Soft Plaque Research Articles

Synthesis, Chemical and Biomedical Aspects of the Use of Sulfated Chitosan

This work is devoted to the chemical synthesis of sulfated chitosan and its experimental verification in an animal model of early atherosclerosis. The method of chitosan quaternization with sulfate-containing ingredients resulted in a product with a high content of sulfate groups. Implantation of this product into the fascial-muscular sheath of the main limb artery along the leg and thigh in rabbits led to the extraction of cholesterol from the subintimal region. Simplified methods for the chemical synthesis of quaternized sulfated chitosan and the use of these products in a model of experimental atherosclerosis made it possible to perform a comparative morphological analysis of the vascular walls of the experimental and control limbs under conditions of a long-term high-cholesterol diet. The sulfated chitosan samples after implantation were shown to change the morphological pattern of the intimal and middle membranes of the experimental limb artery. The implantation led to the degradation of soft plaques within 30 days after surgical intervention, which significantly increased collateral blood flow. The implantation of sulfated chitosan into the local area of the atherosclerotic lesions in the artery can regulate the cholesterol content in the vascular wall and destroy soft plaques in the subintimal region.

Association of blood lipids with coronary artery plaque among Saudi patients referred to computed tomography

BackgroundBlood lipids are strong risk factors for the progression of atherosclerotic plaques. However, data on gender-specific associations are limited.ObjectivesTo examine gender-specific associations of coronary plaque with blood lipids among a large sample of Saudi patients without CAD.MethodsRetrospective cross-sectional study was conducted among adult patients referred to (64 multidetector spiral) computed tomography (CT) for standard indications at the Prince Sultan Cardiac Centre (Riyadh, Saudi Arabia) between July 2007 and December 2017. Those with pre-existing CAD were excluded. Plaques were determined based on quantification of coronary calcium and Coronary CT angiography.ResultsA total 2421 patients (1498 males and 923 females) were included. The prevalence of any plaque was 36.6% with higher burden in males than females (41.3% versus 28.9%, p < 0.001). Approximately 78.9% of all plaques were calcified. Blood lipids (mmol/L) were 4.75 ± 1.14 for total cholesterol, 2.90 ± 0.96 for LDL cholesterol, 1.20 ± 0.36 for HDL cholesterol, and 1.64 ± 1.09 for triglycerides. Males had significantly higher triglycerides and lower HDL cholesterol compared with females. In adjusted models in males and all patients, soft and/or calcified plaques were significantly associated with lower HDL cholesterol and higher triglycerides. In females, the only significant association was between soft plaques and higher triglycerides.ConclusionsMiddle-aged patients without clinical CAD in Saudi Arabia have a high burden of plaques, specially calcified ones. The findings may impact the use of lipid lowering mediations, by underscoring the importance of assessing the risk of CAD in patients without clinical CAD even in case of lack of coronary calcification.

C47 CORO–CT PLAQUE ANALYSIS IN ASSESSMENT OF CARDIOVASCULAR RISK

Abstract Background Computed tomographic (CT) coronary angiography represents a non–invasive approach to assess plaque characteristics that provides information to change treatment of coronary artery disease (CAD) and to asses risk stratification. Purpose Analyze the differences in plaque composition between patients with different plaque features: soft unstable plaques, hard stable plaques and no plaques; identify whether there is a relationship between the plaque density and the pericoronary fat attenuation index (pFAI). Materials and methods: 372 patients retrospectively analyzed who underwent CTCA for exclusion of CAD. They were divided into three groups: 37 (10%) patients with high attenuated plaques (&amp;gt; 60HU), 137 (37%)with low attenuated plaques (&amp;lt;29 HU and a volume of at least 15 mm3 and/or 30–59 HU with a volume greater than 52 mm3) and 198 (53%) patients without significant CAD. For each patients we collected clinical, radiological and follow–up data. Results and Discussion Low–attenuated plaques are significantly associated with older age, male sex, dyslipidemia and diabetes mellitus (p &amp;lt; 0.001). Higher values of pFAI were more present in patients with soft plaques than in those with stable plaques and without plaques (p = 0.005). It was also found that soft plaques were present in more CA segments compared to stable plaques. Overall volume of soft plaque appears greater than hard plaques and mainly localized in the anterior descendant coronary artery with higher stenosis values (p &amp;lt; 0.001). Presence of plaques with soft or high–risk features predisposes significantly and independently (p &amp;lt; 0.001) to a composite outcome (death, in–hospital admissions for percutaneous angioplasty or by–pass procedures) at the follow up. Conclusions Coronary plaque analysis showed a good correlation between high–risk plaques and pFAI, supporting the hypothesis that the presence of high–risk plaques can be correlated to inflammatory burden. Furthermore, the presence of high risk plaques predispose to death or hospitalization for coronary intervention.

Pulse wave propagation through a stenotic artery with plaque constituents of different stiffnesses: In vitro-experiment and fluid–structure interaction simulation

Vulnerable (typically, softer) carotid plaques may rupture leading to blockages downstream in the brain with high potential for ischemic stroke. Pulse Wave Imaging (PWI) developed by our group is an ultrasound-based technique for pulse wave visualization and pulse wave velocity (PWV) mapping. In this study, the accuracy of PWV estimation in stenotic vessels was assessed in simulation and phantom studies. Fluid–structure interaction simulations were performed in a stenotic (50%) vessel. Experimental stenotic (50%) polyvinyl alcohol (PVA) phantoms (2 mm thickness, 8 mm lumen diameter, and 165 mm length) with soft/medium/hard plaque constituents of different stiffness (E0 = 12 kPa, 30 kPa, 94 kPa) were constructed matching the simulation geometry and parameters. Pulse waves were generated by a computer-controlled pump using a physiologic flow waveform. The RF frames were acquired by a Verasonics Vantage 256 system using a 5 MHz (L7-4) linear array. The acquired RF frames were beamformed using a delay and sum algorithm, and a GPU-based, 1-D cross correlation method was used to estimate the wall velocities. The acceleration peak of the pulse wave was tracked to estimate PWV. PWVs of 2.6 ms−1, 3.4 ms−1, and 4.5 ms−1 were, respectively, measured for the soft, medium, and stiff plaque material in experimental phantoms. The PWV of 2.7 m/s was confirmed for the medium plaque in simulation. This fundamental study demonstrated, thus, a good accuracy by PWI in the estimation of plaque PWV and its underlying stiffness for future stroke risk assessment.

Cylindrical Transducer Array for Intravascular Shear Wave Elasticity Imaging: Preliminary Development.

We present an intravascular ultrasound (IVUS) transducer array designed to enable shear wave elasticity imaging (SWEI) of arteries for the detection and characterization of atherosclerotic soft plaques. Using a custom dicing fixture, we have fabricated single-element and axially-segmented array transducer prototypes from 4.6-Fr to 7.6-Fr piezoceramic tubes, respectively. Focused excitation of the array prototype at 4 MHz yielded a focal gain of 5× in intensity, for an estimated 60 mW/cm2 [Formula: see text] and 1.6-MPa negative peak pressure at 4.5-mm range in water. The single-element transducer generated a peak radial displacement of [Formula: see text] in a uniform elasticity phantom, with axial shear waves detectable by an external linear array probe up to 5 mm away from the excitation plane. In a vessel phantom with a soft inclusion, the array prototype generated peak displacements of 2.2 and [Formula: see text] in the soft inclusion and vessel wall regions, respectively. A SWEI image of the vessel phantom was reconstructed, with measured shear wave speed (SWS) of 1.66 ± 0.91 m/s and 0.97 ± 0.59 m/s for the soft inclusion and vessel wall regions, respectively. The array prototype was also used to obtain a SWEI image of an ex vivo porcine artery, with a mean SWS of 3.97 ± 1.12 m/s. These results suggest that a cylindrical intravascular ultrasound (IVUS) transducer array could be made capable of SWEI for atherosclerotic plaque detection in coronary arteries.

Impact Analysis of Different CT Configurations of Carotid Artery Plaque Calcifications on Cerebrovascular Events.

CT is considered the standard reference both for quantification and characterization of carotid artery calcifications. Our aim was to investigate the relationship among different types of calcium configurations detected with CT within the plaque with a novel classification and to investigate the prevalence of cerebrovascular events. Seven hundred ninety patients (men = 332; mean age, 69.7 [SD, 13] years; 508 symptomatic for cerebrovascular symptoms and 282 asymptomatic) who underwent computed tomography of the carotid arteries were retrospectively included in this institutional review board-approved study. The plaque was classified into 6 types according to the different types of calcium configurations as the following: type 1, complete absence of calcification within the plaque; type 2, intimal or superficial calcifications; type 3, deep or bulky calcifications; type 4, adventitial calcifications with internal soft plaque of <2 mm thickness; type 5, mixed patterns with intimal and bulky calcifications; and type 6, positive rim sign. The highest prevalence of cerebrovascular events was observed for type 6, for which 89 of the 99 cases were symptomatic. Type 6 plaque had the highest degree of correlation with TIA, stroke, symptoms, and ipsilateral infarct for both sides with a higher prevalence in younger patients. The frequency of symptoms observed by configuration type significantly differed between right and left plaques, with symptoms observed more frequently in type 6 calcification on the right side (50/53; 94%) than on the left side (39/46; 85%, P < .001). We propose a novel carotid artery plaque configuration classification that is associated with the prevalence of cerebrovascular events. If confirmed in longitudinal analysis, this classification could be used to stratify the risk of occurrence of ischemic events.

Identification and treatment of the vulnerable coronary plaque.

Acute coronary syndrome mostly arises from rupture or erosion of a vulnerable plaque. Vulnerable plaques typically appear as lipid-rich plaques with a thin cap, called thin-cap fibroatheromas. Various intracoronary imaging techniques can be used to detect vulnerable plaques, such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS), each visualizing different high-risk plaque characteristics. IVUS and its post-processing techniques, such as virtual histology IVUS, can primarily be used to identify calcified and soft plaques, while OCT is also able to quantitatively measure the cap thickness. The addition of NIRS allows the exact measurement of lipid content in the plaque. Non-invasive imaging techniques to identify vulnerable plaques, such as computed tomography, are less often used but are evolving and may be of additional diagnostic use, especially when prophylactic treatments for vulnerable plaques are further established. Pharmacological treatment with lipid-lowering or anti-inflammatory medication leads to plaque stabilization and reduction of cardiovascular events. Moreover, the implantation of a stent or scaffold for the local treatment of vulnerable plaques has been found to be safe and to stabilize high-risk plaque features. The use of drug-coated balloons to treat vulnerable plaques is the subject of ongoing research. Future studies should focus on non-invasive imaging techniques to adequately identify vulnerable plaques and further randomized clinical studies are necessary to find the most appropriate treatment strategy for vulnerable plaques.

A red plaque on the face of a healthy man

A 65-year-old man presented with a red, soft plaque on his left nasal sidewall of 2 months’ duration (Fig 1). Per the patient report, the plaque initially developed 2 days after dental surgery. Previous treatments included several courses of antibiotics, including clindamycin, amoxicillin-clavulanate, and cefalexin, ranging in duration from 1 week to 4 weeks of therapy. A computed tomography scan of the face with intravenous contrast revealed a soft-tissue swelling without evidence of an abscess.

Strategy for Carotid Artery Stenting of Soft Plaques

Strategy for Carotid Artery Stenting of Soft Plaques

C68. Patient with Zero Coronary Calcium Score and Significant Stenosis in Left Anterior Descending Coronary Artery: a case report

Abstract Background Coronary heart disease is pathological process characterized by the accumulation of atherosclerotic plaque in the epicardial artery, either obstructive or non-obstructive. Coronary calcium score (CCS) detects and calculates coronary artery calcification (CAC) and CT coronary angiography (CTCA) allows evaluation of the coronary arteries anatomy for luminal stenosis due to atherosclerotic plaque with or without calcification. Case Description A 70 years-old man, admitted to the emergency department with a chief complain of chest pain. Physical examination was within normal limits. His treadmill stress testing was positive ischemic response one month prior. Then patient undergoing CTCA, the result was zero calcium score with 90-99% stenosis at proximal left anterior descending (LAD) due to soft plaque. Invasive coronary angiography (ICA) confirmed the CT findings and showed total occlusion with grade V thrombus in osteal LAD. Discussion A study showed that 1-2% of symptomatic patients with zero CAC potentially had obstructive CAD. It is supported with this report that the patient had typical chest pain with zero calcium score. CCTA has high sensitivity and negative predictive value for the detection of CAD but has a relatively low positive predictive value, especially for moderate severity coronary. In this report CTCA showed 90% -99% stenosis at the proximal LAD and correlate with ICA findings.

C68. Patient with Zero Coronary Calcium Score and Significant Stenosis in Left Anterior Descending Coronary Artery: a case report

Abstract Background Coronary heart disease is pathological process characterized by the accumulation of atherosclerotic plaque in the epicardial artery, either obstructive or non-obstructive. Coronary calcium score (CCS) detects and calculates coronary artery calcification (CAC) and CT coronary angiography (CTCA) allows evaluation of the coronary arteries anatomy for luminal stenosis due to atherosclerotic plaque with or without calcification. Case Description A 70 years-old man, admitted to the emergency department with a chief complain of chest pain. Physical examination was within normal limits. His treadmill stress testing was positive ischemic response one month prior. Then patient undergoing CTCA, the result was zero calcium score with 90-99% stenosis at proximal left anterior descending (LAD) due to soft plaque. Invasive coronary angiography (ICA) confirmed the CT findings and showed total occlusion with grade V thrombus in osteal LAD. Discussion A study showed that 1-2% of symptomatic patients with zero CAC potentially had obstructive CAD. It is supported with this report that the patient had typical chest pain with zero calcium score. CCTA has high sensitivity and negative predictive value for the detection of CAD but has a relatively low positive predictive value, especially for moderate severity coronary. In this report CTCA showed 90% -99% stenosis at the proximal LAD and correlate with ICA findings.

Abstract 17117: Hyperhomocysteinemia Associated St Elevation Myocardial Infarction In A Young Male

Case Presentation: A 24-year-old male with a medical history of Crohn’s on mesalamine presented to the emergency room with crushing substernal chest pain at rest. Electrocardiogram revealed ST elevations in Lead V2-V5 (Figure-1a). He was taken emergently to the catheterization laboratory and had 100% thrombotic occlusion of his proximal left anterior descending coronary artery (LAD) (Figure-1b). Intravascular ultrasound (IVUS) confirmed the presence of soft atheromatous lipid-rich plaque in the proximal LAD with heavy thrombus burden (Figure-1c/d). He underwent aspiration thrombectomy and IVUS guided percutaneous coronary intervention with a 4.5 mm x 32 mm drug-eluting stent. Echocardiogram revealed an akinetic anterior wall with an ejection fraction of 35% without a patent foramen ovale. Hypercoagulable workup was initiated and showed a significantly elevated homocysteine level of 84.4 umol/L (normal:3.5-10.4). Family history, drug screen, hemoglobin A1C, and lipid profile were unremarkable. Discussion: The differential diagnosis in a young male presenting with a STEMI includes thromboembolism versus plaque rupture. IVUS showed clear evidence of a lipid-rich plaque demonstrating premature atherosclerotic vascular disease rather than a thromboembolic event. His most striking risk factor was hyperhomocysteinemia with a level of 84.4 umol/L. Elevations in homocysteine plasma concentration has been identified as an independent risk factor for atherosclerosis due to its atherogenic and prothrombotic properties. To date lowering homocysteine levels with folate and additional therapies have not shown to reduce the risk of coronary disease. Our case stresses the importance of intravascular imaging, especially in atypical cases such as a young male presenting with a STEMI to differentiate plaque rupture versus thromboembolism. Further studies are needed to identify risk modifying therapies for hyperhomocysteinemia associated vascular disease.

ORAL HYGIENE STATE AND ITS CORRECTION OPTIONS IN CHILDREN WITH HODGKIN’S DISEASE

The Hodgkin’s disease (lymphogranulomatosis, LGM) stands at the top of the list among malignant lymphomas in children. The highest rate of it occurrence coincides with childhood. LGM is most common at 4-6 and 12-14 years. The scope of scientific clinical research on odontoand parodontopathology is limited among pediatric population. The quantitative and qualitative composition of plaque, its thickness and area is primary pathogenic chain. In turn, unsatisfactory oral hygiene contributes to the development of decay and periodontal and oral mucosal disease in children with LGM.&#x0D; Our research aims to study the oral hygienic condition in patients with LGM during different clinical stages of the underlying disease. In order to reduce the toxic effect of LGM treatment, rational oral hygiene preventive measures shall be implemented.&#x0D; Matherials and methods. A total of 45 patients of both sexes in the 5-15 year age group diagnozed with lymphogranulomatosis (LGM) were examined. 243 healthy age-and-sex-matched children were included in the control group. The patients with lymphogranulomatosis (LGM I) were examined after the initial diagnosis. Group II (LGM II) consisted of patients who had completed the first polychemestry treatment cycle. Group III (LGM III) included patients who had a constant remission period (from over 6 months to 5 years).&#x0D; The oral hygienic condition was studied using the Pahomov’s hygienic index, the simplified oral hygiene index (OHI-S by Greene and Vermilion), the PHP hygiene hygiene efficiency index (Podshadley, Haley, 1968), the modified Turesky index (1970), and API surfaces [6]. The data was statistically analyzed using Student's-Fisher's method.&#x0D; The Pahomov's hygienic index (PHI) in children aged 5-15 with LGM was quite different in the main and control groups (p&lt;0.05). The score of PHI was 2.3 ± 0.05 (p&lt;0.05) in patient group with LGM (LGM I). The Pahomov's hygienic index had increased in the children aged 5-15 diagnozed with LGM. The Pahomov’s index values from the second (LGM II) and third (LGM III) examinations were found to be quite different when compared to the control group of children of the same age (p&lt;0.05). This PHI value was 3.39 ± 0.11 (very poor) after the second examination (LGM II) and was at 2.7 ± 0.10 (poor) during the third examination (LGM II). The satisfactory and unsatisfactory oral hygiene conditions according to the Pahomov’s index were observed in 5-15 year old children with LGM.&#x0D; The satisfactory and unsatisfactory oral hygiene conditions have been established using the Pahomov’s index, Green-Vermilion, Tureski, PHP, API in 5-15 year old children with LGM. The children might have completely given up on tooth brushing due to increased trauma and bleeding gums.&#x0D; Soft plaque is often responsible for dental decay in primary and permanent teeth in children and periodontal diseases. The analysis of the individual oral hygiene condition determined poor level of hygiene skill in patients with LGM compared to somatically healthy children. Hygienic condition and care depend on age, clinical stage of the underlying disease, the course of pathological complications in hard dental and soft oral tissues.&#x0D; Conclusion. Our clinical study established a poor oral hygiene condition by using different groups of dental hygiene indicators in patients with LGM. This condition particularly worsens during chemotherapy, which causes significant changes in periodontal, oral mucous and hard dental tissues. Children have low awareness of oral cavity care requirements or the specifics of selecting hygiene supplies and facilities. In those cases, the dental examination was required for raising awareness and providing oral hygiene control which was carried out among patients at different stages of the Hodgkin’s disease and it remission. Therefore, adopting such measures would provide an opportunity to increase the resistance of hard dental and periodontal tissues.

Prevalence and characteristics of atherosclerotic plaque: Left compared with right arteries and anterior compared with posterior circulation stroke

PurposeTo evaluate atherosclerotic plaque prevalence and characteristics between left and right cervicocephalic arteries and between anterior and posterior circulation stroke (ACS and PCS). MethodsThis retrospective study included 284 patients with acute ischemic stroke (199 ACS and 85 PCS) involving large-artery atherosclerosis or small-artery occlusion. We assessed atherosclerotic plaque prevalence and characteristics (plaque type, plaque surface morphology, plaque distribution, location of calcified nodules and plaque thickness) in each segment and their comparisons between left and right arteries and between ACS and PCS. ResultsThe left subclavian artery (L-SA), common carotid artery (L-CCA) and intracranial vertebral artery (L-IVA) had significantly higher prevalence of atherosclerotic plaque than the right (R) corresponding arteries (70.1% versus 59.5%, P = 0.008), (48.1% versus 28.9%, P < 0.001), (23.9% versus 16%, P = 0.018), respectively. L-SA had a higher prevalence of mixed plaque (non-calcified > calcified) (19.6% versus 16.4%) and noncalcified plaque (51.9% versus 31.7%), and a lower prevalence of calcified plaque (8.9% versus 23.3%) and mixed plaque (calcified > non-calcified) (19.6% versus 28.6%) than R-SA, P < 0.001. The distribution of plaque type in the SA and extracranial vertebral artery (EVA) were significantly different between ACS and PCS. The soft plaque thickness of SA in PCS was significantly greater than that in ACS (3.85 ± 1.27 versus 3.51 ± 1.04, P = 0.032). ConclusionsAtherosclerotic plaque prevalence and characteristics vary in different segments, sides and between ACS and PCS. These differences should be noted during plaque diagnosis.

Оral hygiene and fluoride influence on dental health in early childhood

Early childhood caries occurs immediately after the eruption of deciduous teeth. During this period, children are too young to be able to properly implement oral hygiene. Consequently, it is at a negligible level, with plenty of soft plaque on the deciduous tooth surfaces. The objective of this investigation was to determine the correlation between oral hygiene (shown with the OHI index) and the initial stages of early childhood caries: initial lesion (white spot) and superficial form, before and after local fluoride treatment. Material and methods: For determining the OHI index among our examinees we used the method of Green-Vermillion. It was determined in 117 examinees twice, during the first visit and immediately before physiological replacement of deciduous teeth. Patients were two to three years of age, diagnosed with initial stages of early childhood caries and fluoride preparate (amino fluoride solution) was applied once a week, for 6 months. Results: In 30 subjects treated with local fluoride treatment from both basic groups (with initial and superficial lesions), just before the physiological change of the teeth, we received a statistically significant improvement in the OHI index (p = 0.000038; p = 0.00006) at the end from the examination. Conclusion: From the conducted analysis of the obtained results, we can conclude that the level of oral hygiene is correlated with the progression of changes in the enamel. Oral hygiene and fluoride treatment significantly reduce soft tissue levels and improve the OHI index.

MULTI-DETECTOR CT CHARACTERIZATION OF CORONARY ATHEROMATOUS PLAQUES

Background: Atherosclerotic cardiovascular diseases are the leading cause of death worldwide (30% of the mortalities).Coronary atherosclerotic plaques are classified into stable and unstable. Unstable plaques increase the risk of acute coronary syndrome and early detection will help prevention. Evaluation of plaque vulnerability is done best by invasive intravascular ultrasound and so, this study aims to evaluate the possible use of non invacive CT for plaque characterization.Aim of the work: Determine the role of multidetector CT in the assessment of plaque composition and configuration. This will improve risk stratification thus, decreasing the incidence of sudden death.Patients and methods: This study included 46 patients with coronary atherosclerotic plaques. The most expansive or solitary lesion was selected for each patient.Results: Forty-six atherosclerotic plaques were evaluated by multi-slice coronary CT; 30 patients were unstable clinically and 16were stable. Dyslipidemia was found in 40 patients while diabetes was found in 22 patients. 69.6% of the lesions were found in the proximal LAD. Most of unstable patients showed mixed plaques and soft plaques. In a stable group, most of the plaques were calcified. As for the attenuation pattern 18/46 of the plaque with heterogeneous attenuation were in the unstable clinical group. 28/46 of the plaques with homogenous attenuation were stable. Regarding the Napkin ring sign it was positive in 18/46 of the plaques and the 18 patients on follow up were found to be unstable.All patients with spotty calcification proved to be unstable clinically.Remodeling index, low hounse field unit and plaque burden were higher in the unstable group.. No association between stability and degree of stenosis.Conclusion: A strong correlation between plaque characteristics and clinical presentation: Multislice coronary CT angiography detect high-risk plaque criteria.

3. EXTRACRANIAL CAROTID AND VERTEBRAL ARTERIES PROFILE IN DIZZINES

Background: Dizziness is one of the most common neurologic symptoms found in clinical practice. Carotid and vertebral ultrasound can be performed to detect any factors predisposing dizziness. Objective: This study aimed to describe the profile of extracranial carotid and vertebral arteries using carotid and vertebral ultrasound in dizziness. Methods: This was a retrospective cross-sectional study using the registry of Neurology Outpatient Clinic, RSUPN Dr. Cipto Mangunkusumo, Jakarta from January 2018 until September 2020. Characteristics of subjects with dizziness were evaluated using carotid and vertebral ultrasound. Results: Of 2,699 subjects referred to transcranial doppler/carotid doppler (TCD-CD) clinic, there were 121 (4.53%) with dizziness. Incomplete data of 48 subjects were excluded. There were 42 (57.5%) female and 31 (42.5%) male with the mean age of 53.9 ± 14.5 years. Hypertension was found in 43 (58.9%) subjects. Thickening of intima medial complex was found in 20 (27.4%) subjects. Carotid artery abnormalities were found in 23 (31.5%) subjects. Soft plaque, hard plaque, and mixed plaque were found in 9, 8, and 1 subject, respectively. Tortous arteries were found in 3 subjects. Vertebral artery abnormalities were found in 3 (4.1%) subjects, in which 2 subjects had stenosis in bilateral vertebral arteries and one subject had occlusion in right vertebral artery. Conclusion: Carotid and vertebral ultrasound can be performed in dizziness to evaluate extracranial carotid and vertebral arteries as one of the risk factors of dizziness. Some extracranial carotid and vertebral artery abnormalities including artherosclorosis, plaque, and stenosis may present in dizziness.

Comparative evaluation of color Doppler and conventional digital subtraction angiography in arterial disease

Introduction: Peripheral Arterial Occlusive Disease (PAOD) leads to narrowing and hardening of arteries which leads to increased risk of lower extremity amputation. Hence, the accuracy of non-invasive diagnostic methods such as Color Doppler (CD) needs to be assessed in comparison to the conventional digital subtraction angiography (CDSA). Objective: To compare color Doppler and conventional digital subtraction arteriography in patients of infragenicular arterial disease. To evaluate and correlate the findings of CD with arteriography as the gold standard, in PAOD of the lower extremities in supra-genicular part and to define whether color Doppler, is an alternative or an adjunct to DSA. Methods: In this study 60 patients suspected of lower limb PAD aged between 40 and 70 years were included. All these patients with symptoms suggestive of PAOD underwent color Doppler study of lower limb arterial system. Afterward, 55 patients of PAOD formed the subjects and their affected lower limbs evaluated by CD and arteriography, for localization and grading of lesion in the arteries, into normal/insignificant stenosis and occlusion. The sensitivity, specificity, and positive and negative predictive values of CD as compared to CDSA in arterial disease were calculated. Results were analyzed by two way contingency tables, using calculator, and SSP software. Results: As compared to conventional digital subtraction angiography, Doppler assessment was more sensitive specific with greater diagnostic accuracy. Conclusion: CD is better than conventional digital subtraction angiography in diagnosis of Grade 1 &2 cases, with better assessment of soft plaques, segmental flow and recanalization in PAD and CD performed well compared with conventional digital subtraction angiography. Hence color Doppler can be an alternative to conventional digital subtraction angiography in diagnosing peripheral arterial occlusive diseases in supragenicular part of lower limb arteries.

Pink plaque on the ear

A 65-year-old woman presented to Dermatology with a soft, vascular-appearing, tender, and painful pink plaque on her left proximal helix. Dermoscopy revealed a salmon-colored background and nonspecific vascular network.1 The 2-cm plaque had first appeared 1 month earlier. Her primary care physician had previously attempted a biopsy, but it was aborted due to significant bleeding. The patient had a history of stage III marginal zone lymphoma with stable pulmonary tumors that remained unchanged after 4 cycles of rituximab more than a year earlier.What’s your diagnosis?

Impact of Guidewire Route on Severe Dissection After Balloon Angioplasty for Femoropopliteal Chronic Total Occlusion Lesions: An Intravascular Ultrasound Analysis

To determine the impact of the guidewire route on severe dissection after balloon angioplasty for femoropopliteal chronic total occlusion (CTO) lesions using a new intravascular ultrasound (IVUS) assessed classification scheme corresponding to a conventional angiographic classification scheme. Images for 21 femoropopliteal CTO lesions treated endovascularly between May 2018 and December 2019 were used for analysis. IVUS images after guidewire passage and those after balloon angioplasty were evaluated at 1 cm intervals. Cross sectional images were obtained (n = 219) and divided into two groups by the guidewire route: those in which the guidewire passed through the inner half of the luminal radius (central wiring group, 139 cross sectional images) and those in which the guidewire passed through the outer half of the luminal radius (eccentric wiring group, 80 cross sectional images). Angiographically severe dissection was defined as Type C or greater according to the National Heart, Lung, and Blood Institute classification, to which six dissection morphology patterns were applied based on IVUS images (Types A - E2). Central wiring was achieved in an average of 69.6 ± 28.0% of the CTO length from per limb analysis. Among the IVUS assessed dissection morphology patterns, Types D - E2 were more frequently correlated with angiographically severe dissection than were Types A - C (57.5% vs. 13.7%, p < .001). Multivariable analysis showed that soft plaque was a predictive factor for (odds ratio [OR] 2.14; 95% confidence interval [CI] 1.007 - 4.72; p= .048) and central wiring was a protective factor (OR 0.27; 95% CI 0.14 - 0.49; p < .001) against Type D - E2 dissection patterns assessed by IVUS after balloon angioplasty. Lesions with Type D - E2 dissection patterns assessed by IVUS were correlated with angiographically severe dissection. Central wiring may be useful for preventing severe dissection after balloon angioplasty for femoropopliteal CTO lesions.