Location Of Artery Research Articles

Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch

Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical–functional mismatch) and its influence on reclassification of functional significance. Distal-to-aortic pressure ratio (Pd/Pa) was measured using adenosine (Pd/PaADN) and papaverine (Pd/PaPAP) in 326 patients (326 vessels). The overestimation of FFR was calculated as Pd/PaADN–Pd/PaPAP. The anatomical–functional mismatch was defined as diameter stenosis > 50% and Pd/PaADN > 0.80. Reclassification was indicated by Pd/PaADN > 0.80 and Pd/PaPAP ≤ 0.80. The mismatch (n = 72) had a greater overestimation of FFR than the non-mismatch (n = 99): median 0.02 (interquartile range 0.01–0.05) versus 0.01 (0.00–0.04), p = 0.014. Multivariable analysis identified the overestimation of FFR (p = 0.003), minimal luminal diameter (p = 0.001), and non-left anterior descending artery (LAD) location (p < 0.001) as determinants of the mismatch. Reclassification was indicated in 29% of the mismatch and was more frequent in the LAD than in the non-LAD (52% vs. 20%, p = 0.005). The overestimation of FFR is an independent determinant of anatomical−functional mismatch. Anatomical−functional mismatch, specifically in the LAD, may suggest a false-negative result.

Evaluation of the posterior superior alveolar artery location and diameter with a newly defined stable plane

The aim of this study was to analyse the vertical location of the posterior superior alveolar artery (PSAA) using a reliable new reference plane regardless of tooth and alveolar bone, and to measure the diameter in each posterior tooth region, which is of relevance to lateral sinus floor elevation surgery. A total of 270 sinuses in 139 patients were examined in this study. The A-plane was defined by A-point and the bilateral jugal points on reconstructed three-dimensional images. The distance from the PSAA to the defined plane was measured in four regions: first premolar (P1), second premolar (P2), first molar (M1), and second molar (M2). The average distance of the PSAA above the plane in the P1, P2, M1, and M2 regions was determined to be 10.24mm, 7.35mm, 5.47mm, and 7.23mm, respectively. The PSAA was found to run above the plane in 97.4% of sinuses, below the plane in 1.1%, and on the plane in 1.5%. In conclusion, the new plane is useful for intraoperative location of the PSAA. According to the study findings, the area below the reference plane can be considered safe for lateral approach sinus surgery in terms of preserving the integrity of the PSAA.

Dynamic Microwave Imaging of the Cardiovascular System Using Ultra-Wideband Radar-on-Chip Devices.

Microwave imaging has been investigated for medical applications such as stroke and breast imaging. Current systems typically rely on bench-top equipment to scan at a variety of antenna positions. For dynamic imaging of moving structures, such as the cardiovascular system, much higher imaging speeds are required than what has thus far been reported. Recent innovations in radar-on-chip technology allow for simultaneous high speed data collection at multiple antenna positions at a fraction of the cost of conventional microwave equipment, in a small and potentially portable system. The objective of the current work is to provide proof of concept of dynamic microwave imaging in the body, using radar-on-chip technology. Arrays of body-coupled antennas were used with nine simultaneously operated coherent ultra-wideband radar chips. Data were collected from the chest and thigh of a volunteer, with the objective of imaging the femoral artery and beating heart. In addition, data were collected from a phantom to validate system performance. Video data were constructed using beamforming. The location of the femoral artery could successfully be resolved, and a distinct arterial pulse wave was discernable. Cardiac activity was imaged at locations corresponding to the heart, but image quality was insufficient to identify individual anatomical structures. Static and differential imaging of the femur bone proved unsuccessful. Using radar chip technology and an imaging approach, cardiovascular activity was detected in the body, demonstrating first steps towards biomedical dynamic microwave imaging. The current portable and modular system design was found unsuitable for static in-body imaging. This first proof of concept demonstrates that radar-on-chip could enable cardiovascular imaging in a low-cost, small and portable system. Such a system could make medical imaging more accessible, particularly in ambulatory or long-term monitoring settings.

Characteristics and distribution of intracranial aneurysms in Autosomal Dominant Polycystic Kidney Disease patients compared to the general population

Autosomal Polycystic Kidney Disease (ADPKD) is the most common genetic condition associated with intracranial aneurysms (IA). The aim of this study is to compare sporadic (SPO) and ADPKD aneurysms in term of distribution and multiplicity. ADPKD-patients with IA from the Geneva @neurIST, the UCAS and the Novosibirsk cohort, and from a review of the literature (2016-2019) were included. ADPKD-patients were compared to SPO-patients from the @neurIST and the UCAS cohort. IA-locations were defined as : internal carotid artery (ICA), middle cerebral artery (MCA), anterior- and posterior communicating artery (Acom and Pcom), pericallosal artery (Peri), posterior circulation (PCir), and other locations (Oth). Binary factors were compared using the Fisher exact test or Mann-Whitney U-test. Continuous variables were compared using a two-tailed non-paired student t-test. The difference in distribution among IA-locations were assessed by Pearson's residuals. 6606 SPO-patients were compared to 841 ADPKD-patients, and 7709 SPO-IA were compared to 1089 ADPKD-IA. 78.9 % of APDK-patients suffered from hypertension and 46.6 % of SPO-patient ( p < 0.001). ADPKD-patients had more multiple IA than SPO patients ( p < 0.001). APKD-IA are diagnosed with smaller diameters than SPO-patients (mean 4.7 mm ± 1.6 ; mean 6.3 mm ± 0.9) without reaching the significant level. ADPDK-IAs were found more along the ICA and the Acom (Pearson's residual > 2). Pcom, Peri and Pcir IAs were more frequent in SPO than in ADPKD-cases (Pearson's residual > 3). No difference was found regarding the frequencies the MCA location. More PCir and Oth IA were observed in the SPO-group. In contrario to SPO-IA, ADPKD-IAs differ from non-PKD-IA in that they are more commonly located in the anterior circulation and in large-caliber arteries. The ADPKD-population more often presents with multiple IAs compared to the SPO-individuals. Because of these particularities, these IA should not be considered as “standard” IA and should receive a specific treatment plan

The assessment of lower extremity peripheral artery disease impact on body mass center disorders

BackgroundLower extremity peripheral artery disease is a problem of contemporary medicine and along with the ischemic heart disease it is considered to be a civilization disease. The risk of the disease increases significantly within a group of people reaching the age of 55 years and is closely related to co-occurring hazardous factors, such as diabetes, hyperlipidemia, hypertension or tobacco smoking. The first symptom reported by patients is intermittent claudication. Such symptoms may indicate that lower extremity peripheral artery disease does have an impact on posture disorders and motor skills. MethodsThe study covered four stages. The first stage involved medical interviews to obtain information regarding anthropometry, age, motor organ surgery, concomitant diseases and the lifestyle. In the following stage the value of the ankle brachial index for both lower limbs were calculated. In case of symptomatic patients, additionally, the location of artery stenosis/aortoiliac section, was verified. The third stage involved using a dynamometric platform for determination of the body mass center position for both studied groups. In the fourth stage a treadmill walk test was used to assess the participants for intermittent claudication. FindingsBased on the obtained results, an attempt was taken to observe the relationship between the clinical characteristics of the disease and the body mass center position deviations. Interpretation: The attempt was undertaken to assess whether the measurement of body mass center position might be a diagnostic parameter to evaluate the patient's condition and thus an indication for taking a decision for surgical treatment or rehabilitation.

Supera stent implantation for the treatment of isolated popliteal artery disease systematic review and evaluation of current endovascular strategies.

&lt;b&gt;Introduction:&lt;/b&gt; The anatomical location of the popliteal artery is one of the greatest challenges for percutaneous interventions. The biomechanical attributes of the vessel lead to higher rates of restenosis, stent fracture, and occlusion. Some surgeons consider the popliteal artery as a no stenting zone. Many specialists favor percutaneous transluminal angioplasty to be the first line of endovascular treatment in the popliteal artery with bail-out stent implantation if the results are suboptimal. The Supera peripheral stent system is a novel stent that has been manufactured with a high degree of flexibility and supposedly might be appropriate for implantation in the popliteal artery. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; Evaluation of the performance of Supera stent in isolated popliteal artery disease in comparison to other methods of treatment. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Methods:&lt;/b&gt; As many as 92 articles were found in the databases and after full-text review, 4 studies matched the inclusion criteria and were evaluated. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Primary patency rates of Supera implantation in an isolated popliteal artery at 12 months ranged from 68% to 90%. In all four studies, no stent fractures were observed. Only one study provided longer follow-up than 12 months and evaluated the performance of the Supera stent 36 months after implantation. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusion:&lt;/b&gt; In conclusion, mentioned studies show promising and superior to other stent patency rates of the Supera stent regarding popliteal artery lesions. What is more, no stent fracture is promising regarding longer follow-up. However, more studies with longer follow-ups and direct comparison to other methods are required to fully evaluate Supera&apos;s performance in the popliteal artery.

Cosmetic outcomes of improved microscopic subinguinal varicocelectomy in patients with varicoceles.

Cosmetic outcomes of improved microscopic subinguinal varicocelectomy in patients with varicoceles.

Computational fluid dynamic analysis of the initiation of cerebral aneurysms.

Relationships between aneurysm initiation and hemodynamic factors remain unclear since de novo aneurysms are rarely observed. Most previous computational fluid dynamics (CFD) studies have used artificially reproduced vessel geometries before aneurysm initiation for analysis. In this study, the authors investigated the hemodynamic factors related to aneurysm initiation by using angiographic images in patients with cerebral aneurysms taken before and after an aneurysm formation. The authors identified 10 cases of de novo aneurysms in patients who underwent follow-up examinations for existing cerebral aneurysms located at a different vessel. The authors then reconstructed the vessel geometry from the images that were taken before aneurysm initiation. In addition, 34 arterial locations without aneurysms were selected as control cases. Hemodynamic parameters acting on the arterial walls were calculated by CFD analysis. In all de novo cases, the aneurysmal initiation area corresponded to the highest wall shear stress divergence (WSSD point), which indicated that there was a strong tensile force on the arterial wall at the initiation area. The other previously reported parameters did not show such correlations. Additionally, the pressure loss coefficient (PLc) was statistically significantly higher in the de novo cases (p < 0.01). The blood flow impact on the bifurcation apex, or the secondary flow accompanied by vortices, resulted in high tensile forces and high total pressure loss acting on the vessel wall. Aneurysm initiation may be more likely in an area where both tensile forces acting on the vessel wall and total pressure loss are large.

Vascular calcification in different arterial beds in ex vivo ring culture and in vivo rat model

Vascular calcification is a risk factor for cardiovascular and kidney diseases. Medial calcification may differently affect the arterial tree depending on vessel location and smooth muscle injury. The aim was to map the anatomical distribution of vascular calcifications on different arteries and artery locations, in cultured artery rings (ex vivo) and in a rat model of elastocalcinosis (in vivo). Vascular calcification was assessed histologically (von Kossa staining of the media) and by calcium content measurement. Arteries of different sizes were harvested from untreated rats for ring culture and from the vitamin D3-nicotine (VDN) rat model for direct observation. When cultured in pro-calcifying conditions, thoracic aorta exhibited similar calcification from the arch to the diaphragm. Calcification increased in abdominal aorta along with the reduction in cross sectional area. Carotid and renal arteries exhibited similar ex vivo calcification. In VDN rats, calcification was greater in carotid artery than in aorta, and was accompanied by fibrosis and apoptosis. Ex vivo, calcification was increased by the induction of lesions on arteries. Along the vascular tree, calcification of the arterial wall increases with the narrowing of vessels in ex vivo ring culture and in vivo. The observed differences represent local susceptibility of the vessels to the calcifying processes.

A novel technique of pulmonary artery banding by means of radiofrequency ablation: An experimental study in rabbits.

Background The aim of this study was to evaluate the efficacy and feasibility of a novel method of narrowing pulmonary arteries with catheter angiography using radiofrequency energy in rabbits. Methods A total of nine New Zealand white rabbits weighing 3.0 to 4.2 kg each were utilized in this experimental study. After the location of pulmonary artery was confirmed by echocardiography and angiography, radiofrequency energy was applied by starting with 5 W energy for the first time and increasing by 5 W, if there was no rupture to a maximum of 20 W. Multiple applications of radiofrequency energy with different durations were performed at different levels of the pulmonary artery. Eight weeks later, surviving rabbits were sacrificed. The pulmonary arteries were removed for histological investigation. Results Five rabbits remained alive after the experiment. There was a significant correlation between radiofrequency power and the degree of vessel thickness change in the pulmonary artery. The endothelial integrity of the tunica intima was impaired in all groups and the diameter of vessel was thickened by an average of 3.5 times. Conclusion The narrowing of the pulmonary artery using radiofrequency energy was successfully performed in a small sample size of experimental animals in this study.

A Flexible Ultrasound Array for Local Pulse Wave Velocity Monitoring.

Pulse wave velocity (PWV) measured at a specific artery location is called local PWV, which provides the elastic characteristics of arteries and indicates the degree of arterial stiffness. However, the large and cumbersome ultrasound probes require an appropriate sensor position and pressure maintenance, introducing usability constraints. In this paper, we developed a light (0.5 g) and thin (400 m) flexible ultrasound array by encapsulating 1–3 composite piezoelectric transducers with a silicone elastomer. It can capture the distension waveforms of four arterial positions with a spacing of 10 mm and calculate the local PWV by multi-point fitting. This is illustrated by in vivo experiments, where the local PWV value of five normal subjects ranged from 3.07 to 4.82 m/s, in agreement with earlier studies. The beat-to-beat coefficient of variation (CV) is 12.0% ± 3.5%, showing high reliability. High reproducibility is shown by the results of two groups of independent measurements of three subjects (the error between the mean values is less than 0.3 m/s). These properties of the developed flexible ultrasound array enable the bandage-like application of local PWV monitoring to skin surfaces.

Robotic vaginal natural orifice transluminal endoscopic myomectomy

Robotic vaginal natural orifice transluminal endoscopic myomectomy

IMPACT OF ARTERIAL SITE AND PULSE WAVE ANALYSIS METHOD ON ARTERIAL FORM FACTOR AND MEAN ARTERIAL PRESSURE ESTIMATION

Objective: Mean arterial pressure (MAP) is often estimated from systolic (S) and diastolic (D) blood pressure (BP) using a constant “form factor’’ (FF), usually MAP = DBP + 0.33*pulse pressure (PP), yet accurate measurement requires pulse wave analysis (PWA) and waveform integration. MAP is constant across all conduit arteries but PP increases distally [peripheral (p)PP &gt; central ©PP]. Thus, cFF should be higher than pFF; results should also be similar between PWA methods. Design and method: We tested these principles in 2 cohorts using 2 transfer function-dependent PWA devices: SphygmoCor (SPG, radial tonometric PWA with integrated MAP) and Mobil-O-Graph (MOB, 24-hour ambulatory brachial oscillometric PWA with proprietary MAP). SPG data (signal-average of 10 PWA) were obtained after 5–10 minutes of rest and MOB values at 20-minute intervals. For direct MAP comparisons, 101 pairs from the SPG and MOB cohorts were matched precisely for pSBP and pDBP (130.9/78.7 mmHg for each, p&gt;.999). Results: For SPG, n = 376, [mean(SD)]: pBP 140(28)/80(15) and cBP 126(28)/81(15) mmHg, age 48(20) yr, BMI 28(6.6), 54% men, 20% black. SPG-cFF was higher than SPG-pFF [0.44(.049) vs 0.34(.056), p &lt; 0.000] and cFF and pFF were correlated (r2 = 0.23, p &lt; 0.000). On stepwise multiple regression, SPG-pFF was related to MAP &gt; gender &gt; age (multiple-r2 = 0.37, p &lt; 0.000; BMI and race were excluded). For MOB: n = 157, pBP 135(18)/81(12) and cBP 123(16)/83(12) mmHg, age 59(16) yr, BMI 30(6), 52% men, 24% black. MOB-pFF was almost invariate, lower than MOB-cFF [0.46(0.00098) vs 0.57(0.048), p &lt; 0.000], and not correlated with MOB-cFF or any other characteristic. MOB-cFF was higher than SPG-cFF (p &lt; 0.000) with similar variability. In the paired cohorts, mean FF’s were similar to the full cohorts but SPG-MAP was much lower than MOB-MAP [96.3 vs 102.6 mmHg (p &lt; 0.000)]. Conclusions: 1) FF varies within-subjects by arterial location, with cFF &gt; pFF; 2) SPG-pFF varies between-subjects and is affected by MAP, gender, and age; 3) proprietary MOB-pFF is invariate and higher than integrated SPG-pFF; and 4) MOB-MAP is 6% higher than SPG-MAP. These findings may impact studies requiring FF or MAP estimates, especially from proprietary oscillometric devices.

A CASE REPORT OF ASYMPTOMATIC SPONTANEOUS LEFT SUBCLAVIAN ARTERY DISSECTION: CLINICAL SIGNIFICANCE

TYPE: Case Report TOPIC: Cardiothoracic Surgery INTRODUCTION: Spontaneous subclavian artery dissection (SSAD) is rare. Often it is associated with a history of trauma or catheterisation. We are presenting an asymptomatic case of SSAD and its clinical significance. CASE PRESENTATION: 78 year old female with history of COPD, peripheral arterial disease presented after a mechanical fall. Initial workup showed a left hip fracture on x-ray. Patient underwent surgical repair, during the postoperative period, she experienced shortness of breath requiring additional oxygen. Computed tomography (CT) chest with contrast was negative for pulmonary embolism but noted to have left subclavian artery dissection involving the short segment before the origin of vertebral artery and small pleural effusions. Shortness of breath improved with diuretics. Vascular surgery recommended to manage conservatively as she didn’t have symptoms of stroke, MI, limb ischemia. She was discharged to a rehabilitation facility and remained asymptomatic after one month follow up. DISCUSSION: In our case, there is no neck or chest injury with fall. No history of hypertension or catheterization procedures. CT chest didn’t show any tortuous anatomy. It was an incidental finding with no symptoms. Uncontrolled hypertension, location of subclavian artery below clavicles can increase the risk for dissection apart from traumatic or iatrogenic catheterisation. Other presentations could be stroke, neck pain with cervical disk problems ; non ST segment elevation myocardial infarction or limb ischemia. CONCLUSIONS: If asymptomatic, SSAD can be managed conservatively, but in symptomatic cases causing acute limb ischemia or acute coronary syndrome or stroke they could potentially benefit from early surgical endovascular repair decreasing morbidity and mortality. DISCLOSURE: Nothing to declare. KEYWORD: subclavian artery dissection

Topographic location and branching pattern of the superior mesenteric artery with its clinical relevance: a cadaveric study.

The topographic location of the superior mesenteric artery (SMA) and its branching pattern are usually arbitrary in textbooks. This study, therefore, aims to provide topographic information of SMA with reference to the vertebral bodies, ventral branches of aorta and branching pattern of SMA. The study was conducted on 35 embalmed adult human cadavers. We performed detailed dissection of the SMA to topographically locate its origin in respect to vertebral level and other ventral branches of the abdominal aorta. We have categorised the branching pattern of SMA into three different types depending upon the number of arterial pedicles, traced from proximal to distal to look into their anastomoses and formation marginal artery of Drummond. Vertebral level of origin of SMA varied between the lower third of twelfth thoracic vertebra (T12) and lower third of first lumbar vertebra (L1), most commonly arose at the level of the lower third of L1 (77.14%). The average distances between the origin of SMA and coeliac trunk (CT), inferior mesenteric artery (IMA) and aortic bifurcation were 1.84 cm, 6.67 cm and 10.39 cm, respectively. Depending on the branching pattern, type A was found in 29 (82.85%) cases, type B in 5 (14.28%) and type C in 1 (2.85%). In 2 cases (both of type B), the marginal artery was incomplete. The most common topography of origin of the SMA was opposite the lower third of L1. The coeliac-superior mesenteric relationship was most consistent than between any other two points on the abdominal aorta; 85% of the SMAs were concentrated within a space of 1.00 cm (0.60-1.50 cm) from the CT. Type A branching pattern was most commonly seen in our study population.

Analysis of popliteal artery location for high tibial and distal tuberosity osteotomy using contrast-enhanced computed tomography

BackgroundOur objective was to evaluate the location of popliteal artery (PA) in osteotomy planes during high tibial osteotomy (HTO) and to determine a safer angle for screw drilling to the tibial tuberosity during distal tuberosity osteotomy (DTO).MethodsTwenty knees in 20 patients who underwent contrast-enhanced computed tomography for cardiovascular diseases were examined. Osteotomy planes for open-wedge HTO (OWHTO) and hybrid closed-wedge HTO (hybrid CWHTO) were created using three-dimensional bone models. The distance from the posterior cortex of the tibia to the PA (dPC-PA) in the osteotomy planes was measured in the virtual osteotomy planes. The dangerous point (Point D1) was defined as the point 17.5 mm away from PA, setting the working length of the bone saw as 35 mm. The distance between the most medial point of the tibial cortex (Point M) and Point D1 in OWHTO and the most lateral point (Point L) and Point D1 in hybrid CWHTO were examined (dM-D1 and dL-D1, respectively). The location of Point D1 to the osteotomy line (%D1) was expressed as percentage, setting the start and end of the osteotomy line as 0% and 100%, respectively. To determine the safe angle for screw drilling in DTO, the angle between the line tangential to the medial cortex of the tibia and that passing through the center of the tibial tuberosity and PA were measured.ResultsIn OWHTO and hybrid CWHTO, the mean dPC-PA was 10.6 mm (6.9–16.5 mm) and 10.2 mm (7.3–15.4 mm), respectively. The mean dM-D1 in OWHTO was 25.9 mm (24.6–27.2 mm) and dL-D1 in hybrid CWHTO was 5.1 mm (2.9–7.4 mm). The mean %D1 was 47.6 ± 3.7% in OWHTO and 9.3 ± 4.1% in hybrid CWHTO, respectively. The minimal angle between the two lines in DTO was 35.2°.ConclusionPAs could run within 10 mm from the posterior cortex in the osteotomy planes of HTO. Therefore, proper posterior protection is necessary when cutting posterior cortex. An angle of less than 35° against the medial cortex line would be safe for screw fixation to avoid vascular injury in DTO.

Preoperative 3D Image Evaluation of EC-IC Bypass by 3D Visualization Analysis Software Amira®.

Careful evaluation of the preoperative imaging for extracranial-intracranial bypass performed for conditions like intracranial stenosis and Moya disease is important. The traditional use of 2D imaging has a significant limitation for neurosurgeons, primarily to determine the optimal location of the recipient artery for performing the surgical bypass. Therefore, many neurosurgeons use 3D angiograms more frequently to overcome these shortcomings. We performed the preoperative evaluation of the possibility of performing an anastomosis between the superficial temporal artery and the middle cerebral artery (STA-MCA) bypass by synthesizing images of computerized tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) using Amira® of 3D visualization analysis software (Thermo Scientific Co.). The 3D images prepared before surgery using this software showed good agreement with the intraoperative findings. Preoperative image processing using tools like Amira provide optimal information for good planning and communication for performing STA-MCA bypass and may become a helpful tool.

Location of the Internal Mammary Arteries in Relation to the Lateral Border of the Sternum: A Key to Avoid Injury during Computed Tomography-Guided Biopsy of Anterior Mediastinal Masses

Location of the Internal Mammary Arteries in Relation to the Lateral Border of the Sternum: A Key to Avoid Injury during Computed Tomography-Guided Biopsy of Anterior Mediastinal Masses

Effect of Infarction-Related Artery Location on Clinical Outcome of Patients With Acute Myocardial Infarction in the Contemporary Era of Percutaneous Coronary Intervention - Subanalysis From the Prospective Japan Acute Myocardial Infarction Registry (JAMIR).

Previous studies have reported that acute myocardial infarction (AMI) related to left anterior descending (LAD) lesion is associated with worse outcomes than left circumflex artery (LCX) or right coronary artery (RCA) lesions. However, it is unknown whether those relationships are still present in the contemporary era of primary percutaneous coronary intervention (PCI), using newer generation drug-eluting stents and potent antiplatelet agents. This study is a sub-analysis of the Japan AMI Registry (JAMIR), a multicenter, prospective registry enrolling 3,411 AMI patients between December 2015 and May 2017. Among them, 2,780 patients undergoing primary PCI for only a culprit vessel were included and stratified based on infarction-related artery type (LAD, LCX, and RCA). The primary outcome was 1-year cardiovascular death. The overall incidence of cardiovascular death was 3.4%. Patients with LAD infarction had highest incidence of cardiovascular death compared to patients with LCX and RCA infarction (4.8%, 1.3%, and 2.4%, respectively); however, landmark analysis showed that culprit vessel had no significant effect on cardiovascular death if a patient survived 30 days after primary PCI. LAD lesion infarction was an independent risk factor for cardiovascular death in adjusted Cox regression analysis. The present sub-analysis of the JAMIR demonstrated that LAD infarction is still associated with worse outcomes, especially during the first 30 days, even in the contemporary era of PCI.

A Predictive Model for the Risk of Posterior Circulation Stroke in Patients with Intracranial Atherosclerosis Based on High Resolution MRI.

Intracranial vertebrobasilar atherosclerosis is the main cause of posterior circulation ischemic stroke. We aimed to construct a predictive model for the risk of posterior circulation ischemic stroke in patients with posterior circulation atherosclerosis based on high-resolution MRI (HR-MRI). A total of 208 consecutive patients with posterior circulation atherosclerosis confirmed by HR-MRI, from January 2020 to July 2021, were retrospectively assessed. They were assigned to the posterior circulation stroke (49 patients) and non-posterior circulation stroke group (159 patients) based on clinical presentation and diffusion-weighted imaging (DWI). Demographic data, risk factors of atherosclerosis, laboratory findings, and imaging characteristics were extracted from electronic health records. Plaque features were investigated by HR-MRI. Fifty-three clinical or imaging features were used to derive the model. Multivariable logistic regression analysis was employed to construct the prediction model. The nomogram was evaluated for calibration, differentiation, and clinical usefulness. Plaque enhancement, plaque irregular surface morphology, artery location of plaque, and dorsal quadrant of plaque location were significant predictors for posterior circulation stroke in patients with intracranial atherosclerosis. Subsequently, these variables were selected to establish a nomogram. The model showed good distinction (C-index 0.830, 95% CI 0.766-0.895). The calibration curve also showed excellent consistency between the prediction of the nomogram and the observed curve. Decision curve analysis further demonstrated that the nomogram conferred significantly high clinical net benefit. The nomogram calculated from plaque characteristics in HR-MRI may accurately predict the posterior circulation stroke occurrence and be of great help for stratification of stroke decision making.