Artery Stenosis Research Articles

Cerebrovascular disease in patients with antiphospholipid antibody syndrome: a transcranial Doppler and magnetic resonance imaging study.

Transcranial Doppler (TCD) and brain MRI may be useful in evaluating patients with APS, helping to stratify the risk of cerebrovascular ischaemic events in this population. This study aimed to assess the frequency of brain MRI abnormalities in patients with primary antiphospholipid syndrome, secondary antiphospholipid syndrome and SLE and correlate to TCD findings. The study, conducted over four years at two autoimmune disease referral centres, included 22 primary antiphospholipid syndrome patients, 24 secondary antiphospholipid syndrome patients, 27 SLE patients without APS and 21 healthy controls. All participants underwent TCD to assess cerebral haemodynamics, detect microembolic signals and evaluate right-to-left shunts, followed by brain MRI and magnetic resonance angiography. MRI scans were reviewed for acute microembolism, localized cortical infarctions, border infarctions, lacunar infarctions, ischaemic lesions, white matter hyperintensity, micro and macro haemorrhages and arterial stenosis ≥50% of the cervical carotid artery, by two neuroradiologists blinded to the clinical data. Brain MRI findings were similar between the groups, except for lacunar infarction, more frequent in patients with secondary antiphospholipid syndrome (P = 0.022). Patients with intracranial stenosis detected by TCD had a higher frequency of territorial infarction (40% vs 7.5%, P = 0.02), lacunar (40% vs 11.3%, P = 0.075) and border zone infarcts (20% vs 1.9%, P = 0.034). Patients with intracranial stenosis presented a higher frequency of territorial, lacunar and border zone infarcts, suggesting that evaluating the intracranial vasculature should not be neglected in patients with APS and stroke.

Numerical investigation of solute dispersion in a non-Newtonian fluid flow through a catheterized artery with mild stenosis

The phenomenon of Casson fluid flow and solute dispersion through a catheterized artery with constriction is studied. An analytical solution to the flow equations is obtained for low Womersley number. The finite element method is utilized to numerically solve the governing equation for solute dispersion and obtain the local and mean concentrations. The combined influence of pulsatile flow nature, catheter insertion, non-Newtonian rheology, and mild stenosis on dispersion within the artery are analysed by considering axial and temporal variations of the local concentration and mean concentration. The study shows that the Womersley frequency parameter and amplitude of the pressure gradient have no qualitative effect on the dispersion in the case of mild stenosis artery; this is in agreement with the case of tube flow with rigid walls. However, the fluid yield stress and height of the stenotic region have a marked impact on the dispersion phenomenon. These results have applications to oxygen or drug transport processes in catheterized and stenosed arteries.

Retrospective evaluation of interventional radiological treatments for chronic mesenteric ischemia in Germany based on a four-year period of the DeGIR Registry: comparison of outcomes with international quality standards.

Endovascular treatment has emerged as the gold standard for managing chronic mesenteric ischemia (CMI) resulting from arterial stenosis or occlusion. This study aimed to assess the efficacy and complication rates of continuous interventional radiology treatment for CMI in Germany between 2018 and 2021, comparing these findings with international quality standards. Data for CMI therapy with stenting and percutaneous transluminal angioplasty (PTA) was obtained from the quality management system of the German Interventional Radiological Society (DeGIR). A total of 3752 endovascular procedures for CMI performed from 2018 to 2021 were documented (PTA: n = 675; stenting: n = 3077). Data was analyzed for technical and clinical success rates, as well as major complication rates. Overall technical and clinical success rates for PTA and stenting procedures were 92.03 %/85.9 % and 98.76 %/96.62 %, respectively. The most common major complications were: arterial occlusion (PTA: 0.73 %; stenting: 0.63), major bleeding (PTA: 1.05 %; stenting: 0.68 %), aneurysm formation (PTA: 0.29 %; stenting: 0.72 %), stent dislodgment (PTA: 0 %; stenting: 0.06 %), and organ failure (PTA: 0.43 %; stenting: 0.96 %). Technical and clinical success rates were higher, while complication rates were lower than the corresponding threshold recommended by the Society of Interventional Radiology for the percutaneous management of chronic mesenteric ischemia. Treatment of CMI performed by interventional radiologists in Germany is safe and effective during daily and on-call shifts with results exceeding internationally accepted standards. · Treatment of CMI by interventional radiologists in Germany is effective and safe.. · The interventions are safe and effective regardless of whether they are performed during on-call shifts or the daily routine.. · The clinical and technical success rates favorably surpass the thresholds presented by SIR.. · Different major complications occurred in under 1.1 % of CMI interventions..

Thirteen Years of Impactful, Minimally Invasive Coronary Surgery: Short- and Long-Term Results for Single and Multi-Vessel Disease

Objectives: Minimally invasive coronary surgery (MICS) via lateral thoracotomy is a less invasive alternative to the traditional median full sternotomy approach for coronary surgery. This study investigates its effectiveness for short- and long-term revascularization in cases of single and multi-vessel diseases. Methods: A thorough examination was performed on the databases of two cardiac surgery programs, focusing on patients who underwent minimally invasive coronary bypass grafting procedures between 2010 and 2023. The study involved patients who underwent either minimally invasive direct coronary artery bypass grafting (MIDCAB) for the revascularization of left anterior descending (LAD) artery stenosis or minimally invasive multi-vessel coronary artery bypass grafting (MICSCABG). Our assessment criteria included in-hospital mortality, long-term mortality, and freedom from reoperations due to failed aortocoronary bypass grafts post-surgery. Additionally, we evaluated significant in-hospital complications as secondary endpoints. Results: A total of 315 consecutive patients were identified between 2010 and 2023 (MIDCAB 271 vs. MICSCABG 44). Conversion to median sternotomy (MS) occurred in eight patients (2.5%). The 30-day all-cause mortality was 1.3% (n = 4). Postoperative AF was the most common complication postoperatively (n = 26, 8.5%). Five patients were reoperated for bleeding (1.6%), and myocardial infarction (MI) happened in four patients (1.3%). The mean follow-up time was six years (±4 years). All-cause mortality was 10.3% (n = 30), with only five (1.7%) patients having a confirmed cardiac cause. The reoperation rate due to graft failure or the progression of aortocoronary disease was 1.4% (n = 4). Conclusions: Despite the complexity of the MICS approach, the results of our study support the safety and effectiveness of this procedure with low rates of mortality, morbidity, and conversion for both single and multi-vessel bypass surgeries. These results underscore further the necessity to implement such programs to benefit patients.

Impact of hematocrit on pulsatile blood flow in stenosed arteries: a computational study in healthy, diabetic, and anemic models

In this study, researchers aim to enhance the realism of circulatory system simulations, focusing on factors affecting flow variations, particularly in stenotic arteries of individuals with altered hematocrit levels. Through extensive data collection and varied conditions, the goal is to attain more precise and valid results. The study conducts approximate simulations to comprehensively describe the dynamic motion of pulsatile flow. Different values of inlet velocity (UDF) are introduced, considering potential arterial distortion or occlusion due to plaque deposition, along with variations in hematocrit (Hct) levels commonly observed in patients. Three distinct types of pulsatile blood flow, corresponding to diabetes (Hct 65%), healthy (Hct 45%), and anemia (Hct 25%), are studied and compared. The research illuminates that stenosis in arteries with varying hematocrit levels significantly impacts hydrodynamic features, potentially predisposing individuals to cardiovascular diseases. Through meticulous analysis, several conclusions about hemodynamic characteristics are drawn. It is observed that both velocity and wall shear stress exhibit variation along the affected artery, influenced by stenosis and changes in hematocrit levels. Notably, the highest influence on velocity and wall shear stress is observed with Hct 65%, compared to Hct 45% and Hct 25% at the moment of stenosis. These findings hold substantial practical implications for the field of cardiovascular health, providing valuable insights into blood flow behavior in stenotic arteries with diverse hematocrit levels. Ultimately, this research contributes to more effective clinical interventions.

Temporal Trend in Revascularization for Patients With Ischemic Cardiomyopathy and Multivessel Coronary Artery Disease.

Current guidelines recommend revascularization in patients with ischemic cardiomyopathy (ICM). However, there is limited information about the trends and outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in ischemic cardiomyopathy patients with multivessel coronary artery disease. Using New Jersey state mandatory registries, 8083 patients with ischemic cardiomyopathy with CABG or PCI revascularization for multivessel coronary artery disease from 2007 to 2018 were included in the analysis. Joinpoint regression and multivariable logistic regression analyses were performed to assess the annual percentage change in trends and predictors of the 30-day mortality rate, respectively. A decline in CABG procedures was observed from 2007 to 2011 (annual percentage change, -11.5%; P=0.003), followed by stabilization. The PCI trend remained unchanged from 2007 to 2010 and then increased significantly (annual percentage change, 3.2%; P=0.02). In the subsample of patients with proximal left anterior descending artery plus circumflex and right coronary artery, CABG was a predominant procedure until 2011, and the proportion of both procedures did not differ thereafter. In the subsample of patients with left anterior descending artery and any other artery stenosis, PCI remained dominant from 2007 to 2018, while in patients with left main and any other artery stenosis, CABG remained dominant from 2007 to 2018 (P<0.001). The 30-day risk-adjusted mortality rate was higher after PCI versus CABG for each year, but after adjustment for completeness of revascularization, there was no difference between groups. The patterns of revascularization procedures for patients with ischemic cardiomyopathy with multivessel coronary artery disease have changed over the years, as evidenced by the changes in CABG and PCI trends. CABG and PCI had comparable 30-day risk-adjusted mortality risks.

EFFECT OF MOTILE GYROTACTIC MICROORGANISMS ON ARTERIAL STENOSIS SISKO NANOFLUID FLOW THROUGH POROUS MEDIUM: A NUMERICAL STUDY

The present study is concerned with an incompressible nano-liquid movement obeying the non-Newtonian Sisko model (NSM). The flow occupies a cylindrical arterial tube with mild stenosis through permeable media, in accordance with the modified Darcy's law. The motile gyrotactic microorganisms are involved in the flow. The originality of the current work emerges from the need to realize the effects of fluctuating viruses and microbes in addition to nanoparticles through arterial stenosis. The buoyancy-driven flow (BA) is considered, where density is a function of heat and particles' concentration. Furthermore, the nanoparticles dispersal is illustrated along with an activated energy chemical reaction. The mathematical construction is implemented by a group of nonlinear partial differential equations (NPDEs) concerning momentum, energy, nanoparticles' volume fraction, and microorganism concentration. Appropriate time-varying tapered stenosis BCs are utilized to comprehend the present boundary-value problem (BVP). The RK-4 analysis, in conjunction with the shooting approach, is performed on the prior system. Subsequently, a significant graphical construction of the assessed data is designed to understand the controls of the generated physical features. Biological infections by harmful microbes represent reasons for blood thinner diseases. According to the current study, the presence of microorganisms improves the flow and increases its speed. Therefore, the rapidity of the flow can be controlled by regulating the characterized parameters of the microbe's divergence. Moreover, most of the heat-related parameters in this discussion are observed as raising features of heat fluctuation, which is a vital characteristic in diagnosing narrowing vessels therapy.

STA – MCA bypass surgery

Cerebral bypass surgery, such as the STA-MCA (superficial temporal artery to middle cerebral artery) bypass, is a critical procedure aimed at restoring blood flow to oxygen-deprived areas of the brain. This surgery involves rerouting blood from a donor vessel, typically the superficial temporal artery, to a recipient vessel within the brain, bypassing blockages or damaged arteries. Indications for this surgery include Moyamoya disease, aneurysms, skull base tumors, and arterial stenosis. Pre-operative imaging helps in planning the surgery, while post-operative care involves monitoring for complications like stroke and graft occlusion. Although bypass surgery improves blood supply, it does not cure underlying vascular diseases. Thus, patients are advised to adhere to medication regimens and adopt a healthy lifestyle for optimal long-term outcomes. Bypass surgery offers a vital intervention in managing cerebrovascular conditions, emphasizing the importance of multidisciplinary care and patient education.

Tuberculosis Meningitis in a 9‐Month‐Old Girl during the COVID‐19 Pandemic

Tuberculous meningitis (TBM) is a serious form of TB disease that can result in high morbidity and mortality, particularly if there are delays in diagnosis and treatment. In this case report, a 9‐month‐old girl was admitted with persistent vomiting and focal seizures. On examination, she was found to have a right‐side hemiparesis. Brain imaging showed intense nodular leptomeningeal enhancement, hydrocephalus, a hypolucent lesion in the left basal ganglia, arterial stenosis and vasculitis, and an old ischemic insult. The patient was initially diagnosed with an acute ischemic stroke and was treated with aspirin and antiepileptic drugs. The patient’s condition failed to improve despite initial treatment, leading to further diagnostic procedures. The results uncovered a diagnosis of TBM. The case highlights the importance of considering TBM as a possible cause of neurological symptoms, especially during the coronavirus disease 2019 (COVID‐19) pandemic where similar symptoms can be present in cases of neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and multisystem inflammatory syndrome in children (MIS‐C).

Analysis of Effect of Hemodynamic Parameters on Two-layered Blood Flow in a Mild Stenosed Artery

Arterial stenosis is the lessening of the arterial wall due to the growth of aberrant tissues that prevent adequate blood flow in the human circulatory system and induces cardiovascular diseases. Mild stenosis, over time, can lead to serious and permanent damage if it remains uncured. Navier-Stokes equation in cylindrical polar coordinates system has been extended by two-layered blood flow along the axial direction with appropriate boundary conditions.A steady flow through a stenosed artery has been investigated extensively using the analytical approach in the case of two-layered blood flow. Mathematical expressions for two-layer hemodynamic parameters such as velocity profile, volumetric flow rate, and effect of stenosis progression on parameters with the variation of core and peripheral layered coefficient of viscosity are derived. Moreover, pressure drop, and shear stress have been calculated analytically in an artery with and without stenosis. Peripheral viscosity has less contribution to varying velocity distribution than the core and is proportional to stenosis size.The volumetric flow rate decreases with an increasing viscosity coefficient. Pressure drop and shear stress attain maximum value in the region stenosis occur maximum height in core layer.The present work could serve as a model in biomedical engineering for the cure of vascular-related diseases and has the potential in designing the devices of this field.

Clinical and Molecular Characterization of a Patient with Generalized Arterial Calcification of Infancy Caused by Rare ABCC6 Mutation.

Generalized arterial calcification of infancy (GACI) is a rare autosomal-recessive disease characterized by extensive arterial calcification in infancy, with clinical manifestations such as arterial stenoses and heart failure. The ENPP1 inactivation mutation has been identified as a potential defect in most of the cases of GACI, while mutations in ABCC6 are demonstrated in patients who are genotyped as pseudoxanthoma elasticum and only limited cases of GACI are reported. Whole-exome sequencing was applied for the detection of pathogenic variants. Copy-number variants of pathogenic genes were also evaluated through a bioinformatic process and were further validated by real-time quantitative PCR. In this report, we described the clinical information and treatment of a patient with extensive arterial calcification. We have identified the underlying cause as biallelic mutations in ABCC6 (NM_00117: exon30, c.4223_4227dupAGCTC p.(Leu1410Serfs*56)) and a unique exonic deletion that spans from the first to the fourth exons of ABCC6 (chr16:16313388-16330869)). This discovery was made by utilizing a combined genetic testing approach. With the review of previously reported GACI patients with ABCC6 mutation, our work contributed to enriching the mutation spectrum of GACI and providing further information on this rare form of inherited disorder.

PREVALENCE OF CEREBRAL VENOUS DRAINAGE STENOSES ON RETROSPECTIVELY ANALYZED CTA FOR STROKE TRIAGE

Abstract Cerebral venous congestion (CVC) has been identified as a hypothetic cause of cognitive impairment. Prior work has estimated that 15-30% of the population may have jugular venous narrowing, a potential cause of CVC, based on reviews of CT angiography (CTA) performed at a large academic medical center. However, few comprehensive studies exist. Therefore, for the current work, we reviewed fifty CTAs that were obtained for ischemic stroke triage and thrombectomy planning at a comprehensive stroke center in Hawaii (Queens Hospital, Honolulu HI). These brain CTAs were analyzed for arterial and venous variants and other abnormalities that might place the patient at increased risk for arterial injury and/or venous congestion, both of which may result in cognitive decline. The CTAs were analyzed retrospectively for every known level of venous and arterial stenosis, and CVC-associated pre-morbid symptoms were analyzed. Preliminary data support the hypothesis that venous anatomical anomalies may be a risk factor for cognitive impairment. CVC may be an under-diagnosed contributor to cognitive impairment, particularly in older patients.

Elasticity Amelioration in transporting blood flow within curved stenotic tubes

AbstractIn biomechanical devices, blood can be transfused through small, curved walls. Accordingly, this research highlights the study of blood flow in cases of stenosis of the elastic artery with curvature. The effects of bending on the shear and resistance through this elastic tube have been investigated. The moderate stenosis case has been used to simulate the governing equations for an incompressible and steady non‐Newtonian fluid, or “tangent hyperbolic fluid”. A perturbation technique has been used to obtain an analytical solution. The Rubinow &amp; Keller model [24] simulates the flexibility of the stenosis artery walls. The results showed that increasing the parameters linked to the walls' flexibility made it easier for blood to flow through the stenosis area, which emphasizes the need for a thorough investigation of non‐Newtonian fluid flow phenomena. One of the most important threats facing humanity is blood stenosis. In microvasculature, there are many conditions in which the blood vessels are curved or twisted, especially in the case of disease.

The effects of incretin mimetics on the level of the microbial metabolite trimethylamine-N-oxide, a marker of cardiovascular risk in type 2 diabetic patients

Background. The purpose was to investigate the effect of therapy with glucagon-like peptide-1 receptor agonists (GLP-1ra) on the serum concentration of trimethylamine-N-­oxide (TMAO), an intestinal microbiome metabolite, in patients with type 2 diabetes mellitus (T2DM) in relation to clinical and laboratory indicators and parameters of body composition. Materials and methods. Thirty-three T2DM patients (17 women and 16 men) were examined aged 31 to 72 years who had unsatisfactory control of carbohydrate metabolism (HbA1c &gt; 7.4 %) against the background of previous glucose-lowering therapy (metformin, sulfonylurea derivatives, insulin, gliflozin) and were administered GLP-1ra. Before the start of treatment and after 6 months of therapy, parameters of anthropometry, body composition were measured (using the bioelectrical impedance analysis with the Tanita analyzer); blood glucose and glycated hemoglobin, TMAO concentration, blood lipids were assessed. Results. Patients diagnosed with Т2DM had HbA1c &gt; 7.4 %; 91 % had general obesity (body mass index 34.7 ± 6.6 kg/m2), 100 % had abdominal obesity (waist circumference 118.00 ± 11.24 cm, Med ± SD). In 72 % of cases, there was a history of cardiovascular complications (myocardial infarction, stroke, coronary and peripheral atherosclerosis, arterial stenosis). Under the influence of a 6-month administration of GLP1ra, there was a decrease in the degree of total and abdominal obesity, a significant drop in the percentage of fat and the level of visceral fat, which was accompanied by an increase in hydration, a reduction in triglyceridemia and the concentration of very-low-density lipoprotein cholesterol (VLDL-C). A significant decrease in the level of TMAO microbial metabolite in the blood serum was recorded, which may reflect the antiatherogenic effect of GLP1ra, associated with the control of cholesterol and bile acid metabolism, the stimulation of VLDL-C receptors, and the effect on the secretion of insulin, glucagon, ghrelin, leptin, incretins. Conclusions. A study on the clinical effects of the incretin mimetic (GLP-1ra) in patients with T2DM confirmed its positive impact on glucose metabolism and blood lipids. At the same time, during GLP-1ra therapy, an improvement of some compositional and lipid indicators (visceral fat, triglycerides, VLDL-C) was recorded with a simultaneous decrease in the concentration of TMAO toxic metabolite.

Correction to: Abstract P3028: Animal In Vivo: The Proof Of Flow Choking And Bulging Of The Downstream Region Of The Stenosis Artery Due To Air Embolism.

Correction to: Abstract P3028: Animal In Vivo: The Proof Of Flow Choking And Bulging Of The Downstream Region Of The Stenosis Artery Due To Air Embolism.

Electromagnetohydrodynamics Casson pulsatile nanofluid flow through a bifurcated stenosed artery: Magnetically targeted drug delivery

The current study is centered on the application of magnetically targeted drug delivery in a constricted vertical bifurcated artery utilizing Fe3O4 nanoparticles. The arterial stenosis is characterized by a bell-shaped narrowing in the parent artery and overlapping narrowing in the daughter artery. The blood is regarded as exhibiting the rheological behavior of a Casson fluid. The temperature-dependent nature of blood viscosity is postulated, and Reynold’s viscosity model describes it. This study examines the impact of electromagnetohydrodynamics (EMHD), body acceleration, Joule heating, and viscous dissipation. The assumption of a no-slip velocity condition is made at the walls of the artery. The governing equations are subjected to a process of non-dimensionalization and simplification, employing the mild-stenosis approximation. The resulting equations are subsequently solved in MATLAB by employing the finite-difference Crank–Nicolson technique. Entropy plays a significant role during any treatment or surgery; therefore, the present problem addresses entropy generation minimization. The results for velocity, temperature, wall shear stress, flow rate, impedance, heat transfer rate, entropy generation number, and Bejan number are represented graphically. The velocity contours illustrate that the flow velocity enhances with the Casson fluid and particle mass parameters. Furthermore, the number of trapped bolus also increases in the daughter artery. The nanofluid velocity and particle velocity decrease with an increase in the particle concentration parameter in the parent artery and the daughter artery. Entropy declines with the temperature difference parameter increment, whereas the Bejan number enhances. Magnetite (Fe3O4) nanoparticles have various applications owing to their biocompatibility, elevated magnetic susceptibility, chemical stability, non-toxic nature, and cost-effectiveness.

Abstract 13325: Novel Heterozygous EFEMP2 Variant Detected in a Patient With Bilateral Internal Carotid Artery Dissection and Oligodontia

Cutis laxa is a rare connective tissue disorder characterized by sagging or inelastic skin. This phenotype is caused by multiple genotype variants. Biallelic variants in the EFEMP2 gene cause cutis laxa subtype IB characterized by aortic aneurysm, arterial tortuosity, arterial stenosis, joint laxity, arachnodactyly, emphysema, and retrognathia. EFEMP2 encodes fibulin-4, an extracellular matrix protein involved in elastogenesis and modulation of TGF-beta signaling. To date, monoallelic variants in EFEMP2 have not been described as pathogenic. Furthermore, oligodontia has not been associated previously with variants in EFEMP2 . We describe a 67-year-old male with a past medical history of left distal internal carotid artery (ICA) pseudoaneurysm and dissection, right distal ICA dissection, arterial tortuosity, and oligodontia who was found to have a heterozygous variant of uncertain significance in EFEMP2: c.1279_1289del11, p.Arg427CysfsX27. The variant has not been observed previously in large population cohorts and causes a shift in reading frame that substitutes the carboxyl terminal 17 amino acids with 26 alternative amino acids. This carboxyl terminal variant of EFEMP2 has been predicted to interact with PITX2 in yeast two-hybrid analyses. Furthermore, variants in PITX2 have been associated with dental agenesis, including oligodontia. We hypothesize that heterozygous variants in EFEMP2 represent a new syndrome characterized by arteriopathy and dental agenesis.

Abstract 159: Computed Tomography Angiography Negative Spinal Artery Dissection

Introduction Vertebral artery dissection (VAD) is a relatively common cause of ischemic stroke, especially after chiropractic neck manipulation. VAD usually can be diagnosed by noninvasive imaging studies such as CT angiography (CTA) of the head and neck with suggestive findings of an arterial string sign, arterial stenosis, a double lumen sign, a pseudoaneurysm, or an occlusion. However, in rare situations, CTA may display normal arterial caliber except for very subtle signs such as abnormal dorsal thickening of the arterial wall against adjacent fat at the V3 segment of the vertebral artery. This is referred to as the "suboccipital rind sign." Here we wish to report such a case as identified at our institution. Methods Electronic charts of a patient with acute spinal shock and strokes were reviewed. Results The patient is a 36‐year‐old female with chronic neck pain, status‐post C5‐T1 spinal fusion who presented emergently with quadriparesis that following chiropractic neck manipulation. She felt a “pop” at the neck during the neck manipulation. She shortly thereafter began experiencing persistent neck pain associated with tingling sensations of both upper extremities on her drive home. She then noted transient right‐hand weakness as she was attempting to open a package. Her symptoms then temporarily resolved with rest, but after some time the paresthesia and neck pain reoccurred, worsened, and quickly progressed to quadriplegia. Brain MRI was negative for acute stroke. However, MRI of the cervical spine demonstrated acute cervical spinal cord ischemia in addition to post‐surgical changes. CTA head and neck reported normal arterial caliber. A diagnostic angiogram was performed that showed no evidence of arterial dissection but did demonstrate absence of the anterior spinal artery. Subsequently, CTA was further reviewed on thin slice revealing a “suboccipital rind sign" of the left V3 segment, suggesting left vertebral artery V3 segment dissection. Hypercoagulable workup was negative, and the patient was treated with anticoagulation. Conclusion Arterial dissection is usually readily diagnosable by CTA with high sensitivity. However, a study with normal caliber vessels in the reconstituted images does not always exclude an arterial dissection. To our knowledge there have been six reported vertebral dissection cases with a normal appearing lumen on CTA or conventional angiography. However, similar to our case, they displayed “suboccipital rind” signs on CTA thin cross‐section due to the thickening of the dissected artery on the V3 segment. The V3 segment has a horizontal course which runs parallel to the axially acquired imaging plane, which makes it difficult to appreciate the classic crescentic wall hematoma associated with arterial dissection. We hope that increased awareness of the typical location and appearance of the “suboccipital rind” sign on CTA may increase the detection rates of subtle arterial dissections in the setting normal‐appearing arterial lumens.

Poplitea Artery Entrapment Syndrome

Popliteal artery entrapment syndrome (PAES) is a rare pathological compression of the popliteal artery, mostly unilateral. Its diagnosis is a challenge due to low recurrence and confusion with other injuries that affect the lower limb. Delay in its repair can cause arterial stenosis, emboli, aneurysm, inability to perform physical activities, thromboembolism and acute limb ischemia. Young men without comorbidities who may exercise regularly with intermittent claudication that affects their daily activities should draw attention to research and treatment of the syndrome. Investigation is extremely important to rule out differential diagnoses, such as chronic compartment syndrome, neurogenic claudication, peripheral atherosclerosis and cystic disease of the popliteal artery.

Serum YKL-40 in coronary heart disease: linkage with inflammatory cytokines, artery stenosis, and optimal cut-off value for estimating major adverse cardiovascular events.

YKL-40, previously known as chitinase-3-like protein 1 (CHI3L1), is an inflammation-related glycoprotein that promotes atherosclerosis, but its application and optimal cut-off value as a prognostic biomarker in coronary heart disease (CHD) require more clinical evidence. Thus, this prospective study aimed to evaluate the linkage of serum YKL-40 with disease features, inflammatory cytokines, and major adverse cardiovascular events (MACEs) in CHD patients. A total of 410 CHD patients were enrolled for serum YKL-40 determination via enzyme-linked immunosorbent assay. Meanwhile, serum YKL-40 levels in 100 healthy controls (HCs) were also quantified. YKL-40 level was higher in CHD patients compared with that in HCs (P < 0.001). YKL-40 was positively linked with hyperlipidemia (P = 0.014), diabetes mellitus (P = 0.001), fasting blood glucose (P = 0.045), C-reactive protein (P < 0.001), the Gensini score (P < 0.001), and stenosis degree (graded by the Gensini score) (P < 0.001) in CHD patients. In addition, an elevated YKL-40 level was associated with increased levels of tumor necrosis factor alpha (P = 0.001), interleukin (IL)-1β (P = 0.001), IL-6 (P < 0.001), and IL-17A (P = 0.002) in CHD patients. The 1-/2-/3-year cumulative MACE rates of CHD patients were 5.5%, 14.4%, and 25.0%, respectively. Regarding the prognostic capability, YKL-40 ≥100 ng/ml (the median cut-off value) (P = 0.003) and YKL-40 ≥150 ng/ml (the third interquartile cut-off value) (P = 0.021) reflected an elevated accumulating MACE rate, whereas accumulating MACE was not different between CHD patients with YKL-40 ≥80 and <80 ng/ml (the first interquartile cut-off value) (P = 0.083). Serum YKL-40 is positively linked with inflammatory cytokines and the Gensini score, whose high expression cut-off by 100 and 150 ng/ml estimates a higher MACE risk in CHD patients.