Alexey V. Kamenskiy, PhD, Iraklis I. Pipinos, MD, PhD, Jeffrey S

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Age and disease-related geometric and structural remodeling of the carotid artery Alexey V. Kamenskiy, PhD, Iraklis I. Pipinos, MD, PhD, Jeffrey S. Carson, MD, Jason N. MacTaggart, MD, B. Timothy Baxter, MD Journal of Vascular Surgery Volume 62, Issue 6, Pages 1521-1528 (December 2015) DOI: 10.1016/j.jvs.2014.10.041 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 Anatomy of the diseased carotid artery demonstrates the common (CCA), internal (ICA), and external (ECA) carotid arteries, the bifurcation, the bulb, and atherosclerotic plaque. The proximal bulb boundary was determined as the level at which the CCA begins to rapidly widen. The distal bulb boundary was defined as the level at which diameter of the ICA is reduced to the size of the distal ICA. Journal of Vascular Surgery 2015 62, 1521-1528DOI: (10.1016/j.jvs.2014.10.041) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 Shown is a (left) representative three-dimensional (3D) reconstruction of carotid artery geometry from two-dimensional cross-sections and (right) measurements of the geometric features in the artery. CCA, Common carotid artery; ICA, internal carotid artery. Journal of Vascular Surgery 2015 62, 1521-1528DOI: (10.1016/j.jvs.2014.10.041) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 3 Remodeling of the carotid geometry during normal aging demonstrates changes in the diameters, tortuosity, and bifurcation angle with age. Data are presented for the left (L) and right (R) arteries. The r values assess correlation with age. CCA, Common carotid artery; ICA, internal carotid artery. Journal of Vascular Surgery 2015 62, 1521-1528DOI: (10.1016/j.jvs.2014.10.041) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 4 A representative carotid artery from a 22-year-old male demonstrates layers of elastin fibers in the (left panel) longitudinal and (right panel) transverse (circumferential) directions. C and F, Elastin in the common carotid artery (CCA) is dense and is distributed evenly through the media. B and E, In the carotid bulb, elastin becomes less dense while the artery becomes more muscular. A and D, In the internal carotid artery (ICA), elastin is concentrated mostly in the external elastic lamina, with a predominantly longitudinal orientation, whereas smooth muscle dominates in the media. Verhoeff-Van Gieson staining, with elastin stained black and collagen stained red. The scale bar = 200 μm. Journal of Vascular Surgery 2015 62, 1521-1528DOI: (10.1016/j.jvs.2014.10.041) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 5 Elastin density in the common carotid artery (CCA) decreases with age. Elastin density was calculated as volume fraction (%) of elastin in the medial layer. Data are presented as mean ± standard deviation. Journal of Vascular Surgery 2015 62, 1521-1528DOI: (10.1016/j.jvs.2014.10.041) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 6 A comparison of the longitudinal and transverse histologic sections of the proximal common carotid artery (CCA) in individuals aged (A and D) 22 years, (B and E) 43 years, and (C and F) 75 years demonstrates more fragmented and less dense elastin in the older individuals. Verhoeff-Van Gieson staining, with elastin stained black and collagen stained red. The scale bar = 200 μm. Journal of Vascular Surgery 2015 62, 1521-1528DOI: (10.1016/j.jvs.2014.10.041) Copyright © 2015 Society for Vascular Surgery Terms and Conditions