Arterial System Research Articles

Dual left anterior descending artery - a clinical entity in search of an identity: A novel classification.

A dual left anterior descending artery (LAD) is not an uncommon anomaly of the coronary arterial system. The earlier classifications by various authors lacked standardization and uniformity and are too complex for clinical usage. Therefore, a new classification in the form of coding system is proposed to facilitate the identification and reporting of the anomaly by the cardiologists to maintain uniformity in reporting, which aids in adequate planning of the revascularization strategies in patients with symptomatic coronary artery disease involving the dual LAD system.

Targeted drug delivery during radioembolization in a comprehensive hepatic artery system: A computational study

Nonresectable liver tumors can be successfully treated with radioembolization (RE) using yttrium-90 (90Y) microspheres. However, hepatocellular carcinoma's therapeutic methods are hindered primarily by the complex arterial morphology of the liver and its high dependence on arteries' geometry to target the tumors. Thus, this study aims to investigate the particle-fluid dynamics of yttrium-90 (90Y) loaded microspheres injected into the blood flow within a comprehensive hepatic artery system consisting of 17 daughter vessels branches. Also, the effect of particles' characteristics (size and density) with two types of commercially available 90Y microspheres, SIR-Spheres and TheraSpheres, and time infusion intervals (various release phases) were studied leading to a total of 20 investigated cases. The results demonstrated the vital influence of flow dynamics on the particles' preference to deposit in specific daughter vessels. Regardless of phase shift, except GDA, outlet 1 receives the largest portion of CHA inflow with nearly 14.5% which consequently implies the highest value of exit fraction after particles injection, and outlet 11 receives the minimum portion of CHA inflow with 1.97%. The maximum and minimum reductions of mean flow rate through the phase shift from acceleration toward minimum phase are for daughter vessels 17 and 10 with nearly 17.7% and 4.8%, respectively. The maximum percentage of particles that remains in the domain after 4 heart cycle simulation time is for glass microspheres consisting of particles with the diameter of 80μm released at t=0 sec, indicating that 25.4% of the injected particles are unable to discharge the domain. Whereas, the minimum percentage (0.16%) of remaining particles is for resin microspheres with a diameter of 20μm released at t=0 sec. Moreover, regardless of particles type, 7 daughter vessels discharge their maximum number of particles at the time point of injection associated with the minimum velocity of CHA flow rate which highlights the significant importance of minimum phase for those daughter vessels, potentially terminating tumor cells. Results exhibit that for none of the daughter vessels, the acceleration phase and peak phase (except for the GDA outlet) are proper time zones to release the 90Y microspheres, regardless of particles type. Finally, to conduct the released particles to particular vessels which are connected to tumor cells, the best radial position of the micro-catheter at the CHA inlet cross-section was identified by generating particle release maps (PRMs) for each investigated case.

Influence of Blood Compressibility on Pulse Wave Propagation Properties Based on Elastic Thin-Walled Tube Theory

Pulse wave carries abundant physiological and pathological data about the human body. Understanding the effect of blood compressibility on the transmission qualities of pulse waves is necessary to detect, cure, and prevent cardiovascular problems. In this research, the fluid–solid coupling finite element analysis model of artery system was developed using COMSOL MultiPhysics software. The influence of blood compressibility on pulse wave propagation properties in the brachial artery was investigated using the blood volume compression modulus. Results show that the influence of blood compressibility on pulse wave propagation is relatively weak and may be ignored when evaluating the compressibility of blood and that the volume compression modulus swings 2GPa over and beyond the typical range of the human body. The influence of blood compressibility on the peak value of pressure pulse wave is minor. The attenuation amplitude of the peak value of a pulse wave is bigger for the case with compressible blood than those of case with incompressible blood, and the difference between compressible and incompressible models is less than 1%. But blood compressibility has a clear impact on pulse wave velocity. It is found that the pulse wave velocity is greater than that of blood flow velocity. These findings will be valuable to investigate deeply for evaluating pressure and velocity pulse waves, as well as in providing a waveform-based preliminary diagnosis of symptoms in human body.

Ultrasonic hemodynamic changes of superficial temporal artery graft in different angiogenesis outcomes of Moyamoya disease patients treated with combined revascularization surgery.

Combined bypass is commonly used in adult Moyamoya disease (MMD) for revascularization purposes. The blood flow from the external carotid artery system supplied by the superficial temporal artery (STA), middle meningeal artery (MMA), and deep temporal artery (DTA) can restore the impaired hemodynamics of the ischemic brain. In this study we attempted to evaluate the hemodynamic changes of the STA graft and predict the angiogenesis outcomes in MMD patients after combined bypass surgery by using quantitative ultrasonography. We retrospectively studied Moyamoya patients who were treated by combined bypass between September 2017 and June 2021 in our hospital. We quantitatively measured the STA with ultrasound and recorded the blood flow, diameter, pulsatility index (PI) and resistance index (RI) to assess graft development preoperatively and at 1 day, 7 days, 3 months, and 6 months after surgery. All patients received both pre- and post- operative angiography evaluation. Patients were divided into either well- or poorly-angiogenesis groups according to the transdural collateral formation status on angiography at 6 months after surgery (W group or P group). Patients with matshushima grade A or B were divided into W group. Patients with matshushima grade C were divided into P group, indicating a poor angiogenesis development. A total of 52 patients with 54 operated hemispheres were enrolled, including 25 men and 27 women with an average age of 39 ± 14.3 years. Compared to preoperative values, the average blood flow of an STA graft at day 1 postoperation increased from 16.06 ± 12.47 to 117.47± 73.77 (mL/min), diameter increased from 1.14 ± 0.33 to 1.81 ± 0.30 (mm), PI dropped from 1.77 ± 0.42 to 0.76 ± 0.37, and RI dropped from 1.77 ± 0.42 to 0.50 ± 0.12. According to the Matsushima grade at 6 months after surgery, 30 hemispheres qualified as W group and 24 hemispheres as P group. Statistically significant differences were found between the two groups in diameter (p = 0.010) as well as flow (p = 0.017) at 3 months post-surgery. Flow also remained significantly different at 6 months after surgery (p = 0.014). Based on GEE logistic regression evaluation, the patients with higher levels of flow post-operation were more likely to have poorly-compensated collateral. ROC analysis showed that increased flow of ≥69.5 ml/min (p = 0.003; AUC = 0.74) or a 604% (p = 0.012; AUC = 0.70) increase at 3 months post-surgery compared with the pre-operative value is the cut-off point which had the highest Youden's index for predicting P group. Furthermore, a diameter at 3 months post-surgery that is ≥0.75 mm (p = 0.008; AUC = 0.71) or 52% (p =0.021; AUC = 0.68) wider than pre-operation also indicates a high risk of poor indirect collateral formation. The hemodynamic of the STA graft changed significantly after combined bypass surgery. An increased flow of more than 69.5 ml/min at 3 months was a good predictive factor for poor neoangiogenesis in MMD patients treated with combined bypass surgery.

A Young Healthy Woman with Supraventricular Tachycardia Reveals an Underlying Left Ventricular Non-compaction Cardiomyopathy: A Rare Case Report

LVNC (left ventricular non-compaction) is a rare congenital cardiomyopathy with a reported incidence of 0.05% in adults. It can occur in isolation or affect both ventricles. It’s characterized by prominent LV trabeculae and deep intertrabecular recesses which are filled with blood from the ventricular cavity without evidence of communication to the epicardial coronary artery system. Frequent premature supra ventricular tachycardia as unique finding in LVNC cardiomyopathy is rare manifestation of this disease. We report a case of a frequent persistent supraventricular tachycardia as first manifestation of a patient with LVNC cardiomyopathy in a young healthy woman who despite radio frequency ablation therapy of the supraventricular tachycardia remains symptomatic. The patient was later placed on medical therapy based on a non-cardio selective beta-blocker with a good clinical outcome without recurrent of supra-ventricular arrythmias.

The Hibiscus Model: A Feasible Cadaveric Model Using Continuous Arterial Circulation for Intracranial Bypass Training and Its Validation

The frequency of intracranial bypass procedures has declined. Thus it is difficult for neurosurgeons to develop the necessary skills for this complex procedure. We present a perfusion-based cadaveric model to provide a realistic training experience with high anatomic and physiological fidelity, as well as instantaneous assessment of bypass patency. Validation was assessed by evaluating the educational impact and skill improvement of the participants. Fourteen participants attended a hands-on revascularization course with 7 cadaveric models connected to a continuous arterial circulation system pumping a red-colored solution through the entire cranial vasculature, mimicking blood circulation. The ability to perform a vascular anastomosis was evaluated initially. Further, a questionnaire on prior experience was provided. At the end of the 36-hour course, the ability to perform an intracranial bypass was reexamined and the participants completed a self-assessment questionnaire. Initially, only 3 attendees were able to perform an end-to-end anastomosis within the time limit, and only 2 of these anastomoses showed adequate patency. After having accomplished the course, all participants were able to complete a patent end-to-end anastomosis within the time limit, thus demonstrating a significant improvement. Further, both overall educational gain and surgical skills were regarded as remarkable (n= 11 and n= 9). Simulation-based education is considered an important aspect of medical and surgical development. The presented model is a feasible and accessible alternative to the prior models used for cerebral bypass training. This training may serve as a helpful and widely available tool to improve neurosurgeons' development irrespective of financial resources.

Automatic cerebral computed tomography venographic imaging based on the prior knowledge of cerebral blood circulation

Background and purposeCurrent clinical computed tomography venographic (cCTV) images present limited cerebral venous profiles. Therefore, this study aimed to develop an automatic cerebral CTV imaging technique using computed tomographic perfusion (CTP) images in a cohort of patients with stroke. Materials and MethodsWe retrospectively evaluated 10 (intracerebral hemorrhage) and 2 (acute ischemic stroke) patients who underwent institutional CTP imaging. CTV images were processed with the proposed CTV (pCTV) technique, and pCTV and cCTV images were then independently evaluated by two experienced neuroradiologists blinded to all clinical information using a novel scoring method that considered overall image quality, venous visibility, and arterial mis-segmentation. Venous visibility was separately evaluated for the dural sinus, superficial vein, and deep vein. Then, statistical analysis was performed to determine whether the pCTV technique was superior to the cCTV technique. ResultsIn total, 14 sets of pCTV images were generated and compared with cCTV images. The overall image quality and venous visibility scores of pCTV images were significantly higher than those of cCTV images (all values of p<0.05), especially for the dural sinus (median [25th, 75th percentiles], 14.00 [13.63, 15.50] vs. 7.50 [7.00, 10.88]), and superficial vein (9.00 [8.88, 10.00] vs. 3.25 [1.63, 8.25]), while the difference in arterial mis-segmentation was not statistically significant (p= 0.164). ConclusionsThis study proposed an automatic cerebral CTV imaging technique to eliminate residual bone and soft tissues, minimize the impact of the cerebral arterial system, and present a relatively comprehensive cerebral venous system, which would help physicians assess cerebral venous outflow profiles after stroke and seek imaging markers associated with clinical outcomes.

Analysis of Anatomical Variations of Hepatic Arterial System and Coeliac Trunk in Multi Detector Computed Tomography

Analysis of Anatomical Variations of Hepatic Arterial System and Coeliac Trunk in Multi Detector Computed Tomography

Facilitating intra arterial chemotherapy with an implanted arterial access system

Facilitating intra arterial chemotherapy with an implanted arterial access system

Perspectives.

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Issues in Medicine.

Rasmussen aneurysms are abnormalities of the pulmonary arterial system caused by tuberculosis (TB). They are associated with a highmortality rate when they cause life-threatening haemoptysis. High TB-prevalence regions have a large burden of TB-related haemoptysisbut often limited resources. This series of 25 patients who presented with life-threatening haemoptysis from current and/or previous TBwere found to have abnormal pulmonary arteries on computed tomography pulmonary angiogram (CTPA), which were judged to belikely contributors to their bleeding, either in isolation or with concomitant abnormal bronchial or systemic vasculature. These patientsunderwent transcatheter placement of Amplatzer vascular plugs in the feeder pulmonary artery. Bronchial and systemic lesions wereaddressed separately as needed. Immediate technical success was achieved in all patients, but four of them experienced intraoperativehaemoptysis related to dislodgement of the occluding platelet plug by the high-pressure automatic injector and wire. At 48 hours after theprocedure, 18 (72%) remained haemoptysis-free. Six of these experienced recurrence within 1 year of their procedure. Pulmonary arteryplacement of an Amplatzer vascular plug is a feasible option for treating bleeding Rasmussen aneurysms, but should be part of a combinedapproach to addressing suspected culprit vascular lesions in all intrathoracic vascular systems.

Possibilities of the Hybrid Method (Three-Phase Scintigraphy-SPECT/CTAngiography) in the Diagnosis and Staging of Acute Lower Limb Ischemia

ABSTRACT Acute lower limb ischemia (ALLI) is a limb threatening condition with high risk of adverse outcomes. The timely and proper diagnosis of the severity of limb ischemia is crucial in selecting the optimal treatment method.AIM OF STUDY To evaluate the advantages of hybrid imaging in diagnosis of ALLI, patient selection and its severity in order to choose an optimal revascularization method.MATERIAL AND METHODS we examined 163 patients with grade 1–3A ALLI based on I.I. Zatevakhin et al. classification (2002) on a Discovery 670 NM/CT hybrid device, using X-ray (computed tomographic angiography) and radionuclide method (three-phase scintigraphy/single photon emission computed tomography with osteotropic or perfused radiopharmaceutical).RESULTS CT angiography accurately showed level of acute occlusion as well as distal arterial blood flow in all ALLI cases, thus allowing optimal choice of possible revascularization. CT angiography findings alone did not allow optimal staging of ALLI, which is essential for choosing an optimal revascularization method and were considered as supplementary. Three-phase scintigraphy allowed to differentiate the degrees of ALLI based on the visual picture and calculated data, while studies with osteotropic radiopharmaceutical 99mТс-PYP provided information on viability of affected tissues showing the areas of muscle necrosis, compared to perfused radiopharmaceutical.CONCLUSION 1. CT angiography makes it possible to assess in detail the level and severity of occlusive lesions of the arterial system and study the vascular anatomy of the lower limb to resolve the issue of the possibility of revascularization, and also indirectly characterizes the presence of ischemic changes in soft tissues. 2. The radionuclide method (three-phase scintigraphy with an osteotropic radiopharmaceutical/single photon emission computed tomography), performed in addition to computed tomographic angiography, allows not only to detect the presence of ischemic changes in soft tissues, but also to differentiate the degree of acute ischemia of the lower. 3. The hybrid method (three-phase scintigraphy in combination with computed tomographic angiography) contributes to an objective assessment of the state of blood flow in the lower extremities in acute ischemia, both at the main and at the microcirculatory

Redistribution of Perfusion and Myocardial Function in Patients With Multivessel Disease and Myocardial Infarction With ST Segment Elevation After Recanalization of an Infarct-Associated Artery According to the Results of Single Photon Emission Computed Tomography, Synchronized With Electrocardiography

BACKGROUND Numerous studies have shown that coronary reperfusion with primary percutaneous coronary intervention (PCI) improves outcomes in patients with ST-segment elevated myocardial infarction (STEMI). However, the question of the effect on the myocardium as a whole of an isolated intervention on an infarct-related artery in multivessel coronary disease remains incompletely studied.AIM OF STUDY To study the features of perfusion redistribution and myocardial function using perfusion single photon emission computed tomography (SPECT) in patients with STEMI and multivessel coronary disease after isolated PCI on an infarct-related artery.MATERIAL AND METHODS SPECT-ECG (electrocardiography) was performed in 32 patients (27 men and 5 women) with STEMI. According to the ECG results, the location of focal myocardial changes was regarded as “lower” MI in 19 (59%) patients, “anterior” in 13 patients (41%). Coronary angiography revealed a multivessel lesion of the coronary vessels in all of them. The patients were divided into groups according to the location of the infarction and the area of the lesion: group 1 — lower MI (stenting of the right coronary artery (RCA) and its branches) — 19 patients (mean age — 57.7±2.5; median — 55 [51.5; 63.5]), of which 8 with small-focal (1a) and 11 with large-focal infarction (1b); group 2 — anterior MI (stenting of the left coronary artery (LCA) and its branches) — 13 patients (mean age — 55.4±3.5; median — 54 [48.5; 62.5]), of which 5 with small-focal (2a) and 8 with large-focal infarction (2b). SPECT-ECG was performed 3 times: 1st — on days 2–3 after PCI of the infarct-related artery, 2nd — 6 days after PCI, and 3rd — 6 months after PCI.RESULTS After RCA stenting in patients with lower MI and multivessel coronary disease, SPECT-ECG revealed a statistically significant decrease in local contractility of individual segments of the anterior septal and lateral walls (with sufficient revascularization of the RCA system) and worsening of perfusion and right ventricular (RV) volumes. After stenting of the LCA branches in patients with anterior MI and multivessel coronary disease, a statistically significant decrease in local contractility in the basal segment of the diaphragmatic wall was observed, as well as impaired perfusion and an increase in the volume of the RV (with successful revascularization of the anterior interventricular branch). All these findings could be the result of partial steal of the blood supply to neighboring areas and myocardial remodeling after PCI in patients with multivessel coronary artery disease.CONCLUSION 1. According to the data of single-photon emulsion computed tomography synchronized with electrocardiography in the early and late period of myocardial infarction after percutaneous coronary intervention in patients with multivessel coronary disease, there is a significant improvement in perfusion and function of the infarct-associated artery system. 1. Recanalization of only the left coronary artery with remaining stenoses in the right coronary artery in the long-term period can lead to an increase in the size of the cavity of the right ventricle of the heart and uneven distribution of perfusion in its The revealed statistically significant disturbances in perfusion and local contractility of neighboring areas after percutaneous coronary intervention of an infarct-related artery may be the result of steal of the blood supply and early myocardial remodeling in multivessel disease. 3. Disturbances in perfusion and local contractility in neighboring myocardial blood supply pools after percutaneous coronary intervention of an infarct-related artery dictates the need to repeated single-photon emulsion computed tomography synchronized with electrocardiography as early as possible in patients with multivessel coronary disease in order to assess the redistribution of perfusion and myocardial remodeling for timely complete revascularization, preventing recurrent coronary

Traumatic basal subarachnoid haemorrhage

Traumatic basal subarachnoid haemorrhage (TBSAH) refers to a severe basal centred bleed, almost invariably resulting from a micro-tear or in exceptional circumstances a more lengthy dissection of the intracranial vertebrobasilar arterial system. This is typically caused by an impact to the side of the upper neck, angle of jaw and/or ear/mastoid region. TBSAH is typically associated with an immediate comatose state, often accompanied by the intervention of cardiorespiratory arrest. Delayed presentations are rare but do occur and may be related to dissections or traumatic false aneurysms. The forensic approach to cases of suspected TBSAH can be a very rewarding exercise if carried out with due diligence and technique as this may yield evidence informative on (i) any predisposing vasculopathy enhancing susceptibility to tearing, (ii) whether undue force was implicated and (iii) incontrovertible, pathognomonic evidence of a mechanical basis of rupture confirming overstretching of the vessel, thus ruling out natural disease such as a berry aneurysm. The main focus of this presentation will be to discuss optimum techniques addressing these issues. Whilst the source of haemorrhage is intracranial, best practice includes examination of the extracranial vertebral arteries which does not need to be an onerous task.

A randomized, double-blind, placebo-controlled, multicenter trial- DL-3-n-butylphthalide therapy for cerebral hypoperfusion from unilateral internal carotid system stenosis study: study protocol

Background: Cerebral hypoperfusion caused by large-vessel stenosis is an important risk factor for ischemic stroke and vascular cognitive impairment. In vitro, animal and clinic studies demonstrated that DL-3-n-butylphthalide (NBP) can improve the collateral circulation and the cerebral perfusion. In this trial, the benefit of NBP to ameliorate the chronic cerebral hypoperfusion resulting from unilateral internal carotid system stenosis will be explored. Methods: This trial is a randomized, double-blind, placebo-controlled, multicenter clinical study. A total 480 subjects with ≥70% stenosis or occlusion in unilateral internal carotid artery system, cerebral hypoperfusion in the ipsilateral middle cerebral artery (MCA) territory, and no transient ischemic attacks (TIA) or ischemic strokes within 2 weeks will be enrolled in China. Patients will be assigned in a 1:1 ratio to NBP and placebo groups. Patients in NBP or placebo group received 200 mg or 20 mg of NBP capsules three times daily for 4 weeks respectively. The cerebral perfusion will be assessed again after 12 weeks. The primary efficacy outcome is the proportion of patients with cerebral blood flow (CBF) amelioration, stabilization and deterioration after treatment. Conclusions: This trial will provide a high-level of evidence for NBP to treat the cerebral hypoperfusion, and a novel strategy to improve the cerebral hemodynamic impairment due to large intracranial and extracranial atherosclerotic stenosis in the surgical high-risk patients, especially in the aged and Asians. Trial registration: This trial is registered as ChiCTR2100053112 on November 12th, 2021.

The association between glycemia and clinical outcomes in patients with diabetes mellitus and pulmonary thromboembolism.

Various studies have shown that diabetes mellitus (DM) increases the risk of thrombosis in the venous system as well as in the arterial system. In this study, it was aimed to evaluate the association between admission blood glucose levels and clinical severity, recurrence, and mortality in pulmonary embolism in patients with DM. This study was designed as a retrospective cross-sectional study. Patients with DM who were admitted to a tertiary care hospital due to pulmonary embolism (PE) between 2014 and 2019 were included. Demographic characteristics, radiological findings, clinical class of embolism, and mortality data were retrieved from hospital records. Patients with and without recurrent disease, as well as patients who survived and died, were compared. Also, patients were classified according to quartiles of admission blood glucose levels. The quartiles were compared in terms of mortality, clinical, class, and recurrence. Two hundred ninety-three patients with DM and PE were included in the study. Patients with adverse outcome had significantly higher admission blood glucose levels (respectively, 197.9 ± 96.30 mg/dL vs. 170.7 ± 74.26 mg/dL; p = 0.03). Patients in the third and fourth quartile of admission blood glucose levels (>152 mg/ dL) had significantly more severe disease with a higher proportion of massive and sub-massive PE and higher pro-BNP levels (respectively, p = 0.01 and 0.02). Non-survived patients and recurrent disease were associated with higher admission blood glucose levels. Also, patients with admission blood glucose levels higher than 152 mg/dL tend to have clinically more severe diseases.

Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement

This case describes an 84-year-old female with chronic diastolic heart failure, coronary artery disease status post coronary artery bypass and percutaneous coronary intervention, hypertension, diabetes mellitus and chronic kidney disease stage III, who presented with progressive dyspnea found to have severe aortic stenosis demonstrated by echocardiogram (aortic valve area, .06 ^cm2; mean gradient, 42 mm Hg). She was evaluated by the Heart Team and deemed to be a candidate for a transfemoral transcatheter aortic valve replacement (TAVR) after computed tomography angiography (CTA) evaluation. During insertion of the valve sheath through the external iliac, intimal “snowplowing” occurred resulting in complete occlusion of the iliac artery. The intima was successfully milked back into anatomical position using a “reverse snowplow” technique. Extravasation was managed with covered stents. The patient recovered over several days and was discharged home on post-procedure day 7. When appropriate, Endovascular management of vascular complications avoids the morbidity associated with open repair. Pre-operative evaluation is imperative in identifying anatomical features that pose a risk to vascular complications. This patient had an increased risk with an elevated iliofemoral tortuosity score, however, had minimal calcification and no acute angulation in the iliofemoral arterial system. This case highlights the complexity of vascular complication management and difficulty faced in identifying patients who are at risk for these types of complications.

TP53-mediated clonal hematopoiesis confers increased risk for incident atherosclerotic disease.

Somatic mutations in blood indicative of clonal hematopoiesis of indeterminate potential (CHIP) are associated with an increased risk of hematologic malignancy, coronary artery disease, and all-cause mortality. Here we analyze the relation between CHIP status and incident peripheral artery disease (PAD) and atherosclerosis, using whole-exome sequencing and clinical data from the UK Biobank and Mass General Brigham Biobank. CHIP associated with incident PAD and atherosclerotic disease across multiple beds, with increased risk among individuals with CHIP driven by mutation in DNA Damage Repair (DDR) genes such as TP53 and PPM1D. To model the effects of DDR-induced CHIP on atherosclerosis, we used a competitive bone marrow transplantation strategy, and generated atherosclerosis-prone Ldlr-/- chimeric mice carrying 20% p53-deficient hematopoietic cells. The chimeric mice were analyzed 13-weeks post-grafting and showed increased aortic plaque size and accumulation of macrophages within the plaque, driven by increased proliferation of p53-deficient plaque macrophages. In summary, our findings highlight the role of CHIP as a broad driver of atherosclerosis across the entire arterial system beyond the coronary arteries, and provide genetic and experimental support for a direct causal contribution of TP53-mutant CHIP to atherosclerosis.

Persistent trigeminal artery incidentally found in a patient with brain posterior system infarction: a rare case report

The persistent trigeminal artery (PTA) is a persistent, primitive, embryonic anastomosis that provides the blood flow between the vertebro-basilar system and the carotid system. The presence of PTA anastomosis may create an advantage by providing collateral circulation during a stroke as in cases of leptomeningeal collaterals, external-internal carotid artery anastomoses, and the polygon of Willis. However, patients with this variation are more susceptible to the development of non-occlusive posterior arterial system infarction when they experience hypotension attacks. In the literature, there are only few case reports on non-occlusive posterior system infarction associated with PTA variation. In this case report, we present to an 81-year-old patient with posterior system infarct findings and persistent trigeminal artery variation.

Milk Fat Globule Epidermal Growth Factor VIII Fragment Medin in Age-Associated Arterial Adverse Remodeling and Arterial Disease.

Medin, a small 50-amino acid peptide, is an internal cleaved product from the second discoidin domain of milk fat globule epidermal growth factor VIII (MFG-E8) protein. Medin has been reported as the most common amylogenic protein in the upper part of the arterial system, including aortic, temporal, and cerebral arterial walls in the elderly. Medin has a high affinity to elastic fibers and is closely associated with arterial degenerative inflammation, elastic fiber fragmentation, calcification, and amyloidosis. In vitro, treating with the medin peptide promotes the inflammatory phenotypic shift of both endothelial cells and vascular smooth muscle cells. In vitro, ex vivo, and in vivo studies demonstrate that medin enhances the abundance of reactive oxygen species and reactive nitrogen species produced by both endothelial cells and vascular smooth muscle cells and promotes vascular endothelial dysfunction and arterial stiffening. Immunostaining and immunoblotting analyses of human samples indicate that the levels of medin are increased in the pathogenesis of aortic aneurysm/dissection, temporal arteritis, and cerebrovascular dementia. Thus, medin peptide could be targeted as a biomarker diagnostic tool or as a potential molecular approach to curbing the arterial degenerative inflammatory remodeling that accompanies aging and disease.