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PubMedDate not supplied

Aortic intimal response to endothelial removal in cebus and squirrel monkeys.

Whereas squirrel monkeys have an inherent susceptibility to atherosclerosis, cebus monkeys are relatively resistant. To assess whether this difference might lie in their response to endothelial injury, the acute morphologic changes in the aortic intima after endothelial removal were examined in the two species. The endothelium of the lower thoracic aorta was removed with an embolectomy catheter, and the intimal response was compared with the uninjured upper thoracic aorta in each monkey. By 21 days after aortic denudation, regrowth of the endothelium (assessed by in vivo Evans' blue dye staining) was significantly greater in squirrel monkeys (90% +/- 5% of aortic surface) than in cebus (56% +/- 11%). Squirrel monkeys had comparable sudanophilic surface in the nonballooned, control aorta (25% +/- 7%) and the ballooned, lower thoracic segment (17% +/- 6%). Cebus monkey aortas had no sudanophilia in either segment. The intima/media ratios (IMR) in all regions of the aorta were significantly greater in squirrel monkeys than in cebus, but in both species the IMR of the ventral ballooned segment was two to three times the IMR of the nonballooned control segment. In the dorsal aorta, where endothelial regrowth was more rapid, the IMR was similar to the control aortic segment. By electron microscopy the thickened aortic intima in both species contained a marked increase in modified smooth muscle cells, but lipid accumulation did not result from endothelial removal or regrowth in either species. Thus, although the squirrel monkey aorta had atherosclerotic lesions before endothelial removal, the acute intimal response to endothelial injury was similar in degree and kind in both cebus and squirrel monkeys. This suggests that factors other than those controlling the initial intimal thickening following endothelial injury are responsible for the observed difference in arterial lipid accumulation between cebus and squirrel monkeys.

Animals↗
PubMed2003

Probucol promotes functional reendothelialization in balloon-injured rabbit aortas.

BACKGROUND: Probucol remains the only conventional drug that reduces restenosis after coronary angioplasty. Apart from its weak cholesterol-lowering effect, probucol has antioxidant properties, but it remains unclear how this drug inhibits restenosis. METHODS AND RESULTS: Aortic balloon-injured New Zealand White rabbits were fed 2% (wt/wt) cholesterol-enriched or normal chow, with 0.75% (wt/wt) probucol (P) or without (controls, C) for 6 weeks. Endothelial denudation of the abdominal aorta was performed at week 3 with a 3F Fogarty embolectomy catheter. The arteries were harvested after week 6 and analyzed for histology, lipids and antioxidants, and endothelial regeneration and function. Probucol significantly decreased aortic intima-to-media ratio (cholesterol-fed: C, 1.10+/-0.08 versus P, 0.70+/-0.10; normal: C, 0.89+/-0.02 versus P, 0.83+/-0.05; P<0.05) and the numbers of proliferating intimal smooth muscle cells and lowered serum cholesterol without altering the proportion of aortic lipids that was oxidized. Probucol promoted endothelial regeneration in the injured aorta in cholesterol-fed rabbits (25% increase in reendothelialization, P<0.05) and in those on normal chow (37% increase, P<0.01). This was associated with both improved endothelial function as assessed by enhanced aortic ring relaxation and cGMP production in response to acetylcholine and decreased intimal thickening. CONCLUSIONS: Probucol inhibits intimal thickening in balloon-damaged arteries of rabbits by promoting the regeneration of functional endothelium, without affecting the proportion of aortic lipids that was oxidized. This novel in vivo finding helps explain how probucol inhibits restenosis after coronary angioplasty and highlights potential new targets for therapeutic intervention.

Angioplasty, Balloon↗
PubMed2003

Low pro-brain natriuretic peptide levels predict benign clinical outcome in acute pulmonary embolism.

BACKGROUND: The role of pro-brain natriuretic peptide (proBNP) for the prediction of clinical outcome has not been examined in patients with acute pulmonary embolism (PE). METHODS AND RESULTS: ProBNP levels were measured in 73 patients with acute PE within 4 hours of admission. Adverse clinical outcome was defined as in-hospital death or the need for at least 1 of the following: cardiopulmonary resuscitation, mechanical ventilation, pressors, thrombolysis, catheter fragmentation, or surgical embolectomy. In the 53 patients with a benign clinical outcome, proBNP (median 121, range 16 to 34 802 pg/mL) was lower than in 20 patients with adverse clinical outcome (median 4250, range 92 to 49 607 pg/mL; P<0.0001). The negative predictive value of proBNP levels <500 pg/mL to predict adverse clinical outcome was 97% (95% confidence interval 84 to 99). ProBNP remained an independent predictor for adverse clinical outcome (odds ratio 14.6; 95% confidence interval 1.5 to 139.0; P=0.02) after adjusting for severity of PE (submassive/massive), troponin T levels >0.01 ng/mL, age >70 years, gender, and history of congestive heart failure. CONCLUSIONS: Low proBNP levels predict an uneventful hospital course in patients with acute PE. A proBNP level <500 pg/mL identifies patients who will be potential candidates for an abbreviated hospital length of stay or care on a completely outpatient basis.

Acute Disease↗
PubMed2004

Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism.

BACKGROUND: We investigated the prognostic role of right ventricular enlargement on multidetector-row chest CT in acute pulmonary embolism (PE). METHODS AND RESULTS: We studied 63 patients with CT-confirmed PE who underwent echocardiography within the ensuing 24 hours. Adverse clinical events, defined as 30-day mortality or the need for cardiopulmonary resuscitation, mechanical ventilation, pressors, rescue thrombolysis, or surgical embolectomy, were present in 24 patients. We performed off-line CT measurements of right and left ventricular dimensions (RV(D), LV(D)) with axial and 2-dimensional reconstructed 4-chamber (4-CH) views. The proportion of patients with RV(D)/LV(D)>0.9 on the axial view was similar in patients with (70.8%) and those without adverse events (71.8%; P=0.577). In contrast, RV(D)/LV(D)>0.9 on the 4-CH view was more common in patients with (80.3%) than without (51.3%; P=0.015) adverse events. The area under the curve of RV(D)/LV(D) from the axial and 4-CH views for predicting adverse events was 0.667 and 0.753, respectively. Sensitivity and specificity of RV(D)/LV(D)>0.9 for predicting adverse events were 37.5% and 92.3% on the axial view and 83.3% and 48.7% on the reconstructed 4-CH view, respectively. RV(D)/LV(D)>0.9 on the 4-CH view was an independent predictor for adverse events (OR, 4.02; 95% CI, 1.06 to 15.19; P=0.041) when adjusted for age, obesity, cancer, and recent surgery. CONCLUSIONS: Right ventricular enlargement on the reconstructed CT 4-CH views predicts adverse clinical events in patients with acute PE. Ventricular CT measurements obtained from 4-CH views are superior to those from axial views for identifying high-risk patients.

Acute Disease↗
PubMed1982

Echocardiographic identification of right-sided cardiac intracavitary thromboembolus in massive pulmonary embolism.

In a patient with clinical features of massive pulmonary embolism, two-dimensional echocardiography demonstrated an echo-dense mass moving freely across the tricuspid valve between the right atrium and right ventricle. This mass was also visualized at angiography, which in addition confirmed extensive pulmonary embolism. At autopsy, the mass was found to be a coiled thrombus, one end of which had become wedged in a probe-patent foramen ovale. In another patient, bedside echocardiographic demonstration of thrombus in the right ventricular outflow tract was followed by immediate and successful embolectomy.

Aged↗
PubMed1999

Angiotensin-(1-7) reduces smooth muscle growth after vascular injury.

Regulation of vascular smooth muscle cell growth is critical to the maintenance of normal blood flow and vessel patency. Angiotensin-(1-7) [Ang-(1-7)] inhibits proliferation of vascular smooth muscle cells in vitro and opposes the mitogenic effects of angiotensin II. The present study investigated whether Ang-(1-7) inhibits vascular smooth muscle cell growth in vivo by determining its effect on neointimal formation and medial remodeling in balloon-injured carotid arteries. The carotid arteries of adult male Sprague-Dawley rats were injured with a balloon embolectomy catheter. Ang-(1-7) in saline (24 microg/kg per hour) or saline alone was infused intravenously for 12 days after injury. Pumps containing bromodeoxyuridine were implanted at the same time to determine DNA synthesis. Intravenous infusion increased plasma Ang-(1-7) to 166. 0+/-41.2 fmol/mL (n=6) compared with 46.9+/-4.2 fmol/mL (n=8) in saline-infused rats. Plasma concentrations of Ang II were not changed by Ang-(1-7) infusion. Elevation in circulating Ang-(1-7) had no effect on either blood pressure or heart rate compared with saline controls. Histomorphometric analysis of carotid arteries indicated that Ang-(1-7) infusion significantly reduced neointimal area compared with rats infused with saline (0.063+/-0.011 versus 0. 100+/-0.009 mm2; P<0.05). In contrast, Ang-(1-7) infusion had no effect on medial area of the injured or the contralateral uninjured artery compared with saline controls. Ang-(1-7) infusion also reduced the rate of DNA synthesis in both the neointima and the media of the injured vessels. Therefore, exogenous Ang-(1-7) inhibited vascular smooth muscle cell proliferation associated with balloon-catheter injury. Similar increases in endogenous plasma Ang-(1-7) and inhibition of neointimal growth were observed in rats after angiotensin-converting enzyme inhibitor or angiotensin type 1 receptor antagonist administration, suggesting that Ang-(1-7) may contribute to the in vivo antiproliferative effects of these agents on vascular smooth muscle.

Angiotensin I↗
PubMed2003

Novel NAD(P)H oxidase inhibitor suppresses angioplasty-induced superoxide and neointimal hyperplasia of rat carotid artery.

Neointimal proliferation occurring after vascular or endovascular procedures is a major complication leading to end-organ or limb ischemia. In experimental models, balloon injury has been shown to induce NAD(P)H oxidase to produce vascular superoxide anion (O2*-) production, which has been implicated in cell proliferation, but a direct link is still unclear. We postulated that inhibition of arterial NAD(P)H oxidase, resulting in decreased O2*-, would lessen the neointimal hyperplasia caused by balloon injury to the common carotid artery (CCA). Sprague-Dawley rats were implanted with osmotic minipumps containing either vehicle, a cell-permeant peptide that inhibits NAD(P)H oxidase (gp91ds-tat, 10 mg/kg per day), or a scrambled peptide control (scrmb-tat). Two days after pump implantation, the left CCA was injured using an intravascular balloon embolectomy catheter (2F Fogarty). Systolic blood pressure was monitored by tail cuff. Fourteen days after injury, CCAs were harvested and analyzed by digital morphometry. Rats in both groups remained normotensive, with no significant differences in systolic blood pressure. Reactive oxygen species measurements after injury indicated a significant reduction in vascular O2*- in rats infused with gp91ds-tat, and the neointima/media area and thickness ratios were significantly lower in their arteries compared with control. On the contrary, no significant change in overall CCA diameter was observed in any group. Our data indicate that in response to balloon injury of the rat carotid artery, NAD(P)H oxidase activity contributes to neointimal hyperplasia and is involved in vascular cell proliferation and migration during restenosis.

Angioplasty↗
PubMed2000

Ceramide-coated balloon catheters limit neointimal hyperplasia after stretch injury in carotid arteries.

Neointimal hyperplasia at the site of surgical intervention is a common and deleterious complication of surgery for cardiovascular diseases. We hypothesized that direct delivery of a cell-permeable growth-arresting lipid via the balloon tip of an embolectomy catheter would limit neointimal hyperplasia after stretch injury. We have previously demonstrated that sphingolipid-derived ceramide arrested the growth of smooth muscle cell pericytes in vitro. Here, we show that ceramide-coated balloon catheters significantly reduced neointimal hyperplasia induced by balloon angioplasty in rabbit carotid arteries in vivo. This ceramide treatment decreased the number of vascular smooth muscle cells entering the cell cycle without inducing apoptosis. In situ autoradiographic studies demonstrated that inflating the balloon catheter forced cell-permeable ceramide into the intimal and medial layers of the artery. Intercalation of ceramide into vascular smooth muscle cells correlated with rapid inhibition of trauma-associated phosphorylation of extracellular signal-regulated kinase and protein kinase B. These studies demonstrate the utility of cell-permeable ceramide as a novel therapy for reducing neointimal hyperplasia after balloon angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed2006

Neutralization of interleukin-18 inhibits neointimal formation in a rat model of vascular injury.

BACKGROUND: Studies in humans and animal models suggest that interleukin-18 (IL-18) plays a crucial role in vascular pathologies. IL-18 is a predictor of cardiovascular death in angina and is involved in atherotic plaque destabilization. Higher IL-18 plasma levels also are associated with restenosis after coronary artery angioplasty performed in patients with acute myocardial infarction. We investigated the effective role of IL-18 in neointimal formation in a balloon-induced rat model of vascular injury. METHODS AND RESULTS: Endothelial denudation of the left carotid artery was performed by use of a balloon embolectomy catheter. Increased expression of IL-18 and IL-18Ralpha/beta mRNA was detectable in carotid arteries from days 2 to 14 after angioplasty. The active form of IL-18 was highly expressed in injured arteries. Strong immunoreactivity for IL-18 was detected in the medial smooth muscle cells at days 2 and 7 after balloon injury and in proliferating/migrating smooth muscle cells in neointima at day 14. Moreover, serum concentrations of IL-18 were significantly higher among rats subjected to vascular injury. Treatment with neutralizing rabbit anti-rat IL-18 immunoglobulin G significantly reduced neointimal formation (by 27%; P < 0.01), reduced the number of proliferating cells, and inhibited interferon-gamma, IL-6, and IL-8 mRNA expression and nuclear factor-kappaB activation in injured arteries. In addition, in vitro data show that IL-18 affects smooth muscle cell proliferation. CONCLUSIONS: These results identify a critical role for IL-18 in neointimal formation in a rat model of vascular injury and suggest a potential role for IL-18 neutralization in the reduction of neointimal development.

Actins↗
PubMed2003

Arterial embolism to the upper extremity in a patient with factor V Leiden mutation (APC resistance)--a case report and review of the literature.

Factor V Leiden mutation has emerged as one of the leading abnormalities in inherited blood coagulation disorders, resulting in a markedly increased risk for deep leg vein thrombosis. A 24-year-old woman presented with acute onset of critical ischemia of her left thumb and index finger. Intraarterial angiography revealed an embolus in the distal radial artery and a thrombotic occlusion of the digital artery of the thumb and index finger. Immediate therapy encompassed a selective surgical embolectomy of the distal radial artery followed by a local intraarterial lysis that was continued for 3 days. Additionally, therapeutic anticoagulation and vasodilating drugs (prostaglandin E) were administered. Within 2 days, capillary refill reappeared and the initial loss of sensory function at the tip of the thumb and index finger diminished. A screening test for thrombophilic disorders led to the diagnosis of a heterozygous mutation of factor V (Leiden mutation). Arterial thromboembolic events of factor V Leiden mutation are rare and have to date been described only in the supraaortic and coronary circulation. Therefore, the arterial embolism to the left hand presented in this report constitutes a rarity that could be successfully salvaged by the combined use of a vascular surgical procedure and intensified medical management.

Activated Protein C Resistance↗
PubMed1992

Right-sided cardiac thromboembolism and its successful treatment with streptokinase: case report.

A sixty-eight-year-old woman with a clinical diagnosis of pulmonary embolism and large right-heart embolus on echocardiography is presented. Because of the critical clinical condition of the patient and the inability to perform surgical intervention, thrombolytic treatment (streptokinase) was administered. The patient's condition improved, the right-heart embolus disappeared, and on the perfusion lung scan there was only one small perfusion defect in the right lung. The authors consider thrombolysis to be appropriate treatment for right-heart thromboembolism whenever surgical embolectomy is not possible.

Female↗
PubMed1991

Venous bullet embolism: a complication of airgun pellet injuries.

Bullet emboli are an interesting but rare occurrence and their management when situated in the venous system remains controversial. Two cases of venous bullet embolism to the right heart are reported due to airgun pellet injuries. Both cases required bullet embolectomy using cardio-pulmonary bypass.

Child↗
PubMedDate not supplied

Obstructed feeding jejunostomy tube: a new method of salvage.

The jejunostomy tube is an important means of access for enteral feeding in the surgical and medical patient. A common complication of this technique is tube occlusion. Once a mature tract has formed the tube can be removed and replaced, following by contrast radiologic documentation of its intraluminal position. With an immature tract, this option is not available. We report a safe, simple, and cost-effective method of unblocking a clogged jejunostomy using an arterial embolectomy catheter.

Catheterization↗
PubMed2002

Vascular echinococcosis.

Three patients with arterial echinococcosis presented with chronic or acute arterial occlusion. One case diagnosed as Leriche's syndrome was found at surgery to have aortic occlusion caused by hydatid cysts; arterial reconstruction was performed by aortoiliac interposition of a woven Dacron vascular graft. In the other 2 cases presenting with acute femoral or brachial artery occlusion, embolectomy revealed hydatid cysts as the cause of occlusion.

Adult↗
PubMed2002

Caught in the act: impending paradoxical embolism.

In a 73-year-old woman admitted with pulmonary embolism, a thrombus wedged across a patent foramen ovale was revealed by transesophageal echocardiography. After systemic anticoagulation, cardiac embolectomy and closure of the atrial septal defect were considered. Before surgery, repeat transesophageal echocardiography revealed only a small patent foramen ovale with no residual thrombus. We assumed dissolution of the thrombus as the patient had no sign of systemic or recurrent pulmonary embolism.

Aged↗
PubMed2000

Mechanical circulatory assist for pulmonary embolism.

Optimal management of acute pulmonary embolism remains controversial, despite advances in thrombolytic therapy. Haemodynamic instability and, in particular, right ventricular dysfunction is associated with poor outcomes. Urgent surgical embolectomy has been the treatment of choice in this category of patients. We present two cases in which percutaneous cardiopulmonary support (PCPS) was used as an adjunct to thrombolytic therapy for progressive circulatory collapse secondary to massive acute pulmonary embolism. This experience suggests that PCPS may offer an attractive option for a condition which continues to carry significant morbidity and mortality.

Adult↗
PubMed2006

Massive intraoperative pulmonary embolism: it may not be as bad as it looks....

An elderly patient suffered a cardiac arrest while undergoing repair of a pathological femoral fracture. Intraoperative transoesophageal echocardiography demonstrated massive pulmonary embolism. Pulmonary embolectomy was considered inappropriate in view of her underlying terminal disease, so a decision was made to withdraw all further supportive measures. Despite this, the patient's haemodynamics improved spontaneously. The embolic material was presumed to be bone marrow fat. Fat may traverse the pulmonary circulation; hence the clinical consequences (and management implications) of massive intraoperative pulmonary embolism may vary, depending on the composition of the embolic material. As there are no reliable means of determining the composition of embolic material intraoperatively, the clinical suspicion of fat embolism poses a management dilemma. Should these cases be managed surgically or conservatively?

Aged↗
PubMed1975

Selective bronchial blocking in children.

The use of the Fogarty arterial embolectomy catheter as an endobronchial blocker in infants and children has previously been reported. The further development of this technique is outlined and its use in two patients is described.

Bronchi↗