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Arteriosclerosis, Thrombosis, and... Sep 2020Atherosclerosis is a systemic disease that involves multiple vascular beds. The pathological characteristics and clinical presentation, however, vary among the different... (Review)
Review
Atherosclerosis is a systemic disease that involves multiple vascular beds. The pathological characteristics and clinical presentation, however, vary among the different vascular territories. Acute coronary syndrome is a relatively common manifestation of coronary atherosclerotic disease, wherein the thrombosis occurs secondary to disruption (65%-75%) and erosion (25%-35%) of the fibrous caps of atheromatous plaques. The plaques associated with plaque rupture have large necrotic cores and thin and inflamed fibrous caps. However, the pathological manifestations of peripheral artery disease result from thrombosis regardless of the extent of atherosclerosis. Approximately 75% of peripheral arteries with significant stenosis demonstrate presence of thrombi, of which two-thirds have thrombi associated with insignificant atherosclerosis. The presence of obliterative thrombi in peripheral arteries of patients with critical limb ischemia in the absence of coronary artery-like lesions suggests a locally thrombogenic or remotely embolic basis of disease. Extensive calcification of the medial vascular layer is commonly observed. In this review, we have described and compared the pathological basis of coronary and peripheral artery disease in patients with acute coronary syndrome and critical limb ischemia. It is expected that pathogenetic characterization would allow for definition of strategic targets for superior management of peripheral artery disease.
Topics: Acute Coronary Syndrome; Arteries; Coronary Artery Disease; Coronary Vessels; Critical Illness; Disease Progression; Fibrinolytic Agents; Fibrosis; Humans; Ischemia; Peripheral Arterial Disease; Plaque, Atherosclerotic; Prognosis; Rupture, Spontaneous; Thrombosis
PubMed: 32673526
DOI: 10.1161/ATVBAHA.119.312864 -
Swiss Dental Journal May 2018Vascular supply is key for maintenance of healthy tissue conditions but also with regard to healing following trauma or therapeutic interventions. The face is probably... (Review)
Review
Vascular supply is key for maintenance of healthy tissue conditions but also with regard to healing following trauma or therapeutic interventions. The face is probably the most exposed part of the body and any changes of vascularity are readily visible (skin blanching, ecchymosis, hematoma, edema). With regard to the arterial supply, all vessels reaching the facial skin originate from the bilateral common carotid arteries. The ophthalmic artery is considered the major arterial shunt between the internal and external carotid artery systems. Main arterial contributors to the face include the facial, transverse facial, and infraorbital arteries. In general, homonymous veins accompany the arteries, but there are some exceptions (inferior ophthalmic vein, retromandibular vein). Furthermore, the facial vein demonstrates a consistently more posterior course compared to the facial artery. Lymphatic vessels including lymph nodes play an important role for facial drainage.
Topics: Arteries; Carotid Artery, External; Carotid Artery, Internal; Face; Humans; Lymphatic System; Maxillary Artery; Ophthalmic Artery; Orbit; Reference Values; Skin; Temporal Arteries; Veins
PubMed: 29734800
DOI: No ID Found -
Circulation Research Sep 2018Advancing age promotes cardiovascular disease (CVD), the leading cause of death in the United States and many developed nations. Two major age-related arterial... (Review)
Review
Advancing age promotes cardiovascular disease (CVD), the leading cause of death in the United States and many developed nations. Two major age-related arterial phenotypes, large elastic artery stiffening and endothelial dysfunction, are independent predictors of future CVD diagnosis and likely are responsible for the development of CVD in older adults. Not limited to traditional CVD, these age-related changes in the vasculature also contribute to other age-related diseases that influence mammalian health span and potential life span. This review explores mechanisms that influence age-related large elastic artery stiffening and endothelial dysfunction at the tissue level via inflammation and oxidative stress and at the cellular level via Klotho and energy-sensing pathways (AMPK [AMP-activated protein kinase], SIRT [sirtuins], and mTOR [mammalian target of rapamycin]). We also discuss how long-term calorie restriction-a health span- and life span-extending intervention-can prevent many of these age-related vascular phenotypes through the prevention of deleterious alterations in these mechanisms. Lastly, we discuss emerging novel mechanisms of vascular aging, including senescence and genomic instability within cells of the vasculature. As the population of older adults steadily expands, elucidating the cellular and molecular mechanisms of vascular dysfunction with age is critical to better direct appropriate and measured strategies that use pharmacological and lifestyle interventions to reduce risk of CVD within this population.
Topics: Age Factors; Aging; Animals; Arteries; Autophagy; Cardiovascular Diseases; Cellular Senescence; Genomic Instability; Humans; Inflammation Mediators; Oxidative Stress; Signal Transduction; Vascular Stiffness
PubMed: 30355078
DOI: 10.1161/CIRCRESAHA.118.312563 -
Journal of Internal Medicine May 2017Complex structural and functional changes occur in the arterial system with advancing age. The aged artery is characterized by changes in microRNA expression patterns,... (Review)
Review
Complex structural and functional changes occur in the arterial system with advancing age. The aged artery is characterized by changes in microRNA expression patterns, autophagy, smooth muscle cell migration and proliferation, and arterial calcification with progressively increased mechanical vessel rigidity and stiffness. With age the vascular smooth muscle cells modify their phenotype from contractile to 'synthetic' determining the development of intimal thickening as early as the second decade of life as an adaptive response to forces acting on the arterial wall. The increased permeability observed in intimal thickening could represent the substrate on which low-level atherosclerotic stimuli can promote the development of advanced atherosclerotic lesions. In elderly patients the atherosclerotic plaques tend to be larger with increased vascular stenosis. In these plaques there is a progressive accumulation of both lipids and collagen and a decrease of inflammation. Similarly the plaques from elderly patients show more calcification as compared with those from younger patients. The coronary artery calcium score is a well-established marker of adverse cardiovascular outcomes. The presence of diffuse calcification in a severely stenotic segment probably induces changes in mechanical properties and shear stress of the arterial wall favouring the rupture of a vulnerable lesion in a less stenotic adjacent segment. Oxidative stress and inflammation appear to be the two primary pathological mechanisms of ageing-related endothelial dysfunction even in the absence of clinical disease. Arterial ageing is no longer considered an inexorable process. Only a better understanding of the link between ageing and vascular dysfunction can lead to significant advances in both preventative and therapeutic treatments with the aim that in the future vascular ageing may be halted or even reversed.
Topics: Aging; Arteries; Atherosclerosis; Endothelium, Vascular; Humans; Plaque, Atherosclerotic; Stress, Physiological; Vascular Calcification
PubMed: 28345303
DOI: 10.1111/joim.12605 -
Arteriosclerosis, Thrombosis, and... Jul 2020Peripheral artery disease is a common disorder and a major cause of morbidity and mortality worldwide. Therapy is directed at reducing the risk of major adverse... (Review)
Review
Peripheral artery disease is a common disorder and a major cause of morbidity and mortality worldwide. Therapy is directed at reducing the risk of major adverse cardiovascular events and at ameliorating symptoms. Medical therapy is effective at reducing the incidence of myocardial infarction and stroke to which these patients are prone but is inadequate in relieving limb-related symptoms, such as intermittent claudication, rest pain, and ischemic ulceration. Limb-related morbidity is best addressed with surgical and endovascular interventions that restore perfusion. Current medical therapies have only modest effects on limb blood flow. Accordingly, there is an opportunity to develop medical approaches to restore limb perfusion. Vascular regeneration to enhance limb blood flow includes methods to enhance angiogenesis, arteriogenesis, and vasculogenesis using angiogenic cytokines and cell therapies. We review the molecular mechanisms of these processes; briefly discuss what we have learned from the clinical trials of angiogenic and cell therapies; and conclude with an overview of a potential new approach based upon transdifferentiation to enhance vascular regeneration in peripheral artery disease.
Topics: Angiogenesis Inducing Agents; Animals; Arteries; Cytokines; Humans; Neovascularization, Physiologic; Peripheral Arterial Disease; Recovery of Function; Regeneration; Regional Blood Flow; Stem Cell Transplantation; Treatment Outcome
PubMed: 32434408
DOI: 10.1161/ATVBAHA.120.312862 -
Arteriosclerosis, Thrombosis, and... May 2020Despite the wide recognition of larger artery stiffness as a highly clinically relevant and independent prognostic biomarker, it has yet be incorporated into routine... (Review)
Review
Despite the wide recognition of larger artery stiffness as a highly clinically relevant and independent prognostic biomarker, it has yet be incorporated into routine clinical practice and to take a more prominent position in clinical guidelines. An important reason may be the plethora of methods and devices claiming to measure arterial stiffness in humans. This brief review provides a concise overview of methods in use, indicating strengths and weaknesses. We classified and graded methods, highly weighing their scrutiny and purity in quantifying arterial stiffness, rather than focusing on their ease of application or the level at which methods have demonstrated their prognostic and diagnostic potential.
Topics: Arterial Pressure; Arteries; Blood Pressure Determination; Cardiovascular Diseases; Elasticity; Elasticity Imaging Techniques; Humans; Predictive Value of Tests; Prognosis; Pulse Wave Analysis; Reproducibility of Results; Risk Assessment; Risk Factors; Severity of Illness Index; Vascular Stiffness
PubMed: 31875700
DOI: 10.1161/ATVBAHA.119.313132 -
Interventional Neuroradiology : Journal... Dec 2022The basic pattern of arterial vascularization is highly conserved across vertebrates and develops under neuromeric rules. The hindbrain has an angioarchitecture that is... (Review)
Review
The basic pattern of arterial vascularization is highly conserved across vertebrates and develops under neuromeric rules. The hindbrain has an angioarchitecture that is homologous to that of the spinal cord, and the hindbrain vascular system can be analyzed at the longitudinal and axial structures. During development, there are two main longitudinal arteries: the longitudinal neural artery and primitive lateral basilovertebral anastomosis. This review discusses the basic pattern of the blood supply of the hindbrain, the development of vascularization, and the anatomical variations, with a special reference to the embryological point of view of two main longitudinal anastomoses (longitudinal neural artery and primitive lateral basilovertebral anastomosis). The formation of commonly observed variations, such as fenestration and duplication of the vertebrobasilar artery, or primitive trigeminal artery variant, can be explained by the partial persistence of the primitive lateral basilovertebral anastomosis. Understanding the pattern and the development of the blood supply of the hindbrain provides useful information of the various anomalies of the vertebrobasilar junction and cerebellar arteries.
Topics: Humans; Basilar Artery; Vertebral Artery; Rhombencephalon; Cerebral Arteries; Spinal Cord
PubMed: 34935534
DOI: 10.1177/15910199211063011 -
Journal of Interventional Cardiology 2022Coronary arteries are exposed to a variety of complex biomechanical forces during a normal cardiac cycle. These forces have the potential to contribute to coronary stent...
INTRODUCTION
Coronary arteries are exposed to a variety of complex biomechanical forces during a normal cardiac cycle. These forces have the potential to contribute to coronary stent failure. Recent advances in stent design allow for the transmission of native pulsatile biomechanical forces in the stented vessel. However, there is a significant lack of evidence in a human model to measure vessel motion in native coronary arteries and stent conformability. Thus, we aimed to characterize and define coronary artery radial deformation and the effect of stent implantation on arterial deformation.
MATERIALS AND METHODS
Intravascular ultrasound (IVUS) pullback DICOM images were obtained from human coronary arteries using a coronary ultrasound catheter. Using two-dimensional speckle tracking, coronary artery radial deformation was defined as the inward and outward displacement (mm) and velocity (cm/s) of the arterial wall during the cardiac cycle. These deformation values were obtained in native and third-generation drug-eluting stented artery segments.
RESULTS
A total of 20 coronary artery segments were independently analyzed pre and poststent implantation for a total of 40 IVUS runs. Stent implantation impacted the degree of radial deformation and velocity. Mean radial deformation in native coronary arteries was 0.1230 mm ± 0.0522 mm compared to 0.0775 mm ± 0.0376 mm in stented vessels (=0.0031). Mean radial velocity in native coronary arteries was 0.1194 cm/ ± 0.0535 cm/s compared to 0.0840 cm/ ± 0.0399 cm/s in stented vessels (=0.0228).
CONCLUSION
In this in vivo analysis of third-generation stents, stent implantation attenuates normal human coronary deformation during the cardiac cycle. The implications of these findings on stent failure and improved clinical outcomes require further investigation.
Topics: Coronary Angiography; Coronary Vessels; Humans; Radial Artery; Stents; Ultrasonography, Interventional
PubMed: 35401063
DOI: 10.1155/2022/5981027 -
VASA. Zeitschrift Fur Gefasskrankheiten Aug 2017Peripheral artery disease of the lower limbs (PAD) is a common disease. Evaluation of PAD is primarily based on non-invasive examinations with analysis of the arterial... (Review)
Review
Peripheral artery disease of the lower limbs (PAD) is a common disease. Evaluation of PAD is primarily based on non-invasive examinations with analysis of the arterial Doppler signal being a key element. However, the description of arterial Doppler waveforms morphologies varies considerably across medical schools and from country to country. In order to overcome this issue, the French College of Teachers for Vascular Medicine (Collège des Enseignants de Médecine Vasculaire; CEMV) has summarised the published data on Doppler waveforms analysis and proposes a new "Saint-Bonnet" classification system to describe Doppler waveforms morphologies. The simplified Saint-Bonnet classification comprises eight types and allows taking into account if the Doppler signal does not revert to baseline. This classification, which is based on previous classifications, could improve the descriptions of both physiological and pathological waveforms, recorded in lower limb arteries. According to the reviewed literature, recommendations about the use of Doppler waveforms are proposed. This statement is a preamble to reach an international consensus on the subject, which would standardize the description of arterial waveforms and improve the management of PAD patients.
Topics: Arteries; Blood Flow Velocity; Humans; Image Interpretation, Computer-Assisted; Lower Extremity; Peripheral Arterial Disease; Predictive Value of Tests; Prognosis; Regional Blood Flow; Reproducibility of Results; Ultrasonography, Doppler
PubMed: 28521662
DOI: 10.1024/0301-1526/a000638 -
Arteriosclerosis, Thrombosis, and... May 2020The large elastic arteries fulfill an important role in buffering the cyclical changes in blood pressure, which result from intermittent ventricular ejection. With aging... (Review)
Review
The large elastic arteries fulfill an important role in buffering the cyclical changes in blood pressure, which result from intermittent ventricular ejection. With aging and accrual of cardiovascular risk factors, the elastic arteries stiffen, and this process holds a number of deleterious consequences for the cardiovascular system and major organs. Indeed, arterial stiffness is now recognized as an important, independent determinant of cardiovascular disease risk. Additional, important information concerning the mechanisms underlying arterial stiffening has come from longitudinal studies of arterial stiffness. More recently, attention has focused on the role of peripheral, muscular arteries in cardiovascular disease risk prediction and, in particular, the clinical consequences of reversal of the normal gradient of arterial stiffness between central and peripheral arteries, with aging and disease.
Topics: Age Factors; Animals; Arteries; Cardiovascular Diseases; Elasticity; Humans; Prognosis; Risk Assessment; Risk Factors; Vascular Remodeling; Vascular Stiffness
PubMed: 32188277
DOI: 10.1161/ATVBAHA.120.313128