Vessel Diameter Measurements Research Articles

Effectiveness of 1α-25-dihydroxyvitamin D3 active substance on anastomosis safety in the rat femoral artery end-to-end anastomosis experimental model: Macroscopic and histological analyses

In inflammatory conditions, macrophage dominance affects the degree of inflammation. We assessed the effects of the active vitamin D (calcitriol) on inflammatory processes and macrophage dominance and aimed to determine the potential positive macroscopical and histological effects in the supermicrosurgical arterial anastomosis model of rats. Forty rats were divided into five groups: control surgery (Group 1), surgery with preoperative (Group 2), postoperative (Group 3) and peroperative (Group 4) systemic calcitriol, and surgery with local calcitriol (Group 5). Eighty femoral artery anastomoses were planned in both legs of rats. Systemic calcitriol was administered intraperitoneally to the relevant groups daily. Preoperative vessel diameter measurements were taken before anastomosis. Three weeks postsurgery, postoperative vessel diameter measurements were taken, anastomosis patency was assessed, and vascular segments were collected for histological examination, which included assessment of M1 and M2 macrophage depolarization, leucocyte infiltration, intima–media ratio, and luminal gap scoring. Systemic calcitriol administration (pre-, post-, or perioperative) significantly improved vessel diameter (p < 0.001); there was no significant difference among Groups 2–4. Histological findings revealed that Groups 3 and 4 had lower intima–media ratios (p < 0.05 and p < 0.01), higher M2-M1macrophage ratios (p < 0.01 and p < 0.001), and lower leucocyte infiltration (p < 0.05, p < 0.01, and p < 0.001). Local calcitriol administration had no vasodilatory effects or resulted in positive histological outcomes. Although the administration of calcitriol pre- and postoperatively increased vessel diameter, the latter appeared to have a more favorable impact on the histological analyses.

Optimizing thrombectomy in medium vessel occlusion: Focus on vessel diameter.

Mechanical thrombectomy for medium vessel occlusion (MeVO) is a challenging field with limited results. In this study, we aimed at evaluating the efficacy and safety of a procedural strategy beginning with occluded vessel diameter measurement and matched aspiration catheter selection. We retrospectively analyzed all sequentially treated patients by mechanical thrombectomy at two comprehensive stroke centers between May 2020 and April 2023, focusing on the occluded vessel diameter. We included patients who underwent thrombectomy for MeVO based on the matching strategy (a procedural approach involving vessel diameter assessment, matching aspiration catheter selection, and firm clot engagement with or without a stent retriever). We evaluated efficacy and safety using the modified Thrombolysis in the Cerebral Infarction Scale (mTICI) and intracranial hemorrhage (ICH) and procedure-related complications. Seventy patients fulfilled the final inclusion criteria. The median occluded vessel diameter was 1.71 mm. We achieved mTICI 2b/2c/3 in 82.9% and mTICI 2c/3 in 51.4% of the cases and did not observe any symptomatic ICH. We detected asymptomatic subarachnoid hemorrhage (SAH) in 24.3% of the cases, that is, 5.6%, 20.0%, and 45.5% in the vessel diameter groups ≥2.0, 1.5-2.0, and ≤1.5 mm, respectively. The SAH incidence was significantly higher in narrower vessel groups. The occluded vessel diameter and the contact method with clots predicted clinical outcomes. Matching strategy-based thrombectomy yields acceptable efficiency and safety results. In narrower vessels, it is optimal to engage matched aspiration catheters and clots without the assistance of conventional stent retrievers.

Comparison of Small Blood Vessel Diameter with Intravascular Ultrasound and Coronary Angiography for Guidance of Percutaneous Coronary Intervention.

Major cardiovascular events (MACEs) are a cause of major mortality worldwide. The narrowing and blockage of coronary arteries with atherosclerotic plaques are diagnosed and treated with percutaneous coronary intervention (PCI). During this procedure, coronary angiography (CAG) remains the most widely used guidance modality for the evaluation of the affected blood vessel. The measurement of the blood vessel diameter is an important factor to consider in order to decide if stent colocation is suitable for the intervention. In this regard, a small blood vessel (<2.75 mm) is majorly left without stent colocation; however, small vessel coronary artery disease (SvCAD) is a significant risk factor for the recurrence of MACEs, maybe due to the lack of a standardized treatment related to the diameter of the affected blood vessel; therefore, a more precise measurement is needed. The use of CAG for the measurement of the blood vessel diameter has some important limitations that can be improved with the use of newer techniques such as intravascular ultrasound (IVUS), although at higher costs, which might explain its underuse. To address differences in blood vessel diameter measurements and identify specific cases where IVUS might be of additional benefit for the patient, we conducted a retrospective study in patients who underwent PCI for MACEs with affection for at least one small blood vessel. We compared the measurements of the affected small blood vessels' diameter obtained by CAG and IVUS to identify cases of reclassification of the affected blood vessel; additionally, we underwent a multivariate analysis to identify risk factors associated with blood vessel reclassification. We included information from 48 patients with a mean ± SD age of 69.1 ± 11.9 years; 70.8% were men and 29.2% were women. The mean diameter with CAG and IVUS was 2.1 mm (95% CI 1.9-2.2), and 2.8 (2.8-3.0), respectively. The estimated difference was of 0.8 mm (95% CI 0.7-0.9). We found a significant positive low correlation in diameter measurements of small blood vessels obtained with CAG and IVUS (r = 0.1242 p = 0.014). In total, 37 (77%) patients had a reclassification of the affected blood vessel with IVUS. In 21 cases, the affected blood vessel changed from a small to a medium size (2.75-3.00 mm), and in 15 cases, the affected vessel changed from a small to a large size (<3.00 mm). The Bland-Altman plot was used to evaluate agreement in measurements with CAG and IVUS. The change in blood vessel classification with IVUs was important for the decision of intervention and stent collocation. The only variable associated with reclassification of blood vessels after adjustment in a multivariate analysis was T2D (type 2 diabetes) (p = 0 0.035). Our findings corroborate that blood vessels might appear smaller with CAG, especially in patients with T2D; therefore, at least in these cases, the use of IVUS is recommended over CAG.

Parvalbumin interneuron activity induces slow cerebrovascular fluctuations in awake mice.

Neuronal regulation of cerebrovasculature underlies brain imaging techniques reliant on cerebral blood flow (CBF) changes. However, interpreting these signals requires understanding their neural correlates. Parvalbumin (PV) interneurons are crucial in network activity, but their impact on CBF is not fully understood. Optogenetic studies show that stimulating cortical PV interneurons induces diverse CBF responses, including rapid increases, decreases, and slower delayed increases. To clarify this relationship, we measured hemodynamic and neural responses to optogenetic stimulation of PV interneurons expressing Channelrhodopsin-2 during evoked and ongoing resting-state activity in the somatosensory cortex of awake mice. Two-photon microscopy (2P) Ca2+ imaging showed robust activation of PV-positive (PV+) cells and inhibition of PV-negative (PV-) cells. Prolonged PV+ cell stimulation led to a delayed, slow CBF increase, resembling a secondary peak in the CBF response to whisker stimulation. 2P vessel diameter measurements revealed that PV+ cell stimulation induced rapid arterial vasodilation in superficial layers and delayed vasodilation in deeper layers. Ongoing activity recordings indicated that both PV+ and PV- cell populations modulate arterial fluctuations at rest, with PV+ cells having a greater impact. These findings show that PV interneurons generate a complex depth-dependent vascular response, dominated by slow vascular changes in deeper layers.

Relationships between diameter growth and functional wood anatomy in Eucalyptus globulus clones

Aim of study: We aimed to 1) analyze the variability of wood hydraulic anatomical traits in 10 clones of E. globulus Labill. with different growth rates, and 2) determine whether the magnitude of diameter growth affects the relationships between anatomical variables and diameter at breast height (DBH). Area of study: 25-year-old common garden trial in Balcarce, Buenos Aires, Argentina. Material and methods: We measured vessel diameter and number per unit area in transverse histological sections of stem wood, and calculated the proportion of vessel lumens, vessel composition (S), and theoretical specific hydraulic conductivity (Ks) of 10 E. globulus clones of high (HG) and low (LG) mean growth rates (measured as DBH) under field conditions. Main results: There was a difference in the range of variability in hydraulic anatomy between HG and LG clones, with LG clones showing a wider range. HG clones had wood with larger and fewer vessels and higher S compared to LG clones, with similar Ks between both growth groups. No clear or strong trends were observed between wood anatomy and DBH within the HG and LG groups, but across all clones a high correlation (Spearman coefficient r; p&lt;0.001) was observed between vessel number ‒ DBH (r= -0.68), and S ‒ DBH (r= 0.74). These correlations were driven by contrasting mean values of both growth groups. Research highlights: Commercial E. globulus clones present a relatively large variation in anatomical and hydraulic strategies. However, in contrast to what is postulated for various woody species, there was no clear relationship between theoretical hydraulic efficiency and individual diameter growth rate in the genotypes studied.

The differential effects of acute and prolonged L-NAME exposure on A23187-induced NO-dependent dilation in human arterioles

The Ca2+ ionophore A23187 induces endothelium-dependent and non-receptor-mediated vasodilation in human adipose arterioles (HAA). Preliminary data from our group suggest that while A23187 dilation mainly depends on NO as a vasodilator factor in healthy HAAs, there is a component of non-NO and likely hydrogen peroxide (H2O2)-mediated dilation, especially in arterioles from patients with coronary artery disease (CAD). The mechanisms underlying the release of two different vasodilator factors remain largely unclear. There is evidence that NO-mediated S-nitrosylation inhibits the catalytic activity of mitochondrial electron transport chain (ETC) complexes or other reactive oxygen species (ROS)-producing enzymes such as NADPH oxidases (NOX). The objective of this study was to compare the effects of acute (30 minutes) and prolonged (90 minutes) nitric oxide (NO) synthase inhibitor nitro-L-arginine methyl ester (L-NAME) exposure on A23187 dilation to elucidate whether prolonged incubation with L-NAME results in transition from NO-dependent to H2O2-dependent vasodilation in HAAs. HAAs (~150 μm ID), isolated from fat tissues obtained from subjects with and without CAD, were cannulated and pressurized at 60 mmHg for videomicroscopic measurement of vessel diameters. In non-CAD HAAs constricted with endothelin-1, A23187 (10−11 to 10−7 M) elicited concentration-dependent dilation (maximal dilation at 10−7 M: 68±5%, n=5), and this dilation was largely abolished after acute exposure to L-NAME (maximal dilation at 10−7 M: 21±7%, n=5). Prolonged L-NAME incubation restored A23187-dependent dilation (maximal dilation at 10−7 M: 74±2%, n=5), which was subsequently inhibited by hydrogen peroxide scavenger catalase (500 U/ml; maximal dilation at 10−7 M: 14±4%, n=5). HAAs obtained from CAD patients, responded to A23187 in a similar dose-dependent fashion (maximal dilation at 10−7 M: 68±3%, n=5), and this dilation was not affected by acute L-NAME exposure (maximal dilation at 10−7 M: 65±3%, n=5), but was reduced by catalase (maximal dilation at 10−7 M: 31±6%, n=6). To further determine the role of mitochondria-derived ROS in A23187-induced dilation, we treated arterioles with ETC inhibitor rotenone (1 mM). In non-CAD HAAs not pretreated with L-NAME, rotenone had no effect on A23187-induced dilation (maximal dilation at 10−7 M: 68±6%, n=5). In the presence of rotenone, however, prolonged L-NAME incubation no longer restored A23187-dependent dilation (maximal dilation at 10−7 M: 20±3%, n=5). Together, these data provide the first evidence that in healthy HAAs, prolonged L-NAME exposure changes the mechanism of vasodilation from NO to H2O2-mediated CAD-like vasodilation in response to A23187. In addition, the signaling process likely involves mitochondrial ROS. To elucidate the precise mechanisms underlying this process, future studies will be required to evaluate whether in healthy vasculature, basal NO inhibits mitochondrial ETC or other proteins such as NOXs through NO-mediated protein modification, which can be reversed by prolonged L-NAME incubation thereby promoting a switch from NO to H2O2 -mediated dilation. This work was supported by the National Heart, Lung, and Blood Institute [R01HL096647]. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Down to the Wire and Under Pressure: a historical perspective of the development of small vessel myography

Wire and pressure myography are both isolated vessel preparations that developed in the 1970s and '80s to study the microvasculature. These two in vitro methods shaped the possibilities for experimentation on small vessels, including arteries, veins, and lymphatics. In this work, publications and book chapters were used to synthesize a historical record of the emergence and landmark developments of wire and pressure myography. Following the creation of these techniques, vascular physiologists could now obtain either isometric measurements of vessel tension (wire myography) or isobaric measurements of vessel diameter (pressure myography). Further, vascular smooth muscle cells and endothelial cells could be individually assessed using pharmacological agents or following denudation, the process of removing the endothelial cell layer. This work examines the role of wire and pressure myography in furthering our understanding of microvascular physiology, highlights the different values of these two techniques, and acts as a supplement to enrich the current understanding of the standard practice of wire and pressure myography. These techniques left a lasting impact on the field of vascular physiology and, today, benefit researchers across fields, especially when linked to other tools including calcium imaging, electrophysiology, and disease or transgenic animal models. Project supported by NIH Grant R01HL155618. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Variability in Intracranial Vessel Diameters and Considerations for Neurovascular Models: A Systematic Review and Meta‐Analysis

Background In vitro experiments are critical for understanding the impact of medical devices and techniques on blood vessels and blood flow. However, their interpretation is often limited by anatomical models’ inability to capture the wide range of vessel sizes observed in real‐world practice. The current study aims to address this limitation by describing the distribution of vessel diameters in a real‐world population. Methods This systematic literature review using the PubMed database analyzed cerebral vessel diameters in patients from 2000 to 2022. The diameter measurements of various vessels within the neurovasculature were extracted. Random‐effects meta‐analyses were performed to synthesize vessel diameters across studies. Predicted distributions were generated from the meta‐analytical results. Results Seventy‐six studies were included in the analysis. The M1 segment, internal carotid artery (cervical and communicating segments), A1 segment, V2 segment, V4 segment, and basilar artery had sufficient data for generating predicted distributions of vessel diameters. Predicted mean diameters were as follows: M1 segment, 2.55 ± 0.42 mm (95th interpercentile range [IPR]: 1.71–3.38); internal carotid artery‐cervical segment, 4.74 ± 0.64 mm (95th IPR: 3.49–5.99); internal carotid artery‐communicating segment, 3.40 ± 0.64 mm (95th IPR: 2.15–4.66); A1 segment, 1.89 ± 0.34 mm (95th IPR: 1.23–2.55); V2 segment, 3.36 ± 0.67 mm (95th IPR: 2.05–4.67); V4 segment, 2.42 ± 0.74 mm (95th IPR: 0.98–3.86); and basilar artery, 2.96 ± 0.52 mm (95th IPR: 1.94–3.97). Conclusion Cerebral vessel diameter measurements can vary substantially due to patient‐specific factors and imaging techniques. This literature review highlights the diverse range of vessel sizes observed in different patient populations, emphasizing the need for anatomical models that accurately represent clinical observations.

Imaging Assessment of Peripapillary Vessel Diameters in Postmortem Eyes.

Proof of concept of ex vivo retinal vessel diameter measurements in human postmortem eyes. En face near-infrared (IR) images and optical coherence tomography (OCT) of the optic nerve head (ONH) were captured ex vivo with a Heidelberg Engineering Spectralis (Spectralis, version 7.0.4, Image Capture Module, version 1.2.4, Heidelberg Heidelberg, Germany) device, using a custom-made eye chamber holding and positioning the eyes during the image process. Thirty-two formaldehyde-fixated eyes of 16 patients were imaged. In the IR images, two independent graders measured retinal vessel diameters at the intersection of a drawn circle centered on the ONH with diameters of 2.0 mm and 3.4 mm, respectively. The anatomically corresponding measurements between both graders were statistically analyzed using a Wilcoxon signed-rank test. A total of 246 matched measurements of both graders were analyzed across all 32 imaged eyes. Statistically significant differences between the graders were found for arterioles at 2 mm from the ONH. The other measurements did not show statistically significant intergrader differences. The mean values for arteriole diameters were 72.2 µm at 2.0 mm and 61.5 µm at 3.4 mm for grader 1, and 66.4 µm at 2.0 mm and 63.2 µm at 3.4 mm for grader 2. The mean diameter for venules were 75.5 µm at 2.0 mm and 79.3 µm at 3.4 mm for grader 1, and 67.4 µm at 2 mm and 79.1 µm at 3.4 mm for grader 2. To the best of our knowledge, this is the first study to present IR image-based retinal vessel diameters in ex vivo postmortem eyes. Retinal IR/OCT imaging is possible, and measurements are reproducible in formaldehyde-fixated human eyes. Fixation artefacts result in lower image quality, and this can impose challenges in correctly detecting, classifying, and measuring retinal vessels.

Vascularization of choroidal melanomas as a prognostic factor: Comparative analysis between color Doppler and histopathological aspects of tumors

Objectives: The objective of the study was to correlate color Doppler with the vascularization of choroidal melanoma (CM) observed in histopathological sections and also to analyze the vascular histopathological prognostic factors of these tumors. Patients, Materials, and Methods: This was an experimental, cross-sectional, and analytical study carried out at Escola Paulista de Medicina - UNIFESP (São Paulo) and at the Ocular Pathology and Translational Research Laboratory of McGill University (Montreal/Canada). Twenty-five enucleated eyes of patients with CM were studied, 10 patients studied at UNIFESP and 15 patients studied at McGill University. The first 10 patients (Brazil), before enucleation, were submitted to color Doppler, all performed at UNIFESP. The resistance index (RI) and maximum systolic velocity of each tumor were calculated. The inclusion criteria of this study were as follows: CMs &gt;8 mm in thickness, enucleation as primary treatment, histopathological blocks sufficient for hematoxylin–eosin staining, periodic acid–Schiff, and CD34 immunohistochemistry. Exclusion criteria included tumors smaller than 8 mm and/or previous treatments such as laser or brachytherapy. Regarding the histopathology of each CM, cell-type classification, vessel diameter measurements, count of the number of mitoses, and vascular clefts were carried out. The latter are considered vessels because they are lined by endothelium (CD34 positive) and surrounded by melanoma cells. Results: There was a statistical correlation between RI and cell type (P &lt; 0.05). Tumors with a better prognosis (spindle cell) showed higher RI compared to epithelioid tumors, with a worse prognosis. The number of mitoses and vascular clefts correlated with the cell type, with a statistically significant difference (P &lt; 0.001). Tumors of worse prognosis (epithelioid) showed an increase in the number of mitoses and in the number of vascular clefts. There was no difference between vessel diameter and cell type. Conclusions: The number of vascular clefts has a positive prognostic correlation with the malignancy of CM. Doppler RI showed a positive prognostic correlation with CM malignancy. For the first time, the usefulness of vascular clefts as prognostic factors was proven, and a new classification of the vascular network in CMs was proposed.

Non-contrast free-breathing 2D CINE compressed SENSE T1-TFE cardiovascular MRI at 3T in sedated young children for assessment of congenital heart disease.

Cardiac MRI is a crucial tool for assessing congenital heart disease (CHD). However, its application remains challenging in young children when performed at 3T. The aim of this retrospective single center study was to compare a non-contrast free-breathing 2D CINE T1-weighted TFE-sequence with compressed sensing (FB 2D CINE CS T1-TFE) with 3D imaging for diagnostic accuracy of CHD, image quality, and vessel diameter measurements in sedated young children. FB 2D CINE CS T1-TFE was compared with a 3D non-contrast whole-heart sequence (3D WH) and 3D contrast-enhanced MR angiography (3D CE-MRA) at 3T in 37 CHD patients (20♂, 1.5±1.4 years). Two radiologists independently assessed image quality, type of CHD, and diagnostic confidence. Diameters and measures of contrast and sharpness of the aorta and pulmonary vessels were determined. A non-parametric multi-factorial approach was used to estimate diagnostic accuracy for the diagnosis of CHD. Linear mixed models were calculated to compare contrast and vessel sharpness. Krippendorff's alpha was determined to quantify vessel diameter agreement. FB 2D CINE CS T1-TFE was rated superior regarding image quality, diagnostic confidence, and diagnostic sensitivity for both intra- and extracardiac pathologies compared to 3D WH and 3D CE-MRA (all p<0.05). FB 2D CINE CS T1-TFE showed superior contrast and vessel sharpness (p<0.001) resulting in the highest proportion of measurable vessels (740/740; 100%), compared to 3D WH (530/620; 85.5%) and 3D CE-MRA (540/560; 96.4%). Regarding vessel diameter measurements, FB 2D CINE CS T1-TFE revealed the closest inter-reader agreement (Krippendorff's alpha: 0.94-0.96; 3D WH: 0.78-0.94; 3D CE-MRA: 0.76-0.93). FB 2D CINE CS T1-TFE demonstrates robustness at 3T and delivers high-quality diagnostic results to assess CHD in sedated young children. Its ability to function without contrast injection and respiratory compensation enhances ease of use and could encourage widespread adoption in clinical practice.

Application and reduction of a nonlinear hyperelastic wall model capturing ex vivo relationships between fluid pressure, area, and wall thickness in normal and hypertensive murine left pulmonary arteries.

Pulmonary hypertension is a cardiovascular disorder manifested by elevated mean arterial blood pressure (>20 mmHg) together with vessel wall stiffening and thickening due to alterations in collagen, elastin, and smooth muscle cells. Hypoxia-induced (type 3) pulmonary hypertension can be studied in animals exposed to a low oxygen environment for prolonged time periods leading to biomechanical alterations in vessel wall structure. This study introduces a novel approach to formulating a reduced order nonlinear elastic structural wall model for a large pulmonary artery. The model relating blood pressure and area is calibrated using ex vivo measurements of vessel diameter and wall thickness changes, under controlled pressure conditions, in left pulmonary arteries isolated from control and hypertensive mice. A two-layer, hyperelastic, and anisotropic model incorporating residual stresses is formulated using the Holzapfel-Gasser-Ogden model. Complex relations predicting vessel area and wall thickness with increasing blood pressure are derived and calibrated using the data. Sensitivity analysis, parameter estimation, subset selection, and physical plausibility arguments are used to systematically reduce the 16-parameter model to one in which a much smaller subset of identifiable parameters is estimated via solution of an inverse problem. Our final reduced one layer model includes a single set of three elastic moduli. Estimated ranges of these parameters demonstrate that nonlinear stiffening is dominated by elastin in the control animals and by collagen in the hypertensive animals. The pressure-area relation developed in this novel manner has potential impact on one-dimensional fluids network models of vessel wall remodeling in the presence of cardiovascular disease.

Blood shear stress during the cardiac cycle and endothelial cell orientation and polarity in the carotid artery of male and female mice.

Introduction: Blood flow produces fluid shear stress (SS), a frictional force parallel to the blood flow, on the endothelial cell (EC) layer of the lumen of the vessels. ECs themselves are sensitive to this frictional force in terms of directionality and intensity. The aim of this study was to determine the physiological shear stress value during the cardiac cycle and EC polarity and orientation from blood flow in healthy male and female mouse carotid artery. Methods: Experimentation is done on anesthetized male and female 8-week-old C5BL/6J mice. In vivo measurements of maximum blood velocity and vessel diameter in diastole and systole were performed on the right common carotid artery by Doppler ultrasound imaging. Blood viscosity (total and plasmatic) and hematocrit were determined on blood samples. For SS calculation, we developed a new method assuming heterogenous blood flow, i.e., a red cell central plug flow surrounded by a peripheral plasma sheath flow, and computing SS from vessel diameter and hemodynamical measurements (maximal blood velocity, hematocrit and plasmatic viscosity). Results: Results were compared with the classical method assuming a homogenous blood flow with constant apparent total blood viscosity. EC polarity and orientation were determined ex vivo on the carotid endothelium by confocal imaging after labeling of the EC nucleus and Golgi apparatus. Diastolic and systolic SS were 6 ± 2.5 Pa and 30 ± 6.5 Pa, respectively. Total blood and plasmatic viscosity was 4 ± 0.5 cP and 1.27 cP, respectively. ECs were polarized and significantly oriented against blood flow. No sex difference was identified.

Absolute retinal blood flow in healthy eyes and in eyes with retinal vein occlusion

PurposeTo measure non-invasively retinal venous blood flow (RBF) in healthy subjects and patients with retinal venous occlusion (RVO). MethodsThe prototype named AO-LDV (Adaptive Optics Laser Doppler Velocimeter), which combines a new absolute laser Doppler velocimeter with an adaptive optics fundus camera (rtx1, Imagine Eyes®, Orsay, France), was studied for the measurement of absolute RBF as a function of retinal vessel diameters and simultaneous measurement of red blood cell velocity. RBF was measured in healthy subjects (n = 15) and patients with retinal venous occlusion (RVO, n = 6). We also evaluated two softwares for the measurement of retinal vessel diameters: software 1 (automatic vessel detection, profile analysis) and software 2 (based on the use of deep neural networks for semantic segmentation of vessels, using a M2u-Net architecture). ResultsSoftware 2 provided a higher rate of automatic retinal vessel measurement (99.5 % of 12,320 AO images) than software 1 (64.9 %) and wider measurements (75.5 ± 15.7 μm vs 70.9 ± 19.8 μm, p < 0.001). For healthy subjects (n = 15), all the retinal veins in one eye were measured to obtain the total RBF. In healthy subjects, the total RBF was 37.8 ± 6.8 μl/min. There was a significant linear correlation between retinal vessel diameter and maximal velocity (slope = 0.1016; p < 0.001; r2 = 0.8597) and a significant power curve correlation between retinal vessel diameter and blood flow (3.63 × 10−5 × D2.54; p < 0.001; r2 = 0.7287). No significant relationship was found between total RBF and systolic and diastolic blood pressure, ocular perfusion pressure, heart rate, or hematocrit. For RVO patients (n = 6), a significant decrease in RBF was noted in occluded veins (3.51 ± 2.25 μl/min) compared with the contralateral healthy eye (11.07 ± 4.53 μl/min). For occluded vessels, the slope between diameter and velocity was 0.0195 (p < 0.001; r2 = 0.6068) and the relation between diameter and flow was Q = 9.91 × 10−6 × D2.41 (p < 0.01; r2 = 0.2526). ConclusionThis AO-LDV prototype offers new opportunity to study RBF in humans and to evaluate treatment in retinal vein diseases.

Bio-MEMS Devices for Medical and Healthcare Measurements from the Body Surface

In the present study, we describe attempts to develop medical/healthcare measurement devices from the body surface using microfabrication technology. These devices can be divided into two types: internal vessel diameter measurement from the body surface using ultrasound to measure blood pressure and vascular tone, and collection and measurement of biological substances and collection of cells from the body surface.

The value of metal artifact reduction and iterative algorithms in dual energy CT angiography in patients after complex endovascular aortic aneurysm repair

Rationale and objectivesEvaluation of the diagnostic value of linearly blended (LB) and virtual monoenergetic images (VMI) reconstruction techniques with and without metal artifacts reduction (MAR) and of adaptive statistical iterative reconstructions (ASIR) in the assessment of target vessels after branched/fenestrated endovascular aortic repair (f/brEVAR) procedures. Materials and methodsCT scans of 28 patients were used in this study. Arterial phase of examination was obtained using a dual-energy fast-kVp switching scanner. CT numbers in the aorta, celiac trunk, superior mesenteric artery, and renal arteries were measured in the following reconstructions: LB, VMI 60 keV, VMI MAR 60 keV, VMI ASIR 60 % 60 keV. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were calculated for each reconstruction. Luminal diameters (measurements at 2 levels of stent) and subjective image quality (5-point Likert scale) were assessed (2 readers, blinded to the type of reconstruction). ResultsThe highest mean values of CNR and SNR in vascular structures were obtained in VMI MAR 60 keV (CNR 12.526 ± 2.46, SNR 17.398 ± 2.52), lower in VMI 60 keV (CNR 11.508 ± 2.01, SNR 16.524 ± 2.07) and VMI ASIR (CNR 11.086 ± 1.78, SNR 15.928 ± 1.82), and the lowest in LB (CNR 6.808 ± 0.79, SNR 11.492 ± 0.79) reconstructions. There were no statistically significant differences in the measurements of the stent width between reconstructions (p > 0.05). The highest subjective image quality was obtained in the ASIR VMI (4.25 ± 0.44) and the lowest in the MAR VMI (1.57 ± 0.5) reconstruction. ConclusionDespite obtaining the highest values of SNR and CNR in the MAR VMI reconstruction, the subjective diagnostic value was the lowest for this technique due to significant artifacts. The type of reconstruction did not significantly affect vessel diameter measurements (p > 0.05). Iterative reconstructions raised both objective and subjective image quality.

Novel endovascular transmural technique for pharmacological block of superior cervical ganglion prevents sympathetic-mediated cerebral vasospasm

BackgroundSympathetic-mediated vasoconstriction from the superior cervical ganglion (SCG) is a significant contributor to cerebral vasospasm. Inhibition of the SCG has been shown to improve cerebral blood flow and reverse cerebral...

Endovascular Approach to Complex CTO Lesion in a Poor Surgical Candidate

Despite the various uses of endovascular and surgical techniques in management of patients with critical limb ischemia (CLI), traditional open bypass surgery with vein graft was shown to be more durable in the long term in long segment and heavily calcified lesions per the Best-CLI trial. However, patients with extensive cardiovascular risk factors and poor surgical candidates benefit from an endovascular approach. Endovascular revascularization of long segment lesions is complex and often requires the use of multiple unique techniques. Here, we present a case of a 76-year-old male with complex cardiovascular history with history of partial amputation of the right great toe and fifth toe who presented with non-healing ulcers overlying the right first and fifth distal metatarsals. A 76-year-old man with complex cardiovascular history presented with limited mobility, rest pain, and non-healing ulcers overlying the right first and fifth distal metatarsals. Bilateral common femoral artery (CFA) endarterectomy and lower left extremity angioplasty with stenting was done in the past. Doppler studies demonstrated dampened and flat pulses throughout the right lower extremity. Current computed tomography angiography (CTA) showed occlusion of the right superficial femoral artery (SFA) from the ostium to the P3 segment of the popliteal artery with significant calcification. Through ultrasound-guided left CFA access, a .035 guidewire and sheath were advanced into right distal CFA/proximal SFA and with angiogram confirming CTA results. Through the ultrasound-guided right PTA access and double flossing technique, retrograde V-18 guidewire was advanced into the antegrade Navicross catheter positioned within the right CFA. Subsequently, over the guidewire orbital atherectomy and balloon angioplasty were performed from the distal CFA to the proximal ATA region. With use of intravascular ultrasound for vessel diameter measurement, self-expanding stents were placed from the proximal SFA to the distal popliteal region. Final angiogram demonstrated an improvement of luminal diameter with less than 30% stenosis through the right lower extremity. Patient was started on Xarelto and aspirin. Multimodal endovascular technical approaches such as double-crossing flossing technique, controlled antegrade and retrograde tracking (CART) and reverse CART technique, and synapse rendezvous technique help with management of complex long segment occlusions. The case above demonstrates the use of double-crossing flossing technique in successful revascularization of a patient with end-stage CLI.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Three-dimensional aneurysm wall enhancement in fusiform intracranial aneurysms is associated with aneurysmal symptoms.

Aneurysm wall enhancement (AWE) in high-resolution magnetic resonance imaging (HR-MRI) is a potential biomarker for evaluating unstable aneurysms. Fusiform intracranial aneurysms (FIAs) frequently have a complex and curved structure. We aimed to develop a new three-dimensional (3D) aneurysmal wall enhancement (AWE) characterization method to enable comprehensive FIA evaluation and to investigate the ability of 3D-AWE to predict symptomatic FIA. We prospectively recruited patients with unruptured FIAs and received 3 T HR-MRI imaging from September 2017 to January 2019. 3D models of aneurysms and parent arteries were generated. Boundaries of the FIA were determined using 3D vessel diameter measurements. Dmax was the greatest diameter in the cross-section, while Lmax was the length of the centerline of the aneurysm. Signal intensity of the FIA was normalized to the pituitary stalk and then mapped onto the 3D model, then the average enhancement (3D-AWEavg), maximum enhancement (3D-AWEmax), enhancement area (AWEarea), and enhancement ratio (AWEratio) were calculated as AWE indicators, and the surface area of the entire aneurysm (Aarea) was also calculated. Areas with high AWE were defined as those with a value >0.9 times the signal intensity of the pituitary stalk. Multivariable logistic regression analyses were performed to determine independent predictors of aneurysm-related symptoms. FIA subtypes were defined as fusiform, dolichoectasia, and transitional. Differences between the three FIA subtypes were also examined. Forty-seven patients with 47 FIAs were included. Mean patient age was 55 ± 12.62 years and 74.5% were male. Twenty-nine patients (38.3%) were symptomatic. After adjusting for baseline differences in age, hypertension, Lmax, and FIA subtype, the multivariate logistics regression models showed that 3D-AWEavg (odds ratio [OR], 4.029; p = 0.019), 3D-AWEmax (OR, 3.437; p = 0.022), AWEarea (OR, 1.019; p = 0.008), and AWEratio (OR, 2.490; p = 0.045) were independent predictors of aneurysm-related symptoms. Dmax and Aarea were larger and 3D-AWEavg, 3D-AWEmax, AWEarea, and AWEratio were higher with the transitional subtype than the other two subtypes. The new 3D AWE method, which enables the use of numerous new metrics, can predict symptomatic FIAs. Different 3D-AWE between the three FIA subtypes may be helpful in understanding the pathophysiology of FIAs.

The Ultrasound Signal Processing Based on High-Performance CORDIC Algorithm and Radial Artery Imaging Implementation

The radial artery reflects the largest amount of physiological and pathological information about the human body. However, ultrasound signal processing involves a large number of complex functions, and traditional digital signal processing can hardly meet the requirements of real-time processing of ultrasound data. The research aims to improve computational accuracy and reduce the hardware complexity of ultrasound signal processing systems. Firstly, this paper proposes to apply the coordinate rotation digital computer (CORDIC) algorithm to the whole radial artery ultrasound signal processing, combines the signal processing characteristics of each sub-module, and designs the dynamic filtering module based on the radix-4 CORDIC algorithm, the quadrature demodulation module based on the partitioned-hybrid CORDIC algorithm, and the dynamic range transformation module based on the improved scale-free CORDIC algorithm. A digital radial artery ultrasound imaging system was then built to verify the accuracy of the three sub-modules. The simulation results show that the use of the high-performance CORDIC algorithm can improve the accuracy of data processing. This provides a new idea for the real-time processing of ultrasound signals. Finally, radial artery ultrasound data were collected from 20 volunteers using different probe scanning modes at three reference positions. The vessel diameter measurements were averaged to verify the reliability of the CORDIC algorithm for radial artery ultrasound imaging, which has practical application value for computer-aided clinical diagnosis.