Volumetric Flow Changes in Extracranial Arteries in a Symptomatic Patient with Significant Bilateral Carotid Artery Stenosis: A Case Study and Literature Review

(1) Background: Carotid artery occlusion (CAO) in population studies has a reported prevalence of about 6 per 100,000 people; however, the data may be underestimated. CAO carries a significant risk of stroke. Up to 15% of large artery infractions may be secondary to the CAO, and in 27–38% of patients, ischaemic stroke is a first presentation of the disease. The presence of sufficient and well-developed collateral circulation has a protective influence, being a good prognostic factor in patients with carotid artery disease, both chronic and acute. Understanding the mechanisms and role of collateral circulation may be very important in the risk stratification of such patients. (2) Materials and Methods: This study included 46 patients (mean age: 70.5 ± 6 years old; 15 female, mean age 68.5 ± 3.8 years old and 31 male, mean age 71.5 ± 6.7 years old) with unilateral or bilateral ICA occlusion. In all patients, a Doppler ultrasound (DUS) examination, measuring blood flow volume in the internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA), was performed. The cerebral blood flow (CBF) was compared to the previously reported CBF values in the healthy population >65 years old. (3) Results: In comparison with CBF values in the healthy population, three subgroups with CBF changes were identified among patients with ICA occlusion: patients with significant volumetric flow compensation (CBF higher than average + standard deviation for healthy population of the same age), patients with flow similar to the healthy population (average ± standard deviation), and patients without compensation (CBF lower than the average-standard deviation for healthy population). The percentage of patients with significant volumetric flow compensation tend to rise with increasing age, while a simultaneous decline was observed in the group without compensation. The percentage of patients with flow similar to the healthy population remained relatively unchanged. ICA played the most important role in volumetric flow compensation in patients with CAO; however, the relative increase in flow in the ICA was smaller than that in the ECA and VA. Compensatory increased flow was observed in about 50% of all patent extracranial arteries and was more frequently observed in ipsilateral vessels than in contralateral ones, in both the ECA and the VA. In patients with CAO, there was no decrease in CBF, ICA, ECA, and VA flow volume with increasing age. (4) Conclusions: Volumetric flow compensation may play an important predictive role in patients with CAO.

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“…The changes in blood flow volume and the level of compensation may be related to the presence of neurological symptoms [12,13].…”

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confidence: 99%

Intracranial Flow Volume Estimation in Patients with Internal Carotid Artery Occlusion

et al. 2022

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“…There are also patients in whom the CBF is similar to healthy population—due to the mild increase in the flow in other extracranial vessels, and the patients in whom there is no flow increase in other arteries—those patients have lower CBF values than the healthy population. It was reported that higher CBF values are correlated with a lower risk of occurrence of ischaemic symptoms, while in patients with lower CBF values the risk of occurrence of ischaemic symptoms is twice as large [ 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Volumetric Flow Assessment in Extracranial Arteries in Patients with 70–99% Internal Carotid Artery Stenosis

et al. 2022

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Background: Cerebral blood flow (CBF) can be related to the risk of occurrence of neurological symptoms. Well-developed collateral circulation is a good prognostic factor in patients with cerebrovascular disease. Understanding the mechanisms of collateral circulation may be important in the diagnosis, treatment, and monitoring in this group of patients. The aim of this study covered the assessment of CBF in patients with 70–99% Internal carotid artery (ICA) stenosis, focusing on the circulation pathways and flow volume in extracranial arteries. Materials and methods: 53 patients with 70–99% ICA stenosis (mean age 73.4 ± 7 years old; 17 female, mean age 73.9 ± 7.5 years old; 36 male, mean age 73.2 ± 6.8 years old) were included in the study. In all patients a Doppler ultrasound (DUS) examination, measuring blood flow volume in the internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA), was performed. The cerebral blood flow (CBF) was compared to the previously reported CBF values in the healthy population >65 years old. Results: Among the study groups three subgroups with flow differences were identified: patients with elevated CBF (significant volumetric flow compensation—26/53, 49%), patients with CBF similar to (mild compensation—17/53, 32%), and patients with CBF lower than (no compensation—10/53, 19%) the healthy, equally aged population. The percentage of patients with significant volumetric flow compensation was the highest in age groups 65–69 years old (62.5%) and >80 years old (60%). In the oldest age group (>80 years old) no patients without flow compensation (0%) were observed. The level of compensation depends on the number of the arteries with compensatory increased flow. In patients with significant volumetric flow compensation, the compensatory increased flow was observed, on average, in 3.31 arteries, in the mild compensation group—in 2.18 arteries, and in the no compensation group only in 1 artery. ICA plays the most important role in the volumetric flow compensation—the increase in the flow volume, in comparison to the reference values, was between 116.7 mL/min and 251.9 mL/min (in the ECA 57.6 mL/min–110.4 mL/min; in the VA 73.9 mL/min–104.9 mL/min). The relative flow increase was highest in the VA: 215–246%, then in the ECA: 163–206%, and finally in the ICA: 148.6–192%. The increased flow was most commonly observed in the VA—57 arteries, in second place in the ECA—42 arteries, and ICA—31 arteries. In patients with unilateral ICA stenosis, the volumetric flow increase was stated more frequently in the ipsilateral ECAs then in the contralateral ones (23 vs. 14). In the VA the opposite tendency was observed (29 contralateral vs. 23 ipsilateral). The ability of volumetric flow compensation decreased significantly with increasing age. Conclusions: Understanding the mechanisms of collateral circulation and their assessment in Doppler ultrasonography may provide a novel and easily accessible tool of identifying and monitoring patients with cerebrovascular disease.

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“…Основным этиологическим фактором риска развития стеноза сонных артерий является образование атеросклеротической бляшки на внутренней поверхности артерий [3]. Атеросклеротические поражения сонных артерий наблюдаются примерно у 25-26% взрослого населения, а стенотические бляшки наблюдаются у 1,5-2,7% населения [4]. Согласно данным систематического обзора, проведенными китайскими учеными Ji Х. и соавторами основными факторами риска развития атеросклеротической бляшки сонных артерий являются: гиперлипидемия, гипергомоцистеинемия, гиперурикемия, гипертриглицеридемия, повышенный уровень липопротеинов низкой плотности, курение, метаболический синдром, артериальная гипертензия, са- КЛИНИЧЕСКАЯ МЕДИЦИНА И ФАРМАКОЛОГИЯ харный диабет.…”

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Факторы Риска Экстракраниального Стеноза Сонных Артерий (Обзор Литературы)

САДУАКАС,

КУРАКБАЕВ,

БАЙМУРАТОВА

et al. 2024

Farmaciâ Kazahstana

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Экстракраниальные стенозы сонных артерий занимают наиболее актуальную проблему в структуре заболеваний систем кровообращения в виду с острым течением, быстрым прогрессированием до ишемического инсульта, что оказывает серьезное влияние на здоровье и качество жизни пациентов всех возрастных групп. Они также являются одной из важных причин инвалидности и смертности во всем мире. Поэтому раннее выявление, своевременное лечение и профилактика экстракраниальных стенозов сонных артерий имеют большое значение в деятельности системы здравоохранения. Целью явилось обобщение сведений литературы о факторах риска, приводящих к экстракраниальному стенозу сонных артерий. Материалы и методы: Нами был проведен аналитический обзор источников в открытом доступе из научных баз данных Google Scholar, Scopus, Web of Science, PubMed, e-library за последние 10 лет (2013-2023 гг.). Публикации, включенные в обзор литературы, были полнотекстовые статьи на русском и английском языках. Всего было проанализировано 175, из них цели исследования и критериям включения соответствовали 48. Результаты: В данной обзорной статье подробно описаны факторы риска, способствующие развитию экстракраниальному стенозу сонных артерий. Отмечено что экстракраниальный стеноз сонных артерий развивается с увеличением возраста, при чем ему больше подвержены мужчины чем женщины. Основным этиологическим фактором развития стеноза сонных артерий является атеросклероз. Определены ведущие анамнестические факторы риска развития экстракраниального стеноза сонных артерий. Рассмотрена категория пациентов с бессимптомным течением стеноза артерий, которые ввиду отсутствия лечения подвержены высокому риска развития инсульта. Заключение: По результатам проанализированных сведений научной литературы, считаем, что для дополнения теоретических основ экстракраниальных стенозов сонных артерий следует расширить изучение факторов риска развития патологического процесса, приводящего к ишемическому инсульту. Вместе с тем представленная информация позволит обогатить, в перспективе, прикладные знания для врачей ПМСМ и стационаров с целью улучшения ранней диагностики и профилактики сердечно-сосудистых заболеваний.

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Volumetric Flow Changes in Extracranial Arteries in a Symptomatic Patient with Significant Bilateral Carotid Artery Stenosis: A Case Study and Literature Review

Cited by 3 publications

References 25 publications

Intracranial Flow Volume Estimation in Patients with Internal Carotid Artery Occlusion

Intracranial Flow Volume Estimation in Patients with Internal Carotid Artery Occlusion

Volumetric Flow Assessment in Extracranial Arteries in Patients with 70–99% Internal Carotid Artery Stenosis

Факторы Риска Экстракраниального Стеноза Сонных Артерий (Обзор Литературы)

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