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1.
Colomb. med ; 52(2): e4054807, Apr.-June 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1339730

ABSTRACT

Abstract Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. If the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock, urgent surgical intervention is indicated. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.


Resumen El trauma de la arteria carótida tiene una alta probabilidad de muerte y de secuelas neurológicas. El manejo quirúrgico es objeto de controversia porque se tiene que decidir entre reparar la arteria carótida o ligarla, para lo cual aún no existe un consenso. El objetivo de este artículo es proponer una nueva estrategia de manejo para el trauma de la arteria carótida con los principios de la cirugía de control de daños y el uso de técnicas como el reparo endovascular o el manejo conservador. La decisión de operar el paciente inmediatamente o realizar estudios imagenológicos dependerá del estado hemodinámico del paciente. Si el paciente presenta sangrado masivo, hematoma expansivo o choque hipovolémico refractario, una intervención quirúrgica urgente esta indicada. Un déficit del estado neurológico al ingreso es un marcador de mal pronóstico en estos casos e influye en la toma de decisiones. Se describe el paso a paso del reparo vascular abierto y se incluye las estrategias de manejo tanto endovasculares como abiertas. Adicionalmente, el manejo conservador también ha sido incluido como una estrategia viable en pacientes seleccionados, evitando cirugías innecesarias.

2.
Rev. colomb. cir ; 36(3): 421-426, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1253955

ABSTRACT

Introducción. La mayoría de las lesiones de carótida cervical en nuestra institución se manejan por vía endovascular. El objetivo de este estudio fue describir los desenlaces del manejo de las lesiones de carótida cervical en un hospital de cuarto nivel en la ciudad de Cali, Colombia. Métodos. Estudio de series de casos, retrospectivo, descriptivo, en pacientes con trauma de carótida (penetrante y cerrado), admitidos en un centro de alta complejidad de la ciudad de Cali, en el periodo comprendido desde enero de 2018 hasta enero de 2020. Resultados. Se evaluaron 20 pacientes con lesión de carótida, de los cuales 90 % tenía trauma penetrante, en su mayoría por proyectil de arma de fuego. La zona más frecuentemente afectada fue la carótida interna (65 %) y el 40 % de los pacientes presentaban síntomas neurológicos al ingreso. Se realizó manejo endovascular en 13 pacientes, con un 75 % de éxito en el manejo endovascular al ingreso. La mortalidad general fue del 20 %, que en su mayoría estuvo relacionada con traumatismo en otros órganos. El 69 % de los pacientes quedaron sin secuelas neurológicas al alta y el 25 % con secuelas mínimas. Discusión. Se muestra una serie de casos con lesión de carótida donde, teniendo en cuenta las variables de mal pronóstico para hacer una selección adecuada de los pacientes candidatos a este tipo de terapia, el resultado del manejo endovascular fue exitoso


Introduction. Most cervical carotid injuries in our institution are managed by endovascular approach. The objective of this study was to describe the outcomes of the endovascular management of cervical carotid lesions in at a I Level Trauma Center in Cali, Colombia. Methods. Retrospective, descriptive case series study in patients with both penetrating and blunt carotid trauma who were admitted to a I Level Trauma Center between January 2018 and January 2020. Results. Twenty patients with carotid injury were evaluated, of which 90% had penetrating trauma, mostly from a firearm projectile. The most frequently affected area was the internal carotid (65%) and 40% of the patients had neurological symptoms on admission. Endovascular management was performed in 13 patients, with a 75% success rate in endovascular management on admission. Overall mortality was 20%, most of which was related to trauma to other organs; 69% of the patients were left without neurological sequelae at discharge and 25% with minimal sequelae.Discussion. We describe a case series of patients with cervical carotid injury, taking into account the variables of poor prognosis to make an adequate selection of patients for endovascular management, the result of endovascular management was successful


Subject(s)
Humans , Carotid Artery Injuries , Endovascular Procedures , Wounds and Injuries , Multiple Trauma , Angiography , Embolization, Therapeutic
3.
Chinese Journal of Trauma ; (12): 162-168, 2019.
Article in Chinese | WPRIM | ID: wpr-745036

ABSTRACT

Objective To construct a three-dimensional finite element model to investigate the biomechanical mechanism of carotid blast injuries.Methods Based on the head and neck CT angiography data of a healthy male volunteer,the 3D geometric model was extracted by Mimics software.The 3D solid model was obtained by fitting the geometric model to the non-uniform rational B-splines (NURBS) by Geomagic Studio software.The mesh of blood vessels,blood and soft tissue was divided by HyperMesh software to obtain the three-dimensional finite element model of the carotid artery.The material parameters and boundary conditions were set,and the vessel wall rupture damage threshold was 1 MPa.The dynamic process of carotid injury caused by MK3A2 grenade explosion shock wave at the distance of 60,70 and 80 cm to the neck was simulated using the LS-DYNA,generating the shock waveform and peak overpressure.The stress cloud map was used to analyze the stress distribution and damage morphology,and the stress curve was used to analyze the mechanical changes.Results The peak values of shock wave overpressure were 0.45,0.63 and 0.96 MPa at the distance of 80,70 and 60 cm away from the explosion center,respectively.At 80 cm,the peak stress of vessel wall was 0.43 MPa,and the vessel wall was not ruptured;at 70 cm,the peak stress of anonyma was greater than 1 MPa,which resulted in small rupture;at 60 cm,the peak stress of both anonyma the ascending aorta were greater than 1 MPa,leading to obvious rupture.The root part of the common carotid artery,anonyma and the arch of the aorta were high stress concentration areas,manifested as high-prevalence areas of damage and rupture.Conclusions The finite element model of explosive carotid artery injury is successfully constructed,which can be used to analyze the mechanical response and damage mechanism of carotid blast injuries.The main cause of injury and rupture is that the sudden change of stress in the process of explosion shock reaches or exceeds the threshold of vascular wall injury.Carotid artery rupture will occur when the vessel wall stress peak is greater than 1 MPa at 60 and 70 cm away from the explosion center,providing references for the clinical treatment and injury prevention.

4.
Article in English | WPRIM | ID: wpr-762011

ABSTRACT

An iatrogenic internal carotid artery (ICA) pseudoaneurysm is an extremely rare complication of cervical spine surgery. Here we report an extraordinary case of massive hematemesis due to a ruptured ICA pseudoaneurysm caused by the laminoplasty plate 10 years after cervical spine surgery. Computed tomography angiography revealed a ruptured 4×10-mm left extracranial ICA pseudoaneurysm probably connected to the pharynx. Emergent surgery was performed because of the uncontrolled massive bleeding. After complete resection of the injured segment, an interposition graft with a 6-mm polytetrafluoroethylene graft was placed and the fistula tract to the pharynx was repaired.


Subject(s)
Aneurysm, False , Angiography , Carotid Artery, Internal , Fistula , Hematemesis , Hemorrhage , Laminoplasty , Pharynx , Polytetrafluoroethylene , Spine , Transplants
5.
Rev. neuropsiquiatr ; 80(2): 137-143, abr. 2017. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-991466

ABSTRACT

La fistula carótido-cavernosa es una comunicación anómala entre la arteria carótida y el seno cavernoso que provoca un shunt arteriovenoso patológico y cuyo origen es traumático o espontáneo. Las manifestaciones clínicas están relacionadas con el cambio de dirección del drenaje venoso y del flujo sanguíneo a través de la fístula e incluyen síntomas oculares tales como quemosis, exoftalmos y soplo orbitario, además de manifestaciones neurológicas como infartos venosos y hemorragias intracerebrales. Su presencia se confirma mediante la angiografía por sustracción digital (ASD) y la clasificación generalmente aceptada se basa en la propuesta por Barrow. El tratamiento endovascular ha sido el enfoque terapéutico preferido durante las últimas dos décadas; sin embargo, el tratamiento quirúrgico sigue siendo una opción cuando aquél falla o no está disponible. Se reporta el caso de una paciente de 71 años de edad, con antecedente de traumatismo cráneo-encefálico en la que se diagnósticó fístula carótido-cavernosa izquierda y síntomas neuro-oftalmológicos bilaterales asociados a un infarto venoso a nivel temporal izquierdo. La paciente fue intervenida quirúrgicamente y presentó una evolución clínica favorable.


The carotid-cavernous fistula is an abnormal communication between the carotid artery and the cavernous sinus that induces a pathological arterio-venous shunt, and whose origin may be traumatic or spontaneous. Its clinical symptoms are related to changes in the direction of the venous drainage and blood flow through the fistula, and include ocular symptoms as chemosis, exophthalmos and orbital murmur besides neurological manifestations such as venous infarctions and intracerebral hemorrhage. Its presence is confirmed by digital subtraction angiography and the generally accepted classification is based on Barrow'se proposal. Endovascular treatment has been the preferred treatment approach for the past two decades; however, surgical treatment remains an option when the former fails or is not possible. The case of a 71 year-old woman with a history of traumatic brain injury is reported: the patient was diagnosed with carotid-cavernous fistula and bilateral neuro-ophthalmic symptoms associated with left temporal venous infarction, and underwent surgical treatment with a favorable clinical outcome.

6.
Rev. Col. Bras. Cir ; 44(1): 46-53, Jan.-Feb. 2017. graf
Article in English | LILACS | ID: biblio-842645

ABSTRACT

ABSTRACT Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. Methods: we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF) undergoing endovascular treatment. Results: we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction.


RESUMO Objetivo: avaliar o tratamento endovascular de lesões vasculares da artéria carótida interna (ACI), segmento cavernoso, realizado na Santa Casa de São Paulo. Métodos: estudo descritivo, retrospectivo e prospectivo, de pacientes com aneurisma da porção cavernosa da ACI ou com fístulas carótido-cavernosas diretas (FCCd) submetidos a tratamento endovascular. Resultados: foram incluídos 26 pacientes com aneurismas intracavernosos e dez com FCCd. Todos os aneurismas foram tratados com oclusão da ACI. Os com FCCd foram tratados com oclusão, em sete casos, e com oclusão seletiva da fístula nos outros três. Houve melhora da dor e proptose ocular em todos os pacientes com FCCd. Nos pacientes com aneurisma intracavernoso, a incidência de dor retro-orbitária caiu de 84,6% para 30,8% após o tratamento. Após o tratamento endovascular houve uma melhora importante da disfunção de nervos cranianos afetados em ambos os grupos, sobretudo no nervo oculomotor. Conclusão: o tratamento endovascular trouxe melhora para os pacientes deste estudo, especialmente nos critérios dor e acometimento do nervo oculomotor.


Subject(s)
Humans , Male , Female , Adult , Carotid-Cavernous Sinus Fistula/surgery , Endovascular Procedures , Retrospective Studies , Carotid-Cavernous Sinus Fistula/complications , Middle Aged
7.
Article in Chinese | WPRIM | ID: wpr-808363

ABSTRACT

Objective@#To summarize our experience in the diagnosis of internal carotid artery trauma in patients with traumatic optic neuropathy, and to make recommendations for the treatment.@*Methods@#The clinic data of 6 cases who had traumatic optic neuropathy with internal carotid artery trauma and who were admited in Department of Otorhinolaryngology, the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University from Jan. 2013 to Dec. 2015 were analyzed retrospectively.@*Results@#All 6 cases were monocular blindness. Four cases did not undergo nasal endoscopic optic nerve decompression because of the diagnoses of internal carotid artery trauma. One case was diagnosed after nasal endoscopic optic nerve decompression because of fatal bleeding during the operation. One case was diagnosed because of late-onset recurrent epistaxis. Among the 6 cases with internal carotid artery trauma, 3 cases were successfully treated with endovascular interventional treatment (stent embolization was used in one case, Coil embolization was used in two cases), and 3 patients refused treatment.@*Conclusions@#The patients with traumatic optic neuropathy have the possibility of severe carotid artery trauma. Endoscopic optic nerve decompression is not suitable for these cases. It should pay more attention to patients with traumatic optic neuropathy. For suspected cases, vascular-enhanced computed tomography screening and digital subtraction angiography should be recommended and patients should be treated by endovascular intervention in a timely manner.

8.
Article in English | WPRIM | ID: wpr-106733

ABSTRACT

Carotid artery dissection is a significant cause of stroke in young patients. It may be asymptomatic and go undiagnosed, or minimal transient manifestations may follow, commanding a higher index of suspicion than ordinarily exists to avoid misdiagnosis. Reported herein is a 27-year-old man who suffered extracranial internal carotid artery dissection while practicing a Brazilian Jiu-Jitsu submission maneuver. The patient's condition suddenly deteriorated one week later due to distal embolization and stroke. Despite endovascular treatment, with stenting of the cervical carotid artery, neurologic deficits remained. Of note, the objective in martial arts, which is to kill or incapacitate, has yet to be fully tempered in transitioning to sport. Brazilian Jiu-jitsu, a relatively new and fast-growing form of martial art, places emphasis on submission maneuvers. Related injuries are not common knowledge and are poorly described in the literature. This account is intended to shed light on the risk of this discipline. Through education and improved supervision, vascular injuries of this nature and the potentially lethal or disabling consequences may thus be prevented in young athletes.


Subject(s)
Adult , Athletes , Carotid Arteries , Carotid Artery Injuries , Carotid Artery, Internal , Carotid Artery, Internal, Dissection , Diagnostic Errors , Education , Humans , Martial Arts , Neurologic Manifestations , Organization and Administration , Sports , Stents , Stroke , Vascular System Injuries
9.
Rev. Assoc. Med. Bras. (1992) ; 62(1): 78-84, Jan.-Feb. 2016. graf
Article in English | LILACS | ID: lil-777443

ABSTRACT

SUMMARY Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.


RESUMO As fístulas carotidocavernosas (FCC) são comunicações anormais entre a artéria carótida e o seio cavernoso. Elas são consideradas diretas quando há uma comunicação direta entre a artéria carótida interna e o seio cavernoso. Nesses casos, são geralmente traumáticas. As FCC diretas são lesões de alto fluxo, podendo estar relacionadas a sangramento intracraniano, perda visual, exposição corneana ou até mesmo a epistaxe fatal. Seu tratamento é sempre indicado. O tratamento ideal da FCC direta é a exclusão da fístula da circulação, com preservação do fluxo carotídeo. Isso pode ser obtido por meio de técnicas endovasculares diversas. O objetivo do presente artigo é realizar uma revisão sobre as FCC diretas, com especial enfoque nas opções de tratamento endovascular disponíveis na atualidade.


Subject(s)
Humans , Carotid Artery, Internal/surgery , Carotid-Cavernous Sinus Fistula/surgery , Endovascular Procedures/methods , Angiography/methods , Carotid-Cavernous Sinus Fistula/diagnosis , Balloon Occlusion/methods , Endovascular Procedures/trends
10.
Tianjin Medical Journal ; (12): 1221-1224, 2016.
Article in Chinese | WPRIM | ID: wpr-504038

ABSTRACT

Objective To evaluate the effects of geraniol(GOH) on neointima hyperplasia in rat carotid artery balloon injury model, and explore the potential molecular mechanisms associated with this effect. Methods Totally 20 male Sprague-Dawley (SD) rats were randomly divided into sham operation group (without balloon injury), control group (with balloon injury), low concentration group (with 50 mg/kg GOH intervention after balloon injury) and high concentration group (with 200 mg/kg GOH intervention after balloon injury). The intima to media (I/M) area ratio of neointima was measured by hematoxylin- eosin (HE) staining. The expression of proliferating cell nuclear antigen (PCNA) was measured by immunohistochemical staining at 14th day after operation. As the marker of oxidative stress, the levels of 8-hydroxy-2’-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) were measured by enzyme linked inmmnosorbent assay (ELISA). Results The I/M ratio, IOD, 8-OHdG and MDA values were increased in control group compared with those of sham group. The I/M ratio, IOD and 8-OHdG values were reduced in low concentration group compared with those of control group. But there was no significant difference in MDA level between low concentration group and control group. The I/M ratio, IOD, 8-OHdG and MDA values were significantly reduced in high concentration group compared with those of control group, which showed a more significant inhibitory effect than that of low concentration group (P<0.05). Conclusion GOH could attenuate balloon iniury induced neointima hyperplasia, which might be related to its effect on inhibiting expression of PCNA and decreasing oxidative stress.

11.
Tianjin Medical Journal ; (12): 158-161, 2015.
Article in Chinese | WPRIM | ID: wpr-461204

ABSTRACT

Objective To investigate the effect and mechanism of Imatinib mesilate (Imatinib) on intimal hyperplasia of rabbit carotid arteries after balloon injury. Methods Thirty adult Newzealand rabbits were randomly divided into three groups:group A, B and C. Their right carotid arteries were injuried then administered with 0, 25 or 50 mg/kg of Imatinib dai?ly for 14 consecutive days when the rabbits were sacrificed. The carotid arteries were harvested and sectioned for HE-stain?ing and immunohistochemisty staining. Real-Time PCR was used to examine transcription levels of PDGF-B and PDGFR-βmRNA. The plasma level of PDGF-BB was assayed by ELISA. Results Arterial intimal hyperplasia and stenosis following balloon injury were seen in three groups. Thickness and area of neointima, ratio of thickness of intima to media, ratio of area of intima to media and mRNA level of PDGF-β are all higher in group A than those in group B than those in group C (P<0.01). By contrast, the mRNA transcription level of PDGFR-β increased significantly in group C than that in group A (1.236±0.356 vs 0.708±0.372;t=2.91;P<0.01). Plasma level of PDGF-BB increased in all three groups after balloon injury than that in the baseline (P<0.01). The transcription level of PDGF-BB is higher in group A than that in group B and in group C (ng/L:23.464±3.542, 19.504±2.454, 16.588±1.207, F=17.322, P<0.05). There was no difference between group B and C. There was positive correlation between mRNA transcription level of PDGF-B and plasma level of PDGF-BB ( r=0.806, P<0.01). Conclusion Vascular injury can cause intimal hyperplasia and increased PDGF-B mRNA transcription. Imatinib mesilate could inhibit the intimal hyperplasia through down regulating PDGF-B mRNA transcription.

12.
Article in English | WPRIM | ID: wpr-205917

ABSTRACT

Perfusion study should be preoperatively required for the trapping of an internal carotid artery (ICA) in the traumatic pseudoaneurysm in the petrous ICA. A 23-year-old man was admitted with a semicomatose consciousness after a passenger traffic accident. A fracture on the right petrous apex and a pseudoaneurysm in the right petrous ICA was found in the brain computed tomography (CT) angiogram. The size of aneurysm grew in the catheter angiogram at the 3rd day of trauma. One-day protocol of brain single photon emission CT (SPECT), which the first scan with 20 mCi of technetium-99m-ethyl cysteinate diethylester ((99m)Tc-ECD) and the second scan with 40 mCi in double dose at 15 minutes during the balloon test occlusion (BTO) at the same day, was done for the perfusion evaluation before trapping the right ICA. Perfusion asymmetry was aggravated of 21% at the post-occlusion scan in the right frontal cortex. So, he got a superficial temporal artery-middle cerebral artery anastomosis and then ICA trapping. After the surgery, he recovered consciousness and went back to his normal life. He has not developed new neurologic symptom for 8 years. Brain SPECT with double-dose injection of (99m)Tc-ECD may be a useful tool to be performed with BTO.


Subject(s)
Accidents, Traffic , Aneurysm , Aneurysm, False , Brain , Carotid Artery Injuries , Carotid Artery, Internal , Catheters , Cerebral Arteries , Consciousness , Humans , Neurologic Manifestations , Perfusion , Tomography, Emission-Computed, Single-Photon , Young Adult
14.
Article in English | WPRIM | ID: wpr-32509

ABSTRACT

Traumatic intracranial pseudoaneurysms occurring after blunt head injuries are rare. We report an unusual case of subarachnoid hemorrhage (SAH) caused by rupturing of the traumatic pseudoaneurysm of the internal carotid artery (ICA) bifurcation that resulted from a non-penetrating injury. In a patient with severe headache and SAH in the right sylvian cistern, which developed within 7 days after a blunt-force head injury, a trans-femoral cerebral angiogram (TFCA) showed aneurysmal sac which was insufficient to confirm the pseudoaneurysm. We obtained a multi-slab image of three dimensional time of flight (TOF) of magnetic resonance angiography (MRA). The source image of the gadolinium-enhanced MRA revealed an intimal flap within the intracranial ICA bifurcation, providing a clue for the diagnosis of a dissecting pseudoaneurysm at the ICA bifurcation due to blunt head trauma. We performed direct aneurysmal neck clipping, without neurological deficit. A follow-up TFCA did not show either aneurysm sac or luminal narrowing. We suggest that in the patient with a history of blunt head injury with SAH following shortly, multi-slab image of 3D TOF MRA can give visualization of the presence of a pseudoaneurysm.


Subject(s)
Aneurysm , Aneurysm, False , Carotid Artery Injuries , Carotid Artery, Internal , Craniocerebral Trauma , Diagnosis , Follow-Up Studies , Head Injuries, Closed , Headache , Humans , Magnetic Resonance Angiography , Neck , Phenobarbital , Subarachnoid Hemorrhage
15.
Article in English | WPRIM | ID: wpr-32508

ABSTRACT

Intracranial traumatic pseudoaneurysms are rare, and their vessel structures are immature and easy to disrupt, especially in children. Furthermore, it is difficult to diagnose and treat, which is a characteristic of traumatic pseudoaneurysm. In this study, the authors described a traumatic pseudoaneurysm in A2 segment of anterior cerebral artery, and the treatment with stent for structural stability of vessel.


Subject(s)
Aneurysm, False , Anterior Cerebral Artery , Carotid Artery Injuries , Child , Humans , Intracranial Aneurysm , Stents
16.
Chinese Journal of Geriatrics ; (12): 996-1000, 2013.
Article in Chinese | WPRIM | ID: wpr-442382

ABSTRACT

Objective To investigate the effect of transplantation of CXC receptor 4 (CXCR4)gene-modified bone marrow mesenchymal stem cells (BMSCs) on repairment of carotid injure in rats.Methods BMSCs were cultured and transfected with lentivirus vector carrying CXCR4 gene to generate CXCR4 gene-modified BMSCs (CXCR4-BMSCs).CXCR4 expression was detected by Western blot.Rat model of carotid artery balloon injury was established.Rats were randomly divided into the PBS control group (n=12),CXCR4-BMSCs group (n=12) and BMSCs group (n=12).Two weeks after transplantation,the injured arteries were obtained.The homing of BMSCs was detected by immunofluorescence with green fluorescent protein (GFP).Platelet endothelial cell adhesion molecule (CD31) expression was detected by immunofluorescence staining.At 4 weeks after transplantation,proliferating cell nuclear antigen (PCNA) expression was determined by immunohistochemical staining,and the vascular morphological changes were observed by hematoxylineosin staining (HE).Results Compared with the control and BMSCs groups,the protein level of CXCR4 was increased in CXCR4-BMSCs group (both P<0.05).The percentage of GFP-positive cells homing were much more in CXCR4-BMSCs group than in BMSCs group [(58.8±4.4)% vs.(36.2±5.0) %,P<0.05].The CD31 expression were higher in CXCR4-BMSCs group than in BMSCs group [(58.8±4.3)% vs.(28.8±4.2)%,P<0.05].Compared to the control group,the PCNA expression was decreased in CXCR4-BMSCs and BMSCs groups [(21.0±4.2) %,(36.5±4.9) %vs.(78.3±3.5) %,both P<0.05].There was a significant difference in PCNA expression between the CXCR4-BMSCsgroupandBMSCs group [(21.0±4.2)%vs.(36.5±4.9)%,P<0.05].The neointimal area and the ratio of neointimal/medial area were decreased in CXCR4 BMSCs and BMSCs group as compared with the control group [(0.205±0.018) mm2,(0.323±0.071) mm2 vs.(0.536 ± ±0.054) mm2; (1.039±0.123),(1.660±0.404) vs.(2.460±0.328); all P<0.05],and there were significant differences in neointimal area and the ratio of neointimal/medial area in CXCR4-BMSCs group and BMSCs group [[(0.205±0.018) mm2 vs.(0.323±0.071) mm2,(1.039±0.123)vs.(1.660±0.404),both P<0.05].Conclusions CXCR4 gene-modified BMSCs may increase the CXCR4 expression in BMSCs.CXCR4-BMSCs transplantation is more effective than BMSCs transplantation in increasing BMSCs homing capacity,reducing the reendothelialization and vascular restenosis.

17.
Article in Korean | WPRIM | ID: wpr-138335

ABSTRACT

PURPOSE: Carotid artery injuries are common complications during catheterization of the internal jugular vein. To increase successful catheterization, the best position for the reduction of carotid artery injuries was determined. Unlike a previous study, only critically ill patients who needed central venous catheterization in an emergency medical center were included. Three maneuvers were evaluated: Trendelenburg position, head rotation, and adjustments according to ultrasound probe level. METHODS: Eight positions were tested in each patient. The positions were classified by maneuver and ultrasound images of each position were stored. Two factors were determined at each position: "safety width" (the part of the internal jugular vein that did not overlap with the carotid artery) and "overlap width" (the part of the internal jugular vein that did overlap with the carotid artery). RESULTS: Compared with the neutral bed position, safety widths were significantly larger in the Trendelenburg position, and there were no statistical difference in overlap widths. Compared with the non-head rotation position, safety widths were smaller and overlap widths were significantly larger in the 45degrees head rotation positions. Safety widths did-not statistically change safter adjustments for ultrasound probe level. However, changing the ultrasound probe level from the base of Sedillot's triangle to thyroid cartilage significantly decreased overlap widths. Overall, The group of Trendeleberg position, with non-head rotation, whose ultrasound probe level was thyroid cartilage had largest safety widths among 8 groups. CONCLUSION: Among the eight positions tested, the Trendelenburg position (with limited head rotation and adjustments for ultrasound probe level) can reduce carotid artery injuries and increase the successful catheterization of the jugular vein in critically ill patients.


Subject(s)
Carotid Artery Injuries , Catheterization , Catheterization, Central Venous , Catheters , Central Venous Catheters , Critical Illness , Emergencies , Head , Head-Down Tilt , Humans , Jugular Veins , Prospective Studies , Thyroid Cartilage , Ultrasonography
18.
Article in Korean | WPRIM | ID: wpr-138334

ABSTRACT

PURPOSE: Carotid artery injuries are common complications during catheterization of the internal jugular vein. To increase successful catheterization, the best position for the reduction of carotid artery injuries was determined. Unlike a previous study, only critically ill patients who needed central venous catheterization in an emergency medical center were included. Three maneuvers were evaluated: Trendelenburg position, head rotation, and adjustments according to ultrasound probe level. METHODS: Eight positions were tested in each patient. The positions were classified by maneuver and ultrasound images of each position were stored. Two factors were determined at each position: "safety width" (the part of the internal jugular vein that did not overlap with the carotid artery) and "overlap width" (the part of the internal jugular vein that did overlap with the carotid artery). RESULTS: Compared with the neutral bed position, safety widths were significantly larger in the Trendelenburg position, and there were no statistical difference in overlap widths. Compared with the non-head rotation position, safety widths were smaller and overlap widths were significantly larger in the 45degrees head rotation positions. Safety widths did-not statistically change safter adjustments for ultrasound probe level. However, changing the ultrasound probe level from the base of Sedillot's triangle to thyroid cartilage significantly decreased overlap widths. Overall, The group of Trendeleberg position, with non-head rotation, whose ultrasound probe level was thyroid cartilage had largest safety widths among 8 groups. CONCLUSION: Among the eight positions tested, the Trendelenburg position (with limited head rotation and adjustments for ultrasound probe level) can reduce carotid artery injuries and increase the successful catheterization of the jugular vein in critically ill patients.


Subject(s)
Carotid Artery Injuries , Catheterization , Catheterization, Central Venous , Catheters , Central Venous Catheters , Critical Illness , Emergencies , Head , Head-Down Tilt , Humans , Jugular Veins , Prospective Studies , Thyroid Cartilage , Ultrasonography
19.
Rev. chil. neurocir ; 38(2): 147-150, dic. 2012. ilus
Article in English | LILACS | ID: lil-716552

ABSTRACT

Lesiones accidentales de la arteria carótida son complicaciones poco frecuentes de diversos procedimientos diagnósticos y terapéuticos. Representan una condición grave y potencialmente mortal si el tratamiento no se realiza adecuadamente. Un paciente de sexo femenino, 45 años de edad, que ingresó en el servicio de Otorrinolaringología con queja de la disminución de la agudeza auditiva y acúfenos en el oído izquierdo. La resonancia magnética encefálica mostro una formación expansiva / infiltrativa a comprometer desde la nasofaringe izquierda hasta la base del cráneo, con la participación de la arteria carótida interna (ACI) en el mismo lado en su segmento petroso. Durante el procedimiento de biopsia, se produjo una laceración en la carótida derecha intracavernosa con sangrado abundante. Se realizó un taponamiento local y el paciente fue remitido a la angiografía cerebral que mostró un seudoaneurisma en la arteria carótida interna derecha en su segmento cavernoso. Después de una prueba de oclusión, la ACI derecha fue ocluida por 2 globos. Tres semanas después, el estado del paciente mostró empeoramiento progresivo de la agudeza visual, proptosis ocular, hiperemia conjuntival y la restricción del movimiento ocular en el ojo derecho. Una nueva angiografía fue realizada y mostró la persistencia de la oclusión de la ACI en su origen y un seudoaneurisma asociado con fístula carótido-cavernosa derecha, que se opacificado después de la inyección de contraste en la ACI izquierda, a través de la arteria comunicante anterior. El paciente fue sometido a un nuevo tratamiento endovascular con resolución de la lesión. Laceración de ACI durante la cirugía transesfenoidal es una complicación rara y potencialmente fatal. La prevención es el mejor tratamiento para cualquier lesión accidental. La utilización de técnicas endovasculares ha permitido para el tratamiento satisfactorio de esta condición.


Accidental carotid artery lesions are uncommon complications from diverse diagnostic and therapeutic procedures. It represents a grave and potentially lethal condition if treatment is not adequately performed. A female patient, 45 years old, who was admitted to the Otolaryngology service complaining of diminished auditory acuity and tinnitus in the left ear. The encephalic magnetic resonance imaging (MRI) showed an expansive/infiltrative formation compromising the left nasopharynx to the skull base, involving the ipsilateral internal carotid artery (ICA) in its petrous segment. During the biopsy procedure, there was a right intracavernous ICA laceration with copious bleeding. A local tamponade was performed and the patient was referred to cerebral angiography (CAG), which showed a right ICA pseudoaneurysm in its intracavernous segment. After a balloon occlusion test, the right ICA was occluded by 2 balloons. Three weeks after, the patient’s condition showed progressive worsening of visual acuity, occular proptosis, conjuctival hyperemia and occular movement restriction in the right eye. A new CAG was performed and showed persistence in the right ICA occlusion in its origin and an intracavernous pseudoaneurysm associated with ipsilateral carotidcavernous fistula, which became opacified after contrast injection in left ICA, through the anterior communicating artery. The patient was submitted to a new endovascular treatment with lesion resolution. ICA laceration during transsphenoidal surgery is a rare and potentially fatal complication. The prevention is the best treatment for any accidental lesion. Utilization of endovascular techniques has allowed for satisfactory treatment of this condition.


Subject(s)
Humans , Female , Middle Aged , Carotid-Cavernous Sinus Fistula , Carotid Artery Injuries/complications , Carotid Artery Injuries/diagnosis , Carotid Artery Injuries/mortality , Carotid Artery Injuries/therapy , Skull Base Neoplasms/complications , Endovascular Procedures/methods , Sphenoid Sinus/surgery , Diagnostic Imaging
20.
Article in Korean | WPRIM | ID: wpr-141509

ABSTRACT

PURPOSE: The aim of this study was to evaluate the effect of head rotation and leg elevation as it impacts the depth from the skin surface to the internal jugular vein (IJV), the diameter of the IJV, and the relative anatomical location of the IJV to the carotid artery (CA). METHODS: A total of 20 volunteers were enrolled in this study. In a supine position with/without 30degrees head rotation to the left, and with/without 30degrees leg elevation, the depth from skin surface to IJV, the IJV diameters, and the anatomical relationship between IJV and CA were measured using 2-dimensional ultrasound from the right side of the neck. The relative position of the IJV to the CA was depicted as an angle ranging from -180degrees to +180degrees. The measurements observed in each position were compared. RESULTS: As the head was rotated to the left, the depth of the IJV from the skin surface decreased and the anteroposterior IJV diameter increased significantly (all p<0.001). The relative position of the IJV to the CA tended to move in an anterior and medial direction during head rotation. Leg elevation had a significant impact on the transverse diameter of the IJV, but only when the head was rotated (p=0.027). With leg elevation, there was no consistent locational change of the IJV relative to the carotid artery, and there were no significant changes observed for IJV depth relative to the surface of the skin or IJV anteroposterior diameter. CONCLUSION: Our results indicated that head rotation increases the risk of carotid artery puncture by increasing the overlap of the carotid artery and the IJV. To decrease the risk of carotid artery puncture, a neutral head position should be maintained during IJV catheterization, with a central approach.


Subject(s)
Carotid Arteries , Carotid Artery Injuries , Catheterization , Catheterization, Central Venous , Catheters , Head , Jugular Veins , Leg , Neck , Punctures , Skin , Supine Position
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