Artery Involvement Research Articles

Multidisciplinary treatment of pancreatic cancer with major arterial involvement in the US

Multidisciplinary treatment of pancreatic cancer with major arterial involvement in the US

Occipital Artery Involvement in Giant Cell Arteritis.

Occipital Artery Involvement in Giant Cell Arteritis.

Coronary artery involvement in fibromuscular dysplasia (FMD): a review

Coronary artery involvement in fibromuscular dysplasia (FMD): a review

Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19.

Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500ng/L) and TnI (≥ 20ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions.

Application of intravascular physiology methods in clinical practice: two-year data from the Russian registry

Aim. To analyze the use in clinical practice of intravascular coronary assessment methods based on two-year data from the Russian Registry on the Use of Intravascular Imaging and Physiology.Material and methods. Since 2021, the Russian Registry on the Use of Intravascular Imaging and Physiology has included data from 7967 studies in 3932 patients, of which 3086 (38,7%) were studies of intravascular physiology. In 2021, 13 branches from 9 cities participated in the registry, in 2022 — 20 branches from 11 cities. For chronic coronary artery disease, 2484 (80,5%) studies were performed, for acute coronary syndrome (ACS) — 598 (19,4%).Results. In 2022, the registry included 1,9 times more intravascular functional studies compared to 2021. The contribution of different clinics was uneven — 75,7% of studies were performed in three departments. The use of non-hyperemic indexes prevailed over hyperemic ones (58%), and in ACS they were used three times more often. All coronary arteries were examined, most often the anterior descending artery. As a primary diagnosis, 1968 (63,8%) studies were performed, while for the purpose of dynamic control — 122 (3,9%), at the surgical stage — 996 (32,3%). In 85,5% (n=2638) of observations, the functional assessment of stenosis hemodynamic significance directly influenced the treatment tactics.Conclusion. The registry data indicate the significant role of functional methods among intravascular diagnostic options in the practice of domestic clinics participating in the registry. The registry demonstrated their use as a primary diagnosis 2 times more often than for coronary artery stenting. Some indications for the active use of intravascular physiology methods (in acute coronary syndrome, left coronary artery involvement) are currently controversial and require further research.

Posterior cerebral artery involvement in unilateral moyamoya disease is exclusively ipsilateral and influenced by RNF213 mutation gene dose: The SUPRA Japan study: PCA involvement in unilateral moyamoya

ObjectivesThe characteristics and clinical implications of posterior cerebral artery (PCA) involvement in unilateral moyamoya disease (U-MMD), such as laterality, frequency of the RNF213 p.R4810K mutation, and clinical outcomes, have not been well studied. Population and methodsWe analyzed a cohort of 93 patients with U-MMD who participated in the SUPRA Japan study. Clinical characteristics and radiological examinations were collected from medical records. The presence of the p.R4810K mutation was determined using a TaqMan assay. The clinical outcome was assessed using the modified Rankin Scale (mRS). Univariate and multivariate logistic regression analyses were performed to assess the associations. ResultsAmong the patients with U-MMD, PCA involvement was observed in 60.0 % (3/5) of patients with homozygous mutation, 11.3 % (7/62) of those with heterozygous mutation, and 3.8 % (1/26) of those with wild type, showing a significant linear trend (p < 0.001 for trend). PCA involvement was observed exclusively on the same side as the affected anterior circulation. Dyslipidemia and cerebral infarction at initial onset were independently associated with mRS ≥1. Hypertension was associated with mRS ≥1 and it was also linked to infarction at initial onset, suggesting a potential confounding effect. Although PCA involvement showed a trend for higher mRS, it was not statistically significant. ConclusionsOur findings indicate a gene dose effect of the p.R4810K mutation on PCA involvement, with the homozygous state showing the most significant effect. Both genetic and modifiable factors such as dyslipidemia may influence the progression of U-MMD.

Clinical and Angiographic Outcomes of Endovascular Treatment for Acute Intracranial Vertebral Artery Dissecting Aneurysms Using Double-Overlapping Stents : Low-Profile Visualized Intraluminal Support within Enterprise Stents.

The use of reconstructive treatment with a double-overlapping stents has proven to be effective and safe in the current treatment of intracranial vertebral artery dissecting aneurysms (VADAs). We employed a combination of overlapping stents, using low-profile visualized intraluminal support (LVIS) within the Enterprise stent. This combination was chosen to minimize the outward bulging of the inner LVIS by overlapping it with the Enterprise stent while maintaining flow diversion and stability. This study aimed to evaluate the clinical and angiographic outcomes following the use of double-overlapping stents with LVIS within the Enterprise stent for the treatment of VADAs. From March 2016 to January 2022, total 28 patients with unruptured VADAs were treated with the double-overlapping stent technique using LVIS within an Enterprise stent in our institute. The Enterprise stent was deployed first, followed by the LVIS stent. Patient clinical and angiographic characteristics, procedural complications, and follow-up outcomes were retrospectively reviewed. All 28 patients (18 males and 10 females) were successfully treated with double-overlapping stent deployment. There were no procedural complications or new neurological deficits in any patient. Of the 28 patients, four VADAs had posterior inferior cerebellar artery involvement. Procedure-related parent artery occlusion did not occur during the angiographic follow-up conducted 6 to 12 months after the procedure. Out of 28 patients, 24 showed complete healing, three had focal residual stenosis or dilatation with residual sac and only one had a residual dissecting flap with aneurysm. All patients, including the four patients, did not require any additional procedures. The postoperative modified Rankin scale scores were 0-1 for all patients. A double-overlapping stent, with a flow-diversion effect, is a safe and effective treatment for patients with VADAs. In particular, when using the LVIS stent within an Enterprise stent, it minimizes the bulging of the inner LVIS stent while maintaining flow diversion and stability. Therefore, both can be effectively utilized as overlapping stents.

Natural history of superior mesenteric artery in-stent restenosis

ObjectiveSuperior mesenteric artery (SMA) stenting is the preferred approach for patients with symptomatic SMA-associated chronic mesenteric ischemia (CMI). The durability of this modality is impacted by in-stent restenosis (ISR). Duplex ultrasound (DUS) and computed tomographic angiography (CTA)-measured ISR may be weakly correlated and not uniformly associated with recurrence of presenting symptoms. This study aims to analyze the association between the degree of ISR for patients with CMI and to develop a predictive model for symptom recurrence. MethodsSingle center, retrospective study included all patients with CMI with SMA stents from the period of 2003 to 2020. Follow-up period analysis included patients’ symptoms recurrence, DUS, CTA, and angiography. A receiver operating characteristic (ROC) analysis was used to evaluate whether peak systolic velocity (PSV) was predictive of symptom recurrence. A subgroup analysis of patients (asymptomatic and symptomatic) with SMA ISR was identified; restenosis defined by DUS with peak systolic velocity (PSV) ≥350. ResultsThe study included 186 patients with the ROC analysis obtained from 503 postoperative visits. PSV was not a predictor of symptoms return with area under the curve (AUC) = 0.49 (95% confidence interval [CI], 0.40-0.57). Agreement analysis between imaging modalities showed higher agreement between CTA and angiogram (AUC, 0.769; 95% CI, 0.688-0.849) vs CTA and DUS (AUC, 0.650; 95% CI, 0.589-0.711). The subgroup analysis of patients with ISR included 99 patients (asymptomatic n = 67; symptomatic n = 32). There was no statistical difference between median time (months) to ISR between both groups: 4.5 (asymptomatic group) and 7.6 (symptomatic group). The use of preoperative antiplatelet (86% vs 65%; P = .015) and P2Y12 receptor blockers (36% vs 13%; P = .016) was more prevalent in the asymptomatic group. There was no difference between the type or number of stents placed, stent diameter, or concomitant celiac artery intervention between both groups. ConclusionsThe natural history of SMA and multimodality defined ISR in CMI has not previously been described. Elevated PSV was a poor predictor of symptoms recurrence. Both asymptomatic and symptomatic patients with ISR did not differ in type of stent placed, time to ISR, or involvement of celiac artery. Antiplatelet use pre- and postoperatively appears protective against symptoms recurrence. Our findings underscore the need for long-term surveillance integrating clinical evaluation and multimodality imaging when indicated.

Splenic Hilar Involvement and Sinistral Portal Hypertension in Unresectable Pancreatic Tail Cancer.

Pancreatic tail cancer (PTC) frequently displays splenic hilar involvement (SHI), but its impact on clinical outcomes remains unclear. We investigated the clinical impact of SHI in patients with unresectable PTC. We retrospectively reviewed all patients with unresectable PTC who received first-line therapy at our institution from 2016 to 2020. Of the 111 included patients, 48 had SHI at diagnosis. SHI was significantly associated with younger age, liver metastasis, peritoneal dissemination, larger tumor size, modified Glasgow prognostic score of 1 or more, splenic artery involvement, gastric varices, and splenomegaly. Shorter median overall survival (OS; 9.3 vs. 11.6 months, p = 0.003) and progression-free survival (PFS; 4.3 vs. 6.3 months, p = 0.013) were observed in SHI patients. Poor performance status of 1 or 2, tumor size > 50 mm, hepatic metastasis, mGPS of 1 or 2, and SHI (hazard ratio: 1.65, 95% confidence interval: 1.08-2.52, p = 0.020) were independent predictors of shorter OS. Splenic artery pseudoaneurysm rupture and variceal rupture were rare and only observed in cases with SHI. Splenic hilar involvement is associated with worse outcomes in pancreatic tail cancer.

The involvement of the hepatic artery is a risk factor for unresectability after neoadjuvant treatment in borderline pancreatic adenocarcinoma

IntroductionBorderline Resectable Pancreatic Ductal Adenocarcinoma (BR-PDAC) benefits from neoadjuvant treatment (NAT) with the intent of surgical salvage in the absence of disease progression during chemotherapy (CT) or chemoradiotherapy (CRT). Scarce literature exists about prognostic factors of resectability at the time of diagnosis or during neoadjuvant treatment, especially regarding vascular relationships. MaterialsWe reviewed our prospective BR-PDAC cohort to determine resectability predictors. We collected data about clinical baseline characteristics, vessels’ involvement, type of NAT, CA19-9 evolution, and radiological outcome. We performed a descriptive analysis and a logistic regression model to define resectability predictors; we finally compared overall survival (OS) and progression-free survival (PFS) for those predictors. ResultsOne hundred patients started NAT, with a resection rate of 44 % (40 pancreaticoduodenectomies, 4 distal pancreatectomies). The most frequent vessel relationship was the abutment of the superior mesenteric artery (44 %), and 26 patients had ≥2 vessels involved. Prognostic factors of resectability were CA19-9 response >10 % (OR 3.07, p = 0.016) and Hepatic Artery involvement (OR 0.21, p = 0.026). Median overall survival was better for CA19-9 responders than for non-responders (20.9 months and 11.8 months respectively, p < 0.001), and similar to normalized CA19-9 (25.0 months, p = 0.48). There were no differences in terms of OS or PFS with the involvement of the HA (17.7 vs 17.1 months, p = 0.367; and 8.7 vs 12.0 months, p = 0.267). ConclusionThe involvement of the Hepatic Artery seems to confer a worse prognosis regarding resectability. A decrease of only >10 % of CA19-9 is a predictive factor for resectability and better overall and progression-free survival.

Risk of Diabetes Mellitus in Carotid Artery Involvement Among Coronary Artery Disease Patients Including History of Infection and Antibiotics Uses

Background: Diabetes mellitus causes involvement of coronary artery diseases. Objective: The purpose of the present study was to determine the risk of diabetes mellitus in the involvement of carotid artery among coronary artery disease patients. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2015 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75 gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. The mean height of the DM was 163.4±8.5 cm and in NDM was 160.6±7.1 cm, mean weight of DM 63.5±7.2 kg, in NDM was 62.0±15.4 kg and mean BMI in DM was 26.24±2.36 kg/m2 and in NDM was 26.38±2.05 kg/m2. The mean total cholesterol in DM was 236.9±34.1 mg/dL and in NDM was 208.0±36.4 mg/dL, mean serum TG in DM 240.5±76.3 mg/dl and in NDM was 207.6±57.8 mg/dl and mean serum IDL in DM was 166.1±130.6 mg/dL and in NDM was 142.8±30.4 mg/dL, no significant mean difference was observed between DM and NDM in height, weight and BMI (P&gt;0.05). Concussion: In conclusion, significant mean difference is observed between DM and NDM in total cholesterol, serum triglycerides. Bangladesh Journal of Medical Microbiology, July 2023;17 (2):82-87

Ischemic injury of colon mucosa as a first manifestation of Takayasu arteritis in a young female patient: challenges in the differential diagnosis

Takayasu arteritis (TA) is a type of chronic large vessel vasculitis, which most often affects the aorta and its main branches as a kind of destructive-productive segmental aortitis and subaortic panarteritis, with possible obliteration of their orifices. Clinical picture of TA may be different depending on the nature and localization of the pathological process.&#x0D; We present a clinical case of ischemic injury of the colon mucosa in TA in a young (21 year old) female patient after she had a novel coronavirus infection (COVID-19). Due to ineffectiveness of out-patient treatment of ulcerative colitis, as well as complaints that were not meeting the diagnosis of ulcerative colitis, the patient was referred for additional examination and treatment modification in inpatient settings. Taking into account her diarrheal syndrome at the disease onset, the ileocolonoscopy results (rectal and colonic erosions), the results of histological examination (diffuse leukocytic infiltration of the mucosa, lymphoid infiltration of submucosa of the colon), elevation of proinflammatory markers, involvement of the inferior mesenteric artery at ultrasound dopplerography, the differential diagnosis was made between the TA overlap syndrome with inflammatory bowel diseases and TA-associated ischemic colitis. The assessment results made it possible to exclude inflammatory bowel diseases, to establish the diagnosis of TA and to consider colonic mucosa abnormalities as ischemic with underlying disease.&#x0D; The clinical case described is a rare event of intestinal ischemia as a first TA manifestation. Given the increasing worldwide prevalence of TA, especially after the new coronavirus infection pandemic, it is necessary to include this rare cause of gastrointestinal vasculitis to the differential diagnostic search, since mesenteric ischemia is one of the main causes of death in AT patients.

A Rare Case of Immunoglobulin G4-Related Disease Presenting With Coronary Artery Pseudotumor And Aneurysm.

Immunoglobulin G4-related disease (IgG4-RD) is a chronic systemic disease characterized by inflammatory fibrosis and high serum IgG4 levels.IgG4-RD can involve the coronary artery, presenting as a coronary aneurysm, and may mimic coronary artery disease.Treatment of IgG4-RD with coronary artery involvement includes corticosteroid therapy, with or without other immunosuppressant, as well as surgical intervention.

Renal artery involvement is associated with increased morbidity but not mortality in Takayasu arteritis: a matched cohort study of 215 patients.

We analyzed differences in presentation and survival of Takayasu arteritis (TAK) with or without renal artery involvement (RAI) from a large monocentric cohort of patients with TAK. Clinical and angiographic features were compared between TAK with versus without RAI, with bilateral versus unilateral RAI, and with bilateral RAI versus without RAI using multivariable-adjusted logistic regression. Inter-group differences in survival were analyzed [hazard ratios (HR) with 95% confidence intervals (95%CI)] adjusted for gender, age at disease onset, diagnostic delay, baseline disease activity, and significant clinical/angiographic inter-group differences after multivariable-adjustment/propensity score matching (PSM). Of 215 TAK, 117(54.42%) had RAI [66(56.41%) bilateral]. TAK with RAI or with bilateral RAI had earlier disease onset than without RAI (p < 0.001). Chronic renal failure (CRF) was exclusively seen in TAK with RAI. TAK with RAI (vs without RAI) had more frequent hypertension (p = 0.001), heart failure (p = 0.047), abdominal aorta (p = 0.001) or superior mesenteric artery involvement (p = 0.018). TAK with bilateral RAI (vs unilateral RAI) more often had hypertension (p = 0.011) and blurring of vision (p = 0.049). TAK with bilateral RAI (vs without RAI) more frequently had hypertension (p = 0.002), heart failure (p = 0.036), abdominal aorta (p < 0.001), superior mesenteric artery (p = 0.002), or left subclavian artery involvement (p = 0.041). Despite higher morbidity (hypertension, CRF), mortality risk was not increased with RAI vs without RAI (HR 2.32, 95%CI 0.61-8.78), with bilateral RAI vs unilateral RAI (HR 2.65, 95%CI 0.52-13.42) or without RAI (HR 3.16, 95%CI 0.79-12.70) even after multivariable adjustment or PSM. RAI is associated with increased morbidity (CRF, hypertension, heart failure) but does not adversely affect survival in TAK. Key Points •Renal artery involvement in TAK is associated with chronic renal failure. •TAK with renal artery involvement more often have heart failure and hypertension. •Bilateral renal artery involvement (compared with unilateral) is more often associated with hypertension and visual symptoms. •Renal artery involvement is not associated with an increased risk of mortality in TAK.

Coronary Angiographic Profile of Patients with Acute Coronary Syndrome

Abstract Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. It occurs due to blockage of blood vessels supplying the area of the heart. Increased age, diabetes, hypertension, dyslipidemia, and significant alcohol history are some of the major risk factors for acute coronary syndrome (ACS). After coronary angiography, (CAG) angioplasty is the mainstay of treatment. Objectives: The objectives were: (1) To assess the clinical profile of patients with ACS. (2) To study the angiographic profile of patients with ACS. Materials and Methods: A cross-sectional study of 110 patients who underwent CAG at a tertiary care teaching hospital, Amritsar, from April 2021 to July 2022 was studied. Detailed history and echocardiographic findings were obtained. Angiographic findings were studied with management. Data were analyzed using SPSS (version 22) and Chi-square test. Results: Double-vessel disease was the most common angiographic abnormality in unstable angina and ST-elevation myocardial infarction (STEMI); whereas in non-STEMI, triple-vessel disease was the most common. The left anterior descending artery was the most common artery involved. Patients with the age of 51–60 years were the most commonly involved patients, and males had a more severe form of CAD. Smoking did not affect the severity of the disease. Conclusions: Increased age, male sex, and patients with diabetes mellitus, hypertension, and dyslipidemia were predisposed to develop ACS. Smoking did not affect the severity or pattern of artery involvement.

Operative Strategies for Aplastic Circle of Willis Arteries on CTA in Meningioma Surgery: A Case Report

BACKGROUND AND IMPORTANCE: Meningiomas frequently involve critical neurovascular structures. Preoperative imaging with computed tomography angiography (CTA) can help understand the relationship of tumor with neurovascular structures. Although CTA was useful in preoperative planning and less invasive, we present a unique case in which it mistakenly represents a hypoplastic anterior cerebral artery as aplastic and thus displays poor sensitivity in the Circle of Willis. CLINICAL PRESENTATION: A 66-year-old woman presented with new onset seizures and MRI demonstrated a sphenoid wing meningioma with tumor involvement of the internal carotid artery and right M1 artery. On preoperative CTA, a right A1 artery was not appreciated. However, a hypoplastic right A1 artery was identified during careful dissection guided by micro-Doppler and found to be encased within the tumor. All arteries were preserved, and a near-total resection was achieved with a small remnant of tumor at the supraclinoid internal carotid artery. CONCLUSION: Although CTAs can be useful in understanding vascular anatomy and its association with tumors, they are not ideal for providing information about hypoplastic arterial segments. Seemingly aplastic arteries on CTA may very well be present, albeit hypoplastic. While we recognize the usefulness of a less invasive modality of CTA to help guide surgical strategy, we underscore recognizing this potential pitfall and recommend the use of the microvascular Doppler during careful dissection when working within tumor in the location of a seemingly aplastic artery.

Abstract LB_C05: A novel approach to convert non-resectable pancreatic cancer with major artery involvement using endovascular activation of Padeliporfin by vascular-targeted photodynamic therapy

Abstract Pancreatic cancer is a fatal disease: the patient usually has a very poor prognosis and limited treatment options. It is projected to be the second leading cause of cancer-related death by 2030. It is estimated that 80% of patients have metastatic or localized disease with vascular involvement at presentation, not amenable to surgery. Thus, a therapy that will convert unresectable, due to vascular involvement, tumors to resectable is an unmet medical need. We developed a novel treatment relying on endovascular activation of a photosensitizer Padeliporfin, by a vascular-targeted photodynamic therapy (VTP) to clear the artery from the encasing tumor enabling surgery. Padeliporfin is administered intravenously and activated locally by illumination via an optical fiber, deployed within the tumor encased artery by an angioplasty procedure under fluoroscopy. In a proof-of-concept study in normal swine model, treatment induced areas of ablation in normal pancreatic parenchyma while sparing the artery and other major structures in it’s vicinity. Drug and light doses used were proved effective in other solid tumors in preclinical and clinical studies. Safety was evaluated in a controlled study comprised of 12 pigs subjected to Padeliporfin VTP in a superior mesenteric artery (SMA). Two light doses were tested. Control groups received no drug or no illumination and drug. Follow up was 48 hours or seven days post treatment. Clinical observations and blood test results did not reveal any signs of decreased wellness without differences between treated and control groups. Lipase results were unchanged compared to the baseline. Amylase levels were within the normal range in all animals. Histopathology findings 48 hours post VTP in the SMA and surrounding tissues were similar in treated and control animals. Observed changes were manifested as small lesions consistent with angioplasty procedure impact, involving less than 25% of the media circumference. Small foci of coagulative necrosis were observed in the pancreatic parenchyma in the vicinity of SMA. In the seven-day samples, there was media pressure necrosis in occasional sections of the artery in all groups involving less than 25% of the circumference, attributed to the angioplasty procedure. Minimal fibrosis in a few samples, consisted of focal areas of fibroblast proliferation, indicating early regeneration, with no architectural or thickness changes of the arterial wall. The tissues surrounding SMA as well as organs downstream to the treated artery were mostly within normal ranges. Our results demonstrate that endovascular Padeliporfin VTP is feasible and has an acceptable safety profile together with evidence of ability to ablate pancreatic tumors encasing major abdominal arteries. The efficacy is further supported by our studies showing effective tumor ablations in orthotopic mouse models especially in combination with immune modulating therapies. A phase I trial (NCT5918783) aims to evaluate the potential of this approach for converting unresectable pancreatic cancer patients to amenable for surgery. Citation Format: Dina Preise, Yaniv Cohen, Genia Alpert, Zachary Sacks, Tamar Yechezkel, Natalia Kudinova, Eyal Morag, Ehud Willenz, Julia Rothman, Keren Brook, Inna Krasnopolskaya, Lilach Agemy, Sofia Zilber, Hooman Yarmohammadi, David Kelsen, David Perry, Avigdor Scherz. A novel approach to convert non-resectable pancreatic cancer with major artery involvement using endovascular activation of Padeliporfin by vascular-targeted photodynamic therapy [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr LB_C05.

Right Ventricular Function in Takayasu's Arteritis Patients With Pulmonary Artery Involvement Using MRI Feature Tracking.

Pulmonary artery involvement (PAI) is not rare in Takayasu arteritis (TA). Persistently elevated pulmonary arterial pressure in TA-PAI patients leads to pulmonary hypertension (PH), and eventually cardiac death. Thus, the early detection of right ventricular dysfunction before the onset of PH is important. To explore the potential of right ventricular global peak longitudinal and circumferential strain (RVGLS and RVGCS, respectively) in detecting right ventricular myocardial damage in TA-PAI patients without PH. Retrospective. One hundred and six TA patients (39.6 ± 13.9 years), of whom 52 were non-PAI and 54 were PAI patients (36 without PH and 18 with PH), along with 58 sex- and age-matched healthy volunteers (HVs) (36.7 ± 13.2 years). The involved arteries were validated by aorta magnetic resonance (MR) angiography and pulmonary artery computed tomography angiography. 3 T/Cine imaging sequence with a steady-state free precession readout. Cardiac MRI-derived parameters measured by two radiologists independently were compared among HVs, and TA patients with and without PAI. In addition, these indices were further compared among HVs, and TA-PAI patients with and without PH. Student's t test, one-way ANOVA analysis, Pearson and Spearman correlation analysis, and reproducibility analysis. A P-value of <0.05 was considered statistically significant. Although the TA-PAI patients without PH had a similar RV ejection fraction (RVEF) with HV (P = 0.348), RVGLS (non-PH 20.6 ± 3.7% vs. HV 24.0 ± 3.1%) was significantly lower and RVGCS (non-PH 14.8 ± 3.9% vs. HV 13.0 ± 2.7%) higher. The TA-PAI patients with PH had significantly poorer RVGLS (PH 13.5 ± 3.8% vs. non-PH 20.6 ± 3.7%) and RVGCS (PH 10.9 ± 3.2% vs. non-PH 14.8 ± 3.9%) than those without PH. Right ventricular dysfunction was detected in the TA-PAI patients without PH. MR-feature tracking may be an effective method for detecting early cardiac damage in the TA-PAI patients without PH. 3 TECHNICAL EFFICACY: Stage 3.

Pre-Pulseless Takayasu Arteritis is Associated with Distinct Clinical and Angiographic Features but Similar Outcomes - A Cohort Study.

To compare the presentation, angiographic features, evolution, and prognosis of prepulseless Takayasu arteritis (TAK) with TAK with pulse loss. Pre-pulseless TAK (defined as without pulse loss in the upper limbs, lower limb, carotid, or subclavian arteries) were identified from a cohort of TAK. Demographic characteristics, clinical features, angiographic involvement, baseline and longitudinal patterns of disease activity, medication use, and mortality rates were compared between pre-pulseless TAK and TAK with pulse loss. Adjusted odds ratios (aOR, with 95%CI) for categorical variables between pre-pulseless TAK and TAK with pulse loss were computed using multivariable-adjusted logistic regression models. Time-to-event data was compared using hazard ratios (HR) with 95%CI. Compared with TAK with pulse loss, pre-pulseless TAK (91/238, 38.24%) more frequently had deranged renal function (aOR 4.43, 95%CI 1.58-12.37) and Hata's type IV disease (aOR 8.02, 95%CI 2.61-24.65), and less often had pulse or blood pressure asymmetry (aOR 0.34, 95%CI 0.18-0.63), limb claudication (aOR for upper limb 0.38, 95%CI 0.18-0.82, for lower limb 0.28, 95%CI 0.12-0.68), right subclavian (aOR 0.45, 95%CI 0.23-0.90) or left carotid artery involvement (aOR 0.42, 95%CI 0.21-0.84). Only two patients with pre-pulseless TAK developed pulse loss on follow-up. Despite fewer pre-pulseless TAK having active disease at presentation, similar proportions of patients in both groups had active disease on follow-up. Survival was similar in both groups (HR for mortality 0.41, 95%CI 0.09-1.90). Pulse loss on follow-up is uncommon in those with prepulseless TAK. Pre-pulseless TAK is associated with similar long-term outcomes to TAK with pulse loss.

Surgical management and outcomes of coronary artery involvement secondary to acute type A aortic dissection: a retrospective cohort study.

Coronary artery involvement (CAI) remains a fatal comorbidity in the context of acute type A aortic dissection (ATAAD). We evaluated the impact of CAI on the perioperative and short-term outcomes of patients with ATAAD who underwent total arch replacement (TAR) and frozen elephant trunk (FET) implantation and shared our surgical management experience with the involved coronary artery. In this retrospective cohort study, a total of 204 patients with ATAAD between June 2019 and December 2021 were enrolled and divided into the CAI group (n=67) and the non-CAI group (n=137). The characteristics of CAI lesions were described according to the Neri classification. Univariable and multivariable analyses were used to identify independent risk factors for in-hospital mortality. Survival analysis was performed using the Kaplan-Meier method and compared using the log-rank test. Patients in the CAI group had a longer intraoperative duration of cardiopulmonary bypass (CPB) and cross-clamp, and experienced longer mechanical ventilation time and intensive care unit stays postoperatively. Regarding perioperative outcomes, the prevalence rates of new-onset continuous renal replacement therapy requirement (23.9% vs. 10.2%, P=0.01) and in-hospital mortality (17.9% vs. 7.3%, P=0.02) were higher in the CAI group. Coronary artery malperfusion (CAM) was an independent risk factor for in-hospital mortality. Short-term survival analysis was similar between the two groups (P=0.146). For patients with ATAAD undergoing TAR and FET implantation, concomitant CAI may complicate surgery and increase in-hospital morbidity and mortality. CAM secondary to CAI was identified as an independent risk factor. However, short-term survival after hospital discharge was comparable between the two groups. Coronary ostium repair is quick and operable for both type A and type B lesions, while optimal management still warrants further investigation.