Retrograde Tracking Research Articles

Intestinal perfusion of unacylated ghrelin alleviated metabolically associated fatty liver disease in rats via a central glucagon-like peptide-1 pathway.

Unacylated ghrelin (UAG), the unacylated form of ghrelin, accounts for 80%-90% of its circulation. Accumulated studies have pointed out that UAG may be used to treat metabolic disorders. This study aimed to investigate the effect of intestinal perfusion of UAG on metabolically associated fatty liver disease (MAFLD) induced by a high-fat diet and its possible mechanisms. Neuronal retrograde tracking combined with immunofluorescence, central administration of a glucagon-like peptide-1 receptor (GLP-1R) antagonist, and hepatic vagotomy was performed to reveal its possible mechanism involving a central glucagon-like peptide-1 (GLP-1) pathway. The results showed that intestinal perfusion of UAG significantly reduced serum lipids, aminotransferases, and food intake in MAFLD rats. Steatosis and lipid accumulation in the liver were significantly alleviated, and lipid metabolism-related enzymes in the liver were regulated. UAG upregulated the expression of GLP-1 receptor (GLP-1R) in the paraventricular nucleus (PVN) and GLP-1 in the nucleus tractus solitarii (NTS), as well as activated GLP-1 neurons in the NTS. Furthermore, GLP-1 fibers projected from NTS to PVN were activated by the intestinal perfusion of UAG. However, hepatic vagotomy and GLP-1R antagonists delivered into PVN before intestinal perfusion of UAG partially attenuated its alleviation of MAFLD. In conclusion, intestinal perfusion of UAG showed a therapeutic effect on MAFLD, which might be related to its activation of the GLP-1 neuronal pathway from NTS to PVN. The present results provide a new strategy for the treatment of MAFLD.NEW & NOTEWORTHY Intestinal perfusion of UAG, the unacylated form of ghrelin, has shown promising potential for treating MAFLD. This study unveils a potential mechanism involving the central GLP-1 pathway, with UAG upregulating GLP-1R expression and activating GLP-1 neurons in specific brain regions. These findings propose a novel therapeutic strategy for MAFLD treatment through UAG and its modulation of the GLP-1 neuronal pathway.

Characteristics of patients undergoing percutaneous coronary intervention for chronically total occluded arteries: a single-center observational study in India [RETRACTED

Background and purpose: Percutaneous coronary intervention (PCI) is the gold standard for managing chronic total occlusion (CTO), but data on characteristics of the patients undergoing PCI for CTO are scarce. The present study was designed to evaluate the clinical profile of the patients who underwent PCI to CTO. Methods: This single-center, prospective, and observational study included consecutive patients who successfully underwent PCI for angiographically confirmed CTO at author’s center from March 2017 to March 2019. Follow-up was conducted at 6 and 12 months. Results: The final analysis included a total of 108 patients. The mean age was 64.5 ± 8.2 years. Majority of the patients (72.2%) were men. The most common morbid risk factors were diabetes mellitus (56.5%), hypertension (53.7%), and dyslipidemia (52.8%). Mean left ventricular ejection fraction (LVEF) was 51% ± 0.0% and 73% had New York Heart Association (NYHA) class II. The most common site of CTO was the right coronary artery (34.3%). PCI was conducted using an antegrade approach, 75.9% of the cases. The majority of patients underwent wire escalation PCI technique (52.8%) followed by adverse drug reaction (34.3%), reverse-controlled antegrade and retrograde tracking (CART) (8.3%) and CART (4.6%). Stress test was negative in 63% and 64.8% of the patients at 6 and 12 months, respectively. The 6-month symptom-free survival rate was higher in patients without hypertension. Symptom-free survival rate was 96.9%, 95.9% and 88.9% in patients with Japanese Multicenter CTO Registry (J-CTO) score of 0, 1 and >3, respectively. The rate of abnormal electrocardiogram at 12 months was higher in patients with J-CTO score of 0 or 1 versus >3. Conclusion: PCI is a viable option for patients who are not willing to undergo coronary artery bypass grafting, particularly in those with low J-CTO score.

A "messenger zone hypothesis" based on the visual three-dimensional spatial distribution of motoneurons innervating deep limb muscles.

Abstract JOURNAL/nrgr/04.03/01300535-202407000-00036/figure1/v/2023-11-20T171125Z/r/image-tiff Coordinated contraction of skeletal muscles relies on selective connections between the muscles and multiple classes of the spinal motoneurons. However, current research on the spatial location of the spinal motoneurons innervating different muscles is limited. In this study, we investigated the spatial distribution and relative position of different motoneurons that control the deep muscles of the mouse hindlimbs, which were innervated by the obturator nerve, femoral nerve, inferior gluteal nerve, deep peroneal nerve, and tibial nerve. Locations were visualized by combining a multiplex retrograde tracking technique compatible with three-dimensional imaging of solvent-cleared organs (3DISCO) and 3-D imaging technology based on lightsheet fluorescence microscopy (LSFM). Additionally, we propose the hypothesis that “messenger zones” exist as interlaced areas between the motoneuron pools that dominate the synergistic or antagonist muscle groups. We hypothesize that these interlaced neurons may participate in muscle coordination as messenger neurons. Analysis revealed the precise mutual positional relationships among the many motoneurons that innervate different deep muscles of the mouse. Not only do these findings update and supplement our knowledge regarding the overall spatial layout of spinal motoneurons that control mouse limb muscles, but they also provide insights into the mechanisms through which muscle activity is coordinated and the architecture of motor circuits.

Ostial Left Anterior Descending Artery Chronic Total Occlusion - Left Main Coronary Artery Intramural Hematoma

Chronic total occlusion intervention of ostial left anterior descending artery lesion without clear cap poses challenges for wiring. Intravascular ultrasound guided antegrade cap puncture and guide extension assisted reverse controlled antegrade and retrograde tracking away from ostium would minimize inflow injuries. This case report explores inflow injury and its detection by imaging in ostial LAD CTO PCI.

Reverse Controlled Antegrade and Retrograde Tracking in Left Internal Mammary Artery Bypass Grafts

Reverse Controlled Antegrade and Retrograde Tracking in Left Internal Mammary Artery Bypass Grafts

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)

Regulation of the central amygdala on intestinal motility and behavior via the lateral hypothalamus in irritable bowel syndrome model mice.

Impaired bidirectional communication between the gastrointestinal tract and the central nervous system (CNS) is closely related to the development of irritable bowel syndrome (IBS). Studies in patients with IBS have also shown significant activation of the hypothalamus and amygdala. However, how neural circuits of the CNS participate in and process the emotional and intestinal disorders of IBS remains unclear. The GABAergic neural pathway projecting from the central amygdala (CeA) to the lateral hypothalamus (LHA) in mice was investigated by retrograde tracking combined with fluorescence immunohistochemistry. Anxiety, depression-like behavior, and intestinal motility were observed in the water-immersion restraint stress group and the control group. Furthermore, the effects of the chemogenetic activation of the GABAergic neural pathway of CeA-LHA on behavior and intestinal motility, as well as the co-expression of orexin-A and c-Fos in the LHA, were explored. In our study, Fluoro-Gold retrograde tracking combined with fluorescence immunohistochemistry showed that GABAergic neurons in the CeA were projected to the LHA. The microinjection of the gamma-aminobutyric acid (GABA) receptor antagonist into the LHA relieved anxiety, depression-like behavior, and intestinal motility disorder in the IBS mice. The chemogenetic activation of GABAergic neurons in the CeA-LHA pathway led to anxiety, depression-like behavior, and intestinal motility disorder. In addition, GABAergic neurons in the CeA-LHA pathway inhibited the expression of orexin-A in the LHA, and orexin-A was co-expressed with GABAA receptors. The CeA-LHA GABAergic pathway might participate in the occurrence and development of IBS by regulating orexin-A neurons.

Retrograde Percutaneous Intervention of Chronic Total Occlusion Step by Step

AbstractRetrograde approach for chronic total occlusion percutaneous intervention is the ultimate technique for success in cases of high Japan-CTO (JCTO) score, ostial locations, long calcific lesions with calcium, and in retry cases. There are various methods of collateral cross, reverse controlled antegrade and retrograde tracking, and externalization, which are practiced by various experts. Intravascular ultrasound-guided procedures will minimize complications and increase chances of stent optimization for better outcomes.

Active Retrograde Extra Backup with a Mother-and-Child Catheter to Facilitate Retrograde Microcatheter Collateral Channel Tracking in Recanalization of Coronary Chronic Total Occlusion.

Objective To explore the feasibility and safety of the active retrograde backup (ARB) for treatment of chronic total occlusion (CTO) during retrograde percutaneous coronary intervention (PCI). Background Guiding support plays an important role in guidewire and microcatheter coronary channel (CC) tracking in retrograde PCI therapy for patients with CTO. However, the feasibility and safety of retrograde active use of a mother-and-child catheter are still unclear. Patients and Methods. A total of 271 consecutive patients with CTO who underwent retrograde PCI between January 2015 and January 2020 were retrospectively analyzed. Clinical data of two groups were compared to evaluate the feasibility and safety of ARB. Results Of the 271 patients, 69.0% (187/271) underwent therapy through the septal branch, 31.0% (84/271) through the epicardial collateral channel, and 47.6% (129/271) through active retrograde extra backup with a mother-and-child catheter to facilitate retrograde microcatheter collateral CC tracking. The time of wire CC tracking was shorter in the ARB group than that in the non-ARB group (25.4 ± 8.5 vs 26.4 ± 9.7, p=0.348), but there was no significant difference. The duration of the retrograde microcatheter tracking (10.2 ± 3.8 vs 15.5 ± 6.8, p=0.012) and the retrograde approach (62.8 ± 20.3 vs 70.4 ± 24.3, p=0.026) in the ARB group was significantly shorter than that in the non-ARB group. The radiation dose (223.6 ± 112.7 vs. 295.2 ± 129.3, p=0.028), fluoroscopy time (50.6 ± 21.3 vs 62.3 ± 32.1, p=0.030), and contrast volume (301.8 ± 146.7 vs 352.2 ± 179.5, p=0.032) in the ARB group were significantly lower than that in the non-ARB group. There were no life-threatening procedural complications in either group. Complications unrelated to ARB included two cases of donor-vessel dissection, one case of CC perforation, and two cases of target-vessel perforation. There was no statistically significant difference in major adverse cardiac and cerebrovascular events between the groups during hospitalization (p > 0.05). Conclusion ARB is feasible, safe, and conducive to guidewire and microcatheter CC tracking in the recanalization of coronary CTO. It improves procedural efficiency and is worthy of further promotion.

Iteration of Reverse Controlled Antegrade and Retrograde Tracking for Coronary Chronic Total Occlusion Intervention: a Current Appraisal.

Coronary chronic total occlusion (CTO) remains one of the most challenging subsets for percutaneous coronary intervention (PCI). The retrograde recanalization is one of the most significant amendments of the technique that remains critical to improved success of CTO PCI. Currently the reverse controlled antegrade and retrograde tracking (CART) is the most dominant retrograde technique. With emergence of new equipment and important iterations, this approach has become safer, faster and more successful. In this review, the author proposes the iteration and standardization of this technique which would further facilitates its adoption with more efficacy and safety.

Primary Retrograde Tibio-Pedal Approach for Endovascular Intervention of Femoropopliteal Disease with Chronic Total Occlusion.

This study investigated the feasibility, safety, and the acute outcome of primary retrograde tibio pedal approach (TPA) in the treatment of peripheral arterial disease (PAD) with femoropopliteal (FP) chronic total occlusion (CTO). With maturing in endovascular technology and further development in new devices, endovascular therapy has become a comparable and preferred treatment for patients with PAD. The retrograde TPA has not been studied to treat FP CTO extensively. We performed a retrospective analysis of 98 consecutive patients who underwent peripheral angiogram and intervention of 123 FP CTO lesions from June 1st, 2016 to June 30th, 2018 in a single center. Peripheral angiography and percutaneous balloon angioplasty was done primarily via retrograde TPA. Demographic data, procedural success rate, peri-procedural major adverse complications, and 30-day outcomes were recorded. Out of 123 procedures, the dorsalis pedis artery/distal anterior tibial artery was the most common TPA site (59%) followed by the posterior tibial artery in 27% patients and peroneal artery in 14% patients. In 40 (33%) FP CTO lesions, additional transradial accesses were needed for controlled antegrade and retrograde tracking (CART) technique. Overall procedural success was achieved in 122 FP CTO (99%) lesions. No patients had significant access site bleeding, hematoma, worsening kidney dysfunction or acute limb ischemia within 30-day following this procedure. The primary retrograde TPA for FP CTO lesions is safe and feasible. With a combination of tibio pedal and transradial approach, our procedural success rate is very high for FP CTO intervention.

Intravascular Imaging for Chronic Total Occlusion Intervention

We sought to summarize the current evidence on use of intravascular imaging (with intravascular ultrasound [IVUS] or optical coherence tomography [OCT]) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Utilization of intravascular imaging in CTO PCI is increasing over time, both to facilitate CTO crossing and for optimization of the final result. OCT is used less often than IVUS due to its lower depth of penetration and need for contrast injection. Intravascular imaging has multiple uses in CTO PCI: (a) it can facilitate CTO crossing by resolving proximal cap ambiguity and facilitating and confirming true lumen wire re-entry in case of initial subintimal wire crossing in both the antegrade and retrograde direction (for example by selecting the appropriate balloon size during the reverse controlled antegrade and retrograde tracking (reverse CART) technique; (b) it can be used to optimize the PCI result by ensuring good stent expansion and stent strut apposition, which may in turn result in lower rates of subsequent in-stent restenosis and stent thrombosis; (c) can facilitate evaluation and treatment of complications.

TCT-138 Comparison Between Traditional and Guide Catheter Extension Reverse CART: Insights From the PROGRESS-CTO Registry

The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is the reverse controlled antegrade and retrograde tracking (rCART) technique. Use of guide catheter extensions can facilitate rCART but its application has received limited

IDENTIFICATION OF RECURRENT LARYNGEAL NERVE AT ITS ENTRY POINT USING CRICOTHYROID MUSCLE AS A LANDMARK DURING THYROIDECTOMY- OUR EXPERIENCE

Thyroidectomy is a commonly performed surgery for various thyroid diseases. The common complications associated with a thyroid surgery are recurrent laryngeal nerve palsy (unilateral or bilateral), hypoparathyroidism due to injury to parathyroid glands during surgery. We employed the technique of identifying recurrent laryngeal nerve at its entry point using cricothyroid muscle as land mark and noted the frequency of recurrent laryngeal nerve palsy and hypoparathyroidism in this technique.Objective: To predict the frequency of occurrence of recurrent laryngeal nerve palsy and permanent hypo-parathyroidism during thyroidectomy by identifying the recurrent laryngeal nerve at its entry point using cricothyroid muscle as landmark and retrograde tracking of it.Material and methods: We conducted a retrospective study at two tertiary care centres in India. In this study, we took all the patients of thyroidectomise where recurrent laryngeal nerve was identified at its entry point using cricothyroid muscle as landmark and traced in a retrograde manner. A total of 36 patients were included in the study. We predicted the frequency of recurrent laryngeal nerve palsy and hypoparathyroidism by using our method to identify recurrent laryngeal nerve.Results and discussion: In present study there was no permanent laryngeal nerve palsy but the frequency of permanent hypoparathyroidism was 11.6 %.

Overview and proposed terminology for the reverse controlled antegrade and retrograde tracking (reverse CART) techniques.

During recent years, equipment and techniques for percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) have improved significantly. The retrograde approach remains critical to the improved success of CTO PCI. Currently, the reverse controlled antegrade and retrograde tracking (CART) technique has become the dominant retrograde wire crossing technique. In this article, we propose a standardised terminology and classification for this technique divided into three subtypes: a) conventional reverse CART, usually involving the use of large balloons on the antegrade wire to achieve re-entry within the CTO segment; b) "directed" reverse CART, which is characterised by small antegrade balloon size and more active, intentional vessel tracking and penetration with a controllable retrograde wire, still within the CTO segment; and c) "extended" reverse CART, in which the intimal/subintimal dissection is extended proximal or distal to the CTO segment, achieving re-entry outside the CTO segment. The proposed standardised terminology will facilitate the communication, teaching and adoption of the reverse CART techniques.

An algorithmic approach for the management of ostial right coronary artery chronic total occlusions.

Treatment of ostial chronic total occlusions (CTOs) of the right coronary artery (RCA) can be challenging. We present an algorithmic approach to the management of such lesions that incorporates all contemporary equipment and techniques. If the RCA ostium can be engaged with a guide catheter then antegrade crossing attempts should be performed. If the antegrade guidewire enters the subintimal space, re-entry into the distal true lumen is performed provided that the antegrade guide catheter provides enough support. If re-entry cannot be achieved, the antegrade wire is left in place to facilitate retrograde recanalization attempts (usually performed using the reverse controlled antegrade and retrograde tracking and dissection-reverse CART-technique). If the RCA ostium cannot be engaged with a guide catheter (for example in flush ostial occlusions) or if the guide catheter does not provide sufficient support, a primary retrograde approach is required, aiming for retrograde guidewire puncture into the aorta, followed by snaring and externalization. Retrograde guidewire puncture can be challenging, requiring use of stiff, highly penetrating guidewires or occasionally use of the Carlino technique. The aforementioned algorithm can facilitate crossing of ostial RCA CTOs.

A novel maneuver to facilitate retrograde wire externalization during retrograde chronic total occlusion percutaneous coronary intervention

Although the retrograde approach has improved the success rate and procedural efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), it can still be challenging and time-consuming. We introduce a novel technique that aims to facilitate the critical step of retrograde wire externalization during reverse controlled antegrade and retrograde tracking and dissection (CART), which we named DRAFT (Deflate, Retract and Advance into the Fenestration Technique). DRAFT is performed by simultaneous retraction of the deflating antegrade balloon (after inflation in the subintimal space) and advancement of the retrograde looped wire in the same plane through the transient fenestrations created by reverse CART, in order to cross through the fenestrated dissection flap before its collapse. The retrograde wire is then quickly and easily advanced into the antegrade guiding catheter. DRAFT was used in 11 patients (8 with right coronary artery and 3 with left anterior descending artery CTOs). Several different guidewires were used, since this technique does not need any specific wire to be performed. DRAFT was successful in all cases, after at most five attempts. CTO PCI was then completed as per standard retrograde practice. No complications occurred. DRAFT is a versatile approach that allows easy and quick re-entry of the retrograde wire into the true lumen during reverse CART. It can be performed with a variety of guidewires and is feasible both in the left and right coronary arteries. © 2016 Wiley Periodicals, Inc.

Approach for Chronic Total Occlusion With Intravascular Ultrasound–Guided Reverse Controlled Antegrade and Retrograde Tracking Technique: Single Center Experience

Controlled antegrade and retrograde subintimal tracking (CART) or reverse CART techniques is the final step for percutaneous revascularization of coronary chronic total occlusion (CTO), but it still represents technical challenges and risk in interventional procedures. Our purpose was to utilize intravascular ultrasound (IVUS)-guided reverse CART approach for percutaneous revascularization of CTO in our heart center, focusing on its safety, efficacy, and latest technical developments. From November 2006 to November 2012, 49 patients with CTO failed to antegrade and/or retrograde percutaneous revascularization of CTO from true lumen to true lumen were enrolled in and underwent IVUS guided reverse CART approach. The mean J-CTO score of cases was 2.5. IVUS guidance was successfully implemented in 95.9%; IVUS identified that 61.7% of retrograde wires were located at intimal space, and 59.5% of antegrade wires were located at subintimal space. A Corsair channel dilator was used in 77.6% of cases. The success rates of technique and procedure were 95.9% and 93.9%, respectively; the technical minor complications were observed in 10.2% of cases, without significant clinic outcomes; 2.0% of cases occurred with a major adverse cardiac event of non-ST-elevation myocardial infarction; and no case occurred with target vessel revascularization or death. The mean length of stent implanted in a single CTO vessel was 51.3 mm. No patient appeared with radiation dermatitis and contrast-induced rise of creatinine. IVUS guided reverse CART approach is effective and safe for percutaneous revascularization of complex CTO, with a high success and a low complication rate. It is feasible to develop this approach for percutaneous revascularization of complex CTO. However, suitable case selection and lately device handling by experienced operators are the crucial points of success.

Japanese multicenter registry evaluating the retrograde approach for chronic coronary total occlusion

This registry evaluated the current trends and outcomes associated with retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Since its introduction, several techniques and technologies have been introduced for retrograde PCI for CTO. Eight hundred and one patients who underwent retrograde PCI for CTO in 28 Japanese centers between January 2009 and December 2010 were enrolled in this registry. Overall procedural and clinical success rates were 84.8 and 83.8%, respectively, of which, retrograde procedures accounted for 71.2 and 70.3%, respectively. The use of channel dilators increased in 2010 compared to that in 2009 (36 vs. 95.3%, P < 0.0001), attributed improving collateral channel crossing using a wire and catheter (70.6% vs. 81.1%, P = 0.0005) and increased availability of epicardial channels (27.6% vs. 36.9%). The use of the reverse controlled antegrade and retrograde tracking technique also increased (41.9 vs. 66.5%). Although these changes decreased procedure time (203.3 min vs. 187.9 min, P = 0.024), they did not significantly improve overall procedural success rate (84.1% vs. 85.3%, P = 0.63). Multivariate analysis identified age 65 years or more and lesion calcification as unfavorable factors and the use of a channel dilator as a favorable factor for retrograde procedural success. Increased availability of channel dilators has altered strategies for retrograde PCI for CTO. However, retrograde PCI for CTO could be improved by overcoming its main obstacle of severe calcification.

A case of successful use of microsnare to hold and pull the retrograde guidewire for the intervention to peripheral chronic total occlusion

A basket-shaped microsnare has various uses such as the pull through technique during coronary intervention to chronic total occlusion (CTO). A 79-year-old man underwent angioplasty for the femoral artery occlusion. We performed a controlled antegrade and retrograde tracking (CART) with dilatation of a balloon on the antegrade guidewire. The retrograde guidewire partly ran in the true lumen but could not pass through the CTO lesion because of inadequate CART. Eventually, we successfully gripped the top of the retrograde guidewire in the CTO lesion using the basket-shaped microsnare (Soutenir(®)). The microsnare may be useful for bidirectional approach in peripheral CTO lesions.