Presence Of Tortuosity Research Articles

Correlation analysis of coronary artery tortuosity and calcification score

BackgroundCoronary artery tortuosity (CAT) is regarded as a variation of vascular anatomy, and its relationship with coronary artery calcification (CAC) score is still not well clarified. Studying the correlation between coronary artery calcification scores and CAT to determine specific prevention and intervention populations seems to have more meaningful.MethodsThe study is a cross-sectional retrospective study, including 1280 patients. CAT is defined as the presence of at least three consecutive curvatures of more than 45°measured during systole or diastole of a major epicardial coronary artery. Multivariable regression analysis was used to adjust the clinical parameters directly affecting CAT.ResultsOf these individuals, 445 (35%) were evaluated having CAT, of which females are higher than males (59.1% vs. 40.9%). Moderate CAC score (101–400) (odds ratio (OR) 1.49, 95% confidence interval [95%CI] 1.05–2.10, P = 0.025) revealed significantly associated with CAT on univariable analysis. However, multivariable analysis after adjusting for confounding factors only indicated that CAT was positively correlated with female (OR 1.68, 95%CI 1.30–2.17, P < 0.001), hypertension (OR 1.35, 95% CI 1.04–1.75, P = 0.024), and age (OR 1.02, 95% CI 1.01–1.03, P = 0.001), while was negatively associated with body mass index (BMI) 24–27.9(OR 0.76, 95% CI 0.58–1.00, P = 0.044), and BMI > 28 (OR 0.46, 95% CI 0.31–0.68, P < 0.001). Further analysis stratified by gender showed that compared with non-CAT, CAT was significantly linked with moderate CAC score (OR 1.79, 95% CI 1.00–3.20, P = 0.048), hypertension (OR 1.54, 95% CI 1.07–2.22, P = 0.021), and high-density lipoprotein (HDL) (OR 1.86, 95% CI 1.07–3.24, P = 0.028), while was negatively related to BMI > 28 (OR 0.51, 95% CI 0.31–0.84, P = 0.008) in female patients.ConclusionsCAT is more likely to be found in females, connected with hypertension, age, and BMI. No significant correlation is found between the presence of tortuosity and calcium score or diameter stenosis on multivariable analysis. Whereas the CAT is associated with moderate CAC score in correlation analysis when women are selected as the main group.

Cumulative Incidences and Risk Factors for Intra and Extracranial Cerebral Arteriopathy in Sickle Cell Disease Children

In children with sickle cell disease (SCD), cerebral vasculopathy is responsible for overt strokes and silent cerebral infarcts (SCI). Transcranial Doppler (TCD) detects children at risk of strokes (intracranial time averaged mean of velocities (TAMV) ≥200cm/s). The extracranial portion of the internal carotid artery (eICA) can also be the site of stenosis or occlusion. eICA assessment requires cervical Doppler using a submandibular approach and cervical MRA (cMRA). We previously reported that eICA TAMV≥160cm/s are highly predictive of eICA stenosis and are a risk factor for SCI independently of acute and chronic anemia. However, the kinetics of eICA arteriopathy are unknown. The aim here was to evaluate and compare the cumulative incidence of intra/extracranial arteriopathy and associated risk factors in a longitudinal SCD cohort. Children born between 01/1988 and 01/ 2018, followed at our center at least until 06/2012 and up to 09/2019, annually assessed by TCD imaging and at least once by cervical Doppler were included, resulting in 493 SCD children (238F-255M) with 398 SCA (385SS,10Sb0,3SDPunjab), and 95 SC/Sb+ children (65SC,30Sb+). Alpha-genes, b-globin haplotypes, G6PD activity, CD36 expression were recorded. The average of baseline biologic parameters recorded between 1 and 3 years of age, a minimum of 3 months away from transfusion, 1 month from a painful episode, and before any intensive therapy was calculated. The median (range) follow-up of the overall cohort was 10.6 years (1.1-22.9), providing 5335 patient-years of follow-up. Six deaths occurred (5 SCA-children at 2, 4, 7, 19 &amp; 20 years and 1 in SB+ patient at 13 years). Three SS patients had an ischemic stroke at 1.5, 3 and 4.3 years. Kaplan-Meier estimates of cumulative incidence (95%CI) are shown (Figure). In SCA-children, abnormal eICA TAMV and/or eICA stenosis were sometimes associated with abnormal intracranial TAMV and/or stenosis, but isolated eICA TAMV≥200cm/s or 160-199cm/s were observed in 19 (4.8%) and 28/398 (7.0%) patients, respectively, and isolated eICA stenoses in 33/294 (11.2%).Thus, risk factors were only analyzed in patients with isolated intra- or extracranial arteriopathy. COX regression analyses are shown (Table). For isolated intracranial TAMV≥200cm/s, multivariate analyses after introducing all significant genetic and biological risk factors retained the number of SEN b-haplotypes [HR=0.547 (95%CI:0.335-0.893); p=0.016], reticulocyte count&amp;gt;400x109/L [HR=1.961 (95%CI:1.119-3.436); p=0.019], and WBC count&amp;gt;20x109/L [HR=2.410 (95%CI:1.340-4.329); p=0.003] as independent risk factors. Isolated eICA TAMV≥160 cm/s were only strongly associated with the presence of tortuosities [HR=8.6 (95%CI :4.3-17.2); p&amp;lt;0.001]. eICA tortuosities were present in 94/284 (33.1%) SCA vs 5/43 (11.6%) SC/Sb+ children (p=0.004), most often seen at the first cMRA but secondarily in 16 patients. Multivariate COX analysis retained genotype [HR/SCA vs SC/Sb+ = 3.6 (95%CI:1.4-9.4); p=0.010], low hemoglobin [HR=1.25 (95%CI:1.04-1.50); p=0.020], and high LDH [HR=1.002 (95%CI:1.001-1.002); p=0.001], as independent risk factors for eICA tortuosities. As expected, the risk of intracranial stenosis was significantly associated with isolated intracranial TAMV≥200 cm/s [HR (95%CI)=4 .255 (2.146-8.475); p&amp;lt;0.001]. After adjustment with isolated intracranial TAMV≥200 cm/s, a-thalassemia, low hemoglobin, high WBC, MCV and LDH remained as significant, but not independent, risk factors for intracranial stenosis. The risk for eICA stenosis was only highly associated with the presence of tortuosities [HR=10.9 (95%CI:4.7-25.0); p&amp;lt;0.001], or a history of eICA≥160cm/s [HR=15.4 (95%CI :7.5-31.2); p&amp;lt;0.001]. This study reports eICA arteriopathy kinetics using a longitudinal cohort of SCD children systematically assessed by Doppler and cMRA. While we confirm that only SCA and not SC/Sb+ children are at risk of intra/extracranial arteriopathy, we show for the first time that extracranial arteriopathy progressively develops as early as 2 years old in SCA-children and reaches a plateau around 10 years of age, as for intracranial arteriopathy. Furthermore, eICA tortuosities, which are the risk factor for eICA arteriopathy, are themselves significantly and independently associated with the SCA genotype and the severity of hemolytic anemia. Figure Disclosures Bernaudin: BlueBirdBio: Consultancy; AddMedica: Honoraria, Other; GBT: Membership on an entity's Board of Directors or advisory committees. Verlhac:BlueBirdBio: Consultancy; AddMedica: Honoraria.

The developing mechanism of atherosclerotic lesion in coronary side branch on the ventricular free wall differs by the location of lesion

Abstract Background The effective treating method of coronary side branch lesions such as ostial stenosis or thin arteries has not been established. On the other hand, tortuous side branch rarely has stenotic lesions. Purpose We focused on coronary side branches on the ventricular free wall, and examined coronary risk factors and bending and stretching motion of branch which can contribute to the development of atherosclerotic lesion. Methods In elective and first-time coronary angiograms, we included side branches on the ventricular free wall (&amp;gt;2mm in diameter) and excluded previously treated ones. Study A; we divided arteries into proximal, middle, and distal segment, and examined the presence of tortuosity and stenotic lesions exceeding 50% diameter stenosis (DS) for each segment. A score of 1 was assigned to tortuous segment, and 0 to non-tortuous one. Study B; we included stenotic lesion (&amp;gt;50% DS) in side branch ostium and excluded those extended across main coronary arteries. Relation between lesions and patients' characteristics was examined. Results Study A; in 1,828 side branches from 472 patients, middle and distal segments had significantly higher tortuosity score than proximal (0.68, 0.78 vs. 0.34; p&amp;lt;0.0001). On the contrary, proximal segments had more stenotic lesions except ostial stenosis (230 vs. 69, 5; p&amp;lt;0.0001). Study B; in 1,740 side branches from 465 patients, 122 ostial stenotic lesions were found (7.0%). Multivariate logistic regression analysis revealed diabetes mellitus and age as independent contributors to development of ostial stenosis (Table). Conclusions Side branch stenosis developed less frequently in middle and distal segments, where stronger ventricular wall motion reinforces bending and stretching motion and tortuosity of arteries. This fact indicates that those characteristics may prevent developing atherosclerosis through increasing shear stress. On the other hand, diabetes mellitus strongly contributes to the development of ostial stenosis. Thus, the developing mechanism of atherosclerotic lesion in side branch on the ventricular free wall differs by the location of lesion. Funding Acknowledgement Type of funding source: None

Abstract WP24: Arterial Tortuosity is a Potent Determinant of Safety in Endovascular Therapy for Ischemic Stroke

Background: Subarachnoid hemorrhage (SAH) associated with vessel injury during endovascular therapy for acute ischemic stroke is a known complication. Arterial anatomy may predispose to increased risk of SAH and technical safety, yet factors such as clot location, arterial size and tortuosity have not been explored. We examined these anatomical factors with respect to SAH during thrombectomy. Methods: Arterial anatomy at the site of occlusion and mechanical thrombectomy during device deployment was detailed by the STRATIS core lab. Luminal diameters, arterial branching and segmental tortuosity were measured. Arterial tortuosity was quantified using the distance factor metric (DFM). Statistical analyses included descriptives of arterial anatomy, with univariate and multivariate modeling to predict SAH. Results: Arterial tortuosity in each segment from the proximal cerebral arteries to the site of occlusion was quantified in 790 subjects treated with mechanical thrombectomy in STRATIS. Cumulative arterial tortuosity to the site of vessel occlusion was greater in distal lesions (Table 1). SAH was clearly linked with more distal thrombectomy (p=0.017), with 19.0% of distal M2, 16.7% of M3, 7.3% of distal M1, 5.8% of proximal M2, 2.4% of distal ICA and 2.1% of proximal M1. Multivariate prediction of SAH revealed that arterial diameter was unrelated to SAH (p=0.30) when accounting for tortuosity, whereas the presence of tortuosity tripled the risk of SAH (OR 3, p&lt;0.05). Conclusions: This novel systematic analysis of arterial tortuosity and angiographic anatomy during mechanical thrombectomy establishes tortuosity as a determinant of SAH, providing insight for future techniques and innovative device designs.

Cervical internal carotid artery tortuosity: A morphologic analysis of patients with acute ischemic stroke.

Cervical internal carotid artery (ICA) tortuosity is thought to impede distal catheterization during attempted mechanical thrombectomy in patients with acute ischemic stroke. This study sought to assess the morphologic characteristics of ICAs and the effects of tortuosity on thrombectomy attempts. A retrospective review was completed of neck CTAs of patients with acute ischemic stroke due to a large vessel occlusion that underwent attempted endovascular recanalization. Significant tortuosity of ICAs was defined as the presence of kink(s) (acute (<90°) angulation), loop(s) (C- or S-shaped curvature with 2+ areas of acute (<90°) angulation), or coil(s) (full 360° turn arterial bend). Findings were statistically compared to procedure time, successful recanalization rate, patient demographics, and co-morbidities. Of 120 included patients, 47 (39.2%) had some form of tortuosity of one or both ICAs. Twenty-eight patients (23.3%) had a kink of one or both ICAs; this was followed in frequency by loops (n = 20; 16.7%) and coils (n = 8; 6.7%). Kinks were associated with lower rates of successful recanalization (p = 0.02). The presence of any tortuosity (kinks, loops, or coils) was not associated with number of passes during thrombectomy (p = 0.88), successful recanalization (p = 0.11), or total procedure time (p = 0.22). No association was noted between the presence of tortuosity and age (p = 0.96) or prior or current tobacco use (p = 0.75 and p = 0.69, respectively). Among patients referred for urgent revascularization for large vessel occlusion, approximately 40% exhibit some tortuosity. Kinks may portend lower likelihood of recanalization success, although tortuosity as a whole seems to have little effect on endovascular thrombectomy.

Impact of coronary tortuosity on the artery hemodynamics

The presence of tortuosity in coronary artery (CA) affects the local wall shear stress (WSS) which is an influencing hemodynamic descriptor (HD) for the development of atherosclerotic sites. To conduct a morphological parametric study in coronary arteries (CAs), several idealized tortuous artery models were obtained by varying three morphological indices namely, curvature radius (CR), distance between two bends (DBB) and the angle of bend (AoB). Computational fluid dynamics methodology with multiphase mixture theory is used to explore the effect of coronary tortuosity on various WSS based hemodynamic descriptors (HDs) namely, time-averaged WSS, oscillatory shear index, time-averaged WSS gradient, endothelial cell activation potential and the relative residence time that are used to determine the vulnerable locations for the onset of thrombosis and atherosclerosis. Our findings suggest that all the tortuosity morphological indices, CR, DBB and AoB have significant influence on the distributions of various HDs and hemodynamics. It is also observed that atherosclerosis prone sites were witnessed at the inner artery wall at downstream regions of the bend section 1 and bend section 2 in all the tortuous artery models studied and found to increase as the CR and DBB were reduced however, found to increase as the AoB is increased. Hence, severe coronary tortuosity in CAs with small CR, small DBB and higher AoB may have lower WSS zones at inner bend sections which promote atherosclerosis plaque progression. The analysis obtained from this multiphase blood flow study can be employed potentially in the clinical assessment on the severity of atherosclerosis lesions as well as in understanding the underlying mechanisms of localization and formation of atherosclerotic plaques.

A Spectrum of Regression Following Intravitreal Bevacizumab in Retinopathy of Prematurity

To describe an improved understanding of the regression patterns following off-label intravitreal bevacizumab (IVB) treatment for retinopathy of prematurity (ROP). Retrospective cohort study. All infants treated with IVB for type 1 ROP at a single institution from June 2013 to March 2018 were retrospectively reviewed and the amount of retinal nonperfusion on fluorescein angiogram was calculated. In the 92 eyes of 46 patients analyzed, only 3 eyes (3.3%) reached full vascular maturity. Of the 89 eyes not reaching maturity, 39 eyes (43.8%) had vascular arrest alone (VAA), 34 eyes (38.2%) had vascular arrest with persistent tortuosity (VAT), and 16 eyes (18.0%) had ROP reactivation. Those eyes that reactivated were more likely to be initially classified as having aggressive posterior ROP (P= .004) and of Asian ethnicity (P= .008). There were greater areas of ischemia in eyes with reactivation as compared to VAT and VAA (112.1mm2 vs 72.5mm2 vs 56.6mm2, respectively, P= .007). Younger gestational age at birth was found to be an independent predictor of persistent tortuosity (VAT vs VAA) in a logistic regression model. Incomplete vascularization following IVB is very common and is associated with a younger gestational age at birth, Asian ethnicity, and aggressive posterior ROP. The presence of tortuosity following IVB may be indicative of persistently elevated vascular endothelial growth factor levels and an early indicator of potential reactivation.

Modified Curvature-based Trigonometric Identities for Retinal Blood Vessel Tortuosity Measurement in Diabetic Retinopathy Fundus Images

In current clinical practice, there is no specific standard and grading system that can be used to measure the behaviour of the retinal blood vessel curvature. The retinal blood vessel curvature is measured based on clinical experiences. It is very subjective and inconsistent to describe the presence of tortuosity in fundus images. Thus, this paper aims to measure the tortuosity of retinal blood vessel using curvature-based method and investigate its relationship with diabetic retinopathy (DR) disease. The proposed tortuosity measures have been tested on 43 fundus images belonging to patients who have been diagnosed with DR disease and validated by two clinical experts from our collaborative hospital. On average, the proposed algorithm achieved 90.7% (accuracy), 98.72% (sensitivity) and 9.3% (false negative rate), that shows significant tortuosity presence in diabetic retinopathy fundus images.

Predictors of success in percutaneous Coronary intervention for chronic total occlusion

We performed a retrospective analysis of 146 chronic total occlusion CTO patients to evaluate the antecedents of success and failure in CTO – Percutaneous Coronary Intervention (PCI) in Indian patients. The study aimed to identify the technical success rate, analyse immediate patient outcomes, and understand the factors impacting the successful outcomes. Our results showed that J-CTO (Multicenter CTO Registry of Japan) scores correlate well with the success rates of CTO-PCI and two most important factors deciding failure are lesion length more than 20 mm and lesions with calcification. Most important step to success of CTO is wiring, once wire crosses the segment, success rates of the procedure is around 97%. The wire escalation strategy has to be modified once the initial soft (polymer) wire fails, it’s reasonable to use high tip load wire like conquest pro without the use of intermediate wires (except in presence of tortuosity). At 1 year follow up of these patients, there was a statistically significant drop in angina class and major adverse cardiac event rates in the successful CTO group.

A weighted angiographic scoring model (W-CTO score) to predict success of antegrade wire crossing in chronic total occlusion: analysis from a single centre.

The aim of this study was to derive a weighted score model predicting success/failure of antegrade wire crossing in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Four hundred and four consecutive CTO cases (408 lesions) undergoing CTO-PCI between January 2009 and March 2015 were included. Data were divided into two sets, namely "derivation" and "validation", in a 70:30 ratio. The score was derived using multivariate analysis to identify independent predictors of wire crossing failure from the derivation set (n=285 lesions) and validated on the remaining 123 lesions (validation set). The overall procedural success rate was 83.6%. Independent predictors of CTO-PCI failure and their contribution to the weighted score were a blunt stump (beta coefficient 2.12), length of occlusion >20 mm (beta coefficient 1.71), presence of calcification (beta coefficient 0.72), presence of tortuosity (beta coefficient 1.06) and collateral with Rentrop grade <2 (beta coefficient 1.06). The respective scores allotted were +2.0, +1.5, +1, +1, +1 (total 6.5), rounding the coefficient to the nearest 0.5. Score values of 0-2, >2-4 and >4 were classified as low, intermediate and high levels of difficulty for CTO-PCI success and were associated with 98%, 74.2%, and 42.5% (p<0.0001), respectively, of antegrade wire crossing success in the derivation set. This was also validated on the validation set with CTO success in the three derived difficulty levels being 100%, 82.4% and 48.4%, respectively. Our weighted angiographic CTO score is a strong predictor of final antegrade wire crossing success and could be used in day-to-day clinical practice of CTO interventions.

Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease

BackgroundLittle is known about the significance of severe coronary tortuosity (SCT) despite it being a relatively common finding on coronary angiography. We examined whether the presence of tortuosity was influenced by gender or cardiac risk factors. Methods and resultsWe examined 870 patients (Men=589, Women=281) who presented to Westmead Hospital, Sydney, Australia for invasive coronary angiography for the assessment of chest pain due to suspected CAD. Female gender and age were significantly associated with SCT (p<0.001 for age) with 45.2% of women having SCT as opposed to 19.7% of men (p<0.001). Men with SCT had lower Extent scores only compared than those without tortuosity (22.4 vs. 32.4, p=0.003). However, women with SCT had less severe coronary artery disease than those with no SCT as measured by both the Extent score (12.4 vs. 19.1, p=0.03) and Gensini score (10.4 vs. 15.5, p=0.02). ConclusionThere is a significant relationship between coronary artery tortuosity and gender. Women with severe tortuosity are more likely to have normal coronary arteries or less severe disease than men despite presenting with chest pain.

Implantation of a novolimus-eluting bioresorbable scaffold with a strut thickness of 100 µm showing evidence of self-correction.

Practical concerns regarding poly-L-lactic acid (PLLA)-based bioresorbable scaffolds (BRS) are mostly related to the strut thickness of 150 μm. Implantation may cause more vessel injury as well as non-laminar flow and activation of platelet function. Furthermore, constraints of deliverability preclude BRS use in the presence of tortuosity or severe calcification. The PLLAbased novolimus-eluting DESolve® 100 scaffold (Elixir Medical Corporation, Sunnyvale, CA, USA) has a strut thickness of 100 μm. Complete degradation is achieved within two years. Furthermore, it has wider expansion ranges than other BRS and self-correction properties corresponding to nominal diameters, which can resolve minor malapposition. In a mid-RCX stenosis, predilatation was performed with a noncompliant and a scoring balloon. Thereafter, a 2.5/28 mm BRS was implanted. Optical coherence tomography (OCT) revealed malapposition with a maximum vessel-wall distance of 0.33 mm and further edge dissection. Thus, a second 2.5/14 mm BRS was implanted distally. Another OCT run revealed a reduction of malapposition of the first BRS within 15 minutes: the vessel-wall distance decreased from 0.33 mm to 0.25 mm, and the minimal scaffold area increased from 3.94 mm2 to 4.28 mm2 (Figure 1). Nevertheless, malapposition was still present and post-dilatation was implemented with a non-compliant balloon. Final OCT confirmed a satisfactory result. The Online Appendix, Online Figure 1, Online Figure 2 and Moving image 1-Moving image 6 can be found online. The in vitro scaffold cross-sectional area under nominal pressure for the 2.5 mm DESolve 100 is 4.91 mm2, thus further self-correction is presumable. Self-correction appears reasonable especially in the presence of thrombi. Additional investigations will certainly be required for a conclusive proof-of-concept.

Impact of tortuous flow on bacteria streamer development in microfluidic system during filtration.

The way in which bacterial communities colonize flow in porous media is of importance, but basic knowledge on the dynamic of these phenomena is still missing. The aim of this work is to develop microfluidic experiments in order to progress in the understanding of bacteria capture in filters and membranes. PDMS microfluidic devices mimicking filtration processes have been developed to allow a direct dynamic observation of bacteria across 10 or 20 μm width microchannels. When filtered in such devices, bacteria behave surprisingly: Escherichia coli, Pseudomonas aeruginosa or Staphylococcus aureus accumulate in the downstream zone of the filter and form large streamers which oscillate in the flow. In this study, streamer formation is put in evidence for bacteria suspension in non nutritive conditions in less than 1 h. This result is totally different from the one observed in same system with "inert" particles or dead bacteria which are captured in the bottleneck zone and are accumulated in the upstream zone. Observations within different flow geometries (straight channels, connected channels, and staggered row pillars) show that the bacteria streamer development is influenced by the flow configuration and, particularly by the presence of tortuosity within the microchannels zone. These results are discussed at the light of 3D flow simulations. In confined systems and in laminar flow, there is secondary flow (z-velocities) superimposed to the streamwise motion (in xy plane). The presence of the secondary flow in the microsystems has an effect on the bacterial adhesion. A scenario in three steps is established to describe the formation of the streamers and to explain the positive effect of tortuous flow on the development kinetics.

THU0399 Is pernio a microvascular disease?

BackgroundPernio is a disorder that affects unprotected skin regions of the individuals who are exposed to nonfreezing, damp cold. Various hypotheses such as abnormal vasoconstriction, vasculitis, and hyperviscosity have been...

Changes in meibography in pediatric blepharokeratoconjunctivitis

AbstractPurpose Pediatric blepharokeratoconjunctivitis is an underrecognized and poorly defined disorder. Few details are known about its underlying etiology because children are less cooperative with intensive examination. Nevertheless the meibomian gland dysfunction seems to play an important role in the etiology. Non‐contact Meibography can achieve a non‐invasive investigation of the meibomian glands inside the tarsal plates of the eyelids. The purpose of this study was to investigate meibomian gland morphology in pediatric blepharokeratoconjunctivitis by non‐contact infrared Meibography.Methods The study group included 10 children (20 eyes) suffering from pediatric blepharokeratoconjunctivitis. Subjective symptoms of ocular discomfort, conjunctival and corneal involvement were recorded. The lid margins were evaluated and non‐contact Meibography was performed. Partial or complete loss of the meibomian glands and the presence of tortuosity were checked.Results All patients reported ocular discomfort as well as lid margin, conjunctival, and corneal involvement. The mean age of the study population was 8 years (2‐16 years) and 60% were female. In 8 children (out of 10) meibography revealed partial or complete drop out of meibomian glands in the upper or lower tarsal plate but more frequently in the lower tarsal plate, also abnormal tortuosity of the meibomian glands in the upper eyelid was found.Conclusion Our investigations showed that pediatric blepharokeratoconjunctivitis can be associated with drop out or abnormal tortuosity of meibomian glands evaluated with meibography.

Infrared Imaging of Meibomian Gland Structure Using a Novel Keratograph

To examine the ability of a novel non-contact device (Keratograph 4) to image the meibomian gland (MG) structures and their morphological changes in the upper and lower eyelids. Thirty-seven participants (mean age 57.8 ± 8.5 years; 3 males and 34 females) completed the Ocular Surface Disease Index questionnaire to assess dryness symptoms. Meibum secretion quality score, number of blocked gland orifices, and meibum expressibility scores were assessed. The lower lid (LL) and upper lid (UL) of all subjects were everted and images of the MGs were taken using the Keratograph 4 (OCULUS). A MG dropout score (MGDS) due to complete or partial gland loss of both lids was obtained using a subjective 4-grade scoring system, and digital analysis of the images using ImageJ was performed. Presence of tortuosity and visible acinar changes of the MGs were also noted. MGDS for both lids was significantly positively correlated with the Ocular Surface Disease Index score (r = 0.51; p < 0.05). The MGDS determined using the digital grading was also significantly positively correlated (UL: r = 0.68, p < 0.05; LL: r = 0.42, p < 0.05). The sum of the MGDS for both lids using the subjective grading scale was significantly different between the non-MGD and MGD group (1.3 ± 1.0 vs. 3.1 ± 1.1; p = 0.0004). MGDS assessment using the digital grading was significantly different between non-MGD (UL = 6%, LL = 8%) and MGD group (UL = 32%, LL = 42%; p = 0.001). Tortuous MG was observed only on the UL in 6% of the participants. Visible acinar changes were noted in 40% of the study participants. Infrared meibography is now possible in a clinical setting using commercially available devices, and meibography can help determine differences in MG structure in subjects symptomatic of dry eye.

Implantation de valve aortique percutanée : sélection des patients

A good selection of patients is a crucial step before transcatheter aortic valve implantation (TAVI) in order to select the good indications and choose the access route. TAVI should be considered only in patients with symptomatic severe aortic stenosis and either contraindication or high surgical risk. Indication for TAVI should be discussed in a multidisciplinary team meeting. Echocardiography and/or CT scan are mandatory to evaluate the aortic annulus size and select the good prosthesis size. The possibility of transfemoral implantation is evaluated by angiography and CT scan, and based on the arterial diameters, but also on the presence of tortuosities and arterial calcifications.

Morphologic evaluation of the use of a latex prosthesis in videolaparoscopic inguinoplasty: an experimental study in dogs

To evaluate the morphological aspects of the behavior of 4 types of latex biomembranes implanted in preperitoneal videolaparoscopic inguinoplasty. Sixteen inguinoplasties were performed in 12 dogs: group 1 received an impermeable latex biomembrane in the right inguinal region and a prolene prosthesis, as control, in the contralateral inguinal region; groups 2, 3 and 4 received latex biomembranes respectively containing impermeable polyamide, 1-mm thick porous polyamide and 0.5-mm thick porous polyamide. Macro- and microscopic evaluations of the inguinal region and of the removed implants were made on the 7th, 14th, 21st and 28th days in group 1 and on the 28th postoperative day in the other groups. We observed absence of hematoma, seroma and infection; presence of tortuosities; induction of vascular neoformation, inflammatory reaction and collagen deposition, and full encystment of the latex biomembranes, except that with fine porous polyamide, which was partially incorporated, with the formation of microcysts. No latex biomembrane induced fibrosis as observed in the prolene control group. The biomembranes maintain induction of the healing process without fibrosis, are fully encysted and, except for the one with fine porous polyamide, are not incorporated into adjacent tissues. The latex biomembrane, with or without polyamide, is not recommended as a separate material for preperitoneal inguinoplasty.

0034: Carotid Interpretation Criteria. How to Choose What You Use

The first criteria for estimation of carotid stenosis were developed by the Strandness group at the University of Washington in the 1980s. Others proposed different criteria around the same time. The major carotid surgery trials of the 1990s (NASCET, ECST and ACAS) prompted the development of CDUS criteria to match the 70% and 60% ICA diameter reducing stenosis cut-offs used in these trials. It is to be remembered that these trials used differing methods for estimating stenosis. B mode measurement of stenosis has improved substantially on modern duplex scanners. In 1988 Gray-Weale proposed a classification of carotid plaques on the basis of their echogenicity. Recently interest has returned to plaque characterization with measurement of Gray scale median and other features in an attempt to identify the “vulnerable carotid plaque” and better select asymptomatic patients who might benefit from intervention. The diagnosis of ICA occlusion is important clinically but is not 100% accurate with any of the available imaging modalities. Anatomic information regarding abnormal height of the bifurcation (high or low), the distal extent of the plaque, the diameter of the distal ICA and the presence of tortuosity or kinking of the vessels is also important information and may prompt additional imaging. Care is required in the interpretation of the CDUS and application of standard criteria in a variety of circumstances including contralateral high-grade ICA stenosis or occlusion; elevated CCA velocities and proximal stenosis; tandem ICA stenosis; altered cardiac output states and valvular heart disease, and the presence of intracranial disease. Standard criteria are employed for restenosis follow-up after CEA. Dimensions of the patched bulb should be recorded for serial follow-up. Different criteria with higher cut-off velocities for restenosis and B mode assessment of stent apposition are required following carotid stenting (CAS). A number of consensus panel criteria for carotid stenosis have been developed including the Society of Radiologists in Ultrasound Carotid Stenosis Consensus Conference Criteria (2002) and in Australia, the ASUM criteria (1999). Ideally individual vascular laboratories should validate the criteria they use with the results of alternative imaging modalities and operative pathology. The reality however is that this is increasingly difficult with a reduction in the use of conventional angiography and the dispersion of comparative imaging between CTA, MRA and angiography, each of which has its own inherent limitations for stenosis measurement. This presentation will discuss carotid interpretation criteria with particular emphasis on how the information assists the practicing clinician.

Arterial duct morphology with reference to angioplasty and stenting

We studied the angiographic morphology of the arterial duct in neonates with congenital heart diseases. We defined the variations in ducto-aortic angle, number of tortuosities and site of insertion into the aorta of the duct in five diagnostic groups: (i) patent arterial duct (unobstructed) ( n = 27), (ii) coarctation of the aorta ( n = 24), (iii) pulmonary stenosis ( n = 23), (iv) pulmonary atresia ( n = 19) with or without ventricular septal defect, (v) hypoplastic left heart syndrome ( n = 3). In the patent arterial duct group the angles ranged from 80 to 139°, mean 107°; in the coarctation group, 76 to 136°, mean 104°; in the pulmonary stenosis group, −60 to 111°, mean 43°; in the pulmonary atresia group, −55 to 115°, mean 25°; in the hypoplastic left heart syndrome 92 to 105°, mean 98°. The angles for the pulmonary atresia and stenosis groups were significantly less than those for the coarctation and patent ductus groups ( P < 0.001). A ventricular septal defect in patients with pulmonary atresia or pulmonary stenosis was significantly associated with a smaller angle, a more proximal and a more tortuous duct ( P < 0.01). The varying morphology of the duct in neonates with congenital heart lesions, especially with right heart obstruction requires special attention when attempting catheter techniques of ductal stenting. In particular the angle of approach and the presence of tortuosities may increase the difficulty of endovacular stenting.