Abstract T P171: Impaired Brachial Flow-mediated Dilatation in Patients With Symptomatic Nontraumatic Intracranial Arterial Dissections

Background: Non-traumatic intracranial arterial dissections (IADs) are characterized by the sudden disruption of the internal elastic lamina in intracranial arteries. It is still unknown why IADs occurs. There are few reports concerned with relationship between the endothelial function and IADs. Purpose: The purpose of our retrospective study was to investigate whether or not patients with nontraumatic IADs had normal endothelial function. Methods: Included for retrospective analysis were patients with symptomatic nontraumatic IADs (1) who were admitted to our institution from 2012 to 2013 and (2) who underwent an endothelial function test during hospitalization. Headache patients admitted to outpatient clinic were selected as a control matched for sex and age. The endothelial function was assessed using flow-mediated dilatation (FMD). We investigated ankle brachial index (ABI) and pulse wave velocity (PWV) to determine the degree of atherosclerosis. Patients’ characteristics, brachial FMD, ABI and PVW were assessed in two groups. Results: During study periods, there were 14 patients (median age 45.5 years, IQR 38-53.5 years) with nontraumatic IADs. Fourteen patients of the control had median age of 47 years (IQR: 44-53.5 years). The locations of IADs were the vertebral artery (n=10), the internal carotid artery (n=3) and the superior cerebellar artery (n=1). Between two groups, there were no significant differences of clinical features, atherosclerotic risk factors, ABI and PWV except FMD, indicating that most of them did not suffer from atherosclerosis. However, FMD in IADs was significantly lower than in control (4.85 vs. 7.4, p<0.01) Conclusion: ur results suggest that the endothelial function of intracranial arteries might be impaired in patients with symptomatic nontraumatic IADs in spite of no atherosclerotic change.

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Healing Process for Cerebral Dissecting Aneurysms Presenting with Subarachnoid Hemorrhage

Neurosurgery ◽

10.1227/01.neu.0000103449.80484.7e ◽

2004 ◽

Vol 54 (2) ◽

pp. 342-348 ◽

Cited By ~ 61

Author(s):

Tohru Mizutani ◽

Hideaki Kojima ◽

Shunji Asamoto

Keyword(s):

Subarachnoid Hemorrhage ◽

Healing Process ◽

Superior Cerebellar Artery ◽

Internal Elastic Lamina ◽

Neointimal Proliferation ◽

Specimen Collection ◽

Cerebellar Artery ◽

The Media ◽

Wall Injury ◽

Dissecting Aneurysms

Abstract OBJECTIVE This was a pathological study to investigate the healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage (SAH). METHODS Thirteen dissecting aneurysms that presented with SAH were obtained from 13 patients. Nine aneurysms arose from the vertebral artery, two arose from the anterior cerebral artery, one arose from the internal carotid artery, and one arose from the superior cerebellar artery. Eight aneurysm specimens were collected during autopsy and five were resected during surgery (trapping with or without bypass). The period between the onset of SAH and the time of specimen collection ranged from 6 hours to 35 days. All 13 aneurysms were pathologically examined with immunohistochemical staining, with a focus on the chronological healing process after SAH. RESULTS All dissecting aneurysms were generated with sudden widespread disruption of the internal elastic lamina and media. The healing process occurred with neointimal proliferation. The neointima, consisting mainly of newly synthesized smooth muscle cells and collagen fibers, extended from the disrupted ends of the media proper forward to the ruptured portion. CONCLUSION It is assumed that the healing process, with neointimal proliferation, begins after 1 week and may not be complete even after 1 month, depending on the extent of the wall injury.

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Segmental anatomy of cerebellar arteries: a proposed nomenclature

Journal of Neurosurgery ◽

10.3171/2011.3.jns101413 ◽

2011 ◽

Vol 115 (2) ◽

pp. 387-397 ◽

Cited By ~ 30

Author(s):

Ana Rodríguez-Hernández ◽

Albert L. Rhoton ◽

Michael T. Lawton

Keyword(s):

Cerebral Arteries ◽

Posterior Inferior Cerebellar Artery ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Microsurgical Anatomy ◽

Numbering System ◽

Segmental Anatomy ◽

Cerebellar Artery ◽

Intracranial Arteries

Object The conceptual division of intracranial arteries into segments provides a better understanding of their courses and a useful working vocabulary. Segmental anatomy of cerebral arteries is commonly cited by a numerical nomenclature, but an analogous nomenclature for cerebellar arteries has not been described. In this report, the microsurgical anatomy of the cerebellar arteries is reviewed, and a numbering system for cerebellar arteries is proposed. Methods Cerebellar arteries were designated by the first letter of the artery's name in lowercase letters, distinguishing them from cerebral arteries with the same first letter of the artery's name. Segmental anatomy was numbered in ascending order from proximal to distal segments. Results The superior cerebellar artery was divided into 4 segments: s1, anterior pontomesencephalic segment; s2, lateral pontomesencephalic segment; s3, cerebellomesencephalic segment; and s4, cortical segment. The anterior inferior cerebellar artery was divided into 4 segments: a1, anterior pontine segment; a2, lateral pontine segment; a3, flocculopeduncular segment; and a4, cortical segment. The posterior inferior cerebellar artery was divided into 5 segments: p1, anterior medullary segment; p2, lateral medullary segment; p3, tonsillomedullary segment; p4, telovelotonsillar segment; and p5, cortical segment. Conclusions The proposed nomenclature for segmental anatomy of cerebellar artery complements established nomenclature for segmental anatomy of cerebral arteries. This nomenclature is simple, easy to learn, and practical. The nomenclature localizes distal cerebellar artery aneurysms and also localizes an anastomosis or describes a graft's connections to donor and recipient arteries. These applications of the proposed nomenclature with cerebellar arteries mimic the applications of the established nomenclature with cerebral arteries.

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Fusiform vertebral artery aneurysms as a cause of dissecting aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1999.91.1.0139 ◽

1999 ◽

Vol 91 (1) ◽

pp. 139-144 ◽

Cited By ~ 40

Author(s):

Toshihiro Yasui ◽

Masaki Komiyama ◽

Misao Nishikawa ◽

Hideki Nakajima ◽

Yasutsugu Kobayashi ◽

...

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Internal Elastic Lamina ◽

Content Type ◽

Pathological Characteristics ◽

Vertebral Arteries ◽

Cerebellar Artery ◽

The Media ◽

Dissecting Aneurysms ◽

Elastic Lamina

✓ Two autopsy cases of angiographically determined fusiform aneurysms of the vertebral arteries (VAs) are reported and the appropriate literature is reviewed to investigate the pathological characteristics of both fusiform and dissecting VA aneurysms and the pathogenesis of dissecting aneurysms. One patient had suffered a subarachnoid hemorrhage (SAH) due to dissection of a previously documented incidental fusiform aneurysm. The other patient had harbored incidental fusiform aneurysms coexistent with a ruptured aneurysm of the posterior inferior cerebellar artery. The location and pathological features of the aneurysms were similar in the two cases. The aneurysms in both cases displayed intimal thickening, disruption of the internal elastic lamina, and degeneration of the media. A mural hemorrhage and patchy calcification were also found in the case that included SAH. Based on their pathological investigation of these two cases and a review of reported cases, the authors propose that incidental fusiform aneurysms in the VAs are characterized by weakness in the internal elastic lamina and, therefore, have the potential to become dissecting aneurysms, resulting in a fatal prognosis. This suggests that long-term control of blood pressure is mandatory in patients with incidental fusiform aneurysms in the VAs.

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Anchoring Fibrils in Arterial Endothelium

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100063287 ◽

1969 ◽

Vol 27 ◽

pp. 274-275

Author(s):

A. Trillo

Keyword(s):

Carotid Arteries ◽

Animal Species ◽

Cell Layer ◽

Present Communication ◽

Internal Elastic Lamina ◽

Endothelial Cell Layer ◽

Structural Details ◽

Rats And Mice ◽

Arterial Endothelium ◽

Elastic Lamina

There are conflicting reports regarding some fine structural details of arteries from several animal species. Buck denied the existence of a sub-endothelial space, while Karrer and Keech described a space of variable width which separates the endothelium from the underlying internal elastic lamina in aortas of aging rats and mice respectively.The present communication deals with the ultrastrueture of the interface between the endothelial cell layer and the internal elastic lamina as observed in carotid arteries from rabbits of varying ages.

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Scanning electron microscopic study of hemodynamically induced tears in the internal elastic lamina of rabbit arteries

Pathology ◽

10.3109/00313028909061060 ◽

1989 ◽

Vol 21 (3) ◽

pp. 207-212 ◽

Cited By ~ 22

Author(s):

Barry J. Martin ◽

William E. Stehbens ◽

Paul F. Davis ◽

Pat A. Ryan

Keyword(s):

Microscopic Study ◽

Electron Microscopic Study ◽

Internal Elastic Lamina ◽

Electron Microscopic ◽

Scanning Electron Microscopic Study ◽

Scanning Electron Microscopic ◽

Elastic Lamina ◽

Scanning Electron

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Transient Reduction of FMD-Response and L-Arginine Accompanied by Increased Levels of E-Selectin, VCAM, and ICAM after Prolonged Strenuous Exercise

Sports ◽

10.3390/sports9060086 ◽

2021 ◽

Vol 9 (6) ◽

pp. 86

Author(s):

Christoffer Nyborg ◽

Helene Støle Melsom ◽

Martin Bonnevie-Svendsen ◽

Jørgen Melau ◽

Ingebjørg Seljeflot ◽

...

Keyword(s):

Endothelial Function ◽

Strenuous Exercise ◽

Finish Line ◽

Endothelial Inflammation ◽

Flow Mediated Dilatation ◽

Line P ◽

Ironman Distance

We assessed endothelial function by flow-mediated dilatation (FMD), levels of the NO-precursor L-arginine, and markers of endothelial inflammation before, at the finish line, and one week after the Norseman Xtreme triathlon. The race is an Ironman distance triathlon with a total elevation of 5200 m. Nine male participants were included. They completed the race in 14.5 (13.4–15.3) h. FMD was significantly reduced to 3.1 (2.1–5.0)% dilatation compared to 8.7 (8.2–9.3)% dilatation before the race (p < 0.05) and was normalized one week after the race. L-arginine showed significantly reduced levels at the finish line (p < 0.05) but was normalized one week after the race. Markers of endothelial inflammation E-Selectin, VCAM-1, and ICAM-1 all showed a pattern with increased values at the finish line compared to before the race (all p < 0.05), with normalization one week after the race. In conclusion, we found acutely reduced FMD with reduced L-arginine levels and increased E-Selectin, VCAM-1, and ICAM-1 immediately after the Norseman Xtreme triathlon. Our findings indicate a transient reduced endothelial function, measured by the FMD-response, after prolonged strenuous exercise that could be explained by reduced NO-precursor L-arginine levels and increased endothelial inflammation.

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Elastic Fibers of the Internal Elastic Lamina Are Unraveled But Not Created With Expanding Arterial Diameter in Arteriogenesis

JVS: Vascular Science ◽

10.1016/j.jvssci.2020.11.002 ◽

2020 ◽

Vol 1 ◽

pp. 247

Author(s):

Derek Afflu ◽

Dylan D. McCreary ◽

Nolan Skirtich ◽

Kathy Gonzalez ◽

Edith Tzeng ◽

...

Keyword(s):

Elastic Fibers ◽

Internal Elastic Lamina ◽

Arterial Diameter ◽

Elastic Lamina

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Decreased Flow-Mediated Dilatation in Children With Type 1 Diabetes: A Systematic Review and Meta-Analysis

Angiology ◽

10.1177/00033197211010096 ◽

2021 ◽

pp. 000331972110100

Author(s):

Lei Cao ◽

Miao Hou ◽

Wanping Zhou ◽

Ling Sun ◽

Jie Shen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Endothelial Function ◽

Meta Analysis ◽

Quality Data ◽

Cochrane Library ◽

Healthy Children ◽

Healthy Controls ◽

Flow Mediated Dilatation

Type 1 diabetes (T1DM) is a strong risk factor for the development of cardiovascular disease. Flow-mediated dilatation (FMD) is an early noninvasive marker of endothelial function and it predicts future cardiovascular disease. However, the changes in FMD among T1DM children are still controversial. The present meta-analysis aimed to investigate whether FMD is impaired in children with T1DM. PubMed, EMBASE, Cochrane library, and Web of Science were searched for studies comparing FMD in children with T1DM and healthy controls. The Newcastle-Ottawa quality assessment scale for case–control studies was used to assess study quality. Data were pooled using a random effects models to obtain the weighted mean differences (WMD) in FMD and 95% CIs. Overall, 19 studies with 1245 patients and 872 healthy controls were included in this meta-analysis. Children with T1DM had significantly lower FMDs compared with healthy controls (WMD: −2.58; 95% CI: −3.36 to −1.81; P < .001). Meta-regression analysis revealed that low-density lipoprotein cholesterol levels impacted the observed difference in FMD between T1DM and healthy children. This meta-analysis showed that T1DM children have impaired endothelial function, which indicates they are at higher risk of developing cardiovascular disease in later life.

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Flow-mediated dilatation following wrist and upper arm occlusion in humans: the contribution of nitric oxide

Clinical Science ◽

10.1042/cs1010629 ◽

2001 ◽

Vol 101 (6) ◽

pp. 629-635 ◽

Cited By ~ 180

Author(s):

Sagar N. DOSHI ◽

Katerina K. NAKA ◽

Nicola PAYNE ◽

Christopher J.H. JONES ◽

Moira ASHTON ◽

...

Keyword(s):

Nitric Oxide ◽

Endothelial Function ◽

Brachial Artery ◽

Peak Flow ◽

Ultrasound Probe ◽

Upper Arm ◽

Flow Mediated Dilatation ◽

Synthase Inhibitor ◽

Increased Blood Flow ◽

Similar Peak

Flow-mediated dilatation (FMD) of the brachial artery assessed by high-resolution ultrasound is widely used to measure endothelial function. However, the technique is not standardized, with different groups using occlusion of either the wrist or the upper arm to induce increased blood flow. The validity of the test as a marker of endothelial function rests on the assumption that the dilatation observed is endothelium-dependent and mediated by nitric oxide (NO). We sought to compare the NO component of brachial artery dilatation observed following wrist or upper arm occlusion. Dilatation was assessed before and during intra-arterial infusion of the NO synthase inhibitor NG-monomethyl-l-arginine (l-NMMA) following occlusion of (i) the wrist (distal to ultrasound probe) and (ii) the upper arm (proximal to ultrasound probe) for 5min in ten healthy males. Dilatation was significantly greater after upper arm occlusion (upper arm, 11.62±3.17%; wrist, 7.25±2.49%; P = 0.003). During l-NMMA infusion, dilatation after wrist occlusion was abolished (from 7.25±2.49% to 0.16±2.24%; P < 0.001), whereas dilatation after upper arm occlusion was only partially attenuated (from 11.62±3.17% to 7.51±2.34%; P = 0.006). The peak flow stimulus was similar after wrist and upper arm occlusion. We conclude that dilatation following upper arm occlusion is greater than that observed after wrist occlusion, despite a similar peak flow stimulus. l-NMMA infusion revealed that FMD following wrist occlusion is mediated exclusively by NO, while dilatation following upper arm occlusion comprises a substantial component not mediated by NO, most probably related to tissue ischaemia around the brachial artery. FMD following wrist occlusion may be a more valid marker of endothelial function than dilatation following upper arm occlusion.

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