Purpose: We attempted to detect high intensity transient signals (HITS) at common carotid artery (carotid HITS) by paste type Doppler probe in residents at Kashiwazaki City where big earthquake occurred in 2008. Calf deep venous thrombosis (DVT) has been detected frequently in the residents due to earthquake. It was examined whether it relates to DVT, cerebro-cardiovascular diseases (CCVDs), etc.
Subjects and Methods: We conducted screening for 522 residents in Kashiwazaki City in 2016–2017. HITS were detected by using 2.0MHz paste type probe at carotid artery for 5min.
Results: Carotid HITS was detected in 39 (7.5%). Statistically significant risk factors in the carotid HITS positive group were arterial velocity pulse index (AVI), CCVDs and atrial fibrillation. Univariate analysis of cerebro-cardiovascular disease indicated an odds ratio of 3.8 (95% CI: 1.8–7.9, p = 0.001) in the carotid HITS positive, and furthermore odds ratio 3.6 (95% CI: 1.6–7.9, p = 0.001) was found in the same group in multivariate analysis.
Conclusion: Carotid HITS was a significant risk factor for CCVDs and atrial fibrillation in the general population. Therefore, it was suggested that detection of HITS at carotid artery by paste type probe may be useful for prevention of embolic disease.

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Background: The characteristics of carotid plaque strongly influence the potential risk of stroke. However, few studies have followed up patients with carotid characteristics using contrast-enhanced ultrasonography (CEUS).
Objective and Methods: Between July 2015 and September 2017, we enrolled 50 patients with carotid stenosis who underwent carotid ultrasonography (CUS), CEUS, and black-blood magnetic resonance imaging (BB-MRI) to evaluate the carotid characteristics. We assessed the correlation between enhancement-positive, ulcer-positive, T1-high, and recurrence or ipsilateral ischemic stroke or death.
Results: Of the 50 patients hospitalized for carotid stenosis, 8 (16%) developed recurrence of ipsilateral ischemic stroke or died in the first year of follow-up. In the ulcer-positive group, the recurrence or death rate was 35% (6/17) during the first year, which was statistically different from that in the ulcer-negative group (p < 0.05).
Conclusions: Follow-up by CEUS in patients with ulcer-positive carotid plaque can provide valuable information regarding ipsilateral ischemic recurrences or death.

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Transoral carotid ultrasonography (TOCU) is a powerful tool for evaluating the high internal carotid artery (ICA). Multiple reports have documented its excellent ability to show dissection of the high ICA. Superb microvascular imaging (SMI) is a new Doppler imaging technique that reduced motion artifacts and allows visualization of low-velocity blood flow in vessels. A 45-year-old man with aphasia and right hemiplegia was brought to our hospital. MRI showed acute cerebral infarction, and he was treated by recombinant tissue plasminogen activator (rt-PA). A carotid angiogram showed the dissection of the left extracranial ICA, and carotid artery stenting of the left ICA was performed. Postoperative SMI-TOCU showed that blood flow was preserved with no stenosis. It seemed that a part was missing. This was caused by slight turbulence caused by the step of the stent. The present case suggests that post-procedure evaluation by SMI-TOCU for carotid artery stenting in ICA dissection may be useful.

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