Antegrade vertebral artery flow
Femoral angiogram/angioplasty with oec hybrid or | ge
Carotid artery stenosis (CAS), or atherosclerotic narrowing of the extracranial carotid arteries, is a clinically important condition because it is a risk factor for ischemic stroke, which affects more than 600,000 adults in the United States each year. The vast majority of strokes are ischemic, and atherothrombosis of large arteries, including the carotids, accounts for around 15% of all ischemic strokes. 1 The concept of hemodynamically significant CAS varies from study to study, with stenosis levels varying from 50% to 70% and higher. Clinically important CAS is described as 60 percent to 99 percent by the US Preventive Services Task Force. 2 Early atherosclerotic disease is detected using carotid intima-media thickness (CIMT), a test of the intimal and medial layers of the carotid artery walls. Increased CIMT is linked to an increased risk of myocardial infarction and stroke, but it’s uncertain if its use results in measurable health benefits. 3
Advanced age, cigarette smoking, hyperlipidemia, hypertension, diabetes, and physical inactivity are all risk factors for CAS, as are those for atherosclerosis in other vascular beds. Men are marginally more likely than women to have CAS. 4
Hot tips – finding the vertebral artery with ultrasound
A narrowing of the carotid arteries, the two main arteries that carry oxygen-rich blood from the heart to the brain, is known as carotid stenosis. Carotid stenosis, also known as carotid artery disease, is caused by plaque accumulation (atherosclerosis) within the artery wall, which decreases blood flow to the brain. Treatment helps to minimize the risk of stroke by preventing blood clots and controlling or eliminating plaque accumulation.
Understanding the circulatory function of the head and neck is helpful in understanding carotid stenosis (see Anatomy of the Brain). The common carotid artery starts at the aorta in the chest and travels up through the neck to the head. You can feel the pulse in your carotid arteries by putting your hands on either side of your spine. The common carotid artery splits into the external and internal carotid arteries near the larynx. Blood is supplied to the face and scalp by the external carotid arteries. The internal carotid arteries are the blood vessels that supply blood to the brain. The carotid bifurcation (Fig. 1), where the normal carotid splits into the internal and external carotid arteries, is the most common site of atherosclerotic plaque accumulation.
Flow diversion for brain aneurysm, animation.
The aim of this study was to see how normal antegrade internal carotid artery collateral flow is in patients with common carotid artery occlusion, which artery supplies blood to the internal carotid artery, and whether the flow affects regional cerebral blood flow in the middle cerebral artery territory.
We used carotid sonography to determine the incidence of antegrade internal carotid artery collateral flow and identify its arterial origins in 10 patients with common carotid artery occlusion, and single-photon emission computed tomography to evaluate regional cerebral blood flow in the middle cerebral artery territory in these patients and 30 age- and sex-matched patients with internal carotid artery occlusion.
Six of the ten patients with a typical carotid artery occlusion (60%) had antegrade internal carotid artery collateral flow, which was supplied through the carotid bifurcation from retrograde external carotid artery flow in five cases and by a small artery directly into the internal carotid artery in one case. Patients with common carotid artery occlusion had higher regional cerebral blood flow ipsilateral to the occlusion at rest than those with internal carotid artery occlusion (mean SD, 40.4 8.5 versus 34.3 6.2 mL/100 g/min; P =.02). At rest, regional cerebral blood flow was slightly higher in the 6 patients with antegrade internal carotid artery flow than in those with internal carotid artery occlusion (42.2 7.2 versus 34.3 6.2 mL/100 g/min; P =.02), but not in the other 4 patients without antegrade internal carotid artery flow (42.2 7.2 versus 34.3 6.2 mL/100 g/min; P =.02).
Extension rotation test | vertebrobasilar insufficiency (vbi
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Three individuals with vertigo, transient speech difficulty, and cardiac prebypass graft surgery had their carotid Doppler imaging results showed two systolic peaks in one of the vertebral arteries. With antegrade flow, the vertebral artery waveform reveals two systolic peaks with a deep cleft between the two peaks or two systolic peaks with a sharp first and rounded second systolic peak in presteal circumstances. There is bidirectional flow and later flow reversal when stenosis exceeds more than 80%. The types of presteal vertebral artery waveforms, their clinical effects, and a review of the literature are discussed.