2017;105:63242. 2019;28(8):22217. It should be noted that the anatomical variation of carotid artery is common in the population; meanwhile, the anatomical characteristics of cerebral artery are also affected by age, gender, and other factors. Treatment typically involves reducing or managing risk factors, such as high blood pressure, cholesterol level, diabetes and smoking. https://doi.org/10.1007/s10557-014-6562-5. Much depends on the age of the patient, the timeliness of the treatment measures initiated, the ability to completely eliminate the existing risk factors. 2018;115:23444. AJNR Am J Neuroradiol. Using four sets of clinical criteria, Gold et al (2002) found high specificities but low sensitivities for probable and possible vascular dementia. Google Scholar. Ann Transl Med. Role of hemodynamics in initiation/growth of intracranial aneurysms. There are 2 types of operations: endarterectomy (removal of an atherosclerotic plaque together with a portion of the intima of the vessel) and the creation of a vascular shunt bypassing the area of the artery obstructed by an atherosclerotic plaque. Data Brief. Treatments include proximal arterial ligation, trapping and bypass, surgical obliteration (often requiring encircling clips), and wrapping. 2015;14(2):427681. It can also be used to identify the plaques structure. Blood cell fragments, also known as platelets or thrombocytes, accumulate at the affected area when the plaque raptures. In iNOS knockout mice, compared with wild-type mice, the incidence of aneurysms in iNOS knockout mice was not significantly different, but the diameter of aneurysms was significantly reduced [40]. In the second case, part of the atherosclerotic plaque breaks off from it and in the form of an embolus with blood flow is transferred to a smaller arterial vessel, causing its sudden and complete occlusion (thrombosis). Biomed Eng Online. Cerebral arteriosclerosis can lead to life threatening health events such as ischemic or hemorrhagic strokes. The accumulation causes blood vessels to narrow and harden, obstructing blood flow to the brain, in the case of cerebral atherosclerosis. LOS Hospice Median LOS Compassionate Care Hospice - Clifton, NJ Grace Healthcare Services - In patients with ischemic stroke, it has been reported that baPWV is significantly correlated with calcification or stenosis of cerebral arteries.53,54 In addition, baPWV increases the risk of cerebral infarction, above and beyond the risk associated with traditional risk factors, including hypertension, diabetes, dyslipidemia, and fasting blood glucose.55 However, not all studies have reported these positive associations. In contrast to saccular aneurysms that occur at arterial bifurcations, traumatic aneurysms occur along the longitudinal aspect of vessel walls. 2013;16(1):3353. Guidelines for Hospice Eligibility - Agrace Ishii D, Matsushige T, Sakamoto S, Shimonaga K, Akiyama Y, Okazaki T, et al. Hypertensive patients need careful selection of antihypertensive treatment. Olubajo et al. (2016). The resulting atherosclerotic plaque, increasing in size, gradually increasingly blocks the lumen of the affected vessel and can serve as a source of thromboembolism. Platelets and plaque fragments can stick on to each other and form lumps. revealed that low WSS and high OSI promoted IA growth, and in their study, they clarified that the areas of IA growth showed low shear conditions with increased oscillations at the site of growth [31]. Wang Z, Kolega J, Hoi Y, Gao L, Swartz DD, Levy EI, et al. Article Neurons in the brain are very long-lived cells, as they are established before birth and survive for the lifetime of the individual. Life Science Journal. 1996;27(11):197480. Fan T, Zhou Z, Fang W, Wang W, Xu L, Huo Y. Morphometric and hemodynamic parameter dataset for coronary artery aneurysms caused by atherosclerosis. Adherence to a MeDi may be protective against the risk of clinical outcomes including stroke, CVD, and cognitive impairment by affecting subclinical vascular conditions such as (WMH, subclinical brain infarctions (SBI), and atherosclerosis. Applicable To Chronic cerebral ischemia Prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years: a cross-sectional study. The diagnosis uses REG, ultrasound, duplex scanning or MRI of cerebral vessels, as well as electroencephalography, CT and brain MRI. In 2007, researchers from the University of California found evidence of increased risk of bad cholesterol buildup in the arteries due to exposure to diesel exhaust particles in the air. LCD - Hospice - Determining Terminal Status (L33393) %%EOF 2003;34(12):29804. To run Money Maker Software properly, Microsoft .Net Framework 3.5 SP1 or higher version is required. Close, in Handbook of Clinical Neurology, 2018. 2008;39(7):208590. Hashimoto Y, Matsushige T, Shimonaga K, Hosogai M, Kaneko M, Ono C, et al. People who survive stroke may have long-term neurological and motor impairments. Liu WS, Geng HJ, Wang CD, Li AJ, Cao PC, Wang DK, et al. When the blood vessels are stimulated by the continuous abnormal blood flow, the functional structure of the blood vessels changes, which becomes the pathophysiological basis of the inflammation and atherosclerosis of the blood vessels and further promotes the occurrence and development of the intracranial aneurysm. Under physiological condition, the stable blood flow supplies energy and oxygen to brain tissue via cerebral vessel. For people who survive a stroke, the two most important outcomes are functional outcomes and life expectancy. The presence of cerebral arteriosclerosis in the elderly is often characterized by personality changes including irritability, apathy, and weeping. Cerebral amyloid angiopathy is associated with A deposits in leptomeningeal and cerebral vessel walls (Revesz et al., 2009; Grinberg and Thal, 2010; Attems et al., 2011; Jellinger, 2013). 2012;9(3):1296301. https://doi.org/10.1111/j.1447-073X.2007.00216.x. https://doi.org/10.1016/j.jocn.2011.02.014. Liu H, Lan L, Leng X, Ip HL, Leung TWH, Wang D, et al. Portegies ML, et al. This work was supported by the National Key Research and Development Program of China (grant No: 2016YFC1300703) and the National Natural Science Foundation of China (grant No: 81701136, 81771264). Validation of wall enhancement as a new imaging biomarker of unruptured cerebral aneurysm. Web30 Day Hospice Admission Rate Post Hospital Discharge (%) Hospice Avg. Cerebrovascular disease includes a range of conditions that affect the flow of blood through the brain. The test also helps doctors to establish various features of the plaque including its likelihood to rupture. The numerous repetition of such vascular changes is a favorable basis for the development of cerebral atherosclerosis. In modern society, subarachnoid hemorrhage, mostly caused by intracranial aneurysm rupture, is accompanied by high disability and mortality rate, which has become a major threat to human health. Hong B, Wang W, Wang X, Wang J, Ye M. Numerical simulation to get flow pattern in modified carotid artery bifurcation model using PIV. The existence of a large number of predisposing factors suggests the polyetiology of this process. Study suggested that iNOS was not directly related to the occurrence of IA, but may play an important role in IA progression and size growth. Hemodynamic induced inflammatory process in intracranial aneurysm development. Sadamasa N, Nozaki K, Hashimoto N. Disruption of gene for inducible nitric oxide synthase reduces progression of cerebral aneurysms. Hemodynamics of focal versus global growth of small cerebral aneurysms. Autosomal dominant polycystic kidney disease: the last 3 years. https://doi.org/10.1161/01.ATV.18.5.708. 2016;78(4):51020. volume7, Articlenumber:44 (2021) Till now, the etiology of intracranial aneurysm has not been entirely clarified. Staying away from unhealthy foods with high saturated fat content is another lifestyle change that can help prevent cerebral arteriosclerosis. When the thickening and hardening is uneven, arterial walls can develop bulges (called aneurysms). When the blood flow velocity suddenly increases and the blood flow morphology is unstable, the increase of WSS is accompanied by the increase of eNOS activity and NO expression, and this effect is mediated by MAPK signal pathway phosphorylation [38]. statement and Heart-healthy living, along with ongoing medical care, can help prevent complications of atherosclerosis and make for a long, healthy life. There is progressive stiffening of arterial walls, with an increase in collagen in the tunica intima and in the tunica media. This valuable tool offers detailed descriptions, facts on treatment and prognosis, and patient organization contact information for over 500 identified neurological disorders. In addition to eNOS, there are also inducible nitric oxide synthases (iNOS) in endothelial cells. Alzheimer's disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Patients with dementia or Alzheimers are eligible for hospice care when they show all of the following characteristics: 1 Unable to ambulate without assistance Unable to dress without assistance Provided by the Springer Nature SharedIt content-sharing initiative. They are typically the result of severe, A Mediterranean Diet in Relation to Subclinical Vascular Conditions, Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease. Medicare coverage of hospice depends on a physicians certification https://doi.org/10.1161/01.STR.0000102556.55600.3B. Race and sex differences in the distribution of cerebral atherosclerosis. Poor functional status with a Palliative Performance Scale (PPS) of 40 or less. Marbacher S, Erhardt S, Schlappi JA, Coluccia D, Remonda L, Fandino J, et al. Depending on the severity of your condition, you may be left with permanent mental disability, problems with mobility, or weakness or paralysis in your arms, face, or legs. 2016;16(1):231. https://doi.org/10.1186/s12883-016-0759-0. Other for WSS, CFD can also provide with oscillating shear index (OSI) which reflect the vessel wall resilience. Computational fluid dynamics of vascular disease in animal models. 2005;280(12):1118591. Cardiovascular risk factors and magnesium: relationships to atherosclerosis, ischemic heart disease and hypertension. Anti-coagulation medication may also be prescribed to help prevent the development of cerebral arteriosclerosis. Curr Protein Pept Sci. These factors together determine that atherosclerosis are more prone to initiate in the lateral wall of the carotid sinus [54]. Cerebral atherosclerosis is the process of formation of atherosclerotic plaques inside the cerebral vessels, resulting in disorders of the cerebral blood supply. WebMicrovascular ischemic disease is a brain condition that commonly affects older people. These aneurysms usually present with cranial nerve or brainstem compression but may occasionally cause ischemia or SAH. At present, many studies have confirmed that abnormal hemodynamics, as an initiating factor, is involved in the occurrence and development of IA [7, 8]. https://doi.org/10.1227/NEU.0000000000001083. This has not been well validated but can have good interrater reliability. Chapter 55 - cerebrovascular disease. Under the physiological condition, the mechanical force produced by the stable blood flow in the blood vessels keeps balance with the structure of the blood vessels. The patient can then develop plaques and lesions in their cerebral arteries which narrow as a result. Complex bilobular, bisaccular, and broad-neck microsurgical aneurysm formation in the rabbit bifurcation model for the study of upcoming endovascular techniques. The chronic inflammation further provides an ideal environment for the formation of atherosclerotic plaque. According to the Centers for Disease Control and Prevention, 6.5 million people have had some type of stroke in the United States in 2015. Damaged mitochondria and membranes are broken down by lysosomal hydrolytic enzymes, and residual material accumulates in the cytoplasm of neurons as secondary lysosomes (lipofuscin). Wong GK, Poon WS. This buildup decreases the amount of However, there are other treatments approaches including lifestyle changes that can prevent cerebral atherosclerosis before it even develops. Good DC. Coverage Indications, Limitations, and/or Medical Necessity. 2020;8(1):16. https://doi.org/10.21037/atm.2019.10.111. The 2023 edition of ICD-10-CM I67.82 became effective on October 1, 2022. This change is simultaneously companied with local hemodynamic alteration of blood vessels. https://doi.org/10.1007/978-3-319-96445-4_5. 106 0 obj <>stream Hypoxia and lack of nutrients occur in the cerebral tissues of this zone chronic ischemia develops, which eventually leads to degeneration and death of individual neurons. In endothelial cells, NO is continuously synthesized by endothelial nitric oxide synthetase (eNOS). Relationship between endothelial nitric oxide synthase (eNOS) and natural history of intracranial aneurysms: meta-analysis. Li MH, Chen SW, Li YD, Chen YC, Cheng YS, Hu DJ, et al. World Neurosurg. If there are indications, surgical treatment is performed. Mass effect and ischemia from intraluminal thrombus can often be treated with anticoagulation. After a stroke, there may be paresis and other neurological deficits. CAS reported the activation of eNOS in endothelial cells is positively related to the size of WSS [37]. The mechanical force of blood flow on the tube wall mainly include the stretch of endothelial cells, the impulse force on the tube wall, and the tangential force between the blood flow and the tube wall. By using this website, you agree to our Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Cerebrovascular disease [Abstract]. Patients with intracranial stenosis are often advised to take platelet inhibitors such as aspirin. Anatomical Science International. The test does not use contrast dye and will take about 10 2018;13(1):e0191287. reported that elastin layer of the vascular wall in intracranial aneurysms is often missing, which may be related to the abnormal gene expression of the structural protein of the vascular wall in human body [23]. Oyre S, Ringgaard S, Kozerke S, Paaske WP, Erlandsen M, Boesiger P, et al. Dysphagia is severe enough to prevent the patient from receiving food/fluid necessary to sustain life in a patient who does not receive artificial nutrition/hydration. 2011;32(1):14551. https://doi.org/10.1016/j.mri.2017.12.005. https://doi.org/10.1016/S1474-4422(11)70109-0. Be sure to consult a doctor! 2018;17(1):5. https://doi.org/10.1186/s12938-017-0431-y. Damaged proteins become associated with ubiquitin and are delivered to proteosomes for degradation. Ravensbergen J, Ravensbergen JW, Krijger JKB, Hillen B, Hoogstraten HW. With the development of modern society, cerebrovascular disease has gradually become a major threat to human health, causing serious economic burden to families and society. Disease-specific guidelines for hospice - UpToDate The structure of cerebrovascular is complex, determining the variation of blood flow. 2011;10(7):62636. https://doi.org/10.1097/MD.0000000000000452. J Biomech Eng. 2014;34(8):17318. Your email address will not be published. Cerebral arteriosclerosis is related to vascular dementia which can result from silent strokes and transient ischemic attacks (also known as mini-strokes). However, if you think someone around you is having stroke-like symptoms, call 911 immediately. Petridis AK, Kamp MA, Cornelius JF, Beez T, Beseoglu K, Turowski B, et al. Atherosclerosis can begin in a patient at a young age as fatty streaks in their blood vessels. Oxidized low-density lipoprotein induces long-term proinflammatory cytokine production and foam cell formation via epigenetic reprogramming of monocytes. Lancet Neurol. Understanding the hospice criteria for stroke is essential when. Terms and Conditions, Some patients may not meet the criteria but may still be eligible for hospice care due to comorbidities or rapid functional decline. J Neurointerv Surg. Our care teams are here to provide support and answer any questions you may have. The diagnosis of multi-infarct dementia arose and was the basis for the earlier DSM and ICD classification systems, which was later felt to represent only one type of vascular dementia. Till now, the etiology of IA remains to be clarified; the genetic aspect, living habit, environment, and estrogen hormone are all reported to be closely related to IA development [3,4,5]. In the location where internal carotid artery enters the skull, the siphon segment blood vessels become S-shaped, which determines the complexity of hemodynamic characteristics of blood flow [59]. ICD-9-CM Diagnosis Code 437.0 One study demonstrated a strong protective association between adherence to a MeDi and the occurrence of SBIs. Hou X, Chen H. Proposed antithrombotic strategy for acute ischemic stroke with large-artery atherosclerosis: focus on patients with high-risk transient ischemic attack and mild-to-moderate stroke. There was a diagnosis in the hospital of metabolic The hospice eligibility for stroke or cerebral vascular accident (CVA) is based on the patients prognosis and includes specific requirements to qualify for hospice services. To meet stroke hospice criteria, the patient must have had an acute CVA within the past 14 days or a subacute stroke within the past six months. Work experience in medicine - 7 years. As cerebral atherosclerosis progresses, signs of cerebral ischemia (i.e., lack of blood flow) may develop as the narrowed artery thromboses or as embolic debris dislodges and travels downstream. The resultant signs and symptoms of VaD are dependent upon the locations and severity of ischemia (Alzheimer's Association, 2014). Two identical location of intracranial aneurysm in the brain. Untreated, it can lead to dementia, stroke and difficulty walking. 1991;10(2-4):18292. Can A, Du R. Association of hemodynamic factors with intracranial aneurysm formation and rupture: systematic review and meta-analysis. Not all questions of the etiology of atherosclerosis are completely clear. Correspondence to It is necessary to follow a plant-based diet with the exception of nutrients with a high cholesterol content (meat, eggs, margarine, canned fish, sausage, fast food), introduce daily hiking, reduce psycho-emotional stress, eliminate smoking and alcohol intake, optimize body weight. Clinical manifestations of cerebral atherosclerosis are associated with gradually developing cerebral circulatory insufficiency and ischemia of brain tissues as a result of vascular damage. These are determined by the specific condition causing the stroke, the severity of the stroke, and the individuals response to rehabilitation therapy. created new branch points in the carotid artery in dogs, under high WSS and high WSS gradient environment, the arterial wall presented with destructive remodeling around the irregular flow, resembling the process of IA initiation [27]. The following activated monocyte and macrophage further promote the transformation of foam cells from smooth muscle cells [45]. Top 20 Principal Hospice Diagnoses for 2017 - AAPC It is also necessary to take into account a certain role of hereditary mechanisms, since family cases of such complications of cerebral atherosclerosis as stroke are widely known. Cortical vessels are usually spared, and the brainstem is only affected in the late stages of SVD (Thal et al., 2003). Atherosclerotic plaques are common in the elderly and increase with age. Mestas J, Ley K. Monocyte-endothelial cell interactions in the development of atherosclerosis. As cerebral atherosclerosis progresses, signs of cerebral ischemia (i.e., lack of blood flow) may develop as the narrowed artery thromboses or as embolic debris dislodges and travels downstream. Researchers say a drug used to treat epilepsy seizures shows promise in reducing autism-like behavior in mice. Torres VE, Harris PC. Well help you every step of the way, from determining hospice eligibility to providing compassionate care to your loved one. Cognitive abilities are improved by taking nootropics: piracetam, picamilon, nicergoline, etc. October 6, 2016, http://medlexi.com/Cerebral_atherosclerosis. RE`+Mu%:,dpLNj5]Q Jsm;=m-|sA{0ey?n|iwW~|pWc\/yX. By continuing you agree to the use of cookies. To successfully treat cerebral atherosclerosis, a doctor has to target the factors that caused it. 0 Morimoto M, Miyamoto S, Mizoguchi A, Kume N, Kita T, Hashimoto N. Mouse model of cerebral aneurysm experimental induction by renal hypertension and local hemodynamic changes. Cerebral atherosclerosis 2018;48:629. Hospice Admissions Guidelines for Dementia & Alzheimer's - VITAS The primary pathology is the atherosclerotic plaque. Tutino VM, Mandelbaum M, Choi H, Pope LC, Siddiqui A, Kolega J, et al. Use of this procedure is limited because it exposes patients to significant amounts of radiation. Localizing role of hemodynamics in atherosclerosis in several human vertebrobasilar junction geometries. Much of this research is aimed at finding ways to prevent and treat conditions such as cerebral arteriosclerosis. This review will focus on the relationship between hemodynamics and intracranial aneurysms, will discuss the mechanism of occurrence and development of intracranial aneurysms, and will provide a new perspective for the research and treatment of intracranial aneurysms. The authors declare that they have no competing interests. https://doi.org/10.3174/ajnr.A2419. OS Supported: Windows 98SE, Windows Millenium, Windows XP (any edition), Windows Vista, Windows 7 & Windows 8 (32 & 64 Bit). 2007;38(6):192431. Morimoto et al. 2003;65(3):13744. XZ, ZZ, YY, and ZL completed the draft of the article. Adv Exp Med Biol. Underlying mechanism of hemodynamics and intracranial aneurysm. Cerebral Arteriosclerosis | National Institute of Buildup of calcium, or calcifications, are a sign of atherosclerosis or coronary heart disease. Abstract. $FpXDt 7$$wi @BdFK> 7 Inherent risks can also be determined using MDCT. They evidenced that all rabbits in model group formed nascent aneurysms under high WSS condition and further histology examination evidenced the aneurysms share similar characteristics with absent internal elastic lamina and thinned media layer [28]. The natural history of these aneurysms is unpredictable. Meanwhile, the anatomical of cerebral artery is much more complicated, especially the curves and bifurcations in Willis circle [14]. 2014;35(10):184957. WebCerebrovascular disease is a term for conditions that affect blood flow to your brain. Cerebral Atherosclerosis - Causes, Symptoms and Treatment 2008;41(1):119. 2020;193:105775. https://doi.org/10.1016/j.clineuro.2020.105775. As a result of a malfunction in metabolism, low-density lipoprotein cholesterol (LDL) is deposited on the inner surface of the walls of cerebral vessels. Her symptoms gradually disappeared after she was given adrenaline 0.5mg subcutaneously plus intramuscular promethazine 50mg and dexamethasone 5mg. A 48-year-old woman with cerebral arteriosclerosis was given an intravenous infusion of Ci wu jia injection 60ml in 250ml of 5% dextrose. 9707 East Easter LaneSuite BCentennial, CO 80112-3747[emailprotected]http://www.stroke.orgTel: CentennialFax: 303-649-1328, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, DHHS31 Center Drive, Rm. Wang et al. The most effective treatment for you will depend on the extent of the loss of blood flow. Changes occur progressively in the brain and cerebral arteries with advancing age, and age is a major risk factor for Alzheimer's disease and for cerebrovascular disease. The severity of the latter depends on the prevalence of atherosclerosis, the caliber of the affected vessel, the size of the atherosclerotic plaque, the degree of development of alternative (collateral) blood supply to the ischemic area of the brain. A Intracranial aneurysm located in vessel bifurcation. The features used as the neuropathological diagnostic criteria in the various dementias are in, Companion to Psychiatric Studies (Eighth Edition), VaD is a disease of chronic brain ischemia brought about by, Vascular Dementia and Cognitive Impairment, Encyclopedia of the Neurological Sciences, ). In normal condition, the cerebral artery consists of 3 layers: the intima layer, the medial layer, and the adventitia layer. Microvasc Res. Other symptoms include recurrent epistaxis, progressive cranial nerve palsy, enlarging skull fracture, and severe headache. Specifically, it is unclear whether atherosclerosis can cause the neuritic plaques and neurofibrillary tangles that define Alzheimer neuropathology and In familial forms of CAA other proteins, along with A, are deposited in vessel walls (Revesz et al., 2009; Grinberg and Thal, 2010; Attems et al., 2011; Jellinger, 2013). Hemodynamic stress, inflammation, and intracranial aneurysm development and rupture: a systematic review. We avoid using tertiary references. The patient must also meet certain criteria for their prognosis and medical condition. 2019;29(2):28593. In modern society, subarachnoid hemorrhage, mostly caused by intracranial aneurysm rupture, is accompanied by high disability and mortality rate, which has become a major threat to human health. Greim-Kuczewski K, Berenstein A, Kis S, Hauser A, Killer-Oberpfalzer M. Surgical technique for venous patch aneurysms with no neck in a rabbit model. Among the potential risk factors of IA, abnormal hemodynamics is one of the location-specific dangerous factors, which show high relevance with vessel inflammation and atherosclerotic plaque [6]. In addition to the changes that occur within aging neurons, astrocytosis is seen in the brain, with advancing age reflecting the damage that occurs throughout life from head injuries, episodes of viral encephalitis, and ischemia. found that in the process of atherosclerosis development, the decrease of WSS level was negatively associated with vessel wall elasticity; thus, the analysis of WSS can reflect the atherosclerosis development, which can further reveal the location of IA initiation [13]. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. J Clin Neurosci. They are typically the result of severe cerebral atherosclerosis in older patients and vessel wall abnormalities in children that predispose these vessels to vascular enlargement with hemodynamic stress. Eng E, Ballermann BJ. Cite this article. Cerebral arteriosclerosis is a disease that occurs when the arteries in the brain become hard, thick, and narrow due to the buildup of plaque (fatty deposits) inside the artery walls. Does hospice falsify cause of death? - AgingCare.com However, there are also studies showing that low WSS stimulation is closely related to the progression of aneurysm [30]. The atherosclerosis and inflammation jointly promote IA occurrence and development. 2018;140(8):080801108080114. created rabbit aneurysm models by carotid artery ligation, increasing the regional blood flow. Although cerebrovascular disease is a fairly common medical condition, there are things you can do to help prevent it. WebObjective: Although it is now accepted that asymptomatic cerebral infarcts are an important cause of dementia in the elderly, the relationship between atherosclerosis per se and dementia is controversial. Although many researches have shed light on the strong relationship between hemodynamics and IA, the exact mechanism during the IA initiation and progression is still lacking. Tang, H., Wang, Q., Xu, F. et al. 2013;159(8):51421. Ci wu jia injection is a sterilized injection fluid made of Radix et Caulis Acanthopanacis senticosi (also known as Siberian ginseng). Sumpio et al. In addition, artery stenosis caused by atherosclerosis not only brings high blood flow status in the stenosis site, but also brings disorder in the downstream of the stenosis site.