Left Carotid Artery Research Articles

Intestinal microbiota modulates neuroinflammatory response and brain injury after neonatal hypoxia-ischemia

ABSTRACT Premature infants lack a normal intestinal microbial community and also at risk of perinatal hypoxic-ischemic (HI) brain injury, which is considered to be one of the major factors for motor, sensory, and cognitive deficits. We hypothesized that neonatal gut microbiota composition modulated the immune reaction and severity of neonatal H-I brain injury. Neonatal C57BL/6J mouse pups were exposed to H-I protocol consisting of permanent left carotid artery ligation, followed by 8% hypoxia for 60 min. Microbial manipulation groups included 1) antibiotic treatment, E18 (maternal) to P5; 2) antibiotic treatment E18 to P5 + E. coli gavage; 3) antibiotic treatment E18 to P5 + B. infantis gavage; and 4) saline to pups with dams getting fresh water. The extent of brain injury and recovery was measured on MRI. Edematous injury volume was significantly higher in E. coli group than that in B. infantis group and in fresh water group. Gene expression in brains of pro-inflammatory cytokines (IL1β, IL6, IL2, TNF-α and toll-like receptors 2–6) were elevated to a greater extent in the E. coli group at P10, no injury, and at P13, 72 hours after H-I relative to sham control and B. infantis groups. Significant effects of microbiome and brain injury and interaction of these factors were found in abundance of major phyla. The neuroinflammatory response and brain injury after neonatal hypoxia-ischemia are affected by intestinal microbiota, providing opportunities for therapeutic intervention through targeting the early colonization and development of the gut microbiota.

Deconstructive repair of a direct carotid-cavernous fistula via a posterior circulation retrograde approach.

We report a case of a 24-year-old patient who presented after a head trauma with a traumatic occlusion of his left internal carotid artery. He underwent diagnostic cerebral angiogram and was found to have a direct left carotid-cavernous fistula (CCF) with retrograde filling from the posterior circulation across the posterior communicating artery. Because of the severe injury to the left internal carotid artery (ICA), reconstructive repair of the ICA was not possible. The patient underwent deconstructive repair of the CCF by coil embolization using a posterior retrograde approach. Coils were successfully placed in the cavernous sinus and back into the left ICA with complete cure of the CCF and restoration of cerebral perfusion distal to the treated CCF. We review the types of CCFs, their clinical presentation, and their endovascular treatments. Retrograde access of a direct CCF is rarely reported in the literature, and we believe this approach offers a viable alternative in appropriately selected patients.

Ruptured pial-pial collateral aneurysm associated with left internal carotid artery occlusion: nuances of surgical management. Illustrative case.

Carotid occlusion often leads to the formation of a collateral network. On rare occasions, due to hemodynamic influence, aneurysms can occur. Here, the authors describe a 69-year-old male presenting with intracerebral hemorrhage secondary to a ruptured aneurysm within such a network. The patient presented to the emergency department with an altered level of consciousness. Imaging showed a left temporal lobe hemorrhage extending into the ventricle, subdural hematoma, and evidence of contrast extravasation. Digital subtraction angiography revealed an occluded left internal carotid artery with the left middle cerebral artery territory reconstituted by flow through an external carotid artery-internal carotid artery anastomosis. The latter was formed by the superficial temporal artery-superior orbital artery, as well as pial-pial collaterals from the posterior temporal artery. Notably, a 4-mm aneurysm arising from the pial-pial collateral network was identified. Surgical intervention involved a left temporal craniectomy and aneurysm excision, with special attention paid to preserving the anastomotic flow through the superficial temporal artery. This case underscores the importance of recognizing and preserving collateral vascular pathways in cases of carotid occlusion with an associated aneurysm. It emphasizes the necessary balance between managing aneurysm risk and maintaining cerebral perfusion, highlighting the need for careful preoperative planning and intraoperative caution.

Bilateral vertebral artery injury leads to brain death following traumatic brain injury: a case report

BackgroundVertebral artery injury is a rare condition in trauma settings. In the advanced stages, it causes death.CaseA 31-year-old Sundanese woman with cerebral edema, C2–C3 anterolisthesis, and Le Fort III fracture after a motorcycle accident was admitted to the emergency room. On the fifth day, she underwent arch bar maxillomandibular application and debridement in general anesthesia with a hyperextended neck position. Unfortunately, her rigid neck collar was removed in the high care unit before surgery. Her condition deteriorated 72 hours after surgery. Digital subtraction angiography revealed a grade 5 bilateral vertebral artery injury due to cervical spine displacement and a grade 4 left internal carotid artery injury with a carotid cavernous fistula (CCF). The patient was declared brain death as not improved cerebral perfusion after CCF coiling.ConclusionsBrain death due to cerebral hypoperfusion following cerebrovascular injury in this patient could be prevented by early endovascular intervention and cervical immobilisation.

A CFD-based framework to evaluate surgical alternatives in cerebral aneurysms

ABSTRACT Computational Fluid Dynamic (CFD) simulations on patient-specific geometries may guide the choice between alternative surgical interventions, especially in the case on non-conventional treatments. We propose and formalise a CFD-based framework to evaluate alternative surgical interventions. It provides surgeons with the CFD analyses of different surgical options, so that they may decide the best strategy based on quantitative haemodynamic parameters for each surgical alternative. The proposed framework is largely automatised and, when it necessarily requires the intervention of a human operator due to the patient-specific nature, this intervention is well-formalised to reduce inter-operator variability and guarantee reproducibility. To provide preliminary evidence on the effectiveness of the framework, we present its application to complex Intracranial Aneurysms (IAs), which involve less than 5% of brain aneurysms, but are usually at a high risk of rupture and often show unexpected response to therapy. Complex IAs include aneurysms that cannot be treated with conventional therapies, such as neck clipping, sac coiling or stenting, while instead their treatment requires the sacrifice of the parent artery. In particular, we refer to a giant cavernous sinus aneurysm inside the left internal carotid artery. Results show the ability of the framework to provide haemodynamic quantitative evaluations, which can be useful additional information for the neurosurgeon towards optimal surgical planning.

Effect of 2-Week Naringin Supplementation on Neurogenesis and BDNF Levels in Ischemia–Reperfusion Model of Rats

Background: Ischemic stroke is the leading cause of mortality and disability worldwide with more than half of survivors living with serious neurological sequelae; thus, it has recently attracted a lot of attention in the field of medical study. Purpose: The aim of this study was to determine the effect of naringin supplementation on neurogenesis and brain-derived neurotrophic factor (BDNF) levels in the brain in experimental brain ischemia–reperfusion. Study design: The research was carried out on 40 male Wistar-type rats (10–12 weeks old) obtained from the Experimental Animals Research and Application Center of Selçuk University. Experimental groups were as follows: (1) Control group, (2) Sham group, (3) Brain ischemia–reperfusion group, (4) Brain ischemia–reperfusion + vehicle group (administered for 14 days), and (5) Brain ischemia–reperfusion + Naringin group (100 mg/kg/day administered for 14 days). Methods: In the ischemia–reperfusion groups, global ischemia was performed in the brain by ligation of the right and left carotid arteries for 30 min. Naringin was administered to experimental animals by intragastric route for 14 days following reperfusion. The training phase of the rotarod test was started 4 days before ischemia–reperfusion, and the test phase together with neurological scoring was performed the day before and 1, 7, and 14 days after the operation. At the end of the experiment, animals were sacrificed, and then hippocampus and frontal cortex tissues were taken from the brain. Double cortin marker (DCX), neuronal nuclear antigen marker (NeuN), and BDNF were evaluated in hippocampus and frontal cortex tissues by Real-Time qPCR analysis and immunohistochemistry methods. Results: While ischemia–reperfusion increased the neurological score values, DCX, NeuN, and BDNF levels decreased significantly after ischemia in the hippocampus and frontal cortex tissues. However, naringin supplementation restored the deterioration to a certain extent. Conclusion: The results of the study show that 2 weeks of naringin supplementation may have protective effects on impaired neurogenesis and BDNF levels after brain ischemia and reperfusion in rats.

Acute large-vessel occlusion due to an infected thrombus formation induced by invasive sphenoid sinus aspergillosis: illustrative case.

The authors describe a rare case of acute large-vessel occlusion due to an infected thrombus formation that was induced by invasive sphenoid sinus aspergillosis. An 82-year-old man with a history of immunoglobulin G4-related disease and long-term use of steroids and immunosuppressants was admitted to the authors' hospital with severe right hemiparesis. Cerebral angiography revealed occlusion of the left internal carotid artery (ICA). He underwent thrombectomy, resulting in successful recanalization. However, severe stenosis was evident in the left ICA cavernous segment. Pathological analysis of the retrieved thrombus identified Aspergillus. Postoperative magnetic resonance imaging revealed sinusitis in the left sphenoid sinus as a possible source of the infection. The patient's general condition deteriorated during the course of hospitalization due to refractory aspiration pneumonia, and he died 46 days after thrombectomy. Pathological autopsy and histopathological investigation of the left ICA and the left sphenoid sinus showed that Aspergillus had invaded the wall of the left ICA from the adjacent sphenoid sinus. These findings indicate a diagnosis of acute large-vessel occlusion due to infected thrombus formation induced by invasive sphenoid sinus aspergillosis. Pathological analysis of a retrieved thrombus appears useful for identifying rare stroke etiologies such as fungal infection.

SOLAMEN syndrome in a toddler

BackgroundSegmental overgrowth, lipomatosis, arteriovenous malformation, and epidermal nevus (SOLAMEN) syndrome is a segmental overgrowth syndrome that is part of Cowden’s Syndrome, a subset of the PTEN hamartoma tumor syndrome cluster. Due to SOLAMEN disease’s rarity, clinical suspicion should arise if multiple small nonspecific variably low-attenuated nodular lesions in the back, shoulders, and upper arms are present on CT, which are associated with mucocutaneous lesions. We present a rare case of SOLAMEN syndrome with widespread lipomatous growth, greater than reported in literature, with confirmed PTEN genetic testing.Case presentationWe describe a case of a 2-year-old boy with a slowly growing left neck mass since birth. Physical exam revealed macrocephaly and epidermal nevi on left axilla, arm, and fingers, appearing as pink verrucous and has visible veins on chest wall/abdomen. CT and MRI imaging showed a lipomatous hibernoma extending from the leftward neck to the abdominal cavity, encasing vascular structures form the left carotid and subclavian arteries to the diaphragmatic hiatus, in addition to the spleen and kidney. Biopsy of the left shoulder revealed hibernoma, a fatty neoplasm of benign brown fat. Patient had a resection of his left shoulder hibernoma and is currently asymptomatic, undergoing surveillance.ConclusionDue to SOMAMEN syndrome’s rarity, clinical suspicion should arise if a patient presents with multiple small-nonspecific variably low-attenuated nodular lesions on CT and mucocutaneous lesions. Ongoing monitoring should be done as there is an increased risk of cancer.

Diagnostic Accuracy of Duplex Ultrasonography Versus Computed Tomographic Angiography in the Detection of Significant Carotid Artery Atherosclerosis

Objective: To determine the diagnostic accuracy Duplex of Ultrasonography in detecting clinically significant carotid atherosclerosis by keeping Computed Tomographic Angiography as a gold standard. Study Design: Cross-Sectional study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging Rawalpindi Pakistan, from Jun to Nov 2019. Methodology: All patients referred with neurological symptoms during the study were included. Duplex (Doppler) ultrasound and Computed Tomographic Angiography of bilateral carotid arteries were performed on all these patients. The percentage of carotid stenosis was calculated for both modalities. Data was recorded separately for both right and left carotid arteries. Results: Out of 170 carotid arteries in 85 patients, Duplex ultrasound supported the diagnosis of clinically significant carotid atherosclerosis in 89 arteries (52.3%), and CTA confirmed it in 86 arteries (50.5%). Overall, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Duplex ultrasonography in the detection of clinically significant carotid atherosclerosis by taking computed tomographic angiography (CTA) as a gold standard was 92.0%, 89.0%, 89.8%, 92.5% and 91.1% respectively Conclusion: Duplex ultrasonography is an accurate, non-invasive imaging investigation for detecting carotid atherosclerosis.

Acute Ischemic Stroke in a 41-year-old Female Secondary to Internal Carotid Artery Dissection: A Case Report

Spontaneous carotid artery dissection is an important cause of ischemic stroke and is most common in young and middle-aged adult patients. Dissection occurs after tearing of the intima layer of the artery causes the formation of a thrombus (intramural), and it leads to thrombosis or embolism. The thrombosis or embolism, in turn, interrupts arterial circulation and, subsequently, induces infarction in the territory of the affected artery. The case of an ischemic vascular event involving the left cerebral hemisphere secondary to a spontaneous dissection of the left internal carotid artery is presented here.

Crossed Cerebellar Diaschisis and Cerebral Infarction After Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting: A Case Report

Crossed cerebellar diaschisis (CCD) often occurs after ischemic or hemorrhagic stroke that does great damage to the cortico-ponto-cerebellar pathway (CPCP). Nevertheless, as far as we know, CCD due to cerebral hyperperfusion syndrome (CHS) following carotid artery stenting (CAS) is rare. We report a case where CCD and new cerebral infarction after CHS following CAS was effectively treated by intravenous use of edaravone and mannitol. The patient was a 74-year-old female. She developed dizziness and vomiting accompanied with weakness of the right limb for 8 days and was admitted to our hospital. Computed tomography angiography scan revealed severe stenosis at the beginning of the left internal carotid artery. Further digital subtraction angiography (DSA) revealed severe stenosis at the beginning of the left internal carotid artery, with a stenosis rate of approximately 90%. Therefore, she underwent left CAS implantation. After the operation, the patient developed disturbance of consciousness and decreased muscle strength in the right limb. Intravenous infusion of edaravone and mannitol were then started. After 10 days of medical treatment, the condition of patient improved to mild hemiparesis. The findings in this present case strongly suggest that CHS after CAS for carotid artery stenosis may cause transient CCD.

Focal finger palsy and wrist pain due to cortical infarction: a case report

Abstract Background Hand knob infarction induced focal weakness of contralateral hand or distal arm, only accounts for less than 1% of all ischemic strokes. To date, there is no case with pain during sleep as the onset symptoms being reported. The atypical symptoms of hand knob infarction might increase the risk of delaying treatment especially in the hyperacute phase of stroke. Case presentation A 70-year-old man awoke from sleep due to sudden pain of his right medial wrist and presented to the emergency department with difficulty extending his right index and middle fingers within the time window of intravenous thrombolysis. But the intravenous thrombolysis was not given based on the NIHSS score (0) and atypical symptoms. MRI showed multiple DWI hyperintense lesions, including partial left hand knob area and left posterior central gyrus. CTA showed a severe focal stenosis of proximal left internal carotid artery. Conclusions The hand knob infarction might onset with unusual pain and should be carefully inspected in patients combined with acute onset of focal hand paresis.

Right-sided aortic arch with isolation of the left innominate artery and hypoplasia of the left internal carotid artery.

Here, we report a case of the right-sided aortic arch with isolation of the left innominate artery and hypoplasia of the left internal carotid artery. A 42-year-old male patient underwent a whole-body computed tomography angiography (CTA) examination upon the clinical suspicion of vasculitis. CTA revealed a right-sided aortic arch with the isolation of the left innominate artery and hypoplasia of the left internal carotid artery. The right-sided aortic arch, with the isolation of the left innominate artery, is a scarce vascular variation that may occur with other cardiovascular anomalies such as ventricular septal defect. It can be asymptomatic or can present with symptoms of subclavian steal syndrome. Although its association with the agenesis of the left internal carotid artery has been reported, its association with the hypoplasia of the left internal carotid artery has not been reported previously to the best of our knowledge.

Dolichoectasia of the ophthalmic artery: a case report on the treatment strategy in endovascular therapy and literature review

BackgroundDolichoectasia is a rare arterial condition characterized by the dilatation, tortuosity, and elongation of cerebral blood vessels. The vertebrobasilar artery and internal carotid artery are the common sites of dolichoectasia. However, dolichoectasia of the branch arteries, such as the ophthalmic artery (OA), is extremely rare. To the best of our knowledge, this is the first case of ophthalmic dolichoectasia that was successfully treated with endovascular internal coil trapping.Case presentationA 54-year-old female patient presented with transient left ophthalmalgia and visual disturbance. Magnetic resonance imaging revealed a dilated and elongated left OA compressing the optic nerve at the entrance of the optic canal. However, a previous image that was taken 17 years back revealed that the OA was normal, which suggested the change in dolichoectasia was acquired. Cerebral angiography showed that the dilated and tortuous OA was running from the ophthalmic segment of the left internal carotid artery into the orbit. The symptoms could have been attributed to the direct compression of the dolichoectatic OA in the optic canal. A sufficient anastomosis between the central retinal artery and the middle meningeal artery was identified on external carotid angiography with balloon occlusion of the internal carotid artery. Endovascular treatment with internal trapping of the OA was performed due to ophthalmic symptom progression. Internal coil trapping of the OA was performed at the short segment between the OA bifurcation and the entrance of the optic canal. As expected, the central retinal artery was supplied via the middle meningeal artery after the treatment. The transient visual disturbance was immediately resolved. Ophthalmalgia worsened temporarily after the treatment. However, it completely resolved after several days of oral corticosteroid therapy. Postoperative angiography showed that the origin of the OA was occluded and that the OA in the optic canal was shrunk. The flow of the central retinal arteries via the middle meningeal artery was preserved.ConclusionsOA dolichoectasia is rare, and its pathogenesis and long-term visual prognosis are still unknown. However, endovascular therapy can improve symptom by releasing the pressure site in the optic canal.

Validation of Signal Intensity Gradient from TOF-MRA for Wall Shear Stress by Phase-Contrast MR.

To validate the correlation between the signal intensity gradient (SIG) from time-of-flight magnetic resonance angiography (TOF-MRA) and wall shear stress (WSS) determined by phase contrast magnetic resonance (PC-MR), we conducted both experimental and human studies. In the experimental study, we measured WSS in four tubes of different sizes with variable flow rates using PC-MR and TOF-MRA. The flow rates of water in the experimental study ranged from 0.06 to 12.75mL/s, resulting in PC-WSS values between 0.1 and 1.6 dyne/cm2. The correlation between PC-WSS and SIG was statistically significant, showing a coefficient of 0.86 (P < 0.001, R2 = 0.75). The line fit provided the conversion equation as Y = 1.6287X - 1.1563 (Y = PC-WSS, X = SIG). For the human study, 28 subjects underwent TOF-MRA and PC-MR examinations of carotid and vertebral arteries. Arterial PC-WSS and SIG were determined in the same segment for each subject. The arterial PC-WSS ranged from 1.9 to 21.0 dyne/cm2. Both carotid and vertebral arteries showed significant correlations between PC-WSS and SIG, with coefficients of 0.85, 0.86, 0.91, and 0.81 in the right and left carotid and vertebral arteries, respectively. Our results show that SIG from TOF-MRA and SIG-WSS derived from the conversion equation provide concurrent in vivo hemodynamic information on arterial shear stress.This study was registered on ClinicalTrials.gov with the identifier NCT04585971 on October 14, 2020.

Correlation between Morphological and Hemodynamic Parameters of Carotid Arteries and Cerebral Vasomotor Reactivity.

The function of cerebral small vessels can be assessed using cerebral vasomotor reactivity (VMR). Our aim in this retrospective cross-sectional study was to investigate a correlation between carotid artery stenosis measured through ultrasonographic morphological and hemodynamic parameters and cerebral VMR. A total of 285 patients (125 males; mean age 54) were included. The breath-holding index (BHI) was used to evaluate cerebral VMR. Ultrasonographic carotid artery parameters were collected: the presence and characteristics of carotid plaques, the degree of carotid diameter stenosis, intima-media thickness (IMT), peak systolic velocity (PSV), and end diastolic velocity (EDV). Additionally, hemodynamic parameters of the middle cerebral artery (MCA) were evaluated, including the mean flow velocity (MFV) and pulsatility index (PI). The following was collected from patients' medical histories: age, gender, and vascular risk factors. A negative correlation between the BHI and age (r = -0.242, p < 0.01), BHI and the presence of carotid plaques, BHI and IMT (r = -0.203, p < 0.01), and BHI and the PI of MCA on both sides (r = -0.268, p < 0.01) was found. We found a positive correlation between the BHI in the left MCA and EDV in the left internal carotid artery (r = 0.121, p < 0.05). This study shows the correlation between cerebral VMR and carotid stenosis but indicates a higher influence of morphological parameters on VMR values.

Takayasu’s arteritis during pregnancy: A case report

Takayasu’s arteritis (TA) is also known as aorto arteritis having an incidence is 13/per million population. Here, we report the case of a 30-year-old woman gravida 2, para 1, who was admitted for safe delivery at 38 weeks of pregnancy. Clinical examination revealed an absence of radial pulse and blood pressure (BP) in both upper limbs and lower limbs BP recording showed 150/90 mm Hg with a pulse rate of 112/min. She was a known case of TA diagnosed during her first pregnancy. An elective cesarean section was done and a healthy male baby weighing 3.2 kg was delivered. The postnatal period was uneventful. She was discharged on the 8th day. A magnetic resonance imaging (MRI) angiogram was done before the second pregnancy. There was complete occlusion of the left common carotid artery from the origin with occlusion of the left internal carotid artery and there was collateral refilling of the left anterior cerebral artery and middle cerebral artery from the posterior communicating artery. The left vertebral artery showed circumferential wall thickening with hypointense flap within.

Abstract TP143: Longitudinal Evaluation of Vessel Wall MRI Demonstrates Bilaterally Symmetric Evolution of Carotid Atherosclerosis

Introduction: Carotid atherosclerosis is a leading cause of stroke worldwide. Previous studies demonstrated bilateral symmetry in atherosclerotic plaque burden and calcification scores. By leveraging longitudinal 3D vessel wall MRI, this study aims to investigate if there is a symmetrical trend of bilateral plaque progression. Methods: Asymptomatic patients with confirmed carotid stenosis were prospectively recruited in the study. Subjects underwent baseline and follow-up 3D vessel wall imaging for a time span up to 8 years. A deep learning-based pipeline was used to bilaterally segment the carotid lumen and vessel wall on axial image slices. Within each artery, the range of slices with wall thickness &gt; 2mm on any scan was included as potential atherosclerotic plaque. Plaque burden, positively associated with stroke risk, was defined as the percent wall volume (wall volume / total vessel volume х 100%). For each plaque, a linear model was fitted across all available time points to determine the growth rate of plaque burden. We used generalized estimating equation-based linear regression models to evaluate associations of the growth rate of each side with the contralateral side, adjusted for clinical risk factors and medications. Effect sizes were summarized using the partial correlation coefficient. Results: 20 subjects (mean age 73.5 years, 3 females, 14 on statins) who underwent at least three scans with bilateral carotid plaque were included in the analysis. Each subject underwent an average of 4.8 scans over 5.2 years. Overall, the plaque growth rate of one side was moderately correlated with the contralateral side (r=0.50, p=0.004), even after adjusting for age, sex and statins use. Then, for each subject, the larger of the two plaques at baseline (left or right side) was identified. The growth rate of the larger plaque was also predictive of the growth rate of the smaller plaque over the same time period (r=0.66, p=0.004). Conclusion: The systemic nature of atherosclerotic disease entails an association in symmetrical disease evolution for left and right carotid arteries. In bilaterally diseased patients, the longitudinal monitoring of the more advanced carotid lesion may provide prognostic information on the less advanced contralateral plaque.

Abstract WMP116: A P2X4 Inhibitor Dramatically Suppresses the Progression of Cervical Internal Carotid Artery Stenosis - An Attempt to Develop a Therapeutic Agent for Carotid Artery Stenosis Focusing on the Role of Hemodynamic Factors-

Introduction: Medical treatment of internal carotid artery stenosis consists of treatment of underlying conditions such as hypertension, dyslipidemia, and diabetes mellitus, as well as antiplatelet therapy. Hemodynamic studies suggest that endothelial cells sense disturbances and stagnation of blood flow caused by vessel geometry, which trigger the progression of stenosis. Similarly, cerebral aneurysms are known to progress due to hemodynamic effects. We have shown in animal studies that inhibition of P2X4 purinoceptor, an endothelial blood flow sensing-related protein, significantly inhibits the development of cerebral aneurysms. In the present study, we examined whether P2X4 disruption can suppress the progression of internal carotid artery stenosis using an animal model of carotid artery stenosis. Methods: Carotid stenosis coils were implanted in the left carotid artery of 7-week-old P2X4(-/-) and (+/+) mice fed a high-cholesterol diet. Four weeks after placement, the carotid arteries were removed and the occlusion rates of the carotid arteries were compared. The expression of known stenosis-related inflammatory factors was also examined by Western blotting. Results: The carotid occlusion rate was significantly lower in the P2X4 gene-deficient mice, with 5 of 16 occlusions, compared with 9 of 13 occlusions in the control group (p=0.0394, Student's t-test). The expression levels of MCP-1, COX-2, TNFα, and IL-1β were significantly increased in the carotid arteries of P2X4(+/+) mice with the coil compared to the non-operated group (p=0.0073, 0.0012, 0.0016, 0.0031, respectively, Wilcoxon's signed rank test). The carotid arteries of P2X4(-/-) mice with coils showed significantly lower expression of all of the above compared to those of P2X4(+/+) mice (p=0.0233, 0.0020, 0.0098, 0.0046, respectively). Conclusions: These results suggest that inhibition of endothelial blood flow sensing by P2X4 disruption may have reduced the progression of carotid artery stenosis by suppressing the expression of a group of inflammatory factors associated with carotid artery stenosis. This may lead the way to new drug therapies for carotid artery stenosis.

Surgical management of stylocarotid Eagle syndrome in a patient with bilateral internal carotid artery dissection: illustrative case.

Eagle syndrome is characterized by an elongated styloid process, which can cause acute neurological symptoms when the projection impinges on local structures. One method by which Eagle syndrome can cause acute stroke is via internal carotid artery dissection. A patient presented with acute aphasia and right-arm weakness. Imaging revealed a left internal carotid artery dissection, which was treated with stenting. Three years later, the patient presented with left-sided weakness, and imaging revealed a new right internal carotid artery dissection. Closer review of the patient's imaging revealed bilateral elongated styloid processes. The patient subsequently underwent staged bilateral styloidectomy and returned to his prior baseline postoperatively. This case report describes a patient with Eagle syndrome who had two internal carotid artery dissections separated by several years. A literature review revealed that styloidectomy is well tolerated in patients with carotid dissection due to Eagle syndrome. Patients with carotid dissection due to Eagle syndrome remain at risk for contralateral dissection, and prophylactic contralateral styloidectomy should be considered.