• Carotid plaque
• Carotid ultrasound
• Internal carotid artery stenosis
• Spectral Doppler

• Humans
• Carotid Stenosis/diagnostic imaging
• Carotid Artery, Internal/diagnostic imaging
• Ultrasonography/methods
• Carotid Arteries/diagnostic imaging
• Contrast Media
• Ultrasonography, Carotid Arteries

• Carotid atherosclerosis
• Early diagnosis
• Nomogram
• Prediction model
• Primary care
• Retinal vascular

• Humans
• Female
• Male
• Asymptomatic Diseases
• Predictive Value of Tests
• Carotid Artery Diseases/diagnosis
• Carotid Artery Diseases/diagnostic imaging
• Middle Aged
• Risk Factors
• Aged
• Retinal Vessels/diagnostic imaging
• Retinal Vessels/pathology
• Retrospective Studies
• Risk Assessment
• Nomograms
• Reproducibility of Results
• Decision Support Techniques
• Early Diagnosis
• Prognosis

• Carotid artery stenting
• Carotid endarterectomy
• Internal carotid artery stenosis
• Plaque ulcer
• Plaque vulnerability

• Carotid artery stenosis
• Carotid artery stenting and angioplasty
• Optical coherence tomography angiography
• Vascular density

• Humans
• Retinal Vessels
• Carotid Stenosis/diagnosis
• Carotid Stenosis/surgery
• Fluorescein Angiography/methods
• Tomography, Optical Coherence/methods
• Prospective Studies
• Microvascular Density
• Stents
• Retina
• Angioplasty
• Carotid Arteries

• carotid ultrasound
• computer-aided diagnosis
• deep learning
• vision transformer

• Humans
• Neural Networks, Computer
• Machine Learning
• ROC Curve
• Stroke/diagnostic imaging
• Ischemic Stroke

• 112-2622-E-004-001 National Science and Technology Council in Taiwan
• 112-2221-E-004-007-MY3 National Science and Technology Council in Taiwan
• MMH-109-129 Mackay Memorial Hospital

• atherosclerosis
• biomarkers
• cardiovascular risk
• carotid artery disease
• intima-media thickness

Many complications in physiology are associated with a deviation in flow in arteries due to a stenosis. The presence of stenosis may transition the flow to weak turbulence. The degree of stenosis as well as its configuration whether symmetric or non-symmetric to the parent artery influences whether the flow would stay laminar or transition to turbulence. Plenty of research efforts focus on investigating the role of varying degrees of stenosis in the onset of turbulence under steady and pulsatile flow conditions. None of the studies, however, have focused on investigating this under oscillatory flow conditions as flow reversal is a major occurrence in a number of physiologic flows, and is of particular relevance in cerebrospinal fluid flow research. Following up on the previous work in which a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$75\%$$\end{document}75% stenosis was studied, this contribution is a detailed investigation of the role of degrees of stenosis on transition in an oscillatory flow. A cylindrical pipe with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$25\%$$\end{document}25%, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$50\%$$\end{document}50% and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$60\%$$\end{document}60% reductions in area in axisymmetric and eccentric configurations is studied for transition with 3 different pulsation frequencies of a purely oscillatory flow. Cycle averaged Reynolds numbers between 1800 and 2100 in steps of 100 are studied for each configuration resulting in 72 simulations each conducted on 76,800 CPU cores of a modern supercomputer. It is found that a higher degree of stenosis and eccentricity causes earlier transition to turbulence in oscillatory flow. The results further demonstrate that a higher frequency of oscillation results in larger hydrodynamic instability in the flow, which is more prominent in smaller degrees of stenosis.

• Hydrodynamic instability
• Lattice Boltzmann method
• Stenosis
• Transitional flow
• Turbulence

This study aimed to construct a radiomics-based MRI sequence from high-resolution magnetic resonance imaging (HRMRI), combined with clinical high-risk factors for non-invasive differentiation of the plaque of symptomatic patients from asyptomatic patients.

A total of 115 patients were retrospectively recruited. HRMRI was performed, and patients were diagnosed with symptomatic plaques (SPs) and asymptomatic plaques (ASPs). Patients were randomly divided into training and test groups in the ratio of 7:3. T2WI was used for segmentation and extraction of the texture features. Max-Relevance and Min-Redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) were employed for the optimized model. Radscore was applied to construct a diagnostic model considering the T2WI texture features and patient demography to assess the power in differentiating SPs and ASPs.

SPs and ASPs were seen in 75 and 40 patients, respectively. Thirty texture features were selected by mRMR, and LASSO identified a radscore of 16 radiomics features as being related to plaque vulnerability. The radscore, consisting of eight texture features, showed a better diagnostic performance than clinical information, both in the training (area under the curve [AUC], 0.923 vs. 0.713) and test groups (AUC, 0.989 vs. 0.735). The combination model of texture and clinical information had the best performance in assessing lesion vulnerability in both the training (AUC, 0.926) and test groups (AUC, 0.898).

This study demonstrated that HRMRI texture features provide incremental value for carotid atherosclerotic risk assessment.

• HRMRI
• asymptomatic
• carotid atherosclerosis
• radiomics
• symptomatic

• Neurosonology
• carotid plaque ulcers
• ulcerated carotid plaque healing

• Carotid Arteries/diagnostic imaging
• Carotid Stenosis/diagnostic imaging
• Carotid Stenosis/epidemiology
• Humans
• Retrospective Studies
• Risk Factors
• Ulcer/diagnostic imaging
• Ultrasonography

• Carotid artery stenosis
• Cerebral ischemia events
• Diagnostic
• MiR-342-5p
• Predicts

Worldwide, the stroke burden remains severe, especially for people in low socioeconomic groups. Atherosclerosis is a leading cause of stroke that is attracting increasingly greater attention. Blood pressure, including pulse pressure (PP) and systolic (SBP) and diastolic (DBP) blood pressures, is a traditional risk factor for atherosclerosis; its association with carotid intima-media thickness (CIMT) has also been widely studied. However, published studies have not reported on the relationship between PP and CIMT in low-income adults. Thus, this study investigated the relationship between PP and CIMT in a low-income population, in China. A total of 3,789 people, aged ≥45 years and without histories of stroke or cardiovascular disease, were recruited into this study. B-mode ultrasonography was performed to determine CIMTs. Demographic characteristics, physical examination data, previous medical histories, and laboratory test results were collected for each study participant. Multiple linear regression models were used to analyze the association between CIMT and PP. The mean CIMT was 567.1 μm (males, 583.5 μm; females, 555.7 μm). The SBP, DBP, PP, and mean arterial pressure (MAP) values were all positively correlated with CIMT, in the univariate analysis; PP and MAP showed the strongest correlations. In addition, in three multiple linear regression models, PP was shown to be significantly associated with CIMT; each 1-mm Hg increase in PP resulted in a CIMT increase of ≥0.41 μm (all P < 0.001). Our results demonstrated that, when compared with SBP, DBP, and MAP, PP may be the best predictor of CIMT. Thus, controlling blood pressure, especially PP levels, is vital to decreasing the prevalence of atherosclerosis, especially in this low socioeconomic status population in China.

• atherosclerosis
• carotid intima-media thickness
• epidemiology
• pulse pressure
• risk factors

The stability of carotid artery plaque serves a key role in the occurrence of stroke. The present study was based on the recruitment of patients with acute ischemic cerebrovascular disease. High-resolution magnetic resonance imaging (HR-MRI) was used to identify the nature of carotid artery plaque, and the results were then used to manage the high-risk group of stroke. The patients were divided equally into a symptomatic group (36 cases) and an asymptomatic group (36 cases). According to the degree of carotid artery stenosis, the patients were divided into mild, moderate and severe stenosis groups, each group comprising 12 patients, and HR-MRI was performed. The proportion of patients with vulnerable plaque in the symptomatic group was higher compared with that in the asymptomatic group (P<0.05). The more severe the stenosis, the higher the proportion of vulnerable plaque that was identified (P<0.05). Compared with carotid ultrasound, HR-MRI was indicated to have the capability to both identify and quantify the different components in the plaque, allowing an assessment of its properties. In conclusion, the present study demonstrated that carotid HR-MRI is able to distinguish and quantify the different components of plaque, which may prove to be helpful for the hierarchical management of a population at high risk of stroke.

• carotid artery
• carotid ultrasound
• high-resolution MRI
• stenosis
• vulnerable plaque

• Carotid artery stenosis
• epidemiology
• population-based study
• prevalence
• risk factor

• atherosclerosis
• carotid
• exosomes
• extracellular vesicles
• microRNA
• stroke

• Carotid arteries
• Convolutional neural network
• Magnetic resonance imaging
• Segmentation
• Vessel wall

• R01 HL128056 NHLBI NIH HHS

• MRI
• Vascular
• arteries
• central nervous system
• magnetic resonance angiography
• magnetic resonance imaging

• Carotid plaque
• Carotid ultrasound
• Internal carotid artery stenosis
• Intimal medial thickening
• Spectral Doppler

The aim of the study presented here was to evaluate retinal and optic nerve head (ONH) perfusion in patients with severe asymptomatic carotid artery stenosis (CAS) compared with healthy controls and to analyze the impact of carotid endarterectomy using optical coherence tomography angiography (OCT-A). 25 eyes of 25 patients with CAS (study group) and 25 eyes of 25 healthy controls (control group) were prospectively included in this study. OCT-A was performed using RTVue XR Avanti (Optovue, Inc, Fremont, California, USA). The flow density data in the superficial and deep retinal OCT-angiogram of the macula and in the radial peripapillary capillary network (RPC) of the ONH were extracted and analyzed. The flow density in the superficial retinal OCT angiogram of the macula and in the ONH were significantly lower in the study group compared with the control group (macula: p = 0.003) (ONH: p = 0.013). The flow density in the ONH improved significantly after carotid endarterectomy (p = 0.004). A reduced flow density was observed in patients with CAS when compared with healthy controls. The flow density also improved after carotid endarterectomy. Quantitative changes in the microvascular density, as measured using OCT-A, could well be useful in the diagnosis of CAS and the evaluation of therapy success.

Chemerin is an adipokine which plays a crucial role in atherosclerosis. Here, we examined whether circulating chemerin is enhanced in patients with advanced carotid stenosis.

Chemerin was quantified in 178 patients prior to carotid end arterectomy (CEA) and in age- and gender-matched controls (n = 163). Chemerin levels were related to anthropometric, clinical and metabolic characteristics of the patients.

Chemerin levels were higher in patients compared to controls (p <  0.001). Chemerin correlated to parameters associated with inflammation such as C-reactive protein (CRP, p <  0.001), leukocyte blood count (p <  0.001) and circulating TNF-α (p = 0.004) in the patients. Chemerin levels did not differ between asymptomatic (n = 93) and symptomatic patients who experienced an ischemic event within 6 months prior to CEA (n = 85). However, in the case of high-grade carotid stenosis (≥ 90%), chemerin levels were higher in symptomatic (n = 44) compared to asymptomatic patients (n = 41, p = 0.014). Chemerin was increased in patients with (n = 50) compared to patients without (n = 128) coronary artery disease (CAD, p = 0.002). A high level of chemerin increases the risk for CAD in patients (p = 0.0013).

Circulating chemerin is increased and correlates to inflammatory parameters in patients with advanced carotid stenosis.

• Carotid stenosis
• Chemerin
• Coronary artery disease

• MRI
• carotid plaque
• vessel wall imaging

Carotid atherosclerotic disease constitutes a major modern health problem whose diagnosis primarily relies on imaging. Grading of stenosis has been long used as the main factor for risk stratification and guiding of management. Nevertheless, increasing evidence has shown that additional plaque characteristics such as plaque composition and surface morphology play an important role in the occurrence of symptoms, justifying the term “vulnerable plaque”. Carotid plaque surface characteristics either in the form of surface irregularities or ulceration represent an important factor of vulnerability and are associated with the occurrence of neurologic symptoms. The delineation of the carotid plaque surface can be performed with virtually all imaging modalities including ultrasound, contrast-enhanced ultrasound, multi-detector computed tomography angiography, magnetic resonance angiography and the traditional reference method of angiography. These techniques have shown varying levels of diagnostic accuracy for the identification of ulcerated carotid plaques or plaque surface irregularities. As a consequence and given its high clinical significance, radiologists should be familiar with the various aspects of this entity, including its definition, classification, imaging findings on different imaging modalities and associations. The purpose of this review is to present the current literature regarding carotid plaque ulcerations and present illustrative images of ulcerated carotid plaques.

• Plaque surface and ulceration represent risk factors for stroke in carotid disease.

• Characterisation of the plaque surface and ulcerations can be performed with every modality.

• US is the first-line modality for carotid disease and identification of ulcerations.

• The administration of microbubbles increases US accuracy for diagnosis of carotid ulceration.

• MDCTA and MRA are valuable for diagnosing ulceration and evaluating plaque composition.

• CT angiography
• Carotid atherosclerosis
• Carotid ulcer
• MRI angiography
• Ultrasound imaging

• atherosclerosis
• carotid artery disease
• carotid artery stenosis
• carotid artery stents
• carotid endarterectomy
• endovascular carotid
• stroke

• AHA = American Heart Association
• CAS = carotid artery stenting
• CEA = carotid endarterectomy
• CEUS = contrast-enhanced ultrasonography
• CTA = CT angiography
• DCE = dynamic contrast-enhanced
• DSCT = dual-source CT
• FDG = fluorodeoxyglucose
• FSE = fast spin echo
• Gd = gadolinium
• HU = Hounsfield units
• IPH = intraplaque hemorrhage
• LRNC = lipid-rich necrotic core
• MDCT = multidetector-row CT
• MDCTA = MDCT angiography
• MES = microembolic signal
• MMP-9 = matrix metalloproteinase-9
• MRA = MR angiography
• MRI
• PDW = proton density-weighted
• SUV = standardized uptake value
• SUVmax = maximal SUV
• TBR = target-to-background ratio
• TCD = transcranial Doppler ultrasonography
• TIA = transient ischemic attack
• TOF = time of flight
• USPIO = ultrasmall superparamagnetic iron oxide
• carotid artery
• risk
• ultrasound
• vascular disorders

• Asymptomatic Diseases
• Carotid Stenosis/complications
• Carotid Stenosis/diagnosis
• Carotid Stenosis/surgery
• Cerebral Angiography/methods
• Cerebral Infarction/diagnosis
• Cerebral Infarction/etiology
• Cerebrovascular Disorders/diagnosis
• Cerebrovascular Disorders/etiology
• Cerebrovascular Disorders/prevention & control
• Endarterectomy, Carotid
• Evidence-Based Medicine
• Humans
• Intracranial Embolism/diagnosis
• Intracranial Embolism/etiology
• Magnetic Resonance Angiography
• Patient Selection
• Predictive Value of Tests
• Prognosis
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Stroke/diagnosis
• Stroke/etiology
• Tomography, X-Ray Computed
• Ultrasonography, Doppler, Transcranial

• RCS/DMT 3RD ROUND (3) The Dunhill Medical Trust

• Aged
• Aged, 80 and over
• Carotid Stenosis/therapy
• Female
• Health Care Surveys
• Humans
• Male
• Middle Aged
• Patient Preference
• Surveys and Questionnaires

• RCS/DMT 3RD ROUND (3) The Dunhill Medical Trust

• Analgesia
• Anesthesia, Local
• Carotid Stenosis/complications
• Carotid Stenosis/surgery
• Comprehension
• Endarterectomy, Carotid/adverse effects
• Endarterectomy, Carotid/psychology
• Health Knowledge, Attitudes, Practice
• Humans
• Informed Consent
• Intraoperative Care
• London
• Pain Measurement
• Pain, Postoperative/etiology
• Patient Education as Topic
• Patient Satisfaction
• Patients/psychology
• Perception
• Quality of Health Care
• Stroke/etiology
• Stroke/prevention & control
• Surveys and Questionnaires
• Treatment Outcome

• RCS/DMT 3RD ROUND (3) The Dunhill Medical Trust

The ABCD² score is increasingly being used to triage patients with transient ischemic attack (TIA). Whether the score can predict the need for in-hospital intervention (IHI), other than initiation of antiplatelets and statins, is unknown.

The ability of the ABCD² score to predict IHI would strengthen the rationale to use it as a decision-making tool. We thus conducted this study to investigate the relationship between the ABCD² score and IHI.

We analyzed prospectively collected data from consecutive TIA patients over 12 months. We determined ABCD² upon admission and collected the results of in-hospital evaluation, treatments initiated during hospitalization, and follow-up status. We defined IHI as arterial revascularization or anticoagulation required during admission. We used chi-square for trend to examine the association between ABCD² and IHI.

We studied 121 patients. Fourteen (12%) had small infarcts on diffusion magnetic resonance imaging; 38 (31%) had a new risk factor recognized during admission [hyperlipidemia (n = 9), hypertension (1), diabetes (1), carotid stenosis ≥ 50% (16), other arterial occlusive lesions (7), and potential cardioembolic source (4)]. Their percentages increased with higher ABCD² scores. However, among 12 patients (10%) with IHI, ABCD² score categories were equally distributed (10% in 0–3, 9% in 4–5, and 10% in 6–7; p = 0.8). One patient (0.8%) worsened during hospitalization; none had a stroke during follow-up.

Patients with an ABCD² score ≤ 3 had an equal chance of requiring IHI as those with a score of 4–7. The decision to admit TIA patients based on the ABCD² score alone is not supported by our experience and requires further study.

• Prognosis
• Stroke risk
• Transient ischemic attack

• R01 HL046690 NHLBI NIH HHS
• R01 NS057127 NINDS NIH HHS

• Aged
• Brain Ischemia/surgery
• Carotid Artery Diseases/mortality
• Carotid Artery Diseases/surgery
• Endarterectomy, Carotid/mortality
• Endarterectomy, Carotid/statistics & numerical data
• Female
• Follow-Up Studies
• Hospital Mortality
• Humans
• Male
• Stroke/surgery
• United Kingdom
• Waiting Lists