scholarly journals Hemodynamic Responses in Carotid Bifurcation Induced by Enhanced External Counterpulsation Stimulation in Healthy Controls and Patients With Neurological Disorders

2021 ◽  
Vol 12 ◽  
Author(s):  
Shuai Tian ◽  
Wei Pan ◽  
Junping Peng ◽  
Hui Wang ◽  
Bin Deng ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Patient Group ◽  
Neurological Disorders ◽  
Cuff Pressure ◽  
Carotid Bifurcation ◽  
Healthy Controls ◽  
Hemodynamic Responses ◽  
External Counterpulsation ◽  
Enhanced External Counterpulsation

Enhanced external counterpulsation is a Food and Drug Administration–approved, non-invasive, assisted circulation therapy for ischemic cardiovascular and cerebrovascular diseases. Previous studies have confirmed that EECP stimulation induces largely different cerebral hemodynamic responses in patients with ischemic stroke and healthy controls. However, the underlying mechanisms remain uncertain. We hypothesize that different blood redistributions at the carotid bifurcation may play a key role. Ten subjects were enrolled in this study, namely, five patients with neurological disorders and five young healthy volunteers as controls. Magnetic resonance angiography (MRA) was performed on the carotid artery. All the subjects received a single session of EECP treatment, with external cuff pressures ranging from 20 to 40 kPa. Vascular ultrasound measurements were taken in the common carotid artery (CCA), external carotid artery (ECA) and internal carotid artery (ICA). Three-dimensional patient-specific numerical models were developed to calculate the WSS-derived hemodynamic factors. The results indicated that EECP increased CCA and ECA blood flow in both groups. The ICA blood flow in the patient group exhibited a mean increase of 6.67% during EECP treatment compared with the pre-EECP condition; a mean decrease of 9.2% was observed in the healthy control group. EECP increased the averaged wall shear stress (AWSS) throughout the carotid bifurcation in the patient group; the ICA AWSS of the healthy group decreased during EECP. In both groups, the oscillatory shear index (OSI) in the ICA increased proportionally with external cuff pressure. In addition, the relative resident time (RRT) was constant or slightly decreased in the CCA and ECA in both groups but increased in the ICA. We suggest that the benefits of EECP to patients with neurological disorders may partly result from blood flow promotion in the ICA and increase in WSS at the carotid bifurcation. In the healthy subjects, the ICA blood flow remained constant during EECP, although the CCA blood flow increased significantly. A relatively low external cuff pressure (20 kPa) is recommended as the optimal treatment pressure for better hemodynamic effects. This study may play an important role in the translation of physiological benefits of EECP treatment in populations with or without neurological disorders.

scholarly journals The Hemodynamic Effect of Enhanced External Counterpulsation Treatment on Atherosclerotic Plaque in the Carotid Artery: A Framework of Patient-Specific Computational Fluid Dynamics Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
Jianhang Du ◽  
Guangyao Wu ◽  
Bokai Wu ◽  
Chang Liu ◽  
Zhouming Mai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Atherosclerotic Plaque ◽  
Carotid Bifurcation ◽  
Patient Specific ◽  
Velocity Spectrum ◽  
External Counterpulsation ◽  
Endothelial Surface ◽  
Computational Fluid Dynamics Analysis ◽  
Enhanced External Counterpulsation

Long-term enhanced external counterpulsation (EECP) therapy has been recommended for antiatherogenesis in recent clinical observations and trials. However, the precise mechanism underlying the benefits has not been fully clarified. To quantify the effect of EECP intervention on arterial hemodynamic environment, a framework of numerical assessment was introduced using a parallel computing algorithm. A 3D endothelial surface of the carotid artery with mild atherosclerotic plaque was constructed from images of magnetic resonance angiography (MRA). Physiologic boundary conditions were derived from images of the ultrasound flow velocity spectrum measured at the common carotid artery and before and during EECP intervention. Hemodynamic factors relating to wall shear stress (WSS) and its spatial and temporal fluctuations were calculated and analyzed, which included AWSS, OSI, and AWSSG. Measuring and computational results showed that diastole blood pressure, perfusion, and WSS level in carotid bifurcation were significantly increased during EECP intervention. Mean AWSS level throughout the model increased by 16.9%, while OSI level did not show a significant change during EECP. We thus suggested that long-term EECP treatment might inhibit the initiation and development of atherosclerotic plaque via improving the hemodynamic environment in the carotid artery. Meanwhile, EECP performance induced a 19.6% increase in AWSSG level, and whether it would influence the endothelial functions may need a further study. Moreover, the numerical method proposed in this study was expected to be useful for the instant assessment of clinical application of EECP .

Persistent Cervical Intersegmental Artery as a Cause of Recurrence of a Traumatic Carotid-Cavernous Fistula

Neurosurgery ◽  
1982 ◽  
Vol 10 (4) ◽  
pp. 492-498 ◽  
Author(s):  
Herbert M. Keller ◽  
Hans-Georg Imhof ◽  
Anton Valavanis
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Flow Direction ◽  
Carotid Bifurcation ◽  
Carotid Cavernous Sinus Fistula ◽  
Increased Blood Flow

Abstract In a 16-year-old boy, minor symptoms of an arteriovenous shunt into the cavernous sinus recurred 3 months after the performance of a trapping operation of the internal carotid artery on the side of a traumatic carotid-cavernous sinus fistula. An arterial and venous cerebrovascular Doppler examination demonstrated increased blood flow in the periorbital veins of both sides, with a pathological flow direction, i.e., from intra- to extracranial. Furthermore, an internal-like artery was found at the level of the carotid bifurcation on the side of the trapped internal carotid artery, and increased blood flow was registered in the homolateral vertebral artery. Angiography confirmed occlusion of the internal carotid artery 0.5 cm distal to the carotid bifurcation, but showed blood flow from the homolateral vertebral artery through a persistent 3rd cervical intersegmental artery into the trapped portion of the internal carotid artery. The latter fed blood into the cavernous sinus through the still-existing arteriovenous fistula. Insufficient involution of the 3rd cervical intersegmental artery was assumed. Obviously, this collateral artery dilated in the presence of a major blood pressure gradient between the vertebral artery and the trapped segment of the internal carotid artery. Thus, a persistent cervical intersegmental artery can be a cause for a recurrent carotid-cavernous sinus fistula.

scholarly journals Acute Hemodynamic Responses to Enhanced External Counterpulsation in Patients With Coronary Artery Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Yahui Zhang ◽  
Ziqi Chen ◽  
Zhouming Mai ◽  
Wenjuan Zhou ◽  
Hui Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Blood Flow ◽  
Coronary Artery ◽  
Carotid Arteries ◽  
Flow Characteristics ◽  
Resistance Index ◽  
Mean Flow ◽  
External Counterpulsation ◽  
Artery Disease ◽  
Enhanced External Counterpulsation

Purpose: Enhanced external counterpulsation is a non-invasive treatment that increases coronary flow in patients with coronary artery disease (CAD). However, the acute responses of vascular and blood flow characteristics in the conduit arteries during and immediately after enhanced external counterpulsation (EECP) need to be verified.Methods: Forty-two patients with CAD and 21 healthy controls were recruited into this study to receive 45 min-EECP. Both common carotid arteries (CCAs), namely, the left carotid (LC) and right carotid (RC), the right brachial (RB), and right femoral (RF) artery were imaged using a Color Doppler ultrasound. The peak systolic velocity (PSV), end-diastolic velocity (EDV), mean inner diameter (ID), resistance index (RI), and mean flow rate (FR) were measured and calculated before, during, and after the 45 min-EECP treatment.Results: During EECP, in the CCAs, the EDV was significantly decreased, while the RI was markedly increased in the two groups (both P < 0.01). However, immediately after EECP, the RI in the RC was significantly lower than that at the baseline in the patients with CAD (P = 0.039). The FR of the LC was markedly increased during EECP only in the CAD patients (P = 0.004). The PSV of the patients with CAD was also significantly reduced during EECP (P = 0.015) and immediately after EECP (P = 0.005) compared with the baseline. Moreover, the ID of the LC, RB, and RF was significantly higher immediately after EECP than that at the baseline (all P < 0.05) in the patients with CAD. In addition, they were also higher than that in the control groups (all P < 0.05). Furthermore, by the subgroup analysis, there were significant differences in the FR, PSV, and RI between females and males during and immediately after EECP (all P < 0.05).Conclusions: Enhanced external counterpulsation creates different responses of vascular and blood flow characteristics in carotid and peripheral arteries, with more significant effects in both the carotid arteries. Additionally, the beneficial effects in ID, blood flow velocity, RI, and FR after 45 min-EECP were shown only in the patients with CAD. More importantly, acute improvement of EECP in the FR of the brachial artery was showed in males, while the FR and RI of the carotid arteries changed in females.

Enhanced external counterpulsation improves peripheral resistance artery blood flow in patients with coronary artery disease

2014 ◽  
Vol 39 (3) ◽  
pp. 405-408 ◽  
Author(s):  
Joseph C. Avery ◽  
Darren T. Beck ◽  
Darren P. Casey ◽  
Paloma D. Sardina ◽  
Randy W. Braith
Keyword(s):  
Coronary Artery Disease ◽  
Blood Flow ◽  
Coronary Artery ◽  
Peripheral Resistance ◽  
Controlled Study ◽  
Resistance Arteries ◽  
External Counterpulsation ◽  
Artery Disease ◽  
Enhanced External Counterpulsation ◽  
Artery Perfusion

Enhanced external counterpulsation (EECP) increases coronary artery perfusion and improves endothelium-dependent vasodilation in peripheral muscular conduit arteries. It is unknown whether vasodilatory capacity is improved in the peripheral resistance vasculature. Here we provide novel evidence from the first randomized, sham-controlled study that EECP increases peak limb blood flow and improves endothelium-dependent vasodilation in both calf and forearm resistance arteries in patients with coronary artery disease.

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