Purpose: In Takayasu’s arteritis and temporal arteritis, vascular inflammation located at sites other than the common carotid artery and subclavian artery has not been adequately investigated. This study examined inflammatory images of the vertebral artery (VA) using ultrasonography. Methods: We examined 54 patients (108 arteries), including 29 patients (58 arteries) with Takayasu’s arteritis and 25 patients (50 arteries) with temporal arteritis), who underwent carotid ultrasonography. The frequency and properties of VA lesions were compared between patients with Takayasu’s arteritis and temporal arteritis. Results: Two of the 58 arteries with Takayasu’s arteritis showed a halo sign, two had stenosis, and three had occlusion. Eleven of the 50 arteries with temporal arteritis had a halo sign, and none showed stenosis or occlusion. Stenosis and occlusion were more common in VA lesions of patients with Takayasu’s arteritis, whereas halo sign was more common in patients with temporal arteritis. Discussion: By the time of ultrasonography, Takayasu’s arteritis had often already progressed to the stage of VA stenosis and occlusion, whereas temporal arteritis may be identified at an earlier stage. Conclusion: Ultrasonographic characteristics of VA lesions differ between Takayasu’s arteritis and temporal arteritis.
We have diagnosed the extremely fragile plaque as motion of the plaque content, and have reported their clinical characteristics and therapeutic importance. A floating mass associated with motion of plaque content could also potentially cause an embolic stroke. However, the origin and pathogenesis of such floating masses have not yet been clarified. We have experienced five cases of patients who had symptoms of CVA and underwent pathological examination following carotid endarterectomy. The floating mass dominantly existed at the distal part of the plaque and was pathologically consistent with thrombus. The relation of hemostasis as well as the existence of a thrombotic core, in addition to the damaged surface membrane of the plaque, was suspected to play an important role in the mechanism of disease in such cases. Such abnormal hemodynamics could result in embolic stroke and should be treated surgically and as soon as possible.
Introduction: Echo intensity is an important finding in muscle echography, but echo intensity varies with factors such as gain, sensitivity, and time control. Methods: When assessing a target muscle, an examiner’s bicep was treated as the control muscle. Dual-screen (target and control muscles) and conventional single-screen (target muscle) methods were used. We examined 10 diseased muscles and 10 normal muscles as target muscles. Three echo beginners rated the target muscle using a visual analog scale (VAS). We also measured intensity differences between target and control muscles using pixel values from a histogram. Results: Using the dual-screen method, intensity of diseased muscles (189.6 ± 28.0 mm, 20.0 ± 21.2 pixels was found to be significantly higher than that of normal muscles (98.7 ± 42.8 mm, p = 0.005; –19.8 ± 13.9 pixels, p = 0.007), according to both VAS and pixel values. Using the single-screen method, no significant difference was observed between diseased muscles (197.7 ± 62.7 mm) and normal muscles (112.7 ± 71.1 mm, p >0.05), as noted by the VAS. However, diseased muscle intensity based on pixel value (49.8 ± 14.9 pixels), was significantly higher than normal muscle intensity (35.0 ± 12.3 pixels, p = 0.047). Conclusion: The present analysis suggests that the dual-screen method may be useful for diagnosing muscle echo intensity.
The aim of this study was to investigate acceleration time (AcT) in carotid ultrasonography for evaluation of severe restenosis after carotid artery stenting (CAS). Subjects comprised 49 consecutive patients (155 examinations) who underwent CAS. Peak systolic velocity (PSV) and AcT of the internal carotid artery (ICA-AcT) were measured using carotid ultrasonography in all patients. ICA-AcT was measured distal to the stent. The stenosis was measured by CT or digital angiography in 16 patients (22 examinations) using the NASCET method. Significant correlations were seen between PSV and ICA-AcT (p < 0.01; correlation coefficient, r = 0.346). ICA-AcT was significantly prolonged by contralateral ICA occlusion or severe stenosis (p < 0.01, standardized partial regression coefficient β = 0.322) and aging (p = 0.03, β = 0.164). In a receiver operating characteristic curve analysis, the sensitivity and specificity of ICA-AcT using 107.7 msec as a cut-off were 85.7% and 88.4%, respectively, for predicting PSV > 300 cm/sec, indicating severe restenosis after CAS. This cut-off is similar to that previously reported for a non-stented carotid artery. AcT in carotid ultrasonography is useful for evaluating restenosis after CAS.
We report two cases of direct-type carotid cavernous fistula (CCF) which was diagnosed on carotid ultrasonography (CUS). Case1: A 69-year-old woman. She had abrupt onset of diplopia and tinnitus. Head computed tomography and magnetic resonance imaging (MRI) indicated she had right CCF. CUS indicated an increase in end-diastolic velocity (EDV) of the right internal carotid artery (ICA). Pulsatility index (PI) and resistance index (RI) decreased to 0.63 and 0.45, respectively. CCA end-diastolic ratio rose, and this showed the significant laterality of flow between the right and left ICAs. Case2: An 88-year-old woman who complained visual impairment had right exophthalmos, conjunctival injection and bruit around right orbit. Head MRI demonstrated the dilatation of right superior ophthalmic vein, which reflected the existence of right CCF. On the CUS study, peak systolic velocity (PSV) and EDV of the right ICA were significantly elevated, and PI and RI were decreased to 0.63 and 0.45, respectively. CCA end-diastolic ratio was also significantly elevated. After treatment of the CCF, these values returned toward normal. Since vascular resistance of the affected side is low in CCF patients, CUS easily determined the abnormality as well as the change after treatment. Thus, CUS is useful for both screening and determining the treatment effect of direct-type CCF.
A 48-year-old man experienced sudden onset of blurred vision followed by transient disturbance of speech. No neurological abnormality was observed other than blurry vision. Conventional carotid ultrasonography revealed left internal carotid artery (ICA) occlusion and double lumen was detected by 3D-CTangiography (CTA). A thrombosed pseudolumen was visualized by transoral carotid ultrasonography (TOCU) in the far distal segment of the ICA. We diagnosed ICA dissection and started anticoagulation. However, the patient suffered transient aphasia on Day 3 and acute ischemic lesion in the left insular cortex was revealed on MRI. On Day 16, a blood flow signal was detected on TOCU in the true lumen, but not in the thrombosed pseudolumen. On Day 23, he was discharged from hospital under antiplatelet monotherapy. At the scheduled follow-up with CTA and TOCU on Day 36, asymptomatic arterial dissection was detected in the contralateral right ICA, and was confirmed by conventional angiography. On Day 58, he was discharged without further ischemic events. Symptomatic ICA dissection may be followed by asymptomatic spontaneous contralateral ICA dissection and TOCU offers a powerful tool for detecting this delayed phenomena.