Arterial Anatomy Research Articles

Impact of chronic kidney disease on patients with Myocardial Infarction with Non Obstructive Coronary Arteries (MINOCA)

Abstract Background Chronic kidney disease (CKD) in patients with myocardial infarction (MI) is associated with more advanced disease, a higher risk of complications and poorer prognosis, as well as increased mortality. The aim of this study is to assess the impact of CKD in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and its influence on the prognosis of these patients. Methods it was an observational, prospective and analytic study. We analyzed all consecutive patients with MI who underwent coronary angiography admitted to our Hospital between 2016 and 2023; MINOCA patients were classified following the 2023 ESC Guidelines definition. The patients were divided into two groups depending on whether they had CKD or not. Median follow-up was 43 months [20-71]. Results we included 136 patients with MINOCA, of whom 11 (8.1%) had CKD. Patients with impaired kidney function were older and mostly male. They also exhibited a higher prevalence of classic cardiovascular risk factors such as hypertension, diabetes, or dyslipidemia. However, there were fewer smokers in this group. We did not find significant differences in coronary artery anatomy (smooth or small plaques) between both groups. Additionally, the majority of patients in both groups had preserved left ventricular function. Despite that, patients with CKD typically had ST segment elevation in the ECG and higher myocardial injury biomarkers’ levels as well as NT-proBNP. During hospitalization, patients without renal dysfunction had more complications (11.2% vs 0%, p=0.062) such as inotropic requirements, stroke or cardiogenic shock, but overall there were very few. In terms of treatment, it was fairly similar in both groups, although patients with kidney disease received diuretics significantly more often. Throughout the follow up, there were no significant differences in MACE (major adverse cardiovascular events) between death (27.3% vs 7.4%, p=0.06), readmission (10% vs 10.8%, p=1) or MI (0% vs 3.4%, p=1), but patients with CKD suffered more frequently from stroke (40% vs 4.2%, p<0.01). Conclusions 1) Patients with MINOCA and CKD are typically older and predominantly male with a high prevalence of cardiovascular comorbidities (hypertension, diabetes, dyslipidaemia). 2) The severity of MI appears to be slightly higher in this group, as evidenced by more ST-segment elevation upon admission and higher hs Troponine T levels. However, they experience fewer cardiovascular complications and maintain normal left ventricular function. 3) Although we found no significant differences in major adverse cardiovascular events (MACE), patients with CKD were more likely to suffer from stroke.Table 1Table 1

Nested Semi-Transparent Isosurface Simulated Volume-Rendering (NESTIS-VR) – An efficient on-device rendering approach for Augmented Reality headsets increasing surgeon confidence of kidney donor arterial anatomy

Background and objectiveVolume-renderings of computed tomography or magnetic resonance angiograms (MRAs) are routinely used by surgeons in the preoperative assessment of vascular anatomy in kidney donors. Stereoscopic headsets (OST-HMD) like Microsoft HoloLens allow intuitive interaction with three-dimensional content for more intuitive comprehension, but do not allow real-time ray-casting volume-rendering of medical volume datasets on-device due to computational limitations. MethodsWe introduce NEsted Semi-Transparent Isosurface Simulated Volume-Rendering (NESTIS-VR), as an on-device alternative to ray-casting volume-rendering and developed an application for HoloLens to render kidney donor MRAs with interactive control of fundamental rendering parameters. We compared NESTIS-VR with current standard pre-calculated 2D ray-cast volume-renderings in an observational study with 2 expert kidney transplant surgeons, measuring their confidence in pre-operatively assessing the kidney pedicle arterial anatomy in 20 potential donors. We also compared it against other 3D rendering techniques to understand which features contributed most to any improvements. ResultsReal-time stereoscopic three-dimensional (3D) NESTIS-VR in Augmented Reality significantly improves surgeons’ confidence compared with pre-calculated conventional two-dimensional (2D) ray-casting volume-rendered images (p = 0.0415/p = 0.00003). 2D non-stereoscopic NESTIS-VR was significantly superior to pre-calculated 2D ray-casting volume-rendered images for both surgeons (p = 0.044/p = 0.0003). Single isosurface 2D rendering was significantly superior than pre-calculated 2D volume-rendered images for one surgeon. There was no significant difference between binocular 3D display over 2D views with NESTIS-VR or between constrained and unconstrained vantage points for 2D viewing. ConclusionNESTIS-VR provides a new approach to rendering medical datasets in computationally limited OST-HMD headsets and significantly increases surgeons’ confidence of kidney donor arterial anatomy. The principal confidence benefit arises from providing surgeons interactive control over rendering parameters compared to pre-calculated renderings at preset parameters whilst rendering on-device and keeping the OST-HMD untethered from a workstation.

Anatomical Variations of the Bifurcation Levels of the Common Carotid Artery and Superior Thyroid Artery.

Variations in the carotid arterial system significantly impact atherosclerosis's clinical and surgical management, which predominantly occurs at arterial bifurcations. This study aimed at evaluating anatomical variations in the bifurcation levels of the common carotid artery (CCA) and the superior thyroidartery (STA), emphasizing clinical relevance. This was an observational cross-sectional study conducted in June 2021 using 32 embalmed cadavers of adult age from medical schools in Khartoum, Sudan. Sixty-four carotids were examined, noting the levels of CCA bifurcation and STA origin, and their symmetry across both sides of the body. Results: Among the cadavers studied, CCA bifurcation most commonly occurred at the superior border of the thyroid cartilage (46.9%), followed by the body of the hyoid bone (40.1%). The STA predominantly originated from the external carotid artery (ECA) (65.6%). Conclusion: No significant correlation was found between the bifurcation levels of the CCA and the origins of the STA. Bilateral symmetry in the bifurcation of the CCA and the origin of the STA was observed in most cases. The study highlights notable variations in the anatomy of the carotid arteries. These findings suggest that pre-surgical imaging and careful planning are crucial to accommodate anatomical diversities.

Exploring the Branching Pattern of the Posterior Division of the Internal Iliac Artery: An Analysis Based on 75 Computed Tomography Angiographies.

The internal iliac artery stands as the main blood supplier of the pelvis, serving as the primary source of blood for the pelvic viscera while also nourishing the musculoskeletal framework within. The arterial anatomy of the pelvis exhibits a vast array of variations, especially regarding the branching pattern of the internal iliac arteries. The posterior division of the internal iliac artery (PDIIA) may also have variable topography, especially regarding the location of its origin in the pelvic region. A retrospective study was carried out to determine the anatomical variations, prevalence, and morphometric data of the PDIIA and its branches. A total of 75 computed tomography angiographies were analyzed. The most prevalent branch of the PDIIA was the superior gluteal artery, as it was present in 114 of the studied cases (77.03%). The median diameter of the PDIIA at its origin was 6.66mm. The median cross-sectional area of the PDIIA at its origin was set to be 34.59 mm2. Our study highlights the critical significance of understanding the PDIIA and its branches in surgical interventions aimed at managing pelvic hemorrhage. The present study provides valuable insights into the precise localization and characteristics of the PDIIA and its branches, which are essential for surgical procedures targeting specific vessels to control bleeding effectively. Owing to the high level of variability of the branching pattern of the PDIIA, a novel classification system consisting of six types was created.

Aberrant right subclavian artery intervention can provide relief of dysphagia.

An aberrant right subclavian artery represents the most common aortic arch vascular anomaly. Conventional wisdom states that these anomalies do not result in dysphagia, but rather serve as "red herrings". Clearly, in the vast majority of cases, this holds true. Nonetheless, one should never say never. Herein, we present a cohort of four children with debilitating dysphagia resulting from an aberrant right subclavian artery. Subclavian reimplantation via a right posterolateral thoracotomy was performed successfully in all cases. Dysphagia resolved postoperatively, and all patients were able to advance to a normal diet. They were able to gain appropriate weight postoperatively and continue to do well at most recent clinical follow-up. This case series suggests that aberrant right subclavian artery anatomy should be considered a potential aetiology of dysphagia, albeit rarely. Surgical intervention for select patients can provide dramatic resolution of symptoms.

Surgical anatomy of the cystic artery: A systematic review with meta-analysis

BackgroundThe current evidence-based systematic review with meta-analysis presents a detailed overview of the cystic artery (CA) surgical anatomy, including its origin, number, topography, and morphometry. Moreover, the surgical implications of these variants are further discussed. MethodsAccording to the Evidence-Based Anatomy Workgroup and PRISMA 2020 guidelines, the systematic review was performed using four online databases. The Anatomical Quality Assurance Tool was used to evaluate the risk of bias. Meta-analysis was performed with the R programming software. The pooled prevalence and pooled mean of different CA parameters were calculated. ResultsThe CA most commonly originated from the right hepatic artery (a pooled prevalence of 85.75 %). Other described origins (in order of frequency) were the aberrant right hepatic artery, the common hepatic, the left hepatic, the gastroduodenal, the superior mesenteric, and the middle hepatic arteries. The CA was single in 88.59 %, while it can be identified as double, triple, or absent. Most commonly, it was located inside the cystohepatic triangle in 83.83 %. Most commonly, it was superomedially to the cystic duct (77.80 %) and posteriorly to the common hepatic duct (35.08 %). The CA pooled mean length was 21.34 mm, and its diameter was more commonly over 1 mm. ConclusionThe CA surgical anatomy is paramount when operating on the gallbladder. The CA's altered anatomy and adjacent area could lead to confusion, iatrogenic injury, and prolonged surgical time. The CA depicts high morphological variability; therefore, surgeons should consider the typical anatomy and possible (usual and unusual) variants.

6538 Find me if you can! A Case of a "Well Placed Solitary Insulinoma" in "The Center" of an SACST

Abstract Disclosure: R. Kennedy: None. D.A. D'Alessio: None. A.V. Vella: None. Introduction: Selective arterial calcium stimulation testing (SACST) can be utilized in patients to localize solitary insulinomas when imaging is non diagnostic. While a heterogenous stimulation pattern suggests NIPHS, or multiple insulinomas this case uniquely demonstrates such a pattern with a solitary insulinoma. Clinical Case: The patient is a 48 year old female who presented to the emergency department (ED) for bizarre behavior which resolved with a sweetened drink. Serum glucose was 62 mg/dL, she was treated with IV dextrose and was discharged from the ED. She was referred to outpatient endocrinology for further evaluation where continuous glucose monitoring confirmed predominantly fasting hypoglycemia. Adrenal insufficiency was excluded. She was admitted for a 72 hour inpatient fast where the patient achieved hypoglycemia within 24 hours, with glucose 46 mg/dL (associated with neuroglycopenic symptoms), beta hydroxybutyrate < 0.18 mmol/L, insulin 3.9 mcIU/mL, proinsulin 157pmol/L, c-peptide 1.4 ng/mL and a glucose rise greater than 25mg/dL after glucagon administration. Sulfonylurea screen and insulin antibodies were negative; IGF1 within normal limits. These labs were consistent with hyperinsulinemic hypoglycemia. An MRI pancreas however did not reveal an insulinoma. The patient therefore underwent a SACST, demonstrating a 10 fold response in the territory of the gastroduodenal artery and splenic artery, as well as a 3 fold response in the superior mesenteric artery. This heterogenous pattern in addition to the marked response in each arterial territory raised the possibility of multiple insulinomas. However as there were no tumors present on imaging, medical management was initiated with close follow up. She was trialed with months of somatostatin analogs and diazoxide with minimal improvement in the frequency and severity of her hypoglycemia. About a year after her initial diagnosis, repeat abdominal imaging (CT and MRI) revealed an 8 mm arterial hyper-enhancing lesion in the body of the pancreas concerning for neuroendocrine tumor. Repeat SACST was performed, this time showing a greater than 10 fold response in all three arterial territories. Angiography showed a tumor blush that was visible when each of the three major arteries were injected sequentially. She underwent laparoscopic pancreatic enucleation. The lesion was located on the body of the pancreas, with histology confirming an insulinoma. The patient responded promptly post operatively; her symptoms resolved without further need of medical management. Conclusion: Our case shows that the interpretation of an SACST should take into account the arterial anatomy before ascribing a non-focal response to multiple territories of insulin hypersecretion. Presentation: 6/1/2024

Microsurgical Anatomy of the Lateral Posterior Choroidal Artery and Its Thalamic Branches

Only a few articles have been published about the lateral posterior choroidal artery (LPChA), and yet none of them contains data regarding the thalamic branches. The LPChA and its twigs of the 26 cerebral hemispheres were injected with a mixture of a 10% Indian ink and gelatin. Following fixation in a 10% formaldehyde solution, the vessels were micro dissected under the stereoscopic microscope. In addition, serial cerebral angiograms of the 168 patients were examined. The LPChA, which was commonly singular or double and averaged 0.68 mm in diameter, most often originated from the P2 and P3 segments (76%) of the posterior cerebral artery (PCA). It always gave off the choroidal, pulvinar and typical thalamic branches, occasionally the parahippocampal (4%), hippocampal (8%), peduncular (8%), tegmental (12%), pretectal (4%), lateral geniculate (40%) and medial geniculate twigs (16%), and the forniceal, subependymal (100%), stria terminalis (32%), and caudate twigs (28%). The pulvinar and thalamic branches averaged almost 4 in number and 0.27 mm in diameter. They most often supplied the pulvinar nuclei, and occasionally portions of the mediodorsal, lateral dorsal, lateral posterior, ventral lateral, and the ventral posterior thalamic nuclei. Among the 168 serial cerebral angiograms, one presented the arteriovenous malformation of the LPChA, but no one showed an aneurysm. This is the first description of the LPChA thalamic branches to date. Their microanatomic features are important for understanding the neurologic symptoms following vessels occlusion, for precise radiologic diagnoses, and for safe neurosurgical and endovascular interventions.

Distribution of the Middle Meningeal Artery Variants in Patients Undergoing Embolization for Chronic Subdural Hematoma

The middle meningeal artery (MMA) is a major dural vessel that plays a significant role in developing chronic subdural hematomas (cSDH). Understanding its variable anatomy is essential for the effective management of cSDH and the prevention of complications. Middle meningeal artery anatomy was retrospectively assessed in a population of 92 patients who underwent digital subtraction angiography of cerebral vessels before middle meningeal artery embolization for chronic subdural hematoma. We assessed 121 middle meningeal arteries in 92 patients who underwent digital subtraction angiography for chronic subdural hematoma treatment from October 2020 to July 2023. The most common type in the extended Adachi classification was IC (19.82%) and the rarest was IB (6.31%). The anterior branch of the MMA was the most frequently dominant, while the most common origin of the posterior branch was observed in the distal segment. We reported 4 cases (3.31%) of the MMA arising from the ophthalmic artery. The most common configuration of MMA was Adachi-type IC. The MMA most often originated from the maxillary artery. The anterior branch of the MMA was typically dominant, and the posterior branch most frequently originated from the distal segment. There was no significant impact of Adachi type on treatment results or fluoroscopy time.

Features of vascular anatomy in pancreaticoduodenal resection

In about 55–79% of patients, the vascular anatomy of the hepatic-pancreaticoduodenal area is characterized by a typical structure. In the rest of patients, the vascular and, primarily, arterial anatomy may vary due to both different variants of branches and additional arteries. Undoubtedly, this creates difficulties in surgical planning and performing pancreaticoduodenal resection. Vascular anatomic variations may contribute to increased intraoperative blood loss, postoperative complications, changes in the course and volume of surgery, and increased duration of hospital stay after surgery. Modern diagnostic methods, CT angiography in particular, facilitate the process of surgical planning and reduce the risk of unforeseen situations related to ligation or damage of arterial vessels, which are to be preserved during operations. In this work, we carry out a review of publications on the topography of arterial vessels in the area of pancreaticoduodenal resection. The issues related to anatomical variations in both trunk and pancreatic vessels are considered. Special attention is paid to the possible influence of variations in the vascular network structure on the course and volume of surgery, as well as the risk of intraoperative and postoperative complications.

Intentionally unilateral prostatic artery embolization: Patient selection, technique and potential benefits.

Prostatic artery embolization (PAE) is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia. Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries (PAs) and with the systematic attempts to catheterize the PAs of both pelvic sides. Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE. The authors hypothesized that, in selected patients, these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side. To describe the authors' approach for intentionally unilateral PAE (IU-PAE) and its potential benefits. This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years. IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA (subgroup A), or with markedly asymmetric prostatic enlargement, with the dominant prostatic lobe occupying at least two thirds of the entire gland (subgroup B). All patients treated with IU-PAE also fulfilled at least one of the following criteria: Severe tortuosity or severe atheromatosis of the pelvic arteries, non-visualization, or visualization of a tiny (< 1 mm) contralateral PA on preprocedural computed tomographic angiography. Intraprocedural contrast-enhanced ultrasonography (iCEUS) was applied to monitor prostatic infarction. IU-PAE patients were compared to a control group treated with bilateral PAE. IU-PAE was performed in a total 13 patients (subgroup A, n = 7; subgroup B, n = 6). Dose-area product, fluoroscopy time and operation time in the IU-PAE group (9767.8 μGy∙m2, 30.3 minutes, 64.0 minutes, respectively) were significantly shorter (45.4%, 35.9%, 45.8% respectively, P < 0.01) compared to the control group. Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group. In the 2 clinical failures of IU-PAE (both in subgroup A), the extent of prostatic infarction (demonstrated by iCEUS) was significantly smaller compared to the rest of the IU-PAE group. In selected patients, IU-PAE is associated with comparable outcomes, but with lower radiation exposure and a shorter procedure compared to bilateral PAE. iCEUS could facilitate patient selection for IU-PAE.

Clinical and Pathophysiologic Correlates of Basilar Artery Measurements in Fabry Disease.

Alterations of the basilar artery (BA) anatomy have been suggested as a possible MRA feature of Fabry disease (FD). Nonetheless, no information about their clinical or pathophysiologic correlates is available, limiting our comprehension of the real impact of vessel remodeling in FD. Brain MRIs of 53 subjects with FD (mean age, 40.7 [SD, 12.4] years; male/female ratio = 23:30) were collected in this single-center study. Mean BA diameter and its tortuosity index were calculated on MRA. Possible correlations between these metrics and clinical, laboratory, and advanced imaging variables of the posterior circulation were tested. In a subgroup of 20 subjects, a 2-year clinical and imaging follow-up was available, and possible longitudinal changes of these metrics and their ability to predict clinical scores were also probed. No significant association was found between MRA metrics and any clinical, laboratory, or advanced imaging variable (P values ranging from -0.006 to 0.32). At the follow-up examination, no changes were observed with time for the mean BA diameter (P = .84) and the tortuosity index (P = .70). Finally, baseline MRA variables failed to predict the clinical status of patients with FD at follow-up (P = .42 and 0.66, respectively). Alterations of the BA in FD lack of any meaningful association with clinical, laboratory, or advanced imaging findings collected in this study. Furthermore, this lack of correlation seems constant across time, suggesting stability over time. Taken together, these results suggest that the role of BA dolichoectasia in FD should be reconsidered.

Intraoperative Incidental Internal Carotid Artery Injury in Extended Endoscopic Endonasal Approaches—Causes, Prevention, and Management: A Technical Note

AbstractIn spite of good anatomical awareness, the position of internal carotid artery (ICA) can be tricky in an intraoperative setup with disease causing very significant distortion of anatomy and shift of carotid artery and its branches. A 45-year-old gentleman presented with complaints of left hemicranial headache and painless progressive vision loss in both eyes (left more than right) for 8 months. A probable clinico-radiological diagnosis of meningioma was reached. Intraoperatively, bleeding occurred from left side ICA, control of which was achieved using a long gauze piece used as conventional nasal pack with crushed muscle beneath the gauze piece along with abdominal fat, which was further reinforced with Surgicel. The parasellar ICA is the most common segment injured. Dehiscent or bulging canal of ICA, presence of pseudoaneurysm, attachment of sphenoid septae to the canal, displacement by the lesion, nonenlarged sella because of small size of lesion or vertically oriented lesions, and vessel wall abnormalities increase the risk of injury. It is very essential to have a preoperative discussion involving the skull base surgeons (neurosurgeons and otorhinolaryngologists), neuroradiologists, and neuroanesthetists regarding the complications expected in the case. In case of ICA bleed, the target should be to achieve a temporary hemostasis. In small tears, cottonoids for pressure and bipolar for cauterization will help stop the bleeding, while in larger tears, giving moderate pressure using crushed muscle and cottonoids to achieve intra-operative hemostasis should be tried. After intraoperative hemostasis, the patient needs to be shifted to angiography suite for endovascular stent placement.

Abstract C004: A window-of-opportunity trial using neoadjuvant hepatic artery chemotherapy for patients with localized pancreas cancer: Interim analysis of safety and feasibility

Abstract Less than 20% of patients diagnosed with pancreatic cancer will present with localized disease and receive both resection and systemic therapy. Within this group of patients, actual 10-year survival is approximately 5%. The liver is the most common site of recurrent disease and is associated with the worst survival outcomes. Randomized trials in patients with localized colorectal cancer have shown the addition of single-dose, neoadjuvant hepatic artery (HA) chemotherapy, which administers a high-dose of chemotherapy directly to the liver, improves liver metastasis-free and overall survival. Because PDAC and colorectal cancer have similar recurrence patterns and are treated with similar systemic therapy, we hypothesized this strategy could improve recurrence rates and potentially overall survival in patients with localized PDAC. This is a prospective, non-randomized window-of-opportunity trial testing single-dose neoadjuvant HA chemotherapy in patients with resectable or borderline resectable PDAC. Target enrollment is 20 patients treated in two arms: three months of mFOLFIRINOX before surgery and three months after, or upfront surgery followed by six months of mFOLFIRINOX. In both arms, patients undergo diagnostic laparoscopy and percutaneous delivery of the experimental HA therapy (floxuridine and oxaliplatin) one week before surgery. Patients then undergo resection of their primary tumor, followed by short-term follow-up, where safety evaluations are performed for 30 days. Patients then enter long-term follow-up, where efficacy will be assessed every three months for up to three years. The primary endpoint is safety and feasibility. Secondary endpoints include three-year disease-free, liver metastasis-free, and overall survival. To date, eight patients have been screened and seven enrolled: four in the neoadjuvant therapy arm and three in the upfront resection arm. All patients have completed the treatment period and 86% have completed short-term follow-up. Mean age was 63+/-11 years and 57% were female. Mean CA 19-9 prior to resection was 60.3+/-50 U/mL. Conventional hepatic artery anatomy was present in 57% of patients. HA chemotherapy was delivered through the proper hepatic artery in 86% of patients, and via the left and right hepatic arteries in 14%. Concomitant ligation or embolization of accessory hepatic arteries was required in 43%. The mean tumor size was 2.5+/-0.8 cm and lymph node metastases were present in 86%; three patients had a microscopically positive resection margin. Four of the seven patients experienced adverse events, including one grade 2 event, three grade 3 events, and one grade 4 event. However, none were attributed to the experimental therapy. At this interim analysis, single-dose neoadjuvant HA chemotherapy appears to be feasible and safe in patients undergoing resection of localized PDAC. We anticipate enrollment to be completed within the calendar year. Long- term follow-up will be required to resolve survival outcomes and correlative endpoints. Citation Format: Ethan S Agritelley, Elishama N Kanu, Jiayin Bao, Ashley A Fletcher, Holly Skinner, Adi Molvin, Stacy Murray, Charles Y Kim, Brendan Cline, Eric Mastria, David Y Johnson, Nicholas C DeVito, Gerard C Blobe, James L Abbruzzese, Erika J Crosby, Allison Martin, Niharika B Mettu, Peter J Allen, Daniel P Nussbaum. A window-of-opportunity trial using neoadjuvant hepatic artery chemotherapy for patients with localized pancreas cancer: Interim analysis of safety and feasibility [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr C004.

The value of CCTA combined with machine learning for predicting angina pectoris in the anomalous origin of the right coronary artery

BackgroundAnomalous origin of coronary artery is a common coronary artery anatomy anomaly. The anomalous origin of the coronary artery may lead to problems such as narrowing of the coronary arteries at the beginning of the coronary arteries and abnormal alignment, which may lead to myocardial ischemia due to the compression of the coronary arteries. Clinical symptoms include chest tightness and dyspnea, with angina pectoris as a common symptom that can be life-threatening. Timely and accurate diagnosis of anomalous coronary artery origin is of great importance. Coronary computed tomography angiography (CCTA) can provide detailed information on the characteristics of coronary arteries. Therefore, we combined CCTA and artificial intelligence (AI) technology to analyze the CCTA image features and clinical features of patients with anomalous origin of the right coronary artery to predict angina pectoris and the relevance of different features to angina pectoris.MethodsIn this retrospective analysis, we compiled data on 15 characteristics from 126 patients diagnosed with anomalous right coronary artery origins. The dataset encompassed both CCTA imaging attributes, such as the positioning of the right coronary artery orifices and the alignment of coronary arteries, and clinical parameters including gender and age. To identify the most salient features, we employed the Chi-square feature selection method, which filters features based on their statistical significance. We then focused on features yielding a Chi-square score exceeding a threshold of 1, thereby narrowing down the selection to seven key variables, including cardiac function and gender. Subsequently, we evaluated seven classifiers known for their efficacy in classification tasks. Through rigorous training and testing, we conducted a comparative analysis to identify the top three classifiers with the highest accuracy rates.ResultsThe top three classifiers in this study are Support Vector Machine (SVM), Ensemble Learning (EL), and Kernel Approximation Classifier. Among the SVM, EL and Kernel Approximation Classifier-based classifiers, the best performance is achieved for linear SVM, optimizable Ensembles Learning and SVM kernel, respectively. And the corresponding accuracy is 75.7%, 75.7%, and 73.0%, respectively. The AUC values are 0.77, 0.80, and 0.75, respectively.ConclusionsMachine learning (ML) models can predict angina pectoris caused by the origin anomalous of the right coronary artery, providing valuable auxiliary diagnostic information for clinicians and serving as a warning to clinicians. It is hoped that timely intervention and treatment can be realized to avoid serious consequences such as myocardial infarction.

Exploring arterial anatomy of the internal capsule: an analysis of the deep vascular structures and related white matter pathways.

The internal capsule is supplied by perforators originating from the internal carotid artery, middle cerebral artery, anterior choroidal artery and anterior cerebral artery. The aim of this study is to examine the vascular anatomy of the internal capsule, along with its related white matter anatomy, in order to prevent potential risks and complications during surgical interventions. Twenty injected hemispheres prepared according to the Klingler method were dissected. Dissections were photographed at each stage. The findings obtained from the dissections were illustrated to make them more understandable. Additionally, the origins of the arteries involved in the vascularization of the internal capsule, their distances to bifurcations, and variations in supplying territories have been thoroughly examined. The insular cortex and the branches of the middle cerebral artery on the insula and operculum were observed. Following decortication of the insular cortex, the extreme capsule, claustrum, external capsule, putamen and globus pallidus structures were exposed. The internal capsule is shown together with the lenticulostriate arteries running on the anterior, genu and posterior limbs. Perforators supplying the internal capsule originated from the middle cerebral artery, anterior cerebral artery, internal carotid artery and anterior choroidal artery. The internal capsule's vascular supply varied, with the medial lenticulostriate arteries (MLA) and lateral lenticulostriate arteries (LLA) being the primary arteries. The anterior limb was most often supplied by the MLA, while the LLA and anterior choroidal artery dominated the genu and posterior limb. The recurrent artery of Heubner originated mostly from the A2 segment. The distance from the ICA bifurcation to the origin of the first LLA on M1 is 9.55 ± 2.32mm, and to the first MLA on A1 is 5.35 ± 1.84mm. MLA branching from A1 and proximal A2 ranged from 5 to 9, while LLA originating from the MCA ranged from 7 to 12. This study provides comprehensive understanding of the arterial supply to the internal capsule by combining white matter dissection. The insights gained from this study can help surgeons plan and execute procedures including oncological, psychosurgical, and vascular more accurately and safely. The illustrations derived from the dissections serve as valuable educational material for young neurosurgeons and other medical professionals.

Anatomy of Inferior Temporal Arteries in Relation to Middle Cranial Fossa Structures: A Postmortem Computed Tomography Angiography Study

Anatomy of Inferior Temporal Arteries in Relation to Middle Cranial Fossa Structures: A Postmortem Computed Tomography Angiography Study

Ethmoid Artery Anatomy (Cadaver)

Dr. Ramakrishnan explores a cadaveric ethmoid sinus to identify clinically relevant arterial anatomy for the ENT residents at Duke University Hospital.

Immersive Photorealistic Three-Dimensional Neurosurgical Anatomy of the Cerebral Arteries: A Photogrammetry-Based Anatomic Study.

Neurosurgeons need a profound knowledge of the surgical anatomy of the cerebral arteries to safely treat patients. This is a challenge because of numerous branches, segments, and tortuosity of the main blood vessels that supply the brain. The objective of this study was to create high-quality three-dimensional (3D) anatomic photorealistic models based on dissections of the brain arterial anatomy and to incorporate this data into a virtual reality (VR) environment. Two formaldehyde-fixed heads were used. The vessels were injected with radiopaque material and colored silicone and latex. Before the dissections, the specimens were computed tomography scanned. Stratigraphical anatomic dissection of the neck and brain was performed to present the relevant vascular anatomy. A simplified surface scanning method using a mobile phone-based photogrammetry application was used, and the data were incorporated into a VR 3D modeling software for post-processing and presentation. Fifteen detailed layered photorealistic and two computed tomography angiography-based 3D models were generated. The models allow manipulation in VR environment with sufficient photographic detail to present the structures of interest. Topographical relevant anatomic structures and landmarks were annotated and uploaded for web-viewing and in VR. Despite that the VR application is a dedicated 3D modeling platform, it provided all necessary tools to be suitable for self-VR study and multiplayer scenarios with several participants in one immersive environment. Cerebral vascular anatomy presented with photogrammetry surface scanning method allows sufficient detail to present individual vessel's course and even small perforating arteries in photorealistic 3D models. These features, including VR visualization, provide new teaching prospects. The whole study was done with simplified algorithms and free or open-source software platforms allowing creation of 3D databases especially useful in cases with limited body donor-based dissection training availability.

Robotic right‐sided colon cancer surgery: Dissecting the outermost layer of the autonomic nerve along the superior mesenteric artery

AbstractIn right‐sided colon cancer surgery, lymph node dissection around the superior mesenteric artery is necessary but technically challenging. Here we introduce the concept of “outermost layer‐oriented robotic surgery” to improve the safety, efficacy, and reproducibility of superior mesenteric artery nodal dissection. In this procedure, the thin, loose connective tissue layer between the autonomic nerve sheath of the superior mesenteric artery and adipose tissue bearing lymph nodes, termed “the outermost layer of the autonomic nerve,” is dissected. The procedure exposes the outermost layer of the nerve plexus covering the surface of the superior mesenteric artery with a width of approximately 1 cm, enabling direct visualization of the anatomy of the main arteries and, if they exist, jejunal veins which cross the superior mesenteric artery ventrally. This allows for sufficient dissection of main lymph nodes at the roots of the ileocolic artery, right colic artery, and middle colic artery and minimizes the risk of unforeseen bleeding. Thirty‐nine patients underwent robotic right hemicolectomy with this procedure. No intraoperative complications were observed. The median number of dissected lymph nodes was 50, including 16 main lymph nodes. The median operative time was 284 min, blood loss was 50 mL, and the median postoperative hospital stay was 8 days. Postoperative complications included two cases of Clavien–Dindo classification grade II, with no cases of grade III or higher. Chylous leakage as well as intractable diarrhea were not observed in any case. These findings demonstrate that the procedure can achieve safe and reliable lymph node clearance.