Carotid baroreceptor reaction after stenting in 2 locations of carotid bulb lesions of different embryologic origin.

BACKGROUND AND PURPOSE: The carotid bulb is innervated by the sinus nerve of Hering, a branch of the glossopharyngeal nerve, derived from the third pharyngeal arch. The aim of this study was to determine the frequency, predictors, and outcome of the carotid BR after carotid stent placement according to the location of the plaque lesion. MATERIALS AND METHODS: Atherosclerotic carotid plaques of apical versus body lesions were prospectively analyzed in 95 consecutive patients who underwent carotid stent placement. Patients with hypertension after stent placement were excluded, and transient (<3 hours) and prolonged (3-24 hours) BR, together with AEs such as strokes and death, were assessed in the 2 lesion locations (apical versus body). Other factors known to affect the carotid baroreceptor were also investigated, and the results were analyzed by χ(2) or Mann-Whitney U tests. RESULTS: Transient BR occurred in 30% of apical lesions in contrast to 70% of body lesions (P = .001). Transient BR showed a significant relationship to lesion location (P = .001), occurring most frequently in body lesions, and to the distance of maximum stenosis from the ICA ostium (P = .001). Hyperperfusion and AE rates (P = .076) in 1 month occurred more frequently in apical lesions. CONCLUSIONS: The frequency of transient BR after carotid stent placement was lower in the apical region of the carotid bulb. Different cardiovascular disturbances after carotid stent placement can be attributed to anatomically different areas of the carotid bulb.

Effect of age and gender on the progression of adult vascular dysfunction in a mouse model of fetal programming lacking endothelial nitric oxide synthase.

The objective of this study was to investigate vascular function at different ages in a transgenic murine model of fetal vascular programming using a model of uteroplacental insufficiency induced by lack of endothelial nitric oxide synthase. Homozygous NOS3 knockout (KO) and wild-type (WT) mice were cross bred to produce WT, KO, and heterozygous that developed in WT (KOP) or KO (KOM) mothers. Male/female offspring from the four groups were killed at 7, 14, and 21 wk of age (n = 5-10/group), and carotid arteries were used for in vitro vascular studies. Responses to phenylephrine (PE), with/without N(G)-nitro-L-arginine methyl ester (L-NAME), angiotensin (ANG), acetylcholine (ACh), sodium nitroprusside, and isoproterenol (ISO) were studied. At 7 wk, only KO offspring showed higher contractile response to PE, whereas, at 14 and 21 wk, both KO and KOM had a higher response. Incubation with L-NAME abolished these differences. ANG contraction was higher in male KO in all age groups and in 21-wk-old females. Relaxation to ACh and ISO was absent in KO, and significantly decreased in KOM offspring in all age groups compared with KOP and WT, independent of gender. Sodium nitroprusside was not different between groups. The effect of the altered intrauterine environment on the development of abnormal vascular function was limited at 7 wk of age and most evident at 14 wk; further deterioration was limited to ANG-mediated vascular contractility in KO offspring. Our findings provide some hope that at least the first seven postnatal weeks may be an appropriate therapeutic window to prevent cardiovascular disease later in life.

Caso clínico radiológico: carótida interna aberrante / Radiologic clinic case: deviant internal carotid

La carótida interna aberrante es una rara malformación congénita. Se presenta el caso de una paciente pediátrica con esta alteración como hallazgo durante la evaluación por imágenes, complementaria de una patología otorrinolaringológica frecuente.

The deviant internal carotid is a unusual congenital malformation. The case of a pediatric patient with this alteration is presented. The finding was made during a rutine image assesment of an ENT disease.

[Internal carotid artery agenesis and multiple aneurysms in the posterior communicating artery]. / Agenesia de la carótida interna y múltiples dilataciones aneurismáticas de la arteria comunicante posterior.

Internal carotid artery agenesia is a rare anomaly of the embryonic development. We present a case with this anomaly and a vascular feeding of this territory out of the contralateral carotid system and the posterior vascular system. There were multiple aneurysms in the right posterior communicating artery, never described before in association with carotid agenesia, that are similar to the angiographic image of the fibromuscular dysplasia ("atypical" pattern). We review and discuss the embryonic development of this anomaly and its relationship with the hemodynamic stress and aneurysm formation.

[A case of carotid superior cerebellar artery anastomosis associated with bilateral hypoplasia of the internal carotid artery represented as the rupture of posterior cerebral artery-posterior communicating artery aneurysm].

A rare case of a variant type of the persistent primitive trigeminal artery associated with bilateral hypoplasia of the internal carotid artery was reported. Left common carotid arteriography revealed a thin left internal carotid artery terminated at the ophthalmic artery. Right common carotid arteriography showed that a narrow internal carotid artery gave off several fine vessels to the cavernous portion, and terminated at the right superior cerebellar artery via the prominent persistent primitive trigeminal artery (PTA). Supraclinoid portions of the bilateral internal carotid arteries were not able to be found. Eventually the entire cerebral hemisphere was supplied by the vertebrobasilar system via the posterior communicating artery. The narrowed supraclinoid portion of the left internal carotid artery was confirmed by surgery of the left posterior cerebellar artery-posterior communicating artery aneurysm. This case may provide an important suggestion about the mechanism of the persistence of the primitive trigeminal artery. In an embryo, at the stage of 5-6mm embryo in size, the posterior communicating artery begins to develop and then PTAs begin to dwindle. If the C1- or C2- portion of the internal carotid artery is gradually occluded, the forebrain, which has to be supplied by the internal carotid system, must be supplied retrogradely by the basilar system via the posterior communicating artery. At this stage, however, the vertebral artery has not developed enough to supply the entire central nervous system. Therefore, the PTA can not regress and this results in the postnatal persistence of the primitive trigeminal artery.

[A case of bilateral spontaneous external carotid-cavernous fistulae with intrahepatic gallbladder (author's transl)]. / Un cas de fistules carotide externe-sinus caverneux bilatérales spontanées avec vésicule intra-hépatique.

A 55-year-old female presented bilateral external ophthalmoplegias and a hypesthesia in the left face and then an intracranial bruit, bilateral conjunctival injections and bilateral chemosis. In her past history, there were right retinal hemorrhage, diabetes mellitus and hypertension but no cranial trauma. The arteriographical aspects were almost identical in both sides: selective external carotid arteriography revealed an opacification of the cavernous sinus through the ascending pharyngeal artery, the accessory meningeal artery and the middle meningeal artery, but the internal carotid arteries and the vertebral arteries did not participate in these fistulae. The association in our case of spontaneous external carotid-cavernous fistulae with intrahepatic gallbladder derived from a developmental arrest in the early stage of embryonic life suggests that spontaneous external carotid-cavernous fistula is derived from communications between extra-cranial vessels and the sinuses in the early stage of embryonic life.