Flip-Flop Phenomenon:  Swallowing-Induced Arterial Displacement as an Indicator of Carotid Artery Disease

Kinoshita, Naoto; Saito, Kozue; Yamaguchi, Yoshitaka; Abe, Soichiro; Wada, Shinichi; Kajimoto, Kan; Yamagami, Hiroshi; Makino, Hírofumi; Toyoda, Kazunori; Ihara, Masafumi; Nagatsuka, Kazuyuki

doi:10.1159/000490180

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…Kinoshita et al reported on a patient with stroke with repeated positional changes of the carotid arteries to and from a retropharyngeal position with interference of the hyoid bone during swallowing, and they named it the “flip-flop phenomenon (FFP)” 121 ) . Patients with FFP exhibited a higher prevalence of internal carotid stenosis than those without 122 ) . Although FFP might be a potential indicator of ischemic stroke, a lack of evidence on whether the presence of FFP is predictor of ischemic stroke exists.…”

Section: Other Aspects Of Assessments Using Carotid Ultrasonographmentioning

confidence: 90%

Usefulness of Carotid Ultrasonography for Risk Stratification of Cerebral and Cardiovascular Disease

Nezu

Hosomi

2020

JAT

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Carotid ultrasonography is useful for the assessments of the risk stratification for stroke or coronary artery disease, because it is a simple, repeatable, and noninvasive procedure. The carotid intima-media thickness (IMT), which is assessed using carotid ultrasonography, is a widely used surrogate marker for the severity of atherosclerosis. Several large clinical studies showed that increased carotid IMT is associated with the future stroke or cardiovascular events. In addition, in many clinical trials, it has been adopted for surrogate markers of clinical endpoints of medical intervention. Moreover, carotid ultrasonography allows the measurement of the presence and characteristics of plaques and the severity of carotid artery stenosis. The unstable morphology of plaque, such as hypoechoic, ulcer, and mobility, is associated with future ischemic stroke events. The screening tool of asymptomatic carotid artery stenosis is also important, although whether routine carotid ultrasonography assessment is recommended in the general population remains controversial. The screening of carotid artery stenosis using ultrasonography is essential for not only daily clinical settings but also management of patients with acute ischemic stroke. The patients with atherothrombotic stroke with severe internal carotid artery stenosis should be considered to surgical intervention, and duplex ultrasound approach is important to estimate for the severity of carotid stenosis. Physicians should keep in mind the usefulness of carotid ultrasonography for risk stratification of cerebral and cardiovascular disease based on various aspects. In addition, visual assessment or dynamic changes using carotid ultrasonography could provide the various and valuable insights in clinical settings.

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Section: Other Aspects Of Assessments Using Carotid Ultrasonographmentioning

confidence: 90%

Usefulness of Carotid Ultrasonography for Risk Stratification of Cerebral and Cardiovascular Disease

Nezu

Hosomi

2020

JAT

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“…A study using computed tomography angiograms showed that the proximity of the hyoid bone to the internal CA is a risk factor for CA dissection (30). The displacement of the internal CA to and from a retropharyngeal position has been reported in several studies (31)(32)(33)(34). Kinoshita et al reported that displacement of the internal CA was related to the internal CA stenosis (32).…”

Section: Neckmentioning

confidence: 96%

“…The displacement of the internal CA to and from a retropharyngeal position has been reported in several studies ( 31 – 34 ). Kinoshita et al reported that displacement of the internal CA was related to the internal CA stenosis ( 32 ). Moreover, a case report showed that mechanical stimulation by the thyroid cartilage is proposed to induce a plaque during frequent neck rotation ( 35 ).…”

Section: Site-specific Pvme In Each Arterial Treementioning

confidence: 99%

“…Atheroprone arteries are markedly affected by EMF, whereas atheroprotective arteries are less affected. Previous studies have reported that the coronary artery is affected by cardiac muscle contraction (13, 14, 18-22), the CA by the hyoid bone and the thyroid cartilage (30)(31)(32)(33)(34)(35), and the abdominal aorta (39, 41, 42) and lower extremity arteries (50,52,53) by musculoskeletal motion. We speculate that the thoracic cage (37, 38) protects the ITA from EMF because of a favorable PVME.…”

Section: Role Of the Pvme In The Progression Of Atherosclerosis: Pers...mentioning

confidence: 99%

“…Furthermore, plaques are frequently observed on an external force-applied side, suggesting that EMF provides plaque eccentricity (12,13). Moreover, the direction that vessels travel and the geometry are regulated by the surrounding tissues and dynamically affected by EMF (31)(32)(33)(34)(35). These findings suggest that the PVME is also a 10.3389/fcvm.2022.944356 determining factor of shear stress.…”

Section: Role Of the Pvme In The Progression Of Atherosclerosis: Pers...mentioning

confidence: 99%

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Perivascular mechanical environment: A narrative review of the role of externally applied mechanical force in the pathogenesis of atherosclerosis

Yamaguchi¹,

Morino

2022

Front. Cardiovasc. Med.

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Atherosclerosis is promoted by systemic factors, such as dyslipidemia, hypertension, diabetes, and smoking, which cause atherosclerosis in blood vessels throughout the body. However, atherosclerotic lesions are characterized by their frequent occurrence in specific vessels and sites. Blood vessels are exposed to various mechanical forces related to blood pressure and flow. Although shear stress promotes the initiation and progression of atherosclerotic lesions, the pathogenesis of site specificity of atherosclerosis is not sufficiently explained by shear stress. We propose the concept of a perivascular mechanical environment (PVME). Compelling evidence suggests that site specificity in atherosclerotic lesions depends on a distinct local PVME. Atheroprone arteries, such as the coronary artery, are markedly affected by externally applied mechanical force (EMF), whereas atheroprotective arteries, such as the internal thoracic artery, are less affected. Recent studies have shown that the coronary artery is affected by cardiac muscle contraction, the carotid artery by the hyoid bone and the thyroid cartilage, and the abdominal aorta and lower extremity arteries by musculoskeletal motion. We speculate that the thoracic cage protects the internal thoracic artery from EMF owing to a favorable PVME. Furthermore, evidence suggests that plaque eccentricity is provided by EMF; plaques are frequently observed on an external force-applied side. In each vascular tree, site-specific characteristics of the PVME differ substantially, inducing individual atherogenicity. From the perspective of the mechanical environment, hemodynamic stress occurs in an inside-out manner, whereas EMF occurs in an outside-in manner. These inward and outward forces apply mechanical load individually, but interact synergistically. The concept of a PVME is a novel pathogenesis of atherosclerosis and also might be a pathogenesis of other arterial diseases.

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Cerebral embolism and carotid-hyoid impingement syndrome

Kho

Bates

Thompson

et al. 2019

Journal of Clinical Neuroscience

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Flip-Flop Phenomenon: Swallowing-Induced Arterial Displacement as an Indicator of Carotid Artery Disease

Cited by 9 publications

References 10 publications

Usefulness of Carotid Ultrasonography for Risk Stratification of Cerebral and Cardiovascular Disease

Usefulness of Carotid Ultrasonography for Risk Stratification of Cerebral and Cardiovascular Disease

Perivascular mechanical environment: A narrative review of the role of externally applied mechanical force in the pathogenesis of atherosclerosis

Cerebral embolism and carotid-hyoid impingement syndrome

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