Artery Trunk Research Articles

Technical aspects of hybrid interventions for multilevel lesion of brachiocephal arteries. Literature review

Carotid artery stenosis is one of the leading causes of ischemic strokes and accounts for about 20 % of all strokes. The widespread use of radiological diagnostic methods and recommendations for the carotid artery stenosis patients management led to the identification of atypical forms of damage to the brachiocephalic arteries — a combination of multi-level stenoses of extra and intracranial localization. Multilevel lesion of brachiocephalic arteries is characterized by a combination of hemodynamically significant stenosis of the internal carotid artery in combination with stenosis of the common carotid artery or brachiocephalic trunk. The prevalence of tandem lesions varies from 0.5 to 6.4 %. Despite the rarity of this pathology, the risk of ischemic complications against the background of tandem stenosis of the brachiocephalic arteries is higher than with a single-level lesion. The surgical intervention strategy should provide for the correction of both stenosis, which can be achieved in three ways: endovascular method, open prosthetics and hybrid method. The essence of the hybrid technique is the simultaneous correction of the distal and proximal zones of stenosis by one surgical team in a hybrid operating room. The aim of the study is to review the available literature data and to demonstrate the developed hybrid intervention technique with a detailed description of the technical aspects of all stages of the surgery.

A Simple Technique for Deploying the SENTINEL Cerebral Protection System in Bovine Aortic Arch Anatomy

The SENTINEL Cerebral Protection System is one of the most commonly used devices for embolic protection during transcatheter aortic valve replacement. However, successful deployment of the SENTINEL device is often challenging in patients with a bovine aortic arch anatomy using the standard technique and requires extensive manipulation in the aortic arch increasing the risk of stroke. We describe a novel and simple technique of 2-filter deployment of SENTINEL device in patients with bovine arch anatomy. In this technique, after the deployment of the proximal filter, the device is hyperflexed on itself facing the lateral aspect of the ascending aorta instead of facing the descending aorta, with its tip pointing toward the common origin of the left common carotid artery (LCCA) and brachiocephalic trunk. The guidewire is then advanced to the LCCA. Since the guidewire can pass either anterior or posterior to the device shaft, the device needs to be untwisted either by clockwise or counterclockwise motion, before pulling the device shaft back to engage the LCCA, after which the distal filter can be deployed. Computed tomography scans obtained for planning transcatheter aortic valve replacement should be reviewed for the presence of bovine aortic arch anatomy so that this technique can be deployed directly, thereby reducing manipulations in the aortic arch, saving time, and not requiring additional equipment.

Pulmonary Atresia (PA) with Anomalous Origin of the Pulmonary Artery

Pulmonary atresia with ventricular septal defect is a severe form of congenital cyanotic heart disease (TOF) but its not very common form. Here main pulmonary does not arises from common arterial trunk. In pulmonary atresia there is no proper formation ofthe pulmonary valve which allows blood from the heart to thelung of patient. Instead of opening and closing of the valve,a solid sheet of tissue develops. Therefore blood cannot flow by its normal path to take oxygen from the lung. Instead, inadequate blood travels to the lung through other natural routes within the heart and its arteries and presenting degree of pulmonary atresia or discontinuity in arteries. MDCT gave structural details in this regard. So, role of MDCT play an important role to evaluate the details important information needed in preoperative evaluation for surgical policy in atretic patients. Here we discuss a case of pulmonary atresia (PA) with anomalous origin of the pulmonary artery.KYAMC Journal Vol. 14, No. 02, July 2023: 102-104.

Medial-type persistent trigeminal artery and ipsilateral posterior communicating artery supplying bilateral posterior cerebral arteries combined with an aberrant right subclavian artery and bicarotid trunk.

To describe a case of a medial-type persistent trigeminal artery (PTA) associated with multiple arterial variations. A 34-year-old woman with multiple sclerosis underwent cranial magnetic resonance (MR) angiography from the aortic arch to the neck region and intracranial region for the evaluation of an unruptured cerebral aneurysm that was previously detected on MR imaging. The MR machine was a 3-T scanner. There was an aberrant right subclavian artery and bicarotid trunk, medial-type left PTA and ipsilateral posterior communicating artery (PCoA) supplying bilateral posterior cerebral arteries (PCAs). The unruptured aneurysm was located at the paraclinoid segment of the left internal carotid artery and was treated successfully by coil embolization via a transfemoral approach. Only 10% of PTAs are classified as the medial type. The association with extremely large ipsilateral PCoA, which supplies the bilateral PCAs, has not been previously reported. Aberrant right subclavian arteries are common and are frequently associated with a bicarotid trunk. Before catheterization of the cerebral arteries, the aortic arch and its branches must be evaluated by MR angiography or computed tomography angiography to prevent catheterization failure via the right transradial approach.

EP24.45: Common arterial trunk type 1 (by Collett and Edwards) – type A1 (by Van Praagh and Van Praagh) at 22 weeks

EP24.45: Common arterial trunk type 1 (by Collett and Edwards) – type A1 (by Van Praagh and Van Praagh) at 22 weeks

Energy device injury. Common basilar arterial trunk injury with harmonic scalpel.

Energy device injury. Common basilar arterial trunk injury with harmonic scalpel.

Anatomic Variants in the Anterior Inferior Cerebellar Artery Encountered During Resection of Vestibular Schwannomas.

Vestibular schwannomas (VS) are often phenotypically benign lesions that may be technically challenging to resect because of involvement of neurovascular structures. The anterior inferior cerebellar artery (AICA) is commonly identified near VS, with variable position in relation to the tumor; however, little published literature describes anatomic and pathologic variants of AICA observed during VS resection. A prospectively maintained cohort of surgically managed VS with available operative reports and clinical/radiographic follow-up was queried and reviewed for noted aberrations. We identified 66 cases with noted AICA abnormalities among 880 reviewer cases, including 20 loops extending into the internal auditory canal (2.3%), 18 arteries embedded in dura (2.0%), 15 AICA branches directly within VS (1.7%), 8 main trunk arteries coursing between cranial nerves 7 and 8 (0.9%), 3 arteries embedded in temporal bone (0.2%), 1 aneurysm (0.1%), and 1 artery bifurcating cranial nerve 6 (0.1%). The median age of AICA-variant patients was 55 years (range 19-74), and 29 were female (45%). Compared with the other AICA variants, tumors embedded with AICA tended to be larger lesions on maximal axial diameter (2.9 vs 1.6 cm; P = .006), they more commonly underwent less than total resection (73% vs 28%; P = .0001), and they had higher rates postoperative House-Brackmann scores >2 (47% vs 20%; P = .005). Two patients had radiographic and symptomatic postoperative cerebral ischemia or hemorrhage-1 from a bone-encased AICA and 1 from a dural embedded variant. Anatomic variants of AICA occur in approximately 7% of VS operations. Most aberrations do not affect surgical or clinical outcomes, and the rate of major vascular injury was low. However, certain types variably add operative time and in the case of AICA encasement in the tumor, likely indicate a more aggressive tumor phenotype with lower rates of gross total resection and high incidences of facial nerve weakness.

Common arterial trunk repair after infancy.

Common arterial trunk repair after infancy.

Criss-cross pulmonary arteries in common arterial trunk – Implications to management and outcome

ObjectivesTo investigate the incidence, types and pathophysiology of criss-cross pattern of the proximal pulmonary arteries in common arterial trunk and its influence on management and outcomes. MethodsRetrospective review of all patients with common arterial trunk who underwent Aswan Truncus Operation with regard to the origin and course of the proximal pulmonary artery branches as defined by 3D segmented models pre, immediately and 1 and 2 years after operation. ResultsBetween January 2019 and September 2022, 39 patients (19 males, aged 1–12 months) underwent the Aswan Truncus Operation. 18 patients (46%) had criss-cross arrangement of the proximal pulmonary artery. The mortality, ICU and hospital stay were not affected by the presence or absence of the criss-cross pattern. However, following operation in the criss-cross group, there was evidence of different degrees of kinking and twisting of the right pulmonary artery. This resulted in severe narrowing which required stenting or reoperation at different stages (1 during ICU stay and another after 1 year). Separate origin of the left pulmonary artery (Criss-cross Type 2) from a long stenotic ductus arteriosus required resection of the stenotic segment followed by anastomosis to the right pulmonary artery recreating a 60° angle of bifurcation. ConclusionCriss-cross pattern of proximal pulmonary arteries is common in patients with common arterial trunk. Pre-operative diagnosis and tailored approaches of repair are required to prevent late complications.

Clinical application of superselective transarterial embolization of renal tumors in zero ischaemia robotic-assisted laparoscopic partial nephrectomy.

To assess the feasibility and safety of zero ischaemia robotic-assisted laparoscopic partial nephrectomy (RALPN) after preoperative superselective transarterial embolization (STE) of T1 renal cancer. We retrospectively analyzed the data of 32 patients who underwent zero ischaemia RALPN after STE and 140 patients who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN). In addition, we selected 35 patients treated with off-clamp RALPN (O-RALPN) from September 2017 to March 2022 for comparison. STE was performed by the same interventional practitioner, and zero ischaemia laparoscopic partial nephrectomy (LPN) was carried out by experienced surgeon 1-12 hours after STE. The intraoperative data and postoperative complications were recorded. The postoperative renal function, routine urine test, urinary Computed Tomography (CT), and preoperative and postoperative glomerular filtration rate (GFR) data were analyzed. All operations were completed successfully. There were no cases of conversion to opening and no deaths. The renal arterial trunk was not blocked. No blood transfusions were needed. The mean operation time was 91.5 ± 34.28 minutes. The mean blood loss was 58.59 ± 54.11 ml. No recurrence or metastasis occurred. For patients with renal tumors, STE of renal tumors in zero ischaemia RALPN can preserve more renal function, and it provides a safe and feasible surgical method.

Anatomical feasibility of a 'semi-custom' unibody single-branch endograft in previous zone 2 thoracic endovascular aortic repair.

The aim of this study was to evaluate the suitability of a subclavian unibody single-branch endograft among patients treated with thoracic endovascular aortic repair (TEVAR) in landing zone 2 (LZ2). This is a pre-clinical, single-centre, real-world, all-comers, retrospective cohort study. Patients treated with TEVAR in LZ2 with an available preoperative computed tomography angiography were included. The primary outcome was the anatomical feasibility of the Castor endograft in patients receiving endovascular treatment in LZ2 between 1999 and 2022. Secondary outcomes were: a comparison of feasible and unfeasible patients; frequencies and description of exclusion causes; non-feasibility risk factor analysis; and analysis of the stent graft configurations necessary to treat 75% of the patients. A logistic regression model was used to find associations between baseline morphological data and non-feasibility. A total of 473 procedures were performed and 72 patients fulfilling inclusion criteria were included. The mean distance between the left carotid artery and left subclavian artery (or between innominate artery and bovine trunk) was 12.4 ± 5.2 mm and its average diameter was 33.0 ± 10.6 mm. The pre-vertebral left subclavian artery's diameter and length were 11.3 ± 2.5 and 38.7 ± 10.8 mm. Forty-nine (68.1%) patients were suitable for Castor implantation. Twenty-one configurations were required to treat 75% of feasible patients and might be lowered to 12 configurations applying less strict criteria. The Castor endograft was anatomically feasible in several patients requiring TEVAR in LZ2. Three-quarters of feasible patients could be treated with a reasonable number of configurations, paving the path for future off-the-shelf applications.

Retracted: Conservative Therapy vs. Endovascular Approach for Intracranial Vertebrobasilar Artery Trunk Large Aneurysms: A Prospective Multicenter Cohort Study.

[This retracts the article DOI: 10.1155/2022/9682507.].

Long-term results of percutaneous coronary interventions in lesions of the left coronary artery trunk

Long-term results of percutaneous coronary interventions in lesions of the left coronary artery trunk

Surgical outcomes of common arterial trunk repair beyond infancy.

The aim of this study is to analyze the clinical outcomes of common arterial trunk repair beyond infancy in terms of both early- and long-term outcomes. Between January 2003 and December 2019, 56 patients underwent repair for common arterial trunk beyond infancy at our institute. Median age was 34.5months, 51.8% were females, and 48.2% were males. 48.2% were type 1, 46.4% were type 2, and 5.4% were type 3. 17.9% patients underwent direct connection technique for right ventricular outflow tract reconstruction; remaining received a conduit. The most common type of truncal valve anatomy was tricuspid (82.1%). Early mortality was 7%. Univariable analysis identified age (p = 0.003), weight (p = 0.04), duration of ventilation (p = 0.036), and pulmonary hypertensive crisis (p ≤ 0.001) as factors affecting early mortality. In our overall cohort of beyond infancy repair for common arterial trunk, at 10years, the survival, freedom from reintervention for right ventricular outflow tract reconstruction, freedom from ≥ moderate conduit obstruction, freedom from impaired right ventricle function, and freedom from ≥ moderate truncal valve regurgitation were 76.7%, 89.7%, 74%, 88.6%, and 66.3%, respectively. Repair for common arterial trunk in patients presenting beyond 1year of age is challenging; however, it can be done with satisfactory early and late outcomes in terms of mortality and reintervention.

PR and QRS interval changes after transcatheter pulmonary valve replacement in children

BackgroundChanges in PR intervals after transcatheter pulmonary valve replacement (TCPVR) have not been thoroughly evaluated in children. This study evaluated the changes in PR and QRS intervals six months after TCPVR in children with congenital heart disease.ResultsThis study included 41 patients who underwent TCPVR from 2010 to 2022. ECG of patients was reviewed before and six months after TCPVR, and the PR and QRS intervals were reported. Right ventricular systolic pressure (RVSP) was retrieved indirectly from echocardiography and compared pre- and 6-months after TPVR. The median age was 13 years (25th–75th percentiles: 11–16), and 61% were males. The preoperative diagnosis was tetralogy of Fallot (n = 29, 71%), transposition of great vessels (n = 4, 10%), common arterial trunk (n = 3, 7%), pulmonary valve stenosis (n = 3, 7%) and pulmonary atresia (n = 2, 5%). The Melody valve was used in 30 patients, and Edwards Sapien was used in 11 patients. RVSP was significantly reduced six months after the procedure (pre-RVSP 40 (30–55) mmHg vs. post-RVSP 25 (20–35) mmHg; P < 0.001). The PR interval was 142 (132–174) msec before TPVR and 146 (132–168) msec post-TCPVR (P = 0.442). Post-TPVR PR was positively related to the pre-PR (β: 0.79 (0.66–0.93), P < 0.001) and inversely related to the right ventricular outflow tract size (− 1.48 (− 2.76 to − 0.21), P = 0.023). The pre-TPVR QRS was 130 (102–146) msec, and the post-TPVR QRS was 136 (106–144) msec (P = 0.668).ConclusionsIn children undergoing TCPVR, the PR and QRS intervals did not change significantly during a 6-month follow-up.

Analysis of the diagnostic and economic impact of the combined artificial intelligence algorithm for analysis of 10 pathological findings on chest computed tomography

BACKGROUND: Artificial intelligence technology can help solve the significant problem of missed findings in radiology studies. An important issue is assessing the economic benefits of implementing artificial intelligence.&#x0D; AIM: To evaluate the frequency of missed pathologies detection and the economic potential of artificial intelligence technology for chest computed tomography compared and validated by experienced radiologists.&#x0D; MATERIALS AND METHODS: This was an observational, single-center retrospective study. The study included chest computed tomography without IV contrast from June 1 to July 31, 2022, in Clinical Hospital in Yauza, Moscow. The computed tomography was processed using a complex artificial intelligence algorithm for 10 pathologies: pulmonary infiltrates, typical for viral pneumonia (COVID-19 in pandemic conditions); lung nodules; pleural effusion; pulmonary emphysema; thoracic aortic dilatation; pulmonary trunk dilatation; coronary artery calcification; adrenal hyperplasia; and osteoporosis (vertebral body height and density changes). Two experts analyzed computed tomography and compared results with artificial intelligence. Further routing was determined according to clinical guidelines for all findings initially detected and missed by radiologists. The hospital price list determined the potential revenue loss for each patient.&#x0D; RESULTS: From the final 160 computed tomographies, the artificial intelligence identified 90 studies (56%) with pathologies, of which 81 (51%) were missing at least one pathology in the report. The second-stage lost potential revenue for all pathologies from 81 patients was RUB 2,847,760 ($37,251 or CNY 256,218). Lost potential revenue only for those pathologies missed by radiologists but detected by artificial intelligence was RUB 2,065,360 ($27,017 or CNY 185,824).&#x0D; CONCLUSION: Using artificial intelligence as an assistant to the radiologist for chest computed tomography can dramatically minimize the number of missed abnormalities. Compared with the normal model without artificial intelligence, using artificial intelligence can provide 3.6 times more benefits. Using advanced artificial intelligence for chest computed tomography can save money.

Novel frameshift mutations in SALL4 in two Chinese families with Okihiro syndrome

In the present study, clinical manifestations of two Chinese Okihiro syndrome families were analyzed, and genetic detections were performed on the two probands by exome sequencing and verified by Sanger sequencing for family members to determine the biological pathogenesis. Prenatal diagnoses were provided for three high-risk fetuses. The affected members exhibited a wildly spectrum of phenotypes, including ultrasound abnormalities of skeletal system (radius deformity and abnormal posture), and cardiac system (persistent common arterial trunk and ventricular septal defect) in the prenatal period of family 1, the severe phenotypes (grossly shortened and deformed forearm, Duane's anomaly and hearing loss), and the mild ones (usually only thenar dysplasia, or short radius styloid process). Two SALL4 variants, c.844delC p.(Q282Kfs*8) and c.2210delG p.(G737Vfs*23), have been identified respectively in two probands, and c.2210delG of SALL4 gene was unreported previously. The two variants were verified in all affected individuals, not in normal family members. Genotyping results of three fetuses indicated that one fetus was normal, and the two fetuses with heterozygous variation were affected. The two variants of SALL4 gene, c.844delC p.(Q282Kfs*8) and c.2210delG p.(G737Vfs*23), were the molecular pathological cause of Okihiro syndrome in the present study and enriched the spectrum of SALL4 variants. Our study provides accurate prenatal genetic diagnosis for the two families to avoid the birth of affected children.

Evaluation of the Correlation of Pulmonary Arterial Hypertension (PAH) with the Pulmonary Artery Trunk Diameter and Serum Level of N-Terminal Pro B-Type Natriuretic Peptide (NT-proBNP) in Patients with PAH

Background: Due to its non-specific symptoms, pulmonary arterial hypertension (PAH) is difficult to diagnose via non-invasive methods. Various diagnostic tests are required to evaluate PAH patients. The increased diameter of the main pulmonary artery in computed tomography (CT) imaging represents a high probability of PAH. Moreover, N-terminal pro B-type natriuretic peptide (NT-proBNP) and pro B-type natriuretic peptide (proBNP) can be considered as prognostic predictors in patients with PAH. Objectives: This study aimed to evaluate the correlation of CT-based main pulmonary artery diameter (MPAD) and the serum level of NT-proBNP (as a strong pro-inflammatory factor) with the severity of PAH in echocardiography among patients with PAH. Patients and Methods: In this cross-sectional study, a total of 63 hospitalized patients with PAH due to chronic obstructive pulmonary disease were recruited from 2019 to 2020 after initial evaluations and collection of serum NT-proBNP measurements and echocardiographic findings. On the chest CT scans, the largest diameter of the pulmonary artery trunk was determined, and then, correlation of CT-based MPAD with both PAH severity on echocardiography and NT-proBNP level in patients with PAH were evaluated. Results: The results of the present study on 63 patients (70% male; mean age, 67.02 years) showed a significant positive correlation between the MPAD and NT-proBNP level (r = 0.444, P &lt; 0.001). Moreover, a significant positive relationship was observed between the pulmonary artery pressure (PAP) and NT-proBNP (r = 0.353, P = 0.005) and also between MPAD and PAP (r = 0.306, P = 0.015). In PAH patients, the mean values of MPAD, PAP, and NT-proBNP were 32.58 mm, 47.9 mmHg, and 6563 pg/mL, respectively. Conclusion: Considering the significant positive correlation between PAP, MPAD, and NT-proBNP level in subgroup comparisons based on MPAD and PAP, if the MPAD is abnormal on CT scan, additional echocardiographic assessments and serum NT-proBNP measurements can be helpful.

Clinical value of prenatal ultrasound in diagnosis and classification of common arterial trunk.

To investigate the clinical value of prenatal ultrasound in the diagnosis of the common arterial trunk (CAT) classification and associated malformations. The 2D ultrasound images, spatiotemporal image correlations (STICs) and clinical data of 88 fetuses diagnosed with CAT malformations by prenatal ultrasound were retrospectively analyzed and classified. The correlation between different types, fetal malformation and pregnancy outcomes were analyzed. Among the 88 fetuses, there were 39 cases (44.32%) of type A1, 40 cases (45.45%) of type A2, 8 cases (9.09%) of type A3, and 1 case of type A4 (1.14%). There were 16 cases (18.18%) with isolated CAT, 48 cases (54.55%) with complex intra-cardiac structural abnormalities, and 24 cases (27.27%) with intra-cardiac and extra-cardiac structural abnormalities. In extra-cardiac structural malformations, 14 cases were associated with 1 other system abnormality, 4 cases with 2 other system abnormalities, 3 cases with 3 other system abnormalities, while 3 cases were combined with 4 other system abnormalities, among which the facial and physical abnormalities had the highest incidence (39.13%). The STIC images were completely displayed in all 88 cases. There was a statistical difference between isolated CAT and CAT combined with other abnormalities in fetal pregnancy outcomes. Prenatal ultrasound had a high clinical application value in CAT classification. Pregnancy outcomes were highly correlated with the classification and associated intra-cardiac and extra-cardiac structural malformations. The early evaluation of fetal prognosis before birth has important value for clinical intervention.

Catheter closure of residual muscular VSD after common arterial trunk repair using Amplatzer muscular occluder (patient number 3 in Table S1). VSD, ventricular septal defect.

Catheter closure of residual muscular VSD after common arterial trunk repair using Amplatzer muscular occluder (patient number 3 in Table S1). VSD, ventricular septal defect.