Bifurcation Angle Research Articles

Presacral Anatomy in Women With a Horseshoe Kidney.

Horseshoe kidney (HSK) is the most common renal fusion defect that can alter vascular and upper urinary tract anatomy. Anatomic variations in the presacral space can make surgical dissection very challenging. The aim of this study was to characterize presacral anatomy in women with HSK. Large academic centers' database was queried to identify imaging studies in adult women with HSK. Available multiplanar computed tomography and magnetic resonance imaging images were reviewed, and relevant vascular and upper urinary tract anatomy was measured and compared with published normal values. Study population was compared with the normal controls using Student t test, χ test, or Fisher exact test as appropriate. One hundred seventy-eight women were identified initially, and 20 confirmed to have HSK on imaging. The mean ± SD age was 54.5 ± 16.9 years, and body mass index was 27.3 ± 7.5 kg/m. Women with HSK had a narrower angle of aortic bifurcation (39.1 ± 18.7 degrees vs 55.6 ± 4.5 degrees, P = 0.014); the right ureter was closer to midline (22.9 ± 8.8 mm vs 32.3 ± 1.2 mm, P < 0.001) when compared with normal controls anatomy. In 40% of women with HSK, the bifurcation of the vena cava was below the level of L5 in contrast to the 8% in the normal population (P < 0.001). In 60% of women with HSK, the inferior pole of the kidney was at or below L5. Ureteral, renal, and vascular anatomic alterations in women with HSK may make presacral surgical anatomy challenging by obscuring the anterior longitudinal ligament anchoring point. Preoperative imaging is warranted to determine the feasibility of female pelvic reconstructive surgery in HSK patients.

Geometry of the Carotid Artery and Its Association With Pathologic Changes in a Chinese Population.

ObjectivesCarotid artery geometry influences blood flow disturbances and is thus an important risk factor for carotid atherosclerosis. Extracellular matrix (ECM) and yes-associated protein (YAP) expression may play essential roles in the pathophysiology of carotid artery stenosis, but the effect of blood flow disturbances of carotid bifurcation location on the ECM is unknown. We hypothesized that carotid artery anatomy and geometry are independently associated with the ECM and YAP expression.MethodsIn this cross-sectional study, 193 patients were divided into two groups: an asymptomatic group (n = 111) and a symptomatic group (n = 82), symptomatic patients presenting with ischemic attack, amaurosis fugax, or minor non-disabling stroke. For all subjects before surgery, carotid bifurcation angle and internal artery angle were measured with computed tomography angiography (CTA), and laminar shear stress was measured with ultrasonography. After surgery, pathology of all plaque specimens was analyzed using hematoxylin and eosin (HE) staining and Movat special staining. Immunohistochemistry was performed to detect expression of YAP in a subset of 30 specimens.ResultsSymptomatic patients had increased carotid bifurcation angle and laminar shear stress compared to asymptomatic patients (P < 0.05), although asymptomatic patients had increased internal carotid angle compared to symptomatic patients (P < 0.001). Relative higher bifurcation angles were correlated with increased carotid bifurcation, decreased internal angle, and decreased laminar shear stress. For each change in intervertebral space or one-third of vertebral body height, carotid bifurcation angle changed 4.76°, internal carotid angle changed 6.91°, and laminar shear stress changed 0.57 dynes/cm2. Pathology showed that average fibrous cap thickness and average narrowest fibrous cap thickness were greater in asymptomatic patients than symptomatic patients (P < 0.05). Expression of proteoglycan and YAP protein in symptomatic patients was higher than in asymptomatic patients (P < 0.001), while collagen expression was lower in symptomatic patients than asymptomatic patients (P < 0.05).ConclusionGeometry of the carotid artery and position relative to cervical spine might be associated with ECM and YAP protein expression, which could contribute to carotid artery stenosis.

Effect of asymmetry on the flow behavior in an idealized arterial bifurcation

Flow behavior at the arterial bifurcations has significant implications on the plaque formation. It depends on the vessel size, two bifurcation angles, i.e. angle between the mother and daughter vessels and their relative magnitudes. In this study, hemodynamics for steady and pulsatile flow of blood has been investigated in an idealized carotid artery bifurcation having all the vessels in the same plane for a range of bifurcation angles for symmetric and asymmetric bifurcation. The simulations reveal the presence of a pair of helical vortices, symmetric about the bifurcation plane, in each daughter tube near the bifurcation.

The increased main branch to stent diameter ratio is associated with side branch decreased coronary flow in "true" coronary artery bifurcations treated by "provisional" stenting - a two-dimensional quantitative coronary angiography study

Background/Aim. Percutaneous coronary interventions (PCI) in bifurcation lesions having more than 50% stenosis of both the main branch (MB) and the side branch (SB) remain challenging. Measurements of the vessel diameters and angles using quantitative coronary angiography (QCA) software have been used in evaluating PCI outcomes. We investigated potential effects of provisional stenting of the MB on SB coronary blood flow by determining quantitative vessel parameters in ?true? non-left main coronary bifurcation lesions using conventional two-dimensional QCA. Methods. The study was prospective and conducted in a highvolume university PCI center. Study included patients with ?true? native coronary artery bifurcations (Medina 1.0.1; 0.1.1; 1.1.1) treated with ?provisional? stenting of the MB. Patients were excluded from the study if having left ventricular ejection fraction of less than 30%, having renal failure with creatinine clearance below 30 mL/kg/m2 or bifurcation lesions within the culprit artery causing myocardial infarction, grafted surgically or previously treated by PCI. QCA analysis included measurements of reference vessel diameters (RVD), diameter stenosis (DS) and bifurcation angles. Results. The study included 70 patients with 72 ?true? non-left main bifurcations. Most of the bifurcations were located in the left anterior descending (LAD) ? diagonal (Dg) territory. Compromise of the SB ostium defined as thrombolysis in myocardial infarction (TIMI) &lt; 3 coronary flow occurred in 17/72 (23.6%) bifurcations. It was treated by either balloon angioplasty only of the SB ostium (9/17, 52.9%) or stent implantation [8/17 (47.1%)]. In a logistic regression analysis, including previously recognized predictors of SB compromise (bifurcation?s angles, RVD, DS and ratio of MB RVD to stent diameter ratio), only MB RVD to stent diameter ratio after PCI remained independent predictor of SB coronary flow compromise after stent implantation in the MB [OR 2.758 (95% CI 1.298?5.862); p = 0.008]. Conclusions. It appears that SB decreased coronary blood flow after ?provisional? stenting in ?true? non-left main bifurcations is associated with greater MB to stent diameter ratio.

Carotid geometry is an independent predictor of wall thickness \u2013 a 3D cardiovascular magnetic resonance study in patients with high cardiovascular risk

BackgroundThe posterior wall of the proximal internal carotid artery (ICA) is the predilection site for the development of stenosis. To optimally prevent stroke, identification of new risk factors for plaque progression is of high interest. Therefore, we studied the impact of carotid geometry and wall shear stress on cardiovascular magnetic resonance (CMR)-depicted wall thickness in the ICA of patients with high cardiovascular disease risk.MethodsOne hundred twenty-one consecutive patients ≥50 years with hypertension, ≥1 additional cardiovascular risk factor and ICA plaque ≥1.5 mm thickness and < 50% stenosis were prospectively included. High-resolution 3D-multi-contrast (time of flight, T1, T2, proton density) and 4D flow CMR were performed for the assessment of morphological (bifurcation angle, ICA/common carotid artery (CCA) diameter ratio, tortuosity, and wall thickness) and hemodynamic parameters (absolute/systolic wall shear stress (WSS), oscillatory shear index (OSI)) in 242 carotid bifurcations.ResultsWe found lower absolute/systolic WSS, higher OSI and increased wall thickness in the posterior compared to the anterior wall of the ICA bulb (p < 0.001), whereas this correlation disappeared in ≥10% stenosis. Higher carotid tortuosity (regression coefficient = 0.764; p < 0.001) and lower ICA/CCA diameter ratio (regression coefficient = − 0.302; p < 0.001) were independent predictors of increased wall thickness even after adjustment for cardiovascular risk factors. This association was not found for bifurcation angle, WSS or OSI in multivariate regression analysis.ConclusionsHigh carotid tortuosity and low ICA diameter were independent predictors for wall thickness of the ICA bulb in this cross-sectional study, whereas this association was not present for WSS or OSI. Thus, consideration of geometric parameters of the carotid bifurcation could be helpful to identify patients at increased risk of carotid plaque generation. However, this association and the potential benefit of WSS measurement need to be further explored in a longitudinal study.

Corrected Bifurcation Angle versus Distal Bifurcation Angle for Prediction of Side Branch Compromise after Provisional Bifurcation Coronary Intervention

Corrected Bifurcation Angle versus Distal Bifurcation Angle for Prediction of Side Branch Compromise after Provisional Bifurcation Coronary Intervention

In vivo cross-sectional topographic anatomy at sternal angle on magnetic resonance imaging

Introduction: The manubriosternal angle, first described by Louis in 1825, is an important landmark in the anatomy of the thorax and has been conventionally described as corresponding to the T4–5 IV disc level based on cadaveric dissections. The objective of this study was to document the level of the angle of Louis and various anatomic structures that also correspond to the same level in living individuals based on multiplanar magnetic resonance (MR) images. Material and Methods: We reviewed MR scans of the cervicodorsal spine of 262 individuals comprising 174 males and 88 females in the age range 14–76 years. For each individual, the vertebral level of the following structures was noted on T1-weighted (T1W)/T2-weighted (T2W) turbo spin echo (TSE) coronal and sagittal images, namely tracheal bifurcation (TB), aortic arch (AA), and sternal angle (SA). Results: The SA was most commonly seen corresponding to the T5 vertebral body level (45.20%) and at T4–5 IV disc level in only 20.45% of the individuals. The convexity of the arch of the aorta was seen in the majority of the individuals corresponding to the T3 vertebral body level (47.96%). TB was seen at T4 level in 34.35% and only in 22.69% at the T4–5 IV disc level. Discussion and Conclusion: The anatomical level of the SA, AA, and TB in living individuals as assessed on MR images is significantly different from the traditionally held belief based on cadaveric dissections.

Human basilar artery: morphology &amp;amp; variations

<sec> Introduction Basilar artery is an unpaired medium-sized artery formed by the confluence of right and left vertebral arteries at the pontomedullary junction and extends to the pontomesencephalic junction. It forms the spine of posterior cerebral circulation which is constituted by the vertebrobasilar system and its branches. Normal morphology of the basilar artery forms an essential component of cerebral circulation. The present study aims to measure the level of formation &amp; termination, length, diameter, and angle of formation of the basilar artery. The data presented are relevant to understanding human variations and would be a good anatomical reference for clinicians, anatomists, and medical students. Caliber, length, and angle of bifurcation of the basilar artery help in assessing the feasibility and approach for various surgical procedures and predict cerebro-vascular diseases. </sec><sec> Materials &amp; methods 96 adult human brain specimens were studied. (78 male, 18 female) (Age range: 19–80 y; Average age: 47.66 y). Measurements were taken using Vernier calliper. Data was analysed using Microsoft Excel and SPSS software version 17. </sec><sec> Results The basilar artery was formed by the confluence of two vertebral arteries in all specimens extending from the pontomedullary junction to the pontomesencephalic junction in 2/3^rd of the cases. The left vertebral artery was found to be dominant in 62.5% specimens. The basilar artery showed an average length of 3.1 cm (demonstrating positive correlation with age), average diameter of 3.6–3.9 mm at different levels, and average angle of formation as 65.38° in males and 62.22° in females. Fetal type posterior cerebral artery was noticed in 9.4% cases. 3.1% and 6.3% cases were seen on the right and left sides respectively. Basilar artery fenestration was noted in 2 percent specimens. </sec><sec> Conclusion Basilar artery morphology was studied in 96 human adult cadavers. Basilar artery formation and termination was normal in more than 2/3^rd cases. Variations were noted in its origin, vessel hypoplasia, presence of fenestrations, and fetal patterns. The data obtained from this study are relevant for anatomists, medical students, interventional radiologists, and neurosurgeons. </sec>

Can diabetic foot development be predicted in diabetic patients with aortic, iliac and femoral bifurcation angles? A Computed Tomography Angiography study.

Can diabetic foot development be predicted in diabetic patients with aortic, iliac and femoral bifurcation angles? A Computed Tomography Angiography study.

A Comparison of Aortoiliac Disease between Eastern and Western Countries.

A variety of diseases are known to develop in the aortoiliac segment; these include abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease. This review summarizes several differences of aortoiliac diseases between eastern and western populations. The prevalence of AAA was higher in western countries (4.57% to 19%) than in eastern countries (0.89% to 4.9%). Greater aortic bifurcation angles were observed in the eastern population, while longer common iliac arteries and aneurysm necks were found in the western population with AAA. However, the angle of the aneurysm was found to be more acute in patients from western countries. Several differences were found between patients from western countries and those from eastern countries regarding the diseases that occur in the aortoiliac segment and their anatomical characteristics. Therefore, different approaches to the treatment of aortoiliac diseases in these two groups should be considered.

The Role of Intraindividual Carotid Artery Variation in the Development of Atherosclerotic Carotid Artery Disease: A Literature Review

Carotid artery disease (CAD) is associated with numerous risk factors, including hypertension, hyperlipidemia, hypercholesterolemia, diabetes mellitus, and smoking. These systemic risk factors do not affect the carotid arteries equally in most patients, resulting in asymmetrical bilateral and unilateral CAD. It is unclear if anatomic variations in the carotid arteries predispose an individual to formation of atherosclerotic CAD. We wanted to assess (1) the inter-individual or intra-individual anatomical variations in the carotid arteries and (2) whether anatomical variations predispose the development of atherosclerotic CAD. PubMed and Medline were utilized to identify relevant literature for critical appraisal, summarization and documentation. Inclusion and exclusion criteria were applied to narrow results and articles were critically appraised and analyzed. Evidence suggests that a low outflow/inflow ratio, elevated bifurcation height, and bifurcation angle are associated with increased risk for CAD. Sex and age demonstrated positive correlation with the disease. Additionally, tortuosity and kinking of the carotid arteries may affect the formation of CAD but coiling of the arteries is a natural age-dependent process and does not affect CAD development. This review suggests there are anatomic variations in the carotid arteries that increase the risk of developing carotid artery disease. The most significant risk factors include a low outflow/inflow ratio, increased internal carotid artery tortuosity, elevated bifurcation height, and bifurcation angle.

Is there any relationship between carotid bifurcation geometry and hemodynamic depression after carotid stenting and angioplasty?

Hemodynamic depression (HD) is a condition that can be encountered after carotid stenting (CAS) and carotid angioplasty (CAP) due to manipulation of the carotid sinus. The aim of this study was to evaluate whether the carotid bifurcation geometry and angles, or changes in angles, were associated with this HD in patients undergoing CAS and CAP. Sixty-two patients with a mean age of 71.1±7.4 years, who underwent CAS and CAP for carotid stenosis were included in the study. HD was defined as periprocedural hypotension (systolic blood pressure <90 mmHg) or bradycardia (heart rate <60 bpm). The effect of carotid bifurcation geometry, plaque morphology and risk factors on subsequent development of HD was analyzed with binary logistic regression models. ICA-CCA angle was measured from digital subtraction angiographies (DSA) before and after stent deployment by two radiologists. Interobserver agreement was calculated. Periprocedural HD was seen in 22 (35.5%) patients. Extension of carotid lesion to bulbus, preoperative internal carotid artery (ICA) angle, postoperative angular changes, pre-op systolic blood pressure, balloon-to-artery ratio and HD were significantly correlated. A significant difference was observed between the angle of ICA before and after the procedure between the patients with HD and those without HD. Carotid anatomy and geometry may enhance the risk of HD independent of other factors and may be of help in very early identification of patients at high risk of developing HD after CAS and CAP.

A significant role of permeability on blood flow for hybrid nanofluid through bifurcated stenosed artery: Drug delivery application

ObjectiveThe prime objective of concerned article is to discuss the permeability impacts on blood flow by considering hybrid nanofluid through bifurcated stenosed artery. Design/approachThe human body circulatory framework involves the arrangement of veins that fuse the bifurcation on parent, at apex and on regions of daughter artery with nanoparticles is viewed. Blood streaming is recognized as Newtonian along vessel segment. The walls of the stenosed bifurcated artery is considered to be permeable as well as compliant. Copper and its oxide as used as drug to minimize the stress and the lesions of the atherosclerotic artery. FindingsThe theoretical investigation is carried out by invoking the experimental values of hybrid nanoparticles into the structured equations. Moreover, impacts of hemodynamics are also make sense of to inspect the progression of blood for atherosclerotic vein. Daughter and parent artery comparison is described through parabolic graph of velocity. Graphical illustration is utilized to present the theoretical results of this drug delivery model. Metallic nanoparticles justify their use in drug delivery. ConclusionsThe flow of blood is viewed as not quite the same as pressure between segments of atherosclerotic and non-atherosclerotic course. Bifurcation angle minimize the stress for daughter artery whereas trend is opposite for parent daughter. The change in compliant wall parameter reduces the circulating bolus size for parent daughter whereas for daughter artery the change in bolus shape is observed.

Mathematical Modeling for Flood Mitigation: Effect of Bifurcation Angles in River Flowrates

This paper investigates the river flowrate at two branches of bifurcated river. The mathematical model from the literature is formulated based on momentum principle and mass continuity to cope with river flowrate at different bifurcation angles. The hydraulic variables, geometric properties of trapezoidal cross-sectional river and other physical characteristics of bifurcated river are provided, which may be assumed to be given beforehand for practical applications. An example of river bifurcation problem is given by UTM Centre for Industrial and Applied Mathematics (UTM-CIAM), Universiti Teknologi Malaysia. Maple software is used to implement the proposed model equation and generate the results. The amount of bifurcated river flowrate with different bifurcation angles is determined, resulting in a reasonable discussion. It is shown that for specific bifurcation angles, the river flowrates after the bifurcated junction are less than the critical flowrate. Finally, the results of applied problem indicate that the right-angled river bifurcation would be preferable to mitigate flood.

Study on the smoke movement characteristics in large scale interchange tunnel fire

For the interchange tunnel fire, the structural features of bifurcation and convergence will make the smoke movement characteristics different from the traditional single tube tunnel fire. This paper carried out numerical simulations by ANSYS Fluent to study the smoke movement characteristics in large scale interchange tunnel fire. Different heat release rates, ventilation velocities and bifurcation angles were considered to analyze the carbon monoxide concentration distribution and critical velocity. Results showed that the CO concentration decreased as the ventilation velocity increased and the variation gradient of CO concentration decreased as the distance away from the fire increased. The CO concentration distribution was symmetrical about the longitudinal centerline of the tunnel when the fire located far away from the bifurcation point, and the asymmetric distribution phenomenon disappeared while the fire located at the bifurcation point. In addition, the critical velocity increased as the bifurcation angle increased while the fire located at the bifurcation point. However, the bifurcation angle had no direct impact on the critical velocity when the fire located far away from the bifurcation point.

Asymmetrical than symmetrical cerebral arterial bifurcations are more vulnerable to aneurysm presence

In order to investigate the role of lateral angle ratio (LA ratio) and daughter artery ratio (DA ratio) for predicting aneurysmal presence in main cerebral arterial bifurcations, three-dimensional cerebral angiographic data of major cerebral artery bifurcations were used for measurement of artery diameters and bifurcation angles including 115 middle cerebral arteries (MCAs), 59 basilar arteries (BAs), 35 internal carotid arteries (ICAs) and 115 anterior cerebral arteries (ACAs) with bifurcation aneurysms and control subjects of 1921 bifurcations with no aneurysms. The LA ratio (larger lateral angle/smaller lateral angle) and DA ratio (larger branch diameter/smaller branch diameter) were calculated, and ROC curve analysis of LA and DA ratios between normal and aneurysmal cases was performed. The LA and DA ratios of MCA bifurcations and the LA ratios of BA and ICA bifurcations with aneurysms were all significantly larger than normal bifurcations (P < 0.05), and the DA ratio of ACA bifurcations with aneurysms was significantly smaller than normal cases (P < 0.01). Moreover, the LA ratio or DA ratio between the normal and aneurysm cases in MCA, BA and ACA bifurcations demonstrated significant differences by ROC analysis (P < 0.01) except in the ICA bifurcations. No significant difference was observed (P > 0.05) between ruptured and unruptured aneurysms in MCA, BA, ICA and ACA bifurcations. In summary, normal MCA, BA and ICA bifurcations show symmetrical morphology in the lateral angles and daughter branches, whereas aneurysmal bifurcations show asymmetrical morphology. Normal ACA bifurcations have asymmetrical bilateral daughter branches while symmetrical branches are associated with ACA bifurcation aneurysm presence.

Asymmetrical middle cerebral artery bifurcations are more vulnerable to aneurysm formation

The objective of this study was to elucidate possible relationship between middle cerebral artery (MCA) bifurcation aneurysms and bifurcation morphology. In the present study, 799 patients with three-dimensional angiography were enrolled, including 115 patients with MCA bifurcation aneurysms and 684 subjects without aneurysms. The MCA bifurcation geometry, including angles formed between two M2 segments (φ1) and between M1 and M2 segments, vessel diameters and aneurysm sizes were measured. DA ratio (larger/smaller M2 in diameter) and LA ratio (larger/smaller lateral angle) were also analyzed. The LA and DA ratios and angle φ1 were significantly (P < 0.0001) greater in patients harboring MCA bifurcation aneurysms than in the control, whereas lateral angles and bifurcation branch diameters were significantly smaller (P < 0.01) in patients with than without bifurcation aneurysms. Angle φ1 was significantly increased (P < 0.0001) while both lateral angles significantly decreased (P < 0.0001 and P = 0.0005, respectively) with increase of patients’ age. The size of MCA bifurcation aneurysms was significantly (P < 0.05) positively correlated with the bifurcation vascular diameter and aneurysm neck at the MCA bifurcation. A significantly positive correlation existed between aneurysm neck and DA ratio (P = 0.0075), whereas an inverse correlation between aneurysm neck and LA ratio (P = 0.0219). MCA bifurcation aneurysms were mostly deviated toward the smaller lateral angles and smaller M2 branch. In conclusion, aneurysmal MCA bifurcations have asymmetrical bifurcation structures with widened bifurcation angles, narrowed lateral angles, decreased M1 diameter, imbalanced lateral angles and M2 segments, with the cutoff bifurcation angle of 125.0° and cutoff lateral angle ratio of 1.57 for predicting MCA bifurcation aneurysms, whereas normal MCA bifurcations show close to symmetrical structures in the lateral angles and M2 branches.

Utilization of Cu-nanoparticles as medication agent to reduce atherosclerotic lesions of a bifurcated artery having compliant walls

ObjectiveA theoretical analysis is presented to study the bio-nanofluid with copper as medication agent for atherosclerotic bifurcated artery with flexible walls. Design/approachThe circulatory framework in human body is comprised of a system of veins that incorporate the bifurcation in this way the impact of copper nanoparticles on parent, at apex and on daughter artery regions (in the wake of being bifurcated) is watched. Streaming of blood along vessel segment is recognized to be newtonian. The consistent idea of the atherosclerotic arterial wall is additionally considered to make relationship with permeability aspects with arterial wall thickness. Copper nanoparticles are utilized to reduce the atherosclertic lesions for bifurcated stenotic artery. FindingsThe designed equations along with the experimental values of copper nanoparticles and blood are utilized for theoretical investigation. Moreover, hemodynamics impacts are also figure out to examine the flow of blood for atherosclertic artery. Comparison between parent and daughter artery is plotted through velocity profile. To see the theoretical assistance of this copper mediated model in biomedical field, graphical illustration is presented. At the end, noticed that the inclusion of copper nanoparticles enhances the velocity significantly both for parent as well as daughter artery. ConclusionsThe circulation of blood is considered to be different from pressure between portions of atherosclerotic and non-atherosclerotic artery. Shear stress is reduces by changing the bifurcation angle for daughter artery while trend is reversed for parent artery. The size of inner circularting bolus decreases by changing compliant parameter for parent artery while shape is changed for daughter artery.

The Chalice Sign : Characteristic Morphology of the Cervical Carotid Bifurcation in Patients with Loeys-Dietz Syndrome.

Loeys-Dietz syndrome (LDS) is aconnective tissue disorder characterized by arterial aneurysms and dissections. This study sought to assess and describe the arterial changes of the cervical arterial vasculature of such patients, with an emphasis on the carotid bifurcation. Aretrospective review of patients with aknown diagnosis of LDS was carried out. The maximum diameters of the external carotid artery (ECA) and internal carotid artery (ICA) origins, common carotid artery (CCA) terminus, maximum transverse and craniocaudal dimensions of the carotid bulb, and bifurcation angle were measured. The presence of achalice sign was defined as acarotid bifurcation angle of ≥80°. Asemi-quantified analysis of vertebral artery tortuosity was completed as well. All measurements were compared to acohort of age-matched controls. A total of 21patients with LDS were included. Compared to normal controls, the presence of achalice sign had 61.9% sensitivity and 100.0% specificity for LDS if present bilaterally; the sensitivity and specificity of aunilateral chalice sign were 66.7% and 82.3%, respectively. Patients with LDS also had significantly higher rates of abilateral chalice sign compared to patients with vascular Ehlers-Danlos syndrome (vEDS) (61.9% versus 0%, P <0.0001) and patients with Marfan syndrome (61.9% versus 14.3%, P = 0.001). Patients with LDS have characteristic findings of the cervical arterial vasculature that enables them to be distinguished from normal controls as well as patients with connective tissue diseases, such as Marfan syndrome and vEDS; most notably including marked widening of the carotid bifurcation angle in what is proposed to be named the chalice sign.

TCT-347 Frequency of Incomplete Stent Apposition at Side-Branch Ostium After Kissing Balloon Inflation Predicted From Pre-Operative Appearance of Coronary Artery Bifurcation on 3-Dimensional Optical Coherence Tomograms

Bifurcation angle (BA) influences incomplete stent apposition (ISA) at side branch ostium after kissing balloon inflation (KBI). Although BA can be measured by various methods, this study investigated whether 3-dimensional (3D)-optical coherence tomography (OCT) bifurcation types could predict ISA