Carotid Bifurcation Position and Branching Angle in Patients with Atherosclerotic Carotid Disease

Carotid artery bifurcation (CB) is the preferred site for development of atherosclerosis (AS) in extracranial cerebral arteries; internal carotid artery stenosis is the most common cause of ischemic stroke. The frequent atherosclerotic disease of CB may best be explained by the hemodynamic influence of complex blood flow that results from the unique geometry of the bifurcation. Few papers analyze all possible geometric structural characteristics of this bifurcation. While performing many carotid endarterectomies, we noticed that a certain correlation between CB height in the neck and its angle existed, that a larger angle is accompanied with increased frequency of elongation and kinking and that CB shape influences distribution of atherosclerosis. The purpose of this paper is to quantify and evaluate these clinical observations. Radiogrametric analysis of 154 bi-plane orthogonal aortic arch arteriograms of patients with symptomatic atherosclerotic carotid artery disease was performed and a total of 289 CBs were analyzed. The CB height in relation to cervical spine segments was measured and real angles of each bifurcation were calculated. A positive linear correlation between CB height and angle exists: the CB angle increases/decreases 3,34o for each third of the cervical vertebral body height or intervertebral space height. The CB is positioned a little higher on the left side. The proximal border of the atherosclerotic process is found at the level of intersection of the axes of the common carotid artery branches in 92.6% of examined CBs. In lower CBs (with smaller angles) the proximal border was located in the last segment of the common carotid artery, while in high bifurcations (wider angles) the proximal border of the AS process is more distally in the blood flow, in the beginning of the internal carotid artery, and the process was more extensive. High CBs are more suitable for eversion endarterectomy while normal and low CBs are more suitable for open (classic) carotid endarterectomy. The influence of the geometric risk factor demands further investigation

Factors Associated with Road Traffic Injuries and Their Severity: A Prospective Cohort Study

Road traffic injuries cause considerable losses to individuals, their families, and to nations as a whole. Factors related to road traffic injuries and to the severity of such injuries have not been fully elucidated or evaluated. The aim of this study was to explore factors related to road traffic injuries and their severity in cohort of 200 road traffic accident (RTA) survivors from Eastern Croatia. Sustaining injury was associated with rural residence (p=0.032), lower education level (p=0.001), unemployment (p=0.001), being single (p=0.014), under average self-assessed economic status (p=0.001), alcohol abstinence (p=0.018), use of medications (p=0.031), self-assessed life-threat (p<0.001), pain after the RTA (p<0.001), hospitalization after the RTA (p<0.001), hospitalization duration (p<0.001), surgery (p=0.048), rehabilitation following the RTA (p=0.001) and PTSD symptoms (p=0.001). Injury severity was associated with lower education level (p=0.013), unemployment (p=0.004), being single (p=0.017), under average self-assessed economic status (p<0.001), alcohol abstinence (p=0.042), use of medications (p=0.014), self-assessed life-threat (p<0.001), pain after the RTA (p<0.001), being a pedestrian or a cyclist (p=0.011), hospitalization after the RTA (p<0.001), hospitalization duration (p<0.001), surgery (p<0.001), rehabilitation following the RTA (p=0.001), depression (p<0.001) and PTSD symptoms (p<0.001). In order to more adequately prevent road traffic injuries knowledge about factors associated with such injuries and their severity should be base for the creation of specific prevention programs at regional and national level

Smjernice za liječenje stenoze karotidne arterije [Guidelines for treatment of carotid artery stenosis]

Carotid artery stenosis is a risk factor for developing a stroke. Large randomized studies have shown that carotid endarterectomy (CEA) plays a significant role in preventing a stroke. Carotid endarterectomy decreases the risk of stroke and increases the quality of life after surgery. During the past decades carotid artery stenting (CAS) has evolved as a less invasive way of treating extracranial artery stenosis. Carotid artery stenting is supposed to be less invasive but equally successful and durable (randomized studies are expected to support this statement). Carotid artery stenting is being performed by vascular surgeons, general surgeons, neurosurgeons, cardiologists, radiologists etc1. In addition to these guidelines we provide indications for CEA (especially within 2 weeks after the onset of symptoms) and indications for the treatment of restenosis after CEA or CAS. Indications were presented and accepted by the members of the Croatian Society for Vascular Surgery (CSVS) during the meeting in Vodice in May, 2016. Making of these guidelines is not financially supported. The guidelines are primarily intended for vascular surgeons and interventional radiologists to provide a unified stance in the treatment of patients with a significant narrowing of the internal carotid artery

GUIDELINES FOR TREATMENT OF CAROTID ARTERY STENOSIS

Stenoza unutarnje karotidne arterije povećava rizik od moždanog udara. Velike randomizirane studije pokazale su da karotidna endarterektomija (engl. carotid endarterectomy – CEA) ima važnu ulogu u prevenciji moždanog udara te da se kod operiranih bolesnika smanjuje rizik i dugoročno poboljšava kvaliteta života. Tijekom posljednjeg desetljeća metoda postavljanja stenta u karotidnu arteriju (engl. carotid artery stenting – CAS) razvila se kao način liječenja ekstrakranijalne stenoze karotide. Ideja je da se karotidna endarterektomija zamijeni manje invazivnim postupkom koji je poštedniji za bolesnika, a s jednakim rezultatima liječenja (što tek treba potvrditi randomiziranim studijama). Zahvat izvode liječnici različitih specijalnosti poput vaskularnih kirurga, općih kirurga, neurokirurga, kardiologa, radiologa i sl.1 Stoga su smjernice namijenjene potonjima radi zauzimanja jedinstvenog stajališta o liječenju bolesnika sa znatnim suženjem unutarnje karotidne arterije. Dodatak smjernicama jest dio koji se odnosi na CEA-u do 2 tjedna nakon moždanog udara te indikacija za liječenje restenoze nakon CEA-e ili CAS-a. Članovi Hrvatskog društva za vaskularnu kirurgiju (HDVK) prihvatili su izložene smjernice na stručnom sastanku HDVK u Vodicama u svibnju 2016. god. Njihova izrada nije bila financijski potpomognuta. Smjernice su namijenjene ponajprije vaskularnim kirurzima i interventnim radiolozima koji provode invazivno liječenje bolesnika sa znatnim suženjem unutarnje karotidne arterije radi zauzimanja jedinstvenog stajališta.Carotid artery stenosis is a risk factor for developing a stroke. Large randomized studies have shown that carotid endarterectomy (CEA) plays a significant role in preventing a stroke. Carotid endarterectomy decreases the risk of stroke and increases the quality of life after surgery. During the past decades carotid artery stenting (CAS) has evolved as a less invasive way of treating extracranial artery stenosis. Carotid artery stenting is supposed to be less invasive but equally successful and durable (randomized studies are expected to support this statement). Carotid artery stenting is being performed by vascular surgeons, general surgeons, neurosurgeons, cardiologists, radiologists etc1. In addition to these guidelines we provide indications for CEA (especially within 2 weeks after the onset of symptoms) and indications for the treatment of restenosis after CEA or CAS. Indications were presented and accepted by the members of the Croatian Society for Vascular Surgery (CSVS) during the meeting in Vodice in May, 2016. Making of these guidelines is not financially supported. The guidelines are primarily intended for vascular surgeons and interventional radiologists to provide a unified stance in the treatment of patients with a significant narrowing of the internal carotid artery

Quality of life in road traffic accident survivors

The loss of quality of life is the major consequence following a non-fatal road traffic accident (RTA). Previous research regarding quality of life did not include uninjured RTA survivors. The research aim was thus to evaluate the quality of life of the RTA survivors regardless of whether or not they sustained injures, and to identify factors associated with decreased quality of life after the RTA