• Annals of Clinical Neurophysiology
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• v.23 no.2
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• pp.82-91
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• 2021

Carotid duplex ultrasound is commonly used to diagnose various carotid artery diseases due to it being noninvasive and easy to perform. Carotid atherosclerosis is a major indicator for the need to perform carotid duplex ultrasound, which can determine the degree of stenosis, plaque characteristics, and intima-media thickness. It can also be used to screen and follow-up after carotid revascularization. Here we discuss the standard techniques, interpretations, and clinical indicators for carotid duplex ultrasounds.

• Journal of Korea Association of Health Promotion
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• v.4 no.1
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• pp.12-27
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• 2006

"본 논문은 대한내과학회지 2006년 제70권 제3호에 실렸던 논문으로 대한내과학회 편집위원회의 승인을 득하고 본 협회지에 게재함. Background : Diabetes mellitus is a major independent risk factor for atherosclerosis. In recent years non-invasive high resolution B-mode ultrasound methods have been developed to measure the intima-media thickness(IMT) of the carotid artery as an indicator for early atherosclerosis. Itis known that obesity plays a role in the development of type 2 diabetes and cardiovascular disease, and it has also been reported that not only the amount but also the distribution of body fat is important. This study investigated the relationship between obesity and the development of carotid atherosclerosis in type 2 diabetic patients. Methods: Carotid IMT was measured by ultrasound B-mode imaging in 144 patients with type 2diabetes mellitus. All subjects underwent assessment for the degree and distribution of obesity, the presence of coronary artery disease risk factors, and the presence of diabetic complications. Resuts: Carotid IMT was increased in the abdominal obese group defined by waist circurference. However, there was no significant difference in carotid TMT between the non-obese group and obese group as defined by body mass index, waist to hip ratio, and total body fat percent measured by bio electrical impedance analysis. There were positive correlations between carotid IMT and age, duration of diabetes, systolic blood pressure, and waist circumference. Multiple linear regression analysis revealed the variable that interacted independently with carotid IMT was age in type 2 diabetic patients. Carotid IMT was significantly increased in type 2 diabetic patients with macrovascular complications and microvascvlar complications .Conclusion: This study suggested that abdominal obesity rather than general obesity was associated with carotid atherosclerosis reflected by increment of carotid IMT in type 2 diabetic subjects.

• The Journal of Internal Korean Medicine
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• v.31 no.3
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• pp.467-476
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• 2010

Object : The purpose of this study was to investigate the correlation of atherosclerosis risk factors and pulse wave velocity (PWV) of carotid-femoral artery with Sasang constitution. This study also aimed to investigate the relationship between PWV and risk factors of atherosclerosis, including serum cholesterol and homosisteine, hs-CRP. Methods : We enrolled 160 patients without experience strokes who visited our hospital for a medical examination from January 1, 2008 to April 30, 2010 except patients whose body constitutions were undetermined according to QSCCII. We investigated the correlation between serum cholesterol values, blood pressure, body mass index(BMI), homosistein, hs-CRP and PWV. Pearson's correlation and partial correlation analysis were applied to examine the relationship between PWV and risk factors of atherosclerosis. Result : Among the 160 subjects, 54 were Taeumin, 54 were Soyangin, and 52 were Soeumin. The prevalences of high BMI (P-value <0.01), high hs-CRP(P-value <0.05), and high PWV(P-value <0.05) of Taeumin were higher than those of the other constitutions. PWV of carotid-femoral artery was significantly different among the three constitutional groups(Taeumin: $8.12{\pm}1.64m/sec$, Soyangin: $7.48{\pm}1.16m/sec$, Soeumin: $7.49{\pm}1.12m/sec$)(P-value <0.05). This research has show a statistical significance between the average amount of carotid-femoral artery PWV that is higher in Taeumin. Age factor of Taeumin was the effective determinant of the increase of mean PWV of carotid-femoral arteries. Conclusions : There were significant differences in the prevalence of atherosclerosis according to Sasang constitution. This study showed that atherosclerosis was more prevalent in Taeumin. Therefore, according to our results, risk of atherosclerosis was higher in Taeumin than among other constitutions.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.1
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• pp.51-57
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• 2024

Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease. We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft's free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits. The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.

• Biomedical Science Letters
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• v.21 no.4
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• pp.198-207
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• 2015

ST-segment elevation myocardial infarction (STEMI) and chronic total occlusion (CTO) of coronary artery are well-known atherosclerotic vascular diseases. However, the difference of intima-media thickness and plaque characteristics of carotid arteries between STEMI and CTO patients were not directly compared in previous studies. Medical records of a total of 158 (101 STEMI, 57 CTO) patients, who underwent carotid artery ultrasonography, were selected for the analysis. The baseline characteristics, ultrasonography findings, and clinical outcomes of the two groups were compared. The prevalence of hypertension, diabetes mellitus, and dyslipidemia was significantly higher in CTO patients. Carotid intima-media thickness ($0.97{\pm}0.13$ vs. $0.78{\pm}0.17cm$, P < 0.0001) and number of plaques ($2.2{\pm}1.0$ vs. $1.7{\pm}1.2$, P < 0.0001) were greater in CTO than STEMI patients. Multiple (${\geq}3$) or echogenic plaques were more frequently observed in CTO patients. During the median follow-up duration of 27 months, major adverse cardiovascular events occurred in 31% of CTO and 14% of STEMI patients (P = 0.008). We found that, compared with STEMI, CTO patients have higher burden of carotid artery atherosclerosis associated with more comorbid diseases and poor clinical outcomes.

• Journal of Chest Surgery
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• v.26 no.11
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• pp.833-837
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• 1993

In an effort to reduce the stroke rate of patients after coronary artery bypass, many authors have studied the prevalence of the extracranial carotid disease and its role in determining neurologic morbidity and mortality rates. From April 1992 to August 1993, Seventy-five patients undergoing coronary artery bypass were preoperatively evaluated for presence of carotid and femoral stenosis by Duplex sono. Among them, fourteen patients was positive by Duplex sono and overall prevalence of carotid or femoral stenosis was 18.7%. And significant carotid stenosis [ > 60% ] had proved to be in 3 patients [ 4.0% ].Prophylatic bilateral carotid endarterectomy was performed in one patient, at 5 months prior to and , 1 week prior to coronary artery bypass respectively. Their mean age was 57.6 years [ ranged from 40 to 70 years] and were composed of 10 males and 4 females. There was no postoperative morbidiry and mortality related to neurologic complications. Our data, although small, suggest that preoperative carotid screening is helpful to determine patients at high risk of stroke, and significant simultaneous carotid and coronary atherosclerosis should be corrected in selected patients by staged operations when feasible.

• The Journal of Internal Korean Medicine
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• v.38 no.6
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• pp.1096-1100
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• 2017

The carotid artery is one of the main vessels supplying blood to the brain. Carotid artery stenosis is mostly caused by atherosclerosis, a disease where cholesterol is deposited in the arterial blood vessels. Tremor refers to rhythmic shaking of a body part. Tremor is a symptom of many diseases, including Parkinson's disease, essential tremor, orthostatic tremor, cerebellar disease, peripheral neuropathy, and alcohol withdrawal. Tremors may be classified as postural, rest, and action tremors. Tremor of a patient with stenosis of the left carotid artery decreased with acupuncture treatment. The acupoints were GB20, TE17, GV8 and GV11. This case shows that the acupuncture treatment is effective against tremor.

• Annals of Clinical Neurophysiology
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• v.11 no.2
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• pp.54-58
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• 2009

Background: Obstructive sleep apnea (OSA) is associated with several cardiovascular diseases. However, the mechanisms are not completely understood. The measure of common carotid artery intima-media thickness (IMT) has been extensively used as an early marker of atherosclerosis. The aim of this study was to test the hypothesis that early signs of atherosclerosis are present in patients with OSA and correlate with OSA severity Methods: Eleven male patients with OSA were studied by using full standard overnight polysomnography and high-definition echo-tracking device to measure intima-media thickness and carotid artery diameter. Eight healthy volunteers matched for age and sex were studied by portable respiratory monitoring device. All participants were free of hypertension, diabetes, and were not on any medications. Patients with OSA were naive to treatment. Results: All patients and normal controls were male. There was no significant difference of age between patients and controls ($48.4{\pm}8.85$ and $48.0{\pm}9.77$). Significant differences existed between control subjects and patients with mild to moderate and severe OSA (apnea-hypopnea index, $1.51{\pm}1.15$ and $38.51{\pm}19.13$ respectively) in intima-media thickness ($0.59{\pm}0.064$ and $0.93{\pm}0.16$; P=0.0023), and carotid diameter ($5.79{\pm}0.44$ and $6.47{\pm}0.51$; P=0.0227). Multivariate analyses showed that the apnea-hypopnea index correlated independently with intima-media thickness and carotid diameter (r=0.79, P=0.0008, and r=0.47, P=0.0482). Conclusions: Middle-aged patients with OSA who are free of overt cardiovascular diseases have early signs of atherosclerosis, which further supports the hypothesis that OSA plays an independent role in atherosclerosis progression.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.94-99
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• 2015

Objective : The purpose of our study was to assess prevalence of carotid intraplaque hemorrhage (IPH) and associations between territorial acute infarction and IPH on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) in patients with acute neurologic symptoms. Methods : 83 patients with suspected acute neurologic symptoms were evaluated with both brain diffusion weighted imaging (DWI) and carotid MPRAGE sequences. Carotid plaque with high signal intensity on MPRAGE of >200% that of adjacent muscle was categorized as IPH. We analyzed the prevalence of IPH and its correlation with territorial acute infarction. Results : Of 166 arteries, 39 had a carotid artery plaque. Of these arteries, 26 had carotid artery stenosis less than 50%. In all carotid arteries, MR-depicted IPH was found in 7.2% (12/166). High-signal intensity on DWI was found in 17.5% (29/166). Combined lesion with ipsilateral high-signal intensity on DWI and IPH on carotid MPRAGE sequence was found in 6 lesions (6/166, 3.6%). Of patients with carotid artery plaque, MR-predicted IPH was found in 30.8% (12/39) and match lesions with high-signal intensity on DWI and MPRAGE was found in 15.4% (6/39). MR-predicted IPH was significantly higher prevalence in high-grade stenosis group (p=0.010). Relative risk between carotid MPRAGE-positive signal and ipsilateral high-signal intensity on DWI in arteries with carotid artery plaques was 6.8 (p=0.010). Conclusion : Carotid MPRAGE-positive signal in patients was associated with an increased risk of territorial acute infarction as detected objectively by brain DWI. The relative risk of stroke was increased in high-grade stenosis categories.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.745-752
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• 2005

Purpose : Adolescent obesity is known to be associated with complications such as hypertension, coronary artery disease and insulin resistance. We measured the common carotid artery by ultrasound as a predictor of atherosclerosis, and investigated the relationship between carotid artery parameters and serum cytokines in obese adolescents. Methods : Twenty-nine obese adolescents(16-17 years old, obesity index>130 percent) and twentyseven normal controls were included. Obesity index and body mass index were calculated from their height and weight. Skin fold thickness was measured at the triceps, and fat mass and fat distribution by bioelectrical impedence analysis. Blood pressure was measured at resting state and serum lipid, insulin, and homocysteine levels after a 12-hour fasting period. Intimal wall thickness, systolic and diastolic diameters of the common carotid artery were measured by ultrasound, and compliance and distensibility calculated by equation. Results : Systolic and diastolic diameters of the carotid artery significantly correlated with arm circumference, body mass index, fat distribution and fat mass. The higher systolic blood pressure was, the larger systolic and diastolic diameter. The higher diastolic blood pressure was, the larger carotid intimal thickness. Insulin levels had positive correlations with systolic, diastolic diameters and serum homocysteine level with intimal thickness. Conclusion : The carotid artery diameter significantly increased with the degree of obesity and blood pressure. The carotid intimal wall thickness significantly correlated with diastolic blood pressure. Measurement of carotid artery thickness, insulin and homocysteine levels might be useful to predict the development of coronary artery disease.