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Objective:To detect the characteristics of vascular remodeling after carotid balloon injury model in rats using ultrasound biomicroscopy(UBM), and to discuss the application value of UBM technique by comparing ultrasonic characteristics with histopathological results.Methods:Carotid balloon injury was performed in 10-week-old SD rats(11 female and 11 male) by 2F Fogarty balloon catheter. The left common carotid artery(CCA) was injured and the right side in the same animal was used as an uninjured control. Arterial structures and hemodynamics were evaluated pre-procedure and post-procedure at 7, 14 days.The intima-media thickness(IMT) inner diameter, outer diameter, lumen area, vessel area, peak systolic velocity, end diastolic velocity of CCA were measured by UBM, and the vascular resistance index, shear stress and blood flow were calculated to evaluate the vascular hemodynamics. The histological data were obtained by H&E staining in cross-sections at 14 days after balloon injury. The characteristics of arterial structure and hemodynamic changes at various time points were compared, the structural changes of CCA between injured and control side after injury were compared. The Spearman correlation and linear regression were used to test the correlation between ultrasonic and histological measurements 14 days after balloon injury.Results:①Compared with pre-procedure, the IMT at 14 days after balloon injury was increased, the inner diameter was decreased, the shear stress in ultrasound was increased(all P<0.05). H&E staining histological test showed that IMT and neointima area in male rats were larger than those of female rats (all P<0.001). ②After carotid balloon injury, the lumen area decreased, but the CCA underwent compensatory positive remodeling and the vessel area increased. ③Significant correlations were demonstrated between UBM and histology in IMT, inner diameter, outer diameter and vessel area of CCA( rs=0.819, 0.965, 0.896, 0.955; all P<0.001). The vessel area value measured by UBM was larger than that of histology( P=0.006). Conclusions:The CCA of rats can be showed clearly by UBM in males and females. The arterial structure cab be measured by UBM accurately with good correlation with histology, as did arterial hemodynamic parameters, which may be benefit for the study in carotid balloon injury model of rats.
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Pseudoaneurysm of the common carotid artery (CCA) is exceptionally unstable and unpredictable; it mandates quick medical attention in order to circumvent neurologic sequelae or hemorrhage. Unanticipated rupture is extremely lethal and a potential provocation for the anesthesia caregiver. It is an arduous challenge for an anesthetist to establish emergency airway when a huge bleeding pseudoaneurysm is compressing and deviating the trachea, securing invasive lines in collapsing vessels, volume and vasopressor resuscitation in deteriorating hemodynamics in order to maintain cerebral perfusion without compromising other vital organs, arranging huge amount of blood and blood products in a short span of time, and transferring an exsanguinating patient for the rapid institution of cardiopulmonary bypass. Not only preoperatively it also necessitates appropriate neuromonitoring and neuroprotection during and after surgery. The association of unforeseen rupture of common carotid artery pseudoaneurysm secondary to the tubercular spine and lifesaving management by the rapid institution of cardiopulmonary bypass (CPB) is a rare occasion. To the best of the authors’ knowledge, there is not any similar case in the peer?reviewed literature. Therefore, the authors enumerate the clinical experience of an unexpected rupture of CCA pseudoaneurysm requiring lifesaving CPB and emphasize the “Timely Teamed Effort Approach” that can sustain a life in such an inevitable situation.
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ObjectiveBased on the protective effect of Dengzhan Shengmai capsules （DZSM） on chronic cerebral hypoperfusion （CCH）， network pharmacology was employed to investigate the molecular mechanism. MethodCCH model was established by right common carotid artery ligation. The mice were divided into sham operation group， model group， ginaton group （48 mg·kg-1）， DZSM low- and high-dose groups （0.040 5， 0.162 g·kg-1）. The efficacy was evaluated by the Morris water maze test and open-field test. The underlying mechanism of DZSM for CCH was analyzed by network pharmacology and verified by molecular biology experiments. PubChem， GeneCards， Metascape and other databases were used for targets collection and enrichment analysis. Besides， the association of ingredients targets of DZSM with disease targets of CCH， core target network and chemical components-core targets-pathways network were constructed by STRING 11.0 and Cytoscape 3.7.1. ResultThe escape latency of CCH mice significantly shortened on the 3rd to 5th day after DZSM low-dose treatment， the crossing times， time spent in the target quadrant， movement distance and distance in the central region of CCH mice significantly increased after DZSM low-dose and high-dose treatment. The results of network pharmacology indicated that DZSM might play a key role by regulating inflammatory response， phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt） signaling pathway， cytokine-cytokine receptor interaction， tumor necrosis factor （TNF） signaling pathway， blood circulation， angiogenesis， extracellular matrix and other related biological processes and pathways， and acting as targets such as interleukin-6 （IL-6）， TNF， insulin-like growth factor 1 （IGF1）， vascular endothelial growth factor A （VEGFA）， epidermal growth factor （EGF）. The results of biological experiments showed that DZSM could reduce the expression of IL-6 in brain tissue of CCH mice. ConclusionDZSM provides a protective effect during CCH， and its multi-component， multi-pathway， multi-target mechanism is also revealed， which provides a basis for further study of the mechanism.
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Abstract Thoracic vascular trauma is associated with high mortality and is the second most common cause of death in patients with trauma following head injuries. Less than 25% of patients with a thoracic vascular injury arrive alive to the hospital and more than 50% die within the first 24 hours. Thoracic trauma with the involvement of the great vessels is a surgical challenge due to the complex and restricted anatomy of these structures and its association with adjacent organ damage. This article aims to delineate the experience obtained in the surgical management of thoracic vascular injuries via the creation of a practical algorithm that includes basic principles of damage control surgery. We have been able to show that the early application of a resuscitative median sternotomy together with a zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) in hemodynamically unstable patients with thoracic outlet vascular injuries improves survival by providing rapid stabilization of central aortic pressure and serving as a bridge to hemorrhage control. Damage control surgery principles should also be implemented when indicated, followed by definitive repair once the correction of the lethal diamond has been achieved. To this end, we have developed a six-step management algorithm that illustrates the surgical care of patients with thoracic outlet vascular injuries according to the American Association of the Surgery of Trauma (AAST) classification.
Resumen El trauma vascular torácico está asociado con una alta mortalidad y es la segunda causa más común de muerte en pacientes con trauma después del trauma craneoencefálico. Se estima que menos del 25% de los pacientes con una lesión vascular torácica alcanzan a llegar con vida para recibir atención hospitalaria y más del 50% fallecen en las primeras 24 horas. El trauma torácico penetrante con compromiso de los grandes vasos es un problema quirúrgico dado a su severidad y la asociación con lesiones a órganos adyacentes. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de las lesiones del opérculo torácico con la creación de un algoritmo de manejo quirúrgico en seis pasos prácticos de seguir basados en la clasificación de la AAST. que incluye los principios básicos del control de daños. La esternotomía mediana de resucitación junto con la colocación de un balón de resucitación de oclusión aortica (Resuscitative Endovascular Balloon Occlusion of the Aorta - REBOA) en zona 1 permiten un control primario de la hemorragia y mejoran la sobrevida de los pacientes con trauma del opérculo torácico e inestabilidad hemodinámica.
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ABSTRACT Objective: To assess the carotid and brachial arteries' intima-media thicknesses (IMTs) in cases with intermittent (obstructive sleep apnoea syndrome (OSAS)) and continuous (chronic obstructive pulmonary disease (COPD)) hypoxaemia together with other confounding demographic and biochemical factors. Methods: The study was prospectively performed on 197 patients allocated in three groups: 80 with severe OSAS, 80 with severe COPD patients and 37 healthy controls. These groups were compared in terms of demographics, biochemical markers and IMTs of the right and left carotid and brachial arteries. Results: Carotid and brachial arterial IMTs were found to be higher in both patient groups than the control group (p < 0.001). Similarly, levels of haemoglobin, haematocrit, cholesterol, triglycerides, low-density lipoproteins (LDL), C-reactive protein and D (domain)-dimer were significantly increased in patient groups. Oxygen saturations (p < 0.001) and ejection fractions (p = 0.001) were found to be worse and D-dimer levels (p = 0.010) were elevated more prominently in COPD patients, whereas, cholesterol (p < 0.001), hemoglobin (p = 0.004) and LDL (p = 0.001) levels were higher in the OSAS group. Except the right carotid IMT, which was increased significantly in OSAS patients, IMT measurements were similar in the OSAS and COPD groups (p < 0.001). Conclusion: We have shown that both intermittent and continuous hypoxia result in remarkable alterations in carotid IMT and brachial IMT. Further prospective trials are warranted to confirm and extend these findings, including the biochemical markers, which may aid in the diagnosis and follow-up of patients suffering from hypoxaemia.
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Introduction: Brachiocephalic artery stenosis rarely causes right hemispheric infarction with associated left hemiparesis. To date, there have been no reported cases of stroke associated with brachiocephalic artery stenosis that were successfully treated with recombinant tissue-type plasminogen activator (rt-PA), alteplase.Case Report: An 80-year-old woman presented with left hemiparesis. Brain computed tomography showed no hemorrhage, and computed tomography angiography demonstrated brachiocephalic artery stenosis. Alteplase was administered based on a diagnosis of ischemic stroke. Brain magnetic resonance imaging showed multiple acute infarctions. Thereafter, the blood pressure of the right arm was found to be lower than that of the left arm. The patient’s neurological deficits gradually improved; she was eventually able to walk again and was thus discharged home.Conclusion: While the combination of left hemiparesis and a decrease in blood pressure in the right arm are well known in patients with stroke associated with Stanford type A aortic dissections, it may also occur in patients with stroke due to brachiocephalic artery stenosis. Unlike stroke associated with Stanford type A aortic dissections, stroke due to brachiocephalic artery stenosis may be treated with alteplase.
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@#BACKGROUND: The purpose of this study was to identify the consistency of invasive dynamic blood pressure (BP) monitoring between the superior mesenteric artery (SMA) and the common carotid artery (CCA). METHODS: Eight male Sprague-Dawley rats were cannulated in SMA and CCA simultaneously for BP monitoring, respectively. The abdominal aorta was prepared for the induction of BP change through clamping/de-clamping by a microvascular clip. The dynamic BP monitoring was performed by a polygraph system. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) values would be recorded during different time periods: the baseline (T1), the increasing period after clamping (T2), the platform period during clamping (T3), the decreasing period after de-clamping (T4), and the final platform period (T5). Three trials were performed on each rat with 15-minute intervals between consecutive monitoring. RESULTS: Systolic BP showed no significant differences between SMA and CCA. However, significant difference was found in diastolic blood pressure except at T5 (P=0.534). Mean arterial pressure of two arteries were signifi cantly different only at T1 (P=0.015). The strength of association was significantly high between BP measurements through SMA and CCA (P<0.001). The Bland- Altman analyses showed that mean bias of MAP changed no more than 5 mmHg and standard deviation less than 8 mmHg during T2 and T4, respectively. CONCLUSION: The study indicates SMA might be an alternative site for invasive BP monitoring during abdominal aorta occlusion and release, especially in cerebrovascular-related research.
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Objective::To investigate the effects of Ginseng Radix et Rhizoma, Notoginseng Radix et Rhizoma and Chuanxiong Rhizoma extracts (GNC) on the protein expression of α-smooth muscle actin (α-SMA) and runt-related transcription factor2(Runx2) after high glucose-induced vascular aging in mice, and elucidate the protective mechanism of GNC in delaying vascular aging. Method::Totally 130 male C57BL/6 mice were randomly divided into normal control group and high glucose group. The mice in high glucose group were intraperitoneally injected with streptozotocin (STZ). After successful modeling, the mice received high-fat diet for 7 months, and then they were randomly divided into model group, GNC low-dose and high-dose groups (0.819, 1.638 g·kg-1), and metformin group (150 mg·kg-1). The drug was given by intragastric administration once a day for 9 weeks. Seven days before tissues collection, a new batch of 4-week-old male C57BL/6 mice were purchased and fed normally for 1 week as a youth group. The general condition of the mice was observed. Morphological changes of the common carotid artery in mice were determined by hematoxylin-eosin (HE) staining and transmission electron microscopy (TEM). Masson trichromatic staining was used to observe the fibrosis of common carotid artery in mice. The expression levels of matrix metalloproteinases-2 (MMP-2), cyclin-dependent kinase inhibitor 2A (p16), cyclic-dependent kinase inhibitor 1A (p21), α-SMA and Runx2 in the common carotid arteries of mice were detected by immunohistochemistry. Result::The results of HE, TEM and Masson showed that there was almost no change in the inimal and adventitial thickness, ultrastructure and relative contents of collagen and elastic fibers in the common carotid arteries of mice between the youth group and normal control group. As compared with the normal control group, the intima of the common carotid artery in the model group was not smooth, the endothelial cells were almost completely detached, the cytoplasm was lysed, the inner elastic membrane became thinner, fractured, or even detached, and the proliferating collagen fibers sneaked into the tunica media. The hyperplasia of tunica media and tunica adventitia was obvious and disordered (P<0.01). The vascular smooth muscle cells showed deformations, protuberances, bifurcations, and even fragmentation, and focal necrosis was observed. There were significantly more vacuoles, lysosomes, and obvious autophagy vesicles. The relative content of collagen and elastic fibers in vascular walls increased significantly (P<0.01). Compared with the model group, the above situation was relieved in each administration group (P<0.01). The results of immunohistochemistry showed that high glucose induced high expression of MMP-2, p16, p21 and Runx2 in the common carotid arteries(P<0.01), low expression of α-SMA(P<0.01), and the protein expression tended to be normal after drug intervention(P<0.05, P<0.01). Conclusion::High glucose can induce the aging of common carotid artery in mice and change the expression of α-SMA and Runx2 proteins. The Ginseng Radix et Rhizoma, Notoginseng Radix et Rhizoma and Chuanxiong Rhizoma extracts can delay vascular aging by regulating the protein expression of α-SMA and Runx2.
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Objective:To observe the effects of Shenma Yizhi prescription（SMYZ）on learning and memory， inflammatory factors and oxidative stress related indexes of rats with chronic cerebral ischemia inducing vascular dementia caused by bilateral common carotid artery ligation. Method:The chronic cerebral ischemia model of SPF grade SD rats was prepared by bilateral common carotid artery ligation. After successful surgery， the rats with cognitive impairment were randomly divided into 5 groups，model， donepezil（0.45 mg·kg-1）， SMYZ-low， medium and high dose（2.97，5.94，11.88 g·kg-1）， with 10 rats in each group， and 10 rats in sham operation group were established. Intragastric administration were given for 8 weeks respectively then followed Morris water maze test. The pathomorphological changes of hippocampus CA1 were observed. The serum levels of acetylcholine(Ach)and acetylcholinesterase (AChE)were detected， and the levels of inflammatory cytokines interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the serum of rats were detected. The contents of glutathione (GSH)， malondialdehyde (MDA)， superoxide dismutase (SOD) and glutathione peroxidase reductase (GSH-Px) were observed. Result:Compared with sham operation group， the escape latency increased significantly in the model group， and the frequency of platform search， the frequency of crossing the original platform and the percentage of swimming time in the original platform quadrant decreased significantly （P<0.05，P<0.01）. The contents of Ach and the contents of GSH and GSH-Px were significantly decreased （P<0.05，P<0.01）. The contents of AChE， IL-1β and TNF-α and the contents of MDA were significantly increased （P<0.05，P<0.01）. Compared with model group， the escape latency of rats in the in the low， medium and high dose groups of SMYZ prescription was significantly reduced （P<0.05，P<0.01）.The frequency of looking for a platform， the frequency of crossing the original platform and the percentage of swimming time in the original platform quadrant of the rats in the low， medium and high dose groups of SMYZ prescription increased significantly （P<0.05，P<0.01）. The content of AChE in high dose group were significantly reduced（P<0.01）， and the content of Ach in high dose group were significantly increased（P<0.05）， the rat serum IL-1β， TNF-α levels and MDA content were significantly reduced（P<0.05，P<0.01）. The GSH， SOD and GSH-Px levels were significantly increased （P<0.05，P<0.01）. Conclusion:SMYZ can improve the learning and memory ability of rats with vascular cognitive disorder caused by chronic cerebral ischemia caused by ligation of bilateral common carotid artery， bilateral common carotid artery ligation， improve the pathological morphology of hippocampal tissue， inhibit inflammatory response， improve cholinergic level and oxidative stress state.
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Objective: Oxidative stress appears to be an early event involved in the pathogenesis of Alzheimer's disease (AD). The present study was designed to investigate the neuroprotective effects of citrullus lanatus on bilateral common carotid artery occlusion (BCCAO) induced cognitive impairment and oxidative stress in Wistar albino rats. Methods: Cognitive impairment and oxidative stress were induced by BCCAO for 30 min, followed by 7 d reperfusion of male wistar rats. Morris water maze and rectangular maze performance tests and locomotor activity were used to assess memory performance tasks. To study the activity, rats weighing 250-300g were pre-treated with successive extracts of n-hexane fraction (HF), ethyl acetate fraction (EAF), ethanol fraction (EF) and aqueous fraction (AF) of 400 mg/kg, 200 mg/kg, p. o of each for 10 d and the treatment was continued for another 7 d after cerebral ischemia. Various biochemical parameters like lipid peroxidation, Catalase, DPPH and AchE were also estimated in the brain after the treatment. Results: There was significantly increased oxidative stress and cholinesterase activity with cognitive decline in the hippocampus in rats of BCCAO group as compared to sham-operated (p<0.05). The animals treated with Donepezil, HF and EF prevented the biochemical changes significantly (p<0.001) and there was significant (p<0.001) improvement in cognitive parameters compared to BCCAO treated rats. Conclusion: Thus present study indicates the neuroprotective effect of citrulus lanatus seed extract (HF and EF) against BCCAO induced cognitive impairment and associative oxidative damage.
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Background: Lichen planus is an idiopathic and chronic inflammatory disease that affects the skin and the mucous membranes, and has been associated with an increased risk for cardiovascular diseases. Hyperhomocysteinemia has been regarded as a risk factor for atherosclerosis and cardiovascular diseases. Increased plasma fibrinogen levels are also associated with increased risk of myocardial infarction. Objective: The main aim of this study is the evaluation of common carotid artery mean intima media wall thickness, serum fibrinogen and homocysteine levels in patients with lichen planus. Methods: Forty-three patients with lichen planus and 43 age, gender and body mass index (BMI) matched healthy controls (from general population without the disease) were included in this study. Results: Compared to the healthy controls, patients had statistically significant greater mean intima media wall thickness of the common carotid artery. Moreover, a positive correlation was observed between lichen planus and increased serum homocysteine and c-reactive protein levels. Limitations: The main limitation of this study is the small sample size due to the time limitation and financial constraints. Conclusion: Early diagnosis of atherosclerosis in patients with lichen planus might afford better prophylaxis, including weight control and/or lipid profile monitoring. Measurement of the mean intima media wall thickness of the common carotid artery by duplex high-resolution B-mode ultrasound scanning could be beneficial as a valuable method for early diagnosis of atherosclerosis in lichen planus.
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Oxiracetam (ORC) is a commonly used nootropic drug for improving cognition and memory impairments. The therapeutic effect and underlying mechanism of ORC in vascular dementia (VaD) treatment remain unknown. In this study, 3-month-old male Sprague-Dawley rats with permanent bilateral common carotid artery occlusion-induced VaD were treated orally with low (100 mg/kg) or high (200 mg/kg) dose ORC once a day for 4 weeks. The results of the Morris water maze test and Nissl staining showed that ORC treatment significantly alleviated learning and memory deficits and neuronal damage in rats with VaD. Mechanistically, the protein levels of a panel of genes associated with neuronal apoptosis (Bcl-2, Bax) and autophagy (microtubule-associated protein 1 chain 3, Beclin1, p62) were significantly altered by ORC treatment compared with VaD, suggesting a protective role of ORC against VaD-induced neuronal apoptosis and autophagy. Moreover, the Akt/mTOR pathway, which is known to be the upstream signaling governing apoptosis and autophagy, was found to be activated in ORC-treated rats, suggesting an involvement of Akt/mTOR activation in ORC-rendered protection in VaD rats. Taken together, this study demonstrated that ORC may alleviate learning and memory impairments and neuronal damage in VaD rats by altering the expression of apoptosis/autophagy-related genes and activation of the Akt/mTOR signaling pathway in neurons.
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Animals , Male , Rats , Pyrrolidines/administration & dosage , Dementia, Vascular/drug therapy , Signal Transduction/physiology , Neuroprotective Agents/administration & dosage , Proto-Oncogene Proteins c-akt/metabolism , Cognitive Dysfunction/drug therapy , Autophagy/drug effects , Dementia, Vascular/physiopathology , Dementia, Vascular/metabolism , Rats, Sprague-Dawley , Apoptosis/drug effects , Maze Learning/drug effects , Disease Models, Animal , TOR Serine-Threonine Kinases/metabolism , Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/metabolismABSTRACT
Background: The superior laryngeal artery (SLA) is the dominant arterial supply of the laryngeal muscles, mucosaand glands. Knowledge of variations in the origin of superior laryngeal artery will be very useful duringreconstructive surgeries of the larynx, partial laryngectomy, laryngeal transplantation, and also during procedureslike super-selective intra-arterial chemotherapy for laryngeal and hypolaryngeal cancers. However, relativelyfew studies have been done on the superior laryngeal artery in comparison to its clinical importance. Thepresent study was aimed at documenting the prevalence of variable origin of the superior laryngeal artery withinthe carotid triangle.Materials and methods: Seventy hemi-necks obtained from 35 cadavers were dissected and studied for variationsin the origin of superior laryngeal artery. Dissection method was employed for this study. The infrahyoid groupof muscles were identified and reflected. The sternocleidomastoid muscle and superior belly of omohyoid weredisplaced laterally. The fascia was removed from the lobes of the thyroid gland exposing its arteries and veins,studied the origin of STA and its branches, especially superior laryngeal artery.Results: It was observed that the superior laryngeal artery took origin from superior thyroid in 92.8% cases.Variable origin from the bifurcation of common carotid artery was noted in 4.28% cases. SLA was found to arisefrom the external carotid artery in 2.85% cases. All the variations that were observed were unilateral.Conclusion: These findings may provide further insight to the anatomists, radiologists and surgeons and canhelp improve performances during surgical manipulations of the larynx.
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Background: The common carotid artery (CCA) divides at the level of superior border of thyroid cartilage. Theexternal carotid artery (ECA) is one of the terminal branches of CCA. ECA gives three anterior branches, Superiorthyroid (STA), Lingual (LA) and Facial arteries (FA). Therefore the present study was carried out to describe thelevel of bifurcation of CCA, its relations with anatomical landmarks and the morphometry of anterior branchesof ECA in relation to bifurcation of CCA.Methods: The present study was carried on 30 sagittal head and neck sections. The level of bifurcation of CCAwas noted. The distances from CCA bifurcation to the superior border of thyroid cartilage (SBTC), angle ofmandible, ear lobule were measured. The ddistances of STA, LA & FA from CCA bifurcation were also measured.Results: In 16 (53.33%) cases the bifurcation of CCA was observed at the level of SBTC, 2 (6.67%)It was between SBTC and hyoid bone, in 5 (16.67%) below SBTC and in 6 (20%) at the level of hyoid bone. The meandistances from the bifurcation of CCA to the SBTC was 24 ± 0.95mm, to the angle of the mandible was 31 ± 0.86mmand to the ear lobule was 54.8 ± 0.96mm. The mean distances of STA, LA and FA from CCA bifurcation were 7.2 ± 0.2,12 ± 0.45 and 17.6 ± 0.48 cm respectively.Conclusion: The anatomical study of CCA is useful for angiographies, thyroid and head and neck surgeries. Incase of common trunks, stenosis or occlusion may cause severe ischemic consequences and prone toatherosclerosis.
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Carotid artery rupture during head and neck surgery is a catastrophic, life-threatening emergency. Although recent incidence has declined, it still occurs in many patients. Hemorrhage from the carotid artery is usually massive and uncontrollable. Fast, aggressive treatment to prevent hemodynamic instability is required. Even if patients survive this event, they may experience severe neurological sequelae. A ruptured carotid artery is usually controlled by direct compression and arterial ligation. However, apart from the inherent difficulty of operation, these traditional surgical treatments are associated with high morbidity and mortality. In the past two decades, endovascular management has become a mainstay of carotid rupture treatment. We report a case of successful recovery without any sequelae after cardiovascular collapse due to an unintentional common carotid artery (CCA) rupture during neck surgery. The exposed CCA was treated with a covered stent. In such a case, multidisciplinary cooperation is crucial.
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Humans , Anesthesia , Carotid Arteries , Carotid Artery, Common , Emergencies , Head , Hemodynamics , Hemorrhage , Incidence , Ligation , Mortality , Neck , Radiology, Interventional , Rupture , StentsABSTRACT
Objective To investigate the application of the cross-sectional area ratio of internal jugular vein and common carotid artery (IJV/CCA) in the evaluating the volume responsiveness of critically ill patients. Methods The capacity of critically ill patients were prospectively assessed. The diameter and sectional area of the IJV and CCA were measured by bedside ultrasonography. The cross-sectional area ratio of IJV/CCA was calculated and compared with the variety of cardiac output (ΔCO) after passive leg raising (PLR). Then the correlation index between the cross-sectional area ratio of IJV/CCA and ΔCO was evaluated, and the sensitivity and specificity parameters of capacity status were assessed by the cross-sectional area ratio of IJV/CCA. Results Of 55 critically ill patients in this study, 34 cases had positive volume responsiveness, and 21 case negative volume responsiveness.The general clinical data of the two groups had no statistically significant difference. The cross-sectional area ratio of IJV/CCA in the positive group was significantly less than that of the negative group (1.38±0.55 vs. 2.16±0.68, P<0.01). There was a significant correlation between the IJV/CCA cross-sectional area ratio and the ΔCO value of PLR (r=-0.67, P<0.01). When the ratio of the cross-sectional area of IJV/CCA was 1.65, the sensitivity of the assessment capacity was 86.4％ and the specificity was 78.8％. Conclusions The use of portable bedside ultrasonography is a noninvasive, convenient and reliable method to evaluate the capacity state of the critically ill patients.
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We report an unusual case of an 83-year-old man who was admitted with dizziness and repeated drop attacks. He was diagnosed with bilateral carotid artery occlusion and he underwent a left subclavian to left carotid bypass with ringed polytetrafluoroethylene graft. The patient's postoperative course was uneventful and no symptoms presented during a 6-month follow-up. Finally, we discuss on proper management of such patients.
Subject(s)
Aged, 80 and over , Humans , Carotid Arteries , Carotid Artery Diseases , Carotid Artery, Common , Carotid Artery, Internal , Dizziness , Follow-Up Studies , Pathology , Polytetrafluoroethylene , Syncope , Transplants , Vertebrobasilar InsufficiencyABSTRACT
Objective To investigate the effects of cornel iridoid glycoside (CIG) on the learning-memory ability and pathological changes in the brain of vascular dementia (VD) rats; To discuss relevant mechanism of action. Methods SD rats were randomly divided into sham-operation group, model group, positive medicine group, CIG groups low-, medium- and high-dose groups. The animal model of VD was replicated by permanent bilateral common carotid artery occlusion (2VO) in rats. Drugs were intragastrically administered 6 h after surgery and then once a day for 3 months. Morris water maze test was used to detect spatial learning-memory ability, and recognition memory was measured by the object recognition test. Immunohistochemical staining was used to detect the neuronal survival and the expression of choline acetyltransferase (ChAT) in the brain. Results Three months after permanent 2VO operation, the model rats showed a longer escape latency in Morris water maze, a lower discrimination index in the object recognition test, and a decrease in NeuN positive neuronal survival and ChAT expression in the hippocampus and cerebral cortex. Compared with the model group, intragastric administration of CIG for 3 months shortened the escape latency in Morris water maze, elevated the discrimination index in the object recognition test, and increased the NeuN positive neuronal survival in the hippocampus and cerebral cortex and ChAT expression of 2VO rats. Conclusion CIG can improve the cognitive impairment of VD model rats through protecting neurons and promoting ChAT expression.
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@#Rats after permanent bilateral common carotid artery ligation would result in cerebral blood flow reduction,learning and memory dysfunction,neuronal injury and death,synaptic and dendritic injury,and neuroinflammation,etc.,which repro-duce the pathology and clinical symptoms of human vascular dementia,that help for further research on pathophysiolo-gy and treatment of vascular dementia.
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Traumatic common carotid artery dissection (CCAD) is rare. To our knowledge, only 14 case reports have described traumatic CCAD previously. Here, we report a case of CCAD in a patient with severe trauma. A 50-year-old man was lying on the road after drinking alcohol when a car drove over him. Computed tomography (CT) revealed multiple rib fractures with hemopneumothorax, lung contusion, flail chest, large amount of hematoma with bladder rupture, and fractures on the C6 spinous process, sacral ala, iliac bone, and pubic ramus. Repair of the bladder rupture, exploratory thoracotomy, and open reduction of multiple rib fractures were performed. Right side hemiparesis was observed on hospital day 4. Brain CT showed a large acute left middle cerebral artery infarction. CT angiography showed focal carotid dissection at the left common carotid artery with intimal flap. The CCAD was located at the C6 level. Clexane (enoxaparin sodium) treatment was initiated. An abdominal CT scan revealed a huge retroperitoneal hematoma and increased amount of hematoma in the prevesical and perivesical space, 10 days later. The patient died two days later. Although traumatic CCAD is rare, this case report provides useful information for trauma surgeons regarding the treatment and diagnosis of similar cases.