[Ct-angiography in assessment of critical occlusive carotid artery disease]
M V Vishnyakova1, I N Pronin2, R N Larkov1
1Vladimirskiy Moscow Regional Research Clinical Institute, Moscow, Russia.
Insights
Critical occlusive carotid artery disease, a major cause of ischemic stroke, was assessed using CT-angiography. This imaging technique precisely identifies critical stenosis, near-occlusion, and local occlusion, aiding in preoperative diagnosis.
Area of Science:
- Vascular Surgery
- Neurology
- Radiology
Background:
- Occlusive carotid artery disease is a leading cause of ischemic stroke globally.
- Severe carotid stenosis can progress to critical stenosis and vascular occlusion.
- A clear definition for critical occlusive carotid artery disease is lacking.
Purpose of the Study:
- To define the role of CT-angiography in assessing critical occlusive carotid artery disease.
- To establish diagnostic criteria for critical occlusive carotid artery disease variants.
Main Methods:
- Analysis of 405 patients undergoing carotid artery assessment and surgery (2016-2019).
- Preoperative contrast-enhanced CT-angiography (256 slices) performed after ultrasound.
- Specialized protocol used for CT angiography data assessment.
Main Results:
- Critical occlusive carotid artery disease found in 31.6% of cases (critical stenosis 24.94%, near-occlusion 5.92%, local occlusion 0.74%).
- Critical stenosis defined as local narrowing ≥90%.
- Near-occlusion involved distal arterial narrowing; local occlusion showed collateral supply via ascending pharyngeal artery.
Conclusions:
- Distal internal carotid artery status serves as a differential diagnostic criterion for critical occlusive carotid disease.
- CT-angiography offers comprehensive data for precise preoperative assessment.
- CT-angiography is recommended for evaluating critical occlusive carotid artery disease.
Background:
Occlusive carotid artery disease is still one of the major causes of ischemic stroke in the world. Progression of severe carotid stenosis may lead to critical stenosis and vascular occlusion. Nevertheless, there is still no pure definition of the concept of critical occlusive carotid artery disease.
Objective:
To define the role of CT-angiography in assessment of critical occlusive carotid artery disease.
Material And Methods:
We analyzed data of 405 patients who underwent preoperative precise assessment of carotid arteries and subsequent surgical treatment for the period from 2016 to 2019. Contrast-enhanced CT-angiography (Philips Ict scanner, 256 slices) was made after previous ultrasound. Contrast agent injection rate was 4-5 ml/sec. CT angiography data were assessed according to a specialized protocol.
Results:
Critical occlusive carotid artery disease was observed in 128 (31.6%) cases including critical stenosis (24.94%), near-occlusion (5.92%) and local occlusion (0.74%). Critical stenosis was characterized by local narrowing ≥90% and normal diameter of distal arterial segment. In case of near-occlusion, local critical stenosis was accompanied by narrowing of distal arterial segment. In case of local occlusion, distal collateral supply of internal carotid artery occurred through atypically originating ascending pharyngeal artery. Patients with near-occlusion and local occlusion of internal carotid artery had no signs of ICA hypoplasia and intracranial stenoses. All elements of circle of Willis were observed in 70% of patients.
Conclusion:
State of distal segment of internal carotid artery can be considered as a differential diagnostic criterion for critical occlusive carotid disease variants. CT-angiography provides all necessary data and can be recommended for precise preoperative assessment.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation