Background: Pulsatility of cerebral arteries and aortic stiffness have been associated with white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct. Methods: We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate-to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis. Results: Eighty-three patients (56 males, mean age $61.5{\pm}11.4$) participated in the study. Uni-variate analysis showed old age and high PI-MCA were significantly correlated with moderate-to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719. Conclusions: PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.
The study aims to identify the mechanism (s) underlying the altered vasodilatory responses of the pial artery of spontaneously hypertensive rats (SHR) under a hypothesis that calcitonin gene-related peptide (CGRP) exerts a modulator role in the autoregulation of cerebral blood flow (CBF). The animals were divided into four groups: 1) Sprague-Dawley rats (SDR), 2) Wistar rats (WR), 3) SHR with high blood pressure $(BP{\ge}150\;mmHg),$ and 4) SHR with normotensive BP $({\le}150\;mmHg).$ The lower limit of CBF autoregulation in SHR shifted to a higher BP $(82.8{\pm}9.3\'mmHg,\;P<0.05)$ than that in SDR $(58.9{\pm}5.7\;mmHg)$. In SHR, whether the BP levels were high or normotensive, the vasodilator responses to a stepwise hypotension were significantly attenuated unlike with SDR and WR. When artificial cerebrospinal fluid (CSF) containing capsaicin $(3{\times}10^{-7}\;M)$ was suffused over the cortical surface, a transient increase in pial arterial diameter was observed in the SHR with high or normotensive BP. In contrast, SDR and WR showed a large increase in diameter, and the increase was sustained for over 10 minutes. In line with these results, the basal releases of CGRP-like immunoreactivity (CGRP-LI) in the isolated pial arteries from SHR with high and normotensive BP were $12.5{\pm}1.4\;and\;9.8{\pm}2.8\;fmole/mm^2/60\;min\;(P<0.05)$, while those from SDR and WR were $25.5{\pm}3.1\;and\;24.6{\pm}3.1\;fmole/mm^2/60\;min,$ respectively. The isolated basilar arteries showed similar results to those of the pial arteries in SHR. Thus, it is summarized that, in the SHR, the reduced autoregulatory vasodilator responses to stepwise hypotension and capsaicin may be, in part, ascribed to the decreased release of CGRP from the perivascular sensory nerve fibers of the pial arteries, and that altered vasomotor activity in SHR may not be related with the hypertensive tone.
Purpose: To investigate the association of carotid intraplaque hemorrhage (IPH) with acute cerebral ischemic events and progression of stenosis using magnetic resonance (MR) imaging. Materials and Methods: From April 2014 to December 2016, 53 patients underwent carotid plaque MR imaging, including magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequence. A total of 66 carotid arteries in 53 patients had carotid stenosis, and they were included in this study. Carotid arteries were classified according to the presence of IPH, the age of hemorrhage, and degree of stenosis. We assessed ipsilateral cerebrovascular event rates and progression of stenosis between the IPH and no-IPH groups. Results: Of the 61 carotid arteries assessed, 34 (56%) had IPH, and 27 (44%) had no IPH. Acute cerebral ischemic events were more frequent in the IPH group (47% vs. 22%, P = 0.045), especially in the < 30%-stenosis group (100% vs. 0%, P = 0.028). However, there was no significant difference in the incidence of ischemic events according to the age of hemorrhage (50% vs. 44%, P = 0.492). Among the 61 carotid arteries, 20 carotid arteries had previously undergone carotid artery imaging and were evaluated for plaque progression. The trend for progression of stenosis favored the IPH group versus the no-IPH group, with a marginal P-value ($20%{\pm}12.7$ vs. $9.6%{\pm}5.7$, P = 0.063). Conclusion: IPH was associated with an increased incidence of acute ischemic events, especially in the mild-stenosis group and it was also associated with progression of stenosis. Evaluation of the carotid IPH by carotid plaque MR could improve discrimination of carotid plaques that cause ischemic events and progression of stenosis.
Seo, Hyo-Seok;Lee, Yoon-Ho;Yun, Young-Dae;Moon, Ok-Kon;Kim, Ji-Sung;Choi, Suk-Ju;Choi, Yoo-Rim;Zoo, Suk-Bum;Kim, Soon-Hee
Journal of International Academy of Physical Therapy Research
/
v.2
no.1
/
pp.251-259
/
2011
The aim of this is to examine the effects of SSP therapy on the internal carotid arteries blood flow of 24 tension type headache patients(study group) and non tension type headache patients(control group), and on the reduction of their headaches, when applied to the acupuncture points. It stimulated the acupuncture point of headache 6 place with the SSP. It measured VAS and the blood flow of the internal carotid arteries with TCD. When the internal carotid arteries blood flow of study group and control group were compared by period, a significant difference was found in the 4th period(p<.05). When the Visual Analog Scale of study group and control group were compared by period, a significant difference was found in the 4th period(p<.05). The comparison of each measurement result of the internal carotid arteries blood flow of the study group found significantly increased. The comparison of each measurement result of the VAS of study group found significantly decreased. With regard to the control group, the VAS significantly decreased. The silver spike point low frequency electrical stimulation treatment, when applied to the acupuncture point, can significantly influence the internal carotid arteries blood flow of headache patients and can significantly reduce their headaches.
Coronary arteries are subjected to very different flow conditions compared to other arteries in systemic blood circulation. We Performed a computational fluid dynamic research to investigate influence of such flow conditions in coronary arteries on development and progress of atherosclerosis in the same. The results showed big differences in the flow field of the coronary artery compared to the abdominal and femoral arteries. The coronary artery showed higher wall shear stresses due to the small vessel diameter. On the other hand, it showed only one vortex distal to the stenosis throat during a whole pulse cycle. However. several vortices were observed in the abdominal and femoral arteries in both proximal and distal sides of the stenosis throat The wall shear stresses and extent of recirculation area were increased with impedance phase angle increasing toward more negative values. Therefore, cardiac contraction and the negative impedance phase angle as large as -110。 may induce a flow field that accelerates atherosclerosis.
Recently endogenous digitalis-like substances were found in the blood of various cardiovascular diseases and they have been considered one of the causes of evoking hypertension. However, the mechanism of endogenous digitalis-like substances-induced hypertension is not clarified yet. Therefore, the effects of Na-K pump inhibition on the contractility of vascular smooth muscle[conduit and resistant artery were investigated, using organ bath and bioassay experiment. Aortic and carotid arterial rings[conduit artery and the branches of brachial and superior mesenteric artery[resistant artery were used to find the effect of Na-K pump inhibition. The results obtained were as followes;The magnitudes of contractions induced by norepinephrine, serotonin, or acetylcholine in all these arteries were significantly increased by the inhibition of Na-K pump. The increased contractile responses to these agonists, especially to serotonin, were much more prominant in resistant arteries. Nitroprusside-induced relaxations were attenuated by Na-K pump inhibition and there were no significant differences in the effects of Na-K pump inhibition on nitroprusside-induced relaxations of these blood vessels. Endothelium-dependent relaxation was suppressed by the inhibition of Na-K pump, especially by the administration of ouabain, and this inhibitory effect was much more prominent in the branches of superior mesenteric artery, compared with other arteries. In the branches of superior mesenteric arteries, endothelium-dependent relaxation was completely blocked by ouabain. The release of EDRF was partially suppressed by Na-K pump inhibition.From the above results, it is suggested that the hypertension due to the increase in vascular resistance can be evoked by the inhibition of Na-K pump and endogenous digitalis-like substances induce hypertension through this mechanism.
Purpose: The anterolateral thigh flap has many advantages over other conventional free flaps. But the anterolateral thigh flap has yet to enter widespread use because perforating arteries exhibit a wide range of anatomic variations and are difficult to dissect when small. The aim of this study is to identify the vascular variability of perforating arteries and pedicle in the anterolateral thigh free flap. Methods: We studied 12 cadavers and dissected 23 thighs. An anterolateral thigh flap ($12{\times}12cm$) was designed and centered at the midpoint of the line drawn from anterior superior iliac spine to the superolateral border of the patella. After we identifed the perforating arteries we dissected up to their origin from lateral circumflex femoral artery along descending branch of lateral circumflex femoral artery. We then investigated the number and the position of perforating arteries, length and diameter of vascular pedicle and pattern of lateral circumflex femoral arterial system. Results: On average $2.3{\pm}1.1$ perforating arteries per thigh were identified. The musculocutaneous perforators were 63.1%. In those perforators five perforators were arose from transverse branch of lateral circumflex femoral artery and two were arose from rectus femoral artery. Most of the perforators were near the intermuscular septum between rectus femoris muscle and vastus lateralis muscle. The length and diameter of pedicle were $11.9{\pm}3.5cm$ and $3.1{\pm}0.8mm$ on average. Conclusion: This study will be helpful for the success in anterolateral thigh free flap.
The distribution of receptor subtypes for endothelin (ET) in the kidney of the freshwater turtle, Amyda japonica, was examined by quantitative in vitro receptor autoradiography using iodinatd mammalian type ET-1 ($^125$/I-ET-1)as a radiolabeled ligand. Specific $^125$/I-ET-1 bindings were localized to renal tubules, renal arteries and ureter with binding densities of 111.21 $\pm$ 19.14, 182.13$\pm$10.57 and 219.46$\pm$12.83 amol/$mm^2$. respectively. Binding dissociation constants in renal tubules, renal arteries and ureter were 1.05 $\pm$ 0.63, 2.03 $\pm$0.56 and 1.70$\pm$0.47nM, respectively. Receptor subtypes for ET in the kidney were characterized by competition with BQ 123 and BQ 788 as specific antagonists for ET receptors, type A (ET$_A$ ), and type B (ET$_B$) subtypes, respectively. Specific $^125$/I-ET-1 bindings in renal arteries and ureter were potently inhibited by BQ 123 in a dose-dependent manner, whereas BQ 788 was not in competing for specific $^125$/I-ET-1 bindings in this structure. However, specific $^125$/I-ET-1 bindings in renal tubules were inhibited more potently by BQ 788. Therefore, these results indicate that specific ET receptors are localized in renal tubules, renal arteries and the ureter of the freshwater turtle. Results also suggest that the predominant ET receptor subtypes are like the ETA receptor in renal arteries and ureter, and like the ET/$_A$ receptor in the renal tubule.
Takayasu's arteritis(aortoarteritis) is a chronic inflammatory disease involving the aorta, the arteries arising from the aorta, and the pulmonary arteries also may be involved. The inflammation leads to either stenosis and occlusion of the involved artery or formation of aneurysm or both. The arterial lesions can lead to secondary hypertension, retinopathy, cardiac involvement, cerebrovascular events, and premature death. The course and prognosis of patients with aortoarteritis show wide variation, and few authors have published systematic studies documenting the natural history of this disease. While the etiology of Takayasu's arteritis remains unknown, various modes of treatment including steroids, vascular surgery, and balloon angioplasty have been used for management of these patients. We experienced a case of Takayasu's arteritis with multiple occlusion of pulmonary arteries, which was confirmed by angiography and perfusion scan, so reported it with a review of literature.
Using an experimental model of pulmonary hypertension, the effects of anticonstrictive drugs on the development of pulmonary vascular remodeling and right ventricular hypertrophy were studied. Male Sprague-Dawley rats weighing 200~250 gm were used. For the experimental model of pulmonary hypertension, a group of animal was given by a subcutaneous injection of monocrotaline on a dose of 20mg, 40mg, or 60mg per kg of body weight. After 4 weeks of injection, all animals were sacrificed. Another group of animal was given by a subcutaneous injection of monocrotaline in a dose of 40 mg per kg of body weight. The animals were sacrificed, in which they were kept alive for 1, 2, 3 and 4 weeks, respectively. For the effects of anticonstrictive drugs on the development of pulmonary vascular remodeling and right ventricular hypertrophy, the animals treated with monocrotaline were given daily by an intraperitoneal injection of phenoxybenzamine in a dose of 1.3mg/kg of body weight, and were given propranolol via their drinking water at a concentration of 400mg/liter. The animals were sacrificed after 4 weeks of administration. The hearts and lungs were examined histopathologically and morphometrically. The results obtained were summarized as follows: 1. The rats treated with monocrotaline showed an interstitial pneumonitis, medial thickening of the pulmonary small arteries and hypertrophy of the right ventricular wall. 2. The medial thickening of the pulmonary arteries in rats treated with monocrotaline was due to muscular hypertrophy and hyperplasia, and the right ventricular hypertrophy was due to hypertrophy of cardiac muscles. Both medial thickening of the pulmonary arteries and hypertrophy of right ventricular wall were more marked with time and with dose. 3. The daily intraperitoneal injection of phenoxybenzamine suppressed significantly the percentage medial thickness of pulmonary small arteries and the index of right ventricular hypertrophy in rats given a single subcutaneous injection of monocrotaline, but propranolol has shown no protective effect on the development of medial thickening of pulmonary arteries and right ventricular hypertrophy in treated with monocrotaline. The results described above suggested that monocrotaline is an alkaloid selectively inducing pulmonary hypertension and that a-adrenergic receptor is responsible for the pathogenesis of monocrotaline induced pulmonary hypertension in rat.
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