Add to dashboard Cite

Dolichoarteriopathies of the internal carotid artery (DICAs) are not uncommon, and although several studies have investigated DICAs, several questions regarding the etiology and best management course for DICAs remain unanswered. It is also difficult to correlate the occurrence of DICAs with the onset of clinical symptoms. Therefore, we surveyed the literature in PubMed and performed a review of DICAs to offer a comprehensive picture of our understanding of DICAs. We found that DICAs can be classified into three types, specifically tortuous, coiling and kinking, and are not associated with atherosclerotic risk factors. Cerebral hemodynamic changes are mainly associated with the degree of bending of DICAs. DICAs can result in symptoms of the brain and eyes due to insufficient blood supply and can co-occur with a pulsatile cervical mass, a pharyngeal bulge and pulsation. The diagnostic tools for the assessment of DICAs include Doppler ultrasonography, computed tomography angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA), and although DSA remains the gold standard, Doppler ultrasonography is a convenient method that provides useful data for the morphological evaluation of DICAs. CTA and MRA are efficient methods for detecting the morphology of the cervical segment of DICAs. Some DICAs should be treated surgically based on certain indications, and several methods, including correcting the bending or shortening of DICAs, have been developed for the treatment of DICAs. The appropriate treatment of DICAs results in good outcomes and is associated with low morbidity and mortality rates. However, despite the success of surgical reconstruction, an appropriate therapeutic treatment remains a subject of numerous debates due to the lack of multicentric, randomized, prospective studies.

show abstract

“…The consistency of the lesion locations across Groups 1 and 2 is compelling, but more study is needed on the mechanisms underlying this regional vulnerability. For example there may be regional differences in vessel tortuosity ( Wang et al, 2016 ) or flow rate that may predict risk factors for lesion deposition. A priori studies of the brain regions identified in this study should enable more sensitive analyses.…”

Section: Discussionmentioning

confidence: 99%

Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization

Rosen

Soman

Bhat

et al. 2018

NeuroImage: Clinical

View full text Add to dashboard Cite

Carotid revascularization (endarterectomy, stenting) prevents stroke; however, procedure-related embolization is common and results in small brain lesions easily identified by diffusion weighted magnetic resonance imaging (DWI). A crucial barrier to understanding the clinical significance of these lesions has been the lack of a statistical approach to identify vulnerable brain areas. The problem is that the lesions are small, numerous, and non-overlapping. Here we address this problem with a new method, the Convergence Analysis of Micro-Lesions (CAML) technique, an extension of the Anatomic Likelihood Analysis (ALE). The method combines manual lesion tracing, constraints based on known lesion patterns, and convergence analysis to represent regions vulnerable to lesions as probabilistic brain atlases. Two studies were conducted over the course of 12 years in an active, vascular surgery clinic. An analysis in an initial group of 126 patients at 1.5 T MRI was cross-validated in a second group of 80 patients at 3T MRI. In CAML, lesions were manually defined and center points identified. Brains were aligned according to side of surgery since this factor powerfully determines lesion distribution. A convergence based analysis, was performed on each of these groups. Results indicated the most consistent region of vulnerability was in motor and premotor cortex regions. Smaller regions common to both groups included the dorsolateral prefrontal cortex and medial parietal regions. Vulnerability of motor cortex is consistent with previous work showing changes in hand dexterity associated with these procedures. The consistency of CAML also demonstrates the feasibility of this new approach to characterize small, diffuse, non-overlapping lesions in patients with multifocal pathologies.

show abstract

Pressure Drop in Tortuosity/Kinking of the Internal Carotid Artery: Simulation and Clinical Investigation

Cited by 27 publications

References 6 publications

Extracranial Internal Carotid Artery Tortuosity and Body Mass Index

Extracranial Internal Carotid Artery Tortuosity and Body Mass Index

Current Understanding of Dolichoarteriopathies of the Internal Carotid Artery: A Review

Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization

Contact Info

Product

Resources

About