Purpose: Previously we reported that the carotid artery (CA) moved longitudinally. In the presented study, we investigated the movement of the CA with or without breath hold (BH) to clarify if the respiration might attribute to the longitudinal movement.
Methods: All subjects underwent carotid ultrasonography between November 2016 and December 2017. A total of 39 vessels with 78 lesions, which had plaques in both ipsilateral ICA (n = 39) and CCA (n = 39) was evaluated. The template matching method was used to measure the total length of the CA movement.
Results: The movement of region of interests in plaques was significantly larger in the group without BH than that in the group with BH (p < 0.0001). In case without breath hold, the total length of the movement in the CCA (3.05 ± 0.40mm) was larger than that in the ICA (1.32 ± 0.14mm) (p = 0.001).
Discussion: Movement of the CA was found to be more affected by breathing. The anatomical condition (i.e., distance from the lung) would be the main reason why the length of wall movement is larger in the CCA than in the ICA.
Conclusion: movement of the CA associates with not only by the pulsation but also by breathing.

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Objective: Lacunar infarction and intracerebral hemorrhage (ICH) have common characteristics of cerebral small-vessel disease (CSVD) although they are classified as different stroke subtypes. Previous studies showed a positive correlation of CSVD with physiological parameters such as pulse wave velocity (PWV) or with radiographical findings such as leukoaraiosis; however, the role of these parameters remains controversial. Therefore, we assessed whether there is a relationship between stroke subtypes and these potential CSVD-related parameters.
Methods: In a multicenter, retrospective study from 8 hospitals, we enrolled 874 patients with a history of cerebral infarction or ICH who underwent both carotid ultrasound and MRI examination between June 2008 and May 2010. We evaluated the values of PWV, ultrasonographic parameters and MRI findings, and compared them between the stroke subtypes.
Results: Of patients, 331 (38%) were classified into the large artery atherosclerosis (LAA) group, 387 (44%) into the small vessel occlusion (SVO) group, and 156 (18%) into the ICH group. Lower max intima media thickness (IMT) and lower plaque score, and higher PWV were shown in SVO and ICH groups than those in LAA groups. Higher pulsatility index (PI) of common carotid artery (CCA) in SVO group, higher PI of ICA and higher prevalence of cerebral micro-bleeds (CMB) in ICH group were also shown than those in LAA group. After adjustment for vascular risk factors, the following parameters in both SVO and ICH groups were significantly different from those in the LAA group: lower max IMT, lower plaque score, higher periventricular hyper-intensity (PVH) grade, and higher prevalence of CMB. PIs of CCA and internal carotid artery (ICA) were higher in ICH group than those in LAA group.
Conclusions: The similar trends of some physiological and radiographical parameters were shown in ICH and SVO group compared with LAA group, which reflected the underlying pathophysiology of CSVD.

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We report the efficacy of ultrasound in two cases of carotid artery stenting (CAS). During CAS, in-stent plaque protrusions were detected by percutaneous ultrasound, which was useful to observe the disappearance of plaque protrusions (PP), after balloon dilation or overlapping stent intervention, in real time. Using ultrasound during CAS provides an easy and non-invasive visualization of PP.

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A 64-year-old man presented to our hospital with visual loss on the left eye due to central retinal artery occlusion diagnosed by another ophthalmological hospital. Magnetic resonance imaging revealed small multiple cerebral infarctions on bilateral hemisphere. Transesophageal echocardiography was performed, which revealed a mass lesion like a tumor with calcification on the mitral valve. We suspected that a mass lesion is calcified amorphous tumor (CAT). Surgical resection of the mass lesion was performed, and it was diagnosed CAT by pathological examination. CAT is considered as high risk of cerebral embolism, surgical treatment should be considered as early as possible.

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Background and purpose: Carotid artery stenting (CAS) usually requires iodinated contrast medium; however, using iodinated contrast medium is difficult for patients with chronic kidney disease and iodine allergy. We report the case of a patient with chronic kidney disease and severe stenosis of the internal carotid artery (ICA) on the right side of the neck who underwent CAS through a balloon distal protection device with little use of contrast medium.
Case: A 79-year-old male was admitted to our hospital for left hemiplegia. Diffusion MRI revealed an acute symptomatic brain infarcts in the right hemicerebrum; a carotid duplex ultrasound revealed right ICA stenosis (peak systolic velocity, 287cm/s). Blood test showed chronic kidney disease (eGFR, 33.8ml/min/1.73m²). Ultrasound-guided CAS was performed to use a minimized contrast medium. Ultrasound-guided CAS plays a vital role in the assessment of distal balloon protection, including inflation or deflation of a balloon. The total volume of iodinated contrast medium was 7ml. The day after CAS, the patient did not develop contrast medium-induced nephropathy.
Conclusions: Ultrasound-guided CAS is safe and feasible for patients with preexisting chronic kidney disease, and intraprocedural status change can be confirmed in real time.

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