Luminal Diameter Research Articles

Growth-related micromorphological characteristics of the porcine femoral artery.

In cardiovascular research small pigs breeds like Göttingen® minipigs (GM) are established animal models, but systematic data about the micromorphology of the GM vasculature at different ages are scarce. The study was aimed at gaining knowledge about the micromorphology of the femoral artery (FA) from German Landrace pigs (DL) and GM during the period of growth over a body weight range of 10-40 kg. FA samples from DL aged two or three months were compared to GM ones, aged 18 or 40 months using transmitted light microscopy. All FA samples showed typical characteristics of muscular arteries. Growth was associated with increased vessel wall thickness. In the GM this resulted in a slight decrease of the luminal diameter (LD), while in the DL pigs, an increase of the LD and smooth muscle cell content (10%) with decreased elastic fiber content (10%) has been detected. In contrast, within the 22 months lasting growth period of the GM, the tunica media content of smooth muscle cells and elastic fibers remained stable. FA maturation strongly depends on the pig breed and age. It can be different from what is described in humans.

Long-term clinical safety and efficacy of drug-coated balloon in the treatment of in-stent restenosis: A meta-analysis and systematic review.

The aim of this study was to evaluate the long-term clinical safety and efficacy of drug-coated balloon (DCB) in the treatment of in-stent restenosis (ISR). There is a long-term safety issue in peripheral arterial disease patients treated with paclitaxel-coated balloon, this has also raised concerns on DCB in coronary intervention. Nine randomized controlled trials (RCTs) and nine observational studies (OSs) were included with a total of 3,782 patients (1,827 in the DCB group, 1,955 in the drug-eluting stent [DES] group) being analyzed. The primary outcome measure-major adverse cardiovascular events (MACEs), target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), cardiac death (CD), stent thrombosis (ST), all-cause death (AD), and coronary angiography outcomes included late lumen loss (LLL), minimum luminal diameter (MLD), diameter stenosis (DS) were analyzed. DCB treatment significantly reduced the LLL (MD: -0.13; [CI -0.23 to -0.03], p = .01). No difference was found for MLD (MD: -0.1; [CI -0.24 to 0.04], p = .17) and DS% (RR = 0.98 [CI 0.80-1.20], p = .86). There was no significant difference in TLR, TVR, MI, CD, ST, AD, and the overall incidence of MACEs between the two groups up to 3 years follow-up. Subgroup analysis for different type of ISR and DES showed no significant difference in the incidence of endpoints, and there is no difference when considering RCTs or OSs only. The safety and efficacy of the DCB and DES in the treatment of ISR is comparable at up to 3 years follow-up.

Radiographic tracheal lumen to vertebral ratios in the normal American Miniature Horse.

Tracheal collapse in horses is reportedly uncommon; however, American Miniature Horses are more commonly affected.There is no description of the tracheal luminal diameter of American Miniature Horses, making early detection of tracheal luminal narrowing difficult. To 1) describe radiographic tracheal luminal diameter in clinically normal American Miniature Horses, 2) report the prevalence of subclinical tracheal collapse in a population of American Miniature Horses, and 3) use tracheal videofluoroscopy to quantify variation in tracheal luminal diameter throughout the respiratory cycle in horses with no clinical respiratory disease. Descriptive observational reference interval study. Thirty-four American Miniature Horses with no reported history of respiratory illness were recruited. Lateral cervical and thoracic radiographs were obtained in unsedated standing horses. Dynamic fluoroscopic images were obtained of the cervical and thoracic trachea throughout the respiratory cycle. Horses were then sedated as needed and tracheoscopy was performed. Twenty-nine horses were categorised as normal, and five horses were categorised as subclinically affected based on 25% or greater tracheal narrowing using tracheoscopy for visual assessment. Radiographic tracheal lumen to vertebral body measurements were obtained throughout the cervical and thoracic trachea. Maximum and minimum fluoroscopic tracheal diameter at each site throughout the respiratory cycle was recorded. A mean, median, 95% confidence interval and bootstrapped 95% reference interval of radiographic tracheal diameter to vertebral body ratios were generated in normal horses. The prevalence of subclinical tracheal collapse inthis population of American MiniatureHorses is 14.7%. Bootstrapped reference range was generated from 29 horses. Radiographic tracheal measurements and ratios of the tracheal diameter to vertebral body in the normal American Miniature Horse are describedherein andcan be used as a guideline when screening for tracheal disease in American Miniature Horses. The prevalence of subclinical tracheal collapse in American Miniature Horses may be higher than previously reported.

Reduced patency in left-sided arteriovenous grafts in a porcine model

ObjectiveThe porcine arteriovenous graft model is commonly used to study hemodialysis vascular access failure, with most studies using a bilateral, paired-site approach in either the neck or femoral vessels. In humans, left- and right-sided central veins have different anatomy and diameters, and left-sided central vein catheters have worse outcomes. We assessed the effect of laterality on arteriovenous prosthetic graft patency and hypothesized that left-sided carotid-jugular arteriovenous prosthetic grafts have reduced patency in the porcine model. MethodsArteriovenous polytetrafluoroethylene grafts were placed ipsilaterally or bilaterally in 10 Yorkshire male pigs from the common carotid artery to the internal jugular vein. Ultrasound measurements of blood flow velocities and diameters were assessed before graft placement. Animals were sacrificed at 1 week, 2 weeks, or 3 weeks. Patency was determined clinically; grafts and perianastomotic vessels were excised and analyzed with histology and immunostaining. ResultsAt baseline, left- and right-sided veins and arteries had similar blood flow velocities. Although internal jugular veins had similar diameters at baseline, left-sided carotid arteries had 11% smaller outer diameters (P = .0354). There were 10 left-sided and 8 right-sided polytetrafluoroethylene grafts placed; only 4 of 10 (40%) grafts were patent on the left compared with 7 of 8 (88%) grafts patent on the right (P = .04). Left-sided grafts had increased macrophages at the arterial anastomosis (P = .0007). Left-sided perianastomotic arteries had thicker walls (0.74 vs 0.60 mm; P = .0211) with increased intima-media area (1.14 vs 0.77 mm2; P = .0169) as well as a trend toward 38% smaller luminal diameter (1.6 vs 2.5 mm; P = .0668) and 20% smaller outer diameter (3.0 vs 3.7 mm; P = .0861). Left- and right-sided perianastomotic veins were similar histologically, but left-sided veins had decreased expression of phosphorylated endothelial nitric oxide synthase (P = .0032) and increased numbers of α-actin-positive smooth muscle cells (P = .0022). ConclusionsLeft-sided arteriovenous grafts are associated with reduced short-term patency compared with right-sided grafts in the Yorkshire pig preclinical model of arteriovenous prosthetic grafts. Laterality must be considered in planning and interpreting surgical preclinical models.

Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection

An optimal treatment regimen is sought for symptomatic isolated mesenteric artery dissection (IMAD) on the basis of its clinical staging. From January 2011 to December 2018, 120 patients with symptomatic IMAD from two institutions were collected retrospectively. We reviewed the clinical features, risk factors, computed tomography (CT) images, treatment modalities, and follow-up results to propose a new management strategy based on the clinical stages of the disease. A total of 120 patients were collected in this study; 77 patients (69 men, 8 women; median age, 52.53years; range, 39-73years) who had undergone successful conservative management with antithrombotic agents were included in group A. The remaining 43 patients (34 men, 9 women; median age, 52.63years; range, 26-66years) who underwent invasive therapy were included in group B. Significant differences were observed between the two groups with respect to dissection length (50.72±27.72mm vs. 62±24.3mm; P=0.02), true lumen residual diameter (3.31±1.05mm vs. 2.83±2.05mm; P=0.01), and branch involvement (8 and 19, respectively; P < 0.001). Success was achieved in 76.24% (77/101) of patients treated by conservative management with antithrombotic agents in the acute stage; 43 patients underwent invasive interventional therapy in different stages of symptomatic IMAD. In group A, 6 patients had recurrent abdominal pain, three of whom underwent invasive intervention, and the remaining patients improved after conservative treatment. Positive remodeling was observed in 80.33% (49/61) of patients treated with conservative management alone versus 19.67% (12/61) of patients who experienced negative remodeling. Endovascular intervention in group B, CT angiography, or mesenteric angiography yielded complete remodeling in 23 (76.67%, 23/30) patients and evidence of stent restenosis in 7 (23.33%, 7/30) patients. Among the surgical patients, 7 patients showed improvement in the luminal diameter. However, 3 patients with short bowel syndrome require long-term parenteral nutrition. Conservative management with antithrombotic agents should be a first-line regimen for symptomatic IMAD in the acute stage. If symptoms persist, endovascular intervention is a safe and feasible treatment in the subacute or chronic stage. When peritonitis is present, surgical treatment should be promptly performed, regardless of the disease stage.

Histomorphological Study of the Wall Thickness and Luminal Diameter of Cadaveric Vermiform Appendix in Bangladeshi People

Vermiform appendix is a blind-ending tubular structure, arises from the posteromedial aspect the cecum inferior to the ileocecal junction. It has a thick wall and narrow lumen due to presence of large lymphoid follicles within its wall. Appendicitis is the most common clinical condition of vermiform appendix, caused by obstruction of the lumen. The causes of the obstruction include lymphoid hyperplasia secondary to irritable bowel disease (IBD) or infections (more common during childhood and in young adults), fecal stasis and fecaliths (more common in elderly patients), parasites (especially in Eastern countries), or, more rarely, foreign bodies and neoplasms. This study was done to find out the wall thickness and luminal diameter of the vermiform appendix in Bangladeshi people to magnify the knowledge regarding the diverse anatomy of vermiform appendix in our population. It was a descriptive cross-sectional study with some analytical components performed on 60 (sixty) cadaveric vermiform appendices of Bangladeshi people of different ages in the department of Anatomy, Sir Salimullah Medical College, Dhaka, from January 2008 to June 2009. For convenience of differentiating the wall thickness and luminal diameter of vermiform appendix in relation to different age, the collected samples were divided into five groups (group A-0 to 20 years, group B-21 to 30 years, group C-31 to 40 years, group D-41 to 50 years and group E->50 years). From each age group, six (6) fresh samples were selected for histological study. From each vermiform appendix three slides were prepared each from its base, middle part and near the tip and were stained with routine H & E stain. The wall thickness and luminal diameter was measured through micrometry. In the present study, average wall thickness of the vermiform appendix ranged from 2.25 mm to 3.10 mm. The average wall thickness was highest in group A (2.53±0.01 mm), which gradually decreased through group B, C, D and the lowest value was in group E (2.26±0.07 mm). Average luminal diameter ranged from 1.90 mm to 2.96 mm. Average luminal diameter was lowest in group A (2.04±0.45 mm) and highest in group D (2.68±0.57 mm). In group E, the value (2.32±0.98 mm) was higher than that of group D. There was negative correlation between age and average wall thickness, and positive correlation between age and average luminal diameter, both of which reached the level of significance (p<0.001***).

Sapropterin reduces coronary artery malformation in offspring of pregestational diabetes mice

Endothelial nitric oxide synthase (eNOS) and oxidative stress are critical to embryonic coronary artery development. Maternal diabetes increases oxidative stress and reduces eNOS activity in the fetal heart. Sapropterin (Kuvan®) is an orally active, synthetic form of tetrahydrobiopterin (BH4) and a co-factor for eNOS with antioxidant properties. The aim of the present study was to examine the effects of sapropterin on fetal coronary artery development during pregestational diabetes in mice. Diabetes was induced by streptozotocin to adult female C57BL/6 mice. Sapropterin (10 mg/kg/day) was orally administered to pregnant mice from E0.5 to E18.5. Fetal hearts were collected at E18.5 for coronary artery morphological analysis. Sapropterin treatment to diabetic dams reduced the incidence of coronary artery malformation in offspring from 50.0% to 20.6%. Decreases in coronary artery luminal diameter, volume and abundance in fetal hearts from diabetic mothers, were prevented by sapropterin treatment. Maternal diabetes reduced epicardial epithelial-to-mesenchymal transition (EMT) and expression of transcription and growth factors critical to coronary artery development including hypoxia-inducible factor 1a (Hif1a), Snail1, Slug, β-catenin, retinaldehyde dehydrogenase 2 (Aldh1a2), basic fibroblast growth factor (bFGF) and vascular endothelial group factor receptor 2 (Vegfr2) in E12.5 hearts. Additionally, eNOS phosphorylation was lower while oxidative stress was higher in E12.5 hearts from maternal diabetes. Notably, these abnormalities were all restored to normal levels after sapropterin treatment. In conclusion, sapropterin treatment increases eNOS activity, lowers oxidative stress and reduces coronary artery malformation in offspring of pregestational diabetes. Sapropterin may have therapeutic potential in preventing coronary artery malformation in maternal diabetes.

Expansive carotid artery remodeling: possible marker of vulnerable plaque.

Accumulated findings in the pathophysiology of atherosclerosis have demonstrated that not only luminal narrowing but also plaque characteristics influence the risk of future ischemic events. The morphology of the carotid artery (CA) changes in response to atherosclerotic development by expansive remodeling (ER), the clinical significance of which remains unclear. This study aimed to define associations between ER and local risk factors, including CA geometry and traditional systemic risk factors for ischemic events, to determine whether ER could serve as a clinical marker of carotid vulnerable plaque. The authors retrospectively analyzed 66 patients with CA stenosis who were scheduled to undergo carotid endarterectomy or CA stenting. They calculated ER ratios in the internal CA (ICA) from long-axis MR images and as the maximal distance between the lumen and the outer borders of the plaque perpendicular to the axis of the ICA/the maximal luminal diameter of the distal ICA at a region unaffected by atherosclerosis. Relative overall signal intensity (roSI) was calculated to assess intraplaque hemorrhage and defined as the signal intensity of plaque on an axial T1-weighted image with maximal stenosis relative to that of the adjacent sternocleidomastoid muscle. The authors evaluated CA geometry by calculating the angles between the common CA (CCA) and ICA, and between the CCA and external CA (ECA) using digital subtraction angiography. The ER ratios, age, sex, percentage of stenosis, roSI, hypertension, hyperlipidemia, low-density lipoprotein, statin medication, diabetes, smoking habit, and ischemic heart disease were compared between 33 symptomatic and 33 asymptomatic patients. The authors also compared symptomatic status, age, sex, percentage of stenosis, ICA angle, ECA angle, roSI, and other traditional atherosclerotic risk factors between groups with extensive and slight ER. The ER ratio was significantly greater in symptomatic than in asymptomatic patients (1.91 ± 0.46 vs 1.68 ± 0.40, p < 0.05). The ICA angle was significantly larger in the group with extensive ER than in those with slight ER (33.9° ± 20.2° vs 21.7° ± 13.8°, p < 0.01). The roSI, ECA angle, percentage stenosis, or any other traditional vascular risk factors were not associated with ER. Carotid ER might be an independent indicator of carotid vulnerable plaque, which should be validated in a longitudinal study of patients with carotid atherosclerosis, including those with nonstenotic to moderate stenosis.

155 Therapeutic Oxygen for Gastrointestinal Atomy (TOGA) Pilot Trial: Management of Acute Colonic Pseudo-Obstruction and Ileus With Oxygen Supplementation

INTRODUCTION: Acute intestinal dysmotility can lead to bowel distension, which promotes hypoperfusion and further negates contractility in acute colonic pseudo-obstruction (ACPO) and ileus. Current medical treatment is supportive. When bowel distension worsens, endoscopic decompression or surgical intervention may be necessary to avoid mortality; Interventions are time-consuming and not without risk. New effective and safe management approaches are needed. Manipulation of partial pressures of oxygen trapped within the bowel has been shown in patients with ACPO and ileus to improve clinical and radiographic outcomes. Therapeutic oxygen for gastrointestinal atomy (TOGA) is a pilot study aimed to demonstrate the benefit of a six hour course of 100% oxygen by non-rebreather mask as an adjunctive treatment for patients with ACPO and ileus who have failed to respond to alternative medical therapy after 24 hours. METHODS: Eight patients with ACPO or ileus were enrolled in this pilot study (ClinicalTrials.gov Identifier: NCT03386136) between May 1, 2018 and March 1, 2019 and administered 100% oxygen by non-rebreather mask for 6 hours in conjunction with traditional medical management. Abdominal radiographs were examined before and after treatment. Patient demographics, maximum diameter of bowel lumen distension on radiography, and clinical symptoms were recorded. RESULTS: Of the 8 patients (mean age 53.6 ± 17.4 years; 37.5% female), 87.5% demonstrated clinical improvement of symptoms after 6 hours of 100% oxygen (Table 1). For 7 patients, maximum luminal diameter improved on average by 1.14 ± 0.87 cm, the percentage decrease in luminal diameter on average was 13.8 ± 7.1%. One patient failed to improve but was later determined to have malignant small bowel obstruction. Only one patient suffered a potential adverse event to the oxygen therapy (transient tachycardia). No patients developed complications from their underlying disease, such as ischemia or perforation. Responding patients also reported improvements in abdominal pain, distension, and bowel movements. CONCLUSION: TOGA demonstrates that high concentrations of supplemental oxygen is a feasible and tolerable intervention to improve the clinical status of patients with ACPO and ileus, which may shorten hospitalization and overall morbidity. Further prospective enrollment is needed to extrapolate these promising findings and ensure confidence of its incorporation into common clinical practice.

86Coronary CT angiography as the first-line diagnostic strategy in patients with non-ST-segment Elevation Acute Coronary Syndrome - The VERDICT trial

Abstract Background In patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) coronary pathology may range from structurally normal vessels to severe coronary artery disease. Current guidelines recommend early invasive coronary angiography (ICA) to guide management strategy. Purpose We tested the hypothesis that a strategy of first-line coronary computed tomography angiography (CCTA) may be used to differentiate between significant and nonsignificant coronary artery stenosis in patients with NSTE-ACS. Methods We included patients with NSTE-ACS confirmed by ischaemic ECG changes and/or elevated biomarkers of myocardial ischaemia, in whom ICA was feasible within 12 hours. Patients were randomised 1:1 to ICA within 12 hours (Very Early) or 48–72 hours (Standard) and CCTA was conducted prior to ICA. The primary endpoint was the ability of CCTA to rule out significant coronary artery stenosis (≥50% stenosis) expressed as the negative predictive value (NPV) using ICA as the reference standard. The VERDICT trial is registered with ClinicalTrials.gov number NCT02061891. Results CCTA was conducted in 1023 patients – Very Early, 2.5 (IQR 1.8, 4.2) hours, N=583 and Standard, 59.9 (IQR 38.9, 86.7) hours, N=440 after establishment of the diagnosis. Significant coronary stenosis was found by ICA in 67.4% of the patients. NPV of CCTA (95% CI) was 90.9% (86.8%-94.1%) and the positive predictive value, sensitivity and specificity were 87.9% (85.3–90.1%), 96.5 (94.9–97.8%) and 72.4 (67.2–77.1%), respectively. False negative patients (24/1023, 2.3%) mostly had lesions in coronary segments with a luminal diameter ≤2.5 mm. NPV was not influenced by patient characteristics or clinical risk profile, including abnormal cardiac troponin, ischaemic ECG changes, or a GRACE risk score&gt;140. CCTA accuracy parameters were similar in Very Early and the Standard strategy group. Conclusions First-line CCTA may be used to rule out clinically significant coronary artery disease in patients with NSTE-ACS and thus potentially guide patient management. Acknowledgement/Funding This study was funded by the Danish Agency for Science, Technology, and Innovation and the Danish Council for Strategic Research (grant no. 09–066994)

P3581Periinterventional cocoa flavanol supplementation prevents functional and structural damage to the arterial wall after transradial catheter intervention

Abstract Background The transradial approach is commonly preferred over the femoral approach for coronary angiography to reduce vascular complications like bleeding, aneurysm formation and all-cause mortality ensuring early ambulation after coronary procedures. However, there is growing evidence that damage to the radial artery endothelium elicits intimal hyperplasia, vascular remodeling and might ultimately lead to total vessel occlusion. Objective Our study aimed to investigate the effects of dietary flavanol intervention on (a) early endothelial functional recovery and (b) late structural changes i.e. intimal hyperplasia after mechanical vascular wall injury in the human forearm model during coronary angiography. Methods Radial artery flow-mediated vasodilation (RA-FMD), local stiffness (fractional diameter change, Fdc), intima-media thickness (IMT), luminal and external arterial diameter at the site of intervention and the contralateral control artery were measured in 38 male patients (19 flavanol intervention, 19 placebo control) undergoing transradial coronary angiography (TCA) at baseline, after 7 days of 450mg flavanol supplementation BID, directly after TCA and 6 months after TCA. Circulating levels of endothelial microparticle (EMP) subpopulations CD31+/41-, CD62e+and CD144+were analyzed simultaneously as a surrogate for endothelial functional integrity and activation. Results One week of flavanol supplementation, not placebo, significantly increased RA-FMD (8.88±2.03% vs. 11.17±2.89%, p&lt;0.01 in flavanol and 8.64±1.87% vs. 8.32±1.63%, p=n.s. in placebo). RA-FMD significantly decreased in the intervention artery directly after TCA, which was partly mitigated by flavanol supplementation (delta to baseline: −2.61±0.82% in flavanol vs. −4.91±0.63% in placebo, p=0.034). TCA induced significant intimal hyperplasia in the radial artery (0.36±0.02mm vs. 0.44±0.04mm, p&lt;0.01) in placebo, but not in the flavanol group (0.36±0.02mm vs. 0.37±0.02mm, p=n.s.) after 6 month. One week of flavanol supplementation increased Fdc (1.94±0.99 vs. 3.07±1.31, p&lt;0.01). No changes occurred in the placebo group (1.99±1.29 vs. 1.96±1.17, p=n.s.). On the contralateral arm, the decrease in RA-FMD was blunted by flavanols (delta to baseline: +0.42±1.05% in flavanol vs. −0.61±1.55% in placebo) along with decreased circulating levels of EMPs. Conclusions TCA impairs endothelial function (RA-FMD), vascular physicomechanics (Fdc) and induces intimal hyperplasia (IMT). Periinterventional flavanol supplementation blunts the acute decreases in endothelial function and physicomechanics and prevents chronic negative vascular remodeling.

P5632Different impact of lesion length on fractional flow reserve in intermediate coronary lesions between each coronary artery

Abstract Background Previous studies reported that lesion length was an important geometric parameter in addition to the degree of stenosis in the determinant of functional significance of coronary artery stenosis. Nevertheless, the optimal cutoff value of lesion length for predicting functional significance for each coronary artery has not yet been evaluated, though previous studies revealed that the cutoff value of minimum lumen diameter measured on coronary angiography (CAG) to predict fractional flow reserve (FFR) &lt;0.80 is different for each coronary artery Purpose This study evaluated whether the impact of lesion length on functional significance is similar between each coronary artery for lesions with intermediate stenosis. Methods Patients with suspected coronary artery disease who had at least one intermediate coronary lesion (luminal diameter stenosis of 70 to 80% by visual estimation on CAG) and underwent FFR measurement for the evaluation of myocardial ischemia were evaluated. Quantitative coronary angiography analysis including percent diameter stenosis and lesion length was performed. FFR was measured as the ratio of the mean distal coronary artery pressure to the mean aortic pressure during maximal hyperemia induced by intravenous infusion of adenosine triphosphate (150 μg /kg/min). The area under the receiver operating characteristics (ROC) curve was estimated for the best cutoff value as a predictor of FFR value of ≤0.80 for each coronary artery. Results A total of 221 de novo lesions that underwent FFR measurement were enrolled. The average FFR value was 0.81±0.07. Although lesion length was similar among the lesions with an FFR &gt;0.80 at different locations, the mean lesion length was significantly longer for lesions in the right coronary artery (RCA) with an FFR ≤0.80 than for those in the left anterior descending artery (LAD) and left circumflex artery (13.4±3.4 versus 8.6±3.1 versus 12.0±3.7 mm, p&lt;0.001). ROC analysis demonstrated that the optimal cutoff value of lesion length for predicting an FFR ≤0.80 was 10.0 mm in the LAD (0.56 area under the curve, 48% sensitivity, 76% specificity), whereas 13.1 mm in the RCA (0.84 area under the curve, 67% sensitivity, 93% specificity) (Figure). ROC analysis of LL for FFR≤0.80 Conclusions A longer lesion length is required to achieve FFR&lt;0.80 in the RCA than in the other arteries. This may suggest the low possibility of an FFR ≤0.80 when stenosis is focal and short in the RCA with stenosis of 70 to 80% by visual estimation on CAG.

P2688A novel risk factor of stent restenosis after drug-eluting stent implantation; Involvement of triglyceride deposit cardiomyovasculopathy, coronary atherosclerosis with triglyceride deposition

Abstract Background Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel disease concept characterized by the excessive accumulation of triglyceride in cardiomyocytes and vascular smooth muscle cells, leading to coronary artery disease (CAD), heart failure, and arrhythmia. However, it is rarely known whether TGCV contributes to the increased risk of vascular failure after drug eluting stent (DES) implantation. Purpose The aim of this study was to evaluate vascular failure after 2nd generation DES implantation in patients with TGCV. Methods Among 637 consecutive patients suspected of having CAD who underwent both coronary angiography and iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy between 2010 and 2018, we analyzed the data from 92 patients who met the inclusion criteria (shown in Table and Figure). Ninety-two patients were allocated to the presence (TGCV group, 11 patients) or absence (control group, 81 patients) of TGCV. All of 92 patients were implanted 2nd generation DES and underwent planned follow up coronary angiography. Control patients were diagnosed of diabetes mellitus. Binary restenosis (ISR), defined as angiographic luminal diameter ≥50% by quantitative coronary angiography, target lesion revascularization (TLR), In-stent late loss and restenosis morphology were assessed in 23 stents of TGCV group and 120 stents of control group. Results There were no significant differences in baseline characteristics between the two groups except for the prevalence of hypertension. In-stent late loss was greater in TGCV than in control (0.45 (−0.04 to 3.33) vs. 0.15 (−0.18 to 2.75), p=0.ehz748.10067), resulting in greater incidence of ISR and TLR in TGCV than in control (34.8% vs. 10.0%, p=0.0017; 21.7% vs. 6.7%, p=0.021, respectively). On multivariable logistic regression analysis, TGCV was found to be a significant and independent predictor for ISR after 2nd generation DES implantation. Regarding restenosis morphology, diffuse and occlusive pattern of ISR, were more frequently observed in TGCV than control (87.5% and 33.3%, Fisher's exact test p=0.028). Table 1.The 4th edition diagnostic criteria for TGCV Items Clinical findings 2 points I) BMIPP scintigraphy Wash-Out Rare &lt;10% II) Diffuse narrowng coronary arteries 1 point III) Jordans anomaly in peripheral blood smear IV) Diabetes Decision 4 points or more → Definite TGCV Figure 1 Conclusion Patients with TGCV showed the greater incidence of vascular failure even after 2nd generation DES implantation, contributing to the novel risk factor for coronary intervention even in the 2nd DES era.

P3508A novel mouse model of sleep-disordered breathing is associated with contractile dysfunction and CaMKII overexpression

Abstract Background Patients with sleep-disordered breathing (SDB) develop arrhythmias and contractile dysfunction, but the mechanisms are poorly understood, possibly due to the lack of mouse models that mimic airway obstruction in spontaneously sleeping mice. Interestingly, New Zealand obese mice have been shown to develop airway obstruction with inspiratory flow limitation resulting in apneas, but these mice also develop diabetes. Purpose We developed a novel mouse model of increased airway obstruction in spontaneously sleeping lean mice and investigated the impact on sleep-related apneas and contractile function. Methods and results Male C57BL6 mice at 8–12 weeks of age were subjected to polytetrafluoroethylene (PTFE) injection (100 μl) into the tongue. This resulted in an increased tongue volume and reduced pharyngeal luminal diameter. Conscious mice behave normal and there was no difference in body weight between PTFE injected mice and untreated littermates (control). Whole body plethysmography was used to monitor spontaneous breathing for 8h in a quiet environment. Interestingly, compared to control, mice with PTFE injection showed a significantly increased frequency of apneas (lasting &gt;1s, fig. A, * indicated P&lt;0.05, t-test). Echocardiographic analysis revealed that ejection fraction was significantly reduced in PTFE-treated mice 8 weeks after surgery (vs. control, fig. B). In accordance, the developed force of isolated papillary muscles from hearts of PTFE mice was significantly reduced compared to control (fig. C). Ca/calmodulin-dependent protein kinase II (CaMKII) has been implicated in the development of heart failure. Intriguingly, compared to control, CaMKII expression was significantly increased in ventricular heart homogenates of PTFE-treated mice (fig. D). Moreover, the magnitude of CaMKII overexpression correlated significantly with the frequency of apneas (fig. E). Papillary muscle post-pause contractions can be used as measure of diastolic sarcoplasmic reticulum (SR) Ca leak, which is known to be enhanced by CaMKII. Compared to control, post-pause contraction amplitude was significantly smaller in PTFE-treated mice, indicating an increased SR Ca leak (fig. F). Figure 1 Conclusion PTFE injection in mice results in an increased frequency of spontaneous apneas. PTFE-treated mice develop mild contractile dysfunction, which is accompanied by CaMKII overexpression. This novel mouse model offers great opportunities for investigation of sleep-related breathing disorders. Acknowledgement/Funding This study was supported by the Medical Faculty of the University of Regensburg (ReForM programme).

1684 Paging Dr. MacGyver: A Novel Approach to Redeploying a Dislodged AXIOS Stent During a Pancreatic Necrosectomy

INTRODUCTION: Although multiple modalities exist for managing walled off and infected pancreatic necrosis, EUS-guided transmural drainage is often favored due to its minimally invasive and highly effective nature. The AXIOS stent has demonstrated clear superiority over double pigtail and fully covered self-expanding metal stents in this setting. Although the radial force from its wide luminal diameter and its dumbbell shape helps secure the stent in place, stent migration and dislodgement can still occur. Here, we present a case of stent dislodgement during a pancreatic necrosectomy, which was salvaged by stent extraction and endoscopic re-deployment using a stone extraction balloon catheter sheath. CASE DESCRIPTION/METHODS: A 68-year-old woman with a medical history notable for prior acute pancreatitis presented to the ED with abdominal pain, nausea, and vomiting. CT Abdomen revealed a large pancreatic fluid collection with surrounding necrosis. She was admitted to the SICU for management of necrotizing pancreatitis, and underwent cystgastrostomy with an AXIOS stent on day 14 of admission. During her necrosectomy one week later, the previously placed AXIOS stent was accidentally displaced into the stomach. The displaced stent was grasped with a rat tooth forceps and removed from the patient. One end of the extracted AXIOS stent was stretched so that it became thin enough to be inserted into an empty stone extraction balloon catheter sheath. The other end was then back-loaded into the larger channel of a double-channel gastroscope. The scope was then re-introduced and advanced into the pancreatic cyst cavity. A rat tooth forceps was inserted into the instrument channel and used to advance the back-loaded stent forward, re-deploying the stent under endoscopic guidance only, such that it again traversed the cystic cavity and stomach. The stent was then adjusted into its desired position using rat tooth forceps. DISCUSSION: As Interventional Endoscopy’s technologies continue to evolve, it will become increasingly important for the skilled endoscopist to understand the mechanics of the tools being used, and trouble shoot these technologies as unforeseen complications arise. The novel method for AXIOS stent re-deployment described here not only demonstrates this understanding, but also serves as an example of a cost saving recourse for dislodged AXIOS stent re-deployment. Indeed, in an era of cost-conscious care, one must trouble shoot in a manner that is both clinically effective and financially efficient. Watch the video: http://bit.ly/2O2RYbW.

Resveratrol Ameliorates Testicular Histopathology of Mice Exposed to Restraint Stress.

Simple SummaryThe search for effective medicines is challenging. Resveratrol is a phytoalexin, and its function remains unelucidated. Therefore, we undertook the present study to investigate reproductive disturbances due to restraint stress in mice and whether resveratrol plays an anti-stress role. Our results confirmed that resveratrol plays a potential role in the reduction of stress in mice. We evaluated immobilization stress and resveratrol supplementation in immature male mice at 30 days of age for 15 consecutive days. Fifty Swiss mice were divided into five groups (10 mice each): Controls, restraint stress (RS), restraint stress + vehicle (RS + V), RS + 2 mg/kg, and RS + 20 mg/kg. We determined results on the basis of hematoxylin and eosin (H&E), “Periodic acid-Schiff” staining, and TUNEL assay. The results indicated that immobilization stress significantly decreased body weight, testis weight, and water/food intake compared to the control; while resveratrol ameliorated these effects. The quantitative histologic evaluation of the seminiferous tubule diameter, luminal diameter, area of seminiferous tubules, area of tubule lumen, epithelial height, Leydig cell number, and the width of the tunica albuginea were similarly decreased after exposure to RS. These parameters recovered back to normal in the RS + 2 mg/kg group. The development of spermatogenesis was significantly delayed in the RS, RS + V, and RS + 20 mg groups based upon our evaluation score system. However, we observed no significant differences in the RS + 2 mg group compared with the control group. The number of TUNEL-positive cells also significantly decreased in the RS + 2 mg/kg group. In conclusion, we found that the administration of 2 mg/kg was an effective dose against immobilization stress in mice.

Treatment of High Surgical Risk Thoracoabdominal Aortic Aneurysms with Stent Graft and Multilayer Bare Stents Joint Technique: Mid-Long-Term Clinical Results

This study aims to present the performance data on stent-graft and multilayer bare stents (MBS) joint technique in the treatment of high-risk thoracoabdominal aortic aneurysm (TAAA). From May 2012 to December 2015, 8 selective TAAA cases (ages 46-75years) ineligible for surgical repair underwent the stent-graft and MBS joint procedure, and were closely followed up for a median of 32months (range 14-58). Using computed tomography images, the aneurysm size, luminal blood flow diameter, and the covered visceral branches were analyzed. Technical success was achieved in all patients (100%, 8/8). Twenty-four visceral branches were covered by MBS in total. There was no complication or death during hospital stay. During follow-up period, no death or complication occurred. Aneurysm shrinkage (maximum diameter decrease ≥5mm) was observed in 7 patients. No aneurysm expansion was observed. Total aneurysm sac thrombosis was observed in all patients. The majority of covered side branches (23/24) were successfully preserved. No visceral ischemia or bleeding complications was observed during follow-up. Total endovascular repair of TAAA using stent-graft and MBS joint technique may be a safe and effective alternative in high surgical risk patients. More approving clinical evidences about the safety and efficacy of this procedure are anticipated.

Hypoxia accelerates intraplaque neovascularization derived from endothelial progenitor cells in carotid stenosis.

The relationship between intraplaque hypoxia and intraplaque hemorrhage (IPH) has been reported, but the details remain obscure. In this study, the authors aimed to clarify the relationship among intraplaque hypoxia, endothelial progenitor cells (EPCs), and neovascularization, which causes IPH. The histological findings of specimens obtained from carotid endarterectomy were assessed. This study included 49 patients who underwent carotid endarterectomy. Magnetic resonance plaque imaging was performed to analyze the components of the carotid plaques, and surgical specimens were subjected to immunohistochemical analysis. The numbers of hypoxia-inducible factor-1 alpha (HIF-1α)-, CD34-, CD133-, and vascular endothelial growth factor receptor-2 (VEGFR-2)-positive cells in the carotid plaques were precisely quantified, as were the number and maximum diameter of CD31-positive microvessels. Plaque components were judged as fibrous in 7 samples, lipid-rich in 22, and IPH in 20. The number of CD34-, VEGFR-2-, and CD133-positive cells as an EPC-specific marker was significantly correlated with the number of HIF-1α-positive cells (r = 0.9, r = 0.82, and r = 0.81, respectively). These numbers varied among the 3 plaque components (IPH > lipid-rich > fibrous). The number and maximum luminal diameter of CD31-positive microvessels were also significantly correlated with the number of HIF-1α-positive cells (r = 0.85 and r = 0.89, respectively) and varied among the 3 plaque components (IPH > lipid-rich > fibrous). The present findings suggest that intraplaque hypoxia may accelerate abnormal microvessel formation derived from EPCs, which in turn promotes IPH. The results also suggest that microvessel enlargement is a pivotal characteristic of IPH and these enlarged microvessels are immature endothelial tubes with disorganized branching and are fragile and prone to rupture.

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

IntroductionTechnical improvements to enhance distal occlusion thrombectomy are desirable. We describe the blind catheter exchange technique and report the pinning technique with small devices (‘mini-pinning’) for distal occlusions.MethodsA retrospective review...

An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclip

Microvascular anastomosis is mandatory for free flap surgery, but free flap transfer can be challenging because of vascular diameter discrepancies during microsurgery. Different methods have been described for preventing vascular discrepancies. The aim of this study was to test a simple technique using a hemostatic clip to taper the vessels. In 12 patients who had free tissue transfer with diameter discrepancies between donor and recipient vessels, tapering with a hemostatic clip technique was used. After key sutures were placed on the vessels, a hemostatic clip was placed in an oblique fashion on the vessel with a larger diameter. After the vessel was tapered and the same diameters in the donor and recipient vessels were achieved, anastomosis was completed. This technique was used in head and neck reconstruction and lower extremity reconstruction. The luminal diameters of arteries, and veins of the flap and recipient differed by 1.6- to 3.0-fold and 1.5- to 2.6-fold, respectively. All the flaps survived without complications. Tapering with a hemoclip technique is a rapid procedure that can be considered for managing vascular diameter discrepancies in free tissue transfers.