Branch Occlusion Research Articles

Revascularization of coronary chronic total occlusions in the elderly: what results? - The insights of a multicentre national registry

Abstract Lately, the remarkable progress in knowledge and treatment of cardiovascular diseases has been significantly impacting society's morbidity and mortality. However, the burden of coronary artery disease (CAD) remains non-negligible. In addition, as a consequence of demographic changes, age, as a non-modifiable cardiovascular risk factor, makes it increasingly important to focus on the elderly. Up to one-fifth of patients with CAD have a chronic total occlusion (CTO) of a coronary artery, defined as a lesion with 100% stenosis and Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 that exists for more than 3 months. There is current evidence that successful CTO-percutaneous coronary intervention (PCI) is associated with clinical benefits. However, elderly patients are currently underrepresented in CTO-PCI randomized controlled trials and registries, and its clinical impact and safety in this group of patients are still debated. This study aims to characterise patients submitted to CTO-PCI and compare the baseline characteristics, coronary intervention features, intraprocedural complications and in-hospital mortality between patients younger and older than 75. The authors performed a retrospective analysis of adult patients submitted to a CTO-PCI, included in the Portuguese Registry on Interventional Cardiology between January 2019 and December 2022. Comparison tests between groups for parametric and non-parametric variables were performed. A p-value less than 0.05 was considered statistically significant. A total of 353 patients who underwent CTO-PCI were analysed, 271 (76.8%) with 18 to 74 years old (group 1) and 82 (23.2%) with 75 or more years old (group 2). Table 1 shows the most important baseline characteristics, with similar features for both groups except body mass index and smoking habits. Table 2 demonstrates the differences between the groups regarding PCI, with the left main and left anterior descending arteries being more treated among older patients and the right coronary artery in younger patients. Complete coronary revascularization and procedure success rate did not differ significantly between groups (p-value=0.19 and p-value=0.59, respectively). Finally, table 3 presents the main intra-procedural and in-hospital complications, with a significant difference only for occlusion of the side branch, occurring in 2 patients aged over 75 years (p-value=0.01). In conclusion, in our registry, the elderly presents a high success rate in the complete recanalization of CTO lesions, comparable to the group under 75 years of age. However, the presence of side branch occlusion was higher in older patients, without other significant differences in intraprocedural and in-hospital complications, including mortality. Further studies including a large sample and follow-up analysis would be essential to better understand the rate of risks related to PCI-CTO potentially associated with the complexity and comorbidities of the elderly.Table 1Table 2 and 3

Double kissing inflation outside the stent versus jailed balloon technique for coronary bifurcation lesions

Abstract Background Side branch (SB) occlusion remains challenging in percutaneous coronary intervention (PCI) for bifurcation lesions even in the era of jailed balloon technique (JBT). Our previous single-arm study introduced a novel method to protect SB named double kissing inflation outside the stent (DKo), which features twice inflation of the protective balloon kissing with the stent balloon and post-dilation balloon. Objective To confirm whether DKo can protect SB better than JBT in a large sample of bifurcation lesions. Methods This retrospective, single-center cohort study enrolled 875 consecutive patients underwent bifurcation PCI either in DKo (n=209) or JBT group (n=666). The primary endpoint was transient SB loss after removal of the protective balloon. The secondary endpoints included rates of SB rewiring, final kissing balloon inflation (FKBI), SB stenting, final SB loss, and peri-procedural myocardial infarction (PMI). Results Transient SB loss occurred in only 1 patient (0.5%) in DKo but 32 patients (4.8%) in JBT (p<0.005). Transient loss in JBT group was triggered by rewiring (n=21), post-dilation (n=8) and severe dissection (n=3). DKo caused lower rates of rewiring (0.5% vs. 13.8%, p<0.001), FKBI (0.5% vs. 7.7%, p<0.001) and PMI (0.5% vs. 2.9%, p=0.045). SB stenting and final SB loss showed a lower tendency in DKo [0% vs. 0.8%, p=0.21; 0% vs. 1.2%, p=0.11]. DKo was the only protector against transient SB loss [odds ratio=0.08, 95% confidence interval (0.01-0.59), p=0.013]. Conclusion DKo protects SB better than JBT in PCI for bifurcation lesions. Randomized controlled studies are required to confirm the long-term benefit.

Appropriate ischemic criteria for type 4a myocardial infarction: insights from the ALPHEUS trial

Abstract Background Different troponin thresholds have been proposed to define periprocedural myocardial injury based on post percutaneous coronary intervention (PCI) troponin increase only, whereas the definition of type 4a myocardial infarction (MI) needs the association of post procedural troponin and one ischemic criterion. These criteria which evolved from the 3rd to the 4th Universal Definition of Myocardial Infarction (UDMI) are frequently under-reported in studies on periprocedural MI. Purpose We aimed to describe rates of type 4a MI additional diagnostic criteria among the ranges of post PCI troponin elevation in the randomized ALPHEUS trial which compared ticagrelor to clopidogrel in high-risk elective PCI patients. Methods 1698 patients with normal pre-PCI troponin values and centralized core laboratory angiogram analyzes were divided into 4 groups according to maximal post PCI troponin elevations (≤ 1x upper reference limit (URL) for group 1; > 1xURL and ≤ 5xURL for group 2; > 5xURL and < 35xURL for group 3 and ≥ 35xURL for group 4). The type 4a MI additional criteria (ischaemic imaging changes, ischaemic ECG changes, chest pain and angiographic complications) as defined by the 3rd and 4th UDMI were reported and the different angiographic complications were detailed for each group. Results The most prevalent additional ischemic criterion was the presence of angiographic complications detected by the core laboratory. The rate of angiographic complications increased in a stepwise manner with higher post PCI troponin elevation (Figure). Interestingly, we found a similar rate of angiographic complications in patients without any increase in post PCI troponin and troponin elevations below the 5xURL threshold (8.4% and 9.9% respectively). Most angiographic complications were related to transient main branch dissection and/or thrombosis, and transient or permanent side branch occlusions (Table). ECG changes and chest pain ischemic criteria also increased in a stepwise manner and were rarely found below the 5-fold threshold increase, although they might be underreported. Conclusion When using a core laboratory, angiographic complications are found even in patients with no or minor troponin elevation. Above the 5 xURL threshold the rates of angiographic complications are 2 to 3-fold more frequent, and ECG changes and chest pain ischaemic criteria are likely to be present. Our findings support the use of angiographic core laboratory in clinical trial using periprocedural MI as an endpoint; similarly, chest pain -which disappeared from the 4th UDMI- should be reconsidered as a diagnostic ischemic criterion.

Abstract 16915: Considerations in Management of Cocaine-Induced Coronary Disease and Embolism

Background: Coronary embolism accounts for ~3% of cases of myocardial infarction (MI). We describe a case of a young patient with cocaine abuse with coronary thrombus resulting in acute coronary syndrome (ACS). Case: 33-year-old male with no known medical history seen in the ER with one hour of typical chest pain. EKG showed ST-segment elevations in inferior leads. Coronary angiogram demonstrated a hazy filling defect in the distal RCA as well as a 100% thrombotic occlusion of the right posterolateral branch of RCA likely due to distal embolization. Aspiration thrombectomy was performed with no residual stenosis. All other vessels were angiographically normal. Decision-Making: Our patient had no traditional coronary artery disease risk factors. Work-up for other coronary embolism causes and genetic thrombophilia was negative. We aspirated the thrombi rather than stenting, as stent thrombosis risk is >10-fold in cocaine users in absence of any residual stenosis. Dual antiplatelet therapy was initiated given ACS presentation. Conclusion: Acute coronary thrombosis is a life-threatening complication of cocaine abuse. In lack of residual stenosis post-aspiration thrombectomy, stenting can be avoided due to high stent thrombosis risk in this patient population.

Abstract 201: Feasibility of an 088” Catheter in the M1 segment for Mechanical Thrombectomy

Introduction Placement of 088” aspiration catheters in the internal carotid artery (ICA) for aspiration in mechanical thrombectomy (MT) has been previously described. However, the use and safety of 088” aspiration catheters beyond the ICA has not been established. Here, we report the utilization and early safety outcomes of 088” catheter placement in the M1 segment for MT. Methods We reviewed a prospectively maintained IRB‐approved database of the senior author to identify consecutive cases where the 088” catheter was navigated to the MCA for use in mechanical thrombectomy. Results We identified 13 cases with placement of an 088” aspiration catheter in the MCA segment (all cases performed in 2023). Average patient age was 71±4 years (range 56‐97 years), with 10 (77%) females, presenting NIHSS was 12±2.1, and 3 (23%) patients received tPA. Location of the thrombus includes 7 (54%) in the M1 and 6 (46%) in the M2. In 13 (100%) cases, the Zoom88 (OD = 2.7 mm, Imperative Care, Campbell, CA) catheter was advanced to at least the M1 segment, and it was used with a coaxial Zoom71 catheter. The average M1 diameter prior to MT was 2.5±0.2mm, 2.3±0.2mm, and 2.2±0.1 in the proximal, mid, and distal M1‐segment, respectively. After MT, the average M1 diameter was 2.4±0.1mm, 2.2±0.1mm, and 2.1±0.2mm in the proximal, mid, and distal M1‐segment, respectively. 85% (n=11) of cases used one or more stentrievers including a Tigertriever, Solitaire, and Trevo. Average number of passes was 1.9±0.2. There were no vessel perforations, catheter‐related dissections, or hemorrhagic complications noted in any case. TICI 2C/3 recanalization was achieved in 100% of cases. The average mRS on discharge was 1.2±0.4. Figure 1. (A) AP angiography demonstrating an M1 branch occlusion (orange). (B) Native view, 088” catheter under aspiration in the MCA (green). (C) Post‐thrombectomy final angiography demonstrating TICI 3 reperfusion. Conclusion The use of large‐bore 088” aspiration catheters in the MCA may offer a safe strategy for direct clot ingestion during mechanical thrombectomy in MCA vasculature that is smaller than the 8‐Fr aspiration catheter.

Transfemoral Access to Implant Iliac Branch Devices After Previous Aortic Grafts.

To report on the outcomes of patients undergoing an iliac branch device implantation after previous open or endovascular aorto-biliac repair, using exclusively femoral access for catheterization and delivery of the covering stent to the hypogastric artery. Single-center retrospective study in which all patients in whom an iliac branch device was implanted after previous open or endovascular aorto-biliac repair were identified. Patients in whom the hypogastric artery catheterization and delivery of the bridging cover stent were achieved via exclusive femoral access were included. Different techniques were used based on surgeon preference. Technical success and access-related complications, as well as iliac branch device endoleak or occlusions during follow-up, were evaluated. From 2015 to 2021, 28 patients with a prior open or endovascular aorto-biliac repair underwent 34 iliac branch device implantations. Most (71%) had juxtarenal or thoracoabdominal aortic aneurysms, 82% had common iliac artery aneurysms, and 25% had hypogastric artery aneurysms. Bilateral iliac branch device implantations were performed in 21% of the patients, and in 26% of cases, landing in the superior gluteal artery was obtained. An "up-and-over" technique from the contralateral groin was used in 65% of the cases, and a steerable sheath in 35%. Technical success was 94%, with no complications related to access or technique to catheterize and deliver the stents in the hypogastric artery. The cohort had 20% of major complications, with 3 perioperative deaths. Kaplan-Meier estimated an iliac branch device freedom from occlusion and endoleak was 92% and 83% at 2 years. The implantation of an iliac branch device over previous aortic or open endografts involving the aortic bifurcation is feasible and safe. We suggest using a femoral approach as the primary access of choice. In this study we present 28 patients with previous aortoiliac grafts in which iliac branch devices were performed as a subsequent step.We demonstrated the feasibility of the technique despite the difficulty of crossing a neobifurcation, with a steep angle, without complications associated with the technique. Based on our experience, we recommend transfemoral access as the first option for bypassing the hypogastric artery stent, preserving upper extremity access and its possible complications.

Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches.

Flow diverter stents (FDSs) have attracted interest for intracranial aneurysm (IA) treatment; however, occlusion of side branches and related complications have been reported. This study aimed to investigate the effects of FDSs in IA management when different branches of intracranial arteries are covered. A cross-sectional study was conducted using PUBMED, Embase, Web of Science, and Cochrane databases to include randomized or nonrandomized comparative-designed studies from January 2000 to August 2022 which reported outcomes of occlusion/narrowing of branches after IA treatment using FDSs. The PRISMA guidelines were used for our report. A random-effects meta-analysis was conducted to pool the outcomes, which included incidence rates of occlusion/narrowing of FDS-covered branches, branch occlusion-related symptoms, obliteration of IAs, and ideal clinical outcomes (modified Rankin Scale score ≤2). The authors identified 57 studies involving 3789 patients with IA managed by FDSs covering different branches. During the median imaging follow-up at 12 months, the IA obliteration rate was satisfactory (>70%) when covering the ophthalmic artery (OA), posterior communicating artery (PComA), anterior choroidal artery (AChoA) or anterior cerebral artery (ACA), but not the middle cerebral artery-M2 segment (MCA-M2; 69.5%; 95% CI: 60.8-77.5%) and posterior inferior cerebellar artery (PICA; 59.1%, 13/22). The overall ideal clinical outcome was observed in 97.4% of patients (95% CI: 95.5-98.9%). Higher rates of occlusion/narrowing of branches were identified when FDSs covered the ACA (66.6%; 95% CI: 45.1-85.3%), PComA (44.3%; 95% CI: 34.2-54.6%), or MCA-M2 (39.2%; 95% CI: 24.5-54.7%); the risks were lower when covering the OA (11.8%; 95% CI: 8.8-15.1%), PICA (6.8%; 95% CI: 1.5-14.5%), and AchoA (0.5%; 95% CI: 0.0-2.9%). The risk of branch occlusion-related complications was low (incidence rate <5%) for each of the six evaluated branches. Acceptable outcomes were identified following treatment of IAs when FDSs were placed across each of the six studied cerebral arteries. Treatment decisions regarding FDS placement across branch arteries should be made with the risk of complications from branch occlusion in mind.

Pre-dilation with a Scoring Balloon on Small Side Branch Occlusions During Long Coronary Stent Implantation

Pre-dilation with a Scoring Balloon on Small Side Branch Occlusions During Long Coronary Stent Implantation

Mitigating the risk of flow deterioration by deferring stent optimization in STEMI patients with large thrombus burden: Insights from a prospective cohort study

ObjectivesIt is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB).BackgroundIn patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with stenting, (DTE) and flow deterioration are common and increase infarct size leading to worse outcomes.MethodsFrom a prospective registry, 74 consecutive STEMI patients with LTB undergoing pPCI with stenting and intentionally deferred stent optimization were analyzed. Imaging data and outcomes up to 2 years follow-up were analyzed.ResultsOverall, 74 patients (18% females) underwent deferred stent optimization. Direct stenting was performed in 13 (18%) patients. No major complications occurred during pPCI. Staged stent optimization was performed after a median of 4 (interquartile range (IQR) 3; 7) days. On optical coherence tomography, under-expansion and residual thrombus were present in 59 (80%) and 27 (36%) cases, respectively. During deferred stent optimization, we encountered no case of flow deterioration (slow or no-reflow) or side branch occlusion. Minimal lumen area (mm2) and stent expansion (%) were corrected from 4.87±1.86mm to 6.82±2.36mm (p<0.05) and from 69±18% to 91±12% (p<0.001), respectively. During follow-up, 1 patient (1.4%) required target lesion revascularization and 1 (1.4%) patient succumbed from cardiovascular death.ConclusionsAmong STEMI patients with LTB, deferring stent optimization in the setting of pPCI appears safe and potentially mitigates the risk of DTE. The impact of this approach on infarct size and clinical outcomes warrants further investigation in a dedicated trial.

Improved Faster Region-Based Convolutional Neural Networks (R-CNN) Model Based on Split Attention for the Detection of Safflower Filaments in Natural Environments

The accurate acquisition of safflower filament information is the prerequisite for robotic picking operations. To detect safflower filaments accurately in different illumination, branch and leaf occlusion, and weather conditions, an improved Faster R-CNN model for filaments was proposed. Due to the characteristics of safflower filaments being dense and small in the safflower images, the model selected ResNeSt-101 with residual network structure as the backbone feature extraction network to enhance the expressive power of extracted features. Then, using Region of Interest (ROI) Align improved ROI Pooling to reduce the feature errors caused by double quantization. In addition, employing the partitioning around medoids (PAM) clustering was chosen to optimize the scale and number of initial anchors of the network to improve the detection accuracy of small-sized safflower filaments. The test results showed that the mean Average Precision (mAP) of the improved Faster R-CNN reached 91.49%. Comparing with Faster R-CNN, YOLOv3, YOLOv4, YOLOv5, and YOLOv6, the improved Faster R-CNN increased the mAP by 9.52%, 2.49%, 5.95%, 3.56%, and 1.47%, respectively. The mAP of safflower filaments detection was higher than 91% on a sunny, cloudy, and overcast day, in sunlight, backlight, branch and leaf occlusion, and dense occlusion. The improved Faster R-CNN can accurately realize the detection of safflower filaments in natural environments. It can provide technical support for the recognition of small-sized crops.

First validation of a model-based hepatic percutaneous microwave ablation planning on a clinical dataset

A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actual ablation ground truth from a clinical dataset in liver. The biophysical model uses a simplified formulation of heat deposition on the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined to assess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model prediction compared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculature shortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermal prediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be used as liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermal ablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate its integration into the clinical workflow.

Experiência inicial com a extensão de cateter-guia ExpressmanTM em um centro terciário de cardiologia de alto volume

Background: Guide catheter extensions provide increased support in complex percutaneous coronary interventions. The ExpressmanTM is a novel guide catheter extension and the objective was to assess the impact of its use on procedural success and complications in a high-volume reference center. Methods: We analyzed data from all consecutive procedures in which the ExpressmanTM guide catheter extension was used. The decision to use a guide catheter extension was at operator’s discretion. Device success was defined as the successful positioning of the guide catheter extension in the coronary vessel and procedural success was defined as &lt;20% residual stenosis and TIMI 3 flow, with no loss of significant side branches. Major adverse cardiac and cerebrovascular events were defined as the composite of all-cause death, myocardial infarction, target vessel revascularization and stroke. Results: From April 2022 to January 2023, 34 procedures were included. The majority of the patients were male (59%) and the mean age was 66.5 years. Guide catheter extension use was not planned pre-procedure in 17 procedures (50%). The most common reasons for guide catheter extension use were target vessel angulation or tortuosity and unfavorable coronary ostium position. Device success was obtained in 88% and revascularization success in 91%. There were three side branch occlusions. During in-hospital clinical follow-up, no major adverse cardiac and cerebrovascular events or major bleeding occurred. Conclusion: The device success and procedural success were high and the rate of complications was low. Guide catheter extension use as bailout technique in complex anatomies allowed procedural success in the vast majority of otherwise untreatable patients.

TCT-633 Presentation Management and Outcomes of Acute Right Ventricular Failure and Cardiogenic Shock After Right Ventricle Marginal Branch Occlusion During Chronic Total Occlusion Percutaneous Intervention

TCT-633 Presentation Management and Outcomes of Acute Right Ventricular Failure and Cardiogenic Shock After Right Ventricle Marginal Branch Occlusion During Chronic Total Occlusion Percutaneous Intervention

Impact of Bifurcation Angle on Side Branch Occlusion in Provisional Bifurcation Stenting

Background: Bifurcation angle (BA) is the critical angle that has impact on side branch (SB) occlusion during coronary intervention due to plaque shift. There have been few research studies especially in Pakistan on the role of BA in plaque shift.&#x0D; Objective: To know the impact of bifurcation angle on the side branch occlusion during provisional stenting.&#x0D; Methodology: A retrospective cohort study was conducted at Punjab Institute of Cardiology, Lahore on consecutively enrolled patients between July 2017 and June 2019. The subjects were split into two groups: high angle and low angle using the median BA. Binary logistic regression analysis was performed to identify BA as an independent predictor of occlusion of SB.&#x0D; Results: Occurrence of side branch occlusion was found in 7.7% of the total of 600 bifurcation lesions. SB occlusion rate was found to be significantly higher in higher angle (HA) group compared to lower angle (LA) group i.e. (37/292, 12.7 %) and (9/308, 2.9 %) respectively, (P &lt; 0.001). Binary logistic regression analysis demonstrated high angle to be an independent predictor for the occlusion of side branches (odds ratio [OR]: 1.026 per degree increment, 95% confidence intervals [CI]: 1.016 – 1.045, P &lt; 0.001).&#x0D; Conclusion: Higher branching angle was noted as the independent predictor of the occlusion of side branches following provisional stenting of main vessel.&#x0D;

Anterior segment complications after dexamethasone implantations:real world data.

We aim to contribute to the literature in terms of treatment safety with our real world data by examining the anterior segment complications and follow-up results of patients who underwent dexamethasone implants in our clinic. The records of patients treated with at least one intravitreal dexamethasone implant for various retinal diseases: diabetic macular edema (265 eyes), central retinal vein occlusion (45 eyes), retinal vein branch occlusion (91 eyes), postoperative cystoid macular edema (18 eyes), non-infectious uveitis (37 eyes) and other (14 eyes) between July 2013 and April 2020 were reviewed. After 925 injections were applied to 470 eyes of a total of 383 patients, the eyes were controlled during a mean follow-up of 24months. No complications were detected in 328 eyes. Intraocular pressure (IOP) above 25mmHg was detected in 97 eyes (20.6%) that had no previous history of ocular hypertension. Of these 97 eyes, 71 (73.1%) eyes with increased IOP were treated with topical monotherapy, 26 (26.8%) eyes were treated with topical combined therapy and 1 (1.03%) patient had glaucoma surgery. Cataracts requiring surgical intervention developed in 55 (%21.73) of 253 phakic eyes. Three patients have anterior chamber dislocation of dexamethasone, 1 patient was hospitalized with sterile endophthalmitis on the 7th day after the injection, and pars plana vitrectomy was performed. This study is the first long-term follow-up study in our country evaluating the safety of dexamethasone implant injections in various retinal diseases and presenting the first real world data. Cataract progression and increased IOP were found to be the most common side effects. We observed that the patient's diagnosis did not cause a statistically significant change in the observation of side effects. As a result of our findings, close follow-up of IOP after the injection of dexamethasone implants would be appropriate.

Predictors of Side Branch Obstruction Following Stenting of the Main Vessel in Coronary Bifurcation Lesions

INTRODUCTION: Percutaneous coronary intervention (PCI) of bifurcation lesions is complicated by the presence of side branch blockage, which contributes to a low procedural success rate and an elevated rate of adverse cardiac events. A shift in the position of the carina and plaque buildup have been proposed as possible causes of SB occlusion. 1,2 It is estimated that between 15-20% of PCI procedures are done to address lesions at coronary bifurcations.3-5 Multiple randomized clinical trials have concluded that an interim stenting procedure should be used for routine bifurcation stenting. 6-11 &#x0D; AIM AND OBJECTIVE: To assess the predictors of side branch obstruction following stenting of the main vessel in coronary bifurcation lesions.&#x0D; MATERIAL AND METHODS: Total 300 patients were enrolled with coronary bifurcation lesions who were undergoing PCI and had at least one major SB. Major SB definition was the same as what had been found in other studies: diameter ?2.0mm. Patients with SB stenting before MV stenting, LMS disease, or in-stent restenosis were excluded. Using quantitative coronary analysis (QCA) software, all of the baseline and procedure characteristics were analyzed. The Student's t-test was used to compare continuous data. A p-value &lt; 0.05 was considered significant.&#x0D; RESULTS: Out of 300 patients, side branch blockage was found in 23 (7.6%) of the patients. The patients were distributed into two groups based on whether they had SB occlusion (SBO) or not. Mean age (years) in the study was 50.36+12.54 in SBO group and 50+30.34 in no-side-branch occlusion (NSBO) group. There were 19(82%) male and 4(18%) female patients in SBO group and 215(77%)male and 62(23%) female in NSBO group. Diameter stenosis of side branch before MV stenting (55%+20 vs30+25%), side branch diameter (2.1+0.3 vs2.2+0.2), bifurcation angle (70+20degree vs 45+22 degree, p=&lt;0.01) and lower TIMI flow in side branch were found significant predictors of major side branch occlusion.&#x0D; CONCLUSION: The bifurcation angle, diameter stenosis of the SB, side branch diameter before to main vessel stenting, and TIMI flow grade of the SB prior to MV stenting were all predictive of severe SB occlusion following MV stenting. As a result, these criteria should be considered when designing PCI for bifurcation lesions in order to increase procedure success.&#x0D; KEYWORDS: Side branch obstruction, stenting, coronary bifurcation lesions.

Low value of inherited thrombophilia testing among patients with stroke or transient ischemic attack: A three-year retrospective study

Background/PurposeInherited thrombophilia testing in the acute inpatient setting is controversial and expensive, and rarely changes clinical management. We evaluated ordering patterns and results of inpatient inherited thrombophilia testing for patients who presented with an isolated acute ischemic stroke or transient ischemic attack (TIA) without concurrent venous thromboembolism. MethodsWe retrospectively analyzed patients admitted for acute ischemic stroke or TIA between January 1st, 2019 and December 31st, 2021 at Thomas Jefferson University Hospitals in Philadelphia, PA and who underwent inherited thrombophilia testing during the hospital admission. Charts were reviewed to determine stroke risk factors, test results, and clinical management. ResultsAmong 2108 patients admitted for acute ischemic stroke or TIA (including branch and central retinal artery occlusions) during the study period, the study included 249 patients (median age 49.0 years, 50.2% female) who underwent inpatient testing for factor V Leiden, prothrombin G20210A variant, hyperhomocysteinemia, PAI-1 elevation, and deficiencies of protein C and S and antithrombin. 42.2% of patients had at least one abnormal test, and among the 1035 tests ordered, 14.3% resulted abnormal. However, 28% of abnormal tests were borderline positive antigen or activity assays that likely represented false positives. There was no significant difference in the likelihood of a positive test among patients without stroke risk factors vs those with risk factors (47.1% vs 40.9%, P = .428), nor any significant difference between those under vs over age 50 years (45.7% vs 38.3%, P = .237). No patients with an abnormal result had their clinical management changed as a result. Charges for the tests totaled $468,588 USD. ConclusionsInherited thrombophilia testing in the hospital immediately following isolated acute arterial ischemic stroke or TIA was associated with high rates of likely false positive results and was expensive. Positive results did not change clinical management in a single case.

Real-time laser speckle contrast imaging measurement during normothermic machine perfusion in pretransplant kidney assessment.

Normothermic machine perfusion (NMP) provides a platform for pre-transplant kidney quality assessment that is essential for the use of marginal donor kidneys. Laser speckle contrast imaging (LSCI) presents distinct advantages as a real-time and noncontact imaging technique for measuring microcirculation. In this study, we aimed to assess the value of LSCI in visualizing renal cortical perfusion and investigate the additional value of dual-side LSCI measurements compared to single aspect measurement during NMP. Porcine kidneys were obtained from a slaughterhouse and then underwent NMP. LSCI was used to measure one-sided cortical perfusion in the first 100 min of NMP. Thereafter, the inferior renal artery branch was occluded to induce partial ischemia and LSCI measurements on both ventral and dorsal sides were performed. LSCI fluxes correlated linearly with the renal blood flow (R2 = 0.90, p < 0.001). After renal artery branch occlusion, absence of renal cortical perfusion could be visualized and semiquantified by LSCI. The overall ischemic area percentage of the ventral and dorsal sides was comparable (medianinterquartile range[IQR], 38 [24-43]% vs. 29 [17-46]%, p = 0.43), but heterogenous patterns between the two aspects were observed. There was a significant difference in oxygen consumption (mean ± standard deviation [SD], 2.57 ± 0.63 vs. 1.83 ± 0.49 mLO2 /min/100 g, p < 0.001), urine output (median [IQR], 1.3 [1.1-1.7] vs. 0.8 [0.6-1.3] mL/min, p < 0.05), lactate dehydrogenase (mean ± SD, 768 ± 370 vs. 905 ± 401 U/L, p < 0.05) and AST (mean ± SD, 352 ± 285 vs. 462 ± 383 U/L, p < 0.01) before and after renal artery occlusion, while no significant difference was found in creatinine clearance, fractional excretion of sodium, total sodium reabsorption and histological damage. LSCI fluxes correlated linearly with renal blood flow during NMP. Renal cortical microcirculation and absent perfusion can be visualized and semiquantified by LSCI. It provides a relative understanding of perfusion levels, allowing for a qualitative comparison between regions in the kidney. Dual-side LSCI measurements are of added value compared to single aspect measurement and renal function markers.

Cucumber Picking Recognition in Near-Color Background Based on Improved YOLOv5

Rapid and precise detection of cucumbers is a key element in enhancing the capability of intelligent harvesting robots. Problems such as near-color background interference, branch and leaf occlusion of fruits, and target scale diversity in greenhouse environments posed higher requirements for cucumber target detection algorithms. Therefore, a lightweight YOLOv5s-Super model was proposed based on the YOLOv5s model. First, in this study, the bidirectional feature pyramid network (BiFPN) and C3CA module were added to the YOLOv5s-Super model with the goal of capturing cucumber shoulder features of long-distance dependence and dynamically fusing multi-scale features in the near-color background. Second, the Ghost module was added to the YOLOv5s-Super model to speed up the inference time and floating-point computation speed of the model. Finally, this study visualized different feature fusion methods for the BiFPN module; independently designed a C3SimAM module for comparison between parametric and non-parametric attention mechanisms. The results showed that the YOLOv5s-Super model achieves mAP of 87.5%, which was 4.2% higher than the YOLOv7-tiny and 1.9% higher than the YOLOv8s model. The improved model could more accurately and robustly complete the detection of multi-scale features in complex near-color backgrounds while the model met the requirement of being lightweight. These results could provide technical support for the implementation of intelligent cucumber picking.

Comparison of the Contour Neurovascular System and Woven EndoBridge device for treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall.

The authors compared the Contour Neurovascular System (Contour) with the Woven EndoBridge (WEB) device for the treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall. Prospective clinical and radiological data were collected for all patients treated with either the Contour or WEB at a tertiary university hospital from May 2018 to June 2022. In patients who had at least 3 months of follow-up data available (median patient age 60.0 [IQR 51.8-67.0] years, male/female ratio 1:1.4), the authors compared 40 aneurysms in 34 patients treated with the Contour and 30 aneurysms in 30 patients treated with the WEB. Overall, 26 middle cerebral artery, 24 anterior communicating artery, 9 basilar artery tip, 4 posterior communicating artery, 4 internal carotid artery, 1 anterior cerebral artery, 1 posterior inferior cerebellar artery, and 1 superior cerebellar artery aneurysm were treated. In the Contour cohort, complete occlusion at last follow-up was achieved for 30 aneurysms (75%) and a small neck remnant was seen in 6 aneurysms (15%), summing up to an adequate occlusion rate of 90%. One aneurysm (2.5%) had to be retreated, and 1 symptomatic thromboembolic event (2.5%) was observed with complete remission at discharge. Three adjunctive stents (10%) had to be used due to branch occlusion. In the WEB cohort, adequate occlusion was also seen in 90% of aneurysms (complete occlusion in 19 [63.3%] and remnant neck in 8 [26.7%], with a retreatment rate of 20%). Four WEBs (13.3%) needed additional stent placement due to device protrusion into a branch, 2 asymptomatic thromboembolic events (6.7%) were noted, and 1 major ischemic event (3.3%) due to M2 occlusion was noted. One patient treated with the WEB died between follow-ups of causes unrelated to the aneurysm, treatment, or device. Time from first measurement to deployment and thus total treatment time was significantly shorter in the Contour group (p = 0.004), regardless of whether a prior angiogram was available for aneurysm measurement and device sizing. Results for the Contour were promising, although longer follow-up is necessary to draw more solid conclusions on the utility and risk profile of this new device compared with the already widely used WEB device. Adequate occlusion at last follow-up was the same for both devices, whereas the probability of complete occlusion at last follow-up was significantly higher for the Contour, and the WEB showed a significantly higher retreatment rate. Median deployment times were significantly shorter with the Contour than the WEB.