Localized in vivo proton magnetic resonance spectroscopy (1H-MRS) has been used to measure the metabolic status of the human brain in a non-invasive manner; thus, it is often called "a non-invasive biochemical assay". MRS is more sensitive than magnetic resonance imaging (MRI) in detecting ischemic damage by measuring the metabolic changes that occur prior to the anatomic changes. We report a patient who presented with innominate artery occlusion and symptoms of posterior circulation insufficiency and showed favorable metabolic changes by 1H-MRS after revascularization. He showed no visible lesion in brain MRI, but in 1H-MRS, decreased N-acetylaspartate (NAA) signal was noted in a resting state. After revascularization, both symptomatic improvement and recovery of NAA signal were observed. 1H-MRS may provide valuable clinical information in diagnosis and management of cerebral hypoperfusion at a much earlier stage prior to the anatomic changes.
Arterial Occlusive Diseases/pathology ; Brachiocephalic Trunk/pathology* ; Brachiocephalic Trunk/surgery ; Brain/metabolism* ; Cerebral Revascularization* ; Human ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Protons

We report a case of ruptured mycotic aneurysm involving innominate artery requiring an urgent surgical treatment. A 62-yr-old woman presented with fever and dyspnea. Previously, she was diagnosed with colon cancer and received right hemicolectomy and one cycle of adjuvant chemotherapy. On echocardiogram, pericardial effusion was noted and emergency pericardiocentesis was performed. CT scan revealed aortic aneurysm involving ascending aorta and innominate artery, and thrombi surrounding those structures. Patch repair of the defect in the ascending aorta and ringed Goretex graft to bypass the innominate and ascending aorta were performed. We believe that this is the first case of ruptured mycotic aneurysm involving innominate artery.
Aneurysm, Infected/*surgery ; Aorta/pathology ; Aortic Aneurysm/surgery ; Brachiocephalic Trunk/pathology ; Colonic Neoplasms/drug therapy/surgery ; Female ; Human ; Middle Aged ; Tomography, X-Ray Computed ; Transplants

Anastomosis, Surgical ; adverse effects ; Brachiocephalic Trunk ; pathology ; Hemorrhage ; etiology ; therapy ; Humans ; Larynx ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Trachea ; surgery ; Tracheal Stenosis ; etiology ; surgery ; Tracheotomy ; adverse effects

Vertebral artery reconstructions are less frequently performed in Korea and diagnosis of vertebrobasilar insufficiency is often missed due to complexity of the symptoms. Authors report 15 vertebral artery reconstructions from September 1995 through December 1997: 5 saphenous vein patch angioplasty, 3 axillary-axillary artery bypass, 2 bovine patch angioplasty, 2 subclavian-vertebral artery bypass, 1 thyrocervical trunk-vertebral artery bypass, 1 carotid-vertebral artery bypass, 1 angioplasty of left vertebral artery & concomitant left subclavian-right axillary artery bypass following by percutaneous transluminal stented angioplasty of innominate artery. Majority of pathology were arteriosclerosis (13 patients) with stenosis at subclavian-vertebral artery junction and Takayasu's arteritis were next (2 patients). Postoperative result was satisfactory and symptoms of dysarthria, ataxic gate, dizziness or vertigo were relieved in all patients. With proper surgical treatment, symptomatic improvement and prevention of cerebral ischemia in vertebrobasilar insufficiency can be achieved.
Angioplasty ; Arteries ; Arteriosclerosis ; Axillary Artery ; Brachiocephalic Trunk ; Brain Ischemia ; Constriction, Pathologic ; Diagnosis ; Dizziness ; Dysarthria ; Humans ; Korea ; Pathology ; Saphenous Vein ; Stents ; Takayasu Arteritis ; Vertebral Artery ; Vertebrobasilar Insufficiency ; Vertigo

BACKGROUNDTakayasu's arteritis (TA) is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty (PTA). Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA.

METHODSFrom January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15 - 42 years (mean 26.5 years). All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years.

RESULTSThere were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients (20%) required further surgery for stenosis (5 patients) or anastomotic aneurysms (3 patients). Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5 - 24 months.

CONCLUSIONSWhen cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.

Adolescent ; Adult ; Arteritis ; drug therapy ; Brachiocephalic Trunk ; pathology ; surgery ; Brain Ischemia ; etiology ; pathology ; surgery ; Cerebral Revascularization ; methods ; Female ; Humans ; Male ; Methylprednisolone ; therapeutic use ; Takayasu Arteritis ; complications ; pathology ; surgery ; Treatment Outcome ; Young Adult

The aortic arch gives rise to three classical branches, namely the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. We report a rare variation of the left common carotid artery and the right vertebral arteries originating from the brachiocephalic trunk, and the left vertebral artery that was arising from the arch of the aorta, proximal to the origin of the left subclavian artery. Variations in the branching pattern of the arch of aorta can alter the cerebral haemodynamics that leads to cerebral abnormalities. Knowledge of the variations in the classical branches of the arch of aorta is important in the diagnosis of intracranial aneurysm after subarachnoid haemorrhage.
Aorta, Thoracic ; abnormalities ; pathology ; Brachiocephalic Trunk ; abnormalities ; anatomy & histology ; Cadaver ; Carotid Artery, Common ; abnormalities ; anatomy & histology ; Humans ; Male ; Middle Aged ; Subclavian Artery ; abnormalities ; anatomy & histology ; Vertebral Artery ; abnormalities ; anatomy & histology

OBJECTIVETo investigate the effect of Qingre Quyu Granule (清热祛瘀颗粒, QRQYG) on stabilizing vulnerable plaques in apolipoprotein E (ApoE) deficient mice.

METHODSSeventy-two male ApoE deficient mice were given a high-fat diet from 6 weeks of age. At the 16th week, all the mice were randomized into 3 groups: the QRQYG group, the simvastatin group, and the control group. Sixteen weeks after administration of 0.9 g/kg QRQYG, 3 mg/kg simvastatin or 10 mg/kg sodium chloride per day to the respective groups, the animals were euthanized. The pathological morphologic changes in the vulnerable plaques were evaluated, the matrix metalloprotease-9 (MMP-9) expression was measured by immunohistofluorescence, the soluble intercellular adhesion molecule 1 (ICAM-1) was determined by ELISA, the nuclear factor kappaB (NF-κB) subunit p65 was measured by quantitative RT-PCR, and, finally, thrombospondin-1 (TSP-1) was determined by the immunohistochemical method.

RESULTSThe plaque cross-sectional area in the brachiocephalic artery (23.7%, P<0.01), the lipid core of the plaque (43.1%±3.1%), and the number of buried fibrotic caps of the plaque were significantly decreased in the QRQYG group compared to the control group (both P<0.01); furthermore, the thickness of the fibrotic cap of the plaque increased and the intra-plaque hemorrhage of the plaque decreased. The serum soluble ICAM-1 (27.1±5.1 μg/mL), the protein expression of MMP-9 and TSP-1 and the p65 mRNA expression increased in the QRQYG group in comparison with the control group (P<0.05 or P<0.01).

CONCLUSIONQRQYG could stabilize the vulnerable plaque through inhibition of the inflammatory response.

Animals ; Apolipoproteins E ; genetics ; Atherosclerosis ; pathology ; Brachiocephalic Trunk ; drug effects ; enzymology ; metabolism ; pathology ; Drugs, Chinese Herbal ; pharmacology ; Enzyme-Linked Immunosorbent Assay ; Intercellular Adhesion Molecule-1 ; metabolism ; Male ; Matrix Metalloproteinase 9 ; metabolism ; Mice ; Mice, Knockout ; NF-kappa B ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Simvastatin ; pharmacology ; Sodium Chloride ; pharmacology ; Thrombospondin 1 ; metabolism