Tomography Angiography In Evaluation Research Articles

Abstract 12773: Computed Tomography Angiography Evaluation of Coronary Plaque Burden in South Asians and Non-Hispanic Whites Over 65 Years of Age

Introduction: South Asians (SA) have greater atherosclerotic cardiovascular disease (ASCVD) rates than non-Hispanic whites (NHW). SA ethnicity is a risk factor for cardiovascular disease, according to ACC/AHA guidelines. However, data on pattern of atherosclerosis in SA is limited. This study examines plaque burden in SA using quantitative plaque analysis from coronary CT angiography (CCTA). Methods: This is a cross-sectional study comparing the prevalence of atherosclerosis in SA to that of NHW. We identified 104 South Asians who underwent CCTA and quantitative plaque analysis. We then matched 1:1 with 104 non-Hispanic whites. Age, gender, diabetes, hypertension and smoking were utilized to perform a 1: 1 covariate match. Quantification of coronary plaque was conducted using automated plaque analysis software (Cleerly, NY, NY). Percentage atheroma volume (PAV), which is a measure of total plaque divided by total vessel volume, was calculated for each plaque subtypes. Results: A total of 208 subjects formed the study population. The mean age was 71.2±4.9, 66% being male, 38% had DM, 72% reported hypertension, and 10% were past smokers in each group. The SA cohort had significantly higher calcified plaque PAV compared to NHW cohort, median (IQR), 7.6(1.9, 15.5) versus 3.9(1.3, 9.6), (p=0.027). Noncalcified plaque PAV was higher in SA 5.2 (3.0, 7.9) versus 4.5 (2.6,7.2), but not statistically significant (p=0.35). The number of subjects with obstructive disease (&gt50% stenosis) trended higher in the SA cohort (71% of SA versus 60% of NHW) (p=0.08). Conclusions: South Asians had significantly higher calcified plaque PAV and a higher prevalence of obstructive disease compared to the NHW cohort. These results are suggestive of a unique plaque burden and distinctive characteristics in the SA population, which may explain the greater incidence of cardiovascular events and supports the current guidelines.

Dual phase multidetector computed tomography angiography in evaluation of pulmonary arteries and collateral vessels in children with cyanotic congenital heart diseases

BackgroundThe purpose of this paper is to compare the efficacy of dual-phase multidetector computed tomography angiography (CTA) with transthoracic echocardiogram (TTE) and cardiac catheterization angiography (CCA) in evaluation of pulmonary arteries and collateral vessels, major aortopulmonary collateral arteries (MAPCAs) in children with cyanotic congenital heart diseases. MethodsThe study was a prospective observational study where 32 pediatric patients (18 males, 14 females and age range 2–116 months) with cyanotic congenital heart diseases (CCHD) were included. All patients underwent TTE, CTA, and CCA. The findings of CTA in evaluation of pulmonary arteries and MAPCAs were compared with TTE and correlated with CCA findings. ResultsAll CTA studies were adequate except in one (3.1%) case in which main pulmonary artery and left pulmonary artery were not visualized on any of the three modalities. Right pulmonary artery anatomy was not clear or not demonstrated in four cases (12.6%) on CCA, whereas CTA was able to demonstrate pulmonary arteries in these cases. TTE was inadequate in 11 cases (34.3 %) in which one or more pulmonary artery was not clearly visualized. In cases with good pulmonary artery diameter (corresponding to Z score between 1 to 2) statistically significant (P < 0.001) correlation was found between pulmonary artery diameters, McGoon ratio, Nakata index, and Z-scores calculated for pulmonary arteries on all three modalities. There was concordance between CTA and CCA in assessment of MAPCAs and patent ductus arteriosus (PDA), whereas TTE failed to demonstrate MAPCAs in six cases (18.8%). ConclusionCTA was found to be superior to TTE and CCA for the assessment of pulmonary arteries and MAPCAs. CTA is also superior to TTE in the detection of extracardiac anomalies.

Choroidal Changes in Blood Flow in Patients with Intermediate AMD after Oral Dietary Supplement Based on Astaxanthin, Bromelain, Vitamin D3, Folic Acid, Lutein, and Antioxidants.

Background and Objectives: The aim of this study was to investigate the impact of oral administration of the combination of astaxanthin (AXT), lutein, folic acid, vitamin D3, and bromelain with antioxidants on choroidal blood flow in patients with age-related intermediate macular degeneration (AMD). Materials and Methods: Patients affected by intermediate AMD and treated with daily oral nutritional supplement with AXT, bromelain, vitamin D3, folic acid, lutein, and antioxidants for a period of at least 6 months were included in this retrospective study. A control group homogenous for age and sex was also included in the analysis. All participants underwent a complete ophthalmologic examination, spectral domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA) evaluation. Outcome measures were choroidal thickness (CHT) and choriocapillary vessel density (CCVD) after six months of AXT assumption. Results: CCVD values showed statistically significant difference between cases and controls at baseline (p < 0.001) and in the cases during follow-up (p < 0.001). The CHT measurements showed statistically significant difference between cases and controls (p = 0.002) and in the cases during follow-up (p < 0.001). Conclusions: The combined use of structural OCT and OCTA allows for a detailed analysis in vivo of perfusion parameters of the choriocapillaris and choroid and evaluation of changes of choroidal blood flow after oral nutritional supplements that affect blood flow velocity.

Coronary Computed Tomography Angiography Evaluation of Plaque Morphology and Its Relationship to HDL and Total Cholesterol to HDL Ratio

<h3>Lead Author's Financial Disclosures</h3> Nothing to disclose. <h3>Study Funding</h3> None. <h3>Background/Synopsis</h3> Traditionally non-high-density lipoprotein (non-HDL) indicators have been utilized to stratify cardiovascular risk. Population studies have demonstrated an inverse relationship between HDL cholesterol levels and cardiovascular risk, however, the mechanism by which HDL exhibits its protective effect on the cardiovascular system remains unclear. <h3>Objective/Purpose</h3> To investigate the relationship between the HDL-C level and the total cholesterol to HDL (TC/HDL) ratio with coronary artery plaque burden as determined by coronary computed tomography angiography (CCTA). <h3>Methods</h3> This is a cross-sectional study evaluating the association of HDL-C and TC/HDL ratio with coronary artery plaque volumes. We identified 190 subjects who had undergone quantitative plaque analysis and had lipoprotein values available at our institution. Plaque was analyzed quantitatively utilizing semi-automated plaque analysis software (QAngio version 2.0.5). The plaque volumes are presented as total atheroma volume normalized (TAVnorm). The HDL-C level and TC/HDL ratio were analyzed as continuous variables and categorized at clinically relevant levels. Multivariate regression models adjusted for cardiovascular risk factors were used to evaluate the association of HDL-C and TC/HDL ratio with coronary plaque volumes. <h3>Results</h3> The mean (SD) age of the 190 subjects was 58.9 (+/-9.8) years, and 63% were male. After adjustment for cardiovascular risk factors, HDL- C (>40mg/dL) is inversely associated with fibrous (p=0.003), fibrous fatty (p=0.009), low attenuation plaque (LAP) (p=0.014), total non- calcified plaque (TNCP)(p=0.003), and total plaque (TP)(p=0.005) volume but not associated with dense calcified plaque (p=0.229). TC/HDL ratio (>4.0) is directly associated with LAP (p=0.024) and not associated with fibrous, fibrofatty, TNCP, dense calcified plaque and TP volume. Notably, when examined as continuous variables, increasing HDL- C level is inversely associated with fibrous plaque, TNCP and TP volume and increasing TC/HDL ratio is directly associated with increasing fibrous plaque, and fibrous fatty plaque, LAP, TNCP and TP volume, independent of other risk factors. <h3>Conclusions</h3> There is a strong association between low HDL-C and increasing TC/HDL ratio with increasing coronary plaque volumes, independent of traditional risk factors of atherosclerosis. The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C in coronary artery disease. Additionally, TC/HDL ratio offers value as a secondary treatment target beyond LDL-C, which is especially beneficial in individuals with prevalent lipid discordance, such as those with diabetes and metabolic syndrome.

Coronary computed tomography angiography evaluation of plaque morphology and its relationship to HDL and total cholesterol to HDL ratio

BackgroundWhile population studies have demonstrated that high density lipoprotein cholesterol (HDL-C) and the ratio of total cholesterol to HDL (TC/HDL) improve cardiovascular risk prediction, the mechanism by which these parameters protect the cardiovascular system remains uncertain. ObjectiveTo investigate the relationship between the HDL-C level and the total cholesterol to HDL (TC/HDL) ratio with the morphology of coronary artery plaque as determined by coronary computed tomography angiography (CCTA). MethodsThis is a cross-sectional study involving 190 subjects with stable coronary artery disease. Semi-automated plaque analysis software was utilized to quantify plaque and plaque volumes are presented as total atheroma volume normalized (TAVnorm). Multivariate regression models were used to evaluate the association of HDL-C and TC/HDL ratio with coronary plaque volumes. ResultsOf the 190 subjects the average (SD) age was 58.9 (9.8) years, with 63% being male. After adjustment for cardiovascular risk factors, HDL- C (>40 mg/dl) is inversely associated with fibrous (p = 0.003), fibrous fatty (p = 0.007), low attenuation plaque (LAP) (p = 0.007), total non-calcified plaque (TNCP) (p = 0.002) and total plaque (TP)(p = 0.004) volume. Furthermore, the TC/HDL ratio (> 4.0) is associated with fibrous (p = 0.047) and total non-calcified plaque (p = 0.039), but not with fibrofatty, LAP, dense calcified plaque, or TP volume. ConclusionThere is a strong association between low HDL-C levels and increasing TC/HDL ratio with certain types of coronary plaque characteristics, independent of traditional risk factors. The findings of this study suggest mechanistic evidence supporting the protective role of HDL-C and the TC/HDL ratio's clinical relevance in coronary artery disease management.

Clinically relevant factors associated with a binary outcome of diabetic macular ischaemia: an OCTA study

AimsWe investigated the demographic, ocular, diabetes-related and systemic factors associated with a binary outcome of diabetic macular ischaemia (DMI) as assessed by optical coherence tomography angiography (OCTA) evaluation of non-perfusion...

Coronary protection for the small left coronary sinus during transcatheter aortic valve replacement: a case report

BackgroundCoronary obstruction (CO) is an infrequent but life-threatening complication during transcatheter aortic valve replacement (TAVR).Case summaryWe report the case of a patient who accepted TAVR with high anatomical risks of CO due to the small congenital left coronary sinus, which was treated with preliminary coronary protection. This case highlighted the importance of computed tomography angiography (CTA) evaluation, 3D-printing stimulation, predilation as a reference sign, and pre-emptive chimney stenting technology to successfully anticipate and prevent CO during TAVR. At the 3rd month follow-up, CTA evaluation and 3D-printing simulation identified the chimney stenting of the left main coronary arterial patency.DiscussionA ‘four-step assessment’ method also proposes a new clinical procedure on how to perform TAVR in patients with high risks of CO.

The Role of Coronary Computed Tomography Angiography in Evaluation of High Troponin Patients with Narrow-Complex Supraventricular Tachycardia.

Aim:The aim of this study was to investigate the relation of high-sensitive cardiac troponin T (hs-cTnT) elevation with characteristics of supraventricular tachycardia (SVT) episode (duration and maximum heart rate) and coronary computed tomography angiography (CCTA) findings in patients with SVT who presented to the emergency room with palpitation.Methods:This retrospective, single-center, noninvasive study included all patients aged between 18 years and 65 years who presented to the emergency department due to narrow-complex SVT and underwent CCTA to rule out coronary artery disease (CAD) due to elevation of hs-cTnT and reverted back to sinus rhythm after intravenous adenosine. The first, second, and the maximum hs-cTnT levels were obtained from the database. The patients were classified into normal coronaries, nonobstructive CAD, and obstructive CAD according to findings of the CCTA. The findings of the groups were compared.Results:Eighty-five patients were enrolled in the study. Of them, 21 (26%) patients were female. Sixty-three patients (74%) had normal coronary arteries as per CCTA results, whereas 22 patients (22%) had nonobstructive CAD and two patients (2%) had obstructive CAD. The groups did not differ statistically in respect to hs-cTnT measurements, duration of the arrhythmia, and maximum heart rate at SVT episode. There was no significant statistical correlation between hs-cTnT and the study parameters except the maximum heart rate.Conclusion:Cardiac troponins may increase in patients with paroxysmal SVT irrespective of the presence of coronary lesions, and the CCTA may not be an appropriate investigation in the differential diagnosis of paroxysmal SVT with elevated hs-cTnT.

Optical coherence tomography angiography evaluation of the effects of phacoemulsification cataract surgery on macular hemodynamics in Chinese normal eyes.

To quantitatively evaluate the possible effects of phacoemulsification cataract surgery on macular hemodynamics using optical coherence tomography angiography (OCTA). This was a prospective observational study. Superficial and deep macular vascular densities, as well as parameters of foveal avascular zone (FAZ), were measured preoperatively (baseline) and at 1day, 1week, and 4weeks postoperatively in normal eyes(≥ 22mm and ≤ 24mm) of patients scheduled for phacoemulsification cataract surgery with intraocular lens implantation. The correlations between the rate of change of pre- and postoperative vascular densities and surgical parameters were analyzed. A total of 107 eyes of 107 patients were included in this study. Compared to the baseline measurements, no statistically significant variation was found in macular vascular densities at 1day after the surgery (P > 0.05). Both superficial and deep macular vascular densities were significantly increased postoperatively at weeks 1 and week 4 (P < 0.05; P < 0.05); however, no statistically significant differences were detected in any of the FAZ parameters between the baseline measurements and the entire follow-up period (P > 0.05 for all). Also, no statistically significant correlations were established between main surgical parameters and macular vascular densities changes. In normal eyes, macular blood perfusion gradually increased after phacoemulsification cataract surgery and was stabilized in one week. The foveal avascular zone was stabilized before and after the surgery. The main parameters and intraoperative perfusion of phacoemulsification surgery may not be the key factors affecting macular hemodynamics.

Systematic review with pooled data analysis reveals the need for a standardized reporting protocol including the visceral vessels during fenestrated endovascular aortic repair (FEVAR).

To collect and analyse the available evidence in the outcomes of patients treated with fenestrated endovascular aortic repair (f-EVAR) technique focusing specifically on visceral vessel outcomes. The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the studies reporting the f-EVAR technique for the management of degenerative pararenal and/or type IV thoracoabdominal aortic aneurysms (TAAA) were considered eligible for inclusion in the study. The main study outcomes (technical success, type I endoleaks, fracture or occlusion of the bridging stents, overall aneurysm-related mortality, and the reintervention rate) were subsequently expressed as proportions and 95% confidence intervals. Fourteen studies with a total of 1804 patients were included in a pooled analysis. The technical success of the procedure was 95.97% (95%CI = 92.35-98.60). Intraoperatively, the pooled proportion of reported type I endoleak was 7.6% (95%CI = 2.52-14.60) while during a median follow-up of 41 months (range 11-96) follow-up period the pooled rate of fracture and occlusion of the bridging stents was 2.79% (95%CI = 0.00-8.52) and 4.46% (95%CI = 1.93-7.77), respectively. The overall aneurysm-related mortality was detected to be 0.63% (95%CI = 0.04-1.63), and the pooled estimate for re-intervention rate was 15.69%. Fenestrated endovascular repair for p-AAA is an effective and safe treatment. Target vessel complications and endoleaks remain the two most important concerns for fenestrated endovascular procedures, contributing to most of the secondary interventions. The lack of computed tomography angiography follow-up evaluation does not allow us to draw robust conclusions about the complication rates for the superior mesenteric artery during f-EVAR. Due to the potential implications of SMA complications on aneurysm-related mortality, standardized reporting of short- and long-term target visceral vessel outcomes is required.

This issue of ACTA

This issue of ACTA

Artificial Intelligence to Assist in Exclusion of Coronary Atherosclerosis During CCTA Evaluation of Chest Pain in the Emergency Department: Preparing an Application for Real-world Use.

Coronary computed tomography angiography (CCTA) evaluation of chest pain patients in an emergency department (ED) is considered appropriate. While a "negative" CCTA interpretation supports direct patient discharge from an ED, labor-intensive analyses are required, with accuracy in jeopardy from distractions. We describe the development of an artificial intelligence (AI) algorithm and workflow for assisting qualified interpreting physicians in CCTA screening for total absence of coronary atherosclerosis. The two-phase approach consisted of (1) phase 1-development and preliminary testing of an algorithm for vessel-centerline extraction classification in a balanced study population (n = 500 with 50% disease prevalence) derived by retrospective random case selection, and (2) phase 2-simulated clinical Trialing of developed algorithm on a per-case (entire coronary artery tree) basis in a more "real-world" study population (n = 100 with 28% disease prevalence) from an ED chest pain series. This allowed pre-deployment evaluation of the AI-based CCTA screening application which provides vessel-by-vessel graphic display of algorithm inference results integrated into a clinically capable viewer. Algorithm performance evaluation used area under the receiver operating characteristic curve (AUC-ROC); confusion matrices reflected ground truth vs AI determinations. The vessel-based algorithm demonstrated strong performance with AUC-ROC = 0.96. In both phase 1 and phase 2, independent of disease prevalence differences, negative predictive values at the case level were very high at 95%. The rate of completion of the algorithm workflow process (96% with inference results in 55-80s) in phase 2 depended on adequate image quality. There is potential for this AI application to assist in CCTA interpretation to help extricate atherosclerosis from chest pain presentations.

Prosthesis-patient mismatch defined by cardiac computed tomography versus echocardiography after transcatheter aortic valve replacement

BackgroundsEvaluation of prosthesis-patient mismatch (P-PM) after transcatheter aortic valve replacement (TAVR) by transthoracic echocardiography (TTE) has provided conflicting results regarding its impact on outcomes. Whether post-TAVR computed tomography angiography (CTA) evaluation of P-PM can improve our understanding is unknown. We aimed to evaluate the inter-modality (TTE vs. CTA) agreement, inter-valve platform (balloon-expanding valve [BEV] vs. self-expandable valve [SEV]) differences in P-PM severity, and outcomes related to P-PM after TAVR. MethodsWe analyzed patients with both CTA and TTE before and after TAVR. Indexed effective orifice area was calculated using two methods: TTE-derived left ventricular outflow tract (LVOT) area from measured diameter and post-TAVR CTA-measured area. Body size specific cut-offs for P-PM severity were used: for body mass index (BMI) ​< ​30 ​kg/m2, moderate ​= ​0.66–0.85 ​cm2/m2 and severe≤0.65 ​cm2/m2; for BMI ≥30 ​kg/m2, moderate ​= ​0.56–0.70 ​cm2/m2 and severe≤0.55 ​cm2/m2. ResultsA total of 447 patients were included (median age, 83 years; 54% male). The prevalence of P-PM (moderate or severe) was lower with CTA vs. TTE (3.5% vs. 19.5%, p ​< ​0.001). The prevalence of P-PM measured by TTE was more common in BEV compared to SEV (p ​= ​0.002), while CTA assessment showed no difference in P-PM incidence and severity between TAVR platforms (p ​= ​0.40). In multivariable analysis, CTA-defined but not TTE-defined P-PM was associated with mortality after TAVR (HR:3.97; 95%CI,1.55–10.2; p ​= ​0.004). Both CTA-defined and TTE-defined P-PM were associated with the composite of death and heart failure rehospitalization. ConclusionAlthough post-TAVR CTA substantially downgraded the prevalence of P-PM compared to TTE, it identified a subset of patients with clinically relevant P-PM which associated with outcomes.

Computed Tomography Angiography Evaluation of Peripheral Arterial Disease and Correlation with Colour Doppler

Background: Peripheral Arterial Disease Is a Major Problem Among the Population of Those 55 Years and Older. MDCT is a Non-Invasive Method of Visualization of Vascular System. It Affords More Widespread Vascular Screening, Allowing Diagnosis to be Made at an Early Stage. The objective is to Assess the Role of Multidetector Computed Tomography Angiography in Peripheral Arterial Disease of Lower Extremities. Subjects &amp; Methods: A Prospective Study of 35 Patients with Signs and Symptoms of PVD, Were Subjected to Colour Doppler Ultrasonography and MDCT Examination Between a Period of 1st August 2018 to 31st May 2019. Results: Our Study Shows a Very Good Sensitivity, Specificity, PPV, NPV and Accuracy of Doppler in Assessing the Soft Plaque (82%, 100%, 100%, 97%, 97% Respectively) &amp; in Evaluation of Stenosis Like &lt;50% Stenosis (100%, 99%, 85%, 100% &amp; 99% Respectively), 50-99% Stenosis (100%, 99%, 96%. 100% &amp; 99.8% Respectively), &amp; Occlusion (84%, 100%. 100%, 98% &amp; 98% Respectively). The Only Parameter Which Showed Poor Result Was in Evaluation of Calcified Plaque. Conclusion: Our Study Shows that Both Colour Doppler &amp; MDCT Can Be Complimentary in Lower Limb Arterial Disease Evaluation.

Computed Tomography Angiography (CTA) Evaluation of Spontaneous Subarachnoid Hemorrhage

Background: In evaluation of non-traumatic subarachnoid hemorrhage CT angiography (CTA) has 97-98% sensitivity and near 100% specificity.&#x0D; Objective: This study was conducted to evaluate the CTA findings of CT positive non traumatic subarachnoid hemorrhage.&#x0D; Methodology: This is an observational cross sectional study performed in Neurology department of National Institute of Neurosciences and Hospital, Dhaka over one year period (January 2019 to December 2019). Total 87 CT positive subarachnoid hemorrhage cases were purposively included in this study. All CT positive patients underwent CTA of Cerebral vessels for further evaluation. The angiography were evaluated by competent neuro-radiologists blinded about the study.&#x0D; Result: Among 87 patients, 40.2% were male and 59.8% were female. The average age was 53.33±11.1 years. Among the studied patient the source of bleeding was found 78.16% aneurysmal and 21.84% non-aneurysmal. 85.30% patients had single aneurysm and 14.70% had multiple aneurysm. The highest number of patient had Acom aneurysm (41.17%) followed by MCA (22.05%), ICA (13.23%), ACA (7.35%) and vertebral artery (1.14%) in order of frequency. Among the multiple aneurysm group most of the patients had combination of Acom, MCA and ICA aneurysm.&#x0D; Conclusion: From this study, we can conclude that CTA can be used as the primary diagnostic tool in evaluation of spontaneous SAH.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 78-81

Microvascular retinal alterations in rhegmatogenous retinal detachment after pneumatic retinopexy

To evaluate the macular microvascularity with optical coherence tomography angiography (OCTA) in rhegmatogenous retinal detachment (RRD) which were successfully treated with pneumatic retinopexy (PR). Thirty eyes of thirty patients who were treated with PR (12 eyes with macula-off RRD and 18 eyes with macula-on RRD) were included in this prospective study. OCTA was used to evaluate the macular perfusion changes postoperatively at 1 and 3months. The fellow eyes (30 eyes) were used as control for comparison. Parafoveal retinal thickness (RT) and best-corrected visual acuity (BCVA) were evaluated. Vessel density (VD) in SCP, DCP and choriocapillaris plexus (CCP) flow area was significantly lower in the macula-off group one month after the PR (p<0.001). In the macula-off group, VD in SCP, DCP and CCP flow area significantly increased at months 3 (p<0.001, p<0.001, p=0.009). The inner RT, RT and FAZ decreased three months after PR (p<0.001, p=0.001, <0.001). The FAZ was significantly larger in the macula-off group at third months after PR (p<0.001). The inner RT was higher in the macula-off group at third month (p=0.012). There was no significant difference between the groups in means of final VD, CCP flow area and RT. There was also a negative correlation between the final BCVA (logMAR) and FAZ at month 3 (r=0.776, p=0.003). Optical coherence tomography angiography evaluation of macular capillary plexuses may be useful for predicting vascular structural changes in patients undergoing PR.

Optical Coherence Tomography Angiography for Evaluation of Retinal Vascular Changes in Patients with Psoriasis according to Disease Severity

ABSTRACT Objectives To investigate foveal avascular zone (FAZ) area and retinal vascular density (VD) in patients with psoriasis according to disease severity using optical coherence tomography angiography (OCTA). Methods Twenty-seven patients with mild psoriasis (Group 1), 28 with moderate to severe psoriasis (Group 2) and 30 healthy controls (Group 3) were evaluated with OCTA. Foveal and parafoveal VD and FAZ area were measured and compared. Results FAZ values were significantly higher in Group 2 (0.20 ± 0.1, 0.31 ± 0.07, 0.20 ± 0.09; P < .001, respectively.). The mean VD value were significantly lower in the deep capillary plexus in parafoveal area in Group 2 (35.5 ± 8.7, 28.7 ± 4.6, 35.0 ± 3.5; P < .001, respectively.). These changes showed significant correlation with Psoriasis Area and Severity Index (PASI) scores of patients. Conclusions Our results suggest that OCTA may have a future role as alert of potentially more severe disease in cases clinically classified as mild disease.

Optical Coherence Tomography Angiography Evaluation of Morphological andVascular Changes in Choroidal Neovascularization in Response to Anti-Angiogenic Treatment

Objective: To detect qualitative and quantitative analysis of the choroidal neovascular membrane based on opticalcoherence tomography angiography OCTA in response to treatment with anti-angiogenesis. Patients and methods: This is a prospective observational study recruited 20 eyes of 20 patients with treatment-naiveCNVM. Patients were examined using the OCTA before and after treatment with Ranibizumab. Patients werefollowed-up monthly over 3 successive months and 1 month after the last injection. The collected data werestatistically analyzed using SPSS software version 22. Repeated measures ANOVA was performed and a paired t-testwas also used for comparison. Main outcome measures: membrane types, patterns, corrected visual acuity, retinalfluids, membrane size, and flow area; all were measured pre and post-intervention. Results: Five patients were males and 15 were females (50.6 ± 17.7 years). Different configuration were detected; adensenet configuration in 6 eyes, a loosenet configuration in 6 eyes, mixed net in 3 eyes, and an unidentifiablepattern in 5 eyes. Visual acuity improved post-injection in all membrane patterns (p value 0.002 in loose-net andunidentifiable types). Signs of membrane activity, size, and flow area; all decreased in all patterns following treatment(p value 0.001). Conclusions: OCTA in conjunction with OCT is both needed for more precise evaluation of differentmorphological and functional membrane criteria at which treatment strategy is based. Detection of blood flowchanges within the membrane itself can be considered as reliable biomarkers in monitoring the membrane activity.

Optimizing Limb Salvage in Shotgun Injuries to the Extremities in Civilian Trauma

Vascular trauma in civilian settings has often resulted in high rates of amputation or mortality. Although treatment was individualized, patients were managed according to the following protocol: (1) Clinical evaluation and identification of those patients that require immediate exploration. (2) Determination of ankle-ankle indices, with a threshold of 0.9 mandating further evaluation. (3) Liberal use of computed tomography angiography (CTA) evaluation of injuries. (4) Selected use of digital subtraction angiography with an attempt to treat via endovascular means if there is thought to be a reasonable likelihood of success. (5) Liberal use of fasciotomy. (6) Reconstruction of arterial injury with contralateral reversed saphenous when available. (7) Postoperative follow-up with noninvasive arterial studies. Hypothesis: Protocol-driven early assessment and intervention can lead to excellent limb salvage in patients with civilian gunshot wound to the extremities. We retrospectively reviewed our gunshot database from 2012 to 2017 for patients with noniatrogenic penetrating vascular extremity injuries. Data analyzed were demographics, mode of injury, vessels injured, physical examination, arteriography findings, ischemic time, type of arterial and venous repair, morbidity, mortality, graft patency and functional outcome. Postoperative follow-up was done with noninvasive arterial studies. Sixteen patients sustained extremity injuries inflicted by shotguns. Fifteen (94%) underwent preoperative arteriography or CTA, revealing occult arterial injury in nine patients. One patient had soft tissue only and the other five who underwent CTA had no evidence of vascular injury. Forty-five percent of patients sustained concomitant venous injury; 64% of all venous injuries and 90% of femoropopliteal venous injuries were repaired. Eighty-one percent underwent fasciotomy at time of surgery. Fasciotomy occurred in 100% of patients with combined arterial and venous injuries (100%) versus 25% with isolated arterial injury. Arterial continuity was restored by interposition grafting with reversed saphenous vein (100%). There were no deaths or amputations at in-office follow-up, which ranged from 6 months to 7 years. Two patients had saphenous nerve injures, one of which fully recovered and the other patient ambulated with a cane due to nerve injury. A protocol of preoperative imaging with either arteriography or CTA for extremity shotgun injuries, use of fasciotomy, frequent use of autologous interposition grafts, repair of major venous injuries, and routine use of completion arteriography can result in limb salvage rates of 100% after shotgun vascular trauma to the extremities.

Optical Coherence Tomography Angiography Evaluation of Retinal Microvasculature Before and After Carotid Angioplasty and Stenting

The aim of the study was to evaluate the influence of carotid angioplasty and stenting (CAS) on retinal microvasculature using optical coherence tomography angiography (OCTA) in patients with severe carotid stenosis. 20 patients with severe carotid stenosis underwent comprehensive ophthalmic examinations and OCTA before and one month after CAS. Automated algorithms were used to quantify vessel density in the macular superficial vascular complex (SVC), deep vascular complex (DVC), and radial peripapillary capillary (RPC) around the optic disc. Eyes on the operated side constituted the ipsilateral eye group, and the other eye constituted the fellow eye group. In the ipsilateral eye group, the vessel density in the DVC increased significantly after stent implantation (P = 0.010), but the vessel density change in the SVC was not statistically different (P = 0.999). In the fellow eye group, the vessel density in the SVC (P = 0.028) and DVC (P = 0.034) were significantly increased after stent implantation. The vessel density in the RPC did not significantly change in the ipsilateral (P = 0.363) or fellow (P = 0.878) eye groups. This study shows that unilateral CAS for severe carotid stenosis increases macular vessel densities in both eyes.