Objective To assess the variation and its significance of messenger ribonucleic acid(mRNA) expression of endothelial nitric oxide synthase (eNOS) in allografts of common carotid transplantation model in white rabbits. Methods To establish an animal model of common carotid transplantation in vivo, 30 rabbits were divided into four groups with random number table. Group A (n=3): autografts; group B (n=9): allografts with the least treated; group C (n=9): allografts treated by penicillin/streptomycin and preserved under room temperature; group D (n=9): allografts treated by penicillin/streptomycin and cryopreserved in liquid nitrogen. All the transplanted grafts were harvested 1-3 weeks later, then compared and evaluated the histomorphological variation and eNOS mRNA expression. Results The vascular structures of autografts in group A were kept approximately normal, only a few infiltration of inflammatory cells could be found. The structural variations of allografts in other trial groups behaved similarly as, intima proliferation in the 1st week, intima hyperplasia in the 2nd week, and both intima and media hypertrophy in the 3rd week. And also there seemed that luminal thrombosis could be found in all the allografts. Allografts in group B were destructed utmost the worst in all the groups. The expression of eNOS mRNA in allografts of group B was significantly less than that in other groups (Plt;0.05). Conclusion The down-regulation of eNOS mRNA expression might lead to intima hyperplasia and thrombosis of allografts.
Objective To evaluate the relationship between COPD and atherosclerosis, and analyze the risk factors of atherosclerosis among COPD patients. Methods A total of 40 COPD patients and 43 normal subjects were enrolled in the study. Carotid intima-media thickness (IMT) and plaques were detected in both groups. Blood samples were collected to measure the concentration of high sensitive C-reactive protein (hs-CRP) , fibrinogen (Fbg) , total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) , while smoking index was recorded. Multiple regression analysis was performed to evaluate the correlative factors of IMT among COPD patients. According to whether luminal stenosis appeared, the COPD patients were allocated into group A ( without luminal stenosis) and group B ( with luminal stenosis) . Age, gender, hs-CRP, Fbg, TC, TG, HDL-C, LDL-C, and smoking index of the two groups were compared respectively. Results Hs-CRP, Fbg, thickness of IMT, plaques detection rate, and smoking index in the COPD group were significantly higher than those in the control group ( Plt;0.05) . TC, HDL-C, LDL-C in the COPD group were significantly lower than those in the control group ( Plt;0. 05) .Multiple regression analysis of IMT correlative factors among COPD patients showed that age, hs-CRP, Fbg, TC, TG, LDL-C, HDL-C, and smoking index were in linear relationship with IMT thickening. Age, hs-CRP, TC, and smoking index were positively correlated with IMT ( Plt;0.05) . Hs-CRP and smoking index in the group A were lower than those in the group B ( Plt;0. 05) .While TC, TG, LDL-C, and HDL-C in the group A were higher than those in the group B ( Plt;0.05) . Conclusions Age, smoking index, hs-CRP, and TC are risk factors for thickening of carotid artery IMT in COPD patients. Furthermore, smoking index, hs-CRP, TC, TG, LDL-C, and HDL-C are related to the severity of IMT thickening. The ultrasound detection of carotid artery IMT can be a valuble tool to screen atherosclerosis in patients with COPD.
More and more people suffered from the car otid artery obstruction. It is reported that it's around 69% of these patients the first clinical manifes tation of carotid occlusive disease is the ocular ischemic syndrome. Owing to th e most symptoms of the ocular ischemic syndrome are very obscure, so there are a lways overlook or made a misdiagnosis of this entity in clinical. Fundus fluores cein angiography (FFA) is the best procedure to find this entity. We should pay close attention to notice the early phase of FFA. It is the most specific FFA si gn in ocular ischemic syndrome, and it is a distinctly unusual finding to find t he ocular ischemic syndrome. (Chin J Ocul Fundus Dis, 2008, 24: 79-81)
ObjectiveTo analyze the effect of carotid artery stenosis degree and intervention for carotid artery stenosis on the incidence of central nervous system complications after off-pump coronary artery bypass grafting (OPCABG) and explore the influencing factors. MethodsA total of 1 150 patients undergoing OPCABG in our hospital from June 2018 to June 2021 were selected and divided into two groups according to whether there were central nervous system complications, including a central nervous system complication group [n=61, 43 males and 18 females with a median age of 68.0 (63.0, 74.0) years] and a non-central nervous system complication group [n=1 089, 796 males and 293 females with a median age of 65.5 (59.0, 70.0) years]. The risk factors for central nervous system complications after OPCABG were analyzed. ResultsUnivariate analysis showed that age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intra-aortic ballon pump (IABP), postoperative arrhythmia, postoperative thoracotomy and blood transfusion volume were associated with central nervous system complications. The incidence of central nervous system complications in patients with severe carotid artery stenosis or occlusion (11.63%) was higher than that in the non-stenosis and mild stenosis patients (4.80%) and moderate stenosis patients (4.76%) with a statistical difference (P=0.038). The intervention for carotid artery stenosis before or during the operation did not reduce the incidence of central nervous system complications after the operation (42.11% vs. 2.99%, P<0.001). Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion were independent risk factors for postoperative central nervous system complications (P<0.05). Conclusion The age, smoking, hyperlipidemia, preoperative left ventricular ejection fraction, intraoperative use of IABP, postoperative arrhythmia, secondary thoracotomy after surgery, blood transfusion volume and OPCABG are associated with the incidence of postoperative central nervous system complications in patients. Age, postoperative arrhythmia, severe unilateral or bilateral carotid artery stenosis and occlusion are independent risk factors for postoperative central nervous system complications. In patients with severe carotid artery stenosis, preoperative treatment of the carotid artery will not reduce the incidence of central nervous system complications.
Objective To update available evidence on safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in treatment of carotid artery stenosis by a meta-analysis of randomized controlled trials (RCTs). Methods A comprehensive search was performed of PubMed, EMBASE, Cochrane Library, Web of science, WanFang, and CNKI databases (from January 1990 to July 2015), to collect articles and past systematic reviews, and then abstraced lists of recent scientific conferences which were related with safety and efficacy of CEA versus CAS in treatment of carotid artery stenosis. At last, Meta analysis was performed by RevMan 5.1 software. Results Fifteen RCTs enrolling 9 828 patients were included in the Meta-analysis. Compared with CAS, CEA was associated with a significantly lower incidences of any stroke or death within 30 days after surgery (OR=0.63, 95% CI: 0.51-0.77, P＜0.05) and any stroke or death during follow-up, or ipsilateral stroke after 30 days of operation (OR=0.61, 95% CI: 0.48-0.76, P＜0.05）, but associated with a significantly greater incidences of myocardial infarction (OR=1.81, 95% CI: 1.14-2.87, P=0.01) and cranial neuropathy (OR=18.28, 95% CI: 7.99-41.82, P＜0.05) within 30 days after surgery. Conclusion In comparison with CAS, CEA is associated with a lower incidences of stroke or death and a greater incidence of myocardial infarction and cranial neuropathy within 30 days after surgery, and was associated with a significantly lower incidence of any stroke or death during follow-up, or ipsilateral stroke after 30 days of operation. So the results of Meta-analysis support continued use of CEA as the standard method in treatment of carotid artery stenosis.
ObjectiveTo observe the effects of endovascular radiation (ER) on the proliferation and apoptosis of medial smooth muscle cells (SMC) and to discuss the possible mechanisms of radiation in the prevention of vascular restenosis (RS) in rabbits after carotid endarterectomy (CEA).MethodsForty rabbits undergoing CEA were randomly divided into four groups (each group=10) and given a radiation dose of 0, 10, 20 and 40 Gy 32P respectively. Rabbits were killed on the 3rd, 7th, 14th, 28th and 56th day after operation. The specimens were collected and histopathologic examinations were done.ResultsProliferation apparently occurred in the intima and media of carotid the lumen became narrow in the control group on the 14 th, 28 th and 56 th day after operation. While in the radiation groups, proliferation was apparently suppressed and the lumen was much less narrowed (P＜0.05). The apoptosis rate of SMCs and PCNA positive cells increased on the 3rd day after operation and reached the peak on the 7th day. There was statistical difference between the ER groups and control group (P＜0.01). The effects were much more evident in 20 Gy and 40 Gy groups compared with 10 Gy group (P＜0.01).ConclusionER may prevent RS by suppressing SMC proliferation and migration as well as inducing SMC apoptosis. The effects are positively correlated with radiation doses. SMC proliferation and apoptosis occur in the early period after balloon injury, while hyperplasia of intima and medial happens later.
ObjectiveTo investigate the relationship between retinal vessel diameters and cerebral infarction of carotid artery stenosis patients. MethodsEighty-seven patients (174 eyes) with carotid stenosis were included in this study. There were 49 males and 38 females, with an average age of (65.25±7.85) years. Thirty-four patients were suffered from cerebral infarction (cerebral infarction group), and the other 53 patients had no cerebral infarction (control group). There was no significant difference in age (t=1.916), male rate (χ2=0.142) and carotid stenosis extent (χ2=0.785) between the two groups (P=0.059, 0.706, 0.675). All patients underwent color fundus photography after mydriasis. Retinal vascular caliber measurements were performed using IVAN software. The main parameters were central retinal artery diameter (central retinal artery equivalent, CRAE), the diameter of the central retinal vein (central retinal vein equivalent, CRVE) and the retinal arteriole to venular ratio (AVR). The relationship between retinal vessel diameter and cerebral vascular disease were analyzed with logistic regression analysis. ResultsIn cerebral infarction group, CRVE, CRAE and AVR ratios were (132.90±20.67) μm, (243.47±43.92) μm and 0.56±0.10, while the control group was (145.26±21.59) μm, (224.99±32.35) μm and 0.68±0.13 respectively. There were significant differences between the two groups (t=-2.648, 2.257, -4.631; P < 0.05). After correction for risk factors, such as age, smoking history, CRAE reduction and CRVE increases were significantly correlated with cerebral infarction. ConclusionCRAE reduction and CRVE increases are risk factors of cerebral infarction in patients with carotid stenosis, and it is useful in the prediction.
Twenty six cases with carotid body tumours (27 tumors) were operaterated on from November,1988 to October, 1997. Eleven of the 26 cases were misdiagnosed in other hospital. Twenty six cases experienced B-mode ultrasonic scanning and 18 carotid arteriography. Seventeen cases underwent general hypothermic anesthesia (30℃-32℃) and 9 general carotid-internal carotid shunt. Eight cases (9 tumors) experienced simple excision of tumor, 3 resection of the tumor with external carotid, 11 excision of the tumor with internal, external and general carotid and carotid-reconstructing. Two cases underwent anestomosis of general carotid with internal carotid and 2 ligation of the internal carotid. All patients showed good results but one complicated with hemiplegia. The authors consider that misdiagnosis can be avoided with careful physical examination, Bmode ultrasonic scanning and arteriography, and hypothermic general anesthesia and intraoperative general carotid internal carotid shunt were important measures for the protection of brain.
ObjectiveTo evaluate the efficacy of staged carotid artery stenting and coronary artery bypass grafting in the treatment of coronary heart disease complicated with carotid stenosis. MethodsThe clinical data of patients with coronary heart disease and carotid stenosis treated in Fuwai Hospital from November 2019 to September 2021 were retrospectively analyzed. All patients underwent staged carotid artery stenting and coronary artery bypass grafting. The incidence and risk factors of severe complications such as myocardial infarction, cerebral infarction and death during the perioperative period and follow-up were analyzed. ResultsA total of 58 patients were enrolled, including 47 males and 11 females with an average age of 52-77 (64.2±5.6) years. No complications occurred before coronary artery bypass grafting. There was 1 myocardial infarction, 1 cerebral infarction and 1 death after the coronary artery bypass grafting. The early complication rate was 5.2%. During the follow-up of 18.3 months, 1 cerebral infarction and 2 deaths occurred, and the overall complication rate was 10.3%. According to Kaplan-Meier survival curve analysis, patients with symptomatic carotid stenosis (log-rank, P=0.037) and placement of close-cell (log-rank, P=0.030) had a higher risk of postoperative ischemic cerebrovascular event, and patients with previous cerebral infarction had a higher risk of postoperative severe complications (log-rank, P=0.044). ConclusionStaged carotid artery stenting and coronary artery bypass grafting is safe and feasible for the treatment of coronary heart disease complicated with carotid stenosis.
ObjectiveTo explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery.MethodsFrom June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed.ResultsFinally 12 patients were enrolled, including 10 males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3% (P＜0.001). The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0% (P＜0.001). Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes.ConclusionCarotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients' symptoms and has high promotion value.