Research Progress of Carotid Artery Injury Caused by Radiotherapy for Nasopharyngeal Carcinoma / 肿瘤防治研究

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.

Intraoperative Common Carotid Artery Injury during Ventriculoperitoneal Shunt Surgery

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.

Endovascular repair with covered stent for the treatment of ruptured carotid artery pseudoaneurysms / 介入放射学杂志

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.

Intimal Hyperplasia in Loop-Injured Carotid Arteries Is Attenuated in Transglutaminase 2-Null Mice

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.

Different Responses of Neointimal Cells to Imatinib Mesylate and Rapamycin Compared with Normal Vascular Smooth Muscle Cells

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.

Inhibition of intimal hyperplasia by local perivascular application of rapamycin and imatinib mesilate after carotid balloon injury / 대한외과학회지

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.

Risk factors of carotid artery plaque formation in radiation-induced late brain injury patients received irradiation for nasopharyngeal carcinoma / 中华神经医学杂志

Objective To investigate the rates and risk factors of carotid artery plaques formation in radiation-induced late brain injury (RILBI) patients who have received irradiation for nasopharyngeal carcinoma. Methods Eighty-two patients with RILBI,admitted to our hospital from January 2008 to September 2011, and 40 healthy controls were recruited in this study; in these 82 patients,we chose 50 patients who did not have such risk factors of main carotid artery plaque formation as stroke,ischemic heart disease,hypertension,diabetes mellitus and smoking as our RILBI group.Their medical histories were obtained,and the levels of fasting blood glucose,triglyceride,total cholesterol,high-density lipoprotein cholesterol, low-density lipoprotein cholesterol were examined. Carotid intima-media thicknesses (CIMT) in these 82 patients were measured by Doppler ultrasound; according to the CIMT, RILBI patients were divided into plaque formation sub-group and non-plaque formation sub-group; unconditional logistic regression was employed to analyze the risk factors of carotid artery plaque formation. Results Relevance ratio of plaque formation in RILBI group (32.0％) was significantly higher than that of controls (12.5％,P＜0.05).Significant differences of age,post-radiation interval without plaque, history of stroke were noted between the RILBI patients of plaque formation sub-group and non-plaque formation sub-group (P＜0.05).Logistic regression demonstrated that age was an independent risk factor for plaque formation in RILBI patients (OR=1.103,95％CI:1.046-1.163,P=0.000). Conclusion The incidence rate of plaque formation in RILBI patients received irradiation for nasopharyngeal carcinoma is high,and age is an important risk factor.Focused screening of carotid artery injury in RILBI patients may be medically beneficial.

Spontaneous Recanalization from Traumatic Internal Carotid Artery Occlusion

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.

Endovascular Stent Treatment for Traumatic Common Carotid Artery Dissection with Cerebral Infarction : Case Report and Literature Review / 대한뇌혈관외과학회지

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.

Advances in the study of carotid injury after radiotherapy in head and neck tumors / 中国癌症杂志

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.

A Case of Arteriovenous Fistula between Common Carotid Artery and Internal Jugular Vein / 대한이비인후과학회지

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.

Endovascular Treatment of a Traumatic Carotid-Jugular Fistula by Using Stent-Graft

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.

Traumatic Blindness Due to Injury of Internal Carotid Artery Associated with Craniomaxillofacial Fracture

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.

Emergency Endovascular Treatment of Internal Carotid Artery Injury During a Transsphenoidal Approach for a Pituitary Tumor: Case Report

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.