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Anatomy of Neck and Blood Supply of Brain
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
The carotid arterial system and the vertebral arterial system (Figures 2.35 and 2.36) contribute to the arterial blood supply of the brain. Left and right common carotid arteries arise from arch of aorta and brachiocephalic trunk respectively. At the superior border of thyroid cartilage, external and internal carotid arteries arise from the common carotid arteries, with the internal carotid being more medially placed. The internal carotid artery in its intracranial course divides into anterior and middle a cerebral artery which provides the anterior cerebral circulation of brain. The posterior cerebral circulation is mainly by the vertebral arteries. Vertebral arteries traverse the foramen transversarium of cervical vertebra and enter the skull through the foramen magnum where they join to form the basilar artery and posterior cerebral arteries are their terminal branches.
Vascular Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Yiu-Che Chan, John Wang, Julian Wong, Edward Choke, Tjun Tang
A health screening scan has detected an 80% right internal carotid artery stenosis in an otherwise well 72-year-old woman who attends your clinic. Discuss your management.Initial history and examination should confirm whether this carotid stenosis is indeed asymptomatic. Although the trials differ in their definitions, absence of neurologic symptoms in the past 6 months would suffice.I would consider the use of antiplatelets, statin therapy and controlling hypertension, and smoking cessation, if relevant. The antiplatelet and statins assist in primary prevention of TIA/stroke and also contribute to a reduction in cardiovascular events.
Noninvasive Diagnostic Procedures in Clinical Thrombosis
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Ted R. Kohler, D. E. Strandness
Indirect noninvasive tests do not precisely locate the disease. In addition, they do not distinguish stenoses from total occlusions. This is why angiography has remained the definitive and final test. Duplex scanning can now supplement angiography by helping locate and classify arterial disease noninvasively. It was first developed for evaluation of the extent of stenosis in the internal carotid artery and is now accepted as an accurate screening test (sensitivity 99%, specificity 84%22). The degree of narrowing is divided into five categories based on the extent of velocity increase and spectral broadening caused by narrowing of the lumen (Figure 5). Recent development of low frequency transducers allows deeper penetration of the ultrasound beam and study of other, deeper peripheral vessels. Criteria for classification of disease from the aorta to the popliteal artery have been developed (Table l).23 Agreement between duplex scanning and angiography is nearly the same as the agreement between two different radiologists reading the same angiograms.23,24
External counterpulsation stimulation combined with acupuncture for vascular endothelial function in patients with hypertension: A randomized pilot trial
Published in Clinical and Experimental Hypertension, 2023
Meilan Lin, Xiaonv Wang, Bingbing Ye, Jun Zhang, Shuman Lin, Yiye Xu, Jianguan Zhou, Sipei Liu, Shiwei Zhou, Xiafei Guan, Yan Jin, Lei Wang
EECP is a noninvasive method that affects circulation by using an electrocardiogram; the blood in the lower body is pushed to the aorta in the diastole phase through a sequential inflation of the cuffs wrapped around the calves, thighs, and buttocks. A diastolic pressure wave is generated, improving blood supply to organs and tissues. The increased blood flow shear stress (scouring force of the blood exerted against the vascular endothelial cells) promotes the release of vasodilator NO (34), and reduces the production of ET-1 (35). NO-mediated vasodilation helps lower DBP, reducing peripheral vascular resistance, which further lowers SBP. EECP can also increase the blood supply of the heart, brain, and other important organs (34,36), and improve the mental health and sleep quality of patients (37). It increases internal carotid artery flow, which increases cerebral vascular perfusion. This approach may help patients with ischemic stroke (36).
Amidst COVID-19 pandemic: the catastrophic sequelae of an inadvertent carotid artery insertion during central venous catheter placement – a case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Mian Tanveer Ud Din, Adeel Nasrullah, Deeksha Sarma, Obaid Ashraf, Hammad Arshad
He was transferred to the Neuro ICU at our hospital for a higher level of care and further neurologic evaluation. Upon arrival to neurologic ICU, the team discontinued the use of the right RCA CVC. He was started on medical management for the right temporoparietal stroke with aspirin and statin. Neuro-intensivist obtained alternative access via right femoral CVC, and a multidisciplinary discussion was initiated to determine the safest approach to remove the misplaced CVC. Patient undergoing vascular intervention for catheter removal would require temporary anticoagulation. After discussion with neurology, it was felt that the risk of bleeding is small from stroke standpoint and he can undergo CVC removal safely following anticoagulation. The approaches discussed included open repair vs placing a covered stent. Open repair was felt less desirable as the catheter on CT Angiogram appeared to enter near the carotid bifurcation, which would require to control the common, internal and external carotid artery to safely remove the external device. Patient underwent successful placement of covered stent in right common and internal carotid artery, followed by removal of carotid artery catheter.
The Effects of Acute Intracranial Pressure Changes on the Episcleral Venous Pressure, Retinal Vein Diameter and Intraocular Pressure in a Pig Model
Published in Current Eye Research, 2021
Deepta Ghate, Sachin Kedar, Shane Havens, Shan Fan, William Thorell, Carl Nelson, Linxia Gu, Junfei Tong, Vikas Gulati
We acknowledge inter-species differences in vascular and orbital anatomy between humans and pigs. The internal carotid artery in humans lies within the cavernous sinus. In pigs and other ungulates, the cavernous sinus is filled with a network of arteries (rostral epidural rete mirabile) from which forms the rostral part of the internal carotid artery.18 The pig optic nerve head has a larger diameter compared to the human optic nerve head and has 5–6 laterally placed retinal arteries while the human optic nerve head has a single retinal artery placed centrally.52 These differences in arterial anatomy do not affect our study of venous parameters, since the porcine ophthalmic venous anatomy is similar to the human eye.53 The porcine optic nerve head has a single centrally placed retinal vein that exits the eye through the lamina cribrosa, like humans. The venous drainage from the choroid and anterior segment occurs through the vortex vein and episcleral vein, with drainage into the cavernous sinus. Thus, the basic schema of the intra-cranial, intra-orbital and ocular anatomy is comparable between humans and pigs for the purposes of our study of changes in EVP, IOP and RVD in response to acute ICP changes. Although our study included a small number of animals, the study hypothesis and results are consistent with known anatomic and physiologic principles that regulate the fluid and vascular pressure within the cranial and orbital compartments. Our study methodology has a statistically robust basis and the outcomes find support in the numerous human and animal studies described above.