Arterial Segments Research Articles

Ultrasound-guided renal artery balloon catheter occluded hybrid partial nephrectomy (UBo-HPN) with branch renal artery occlusion: a single arm trial

BackgroundOne key focus of partial nephrectomy is preserving renal function. Segmental renal artery occlusion with microdissection at the renal hilum confines ischemia, effectively reducing warm ischemic injury. Ultrasound-Guided Renal Artery Balloon Catheter Occluded Hybrid Partial Nephrectomy (UBo-HPN) can achieve branch occlusion without the need for dissecting the renal hilum.ObjectiveTo investigate the feasibility and safety of UBo-HPN of branch renal artery occlusion in the treatment of localized renal tumors.Subject and methodsA prospective single-arm analysis involving 20 patients with renal localized tumors underwent robot assisted UBo-HPN with branch renal artery occlusion from August 2021 to July 2023, with an average follow-up of 12 months.ResultsAll patient was successfully operated on without conversion to conventional arterial clamping or radical nephrectomy. One case (5%) of minor complication occurred in the whole cohort, which was bruising around the puncture site. The mean total operative time was 95.8 min, with a mean operative time of 21.25 min for vascular intervention. The mean warm ischemia time was 20.35 min, and the median estimated blood loss was 50 ml. The median eGFR preservation percentage at postoperative 48 h, 30 days, and the latest follow-up were 87.52%, 91.47%, and 92.2%, respectively. After a median follow-up of 10.2 (2.3–19.2) months, no patients had radiological tumor recurrence or died from tumor-related causes.ConclusionsUBo-HPN with renal artery branch occlusion emerges as an efficient alternative to partial nephrectomy (PN), which achieved branch artery occlusion without dissecting the renal hilum. Long-term follow-up is expected for functional outcomes.

Preoperative evaluation of the segmental artery of left upper lobe by thin-section CT and 3d-CTA.

Understanding pulmonary artery (PA) branches and their variations is crucial for successful lung resection. We aimed to evaluate the segmental PA branching pattern of the left upper lobe (LUL) using thin-section computed tomography (TSCT) images and 3D-CT angiography (3D-CTA). This study included 108 patients who underwent CTA and left upper lobectomy. The segmental PA branching pattern of the LUL was meticulously identified by two thoracic radiologists using 3D-CTA and TSCT images. The lingular artery branches from the left PA (LPA) were classified into mediastinal type (pars mediastinalis: PM), interlobar type (pars interlobaris: PI), and PI originating from the lower portion (PI'), specifically from A8. The intraoperative findings of the PA branches of the LUL were compared with the preoperatively obtained 3D-CTA and TSCT images in each patient's case. The median (range) number of LPA branches of the LUL was 4.36 (3-8). The most common number of A1 + 2 branches was two, seen in 34 cases (31.5%). One or more branches of A1 + 2c directly originating from the LPA were found in 63 cases (58.3%). The number of branches of A3 was single in 85 cases and the most frequent (78.7%). Instances where one or more branches of A3a directly originated from the LPA were found in seven cases (6.5%). A1 + 2 and A3 origins were separate and independent in 40 cases (37.0%). As the branching pattern of the lingular artery, PI/PI' was most frequent (61.1%). PI´ was observed in 26 cases (24.1%). Inter-observer agreement for A1 + 2, A1 + 2c, A3, A3a, and lingular artery branching patterns was moderate to substantial (κ = 0.53-0.72). Preoperative 3D-CTA and TSCT images identified 99.8% of LPA branches compared to intraoperative findings, except one. The segmental PA branching pattern of the LUL can be evaluated using TSCT and 3D-CTA images, providing precise preoperative information.

Bridging the gap between neuroimaging and neurosurgery: a case of epidural arteriovenous fistula with an intradural presentation. Illustrative case.

Epidural arteriovenous fistulas (eAVFs) are rare vascular malformations often mistaken for their intradural counterparts due to similar angiographic features. Differentiation between epidural and intradural vascular lesions is crucial as it impacts surgical planning and prognosis. Despite advancements in diagnostic imaging, these entities can be misinterpreted and challenge management. The authors report the case of a 68-year-old male suspected to have a type I dural arteriovenous fistula based on magnetic resonance angiography and angiographic evaluation. He presented with progressive myelopathy and multiple neurological symptoms exacerbated by recent trauma. A superselective angiogram of the right T10 segmental artery suggested an intradural arteriovenous fistula; however, intraoperatively, the lesion was epidural. The arterialized venous structures were obliterated, and the patient reported significant postoperative symptomatic improvement. This case highlights the critical importance of comprehensive imaging and cautious interpretation in the diagnosis of spinal vascular malformations. It also underscores the need for a multidisciplinary approach to ensure accurate diagnosis and effective treatment. Surgeons must be prepared for intraoperative findings that diverge from preoperative imaging to adapt surgical strategies accordingly. Furthermore, this case contributes to the evolving understanding of eAVFs, suggesting that revised imaging protocols may be required to better distinguish epidural from intradural vascular abnormalities. https://thejns.org/doi/10.3171/CASE24331.

Outcomes of Proximal Hybrid Arterial Reconstruction in Combination with Simultaneous Amputation in Dry Atherosclerotic Gangrene of Toes

INTRODUCTION: When treating atherosclerotic gangrene of the lower limb (LL), the surgeon faces the questions about the reasonability of vascular reconstruction and the optimal timing of amputation after surgery on the LL arteries. The answer to these questions is given by assessing the state of the microvasculature of the operated limb. With sufficient development of the microvasculature and good collateral circulation, it is possible to perform a simultaneous amputation after proximal reconstruction. In this situation, a clear demarcation of the zone of necrosis and reversible ischemia is required, which can be realized by the method of ultraviolet luminescence spectroscopy. AIM: To analyze the results of hybrid reconstructions on the LL arteries with multilevel diffuse atherosclerotic lesions and dry gangrene of toes (DGT). MATERIALS AND METHODS: A prospective, controlled, non-randomized study included 29 patients suffering from critical ischemia of the lower limbs and having DGT, who were operated on in the amount of hybrid arterial reconstruction. The patients were divided into two groups: patients of group 1 (n = 14) underwent restoration of the main blood flow at the level of the iliofemoral arterial segment using a hybrid method, with simultaneous minor amputation of LL at various levels; patients of group 2 (control group, n = 15) underwent a simultaneous proximal and distal hybrid operation, providing main blood flow through at least one of the lower leg arteries, followed by a minor amputation of the lower leg at various levels over the next 4–5 days. RESULTS: There were no statistically significant differences in the groups in the degree of decrease in luminescence intensity after vascular surgery. A histological examination of intraoperative preparations of DGT revealed necrosis of the cellular microenvironment at luminescence amplitude (1.0 ± 0.05) × 105 photons at 410 nm frequency. At luminescence amplitude not exceeding this level, signs of necrobiosis were noted. Luminescence level of ≥ 1.0 × 105 photons was used as the amputation boundary. In the case of an uncomplicated vascular stage of the operation, a comparable decrease in the conventional amputation boundary was noted in the study groups. In the early postoperative period, in patients of group 1, the level of inflammation markers, average number of bed-days, and the number of thrombotic complications were lower than in the control group (p 0.05). A strong correlation was recorded between the morphological signs of the acute phase of inflammation and the intensity of chemiluminescence (r = 0.7, p 0.005). CONCLUSION: In patients with DGT, at a luminescence amplitude on the lower leg and foot not exceeding 1.0 × 105 photons at 410 nm frequency and 0.7 × 105 photons at 450 nm frequency, an effective treatment method is restoration of the main blood flow in the iliofemoral segment using a hybrid method with simultaneous minor amputation at various levels of the foot. This luminescence level is the conventional boundary between necrotic changes and reversible ischemia (necrobiosis) of the soft tissues of the LL.

Cerebral Artery Vasoconstriction After Galcanezumab Loading Dose for Migraine Prevention: A Case Report.

Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies that target CGRP ligands or receptors, may cause a very rare side effect of reversible cerebral vasoconstriction syndrome (RCVS). This study is a case report of a patient who developed cerebral artery vasoconstriction documented on serial brain magnetic resonance angiography (MRA) scans without the typical manifestations of RCVS following galcanezumab loading dose. Case report: A 40-year-old female patient with high-frequency episodic migraine with visual aura on topiramate 100mg/day developed transient numbness of the right upper and lower extremities and right face without headache and a normal neurological examination 10min after a loading dose of galcanezumab, which resolved over the next 2days. Magnetic resonance angiography brain imaging showed segmental arterial constriction of both middle cerebral arteries in the M1-2 segments and both posterior cerebral arteries in the P1-2 segments, which partial resolved in a subsequent study by the end of 6months. There were no other supporting examination data, such as transcranial Doppler, which might provide additional information on the progression and improvement of the vasoconstriction. Her differential diagnosis included prolonged migraine sensory aura without headache, RCVS, or cerebral vasoconstriction secondary to the effect of an anti-CGRP monoclonal antibody. Further research needs to be conducted.

Subacute in-stent thrombosis after carotid artery stenting in a patient with gene polymorphisms associated with aspirin and clopidogrel resistance: a case report

BackgroundCarotid artery stenting (CAS) is a key treatment option for moderate to severe carotid artery stenosis. Carotid stent thrombosis (CST), a rare complication of CAS, has gained significant attention because of its catastrophic nature. More evidences are needed to guide the diagnosis and treatment of CST.Case presentationThis study reports a rare case of sub-acute CST following CAS in a 50-year-old male patient who had experienced repeated cerebrovascular events on the premise of taking antiplatelet drugs. He also suffered an occlusion of the left middle cerebral artery (MCA) in the M2 segment, likely caused by an embolus detached from the stent thrombus. The cause of CST in this patient was presumed to be dual antiplatelet resistance (AR), as indicated by genetic testing. After treated with guide catheter-directed thrombolysis, thrombus aspiration, and a second round of thrombolysis, his in-stent thrombus was basically cleared. His M2 occlusion was resolved by mechanical thrombectomy using the Solitaire FR/Stent with Intermediate Catheter Assisting technique. The patient recovered well after replacement of antiplatelet drugs, and no new thromboembolic event occurred during the 13-month follow-up period.ConclusionsThe occurrence rate of AR-related CST may be underestimated as the cause of majority CST cases remains unclear. Implementation of genetic test for aspirin and clopidogrel resistance may be helpful to find the possible cause of CST and to avoid future repeated cerebrovascular events by replacement of antiplatelet drugs.

Physiological provocation compared to acetazolamide in the assessment of cerebral hemodynamics: a case report

BackgroundSevere large vessel disease may lead to cerebral hemodynamic failure that critically impairs cerebral blood flow (CBF) regulation elevating the risk of ischemic events. Assessment of the condition is often based on changes in CBF during vasodilatation; however, pharmacologically induced vasodilation does not reflect the physiological condition during an ischemic event caused by hemodynamic failure. We compared a [15O]H2O PET brain scan during vasodilation to a [99mTc]HMPAO SPECT brain scan during an ongoing transient ischemic attack (TIA).Case presentationA single patient presenting with limb-shaking TIA underwent CT, Digital Subtraction Angiography, and two different modalities of cerebral perfusion scans: [15O]H2O PET and [99mTc]HMPAO SPECT. Acetazolamide was used in the PET scan to induce vasodilatation, and during the SPECT scan physiological stress, standing up rapidly, was used to induce limb-shaking TIA. CT-angiography and Digital Subtraction Angiography revealed an occlusion in the distal part of the right A2 segment of the anterior cerebral artery, with a corresponding infarction in the watershed area. Collaterals supplied the main vascular territory of the anterior cerebral artery. During rest, neither perfusion modalities demonstrated reduced perfusion outside of the ischemic core. However, we found a pronounced difference between the PET utilizing acetazolamide and the SPECT during the TIA. The PET scan demonstrated relative hypoperfusion in vascular territory supplied by collaterals, while the area around the ischemic core was not affected. Contrary, the SPECT had only minor relative hypoperfusion in the collateral-supplied area, whereas the watershed area proximal to the infarct core had pronounced relative hypoperfusion.ConclusionsThe observed discrepancy in compromised areas during physiological provocation compared to pharmacological induced vasodilation questions the use of an unphysiological stressor for assessment of cerebrovascular hemodynamics. A physiological provocation test may achieve more clinically relevant evaluation.

Coil Embolization of a Ruptured Anterior Spinal Artery Aneurysm Associated with Spinal Cord Arteriovenous Malformation.

The present report describes a patient with spinal cord arteriovenous malformation (AVM) and an associated anterior spinal artery aneurysm presenting with subarachnoid hemorrhage. Diagnostic spinal angiography revealed an intramedullary AVM, located at the T10-T11 level, and a prenidal saccular aneurysm at the junction of the radiculomedullary artery and the anterior spinal axis, fed by the right T8 segmental artery. The patient underwent successful selective coil embolization of the aneurysm. Follow-up angiography 3 months postoperatively showed no recurrence of the aneurysm.

Measurement of transcranial Doppler insonation angles from three-dimensional reconstructions of CT angiography scans.

Blood velocities measured by Transcranial Doppler (TCD) are dependent on the angle between the incident ultrasound beam and the direction of blood flow (known as the Doppler angle). However, when TCD examinations are performed without imaging the Doppler angle for each vessel segment is not known. We have measured Doppler angles in the basal cerebral arteries examined with TCD using three-dimensional (3D) vessel models generated from computed tomography angiography (CTA) scans. This approach produces angle statistics that are not accessible during non-imaging TCD studies. We created 3D models of the basal cerebral arteries for 24 vasospasm patients. Standard acoustic windows were mapped to the specific anatomy of each patient. Virtual ultrasound transmit beams were generated that originated from the acoustic window and intersected the centerline of each arterial segment. Doppler angle measurements were calculated and compiled for each vessel segment. Doppler angles were smallest for the middle cerebral artery M1 segment (median 24.6°) and ophthalmic artery (median 25.0°), and largest for the anterior cerebral artery A2 segment (median 76.4°) and posterior cerebral artery P2 segment (median 75.8°). The ophthalmic artery had the highest proportion of Doppler angles that were less than 60° (99%) while the anterior cerebral artery A2 segment had the lowest proportion of Doppler angles that were less than 60° (10%). These angle measurements indicate the expected deviation between measured and true velocities in the cerebral arteries, highlighting specific segments that may be prone to underestimation of velocity.

Quantitative Analysis on Vessel Stiffness and Vector Flow Imaging in the Assessment of Carotid Artery Structural and Functional Changes in Patients With Type 2 Diabetes

ObjectiveTo explore the value of RF-data-based quantitative analysis on vessel stiffness (R-QVS) combined with dynamic vector flow imaging (VFI) in evaluating structural and functional changes in the carotid arteries of patients with type 2 diabetes mellitus (T2DM). MethodsA prospective study was conducted between October 2022 and April 2024, including 275 consecutive subjects (50 volunteers as controls, 108 patients with T2DM and normal carotid intima-media thickness (CIMT), and 117 patients with T2DM and thickened CIMT). Carotid intima-media thickness (IMT) was measured using real-time intima-media thickness (RIMT) technology, while R-QVS was employed to measure the systolic diameter (Diam), displacement (Dist), hardness coefficient (HC), and pulse wave velocity (PWV) of the distal segment of the carotid artery. VFI was used to measure the maximum wall shear stress (WSSmax), mean wall shear stress (WSSmean), and maximum instantaneous velocity (Vmax) of the vessel wall. Differences in ultrasound parameters among the three groups were compared, and receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC), evaluating the efficacy of these parameters in assessing structural and functional changes in the carotid arteries of patients with T2DM. ResultsThere were statistically significant differences in carotid IMT, Diam, Dist, HC, PWV, WSSmax, and Vmax among the three groups (all p < 0.01). The AUCs for evaluating structural and functional changes in the carotid arteries of patients with T2DM using carotid ultrasound parameters Diam, Dist, HC, PWV, WSSmax, and Vmax were 0.64, 0.68, 0.83, 0.88, 0.86, and 0.82, respectively. Multiple linear regression analysis identified Dist., HC, PWV, WSSmax, and WSSmean as influencing factors for CIMT in T2DM patients (with β values of -0.406, 0.515, 0.564, -0.472, and -0.438, respectively; all p < 0.05). ConclusionR-QVS and VFI techniques contribute to the early assessment of structural and functional changes in the carotid arteries of patients with type 2 diabetes mellitus. Compared with controls, T2DM patients exhibit more advanced functional changes than morphological changes despite normal CIMT. The enhanced sensitivity, reproducibility, and detailed assessment capabilities of these methods make them valuable tools in the early detection and intervention of cardiovascular risk in T2DM.

TCT-201 Deep Learning-Based Segmentation of Coronary Arteries and Stenosis Detection in X-Ray Coronary Angiography: From Training to External Validation

TCT-201 Deep Learning-Based Segmentation of Coronary Arteries and Stenosis Detection in X-Ray Coronary Angiography: From Training to External Validation

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.

Assessing the impact of fetal-type posterior cerebral artery variations on cerebral hemodynamics

The circle of Willis (CoW) is a critical, arterial structure that ensures balanced, cerebral-blood supply. The fetal-type posterior cerebral artery (f-PCA) is a CoW variant that can significantly affect hemodynamics and elevate the risk of cerebrovascular diseases. This study used computational fluid dynamics simulations and a patient-specific, three-dimensional model to evaluate the hemodynamic effects of the f-PCA variants on cerebral-blood flow and key hemodynamic indices—such as time-averaged wall-shear stress (TAWSS), oscillatory shear index (OSI), pulsatility index, and resistive index. The fetal ratio (FR) is defined as the ratio of the diameter of the posterior communicating artery (PCoA) to that of the first segment (P1) of the PCA. Our findings indicate that as the FR increases, the contribution of the basilar artery to the second segment (P2) of PCA decreases significantly. Specifically, the flow rate through ipsilateral P1 decreased by 40.0% for FR = 1 and 70.9% for FR = 2, with the internal carotid artery (ICA) compensating for this reduction. Moreover, variations in f-PCA led to significant increases in TAWSS and OSI in key arterial segments (including the ipsilateral P1, PCoA, and the anterior communicating artery), which are associated with a higher risk of aneurysm initiation and growth. Under conditions of unilateral stenosis in the ipsilateral ICA, f-PCA models exhibit a more complex and pronounced impact on blood flow than models without f-PCA, emphasizing the need for detailed hemodynamic assessments in clinical evaluations and preoperative planning to mitigate the risks associated with CoW anatomical variations.

Results of endovascular interventions for peripheral arterial diseases on the targeted arterial segments.

Endovascular interventions (EVIs) are an effective and minimally invasive therapeutic option for peripheral arterial diseases (PADs). This study aimed to evaluate the results of EVIs for PADs on the targeted arterial segments (TASs). One hundred and sixteen (116) participants with PADs were included in this cohort study. The diagnosis of PAD in this study was based on the ankle-brachial index (ABI) and Rutherford classification, confirmed by Duplex ultrasound and computed tomography angiography (CTA). The targeted arterial segments (TASs) were treated using either balloon angioplasty or endovascular stenting. At the end of each EVI, a post-procedure angiography was performed to evaluate the EVIs' results (i.e., balloon angioplasty and endovascular stenting) for PADs on the TASs. The results of EVIs were classified as either satisfactory or unsatisfactory. Satisfactory if the TASs were recanalized or had <30% stenosis after the EVIs. Unsatisfactory if the TASs were still occluded or had >30% stenosis after the EVIs. The mean participants' age was 54.42±7.74 years; 35.3% of them were diabetic, 36.2% were hypertensive, and 28.5% had multiple medical disorders. Based on Rutherford classification, 44.83% of the participants had grade I, category 2 chronic ischemia, 23.28% had grade I, category 3 chronic ischemia, 12.93% had grade II, category 4 chronic ischemia, and 18.96% had grade III, category 5 chronic ischemia. About 87.1% of the participants' PADs were managed using balloon angioplasty. The affected arteries were the superficial femoral arteries in 47.5%, popliteal arteries in 18.8%, posterior tibial arteries in 18.8%, and anterior tibial arteries in 14.9%. About 12.9% of the participants' PADs were managed using endovascular stenting and the affected arteries were the common iliac arteries in 60%, and external iliac arteries in 40%. The results of EVIs were satisfactory in 98.28% of the participants, while it was unsatisfactory in 1.72% of them. Endovascular interventions in this study were an effective and minimally invasive therapeutic option for PADs, with satisfactory results in 98.28%. Further studies, including the long-term and clinical outcomes after EVIs for PADs, are required.

CONGENITAL ABSENCE OF PULMONARY ARTERY

Isolated unilateral absence of a proximal pulmonary main artery is a rare congenital condition with a prevalence of 1 in 200,000 (1). The first case was reported in 1868, and to date, 350 cases have been reported (2). It usually occurs in conjunction with other cardiovascular anomalies such as tetralogy of Fallot, VSD, truncus arteriosus, etc. (2), and is typically diagnosed in childhood. Survival into adulthood is rare. Symptoms of this condition can include shortness of breath, chest pain, hemoptysis, reduced exercise tolerance, pleural effusion, and recurrent infections. We encountered a case of a 22-year-old female presenting with these symptoms. Initially, the symptoms suggested pulmonary embolism. However, further investigation through CTPA and Echocardiography revealed the absence of the left pulmonary artery. This case report emphasizes that patients showing signs and symptoms indicative of PAH should also be evaluated for the absence of a pulmonary artery." The pulmonary arteries originate from the sixth aortic arch during the sixteenth week of normal embryonic development. The proximal segment of the 6th aortic arch forms the initial portion of the right &amp; left pulmonary arteries, respectively. The link on the arch's right side vanishes, whereas it establishes a connection through the ductus arteriosus on the left side. Pulmonary artery agenesis arises from the aberrant rotation of the afflicted segment's attachment to the aortic arch and dysfunctions during migration (3). Certain publications utilize the phrase “proximal blockage of the pulmonary artery” instead of “agenesis” to describe this anomaly. Although the intraparenchymal distal segment of the pulmonary artery is miniature, it is safeguarded (4). The prevalence of bronchopneumonia is ascribed to multiple causes, such as diminished lung tissue perfusion, impaired mucosal defense, and a possible unbalance of protease-antiprotease enzymes. Moreover, increased collateral blood flow may be associated with the onset of hemoptysis.

Comparison of Laminar and Turbulent K–Omega Shear Stress Transport Models Under Realistic Boundary Conditions Using Clinical Data for Arterial Stenosis

Abstract Early diagnosis of cardiovascular diseases (CVDs), including arterial stenosis, enables targeted treatments that reduce CVD mortality. It is vital to improve the accuracy of early diagnostic tools. Current computational studies of stenosis use mathematical models, such as laminar and k–omega shear stress transport (SST) models, available in ansys (Fluent and CFX), openfoam, and comsol software packages. Users can adjust boundary conditions, such as inlet velocity and outlet pressure using user-defined functions (UDFs) with different expressions and constant values. However, currently there is no rule over what to impose at these boundaries, and previous studies have used various assumptions, such as rigid artery wall, one-way fluid–structure interaction (FSI) or two-way FSI, and the blood's Newtonian or non-Newtonian material properties. This variety in construction has associated deviations of the models from the clinical data and lessens the value of the models as potential diagnostic or predictive tools for medical practitioners. In this study, we examine arterial stenosis models, with severities of 20%, 40%, and 50%, compared with the healthy artery analyzed in terms of strain energy to the artery wall. Additionally, we investigate elastic walls using one-way FSI, comparing with laminar and k–omega SST. These boundary conditions are based on clinical data. The results regarding the strain energy (mJ) behavior along the artery wall show that the k–omega SST model outperforms the laminar model for short arterial segments and under the Newtonian assumption with a no-slip boundary wall and turbulent flow.

Successful coronary angioplasty of a spontaneous occlusion of the conus artery causing a ST-segment elevation myocardial infarction and electrical storm

BackgroundConus artery occlusion is a rare life-threatening event, typically secondary to iatrogenic etiology, and is treated mainly with conservative therapy and/or balloon angioplasty without stenting. However, treatment remains challenging.Case presentationWe report the case of a 60-year-old man with a known history of coronary artery disease presenting with multiple internal defibrillator cardioversions due to an electrical storm (recurrent ventricular fibrillation). The coronary angiography showed an acute occlusion of the conus artery arising from the proximal segment of the right coronary artery, treated by percutaneous transluminal coronary angioplasty with stenting (drug-eluting stent) without any serious complications.ConclusionsTo our knowledge, this is the first case in the literature where a non-iatrogenic occlusion of the conus artery causing a ST-segment elevation myocardial infarction and electrical storm was treated with percutaneous coronary intervention with drug-eluting stenting.Graphical abstract

Patients with STEMI after Revascularization: Is There a Relationship Between Coronary Artery Lesion and Renal Function?

The aim. To establish the relationship between coronary bed lesions and glomerular filtration rate (GFR) calculated on the basis of creatinine, cystatin C and urine albumin-creatinine ratio in patients with ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. Materials and methods. We examined 286 patients with STEMI, aged 39 to 87 years (mean age 62.8 ± 9.8, median age 64, interquartile range 56 to 71 years), 202 (70.6%) were men and 84 (29.4%) were women. All the patients underwent general clinical tests, coronary angiography with subsequent percutaneous coronary intervention, and echocardiography. Results. The most frequent infarct-related coronary artery (CA) was the anterior interventricular branch of the left coronary artery in the proximal and middle segments, and the right coronary artery in the proximal segment. In general, there was no significant difference in the number of affected CAs among the examined patients. The division of patients into groups according to the level of GFR, determined both on the basis of creatinine and cystatin C, did not reveal significant differences in the distribution of infarct-related CAs. At the same time, the number of patients with multivessel lesions significantly increases with decreased GFR. Depending on the level of the urinary albumin-to-creatinine ratio, a significant increase in the number of patients with two- and multivessel lesions of the CAs was noted. Conclusions. Close correlations between multivessel lesions of CAs and gender, age, urinary albumin-to-creatinine ratio, GFR, left and right atrial size, duration of history of hypertension and diabetes mellitus, presence of II-III degree atrioventricular block and mortality were established.

AngioPy Segmentation: An open-source, user-guided deep learning tool for coronary artery segmentation

BackgroundQuantitative coronary angiography (QCA) typically employs traditional edge detection algorithms that often require manual correction. This has important implications for the accuracy of downstream 3D coronary reconstructions and computed haemodynamic indices (e.g. angiography-derived fractional flow reserve).We developed AngioPy, a deep-learning model for coronary segmentation that employs user-defined ground-truth points to boost performance and minimise manual correction. We compared its performance without correction with an established QCA system. MethodsDeep learning models integrating user-defined ground-truth points were developed using 2455 images from the Fractional Flow Reserve versus Angiography for Multivessel Evaluation 2 (FAME 2) study. External validation was performed on a dataset of 580 images. Vessel dimensions from 203 images with mild/moderate stenoses segmented by AngioPy (without correction) and an established QCA system (Medis QFR®) were compared (609 diameters). ResultsThe top-performing model had an average F1 score of 0.927 (pixel accuracy 0.998, precision 0.925, sensitivity 0.930, specificity 0.999) with 99.2 % of masks exhibiting an F1 score > 0.8. Similar results were seen with external validation (F1 score 0.924, pixel accuracy 0.997, precision 0.921, sensitivity 0.929, specificity 0.999). Vessel dimensions from AngioPy exhibited excellent agreement with QCA (r = 0.96 [95 % CI 0.95–0.96], p < 0.001; mean difference − 0.18 mm [limits of agreement (LOA): −0.84 to 0.49]), including the minimal luminal diameter (r = 0.93 [95 % CI 0.91–0.95], p < 0.001; mean difference − 0.06 mm [LOA: −0.70 to 0.59]). ConclusionAngioPy, an open-source tool, performs rapid and accurate coronary segmentation without the need for manual correction. It has the potential to increase the accuracy and efficiency of QCA.

FreeClimb 88 catheter with Tenzing 8 delivery for contact aspiration mechanical thrombectomy of anterior circulation large vessel occlusions.

Contact aspiration mechanical thrombectomy (CAMT) with 0.088-inch catheters may improve first-pass success rates, but delivery of such catheters can be challenging and limit effectiveness. This study examines the initial multicenter experience using the FreeClimb 88 catheter paired with the Tenzing 8 delivery catheter. Retrospective analysis was performed of consecutive patients with large vessel occlusion (LVO) of the internal carotid artery (ICA) or M1 segment of the middle cerebral artery treated with off-label CAMT using the FreeClimb 88 and Tenzing 8 at eight sites participating in the early limited release for these devices. Demographic and procedural variables were collected and analyzed with descriptive statistics and multivariable analysis. Fifty-three consecutive patients were treated. Large vessel occlusion was located in the ICA in 19/53 (35.8%) patients; 34/53 (64.2%) were in the M1 segment. FreeClimb 88 was successfully delivered to the site of occlusion in 50/53 (94.3%) of patients. First-pass TICI 2c or 3 was achieved with FreeClimb 88 delivered by Tenzing 8 in 36 (67.9%) cases. Among cases with successful FreeClimb 88 delivery 9/50 (18.0%) required additional smaller devices to perform thrombectomy of distal occlusions after recanalization of the initial LVO. No complications or symptomatic hemorrhages occurred following thrombectomy. Contact aspiration mechanical thrombectomy performed for ICA or M1 LVOs using FreeClimb 88 delivered with Tenzing 8 was safe, effective, and efficient in this early experience, with first-pass TICI 2c or 3 was achieved in 68% of patients without procedural complications occurring in any cases.