Contralateral Vessels Research Articles

Phase-Contrast Magnetic Resonance Imaging Analysis of Cerebral Hyperperfusion Syndrome After Surgery in Adult Patients with Moyamoya Disease

To investigate potential risk factors for cerebral hyperperfusion syndrome (CHS) after surgery in patients with moyamoya disease (MMD) using phase-contrast magnetic resonance imaging (MRI). The study included 84 adult patients (89brain hemispheres) with MMD who underwent surgery. Preoperative phase-contrast MRI scans were performed for all patients. Peak velocity, average velocity, average flow, forward volume, and region of interest area of the bilateral internal and external carotid arteries, superficial temporal artery, and vertebral artery were calculated and analyzed. Patients were divided into CHS and non-CHS groups. Patients' age, sex, clinical symptoms, Suzuki stage, and MRI flow examination results were compared between the 2groups. Nineteen of 84 patients (89 hemispheres) with MMD were in the CHS group. Patients with ischemic onset symptoms were more likely to develop CHS after surgery (P< 0.05). There were no significant differences in age, sex, and Suzuki stage between the 2 groups. For surgery ipsilateral vessels, peak velocity, average flow and forward volume of superficial temporal artery and average flow of external carotid artery and region of interest area of internal carotid artery in the CHS group were significantly lower compared with the non-CHS group (P < 0.05). For surgery contralateral vessels, forward volume of superficial temporal artery and external carotid artery in the CHS group was significantly lower compared with the non-CHS group (P < 0.05). Patients with MMD and ischemic onset symptoms are more likely to develop CHS after surgery. Preoperative phase-contrast MRI analysis may be helpful to predict CHS in patients with MMD after surgery.

Free latissimus dorsi musculocutaneous flap for external hemipelvectomy reconstruction.

External hemipelvectomy is one of the most extensive surgical procedures for locally advanced pelvic tumors. Stump coverage with the local tissues can be difficult in recurrent cases. Herein, we report our experience with immediate stump coverage using a free latissimus dorsi musculocutaneous (LDMC) flap after external hemipelvectomy for recurrent pelvic malignancies. Six patients underwent external hemipelvectomy and immediate reconstruction using a free LDMC flap between November 2012 and June 2017. The mean age of the patients was 65 years (range: 63-69 years). The primary tumors were myxoid liposarcoma, chondrosarcoma, osteosarcoma, squamous cell carcinoma, and pleomorphic liposarcoma. A free LDMC flap was harvested from the ipsilateral back and transferred to the defect. When an intercostal nerve was found at the recipient site, the thoracodorsal nerve was coaptated with the intercostal nerve to reinnervate the muscle. The mean flap size was 23 × 10 cm and the range was 20 × 8-27 × 13.5 cm. The contralateral deep inferior epigastric vessels were used as recipient vessels in all patients. Thoracodorsal-intercostal nerve coaptation was performed in 2 patients. The flap survived in all patients. Three patients had complications of abscess formation. No patient developed postoperative hernia. Although it is challenging to do reconstruction after external hemipelvectomy, a free LDMC flap has several advantages, including a large coverage area, stability of circulation, ease of elevation, and preservation of the strength of the remaining abdominal wall. Technical tips for selecting anastomosis vessels are important and nerve coaptation could be effective.

Computational Fluid Dynamics as an Indicator of Offending Vessel in Trigeminal Neuralgia and Hemifacial Spasms

Abstract Context: Newer Imaging tool for diagnosing offending vessel in trigeminal neuralgia (TN) and Hemifacial spasms (HFS). Aim: To find out if Computational FluidDynamics (CFD) can correctly predict the offending vessel in HFS and TN &amp; thus improving the outcome of Microvascular Decompression) MVD. Settings and Design: CFD is a relatively new mode of imaging. Its application to indicate offending vessel in TN &amp; HFS was tested. Materials &amp; Methods: Retrospectively we studied 13 consecutive patients operated in 2017 for either HFS or TN. Preoperatively MRI &amp; Computed Tomography Angiogram (CTA) were done and the offending vessel identified along with its point of contact with the concerned nerve. CFD was done using Hemoscope 2015 software and wall pressure, wall shear stress, vector &amp; streamline flow were obtained in the offending vessel (test) &amp; contralateral vessel (control). Results of these were charted on an excel sheet &amp; results analyzed. The postoperativeoutcome were assessed and compared with CFD results. Statistical analysis used: Small study group hence statistical analysis couldn’t be applied. Results: Of the 13 patients, offending artery had high wall pressure in 12 and increased wall shear stress innine. Among the controls six had high wall pressure and only two had high wall shear stress. Conclusion: CFD can be used to determine offending vessel and can predict good outcome following microvascular decompression.

The End-to-Side Anastomosis: A Comparative Analysis of Arterial Models in the Rat

The end-to-side anastomosis is 1 of the most common anastomosis configurations used in cerebrovascular surgery. Although several living practice models have been proposed for this technique, few involve purely arterial vessels. The purpose of the present study was to compare 2 arterial models using common carotid arteries (CCAs) and common iliac arteries (CIAs) in rats. The CIAs and CCAs were exposed in 10 anesthetized rats, and their lengths and diameters were measured. Also, the mobilization extent of each vessel along its contralateral counterpart was measured after each artery had been transected at its proximal exposure point. We also studied the technical advantages and disadvantages of each model for practicing end-to-side anastomosis. The average diameters of the CCA and CIA were 1.1 and 1.3 mm, respectively. The average extent of mobilization along the contralateral vessel was 13.9 mm and 10.3 mm for CCA and CIA, respectively. The CCA model had the advantages of greater arterial redundancy (allowing completion of both suture lines extraluminally) and a minimal risk of venous injury. The main disadvantage of the CCA model was the risk of cerebral ischemia. The CIA model was not limited by the ischemic time and provided the technical challenge of microsurgical dissection of the common iliac vein from the CIA, although it had limited CIA redundancy. Both CCA and CIA models could be efficiently used for practicing the end-to-side anastomosis technique. Each model provides the trainee with a specific set of advantages and disadvantages that could help with the optimal selection of the practice model according to trainee's skill level.

Near-Infrared Fluorescence Imaging of Matrix Metalloproteinase 2 Activity as a Biomarker of Vascular Remodeling in Hemodialysis Access

PurposeTo establish the capability of near-infrared fluorescence (NIRF) imaging for the detection of matrix metalloproteinase 2 (MMP-2) activity as a biomarker of vascular remodeling (VR) in arteriovenous fistulae (AVFs) in vivo. Materials and MethodsAVFs were created in the right groins of Wistar rats (n = 10), and sham procedures were performed in the contralateral groins. Fistulography via a left common carotid artery approach confirmed stenosis (> 50%) in a subset of animals (n = 5) 4 weeks after AVF creation. After administration of MMP-2–activated NIRF probe, near-infrared imaging was performed in vivo and ex vivo of both the AVF and the sham-treated vessels to measure radiant efficiency of MMP-2–activated NIRF signal over background. Histologic analyses of AVF and sham-treated vessels were performed to measure VR defined as inward growth of the vessel caused by intimal thickening. ResultsAVFs demonstrated a significantly higher percentage increase in radiant efficiency over background compared with sham vessels (45.5 ± 56% vs 16.1 ± 17.8%; P = .008). VR in AVFs was associated with increased thickness of neointima staining positively for MMP-2 (161.8 ± 45.5 μm vs 73.2 ± 36.7 μm; P = .01). A significant correlation was observed between MMP-2 activity as measured by relative increase in radiant efficiency for AVFs and thickness of neointima staining positively for MMP-2 (P = .039). ConclusionsNIRF imaging can detect increased MMP activity in remodeled AVFs compared with contralateral sham vessels. MMP-2–activated NIRF signal correlates with the severity of intimal thickening. These findings suggest NIRF imaging of MMP-2 may be used as a biomarker of the vascular remodeling underlying stenosis.

Abstract No. 437 How much do fibers on embolic coils improve embolization efficiency?

Pushable embolic coils are manufactured in numerous styles and configurations. Fibered embolic coils remain the traditional mainstay in coil design. Yet, the impact of these fibers on embolization coils and how these fibers improve embolization are not well validated or studied. We aim to test the impact of these fibers utilizing the same detachable coil, with and without fibers using an animal swine model. Standard commercially available 0.035’ fibered coils were used; we specially acquired the same coils with the fibers removed. Occlusion efficiency was assessed by the number of coils used, unit length of coils, and the amount of time required for complete embolization. A total of 2 swine were used via a transfemoral approach. A total of 12 artery sites were embolized; matched 6 paired and similarly sized arteries (subclavian, inferior renal and internal femoral arteries). Each was subselected and embolized utilizing the same embolization protocol via a 5F JB1 catheter. Embolization was performed with detachable fibered coil on one side, and identical yet unfibered coil on the contralateral vessel. Standard clinical embolization practice and flow scoring (TIMI grading) was employed throughout. Average vessel size was similar for the fibered side (mean, 4.46 mm; range, 3.49-6.93 mm) vs non-fibered (mean, 4.74 mm; range, 3.33-66.9 mm). Average occlusion time was lowest for fibered coils with a mean time 7.16 min. vs 17.16 min in unfibered coils. Unit length coil used to achieve complete embolization was significantly less in fibered coil with a mean length of 28.3 cm (total, 170 cm) vs the unfibered which had a mean length of 60 cm (total, 360 cm). Fibered coils have a substantially improved embolization efficiency over those without fiber in the same coil design as measured by embolization time, number of coils used, and unit length of coil used in an animal model. These fibers directly reduce embolization time and number of coils required for complete embolization, which may translate into a reduction in procedure times and costs.

A volumetric intracoronary ultrasonographic study of coronary bifurcation lesions.

To evaluate the plaque distribution and composition pattern in the left main coronary artery (LMCA) disease using intracoronary ultrasound. Intravascular ultrasound data of 50 patients from the January 2010 to December 2015 with significant LMCA bifurcation lesions, with angiographic diameter stenosis >50%, and requiring revascularization, were evaluated. Plaque burden and percentage of necrotic core (% NC) at the minimal lumen area site and maximal % NC site were measured in different segments. The segments that were included in the study are as follows: segment 1: proximal LMCA, segment 2: left anterior descending (LAD) ostium, segment 3: left circumflex branch (LCX) ostium, segment 4: proximal LAD, segment 5: proximal LCX. According to its relationship with the bifurcation ridge, the blood vessel wall was divided into the contralateral bifurcation ridge blood vessel wall and bifurcation ridge blood vessel wall. Plaque burden results showed that the plaque eccentricity index of segment 2 and segment 3 was significantly higher than that of the other segments at sites of the minimal lumen area and maximal % NC with a statistically significant difference (p<0.05). Plaque eccentricity index of contralateral bifurcation ridge was significantly higher than that of the bifurcation ridge, and the difference was statistically significant (p<0.05). Analysis of plaque composition showed the fibrous tissue percentage of segment 2 and segment 3 was significantly higher than the other segments that at the sites of minimal lumen area and the maximal % NC site. The fibrous percentage of the contralateral bifurcation ridge was significantly lower than that of the bifurcation ridge. Intravascular ultrasound is an effective way for detecting the distribution and composition of the atherosclerotic plaque at the left main coronary artery bifurcation and is of great significance to adjuvant interventional therapy.

Reconstruction of full‐thickness cheek defect with chimeric facial artery free flap: A case report

Full-thickness cheek defects represent a difficult challenge for reconstructive surgeons. Multiple techniques have been described, including local, regional, and free flaps. In this report, the reconstruction of a through and through left cheek defect, resulting from a self-inflicted gunshot injury, with a chimeric facial artery free flap is presented. The patient underwent reconstruction with a chimeric full-thickness facial artery free flap, with 9 × 3 cm diameter skin paddle and a 6 × 5 cm myomucosal paddle, was harvested on the contralateral cheek with a 7-cm length of facial pedicle. The flap was transferred via a microsurgical technique and an end-to-end microsurgical anastomosis was performed between the donor and the contralateral facial vessels. The flap was transplanted successfully and there were no donor or recipient site complications with a satisfactory esthetic result 5 years after surgery. This technique may be a good reconstructive option for medium size, full-thickness, cheek defects allowing a "like with like" reconstruction with minimal donor-site morbidity.

Effect of Preconditioning and Hypothermia in Ischemia–Reperfusion Injury to the Endothelial Cells of Blood Vessels in Oryctolagus cuniculus

Introduction . Ischemia–reperfusion injury (I/RI) remain a problem in post–hypoxia period, leading to remote organ injury. Studies showed that ischemic preconditioning (IPC) and hypothermia (HI) let destructive effect of ischemia to be minimized. The aim of study was to find out the impacts of interventions such as IPC and HI on morphology and function of the endothelial distal to ligation (ischemia) and contralateral vessel (I/RI). Method . An experimental study carried out by ligation the right common femoral artery of Oryctolagus cuniculus to induce ischemia. Endothelial cells distal to ligation and contralateral side was subjected to investigation. The effect of IPC and HI were investigated and compared to those in I/RI. Results. Morphological study showed significant difference scores between endothelial damage in ipsilateral vessels in interventional subjects with control, and intervention with I/RI group (p 0.05). Conclusion . Ischemia may lead to remote endothelial dysfunction; IPC and HI showed the efficacy to minimize the impact of reperfusion, Keywords : Ischemia–reperfusion injury, ischemia–reperfusion preconditioning, hypothermia during ischemia–reperfusion injury, hypoxia, endothelial cells, malondialdehyde

Split pedicle for bilateral free deep inferior epigastric perforator flap breast reconstruction: Use of contralateral recipient vessels with radiotherapy damage

Split pedicle for bilateral free deep inferior epigastric perforator flap breast reconstruction: Use of contralateral recipient vessels with radiotherapy damage

Особливості хірургічного лікування пацієнтів із синдромом підключично-хребтового обкрадання

Мета роботи: систематизувати показання та розробити алгоритм відбору пацієнтів із синдромом підключично-хребтового обкрадання для хірургічного лікування.Матеріали і методи. Проаналізовано результати хірургічного лікування 19 хворих із синдромом підключично-хребтового обкрадання (СПХО). Всіх хворих було прооперовано тільки після вичерпаних можливостей ендоваскулярної реваскуляризації. Артеріальну реконструкцію виконували під загальним знеболюванням в умовах інтраопераційного нейромоніторингу за допомогою транскраніальної оксиметрії. При виборі артеріальної реконструкції надавали перевагу транспозиції підключичної артерії до загальної сонної артерії (9 пацієнтів, 47,4 %). Окрім транспозиції, 5 пацієнтам (26,3 %) виконували сонно-підключичне шунтування, 4 пацієнтам (21,1 %) сонно-сонне шунтування, одному пацієнту (5,3 %) протезування брахіоцефального стовбура.Результати досліджень та їх обговорення. В обстежуваній групі переважали пацієнти з І (36,8%) та ІІ (31,6%) ступенем ішемії верхньої кінцівки. До групи з І ступенем входили 4 пацієнти (21,1 %), у яких запланована імплантація стентграфту із закриттям гирла лівої ЗагСА. ІV ступінь ішемії верхньої кінцівки спостерігали у двох пацієнтів (10,5 %). У ранньому післяопераційному періоді в одного пацієнта (5,3 %) після сонно-сонного шунтування розвинувся ішемічний інсульт. Один хворий помер (5,3 %) – після сонно-сонного шунтування та імплантації стентграфту. Тактика лікування хворих із СПХО залежить не тільки від виду СПХО, стану прохідності гомо- та контрлатеральних судин, які кровопостачають головний мозок, але і від типу порушення мозкового кровообігу.

Reduced arterial elasticity due to surgical skeletonization is ameliorated by abluminal PEG hydrogel.

Arteries for bypass grafting are harvested either with neighboring tissue attached or as skeletonized vessels that are free of surrounding tissue. There are significant benefits to skeletonization, but reports suggest that skeletonized vessels may develop structural defects and are at risk for atherosclerosis. We investigated the specific short‐term effects of skeletonization on carotid artery biomechanics and microanatomy in a rabbit model. Six carotid arteries were surgically skeletonized. To support healing, three of these received polyethylene glycol hydrogel injected along their exterior surfaces. M‐mode ultrasonography was used to track circumferential cyclic strain in the skeletonized, hydrogel‐treated, and contralateral vessels. On day 21, the arteries were harvested, and vessel structure was assessed by histology, immunofluorescence microscopy, two‐photon elastin autofluorescence, and second harmonic generation (SHG) microscopy. Intimal‐medial thickness appeared unaffected by skeletonization, but the SHG signals indicated significant changes in collagen turnover in the adventitia. Skeletonized arteries also exhibited significantly decreased radial compliance (circumferential cyclic strain dropped ∼30%) and decreased numbers of elastic laminae (9.1 ± 2.0 to 2.3 ± 1.4). Hydrogel treatment protected against these effects with treated vessels maintaining normal mechanical properties. These results indicate that arterial skeletonization triggers immediate effects on vessel remodeling and reduced vessel compliance resulting in specific tissue alterations within 21 days, but that these effects can be attenuated by the placement of hydrogel on the exterior surface of the skeletonized vessel.

Lymphedema evaluation using noninvasive 3T MR lymphangiography.

To exploit the long 3.0T relaxation times and low flow velocity of lymphatic fluid to develop a noninvasive 3.0T lymphangiography sequence and evaluate its relevance in patients with lymphedema. A 3.0T turbo-spin-echo (TSE) pulse train with long echo time (TEeffective = 600 msec; shot-duration = 13.2 msec) and TSE-factor (TSE-factor = 90) was developed and signal evolution simulated. The method was evaluated in healthy adults (n = 11) and patients with unilateral breast cancer treatment-related lymphedema (BCRL; n = 25), with a subgroup (n = 5) of BCRL participants scanned before and after manual lymphatic drainage (MLD) therapy. Maximal lymphatic vessel cross-sectional area, signal-to-noise-ratio (SNR), and results from a five-point categorical scoring system were recorded. Nonparametric tests were applied to evaluate study parameter differences between controls and patients, as well as between affected and contralateral sides in patients (significance criteria: two-sided P < 0.05). Patient volunteers demonstrated larger lymphatic cross-sectional areas in the affected (arm = 12.9 ± 6.3 mm2 ; torso = 17.2 ± 15.6 mm2 ) vs. contralateral (arm = 9.4 ± 3.9 mm2 ; torso = 9.1 ± 4.6 mm2 ) side; this difference was significant both for the arm (P = 0.014) and torso (P = 0.025). Affected (arm: P = 0.010; torso: P = 0.016) but not contralateral (arm: P = 0.42; torso: P = 0.71) vessel areas were significantly elevated compared with control values. Lymphatic cross-sectional areas reduced following MLD on the affected side (pre-MLD: arm = 8.8 ± 1.8 mm2 ; torso = 31.4 ± 26.0 mm2 ; post-MLD: arm = 6.6 ± 1.8 mm2 ; torso = 23.1 ± 24.3 mm2 ). This change was significant in the torso (P = 0.036). The categorical scoring was found to be less specific for detecting lateralizing disease compared to lymphatic-vessel areas. A 3.0T lymphangiography sequence is proposed, which allows for upper extremity lymph stasis to be detected in ∼10 minutes without exogenous contrast agents. 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1349-1360.

Surgical treatment of anterior cranial fossa dural arterio-venous fistulas (DAVFs): a two-centre experience.

Anterior cranial fossa dural arterio-venous fistulas (DAVFs) represent 6% of all intracranial DAVFs; characteristically they show an aggressive behaviour with high risk of intracranial haemorrhage. Peculiar anatomical features, such as feeding by the ethmoidal arteries and the pattern of venous drainage (frequently with varices that mimic aneurysmal dilatation), can be evaluated in detail only by digital subtraction angiography (DSA), which represents the "gold standard" in the diagnosis of such cranial fistulas. Recent technological developments in endovascular management of this type of DAVF have partially reduced the morbidity risk related to this modality of treatment. Our purpose is to present our experience in the surgical management of 14 patients with anterior cranial fossa DAVFs, with attention paid to the possible role of preoperative embolisation in these cases and to the surgical technique. Between 1999 and 2015, 14 patients with anterior cranial fossa DAVFs were submitted to surgery in two neurosurgical departments; the mean age was 63years old; nine DAVFs caused intracranial haemorrhage (subarachnoid haemorrhage in three cases, intracerebral haemorrhage in six cases). Pre-operative embolisation was attempted in an early case and was successfully done in one recent case. In all patients, the surgical approach chosen was a pterional craniotomy with a low margin on the frontal bone in order to gain the exposure of the anterior cranial fossa and especially of the olphactory groove region; the resection of the falx at its insertion on the crista galli was needed in five cases in order to get access to the contralateral afferent vessels. Cauterisation of all the dural feeders on and around the lamina cribrosa was needed in all cases; venous dilatations were evident in eight patients (in seven out of nine patients with ruptured DAVF and in one out of five patients with unruptured DAVF) and were removed in all cases. One patient harboured an ophthalmic artery aneurysm, which was excluded by clipping. One patient died 5days after surgery due to the severity of the pre-operative haemorrhage. Postoperative DSA showed the disappearance of the DAVF and of the venous pseudo-aneurysms in all cases. Clinical outcome was favourable (without neurological deficits) in 11 patients; three patients presented an unfavourable clinical outcome, due to the severity of the initial haemorrhage. Surgical exclusion of the anterior cranial fossa DAVFs still represents the gold standard for such lesions, due to low post-operative morbidity and to complete protection against future rebleedings; endovascular techniques may help the surgeon in complex cases.

An anatomical study on the availability of contralateral recipient vessels in hemi-mandibular reconstruction with vascularised free fibula transfer

Background: In mandibular reconstruction with vascularised free fibula transfer, there are situations where the neck on the operated site lacks recipient vessels for vascular anastomosis due to previous radiological/surgical interventions.Methods: The present study aims to clarify the availability of neck vessels on the contralateral side in such situations. Experimental surgery was conducted on 20 fresh cadavers (six males and 14 females). After the left half of the mandible was removed, free vascularised fibula of equivalent length was transferred to fill the defect. The possibility of connecting the peroneal artery and vein to the superior thyroid artery (STA), transverse coli artery (TCA), internal jugular vein (IJV), and external jugular vein (EJV) of the contralateral side was evaluated.Results: In all samples, the peroneal vessels could reach the STA and EJV. However, the peroneal vessels could reach the TCA and IJV of the contralateral side in only 45% and 64.2% of cases, respectively. The average and standard deviation of the lengths by which vessels were insufficient were 1.1 ± 13.9 mm for IJV and 8.8 ± 24.7 mm for TCA.Conclusions: In reference to these findings, it is concluded that, in situations where neck vessels of the defect side are unavailable, availability of the superior thyroid artery and external jugular vein should be examined first. When these vessels are available as recipient vessels, direct vascular anastomosis is highly likely to be successful. In cases where these vessels are unavailable and the transverse coli artery or internal jugular vein is used as the recipient, vascular interposition might be necessary.

Hypothetical Identification of Contra Distinct Human Lung Cancer Cell Lines as Natural Targets in Translational Research

Since the lung cancer cell (LCC) has direct access to the pulmonary vein, left heart and aorta, it has an optimum opportunity for distant dispersal. However, at necropsy, there are as many as ten dispersal patterns which are anomalous in terms of the hematogenous theory of metastasis. As such anomalies may imply imperfections in current concepts, the hematogenous route deserves comparison with its lymphogenous counterpart. On investigating the entire thoracic duct panoramically and the contralateral pulmonary blood vessels selectively, it was demonstrated that LCCs are more prone to necrosis in the blood stream than in the lymph stream. Therefore, it is hypothesized as follows: (a) that LCCs possess different intrinsic or acquired attributes during their transportation in blood and lymph, (b) that LCCs harvested from blood and from lymph will yield contradistinct cell lines when cultured, and (c) that such identifiable cell lines can become natural targets in translational research.

Impact of coronary collateral circulation on angiographic in-stent restenosis in patients with stable coronary artery disease and chronic total occlusion

ObjectiveThis study aimed to evaluate the relationship between coronary collateralization and in-stent restenosis (ISR) in stable coronary artery disease patients with chronic total occlusion (CTO) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. MethodsThe degree of coronary collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded according to Rentrop classification in 216 patients with stable angina undergoing successful DES based PCI for CTO. Univariable and multivariable logistic regression analyses were performed to assess the potential factors related to angiographic ISR during follow-up. ResultsDespite similar number of diseased coronary arteries, good collateralization (Rentrop score 2 or 3) was more frequently associated with right coronary artery occlusion (60%), whereas poor collaterals (Rentrop score 0 or 1) occurred more often in left anterior descending artery occlusion (40%). Despite similar number of CTO intervened, stent length was longer in patients with good collateralization (59±27mm vs 47±23mm, p=0.001). At mean 18months, the rate of ISR did not significantly differ between patients with good collateralization and those with poor collateralization (12.7% vs 20.2%, p=0.148). At multivariable analysis, age (OR 1.058, 95%CI 1.015–1.104, p=0.008), history of diabetes mellitus (OR 2.382, 95%CI 1.109–5.116, p=0.026) and reference CTO vessel diameter (OR 0.219, 95% CI 0.051–0.951, p=0.043) were independent risk factors for ISR while Rentrop collateral grade (OR 0.795, 95% CI 0.365–1.732, p=0.414) was not associated with ISR. ConclusionsThe occurrence of ISR after successful DES based PCI for CTO may be not influenced by coronary collateralization.

Stroke prevention by endovascular treatment of carotid and vertebral artery dissections

IntroductionEndovascular intervention for cervical carotid artery dissection (CAD) and vertebral artery dissection (VAD) may be indicated in specific circumstances.ObjectiveTo review our institutional experience with endovascular treatment of cervical dissections over...

Relationship of pulsatility and resistance indices to cerebral arteriovenous malformation angioarchitectural features and hemorrhage

The role that hemodynamics plays in the pathophysiology of cerebral arteriovenous malformation (AVM) hemorrhage remains unclear. Here, we examine the relationship of pulsatility and resistance indices to AVM angioarchitectural features and hemorrhage. Records of patients with cerebral AVMs evaluated at our institution between 2007–2014 and with flows obtained before treatment using quantitative magnetic resonance angiography (QMRA) were retrospectively reviewed. Flow volume rate and flow velocity were measured in primary arterial feeders and compared to their contralateral counterparts. Pulsatility index (PI)=[(systolic flow velocity−diastolic flow velocity)/mean flow velocity] and resistance index (RI)=[(systolic flow velocity−diastolic flow velocity)/systolic flow velocity] were calculated for each feeder and compared to the normal contralateral vessel. Relationships between PI, RI and AVM clinical and angioarchitectural features were assessed using linear regression. Seventy-two patients with a total of 101 feeder arteries were included. PI and RI were significantly lower in AVM arterial feeders compared to normal vessels, thereby resulting in significantly higher flow volume rates and flow velocities in feeder vessels. There was no significant association of PI and RI with hemorrhagic presentation, exclusive deep venous drainage, venous stenosis, single draining vein, or deep location. In conclusion, PI and RI can be measured using QMRA and are lower in AVM arterial feeders compared to normal vessels. Although we found no significant correlation between PI, RI, and AVM angioarchitectural characteristics thought to be associated with increased hemorrhage risk, future studies with larger sample sizes may better elucidate this relationship.

355 Endovascular Management of Cervical Carotid and Vertebral Artery Dissection

Abstract Endovascular intervention for cervical carotid artery and vertebral artery dissections (CAD and VAD) may be indicated in specific circumstances. We reviewed a prospectively maintained database from January 1996 to January 2016 of extracranial dissections undergoing endovascular intervention. There were 116 patients, including 93 in the CAD cohort and 23 in the VAD cohort, with a mean age of 44.9 years (range 5-76) and mean postprocedure follow-up of 41.6 months (range 1-146). Interventions included stent placement (n = 104), coil occlusion of parent artery (n = 11), or stenting with contralateral vessel coil occlusion (n = 1). The 2 cohorts were well matched in age, sex, dissection etiology, and admission/follow-up modified Rankin Scale (mRS) (P = .362, .371, .175, .355, and .835, respectively). The CAD cohort was significantly more likely to undergo stent placement or have failed medical therapy (P 3) in the CAD cohort (P = .014). Six (9.0%) patients of spontaneous etiology also reported recent chiropractic manipulation. The permanent morbidity/mortality rate was 3.4%, including 2 deaths, with a stroke rate of only 0.9% over 4825 patient-years. At last follow-up, 31 of 93 (33.3%) CAD patients and 10 of 23 (43.5%) VAD patients disabled prior to intervention were nondisabled at last follow-up; no patients in either cohort were worsened. In a long-term experience, endovascular management of CAD and VAD is highly effective in specific indications, with an acceptable complication profile. CAD requiring intervention is more likely than VAD to have failed medical therapy, present with thromboembolic events and pseudoaneurysms, and undergo primary stent placement, whereas VAD is more likely to undergo treatment for traumatic occlusions with recanalization.