Search Results (75)

Objective: Evaluate the efficacy and safety following intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with diabetic macular oedema (DME). Methods: To evaluate retinal microvascular remodelling and photoreceptor metrics using adaptive optics (AO) alongside systemic vascular status assessed by brachial/aortic hemodynamic and carotid ultrasound. We conducted a single-centre longitudinal study including twenty-one patients with DME. The following four diagnostic visits were performed: baseline (V1, no anti-VEGF treatment), 2–3 months (V2), 6–8 months (V3), and 12–14 months (V4). Adaptive optics (rtx1) measured foveal cone number (N) and regularity (Reg) within a standardised 80 × 80 µm window, and superior temporal retinal arteriole morphology after the first bifurcation (vessel diameter [VD], lumen diameter [LD], wall thickness [WT], wall-to-lumen ratio [WLR], and wall cross-sectional area [WCSA]). SphygmoCor provided peripheral (brachial) and central (aortic) pressures, augmentation pressure (AP), augmentation index (AIx), and carotid–femoral pulse wave velocity (PWV and PWVHR heart rate adjusted). Carotid ultrasound assessed intima–media thickness (IMT), carotid lumen diameter (CLD), and IMT/CLD ratio (IMTLR) 2 mm proximal to the bifurcation in diastole. Visual acuity (Visus), intraocular pressure (IOP), and central retinal thickness (CRT) were obtained at each visit. Results: In the treated eye (TE), WLR showed a significant overall change (Friedman p = 0.007), with a modest V4 vs. V1 increase (Wilcoxon p = 0.045); LD also varied across visits (Friedman p = 0.034). Cone metrics improved as follows: Reg increased over time (Friedman p = 0.019), with a significant rise at V4 vs. V1 (p = 0.018), and cone number increased at V3 vs. V1 (p = 0.012). Functional/structural outcomes improved as follows: visual acuity increased at V3 (p = 0.009) and V4 (p = 0.028), while CRT decreased at V3 (p = 0.002) and V4 (p = 0.030); IOP remained stable compared to V1. Systemic hemodynamics was largely unchanged; small fluctuations in DBP and cDBP across V1–V4 were observed (Friedman p = 0.034 and p = 0.022, respectively), whereas AIx, AP, PWV, and PWVHR showed no significant trends. Carotid IMT, CLD, and IMTLR did not change significantly across visits, supporting systemic vascular safety. Conclusions: Intravitreal anti-VEGF therapy in DME was associated with improvements in photoreceptor organisation and macular structure/function, with AO-derived arteriolar remodelling detectable over time, and no adverse changes in large-artery structure. These findings support ocular efficacy and systemic vascular safety; confirmation in larger cohorts is warranted. Full article

Background/Objectives: The ascending pharyngeal artery (APA) exhibits considerable variability in origin. Understanding its anatomy is essential for head and neck surgery, endovascular procedures, and skull base approaches. This study aimed to (1) systematically characterize APA origin sites, (2) evaluate bilateral patterns, and (3) establish a comprehensive sequential classification system for external carotid artery (ECA) branching. Methods: Bilateral computed tomography angiography assessment was performed in 85 patients (170 carotid axes; 54 men, 31 women; mean age 69 ± 10 years). APA origins were classified into six types: Type 0 (absent), Type I (ECA medial wall), Type II (ECA posterior wall), Type III (occipitopharyngeal trunk), Type IV (internal carotid artery), and Type V (other origins). A novel sequential classification system (S-types) documented the complete ECA branching order. Results: APA was absent in 14.71% of cases; APA’s absence or internal carotid origin was noted in 19.41% of cases. Type I occurred in 26.47%, Type II in 35.88%, Type III in 17.06%, Type IV in 4.71%, and Type V in 1.18%. Forty distinct S-types were identified, representing the most comprehensive documentation of ECA branching diversity. No statistically significant side-related (χ² = 42.12, p = 0.379) or gender-related (χ² = 49.81, p = 0.138) differences were found. Twenty-three types occurred in fewer than five cases each. Conclusions: This first comprehensive sequential classification system reveals extraordinary anatomical diversity in ECA branching patterns. The absence of predictable side or gender patterns necessitates bilateral preoperative imaging for surgical planning. Full article

Background: Diabetic neuropathy affects almost half of diabetic patients, yet the relative contributions of metabolic, vascular and clinical factors remain controversial. We aimed to investigate which risk factors are more associated with reduced corneal nerve fiber length (CNFL). Methods: This is a cross-sectional study of 30 patients with type 2 diabetes. We assessed metabolic parameters (HbA1c, lipids), vascular measurements (Doppler ultrasonography of carotid and ophthalmic arteries, central vessel density measured by optical coherence tomography angiography), and corneal epithelial thickness. We explored the data using network analysis, then applied penalized mixed-effect regression (in which $\beta$ represents the standardized coefficients with mean 0 and unit standard deviation), followed by generalized additive models and polynomial transformations. Results: Penalized regression identified vascular parameters as dominant predictors: carotid plaques ($\beta$ = −0.609) and intima-media thickness ($\beta$ = −0.574) showed the strongest associations with CNFL. Traditional metabolic markers including HbA1c failed to meet selection thresholds. Bifurcation velocity ($\beta$ = −0.313) and corneal sensitivity measures ($\beta$ = 0.278–0.135) were also significant. The non-linear modeling showed complex vascular–structural interactions. Conclusions: Vascular compromise, particularly carotid disease, had the highest association with CNFL in our cohort. Thus, our study reports a higher effect of vascular parameters than HbA1c in patients with a longer history of diabetes. This may reflect the progression of diabetic complications, where initial metabolic insults are followed by vascular pathology as the primary driver of end-organ damage. Our findings highlight the need for carotid artery screening in diabetic patients for a better estimation of the neuropathy risk. Full article

Superparamagnetic iron oxide nanoparticles (SPIONs) have shown promise across a wide range of biomedical applications, including targeted drug delivery, magnetic hyperthermia, magnetic resonance imaging, and regenerative medicine. In the context of local tumor therapy (Magnetic Drug Targeting, MDT) SPIONs can be functionalized with chemotherapeutic agents and accumulated at tumor sites using an externally applied magnetic field. To achieve effective drug accumulation and therapeutic efficacy, precise positioning of the accumulation magnet relative to the tumor is essential. To address this need, we propose a dual-modality ultrasound imaging approach combining magnetomotive ultrasound (MMUS) and passive cavitation mapping (PCM). MMUS detects magnetically induced displacements to localize SPIONs embedded in elastic tissue, while PCM monitors cavitation emissions from circulating SPIONs under focused ultrasound exposure. In addition to detection, PCM has the potential to enable feedback-based control of cavitation exposure, allowing cavitation parameters to be kept within a safe regime. The dual imaging modality approach was validated using standard phantoms and a complex carotid bifurcation tumor flow phantom fabricated via 3D printing. Experimental results demonstrate the first coordinated spatiotemporal imaging of MMUS and PCM within the same anatomical model, resolving the key bottleneck of SPIONs monitoring in blood vessels/tissue. This demonstrates the strong potential of complementary MMUS and PCM imaging for monitoring in preclinical and clinical MDT settings. Full article

The carotid body—a chemoreceptive derivative of the neural crest located at the bifurcation of the carotid artery—has been studied for over 282 years. The history of research into this small but vital organ is full of unexpected turns and offers many valuable lessons. Initially considered part of a unified system of paraganglia performing the endocrine function, the carotid body was later reclassified and recognized as a chemosensory organ. This article highlights the key controversies encountered by past researchers. These contradictions though largely forgotten, remain unresolved. The aim of our article is to propose a unified model of the carotid body that integrates its endocrine and chemosensory structural aspects. As we show, the main problem in studying the carotid body was its isolated investigation, detached from other organs of the sympathoadrenal system. Only a comprehensive analysis of the carotid body with other components of this system has allowed researchers to form a more complete understanding of both the structure and function of these formations. Contrary to the prevailing view of the carotid body as the main peripheral chemoreceptor organ, it may also perform endocrine functions during certain periods of human ontogeny. It is these potential functions that may explain the presence of certain morphological structures in the carotid body, the significance of which has until recently remained a mystery. Full article

Pulsatile blood flow generates complex wall shear stress (WSS) patterns at the carotid bifurcation, which critically regulate endothelial function and structure. While physiological pulsatile WSS (PWSS) is essential for maintaining vascular health, low oscillatory WSS (OWSS) near the carotid sinus is closely associated with endothelial dysfunction, atherosclerotic plaque formation, and stenosis. Reproducing these hemodynamic conditions in vitro is therefore crucial for investigating endothelial mechanobiology and elucidating the pathogenesis of atherosclerosis. Although microfluidic technologies have emerged as promising platforms for simulating either pulsatile or oscillatory WSS, a system capable of simultaneously replicating both characteristic waveforms—as found in vivo at the carotid bifurcation—remains undeveloped. In this study, we designed a variable cross-section microfluidic channel using Computational Fluid Dynamics (CFD) simulations. Numerical results demonstrate that the optimized channel accurately reproduces low OWSS at a stepped section emulating the carotid sinus, alongside high PWSS in a downstream uniform section. Vortex formation induced by the step structure is identified as key to generating low OWSS, influenced by step height, channel width ratio, and input flow rate. This work provides a novel and robust methodology for designing microfluidic systems that mimic complex hemodynamic microenvironments, facilitating future studies on the interplay between distinct WSS patterns and endothelial dysfunction. Full article

Background: Accurate localization of internal carotid artery (ICA) occlusion is critical for optimizing endovascular thrombectomy (EVT) strategies. Conventional multiphase CT angiography (mCTA) often omits the carotid bifurcation in delayed phases, limiting differentiation between true cervical ICA occlusion and pseudo-occlusion. Methods: We retrospectively analyzed 56 acute ischemic stroke patients with ICA occlusion who underwent EVT and extended-range mCTA between 2016 and 2020. The scan range of the second and third arterial phases was modified to include the carotid bifurcation. Imaging patterns were evaluated to distinguish bifurcation stenosis with superimposed occlusion from proximal ICA occlusion, and to infer thrombus location by comparing arterial opacification levels across phases. Results: Extended mCTA significantly improved visualization of ICA enhancement patterns in delayed phases (p < 0.001). Cases with bifurcation stenosis showed consistently lower and stable opacification levels across phases, whereas proximal ICA occlusion demonstrated progressive contrast advancement. Distal occlusion, particularly beyond the ophthalmic artery, showed higher opacification. Including the carotid bifurcation increased scan length by ~10%, with acceptable radiation exposure. Conclusions: Incorporating the carotid bifurcation into delayed mCTA phases enhances the ability to differentiate occlusion subtypes and estimate thrombus location. This refined imaging approach enables better EVT planning, including device selection and procedural timing, thereby improving patient outcomes in acute stroke care. Full article

Background: The superior thyroid artery (STA) exhibits significant anatomical variability, which is crucial for head and neck surgical procedures, particularly free flap reconstruction. This systematic review synthesizes the current knowledge on STA origin, branching patterns, perfusion territory, and its relationship with the superior laryngeal nerve (SLN), focusing on implications for flap selection and surgical planning. Methods: A comprehensive search of relevant databases was conducted to identify studies reporting on STA anatomy. Data extraction focused on the STA origin variations, relationships with anatomical landmarks, branching patterns, perfusion territory, and the STA-SLN relationship. Emphasis was placed on variations impacting STA’s suitability as a recipient vessel for free flaps. Data were synthesized qualitatively. Results: The STA most commonly originates from the external carotid artery (ECA), with variations from the carotid bifurcation (CB) and common carotid artery (CCA). Sex-based and laterality differences were noted. Branching patterns varied considerably, influencing perfusion of the thyroid gland, larynx, and adjacent musculature. The STA’s relationship with the external branch of the SLN (EBSLN), classified by Cernea’s classification, highlighted the risk of iatrogenic injury. The STA provides perfusion to the thyroid gland, larynx, sternocleidomastoid muscle, and strap muscles, all of which can be raised as flaps. Conclusions: Understanding STA anatomical variations is essential for surgeons planning free flap reconstruction in the head and neck. This review underscores the importance of preoperative imaging to assess STA suitability as a recipient’s vessel and minimize complications. Further research is needed to quantify the impact of STA variations on free flap outcomes. Full article

Background: The anatomical relationship between the carotid arteries (CAs) and the hyoid bone (HB) has significant clinical implications. The present study investigates the spatial relationship between the HB and common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and carotid bifurcation (CB), analyzing their morphological variants and topographical associations. Materials and Methods: Computed tomography angiographies (CTAs) from 100 patients (50 males, 50 females; mean age 62.2 ± 14.5 years) were analyzed. Measurements included the HB greater horn length (GHL) and greater horn angle (GHA), CA distances, and classification of relationships of the CAs with the HB. Results: The mean GHL was 27.72 ± 3.91 mm, and the mean GHA was 110.36 ± 6.06 degrees. Males exhibited significantly longer GHs than females (p < 0.001). Suprahyoid bifurcations occurred in 35.5% of cases, with a mean CCA-GH distance of 4.54 ± 2.67 mm. Infrahyoid bifurcations were identified in 64.5% of cases, with mean ECA-GH and ICA-GH distances of 4.10 ± 3.11 mm and 6.72 ± 3.85 mm, respectively. GHL significantly influenced these distances. Type 6 (ECA positioned laterally to the GH) was the most prevalent carotid–hyoid configuration (18.5%). Conclusions: The present study provides essential insights into the topographical variability of the CAs relative to the HB, offering valuable guidance for surgical planning and vascular risk assessment. These findings are crucial for procedures such as carotid endarterectomy, where the proximity of the carotid arteries to the hyoid bone impacts the risk of vascular injury. Further research is warranted to explore the clinical implications of these anatomical relationships. Full article

We present a rare case of a 16-year-old male who was admitted with bilateral tinnitus and subsequently underwent magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) for further evaluation. The left internal carotid (ICA) artery had a normal caliber but ended as a stump at the C7 segment, with a network of filiform vessels from both the stump and right posterior communicating artery (PComm). The right PComm was hypertrophic and the right posterior cerebral artery (PCA) was mainly supplied by the right ICA. The right ICA’s bifurcation and the initial middle cerebral artery (MCA) segment were absent, while the MCA trunk was hypoplastic. The right PCA and pial branches vascularized the temporal lobe, with collaterals between the PCA and MCA. The left ICA was slightly enlarged with double fenestration at the left A1 segment. The right A1 segment of the anterior cerebral artery had double fenestration and while several diagnoses were considered, no single diagnosis fully explained all clinical findings. A thorough review of the existing literature yielded no comparable cases, highlighting the uniqueness of this presentation. This case emphasizes the complexity of cerebral vascular anomalies and the challenges associated with diagnosing such rare conditions, underscoring the need for careful assessment. Full article

Background and Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by the degeneration of both upper and lower motor neurons, leading to the rapid decline of motor function. In recent years, dysfunction of the autonomic nervous system (ANS) has also been increasingly recognized as a contributing factor in various neurodegenerative diseases, including ALS. This study is the second publication from our ALS research cohort at Kaunas Clinics. Our previous work examined ultrasonographic changes in the phrenic nerve as a supplementary diagnostic approach for ALS. Materials and Methods: In the present study, we investigated ultrasonographic alterations of the vagus nerve within the same ALS cohort, aiming to explore correlations with ANS involvement. We performed high-resolution ultrasonography of the vagus nerve (VN), collected clinical data, conducted heart rate monitoring, and evaluated respiratory function. Results: We prospectively included 32 ALS patients meeting “Gold Coast” criteria and 64 age- and sex-matched control patients. The average onset of ALS was 57.97 ± 9.22 years, and the duration of the disease was15.41 ± 9.04 months. For ALS patients, we found significantly reduced vagus nerve cross-sectional area (CSA) at the level of the carotid artery bifurcation bilaterally compared to controls (right VN 1.86 ± 0.21 vs. 2.07 ± 0.18 mm², p < 0.001; left VN 1.69 ± 0.21 vs. 1.87 ± 0.21 mm², p < 0.001). Reduced values of the left VN positively correlated with the reduced values of FEV1% and sO₂. Conclusions: Our findings revealed a significant bilateral reduction in vagus nerve size in ALS patients compared to controls, suggesting that vagal atrophy may serve as a potential marker of autonomic dysfunction in ALS. Full article

Background and Objectives: The superior thyroid artery (STA) typically has its origin inferiorly to the greater hyoid horn (GHHB) either from the external carotid artery (ECA) or from the carotid bifurcation (CB) or the common carotid artery (CCA). We aimed to determine the topographic variants of the STA related to the GHHB and the artery of origin and to check their bilateral symmetry. Materials and Methods: Determinations were performed in a sample of 85 archived angio CT adult cases, comprising 53 men and 32 women. The origins of the STAs from the CCA/CB/ECA were classified as types A–C. We defined the vertical topographies of the STA as follows in relation to the GHHB: type 1 (infrahyoid), type 2 (hyoid), and type 3 (suprahyoid). Subtypes of the STA course were added: “a”, lateral to the GHHB; “b”, medial; and “c”, posterior to it. Unilateral combinations of types and bilateral associations of these were established. Results: In 170 carotid axes, we detected STA type A in 8.82%, type B in 28.82%, and type C in 60% of cases. It was absent in 2.35% of the cases. The infrahyoid type 1 of STA was found in 47.06% of cases. The hyoid type 2 was found in 20.59% (2a), 0.59% (2b), and 4.71% (2c). The suprahyoid type 3 was found in 21.18% (3a), 0% (3b), and 3.53% (3c). Thirteen unilateral combinations of types were found. The most prevalent ones were C1 (27.71%), C3a (17.47%), and B1 (15.66%). We established thirty-seven bilateral associations of unilateral combinations of types. The cases with asymmetrical bilateral associations of unilateral combinations of types prevailed. A lowered hyoid bone overlapping the thyroid cartilage was found in one of these cases. The prevailing associations were C1-C1 (bilateral infrahyoid origin of the STA from the ECA, 13/85, 15.29%), C3a-C3a (suprahyoid origins of the STAs from the ECAs and lateral courses over the GHHB, 9/85, 10.58%) and C1-B1 (infrahyoid origins from the ECA and CB, 8/85, 9.41%). Conclusions: The vertical topography of the STA is highly variable and hardly predictable but can be examined in imaging studies. The GHHB may be of use to identify and manage the artery. The STA is rarely absent. Full article

Objectives: Carotid geometry and cardiovascular risk factors play a significant role in the development of carotid atherosclerotic plaques. This study aimed to investigate the correlation between carotid plaque formation and carotid artery geometry characteristics. Methods: A retrospective cross-sectional analysis was performed on 1227 patients, categorized into a normal group (n = 685) and carotid plaque groups causing either mild stenosis (<50% stenosis based on NASCET criteria, n = 385) or moderate-to-severe stenosis (>50%, n = 232). The left and right carotid were evaluated individually for each group. Patient data, including cardiovascular risk factors and laboratory test results, were collected. Carotid geometric measurements were obtained from 3D models reconstructed from cranio-cervical computed tomography angiography (CTA) using semi-automated software (MIMICS). The geometric variables analyzed included the vascular diameter and sectional area of the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and carotid artery bifurcation (CAB), as well as the carotid bifurcation angles and carotid tortuosity. Results: Compared to the normal group, in both the right and left carotid arteries, patients with carotid plaques exhibited a significantly higher age (p < 0.001) and a greater prevalence of hypertension (p < 0.001) and diabetes mellitus (p < 0.001). Additionally, they demonstrated a larger CCA and a smaller carotid bifurcation dimension (p < 0.05). In the analysis of the left carotid artery, patients with carotid plaques also had a significantly smaller ICA dimension (p < 0.05) than the normal group. Conclusions: This study found that patients with carotid plaques were older and had a higher prevalence of hypertension and diabetes, larger CCAs, and smaller carotid bifurcations. The plaque-positive left ICA was significantly smaller than that of the plaque-negative group, suggesting a side-specific vulnerability. These findings highlight the role of carotid geometry in plaque formation and its potential clinical implications for personalized risk assessment and targeted interventions. Full article

Background: The radiological evaluation of the carotid sinus (CS) anatomy and its morphometry is essentially important for various surgical procedures involving the carotid bifurcation and the CS itself. Despite its tremendous clinical significance, studies dealing with the CS anatomy are seldom reported. Hence, the present study aimed to evaluate the frequencies of the CS positional variants and their morphometry and correlate them with age and body mass index (BMI). Methods: In this retrospective cross-sectional study, a total of 754 disease-free carotid arteries were examined using computed tomography angiography scans to determine the CS positional variations (such as types I to III) and its morphometry, including the CS diameter and length. Additionally, the association between these parameters and factors such as sex, age, and body mass index were explored using appropriate statistical tests. The inter-rater agreement of the collected dataset was evaluated using Cohen’s Kappa. Results: The CS type I was observed in 87.67% of the cases, and type II and type III were observed at lower frequencies with 9.02% and 3.32%, respectively. There were statistically significant (p < 0.001) differences observed in the mean diameter and length of the sinus between the sex and the type I CS variations. However, there was no significant and strong correlation between the age and BMI factors with sinus length and sinus diameter. The kappa values for inter-rater agreement ranged from 0.77 to 0.99 for all parameters. Conclusions: In type I, the CS length and carotid vessel’s diameter is significantly different between the sexes. However, age and BMI do not affect the CS anatomy in radiologically disease-free carotid arteries. Knowledge of the CS variant anatomy is clinically significant as it influences the patients’ surgical and physiological outcomes. Full article

Enhanced external counterpulsation (EECP) treatment has been demonstrated to be effectively vasculoprotective and anti-atherosclerotic in clinical observations and controlled trials. The diastolic blood flow augmentation induced by EECP greatly affected the local hemodynamic environment in multiple arterial segments. In this study, a porcine model of hypercholesterolaemia was developed to perform an invasive physiological measurement involving electrocardiogram, blood flow wave, and arterial pressure. Subsequently, a three-dimensional carotid bifurcation model was developed to evaluate the variations in wall shear stress (WSS) and its temporal and spatial oscillations. The results show that, compared to the pre-EECP state, EECP stimulus led to an increase of 28.7% in the common carotid artery (CCA) blood flow volume over a cardiac cycle, as well as an augmentation of 22.73% in the diastolic pressure. Meanwhile, the time-average wall shear stress (TAWSS) over the cardiac cycle increased 25.1%, while the relative residence time (RRT) declined 45.7%. These results may serve to reveal the hemodynamic mechanism of EECP treatment that contributes to its anti-atherosclerotic effects. Full article