Background: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. Methods: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. Results: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. Conclusion: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.
Kim, Ye Jin;Shim, Yoon Hee;Yoo, Joung Hyun;Lee, Keun;Hong, Young Mi
Clinical and Experimental Pediatrics
/
v.48
no.7
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pp.745-752
/
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.
Lee, Yoo-Jung;Nam, Chung-Mo;Kim, Hyeon-Chang;Hur, Nam-Wook;Suh, Il
Journal of Preventive Medicine and Public Health
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v.41
no.2
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pp.107-114
/
2008
Objectives : The aim of this study is to investigate the association between obesity indices(body mass index, weight, waist-hip ratio and waist circumference) in adolescents and the carotid intima-media thickness (C-IMT) in early adulthood. We also wanted to identify the best predictor for C-IMT among these obesity indices. Methods : This study used community-based prospective cohort study, known as the Kangwha Study, and the data we used were from subjects who were 16-years old in 1996 (defined as "adolescence") and 25 years-old in 2005 (defined as "early adulthood"). The 256 subjects (113 men and 143 women) who were used for analysis participated in both follow-ups, and they underwent B-mode ultrasonography of the carotid arteries at the early adulthood follow-up. Obesity indices were defined as the body mass index, weight, waist-hip ratio and waist circumference. The C-IMT was defined as the mean of the maximal IMT of each common carotid artery. The C-IMT and obesity indices associations were evaluated via multivariable regression, logistic regression and the receiver-operator characteristic curve analyses. Results : In men, all the obesity indices in adolescence were showed to have statistically significant positive association with C-IMT in early adulthood. However, no such relationship was showed in women. On multiple regression and logistic regression analysis, the waist-hip ratio showed the biggest relationship with the C-IMT among the 4 obesity indices. However, there were no statistical significant differences and no best predictor was found. For the women, the obesity incidences and C-IMT showed no relationships. Conclusions : This study suggested that obesity in adolescence was related to an increase C-IMT in healthy young Korean men.
Objectives: This study is aimed to examine the effect of Geopungchunghyul-dan on circumferential strain of carotid artery in outpatients of Kyung Hee University hospital of Korean Medicine. Methods: Retrospective chart review is used from June 2016 to August 2017 for outpatients of Kyung Hee University hospital of Korean Medicine. 14 patients taking Geopungchunghyul-dan over 1 month were speculated. Data of circumferential strain and intima-media thickness was taken from carotid ultrasonography and processed by Wilcoxon signed-rank test. Results: Geopungchunghyul-dan lowered circumferential strain of both carotid arteries after 1 month of administration (p<0.05). Intima-media thickness of both carotid arteries did not changed significantly. Conclusions: Geopungchunghyul-dan may ameliorate arterial stiffness.
1. Objectives: This study is to investigate the relationship between Intima Media Thickness(IMT) of common carotid artery and Sasang Constitution. 2. Methods: 839 persons, over 40 years old, participated in community-based cohort of Korea Genome and Epiedemiology Study (KOGES) in Wonju City and Pyeongchang City of South Korea from June 2006 to February 2008. The diagnosis of Common carotid Intima Media Thickness was evaluated by B Mode ultrasonography, cardiovascular risk factors were checked using questionnaire and blood samples. Constitution was verified by a Sasang constitution specialist according to the results of PSSC(Phonetic System for Sasang Constitution), facial photos and a simplified Sasang constitutional questionnaire. Multiple regression analysis and logistic regression analysis were performed with SPSS. 3. Results: There were significantly high values in waist circumference, fasting blood sugar, systolic blood pressure, diastolic blood pressure, triglyceride, HOMA-IR and hsCRP in Taeeumin and low in HDL-cholesterol and adiponectin in Taeeumin. There were significantly high value in Common Carotid Intima Media Thickness in Taeeumin. Age was the significant cardiovascular risk factor irrespective of Sasang constitution in all participants. There was a positive correlation between smoking and Soyangin in all participants and men. There were positive correlations between LDL-cholesterol, BMI and Taeeumin in all participants and men. There were positive correlations between hsCRP and Soeumin in all participants and men. There was significantly high odds ratio of Taeeumin over Soeumin in common carotid Intima Media Thickness. 4. Conclusions: Regimens on cardiovascular diseases should be considered according to Sasang constitution. There are more sensitive risk factor in each constitution; smoking in Soyangin, LDL-cholesterol and BMI in Taeeumin, hsCRP in Soeumin.
Suh, Min-A;Lee, Joo-Young;Ahn, Song-Vogue;Kim, Hyeon-Chang;Suh, Il
Journal of Preventive Medicine and Public Health
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v.42
no.1
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pp.29-34
/
2009
Objectives : This study was performed to evaluate the relationship between C-reactive protein(CRP) and carotid intima-media thickness(carotid IMT) in a population of middle-aged Koreans. Methods : A total of 1,054 men and 1,595 women(aged 40-70 years) from Kanghwa County, Korea, were chosen for the present study between 2006 and 2007. We measured high-sensitivity CRP and other major cardiovascular risk factors including anthropometrics, blood pressure, blood chemistry, and carotid ultrasonography. Health related questionnaires were also completed by each study participant. Carotid IMT value was determined by the maximal IMT at each common carotid artery. The relationship between CRP level and carotid IMT was assessed using multiple linear and logistic regression models after adjustment for age, body mass index, menopause(women), systolic blood pressure, total/HDL cholesterol ratio, triglyceride level, fasting glucose, smoking, and alcohol consumption. Results : Mean carotid IMT values from the lowest to highest quartile of CRP were 0.828, 0.873, 0.898, and 0.926 mm for women(p for trend<0.001), and 0.929, 0.938, 0.949, and 0.979 mm for men(p for trend=0.032), respectively. After adjustment for major cardiovascular risk factors, the relationship between CRP and carotid IMT was significant in women(p for trend=0.017), but not in men(p for trend=0.798). Similarly, adjusted odds ratio of increased IMT, defined as the sex-specific top quartile, for the highest versus lowest CRP quartiles was 1.55(95% CI=1.06-2.26) in women, but only 1.05(95% CI=0.69-1.62) in men. Conclusions : CRP and carotid IMT levels appear to be directly related in women, but not in men.
Objectives : The aim of this study was to investigate the association of blood pressure levels with the common carotid artery intima-media thickness (CCA-IMT) and carotid plaques. Methods : Data were obtained from 2,635 subjects, aged 50 years and over, who participated in the Community Health Survey (a population-based, cross-sectional study) in Dong-gu, Gwangju city between 2007 and 2008. Participants were categorized into three groups according to blood pressure levels; normotensives (<120/80 mmHg), prehypertensives (120-139/80-89 mmHg), and hypertensives ($\geq$140/90 mmHg). Prehypertensives were further categorized as low prehypertensives (120-129/80-84 mmHg) and high prehypertensives (130-139/85-89 mmHg). Carotid intima-media thickness and plaques were evaluated with a high-resolution B-mode ultrasound. Statistical analyses were performed using chi-square test, ANOVA, and multiple logistic regression. Results : Prehypertensives had significantly greater maximal CCA-IMT values than normotensives, with a multivariate adjusted odds ratio of 1.78 (95% CI=1.36-2.32) for abnormal CCA-IMT (maximal CCA-IMT$\geq$1.0 mm), and 1.45 (95% CI=1.19-1.77) for carotid plaques. The multivariate adjusted odds ratio of low prehypertensives was 1.64 (95% CI=1.21-2.21) for abnormal CCA-IMT, and 1.30 (95% CI=1.04-1.63) for carotid plaques compared with normotensives. Subject with hypertension had higher frequency of abnormal CCA-IMT (odds ratio, 2.18; 95% CI=1.49-3.18), and carotid plaques (odds ratio, 1.98; 95% CI=1.46-2.67) compared with normotensives after adjustment for other cardiovascular risk factors. Conclusions : Our results indicate that there is a significant increase in the prevalence of carotid atherosclerosis in subjects with prehypertension (even in low prehypertensives) compared with normotensive subjects. Further studies are required to confirm the benefits and role of carotid ultrasonography in persons with prehypertension.
Noh, Woong Jae;Lee, Hyoung Shin;Kim, Sung won;Lee, Kang Dae
Korean Journal of Head & Neck Oncology
/
v.33
no.1
/
pp.73-77
/
2017
An 81 year-old male patient presented with rapid enlargement of left lateral neck mass, diagnosed two months earlier as cervical nontuberculous mycobacterial lymphadenitis. Abscess formation and impending rupture related to aggravation of nontuberculous mycobacterial lymphadenitis was highly suspected. Unexpectedly, blood flow was detected by Doppler ultrasonography, which indicated possible vascular mass. Computed tomography demonstrated a $6.0cm{\times}4.0cm$ sized enhancing mass consistent with pseudoaneurysm of internal carotid artery. The patient underwent pseudoaneurysmectomy. Surgical drainage without adequate evaluation might have led to potentially life-threatening condition. We describe this rare case with importance of imaging screening in a neck mass.
This study examined 202 patients who was diagnosed as arteriosclerosis obliterans around carotid artery caused by its increase in IMT and who have been tested by carotid artery sonography. The results are as follows : 1. Out of 202 research subjects, 120(59.4%) were male, 82(40.6%) female, and the average age was 58. 2. Among the subjects, 54(26.7%) were diagnosed as DM, 60(29.7%) with hyperlipidemia, 86(42.6%) with hypertension, 61(30.2%) with EGK. 3. There was more increase in the left IMT than in the right IMT, more increase in male subjects than female subjects, and more increase with age. 4. The relationship between IMT & MRA was that subjects tested by MRA showed greater statistically significant correlation than those not tested by MRA(p < 0.01). 5. The increase in IMT was correlated with DM and HTN, but not with EKG and hyperlipidemia. 6. Among subjects tested by MRA, those diagnosed with MCA stenosis showed increase upto 0.94 in the left IMT and 0.96 in the right IMT ; there was a significant correlation(p < 0.01). Thicker IMT was positively correlated with diagnosis of MCA stenosis after MRA test.
Kim, Dae-Sik;Sung, Hyun-Ho;Lee, Jong-Woo;Cho, Eun-Kyung
Korean Journal of Clinical Laboratory Science
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v.49
no.3
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pp.308-315
/
2017
Carotid artery intima-media thickness (CIMT) test is a standardized ultrasound procedure that screens for and monitors atherosclerosis in a safe and non-invasive manner, even in individuals with no symptoms of heart disease. The purpose of this study was to research the relationship between CIMT, as measured by ultrasonography, and the degree of individual perceived stress. There was a total of 168 (male: 46, female: 122) university students in Suwon-si, Gyeonggi-do, Korea, without other diseases. Written informed consent was obtained from all participants. CIMT was measured in the right and left common carotid arteries 1 cm below the bifurcation, and internal carotid artery, using non-invasive high-resolution Medison Accuvix V20 prestige ultrasound equipment and perceived stress, was measured with the 10-item PSS (Perceived Stress Scale) questionnaire. This study indicates that PSS may be appropriate to estimate perceived stress levels and weight. Failure to control stress anxiety could lead to weight and CIMT soaring to dangerous levels, resulting in a myocardial infarction or cerebrovascular accident. There was a statistically significant difference between left CIMT (p<0.05) and weight (p<0.05) according to each stress classification. The results of this study suggest that the weight measurement is influenced in part by one's generalized stress levels. Future continuous studies should be conducted to test the influences of perceived stress and generalized anxiety on CIMT when these are many continuous variables.
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