Collateral Group Research Articles

Association of atherosclerotic plaque features with collateral circulation status in elderly patients with chronic carotid stenosis.

ObjectiveTo determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis.MethodsElderly patients (> 60 years) with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups, and underwent magnetic resonance imaging and computed tomography imaging. The carotid plaque features including lipid-rich necrotic core, intraplaque hemorrhage, calcification, and fibrous cap rupture (FCR) were evaluated, and maximum wall thickness, normalized wall index (NWI), and luminal stenosis were measured. The association between these variables and collateral circulation status was analyzed.ResultsOf the 97 patients (78 males, mean age: 69.0 ± 6.1 years), 19 (19.6%) had poor collaterals. The poor collateral group had a significantly higher NWI (93.7% ± 5.0% vs. 89.0% ± 7.9%, P = 0.011), a greater extent of stenosis (80.0% ± 11.4% vs. 75.3% ± 9.4%, P = 0.036) and FCR (84.2% vs. 55.1%, P = 0.020) compared with good collateral group. Carotid NWI (OR = 3.83, 95% CI: 1.36–10.82, P = 0.011) and more FCR (OR = 6.77, 95% CI: 1.35–33.85, P = 0.020) were associated with poor collateral circulation after adjustment for the confounding factors. The combination of NWI, FCR, systolic blood pressure, and triglycerides had the highest area-under-the-curve (AUC = 0.85) for detection of poor collaterals.ConclusionsCarotid plaque features, specifically NWI and FCR, are independently associated with poor collateral circulation, and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.

The Relationship Between Circulating Neuregulin-1 and Coronary Collateral Circulation in Patients with Coronary Artery Disease.

Coronary collateral circulation (CCC) plays a crucial role in myocardial blood supply, especially for ischemic myocardium. Previous study has shown that neuregulin-1 is a prominent angiogenic factor in diabetic cardiomyopathy, whereas the relationship between neuregulin-1 and CCC has not been investigated. Thus, we aimed to investigate relationship between circulating neuregulin-1 levels and CCC in stable coronary artery disease patients.Coronary artery disease patients with a stenosis of ≥ 90% as evidenced by coronary angiography were included in our study. According to the Rentrop-Cohen classification, coronary collateral degree was graded as 1 to 4. Patients with collateral degree grade 0 or 1 were enrolled in poor CCC group, whereas patients with grade 2 or 3 were enrolled in good CCC group.Plasma neuregulin-1 level was significantly increased in good collateral group and positively related to Rentrop grade (P < 0.01). Multivariate regression analysis and ROC (receiver operating characteristic curve) revealed that plasma neuregulin-1 could predict CCC status effectively.Increased plasma neuregulin-1 level was related to better CCC in patients with coronary artery disease. Neuregulin-1 was an independent and reliable predictor for good coronary collateral development and provided a potential therapeutic strategy to reduce myocardial ischemia injury.

Association between electrocardiographic parameters and collateral circulation in patients with chronic total occlusion

Aim: In patients with chronic total occlusion (CTO), negative cardiovascular outcomes (angina, more frequent ventricular arrhythmias, higher mortality) and reduced survival have been demonstrated. The association between several electrocardiogram (ECG) markers, revealing individuals at high risk for ventricular arrhythmia, and collateral has been investigated in different studies in coronary artery disease patients. In this study, we aimed to investigate the association between the electrocardiographic parameters between good coronary collateral group and poor coronary collateral group in CTO patients with PCI.Material and Methods: Patients retrospectively implemented CTO PCI to those with symptomatic symptoms of myocardial ischemia or with the exact sign of ischemia in the CTO area. The patients were divided into 2 groups according to the Rentrop class: group 1 (Rentrop 0 and 1) and group 2 (Rentrop 2 and 3). Baseline characteristics, laboratory and ECGs, procedural data, and outcome data were retrospectively collected. Results: In this study included 59 CTO patients undergoing PCI. Mean age was 61.0±10.3 years and 43 (72.9%) of patients were male, and PCI success was 69.4%. While 22 (37.2%) of the patients were poor collateral group 1 (Rentrop 0 and 1), the remaining 37 (62.3%) of them were good collateral group 2 (Rentrop 2 and 3). There was a significant difference, in poor and good collateral groups, QT dispersion (77.2±27.9 vs 66.5±22.5, p: 0.041, respectively), QTc dispersion (82.1±26.9 vs 70.4±23.9, p: 0.034, respectively), and the presence of fQRS (63.6% vs 43.2, p: 0.027, respectively). But there was no statistically difference in P wave dispersion (48.0±9.5 vs 47.2±11.3, p: 0.796). Correlation analysis reported the association between Rentrop classification and Syntax score (r: -0.397, p: 0.002), LDL-C (r: -0.198, p: 0.025), QT dispersion (r: -0.156, p: 0.045), QTc dispersion (r: -0.176, p: 0.037), and the presence of fQRS (r: 0.234, p: 0.021) were statistically significant.Conclusion: We suggest that some ECG parameters are an important, easy, simple, and cost effective tool and can be beneficial in predicting the poor or good collateral in patients with CTO.

Blood Group Types O and Non-O Are Associated With Coronary Collateral Circulation Development

Blood group types are associated with coronary artery disease. However, data are scarce about the impact of blood group types on coronary collateral circulation. In this study, we aimed to investigate the relationship between the blood group types and coronary collateral circulation. Two hundred and twelve patients who underwent coronary angiography in our department and had a stenosis of ≥ 90% in at least one major epicardial vessel were included in our study. Collateral degree was graded according to Rentrop-Cohen classification. After grading, patients were divided into poor coronary collateral circulation (Rentrop grade 0 and 1) and good coronary collateral circulation (Rentrop 2 and 3) groups. The ABO blood type of all participants was determined. The incidence rates of O blood group type were significantly higher in the good coronary collateral group compared to the poor collateral group (37.9% vs 17.1%, P < .001). The O type blood group was an independent predictor of good coronary collateral circulation (odds ratio = 1.83, 95% confidence interval = 1.56-6.18, P = .015). Coronary collateral circulation is associated with blood group types. The O blood group predicts good coronary collateral development among patients with coronary artery disease.

The beneficial role of intravascular ultrasound in the diagnosis and treatment of nonthrombotic iliac venous obstructions as compared with traditional venography in the Chinese population

PURPOSE: The efficacy of intravascular ultrasound (IVUS) in diagnosing obstructive venous lesions has been established in the Western countries; however, its beneficial role in the Asian population is seldom reported. Because IVUS is still not widely used in China, we, therefore, investigated whether the salutary effect of IVUS on the diagnosis and treatment of iliac venous outflow obstructions could also be extended to the Chinese population. MATERIALS AND METHODS: This was a prospective single-center study. Patients with nonthrombotic iliac venous obstructions were consecutively enrolled from September 2017 to September 2019. IVUS and venography were performed for every participant. The anatomic characteristics of the venous lesions were measured by these two imaging modalities and then compared with each other. Venous lesions were divided into the collateral and noncollateral group according to the presence of collaterals on venographic images, and comparison was performed between the two groups. The difference of lesion diameter or area at the most compression site was also observed after the endovascular intervention. RESULTS: A total of 50 patients with 59 limbs were eligible (males, 25; females, 25; mean age 63.46 ± 8.07). The clinical-etiology-anatomy-pathophysiology classification was C4: 43 (72.88%), C5: 6 (10.17%), and C6: 10 (16.95%). Compared with IVUS, the diameter and area stenosis calculated by traditional venography were dramatically lower than that measured by IVUS (diameter stenosis, 38.56% ± 17.76% vs. 64.55% ± 15.96%, P CONCLUSIONS: Compared with IVUS, traditional venography underestimates the degree of stenosis and misses significant iliac venous obstructive lesions. The collaterals presented by venography is not a reliable indicator in distinguishing significant lesions. IVUS is a valuable and effective imaging modality in the diagnosis and treatment of nonthrombotic iliac venous obstructions in the Chinese population.

Clinical prognosis analysis of collateral circulation and vascular recanalization in patients with acute ischemic stroke based on multiphase CTA

Objective To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery (MCA) occlusion. Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University from October 2017 to September 2018. According to the ASPECTS collateral circulation score, the patients were divided into two groups: good collateral group (n=31) and poor collateral group (n=18). The benefits and risks after thrombolysis in the two groups were compared, including 24-h NIHSS score, 30-day mortality, 90-day modified rankin scale (mRS) score, and the incidence of symptomatic cerebral hemorrhage. Statistical analysis was performed using t test, corrected χ2 test, or Fisher's exact test. Results The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group (4.6±5.6 vs 12.5±8.4, P=0.00; 1.7±1.7 vs 3.1±1.5, P 0.05), but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group (11.1% vs 0%). Conclusion For patients with acute MCA infarction and receiving vascular recanalization therapy, patients with good collateral circulation can achieve good clinical outcomes, restore better recent neurological function, and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate. Key words: Retrospective studies; Acute ischemic stroke; Intravenous thrombolysis; Multiphase CT angiography; Collateral circulation

P6526Short and long-term outcomes of coronary perforation managed by coil embolization: a single-center experience

Abstract Background Coronary perforation is a serious complication in percutaneous coronary intervention (PCI), as it can lead to pericardial effusion causing tamponade, often necessitating emergency pericardiocentesis and rarely, cardiac surgery. With increasing treatment of complex coronary lesions, such as chronic total occlusion (CTO), the incidence of coronary perforation is also increasing. Distal wire perforation and collateral vessel perforation can be managed by coil embolization during PCI, which prevented the need of cardiac surgery. Purpose To report the short and long-term outcomes of patients with coronary perforation as a complication of PCI managed by coil embolization in our center Methods We retrospectively analyzed 66 patients who had coronary perforation treated by coil embolization during PCI from 32007 PCI procedures performed in our center from Oct 2012 to June 2018. Results Of sixty-six cases of coronary perforation, twenty-six cases were distal coronary perforation, while 40 cases were collateral perforation. The average coil number used in distal coronary and collateral perforation lesion is 1.8±0.9 and 1.8±1.0, respectively. The maximum number of coil implanted in each patient is 4 in both groups. Two emergency cardiac surgery to seal the perforation was performed after coil embolization in distal coronary perforation and pericardiocentesis, including one distal left circumflex artery perforation and one distal left anterior descending artery perforation. In collateral perforation, one case of CABG was performed due to myocardial ischemia caused by CTO lesion. During a follow-up of 707±476 days, one patient in collateral perforation group had CABG one month later, while no death or myocardial infarction (MI) was detected. Fifty-four (81.2%) cases of perforations occurred while treating chronic total occlusion, and 74.0% of these perforations were located in collateral vessels, mostly epicardial vessels. Thirty-nine CTO cases (72.2%) were revascularized successfully with the aid of coil embolization. Conclusion Coil embolization is feasible and effective in treating distal coronary perforation and collateral perforation during PCI procedure. In CTO lesions, coil embolization facilitates the success of revascularization by PCI.

The influence of erdosteine administration on lead-induced oxidative stress in rat muscle

Lead-exposure is known to disrupt the redox balance of tissues leading to oxidative stress. Due to the fact that a mucolytic drug, erdosteine, exerts also antioxidant properties, we decided to perform a pilot study on rats to evaluate its therapeutic potency in lead poisoning. Male Wistar rats were divided randomly into the following seven groups having 10 animals in each. Group I served as the control group. During 8-week period, rats in groups II–IV, except standard alimentation, received: erdosteine in a dose 350 mg/kg (collateral control group), 1200 ppm of lead acetate in drinking water and placebo, as well as the same doses of lead and erdosteine, respectively. Rats in group V–VII received 1200 ppm of lead acetate in drinking water for the initial 6-week period and then administered: placebo, erdosteine and EDTA for 2 weeks, respectively. The levels of malondialdehyde (MDA) were significantly higher in groups III and V compared to the control group. The activities of catalase (CAT) were significantly higher in groups IV, V, and VI compared to the control group. The activities of glutathione-S-transferase (GST) were significantly lower in group II and significantly higher in groups VI and VII compared to the control group, while the activities of glutathione reductase (GR) were significantly lower in group III and significantly higher in group VI. Erdosteine has an effect of protection against lead-induced oxidative stress which is not worse than that of EDTA.

Short and long-term outcomes of coronary perforation managed by coil embolization: A single-center experience

BackgroundCoronary perforation is a serious complication in percutaneous coronary intervention (PCI). In this article, we reported the short and long-term outcomes of patients with coronary perforation managed by coil embolization in our center. MethodsWe retrospectively analyzed 66 patients who had coronary perforation treated by coil embolization during PCI performed in our center from Oct 2012 to June 2018. ResultsOf sixty-six cases of coronary perforation, twenty-six cases were distal coronary perforation, while 40 cases were collateral perforation. The average coil number used in distal coronary and collateral perforation lesion is 1.8 ± 0.9 and 1.8 ± 1.0, respectively. The maximum number of coils implanted in each patient is 4 in both groups. Two emergency cardiac surgery to seal the perforation was performed after coil embolization in distal coronary perforation and pericardiocentesis. In collateral perforation, one case of CABG was performed due to myocardial ischemia caused by CTO lesion. During a follow-up of 707 ± 476 days, one patient in collateral perforation group had CABG one month later, while no death or myocardial infarction (MI) was detected. Fifty-four (81.2%) cases of perforations occurred while treating chronic total occlusion, and 74.0% of these perforations were located in collateral vessels, mostly epicardial vessels. Thirty-nine CTO cases (72.2%) were revascularized successfully with the aid of coil embolization. ConclusionCoil embolization is feasible and effective in treating distal coronary perforation and collateral perforation during PCI procedure. In CTO lesions, coil embolization facilitates the success of revascularization by PCI.

Endothelial Progenitor Cells Induce Angiogenesis: A Potential Mechanism Underlying Neovascularization in Encephaloduroarteriosynangiosis

Background and purpose: Encephaloduroarteriosynangiosis (EDAS) is one of the most commonly used indirect vascular reconstruction methods. EDAS aids in the formation of collateral vessels from the extracranial to the intracranial circulation in patients with moyamoya disease (MMD). However, the underlying mechanism of collateral vessel formation is not well understood. Endothelial progenitor cells (EPCs) differentiate to form the vascular endothelial cells and play a very important role in angiogenesis. We designed this prospective clinical trial to investigate the presence of EPCs in patients with MMD and to explore the neovascularization mechanism mediated by the EPCs in EDAS. Materials and Methods: The patients who were diagnosed with MMD were recruited between February 5, 2017 and January 7, 2018. The blood samples were obtained from an antecubital vein and were analyzed using flow cytometry. EPCs were defined as CD34brCD133+CD45dimKDR+. All the patients enrolled in the study underwent EDAS. Cerebral arteriography was performed 6 months post-EDAS to assess the efficacy of synangiosis. The correlation between EPC count and good collateral circulation was evaluated. Result: Among the 116 patients with MMD enrolled in this study, 73 were women and 43 were men. The average age of the patients was 33.8 ± 15.2 years. The EPC count of the patients with MMD was 0.071% ± 0.050% (expressed as percentage of the peripheral blood mononuclear cells). The EPC count in the good postoperative collateral circulation group was significantly higher (0.085% ± 0.054%) than that in the poor collateral circulation group (0.048% ± 0.034%) (P = 0.000). The age, modified Suzuki-Mugikura grade, and EPC count were significantly correlated with the good collateral circulation post-EDAS in the multivariate analysis (P = 0.018, P = 0.007, and P = 0.003, respectively). Conclusions: The formation of collateral vessels by EDAS is primarily driven by angiogenesis. The EPC count may be the most critical factor for collateral circulation. The therapeutic effect of EDAS is more likely to benefit younger or severe ischemic patients with MMD. Funding: This study was supported by grant from the National Natural Science Foundation of China (Grant Nos. 81571136) and Beijing Municipal Science & Technology Commission No.Z171100001017144). Declaration of Interest: None. Ethical Approval: The study was approved by the Research Ethics Board at the Fifth Medical Center of Chinese PLA General Hospital and all the subjects provided a written informed consent to participate in the study. All the procedures performed in this study involving human participants were in accordance with the Declaration of Helsinki (1964). This study was registered at ClinicalTrials.gov (NCT03613701).

Koroner Kronik Total Oklüzyonu Olan Hastalarda Serum Endokan Düzeyi ile Koroner Kollateral Dolaşım Arasındaki İlişki

Introduction: Endocan, a dermatan sulfate proteoglycan, is synthesized and secreted by the vascular endothelium. It is involved in the pathogenesis of vascular diseases, organ-specific inflammations, and angiogenesis. The aim of the present study was to investigate the relationship between serum endocan level and development of coronary collateral circulation (CCC) in patients with stable angina pectoris. Patients and Methods: Patients with stable angina with at least one chronic total coronary occlusion (CTO) (n= 44) and who had normal coronary artery (n= 29) were included in the study. Collateral degree was evaluated according to the Rentrop and Cohen's classification. Patients who had grade 0 or 1 collateral filling were included in the poorly developed collateral group (n= 19), and those with grade 2 or 3 collateral filling were included in the well-developed collateral group (n= 23). Results: Endocan levels were significantly higher in patients in the well CCC group than in those in the poor CCC and control groups (p< 0.001). Endocan level is higher in patients with poorly developed CCC than in the control group. Endocan was only found as an independent predictor of well CCC in regression analysis (odds ratio 1.002, 95% confidence interval (CI) 1.001-1.005, p= 0.001). Receiver operating characteristic curve analysis detected an optimal cut-off value for endocan level of 1773.9 ng/L that predicted the presence of well development of CCC with a sensitivity of 84% and specificity of 63% (area under the receiver operating characteristic (ROC) curve: 0.749, 95% CI: 0.654-0.849, p< 0.001). Conclusion: Elevated endocan level is associated with better CCC in patients with CTO. Endocan may play an important role in the development of CCC.

Abstract WP157: Beneficial Effects of Collateral Augmentation by Acetazolamide and Head-Down Tilt in Rat Ischemic Stroke Model

Introduction: We investigated whether collateral augmentation treatments with acetazolamide (ACZ), head down tilt (HDT), or combination are effective in rats with the transient middle cerebral artery occlusion (MCAO) models. Methods: All animals were induced MCAO for 1h 30min and reperfusion for 24h. ACZ 100 mg/kg solution in 0.9% saline was administered in a single intravenous bolus of 0.5 ml over 3 min, 30 min after onset of MCAO. HDT was administered using a 15° tilted platform for 60 min, 30 min after onset of MCAO. To measure infarct volume, brain water content and neurological score, 58 male Wistar rats were divided into four groups: control (n=17), ACZ (n=15), HDT (n=13) and combination groups (n=14). Infarction volumes were measured after 2% 2,3,5-triphenyltetrazolium chloride (TTC) staining. Neurologic deficits were assessed using the Garcia and Longa scores at 24h after MCAO. The following formula was used to quantify the brain water content: brain water content (g) = wet brain weight - dry brain weight. Results: The collateral augmentation groups had smaller infarct volume (control, 30.39 ± 8.18 vs. collateral augmentation groups 16.89 ± 11.45, p=0.005) and less brain water content (control, 1.53 ± 0.11 vs. collateral augmentation groups 1.44 ± 0.10, p=0.081). Neurological scores were better in collateral augmentation group than control group (Garcia score; control, 9.8 ± 2.1 vs. collateral augmentation groups, 12.4 ± 3.0, p=0.001) (Longa score; control, 2.5 ± 0.8 vs. collateral augmentation groups, 1.9 ± 1.1, p=0.026). Among groups, the ACZ group was significantly associated with small infarct volume (ACZ, 11.79 ± 5.40 vs. control, 30.39 ± 8.18, p&lt;0.001), followed by the combination group. In addition, the combination group was significantly associated with better neurological scores (Garcia score; combination, 13.33 ± 2.46 vs. control, 9.79 ± 2.12, p=0.017) and less brain water content (combination, 1.35 ± 0.09 vs. control, 1.53 ± 0.11, p=0.031). Conclusion: We found that collateral augmentation was associated with smaller infarction volume and better neurological outcome compared to untreated animal after transient MCAO. Among the treatment methods, the combination group showed the best beneficial effects.

The influence of collateral circulation recruitment on various cognitive functions after severe unilateral stenosis or unilateral occlusion of the internal carotid artery

Objective To investigate the influence of collateral circulation recruitment on cognitive functions in patients with severe unilateral stenosis or unilateral occlusion of the internal carotid artery by using TCD. Methods A total of 176 patients with severe unilateral stenosis or unilateral occlusion of the internal carotid artery were enrolled and were divided into a single vessel collateral group(n=80, 45.5%), a multiple vessel collateral group(n=74, 42.1%)and a no collateral group(n=22, 12.5%). In order to study the influence of single vessel collateral circulation on cognitive functions, the single vessel collateral group was further divided into an anterior communicating subgroup(AcoA), a posterior communicating subgroup(PcoA), an ocular artery subgroup(OA), and a normal control subgroup.All patients and 34 normal controls(NC)received MoCA, and scores for the overall assessment and individual domains were analyzed. Results Compared with the control group(26.3±1.1, 4.7±0.5, 2.0±0.0, 3.6±1.0), the multiple vessel collateral group, the single vessel collateral group and the no collateral group had lower overall scores(24.2±1.7, 21.9±2.3, 19.0±2.4), lower executive/visuospatial function(3.9±0.7, 3.2±0.8, 2.4±0.6), lower abstraction(1.7±0.5, 1.6±0.5, 1.3±0.5), and lower delayed recall(2.9±0.8, 1.9±0.8, 1.6±0.5)(F=80.52, 63.21, 12, 48.99, all P<0.05); both collateral groups had lower scores in subtraction and attention(4.6±0.6 vs. 5.2±0.7, 4.3±0.7 vs. 5.2±0.7); the no collateral group had lower scores in orientation(4.7±0.7 vs. 5.7±0.5)(P<0.05). Compared with the multiple vessel collateral group, both the single vessel collateral group and the no collateral group had lower overall scores(21.9±2.3 vs. 24.2±1.7, 19.0±2.4 vs. 24.2±1.7), executive/visuospatial function(3.2±0.8 vs. 3.9±0.7, 2.4±0.6 vs. 3.9±0.7), subtraction and attention(4.6±0.6 vs. 5.1±0.5, 4.3±0.7 vs. 5.1±0.5)(all P<0.05); the no collateral group had lower scores in abstraction(1.3±0.5 vs. 1.7±0.5), delayed recall(1.6±0.5 vs. 2.9±0.8)and orientation(4.7±0.7 vs. 5.7±0.5)(all P<0.05). Compared with the single vessel collateral group, the no collateral group had lower overall scores(19.0±2.4 vs. 21.9±2.3), executive/visuospatial function(2.4±0.6 vs. 3.2±0.8)and orientation(4.7±0.7 vs. 5.7±0.6)(all P<0.05). In single vessel collateral patients, the AcoA subgroup had higher MoCA scores than the PcoA subgroup(22.9±1.7 vs. 21.2±2.7)(P<0.05), and the AcoA subgroup had higher scores in delayed recall than the OA subgroup(2.2±0.8 vs. 1.7±0.6)(P<0.05). Conclusions Severe unilateral stenosis or unilateral occlusion in the internal carotid artery can result in cognitive impairment, especially in executive/visuospatial function, abstraction, delayed recall, subtraction and attention.However, collateral circulation can protect cognitive function in patients with unilateral internal carotid artery stenosis or occlusion and multiple vessel collateral circulation is more effective than single vessel collateral circulation, and AcoA is more effective than either PcoA or OA, but the difference between PcoA and OA is not significant. Key words: Transcranial Doppler; Internal carotid artery; Severe stenosis or occlusion; Collateral circulation; Cognitive function

Multivariate analysis of short-term prognostic factors in recanalization therapy for acute cerebral ischemia

Objective To analyze the clinical characteristics and short-term prognostic factors in acute cerebral infarction patients who underwent recanalization. Methods This retrospective study enrolled 94 cases of acute cerebral ischemic patients in the First Affiliated Hospital of Nanjing Medical University between October 2014 and August 2016. Based on the clinical characteristics of the enrolled patients, a multivariate Logistic regression model was established to analyze the risk factors of unfavorable prognosis. Besides, patients were further divided into good collateral circulation group (1-2) and poor collateral circulation group (3-5) according to the Pial Collateral score, and the prognosis improvement rates between patients recanalized within 4 h and over 4 h were analyzed in each group. Chi-square test or Fisher’s exact test was used to analyze statistical difference as indicated. Results By multivariate Logistic regression analysis, age older than 70 years old (OR=2.651, 95%CI: 1.013-6.937) and poor collateral circulation (OR=3.160, 95%CI: 1.113-8.977) were independent risk factors of short-term poor prognosis. In the poor collateral circulation subgroup, patients recanalized within 4 h exerted a relatively better prognosis than patients recanalized over 4 h (42.9% vs.10.5%, P=0.047). However, the effect of recanalization duration on the prognosis in the good collateral circulation subgroups was not statistically significant (42.9% vs. 10.5%, P=0.047), however, the effect of recanalization duration on prognosis in patients with good collateral circulation was not statistically significant (58.3% vs. 37.8%, P=0.117). Conclusions For patients with acute cerebral infarction, age and collateral circulation status may influence the prognosis of recanalization therapy. The treatment time had a significant influence on the prognosis in patients with poor collateral, while it had minimal significance on patients with good collateral. Key words: Retrospective research; Cerebral infarction; Vascular recanalization; Prognosis; Influencing factor; Logistic regression model; National Institute of Health Stroke Scale; Collateral circulation

Serum Sphingosine 1 Phosphate Levels in Patients with and without Coronary Collateral Circulation.

Sphingosine 1 phosphate, an active sphingolipid metabolite, functions in both healthy and diseased cardiovascular systems. It has been reported to play a role in angiogenesis and arteriogenesis in various tissues, which are the proposed mechanisms for the development of coronary collateral circulation. To the best of our knowledge, no data exist regarding serum sphingosine 1 phosphate levels and the presence of coronary collateral circulation in the literature. Thus this study aimed to investigate serum sphingosine 1 phosphate levels in patients with and without coronary collateral circulation. A total of 140 patients were included (70 with coronary collateral circulation and 70 with normal coronary arteries and stable coronary artery disease without collaterals). Rentrop collateral grade and the number of coronary arteries with collateral circulation were recorded. Serum sphingosine 1 phosphate levels were higher in the collateral group than in the control group [186.6 (142.3-243.5) μg/l vs. 128.5 (105.0-161.6) μg/l, p < 0.001]. Multivariate logistic regression analysis revealed that the presence of multivessel disease, high serum sphingosine 1 phosphate levels and previous history of P2Y12 use were independent predictors of coronary collateral circulation. Median sphingosine 1 phosphate levels in different Rentrop grades in the collateral group were similar, and there was no significant difference in median serum sphingosine 1 phosphate level with a higher number of coronary arteries with collateral circulation. Our findings demonstrated higher levels of sphingosine 1 phosphate in the patients with coronary collateral circulation.

Determinants of defaulting by collateral lending groups in microfinancing: A probit regression approach

Orientation: Despite the use of group lending, microfinance institutions (MFIs) are still faced with the risk of default by borrowers and the absence of physical collateral means that there is no recourse to borrower assets for repayment. It is therefore imperative to understand characteristics of loan default as a means to reduce possible erosion of the capital base of MFIs.Research purpose: The study identified determinants of loan default for collateral lending groups in microfinancing.Motivation for the study: Default on loans, which can be caused by characteristics of the lending groups themselves, has the undesirable effect of eroding the capital base of MFIs and threatening their continued existence. This study aims to identify those characteristics of loan default which could erode the capital base of MFIs.Research design, approach and methods: The study used the probit regression model to identify characteristics of loan default by collateral lending groups in microfinance in order to assist MFIs with insights regarding which factors to eliminate and which to enhance in the design of the groups to which they lend.Main findings: The key findings of the study indicate that probability of default decreases with larger groups, more female borrowers in a group and larger borrower savings. The results also indicate that probability of default increases with larger loan amounts and with borrowers who have more business experience.Practical and managerial implications: Microfinance institutions should consider having a feeder programme where borrowers whose businesses have become successful and larger can be passed on to bigger commercial banks instead of continuing to borrow from the MFIs as part of a group lending scheme.

Doppler ultrasound follow-up of middle hepatic vein tributaries-interposition vessel graft in recipients of living donor liver transplantation using modified right lobe grafts.

To investigate the value of Doppler ultrasound (US) in recipients of living donor liver transplantation (LDLT) using modified right-lobe grafts (mRLGs) with obstruction of the middle hepatic vein tributaries (MHVTs)-interposition vessel graft (IVG). This study included 240 consecutive LDLT recipients in whom 564 MHVTs (>5 mm) were reconstructed using IVG. Regular follow-up Doppler US was performed to assess the patency of the MHVTs-IVG and, if there was an obstruction, to evaluate for the establishment of collateral drainage. MHVTs with obstruction were subdivided into those with and without intrahepatic veno-venous collaterals on Doppler US and were correlated with CT scans. MHVTs-IVG obstruction was identified in 137 patients with 227 MHVTs on follow-up Doppler US (6.2 ± 4.7 months). 90 patients with 149 MHVTs in whom the time interval between Doppler US and contrast-enhanced dynamic CT scans was<1 week were classified into either collateral (68 patients with 121 MHVTs) or non-collateral (22 patients with 28 MHVTs) groups. The presence of intrahepatic veno-venous collaterals on Doppler US were significantly related to no remarkable hepatic venous congestion on CT by both per-patient and per-vein analyses (66 of 68 patients (97.1%) and 118 of 121 MHVTs (97.5%), p < 0.001 andp < 0.001, respectively). On Doppler US follow-up of LDLT recipients using mRLGs, identification of intrahepatic veno-venous collaterals associated with obstruction of MHVTs-IVG suggests no remarkable hepatic venous congestion. Advances in knowledge: When an obstruction of a MHVTs-IVG is encountered on Doppler US follow-up of LDLT recipients using mRLGs, no further evaluation with CT is warranted if intrahepatic veno-venous collaterals are observed on Doppler US, as this finding suggests no remarkable hepatic congestion.

Collateral status affects the onset-to-reperfusion time window for good outcome

ObjectiveTo characterise the time window in which endovascular thrombectomy (EVT) is associated with good outcome, and to test the differential relationship between functional outcome and onset-to-reperfusion time (ORT), depending on...

Relationship between the maximum carotid plaque area and the severity of coronary atherosclerosis.

Carotid artery plaque is associated with coronary artery disease (CAD). Besides the presence of plaque, plaque characteristics is also related to the severity of CAD. So the characteristic difference of carotid plaque may affect this assessment role. However, it is unclear whether the maximum carotid plaque area can reflect the extents and severity of CAD. We enrolled 388 consecutive CAD patients and 45 controls, and 204 patients were studied after excluding 184 patients without carotid plaque or coronary angiogram. Carotid intima media thickness and carotid plaque were measured by carotid ultrasound. Coronary angiography was applied and Gensini score was calculated. Blood lipid and other parameters were also detected. The total and right maximum carotid plaque area were greater in high Gensini Score group than those in low and moderate score groups (both P<0.05) and multivessel disease patients possessed the highest maximum plaque area. The total and right maximum carotid plaque area were also higher in collateral circulation group than those in non-collateral group (P=0.036 and 0.002 respectively). Multivariate logistic regression showed that Gensini score (OR=2.458, 95% CI=1.111 to 5.439, P=0.027) was associated with increased total maximum carotid plaque area. The optimal cut-off value for predicting the severity of CAD was 46.75 mm2 for total maximum plaque area. The maximum carotid plaque area can reflect the clinical severity of CAD, and it can be used as a simple noninvasive indicator of severity of coronary atherosclerosis.

Three-Year Clinical Results of Carotid Artery Stenting in Treating Patients with Contralateral Carotid Artery Occlusion

Patients presenting a carotid stenosis and contralateral carotid occlusion (CCO) have been historically considered at high risk of carotid surgical treatment, and there are few data regarding short-term recovery after stenting therapy in patients with CCO. The aim of this study is to evaluate the short-term recovery and safety of stenting for patients with CCO and different subgroup population. We retrospectively reviewed the records of consecutive patients with CCO who were treated with stenting endovascular methods between 2008 and 2014. The postoperative outcomes were analyzed according to age, ischemic symptom, cerebral infarction history, and collateral situation subgroups, respectively. Fifty-eight consecutive patients with CCO were treated and 49 (84.5%) completed a 3-year follow-up. There were significant higher stroke, myocardial infarction, or death events in the aged (≥75 years old) group and poor collateral group (P = .007 and .0024, respectively). There was no difference in the 3-year primary endpoint incidence between the cerebral ischemia symptom subgroups and cerebral infarction history subgroups. Event-free survival, aged group, and poor collateral group were lower (P = .007 and P = .0024, respectively). Carotid artery stenting (CAS) for patients with common carotid artery is a safe and effective therapy. Factors such as age 75 years or older and poor collateral are associated with a higher 3-year rate of postprocedural stroke, myocardial infarction and death, and lower event-free survival in patients with CCO treated by CAS. Meanwhile, our data do not show a significant impact of cerebral ischemic symptom and cerebral infarction history on clinical outcome of patients with CCO undergoing CAS.