Pub Date : 2019-04-30DOI: 10.5772/INTECHOPEN.81400
E. Waihrich, B. Parente, Paulo Gonçalves, F. Fernandes, C. Ontiveros, C. Ribeiro, E. Rabahi
Cerebral aneurysms (CA) are acquired lesions, affecting 5–10% of the population, being about three times more common in women than in men. The absolute majority of CA is asymptom - atic. However, in symptomatic cases, cerebral aneurysms present without about 80% of cases with severe intracranial hemorrhage, with mortality up to 50% and severe morbidity of up to 80%. At this point, the carotid siphon is particularly important because it is the blood gateway to the anterior cerebral circulation, being the most sinuous portion of the internal carotid artery, and because it houses about 30% of the intracranial aneurysm. The constant interac - tions of blood flow with carotid siphon curvatures are apparently intrinsically related to the epidemiology of these lesions in the various locations of the intracranial circulation and their presentation form. It is well established that a greater anterior knee angle has a significant independent relation with intracranial aneurysms located after carotid siphon, larger aneu rysms, and greater risk of rupture. These findings may be associated with the hemodynamic interactions of blood flow and the curvature of carotid siphon. Little is known about the anatomical changes in carotid siphon and, consequently, the repercussions of the hemody - namic changes that the neurosurgical interventions mechanisms could entail. Devices such as intracranial stents, detachable coils, and even clips of aneurysms can modify the morphol - ogy of carotid siphon, and the knowledge of these consequences could be used to obtain better therapeutic results. In the last 10 years, a new device for the treatment of intracranial aneurysms has been presenting promising results, flow diverters stents (FDS), and its use to treat aneurysms in carotid siphon appears to cause morphological changes characterized by increased anterior and posterior angles. Specifically, the anterior angle increase was associ - ated with better angiographic results. Aneurysms of the extracranial carotid artery (ECAA) are rare and little is known about its natural history. The etiology is diverse and most ECAA are asymptomatic, but they may progress to a pulsatile mass, cranial nerve compression, or cause a stroke. ECAA treatment is still controversial and a better insight into natural history and risk of complications of the different treatments is needed in order to get the consensus.
{"title":"Carotid Intern Aneurysms","authors":"E. Waihrich, B. Parente, Paulo Gonçalves, F. Fernandes, C. Ontiveros, C. Ribeiro, E. Rabahi","doi":"10.5772/INTECHOPEN.81400","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81400","url":null,"abstract":"Cerebral aneurysms (CA) are acquired lesions, affecting 5–10% of the population, being about three times more common in women than in men. The absolute majority of CA is asymptom - atic. However, in symptomatic cases, cerebral aneurysms present without about 80% of cases with severe intracranial hemorrhage, with mortality up to 50% and severe morbidity of up to 80%. At this point, the carotid siphon is particularly important because it is the blood gateway to the anterior cerebral circulation, being the most sinuous portion of the internal carotid artery, and because it houses about 30% of the intracranial aneurysm. The constant interac - tions of blood flow with carotid siphon curvatures are apparently intrinsically related to the epidemiology of these lesions in the various locations of the intracranial circulation and their presentation form. It is well established that a greater anterior knee angle has a significant independent relation with intracranial aneurysms located after carotid siphon, larger aneu rysms, and greater risk of rupture. These findings may be associated with the hemodynamic interactions of blood flow and the curvature of carotid siphon. Little is known about the anatomical changes in carotid siphon and, consequently, the repercussions of the hemody - namic changes that the neurosurgical interventions mechanisms could entail. Devices such as intracranial stents, detachable coils, and even clips of aneurysms can modify the morphol - ogy of carotid siphon, and the knowledge of these consequences could be used to obtain better therapeutic results. In the last 10 years, a new device for the treatment of intracranial aneurysms has been presenting promising results, flow diverters stents (FDS), and its use to treat aneurysms in carotid siphon appears to cause morphological changes characterized by increased anterior and posterior angles. Specifically, the anterior angle increase was associ - ated with better angiographic results. Aneurysms of the extracranial carotid artery (ECAA) are rare and little is known about its natural history. The etiology is diverse and most ECAA are asymptomatic, but they may progress to a pulsatile mass, cranial nerve compression, or cause a stroke. ECAA treatment is still controversial and a better insight into natural history and risk of complications of the different treatments is needed in order to get the consensus.","PeriodicalId":190527,"journal":{"name":"Carotid Artery - Gender and Health [Working Title]","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131509080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-14DOI: 10.5772/INTECHOPEN.81103
R. Vona, L. Gambardella, E. Straface
Metabolic syndrome (MetS) is a cluster of risk factors for atherosclerosis, including abdominal obesity, hypertension, insulin resistance, dyslipidemia with high triglycerides, and low high-density lipoprotein cholesterol. Affected patients have a sig - nificantly increased risk of developing cardiovascular disorders (CVD), that are the leading cause of death in the Western countries. Several epidemiological studies have investigated the evolution of CVD hypothesizing the presence of a gender difference in the pathogenetic and progression determinants detectable in men and women. In this chapter, we will examine new gender-associated bioindicators of possible diagnostic or prognostic value in the MetS. Moreover, we will provide an overview on current knowledge on sex-associated cardiovascular determinants with the aim to improve CVD diagnostic and prognostic clinical courses and to develop new and gender-biased prevention strategies.
{"title":"Gender-Associated Biomarkers in Metabolic Syndrome","authors":"R. Vona, L. Gambardella, E. Straface","doi":"10.5772/INTECHOPEN.81103","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81103","url":null,"abstract":"Metabolic syndrome (MetS) is a cluster of risk factors for atherosclerosis, including abdominal obesity, hypertension, insulin resistance, dyslipidemia with high triglycerides, and low high-density lipoprotein cholesterol. Affected patients have a sig - nificantly increased risk of developing cardiovascular disorders (CVD), that are the leading cause of death in the Western countries. Several epidemiological studies have investigated the evolution of CVD hypothesizing the presence of a gender difference in the pathogenetic and progression determinants detectable in men and women. In this chapter, we will examine new gender-associated bioindicators of possible diagnostic or prognostic value in the MetS. Moreover, we will provide an overview on current knowledge on sex-associated cardiovascular determinants with the aim to improve CVD diagnostic and prognostic clinical courses and to develop new and gender-biased prevention strategies.","PeriodicalId":190527,"journal":{"name":"Carotid Artery - Gender and Health [Working Title]","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114965304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.80712
A. R. Rasyada, A. Azhim
A significant blood flow disruption as seen in cardiovascular diseases and disorders is related to hemodynamic dysfunction. Gender influences the arterial hemodynamic func tions. Understanding of gender-related differences in blood flow and pressure is crucial in the prevalence and burden of cardiovascular disease. This chapter presents about char acteristic profile of carotid flow velocities to extend the fundamental understanding of arterial hemodynamic functions in gender differences. Comparison of both synchronized carotid blood flow velocity and blood pressures at normodynamics state are introduced to contribute to targeted therapeutic goal based on gender. Gender-related differences in body size has influenced on arterial hemodynamics in carotid artery. Body height has influenced on systolic blood pressure, pulse pressure, wave reflection, pulse wave veloc ity in carotid artery. Carotid blood flow velocities are largely accounted for not only body height but also body weight. The predictors for modulating blood flow velocities were not only limited to age, but also influenced by several body compositions that largely accounted for the gender-related differences including visceral fat, muscle mass and total body fat. These data may useful to effective prevention and management of cardiovascu lar disease by considering the gender-difference.
{"title":"Flow Velocity in Common Carotid Artery","authors":"A. R. Rasyada, A. Azhim","doi":"10.5772/INTECHOPEN.80712","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80712","url":null,"abstract":"A significant blood flow disruption as seen in cardiovascular diseases and disorders is related to hemodynamic dysfunction. Gender influences the arterial hemodynamic func tions. Understanding of gender-related differences in blood flow and pressure is crucial in the prevalence and burden of cardiovascular disease. This chapter presents about char acteristic profile of carotid flow velocities to extend the fundamental understanding of arterial hemodynamic functions in gender differences. Comparison of both synchronized carotid blood flow velocity and blood pressures at normodynamics state are introduced to contribute to targeted therapeutic goal based on gender. Gender-related differences in body size has influenced on arterial hemodynamics in carotid artery. Body height has influenced on systolic blood pressure, pulse pressure, wave reflection, pulse wave veloc ity in carotid artery. Carotid blood flow velocities are largely accounted for not only body height but also body weight. The predictors for modulating blood flow velocities were not only limited to age, but also influenced by several body compositions that largely accounted for the gender-related differences including visceral fat, muscle mass and total body fat. These data may useful to effective prevention and management of cardiovascu lar disease by considering the gender-difference.","PeriodicalId":190527,"journal":{"name":"Carotid Artery - Gender and Health [Working Title]","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124033208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79527
R. Casana, C. Malloggi, V. Tolva, A. Odero, R. Bulbulia, A. Halliday, V. Silani, G. Parati
Carotid artery stenosis is thought to cause up to 10% of ischemic strokes. Till now, the optimal treatment between carotid endarterectomy (CEA) and carotid artery stenting (CAS) remains debated, in particular for specific subgroups of patients. Available data suggest that female have higher risk of perioperative adverse events, but conflicting results comparing CEA and CAS regarding the benefit for male or female are present in the literature. A systematic review of recent publications on gender-related differences in oper-ative risks is reported. Moreover, a consecutive cohort of 912 symptomatic and asymptom- atic patients undergoing CEA (407, 44.6%) or CAS (505, 55.4%) in a single institution has been evaluated to determine the influence of gender (59.7% male vs. 40.3% female) on the outcomes after both revascularization procedures at 30 days and during 3 years of follow-up. Our experience seems to confirm literature data as regarding female higher risk of restenosis. Female patients had higher periprocedural (2.7% female vs. 0.9% male; p < 0.05) and long-term (11.4% female vs. 4.6% male; p < 0.05) restenosis rate. In conclusion, female anatomic and pathologic parameters should be taken into account for an accurate diagnosis of carotid stenosis and guidelines should be adjusted consequently. (cid:1) (SD). compli-cations, and CEA by Survival, MI, and restenosis using Kaplan-Meier to for patient dropouts and were reported using (SVS) (SE) are reported in Kaplan-Meier analyses. The log-rank was used to determine differences among patients submitted CEA and
{"title":"Do Women Have a Higher Risk of Adverse Events after Carotid Revascularization?","authors":"R. Casana, C. Malloggi, V. Tolva, A. Odero, R. Bulbulia, A. Halliday, V. Silani, G. Parati","doi":"10.5772/INTECHOPEN.79527","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79527","url":null,"abstract":"Carotid artery stenosis is thought to cause up to 10% of ischemic strokes. Till now, the optimal treatment between carotid endarterectomy (CEA) and carotid artery stenting (CAS) remains debated, in particular for specific subgroups of patients. Available data suggest that female have higher risk of perioperative adverse events, but conflicting results comparing CEA and CAS regarding the benefit for male or female are present in the literature. A systematic review of recent publications on gender-related differences in oper-ative risks is reported. Moreover, a consecutive cohort of 912 symptomatic and asymptom- atic patients undergoing CEA (407, 44.6%) or CAS (505, 55.4%) in a single institution has been evaluated to determine the influence of gender (59.7% male vs. 40.3% female) on the outcomes after both revascularization procedures at 30 days and during 3 years of follow-up. Our experience seems to confirm literature data as regarding female higher risk of restenosis. Female patients had higher periprocedural (2.7% female vs. 0.9% male; p < 0.05) and long-term (11.4% female vs. 4.6% male; p < 0.05) restenosis rate. In conclusion, female anatomic and pathologic parameters should be taken into account for an accurate diagnosis of carotid stenosis and guidelines should be adjusted consequently. (cid:1) (SD). compli-cations, and CEA by Survival, MI, and restenosis using Kaplan-Meier to for patient dropouts and were reported using (SVS) (SE) are reported in Kaplan-Meier analyses. The log-rank was used to determine differences among patients submitted CEA and","PeriodicalId":190527,"journal":{"name":"Carotid Artery - Gender and Health [Working Title]","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114223723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79762
L. Manchev
In the study of carotid arteries, the different imaging techniques allow to analyze various diseases like stenoses, aneurysms, thromboses, dissections, diseases caused by athero sclerotic plaques or congenital abnormalities. The diagnostic modalities that are used to image the carotid artery diseases are digital subtraction angiography (DSA), duplex ultrasound (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). The goal of the diagnostic imaging is to provide screening and to detect diseases at its earliest and most treatable stage. As initial screening study, the radi - ologists recommend DUS. It is a safe and painless way to produce pictures of the inside of the body using sound waves. It assesses blood flow in the carotid arteries, measures the speed of the blood flow, and estimates the diameter of a blood vessel and degree of obstruction. Digital subtraction angiography (DSA) has assumed a major role in the evaluation of occlusive cerebrovascular disease. While digital subtraction angiography (DSA) is still considered the gold standard, it has increasingly been replaced by computed tomography angiography (CTA) or magnetic resonance angiography (MRA) during the last years. Modern imaging studies like CTA and MRI allow to obtain three-dimensional reconstruction of anatomic structures and pathological abnormalities. Computed tomog raphy angiography (CTA) of carotid arteries is a standardized procedure with excellent image quality but related with high radiation exposure. The rapid technical evolution in hardware and software allows even smaller imaging centers to perform high-quality ves - sel imaging. During the last decade, CTA came up with substantial progress in terms of accuracy in stenosis and aneurysm detection. Magnetic resonance angiography (MRA) is increasingly used as a noninvasive method to assess carotid arteries. Diseases like carotid artery dissections could be detected by using MRA or CTA. occlusion About 190 patients with, or without, proximal extra- and intracranial occlusions were by TCD. The obtained data were compared with those from DSA and MRA. Angiographic examination showed occlusion in 48 patients. The TCD showed Doppler signals unusual for the middle cerebral artery in 66.7%; reverse blood flow through the oph thalmic arteries in 70.6%; and blood flow through the anterior communicating artery in 78.6% and through the posterior communicating artery in 71.4%. The study showed that transcranial Doppler sonography data for large artery occlusions can be used to extend complex diagnosis and improve prognostic value for noninvasive screening in stroke patients The diagnostic capabilities of digital intra-arterial angiography and transcranial sonography were compared in 48 patients with acute ischemia in the artery basin on the fourth hour after onset of symptoms. Data from the exam showed correla with angiographic with clinical suspicion of acute vertebral artery occlusion. Criteria for in
{"title":"Diagnostic Imaging of Carotid Artery","authors":"L. Manchev","doi":"10.5772/INTECHOPEN.79762","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79762","url":null,"abstract":"In the study of carotid arteries, the different imaging techniques allow to analyze various diseases like stenoses, aneurysms, thromboses, dissections, diseases caused by athero sclerotic plaques or congenital abnormalities. The diagnostic modalities that are used to image the carotid artery diseases are digital subtraction angiography (DSA), duplex ultrasound (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). The goal of the diagnostic imaging is to provide screening and to detect diseases at its earliest and most treatable stage. As initial screening study, the radi - ologists recommend DUS. It is a safe and painless way to produce pictures of the inside of the body using sound waves. It assesses blood flow in the carotid arteries, measures the speed of the blood flow, and estimates the diameter of a blood vessel and degree of obstruction. Digital subtraction angiography (DSA) has assumed a major role in the evaluation of occlusive cerebrovascular disease. While digital subtraction angiography (DSA) is still considered the gold standard, it has increasingly been replaced by computed tomography angiography (CTA) or magnetic resonance angiography (MRA) during the last years. Modern imaging studies like CTA and MRI allow to obtain three-dimensional reconstruction of anatomic structures and pathological abnormalities. Computed tomog raphy angiography (CTA) of carotid arteries is a standardized procedure with excellent image quality but related with high radiation exposure. The rapid technical evolution in hardware and software allows even smaller imaging centers to perform high-quality ves - sel imaging. During the last decade, CTA came up with substantial progress in terms of accuracy in stenosis and aneurysm detection. Magnetic resonance angiography (MRA) is increasingly used as a noninvasive method to assess carotid arteries. Diseases like carotid artery dissections could be detected by using MRA or CTA. occlusion About 190 patients with, or without, proximal extra- and intracranial occlusions were by TCD. The obtained data were compared with those from DSA and MRA. Angiographic examination showed occlusion in 48 patients. The TCD showed Doppler signals unusual for the middle cerebral artery in 66.7%; reverse blood flow through the oph thalmic arteries in 70.6%; and blood flow through the anterior communicating artery in 78.6% and through the posterior communicating artery in 71.4%. The study showed that transcranial Doppler sonography data for large artery occlusions can be used to extend complex diagnosis and improve prognostic value for noninvasive screening in stroke patients The diagnostic capabilities of digital intra-arterial angiography and transcranial sonography were compared in 48 patients with acute ischemia in the artery basin on the fourth hour after onset of symptoms. Data from the exam showed correla with angiographic with clinical suspicion of acute vertebral artery occlusion. Criteria for in","PeriodicalId":190527,"journal":{"name":"Carotid Artery - Gender and Health [Working Title]","volume":"151 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121532782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.78621
J. Olszewski, P. Niewiadomski
Currently, Doppler ultrasound examinations are of particular importance, including con- tinuous wave Doppler and color-coded pulsed wave Doppler. Excellent images are obtained using contrast computed tomography angiography (CTA) and magnetic reso- nance angiography (MRA), which give greater understanding of blood flow in the cranial and intracranial vessels under normal conditions and in pathological situations caused by both anatomical anomalies and acquired abnormalities. Our previous studies, concerning the analysis of the frequency and types of anatomical anomalies of the cranial arteries, i.e. vertebral and carotid arteries, in patients with dizziness and impaired hearing, demonstrated that hypoplasia of the right vertebral artery was the most common anatomical anomaly occurring in 58.7% of cases, of which 51.7% were women and 6.9% men; hypoplasia of the left vertebral artery, occurring in 24.7% of the study group, of which 13.8% were women and 10.3% men; hypoplasia of the right internal carotid artery found in 3.4% of women and of the left internal carotid artery in 6.8% of cases, 3.4% in women and 3.4% in men; and hypoplasia of the right common carotid artery was reported in 3.4% of men, whereas critical stenosis of the left subclavian artery with subclavian steal syndrome was observed in 3.4% of women. Although tinnitus was the most frequent symptom occurring in those patients, in this study dizziness was most common in patients admitted to the Department for the diagnosis, possibly because they found it more disturbing.
{"title":"Anatomical Anomalies of Carotid-Vertebral Arteries in Patients with Dizziness and Impaired Hearing","authors":"J. Olszewski, P. Niewiadomski","doi":"10.5772/INTECHOPEN.78621","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.78621","url":null,"abstract":"Currently, Doppler ultrasound examinations are of particular importance, including con- tinuous wave Doppler and color-coded pulsed wave Doppler. Excellent images are obtained using contrast computed tomography angiography (CTA) and magnetic reso- nance angiography (MRA), which give greater understanding of blood flow in the cranial and intracranial vessels under normal conditions and in pathological situations caused by both anatomical anomalies and acquired abnormalities. Our previous studies, concerning the analysis of the frequency and types of anatomical anomalies of the cranial arteries, i.e. vertebral and carotid arteries, in patients with dizziness and impaired hearing, demonstrated that hypoplasia of the right vertebral artery was the most common anatomical anomaly occurring in 58.7% of cases, of which 51.7% were women and 6.9% men; hypoplasia of the left vertebral artery, occurring in 24.7% of the study group, of which 13.8% were women and 10.3% men; hypoplasia of the right internal carotid artery found in 3.4% of women and of the left internal carotid artery in 6.8% of cases, 3.4% in women and 3.4% in men; and hypoplasia of the right common carotid artery was reported in 3.4% of men, whereas critical stenosis of the left subclavian artery with subclavian steal syndrome was observed in 3.4% of women. Although tinnitus was the most frequent symptom occurring in those patients, in this study dizziness was most common in patients admitted to the Department for the diagnosis, possibly because they found it more disturbing.","PeriodicalId":190527,"journal":{"name":"Carotid Artery - Gender and Health [Working Title]","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125855962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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