Carotid Artery Cannulation Research Articles

Carotid versus axillary artery cannulation for descending aorta remodeling in type A acute aortic dissection.

Arterial cannulation sites for the surgical repair of type A aortic dissection (AAD) have evolved from right axillary artery (AA) cannulation to bilateral carotid artery (CA) based of femoral artery (FA) cannulation. Postoperative descending aorta remodeling is closely linked to the false lumen area ratio (FLAR), defined as false lumen area/aortic area, as well as to the incidence of renal replacement therapy (RRT). To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling. A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study. Of these, 209 received right AA cannulation and 234 received bilateral CA cannulation. The primary outcome was the change in FLAR, as calculated from computed tomography angiography in three segments of the descending aorta: Thoracic (S1), upper abdominal (S2), and lower abdominal (S3). Secondary outcomes were the incidence of RRT and the serum inflammation response, as observed by the levels of high sensitivity C reaction protein (hs-CRP) and Interleukin-6 (IL-6). The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group (S2: 0.80 ± 0.08 vs 0.75 ± 0.07, P < 0.001; S3: 0.57 ± 0.12 vs 0.50 ± 0.12, P < 0.001, respectively). The AA group also had a significantly higher incidence of RRT (19.1% vs 8.5%, P = 0.001; odds ratio: 2.533, 95%CI: 1.427-4.493) and higher levels of inflammation cytokines 24 h after the procedure [hr-CRP: 117 ± 17 vs 104 ± 15 mg/L; IL-6: 129 (103, 166) vs 83 (69, 101) pg/mL; both P < 0.001] compared to the CA group. The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation, as observed by a greater change in FLAR and lower incidence of RRT.

Abstract P160: Sex Differences in Age-Dependent Hypertension and Cognitive Impairment in Sprague-Dawley Rats

Objective: We previously found that male (M), but not female (F), Sprague-Dawley (SD) rats develop age-dependent hypertension (HTN) that is associated with cognitive impairment. We hypothesized that ovariectomy (OVRX) at midlife, to model human menopause, would induce hypertension and cognitive impairment with age. Methods: In M and F SD rats at 3-, 8-, and 16-months-old (MO), blood pressure (MAP; mmHg) and sympathetic tone to the vasculature (iv hexamethonium, PeakΔMAP; mmHg) was measured via femoral artery cannulation. Recognition memory was assessed using the novel object recognition task. Blood brain barrier (BBB) integrity in the PVN was assessed as FITC extravasation following carotid artery cannulation. In a separate group of female rats at 8 MO, sham procedure, OVRX, or OVRX with estradiol replacement for 8-months (s.c. estradiol valerate, 1.5 mg extended-release pellet) was performed and rats were aged to 16MO. At 16MO, the previously described procedures were carried out. Results: M, but not F, SD rats develop age-dependent HTN and increased sympathoexcitation that is associated with recognition memory deficits and BBB disruption. Following OVRX, female rats develop age-dependent HTN that is associated with recognition memory deficits and BBB disruption. Replacement of estrogen with 17β-estradiol prevented the development of HTN, cognitive impairment, and BBB disruption. Conclusions: In males, HTN induces BBB disruption and is associated with cognitive impairment. Our studies suggest midlife loss of estrogen likely contributes to the development of age-dependent HTN and cognitive impairment in females. We speculate estrogen supplementation may mitigate HTN-related changes in memory with age.

Novel Blood Pressure-Lowering Effect of Spathulenol in Rats

In recent years, natural compounds from plant sources are sought after as alternative anti-hypertensive treatments. Spathulenol (Spa), a terpenoid plant metabolite obtained mainly from the Origanum species has shown anecdotal evidence of blood pressure (BP)-lowering properties probably through the effects on vasoreactivity. This study aimed to investigate the BP-lowering activities of Spa in vivo as well as to ascertain the mechanisms of action in vitro. Male Sprague-Dawley (SD) rats (n=16) and spontaneously hypertensive rats (SHR) (n=16) with their normotensive Wistar-Kyoto (WKY) rats (n=16) as controls were subjected to anaesthesia and administered intravenous boluses of Spa at 0.0, 0.045, 0.90, 0.18, 0.36, and 0.7 mg/kg or positive control losartan at 0.0, 0.6, 1.2, 1.8, 2.4 and 3.0 mg/kg. The BP and heart rate (HR) of the rats were recorded by a computerised physiographical system (Power Lab) through carotid arterial cannulation that was connected to a pressure transducer. The data were analysed by using the Lab Chart 6 software. Spathulenol was also tested for angiotensin-converting enzyme (ACE) inhibitory activity by using the ACE1 inhibitor screening kit (PromoKine). Spathulenol was able to decrease the BP of rats in a dose-dependent manner with the BP-lowering effect being significantly (p &lt; 0.05) higher in the SHRs than in the WKY controls. Furthermore, Spa was able to inhibit the ACE activity suggesting the possibility that this could be one of the mechanisms underlying the observed BP-lowering effect.

Effects of vitamin C on the pharmacokinetics and pharmacodynamics of nimodipine in rats.

In recent years, researchers have shown a growing interest in the interactions between different pharmaceutical agents. An intriguing instance lies in the possible interaction between nimodipine and vitamin C. To investigate the pharmacokinetic and pharmacodynamic effects of vitamin C on nimodipine in rats, rats were randomly divided into a nimodipine only group and a combination group (nimodipine + vitamin C). The two groups were given intragastric administration and nimodipine blood concentrations were determined using high-performance liquid chromatography-tandem mass spectrum at different time points. Blood pressure and heart rate were measured via carotid artery cannulation. Pharmacokinetic differences were observed between the nimodipine only group and the combination group at the same dose. Compared with the nimodipine only group, the combination group's main pharmacokinetic parameters of peak concentration and area under the curve increased significantly, and the difference was statistically significant (p < 0.05); furthermore, the combination group exhibited a significant reduction in average blood pressure, while no significant effects on heart rate were observed. Vitamin C did not affect the activity of CYP450 in rat liver. The pharmacokinetic characteristics and pharmacodynamics of nimodipine were changed by vitamin C administration in rats.

The Cavernous Nerve Injury Rat Model: A Pictorial Essay on Post-Radical Prostatectomy Erectile Dysfunction Research.

Understanding and addressing post-radical prostatectomy (RP) erectile dysfunction (ED) is of paramount importance for clinicians. Cavernous nerve (CN) injury rat model studies have provided consistently promising experimental data regarding regaining erectile function (EF) after nerve damage-induced ED. However, these findings have failed to translate efficiently into clinical practice, with post-RP ED therapeutic management remaining cumbersome and enigmatic. This disparity highlights the need for further standardization and optimization of the elaborate surgical preparation protocols and multifaceted reporting parameters involved in reliable CN injury rat model experimentation. Even so, despite its technical complexity, this animal model remains instrumental in exploring the functional implications of RP, i.e., surgical lesions of the neurovascular bundles (NVBs). Herein, besides cavernous nerve (CN) dissection, injury, and electrostimulation, multiple pressure measurements, i.e., mean arterial pressure (MAP) and intra-cavernosal pressure (ICP), must also be achieved. A transverse cervical incision allows for carotid artery cannulation and MAP measurements. Conversely, ICP measurements entail circumcising the penis, exposing the ischiocavernous muscle, and inserting a needle into the corporal body. Finally, using an abdominal incision, the prostate is revealed, and the major pelvic ganglia (MPG) and CNs are dissected bilaterally. Specific surgical techniques are used to induce CN injuries. Herein, we provide a narrative and illustrative overview regarding these complex experimental procedures and their particular requirements, reflecting on current evidence and future research perspectives.

Vitamin D Attenuates Cardiac Hypertrophy in Rats through mRNA Regulation of Interleukin-6 and Its Receptor

Abstract Context: Interleukin-6 (IL-6), a pro-inflammatory cytokine, plays an important role in the pathogenesis of myocardial hypertrophy. By integrating its membrane receptor complex (gp80), IL-6 activates the signal guidance components (gp130) and activates the hypertrophic signaling pathways. There is some evidence that 1,25 dihydroxyvitamin D exerts antihypertrophic effects, but the cellular and molecular mechanisms are not fully understood. The aim of this study was to evaluate the effect of calcitriol on the level of IL-6 and its receptor components in hypertrophied rat heart. Subjects and Methods: Male rats were divided into control, hypertrophy, Vitamin D + hypertrophy, and propylene glycol + hypertrophy groups. The groups receiving Vitamin D and propylene glycol were treated 2 weeks before induction of hypertrophy and 2 weeks after hypertrophy. Myocardial hypertrophy was induced by abdominal aortic stenosis. Mean arterial blood pressure was measured by cannulation of the left carotid artery, and expression of genes was determined by reverse transcription-polymerase chain reaction. Results: Blood pressure and heart-to-body weight ratio increased in hypertrophic groups compared to the control group (P &lt; 0.01), but Vitamin D administration decreased these parameters (P &lt; 0.05). Abdominal aortic stenosis increased IL-6 expression levels (P &lt; 0.001) and Vitamin-D decreased IL-6 mRNA levels (P &lt; 0.01). The expression of gp80 in the hypertrophic group increased compared to the control group (P &lt; 0.05), but Vitamin D did not affect the expression of receptor subunits genes. Conclusions: The data from this study suggest a possible mechanism for the antihypertrophic effects of Vitamin D through the regulation of inflammatory responses during hypertrophy. Thus, Vitamin D can reduce IL-6 expression levels, thereby reducing hypertrophy.

Remote Neuronal Activation Coupled with Automated Blood Sampling to Induce and Measure Circulating Luteinizing Hormone in Mice.

Circulating luteinizing hormone (LH) levels are an essential index of the functioning of the hypothalamic-pituitary control of reproduction. The role of numerous inputs and neuronal populations in the modulation of LH release is still unknown. Measuring changes in LH levels in mice is often a challenge since they are easily disrupted by environmental stress. Current techniques to measure LH release and pulsatility require long-term training for mice to adapt to manipulation stress, certain restraint, the presence of the investigator, and working on individual animals, reducing its usefulness for many research questions. This paper presents a technique to remotely activate specific neuronal populations using Designer Receptor Exclusively Activated by Designer Drugs (DREADDs) technology coupled with automated sequential blood sampling in conscious, freely moving, and undisturbed mice. We first describe the stereotaxic surgery protocol to deliver adeno-associated virus (AAV) vectors expressing DREADDs to specific neuronal populations. Next, we describe the protocol for carotid artery and jugular vein cannulation and postsurgical connection to the CULEX automated blood sampling system. Finally, we describe the protocol for clozapine-N-oxide intravenous injection for remote neuronal activation and automated blood collection. This technique allows for programmed automated sampling every 5 min or longer for a given period, coupled with intravenous substance injection at a desired time point or duration. Overall, we found this technique to be a powerful approach for research on neuroendocrine control.

The Phthalic Selenoanhydride Decreases Rat Blood Pressure and Tension of Isolated Mesenteric, Femoral and Renal Arteries.

Phthalic selenoanhydride (R-Se) solved in physiological buffer releases various reactive selenium species including H2Se. It is a potential compound for Se supplementation which exerts several biological effects, but its effect on the cardiovascular system is still unknown. Therefore, herein we aimed to study how R-Se affects rat hemodynamic parameters and vasoactive properties in isolated arteries. The right jugular vein of anesthetized Wistar male rats was cannulated for IV administration of R-Se. The arterial pulse waveform (APW) was detected by cannulation of the left carotid artery, enabling the evaluation of 35 parameters. R-Se (1-2 µmol kg-1), but not phthalic anhydride or phthalic thioanhydride, transiently modulated most of the APW parameters including a decrease in systolic and diastolic blood pressure, heart rate, dP/dtmax relative level, or anacrotic/dicrotic notches, whereas systolic area, dP/dtmin delay, dP/dtd delay, anacrotic notch relative level or its delay increased. R-Se (~10-100 µmol L-1) significantly decreased the tension of precontracted mesenteric, femoral, and renal arteries, whereas it showed a moderate vasorelaxation effect on thoracic aorta isolated from normotensive Wistar rats. The results imply that R-Se acts on vascular smooth muscle cells, which might underlie the effects of R-Se on the rat hemodynamic parameters.

Percutaneous Superficial Temporal Artery Access Facilitating Carotid Artery Stenting Performed From Distal Radial Artery.

The purpose of the study is to describe carotid artery stenting (CAS) via distal transradial access (dTRA) facilitated by additional superficial temporal artery (STA) access, in a patient with complex aortic arch vessel anatomy. A 72-year-old woman with a prior history of complex cervical surgery and radiotherapy due to laryngeal malignancy, presented with a symptomatic 90% stenosis of the left internal carotid artery (ICA). Due to high cervical lesion, the patient was rejected from carotid endarterectomy. Angiography demonstrated 90% stenosis of the left ICA and a type III aortic arch. After failure of left common carotid artery (CCA) cannulation with appropriate catheter support via dTRA and transfemoral approaches, CAS was attempted a second time. After percutaneous ultrasound guided access to right dTRA and left STA, a 0.035 inch guidewire introduced to the left CCA from the contralateral dTRA was snared and externalized via left STA to improve wire support for guiding advancement. Thereafter, the left ICA lesion was successfully stented with a 7×30 mm self-expanding stent via right dTRA. All vessels involved were patent at 6-month follow-up. The STA may be a promising adjunctive access site to increase transradial catheter support for CAS or neurointerventional procedures in the anterior circulation. Transradial cerebrovascular interventions have been gaining popularity, however, unstable catheter access to distal cerebrovascular structures limits its widespread use. Guidewire externalization technique via additional STA access may improve transradial catheter stabilty and increase procedural success with possibly low access stie complication rate.

Persistent Hyperglycemia Worsens the Oleic Acid Induced Acute Lung Injury in Rat Model of Type II Diabetes Mellitus.

This research aimed to study the impacts of persistent hyperglycemia on oleic acid (OA)-induced acute lung injury (ALI) in a rat model of type II diabetes mellitus. Healthy adult male albino rats that weigh 150 to 180 g were divided into four groups (n = 6). Group I-saline (75 μL i.v.) was injected and served as a control; group II-OA (75 μL i.v.) was injected to induce ALI. Group III-pretreated with a high-fat diet and streptozotocin (35 mg/kg), was injected with saline, and served as a control for group IV. Group IV was pretreated with a high-fat diet, and streptozotocin (35 mg/kg) was injected with OA (75 μL i.v). Urethane was used to anesthetize the animal. The jugular venous cannulation was done for drug/saline administration, carotid artery cannulation was done to record blood pressure, and the tracheal cannulation was done to maintain the respiratory tract's patent. Heart rate, mean arterial pressure, and respiratory frequency were recorded on a computerized chart recorder; an arterial blood sample was collected to measure PaO2/FiO2. Additionally, the pulmonary water content and lung histology were examined. Hyperglycemic rats showed no significant change in the cardio-respiratory parameter. Histology of the lungs shows fibroblastic proliferation; however, rats survived throughout the observation period. There was an early deterioration of all the cardio-respiratory parameters in hyperglycemic rats when induced ALI (OA- induced), and survival time was significantly less compared to nonhyperglycemic rats. Persistent hyperglycemia may cause morphological changes in the lungs, which worsens the outcome of acute lung injury.

Bilateral Carotid Artery Cannulation before Resternotomy to Maintain Cerebral Perfusion in Reoperative Aortic Aneurysm Surgery

Aortic pseudoaneurysm is an uncommon complication following major aortic surgery. Surgical intervention is challenging due to risks of pseudoaneurysm rupture, causing increased morbidity and mortality. Maintaining cerebral perfusion during circulatory arrest is therefore vital to improve patient outcomes.

Emodin protects against homocysteine-induced cardiac dysfunction by inhibiting oxidative stress via MAPK and Akt/eNOS/NO signaling pathways

Elevated levels of plasma homocysteine (Hcy) causes severe cardiac dysfunction, which is closely associated with oxidative stress. Emodin, a naturally occurring anthraquinone derivative, has been shown to exert antioxidant and anti-apoptosis activities. However, whether emodin could protect against Hcy-induced cardiac dysfunction remains unknown. The current study aimed to investigate the effects of emodin on the Hcy-induced cardiac dysfunction and its molecular mechanisms. Rats were fed a methionine diet to establish the animal model of hyperhomocysteinemia (HHcy). H9C2 cells were incubated with Hcy to induce a cell model of Hcy-injured cardiomyocytes. ELISA, HE staining, carotid artery and left ventricular cannulation, MTT, fluorescence staining, flow cytometry and western blotting were used in this study. Emodin significantly alleviated the structural damage of the myocardium and cardiac dysfunction from HHcy rats. Emodin prevented apoptosis and the collapse of MMP in the Hcy-treated H9C2 cells in vitro. Further, emodin reversed the Hcy-induced apoptosis-related biochemical changes including decreased Bcl-2/Bax protein ratio, and increased protein expression of Caspase-9/3. Moreover, emodin suppressed oxidative stress in Hcy-treated H9C2 cells. Mechanistically, emodin significantly inhibited the Hcy-activated MAPK by reducing ROS generation in H9C2 cells. Furthermore, emodin upregulated NO production by promoting the protein phosphorylation of Akt and eNOS in injured cells. The present study shows that emodin protects against Hcy-induced cardiac dysfunction by inhibiting oxidative stress via MAPK and Akt/eNOS/NO signaling pathways.

Validity of direct bilateral axillary arterial cannulation in emergency surgery for acute type A aortic dissection

To assess the validity and long-term outcomes of direct bilateral axillary arterial cannulation for acute type A aortic dissection. Between 2003 and 2020, 208 consecutive patients with acute type A aortic dissection underwent emergency surgical repair. Cardiopulmonary bypass was attempted to establish direct bilateral axillary arterial cannulation and bicaval drainage. Antegrade selective cerebral perfusion was established by axillary perfusion and direct cannulation of the left common carotid artery. Ascending aortic, partial arch, and extended total aortic arch replacement were performed in 50 (24.0%), 7 (3.4%), and 151 (72.6%) patients, respectively. Aortic root surgery and coronary artery bypass grafting were performed concomitantly in 23 and seven patients, respectively. Cardiopulmonary bypass was attempted only through bilateral axillary cannulation in all patients but was successful in 13 (6.3%) patients without bilateral axillary cannulation. No postoperative complications occurred related to this technique. There were seven hospital deaths (early mortality rate, 3.4%). Five patients had postoperative reoperation for bleeding, and nine (4.3%) were transferred to other hospitals due to postoperative permanent cerebral infarction, particularly two with arm ischemia. The 10-year survival rate of patients who underwent emergency surgical repair with this technique was 71.4%. Direct bilateral axillary arterial cannulation followed by selective cerebral perfusion was successful in 93.7% of patients and this may be an optimal solution for providing stable outcomes after emergency surgery for acute type A aortic dissection. However, we experienced two complications of arm ischemia, attention should be paid to potential arm ischemia.

Total Percutaneous Endovascular Aortic Arch Repair With a Triple Inner-Branch Device (the Innominate Approach)

Purpose: To describe a completely percutaneous approach for endovascular arch repair (arch–percutaneous endovascular aortic repair [PEVAR]) with a triple inner-branch device: the “Innominate Approach.” Technique: After right axillary and single common femoral arteries percutaneous access, the arch stent-graft is introduced and deployed transfemorally using fusion overlay. The brachiocephalic artery (BCA) and the corresponding inner branch are cannulated from the axillary access. Through this access, a steerable-sheath guides antegrade cannulation of the left common carotid artery (LCCA) through its inner branch. Optionally, a wire preloaded through the left subclavian artery (LSA) and the LCCA branch, is snared from the BCA access providing LCCA through and through access. A 10 Fr sheath is then positioned from the BCA branch in the LCCA branch and a second, trans-axillary wire through the same sheath is used to catheterize the LCCA. The LCCA is then stented antegradely (regardless of approach). Finally, the BCA and LSA are bridged to complete the procedure. An additional novelty described is the use of VBX (W. L. Gore) as a bridging stent for the BCA. Conclusion: Arch-PEVAR is feasible with the use of adjuncts that are well-known for physicians performing complex endovascular repair. The “Innominate Approach” avoids access and exposure of the carotid arteries. Clinical Impact We aim to describe the feasibility of the axillary artery as the main route to perform the brachiocephalic artery (BCA) and the left common carotid artery bridging stenting in case of arch endovascular repair (arch-EVAR) with a triple Inner-Branch Device. According to the present “Innominate Approach”, percutaneous arch-EVAR is feasible using either a steerable sheath or a preloaded through-&-through wire. The Innominate approach, including a VBX bridging stent for the BCA, avoids carotid access and exposure, reduces the number of vascular accesses, and allows the downsizing of the trans-axillary devices.

Intraoperative ultrasound evidence of accidental simultaneous cannulation of the common carotid artery and internal jugular vein: illustrative case.

BACKGROUNDEstablishing central venous access is important to provide fluid resuscitation or medications intravenously to patients.OBSERVATIONSAlthough accidental cannulation of the internal carotid artery has been reported in the literature, to our knowledge this report is the first documented intraoperative ultrasound video demonstrating accidental and simultaneous common carotid artery and internal jugular cannulation during central line placement in the internal jugular vein.LESSONSUltrasound use minimizes accidental carotid cannulation during central line placement in the internal jugular vein. Carotid artery puncture can be managed by external application of pressure or surgical reexploration.

Left axillary cannulation for acute type A aortic dissection

The most commonly used arterial cannulation sites for type A aortic dissection are right axillary artery, femoral artery and both. Direct central aortic cannulation has also been reported. In rare cases, it is extremely difficult to choose an arterial cannulation site for type A aortic dissection due to involvement of the right axillary and both femoral arteries. Herein, we present a 39-year-old male with acute type A aortic dissection with involvement of the right axillary and both femoral arteries. Left axillary cannulation was made and selective cerebral perfusion was performed through direct left common carotid artery cannulation during circulatory arrest. Surgery was performed to replace the ascending aorta and total arch combined with a frozen elephant trunk implantation. The patient recovered uneventfully. To our knowledge, this is a rare case of total aortic arch replacement with frozen elephant trunk implantation through left axillary arterial cannulation for type A aortic dissection in the literature. Left axillary cannulation is a safe and useful choice for type A aortic dissection surgery when right axillary and femoral cannulation are not safe and reliable.

Fluttering cord-like thrombus in the aortic arch

BackgroundThe optimal treatment for aortic thrombus remains to be determined, but surgical treatment is indicated when there is a risk for thromboembolism.Case presentationA 47-year-old male presented with weakness in his left arm upon awakening. Contrast-enhanced computed tomography and transesophageal echocardiography revealed a mobile pedunculated object suggestive of a thrombus arising from the ascending aorta and extending to the left common carotid artery. It was removed under hypothermic circulatory arrest and direct cannulation of the left carotid artery to avoid carotid thromboembolism. Histopathological examination revealed that the object was a thrombus. The patient had an uneventful postoperative course and was discharged 9 days after surgery.ConclusionWhen a thrombus in the aortic arch extends to the neck arteries, direct cannulation of the neck arteries with selective cerebral perfusion via cervical incision is a useful technique.

Inhibition of the Hippo Pathway Prevents Arterial Stiffness and Hypertension in Vascular Smooth Muscle Cell Specific Kdm6a Knockout Mice

Arterial stiffness (AS) results from the progressive loss of elasticity of large vessels due to aging and is correlated with hypertension and other cardiovascular co‐morbidities. Increased collagen deposition and contractile protein loss are key contributors to diminished flexibility. The histone 3 lysine demethylase 6a (Kdm6a) transcriptionally activates target genes via removal of tri‐methyl residues on lysine 27 of histone 3 (H3K27me3). The Hippo signaling pathway is crucial for regulating cell proliferation, cell survival, and organ size. The relationship between H3K27me3 and the Hippo pathway in vascular smooth muscle cells (VSMCs) and their effects on arterial compliance and blood pressure (BP) regulation remains unclear. We generated VSMC‐specific Kdm6a knockout (KO) mice of C57BL/6 background and confirmed Kdm6a KO and elevation of H3K27me3 levels by Western blot. Pilot studies (unpublished) indicate that Kdm6a KO results in increased systolic BP and AS due to aortic ECM remodeling and downregulation of contractile protein expression. Further, increased activity of mammalian sterile 20‐like kinase 2 (MST2), a core kinase of the Hippo pathway, was found in Kdm6a KO VSMCs. The objectives of this study were to investigate the effects of Hippo pathway inhibition on arterial compliance and sBP in a VSMC‐specific Kdm6a KO model. Based on the increased MST2 activity noted in Kdm6a KO VSMCs, we hypothesized that Hippo inhibition would prevent the onset of Kdm6a KO‐induced AS and hypertension or blunt the severity of symptoms. Male Myh11Cre/Kdm6aLoxP and Myh11Cre controls were randomly assigned to four groups (n=7‐8): Kdm6a KO‐treated, Kdm6a KO‐vehicle, control‐treated, or control‐vehicle. Immediately after gene deletion, Kdm6a KO mice and controls were administered the MST1/2 inhibitor XMU‐MP‐1 (1mg/kg, i.p.), or vehicle (2% DMSO, i.p.), daily for 4 weeks. Pulse wave velocity (PWV), the gold‐standard method for determination of degree of arterial compliance, was measured weekly. At the study endpoint, sBPs were obtained via direct carotid artery cannulation. The aortic media were collected for further analyses. After one week of treatment, PWVs of Kdm6a KO‐treated mice (3.05 + 0.26 mm/ms) were significantly lower compared with Kdm6a KO‐vehicle (4.10 + 0.29 mm/ms; p&lt;0.01) and remained so throughout the study. The sBPs of Kdm6a KO‐treated mice (106.3 + 2.9 mmHg) were significantly less than those of the Kdm6a KO‐vehicle mice (118.0 + 6 mmHg; p&lt;0.01). Analysis of aortic media by Western blot and immunohistochemistry revealed that treatment with XMU‐MP‐1 effectively inhibits MST2 phosphorylation and activates the downstream Hippo effector protein YAP. Additionally, treated Kdm6a KO mice produced significantly less collagen (p&lt;0.05) and more Myh11 (p&lt;0.05) and calponin (p&lt;0.05) than the Kdm6a KO‐vehicle group. This study suggests that Kdm6a expression by VSMCs is essential for maintaining arterial compliance and regulating BP. Inhibiting the Hippo signaling pathway prevented Kdm6a KO‐induced vascular deregulation by lowering collagen production and rescuing contractile protein expression. These results demonstrate the therapeutic potential of the Hippo pathway in preservation of arterial compliance and BP.

Compression Device-Assisted Extracorporeal Cardiopulmonary Resuscitation Cannulation in Pediatric Patients-A Simulation Study.

Background: Surgical neck cannulation for pediatric extracorporeal cardiopulmonary resuscitation (ECPR) requires multiple interruptions of manual chest compressions to facilitate the procedure. Effective uninterrupted CPR is essential to prevent neurological injury. We hypothesized that an automated chest compression device can be used to provide effective and uninterrupted chest compressions during pediatric neck ECPR cannulation. The feasibility of surgically cannulating the right carotid artery and right internal jugular vein in an infant during ongoing automated chest compressions was tested in a simulation study. Methods: A working prototype of a pediatric chest compression device was designed to provide automated chest compressions on an infant CPR manikin at the rate of 120 compressions/minute. A feedback device attached to the manikin was used to monitor the effectiveness of CPR. A synthetic artery, vein along with carotid sheath and skin was utilized to simulate surgical neck exploration. ECPR simulation was conducted using the compression device to provide chest compressions. Results: Four ECPR simulations were conducted during which vessel sparing (n = 2) and non-vessel sparing (n = 2) cannulation of the right internal carotid artery and right internal jugular vein were performed during ongoing mechanical chest compressions. All four cannulations were successfully performed without the need to interrupt chest compressions. Conclusions: In a simulated environment, pediatric ECPR neck cannulation with uninterrupted chest compressions may be accomplished using an automated chest compression device. The strategy of compression device-assisted ECPR cannulation requires further study and could potentially reduce the neurological complications of ECPR.

Cerebral Infarction During Cervical Veno-Arterial Extracorporeal Membrane Oxygenation in Children: Can it be Predicted?

Veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in children is often established by cannulation of the right carotid artery and the right internal jugular vein. Cerebral infarction which is sometimes seen in such cases may be secondary to an incomplete circle of Willis. We present 3 cases with VA ECMO using cervical cannulation who suffered cerebral infarction which may be attributed to an incomplete circle of Willis.