Contralateral Artery Research Articles

Aberrant right subclavian artery with right type 1 proatlantal artery and segmental dysplasia of the right internal carotid artery: a case report

We present a case of an aberrant right subclavian artery (ARSA) with extremely rare vascular anomalies. A 69-year-old woman was suspected to have right internal carotid artery (ICA) stenosis. Computed tomography angiography demonstrated an ARSA and hypoplasia of the right ICA. The proximal segment of the right vertebral artery (VA) was aplasia, and a right type 1 proatlantal artery (PA) arose from the right common carotid artery. Cerebral angiography demonstrated segmental dysplasia of the right ICA. The ascending intrapetrous segment and the ascendingforamen lacerum-horizontal intracavernous segment of the right ICA demonstrated hypoplasia. The collateral pathways promoted reconstitution of each of the distal segments. Left internal carotid angiography demonstrated anterior communicating artery aneurysm and sufficient cross flow to the contralateral middle cerebral artery via the AcomA. A type 1 PA with an ARSA may result in the regression of the right dorsal aorta with persistence of the first cervical intersegmental artery. Although there are few findings of a relationship between an ARSA and intracranial artery anomalies, a developmental error of the right dorsal aorta may cause such complex vascular anomalies. Knowledge of anatomical variations in patients with ARSA is useful when performing angiography or endovascular therapy, as well as during clinical follow-up.

Accuracy and Potential Benefit of Ultraselective Invasive Coronary Angiography Guided by Computed Tomographic Coronary Angiography.

It is unknown whether computed tomographic coronary angiography (CTCA) can be used to perform ultraselective invasive coronary angiography (ICA) by only visualizing the abnormal coronary artery on CTCA and defer visualization of the normal contralateral coronary artery. This study assessed the accuracy of CTCA in patients with coronary artery disease (CAD) on CTCA limited to either the left (LCA) or right coronary artery (RCA) in predicting a contralateral coronary artery without abnormalities on CTCA determined to be normal by ICA. This retrospective analysis included patients with CAD limited to the LCA or RCA on CTCA. Primary endpoint was the accuracy of CTCA to predict a contralateral coronary artery without abnormalities on CTCA to be normal by ICA. Secondary endpoints were potential reductions in procedure time and radiation exposure if an ultraselective ICA approach would be used compared to standard ICA. In total, 202 patients were included. CTCA was correct in predicting a normal contralateral coronary artery in 201 of the 202 patients (99.5%). Deferring ICA of the normal contralateral coronary artery on CTCA resulted in a potential reduction in procedure time and dose area product of 4.22 ± 2.67 minutes (61 ± 16% reduction) and 1501 ± 1304 mGy•cm² (29 ± 13% reduction). In this retrospective study, CTCA was extremely accurate in predicting a normal contralateral coronary artery in patients with LCA- or RCA-limited CAD on CTCA. A potential CTCA-guided ultraselective ICA approach was feasible and would have led to a considerable decrease in procedure time and radiation exposure.

Transarterial Embolization of Ethmoidal Dural Arteriovenous Fistula: 2-Dimensional Video.

Cranial dural arteriovenous fistulae (dAVF) are rare cerebrovascular lesions characterized by direct arteriovenous shunting within the dural leaflets, with stark heterogeneity in angioarchitecture among different patients.1,2 It is, therefore, crucial to personalize treatment strategies to unique patients and their specific lesion. The authors describe an ethmoidal dAVF in an elderly female patient with arterial supply from the ophthalmic arteries and the contralateral middle meningeal artery. This, together with recent advances in microcatheter technology and the controllability of modern liquid embolic agents, opened up a route for transarterial embolization, obviating the need to course through the ophthalmic artery or the need for open surgery.3 Onyx is Food and Drug Administration-approved for treatment of arteriovenous malformations and can be used off-label for treatment of dAVF, as described here. This video demonstrates the technical nuances and safety considerations of transarterial liquid embolization through the middle meningeal artery while providing an overview of alternative treatment approaches for ethmoidal dAVFs. The patient consented to the procedure.

Outcomes of Mobilization of Patients on Veno-Arterial Extracorporeal Membrane Oxygenation

<h3>Purpose</h3> Weakness and deconditioning are common findings in those with critical illness. Mobilization is associated with improved outcomes.VA-ECMO is the highest level of mechanical circulatory support (MCS) offered with bypass of the heart and lungs. Mortality is approximately 60% for those on VA-ECMO support. This retrospective study aims to present characteristics and outcomes associated with mobilization on VA-ECMO. <h3>Methods</h3> Patients were identified at our quarternary care system. Seventy-five consecutive were cannulated with VA-ECMO support for cardiogenic shock over a three year period. Seven patients were mobilized while on VA-ECMO. Baseline characteristics, fraility, ICU Mobility scales, and standard outcomes as defined by the Extracorporeal Life Support Organization were obtained. <h3>Results</h3> The mobilized group was younger (39.7 ± 17.7 years vs 55.3 ± 14.6 years; p = 0.010) and were more likely to have normal body mass index (22.4 ± 5.1 kg/m² vs 28.2 ± 6.5; p = 0.025). All patients mobilized were male (100% vs 70.5%). Mobilized patients had support cannulas placed in the femoral position with 6/7 (85.7%) having ipsilateral venous and femoral access. Five (71.4%) patients had percutaneous devices placed in the contralateral femoral artery or left axillary artery. Five (71.4%) patients were cannulated peripherally. All patients mobilized on VA-ECMO survived to discharge while 29.4% of patients not mobilized survived to discharge (p = 0.008). Vascular complications between mobilized (0%) and non-mobilized patients (7; 10.9%) were non-significant (p = 0.584). <h3>Conclusion</h3> Patients mobilized on VA-ECMO are more likely to survive than those who were not mobilized. Complex patients with the presence of MCS devices can be mobilized. Thorough multidisciplinary planning must be taken to ensure that access sites are secure and patients that are appropriate for extubation are extubated in a timely manner while on VA-ECMO. Thought should be given to cannulation location and insertion depth and how this will affect a patient ability to mobilize. Patients with VA-ECMO as a bridge to transplant may introduce selection bias and may skew safety profiles. Ultimately, this study is limited in its single center, retrospective nature, but further prospective trials should be utilized to help identify appropriate candidates for mobilization while on VA-ECMO support for cardiogenic shock.

TCTAP C-148 The Masquerading Pickering; In-stent Restenosis of Renal Artery Stenting With Contralateral Renal Artery Stenosis Presenting With Flash Acute Pulmonary Edema

TCTAP C-148 The Masquerading Pickering; In-stent Restenosis of Renal Artery Stenting With Contralateral Renal Artery Stenosis Presenting With Flash Acute Pulmonary Edema

Parallel Cross-Leg Free Flap with Posterior Tibial Artery Perforator Pedicle Propeller Cable Bridge Flap for the Treatment of Lower Extremity Wounds: A Case Series Report

Background A cross-leg flap can be used to treat severely injured lower limbs but associated with complications. Herein, we describe a technique of a parallel cross-leg free flap combined with posterior tibial artery perforator pedicle propeller cable bridge flap for the treatment of lower extremity wounds. Methods The artery and veins of the free flap are anastomosed to the contralateral posterior tibial artery and vein, respectively. The vascular pedicle is wrapped with a posterior tibial artery perforator pedicle propeller flap. The legs are allowed to remain in a straight, relaxed position which is maintained with a bandage or Kirschner wire placed at the distal limbs. Pedicle division is performed around 21 days after flap creation, and the posterior artery is re-anastomosed and pedicled flap returned to its original position. Results From June 2017 to March 2020, 7 patients with lower extremity wounds and tissue loss received reconstruction with this method. The recipient vessels for all flaps were the posterior tibial artery and vein. The average operation time was 5 hours. The average time to ambulation was 4 weeks, and the average follow-up time was 13.7 months. All flaps survived, and limb salvage was successful in all patients. Patients were not uncomfortable with the limbs held in position until pedicle division, and there were no complications. At the final follow-up, the function of all limbs was normal, and the esthetic appearance was acceptable to all patients. Conclusions The method described overcomes the disadvantages of traditional cross-leg flaps for the treatment.

Two cases of combined anatomical variations: maxillofacial trunk, vertebral, posterior communicating and anterior cerebral atresia, linguofacial and labiomental trunks.

Commonly, arterial anatomic variants are reported as single entities. However, different such variants can occur in a single patient. During a retrospective study of computed tomography angiograms of 52 adult patients, 2 cases were found with unilateral maxillofacial trunks. In each case different other anatomic variants were documented. The maxillofacial trunk in the first case was associated with bilateral posterior kinks of the internal carotid artery which passed beyond the transverse processes of the atlas vertebra and indented and displaced the internal jugular veins. Common carotid origins of the superior thyroid arteries were found, as well as a high origin of the contralateral facial artery. In the second case a plethora of variants were associated with a unilateral maxillofacial trunk: 1) direct occipital-vertebral arterial anastomosis; 2) ipsilateral atresia of the distal vertebral artery and of the A1 segment of the anterior cerebral artery; 3) bilateral atresia of posterior communicating arteries; 4) linguofacial and labiomental trunks; 5) terminal trifurcation of the external carotid artery. The arterial anatomical variants of the head and neck should be carefully documented prior to specific surgical and interventional procedures, as well as for understanding the compensatory anatomical pathways of circulatory insufficiencies.

Carotid artery endarterectomy in patients with symptomatic non-stenotic carotid artery disease

ObjectWe sought to determine the safety and efficacy in secondary stroke prevention of carotid endarterectomy (CEA) in patients with symptomatic non-stenotic carotid artery disease (SyNC).MethodsThis was a single-centre retrospective case...

Successful Revascularization of Left Traumatic Subclavian Artery Transection from Contralateral Thoracoacromial Artery.

Successful Revascularization of Left Traumatic Subclavian Artery Transection from Contralateral Thoracoacromial Artery.

Transcriptomic Analysis Identifies Differentially Expressed Genes Associated with Vascular Cuffing and Chronic Inflammation Mediating Early Thrombosis in Arteriovenous Fistula.

Arteriovenous fistula (AVF) is vascular access created for hemodialysis in end-stage renal disease patients. AVF creation causes increased blood flow in the outflow vein with increased pressure. Increased blood flow, blood volume, and shear stress causes outward remodeling so that the outflow vein can withstand the increased pressure. Outward remodeling of the vein involved in AVF is necessary for AVF maturation, however, inward remodeling due to excessive neointimal hyperplasia (NIH) and chronic inflammation may end up with vessel thrombosis and AVF maturation failure. Early thrombosis of the vessel may be due to the luminal factors including NIH and chronic inflammation or due to chronic inflammation of the adventitial due to perivascular cuffing. Inflammation may either be due to an immune response to the vascular injury during AVF creation or injury to the surrounding muscles and fascia. Several studies have discussed the role of inflammation in vascular thrombosis due to intimal injury during AVF creation, but there is limited information on the role of inflammation due to surrounding factors like a muscle injury. The concept of perivascular cuffing has been reported in the nervous system, but there is no study of perivascular cuffing in AVF early thrombosis. We performed the bulk RNA sequencing of the femoral arterial tissue and contralateral arteries as we found thrombosed arteries after AVF creation. RNA sequencing revealed several significantly differentially expressed genes (DEGs) related to chronic inflammation and perivascular cuffing, including tripartite motif-containing protein 55 (TRIM55). Additionally, DEGs like myoblast determination protein 1 (MYOD1) increased after muscle injury and relates to skeletal muscle differentiation, and network analysis revealed regulation of various genes regulating inflammation via MYOD1. The findings of this study revealed multiple genes with increased expression in the AVF femoral artery and may provide potential therapeutic targets or biomarkers of early thrombosis in AVF maturation failure. Thus, not only the luminal factors but also the surrounding factors mediating vascular cuffing contribute to vessel thrombosis and AVF failure via early thrombosis, and targeting the key regulatory factors may have therapeutic potential.

Abstract WMP91: Angiographic Predictors Of Balloon Test Occlusion Outcomes

Introduction: Balloon test occlusion (BTO) with adjunctive single-photon emission computed tomography (SPECT) has been utilized to predict clinical tolerance after permanent internal carotid artery (ICA) occlusion. Cerebrovascular anatomical characteristics might predict BTO outcomes and identify patients susceptible to test failure. Methods: We performed a single center retrospective study of patients who underwent catheter based cerebral angiogram and ICA BTO from July 2013 to June 2020. SPECT imaging was completed in all the patients who passed the clinical BTO; technetium 99m-ethyl cysteinate dimer was injected intravenously after 15-30 min of occlusion and induced hypotension. The diameter of each of the vessels of the Circle of Willis was measured angiographically. The severity of hypoperfusion on SPECT imaging was classified as none, mild, low intermediate, high intermediate, and severe. Results: A total of 57 patients underwent BTO; neoplasia was the most common indication (n=43, 75%). Twelve patients (21.1%) developed neurologic symptoms and clinically failed the BTO; 45 patients (78.9%) passed and proceeded to SPECT. Contralateral dominant vertebral artery (p=0.02), smaller ACom (p=0.002) and ipsilateral PCom (p=0.03) diameters were correlated with clinical BTO failure. Smaller ACom was most predictive with an AUC of 0.907. The Youden index identified an ACom diameter threshold of 1.1 mm, which demonstrated a sensitivity of 91.7% and specificity of 77.8% (OR 0.026, 95% CI 0.003 - 0.226, ROC=0.847) for the prediction of BTO failure. Patients with severe SPECT asymmetry had significantly smaller caliber ACom arteries (ACom median diameter 0.95 mm vs. rest of cohort median 1.4; p=0.0073). Conclusions: BTO outcomes may be predicted using angiographic findings. A small (&lt;1.1 mm) anterior communicating artery, and, less significantly, a small ipsilateral posterior communicating artery can be used to identify patients who are likely to fail BTO.

Late Access Site Complications Following Transfemoral Aortic Valve Implantation

Few data exist on late vascular complications (VCs) after transfemoral (TF) transcatheter aortic valve implantation (TAVI). The objective of this study was to evaluate the incidence and predictors of late access site VC after TF TAVI. A total of 128 patients (mean age: 80 ± 8 years, women: 52%) who underwent TF TAVI without major VC were included. A femoral US-Doppler evaluation was performed in all patients at a median of 5 (3 to 15) months after the procedure, and 76 patients (59.4%) also had a preprocedural ultrasound (US)-Doppler examination. The impact of baseline and procedural factors (including the use of simple 2 Proglides or complex additional Proglide or Angioseal device on top of the 2 Proglide technique, hemostasis techniques, and the use of balloon dilation for optimizing femoral hemostasis) were evaluated. The follow-up US-Doppler evaluation detected 2 asymptomatic VCs (1.6%), and 5 (3.9%) patients exhibited significant femoral stenosis (peak systolic velocity [PSV] ≥300 cm/s). Female gender (p <0.001) and smaller femoral diameter (p=0.045) were associated with higher femoral PSV values. In those patients who underwent a pre-TAVI femoral US-Doppler, the median PSV values after TAVI were higher compared with those obtained pre-TAVI (p <0.001), but similar results were found for the contralateral femoral arteries. A complex hemostasis technique or the use of balloon optimization at the puncture site was not associated with any increase in PSV values. In conclusion, percutaneous femoral hemostasis after TAVI was associated with a low rate of late VC. The results were similar irrespective of the hemostasis technique and the use of balloon dilation at the puncture site, but women and a smaller femoral size were associated with increased PSV values. Further studies are needed to determine the optimal femoral hemostasis technique in TAVI procedures.

Establishment of Standard Human Blood Vessel Model Based on Image Registration and Fitting Technology

PurposeThe blood vessel gives key information for pathological changes in a variety of diseases. In view of the crucial role of blood vessel structure, the present study aims to establish a digital human blood vessel standard model for diagnosing blood vessel-related diseases.MethodsThe present study recruited eight healthy volunteers, and reconstructed their bilateral upper extremity arteries according to CTA. The reconstructed vessels were segmented, registered, and merged into a bunch. After being cut by continuous cut planes, the dispersion of the blood vessel bunches on each cut plane were calculated.ResultsThe results demonstrated that the middle segment of the brachial artery, the proximal segment of the ulnar artery, and the middle and distal segments of the radial artery had a low degree of dispersion. A standard blood vessel model was finally established by the integral method using the low-dispersion segments above. The accuracy of the standard blood vessel model was also verified by an actual contralateral vessel, which revealed that the deviation between the model and the actual normal contralateral brachial artery was relatively small.ConclusionThe structure of the model was highly accordant with the real ones, which can be of great help in evaluating the blood vessel changes in blood vessel-related diseases, bone and soft-tissue tumors, and creating accurate surgical plans.

Association of symptomatic atherosclerotic carotid arteries with plaque areas showing low densities on computed tomographic angiography

Intraplaque hemorrhage is a key feature of vulnerable carotid atherosclerotic plaque (CAP), associated with low densities (<25 Hounsfield units [HU]) on computed tomographic angiography (CTA). This study aimed to analyze CAP on routine CTA performed in patients with symptomatic and asymptomatic carotid stenosis undergoing carotid endarterectomy (CEA) by assessing HU of the CAP area showing the lowest density (CAPALD) using radiological tools available in daily clinical practice, and to compare CAPALD values between symptomatic and asymptomatic carotids. We retrospectively screened preoperative CTA scans of 206 consecutive adult patients undergoing CEA for symptomatic or asymptomatic stenosis. CAPALD values were compared between symptomatic and asymptomatic carotids. Asymptomatic carotids included arteries contralateral to the symptomatic CEA artery, and asymptomatic stenotic arteries undergoing CEA and their contralateral arteries. Carotids were excluded when there was <30% stenosis, or when CAP could not be identified or CAPALD could not be measured. In total, 95 symptomatic and 112 asymptomatic carotids (derived from 174 patients) were analyzed. In multivariate analysis, symptomatic arteries showed more severe stenosis (median 70% vs. 67%, p=0.0228) and lower CAPALD values (median 17 vs. 25 HU, p=0.049), whereas degree of stenosis and CAPALD values were not correlated (rho=-0.02, p=0.77). HU values of <25 were more frequent in symptomatic than asymptomatic carotids (68% vs. 47%, p=0.0022). On CTA, symptomatic carotids are associated with CAP areas with low densities. CTA analysis of CAP may be interesting to help identify vulnerable plaques at risk for future stroke, especially in patients lacking strict indications for CEA based on the current guidelines.

Bilateral mechanical thrombectomy for internal carotid artery occlusion and contralateral middle cerebral artery occlusion during transvenous thrombolysis: Case report

【緒言】両側中大脳動脈（MCA）の急性閉塞症は稀で，予後は悪い．両側MCA急性閉塞症に対し両側の血栓回収術を施行した症例を報告する．【症例】87歳，男性．初診時 JCS II-10，重度左片麻痺，NIHSS 29点で，MRAで右内頚動脈と右MCAの閉塞を認めたが，左MCAは開通していた．アルテプラーゼ静注療法後，突然に昏睡，四肢麻痺となり，呼吸状態が悪化した．血管撮影で両側MCA閉塞を認め，左右両側で順に機械的血栓回収術を行い，完全再開通が得られた．救命し得たが，全介助で転院となった．【結語】両側MCA閉塞症に対し機械的血栓回収術が有用な可能性がある．

A Case of Occlusion of the Contralateral Posterior Cerebral Artery Caused by the Migration of Onyx during Embolization of Cerebral Arteriovenous Malformation and Successful Recanalization Therapy Using a Stent Retriever

A Case of Occlusion of the Contralateral Posterior Cerebral Artery Caused by the Migration of Onyx during Embolization of Cerebral Arteriovenous Malformation and Successful Recanalization Therapy Using a Stent Retriever

Antegrade revascularization of long-segment femoropopliteal chronic total occlusion

Although revascularization of a femoropopliteal (CTO) always remains challenging through a retrograde or contralateral crossover approach, we report a case of successful revascularization of a long-segment femoropopliteal CTO through antegrade femoral puncture which stands as the crux of the procedure. In routine peripheral intervention, long-segment femoropopliteal occlusion is usually approached from a contralateral femoral artery or ipsilateral brachial artery, antegrade revascularization of femoropopliteal CTO is not adapted by many in routine practice. Here, we describe the technique and the tips and tricks of antegrade puncture of common femoral artery. We will also discuss the literature review of antegrade technique versus retrograde and crossover technique for revascularization of femoropopliteal CTO which may be useful for budding young interventionists. Our case carries another important learning point about management of popliteal disease where revascularization with a stent is of concern due to high knee joint mobility.

Rhino-Orbital-Cerebral Mucormycosis Presenting as Cavernous Sinus Thrombosis with Ocular Ischemic Syndrome and Contralateral Central Retinal Artery Occlusion: A Case Report

Rhino-Orbital-Cerebral Mucormycosis Presenting as Cavernous Sinus Thrombosis with Ocular Ischemic Syndrome and Contralateral Central Retinal Artery Occlusion: A Case Report

Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization.

Chronic subdural hematoma (CSDH) is one of the most commonly encountered neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a technique for the management of CSDH that has elicited promising results. Despite the encouraging results of MMAE, recurrence does occur. One uncommon mechanism for recurrence of CSDH is by means of neovascularization of the contralateral middle meningeal artery (MMA). We describe two cases of CSDH recurrence by means of contralateral middle meningeal artery neovascularization treated with contralateral MMAE. We identified two cases of recurrent subdural hematoma secondary to neovascularization following treatment with contralateral MMAE. Two patients initially treated with MMAE were identified with CSDH recurrence secondary to contralateral MMA neovascularization. There was no traumatic or coagulopathic contribution to CSDH recurrence. In both cases, patients underwent contralateral MMAE. Both patients were neurologically intact with radiographic improvement of CSDH at follow up. Re-accumulation of SDH following MMAE by means of contralateral MMA neovascularization is a rare subtype of subdural hematoma (SDH) recurrence following MMAE. Within the context of re-accumulation of SDH following MMAE, catheter angiography is an important diagnostic investigation to elucidate the etiology of the recurrence. Furthermore, when angiography reveals neovascularization of the contralateral MMA, embolization of the contralateral MMA achieves good clinical and radiographic result.

Validation of oscillometric blood pressure measurement using a Datex S/5 Compact multiparameter monitor in anaesthetized adult dogs

ObjectiveTo compare noninvasive (NIBP) with invasive blood pressure (IBP) measurements from a Datex S/5 Compact monitor in anaesthetized adult dogs, and to evaluate it according to the American College of Veterinary Internal Medicine (ACVIM) and the Association for the Advancement of Medical Instrumentation (AAMI) criteria. Study designProspective clinical study. AnimalsA group of 34 client-owned adult dogs. MethodsDogs were anaesthetized for different surgical procedures using different anaesthetic protocols. IBP was measured using a catheter placed in a dorsal pedal artery. A blood pressure cuff was placed over the contralateral dorsal pedal artery for NIBP measurement. Data were recorded using the Datex iCollect program, and paired readings were matched every 3 minutes for 60 minutes. Bland-Altman and error grid analyses were used to estimate the agreement between IBP and NIBP measurements, and its clinical significance, respectively. Data were reported as mean bias [lower, upper limits of agreement (LoA)]. ResultsThe Datex S/5 monitor conformed to most ACVIM criteria. The correlation coefficient was less than 0.9 for systolic, diastolic, and mean arterial pressures (MAP). The best agreement between the noninvasive and invasive methods was observed for MAP, with LoA (–17 to 13 mmHg) and higher percentage of NIBP readings within 5 (55.6%), 10 (81.7%) and 20 (98.6%) mmHg of the IBP values. The Datex S/5 NIBP technology did not meet the AAMI validation criteria and less than 95% of the paired measurements were found within the green zone of the error grid analysis. Conclusions and clinical relevanceThe Datex S/5 monitor conformed to most ACVIM criteria but not with the more rigorous AAMI standards. Despite good agreement between IBP and NIBP for MAP measurements, care must be taken when using this device to guide therapeutic interventions of blood pressure in anaesthetized healthy adult dogs.