Platelet aggregability in patients with common carotid artery ligation

Increased platelet aggregability is regarded as being a sensitive indicator of the initiation of thrombotic processes. Platelet aggregation was analysed in blood taken from the common carotid artery before and 30 min after its ligation in 3 patients, as well as in the venous blood of 14 patients in the late postoperative period. No tendency towards increasing platelet aggregation was observed in either of the groups investigated.     

Ultrasound evaluation of extracranial carotid artery lesions in Parkinsonian patients

The purpose of this investigation was to determine the atherosclerotic changes in patients with vascular parkinsonism and in patients with idiopathic Parkinson's disease, in order to evaluate the possible influence of the extracranial pathology of carotid arteries in developing lacunar cerebral infarcts. Degree of stenosis and plaque morphology of the extracranial part of carotids in both group of patients were evaluated by color Doppler flow imaging ultrasound investigation and the results were compared. We selected two matched groups of patients with parkinsonism: 22 patients with vascular parkinsonism, and 28 with idiopathic Parkinson's disease.The atherosclerotic changes found in patients with Parkinson's disease showed mild carotid lesions with mostly stable calcified plaques and lesser risk for embolic cerebral intravascular events contrary to the higher degree of carotid stenosis found in patients with vascular parkinsonism with mostly mixed plaques prone to embolization. Therefore, we suggest performing ultrasonographic examination of the extracranial part of carotid arteries in all patients with parkinsonism to assess risk of vascular accidents originating from carotid lesions. That would enable adequate treatment of parkinsonism and prevent further occurrence of intracranial vascular changes.     

Stenotic occlusive lesions of internal carotid artery in diabetic patients

Diabetes deteriorates atherosclerotic changes in the arteries. The aim of the study was to assess the prevalence and localization of stenotic atherosclerotic lesions of the internal carotid artery (ICA) in patients with diabetes. A prospective analysis of angiography findings was carried out in 150 diabetic and 150 non-diabetic patients with symptoms of cerebral ischemia using double-blind angiogram readings by two independent investigators. The degree of stenosis was determined using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Stenoses of the proximal arterial segment accounted for the majority of extracranial ICA stenoses, being more frequent in diabetic (left ICA 50.7%, right ICA 58.0%) than in the non-diabetic patients (left ICA 29.3%, right ICA 32.7%). Diabetic patients revealed a more significant rate of unilateral tandem ICA stenoses (14.0-21.3%), as well as a statistically significantly higher prevalence of intracranial ICA stenoses (left ICA 24.0% and right ICA 17.3%) than did non-diabetic patients (left and right ICA 3.3% each). Our results confirm that there is a morphological basis in ICA for increased incidence of ICA lesions in patients with diabetes as compared to those without it. Data on the incidence of stenotic ICA lesions in diabetes suggest the importance of assessing overall ICA status using digital subtraction angiography. Such an assessment is a precondition for an optimal therapeutic approach, especially in diabetic patients who are at an increased risk of cerebrovascular disease.     

Microbiological monitoring in prophylaxis and treatment of pyoinflammatory complications during early postoperative period in patients with cicatricial tracheostenosis]

The species composition and antibiotic susceptibility of microflora isolated from patients with cicatricial tracheostenosis (CTS) and infectious processes were investigated. Schemes for the treatment of CTS with an account of the pathogen species and multidrug resistant staphylococcal infection are described. Comparative efficacy of the combined schemes (antibiotic + bacteriophage) for the therapy of pyoinflammatory processes in the patients with CTS and the efficacy of the treatment of the patients with CTS according to the traditional antibacterial schemes were studied.     

Comparison between carotid stenting and carotid endarterectomy in early outcome

Carotid artery stenting (CAS) is a widely used method in prevention of stroke for carotid artery stenosis as an alternative to surgical treatment. Initial studies reveal higher morbidity and mortality rates for CAS than acceptable standards for carotid endarterectomy (CEA). The aim of this study was to compare results in a series of CAS with concurrent risk-matched group of CEA patients. The study included two groups of 50 patients with internal carotid artery stenosis. We compared early outcome (30 days after procedure) in risk-matched groups of patients that underwent these procedures. Post procedural complications were equally frequent in both groups. There was no significant difference in perioperative complication rates (P = 0.871). Comparison of these two methods shows that CAS and CEA are competitive methods for treatment of carotid artery stenosis. Particularly in symptomatic patients with high risk for surgery CAS is alternative treatment.     

Wall stress of the cervical carotid artery in patients with carotid dissection: a case-control study

Spontaneous internal carotid artery (ICA) dissection (sICAD) results from an intimal tear located around the distal carotid sinus. The mechanisms causing the tear are unknown. This case-control study tested the hypotheses that head movements increase the wall stress in the cervical ICA and that the stress increase is greater in patients with sICAD than in controls. Five patients with unilateral, recanalized, left sICAD and five matched controls were investigated before and after maximal head rotation to the left and neck hyperextension after 45° head rotation to the left. The anatomy of the extracranial carotid arteries was assessed by magnetic resonance imaging and used to create finite element models of the right ICA. Wall stress increased after head movements. Increases above the 80th and 90th percentile were located at the intimal side of the artery wall from 7.4 mm below to 10 mm above the cranial edge of the carotid sinus, i.e., at the same location as histologically confirmed tears in patients with sICAD. Wall stress increase did not differ between patients and controls. The present findings suggest that wall stress increases at the intimal side of the artery wall surrounding the distal edge of the carotid bulb after head movements may be important for the development of carotid dissection. The lack of wall stress difference between the two groups indicates that the carotid arteries of patients with carotid dissection have either distinct functional or anatomical properties or endured unusually heavy wall stresses to initiate dissection.     

Blood flow in the carotid artery during breath-holding in relation to diving bradycardia

The present study investigated the mechanism of diving bradycardia. A group of 14 healthy untrained male subjects were examined during breath-holding either out of the water (30–33°C), in head-out immersion, or in whole-body submersion (27–29°C) in a diving pool. Blood velocity, blood volume flow in the carotid artery, diastolic blood pressure and electrocardiogram were measured and recorded during the experiments. The peak blood velocity increased by 13.6% (P < 0.01) and R-wave amplitude increased by 57.1% (P < 0.005) when the subjects entered water from air. End-diastolic blood velocity in the carotid artery increased significantly during breath-holding, e.g. increased from 0.20 (SD 0.02) m · s⁻¹ at rest to 0.33 (SD 0.04) m · s⁻¹ (P < 0.001) at 50.0 s in breath-hold submersion to a 2.0-m depth. Blood volume flow in the carotid artery increased by 26.6% (P < 0.05) at 30 s and 36.6% (P < 0.001) at 40 s in breath-hold submersion to a 2.0-m depth. Diastolic blood pressure increased by 15.4% (P < 0.01) at 60 s during breath-holding in head-out immersion. Blood volume flow, and diastolic blood pressure increased significantly more and faster during breath-holding in submersion than out of the water. There was a good negative correlation with the heart rate: the root mean square correlation coefficient r was 0.73 (P < 0.001). It was concluded that an increased accumulation of blood in the aorta and arteries at end-diastole and decreased venous return, caused by an increase in systemic peripheral resistance during breath-holding, underlies diving bradycardia. Accepted: 22 November 1996     

Mitochondria-targeted plastoquinone antioxidant SkQR1 decreases trauma-induced neurological deficit in rat

A protective effect of a mitochondria-targeted antioxidant, a cationic rhodamine derivative linked to a plastoquinone molecule (10-(6′-plastoquinonyl)decylrhodamine-19, SkQR1) was studied in the model of open focal trauma of rat brain sensorimotor cortex. It was found that daily intraperitoneal injections of SkQR1 (100 nmol/kg) for 4 days after the trauma improved performance in a test characterizing neurological deficit and decreased the volume of the damaged cortical area. Our results suggest that SkQR1 exhibits profound neuroprotective effect, which may be explained by its antioxidative activity.     

Early identification of patients with the risk for postoperative carotid restenosis development

Multiple randomized trials over the last decade for both symptomatic and asymptomatic carotid stenosis have proven the efficacy of carotid endarterectomy (CEA) in reducing the risk of stroke. The aim of this prospective non-randomizing cohort study was to determine the incidence of carotid arteries restenosis after CEA as well as to ascertain the clinical and etiological characteristics for the development of restenosis. Treatment data from 178 KBC Rijeka patients that had undergone CEA in the period 1. 09. 2005-30. 8. 2009 has been processed. All patients are monitored trough our Neurosonology laboratory algorythm--first Doppler ultrasound examination within the first week after CEA and the following after 1, 3, 6 and 12 months. After this time once a years. The average monitoring time was 21 month (1-36 months). In the stated period 27 restenosis was diagnosed (15.16%). Only four of them were symptomatic (14.81%). Patient survival rate is 98% in the first 12 and 92% in the first 36 months. Carotid restenosis is usually asymptomatic. Non-invasive postoperative carotid arteries color Doppler screening is essential in the early identification of patients with the risk for the development of restenosis.     

Naloxone effect on the neurological deficit induced by forebrain ischemia in rats

The effect of naloxone upon neurologic deficit was evaluated in a model of transient forebrain ischemia in rats. Awake male Wistar rats were subjected to a 30 minute ischemia by occluding both common carotid arteries 8 days after cauterizing vertebral arteries. Administration of naloxone 1 or 5 mg/kg iv 10 minutes after carotid occlusion or 1 mg/kg iv one hour after clamp removal failed to reduce immediate and tardive neurologic postischemic deficits. On the other hand, in rats treated by a dose of 1 mg/kg naloxone 10 minutes after carotid occlusion and perfused with an additional dose of 2 mg/kg/h for 80 minutes, neurologic score was improved one hour after ischemia. However mortality was not decreased whatever was the modality of naloxone administration. This result confirms previous data showing that naloxone exerts a protective effect when given at sufficiently high dosage.     

Remodeling of the uterine artery during and early after pregnancy in the mouse

Biomechanics and Modeling in Mechanobiology - Pregnancy associates with dramatic changes in maternal cardiovascular physiology that ensure that the utero-placental circulation can support the...     

Cerebral perfusion changes in patients with internal carotid artery stenoses after surgical revascularization

Changes of cerebral perfusion and the condition of collateral blood supply in patients with internal carotid artery stenoses may have a prognostic value for effective blood flow restoration after revascularization of the internal carotid arteries (ICAs). To determine the patterns of cerebral perfusion changes in patients with ICA stenoses before and after surgical treatment, a clinical CT perfusion study of 41 patients with moderate to severe ICA stenoses was performed. Perfusion CT (PCT) had been conducted in 17 patients with moderate ICA stenoses (50–69%) and in 24 patients with severe ICA stenoses (70–99%) 3 times: before intervention (balloon angioplasty with stenting or carotid endarterectomy), on the 3rd to 7th day, and within 1 to 3 months after surgery. Scanning was performed at the level of the basal ganglia and semioval centers. In patients without ICA stenosis (control group of 39 individuals), PCT was conducted once. We found that surgical recanalization of the ICA leads to normalization of the cerebral blood flow parameters in the perfusion area of the middle cranial artery, as evidenced by a decrease of MTT and CBV and an increase of CBF to values comparable to those in the control group. However, blood flow restoration in the anterior and posterior watershed areas, which are known to be mostly affected under chronic hypoperfusion conditions, was observed only in patients with a complete circle of Willis (CW) and moderate ICA stenosis. Therefore, severe stenosis (>70%) and the incomplete CW are the prognostic factors for inadequate blood flow restoration after revascularization in patients with ICA stenoses.     

Purine catabolism in advanced carotid artery plaque

This study was carried out on carotid artery plaque and plasma of 50 patients. We analyzed uric acid, hypoxanthine, xanthine, and allantoin levels to verify if enzymatic purine degradation occurs in advanced carotid plaque; we also determined free radicals and sulphydryl groups to check if there is a correlation between oxidant status and purine catabolism. Comparing plaque and plasma we found higher levels of free radicals, hypoxanthine, xanthine, and a decrease of some oxidant protectors, such as sulphydryl groups and uric acid, in plaque. We also observed a very important phenomenon in plaque, the presence of allantoin due to chemical oxidation of uric acid, since humans do not have the enzyme uricase. The hypothetical elevated activity of xanthine oxidase in atherosclerosis could be reduced by specific therapies using its inhibitors, such as oxypurinol or allopurinol.     

Antioxidant status and purine bases in carotid artery plaque

Free radical excess and oxidative stress are implicated in the formation and progression of atherosclerotic plaque through actions on susceptible vascular cells, such as by activating xanthine oxidase. Purine bases and other antioxidant compounds could play important protective roles in atherogenesis, as could nonenzymatic low molecular weight thiol defenses, not previously evaluated in carotid artery plaque. Therefore, we measured purine catabolites (hypoxanthine, xanthine, uric acid, allantoin) and antioxidant compounds (total sulphydryl groups, homocysteine, cysteine, and glutathione) in advanced carotid artery plaque and found a high ratio of allantoin to uric acid, suggesting a ongoing local oxidative stress.     

Longitudinal MRI study on the natural history of carotid artery plaques in symptomatic patients

Purpose

To investigate the natural history of carotid atherosclerosis in patients who experienced a TIA or ischemic stroke.

Patients and Methods

Ninety-two TIA/stroke patients (57 men, mean age 67.7±9.8 years) with ipsilateral <70% carotid stenosis underwent multisequence MRI of the plaque ipsilateral to the symptomatic side at baseline and after one year. For each plaque, several parameters were assessed at both time points.

Results

Carotid lumen, wall and total vessel ( = carotid lumen and wall) volume did not significantly change. Forty-four patients had a plaque with a lipid-rich necrotic core (LRNC) at baseline, of which 34 also had a LRNC after one year. In three patients a LRNC appeared after one year. Thirty patients had a plaque with a thin and/or ruptured fibrous cap (FC) at both time points. In seven patients, FC status changed from thin and/or ruptured into thick and intact. In three patients, FC status changed from thick and intact into thin and/or ruptured. Twenty patients had intraplaque hemorrhage (IPH) at both time points. In four patients, IPH disappeared, whereas in three patients, new IPH appeared at follow-up.

Conclusion

In TIA/stroke patients, carotid plaque morphology does not significantly change over a one-year period. IPH and FC status change in a minority of patients.     

A morphometric study of age-related changes in the elastic systems of the common carotid artery and internal carotid artery in humans

The present study aims to quantify the distribution of the elastic fiber system in the walls of the common carotid artery and the internal carotid artery in humans. In order to identify specific fibers, segments of carotid arteries were stained using the Verhoeff (for elastic fibers), Weigert (for elastic and elauninic fibers) and Weigert-oxone (for elauninic and oxytalanic fibers) methods. A histomorphometric study was undertaken in order to estimate the linear density (LV) of the fibrous components present in the elastic system and determine the total length of these components in each segment. Microscopic fields were sampled using a test system in which the colors and bands defined in the current study were superimposed on the histological preparations. Data were analyzed through linear regression using first-order rate equations and computer software. The internal carotid artery can be loosely defined as muscular in nature. In order to classify common carotid arteries, it is necessary to consider subject age. From 0 to 30 years of age, the LV of mature elastic fibers does not change significantly in either (left or right) common carotid artery, although a significant reduction in the LV of this type of fiber occurs in the right internal carotid artery. The most marked reduction in oxytalanic and elauninic fibers occurs between 0 and 10 years of age, becoming less intense between the ages of 10 and 30.