Tomography Angiography In Evaluation Research Articles

Carotid Endarterectomy with Twisted Internal Jugular Vein Located Anterior to the Common Carotid Artery

AbstractThe knowledge of both normal and abnormal anatomy of the veins of the neck may be important for surgeons performing carotid endarterectomy (CEA), to avoid inadvertent injury to vascular structures. We present three cases of abnormal course of the internal jugular vein (IJV) which run anterior to the common carotid artery, named twisted IJV, that usually run posterolateral to the common carotid artery in patients undergoing CEA. These twisted IJV cases were detected by preoperative multidetector computed tomography angiography evaluation. During the CEA procedure, before identifying the common carotid artery, we dissected the retromandibular space to find the common facial vein. Then, dissection proceeded along the common facial vein caudally to find the IJV. After ligation and cutting of the common facial vein, a carotid sheath with the IJV turned laterally revealed the common carotid artery safely, and CEA was accomplished. Our clinical experience shows that knowledge of the anatomical anomaly of the IJV allows safe dissection of the carotid triangle avoiding inadvertent injury to the vasculature and vagus nerve.

A Case of the Uncommon Cause of Chronic Coronary Syndrome: Coronary Fistula and Coronary Stenosis, Which One to Intervene?

AbstractWe report a case of chronic coronary syndrome (CCS) that had two completely distinct mechanisms in one patient. We applied comprehensive diagnostic tools using noninvasive and invasive physiology and imaging tests before, during, and after the intervention procedure to evaluate the outcome. The patient had previously visited many physicians and was diagnosed with noncardiac chest pain. He was referred to our department due to the increased frequency and intensity of angina pectoris. After a careful diagnosis, we found a nonsignificant stenosis (50%) in the mid-left anterior descending (mid-LAD) artery and an unexpectedly high-flow coronary artery fistula from the LAD to the main pulmonary artery (MPA). We tried a combination therapy with escalation of the anti-ischemic therapy but failed. He was rehospitalized with unstable angina pectoris. After a comprehensive physiology and imaging test, our team decided to perform fistula embolization with detachable coils and defer stenting in the mid-LAD artery. After the intervention procedure, his angina subsided, and his exercise capacity was remarkably improved. Cardiac computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) evaluation in 3 months revealed all coils in situ and improved cardiac function. We postulate that comprehensive diagnostic tools are required to select appropriate management and prevent unnecessary procedures.

TCT-359 Emergence of Computed Tomographic Angiography in Evaluation and Management of Diverse Coronary Artery Anomalies: A Single-Center Registry

TCT-359 Emergence of Computed Tomographic Angiography in Evaluation and Management of Diverse Coronary Artery Anomalies: A Single-Center Registry

Optical Coherence Tomography Angiography Evaluation of Retinochoroidal Microvascular Circulation Differences in Pregnant Women with Pregestational and Gestational Diabetes Mellitus.

In this study, the changes in microvascular circulation caused by pregestational and gestational diabetes were observed, without focusing on retinal findings, to reveal the effect of diabetes regulation. A total of 135 subjects were included: 30 with gestational diabetes (GDM), 30 pregestational diabetes (PGDM), 30 healthy pregnant normoglycemic subjects, and 45 healthy non-pregnant subjects. All subjects were examined by optical coherence tomography (OCT) and angiography. The retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), choroidal thickness (CT), superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC), vascular density (VD), and foveal avascular zone (FAZ) areas were measured. The foveal VD of SCP and DCP was significantly lower in the PGDM and GDM groups compared to the control groups (p:0.006 and p:0.001, respectively). CC VD was significantly higher in all pregnant groups compared to non-pregnant controls (p<0.001). The choroidal thickness values were highest in the healthy pregnant group and lowest in the PGDM group. There was no significant difference in FAZ area, retina, RNFL and GCL thickness between the groups. In the PGDM group, a negative correlation was observed between the FAZ area and the HbA1c level (r:- 0.417, p:0.043). There was a decrease in vascular density in pregnant women with diabetes compared to healthy pregnant women and controls. In the pregnant group with PGDM, a narrowing of the FAZ area was observed with increasing worsening of diabetes control. Diabetes type and glycemic control could influence the microvascular changes even in the absence of clinical or retinal findings.

Optical coherence tomography angiography evaluation of retinal and optic disc alterations in children with type 1 diabetes without retinopathy.

To determine the earliest characteristics of retinal and optic disc alterations in diabetic children without diabetic retinopathy (DR) changes by using optical coherence tomography angiography (OCTA). This was a prospective, non-interventional case-control study that involved 25 patients with type 1 diabetes mellitus (T1DM) without clinical signs of DR and a demographically similar group of 25 healthy children as the control. The retina and optic disc were examined using OCTA. Correlations between the OCTA parameters and clinical predictors were evaluated. Twenty-five patients (median age: 14 years, interquartile range [IQR]: 13-15.9 years; 12/25 [48%] girls) with T1DM and 25 age-matched controls were enrolled. The patients had a tendency toward thinner fovea (232.5 Symbolm) as compared to the controls (244.3 Symbolm) (P = 0.142). Superficial vascular density was significantly lower in the DM group compared to the controls (48.90 ± 2.3 vs. 50.91 ± 3.1, P = 0.015). However, no such differences were observed at deeper vascular densities. The patients also had lower whole-disc (48.65 vs. 50.21, P = 0.029), disc interior (49.14 vs. 52.11, P = 0.044), superior (50.67 vs. 53.45, P = 0.039), and peripapillary capillary densities (50.49 vs. 52.68, P = 0.033). There was no statistical correlation between retinal/optic disc angiography parameters and clinical predictors. In diabetic children without visual impairment or DR, signs of microvasculopathy were found in the superficial macular vascular density and inside the disc.

Optical coherence tomography angiography evaluation of retinal and choroidal microvascular changes in pregnant women with a history of unexplained recurrent spontaneous abortions.

To study retinal and choroidal microcirculation by optical coherence tomography angiography (OCTA) in pregnant women with unexplained recurrent spontaneous abortion (RSA) and to compare them with healthy pregnant and nonpregnant subjects. Pregnant women with an unexplained history of RSA (group 1), healthy pregnant (group 2), and healthy non-pregnant women (group 3) were included in the study. After a thorough ophthalmologic examination:best-corrected visual acuity, intraocular pressure,slit-lamp biomicroscopy, fundus examination,autorefractometer, biometry, and axial length measurement; OCT and OCTA measurements were performed with Swept Source OCT-Angiography (Topcon Co, Japan). The nonpregnant group had higher values for central foveal superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density (VD) and lower values for superior, inferior, and mean VD compared with pregnant groups (p < 0.001). Choriocapillaris values (CC) VD were higher in groups 1 and 2 than in group 3 (p < 0.001). The group with unexplained RSA had a relatively smaller FAZ (foveal avascular zone) area than the group of healthy pregnant women (p:0.047). There were no statistically significant differences between groups in the retina, retinal nerve fiber layer, ganglion cell layer, and choroidal thickness (p > 0.05). Although our study did not identify any etiology in pregnant women with RSA, we observed detectable differences in FAZ area and vessel density values using OCTA, when comparing them with healthy pregnant women and healthy nonpregnant controls. We believe that OCTA, as used in many pathologies such as diabetic and hypertensive retinopathy and retinal vascular occlusion, can also be extended to unexplained RSA both to detect etiology and to monitor treatment in studies with a larger number of patients.

Ischemia-Guided Coronary Revascularization Following Lower-Extremity Revascularization Improves 5-Year Survival of Patients With Chronic Limb-Threatening Ischemia.

To determine whether diagnosis of asymptomatic (silent) coronary ischemia using coronary computed tomography (CT)-derived fractional flow reserve (FFRCT) together with targeted coronary revascularization of ischemia-producing coronary lesions following lower-extremity revascularization can reduce adverse cardiac events and improve long-term survival of patients with chronic limb-threatening ischemia (CLTI). Prospective cohort study of CLTI patients with no cardiac history or symptoms undergoing elective lower-extremity revascularization. Patients with pre-operative coronary computed tomography angiography (CTA) and FFRCT evaluation with selective post-operative coronary revascularization (FFRCT group) were compared with patients with standard pre-operative evaluation and no post-operative coronary revascularization (control group). Lesion-specific coronary ischemia was defined as FFRCT≤0.80 distal to a coronary stenosis with FFRCT≤0.75 indicating severe ischemia. Endpoints included all-cause death, cardiac death, myocardial infarction (MI) and major adverse cardiovascular (CV) events (MACE=CV death, MI, stroke, or unplanned coronary revascularization) during 5 year follow-up. In the FFRCT group (n=111), FFRCT analysis revealed asymptomatic (silent) coronary ischemia (FFRCT≤0.80) in 69% of patients, with severe ischemia (FFRCT≤0.75) in 58%, left main ischemia in 8%, and multivessel ischemia in 40% of patients. The status of coronary ischemia in the control group (n=120) was unknown. Following lower-extremity revascularization, 42% of patients in FFRCT had elective coronary revascularization with no elective revascularization in controls. Both groups received guideline-directed medical therapy. During 5 year follow-up, compared with control, the FFRCT group had fewer all-cause deaths (24% vs 47%, hazard ratio [HR]=0.43 [95% confidence interval [CI]=0.27-0.69], p<0.001), fewer cardiac deaths (5% vs 26%, HR=0.18 [95% CI=0.07-0.45], p<0.001), fewer MIs (7% vs 28%, HR=0.21 [95% CI=0.10-0.47], p<0.001), and fewer MACE events (14% vs 39%, HR=0.28 [95% CI=0.15-0.51], p<0.001). Ischemia-guided coronary revascularization of CLTI patients with asymptomatic (silent) coronary ischemia following lower-extremity revascularization resulted in more than 2-fold reduction in all-cause death, cardiac death, MI, and MACE with improved 5 year survival compared with patients with standard cardiac evaluation and care (76% vs 53%, p<0.001). Silent coronary ischemia in patients with chronic limb-threatening ischemia (CLTI) is common even in the absence of cardiac history or symptoms. FFRCT is a convenient tool to diagnose silent coronary ischemia perioperatively. Our data suggest that post-surgery elective FFRCT-guided coronary revascularization reduces adverse cardiac events and improves long-term survival in this very-high risk patient group. Randomized study is warranted to finally test this concept.

Sapheno Femoral Graft End-to-End Anastomose due to Total Occlusion of Left Popliteal Artery: A Case Report and Literature Review

Background: For patients suffering from trauma around the knee joint, the clinician should be highly vigilant about the risk of popliteal artery acute thrombosis. It is essential to promptly detect and treat acute popliteal artery thrombosis for limb salvaging. Further diagnostic procedures may be performed according to the patient’s hemodynamics. Doppler should be considered done bedside, while CTA should be considered if the obstruction could not be concluded by physical examination. Case: A 40-year-old male complained of a bluish left leg, difficulty in movement, and decreased sensation. Computed tomography angiography (CTA) evaluation revealed total occlusion of the left popliteal artery. An open wound that was managed improperly was referred to a vascular surgeon in the central hospital to be further treated. The patient was hospitalized for 3 days for anastomosis monitoring and discharged uneventfully. Conclusion: Sapheno Femoral Graft End-to-End Anastomose is an effective therapeutic option in patients with total occlusion popliteal artery.

Optical coherence tomography angiography evaluation of retinal microvascular structure in young male patients presenting with acute coronary syndrome

Optical coherence tomography angiography evaluation of retinal microvascular structure in young male patients presenting with acute coronary syndrome

Oxidative stress and optical coherence tomography angiography evaluation of choriocapillaris and retinal vessel density in children with obstructive sleep apnea.

To investigate the vascular networks of the retina and choroid using optical coherence tomography angiography (OCTA) to identify early biomarkers of obstructive sleep apnea (OSA) severity and to evaluate correlations with blood levels of oxidative stress. Patients with OSA were diagnosed based on video-polysomnography (PSG) and blood samples were collected to evaluate oxidative stress markers: total antioxidant status (TAS), biological antioxidant potential (BAP) test, Diacron reactive oxygen metabolites (d-ROMs) test. The eyes of children with OSA were evaluated and compared with eyes of healthy age-matched children. OCTA imaging was carried out to evaluate the choroidal and retinal vascular network density indices. A total of 31 children with OSA were recruited and compared with 10 healthy children. Choriocapillaris flow area decreased (p = 0.006) and superficial capillary plexus vessel density increased (p=0.01) with increasing severity of OSA. Children with OSA showed significant differences in TAS and d-ROMs test when compared to normal pediatric values (p<0.05). In calculating the correlations between PSG, oxidative stress, and OCTA variables, there was a negative correlation between choriocapillaris flow area and apnea hypopnea index (AHI) (p = 0.02, r2 -0.5) and between choriocapillaris flow area and the d-ROMs test (p 0.03; r2 0.5). The severity of OSA was associated with the choroidal and retinal capillary vascular networks. The correlation of the choriocapillaris flow area with AHI and the d-ROMs test indicates the connection of the choroidal microvasculature with the number of obstructive apnea and hypopnea events and oxidative stress.

Optical coherence tomography angiography evaluation of optic disc and retinal vascular densities in obese patients

BackgroundTo evaluate optic disc and retinal vascular densities in obese patients using optical coherence tomography angiography (OCTA). MethodsThis study included 27 eyes from 27 obese patients with a body mass index (BMI) of ≥35 who were scheduled for bariatric surgery at the general surgery clinic and 26 eyes from 26 healthy individuals with a BMI of 18.5–24.9 kg/m2 who were of similar age and gender to the obese group. The macular vascular densities of the superficial and deep capillary plexuses (SCP and DCP, respectively), choriocapillaris flow area, optic disc peripapillary vascular density, and retinal thicknesses were evaluated using the OCTA device in obese patients and controls. ResultsThe mean age of the obese patients was 35.89 ± 10.93 years, and that of the controls was 32.31 ± 7.88 years (p = 0.199). The mean BMI values of the obese and control groups were 45.04 ± 6.89 kg/m2 and 23.19 ± 1.66 kg/m2, respectively (p < 0.0001). The whole, parafoveal, and perifoveal vascular density values of the SCP and those of the DCP were statistically significantly lower in the obese group than in the control group (p = 0.004, p = 0.011, p = 0.006, p = 0.036, p = 0.029, and p = 0.024, respectively). There was no significant difference between the two groups in terms of optic disc vascular density. Full retinal perifoveal thickness, full retinal perifoveal volume, inner retinal perifoveal thickness, and inner retinal perifoveal volume were statistically significantly lower in obese patients compared to the controls (p = 0.043, p = 0.042, p = 0.027, and p = 0.024, respectively). In addition, statistically significant negative correlations were found between BMI and the whole, parafoveal, and perifoveal vascular densities of the SCP and DCP and the whole vascular density values of the optic disc for all vessels and small vessels ​​(p = 0.017, r = -0.327; p = 0.043, r = -0.280; p = 0.033, r = -0.293; p = 0.034, r = -0.291; p = 0.017, r = -0.327; p = 0.023, r = -0.311; p = 0.031, r = -0.296; and p = 0.047, r = -0.274, respectively). ConclusionWe consider that the decrease in retinal vascular density and retinal thickness in obese patients is responsible for obesity-induced oxidative stress, increased inflammatory cytokines, and microvascular damage.

How early can atherosclerosis be detected by coronary CT angiography? Insights from quantitative CT analysis of serial scans in the PARADIGM trial

BackgroundNon-obstructing small coronary plaques may not be well recognized by expert readers during coronary computed tomography angiography (CCTA) evaluation. Recent developments in atherosclerosis imaging quantitative computed tomography (AI-QCT) enabled by machine learning allow for whole-heart coronary phenotyping of atherosclerosis, but its diagnostic role for detection of small plaques on CCTA is unknown. MethodsWe performed AI-QCT in patients who underwent serial CCTA in the multinational PARADIGM study. AI-QCT results were verified by a level III experienced reader, who was blinded to baseline and follow-up status of CCTA. This retrospective analysis aimed to characterize small plaques on baseline CCTA and evaluate their serial changes on follow-up imaging. Small plaques were defined as a total plaque volume <50 ​mm3. ResultsA total of 99 patients with 502 small plaques were included. The median total plaque volume was 6.8 ​mm3 (IQR 3.5–13.9 ​mm3), most of which was non-calcified (median 6.2 ​mm3; 2.9–12.3 ​mm3). The median age at the time of baseline CCTA was 61 years old and 63% were male. The mean interscan period was 3.8 ​± ​1.6 years. On follow-up CCTA, 437 (87%) plaques were present at the same location as small plaques on baseline CCTA; 72% were larger and 15% decreased in volume. The median total plaque volume and non-calcified plaque volume increased to 18.9 ​mm3 (IQR 8.3–45.2 ​mm3) and 13.8 ​mm3 (IQR 5.7–33.4 ​mm3), respectively, among plaques that persisted on follow-up CCTA. Small plaques no longer visualized on follow-up CCTA were significantly more likely to be of lower volume, shorter in length, non-calcified, and more distal in the coronary artery, as compared with plaques that persisted at follow-up. ConclusionIn this retrospective analysis from the PARADIGM study, small plaques (<50 ​mm3) identified by AI-QCT persisted at the same location and were often larger on follow-up CCTA.

Comparative study between fundus fluorescein angiography and optical coherence tomography angiography in evaluation of diabetic maculopathy

Background Diabetic maculopathy is a serious consequence of diabetic retinopathy (DR) that greatly affects the visual acuity. Diabetic macular edema (DME) and diabetic macular ischemia (DMI) are major causes of vision affection in diabetic patients. Purpose The aim of this study was to compare fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) in evaluation of diabetic maculopathy. Patients and methods This comparative cross-sectional study was performed on 87 eyes of 54 patients with type I or type II diabetes, older than 18 years old with any diabetic retinal changes, and 108 eyes of 54 control subjects. An ocular examination was performed as well as color fundus photography, FA, and OCTA. Investigations were done on the same day. FA and OCTA findings were summarized and compared. Results The mean age of the patients was 59.4±8.5 years. OCTA was statistically significantly superior to FA in diagnosing DMI. The foveal avascular zone (FAZ) was ischemic (enlarged) in 74 (85.06%) eyes by OCTA compared with only 46 (52.87%) eyes by FA, with a statistically significant difference (P = 0.001). In addition, OCTA detected microaneurysms significantly more than FA (P = 0.001). The mean FAZ area of the control eyes by OCTA was significantly less than in the ischemic eyes (U = 56.602, P &lt; 0.001), while the superficial capillary plexus (SCP) vascular density (VD) and the deep capillary plexus (DCP) VD in the control eyes was statistically significantly higher than in the ischemic eyes (U = 36.984, P &lt; 0.001, and U = 35.955, P &lt; 0.001, respectively). FA showed diffuse leakage (edema) at the macula as the most common pattern of DME that was detected in 37.9% of the eyes followed by focal macular leakage in 18.4% of the eyes and cystoid leakage in 8% of the eyes while 35.5% of the eyes showed no macular edema. Conclusion OCTA is a cornerstone in DMI diagnosis both qualitatively and quantitatively. In addition, it is essential in evaluating the deep retinal vasculature, while FA is essential in diabetic retinopathy grading and in the diagnosis of DME in a qualitative manner. Both investigations are complementary to each other in diabetic maculopathy evaluation.

OCT-A evaluation of the retinal and choroidal structures of patients with a history of radiotherapy due to nasopharyngeal carcinoma

BackgroundTo perform the optical coherence tomography angiography (OCT-A) evaluation of the microvascular structures of the retina and choroidal tissue in asymptomatic patients who received radiotherapy for nasopharyngeal carcinoma and to compare the results to those of healthy individuals. MethodsOphthalmological examinations were performed in all asymptomatic patients without vascular or systemic diseases, or fundus findings who had received radiotherapy at least two years earlier. Then, OCT-A scans were obtained. Foveal, parafoveal, and whole retinal thicknesses, vessel densities in the superficial and deep capillary plexuses, subfoveal choroidal thickness, the non-flow area in the superficial capillary plexus, and the choriocapillaris flow area were measured and compared to the values of the healthy control group. ResultsThe radiotherapy group had significantly lower deep capillary plexus vascular density and subfoveal choroidal thickness values and significantly higher choriocapillaris flow area values compared to the control group. ConclusionsWe consider that OCT-A is useful in the early diagnosis of radiation retinopathy that may develop during follow-up in patients with nasopharyngeal carcinoma who have received radiotherapy.

Automated advanced imaging in acute ischemic stroke. Certainties and uncertainties

The purpose of this is study was to review pearls and pitfalls of advanced imaging, such as computed tomography perfusion and diffusion-weighed imaging and perfusion-weighted imaging in the selection of acute ischemic stroke (AIS) patients suitable for endovascular treatment (EVT) in the late time window (6–24 h from symptom onset). Advanced imaging can quantify infarct core and ischemic penumbra using specific threshold values and provides optimal selection parameters, collectively called target mismatch. More precisely, target mismatch criteria consist of core volume and/or penumbra volume and mismatch ratio (the ratio between total hypoperfusion and core volumes) with precise cut-off values. The parameters of target mismatch are automatically calculated with dedicated software packages that allow a quick and standardized interpretation of advanced imaging. However, this approach has several limitations leading to a misclassification of core and penumbra volumes. In fact, automatic software platforms are affected by technical artifacts and are not interchangeable due to a remarkable vendor-dependent variability, resulting in different estimate of target mismatch parameters. In addition, advanced imaging is not completely accurate in detecting infarct core, that can be under- or overestimated. Finally, the selection of candidates for EVT remains currently suboptimal due to the high rates of futile reperfusion and overselection caused by the use of very stringent inclusion criteria. For these reasons, some investigators recently proposed to replace advanced with conventional imaging in the selection for EVT, after the demonstration that non-contrast CT ASPECTS and computed tomography angiography collateral evaluation are not inferior to advanced images in predicting outcome in AIS patients treated with EVT. However, other authors confirmed that CTP and PWI/DWI postprocessed images are superior to conventional imaging in establishing the eligibility of patients for EVT. Therefore, the routine application of automatic assessment of advanced imaging remains a matter of debate. Recent findings suggest that the combination of conventional and advanced imaging might improving our selection criteria.

Acute Nonvariceal Gastrointestinal Bleeding: A Comprehensive Review and Approach for an Interventional Radiologist

AbstractGastrointestinal bleeding (GIB) is one of the most common leading life-threatening conditions requiring prompt diagnosis and rapid endoscopic and interventional radiology (IR) management. Endoscopy is the first line of management for upper GIB, while it has a limited role in lower GIB, especially in acute clinical settings, due to poor bowel preparation. Patients with failed and refractory endoscopic management necessitate emergent computed tomography angiography (CTA) evaluation. CTA is crucial in assessing underlying causes and planning transarterial embolization (TAE). It has been almost three decades since IR gained popularity by virtue of increased technical experience, availability of sophisticated hardware, and evolving techniques. Newer embolization agents and catheters, as well as the established role of CTA, have expanded and enhanced the role of IR in the management of GIB. TAE has been proven to be a safe, rapid, effective, and minimally invasive procedure alternative to surgery when endoscopic management fails to control GIB. We present a comprehensive approach for managing nonvariceal GIB, including CTA protocol, anatomical variants, visceral to visceral collateral pathways, and specific embolization techniques. This article will help readers get an insight into TAE that will help better management of patients with GIB.

Mid-term outcomes of left subclavian artery revascularization with Castor stent graft in treatment of type B aortic dissection in left subclavian artery

BackgroundHere we analyzed mid-term data of thoracic endovascular aneurysm repair (TEVAR) surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection (STBAD) involving the left subclavian artery (LSA). MethodsBetween April 2014 and February 2019, 32 patients with STBAD involving a Castor single-branched stent graft were included. We analyzed their outcomes, including technical success rate (TSR), surgical duration (SD), presence of ischemia, perioperative complications, LSA patency, and survival rate (SR), using computed tomography angiography and clinical evaluation during mid-term follow-up. ResultsThe mean patient age was 54.63 ​± ​12.37 years (range, 36–83 years). The TSR was 96.88% (n ​= ​31/32). The mean SD was 87.44 ​± ​10.89 with a mean contrast volume of 125.31 ​± ​19.30 ​mL. No neurological complications or deaths occurred during the study period. The patients had a mean hospital stay of 7.84 ​± ​3.20 days. At a mean follow-up of 68.78 ​± ​11.26 months, four non-aortic deaths (12.5%) were observed. The LSA patency rate was 100% (n ​= ​28/28). There was only one case of type I endoleak immediately after surgery (3.12%) (type I from LSA). However, none of the patients experienced type II endoleaks, and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry. Finally, all patients exhibited good LSA patency. ConclusionTEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.

Optical coherence tomography angiography evaluation of retinal and optic disc microvascular morphological characteristics in retinal vein occlusion.

To evaluate microvascular morphological characteristics of the retina and optic disc (OD) in retinal vein occlusion (RVO) patients using optical coherence tomography angiography (OCTA), compare the results to age- and gender-matched healthy subjects, and determine correlations between OCTA parameters and best-corrected visual acuity (BCVA) and age. In this retrospective study, right eyes of 53 RVO patients and 51 healthy subjects were compared regarding BCVA, as well as superficial and deep capillary plexus (SCP and DCP) vessel densities (VDs), foveal avascular zone (FAZ) parameters, outer retinal and choriocapillaris flow areas, OD whole and peripapillary VDs, and retinal nerve fiber layer thickness (RNFLT). Retinal vein occlusion patients were further divided into subgroups based on therapy and risk factors, and OCTA parameters were compared. Retinal vein occlusion rate or OCTA parameters did not differ significantly by gender (p>0.05). Retinal vein occlusion patients had significantly decreased BCVA, whole, parafoveal and perifoveal SCP and DCP VDs, as well as VDs 300µm area around FAZ (FD-300) than healthy subjects (p<0.001). Their choriocapillaris flow area, RNFLT, whole and peripapillary VDs were also affected. However, FAZ area did not differ significantly between groups. Superior RNFLT (p=0.016) and whole peripapillary VD (p<0.001) differed significantly between laser photocoagulation-treated and non-treated patients. The remaining OCTA parameters revealed no significant differences CONCLUSIONS: The RVO and its therapeutic alternatives may affect both OD and retinal VDs. Given its numerous benefits, it seems that OCTA will be used more frequently in clinics for RVO diagnosis, monitoring, and therapeutic response evaluation.

Comparison of Doppler Ultrasound and Computerized Tomographic Angiography in Evaluation of Cervical Arteries Stenosis in Stroke Patients, a Retrospective Single-Center Study.

There are different diagnostic modalities to investigate atherosclerosis cervical artery disease in suspected stroke patients. We aimed to test the concordance of findings of the two most widely used diagnostic modalities in stroke patients: duplex ultrasound (DUS) and computerized tomographic angiography (CTA). A total of 100 stroke patients were retrospectively included in the study, all of them had DUS followed by CTA. Discrepancies of DUS compared to the CTA results in both the internal carotid and vertebral arteries were found in 44% of the patients. The patients with significant differences in diagnostic results were characterized by older age. Evaluation of the degree of carotid artery stenosis revealed vast differences in patients with 50-69% stenosis found by DUS, in which 45.5% of them had a different percentage of stenosis found by CTA. In studying the degree of stenosis of the vertebral artery, only 47.1% of the patients with more than 50% stenosis found by DUS had the same results with CTA, while the remaining revealed normal or less than 50% stenosis by CTA. The current study emphasizes that CTA is more accurate than DUS in the evaluation of stenosis of the cervical arteries including both the internal carotid and vertebral arteries.

Endovascular Management of External Iliac “Snowplowing” Using “Reverse Snowplow” Technique During Transcatheter Aortic Valve Replacement

This case describes an 84-year-old female with chronic diastolic heart failure, coronary artery disease status post coronary artery bypass and percutaneous coronary intervention, hypertension, diabetes mellitus and chronic kidney disease stage III, who presented with progressive dyspnea found to have severe aortic stenosis demonstrated by echocardiogram (aortic valve area, .06 ^cm2; mean gradient, 42 mm Hg). She was evaluated by the Heart Team and deemed to be a candidate for a transfemoral transcatheter aortic valve replacement (TAVR) after computed tomography angiography (CTA) evaluation. During insertion of the valve sheath through the external iliac, intimal “snowplowing” occurred resulting in complete occlusion of the iliac artery. The intima was successfully milked back into anatomical position using a “reverse snowplow” technique. Extravasation was managed with covered stents. The patient recovered over several days and was discharged home on post-procedure day 7. When appropriate, Endovascular management of vascular complications avoids the morbidity associated with open repair. Pre-operative evaluation is imperative in identifying anatomical features that pose a risk to vascular complications. This patient had an increased risk with an elevated iliofemoral tortuosity score, however, had minimal calcification and no acute angulation in the iliofemoral arterial system. This case highlights the complexity of vascular complication management and difficulty faced in identifying patients who are at risk for these types of complications.