Severe Artery Stenosis Research Articles

Frequency of subclavian artery stenosis in patients with mammarian artery coronary bypass and suspected coronary artery disease progression

We retrospectively analyzed patient records of all patients with a history of internal mammarian artery (IMA) coronary bypass undergoing coronary angiography at two cardiovascular centers between January 1st 1999 and December 31st 2019. A total of 11,929 coronary angiographies with or without percutaneous coronary intervention were carried out in 3921 patients. Our analysis revealed 82 (2%) patients with documented subclavian artery stenosis. Of these, 8 (10%) patients were classified as having mild, 18 (22%) moderate, and 56 (68%) severe subclavian artery stenosis. In 7 (9%) patients with subclavian artery stenosis, angiography revealed occlusion of the IMA graft. 26 (32%) patients with severe subclavian artery stenosis underwent endovascular or surgical revasculararization of the subclavian artery. In this retrospective multicenter study, subclavian artery stenosis was a relevant finding in patients with an internal mammarian artery coronary bypass graft undergoing coronary angiography. The development of dedicated algorithms for screening and ischemia evaluation in affected individuals may improve treatment of this potentially underdiagnosed and undertreated condition.

Circulating miR-143 and miR-145 as promising biomarkers for evaluating severity of coronary artery stenosis in patients with acute coronary syndrome

BackgroundMultiple studies have provided evidence that miR-143 and miR-145 play a crucial role in the pathogenesis and progression of atherosclerosis. In the present study, we aim to investigate the expression of plasma miR-143 and miR-145 in patients with acute coronary syndrome (ACS) and their association with the severity of coronary artery stenosis. MethodsThe study enrolled 279 patients with ACS, including 201 patients with unstable angina (UA) and 78 patients with acute myocardial infarction (AMI), and 65 matched subjects as the control group. The plasma levels of miR-143 and miR-145 were detected by quantitative real-time PCR (qRT-PCR). Gensini score was applied to evaluate the severity of coronary artery stenosis. ResultsPlasma levels of miR-143 and miR-145 in patients with ACS were both decreased compared with the control group (p < 0.001). Plasma levels of miR-143 and miR-145 were negatively correlated with Gensini score (miR-143: r = −0.246, p < 0.001; miR-145: r = −0.222, p < 0.001). Logistic regression analysis showed that miR-143 and miR-145 were protective factors for the onset of ACS, UA, or AMI separately. MiR-143 (AUC: 0.786, p < 0.001) and miR-145 (AUC: 0.793, p < 0.001) were able to predict the degree of coronary artery stenosis greater than 50 %. ConclusionThe plasma levels of miR-143 and miR-145 were significantly decreased in ACS patients and were negatively correlated with coronary stenosis. In conclusion, plasma miR-143 and miR-145 levels can be used as noninvasive biomarkers for evaluating coronary artery stenosis.

Risks of Carotid Artery Stenosis and Atherosclerotic Cardiovascular Disease in Patients with Calcium Kidney Stone: Assessment of Systemic Inflammatory Biomarkers.

(1) Background: To assess the clinical significance of preoperative inflammatory biomarkers combined with atherosclerotic cardiovascular disease (ASCVD) risk score to evaluate carotid artery stenosis in patients with calcium kidney stones; (2) Methods: We conducted a prospective observational case-control study, enrolling 74 patients with calcium kidney stones and 66 age- and sex-matched healthy controls. We calculated the inflammatory biomarkers including the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI). An ultrasound of the carotid arteries was performed on all participants to identify the severity of the stenosis; (3) Results: All inflammatory biomarkers and the severity of carotid artery stenosis were higher in the calcium kidney stone group than in controls. After stratification of ASCVD, inflammatory biomarkers and carotid artery stenosis severity were still significantly higher in the calcium kidney stone group. Multivariate analyses showed that calcium kidney stones significantly increased the risk of ASCVD and carotid artery stenosis. In multivariate linear logistic regression analyses, calcium kidney stone and ASCVD score had a significant association with carotid artery occlusion, but SIRI did not; (4) Conclusions: Calcium kidney stone is associated with higher levels of inflammatory biomarkers and carotid artery stenosis. Calcium kidney stone is associated with higher levels of inflammatory biomarkers and carotid artery stenosis.

Coronary artery stenosis and vulnerable plaque quantification on CCTA by deep learning methods

Abstract Introduction Coronary computed tomography angiography (CCTA) has emerged as a reliable non-invasive modality to assess coronary artery stenosis (CAS) severity and vulnerable plaque (VP). However, comprehensive CCTA assessment, especially VP, is time-consuming and dependent on reader expertise, limiting CCTA's true potential. Purpose In this study, we aim to develop and validate a deep learning (DL) based system capable of evaluating CAS severity and characterising VP on CCTA. Methods A DL system was trained to assess CAS severity on 3909 expert annotated vessels. A subset of 824 vessels was used to train the model to assess for the presence of VP. The model was based on a 2D U-Net and 3D convolutional neural network architecture. The system automatically performed vessel tracking and segmentation to quantify stenosis severity and characterise the presence of VP. CAS severity was categorised as 0%, 1–49% and ≥50%. VP was defined as: low attenuation plaque (LAP; ≤30 Hounsfield units), positive remodelling (PR; ≥10% diameter) and spotty calcification (SC; &amp;lt;3mm). The model was then tested on 1435 vessels for CAS (mean calcium score 197±502) and a subset of 365 vessels for VP (mean calcium score 419±551), and its diagnostic performance compared with expert readers. Results The CAS testing data had a prevalence of 75% (1080/1435), 18% (257/1435) and 6.8% (98/1435) for 0%, 1–49% and ≥50% stenosis, respectively. VP was present in 20% (72/365) in the respective dataset with 44% (32/72) LAP, 19% (14/72) PR and 36% (26/72) SC. Average analysis time for CAS severity and VP was 3.7±2.0s and 3.5±1.8s, respectively. Diagnostic performance of our system is summarised in Tables 1 (CAS severity) and 2 (VP characteristics). Conclusions We developed an DL based system capable of rapidly evaluating CAS severity and characterising VP on CCTA. Our system demonstrated high specificity and accuracy for both CAS severity and VP quantification when compared with expert readers. Funding Acknowledgement Type of funding sources: None.

Towards noninvasive early detection and classification of peripheral arterial disease stenosis severity by perfusion dynamics and artificial intelligence

Abstract Introduction Recent guidelines suggest Ankle-Brachial Index (ABI) measurement for assessing and reducing cardiovascular risk. PAD patients suffer from generalized arterial stiffening (arteriosclerosis) and develop threatening arterial stenosis foci. ABI cannot differentiate between the two, and detecting focal stenosis is especially challenging in the elderly and diabetics suffering from severe arteriosclerosis. Thus, better diagnostic tools are required for early detection of severe arterial stenosis in order to improve patient management reduce atherosclerotic cardiovascular risk and amputation rates. Purpose We hypothesized that quantifying the peripheral perfusion dynamics would provide more sensitive indices for monitoring atherosclerotic disease severity. Thus, we compared the utility of ABI, impedance-plethysmography (IPG), and photoplethysmography (PPG) in detecting and classifying arterial-stenosis using machine learning and artificial intelligence. Methods Arterial stenosis was emulated in supine lying healthy consenting volunteers (n=31) by inflating a blood-pressure cuff around their thigh to 45 and 90 mmHg for six minutes. We quantified the perfusion dynamics by IPG and PPG signal analyses in the time-frequency domain. The induced stenosis levels were classified by artificial intelligence using novel indices. Results Hallux O2-saturation remained intact (96±3%, p=0.4) even during 90 mmHg thigh-cuff compression. The baseline ABI (1.19±0.01) remained unchanged during 45 mmHg compression, slightly declined (1.12±0.02) upon 90 mmHg compression; but, all ABI values were above the 0.9 threshold. The pulse transit time, a well-established index of arteriosclerosis, remained unchanged. Conversely, upon stenosis emulation (compression), the IPG immediately recorded a significant proportional phase delay between the compressed and contralateral legs and a significant proportional correlation decline. At baseline, the IPG phase-difference between legs over the 2–4 Hz band was 1.79±0.48° and grew to 29.5±2.4° and 71.2±1.8° upon 45 and 90 mmHg compression (p&amp;lt;0.001). The IPG inter leg correlation at the 4–6 Hz band declined from 0.962±0.005 at baseline to 0.857±0.012 and 0.676±0.015 during 45 and 90 mmHg compression (p&amp;lt;0.001). The PPG phase difference grew significantly and proportionally upon compression (p&amp;lt;0.001, n=28) but without a significant correlation decline. A neural-network classifier achieved 100% accuracy in classifying baseline and each compression level based on the IPG phase and correlation. The best classifier achieved only 81.25% accuracy, 83.33% sensitivity, and 90% Specificity based on the PPG. Conclusion Our perfusion-dynamic indices outperformed the ABI, and the IPG outperformed the PPG in detecting and classifying emulated stenosis. Differentiation between arteriosclerosis and arterial stenosis may be of immense clinical merit. Therefore, this simple, noninvasive method merits clinical evaluation. Funding Acknowledgement Type of funding sources: None.

Computed Tomography Angiography in the Diagnosis of Subclavian-Vertebral Artery Steal.

PurposeComputed tomography angiography (CTA) is commonly used in the diagnosis and evaluation of subclavian steal (SS). However, the abnormal manifestations of vertebral artery (VA) in SS on CTA are vastly under-recognized and prone to misdiagnosis. We reported for the first time the abnormal CTA manifestations of VA in SS, and evaluated the value and pitfalls of CTA in the diagnosis of SS, aiming to avoid misdiagnosis and facilitate correct diagnosis of SS using CTA.Patients and MethodsThis study retrospectively included 19 patients diagnosed with SS using carotid duplex sonography (CDS) and digital subtraction angiography (DSA) between 2018 and 2022 at a tertiary neurology clinic in Chongqing, China. Their CDS, DSA and CTA results were collected and analyzed. The diagnostic consistency between CTA and DSA in grading subclavian artery stenosis was evaluated, and the CTA manifestations of VA were summarized.ResultsAll patients presented subclavian steno-occlusion on the affected side, without steno-occlusion of the contralateral subclavian artery or bilateral VA on DSA. A high concordance was observed between CTA and DSA in grading subclavian artery stenosis (Kappa = 0.825, P = 0.000). However, only 26.3% of patients presented normal VA on CTA, whereas 73.7% of patients presented shallow VA ipsilateral to subclavian steno-occlusion. A 28.6% of patients with shallow VA were misdiagnosed as having vertebral arteriopathy. The presence of shallow VA had no significant correlation with age, gender, severity of subclavian artery stenosis, diameter of VA or model of CT scanner (all P>0.05). Although not statistically significant, the incidence of shallow VA increased with higher SS grade.ConclusionCarotid CTA is highly accurate for diagnosing subclavian steno-occlusion, whereas shallow VA is the pitfall of CTA in diagnosing SS. It is important to improve the recognition of shallow VA to avoid misdiagnosis.

Mediating roles of leukoaraiosis and infarcts in the effects of unilateral carotid artery stenosis on cognition.

Background and objectivesLeukoaraiosis and infarcts are common in patients with carotid artery stenosis (CAS), and CAS severity, leukoaraiosis and infarcts all have been implicated in cognitive impairments. CAS severity was not only hypothesized to directly impede specific cognitive domains, but also transmit its effects indirectly to cognitive function through ipsilateral infarcts as well as periventricular leukoaraiosis (PVL) and deep white matter leukoaraiosis (DWML). We aimed to delineate the contributions of leukoaraiosis, infarcts and CAS to different specific cognitive domains.Materials and methodsOne hundred and sixty one participants with unilateral CAS (>50%) on the left (n = 85) or right (n = 76) side and 65 volunteers without significant CAS (<50%) were recruited. The PVL, DWML, and infarct severity were visually rated on MRI. A comprehensive cognitive battery was administered and standardized based on age norms. Correlation and mediation analyses were adopted to examine the direct and indirect influence of CAS, leukoaraiosis, and infarct on specific cognitive domains with adjustment for education, hypertension, diabetes mellitus, and hyperlipidemia.ResultsCarotid artery stenosis severity was associated with ipsilateral leukoaraiosis and infarct. Left CAS had direct effects on most cognitive domains, except for visual memory and constructional ability, and transmitted its indirect effects on all cognitive domains through ipsilateral PVL, and on constructional ability and psychomotor through infarcts. Right CAS only had negative direct effects on visual memory, psychomotor, design fluency and color processing speed, and transmitted its indirect effects on visual memory, word and color processing speed through ipsilateral infarcts. The trends of direct and indirect cognitive effects remained similar after covariate adjustment.ConclusionLeft and right CAS would predominantly lead to verbal and non-verbal cognitive impairment respectively, and such effects could be mediated through CAS-related leukoaraiosis and infarct. Given that cognition is subject to heterogeneous pathologies, the exact relationships between markers of large and small vessel diseases and their composite prognostic effects on cognition requires further investigation.

Verifynow P2Y12 PRU-Guided Modification of Clopidogrel for Prevention of Recurrent Ischemic Stroke: A Real-World Prospective Cohort Study.

Clopidogrel resistance causes recurrent stroke. However, outcomes of modified antiplatelet medications to prevent recurrent ischemic stroke are not well known. Patients who received clopidogrel with and without modification as initial treatment for stroke were recruited and compared. The primary outcome was ischemic stroke and myocardial infarction at the 1-year follow-up. The secondary outcome was bleeding complications. Overall, 206 patients treated with clopidogrel were enrolled and were divided into the modification (n = 39) and no modification (n = 167) groups. There was a significant difference in the incidence of severe cerebral arterial stenosis between the two groups (modification group, 16/39, 41.03%; no modification group, 36/167, 21.56%, P = 0.012) at baseline. The loss to follow-up rate was 12.14% (25/206). After adjustment for severe cerebral artery stenosis, antiplatelet modification based on the platelet reactivity unit (PRU) value significantly improved in the per protocol set (odds ratio 0.142, 95% confidential interval 0.022-0.898, P = 0.038). The area under the curve of the different PRU cutoff values were 0.630, 0.605, and 0.591 (P = 0.016, 0.051, and 0.092) for PRU 190, 208, and 235, respectively. Verifynow P2Y12 PRU-guided modification of clopidogrel for ischemic stroke significantly improved or prevented recurrence at the 1-year follow-up. Our findings suggest that clopidogrel therapy based on the PRU cutoff value of 190 should be considered to improve outcomes. ClinicalTrials.gov NCT02618265 (December 1, 2015).

Evaluation of collateral status and outcome in patients with middle cerebral artery stenosis in late time window by CT perfusion imaging.

ObjectivesCollateral status (CS) is a crucial determinant of outcome in patients with ischemic stroke. We aimed to test whether the cerebral blood volume (CBV) and cerebral blood flow (CBF) based on computed tomography perfusion (CTP) measurements can quantitatively evaluate CS and explore the predictive ability of CTP parameters in determining clinical outcomes in patients with MCA severe stenosis or occlusion presenting beyond 24 h.Materials and methodsIn this retrospective study, data obtained from September 2018 to March 2022 in consecutive stroke patients caused by isolated middle cerebral artery severe stenosis or occlusion were reviewed within 24–72 h after onset. Correlation between the collateral score systems assessed with CT angiography (CTA) and CTP parameters was calculated using the Spearman correlation. The optimal threshold of the CBV ratio for predicting a good outcome was determined using receiver operating characteristic curve (ROC) analysis.ResultsA total of 69 patients met inclusion criteria. Both the CBV ratio and the CBF ratio had significant correlation with collateral score systems assessed with CTA [CBV ratio and Tan score: rs = 0.702, P < 0.0001; CBV ratio and regional leptomeningeal collateral (rLMC) score: rs = 0.705, P < 0.0001; CBV ratio and Miteff score: rs = 0.625, P < 0.0001. CBF ratio and Tan score: rs= 0.671, P < 0.0001; CBF ratio and rLMC score: rs = 0.715, P < 0.0001; CBF ratio and Miteff score: rs = 0.535, P < 0.0001]. ROC analysis revealed the CBV ratio performed better than the qualitative collateral assessments and the CBF ratio in the prediction of a favorable 90-day modified Rankin scale score. The CBV ratio was a useful parameter that predicted a good functional outcome [area under the curve (AUC), 0.922; 95% CI, 0.862 ± 0.982].ConclusionsIn late time window stroke patients, the CBV and CBF ratio on CTP may be valuable parameters for quantitatively revealing the collateral status after stroke. In addition, the CBV ratio was the predictor of clinical outcomes in patients with MCA severe stenosis or occlusion.

Diagnostic value of myocardial stress detection based on feature tracking MRI in patients with acute myocardial infarction.

BackgroundEvaluate the predictive value of myocardial stress measured by magnetic resonance imaging (MRI) on the severity of coronary artery stenosis and acute myocardial infarction (AMI). In the early stage of acute myocardial infarction, many imaging findings are negative, and MRI myocardial stress detection is controversial in the diagnosis of this aspect. Therefore, it is necessary to determine whether MRI myocardial stress can diagnose acute myocardial infarction.MethodsA total of 120 patients were divided into an AMI group and non-AMI group. The AMI group was further divided into a mild group, moderate group, and severe group. The myocardial stress was measured by MRI, compared in each group, the correlation between myocardial stress and coronary artery stenosis rate was analyzed, and coronary artery disease (CAD) compared between patients with AMI, and the relationship between myocardial stress and AMI was observed.ResultsAmong the 120 patients, there were 77 cases in the AMI group, including 21 cases in the mild group, 40 cases in the moderate group, and 16 cases in the severe group. There were a total of 43 cases in the non-AMI group. Myocardial stress in the AMI group was significantly higher than that in the non-AMI group (P<0.05). The myocardial stress increased gradually in the mild, moderate, and severe AMI groups (P<0.001). Myocardial stress was positively correlated with coronary artery stenosis rate (P<0.001) and CAD (P<0.05). Logistic regression analysis showed that myocardial stress was an independent risk factor for AMI (P<0.05). The sensitivity and specificity of myocardial stress >5.15 mm in the diagnosis of AMI were 83.5%, 68.6% (AUC =0.834), respectively. Acute myocardial infarction is often caused by risk factors such as hyperlipidemia, hypertension and hyperglycemia, as well as vascular stenosis caused by arterial wall malformation, vascular wall inflammation or vasospasm.ConclusionsThe MRI measurement of myocardial stress is simple, reliable, and practical to evaluate the degree of coronary artery lesions. Myocardial stress is closely related to AMI and can assist in the diagnosis of AMI.

The Role of Breast Arterial Calcification on Mammogram as a Predictor for Risk of Coronary Artery Disease in Women

Introduction and Aim: Cardiovascular disease is a leading cause of death worldwide. Thus, the detection of mammographic arterial calcifications can be an early, noninvasive instrument for predicting the possible development of coronary heart disease in women. The current work aimed to assess the significance of Breast arterial calcification (BAC) detected by digital mammogram and its relation to coronary artery calcium score and degree of coronary artery stenosis if present.&#x0D; Patients and methods: The study included 100 female patients submitted to digital mammography for breast cancer screening programs and showed BAC then coronary artery calcification (CAC) score and multidetector coronary computed tomography angiography (MDCCTA) had done to determine the severity of coronary artery stenosis.&#x0D; Results: The age was ranged between 40 and 80 years; the mean was 56.7+9.42 years. The prevalence of positive BAC and CAD were 50% and 10%, respectively. Hypertension, diabetes mellitus (DM), hyperlipidemia, and Family history of cardiovascular disease was higher in the BAC (+) than in BAC (-) group. The presence of BAC appears to strongly and proportionately correlate with CAC Score and Coronary artery stenosis as determined by coronary CTA (r =0.809, and r = 0.811, respectively).&#x0D; Conclusion: BAC can indicate a risk of CAD development. Besides, there was a significant correlation between BAC and some cardiac risk factors ( e.g., age, family history of CAD, and DM).

Chronic Headache Attributed to Vertebrobasilar Insufficiency.

Vertebrobasilar insufficiency, a condition characterized by poor blood flow to the posterior portion of the brain, can cause headaches. However, the exact underlying mechanism is not yet fully understood. The patient enrolled in our study reported experiencing intermittent headaches radiating from the left shoulder, similar to chronic tension-type headaches. His aggravated headache and severe left vertebral artery stenosis were detected by brain computed tomography angiography. Stent insertion successfully expanded the patient’s narrowed left vertebral artery orifice. Subsequently, the patient’s headaches improved without recurrence during the one-year follow-up period. In summary, chronic headaches attributed to vertebrobasilar insufficiency in this study, improved after stent insertion to reverse severe left vertebral artery stenosis.

Correlation of Earlobe Crease and Clinically Identified Forehead Wrinkles with Severity of Coronary Artery Lesions in Patients with Stable Angina Pectoris

Abstract: Identification of high-risk subjects is crucial in prevention of coronary heart disease. Ear lobe crease and forehead wrinkles are easily identifiable physical signs that could potentially be an indicator of coronary artery lesion severity. This study aimed to determine the relationship between earlobe crease and forehead wrinkles morphology with severity of coronary artery stenosis in patients with stable angina pectoris using modified Gensini score. This was an observational study with a cross-sectional approach. All subjects who met the inclusion criteria were taken photos of their forehead area and both right and left ears. Assessment of scores and correlation analysis of earlobe crease and forehead wrinkles assessment with the severity of coronary artery stenosis using Gensini modification scores were later done. The results showed that from a total of 40 study subjects, 28 patients (70%) were male. Forehead wrinkle scores in patients with stable angina pectoris were mainly classified into score 1 and 2, totalling 32 (80%) patients. Earlobe crease form were dominated by type A (65% vs 35%). Patients with type B morphology on average have a Gensini value of 9 points lower than type A (reference) (p &lt;0.001). As for the Gensini modified score in patients with non-zero forehead wrinkle scores, it was clearly 4−5 units greater than those with a zero score. However, the sample size of patients with zero forehead wrinkle score was indeed too small (n=3) to make the difference meaningful (p=0.507). In conclusion, there is a significant positive relationship between identification of earlobe crease and the severity of coronary artery stenosis but there is no strong relationship between the identification of forehead wrinkles and the severity of coronary artery stenosis in patients with stable angina pectoris, in this case with a modified Gensini score.Keywords: stable angina; earlobe crease; forehead wrinkles; modified Gensini score

СООТНОШЕНИЕ ПРОЦЕССОВ СТЕНОЗИРОВАНИЯ И КАЛЬЦИНОЗА В КОРОНАРНЫХ АРТЕРИЯХ У ПАЦИЕНТОВ С ИБС

Abstract. Introduction. Coronary heart disease is one of frequent nosological forms in clinical practice. It is based on atherosclerosis of coronary arteries, main element of which are atherosclerotic plaques. Proliferation of plaques in lumen of vessel leads to its stenosis. Usually coronary atherosclerosis has progressive course, which manifests itself in change in internal composition of plaque. Progression of atherosclerosis is also reflected in increase in degree of calcification of coronary arteries, which can be characterized by degree of calcification. Calcification index is indicator of prevalence and severity of atherosclerotic lesions of coronary bed. Aim. To compare indicators characterizing severity of coronary artery stenosis and calcification according to coronary computed tomography angiography in patients with coronary heart disease. Material and methods. Study included 56 patients. Indicators of calcification of coronary arteries (calcium index of left descending artery, left circumflex artery, right coronary artery, Agatson index), as well as degree of coronary artery stenosis were used. Results and discussion. Degree of calcification was highest in left descending artery, lowest calcification in left circumflex artery, and in right coronary artery calcium index had intermediate value. Regression analysis was used to determine relation of severity of calcification of coronary arteries and degree of their stenosis. Values of these indicators showed significant dependence. In proximal segments of all arteries this dependence is linear. In distal segments of all arteries dependence of stenosis and calcification had form of non-linear regression. Conclusion. Coronary arteries have different severity of calcification: it is most pronounced in left descending artery. Degree of stenosis and calcification demonstrate different variants of relationship depending on artery and segments.

Influence of angioplasty and stenting on intracranial artery stenosis: preliminary results of high-resolution vessel wall imaging evaluation.

To investigate whether the imaging changes on high-resolution vessel wall imaging (HR-VWI) in patients before and after percutaneous transluminal angioplasty and stenting (PTAS) contribute to predicting the clinical outcome. The study included 24 severe intracranial artery stenosis (SICAS) patients undergoing PTAS with Wingspan Stent between 2018 and 2020 and had a 1-year follow-up. Three HR-VWI sessions (preprocedural, early [within 24 h], and delayed postprocedural [134.7 ± 27.1 days)]) in each subject were performed with 3-Tesla MRI. We evaluated periprocedural HR-VWI changes in patients with and without recurrent cerebral ischemic symptoms (RCIS) within 1-year follow-up. On CE-T1WI of the patients without RCIS, a significant decrease in enhanced area was observed on early postprocedural (0.04 ± 0.02 cm2, p = 0.001) and delayed postprocedural (0.04 ± 0.02 cm2; p = 0.001) HR-VWI compared to preprocedural (0.07 ± 0.02 cm2) HR-VWI. Patients with RCIS demonstrated no significant loss of enhanced area on CE-T1WI of early postprocedural HR-VWI (p = 0.180). Significant decreases in calibrated T1 signals were observed in both presence (1.77 ± 0.70 vs. 0.79 ± 0.52; p = 0.018) and absence (1.42 ± 0.62 vs. 0.83 ± 0.40; p = 0.001) of RCIS in early postprocedural HR-VWI. The preliminary results showed the presence of reduced contrast enhancement immediately after PTAS may indicate less recurrent stroke events within 1 year. Further studies are necessary to confirm the phenomena in a longer observation period. • Early postprocedural high-resolution vessel imaging (HR-VWI) within 24 h can effectively predict a 1-year outcome following intracranial stenting. • For stenotic lesions after stenting without reduced contrast enhancement on HR-VWI within 24 h may need closer clinical surveillance for potentially higher risk of stroke events within 1 year.

434 Continuous FfrCt As A Predictor Of Significant Coronary Artery Disease On Invasive Coronary Angiography

Introduction: Fractional flow reserve derived from coronary computed tomography angiography (FFRCT) is commonly used as a binary index, with a value of ≤0.80 suggesting the presence of hemodynamically significant stenosis. In this study, we tested the hypothesis that there is continuous distribution of the severity of coronary artery stenosis derived from invasive coronary angiogram (ICA) across continuous FFRCT values including the normal range.

448 Comprehensive Assessment Of Coronary Artery Disease On CCTA Using Deep Learning Methods

Introduction: Coronary computed tomography angiography (CCTA) has emerged as a reliable non-invasive modality to assess coronary artery stenosis (CAS) severity and high-risk plaque (HRP). However, comprehensive CCTA assessment, especially HRP, is time-consuming and dependent on reader expertise, limiting clinical translation. In this study, we aim to develop and validate a fully automated deep learning (DL) system capable of evaluating CAS severity and characterising HRP on CCTA.

Successful Treatment of Central Nervous System Vasculitis Associated with Antiphospholipid Syndrome

We report a case of severe, non-migraine headache accompanied by multifocal cerebral artery stenosis in a 41-year-old man with antiphospholipid syndrome (APS). He visited the emergency department with a headache that had occurred 2 days prior to presentation. He was administered low-dose aspirin (100 mg) daily after being diagnosed with antiphospholipid syndrome. Magnetic resonance angiography revealed severe multifocal cerebral artery stenosis. We assumed that multiple stenoses of the cerebral blood vessels were caused by APS; hence, we initiated pulse intravenous methylprednisolone therapy. Oral anticoagulation with warfarin was continued. After treatment, the symptoms and stenosis of the cerebral arteries gradually improved. Awareness of central nervous system vasculitis (with non-migraine headaches) caused by APS should be created among clinicians.

Association of plasma Ninjurin-1 and SYNTAX score in patients with coronary artery disease

BackgroundExpression of nerve injury-induced protein 1 (Ninj1) is associated with several inflammatory disease. The soluble Ninj1 is an antiatherogenic protein. However, the role of plasma Ninj1 levels in patients with coronary artery disease (CAD) and its correlation with the severity of the disease remains unknown. This study investigated the association between plasma Ninj1 levels and the severity of coronary artery stenosis in patients with CAD. MethodsA total of 207 subjects were recruited in this study. Blood samples were obtained to assess plasma Ninj1 level using enzyme-linked immunosorbent assay. The SYNTAX score calculated from baseline coronary angiography results was used to evaluate the severity of coronary artery stenosis. The least absolute shrinkage and selection operator (LASSO) regression analysis was performed to select the predictive factors. Then, a nomogram based on Ninj1 was constructed to predict the probability of CAD. ResultsPatients with CAD had significantly higher plasma Ninj1 than those without CAD (P < 0.001). A positive correlation was established between the Ninj1 levels and SYNTAX score (R = 0.352, P < 0.001). The multivariate logistical regression analysis indicated that plasma Ninj1 (P = 0.024) was an independent predictor of CAD occurrence after adjustment for clinical risk factors. The nomogram based on plasma Ninj1 level demonstrated good calibration and discrimination with the area under the curve 0.814. ConclusionsPlasma Ninj1 levels are increased in patients with CAD. Elevated levels of plasma Ninj1 are associated with CAD and the severity of coronary stenosis. A nomogram based on plasma Ninj1 and sectional clinical characteristics exerted a predictive potential for CAD.

Akut iskemik serebrovasküler olay geçiren hastalarda aritmi sıklığının holter elektrokardiyografi ile değerlendirilmesi

Amaç: Akut iskemik serebrovasküler olaydan (SVO) sonra yüksek riskli hastaların belirlenmesi, uygun kardiyak izlem ve aritmilerin saptanması, kardiyak morbidite ve mortalitenin önlenmesi açısından önemlidir. Çalışmamızın amacı, akut iskemik SVO nedeniyle kardiyoloji kliniğine yönlendirilen hastalarda, altta yatan etiyolojinin belirlenmesi ve 24 saatlik holter elektrokardiyografi (EKG) ile aritmi sıklığının saptanmasıdır. Gereç ve Yöntem: Çalışmaya Ocak 2019-Haziran 2021 tarihleri arasında akut iskemik SVO geçiren ve bazal EKG’ si sinüs ritminde olan ardışık 135 hasta alındı. Çalışmamız, retrospektif kesitsel bir çalışmadır. Bulgular: Hastaların ortalama yaşı 72.02±11.02 yıl, ortalama sistolik arteryal kan basıncı 138,84±20.45 mmHg ve ortalama kalp hızı 81.63±16.18 atım/dk idi. Hastalarda en sık görülen komorbid hastalıklar hipertansiyon (n=67, %49,6) ve koroner arter hastalığıydı (n=55, %40,7). Hastaların %5.9’unda protez kalp kapağı ve %5.2‘sinde kalıcı kalp pili vardı. 5 (%3,7) hastada intrakardiyak trombüs tespit edildi. Ortalama sol ventrikül ejeksiyon fraksiyonu %54,4±9,1 idi. Karotis dopler ultrasonografide (USG) hastaların 27 (%20)’ sinde tek taraflı ve 17’sinde (%12,6) iki taraflı ciddi karotis arter darlığı mevcuttu. Holter EKG’ de en sık tesbit edilen aritmiler ventriküler ekstrasistol (n=34, %25,2) ve paroksismal atrial fibrilasyondu (n=31, %23). Ayrıca 6 (%4,4) hastada non-sustained ventriküler taşikardi saptandı. Sonuç: Akut iskemik SVO geçiren hastalarda alta yatan etiyolojiyi tesbit etmek hastalığın tedavisi açısından önem arz etmektedir. Bu hasta grubunda tedavi edilmesi gereken aritmi sıklığı göz ardı edilmeyecek kadar yüksektir.