ObjectiveTo observe the morphological characteristics of internal carotid artery (ICA) siphon and ophthalmic artery (OA) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) based on CT angiography (CTA) three-dimensional reconstruction of ICA siphon and OA models. MethodsA retrospective cohort study. From January 2017 to January 2019, 26 patients with 31 eyes (NAION group) who were diagnosed with NAION by ophthalmic examination at Beijing Friendship Hospital, Capital Medical Universitywere included in the study. Among them, there were 11 males with 13 eyes, and 15 females with 18 eyes; the age was 67.52±6.30 years old. Nineteen eyes of 19 non-affected contralateral eyes were selected as the contralateral eye group. Among them, there were 9 males with 9 eyes and 10 females with 10 eyes; the age was 65.95±5.66 years old. Twenty-six eyes of 26 age- and sex-matched subjects with normal fundus examination during the same period were selected as the normal control group. All subjects underwent best corrected visual acuity (BCVA), intraocular pressure, fundus photography and CTA examination. The data obtained from CT scans were reconstructed by 3D model, and the anatomical morphology of ICA siphon was divided into U-shape, V-shape, C-shape and S-shape; the diameter of ICA siphon portion and the diameter at the beginning of OA were measured. One-way analysis of variance was used to compare the diameter of the OA at the beginning of the OA and the diameter of the ICA siphon between the three groups of eyes. ResultsThe diameters at the beginning of OA in the NAION group, the contralateral eye group, and the normal control group were 1.17±0.20, 1.34±0.17, and 1.39±0.15 mm, respectively, and the differences among the three groups were statistically significant (F=12.325, P<0.05); there was no significant difference between the contralateral eye group and the normal control group (P=0.310). In the NAION group, the anatomical morphology of the ICA siphon was U-shaped and V-shaped in 20 (64.52%) and 8 (25.81%) eyes respectively, and S and C-shaped in 3 eyes (9.67%); in the contralateral eye group, in the control group, the ICA siphon shape of the eyes examined was U-shaped and V-shaped, and S-shaped and C-shaped were rare. The diameters of the ICA siphons in the NAION group, the contralateral eye group, and the normal control group were 3.50±0.69, 3.22±0.59, and 3.55±0.54 mm, respectively. There was no significant difference between the three groups (F=1.860, P=0.163). ConclusionU-shaped and V-shaped ICA siphons are more common in NAION-affected eyes; the diameter of the starting point of OA is significantly reduced.
Objective To compare the early compl ications of carotid stenting (CAS) and carotid endarterectomy (CEA) in treatment of carotid artery stenosis. Methods Between January 2005 and December 2007, 63 patients with carotid artery stenosis were treated with CEA in 36 cases (CEA group) and with CAS in 27 cases (CAS group). There were 42 males and 21 females with an average age of 67.5 years (range, 52-79 years). The locations were the left side in 28 cases and the rightside in 35 cases. The carotid stenosis was 60%-95% (mean, 79%). The major cl inical symptoms were stroke and transient ischemic attack. The cranial CT showed old cerebral infarction in 24 cases, lacunar infarction in 22 cases, and no obvious abnormal change in 17 cases. The encephalon, heart, and local compl ications were compared between 2 groups within 7 days after operation. Results In CEA group, encephalon compl ications occurred in 3 cases (8.3%), heart compl ications in 2 cases (5.6%), and local compl ications in 5 cases (13.9%); while in CAS group, encephalon compl ications occurred in 8 cases (29.6%), heart compl ications in 1 case (3.7%), and local compl ications in 3 cases (11.1%). The encephalon compl ication ratio of CAS group was significantly higher than that of CEA group (χ2=4.855, P=0.028); and there was no significant difference in other compl ications ratios between 2 groups (P gt; 0.05). Conclusion CEA is the first choice to treat carotid artery stenosis.
ObjectiveTo summarize the etiology and prevention measures of carotid artery pseudoaneurysms following carotid endarterectomy (CEA) and discuss the complications and prognosis of it performed surgery and endovascular treatment.
MethodsThe process and experience of diagnosis and treatment of two patients with carotid pseudoaneurysm following CEA admitted in this hospital from January 2000 to March 2014 were analyzed retrospectively. The related English literatures concerning carotid artery pseudoaneurysm following CEA in PubMed, SpringerLink, ELSEVIER, and ScienceDirect database were searched and then made a conclusion.
Results①The incidence of carotid artery pseudoaneurysms following CEA in this hospital was 0.31% (2/641). These two patients were treated with surgery and endovascular therapy respectively, and both recovered well after the treatment.②Thirty-nine related literatures totally were collected, including 187 patients with carotid artery pseudoaneurysm. One hundred and forty patients were treated with artificial patches during CEA, and 36 patients suffered secondary infection in the surgical sites. One hundred and fifty-two patients were treated with surgery, while 33 patients were treated with endovascular therapy, the residual two patients were accepted hybrid surgery. The overall incidence of cranial nerve injuries, the incidence of 30-day stroke, and the incidence of 30-day mortality were 6.4% (9/141), 7.4% (12/163), and 2.7% (5/182), respectively.
ConclusionsSurgical site infection is one of the important reasons which lead to carotid artery pseudoaneurysm following CEA. Aneurysm resection and carotid artery reconstruction is still the main treatment of the carotid artery pseudoaneurysm; endovascular therapy could be used as a choice for a part of the patients. How to reduce the perioperative cranial nerve damage and the incidence of complications such as stroke still need further to be studied.
ObjectiveTo study the correlation between neck artery vascular sclerosis and homocysteine levels in hypertensive patients.
MethodsA total of 2 132 patients with hypertension participated in the program of "Stroke screening and prevention in Dongying city" were included from Sep. 2012 to Jan. 2013. Questionnaire, physical examination, biochemical blood tests and carotid artery ultrasound were conducted in all included patients. According to the level of homocysteine (Hcy), patients were divided into three groups:716 patients with Hcy level less than 12.3 mm/L were in Group 1, 703 patients with Hcy level 12.3 to 16.5 mm/L were in Group 2, and 713 patients with Hcy level more than 16.5 mm/L were in Group 3. The influence of Hcy levels on carotid atherosclerosis was analyzed.
Results① The prevalence rate for carotid plaques in Groups 1, 2, and 3 were 50.28%, 60.03% and 65.36%, respectively. The prevalence rate for carotid plaques in Group 2 was higher than that in Group 1 with a statistical difference (OR=1.485, 95% CI 1.203 to 1.833, P=0.000). The prevalence rate in Group 3 was also higher than that in Group 1 with a statistical difference (OR=1.866, 95% CI 1.508 to 2.308, P=0.000). ② The prevalence rate for carotid plaques was 62.24% in the rural population, and 52.39% in the urban population. The difference between urban and rural populations was statistically significant (OR=1.500, 95% CI 1.259 to 1.788, P=0.000). ③ Using the presence of carotid plaques as a dependent variable and Hcy level as a covariant, logistic regression analysis found that the plaque formation in Group 2 was 1.491 times than in Group 1 and the plaque formation in Group 3 was 1.752 times than in Group 1. After adjusting the risk factors (gender, age, BMI, TG, TC, LDL-C, HDL-C and blood sugar level), the results showed that the plaque formation in Group 2 was 1.388 times than in Group 1, and the plaque formation in Group 3 was 1.452 times than in Group 1.
ConclusionThere is a correlation between the increased incidence of carotid plaque and homocysteine levels in patients with hypertension. The incidence of carotid plaque in the rural population with hypertension is higher than that in the urban population. In the population with hypertension, high homocysteine level is an independent risk factor for the formation of carotid plaques.
【摘要】 目的 探討血尿酸水平、頸動脈斑塊與冠心病之間的關系。 方法 收集2006年1月-2009年12月擬診為冠心病的住院患者280例,冠狀動脈造影檢查冠狀動脈狹窄程度gt;50%的194例為冠心病組,冠狀動脈無狹窄或狹窄程度lt;50%的86例為對照組;冠心病組又分為單支、雙支、多支病變亞組。分別測定冠心病組與對照組頸總動脈與頸動脈分叉處內膜中層厚度(IMT)、等級評分、Crouse積分、血尿酸濃度。結果 與對照組相比,冠心病組頸總動脈與頸動脈分叉處IMT、等級評分、Crouse積分、血尿酸濃度均高于對照組,差異有統計學意義。在冠心病組,隨病變分支的增多,頸動脈超聲檢查指標與血尿酸隨之升高(Plt;0.05或0.01)。 結論 頸動脈IMT、等級評分、Crouse積分、血尿酸濃度與冠心病相關,是冠心病的獨立危險因素。【Abstract】 Objective To investigate the relationships between serum uric acid levels, carotid artery plaque and coronary heart disease (CHD). Methods 194 patients with CHD and 86 nonCHD patients were selected through coronary angiography in patients with essential hypertension. CHD group was divided into three subgroups including a single branch, doublebranch and multivessel disease. Intimamedia thickness (IMT) of carotid artery and carotid bifurcation, grade score, Crouse score, serum uric acid concentrations were detected in patients with coronary heart disease and control group. Results IMT of carotid artery and carotid bifurcation, grade score,crouse score, serum uric acid concentrations were higher in CHD group than that in control group, and the difference was statistically significant. In the CHD group, ultrasound parameters of carotid artery and serum uric acid increased with the increase in branch lesions (Plt;005 or 001). Conclusions Carotid IMT, grade score, Crouse score, serum uric acid concentration relate to coronary heart disease, which is an independent risk factor for coronary heart disease, respectively.
ObjectiveTo observe the effects of carotid artery stenting (CAS) on ophthalmic artery blood flow in patients with ischemic ophthalmopathy (IOP).MethodsA prospective case-control study. Sixty IOP patients (60 eyes) who met inclusive criteria for CAS were enrolled in this study. There was 50% stenosis of internal carotid artery on one side at least confirmed by color doppler flow imaging (CDFI). Among 60 eyes, there were 3 eyes with central retinal artery occlusion, 15 eyes with retinal vein occlusion, 37 eyes with ischemic optic neuropathy, 5 eyes with ocular ischemia syndrome. The patients were randomly divided into CAS group (32 eyes of 32 patients) and medicine therapy group (28 eyes of 28 patients). The difference of age (t=1.804) and sex (χ2=1.975) between two groups was not significant (P＞0.05). The examinations of fundus fluorescein angiography (FFA), CDFI and digital substraction angiography (DSA) were performed before, 1 week and 6 months after treatment. The following parameters were recorded: arm-retinal circulation time (A-Rct), peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) in the ophthalmic artery (OA) and central retinal artery (CRA), and the best corrected visual acuity (BCVA).ResultsThere was no significant differences in A-Rct (t=1.354) and BCVA (t=0.376) between the two groups before treatment (P＞0.05). Also, there was no significant differences in PSV (t=?0.294, ?2.446), EDV (t=0.141, ?0.305), and RI (t=?0.222, ?0.694) of OA and CRA between the two groups before treatment before treatment (P＞0.05). Compared with the medicine therapy group, the lower A-Rct was found in the CAS group at different time points after the treatment. The difference was significant on 1 week after treatment (t=?3.205, P＜0.05), but not on 6 months after treatment (t=1.345, P＞0.05). The BCVA of eyes in the two groups were increasing with the extending of time of therapy. Compared with the medicine therapy group, the better BCVA was found in the CAS group at different time points after the treatment (t=0.800, 1.527; P＜0.05). Compared with the medicine therapy group, the higher PSV, EDV and lower RI of OA and CRA were found in the CAS group at different time points after the treatment. (P＜0.05).ConclusionCompared with conventional medicine therapy, CAS shows earlier effects in improving ocular hemodynamics for IOP patients with carotid artery stenosis, which benefits visual function improvement of the patients.
Objective To find out the follow-up results of early in-stent restenosis (ISRS) and develop effective way to improve clinical treatment and precaution of restenosis. Methods The data from a registry of 51 consecutive patients who underwent elective carotid artery angioplasty and stenting （CAS） at our institution between Jan. 2003 and Sept. 2005 were retrospectively reviewed. Complete data for 37 of these patients were available. All patients underwent duplex ultrasound scanning in follow-up period, which was used to determine the degree of restenosis. Results CAS was performed in 37 patients， 8.1% (3/37) were women. Mean age was (70.5±5.9) years. Mean time of follow-up was (12.2±7.7) months. Sixteen (43.2%) caces of ISRS （gt;30%） were found by color duplex ultrasound scanning， but only 1 (2.7%) ISRS was found gt;50%; 3 female patients had minor ISRS. Among all factors, female patients had higher incidence of ISRS than male (P=0.038); balloon-expanding after stenting and accompanying with other artherosclerosis of periphery vessel had correlation about ISRS （P=0.037, P=0.016）. Conclusion The severe restenosis rate is acceptable. Female patients were more likely to have ISRS. Balloon-expanding maybe have effect on reducing incidence of ISRS and controlling artherosclerosis was helpful.
Objective
To investigate the clinical characteristics and mechanisms of ocular manifestations
related to carotid artery stenosis.
Methods
The general clinic data and related ocular manifestations in 124 patients with
carotid artery stenosis were retrospectively.
Results
In the 124 patients, 36 (29%) had ocular manifestations, and 28 (22. 6 %)
complained the ocular discomfort as the first symptom. Among the 36 patients,
31 patients (86.1%) had been disclosed unilateral or double stenosis of internal
carotid artery by carotid Doppler ultrasound examination, and the result of digital subtract angiography revealed middle and severe degree of internal carotid artery stenosis in 8 and 23 patients respectively. There was no statistic difference of incidence of ocular manifestations between 67 patients of severe internal carotid artery stenosis and 34 patients with middle one（chi;２test,P =0.266 2，P＞0.05). The ocular manifestations included amaurosis fugax (52.8%),acute decline or loss of the visual ability and defect of visual fields (36.1%), binocular diplopia (13.9%), ptosis (13.9%), and persistent high intraocular pressure(2.8%) one patient might had several ocular manifestations simultaneously. In 36 patients, central retinal artery occlusion had been diagnosed in 4, venous stasis retinopathy in 1,central or branch retinal vein occlusion in 6, neovascular glaucoma in 1, and anterior ischemic opticneuropathy in 2. One patient with double occlusion of internal carotid artery didnrsquo;t have any ocular manifestation.
Conclusion
Carotid artery stenosis, especially internal carotid artery may lead to acute or
chronic ocular ischemic lesions, and the occurrence of ocular manifestations in
chronic ocular ischemic lesions relates to compensa tion of collateral circulation；patients with ocular ischemic lesions are recomm end to undergo a routine carotid artery examination.
(Chin J Ocul Fundus Dis, 2006,22:376-378)
ObjectiveTo investigate the MRI manifestations of internal carotid artery dissection (ICAD) before and after treatment.
MethodsMRI materials of 20 patients with ICAD between November 2007 and February 2013 were collected for analysis.
ResultsMRI manifestations of ICAD showed 17 cases of artery stenosis, 16 cases of mural hematoma or thrombus, 3 cases of aneurysmal dilatation, and 2 cases of lines of intimal flap. The treatment outcome MRI manifestations showed that 18 patients had effective response, including disappeared (n=9) and lessened (n=8) artery stenosis, disappeared (n=13) and diminished (n=3) hematoma and thrombus, and shrunken aneurysmal dilatation (n=1); and there were 2 cases of unchanged aneurysmal dilatation, and another 2 patients had aneurysmal dilatation while stenosis lessened.
ConclusionMRI manifestations of internal carotid artery dissection mainly include stenosis, mural hematoma or thrombus, and aneurysmal dilatation. Stenosis, mural hematoma or thrombus usually disappear and lessen in the treatment, and all MRI findings may vary among each other.
ObjectiveTo summarize the experience in treating the elderly patients (≥75 years old) with carotid artery stenosis, and to evaluate the efficacy and safety of the carotid endarterectomy (CEA).
MethodsThe datum of 312 cases with carotid artery stenosis and underwent the CEA in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were retrospectively analized.The risk factors of the CEA in treating the elderly patients were analized, and the measures to prevent perioperative complications were discussed.
ResultsThirty-nine cases were brought into the research.The mean follow-up was (22.18±8.71) months.Thirty-three cases (84.6%) were male and 6 cases (15.4%) were female.The median age was 77 years old (75-82 years old).Eleven cases (28.2%) were with bilateral lesions, and 7 cases (17.9%) were asymptomatic.A total of 39 CEA procedures were successfully performed, 22 artificial vascular patches (56.4%) and 16 shunts (41.0%) were used.The mean average hospital stay was (17.38±5.39) days.One case showed cerebral hyperperfusion syndrome in 2th day after operation, another 1 case was found ipsilateral restenosis in 15th month after operation.
ConclusionCEA is a safe and effective measure in treating the elderly patients with carotid artery stenosis, if the the indications of surgery is performed strictly.
