Innominate Artery Research Articles

Thyroid ima artery (the artery of Neubauer) - how much do we know?

Blood supply of the thyroid gland was the subject of numerous original studies, case reports and meta-analysies. The number of surgical procedures carried out on the thyroid gland significantly increases during last few decades. The cadaveric report discusses the case of a thryoidea ima artery (TIA) which originated from the brachiocephalic artery before its terminal subdivision, giving off numerous branches to the infrahyoid muscles, trachea and thyroid gland. Based on the current literature we discuss the prevalence of TIA, its embryology, and possible clinical aspects of this variation, with special attention paid to the postoperative complications.

Dynamic contrast enhancement and wall enhancement index for the quantitative assessment of vascular wall abnormalities in intracranial atherosclerosis: a pilot study

Background: Breakthrough neurotechnologies have allowed for new understanding of some brain disorders; however, identification and differential diagnosis of intracranial stenotic and occlusive lesions remains challenging. Magnetic resonance imaging (MRI) with dynamic contrast enhancement (DCE) is a tool that could be used for the quantitative assessment of endothelial permeability and microvascular volume in atherosclerotic plaques (AP). Aim: To assess quantitative parameters of vascular wall abnormalities in AP area and in obviously unchanged wall of intracranial arteries with MRI DCE and high spatial resolution Т1-weighed images before and after contrast injection, with calculation of the wall enhancement index (WEI) by mathematical modelling. Methods: This was a pilot cross-sectional uncontrolled study with consecutive recruitment of 29 patients with atherosclerotic abnormalities of brachiocephalic arteries, including intracranial. The patients’ median age was 66 [57; 72] years; they were mostly men (75.9%, n = 22). For the assessment of any brain abnormalities, MRI (magnetic induction 3 Tesla, Magnetom Prisma, Siemens) was performed in patients with standard sequence (Т2, T2-FLAIR), as well as MRI DCE for the assessment of intracranial arteries, before and after intravenous contrast injection, with high spatial resolution T1-weighed imaging and suppression of the signal from bloodstream and fat, with the calculation of WEI. Results: There were significant differences in WEI in AP and in unchanged wall (0.962 [0.686; 1.387] vs. 0.111 [0.014; 0.206], p 0.001). No significant differences were found between WEI values in internal carotid arteries APs (0.722 [0.573; 1.580]), middle cerebral arteries (0.921 [0.725; 1.183]), and basilar artery (1.343 [1.002; 1.419]) (p = 0.381). We also found significant difference (p = 0.034) in the extravascular extracellular fraction volumes ve (Tofts) in AP located in the basilar artery (0.171 [0.146; 0.325]), internal carotid arteries (0.579 [0.358; 1.000]), and middle cerebral arteries (0.134 [0.101; 0.269]). Conclusion: This is the first description of quantitative parameters characterizing vascular wall abnormalities in intracranial atherosclerosis. Despite its obviously intact state, vascular walls outside the intracranial AP was shown to be abnormal as well.

Instrumental diagnosis of cognitive impairment in workers engaged in the maintenance of agricultural machinery

Workers engaged in the maintenance of agricultural machinery are exposed to a number of production factors in the course of their work, which can be considered as risk factors for the development of cognitive impairment. The purpose of the work: to diagnose cognitive disorders using informative instrumental methods of examination of mental functions, such as cognitive evoked potentials P 300, ultrasound duplex scanning of brachiocephalic arteries in combination with the determination of the atherogenicity index. In order to diagnose the stages of cognitive impairment early, optimal quantitative and qualitative signs in combination with professional experience and age have been determined. Each feature was evaluated in points, which are further summarized. The stages of cognitive impairment are determined by the sum of the points.

Ascending Geometry After Thoracic Endovascular Aortic Repair for Descending Aortic Dissection

ObjectivesThis study aimed to assess geometry changes of the ascending aorta after thoracic endovascular aortic repair (TEVAR) for descending aortic dissection and identify potential risk factors for diameter and length change. MethodsBetween 04/2009 and 07/2021, 102 patients were treated for acute descending aortic dissections (Type B and non-A non-B) with TEVAR and were included in this analysis. Computed tomography angiographic scans were transferred to a dedicated imaging software and detailed aortic measurements (including length, diameter and area) were taken in multiplanar reconstruction postoperatively, after six months and annually thereafter. ResultsSixty-five (58%) patients were male, with a mean age of 66 (±11). Four (4%) patients were diagnosed with a connective tissue disease. Before TEVAR, 79% of our patients were treated with a mean of 1.5 (±1.2) different classes of antihypertensive medications. This number rose to 98% after TEVAR and 2.7 (±1.0) different antihypertensive drugs. There was no significant change in length, diameter, cross-sectional area, or volume of the ascending aorta during the follow-up of 3 years after TEVAR. Body height was a negative predictor for mean ascending aortic diameter (p-value = -0.013; B = -8.890) and mean aortic diameter at the level of the brachiocephalic trunk (p-value = 0.039; B = -14.763). ConclusionsOur data suggests no significant changes in the ascending aorta following TEVAR of the descending thoracic aorta during mid-term follow-up when under stringent blood pressure medication. Additionally, we did not find any modifiable risk factors for geometry parameter increase.

Diagnostic utility of sortilin & other biomarkers in the diagnosis of carotid & coronary atherosclerosis in individuals with arterial hypertension.

Background & objectives Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide. The aim of this investigation was to study the role of biological markers in predicting the risk of carotid and coronary artery atherosclerosis. Methods A total of 161 males in the age group of 30-65 yr were included in this study. All participants underwent biochemical analyses [cholesterol, low density lipoprotein cholesterol (LDL-C), triglycerides, glucose, (interleukin) IL-8, IL-10, (proprotein convertase inhibitors subtilisin/kexin type 9) PCSK9, sortilin, creatinine]; ECG; echocardiography; coronary angiography; ultrasound doppler of brachiocephalic arteries. Based on PCSK9 levels, participants were divided into four groups: group 1, n=41 individuals with PCSK9 level of 100-250 ng/ml; group 2, n=37 individuals with PCSK9 level of 251-400 ng/ml; group 3, n=51 individuals with PCSK9 level of 401-600 ng/ml and group 4, n=32 individuals with PCSK9 level of 601-900 ng/ml. Results Sortilin level was the highest in group 2. Group 3 individuals had the highest level of IL-8. Correlation analysis of the entire data set revealed the relationship of relative left ventricular thickness index with age, cardiovascular risk, body mass index, intima-media thickness and left ventricular mass index; sortilin had a negative relationship of weak strength with age and smoking, a direct relationship between the risk of cardiovascular complications and with IL-10. Interpretation & conclusions Sortilin is the innovative marker of CVDs. In the present investigation, we demonstrated the clear increase in the inflammatory markers (IL-8) in individuals with subclinical atherosclerosis. This fact can be explained by the oxygen stress activation. In individuals with coronary artery stenosis (50% and more), the increase in IL-10 levels demonstrates, to our opinion, the activation of antioxidant protection activation.

Superior vena cava thrombosis induced by chemotherapy port: About a case

Superior vena cava syndrome is secondary to obstruction of the superior vena cava and/or brachiocephalic venous trunk, which are currently common during venous catheterization (implantable chamber, dialysis catheter or during placement of an endocavitary stimulation lead). We report the case of a 50-year-old patient with beta thalassemia who had been wearing a chemotherapy box for 2 years, and presented with clinically symptomatic superior vena cava syndrome. A phleboscanner was ordered, showing a tight stenosis of the superior vena cava. A double-approach angioplasty was performed with good postoperative results.

Preventing Sheep Carotid Artery Spasm for Vascular Graft Surgery and Computed Tomography Angiography.

The development of small-diameter vascular grafts requires testing in large animal models before advancing to clinical trials. Vascular graft interposition implantation in sheep carotid arteries (CAs) is the most widely used model, but ovine CAs are prone to severe spasm following surgical manipulation, potentially impairing graft performance assessment. There is paucity in the literature on reducing sheep CA spasm using effective vasodilator therapeutic protocols. In this study, four healthy Merino cross White Suffolk wethers (1-2 years, 52.1 ± 0.8 kg) underwent CT angiography and CA graft surgery. CT angiography using iodinated contrast agent was performed with innominate artery access through the CA or ascending aortic arch access through the femoral artery. Sheep then underwent right CA sham surgery or left CA vascular graft implantation. A variety of vasodilators, including papaverine, sodium nitroprusside, verapamil, and their combination, were tested for preventing or treating CA spasms intraoperatively. Blood flow was reassessed immediately after CA surgery using CT angiography. The results showed that innominate artery access through the CA for CT angiography in sheep induced presurgical CA spasm with reduced arterial flow. Conversely, ascending aortic arch access through the femoral artery for CT angiography did not cause CA spasm and maintained arterial flow. During CA graft surgery, surgical trauma induced CA spasm, which was prevented by localized intra-arterial administration of vasodilators papaverine hydrochloride and verapamil before significant surgical manipulation.

Ultrasound parameters of arteries and heart in normal fetuses

BackgroundCurrently, no normal ultrasound data of the fetuses during the 20–40 gestation have been obtained for references of fetal growth and development. If such ultrasound data existed for prenatal diagnosis of possible diseases and abnormalities, neonates would be able to get timely treatment immediately after birth. This study was thus performed to obtain ultrasound parameters of normal fetuses during the 20–40 week gestation and the distribution of ultrasound parameters with the gestational age for references of detecting potential fetal diseases and abnormalities.MethodsNormal fetuses without any abnormalities were enrolled, and the ultrasound parameters of the general biology, arteries, and aorta were measured and analyzed.Results417 normal fetuses were enrolled. A significant (P < 0.05) negative correlation with the gestational age was detected in the peak systolic velocity/peak diastolic velocity (S/D), pulsatility index (PI) and resistance index (RI) of the umbilical artery (UA). A relatively stable relationship with the gestational age was detected in the fetal weight%, S/D, PI and RI of the middle cerebral artery (MCA), peak systolic velocity (PSV) and velocity time integral (VTI) of the intra-abdominal UA, fetal heart to chest ratio, mitral valve (MV)- and tricuspid valve (TV)-E/A peak flow velocity, aortic isthmic Z-score and displacement, distance between the brachiocephalic artery-left common carotid artery (BA-LCCA) and LCCA-left subclavian artery (LSA), Z-score of aorta, ascending aorta (AAO), pulmonary artery (PA), main pulmonary artery (MPA), and descending aorta (DAO). A significant (P < 0.05) positive correlation with the gestational age was detected in the fetal biological data, MCA PSV and VTI, free-UA PSV and VTI and cardio-thoracic ratio, cardiac parameters, ductus arteriosus (DA) and isthmus diameter, aortic parameters, PA and MPA diameter, MPA PSV and VTI, isthmus flow volume and velocity and PA flow volume, DA and BA parameters, and LCCA and LSA parameters (flow volume, PSV, and VTI).ConclusionA certain correlation and distribution trend is detected in the ultrasound parameters of normal fetuses, and the ratios among different parameters remain relative stable. These findings can be used for determination of abnormal growth of the fetuses in prenatal ultrasound scan.Graphic

In vitro quantification of stent-graft behaviour during chimney thoracic endovascular aortic repair.

To quantify dynamic gutter phenomena and endograft deformations during double chimney thoracic endovascular aortic repair (ch-TEVAR) in a physiological model of the thoracic aorta subjected to pulsatile haemodynamic conditions. Two in vitro procedures revascularizing the brachiocephalic trunk and left common carotid artery were performed representing both balloon-expandable (BE, Ankura-BeGraft) and self-expandable (SE, Ankura-Viabahn) double ch-TEVAR configurations. Retrospectively gated computed tomography (CT) was used to evaluate endograft behaviour. Device interactions were characterised according to gutter volume, gutter surface deviation, and endograft deformation (D-ratio) at end-diastolic and peak-systolic aortic pressure. Use of BE chimney grafts resulted in three times total gutter volume compared to SE chimney grafts. Gutter volumes were observed to vary dynamically between the end-diastolic and peak-systolic phases of the cardiac cycle, with the most substantial change associated with the BE configuration. Chimney graft deformations were dependent on device type, with SE devices exhibiting up to twice the deformation as BE devices. When adjacent, SE chimney grafts were observed to support each other, and thus tended towards a more consistently circular shape. Gutter and chimney graft behaviour were dependent on device type, and exhibited both spatial and temporal variability. This study emphasises notable differences between BE and SE double ch-TEVAR configurations which should be considered when evaluating risk of endoleak. The findings reported here also support the use of gated CT to better identify device-related complications with ch-TEVAR, and can be used in the design of next generation devices.

Ultrasound imaging for assessing aortic phenotypes: A preclinical tool for measuring cardiac disease model progression and therapeutic effect

Cardiac dysfunction is a common feature of numerous diseases, ranging from metabolic disorders like Mucopolysaccharidosis Type 1 (MPS I), a.k.a. Hurler syndrome to neuromuscular disorders such as Myotonic Dystrophy type 1 (DM1). The ability to quantify cardiac abnormalities in animal models of these diseases is a valuable translational tool for preclinical testing of novel therapeutic approaches. In contrast to methods that measure the left ventricle (LV) phenotype, we employed ultrasound imaging to assess the ascending aortic diameter and ascending aortic blood velocity. MethodsWe imaged two disease models - MPS I Hurler mouse model and DM1 mouse model (DMSXL) - using the Vevo2100 platform. Ascending aortic diameter in the proximal thoracic aortic region and ascending aortic blood velocity just before the branching point of the brachiocephalic artery were measured as rapid imaging readouts. In addition, histopathology was performed on relevant tissue samples. ResultsThe two mouse models demonstrate opposing aorta phenotypes. Hurler mice had a dilated aorta and slightly increased blood velocity with disease progression, while the aorta diameter in DMSXL mice narrowed and had a blood velocity decrease as the disease progressed. In the Hurler model, we demonstrated that a single dose of adeno-associated virus (AAV) delivered gene therapy provides aortic phenotype improvement. In the DMSXL model, we established aortic phenotype criteria at baseline. ConclusionUltrasound imaging of aortic diameter and blood velocity can offer objective and longitudinal assessments of disease progression and treatment efficacy in real time. This method might therefore have noninvasive clinical applicability as phenotype indicator of cardiac dysfunction.

A combined endovascular and open repair of innominate artery bifurcation pseudoaneurysm: a case report

BackgroundInnominate artery aneurysms (IAAs) are rare and may result in rupture, distal arterial embolization, or local compression without timely treatment. Rupture is the most dangerous of these complications. This article reports a case of innominate artery bifurcation pseudoaneurysm.Case presentationThe patient was a 45-year-old man who was admitted to the emergency department due to chest discomfort. The computed tomographic angiography (CTA) imaging indicated the presence of a 3.6*2.4 cm saccular aneurysm in the bifurcation of the innominate artery, involving both the right proximal subclavian and common carotid arteries. The patient’s vital signs were normal, there was equal blood pressure in the upper arms and no neurological dysfunction was observed. Gadolinium-enhanced magnetic resonance angiography indicated that the circle of Willis was intact. The treatment involved open surgery combined with endovascular therapy. The external carotid artery was first transposed to the right subclavian artery (RSA) and an 8-mm woven Dacron graft was inserted in the middle. The covered stent graft was then placed in the proximal part of the innominate artery to close the entrance of the aneurysm. Lastly, an occluder was implanted at the origin of the RSA. There were no perioperative or postoperative complications. At 1-year follow-up, no aneurysm was observed on CTA and the right vertebral artery was patent.ConclusionsThis study indicated that the combined use of endovascular therapy and open repair surgery is an effective strategy to treat innominate artery bifurcation pseudoaneurysm.

High-frequency ultrasound with superb microvascular imaging: a potential tool for ultrasound assessment in patients with giant cell arteritis.

The objective of this study was 2-fold: first, to evaluate whether superb microvascular imaging (SMI) could be used to visualize neovascularization in temporal arteries, and, second, to evaluate the diagnostic performance of high frequency ultrasound with SMI using an extended protocol in patients with suspected giant cell arteritis (GCA). This retrospective study comprised 120 patients consecutively examined with an extended CDU protocol (temporal, facial, axillary, subclavian, brachiocephalic, and carotid arteries) between 2020 and 2022. Of all patients, 107 had no previous GCA diagnosis and 13 had a previous GCA diagnosis. SMI was used to evaluate neovascularization in the temporal arteries. Arteritis were characterized as low- or medium-echogenic, homogeneous wall thickening, with or without a positive compression sign in the temporal arteries. The Halo count, i.e., the number of temporal and axillary artery segments with signs of arteritis, was evaluated. The reference was clinically diagnosed GCA confirmed after ≥6-month follow-up. Of the eligible 107 patients with new suspected GCA, 33 (31%) received a clinical GCA diagnosis. Neovascularization was detected in 14 patients (43%). Patients with neovascularization displayed a higher halo count [median 6 (25th-75th percentile 4.75-7) vs. 3 (2-4-4), p = 0.005]. CDU of only the temporal arteries showed sensitivity and specificity (95% confidence intervals) of 94% (80-100%) and 100% (95-100%), respectively. The addition of extra-cranial arteries increased the sensitivity to 100%. Of the 13 patients investigated for suspected relapse, three had a clinically confirmed relapse. One of them displayed neovascularization together with other signs of inflammation. We show for the first time that inflammatory neovascularization of the temporal arteries can be detected by SMI. Neovascularization is associated with a more-widespread cranial disease. The value of neovascularization should be further investigated, especially for the detection of GCA relapse.

Vertebrobasilar system variations; Analysis with multi-detector CT angiography

Objective: The vertebrobasilar system provides vascular nutrition to the posterior part of the brain, medulla spinalis, medulla oblongata, and cerebellum. Anatomical variations in these vascular structures increase the incidence of thrombus and aneurysms in patients. This study examines the presence of anatomical anomalies in the vertebrobasilar system. Material and Methods: Retrospective CT angiogram images of 93 adult cases over 18 years of age who were examined for any reason in KSU, Training and Research Hospital Radiology Unit. Results: Vertebral artery hypoplasia was observed in 15% of the cases. Left dominance was observed in 64.2% of the cases, right dominance in 28.6%, and co-dominance in 7.2%. Vertebral artery duplication was not observed. Vertebral artery fenestration was observed in 2.1% of cases. Vertebral artery of flexible origin was detected in 7.5%. In 57% of cases with a variable origin, the vertebral artery originated as the second branch of the subclavian artery. The right vertebral artery originating from the brachiocephalic artery was seen in 14.2%, the left vertebral artery originating from the arcus aorta was seen in 14.2%, and the left aberrant vertebral artery was seen in 14.2%. Fenestration of the basilar artery was observed in 2.1%, and hypoplasia of the basilar artery in 1.1%. Fetal type PCA variation was observed in 35.4% of cases, bilateral fetal PCA in 3.2%, right fetal PCA in 17.2%, and left fetal PCA in 15%. PCA duplication was observed in 3.2%, SCA duplication in 16.1%, unpaired single SCA in 2.1%, and SCA fenestration in 1.1%. An unpaired single AICA was observed in 15%, duplication of AICA in 2.1%, hypoplastic AICA in 6.4%, and AICA originating from SCA in 1.1%. An unpaired single PICA was observed in 12.9%, hypoplastic PICA in 2.1%, basilar artery originating PICA in 9.6%, AICA originating PICA in 4.3%, and PICA duplication in 1.1%. Conclusion: This study provides a detailed analysis of anatomical variations in the vertebrobasilar system using multi-detector CT angiography. The findings highlight the prevalence and diversity of these variations, such as vertebral artery hypoplasia, dominance patterns, fenestrations, and origin variations. These variations have significant clinical implications, particularly in the context of interventional and surgical procedures, as well as in the diagnosis and management of cerebrovascular diseases. Recognizing and understanding these anatomical differences can aid clinicians in planning more effective treatment strategies, potentially reducing the risk of complications associated with thrombus and aneurysm formation. Further research with larger and more diverse populations is recommended to validate these findings and to explore the impact of these variations on clinical outcomes. Ultimately, this study contributes to the existing body of knowledge and underscores the importance of personalized approaches in the management of vertebrobasilar system anomalies.

Y-shaped graft replacement of an isolated innominate artery aneurysm via the transmanubrial approach.

We report the rare case of an obese woman with a 32-mm isolated innominate artery aneurysm. Due to the deep location of the aneurysm within the thoracic inlet, we selected a transmanubrial osteomuscular sparing approach to obtain a clear field of vision. During the aneurysmectomy and reconstruction with a Y-shaped graft, we performed a temporary bypass using a contralateral leg of the graft to the right common carotid artery. Through these techniques, we successfully achieved complete resection and reconstruction of the aneurysm without the need for cardiopulmonary bypass.

Branch Thrombus after Endovascular Treatment with Arch Branched Devices for Aortic Arch Pathologies

The aim of this study was to describe the occurrence of branch thrombosis following endovascular treatment of aortic arch pathology using an arch branched device (ABD) and to determine whether this is influenced by clinical and geometric parameters. In this retrospective observational study of patients treated with an ABD in three centres, the primary endpoint was thrombus formation within a branch during follow up. Secondary endpoints were technical success, serious adverse events (SAEs), early and late death, stroke, and re-interventions. Geometric measurements (tortuosity index and curvature) were determined on pre-operative and post-operative computed tomography angiographies. Thirty nine patients were treated and 68 antegrade branches were analysed (innominate artery, n = 27; common carotid artery [CCA], n = 40; left subclavian artery [LSA], n = 1). Thrombus was identified within seven branches (10%) on surveillance imaging (innominate artery, n = 6; CCA, n = 1; LSA, n = 0; p = .021) and was associated with a wider distal bridging stent diameter (median 14.0 mm [interquartile range {IQR} 2.0] vs. 8.7 mm [IQR 5.9]; p = .026), a higher degree of reversed tapering (4.3 mm [IQR 1.4] vs. 1.2 mm [IQR 2.8]; p = .023), use of polyethylene terephthalate (Dacron) covered (vs. expanded polytetrafluoroethylene) bridging stents (23% vs. 2%; p = .011), and higher body mass index (BMI) (32.1 kg/m2 [IQR 7.5] vs. 25.7 kg/m2 [IQR 5.4]; p = .029), but not with pre-operative or post-operative tortuosity index or curvature or alterations. Regarding secondary outcomes, the technical success rate was 97%, SAEs occurred in 15 patients (38%), early and late death rates were 8% and 23%, respectively, and early and late stroke rates were 5% and 23%, respectively. The risk of developing branch thrombosis after endovascular intervention with an ABD is considerable, especially of innominate artery branches, characterised by Dacron covered large diameter bridging stents, and in patients with a high BMI. Large prospective studies are required to analyse factors associated with branch thrombosis.

Aberrant Origin of Left Vertebral Artery – Multidetector Computed Tomography Study

Background: The vertebral arteries originating from respective subclavian arteries are the major source of oxygenated blood to posterior cerebral circulation and supply the upper spinal cord, brain stem, cerebellum, and occipital lobes of the cerebrum. Paucity of radiological studies prompted us to undertake this study which aims to analyze the variations in origin of left vertebral artery (LVA). Materials and Methods: This is a retrospective cross-sectional study of contrast-enhanced computed tomography chest scans of 710 subjects retrieved from the archives of a single imaging center. Observations and Discussion: Normal origin of LVA from the left subclavian artery (LSA) in the root of the neck was noted in 90.56% and variant origin in 9.44% of cases. Four-branched aortic arch (AA) with direct AA origin of LVA was observed in 6.76% of cases. An atypical three-branched pattern with LVA origin between the bovine trunk (common trunk of brachiocephalic trunk [BCT] and left common carotid artery [LCCA]) and LSA was seen in 0.84% of cases. Common origin of both LVA and LSA from a vertebro-subclavian trunk (VST) is found in 0.98% of cases. LVA as the last branch of arch distal to LSA and LVA of arch origin associated with aberrant right subclavian artery were noted in 0.14% of cases each. A rare but important observation is the presence of two common trunks (bovine trunk (BCT + LCCA) and VST (LVA + LSA) in an atypical two-branched fashion found in 0.56%. Conclusion: Critical knowledge of variations of the origin of LVA is clinically relevant as such variations are more prone to vascular pathologies. Variations of the LVA are thought to alter cerebral hemodynamics and can produce cerebral dysfunction. Preprocedural knowledge of such variations aids in the successful accomplishment of catheterization of LVA and avoids complications during neuroradiological interventions and surgical procedures.

ATHEROSCLEROTIC CHANGES OF BRACHIOCEPHALIC ARTERIES IN DIFFERENT AGE GROUPS ACCORDING TO SONOGRAPHY

Background. One of the most frequent causes of death is considered to be stroke on the back of atherosclerosis of the extracranial carotid arteries. Detection of atherosclerosis at an early stage facilitates timely prevention and reduces the risk of developing of an acute cardiovascular event in the future. Purpose. To evaluate the clinical significance of ultrasound in the diagnosis of atherosclerotic changes in the brachiocephalic arteries in people of different age groups. Materials and methods. Echography of brachiocephalic arteries was performed among 155 people aged 45 to 89 years, who were randomized into 3 age groups. The middle–aged group included 56 people; the elderly group – 54 people; the senile group - 45 people. The processing of the results of the study was carried out in the programs Statistica 10 (StatSoft, USA). Results. According to the data of sonography, atherosclerotic plaques were detected in 62.5% of the middle–aged group, 83.3% of the elderly group and 88.9% of senile age. Heterogeneous hypoechoic and calcified plaques are found only among people who are over 60 years old. Moderate stenosis was observed at the bifurcation of the common carotid artery in all age groups. Pronounced stenosis and critical vascular stenosis in the proximal part of the internal carotid artery are observed in senile age. The index of the maximum systolic velocity among people with atherosclerosis decreases with age. With increasing age, the level of vascular resistance increases. Conclusion. Considering significant changes in the indicators of atherosclerotic manifestations already in middle age, in order to reduce the increase in population mortality from cardiovascular diseases, the healthcare system should introduce early ultrasound screening of brachiocephalic arteries for patients from 18 years of age.

Novel Mouse Model of Myocardial Infarction, Plaque Rupture, and Stroke Shows Improved Survival With Myeloperoxidase Inhibition.

Thromboembolic events, including myocardial infarction (MI) or stroke, caused by the rupture or erosion of unstable atherosclerotic plaques are the leading cause of death worldwide. Although most mouse models of atherosclerosis develop lesions in the aorta and carotid arteries, they do not develop advanced coronary artery lesions. Moreover, they do not undergo spontaneous plaque rupture with MI and stroke or do so at such a low frequency that they are not viable experimental models to study late-stage thrombotic events or to identify novel therapeutic approaches for treating atherosclerotic disease. This has stymied the development of more effective therapeutic approaches for reducing these events beyond what has been achieved with aggressive lipid lowering. Here, we describe a diet-inducible mouse model that develops widespread advanced atherosclerosis in coronary, brachiocephalic, and carotid arteries with plaque rupture, MI, and stroke. We characterized a novel mouse model with a C-terminal mutation in the scavenger receptor class B, type 1 (SR-BI), combined with Ldlr knockout (designated SR-BI∆CT/∆CT/Ldlr-/-). Mice were fed Western diet (WD) for 26 weeks and analyzed for MI and stroke. Coronary, brachiocephalic, and carotid arteries were analyzed for atherosclerotic lesions and indices of plaque stability. To validate the utility of this model, SR-BI∆CT/∆CT/Ldlr-/- mice were treated with the drug candidate AZM198, which inhibits myeloperoxidase, an enzyme produced by activated neutrophils that predicts rupture of human atherosclerotic lesions. SR-BI∆CT/∆CT/Ldlr-/- mice show high (>80%) mortality rates after 26 weeks of WD feeding because of major adverse cardiovascular events, including spontaneous plaque rupture with MI and stroke. Moreover, WD-fed SR-BI∆CT/∆CT/Ldlr-/- mice displayed elevated circulating high-sensitivity cardiac troponin I and increased neutrophil extracellular trap formation within lesions compared with control mice. Treatment of WD-fed SR-BI∆CT/∆CT/Ldlr-/- mice with AZM198 showed remarkable benefits, including >90% improvement in survival and >60% decrease in the incidence of plaque rupture, MI, and stroke, in conjunction with decreased circulating high-sensitivity cardiac troponin I and reduced neutrophil extracellular trap formation within lesions. WD-fed SR-BI∆CT/∆CT/Ldlr-/- mice more closely replicate late-stage clinical events of advanced human atherosclerotic disease than previous models and can be used to identify and test potential new therapeutic agents to prevent major adverse cardiac events.

Urolithin A promotes atherosclerotic plaque stability by limiting inflammation and hypercholesteremia in Apolipoprotein E-deficient mice.

Urolithin A (UroA), a dietary phytochemical, is produced by gut bacteria from fruits rich in natural polyphenols ellagitannins (ETs). The efficiency of ETs metabolism to UroA in humans depends on gut microbiota. UroA has shown a variety of pharmacological activities. In this study we investigated the effects of UroA on atherosclerotic lesion development and stability. Apolipoprotein E-deficient (ApoE-/-) mice were fed a high-fat and high-cholesterol diet for 3 months to establish atherosclerosis model. Meanwhile the mice were administered UroA (50 mg·kg-1·d-1, i.g.). We showed that UroA administration significantly decreased diet-induced atherosclerotic lesions in brachiocephalic arteries, macrophage content in plaques, expression of endothelial adhesion molecules, intraplaque hemorrhage and size of necrotic core, while increased the expression of smooth muscle actin and the thickness of fibrous cap, implying features of plaque stabilization. The underlying mechanisms were elucidated using TNF-α-stimulated human endothelial cells. Pretreatment with UroA (10, 25, 50 μM) dose-dependently inhibited TNF-α-induced endothelial cell activation and monocyte adhesion. However, the anti-inflammatory effects of UroA in TNF-α-stimulated human umbilicalvein endothelial cells (HUVECs) were independent of NF-κB p65 pathway. We conducted RNA-sequencing profiling analysis to identify the differential expression of genes (DEGs) associated with vascular function, inflammatory responses, cell adhesion and thrombosis in UroA-pretreated HUVECs. Human disease enrichment analysis revealed that the DEGs were significantly correlated with cardiovascular diseases. We demonstrated that UroA pretreatment mitigated endothelial inflammation by promoting NO production and decreasing YAP/TAZ protein expression and TEAD transcriptional activity in TNF-α-stimulated HUVECs. On the other hand, we found that UroA administration modulated the transcription and cleavage of lipogenic transcription factors SREBP1/2 in the liver to ameliorate cholesterol metabolism in ApoE-/- mice. This study provides an experimental basis for new dietary therapeutic option to prevent atherosclerosis.

Practical uses of the BENCHMARK™ BMX®81 in the road less travelled: Guide catheter comparison for radial access in neurovascular intervention.

Radial arterial access has gained interest for neurovascular procedures in recent years. Although there are no randomized control trials for neurointervention procedures using radial access, there is growing literature demonstrating its feasibility and favorable outcomes. Equipment technical improvements, like the recently introduced BENCHMARK™ BMX®81 System, have made radial navigation safer, with improved maneuverability and support for a variety of procedures. We present a multicenter case series highlighting our institutional radial access experience comparing the BMX®81 with alternative catheters. Multicenter retrospective cohort study of 80 patients who underwent neurovascular procedures through a radial approach. In half of the cases a BENCHMARK™ BMX®81 System was used. The comparison group consisted of the BENCHMARK™071 and 96, Neuron MAX®088 and BALLAST™ systems. Procedures included endovascular thrombectomy, carotid and brachiocephalic artery stenting, middle meningeal artery embolization, flow diverter stenting, vertebral artery sacrifice, aneurysm coiling, and WEB™ device deployment. In our series, the BMX®81 was successful in the navigation of the anatomy to the target location in 95% of cases. No radial access or BMX®81 related complications were identified. There was no significant difference in fluoroscopy time between the BMX81 and the comparison group. Four patients in the comparison group had catheter-related complications due to vasospasm. Eighty-six percent of BMX®81 cases had satisfactory outcomes and no technical difficulties. The remainder presented technical difficulties, but none of these were considered secondary to the puncture site or support structure. The BENCHMARK™ BMX®81 System is a recently developed guiding catheter which has design and size features supporting radial access for a variety of neurovascular interventions. Early multicenter experience highlights the ease of use and versatility of this new catheter as an alternative to transfemoral access as well as other catheters used for radial access.