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Al-Mutairi FF, Al-Hussaini A, Marsh AM, Samani N, McCann G, Adlam D, Chung EML, Ramnarine KV. Ultrasound shear wave elastography imaging of common carotid arteries in patients with Spontaneous Coronary Artery Dissection (SCAD). J Ultrasound 2022; 25:585-589. [PMID: 35032295 PMCID: PMC9402834 DOI: 10.1007/s40477-021-00627-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/18/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Shear wave elastography (SWE) is emerging as a valuable clinical tool for a variety of conditions. The aim of this pilot study was to assess the potential of SWE imaging of the common carotid arteries (CCA) in patients with spontaneous coronary artery dissection (SCAD), a rare but potentially life-threatening condition, hypothesized to be linked to changes in vessel wall elasticity. METHODS Ultrasound shear wave elastography (SWE) estimates of artery wall elasticity were obtained from the left and right CCAs of 89 confirmed SCAD patients and 38 non-dissection controls. SWE images obtained over multiple cardiac cycles were analysed by a blinded observer to estimate elasticity in the form of a Young's Modulus (YM) value, across regions of interest (ROI) located within the anterior and posterior CCA walls. RESULTS YM estimates ranged from 17 to 133 kPa in SCAD patients compared to 34 to 87 kPa in non-dissection controls. The mean YM of 55 [standard deviation (SD): 21] kPa in SCAD patients was not significantly different to the mean of 57 [SD: 12] kPa in controls, p = 0.32. The difference between groups was 2 kPa [95% Confidence Interval - 11, 4]. CONCLUSIONS SWE imaging of CCAs in SCAD patients is feasible although the clinical benefit is limited by relatively high variability of YM values which may have contributed to our finding of no significant difference between SCAD patients and non-dissection controls.
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Affiliation(s)
- Fahad F Al-Mutairi
- Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia. .,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | - Abtehal Al-Hussaini
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anne-Marie Marsh
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Nilesh Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Emma M L Chung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.,Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kumar V Ramnarine
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Medical Physics, University Hospitals of Leicester NHS Trust, Leicester, UK.,Medical Physics Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Engelter ST, Traenka C, Grond-Ginsbach C, Brandt T, Hakimi M, Worrall BB, Debette S, Pezzini A, Leys D, Tatlisumak T, Nolte CH, Lyrer P. Cervical Artery Dissection and Sports. Front Neurol 2021; 12:663830. [PMID: 34135851 PMCID: PMC8200565 DOI: 10.3389/fneur.2021.663830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/29/2021] [Indexed: 12/29/2022] Open
Abstract
Cervical artery dissection (CeAD) occurring in the context of sports is a matter of concern for CeAD patients. They seek advice on the role of sports in CeAD and on the safety of resuming sports after CeAD. The scarcity of studies and guidelines addressing these issues poses a challenge. We aimed at summarizing the current knowledge about CeAD and sports in order to provide an informed, comprehensive opinion for counseling CeAD patients. We took into account pathophysiological considerations, observations of cases reports, series, and registries, and conclusions by analogy from aortic dissection or inherited connective tissue syndromes. In summary, practicing active sports as the cause of CeAD seems uncommon. It seems recommendable to refrain from any kind of sports activities for at least 1 month, which can be extended in case of an unfavorable clinical or neurovascular course. We recommend starting with sport activities at low intensity—preferably with types of endurance sports—and to gradually increase the pace in an individually tailored manner, taking into circumstances of the occurrences of the CeAD in the individual patient (particularly in relation to sports), the meaning of sports activities for the individual well-being, the presence or absence of comorbidities and of neurological sequela, neurovascular findings, and whether there are signs of an underlying connective tissue alteration. Major limitations and several forms of bias are acknowledged. Still, in the absence of any better data, the summarized observations and considerations might help clinicians in advising and counseling patients with CeAD in clinical practice.
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Affiliation(s)
- Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Christopher Traenka
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Caspar Grond-Ginsbach
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.,Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Brandt
- Schweizerische Unfallversicherungsanstalt (SUVA), Swiss National Accident Insurance Institution, Lucerne, Switzerland
| | - Maani Hakimi
- Department of Vascular Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, VA, United States
| | - Stephanie Debette
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France.,Inserm U1219, Bordeaux, France
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Didier Leys
- Univ-Lille, Inserm U1171, Centre Hospitalier Universitaire (CHU) Lille, Lille, France
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Department of Clinical Neuroscience, Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christian H Nolte
- Department of Neurology, and Center for Stroke Research Berlin Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
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Venketasubramanian N, Mundada P, Hegde AN, Tan M, Ng D. Post-Traumatic Carotid Artery Dissection Begins at the Skull Base: A Case Report. Case Rep Neurol 2020; 12:143-148. [PMID: 33505286 DOI: 10.1159/000504567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022] Open
Abstract
Cervical artery dissection is a rare complication of head and neck trauma. Though it is an infrequent cause of ischaemic stroke, it is more common among the young with cerebral ischaemia. The usual location of carotid dissection is just beyond the carotid bulb. We report a case of post-traumatic internal carotid dissection that began at the base of the skull after blunt head trauma from a road traffic accident. The patient is a 25-year-old right-handed lady who, 2 days after the accident, developed dysphasia and right-sided limb weakness. She had no significant past medical history. Magnetic resonance imaging (MRI) showed acute ischaemic stroke in the internal watershed regions of the left cerebral hemisphere. MR angiogram revealed focal near-occlusion of the left internal carotid artery at the base of the skull just prior to its entry into the petrous temporal bone. There were no skull fractures. She progressed despite anticoagulation. The location of the site of dissection at the base of the skull is likely due to stresses on the carotid intima at this point during flexion-extension-rotation that occurs during head injury, as this is where the internal carotid artery is tethered to the skull. Rapid recognition of symptoms of cerebral ischaemia among patients with blunt head trauma is needed to allow prompt investigation and institution of relevant therapies.
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Affiliation(s)
| | - Pravin Mundada
- Department of Diagnostic Radiology, Raffles Hospital, Singapore, Singapore
| | | | - Marcus Tan
- Raffles Eye Centre, Raffles Hospital, Singapore, Singapore
| | - Darren Ng
- Raffles Skin and Aesthetics Centre, Raffles Hospital, Singapore, Singapore
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4
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Thomas LC, Chan K, Durbridge G. Changes in internal carotid and vertebral arterial wall stiffness with head movement can be detected with shear wave elastography. J Man Manip Ther 2020; 28:103-110. [PMID: 31663837 PMCID: PMC7170308 DOI: 10.1080/10669817.2019.1686210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Safe practice is important for patients with neck pain, with the potential for injury to cervical arteries. Cervical manipulation or end range techniques/positions may place considerable strain on the arteries. Altered integrity of the arterial wall may render them more susceptible to minor trauma, particularly in the upper cervical region. Screening of blood flow velocity is limited for predicting those at risk. Examining properties of the cervical arterial wall (stiffness characteristics) and their response to head movement may provide an alternate measure of arterial susceptibility.Objectives: To investigate whether shear wave ultrasound elastography can detect any changes in internal carotid (ICA) and vertebral (VA) arterial wall stiffness in neutral compared with contralateral head rotation.Design: Observational studyMethods: Shear wave ultrasound elastography was used to measure the stiffness of the ICA and VA. Shear wave velocity (m/s), indicative of arterial stiffness, was measured in both arteries proximally (C3-4) and distally (C1-2) in neutral and contralateral head rotation as were intimal thickness (mm) and flow velocity (cm/s).Results: Thirty participants (20-62 years) were successfully imaged. The VA was stiffer than ICA and it became significantly stiffer in contralateral rotation (p = 0.05). The ICA became significantly less stiff (p = 0.01). Effects were more apparent at C1-2 but significant in the ICA only (p = 0.03). Flow velocity and intimal thickness were unchanged in rotation.Conclusions: Changes in VA and ICA arterial wall stiffness can be measured with shear wave ultrasound elastography. This measure may ultimately help identify arteries with greater vulnerability to rotational stresses.
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Affiliation(s)
- Lucy Caroline Thomas
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Kalos Chan
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - Gail Durbridge
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
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5
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Thomas L, Low J, Chan K, Durbridge G. Shear wave elastography of the cervical arteries: A novel approach to the assessment of cervical arterial wall stiffness. An investigation of psychometric properties and intra-rater reliability. Musculoskelet Sci Pract 2019; 40:96-100. [PMID: 30262424 DOI: 10.1016/j.msksp.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/08/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cervical arterial dissection, can occur spontaneously and is a rare but catastrophic adverse event associated with neck manipulation. Pathophysiology involves altered integrity of the arterial wall increasing its vulnerability to minor trauma. Those at risk are difficult to detect. Previous screening investigated blood flow but altered mechanical properties as stiffness of cervical arterial wall could provide a more valid indication of arterial integrity or even early dissection. OBJECTIVES To investigate suitability and intra-rater reliability of shear wave ultrasound elastography to measure mechanical properties of the cervical arterial wall. Suitability was assessed by ability to track arteries along their length and measurement accuracy. DESIGN Observational and intra-rater reliability study. METHODS Internal carotid (ICA) and vertebral arteries (VA) of healthy participants were examined with shear wave elastography. Shear wave velocity (m/s) indicative of wall stiffness was measured with the head in the neutral position: proximally (C3-4) and distally (C1-2) where injuries have been more commonly reported. Proximal measures were repeated to assess intra-rater reliability. RESULTS Thirty healthy participants (13 female), mean age of 29 (±12.8) years were imaged. Mean VA wall stiffness (3.4 m/s) was greater than ICA (2.3 m/s) (p < 0.000). Intra-rater reliability for ICA was ICC 0.81 (CI 0.52 to 0.92) and for VA ICC 0.76 (CI 0.38 to 0.9). Standard error of measurement was 0.16 for ICA and 0.34 for VA. CONCLUSIONS Shear wave ultrasound elastography appears a suitable and reliable method to measure cervical arterial wall stiffness, justifying further research into its use for screening arterial integrity.
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Affiliation(s)
- Lucy Thomas
- School of Health and Rehabilitation Sciences, University of Queensland, Australia.
| | - Juanita Low
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Kalos Chan
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Gail Durbridge
- Centre for Advanced Imaging, University of Queensland, Australia
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Abstract
Cervical artery dissections (CeAD) include both internal carotid and vertebral artery dissections. They are rare but important causes of stroke, especially in younger patients. CeAD should be considered in patients with strokelike symptoms, a new-onset headache and/or neck pain, and/or other risk factors. Early imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is key to making the diagnosis. Treatment may vary depending on the extent of the dissection, timing of the dissection, and other comorbidities. The overall prognosis is good, but does depend on the initial severity of symptoms.
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Affiliation(s)
- Jennifer J Robertson
- Department of Emergency Medicine, Emory University School of Medicine, 1648 Pierce Drive Northeast, Atlanta, GA 30307, USA
| | - Alex Koyfman
- Department of Emergency Medicine, University of Texas-Southwestern, Parkland Hospital, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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7
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Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, Kloss M, Grond-Ginsbach C, Majersik JJ, Worrall BB, Leys D, Baumgartner R, Caso V, Béjot Y, Compter A, Reiner P, Thijs V, Southerland AM, Bersano A, Brandt T, Gensicke H, Touzé E, Martin JJ, Chabriat H, Tatlisumak T, Lyrer P, Arnold M, Engelter ST. Cervical artery dissection in patients ≥60 years. Neurology 2017; 88:1313-1320. [DOI: 10.1212/wnl.0000000000003788] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years.Methods:We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients–Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated.Results:Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33–0.66]), headache (ORadjusted 0.58 [0.42–0.79]), mechanical trigger events (ORadjusted 0.53 [0.36–0.77]), and migraine (ORadjusted 0.58 [0.39–0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1–2.10]) and hypertension (ORadjusted 3.08 [2.25–4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0–2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]).Conclusion:In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.
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8
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Cervical Artery Dissections: A Review. J Emerg Med 2016; 51:508-518. [DOI: 10.1016/j.jemermed.2015.10.044] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 09/22/2015] [Accepted: 10/17/2015] [Indexed: 01/03/2023]
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9
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Nouh A, Vela-Duarte D, Grobelny T, Hoganson G, Pasquale D, Biller J. Internal carotid artery dissection after a roller coaster ride in a 4-year-old: case report and review of the literature. Pediatr Neurol 2015; 52:349-51. [PMID: 25559937 DOI: 10.1016/j.pediatrneurol.2014.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/16/2014] [Accepted: 11/18/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Strokes associated with roller-coaster rides are unusual. PATIENT A previously healthy 4-year-old boy developed acute onset of left-sided weakness when flying home from a trip to an amusement park. He had frequented two roller coaster rides the day prior. Upon evaluation, he was found to have an acute right middle cerebral artery territory infarction. RESULTS Cerebral angiography showed dissection of the right cervical internal carotid artery and right middle cerebral artery occlusion involving the M1 segment. He was treated with aspirin. Evaluation for underlying connective tissue diseases was unremarkable. CONCLUSION We speculate that repetitive forces of acceleration and deceleration may have led to a cervical internal carotid artery intimal tear, followed by thromboembolism. It remains uncertain what the threshold of susceptibility to repetitive rotational changes and tolerability to G forces in an otherwise healthy child truly is.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, University of Connecticut, Hartford Hospital, Hartford, Connecticut
| | - Daniel Vela-Duarte
- Department of Neurology, Loyola University Chicago Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - Thomas Grobelny
- Department of Neuroradiology, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - George Hoganson
- Loyola University Chicago Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - David Pasquale
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, Loyola University, Maywood, Illinois
| | - José Biller
- Department of Neurology, Loyola University Chicago Stritch School of Medicine, Loyola University, Maywood, Illinois.
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10
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Piper SL, Howarth SJ, Triano J, Herzog W. Quantifying strain in the vertebral artery with simultaneous motion analysis of the head and neck: a preliminary investigation. Clin Biomech (Bristol, Avon) 2014; 29:1099-107. [PMID: 25457973 DOI: 10.1016/j.clinbiomech.2014.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spontaneous vertebral artery dissection has significant mortality and morbidity among young adults. Unfortunately, causal mechanisms remain unclear. The purpose of this study was to quantify mechanical strain in the vertebral artery while simultaneously capturing motion analysis data during passive movements of the head and neck relative to the trunk during spinal manipulation and cardinal planes of motion. METHODS Eight piezoelectric crystals (four per vertebral artery) were sutured into the lumen of the left and right vertebral arteries of 3 cadaveric specimens. Strain was then calculated as changes in length between neighboring crystals from a neutral head/neck reference position using ultrasound pulses. Simultaneously, passive motion of the head and neck on the trunk was captured using eight infrared cameras. The instantaneous strain arising in the vertebral artery was correlated with the relative changes in head position. FINDINGS Strain in the contralateral vertebral artery during passive flexion-rotation compared to that of extension-rotation is variable ([df=32]: -0.61<r<0.55). Peak strain does not coincide with peak angular displacement during spinal manipulation and cardinal planes of motion. Axial rotation displayed the greatest amount of strain. The greatest amount of strain achieved during spinal manipulation was comparably lower than strains achieved during passive end range motions and previously reported failure limits. INTERPRETATION The results of this study suggest that vertebral artery strains during head movements including spinal manipulation, do not exceed published failure strains. This study provides new evidence that peak strain in the vertebral artery may not occur at the end range of motion, but rather at some intermediate point during the head and neck motion.
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Affiliation(s)
- Steven L Piper
- Canadian Memorial Chiropractic College, Toronto, Ontario M2H 3J1, Canada
| | - Samuel J Howarth
- Canadian Memorial Chiropractic College, Toronto, Ontario M2H 3J1, Canada
| | - John Triano
- Canadian Memorial Chiropractic College, Toronto, Ontario M2H 3J1, Canada
| | - Walter Herzog
- University of Calgary, Calgary, Alberta T2N 1N4, Canada,.
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11
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Common variation in PHACTR1 is associated with susceptibility to cervical artery dissection. Nat Genet 2014; 47:78-83. [PMID: 25420145 DOI: 10.1038/ng.3154] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/31/2014] [Indexed: 01/08/2023]
Abstract
Cervical artery dissection (CeAD), a mural hematoma in a carotid or vertebral artery, is a major cause of ischemic stroke in young adults although relatively uncommon in the general population (incidence of 2.6/100,000 per year). Minor cervical traumas, infection, migraine and hypertension are putative risk factors, and inverse associations with obesity and hypercholesterolemia are described. No confirmed genetic susceptibility factors have been identified using candidate gene approaches. We performed genome-wide association studies (GWAS) in 1,393 CeAD cases and 14,416 controls. The rs9349379[G] allele (PHACTR1) was associated with lower CeAD risk (odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.69-0.82; P = 4.46 × 10(-10)), with confirmation in independent follow-up samples (659 CeAD cases and 2,648 controls; P = 3.91 × 10(-3); combined P = 1.00 × 10(-11)). The rs9349379[G] allele was previously shown to be associated with lower risk of migraine and increased risk of myocardial infarction. Deciphering the mechanisms underlying this pleiotropy might provide important information on the biological underpinnings of these disabling conditions.
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12
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Nam KH, Bok TH, Jin C, Paeng DG. Asymmetric radial expansion and contraction of rat carotid artery observed using a high-resolution ultrasound imaging system. ULTRASONICS 2014; 54:233-240. [PMID: 23664377 DOI: 10.1016/j.ultras.2013.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 03/17/2013] [Accepted: 04/08/2013] [Indexed: 06/02/2023]
Abstract
The geometry of carotid artery bifurcation is of high clinical interest because it determines the characteristics of blood flow that is closely related to the formation and development of atherosclerotic plaque. However, information on the dynamic changes in the vessel wall of carotid artery bifurcation during a pulsatile cycle is limited. This pilot study investigated the cyclic changes in carotid artery geometry caused by blood flow pulsation in rats. A high-resolution ultrasound imaging system with a broadband scanhead centered at 40 MHz was used to obtain longitudinal images of the rat carotid artery. A high frame rate retrospective B-scan imaging technique based on the use of electrocardiogram to trigger signal acquisition was used to examine precisely the fast arterial wall motion. Two-dimensional geometry data obtained from nine rats showed that the rat carotid artery asymmetrically contracts and dilates during each cardiac cycle. Systolic/diastolic vessel diameters near the upstream and downstream regions from the bifurcation were 0.976 ± 0.011/0.825 ± 0.015 mm and 0.766 ± 0.015/0.650 ± 0.016 mm, respectively. Their posterior/anterior wall displacement ratios in the radial direction were 41.0 ± 14.9% and 2.9 ± 1.6%, respectively. These results indicate that in the vicinity of bifurcation, the carotid artery favorably expands to the anterior side during the systolic phase. This phenomenon was observed to be more prominent in the downstream region near the bifurcation. The cyclic variation pattern in wall movement varies depending on the measurement site, which shows different patterns at far upstream and downstream of the bifurcation. The asymmetric radial expansion and contraction of the rat carotid artery observed in this study may be useful in studying the hemodynamic etiology of cardiovascular diseases because the pulsatile changes in vessel geometry may affect the local hemodynamics that determines the spatial distribution of wall shear stress, one of important cardiovascular risk factors. Further systematic study is needed to clarify the effects of wall elasticity, branch angle and vessel diameter ratio on the asymmetric wall motion of carotid artery bifurcation.
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Affiliation(s)
- Kweon-Ho Nam
- Department of Ocean System Engineering, Jeju National University, Jeju, South Korea
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13
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Warwick R, Mediratta N, Chalmers J, Pullan M, Shaw M, McShane J, Poullis M. Is single-unit blood transfusion bad post-coronary artery bypass surgery? Interact Cardiovasc Thorac Surg 2013; 16:765-71. [PMID: 23449665 DOI: 10.1093/icvts/ivt062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Publications in the surgical literature are very consistent in their conclusions that blood is dangerous with regard to in-hospital mortality, morbidity and long-term survival. Blood is frequently used as a volume expander while simultaneously increasing the haematocrit. We investigated the effects of a single-unit blood transfusion on long-term survival post-cardiac surgery in isolated coronary artery bypass grafting patients. METHODS A prospective single-institution cardiac surgery database was analysed involving 4615 patients. Univariate, multivariate stepwise Cox regression analysis and propensity matching were performed to identify whether a single-unit blood transfusion was detrimental to long-term survival. RESULTS Univariate analysis revealed that blood was significantly associated with a reduced long-term survival even with a single-unit transfused, P = 0.0001. Cox multivariate regression analysis identified age, ejection fraction, preoperative dialysis, logistic EuroSCORE, postoperative CKMB, blood transfusion, urgent operative status and atrial fibrillation as significant factors determining long-term survival. When the Cox regression was repeated with patients who received no blood or only one unit of blood, transfusion was not a risk factor for long-term survival. An interaction analysis revealed that blood transfusion was significantly interacting with preoperative haemoglobin levels, P = 0.02. Propensity analysis demonstrated that a single-unit transfusion is not associated with a detrimental long-term survival, P = 0.3. CONCLUSIONS Cox regression and propensity matching both indicate that a single-unit transfusion is not a significant cause of reduced long-term survival. Preoperative anaemia is a significant confounding factor. Despite demonstrating the negligible risks of a single-unit blood transfusion, we are not advocating liberal transfusion and would recommend changing from a double-unit to a single-unit transfusion policy. We speculate that blood is not bad, but that the underlying reason that it is given might be.
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Affiliation(s)
- Richard Warwick
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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14
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Heim L, Poole RJ, Warwick R, Poullis M. The concept of aortic replacement based on computational fluid dynamic analysis: patient-directed aortic replacement. Interact Cardiovasc Thorac Surg 2013; 16:583-8. [PMID: 23407695 DOI: 10.1093/icvts/ivt031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Aortic replacement is based on the aortic diameter in the absence of dissection or connective tissue diseases. Frequently, a number of different aortic-to-prosthetic anastomotic positions are possible depending on patient factors and surgeon preferences. High stress on residual aortic tissue may result in aneurysm formation or aneurysmal dilatation. Utilizing a computational fluid dynamic evaluation, we aimed to define possible optimal operative interventions with regard to the extent of aortic replacement. METHODS For proof of principle, a computational fluid dynamic (CFD) analysis, using Fluent 6.2 (Ansys UK Ltd, Sheffield, UK), was performed on a simplified ascending arch and descending aortic geometry. Wall shear stress in three dimensions was assessed for the standard operations: ascending aortic replacement, arch replacement and proximal descending aortic replacement. RESULTS Hermiarch replacement is superior to isolated ascending aortic replacement with regard to residual stress analysis on tissues (up to a 10-fold reduction). Aortic arch replacement with island implantation of the supra-aortic vessels may potentially result in high stress on the residual aorta (10-fold increase). Aortic arch replacement with individual supra-aortic vessel implantation may result in areas of high stress (10-fold increase) on native vessels if an inadequate length of supra-aortic tissue is not resected, regardless of it being aneurysmal. CONCLUSIONS Computational fluid dynamic evaluation, which will have to be patient-specific, 3D anatomical and physiological, potentially has enormous implications for operative strategy in aortic replacement surgery. CFD analysis may direct the replacement of normal-diameter aortas in the future.
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Affiliation(s)
- Laurant Heim
- School of Engineering, University of Liverpool, UK
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Shared associations of nonatherosclerotic, large-vessel, cerebrovascular arteriopathies. Curr Opin Neurol 2013; 26:13-28. [DOI: 10.1097/wco.0b013e32835c607f] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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