OBJECTIVE: To analyze clinical features, surgical treatment and outcomes of neurilemmoma and carotid body tumors in bifurcation of carotid artery. METHODS: The clinical data of 17 patients with neurilemmomas and 76 patients with carotid body tumors at the bifurcation of carotid artery, who were surgically treated in Zhongshan Hospital of Fudan University from March 2012 to November 2016, were retrospectively analyzed. The clinicopathological characteristics, surgical procedures and outcomes were compared between two groups. RESULTS: No difference of preoperative clinical demographic data was found between two groups. Operation time of the neurilemmoma group was significantly shorter than that of the carotid body tumor group[(93.9±30.8) min vs. (159.3±52.9) min, <0.01]. The neurilemmoma group had lower volume of intra-operative blood loss[(110±96) mL vs. (356±239) mL, <0.01] and lower rate of external carotid artery resection (11.8% vs. 68.4%, <0.01) than the carotid body tumor group. In the neurilemmoma group, 17 tumors were completely resected and no malignant disease was found. In the carotid body tumor group, 76 patients underwent complete surgical resection for the tumor, of which 5 (6.6%) were malignant. Tumor size of the neurilemmoma group was larger than that of the carotid body tumor group[(4.5±1.4) cm vs. (3.1±1.0) cm, <0.01]. There was no significant difference in the incidence of peri-operative complications and length of hospital stay between two groups (>0.05). CONCLUSIONS The clinical manifestations of neurilemmoma and carotid body tumors at carotid artery bifurcation are similar. The carotid body tumor group has a longer operating time, larger intra-operative blood loss, higher external carotid resection rate and relative higher incidence of malignancy. More cautions should be given when carotid body tumors at carotid artery bifurcation are treated.
Carotid Arteries ; surgery ; Carotid Body Tumor ; pathology ; surgery ; Humans ; Neurilemmoma ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome

Hemodynamic situation is an important factor of recurrence of postoperative carotid artery aneurysm. In order to investigate the hemodynamic factors of postoperative carotid artery aneurysm affect carotid artery aneurysm recurrence, we established a 3D finite element carotid artery aneurysm for the preoperative and postoperative periods using the three-dimensional reconstruction techniques. And then we measured the hemodynamic factors of carotid artery aneurysm of preoperative and postoperative by the finite element method. The carotid artery aneurysm model has an accurate and realistic shape; the pressure of the recurrence of aneurysm was reduced significantly after surgery,wall shear stress increased significantly at residual neck, and blood flow velocity increased significantly, which will increase the risk of recurrence. The hemodynamic analysis provides a reference for development of aneurysm clinical treatment programs and prevention of recurrence.
Aneurysm ; pathology ; surgery ; Blood Flow Velocity ; Carotid Arteries ; pathology ; surgery ; Computer Simulation ; Hemodynamics ; Humans ; Stress, Mechanical

Objective:To investigate surgical treatment of carotid artery diseases in neck tumor surgery. Methods:A retrospective analysis of the clinical data on carotid artery treatment was conducted in the five cases of neck tumor surgeries treated at Department of Surgical Oncology, the First Peoples Hospital of Lanzhou from March 2010 to May 2020. Surgical methods, including carotid artery resection and ligation, tumor-involved artery resection and vascular reconstruction, and tumor peeling and carotid rupture repairing were used, respectively. Results:Five cases were successfully operated on. One case of carotid artery ligation was followed by intermittent dizziness and decreased contra-lateral limb strength after the surgery. The remaining patients exhibited no neurological complications. A patient with cervical low-grade myofibroblastoma developed into lung metastases 8 months after the surgery. Another patient with cervical lymph node metastases in papillary thyroid cancer developed into lung metastases 24 months after the surgery. Conclusion:Currently, surgical methods for clinical treatment of diseased carotid arteries include carotid artery resection and ligation, simple tumor peeling, tumor invasion artery resection and vascular reconstruction, and interventional therapy. Each surgical method has its own advantages and disadvantages. Therefore, the choice of treatment depends on the patient's specific conditions, physician's clinical experience, and the equipment available.
Humans ; Retrospective Studies ; Carotid Arteries/pathology* ; Head and Neck Neoplasms/pathology* ; Thyroid Neoplasms/surgery* ; Lung Neoplasms/pathology*

The aim of the present study was to investigate the effect of removal of the adventitia on vascular remodeling and vasoconstriction of the carotid artery in New Zealand rabbit. Adventitia of carotid artery was removed mechanically. The histology, morphology and reactivity of the carotid artery was observed by immunohistochemistry and measurement of carotid ring tension immediately, 1 week and 2 weeks after removal of the adventitia. No damage of intima and media was observed after removing the adventitia. Removal of the adventitia caused a remarkable proliferation of the vascular media and formed the neointima. Compared with the control ring, norepinephrine (NE)-induced vasocontraction in adventitia-denuded carotid artery was significantly reduced immediately and 1 week after the operation (P<0.05). Adventitia removal promoted the neointima formation and decreased vasoconstriction of the carotid artery, indicating that the adventitia is involved in the regulation of vascular remodeling and vasoconstriction.
Animals ; Carotid Arteries ; pathology ; physiology ; surgery ; Connective Tissue ; physiology ; surgery ; Muscle, Smooth, Vascular ; pathology ; Rabbits ; Tunica Intima ; pathology ; Vasoconstriction ; physiology

OBJECTIVETo investigate the effect of bone marrow derived endothelial cells implantation on healing of acute injured intima.

METHODSMononuclear cells derived from bone marrow were differentiated to endothelial cells. The cells were labeled with bromodeoxyuridine. Carotids injuring was induced by a balloon in 40 rabbits, endothelial cell suspension (2 x 10(6)/ml, n = 20) or PBS (2 ml, n = 20) was infused to injured arteries. The intima covered area was tested by Evan's Blue staining. The average intima thickness and media thickness were observed 7 and 14 days post procedure by histological assay. The immunofluorescent staining was performed for testing the BrdU labeled-cells, and these cells were detected under a fluorescent microscope.

RESULTSIntima covered area rate was significant higher (54.1% +/- 8.2% vs. 30.0% +/- 5.5% at day 7, and 81.8% +/- 6.0% vs. 63.6% +/- 8.4% at day 14, all P < 0.05) and the intima thickness and media thickness were significantly reduced in the endothelial cell suspension group.

CONCLUSIONThe bone marrow derived endothelial cell promoted healing post intima injury in this model compared to PBS group (all P < 0.05).

Animals ; Bone Marrow Cells ; cytology ; Bone Marrow Transplantation ; Carotid Arteries ; pathology ; Carotid Artery Injuries ; pathology ; surgery ; Endothelial Cells ; cytology ; pathology ; transplantation ; Female ; Male ; Rabbits ; Transplantation, Autologous

Sutures may cause endothelial trauma and occlusion. The vascular clip system (VCS) clip applier may minimize endothelial injury. Fourteen carotid arteries of nine adult rabbits were transected and re-anastomosed with either #7-0 polypropylene (Group I, n=8) or VCS clips (Group II, n=6). The animals were sacrificed at 1, 3, 8, 14, and 30 days postoperatively. The operation time and bleeding amount were checked for each anastomosis. Carotid angiograms, photography, H&E staining and scanning electron microscopy (SEM) were performed. Fibrin and thrombus, inflammatory cell infiltration, endothelial disruption, luminal distortion, fibrosis, and wall thickening were compared. The luminal diameter was greater in group II. There were minimal differences in thrombosis, wall thickening and fibrosis between the two groups. However, fibrin, inflammatory cell infiltration, multinucleated giant cell formation, endothelial disruption, and luminal distortion were greater in group I. On SEM, group I showed trans-mural penetration. In contrast, group II showed suture margin eversion and no transmural penetration. Stenosis was greater in group I than in group II on carotid angiogram. The operation time was shorter in group II than in group I, i.e. 5+/-1.4 min vs. 11+/-3.8 min, respectively. The current data showed similar or superior results with VCS clips in comparison to conventional suturing with polypropylene.
Angiography ; Animal ; Arteriovenous Shunt, Surgical/*instrumentation/methods ; Carotid Arteries/pathology/*surgery/ultrastructure ; Microscopy, Electron, Scanning ; Rabbits ; Surgical Stapling/*instrumentation/methods

Hypothermia and cardiopulmonary bypass has rarely been used for difficult lesions of the brain such as giant aneurysms and hemangioblastoma of the brainstem. We report a case of huge recurrent angioblastic meningioma operated under the profound hypothermia and cardiopulmonary bypass. We reviewed the complications related to hypothermia and cardiopulmonary bypass for brain lesions.
Adult ; Brain Neoplasms/*surgery ; Cardiopulmonary Bypass/*methods ; Carotid Arteries/pathology ; Carotid Artery Diseases/therapy ; Case Report ; Cerebral Angiography ; Embolization, Therapeutic ; Fatal Outcome ; Female ; Human ; Hypothermia, Induced/*methods ; Lung/pathology/radiography ; Magnetic Resonance Imaging ; Meningioma/*surgery ; Neoplasms, Second Primary/*surgery ; Recurrence

Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rete mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.
Adult ; Angioplasty, Balloon ; Carotid Arteries/pathology/*radiography/*surgery ; Cerebral Angiography ; Female ; Humans ; *Stents ; Syncope/etiology ; Treatment Outcome ; Vertebrobasilar Insufficiency/*radiography/*surgery ; Young Adult

Arterial restenosis frequently develops after open or endovascular surgery due to intimal hyperplasia. Since tissue transglutaminase (TG2) is known to involve in fibrosis, wound healing, and extracellular matrix remodeling, we examined the role of TG2 in the process of intimal hyperplasia using TG2-null mice. The neointimal formation was compared between TG2-null and wild-type (C57BL/6) mice by two different injury models; carotid ligation and carotid loop injury. In ligation model, there was no difference in intimal thickness between two groups. In loop injury model, intimal hyperplasia developed in both groups and the intimal/medial area ratio was significantly reduced in TG2-null mice (P = 0.007). TG2 was intensely stained in neointimal cells in 2 weeks. In situ activity of TG2 in the injured arteries steadily increased until 4 weeks compared to uninjured arteries. Taken together, intimal hyperplasia was significantly reduced in TG2-null mice, indicating that TG2 has an important role in the development of intimal hyperplasia. This suggests that TG2 may be a novel target to prevent the arterial restenosis after vascular surgery.
Animals ; Carotid Arteries/pathology/*surgery ; Disease Models, Animal ; GTP-Binding Proteins/deficiency/genetics/*metabolism ; Hyperplasia ; Mice ; Mice, Inbred C57BL ; Transglutaminases/deficiency/genetics/*metabolism ; Tunica Intima/*pathology

OBJECTIVEThe purpose of this study was to establish an ideal operation method to deal with head and neck carcinomas of late stage and involving the carotid.

METHODSA total of four metastasized head neck carcinomas involving the carotid arteries were included in this clinical trial. The primary tumors of the four cases tumors were carcinomas of tongue, esophagus, laryngeal and parotid glands. All four cases were examined by means of TCD, DSA, SPECT to confirm good compatibility of brain blood circulation before operations. The bony petrous sections of carotid arteries were drawn off after the exposure of the bone tissue for exterior skull. A by-pass was set up by inserting a shunt tube between the common carotid and the infernal carotid artery. The extended tumor resection was carried out involving the resection of the carotid artery. The artery was reconstructed with saphena magna vein transplantation in one case, and replaced by artificial vessels in two cases. Tissue defects were repaired by pedicle PMMF.

RESULTSThe B-typed ultrasound and TCD examination two weeks to six months post-operatively showed the four cases revealed good condition of transplanted carotid arteries, except one case occurred Honer's syndrome, but there was no central nerve's symptom or complication in the other three cases.

CONCLUSIONThis operation method could provide a good chance of survival by curettage of later staged head neck tumors. The authors recommend reconstruction of carotid artery in the operation treatment of malignant head neck carcinomas during late stages.

Adult ; Aged ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; methods ; Carcinoma, Squamous Cell ; pathology ; surgery ; Carotid Arteries ; surgery ; Female ; Head and Neck Neoplasms ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Saphenous Vein ; transplantation ; Vascular Surgical Procedures ; methods