Exposure of the V1–V3 segments of the vertebral artery via the posterior cervical triangle: a cadaveric feasibility study

2006 ◽  
Vol 5 (4) ◽  
pp. 320-323 ◽  
Author(s):  
R. Shane Tubbs ◽  
Mohammadali M. Shoja ◽  
Leslie Acakpo-Satchivi ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Feasibility Study ◽  
Subclavian Artery ◽  
Sternocleidomastoid Muscle ◽  
Proximal Segment ◽  
Surgical Exposure ◽  
Left And Right ◽  
Equal Efficacy

Object Surgical exposure of the extracranial part of the vertebral artery (VA) is occasionally necessary. Historically, the greater portion of the extracranial portion of the VA has been approached by traversing the anterior cervical triangle. The authors speculated that this entire segment of the VA could be reached with equal efficacy via the posterior cervical triangle (PCT). Methods Six adult cadavers underwent dissection of the left and right VAs via the PCT. The entire extracranial VA was easily exposed through this approach. Only three of 12 sides required the transection of the clavicular head of the sternocleidomastoid muscle for exposure of the most proximal segment of the VA as it originated from the subclavian artery. No gross injury to the VA or other regional vessels or nerves was noted. Conclusions The authors found that the extracranial VA can be exposed easily through the PCT. Following confirmation of this technique in vivo, this approach may be added to the surgeon’s armamentarium for exposing the extracranial segment of the VA.

scholarly journals Persistent second cervical intersegmental artery in a case of possible PHACE syndrome

2020 ◽  
pp. 159101992094555
Author(s):  
Philippe Gailloud
Keyword(s):  
Vertebral Artery ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Internal Carotid ◽  
Proximal Segment ◽  
Phace Syndrome ◽  
Arterial Variations

The proximal segment of the vertebral artery most often consists of a persistent sixth cervical intersegmental artery that originates from the subclavian artery, but it may also derive from a fifth, fourth, or third cervical intersegmental artery (in decreasing order of frequency), or from a first thoracic intersegmental artery. The involvement of more cranial cervical branches is exceptional, with no known persistent first cervical intersegmental artery and possibly five cases of persistent second cervical intersegmental arteries reported so far. This report describes a patient with multiple arterial variations including right persistent second cervical intersegmental artery of common carotid origin, distal VA duplication, circumflex aortic arch, and segmental internal carotid agenesis in a context of possible PHACE syndrome.

Endovascular therapy of subclavian artery occlusive disease involving the vertebral artery origin

VASA ◽  
2020 ◽  
Vol 49 (3) ◽  
pp. 205-213
Author(s):  
Vera Schneider ◽  
Ralf Dirschinger ◽  
Isabel Wustrow ◽  
Arne Müller ◽  
Salvatore Cassese ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Subclavian Artery ◽  
Distal Segment ◽  
Proximal Segment ◽  
Lesion Location ◽  
Medial Segment ◽  
Bifurcation Stenting ◽  
Procedural Success ◽  
Percutaneous Revascularization

Summary. Background: While the majority of subclavian artery (SA) lesions are localized in the proximal segment, the evidence in patients with medial SA disease involving the vertebral artery (VA) origin are scarce. Patients and methods: We retrospectively analyzed all patients who underwent percutaneous revascularization of the SA at our institution. Results: A total of 196 patients were retrospectively analyzed. The majority of SA lesions (n = 163, 83 %) were located in the proximal segment, whereas 28 lesions (14 %) were located in the medial segment, and only 5 lesions (3 %) involved the distal segment. Procedural success was high for both stenosis (96 %) and occlusion (89 %) and did not differ depending on lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 patients), and bifurcation stenting of the SA and VA using T-stenting technique (9 patients). Outcome after a median of 12 months showed no significant differences in freedom from restenosis between proximal and medial lesions (90 % vs. 95 %; p = 0.67). Conclusions: Endovascular revascularization of SA disease with medial segments involving the VA origin required more complex techniques and showed long-term patency rates comparable to those in lesions located within the proximal SA.

P4707Incidence and outcome of endovascular therapy in subclavian occlusive disease involving the vertebral artery origin

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V S Schneider ◽  
R Dirschinger ◽  
I Wustrow ◽  
S Cassese ◽  
M Fusaro ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Subclavian Artery ◽  
Endovascular Therapy ◽  
Innominate Artery ◽  
Distal Segment ◽  
Proximal Segment ◽  
Special Focus ◽  
Medial Segment ◽  
Artery Disease

Abstract Background Endovascular revascularization represents the treatment option of choice in symptomatic steno-occlusive disease of the subclavian artery (SA). While the majority of lesions are localized in the proximal segment of the subclavian artery, studies in regards to the medial segment involving the vertebral artery (VA) origin are scarce. Purpose The aim of this study was to analyze the technical approaches and outcome of endovascular therapy of subclavian artery disease with a special focus on medial lesions involving the VA origin. Methods We retrospectively analyzed all patients who underwent percutaneous revascularization of the subclavian or innominate artery with a special focus on medial lesions involving the VA origin. Results In total 196 patients with subclavian or innominate artery intervention were analyzed. The majority of lesions (83%) were located in the proximal, whereas 28 patients (14%) presented with lesions in the medial segment of the SA, and only 3% involved the distal segment. Overall procedural success was high for both stenosis (96%) and occlusion (89%) and did not differ according to the lesion location. Revascularization techniques in the medial segment included stenting of the SA only (13 patients), additional VA balloon-dilatation (6 Patients), and bifurcational stenting of the SA and VA using T-stenting technique (9 patients). Overall periprocedural complication rate was low (6%) and comparable between different SA segments (6% in proximal segment vs. 7% in medial segment vs. 0% in distal segment; p=0.81). Outcome assessed after a median of 12 months (interquartile range 4–30) showed no significant differences in terms of Kaplan-Meier estimated freedom from restenosis between proximal and medial lesions despite the technically demanding approach in the medial segment (90% vs. 95%; p=0.67). Long-term patency Conclusion Endovascular revascularization of medial subclavian artery lesions involving the vertebral artery origin shows comparable safety and efficacy in terms of long-term patency rates compared to lesions located within the proximal subclavian artery. However, more complex endovascular techniques with bifurcational ballooning or stenting is required in a considerable number of patients with medial subclavian artery disease.

Visualization of brain microvasculature and blood flow in vivo: Feasibility study using confocal laser endomicroscopy

2021 ◽  
Author(s):  
Evgenii Belykh ◽  
Xiaochun Zhao ◽  
Brandon Ngo ◽  
Dara S. Farhadi ◽  
Adam Kindelin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Feasibility Study ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Brain Microvasculature

scholarly journals Inducibility, but not stability, of atrial fibrillation is increased by NOX2 overexpression in mice

2021 ◽  
Author(s):  
Alexandra S Mighiu ◽  
Alice Recalde ◽  
Klemen Ziberna ◽  
Ricardo Carnicer ◽  
Jakub Tomek ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Superoxide Production ◽  
Right Atrial ◽  
Burst Stimulation ◽  
Lv Mass ◽  
Surface Ecg ◽  
Tissue Homogenates ◽  
Genotype Difference ◽  
Left And Right

Abstract Aims Gp91-containing NADPH oxidases (NOX2) are a significant source of myocardial superoxide production. An increase in NOX2 activity accompanies atrial fibrillation (AF) induction and electrical remodelling in animal models and predicts incident AF in humans; however, a direct causal role for NOX2 in AF has not been demonstrated. Accordingly, we investigated whether myocardial NOX2 overexpression in mice (NOX2-Tg) is sufficient to generate a favourable substrate for AF and further assessed the effects of atorvastatin, an inhibitor of NOX2, on atrial superoxide production and AF susceptibility. Methods and results NOX2-Tg mice showed a 2- to 2.5-fold higher atrial protein content of NOX2 compared with wild-type (WT) controls, which was associated with a significant (twofold) increase in NADPH-stimulated superoxide production (2-hydroxyethidium by HPLC) in left and right atrial tissue homogenates (P = 0.004 and P = 0.019, respectively). AF susceptibility assessed in vivo by transoesophageal atrial burst stimulation was modestly increased in NOX2-Tg compared with WT (probability of AF induction: 88% vs. 69%, respectively; P = 0.037), in the absence of significant alterations in AF duration, surface ECG parameters, and LV mass or function. Mechanistic studies did not support a role for NOX2 in promoting electrical or structural remodelling, as high-resolution optical mapping of atrial tissues showed no differences in action potential duration and conduction velocity between genotypes. In addition, we did not observe any genotype difference in markers of fibrosis and inflammation, including atrial collagen content and Col1a1, Il-1β, Il-6, and Mcp-1 mRNA. Similarly, NOX2 overexpression did not have consistent effects on RyR2 Ca2+ leak nor did it affect PKA or CaMKII-mediated RyR2 phosphorylation. Finally, treatment with atorvastatin significantly inhibited atrial superoxide production in NOX2-Tg but had no effect on AF induction in either genotype. Conclusion Together, these data indicate that while atrial NOX2 overexpression may contribute to atrial arrhythmogenesis, NOX2-derived superoxide production does not affect the electrical and structural properties of the atrial myocardium.

scholarly journals Bias between the Left and Right Inverted Repeats during IS911 Targeted Insertion

2008 ◽  
Vol 190 (18) ◽  
pp. 6111-6118 ◽  
Author(s):  
P. Rousseau ◽  
C. Loot ◽  
C. Turlan ◽  
S. Nolivos ◽  
M. Chandler
Keyword(s):  
Insertion Sequence ◽  
Regulatory Protein ◽  
Open Reading Frames ◽  
Inverted Repeats ◽  
Functional Differences ◽  
Left And Right ◽  
Ordered Assembly ◽  
Overlapping Open Reading Frames ◽  
Reading Frames

ABSTRACT IS911 is a bacterial insertion sequence composed of two consecutive overlapping open reading frames (ORFs [orfA and orfB]) encoding the transposase (OrfAB) as well as a regulatory protein (OrfA). These ORFs are bordered by terminal left and right inverted repeats (IRL and IRR, respectively) with several differences in nucleotide sequence. IS911 transposition is asymmetric: each end is cleaved on one strand to generate a free 3′-OH, which is then used as the nucleophile in attacking the opposite insertion sequence (IS) end to generate a free IS circle. This will be inserted into a new target site. We show here that the ends exhibit functional differences which, in vivo, may favor the use of one compared to the other during transposition. Electromobility shift assays showed that a truncated form of the transposase [OrfAB(1-149)] exhibits higher affinity for IRR than for IRL. While there was no detectable difference in IR activities during the early steps of transposition, IRR was more efficient during the final insertion steps. We show here that the differential activities between the two IRs correlate with the different affinities of OrfAB(1-149) for the IRs during assembly of the nucleoprotein complexes leading to transposition. We conclude that the two inverted repeats are not equivalent during IS911 transposition and that this asymmetry may intervene to determine the ordered assembly of the different protein-DNA complexes involved in the reaction.

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