Arch Artery Research Articles

Abstract P1004: Cellular Heterogeneity In The Nkx2.5 + Anterior Lateral Plate Mesoderm Underlies Lineage Diversity Of The Cardiovascular System

The cardiovascular system comprises diverse cellular lineages that emerge from progenitor cells in the anterior lateral plate mesoderm (ALPM). In zebrafish, nkx2.5 expression initiates in the bilateral field of ALPM progenitors during early somitogenesis before their spatial segregation into two main subpopulations. The cardiac fraction, including first (FHF) and second heart field (SHF) progenitors, migrates to the midline and gives rise to ventricular myocardium. The pharyngeal fraction remains lateral and sequesters in the cores of the pharyngeal arches (PAs). Progenitors in PA2 give rise to craniofacial muscles and three lineages in the outflow tract, while those in PA3-6 differentiate into pharyngeal arch artery (PAA) endothelium. The mechanisms underlying nkx2.5 + progenitor cell segregation into the various downstream fates remain unclear. Here, we demonstrate that nkx2.5 + progenitors in the ALPM are heterogenous with predetermined lineage outcomes. Specifically, single-cell RNA sequencing of nkx2.5:ZsYellow + progenitors revealed six transcriptionally unique populations, including a cardiomyocyte cluster (FHF-derived) and a large lateral plate mesoderm (LPM) population that further subclustered into three distinct groups. LPM-1 differentially expressed aplnra , hey1 , and the retinoic acid (RA)-eliminating enzyme cyp26c1 , LPM-2 expressed bmp4, bmp6 , and cdh11 , and LPM-3 expressed the transcriptional repressor prdm1a and the RA-producing enzymes rhd10a and aldh1a2 . In situ hybridization uncovered regionalization in the nkx2.5 + ALPM with LPM-1 cells occupying the anterior-medial and central region of the field and LPM-3 the posterior domain. Targeted photoconversion of nkx2.5:Kaede revealed that LPM-1 are PA2 progenitors while LPM-3 are progenitors for PA3-6. We are currently performing spatial transcriptomics to generate a comprehensive expression map of the ALPM, localizing and tracing LPM-2 progenitors, and performing functional studies that suggest a tbx1 -RA-prdm1a signaling pathway is required for LPM-3 specification. In conclusion, our data highlight progenitor heterogeneity in the ALPM as a source of the lineage diversification required to build the cardiovascular system.

How to implement minimally invasive duodenum-preserving total pancreatic head resection for patients with pancreatic head lesions: A retrospective study.

Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has been widely reported. However, due to the challenges involved in performing total pancreatic head resection during operation, there are few studies reporting it. Between November 2016 and October 2022, we performed laparoscopic duodenum-preserving total pancreatic head resection (LDPPHRt) on 64 patients in the Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University. Perioperative data of the patients such as age, gender, body mass index, operation time, blood loss, and postoperative hospital stay were collected and analyzed. This study included 40 women and 24 men aged 41.4 ± 15.7 years. All patients completed the surgery, and none of the patients underwent laparotomy. The average operation time was 275 (255, 310) min. The average postoperative hospital stay was 12 (10, 16) days. The rate of occurrence of pancreatic fistula was 10.9% (7/64), and that of the biliary fistula was 9.4% (6/64). One of the patients underwent cholangiojejunostomy 3 months after the operation due to painless jaundice and bile duct dilatation. By dissecting the space between the pancreatic head and duodenum, the posterior pancreatic duodenal arterial arch and the surface vascular network of the common bile duct (CBD) can be preserved. This ensures the success of LDPPHRt and avoids postoperative complications in the absence of intraoperative image guidance.

Cutaneous vascularization of the proximal two-thirds of the dorsal aspect of the hand: descriptive anatomical study of a perforating arterial arch.

Several reports have suggested that transverse arches between the radial and ulnar sides of dorsal hand skin supply the proximal part of the skin. The main objective of the study was to provide an anatomical and radiological description of a superficial vascular arch in the proximal third of the metacarpals of the long fingers. We dissected 11 hands after injection with a mixture of lead and resin. A CT scan was performed before dissection. All vessels supplying the skin were individualized on the back of the hand and measured. A superficial perforating dorsal arch of the hand was present in all cases in this study. It was supplied by a dorsal radial perforating artery arising from the radial artery and by a dorsal ulnar perforating artery arising from the dorsal carpal arch. The distal recurrences of the intermetacarpal spaces communicated with this arch. This arch was the only source of vascularization of thess proximal third of the third space and presented a dominant ulnar side in the majority of cases. It presented numerous anatomical variations. The source vessels had mean diameters of 0.5mm. There was an excellent radiological-anatomical correlation on CT scan. Given the constancy of this arch in the study, perforating flaps not yet described could be considered, having as pivot points the ulnar or radial origin of this arch.

Persistent descending mesocolon as a vital risk factor for anastomotic failure and prolonged operative time for sigmoid colon and rectal cancers

BackgroundThe diagnostic criteria and effect of persistent descending mesocolon (PDM) on sigmoid and rectal cancers (SRCs) remain controversial. This study aims to clarify PDM patients' radiological features and short-term surgical results.MethodFrom January 2020 to December 2021, radiological imaging data from 845 consecutive patients were retrospectively analyzed using multiplanar reconstruction (MRP) and maximum intensity projection (MIP). PDM is defined as the condition wherein the right margin of the descending colon is located medially to the left renal hilum. Propensity score matching (PSM) was used to minimize database bias. The anatomical features and surgical results of PDM patients were compared with those of non-PDM patients.ResultsThirty-two patients with PDM and 813 patients with non-PDM were enrolled into the study who underwent laparoscopic resection. After 1:4 matching, patients were stratified into PDM (n = 27) and non-PDM (n = 105) groups. The lengths from the inferior mesenteric artery (IMA) to the inferior mesenteric vein (1.6 cm vs. 2.5 cm, p = 0.001), IMA to marginal artery arch (2.7 cm vs. 8.4 cm, p = 0.001), and IMA to the colon (3.3 cm vs. 10.2 cm, p = 0.001) were significantly shorter in the PDM group than those in the non-PDM group. The conversion to open surgery (11.1% vs. 0.9%, p = 0.008), operative time (210 min vs. 163 min, p = 0.001), intraoperative blood loss (50 ml vs. 30 ml, p = 0.002), marginal arch injury (14.8% vs. 0.9%, p = 0.006), splenic flexure free (22.2% vs. 3.8%, p = 0.005), Hartmann procedure (18.5% vs. 0.0%, p < 0.001) and anastomosis failure (18.5% vs. 0.9%, p = 0.001) were significantly higher in the PDM group. Moreover, PDM was an independent risk factor for prolonged operative time (OR = 3.205, p = 0.004) and anastomotic failure (OR = 7.601, p = 0.003).ConclusionPDM was an independent risk factor for prolonged operative time and anastomotic failure in SRCs surgery. Preoperative radiological evaluation using MRP and MIP can help surgeons better handle this rare congenital variant.

Kommerell's Diverticulum in a Right-Sided Aortic Arch With an Aberrant Left Subclavian Artery Hybrid Repair.

Kommerell's diverticulum (KD) with a right aortic arch (RAA) and aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the aortic arch. Treatment is not well defined due to its uncommon presentation, with rupture and dissection risk rates of up to 53%. A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presented with difficulty breathing during exercise without dysphagia. Follow-up computerized tomography angiogram (CTA) revealed the presence of a RAA and aLSCA arising from the descending thoracic aorta with an adjacent 58 × 41-mm KD and tracheal and esophageal displacement. Due to the size of the KD, risk of rupture, unsuitable anatomy for total endovascular aortic repair (EVAR), and high COPD burden, the patient was planned to undergo a hybrid surgical repair. Left common carotid (LCCA) artery to LSCA bypass, full aortic debranching, LSCA embolization and percutaneous thoracic endovascular aortic repair (TEVAR) were performed. Successful device position and exclusion of the diverticulum and aneurysmal aorta were observed after completion thoracic aortogram. 18-month follow-up CTA demonstrated patency of the LSCA to LCCA bypass graft and arch vessel branches, as well as stable exclusion of the KD. Persistence of a type II endoleak originated at the right first posterior intercostal artery has been noted and is being followed conservatively since no sac growth has occurred. We highlight the presence of a KD with RAA and aberrant subclavian artery, a rare congenital anatomic variation of the aortic arch with complex anatomy. Surgical planning must be individualized according to comorbidities and anatomical variations identified on imaging and 3D reconstructions.

Anatomical study about the variations in renal vasculature.

Renal vascularization is classically described as a renal artery and vein. However, this vascular pattern presents numerous anatomical variations in terms of their number, origin and course due to ontogenetic alterations. The aim was to carry out a descriptive study of the renal vascular pattern observed during the dissection of cadavers intended for teaching purposes. A descriptive and observational study of renal vascular anatomy was carried out by dissecting 16 renal blocks from 8 cadavers donated to science and used for teaching at the Faculty of Medicine of the University of Zaragoza. The prevalence of arterial variations was 75% (56.3% for polar renal arteries, 12.5% for pre-hilar branching and 6.25% for double communicating arterial arch) and venous was 62.5% (12.5% for polar renal veins, 25% for late venous confluence, 6.25% for triple renal vein and 18.75% for double circumaortic renal vein). We conclude that the renal vascular anomalies occur with high frequency; for this reason, knowledge of these anomalies is extremely important for the correct planning of numerous medical-surgical activities.

The Impact of Prenatal Diagnosis on Clinical Outcomes of Isolated Vascular Rings From a Statewide Paediatric Cardiology Tertiary Service.

Vascular rings, including right aortic arch with aberrant left subclavian artery (RAA-ALSCA), double aortic arch (DAA) and pulmonary artery sling (PAS), are congenital anomalies that may cause airway and oesophageal compression. As prenatal detection has improved, literature comparing clinical outcomes of antenatally versus postnatally diagnosed cases continues to emerge. The aim is to define a statewide tertiary paediatric institution's clinical profile and outcomes of prenatal versus postnatally diagnosed isolated vascular rings. A retrospective single-centre review of isolated RAA-ALSCA, DAA and PAS between 1 January 1999 and 31 December 2020 was conducted. Clinical characteristics, surgical and follow-up information were collected. Antenatal and postnatally diagnosed groups were compared. Out of 123 cases diagnosed with isolated vascular rings, 98 (79.7%) cases had RAA-ALSCA, 21 (17.1%) with DAA, 4 (3.3%) with PAS. The antenatal detection rate was 73.6% in the past decade; 20.3% had a genetic disorder, of which 48% had 22q11.21 microdeletion. Of prenatally diagnosed cases, 31.3% developed symptoms, commonly stridor and dysphagia, at a median age of 2.0 months (IQR 0.0-3.0), compared to a median age of diagnosis for the postnatal cohort of 9 months (IQR 1.0-40.7). Postnatally diagnosed cases were more likely to present with symptoms, primarily respiratory distress, than prenatally diagnosed cases (p=0.006). Fifty-nine (59) cases (50% antenatally diagnosed) required vascular ring division; 6.8% had residual symptoms following surgery. Antenatal diagnosis has improved and leads to better parental awareness and more timely, appropriate intervention. Postnatally diagnosed patients were older, more likely to be symptomatic, underwent more investigations and were commenced on more medications for symptom management prior to diagnosis. One in five cases of isolated vascular ring anomalies carried a genetic diagnosis, which has important implications on prenatal counselling and genetic testing.

The feasibility of debranching aortic arch and visceral arteries with sutureless telescoping anastomoses during open aortic aneurysm repair.

Open repair of aortic aneurysms frequently requires reimplantation of major aortic vessels. Traditional techniques can be time consuming, require meticulous hemostasis, and risk aneurysmal patch degeneration, which can require a challenging reoperation. We describe our experience using a stent graft to create a sutureless anastomosis that obviates these drawbacks. Between April 2018 and March 2021, all consecutive adult patients who underwent open repair of the aorta with at least one supra-aortic trunk or visceral vessel reimplanted using the sutureless anastomotic technique were included. Anastomoses were constructed by bridging a branch graft and the target artery with a Viabahn self-expanding stent (W.L. Gore & Associates, Flagstaff, AZ). Clinical information and perioperative outcomes for the patients were collected and analyzed. Among 26 patients, 50 individual aortic vessels were debranched using sutureless self-expanding stent anastomoses, including 42 visceral vessels and 8 supra-aortic trunk vessels. Technical success was 100%. The median time to complete the anastomosis was 3minutes, 12seconds (range, 2-6minutes). Perioperative mortality was 15% (n= 4). No stent-related complications, such as occlusion, bleeding, stroke, renal failure requiring hemodialysis, bowel ischemia, or the need for anastomotic reintervention, occurred. Follow-up imaging at 1 year revealed a 100% patency rate and no anastomotic stenosis, misalignment, or kinking. The sutureless anastomosis technique to debranch the aorta during open aortic aneurysm repair is technically feasible and reliably hemostatic and does not require early reintervention. The operative outcomes have been acceptable, and the short-term follow-up imaging findings demonstrated excellent patency without anastomotic kinking. In select cases, sutureless anastomoses are a possible alternative to traditional sutured anastomoses during aortic debranching. Further research is needed to compare the operative times and long-term patency of sutureless anastomosis to those of traditional sutured techniques.

A revised terminology for the pharyngeal arches and the arch arteries.

The pharyngeal arches are a series of bulges found on the lateral surface of the head of vertebrate embryos. In humans, and other amniotes, there are five pharyngeal arches and traditionally these have been labelled from cranial to caudal-1, 2, 3, 4 and 6. This numbering is odd-there is no '5'. Two reasons have been given for this. One is that during development, a 'fifth' arch forms transiently but is not fully realised. The second is that this numbering fits with the evolutionary history of the pharyngeal arches. Recent studies, however, have shown that neither of these justifications have basis. The traditional labelling is problematic as it causes confusion to those trying to understand the development of the pharyngeal arches. In particular, it creates difficulties in the field of congenital cardiac malformations, where it is common to find congenital cardiac lesions interpreted on the basis of persistence of the postulated arteries of the fifth arch. To resolve these problems and to take account of the recent studies that have clarified pharyngeal arch development, we propose a new terminology for the pharyngeal arches. In this revised scheme, the pharyngeal arches are to be labelled as follows-the first, most cranial, the mandibular (M), the second, the hyoid (H), the third, the carotid (C), the fourth, the aortic (A) and the last, most caudal, the pulmonary (P).

Oxygen Reserve Index and Arterial Partial Pressure of Oxygen: Relationship in Open Heart Surgery.

Mild to moderate hyperoxia is potentially beneficial to patients undergoing open heart surgery. Oxygen Reserve Index (ORI) is a novel parameter that correlates to arterial oxygen tension (PaO2) in the hyperoxic range. This prospective study aimed to assess whether the relationship between ORI and PaO2 remains intact in the setting of open-heart surgery. This study included patients undergoing valve, aortic arch and coronary artery bypass grafting(CABG) surgeries, on and off pump, between September 1st 2019 and August 31st 2021. Enrolled patients had arterial blood gas samples collected and analyzed after induction of anesthesia and increases in FiO2 in steps of 0.08 with ORI being recorded at the time of sample collection for cross reference and analysis. ORI values showed a statistically significant correlation with PaO2 values in the 100-200 mmHg range (r = 0.8193, p < 0.001). Additionally, there was a significant correlation between ORI and SpO2 values in the range of 95% and 100% (r = 0.529, p < 0.05). The preserved relationship between ORI and PaO2 in the mild and moderate hyperoxic range can allow more precise titration of oxygen therapy to guide therapy targeting normoxia, mildly and moderately hyperoxia. Additionally, it could have a potential use as an early warning system for impeding hypoxia.

Single-cell transcriptomics uncovers a non-autonomous Tbx1-dependent genetic program controlling cardiac neural crest cell development

Disruption of cardiac neural crest cells (CNCCs) results in congenital heart disease, yet we do not understand the cell fate dynamics as these cells differentiate to vascular smooth muscle cells. Here we performed single-cell RNA-sequencing of NCCs from the pharyngeal apparatus with the heart in control mouse embryos and when Tbx1, the gene for 22q11.2 deletion syndrome, is inactivated. We uncover three dynamic transitions of pharyngeal NCCs expressing Tbx2 and Tbx3 through differentiated CNCCs expressing cardiac transcription factors with smooth muscle genes. These transitions are altered non-autonomously by loss of Tbx1. Further, inactivation of Tbx2 and Tbx3 in early CNCCs results in aortic arch branching defects due to failed smooth muscle differentiation. Loss of Tbx1 interrupts mesoderm to CNCC cell-cell communication with upregulation and premature activation of BMP signaling and reduced MAPK signaling, as well as alteration of other signaling, and failed dynamic transitions of CNCCs leading to disruption of aortic arch artery formation and cardiac outflow tract septation.

Histological study of the thin membranous dense connective tissues around the curving portion of the bilateral recurrent laryngeal nerves.

We aimed to demonstrate the anatomical relationship between the recurrent laryngeal nerves (RLNs), thin membranous dense connective tissue (TMDCT [e.g., the visceral or vascular sheaths around the esophagus]), and the lymph nodes around the esophagus at the curving portion of the RLNs for rational and efficient lymph node dissection. Transverse sections of the mediastinum at 5mm or 1mm intervals were obtained from four cadavers. Hematoxylin and eosin staining and Elastica van Gieson staining were performed. The visceral sheaths could not be clearly observed the curving portions of the bilateral RLNs, which were observed on the cranial and medial side of the great vessels (aortic arch and right subclavian artery [SCA]). The vascular sheaths could be clearly observed. The bilateral RLNs diverged from the bilateral vagus nerves, which ran along with the vascular sheaths, went up around the caudal side of the great vessels and the vascular sheath, and ran cranially on the medial side of the visceral sheath. Visceral sheaths were not observed around the region containing the left tracheobronchial lymph nodes (No. 106tbL) or the right recurrent nerve lymph nodes (No. 106recR). The regions containing the left recurrent nerve lymph nodes (No. 106recL) and the right cervical paraesophageal lymph nodes (No. 101R) were observed on the medial side of the visceral sheath, with the RLN. The recurrent nerve, which branched off from the vagus nerve descending along the vascular sheath, ascended the medial side of the visceral sheath after inversion. However, no clear visceral sheath could be identified in the inverted area. Therefore, during radical esophagectomy, the visceral sheath along No. 101R or 106recL may be recognized and available.

Non-invasive estimation of the parameters of a three-element windkessel model of aortic arch arteries in patients undergoing thoracic endovascular aortic repair.

Background: Image-based computational hemodynamic modeling and simulations are important for personalized diagnosis and treatment of cardiovascular diseases. However, the required patient-specific boundary conditions are often not available and need to be estimated. Methods: We propose a pipeline for estimating the parameters of the popular three-element Windkessel (WK3) models (a proximal resistor in series with a parallel combination of a distal resistor and a capacitor) of the aortic arch arteries in patients receiving thoracic endovascular aortic repair of aneurysms. Pre-operative and post-operative 1-week duplex ultrasound scans were performed to obtain blood flow rates, and intra-operative pressure measurements were also performed invasively using a pressure transducer pre- and post-stent graft deployment in arch arteries. The patient-specific WK3 model parameters were derived from the flow rate and pressure waveforms using an optimization algorithm reducing the error between simulated and measured pressure data. The resistors were normalized by total resistance, and the capacitor was normalized by total resistance and heart rate. The normalized WK3 parameters can be combined with readily available vessel diameter, brachial blood pressure, and heart rate data to estimate WK3 parameters of other patients non-invasively. Results: Ten patients were studied. The medians (interquartile range) of the normalized proximal resistor, distal resistor, and capacitor parameters are 0.10 (0.07-0.15), 0.90 (0.84-0.93), and 0.46 (0.33-0.58), respectively, for common carotid artery; 0.03 (0.02-0.04), 0.97 (0.96-0.98), and 1.91 (1.63-2.26) for subclavian artery; 0.18 (0.08-0.41), 0.82 (0.59-0.92), and 0.47 (0.32-0.85) for vertebral artery. The estimated pressure showed fairly high tolerance to patient-specific inlet flow rate waveforms using the WK3 parameters estimated from the medians of the normalized parameters. Conclusion: When patient-specific outflow boundary conditions are not available, our proposed pipeline can be used to estimate the WK3 parameters of arch arteries.

Moxonidine Increases Uptake of Oxidised Low-Density Lipoprotein in Cultured Vascular Smooth Muscle Cells and Inhibits Atherosclerosis in Apolipoprotein E-Deficient Mice.

This study aimed to investigate the effect of the sympatholytic drug moxonidine on atherosclerosis. The effects of moxonidine on oxidised low-density lipoprotein (LDL) uptake, inflammatory gene expression and cellular migration were investigated in vitro in cultured vascular smooth muscle cells (VSMCs). The effect of moxonidine on atherosclerosis was measured by examining aortic arch Sudan IV staining and quantifying the intima-to-media ratio of the left common carotid artery in apolipoprotein E-deficient (ApoE-/-) mice infused with angiotensin II. The levels of circulating lipid hydroperoxides in mouse plasma were measured by ferrous oxidation-xylenol orange assay. Moxonidine administration increased oxidised LDL uptake by VSMCs via activation of α2 adrenoceptors. Moxonidine increased the expression of LDL receptors and the lipid efflux transporter ABCG1. Moxonidine inhibited mRNA expression of inflammatory genes and increased VSMC migration. Moxonidine administration to ApoE-/- mice (18 mg/kg/day) decreased atherosclerosis formation in the aortic arch and left common carotid artery, associated with increased plasma lipid hydroperoxide levels. In conclusion, moxonidine inhibited atherosclerosis in ApoE-/- mice, which was accompanied by an increase in oxidised LDL uptake by VSMCs, VSMC migration, ABCG1 expression in VSMCs and lipid hydroperoxide levels in the plasma.

Results of the in situ fenestration technique for preservation of the Left subclavian artery in the endovascular repair of acute aortic syndromes in a reference center.

The in situ fenestration (ISF) technique consists of maintaining the patency of the aortic branch after the endoprosthesis is already in place as a viable, effective, and fast-performing alternative to revascularize the aortic arch arteries. To report the experience with a series of cases of endovascular treatment of Acute Aortic Syndromes involving the aortic arch, using the ISF technique in a specialized center. We analyzed data collected from patients treated with ISF during TEVAR for Acute Aortic Syndromes involving the aortic arch from June 2020 to January 2022, assessing perioperative outcomes, including immediate and late success rates, complications, morbidity and mortality, and short and medium term aortic branch patency. Of the 11 patients eligible for the ISF procedure, 9 were successful, with a technical success rate of 81%. No patient had a type 1A endoleak related to fenestration. There was complete thrombosis of the false lumen in the thoracic aorta in 77% cases. No death was related to the fenestration technique. ISF as feasible and with a high rate of technical success and good results in the short and medium term. Prospective studies with long-term clinical follow-up are still needed to fully assess the durability of these unreinforced fenestrations.

Tmem88 confines ectodermal Wnt2bb signaling in pharyngeal arch artery progenitors for balancing cell cycle progression and cell fate decision.

Pharyngeal arch artery (PAA) progenitors undergo proliferative expansion and angioblast differentiation to build vessels connecting the heart with the dorsal aortae. However, it remains unclear whether and how these two processes are orchestrated. Here we demonstrate that Tmem88 is required to fine-tune PAA progenitor proliferation and differentiation. Loss of zebrafish tmem88a/b leads to an excessive expansion and a failure of differentiation of PAA progenitors. Moreover, tmem88a/b deficiency enhances cyclin D1 expression in PAA progenitors via aberrant Wnt signal activation. Mechanistically, cyclin D1-CDK4/6 promotes progenitor proliferation through accelerating the G1/S transition while suppressing angioblast differentiation by phosphorylating Nkx2.5/Smad3. Ectodermal Wnt2bb signaling is confined by Tmem88 in PAA progenitors to ensure a balance between proliferation and differentiation. Therefore, the proliferation and angioblast differentiation of PAA progenitors manifest an inverse relationship and are delicately regulated by cell cycle machinery downstream of the Tmem88-Wnt pathway.

Abstract TP134: The Effect Of Aortic Arch And Carotid Artery Anatomy Parameters On Door-To-Recanalization Times At A Comprehensive Stroke Center

Introduction: The American Heart Association recommends a Door-to-Recanalization/Reperfusion (DTRp) time of ≤120 minutes. We aim to identify aortic arch and carotid artery anatomy parameters associated with a delayed DTRp at a comprehensive stroke center (CSS). Methods: We performed a retrospective chart review of patients who underwent mechanical thrombectomy (MT) for an anterior circulation large vessel occlusion (LVO) at a CSS from 1/2015 to 12/2021. We compared various aortic arch and carotid artery anatomy parameters between patients who achieved DTRp in ≤120 minutes vs.&gt;120 minutes. A blinded board-certified neuroradiologist used the pre-MT CT Angiogram to document different aortic arch and carotid artery anatomy variables. A binary logistic regression analysis was performed, controlling for age, gender, presenting mean arterial pressure (MAP), presenting serum glucose, Hb A1C, LDL, intravenous alteplase, left hemispheric location, location of occlusion [proximal (ICA or M1 segment of the middle cerebral artery) versus distal (M2 segment of the middle cerebral artery)], ASPECTS≥6, general anesthesia, transradial approach, number of passes. Results: 256 patients met our inclusion criteria. The mean age was 65.18±14.89 years. In our cohort, the presence of a bovine arch was significantly associated with a DTRp of &gt;120 minutes (39.19% vs. 20.59%; OR, 0.37; 95 % CI, 0.15-0.94; P 0.035). Whereas, the other aortic arch and carotid artery anatomy parameters were not significantly associated with DTRp of &gt;120 minutes, as shown in the Table. Conclusion: Among aortic arch and carotid artery anatomy parameters, the presence of a bovine arch was associated with significantly delayed DTRp of &gt;120 minutes in our cohort.

Abstract WP147: The Effect Of Aortic Arch And Carotid Artery Anatomy Parameters On The Conversion From A Transradial Artery Approach To A Transfemoral Artery Approach For Mechanical Thrombectomy At A Comprehensive Stroke Center

Introduction: Transradial approach (TRA) is emerging as an alternative to the traditional transfemoral approach (TFA) for mechanical thrombectomy (MT). We aim to identify various aortic arch and carotid artery anatomy parameters associated with a conversion from a TRA to a TFA for MT at a comprehensive stroke center (CSS). Methods: We performed a retrospective chart review of patients who underwent MT at a CSS from 1/2019 to 12/2021. We compared various aortic arch and carotid artery anatomy parameters between patients who had a successful MT via the TRA versus those who required a conversion from a TRA to a TFA for MT. A blinded board-certified neuroradiologist used the pre-MT CT Angiogram to document different aortic arch and carotid artery anatomy variables. A binary logistic regression analysis was performed, controlling for age, gender, presenting mean arterial pressure (MAP), presenting serum glucose, Hb A1C, LDL, left hemispheric location, and the location of occlusion [proximal (ICA or M1 segment of the middle cerebral artery) versus distal (M2 segment of the middle cerebral artery)]. Results: 68 patients met our inclusion criteria. The mean age was 66.08±15.09 years. 12 (17.65%) patients had to be converted from a TRA to a TFA for MT. In our cohort, the absence of a double subclavian-innominate curve (55.36% vs. 27.28%; OR, 12.5; 95 % CI, 1.76-88.52; P 0.011) and a higher diameter of the aortic arch at the apex (28.75±2.38mm vs.27.5±2.88mm; OR, 1.44; 95 % CI, 1.01-2.06; P 0.042) were significantly associated with a conversion from TRA to TFA. The other aortic arch and carotid artery anatomy parameters were not significantly associated with the conversion from a TRA to a TFA, as shown in the Table. Conclusion: Among aortic arch and carotid artery anatomy parameters, the absence of a double subclavian-innominate curve and a higher diameter of the aortic arch at the apex were significantly associated with a conversion from a TRA to a TFA for MT in our cohort.

An unusual collateral from the sinoatrial nodal artery to the left carotid artery in a patient with Takayasu arteritis: a case report

BackgroundTakayasu arteritis is a noninfective chronic vasculitis mainly involving the aorta and its main branches. The presentation of the disease is heterogeneous, ranging from asymptomatic to catastrophic illness.Case presentationA 52-year-old Caucasian woman with known Takayasu arteritis was referred to our hospital as she suffered symptoms suspicious for cerebral hypoperfusion. Computed tomography thorax angiography revealed occlusion of all aortic arch arteries and previous surgical bypasses. Cerebral perfusion depended on a few collaterals (from the distal common carotid artery to the right internal carotid artery and from the left and right internal mammary artery and the dorsal thoracic branches to both vertebral arteries). In addition, preoperative coronary angiography revealed an unusual and large collateral arising from the sinoatrial nodal artery to the left carotid artery.ConclusionTakayasu arteritis is a relatively rare disease, with various and sometimes devastating neurological manifestations due to occlusion of the aortic arch branches. Our case highlights the importance of a thorough preoperative evaluation in search of collateral supply in symptomatic patients with Takayasu arteritis.

Ductus arteriosus morphology in duct-dependent pulmonary circulation: CT classification and pattern in different ventricular morphology.

The objective was to study the ductus arteriosus morphology in duct-dependent pulmonary circulation and its pattern in different ventricle morphology using CT angiography. From January 2013 to December 2015, patients aged 6 months and below with duct-dependent pulmonary circulation underwent CT angiography to delineate the ductus arteriosus origin, tortuosity, site of insertion, and pulmonary artery anatomy. The ductus arteriosus were classified into type I, IIa, IIb, and III based on its site of origin, either from descending aorta, distal arch, proximal arch, or subclavian artery, respectively. A total of 114 patients and 116 ductus arteriosus (two had bilateral ductus arteriosus) were analysed. Type I, IIa, IIb, and III ductus arteriosus were seen in 13 (11.2 %), 71 (61.2%), 21 (18.1%), and 11 (9.5%), respectively. Tortuous ductus arteriosus was found in 38 (32.7%), which was commonly seen in single ventricular lesions. Ipsilateral and bilateral branch pulmonary artery stenosis was seen in 68 (59.6%) and 6 (5.3%) patients, respectively. The majority of patients with pulmonary atresia intact ventricular septum had type I (54.4%) and non-tortuous ductus arteriosus, while those with single and biventricular lesions had type II ductus arteriosus (84.9% and 89.7%, respectively). Type III ductus arteriosus was more common in biventricular lesions (77.8%). Ductus arteriosus in duct-dependent pulmonary circulation has a diverse morphology with a distinct origin and tortuosity pattern in different types of ventricular morphology. CT may serve as an important tool in case selection and pre-procedural planning for ductal stenting.