Effect of common carotid artery inlet length on normal carotid bifurcation hemodynamics

Controversy exists regarding the suitability of fully developed versus measured inlet velocity profiles for image-based computational fluid dynamics (CFD) studies of carotid bifurcation hemodynamics. Here, we attempt to resolve this by investigating the impact of the reconstructed common carotid artery (CCA) inlet length on computed metrics of "disturbed" flow. Twelve normal carotid bifurcation geometries were reconstructed from contrast-enhanced angiograms acquired as part of the Vascular Aging--The Link That Bridges Age to Atherosclerosis study (VALIDATE). The right carotid artery lumen geometry was reconstructed from its brachiocephalic origin to well above the bifurcation, and the CCA was truncated objectively at locations one, three, five, and seven diameters proximal to where it flares into the bifurcation. Relative to the simulations carried out using the full CCA, models truncated at one CCA diameter strongly overestimated the amount of disturbed flow. Substantial improvement was offered by using three CCA diameters, with only minor further improvement using five CCA diameters. With seven CCA diameters, the amounts of disturbed flow agreed unambiguously with those predicted by the corresponding full-length models. Based on these findings, we recommend that image-based CFD models of the carotid bifurcation should incorporate at least three diameters of CCA length if fully developed velocity profiles are to be imposed at the inlet. The need for imposing measured inlet velocity profiles would seem to be relevant only for those cases where the CCA is severely truncated.     

Trifurcations of the middle cerebral arteries

The furcation types of 100 human middle cerebral arteries (MCA) were investigated. Considering the physiological flow characteristics in furcations, a distinct definition for a bifurcation and a trifurcation was found. The common ramification type of the human MCA is the bifurcation. Trifurcations are very rare and we found them only in the proximal parts of the MCA. In 7 of the 100 cases, a trifurcation was found at the main division of the MCA, in 3 cases a secondary trunk trifurcated. Quadro- and pentafurcations according to the hydrodynamic definitions were not observed at all. Only in 1 case did the internal carotid artery trifurcate into the anterior cerebral artery, a superior trunk and an inferior trunk of the MCA.     

Comparative anatomical studies of thyroid and thymic arteries: I. Rat (Rattus norvegicus albinus)

The thyroid and thymic arteries were investigated in 50 male and 50 female rats. In more than 70% of the animals, on both sides the cranial thyroid artery forms a common trunk with the ascending pharyngeal artery. The caudal thyroid artery arises not from the deep cervical but from the pericardiacophrenic artery. It may be replaced, however, by a branch of some other artery, such as the brachiocephalic, subclavian, vertebral, or ascending cervical, suggesting a shift of its origin from the internal thoracic artery to the thyrocervical trunk as in man. All the thoracic lobes of the thymus are supplied directly by a thymic branch of the internal thoracic artery or indirectly by a branch of the pericardiacophrenic artery. More than half of the specimens have a cervical thymic lobe of variable size, which is supplied by a branch of the cranial thyroid, external carotid, and/or occipital arteries. Some of these thymic arteries, except those from the external carotid and occipital arteries, reach the thoracic lobe. The thoracic lobes lacking a cervical lobe may be supplied by the thymic branch arising only from the cranial thyroid artery. Other anomalous arteries supplying the thoracic lobe are derived from the superficial cervical and/or the right common carotid arteries. These results show that the thymic arteries of rats are basically similar to those of man, although they display a clear difference in their frequency and origin.     

Carotid bifurcation position and branching angle in patients with atherosclerotic carotid disease

Carotid artery bifurcation (CB) is the preferred site for development of atherosclerosis (AS) in extracranial cerebral arteries; internal carotid artery stenosis is the most common cause of ischemic stroke. The frequent atherosclerotic disease of CB may best be explained by the hemodynamic influence of complex blood flow that results from the unique geometry of the bifurcation. Few papers analyze all possible geometric structural characteristics of this bifurcation. While performing many carotid endarterectomies, we noticed that a certain correlation between CB height in the neck and its angle existed, that a larger angle is accompanied with increased frequency of elongation and kinking and that CB shape influences distribution of atherosclerosis. The purpose of this paper is to quantify and evaluate these clinical observations. Radiogrametric analysis of 154 bi-plane orthogonal aortic arch arteriograms of patients with symptomatic atherosclerotic carotid artery disease was performed and a total of 289 CBs were analyzed. The CB height in relation to cervical spine segments was measured and real angles of each bifurcation were calculated. A positive linear correlation between CB height and angle exists: the CB angle increases /decreases 3.34 degrees for each third of the cervical vertebral body height or intervertebral space height. The CB is positioned a little higher on the left side. The proximal border of the atherosclerotic process is found at the level of intersection of the axes of the common carotid artery branches in 92.6% of examined CBs. In lower CBs (with smaller angles) the proximal border was located in the last segment of the common carotid artery, while in high bifurcations (wider angles) the proximal border of the AS process is more distally in the blood flow, in the beginning of the internal carotid artery, and the process was more extensive. High CBs are more suitable for eversion endarterectomy while normal and low CBs are more suitable for open (classic) carotid endarterectomy. The influence of the geometric risk factor demands further investigation.     

Homeobox gene hoxa3 is essential for the formation of the carotid body in the mouse embryos

Homeobox gene Hoxa3 is strongly expressed in the third pharyngeal arch and pouch. We found that Hoxa3 homozygous null mutant mice had the lack of the carotid body. In all late-term mutant embryos examined (n = 10), no carotid body was present. The carotid body rudiment is formed in the wall of the third branchial artery, which develops into the common carotid artery and the first part of the internal carotid artery. The symmetrical patterns of the third, fourth, and sixth arch arteries were observed in wild-type littermates at embryonic day (E) 10.5-12.5. In Hoxa3 homozygous mutant embryos, however, the third arch artery began to degenerate at E10.5 and almost disappeared at E11.5. Furthermore, the bifurcation of the common carotid artery at the normal position, i.e., at the upper end of the larynx, was never detected in the mutant embryos at E16.5-E18.5. The common carotid artery of the homozygous mutants was separated into the internal and external carotid arteries immediately after its origin. Thus, the present study evidenced that the absence of the carotid body in Hoxa3 homozygous mutants is due to the defect of development of the third arch artery, resulting in malformation of the carotid artery system. During fetal development, the carotid body of mice is in close association with the superior cervical ganglion of the sympathetic trunk. The superior cervical ganglion rather showed hypertrophic features in Hoxa3 homozygous mutants lacking the carotid body.     

Sympathetic innervation of the carotid bifurcation in the rabbit and cat: Blood vessels,carotid body and carotid sinus

Summary Two postganglionic branches of the superior cervical ganglion enter the area of the carotid bifurcation in the rabbit and the cat. The common and external carotid arteries receive a rich adrenergic nerve supply, which can be demonstrated by fluorophores of biogenic amines appearing after formaldehyde treatment. The internal carotid artery is only sparsely innervated; however, it shows a dense sympathetic supply at the site of pressor receptors. Following removal of the superior cervical ganglion, a total loss of fluorescent adrenergic nerves occurs and degeneration of nerve endings possessing dense core vesicles is conspicuous. These nerve terminals are situated mainly subendothelially in the carotid body sinusoids; they only rarely terminate on type I cells.     

Three-dimensional geometry of the human carotid artery

Accurate characterization of carotid artery geometry is vital to our understanding of the pathogenesis of atherosclerosis. Three-dimensional computer reconstructions based on medical imaging are now ubiquitous; however, mean carotid artery geometry has not yet been comprehensively characterized. The goal of this work was to build and study such geometry based on data from 16 male patients with severe carotid artery disease. Results of computerized tomography angiography were used to analyze the cross-sectional images implementing a semiautomated segmentation algorithm. Extracted data were used to reconstruct the mean three-dimensional geometry and to determine average values and variability of bifurcation and planarity angles, diameters and cross-sectional areas. Contrary to simplified carotid geometry typically depicted and used, our mean artery was tortuous exhibiting nonplanarity and complex curvature and torsion variations. The bifurcation angle was 36 deg?±?11 deg if measured using arterial centerlines and 15 deg?±?14 deg if measured between the walls of the carotid bifurcation branches. The average planarity angle was 11 deg?±?10 deg. Both bifurcation and planarity angles were substantially smaller than values reported in most studies. Cross sections were elliptical, with an average ratio of semimajor to semiminor axes of 1.2. The cross-sectional area increased twofold in the bulb compared to the proximal common, but then decreased 1.5-fold for the combined area of distal internal and external carotid artery. Inter-patient variability was substantial, especially in the bulb region; however, some common geometrical features were observed in most patients. Obtained quantitative data on the mean carotid artery geometry and its variability among patients with severe carotid artery disease can be used by biomedical engineers and biomechanics vascular modelers in their studies of carotid pathophysiology, and by endovascular device and materials manufacturers interested in the mean geometrical features of the artery to target the broad patient population.     

A comparative study of the distribution of carotid body type-I cells and periadventitial type-I cells in the carotid bifurcation regions of the rabbit,rat, guinea-pig and mouse

Summary The bilateral distribution of carotid body type-I cells was investigated in five rabbits, rats, guinea-pigs and mice by serially sectioning the carotid bifurcation regions. Carotid body type-I cells occurred bilaterally in close proximity to the wall of the internal carotid artery in the rabbit, rat and mouse and to the wall of the ascending pharyngeal artery in the guinea-pig. The rat carotid body was sometimes recessed into the lateral aspect of the superior cervical ganglion and was the most easily defined organ in the four animals studied. Caudally, and separate from the principal mass of carotid body type I cells, isolated groups of periadventitial type-I cells were observed in the connective tissues around the internal carotid artery and adjacent to the carotid bifurcation and common carotid artery in the rabbits only. An overall picture of the carotid body in the four animals was constructed. In all specimens rostral-caudal dimensions were recorded and compared bilaterally.The authors are indebted to Mr. Stephen Jones and Miss Alison Field of the Department of Histopathology, St Bartholomew's Hospital, for expert assistance in the preparation of the material; Miss J. McClelland and Miss C. Slatter for illustrations, and Mr. A. J. Aldrich and Mr. P.S. Hazell for photography. This work was supported by a grant from the Wellcome Trust to one of us (M. de B. D.)     

The superior laryngeal nerve and the superior laryngeal artery

Length, diameter and anastomoses of the nervus vagus and its ganglion inferius were measured 44 halved heads. On the average, 8.65 fiber bundles of the vagus nerve leave the retro-olivary area. In the area of the jugular foramen is the near superior ganglion of the 10th cranial nerve. In this area were found 1.48 (mean value) anastomoses with the 9th cranial nerve. 11.34 mm below the margo terminalis sigmoidea branches off the ramus internus of the accessory nerve which has a length of 9.75 mm. Further anastomoses with the 10th cranial nerve were found. The inferior ganglion of the 10th nerve had a length of 25.47 mm and a diameter of 3.46 mm. Five mm below the ganglion the 10th nerve had a width of 2.9 and a thickness of 1.5 mm. The mean length of the superior sympathetic ganglion was 26.6 mm, its width 7.2 and its thickness 3.4 mm. In nearly all specimens anastomoses of the superior sympathetic ganglion with the ansa cervicalis profunda and the inferior ganglion of the 10th cranial nerve were found. The superior laryngeal nerve branches off about 36 mm below the margo terminalis sigmoidea. The width of this nerve was 1.9 mm, its thickness 0.8 mm on the right and 1.0 mm on the left side. The division in the internal and external rami was found about 21 mm below its origin. Between the n. vagus and thyreohyoid membrane the ramus internus had a length of 64 mm, the length of external ramus between the vagal nerve and the inferior pharyngeal constrictor muscle was 89 mm. Its mean length below the thyreopharyngeal part was 10.7 mm, 8.6 branchlets to the cricothyroid muscle were counted. The superior laryngeal artery had its origin in 80% of cases in the superior thyroideal artery, in 6.8% this vessel was a branch of the external carotid artery. Its average outer diameter was 1.23 mm on the right side and 1.39 mm on the left. The length of this vessel between its origin and the thyreohyoid membrane was 34 mm. In 7% on the right side and in 13% on the left, the superior laryngeal artery reached the larynx through a foramen thyreoideum. Ranges of diameters and lengths of vessels and nerves in the larynx are given.     

Disruption of the Hoxa3 homeobox gene results in anomalies of the carotid artery system and the arterial baroreceptors

Homeobox gene Hoxa3 is expressed in the third pharyngeal arch and pouch and is required for development of the third arch artery in addition to the thymus, parathyroid gland and carotid body. We therefore statistically analyzed malformations of the carotid artery system in Hoxa3 homozygous mutant mice, in comparison with wild-type and heterozygous littermates. To identify the carotid artery system, red carbon ink was injected, or vascular casts were made by injection of Mercox resin and observed by scanning electron microscopy. Furthermore, innervation of the carotid sinus and baroreceptor regions in the aortic arch and right subclavian artery were studied in the Hoxa3 null mutants having an abnormal carotid artery system by immunohistochemistry with TuJ1 and protein gene product (PGP) 9.5 antibodies, which recognize nerve fibers and neurons. The common carotid artery of Hoxa3 homozygous mutants was absent or very short and therefore the internal and external carotid artery arose from a more proximal level than those of wild types. The baroreceptor innervation, however, persisted in the mutants, although vascular targets were changed. These results indicate that Hoxa3 gene is crucial for the formation of the common carotid artery and the null mutant mice are the first useful animal models to show that the third arch arteries on both sides specifically degenerate but the fourth and sixth arch arteries are normal.     

A tortuous distal carotid artery: how to overcome the problem,with the aim of guaranteeing distal protection

This report describes a case of stent implantation in a right internal carotid artery with severe distal tortuosity, which caused difficulty in advancing a filter protection device. Advancement of the introducing sheath at the level of the carotid bifurcation and exchange for a third-generation distal filter protection device overcame the problem.     

Morphological age-dependent development of the human carotid bifurcation

The unique morphology of the adult human carotid bifurcation and its sinus has been investigated extensively, but its long-term, age-dependent development has not. It is important fundamentally and clinically to understand the hemodynamics and developmental forces that play a role in remodeling of the carotid bifurcation and maturation of the sinus in association with brain maturation. This understanding can lead to better prognostication and therapy of carotid disease. We analyzed the change of sinus morphology and the angle of the carotid bifurcation in four postnatal developmental stages (Group I: 0-2 years, Group II: 3-9 years, Group III: 10-19 years, and Group IV: 20-36 years, respectively) using multiprojection digital subtraction angiograms and image post-processing techniques. The most significant findings are the substantial growth of the internal carotid artery (ICA) with age and the development of a carotid sinus at the root of the ICA during late adolescence. The bifurcation angle remains virtually unchanged from infancy to adulthood. However, the angle split between the ICA and external carotid artery (ECA) relative to the common carotid artery (CCA) undergoes significant changes. Initially, the ICA appears to emanate as a side branch. Later in life, to reduce hydraulic resistance in response to increased flow demand by the brain, the bifurcation is remodeled to a construct in which both daughter vessels are a skewed continuation of the parent artery. This study provides a new analysis method to examine the development of the human carotid bifurcation over the developmental years, despite the small and sparse database. A larger database will enable in the future a more extensive analysis such as gender or racial differences.     

FRS2 alpha 2F/2F mice lack carotid body and exhibit abnormalities of the superior cervical sympathetic ganglion and carotid sinus nerve

The docking protein FRS2α is an important mediator of fibroblast growth factor (FGF)-induced signal transduction, and functions by linking FGF receptors (FGFRs) to a variety of intracellular signaling pathways. We show that the carotid body is absent in FRS2α^2F/2F mice, in which the Shp2-binding sites of FRS2α are disrupted. We also show that the carotid body rudiment is not formed in the wall of the third arch artery in mutant embryos. In wild-type mice, the superior cervical ganglion of the sympathetic trunk connects to the carotid body in the carotid bifurcation region, and extends thick nerve bundles into the carotid body. In FRS2α^2F/2F mice, the superior cervical ganglion was present in the lower cervical region as an elongated feature, but failed to undergo cranio-ventral migration. In addition, few neuronal processes extended from the ganglion into the carotid bifurcation region. The number of carotid sinus nerve fibers that reached the carotid bifurcation region was markedly decreased, and baroreceptor fibers belonging to the glossopharyngeal nerve were absent from the basal part of the internal carotid artery in FRS2α^2F/2F mutant mice. In some of the mutant mice (5 out of 14), baroreceptors and some glomus cells were distributed in the wall of the common carotid artery, onto which the sympathetic ganglion abutted. We propose that the sympathetic ganglion provides glomus cell precursors into the third arch artery derivative in the presence of sensory fibers of the glossopharyngeal nerve.     

Intima-Media Thickness Does Not Differ between Two Common Carotid Artery Segments in Children

Carotid intima-media thickness (cIMT) is a surrogate marker of early atherosclerotic changes in children. cIMT-studies are hard to compare, due to variations in ultrasound protocols, especially regarding the common carotid artery (CCA) segment measured in relation to the bulb. This study’s purpose was therefore to compare two distinct CCA segments in children, to see if cIMT values differ substantially according to the site of measurement. cIMT was assessed after power calculation in 30 children (15 girls) aged 8–17, using B-Mode ultrasound (5–13 MHz) at two CCA locations. The first measurement was performed over a distance of 1 cm immediately after the bulb (A), the second 1cm proximal the bulb (B) over the same distance of 1cm length. Means of end-diastolic far wall cIMT were compared between measurement A and B. cIMT in 30 participants was 0.51±0.06 mm for measurement A and 0.51±0.05 mm for measurement B. Results did not differ significantly (p = .947) over a distance of 2 cm after the bulb. According to our results, studies measuring CCA IMT within the first 2 cm, either close to the bulb or further proximal, can be compared. This will improve interpretation of data and application of reference values.     

Effect of zooming on texture features of ultrasonic images

Background

The effect of age on common carotid artery diameter is unclear for varying atherosclerosis risk levels.

Methods

Cross-sectional data from the Atherosclerosis Risk in Communities Limited Access Data set were used to estimate the association of age with B-mode ultrasound common carotid artery diameter for three atherosclerosis risk levels. Based on information from clinical examinations, B-mode ultrasounds, questionnaires, blood and other tests, participants were categorized into three groups: pre-existing disease (prevalent stroke and/or coronary heart disease), high risk group (no pre-existing disease, but prevalent diabetes, hypertension, plaques/shadowing, body mass index >= 30, current smoking, or hyperlipidemia), and a low risk group (no pre-existing disease, no plaques/shadowing, and no major elevated risk factors). Multivariable linear regression analyses modeled the common carotid artery diameter relationship with age.

Results

Age was positively and significantly associated with common carotid artery diameter after risk factor adjustment in the overall sample, but age had a larger effect among persons with evidence of atherosclerosis (interaction p < 0.05). Each year of older age was associated with 0.03 mm larger diameter/year among persons with pre-existing disease, with 0.027 mm larger diameter/year in the high risk group, but only 0.017 mm/year among the low risk group. Results were qualitatively similar using plaques/shadowing status to indicate atherosclerosis severity.

Conclusion

The significant impact of age on common carotid artery diameter among low risk, middle-aged, black and white men and women suggests arterial remodelling may occur in the absence of identified risk factors. The significantly larger impact of age among persons with, compared to persons without identified atherosclerosis or its risk factors, suggests that arterial remodelling may be an indicator of exposure duration.     

CTA联合CEUS在锁骨上皮瓣术前设计中的应用

目的:探讨计算机断层扫描血管造影(CTA)联合对比增强超声(CEUS)在锁骨上皮瓣术前设计中的应用价值。方法:将2016年1月2018年12月本院收治的15例锁骨上皮瓣术前患者作为研究对象。所有患者术前进行CTA和CEUS联合检查以观察锁骨上动脉穿支解剖变异及走行,应用于锁骨上皮瓣术前的辅助设计,评估该方法的成功率和并发症的发生情况。结果:15例患者的锁骨上动脉来源于颈横动脉,其中5例(33.33%)来自甲状颈干,10例(66.67%)来自锁骨下动脉。CTA检查中,10例识别出右锁骨上动脉,血管平均长度为(38.25±11.08)mm,血管平均直径(1.52±0.45)mm;13例确定了左锁骨上动脉,血管平均长度为(38.14±11.05)mm,血管平均直径(1.52±0.51)mm。CEUS检查的15个皮瓣中,发现27个胸锁骨上动脉的胸廓分支(TBSA),平均口径为(0.8±0.2)mm,平均收缩期峰值流速(PSV)为(11.95±2.08)cm/s。所有病例(100%)术中观察皮瓣血管数量、走形等情况与术前影像学相一致的手术结果。与造影剂有关的并发症发生率为6.67%。所有患者均随访1年以上,无进一步并发症,手术效果满意。结论:将CTA和CEUS相结合用于锁骨上皮瓣术前的辅助设计,可互为补充,尤其适用于锁骨上皮瓣(SCF)存在血管解剖变异而且管径细小的皮瓣术前设计。     

Cervical paraganglioma with intranuclear vacuoles in a fine needle aspirate

In a 56-year-old man who presented with a cervical mass, a fine needle aspiration specimen was suggestive of a papillary thyroid adenocarcinoma because of the presence of prominent intranuclear vacuoles in rare cells. Operation and subsequent examination of the mass removed from the bifurcation of the carotid artery clearly identified a paraganglioma. This case emphasizes the following points: aspirates of cervical paragangliomas are difficult to interpret, especially when scanty; intranuclear vacuoles are found in cells of a variety of cervical lesions, including paragangliomas, and should not in themselves define the diagnosis of papillary thyroid adenocarcinoma; and aspiration of cervical paragangliomas is probably contraindicated (but may be done unwittingly from time to time).     

Monophasic synovial sarcoma presenting as a primary ileal mass: a case report and review of the literature

Introduction

Iliocaval fistulas can complicate an iliac artery aneurysm. The clinical presentation is classically a triad of hypotension, a pulsatile mass and heart failure. In this instance, following presentation with multiorgan failure, management included the immediate use of an endovascular stent graft on discovery of the fistula.

Case presentation

A 62-year-old Caucasian man presented to our tertiary hospital for management of iatrogenic trauma due to the insertion of a central venous line into his right common carotid artery, causing transient ischemic attack. Our patient presented to a peripheral hospital with fever, nausea, vomiting, acute renal failure, acute hepatic dysfunction and congestive heart failure. A provisional diagnosis of sepsis of unknown origin was made. There was a 6.5 cm×6.5 cm right iliac artery aneurysm present on a non-contrast computed tomography scan. An unexpected intra-operative diagnosis of an iliocaval fistula was made following the successful angiographic removal of the central line to his right common carotid artery. Closure of the iliocaval fistula and repair of the iliac aneurysm using a three-piece endovascular aortic stent graft was then undertaken as part of the same procedure. This was an unexpected presentation of an iliocaval fistula.

Conclusion

Our case demonstrates that endovascular repair of a large iliac artery aneurysm associated with a caval fistula is safe and effective and can be performed at the time of the diagnostic angiography. The presentation of an iliocaval fistula in this case was unusual which made the diagnosis difficult and unexpected at the time of surgery. The benefit of immediate repair, despite hemodynamic instability during anesthesia, is clear. Our patient had two coronary angiograms through his right femoral artery decades ago. Unusual iatrogenic causes of iliocaval fistulas secondary to previous coronary angiograms with wire and/or catheter manipulation should be considered in patients such as ours.     

Cadaveric study of the arterial anatomy of the upper lip

Arterial distribution of the upper lip was investigated in this study. The location, course, length, and diameter of the superior labial artery and its alar and septal branches were determined on 14 preserved cadaver heads. Another cadaver head was used to show the arterial tree by the colored silicone injection technique. The superior labial artery was the main artery of the upper lip and always originated from the facial artery. The superior labial artery was 45.4 mm in length, with a range from 29 to 85 mm. The mean distance of the origin of the superior labial artery from the labial commissura was 12.1 mm. The superior labial artery was 1.3 mm in external diameter at its origin. The mean distance of origin of the superior labial artery from the lower border of the mandible was 46.4 mm. The alar division of the superior labial artery was mostly found as a single branch (82 percent). Its mean length was 14.8 mm and the mean diameter at the origin was 0.5 mm. The distance between the origins of the superior labial artery and the septal branch was 33.3 mm. The septal branch was single in most of the cases (90 percent). The mean length of the septal branch was 18.0 mm and the diameter at its origin was 0.9 mm. After all dissections, it was concluded that the arterial distribution of the upper lip was not constant. The superior labial artery can occur in different locations unilaterally and bilaterally, with the branches showing variability.     

Distribution of carotid body type I cells and other periadventitial type I cells in the carotid bifurcation regions of the rabbit

Summary The distribution of carotid body type I and periadventitial type I cells in the carotid bifurcation regions was investigated unilaterally in seven and bilaterally in two New Zealand White rabbits. Carotid body type I cells occurred in close proximity to the wall of the internal carotid artery immediately rostral to the carotid bifurcation, within a division of connective tissue with defineable but irregular borders. Caudally, and separate from the main mass of carotid body type I cells, isolated groups of periadventitial type I cells lay freely in the connective tissue around the internal carotid artery and alongside the carotid bifurcation and common carotid artery. A overall picture of the carotid body in the rabbit was reconstructed and the occurrence and significance of periadventitial type I cells discussed.The authors are indebted to Mr. Stephen Jones of the Department of Histopathology, St Bartholomew's Hospital, for expert assistance in the preparation of the material, and to Mr. A.J. Aldrich of the Department of Anatomy for photography. This work was supported by a grant from the Wellcome Trust to one of us (M. de B.D.)