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Complications of stenting for occlusive disease of aortic arch branches
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Christopher A. Latz, Mark F. Conrad
Disease in the left common carotid artery is most likely to occur at the ostium of the vessel, as it is usually an extension of disease from the aortic arch. In its normal anatomic position, the common carotid can be approached from the groin in a manner similar to the left subclavian artery with angioplasty and stenting delivered via a guiding catheter or a sheath. Access to the origin of the vessel is aided, and the access sheath or guide can be stabilized, by a “buddy-wire” placed in the left external carotid artery. A protection device can be deployed in the left internal carotid artery, and the wire used to deploy the protection device is also the wire over which the intervention is performed. The need for neuroprotection during angioplasty and stenting of lesions of the left common carotid arteries remains controversial. In a study of 147 patients with 153 lesions, neuroprotection was not used for isolated ostial lesions and they reported a 2% ipsilateral stroke rate and 2.6% rate of TIA.18 Indeed, a recent update in the European Society for Vascular Surgery guidelines for the management of atherosclerotic disease recommended against the use of protection devices in the endovascular treatment of common carotid lesions19 (Figure 3.4).
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Carotid systemOriginThe right common carotid artery arises from a bifurcation of the brachiocephalic trunk (the right subclavian artery is the other branch).The left common carotid artery branches directly from the arch of aorta.The left and right common carotid arteries ascend up the neck, lateral to the trachea and the oesophagus. They do not give off any branches in the neck.CourseAt the level of the superior margin of the thyroid cartilage (C4), the carotid arteries split into the external and internal carotid arteries. The internal carotid arteries do not supply any structures in the neck, entering the cranial cavity via the carotid canal in the petrous part of the temporal bone.
Technical aspects of treating aortic aneurysms
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
The most common of these procedures is the left carotid-to-subclavian artery bypass (Figure 28.16). This is because type B aortic dissection is increasingly being treated with stent–graft coverage to manage short-term complications, enhance long-term remodeling, and prevent aneurysm degeneration. Because the pathology of type B aortic dissection usually initiates at the level of the left subclavian artery, it is common for this area to require coverage in order to have graft sealing in healthy aorta proximal to the dissection site. The left carotid-to-subclavian artery bypass is best performed by using a transverse supraclavicular incision. The proximal left common carotid artery is exposed. The anterior scalene muscle is divided. The phrenic nerve is located on the anterior surface of the muscle and must be preserved. Just posterior to the muscle is the left subclavian artery. The jugular vein is located slightly anterior and lateral to the common carotid artery. The graft is usually tunneled posterior to the jugular vein. Either anastomosis may be performed first. After the carotid-to-subclavian bypass has been carried out, the aortic stent–graft is placed. Lastly, a plug is placed in the proximal left subclavian artery. The proximal left subclavian artery can also be ligated, but it must be ligated proximal to the origin of the left vertebral artery. This can be difficult when the origin of the vertebral artery is quite proximal.
Mechanistic exploration of Yiqi Liangxue Shengji prescription on restenosis after balloon injury by integrating metabolomics with network pharmacology
Published in Pharmaceutical Biology, 2023
Tianshi Mao, Long Xie, Yanqiong Guo, Xiang Ji, Jie Wan, Xiaoyun Cui, Qian Fan, Wei Liu, Shuai Wang, Wenbo Han, Qian Lin, Wenhao Jia
Forty rats were randomly divided into 4 groups: sham group, model group, YQLXSJ group and positive group (n = 10 in each group). The restenosis model was established by balloon-induced abdominal aorta injury according to a published study (Zou et al. 2019). Rats were anaesthetized by intraperitoneal injection of 0.3% sodium pentobarbital (1 mL/100 g). After making an incision along the midline of the neck, the left common carotid artery (1–1.5 cm) was separated, the distal end of the artery from the heart was ligated, and the proximal end was clipped with an artery clamp. To prevent acute thrombosis, an anticoagulant (heparin sodium, 100 u/kg) was injected. A V-shaped incision was made between the arterial clamp and ligation, and a balloon catheter (2.0 mm) was inserted. Then, guided by the guide wire, the balloon catheter was pushed down over the aortic arch to the abdominal aorta, with a depth of approximately 6–7 cm. After expanding with a pressure of 6–10 atm, the following procedure was repeated four times: the inflatable balloon was pulled back to the aortic arch and pushed forwards to the original location in the abdominal aorta. The proximal end of the left common carotid artery was ligated to stanch the bleeding, and the incision was sutured. A total of 40,000 U of gentamicin was injected intramuscularly for 3 days to prevent infection. The rats in the sham group underwent left carotid artery ligation only, without balloon injury.
CT findings in aggressive Takayasu arteritis
Published in Acta Cardiologica, 2022
Benjamín Roque Rodríguez, Luis Enrique Lezcano Gort, María Victoria Mogollón Jiménez, Ignacio Díaz Villalonga, Sergio Moyano Calvente, Zineb Kounka
A 52-year-old woman was referred to our hospital with grade-2 dyspnoea without intermittent claudication. She complained of self-limiting episodes of fever, asthenia, and myalgias since the adolescence. Physical examination revealed a loud panfocal systolic murmur (IV/VI), and large inter-arm blood pressure difference (180/80-120/70 mmHg in right and left arm respectively). Treponema pallidum serological-test and autoantibodies were negative, and acute phase reactants were normal. Doppler echocardiogram reveals doubtful patent ductus arteriosus. CT angiography with multiplanar (Figure 1, panels 1 and 4) and volumen-rendered reformatted images (Figure 1, panels 2 and 3) showed severe narrowing of the middle segment of the descending thoracic/abdominal aorta (a), and both iliac arteries, with intima-media thickening in all of them (b). Collaterals have been developed, like a huge and tortuous right internal mammary artery which anastomoses with branches of the epigastric arteries (c). We found severe stenosis in common carotid arteries (critical in left common carotid artery) (d) and in both subclavian arteries at the ostia of vertebral arteries(e). On the basis of clinical and angiographic abnormalities, the diagnosis of Takayasu arteritis (TA) was made. TA is a large-vessel granulomatous vasculitis that primarily affects the aorta and its primary branches, specially supraaortic trunk and subclavian artery. It principally affects young women. The patient refused to take any treatment or perform new tests. Actually, she remains asymptomatic.
Arterial Stiffness and Cardiorespiratory Fitness Are Associated With Cognitive Function in Older Adults
Published in Behavioral Medicine, 2022
Justin R. Mason, Gershon Tenenbaum, Salvador Jaime, Nelson Roque, Arun Maharaj, Arturo Figueroa
Characteristics of the left common carotid artery were obtained by using an ultrasound scanner (Phillips HD11 XE, Philips Medical) equipped with a high-resolution linear array transducer. A longitudinal image (30 seconds) of the cephalic portion of the common carotid artery was acquired ∼2cm proximal to the carotid bulb and optimized for diameter detection. All digital images were analyzed offline by a single researcher using automated image analysis software (Carotid Artery Analyzer, Quipu srl.). This setup enabled the measurement of the intima-media thickness, end-diastolic diameter (d), and change in diameter (Δd = end-systolic diameter – end-diastolic diameter). Combined with brachial BP, three markers were calculated to evaluate elastic properties of the common carotid artery: (a) β-stiffness index = ln(systolic BP/diastolic BP)/(Δd/d), as stress-to-strain ratio; (b) distensibility = 1/(β-stiffness × intima-media thickness), as the inverse of β-stiffness and adjusted to intima-media thickness; and (c) Young’s elastic modulus = 133.3 (pulse pressure) (PP)/(Δd/d), representing elastic properties of arterial wall material.33,34