Endothelial Injury Preceding Intracranial Aneurysm Formation in Rabbits
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Objective: This study investigates the change of endothelial cell morphology and function at the rabbit basilar bifurcations in response to sustained high blood flow after bilateral common carotid artery ligation.Methods: Fifteen adult female New Zealand white rabbits were divided into experimental and sham control groups.The experimental group was subjected to bilateral common carotid artery ligation to increase the compensatory basilar artery flow.Basilar artery flow was monitored by transcranial Doppler after surgery.The endothelial cells at the arterial bifurcations were studied morphologically by electron microscopy and immunohistochemistry using β-catenin antibodies.Basilar artery flow increased significantly following common carotid artery ligation.Results: Early-stage basilar artery bifurcation aneurysms were present in all rabbits at three months after ligation.The endothelial cells changed from a fusiform to column shape at the basilar artery bifurcation.Gaps between endothelial cells of the experimental group appeared wider in the electron microscopic photographs compared with those of the control group.The expression of endothelial βcatenin at the arterial bifurcations also decreased. Conclusion:This study is the first to present endothelial cell changes of basilar artery bifurcation in response to sustained high blood flow in rabbits.Endothelial cell impairment possibly initiates aneurysm formation.The mortality resulting from ligation of the common carotid artery in man varies from 7 to 90%, depending on the condition for which the ligation was done, and the age of the patient. The value of pre-ligation compression of the carotid artery to establish collateral circulation, is not definitely established. This work was primarily undertaken to determine the effect of pre-ligation compression of the common carotid in monkeys. Dogs and rabbits seldom develop symptoms after ligation of a common carotid artery, whereas we hoped that monkeys, whose cranial blood supply is quite similar to that of man, would react in a way comparable to man. However, we were unable to cause paralysis or death in monkeys by ligation of a common carotid artery, or by simultaneous unilateral ligation of vertebral, internal, external and common carotid arteries. The ligations were continued in an effort to determine how much alteration of cranial blood supply the monkey would tolerate, and what changes in the brain were produced.Table I summarizes the procedures and results obtained.1. The rhesus monkey is unaffected by ligation of a common carotid artery, and in more than one-half of the procedures, will be unaffected by simultaneous ligation of the common, internal and external carotid and vertebral arteries. In no instance did hemiplegia result; in one there was weakness of the opposite side; and in 2, transient ataxia2. If, in addition to the ligation of the main cervical vessels on one side, the common carotid artery on the other side is ligated, the animals will die, even though the second ligation is done 9 months to a year after the first. The survival of the animals following the first ligation is due to the adequate blood supply obtained from the vessels of the opposite side, as demonstrated by the injection of ink, or of barium solution into the common carotid of one side, and its equal distribution in the superficial vessels of both hemispheres.
External carotid artery
Collateral circulation
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Although intracranial obliteration or detachable balloon occlusion of the proximal artery has been recommended for treatment of unruptured aneurysms of the cavernous sinus, carotid artery ligation continues to be used by many neurosurgeons. This study compares the long term outcome after carotid ligation with that following conservative treatment. Nine of 13 patients treated by common carotid ligation improved, two were unchanged but two patients subsequently needed internal carotid ligation (mean FU 8.2 years). Ten patients were managed conservatively. Three improved, six were unchanged and one patient died following intracranial haemorrhage (mean FU 6.9 years). The authors conclude that carotid ligation remains an acceptable method for treating these difficult lesions.
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Objective:The study was to analyze the changes in magnetic resonance spectroscopy of the brains of rats with permanent bilateral common carotid artery.Methods:After the permanent bilateral common carotid artery ligation was modeled,the 12 rats were randomly divided into the operative group and the pseudo-operative group.There were 6 rats in each group.After 30 days,abilities of learning and memory of the two section rats were tested by using the morris water maze.Then we observed the changes of magnetic resonance spectroscopy and NAA、NAA/(Cr+Cho)in lobus temporalis of rats.Results:Abilities of learning and memory of rats were significantly poorer in the operative section than that in the pseudo-operative group.The levels of NAA、NAA/(Cr+Cho)in lobus temporalis of rats with permanent bilateral common carotid artery ligation were significantly lower in the operative section than that in the pseudo-operative group.Conclusions:The method of permanent bilateral common carotid artery ligation can obviously impair the abilities of learning and memory and lower the levels of NAA、NAA/(Cr+Cho)in lobus temporalis of rats.
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Objective To investigate the value of CT in the diagnosis of schwannomas of the cervical sympathetic nerve(SSN) corrleated with surgical findings.Method Sixteen consecutive patients with schwannomas of the cervical sympathetic nerve,proven by surgery and pathology,were referred to computed tomography axial scanning.The CT findings for the location of masses,size,margin,contrast enhancement,and the rules of displacement of the common carotid artery,internal carotid artery and internal jugular vein were evaluated.Also the locations,characteristics of the lesions and rules of displacement of the common carotid artery,internal carotid artery and internal jugular vein were described with surgical correlation.Results 10 SSNs were located at the level of the common carotid bifurcation with the common carotid artery abutting against and displacing the lateral periphery of the tumor,and 16 SSNs with the internal carotid artery abutting against and displacing the lateral periphery of the tumor.In 14 SSNs with enhanced CT,the internal jugular vein also abutted against and displaced the lateral periphery of the tumor.All the anatomical positional relationships among the common carotid artery,internal carotid artery and internal jugular vein with the cervical sympathetic nerve were proved by operation.Conclusion CT axial scan can accurately reflect the anatomical positional relationships among the common carotid artery,internal carotid artery and internal jugular vein with the cervical sympathetic nerve.
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Oral and maxillofacial surgery in veterinary medicine carries the risk of severe hemorrhage due to the great vascular supply of the head. Temporary hemostasis can be achieved with the application of pressure or hemostatic agents, but more definitive treatment may be needed to ensure bleeding will not resume once the patient is awake and normotensive. 1 , 2 Actively bleeding vessels encountered during maxillofacial surgery may be inaccessible, and vessels may recoil into bone, sometimes preventing definitive ligation. These scenarios may require ligation of the common carotid artery. 1 The purpose of this paper is to describe how to perform ligation of the common carotid artery in a step-by-step fashion. Both temporary and permanent ligation techniques are described.
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Bilateral common carotid artery (CCA) ligation in rabbits is a model for basilar terminus (BT) aneurysm formation. We asked if this model could be replicated in rats. Fourteen female Sprague Dawley rats underwent bilateral CCA ligation (n=8) or sham surgery (n=6). After 7 days, 5 ligated and 3 sham rats were euthanized for histological evaluation of BT aneurysm formation, while the remaining rats were imaged with magnetic resonance angiography, euthanized, and subjected to corrosion casting of the Circle of Willis (CoW). 3D micro computed tomography images of CoW casts were used for flow simulations at the rat BT, and electron micrographs of the casts were analyzed for aneurysmal and morphological changes. Results from these analyses were compared to rabbit model data (n=10 ligated and n=6 sham). Bilateral CCA ligation did not produce aneurysmal damage at the rat BT. While the surgical manipulation increased rat basilar artery flow, fluid dynamics simulations showed that the initial hemodynamic stress at the rat BT was significantly less than in rabbits. Rats also exhibited fewer morphological and pathological changes (minor changes only occurred in the posterior CoW) than rabbits, which had drastic changes throughout the CoW. A comparison of CoW anatomies demonstrated a greater number of branching arteries at the BT, larger CoW arteries in relation to basilar artery, and a steeper BT bifurcation angle in the rat. These differences could account for the lower hemodynamic stress at the BT and in the cerebrovasculature of the rat. In conclusion, bilateral CCA ligation in rats does not recapitulate the rabbit model of early flow-induced BT aneurysm. We suspect that the different CoW morphology of the rat lessens hemodynamic insults, thereby diminishing flow-induced aneurysmal remodeling. Keywords: Intracranial aneurysm, computational fluid dynamics, cerebral blood flow, animal models, Circle of Willis, vascular remodeling.
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A study was undertaken to ascertain the microvascular pattern of the collateral circulation of the tongue after unilateral ligation of the common carotid artery. The right common carotid artery was ligated in 25 New Zealand White male rabbits. These animals were killed in groups of five at intervals of an hour, six hours, 24 hours, one week, and two weeks. The vasculature in the head and neck of these animals was flushed with heparinized saline solution and perfused with latex. The results show that circulation was present but signifincatly reduced in the one-hour group, slightly reduced in the six-hour and 24-hour groups, and normal in the one- and two-week groups. This study indicates that the collateral circulation of the tongue is extensive and that a normal vascular pattern returns within a week after unilateral ligation of the common carotid artery.
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Paragangliomas (PGLs) are rare neuroendocrine tumors. About 50% of PGLs develop in the head and neck region, of which approximately 50% originate from the carotid body, and classified as Carotid body tumors (CBTs). Proper management and therapeutic options for CBTs have not yet been clearly determined, to date. We hereby report a case of a huge transected CBT treated by ligation of internal carotid artery (ICA), resulting to an unexpected ipsilateral embolic stroke despite an anticoagulation therapy.
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