AIM: To describe the case history and new histopathological findings of a young woman suffering from moyamoya disease. METHODS: The patient underwent brain computed tomography, magnetic resonance imaging and brain angiography. Vessel samples of a. temporalis superficialis were processed by standard histopathological and immunohistochemical methods by analysis of VEGF, VEGFR and nestin expression. RESULTS: Brain angiography revealed both internal carotid artery stenoses and stenoses of the anterior cerebral arteries. Stenotic parts of vessels were accompanied by coiled and elongated vessels with a picture of "smoke puffs carried away by breeze" after contrast medium application. Histological examination showed: obstruction of lumen, fibrocellular intimal thickening, tortuosity and disruption of internal elastic lamina. Imunohistochemistry confirmed a defect of the internal elastic membrane of the muscular arteria and progressive intimal thickening accompanied by abnormal smooth muscle cells and, VEGF/VEGFR expression in intima. Nestin positivity in endothelium of arteria indicated that endothelial cells are activated. CONCLUSION: We found that the endothelium of affected vessels is nestin positive. This, together with the finding of VEGF/VEGFR expression, might suggest an active angiogenetic process We present a new conception of pathogenesis but further studies with higher number of patients are necessary to elucidate the role of these growth factors in the moyamoya disease.
- MeSH
- arteriae carotides radiografie MeSH
- cévní endotel metabolismus patofyziologie patologie MeSH
- dospělí MeSH
- financování organizované MeSH
- imunohistochemie MeSH
- lidé MeSH
- moyamoya nemoc MeSH
- proteiny intermediálních filament analýza MeSH
- proteiny nervové tkáně analýza MeSH
- receptory vaskulárního endoteliálního růstového faktoru analýza MeSH
- vaskulární endoteliální růstové faktory analýza MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Patients' life expectancy, clinical symptomatology and the extent of carotid stenosis are the most important factors when deciding whether to perform carotid endarterectomy (CEA) in patients with carotid stenosis. Therefore, the accuracy of measuring carotid stenosis is of utmost importance. METHODS: Patients with internal carotid artery (ICA) stenosis were investigated by digital subtraction angiography (DSA), Doppler ultrasonography (DUS) and magnetic resonance angiography (MRA). Atherosclerotic plaque specimens were transversally cut into smaller segments and histologically processed. The slides were scanned and specimens showing maximal stenosis were determined; the minimal diameter and the diameter of the whole plaque were measured. DSA, DUS and MRA measurements were obtained in 103 patients. A comparison between preoperative and histological findings was performed. In addition, correlation coefficients were computed and tested. RESULTS: Results show a significant correlation for each of the diagnostic procedures. Mean differences in the whole cohort between preoperative measurements and the histological measurements are as follows: angiographic measurement of carotid stenosis underestimated histological measurement by 14.5% and MRA by 0.7%, but DUS overestimated by 6.6%. The results in severe stenosis (> or =70%) are as follows: angiographic measurement underestimated the histological measurements by 2.3%, but MRA overestimated by 12.1% and DUS by 11.3%. The results in moderate stenosis (50-69%): angiographic measurement underestimated the histological measurements by 12.3%, but MRA overestimated by 0.2% and DUS by 7.2%. The results in mild stenosis (30-49%): angiographic measurement underestimated the histological measurements by 24.7% and MRA by 7.6%, but DUS overestimated by 3.3%. CONCLUSIONS: Our study confirms that DSA underestimates moderate and mild ICA stenosis. DUS slightly overestimated moderate ICA stenosis and highly overestimated high-grade ICA stenosis. MRA proved to be accurate in detecting moderate ICA stenosis, but slightly underestimated mild stenosis and overestimated high-grade stenosis. The surgeon should be aware of these discrepancies when deciding whether to perform CEA in patients with ICA stenosis.
- MeSH
- arteriae carotides * patologie radiografie ultrasonografie MeSH
- digitální subtrakční angiografie metody normy MeSH
- kohortové studie MeSH
- lidé MeSH
- magnetická rezonanční angiografie metody normy MeSH
- prediktivní hodnota testů MeSH
- předoperační péče metody MeSH
- stenóza arteria carotis diagnóza patologie ultrasonografie MeSH
- ultrasonografie dopplerovská metody normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- MeSH
- arteriae carotides radiografie MeSH
- dospělí MeSH
- kontrastní látky otrava MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mozková angiografie škodlivé účinky MeSH
- nemoci autonomního nervového systému etiologie chemicky indukované MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- senioři MeSH
- MeSH
- arteriae carotides radiografie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- fonokardiografie MeSH
- kardiomyopatie diagnóza radiografie MeSH
- kinetokardiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- srdeční selhání diagnóza MeSH
- trombocytopenie komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
