The carotid and vertebral arteries discovery ­ initial findings / A descoberta das artérias carótidas e vertebrais ­ achados iniciais

The studies on the vascular system, including the cervicocephalic arteries (carotid and vertebral arteries), present a long trajectory, having their deep roots in the far past, considering the Western authors, having as representatives the Greek sages Alcmaeon, Diogenes, Hippocrates, Aristoteles, Rufus, and Galenus. They produced pivotal knowledge dissecting mainly cadavers of animals, and established solid bases for the later generations of scholars. The information assembled from these six authors makes it possible to build a quite clear picture of the vascular system, here specifically focused on the cervicocephalic arteries, and mainly of the extracranial segments. Thus, the carotid system became fairly well identified, origin, course, and name, as well as the origin of the still unnamed arteries running through the orifices of the transversal processes of the cervical vertebrae, and entering into the cranium. Almost all that was then known about human anatomy, since this period, and then throughout the Middle Ages, was extrapolated from animal dissections. This state of affairs was maintained until the 14th century, when human corpses dissections were again allowed.

Os estudos do sistema vascular, incluindo as artérias cervicocefálicas (artérias carótidas e vertebrais), apresentam um longo percurso, tendo suas raízes profundas no passado distante, considerando os autores ocidentais, tendo como representantes os doutos gregos Alcméon, Diógenes, Hipócrates, Aristóteles, Rufus e Galenus. Eles produziram conhecimento pivotal, dissecando principalmente cadáveres de animais e estabelecendo bases sólidas para as gerações futuras de estudiosos. A informação reunida desses seis autores permite construir um quadro bastante claro do sistema vascular, aqui focado especificamente nas artérias cervicocefálicas e principalmente nos seus segmentos extracranianos. Assim, o sistema carotídeo ficou bastante bem identificado, origem, trajeto e nome, assim como a origem das ainda não nomeadas artérias que percorrem os orifícios dos processos transversos das vértebras cervicais e entrando no crânio. Quase tudo que era conhecido sobre anatomia humana, desde esse período, e depois ao longo da Idade Média, foi extrapolado a partir de dissecções de animais. Esse estado de coisas foi mantido até o século 14, quando a dissecção de cadáveres humanos foi novamente permitida.

Anatomical description and variations of the anterior arterial brain circulation in Colombian cadaveric specimens / Descripción anatómica y variaciones de la circulación cerebral arterial anterior en especímenes cadavéricos colombianos

SUMMARY: Understanding microsurgical neuroanatomy is a fundamental part of the training of neurosurgeons. Notwithstanding the fact that throughout history the study in cadavers has been a fundamental part of training, the publication of these studies has never marked a trend, and in our country the available studies are limited. A descriptive anatomical study was carried out on 22 specimens regarding the anatomical arrangement of the anterior circulation arteries of the brain and the most frequent anatomical variants in the sample used. To this end, bilateral pterional and bifrontal approaches were performed, obtaining a total of 132 arteries, including supraclinoid internal carotid arteries (ICA), anterior cerebral arteries in their A1 segment (ACA), and middle cerebral arteries in their M1 segment (MCA). measurements in each of these segments were made and anatomical variants were documented. Out of 22 cadaveric specimens, 17 (77 %) were male. the mean age was 59 years (range 36-81 years). Internal carotid artery mean length was 12.73 and 12.86 in the right and left side respectively. Anatomical variants identified were hypoplasia of segment A1 in 1 (4.5 %) specimen, duplication in 1 (4.5 %) and trifurcation of segment M1 in 3 (13.6 %) specimens. A similarity was found between our data and data reported by literature, with some differences, especially in the anterior communicating artery.

RESUMEN: Entender la neuroanatomía microquirúrgica es una parte fundamental de la formación de los neurocirujanos. A pesar de que, durante la historia, el estudio en cadáveres ha sido parte fundamental del entrenamiento, no ha sido tendencia la publicación de estos estudios, y en nuestro país son limitados los que se encuentran. Se realizó un estudio descriptivo anatómico en 22 especímenes acerca de la disposición anatómica de las arterias de la circulación cerebral anterior y las variantes anatómicas más frecuentes en población colombiana. Para dicho objetivo se realizaron abordajes bilaterales pterionales, y bifrontales obteniendo un total de 132 arterias incluyendo las arterias carotídeas internas supraclinoideas (ACI), arterias cerebrales anteriores en su segmento A1 (ACA) y las arterias cerebrales medias en su segmento M1 (ACM), se realizaron mediciones en cada uno de estos segmentos y se documentaron las variantes anatómicas. De los 22 especímenes cadavéricos, 17 (77 %) eran masculinos, la edad media fue de 59 años (rango 36-81 años). La longitud media de la arteria carótida interna fue de 12,73 mm en el lado derecho y de 12,86 mm en el lado izquierdo. Las variantes anatómicas identificadas fueron hipoplasia del segmento A1 en 1 (4,5 %), duplicación de A1 en 1 (4,5 %) y trifurcación del segmento M1 en 3 (13,6 %) muestras. Se encontró una similitud entre nuestros datos y los reportados por la literatura, con algunas diferencias, especialmente en el segmento de la arteria comunicante anterior.

Comparison of right and left common carotid arteries of horses and mules by two-dimensional ultrasound and Doppler flow / Comparação das artérias carótidas comuns direita e esquerda dos gêneros de equinos e muares por ultrassonografia bidimensional e Dopplerfluxométrico

In ultrasonography, the bi-dimensional mode (B-mode) allows the morphological and morphometric evaluation of several types of organs and tissues, while the Doppler mode allows the hemodynamic evaluation. In humans, the Doppler evaluation is routinely used in the assessment of important arteries and veins, such as the carotid arteries and jugular veins, with significant differences between genres and sides. However, in veterinary medicine, this diagnostic method is not yet well established in the evaluation of the carotid arteries, with only few reports in domestic horses. This study aims to compare the right and left common carotid arteries of domestic horses and mules using bi-dimensional and Doppler ultrasound evaluation. The common carotid arteries from 10 domestic horses (five males and five females) and 10 mules (five males and five females) were evaluated. The following variables were measured at three different portions (cranial, middle and caudal): diameter, intima-media thickness (IMT), resistivity index (RI), pulsatility index (PI), peak of systolic velocity (pSV) and final diastolic velocity (fDV). No significant differences were observed in the bi-dimensional variables (diameter and IMT) between the common carotid arteries of horses and mules, regardless of gender (p>0.05). In Doppler mode, there were no significant differences between carotid values in male and female horses (p> 0.05). In the mules, it was only possible to observe differences between the RI and PI values (p<0.05), being higher on the left side (0.81 and 2.04 respectively), and the fDV (p<0.05) higher, on the right side (14.35) in males. As for females, there was only in fDV (p<0.05), with the upper right side (23.16). Diameters and IMT do not differ between sides in horses and mules in B-mode ultrasound. Spectral Doppler in horses does not differ between sides, regardless of gender. As for mules, males differ in RI, PI and fDV between sides, while females differ only in fDV.(AU)

Na ultrassonografia, o modo bidimensional (modo B) permite a avaliação morfológica e morfométrica de vários tipos de órgãos e tecidos, enquanto o modo Doppler permite a avaliação hemodinâmica. Em humanos, a avaliação com Doppler é usada rotineiramente na avaliação de artérias e veias importantes, como as artérias carótidas e veias jugulares, com diferenças significativas entre gêneros e lados. No entanto, em medicina veterinária, este método diagnóstico ainda não está bem estabelecido na avaliação das artérias carótidas, com apenas poucos relatos em equinos domésticos. Este estudo tem como objetivo comparar as artérias carótidas comuns direita e esquerda de equinos e mulas domésticos, utilizando a avaliação bidimensional (modo B) e por ultrassonografia Doppler espectral. Avaliaram-se as artérias carótidas comuns de 10 equinos domésticos (cinco machos e cinco fêmeas) e 10 mulas (cinco machos e cinco fêmeas). As seguintes variáveis foram medidas em três porções diferentes (cranial, médio e caudal): diâmetro, espessura íntima-média (IMT), índice de resistividade (RI), índice de pulsatilidade (PI), pico de velocidade sistólica (pSV) e velocidade diastólica final (fDV). Não foram observadas diferenças significativas nas variáveis bidimensionais (diâmetro e IMT) entre as artérias carótidas comuns de cavalos e muares, independentemente do gênero (p>0,05). No modo Doppler, não houve diferenças significativas entre os valores para carótidas em equinos machos e fêmeas (p>0,05). Nos muares, só foi possível observar diferenças entre os valores de RI e PI (p<0,05), sendo maiores no lado esquerdo (0,81 e 2,04 respectivamente), e o fDV (p<0,05) superior no lado direito (14,35) nos machos. Quanto as fêmeas, houve apenas no fDV (p<0,05), sendo o lado direito superior (23,16). Os diâmetros e IMT não diferem entre os lados em equinos e muares na ultrassonografia modo B. Já o Doppler espectral nos equinos não difere entre os lados, independentemente do gênero. Quanto aos muares, os machos diferenciam no IR, IP e fDV entre os lados, enquanto as fêmeas apenas para fDV.(AU)

Grayscale histogram analysis to study the echogenicity and echotexture of the walls of the common carotid arteries of horses and mules / Análise por histograma em escala de cinza para estudo da ecogenicidade e ecotextura das paredes das artérias carótidas comuns de equinos e muares

Visual inspection of ultrasound examination for assessment of echogenicity and echotexture of blood vessel tissues is a technique routinely used in medical practice in humans. However, simple visual inspection can lead to poor quality diagnoses and errors. The use of grayscale histogram (GSH) analysis has proved to be an efficient technique to quantify the region of interest, allowing minimization of image interpretation errors. This study aimed to evaluate and compare the echogenicity and echotexture of the walls of the common carotid arteries of healthy female horses and mules using the GSH technique and correlate them with age, body mass, and vessel diameters. B-mode ultrasound examinations were performed in the left and right common carotid arteries in three regions (cranial, middle, and caudal) in 11 horses and 11 healthy mules. The GSH of the animals showed heterogeneous walls, but did not differentiate statistically between female horses and mules. The Mean variable of the middle right, middle left and caudal right sides showed differences, more significant in the mules. On the middle right side, the Min variable was different, higher in the mules. On the middle and caudal left side, the variables Max and Mode showed higher values in the mules. For the mules, the age factor presented negative correlation with the Mean, Mode,, Mode(Count), and Mode(Count)/Count(%) variables, and the body mass factor presented negative correlation with the Mode, Mean and Max variables. For the female horses, the body mass factor showed positive correlation with the Mean and Mode variables. Echogenicity of the carotid artery walls differed between female horses and mules, whereas echotexture was heterogeneous and statistically similar among the animals. The age and body mass factors inversely influenced the echogenicity of the mules, but were not significant in the female horses, in which only the body mass factor positively influenced echogenicity.(AU)

A técnica de avaliação da ecogenicidade e ecotextura dos tecidos dos vasos sanguíneos por inspeção visual do exame de ultrassonografia, já é uma prática da rotina médica em humanos. No entanto, a simples visualização manual pode induzir à erros e diagnósticos de pouca qualidade. O uso de análise por histograma em escala de cinza (HEC) tem se demostrado uma eficiente técnica para quantificar a região avaliada, permitindo minimizar erros de interpretação. O objetivo deste trabalho foi avaliar e comparar a ecogenicidade e ecotextura das paredes das artérias carótidas comuns das fêmeas equina e muares hígidos usando a técnica de HEC, e correlacioná-las com a idade, massa corpórea e diâmetros dos vasos. Exames de ultrassonografia modo-B foram realizados nas artérias carótidas comuns esquerda e direita em três regiões (cranial, médio e caudal) em 11 fêmeas equina e 11 muares hígidos. O HEC dos animais apresentou paredes heterogêneas, mas não diferenciaram estatisticamente entre fêmeas equinas e muares. A variável Mean do lado direito médio, esquerdo médio e caudal apresentou diferenças, sendo maiores nos muares. No lado direito médio, o Min foi diferente, sendo superior nos muares. Já para o lado esquerdo médio e caudal, as variáveis Max e Mode apresentaram valores maiores nos muares. Para os muares, o fator idade apresentou correlação negativa com Mean, Mode, Mode (Count) e Mode(Count)/Count (%) e o fator massa corpórea apresentou correlação negativa com Mode, Mean e Max. Para as fêmeas equinas o fator massa corpórea apresentou correlação positiva com Mean e Mode. A ecogenicidade das paredes das artérias carótidas diferiram entre fêmeas equina e muares, já a ecotextura foi heterogênea e semelhante estatisticamente entre os animais. A idade e a massa corpórea influenciaram inversamente na ecogenicidade dos muares, enquanto que nas fêmeas equina a idade não foi significativa, apenas a massa corpórea influenciou positivamente com a ecogenicidade.(AU)

Grayscale histogram analysis to study the echogenicity and echotexture of the walls of the common carotid arteries of horses and mules / Análise por histograma em escala de cinza para estudo da ecogenicidade e ecotextura das paredes das artérias carótidas comuns de equinos e muares

Visual inspection of ultrasound examination for assessment of echogenicity and echotexture of blood vessel tissues is a technique routinely used in medical practice in humans. However, simple visual inspection can lead to poor quality diagnoses and errors. The use of grayscale histogram (GSH) analysis has proved to be an efficient technique to quantify the region of interest, allowing minimization of image interpretation errors. This study aimed to evaluate and compare the echogenicity and echotexture of the walls of the common carotid arteries of healthy female horses and mules using the GSH technique and correlate them with age, body mass, and vessel diameters. B-mode ultrasound examinations were performed in the left and right common carotid arteries in three regions (cranial, middle, and caudal) in 11 horses and 11 healthy mules. The GSH of the animals showed heterogeneous walls, but did not differentiate statistically between female horses and mules. The Mean variable of the middle right, middle left and caudal right sides showed differences, more significant in the mules. On the middle right side, the Min variable was different, higher in the mules. On the middle and caudal left side, the variables Max and Mode showed higher values in the mules. For the mules, the age factor presented negative correlation with the Mean, Mode,, Mode(Count), and Mode(Count)/Count(%) variables, and the body mass factor presented negative correlation with the Mode, Mean and Max variables. For the female horses, the body mass factor showed positive correlation with the Mean and Mode variables. Echogenicity of the carotid artery walls differed between female horses and mules, whereas echotexture was heterogeneous and statistically similar among the animals. The age and body mass factors inversely influenced the echogenicity of the mules, but were not significant in the female horses, in which only the body mass factor positively influenced echogenicity.(AU)

A técnica de avaliação da ecogenicidade e ecotextura dos tecidos dos vasos sanguíneos por inspeção visual do exame de ultrassonografia, já é uma prática da rotina médica em humanos. No entanto, a simples visualização manual pode induzir à erros e diagnósticos de pouca qualidade. O uso de análise por histograma em escala de cinza (HEC) tem se demostrado uma eficiente técnica para quantificar a região avaliada, permitindo minimizar erros de interpretação. O objetivo deste trabalho foi avaliar e comparar a ecogenicidade e ecotextura das paredes das artérias carótidas comuns das fêmeas equina e muares hígidos usando a técnica de HEC, e correlacioná-las com a idade, massa corpórea e diâmetros dos vasos. Exames de ultrassonografia modo-B foram realizados nas artérias carótidas comuns esquerda e direita em três regiões (cranial, médio e caudal) em 11 fêmeas equina e 11 muares hígidos. O HEC dos animais apresentou paredes heterogêneas, mas não diferenciaram estatisticamente entre fêmeas equinas e muares. A variável Mean do lado direito médio, esquerdo médio e caudal apresentou diferenças, sendo maiores nos muares. No lado direito médio, o Min foi diferente, sendo superior nos muares. Já para o lado esquerdo médio e caudal, as variáveis Max e Mode apresentaram valores maiores nos muares. Para os muares, o fator idade apresentou correlação negativa com Mean, Mode, Mode (Count) e Mode(Count)/Count (%) e o fator massa corpórea apresentou correlação negativa com Mode, Mean e Max. Para as fêmeas equinas o fator massa corpórea apresentou correlação positiva com Mean e Mode. A ecogenicidade das paredes das artérias carótidas diferiram entre fêmeas equina e muares, já a ecotextura foi heterogênea e semelhante estatisticamente entre os animais. A idade e a massa corpórea influenciaram inversamente na ecogenicidade dos muares, enquanto que nas fêmeas equina a idade não foi significativa, apenas a massa corpórea influenciou positivamente com a ecogenicidade.(AU)

B-mode and Doppler ultrasonography in the assessment of the common carotid arteries of equines and mules and the relation with body mass, age and neck circumference / Estudo de ultrassonografia modo-B e Doppler na avaliação das artérias carótidas comuns de equinos e muares e a relação com o peso, idade e a circunferência do pescoço

As age increases, changes in cardiovascular anatomy and physiology occur, even in the absence of disease. Thus, studies of vessel hemodynamics are considered primordial to detect any cardiovascular changes. The objective of this study has been to describe the parameters of B-mode and spectral Doppler ultrasonography in the evaluation of the common carotid arteries of 11 equine and 11 mules, and correlate with age, body mass and neck circumferences. The diameters, intima - media thickness (IMT), resistivity index (RI), pulsatility index (PI), systolic velocity (SV), diastolic velocity (DV), maximum velocity (MV), vascular flow index (VFI), body mass, age, circumference and neck length. Ultrasonographic variables were evaluated in three different region called cranial, middle and caudal. Equine females presented higher values regarding the body mass, age and neck length, as compared to the neck circumferences of the animals, those of the mules were superior. The age of the mules had a positive correlation with the body mass, diameter and neck circumferences, it has a negative correlation between age and vessel diameters. The body mass of the mules had a positive correlation with age and vessel diameters, and with vessel diameters and neck circumferences in equine females. The RI and PI variables had a positive correlation with body mass for mules, and with age for equine females. The DV had a negative correlation with body mass for both equine and mule females. Regarding the variables MV and VFI, age correlated negatively for mules, while it was not significant for equine females. It found a difference between equine females and mules in the correlations performed, with body mass, age, neck circumferences and between B-mode and Doppler ultrasonography variables.(AU)

Com o aumento da idade ocorrem alterações na anatomia e fisiologia cardiovascular, mesmo na ausência de doenças. Assim, os estudos da hemodinâmica dos vasos são considerados primordiais para detectar quaisquer alterações cardiovasculares. Esse trabalho tem como objetivo descrever as variáveis de ultrassonografia modo-B e Doppler espectral na avaliação das artérias carótidas comuns de 11 fêmeas equinas e 11 muares, e correlacionar com idade, massa corpórea e circunferências dos pescoços. Para tais procedimentos foram avaliados os diâmetros, espessura da camada íntima média (EIM), índice de resistividade (IR), índice de pulsatilidade (IP), velocidade sistólica (VS), velocidade diastólica (VD), velocidade máxima (VM), índice de vascularização de fluxo (IVF), massa corpórea, idade, circunferências e comprimentos dos pescoços. As variáveis ultrassonográficas foram avaliadas em três regiões diferentes denominados de crania médio e caudal. As fêmeas equinas apresentaram valores maiores referente ao massa corpórea, idade e comprimento dos pescoços, já em relação às circunferências dos pescoços dos animais, as dos muares foram superiores. A idade dos muares possuiu correlação positiva com a massa corpórea, diâmetro e com as circunferências dos pescoços, com as fêmeas equinas, possui correlação negativa entre idade e os diâmetros dos vasos. A massa corpórea dos muares teve correlação positiva com idade e diâmetros dos vasos, já às fêmeas equinas com diâmetros dos vasos e as circunferências dos pescoços. As variáveis IR e IP tiveram correlação positiva com a massa corpórea para os muares, e com idade para fêmeas equinas. O VD teve correlação negativa com a massa corpórea tanto para as fêmeas equinas quanto nos muares. Já as variáveis VM e IVF, a idade correlacionou negativamente para os muares, enquanto não foi significativo para as fêmeas equinas. Averiguou diferença entre fêmeas equinas e muares nas correlações realizadas, com a massa corpórea, idade, circunferências dos pescoços e entre as variáveis da ultrassonografia modo-B e Doppler.(AU)

B-mode and Doppler ultrasonography in the assessment of the common carotid arteries of equines and mules and the relation with body mass, age and neck circumference / Estudo de ultrassonografia modo-B e Doppler na avaliação das artérias carótidas comuns de equinos e muares e a relação com o peso, idade e a circunferência do pescoço

As age increases, changes in cardiovascular anatomy and physiology occur, even in the absence of disease. Thus, studies of vessel hemodynamics are considered primordial to detect any cardiovascular changes. The objective of this study has been to describe the parameters of B-mode and spectral Doppler ultrasonography in the evaluation of the common carotid arteries of 11 equine and 11 mules, and correlate with age, body mass and neck circumferences. The diameters, intima - media thickness (IMT), resistivity index (RI), pulsatility index (PI), systolic velocity (SV), diastolic velocity (DV), maximum velocity (MV), vascular flow index (VFI), body mass, age, circumference and neck length. Ultrasonographic variables were evaluated in three different region called cranial, middle and caudal. Equine females presented higher values regarding the body mass, age and neck length, as compared to the neck circumferences of the animals, those of the mules were superior. The age of the mules had a positive correlation with the body mass, diameter and neck circumferences, it has a negative correlation between age and vessel diameters. The body mass of the mules had a positive correlation with age and vessel diameters, and with vessel diameters and neck circumferences in equine females. The RI and PI variables had a positive correlation with body mass for mules, and with age for equine females. The DV had a negative correlation with body mass for both equine and mule females. Regarding the variables MV and VFI, age correlated negatively for mules, while it was not significant for equine females. It found a difference between equine females and mules in the correlations performed, with body mass, age, neck circumferences and between B-mode and Doppler ultrasonography variables.(AU)

Com o aumento da idade ocorrem alterações na anatomia e fisiologia cardiovascular, mesmo na ausência de doenças. Assim, os estudos da hemodinâmica dos vasos são considerados primordiais para detectar quaisquer alterações cardiovasculares. Esse trabalho tem como objetivo descrever as variáveis de ultrassonografia modo-B e Doppler espectral na avaliação das artérias carótidas comuns de 11 fêmeas equinas e 11 muares, e correlacionar com idade, massa corpórea e circunferências dos pescoços. Para tais procedimentos foram avaliados os diâmetros, espessura da camada íntima média (EIM), índice de resistividade (IR), índice de pulsatilidade (IP), velocidade sistólica (VS), velocidade diastólica (VD), velocidade máxima (VM), índice de vascularização de fluxo (IVF), massa corpórea, idade, circunferências e comprimentos dos pescoços. As variáveis ultrassonográficas foram avaliadas em três regiões diferentes denominados de crania médio e caudal. As fêmeas equinas apresentaram valores maiores referente ao massa corpórea, idade e comprimento dos pescoços, já em relação às circunferências dos pescoços dos animais, as dos muares foram superiores. A idade dos muares possuiu correlação positiva com a massa corpórea, diâmetro e com as circunferências dos pescoços, com as fêmeas equinas, possui correlação negativa entre idade e os diâmetros dos vasos. A massa corpórea dos muares teve correlação positiva com idade e diâmetros dos vasos, já às fêmeas equinas com diâmetros dos vasos e as circunferências dos pescoços. As variáveis IR e IP tiveram correlação positiva com a massa corpórea para os muares, e com idade para fêmeas equinas. O VD teve correlação negativa com a massa corpórea tanto para as fêmeas equinas quanto nos muares. Já as variáveis VM e IVF, a idade correlacionou negativamente para os muares, enquanto não foi significativo para as fêmeas equinas. Averiguou diferença entre fêmeas equinas e muares nas correlações realizadas, com a massa corpórea, idade, circunferências dos pescoços e entre as variáveis da ultrassonografia modo-B e Doppler.(AU)

Histological verification of atherosclerosis due to bends and bifurcations in carotid arteries predicted by hemodynamic model / Confirmação histológica de aterosclerose devido a dobras e bifurcações das artérias carótidas previstas por modelo hemodinâmico

Tortuosity and bifurcations in carotid arteries alter the blood flow, causing atherosclerosis. Objectives:The aim of the present study is to analyze the effect of variant vascular anatomy in the cervical region on development of atherosclerosis by microanatomical examination. Methods: The effect of blood flow at anomalous bends and bifurcations was observed in right carotid arteries of a seventy year old female cadaver. Fifteen histological slides were prepared from the carotid arteries and interpreted to verify predictions of atherosclerosis. Results: The model predicts atherosclerosis at bends, bifurcations and large aperture arteries. Microanatomical examination revealed presence of atherosclerosis of varying thickness at the bends and bifurcation in the right carotid arteries, as predicted. Atherosclerosis was also detected in the straight part of the wider common carotid artery. No atherosclerosis was observed in the contralateral carotid arteries. The variant carotid vascular anatomy consisting of bends, bifurcations and wider arteries revealed that the shear stress and velocity of blood flow are reduced at these anomalous sites. Conclusions: Anatomical anomalies such as bends and branching in the carotid arteries alter the irrigation pattern and generate biomechanical forces that cause turbulent flow and reduce shear stress/blood flow velocity. Decreased shear stress and velocity causes development of atherosclerosis. Histological slides established the presence of atherosclerosis at bends and bifurcations and in wider arteries

Tortuosidade e bifurcações das artérias carótidas alteram o fluxo sanguíneo, causando aterosclerose. Objetivos: O objetivo do presente estudo foi analisar o efeito de anatomia vascular variante na região cervical sobre o desenvolvimento de aterosclerose via exame microanatômico. Métodos: O efeito do fluxo sanguíneo em dobras e bifurcações anômalas foi observado nas artérias carótidas do lado direito em um cadáver do sexo feminino de 70 anos de idade. Quinze lâminas histológicas foram preparadas a partir das artérias carótidas e interpretadas para confirmar as previsões de aterosclerose. Resultados: O modelo prevê aterosclerose em dobras, bifurcações e artérias de grande calibre. O exame microanatômico revelou a presença de aterosclerose de densidades variáveis nas dobras e bifurcação das artérias carótidas do lado direito, conforme previsto. Aterosclerose também foi detectada na parte reta da artéria carótida comum mais larga. Não foi observada aterosclerose nas artérias carótidas contralaterais. A anatomia vascular carotídea variante consistindo de dobras, bifurcações e artérias mais largas revelou que a tensão de cisalhamento (shear stress) e a velocidade do fluxo sanguíneo são reduzidos nesses pontos anômalos. Conclusões: Anomalias anatômicas tais como dobras e ramificações das artérias carótidas alteram o padrão de irrigação e geram forças biomecânicas que causam fluxo turbulento e reduzem a tensão de cisalhamento e a velocidade do fluxo. Tensão e velocidade menores causam o desenvolvimento de aterosclerose. As lâminas histológicas estabeleceram a presença de aterosclerose nas dobras e bifurcações nas artérias mais largas

Localization of the carotid bifurcation according to hyoid bone and mandibular angle / Localización de la bifurcación carotídea según el hueso hióides y el ángulo mandibular

The aim of this study was to determine the carotid bifurcation level in relation with the hyoid bone and mandibular angle. Common carotid artery is the largest artery in the neck, and it gives off two terminal branches, namely external and internal carotid arteries. The bifurcation level of it shows variations, however it is usually situated at the level of C4 vertebra or at the upper border of thyroid cartilage. On the other hand, carotid bifurcation may be situated as low as T3 vertebra, or as high as the level of hyoid bone. In this study, conventional angiographic images of 112 patients were used. The distances of carotid bifurcation to hyoid bone and mandibular angle were measured on those images. In addition, right and left side difference was determined. The distance of carotid bifurcation level to the mandibular angle was measured as 21.26 ± 8.57 mm on the right and 20.25 ± 8.75 mm on the left side in males, and 19.72 ± 8.89 on the right, and 18.5 ± 9.25 mm on the left side in females. Distance between the carotid bifurcation level and hyoid bone ranged 1.94 ± 12.69 mm in female and 3.04 ± 9.00 mm in male on the left side. Having information about the level of carotid bifurcation is important in surgical and radiological procedures for determining the appropriate surgical procedure, and to prevent complications. We believe that the results of this study will shed light to planning of all interventions concerning common carotid artery.

El objetivo de este estudio fue determinar el nivel de bifurcación carotídea en relación con el hueso hioides y el ángulo de la mandíbula. La arteria carótida común es la arteria más grande del cuello, y tiene dos ramas terminales, las arterias carótidas externa e internas. El nivel de bifurcación muestra variaciones, sin embargo suele situarse a nivel de la cuarta vértebra cervical o en el margen superior del cartílago tiroideo. Por otro lado, la bifurcación carotídea puede estar situada tan baja como a nivel de la tercera vértebra torácica, o tan alta como a nivel del hueso hioides. En este estudio se utilizaron imágenes angiográficas convencionales de 112 pacientes. Se midieron las distancias de la bifurcación carotídea con el hueso hioides y el ángulo de la mandíbula en esas imágenes. Además, se determinó la diferencia entre los lados derecho e izquierdo. La distancia entre el nivel de bifurcación carotídea y el ángulo de la mandíbula se midió, siendo de 21,26 ± 8,57 mm a la derecha y 20,25 ± 8,75 mm en el lado izquierdo, en los hombres, y 19,72 ± 8,89 a la derecha y 18,5 ± 9,25 mm a la izquierda en mujeres. La distancia entre el nivel de bifurcación de la carótida y el hueso hioides osciló entre 1,94 ± 12,69 mm en mujeres y, 3,04 ± 9,00 mm en hombres, en el lado izquierdo. La información sobre el nivel de bifurcación carotídea es importante en los procedimientos quirúrgicos y radiológicos para determinar el procedimiento quirúrgico apropiado y prevenir complicaciones. Creemos que los resultados de este estudio arrojarán luz a la planificación de las intervenciones relacionadas con la arteria carótida común.

Assessment of Intima-Media Thickness in Healthy Children Aged 1 to 15 Years / Avaliação da Espessura Médio-Intimal em Crianças Saudáveis entre 1 e 15 Anos

Abstract Background: Carotid intima-media thickness (CIMT) has been shown to be increased in children and adolescents with traditional cardiovascular risk factors such as obesity, hypertension, and chronic kidney disease, compared with those of healthy children. Objective: To assess the influence of sex, age and body mass index (BMI) on the CIMT in healthy children and adolescents aged 1 to 15 years. Methods: A total of 280 healthy children and adolescents (males, n=175; mean age, 7.49±3.57 years; mean BMI, 17.94±4.1 kg/m2) were screened for CIMT assessment. They were divided into 3 groups according to age: GI, 1 to 5 years [n=93 (33.2%); males, 57; mean BMI, 16±3 kg/m2]; GII, 6 to 10 years [n=127 (45.4%); males, 78; mean BMI, 17.9±3.7 kg/m2], and GIII, 11 to 15 years [n=60 (21.4%); males, 40; mean BMI, 20.9±4.5 kg/m2]. Results: There was no significant difference in CIMT values between male and female children and adolescents (0.43±0.06 mm vs. 0.42±0.05 mm, respectively; p=0.243). CIMT correlated with BMI neither in the total population nor in the 3 age groups according to Pearson correlation coefficient. Subjects aged 11 to 15 years had the highest CIMT values (GI vs. GII, p=0.615; GI vs. GIII, p=0.02; GII vs. GIII, p=0.004). Conclusions: CIMT is constant in healthy children younger than 10 years, regardless of sex or BMI. CIMT increases after the age of 10 years.

Resumo Fundamentos: A espessura médio-intimal (EMI) na artéria carótida comum tem se mostrado aumentada em crianças e adolescentes com fatores de risco tradicionais, como obesidade, hipertensão e doença renal crônica, quando comparada à de crianças saudáveis. Objetivos: Avaliar a influência do sexo, idade e índice de massa corpórea (IMC) sobre a EMI em crianças e adolescentes saudáveis entre 1 e 15 anos de idade. Métodos: Este estudo incluiu 280 indivíduos saudáveis (sexo masculino, n=175; idade, 7,49±3,57 anos; IMC, 17,94±4,1 kg/m2), que foram divididos em 3 grupos de acordo com a faixa etária: GI, crianças de 1 a 5 anos [n=93 (33,2%); sexo masculino, 57; IMC, 16±3 kg/m2]; GII, crianças de 6 a 10 anos [n=127 (45,4%); sexo masculino, 78; IMC, 17,9±3,7 kg/m2]; e GIII, crianças de 11 a 15 anos [n=60 (21,4%); sexo masculino, 40; IMC, 20,9±4,5 kg/m2]. Resultados: Não houve diferença significativa nos valores da EMI entre os sexos (masculino, 0,43±0,06 mm; feminino, 0,42±0.05 mm; p=0,243). A EMI não se correlacionou com o IMC na população total ou nos 3 grupos de acordo com o coeficiente de correlação de Pearson. Crianças entre 11 e 15 anos apresentaram maiores valores de EMI (GI vs. GII, p=0,615; GI vs. GIII, p=0,02; GII vs. GIII, p=0,004). Conclusões: Independentemente de sexo e IMC, a EMI é constante em crianças saudáveis abaixo dos 10 anos de idade, aumentando a partir daí.

Assessment of Intima-Media Thickness in Healthy Children Aged 1 to 15 Years.

BACKGROUND: Carotid intima-media thickness (CIMT) has been shown to be increased in children and adolescents with traditional cardiovascular risk factors such as obesity, hypertension, and chronic kidney disease, compared with those of healthy children. OBJECTIVE: To assess the influence of sex, age and body mass index (BMI) on the CIMT in healthy children and adolescents aged 1 to 15 years. METHODS: A total of 280 healthy children and adolescents (males, n=175; mean age, 7.49±3.57 years; mean BMI, 17.94±4.1 kg/m2) were screened for CIMT assessment. They were divided into 3 groups according to age: GI, 1 to 5 years [n=93 (33.2%); males, 57; mean BMI, 16±3 kg/m2]; GII, 6 to 10 years [n=127 (45.4%); males, 78; mean BMI, 17.9±3.7 kg/m2], and GIII, 11 to 15 years [n=60 (21.4%); males, 40; mean BMI, 20.9±4.5 kg/m2]. RESULTS: There was no significant difference in CIMT values between male and female children and adolescents (0.43±0.06 mm vs. 0.42±0.05 mm, respectively; p=0.243). CIMT correlated with BMI neither in the total population nor in the 3 age groups according to Pearson correlation coefficient. Subjects aged 11 to 15 years had the highest CIMT values (GI vs. GII, p=0.615; GI vs. GIII, p=0.02; GII vs. GIII, p=0.004). CONCLUSIONS: CIMT is constant in healthy children younger than 10 years, regardless of sex or BMI. CIMT increases after the age of 10 years.

Carotid rete mirabile associated with subarachnoid hemorrhage from intracranial aneurysm: A case report and systematic review.

Carotid rete mirabile (CRM) is a rare physiological vascular network in humans that is most often found in Eastern populations. This paper describes a CRM associated with an aneurysmal subarachnoid hemorrhage (aSAH) and discusses the details of the patient's treatment. A 28-year-old woman was admitted to our service with clinical signs and symptoms of a spontaneous aSAH. Computed tomography revealed a diffuse and extensive SAH (Fisher group IV), while an angiogram showed an abnormal collateral network in the right carotid system and a hypoplastic aspect to the internal carotid artery (ICA) on the same side. In addition, a saccular aneurysm with a diameter of 9.5 mm was present in the ophthalmic segment of the left ICA. This case is extremely uncommon. To avoid rebleeding in the patient, we successfully treated the patient by clipping the aneurysmal lesion. No procedure was performed for the CRM.

Association between cardiovascular risk factors and carotid intima-media thickness in prepubertal Brazilian children.

BACKGROUND: Early exposure to cardiovascular risk factors creates a chronic inflammatory state that could damage the endothelium followed by thickening of the carotid intima-media. OBJECTIVE: To investigate the association of cardiovascular risk factors and thickening of the carotid intima. SUBJECTS/METHODS: Media in prepubertal children. In this cross-sectional study, carotid intima-media thickness (cIMT) and cardiovascular risk factors were assessed in 129 prepubertal children aged from 5 to 10 year. Association was assessed by simple and multivariate logistic regression analyses. RESULTS: In simple logistic regression analyses, body mass index (BMI) z-score, waist circumference, and systolic blood pressure (SBP) were positively associated with increased left, right, and average cIMT, whereas diastolic blood pressure was positively associated only with increased left and average cIMT (p<0.05). In multivariate logistic regression analyses increased left cIMT was positively associated to BMI z-score and SBP, and increased average cIMT was only positively associated to SBP (p<0.05). CONCLUSIONS: BMI z-score and SBP were the strongest risk factors for increased cIMT.

Carotid intima-media thickness at age 30, birth weight, accelerated growth during infancy and breastfeeding: a birth cohort study in Southern Brazil.

OBJECTIVE: To examine the relationship between carotid intima-media thickness (IMT) at age 30 and birth characteristics, growth during infancy, and breastfeeding duration, among subjects who have been prospectively followed since birth. METHODS AND RESULTS: In 1982, all births in the city of Pelotas, southern Brazil, were identified and those children (n = 5,914) whose families lived in the urban area of the city have been followed and evaluated at several time points. The cohort participants were evaluated in 2012-13, and IMT was measured at the posterior wall of the right and left common carotid arteries in longitudinal planes using ultrasound imaging. We obtained valid IMT measurements for 3,188 individuals. Weight-for-age z-score (WAZ) at age 2 years, weight-for-height z-score (WHZ) at age 4, height-for-age z-score (HAZ) at 4 years, WAZ at age 4 and relative conditional weight at 4 years were positively associated with IMT, even after controlling for confounding variables. The beta-coefficient associated with ≥ 1 s.d. WAZ at age 2 (compared to those with a <-1 s.d.) was 3.62 µm (95% CI 0.86 to 6.38). The beta-coefficient associated with ≥ 1 s.d. WHZ at 4 (in relation to <-1 s.d) was 3.83 µm (95% CI 0.24 to 7.42). For HAZ at 4, the beta-coefficient for ≥ 1 s.d. in relation to <-1 s.d. was 4.19 µm (95% CI 1.14 to 7.25). For WAZ at 4, the beta-coefficient associated with ≥ 1 s.d. in relation to <-1 s.d. was 4.28 µm (95% CI 1.59 to 6.97). The beta-coefficient associated with conditional weight gain at age 2-4 was 1.26 µm (95% CI 0.49 to 2.02). CONCLUSION: IMT at age 30 was positively associated with WAZ at age 2 years, WHZ at age 4, HAZ at age 4, WAZ at age 4 and conditional weight gain at age 4 years.

Sistemática para el estudio Doppler de carótidas / Systematic assessment in carotid doppler ultrasound

La exploración de los ejes carotideo y vertebral resulta sencilla técnicamente, con un aprendizaje relativamente rápido para el que inicia la actividad, especialmente si se establecen protocolos de exámenes estandarizados y fácilmente reproducibles. El objetivo de la sistematización en los servicios de Doppler vascular es que los exámenes realizados por distintos operadores sean similares en cuanto a la técnica y la terminología del informe; a nivel docente la sistematización ofrece al neófito una metodología clara a seguir con el fin de completar las evaluaciones y solidificar el proceso de aprendizaje.

Morfologia dos vasos da base do encéfalo do quati (Nasua nasua) / Morphology of the main vessels of the coati brain (Nasua nasua)

Estudou-se a morfologia do encéfalo de Nasua nasua - quati, buscando comparar estes achados com outras espécies já descritos. Foram utilizados cinco encéfalos de quatis, provenientes do Criatório Científico (Cecrimpas), Unifeob. Os animais foram eutanásiados de acordo com a legislação (Cobea). Canulou-se a artéria carótida comum e a veia jugular externa sentido cranial, injetou-se solução de látex/bário corado de vermelho na artéria carótida, e solução de látex corado de azul na veia jugular. Em seguida os animais fixados em solução de formaldeído a 10%. O encéfalo tem sua nutrição dependente de quatro artérias, as artérias carótidas internas e as artérias vertebrais direitas e esquerdas. Esses vasos compuseram o circuito basilar e carotídeo que se anastomosam através das artérias cerebrais caudais. Correm na base do encéfalo sob a meninge pia mater.

The morphology of the brain of coati, Nasua nasua, was studied, to compare the findings with other species described. The brains of five coatis were used, proceeding from the Scientific Breeding School (Cecrimpas), Unifeob. The animals were sacrificed in accordance with the legislation (Cobea). With a needle, the common carotid artery and the external jugular vein was cannulated to cranial direction, injected latex solution stained with colored red barium respectively. Afterwards the animals were fixed in 10% formaldehyde solution. Brain has its dependent nutrition of four arteries, the internal carotid arteries and the right and left vertebral arteries. These vessels had composed the basal and carotid circuits that anastomose through the cerebral arteries volumes. They run in the base of the brain under piamater meninges.

Morfologia dos vasos da base do encéfalo do quati (Nasua nasua) / Morphology of the main vessels of the coati brain (Nasua nasua)

Estudou-se a morfologia do encéfalo de Nasua nasua - quati, buscando comparar estes achados com outras espécies já descritos. Foram utilizados cinco encéfalos de quatis, provenientes do Criatório Científico (Cecrimpas), Unifeob. Os animais foram eutanásiados de acordo com a legislação (Cobea). Canulou-se a artéria carótida comum e a veia jugular externa sentido cranial, injetou-se solução de látex/bário corado de vermelho na artéria carótida, e solução de látex corado de azul na veia jugular. Em seguida os animais fixados em solução de formaldeído a 10%. O encéfalo tem sua nutrição dependente de quatro artérias, as artérias carótidas internas e as artérias vertebrais direitas e esquerdas. Esses vasos compuseram o circuito basilar e carotídeo que se anastomosam através das artérias cerebrais caudais. Correm na base do encéfalo sob a meninge pia mater.(AU)

The morphology of the brain of coati, Nasua nasua, was studied, to compare the findings with other species described. The brains of five coatis were used, proceeding from the Scientific Breeding School (Cecrimpas), Unifeob. The animals were sacrificed in accordance with the legislation (Cobea). With a needle, the common carotid artery and the external jugular vein was cannulated to cranial direction, injected latex solution stained with colored red barium respectively. Afterwards the animals were fixed in 10% formaldehyde solution. Brain has its dependent nutrition of four arteries, the internal carotid arteries and the right and left vertebral arteries. These vessels had composed the basal and carotid circuits that anastomose through the cerebral arteries volumes. They run in the base of the brain under piamater meninges.(AU)

Aging-related changes and reference values for the carotid intima-media thickness in a Uruguayan population.

UNLABELLED: Carotid intima-media thickness (CIMT) is a well-established subclinical marker of atherosclerosis. Non-invasive vascular evaluation has emerged as a useful tool to aid in individual cardiovascular (CV) risk stratification and diagnose. The use of CIMT in CV risk stratification requires knowing the expected reference values for the population studied. Our aim were: a) to evaluate the relationship between aging and CIMT, b) to analyze gender and side (right vs left) related-differences in CIMT and c) to determine the CIMT reference values for an Uruguayan population taking into account aging-related CIMT changes. METHODS: 367 asymptomatic subjects without known CV disease or risk factors were included in the study. Subjects were divided into six age groups. High-resolution B-mode ultrasound images of both (right and left) common carotid arteries were obtained based on the techniques and recommendations described in international consensus. RESULTS: No significant age-related differences in CIMT between men and women were observed. The mean left CIMT was thicker compared with right CIMT in groups 4, 5 and 6. However, there were no significant differences in those groups. The nomogram model was constructed from data base, in which the 95% confidence interval was considered. Diagnosis thresholds were determined as well. CONCLUSION: We define reference values of CIMT for our population using gold standard techniques which contributes to standard techniques which contributes to an improved insight into clinical practice and can be used routinely for evaluation.

The AMA study (Multi-Arterial Atherosclerosis): correlation ofmalformation of cardiac and cerebral arteries

We are performing a study on the distribution of atherosclerosis in the arteries and during our dissectionswe have found arterial malformations in the brain and heart. Of these, 6 are related to the posterior cerebralarteries and 3 are related to the posterior Interventricular artery of the heart. In all these three cases, suchaforementioned abnormality in the circle of Willis also occurred. It is an interesting and unexpected findingand we are still waiting for further development in our work in order to clarify these “related” malformations.