Objective To explore the arterial origin and the distribution of the extracranial branches of the facial nerve. Methods Red latex or red chlorinated polyvinyl chloride was injected into the arteries of 15 fresh adult head specimens by both common carotid artery catheterization. The arterial origin and distribution of the extracranial branches of the facial nerve were observed. Results The nutrient arteries of the extracranial branches of the facial nerve originated from stylomastoid artery of the posterior auricular artery, the facial nervous branch of superficial temporal artery, transverse facial artery, superior and inferior facial nervous branches of external carotid artery and the posteriorand anterior facial nervous branches of external carotid artery. The outer diameters of them were (0.8±0.2) mm, (0.9±0.4) mm, (1.9±0.3) mm, (1.0±0.2) mm, (1.1±0.4) mm, (1.0±0.2) mm and (1.1±0.6) mm respectively. The sub-branches ofthe attendant artery of the facial nerve anastomosed each other in addition to supplying their own nerve, and a rich vascular network was formed between the facial nerve and adjacent tissue. Conclusion The study on blood supply of the extracranial segment of the facial nerve can provide anatomic basis for avoiding injury of the nutrient arteries of the facial nerve during operation of the parotidean and masseteric region clinically.
ObjectiveTo analyze the short-term and long-term efficacy of staged coronary artery bypass grafting (CABG) and carotid artery stenting (CAS) compared with CABG alone in patients with coronary heart disease with preoperative history of stroke and carotid stenosis. MethodsWe reviewed the clinical data of 55 patients (48 males, 7 females, aged 67.62±7.06 years) with coronary heart disease and carotid stenosis who had a history of stroke and underwent CABG+CAS or CABG alone in Zhongshan Hospital from 2008 to 2017. There were 13 patients in the staged CABG+CAS group and 42 patients in the CABG alone group. The differences in the incidence of perioperative adverse events and long-term survival between the two groups were studied, and univariate and multivariate analyses were carried out to determine the independent risk factors of long-term adverse events. Results Perioperative adverse events occurred in 1 (7.69%) patient of the staged CABG+CAS group, and 4 (9.52%) patients of the CABG alone group (P=0.84). During the follow-up period (67.84±37.99 months), the long-term survival rate of patients in the staged CABG+CAS group was significantly higher than that in the CABG alone group (P=0.02). The risk of long-term adverse events in the staged CABG+CAS group was 0.22 times higher than that in the CABG alone group (95%CI 0.05-0.92, P=0.04). ConclusionStaged CABG+CAS can significantly improve the long-term survival prognosis without increasing the perioperative risk. It is a safe and effective treatment, but prospective randomized studies are still needed to further confirm this finding.
Hemodynamic situation is an important factor of recurrence of postoperative carotid artery aneurysm. In order to investigate the hemodynamic factors of postoperative carotid artery aneurysm affect carotid artery aneurysm recurrence, we established a 3D finite element carotid artery aneurysm for the preoperative and postoperative periods using the three-dimensional reconstruction techniques. And then we measured the hemodynamic factors of carotid artery aneurysm of preoperative and postoperative by the finite element method. The carotid artery aneurysm model has an accurate and realistic shape; the pressure of the recurrence of aneurysm was reduced significantly after surgery,wall shear stress increased significantly at residual neck, and blood flow velocity increased significantly, which will increase the risk of recurrence. The hemodynamic analysis provides a reference for development of aneurysm clinical treatment programs and prevention of recurrence.
Objective To investigate the experience of selective embolization combined with intraoperative internal carotid artery shunt for surgical treatment of carotid body tumor （CBT）. Methods The data of 21 patients （22 sides） with CBT who underwent surgical resection from January 2002 to July 2012 in our hospital were retrospectively reviewed. The all patients’ conditions were fully assessmented and all patients were performed the carotid arteriography and superselective embolization treatment for the blood supply of tumor by with microcatheter on 2-3 days before operation，and then intraoperative internal carotid artery shunt and resection of carotid body tumors were performed. Results Surgical procedures were successfully performeded in all 21 patients （22 sides）. Among them， 16 patients （17 sides） were taken carotid body tumor resected， 5 patients were taken carotid body tumor resected and internal carotid artery reconstruction （autogenous long saphenous vein were used in 3 patients， vascular prosthesis were used in 2 patients）. The postoperative complications were found in 5 patients after anesthesia recovery， which included crooked tongue in 3 cases and facial numbness in 2 cases， and they were cured in 3 months. There were no cerebral infarction， hemiplegia， and death cases. All 21 patients were followed-up for a period from 2 months to 9 years（average 57 months）， there was no tumor recurred. Conclusions Surgical resection is the first choice for treatment of carotid body tumor. The application of selective embolization and intraoperative internal carotid artery shunt for surgical treatment of carotid body tumor in complicated Shamblin Ⅲ stage is safe and effective.
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 clinical value of dual-source CT perfusion imaging (CTPI) in the assessment of cerebral hemodynamic changes in patients with internal carotid atherosclerosis. MethodsThirty patients diagnosed to have internal carotid atherosclerosis by CT angiography examination with various degrees of stenosis or occlusion were treated between January 2012 and May 2013. Whole brain perfusion imaging was performed on all the patients. We rebuilt the CTPI figure parameters respectively, including cerebral blood volume (CBV), blood flow (CBF), mean transit time (MTT) and time to peak (TTP) to assess brain tissue perfusion. ResultsIn the 30 patients with internal carotid atherosclerosis, 8 had mild stenosis lumen, 12 moderate stenosis, 7 severe stenosis and 3 had occlusion. In mild stenosis cases, TTP of stenosis-side vessels was higher than those of coutralateral side (P<0.05), and there were no significant differences in other perfusion parameters between bilateral vessels among mild stenosis cases (P>0.05). MTT and TTP of stenosis-side vessels were higher than those of contralateral side in moderate stenosis cases (P<0.05). In severe stenosis or obstruction cases, MTT and TTP of stenosis-side vessels were higher than those of contralateral side, while CBF and CBV of stenosis-side vessels were lower than contralateral side (P<0.05). Twenty-two in the 30 cases had perfusion abnormalities, and there was a significant difference between the stenosis side cerebral perfusion and the healthy side mirror area (P<0.05). ConclusionCTPI can reflect brain tissue perfusion early and comprehensively, and fully reflect internal carotid atherosclerosis caused by severe stenosis or occlusion of cerebral hemodynamic changes, which provides important information for clinical treatment and helps clinicians to formulate individualized treatment plan.
A method of ultrasonic simulation based on the FIELD II software platform for carotid artery plaque was proposed according to the analysis for geometrical shape, tissue characteristics and acoustic properties of carotid artery plaques in clinic, and then a simulation system was developed by using the MATLAB graphical user interface (GUI). In the simulation and development, a three-dimensional geometric model of blood vessel with plaques was set up by using the metaball implicit surface technique, and a tissue model was established based on the scatterers with spatial position of gamma random distribution. Comparison of the statistical and geometrical characteristics from simulated ultrasound B-mode images with those based on clinical ones and preset values, the results fully demonstrated the effectiveness of the simulation methods and system.
ObjectiveTo explore the short-term and long-term efficacy of carotid endarterectomy (CEA) in patients with carotid artery stenosis, and analyze the risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after operation.MethodsThe clinical data of 326 patients with carotid artery stenosis who underwent CEA in the Second Department of General Surgery, Hospital of Traditional Chinese Medicine Affiliated to Xinjiang Medical University from January 2012 to December 2017 were retrospectively analyzed. Multivariate logistic regression analysis was performed to screen the risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after CEA, and the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of serum homocysteine (Hcy) and modified Rankin scale (mRS) score.ResultsAll patients underwent successful surgery. Follow-up results showed that the incidence rate of cardiovascular and cerebrovascular events within 30 days after surgery was 6.7% (22/326), and the incidence rate of cardiovascular and cerebrovascular events within one year after surgery was 11.8% (38/323). Multivariate logistic regression analysis showed that smoking history (OR=2.373), contralateral carotid artery stenosis (OR=4.669), preoperative mRS score≥3 (OR=2.550), and preoperative serum Hcy≥20 μmmol/L (OR=1.335) were independent risk factors for occurrence of cardiovascular and cerebrovascular events within 30 days after CEA (P<0.05). ROC curve analysis showed that the area under the curve of serum Hcy level was 0.834 in predicting cardiovascular and cerebrovascular events within 30 days after CEA [95%CI was (0.769, 0.899), P=0.003]. The area under the ROC curve of mRS score for predicting cardiovascular and cerebrovascular events within 30 days after CEA was 0.697 [95%CI was (0.552, 0.842), P=0.009].ConclusionsCEA is a safe and effective procedure for the treatment of carotid artery stenosis. The smoking history, contralateral carotid artery stenosis, preoperative severe neurological deficit, and elevated serum Hcy are independent risk factors for occurrence of cardiovascular and cerebrovascular events after CEA.
ObjectiveTo achieve a better early clinical result by modifying the total arch replacement and optimi-zing the procedure of operation. MethodWe retrospectively analyzed the clinical data of 38 patients patients with stanford a aortic dissection underwent the modifed total arch replacement in our hospital from September to December 2014. There were 26 males and 12 females with a mean age of 52.5 years ranging from 21-76 years. Three artery conduits were adopted during the surgical procedure. Right axillary artery and femoral artery cannulation were performed for cardiopulmonary bypass. The artificial graft and the left common carotid artery was anastomosed to provide simultaneous perfusion. Low rate bilateral brain perfusion began when circulation arrested at 26℃. Reperfusion restoration was obtained after the four-branch vascular graft anastomosed to the stent and aortic wall and completed the implantation of the elephant trunk. Then the aortic root and the vascular graft anastomosis were performed to reconstruct the ascending aorta. At last, the left subclavian artery and innominate artery were anastomosed to the branch of the vascular graft under the beating heart. ResultAll 38 operations were successful. The mean hypothermic circulatory time of the whole group was 18.8±4.2 min, the time of ascending aorta blocking was 86.1±14.2 min, the time of cardiopulmonary bypass was 178.4±71.4 min, the time of postoperative awakening was 4.7±2.0 h, the time of assisted mechanical ventilator was 38.7±19.9 h. One patient died because of multiple organ dysfunction syndrome (MODS), 3 patients accepted the hemodialysis, 6 patients suffered from transient neurological dysfunction, 1 patient suffered from paraparesis. There was no further complication during the follow-up of 1-3 months. ConclusionThe modified total aortic arch replacement can shorten the circulatory arrest time, cardiac arrest time and cardiopulmonary time, provide effective organ perfusion, and reduce the neurological complication and visceral damage.
Takayasu arteritis (TA) is a chronic nonspecific inflammation that commonly occurs in the aorta and its main branches. Most patients with TA are lack of clinical manifestations, leading to misdiagnosis. When the TA is correctly diagnosed, the patients may already have stenosis or occlusion in the involved arteries, resulting in arterial ischemia and hypoxia symptoms, and in severe cases it will be life-threatening. Contrast-enhanced ultrasonography (CEUS) is an emerging method for assessing TA, but the assessment relies heavily on experiences of radiologists performing manual and qualitative analyses, so the diagnostic results are often not accurate. To overcome this limitation, this paper presents a computer-assisted quantitative analysis of TA carotid artery lesions based on CEUS. First, the TA lesion was outlined on the carotid wall, and one homogeneous rectangle and one polygon were selected as two reference regions in the carotid lumen. The temporal and spatial features of the lesion region and the reference regions were then calculated. Furthermore, the difference and ratio of the features between the lesion and the reference regions were computed as new features (to eliminate interference factors). Finally, the correlation was analyzed between the CEUS features and inflammation biomarkers consisting of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The data in this paper were collected from 34 TA patients in Zhongshan Hospital undergoing CEUS examination with a total of thirty-seven carotid lesions, where two patients were with two lesions before and after treatment and one patient was with left and right bilateral lesions. Among these patients, 13 were untreated primary patients with a total of 14 lesions, where one patient was with bilateral lesions. The results showed that for all patients, the neovascularization area ratio in the 1/3 inner region of a lesion (ARi1/3) achieved a correlation coefficient (r) of 0.56 (P=0.001) with CRP, and for the primary patients, the neovascularization area ratio in the 1/2 inner region of a lesion (ARi1/2) had an r-value of 0.76 (P=0.001) with CRP. This study indicates that the proposed computer-assisted method can objectively and semi-automatically extract quantitative features from CEUS images, so as to reduce the effect on diagnosis due to subjective experiences of the radiologists, and thus it is expected to be used for clinical diagnosis and severity evaluation of TA carotid lesions.