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Neck radiotherapy is an important means to prevent and treat cervical lymph node metastasis of nasopharyngeal carcinoma. Studies have found that radiation can directly or indirectly damage blood vessels, accelerate the process of atherosclerosis, and then cause carotid artery stenosis, increasing the risk of transient cerebral ischemia and stroke after radiotherapy. At present, we often apply color doppler ultrasound to detect the changes of carotid artery and actively prevent and reduce risk factors to decrease the occurrence of carotid artery stenosis. Carotid artery stenosis can be treated with early drug intervention and surgery. This article reviews the current research status of carotid artery injury caused by radiotherapy.
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Objective To evaluate the efficacy and safety of endovascular repair with covered stent in treating ruptured carotid artery pseudoaneurysms.Methods The clinical data of 15 patients with ruptured carotid artery pseudoaneurysm,who were admitted to Sun Yat-Sen Memorial Hospital of Zhongshan University during the period from July 2009 to July 2015 to receive emergency rescue with endovascular covered stent implantation,were retrospectively analyzed.Of the 15 patients,the rupture of common carotid artery pseudoaneurysm caused by direct trauma was seen in one and caused by cervical operation was observed in one,the rupture of internal carotid artery pseudoaneurysm caused by cervical operation was found in 3,and the rupture of internal carotid artery pseudoaneurysm due to radiotherapy for nasopharyngeal carcinoma was seen in 10.Results Successful rescue with endovascular repair using covered stent implantation was obtained in all 15 patients.No immediate procedure-related complications or death occurred.The mean follow-up time was 11 months.During the follow-up period,no re-bleeding or cerebral ischemic complications occurred.Conclusion For the treatment of ruptured carotid artery pseudoaneurysms,endovascular repair with covered stent is minimally invasive,safe and effective with less complications;and along with the occlusion of carotid artery rupture,the blood supply of the head and neck returns to normal.However,further clinical researches with larger samples are needed before its long-term efficacy can be completely clarified.
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There are a number of complications associated with ventriculoperitoneal shunt (VPS) surgery. The authors present a rare case of iatrogenic common carotid artery injury during VPS surgery.
Subject(s)
Carotid Artery, Common , Ventriculoperitoneal ShuntABSTRACT
PURPOSE: This study was designed to investigate whether vascular smooth muscle cells (VSMC) from the neointima showed any different response to antiproliferative agents, such as rapamycin or imatinib mesylate, compared to VSMCs from normal artery. MATERIALS AND METHODS: Intimal hyperplasia was made by carotid balloon in jury in male rats. Neointimal cells at 4 weeks after injury and normal VSMCs were extracted by enzymatic isolation method and cultured. Cell viability and proliferation were tested in VSMCs from injured left carotid artery and uninjured right carotid artery. Tests were repeated with rapamycin, imatinib mesylate or both in various concentrations. RESULTS: Rapamycin decreased cell viability only at a high concentration of 10(-5) M in uninjured VSMCs. Combined drugs decreased cell viability at a lower concentration of 10(-7) M in uninjured VSMCs, and at a higher concentration of 10(-5) M in neointimal cells. Overall, rapamycin showed cytocidal effects at a high concentration of 10(-5) M, whereas imatinib did not. Cell proliferation of neointima was significantly decreased along with the drug concentration. Cell proliferation of uninjured VSMCs was significantly decreased at higher drug concentrations. Combined drug therapy showed synergistic effects. Overall, neointimal cells are more susceptible to the antiproliferative effects of the drugs. CONCLUSION: Neointimal cells from the injured carotid artery are more susceptible to the antiproliferative effect of imatinib and rapamycin. Both drugs can be a used for the prevention of intimal hyperplasia, which could be investigated through further in vivo studies.
Subject(s)
Animals , Humans , Male , Rats , Arteries , Carotid Arteries , Carotid Artery Injuries , Cell Proliferation , Cell Survival , Drug Therapy , Hyperplasia , Mesylates , Muscle, Smooth, Vascular , Neointima , Sirolimus , Imatinib MesylateABSTRACT
Arterial restenosis frequently develops after open or endovascular surgery due to intimal hyperplasia. Since tissue transglutaminase (TG2) is known to involve in fibrosis, wound healing, and extracellular matrix remodeling, we examined the role of TG2 in the process of intimal hyperplasia using TG2-null mice. The neointimal formation was compared between TG2-null and wild-type (C57BL/6) mice by two different injury models; carotid ligation and carotid loop injury. In ligation model, there was no difference in intimal thickness between two groups. In loop injury model, intimal hyperplasia developed in both groups and the intimal/medial area ratio was significantly reduced in TG2-null mice (P = 0.007). TG2 was intensely stained in neointimal cells in 2 weeks. In situ activity of TG2 in the injured arteries steadily increased until 4 weeks compared to uninjured arteries. Taken together, intimal hyperplasia was significantly reduced in TG2-null mice, indicating that TG2 has an important role in the development of intimal hyperplasia. This suggests that TG2 may be a novel target to prevent the arterial restenosis after vascular surgery.
Subject(s)
Animals , Mice , Carotid Arteries/pathology , Disease Models, Animal , GTP-Binding Proteins/deficiency , Hyperplasia , Mice, Inbred C57BL , Transglutaminases/deficiency , Tunica Intima/pathologyABSTRACT
PURPOSE: Inhibition of the intimal hyperplasia after vascular surgery is an important issue. The purpose of this study is to define whether perivascular application of rapamycin, imatinib mesylate or cysteamine can reduce intimal hyperplasia in a carotid balloon injury model. METHODS: Each drug was mixed with 40% pluronic gel solution and was topically applied over the injured carotid artery evenly. Two or four weeks after injury, the arteries were harvested and morphometric analysis was done. RESULTS: The medial areas were not significantly different in each group and a thinning of the media as a toxic drug effect was not observed in any treatment group. The intimal area and intima-to-media (I/M) ratio were significantly reduced in rapamycin-treated group and imatinib-treated group (P < 0.05). But cysteamine-treated group showed a trend of decrease in I/M ratio in 2 weeks, but no difference in 4 weeks. CONCLUSION: Perivascular delivery of imatinib or rapamycin with pluronic gel attenuated the development of intimal hyperplasia. But cysteamine did not. Further studies are needed to refine the optimal drug dosages in large animal models.
Subject(s)
Arteries , Benzamides , Carotid Arteries , Carotid Artery Injuries , Cysteamine , Hyperplasia , Imatinib Mesylate , Mesylates , Models, Animal , Piperazines , Pyrimidines , SirolimusABSTRACT
The incidence of spontaneous recanalization after traumatic internal carotid artery occlusion is very rare. We have experienced a case of spontaneous recanalization after a traumatic internal carotid artery occlusion. A 5-year-old boy developed contra-lateral hemiparesis and dysphasia after a blunt injury on the head and neck. He had a complete left internal carotid artery occlusion which was diagnosed through angiography. We treated the patient with an antiplatelet agent and rehabilitation. Six months later, he regained motor power of right extremities, language ability, and revisualization of internal carotid artery on the follow-up magnetic angiography. We confirmed a recanalization of injured internal carotid artery on the conventional cerebral angiography which was performed one year later. We suggest conservative treatment with serial angiographic studies as a possible option of traumatic internal carotid artery occlusion even though there is hemodynamic instability.
Subject(s)
Child, Preschool , Humans , Male , Angiography , Aphasia , Carotid Artery Injuries , Carotid Artery, Internal , Carotid Artery, Internal, Dissection , Cerebral Angiography , Extremities , Follow-Up Studies , Head , Hemodynamics , Incidence , Language , Neck , Paresis , Rehabilitation , Wounds, NonpenetratingABSTRACT
Radiotherapy is the main treatment method for treating head and neck tumors. however, carotid injury after irradiation is a major concern which contributes to the quality of life in head and neck patients, especially in long term survivors. At present, duplex Doppler ultrasound is commonly used in detecting the change of carotid artery after irradiation in the clinic. Internal diameter and mean intima-media thickness(IMT) of carotid artery are predominant objects of observation. Precaution and management of carotid artery damage after irradiation have signifi cant clinical value to long term survivors. In this view, we summarized the advances in the study of carotid artery damage of head and neck tumors after irradiation.
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Accurate determination of the true incidence of blunt carotid artery injury is difficult because the patient may be asymptomatic or the condition may be masked by concomitant injuries. We present a case of blunt injury to the right common carotid artery and dissection with acute infarction on right fronto-temporo-parietal area and treated with carotid stent. We review the blunt carotid artery injury rate of occurrence, mechanism, presentation, screening, radiologic diagnosis, management and outcome.
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Humans , Carotid Artery Injuries , Carotid Artery, Common , Cerebral Infarction , Diagnosis , Incidence , Infarction , Masks , Mass Screening , Stents , Wounds, NonpenetratingABSTRACT
Traumatic arteriovenous fistula between common carotid artery and internal jugular vein is extremely rare. Major cervical vascular injury may present as vigorous external bleeding, an expanding or stable cervical hematoma, or a hemispheric neurologic deficit. A rapidly expanding hematoma is immediate to the patient's airway and severe ongoing hemorrhage may lead to exanguination. The authors have experienced a case of traumatic pseudoaneurysm and arteriovenous fistula between common carotid artery and internal jugular vein. We treated this case successfully with exploration and vascular autograft, and so, we report it with a review of the literature.
Subject(s)
Aneurysm, False , Arteriovenous Fistula , Autografts , Carotid Artery Injuries , Carotid Artery, Common , Hematoma , Hemorrhage , Jugular Veins , Neurologic Manifestations , Vascular System Injuries , Wounds, PenetratingABSTRACT
A case of traumatic internal carotid artery injury associated with skull base fracture, Le Fort II fracture and mandible fracture after maxillofacial blunt trauma which resulted in delayed blindness is presented. This condition would appear to be a rare consquence of maxillofacial trauma. Internal carotid artery injury including dissection is an important consequence of blunt craniomaxillofacial trauma with potentially devastating consquences. It should be emphasized that skull base fracture involving the course of the internal carotid artery provides an important clue to significant vascular injury and, when present, provides the impetus for vascular imaging study.
Subject(s)
Blindness , Carotid Artery, Internal , Mandible , Skull Base , Vascular System InjuriesABSTRACT
Traumatic arteriovenous fistulas following carotid artery injuries are rare. Treatment of carotid artery-to-jugular vein fistula requires direct closure of the fistula or occlusion of the carotid artery above and below the level of the fistula, by a surgical or endovascular approach. A 32-year-old man presented with right-sided pulsatile neck swelling and left-sided limb weakness 2 days following a stab wound. Neck computed tomography demonstrated a vascular mass protruding the anterior neck. Digital subtraction arteriography demonstrated a bilobular large internal carotid artery pseudoaneurysm just distal to its bifurcation. There was simultaneous opacification of a dilated left internal jugular vein indicating a high-flow internal carotid-internal jugular fistula. A balloon-expandable stent-graft was delivered and successfully positioned across the fistula. The arteriovenous fistula and pseudoaneurysm were completely disappeared and the right internal carotid artery was preserved well. The stent-graft is a promising technology to obliterate the fistula and preserve the parent artery with relative safety.
Subject(s)
Adult , Humans , Aneurysm, False , Angiography , Arteries , Arteriovenous Fistula , Carotid Arteries , Carotid Artery Injuries , Carotid Artery, Internal , Embolization, Therapeutic , Extremities , Fistula , Jugular Veins , Neck , Parents , Veins , Wounds, StabABSTRACT
Carotid artery injury is a very rare, but life threatening complication that can occur during a transsphenoidal approach. We experienced one case of carotid artery injury during a transsphenoidal pituitary tumor surgery. The patient was immediately treated by a balloon occlusion and complete packing of the cavernous carotid artery using Guglielmi detachable coils (GDCs) and the rest of the tumor was removed after the carotid occlusion. The patient recovered without showing any neurological deficits.