Luminal Diameter Research Articles

Correlation and assessment of coronary artery luminal stenosis: Post-mortem computed tomography angiogram versus histopathology

BackgroundPost-mortem Computed Tomography (PMCT) allows non-invasive or minimally invasive detection of findings that may or may not be visible during conventional autopsy, however, it does not allow the investigator to draw any conclusions regarding patency of the vessel’s lumen. To address this deficiency, Post-mortem Computed Tomography Angiography (PMCTA) utilizing different contrast media and techniques have been introduced with various studies looking at the correlation between PMCTA, autopsy (gross) findings and coronary artery histology in diagnosing coronary artery disease. ObjectivesThe aim of this study is to investigate the sensitivity and specificity of PMCTA in diagnosing coronary artery stenosis using water-based contrast media introduced though the vessels of the neck, compared to the gold standard of diagnosis i.e. gross and histological evaluation of the coronary artery. MethodThis was a cross sectional study of 158 arterial sections involving 37 subjects recruited from the National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur (HKL). An unenhanced PMCT was performed followed by PMCTA using water-based contrast media introduced though the vessels of the neck. Coronary artery stenosis was determined using multiplanar reconstructionD while the degree of stenosis was determined by calculating the percentage of luminal diameter divided by the diameter of the vessel internal elastic. ResultsThe analysis of PMCTA and histopathology examinations revealed a sensitivity of 61.5%, specificity of 91.7%; positive predictive value (PPV) of 40.0% and negative predictive value (NPV) of 96.4%. ConclusionPMCTA utilizing water-based contrast introduced though the vessels of the neck yielded similar results as other methods and techniques of PMCTA. We would therefore conclude that PMCTA utilizing this technique could be used to assess the degree of calcification and the presence of significant stenosis.

Imaging features of vertebral artery fenestration.

Vertebral artery fenestration (VAF) is a rare congenital vascular anomaly which has been associated with intracranial aneurysm. VAF can share some similar imaging features with vertebral artery dissection (VAD), which may confound diagnosis of the latter on CT and MR angiography. The purpose of this investigation is to assess the prevalence of VAF, evaluate its association with other vascular anomalies, and identify imaging features to help in distinguishing VAF and VAD. Using keyword search on CTA and MRA head and neck imaging reports from 2010 to 2017, cases of VAF and VAD were retrospectively identified and imaging was reviewed. Imaging features including laterality; vertebral segment; length of affected segment; presence, number, and caliber of lumen(s); and presence of other vascular abnormalities were recorded for all cases and subsequently compared using Pearson's chi-squared test to assess for significant differences between the groups. Patient age, gender, and clinical presentations were also recorded. Of 64,888 CT and MR angiographic examinations performed, VAF was identified in 67 (0.1%) and VAD in 54 (0.1%) patients. Compared with VADs, VAFs were shorter in length (p< 0.001), wider in luminal diameter (p< 0.001), more likely to occur at the V4 segment (p< 0.01), more likely to have two distinct lumens rather than one (p< 0.01), and less likely to present post-trauma (p< 0.01). Coexisting intracranial aneurysms were identified in 9% of patients with VAF. VAFs, although rare, can be readily distinguished from VADs on angiographic imaging. Diagnosis of VAF should prompt review for intracranial aneurysm.

Collateral Development and Arteriogenesis in Hindlimbs of Swine After Ligation of Arterial Inflow

BackgroundDevelopment of collateral vasculature is key in compensating for arterial occlusions in patients with peripheral artery disease (PAD). We aimed to examine the development of collateral pathways after ligation of native vessels in a porcine model of PAD. MethodsRight hindlimb ischemia was induced in domestic swine (n = 11) using two versions of arterial ligation. Version 1 (n = 6) consisted of ligation with division of the right external iliac, profunda femoral, and superficial femoral arteries. Version 2 (n = 5) consisted of the ligation of version 1 with additional ligation with division of the right internal iliac artery. Development of collateral pathways was evaluated with standard angiography before arterial ligation and at termination (30 days later). Relative luminal diameter of the arteries supplying the ischemic right hind limb were determined by two-dimensional angiography. ResultsThe dominant collateral pathway that developed after version 1 ligation connected the right internal iliac artery to the right profunda femoral and then to the right superficial femoral and popliteal artery. Mean luminal diameter of the right internal iliac artery at termination increased by 38% compared with baseline. Two codominant collateral pathways developed in version 2 ligation: (i) from the left profunda femoral artery to the reconstituted right profunda femoral artery and (ii) from the common internal iliac trunk and the left internal iliac artery to the reconstituted right internal iliac artery, which then supplied the right profunda femoral and then the right superficial femoral and popliteal artery. The mean diameter of the left profunda and the left internal iliac artery increased at termination by 26% and 21%, respectively (P < 0.05). ConclusionsTwo versions of hindlimb ischemia induction (right ilio-femoral artery ligation with and without right internal iliac artery ligation) in swine produced differing collateral pathways, along with changes to the diameter of the inflow vessels (i.e., arteriogenesis).

Morphology of ejaculatory ducts: A systematic review.

The morphology of human ejaculatory ducts has not been well established. The objective of this study was to describe macroscopic and microscopic anatomy of ejaculatory ducts. We conducted a systematic review using MEDLINE, Scopus, PubMed, and Cochrane databases. Search terms were: "ejaculatory ducts," "seminal colliculus," "prostatic utricle," "anatomy," "histology," "radiology," and "embryology." We only included studies assessing adult (>18 years) humans published before November 1, 2019. We excluded studies describing pathological ducts and case reports. Independent authors extracted data using predefined criteria. Fourteen studies were included in the qualitative synthesis. Usually, the ejaculatory ducts entered the prostate by piercing the central part of its base. Most studies identified an anteromedial curve of the ducts at the outset within the prostate, their subsequent course being a straight path towards the seminal colliculus, their terminal parts diverging immediately before joining the prostatic urethra. However, the morphology of the terminal part of the ducts was inconsistent. The mean length of the ducts ranged from 1.4 to 2.2 cm. In conclusion, the luminal diameter gradually decreased as the ducts traveled towards the seminal colliculus. Ejaculatory ducts angulate anteromedially at their onset within the prostate and travel straight towards the seminal colliculus. Their terminal parts diverge immediately before joining the prostatic urethra. However, the reported dimensions of the ducts differ among studies.

Euterpe oleracea (Martius) Oil Reverses Testicular Alterations Caused after Cadmium Administration.

Cadmium (Cd) is an environmental pollutant that induces reproductive toxicity by generating reactive oxygen species, which leads to oxidative stress. Euterpe oleracea fruits are known for being rich in oils containing triacylglycerol and phenolic compounds. They are considered as potent antioxidants to be used to counteract Cd effects within the testis. In the present study, adult males Swiss mice were treated with CdCl2 aqueous solution (4.28mg/kg) by gavage for 7days. The experimental groups were treated with Euterpe oleracea oil at the doses of 50, 100, and 150mg/kg, for 42days. The results showed that Cd intoxication led to increased tubular pathologies, such as reduction in epithelium height and area thus increasing both luminal diameter and tubule-epithelium ratio. Besides, Leydig cell's morphometry indicated reduction in nucleus and cytoplasm volumes of this cell type, which were recovered after E. oleracea oil intake. In addition, serum testosterone levels, testicular Mn and Zn concentrations, SOD and CAT activity, and germ cell viability increased after oil intake. Therefore, E. oleracea oil showed a regenerative effect in the testicular parenchyma negatively affected by Cd, mainly in the animals that received the highest oil concentration (150mg/kg).

Is the Natural Anatomical Evolution of Type B Intramural Hematomas Reliable to Identify the Patients at Risk of Aneurysmal Progression?

The natural history of type B intramural hematomas is little-known. Aneurysmal progression or an aortic dissection occurs in 15 to 20% of the cases. The study of the natural anatomical evolution could help identify the patients at risk of unfavorable evolution. All the patients monitored for a type B intramural hematoma between 2009 and 2018 were included in this monocentric retrospective study. Computed tomography angiography centerline measurement of diameters was obtained in various points of aortic segmentation on day (D) 0 and at one month (M1). Aortic volumes (lumen, intramural hematoma, and total volume) were calculated. The circulating volume was calculated using the volume rendering method. The volume of the intramural hematoma was measured using a manual section-by-section segmentation tool, and the total volume was obtained by summing up the two preceding volumes. Two groups of patients were compared: group 1 (favorable anatomical evolution) and group 2 (unfavorable anatomical evolution). Between January 2008 and August 2018, 25 patients were managed for a type B intramural hematoma in our center. After an average follow-up of 15.5months (1-52), 13 patients (52%) presented a favorable evolution and 12 (48%) an unfavorable evolution. At M1, a significant increase of the luminal diameters (37mm vs. 32mm; P<0.01) and a significant reduction in the longitudinal extension (19mm vs. 26mm; P<0.01) were observed. The maximum aortic diameter evolved significantly between D0 and M1 in the unfavorable evolution group (49mm vs. 44 mm, respectively; P=0.038). Such a difference was not found in the favorable evolution group (37.4 vs. 37.1, respectively; P=0.552). An overall significant reduction in the total aortic volume (166cm3 vs. 219cm3; P<0.01), the circulating volume (124cm3 vs. 145cm3; P=0,026), and the volume of the hematoma (42cm3 vs. 39cm3; P<0.01) was observed. The circulating volume decreased significantly between D0 and M1 in the favorable evolution group (110cm3 vs. 135cm3; P=0.05), whereas no difference was noted in the unfavorable group (142cm3 vs, 157cm3; P=0.24). The progression of the maximum aortic diameter and of the circulating volume after one month of follow-up could be predictive factors of the poor long-term evolution of type B intramural hematomas.

P1443 Sex differences of coronary physiology can be justified by fractional myocardial mass

Abstract Background Women has lower prevalence of coronary artery disease but has higher mortality from acute myocardial infarction. The gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease. Purpose We hypothesized that the gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease. Background Women has lower prevalence of coronary artery disease but has higher mortality from acute myocardial infarction. The gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease. Methods In this multicenter registry, 482 patients who underwent coronary CT angiography and fractional flow reserve (FFR) measurement were enrolled. Fractional myocardial mass (FMM, a vessel-specific amount of myocardium) and %FMM (fraction of FMM to whole myocardial mass) was measured in major coronary arteries and branches. FFR and quantitative coronary angiography (QCA) were interrogated in the subset of 772 vessels. The severity of physiological or anatomical stenosis was assessed by FFR and diameter stenosis (DS), respectively. Results In the analysis of all major epicardial arteries (N = 3,833), FMM was lower in women compared to men (p &amp;lt; 0.01, all), but %FMM was similar between women and men (p = NS, all). Among physiologically assessed 772 vessels, compared to men (N = 587), vessels of women (N = 185) showed smaller dimension (reference diameter (RD) = 2.90 ± 0.65 vs 3.14 ± 0.69 mm, minimal luminal diameter (MLD) = 1.30±.0.57 vs 1.40 ± 0.57 mm (p &amp;lt; 0.05, all), similar severity of stenosis (DS = 55% vs 55% p = NS), and higher FFR (0.81 ± 0.13 vs 0.78 ± 0.15, p &amp;lt; 0.001). In subgroup analysis according to the tertiary categories of DS, RD, and MLD, vessels of women showed higher FFR and lower FMM. Generalized estimating equations modeling demonstrated that gender, DS, RD, MLD, and location in left anterior descending artery were not (p = NS, all) but FMM/MLD were significant predictors for FFR ≤ 0.80 (p = 0.021). Conclusions Compared to men, coronary arteries of women are smaller and supply smaller amount of myocardium even after adjusting for vessel size, which may explain overall higher FFR value of women. This gender difference in anatomical-physiological relationship may explain the gender difference in the clinical coronary artery disease. Abstract P1443 Figure.

Mirizzi syndrome - a reconstruction reconstrued: Technique for bile duct reconstruction using a vascularized gallbladder pedicle

Presenter: Prakash Jayanthi MD | Michigan State University College of Human Medicine Background: Mirizzi’s Syndrome is rare, with < 1% incidence in developed countries. No best treatment algorithm is available. Correct preoperative identification and planning is associated with less morbidity, with operative preference based on surgeon experience. The greater the degree of inflammation/erosion, the more complex the treatment - Csendes Type 1 Mirizzi patients benefit from cholecystectomy alone; Types 2-4 may require subtotal cholecystectomy/choledochoplasty versus biliary-enteric reconstruction; Type 5 usually requires fistula takedown/reconstruction. Methods: A 74-year old female presented with severe RUQ pain. CECT Abd/Pelvis: pneumobilia with air in gallbladder fossa. Perforated, gangrenous cholecystitis was suspected. MRI/MRCP: 3.5 cm gallstone impacted in the gallbladder neck, proximal hepatic duct dilatation, likely adjacent abscess. Bilioenteric fistula was suspected due to pneumobilia. Open cholecystectomy was planned for a diagnosis of Csendes Type V - fistula with complete bile duct wall erosion. Normally, fistula takedown with bilio-enteric reconstruction is preferred; however, the fistula ruptured, with resultant severe inflammation making bilio-enteric reconstruction hazardous. Hence, choledochoplasty using a well-vascularized pedicle of gallbladder neck was performed. Results: Intraoperatively, severe inflammation obscured normal anatomy. The gallbladder was taken dome-down. A broad neck of the gallbladder was attached to the CHD, consistent with Mirizzi’s Syndrome. Subtotal cholecystectomy was performed, leaving a remnant cuff vascularized via cystic artery. Frozen sections were sent, with no evidence of cancer. A pericholecystic abscess, likely from a ruptured bilioenteric fistula, was debrided. A 3.5cm gallstone caused near complete erosion of anterior bile duct - Csendes Type V. The back wall of the duct was identified, with proximal channel towards the liver and distal channel towards duodenum. Choledochoscopy demonstrated no obstruction or lesions. Extensive xanthogranulomatous inflammation precluded biliary-enteric reconstruction, with further dissection concerning for possible Right Hepatic artery compromise. The gallbladder flap approximated easily- therefore choledochoplasty was decided upon. Proximal/distal bile duct was cannulated by 18Fr T-tube; choledochoplasty was performed over it, using interrupted 3-0 Maxon suture without narrowing luminal diameter, re-creating an anterior wall for the bile duct common channel. Pressurized saline through T-tube showed no leak. T-tube cholangiogram confirmed patency and absence of stenosis/obstruction. Several weeks later, a T-tube cholangiogram showed satisfactory repair, with appropriate passage of contrast. Hence, the tube was then removed. The patient did not have any complications. Conclusion: Although rare, Mirizzi’s Syndrome is well-known and historically classified into Type 1 - Gallstone compression of bile duct; Type 2 - Common hepatic/bile duct erosion. Csendes et al. (1989) classified Mirizzi syndrome based on degree of erosion of duct wall into 4 types. Type 5 including cholecystoenteric fistula +/- gallstone ileus was added in 2007. Preoperative suspicion is paramount as bile duct injury approaches 17% incidence, with preoperative diagnosis only made in 62% of patients. Open repair is the gold standard. Cholecystectomy should be sufficient in type 1; any duct wall erosion makes a total cholecystectomy potentially unsafe. Bilioenteric reconstruction, e.g. choledochoplasty or hepaticojejunostomy, may be required for continuity. Choledochoscopy is used to confirm patency, as are cholangiograms in patients with T-tube. This case highlights this disease's unpredictable nature, and the need for familiarity with options for repair.

Coronary computed tomography angiography findings in low-risk population with family history of coronary disease

A family history of early-onset CAD may promote enhanced development and progression of coronary atherosclerosis in a sibling population. Baseline algorithms may underestimate the risk of coronary incidents in susceptible individuals. CCTA provides a high diagnostic performance for the detection of atherosclerosis. However, there is a paucity of data concerning the prognostic value of this technology in relatives at familial risk of CAD. To assess CV risk and pre-test probability of CAD in patients with atypical symptoms from high-risk families. To describe CCTA findings and data on coronary angiograms. Fifty siblings of patients with premature (< 60 yrs) cardiac events were investigated. The CAD consortium was calculated (clinical model). Risk algorithms were compared (SCORE, FRS for hard coronary disease, PROCAM). Significant CAD was defined as ≥ 50% reduction in coronary luminal diameter. Pre-test probability of CAD was low: CAD consortium < 10% in 60%, SCORE < 5% in 100%, FRS < 10% in 88%, CAC scoring < 100% in 71%. Conversely, PROCAM was > 10% in 16 cases (32%). Only 12 patients (24%) presented normal CCTA. Angiography was performed in 31 cases (62%). Most patients presented no significant lesions (55%). Revascularization was performed in 8 patients (16%). In patients with abnormal CCTA findings ( n = 38), PROCAM was higher than FRS in 20 patients (53%). After investigation, lipid-lowering therapy was enhanced in 66% ( Table 1 , Fig. 1 ). We investigated patients with family history and low pre-test probability of CAD. The reclassification of cardiac risk in middle-aged adults at familial risk is a fundamental issue in preventive cardiology. Most patients presented coronary atherosclerosis on CCTA. PROCAM is more appropriate. CCTA may become useful for the screening of subclinical atherosclerosis and the prediction of coronary risk, leading to the institution of appropriate and targeted preventive measures in patients at familial risk.

Measurement of the Luminal Diameter of Peripheral Arterial Vasculature in Yorkshire × Landrace Swine by Using Ultrasonography and Angiography.

To select animals of appropriate size for preclinical studies of cardiovascular devices, reference knowledge of the cardio- vascular anatomy relative to body weight is crucial. We measured the luminal diameters of the arteries (carotid, femoral, and iliac arteries) that are the common access vessels for endovascular and vascular procedures in Yorkshire × Landrace swine. Measurements were performed by using both ultrasound and angiographic methods and were correlated with body weight. Results showed no statistically significant difference between the left and right vessels in the diameters of the carotid, femoral, and iliac arteries. The diameters of the measured arteries showed high correlation with animal weight in pigs that weighed less than 70 kg.

Quantification of Aortic Stiffness by Ultrasound Time-Harmonic Elastography: The Effect of Intravascular Pressure on Elasticity Measures in a Porcine Model.

The aim of this study was to investigate blood pressure dependency of ultrasound time-harmonic elastography (THE) for quantification of aortic stiffness. Thoracoabdominal aortas were surgically removed from 9 healthy domestic pigs and prepared for elastographic experiments. All vessels were connected to a saline-filled water column with adjustable height and pressurized over a range of 0 to 110 mm Hg in 10 mm Hg increments to simulate different levels of mean arterial pressure. In addition, 3 of the 9 aortas were soaked in 4% buffered formaldehyde for 60 minutes to simulate pathologic aortic stiffening. Ultrasound THE was performed in each vessel at each pressure level. For each pressure level, shear-wave speed (SWS) as a measure of aortic wall stiffness and luminal diameter were recorded. The pressure range between 30 and 110 mm Hg was used for statistical evaluation as it reflects a physiological mean arterial pressure range. Linear regression analysis and multivariate analysis with a general linear model were performed to evaluate the influence of increasing intravascular pressure and vessel diameter on measured SWS. Median SWS in formalin-soaked aortas was significantly higher with 3.22 m/s (interquartile range [IQR], 0.01 m/s) versus 2.14 m/s (IQR, 0.09) at 30 mm Hg and 3.38 m/s (IQR, 0.01 m/s) versus 2.28 m/s (IQR, 0.07 m/s) at 110 mm Hg (each P = 0.01). Using linear regression analysis, an increase of aortic wall SWS of 0.017 m/s per 10 mm Hg intraluminal pressure was found in untreated aortas, whereas SWS increased by 0.020 m/s per 10 mm Hg in formalin-soaked aortas (both P = 0.001). The percentage of SWS caused by intraluminal pressure was 1.89% in formalin-soaked aortas and 2.50% in untreated aortas at 30 mm Hg and 6.61% for formalin-soaked aortas and 8.60% for untreated aortas at 110 mm Hg. Multivariate analysis showed no significant interaction of luminal diameter and measured SWS (P = 0.893). In our model, aortic stiffness measurements by ultrasound time-harmonic elastography are influenced to a small extent by mean arterial pressure in a range of 1.89% to 8.60%. These findings emphasize the potential of ultrasound THE for measuring the intrinsic stiffness of the aortic wall in clinical routine.

Differential expression of angiotensin II type 1 receptor subtypes within the cerebral microvasculature.

Arteries and arterioles constrict in response to intraluminal pressure to generate myogenic tone, but the molecular nature of the vascular force-sensing mechanism is not fully characterized. Here, we investigated the role of angiotensin II type 1 receptors (AT1Rs) on vascular smooth muscle cells in the development of myogenic tone in cerebral parenchymal arterioles from mice. We found that pretreatment with the AT1R blocker losartan inhibited the development of myogenic tone in these vessels but did not alter the luminal diameter of arterioles with preestablished tone. Rodents express two AT1R isotypes: AT1Ra and AT1Rb. We previously demonstrated that AT1Rb is expressed at much higher levels compared with AT1Ra in cerebral pial arteries and is required for myogenic contractility in these vessels, whereas AT1Ra is unnecessary for this function. Here, we found that AT1Ra and AT1Rb are expressed at similar levels in parenchymal arterioles and that genetic knockout of AT1Ra blunted the ability of these vessels to generate myogenic tone. We also found that AT1Rb and total AT1R expression levels are much lower in parenchymal arterioles compared with pial arteries and that parenchymal arterioles are less sensitive to the vasoconstrictive effects of the endogenous AT1R ligand angiotensin II (ANG II). We conclude that 1) AT1Rs are critical for the initiation, but not the maintenance, of myogenic tone in parenchymal arterioles, and 2) lower levels of AT1Rb and total AT1R in parenchymal arterioles compared with pial arteries result in differences in myogenic and ANG II-induced vasoconstriction between these vascular segments.NEW & NOTEWORTHY Myogenic tone is critical for appropriate regulation of cerebral blood flow, but the mechanisms used by vascular smooth muscle cells to detect changes in intraluminal pressure are not fully characterized. Here, we demonstrate angiotensin II receptor type 1 (AT1R) is indispensable to initiation, but not maintenance, of myogenic tone in cerebral parenchymal arterioles. Furthermore, we demonstrate differences in AT1R expression levels lead to critical differences in contractile regulation between parenchymal arterioles and cerebral pial arteries.

The Clinical Outcomes Based on the Achievement of Low-Density Lipoprotein Cholesterol Targets after ST Elevation Myocardial Infarction.

The clinical outcome of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), with or without achievement of low-density lipoprotein cholesterol (LDL-C) targets, has rarely been investigated. This study was performed to investigate the comparison of clinical outcome in STEMI patients with or without achievement LDL-C targets (below 70 mg/dL and/or ≥50% reduction). Between November 2013 and December 2016, 689 STEMI patients underwent primary PCI in our hospital. Patients who were deceased, lost to follow-up, had no follow-up lipid profile, or had no side effects after statin use were excluded. A total of 343 patients were classified into group 1 (with LDL-C target achievement) and 172 patients were classified into group 2 (without LDL-C target achievement). Between the two groups, a higher prevalence of left main coronary artery disease, smaller pre-PCI stenosis, and a larger pre-PCI minimal luminal diameter were noted in group 2. The incidence of post-MI angina (8.7% vs. 6.4%; p = 0.393), target vessel revascularization (2.3% vs. 3.5%; p = 0.566), and recurrent MI (1.5% vs. 1.2%; p = 1.000), showed similar results between the two groups during a one-year follow-up period. Initial LDL-C levels ≥130 mg/dL, left main coronary artery disease, and absence of diabetes mellitus were positively associated with non-achievement of LDL-C targets. After STEMI, 66.6% of patients could achieve LDL-C targets one year later. However, such patients did not show better clinical outcomes. Non-DM, initial LDL-C levels ≥130 mg/dL, and left main coronary artery disease were related to non-achievement of LDL-C targets.

The effects of sublingual nitroglycerin administration in coronary computed tomography angiography

PurposeThe purpose of our study was to compare coronary luminal diameters in patients undergoing coronary computed tomography angiography (CCTA) performed with different sublingual nitroglycerin (NTG) spray regimens. Materials and methodsWe retrospectively reviewed CCTA studies performed in two historical groups (Group 1, single dose nitroglycerin 2 min prior to CCTA, and Group 2, single dose 10 min prior), and a current protocol group (Group 3, single dose at 2 and 10 min prior). Thirty patients were evaluated per group. Two blinded readers measured coronary luminal diameters with comparison of diameter measurements. A third blinded reader assessed image quality of coronary artery segments. ResultsSignificant group-level differences in median luminal diameters were identified. Higher median diameters (95% CI) across all segments of 0.40 mm (0.20, 0.60) for Group 2 versus 1 and 0.50 mm (0.30, 0.70) for Group 3 versus 1 were recorded (both P < 0.001). No significant differences in median luminal diameters were found between Groups 2 and 3. No significant differences in image quality were found among the groups apart from higher image quality for the distal LAD for both Groups 2 and 3 compared to Group 1. ConclusionSublingual nitroglycerin spray administered as a single dose at 10 minute dilates coronary arteries more than when only administered at 2 min prior to CCTA. Combined two doses at 10 and 2 min prior to CCTA do not yield further dilatation of coronary arteries.

Growth-related micromorphological characteristics of the porcine common carotid artery.

The purpose of this study was to gain knowledge about the micromorphology of the porcine common carotid artery (CCA) during the period of growth over the bodyweight range of 10-40kg. CCA samples from German landrace pigs (DL) aged either 2 or 3months (DL-2 and DL-3) were compared with samples from Göttingen minipigs (GM) aged either 18 or 40months (GM-18 and GM-40) using transmitted light (phase-contrast mode) and transmission electron microscopy. The GM-18, GM-40 and the DL-3 groups had typical muscular artery histological characteristics. Contrasting to this, the 2-month-old DL pigs had a transitional artery type being characterized by a significantly higher proportion of elastic fibres and a significantly lower number of smooth muscle cells than did the 1month older DL-3. During the period of maturation, the tunica media of the CCA in GM animals thickened by 1.3× and in DL animals by 2.5× resulting in an overall increased vessel wall thickness. The cumulated thickness of the tunica interna (endothelium, stratum subendotheliale and internal elastic lamina) and the tunica media (including the external elastic lamina) of DL-3 and GM-40 pigs were similar to each other and comparable to that of humans. With an increasing vessel wall thickness, the luminal diameter decreased in GM by 19% and in DL by 11%. Additionally, in the older age groups, GM-40 and DL-3, the internal elastic lamina principally was continuous, but there were also interrupted large segments of elastic lamina separated by gaps. In addition, the principal internal elastic lamina was duplicated in several places.

Intralesional steroid injections to prevent refractory strictures in patients with oesophageal atresia: study protocol for an international, multicentre randomised controlled trial (STEPS-EA trial)

IntroductionAnastomotic stricture formation is the most common postoperative complication after oesophageal atresia (OA) repair. The standard of care is endoscopic dilatation. A possible adjuvant treatment is intralesional steroid injection, which...

An abluminal biodegradable polymer sirolimus-eluting stent versus a durable polymer everolimus-eluting stent in patients undergoing coronary revascularization: 3-year clinical outcomes of a randomized non-inferiority trial

The Cordimax stent has proved non-inferior to the Cypher Select durable polymer sirolimus-eluting stent for the primary endpoint of angiographic in-stent late luminal loss and in-stent mean diameter stenosis at 9 months. The trial was designed to compare the efficacy and safety of the Cordimax stent with the Xience V stent in patients undergoing coronary revascularization. This randomized, multicenter trial enrolled 3697 patients treated with Cordimax stent (2460 patients) and Xience V stent (1237 patients). The primary efficacy endpoint was a target-lesion failure (TLF) at 1 year and the primary safety endpoint was a composite of death or myocardial infarction (MI) at 3 years. 3399 patients (91.9%) completed 3-year follow-up. At 1 year, the primary efficacy endpoint occurred in 86 (3.5%) patients in the Cordimax group versus 40 (3.2%) patients in the Xience V group (0.3% absolute risk difference, 95% CI −1.0–1.5%, Pnon-inferiority < 0.0001). At 3 years, the primary safety endpoint occurred in 39 (1.6%) patients in the Cordimax group versus 19 (1.5%) patients in the Xience V group (0.05% absolute risk difference, 95% CI −0.8–0.9%, Pnon-inferiority < 0.0001). The incidence of target lesion revascularization was low in Cordimax group compared with Xience V group (3.6% versus 5.1%, P = 0.03). There were no differences between Cordimax and Xience V in terms of Cardiac death (0.3% versus 0.4%, P = 0.70), myocardial infarction (1.2% versus 0.9%, P = 0.37), and the stent thrombosis (0.4% versus 0.6%, P = 0.61). In conclusion, safety and efficacy outcomes of Cordimax stent were non-inferior to the Xience V stent 3 years after stent implantation.

Significance of Preoperative Thrombus Burden in the Prediction of Persistent Type Iiendoleak and Re-intervention Following Infra-renal Evar

Introduction: Persistent Type II Endoleak (PE II) has necessitated prolonged surveillance and requirement of re-intervention following infra-renal endovascular aneurysm repair (EVAR). The aim of this study was to assess the association of the percentage of aneurysmal sac thrombus (ST) with the incidence of PE II & subsequent re-intervention. Methods: Study included all consecutive patients undergoing infra-renal EVAR from October 2009 to October 2017 in a single vascular centre. ST was assessed on preoperative CT angiogram (CTA) and was defined as a percentage of thrombus across the maximal sac diameter in comparison to the luminal diameter, measured orthogonally at the same level. Patients were categorised into 3 groups; Group 1 (< 25% ST), Group 2 (25%-50% ST) and Group 3 (>50% ST). All patients underwent postoperative EVAR surveillance, which comprised of CTA or duplex ultrasound. The scans were assessed for PE II, which was defined as type II endoleak persistent for more than 1 year post-procedure. GraphPad Prism8 was used for analysis with Fisher's exact test & Student's T-test being used to determine significance. Results: Some 275 EVARs were performed in the study period. 45 procedures were excluded due to either iliac-only intervention (n=9), no pre-operative information (n=7), abandoned (n=1) or less than 1 years follow-up data (n=28). For the 230 procedures included, the median follow-up was 43 months (12-102 months); Group 1 (N=90), Group 2 (N=94) and Group 3 (n=46). There were no significant differences between the groups respectively for mean age (75 vs. 75 vs. 76 years); gender (male 88/90 vs. 89/94 vs. 43/46) and mean preoperative sac diameter (63mm vs. 65mm vs. 66mm). PE II occurred more frequently in Group 1 when compared to Group 2 and Group 3 [41% (n/N=37/90)vs.21% (n/N=20/94) vs. 4.3% (n/N=2/46), OR 2.6 (1.4 - 4.9)p=0.004and OR 15.4 (3.5-67.3) p=0.0003] respectively. Re-intervention was performed more frequently in Group 1 compared to Group 2 and Group 3 [11% (n/N=10/90) vs. 3.2% (n/N=3/94) vs. 0% (n/N=0/46) respectively, OR 3.8 (1.0 - 14.3) p=0.048) and OR 12.1 (0.69-211) p=0.09]. Sac size reduction was significantly greater in Groups 2 and 3 when compared to Group 1; -24% and 27% vs. -15% (p=0.009 andp=0.0002). Conclusion: Less than 25% thrombus is associated with increased incidence of PE II, reduced sac size reduction & increased re-intervention rates. Pre-emptive treatment could be considered in these patients whilst those with higher ST could be offered less frequent surveillance. Disclosure: Nothing to disclose

Coronary CT angiography derived plaque markers correlated with invasive instantaneous flow reserve for detecting hemodynamically significant coronary stenoses

PurposeThe study aimed to compare morphological and anatomic plaque markers derived from coronary computed tomography angiography (cCTA) for the detection of lesion specific ischemia with invasive instantaneous wave free ratio (iFR®) as the reference standard. MethodsIn our prospective study, we enrolled patients with suspected coronary artery disease (CAD), who had undergone cCTA, using a low-dose third-generation dual-source CT and invasive coronary angiography (ICA) with iFR® measurement. Various plaque markers were assessed on cCTA. Discriminatory power of these markers for the detection of ischemia-inducing coronary artery disease was evaluated against invasive iFR®. ResultsOur study cohort included 39 patients (66.6 ± 12.0 years, 72 % male). Among 54 vessel-specific lesions, 15 lesions (28 %) were characterized as hemodynamically significant by iFR® ≤0.89. The area under the curve (AUC) of lesion length/ minimal luminal diameter4 (LL/MLD4) (0.84) was greater than the AUC of minimal luminal area (MLA) (0.82), MLD (0.81), the degree of luminal diameter stenosis (0.81), corrected coronary opacification (CCO) (0.79), remodeling index (RI) (0.75), and percentage aggregate plaque volume (%APV) (0.72). LL, vessel volume (VV), total plaque volume (TPV), calcified and non-calcified plaque volume (CPV and NCPV) did not reach statistical significance and were unable to discriminate between vessels with and without ischemia-inducing coronary stenosis. ConclusionLL/MLD4, MLA, MLD, the degree of luminal diameter stenosis, CCO, RI, and %APV derived from cCTA can support the detection of hemodynamically significant coronary stenosis as compared with iFR®, with LL/MLD4 showing the greatest discriminatory power.

Evaluation of neutral oral contrast agents for assessment of the small bowel at abdominal staging CT.

BackgroundAlthough neutral oral contrast agents are widely in use, a consensus regarding a standardized protocol in abdominal staging CT does not exist.PurposeTo test the null hypothesis that there is no quantitative or qualitative difference between water and mannitol for evaluation of the small bowel at abdominal staging CT.Material and methods180 patients prospectively underwent abdominal staging CT with oral administration of either 1 liter mannitol solution (n = 88) or water (n = 92). Intestinal distension was measured in 6 different segments of the small intestine. In addition, two radiologists separately evaluated diagnostic image quality with regards to luminal distension (three-point scale) in each segment and the possibility to rule out a possible underlying pathology. Quantitative and qualitative results were compared (Mann-Whitney test).ResultsQuantitatively, intestinal distension was comparable in all segments (p>0.05), except for the horizontal duodenum (p = 0.019). The mean luminal diameter over all intestinal segments was 19.0 mm (18.1–19.9 mm) for the water group and 18.4 mm (17.5–19.2 mm) for the mannitol group, respectively. Qualitatively, ratings were comparable for the first three segments, while distal segments were rated better using mannitol. Side effects were only observed using mannitol (n = 26; 29.5%).ConclusionsOrally administered water and mannitol solution for evaluation of the small bowel at abdominal staging CT in clinical routine resulted in comparable results for the quantitative, but not for the qualitative analysis. Looking more differentiated at the overall performance, water has advantages in terms of patient comfort, side effects and costs, and can therefore be regarded as noninferior to mannitol in this specific patient group.