Cross-sectional Area Stenosis Research Articles

Value of nerve root sedimentation sign in diagnosis and surgical indication of lumbar spinal stenosis

BackgroundLumbar spinal stenosis (LSS) is a prevalent and disabling cause of low back and leg pain in elderly people and nerve root sedimentation sign (NRSS) has been demonstrated to have high sensitivity and specificity in diagnosing LSS in selected patients. The purpose of this study was to investigate the diagnosis of LSS and the predictive value of NRSS.MethodsThe clinical and imaging data of 176 patients diagnosed with LSS and 156 patients with non-specific low back pain (LBP) were analyzed retrospectively. Transverse magnetic resonance images (MRI) of the narrowest spinal canal in all patients were acquired and graded by two experienced doctors using the Braz classification, Schizas classification and Chen Jia classification. Receiver operating curve (ROC) was used to compare the diagnostic efficacy of the three classifications. Univariate and multivariate logistic regression models were established to predict the surgical indications of LSS patients.ResultThe diagnostic efficacy of Schizas classification (AUC:0.943; 95%CI:0.918,0.969) and Chen Jia classification (AUC:0.942; 95%CI:0.918,0.966) was significantly higher than that of Braz classification (AUC:0.853; 95%CI:0.808,0.898). Chen Jia classification had the highest correlation with the degree of dural sac cross-sectional area (DCSA) stenosis. In the multivariate analysis of LSS surgical indications, Chen Jia classification (odds ratio [OR], 2.127; 95%CI:1.596,2.835), DCSA (OR,0.398; 95%CI:0.169,0.802) and intermittent claudication (OR,9.481; 95%CI:3.439,26.142) were associated with surgical indications.ConclusionAmong the three types, it is found that Chen Jia classification has better diagnostic efficacy in differentiating LSS from LBP. In addition, Chen Jia classification is simple to be implemented in clinical practice and has high clinical application value. Hence, Chen Jia classification can be used as an effective surgical treatment indicator for LSS patients.

Evaluation of acute chest pain – is it possible to associate cardiovascular risk scores (TIMI, HEART, GRACE) and the presence of obstructive plaque on coronary computed tomography angiography?

Abstract Introduction Coronary artery disease (CAD) answers for almost 43.2% of cardiovascular deaths worldwide. In the United States, more than 8 million patients present to the emergency department each year with acute chest pain. Although, as few as 10% will be diagnosed with acute coronary syndrome. Cardiovascular risk scores are frequently used as tools to evaluate the chance of coronary disease, despite the fact that they were initially validated as prognostic schemes to categorize a patient's risk of death and ischemic events. The association of these scores and the presence of obstructive atherosclerotic plaques is scarce. Purpose To associate the presence of obstructive atherosclerotic plaque on coronary computed tomography angiography (CCTA) and cardiovascular risk scores, in the evaluation of patients who present with acute chest pain to the emergency department in a tertiary referral center in cardiovascular disease. Methods This is an observational and retrospective study that evaluated patients presenting to the emergency department with acute chest pain and were referred to CCTA. Exclusion criteria were ischemic EKG signs, positive troponin or history of coronary revascularization. CCTA images were reviewed by trained observers who performed a per-segment analysis to assess coronary artery stenosis, with complex cases classified by consensus. Atherosclerotic plaque was categorized as obstructive if luminal cross-sectional area stenosis was >50% in ≥1 major epicardial artery. Results Overall, 350 patients were recruited (52.6±11.9 years, 50% women) in whom 20.6% (72 patients) had significant atherosclerotic plaque. Male gender (OR: 1.87; 95% CI: 1.08–3.26), age >52 years (OR: 2.85; 95% CI: 1.6–5.07), diabetes (OR: 2.17; 95% CI: 1.12–4.2) and typical angina (OR: 2.17; 95% CI: 1.12–4.2) were the only clinical characteristics independently associated with the presence of obstructive plaque. More then 90% of patients with significant coronary stenosis were classified as low risk by GRACE and TIMI scores. HEART score was <4 in 23.6% of patients with obstructive plaque. Conclusion In patients who present to the emergency department in a tertiary referral hospital with acute chest pain, the initial evaluation based on clinical characteristics and cardiovascular risk scores was not sufficient to exclude safely the presence of coronary artery disease. Therefore, in such patients, CCTA could help to identify those with occult CAD and to target preventative treatments, thereby improving clinical outcomes. Funding Acknowledgement Type of funding sources: None.

P.174 The nerve root sedimentation sign on MRI is not only correlated with neurogenic claudication: association with leg dominant mechanical pain

Background: A correlation between the nerve root sedimentation sign (SedSign) and neurogenic claudication has been demonstrated; though it did not account for leg-dominant pain. This study analyzed the utility of SedSign to diagnose leg-dominant pain using validated classification systems. Methods: We retrospectively reviewed prospective data from 367 patients with back or leg pain collected between January 1, 2012 to May 31, 2018. Baseline characteristics included SSPc (Saskatchewan Spine Pathway classification), Oswestry disability index (ODI), visual analogue pain scores (VAS), and EuroQol Group 5-Dimension Self-Report (EQ5D). Inter- and intra-rater reliability for SedSign was 73% and 91%. Results: SedSign was positive in 111 (30.2%) and negative in 256 (69.8%) patients. Univariate analysis showed a correlation between SedSign and age, male sex, ODI, EQ5D, cross-sectional area (CSA) of stenosis, antero-posterior diameter of stenosis, and leg-dominant pain; negative SedSign was correlated with back-dominant pain. Multivariate analysis revealed an association between SedSign and age, male sex, CSA stenosis, and ODI walking distance. The sensitivity, specificity, positive and negative predictive values of SedSign for leg-dominant pain were 33.5%, 83.2%, 77.0%, and 57.3%. Conclusions: SedSign has high specificity but low sensitivity for leg-dominant pain. Despite a similar correlation between SedSign and neurogenic claudication or sciatica, significance was lost on multivariate analysis.

Intermediate stage atherosclerosis regression using combined methotrexate- mediated ultrasound sonoporation therapy and gold nanoparticles- mediated X- rays- based Auger electron therapy

Abstract Background Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. Atherosclerosis is the main cause of stroke and myocardial infarction. In atherosclerosis, local inflammation and associated macrophage activity can lead to foam cell-rich lesion formation, making inflammation an important therapeutic target in cerebrovascular and cardiovascular diseases. Aims In this study, we developed an experimental pulsed low level focused ultrasound system, and investigated its effectiveness on intermediate stage atherosclerosis regression accompanied by intravenous lipid-based encapsulated methotrexate nanoparticles administration and lipid based encapsulated gold nanoparticles-mediated X-rays-based Auger electron therapy in the golden Syrian hamster common carotid artery, wherein diagnostic B-mode ultrasound is combined with ultrasound therapy system, with a goal of increased safety. Methods In this study, common carotid arteries of hamsters submitted to intermediate stage atherosclerosis using intravascular balloon injury and high-cholesterol diet injury. Then common carotid arteries of the treatment group (n=10) at the injured region, underwent pulsed low level focused ultrasound (F=1.3 MHz, P=24 W, PD=100 ms)-mediated sonoporation therapy accompanied by intravenous lipid-based encapsulated methotrexate nanoparticles (10ml/kg) administration and lipid based encapsulated gold nanoparticles-mediated X-rays (25 Gy)-based Auger electron therapy. Wall mean thickness and percentage of luminal cross-sectional area of stenosis were measured by ultrasonography and histopathology. Results Results from ultrasonography and histopathology showed a significant reduction in the mean value for wall mean thickness, percentage of luminal cross-sectional area of stenosis, lipid-laden cells and lipid droplets density at the stenotic region in the treatment group compared with the other groups (P<0.05) Conclusions Enhanced apoptotic and anti-proliferative effect of methotrexate, induced by enhanced inertial cavitation-based sonoporation effect of focused ultrasound, due to collapsed capsules accompanied by enhanced apoptotic effect of Auger electron therapy, can cause to regress of the intermediate stage atherosclerosis and significantly dilate the luminal cross-sectional area of stenosis. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Mehrad Research Lab

Nerve root sedimentation sign on MRI: A triage screen for leg dominant symptoms?

PurposeSurgical indications for lumbar spinal stenosis are controversial, but most agree that leg dominant pain is a better predictor of success after decompression surgery. The objective of this study is to analyze the ability of the Nerve Root Sedimentation Sign (SedSign) on MRI to differentiate leg dominant symptoms from non-specific low back pain.MethodsThis was a retrospective review of 367 consecutive patients presenting with back and/or leg pain. Baseline clinical characteristics included Oswestry disability index (ODI), visual analog pain scores, EuroQol Group 5-Dimension Self-Report (EQ5D) and Saskatchewan Spine Pathway Classification (SSPc). Inter- and intra-rater reliability for SedSign was 73% and 91%, respectively (3 examiners).ResultsSedSign was positive in 111 (30.2%) and negative in 256 (69.8%) patients. On univariate analysis, a positive SedSign was correlated with age, male sex, several ODI components, EQ5D mobility, cross-sectional area (CSA) of stenosis, antero-posterior diameter of stenosis, and SSPc pattern 4 (intermittent leg dominant pain). On multivariate analysis, SedSign was associated with age, male sex, CSA stenosis and ODI walking distance. Patients with a positive SedSign were more likely to be offered surgery after referral (OR 2.65). The sensitivity and specificity for detecting all types of leg dominant pain were 37.4 and 82.8, respectively (ppv 77.5%, npv 43.8%).ConclusionsPatients with a positive SedSign were more likely to be offered surgery, in particular non-instrumented decompression. The SedSign has high specificity for leg dominant pain, but the sensitivity is poor. As such, its use in triaging appropriate surgical referrals is limited.

Transabdominal duplex ultrasound and intravascular ultrasound planimetry measures of common iliac vein stenosis are significantly correlated in a symptomatic population

ObjectiveThe objectives of the present study were to determine the validity of transabdominal duplex ultrasound (TAUS) against the reference standard of intravascular ultrasound (IVUS) examinations for the detection of iliac vein obstruction (IVO). MethodsWe analyzed the data from patients at a private vascular laboratory who had undergone IVUS investigation with an intention to treat because of symptoms of chronic venous insufficiency and a high suspicion of IVO. These patients had also previously undergone a TAUS examination at the same location. The TAUS and IVUS planimetry measures of the left common iliac vein (CIV) were correlated. These included the TAUS-measured minimum and maximum diameter and the percentage of stenosis with the IVUS-measured minimum and maximum diameter and area and the percentage of stenosis. ResultsThe TAUS and IVUS data from 47 patients (83% female; age, 49.3 ± 17.3 years; 64% obese) were included in the analyses. We found 89% agreement between the TAUS and IVUS findings regarding the identification of left CIV stenosis of ≥50%. The TAUS data had a positive predictive value of 95.5%. The TAUS measures of the minimum diameter and percentage of stenosis correlated significantly with the IVUS measures of the minimum diameter, minimum area, and cross-sectional area of the percentage of stenosis. The strongest correlations were between the TAUS-measured minimum diameter and IVUS-measured minimum area and percentage of the area of stenosis according to the literature-derived value. The TAUS-measured vein diameter of 8 mm equated to an IVUS cross-sectional area of 94.2 mm2 (53% stenosis), and an IVUS cross-sectional area of 50% of stenosis equated to a TAUS diameter of 8.56 mm. ConclusionsThe findings from the present study support the validity of TAUS evaluation as a workup diagnostic tool for the detection of IVO. Our findings also support the use of TAUS planimetry—in particular, the CIV diameter of ≤8 mm as a threshold value—to indicate clinically relevant stenosis and trigger an IVUS investigation with an intention to treat, because this correlated with a cross-sectional area stenosis of ≥50%, as determined by IVUS examination.

Coronary atherosclerosis in diabetics: A postmortem teaching hospital experience in South-South Nigeria

Context: Diabetes mellitus (DM) is a risk factor for the development of coronary artery disease. It is plausible that there is no significant association in the grade/severity of coronary atherosclerosis in diabetics in comparison with nondiabetics. Aims: The aim of this study, therefore, was to test this hypothesis by assessing the association of DM on the grade of coronary atherosclerosis. Settings and Design: This study was carried out at the Department of Morbid Anatomy, University of Benin Teaching as a prospective postmortem study. Subjects and Methods: This study employed consecutive sampling technique for recruiting the study population from June 1, 2012, to May 31, 2013. At postmortem, the coronary artery of each subject was graded into one of four grades on the basis of the percentage of cross-sectional area stenosis. Statistical analysis used: the data obtained were analyzed with Chi-square, Mann–Whitney U-test, Spearman's correlation, and multinomial logistic regression to determine the association/relationship between DM and coronary atherosclerosis. Results: Fifty-two cases constituted the study population. Their age ranged from 23 to 82 years with a mean age of 50.35 years (standard deviation = 16.62), median age of 50 years and modal age of 36 years. The severity of the grades of coronary atherosclerosis increased with age. There was a statistically significant association between the atherosclerotic grades of those participants with DM in comparison with those without the disease. Conclusion: The null hypothesis is therefore rejected as there is a statistical significant association in the grades of atherosclerosis in the study population with and without DM.

Severity of coronary atherosclerosis in hypertensive: A postmortem study

The development of coronary atherosclerosis and ischaemic heart disease had been attributed to risk factors that include but not limited to hypertension. These factors were determined without reference to data from autopsy studies. It is likely that there is no significant difference on the grades of coronary atherosclerosis in hypertensive’s when compared with the non-hypertensive’s. The aim of this study, therefore, is to test this hypothesis by assessing the impact of hypertension on the grades of atherosclerosis. A prospective postmortem study carried out from 1st of June, 2012 to 31st of May 2013. Consecutive sampling technique was employed to recruit the study population. At post-mortem, the coronary artery of each subject was graded on the basis of the percentage of cross-sectional area stenosis. The data obtained was analyzed with the SPSS version 20. There were 142 cases in this study with a male preponderance. Their mean age was 49.86 years. The grades of coronary atherosclerosis increases with age. The grades of coronary atherosclerosis in hypertensive’s were more severe when compared with the non-hypertensive’s (p=0.0001). The odds of a hypertensive developing grade III coronary atherosclerosis relative to a grade I lesion was 17.655 higher. The grades of coronary atherosclerosis is related to the presence of hypertension, thus we reject the null hypothesis. Key words: Hypertensive’s, non-hypertensive’s, risk factors, grades of coronary atherosclerosis.

P.104 The diagnostic value of the nerve root sedimentation sign for symptomatic lumbar stenosis

Background: Previous studies have shown varied results with respect to the diagnostic utility of a positive nerve root sedimentation sign (SedSign) on MRI for symptomatic lumbar stenosis. The objective of this study was to analyze the clinical characteristics of SedSign utilizing a validated classification for low back and leg pain (Saskatchewan Spine Pathway classification; SSPc). Methods: This was a retrospective review of prospectively-collected data in 367 consecutive adult patients presenting to a spine surgeon with back and/or leg pain between January 1, 2012 and May 31, 2018. Inter- and intra-rater reliability for SedSign was 73% and 91%, respectively (3 examiners). Results: SedSign was positive in 111 (30.2%) and negative in 256 (69.8%) of patients. On the univariate analysis, a positive SedSign was correlated with age, male sex, several components of ODI, EQ5D mobility, cross-sectional area (CSA) of stenosis, and SSPc pattern 4 (intermitted leg dominant pain). On multivariate analysis, SedSign was associated with age, male sex, CSA stenosis and ODI sub-score for walking distance. The sensitivity and specificity of SedSign for neurogenic claudication was 50.3 and 82.9, respectively (positive predictive value 65.8%, negative predictive value 71.9%). Conclusions: The SedSign has high specificity for neurogenic claudication, but the sensitivity is poor.

Diagnostic value of color Doppler sonography for spontaneous isolated superior mesenteric artery dissection.

The present study aimed to evaluate the clinical significance of color Doppler sonography (CDS) in the diagnosis of spontaneous isolated superior mesenteric artery dissection (SISMAD). The ultrasonographic images of 19 patients with SISMAD confirmed by computed tomography angiography (CTA) were retrospectively analyzed and the ultrasonographic features were summarized. The paired t-test was used to statistically analyze the differences in parameters determined by CTA vs. CDS, including the minimal inner diameter (MID), cross-sectional area (CSA), diameter and area stenosis rate, and flow rate of the true lumen. Of the 19 patients, 18 (94.7%) were diagnosed with SISMAD with correct classification by CDS. There was no significant difference between CTA and CDS with regard to minimal ID, CSA, diameter stenosis and area stenosis rate, and flow rate of the true lumen (all P>0.05). CDS was indicated to be an effective imaging modality for the diagnosis of SISMAD.

Optical coherence tomographic analysis of drug-eluting in-stent restenosis at different times

The imaging characteristics of drug-eluting in-stent restenosis (ISR) at different times varied; however, the mechanism had not yet been elucidated.To analyze the imaging characteristics of drug-eluting ISR at different time points by optical coherence tomography (OCT) and investigate the cause of the stent treatment failure.A total of 70 patients with drug-eluting ISR undergoing OCT were enrolled (intimal hyperplasia ≥50% of stent area) and implanted with drug-eluting stents. According to stent implantation time, the patients were divided into 2 groups: early in-stent restenosis group (E-ISR group) (group A, n = 35, stent age ≤12 months) and late in-stent restenosis group (L-ISR group) (group B, n = 35, stent age ≥24 months). A qualitative analysis of the restenosis tissue included the nature of restenosis tissue (homogeneous and heterogeneous), neoatherosclerosis, thin-cap fibroatheroma (TCFA), and microvessels.The ratio of ≥75% cross-sectional area stenosis between the L-ISR and E-ISR groups was (60.00% vs 34.28%, P < .05). The heterogeneous intima, neoatherosclerosis, TCFA, and microvessels were more prevalent in the L-ISR group as compared to the E-ISR group (71.43% vs 45.71%, P < .05; 48.57% vs 22.86%, P < .05; 25.71% vs 5.71%, P < .05; 22.86% vs 2.86%, P < .05, respectively).The morphological characteristics of L-ISR were significantly different from those in the E-ISR; the former was closer to the atherosclerotic plaque, which provided a new approach for the treatment of drug-eluting ISR.

Venogram Versus Intravascular Ultrasound for Diagnosing and Treating Iliofemoral Vein Obstruction (VIDIO): Report From a Multicenter, Prospective Study of Iliofemoral Vein Interventions

Venogram Versus Intravascular Ultrasound for Diagnosing and Treating Iliofemoral Vein Obstruction (VIDIO): Report From a Multicenter, Prospective Study of Iliofemoral Vein Interventions

Mechanisms of Postintervention and Nine-Month Luminal Enlargement After Treatment of Drug-Eluting In-Stent Restenosis With a Drug-Eluting Balloon

Using optical coherence tomography (OCT), the mechanisms of postintervention and 9-month luminal enlargement in drug-eluting stent in-stent restenosis (ISR) lesions treated with a drug-eluting balloon (DEB) were evaluated. A total of 42 patients with DEB-treated drug-eluting stent ISR lesions underwent serial OCT examination before intervention, after intervention, and at 9-month follow-up. Preintervention OCT-derived neointima was classified as either a homogeneous or nonhomogeneous pattern. Ten ISR lesions with homogeneous neointima were identified and compared with 32 ISR lesions with nonhomogeneous neointima. When comparing pre- and postintervention evaluations, changes in luminal cross-sectional area (CSA) were 3.4mm(2) in ISR lesions with homogeneous neointima and 3.7mm(2) in those with nonhomogeneous neointima, respectively (p= 0.529); changes in stent CSA were 2.5mm(2) and 1.4mm(2), respectively, p= 0.004; and changes in neointimal CSA were-0.9mm(2) and-2.3mm(2), respectively, p= 0.001. At 9-month follow-up, changes in luminal CSA were-2.0mm(2) and-0.9mm(2) in ISR lesions with homogeneous and nonhomogeneous neointima, respectively (p= 0.021); in stent CSA changed by-0.2mm(2) in both groups (p= 0.851) and changes in neointimal CSA was 1.8mm(2) and 0.7mm(2), respectively (p= 0.003). At the 9-month follow-up, >50% neointimal CSA stenosis was observed in 60% and 19% of the ISR lesions with homogeneous and nonhomogeneous neointima, respectively (p= 0.020). In conclusion, the mechanism of postintervention luminal enlargement by DEB varied with the preintervention OCT-based neointimal characteristics. ISR lesions with homogeneous neointima determined by OCT were associated with greater subsequent regrowth of neointima after DEB treatment.

Optical coherence tomographic observation of morphological features of neointimal tissue after drug-eluting stent implantation.

PurposeThe impacts of different time courses and the degree of neointimal growth on neointimal morphology have not yet been sufficiently investigated. Therefore, we evaluated the morphological features of neointimal tissue after drug-eluting stent (DES) implantation using optical coherence tomography (OCT).Materials and MethodsThe morphological features of neointimal tissue in stented segments with a maximal percentage of cross-sectional area (CSA) stenosis of neointima were evaluated in 507 DES-treated lesions with >100 µm mean neointimal thickness on follow-up OCT. Neointimal tissue was categorized as homogeneous, heterogeneous, layered, or neoatherosclerotic.ResultsIn lesions with <50% of neointimal CSA stenosis, homogeneous neointima (68.2%) was predominant, followed by heterogeneous neointima (14.1%) and layered neointima (14.1%). In lesions with ≥50% of neointimal CSA stenosis, layered neointima was most frequently observed (68.3%), followed by neoatherosclerotic neointima (25.2%). In subgroup analysis of lesions with ≥50% of neointimal CSA stenosis, 89.5% of the lesions with a stent age <30 months were layered neointima, while 62.3% of the lesions with a stent age ≥30 months were neoatherosclerotic neointima.ConclusionThis study suggests that the OCT-detected morphology of DES neointimal tissue was different according to the follow-up time course and degree of neointimal hyperplasia.

Optical coherence tomography-based evaluation of in-stent neoatherosclerosis in lesions with more than 50% neointimal cross-sectional area stenosis

To use optical coherence tomography (OCT) to evaluate the time course, risk factors, and clinical implication of in-stent neoatherosclerosis. The neointimal characteristics of 152 lesions, 128 drug-eluting stents (DESs) and 24 bare metal stents (BMSs), with >50% percent cross-sectional area (CSA) neointimal stenosis were evaluated. Neoatherosclerosis was defined as neointima with presence of lipid or calcification. Neoatherosclerosis was observed in 54 lesions (35.5%, 35 DESs and 19 BMSs). Median time to follow-up was 70.7 months in lesions with neoatherosclerosis (longer than lesions without neoatherosclerosis [13.4 months, p<0.001]): 58.7 months in DES-treated lesions and 129.5 months in BMS-treated lesions (p<0.001). The optimal cut-off time to predict neoatherosclerosis in DES-treated lesions was 30 months with a sensitivity of 91.4% and a specificity of 72.0% (area under curve: 0.839, 95% confidence interval: 0.764-0.898, p<0.001). Independent risk factors for neoatherosclerosis were stent age, use of first-generation DES and hypertension. Patients with neoatherosclerosis (versus without neoatherosclerosis) had a higher rate of target lesion revascularisation (92.6% vs. 77.6%, respectively, p=0.018) and stent thrombosis (14.8% vs. 0%, respectively, p<0.001). Neoatherosclerosis occurred in one-third of stented lesions with >50% percent CSA stenosis of neointima. Late-phase development of neoatherosclerosis might be associated with clinical deterioration of stented lesions.

Endovascular Diagnosis and Management of Chronic Cerebrospinal Venous Insufficiency: Retrospective Analysis of 30-Day Morbidity and Mortality in 95 Consecutive Patients

The purpose of this study is to report the 30-day morbidity and mortality associated with the endovascular diagnosis and management of chronic cerebrospinal venous insufficiency. The medical records of 95 consecutive patients (60 women and 35 men) with a mean age of 48 years (age range, 25-66 years) who underwent diagnostic endovascular evaluation and intervention for chronic cerebrospinal venous insufficiency between June 2010 and September 2011 were reviewed retrospectively. All patients had a diagnosis of multiple sclerosis by McDonald criteria. Endovascular evaluation of the internal jugular and azygos veins was performed with digital subtraction venography and intravascular ultrasound. Indications for percutaneous transluminal angioplasty (PTA) were venographic findings of a greater than 50% diameter stenosis, the presence of reflux on digital subtraction venography, greater than 50% cross-sectional area stenosis by intravascular ultra-sound, or a finding of abnormal thick valves or webs by either method. The primary endpoint of this study was the 30-day mortality, and the secondary endpoint was the presence of major complications. Results are presented as means and percentages. A total of 107 procedures were performed in 95 patients. Endovascular evaluation showed venous lesions requiring intervention in 90 of 95 patients (94.7%) and was negative in five of 95 patients (5.3%). A total of 193 venous lesions were treated; angioplasty was technically successful in 188 of 193 (97.4%) lesions. Internal jugular vein thrombosis after PTA was identified in three of 95 (3.2%) of the treated patients. Bleeding at the puncture site not requiring transfusion occurred in four of 95 patients (4.2%). There were no reported procedure-related deaths. The results of the current study suggest that endovascular evaluation and management of chronic cerebrospinal venous insufficiency is safe, with low morbidity and no procedure-related mortality.

Conductance catheter measurements of lumen area of stenotic coronary arteries: theory and experiment

An injection of saline solution is required for the measurement of vessel lumen area using a conductance catheter. The injection of room temperature saline to displace blood in a vessel inevitably involves mass and heat transport and electric field conductance. The objective of the present study is to understand the accuracy of conductance method based on the phenomena associated with the saline injection into a stenotic blood vessel. Computational fluid dynamics were performed to simulate flow and its relation to transport and electric field in a stenotic artery for two different sized conductance catheters (0.9 and 0.35 mm diameter) over a range of occlusions [56-84% cross-sectional area (CSA) stenosis]. The results suggest that the performance of conductance catheter is dependent on catheter size and severity of stenosis more significantly for 0.9 mm than for 0.35 mm catheter. Specifically, the time of detection of 95% of injected saline solution at the detection electrodes was shown to range from 0.67 to 3.7 s and 0.82 to 0.94 s for 0.9 mm and 0.35 mm catheter, respectively. The results also suggest that the detection electrodes of conductance catheter should be placed outside of flow recirculation region distal to the stenosis to minimize the detection time. Finally, the simulations show that the accuracy in distal CSA measurements, however, is not significantly altered by whether the position of detection electrodes is inside or outside of recirculation zone (error was within 12% regardless of detection electrodes position). The results were experimentally validated for one lesion geometry and the simulation results are within 8% of actual measurements. The simulation of conductance catheter injection method may lead to further optimization of device and method for accurate sizing of diseased coronary arteries, which has clinical relevance to percutaneous intervention.

Assessment of flow velocity in saphenous vein graft using the Doppler guidewire

The purpose of the study is to evaluate flow velocity characteristics in saphenous vein graft for coronary artery bypass grafting, especially in the graftnative vessel anastomotic site. The flow velocity was measured in 13 patients with saphenous vein graft (Group I) using a Doppler guidewire, and values were compared with those in patients who had severe (≧75%, Group II, n=31) or intermediate (<75%, Group III, n=27) coronary artery stenosis. In Group I, the flow velocity data were measured in the graft, in the anastomotic site, and in the native artery distal to the anastomosis, and in Groups II and III data were measured proximal to the stenosis, in the stenosis, and distal to the stenosis. In the saphenous vein graft, average peak velocity (APV) was significantly lower than that proximal to the stenosis. The APV increased significantly from the graft to the anastomotic site (13.3±7.2 → 36.2±15.8 cm/s,p<0.001). The APV in the anastomotic site was significantly lower than that in the stenotic site in Group II (Group II: 100.5±54.7 cm/s,p<0.001), but it was similar to that in Group III (Group III: 58.6±25.2 cm/s). The APV distal to the anastomosis in Group I was normal (22.4±8.0 cm/s), and it was significantly faster than the APV distal to the stenosis in Group II (Group II: 11.7±8.0 cm/s,p <0.001) or Group III (Group III: 15.9±8.2 cm/s,p< 0.05). In Group I, the diameter of saphenous vein graft was significantly larger than that of the native distal artery (4.23±0.85 vs 2.06±0.17 mm,p<0.001), and the Doppler-derived percent cross-sectional area stenosis at the anastomosis showed a significant correlation with the angiographically derived percent crosssectional area stenosis of the graft to the native distal artery (r=0.95,p<0.001). From these results it was thought that the increase of the APV from the graft to the anastomosis was due to caliber change from the graft to the native artery.

Women have less severe and extensive coronary atherosclerosis in fatal cases of ischemic heart disease: An autopsy study

The study aims to evaluate sex differences in extent and severity of coronary artery disease (CAD) and myocardial findings at autopsy among young people with fatal ischemic heart disease (IHD). Women with acute coronary syndrome are less likely than men to display obstructive CAD at angiography. This suggests unique mechanisms of acute coronary syndrome exist in women or may reflect prehospital death of women with the most severe CAD. Reports of autopsies by the Office of the Chief Medical Examiner of New York City on people aged 21 to 54 years who died between January 1, 2006, and December 31, 2008, were reviewed. A total of 639 cases of death due to atherosclerotic or arteriosclerotic cardiovascular disease according to the medical examiner were analyzed. Significant CAD was defined as ≥75% cross-sectional area stenosis in an epicardial vessel or ≥50% left main. Women were less likely to have obstructive CAD (63% vs 77% of men, P = .002). There was pathologic evidence of myocardial infarction (MI) in 43% of cases, 17% of which had nonobstructive CAD. Frequency of MI did not vary by sex overall (38% of women vs 45% of men, P = .18) or among those without significant CAD (23% vs 29%, P = .45). Among young people determined at autopsy to have died of IHD, fewer women had obstructive CAD, consistent with angiographic data in other IHD syndromes. Pathologic evidence of MI may exist in the absence of obstructive CAD.

Quantification of coronary stenosis by dual source computed tomography in patients: A comparative study with intravascular ultrasound and invasive angiography

To determine the accuracy of dual-source CT (DSCT) to quantify coronary stenosis compared to intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA). 21 patients (23 vessels) were examined with DSCT, IVUS and invasive coronary angiography. Coronary minimal luminal diameter (MLD) and area (MLA) were measured in cross-sectional multi-planar reformatted images perpendicular to the vessel long-axis. The vessel cross-sectional area stenosis (MLA/CSA ratio) was calculated. DSCT results were compared with IVUS and QCA. A good correlation between DSCT and IVUS was noted for diameter and area stenosis (r=0.69 and r=0.73), with an overestimation of MLD stenosis by DSCT (+9.1%) and an underestimation of MLA stenosis (-5.8%). For MLD and MLA, high correlation coefficients (r=0.78 and r=0.90, respectively) were found between DSCT and IVUS; and the bias was almost zero (-0.41 mm and +0.1mm(2), respectively). The correlation between DSCT and QCA was moderate (r=0.60) for MLD stenosis with minor overestimation by DSCT (+4.0%) and moderate (r=0.59) for MLD (bias, +0.01 mm). The cross-sectional area stenosis showed a moderate correlation (r=0.59) between DSCT and IVUS (+0.00). DSCT allows accurate quantification of coronary stenosis as compared to IVUS. An excellent correlation was found for the MLA between DSCT and IVUS.