- MeSH
- arteriae carotides chirurgie MeSH
- cerebrovaskulární poruchy * etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace MeSH
- transplantace cév * škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
BACKGROUND: Coronary artery bypass grafting (CABG) is a common cardiac surgery. Manufacturing small-diameter (2-5 mm) vascular grafts for CABG is important for patients who lack first-choice autologous arterial, or venous conduits. Ovine and porcine common carotid arteries (CCAs) are used as large animal models for in vivo testing of newly developed tissue-engineered arterial grafts. It is unknown to what extent these models are interchangeable and whether the left and right arteries of the same subjects can be used as experimental controls. Therefore, we compared the microscopic structure of paired left and right ovine and porcine CCAs in the proximodistal direction and compared these animal model samples to samples of human coronary arteries (CAs) and human internal thoracic arteries (ITAs). METHODS: We compared the histological composition of whole CCAs of sheep (n = 22 animals) with whole porcine CCAs (n = 21), segments of human CAs (n = 21), and human ITAs (n = 21). Using unbiased sampling and stereological methods, we quantified the fractions of elastin, total collagen, type I collagen, type III collagen, smooth muscle actin (SMA) and chondroitin sulfate (CS) A, B, and C. We also quantified the densities and distributions of nuclear profiles, nervi vasorum and vasa vasorum as well as the thickness of the intima-media and total wall thickness. RESULTS: The differences between the paired samples of left and right CCAs in sheep were substantially greater than the differences in laterality in porcine CCAs. The right ovine CCAs had a smaller fraction of elastin (p < 0.001), greater fraction of SMA (p < 0.01), and greater intima-media thickness (p < 0.001) than the paired left side CCAs. In pigs, the right CCAs had a greater fraction of elastin (p < 0.05) and a greater density of vasa vasorum in the media (p < 0.001) than the left-side CCAs. The fractions of elastin and CS decreased and the fraction of SMA increased in the proximodistal direction in both the ovine (p < 0.001) and porcine (p < 0.001) CCAs. Ovine CCAs had a muscular phenotype along their entire length, but porcine CCAs were elastic-type arteries in the proximal segments but muscular type arteries in middle and distal segments. The CCAs of both animals differed from the human CAs and ITAs in most parameters, but the ovine CCAs had a comparable fraction of elastin and CS to human ITAs. CONCLUSIONS: From a histological point of view, ovine and porcine CCAs were not equivalent in most quantitative parameters to human CAs and ITAs. Left and right ovine CCAs did not have the same histological composition, which is limiting for their mutual equivalence as sham-operated controls in experiments. These differences should be taken into account when designing and interpreting experiments using these models in cardiac surgery. The complete morphometric data obtained by quantitative evaluation of arterial segments were provided to facilitate the power analysis necessary for justification of the minimum number of samples when planning further experiments. The middle or distal segments of ovine and porcine CCAs remain the most realistic and the best characterized large animal models for testing artificial arterial CABG conduits.
- MeSH
- arteriae carotides chirurgie MeSH
- intimomediální šíře tepenné stěny * MeSH
- koronární bypass metody MeSH
- lidé MeSH
- mamární tepny * MeSH
- modely u zvířat MeSH
- ovce MeSH
- prasata MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
A case is reported of a 40-year-old woman clinically diagnosed as moyamoya disease with associated fibromuscular dysplasia of intrapulmonary bronchial arteries incidentally revealed during autoptic examination. Moyamoya disease represents an idiopathic noninflammatory and nonatherosclerotic arterio-occlusive process of intracranial arteries. Prolonged brain ischemia leads to formation of tiny and fragile collaterals. Clinically, patients with moyamoya angiopathy commonly present with severe neurological symptoms caused by brain infarction or hemorrhage. Histologically, the steno-occlusive process is based on fibrocellular thickening of intima and intimal smooth muscle cell proliferation. In the literature, extracranial arterial involvement, i.e. fibromuscular dysplasia of renal or pulmonary arteries, has been described in several cases of moyamoya disease. Our aim is to show a unique case of moyamoya disease associated with fibromuscular dysplasia affecting an uncommon site.
- MeSH
- arteriae bronchiales patologie MeSH
- arteriae carotides diagnostické zobrazování patologie chirurgie MeSH
- arteriae cerebrales diagnostické zobrazování patologie chirurgie MeSH
- biopsie MeSH
- digitální subtrakční angiografie MeSH
- dospělí MeSH
- fatální výsledek MeSH
- fibromuskulární dysplazie komplikace patologie MeSH
- lidé MeSH
- moyamoya nemoc komplikace diagnostické zobrazování patologie chirurgie MeSH
- mozková angiografie MeSH
- pitva MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Using animal models in experimental medicine requires mapping of their anatomical variability. Porcine common carotid arteries (CCA) are often preferred for the preclinical testing of vascular grafts due to their anatomical and physiological similarity to human small-diameter arteries. Comparing the microscopic structure of animal model organs to their human counterparts reveals the benefits and limitations of translational medicine. METHODS: Using quantitative histology and stereology, we performed an extensive mapping of the regional proximodistal differences in the fractions of elastin, collagen, and smooth muscle actin as well as the intima-media and wall thicknesses among 404 segments (every 1 cm) of porcine CCAs collected from male and female pigs (n = 21). We also compared the microscopic structure of porcine CCAs with segments of human coronary arteries and one of the preferred arterial conduits used for the coronary artery bypass grafting (CABG), namely, the internal thoracic artery (ITA) (n = 21 human cadavers). RESULTS: The results showed that the histological structure of left and right porcine CCA can be considered equivalent, provided that gross anatomical variations of the regular branching patterns are excluded. The proximal elastic carotid (51.2% elastin, 4.2% collagen, and 37.2% actin) transitioned to more muscular middle segments (23.5% elastin, 4.9% collagen, 54.3% actin) at the range of 2-3 centimeters and then to even more muscular distal segments (17.2% elastin, 4.9% collagen, 64.0% actin). The resulting morphometric data set shows the biological variability of the artery and is made available for biomechanical modeling and for performing a power analysis and calculating the minimum number of samples per group when planning further experiments with this widely used large animal model. CONCLUSIONS: Comparison of porcine carotids with human coronary arteries and ITA revealed the benefits and the limitations of using porcine CCAs as a valid model for testing bioengineered small-diameter CABG vascular conduits. Morphometry of human coronary arteries and ITA provided more realistic data for tailoring multilayered artificial vascular prostheses and the ranges of values within which the conduits should be tested in the future. Despite their limitations, porcine CCAs remain a widely used and well-characterized large animal model that is available for a variety of experiments in vascular surgery.
- MeSH
- arteriae carotides anatomie a histologie chirurgie MeSH
- cévní protézy * klasifikace normy MeSH
- imunohistochemie MeSH
- koronární bypass metody MeSH
- lidé MeSH
- modely u zvířat MeSH
- mrtvola MeSH
- pilotní projekty MeSH
- prasata MeSH
- srdce anatomie a histologie MeSH
- tkáňové inženýrství MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Průměrný výskyt perioperační cévní mozkové příhody během velkého nekardiálního chirurgického výkonu je nižší než 1 %, což naznačuje, že pro velkou většinu pacientů je zřídka velkým problémem. Metoda: V našem sdělení prezentujeme 46letou nemocnou po akutní pravostranné hemikolektomii, u které se perioperačně rozvinula pravostranná hemiparéza. Bezprostředním CTAg vyšetřením byl prokázán ischemický iktus v oblasti levé hemisféry jako důsledek trombózy levé vnitřní karotidy. Rekanalizační operační výkon na levé karotidě byl proveden po 14 hodinách od začátku neurologické symptomatologie a neurologický deficit se postupně plně zreparoval. Závěr: Naše kazuistika podporuje studie, že důkladné diagnostické zhodnocení umožňuje výběr pacientů, kteří mohou mít prospěch z urgentní revaskularizace akutní okluze vnitřní karotidy ve fázi akutní ischemie mozku.
Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.
- MeSH
- arteriae carotides chirurgie patologie MeSH
- ischemie mozku * diagnóza terapie MeSH
- kolektomie MeSH
- lidé středního věku MeSH
- lidé MeSH
- peroperační komplikace MeSH
- trombektomie MeSH
- trombóza arteria carotis * diagnóza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- arteriae carotides * chirurgie MeSH
- cévy - implantace protéz * metody škodlivé účinky MeSH
- embolie etiologie prevence a kontrola MeSH
- karotická endarterektomie MeSH
- lidé MeSH
- pomůcky zabraňující embolii MeSH
- stenóza arteria carotis chirurgie etiologie prevence a kontrola MeSH
- stenty škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
We compared graft outcome between two types of a novel composite three-layer carp-collagen-coated vascular graft in low-flow conditions in a sheep model. Collagen in group A underwent more cycles of purification than in group B in order to increase the ratio between collagen and residual fat. The grafts were implanted end-to-side in both carotid arteries in sheep (14 grafts in 7 sheep in group A, 18 grafts in 9 sheep in group B) and artificially stenosed on the right side. The flow in the grafts in group A decreased from 297±118 ml/min to 158±159 ml/min (p=0.041) after placement of the artificial stenosis in group A, and from 330±164ml/min to 97±29 ml/min (p=0.0052) in group B (p=0.27 between the groups). From the five surviving animals in group A, both grafts occluded in one animal 3 and 14 days after implantation. In group B, from the six surviving animals, only one graft on the left side remained patent (p=0.0017). Histology showed degradation of the intimal layer in the center with endothelization from the periphery in group A and formation of thick fibrous intimal layer in group B. We conclude that the ratio between collagen and lipid content in the novel three-layer graft plays a critical role in its patency and structural changes in vivo.
Kontext: Implantace stentů do karotických tepen (carotid artery stenting, CAS) se v současnosti ve velkém měřítku používá v léčbě stenózy karotických tepen. Klinické studie z poslední doby prokázaly nízkou incidenci příhod po CAS. Tato studie hodnotí 30denní a roční výsledky pacientů léčených pro CAS intenzivní farmakoterapií na pracovišti provádějícím vysoké počty perkutánních koronárních intervencí ročně. Metoda: V období od ledna 2011 do prosince 2013 byla CAS provedena celkem u 184 pacientů. Mimo protidestičkové léčby byla prováděna i intenzivní antihypertenzní léčba spolu s vysoce intenzivní terapií statiny a léčbou zaměřenou na normalizaci srdeční frekvence. Pacienti byli stratifikováni podle věku a symptomů. Výsledky: Většina pacientů (86,4 %) splňovala alespoň jedno kritérium vysokého operačního rizika. Výkon byl úspěšný v 98,4 % případů. Třicetidenní a roční incidence cévních mozkových příhod (CMP) byla 4,1 %, resp. 4,5 %. Po 30 dnech byla kombinovaná incidence CMP/úmrtí z kardiovaskulárních (KV) příčin/infarktu myokardu (IM) 5,8 %; po jednom roce dosáhla hodnoty 10,9 %. Třicetidenní incidence CMP/úmrtí z KV příčin u asymptomatických a symptomatických pacientů byla 5,4 %, resp. 4,2 %. Věk ≥ 80 let zvyšoval riziko vzniku CMP/úmrtí z KV příčin/IM do jednoho roku (OR 4,41; 95% CI 1,06–18,36; p = 0,04). Závěry: Studie prokázala přijatelné klinické výsledky pacientů s CAS a vysokou incidencí přidružených onemocnění, kteří byli léčeni intenzivní farmakoterapií. Incidence příhod u symptomatických pacientů nepřesáhla rozmezí uváděné v guidelines jako doporučené, zatímco u asymptomatických pacientů byla incidence zvýšená.
Background: Carotid artery stenting (CAS) is now being widely used in the treatment of carotid artery stenosis. Recent clinical studies have demonstrated low adverse event rates after CAS. This study evaluates the 30-day and 1-year results in patients treated with CAS and receiving intensive medical therapy in a high-volume percutaneous coronary intervention centre. Methods: A total of 184 patients underwent CAS between January 2011 and December 2013. In addition to antiplatelet therapy, patients received intensive antihypertensive treatment, high intensity statin and heart rate normalization therapy. Patients were stratified according to age and symptomatic status. Results: Most of the patients (86.4%) had at least one high surgical risk criteria. The procedural success rate was 98.4%. The 30-day and 1-year incidence of stroke was 4.1% and 4.5%. At 30 days the combined rate of stroke/cardiovascular (CV) death/myocardial infarction (MI) was 5.8% and 10.9% in 1 year. The 30-day incidence of stroke/CV death in asymptomatic and symptomatic patients was 5.4% and 4.2%. Age ≥80 years increased the risk of stroke/CV death/MI at 1 year (OR 4.41; 95% CI 1.06–18.36; p = 0.04). Conclusions: The study demonstrated acceptable clinical outcome results in patients with high medical comorbidities treated with CAS and intensive medical therapy. Adverse event rate in symptomatic patients did not exceed the guideline recommended range while in asymptomatic patients it was increased.
- MeSH
- antihypertenziva terapeutické užití MeSH
- arteriae carotides chirurgie MeSH
- cévní mozková příhoda mortalita prevence a kontrola MeSH
- inhibitory agregace trombocytů terapeutické užití MeSH
- kardiovaskulární nemoci mortalita prevence a kontrola MeSH
- lidé MeSH
- nemoci koronárních tepen * farmakoterapie chirurgie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statiny terapeutické užití MeSH
- stenóza arteria carotis * farmakoterapie chirurgie MeSH
- stenty MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- klinická studie MeSH
BACKGROUND: Intraoperative use of the intraluminal shunt may reduce the risk of a stroke by reducing cerebral blood flow compromise, but it may also increase the risk of atherosclerotic arterial wall damage with subsequent stroke during carotid endarterectomy (CEA). There is still no evidence to support routine or selective shunting. MATERIAL AND METHODS: A total of 754 CEAs were performed in a prospective study from 2005 to 2011 at our department. All procedures were done under regional anesthesia with selective carotid artery shunting according to neurologic status after internal carotid artery clamping. Magnetic resonance (MR) evaluation of brain parenchyma using diffusion-weighed imaging (DWI) sequence was performed upon hospital admission and 24 hours after the surgical procedure. Acute new MR DWI lesions were evaluated according to the classification published by Szabo et al. A routine neurologic evaluation was recorded as well. RESULTS: The intraluminal shunt was used in 46 of 754 patients (6.1%). A new ischemic lesion was detected in 45 patients (6%). Most of these lesions were neurologically asymptomatic (80%). A new lesion on MR DWI in the subgroup of shunted patients was detected in 15 cases (32.6%) and in the subgroup of nonshunted patients in 30 cases (4.2%). Most of these lesions were due to embolization or hypoperfusion during shunt insertion. CONCLUSION: Use of the intraluminal shunt was the most important risk factor for the new MR DWI lesion in the entire group of CEAs. Results support the strategy of a selective use of intraluminal shunts.
- MeSH
- arteriae carotides patologie chirurgie MeSH
- cévní mozková příhoda etiologie MeSH
- difuzní magnetická rezonance * MeSH
- karotická endarterektomie škodlivé účinky metody MeSH
- lidé MeSH
- předoperační období MeSH
- prognóza MeSH
- rizikové faktory MeSH
- stenóza arteria carotis patologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
