Calcified Atheromas Research Articles

Effectiveness of Atherectomy and Drug-Coated Balloon Angioplasty in Femoropopliteal Disease: A Comprehensive Outcome Study.

Atherectomy has been reintroduced for debulking calcified atheroma to enhance the efficacy of drug-coated balloons (DCBs); however, its efficacy in severe calcification and related outcomes have not been fully evaluated. This study aimed to evaluate the outcomes of atherectomy and DCB angioplasty for treating femoropopliteal occlusive disease (FPOD). From 2014 to July 2022, 85 limbs in 76 patients with FPOD underwent atherectomy with DCB angioplasty. We evaluated the efficacy of this procedure using primary patency (PP) and clinically driven target lesion revascularization (CD-TLR)-free survival. PP was defined as the duration of uninterrupted patency without occlusion or a peak systolic velocity ratio more than 2.5 at the target lesion. Lesion calcification was evaluated according to Peripheral Arterial Calcium Scoring System, and Grade 4 was classified as severe. Seventy-one (84%) cases were male, and 56 limbs (66%) were treated for claudication. Rotational and directional atherectomies were performed in 62 (73%) and 23 limbs, respectively. The improvement in the median ankle-brachial index was 0.36 (interquartile range, 0.25-0.48). Median follow-up duration was 19.4 months. The overall PP and CD-TLR-free survival rates were 77% and 93% at 1 year and 64% and 83% at 2 years, respectively. On multivariable analysis, female sex (adjusted hazard ratio [aHR], 3.77; 95% confidence interval (CI), 1.30-10.87, P=0.014), dialysis (aHR, 4.35; 95% CI, 1.33-13.22, P=0.015), and severe calcification (aHR, 2.42; 95% CI, 1.07-5.46, P=0.033) were independent risk factors for poor PP. Dialysis (aHR, 11.07; 95% CI, 3.72-32.92, P<0.001) and severe calcification (aHR, 3.19; 95% CI, 1.15-8.84, P=0.026) were identified as independent risk factors for CD-TLR. Atherectomy with DCB angioplasty for FPOD did not work well in female patients, patients with lesions with severe calcification, and patients undergoing dialysis. Therefore, careful monitoring of these patients is crucial for patency loss and the requirement for revascularization. Additionally, for these patients requiring revascularization, surgical bypass may be appropriate for suitable candidates; whereas more proactive conservative management may be justified for claudicants.

Correlation of Pulp Calcification and Cardiovascular Conditions: A Literature Review.

The pathophysiology of calcified dental pulp is considered to be comparable to that of calcified atheroma in the artery. These calcified masses are small nodular which is seen more often in the coronal pulp regionthan in the radicular pulp. This is generally more common in the elderly population and usually corresponds to increasing age. Calcifications are also found in the brain, breast, arteries, and kidneys. There is a link between pulp calcification and cardiovascular problems. It is commonly assumedthat individuals suffering from cardiovascular diseases have a higher risk of calcification in the pulp. The use of radiography as a quick means of detecting cardiovascular disease is possible. The pulp calcification process is usually triggered by the osteoblastic process. The process is identified by the presence of an osteoid matrix, which is built down by odontoblast cells in the pulp's peripheral portions, culminating in the production of tissue that is comparable to dentine. This review will look at pulp calcifications from all angles, including their mechanism, clinical considerations, radiographic features, and management, and also to determine if there is a link between pulp calcification and cardiovascular problems.

Calcified plaque harboring lipidic materials associates with no-reflow phenomenon after PCI in stable CAD

Calcified atheroma has been viewed conventionally as stable lesion which less likely increases no-reflow phenomenon. Given that lipidic materials triggers the formation of calcification, lipidic materials could exist within calcified lesion, which may cause no-reflow phenomenon after PCI. The REASSURE-NIRS registry (NCT04864171) employed near-infrared spectroscopy and intravascular ultrasound imaging to evaluate maximum 4-mm lipid-core burden index (maxLCBI4mm) at target lesions containing small (maximum calcification arc < 180°: n = 272) and large calcification (maximum calcification arc ≥ 180°: n = 189) in stable CAD patients. The associations of maxLCBI4mm with corrected TIMI frame count (CTFC) and no-reflow phenomenon after PCI were analyzed in patients with target lesions containing small and large calcification, respectively. No-reflow phenomenon occurred in 8.0% of study population. Receiver-operating characteristics curve analyses revealed that optimal cut-off values of maxLCBI4mm for predicting no-reflow phenomenon were 585 at small calcification (AUC = 0.72, p < 0.001) and 679 at large calcification (AUC = 0.76, p = 0.001). Target lesions containing small calcification with maxLCBI4mm ≥ 585 more likely exhibited a greater CTFC (p < 0.001). In those with large calcification, 55.6% of them had maxLCBI4mm ≥ 400 [vs. 56.2% (small calcification), p = 0.82]. Furthermore, a higher CTFC (p < 0.001) was observed in association with maxLCBI4mm ≥ 679 at large calcification. On multivariable analysis, maxLCBI4mm at large calcification still independently predicted no-reflow phenomenon (OR = 1.60, 95%CI = 1.32–1.94, p < 0.001). MaxLCBI4mm at target lesions exhibiting large calcification elevated a risk of no-reflow phenomenon after PCI. Calcified plaque containing lipidic materials is not necessarily stable lesion, but could be active and high-risk one causing no-reflow phenomenon.

Incidental findings in cone beam computed tomography volumes: Calcified head-and-neck atheromas detected during dental evaluation.

Atheromas can be detected incidentally in routine dental cone beam computed tomography (CBCT) images. This study aims to assess prevalence and risk factors associated with these vascular lesions. The maxillofacial CBCTs of 458 subjects were evaluated and divided into 4 groups based on the presence of calcified atheroma: subjects with no calcified atheroma, subjects with intracranial calcified atheroma (ICA), subjects with extracranial calcified atheroma (ECA), and subjects exhibiting combined lesions. Age, sex, medical conditions, family history, and size were documented. Analysis of variance followed by a multiple comparison test was used for data satisfying parametric test assumptions. Chi-squared tests were used to assess categorical data. The Spearman Rho test was used to assess the correlation between the incidence of calcified atheroma and subjects' medical condition. Of the 458 CBCTs evaluated, 29.90% presented with calcified atheroma. Calcified atheroma prevalence was significantly higher in older patients versus younger patients (p=0.004) and in males compared to females (p=0.004). Males were more likely to have the combination of ICA and ECA, whereas females were more likely to have ICA alone (p≤0.040). Patients with calcified atheroma were significantly more likely to have a history of hyperlipidemia (p=0.001), hypertension (p=0.001), and myocardial infarction/coronary artery diseases (p=0.001). Overall, patients exhibiting both intracranial and extracranial lesions were more likely to have cardiovascular risk factors (p=0.001). Incidentally detected calcified atheromas in CBCTs are common. Subjects with combined atheroma lesions are at higher risk for cardiovascular disease. The diagnosis of incidental calcified atheromas in CBCT's warrants early referral to medical specialists, especially if there is no medical history of existing cardiovascular disease.

Characterization of lipidic plaque materials at calcified atheroma: its association with calcification thickness evaluated by optical coherence tomography and near-infrared spectroscopy imaging

Abstract Introduction The degree of calcification and its thickness have been considered to affect stent expansion, leading to an increases risk of repeat revascularization in patients receiving PCI. Pathophysiologically, accumulation of lipidic materials within vessel wall could trigger the formation of plaque calcification. Elucidating characteristics of lipidic plaque components at calcified atheroma may enable to identify phenotypes with thick calcification which less likely responds to PCI. Purpose This study investigated the relationship of calcification thickness with lipidic plaque materials at calcified atheroma by using OCT and near-infrared spectroscopy (NIRS) imaging. Methods We analyzed 52 calcified lesions (culprit/non culprit lesions=44/8) in 47 CAD patients (stable CAD/ACS=36/11) from the REASSURE-NIRS registry (NCT04864171). OCT and NIRS imaging evaluated 4-mm segment exhibiting maximum superficial calcification arc. Calcification thickness on OCT imaging, its arc on IVUS imaging, and NIRS-derived lipid arc were analyzed at every 1-mm interval cross-sectional images. In addition, yellow-calcification ratio (YCR = lipid arc/calcification arc) was calculated (Figure 1). Results 53% of study subjects exhibited chronic kidney disease and 70% of them received a statin (averaged on-treatment LDL-C =89mg/dL). Throughout OCT and NIRS/IVUS imaging analysis of 260 cross-sectional images, the averaged calcification arc, its maximum thickness, lipid arc and YCR were 210° (167–285°), 0.78mm (0.62–0.95mm), 95° (31–169°) and 0.33 (0.09–0.59), respectively. As expected, thicker calcification more likely exhibited a greater calcification arc (r=0.30, p&amp;lt;0.001). Furthermore, a greater thickness of calcification was associated with smaller lipidic plaque burden, reflected by yellow arc (r=−0.36, p&amp;lt;0.001) and YCR (r=−0.36, p&amp;lt;0.001) (Figure 2). After adjusting age, gender and ACS, calcification arc (p&amp;lt;0.001) and YCR (p&amp;lt;0.001) continued to predict thicker calcification. Conclusion Thickening of calcification was associated with severer calcification arc, which was accompanied by the shrinkage of lipidic plaques. Our findings suggest the evaluation of lipidic plaque component as a potential tool to identify calcified atheroma harbouring thick calcification, which may cause a greater risk of stent underexpansion. Funding Acknowledgement Type of funding sources: None.

High- vs. low-intensity statin therapy and changes in coronary artery calcification density after one year

Abstract Introduction High-dose statin therapy (HIST) halts coronary plaque progression and reduces the risk of cardiovascular events by increasing atheroma calcification. The Agatston score is well established in the clinical routine for assessment of coronary artery calcification using non-contrast computed tomography. However, randomized controlled trials failed to detect an influence of HIST vs. low-to-intermediate statin therapy (LIST) on the Agatston and CAC volume score after one year. Coronary plaques with lower density including spotty calcifications may represent dynamic and early stages of atherosclerosis. We evaluated whether CAC density differentiates in HIST- vs. LIST-treated patients after one year. Methods The meta-analysis contains data from two prospective, randomized, double-blind studies (BELLES, EBEAT) that were designed to detect CAC changes after one year comparing HIST vs. LIST. In both studies, patient's coronary calcification burden was measured at baseline and one-year follow-up using electron beam computed tomography (EBCT). Patients data were pooled and stratified by intensity of statin therapy. Furthermore, the cohort was divided into several subgroup analyses, accounting for LDL-Cholesterol reduction, initial Agatston score and a consistent number of lesions. Results Data from 852 patients, 66% female were included. The amount of CAC overall increased after 1 year [Agatston score: 169.3 (80.0, 377.1) vs. 214.9 (95.4, 450.0); p&amp;lt;0.0001NP; volume score: 292.1±445.4 vs. 355.5±482.4; p&amp;lt;0.0001; number of lesions: 6 (3,10) vs. 7 (4,12); p&amp;lt;0.0001NP, at baseline and follow-up, respectively]. Likewise, the average CAC density was higher at follow-up [CAC density: 228.8±35.4 vs. 232.6±37.0; p&amp;lt;0.0001]. HIST vs. LIST more effectively reduced LDL-cholesterol (annualized change: −58.6±50.9 vs. −44.4±43.7 mg/dL, p=0.005). Comparing patients on HIST vs. LIST, CAC density at follow-up (231.9±36.1 HU vs. 233.3±37.7, p=0.59) and its change from baseline (4.0±19.1 HU vs. 3.6±19.6 HU, p=0.73) did not differ. Subgroup analyses, stratifying by LDL-reduction ( Conclusion HIST vs. LIST leads to a higher reduction in cholesterol levels, which does not translate into relevant differences in the change of CAC density at one-year follow-up. Funding Acknowledgement Type of funding sources: None.

Preventive Health Screening for Women at Risk for Cardiovascular Disease: Targeting Women 40 to 64 Years of Age

Objective: The Centers for Disease Control and Prevention (CDC) has documented that the leading cause of death in the United States is cardiovascular disease (CVD). Specifically, CVD is responsible for the death of one out of every five women in the United States. Therefore, the research question was, “What specific diagnostic tests, including a novel approach to detecting abdominal aortic calcifications (AAC), could be added to screening women for CVD?” Materials and Methods: A prospective cohort of 14 female volunteers, between the ages of 40 and 60 years, were consented to sonography of the aorta, collection of demographic data, as well as contributing biometric data. Each volunteer gave informed consent in compliance with the university’s Institutional Review Board. Volunteers also were provided with a Health Insurance Portability and Accountability Act (HIPAA) release that was signed prior to the collection of any data. All sonographic images were analyzed post-examination and aortic calcifications were graded using a modified scoring system derived from a dual-energy x-ray absorptiometry (DXA)-based grading system. Results: In this cohort of 14 females, their AAC category scores ranged from I to IIIB (grades: normal to multiple calcified atheroma). Descriptive statistics demonstrate that it is possible to document AAC on this cohort of women using sonography. Correlational statistics showed a statistically significant association between a volunteer’s posterior aortic-intimal media thickness (a-IMT) and their atherosclerotic cardiovascular disease (ASCVD) 10-year risk score. Conclusion: This pilot study suggests the need for further research on screening techniques to determine women’s specific CVD risk in this age group. Although the preliminary results allude to sonographic measures of a-IMT being a possible CVD screening method in the future, more research data are needed.

Viridans streptococcal immunopositivity associates with calcified coronary plaque area and coronary stenosis severity. The Tampere Sudden Death Study (TSDS)

Background and Aims : Development of atherosclerosis shares features of chronic inflammation. Most chronic infections are considered to be due to biofilms. We have shown that coronary atheromas and thrombosis aspirates harbor DNA from several oral bacteria among which DNA from viridans group streptococci was the most common. In the oral cavity viridans streptococci act as early colonizers in the formation of dental biofilm which calcifies into dental plaque. Here we studied whether viridans streptococcal immunopositivity correlates with coronary calcification and stenosis percentage.Methods: The surface areas of atherosclerosis lesion types (fatty, fibrous, calcified, complicated) and stenosis percentage were measured in the left anterior descending (LAD) coronary artery of 121 victims of sudden out-of-hospital death in the Tampere Sudden Death Study (TSDS). Coronary sections were stained immunohistochemically with a pool of antibodies raised against 3 most common viridans streptococcal strains. The strength of the immunopositivity was scored into no positivity (-), slight (+), moderate (++) or severe (+++).Conclusions: Viridans streptococcal immunopositivity of coronary atheromas was linked with coronary atheroma calcification and stenosis but not with other atherosclerosis lesion types. This suggests a new mechanism involved in the calcification of coronary atheroma. Background and Aims : Development of atherosclerosis shares features of chronic inflammation. Most chronic infections are considered to be due to biofilms. We have shown that coronary atheromas and thrombosis aspirates harbor DNA from several oral bacteria among which DNA from viridans group streptococci was the most common. In the oral cavity viridans streptococci act as early colonizers in the formation of dental biofilm which calcifies into dental plaque. Here we studied whether viridans streptococcal immunopositivity correlates with coronary calcification and stenosis percentage. Methods: The surface areas of atherosclerosis lesion types (fatty, fibrous, calcified, complicated) and stenosis percentage were measured in the left anterior descending (LAD) coronary artery of 121 victims of sudden out-of-hospital death in the Tampere Sudden Death Study (TSDS). Coronary sections were stained immunohistochemically with a pool of antibodies raised against 3 most common viridans streptococcal strains. The strength of the immunopositivity was scored into no positivity (-), slight (+), moderate (++) or severe (+++). Conclusions: Viridans streptococcal immunopositivity of coronary atheromas was linked with coronary atheroma calcification and stenosis but not with other atherosclerosis lesion types. This suggests a new mechanism involved in the calcification of coronary atheroma.

Atherectomy vs Other Modalities for Treatment During Peripheral Vascular Intervention.

Calcified atheroma is frequently encountered in peripheral vascular intervention. Standard treatment with balloon and/or stenting alone does poorly in these cases due to vessel recoil, suboptimal luminal gain, and inadequate stent expansion. In light of the above challenges with angioplasty and stenting for PAD, endovascular atherectomy has emerged as a novel technology for atheroma treatment and removal, offering the benefits of surgical endarterectomy in a minimally invasive percutaneous approach. This review outlines the endovascular atherectomy devices available in clinical practice to date, compares and contrasts their mode of action, summarizes the relevant published data on indication and role of atherectomy over other treatment modalities for PAD, and discusses the future prospective on this emerging technology. Currently, there are host of peripheral atherectomy devices available with unique mechanism of action and relative advantages and disadvantages. Despite these recent technological advancements, there remains a paucity of data from well-designed studies regarding the superiority of atherectomy as an adjunctive treatment versus standard treatment with balloon and stenting. Emerging data have supported its use to improve patency rates in conjunction with drug-coated balloons. Although associated risks, including distal embolization and perforation, are often marginal, the cost of these devices to the healthcare system necessitates further investment in to establishing level 1 data to support their use. Peripheral atherectomy has the potential to improve limb-related outcomes, potentially through reduced need for bail-out scaffolds and improved drug uptake. Nonetheless, further investment in the evidence foundation supporting these devices versus standard practices is required.

Warfarin involvement, in comparison to NOACs, in the development of systemic atherosclerosis.

Adverse effects of drugs are one of the objective criteria used for choosing the most appropriate anticoagulant. It is worrying that warfarin may be involved in the progression of systemic atherosclerosis, as more and more articles suggest. Warfarin has been widely used in the past and has greater efficacy compared to dabigatran in patients with mechanical heart valves; there is an antidote to it and it is cheap. Unfortunately, warfarin inhibits the synthesis and activity of Matrix-Gla-Protein, which is the major vitamin K-dependent inhibitor of arterial calcification - an active process associated with atherosclerosis, stimulated by inflammatory mechanisms. Vitamin K antagonizes the NF-κB signaling mechanism and contributes to the prevention of arterial calcifications. Warfarin given in experimental animal models of atherosclerosis contributed to the occurrence of an increased number of aortic calcifications. Warfarin treatment used in clinical trials was associated with the progressive increase of coronary atheroma calcification. Younger patients are more sensitive to warfarin-related arterial calcifications compared to older patients, due to warfarin-induced cellular senescence changes. Non-vitamin K antagonist direct oral anticoagulants do not interact with vitamin K. Edoxaban reduces the inflammatory process in the vascular walls and the proliferation of smooth vascular muscle cells, so it is involved in the prevention of vascular maladaptive remodeling process. Apixaban is able to stabilize the coronary atherosclerotic process. Randomized clinical trials are needed to evaluate the impact of warfarin on plaque stability and cardiovascular evolution of patients.

Statins Accelerate Coronary Calcification and Reduce the Risk of Cardiovascular Events.

Lipid-lowering therapy with statins is well recognized as an effective therapy in reducing adverse cardiovascular events. However, the relationship between statin therapy and progression of coronary artery calcification (CAC) is unclear. A few of studies suggested that statins fail to slow and even accelerate progression of CAC; meanwhile, some researchers demonstrate opposite results. With the purpose of seeking out the effect of statin therapy on CAC, we summarized the existing evidence on statins and undertook meta-analyses of clinical trials assessing the effect of statin therapy on CAC. Fourteen trials were identified suitable for inclusion in the analysis of the effect of statin treatment on CAC, of which 11 were randomized controlled trails, 1 was case-control study, 1 was cross-sectional study, and 1 was observational study. In the meta-analysis of CAC progression, statin therapy seemed to accelerate the progression of CAC. Meanwhile, the analysis revealed a significant correlation between statin treatment and lower risk of cardiovascular events. In conclusion, meta-analyses of the available trials have shown a significant reduction of risk of cardiovascular events. In contrast, statins accelerated CAC. This suggests that statin-mediated atheroma calcification may enhance plaque stability and reduce the risk of plaque rupture.

The Effect of Aggressive Wire Recanalization in Calcified Atheroma and Dilatation (ARCADIA) Technique in Eccentric Calcified Lesion of No-stenting Zone

Purpose: The endovascular approach for eccentric calcified lesions of the no-stenting zone is challenging. This study aimed to investigate the effect of a novel technique for these lesions. Methods: We performed EVT for severe and eccentric calcified lesions using the technique, which is presented previously and named aggressive wire recanalization in calcified atheroma and dilatation (ARCADIA). In brief, a guidewire is passed to the residual lumen firstly. Next, another guidewire is advanced into and cross through the calcified plaque and returned to the distal original lumen with intravascular ultrasound (IVUS) guided. The calcified plaque is dilated by using a scoring-balloon or non-compliant balloon. Results: Consecutive 14 peripheral artery disease patients with isolated and eccentric calcification in a no-stenting zone were treated using ARCADIA technique between January 2018 and March 2020. In IVUS data, lumen cross-section area was significantly increased from 5.2 ± 2.0 mm2 to 18.1 ± 6.9 mm2 (p < 0.01), lumen area was expanded roundly evaluating as symmetry index from 0.45 ± 0.09 to 0.81 ± 0.12 (p < 0.01). There were no distal embolization and perforation after ARCADIA technique. One-year target lesion revascularization occurred in only 2 cases. The primary patency of 1 year was 85.7%. Conclusion: ARCADIA technique is safe and appropriate, and can be 1 option to treat for eccentric calcified lesions of the no-stenting zone as an optimal wire crossing method.

Radiografía panorámica para la detección de ateroma calcificado carotídeo bilateral: Reporte de un caso inusual

Introduction: Atherosclerosis is a progressive inflammatory disease that can trigger serious medical consequences like acute myocardial infarction or stroke. Case Report: The purpose of this study is to report an unusual case of finding calcified atheromatous plaques in the carotid arteries bilaterally using a panoramic radiography (PR). A 75-year-old female with a morbid history, attends the Teaching Dental Clinic of the Pontifical Catholic University with complementary exams. PR showed well-defined radiopaque structures adjacent to C4. Using a Doppler ultrasound, the presence of calcified atheromas in the right and left carotid arteries were confirmed. The patient was informed of these findings and is currently under medical follow-up. Conclusion: PR is a useful complementary resource in the detection of atherosclerotic plaques of the upper carotid region.

Detection of calcified atheromas on panoramic radiographs of cirrhotic patients.

The present study aimed to investigate the prevalence of calcified atheromas in carotid arteries (CACA) on panoramic radiographs of patients with liver cirrhosis (LC). A case-control study of 67 individuals with LC (case group) and 67 healthy individuals (control group), matched by gender and age, was performed. In addition to demographic information, data on LC were also collected for the case group. Panoramic radiographs were evaluated by two previously calibrated examiners. The sample consisted predominantly of male individuals (n=50; 74.62%), with mean age of 55 years old. In the case group, the mean value for the model of end-stage liver disease was 16, and the major aetiology of LC was alcoholism (n=26; 38.8%). Thirteen (19.4%) LC patients had CACA, whereas only four (5.9%) healthy patients had this condition. LC patients are 3.72 times more likely to have CACA compared to healthy individuals (P=.02). The presence of nephropathies increases the risk of development of atheromas by 18.58 times in cirrhotic individuals (P=.04). Cirrhotic patients are more likely to have CACA compared to healthy patients, and this risk increases significantly when kidney disease is involved.

Abstract 14935: Targeted Optical Molecular Imaging of Atheroma Calcification Using Novel Aldendronate-based Probe

Background/Objectives: Vascular spotty calcification is an actively regulated biological process resulting in plaque vulnerability. We investigated the feasibility of a novel alendronate-based near-infrared fluorescence (NIRF)-emitting probe to specifically target atherosclerotic calcification in a murine model in vivo using our customized high-resolution multichannel intravital molecular imaging system (IVFM). Methods/Results: We have fabricated a calcium-binding NIRF probe by chemically coupling alendronate, a specific targeting ligand, and NIRF-emitting Cy5.5 to the ends of azide-PEG-NHS ester (Al-Cy5.5). Prepared Al-Cy5.5 has high affinity for calcium phosphate-containing bone minerals. In vitro, Al-Cy5.5 specifically binds to RANKL-induced osteogenic-macrophages as compared to macrophages (p&lt;0.01). On whole body fluorescence imaging to assess time-dependent excretion, NIRF signals remained visible up to 48 hrs. Then, in mice with calcified plaque induced by a combination diet of high-cholesterol and warfarin, Al-Cy5.5 (2.5 mg/kg) was intravenously injected. 48 hrs after administration, murine calcified atheroma was assessed using a customized high-resolution multichannel IVFM, which demonstrated highly enhanced NIRF signals in vivo in the calcified areas of murine carotid plaques (p&lt;0.01, Figure). Ex vivo laser scanning fluorescence microscopic and immune-histological findings from the corresponding sister sections well corroborated the in vivo imaging results, which demonstrated the co-localization of NIRF signals with plaque calcifications (von-Kossa stain). Conclusions: Our novel calcification targeted probe, Al-Cy5.5, was able to selectively target atheroma calcification in vivo in a murine model as assessed by optical IVFM. This novel targetable strategy is expected to provide a promising theranostic basis for calcified high-risk plaques by integration with multimodal customized catheter imaging system.

Prevalence of soft tissue calcifications in cone beam computed tomography images in the region of head and neck

Objective: to evaluate the prevalence of calcifications in the soft tissues of the cervical-facial region using cone beam computed tomography (CBCT) images. Material and Methods: two hundred and ten CBCT exames was analyzed by 01 examiner previously trained, with fild of view (FOV) of 16 x 13 cm and voxel of 0.25 mm, in ICAT Vision software (Imaging Science International, Hatfield, PA, USA) in coronal, axial and sagittal sections. The following calcifications were evaluated: tonsiloliths, sialolites, calcification of the styloid complex, calcified carotid atheromas, calcifications in laryngeal cartilages, calcified lymph nodes and osteoma cutis. The findings were tabulated according to the total of the sample, related to the gender, age group of the individuals. Results: Calcification of the styloid complex was the most frequent in the sample studied in both genres (39.04%), followed by the presence of tonsiloliths (19.52%), and calcified lymph nodes (6,67%). Conclusion: calcifications are frequent radiographic findings in CBCT and important for the diagnosis of some possible pathologies that do not present clinical symptoms.KEYWORDSCone-beam computed tomography; Prevalence; Soft tissue calcification.

P6185Impact of coronary atherosclerotic plaque metrics on the correlation between on-site CT-FFR and invasive FFR

Abstract Background Developed in the last years, coronary computed tomography-derived fractional flow reserve (CT-FFR) has shown good correlation with invasive fractional flow reserve (FFR). However, little is known about the interaction of coronary atherosclerotic plaque characteristics in the correlation between CT-FFR and FFR. Purpose This study sought to determine the effect of main coronary atherosclerotic plaque metrics (APM) on the correlation between on-site CT-FFR and invasive FFR. Methods Patients referred for invasive coronary angiography (ICA) who accepted to undergo a CT-FFR study were prospectively included. We excluded patients with atrial fibrillation, chronic total occlusions, severe ventricular hypertrophy or previous coronary revascularization, and those with any contraindication for CT. On-site CT-FFR and APM were calculated for each coronary vessel. Continuous variables of APM were dichotomized as above and below the median and their interaction on the correlation between on-site CT-FFR and invasive FFR was assessed by multiple linear regression model. Results 33 patients (90 vessels) were included. Mean age was 65±10 years, 88% were males, 60% had hypertension, 77% dyslipidaemia and 40% diabetes. The mean delay time between CTA and ICA of 21 days. The average analysis time of CT-FFR was 16±4 minutes. Overall, correlation between FFR and CT-FFR showed a Pearson's r coefficient of 0.77±0.06 and a standardized beta coefficient of 0.8 (p&lt;0.001). The beta coefficients between CT-FFR and FFR did not change significantly after the interaction with different APM (p&gt;0.05 for all) (see Table). Standardized Beta coefficients for on-site CT-FFR with invasive FFR as a gold standard Below the median Above the median p value for interaction Total atheroma volume (TAV) (mm3) 0.66 0.93 0.071 Percent atheroma volume (PAV) (%) 1.00 0.69 0.063 Calcified atheroma plaque volume (%) 0.89 0.68 0.175 Remodeling index 0.94 0.71 0.129 Lesion length (LL) (mm) 0.67 0.89 0.158 Minimal lumen area (mm2) 0.73 0.71 0.955 Conclusions There is a good correlation between on-site CT-FFR and invasive FFR, which is not affected by main atherosclerotic plaque characteristics.

Brightness and contrast adjustments influence the radiographic detection of soft tissue calcification.

To assess the influence of subjective enhancement of brightness and contrast of digital panoramic radiographs on the detection of soft tissue calcifications. In this observational study, 500 digital panoramic radiographs were evaluated by two examiners in consensus, who scored the images for the presence of calcifications for each right and left side of the image. After 30days, all images were revaluated under subjective manipulation of digital brightness and contrast. Calcifications were classified based on the diagnostic hypothesis: sialolith, tonsillolith, calcified atheroma, phlebolith, rhinolith, maxillary sinus antrolith, synovial chondromatosis, lymph node calcification, stylohyoid ligament, triticeous cartilage, or/and upper horn of thyroid cartilage calcification. For intra-examiner agreement, 20% of the sample was reevaluated. The Kappa test and McNemar test were used (α=0.05). In original images, calcifications were observed in 44.2% of the patients, and in enhanced images, this number was 70.8%. Many calcifications were detected only in enhanced images, mainly in the diagnostic hypotheses of calcified atheroma and stylohyoid ligament. Intra-examiner agreement was excellent for the detection of soft tissue calcifications (0.82) and for the classification (0.81). Subjective enhancement of brightness and contrast alters the detection of soft tissue calcifications in digital panoramic radiograph.

Triticeal cartilage calcification

The triticeal cartilage (TC) is a tiny oval-shaped cartilage located at the lateral border of the thyrohyoid membrane between the hyoid bone greater horn and the thyroid cartilage superior horn. The exact function o TC is unknown; it has been proposed that TC was the site of the attachment for the triticeoglossus muscle. On panoramic radiographs, calcified TC may be observed in the soft tissues of the pharynx region, positioned inferior to the greater horn of the hyoid bone and adjacent to the superior border of the C4 vertebrae. The major concern of a calcified TC found incidentally in a routine radiographic examination is the differentiation between this alteration and other calcified tissue manifestations that require additional investigations, such as carotid calcified atheroma artery or other neck pathology such as foreign bodies. Thus, this report describes 3 cases in which TC calcifications were incidentally found in panoramic radiographs.

3D multi-tissue printing for kidney transplantation.

The kidneys are among the most commonly transplanted organs in the world. Transplant patients, as a consequence of their kidney disease and other risk factors which make it difficult for the surgeon to perform vascular anastomosis during kidney transplantation, often have numerous arterial calcifications. The preoperative assessment for transplantation includes an abdominal and pelvic CT scan without contrast that allows for the mapping of atheromatous calcification. However, non-contrast enhanced CT is not optimal and the surgeon is obliged to palpate the arteries during the operation to choose the anatomical site of the vascular anastomosis. This technical note reports the development of a new technique of preoperative reproduction of atherosclerotic arteries, owing to advancements in 3D multi-tissue printing technology. We used scans of four patients with varying degrees of calcified atheroma to model and print their arteries for their pre-surgical planning.