Extracranial Vascular

Ascending and Descending Thoracic Vertebral Arteries

Fellows’ Journal Club

The authors report the angiographic anatomy and clinical significance of 9 cases of descending and 2 cases of ascending thoracic vertebral arteries. Located within the upper costotransverse spaces, ascending and descending thoracic vertebral arteries may have important implications during spine interventional or surgical procedures. They frequently provide radiculomedullary or bronchial branches, so they can also be implicated in spinal cord ischemia, as a supply of vascular malformations, or be a source of hemoptysis.

Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents

Editor’s Choice

The authors investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting in 15 patients. They specifically evaluated long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥ 3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥ 4). Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b–3 reperfusion. They conclude that emergent stent reconstruction of long-segment and flow-limiting carotid dissections in acute ischemic stroke intervention is safe and effective, with favorable clinical outcomes.

Vitamin D and Vulnerable Carotid Plaque

Fellows’ Journal Club

Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. The authors’ purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage (IPH). In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders and local lumen imaging markers were recorded. They performed multivariable Poisson regression by using generalized estimating equations to account for up to 2 carotid arteries per patient and backward elimination of confounders. The authors found that low vitamin D levels (<30 ng/mL) were a significant predictor of MRI-detected IPH, along with plaque thickness. They conclude that vitamin D insufficiency was associated with both the presence and volume of carotid IPH in patients with carotid atherosclerosis and that these results link low vitamin D levels with plaque vulnerability.

Abstract

Figure 5 from text
Vitamin D supplementation and follow-up. A, Patient 1: Baseline (upper arrow) versus 1-year follow-up (lower arrow) with vitamin D supplementation and medical therapy, including statins and antiplatelet and antihypertensive medications, demonstrates decreased IPH volume in a patient with no interval stroke (vitamin D baseline/1 year: 18.1/26.8 ng/mL; carotid IPH baseline/1 year: 0.151/0.115 cm3, or 24.1% decreased IPH volume). The patient remained asymptomatic in the year between the 2 scans. B, Patient 2: Baseline (upper arrow) versus 1-year follow-up (lower arrow) without vitamin D supplementation but with medical therapy, including statins and antiplatelet and antihypertensive medications, demonstrates minimally changed IPH volume (vitamin D baseline/1 year: 20.9/10.7 ng/mL; carotid IPH baseline/1 year: 1.041/0.996 cm3, or 4.3% decreased IPH volume). In addition, this patient had bilateral strokes in the year between the 2 scans.

BACKGROUND AND PURPOSE

MR imaging–detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans.

MATERIALS AND METHODS

In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders