Mycotic Aneurysm of Internal Carotid Artery Secondary to Livestock-associated Methicillin-resistant Staphylococcus Aureus Clonal Complex CC398.

The aim of this article is to present a case of mycotic aneurysm of internal carotid artery secondary to livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) treated with resection and common-to-internal carotid artery bypass with autologous vein graft in a male pig farmer. A 69-year-old man, pig farmer, with recent dental extraction was admitted with a right cervical pulsatile mass, dysphonia, pain, leukocytosis and elevated C-reactive protein (CRP). Ultrasonography (US) and computed tomography angiography (CTA) showed a 3.9 × 4.5 cm mycotic aneurysm of right internal carotid artery with hypermetabolic uptake in positron emission tomography (PET) scan. Resection of the mycotic aneurysm and a common-to-internal carotid artery bypass with major saphenous vein graft were performed. LA-MRSA clonal complex (CC) 398 was detected in intraoperative samples and antibiotic therapy was changed according to antibiogram. Patient was discharged at the seventh postoperative day and received antibiotic therapy for 6 weeks. US 12 months later showed patency of the bypass without collections. Mycotic aneurysms of internal carotid artery are very infrequent. MRSA isolation is rare, and to the best of our knowledge this is the first case caused by multi-drug resistant LA-MRSA CC398. The treatment includes mycotic aneurysm resection and reconstruction with venous graft bypass plus intensive antibiotic therapy.

Distribution and Migration of Human Placental Mesenchymal Stromal Cells in the Brain of Healthy Rats after Stereotaxic or Intra-Arterial Transplantation.

Human placenta mesenchymal stromal cells were injected to healthy rats either stereotaxically into the striatum or intra-arterially through the internal carotid artery. Some cells injected into the brain migrated along the corpus callosum both medially and laterally or concentrated around small blood vessels. A small fraction of MSC injected intra-arterially adhered to the endothelium and stayed inside blood vessels for up to 48 hours mostly in the basin of the middle cerebral artery. Neither stereotaxic, nor intra-arterial transplantation of mesenchymal stromal cells modulated the proliferation of neural stem cells in the subventricular zone of the brain, but stereotaxic transplantation suppressed activation of their proliferation in response to traumatization with the needle.

Agenesia de arteria carótida interna en paciente con hipopituitarismo congénito / Internal carotid artery agenesis in a patient with congenital hypopituitarism

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Insights into the co-localization of magnitude-based versus direction-based indicators of disturbed shear at the carotid bifurcation.

The observed co-localization of disturbed flow and lesion prevalence at predisposed districts such as the carotid bifurcation has led to the identification of the wall shear stress (WSS) as biomechanical localizing factor of vascular dysfunction. In particular, a proatherogenic role is attributed to low and oscillatory WSS. However, the endothelial cells (ECs) are exposed to a complex hemodynamic milieu that can be only partially described by low/oscillatory WSS. Recently, in the attempt to close this gap, descriptors of the complex multidirectional nature of WSS have been proposed, i.e., the axial component of WSS (aligned with the vessel׳s centerline, to quantify flow reversal), and the transverse WSS (transWSS, quantifying the WSS component orthogonal to the cycle averaged WSS direction). Here we explore the relationship between recently-proposed indicators quantifying WSS multidirectionality and "established" WSS-based hemodynamic descriptors of low/oscillatory WSS, in a representative sample (N=46) of subject-specific computational hemodynamics models of ostensibly normal carotid bifurcations. To do it, we quantitatively assess the co-localization of those descriptors at the luminal surface, aiming at providing connections among the peculiar hemodynamic features captured by the different descriptors. According to our findings: (1) regions of flow reversal are moderately co-localized with low WSS; (2) high WSS oscillations (quantified by the oscillatory shear index, OSI) at the carotid bulb are prevalently aligned with the main flow, where flow reversal is predominant; (3) regions where transWSS is high do not co-localize with the other descriptors. We suggest that the investigated WSS-based descriptors might represent different hemodynamic disturbances with different impact on ECs homeostasis, potentially being part of WSS phenotypes more effective in localizing the map of vascular atherosclerotic lesions.

Carotid baroreceptors are mainly localized in the medial portions of the proximal internal carotid artery.

AIM: To visualize baroreceptors in the human carotid bifurcation by light microscopy. Baroreceptor location is investigated in order to provide recommendations for the extent of adventitial stripping in the treatment for carotid sinus syndrome (CSS). METHODS: Human carotid specimens were transversely cut in 20 µm sections. After immunohistochemical staining using antibodies to vesicular glutamate transporter 2 (VGLUT2) and protein gene product 9.5 (PGP 9.5), the presence of baroreceptor tissue was studied using light microscopic techniques. RESULTS: Visual assessment indicated that VGLUT2 and PGP 9.5 immunoreactivity was present in the adventitia of the carotid arteries and that nerve density was highest in the medial wall of the proximal first cm of the internal carotid artery (ICA). CONCLUSION: Human carotid baroreceptors, as reflected in immunoreactivity for VGLUT2 and PGP 9.5, are mainly localized in the medial portions of the proximal ICA. If surgical carotid denervation is indicated in patients suffering from carotid sinus syndrome, adventitial stripping of the proximal portion of the ICA should be sufficient.

Effects of reduced cyclic stretch on vascular smooth muscle cell function of pig carotids perfused ex vivo.

BACKGROUND: With advancing age arteries stiffen, reducing arterial compliance and leading to the development of systolic hypertension and to a substantial increase in pulse pressure. An augmented pulse pressure can be a predictor of the development of hypertension, which has been linked to several cardiovascular diseases including atherosclerosis, and to pathologies such as diabetes and renal dysfunction. In this study, we tested the hypothesis that reduced wall compliance induces pulse-pressure-mediated changes in arterial wall metabolism and remodeling. METHODS: Porcine carotid arteries were perfused for 24 h using an ex vivo arterial support system. Control arteries were exposed to a pulse shear stress (6 +/- 3 dynes/cm(2)) combined with a pulse pressure of 80 +/- 10 mm Hg, yielding a physiological cyclic stretch of 4-5%. A reduced compliance group was also studied, in which arteries were wrapped with an external band, thereby decreasing cyclic stretch to levels <1%. RESULTS: The experimentally reduced compliance caused a decreased contraction capacity induced by norepinephrine(NE), and this was associated with lower levels of alpha-smooth muscle cell-actin (alpha-SMC-actin) and desmin protein expressions. Arteries that were exposed to a reduced cyclic stretch exhibited a higher level of matrix metalloproteinase-2 (MMP-2) expression activity as well as an increase in Ki67 expression, thereby suggesting that matrix degradation and cellular proliferation had been initiated. Furthermore, the expression of plasminogen activator inhibitor-1 (PAI-1) in stiffened arteries was lower than in the control arteries. CONCLUSIONS: These findings underline the importance of cyclic stretch in the maintenance of a differentiated and fully functional phenotype of vascular SMCs, as well as in the regulation of migratory properties, proliferation, and matrix turnover.

Role of SK(Ca) and IK(Ca) in endothelium-dependent hyperpolarizations of the guinea-pig isolated carotid artery.

1. This study was designed to determine whether the endothelium-dependent hyperpolarizations evoked by acetylcholine in guinea-pig carotid artery involve a cytochrome P450 metabolite and whether they are linked to the activation of two distinct populations of endothelial K(Ca) channels, SK(Ca) and IK(Ca.) 2. The membrane potential was recorded in the vascular smooth muscle cells of the guinea-pig isolated carotid artery. All the experiments were performed in the presence of N(omega)-L-nitro arginine (100 microM) and indomethacin (5 microM). 3. Under control conditions (Ca(2+): 2.5 mM), acetylcholine (10 nM to 10 muM) induced a concentration- and endothelium-dependent hyperpolarization of the vascular smooth muscle cells. Two structurally different specific blockers of SK(Ca), apamin (0.5 microM) or UCL 1684 (10 microM), produced a partial but significant inhibition of the hyperpolarization evoked by acetylcholine whereas charybdotoxin (0.1 microM) and TRAM-34 (10 microM), a nonpeptidic and specific blocker of IK(Ca), were ineffective. In contrast, the combinations of apamin plus charybdotoxin, apamin plus TRAM-34 (10 microM) or UCL 1684 (10 microM) plus TRAM-34 (10 microM) virtually abolished the acetylcholine-induced hyperpolarization. 4. In the presence of a combination of apamin and a subeffective dose of TRAM-34 (5 microM), the residual hyperpolarization produced by acetylcholine was not inhibited further by the addition of either an epoxyeicosatrienoic acid antagonist, 14,15-EEZE (10 microM) or the specific blocker of BK(Ca), iberiotoxin (0.1 microM). 5. In presence of 0.5 mM Ca(2+), the hyperpolarization in response to acetylcholine (1 microM) was significantly lower than in 2.5 mM Ca(2+). The EDHF-mediated responses became predominantly sensitive to charybdotoxin or TRAM-34 but resistant to apamin. 6. This investigation shows that the production of a cytochrome P450 metabolite, and the subsequent activation of BK(Ca), is unlikely to contribute to the EDHF-mediated responses in the guinea-pig carotid artery. Furthermore, the EDHF-mediated response involves the activation of both endothelial IK(Ca) and SK(Ca) channels, the activation of either one being able to produce a true hyperpolarization.

Characterization of Ca2+ channels involved in ET-1-induced transactivation of EGF receptors.

The purpose of this study was to demonstrate the involvement of Ca(2+) influx through voltage-independent Ca(2+) channels (VICCs) in endothelin-1 (ET-1)-induced transactivation of epidermal growth factor receptor protein tyrosine kinase (EGFR PTK) using the Ca(2+) channel blockers LOE-908 and SK&F-96365 in rabbit internal carotid artery vascular smooth muscle cells. ET-1-induced EGFR PTK transactivation was completely inhibited by AG-1478, which is a specific inhibitor of EGFR PTK. In the absence of extracellular Ca(2+), the magnitude of EGFR PTK transactivation was near the basal level. Based on sensitivity to nifedipine, which is a specific blocker of voltage-operated Ca(2+) channels (VOCCs), VOCCs have minor roles in EGFR PTK transactivation. In contrast, Ca(2+) influx through VICCs plays an important role in EGFR PTK transactivation. Moreover, based on the sensitivity of VICCs to SK&F-96365 and LOE-908, VICCs were shown to consist of two types of Ca(2+)-permeable nonselective cation channels (NSCCs), which are designated NSCC-1 and NSCC-2, and a store-operated Ca(2+) channel. In summary, Ca(2+) influx through VICCs plays an essential role in ET-1-induced EGFR PTK transactivation in rabbit internal carotid artery vascular smooth muscle cells.

Comparative microanatomy of the lateral wall of the 'cavernous sinus' in humans and the olive baboon.

Despite many studies of the 'cavernous sinus' lateral wall, the anatomy of this area remains controversial. We performed a comparative microanatomical and histoarchitectural study in 14 humans and in 10 nonhuman primates (Papio cynocephalus anubis). Venous channels and cranial nerves were embedded in the 'interperiosteodural space'. The dura propria of the lateral wall could be removed without entering the venous compartment. The oculomotor and trochlear nerves were accompanied by an arachnoidal and dural sheath. The oculomotor nerve sheath stopped under the anterior clinoid process in baboons. The trigeminal ganglion was covered posteriorly with an arachnoid membrane and adhered firmly to the dura propria on lateral and anterior sections. The three branches of the trigeminal nerve had no arachnoid covering, except for arachnoid granulations in humans. In baboons, the oculomotor and trochlear nerves were thicker than in humans, while the ophthalmic nerve was thinner. The abducens nerve belonged to the lateral wall of the sinus in baboons and had no arachnoidal sheath except in the first millimeters of Dorello's canal. After leaving their arachnoidal and dural sheath, the intracavernous cranial nerves acquired a typical peripheral sheath. The venous channels in both species were true dural sinuses. Willis cords and adipose tissue were identified.

Early changes in cerebral aneurysms in the internal carotid artery/posterior communicating artery junction.

In order to obtain information about preaneurysmal changes, the junction of the internal carotid artery/posterior communicating artery (ICA/PComA) in the circles of Willis in subjects with aneurysms at sites other than the junction, and in control subjects without aneurysms, were studied by light microscopy. Small evaginations and thinnings of the media with and without dilatation were observed at the apical areas of the forks with a significantly higher incidence in the aneurysm series than in the control, suggesting some predisposing factor in subjects with aneurysms. As well as funnel-shaped dilatations previously described as the only type of ICA/PComA preaneurysmal change, other more localized types were observed. All the small evaginations and about half of the thinnings and dilatations were observed at the apex in association with a medial gap, but the other half occurred at some distance from the apex. The thinned arterial wall showed degenerative changes of the elastic lamina and media. Intimal pads were observed at the apex, the ICA/PComA lateral angle and the ICA stem/branch curve. Their combination with preaneurysmal changes was more frequent in the aneurysm series in comparison with the control. Degenerative changes of the elastic lamina and media caused by hemodynamic stress due to branching structures including intimal pads are thus presumed to be the initial lesions existing prior to aneurysm formation.

[Histological study on the arterial wall of Göttingen miniature swine].

In order to clarify the histological aspects of arterial walls of miniature swine, 41 arterial segments removed from each of 17 Göttingen miniature swines/csk at 6-12 months after birth were examined by light microscopy. Every segment was classified into three types--elastic, transitional, and muscular--according to its histological architecture. Each type was identified on the basis of relative volume and disposition of elastic tissues, collagenous fibers, and smooth muscles in three coats, Tunica intima, Tunica media, Tunica externa. The distribution of each type was demonstrated in a transition from the elastic to the muscular type. The transitional type was designated as a representative type of artery in transitional regions between elastic and muscular types and had some characteristic structures like a mixture of both of them. This type also had longer regions in the back district with the heart as the starting point, such as the Aorta abdominalis, than that of the front. Every artery belonging to the three types had some different structures at different levels, respectively. It was supposed that the histological arrangement of tissues in the walls of a vessel from various parts of the arterial tree would respond properly to the functional demand.

Histomorphologic structure of the carotid rete-cavernous sinus complex and its functional importance in sheep (Ovis aries).

Paraffin sections of the carotid rete-cavernous sinus complex of sheep were studied, using different stains. The carotid rete of sheep was composed of medium-sized arteries with smooth muscle layers that were oriented in different directions. The carotid body cells may have migrated proximally in the adventitia of the intracranial portion of the internal carotid artery as its extracranial portion degenerates early in life. The cavernous sinus shared a common tunica adventitia with surrounding rete branches. At places, the wall of the cavernous sinus had a distinct tunica media interposed between the endothelial cells and the tunica adventitia. Therefore, the name cavernous venous plexus has been proposed for the cavernous sinus in sheep.

Distribution of carotid body type I cells and other periadventitial type I cells in the carotid bifurcation regions of the rabbit.

The distribution of carotid body type I and periadventitial type I cells in the carotid bifurcation regions was investigated unilaterally in seven and bilaterally in two New Zealand White rabbits. Carotid body type I cells occurred in close proximity to the wall of the internal carotid artery immediately rostral to the carotid bifurcation, within a division of connective tissue with definable but irregular borders. Caudally, and separate from the main mass of carotid body type I cells, isolated groups of periadventitial type I cells lay freely in the connective tissue around the internal carotid artery and alongside the carotid bifurcation and common carotid artery. A overall picture of the carotid body in the rabbit was reconstructed and the occurrence and significance of periadventitial type I cells discussed.