Aneurysm, False/etiology* ; Carotid Artery Injuries/therapy* ; Carotid Artery, Internal ; Embolization, Therapeutic ; Epistaxis/etiology* ; Humans

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of traumarelated extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpet-rosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.
Adult ; Carotid Artery Injuries/complications ; Carotid Artery, Internal, Dissection/etiology/radiography/*therapy ; Case Report ; Cerebral Angiography ; Human ; Male ; *Stents

Carotid Artery Injuries/etiology* ; Carotid Artery, Internal/diagnostic imaging* ; Foreign Bodies/complications* ; Humans ; Skull ; Skull Base/diagnostic imaging*

Animals ; Carotid Arteries ; surgery ; Carotid Artery Injuries ; etiology ; Disease Models, Animal ; Female ; Mice ; Mice, Inbred C57BL ; Microsurgery ; Random Allocation

OBJECTIVETo explore the cause, urgent management, further treatment, outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.

METHODSFive ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region, involving 1 case of traumatic optic neuropathy, 1 case of sphenoidal cyst, 1 case of fungal sphenoid sinusitis, 1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor. These five cases were from three different hospitals in 1990 - 2009, and the clinical data were collected and retrospectively reviewed.

RESULTSInjury of ICA was related with improper anatomic localization and operative procedures. The locations of injury were in cavernous segment in 3 cases, lacerum segment in 1 case, and clinic segment in 1 case, respectively. The types of injury included 3 cases of bleeding of laceration, 1 case of carotid cavernous fistula and 1 case of pseudoaneurysm. Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding. Four cases were successfully treated without craniocerebral or ocular complications, only 1 case died of massive blood loss. Among 4 survival cases, 1 patient abandoned further therapy, the other 3 patients were cured of primary disease by reoperation or subsequent treatment.

CONCLUSIONPreoperatively, reading carefully the imaging data, intraoperatively, identifying anatomical positions accurately, performing proper operation, and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages, all these procedures can effectively reduce the surgical risk of ICA injury.

Adolescent ; Aged ; Carotid Artery Injuries ; etiology ; prevention & control ; surgery ; Carotid Artery, Internal ; Endoscopy ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Retrospective Studies

Epistaxis is commonly encountered in otorhinolaryngologic practice. However, severe and recurrent epistaxis is rarely seen, especially that originating from a pseudoaneurysm of the intracavernous internal carotid artery (ICA). We herein present the case of a 32-year-old man who was involved in a motor vehicle accident and subsequently developed recurrent episodes of profuse epistaxis for the next three months, which required blood transfusion and nasal packing to control the bleeding. Computed tomography angiography revealed a large intracavernous ICA pseudoaneurysm measuring 1.7 cm × 1.2 cm × 1.0 cm. The patient underwent emergent four-vessel angiography and coil embolisation and was discharged one week later without any episode of bleeding. He remained asymptomatic after three-month and one‑year intervals. This case report highlights a large intracavernous ICA pseudoaneurysm as a rare cause of epistaxis, which requires a high index of suspicion in the right clinical setting and emergent endovascular treatment to prevent mortality.
Accidents, Traffic ; Adult ; Aneurysm, False ; diagnostic imaging ; etiology ; surgery ; Carotid Artery Injuries ; Carotid Artery, Internal ; diagnostic imaging ; pathology ; surgery ; Coronary Angiography ; methods ; Embolization, Therapeutic ; Epistaxis ; etiology ; Humans ; Male ; Tomography, X-Ray Computed

OBJECTIVETo observe the preventive effect of Radix Paeoniae Rubra (RPR) to restenosis after carotid balloon injury in rabbits.

METHODSThe rabbit model of carotid balloon injury was established adopting Clowes method, and treated with extract of RPR. Component of new genesic intima and expression of proliferating cell nuclear antigen (PCNA) and macrophage was determined by immunochemical stain. The collagen of type I was detected by special staining for blood vessels and the area of new genesic intima was measured by image assay system.

RESULTSRPR could remarkably decreased the PCNA positive expression and inhibit the proliferation of collagen type I and reduce the generating of new intima.

CONCLUSIONRPR has significant preventive effect on the restenosis after carotid ballon injury in high fat-diet induced atherosclerotic rabbits.

Angioplasty, Balloon ; adverse effects ; Animals ; Arteriosclerosis ; etiology ; pathology ; therapy ; Carotid Artery Injuries ; etiology ; Carotid Artery, Common ; pathology ; Carotid Stenosis ; etiology ; pathology ; therapy ; Drugs, Chinese Herbal ; pharmacology ; Hypercholesterolemia ; complications ; Muscle, Smooth, Vascular ; pathology ; Paeonia ; Proliferating Cell Nuclear Antigen ; metabolism ; Rabbits ; Secondary Prevention

OBJECTIVETo observe the preventive and therapeutic effect of tanshinone (TA) on artery restenosis in the rat carotid injury model and explor the mechanism.

METHODMale SD rats were randomly divided into model control group, and low dose, moderate dose and high dose TA groups. Each group had 10 rats. The rats in the high, moderate and low dose groups were respectively fed with TA 120, 40,13.3 mg x kg(-1) x d(-1) by gast rogavage; the rats in the model control group were fed with the same volume solvent. Two days later, the rat's right carotid artery was injuried by balloon dilatation to induce intimal thickening for establishing the restenosis model. After 2 weeks of treatment, the artery was harvested and stained by hematoxylin-elsin (HE) and immunohistochemistry of PCNA, NF-kappaB and iNOS. The morphological changes were checked under microscope. The area of the intimal and medial layer of the vessels, and their ratios were analyzed with image analysis software. The expression level of PCNA, NF-kappaB and iNOS were used as the positive index.

RESULTThe intimal area and intima-to-media ratio of the injuried artery increased obviously, suggesting the model was successful. Compared with the model group, TA significantly decreased the intimal area and intima-to-media ratio (P < 0.05), and also decreased the positive index of PCNA and the positive ratio of NF-kappaB and iNOS (P < 0.05).

CONCLUSIONTA can effectively inhibit intimal thickening and inflammation. This result suggestes that TA may play a positive role in the prevention of restenosis after PTCA.

Angioplasty, Balloon, Coronary ; adverse effects ; Animals ; Carotid Artery Injuries ; complications ; Carotid Artery, Common ; metabolism ; pathology ; Carotid Stenosis ; etiology ; metabolism ; pathology ; Diterpenes, Abietane ; Male ; NF-kappa B ; metabolism ; Nitric Oxide Synthase Type II ; metabolism ; Phenanthrenes ; isolation & purification ; pharmacology ; Plants, Medicinal ; chemistry ; Proliferating Cell Nuclear Antigen ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Salvia miltiorrhiza ; chemistry ; Tunica Intima ; metabolism ; pathology

INTRODUCTIONComplications occur in over 15% of central venous cannulations, often a result of anatomical variations. This study aimed to determine the anatomical variations of the internal jugular vein (IJV), demonstrate the likely success of cannulation and assess the risk of carotid artery (CA) injury when catheterising the IJV using the external landmarks technique at various degrees of head rotation in the local population.

METHODS100 elective cardiac surgical patients were prospectively enrolled. Simulated catheterisations were performed with patients placed in the Trendelenburg position. The standard landmark technique was used to identify anatomy. Simulations were done at six different degrees of rotation of the head: 0°, 30° and 60° for both right and left IJVs. Difficult catheterisation was defined as an IJV diameter < 7 mm.

RESULTSThere was no thrombosed or absent IJV in any patient. Catheterisation was potentially difficult in 15% of patients at 30° head rotation and more difficult for the left IJV than the right (20% vs. 10%; p < 0.05). The simulated needle hit the IJV in 82% of the attempts, but the needle was in the middle 80% of the vein only 70% of the time. Neck rotation increased the degree of overlap of the CA relative to the IJV from 20%-30% to 50%.

CONCLUSIONAnatomical variations play a significant role in determining the success of IJV catheterisation as well as the incidence of catheterisation-associated complications. This study emphasises the importance of using ultrasonography to guide IJV catheterisation, even in patients with seemingly normal neck anatomy.

Adult ; Aged ; Aged, 80 and over ; Carotid Artery Injuries ; epidemiology ; etiology ; prevention & control ; Catheterization, Central Venous ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Jugular Veins ; anatomy & histology ; Male ; Middle Aged ; Posture ; Prospective Studies ; Risk Factors ; Young Adult

The novel paclitaxel-loaded nanopaticle through surface modification with didodecylmethylammonium bromide (DMAB) was prepared and its prevenative against neointimal formation in a rabbit carotid artery injury model was tested. Paclitaxel-loaded nanoparticles were prepared from oil-water emulsions using biodegradable poly (lactic acid-co-glycolic acid) (PLGA). Specific additive for surface conjugation was added after particle formation. To enhance arterial retention using a cationic surfactant, DMAB, was used. The size and distribution, surface morphology and surface charge of the paclitaxel-loaded nanoparticles were then investigated by laser light scattering, scanning electron microscope and zeta potential analyzer. The drug encapsulation efficiency (EE) and in vitro release profile were measured by high-performance liquid chromatography (HPLC). Balloon injured rabbit carotid arteries were treated with single infusion of the paclitaxel-loaded NP suspension and observed for 28 days. The inhibitory effects of vascular smooth muscle cell migration and proliferation were evaluated as end-point. The NPs showed spherical shape with diameter ranging from 200 to 500 nm. The negatively charged PLGA NPs shifted to positive after the DMAB modification. The in vitro drug release profile showed a triphasic release pattern. 28 days later, morphologic analysis revealed that the inhibitory effect of intima proliferation is dose-dependent, and the 30 mg x mL(-1) nanoparticle concentration suspension could completely inhibit proliferation of intima. Paclitaxel-loaded nanoparticles through surface modification with DMAB provide an effective means of inhibiting proliferation response to vascular injury in the rabbit.
Animals ; Antineoplastic Agents, Phytogenic ; administration & dosage ; chemistry ; therapeutic use ; Carotid Artery Injuries ; etiology ; pathology ; prevention & control ; Catheterization ; adverse effects ; Delayed-Action Preparations ; Drug Compounding ; Drug Delivery Systems ; Female ; Hyperplasia ; prevention & control ; Lactic Acid ; chemistry ; Male ; Nanoparticles ; Nanotechnology ; Paclitaxel ; administration & dosage ; chemistry ; therapeutic use ; Particle Size ; Polyglycolic Acid ; chemistry ; Rabbits ; Tunica Intima ; injuries ; pathology