Collateral Development Research Articles

Predictive factors of collateral vessel development induced by oxaliplatin-based chemotherapy.

Oxaliplatin can lead to hepatic sinusoidal injury, called hepatic sinusoidal obstruction syndrome (SOS), resulting in portal hypertension-related complications. This could worsen the clinical course of the patients treated with oxaliplatin. Early diagnosis is challenging. We explored predictive markers of oxaliplatin-induced collateral vessels. Patients who received oxaliplatin-based chemotherapy were retrospectively screened. We evaluated their laboratory findings and spleen size on computed tomography immediately before oxaliplatin-based chemotherapy and after 6months of treatment. The primary outcome was collateral vessel development, as a surrogate marker for oxaliplatin-induced SOS in patients who underwent oxaliplatin-based chemotherapy. The secondary outcome was the identification of factors that predicted the development of collateral vessels. We enrolled 161 patients who received oxaliplatin-based chemotherapy. They had a median age of 69years, and 63.3% were men. Collateral vessels developed in nine (5.6%) patients during the study period. After oxaliplatin-based chemotherapy, the spleen size increased in 104 patients (64.6%), with a ≥ 30% increase in 19.4% of the patients. Univariate analysis showed that the Fibrosis-4 (FIB-4) index (≥ 1.76; OR 9.17), aspartate aminotransferase:platelet ratio index (APRI) (≥ 0.193; OR 9.62), cumulative dose of oxaliplatin (≥ 1000mg; OR 8.43), and increase in spleen size (≥ 30%; OR 6.01) were significant risk factors for collateral vessel development. Multivariate analysis after stepwise selection revealed that the FIB-4 index and spleen size were significant independent predictive factors. A ≥ 1.76 increase in the FIB-4 index and a ≥ 30% increase in spleen size after 6months of oxaliplatin-based chemotherapy were significant predictive markers for collateral vessel development.

806 BRIDGING COLLATERALS OF CHRONICALLY OCCLUDED LEFT INTERNAL MAMMARY ARTERY BYPASS GRAFT TO LEFT ANTERIOR DESCENDING ARTERY

Abstract Methods and results The internal mammary artery (IMA) is the conduit of choice to bypass the left anterior descending (LAD) coronary artery in patients eligible for coronary artery bypass grafting (CABG). In case of graft occlusion, it is still not clear whether it is better to revascularize the graft or the recipient native vessel, on top of optimal medical therapy. A 55-year-old man, with prior CABG, underwent urgent coronary angiography for an acute coronary syndrome. LAD CTO, severe proximal circumflex artery stenosis, and mild atherosclerosis of the right coronary artery were found. Moreover, a proximal occlusion of the venous graft to the obtuse marginal branch and LIMA CTO within the body of the graft were shown as well. Surprisingly, many well-developed bridging collaterals, arising close to the proximal cap of the LIMA occlusion, supplied the bloodstream circulation distal to the occlusion within the LIMA. At that time, a left main–proximal circumflex artery stenting was performed (3.5×24-mm Xience Sierra, Abbott) because that was judged the culprit lesion. One month later the patient still complained of effort angina and dyspnoea despite optimized antianginal medical therapy. The patient was scheduled for elective antegrade LIMA CTO PCI, considered the most appropriate treatment strategy. Indeed, the presence of a prior stent implanted in the left main– circumflex artery would have made difficult a proximal cap negotiation and its penetration by guidewires in case of antegrade LAD CTO PCI. Thus, the LIMA CTO negotiation was initially attempted with a Fielder FC guidewire (Asahi Intecc) and a supporting Corsair Pro (Asahi Intecc) microcatheter. The polymeric soft wire prolapsed preferentially into the bridging collaterals without the chance to engage the CTO proximal cap. Finally, a moderate-weight hydrophilic GAIA second (Asahi Intecc) succeeded in cap penetration and final CTO crossing. After lesion predilatation with a 2.0×15-mm balloon (Emerge, Boston Scientific), 2 overlapped stents, respectively 2.75×44 mm and 3.0×18 mm (VIVO ISAR, Translumina) were deployed and postdilated by a 3.0×15-mm non-compliant balloon (Accuforce, Terumo). The final result was deemed very satisfactory with a TIMI 3 flow. Conclusions Many studies showed that IMA has active biological functions, providing a sort of protection against atherosclerosis and self-reparative properties. These biological properties might justify the IMA high long-term patency rates as CABG conduits. The development of bridging collaterals in this patient, represents a clear proof of the LIMA self-reparative properties. Whereas bridging collaterals are a common feature of coronary CTO, their development in a LIMA bypass graft represents a unique finding which requires further investigation.

The association of collaterals with myocardial ischemia and viability in chronic total occlusions.

Collateral development in chronic total occlusions (CTO) is crucial to perfuse the distal myocardium and its angiographic evaluation is frequently used to assess the need for revascularization. We aimed to analyse the association between the presence of ischemia and hibernating myocardium, evaluated by cardiac [13N]NH3/2-[18F]FDG PET-CT, and the angiographic characterization of the collateral circulation. Prospective study including patients with a CTO who underwent a [13N]NH3 and, when deemed necessary, 2-[18F]FDG PET-CT. Well developed (WD) collaterals were defined as a concomitant angiographic Rentrop grade 3 and Werner collateral connection score 2 or 3, whereas the remaining as poorly developed (PD). 2% thresholds used to identify prognostic benefit of revascularization were applied: ischemia > 10% and hibernating myocardium > 7%. Fifty-nine patients (age 62.9±9.1 years, 58 male) were recruited, WD collaterals were present in 28 (47.5%). No significant differences were found in ischemia (WD 6.4±4.3 vs. PD 7.0±4.1, p = 0.64) and hibernation (WD 1.8±1.9 vs. PD 3.1±3.3, p = 0.18) scores. Most CTO territories demonstrated ischemia, but only 19 (46.3%) were associated with an area > 10% (WD 47.6% vs. PD 45.0%, p = 0.58). Scared non-viable myocardium was limited to 9 (15.3%) patients and was not associated with PD collaterals. Hibernating myocardium was frequent (54.2%), but just 6 (10.2%) CTO patients had an area of > 7% (WD 3.6% vs. PD 16.1%, p = 0.20). Collateral assessment by angiography has a poor association with the ischemic burden and hibernation state of CTO territories. Myocardial viability was present even in most CTO with angiographic PD collaterals.

Clinical use of color Doppler ultrasonography to predict and evaluate the collateral development of two common revascularizations in patients with moyamoya disease.

To explore the value of color Doppler ultrasonography (CDU) to predict preoperatively and evaluate postoperatively the collateral development of two common revascularizations in patients with moyamoya disease (MMD). We prospectively enrolled 49 patients with MMD who underwent unilateral superficial temporal artery (STA) -middle cerebral artery (MCA) anastomosis or encephalo-duro-arterio-synangiosis (EDAS). The parameters of the extracranial arteries, including STA, internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA), were performed before and at 3-6 months after surgery. DSA results were used to assess surgical collateral development. To predict good collateral development before STA-MCA anastomosis, the preoperative D > 1.75 mm in the STA had the highest area under the Receiver Operating Characteristic curve (AUC). To predict good collateral development before EDAS, the preoperative EDV > 12.00 cm/s in the STA had the highest AUC. To evaluate the good collateral development after STA-MCA anastomosis, the postoperative EDV > 16.50 cm/s in the STA had the highest AUC. To evaluate the good collateral development after EDAS, an increase of D of 0.15 mm in the STA had the highest AUC. Logistic regression analysis showed that the preoperative RI and EDV in the STA were highly correlated with collateral development. Besides, the preoperative RI was an independent risk factor for collateral development. CDU could predict preoperatively and evaluate postoperatively the collateral development of STA-MCA anastomosis and EDAS surgery postoperatively by detecting ultrasound parameters of the STA.

A CASE OF VENTRICULAR SEPTAL RUPTURE AFTER ACUTE MYOCARDIAL INFARCTION

When ventricular septal rupture (VSR) complicates acute myocardial infarction the mortality is usually high. Reperfusion therapy has reduced its incidence. However if VSR has developed then rapid diagnosis, aggressive medical management, and surgical intervention are required to optimize recovery and survival. In the era before reperfusion therapy, septal rupture complicated 1 to 3 percent of acute myocardial infarctions. Among the 41,021 patients in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial, ventricular septal rupture was suspected in 140 patients (0.34 percent) and confirmed by a retrospective review in 84 (0.2 percent). Thus, reperfusion therapy has decreased the incidence of septal rupture. Septal rupture occurs more frequently with anterior wall acute myocardial infarction than other types of acute myocardial infarction. Risk factors for septal rupture included hypertension, advanced age (60 to 69 years), female sex and the absence of a history of angina or myocardial infarction. Angina or previous infarction may lead to myocardial preconditioning as well as to the development of coronary collaterals, both of which reduce the likelihood of septal rupture. In patients undergoing thrombolysis advanced age, female sex, and the absence of smoking are often associated with an increased risk of septal rupture, whereas the absence of antecedent angina has not been associated with an increased risk. In the GUSTO-I trial, there was a nonlinear relation between the systolic and diastolic blood pressures at enrolment and septal rupture, since hypertension and extensive myocardial infarction and right ventricular infarction are also risk factors for septal rupture

The relationship between good collateral development and magnesium/phosphate ratio in chronic total occlusion

Objective: Coronary collateral formation can be triggered by many acquired factors such as ischemia and growth factors, which ultimately manifests as differences in the quality of the coronary collateral circulation (CCC) in patients. Low magnesium (Mg) levels can increase endothelial cell dysfunction and potentially increase the risk of thrombosis and atherosclerosis. However, it has been reported that high serum phosphate (P) levels are correlated with the development of atherosclerosis and mortality. In this article, we aimed to reveal the relationship between CCC quality and Mg/P ratio in chronic total occlusion (CTO).
 Methods: A total of 269 patients with detected CTO in coronary angiography between March 2014 and June 2018 were included in the study. The patients were divided into two groups as group I (127 patients) and group II (142 patients) according to the Rentrop classification. The study is a retrospective, observational study.
 Results: In the multivariable regression analysis; smoking (p=0.004), triglyceride (p

The association of new atherosclerosis markers with coronary collaterals in chronic total occlusion patients

Objectives: In the present study, we investigated the relationship between mentioned markers and chronic total occlusion collateral development. Patients and methods: A total of 243 patients (210 males, 33 females; mean age: 63.3±11.5; range, 51 to 76 years) who underwent coronary angiography due to typical chest pain or myocardial ischemia detected in noninvasive stress tests and diagnosed with ≥1 major coronary artery occlusion between January and September 2020 were included in the cross-sectional observational study. The angiographic collateral index was determined according to the Cohen-Rentrop classification. The patients were divided into two groups according to the sufficiency of collateral development: the well-developed collaterals group (n=155) and the poor-developed collaterals group (n=88). Results: Statistically significant parameters in univariate logistic regression analysis were evaluated with multivariate (stepwise) logistic regression analysis; as a result, presence of chronic total occlusion in left anterior descending artery (odds ratio [OR]=2.447; 95% confidence interval [CI], 1.160-5.162; p=0.019), total number of occlusions (OR=3.503; 95% CI, 1.445-8.494; p=0.006), left ventricular ejection fraction (OR=1.056; 95% CI, 1.022-1.091; p=0.001), and the atherogenic index of plasma (OR=0.017; 95% CI, 1.022-1.091; p<0.001) were independently associated with well-developed collaterals. Although the triglyceride-glucose index had statistical significance in the univariate analysis, it was not detected as an independent variable in the multivariate analysis. The monocyte-lymphocyte ratio was not significant in the univariate analysis. Conclusion: Of the new atherosclerosis markers, only the atherogenic index of plasma had an independent association with poor collateral development.

ANATOMICALLY SUSTAINABLE VARIATION OF UNILATERAL PULMONARY ARTERY AGENESIS (UPAA)

ANATOMICALLY SUSTAINABLE VARIATION OF UNILATERAL PULMONARY ARTERY AGENESIS (UPAA)

Hybrid revascularization of chronic occlusion of the aorto-femoral segment in a patient with critical ischemia of the lower limbs and ischemic heart disease

Backgound. The number of patients with Leriche’s syndrome has increased dramatically. Despite the compensatory development of collaterals, this condition most often leads to symptoms of intermittent claudication and can result in critical ischemia and amputations. TASC II guidelines recommend reconstructive surgery, but this approach is associated with high perioperative mortality. So far, only few studies reported the results of endovascular correction of the atherogenic process in the infrarenal aorta.Objective. To present a clinical case of hybrid revascularization of the aortofemoral segment in a patient with ischemic heart disease.Design and methods. A 68-year-old patient with Leriche’s syndrome underwent ultrasound of the brachiocephalic arteries, coronary angiography, and multispiral computed tomography with angiography. Subsequently, hybrid surgery was performed.Results. Given the critical ischemia of the lower extremities and comorbidities, a hybrid surgical intervention was performed: endarterectomy from the femoral arteries and endovascular recanalization of the occlusion of the aortoiliac segment using the “kissing stents” technique.Conclusions. The requirements for equipment and experience of the surgical team limit the widespread use of hybrid correction of an occlusive lesion of the infrarenal aorta. The lack of randomized trials creates uncertainty in the choice of revascularization tactics. In the framework of this clinical case, the effectiveness of hybrid surgery in the treatment of a patient with multifocal atherosclerosis has been proven.

Diabetic dyslipidemia impairs coronary collateral formation: An update.

Coronary collateralization is substantially impaired in patients with type 2 diabetes and occlusive coronary artery disease, which leads to aggravated myocardial ischemia and a more dismal prognosis. In a diabetic setting, altered serum lipid profiles and profound glycoxidative modification of lipoprotein particles induce endothelial dysfunction, blunt endothelial progenitor cell response, and severely hamper growth and maturation of collateral vessels. The impact of dyslipidemia and lipid-lowering treatments on coronary collateral formation has become a topic of heightened interest. In this review, we summarized the association of triglyceride-based integrative indexes, hypercholesterolemia, increased Lp(a) with its glycoxidative modification, as well as quantity and quality abnormalities of high-density lipoprotein with impaired collateral formation. We also analyzed the influence of innovative lipid-modifying strategies on coronary collateral development. Therefore, clinical management of diabetic dyslipidemia should take into account of its effect on coronary collateralization in patients with occlusive coronary artery disease.

Correlation between hepatic venous pressure gradient and portal venous pressure gradient in hepatitis B cirrhosis with different hepatic veins anatomy

PurposeThe hepatic venous pressure gradient (HVPG) has been employed as the gold standard for indicating the portal venous pressure gradient (PPG) in the diagnosis of portal hypertension (PHT). However, little has been reported on whether the HVPG can accurately estimate the PPG in patients with hepatic vein collateral shunts. We aimed to explore the correlation between the HVPG and the PPG in hepatitis B cirrhosis patients with different hepatic vein anatomies. MethodsA total of 461 hepatitis B cirrhosis patients with portal hypertension (PHT) who were treated with a transjugular intrahepatic portosystemic shunt (TIPS) between January 2016 and June 2020 were included. All patients underwent various venous pressure measurements and balloon-occluded compression hepatic venography during the TIPS operation. Agreements were evaluated by Pearson’s correlation and the Bland–Altman method. Disagreements were assessed by paired t tests. ResultsThe correlation coefficient (r) values (P < 0.001) between the HVPG and the PPG of the early (151 patients, 32.8 %), middle (73 patients, 15.8 %), late (46 patients, 10.0 %), portal vein (151 patients, 32.8 %), and no lateral branch development groups (40 patients, 8.7 %) were 0.373, 0.487, 0.569, 0.690, and 0.575, respectively; the determination coefficient (R2) values were 0.139, 0.238, 0.323, 0.475, and 0.330, respectively. According to the Bland–Altman method, agreement was the greatest in the portal vein development group, with the 95 % limits of agreement (95 % LoA, mean differences ± 1.96 SD) being the smallest. The differences were statistically significant (P < 0.05). ConclusionThe correlation between the HVPG and the PPG is the worst in early lateral branch development, followed by middle development, and the influence of lateral branches becomes significantly reduced in late development. Hepatic venous collateral formation is a vital factor for underestimation of the HVPG, which is the most accurate predictor of PPG in patients with portal vein development. Patients with no collateral channel development in the hepatic vein have a higher HVPG than PPG, which is an important reason for overestimation of the HVPG.

Collateral Development in Patients Undergoing Coronary Angiography in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Coronary artery disease is one of the major cardiovascular diseases affecting the global human population. When the primary stenotic or blocked channel fails to deliver enough blood to the myocardium, the coronary collateral circulation serves as a backup source of blood supply. The aim of this study was to find out the prevalence of collateral development in patients undergoing coronary angiography in a tertiary care centre. This descriptive cross-sectional study was conducted among patients with peripheral vascular injuries that underwent operative management in a tertiary care centre from November 2021 to April 2022. Ethical approval was taken from the Institutional Review Committee (Registration number: CMC-IRC/078/079-027). Convenience sampling technique was used. Data for the study was retrieved from operation records of the patients along with their treatment summaries. Point estimate and 95% Confidence Interval were calculated. Among 170 patients undergoing coronary angiography, 84 (49.41%) (41.6-56.6, 95% Confidence Interval) had developed collateral circulation. The mean age was 62.8±11.7 years. The prevalence of collateral development in the coronary artery was similar to other published literature. angiography; artery; blood circulation; prevalence.

P1490: CHILDREN WITH SICKLE CELL DISEASE AND MOYAMOYA SYNDROME: A 10-YEAR EXPERIENCE

Background: Sickle cell anemia (SCD) is a multiorgan disease. Involvement of the central nervous system (CNS) is associated with increased mortality. Cerebrovascular accidents, especially when associated with permanent neurological deficits, are one of the most devastating potential outcomes of SCD. SCD can be complicated by Moyamoya syndrome (MMS), which is characterized by progressive stenosis of the supraclinoid segment of carotid arteries and development of typical collaterals, resulting in increased risk for both ischemic and hemorrhagic strokes. Aims: We describe the clinical characteristics of children with SCD and MMS treated at our center over the last 10 years and define the prevalence of MMS in our setting. Methods: We conducted a retrospective, descriptive study of all patients with SCD who were diagnosed with cerebrovascular disease and with MMS in our institution from 2012 to 2021. Indications for neuroimaging [(magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA)] in our center include recurrent episodes of syncope, epileptic seizures, neurocognitive changes, time-averaged maximum mean velocity (TAMMV) of the middle cerebral or intracranial internal carotid arteries (ICA) measured ≥200 cm/s or before starting regular transfusion regime. Relevant clinical data was collected and summarized using descriptive statistics. Results: The study included 109 patients with SCD and 19,3% of them (21 patients) required neuroimaging. Within these patients, 6 presented with acute focal neurological signs that resulted in a diagnosis of ischemic stroke in four patients, and posterior reversible encephalopathy syndrome diagnosis in the other two. Besides these, 2 patients (9,5%) were diagnosed by neuroimaging with MMS and 1 (4,8%) had a pattern suggestive of MMS on brain MRI not confirmed by angiography. Furthermore, whereas four (19%) patients had no imaging findings suggestive of cerebrovascular disease, they presented with TAMMV ≥200cm/s, so they were proposed to regular transfusion regimen for primary prevention of stroke. Regarding the patients diagnosed with SCD and MMS, MMS was diagnosed at 9 years old in one patient and at 10 years old in another. Both patients had a SS genotype and were diagnosed following an abnormal surveillance transcranial doppler study, since they were asymptomatic for the disease. One of the patients was under erythrocytapheresis protocol and achieved a HbS level <20%. Currently she is without critical stenosis or cerebrovascular events, maintaining only imaging follow-up. The other patient was under regular transfusion regimen with HbS levels between 40 and 50%, and has been proposed for sibling bone marrow transplantation and encephaloduroarteriosynangiosis. Summary/Conclusion: The prevalence of MMS in our center (1,8%) is lower than described in other studies. Recent guidelines recommend at least a one-time MRI screening in early-school-age children to detect cerebrovascular disease earlier and reduce the burden of CNS complications in children and adults with SCD. By following these new recommendations, we expect an earlier and more frequent diagnosis of MMS, thus reducing the morbidity of these patients.

Evaluation of cerebral collateral status using computed tomography angiography in ischemic stroke: review of manual and automated methods

In ischemic stroke, the condition of cerebral collateral circulation is one of the key factors determining the outcome. Digital subtraction angiography is considered the gold standard of evaluation of cerebral collateral circulation. However, computed tomography angiography is the most widely used method characterized by high level of conformity with subtraction angiography. Currently, several scales of visual evaluation of collateral circulation development in images obtained by computed tomography angiography are used. The scales describe the territory of stroke-associated cerebral artery, as well as details of various areas of the territory. The association between the score and severity of neurological deficit and volume of cerebral ischemia was demonstrated in numerous studies. However, consensus on the most reliable method of description of cerebral collateral status has not been reached. Use of modern methods of processing of medical images and artificial intelligence allowed to make a significant step towards automatization of collateral status evaluation with such benefits as high processing speed and resistance to subjective opinion. Despite low number of studies on this subject, implementation of automated solutions has already showed its effectiveness. In this review, scales for manual evaluation of cerebral collateral status are considered, their reliability is described, and current approaches to automated evaluation of collateral circulation in ischemic stroke are presented.

Moyamoya syndrome and stroke among pediatric sickle cell disease patients in Sudan: A cross-sectional study

BackgroundSickle cell disease (SCD) is autosomal recessive hemolytic anemia due to hemoglobinopathy commonly in Sub-Saharan Africa, and particularly in Sudan. The disease induces a pro-inflammatory cascade in the intimal layer that leads to hyperplasia and progressive stenosis in the major vessel of the circle of Willis. This is associated with the development of Moyamoya collaterals. The aim of this study is to highlight the frequency of Moyamoya syndrome in Sudanese pediatric patients with sickle cell disease presenting with stroke. Materials and methodsA descriptive cross-sectional hospital-based study was conducted in the Department of Hematology at Gaafar Ibnauf Pediatric Tertiary Hospital in Khartoum state in Sudan, in the period between March 2021 and August 2021. Secondary data has been collected from the medical record after ethical approval and informed consent. ResultsA total of 104 patients were included in the study. The males were the majority, about 60 (57.7) compared to 44 (42.3%) females. More than half of our study population was in the school-age 54 compared to 42 adolescents and only 8 patients of preschool age. Only 50 out of 104 patients had diagnostic MRA which revealed features of Moyamoya syndrome in 48 (96%) patients. Motor weakness (100%), aphasia (52.9%), and facial palsy (35%) were the major stroke presentations. The left anterior circulation territory was the most common site of moyamoya features involvement in 31 patients out of 48. ConclusionStroke is a common problem in Sudanese pediatric patients with sickle cell disease, with a very high frequency of Moyamoya vasculopathy among patients with stroke presentation. The burden of Moyamoya syndrome in Sudanese pediatric patients with sickle cell disease is underestimated due to the cost of the available screening and diagnostic tools.

Hypoperfusion Intensity Ratio is Associated with Stroke Mechanism in Patients Undergoing Mechanical Thrombectomy

BackgroundHypoperfusion Intensity Ratio (HIR), defined as Tmax >10s/Tmax >6s on computed tomography perfusion (CTP), and stroke mechanisms have been independently correlated with angiographic collaterals and patient outcomes. Slowly developing atherosclerotic stenosis may foster collateral development, whereas cardioembolic occlusion may occur before collaterals mature. We hypothesized that favorable HIR is associated with large artery atherosclerosis (LAA) stroke mechanism and good clinical outcome. MethodsRetrospective study of consecutive endovascularly-treated stroke patients with intracranial ICA or MCA M1/M2 occlusions, who underwent CTP before intervention, between January 2018 and August 2021. Patients were dichotomized into LAA+ or LAA- based on presence of LAA on angiography. HIR was dichotomized into favorable (HIR+) or unfavorable (HIR-) groups based on published thresholds. Good early outcome was defined as discharge mRS of 0-2. Bivariate and multivariable logistic regression were performed. Results143 patients met inclusion. 21/143 were LAA+ (15%) and 65/143 (45%) were HIR+. HIR+ was significantly more frequent in LAA+ patients (67% vs. 42%, p= 0.035). Controlling for demographics, stroke severity, imaging findings, and medical comorbidities, LAA+ remained independently associated with HIR+ (OR 5.37 [95% CI 1.43 – 20.14]; p=0.013) as did smaller infarction core volume (<30 mL of CBF <30%: OR 7.92 [95% CI 2.27 – 27.64]; p = 0.001). HIR+ was not associated with good clinical outcome. ConclusionsLarge artery atherosclerosis was independently associated with favorable HIR in patients undergoing mechanical thrombectomy. While favorable HIR was associated with smaller pre-treatment core infarcts, reflecting more robust collaterals, it was not associated with good clinical outcome.

Effect of obstructive sleep apnoea on coronary collateral vessel development in patients with ST-segment elevation myocardial infarction.

The impact of obstructive sleep apnoea (OSA) in the setting of acute ST-segment elevation myocardial infarction (STEMI) is complex and divergent. This study aimed to investigate the association between OSA and coronary collateral vessel (CCV) development in patients with STEMI. The present study prospectively screened 282 STEMI patients with an overnight sleep study. OSA was defined as apnoea-hypopnoea index (AHI) ≥15 events/h. The coronary angiograms were used for the assessment of Rentrop grades representing CCVs. Among 119 patients enrolled, 60 patients had OSA (50.4%). The prevalence of CCV development (Rentrop grade ≥ 2) was significantly higher in OSA group than in the non-OSA group (43.3% vs. 5.1%, p < 0.001). There was a parallel increase in the Rentrop grades associated with OSA severity and worsening of hypoxaemia indicators (minimum arterial oxygen saturation [SaO2 ], mean SaO2 and time with SaO2 below 90%). After adjustment for clinical and angiographic characteristics, and pre-procedure medications that might interact with OSA, AHI as a continuous variable (OR 1.11, 95% CI 1.08-1.21, p < 0.001) and the presence of OSA (OR 11.41, 95% CI 2.70-48.15, p=0.001) were both associated with dramatically higher incidence of CCV development. Our study demonstrated that the presence of OSA might augment CCV development in STEMI patients. The potential protective effects and mechanisms of OSA in the acute setting of STEMI should be further investigated in larger studies.

Correlation of serum vascular endothelial growth factor and cardiovascular risk factors on collateral formation in patients with acute coronary artery syndrome.

Coronary collaterals serve as an alternative source of blood flow in obstructive coronary heart disease. Coronary collateral development is induced by various angiogenic growth factors, including vascular endothelial growth factor-A (VEGF-A). Cardiovascular risk factors strongly associated with coronary artery disease include age, sex, elevated serum cholesterol, disturbed carbohydrate metabolism, and elevated blood pressure. A better understanding of the effects of these cardiovascular risk factors and serum VEGF-A level on collateral recruitment is necessary for a better prognosis in coronary artery diseases and new insight for further therapeutic promotion of coronary collaterals.220 consecutive patients undergoing coronary angiography with a mean age of 61 ± 9.83 were selected for the analysis. Two milliliters of blood were taken from the patients for analysis. The blood serum VEGF concentration was quantified via the ELISA method. Angiograms and other clinical reports were collected. Significant coronary artery disease was diagnosed in those with ≥ 70% of stenosis in at least one of the coronary arteries. The angiographic and clinical data were documented. The collateral grading was done according to the Rentrop Scoring system. The serum vascular endothelial growth factor level was correlated with the collateral score and cardiovascular risk factors like age, sex, type II diabetes, blood pressure, and cholesterol level. An increase in the level of the collateral score was noted with an increase in the level of VEGF in blood serum. A significant association was founded between serum VEGF level and cardiovascular risk factors on collateral formation in patients with diabetes and hypertension.

Bilateral Ortak Karotis Arter Ligasyonu Sonrası Kraniyofacioservikal Resirkülasyon Sırasında Trigeminal Ağ ve Karotiko-vertebrobaziler Vaskülatürü Arasındaki Sihirli İlişki: Ön Çalışma

Aim: Steno-occlusive carotid artery disease causes increased intraluminal pressure, retrograde blood flow, intraluminal enlargement, vessel wall thinning, convolution, vascular remodelling, angiogenesis, and aneurysm formation. We investigated whether there is a relationship between trigeminal ganglion (TGG) ischemia and luminal surface area values of external/internal carotid arteries (ECA/ICA) after common carotid artery ligation (BCCAL). &#x0D; Material and Methods: This study was conducted in 20 hybrid male rabbits as control (GA;n=5), SHAM (GB;n=5), and study group (GC,n=10). Following anterior mid-cervical incision, permanent BCCAL was performed for only GC and animals sacrificed under general anaesthesia after three months. Degenerated neuron (DN) density of TGGs and ECAs/ICAs' luminal surface values were estimated by Cavalieri and Stereological methods. Lumen enlargement, wall thinning, elongation, convolution, and dolichoectasia were detected in the carotid artery vasculature. &#x0D; Results: The mean DN density of TGG was 12±4 in GA, 53±11 in GB, and 960±112 in GC. The mean number of ECA branches was calculated as 4±1/GA, 7±2/GB, and 11±3/GC. Total surface values of ECA/ICA (as mm2): 4.8±1.2/GA; 3.9±0.8/GB and 3.6±0.4/GC. &#x0D; Conclusion: The low density of DN in TGG could have a beneficial effect on neovascularization, collateral development, a renormalization of carotid circulation, and prevention of ischemic damage supplied by ECA/ICA of study group.

The Interplay Between Biliary Occlusion and Liver Regeneration: Repeated Regeneration Stimuli Restore Biliary Drainage by Promoting Hepatobiliary Remodeling in a Rat Model.

Background and AimsPatients with malignant biliary obstruction do not seem to benefit from “two-stage hepatectomy” due to an impairment of liver regeneration. We designed a novel model of “repeated regeneration stimuli” in rats mimicking a “two-stage hepatectomy” with selective or complete biliary occlusion mimicking Klatskin tumors III° or IV°. Using this new model, we wanted to investigate (1) the impact of preexistent cholestasis of different extent on the time course of liver regeneration and (2) the dynamics of hepatobiliary remodeling under regeneration conditions.Materials and MethodsRats were subjected to a sequence of three operations: surgical induction of biliary occlusion, followed by “repeated regeneration stimuli” consisting of ligation of the left branch of the portal vein (supplying 70% of the liver volume, sPVL) as first stage and a 70%-hepatectomy (70%PHx) as second stage. Biliary occlusion (1st procedure) was induced by ligating and transection of either the common (100%, tBDT) or the left bile duct (70%, sBDT). A sham operation without ligating the bile duct was performed as control (0%, Sham). Two weeks later, on day 14 (POD14), the sPVL (2nd procedure) was performed. Another week later (POD 21), the 70%PHx (3rd procedure) took place and animals were observed for 1 week (POD 28). The first experiment (n = 45 rats) was dedicated to investigating liver regeneration (hypertrophy/atrophy), proliferative activity and hepatobiliary histomorphology (2D-histology: HE, BrdU) in the future liver remnant (FLR). The second experiment (n = 25 rats) was performed to study the dynamics of hepatobiliary remodeling in livers with different regenerative pressure (tBDT only POD21 vs. tBDT only POD 28 vs. tBDT + sPVL vs. tBDT + 70%PHx vs. tBDT + sPVL + 70%PHx) using μCT scans of explanted livers.ResultsEffect of biliary occlusionTotal biliary occlusion (tBDT) led to a 2.4-fold increase in whole liver volume due to severe biliary proliferation within 14 days. In contrast, partial biliary occlusion (sBDT) caused only a volume gain of the obstructed liver lobes due to biliary proliferates, resulting in a minor increase of total liver volume (1.7-fold) without an increase in bilirubin levels.Liver regeneration and atrophyAs expected, sPVL caused substantial volume gain (tBDT: 3-fold; sBDT: 2.8-fold; Sham 2.8-fold) of FLR and a substantial volume loss (tBDT: 0.9-fold; sBDT: 0.6-fold; Sham: 0.4-fold) of the portally deprived “future resected lobes” compared to the preoperative liver volume. The subsequent 70%PHx promoted a further volume gain of the FLR in all groups (tBDT: 4-fold; sBDT: 3-fold; Sham 3-fold compared to original volume) until POD 28. Hepatobiliary remodeling: After tBDT, we identified histologically three phases of hepatobiliary remodeling in the FLR. Following tBDT, biliary proliferates developed, replacing about 15% of the hepatocellular tissue. After sPVL we found incomplete restoration of the hepatocellular tissue with a visible reduction of the biliary proliferates. The 70%PHx led to an almost complete recovery of the hepatocellular tissue in the FLR with a nearly normal liver architecture. In contrast, after sBDT and Sham we observed a near normal liver morphology in the FLR at all time points. CT-scanning of the explanted livers and subsequent 3D reconstruction visualized the development of extrahepatic biliary collaterals. Collaterals were detected in 0/5 cases 1 week after sPVL (first regeneration stimulus), and in even more cases (3/5) 1 week after the 70%PHx (second regeneration stimulus). Histological workup identified the typical biliary cuboid epithelium as inner lining of the collaterals and peribiliary glands.ConclusionLiver volume of the FLR increased in cholestatic rats mainly due to biliary proliferates. Application of repeated regeneration stimuli in the style of a “two-stage hepatectomy” promoted almost full restoration of hepatocellular tissue and architecture in the FLR by reestablishing biliary drainage via formation of biliary collaterals. Further exploration of the dynamics in hepatobiliary modeling using this model might help to better understand the underlying mechanism.