Frequency and Extent of Media in the Internal Carotid Artery in “Endarterectomy” Specimens

Roberts, William C.; Laborde, N.; Pearl, Gregory J.

doi:10.1016/j.amjcard.2006.11.043

Cited by 4 publications

(2 citation statements)

References 5 publications

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“…Our findings reflect those of several previous reports. Investigation of 147 plaques obtained at CEA found that the media was included as the outer border of the endarterectomy specimen, and suggested that a more correct term for the operative procedure might be “endomediaectomy” rather than “endarterectomy,” 11) which indicates that the easiest dissection plane might extend between the media and the adventitia. Moore 5) also emphasized the relevant issues in his textbook as follows: “Generally speaking, the easiest endarterectomy plane to achieve is that between the media and adventitia along the line of the external elastic lamina.…”

Section: Discussionmentioning

confidence: 99%

“…Major surgical studies and text books recommend or imply that the dissection plane for CEA should be located between the thickened intima (plaque) and the media, which theoretically preserves the media as the luminal surface of the arterial wall and is reportedly the easiest plane to dissect. 5 , 8 – 10) However, one previous study identified media in all of the 147 CEA specimens, 11) and we also have experienced technical difficulty in dissecting between the plaque and the media. This technical issue is important not only for safe CEA but also for the training of young surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Maximum Preservation of the Media in Carotid Endarterectomy

Niizuma

Shimizu

Inoue

et al. 2014

Neurol. Med. Chir.(Tokyo)

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Carotid endarterectomy (CEA) is intended to remove atheromatous plaque by dissecting a plane between the intima and the media (circular medial fibers), but this may not be the optimal dissection plane. The present technique is based on identifying the plane that divides the media from the plaque, so preserving the media on the adventitia as much as possible. This plane is more difficult to find and follow than the easy-to-dissect plane usually located between the media and the adventitia, because the plaque invades the media and so the dividing plane is located within the media. In this prospective observational study, CEA was performed in 22 patients to histologically examine the excised plaques and small samples of the whole arterial wall, and evaluate the clinical outcomes. Plaque had invaded the luminal part of the media in the whole arterial wall sample of 80% of cases. Thin medial layers covering > 80% of the surface of the plaque were found in 16 of 22 plaques (73%). Some atheromatous component was sometimes left in the preserved media, rather than completely removed with the media. No morbidity or mortality had occurred by discharge. Only 1 small ipsilateral infarction (4.5%) and no restenosis of greater than 50% were detected during the mean follow-up period of 7 years. Since the plaque usually invades the media, the optimum dissection plane may be located within the media, dividing it into two layers. The presence of some remnant atheromatous components in the preserved media was not associated with surgical complications or restenosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maximum Preservation of the Media in Carotid Endarterectomy

Niizuma

Shimizu

Inoue

et al. 2014

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

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Histological Analysis of a Long Term Patent Subintimal Canal in the Superficial Femoral Artery

Lund

Svindland

Bay

et al. 2021

EJVES Vascular Forum

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3D Fiber Orientation in Atherosclerotic Carotid Plaques

Akyildiz

Chai

Oomens

et al. 2017

Journal of Structural Biology

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Atherosclerotic plaque rupture is the primary trigger of fatal cardiovascular events. Fibrillar collagen in atherosclerotic plaques and their directionality are anticipated to play a crucial role in plaque rupture. This study aimed assessing 3D fiber orientations and architecture in atherosclerotic plaques for the first time. Seven carotid plaques were imaged ex-vivo with a state-of-the-art Diffusion Tensor Imaging (DTI) technique, using a high magnetic field (9.4Tesla) MRI scanner. A 3D spin-echo sequence with uni-polar diffusion sensitizing pulsed field gradients was utilized for DTI and fiber directions were assessed from diffusion tensor measurements. The distribution of the 3D fiber orientations in atherosclerotic plaques were quantified and the principal fiber orientations (circumferential, longitudinal or radial) were determined. Overall, 52% of the fiber orientations in the carotid plaque specimens were closest to the circumferential direction, 34% to the longitudinal direction, and 14% to the radial direction. Statistically no significant difference was measured in the amount of the fiber orientations between the concentric and eccentric plaque sites. However, concentric plaque sites showed a distinct structural organization, where the principally longitudinally oriented fibers were closer to the luminal side and the principally circumferentially oriented fibers were located more abluminally. The acquired unique information on 3D plaque fiber direction will help understanding pathobiological mechanisms of atherosclerotic plaque progression and pave the road to more realistic biomechanical plaque modeling for rupture assessment.

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Frequency and Extent of Media in the Internal Carotid Artery in “Endarterectomy” Specimens

Cited by 4 publications

References 5 publications

Maximum Preservation of the Media in Carotid Endarterectomy

Maximum Preservation of the Media in Carotid Endarterectomy

Histological Analysis of a Long Term Patent Subintimal Canal in the Superficial Femoral Artery

3D Fiber Orientation in Atherosclerotic Carotid Plaques

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