Introduction: Atherosclerotic carotid artery disease (CAD) is a major cause of ischemic stroke. Duplex ultrasonography (DUS) is one of the most valuable examinations which can provide not only morphologic data but also velocity. The purpose of this study is to investigate relationship among hemodynamic impairment (HDI), peak systolic velocity (PSV) in patients with CAD.
Methods: From April 2009 and May 2019, 104 patients suffering from atherothrombotic brain infarction (ATBI) due to CAD were collected in this study. Magnetic resonance imaging (MRI), DUS and quantitative single-photon emission computed tomography (QSPECT) were conducted. All patients were divided into 2 groups according to cerebrovascular reserve capacity (CVRC) of ≥10% or <10% and designated non-HDI group or HDI group, respectively.
Results: The number of non-HDI group and HDI group were 67 and 37. NASCET stenosis ratio and peak systolic velocity (PSV) were significantly higher in HDI group (71.3 ± 10.5% vs. 77.2 ± 8.3%, ρ < 0.01; 299 ± 153cm/s vs. 431 ± 131cm/s, ρ < 0.0001; respectively). A multi-logistic regression analysis revealed that high PSV (odds ratio, 65.94; 95% CI, 4.78–910.10; ρ < 0.001) was independently associated with HDI. A receiver operating characteristic curve of PSV to distinguish non-HDI and HDI showed area under the curve was 0.768. Cutoff value was PSV = 381cm/s. This study demonstrated increasing PSV was independently associated with HDI in patients with ATBI.

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Pseudoaneurysms typically occur iatrogenically as a result of procedures such as femoral artery puncture, and are often associated with pain and a pulsatile mass, for which manual compression is the first treatment choice. Here we report a pseudoaneurysm without mass or pain that was found incidentally after femoral artery puncture. A 74-year-old woman with left middle cerebral artery occlusion underwent mechanical thrombectomy using a 9Fr sheath via the right femoral artery. After treatment, a hemostatic device was used to seal the sheath puncture site. No pulsatile mass or groin pain was noted thereafter. However, on the 17th postoperative day, a lower extremity ultrasound examination incidentally revealed a pseudoaneurysm of the right femoral artery. On the same day, ultrasound-guided compression was performed, and loss of blood flow to the pseudoaneurysm was confirmed. However, a repeat ultrasound examination on the following day demonstrated return of blood flow to the pseudoaneurysm. Ultrasound-guided compression was performed again, and repeat ultrasonography on the following day showed no resumption of blood flow to the pseudoaneurysm. The present case illustrates that pseudoaneurysms occurring after femoral artery puncture may not be associated with an inguinal mass or pain. Careful follow-up is also necessary because pseudoaneurysms may recur after manual treatment.

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