Computed Tomography Angiography Findings Research Articles

Clinical impacts of CT-derived fractional flow reserve under insurance reimbursement: Results from multicenter, prospective registry

BackgroundAlthough computed tomography-derived fractional flow reserve (FFRCT) has been reimbursed in a few countries, its impacts on daily practice of coronary artery diseases are not fully elucidated. We evaluated the clinical impacts of FFRCT under the real Japanese insurance reimbursement. MethodsIn the multicenter prospective registry: DYNAMIC-FFRCT study, a total of 410 patients who underwent FFRCT analysis under reimbursement were prospectively enrolled at 6 Japanese sites from October 2019 to November 2021. Coronary CT angiography and FFRCT findings, treatment plans, and 90-day outcomes were recorded. The primary endpoint was the redirection rate from the tests that might be expected without FFRCT [invasive coronary angiography (ICA)-selected group, myocardial perfusion single photon emission CT (MPS)-selected group, optimal medical therapy (OMT)-selected group, and others-selected group] to those that were actually performed based on FFRCT. ResultsICA could be avoided in 39.5 % in the ICA-selected group (N = 233). In particular, in 94.3 % of patients with an FFRCT value of >0.80, additional examinations, such as ICA, were avoided. In addition, in the MPS-selected group (N = 133), 92.6 % had no additional tests with FFRCT > 0.80, while only 2 cases with FFRCT ≤ 0.80 underwent additional MPS examination. On the contrary, 33.3 % of the OMT-selected group (N = 33) had FFRCT ≤ 0.80. Approximately, 35 % medical cost reduction was also finally expected. ConclusionIntroduction of FFRCT could not only reduce unnecessary ICA and be a test that replaces the conventional non-invasive functional assessment modality but also result in medical cost reduction even when used under real Japanese insurance reimbursement.

Pre-operative Imaging of Critical Coarctation of the Aorta: Impact on Surgical Approach and Outcomes.

Computed tomographic angiography (CTA) has been increasingly used for the evaluation of infants with aortic arch hypoplasia and coarctation of the aorta. The goals of this study were to compare echocardiographic and CTA findings in critical coarctation of the aorta, to evaluate each modality's influence on surgical approach for repair and determine if pre-operative measurements or surgical approach are associated with residual lesions/re-interventions. This was a single-center retrospective cohort study that included 85 neonates and infants who underwent repair of coarctation/arch hypoplasia by three months of age. Two groups were compared: patients with pre-operative echocardiograms only and patients with both echocardiogram and CTA evaluations. 44 (52%) patients received an echocardiogram and CTA, and 41 (48%) patients received an echocardiogram only. Patients in the CTA + echo group had smaller mitral valve and ascending aorta measurements (p = 0.01). When comparing CTA to echocardiogram measurements, the aortic valve annulus, ascending aorta, proximal and distal transverse arch, and isthmus were smaller on echo (p < 0.01). A smaller aortic valve annulus and aortic root as well as thoracotomy approach were associated with residual gradients/re-intervention (p < 0.01). Our study found that patients who underwent CTA preoperatively had smaller left-sided structures. Aortic measurements were smaller on echocardiogram when compared to CTA. Smaller left-sided structures proximal to the aortic arch and thoracotomy predicted the development of residual lesions/re-intervention. CTA is useful in the surgical planning for neonates with arch hypoplasia/coarctation and may help risk stratify for residual lesions/re-intervention.

Morphometry of the Middle Cerebral Arteries: A Radio-Anatomical Study Based on Computed Tomography Angiography Findings

Morphometry of the Middle Cerebral Arteries: A Radio-Anatomical Study Based on Computed Tomography Angiography Findings

CT angiography of non-aortic thoracic arterial trauma.

While aortic injury is the most commonly cited thoracic arterial injury, non-aortic arterial injuries represent an uncommon but significant source of morbidity and mortality in blunt and penetrating thoracic trauma patients. Knowledge of the spectrum of vascular injury and anatomic considerations that dictate patterns of associated thoracic hemorrhage will assist the radiologist in the accurate and efficient diagnosis of these injuries. This article provides a review of anatomy, pertinent clinical exam and CT angiography findings, as well as therapeutic options for non-aortic thoracic arterial trauma.

Vascular imaging immediately after tourniquet removal does not increase vasospasm risk

BackgroundPrehospital tourniquet use is now standard in trauma patients with diagnosed or suspected extremity vascular injuries. Tourniquet-related vasospasm is an understudied phenomenon that may confound management by causing erroneous arterial pressure indices (APIs) and abnormalities on computed tomography angiography (CTA) that do not reflect true arterial injuries. We hypothesized that shorter intervals between tourniquet removal and CTA imaging and longer total tourniquet times would be correlated with a higher likelihood of false positive CTA. Materials and MethodsWe performed a single-institution retrospective cohort study of patients presenting to a busy, urban Level 1 Trauma Center with prehospital tourniquets from 2019 to 2021. Patients who presented with a tourniquet disengaged upon arrival or who died prior to admission to the Trauma Unit were excluded. Tourniquet duration, time between tourniquet removal and CTA imaging (CTA interval), CTA findings, and management of extremity arterial injuries were extracted. The proportion of false positive injuries on CTA was assessed for correlation with increasing time interval from tourniquet removal to CTA imaging and correlation with increasing total tourniquet time using multivariable logistic regression. Results251 patients were identified with prehospital tourniquets. 127 underwent CTA of the affected extremity, 96 patients had an abnormal CTA finding, and 57 (45% of total CTA patients) had false positive arterial injuries on imaging. Using multivariable logistic regression, neither the CTA interval nor the tourniquet duration was associated with false positive CTA injuries. Female sex was associated with false positive injuries on CTA (OR 2.91, 95% CI: 1.01 – 8.39). Vasospasm was cited as a possible explanation by radiologists in 40% of false positive CTA reports. ConclusionsArterial vasospasm is a frequent finding on CTA after tourniquet use for extremity trauma, but concerns regarding tourniquet-related vasospasm should not alter trauma patient management. Neither the duration of tourniquet application nor the time interval since removal is associated with decreased CTA accuracy, and any delay in imaging does not appear to reduce the likelihood of vasospasm. These findings are important for supporting expedited care of trauma patients with severe extremity injuries.

Diagnostic Value of Computed Tomography Angiography in Suspected Acute Ischemic Stroke Patients With Respect to National Institutes of Health Stroke Scale Score.

Noncontrast computed tomography (NCCT) plus computed tomography angiography (CTA) is the standard imaging modality for acute stroke. We investigated whether there is an additional diagnostic value of supra-aortic CTA in relation to National Institutes of Health Stroke Scale (NIHSS) and resultant effective radiation dose. In this observational study, 788 patients with suspected acute stroke were included and divided into 3 NIHSS groups: group 1, NIHSS 0-2; group 2, NIHSS 3-5; and group 3, NIHSS ≥ 6.Computed tomography scans were assessed for findings of acute ischemic stroke and vascular pathologies in 3 regions. Final diagnosis was obtained from medical records. Effective radiation dose was calculated based on the dose-length product. Seven hundred forty-one patients were included. Group 1 had 484 patients, group 2 had 127 patients, and group 3 had 130 patients. Computed tomography diagnosis of acute ischemic stroke was made in 76 patients. In 37 patients, a diagnosis of acute stroke was made based on pathologic CTA findings in case of an unremarkable NCCT. Stroke occurrence was the lowest in groups 1 and 2, with 3.6% and 6.3%, respectively, compared with 12.7% in group 3. If both NCCT and CTA were positive, the patient was discharged with a stroke diagnosis. Male sex had the highest effect on the final stroke diagnosis. The mean effective radiation dose was 2.6 mSv. In female patients with NIHSS 0-2, additional CTA rarely contains relevant additional findings decisive for treatment decisions or overall patient outcomes; therefore, CTA in this patient group might yield less impactful findings, and the applied radiation dose could be lowered by approximately 35%.

COMPARATIVE ANALYSIS OF THE FINDINGS OF CT ANGIOGRAPHY AND ECHOCARDIOGRAPHY IN AORTIC ARCH ANOMALIES

The retrospective study was conducted in the Department of Cardiology Nishtar Medical Hospital Multan from January 2021 to January 2022 to compare CT angiography and echocardiography findings in patients with aortic arch abnormalities. The study was conducted on a total of 200 patients. Patient data was recorded, including demographic details and CT angiographic and echocardiographic findings. Results showed that Anomalies of coarctation of the aorta (COA) were most commonly reported. The most common anomalies associated with aortic arch anomaly included patent ductus arteriosus (PDA), patent ductus arteriosus (PDA), and ventricular septal defect (VSD). Of 200 patients, 66 (33%) had normal CT results, while 64 (32%) had normal transthoracic ECG results. For aortic arch anomalies, the specificity and sensitivity of TEC were 100% and 58%, and the agreement between CT angiography and TEC was .72 (Kappa coefficient). For COA, the specificity and sensitivity of TEC were 100% and 90%, and agreement in both modalities was 0.93. Transthoracic echocardiography was unable to detect congenital anomalies in a few cases. CT angiography provides better imaging quality and anatomical coverage and can be used to improve diagnostic accuracy.

Vascular anatomical study of persistent descending mesocolon in patients undergoing laparoscopic surgery for colorectal cancer.

Persistent descending mesocolon (PDM) is a rare congenital atypia of fixation of the descending colon, and currently, very few detailed studies exist on its vascular anatomy. This study was conducted to evaluate the features of the vascular anatomy of PDM to help avoid intraoperative lethal injury and subsequent postoperative complications in laparoscopic colorectal surgery. We retrospectively analyzed the data of 534 patients who underwent laparoscopic left-sided colorectal surgery. PDM was diagnosed using preoperative axial computed tomography (CT) view. The vascular anatomical features were compared between PDM and non-PDM cases based on three-dimensional (3D)-CT angiography findings. Additionally, the perioperative short-term outcomes of laparoscopic surgery in the 534 patients were also compared between PDM and non-PDM cases. Of the total 534 patients, 13 patients (2.4%) presented with PDM. No branching pattern of the inferior mesenteric artery (IMA) specific to PDM was found. In the running direction of the IMA and sigmoidal colic artery (SA), the midline-shift of IMA and the right-shift of SA were significantly more in PDM than in non-PDM cases, respectively (38.5% vs. 2.5%, P ≤ .0001; 61.5% vs. 4.6%, P ≤ .0001). The perioperative short-term outcomes of laparoscopic surgery in the 534 patients were similar between PDM and non-PDM cases. Because changes in the direction of the vascular running are often observed due to adhesions and shortening of the mesentery in PDM cases, performing a detailed preoperative evaluation of vascular anatomy using imaging modalities such as 3D-CT angiography is important.

Association of intravascular enhancement sign detected on high-resolution vessel wall imaging with ischaemic events in middle cerebral artery occlusion

PurposePatients with intracranial artery occlusion have high rates of ischaemic events and recurrence. Early identification of patients with high-risk factors is therefore beneficial for prevention. Here we assessed the association between the intravascular enhancement sign (IVES) on high-resolution vessel wall imaging (HR-VWI) and acute ischaemic stroke (AIS) in a population with middle cerebral artery (MCA) occlusion. MethodWe retrospectively analysed the records of 106 patients with 111 MCA occlusions, including 60 with and 51 without AIS, who had undergone HR-VWI and computed tomography angiography (CTA) examinations from November 2016 to February 2023. Numbers of IVES vessels were counted and compared to the CTA findings. Statistical analyses of demographic and medical data were also performed. ResultsOccurrence rates and numbers of IVES vessels were significantly higher in the AIS than the non-AIS group (P < 0.05), and most vessels were detected on CTA. Numbers of vessels positively correlated with AIS occurrence (rho = 0.664; P < 0.0001). A multivariable ordinal logistic regression model adjusted for age, degree of wall enhancement, hypertension, and heart status identified the number of IVES vessels as an independent predictor for AIS (odds ratio = 1.6; 95% CI, 1.3–1.9; P < 0.0001). ConclusionNumber of IVES vessels is an independent risk factor for AIS events, and may represent poor cerebral blood flow status and collateral compensation level. It thus provides cerebral haemodynamic information for patients with MCA occlusion for clinical use.

3D convolutional neural networks for detecting intracranial aneurysms on brachiocephalic arteries CTA scans

Background: Computed tomography angiography (CTA) is the primary and minimally invasive imaging modality currently used for diagnosis and monitoring of intracranial aneurysms as well as preoperative planning of their treatment. However, its interpretation is time-consuming even for specially trained neuroradiologists. Nowadays little is known whether trained neural networks contribute to analyzing medical images and reduce the time to diagnosis, and how effective they are in detecting intracranial aneurysms according to the CTA findings.Objective: To assess the diagnostic value of a convolutional neural network prototype in the intracranial aneurysm detection according to the brachiocephalic arteries CTA findings.Materials and methods: We analyzed the 3D convolutional neural network prototype based at Kuban State University (Krasnodar, Russian Federation).This prototype was to determine the probability of intracranial aneurysms according to the brachiocephalic arteries CTA findings, obtained in the Radiology Department of Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1. The study included 451 CTA scans of 205 patients with confirmed intracranial aneurysms and 246 patients without aneurysms.Results: The sensitivity of the 3D convolutional neural network prototype in the aneurysms detection according to the brachiocephalic arteries CTA findings was 85.1%, the specificity was 95.1%, and the overall accuracy was 91%.Conclusions: The 3D convolutional systems may predict aneurysms with a high accuracy as well as localize them with an accuracy of more than 90%. Such results require a larger dataset.

Evaluating Types of TAPVR on Echocardiography and CT Angiography in Paediatric Patients Admitted in Tertiary Care Hospital: A Comparative Study

Objective: To evaluate the types of TAPVR on Echocardiography and CT Angiography in Paediatric Patients Study design: A comparative study Place and Duration: Pediatric cardiology department and CT Angiography department of the National Institute of Cardiovascular Diseases (NICVD) Karachi from January 2019 to December 2021 Methodology: Patients who have TAPVR confirmed by CT angiography and detected by echocardiography were included in the research. Cases having anomalies in the systemic veins were eliminated. Demographic variables (age, gender, weight, etc.), echocardiographic results (such as type of TAPVR, obstructive and non-obstructive), and CT angiography findings were collected for the study using a preset structured proforma. We evaluated the diagnostic disparity between the two modalities. Results: In the present study there were 107 patients, 67.3% were male gender, 56.1% with age less than 6 months, the median age was 6 months, median weight was 4.5 kg. On echocardiography, there were 83.2% non-obstructive, 47.7% supracardiac and 36.4% cardiac TAPVR. On CT angiography, there were 66.4% were non-obstructive, 53.3% supracardiac and 23.4% cardiac TAPVR. Of the associated cardiac diseases, in common 86.9% were found with atrial septal defect, 13.1% were persistent left superior vena cava, 12.1% were patent ductus arteriosus, 8.4% were a ventricular septal defect, 6.5% were of pulmonary atresia, and 3.7% were complete endocardial cushion defect. Conclusion: As compared to echocardiography, CT angiography is more reliable for the detection of obstructive and mixed types of TAPVR. Detection of the supracardiac type of TAPVR is also almost the same as on echocardiography and CT angiography. As compared to CT angiography, echocardiography over diagnoses the non-obstructive type of TAPVR. CT angiogram is also useful in detecting other associated lesions such as heterotaxy, abnormal coronaries, presence of bilateral superior vena cava and coronary sinus. Keywords: TAVPR, echocardiography, CT angiography, cardiac disorders

Characteristic CT angiography findings and clinical value of catheter-related central venous thrombosis in hemodialysis patients with end-stage renal disease.

Central catheter-related thrombosis (CRT) is the most common catheter-related complication in patients with end-stage renal disease (ESRD) but is often underappreciated and misdiagnosed by radiologist. To find the computed tomography angiography (CTA) characteristics of central CRT, then raise the diagnosis of this disorder. A total of 301 eligible patients with ESRD who experienced both chest multi-phase multidetector CTA (MDCTA) and digital subtraction angiography were enrolled in the final analysis. The location, shape, and related signs of the central CRT in MDCTA images were evaluated. Independent-samples T test, chi-square test, and binary logistic regression were analyzed using SPSS software. In total, 166 patients were found to have CRT using MDCTA, and this was verified by DSA. Central CRT was usually irregular in the superior vena cava segment, and the angle of the contact area between central CRT and catheter was <180° (all P < 0.05). Age, collateral circulation, and venous stenosis were shown to have significant differences when compared to patients without CRT (all P < 0.05), but there were no significant differences about the sex or catheter insertion site. In addition, age and collateral circulation were the factors found to be significantly associated with thrombosis (P < 0.05). In particular, the thrombosis was 2.213 times more likely to be found in those patients with collateral circulation (odds ratio = 2.213, 95% confidence interval = 1.236-3.961). Chest multi-phase MDCTA can effectively reduce the missed diagnosis and misdiagnosis of central CRT. It is worth paying more attention to the central CRT especially when the collateral circulation is observed.

Pulmonary circulation abnormalities in post-acute COVID-19 syndrome: dual-energy CT angiographic findings in 79 patients.

To evaluate the frequency and pattern of pulmonary vascular abnormalities in the year following COVID-19. The study population included 79 patients remaining symptomatic more than 6months after hospitalization for SARS-CoV-2 pneumonia who had been evaluated with dual-energy CT angiography. Morphologic images showed CT features of (a) acute (2/79; 2.5%) and focal chronic (4/79; 5%) PE; and (b) residual post COVID-19 lung infiltration (67/79; 85%). Lung perfusion was abnormal in 69 patients (87.4%). Perfusion abnormalities included (a) perfusion defects of 3 types: patchy defects (n = 60; 76%); areas of non-systematized hypoperfusion (n = 27; 34.2%); and/or PE-type defects (n = 14; 17.7%) seen with (2/14) and without (12/14) endoluminal filling defects; and (b) areas of increased perfusion in 59 patients (74.9%), superimposed on ground-glass opacities (58/59) and vascular tree-in-bud (5/59). PFTs were available in 10 patients with normal perfusion and in 55 patients with abnormal perfusion. The mean values of functional variables did not differ between the two subgroups with a trend toward lower DLCO in patients with abnormal perfusion (74.8 ± 16.7% vs 85.0 ± 8.1). Delayed follow-up showed CT features of acute and chronic PE but also two types of perfusion abnormalities suggestive of persistent hypercoagulability as well as unresolved/sequelae of microangiopathy. Despite dramatic resolution of lung abnormalities seen during the acute phase of the disease, acute pulmonary embolism and alterations at the level of lung microcirculation can be identified in patients remaining symptomatic in the year following COVID-19. • This study demonstrates newly developed proximal acute PE/thrombosis in the year following SARS-CoV-2 pneumonia. • Dual-energy CT lung perfusion identified perfusion defects and areas of increased iodine uptake abnormalities, suggestive of unresolved damage to lung microcirculation. • This study suggests a complementarity between HRCT and spectral imaging for proper understanding of post COVID-19 lung sequelae.

Incidence of vascular lesions associated with disruption of the bile duct secondary to cholecystectomy.

One of the most serious complications of cholecystectomy is bile duct disruption, which can be associated with concomitant vascular injury in up to 3.4%. The incidence, demographic characteristics and treatment are underreported worldwide. To determine the incidence of vascular lesions in patients with a diagnosis of bile duct disruption secondary to cholecystectomy from January 1, 2015 to December 31, 2019, confirmed by preoperative CT angiography or intraoperative findings. Retrospective, observational and analytical study of a series of cases between 2015 and 2019. Where a total of 144 cases of bile duct disruption were found, 15 cases (10%) with concomitant vascular injury. The most frequent vascular injury was of the right hepatic artery in 13 patients (87%). The level of biliary disruption most frequently associated was Strasberg E3 and E4 in 5 patients (36%), respectively. The treatment of vascular injury was ligation of the injured vessel in 11 patients (73%). The treatment established for the repair of biliary disruption was the hepatic jejunum anastomosis in 14 patients (93%). The presence of injury at the level of the right hepatic artery is the most frequent and its ligation did not show a significant impact on biliodigestive reconstruction, as long as an adequate technique is performed (Hepp-Couinaud).

Coronary Computed Tomography Angiography Findings of Plaque Erosion

Compared with plaque rupture, plaque erosion has distinct features, which can be diagnosed only by intravascular optical coherence tomography. Computed tomography angiography (CTA) features of plaque erosion have not been reported. The aim of the present study was to identify the CTA features specific for plaque erosion in patients with non-ST-segment elevation acute coronary syndromes to enable a diagnosis of erosion without invasive procedures. Patients with non-ST-segment elevation acute coronary syndromes who underwent preintervention CTA and optical coherence tomography imaging of culprit lesions were enrolled. Plaque volume and high-risk plaque (HRP) features were assessed by CTA. Among 191 patients, plaque erosion was the underlying mechanism in 89 patients (46.6%) and plaque rupture in 102 patients (53.4%). The total plaque volume (TPV) was lower in plaque erosion than in plaque rupture (133.6 vs 168.8mm3, p=0.001). Plaque erosion had a lower prevalence of positive remodeling than plaque rupture (75.3% vs 87.3%, p=0.033). As the number of HRP features decreased, plaque erosion became more prevalent (p=0.014). In the multivariable logistic regression analysis, lower TPV and less prevalent HRP features were associated with a higher prevalence of plaque erosion. The addition of TPV ≤116mm3 and HRP features ≤1 to the known predictors significantly increased the area under the curve of the plaque erosion prediction receiver operator characteristics. Plaque erosion, compared with plaque rupture, had a lower plaque volume and less prevalent HRP features. CTA may be helpful for identifying the underlying pathology of acute coronary syndromes.

Auditing the Findings of Computed Tomographic Angiographic Examinations Using 160-Slice Scanner: Analysis of 5-Year Experiences from Northwestern Nigeria.

Computed tomographic angiography (CTA) is a promising tool for the rapid characterisation of the anatomy and structural lesions of the vascular system. The aims/objectives of the study were to determine the frequency and pattern of vascular lesions in northern Nigeria. We also set to determine the agreement between clinical and CTA diagnosis of vascular lesions. We study patients that had CTA studies over a 5-year period. In total, 361 patients were referred for CTA, but only the records of 339 of them were retrieved and analysed. The information about patients' characteristics, clinical diagnosis, and the findings on CTA was also retrieved and analysed. The categorical data results were expressed as proportions and percentages. The Cohen's kappa coefficient (κ statistic) was used to determine the agreement between the clinical and CTA findings. A P value of <0.05 was considered statistically significant. The mean (standard deviation) age of the subjects was 49.3 (17.9) years with a range of 1-88 years, consisting of 138 (40.7%) females. Up to 223 patients had various abnormalities on CTA. There were 27 (8.0%) cases of aneurysms, eight (2.4%) cases of arteriovenous malformations, and 99 (29.2%) cases of stenotic atherosclerotic disease. There was a significant agreement between the clinical diagnosis and corresponding findings on CTA showed for intracranial aneurysms (k = 15.0%; P < 0.001), for pulmonary thromboembolism (k = 4.3%; P < 0.001), and for coronary artery disease (k = 34.5%; P < 0.001). The study found that close to 70% of the patients referred for CTA have abnormal findings, out of which stenotic atherosclerosis and aneurysm are the common findings. Our findings highlighted the diagnostic value of CTA variety of clinical conditions and underscored the prevalence of many vascular lesions in our environment, which hitherto were regarded as uncommon.

Use of Computed Tomography and Magnetic Resonance Angiograms Combined with a 3D Surgical Guide in an Elderly Cat with an Occipital Lobe Meningioma

We present a case of occipital lobe meningioma resection in an elderly cat. The surgery was performed with the goal of avoiding major bleeding. An 11-year-old castrated indoor-only male Persian Chinchilla (5.5 kg) was presented with a month-long history of progressive tetraparesis for a left occipital lobe meningioma. Magnetic resonance imaging revealed a T2-weighted heterogeneously hyperintensity and a T1-weighted well-contrast enhancing extradural mass in the left occipital lobe of the brain. Cerebral angiographic data were obtained using magnetic resonance (MRA) and computed tomography angiography (CTA). Advanced angiograms and virtual reconstruction of images revealed that the tumor was surrounded by the caudal parasagittal meningeal vein. A left caudal rostrotentorial craniotomy and en bloc resection of the tumor were performed, and histopathology revealed a meningioma. Complete neurological recovery was achieved within 10 days after surgery. To the best of our knowledge, this is the first case report describing CTA and MRA findings and favorable clinical outcomes after surgical management of a brain meningioma without severe perioperative complications.

Incidental Computed Tomography Angiography Finding of a Delayed Asymptomatic Ascending Aortic Dissection after Transcatheter Aortic Value Implantation: a Case Report

Incidental Computed Tomography Angiography Finding of a Delayed Asymptomatic Ascending Aortic Dissection after Transcatheter Aortic Value Implantation: a Case Report

Five-Year Outcomes of the Bioresorbable Peripheral Remedy Stent in the Treatment of Iliac Artery Disease

PurposeTo evaluate the 5-year performance of a bioresorbable vascular scaffold, the Remedy stent, for the treatment of iliac artery atherosclerotic disease. Materials and MethodsThis prospective, multicenter, single-arm clinical study evaluated 97 patients (97 lesions) with symptomatic TransAtlantic Inter-Society Consensus II A/B iliac artery lesions for 5 years after stent placement. The primary efficacy end point was 12-month primary patency compared with the prespecified standard derived from historical data with metallic stents, and the primary safety end point was the occurrence of major adverse clinical events within 5 years. All angiographic and computed tomography angiographic findings were evaluated by an independent core laboratory for quantitative vessel analysis. ResultsThe 12-month primary patency rate was 88.6% (95% CI, 80.1%–94.4%), which was lower than the prespecified standard. No significant difference was noted between the diameter stenosis at 9 and 12 months. There were no device- or procedure-related deaths, major amputation, or distal embolization during the follow-up period. The ankle-brachial index maintained significant improvement through the 5-year period compared with that at baseline. The Kaplan–Meier estimates of freedom from target lesion revascularization (TLR), major adverse cardiovascular events, and major adverse cardiovascular and limb events were 95.8%, 91.7%, and 87.5% at 12 months and 85.4%, 72.1%, and 62.5% at 5 years, respectively. ConclusionsThe 5-year follow-up outcomes, including freedom from TLR, of the Remedy stent in iliac artery lesions were satisfactory, with a good safety profile. Nevertheless, the 12-month primary patency did not meet the expected standard compared with that of contemporary metallic stents.

The Incidence of Cardiovascular Events in Small Versus Large Ischemic Stroke; A Three-Year Cohort Study.

Cerebral ischemia and coronary artery disease (CAD), the major leading causes of mortality and morbidity worldwide, are pathophysiologically interrelated. Cerebral ischemic events are categorized as large or small vessels disease. The current study compares the factors related to CAD events incidence following ischemic large versus small disease CVA. The current cohort study was conducted on 225 patients with ischemic stroke in two groups of large (n=75) and small (n=150) vessel disease during 2018-19. The patients' demographic, medical, and clinical characteristics were recruited. They were followed for three years regarding the incidence of CAD events, including ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), unstable angina (UA), and sudden cardiac death (SCD). Data about the coronary angiography, computed tomography angiography (CTA), Single Photon Emission Computed Tomography (SPECT), and the therapeutic approach were gathered. There were insignificant differences between the patients with small versus large vessels CVA in terms of ACS incidence (P-value=0.105), type of the events (P-value=0.836), angiographic (P-value=0.671), SPECT (P-value=0.99) and CTA findings (P-value>0.99) and approached CAD (P-value=0.728). Cox regression assessments revealed an increased risk of CAD events due to large versus small vessels disease after adjustments for hypertension, diabetes mellitus, dyslipidemia, re-stroke, and the previous history of IHD (HR=2.005, 95%CI: 1.093-2.988, P-value=0.021). According to the findings of this study, large-vessel involvement in an ischemic stroke was associated with more than a two-fold increase in the three-year probability of ischemic heart disease incidencet.