Possible involvement of angiotensin-converting enzyme 2 and Mas activation in inhibitory effects of angiotensin II Type 1 receptor blockade on vascular remodeling

We explored the roles of angiotensin-converting enzyme 2 (ACE2), angiotensin-(1-7), and Mas activation in angiotensin II type 1 receptor blockade-mediated attenuation of vascular remodeling. Vascular injury was induced by polyethylene-cuff placement around the mouse femoral artery. After cuff placement, the mRNA level of both ACE2 and Mas was markedly decreased in wild-type mice, whereas ACE mRNA was not changed. Immunostaining of ACE2 and Mas was observed mainly in the media and was reduced in the injured artery. Administration of angiotensin-(1-7) decreased neointimal formation after cuff placement, whereas administration of [D-Ala(7)] angiotensin-(1-7), a Mas antagonist, increased it. Consistent with these results, we also demonstrated that neointimal formation induced by cuff placement was further increased in ACE2 knockout mice. In angiotensin II type 1a receptor knockout mice, mRNA expression and immunostaining of ACE2 and Mas in the injured artery were greater, with less neointimal formation than in wild-type mice. Increased ACE2 expression in the injured artery was also observed by treatment of wild-type mice with an angiotensin II type 1 receptor blocker, olmesartan. These results suggested that activation of the ACE2-angiotensin-(1-7)-Mas axis is at least partly involved in the beneficial effects of angiotensin II type 1 receptor blockade on vascular remodeling.     

Revisit of aneurysm clip closing forces: comparison of titanium versus cobalt alloy clip

Although closing force of cobalt alloy clip is well studied, there is only little information of titanium alloy clip available in the literature. In the present study, we examined and compared closing forces of various types and points of cerebral titanium and cobalt aneurysm clips for cerebral aneurysms. Straight, temporary, bayonet, angled, and fenestrated titanium or cobalt alloy clips were tested by measuring the closing forces at various points along their blade length. Closing forces of all the tested clips linearly increased from tip to base of clip blades. Sugita Titanium II clips had bigger closing forces than Elgiloy clips in all type clips except for the temporary clips. The closing forces of Sugita Titanium II and Yasargil titanium clips were similar in straight permanent type clip although there were some differences in closing forces between other types of Sugita and Yasargil clips. Our data showed that the closing forces differed depending not only on manufacturers but also on materials and shapes.     

Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke

Previous studies have shown that extracranial–intracranial (EC-IC) bypass surgery has no preventive effect on subsequent ipsilateral ischemic stroke in patients with symptomatic atherosclerotic internal carotid occlusion and hemodynamic cerebral ischemia. A few studies have assessed whether an urgent EC-IC bypass surgery is an effective treatment for main trunk stenosis or occlusion in acute stage. The authors retrospectively reviewed 58 consecutive patients who underwent urgent EC-IC bypass for symptomatic internal carotid artery or the middle cerebral artery stenosis or occlusion between January 2003 and December 2011. Clinical characteristics and neuroimagings were evaluated and analyzed. Based on preoperative angiogram, responsible lesions were the internal carotid artery in 19 (32.8 %) patients and the middle cerebral artery in 39 (67.2 %). No hemorrhagic complication occurred. Sixty-nine percent of patients showed improvement of neurological function after surgery, and 74.1 % of patients had favorable outcome. Unfavorable outcome was associated with insufficient collateral flow and new infarction after bypass surgery.