Luminal Diameter Research Articles

The functional lumen imaging probe in gastrointestinal disorders: the past, present, and future.

The functional lumen imaging probe (FLIP) is a diagnostic tool that utilizes impedance planimetry to allow the assessment of luminal diameter and distensibility. It has been used primarily in esophageal diseases, in particular, in the assessment of achalasia, esophagogastric junction outflow obstruction, and eosinophilic esophagitis (EoE). The usage and publications have increased over the past decade and it is now an essential tool in the armamentarium of the esophagologist. Indications are emerging outside of the esophagus, in particular with regard to gastroparesis. Our paper will review the history of FLIP, optimal current usage, data for key esophageal disorders (including achalasia, reflux, and EoE), data for nonesophageal disorders, and our sense as to whether FLIP is ready for prime time, as well as gaps in evidence and suggestions for future research.

The Effect of Post-Operative Handgrip Exercise on the Maturation of Arteriovenous Fistula: a Randomized Controlled Trial

Hand exercise is advised for newly placed arteriovenous fistulae for hemodialysis because of its effects on vein diameter and fistula maturation, however with controversy and inconsistent results. The objective of this study is to evaluate the effect of post-operative handgrip exercise on the maturation of arteriovenous fistula (AVF). A single institution, single surgeon, in-hospital, two arm, open-labeled randomized control trial, comparing exercise group and control group, was conducted between 2017 and 2018. Clinical maturation was defined as the use of AVF for repetitive hemodialysis. Duplex ultrasound (DUS) maturation was defined as the cross-sectional luminal diameter of draining vein > 4 mm and intra-access flow rate > 500 ml/min. Out of 200 patients recruited, 98 were randomized to exercise group and 96 to control and 6 were excluded as they were lost to follow-up. Mean age was 40 ± 13 years, with 71.6% males. Radiocephalic AVF was created in 130/194 (67%) patients. In RCAVF, 104/130 (80%) achieved clinical maturation, 59/104 (56.7%) in exercise group, and 45/104 (43.26%) in control group (p = 0.043). Duplex ultrasound (DUS) maturation was seen in 86/130 (66.2%) cases, 48/86 (55.8%) in exercise group and 38/86 (44.2%) in control group (p = 0.263). In brachiocephalic AVF, clinical maturation was seen in 57/64 (89.1%) cases, 27/57 (47.4%) and 30/57 (52.6%) in exercise and control group respectively (p = 0.821). Duplex ultrasound (DUS) maturation in BCAVF was seen in 57/64 (89.1%) cases, 27/57 (47.4%) in exercise and 30/57 (52.6%) in control group (p value = 0.821). Post-operative handgrip exercise improves clinical maturation in radiocephalic arteriovenous fistula. Registration number: CTRI/2017/04/008283, Registered on 03.04.2017

Stenting-induced Vasa Vasorum compression and subsequent flow resistance: a finite element study.

Vascular stenting is a common intervention for the treatment for atherosclerotic plaques. However, stenting still has a significant rate of restenosis caused by intimal hyperplasia formation. In this study, we evaluate whether stent overexpansion leads to Vasa Vasorum (VV) compression, which may contribute to vascular wall hypoxia and restenosis. An idealized multilayered fibroatheroma model including Vasa Vasorum was expanded by three coronary stent designs up to a 1.3:1 stent/artery luminal diameter ratio (exp1.1, exp1.2, exp1.3) using a finite element analysis approach. Following Poiseuille's law for elliptical sections, the fold increase in flow resistance was calculated based on VV compression in the Intima (Int), Media (Med) and Adventitia (Adv). The VV beneath the plaque experiences the smallest degree of compression, while the opposite wall regions are highly affected by stent overexpansion. The highest compressions for Adv, Med and Int at exp1.1 are 60.7, 65.9, 72.3%, at exp1.2 are 62.1, 67.3, 73.5% and at expp1.3 are 63.2, 68.7, 74.8%. The consequent fold increase in resistance to flow for Adv, Med and Int at exp1.1 is 3.3, 4.4, 6.6, at exp1.2 is 3.5, 4.7, 7.2 and at exp1.3 is 3.8, 5.1, 7.9. Stent overexpansion induces significant VV compression, especially in the Intima and Media layers, in agreement with previously observed Media necrosis and loss in elasticity after stenting. The observed steep increase in flow resistance suggests the blood flow and associated oxygen delivery would drop up to five times in the Media and almost eight in the Intima, which may lead to intimal hyperplasia and restenosis.

Medium-Term Complications Associated With Coronary Artery Aneurysms After Kawasaki Disease: A Study From the International Kawasaki Disease Registry.

BackgroundCoronary artery aneurysms (CAAs) may occur after Kawasaki disease (KD) and lead to important morbidity and mortality. As CAA in patients with KD are rare and heterogeneous lesions, prognostication and risk stratification are difficult. We sought to derive the cumulative risk and associated factors for cardiovascular complications in patients with CAAs after KD.Methods and ResultsA 34‐institution international registry of 1651 patients with KD who had CAAs (maximum CAA Z score ≥2.5) was used. Time‐to‐event analyses were performed using the Kaplan–Meier method and Cox proportional hazard models for risk factor analysis. In patients with CAA Z scores ≥10, the cumulative incidence of luminal narrowing (>50% of lumen diameter), coronary artery thrombosis, and composite major adverse cardiovascular complications at 10 years was 20±3%, 18±2%, and 14±2%, respectively. No complications were observed in patients with a CAA Z score <10. Higher CAA Z score and a greater number of coronary artery branches affected were associated with increased risk of all types of complications. At 10 years, normalization of luminal diameter was noted in 99±4% of patients with small (2.5≤Z<5.0), 92±1% with medium (5.0≤Z<10), and 57±3% with large CAAs (Z≥10). CAAs in the left anterior descending and circumflex coronary artery branches were more likely to normalize. Risk factor analysis of coronary artery branch level outcomes was performed with a total of 893 affected branches with Z score ≥10 in 440 patients. In multivariable regression models, hazards of luminal narrowing and thrombosis were higher for patients with CAAs of the right coronary artery and left anterior descending branches, those with CAAs that had complex architecture (other than isolated aneurysms), and those with CAAs with Z scores ≥20.ConclusionsFor patients with CAA after KD, medium‐term risk of complications is confined to those with maximum CAA Z scores ≥10. Further risk stratification and close follow‐up, including advanced imaging, in patients with large CAAs is warranted.

Measurement of the Internal Carotid Artery Cross-Sectional Area: Systematic Differences Depending on Grayscale, Power Doppler, and Color Doppler Techniques.

To determine how measurements of the internal carotid artery (ICA) cross-sectional area will differ systematically when obtained by grayscale, color Doppler, and power Doppler imaging. A total of 451 patients had greater than 40% diameter stenosis in at least a single ICA. Anteroposterior and transverse luminal diameters were measured in 609 arteries on grayscale, color, and power Doppler transverse images of the carotid bulb and proximal and distal ICAs. Cross-sectional areas were calculated and compared by a repeated-measures analysis of variance model to assess for significant differences. Mean ICA cross-sectional areas ± SDs as measured by grayscale, power Doppler, and color Doppler imaging were 122 ± 81, 122 ± 79, and 125 ± 79 mm2 , respectively. The mean ICA area estimated by color Doppler imaging was significantly greater than that estimated by power Doppler imaging (P < .0001) and grayscale imaging (P = .02). Area estimates on grayscale and power Doppler images were not significantly different (P = .99). After accounting for the correlation of repeated measurements within single vessels, color Doppler estimates of the luminal area were on average 3.44 and 9.5 mm2 greater than grayscale and power Doppler estimates. Relative cross-sectional area estimates were on average 9.4% greater with color Doppler imaging at smaller luminal diameters (<60 mm2 ) compared with larger luminal diameters. Measurements of the ICA cross-sectional area by color Doppler imaging were significantly greater than those obtained by power Doppler or grayscale imaging. This difference should be considered when stenosis estimates are confirmed or graded by luminal measurements.

Potential MR Enterography Features to Differentiate Primary Small Intestinal Lymphoma From Crohn Disease.

OBJECTIVE. The purpose of this study was to assess the MR enterographic features of primary small intestinal lymphoma (PSIL) and compare them with active Crohn disease (CD) presenting with severe (≥ 10 mm) mural thickening of the small bowel. MATERIALS AND METHODS. This retrospective study included 15 patients with pathologically proven PSIL and 15 patients with active inflammatory CD with severe mural thickening. Various morphologic, enhancement, and diffusion parameters were compared between the two groups at MR enterography. The ratios of the upstream to involved luminal diameter and mural thickness to luminal diameter in the involved segment were calculated. An attempt was made to define a predictive model (morphologic score) for discriminating PSIL from CD with severe mural thickening. RESULTS. Patients with PSIL were more likely than those with CD to have unifocal disease (66.7% vs 20.0%, p = 0.025), circumferential involvement (86.7% vs 26.7%, p < 0.001), luminal dilatation (60.0% vs 7.0%, p = 0.005), and an attenuated fold pattern (53.3% vs none, p < 0.001). They were less likely to have serosal surface involvement (40.0% vs 100%, p = 0.001) and mesenteric fat infiltration (33.3% vs 100%, p < 0.001). Median upstream to involved luminal diameter ratio (1.5 vs 9.6, p < 0.001) and mural thickness to involved luminal diameter ratio (1.1 vs 4.3, p = 0.044) were significantly lower in patients with PSIL than in those with CD with severe mural thickening. No significant difference was observed in enhancement and diffusion measures. Morphologic score was based on the presence of luminal dilatation, unifocal involvement, mesenteric fat infiltration, and luminal stricture, yielding accuracy of 98% for differentiation between PSIL and CD with severe mural thickening. CONCLUSION. Morphologic features seen at MR enterography rather than enhancement or diffusion parameters may be valuable for differentiation of PSIL from active CD with severe mural thickening with significantly lower ratios of upstream to involved luminal diameter and mural thickness to involved luminal diameter in PSIL.

Retinal Glial and Choroidal Vascular Pathology in Donors Clinically Diagnosed With Stargardt Disease.

PurposeThe present study investigated retinal glia and choroidal vessels in flatmounts and sections from individuals with clinically diagnosed Stargardt disease (STGD).MethodsEyes from three donors clinically diagnosed with STGD were obtained through the Foundation Fighting Blindness (FFB). Genetic testing was performed to determine the disease-causing mutations. Eyes were enucleated and fixed in 4% paraformaldehyde and 0.5% glutaraldehyde. After imaging, retinas were dissected and immunostained for glial fibrillary acidic protein, vimentin, and peanut agglutin. Following RPE removal, the choroid was immunostained with Ulex europaeus agglutinin lectin. For each choroid, the area of affected vasculature, percent vascular area, and choriocapillaris luminal diameters were measured. The retina from one donor was hemisected and cryopreserved or embedded in JB-4 for cross-section analysis.ResultsGenetic testing confirmed the STGD diagnosis in donor 1, whereas a mutation in peripherin 2 was identified in donor 3. Genetic testing was not successful on donor 2. Therefore, only donor 1 can definitively be classified as having STGD. All donors had areas of RPE atrophy within the macular region, which correlated with underlying choriocapillaris loss. In addition, Müller cells formed pre- and subretinal membranes. Subretinal gliotic membranes correlated almost identically with RPE and choriocapillaris loss.ConclusionsDespite bearing different genetic mutations, all donors demonstrated choriocapillaris loss and Müller cell membranes correlating with RPE loss. Müller cell remodeling was most extensive in the donor with the peripherin mutation, whereas choriocapillaris loss was greatest in the confirmed STGD donor. This study emphasizes the importance of genetic testing when diagnosing macular disease.

Covered airway stent loaded with (125)I seeds for tracheal adenoid cystic carcinoma: a clinical observation of 8 cases

Objective: To explore the efficacy and safety of the covered airway stent loaded with (125)I seeds for the treatment of tracheal adenoid cystic carcinoma (TACC). Methods: We retrospectively reviewed the clinical data from 8 patients with TACC who had received placement of the covered stent loaded with (125)I seeds between December 2014 and July 2017 in the endoscopic center of the Second Affiliated Hospital of Xiamen Medical College. We compared the difference in the dyspnea index, the diameter of the airway lumen, and the lesion surrounding the airway wall before and after treatment. The complications were also recorded during follow-up. Results: Eight patients underwent successful placement of a total of 11 radioactive stents (2 straight-type stents, 2 L-shape stents, and 7 Y-shape stents, all loaded a total of 243 radioactive particles). Displacement of stents took place within 2 weeks in 2 patients, who were managed with re-stenting and fixation. No further displacement occurred during follow-up. The median time to stent removal was 2.9(interquartile range: 2.3,3.0) months. After stent placement, the dyspnea index was significantly decreased compared with pre-treatment level (mean: 0.1 vs. 3.4, t=8.881, P<0.001). Bronchoscopic re-assessment showed that the residual tumor within the airway was detected in only one patient and that the tumor completely disappeared in the remaining 7 patients. Treatment with stents loaded with radioactive particles yielded smooth and pale airway mucosa with formation of partial scar formation. Chest computed tomography re-assessment demonstrated significantly larger luminal diameter than that before treatment (mean: 13.1 mm vs. 3.3 mm, t=-7.839, P<0.001). The airway wall thickness was notably reduced after treatment (mean: 4.3 mm vs. 14.4 mm, t=7.620, P<0.001). The lesions surrounding the airway wall completely disappeared in 7 patients and decreased for more than 50% in a single patient. The median duration of follow-up was 28.0(interquartile range: 24.8,31.5) months. Recurrence of tumor was documented in a single case within 2 years. Six patients did not experience recurrence within the 2-year follow-up period. No death or severe complications were recorded during follow-up. Conclusion: The (125)I radioactive stent is effective for dilating the stenotic airway and ameliorating the symptoms, and thus might be an effective and safe method for the treatment of TACC. Further studies that explore the efficacy of stents loaded with (125)I particles are needed.

Late lumen enlargement after drug-coated balloon angioplasty for de novo coronary artery disease.

We aimed to identify predictors of late lumen enlargement (LLE) after drug-coated balloon (DCB) angioplasty for de novo coronary lesions. LLE, which is defined as an increase in the luminal diameter of the vessel from the immediate postprocedural measurement to follow-up measurements, is frequently observed after DCB angioplasty for de novo coronary artery disease. No predictors of LLE are known. This retrospective observational study analyzed 196 de novo coronary lesions in 182 patients who underwent both DCB angioplasty and follow-up angiography. Of the 196 lesions, 109 (56%) developed LLE during a mean follow-up period of 7.2 ± 2.5months. As defined by American College of Cardiology (ACC)/American Heart Association (AHA) lesion types, lesions with LLE were significantly less severe than lesions without LLE (types A, B1, B2 and C 15%, 35%, 38% and 13% vs. 7%, 24%, 45% and 24%, respectively; p = 0.036), although no significant differences in clinical or other lesion background characteristics were observed between the groups. Among type C lesions, chronic total occlusion (CTO) was more frequently observed in lesions with LLE than in lesions without LLE (79% vs 43%, p = 0.036). Lesion severity predicts LLE after DCB angioplasty for de novo coronary artery disease. Among type C lesions, CTO is expected in lesions showing LLE, and preparations should therefore be made prior to DCB application. Further research is needed.

Undernutrition Promotes Oxidative Stress &amp; Capillary Regression In Skeletal Muscle

PURPOSE: An undernutrition condition results in muscle atrophy and mitochondrial dysfunction. However, it is still not well-known that the characteristics of the skeletal muscle capillary network during undernutrition. The purpose of the present study was to verify the effects of undernutrition on the capillary network in skeletal muscle. METHODS: Male Wistar rats were assigned randomly to control and undernutrition groups. The rats in the undernutrition group fed low protein and limited 50% diets daily for 12 weeks. Plantaris and soleus muscle were analyzed. The three-dimensional capillary network of skeletal muscle was visualized using a confocal laser scanning technique. The capillary volume, mean luminal diameter and capillary-to-fiber ratio were measured in both skeletal muscles. In addition, the levels of VEGF and thrombospondin-1 proteins, lipid peroxidation and SOD-2 proteins were determined. RESULTS: The muscle mass decreased only plantaris muscle in the undernutrition group. The level of lipid peroxidation was increased, and the expression levels of SOD-2 in plantaris and soleus muscles were decreased. In addition, the capillary volume, mean luminal diameter and capillary-to-fiber ratio were decreased in both muscles of the undernutrition group. Furthermore, the level of VEGF protein was decreased, and thrombospondin-1 was increased in both muscles of undernutrition group. CONCLUSIONS: These results suggest that undernourished skeletal muscle induces capillary regression with increased oxidative stress, which also occurs in slow muscle without atrophy.

Correlation of optical coherence tomography-derived variables with fractional flow reserve (≤0.8) in patients with coronary artery stenosis: An observational study

Objective: The present study was designed to establish the correlation between anatomical variables analyzed using optical coherence tomography (OCT) and physiological assessment provided by fractional flow reserve (FFR, ≤0.8) in patients with significant coronary artery stenosis. Materials and Methods: This was a prospective, single-center observation study which included total fifty patients who were diagnosed with coronary artery disease in the presence of significant stenosis (>70%) as per coronary angiography. The FFR ≤0.8 was considered as positive with severe stenosis. Minimal luminal area (MLA), minimal luminal diameter (MLD), percent area stenosis, and percent diameter stenosis were calculated as OCT variables in all patients. Results: The mean age of the patients was 56 ± 7.13 years. The mean FFR was found to be 0.72 ± 0.06. The OCT-derived MLA was 1.97 ± 0.53 mm2 and MLD was 1.35 ± 0.22 mm. The Pearson correlation coefficients of OCT-derived MLA (cutoff: 2 mm2) and MLD (cutoff: 1.24 mm) with FFR were 0.21 (P

Drug-Coated balloons vs drug-eluting stents for the treatment of small coronary artery disease: A meta-analysis of randomized trials.

There is conflicting evidence about the effects of drug-coated balloons (DCB) compared with drug-eluting stents (DES) in patients with native small vessel coronary artery disease (CAD). The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases and main international conference proceedings were searched for randomized controlled trials (RCT) comparing DCB versus DES in patients with native small vessel CAD. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was target vessel revascularization (TVR). Secondary clinical endpoints were: myocardial infarction (MI), target lesion revascularization (TLR), all-cause death, cardiac death, and stent thrombosis or target vessel thrombosis. Secondary angiographic outcomes were: in-segment restenosis, in-segment percentage-diameter stenosis, in-segment late lumen loss, in-segment net luminal gain, and in-segment minimal lumen diameter. Five trials enrolling 1,459 patients were included. Mean clinical follow-up was 10.2months. The use of DCB, compared with DES, was associated with similar risk of TVR (odds ratio [OR]: 0.97; 95% confidence interval [CI] 0.56 to 1.68; p=.92), TLR (OR: 1.74; 95% CI: 0.57 to 5.28; p=.33), all-cause death (OR: 1.03; 95% CI: 0.14 to 7.48; p=.98), with a trend toward a lower risk of MI (OR: 0.49; 95% CI: 0.23 to 1.03; p=.06), and with significant lower risk of vessel thrombosis (OR: 0.12; 95% CI: 0.01 to 0.94; p=.04). DCB use was associated with similar risk of angiographic restenosis (OR: 1.12; 95% CI 0.69 to 1.84; p=.64), comparable late luminal loss (standardized mean difference (SMD): -0.18; 95% CI: -0.39 to 0.03; p=.09), while leading to significant higher percentage diameter stenosis (SMD: 0.27; 95% CI 0.12 to 0.41; p < .01) and smaller minimal luminal diameter (SMD: -0.52; 95% CI: -0.86 to -0.18; p=.003). Compared with DES, the use of DCB for the treatment of native small vessel CAD is associated with similar TVR and restenosis and reduces the risk of vessel thrombosis, although DES implantation yields slightly better angiographic surrogate endpoints.

Neuroprotective effects of quercetin on cerebral vasospasm following experimental subarachnoid haemorrhage in rats

Background/aim We examined the protective effects of the natural flavonoid, quercetin, against cerebral vasospasm in an experimental rat subarachnoid haemorrhage (SAH) model. Materials and methods Thirty-eight albino Wistar rats were divided into five groups as follows: group 1 (G1, n=8), no experimental intervention; group 2 (G2, n=8), subarachnoid physiological saline; group 3 (G3, n=8), SAH; group 4 (G4, n=7) SAH and low-dose (10 mg/kg) quercetin treatment; group 5 (G5, n=7), SAH and high-dose (50 mg/kg) quercetin treatment. Subarachnoid haemorrhage was induced by injection of 0.15 cc of autologous blood taken from the tail artery into the cisterna magna from the craniocervical junction and basilar arteries and blood samples were taken for biochemical and histopathological analyses. Results Malondialdehyde (MDA) levels were significantly higher in G2 and G3 than in G1 (P < 0.05). Significant decreases in MDA were observed in G4 and G5 compared with G2 (P < 0.05, G4–G2; P < 0.05, G5–G2). There were no significant differences between G2 and G3 or among G1, G4, and G5. No statistically significant differences were found in total antioxidant capacity between the groups (P > 0.05). There were no significant differences in basilar artery (BA) wall thickness between G3 and G4 or between G3 and G5, but G4 and G5 showed greater luminal diameters than G3 (P < 0.05). There were no significant differences in BA thickness or luminal diameter between G4 and G5. Conclusion Our results suggested that quercetin may be beneficial in SAH therapy by preventing vasospasm.

Iliac Artery Endoconduits Should Be the Preferred Adjunctive Access Procedure to Facilitate Endovascular Complex Aortic Aneurysm Repair

Anatomic factors of the iliac arteries, including vessel calcification, luminal diameter, and tortuosity can have a dramatic impact on the success complex endovascular aortic procedures. The aim of this study was to evaluate the outcomes of open and endovascular iliac conduits performed to facilitate complex aortic aneurysm endovascular repair. All patients who underwent complex endovascular aortic aneurysm repair through an iliac conduit to treat thoracoabdominal, juxtarenal or suprarenal aneurysms at the University of Colorado Hospital from September 2013 through June 2019 were included. Primary outcomes were endovascular and open iliac conduits morbidity and mortality. A total of 27 patients with 43 conduits were included in the study. The majority of the patients were female (n = 15, 56%). Hypertension (n = 16, 59%) and diabetes (n = 4, 20%) were the most prevalent risk factors. Twenty-two (51%) endoconduits and 21 (49%) open conduits were performed. Patients undergoing endo conduits had significant less complications than those undergoing open conduits (1, 4% vs 10, 48%; P = .02). The most common complications of open conduits were infection (n = 5, 24%) and postoperative hemorrhage (n = 4, 19%). The only complication noted for endoconduits was one access site hematoma requiring surgical evacuation. Overall mortality rate was similar and not related to type of conduit (endoconduits 1, 4% vs open 0; P = NS). Overall complication rate associated with open iliac artery conduits is not negligible. Endoconduits, however, carry less morbidity than open conduits and are thus preferred as a first line adjunctive access to facilitate complex endovascular aneurysm repair whenever feasible.

Shockwave™ Lithoplasty in Combination With Atherectomy in Treating Severe Calcified Femoropopliteal and Iliac Artery Disease: A Single-Center Experience

BackgroundCalcium is a predictor of poor outcome in the treatment of infrainguinal arterial disease. Rotational atherectomy can effectively debulk atherosclerotic calcium but is less likely to significantly modify medial and adventitial calcinosis. Shockwave IVL provides circumferential sonic pressure waves capable of disrupting deeper calcium and theoretically complements the debulking process of atherectomy. We present acute and intermediate outcome data from patients with severe femoral or iliac artery calcified disease treated with the combination of rotational atherectomy and Shockwave IVL at a single center. MethodsThis is a retrospective study of prospectively collected data on rotational atherectomy (Jetstream (Boston Scientific) and orbital atherectomy (CSI)) from a single operator at a single center with core laboratory analysis of angiographic imaging. All patients that received the combination treatment of rotational atherectomy and Shockwave IVL were included in this study. Patient follow-up was done from medical records with data extracted by an experienced research coordinator. Primary safety endpoint was freedom from major adverse events including major dissection (NHLBI C or higher), perforation, distal embolization, or major amputation defined as amputation above the ankle. Primary effectiveness endpoint was procedural success (≤ 30% residual at end of procedure). 23/24 (95.8%) patients were treated with drug coated balloons (DCB) post combination therapy. Secondary endpoint on follow-up was target lesion revascularization (TLR). ResultsA total of 24 patients were included. Mean age was 70.7 ± 9.9 years. Lesions were in the femoropopliteal 79.1%, common femoral 12.5% and iliac 8.3% arteries. 87.0% were claudicants and 58.3% diabetics. Chronic total occlusion was 12.5%, severe calcium 100%, lesion length 84.5 ± 37.1 mm, baseline stenosis 57.1 ± 18.9% and baseline minimal luminal diameter (MLD) 2.2 ± 1.1 mm. Patients were treated with Jetstream (n = 19) or Orbital (n = 5) atherectomy. Embolic filter was used in 58.3% of cases. Post atherectomy stenosis was 36.4 ± 17.5%, post adjunctive IVL 21.1 + 15.7%, and final stenosis 13.0 ± 10.9%. Bailout stenting was 4.6% and primary stenting 13.6% (total stenting rate 18.2%). Final MLD was 4.7 ± 0.8 mm, resulting in an acute gain of 2.5 mm. No infrapopliteal embolization or amputation was noted. At a mean follow up of 591.4 ± 175.2 days, 2 patients died (unrelated to procedure or device). Target lesion revascularization (TLR) at 12 months occurred in 2 patients or 2/22 (9%). At 18-month of follow up TLR occurred in 7/22 (31%) patients. ConclusionThe combination of atherectomy and shockwave IVL followed by adjunctive DCB is safe and appears to be effective in treating severe calcified disease with acceptable TLR on long term follow-up in a population of severe femoropopliteal disease.

Production of Swine Myocardial Infarction and Ischemic Heart Failure Models Using a Three-Dimensional Bioprinted Occluder

Objectives: Clinical reproducibility of large animal models is important for developing new therapies for myocardial infarction (MI) and ischemic heart failure (IHF). This study aimed to induce MI and IHF in a swine model by using 3D bioprinted occluders to interrupt intravascular blood flow permanently. Methods: The 3D bioprinted occluder was placed in the proximal left anterior descending artery using a guide wire and a balloon catheter. Echocardiography was performed at the baseline, post MI (day 7-14), and at 28 days follow-up after the placement of the occluder to evaluate cardiac function. Quantitative coronary angiography was performed at baseline, post MI (immediately after the procedure) and at 42 days follow-up. Histopathology confirmed the deformation of the heart tissue and hypoxic damage.Results: Luminal diameter distal to the 3D bioprinted occluder was significantly reduced from the baseline to 42 days follow-up and left ventricular (LV) ejection fraction gradually decreased from the baseline to 28 days follow-up after the induction of MI. Tetrazolium staining showed firm and white area of the infarction in the LV apex and LV anterior wall. Hematoxylin and eosin stained section samples showed loss of normal architecture and morphology of myocytes in the LV myocardium. In addition, HIF-1 alpha was expressed in the ischemic myocardium area by immunohistochemistry staining. Conclusions: The customized occluder via 3D bioprinting technology could induce a stable, consistent and reproducible swine MI and IHF model.

Intracranial Atherosclerosis: A Disease of Functional, not Anatomic Stenosis? How Trans-Stenotic Pressure Gradients Can Help Guide Treatment.

Most trials have assessed intracranial atherosclerotic disease (ICAD) severity based on angiographic stenosis. However, anatomic stenosis might not accurately identify the actual state of functional post-stenotic flow limitation. To investigate whether angiographic stenosis correlates with physiologic distal flow limitation, measured as trans-stenotic pressure gradients, in ICAD patients. In patients referred for endovascular treatment of anterior circulation symptomatic ICAD who failed maximal medical therapy (MMT) per SAMMPRIS (Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis) criteria, angiographic luminal diameters and percentages of stenosis were correlated with trans-stenotic pressure gradients, calculated as distal/proximal pressure ratios (DPPR) and proximal minus distal pressure gradients (PDPG), by way of Spearman correlation coefficients. Nine patients (3 men, 6 women) were evaluated. Atherosclerotic lesions' locations included internal carotid artery in 5 subjects (2 cavernous, 3 supraclinoid) and proximal middle cerebral artery (M1) in 4 patients. Mean percentage of stenosis was 80±8% (range 75%-94%). Minimal lumen diameter at the most stenotic ICAD site ranged from 0.2 to 0.9 mm (0.59±0.41 mm). DPPR ranged from 0.38 to 0.63 (0.56±0.14). PDPG ranged from 35 to 57 mm Hg (50±8 mm Hg). Spearman coefficients showed no correlation between DPPR or PDPG and angiographic minimal luminal diameters or percentages of stenosis. There were no procedural complications related to trans-stenotic pressure measurements. Angiographic stenosis does not reflect the physiologic severity of distal flow limitation in patients with ICAD. Hemodynamic assessment using trans-stenotic pressure ratios and gradients may serve as a more reliable predictive biomarker for MMT failure and response to revascularization.

Age related changes of vermiform appendix (Histomorphometric study)

Background: Many researches and studies were performed to investigate many aspects of the vermiform appendix. Many variations were observed at the different regions, among that, the focus was made on the lymphoid number and diameter, wall thickness, and luminal diameter. Objective: The aim of this work was to a finding of histomorphometery features of the adult vermiform appendix for different sex and age groups. Materials & methods: Fifty cadavers were included and divided into five age groups; A(20-29), B(30-39), C(40-49), D(50-59), and E(60-70)years. Ten cadavers were included for each age group. The inclusion criteria of the cadavers were brain stroke, built injuries, sudden death, car accident, and angina pectorals. The exclusion was with gangrenous, grossly inflammation and perforated appendices cadavers. Total length was measured from the base to the tip, as well as the diameter using a digital vernier caliper. Histological slides were made using HE Number and diameter of lymphoid follicles. Male and females have shown clear differences with increasing age groups.

Outcomes of Kawasaki disease with giant coronary aneurysms: a single-centre study in southwest China.

Giant coronary aneurysms are the most severe complications of Kawasaki disease. There are few reports of outcomes from China. Most previous studies were based only on absolute aneurysmal dimensions. The aim of the present study was to catalog the outcomes of Kawasaki disease with giant coronary aneurysms in southwest China based on absolute dimensions and the z-score adjusted for body surface area. All patients diagnosed with giant coronary aneurysms (z-score≥10 or absolute dimension≥8mm) between December, 2002 and December, 2018 were included. We retrospectively analysed patient characteristics and clinical data from 38 patients with giant coronary aneurysms. Over a median follow-up period of 30.5 months (range from 1.7 months to 22.3 years), including patients in chronic phase who had been diagnosed prior to 2002, eight patients had myocardial infarction, including two deaths and one patient with coronary artery bypass grafting. The 1-, 2-, and 5-year event-free rates were 0.63, 0.63, and 0.53 for thrombosis, respectively, and 0.86, 0.81, and 0.81 for major adverse cardiac events, respectively. The 1-, 2-, and 5-year regression-free rates were 0.94, 0.85, and 0.67, respectively. A total of 73.7% of patients remained active. In the early stages of Kawasaki disease, patients with giant coronary aneurysms often experience major cardiovascular events; however, they are also likely to have normalisation of the coronary internal luminal diameter. With long-term anticoagulation, close cardiologic monitoring, and prompt thrombolytic therapy, most patients can achieve disease-free periods.

Ultrasonographic measurement of adrenal gland-to-aorta ratio as a method of estimating adrenal size in dogs.

Adrenal size has been used as the principal criterion for differentiating a normal gland from adrenal hyperplasia. The objectives of this study were to establish an ultrasonographic measurement of adrenal gland-to-aorta (adrenal/Ao) ratio to estimate the adrenal size and to assess the effects of bodyweight, age and sex on the adrenal/Ao ratio in non-adrenal gland disease dogs. Two hundred and thirty-four dogs (120 entire females and 114 entire males) considered non-adrenal gland disease were included in this study. Dogs were allocated into three bodyweight categories (<10 kg, 10-20 kg and >20 kg), and four age groups (<1 year, 1-5 years, 5-10 years and >10 years old). Measurements of the maximal thickness of caudal pole of both adrenal glands and the aortic luminal diameter in sagittal plane were performed on the ultrasonographic images. Three different ratios were calculated for each dog. Sex and age did not influence on the adrenal/Ao ratio. There were differences (P<0.05) between the three dog sizes for adrenal/Ao ratio, being the highest value for small size and the lowest value for large size. In this study, only bodyweight influences the ultrasound measurement of the adrenal/Ao ratio in non-adrenal gland disease dogs.