Selective elevation in external carotid artery flow during acute gravitational transition to microgravity during parabolic flight

This study sought to determine to what extent acute exposure to microgravity (0 G) and related increases in central blood volume (CBV) during parabolic flight influence the regional redistribution of intra and extra cranial cerebral blood flow (CBF). Eleven healthy participants performed during two parabolic flights campaigns aboard the Airbus A310-ZERO G aircraft. The response of select variables for each of the 15 parabolas involving exposure to both 0 G and hypergravity (1.8 G) were assessed in the seated position. Mean arterial blood pressure (MAP) and heart rate (HR) were continuously monitored and used to calculate stroke volume (SV), cardiac output ([Formula: see text]), and systemic vascular resistance (SVR). Changes in CBV were measured using an impedance monitor. Extracranial flow through the internal carotid, external carotid, and vertebral artery ([Formula: see text]ICA, [Formula: see text]ECA, and [Formula: see text]VA), and intracranial blood velocity was measured by duplex ultrasound. When compared with 1-G baseline condition, 0 G increased CBV (+375 ± 98 mL, P = 0.004) and [Formula: see text] (+16 ± 14%, P = 0.024) and decreased SVR (-7.3 ± 5 mmHg·min·L-1, P = 0.002) and MAP (-13 ± 4 mmHg, P = 0.001). [Formula: see text]ECA increased by 43 ± 46% in 0 G (P = 0.030), whereas no change was observed for CBF, [Formula: see text]ICA, or [Formula: see text]VA (P = 0.102, P = 0.637, and P = 0.095, respectively).NEW & NOTEWORTHY Our findings demonstrate that in microgravity there is a selective increase in external carotid artery blood flow whereas global and regional cerebral blood flow remained preserved. To what extent this reflects an adaptive, neuroprotective response to counter overperfusion remains to be established.

Effects of head position on internal and external carotid pressures in standing sedated horses

The effects of head position on internal carotid artery (ICA) and external carotid artery (ECA) pressures in standing sedated horses were evaluated in this study. The common carotid artery (CCA) was catheterized in 6 horses using an ultrasound-guided technique to facilitate placement of a pressure transducer within the ICA and ECA at the level of the guttural pouch. Transducer position was confirmed by endoscopic visualization. Mean arterial pressure (MAP) was measured with horses in both a head-up and head-down position. The dorsal metatarsal artery was catheterized as a control. Maintaining a head-up position decreased MAP in both the ICA (median: 75.21 mmHg) and ECA (median: 79.43 mmHg), relative to the head-down position (ICA median: 104.65 mmHg; ECA median: 102.26 mmHg). Mean arterial pressure in the dorsal metatarsal artery was not affected by head position. The head-up position resulted in lower arterial pressures in both the ICA and ECA (P = 0.03) compared with the head-down position in standing sedated horses.

Blood flow reversal from the external into the internal carotid artery-New insights into the hemodynamics at the carotid bifurcation

BACKGROUND

Complex blood flow patterns are a well-known phenomenon at the carotid bifurcation. However, unlike for the descending aorta, a blood flow reversal has not been detected at the carotid bifurcation, so far.

METHODS

In 17 subjects, flow patterns with focus on blood flow reversal were examined at the carotid bifurcation with vector flow imaging.

RESULTS

We found a blood flow reversal from the external carotid artery (ECA) into the internal carotid artery (ICA) in 13 of 25 (52%) carotid bifurcations. The blood flow reversal ranged 5.3 ± 1.7 mm (range 2.6-8.3 mm) distally to the beginning of the ECA and lasted 105 ± 59 ms (range 32-225 ms). The mean peak systolic velocity within the blood flow reversal was 12.5 ± 4.6 cm/s (range 5-18 cm/s).

CONCLUSION

A blood flow reversal from the ECA into the ICA during the systole is a frequent finding at the carotid bifurcation. Considering ischemic stroke, retrograde embolism from plaques in the proximal ECA into the ICA might play a role.

Investigation of blood flow in the external carotid artery and its branches with a new 0D peripheral model

BACKGROUND

Patient-specific modelling in clinical studies requires a realistic simulation to be performed within a reasonable computational time. The aim of this study was to develop simple but realistic outflow boundary conditions for patient-specific blood flow simulation which can be used to clarify the distribution of the anticancer agent in intra-arterial chemotherapy for oral cancer.

METHODS

In this study, the boundary conditions are expressed as a zero dimension (0D) resistance model of the peripheral vessel network based on the fractal characteristics of branching arteries combined with knowledge of the circulatory system and the energy minimization principle. This resistance model was applied to four patient-specific blood flow simulations at the region where the common carotid artery bifurcates into the internal and external carotid arteries.

RESULTS

Results of these simulations with the proposed boundary conditions were compared with the results of ultrasound measurements for the same patients. The pressure was found to be within the physiological range. The difference in velocity in the superficial temporal artery results in an error of 5.21 ± 0.78 % between the numerical results and the measurement data.

CONCLUSIONS

The proposed outflow boundary conditions, therefore, constitute a simple resistance-based model and can be used for performing accurate simulations with commercial fluid dynamics software.

Shear stress-induced activation of Tie2-dependent signaling pathway enhances reendothelialization capacity of early endothelial progenitor cells

Although endothelial progenitor cells (EPCs) play a pivotal role in the endothelial repair following arterial injury and shear stress has a beneficial effect on EPCs, however, the molecular mechanism underlying the influence of EPCs on the endothelial integrity and the regulation of shear stress on the EPC signaling remained to be studied. Here, we investigated the effects of laminar shear stress on the tyrosine kinase with immunoglobulin and epidermal growth factor homology domain-2 (Tie2)-dependent signaling and its relation to in vivo reendothelialization capacity of human early EPCs. The human early EPCs were treated with shear stress. Shear stress in a dose-dependent manner increased angiopoietin-2 (Ang2)-induced migratory, adhesive and proliferatory activities of EPCs. Transplantation of EPCs treated by shear stress facilitated in vivo reendothelialization in nude mouse model of carotid artery injury. In parallel, the phosphorylation of Tie2 and Akt of EPCs in response to shear stress was significantly enhanced. With treatment of Tie2 knockdown or Akt inhibition, shear stress-induced phosphorylation of Akt and endothelial nitric oxide synthase (eNOS) of EPCs was markedly suppressed. After Tie2/PI3K/Akt/eNOS signaling was blocked, the effects of shear stress on in vitro function and in vivo reendothelialization capacity of EPCs were significantly inhibited. The present findings demonstrate for the first time that Tie2/PI3k/Akt/eNOS signaling pathway is, at least in part, involved in the EPCs-mediated reendothelialization after arterial injury. The upregulation of shear stress-induced Tie2-dependent signaling contributes to enhanced in vivo reendothelialization capacity of human EPCs.

Compensatory collateral circles in vertebral and carotid artery occlusion

The obstructive disease of the supraaortic trunks has considerable clinical importance. Patients with the same grade of obstruction can display a wide spectrum of symptoms. Apart from the grade, etiology and localization of the obstruction, the presence of collateral circles plays an essential role in the determination of the symptoms. We selected all asymptomatic patients, undergoing a diagnostic investigation with EchoColorDoppler in a period of 13 years, in whom an occlusion of the common carotid artery, of the internal carotid artery or of the vertebral artery was present, and we studied the compensatory collateral circles. We considered 8 subjects affected by common carotid occlusion, 66 subjects with internal carotid occlusion and 24 subjects with vertebral artery occlusion. In the 8 subjects affected by common carotid occlusion, before the bifurcation, the collateral circle was realized by the superior thyroid arteries through the supraisthmic thyroid artery. All of the 66 subjects with internal carotid disease showed collateral circles through the ophthalmic branches and through the communicating arteries. In the 24 subjects with vertebral artery occlusion, the compensatory collateral circle was realized by the cervical, costocervical and occipital branches. In conclusion, the presence of an adequate hemodynamic compensation through a collateral circle represents an important positive prognostic factor and can avoid invasive procedures, thus avoiding possible complications.

Stress-modulated collagen fiber remodeling in a human carotid bifurcation

This work concerns with the implementation of a new stress-driven remodeling model for simulating the overall structure and mechanical behavior of a human carotid bifurcation. By means of an iterative finite element based procedure collagen fiber direction and maximal principal stresses are computed. We find that the predicted fibers' architecture at the cylindrical branches and at the apex of the bifurcation correlates well with histological observations. Some insights about the mechanical response of the sinus bulb and the bifurcation apex are revealed and discussed. The results are compared with other, isotropic and orthotropic, models available in the literature.

External carotid artery blood supply to the orbit

The utility of angiography and embolisation of selected branches of the external carotid artery is occasionally helpful in the management of recurrent epistaxis, pre-operative devascularisation of tumours such as angiofibromas, and other head and neck conditions. The use of embolisation for recalcitrant post-tonsillectomy bleeding due to the formation of an aneurysm or pseudoaneurysm of branches of the external carotid artery has been described [P. Simoni, J. Bello, B. Kent, Pseudoaneurysm of the lingual artery secondary to tonsillectomy treated with selective embolization, Int. J. Pediatr. Otorhinolaryngol. 59 (2) (2001) 125-128]. There are also reports of pseudoaneurysm formation on the internal carotid following tonsillectomy [F. Tovi, A. Leiberman, Y. Hertzanu, L. Golcman, Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy, Int. J. Pediatr. Otolaryngol. 13 (1987) 69-75]. The repeated presentation of a 5-year-old girl with post-operative tonsillectomy bleeding on three separate occasions, each approximately 1 week apart, prompted the consideration of the diagnosis of aneurysm formation, and hence, angiography was performed. The anomalous finding from this study precluded embolisation due to the risk of blindness. This experience has prompted this review which highlights the important issues of angiographic assessment prior to embolisation. The relevance of this to external carotid artery ligation is also reflected upon.

Predictive haemodynamics in a one-dimensional human carotid artery bifurcation. Part I: Application to stent design

A diagnostic technique is proposed to identify patients with carotid stenosis who could most benefit from angioplasty followed by stent implantation. This methodology involves performing a parametric study to investigate the haemodynamic behavior due to alterations in the stenosis shapes in the internal carotid artery (ICA). A pulsatile 1-D Navier-Stokes solver incorporating fluid-wall interactions for a Newtonian fluid which predicts pressure and flow in the human carotid artery bifurcation is used for the numerical simulations. In order to assess the performance of each individual geometry, we introduce pressure variation factor as a metric to directly compare the global effect of variations in the geometry. It is shown that the probability of an overall catastrophic effect is higher when the stenosis is present in the upstream segment of the ICA. Furthermore, maximum pressure is used to quantify the local effects of geometry changes. The location of the peak and extent of stenosis are found not to influence maximum pressure. We also show how these metrics respond after stent deployment into the stenosed part of the ICA. In particular, it is found that localized pressure peaks do not depend on the length of a stent. Finally, we demonstrate how these metrics may be applied to cost-effectively predict the benefit of stenting.

Carotid artery dynamics after carotid angioplasty and stenting

Carotid angioplasty and stenting (CAS) has emerged as an alternative treatment for carotid artery occlusive disease. As initial results in patients with an increased surgical risk appeared promising, the popularity of CAS has increased substantially over the last years and CAS has more often been advocated as an alternative to the gold standard, carotid endarterectomy (CEA). Several controlled trials comparing CAS with CEA are currently being conducted. However, long-term results of CAS are still sparse and several issues regarding the inherent differences between treatment modalities have not yet been elucidated. Interestingly, to date, very little attention has been directed towards the mobile features of the carotid artery and the implications of stent placement on carotid artery dynamics.

[Segmental occlusion of the internal carotid artery with collateral reinjection downstream from the carotid sinus]

The preoperative evaluation before coronary bypass led to the discovery of complete atheromatous obstruction of the internal carotid artery sinus in a 79-year-old man free of any neurological symptom. Downstream from the carotid sinus, the patency of the internal carotid artery was ensured by a collateral branch fed by the ipsilateral external carotid artery. This exceptional anatomic variation can be explained by a persistent embryonic artery. The recognition of this atypical feature is clinically relevant because surgery may be possible in some cases, while it is not technically feasible in patients with total obstruction.

A Computational Study of Flow in a Compliant Carotid Bifurcation–Stress Phase Angle Correlation with Shear Stress

The present study presents a three-dimensional, unsteady supercomputer simulation of the coupled fluid-solid interaction problem associated with flow through a compliant model of the bifurcation of the common carotid artery into the internal and external carotid arteries. The fluid wall shear stress (WSS) and solid circumferential stress/strain (CS) are computed and analyzed for the first time using the complex ratio of CS to WSS (CS/WSS). This analysis reveals a large negative phase angle between CS and WSS (stress phase angle--SPA) on the outer wall of the carotid sinus where atherosclerotic plaques are localized. This finding is consistent with other measurements and computations of the SPA in coronary arteries and the aortic bifurcation that show large negative SPA correlating with sites of plaque location and in vitro studies of endothelial cells showing that large negative SPA induces pro-atherogenic gene expression and metabolite release profiles.

The Influence of Flow, Vessel Diameter, and Non-Newtonian Blood Viscosity on the Wall Shear Stress in a Carotid Bifurcation Model for Unsteady Flow

OBJECTIVES

The atherosclerotic process in arteries is correlated with the local wall shear stress (WSS). Plaque development particularly occurs in regions with recirculation (ie, where the WSS oscillates). We investigated the effects of non-Newtonian blood viscosity, variations in flow rate, and vessel diameter on wall phenomena in a carotid bifurcation model.

MATERIALS AND METHODS

The flow through a model of a carotid artery bifurcation was simulated by means of the finite element method. The whole-blood viscosity is a function of shear rate, and was modeled by the Carreau-Yasuda (CY) model. Flow rate and vessel morphology were assessed with magnetic resonance imaging. Flow rate, blood viscosity, and hematocrit levels (Hct) were measured in 49 healthy volunteers. We propose an adaptation of the CY model so that differences in Hct can be incorporated; furthermore, plasma viscosity was varied in the CY model.

RESULTS

The data from our model indicate that flow increases have a larger effect on the WSS than predicted with a simple paraboloid model. Hct had more influence on the WSS when the plasma viscosity was low. Low plasma viscosity was associated with a low WSS, which implies a contradiction, because both high WSS and low plasma viscosity are thought to be indicators for a healthy system. Maximum WSS oscillations were found at the edges of the recirculation region.

CONCLUSIONS

Flow and diameter changes have significant influence on wall shear stress values; the same is true for the viscosity, but to a lesser extent.

[Modern morpho-functional concepts in cephalic arterial distribution]

The present paper provides a general morphofunctional study of the oro-maxillary-facial cephalic arterial area that shows some particular hemodynamic characteristics. The internal maxillary artery supplies a very large territory, with numerous and wide anastomoses. In order to understand the hemodynamic characteristics of this artery, we analyzed some older theories, such as: Ludwig von Bertalanffy's General Systems Theory, Walter Zimmermann's Telome Theory, and some general rheological principles also.

5-HT1B receptors and alpha 2A/2C-adrenoceptors mediate external carotid vasoconstriction to dihydroergotamine

Dihydroergotamine produces external carotid vasoconstriction in vagosympathectomized dogs by 5-HT(1B/1D) receptors and alpha(2)-adrenoceptors. This study identified the specific subtypes involved in this response. One-minute intracarotid infusions of dihydroergotamine (5.6-10 microg/min) dose-dependently decreased external carotid blood flow without affecting blood pressure or heart rate. This response was: (1) partly blocked in dogs pretreated intravenously with the antagonists SB224289 (5-HT(1B); 2,3,6,7-tetrahydro-1'-methyl-5-[2'-methyl-4' (5-methyl-1,2,4-oxadiazol-3-yl)biphenyl-4-carbonyl]furo[2,3-f]indole-3-spiro-4'-piperidine hydrochloride), rauwolscine (alpha(2)), BRL44408 (alpha(2A); 2-[2H-(1-methyl-1,3-dihydroisoindole)methyl]-4,5-dihydroimidazole) or MK912 (alpha(2C); (2S,12bS)-1'3'-dimethylspiro(1,3,4,5',6,6',7,12b-octahydro-2Hbenzo[b]furo[2,3-a]quinazoline)-2,4'-pyrimidin-2'-one); (2) markedly blocked after SB224289 plus rauwolscine; and (3) unaffected after BRL15572 (5-HT(1D); 1-(3-chlorophenyl)-4-[3,3-diphenyl (2-(S,R) hydroxypropanyl) piperazine] hydrochloride) or imiloxan (alpha(2B)). Therefore, the above response involves 5-HT(1B) receptors and alpha(2A/2C)-adrenoceptors.

Computational analysis of the effects of exercise on hemodynamics in the carotid bifurcation

The important influence of hemodynamic factors in the initiation and progression of arterial disease has led to numerous studies to computationally simulate blood flow at sites of disease and examine potential correlative factors. This study considers the differences in hemodynamics produced by varying heart rate in a fully coupled fluid-structure three-dimensional finite element model of a carotid bifurcation. Two cases with a 50% increase in heart rate are considered: one in which peripheral resistance is uniformly reduced to maintain constant mean arterial pressure, resulting in an increase in mean flow, and a second in which cerebral vascular resistance is held constant so that mean carotid artery flow is nearly unchanged. Results show that, with increased flow rate, the flow patterns are relatively unchanged, but the magnitudes of mean and instantaneous wall shear stress are increased roughly in proportion to the flow rate, except at the time of minimum flow (and maximum flow separation) when shear stress in the carotid bulb is increased in magnitude more than threefold. When cerebral peripheral resistance is held constant, the differences are much smaller, except again at end diastole. Maximum wall shear stress temporal gradient is elevated in both cases with elevated heart rate. Changes in oscillatory shear index are minimal. These findings suggest that changes in the local hemodynamics due to mild exercise may be relatively small in the carotid artery.

Pharmacological profile of the vascular responses to dopamine in the canine external carotid circulation

The present study investigated the effects of dopamine on the canine external carotid circulation. One min. intracarotid artery (i.c.) infusions of dopamine (10-310 microg min.-1) produced dose-dependent decreases in the canine external carotid conductance without affecting blood pressure or heart rate. This effect was mimicked by the D1/2-like receptor agonist apomorphine (1-310 microg min-1), but not by the D2-like receptor agonist, bromocriptine (31-310 microg min.-1). In contrast, fenoldopam (1-310 microg min.-1, intracarotid), a D1-like receptor agonist, produced dose-dependent increases in external carotid conductance. The vasoconstrictor response to dopamine was abolished after intravenous administration of the antagonists, phentolamine (alpha1/2; 2000 microg kg-1) or rauwolscine (alpha2; 100 microg kg-1), but remained unaffected after prazosin (alpha1; 100 microg kg-1) or haloperidol (D2-like; 1000 microg kg-1). Interestingly, after phentolamine not only were the vasoconstrictor responses to dopamine abolished, but even a dose-dependent vasodilator component was unmasked. These vasodilator responses to dopamine remained unchanged after intravenous haloperidol or propranolol (1000 microg kg-1 each). On the other hand, the vasodilator responses to fenoldopam, which remained unchanged after intravenous saline (0.1 ml kg-1), propranolol (1000 microg kg-1) or vagosympathectomy, were abolished by the D1-like receptor antagonist, SCH-23390 (10 microg kg-1). Lastly, the responses to dopamine and fenoldopam were not significantly altered after intraperitoneal pretreatment with reserpine (5 mg kg-1; -24 hr). The above results suggest that the canine external carotid vasoconstrictor responses to dopamine: (i) are mainly mediated by alpha2-adrenoceptors; and (ii) overshadow a vasodilator component, which involves vascular D1-like receptors.

Changes in carotid artery flow velocities after stent implantation: a fluid dynamics study with laser Doppler anemometry

PURPOSE

To study the influence of stent size and location on flow patterns in a physiological carotid model.

METHODS

Wallstents were positioned in silicon models of the carotid artery at various locations: 2 stents appropriately sized to the anatomy were placed in (1) the internal carotid artery (ICA) and (2) the ICA extending completely into the common carotid artery so as to cover the external carotid artery (ECA) orifice. Another 2 stents were placed in the ICA extending (1) partially and (2) completely into the bulb to simulate stent displacement and disproportion between stent size and the original vessel geometry. Measurements were performed with laser Doppler anemometry (LDA) using pulsatile flow conditions (Reynolds number=250; flow 0.431 L/min; ICA:ECA flow rate ratio 70:30) in hemodynamically relevant cross sections. The hemodynamic changes were analyzed with 1-dimensional flow profiles.

RESULTS

With the stent in the ICA, no changes of the normal flow profile were seen. For stents positioned in the ICA and extending partially or completely into the carotid bulb, the flow behavior was affected by the resistance of the stent to flow in the ECA. Hemodynamically relevant disturbances were seen in the ICA and ECA, especially in the separation zones (regions along the walls just after a bifurcation, bend, or curve). The ICA:ECA flow rate ratios shifted from 70:30 to 71.3:28.7 and from 70:30 to 75.1:24.9, respectively, in the 2 malpositioned stent models. With the stent placed in the ICA extending completely into the CCA, the ICA:ECA flow rate ratio shifted from 70:30 to 72.4:27.6. In this configuration, there were no notable flow changes in the ICA, but a clear diminishing of the separation zones in the ECA separation zones.

CONCLUSIONS

Anatomically correct positioning of appropriately sized stents does not lead to relevant flow disturbances in the ICA. In the ECA, depending on the position, size, and interstices of the stent, the physiological flow was considerably disturbed when any part of the stent covered the inflow of the vessel. Disturbances were seen when the stent was positioned into the bulb. For clinical application, stent location and size must be carefully determined so that the stent covers the bifurcation completely or is in the ICA only.

A new angle-independent Doppler ultrasonic device for assessment of blood flow volume in the extracranial internal carotid artery

OBJECTIVE

To evaluate a new angle-independent ultrasonic device for assessment of blood flow volume in the internal carotid artery.

METHODS

In vitro, a pulsatile pump was set to provide an outflow of physiological fluid at 500 mL/min through an 8-mm-diameter tube. Flow volume rates were measured 10 times by 10 different operators and compared with time-collected flow volume rates. In vivo, internal and common carotid artery blood flow volumes were measured in 28 volunteers by 2 operators using a FlowGuard device (Biosonix Ltd). Internal and common carotid artery diameters and blood flow volumes were also assessed by Duplex sonography and compared with FlowGuard measurements. In 10 volunteers, internal carotid artery blood flow volume changes in response to monitored breath manipulations were recorded.

RESULTS

In vitro, intraoperator variability was 4.04% (range, 2%-5.7%). The mean error rate +/- SD was 3.54% +/- 0.8% (range, 2.7%-5.2%). In vivo, the mean common carotid artery blood flow volume was 456 +/- 39 mL/min (range, 417-583 mL/min) with a mean diameter of 6.7 +/- 0.7 mm (range, 5.8-8.7 mm). The mean internal carotid artery blood flow volume was 277 +/- 25 mL/min (range, 239-338 mL/min) with a mean diameter of 5 +/- 0.5 mm (range, 4.1-6.1 mm). No significant difference was found between operators. Internal carotid artery diameter and blood flow volume measured by the FlowGuard were closely correlated with the results of Duplex sonography. Repeated shifts of end-tidal CO2 induced reproducible changes in internal carotid artery flow volume: 187.5 +/- 18.1 mL/min at 26.8 +/- 1.9 mm Hg and 382.1 +/- 18.2 mL/min at 47 +/- 2.2 mm Hg.

CONCLUSIONS

The FlowGuard showed that volume flow studies in the internal carotid artery could be easily performed, with results compatible with those of previous clinical reports. Duplex comparative results and breath-induced changes in internal carotid artery flow volume justify further evaluation of the system.

A dual-pressure boundary condition for use in simulations of bifurcating conduits

A dual-pressure boundary condition has been developed for computational modelling of bifurcating conduits. The condition involves the imposition of a constant pressure on one branch while adjusting iteratively the pressure on the other branch until the desired flow division is obtained. The dual-pressure condition eliminates the need for specifying fully-developed flow conditions, which thereby enables significant reduction of the outlet branch lengths. The dual-pressure condition is suitable for both steady and time-periodic simulations of laminar or turbulent flows.

Pharmacological profile of the mechanisms involved in the external carotid vascular effects of the antimigraine agent isometheptene in anaesthetised dogs

The present study set out to investigate the external carotid vascular effects of isometheptene in vagosympathectomised dogs, anaesthetised with pentobarbital. One-minute intracarotid (intra-arterial; i.a.) infusions of isometheptene (10, 30, 100 and 300 microg/min) produced dose-dependent decreases in external carotid blood flow, without affecting blood pressure or heart rate. The vasoconstrictor responses to 100 microg/min and 300 microg/min of isometheptene were clearly attenuated in animals pretreated with reserpine (5,000 microg/kg). Moreover, after prazosin (an alpha1-adrenoceptor antagonist; 100 microg/kg), the responses to isometheptene remained unaltered in untreated as well as reserpine-pretreated dogs. In contrast, the responses to isometheptene were attenuated by rauwolscine (an alpha2-adrenoceptor antagonist; 300 microg/kg) in untreated animals, and were practically abolished in reserpine-pretreated dogs. Further investigation into the specific alpha2-adrenoceptor subtypes, using selective antagonists, showed that BRL44408 (alpha2A) and MK912 (alpha2C) markedly attenuated this response, while imiloxan (alpha2B) was ineffective. The involvement of 5-HT1B and 5-HT1D receptors seems highly unlikely since antagonists at 5-HT1B (SB224289) and 5-HT1D (BRL15572) receptors (both at 300 microg/kg) were ineffective. On this basis, it is concluded that isometheptene-induced canine external carotid vasoconstriction is mediated by both indirect (a tyramine-like action) and direct (acting at receptors) mechanisms, which mainly involve alphaA- and alpha2C-adrenoceptors, while the involvement of alpha1-adrenoceptors seems rather limited.

Pharmacological identification of the major subtypes of adrenoceptors involved in the canine external carotid vasoconstrictor effects of adrenaline and noradrenaline

This study investigated the potential effects of adrenaline and noradrenaline on the external carotid blood flow of vagosympathectomised dogs and the receptor mechanisms involved. One minute (1 min) intracarotid infusions of adrenaline and noradrenaline produced dose-dependent decreases in external carotid blood flow without changes in blood pressure or heart rate. These responses, which remained unaffected after saline, were: (i) mimicked by the adrenoceptor agonists, phenylephrine (alpha1) and BHT933 (6-Ethyl-5,6,7,8-tetrahydro-4H-oxazolo [4,5-d] azepin-2-amine dihydrochloride; alpha2); (ii) abolished after phentolamine (2000 microg/kg) unmasking a vasodilator component (subsequently blocked by propranolol; 1000 microg/kg); and (iii) partly blocked by rauwolscine (30 and 100 microg/kg), and subsequently abolished by prazosin (100 microg/kg). Accordingly, rauwolscine (100 and 300 microg/kg) markedly blocked the responses to BHT933 without affecting those to phenylephrine; likewise, prazosin (100 microg/kg) markedly blocked the responses to phenylephrine without affecting those to BHT933. These results show that both alpha1- and alpha2-adrenoceptors mediate vasoconstriction within the canine external carotid circulation. Moreover, after blockade of alpha1/alpha2-adrenoceptors, both adrenaline and noradrenaline exhibit a beta-adrenoceptor-mediated vasodilator component.

Both central command and exercise pressor reflex reset carotid sinus baroreflex

In decerebrate unanesthetized cats, we determined whether either "central command," the exercise pressor reflex, or the muscle mechanoreceptor reflex reset the carotid baroreflex. Both carotid sinuses were vascularly isolated, and the carotid baroreceptors were stimulated with pulsatile pressure. Carotid baroreflex function curves were determined for aortic pressure, heart rate, and renal vascular conductance. Central command was evoked by electrical stimulation of the mesencephalic locomotor region (MLR) in cats that were paralyzed. The exercise pressor reflex was evoked by statically contracting the triceps surae muscles in cats that were not paralyzed. Likewise, the muscle mechanoreceptor reflex was evoked by stretching the calcaneal tendon in cats that were not paralyzed. We found that each of the three maneuvers shifted upward the linear relationship between carotid sinus pressure and aortic pressure and heart rate. Each of the maneuvers, however, had no effect on the slope of these baroreflex function curves. Our findings show that central command arising from the MLR as well as the exercise pressor reflex are capable of resetting the carotid baroreflex.

The role of several alpha(1)- and alpha(2)-adrenoceptor subtypes mediating vasoconstriction in the canine external carotid circulation

1. It has recently been shown that both alpha(1)- and alpha(2)-adrenoceptors mediate vasoconstriction in the canine external carotid circulation. The present study set out to identify the specific subtypes (alpha(1A), alpha(1B) and alpha(1D) as well as alpha(2A), alpha(2B) and alpha(2C)) mediating the above response. 2. Consecutive 1 min intracarotid infusions of phenylephrine (alpha(1)-adrenoceptor agonist) and BHT933 (alpha(2)-adrenoceptor agonist) produced dose-dependent decreases in external carotid blood flow, without affecting mean arterial blood pressure or heart rate. 3. The responses to phenylephrine were selectively antagonized by the antagonists, 5-methylurapidil (alpha(1A)) or BMY7378 (alpha(1D)), but not by L-765,314 (alpha(1B)), BRL44408 (alpha(2A)), imiloxan (alpha(2B)) or MK912 (alpha(2C)). In contrast, only BRL44408 or MK912 affected the responses to BHT933. 4. The above results support our contention that mainly the alpha(1A), alpha(1D), alpha(2A) and alpha(2C)-adrenoceptor subtypes mediate vasoconstriction in the canine external carotid circulation.

Unravelling the pharmacological profile of the canine external carotid vasodilator '5-HT1-like' receptors: coexistence of sympatho-inhibitory 5-HT1B and postjunctional 5-HT7 receptors

It has been suggested that the external carotid vasodilatation produced by serotonin (5-hydroxytryptamine; 5-HT) in anaesthetised dogs with intact vagosympathetic trunks is mediated by sympatho-inhibitory '5-HT1D' receptors and musculotropic '5-HT1-like' receptors. The present study has re-analysed this suggestion with regard to the classification schemes recently proposed by the NC-IUPHAR subcommittee on 5-HT receptors. In pentobarbital-anaesthetised dogs with intact vagosympathetic trunks, 1-min intracarotid (i.c.) infusions of 5-carboxamidotryptamine (5-CT; 0.01-0.3 microg/min), 5-HT (0.3-30 microg/ min), 5-methoxytryptamine (5-MeO-T; 1-100 microg/min) or sumatriptan (1-100 microg/min) dose-dependently increased the external carotid blood flow without affecting blood pressure or heart rate. The selective 5-HT1D receptor agonist, PNU-142633 (1-1000 microg/min), was essentially inactive. After mesulergine (300 microg/kg, i.v.), an antagonist at cardiovascular 5-HT7 receptors, the above responses to 5-HT, 5-CT and 5-MeO-T were blocked, whilst those to sumatriptan remained unaffected. In contrast, after the 5-HT1B/1D receptor antagonist, GR127935 (10 microg/kg, i.v.), the responses to 5-HT, 5-CT and 5-MeO-T were not affected, but those to sumatriptan were abolished. Furthermore, after the selective 5-HT1B receptor antagonist, SB224289 (300 microg/kg, i.v.), the responses to 5-HT, 5-CT and 5-MeO-T were significantly enhanced, whereas those to sumatriptan were abolished. Interestingly, the responses to all these agonists remained unmodified after the selective 5-HT1D receptor antagonist, BRL15572 (300 microg/kg, i.v.). The above results suggest that the '5-HT1-like' receptors, which mediate canine external carotid vasodilatation, display the pharmacological profile of sympatho-inhibitory 5-HT1B receptors and musculotropic 5-HT7 receptors, and confirm the existence of vasoconstrictor 5-HT1B receptors.

Suppressed smooth muscle proliferation and inflammatory cell invasion after arterial injury in elafin-overexpressing mice

Elastases degrade the extracellular matrix, releasing growth factors and chemotactic peptides, inducing glycoproteins such as tenascin, and thereby promoting vascular cell proliferation and migration. Administration of serine elastase inhibitors reduces experimentally induced vascular disease. The ability to mount an intrinsic anti-elastase response may, therefore, protect against intimal/medial thickening after vascular injury. To investigate this, we showed that wire-induced endothelial denudation of the carotid artery is associated with transient elevation in elastase activity and confirmed that this is abolished in transgenic mice overexpressing the serine elastase inhibitor, elafin, targeted to the cardiovascular system. Ten days after injury, nontransgenic littermates show vessel enlargement, intimal thickening, increased medial area and cellularity, and 2-fold increase in tenascin. Injured vessels in transgenic mice become enlarged but are otherwise similar to sham-operated controls. Injury-induced vessel wall thickening, which is observed only in nontransgenic mice, is related to foci of neutrophils and macrophages, in addition to smooth muscle cells that fail to stain for alpha-actin and are likely dedifferentiated. Our study therefore suggests that a major determinant of the vascular response to injury is the early transient induction of serine elastase activity, which leads to cellular proliferation and inflammatory cell migration.

The contribution of the external carotid artery to cerebral perfusion in carotid disease

PURPOSE

In the presence of carotid occlusion, the external carotid artery (ECA) becomes an important source of cerebral blood flow, especially if the circle of Willis is incomplete. The contribution of the ECA to hemispheric blood flow in patients with severe ipsilateral carotid stenosis has never been previously investigated.

METHODS

One hundred eight patients were monitored during sequential cross-clamping of the external (ECA) and then ipsilateral internal carotid artery (ICA) during carotid endarterectomy using transcranial Doppler sonography (TCD) (Neuroguard CDS, Los Angeles, Calif), to measure middle cerebral artery blood flow velocity, and near-infrared spectroscopy, to measure regional cerebral oxygen saturation (CsO(2)) (Invos 3100A; Somanetics, Troy, Mich).

RESULTS

On the ipsilateral ECA cross-clamp, the median fall in CsO(2) was 3% (interquartile range, 1%-4%; P <.0001). On addition of the ICA cross-clamp there was a further fall of 3% and a total fall of 6% (3%-9%; P <.0001). The median percentage fall in middle cerebral artery blood flow velocity on ECA clamping was 12% (4%-24%; P <.0001); on ICA clamping it was 48% (25%-74%; P <.0001). Falls in TCD on ECA clamping were greater with increasing severity of ipsilateral ICA stenosis. The correlation between CsO(2) and TCD on external clamping, although less strong than that on internal clamping, was statistically significant r = 0.32; P =.01; Spearman rank correlation).

CONCLUSIONS

The falls in TCD and CsO(2) were of a similar order of magnitude and must therefore reflect a fall in cerebral perfusion. The ipsilateral ECA contributes significantly to intracranial blood flow and oxygen saturation in severe carotid stenosis.

Simulated pathline visualization of computed periodic blood flow patterns

Improvements in computer hardware and software have made it possible to model pulsatile blood flow in realistic arterial geometries. Such studies produce enormous amounts of velocity data, which are often difficult to interpret and communicate using traditional contour and/or vector field plots. Inspired by in vitro flow visualization techniques such as particle image velocimetry (PIV), we describe a simple and effective method for visualizing periodic three-dimensional velocity data, based on the subdivision and sequential display of computed particle trajectories. Analogous to a PIV experiment, the length and spacing of such simulated particle pathlines are controlled by user-specified shutter-speed and frame rate variables. Strategies for color-coding pathlines to highlight important hemodynamic features such as recirculation zones and branch flow division are presented.

5-HT receptors mediating external carotid vasoconstriction in vagosympathectomized dogs

One specific example reflecting the complexity of cardiovascular responses induced by serotonin (5-hydroxytryptamine; 5-HT) and the progress achieved in the pharmacological characterization of the receptors involved can be illustrated by the effects of 5-HT on the canine external carotid artery bed. Within this framework, it has been shown that the external carotid vasoconstrictor response to 5-HT in the dog is mediated by '5-HT1-like' receptors, which being blocked by the 5-HT1B/1D receptor antagonist GR127935, resemble 5-HT1B/1D (previously called 5-HT1D beta/1D alpha) receptors. It was proposed that these receptors could belong to the 5-HT1B, rather than the 5-HT1D, subtype on the basis of their resistance to blockade by a high dose of ritanserin (a potential 5-HT1D receptor antagonist) and the presence of mRNA for 5-HT1B(5-HT1D beta) receptors, but not for 5-HT1D(5-HT1D alpha) receptors, in vascular smooth muscle. With the advent of subtype-selective antagonists it was subsequently shown that external carotid vasoconstriction to 5-HT and sumatriptan is dose-dependently antagonized by the selective 5-HT1B receptor antagonist SB224289 (2,3,6,7-tetrahydro-1'-methyl-5-[2'-methyl-4' (5-methyl-1,2,4-oxadiazol-3-yl) biphenyl-4-carbonyl] furo [2,3-f] indole-3-spiro-4'-piperidine hydrochloride), whereas the selective 5-HT1D receptor antagonist BRL15572 (1-(3-chlorophenyl)-4-[3,3-diphenyl (2-(S,R) hydroxypropanyl) piperazine] hydrochloride) was ineffective. These findings represent the first in vivo evidence showing that vascular constriction induced by 5-HT and sumatriptan is mediated primarily via 5-HT1B, but not 5-HT1D receptors. The pharmacological profile of these receptors could be similar (isolated human temporal artery and porcine carotid arteriovenous anastomoses) to other putative 5-HT1B receptors mediating vasoconstrictor responses. In view of the putative pathophysiologic role of external carotid (and extracerebral) vasodilation in migraine, the constriction of these blood vessels by sumatriptan via 5-HT1B receptors may be, at least partly, responsible for its therapeutic efficacy in migraine.

Summation of dynamic transfer characteristics of left and right carotid sinus baroreflexes in rabbits

Although interactions among parallel negative-feedback baroreflex systems have been extensively investigated with respect to their steady-state responses, the dynamic interactions remain unknown. In anesthetized, vagotomized, and aortic-denervated rabbits, we perturbed isolated intracarotid sinus pressure (CSP) unilaterally or bilaterally around the physiological operating pressure according to binary white noise. The neural arc transfer function from CSP to cardiac sympathetic nerve activity (SNA) and the peripheral arc transfer function from SNA to aortic pressure were estimated. The gain values of the neural arc at 0.01 Hz estimated by the left (L) and right (R) CSP perturbations were 0.94 +/- 0.31 and 0.96 +/- 0.25, respectively. The gain value increased to 2.17 +/- 0.97 during the bilateral identical CSP perturbation and was not significantly different from L + R. The phase values of the neural arc did not differ among protocols. No significant differences were observed in the peripheral arc transfer functions among protocols. We conclude that summation of the dynamic transfer characteristics of the bilateral carotid sinus baroreflexes around the physiological operating pressure approximates simple addition.

Correlation of flow probe determinations of common carotid artery blood flow and internal carotid artery blood flow with microsphere determinations of cerebral blood flow in piglets

We investigated whether blood flow determined by a flow probe situated on one common carotid artery provided an accurate estimation of unilateral cerebral blood flow (CBF) in piglets. In eight anesthetized, mechanically ventilated piglets, blood flow determined by an ultrasonic flow probe placed on the right common carotid artery was correlated with CBF determined by microspheres under two experimental conditions: 1) before ligation of the right external carotid artery with both the right external and internal carotid circulations intact [common carotid artery blood flow (CCABF) condition], and 2) after ligation of the right external carotid artery (ipsilateral to the flow probe) with all residual right-sided carotid artery blood flow directed through the right internal carotid artery [internal carotid artery blood flow (ICABF) condition]. The left carotid artery was not manipulated in any way in either protocol. Independent correlations of unilateral CCABF and ICABF with microsphere-determined unilateral CBF were highly significant over a 5-fold range of CBF induced by hypercarbia or hypoxia (r = 0.94 and 0.92, respectively; both p < 0.001). The slope of the correlation of unilateral CCABF versus unilateral CBF was 1.68 +/- 0.19 (SEM), suggesting that CCABF overestimated CBF by 68%. The slope of the correlation of unilateral ICABF versus unilateral CBF did not differ significantly from unity (1.06 +/- 0.15), and the y intercept did not differ significantly from zero [-1.3 +/- 5.2 (SEM) mL]. Consequently, unilateral ICABF determined by flow probe accurately reflected unilateral CBF determined by microspheres under these conditions. Flow probe assessments of CCABF and ICABF in piglets may provide information about dynamic aspects of vascular control in the cerebral circulation that has heretofore been unavailable.

An assessment of contributions made by extracranial tissues during cerebral oximetry

This study was designed to determine the extent of contribution made by extracranial tissues to estimation of regional cerebrovascular saturation (ScO2) during cerebral oximetry. Thirty four patients undergoing carotid endarterectomy under regional anesthesia were studied. Bilateral ScO2 monitoring with two INVOS 3100 A cerebral oximeters was used. Effect of occlusion of external carotid artery (ECA) for five minutes on ScO2 readings followed by occlusion of internal and common carotid arteries was studied. ScO2 readings at 1 minute intervals were stored on computer disks for off-line analysis. Numerical data were subjected to a two way repeated measures analysis of variance to study the effect of side (ipsilateral or contralateral) and phase (pre clamp, ECA clamp, ICA clamp and post clamp) of operation. A value of p<0.05 was considered significant. There was no significant change in ScO2 on the contralateral side. On the ipsilateral hemisphere ScO2 decreased from 67.4+/-8.5 to 65.6+/-8.3 with ECA occlusion and to 61.4+/-9.6 after ICA occlusion returning to 64.8+/-9.8 after all clamps were released. Decrease after ECA occlusion was not significant (p = 0.12) while that after ICA occlusion was significant when compared to pre clamp value (p<0.001). After release of all clamps ipsilateral ScO2 returned toward baseline but remained significantly lower (p<0.05) than pre clamp values. When readings from two hemispheres were compared, a significant difference (p<0.001) was noted during ICA occlusion only. We conclude that the mathematical algorithm used for calculation of ScO2 by INVOS 3100 A cerebral oximeter measures predominantly the intracranial cerebrovascular saturation.

External carotid effects of 2-(2-aminoethyl)-quinoline (D-1997) in vagosympathectomized dogs

Serotonin (5-hydroxytryptamine; 5-HT) elicits external carotid vasoconstriction in vagosympathectomized dogs via 5-HT1B/1D receptors and a mechanism unrelated to the 5-HT1, 5-HT2, 5-HT3 and 5-HT4 types. In order to further explore the nature of this novel mechanism, the canine external carotid effects of 2-(2-aminoethyl)-quinoline (D-1997), a novel 5-HT1 receptor agonist, were analyzed and compared with those of 5-HT and sumatriptan. Intracarotid (i.c.) infusions of 5-HT, D-1997 and sumatriptan to vagosympathectomized dogs dose-dependently decreased external carotid conductance, the rank order of agonist potency being 5-HT > sumatriptan > D-1997. The effects to D-1997 were resistant to intravenous (i.v.) pretreatment with 5-HT2 and 5-HT3/5-HT4 receptor antagonists. Remarkably, the effects induced by lower (10-100 microg/min), but not higher (300-1000 microg/min), doses of D-1997 were blocked by high doses of methiothepin (1 and 3 mg/kg, i.v.), as previously shown with 5-HT. In addition, GR-127935 (1-10 microg/kg, i.v.), partially and dose-dependently antagonized D-1997-induced responses. However, the effects of D-1997 remained unaltered after blockade of alpha- and beta-adrenoceptors, muscarinic, nicotinic, histamine and dopamine receptors, or inhibition of 5-HT-uptake or cyclo-oxygenase, depletion of biogenic amines or blockade of Ca2+ channels. These results may support our previous contention that lower doses of 5-HT elicit external carotid vasoconstriction in vagosympathectomized dogs by activation of 5-HT1B/1D receptors, whilst higher doses of 5-HT stimulate a novel vasoconstrictor mechanism.

The development of hemodynamics in the extracranial carotid and vertebral arteries

To investigate the development of hemodynamics in the extracranial carotid and vertebral artery system, a prospective color duplex sonography study was performed in 94 healthy children and adolescents between 3 and 18 y old. Angle-corrected flow velocities and luminal diameters were measured; waveform parameters and flow volumes were calculated. Side-to-side differences of volumetric data were analyzed. In 53 children, an intrasession test-retest flowmetry of the internal carotid and vertebral arteries was performed. From 3 to 18 y old, flow volumes decreased significantly in the vertebral arteries (p < or = 0.01) and increased in the external carotid artery (p < or = 0.0001); the luminal diameter increased in all the carotid arteries (p < or = 0.0001) and remained constant in the vertebral arteries; mean flow velocities declined in the common and internal carotid arteries and in the vertebral arteries (p < or = 0.0001), but increased in the external carotid arteries (p < or = 0.01). Flow volume rate was lower in the right than the left vertebral artery (p < or = 0.0001), and there was no side difference in any of the carotid arteries. The test-retest correlation of volumetric data was high (0.81 < or = r < or = 0.97; p < or = 0.0001). By comparing the reference data presented here with analogous adult data, we were able to delineate the physiologic development of extracranial and cerebral hemodynamics from childhood to adulthood. These data make possible the clinical application of quantitative flowmetry in extracranial cerebral arteries of children and adolescents.

Anatomy and orientation of the human external ear

A knowledge of the external ear and tympanic membrane is essential to practicing audiologists. This article provides an introduction to the anatomy of this area including dimensions, orientation, vasculature, innervation, and relations to other structures. Traditional diagrams are often inadequate in describing these structures. For example, typical frontal and sagittal views of the external auditory meatus do not adequately describe its anteroposterior course. Axial (transverse) views provide easier visualization of these areas. A nomenclature is also provided for areas and angles of the external auditory meatus.

Inhibition of platelet-derived growth factor receptor tyrosine kinase inhibits vascular smooth muscle cell migration and proliferation

Platelet-derived growth factors (PDGFs) and their receptors (PDGFRs) have been linked to vascular smooth muscle cell (SMC) migration and proliferation leading to atherosclerosis, restenosis, and chronic allograft rejection. This study describes the effect of CGP 53716, a specific PDGFR tyrosine kinase inhibitor on SMC proliferation and migration in vitro and in neointimal formation in vivo. CGP 53716 inhibited dose dependently tyrosine phosphorylation of both the known PDGFRs: the PDGFR-alpha and PDGFR-beta. In primary rat SMC cultures, a dose-dependent inhibition of PDGF-AA and PDGF-BB induced migration, and tritiated thymidine incorporation of SMC was seen at nontoxic concentrations. After rat carotid artery ballooning injury in vivo, the migration of alpha-actin-positive cells on the luminal side of internal elastic lamina was decreased with 50 mg x kg(-1) x day(-1) of CGP 53716 from 38 +/- 10 (control group) to 4 +/- 2 (P<0.0001, Mann-Whitney U test, N=18). CGP 53716 did not inhibit the number of replicating bromodeoxyuridine (BrdU)-incorporating cells in the intima, media, or adventitia during BrdU labeling at 0-96 postoperative h, though it inhibited significantly (P<0.01) the replication of medial and intimal cells from 93 h onward. Intima/media ratio was inhibited by 40% after 14 days in the CGP 53716-treated group (P=0.028) after rat aortic denudation. The results indicate that inhibition of the PDGFR tyrosine kinase inhibits SMC migration and proliferation in vitro, SMC migration, and, to a lesser extent, proliferation after ballooning injury in vivo, confirming a causal role for activation of the PDGFR and the formation of neointimal lesions.

Extended Willis circle model to explain clinical observations in periorbital arterial flow

A fluid-dynamic model of the circle of Willis and its periorbital links with the external carotid arteries has been established and tested. It is based on anatomic data and takes Doppler measurements as flow input conditions. The model explains, on fluid-dynamic grounds, the clinical observations of periorbital reverse flow and arrival pulse time delay. It also obtains the velocity and pressure pulse at any point of the studied area. This allows the comparison between the normal or healthy condition and the flow distribution when an internal carotid is externally or pathologically occluded. Several combinations of the communicating artery sizes are explored to obtain the reduced cerebral flow. The combination of the communicating diameters can lead to insufficient irrigation which can be hydrodynamically assessed. No other physiological response is included, and the results must be considered as a minimum assured. These results show the need for a common evaluation of the alternative paths and explain some paradoxes found in literature.

Experimental ligation versus embolization of the external carotid artery: a comparative hemodynamics study

Patterns of collateral vascularization were investigated by SEM evaluation of microvascular corrosion casts following either ligation or embolization of the external carotid artery in the rabbit. Results indicated that rich collateral channels were established soon after ligation of this artery, and blood supply to the lesional area was never cut off. In contrast, embolization effectively obstructed blood supply by reducing collateral branches. We concluded that for purposes of controlling blood loss, it is more helpful to employ external carotid embolization rather than ligation for oral maxillofacial lesions with a rich blood supply.

Modification of superior cervical ganglion transmission, by changes of carotid bifurcation pressure

We investigated the effect of alterations in carotid bifurcation pressure on transmission in the superior cervical ganglion of pentobarbital-anaesthetized rabbits. Compound action potentials were evoked in the internal and external carotid nerves (post-ganglionic fibres) by electrical stimulation of the decentralized cervical sympathetic trunk. Pressure in the ipsilateral isolated carotid bifurcation (CBP) was maintained at a control value of 100 mmHg. Increases of CBP to between 125 and 200 mmHg caused graded reductions in the height and increases in the time to peak (TTP) of the S2 wave of the compound action potential recorded from the external carotid nerve (mean +/- SEM: -5.8 +/- 0.9% and +3.0 +/- 0.5%, respectively, at 200 mmHg, P < 0.05). In the same nerve, reductions in CBP to between 25 and 75 mmHg caused graduated increases in the height and decreases in TTP of the S2 wave (+6.3 +/- 0.8% and -2.8 +/- 0.4% at 25 mmHg, P < 0.05). Similar responses were obtained from the internal carotid nerve. The response of the S2 wave in the external carotid nerve to a step increase of CBP from 100 to 175 mmHg was examined before and after section of either the ganglioglomerular or carotid sinus nerve. Section of the ganglioglomerular nerve abolished the response (height and TTP of the S2 wave: before -10.7 +/- 0.8% and +5.9 +/- 0.9%; after -0.6 +/- 0.6% and +0.2 +/- 0.5%, P < 0.05). Section of the carotid sinus nerve had no effect on the S2 wave response. It appears that a population of ganglioglomerular nerve fibres, with pressure-sensitive endings located in the wall of the carotid bifurcation, form the afferent limb of a reflex integrated in the superior cervical ganglion of the rabbit. The efferent limb includes postganglionic fibres in the internal and external carotid nerves.

Duplex US of the external carotid artery

The ratio between the systolic peak velocities of the internal and common carotid arteries (vpICA/vpCCA), vpICA and grey-scale imaging measurement are generally used to evaluate internal carotid stenosis against known flow criteria in order to differentiate non-significant from significant stenosis. The same criteria are also used for evaluating the external carotid artery (ECA). Our data on 707 normal or stenotic ECA nevertheless showed that the systolic peak velocity of the normal ECA (vpECA) and its ratio to the systolic velocity of the CCA (vpECA/vpCCA) are higher than vpICA and vpICA/vpCCA. vpECA/vpCCA is about 2 in > 0-49% ECA stenosis. Only in severe stenosis are the peak velocities almost comparable. The ratio between the peak end diastolic velocities (edvECA/edvCCA) and edvECA proved to be unreliable, as did grey-scale imaging measurement of the external carotid stenosis. In addition, ipsi-lateral internal carotid stenosis greatly affects the non-stenotic external carotid flow values, and probably has the same effect on the flow values of a stenotic external artery. Thus, external carotid flow values must be considered carefully.

Pressure-induced mechanical stress in the carotid artery bifurcation: a possible correlation to atherosclerosis

A possible correlation between regions of high intramural wall stress and the development of atherosclerotic lesions in the carotid artery bifurcation is investigated. The bifurcation geometry is determined through in vivo studies, as well as the analysis of cadaver specimens. Having compiled accurate geometric data, two representative finite element models were created in order to determine the areas of localized stress concentrations that occur in the bifurcation. The artery is assumed isotropic and is mechanically loaded with an incremental pressure of 40 mmHg. A highly localized stress concentration of approximately 9 to 14 times the proximal circumferential wall stress occurs at the point of bifurcation. A lower stress concentration of approximately 3 to 4 times the proximal circumferential stress occurs over a large area of the sinus bulb. Acknowledging that these two regions of the carotid bifurcation are highly susceptible to atherosclerotic lesions, it appears possible that a correlation between wall stress and atherosclerosis may exist.

Role of alpha1-adrenoceptors in the reduction of external carotid blood flow induced by buspirone and ipsapirone in the dog

The effects of the 5-HT1A receptor agonist with anxiolytic properties, buspirone and ipsapirone, in the external carotid bed of anaesthetized dogs were analyzed. Since these agonists produce several vascular effects via activation of both 5-HT receptors and alpha1-adrenoceptors, their effects were compared with those elicited by the 5-HT agonist, quipazine, and the alpha1-adrenoceptor agonist, methoxamine. 1-Min intracarotid (i.c.) infusions of buspirone (300 microgram/min), ipsapirone (40 microgram/min), quipazine (300 microgram/min) and methoxamine (15 microgram/min) produced consistent decreases in external carotid blood flow (ECBF); since these changes in blood flow were not accompanied by modifications in systemic blood pressure, the agonists produced parallel increases in external carotid resistance. After interruption of the sympathetic tone by bilateral cervical vagosympathectomy, the vasoconstrictor responses to all the agonists remained unaffected. The intravenous (i.v.) administration of the nonselective 5-HT1-like receptor antagonist, methiothepin (1-100 microgram/kg), potently and dose-dependently antagonized buspirone-, ipsapirone- and quipazine-induced vasoconstriction; methiothepin similarly antagonized the vasoconstrictor responses to methoxamine. Interestingly, the alpha1-adrenoceptor antagonist, prazosin (1-100 microgram/kg, i.v.), also antagonized the vasoconstrictor responses to buspirone, ipsapirone and methoxamine in a dose-dependent manner. Finally, buspirone (300 microgram/min, i.c.) and ipsapirone (40 microgram/min, i.c.) did not modify the responses to noradrenaline (10 microgram/min, i.c.) or tyramine (100 microgram/min, i.c.). It is concluded that canine external carotid vasoconstriction induced by buspirone and ipsapirone is mainly mediated by activation of alpha1-adrenoceptors located in vascular smooth muscle. These data further highlight the ability of the above anxiolytics to produce significant vascular effects under in vivo conditions.

Computer simulation of local blood flow and vessel mechanics in a compliant carotid artery bifurcation model

To investigate the effect of the distensible artery wall on the local flow field and to determine the mechanical stresses in the artery wall, a numerical model for the blood flow in the human carotid artery bifurcation has been developed. The wall displacement and stress analysis use geometrically non-linear shell theory where incrementally linearly elastic wall behavior is assumed. The flow analysis applies the time-dependent, three-dimensional, incompressible Navier-Stokes equations for non-Newtonian inelastic fluids. In an iteratively coupled approach the equations of the fluid motion and the transient shell equations are numerically solved using the finite element method. The study shows the occurring characteristics in carotid artery bifurcation flow, such as strongly skewed axial velocity in the carotid sinus with high velocity gradients at the internal divider wall and with flow separation at the outer common-internal carotid wall and at the bifurcation side wall. Flow separation results in locally low oscillating wall shear stress. Further strong secondary motion in the sinus is found. The comparison of the results for a rigid and a distensible wall model demonstrates quantitative influence of the vessel wall motion. With respect to the quantities of main interest, it can be seen, that flow separation and recirculation slightly decrease in the sinus and somewhat increase in the bifurcation side region, and the wall shear stress magnitude decreases by 25% in the distensible model. The global structure of the flow and stress patterns remains unchanged. The deformation analysis shows that the tangential displacements are generally lower by one order of magnitude than the normal directed displacements. The maximum deformation is about 16% of the vessel radius and occurs at the side wall region of the intersection of the two branches. The analysis of the maximum principal stresses at the inner vessel surface shows a complicated stress field with locally high gradients and indicates a stress concentration factor of 6.3 in the apex region.

[A comparison of the effects of serotonin, 2-(2-aminoethyl)quinoline (D-1997) and sumatriptan on the external carotid blood flow in the dog]

The quinoline derivative, 2-(2-aminoethyl)-quinoline (D-1997) has been shown to mimic the contractile effects induced by serotonin (5-hydroxytryptamine; 5-HT) in the saphenous vein and basilar artery of the dog. Inasmuch as the receptor mechanisms mediating the above effects are similar to those involved in 5-HT-induced vasoconstriction of the canine common carotid circulation, the present study was set out to analyze the haemodynamic profile of D-1997 in the canine external carotid vascular bed. The effects of D-1997 were compared with those produced by 5-HT and the antimigraine drug, sumatriptan. One-min intracarotid (i.c.) infusions of D-1997 (10, 30, 100, 300 and 1000 micrograms/min), 5-HT (0.3, 1, 3, 10, 30 and 100 micrograms/min) and sumatriptan (3, 10, 30 and 100 micrograms/min) elicited dose-dependent decreases in external carotid blood flow (ECBF); since the infusions of agonists did not modify arterial blood pressure, they produced dose-dependent increases in external carotid resistance (ECR). The vasoconstrictor responses to D-1997 and 5-HT were of short duration (up to 10 min) whilst those to sumatriptan were longer lasting (up to 40 min). In addition, the effects induced by the agonists in the external carotid bed did not affect basal resistance in the contralateral common carotid, thereby suggesting a local effect by D-1997. The rank order of agonist potency was 5-HT > sumatriptan > D-1997; however, the order of agonist efficacy, represented as the maximum response obtained with the highest dose, displayed a different pattern, namely, D-1997 > or = sumatriptan > 5-HT.(ABSTRACT TRUNCATED AT 250 WORDS)

The 5-HT1-like receptor mediating the increase in canine external carotid blood flow: close resemblance to the 5-HT1D subtype

1. It has recently been shown that the increase in external carotid blood flow induced by 5-hydroxy-tryptamine (5-HT) in the anaesthetized dog, being mimicked by 5-carboxamidotryptamine (5-CT), inhibited by methiothepin, vagosympathectomy and sympatho-inhibitory drugs, and resistant to blockade by ritanserin and MDL 72222, is mediated by stimulation of prejunctional 5-HT1-like receptors leading to an inhibitory action on carotid sympathetic nerves; these 5-HT1-like receptors are unrelated to either the 5-HT1A, 5-HT1B or 5-HT1C (now 5-HT2C) receptor subtypes. Inasmuch as 5-CT, 5-methoxytryptamine, sumatriptan and metergoline display high affinity, amongst other 5-HT binding sites, for the 5-HT1D subtype, in the present study we have used these drugs in an attempt to determine whether the above inhibitory prejunctional 5-HT1-like receptors correlate with the 5-HT1D subtype. 2. One-minute intracarotid (i.c.) infusions of 5-HT (0.3, 1, 3 and 10 micrograms), 5-CT (0.01, 0.03, 0.1 and 0.3 micrograms), 5-methoxytryptamine (1, 3, 10 and 30 micrograms) and sumatriptan (1, 3, 10, 30 and 100 micrograms) resulted in dose-dependent increases in external carotid blood flow (without changes in mean arterial blood pressure or heart rate) with the following rank order of agonist potency: 5-CT >> 5-HT > 5-methoxytryptamine > or = sumatriptan. Interestingly, sumatriptan-induced vasodilatation was followed by a more pronounced vasoconstriction. 3. The external carotid vasodilator effects of 5-HT, 5-CT, 5-methoxytryptamine and sumatriptan were dose-dependently and specifically antagonized by metergoline (10, 30 and/or 100 micrograms kg-1, i.v.). In addition, 5-methoxytryptamine- and sumatriptan-induced vasodilator effects were, respectively, markedly inhibited or abolished after vagosympathectomy, as previously shown for 5-CT and 5-HT.4. Sumatriptan showed tachyphylaxis in its vasodilator component and antagonized 5-HT-induced external carotid vasodilatation in a specific manner, suggesting that a common site of action may be involved.5. Taken together, the above results support our contention that 5-HT, 5-CT, 5-methoxytryptamine and sumatriptan produce external carotid vasodilatation in the dog by an action that might primarily involve a prejunctional inhibition on carotid sympathetic nerves; a secondary component of this vasodilator response may be postsynaptic (endothelium-dependent and/or even directly on the vasculature).Based on the rank order of agonist potency, inhibition by vagosympathectomy and blockade by metergoline, we suggest that the inhibitory prejunctional 5-HT1-like receptors mediating external carotid vasodilatation in the dog closely resemble the 5-HTID receptor subtype. The pharmacological profile of these receptors is similar (sympathetic nerves of the rat kidney and human saphenous vein, as well as porcine coronary endothelium) to other putative 5-HTID receptors mediating vascular responses.

Conjunctival oxygen tension is influenced by plasma and blood volume, and flow through the external carotid artery

An investigation of the feasibility and validity of measurement of the conjunctival oxygen tension as a monitor of peripheral circulation, blood and extracellular fluid volume and cerebral circulation was carried out in 7 healthy volunteers and 5 unconscious critical care patients with proven total cerebral infarction. The healthy volunteers were subjected to changes in hydration achieved by the administration of furosemide and subsequent rehydration by administration of normal saline. Conjunctival oxygen tension was found to be a sensitive indicator of changes in the degree of hydration presumably by its ability to detect changes in peripheral circulation depending upon circulating blood and extracellular fluid volume. A drawback is that other stimuli of the sympatho-adrenergic system such as temperature and pain, interfere with measurement in the conscious volunteer. In patients with presumed total brain infarction the conjunctival PO2 cannot be used as a reliable monitor of cerebral blood flow because of varying perfusion of the palpebral conjunctiva from the external carotid artery in the occasional patient.

Comparison of measurement of stump pressure and transcranial measurement of flow velocity in the middle cerebral artery in carotid surgery

Transcranial Doppler ultrasound measurement of the velocity of blood flow in the middle cerebral artery (MCA) was performed in 24 consecutive patients undergoing carotid endarterectomy. Measurements were performed preoperatively at rest, following common carotid artery compression, and continuously during surgery. In addition, internal carotid artery stump pressures were measured and a subjective assessment of back flow was made. No relationship between MCA flow velocity and stump pressure following carotid clamping was demonstrated. Peak and mean MCA flow velocity was significantly lower in patients with stump pressures < 30 mm Hg (p < 0.03) and those with poor back flow (p < 0.02).

MR imaging of flow through tortuous vessels: a numerical simulation

A novel computer simulation technique is presented that allows the calculation of images from Magnetic Resonance Angiography (MRA) studies of blood flow in realistic curving and branching two-dimensional vessel geometries. Fluid dynamic calculations provide flow streamlines through curved or branching vessels. MR simulations generate images for specific MR pulse sequence parameters. Simulations of steady flow in carotid bifurcation and carotid siphon geometries as imaged by a standard, flow-compensated, spoiled gradient echo sequence illustrate the major features seen in clinical time of flight MRA studies. The simulations provide insight into a number of artifacts encountered in MRA such as displacement artifacts, signal pile-up, truncation artifacts, and intravoxel phase dispersion.