Bilateral Stenosis Research Articles

Ambient RNAs removal of cortex-specific snRNA-seq reveals Apoe+ microglia/macrophage after deeper cerebral hypoperfusion in mice

BackgroundAmbient RNAs contamination in single-nuclei RNA sequencing (snRNA-seq) is a challenging problem, but the consequences of ambient RNAs contamination of damaged and/or diseased tissues are poorly understood. Cognitive impairments and white/gray matter injuries are characteristic of deeper cerebral hypoperfusion mouse models induced by bilateral carotid artery stenosis (BCAS), but the molecular mechanisms still need to be further explored. More importantly, the BCAS mice can also offer an excellent model to examine the signatures of ambient RNAs contamination in damaged tissues when performing snRNA-seq.MethodsAfter the sham and BCAS mice were established, cortex-specific single-nuclei libraries were constructed. Single-nuclei transcriptomes were described informatically by the R package Seurat, and ambient RNA markers of were identified in each library. Then, after removing ambient RNAs in each sample using the in silico approaches, the combination of CellBender and subcluster cleaning, single-nuclei transcriptomes were reconstructed. Next, the comparison of ambient RNA contamination was performed using irGSEA analysis before and after the in silico approaches. Finally, further bioinformatic analyses were performed.ResultsThe ambient RNAs are more predominant in the BCAS group than the sham group. The contamination mainly originated from damaged neuronal nuclei, but could be reduced largely using the in silico approaches. The integrative analysis of cortex-specific snRNA-seq data and the published bulk transcriptome revealed that microglia and other immune cells were the primary effectors. In the sequential microglia/immune subgroups analysis, the subgroup of Apoe+ MG/Mac (microglia/macrophages) was identified. Interestingly, this subgroup mainly participated in the pathways of lipid metabolism, associated with the phagocytosis of cell debris.ConclusionsTaken together, our current study unravels the features of ambient RNAs in snRNA-seq datasets under diseased conditions, and the in silico approaches can effectively eliminate the incorrected cell annotation and following misleading analysis. In the future, snRNA-seq data analysis should be carefully revisited, and ambient RNAs removal needs to be taken into consideration, especially for those diseased tissues. To our best knowledge, our study also offers the first cortex-specific snRNA-seq data of deeper cerebral hypoperfusion, which provides with novel therapeutic targets.

Case Report: Multiple atherosclerotic plaques at its extreme in synchrony

Peripheral vascular disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral vascular disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.

A Pseudo-Cardiogenic Shock Due to Bilateral Subclavian Artery Stenosis

A Pseudo-Cardiogenic Shock Due to Bilateral Subclavian Artery Stenosis

A Novel Staged Revascularization Strategy for Bilateral Severe Internal Carotid Artery Stenosis at High Risk for Hyperperfusion Syndrome

Since bilateral severe internal carotid artery stenosis often is associated with severely decreased cerebrovascular reactivity (CVR) due to poor collateral blood flow, revascularization carries a high risk for development of hyperperfusion syndrome. In this study, we report a new staged strategy to prevent postoperative hyperperfusion syndrome in such patients. Bilateral severe cervical internal carotid artery stenosis patients with decreased CVR to 10% or less on one side were prospectively enrolled in this study. We first performed carotid artery stenting on the side with the milder CVR decrease (lower-risk side), aiming to improve hemodynamics associated with the severe CVR decrease on the greater-risk side. Then, carotid endarterectomy or carotid artery stenting was performed on the contralateral side after an interval of 4-8 weeks. In all 3 cases enrolled in this study, CVR on the greater-risk side improved to 10% or more 1 month after the first treatment. The ratio of regional cerebral blood flow on the contralateral greater-risk side was 114% 1 day after the second treatment, and HPS did not develop in any of the cases. Our treatment strategy, in which revascularization on the lower-risk side precedes that on the greater-risk side, is effective for the prevention of HPS in bilateral ICA stenosis patients.

#6682 RENAL ARTERY STENOSIS: A SINGLE CENTRE STUDY

Abstract Background and Aims Renal artery stenosis (RAS) is present from 1% to 5% in people affected by arterial hypertension and it is often associated with peripheral artery disease and coronary artery disease; as the matter of fact, it is commonly found in people undergoing cardiac catheterization (18-20%) or angiography for aorto-iliac and lower extremities diseases. The major cause of renal artery stenosis is an atherosclerotic lesion localized in the proximal segment or to the ostium. Clinical presentations are renovascular hypertension and ischemic nephropathy. The aim of the study is to define either endovascular treatment gives a significant benefit on renal function and blood pressure control, when associated to medical therapy. Method This is a retrospective study focused on patients who underwent renal artery angioplasty and stenting in the last ten years, from November 2011 to April 2021 in the Nephrology Department, at Sant'Andrea Hospital, La Spezia (Italy). The primary outcome was kidney function, while secondary outcomes were blood pressure and the number of antihypertensive drugs one year after the revascularization. Patients included in the study had uncontrolled and refractory arterial hypertension (PA ≥140/90 mmHg) and/or progressive worsening of renal function, secondary to bilateral or unilateral stenosis in one functional kidney, that was identified at the color-doppler ultrasound examination by a peak systolic velocity (PSV) >200 ml/min and an aortic-renal ratio >3,5. We found 36 patients who had these characteristics. They were all affected by chronic kidney disease (CKD) (mean±SD eGFR 25,3±15,3 ml/min/1,73 m2) equally divided into stage 3 (33%, eGFR 30-60 ml/min/1,73 m2), stage IV (31% eGFR 15-29 ml/min/1,73 m2) and stage V (36%, eGFR <15 ml/min/1,73 m2). Results Kidney function, measured as serum creatinine (SCr) (mg/dl), improved immediately after the revascularization (mean ± SD SCr after vs before 2,52 ± 1,61 vs 3,31 ± 2,47 mg/dl p<0.05), after 30 days (mean ± SD SCr after vs before creat. 2,36 ± 1,53 vs 3,19 ± 2,39 mg/dl p<0.05) and after one year (mean ± SD SCr after vs before creat. 2,04 ± 1,16 vs 2,99 ± 2,40 mg/dl p<0.05) (Fig. 1). Regarding arterial hypertension, a significant reduction of both systolic (SBP) and diastolic (DBP) blood pressure was detected in the subgroup of people under 75 years old (mean ± SD SBP after vs before, 144,62 ± 12,55 vs 168,18 ± 36,40 mmHg, p< 0,01; after one year vs before, 143,95 ± 21,10 vs 167,83 ± 38,16 mmHg, p<0.05) (mean ± SD DBP after vs before, 73,62 ± 9,62 vs 83,07 ± 21,75 mmHg, p< 0,05; after one year vs before 75,20 ± 9,02 vs 83,33 ± 23,10 mmHg, p = 0.07) (Fig. 2). The number of antihypertensive drugs dropped immediately after the angioplasty (mean ± SD tablets after vs before 2,28 ± 1,11 vs 3,21 ± 1,43, p<0.01), while after one year there was not a significant increase of therapy (mean ± SD tablets after one year vs before, 3,00 ± 1,41 vs 3,23 ± 1,42, p = 0,47), even if blood pressure was better controlled than before the procedure with the same amount of tablets (Fig. 3). Conclusion Although our population was quite small, we demonstrated the advantages of renal artery revascularization in atherosclerotic renovascular disease, as demonstrated by kidney function and blood pressure control. Our results contrast the larger studies considered, that found no relevant clinical benefit on renal function and incidence of major adverse cardiovascular and renal events by comparing patients treated with medical therapy alone or with medical therapy plus angioplasty. The different conclusions are probably due to our strict adhesion to the endovascular treatment indications, which consider the revascularization as the optimal strategy for a well-defined population.

Compound from Magnolia officinalis Ameliorates White Matter Injury by Promoting Oligodendrocyte Maturation in Chronic Cerebral Ischemia Models.

Chronic cerebral hypoperfusion leads to white matter injury (WMI), which subsequently causes neurodegeneration and even cognitive impairment. However, due to the lack of treatment specifically for WMI, novel recognized and effective therapeutic strategies are urgently needed. In this study, we found that honokiol and magnolol, two compounds derived from Magnolia officinalis, significantly facilitated the differentiation of primary oligodendrocyte precursor cells (OPCs) into mature oligodendrocytes, with a more prominent effect of the former compound. Moreover, our results demonstrated that honokiol treatment improved myelin injury, induced mature oligodendrocyte protein expression, attenuated cognitive decline, promoted oligodendrocyte regeneration, and inhibited astrocytic activation in the bilateral carotid artery stenosis model. Mechanistically, honokiol increased the phosphorylation of serine/threonine kinase (Akt) and mammalian target of rapamycin (mTOR) by activating cannabinoid receptor 1 during OPC differentiation. Collectively, our study indicates that honokiol might serve as a potential treatment for WMI in chronic cerebral ischemia.

Comparative Analysis of Symptomatic and Asymptomatic Carotid Plaque With Bilateral Mild Carotid Stenosis (30%-50%).

HomeStrokeAhead of PrintComparative Analysis of Symptomatic and Asymptomatic Carotid Plaque With Bilateral Mild Carotid Stenosis (30%–50%) No AccessResearch ArticleRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessResearch ArticleRequest AccessComparative Analysis of Symptomatic and Asymptomatic Carotid Plaque With Bilateral Mild Carotid Stenosis (30%–50%) Atulabh Vajpeyee, Pushan Sharma, Piyush Kumar Anshu, Shivam Tiwari, Lokendra Bahadur Yadav, Kapil Vyas and Manisha Vajpeyee Atulabh VajpeyeeAtulabh Vajpeyee Correspondence to: Atulabh Vajpeyee, MD, DM (Neurology), FINS, Department of Neurosciences, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, India313001. Email E-mail Address: [email protected] https://orcid.org/0000-0002-7942-4302 Department of Neurosciences, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India (A.V., P.S., P.K.A., S.T., L.B.Y.). *A. Vajpeyee, S. Tiwari, and L.B. Yadav contributed equally. Search for more papers by this author , Pushan SharmaPushan Sharma https://orcid.org/0000-0002-4965-6655 Department of Neurosciences, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India (A.V., P.S., P.K.A., S.T., L.B.Y.). Search for more papers by this author , Piyush Kumar AnshuPiyush Kumar Anshu https://orcid.org/0000-0003-1606-9208 Department of Neurosciences, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India (A.V., P.S., P.K.A., S.T., L.B.Y.). Search for more papers by this author , Shivam TiwariShivam Tiwari https://orcid.org/0000-0001-9465-1215 Department of Neurosciences, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India (A.V., P.S., P.K.A., S.T., L.B.Y.). *A. Vajpeyee, S. Tiwari, and L.B. Yadav contributed equally. Search for more papers by this author , Lokendra Bahadur YadavLokendra Bahadur Yadav https://orcid.org/0000-0002-5035-0573 Department of Neurosciences, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India (A.V., P.S., P.K.A., S.T., L.B.Y.). *A. Vajpeyee, S. Tiwari, and L.B. Yadav contributed equally. Search for more papers by this author , Kapil VyasKapil Vyas Department of Radiology, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India.(K.V.) Search for more papers by this author and Manisha VajpeyeeManisha Vajpeyee https://orcid.org/0000-0001-5010-2863 Department of Reproductive Medicine and Research, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, Rajasthan, India. (M.V.) Search for more papers by this author Originally published2 Jun 2023https://doi.org/10.1161/STROKEAHA.123.042874Stroke. 2023;0"Comparative Analysis of Symptomatic and Asymptomatic Carotid Plaque With Bilateral Mild Carotid Stenosis (30%–50%)." Stroke, , pp. FootnotesFor Sources of Funding and Disclosures, see page XXX.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.123.042874.*A. Vajpeyee, S. Tiwari, and L.B. Yadav contributed equally.Correspondence to: Atulabh Vajpeyee, MD, DM (Neurology), FINS, Department of Neurosciences, Pacific Medical College and Hospital, Pacific Medical University, Udaipur, India313001. Email [email protected]com Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.123.042874PMID: 37264912 Originally publishedJune 2, 2023 Keywordscarotid arterieshemorrhagefibrous capmorphologyconsentPDF download Advertisement SubjectsPhysiologyVascular Biology

Microbial lipopolysaccharide-induced inflammation contributes to cognitive impairment and white matter lesion progression in diet-induced obese mice with chronic cerebral hypoperfusion.

White matter lesions (WMLs) are involved in the pathological processes leading to cognitive decline and dementia. We examined the mechanisms underlying the exacerbation of ischemia-induced cognitive impairment and WMLs by diet-induced obesity, including lipopolysaccharide (LPS)-triggered neuroinflammation via toll-like receptor (TLR) 4. Wild-type (WT) and TLR4-knockout (KO) C57BL/6 mice were fed a high-fat diet (HFD) or low-fat diet (LFD), and subjected to bilateral carotid artery stenosis (BCAS). Diet groups were compared for changes in gut microbiota, intestinal permeability, systemic inflammation, neuroinflammation, WML severity, and cognitive dysfunction. In WT mice, HFD induced obesity and increased cognitive impairment and WML severity compared with LFD-fed mice following BCAS. HFD caused gut dysbiosis and increased intestinal permeability, and plasma LPS and pro-inflammatory cytokine concentrations. Furthermore, HFD-fed mice had higher LPS levels and higher neuroinflammatory status, including increased TLR4 expression, in WMLs. In TLR4-KO mice, HFD also caused obesity and gut dysbiosis but did not increase cognitive impairment or WML severity after BCAS. No difference was found between HFD- and LFD-fed KO mice for LPS levels or inflammatory status in either plasma or WMLs. Inflammation triggered by LPS-TLR4 signaling may mediate obesity-associated exacerbation of cognitive impairment and WMLs from brain ischemia.

Transcriptome Profiling of Hippocampus After Cerebral Hypoperfusion in Mice.

Chronic cerebral hypoperfusion (CCH) is considered to be one of the major mechanism in the pathogenesis of vascular cognitive impairment (VCI). Increased inflammatory cells, particularly microglia, often parallel hypoperfusion-induced gray matter damage such as hippocampal lesions, but the exact mechanism remains largely unknown. To understand the pathological mechanisms, we analyzed hippocampus-specific transcriptome profiles after cerebral hypoperfusion. The mouse hypoperfusion model was induced by employing the 0.16/0.18mm bilateral common carotid artery stenosis (BCAS) procedure. Cerebral blood flow (CBF) was assessed after 3-week hypoperfusion. Pathological changes were evaluated via hematoxylin staining and immunofluorescence staining. RNA-sequencing (RNA-seq) was performed using RNA samples of sham- or BCAS-operated mice, followed by quantitative real-time PCR (qRT-PCR) validation. We found that the 0.16/0.18mm BCAS induced decreased CBF, hippocampal neuronal loss, and microglial activation. Furthermore, GSEA between sham and BCAS mice showed activation of interferon-beta signaling along with inflammatory immune responses. In addition, integrative analysis with published single-cell RNA-seq revealed that up-regulated differentially expressed genes (DEGs) were enriched in a distinct cell type of "microglia," and down-regulated DEGs were enriched in "CA1 pyramidal," not in "interneurons" or "S1 pyramidal." This database of transcriptomic profiles of BCAS-hypoperfusion will be useful for future studies to explore potential targets for vascular cognitive dysfunction.

Persistent diurnal enuresis in a 6-year-old boy after bilateral ureteroneocystostomy

Urinary incontinence is one of the most common symptoms in children and adolescents. Due to numerous causes, a thorough examination is necessary. We present a case of a 6-year-old boy with diurnal enuresis, who was admitted to our Department for further treatment after the procedure of bilateral ureteroneocystostomy due to suspected bilateral ureter stenosis. With the persistence of the incontinence, our examination revealed a posterior urethral valve which was incised and the symptoms subsided.

Effect of anterior communicating artery patency on the flow velocity in bilateral carotid artery stenosis after carotid endarterectomy.

The effect of anterior communicating artery (ACoA) patency on the flow velocity of the extracranial carotid arteries is unclear. A total of 285 patients with carotid artery stenosis were included between January 2019 and January 2021. All patients received unilateral carotid endarterectomy (CEA). The patients were classified into ACoA-patent (161) and ACoA-nonpatent (124) groups using digital subtraction angiography (DSA) and/or computed tomography angiography (CTA). The peak systolic velocity (PSV) and end-diastolic velocity (EDV) measured by carotid duplex ultrasonography (CDU) were compared between both groups, pre- and post-CEA. There was no significant difference in the risk factors for cerebrovascular disease between the two groups. Within 1 week after CEA, the PSV and EDV on operative and nonoperative carotid (contralateral carotid in the same patient) arteries decreased significantly (both p < 0.01). Comparison of nonoperative carotid artery pre- and post-CEA between the two groups showed that post-CEA PSV and EDV in the ACoA-patent group were significantly lower than that of pre-CEA (PSV and EDV, t = 11.507 and 6.716, respectively, both p < 0.001) (according to the Society of Radiologists in Ultrasound Consensus Conference [SRUCC] PSV standard). There was no significant difference in the ACoA-nonpatent group (PSV: t = 1.924, p = 0.057; EDV: t = 1.237, p = 0.218). In the nonoperative carotid artery of the ACoA-patent group, the degree of stenosis assessed by CDU was inconsistent with that of DSA/CTA (κ = 0.294), whereas that in the ACoA-nonpatent group had a high consistency (κ = 0.982). Among 161 ACoA-patent cases, 68 showed overestimated stenosis. The patent ACoA increases PSV and EDV, causing an overestimation of carotid artery stenosis.

Renal Cell Carcinoma Metastasizing to the Cricoid Cartilage Presenting With Subglottic Stenosis: A Case Report and Literature Review.

A 72-year-old Japanese man with a 4-month history of hoarseness and 1-week history of difficulty breathing was admitted to our department. He underwent right total nephrectomy for primary clear cell-type renal cell carcinoma (RCC) 6 years ago and left partial nephrectomy for the metastasis 4 years ago. Flexible laryngeal fiberscope examination revealed bilateral subglottic stenosis without obvious mucosal lesions. Enhanced computerized tomography (CT) scan of the neck revealed that the cricoid cartilage had become bilaterally expansive and tumorous lesion exhibiting enhancement. We performed tracheostomy on the appointed day and biopsied the tumor in the cricoid cartilage via the skin incision. Results of histologic and immunohistologic examinations for AE1/AE3, CD10, and vimentin positivity were consistent with clear cell-type RCC. Chest and abdomen CT scans revealed a few tiny metastases in the upper lobe of the left lung but no recurrence in the abdomen. At 2 weeks from the day of tracheostomy, total laryngectomy was performed. Postoperatively, the patient was treated transorally with axitinib (10 mg/day) and as of 12 months he remains alive with unchanging lung metastasis. Next-generation sequencing of targeted regions using a surgical specimen from the tumor revealed a frameshift mutation in the von Hippel-Lindau gene (p.T124Hfs*35) and a missense mutation in the TP53 gene (p.H193R).

3D Visualization of Whole Brain Vessels and Quantification of Vascular Pathology in a Chronic Hypoperfusion Model Causing White Matter Damage.

Chronic cerebral hypoperfusion is an important pathological factor in many neurodegenerative diseases, such as cerebral small vessel disease (CSVD). One of the most used animal models for chronic cerebral hypoperfusion is the bilateral common carotid artery stenosis (BCAS) mouse. For the therapy of CSVD and other diseases, it will be beneficial to understand the pathological alterations of the BCAS mouse, particularly vascular pathological changes. A mouse model of BCAS was used, and 8 weeks later, cognitive function of the mice was examined by using novel object recognition test and eight-arm radial maze test. 11.7 T magnetic resonance imaging (MRI) and luxol fast blue staining were used to evaluate the injury of the corpus callosum (CC), anterior commissure (AC), internal capsule (IC), and optic tract (Opt) in the cerebral white matter of mice. Three-dimensional vascular images of the whole brain of mice were acquired using fluorescence micro-optical sectioning tomography (fMOST) with a high resolution of 0.32 × 0.32 × 1.00 μm3. Then, the damaged white matter regions were further extracted to analyze the vessel length density, volume fraction, tortuosity, and the number of vessels of different internal diameters. The mouse cerebral caudal rhinal vein was also extracted and analyzed for its branch number and divergent angle in this study. BCAS modeling for 8 weeks resulted in impaired spatial working memory, reduced brain white matter integrity, and myelin degradation in mice, and CC showed the most severe white matter damage. 3D revascularization of the whole mouse brain showed that the number of large vessels was reduced and the number of small vessels was increased in BCAS mice. Further analysis revealed that the vessel length density and volume fraction in the damaged white matter region of BCAS mice were significantly reduced, and the vascular lesions were most noticeable in the CC. At the same time, the number of small vessels in the above white matter regions was significantly reduced, while the number of microvessels was significantly increased in BCAS mice, and the vascular tortuosity was also significantly increased. In addition, the analysis of caudal rhinal vein extraction revealed that the number of branches and the average divergent angle in BCAS mice were significantly reduced. The BCAS modeling for 8 weeks will lead to vascular lesions in whole brain of mice, and the caudal nasal vein was also damaged, while BCAS mice mainly mitigated the damages by increasing microvessels. What is more, the vascular lesions in white matter of mouse brain can cause white matter damage and spatial working memory deficit. These results provide evidence for the vascular pathological alterations caused by chronic hypoperfusion.

Timing and Outcomes of Precoronary Artery Bypass Grafting Carotid Endarterectomy

The Society for Vascular Surgery Clinical Practice Guidelines suggests the timing of carotid endarterectomy (CEA) in patients with symptomatic or bilateral severe asymptomatic carotid stenosis needing coronary artery bypass grafting (CABG) be performed either with preoperative CEA or concomitantly with CABG. The optimal timing of CEA in patients with high grade unilateral stenosis, however, has been controversial due to equivocal and/or scarce data. This study examines our experience with pre-CABG CEA and timing in this patient population. This is a single-center retrospective review of all patients who underwent CEA before or during CABG between January 2010 and January 2021. All patients receiving CEA were anesthetized by a dedicated cardiac anesthesiologist. Patients were compared based on timing of CEA in relation to CABG: concomitant (CABG day 0 from CEA) and nonconcomitant (CABG day 1-30 after CEA). The nonconcomitant cohort was substratified into hyperacute (CABG within 48 hours), acute (CABG within 2 weeks), and subacute (CABG within 30 days). Demographics and status of carotid disease were collated. Primary outcomes included stroke, defined as new neurologic deficit, myocardial infarction (MI), 30-day readmission, and 30-day mortality. A total of 39 patients were identified in the study population. Of these, 9 (23%) patients underwent CEA and CABG concomitantly, with 30 receiving nonconcomitant CEA (hyperacute [9, 23%]; acute [16, 41%]; subacute [5, 13%]). Baseline demographics and comorbidities were similar between groups. The degree of internal carotid artery stenosis, presence of high-grade contralateral stenosis, and symptomatic carotid presentation did not impact perioperative outcomes. One stroke occurred after a concomitant CEA/CABG that was a bi-hemispheric event believed to be due to cannulating a highly diseased ascending aorta. One patient in the concomitant cohort developed postoperative MI, cardiogenic shock, and subsequent death (Table I). There was no observed stroke, MI, or death in the nonconcomitant cohort. Thirty-day readmission and mortality were similar between all groups (Tables I and II). However, when comparing aggregate stoke/MI (Table I), a statistically significant difference was observed in favor of the nonconcomitant cohort (P = .007). Careful consideration is needed when determining appropriate timing for coronary revascularization in patients with carotid disease. These data suggest that nonconcomitant, preoperative CEA can be performed safely by a dedicated cardiac anesthesiologist before CABG. Concomitant CEA/CABG, as reflected in these data, carries an added procedural risk of stroke and a potentially poor cardiac outcome. Further study is warranted to elucidate the role of timing in perioperative outcomes for patients requiring CEA and CABG.Table IPerioperative outcomes for patients undergoing coronary artery bypass grafting (CABG) within 30 days of carotid endarterectomy (CEA)Concomitant CABG (n = 9)Nonconcomitant CABG (n = 30)P valuePostoperative events (MI, NS), No. (%)2 (22.2)0 (0).007a30-day readmission, No. (%)1 (11.1)3 (10).9330-day mortality, No. (%)1 (11.1)0 (0).07MI, Myocardial infarction; NS, neurologic symptoms. Open table in a new tab Table IIPerioperative outcomes for patients undergoing coronary artery bypass grafting (CABG) within 30 days of carotid endarterectomy (CEA), with the nonconcomitant CEA/CABG cohort substratified by timingConcomitant CABG (n = 9)Hyperacute CABG (n = 9)Acute CABG (n = 16)Subacute CABG (n = 5)P valuePostoperative events (MI, NS), No. (%)2 (11.1)0 (0)0 (0)0 (0).3530-day readmission, No. (%)1 (11.1)0 (0)1 (6.3)2 (40).1130-day mortality, No. (%)1 (11.1)0 (0)0 (0)0 (0).35MI, Myocardial infarction; NS, neurologic symptoms. Open table in a new tab

Change in Peak Systolic Velocity Estimation in Internal Carotid Artery Following Contralateral Near Occlusive Carotid Endarterectomy

Carotid artery stenosis (CAS) is one of the main causes of stroke, as the internal carotid artery (ICA) is a major source of cerebral blood supply. A common surgical intervention for CAS is carotid endarterectomy (CEA), which carries a high risk of stroke and mortality. CEA is indicated for 50% to 99% stenosis in symptomatic patients and 60% to 99% stenosis in asymptomatic patients. Carotid duplex ultrasound is frequently used to estimate peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/common carotid artery (CCA) ratio to determine the extent of stenosis. This does not account for other factors that can artificially change PSV and EDV, such as a contralateral carotid artery near occlusion with >90% stenosis. Although >70% contralateral stenosis has been previously studied, limited research exists on the impact of ICA near occlusions. We hypothesize that the degree of stenosis in an ipsilateral patent vessel can be more accurately estimated by examining the change in PSV pre- vs post-CEA of the contralateral ICA near occlusion. A retrospective study was conducted on 239 patients, at least 18 years of age, who underwent standard, routine carotid duplex ultrasound at a single institution. Patients who qualified for the study had bilateral carotid stenosis with ICA near occlusive disease on at least one side and underwent CEA. Near occlusion was determined by either a carotid duplex ultrasound >70% with one of the following criteria: PSV >400, EDV >140, or ratio of ICA/CCA >6, or a carotid computed tomography angiography showing near occlusion interpreted by a physician. Preoperative duplex velocities contralateral to the CEA were recorded and compared postoperatively. Interestingly, in the presence of contralateral >50% ICA stenosis, the PSV, EDV, and ICA/CCA ratio in the unoperated artery increased significantly following contralateral CEA (P < .001). In greater than 70% contralateral ICA occlusion, PSV, EDV, and ICA/CCA ratio increased to a greater extent compared with >50% contralateral ICA stenosis (P < .001). In detecting ≥70% stenosis of the patent vessel pre-CEA, PSV ≥250 cm/s had 87.2% sensitivity. In predicting ≥70% stenosis of the patent vessel pre-CEA, PSV >300 cm/s had 96.0% sensitivity. The present study deviates from the current theoretical model and shows that ultrasound PSV, EDV, ICA/CCA ratios can be significantly elevated in the patent vessel pre-CEA and post-CEA of the contralateral ICA near occlusion. This study provides novel insight into customized duplex ultrasound criteria for estimation of stenosis and to avoid unnecessary high-risk surgery.

Internal carotid artery stenosis: hemodynamics in the ipsilateral ACA affects CT angiography manifestations.

This study aimed to evaluate whether CT angiography (CTA) manifestations in anterior cerebral artery a1 segment (A1) were related to the hemodynamics in patients with internal carotid artery stenosis (ICAS). A total of 97 cases were selected. The degree of ICAS and symmetry of A1 were evaluated by CTA examination. Hemodynamic indexes were detected by transcranial Doppler (TCD). The differences in CTA presentations of A1 and hemodynamics between the vessels on the stenotic and contralateral sides were analyzed according to the different degrees of stenosis. The degree of ICAS according to the different manifestations of A1 and the hemodynamics of A1's adjacent vessels were also analyzed. In the case of unilateral ICAS, the difference in Vm of A1 between the stenotic and the contralateral side was the most significant relative to the stenosis degree. When unilateral ICAS was ≥70%, the presentation of A1 on the stenotic side was more slender or non-visualized compared to that on the contralateral side, while in cases with unilateral stenosis <70% or bilateral stenosis with a similar degree of stenosis, A1 were mainly symmetrical. When A1 on the side of ICAS was slender or non-visualized, the Vm of A1 was significantly slower than that on the contralateral side (P < 0.001). The CTA manifestations of A1 on the side of ICAS embodied the overall changes of the intracranial hemodynamics after ICAS. A combination of TCD and CTA examination of A1 can assist in judging the location and degree of ICAS.

Metformin attenuates white matter injury and cognitive impairment induced by chronic cerebral hypoperfusion.

Vascular cognitive impairment and dementia (VCID) is a series of cognitive dysfunction associated with cerebrovascular diseases and currently lacks effective treatments. The white matter, which is essential for neuronal information processing and integration, is nourished by a network of capillaries and is vulnerable to chronic hypoperfusion. Here, we show that metformin, a widely used drug for the treatment of type 2 diabetes, alleviates the white matter damage and improves cognitive impairment in a mouse model of VCID established by bilateral carotid artery stenosis (BCAS)-induced chronic hypoperfusion. Mechanistically, metformin restores the dysfunctions of oligodendrocyte precursor cells (OPCs) under hypoxia. Metformin up-regulates prolyl hydroxylases 2 via activating the AMP-activated protein kinase pathway, leading to hypoxia-inducible factor-1α (HIF-1α) degradation in OPCs. These findings suggest that metformin may have a promising therapeutic role in alleviating cognitive abnormalities by ameliorating white matter damage of VCID.

Tooth-Cutting-Induced Maxillary Malocclusion Exacerbates Cognitive Deficit in a Mouse Model of Vascular Dementia.

Treatments to restore the balance of the temporomandibular joint (TMJ) are performed in the field of complementary and alternative medicine; however, evidence supporting this approach remains weak. Therefore, this study attempted to establish such evidence. Bilateral common carotid artery stenosis (BCAS) operation, which is commonly used for the establishment of a mouse model of vascular dementia, was performed, followed by tooth cutting (TEX) for maxillary malocclusion to promote the imbalance of the TMJ. Behavioural changes, changes in nerve cells and changes in gene expression were assessed in these mice. The TEX-induced imbalance of the TMJ caused a more severe cognitive deficit in mice with BCAS, as indicated by behavioural changes in the Y-maze test and novel object recognition test. Moreover, inflammatory responses were induced via astrocyte activation in the hippocampal region of the brain, and the proteins involved in inflammatory responses were found to be involved in these changes. These results indirectly show that therapies that restore the balance of the TMJ can be effectively used for the management of cognitive-deficit-related brain diseases associated with inflammation.

Association between the degree of vertebrobasilar stenosis, location, infarction pattern, and QMRA flow state.

We aimed to investigate the relationship between the degree and location of vertebrobasilar stenosis and quantitative magnetic resonance angiography (QMRA) distal flow. We retrospectively reviewed patients who presented with acute ischemic stroke with ≥50% stenosis of the extracranial or intracranial vertebral or basilar arteries, and QMRA performed within 1year of stroke. Standardized techniques were used to measure stenosis and to dichotomize vertebrobasilar distal flow status. Patients were grouped based on the involved artery and the severity of disease. All p-values were calculated using chi-squared analysis and Fisher exact test with statistical significance defined as p<.05. Sixty-nine patients met study inclusion, consisting of 31 with low distal flow and 38 with normal distal flow. The presence of severe stenosis or occlusion was 100% sensitive, but only 47% predictive and 26% specific of a low distal flow state. Bilateral vertebral disease was only 55% sensitive but was 71% predictive and 82% specific of a low-flow state and was five times and nearly three times more likely to result in a low-flow state compared to unilateral vertebral disease (14%) and isolated basilar disease (28%), respectively. Severe stenosis of ≥70% may mark the minimal threshold required to cause hemodynamic insufficiency in the posterior circulation, but nearly half of these patients may remain hemodynamically sufficient. Bilateral vertebral stenosis resulted in a fivefold increase in QMRA low distal flow status compared to unilateral vertebral disease. These results may have implications in the design of future treatment trials of intracranial atherosclerotic disease.

CORONARY ARTERY BYPASS SURGERY IN YOUNG ADULT A INSTITUTIONAL RETROSPECTIVE STUDY

Objective: To study the overall causes, perioperative mortality, post operative complications, prognosis, outcome and follow up in a young adult present with coronary artery disease under going coronary artery bypass in our institute. Methods: Asum of 56 patient who are 40 years and less then 40 years who underwent coronary artery bypass surgery between January 2017 to December 2022 who's clinical case history, coronary angiography, pre operative and post operative echo cardiography, operative notes, post operative notes, outpatient follow up are collected from our computer stored data and from medical record department in our college and from Tamilnadu chief minister comprehensive health insurance scheme institutional Web site data base Results: Out of 56 patient,8 Female(14.3%) and 48 Male(85.7%),mean age 37.1 years (range 32 – 40 years),Diabetic 39 Patient (62.5%),Hypertensive 21 patient (37.5%) 7 / 8 women(87.5%) diabetic ,3/8 women both diabetic and hypertensive. Out of 48 male 47(97.9%) chronic smoker, 45 (93.8%) chronic alcoholic,44 (91.6%) both alcoholic and smoke , no women in this study neither alcoholic or smoker, 3patient (5.35%) hyperlipidaemia, 2 patient (3.57%) hypothyroidism all 2/8 (25%) are female,2 patient on haemodialysis for kidney disease, 1patient with bilateral renal artery stenosis, 1 patient with right innominate, right subclavian, bilateral carotid stenosis. Left ventricular function was impaired with ejection fraction average 46% (range 30% - 55%). 1 patient with ventricular septal rupture.2 patient with post coronary stent, The indication for surgery was triple vessel disease in 30 patient(53.57%) ,double vessel disease in 20 patient(35.7%),single vessel disease in 1 patient, single vessel disease with ventricular septal rupture in 1 patient, left main coronary artery stenosis in 4 patient(7%). Surgical procedure Off pump coronary artery bypass surgery in 51 patient(91%), On pump beating heart coronary artery bypass surgery in 2 patient (3.57%),On pump arrested heart coronary artery bypass surgery in 3 patient(5.35%). A total of 132 grafts were constructed(mean 2.4 grafts per patient),35 (27%) of them being arterial only left internal mammary artery harvested and other grafts were great saphenous vein. Post operative average ventilation time18hrs (range 18hrs to 24hrs), There were 5(8.9%)hospital death and 5(8.9%) late death in follow up, total 10 (17.8%) death till now. Conclusion: Most common cause for young coronary artery disease from our clinical history is found to be early onset diabetic mellitus and from our personal history chronic smoking and chronic alcoholism, intra operative mortality and morbidity is high in patient present with severe left ventricular dysfunction, coronary artery diseases induced complication and additional comorbidity, however most of patient recovered from post operative cardiovascular lethal or morbid event and on regular clinical follow up